bluuebunny/crossref_metadata_2025 huggingface dataset:
National Trends of Pediatric Aspirated/Ingested Foreign Bodies
Authors: Saw-Aung Monica , Kong Ryan M. , Cipriano Natalie , Daniels Adam , Newen Naomi L. , Goldstein Nira A. , Plum Ann W.
Published: June 2023

Foreign body (FB) aspiration/ingestion in children represents a major cause of hospital admission and mortality. Evaluating risk factors and identifying trends in specific FB products could improve targeted health literacy and policy changes. A cross-sectional study querying emergency department patients less than 18 years old with a diagnosis of aspirated/ingested FB was conducted using the National Electronic Injury Surveillance System database between 2010 and 2020. Incidence rates per 100 000 people-year were calculated and multivariate analyses were performed to identify risk factors for hospital admission and mortality. There has been a significantly decreasing rate of aspirated (−23.6%; P = .013) but not ingested FB (−9.4%; P = .066) within the study period. Within pediatric aspirated FB, black compared with white patients had decreased odds of same hospital admission (odds ratio [OR]: 0.8), but increased odds of transfer admission (OR: 1.6) and mortality (OR: 9.2) (all, P < .001).
Challenges and opportunities for teaching Italian as a second language: A case study at the University of Toronto Mississauga
Authors: Casini Simone
Published: June 2023

This article analyses the current condition of teaching Italian abroad and the ways in which second-language programmes can engage learners and meet their educational goals. While we are aware of the need for systematic action amongst various actors to ensure the future of Italian-language teaching, we choose to focus on the concept of Experiential Learning (EL). EL is a didactic action (i.e. a linguistic policy) which can be directly implemented into university courses or programmes and represents an innovative method of teaching Italian as a second language. Research on the theme of EL was conducted on Italian L2 courses at the University of Toronto Mississauga and involved instructors and students from various departments. These results lay the foundation for the creation of concrete educational policies, consistent with international literature on the action-oriented approach (CEFR, ACTFL), and for the ‘power of feasibility’ of individual classes (and individual teachers) of L2.
Book review: Jean-Francois Salles, Sources on the Gauda Period in Bengal: Essay in Archaeology
Authors: De Nilanjan
Published: June 2023

Jean-Francois Salles, Sources on the Gauda Period in Bengal: Essay in Archaeology (Delhi: Primus Book, 2020), xvi + 249 pp., ₹1,095, ISBN: 9789390022847 (Hardback).
Racial/Ethnic Differences in the Predictive Utility of Psychosocial Determinants of COVID-19 Vaccination Intentions
Authors: Pierce Jace D. , Segundo Joahana , Derrick Jaye L.
Published: June 2023

Purpose

To test whether the impact of subjective norms, race/ethnicity-specific descriptive norms, vaccine conspiracy beliefs, and prosocial concern on COVID-19 vaccination intentions differs by race/ethnicity for young adults.

Design

Cross-sectional study.

Setting

May-August 2021 in Texas.

Subjects

Racially/ethnically diverse unvaccinated college students (N = 314).

Measures

COVID-19 vaccination intentions, theory-driven constructs (eg, perceived susceptibility), vaccine conspiracy beliefs, prosocial concern, and social norms.

Analysis

Block-sequential multiple Tobit regression.

Results

Results revealed three significant two-way interactions between race/ethnicity and (1) subjective norms, F (5, 251) = 2.28, P < .05; (2) COVID-19 vaccine conspiracy beliefs, F (5, 251) = 2.88, P < .05; and (3) prosocial concern, F (5, 251) = 2.61, P < .05. There was a positive association between subjective norms and intentions for European and African Americans, a positive association between prosocial concerns and intentions for European and multiracial/multiethnic Americans, and a negative association between conspiracy beliefs and intention for Hispanics. The interaction between race/ethnicity and race/ethnicity-specific descriptive norms was not significant, F (5, 251) = 1.09, P = .37.

Conclusion

Although based on a relatively small sample, our findings suggest the importance of culturally tailoring COVID-19 vaccination messages to correct conspiracy beliefs, signaling a positive subjective norm, and enhancing prosocial concerns for specific racial-ethnic groups.
The marginalization of policy integration: Dynamics of integrated policymaking in the periphery of bureaucracy
Authors: Joosse Hans , van Buuren Arwin
Published: June 2023

Governmental organizations face the challenge to integrate different sectoral policy perspectives and interests to deal effectively with the wicked issues of late-modern societies. This article delves into attempts of governmental organizations to realize such integrated policies and unravels the intra-organizational dynamics of collaborating on policy integration.

Based on two in-depth case studies from The Netherlands, one focusing on public transport for specific target groups in the city of Rotterdam and the other focusing on a national policy program for criminal youth groups, we show how attempts at policy integration take place in the periphery of bureaucracies by temporary program teams. After the abolishment of the program team, the integrated policy easily volatilizes because of the lack of foothold and ownership in the line organization. Ironically, policy integration becomes a differentiated activity in the margins of public organizations rather than a joint exercise of sectoral organizational units.

