bluuebunny/crossref_metadata_2025 huggingface dataset:
Fabrication of Kevlar®-reinforced ultra-high molecular weight polyethylene composite through microwave-assisted compression molding for body armor applications
Authors: Guleria Taresh , Verma Nishant , Zafar Sunny , Jain Vivek
Published: September 2020

Kevlar®-reinforced composites are used in high energy absorption applications. In the present work, Kevlar®-reinforced ultra-high molecular weight polyethylene composites were fabricated through microwave-assisted compression molding. The microwave-assisted compression molding parameters were optimized through trial and error method. Analysis of mechanical behavior of composites was accessed through uniaxial tensile testing, flexural testing, impact testing, and nano-indentation. The fractured specimens were observed using scanning electron microscopy. An increment of 92.2% was observed in the ultimate tensile strength of the ultra-high molecular weight polyethylene/Kevlar® composite compared to neat ultra-high molecular weight polyethylene. Flexural properties, impact energy absorption rate, and hardness property of the composite were increased by 27.1%, 91.6%, and 4.77%, respectively, compared to pure ultra-high molecular weight polyethylene. Enhanced mechanical properties may be attributed to unique microwave heating phenomena during microwave-assisted compression molding.
Variation in Arterial and Central Venous Catheter Use in Pediatric Intensive Care Units
Authors: Mahendra Malini , McQuillen Patrick , Dudley R. Adams , Steurer Martina A.
Published: September 2020

Objective:

Describe patient and hospital characteristics associated with Arterial Catheter (AC) or Central Venous Catheter (CVC) use among pediatric intensive care units (ICUs).

Design:

Hierarchical mixed effects analyses were used to identify patient and hospital characteristics associated with AC or CVC placement. The ICU adjusted median odds ratios (ICU-AMOR) for the admission ICU, marginal R2, and conditional intraclass correlation coefficient were reported.

Setting:

166 PICUs in the Virtual PICU Systems (VPS, LLC) Database.

Patients:

682,791 patients with unscheduled admissions to the PICU.

Intervention:

None.

Measures and Main Results:

ACs were placed in (median, [interquartile range]) 8.2% [4.9%-11.3%] of admissions, and CVCs were placed in 14.9% [10.4%-19.3%] of admissions across cohort ICUs. Measured patient characteristics explained about 25% of the variability in AC and CVC placement. Higher Pediatric Index of Mortality 2 (PIM2) illness severity scores were associated with increased odds of placement (Odds Ratio (95th% Confidence Interval)) AC: 1.88 (1.87-1.89) and CVC: 1.82 (1.81-1.83) per 1 unit increase in PIM2 score. Primary diagnoses of cardiovascular, gastrointestinal, hematology/oncology, infectious, renal/genitourinary, rheumatology, and transplant were associated with increased odds of AC or CVC placement compared to a primary respiratory diagnosis. Presence of in-house attendings 24/7 was associated with increased odds of AC placement 1.32 (1.11-1.57). Admission ICU explained 4.9% and 3.5% of the variability in AC or CVC placement, respectively. The ICU-AMOR showed a patient would have a median increase in odds of 55% and 43% for AC or CVC placement, respectively, if the same patient moved from an ICU with lower odds of placement to an ICU with higher odds of placement.

Conclusions:

Variation in AC or CVC use exists among PICUs. The admission ICU was more strongly associated with AC than with CVC placement. Further study is needed to understand unexplained variation in AC and CVC use.
“Prevention Alone Is Not Enough:” Stakeholders’ Perspectives About School-based Child Sexual Abuse (CSA) Prevention Programs and CSA Research in China
Authors: Lu Mengyao , Barlow Jane , Meinck Franziska , Wu Yumeng
Published: September 2020

While existing studies have examined the effectiveness of school-based child sexual abuse (CSA) prevention programs in China, there is currently little qualitative evidence on how stakeholders view these programs and research on CSA in China more generally. To address this research gap, the aims of this study were to explore stakeholders’ perspectives on: (a) school-based CSA prevention programs in China; (b) the components of these programs; (c) CSA research in China. Qualitative semi-structured interviews were conducted with 21 participants in Beijing and a county under Lanzhou City, China. Interview transcripts were systematically coded and emerging themes were developed from the codes. An inductive thematic analysis approach was utilized to analyze the interview data. Participants’ perspectives on school-based CSA prevention programs included: (a) recognition of the importance of school-based CSA prevention programs; (b) fear about a possible negative impact on children participating in such programs; (c) assessment that school-based CSA prevention programs alone are not enough to prevent CSA. Components that participants thought needed to be part of Chinese school-based CSA prevention programs were: (a) content regarding online-facilitated CSA; (b) the use of a rights-based approach; and (c) greater parental and community involvement. Participants also identified factors that have both fostered the implementation of CSA research (e.g., the growing awareness of CSA in the central government) and prevented researchers from effectively conducting CSA research: (a) lack of national data; (b) inadequate government support; and (c) barriers to research collaboration among organizations. The findings indicate that while CSA prevention programs are on the whole regarded positively by key stakeholders in China, a number of important concerns were identified. Our study highlighted a number of ways in which future CSA prevention programs and research on CSA could be strengthened in the Chinese context.
Fully integrated multi-scale modelling of damage and time-dependency in thermoplastic-based woven composites
Authors: Praud F , Chatzigeorgiou G , Meraghni F
Published: September 2020

