bluuebunny/crossref_metadata_2025 huggingface dataset:
The assemblage of British politics’ breaking point
Authors: Bradshaw Alan , Haynes Paul
Published: February 2023

This paper investigates the UKIP Breaking Point advertisement, which appeared prominently during the Brexit referendum campaign and used a documentary photograph of Syrian refugees, implying that they were migrating to Britain. We chart the assemblage through which the transformation of the image occurred: starting as Jeffrey Mitchell’s documentary photograph, charting news of the journey of a group of refugees, but becoming appropriated as an advertising image and ultimately an expression of political notoriety. The controversy generated by the advertisement serves as an example of advertising's meaning becoming a source of unpredictable contestation as different interests clash to define the image’s ‘real’ meaning. Rather than take advertising as a managed process, with meaning directly encoded and carefully crafted by producers, a cultural politics of advertising perceives advertisements as comprised of raw material whose meanings are ambiguous, negotiable and politically charged. Through this lens, advertising images are contextualized by a process of production and consumption, partly shaped by the producers of the advertisement, but also largely mediated by responses of the wider public, creative fields from where the original image was produced, and by unforeseen factors, such as when texts become overtaken by events and appropriated by intermediaries. Breaking Point, in other words, presents a perfect example to illustrate that advertising is not merely a passive channel that represents but is instead an assemblage able to shape engagement and (coercively) infer meanings and draw distorted patterns from different social worlds.
Baseline-free damage detection and sizing under varying temperatures using Lamb waves without temperature compensation
Authors: Sharma Bhabagrahi Natha , Kapuria Santosh , Arockiarajan A , Kannusamy M
Published: February 2023

The Lamb wave time-reversal method (TRM) has been widely proposed as a baseline-free technique for Structural health monitoring (SHM) of plate/shell-type structures. Still, its efficacy has never been tested under a variable environment. The present study examines the conventional TRM and establishes that it is unsuitable for baseline-free detection and sizing of damage under varying temperatures since the damage index (DI) is prone to change with temperature rise and generally has low sensitivity to damage. The investigation is performed for block mass-type and notch-type defects using experiments and numerical simulations. The study further tests the refined time-reversal method (RTRM), presented recently, against the same objective. This technique uses Lamb waves of the best reconstruction frequency to probe the structure, at which the reconstructed signal in a healthy plate undergoes minimum deviation from the input signal. It considers an extended wave packet for computing the DI instead of using the main mode alone. We show that this process leads to the lowest DI for undamaged plates and the highest sensitivity to damage. Also, the DI remains almost unchanged during temperature change, irrespective of the damage type, size, and plate thickness. It makes the RTRM very effective for baseline-free identification and sizing of damage under varying temperatures.
Physically meaningful uncertainty quantification in probabilistic wind turbine power curve models as a damage-sensitive feature
Authors: Mclean Jacques H , Jones Matthew R , O’Connell Brandon J , Maguire Eoghan , Rogers Tim J
Published: February 2023

A wind turbines’ power curve is an easily accessible form of damage-sensitive data, and as such is a key part of structural health monitoring (SHM) in wind turbines. Power curve models can be constructed in a number of ways, but the authors argue that probabilistic methods carry inherent benefits in this use case, such as uncertainty quantification and allowing uncertainty propagation analysis. Many probabilistic power curve models have a key limitation in that they are not physically meaningful – they return mean and uncertainty predictions outside of what is physically possible (the maximum and minimum power outputs of the wind turbine). This paper investigates the use of two bounded Gaussian processes (GPs) in order to produce physically meaningful probabilistic power curve models. The first model investigated was a warped heteroscedastic Gaussian process, and was found to be ineffective due to specific shortcomings of the GP in relation to the warping function. The second model – an approximated GP with a Beta likelihood was highly successful and demonstrated that a working bounded probabilistic model results in better predictive uncertainty than a corresponding unbounded one without meaningful loss in predictive accuracy. Such a bounded model thus offers increased accuracy for performance monitoring and increased operator confidence in the model due to guaranteed physical plausibility.
Domestic Violence in the Context of the COVID-19 Pandemic: A Synthesis of Systematic Reviews
Authors: Kim Bitna , Royle Meghan
Published: February 2023

The current systematic meta-review aimed to map out, characterize, analyze, and synthesize the overarching findings of systematic reviews on domestic violence (DV) in the context of COVID-19. Specifically, a systematic meta-review was conducted with three main objectives: (1) to identify what types and aspects of DV during COVID-19 have been reviewed systematically to date (research trends), (2) to synthesize the findings from recent systematic reviews of the theoretical and empirical literature (main findings), and (3) to discuss what systematic reviewers have proposed about implications for policy and practice as well as for future primary research (implications). We identified, appraised, and synthesized the evidence contained in systematic reviews by means of a so-called systematic meta-review. In all, 15 systematic reviews were found to be eligible for inclusion in the current review. Thematic codes were applied to each finding or implication in accordance with a set of predetermined categories informed by the DV literature. The findings of this review provide clear insight into current knowledge of prevalence, incidence, and contributing factors, which could help to develop evidence-informed DV prevention and intervention strategies during COVID-19 and future extreme events. This systematic meta-review does offer a first comprehensive overview of the research landscape on this subject. It allows scholars, practitioners, and policymakers to recognize initial patterns in DV during COVID-19, identify overlooked areas that need to be investigated and understood further, and adjust research methods that will lead to more robust studies.
Parental Counseling About Sudden Unexpected Death in Epilepsy: Why, When, Where, What, Who, and How?
Authors: Karakis Ioannis
Published: February 2023

