bluuebunny/crossref_metadata_2025 huggingface dataset:
International short‐term placements in health professions education—A meta‐narrative review
Authors: Fruhstorfer Birgit H. , Jenkins Simon P. , Davies David A. , Griffiths Frances
Published: December 2023

Introduction

In order to be prepared for professional practice in a globalised world, health professions students need to be equipped with a new set of knowledge, skills and attitudes. Experiential learning gained during an international placement has been considered as a powerful strategy for facilitating the acquisition of global health competencies.

The aim of this review was to synthesise the diverse body of empirical research examining the process and outcomes of international short‐term placements in health professions education.

Methods

A systematic review was conducted using a meta‐narrative methodology. Six electronic databases were searched between September 2016 and June 2022: Medline, Embase, CINAHL, PsycINFO, Education Research Complete and Web of Knowledge. Studies were included if they reported on international placements undertaken by undergraduate health professions students in socio‐economically contrasting settings. Included studies were first considered within their research tradition before comparing and contrasting findings between different research traditions.

Results

This review included 243 papers from 12 research traditions, which were distinguished by health profession and paradigmatic approach. Empirical findings were considered in four broad themes: learner, educational intervention, institutional context and wider context. Most studies provided evidence on the learner, with findings indicating a positive impact of international placements on personal and professional development. The development of cultural competency has been more focus in research in nursing and allied health than in medicine. Whereas earlier research has focussed on the experience and outcomes for the learner, more recent studies have become more concerned with relationships between various stakeholder groups. Only few studies have looked at strategies to enhance the educational process.

Conclusion

The consideration of empirical work from different perspectives provides novel understandings of what research has achieved and what needs further investigation. Future studies should pay more attention to the complex nature of the educational process in international placements.
Aerial withdrawal: An atmospheric reading of Monika Maron's Flugasche
Authors: Szczepaniak Monika
Published: December 2023

In Monika Maron's Flugasche (1981)—the first novel from the GDR to deal with environmental issues—the poisoned atmosphere in the city of B. functions as an affective centre, around which emotions, actions and reactions of the main protagonist as well as of the other characters revolve. The journalist Josefa Nadler falls into the sphere of the environmental catastrophe and is overwhelmed by the atmospheric power of this meaningful situation. The corporeal experience of being exposed to subtle environmental violence, which has devastating consequences for the city of B. and debilitating effects on its inhabitants, evokes feelings such as fear, anger, shame and compassion. Moreover, it develops into a driving force for thoughts, decisions, commitment and resistance against the unfair air distribution, accompanied by a sense of powerlessness. The aim of the article is a re‐reading of the novel with a central focus on the largely non‐representational, affective and meteorological elemental spacetimes, which can not only be felt or bodily experienced but also designed or engineered in order to produce a certain time‐bound structure of feeling, for example, an oppressive climate of fear.
Spanish version of the Maastricht Personal Autonomy Questionnaire: A validation study among community‐dwelling older adults with chronic multimorbidity
Authors: Hernández‐Padilla José Manuel , Dobarrio‐Sanz Iria , Correa‐Casado Matías , del Mar Jiménez‐Lasserrotte María , Fernández‐Sola Cayetano , Ruiz‐Fernández María Dolores
Published: December 2023

Background

Loss of personal autonomy in older adults with chronic multimorbidity is associated with worsened biopsychosocial health. In order to facilitate the standardised assessment of personal autonomy in older adults with chronic conditions, nurses could use the Maastricht Personal Autonomy Questionnaire (MPAQ).

Objective

To translate, culturally adapt and psychometrically assess the Spanish version of the MPAQ in community‐dwelling older adults with chronic multimorbidity (MPAQ‐Sp).

Methods

Observational cross‐sectional study. A convenience sample of 884 community‐dwelling older adults was recruited from 10 community centres in five health districts in southeastern Spain. Data were collected between January 2021 and September 2022. The study was completed in four phases. Phase 1: The MPAQ was translated into Spanish. Phase 2: A pilot test of reliability and content validity was conducted. Phase 3: To test the dimensionality of the tool, an exploratory factor analysis (EFA) was conducted. Phase 4: a final validation study was conducted which included a confirmatory factor analysis (CFA) and assessed the validity (content, criterion and construct), reliability and readability of the MPAQ‐Sp.

Results

The average age of the sample was 75.89 years (SD = ±8.04). Their mean number of chronic conditions was 4.84 (SD = ±2.19) and 67% were women. The MPAQ‐Sp is comprised of 16 items distributed in four subscales: [1] the ‘Degree of autonomy’ scale, [2] the ‘Working on autonomy’ scale, [3] the ‘Dilemmas: health over preferences’ scale and [4] the ‘Dilemmas: preferences over health’ scale.

Conclusions

The Spanish version of the MPAQ‐Sp is a valid and reliable instrument to assess personal autonomy in Spanish‐speaking, community‐dwelling older adults with chronic multimorbidity.