In this work, a multi-scale model established from the concept of periodic homogenization is utilized to predict the cyclic and time-dependent response of thermoplastic-based woven composites. The macroscopic behaviour of the composite is determined from finite element simulations of the representative unit cell of the periodic microstructure, where the local non-linear constitutive laws of the components are directly integrated, namely, the matrix and the yarns. The thermoplastic matrix is described by a phenomenological multi-mechanisms constitutive model accounting for viscoelasticity, viscoplasticity and ductile damage. For the yarns, a hybrid micromechanical–phenomenological constitutive model accounting for anisotropic damage and anelasticity induced by the presence of a diffuse micro-crack network is utilized. The capabilities of the overall multi-scale model are validated by comparing the numerical predictions with experimental data. Further illustrative examples are also provided, where the composite undergoes time-dependent deformations under uni-axial and non-proportional multi-axial loading paths. The multi-scale model is also employed to analyze the influence of the local deformation processes on the macroscopic response of the composite.
Agile-Concurrent hybrid: A framework for concurrent product development using Scrum
Authors: Žužek Tena , Kušar Janez , Rihar Lidija , Berlec Tomaž
Published: September 2020

Agile development became very popular at the beginning of the 21st century when the Manifesto for Agile Software Development was released. Since then, it has been predominant in the software industry and has been increasingly transferred to the development of physical products due to its great success. There are many studies on Agile-Stage-Gate hybrids that combine agile Scrum and the traditional Stage-Gate model, however no research has been found that addresses a direct integration of Scrum into a concurrent product development model in a similar way. In this paper, we therefore examine the possibility of introducing Scrum into the concurrent product development and propose a Scrum framework for an Agile-Concurrent hybrid. We propose that the framework for concurrent development remains unchanged: the stages overlap and the track-and-loop approach is preserved, while Scrum is proposed for the execution of day-to-day work. The main advantage of the proposed hybrid is that after each iteration the customer reviews the results of an entire loop, not just of one stage, which enables a broader understanding of the progress and facilitates a more extensive feedback. A quicker resolution of discrepancies, and a faster and more effective response to change is thus ensured. In the paper, the needed organizational changes and potential implementation issues are also discussed.
The Future of B2B Customer Solutions in a Post-COVID-19 Economy: Managerial Issues and an Agenda for Academic Inquiry
Authors: Bond Edward U. , de Jong Ad , Eggert Andreas , Houston Mark B. , Kleinaltenkamp Michael , Kohli Ajay K. , Ritter Thomas , Ulaga Wolfgang
Published: September 2020

Customer solutions have been touted as the next service-growth engine. Yet, pursuing a solutions strategy can seriously backfire in times of severe crises. The massive economic shock wave brought on by the recent COVID-19 pandemic challenges some of the presumed advantages of business-to-business customer solutions and reveals downsides of these complex offerings to which academics and managers alike may have given insufficient attention. This editorial focuses on goods-centered companies’ recent foray into the solution business and the pressing managerial questions regarding the evolution of solutions as the world begins to emerge from the COVID-19 pandemic. Based on the key characteristics of solution offerings, we identify seven potential downsides of customer solutions that are revealed by the current global crisis and develop promising research avenues mirroring these challenges. In each area, we propose three illustrative sets of research questions that may guide scholars and provide insights to practitioners for positioning solution businesses in the post-COVID-19 “next-normal” world.
Face and content validity of an artificial eye model for Ab-Interno Goniotomy
Authors: Swift Andrew , Waldner Derek , Gorner Adam , Chung Helen , Ahmed Yusuf , Docherty Gavin , Gooi Patrick
Published: September 2020

Purpose:

To determine the face and content validity of an artificial eye model for ab-interno goniotomy (SimulEYE KDB model, InsEYEt, Westlake Village, CA) by surveying ophthalmologists with varying experience using a Kahook Dual Blade (KDB; New World Medical, Rancho Cucamonga, CA, USA) following a 90-min wet-lab course using the model.

Participants:

Overall 13 ophthalmologists participated following a surgical simulation session on goniotomy using the goniotomy blade at the 2019 Canadian Ophthalmological Society annual meeting.

Methods:

A 17-question survey to assess the face and content validity of the model was given immediately following the surgical simulation session on goniotomy using the goniotomy blade. Responses to each survey question were recorded on a 5-point Likert scale ranging from (1) strongly agree to (5) strongly disagree.

Results:

Respondents rated statements regarding the model with a median response of 1 (Strongly Agree) to 3 (Neither agree or disagree). Mann–Whitney U nonparametric analysis revealed no significant difference in responses between instructor vs. non-instructor or between prior experience vs. no prior experience for any of the survey statements. The model received highest survey ratings for utility in training residents, acquisition of surgical skills, accessibility, and higher likelihood of success with the procedure than theory and observation alone. Lowest ratings were for realism of the model compared to a human cadaveric eye.