[Box: see text]
Differences in Metabolomic Profiles by Birthplace in Mexican-Origin Hispanic Men Who Participated in a Weight Loss Lifestyle Intervention
Authors: Lopez-Pentecost Melissa , Garcia David O. , Sun Xiaoxiao , Thomson Cynthia A. , Chow H.-H. Sherry , Martinez Jessica A.
Published: February 2023

Birthplace, as a proxy for environmental exposures (e.g., diet), may influence metabolomic profiles and influence risk of cancer. This secondary analysis investigated metabolomic profile differences between foreign and U.S.-born Mexican-origin (MO) Hispanic men to shed light on potential mechanisms through which foreign- and U.S.-born individuals experience differences in cancer risk and risk factors. Plasma samples from MO Hispanic men ( N = 42) who participated in a previous lifestyle intervention were collected pre-and post-intervention. Metabolomic profiles were characterized from samples using ultra performance liquid chromatography–quadrupole time of flight mass spectrometry (UPLC-QTOF). Models were visualized using supervised orthogonal projections to latent structures–discriminant analysis (OPLS-DA). Progenesis QI was used for peak integration and metabolite identification. Plasma metabolomic profiles differed between foreign- and U.S.-born pre-intervention (R2 = .65) and post-intervention (R2 = .62). Metabolomic profiles differed pre- versus post-intervention (R2 = .35 and R2 = .65) for the foreign- and U.S.-born group, respectively. Both endogenous metabolites and dietary components characterized differences between foreign- and U.S.-born participants pre- and post-intervention. Plasma metabolomic profiles from MO Hispanic men differed by birthplace. These results advance our understanding of relevant exposures that may affect cancer risk among MO Hispanic men born abroad or in the United States.
Using Co-design Methods With Chinese Late-Life Immigrants to Translate Mixed-Method Findings to Social Resources
Authors: Yan Zhao Ivy , Holroyd Eleanor , Garrett Nick , Neville Stephen , Wright-st Clair Valerie A.
Published: February 2023

Mainland Chinese born in the 1940s–1950s have experienced unique socio-cultural circumstances that have shaped their late-life immigration experiences. Little is known about what this population perceives would reduce their loneliness. This study aimed to investigate the role of co-design in the development of community-based resources/services for ameliorating the loneliness of Chinese late-life immigrants. Eight co-researchers completed three co-design workshops, and two key service providers were consulted. Co-researchers co-designed guidebooks on accessing primary healthcare facilities, social services, aged care facilities, and public transport, which were considered helpful for ameliorating loneliness. Co-housing was co-designed as a concept and regarded as a feasible way of living to strengthen social interactions and reduce loneliness. Providing more public social housing, adding ‘next-bus stop’ announcements, and conducting loneliness screening were recommended at the national level. Our findings affirmed the need to truly listen to the voices of both service end-users and service providers.
Failure analysis of gas explosion load based on structural impact failure characteristics
Authors: Xu Cimin , Yao Wenjuan
Published: February 2023

The purpose of this study is to obtain the peak of the gas explosion load which is affected by many factors and is not easy to determine. Explosion peak is a key factor in the time-load curve of the explosion field. In this paper, the static and dynamic modal analysis method of gas explosion fracture of reinforced concrete prefabricated slabs is used to obtain the static fracture, maximum reflective pressure applied and peak dynamic load of prefabricated plates. In the actual explosion study, all three prefabricated plates broke at one-third, and the peak dynamic load was 6.743 times the span buckling load in the plate. The analysis also shows that when plastic hinges appear at one-half, the above ratio is 3 times. The calculated peak is within the pressure range of the explosion test. The Baker model is used to fit the explosion time-load curve. This function is applied to the dynamic analysis of the finite element analysis of the explosion plate, and the failure of the plate is more consistent with the explosion case site. The median value of the explode field load time-load equation with the curve function can be applied to the rapid evaluation of post-explosion structure.
Male nurses’ mental health and provision of emotional support during COVID-19: a thematic analysis
Authors: Gadimova Farida , Hall Marc , Jackson Jennifer
Published: February 2023

Background:

COVID-19 has created mental health challenges for nurses. However, it is unknown if there is a gendered influence on nurses’ experiences during the pandemic.

Aim:

The aim of this study was to explore the experiences of male nurses during COVID-19, including their mental health and experiences of providing emotional support.

Methods:

We conducted semi-structured interviews using Zoom with nine male nurses and analysed the interviews using thematic analysis.

