bluuebunny/crossref_metadata_2025 huggingface dataset:
A scoping review of graphene-based biomaterials for in vivo bone tissue engineering
Authors: Achôa Gustavo L , Mattos Patrícia A , Clements Adam , Roca Yvonne , Brooks Zachary , Ferreira José Ricardo M , Canal Raul , Fernandes Tiago L , Riera Rachel , Amano Mariane T , Hokugo Akishige , Jarrahy Reza , Lenz e Silva Guilherme FB , Bueno Daniela F
Published: July 2023

The growing demand for more efficient materials for medical applications brought together two previously distinct fields: medicine and engineering. Regenerative medicine has evolved with the engineering contributions to improve materials and devices for medical use. In this regard, graphene is one of the most promising materials for bone tissue engineering and its potential for bone repair has been studied by several research groups. The aim of this study is to conduct a scoping review including articles published in the last 12 years (from 2010 to 2022) that have used graphene and its derivatives (graphene oxide and reduced graphene) in preclinical studies for bone tissue regeneration, searching in PubMed/MEDLINE, Embase, Web of Science, Cochrane Central, and clinicaltrials.gov (to confirm no study has started with clinical trial). Boolean searches were performed using the defined key words “bone” and “graphene”, and manuscript abstracts were uploaded to Rayyan, a web-tool for systematic and scoping reviews. This scoping review was conducted based on Joanna Briggs Institute Manual for Scoping Reviews and the report follows the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses – Extension for Scoping Reviews (PRISMA- ScR) statement. After the search protocol and application of the inclusion criteria, 77 studies were selected and evaluated by five blinded researchers. Most of the selected studies used composite materials associated with graphene and its derivatives to natural and synthetic polymers, bioglass, and others. Although a variety of graphene materials were analyzed in these studies, they all concluded that graphene, its derivatives, and its composites improve bone repair processes by increasing osteoconductivity, osteoinductivity, new bone formation, and angiogenesis. Thus, this systematic review opens up new opportunities for the development of novel strategies for bone tissue engineering with graphene.
Racial Differences in Nursing Home Quality of Life Among Residents Living With Alzheimer’s Disease and Related Dementias
Authors: Shippee Tetyana Pylypiv , Parikh Romil R. , Baker Zachary G. , Bucy Taylor I. , Ng Weiwen , Jarosek Stephanie , Qin Xuanzi , Woodhouse Mark , Nkimbeng Manka , McCarthy Teresa
Published: July 2023

Objectives

Among nursing home (NH) residents with Alzheimer’s disease (AD) and AD-related dementias (AD/ADRD), racial/ethnic disparities in quality of care exist. However, little is known about quality of life (QoL). This study examines racial/ethnic differences in self-reported QoL among NH residents with AD/ADRD. Methods: Validated, in-person QoL surveys from 12,562 long-stay NH residents with AD/ADRD in Minnesota (2012–2015) were linked to Minimum Data Set assessments and facility characteristics. Hierarchical linear models assessed disparities in resident-reported mean QoL score (range, 0–100 points), adjusting for case-mix and facility factors. Results: Compared to White residents, racially/ethnically minoritized residents reported significantly lower total mean QoL scores (75.53 points vs. 80.34 points, p < .001). After adjustment for resident- and facility-level characteristics, significant racial/ethnic differences remained, with large disparities in food enjoyment, attention from staff, and engagement domains. Discussion: Policy changes and practice guidelines are needed to address racial/ethnic disparities in QoL of NH residents with AD/ADRD.
Tribo-mechanical, physical and thermal behaviour of Al/Si3N4 composite with and without the addition of Cu, Ni and Cr entropy elements
Authors: Dwivedi Shashi Prakash , Yadav Ashok Kumar , Saxena Ambuj , Dwivedi Vijay Kumar
Published: July 2023

In the present investigation, a comparative study has been presented between Al/Si3N4 and entropy elements (Cu, Ni and Cr) mixed Al/Si3N4 composite material. The investigation revealed that the tensile strength and hardness of base material were enhanced by 23.65% and 56.66% respectively with an increase of 10 wt. % of Si3N4. The tensile strength of Al and Al/10 wt. % Si3N4 composite was enhanced by 46% and 18% respectively after the addition of entropy elements 1.5 wt. % Cu, 1.5 wt. % Ni and 1 wt. % Cr. Further, the same wt.% of entropy elements enhanced the hardness of Al and Al/10 wt. % Si3N4 composite by 83.66% and 27%, respectively. The ductility and toughness of the composite were further improved by adding the 1.5 wt. % Cu, 1.5 wt.% Ni and 1 wt.% Cr in Al/10 wt. % Si3N4 composite. However, corrosion weight loss, volume thermal expansion and wear of the composite are reduced by adding the entropy elements. The number of grains per square inch for Al/10 wt% Si3N4 composite with and without adding the 1.5 wt. % Cu, 1.5 wt.% Ni and 1 wt.% Cr was found to be 3590.57 and 2385.37, respectively. The addition of entropy elements results in a finer grain structure of the composite which shows grain refinement.
Influence of the evolution of near-surface rail wheel microstructure on crack initiation by micro-bending investigations
Authors: Freisinger Matthias , Trausmuth Andreas , Hahn Rainer , Badisch Ewald
Published: July 2023