Implications for Practice

The use of the MPAQ‐Sp would allow researchers and healthcare professionals to identify a loss of personal autonomy among Spanish‐speaking community‐dwelling older adults with chronic multimorbidity.
Bias analyses to investigate the impact of differential participation: Application to a birth defects case‐control study
Authors: Petersen Julie M. , Kahrs Jacob C. , Adrien Nedghie , Wood Mollie E. , Olshan Andrew F. , Smith Louisa H. , Howley Meredith M. , Ailes Elizabeth C. , Romitti Paul A. , Herring Amy H. , Parker Samantha E. , Shaw Gary M. , Politis Maria D. ,   The National Birth Defects Prevention Study
Published: December 2023

Background

Certain associations observed in the National Birth Defects Prevention Study (NBDPS) contrasted with other research or were from areas with mixed findings, including no decrease in odds of spina bifida with periconceptional folic acid supplementation, moderately increased cleft palate odds with ondansetron use and reduced hypospadias odds with maternal smoking.

Objectives

To investigate the plausibility and extent of differential participation to produce effect estimates observed in NBDPS.

Methods

We searched the literature for factors related to these exposures and participation and conducted deterministic quantitative bias analyses. We estimated case‐control participation and expected exposure prevalence based on internal and external reports, respectively. For the folic acid‐spina bifida and ondansetron‐cleft palate analyses, we hypothesized the true odds ratio (OR) based on prior studies and quantified the degree of exposure over‐ (or under‐) representation to produce the crude OR (cOR) in NBDPS. For the smoking‐hypospadias analysis, we estimated the extent of selection bias needed to nullify the association as well as the maximum potential harmful OR.

Results

Under our assumptions (participation, exposure prevalence, true OR), there was overrepresentation of folic acid use and underrepresentation of ondansetron use and smoking among participants. Folic acid‐exposed spina bifida cases would need to have been ≥1.2× more likely to participate than exposed controls to yield the observed null cOR. Ondansetron‐exposed cleft palate cases would need to have been 1.6× more likely to participate than exposed controls if the true OR is null. Smoking‐exposed hypospadias cases would need to have been ≥1.2 times less likely to participate than exposed controls for the association to falsely appear protective (upper bound of selection bias adjusted smoking‐hypospadias OR = 2.02).

Conclusions

Differential participation could partly explain certain associations observed in NBDPS, but questions remain about why. Potential impacts of other systematic errors (e.g. exposure misclassification) could be informed by additional research.
Periodontitis and risk of cancer: Mechanistic evidence
Authors: Baima Giacomo , Minoli Margherita , Michaud Dominique S. , Aimetti Mario , Sanz Mariano , Loos Bruno G. , Romandini Mario
Published: December 2023

This review aims to critically analyze the pathways of interaction and the pathogenic mechanisms linking periodontitis and oral bacteria with the initiation/progression of cancer at different body compartments. A higher risk of head and neck cancer has been consistently associated with periodontitis. This relationship has been explained by the local promotion of dysbiosis, chronic inflammation, immune evasion, and direct (epi)genetic damage to epithelial cells by periodontal pathobionts and their toxins. Epidemiological reports have also studied a possible link between periodontitis and the incidence of other malignancies at distant sites, such as lung, breast, prostate, and digestive tract cancers. Mechanistically, different pathways have been involved, including the induction of a chronic systemic inflammatory state and the spreading of oral pathobionts with carcinogenic potential. Indeed, periodontitis may promote low‐grade systemic inflammation and phenotypic changes in the mononuclear cells, leading to the release of free radicals and cytokines, as well as extracellular matrix degradation, which are all mechanisms involved in carcinogenic and metastatic processes. Moreover, the transient hematogenous spill out or micro‐aspiration/swallowing of periodontal bacteria and their virulence factors (i.e., lipopolysaccharides, fimbriae), may lead to non‐indigenous bacterial colonization of multiple microenvironments. These events may in turn replenish the tumor‐associated microbiome and thus influence the molecular hallmarks of cancer. Particularly, specific strains of oral pathobionts (e.g., Porphyromonas gingivalis and Fusobacterium nucleatum) may translocate through the hematogenous and enteral routes, being implicated in esophageal, gastric, pancreatic, and colorectal tumorigenesis through the modulation of the gastrointestinal antitumor immune system (i.e., tumor‐infiltrating T cells) and the increased expression of pro‐inflammatory/oncogenic genes. Ultimately, the potential influence of common risk factors, relevant comorbidities, and upstream drivers, such as gerovulnerability to multiple diseases, in explaining the relationship cannot be disregarded. The evidence analyzed here emphasizes the possible relevance of periodontitis in cancer initiation/progression and stimulates future research endeavors.
Inconvenient truths about logistic regression and the remedy of marginal effects
Authors: Howell‐Moroney Michael
Published: December 2023