Findings:

Male nurses experienced negative mental health outcomes from the pandemic, but participants attributed these outcomes to the context. Male nurses provided emotional support for patients, students, families and other staff and did not describe emotional support as a difficult part of their work. Participants identified their role as a ‘breadwinner’ of being part of their concern during COVID-19. Participants used a variety of approaches to manage the stressors from the pandemic and cautioned against alcohol as a coping strategy.

Discussion and Conclusions:

Participants provided emotional support routinely as part of their work and went to great lengths to do so. This finding differs from most published literature that suggests male nurses struggle with emotional and interpersonal aspects of nursing. Male nurses require emotional support and employers can note that need for support may present differently by gender.
The influence of foreperiod duration on the preparation and control of sequential aiming movements
Authors: Khan Michael A , Kurniawan Aryan , Khan Madison ER , Khan Michaela CM , Smith Kristy L , Scharoun Benson Sara , Carlsen Anthony N , Lawrence Gavin P
Published: February 2023

Reaction time (RT) and movement times (MTs) to the first target are typically longer for two-target sequential movements compared to one-target movements. While this one-target advantage has been shown to be dependent on the availability of advance information about the numbers of targets, there has been no systematic investigation of how foreperiod duration (i.e., interval between presentation of the target(s) and stimulus) influences the planning and execution of sequential movements. Two experiments were performed to examine how the one-target advantage is influenced by the availability and timing of advance target information. In Experiment 1, participants performed one- and two-target movements in two separate blocks. In Experiment 2, target conditions were randomised from trial to trial. The interval between target(s) appearing and stimulus tone (i.e., foreperiod) was varied randomly (0, 500, 1,000, 1,500, and 2,000 ms). The results of Experiment 1 revealed that while the one-target advantage in RT was not influenced by foreperiod duration, the one-target advantage in MT increased as foreperiod duration increased. The variability of endpoints at the first target was greater in the two- compared to one-target condition. In Experiment 2, the one-target advantage in both RT and MT increased as the length of the foreperiod increased. However, there was no difference in limb trajectory variability between target conditions. The implication of these findings for theories of motor planning and execution of multiple segment movements is discussed.
Heterogeneity in the diagnosis and prognosis of ischemic stroke subtypes: 9-year follow-up of 22,000 cases in Chinese adults
Authors: Chun Matthew , Qin Haiqiang , Turnbull Iain , Sansome Sam , Gilbert Simon , Hacker Alex , Wright Neil , Zhu Tingting , Clifton David , Bennett Derrick , Guo Yu , Pei Pei , Lv Jun , Yu Canqing , Yang Ling , Li Liming , Lu Yan , Chen Zhengming , Cairns Benjamin J , Chen Yiping , Clarke Robert
Published: February 2023

Background:

Reliable classification of ischemic stroke (IS) etiological subtypes is required in research and clinical practice, but the predictive properties of these subtypes in population studies with incomplete investigations are poorly understood.

Aims:

To compare the prognosis of etiologically classified IS subtypes and use machine learning (ML) to classify incompletely investigated IS cases.

Methods:

In a 9-year follow-up of a prospective study of 512,726 Chinese adults, 22,216 incident IS cases, confirmed by clinical adjudication of medical records, were assigned subtypes using a modified Causative Classification System for Ischemic Stroke (CCS) (large artery atherosclerosis (LAA), small artery occlusion (SAO), cardioaortic embolism (CE), or undetermined etiology) and classified by CCS as “evident,” “probable,” or “possible” IS cases. For incompletely investigated IS cases where CCS yielded an undetermined etiology, an ML model was developed to predict IS subtypes from baseline risk factors and screening for cardioaortic sources of embolism. The 5-year risks of subsequent stroke and all-cause mortality (measured using cumulative incidence functions and 1 minus Kaplan–Meier estimates, respectively) for the ML-predicted IS subtypes were compared with etiologically classified IS subtypes.

Results:

Among 7443 IS subtypes with evident or probable etiology, 66% had SAO, 32% had LAA, and 2% had CE, but proportions of SAO-to-LAA cases varied by regions in China. CE had the highest rates of subsequent stroke and mortality (43.5% and 40.7%), followed by LAA (43.2% and 17.4%) and SAO (38.1% and 11.1%), respectively. ML provided classifications for cases with undetermined etiology and incomplete clinical data (24% of all IS cases; n = 5276), with area under the curves (AUC) of 0.99 (0.99–1.00) for CE, 0.67 (0.64–0.70) for LAA, and 0.70 (0.67–0.73) for SAO for unseen cases. ML-predicted IS subtypes yielded comparable subsequent stroke and all-cause mortality rates to the etiologically classified IS subtypes.