Severe mechanical and thermal loadings, as well as the corrosive environment change the near-surface microstructure of rail wheels during service. Resulting severely plastically deformed (SPD) and corrosion affected microstructures are prone to influence crack initiation along the wheel tread. To evaluate the crack initiation and fracture behaviour, the in-situ micro-bending method is first applied on rail wheel samples from field within this work. Results reveal detailed insights in material behaviour of SPD microstructures, where the conducted micro-bending investigations point out predominant plastic behaviour without cracks initiated at the artificial notch of the micro-cantilevers during bending. In contrast, micro-bending investigations in microstructural regions with increased oxygen and silicon composition show crack initiation, fracture, and low maximum stress levels (approximately one seventh of the SPD microstructure). The presented study underlines the increased risk of crack initiation in corrosion affected regions by a novel testing method in this field with high spatial resolution and acknowledge the importance of periodic reprofiling of the rail wheels in service.
Value frames in discourse supporting transgender athlete bans
Authors: Martin Kimberly , Rahilly Elizabeth
Published: July 2023

American states began passing legislation that would ban transgender girls from competing on sports teams that match their gender identity in 2020. During legislative debate, supporters of transgender athlete bans adopted rhetoric that framed their arguments in terms of commonly held values. ‘Value frames’ establish connections between people and spoken values and have a powerful effect on the way that opinions about public policy are formed. We conduct a discourse analysis of video and audio footage from committee testimony and chamber debate from 18 US states to identify the major discursive themes used by the bans’ supporters. Themes include gender simplicity, male advantage, protecting women and preventing change. Our discussion and analysis connects these themes to long-standing value frames used by political elites, namely tradition, fairness and equal opportunity. The conclusion addresses the implications of this discourse for shaping the public’s understanding of sex and gender.
A flexible micro-randomized trial design and sample size considerations
Authors: Xu Jing , Yan Xiaoxi , Figueroa Caroline , Williams Joseph Jay , Chakraborty Bibhas
Published: July 2023

Technological advancements have made it possible to deliver mobile health interventions to individuals. A novel framework that has emerged from such advancements is the just-in-time adaptive intervention, which aims to suggest the right support to the individuals when their needs arise. The micro-randomized trial design has been proposed recently to test the proximal effects of the components of these just-in-time adaptive interventions. However, the extant micro-randomized trial framework only considers components with a fixed number of categories added at the beginning of the study. We propose a more flexible micro-randomized trial design which allows addition of more categories to the components during the study. Note that the number and timing of the categories added during the study need to be fixed initially. The proposed design is motivated by collaboration on the Diabetes and Mental Health Adaptive Notification Tracking and Evaluation study, which learns to deliver effective text messages to encourage physical activity among patients with diabetes and depression. We developed a new test statistic and the corresponding sample size calculator for the flexible micro-randomized trial using an approach similar to the generalized estimating equation for longitudinal data. Simulation studies were conducted to evaluate the sample size calculators and an R shiny application for the calculators was developed.
That Special Time of the Month: Feminine Hygiene in College Outdoor Recreation
Authors: Campano Meghan , Langdon Shelby , Hodges Jan , Deringer Anthony
Published: July 2023

Background

More women are going outdoors and menstrual hygiene is a concern for these women, we do not know how collegiate outdoor programs are addressing this topic, if at all. It is possible that feminine hygiene may not be adequately discussed in these settings. Because of this, the overall health and outdoor experiences of female participants are potentially at risk.

Purpose

The purpose of this study was to gain a better understanding of current practices and potential barriers surrounding feminine hygiene and menstruation dialogs in college outdoor recreation programs in Texas.

Methodology/Approach

An open-ended online survey was distributed to 36 schools with outdoor recreation programs in Texas. Responses were independently analyzed and coded for emergent themes.

Findings/Conclusions

Thirty-eight percent of schools did not address feminine hygiene and menstruation in pretrip communications. Predominant themes consisted of an emphasis on health and hygiene, dependence on female leaders, a need for more knowledge and resources, and a desire for normalization.

Implications

Most professionals expressed that resources to expand their knowledge on these topics can help to better prepare participants. Current practices surrounding these topics may be insufficient and able to improve. Further research is needed to evaluate the efficacy of the curriculum and the preference of participants.
Passive Ankle Plantarflexion Position and Skin Surface Blood Flow Adjacent to the Achilles Tendon
Authors: Minokawa So , Yoshimura Ichiro , Hagio Tomonobu , Ishimatsu Tetsuro , Sugino Yuki , Izaki Teruaki
Published: July 2023

Background:

Open repair of the Achilles tendon carries a risk of wound complications and infection. The Achilles tendon is covered by a thin layer of skin and subcutaneous tissue, which has a fragile blood supply. The full plantarflexion position may cause sustained blanching of the skin above the Achilles tendon. However, no reports have described the in vivo blood flow (BF) changes at the skin surface with ankle position. This study aimed to use laser Doppler flowmetry to evaluate the in vivo BF at the skin surface and thereby clarify the changes in BF with ankle position.

