bluuebunny/crossref_metadata_2025 huggingface dataset:
Comics, Cartoons, Graphic Novels
Authors: Catalá Jorge , Scorer James
Published: February 2023

The field of Latin American comics studies is relatively young. Though there are earlier studies of caricature, the most significant developments in studies of the region’s comics date from the 1970s and 1980s. During this period, intellectuals, scholars, and historians focused on comics as a neocolonial site of struggle or as expressions of autochthonous national-popular traditions. Some artists and scholars also explored the language of comics itself, setting out innovative approaches to page composition, interrelations between word and image, sequentiality, panel arrangements, or use of color, often as part of the wider political backdrop. Since that period, and particularly given the historic ties between comics and popular culture, the region’s comics have usually been read through the prism of the nation, a means of tapping into the social and political imaginaries of “the people.” That tendency persists into the twenty-first century: edited books tend to draw out overarching regional trends in introductions before individual chapters focus on individual national case studies and the work of specific authors. Much scholarship on Latin American comics has focused on the three countries that can claim to have had something akin to a comics industry: Argentina, Brazil, and Mexico, the latter also significant as the conduit for translated works within the region. There are, nonetheless, a significant and growing number of studies of comics in other Latin American countries, particularly Chile, Colombia, Cuba, and Peru. There is also an established and influential body of work on Latinx comics, though that falls beyond the scope of this bibliography. Scholarship on comics in other countries remains, unfortunately, underdeveloped. Though reading Latin American comics through national narratives remains important, the increasingly transnational nature of Latin American comics in the new millennium—a situation facilitated by the digital turn, growth in indie publishers, international comics festivals, and a thriving and sometimes itinerant zine scene—has meant a shift toward more comparative and transregional studies. Innovative studies on specific works, authors, and magazines are being supplemented by new methodological approaches, such as recent studies of the graphic novel. Though there is scope for more research into artistic working practices, the wider roles associated with comics work (not just writers and illustrators, but also pencillers, inkers, editors, graphic designers, publishers, etc.), and audiencing (particularly using quantitative analysis), scholarship is becoming increasingly diverse, with long-standing political commentaries now embedded in more extended and far-reaching analysis of issues such as gender and sexuality, race, memory politics, and ecology, as well as a greater awareness of intermediality, which has opened up innovative and rich analytical avenues for comics analysis.
Cognitive Pragmatics
Authors: Mazzone Marco
Published: February 2023

If pragmatics is the study of human communication (with a specific focus on verbal language) in context, cognitive pragmatics can be defined as the study of the psychological processes and states involved in that activity. As a matter of fact, however, its focus is almost exclusively on language understanding, while very little attention has been paid to language production. Cognitive pragmatics has grown out of a tradition rooted in philosophy and linguistics. Philosophical pragmatics has especially provided two general frameworks. One is Paul Grice’s theory, according to which comprehension is essentially an inferential process, through which the addressee reconstructs the communicative intention behind the speaker’s use of a certain utterance in context. Grice coins the word “implicature” to refer to this inferential transition from what the utterance conventionally says to what the speaker intends with it in a specific context. The other framework is John Austin’s theory of speech acts, which stays closer to Wittgenstein’s idea that utterances are to be understood as components of linguistic games, that is, they gain their specific contextual meaning against the background of (more or less) conventional activities the speakers are engaged in. Within philosophical pragmatics, a synthesis of the two approaches has been proposed by Strawson and Searle, but while Grice’s framework has deeply influenced the development of psychologically oriented research in pragmatics, Austin’s approach is often preferred by scholars who claim to be interested in normative, rather than psychological, views of language use. Starting from Grice’s framework, cognitive pragmatics has gone beyond him in exploring the idea that there must be some specific psychological mechanism responsible for the contextual, intention-based inferences involved in comprehension, and that this is what ensures a theoretically robust definition of pragmatics as distinct from semantics. This theoretical investigation of the mechanism(s) underlying pragmatic understanding is older than their relatively recent experimental assessment, whether by psycholinguistic methods (experimental pragmatics in a strict sense) or by neuroscientific and clinical ones (neuropragmatics and clinical pragmatics). Here the focus will be on this theoretical level of description—we might describe it as theoretical psychology of (verbal) understanding—in a middle ground between traditional philosophical pragmatics and more recent experimental pragmatics.
Touch of Evil
Authors: Simpson Craig
Published: February 2023