Conclusion:

Our results suggest the SimulEYE KDB model is a reasonably cost-effective solution for simulating angle-based surgeries. Additionally, our project shows that experienced ophthalmologists found the artificial eye models useful and helpful for angle-based surgery training.
Māori experiences of bariatric surgery in South Auckland, New Zealand
Authors: Rahiri (Ngāti Porou, Te Atihaunui-a-Pāpārangi, Ngāti Whātua Jamie-Lee , Gillon (Ngāti Awa) Ashlea , Tuhoe (Ngāti Maru, Ngāti Pūkenga, Ngā Puhi) Jason , MacCormick Andrew D , Hill Andrew , Harwood (Ngā Puhi) Matire
Published: September 2020

Access to publicly funded bariatric surgery in New Zealand is limited, but privileges patients who identify as New Zealand European or Other European. This example of institutional racism in the New Zealand health system further reiterates that Māori face inequitable access to gold standard medical interventions. This article analyses semi-structured interviews undertaken with Māori who had bariatric surgery at Counties Manukau Health which houses the largest public bariatric service. Thirty-one interviews were conducted, from which six themes were identified in relation to the stages of the bariatric journey. A thematic analysis of transcripts using an inductive approach was undertaken. Using Kaupapa Māori Research–aligned methodology, sites of racism, compassion, clinical barriers to positive health experiences and life-changing experiences were identified along the bariatric journey for Māori patients.
Navigating ‘Home Schooling’ during COVID-19: Australian public response on Twitter
Authors: Ewing Lee-Ann , Vu Huy Quan
Published: September 2020

COVID-19 has wreaked havoc worldwide. Schools have escaped neither the pandemic nor its consequences. Indeed, by April 2020, schools had been suspended in 189 countries, affecting 89% of learners globally. While the Australian government has implemented variously effective health and economic policies in response to COVID-19, their inability to agree with states on education policy during the pandemic caused considerable confusion and anxiety. Accordingly, this study analyses 3 weeks of Tweets during April, leading up to the beginning of term 2, during the height of Government policy incongruity. Findings confirm a wide and rapidly changing range of public responses on Twitter. Nine themes were identified in the quantitative analysis, and six of these (positive, negative, humorous, appreciation for teachers, comments aimed at Government/politicians and definitions) are expanded upon qualitatively. Over the course of 3 weeks, the public began to lose its sense of humour and negative tweets almost doubled.
How is autistic identity in adolescence influenced by parental disclosure decisions and perceptions of autism?
Authors: Riccio Ariana , Kapp Steven K , Jordan Allison , Dorelien Anna Marie , Gillespie-Lynch Kristen
Published: September 2020

A large body of literature examines parental interpretations of their child’s autism diagnosis. However, research examining intersections between parental disclosure of their child’s autism diagnosis to their child and their child’s identity development is lacking. The primary aim of this study was to analyze if parental decisions to disclose/withhold their child’s autism diagnosis influence adolescents’ perceptions of autism and identity development. Adolescent participants ( n = 19) and their mothers, recruited from an informal educational program, completed in-person interviews and online questionnaires, respectively. Adolescents were told about their autism diagnosis in varying ways. Adolescents whose parents voluntarily disclosed their autism diagnosis to them described autism and themselves more positively than adolescents who did not experience voluntary disclosure. Although parents and teens showed similarities on a group level when defining autism, parents and children expressed diverse themes in their definitions of autism. Findings suggest that parents can help their children develop neurodiversity-aligned perspectives about autism by mindfully discussing autism with them early in their development.

Lay abstract

There is a lot of research about how parents think about their child’s autism but we don’t know much about how parents talk with their kids about autism. How parents talk with their kids about autism may shape how kids see autism. A team of autistic and non-autistic people (including a mother of an autistic person) did a study. We wanted to know if how parents talk with their kids about autism shapes how their kids see autism. Nineteen teens from a summer camp did interviews and surveys. Their mothers did surveys. Teens learned about if they had autism in different ways. Some teens still didn’t know they were autistic. Teens whose moms chose to tell them about their autism talked about autism and themselves more positively than teens whose moms didn’t choose to talk with them about autism. Only teens whose moms chose to talk with them about autism described themselves as having social strengths. Teens had a harder time defining autism than moms. However, teens and moms talked about autism in similar ways. Our study shows that parents can help their kids see autism and themselves more positively by talking with their kids about autism early in development.
Social nothingness: A phenomenological investigation
Authors: Scott Susie
Published: September 2020

This article identifies and explores the realm of ‘social nothingness’: objects, people, events and places that do not empirically exist, yet are experienced as subjectively meaningful. Taking a phenomenological approach, I investigate how people perceive, imagine and reflect upon the meanings of unlived experience: whatever is significantly not present, never appeared or cannot happen to them. These ‘negative symbolic social objects’ include no-things, no-bodies, non-events and no-where places: for example, rejected roles, unpursued careers or absent people. Reversing some key concepts from phenomenology, I examine the process of ‘negative noesis’ (subject-object relations) in three aspects. ‘Negative intentionality’ describes people’s motivational stance towards absent things, such as feelings of missing, wishing, haunting, avoidance or surrender. ‘Negative embodiment’ is the corporeal grounding of negational acts, through experiences of impairment, incapacity, severance, disturbance and decline. ‘Negative temporality’ describes the recognition of past or future impossible selves and their place within biographical identity stories.
Augmented reality for next generation infrastructure inspections
Authors: Mascareñas David DL , Ballor JoAnn P , McClain Oscar L , Mellor Miranda A , Shen Chih-Yu , Bleck Brian , Morales John , Yeong Li-Ming R , Narushof Benjamin , Shelton Philo , Martinez Eric , Yang Yongchao , Cattaneo Alessandro , Harden Troy A , Moreu Fernando
Published: September 2020