Methods:

The study cohort comprised 30 feet in 15 participants with no history of Achilles tendon rupture. Laser Doppler flowmetry was used to measure the BF at the skin surface above the medial Achilles tendon in the natural plantarflexion (NP) and full plantarflexion (FP) positions.

Results:

In the NP and FP positions, the BF at 5 cm proximal to the calcaneal insertion (frequent site of Achilles tendon rupture) was 1.50 ± 0.32 and 0.97 ± 0.28 mL/min/100 g, respectively ( P < .0001).

Conclusion:

The BF at the skin surface adjacent to the medial Achilles tendon at 5 cm proximal to the calcaneal insertion was significantly less in the FP position than the NP position.
Comparison of the 1-year surgical outcomes of ab interno trabeculotomy using three types of microhooks
Authors: Kawashima Rumi , Matsushita Kenji , Nishida Kohji
Published: July 2023

Purpose

We compared the 1-year surgical outcomes of microhook ab interno trabeculotomy (μLOT) using three types of microhooks.

Methods

We retrospectively analyzed 81 eyes that underwent μLOT, in which three microhooks, the Sinskey hook, Tanito Micro-Hook-trabeculotomy-device (TMH), and Matsushita ed. TMH, were used. We collected the data from the medical records. We analyzed the success rates and risk factors. Failure was defined as the need for additional surgery for IOP reduction, loss of light perception, and IOP ≧22 mmHg and IOP reduction <20% (definition 1), IOP ≧17 mmHg and IOP reduction <20% (definition 2), IOP ≧15 mmHg and IOP reduction <25% (definition 3), or IOP ≧12 mmHg and IOP reduction <30% (definition 4) at two consecutive follow-up visits.

Results

Twenty-six eyes underwent μLOT using the Sinskey microhook (group S), 21 eyes using the TMH (group T), and 34 eyes using the Matsushita ed. TMH (group M). The mean postoperative IOP and IOP-lowering medication score decreased significantly. The respective success rates among groups S, T, and M did not differ significantly (definition 1, 65.4%, 61.9%, and 55.9%; definition 2, 42.3%, 47.6%, and 32.3%; definition 3, 15.4%, 28.6%, and 23.5%; definition 4, 0%, 9.5%, and 2.9%). In group S, the hyphema-related IOP spikes decreased within 2 weeks postoperatively, and in group M, the non-hyphema-related IOP spikes decreased significantly.

Conclusion

The 1-year surgical outcomes and complications after μLOT did not differ significantly among the three microhooks. The differences in the microhook tips might be associated with postoperative transient IOP spikes.
A scoping review of outcomes with routine surveillance of arterio-venous fistulas
Authors: Evans Leanne M , Raj Rajesh
Published: July 2023

The arteriovenous fistula (AVF) is the preferred venous access for maintenance haemodialysis. AVF dysfunction can progress to access failure, with all the associated morbidity and costs of revising vascular accesses. Routine surveillance of AVFs using specialised equipment has the potential to enable early detection of potential problems. The KDOQI Clinical Practice Guidelines for Vascular Access: Update 2019 suggest that surveillance may be useful to supplement regular clinical monitoring but acknowledge a lack of evidence to make firm recommendations. This scoping review of peer-reviewed literature explored outcomes with the routine surveillance of AVFs using specialised equipment in haemodialysis dependent adults. A systematic search was undertaken using terms such as ‘vascular access’, haemodialysis, surveillance and ‘access flow’, utilising the data bases ProQuest (Medline), CINAHL and Embase to include original research articles published between October 2016 and August 2022. A total of eight papers were identified for comprehensive analysis, including two randomised controlled trials, two cross-sectional studies, two retrospective reviews and two evaluations. Themes identified include the incidence of thrombotic events, the role of access blood flow measurements, the need for follow-up angiograms after surveillance and identification of the at-risk access. This review of research published in recent years demonstrated an ongoing paucity of evidence for the benefits of routine AVF surveillance. More research focused on actual outcomes is needed in this important area that is a routine part of dialysis unit workloads everywhere.
Mirvetuximab Soravtansine in Platinum-Resistant Ovarian Cancer
Authors: Gonzalez-Ochoa Eduardo , Veneziani Ana C , Oza Amit M
Published: July 2023

Ovarian cancer is the second leading cause of death from gynecologic malignancies worldwide. Management of platinum-resistant disease is challenging and clinical outcomes with standard chemotherapy are poor. Over the past decades, significant efforts have been made to understand drug resistance and develop strategies to overcome treatment failure. Antibody drug conjugates (ADCs) are a rapidly growing class of oncologic therapeutics, which combine the ability to target tumor-specific antigens with the cytotoxic effects of chemotherapy. Mirvetuximab soravtansine is an ADC comprising an IgG1 monoclonal antibody against the folate receptor alpha (FRα) conjugated to the cytotoxic maytansinoid effector molecule DM4 that has shown promising clinical activity in patients with FR-α-positive ovarian cancer. This review summarizes current evidence of mirvetuximab soravtansine in platinum-resistant ovarian cancer, focusing on clinical activity, toxicity, and future directions.
Mental health latent profiles and emotion regulation in women with polycystic ovary syndrome: A cross-sectional study
Authors: Wang Guangpeng , Liu Xueyan , Lei Jun
Published: July 2023