We present three explanatory hypotheses of this dynamic of marginalization. First, from a system-psychodynamic perspective, the line organization and the program team maintain distance from each other to reduce the tensions that are inherent in policy integration. Second, from an institutional perspective, the line organization marginalizes policy integration to protect their sectoral and vested interests. Third, from an innovation perspective, however, innovative policy integration does need the margins of organizations to protect itself against conservative reflexes from bureaucracies at risk of becoming marginalized and alienated. To facilitate a productive dynamic of policy integration in governmental organizations, this article concludes with providing the components for such an organizational design.
Novel robust approach–based dynamic global terminal synergetic tracking control for uncertain second-order systems: Wind turbine system and power converter applications
Authors: Halledj Salah Eddine , Bouafassa Amar
Published: June 2023

This article provides a systematic approach for synthesizing a novel robust synergetic control mechanism. This controller employs a dynamic global terminal synergetic surface with additional sinusoidal function. The overall macrovariable gives the system a rapid approaching rate, maintains the finite time stability, and provides a chattering-free control law. The stability analysis is validated for any uncertain second-order system via indirect approach of Lyapunov theorems. Furthermore, a hyperbolic tangent nonlinear disturbance observer is designed in order to estimate any lumped disturbance. The feasibility and the effectiveness of the proposed composite control law is tested and evaluated through simulations for simple model, wind turbine system and DC-DC buck converter. Finally, the simulation results show that the presented dynamic global terminal synergetic control–based hyperbolic tangent nonlinear disturbance observer can effectively reject the disturbances, enhance the robustness, and guarantee the tracking accuracy and rapidity.
Book review: Sanjeev Kumar (ed.), China’s BRI in Different Regions of the World: Cooperation, Contradictions and Concerns
Authors: Singh Gunjan
Published: June 2023

Sanjeev Kumar (ed.), China’s BRI in Different Regions of the World: Cooperation, Contradictions and Concerns. Indian Council of World Affairs and KW Publishers, 2022, pp. 398, ₹1299, ISBN: 978-93-83445-64-6.
Careers in Disarray? COVID-19 and Self-Perceived Employability
Authors: Ren Shuang , Islam Mohammad Tarikul , Chadee Doren
Published: June 2023

The COVID-19 pandemic has produced disruptions to the employment and higher education contexts, exacerbating complexities involved in one’s assessment of their opportunities of employment in these contexts. The career literature has largely overlooked a vulnerable population of potential job candidates (i.e., final-year MBA students) who are at a critical juncture in response to COVID-19 career shock. Drawing from the challenge-hindrance appraisal framework, this research aims to theorize and test a moderated-mediation model in terms of how COVID-19 career shock associates with self-perceived employability. We use a simple random sampling procedure to collect data from 301 final year MBA students in Australia at the peak of the COVID-19 pandemic. The findings show that COVID-19 career shock can be perceived both as a challenge and a hindrance, which in turn associates with self-perceived employability differently. Results further demonstrate that the extent to which COVID-19 career shock is perceived as a challenge or hindrance is moderated by one’s career networking behavior. This research is a timely response to research calls for understanding how the COVID-19 has an impact on people’s work and career with a particular focus on a vulnerable yet under-studied group of labor force in the career literature.
A Qualitative Study of Health Equity’s Role in Community Coalition Development
Authors: Chen Sadie , Walt Galya , Aldrich Alison , McAlearney Ann Scheck , Linas Benjamin , Amuchi Brenda , Freedman Darcy A. , Goddard-Eckrich Dawn , Gibson Erin , Hartman, MS Jeanie , Bosak Julie , Lunze Karsten , Jones Latasha , Christopher Mia , Salsberry Pamela , Jackson Rebecca , Back Sandi , Drainoni Mari-Lynn , Walker Daniel M.
Published: June 2023

Opioid overdose deaths are dramatically increasing in the United States and disproportionately affecting minority communities, with the increasing presence of fentanyl exacerbating this crisis. Developing community coalitions is a long-standing strategy used to address public health issues. However, there is a limited understanding of how coalitions operate amid a serious public health crisis. To address this gap, we leveraged data from the HEALing Communities Study (HCS)—a multisite implementation study aiming to reduce opioid overdose deaths in 67 communities. Researchers analyzed transcripts of 321 qualitative interviews conducted with members of 56 coalitions in the four states participating in the HCS. There were no a priori interests in themes, and emergent themes were identified through inductive thematic analysis and then mapped to the constructs of the Community Coalition Action Theory (CCAT). Themes emerged related to coalition development and highlighted the role of health equity in the inner workings of coalitions addressing the opioid epidemic. Coalition members reported seeing the lack of racial and ethnic diversity within their coalitions as a barrier to their work. However, when coalitions focused on health equity, they noted that their effectiveness and ability to tailor their initiatives to their communities’ needs were strengthened. Based on our findings, we suggest two additions to enhance the CCAT: (a) incorporating health equity as an overarching construct that affects all stages of development, and (b) ensuring that data about individuals served are included within the pooled resource construct to enable monitoring of health equity.
A Mixture Model for Random Responding Behavior in Forced-Choice Noncognitive Assessment: Implication and Application in Organizational Research
Authors: Peng Siwei , Man Kaiwen , Veldkamp Bernard P. , Cai Yan , Tu Dongbo
Published: June 2023