Logistic regression is a standard technique in public administration research. However, there are two inconvenient truths about logistic regression of which scholars should be aware. First, logistic regression results are difficult to interpret. Raw coefficients are expressed in an enigmatic log odds scale and odds ratios are regularly misinterpreted as risk ratios. Second, logistic regression results are non‐collapsible, which renders model comparisons invalid. A review of recent public administration articles reveals that these inconvenient truths still plague the discipline. This paper advocates the use of average marginal effects to reckon with both inconvenient truths. Average marginal effects are easy to comprehend because they measure effect sizes on a probability scale. And average marginal effects are collapsible, and hence facilitate valid model comparisons. These concepts are illustrated using data simulations and data from the 2017 Current Population Survey. The paper concludes with suggestions for improved research practice.
Carbonate production and reef building under ferruginous seawater conditions in the Cambrian rift branches of the Avalon Zone, Newfoundland
Authors: Álvaro José Javier , Mills Andrea
Published: December 2023

The characterization of carbonate production on rift basins is critical for understanding the nucleation and demise of reefs in tectonically active areas. A new petrographic and mineralogical analysis of Cambrian strata from the Avalon Zone in Newfoundland, based on scanning electron microscopy – back‐scattered electron detector and Raman spectrometer analyses, facilitates recognition of several episodes of Terreneuvian–Miaolingian carbonate production and associated precipitation of ironstone and phosphorite. These distinct units mainly developed on uplifted rift shoulders and basaltic lava palaeoreliefs, and reflect amalgamated high‐energy events, interrupted by scouring discontinuities (diastems) commonly lined by phosphatized and ferruginized microbial crusts. Mud‐mounds, in contrast, nucleated under calm conditions episodically punctuated by high‐energy episodes, where scattered thromboid structures occur as both clotted textures and distinct calcimicrobes. Precipitation of hematite/goethite versus chamosite couplets, both occluding primary porosities and replacing interlaminae and cortices of oncoids and coated aggregates, point to marine substrates close to the Fe‐redox boundary. Upwelling of phosphate‐rich ferruginous hydrothermal waters contributed to the precipitation of ironstone and phosphate interbeds. Ferruginous waters related to penecontemporaneous hydrothermal activity, reflected by the record of synsedimentary fissuring and stockwork ore bodies, were delivered to confined rift‐related horst‐and‐graben settings, largely controlled by the development of specific Cambrian carbonate and associated ironstone facies. The influence of ferruginous waters necessarily affected the record of climatically sensitive evaporitic pseudomorphs, reefs/mounds and phosphorites, which are then not suitable criteria to discriminate palaeolatitude, as demonstrated by a comparison of low‐latitude to middle‐latitude margins fringing Baltica, and the Avalonian and Atlas – Ossa‐Morena – Northarmorican rift transects of West Gondwana.
Coworker support amplifies strain in the COVID‐19 pandemic for working parents
Authors: O'Brien Kimberly E. , Shepard Agnieszka K. , Donnelly Lilah I.
Published: December 2023

The COVID‐19 pandemic directly threatened our health and safety, while contradictory scientific and media reports generated uncertainty. Social information processing theory suggests that employees may have relied on their coworkers, via coworker support, to make sense of the confusion. Because previous research shows that coworker support can counterintuitively increase strain, we investigated the effects of coworker support on strain during the pandemic. Specifically, we collected data from a heterogeneous US sample of 314 working parents in May 2020 to illustrate the path from personal traits (i.e., optimism, generalized self‐efficacy, and internal locus of control) to COVID‐19 anxiety to workplace outcomes (i.e., self‐rated performance, emotional exhaustion, and work–family conflict) in a multiphasic study design. Employees with low levels of these traits reported more COVID‐19 anxiety, and in turn, more decrement to their workplace outcomes. This mediation is moderated by coworker social support, such that the indirect effect is exacerbated by coworker social support. This is consistent with social information processing theory, which states that coworker social support can unintentionally corroborate and amplify employee stress perceptions. We therefore recommend that, when faced with significant adversity, organizations provide communication training oriented toward increasing positive coworker interactions and guiding social information.
Coping profiles of adolescent football players and association with interpersonal coping: Do emotional competence and psychological need satisfaction matter?
Authors: Doron Julie , Hayotte Meggy , d'Arripe‐Longueville Fabienne , Leprince Chloé
Published: December 2023

Using a person‐centered approach, the present study aimed to investigate the coping profiles of adolescent football players involved in elite football training centers. The purposes were to (1) identify coping profiles based on the reported use of multiple coping strategies in response to competitive stress, (2) explore whether emotional competencies and psychological need satisfaction would predict coping profile membership, and (3) examine the extent to which coping profiles were differently associated with individual and team perceived stress, interpersonal coping, and subjective team performance, as well as demographic characteristics. A sample of 416 young French football players (males = 282; females = 134; Mage = 16.2; SDage = 1.2) from 12 elite football training centers participated in this study. Latent profile analysis results yielded three coping profiles allowing players to be grouped according to their preferences for a combined use of certain strategies (i.e., low copers, high disengaged copers, and high task copers). Results provided further insight into each coping profile membership by indicating the role played by intrapersonal emotional competence and psychological need satisfaction. Finally, differences between coping profiles have been shown in terms of individual perceived stress intensity, interpersonal coping approach, and gender. These findings provide a deeper understanding of adaptive coping profiles within a population of adolescent football players involved in elite training centers. Implications for developing and tailoring psychoeducational interventions for adolescent football players exhibiting a maladaptive coping profile (i.e., disengagement‐oriented coping profile) are considered.
Landslide susceptibility zoning based on Rock Engineering System application to the Tehran case study
Authors: Khosronezhad Ali , Pourkermani Mohsen , Almasiyan Mahmoud , Bouzari Soheila , Uromeihy Ali
Published: December 2023

