bluuebunny/crossref_metadata_2025 huggingface dataset:
Multi-objective optimization of sandwich structures for reinforcing composite fuselages
Authors: Albanesi Alejandro Eduardo , Volpe Nahuel José , Langhi Federico , Fachinotti Víctor Daniel
Published: October 2023

This study introduces a simulation-based optimization approach that combines a multi-objective genetic algorithm and the finite element method to design sandwich structures to reinforce composite fuselages. The sandwich structure has been parametrized with a set of mixed integer-continuous variables representing the polymer core thickness, the number and weight of laminated fiberglass layers, and size and position of the structure. Automatic scripting builds the geometry of the structure, then mounts it in the fuselage, and finally creates a conformal mesh. During the optimization, each reinforced fuselage is subjected to several load cases specified by the CS-22 EASA design standard, determining the worst load condition. Two objectives were considered: increasing the reinforced fuselage’s minimum fiber stress safety factor for improved safety and reducing the number of layers of the sandwich structure to minimize manufacturing costs. Structural constraints were the mass of the sandwich structure and buckling and flexo-torsional deformation of the reinforced fuselage. Results show an efficient material arrangement due to the reduced number of layers in the sandwich structure and a stress safety factor surpassing that set by the standard. Finally, the reinforcement of a glider fuselage to incorporate a retractable electric propulsion system is presented as a real-world industrial application.
Reflex to turn: the rise of turn-talk in International Relations
Authors: Heiskanen Jaakko , Beaumont Paul
Published: October 2023

The field of International Relations (IR) is being spun around by a seemingly endless number of ‘turns’. Existing analyses of turning are few in number and predominantly concerned with the most prominent recent turns. By excavating the forgotten history of IR’s earliest turns from the 1980s and tracing the evolution of turn-talk over time, this article reveals a crucial yet overlooked internalist driver behind the phenomenon: the rise of reflexivity. Rather than emerging in the 21st century, turn-talk began at the end of the 1980s as a series of turns away from positivism and towards reflexivity. Cumulatively, this first wave of turns would denaturalise IR’s state-centric ontology while enshrining reflexivity as a canonical good among critical scholars. By the mid-1990s, however, these metatheoretical critiques of positivism had produced a substantial backlash. Charged with fostering an esoteric deconstructivism, a new generation of reflexivists set out to demonstrate the feasibility of post-positivist empirical research. As a result, IR’s turning also took on a different form from the 2000s: whereas the first wave of turns had mounted an epistemological and methodological attack against the positivist mainstream, the second wave set about bringing new ontological objects under the scrutiny of reflexivist scholars. This shift from anti-positivist to mostly intra-reflexivist turning was facilitated by the institutionalisation of critical IR as a major subfield of the discipline. It is the privileged position of reflexivity among critical IR scholars that is the condition of possibility for endless turning, accentuated by mounting pressures to demonstrate novelty in an increasingly competitive environment.
Eco-social policy in the global political economy: Analysing shifting discourses on agricultural subsidies
Authors: Schulze Waltrup Robin , Moore Madelaine , Paulsen Tim
Published: October 2023

While critical political economy (CPE) has yet to play a prominent role in eco-social policy research, this paper argues that a deeper engagement with CPE and a better understanding of the global political economy can enhance eco-social policy debates. CPE can help us to see the contradictions in and impediments to integrating environmental and social policies, and particularly why both of these categories continue to be mediated and shaped by economic logics. In order to develop these arguments, we analyse recent international discourses on agricultural subsidies promoted by key policy actors such as the Food and Agriculture Organisation, the World Bank, and the International Fund for Agricultural Development. By examining agriculture as a nodal point between diverse scales and domains such as the local, global, environmental, social, and economic spheres, we explore how certain positions are prioritised over others. We argue that the discourse on ‘repurposing subsidies’ in global agricultural policy expresses a ‘new critical orthodoxy’ that recognises the need for transformation but fails to address the structural conditions of the global political economy responsible for environmental and social crises. Instead, the proposed solutions rely on existing institutions and capitalist logics to resolve current crises, even if the latter are underpinned by these logics. Our analysis underlines the need for eco-social policy scholarship to be cognizant of how environmental and social policy integration is always embedded within a particular global political economy that reproduces certain inequalities and is not a neutral policy terrain.
The interaction of charge motion and EGR on anti-knock performance and efficiency of a medium-duty gasoline engine: An experimental study
Authors: Zhao Xumin , Liu Ruilin , Zheng Zunqing , Chen Peng , Wang Hu , Zhou Guangmeng , Zhang Zhongjie , Yao Mingfa
Published: October 2023