This cross-sectional study aimed to identify latent mental health subgroups of reproductive-aged women with polycystic ovary syndrome (PCOS) and examine differences in emotion regulation and social support. A total of 477 samples (age = 27.22 ± 5.37) diagnosed with PCOS were included in this study, all of whom were of the same ethnicity. Latent profile analysis (LPA) was conducted in Mplus version 8.3 to identify mental health latent profiles in women with PCOS based on the dual-factor approach. The current study identified three distinct mental health profiles within women with PCOS: High-Symptom and High-Well-being Profile, Low-Symptom and High-Well-being Profile, and High-Symptom and Low-Well-being Profile, with group proportions of 52.3%, 35.7%, and 11.1%, respectively. This study revealed that cognitive reappraisal and social support are important protective factors for the mental health of women with PCOS, whereas expressive suppression is a negative factor for their mental health.
Urban/image: Conceptualizing Amsterdam as urban environment in virtual renderings
Authors: Kopitz Linda
Published: July 2023

This article proposes that virtual renderings of speculative architectural projects provide a crucial entry point into the reimagination of sustainable urban life through the production of nature(s) within the city. Drawing on case studies of ‘sustainable’ building projects in and around Amsterdam, The Netherlands, I aim to trace the entanglement of virtual and real environments in imagining green futures. With the concept of the ‘render ghost’, James Bridle situates the people inhabiting virtual renderings ‘in the liminal space between the present and the future, the real and the virtual, the physical and the digital’ (2013). Similarly, the imaginations of nature within virtual renderings of sustainable buildings are situated at a point of in-between, a constant state of becoming. More than just visualizing their respective architectural design, the virtual renderings visualize these designs in a specific space, a specific environment – and how that environment could and would change through the spatial presence of these buildings. What makes these immaterial elements – ranging from computer-generated images to virtual renderings and augmented reality applications – particularly productive as research objects is the subjective nature of the atmosphere created in and through them, an atmospheric imagination of sustainable futures embedded in what Degen et al. call a ‘field of negotiation, tension and ambivalence’ (2017). Atmospheric in their imagination of urban environments, contingent in their temporality between the past, the present and the future, and ambiguous in their spatial grounding in simultaneously specific and generic surroundings, virtual renderings arguably allow for an engagement with the possibilities of alternative urban futures.
A review on precast structural concrete walls and connections
Authors: Martins Ricardo , Carmo Ricardo do , Costa Hugo , Júlio Eduardo
Published: July 2023

Extreme events, with natural or manmade causes, such as floods, pandemics and wars, have recently brought the need to provide shelter and field hospitals in a very fast and affordable way. Prefabrication can play an relevant role in this context, by offering several advantages compared to on-site construction. The precast structural wall system is a paradigmatic example of how precast structural members can contribute to speed up construction and reduce costs. A new research project was defined to develop with the aim of delivering a new product, a precast structural concrete wall system, where the design of the wall itself and connections are key, keeping in mind not only the above requirements, but also the new demands created by the recent challenges of the construction sector. To reach this goal, first is necessary to survey the existing commercial solutions and developed by researchers and analyse the main scientific and technical documents about precast structural wall systems. Herein, a comprehensive review is presented, aiming at identifying the most relevant aspects regarding precast structural concrete walls and connections. The main advances made in the past and that are being developed in the present are also highlighted. The growing concerns of the prefabrication sector about durability and sustainability were identified as mandatory for new generation of products. To produce prefabricated solutions with less environmental impact is required, beyond the optimization related with cement consumption, connections that are easier to use, to maintain and that allow disassembly, for future deconstruction and reuse. So, innovative improvements are proposed, namely, dry connections and concrete composite walls to be addressed in future work, with the goal of correcting some of the drawbacks found in existing solutions.
Cause of death certificates in nursing homes: Does quality matter? A retrospective review from two counties in Norway
Authors: Eng Hanna M. , L. Ellingsen Christian , Pedersen Anne G. , Alfsen G. Cecilie
Published: July 2023

Aims:

One half of Norwegians die in nursing homes, where death certificates (DCs) are completed by two types of physicians: in-house physicians or physicians on call. The aims of this study were to examine differences in the quality of DCs due to type of physician and to uncover possible implications of errors for the public statistics.

Methods:

DCs from the year 2013 from nursing homes in the catchment area of Akershus University Hospital were examined with regard to logical deficiencies, garbage code diagnoses and type of certifying physician. In one third of cases, the registered causes of death were compared to information in the medical records.

Results:

A total of 873 DCs from 24 nursing homes were evaluated. Physicians on call certified 46% of all deaths. Logical deficiencies were found in 34% of all DCs and were more common in DCs from physicians on call. Garbage code diagnoses were used in every third DC, with ‘sudden death’ or ‘cause of death unknown’ preferred by physicians on call and ‘unspecified pneumonia’ preferred by in-house physicians. Comparisons against medical records uncovered missing information in 49% and 35% of DCs from physicians on call and in-house physicians, respectively. A dementia diagnosis was frequently overlooked by both physician types. Garbage code diagnoses were more common in DCs with missing information from medical records.