Conclusion:

This study highlighted substantial heterogeneity in prognosis of IS subtypes and utility of ML approaches for classification of IS cases with incomplete clinical investigations.
Ventilatory ratio and mechanical power in prolonged mechanically ventilated COVID-19 patients versus respiratory failures of other etiologies
Authors: Ghiani Alessandro , Tsitouras Konstantinos , Paderewska Joanna , Kahnert Kathrin , Walcher Swenja , Gernhold Lukas , Neurohr Claus , Kneidinger Nikolaus
Published: February 2023

Background:

Evidence suggests differences in ventilation efficiency and respiratory mechanics between early COVID-19 pneumonia and classical acute respiratory distress syndrome (ARDS), as measured by established ventilatory indexes, such as the ventilatory ratio (VR; a surrogate of the pulmonary dead-space fraction) or mechanical power (MP; affected, e.g., by changes in lung-thorax compliance).

Objectives:

The aim of this study was to evaluate VR and MP in the late stages of the disease when patients are ready to be liberated from the ventilator after recovering from COVID-19 pneumonia compared to respiratory failures of other etiologies.

Design:

A retrospective observational cohort study of 249 prolonged mechanically ventilated, tracheotomized patients with and without COVID-19-related respiratory failure.

Methods:

We analyzed each group’s VR and MP distributions and trajectories [repeated-measures analysis of variance (ANOVA)] during weaning. Secondary outcomes included weaning failure rates between groups and the ability of VR and MP to predict weaning outcomes (using logistic regression models).

Results:

The analysis compared 53 COVID-19 cases with a heterogeneous group of 196 non-COVID-19 subjects. VR and MP decreased across both groups during weaning. COVID-19 patients demonstrated higher values for both indexes throughout weaning: median VR 1.54 versus 1.27 ( p < 0.01) and MP 26.0 versus 21.3 Joule/min ( p < 0.01) at the start of weaning, and median VR 1.38 versus 1.24 ( p < 0.01) and MP 24.2 versus 20.1 Joule/min ( p < 0.01) at weaning completion. According to the multivariable analysis, VR was not independently associated with weaning outcomes, and the ability of MP to predict weaning failure or success varied with lung-thorax compliance, with COVID-19 patients demonstrating consistently higher dynamic compliance along with significantly fewer weaning failures (9% versus 30%, p < 0.01).

Conclusion:

COVID-19 patients differed considerably in ventilation efficiency and respiratory mechanics among prolonged ventilated individuals, demonstrating significantly higher VRs and MP. The differences in MP were linked with higher lung-thorax compliance in COVID-19 patients, possibly contributing to the lower rate of weaning failures observed.
Venous thromboembolism in patients with idiopathic pulmonary fibrosis, based on nationwide claim data
Authors: Lee Jang Ho , Lee Hoon Hee , Park Hyung Jun , Kim Seonok , Kim Ye-Jee , Lee Jae Seung , Kim Ho Cheol
Published: February 2023

Background:

Idiopathic pulmonary fibrosis (IPF) is a known risk factor for venous thromboembolism (VTE). However, it is currently unknown which factors are associated with an increase of VTE in patients with IPF.

Objectives:

We estimated the incidence of VTE in patients with IPF and identified clinical characteristics related to VTE in patients with IPF.

Design and methods:

De-identified nationwide health claim data from 2011 to 2019 was collected from the Korean Health Insurance Review and Assessment database. Patients with IPF were selected if they had made at least one claim per year under the J84.1 [ International Classification of Diseases and Related Health Problems, 10th Revision (ICD-10)] and V236 codes of rare intractable diseases. We defined the presence of VTE as at least one claim of pulmonary embolism and deep vein thrombosis ICD-10 codes.

Results:

The incidence rate per 1000 person-years of VTE was 7.08 (6.44–7.77). Peak incidence rates were noted in the 50–59 years old male and 70–79 years old female groups. Ischemic heart disease, ischemic stroke, and malignancy were associated with VTE in patients with IPF, with an adjusted hazard ratio (aHR) of 1.25 (1.01–1.55), 1.36 (1.04–1.79), and 1.53 (1.17–2.01). The risk for VTE was increased in patients diagnosed with malignancy after IPF diagnosis (aHR = 3.18, 2.47–4.11), especially lung cancer [hazard ratio (HR) = 3.78, 2.90–4.96]. Accompanied VTE was related to more utilization of medical resources.

Conclusion:

Ischemic heart disease, ischemic stroke, and malignancy, especially lung cancer, were related to higher HR for VTE in IPF.
Nosocomial bacterial infections in Victoria decreased during the COVID-19 pandemic
Authors: Asgill Tess F , Stupart Douglas
Published: February 2023

Background

A number of infection control interventions were implemented during the COVID-19 pandemic in order to reduce the spread of this virus.

Objective

The purpose of this study was to determine if these interventions were associated with reduced nosocomial bacterial infections in Victoria, Australia.

Methods

Observational data were obtained from the Victorian Healthcare Associated Infection Surveillance System (VICNISS) based on admitted hospital patients in two 6-month timeframes representing pandemic and pre-pandemic hospital practices. Data were collected for surgical site infections, Staphylococcus aureus bacteraemia, Clostridioides difficile infection, and central line-associated bloodstream infections.