Landsliding and slope instability pose significant risks to human settlements and infrastructure. This study aims to develop a landslide susceptibility map for the mountainous regions of Tehran province, Iran. The rock engineering approach was employed at a regional scale, utilizing a database of regional landslides. The semi‐quantitative Rock Engineering System method was applied, considering 10 conditioning factors. The model was validated using historical landslide data, showing strong correlation. The majority of landslides occurred within medium and high susceptibility zones. Geological units, particularly the Karaj Formation's claystone layers, displayed a clear association with landslide susceptibility. The rock engineering approach yielded a highly accurate susceptibility map. Findings can inform future territorial planning in the area.
MdMYB44‐like positively regulates salt and drought tolerance via the MdPYL8‐MdPP2CA module in apple
Authors: Chen Cui , Zhang Zhen , Lei Ying‐Ying , Chen Wen‐Jun , Zhang Zhi‐Hong , Li Xiao‐Ming , Dai Hong‐Yan
Published: December 2023

Abscisic acid (ABA) is involved in salt and drought stress responses, but the underlying molecular mechanism remains unclear. Here, we demonstrated that the overexpression of MdMYB44‐like, an R2R3‐MYB transcription factor, significantly increases the salt and drought tolerance of transgenic apples and Arabidopsis. MdMYB44‐like inhibits the transcription of MdPP2CA, which encodes a type 2C protein phosphatase that acts as a negative regulator in the ABA response, thereby enhancing ABA signaling‐mediated salt and drought tolerance. Furthermore, we found that MdMYB44‐like and MdPYL8, an ABA receptor, form a protein complex that further enhances the transcriptional inhibition of the MdPP2CA promoter by MdMYB44‐like. Significantly, we discovered that MdPP2CA can interfere with the physical association between MdMYB44‐like and MdPYL8 in the presence of ABA, partially blocking the inhibitory effect of the MdMYB44‐like–MdPYL8 complex on the MdPP2CA promoter. Thus, MdMYB44‐like, MdPYL8, and MdPP2CA form a regulatory loop that tightly modulates ABA signaling homeostasis under salt and drought stress. Our data reveal that MdMYB44‐like precisely modulates ABA‐mediated salt and drought tolerance in apples through the MdPYL8–MdPP2CA module.
The relationship between corneal calcareous degeneration and various ophthalmic diseases in dogs: A retrospective study
Authors: Jeong Dajeong , Kang Seonmi , Lee Eunji , Seo Kangmoon
Published: December 2023

Objective

To investigate ocular factors that influence the development of corneal calcareous degeneration (CCD) in dogs.

Animals and Procedures

The medical records of 96 eyes of dogs with CCD and 288 eyes without CCD were retrospectively reviewed. Dogs with evidence of causative systemic illness associated with CCD were excluded from the study. Logistic regression analysis was used to identify the ocular factors associated with the development of CCD. To identify the effect of phosphate‐containing eyedrops on CCD, the application periods of phosphate‐containing antiglaucoma eyedrops were compared between the glaucomatous eyes in the CCD and non‐CCD groups.

Results

Increased age, brachycephalic breed, keratoconjunctivitis sicca, advanced cataract, history of phacoemulsification, and topical corticosteroid application were significantly associated with CCD development. Glaucoma was significantly overrepresented in the non‐CCD group, and the application period of phosphate‐containing antiglaucoma eyedrops was significantly longer in eyes with CCD than in those without CCD.

Conclusions

Ophthalmic diseases requiring long‐term management of ocular inflammation and long‐term application of phosphate‐containing eyedrops may contribute to the development of CCD. Glaucoma is overrepresented in dogs without CCD, which is thought to be due to the differences in predisposed age and breeds between dogs with glaucoma and CCD.
Analysis of Viral Advertising Research Hotspots and Trends Based on Bibliometric Methods
Authors: Wang Yujue , Mohamed Salim Neesa Ameera , Subri Shafilla , Zhang Xia
Published: December 2023

With the popularity and development of social media, viral advertising has also gained tremendous development. Viral advertising as a useful promotional strategy can increase the publicity effectiveness of a brand or product. The purpose of this study is to better understand the research and progress of viral advertising and to explore future research directions. This study examined the viral advertising literature on the Web of Science database from 2004-2022, using bibliometric methods to analyze the data in terms of the annual number of publications, source journals, citations, authors, countries and institutions, and keywords. The results reveal the publishing trend of viral advertising research, the most influential literature and journals, as well as the most productive countries, institutions, and authors, including collaborative partnerships among them. The keyword co-occurrence analysis, cluster analysis, and time evolution analysis identified the research hotspots, themes, and evolution trends of viral advertising. This bibliometric study presents an overall profile of research in the field and proposes a research framework for the study of viral advertising that can serve as a reference, providing valuable guidance for advancing research in this area.
COVID-19 Preventive Behavior and Digital Media: A Bibliometric Study
Authors: Afifi Subhan , Yaman Aris , Bakti I Gede Mahatma Yuda , Sumaedi Sik
Published: December 2023