Much like its maker, Touch of Evil is elusive, durable, and contains multitudes. It marked the auspicious homecoming of Orson Welles to Hollywood, and led to his swift and permanent return to independent filmmaking. It died a quick death upon its initial theatrical run, only to win Best Film at the Brussels World Fair overseas, then be subsequently revived by effusive French critics of Cahiers du Cinema, and finally (re-)introduced to enthusiastic American film scholars. It has been described as wholly consistent with Welles’s technique since Citizen Kane and an outlier to his oeuvre, the greatest B-picture ever made and the end of film noir. To date, Touch of Evil has undergone three permutations: the 1958 studio release, with a 93-minute running-time; the 1976 “preview cut,” discovered a few years earlier by UCLA Professor Robert Epstein in the Universal Studios film archives, at 108 minutes in length; and the 1998 “restoration” or “reconstruction,” adhering to the objectives outlined in a 1957 memo by Welles, and 111 minutes long. Notwithstanding which Touch of Evil is considered the best of the three—an appraisal that may be aligned less with the director’s “intentions” and more with Henry Mancini’s opening score—it is evident that public and academic interest have increased with each version. Especially in the years following the critical and commercial triumph of the 1998 rerelease, Welles’s film has split into tributaries of study about its style and content, and complex (or confused) enough to spawn contentious disputes over its perceived attitudes on race, gender, sexuality, criminal law, police brutality, cultural appropriation, and the Mexican-American border. Even today, Touch of Evil still feels fresh, urgent, and a little dangerous. Yet although it was inducted into the National Film Registry in 1993, and placed fifty-seventh in the critics’ poll and twenty-sixth in the directors’ poll for Sight and Sound in 2012 (dropping from fifteenth among critics yet climbing from thirty-first among directors in 2002), there have been troubling limitations to its availability in the age of streaming. Moreover, as seven of the fourteen films directed by Welles now bear the Criterion imprimatur (a gratifying four since the 2015 Welles centenary), Touch of Evil is the most notable title among the half that do not. It remains to be seen whether its visibility and stature will rise or fall among Orson Welles’s collective works.
The Neuroscience of Emotion Regulation
Authors: Denny Bryan , Dicker Eva , Goodson Pauline
Published: February 2023

Effective emotion regulation is indispensable for mental and physical health. In recent decades, vast progress has been made in elucidating the neural mechanisms that underlie emotion regulation and in relating these neural mechanisms to other levels of analysis (e.g., self-reported experience and behavior). This work has shown that particular emotion regulation strategies differ in the psychological and neural mechanisms through which they operate as well as their adaptiveness and fit to particular contexts and individuals. In this guide, we aim to provide an overview of the literature on the neuroscience of emotion regulation. We will first provide general overviews of the field, including undergirding appraisal-based theoretical frameworks for understanding emotion and emotion regulation and their neural correlates. We will then move to reviewing the literature on the psychological and neural correlates of implementing particular emotion regulation strategies. We will then review the literature on the importance of individual differences and situational context in understanding the neuroscience of emotion regulation. Next, we will review the neuroscience of emotion regulation in clinical disorders. Finally, we will review emotion regulation training interventions as well as review interdisciplinary approaches between emotion regulation, affective neuroscience, and related fields (e.g., developmental neuroscience and psychoneuroimmunology).
Medieval Sermons
Authors: Conti Aidan
Published: February 2023

Sermons have long served as important vehicles for moral and ethical instruction among the three most widespread Abrahamic religions, Christianity, Judaism, and Islam. As a result, the medieval sermon embraces a range of languages, periods, and social environments. As an essentially oral discourse between a preacher and an audience involving instruction and guidance based on a sacred text, the medieval sermon, preserved for us as a written text, poses several methodological challenges that are increasingly met with inter- and multidisciplinary approaches. In practice, research on the sermon per se tends to focus on the written record even as it acknowledges the oral dimension of the genre, while studies of preaching are often seen to emphasize the oral and social event in which the text plays a central, informative role. In Late Antiquity and the early Middle Ages, writing and preaching sermons were frequently an elite activity; preaching was normally the prerogative of the bishop. Parish priests increasingly assumed this duty, and from the thirteenth century on Dominicans and Franciscans were active sermon composers and preachers. A number of impetuses stimulated preaching, most famously the Fourth Lateran Council (1215). Often seen as a window into medieval social life, the medieval sermon is fruitfully studied through contemporary critical methodologies and perspectives. With a vast archive of material, a significant amount of sermon studies research has focused on discovery, description, and transmission, for which manuscript studies has been particularly important. In addition, complementary methods and theory such as communication and network studies, gender studies, and critical race theory yield particularly insightful perspectives. Moreover, the broadening perspectives within medieval sermon studies today encompass not only the European Latin West, but also the Orthodox and Byzantine worlds, Judaism, and Islam, all of which have rich preaching traditions. The following bibliography offers a section on General Overviews including relevant periodicals and series and then surveys a range of Western Vernacular Languages as well as Latin. A section on Multilingualism follows and then there is a brief discussion of Related Literatures, namely artes praedicandi (treatises on preaching) and exempla (short narrative elements). Thereafter, areas Beyond the Latin West, which are particularly important for understanding the medieval sermon as a broad discourse, are treated. Finally, the bibliography presents a selective amount of material related to Thematic and Interdisciplinary Studies of sermons focusing on methodologies that promise to elucidate sermon studies in the decades that come.
Assessment in Geography Education
Authors: Bourke Terri , Mills Reece
Published: February 2023