Conclusions:

Error rates in DCs in nursing homes in Norway are high. The results raise concerns about the validity of public cause of death statistics.
A progressive approach to normative political theorizing
Authors: Biale Enrico , Fumagalli Corrado
Published: July 2023

In this article, we argue that a progressive approach to normative political theorizing should incorporate a conception of meaningful political change that is nonutopian (it conceives of advancements as gradual stages), large-scale (it involves the largest possible numbers of organized and unorganized social movements), and democratically emancipatory (it displays a commitment to breaking down the barriers that prevent individuals from feeling responsible for the direction of society). Bearing this in mind, such an approach should be organized around a cooperative effort between theorists and agents of change and should be oriented toward the collective construction of large-scale actionable proposals for social and political change here and now.
Research on a quantitative fault diagnosis method for rotor rub-impact
Authors: Liang Haiying , Zhao Chencheng , Liu Yang , Gao Chunyue , Cui Ningyuan , Sbarufatti Claudio , Giglio Marco
Published: July 2023

The rotor system during its operation is susceptible to various faults such as unbalance, rub-impact, crack, and misalignment, which usually induce the rotor system to exhibit nonlinear behavior. Some linear diagnosis methods are unable to extract nonlinear characteristics of the faulty rotor system. However, existing nonlinear fault diagnosis methods can describe the nonlinear characteristics but cannot quantitatively indicate the severity of rub-impact faults. To address this issue, this study combines the nonlinear output frequency response functions weighted contribution rate (WNOFRFs) and JS divergence to develop an improved fault diagnosis approach, WNOFRFs based on the JS divergence (WNOFRFs-JS). And a superior NOFRFs-associated index JSRm is developed to indicate the severity of faults. In addition, a sensitive factor is defined to evaluate the sensitivity of the index. The performance of this approach is verified by an established dynamic model and a rotor rub-impact experimental rig. The results prove the effectiveness and merits of this approach for the identification of rotor rub-impact. JSRm is especially sensitive to rub-impact and can also quantitatively detect the severity of faults. The present approach can accurately and quantitatively identify the rub-impact rotor system. These advantages enable the improved WNOFRFs to be applied in the fault diagnosis and condition monitoring of rotating machinery and even other nonlinear systems.
A History of Research on the Aramaic Dead Sea Scrolls
Authors: Jones Robert E.
Published: July 2023

The Aramaic Dead Sea Scrolls have attracted increasing scholarly attention since their official publication was completed in 2009. These manuscripts, representing about thirty distinct compositions, attest to the existence of a previously unknown Jewish Aramaic scribal culture that flourished in the early Hellenistic period (ca. late fourth to mid-second centuries BCE). The Aramaic Scrolls thus have the potential to illuminate an otherwise poorly understood period of Jewish history. In this article, I discuss the various scholarly approaches to their language, literary content, and social location, with a special emphasis on trends in the secondary literature since the late 2000s. This article will also provide interested students and scholars with an overview of the major themes and concerns found throughout the Aramaic Scrolls.
An electronic medical record reminder is independently associated with improved opportunistic influenza vaccination rates for older inpatients
Authors: Chapman Lucy , Kelly Mary , Piggott Raymond Simon , Carr Bernard , Courtney Grainne , McDonagh Ruth , O’Connell Brian , Bannan Ciaran , Cunningham Conal , Briggs Robert
Published: July 2023

Background:

Influenza vaccination will have added importance this winter given the possibility of further waves of the COVID-19 pandemic. This study examines the impact of an electronic medical record (EMR) reminder on influenza vaccine uptake among eligible hospital inpatients.

Methods:

We included a convenience sample of 750 adults (median age 77 years) who are eligible for influenza vaccination (⩾65 years and/or length of stay >30 days). A live electronic dashboard identified patients eligible for vaccination, prompting reminders sent to the clinical teams via the EMR.

Results:

The EMR reminder was associated with almost a 50% higher likelihood of vaccination after adjusting for other covariates (odds ratio 1.48 (95% confidence interval 1.00–2.20); p = 0.048).

Discussion:

Reminders sent to the clinical team via the EMR appear to be an effective means of increasing vaccine uptake and should be considered as part of this year’s drive to vaccinate eligible patients in hospital.
“A Crown is Warranted With Strength”: Bosses, Fantasy, and Democracy in Elden Ring
Authors: Hines Mark
Published: July 2023

This article examines the symbolic and discursive effects of the “final boss” trope in speculative and fantasy games. In contrast to our own world, the rulers, kings, and presidents of speculative games are often the most powerful individuals personally or physically, not just systemically. I employ political theorists Claude Lefort and Eric Santner to argue that the utilization of this trope allows audiences to safely engage with tensions and uncomfortable affects which are inherent to life in a democracy. Fighting bosses which are both monarch and the most powerful of their faction allows audiences to smooth frustrations with the symbolic and discursive chaos which often pervades democratic life. I examine one boss, Godrick the Grafted of Elden Ring, as a particularly fascinating example of this dynamic. I employ close readings of character dialogue and design to argue that such games serve a more concretized political function than scholars have identified.
Adolescents’ and Parents’ Perspectives on a Novel Decision-Making Process for Return of Results in Genomic Research
Authors: Matula Kelly A. , Blumling Amy A. , Myers Melanie F. , McGowan Michelle L. , Lipstein Ellen A.
Published: July 2023