This article introduces the use of emerging augmented reality technology to enable the next generation of structural infrastructure inspection and awareness. This work is driven by the prevalence of visual structural inspection. It is known that current visual inspection techniques have multiple sources of variance that should be reduced in order to achieve less ambiguous visual inspections. Emerging augmented reality tools feature a variety of sensors, computation, and communication resources that can enable relevant structural inspection data to be collected at very high resolution in an unambiguous manner. This work shows how emerging augmented reality tools can be used to greatly enhance our ability to capture comprehensive, high-resolution, three-dimensional measurements of critical infrastructure. This work also provides detailed information on the software architecture for augmented reality structural inspection applications that helps meet the goals of the framework. The fact that the framework is designed to accommodate the considerations associated with high-consequence infrastructure implies that it is also comprehensive enough to be applied to less hazardous but still high-value infrastructure such as bridges, dams, and tunnels. Augmented reality has great potential to enable the next generation of smart infrastructure, and this work focuses on addressing how augmented reality can be leveraged to enable the next generation of structural awareness for high-consequence, long-lifespan structures.
Instrumentalism: A worthwhile critical concept for philosophy of education?
Authors: Sosnowska Paulina
Published: September 2020

The aim of the article is to posit the question whether, or under what conditions ‘instrumentalism’ can be seen as a viable target of the philosophical critique of education. Firstly, I will briefly review and compare three critical conceptions in modern philosophy that interpreted Western civilization as a form of instrumentalism, yet, at the same time, used the concept perhaps too sweepingly: Adorno and Horkheimer (instrumental reason), Heidegger (calculative thinking) and Arendt (means-ends logic in politics). Secondly, I will discuss the exact sweeping moment in those thinkers’ ways of pursuing their critiques of instrumentalism and the way it can, in fact, weaken the pedagogical impact of their analyses. We face a paradox here: if we consistently follow Heidegger and Adorno (Arendt as well, but the situation looks much better with her, as usual), we are prone to ignore the actual perils for freedom in, for example, subsuming education to the global market economy, because it appears to be only a contingent or occasional (ontic) phenomenon that has its ontological roots as early as Homer or Plato. Conversely, if we ignore their analyses, we endanger our critique with inevitable shallowness, i.e. with a tendency to moan about the obvious circumstances without a real understanding of their ontological, historical and cultural backgrounds. This paradox can be translated as a general paradox of the relationship between philosophy and education. To conclude, I will illustrate this by referring to the leading question of this volume: ‘what (is education) for?’, or, to put it differently, to the problem of the purpose of education. If we assume that within the problem itself instrumentalism is inscribed (as all the three philosophers would), we still face the pedagogical and concrete problem of discerning different types of instrumentality. This problem corresponds with the various ways we describe our educational aims and goals.
A Systematic Review of Intimate Partner Violence Interventions Impacting South Asian Women in the United States
Authors: Tripathi Saumya , Azhar Sameena
Published: September 2020

This systematic review is the first published attempt to synthesize literature pertaining to intimate partner violence (IPV) interventions impacting South Asian women in the United States. Applying the conceptual framework of intersectionality, the goals of this review are to (1) understand current trends, intervention modalities, and areas of focus within IPV interventions targeting South Asian communities in the United States and (2) to identify gaps in the address of IPV among these communities. Using the Cochrane Handbook and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched 35 databases and identified 12 research studies. Our study included a collective sample of 318 South Asian IPV survivors and 25 organizations. Findings underscore that there are minimal IPV interventions available to South Asian women living in the United States. Most interventions have not been systematically evaluated, making their efficacy questionable. Those that reported outcome evaluation, namely recurrence of IPV, demonstrated limited efficacy. IPV research on South Asian women often dismisses financial concerns in light of cultural dimensions impacting IPV. Given that financial dependence is a major driver of violence against South Asian women, scholars must question the efficacy of available interventions that cannot foster the social and economic security of IPV survivors. Without sufficient attention to the intersecting social, cultural, and economic challenges that South Asian women face in abusive relationships, the efficacy of IPV interventions will remain limited.
The mechanical performance of the laminated aluminum-epoxy/glass fiber composites containing halloysite nanotubes: An experimental investigation
Authors: El-baky Marwa A Abd , Attia Mohamed A
Published: September 2020