An archaeologist is one who digs through layers of rock and soil to uncover and study what people did in the past from the things they left behind. For this encyclopedia entry, the authors assumed the role of archaeologists digging through databases and bibliographic references to uncover research about assessment in geography education, drawing from empirical studies where possible. They drew on Foucault’s book The Archaeology of Knowledge, using archaeological analysis as the chosen methodology to provide a close examination of themes in assessment in geography education from different authors, as well as showing how assessment foci have changed (or not) over time. Chronological succession is used for the most part, except for introducing important overviews or reports or where papers cluster within a subtheme. The chosen time frame is from the 1980s to the present. This period was chosen to go back beyond two big shifts in assessment in education. First, the 1990s saw the promotion of large-scale (inter)national high-stakes testing as a regime to provide comparative data between states/countries. The Trends in International Mathematics and Science Study (TIMSS) and the Programme for International Student Assessment (PISA) are examples of these. Second, the formation of the assessment-reform group of the British Educational Research Association, which promulgated assessment for learning as a concept and practice, was in the late 1980s. The themes presented in this archaeology of assessment literature in geography education are as follows: Theme One: Overviews/Reports and a Special Issue on Assessment in Geography Education, Theme Two: Large-Scale International Assessments, Theme Three: National Assessment and Data, Theme Four: Teacher/Formative Assessment, Theme Five: Assessing Knowledge and Skills through Mapping, Theme Six: Developing Valid and Reliable Instruments to Assess Spatial Thinking, Theme Seven: Assessment in Geography Textbooks, Theme Eight: Assessment Rubrics and Marking, and Theme Nine: Emerging Trends in Geography Education Assessment.
Electrospun naringin-loaded microsphere/sucrose acetate isobutyrate system promotes macrophage polarization toward M2 and facilitates osteoporotic bone defect repair
Authors: Li Jihong , Song Jinlin , Meng Di , Yi Yin , Zhang Ting , Shu Yu , Wu Xiaohong
Published: February 2023

Repairing osteoporotic bone defects is still a major clinical challenge. Recent studies have revealed that immune response is also essential in osteogenesis. The intrinsic inflammatory response of the host, especially the M1/M2 polarization status and inflammatory secretory function of macrophages, can directly affect osteogenic differentiation. Therefore, in this study, an electrospun naringin-loaded microspheres/sucrose acetate isobutyrate (Ng-m-SAIB) system was constructed to investigate its effect on the polarization of macrophage and osteoporotic bone defects. The results of both in vitro and in vivo experiments showed that Ng-m-SAIB had good biocompatibility and could promote the polarization of macrophage toward M2, thereby forming a favorable microenvironment for osteogenesis. The animal experiments also showed that Ng-m-SAIB could promote the osteogenesis of critical size defects in the skull of the osteoporotic model mouse (the senescence-accelerated mouse-strain P6). Together, these results collectively suggested that Ng-m-SAIB might be a promising biomaterial to treat osteoporotic bone defects with favorable osteo-immunomodulatory effects.
High-Quality Nuclear Genome and Mitogenome of Bipolaris sorokiniana LK93, a Devastating Pathogen Causing Wheat Root Rot
Authors: Zhang Wanying , Yang Qun , Yang Lei , Li Haiyang , Zhou Wenqing , Meng Jiaxing , Hu Yanfeng , Wang Limin , Kang Ruijiao , Li Honglian , Ding Shengli , Li Guotian
Published: February 2023

Bipolaris sorokiniana, one of the most devastating hemibiotrophic fungal pathogens, causes root rot, crown rot, leaf blotching, and black embryos of gramineous crops worldwide, posing a serious threat to global food security. However, the host-pathogen interaction mechanism between B. sorokiniana and wheat remains poorly understood. To facilitate related studies, we sequenced and assembled the genome of B. sorokiniana LK93. Nanopore long reads and next generation sequencing short reads were applied in the genome assembly, and the final 36.4-Mb genome assembly contains 16 contigs with the contig N50 of 2.3 Mb. Subsequently, we annotated 11,811 protein-coding genes. Of these, 10,620 were functional genes, 258 of which were identified as secretory proteins, including 211 predicted effectors. Additionally, the 111,581-bp mitogenome of LK93 was assembled and annotated. The LK93 genomes presented in this study will facilitate research in the B. sorokiniana–wheat pathosystem for better control of crop diseases.

[Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Results of the 2022 Wound Survey on Skin Failure/End-of-Life Terminology and Pressure Injuries
Authors: Sibbald R. Gary , Ayello Elizabeth
Published: February 2023

OBJECTIVE

To summarize the major findings of a survey first conducted in 2019 and repeated in 2022 and review new concepts (angiosomes and pressure injuries) and challenges due to the COVID-19 pandemic.

METHODS

This survey captures participants’ ranking of agreement or disagreement with 10 statements on Kennedy terminal ulcers, Skin Changes At Life’s End, Trombley-Brennan terminal tissue injuries, skin failure, and unavoidable/avoidable pressure injuries. The survey was hosted online by SurveyMonkey from February 2022 until June 2022. All interested persons were able to participate in this voluntary, anonymous survey.

RESULTS

Overall, 145 respondents participated. The same nine statements achieved at least 80% agreement (somewhat agree or strongly agree) as in the previous survey. The one statement that did not reach consensus also failed to reach consensus in the 2019 survey: “The concept of skin failure does not include pressure injuries.”