To understand whether they found a two-step decision process helpful and why, adolescent-parent dyads participating in a study investigating return of genomic testing results were asked about their decision-making experience. Responses were qualitatively coded and analyzed using thematic analysis. Adolescents and parents found both joint and independent decision-making stages helpful. Regarding independent decision-making, adolescents appreciated exercising independence, while parents valued both adolescent and parental independence. Joint decision-making allowed each to hear the other's viewpoints. Some found joint decision-making irrelevant but recognized it might help others. Overall, adolescents and parents had similar reasons for finding the two-step decision-making process helpful. Our findings support using such a process for engaging parents and adolescents in challenging research and clinical decisions.
A systematic review of simulation training for lower extremity bypass procedures
Authors: Siddiqui Nadeem Ahmed , Javed Aden , Pirzada Ammar
Published: July 2023

Objectives

Simulation is used across surgical specialties for skill enhancement. The choice and assessment method of a simulator varies across literature. In the age of endovascular approach, trainees have limited exposure to open lower limb bypass procedures which needs attention. This review aims to assess the utility of simulation training in lower limb bypass surgery using Kirkpatrick’s model.

Methods

Using PRISMA statement, we included all the studies done on simulators in lower limb bypass surgical procedures for this systematic review. The primary outcome was to assess the effectiveness of different types of simulation used for lower limb bypass surgery using the Kirkpatrick’s model for training evaluation.

Results

An initial search identified 295 articles out of which 7 articles were found to be eligible for this systematic review. A variety of simulators were used including cadavers and synthetic models. Most studies ( n=5) found the use of simulation as an effective tool in achieving technical competence. All the five studies we found at level 2 on Kirpatrick's model evaluation.

Conclusion

Most of the existing studies are at level 2 of Kirkpatrick’s model which reflects learning changes in trainees after simulation. Feedback mechanism needs to be evolved where the improvement after simulation training can be gauged by its replication in clinical practice and improved patient care practices corresponding to the highest level of Kirkpatrick’s model.
Mechanical aortic valve may no longer be a contraindication to inner branch aortic arch endografts
Authors: Lim Eric TA , Ruiz Carmen , Lyons Oliver T , Laing Andrew , Khanafer Adib
Published: July 2023

Objectives

The presence of a mechanical aortic valve has been a contraindication to the use of an arch branch aortic endograft due to the risk of damaging the valve, resulting in acute aortic regurgitation, or a trapped endograft.

Methods

We present a 67-year-old woman, with a background of Marfan's syndrome and a previous Bentall’s procedure, who presented with a symptomatic enlarging aortic arch and descending thoracic aortic aneurysm, with a type 1A endoleak.

Results

Using an inner branch arch endograft (Cook Medical, Bloomington, Indiana), the nose cone of the delivery system was passed laterally through the semi-circular aperture of the mechanical aortic valve to facilitate deployment just distal to the coronary buttons.

Conclusions

With advancement of endovascular technology, techniques and experience, endovascular aortic arch repair in the presence of a mechanical aortic valve is feasible.
Endovascular treatment of re-stenotic iliac artery stents with drug-eluting balloons
Authors: Özpak Halil Berkan , Aydın Cihan
Published: July 2023

Aim

To evaluate the results of revascularization of stenotic iliac stents using drug-eluting balloons (DEBs).

Material and Methods

Seventy-four patients with various levels of iliac stent restenosis were enrolled to study. All restenotic stents were treated using paclitaxel-coated balloons.

Results

Through a follow-up median period of 24 months (4–24 months), there were no in-stent re-restenosis in 55 patients (74.3%) and there was one in class 1 (1.4%), four in class 2 (5.4%), and fourteen in class 3 (18.9%).

Conclusion

We conclude that; DEBs can be used for restenotic iliac artery stents for some Type C and D lesions, in addition to Types A and B with satisfacting results.
Comparison of the accuracy of inpatient morbidity coding with ICD-11 and ICD-10
Authors: Zarei Javad , Golpira Reza , Hashemi Nasim , Azadmanjir Zahra , Meidani Zahra , Vahedi Akram , Bakhshandeh Hooman , Fakharian Esmaeil , Sheikhtaheri Abbas
Published: July 2023

Background:

One of the challenges when transitioning from International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) to International Classification of Diseases, 11th Revision (ICD-11) is to ensure clinical coding accuracy.

Objective:

To determine the accuracy of clinical coding with ICD-11 in comparison with ICD-10 and identify causes of coding errors in real clinical coding environments.

Method:

The study was conducted prospectively in two general hospitals. Medical records of discharged inpatients were coded by hospital clinical coders with both ICD-11 and ICD-10 on different days. These medical records were recoded by five mentors. Codes assigned by mentors were used as the gold standard for the evaluation of accuracy.