In this study, the effect of different weight percentages (wt. %) of halloysite nanotubes (HNTs) on the mechanical performance of glass laminate aluminum (Al) reinforced epoxy (GLARE) was investigated. GLARE (3/2) laminates with quasi-isotropic lay-up, [Al/[(0°/90°)/(45°/−45°)]s/Al/[(0°/90°)/(45°/−45°)]s/Al] filled with 0, 0.25, 0.5, 1, 2 and 3 wt. % of HNTs were fabricated using hand lay-up followed by compression molding. To explore the effect of HNTs on the mechanical properties, tensile, flexural, in-plane shear, interlaminar shear, bearing and impact tests were conducted. Results demonstrated that the inclusion of 1 wt. % of HNTs into GLARE leads to maximum improvements of 35.67, 8.50, 28.85, 50.47, 50.27, 30.43, 23.73, 72.08, 30.74, and 51.52% in tensile strength, tensile strain, Young's modulus, modulus of toughness, flexural strength, flexural strain, in-plane shear strength, interlaminar shear strength, bearing strength, and impact strength, respectively, compared to pristine GLARE. An enhancement of 38.89% in the flexural modulus was attained by adding 0.5 wt. % of HNTs to GLARE compared to pristine GLARE. The tensile strength, tensile strain, modulus of toughness, flexural strength, flexural modulus, flexural strain, in-plane shear strength, and interlaminar shear strength of GLARE filled with 3 wt. % of HNTs are 0.91, 0.88, 0.91, 0.91, 0.71, 0.83, 0.85, and 0.91 times those of the original GLARE. But Young’s modulus, bearing strength, and impact strength are 1.10, 1.15 and 1.20 times those of the original GLARE. To investigate the fracture mechanism, field emission scanning electron microscope (FE-SEM) and energy-dispersive X-ray spectroscopy (EDX) were used. The microscopic images revealed that adding HNTs lead to the improvement in the interaction between the epoxy matrix and glass fiber, thereby improving the mechanical properties.
Characterization of glass fiber felt and its performance as an air filtration media
Authors: Zou Chi , Shi Yunlong , Qian Xiaoming
Published: September 2020

The glass fiber felt made through flame blowing process was characterized on morphology and its filtration performance. Fiber diameter has been measured through SEM and BET methods. Theoretical calculations on pressure drop and filtration efficiency were developed and compared with the experimental measurement. The discrepancy between the calculated results and measurement on filtration efficiency is derived from the presence of fine fiber (<0.5µm) in the glass fiber felt, which contributes to the actual high filtration efficiency in measurement. The multiple micro-layered structure in glass fiber felt, which improves the dust holding capacity and enables glass fiber felt as a depth filter. Glass fiber felt showed a longer duration of the slow increase region for pressure drop build-up comparing to other filter materials with lower averaged pressure drop through its filtration service life. Furthermore, quality factor calculation has been developed for prediction on the energy cost performance of the filters based on the pressure drop, separation efficiency and dust holding capacity.
Stress-Induced Neurodegeneration: The Potential for Coping as Neuroprotective Therapy
Authors: Kline Shelby A. , Mega Michael S.
Published: September 2020

Stress responses are essential for survival, but become detrimental to health and cognition with chronic activation. Chronic hypothalamic-pituitary-adrenal axis release of glucocorticoids induces hypothalamic-pituitary-adrenal axis dysfunction and neuronal loss, decreases learning and memory, and modifies glucocorticoid receptor/mineralocorticoid receptor expression. Elderly who report increased stress are nearly 3 times more likely to develop Alzheimer’s disease, have decreased global cognition and faster cognitive decline than those reporting no stress. Patients with mild cognitive impairment are more sensitive to stress compared to healthy elderly and those with Alzheimer’s disease. Stress may also transduce neurodegeneration via the gut microbiome. Coping styles determine hippocampal mineralocorticoid receptor expression in mice, indicating that coping modifies cortisol’s effect on the brain. Identifying neuroprotective coping strategies that lessen the burden of stress may prevent or slow cognitive decline. Treatments and education designed to reduce stress should be recognized as neuroprotective.
Premarital Counseling Practices among Christian and Muslim Lay Counselors in Ghana
Authors: Osei-Tutu Annabella , Oti-Boadi Mabel , Akosua Affram Adjeiwa , Dzokoto Vivian A. , Asante Paapa Yaw , Agyei Francis , Kenin Abraham
Published: September 2020

We examined premarital counseling services offered by Christian and Muslim lay counselors in Ghana. Participants including clergy, Islamic clerics, and laity practicing in four urban centers were interviewed. Thematic analysis showed that common issues covered include medical screening, beliefs and values, expectations, partner knowledge, roles and duties, sex, parenthood, financial management, communication, and conflicts. The findings offer important insight into religious premarital counseling in Ghana and contribute to the global literature on premarital counseling.
He said/She said; Shaming, Blaming … Reframing: Impacts and Implications of Childlessness on Relationships in an Ancient Text
Authors: Zucker David J. , Benjamin Alison
Published: September 2020

Describing the terms of “shaming, blaming, naming, claiming, and reframing” as the possible changing dynamics in some human relationships to achieve a resolution, is a fairly recent insight. Through analyzing a short section of an ancient text, Biblical Antiquities, we show how those matters, although not named as dynamics, were recognized as stages in human interactions millennia ago. They were played out in the announcement and subsequent birth of the biblical judge Samson.
Reflection: The Personal Is Public
Authors: McMullen Bryan
Published: September 2020