CONCLUSIONS

It is the authors’ hope that this will stimulate more research into terminology and etiology of skin changes in persons at end of life and encourage more research regarding terminology and criteria to define which skin lesions are unavoidable or avoidable.
Perinatal Injectable Opioid Agonist Therapy (iOAT) Administration: A Case Series
Authors: Patricelli Charissa J. , Chai Jessie , Gordon Shanlea , Gouin Isabelle J. , Carter Nicole , Stewart Karly , Paquette Vanessa , Urbanoski Karen , Albert Arianne
Published: February 2023

Objectives

Untreated opioid use disorder (OUD) in pregnancy may lead to adverse outcomes for the individual and fetus. Injectable opioid agonist therapy (iOAT) is the highest intensity treatment for severe refractory OUD currently available; however, research on perinatal administration is limited. We present the first known case series of 13 pregnant or postpartum participants who received intravenous hydromorphone while admitted to the Families in Recovery (FIR) unit, an in-patient perinatal stabilization unit in Canada.

Methods

Patients who received iOAT at FIR between 2019 and 2022 were invited to participate. Prospectively enrolled participants completed a self-report sociodemographics and exposures survey. Medical/social backgrounds of participants at admission, iOAT and other opioid agonist therapy administration, and health/social outcomes of mother and infant at discharge were collected on all participants via retrospective maternal and infant medical chart review.

Results

Participants initiated iOAT while pregnant (n = 5) or postpartum (n = 8) and received iOAT for 23 days on average. At discharge, 8 participants underwent planned transition to community with infant in their care and a discharge plan including outpatient prescriptions, housing arrangements, follow-up appointments, and supportive programming. All infants received oral morphine after delivery and were discharged in good health.

Conclusions

This is the first known case series of iOAT administration in the peripartum. The cases illustrate iOAT as an option that can achieve OUD stabilization in perinatal individuals to support patient engagement and retention in care.
Comparison of 3 Methods for Measuring Gastric Tube Length in Newborns
Authors: Manzo Bruna Figueiredo , Marcatto Juliana Oliveira , Ferreira Bruna , Galvão Diniz Catharine , Parker Leslie A.
Published: February 2023

Background:

Incorrectly positioned gastric tubes occur in approximately 60% of infants hospitalized in the neonatal intensive care unit (NICU), increasing the risk of potentially serious complications.

Purpose:

To compare 3 methods of determining gastric tube insertion length in infants in the NICU.

Methods:

In this randomized triple-blind clinical trial, 179 infants admitted to the NICU were randomized to have their gastric tube insertion length determined by 1 of 3 methods: (1) the nose, earlobe, mid-umbilicus (NEMU) method, (2) a weight-based method, or (3) an age-related height-based (ARHB) method. Positioning of the gastric tube was verified by radiograph. R software was used for analyses. To compare categorical variables, Fisher's exact test, χ2 tests, and simulated χ2 tests were used.

Results:

Overall, infants had a mean gestational age of 35 weeks, 115 (58.8%) were male, and the mean birth weight was 2481.5 g. Upon radiological assessment, 145 gastric tubes (81.3%) were correctly positioned in the gastric body or greater curvature of the stomach with the weight-based method having the highest percentage of correctly positioned gastric tubes (n = 53; 36.6%), followed by the ARHB method (n = 47; 32.4%) and the NEMU method (n = 45; 31.0%). No significant differences were identified between groups (P = .128).

Implication for Practice and Research:

Despite the NEMU method being the most commonly used method in clinical practice, the weight-based and ARHB methods to determine gastric tube insertion length may be more accurate.
Long-term results of synovectomy in total knee arthroplasty: a prospective, randomized controlled trial
Authors: Zeng Weinan , Yu Zeping , Wang Simeng , Chen Anjing , Zeng Yiping , Yang Qingjun , Li Yujuan , Li Qi , Zhou Zongke
Published: February 2023

Background:

Synovectomy has been introduced into total knee arthroplasty (TKA) with the aim of relieving pain and inflammation of the synovium. However, there are no long-term, comparative data to evaluate the effect of synovectomy in TKA. This study was aimed at assessing pain, function, and complications in patients undergoing synovectomy during TKA for osteoarthritis (OA) at long-term follow-up.

Methods:

This was a prospective randomized controlled trial of 42 consecutive patients who underwent staged bilateral TKA. Patients undergoing the first-side TKA were allocated to receive TKA with or without synovectomy followed by a 3-month washout period and crossover to the other strategy for the opposite-side TKA. The overall efficacy of both strategies was evaluated by determination of blood loss, the Knee Society score (KSS), and knee inflammation conditions during a 3-month postoperative period. The postoperative pain, range of motion (ROM), and complications were sequentially evaluated to compare the two groups until 10 years after surgery.