Results:

The accuracy of ICD-10 and ICD-11 coding for 1578 and 2168 codes was evaluated. Coding accuracy was 89.1% and 74.2% for ICD-10 and ICD-11. In ICD-11, the lowest accuracy was observed in chapters 22 (injuries), 10 (ear) and 11 (circulatory) (51.1%, 53.8% and 62.7%, respectively). In both ICD-10 and ICD-11, the most important cause of the coding errors was clinical coders’ mistakes (79.5% and 81.8% for ICD-10 and ICD-11, respectively).

Conclusion:

Accuracy of clinical coding with ICD-11 was lower relative to ICD-10. Hence, it is essential to carry out initial preparations, particularly the training of clinical coders based on their needs, as well as the necessary interventions to enhance the documentation of medical records according to ICD-11 before or simultaneous with the country-wide implementation.

Implications:

Clinical coders need complete training, especially in using extension codes and post-coordination coding. Local ICD-11 guidelines based on the needs of local users and reporting policies should be developed. Furthermore, documentation guidelines based on ICD-11 requirements should be developed.
Pulmonary hypertension predicts higher mortality in patients admitted with severe COVID-19 infection
Authors: Minkin Ruth , Hopson Roger , Ramasubbu Kumudha , Gharanei Mayel , Weingarten Jeremy A
Published: July 2023

Objective:

Patients with underlying conditions are predicted to have worse outcomes with COVID-19. A strong association between baseline cardiovascular disease and COVID-19-related mortality has been shown by a number of studies. In the current retrospective study, we aim to identify whether patients with pulmonary hypertension have worse outcomes compared with patients without pulmonary hypertension.

Methods:

Data from patients of ⩾18 years of age with COVID was retrospectively collected and analyzed ( n = 679). Patients who underwent transthoracic echocardiography, at the discretion of the medical team, were identified and the transthoracic echocardiography was reviewed for the presence of pulmonary hypertension. Patient health parameters and outcomes were measured and statistically analyzed.

Results:

Of 679 consecutive patients identified with a diagnosis of COVID-19, 57 underwent transthoracic echocardiography, 32 of which were found to have pulmonary hypertension. Patients who underwent transthoracic echocardiography had a significantly higher intensive care unit admission rate (73.7% versus 25.4%, p < 0.001) and increased presence of acute respiratory distress syndrome (63.2% versus 21.6%, p > 0.001). These patients had longer intensive care unit length of stay, longer mechanical ventilation time, longer hospital length of stay, and a significantly higher mortality rate when compared to those not undergoing transthoracic echocardiography (59.7% versus 32.3%, p < 0.001). Among patients who underwent transthoracic echocardiography, those with pulmonary hypertension had significantly higher mortality compared to those without pulmonary hypertension (80% versus 43.8%, p < 0.01).

Conclusion:

COVID-19 in patients with pulmonary hypertension was associated with high in-hospital mortality even when adjusted for confounding factors. A number of mechanisms have been proposed for the worse outcomes in patients with pulmonary hypertension and right ventricular dysfunction, including right ventricle overload and indirect pro-inflammatory cytokine storm. Further, large-scale studies are required to evaluate the impact of right ventricular dysfunction in COVID-19 patients and to elucidate the associated mechanisms
Facilitators and barriers to blood pressure telemonitoring: A mixed-methods study
Authors: Eze Chinwe E , Dorsch Michael P , Coe Antoinette B , Lester Corey A , Buis Lorraine R , Farris Karen B
Published: July 2023

Background

Telemonitoring of blood pressure (BP) may improve BP control. However, many patients are not using BP telemonitoring due to personal, technological, and health system barriers. Individuals are required to have electronic health literacy (e-HL), defined as knowledge and skills to use technology services effectively, such as BP telemonitoring.

Objective

The objective was to determine the facilitators and barriers experienced by patients with hypertension in telemonitoring of BP using the e-HL framework (e-HLF).

Methods

This study was a prospective mixed-methods study using a convergent design. We recruited a convenience sample of 21 patients with hypertension. The qualitative section was online or phone individual in-depth interviews based on the e-HLF, which has seven domains. The quantitative section was an online survey consisting of demographics, an e-HL questionnaire, and patient–provider communication preferences. A joint display was used in the mixed-methods analysis.

Results

Five themes including knowledge, motivation, skills, systems, and behaviors along with 28 subthemes comprising facilitators or barriers of BP telemonitoring were identified. The mixed-methods results showed concordance between the participants’ e-HL status and their experiences in the ability to actively engage with BP monitoring and managing digital services (domain 3) of the e-HLF. Other e-HL domains showed discordance.

Conclusion

Patients may engage with BP telemonitoring when they feel the usefulness of concurrent access to telemonitoring services that suit their needs.
Relationship between citizens’ perspective on digital health and underlying health risks
Authors: Pedersen Esben RG , Sudzina Frantisek
Published: July 2023

Objective

Digital health has been gaining widespread attention but has not been fully integrated into the existing healthcare system. However, it remains unclear whether the new digital health solutions align with users’ needs and wants. This study examines how citizens perceive the functionalities of digital health and how different health risks influence their perception.