Due to the common operating characteristics of medium duty (MD) gasoline engines, achieving higher load at the expense of fuel efficiency is not an acceptable tradeoff. EGR dilution-stoichiometric combustion can suppress the knocking and improve the thermal efficiency, but has problems such as slow combustion rate and poor combustion stability, which have limitations in optimizing combustion for MD gasoline engines with strong swirl. The experimental investigations in this study focus on the interaction of charge motion and EGR on anti-knock performance and thermal efficiency under different load conditions, and verifies the potential to improve the thermal efficiency of inclined swirl combustion system. The results show that at low-medium load, the tumble-dominated inclined swirl scheme can enhance the effectiveness of EGR in knock suppression, thus reducing the introduction of EGR to avoid its adverse effects on the combustion duration. At medium-high load, although the above benefit wears off, it can enhance the anti-knock performance and thus advance the spark timing by increasing the EGR tolerance. The EGR ratio corresponding to the highest thermal efficiency increases with higher load. The difference in the in-cylinder flow field will affect the combustion rate in a high EGR dilution and high load condition. The scheme adopting the compound intake ports and inverse cuneiform-shaped combustion chamber can improve both EGR tolerance and initial combustion rate under high EGR dilution, with the most significant improvement in thermal efficiency, and the improvement range will increase along with the increase of load.
Performance evaluation of methane oxidation catalyst for marine gas-engine in actual exhaust and simulated gas
Authors: Nitta Yoshifuru , Ichikawa Yasuhisa , Niki Yoichi , Masuda Akiko , Hirata Koichi
Published: October 2023

To reduce methane slip from marine gas engines installed in gas fuelled ships, it is necessary to understand the effects of exhaust composition and temperature on the activity of the methane oxidation catalysts in the marine gas engine exhaust. A comparative study was performed to evaluate catalyst performance in both actual engine exhaust and the simulated gas under the same flow conditions. The test using actual exhaust gas test showed that despite the lower exhaust temperatures during low load operation, the catalyst exhibited an extremely high performance, achieving approximately 100% CH4 conversion. In contrast, at high load, despite high exhaust temperatures, the CH4 conversion was decreased to 50-60%. In the simulated gas test showed that the catalyst’ activity was declined with increasing concentration of H2O and NO, whereas it was improved by CH4 and CO oxidation. The results showed that high CH4 concentrations under low load conditions enhanced catalyst activity owing to the exothermic reaction, which increased the catalyst temperature despite the low exhaust temperature and the presence of H2O vapour. Furthermore, during actual engine operation, the catalytic performance at a high load was improved by controlling the air excess ratio.
Ideology, Information, and Social Welfare Preferences
Authors: Qi Hang , Haselswerdt Jake
Published: October 2023

Research shows that Americans have a generally poor understanding of welfare programs. Providing information about such programs has the potential to shape public preferences, but we argue that such effects may differ based on the content of the information and its correspondence with existing ideological beliefs. Using original survey experiments embedded in the Cooperative Congressional Election Study and through Amazon’s Mechanical Turk, we analyze how the relationship of ideology with welfare programs varies in response to different types of negative information about the program, and different descriptions of policy design. We find that information about inadequate benefits has a larger negative impact on welfare support for liberals than for conservatives but that both liberals and conservatives may be equally concerned about fraud and inefficiency. Other information about policy design has the expected conditional effect: state (as opposed to federal) funding and short time limits for benefits are more appealing to conservatives than liberals.
A Sense of Danger: Gender-Based Violence and the Quest for a Sensory Criminology
Authors: Holt Amanda , Lewis Sian
Published: October 2023

This article responds to recent calls for a ‘sensory criminology’ by offering a multi-sensorial analysis of gender-based violence (GBV). We examine both the often-discussed external senses as well as the more marginalized internal senses and explore how emotion, the broader criminological ‘atmosphere’ of GBV and the shift in atmosphere during the Covid-19 pandemic are implicated in women’s experiences of street-based sexual harassment and sexual assault. By analysing over 140 stories of GBV during the Covid-19 lockdowns, we evidence the scope and value of a fully multi-sensory criminology.
Associations between Configurations of Childhood Adversity and Adult Mental Health Disorder Outcomes
Authors: Kamis Christina , Lynch Scott M. , Copeland William E.
Published: October 2023

The life course perspective and cumulative inequality theory suggest that childhood adversity, occurring during a sensitive period of the life course, can have long-term consequences for adult mental health and well-being. Yet, the long-term influence of adversity on adult outcomes may depend on both the features of adverse childhood experiences (e.g., the number, type, and co-occurrence of adversities) as well as the outcome assessed. Using latent class analysis applied to several waves of prospective data from the Great Smoky Mountains Study (GSMS; N = 1,420), we identify subpopulations that are similar in their adversity experiences before age 18. We then predict adult internalizing and substance use disorder diagnoses by adversity experience. Results reveal five distinct classes of adversity, with unique risks for specific diagnoses in adulthood.
Investigating the Effect of Interface Type on Embodied Interactions in 3D Gestural Human-Computer Interaction
Authors: Kyle Ainsley R. , Jurewicz Katherina A.
Published: October 2023

Through emerging technologies, it is possible to use hand gestures to interact with computing systems in the form of embodied human-computer interaction (eHCI). There is much research done on improving gesture recognition accuracy and on understanding the factors that influence intuitive gesture choice; however, there is a lack of work investigating how to design the interface for 3D gestural interactions. Therefore, a between subjects experimental study was done to study the effect of interface design (e.g, 3D vs. 2D) on intuitive gesture choice and cognitive load for performing an embodied interaction. Two out of ten functions had the same intuitive gesture function mapping for 2D and 3D conditions. However, many of the functions had different mappings between the two different display types. The results illustrate the differences in embodied interactions between 2D and 3D interfaces, and future work should investigate the interface design comprehensively.
Evaluating Responsivity and Resilience in Trust in Healthcare Systems: A Scoping Literature Review
Authors: Nare Matthew T. , Jurewicz Katherina A.
Published: October 2023