Results:

At the 10-year follow-up, both groups had a similarly significantly improved ROM (114.88 ± 9.84° vs. 114.02 ± 9.43°, t = 0.221, P = 0.815) and pain relief with no differences between the two groups (1.0 [1.0] vs. 1.0 [1.5], U = 789.500, P = 0.613). Similar changes in total blood loss, KSS, and knee inflammation were found in both groups during 3 months postoperatively (P > 0.05). Additionally, there was no significant difference regarding complications and satisfaction between the two groups (P > 0.05).

Conclusions:

Synovectomy in conjunction with TKA for primary OA does not seem to provide any benefit regarding postoperative pain, ROM, and satisfaction during a 10-year follow-up. In addition, it may not result in more blood loss and increased incidence of long-term complications. Based on our long-term findings, it should not be performed routinely.

Trial registration:

Chinese Clinical Trial Registry, ChiCTR-INR-16008245; https://www.chictr.org.cn/showproj.aspx?proj=13334.
Leucine-rich repeats containing 4 protein (LRRC4) in memory, psychoneurosis, and glioblastoma
Authors: Deng Kun , Wu Minghua
Published: February 2023

Leucine-rich repeats containing 4 (LRRC4, also named Netrin-G ligand 2 [NGL-2]) is a member of the NetrinGs ligands (NGLs) family. As a gene with relatively high and specific expression in brain, it is a member of the leucine-rich repeat superfamily and has been proven to be a suppressor gene for gliomas, thus being involved in gliomagenesis. LRRC4 is the core of microRNA-dependent multi-phase regulatory loops that inhibit the proliferation and invasion of glioblastoma (GB) cells, including LRRC4/NGL2-activator protein 2 (AP2)-microRNA (miR)182-LRRC4 and LRRC4-miR185-DNA methyltransferase 1 (DNMT1)-LRRC4/specific protein 1 (SP1)-DNMT1-LRRC4. In this review, we demonstrated LRRC4 as a new member of the partitioning-defective protein (PAR) polarity complex that promotes axon differentiation, mediates the formation and plasticity of synapses, and assists information input to the hippocampus and storage of memory. As an important synapse regulator, aberrant expression of LRRC4 has been detected in autism, spinal injury and GBs. LRRC4 is a candidate susceptibility gene for autism and a neuro-protective factor in spinal nerve damage. In GBs, LRRC4 is a novel inhibitor of autophagy, and an inhibitor of protein–protein interactions involving in temozolomide resistance, tumor immune microenvironment, and formation of circular RNA.
Evaluation of Health Literacy in Plastic Surgery Using a Crowdsourced Patient Survey
Authors: Bustos Valeria P. , Haddad Anthony , Kinney JacqueLyn R. , Xun Helen , Nassar Amer H. , Lee Theodore , Lin Samuel J. , Lee Bernard T.
Published: February 2023

Background:

Little is known about the levels of health literacy (HL) among plastic and reconstructive surgery (PRS) patients compared with the general population. This study aimed to characterize HL levels in patients interested in plastic surgery and identify potential risk factors associated with inadequate levels of HL among this population.

Methods:

Amazon’s Mechanical Turk was used to distribute a survey. The Chew’s Brief Health Literacy Screener was used to evaluate the level of HL. The cohort was divided into two groups: non-PRS and PRS groups. Four subgroups were created: cosmetic, noncosmetic, reconstructive, and nonreconstructive groups. A multivariable logistic regression model was constructed to assess associations between levels of HL and sociodemographic characteristics.

Results:

A total of 510 responses were analyzed in this study. Of those, 34% of participants belong to the PRS group and 66% to the non-PRS group. Inadequate levels of HL were evidenced in 52% and 50% of the participants in the non-PRS and PRS groups, respectively (P = 0.780). No difference in HL levels was found in the noncosmetic versus cosmetic groups (P = 0.783). A statistically significant difference in HL levels was evidenced between nonreconstructive versus reconstructive groups after holding other sociodemographic factors constant (0.29, OR; 95% CI, 0.15–0.58; P < 0.001).

Conclusions:

Inadequate levels of HL were present in almost half of the cohort, which highlights the importance of adequately assessing HL levels in all patients. It is of utmost importance to evaluate HL in clinical practice using evidence-based criteria to better inform and educate patients interested in plastic surgery.
Lessons Learned After Integrating the Five Steps of Evidence-Based Practice Into a Doctor of Physical Therapy Curriculum
Authors: Lis Angela , Snowdon Lauren , Downey Kyle
Published: February 2023

Background and Purpose.

Teaching evidence-based practice (EBP) has become a standard curricular goal for Doctor of Physical Therapy (DPT) education programs. In 2014, the American Physical Therapy Association published a consensus document to provide guidance on curricular objectives for teaching EBP in entry-level DPT programs. The document reinforced the need to promote skills related to the efficient and critical consumption of published evidence. The purpose of this case report is to describe the collaborative process of integrating the EBP guidelines in one university's DPT curriculum.

Case Description.

Faculty of EBP courses, in collaboration with a health sciences librarian, worked collaboratively to review and redesign the courses that teach and promote the skills required for an efficient EBP entry-level clinician, using the EBP guidelines as a reference document. Integrating the guidelines, specifically the five steps of teaching EBP, required creating a curricular thread for both the didactic and the clinical portions of the program, the development of standardized tools to optimize the students’ learning, promotion of literature search and appraisal skills, and designing instructional activities, assignments, and standardized rubrics.