Results

There was a significant reduction in the rates of S. aureus bacteraemia (0.74 infections/10, 000 bed days pre-pandemic vs. 0.53/10,000 bed days in the pandemic period [rate ratio 0.72, 95% CI 0.57–0.90]; p = .003) and in C. difficile infections (2.2 infections/10,000 bed days pre-pandemic vs. 0.86/10 000 bed days in the pandemic era [rate ratio 0.76, 95% C.I. 0.67–0.86]; p <.001). There was no change in the overall rate of surgical site infections or central line-associated infections however.

Discussion

The increased emphasis on infection control and prevention strategies during the pandemic period was associated with reduced transmission of S. aureus and C. difficile infections within hospitals.
Preoperative Hypoalbuminemia Not Associated With Total Ankle Arthroplasty Outcomes
Authors: Newton William , Guareschi Alexander S. , Hoch Caroline P. , Scott Daniel J. , Gross Christopher E.
Published: February 2023

Background.

This study aims to investigate the effect of hypoalbuminemia on the rates of 30-day complication, readmission, and reoperation following total ankle arthroplasty (TAA).

Methods.

The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2007 to 2019 to identify 710 TAA patients. Patients were then stratified into normal (n = 673) or low (n = 37) albumin groups. Demographics, medical comorbidities, concomitant procedures, hospital length of stay, and 30-day complication, readmission, and reoperation rates were compared between groups. Preoperative serum albumin level was also used as a continuous variable when analyzing postoperative outcomes.

Results.

The overall cohort was predominantly male (51.5%), and the mean age was 65.02 (range, 45-87) years. We found there to be no statistically significant difference in demographics between cohorts. However, hypoalbuminemia patients were significantly more likely to use long-term steroids for a chronic condition (normal = 6.1%, low = 18.9%; P = .009). Additionally, there was no difference in 30-day complication (normal = 3.0%, low = 0.0%; P = .618), readmission (normal = 2.4%, low = 0.0%; P = .632), and reoperation (normal = 1.0%, low = 0.0%; P = 1.000) rates between groups.

Conclusion.

The results of this study show that malnourished patients are not at an increased risk of 30-day complication, readmission, or reoperation following TAA despite having a worse preoperative comorbidity profile.

Level of Evidence

Level III, Retrospective cohort study
What's New in the Diagnosis and Treatment of Aspirin-Exacerbated Respiratory Disease: A Brief Review
Authors: Douglas Jennifer E. , Bosso John V.
Published: February 2023

Background

Aspirin-exacerbated respiratory disease (AERD) is a chronic condition characterized by the presence of asthma, chronic rhinosinusitis with nasal polyposis, and sensitivity to aspirin and other non-steroidal anti-inflammatory drugs. Diagnosis is based on careful clinical history and physical examination, characteristic laboratory and radiographic findings, and, in unclear cases, aspirin challenge. Established treatment is founded on comprehensive endoscopic sinus surgery followed by topical steroids and aspirin desensitization. T2 biologics are now available for refractory cases.

Objective

To summarize the historic literature on AERD, its diagnosis and treatment options, as well as to review the most current publications on the topic and explore areas for future research.

Methods

A literature review utilizing the PubMed database was performed.

Results

Seminal journal articles regarding the diagnosis and treatment of AERD were reviewed with close attention to evidence-based protocols and knowledge gaps in the field as areas for future research.

Conclusion

AERD is a complex disease which requires careful diagnostic work-up and coordinated care between the allergist and rhinologist to facilitate optimal treatment outcomes.
Economics of Medical and Surgical Management of Chronic Rhinosinusitis with Nasal Polyps: A Contemporary Review
Authors: Chapurin Nikita , Khan Sofia , Gutierrez Jorge , Soler Zachary M.
Published: February 2023

Background

Chronic rhinosinusitis (CRS) with nasal polyposis (CRSwNP) is a chronic inflammatory condition with significant patient morbidity and associated healthcare costs. While the economic burden of CRS overall has been previously described, the economic impact of CRSwNP has received less attention. Patients with CRSwNP have higher disease burden and healthcare resource utilization than those with CRS without nasal polyposis. Rapid evolution of medical management in recent years with the use of targeted biologics warrants further investigation into the economic burden of CRSwNP.

Objective

Provide an updated review of the literature on the economic impact of CRSwNP.

Methods

A literature review.

Results

Research shows that patients with CRSwNP have higher direct costs and usage of ambulatory services compared to matched non-CRS controls. Patients undergoing functional endoscopic sinus surgery (FESS) incur roughly $13,000 in costs which is particularly relevant given the rate of disease recidivism and need for revision surgery associated with CRSwNP. Disease burden additionally leads to indirect costs through loss of wages and productivity due to work absenteeism and presenteeism, with estimates of up to roughly $10,000 lost in mean annual productivity cost in refractory CRSwNP. Several studies have shown FESS to be more cost-effective in intermediate and long-term management than medical therapy with biologics, despite similar long-term outcomes with respect to quality-of-life metrics.