The integration of automation into clinical workflows has increased since 2004. As the next healthcare era (i.e., Health Care 4.0) approaches, it is important to understand how human-automation interaction has evolved. The objective of this research was to perform a scoping literature review on trust in automation in healthcare systems focused on: (1) Understanding the extent to which responsivity and resiliency are studied in trust in automation and (2) Understanding the extent to which automation is studied from a systems thinking perspective. This review evaluated published works between 2004 and early 2022 to determine gaps in the current literature related to evaluating trust in automation in healthcare. Over 5,000 articles were identified during the literature review process using three databases. Twenty-four articles matched the inclusion criteria of being empirical research conducted within hospital environments. The findings of this scoping literature review identify future research opportunities for investigating trust in automation.
Can We Build it? Yes, We Can! Development Procedure of High-Fidelity Simulation Environments for Human-Agent Teams
Authors: Mallick Rohit , Sawant Sarvesh , Brady Camden , McNeese Nathan , Madathil Kapil Chalil , Bertrand Jeff
Published: October 2023

This paper presents a bottom-up approach to designing and developing a high-fidelity simulation environment that fosters human acceptance of artificial intelligence (AI) as teammates by refining their mental models of appropriate teamwork expectations. Our process begins by first identifying an appropriate contextual situation that warrants humans teaming with AI as opposed to other team-based configurations. Those criteria are based on the delegation of roles appropriate to the established strengths of humans/AI, as well as the interdependence created between those roles to accentuate the expectations of teammate behavior. Next, qualitative interviews should be conducted with diverse subject matter experts to gain a comprehensive understanding of the situation and the environmental attributes through various perspectives. Once analyzed using thematic analysis, themes present themselves as design recommendations on how to create a high-fidelity simulation environment that nurtures human-agent team collaboration.
Model Blindness II: Investigating a Model-Based Recommender System’s Impact on Decision Making
Authors: Parmar Sweta , Illingworth David A. , Thomas Rick P.
Published: October 2023

Adoption and use of misspecified models can lead to impoverished decision-making—a phenomenon we term model blindness. A series of two experiments investigated the consequences of model blindness on human decision-making and performance and how those consequences can be mitigated via an explainable AI (XAI) intervention. The experiments implemented a simulated route recommender system as a Decision Support System (DSS) with a true data-generating model. In Experiment 1, the true model generating the recommended routes was misspecified at two different levels to impose model blindness on users. In Experiment 2, the same route-recommender system was augmented with a mitigation technique to overcome the impact of model-misspecifications on decision-making. Overall, the results of both experiments provided little support for performance degradation. The participants' decision strategies revealed that they could understand model limitations from feedback and explanations and could adapt their strategy to account for those misspecifications.
Open Science Practices in The Journal Human Factors: 2017–2022
Authors: McCarley Jason S. , Rose Lauren E. , Fischer Sophia , Haney Madisyn S. , Hyk Alina , Kuhn Kali , Meredith Brooke , Moussaoui Jannah R. , Munoz Gomez Andrade Fernando , Pietrok Emma M. , Silberstein Samuel L.
Published: October 2023

Evidence of low replicability, poor reproducibility, and questionable research practices has prompted a broad effort toward transparency and openness in science, termed the open science movement. We examined articles published in HFES’s flagship journal, Human Factors, to gauge the prevalence of open science practices. Empirical articles published in the journal between the years 2017 and 2022 were assessed for evidence of study preregistration, materials sharing, data sharing, and analytic code sharing. The majority of articles made no mention of any open science practices. The most common practices adopted were data and code sharing, though these were reported in no more than 17% of the articles in any year. Journal policies may be worthwhile to better incentivize openness and transparency.
Exploring Individual Differences in Consumer Understanding of Partially Automated Driving Systems Before and After Exposure
Authors: McDonough Jessica , Tefft Brian
Published: October 2023

With the driver responsibilities that are required to safely operate ADAS driving systems, it is critical that users understand the capabilities and limitations of these systems. The present study was a secondary analysis of data from a previous study that examined driver understanding and expectations of an SAE L2 driving system after brief training and after brief on-road experience using the system. The current analysis examined the role of demographic and individual difference factors on driver understanding and perceptions of the system immediately after training as well as changes after brief experience using the system. Models were used to examine relationships between the demographic and individual difference factors and various outcomes related to understanding and expectations of the system. It was found that age, gender, prosocial driving scores, aggressive driving scores, and education level were significant predictors of participant understanding outcomes surveyed after system training. Gender, employment status, race and ethnicity, prosocial driving scores, and aggressive driving scores were relevant individual differences for significant changes in perceptions of the L2 system capabilities and limitations after experience using the system themselves. These findings have implications for training and other approaches to address knowledge gaps.
Improving Online learning ecosystems with Science of Learning Best Practices
Authors: Craig Scotty D. , Schroeder Noah L.
Published: October 2023