For various reasons, respondents to forced-choice assessments (typically used for noncognitive psychological constructs) may respond randomly to individual items due to indecision or globally due to disengagement. Thus, random responding is a complex source of measurement bias and threatens the reliability of forced-choice assessments, which are essential in high-stakes organizational testing scenarios, such as hiring decisions. The traditional measurement models rely heavily on nonrandom, construct-relevant responses to yield accurate parameter estimates. When survey data contain many random responses, fitting traditional models may deliver biased results, which could attenuate measurement reliability. This study presents a new forced-choice measure-based mixture item response theory model (called M-TCIR) for simultaneously modeling normal and random responses (distinguishing completely and incompletely random). The feasibility of the M-TCIR was investigated via two Monte Carlo simulation studies. In addition, one empirical dataset was analyzed to illustrate the applicability of the M-TCIR in practice. The results revealed that most model parameters were adequately recovered, and the M-TCIR was a viable alternative to model both aberrant and normal responses with high efficiency.
Stratification of Risk Factors of Lung Cancer-Associated Venous Thromboembolism and Determining the Critical Point for Preemptive Intervention: A Systematic Review With Meta-analysis
Authors: Nwagha Theresa , Nweke Martins
Published: June 2023

Background:

Several biomarkers or risk factors have been identified and several prediction models exist. The major limitations inherent in these models include cost-ineffectiveness and lack of systematic stratification of risk factors resulting in the inclusion of clinically insignificant biomarkers in the models. This review aimed to systematically stratify the risk factors of lung cancer-associated venous thromboembolism (VTE) and determine the critical point for preemptive intervention.

Methods:

This systematic review was structured as per the Preferred Reporting Item for Systematic Reviews and Meta-analyses. We searched MEDLINE, PubMed, Cochrane Library, CINAHL, Academic Search Complete, and PsycINFO from the onset to June 2022. We included studies that reported the risk factors of lung cancer-associated VTE and corresponding risk estimates, irrespective of treatment status but studies were excluded if patients were on anti-VTE medications. We employed random effects models of meta-analysis and computed risk stability index and risk weight (Rw) to achieve the review objectives. The review protocol is registered with PROSPERO (CRD42022336476).

Results:

The clinically significant risk factors of VTE in lung cancer patients were D-dimer (odds ratio [OR] = 5.510, 95% CI = 2.6-11.7; Rw = 5.0), albumin (OR = 2.2, 95% CI = 1.0-4.8; Rw = 1.79), leukocyte (OR = 2.48, 95% CI = 1.9-3.2; Rw = 1.77), histological type (OR = 1.69 , 95% CI = 1.2-2.4; Rw = 1.3), age (OR = 1.56; Rw = 0.99), and hemoglobin (OR = 1.85, 95% CI = 1.3-2.6; Rw = 0.92). Based on the distribution of Rw across risk factors, the critical point (upper third of the upper quartile class) was 4.5 and may mark the point at which preemptive intervention should be commenced.

Conclusions:

Targeted screening for VTE in lung cancer patients could be patient-specific and should be based on a combination of the most significant risk factors required to meet the critical point, provided that such a combination is affordable as illustrated in the ALBAH model.

Registration:

The review protocol is registered with PROSPERO (ID: CRD42022336476).
Practice patterns in diagnostics, staging, and management strategies of gallbladder cancer among Nordic tertiary centers
Authors: Takala Sini , Lassen Kristoffer , Søreide Kjetil , Sparrelid Ernesto , Angelsen Jon-Helge , Bringeland Erling A. , Eilard Malin S. , Hemmingsson Oskar , Isaksson Bengt , Karjula Heikki , Lammi Jukka-Pekka , Larsen Peter N. , Lavonius Maija , Lindell Gert , Mortensen Frank V. , Mortensen Kim , Nordin Arno , Pless Torsten , Sandström Per , Sandvik Oddvar , Vaalavuo Yrjö , Villard Christina , Sallinen Ville
Published: June 2023

Background and objective:

Gallbladder cancer (GBC) is a rare malignancy in the Nordic countries and no common Nordic treatment guidelines exist. This study aimed to characterize the current diagnostic and treatment strategies in the Nordic countries and disclose differences in these strategies.

Methods:

This was a survey study with a cross-sectional questionnaire of all 19 university hospitals providing curative-intent surgery for GBC in Sweden, Norway, Denmark, and Finland.

Results:

In all Nordic countries except Sweden, neoadjuvant/downstaging chemotherapy was used in GBC patients. In T1b and T2, majority of the centers (15–18/19) performed extended cholecystectomy. In T3, majority of the centers (13/19) performed cholecystectomy with resection of segments 4b and 5. In T4, majority of the centers (12–14/19) chose palliative/oncological care. The centers in Sweden extended lymphadenectomy beyond the hepatoduodenal ligament, whereas all other Nordic centers usually limited lymphadenectomy to the hepatoduodenal ligament. All Nordic centers except those in Norway used adjuvant chemotherapy routinely for GBC. There were no major differences between the Nordic centers in diagnostics and follow-up.