Conclusion

CRSwNP is a chronic condition with high recurrence rates making it a challenge to manage over time. Current research suggests that FESS is more cost-effective than medical management, including use of newer biologics. Further investigation into both direct and indirect costs associated with medical management is warranted to perform accurate cost-effectiveness analyses and allow for the best allocation of limited healthcare resources.
Biologics for Nasal Polyps: Synthesizing Current Recommendations into a Practical Clinical Algorithm
Authors: Godse Neal R. , Keswani Anjeni , Lane Andrew P. , Lee Stella E. , Sindwani Raj
Published: February 2023

Background

Chronic rhinosinusitis with nasal polyps (CRSwNP) has been traditionally managed with a combination of topical and systemic medical therapy as well as endoscopic sinus surgery. The emergence of biologic therapies that target specific aspects of the inflammatory cascade has ushered in a potentially new paradigm in the management options available for CRSwNP.

Purpose

To summarize the current literature and recommendations supporting the use of available biologic therapies for CRSwNP and to develop an algorithm to aid clinical decision-making regarding treatment selection.

Methods

A review of available literature and studies that demonstrated the clinical efficacy of biologic agents for the treatment of CRSwNP informing current CRSwNP consensus algorithms.

Results

Current biologic medications target immunoglobulin E, interleukins, or interleukin receptors implicated in the Th2 inflammatory cascade. Institution of biologic therapy is now an option for patients who have disease refractory to topical medical therapy and endoscopic sinus surgery, those who cannot tolerate surgery, or patients with other comorbid Th2 diseases. Response to treatment should be monitored at 4–6 months and 1 year after initiating therapy. Across multiple indirect comparisons, dupilumab appears to have the largest therapeutic benefit across multiple subjective and objective outcomes. The choice of therapeutic agent also depends on drug availability, patient tolerance, presence of comorbid illnesses, and cost.

Conclusions

Biologics are emerging as an important option in the management of patients with CRSwNP. While more data is required to fully inform indications, treatment selection, and health economics related to their use, biologics may offer robust symptom relief to patients who have failed other interventions.
Advances in Sinus Surgery for Nasal Polyps
Authors: Norwood T. Graham , Grayson Jessica W. , Woodworth Bradford A.
Published: February 2023

Background

Chronic rhinosinusitis with nasal polyps (CRSwNP) is comprised of a diverse group of endotypes that cause significant morbidity for afflicted patients. While endoscopic sinus surgery helps ameliorate the disease, polyps frequently recur. Newer strategies are intended to provide access for topical steroid irrigations in attempts to improve the disease process and quality of life, and decrease overall recurrence of polyps.

Objective

To review the current literature examining the latest surgical approaches for CRSwNP.

Methods

Review article.

Results

In dealing with the recalcitrant nature of CRSwNP, surgical techniques have simultaneously become more nuanced and aggressive. Bony resection in anatomically unfavorable areas such as the frontal, maxillary, and sphenoid outflow regions, replacing diseased or denuded mucosa with healthy grafts or flaps at the neo-ostia, and introducing drug-eluting biomaterials to newly opened sinus outflow tracts are highlights in the recent advancements in sinus surgery for CRSwNP. The Draf 3 or modified endoscopic Lothrop procedure has become a standard technique and demonstrated to improve quality of life and decrease polyp recurrence. A number of mucosal grafting or mucosal flap techniques have been described that cover exposed bone of the neo-ostium and evidence shows that this improves healing and diameter of the Draf 3. Partial middle turbinectomy, while controversial, appears to help decrease polyp recurrence in long-term follow-up studies. Modified endoscopic medial maxillectomy improves access to the maxillary sinus mucosa, facilitates debridement and, particularly, in the cystic fibrosis nasal polyp patient, improves overall management of the disease. Sphenoid drill-out procedure provides wider access for topical steroid irrigations and also may improve management of CRSwNP.

Conclusion

Surgical intervention remains a mainstay of therapy for CRSwNP. Newer techniques revolve around improving access for topical steroid therapy.
Scientific Advancements That Empower Us to Understand CRS Pathophysiology
Authors: Qureshi Hannan A. , G. Franks Zechariah , Gurung Asiana , Ramanathan Murugappan
Published: February 2023

Background

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a multifactorial inflammatory condition that remains poorly understood. Over the past decade, we have witnessed impressive scientific advancements that have allowed us to better understand the molecular and cellular mechanisms that underlie the inflammatory processes in mucosal diseases including asthma, allergic rhinitis, and CRSwNP.

Objective

The present review aims to summarize and highlight the most recent scientific advancements that have enriched our understanding of CRSwNP.

Methods

A comprehensive review of the available literature on the use of new scientific techniques in CRSwNP was performed. We evaluated the most recent evidence from studies using animal models, cell cultures, and genome sequencing techniques and their impact on our understanding of CRSwNP pathophysiology.

Results

Our understanding of CRSwNP has rapidly progressed with the development of newer scientific techniques to interrogate various pathways involved in its pathogenesis. Animal models remain powerful tools and have elucidated the mechanisms behind esinophilic inflammation in CRSwNP; however, animal models reproducing polyp formation are relatively sparse. 3D cell cultures have significant potential to better dissect the cellular interactions with the sinonasal epithelium and other cell types in CRS. Additionally, some groups are starting to utilize single-cell RNA sequencing to investigate RNA expression in individual cells with high resolution and on a genomic scale.