The dynamic and high-stakes nature of education and training demands that we rely on evidence-based practices and policies to make decisions about technology adoption and implementation within online learning ecosystems. To provide guidance to the field and practitioners, a broadly scoped literature review was conducted to identify the best practices for supporting and creating online learning ecosystems. This review provides a high-level summary of the findings organized into institutional and course best practices.
Feedback Mechanism for Blind and Visually Impaired: A Review
Authors: Bastola Ashish , Gluck Aaron , Brinkley Julian
Published: October 2023

The present study examines feedback mechanisms (FMs) to facilitate communication between the blind and visually impaired (BVI) and their surroundings or devices. Although previous research has led to the development of numerous accessible technologies for aiding BVI individuals in various scenarios, the widespread usage of these technologies has been limited by a lack of user acceptance. This is often due to the high associated cost and difficulty in processing information intuitively, causing a high cognitive load, resulting in the system being mostly unusable. The core of these issues lie within the FMs opted for the intended application. To address these issues, this literature review scrutinizes unique literature with various implementations of FMs, which are then classified based on their cognitive load requirements, associated cost, and applicable scenarios, thereby assisting in making informed decisions for optimal design.
Demonstrations of Retroreflectivity Help Road Users Appreciate Retroreflective Markings
Authors: King Savana L. , Tyrrell Richard A.
Published: October 2023

Retroreflective surfaces reflect light back towards the source of the illumination. All road users benefit from retroreflective markings in the roadway environment, as their use is required on road signs, on lane delineators, and on large trailers. Although a large body of evidence indicates that retroreflective markings can greatly enhance the conspicuity of pedestrians and bicyclists, these road users are largely unaware of strategies to enhance their own conspicuity at night. Here, 47 observers in an online study predicted how bright three stimuli would appear during a demo designed to highlight retroreflectivity. They did not expect a retroreflective swatch to be any brighter than the diffuse reflector. Their brightness predictions were consistently too high for specular and diffuse reflectors, but not for a retroreflector. This indicates that the observers failed to recognize and appreciate the special optical characteristics of retroreflectors. Educational interventions could be particularly useful in this domain.
Field observation: Is the predicted recovery time different from the observed recovery time in an asynchronous indexing assembly line? – A Pilot Study
Authors: Carrasquillo Vernnaliz
Published: October 2023

This pilot study aimed to compare the predicted recovery time of workers of a self-paced, standardized, asynchronous indexing assembly line with the observed recovery time. To achieve this goal, a field observation and event-based motion study of 7 workstations in an automotive assembly line was conducted. Results show that, on average, there was no significant difference between the predicted recovery time and the observed recovery time (p = 0.839). However, results for most workstations (6 out of 7) analyzed individually demonstrated a significant difference (p < 0.05).
May 2021 Riots by the Arab Minority in Israel: National, Civil or Religious?
Authors: Hitman Gadi
Published: October 2023

This study seeks to understand what was behind the May 2021 violence of the Arab minority in Israel, particularly in mixed cities: was it national, religious or civic motives, or a combination of them? Historically, relations between Jews and non-Jews (mostly Muslims) in Israel circle around three axes: religious, national, and civic. While the fragile relations between the parties enjoy a quiet routine, a serious escalation is recorded from time-to-time, leading to a crisis between the parties. This was the case in May 2021, when an outbreak of severe Arab violence was recorded in mixed cities in Israel that resulted in three victims (two Jews, one Arab), dozens of injuries, and heavy damage to Jewish property. This qualitative research, based on interviews with Arab residents in mixed cities and media reports during the clashes and afterward, concludes that despite all three components having a significant contribution to May 2021 violent conflicts, civil affairs were the main reason for riots in mixed cities; however, the outbreak has a national and religious historical background.
Evaluating Tranexamic Acid Administration in Cranial Vault Reconstruction: The Experience of an Academic Center in the Deep South
Authors: Soto Edgar , Johnston James , Niedermeier Krista , Carol Braswell Ann , Rozelle Curtis J. , Grant John H. , Myers Rene P.
Published: October 2023

Background:

In infants with craniosynostosis, cranial vault reconstruction is performed to prevent sequela of premature fusion of cranial sutures. Open correction puts patients at risk for complications of major blood loss. We evaluated the impact of tranexamic acid (TXA) in children undergoing open surgical repair of a variety of types of craniosynostosis.

Methods:

A retrospective review of 102 infants who underwent open cranial vault reconstruction between January 2015 and December 2020 at a tertiary referral hospital was performed. The patients were stratified into TXA or non-TXA based on usage. Outcome measures included volume of blood transfused, perioperative blood loss and any adverse effects were noted.

Results:

In this cohort 42% of patients were treated with TXA. There was no significant difference between the patient demographics of TXA and non-TXA cohorts with the majority classified as Sagittal Craniosynostosis ( P = .1062), an average weight of 8.89 ± 1.37 kg, and age of 9.02 ± 2.02 months at time of surgery. The non-TXA cohort had longer length of hospital stay ( P = .04). The TXA cohort had an average 100 ml decrease in surgical drain output over the course of their hospital stay ( P = .02). Overall surgical complication was 14% ( P = .18) and clinical outcomes were not significantly different between the cohorts.