Conclusions:

The surgical and oncological treatment strategies of GBC vary considerably between the Nordic centers and countries.
Arts-based research with immigrant and racialized older adults: A scoping review
Authors: Salma Jordana , Mirhashemi Bita , Kennedy Megan
Published: June 2023

This scoping review aims to describe the range of research studies using arts-based data collection methods with immigrant and racialized older adults. A secondary aim is to identify challenges and strengths of using these approaches with this population. This review uses Arksey and O'Malley’s five-stage scoping review framework with a final number of 16 references included for the study. Enhanced social connectedness, increased transparency and quality of findings, and self-empowerment were key strengths of using arts-based approaches for data collection. Challenges identified included resource limitations, cultural and language barriers, and barriers to meaningful engagement. Only a small number of studies have utilized arts-based methods with immigrant and racialized older adults. Arts-based approaches require unique methodological adaptations with this population but have the potential to increase engagement in research activities, authenticity of research findings and empowerment of older adults.
True Crime Television as ‘Popular Legality’: Affect, Testimonial Injustice, and the Criminal (In)Justice System in Ava DuVernay’s When They See Us
Authors: Thiem Annika
Published: June 2023

This article examines the Netflix true crime series When They See Us (2019) as a form of “popular legality” (Olson 2022). I argue that the show criticizes structural racism in the US criminal justice system and emphasizes this critique on a level of affect. More precisely, it is through an affective engagement of the audience with the show’s protagonists that When They See Us highlights how Black and Latinx communities are discriminated by US law and the criminal justice system. It thereby not only depicts African American and Latinx legal identities as marginalized by the law and legal system, but makes viewers able to feel them to be so. In addition, I argue that the show negotiates issues of testimonial injustice as one form of discrimination against People of Color in the US legal system. This negotiation of testimonial injustice also primarily takes place on a level of affect by inviting the audience to feel the effects that testimonial injustice has on the show’s protagonists.
A discussion on practices and characteristics of science and technology diplomacy in twentieth-century China
Authors: Li Zheng , Cui Fujuan , Wang Zining
Published: June 2023

Scientists and diplomats have significant differences in professional skills, activity time and work content, but they should work together. With the deepening impact of science and technology (S&T) on socio-economic development and international relations, S&T has become a crucial component of national strategies, particularly for diplomacy. There is a need for scientific evidence and advice, meaning that mastering more knowledge and skills in S&T would be helpful in negotiations. This paper analyses the ideas of S&T diplomacy, including a review of its 40-year history in China, its definition (with detailed connotations) and its characteristics. The paper focuses on the significant role of people-to-people communication in S&T, which may inform future work. Five suggestions are given to strengthen the strategic planning of S&T diplomacy: (1) A more clarified, strategic goal of future-oriented S&T diplomacy is required; (2) It is important to build a theoretical system for China to describe S&T diplomacy; (3) The creation of a global S&T cooperation map that adapts to the new type of international relations would be valuable; (4) Fairness and justice shall be maintained, while a reform of the global S&T governance system is promoted; (5) It is a must to adhere to bottom-line thinking and strengthen risk prediction and emergency responses.
‘GITA’ Cannot wait…
Authors: Krishnan Ganesh
Published: June 2023

The author is a career banker with over 30 years of working experience. The job has given him an opportunity to interact extensively with people from all parts of India. One similarity that is profound, cutting across the landscape of this country, be it a farmer in a rural village in Gujarat, Executive Director of a Public Sector Undertaking in Delhi, a start-up entrepreneur in Bengaluru, or a motivational speaker in Chennai, the Indian DNA is dominated by Karma Theory and we Indians live the ‘Gita’ subconsciously. The article is an attempt to highlight the same for the students and the youth of our country.

The work is subsequent to the current government’s announcement regarding the introduction of Gita as a part of the academic curriculum and the protests that followed against its implementation. The work brings out that Gita is a psychological treatise cutting across age, sex and affiliations. The work breaks the myth that Gita is post-retirement entertainment and establishes that it is a weapon that enables an individual to fight the daily battles of life. The Gita is the nerve centre of Indian culture and has influenced its civilisation. Gita meets the spiritual, emotional and cultural needs of a seeker and enhances resilience of the individual. So, hurry up, as Gita cannot wait.

‘GITA’ Cannot wait ….
Listening to Cancer Patients’ Narratives During Residency: A Pilot Study on a Communication Skills’ Workshop Involving Patients-Partners
Authors: Rivest Jacynthe , Karazivan Philippe , Desbeaumes Jodoin Véronique , Flora Luigi , Lambert Carole , Tranulis Constantin , Daneault Serge
Published: June 2023

The field of cancer care still lacks best practices in communication. Few postgraduate training programs offer formal training to develop such skills. The patient partnership has been used in medical education to increase the sensitivity of the subjective experiences of patients. In our Canadian center, residents and patient-partners participated in an educational workshop on communication focusing on patient's narrative. The aim of this pilot qualitative study was to explore the experiences of participants in the workshop. Using theoretical sampling, we recruited 6 residents and 6 patient-partners. Semi-structured interviews were conducted and transcribed. A thematic analysis was performed. From analysis, 4 themes emerged: (1) lack of communication skills training; (2) barriers to effective communication in cancer care; (3) the empathy of patient-partners towards the communication challenges faced by residents; and (4) the participants’ reactions to the workshop. Based on our findings, our communication skills workshop centered on narrative medicine and involving patient-partners appears feasible. Future research could study its pedagogical value and the optimal learning environment required.
Personalization and Learning Outcome in a Nursing Pathophysiology and Pharmacology Course: Canvas© Mastery Adoption Pilot Study
Authors: Hinkle Julie F.
Published: June 2023

Introduction

Personalized learning has been shown to improve learning outcomes. The aim of this pilot was to test a tool embedded in the Canvas© learning platform to improve personalization and collect data to see if the available level of personalization employed improved learning outcomes.