Methods

Using an online survey, data are collected from over 4000 Danish citizens. The data are analysed using linear regression models.

Results

The results show how users’ perceptions of digital health differ significantly. Users are highly interested in data sharing across different healthcare stakeholders but less interested in online health communities. The results also show that the support for digital health is correlated with various health risks, including age, smoking and social network. However, health risks do not have uniform relationship with the perceived value of digital health.

Conclusions

While developing and implementing new digital health solutions, it is important to consider the perceptions of people who are expected to benefit from such solutions. This study contributes to the literature by deepening the knowledge of how citizens with different risk profiles perceive the multitude of digital health tools being introduced in the healthcare sector.
Leg-Length and Alignment Changes in Children and Adolescents After Transphyseal Anterior Cruciate Ligament Reconstruction With Soft Tissue Graft: Results at 1-Year Follow-up
Authors: Seeto Alexander H. , Carty Christopher P. , Bradford Kylie , Maine Sheanna , Bade David , Johnson Liam , Astori Ivan P.
Published: July 2023

Background:

Growth disturbance to leg length or coronal plane alignment are important considerations in pediatric anterior cruciate ligament (ACL) reconstruction (ACLR).

Purpose/Hypothesis:

The purpose of this study was to investigate the lower limb alignment and leg length of pediatric patients preoperatively and at approximately 1 year after transphyseal ACLR. Our hypothesis was that there would be no significant change in leg-length discrepancy (LLD) or operated-side alignment at follow-up.

Study Design:

Case series; Level of evidence, 4.

Methods:

Data were extracted from the prospective Queensland Children’s Hospital Pediatric ACL Injury Registry. Long-leg alignment radiographs were captured preoperatively and at an approximately 12-month postoperative follow-up. Radiographic measures included leg length, LLD (injured minus uninjured leg length), mechanical axis deviation (MAD), mechanical and anatomical lateral distal femoral angle (mLDFA and aLDFA, respectively), and medial proximal tibial angle. We evaluated the effect of time (annual vs baseline) on imaging measurements with analysis of covariance, using the covariates of age, sex, and body mass index.

Results:

Data were available for 104 patients, of whom 34 (33%) had >12 months of skeletal growth remaining based on skeletal age. At an average follow-up time of 14.5 months after ACLR, there were no significant differences in mean lower limb alignment or longitudinal growth compared with baseline. However, seven patients demonstrated clinically significant changes to their mechanical axis or LLD (>10 mm change). A subgroup analysis of patients with >12 months of growth remaining (n = 34) demonstrated no statistically significant changes in mean alignment or LLD. Before surgery, LLD was -1.39 mm and the injured limb was in significantly more valgus compared with the uninjured lower limb (mean difference: MAD, 4.79 mm [95% CI, 2.64 to 6.94 mm]; mLDFA, -0.93° [95% CI, -1.29° to -0.57°], and aLDFA, -0.91° [95% CI, -1.31° to -0.50°]).

Conclusion:

After ACLR, there were no statistically significant changes in mean alignment or longitudinal growth; however, 7 out of 104 patients (6.7%) demonstrated clinically significant changes in alignment or LLD. Preoperatively, the injured limb was statistically significantly in more valgus compared with the uninjured limb with lateralized MAD.
Debating with the Reservation Policy for Muslims in Higher Education
Authors: Alam Shamsher
Published: July 2023

This article attempts to understand and analyse the nature of the state’s affirmative action policy to include Muslims in higher education in India. In analysing so, it tries to shed light on the Scheduled Castes’ status for Arzal or Dalit Muslims to ensure their representation in higher education. It also strives to map the reservation policy for the backward Muslims and argues that various castes among Muslims are not included in the OBC list. This article also seeks to highlight the debate regarding the minority status of Muslim higher educational institutions. This article argues that although the Indian constitution does not provide reservation based on religion, Muslims, in general, and Pasmanda Muslims, in particular, are at the periphery as far as their representation in higher education. In other words, the state uses differential treatment as far as providing Scheduled Castes Status for Arzal Muslims; the state and its apparatus use the thin and narrower meaning of Article 30 of the Indian constitution while addressing the minority status of Muslim higher educational institutions and the article also aims to elucidate the allocation of seats for Pasmanda Muslims in Muslim minority higher educational institutions.
Exploring the Potential of mHealth to Improve Maternal Health in Rural Bihar
Authors: Srishti
Published: July 2023

In India women suffer from poor maternal health sometime leading to maternal death. The condition is severe in Empowered Action Group states like Bihar. Caste and gender-based biases are responsible for it. Health informatics tools like mHealth is essential for disseminating useful maternal health-related information among rural women since its affordable and portable. A household survey was conducted in Malpur village, Dalsinghsarai block, Samastipur district, Bihar. Purposive random sampling was conducted. Mixed method was used for data collection and analysis. Results show that rural women have severe dependence on their immediate family members for information related to maternal health. ASHAs/AWWs too fail to generate information to lower caste women. Thus, mHealth becomes instrumental in generating maternal health education. The study contends that mHealth is promising in propagating need-based information to women in their own language, thereby becoming a harbinger of health promotion.