Conclusions:

The receipt of TXA in the interoperative period in patients with craniosynostosis undergoing cranial vault remodeling was associated with a decreased surgical drain output and length of stay.
A cluster randomised controlled trial to reduce respiratory effects of cotton dust exposure among textile workers: the MultiTex RCT study
Authors: Nafees Asaad Ahmed , Allana Asad , Kadir Muhammad Masood , Potts James , Minelli Cosetta , Semple Sean , De Matteis Sara , Burney Peter , Cullinan Paul
Published: October 2023

Background

We determined the effectiveness of an intervention to reduce cotton dust-related respiratory symptoms and improve lung function of textile workers.

Methods

We undertook a cluster randomised controlled trial at 38 textile mills in Karachi, Pakistan. The intervention comprised: training in occupational health for workers and managers, formation of workplace committees to promote a health and safety plan that included wet mopping and safe disposal of cotton dust, provision of simple face masks, and further publicity about the risks from cotton dust. Participating mills were randomised following baseline data collection. The impact of the intervention was measured through surveys at 3, 12 and 18 months using questionnaires, spirometry and dust measurements. The primary outcomes were 1) changes in prevalence of a composite respiratory symptom variable, 2) changes in post-bronchodilator percentage predicted forced expiratory volume in 1 s (FEV1) and 3) changes in cotton dust levels. These were assessed using two-level mixed effects linear and logistic regression.

Results

Of 2031 participants recruited at baseline, 807 (40%) were available at the third follow-up. At that point, workers in the intervention arm were more likely to report an improvement in respiratory symptoms (OR 1.58, 95% CI 1.06–2.36) and lung function (FEV1% pred: β 1.31%, 95% CI 0.04–2.57%). Personal dust levels decreased, more so in intervention mills, although we did not observe this in adjusted models due to the small number of samples.

Conclusion

We found the intervention to be effective in improving the respiratory health of textile workers and recommend scaling-up of such simple and feasible interventions in low- and middle-income countries.
An epidemiological surveillance study (2021–2022): detection of a high diversity of Clostridioides difficile isolates in one tertiary hospital in Chongqing, Southwest China
Authors: Cui Yihong , Zhang Chuanming , Jia Qianying , Gong Xue , Tan Yu , Hua Xinping , Jian Wenwen , Yang Shenglin , Hayer Kim , Raja Idris Raja Kamarudin , Zhang Yi , Wu Yuan , Tu Zeng
Published: October 2023

Background

Clostridioides difficile is a bacterium that causes antibiotic-associated infectious diarrhea and pseudomembranous enterocolitis. The impact of C. difficile infection (CDI) in China has gained significant attention in recent years. However, little epidemiological data are available from Chongqing, a city located in Southwest China. This study aimed to investigate the epidemiological pattern of CDI and explore the drug resistance of C. difficile isolates in Chongqing.

Methods

A case-control study was conducted to investigate the clinical infection characteristics and susceptibility factors of C. difficile. The features of the C. difficile isolates were evaluated by testing for toxin genes and using multi-locus sequence typing (MLST). The susceptibility of strains to nine antibiotics was determined using agar dilution technique.

Results

Out of 2084 diarrhea patients, 90 were tested positive for the isolation of toxigenic C. difficile strains, resulting in a CDI prevalence rate of 4.32%. Tetracycline, cephalosporins, hepatobiliary disease, and gastrointestinal disorders were identified as independent risk factors for CDI incidence. The 90 strains were classified into 21 sequence types (ST), with ST3 being the most frequent (n = 25, 27.78%), followed by ST2 (n = 10, 11.11%) and ST37 (n = 9, 10%). Three different toxin types were identified: 69 (76.67%) were A+B+CDT−, 12 (13.33%) were A−B+CDT−, and 9 (10%) were A+B+CDT+. Although substantial resistance to erythromycin (73.33%), moxifloxacin (62.22%), and clindamycin (82.22%), none of the isolates exhibited resistance to vancomycin, tigecycline, or metronidazole. Furthermore, different toxin types displayed varying anti-microbial characteristics.

Conclusions

The strains identified in Chongqing, Southwest China, exhibited high genetic diversity. Enhance full awareness of high-risk patients with HA-CDI infection, particularly those with gastrointestinal and hepatocellular diseases, and emphasize caution in the use of tetracycline and capecitabine. These findings suggest that a potential epidemic of CDI may occur in the future, emphasizing the need for timely monitoring.
Predictors of successful endovascular recanalization in patients with symptomatic nonacute intracranial large artery occlusion
Authors: Yan Shuo , Feng Hao , Ma Lin , Xu Ji-Chong , Han Hong-Jie , Huang Hong-En , Tan Hua-Qiao , Fang Chun
Published: October 2023

Background

Endovascular recanalization in patients with symptomatic nonacute intracranial large artery occlusion (ILAO) has been reported to be feasible, but technically challenging. This study aimed to determine the predictors of successful endovascular recanalization in patients with symptomatic nonacute ILAO.