In this article, the author from Rochester General Hospital reflects on COVID impact: “Communication has sometimes suffered cold and automated relationship outcomes but there are oases in this dessert.” Personal signals in a public world are humanizing artifacts in a new sterile and hypercontrolled virtual reality.
Toward an Integrative Model of Psychospiritual Therapy: Bringing Spirituality and Psychotherapy Together
Authors: Alton Gord
Published: September 2020

As a supervisor-educator for the Canadian Association of Spiritual Care, my primary task is to help developing spiritual care providers and psychospiritual therapists learn how to use psychotherapy within the field of spiritual care. The purpose of this essay is to share a psychospiritual model that I teach my students that helps them see how psychospiritual therapy is a form of spiritual practice that helps their clients experience healing from the sacred.
Identification of Meaningful Data for Providing Real-Time Intraoperative Feedback in Laparoscopic Surgery Using Delphi Analysis
Authors: Jansen Marilou , Barsom Esther Z. , van Dalen Anne-Sophie H. M. , Zondervan Patricia J. , Schijven Marlies P.
Published: September 2020

Background. Surgeons are at risk of being overwhelmed with information while performing surgery. Initiatives focusing on the use of medical data in the operating room are on the rise. Currently, these initiatives require postprocessing of data. Although highly informative, data cannot be used to influence preventable error in real time. Ideally, feedback is provided preemptive. Aims. First, to identify which information is considered to be relevant for real-time feedback during laparoscopic surgery according to surgeons. Second, to identify the optimal routing for providing such feedback, and third, to decide on optimal timing for feedback to alarm users during laparoscopic surgery. Methods. A Delphi study of 3 iterations was conducted within the Amsterdam UMC, location AMC. A total of 25 surgeons and surgical residents performing laparoscopy were surveyed using 5-point Likert scales. Consensus was obtained when 80% of answers fitted the same answering category. Results. Delphi round 1 resulted in 198 unique ideas within 5 scenarios. After round 3, consensus was obtained on 102 items. Feedback most relevant during laparoscopic surgery refers to equipment like the gas insufflator, diathermy, and suction device. Feedback should be delivered via an additional monitor. Surgeons want to be instantly alarmed about aberrations in patients’ vital parameters or combinations of vital parameters, preferably via a designated section on a monitor in their field of vision. Conclusions. Surgeons performing laparoscopy are uniform in their opinion that they need to be alarmed immediately when patients’ vital parameters are becoming aberrant. Surgeons state that information regarding supporting equipment is best displayed on an additional monitor.
Learning Ethnography Through Doing Ethnography: Two Student—Researchers’ Insights
Authors: Ravindran Aisha , Li Jing , Marshall Steve
Published: September 2020

In this article, we present the accounts of the field experiences and challenges of two graduate student-researchers practising ethnographic methodology, conducting fieldwork, and writing up “post-modern” ethnographies that are both creative and “integrative”. We describe the complexities and tensions when two student-researchers negotiated many issues in the field and “behind the desk” as they transformed the texts: epistemology and ontology, reflexivity and auto-ethnography, and writing researchers and participants in and out of accounts. We conclude with a discussion on pedagogical implications, and consider the value of learning ethnography through doing ethnography.
Determinants and mitigating factors of the brain drain among Egyptian nurses: a mixed-methods study
Authors: Hashish E Abou , Ashour HM
Published: September 2020

Background

A brain drain is a migration of employees in their quest for an improved level of living conditions, better earnings, access to advanced technology and secure political conditions in diverse places worldwide. The brain drain of nurses is an ongoing phenomenon that impacts the quality and quantity of the nursing workforce and affects the quality of care. The nurses' brain drain is commonly known as a result of the interplay of many factors. So, identification of these factors and how to manage them is a timely topic in nursing research.

Aims

This study aims to investigate determinants of the nurses' brain drain and mitigating factors from nurses' perspectives in Egypt.

Methods

Mixed-methods research was conducted using a concurrent triangulation design. A sample of 325 nurses who were working at an Egyptian university hospital answered a brain drain questionnaire while the qualitative investigation was guided by a semi-structured interview with a purposive sample of 35 nurses to elicit exploratory perspectives on factors causing brain drain and mitigation strategies. Results were analysed using inferential statistics and thematic data analysis.

Results

Both push and pull factors can predict about 99.6% and 97.5% of the nurses’ brain drain, respectively. Seven themes were derived from the qualitative content analysis, and six themes were categorised under ‘push-pull’ factors. In addition, the ‘mitigating factors theme’ was identified with five sub-factors as possible solutions. Economic and work environment reasons were reported as the most influential for nurses’ brain drain.