COVID-19 preventive behavior is crucial for reducing the spread of COVID-19 infection. During the pandemic, digital media can be used to educate on the behavior. Therefore, it is imperative to study COVID-19 preventive behavior and digital media. Despite extensive examinations on this matter, a distinct lack of bibliometric exploration has been observed. This study involves a bibliometric analysis utilizing data obtained from the Scopus database. Following a comprehensive search and screening procedure, our research examined a total of 68 articles. The findings indicate that Liu, Romer, and Jamieson emerge as the most influential researchers in the realm of studies focused on COVID-19 preventive behavior and digital media. The US and China are observed as the most referenced countries for research on COVID-19 preventive behavior and digital media. The International Journal of Environmental Research and Public Health, PLoS ONE, and the Journal of Medical Internet Research stand out as the three most productive and referenced journals in studies relating to this research topic. Concerning the state of the art, fundamentally, existing research refers to five major topics: the influence of Protection Motivation Theory (PMT) factors, the influence of COVID-19 coverage (infodemiology), the influence of media exposure/information and Health Belief Model (HBM) factors, the influence of e-health literacy, knowledge, and attitude, and the role of digital media in public health intervention strategy to prevent the spread of COVID-19. In conclusion, this bibliometric study sheds light on the multifaceted landscape of COVID-19 preventive behavior and digital media research. By delving into researcher analyses, preferred publication outlets, and the topical state of the art, this study contributes a novel perspective to the existing literature.
German and Albanian Media in Political and Social Change: Challenges, Patterns, and Deviations
Authors: Oktrova Mirela
Published: December 2023

Studying the past interactions between Germany and Albania in the field of media is an important topic, as it is crucial for understanding the current challenges and finding solutions to promote cooperation and communication between two countries in the future. The purpose of the research is to compare the historical development of the mass media in Germany and Albania, as well as to consider the models of interaction between these countries in the field of media. During the research, the following methods of theoretical knowledge were used: analysis, comparison, synthesis, and generalization. As a result of the study, several conclusions were drawn, in particular, regarding the role and position of the mass media in Germany and Albania in different historical periods. Thus, it was found that the development of mass media began in the 19th century, under the influence of the industrial revolution. Albanian media during this period was not as independent as German media, because Albania was part of the Ottoman Empire. In the 20th century, interaction and assimilation of German and Albanian mass media began to take place, in particular, due to the activities of the communist regime and the process of liberalisation. In today’s world, the Albanian mass media have several problems, as they are dependent on private entrepreneurs and are also quite centralised. The study of the media interactions of Germany and Albania is valuable for historians and political scientists who seek to increase knowledge of their history, facilitate communication and cooperation between the two media systems. It is especially valid in identifying the model or standard towards which the Albanian media system should develop in its path towards self-regulation.
Embedding the prime model of real exponentiation into o‐minimal exponential fields
Authors: Krapp Lothar Sebastian
Published: December 2023

Motivated by the decidability question for the theory of real exponentiation and by the Transfer Conjecture for o‐minimal exponential fields, we show that, under the assumption of Schanuel's Conjecture, the prime model of real exponentiation is embeddable into any o‐minimal exponential field, where the embedding is not necessarily elementary. This is a consequence of an unconditional model theoretic embeddability result that we obtain by applying Kőnig's Lemma.
Acute respiratory failure developing in a patient with lymphomatoid granulomatosis
Authors: Nomura Motoko , Yuzawa Motoi , Hiruta Masahiro , Ohta Hiromitsu
Published: December 2023

Lymphomatoid granulomatosis (LYG) is a rare B cell lymphoproliferative disorder associated with Epstein-Barr virus infection. LYG diagnosis is often difficult because of non-specific and varied radiological and pathological findings. The lung is the most common organ of LYG occurrence, but extrapulmonary lesions involving the central nervous system, skin, kidneys and liver are observed. A surgical biopsy is often inevitable for LYG diagnosis.

We encountered a man in his 50s who presented with progressive dyspnoea. Extrapulmonary lesions were not observed. Although he developed respiratory failure within a short period, a low dose of corticosteroid relieved his symptoms. Video-assisted thoracoscopic lung biopsy revealed grade 1 LYG. The patient was successfully treated with chemotherapy, including rituximab. Only a few cases of LYG with progressive respiratory failure are reported, and most have been diagnosed via autopsy. Our case highlights the importance of performing a surgical lung biopsy at the appropriate time to diagnose LYG.
Asymptomatic trigger of adrenal crisis in a patient with Sheehan syndrome: importance of timely recognition and intervention
Authors: Willett Andrew Charles , Hartman Emily , Chandler Natasha , Brown Julianna
Published: December 2023