Methods

The outcomes of endovascular recanalization attempts performed in 70 consecutive patients showing symptomatic nonacute ILAO with hemodynamic cerebral ischemia between January 2016 to December 2022 were reviewed. Potential variables, including clinical and radiological characteristics related to technical success, were collected. Univariate analysis and multivariate logistic regression were performed to identify predictors of successful recanalization for nonacute ILAO.

Results

Technically successful recanalization was achieved in 57 patients (81.4%). The periprocedural complication rate was 21.4% (15 of 70), and the overall 30-day morbidity and mortality rates were 7.1% (5 of 70) and 2.9% (2 of 70), respectively. Univariate analysis showed that successful recanalization was associated with occlusion duration, stump morphology, occlusion length, slow distal antegrade flow sign, and the presence of bridging collateral vessels. Multivariate analysis showed that occlusion duration ≤ 3 months (odds ratio [OR]: 22.529; 95% confidence interval [CI]: 1.636-310.141), tapered stump (OR: 7.498; 95% CI: 1.533–36.671), and occlusion length < 10 mm (OR: 7.049; 95% CI: 1.402–35.441) were independent predictive factors for technical success of recanalization.

Conclusions

Occlusion duration ≤ 3 months, tapered stump, and occlusion length < 10 mm were independent positive predictors of technical success of endovascular recanalization for symptomatic nonacute ILAO. These findings may help predict the likelihood of successful recanalization in patients with symptomatic nonacute ILAO and also provide a reference for the selection of appropriate patients. Further prospective and multicenter studies are required to validate our findings.
Baseline Albumin-Bilirubin grade as a predictor of response and outcome of regorafenib therapy in patients with hepatocellular carcinoma: a systematic review and meta-analysis
Authors: Xu Huilin , Cao Dedong , Zhou Dingjie , Zhao Nan , Tang Xixian , Shelat Vishalkumar G. , Samant Hrishikesh , Satapathy Sanjaya K. , Tustumi Francisco , Aprile Giuseppe , He Anbing , Xu Ximing , Ge Wei
Published: October 2023

Background

The use of regorafenib in the treatment of hepatocellular carcinoma (HCC) is widespread. Albumin-Bilirubin (ALBI) has been shown to be a potential prognostic marker for regorafenib treatment, but its prognostic value remains controversial. Therefore, we conducted a meta-analysis to investigate the value of the baseline ALBI grade in predicting the efficacy and survival outcomes of HCC patients after regorafenib treatment.

Methods

PubMed, Embase, Cochrane library, Web of Science, CNKI, Wan Fang Data, and Vip Database were searched from January 2010 to October 2022. Studies treating HCC patients with regorafenib and with ALBI as a categorical variable, overall survival (OS) and progression-free survival (PFS) as outcome indicators were included. After applying Newcastle–Ottawa Scale (NOS) to evaluate the quality of the included studies, Review Manager 5.4 was used to statistically analyze. Chi-square Q test and I2 statistics were used to detect heterogeneity. Funnel plot asymmetry, Egger’s and Begg’s test were used to evaluate publication bias.

Results

A total of 12 studies, comprising 1,918 patients, were included in the meta-analysis. The included studies were all evaluated as high quality. Compared to the high-grade baseline ALBI group, patients in the low-grade group had a longer survival time after receiving regorafenib and also more suitable for regorafenib treatment [odds ratio (OR) = 6.50, 95% confidence interval (CI): 2.22–18.96, P < 0.01]. The low-grade baseline ALBI group before sorafenib treatment was significantly correlated with better OS [hazard ratio (HR) = 2.36, 95% CI: 1.68–3.31, P < 0.00001] and PFS (HR = 1.56, 95% CI: 1.16–2.08, P = 0.003). Likewise, the low-grade baseline ALBI group before regorafenib was also significantly correlated with better OS (HR = 1.56, 95% CI: 1.15–2.13, P = 0.005) and PFS (HR = 2.06, 95% CI: 1.37–3.11, P = 0.0005). In addition, the ALBI grade was significantly correlated with disease control rate (DCR) (OR = 2.90, 95% CI: 1.45–5.79, P = 0.003), but not the objective response rate (OR = 1.98, 95% CI: 0.71–5.46, P = 0.19).

Conclusions

The baseline ALBI grade could be a valuable prognostic indicator for predicting response and outcomes in HCC patients treated with regorafenib.
Leg position effects on the femoral neurovascular bundle location during a direct anterior approach total hip arthroplasty: a radiographic study
Authors: Tsurumi Yousuke , Hagiwara Shigeo , Horikoshi Takuro , Yokota Hajime , Kurosawa Ryuna , Matsumoto Koji , Masuda Yoshitada , Kawarai Yuya , Nakamura Junichi , Eguchi Yawara , Orita Sumihisa , Ohtori Seiji
Published: October 2023

Background

Femoral neurovascular injury is a serious complication in a direct anterior approach (DAA) total hip arthroplasty. However, dynamic neurovascular bundle location changes during the approach were not examined. Thus, this study aimed to analyze the effects of leg position on the femoral neurovascular bundle location using magnetic resonance imaging (MRI).