Methods

A nursing pathophysiology and pharmacology course was redesigned using the Canvas© Mastery Paths feature to provide personalized learning content to students. Post-class quiz grades were used to trigger Canvas© to conditionally release content review materials to students who did poorly on the quiz and provide a second quiz to test the efficacy of supplementary review materials. Data from the redesigned course was compared to the previous semester's course data.

Results

Use of Canvas© Master Paths to conditionally release supplementary material to poorly performing students resulted in significant improvement in course grades and certain activity scores correlated with improved course and ATI© quiz means.

Conclusion

The degree of personalization of course content available with Master Paths has the potential to have a positive impact on learning outcomes.
Investigating New Literacies Among Teacher Educators: A Multi-Institution Collaborative Self-Study
Authors: Nash Brady Lee , Karkar Esperat Tala Michelle , Pierce Kathryn Mitchell , Shimek Courtney H. , Rose Crystal Dail , Ivanyuk Lyudmyla , Fletcher Lauren
Published: June 2023

This multi-institutional, collaborative self-study explores how teacher educators learn to embed new literacies (NL) in teacher education coursework. Utilizing collaborative self-study methodology, seven faculty engaged in a year-long collaborative study focused on the incorporation of NL in preservice teacher education courses, meeting regularly over the course of the year to share reflections, provide feedback to one another, and continually revise course and assignment designs related to NL. Data sources included recordings of collaborative planning meetings, written reflections, annotated teaching artifacts, notes and transcripts from partner and whole group recorded Zoom sessions and post-meeting reflections. The findings describe diversity in both conceptualizing and teaching NL, parallels between teacher educators’, preservice teachers’ and P-12 teachers’ challenges integrating NL into their teaching, and institutional barriers to collaborative study, curricular revision, and the use of new technologies. The authors discuss these findings in relation to the potential value of multi-institutional study groups and collaborative self-study as a methodology for helping support literacy teacher educators’ ongoing learning.
Subclonal TP53 mutations are frequent and predict resistance to radioimmunotherapy in follicular lymphoma
Authors: Burack W. Richard , Li Hongli , Adlowitz Diana , Spence Janice M. , Rimsza Lisa M. , Shadman Mazyar , Spier Catherine M. , Kaminski Mark S. , Leonard John P. , Leblanc Michael L. , Smith Sonali M. , Friedberg Jonathan W.
Published: June 2023

Although TP53 is commonly mutated in transformed follicular lymphoma, mutations are reported in <5% of pretreatment follicular lymphoma (FL) specimens. We assayed archival follicular B-cell non-Hodgkin lymphoma specimens from a completed clinical trial, Southwest Oncology Group S0016, a phase 3 randomized intergroup trial of CHOP (cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisone) chemotherapy plus R-CHOP (rituximab-CHOP) compared with CHOP chemotherapy plus 131-iodine tositumomab (radioimmunotherapy [RIT]-CHOP). Subclonal TP53 mutations (median allele frequency 0.02) were found in 25% of diagnostic FL specimens and in 27% of a separate validation cohort. In the R-CHOP arm, pathogenic TP53 mutations were not associated with progression-free survival (PFS) (10-year PFS 43% vs 44%). In contrast, among patients with no detectable pathogenic TP53 mutation, RIT-CHOP was associated with a longer PFS than with R-CHOP (10-year PFS 67% vs 44%; hazard ratio = 0.49; P = .008). No relationship was detected between PFS and the extent of activation-induced cytidine deaminase (AICDA)–mediated heterogeneity. In summary, subclonal TP53 mutations are common in FL and are a distinct phenomenon from AICDA-mediated genetic heterogeneity. The absence of a detectable subclonal mutation in TP53 defined a population that particularly benefited from RIT.
What can we learn from biodegradation of natural polymers for regulation?
Authors: Hahn Stefan , Hennecke Dieter
Published: June 2023

Synthetic polymers are chemicals of emerging concern for the environment, which is mainly attributed to their persistence in environmental compartments. On the other hand, polymers exist in nature as well. They are regarded of no concern for the environment. The present article focusses on the environmental fate of natural polymers and the implications on the persistence assessment for synthetic polymers. Natural polymers vary widely in structure, function, and properties. Crystallinity, wettability and surface area are important influencing factors on the (bio)degradation kinetics. Chemical and enzymatic hydrolysis is the most important process for the degradation of natural polymers, which for particulate material takes place either by bulk or surface erosion. Some natural polymers are degraded rapidly, but in other cases, degradation of natural polymers takes very long until complete mineralization. These differences in biodegradability are a result of evolution as they have to fulfil specific functions in nature which might require a certain persistency. Consequently, many natural polymers would have to be considered persistent or very persistent (P or vP) based on the available studies using the standard assessment approach. At the same time, they are considered no concern to the environment for good reasons. The analysis emphasizes that mineralization alone is not a resilient persistence endpoint for polymers. This needs to be recognized when assessing synthetic polymers, many of which would fulfil the existing P/vP criteria as well. For such synthetic polymers, it would be important to establish meaningful endpoints and polymer specific criteria to enable an adequate persistence assessment using a weight-of-evidence approach.
The effect-site concentration of remifentanil blunting endotracheal intubation responses during anesthesia induction with etomidate: a dose-finding study
Authors: Jiang Zhencong , Xiao Jun , Wang Xiaoqing , Luo Tao
Published: June 2023

Background

Remifentanil can inhibit the hemodynamic responses caused by endotracheal intubation, but the effect-site concentration of it required to control intubation responses when combined with etomidate has not been demonstrated. The purpose of this study was to determine the effect-site concentration of remifentanil blunting tracheal intubation responses in 50% and 95% of patients (EC50 and EC95) during etomidate anesthesia.