Our patient is a female in her 70s who initially presented following an episode of bowel and bladder incontinence, as well as unresponsiveness. Her family denied any preceding illness or sick symptoms. During her workup, it was noted that she was wearing a medical bracelet, which listed prednisone as one of her daily medications, raising concern for an acute adrenal crisis (AC). Ultimately, our patient’s condition improved with high-dose intravenous steroids before being tapered to her home regimen. Current literature highlights the pathophysiological complexity of an AC but fails to identify clear risk factors that trigger such events, especially in asymptomatic patients. Accordingly, our case highlights this gap, arguing the importance of appropriate patient education and timely intervention for such clinically ambiguous yet life-threatening presentations.
Emergency definitive management of a subtalar dislocation with an associated lateral malleolus fracture
Authors: Little Max , Beer Alexander , Deierl Krisztian
Published: December 2023

Lateral subtalar dislocations are rare injuries with the potential for misdiagnosis and for poor patient outcomes if missed. Prompt reduction and surgical intervention is the consensus and is key to improved patient outcomes.

We present a case of a male patient in his 70s who was brought in by ambulance to the emergency department late one afternoon with a lateral subtalar dislocation associated with calcaneal and lateral malleolar fractures. He was operated on that evening, involving cannulated screw fixation of the calcaneus and buttress plating of the lateral malleolus. Non-weight-bearing mobilisation was permitted at 2 weeks and weight-bearing was commenced at 6 weeks postoperatively.

The authors could not find any precedent in the literature for same-day definitive fixation and early mobilisation of this rare but significant injury, the combination of which resulted in excellent functional outcomes for the patient.
Cefiderocol-associated brown chromaturia
Authors: Smith Michael , Foong Kap Sum
Published: December 2023

Cefiderocol is a novel siderophore cephalosporin antibiotic. In the present case report, a woman in her 70s presented with a 1-week history of altered mental status and progressive purulent discharge from a non-healing diabetic foot ulcer on her right heel. MRI of the right foot revealed chronic osteomyelitis of the calcaneum. Surgical debridement was performed, and the tissue cultures grew extensively drug resistant (XDR)Pseudomonas aeruginosa, XDRAcinetobacter baumanniiandEnterococcus faecalis. The patient received ampicillin-sulbactam and cefiderocol. The antibiotic treatment course was complicated by brown urine discolouration. Investigations were unrevealing for haemoglobinuria, myoglobinuria and bilirubinuria. A side effect from cefiderocol was suspected and subsequently discontinued. Her urine colour returned to its normal colour within 3 days of discontinuation of cefiderocol.
Changing climates, compounding challenges: a participatory study on how disasters affect the sexual and reproductive health and rights of young people in Fiji
Authors: Murphy Nabreesa , Rarama Tamani , Atama Alanieta , Kauyaca Ilaisa , Batibasaga Kelera , Azzopardi Peter , Bowen Kathryn J , Bohren Meghan A
Published: December 2023

Pacific youth are at the forefront of the climate crisis, which has important implications for their health and rights. Youth in Fiji currently bear a disproportionate burden of poor experiences and outcomes related to their sexual and reproductive health and rights (SRHR). There is limited information about how the increasing climate impacts may affect their SRHR, and what the implications may be for climate action and disaster risk reduction. We aimed to explore the experiences of 21 Fijian youth in fulfilling their SRHR when living through multiple natural hazards. We conducted 2 workshops and 18 individual semistructured interviews using visual and storytelling methods. Irrespective of the type of hazard or context of disasters, participants identified limited agency as the main challenge that increased SRHR risks. Through reflexive thematic analysis, we identified four themes centred around ‘youth SRHR agency’; (1) information and knowledge, (2) community and belonging, (3) needs and resources, and (4) collective risks. These themes encompassed multiple factors that limited youth agency and increased their SRHR risks. Participants highlighted how existing challenges to their SRHR, such as access to SRHR information being controlled by community gatekeepers, and discrimination of sexual and gender diverse youth, were exacerbated in disasters. In disaster contexts, immediate priorities such as water, food and financial insecurity increased risks of transactional early marriage and transactional sex to access these resources. Daily SRHR risks related to normalisation of sexual and gender-based violence and taboos limited youth agency and influenced their perceptions of disasters and SRHR risks. Findings offer important insights into factors that limited youth SRHR agency before, during and after disasters. We underscore the urgency for addressing existing social and health inequities in climate and disaster governance. We highlight four key implications for reducing youth SRHR risks through whole-of-society approaches at multiple (sociocultural, institutional, governance) levels.
Specific gut pathobionts escape antibody coating and are enriched during flares in patients with severe Crohn’s disease
Authors: Eriksen Carsten , Danneskiold-Samsøe Niels Banhos , Moll Janne Marie , Myers Pernille Neve , Bondegaard Pi W , Vejrum Simone , Hansen Tine Brodka , Rosholm Lisbeth Buus , Rausch Philipp , Allin Kristine Højgaard , Jess Tine , Kristiansen Karsten , Penders John , Jonkers Daisy , Brix Susanne
Published: December 2023

Objective

Patients with Crohn’s disease (CD) exhibit great heterogeneity in disease presentation and treatment responses, where distinct gut bacteria and immune interactions may play part in the yet unresolved disease aetiology. Given the role of antibodies in the barrier defence against microbes, we hypothesised that gut bacterial antibody-coating patterns may influence underlying disease-mediated processes.