Conclusions

Policymakers could use the identified factors from quantitative and qualitative data for creating a system that would improve nurses' conditions and policies, and prevent nurses' migration. Nursing leaders have a significant role with non-remuneration strategies in retaining nurses through creating an empowering work environment. In addition, shared governance, a strong nursing syndicate role and professorial marketing would be essential mitigating factors for the nurses' brain drain.
How a School Nurse Can Reduce Student Stress Using Systems-Level Thinking
Authors: Kilfoy Rebecca C.
Published: September 2020

School nurses are essential members of the school community. Their ability to collaborate with other school team members promotes a system’s approach to the identification and management of students’ mental health thereby promoting students’ academic success. By enhancing the students’ abilities to cope with the long-term impacts of chronic medical conditions as well as academic stress and other contributing factors that affect their mental health, school nurses are in a unique position to positively affect the long-term health of students. This article is the fourth in a series focusing on the Framework for the 21st Century School Nursing PracticeTM (Framework) and describes the practice component of systems-level leadership, in the principle of Leadership. This article describes the process to institute systematic change after identifying a need to improve nursing care for the students who frequented the health office for mental health issues during the school year. While utilizing the National Association of School Nurses’ (NASN) Framework, this nurse created a program to address the mental health needs of the students while focusing on the essential selfmanagement and self-awareness skills required to manage and cope with the stress of childhood today.
Magnitude and determinants of drug therapy problems among type 2 diabetes mellitus patients with hypertension in Ethiopia
Authors: Kefale Belayneh , Tegegne Gobezie T , Kefale Yitayih , Molla Mulugeta , Ewunetei Amien , Degu Amsalu
Published: September 2020

Introduction:

Type 2 diabetes mellitus patients with hypertension are at high risk of drug therapy problems since they are subject to receive multiple drug therapies due to comorbidities.

Objectives:

To determine the magnitude of drug therapy problems and its determinants among Type 2 diabetes mellitus patients with hypertension.

Methods:

A cross-sectional study was employed among 423 randomly selected participants based on the inclusion criteria. A structured questionnaire and review of patients’ medical record were employed in the data collection. The classification system used by Cipolle was used to classify and evaluate drug therapy problems. Data were analyzed using Statistical Package for the social sciences version 25.0 software. Multivariate logistic regression analysis was used to identify determinants of drug therapy problems with a statistical significance of p ⩽ 0.05.

Results:

A total of 491 drug therapy problems with a mean of 1.86 ± 0.53 drug therapy problems per patient were identified, and 62.4% (264) of them experienced at least one drug therapy problem. Non-compliance (197, 40.1%), needs of additional drug therapy (119, 24.2%), and dosage too low (91, 18.5%) were the most frequently observed drug therapy problems in the study setting. Anti-diabetic medications (88.4%), statins (44.5%), and aspirin (33.5%) were the most commonly involved drugs in drug therapy problems. The determinants of drug therapy problems were very low family income (adjusted odds ratio = 4.64, p  = 0.010), age (45–65 years old) (adjusted odds ratio = 2.55, p = 0.008), presence of comorbidity (adjusted odds ratio = 9.19, p < 0.001), and taking ⩾5 medications (adjusted odds ratio = 2.84, p = 0.001).

Conclusion:

Approximately three out of five patients had one or more drug therapy problems encountered. In this study, the most common types of drug therapy problems were non-compliance, needs additional drug therapy, and dosage too low. Family monthly income, age, comorbidities, and number of medications were the significant determinants of drug therapy problems. Therefore, patient education regarding medication adherence, routine medication review, and strengthening clinical pharmacy services should be promoted.
Return on Investment of Workplace Wellness: Evidence From a Long-Term Care Company
Authors: Unsal Nilay , Weaver GracieLee , Bray Jeremy W. , Bibeau Daniel , Saake Garrett
Published: September 2020

Background:

Workplace wellness programs (WWPs) are increasingly promoted by businesses and governments as an important strategy to improve workers’ overall health and well-being and to reduce health care and other organizational costs. Few studies have evaluated WWPs in small businesses to provide evidence on the potential return-on-investment (ROI) that WWPs might yield. This study aimed to fill this gap by presenting a quasi-experimental, ROI analysis of a WWP in a small company.

Methods:

This observational quasi-experimental study evaluated economic outcomes of a multicomponent WWP implemented by a small long-term care company. The company provided approximately 2 years of de-identified, individualized data on its employees for 2013–2015. There were 116 WWP participants and 323 nonparticipants. Difference-in-differences models were used to evaluate the program using organizational costs and ROI estimates.

Findings:

The estimated program cost was $132.692 (95% confidence interval [CI]: [$112.957, $156.101]) per participant and the estimated organizational costs savings were $210.342 (95% CI: [−4354.095, 2002.890]). The WWP achieved an ROI of $0.585 (95% CI: [−$35.095, $14.103]) per participant. Although not statistically significant, the results suggest that the WWP saved $1.585 for every $1 invested.