Outcomes.

The effectiveness of the curricular integration process was evaluated using students’ self-efficacy with the acquired EBP skills. Data indicated students who participated in the modified curriculum perceived to have achieved all terminal objectives for each of the EBP steps.

Discussion.

This case study highlights the benefits of progressive and early exposure to EBP to facilitate integration into clinical practice. Additionally, it reinforced the idea of EBP as a learnable skill that requires practice and experiential learning.

Conclusion.

It is feasible to successfully integrate EBP guidelines into a physical therapist program.
Defining the Learning Curve for Endoscopic Ear Skills Using a Modular Trainer: A Multi-Institutional Study
Authors: Wong Kevin , Gorthey Scott , Arrighi-Allisan Annie E. , Fan Caleb J. , Barber Samuel R. , Schwam Zachary G. , Wanna George B. , Cosetti Maura K.
Published: February 2023

Objective

Quantify the learning curve for endoscopic ear skills acquisition in otolaryngology residents using a simulator. The secondary objective was to determine if demographic factors or previous endoscopic experience influenced skill development.

Study Design

Prospective, multicenter study. Resident participants each completed 10 amassed trials using a validated endoscopic ear skill trainer.

Setting

Two academic teaching hospitals.

Subjects

Otolaryngology residents.

Main Outcome Measures

Trial completion times; rate of improvement over time.

Results

Thirty-eight residents completed the study, 26 from program A and 12 from program B. Fifteen participants were women and 23 were men. Mean age was 30 years old (range 26 to 34 years). Previous experience with otoendoscopy (B = −16.7, p = 0.005) and sinus endoscopy (B = −23.4, p = 0.001) independently correlated with lower overall trial times. Age, gender, postgraduate year, handedness, interest in otology, and video gaming were not associated with trial times. On multivariate logistic regression, resident completion times improved with trial number, and residents without previous endoscopy experience improved at a faster rate than those with experience (p < 0.001).

Conclusions

Novice surgeons may acquire basic endoscopic ear experience with self-directed simulation training. The learning curve for transcanal endoscopic ear surgery is comparable to those demonstrated for other otologic surgeries, and specific task competencies can be achieved within 10 trials, suggesting that previous experiences, or lack thereof, may not dictate the ability to acquire new skills. There may be a translational value to previous endoscopic sinus experience on learning transcanal endoscopic ear surgery.
A new approach of estimating insertion length for intermittent orogastric tube feeding in adult patients
Authors: Gan Ting , Luo Yuan , LE Meixian , Sheng Lijuan , Zhao Liping
Published: February 2023

Objective:

To determine the association between human external anthropometry and the in vivo length between the incisor and cardia and develop a new approach for estimating the insertion length of the orogastric tube in adult patients.

Methods:

A cross-sectional study was conducted among participants from the digestive endoscopy department of a tertiary hospital in China. The in vivo length between the incisor and cardia was measured through a digestive endoscopy examination. External anthropometric data were obtained using a weighing scale and a soft ruler. The univariate analysis, correlation analysis, and multiple regression analysis were performed to establish a prediction model of the in vivo length between the incisor and cardia.

Results:

A total of 327 participants were recruited in this study. The in vivo length between the incisor and cardia ranged from 35 to 46 cm (average 40.57  cm). The highest correlation coefficient was observed for height (r=0.71, P<0.001). Multiple regression analysis showed that weight, sex, height, sitting height, and the nose-umbilicus distance could predict the in vivo length between the incisor and cardia and the prediction equation was as follows: 6.990 – 0.066×weight – 1.049×sex + 0.124×height + 0.135×sitting height + 0.128×nose-umbilicus distance (sex=0 if the participant was male; sex=1 if the participant was female).

Conclusion:

The prediction equation for the in vivo length between the incisor and cardia proposed in this study can provide an evidence-based approach for estimating the insertion length of the orogastric tube.
Validity, reliability, and Rasch analysis of the orthotics and prosthetics users' survey: Turkish version of the lower-extremity functional status
Authors: Soyer Kardem , Demirdel Senem , Erol Çelik Seher , Topuz Semra , Karahan Sevilay
Published: February 2023

Background:

It is well known that questionnaires and scales are easy to use, cheap, and provide fast results. In the clinical setting, it will be easier and more comfortable to evaluate lower-extremity functions in both prosthesis and orthosis users with a single questionnaire.

Objectives:

To study the Turkish version of the orthotics and prosthetics users' survey lower-extremity functional status (OPUS-LEFS) and investigate its reliability and validity in the Turkish prosthesis and orthosis users.

Study design:

After forward and backward translation process, test–retest, internal consistency, validity, dimensionality, and Rasch analysis were done for 139 participants.