Methods

This study scanned 30 healthy volunteers (15 males and 15 females) with 3.0T MRI in a supine and 30-degree hip extension position with the left leg in a neutral rotation position and the right leg in a 45-degree external extension position. The minimum distance from the edge of the anterior acetabulum to the femoral nerve (dFN), artery, and vein were measured on axial T1-weighted images at the hip center level, as well as the angle to the horizontal line of the femoral nerve (aFN), artery (aFA), and vein from the anterior acetabulum.

Results

The dFN in the supine position with external rotation was significantly larger than supine with neutral and extension with external rotation position (20.7, 19.5, and 19.0; p = 0.031 and 0.012, respectively). The aFA in supine with external rotation was significantly larger than in other postures (52.4°, 34.2°, and 36.2°, p < 0.001, respectively). The aFV in supine with external rotation was significantly larger than in supine with a neutral position (52.3° versus 47.7°, p = 0.037). The aFN in supine and external rotation was significantly larger than other postures (54.6, 38.2, and 33.0, p < 0.001, respectively).

Conclusions

This radiographic study revealed that the leg position affected the neurovascular bundle location. These movements can be the risk of direct neurovascular injury or traction.
Factors affecting residents’ internal motivation, grit, and well-being
Authors: Chuented Pimwipa , Puranitee Pongtong , Pakakasama Samart , Meepanya Suganda
Published: October 2023

Background

Residents completing competency-based medical education for postgraduate training face many challenging situations that may compromise their well-being or result in exhaustion or burnout. Factors described in self-determination theory and grit are important for residents’ achievement of learning outcomes and well-being. This study explored the relationships among internal motivation, grit, well-being, and related factors among non-Western Asian residents.

Methods

We conducted an explanatory sequential mixed-methods survey-based study to explore correlations among satisfaction with basic psychological needs, grit, and well-being from September to November 2021 among residents at Ramathibodi Hospital, Mahidol University, Thailand. Data were collected with the Basic Psychological Needs Scale, Short Grit Scale, and World Health Organization-Five Well-Being Index. Next, participants with the highest and lowest scores for each scale were purposively invited to participate in semi-structured interviews. Interview data underwent thematic analysis and data collection continued until saturation was reached.

Results

In total, 245 residents (51% major ward, 65% female) completed the survey. There were strong associations between internal motivation, grit, and well-being (r = 0.46–0.90). Female residents had higher autonomy and relatedness scores than males (p = 0.04 and p = 0.01, respectively), and residents with less family responsibility had higher relatedness scores than other residents (p = 0.01). Residents who got more sleep had higher autonomy, relatedness, and well-being scores than those that slept less (p < 0.05). Residents who exercised > 5 times/week had higher well-being scores than other residents (p < 0.01). Thirty residents completed interviews. The thematic analysis revealed internal motivation, grit, and well-being were promoted by a supportive learning environment, a well-designed curriculum, actions and personalities of faculty members, and good personal factors.

Conclusion

Internal motivation is significantly correlated with residents’ grit, well-being, gender, family burdens, exercise, and sleep hours. Priority should be given to promoting internal motivation, grit, and well-being among residents by enhancing a positive learning environment, creating well-designed curricula, fostering good characteristics and actions among faculty members, and supporting residents’ personal lives.
Medical students’ perception of online intensive pediatric review: an experimental cross-sectional study
Authors: Tangcheewinsirikul Sirikarn , Takkinsatian Preyanit , Yenjabog Patcha , Sirimongkolchaiyakul Ornatcha , Prempraparn Pathaporn
Published: October 2023

Background

Despite regular pediatric education, pediatric instructors regularly provide an on-site intensive pediatric review course (IPR) as per medical students (MS)’ request, to summarize pediatric knowledge for fifth-year MS in preparation for their externship. However, considering the coronavirus disease 2019 (COVID-19) pandemic restrictions (e.g., social distancing), an online intensive pediatric review (OIPR) is required instead. Unfortunately, the relationship between MS’ perception and outcome of OIPR remains unclear.

Methods

We developed the OIPR and an online mock pediatric examination (OMPE), aligning it with the essential pediatric components of the Medical Council curriculum. The OIPR comprised of two parts: self-paced online learning and in-class online discussions. The self-paced online learning materials were electronically distributed via Google Classroom to MS ten days priors to the one-day course, which included a pretest, in-class online discussions, posttest, and satisfactory survey. The constructed and validated satisfactory survey was categorized into two parts: demographic data and self-perceived satisfaction with OIPR. For data collection, an anonymous self-administered survey was used and was distributed to MS in April 2022. These data were then analyzed by Wilcoxon signed rank test.

Results

Of the 80 eligible fifth-year MS, 45 agreed to participate (56.3%), of which 24 (53.3%) were females. The mean ± standard deviation (SD) of MS’ age was 23 ± 0.6 years. All (100%) concurred that OIPR is beneficial and recommended it to junior students who were planning to take the examination. The mean ± SD of OMPE significantly increased, from 20.9 ± 3.8 to 22.9 ± 3.3 (p = 0.001).