Design

Absolute and relative single and multicoating of gut bacteria with IgA, IgG1, IgG2, IgG3 and IgG4 in patients with CD and healthy controls were characterised and compared with disease activity. IgG2-coated and non-coated taxa from patients with severe CD were identified, profiled for pathogenic characteristics and monitored for enrichment during active disease across cohorts.

Results

Patients with severe CD exhibited higher gut bacterial IgG2-coating. Supervised clustering identified 25 bacteria to be enriched in CD patients with high IgG2-coating. Sorting, sequencing andin silico-based assessments of the virulent potential of IgG2-coated and bulk stool bacteria were performed to evaluate the nature and pathogenicity of IgG2-coated and non-coated bacteria. The analyses demonstrated IgG2-coating of both known pathogenic and non-pathogenic bacteria that co-occurred with two non-coated pathobionts,CampylobacterandMannheimia. The two non-coated pathobionts exhibited low prevalence, rarely coincided and were strongly enriched during disease flares in patients with CD across independent and geographically distant cohorts.

Conclusion

Distinct gut bacterial IgG2-coating was demonstrated in patients with severe CD and during disease flares. Co-occurrence of non-coated pathobionts with IgG2-coated bacteria points to an uncontrolled inflammatory condition in severe CD mediated via escape from antibody coating by two gut pathobionts.
Cardiovascular sequelae of trastuzumab and anthracycline in long-term survivors of breast cancer
Authors: Glen Claire , Morrow Andrew , Roditi Giles , Hopkins Tracey , Macpherson Iain , Stewart Philip , Petrie Mark C , Berry Colin , Epstein Fred , Lang Ninian N , Mangion Kenneth
Published: December 2023

Objectives

Long-term follow-up of patients treated with trastuzumab largely focuses on those with reduced left ventricular ejection fraction (LVEF) on treatment completion. This study sought to evaluate the prevalence of cardiovascular risk factors, overt cardiovascular disease and cardiac imaging abnormalities using cardiac magnetic resonance (CMR), in participants with normal LVEF on completion of trastuzumab±anthracycline therapy at least 5 years previously.

Methods

Participants with human epidermal growth factor receptor 2-positive breast cancer treated with trastuzumab±anthracycline ≥5 years previously were identified from a clinical database. All participants had normal LVEF prior to, and on completion of, treatment. Participants underwent clinical cardiovascular evaluation, ECG, cardiac biomarker evaluation and CMR. Left ventricular systolic dysfunction (LVSD) was defined as LVEF <50%.

Results

Forty participants were recruited between 15 March 2021 and 19 July 2022. Median time since completion of trastuzumab was 7.8 years (range 5.9–10.8 years) and 90% received prior anthracycline. 25% of participants had LVSD; median LVEF was 55.2% (Q1–Q3, 51.3–61.2). 30% of participants had N-terminal pro-B-type natriuretic peptide >125 pg/mL and 8% had high-sensitivity cardiac troponin T >14 ng/L. 33% of participants had a new finding of hypertension. 58% had total cholesterol >5.0 mmol/L, 43% had triglycerides >1.7 mmol/L and 5% had a new diagnosis of diabetes.

Conclusions

The presence of asymptomatic LVSD, abnormal cardiac biomarkers and cardiac risk factors in participants treated with trastuzumab and anthracycline at least 5 years previously is common, even in those with normal LVEF on completion of treatment. Our findings reinforce the relevance of comprehensive evaluation of cardiovascular risk factors following completion of cancer therapy, in addition to LVEF assessment.
Cannabinoid home storage practices among a national Qualtrics panel of adult users of cannabinoid products in the USA
Authors: Egan Kathleen Louise , Cox Melissa J
Published: December 2023

Introduction

The presence of cannabinoid products in the home may increase the likelihood of unintended adverse consequences for children and adolescents. Secure storage of these products is one prevention method to decrease the risk of diversion and use of cannabinoid products among youth. We sought to examine cannabis, delta-8 tetrahydrocannabinol (THC), and cannabidiol (CBD) storage practices among a sample of adults 18–64 years old residing in the USA.

Methods

In December 2021, we conducted an online cross-sectional survey of 1042 current (past 30 day) users of cannabinoid products (88.3% cannabis, 49.0% delta-8 THC, and 67.2% CBD). Participants were asked about where they typically keep products in their home (ie, in a locked container, unlocked container, or out in the open). We conducted multinomial regression analyses to examine the relationship between sociodemographic characteristics and cannabinoid use behaviours with home storage practices.

Results

For all products, participants more frequently reported locking, followed by storing the product in an unlocked but not visible location. Storing the product in an unlocked and visible location was endorsed the least across all three products. Participants reported more frequent endorsement of locking cannabis products as compared with delta-8-THC and CBD. Storage practices varied by biological sex, sexual orientation, ethnicity, educational attainment, having a child who lives in the home, frequency of use, possession of a medical cannabis card and exposure to advertising.