Conclusion

These emerging scientific technologies represent outstanding opportunities to identify and develop more targeted therapeutics for different pathways that lead to CRSwNP. An additional understanding of these mechanisms will be critical for developing future therapies for CRSwNP.
New Developments in Allergic Fungal Rhinosinusitis Pathophysiology and Treatment
Authors: Cameron Brian H. , Luong Amber U.
Published: February 2023

Background

Allergic fungal rhinosinusitis (AFRS) is an endotype of chronic rhinosinusitis (CRS) with nasal polyps characterized by eosinophilic mucin laden with fungal hyphae entrapped in expanded sinus cavities with an exaggerated hypersensitivity to fungal elements. The last decade has elucidated fungi-driven inflammatory pathways contributing to the pathophysiology of chronic inflammatory respiratory diseases. In addition, novel therapeutic biologic options have become available for CRS over the last several years.

Objective

To review the current literature examining AFRS, focusing on recent developments in our understanding of its pathophysiology and implications for treatment options.

Methods

Review article.

Results

Fungi-driven respiratory inflammation has been linked to fungal proteinases and toxin activity. In addition, AFRS patients demonstrate a local sinonasal immunodeficiency in antimicrobial peptides and hence limited antifungal activity, along with an exaggerated type 2 inflammatory response, highlighting a possible imbalanced type 1, type 2, and type 3 profile. The elucidation of these dysregulated molecular pathways has highlighted novel potential therapeutic targets. As such, the clinical management of AFRS, which once included surgery and extended courses of oral corticosteroids, is transitioning away from long courses of oral corticosteroids to incorporate novel delivery mechanisms of topical therapeutic targets and biologics for recalcitrant disease.

Conclusion

AFRS is an endotype of CRS with nasal polyps (CRSwNP) for which the molecular pathways leading to its inflammatory dysfunction are beginning to be illuminated. In addition to affecting treatment options, these understandings may shape necessary changes to diagnostic criteria and the extrapolated effects of environmental changes on AFRS. More critically, a better appreciation of fungi-driven inflammatory pathways may have implications for the understanding of broader CRS inflammation.
The Impact of Social Determinants and Air Pollution on Healthcare Disparities in Chronic Rhinosinusitis With Nasal Polyps
Authors: Peterson Rachel , Keswani Anjeni
Published: February 2023

Background/Objective

Multiple factors affect healthcare disparities in chronic rhinosinusitis (CRS) with and without nasal polyps. These factors include access to care, economic burdens to treatment, and differences in air pollution and air quality. In this paper, we will discuss how socioeconomic status, race, and air pollution burden influence healthcare disparities in the diagnosis and treatment outcomes of chronic rhinosinusitis with nasal polyps (CRSwNP).

Methods

A literature search was performed via PubMed for articles related to CRSwNP, healthcare disparities, race, socioeconomic status, and air pollution in September 2022. Original studies from 2016 to 2022, landmark articles, and systematic reviews were included. We summarized these articles to cohesively discuss factors contributing to healthcare disparities in CRSwNP.

Results

Literary search produced 35 articles. Individual factors such as socioeconomic status, race, and air pollution influence CRSwNP severity and treatment outcomes. Correlations were noted with socioeconomic status, race, and air pollution exposure and CRS severity and post-surgical outcomes. Air pollution exposure was also associated with histopathologic changes in CRSwNP. Lack of access to care was a notable contributor to healthcare disparities in CRS.

Conclusion

Healthcare disparities in the diagnosis and treatment of CRSwNP differentially affect racial minorities and individuals of lower socioeconomic status. Increased air pollution exposure in areas of lower socioeconomic status is a compounding factor. Clinician advocacy for greater healthcare access and reductions in environmental exposures for patients, among other societal changes, may help improve disparities.
Political Bot Bias in the Perception of Online Discourse
Authors: Schweitzer Shane , Dobson Kyle S. H. , Waytz Adam
Published: February 2023

Four nationally representative studies ( N = 1,986; three preregistered) find evidence for a bias in how people perceive opposing viewpoints expressed through online discourse. These studies elucidate a political bot bias, where political partisans (vs. their out-party) are more likely to view counter-ideological (vs. ideologically consistent) tweets to be social media bots (vs. humans). Study 1 demonstrates that American Democrats and Republicans are more likely to attribute tweets to bots when those tweets express counter-ideological views. Study 2 demonstrated this bias with actual bot tweets generated by the Russian government and comparable human tweets. Study 3 demonstrated this bias manifests in the context of real recent elections and is associated with markers of political animosity. Study 4 experimentally demonstrates the consequences of bot attribution for perceptions of online political discourse. Our findings document a consistent bias that has implications for political discussion online and political polarization more broadly.
The functional impact of implantable hearing devices in patients with single-sided deafness
Authors: Lee Sin Wai , Yuen Heng Wai , Low David , Kamath Savitha , Chua Kenneth Wei De
Published: February 2023

Introduction

Single-sided deafness (SSD) is associated with significant functional impairment such as listening speech in noise and localizing sound. To date, studies on the efficacy of CI and BCI for single-sided deafness are conflicting.