Conclusions/Application to Practice:

These results suggest that the evaluated WWP yielded a positive, although nonsignificant, ROI estimate. While ROI is still one of the most common evaluation metrics used in workplace wellness, few studies present ROI estimates of WWPs in small companies. Given policy efforts to promote WWPs in small businesses, there is a need to conduct high-quality ROI analyses for WWPs in smaller companies.
Endoscopic resection of scar tissues and bone graft with an intramedullary nail left in situ for distal femoral nonunion after nailing: A case report
Authors: Tsujii Masaya , Odake Kazuya , Nishimura Akinobu , Nishimura Makoto , Sudo Akihiro
Published: September 2020

Femoral shaft nonunion after the intramedullary nailing has been successfully treated with advances in surgical technique. Nonetheless, the techniques cause morbidity to periosteum at the fracture site. We report the case of a 67-year-old man who underwent endoscopic surgery for refractory nonunion following the fracture of the distal femoral shaft, despite two fixations using an interlocking nail. In addition, the patient had uncontrolled diabetic mellitus. Endoscopy allowed us to acquire a clear view of the nonunion site, in which the resection of scar tissues and the packing of the cancellous bone were performed. At the final follow-up, bone healing was observed, and the patient was able to return to normal daily and social activity.
A Current Concepts Review of Clavicle Injuries in Ice Hockey From Sternoclavicular to Acromioclavicular Joint
Authors: Jang Eugene S. , Park Caroline N. , Levine William N. , Popkin Charles A.
Published: September 2020

Clavicle injuries are common in ice hockey, and a number of high-profile fractures and dislocations have occurred in elite hockey players in recent years. Acromioclavicular joint injuries, clavicle fractures, and sternoclavicular joint injuries are some of the most frequent hockey-related injuries treated by orthopaedic surgeons, and familiarity with the management of these injuries and sport-specific considerations for treatment and recovery are critical. Injuries involving the clavicle can sometimes be life-threatening, and subtle findings on physical examination and radiographic studies can have profound implications for treatment. The recent literature pertinent to the diagnosis and treatment of clavicle-related injuries in ice hockey players was reviewed and compiled into a clinical commentary. For ice hockey players, the upper extremity was traditionally considered a relatively well-protected area. However, given the evolution of the game and its protective equipment, the upper extremity now accounts for the majority of youth ice hockey injuries, of which clavicle injuries comprise a significant proportion. Acromioclavicular joint injuries are the most common injury in this population, followed closely by clavicle fractures. Sternoclavicular joint injuries are rare but can be associated with serious complications. The treatment of these injuries often differs between athletes and the general population, and surgical indications continue to evolve in both groups. Although the evidence regarding clavicle injuries is ever-increasing and the treatment of these injuries remains controversial, clavicle injuries are increasingly common in ice hockey players. Rule and equipment changes, most notably the increased use of flexible boards and glass, have been shown to significantly decrease the risk of clavicle injuries. We also recommend compulsory use of shoulder pads, even at a recreational level, as well as continued enforcement and evolution of rules aimed at reducing the rate of clavicle injuries. Future research should focus on equipment design changes directed toward clavicle injury prevention, standardized return-to-play protocols, and studies weighing the risks and benefits of nonoperative management of controversial injuries, such as type III acromioclavicular joint dislocations and diaphyseal clavicle fractures.
The bleeding with antithrombotic therapy study 2: Rationale, design, and baseline characteristics of the participants
Authors: Takagi Masahito , Tanaka Kanta , Miwa Kaori , Sasaki Makoto , Koga Masatoshi , Hirano Teruyuki , Kamiyama Kenji , Yagita Yoshiki , Nagakane Yoshinari , Hoshino Haruhiko , Terasaki Tadashi , Yakushiji Yusuke , Kudo Kohsuke , Ihara Masafumi , Yoshimura Sohei , Yamaguchi Yoshitaka , Shiozawa Masayuki , Toyoda Kazunori ,   for BAT2 Investigators
Published: September 2020

Aims

The bleeding risk of current antithrombotic strategies in clinical settings, including recently developed agents, needs to be clarified.

Methods and Design

In an investigator-initiated, prospective, multicentre, observational study, patients with cerebrovascular or cardiovascular diseases who were taking oral antiplatelet or anticoagulant agents were enrolled. Compulsory multimodal magnetic resonance images were acquired at baseline to assess cerebral small vessel disease. Six-month follow-up will be performed for two years. The primary outcome is major bleeding as defined by the International Society on Thrombosis and Hemostasis.

Results

Between October 2016 and March 2019, 5306 patients (71.7 ± 11.2 years old, 1762 women) were enrolled. Previous intracranial haemorrhage was documented in 181 patients (3.4%), cerebrovascular disease (including asymptomatic) requiring antithrombotic therapy in 5006 patients (94.3%), and atrial fibrillation in 1061 patients (20.0%). At entry, 3726 patients (70.2%) were taking antiplatelet agents alone, including 551 (10.4%) using dual antiplatelet agents, 1317 (24.8%) taking anticoagulants alone, and the remaining 263 (5.0%) taking both. The leading antiplatelet agent was clopidogrel (2014 patients), and the leading combination of dual antiplatelet medication was clopidogrel plus aspirin (362). Use of direct oral anticoagulants (1029 patients, 19.4%) exceeded warfarin use (554, 10.4%). The number of pivotal bleeding events exceeded 200 in April 2020.

Conclusions

This study is expected to provide the incidence of bleeding complications of recent oral antithrombotics in clinical practice and identify their associations with underlying small vessel disease and other biomarkers. Novel risk stratification models for bleeding risk will be able to be created based on the study results.