Methods

American Society of Anesthesiologists physical status (ASA) I-II elective surgical patients receiving target-controlled infusion (TCI) of remifentanil, followed by etomidate and rocuronium for anesthesia were enrolled. The Belive Drive A2 monitor was used to calculate the MGRSSI (Maygreen Sedative state index) of hypnotic effect and the MGRNOX (Maygreen Nociception index) of nociception. The MGRSSI and the MGRNOX value were generated every 1 s. Mean arterial pressure (MAP) and heart rate (HR) were measured every minute, noninvasively. Using the modified Dixon’s up-and-down method, the concentration of remifentanil was determined based on the intubation response of the previous patient. The cardiovascular response during endotracheal intubation was defined as positive when MAP or HR is 20% higher than the pre-intubation value. A probit analysis was used for calculating EC50, EC95 and 95% confidence interval (CI).

Results

The EC50 and EC95 of remifentanil blunting tracheal intubation responses were found to be 7.731 ng/ml (95%CI: 7.212–8.278 ng/ml) and 8.701 ng/ml (95%CI: 8.199–11.834 ng/ml). There were statistically significant increases in HR, MGRSSI and MGRNOX value to tracheal intubation in the positive responses group compared to the negative group. The most common adverse event was postoperative nausea and vomiting, which occurred in 3 patients.

Conclusion

Remifentanil effect-site concentration of 7.731 ng/ml is effective in blunting sympathetic responses to tracheal intubation in 50% of patients when combined with etomidate anesthesia.

Trial registration

The trial was registered at the Chinese Clinical Trials Registry (www.chictr.org.cn, registration number: ChiCTR2100054565, date of registration: 20/12/2021).
Impact and usefulness of the transition to the new MAFLD classification for non-B, non-C HCC: a retrospective cohort study
Authors: Johira Yusuke , Nakahara Takashi , Kinami Takahiro , Yamasaki Shintaro , Kosaka Masanari , Shirane Yuki , Miura Ryoichi , Murakami Serami , Yano Shigeki , Amioka Kei , Naruto Kensuke , Ando Yuwa , Kosaka Yumi , Kodama Kenichiro , Uchikawa Shinsuke , Fujino Hatsue , Ono Atsushi , Murakami Eisuke , Okamoto Wataru , Yamauchi Masami , Kawaoka Tomokazu , Hayes C. Nelson , Tsuge Masataka , Imamura Michio , Aikata Hiroshi , Oka Shiro
Published: June 2023

Background

Metabolic dysfunction-associated fatty liver disease (MAFLD) represents a new classification system for fatty liver disease. In this study, we investigated the clinical characteristics of patients with MAFLD-hepatocellular carcinoma (HCC) in comparison with those with nonalcoholic fatty liver disease (NAFLD) and considered the validity and challenges of the new criteria.

Methods

This study included 237 untreated non-B, non-C HCC patients with hepatic steatosis. We examined the profile and laboratory findings of patients with MAFLD-HCC and NAFLD-HCC. We also classified MAFLD-HCC patients according to the factors on which the diagnosis was based and compared their clinical characteristics.

Results

A total of 222 (94%) and 101 (43%) patients were diagnosed with MAFLD and NAFLD, respectively. MAFLD-HCC patients were more likely to be male than NAFLD-HCC, but there were no significant differences in metabolic indices, noninvasive liver fibrosis score or HCC status. In a study of MAFLD-HCC patients by diagnostic factor, those with overweight only were younger and had advanced liver fibrosis histologically, and when limited to patients younger than 70 years, the majority were overweight. Redefinition of overweight as BMI ≥ 25 reduced the number of MAFLD-HCC patients by only 5, from 222 to 217.

Conclusions

MAFLD accounted for the majority of non-B, non-C HCC cases with hepatic steatosis. Examination of additional cases and revision of the detailed criteria is needed so that it can be used to efficiently select patients with fatty liver who are at high risk of developing HCC.
Prophylactic noninvasive respiratory support in the immediate postoperative period after cardiac surgery - a systematic review and network meta-analysis
Authors: Zhou Xiaoyang , Pan Jianneng , Wang Hua , Xu Zhaojun , Zhao Long , Chen Bixin
Published: June 2023

Background

Noninvasive respiratory support has been increasingly applied in the immediate postoperative period to prevent postoperative pulmonary complications (PPCs). However, the optimal approach remains uncertain. We sought to evaluate the comparative effectiveness of various noninvasive respiratory strategies used in the immediate postoperative period after cardiac surgery.

Methods

We conducted a frequentist random-effect network meta-analysis (NMA) of randomized controlled trials (RCTs) comparing the prophylactic use of noninvasive ventilation (NIV), continuous positive airway pressure (CPAP), high flow nasal cannula (HFNC), or postoperative usual care (PUC) in the immediate postoperative period after cardiac surgery. Databases were systematically searched through September 28, 2022. Study selection, data extraction, and quality assessment were performed in duplicate. The primary outcome was the incidence of PPCs.