Objective

Thus, the objective of our study was to describe and compare the functional outcomes between these devices.

Methods

Thirteen subjects with SSD were prospectively recruited for our study. Six underwent CI and seven received BCI. Word recognition scores (WRS) and disease specific outcome measures were obtained pre-implantation, at 6, and 12 months.

Results

WRS improved both in quiet and in noise for CI and BCI recipients. On the contrary, CI recipients displayed improvement in Speech Spatial Quality (SSQ) scores. A decreasing trend of improvement in APHAB scores were observed for the BCI group.

Conclusion

BCI recipients showed a significant improvement in WRS (in noise). Conversely, CI recipients showed a great improvement in SSQ scores. These preliminary findings suggest that true binaural hearing can only be restored with CI for better SSQ performance. However, BCIs could be recommended to a sub-group of patients, if listening to speech in noise is a priority.
An introduction to quality improvement
Authors: Russ Stephanie J , Green James , de Winter Louise , Herrington Ellie , Hughes-Hallett Archie , Taylor Julia M , Sevdalis Nick
Published: February 2023

The concept of quality has moved to the top of the international healthcare agenda in the past 30 years. This has been driven by a growing awareness of the scale of variation in patient outcomes, influenced by both the paucity of and consistency in implementation of evidence-based actions or interventions performed during the delivery of patient care. Concurrently there has been growing interest on the part of healthcare professionals to use a wider range of knowledge and available techniques, from outside of medicine, to continuously improve standards of safe and effective patient care. This is the first in a series of three articles introducing Quality Improvement (QI) methodology and supporting concepts to multidisciplinary teams working in Urology departments in the United Kingdom. We start, in this article, by providing an overview of key QI principles and their industrial roots; we position QI in the context of other approaches to improvement, such as audit, and we outline the key organisations and infrastructure supporting QI work on the ground.
The world wide web of carbon: Toward a relational footprinting of information and communications technology's climate impacts
Authors: Pasek Anne , Vaughan Hunter , Starosielski Nicole
Published: February 2023

The climate impacts of the information and communications technology sector—and Big Data especially—is a topic of growing public and industry concern, though attempts to quantify its carbon footprint have produced contradictory results. Some studies argue that information and communications technology's global carbon footprint is set to rise dramatically in the coming years, requiring urgent regulation and sectoral degrowth. Others argue that information and communications technology's growth is largely decoupled from its carbon emissions, and so provides valuable climate solutions and a model for other industries. This article assesses these debates, arguing that, due to data frictions and incommensurate study designs, the question is likely to remain irresolvable at the global scale. We present six methodological factors that drive this impasse: fraught access to industry data, bottom-up vs. top-down assessments, system boundaries, geographic averaging, functional units, and energy efficiencies. In response, we propose an alternative approach that reframes the question in spatial and situated terms: A relational footprinting that demarcates particular relationships between elements—geographic, technical, and social—within broader information and communications technology infrastructures. Illustrating this model with one of the global Internet's most overlooked components—subsea telecommunication cables—we propose that information and communications technology futures would be best charted not only in terms of quantified total energy use, but in specifying the geographical and technical parts of the network that are the least carbon-intensive, and which can therefore provide opportunities for both carbon reductions and a renewed infrastructural politics. In parallel to the politics of (de)growth, we must also consider different network forms.
A scoping review to assess the effects of virtual reality in medical education and clinical care
Authors: Dhar Eshita , Upadhyay Umashankar , Huang Yaoru , Uddin Mohy , Manias George , Kyriazis Dimosthenis , Wajid Usman , AlShawaf Hamza , Syed Abdul Shabbir
Published: February 2023

Due to the challenges and restrictions posed by COVID-19 pandemic, technology and digital solutions played an important role in the rendering of necessary healthcare services, notably in medical education and clinical care. The aim of this scoping review was to analyze and sum up the most recent developments in Virtual Reality (VR) use for therapeutic care and medical education, with a focus on training medical students and patients. We identified 3743 studies, of which 28 were ultimately selected for the review. The search strategy followed the most recent Preferred Reporting Items for Systematic Reviews and Meta-Analysis for scoping review (PRISMA-ScR) guidelines. 11 studies (39.3%) in the field of medical education assessed different domains, such as knowledge, skills, attitudes, confidence, self-efficacy, and empathy. 17 studies (60.7%) focused on clinical care, particularly in the areas of mental health, and rehabilitation. Among these, 13 studies also investigated user experiences and feasibility in addition to clinical outcomes. Overall, the findings of our review reported considerable improvements in terms of medical education and clinical care. VR systems were also found to be safe, engaging, and beneficial by the studies’ participants. There were huge variations in studies with respect to the study designs, VR contents, devices, evaluation methods, and treatment periods. In the future, studies may focus on creating definitive guidelines that can help in improving patient care further. Hence, there is an urgent need for researchers to collaborate with the VR industry and healthcare professionals to foster a better understanding of contents and simulation development.