Methods:

Participants with a lower-limb prosthesis or orthosis were recruited in this study. Test and retest of the survey was done 1–3 days apart. For convergent validity, Nottingham Health Profile was used. Pearson correlation coefficient was used to analyze test–retest reliability; Cronbach's alpha for internal consistency, Spearman's correlation coefficient for validity, exploratory factor analysis by means of Kaiser–Meyer–Olkin and Bartlett's value of sphericity for dimensionality, and Rasch analysis were used.

Results:

Test–retest reliability of OPUS-LEFS showed very strong correlation (0.994) and for internal consistency with Cronbach's alpha value 0.71 of the Turkish version of OPUS-LEFS. Analyses showed that OPUS-LEFS is valid (p < 0.001) and significant (p < 0.001).

Conclusions:

The Turkish version of the OPUS-LEFS has been shown to be a valid and reliable tool in evaluating both orthosis and prosthesis users with a self-administered questionnaire for LEFS.
Second Primary Cancers in People With HIV/AIDS: A National Data Linkage Study of Incidence and Risk Factors
Authors: Di Ciaccio Pietro R. , Van Leeuwen Marina T. , Amin Janaki , Vajdic Claire M. , McGregor Skye , Poynten Isobel M. , Templeton David J. , Law Matthew , Grulich Andrew E. , Polizzotto Mark N. , Jin Fengyi
Published: February 2023

Background:

Evidence regarding the characteristics of second primary cancer (SPC) in people living with HIV (PLWHIV) is limited.

Setting:

We performed a national population-based data linkage study to determine the incidence and risk factors of SPC in PLWHIV in Australia between 1982 and 2012.

Methods:

We conducted a probabilistic data linkage study to compare the incidence of SPC over time, defined using HIV treatment eras, for SPCs related to oncogenic viral infection in comparison with non–infection-related SPCs. Risk factors considered included age at diagnosis of cancer, sex, HIV exposure modality, and CD4+ count.

Results:

Of 29,383 individuals diagnosed with HIV, 3123 individuals who developed a first primary cancer were included in the analysis. Among them, 229 cases of SPC were identified across 27,398 person-years of follow-up. The most common SPCs were non-Hodgkin lymphomas (n = 71, 31%). The incidence of SPC overall did not change over time; however, there was an increase in individuals diagnosed with HIV in later eras (P trend =0.001). The incidence of non–infection-related SPC increased over time and was associated with older age (P trend = 0.005) and the acquisition of HIV in later eras (P trend <0.001). Conversely, the incidence of infection-related SPC decreased (P trend <0.001), but this was no longer significant after adjustment for age (P trend = 0.14).

Conclusions:

The risk of SPC in PLWHIV in Australia remains high, with a temporal increase observed in non–infection-related cancer, likely due to aging of the population. Optimal screening and prevention strategies for SPC in PLWHIV are increasingly important.
Trajectories of Antiretroviral Therapy Adherence and Virologic Failure in Women With HIV in the United States
Authors: Elbur Abubaker Ibrahim , Ghebremichael Musie , Konkle-Parker Deborah , Jones Deborah L. , Collins Shelby , Adimora Adaora A. , Schneider Michael F. , Cohen Mardge H. , Tamraz Bani , Plankey Michael , Wilson Tracey , Adedimeji Adebola , Haberer Jessica , Jacobson Denise L.
Published: February 2023

Background:

Women with HIV (WHIV) in the United States face many challenges with adherence to antiretroviral therapy (ART), and suboptimal adherence often leads to virologic failure. This study aimed to determine the association between ART adherence trajectories and the risk of virologic failure.

Methods:

We included WHIV (aged 18 years or older) enrolled in the Women's Interagency HIV Study in the United States from April 2014 to September 2019 who had at least 2 consecutive measurements of HIV RNA and ≥3 measurements of self-reported adherence. Group-based trajectory modeling was used to identify adherence trajectories. Cox proportional hazard ratios were used to measure the association.

Main Outcome Measure:

Virologic failure was defined as HIV RNA ≥200 copies/mL at 2 consecutive visits.

Results:

We included 1437 WHIV (median age 49 years). Of all women, 173 (12.0%) experienced virologic failure. Four adherence trajectories were identified, namely “consistently high” (26.3%), “moderate increasing” (9.5%), “moderate decreasing” (30.6%), and “consistently low” (33.5%). Women in the consistently low adherence group consumed alcohol and experienced depression more than other groups. Compared with the “consistently high” trajectory, the risk of virologic failure was higher among women with “consistently low” [adjusted hazard ratio (aHR) 2.8; 95% confidence interval (CI): 1.6 to 4.9; P < 0.001] and “moderate decreasing” adherence trajectories (aHR 1.8; 95% CI: 1.0 to 3.2; P = 0.04), but it was similar to those with “moderate increasing” adherence trajectory (aHR 1.0; 95% CI: 0.4 to 2.5; P = 0.94).