Conclusion

During the peak of the COVID-19 pandemic, which required social distancing, OIPR has helped MS summarize and enhance their knowledge in preparation for externship and the examination.
Nursing students perspectives of psychosocial care: cross-sectional study
Authors: Al-Nawafleh Ahmad H. , Altarawneh Falah Zaal
Published: October 2023

Background

Psychosocial care is an integral component of holistic nursing practices. This study aimed to examine how fourth-year nursing students at Mutah University perceive various care characteristics, specifically psychosocial care.

Methods

A quantitative cross-sectional study was conducted using the Caring Dimension Inventory (CDI). Data were obtained from 105 nursing students before graduating from a Jordanian public educational institution. Data analyzed using the scoring of CDI and descriptive statistics.

Results

The mean scores in the professional and technical domain of care were statistically higher for fourth-year nursing students (4.69 ± 0.25). This exceeded their scores in the psychosocial domain of care (3.37 ± 1.20). This suggests that fourth-year nursing students prioritize professional and technical care over psychosocial care.

Conclusions

Fourth-year nursing students tended to perceive the technical aspects of care as more significant than the psychosocial aspects. This highlights the need for nursing schools and healthcare providers to reconsider their focus and prioritize the importance of psychosocial care.
Outcomes and cost analysis of patients with dementia in the intensive care unit: a population-based cohort study
Authors: Dziegielewski C. , Fernando SM. , Milani C. , Mahdavi R. , Talarico R. , Thompson LH. , Tanuseputro P. , Kyeremanteng K.
Published: October 2023

Background

Dementia is a neurological syndrome affecting the growing elderly population. While patients with dementia are known to require significant hospital resources, little is known regarding the outcomes and costs of patients admitted to the intensive care unit (ICU) with dementia.

Methods

We conducted a population-based retrospective cohort study of patients with dementia admitted to the ICU in Ontario, Canada from 2016 to 2019. We described the characteristics and outcomes of these patients alongside those with dementia admitted to non-ICU hospital settings. The primary outcome was hospital mortality but we also assessed length of stay (LOS), discharge disposition, and costs.

Results

Among 114,844 patients with dementia, 11,341 (9.9%) were admitted to the ICU. ICU patients were younger, more comorbid, and had less cognitive impairment (81.8 years, 22.8% had ≥ 3 comorbidities, 47.5% with moderate-severe dementia), compared to those in non-ICU settings (84.2 years, 15.0% had ≥ 3 comorbidities, 54.1% with moderate-severe dementia). Total mean LOS for patients in the ICU group was nearly 20 days, compared to nearly 14 days for the acute care group. Mortality in hospital was nearly three-fold greater in the ICU group compared to non-ICU group (22.2% vs. 8.8%). Total healthcare costs were increased for patients admitted to ICU vs. those in the non-ICU group ($67,201 vs. $54,080).

Conclusions

We find that patients with dementia admitted to the ICU have longer length of stay, higher in-hospital mortality, and higher total healthcare costs. As our study is primarily descriptive, future studies should investigate comprehensive goals of care planning, severity of illness, preventable costs, and optimizing quality of life in this high risk and vulnerable population.
A national survey on registered products, availability, prices, and affordability of 100 essential medicines in community pharmacies across Sri Lanka
Authors: Liyanage Chiranthi Kongala , Gunawardane Mekala , Kumaradasa Pamodee Panchalee , Ranasinghe Priyanga , Jayakody Raveendra Laal , Galappatthy Priyadarshani
Published: October 2023

Introduction

Availability of essential medicines that meet the expected quality standards, in appropriate dosage forms at affordable prices is a fundamental prerequisite to fulfill healthcare needs of given a population. This study assessed available products, prices and affordability of essential medicines (EM) in community pharmacies in Sri Lanka with comparison of registration status from the National Medicines Regulatory Authority(NMRA).

Methods

A cross-sectional island-wide survey of 80 pharmacies was conducted according to World Health Organization and Health Action International Manual (WHO/HAI). Hundred medicines were selected from the global core list(n = 14), regional core list(n = 16) and the Sri Lanka Essential Medicine List (SL-EML) (n = 70) based on healthcare needs. Number of registered products in 2015 and 2021 were compared.

Findings

Average availability was 85.4%(± 12.31) and availability was lowest in the Northern province (69.38 ± 21.18%)(p = 0.008). Availability between the state owned, franchise and privately owned pharmacies was not significantly different (p > 0.05). 89.4% medicines were affordable except for amiodarone, hydroxychloroquine, sitagliptin, soluble insulin, isophane insulin, losartan, levodopa carbidopa combination, clonazepam and ceftriaxone. The median price ratio (MPR) of 33.7% of medicines was less than 1 and MPR of 37.1% originator brands (OB) was over 3. Median number of generic brands in the market was 8(range 2–44), 9% of medicines had 20 or more products in the market and 72.7% medicines had more products available than the number registered in 2015. The average number of registered products were similar in 2015 (8.27) and 2021(7.59) (p = 0.15).

Conclusion

The overall availability of EMs in Sri Lanka was high in all categories of community pharmacies. Medicines were largely affordable and reasonably priced in 2015, although OBs were generally more expensive. Majority of medicines had more products in the market than the number of registered products.