Conclusions

Increasing the prevalence of secure storage practices of cannabinoid products may facilitate prevention of unanticipated consequences associated with diversion of these products.
Clinical phenotype of FOXP1 syndrome: parent-reported medical signs and symptoms in 40 individuals
Authors: Koene Saskia , Ropers Fabiënne Gwendolin , Wieland Jannelien , Rybak Tamara , Wildschut Floor , Berghuis Dagmar , Morgan Angela , Trelles Maria Pilar , Scheepe Jeroen Ronald , Bökenkamp Regina , Peeters-Scholte Cacha M P C D , Braden Ruth , Santen Gijs W E
Published: December 2023

Background

The first studies on patients with forkhead-box protein P1 (FOXP1) syndrome reported associated global neurodevelopmental delay, autism symptomatology, dysmorphic features and cardiac and urogenital malformations. The aim of this study was to assess the prevalence of congenital abnormalities in an unbiased cohort of patients with FOXP1 syndrome and to document rare complications.

Methods

Patients with FOXP1 syndrome were included, mostly diagnosed via whole-exome sequencing for neurodevelopmental delay. A parent-report questionnaire was used to assess medical signs and symptoms, including questions about features rated as most burdensome by patients and their family.

Results

Forty individuals were included, 20 females and 20 males. The mean age at assessment was 13.2 years (median 8.5 years; range 2–54 years; ≥18 years n = 7). Seven adults were included. All patients had developmental problems, including cognitive, communication, social-emotional and motor delays. The most prevalent medical signs and symptoms include delayed bladder control, sleeping problems, hypermetropia, strabismus, sacral dimple, undescended testes, abnormal muscle tone and airway infections. The most burdensome complaints for patients with FOXP1 syndrome, as perceived by parents, include intellectual disability, impaired communication, behaviour problems, lack of age-appropriate self-reliance, attention problems and anxiety. According to parents, patients have quite similar reported symptoms, although incontinence, obsessions and a complex sensory profile have a higher ranking.

Conclusion

The results of this study may be used to further guide medical management and identify patient priorities for future research targeted on those features of FOXP1 syndrome that most impair quality of life of patients and their families.
Reduced penetrance of gene variants causing amyotrophic lateral sclerosis
Authors: Douglas Andrew G L , Baralle Diana
Published: December 2023

Background

Amyotrophic lateral sclerosis overlaps aetiologically and genetically with frontotemporal dementia and occurs in both familial and apparently sporadic forms. The most commonly implicated genes are
C9orf72
,
SOD1
,
TARDBP
and
FUS
. Penetrance of disease-causing variants in these genes is known to be incomplete, but has not been well studied at population level.

Objective

We sought to determine the population-level penetrance of pathogenic and likely pathogenic variants in genes commonly causing amyotrophic lateral sclerosis.

Methods

Published epidemiological data for amyotrophic lateral sclerosis and frontotemporal dementia were used to calculate expected frequencies of disease-causing variants per gene at population level. Variant data from gnomAD and ClinVar databases were used to ascertain observed numbers of disease-causing variants and to estimate population-level penetrance per gene. Data for
C9orf72
were obtained from the published literature.

Results

Maximum population penetrance for either amyotrophic lateral sclerosis or frontotemporal dementia was found to be 33% for
C9orf72
(95% CI (20.9 to 53.2)), 54% for
SOD1
(95% CI (32.7 to 88.6)), 38% for
TARDBP
(95% CI (21.1 to 69.8)) and 19% for
FUS
(95% CI (13.0 to 28.4)).

Conclusion

Population-level penetrance of amyotrophic lateral sclerosis disease genes is reduced. This finding has implications for the genetic testing and counselling of affected individuals and their unaffected relatives.
Financial model for a transitional pain service at a large tertiary academic center in the USA
Authors: Zubieta Caroline S , Shabet Christina , Lin James , Muzaurieta Aurelio , Arora Akul , Maghsoodi Nazanin , Brummett Chad M , Edelman Anthony
Published: December 2023

Approximately 1 in 10 patients undergoing surgery is considered at high risk for poor pain and opioid-related outcomes due to chronic pain or persistent opioid use prior to surgery, leading to increased hospital lengths of stay, emergency department visits, hospital readmissions, and worse long-term outcomes. Multidisciplinary transitional pain services (TPSs) have been shown to effectively identify and optimize high-risk patients before surgery, leading to a reduction in healthcare utilization. We conducted a series of semistructured interviews, a literature search, and a financial analysis to develop a reproducible business case for establishing a TPS. These interviews involved discussions with clinicians and administrators at Michigan Medicine, as well as leaders of TPS initiatives at peer institutions across the USA and Canada. The aim was to understand possible operational structures and potential sources of revenue and cost savings that needed inclusion in our model. Subsequently, the authors developed a modifiable financial modeling tool, which is freely available for download and adaptable to any healthcare institution. The model suggests that the primary source of cost savings can be attributed to a reduction in length of stay. Furthermore, several operational options exist for incorporating a TPS that performs at breakeven or positive net profit. This tool and these findings are important for informing health systems of operational and financial considerations when implementing a TPS program. Future research should evaluate this financial tool’s reproducibility in community health system contexts.