Conclusions:

Adherence to ART remains a challenge among WHIV. Multilevel behavioral interventions to address poor adherence, alcohol consumption, and depression are needed.
A Quality Improvement Approach to Decrease the Utilization of Docusate in Hospitalized Patients
Authors: Shair Kamal A. , Espinosa Samantha M. , Kwon Joshua Y. , Gococo-Benore Denise A. , McCormick Benjamin J. , Heckman Michael G. , Seim Lynsey A. , Cowdell J. Colt
Published: February 2023

Background and Objectives:

Docusate sodium is a commonly prescribed medication to relieve constipation, but several studies have demonstrated its ineffectiveness. Its continued use in the hospital setting adds unnecessary cost and risk to patients. At the Mayo Clinic Florida campus, docusate was ordered for 9.7% of patients admitted to the internal medicine resident (IMED) teaching services during the month of January 2020, and the average hospital length of stay (LOS) was 3.1 days.

Methods:

A multidisciplinary team of internal medicine resident physicians and pharmacists collaborated to address this quality gap through a quality improvement project. It sought to reduce the number of patients admitted to the IMED teaching services who had an order placed for docusate by 50% in less than 6 months without adversely impacting hospital LOS. Two separate interventions were devised using Six Sigma methodology and implemented to reduce the frequency of docusate orders, which involved educating internal medicine residents and hospital pharmacists, and creating an additional process-related barrier to docusate orders.

Results:

The percentage of docusate orders decreased from 9.7% to 2.4% (P = .004) with a grossly unchanged LOS of 3.1 days to 2.7 days (P = .12) after 5 weeks.

Conclusion:

The implementation of a dual-pronged intervention successfully decreased the use of an ineffective medication in hospitalized patients without impacting the balancing measure, and serves as a model that can be adopted at other institutions with the hope of promoting evidence-based medical care.
Association Between Naloxone Coprescription Mandates and Postoperative Outcomes
Authors: Du Austin L. , Rishel Chris A. , Sun Eric C.
Published: February 2023

Introduction:

The opioid epidemic is a public health issue in the United States. The objective of this study was to evaluate the association between naloxone coprescription mandates and postoperative outcomes.

Background:

Data on naloxone coprescription mandates show mixed evidence for fatal overdoses in the broader population. How these mandates have impacted surgical patients has not been fully explored.

Methods:

Healthcare claims data were used to identify all patients undergoing 1 of 50 common procedures between January 1, 2004, and June 30, 2019, and categorized as high risk for opioid overdose. The primary outcomes were an emergency department visit or hospital admission within 30 postoperative days. To reduce confounding, the association between this outcome and the implementation of naloxone coprescription mandates was estimated using a difference-in-differences approach.

Results:

The study included 429,878 surgical patients with an average age of 54.8 years (SD=15.9 years) and with 257,728 females (60.0%). There was no significant association between naloxone prescribing mandates and the primary outcomes. After adjustment for potential confounders, the incidence of hospital admission was 3.26% after implementation of a naloxone coprescription mandate compared with 3.33% before (difference change: −0.08%, 95% CI: −0.44% to 0.29%, P=0.68). The incidence of an emergency department visit was 7.06% after implementation of a naloxone coprescription mandate compared with 7.73% before (difference: −0.67%, 95% CI: −1.39% to 0.05%, P=0.07). These results were robust to a variety of sensitivity and subgroup analyses.

Conclusions:

Naloxone coprescription mandates were not associated with a statistically or clinically significant change in emergency department visits or hospital admissions within 30 postoperative days.
Financial vulnerability of trauma centers: A national analysis
Authors: Marrotte Alexander , Calvo Richard Y. , Capacio Benedict , Goljan Christopher , Rooney Alexandra S. , Carroll Alyssa N. , Krzyzaniak Andrea , Bansal Vishal , Sise Michael J. , Martin Matthew J.
Published: February 2023

OBJECTIVE

Trauma centers function as an essential safeguard in the United States health care system. However, there has been minimal study of their financial health or vulnerability. We sought to perform a nationwide analysis of trauma centers using detailed financial data and a recently developed Financial Vulnerability Score (FVS) metric.

METHODS

The RAND Hospital Financial Database was used to evaluate all American College of Surgeons–verified trauma centers nationwide. The composite FVS was calculated for each center using six metrics. Financial Vulnerability Score tertiles were used to classify centers as high, medium, or low vulnerability, and hospital characteristics were analyzed and compared. Hospitals were also compared by US Census region and teaching versus nonteaching hospitals.

RESULTS

A total of 311 American College of Surgeons–verified trauma centers were included in the analysis, with 100 (32%) Level I, 140 (45%) Level II, and 71 (23%) Level III. The largest share of the high FVS tier was consisted of Level III centers (62%), with the majority of Level I (40%) and Level II (42%) in the middle and low FVS tier, respectively. The most vulnerable centers had fewer beds, negative operating margins, and significantly less cash on hand. Lower FVS centers had greater asset/liability ratios, lower outpatient shares, and three times less uncompensated care. Nonteaching centers were statistically significantly more likely to have high vulnerability compared with teaching centers (46% vs. 29%). Statewide analysis showed high discrepancy among individual states.

CONCLUSION

With approximately 25% of Levels I and II trauma centers at high risk for financial vulnerability, disparities in characteristics, including payer mix and outpatient status, should be targeted to reduce vulnerabilities and bolster the health care safety net.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.