Results

Sixteen RCTs enrolling 3011 patients were included. Compared with PUC, NIV significantly reduced the incidence of PPCs [relative risk (RR) 0.67, 95% confidence interval (CI): 0.49 to 0.93; absolute risk reduction (ARR) 7.6%, 95% CI: 1.6–11.8%; low certainty] and the incidence of atelectasis (RR 0.65, 95% CI: 0.45 to 0.93; ARR 19.3%, 95% CI: 3.9–30.4%; moderate certainty); however, prophylactic NIV was not associated with a decreased reintubation rate (RR 0.82, 95% CI: 0.29 to 2.34; low certainty) or reduced short-term mortality (RR 0.64, 95% CI: 0.16 to 2.52; very low certainty). As compared to PUC, the preventive use of CPAP (RR 0.85, 95% CI: 0.60 to 1.20; very low certainty) or HFNC (RR 0.74, 95% CI: 0.46 to 1.20; low certainty) had no significant beneficial effect on the incidence of PPCs, despite exhibiting a downward trend. Based on the surface under the cumulative ranking curve, the highest-ranked treatment for reducing the incidence of PPCs was NIV (83.0%), followed by HFNC (62.5%), CPAP (44.3%), and PUC (10.2%).

Conclusions

Current evidence suggest that the prophylactic use of NIV in the immediate postoperative period is probably the most effective noninvasive respiratory approach to prevent PPCs in patients undergoing cardiac surgery. Given the overall low certainty of the evidence, further high-quality research is warranted to better understand the relative benefits of each noninvasive ventilatory support.

Clinical Trial Registration

PROSPERO, https://www.crd.york.ac.uk/prospero/, registry number: CRD42022303904.
Care provider interaction and psychological well-being of persons living with dementia in long-term care: a longitudinal observational study
Authors: Lee Kyung Hee , Yang Eunjin , Lee Ji Yeon
Published: June 2023

Background

Although social interaction is important for dementia care and well-being of persons living with dementia, a limited number of studies have reported. This study aimed to examine whether the presence, type, and quality of social interaction is associated with psychological well-being among residents with dementia.

Methods

This study analyzed 258 videos of 30 participants living with dementia. Social interaction was assessed by quality, type, and presence of interaction. Psychological well-being was measured by positive and negative emotional expressions. A mixed model was used for data analysis since these repeatedly measured observation data were nested within subjects.

Results

Positive and neutral interactions were significantly associated with positive emotional expressions after controlling covariates, while negative interaction was significantly associated with negative emotional expressions. There was no significant relationship found between interaction presence or type and emotional expressions.

Conclusions

This study showed interaction quality is essential to promote psychological well-being in persons living with dementia regardless of presence or type of interaction. This study highlights the importance of positive care provider interactions in dementia care. Additionally, institutional efforts to create an environment to reduce negative interactions appears essential to improve the psychological well-being of persons living with dementia.

Trial registration

The study was reviewed and approved by the Yonsei University Institutional Review Board on October 16, 2020 (ref no: Y-2020-0158).
Left ventricular mass predicts cardiac reverse remodelling in patients treated with empagliflozin
Authors: Puar Pankaj , Hibino Makoto , Mazer C. David , Yan Andrew T. , Pandey Arjun K. , Quan Adrian , Teoh Hwee , Hess David A. , Verma Raj , Connelly Kim A. , Verma Subodh
Published: June 2023

Background

The cardiovascular (CV) benefits of sodium-glucose transport protein 2 inhibitors have been attributed, in part, to cardiac reverse remodelling. The EMPA-HEART CardioLink-6 study reported that sodium-glucose cotransporter-2 inhibition for 6 months with empagliflozin was associated with a significant reduction in left ventricular mass indexed to body surface area (LVMi). In this sub-analysis, we evaluated whether baseline LVMi may influence how empagliflozin affects cardiac reverse remodelling.

Methods

A total of 97 patients with type 2 diabetes and coronary artery disease were randomized to empagliflozin (10 mg/d) or matching placebo for 6 months. The study cohort was divided into those whose baseline LVMi was ≤ 60 g/m2 and those who had a baseline LVMi > 60 g/m2. Subgroup comparisons were conducted using a linear regression model adjusted for baseline values (ANCOVA) that included an interaction term between LVMi subgroup and treatment.

Results

Baseline LVMi was 53.3 g/m2 (49.2–57.2) and 69.7 g/m2 (64.2–76.1) for those with baseline ≤ 60 g/m2 (n = 54) and LVMi > 60 g/m2 (n = 43) respectively. The adjusted difference of LVMi regression between those randomized to empagliflozin and placebo were − 0.46 g/m2 (95% CI: −3.44, 2.52, p = 0.76) in the baseline LVMi ≤ 60 g/m2 subgroup and − 7.26 g/m2 (95% CI: −11.40, −3.12, p = 0.0011) in the baseline LVMi > 60 g/m2 subgroup (p-for-interaction = 0.007). No significant associations were found between baseline LVMi and 6-month change in LV end systolic volume-indexed (p-for-interaction = 0.086), LV end diastolic volume-indexed (p-for-interaction = 0.34), or LV ejection fraction (p-for-interaction = 0.15).

Conclusions

Patients with higher LVMi at baseline experienced greater LVM regression with empagliflozin.
Intratumoural microbiota: from theory to clinical application
Authors: Ji Hao , Jiang Zhengting , Wei Chen , Ma Yichao , Zhao Jiahao , Wang Fei , Zhao Bin , Wang Daorong , Tang Dong
Published: June 2023

Cancer is a major cause of high morbidity and mortality worldwide. Several environmental, genetic and lifestyle factors are associated with the development of cancer in humans and result in suboptimal treatment. The human microbiota has been implicated in the pathophysiological process of cancer and has been used as a diagnostic, prognostic and risk assessment tool in cancer management. Notably, both extratumoural and intratumoural microbiota are important components of the tumor microenvironment, subtly influencing tumorigenesis, progression, treatment and prognosis. The potential oncogenic mechanisms of action of the intratumoural microbiota include induction of DNA damage, influence on cell signaling pathways and impairment of immune responses. Some naturally occurring or genetically engineered microorganisms can specifically accumulate and replicate in tumors and then initiate various anti-tumor programs, ultimately promoting the therapeutic effect of tumor microbiota and reducing the toxic and side effects of conventional tumor treatments, which may be conducive to the pursuit of accurate cancer treatment. In this review, we summarise evidence revealing the impact of the intratumoural microbiota on cancer occurrence and progress and potential therapeutic and diagnostic applications, which may be a promising novel strategy to inhibit tumor development and enhance therapeutic efficacy.
Downregulation of connexin 43-based gap junctions underlies propofol-induced excessive relaxation in hypertensive vascular smooth muscle cells
Authors: Zeng Weiqi , Deng Zhizhao , Gao Yingxin , Sun Guoliang , Li Xianlong , Yuan Dongdong
Published: June 2023

Background

Postinduction hypotension caused by propofol remains a non-negligible problem for anesthesiologists, and is especially severe in chronic hypertensive patients with long-term vasoconstriction and decreased vascular elasticity. The functional change in gap junctions composed of Cx43 (Cx43-GJs) is reported as the biological basis of synchronized contraction or relaxation of blood vessels. Thus, we investigated the role of Cx43-GJs in propofol-induced dramatic blood pressure fluctuations in chronic hypertensive patients, and their internal mechanisms.

Methods

Human umbilical artery smooth muscle cells (HUASMCs) were pretreated with long-term angiotensin II (Ang II), with or without propofol, to simulate the contraction and relaxation of normal and hypertensive VSMCs during anesthesia induction. The levels of F-actin polymerization and MLC2 phosphorylation were used as indicators to observe the contraction and relaxation of HUASMCs. Different specific activators, inhibitors and siRNAs were used to explore the role of Cx43-GJs and Ca2+ as well as the RhoA/ LIMK2/cofilin and RhoA/MLCK signaling pathways in the contraction and relaxation of normal and hypertensive HUASMCs.

Results

Both F-actin polymerization and MLC2 phosphorylation were significantly enhanced in Ang II-pretreated HUASMCs, along with higher expression of Cx43 protein and stronger function of Cx43-GJs than in normal HUASMCs. However, with propofol administration, similar to Gap26 and Cx43-siRNA, the function of Cx43-GJs in Ang II-pretreated HUASMCs was inhibited compared with that in normal HUASMCs, accompanied by a larger decrease in intracellular Ca2+ and the RhoA/LIMK2/cofilin and RhoA/MLCK signaling pathways. Eventually F-actin polymerization and MLC2 phosphorylation were more dramatically decreased. However, these effects could be reversed by RA with enhanced Cx43-GJ function.

Conclusion

Long-term exposure to Ang II significantly enhanced the expression of the Cx43 protein and function of Cx43-GJs in HUASMCs, resulting in the accumulation of intracellular Ca2+ and the activation of its downstream RhoA/LIMK2/cofilin and RhoA/MLCK signaling pathways, which maintained HUASMCs in a state of excessive-contraction. With inhibition of Cx43-GJs by propofol in Ang II-pretreated HUASMCs, intracellular Ca2+ and its downstream signaling pathways were dramatically inhibited, which ultimately excessively relaxed HUASMCs. This is the reason why the blood pressure fluctuation of patients with chronic hypertension was more severe after receiving propofol induction.
Kounis syndrome in a patient following AstraZeneca coronavirus disease 2019 vaccination: a case report
Authors: Farook A. M. , Priyankara D.
Published: June 2023

Introduction and importance

Kounis syndrome, also known as allergic angina syndrome, is defined as the occurrence of an acute coronary syndrome concomitantly with a hypersensitivity reaction. It is a very important diagnosis and missing it may be fatal to the patient. This is a medical emergency, and immediate treatment should be initiated. The treatment of Kounis syndrome is challenging because treatment of either acute coronary syndrome and hypersensitivity reaction can lead to the worsening of the other injury. This case is the first reported case of Kounis syndrome following coronavirus disease 2019 vaccination in Sri Lanka according to our knowledge.

Case presentation

We discuss a 54-year-old female Sri Lankan patient who developed Kounis syndrome following Oxford AstraZeneca COVID-19 vaccination. The patient initially developed anaphylaxis following the AstraZeneca COVID-19 vaccine and subsequently developed acute coronary syndrome secondary to anaphylaxis. The patient was treated appropriately and eventually recovered from her condition.

Conclusion

This syndrome should be suspected when there is a concurrent acute coronary syndrome with allergic reactions. This is an often under- or misdiagnosed condition, and physicians should be educated about it. Caregivers should be aware of its pathophysiology, as treatment of either of the two may worsen the other injury.