bluuebunny/crossref_metadata_2025 huggingface dataset:
The pathogenic role of lupus-specific autoantibodies and Interleukin-6 on demyelination of the brainstem and spinal cord in systemic lupus erythematosus
Authors: Hasegawa Yasuhiro , Arinuma Yoshiyuki , Muramatsu Takumi , Kondou Junichi , Matsueda Yu , Kanayama Yoshiro , Ino Kazuma , Tanaka Tomoki , Wada Tatsuhiko , Oku Kenji , Yamaoka Kunihiro
Published: January 2023

Objectives

Demyelinating syndromes that result in brainstem and/or spinal cord lesions similar to those observed in neuromyelitis optica spectrum disorder (NMOSD) as neuropsychiatric syndromes in systemic lupus erythematosus (NPSLE) occasionally develop in patients with SLE. Cerebrospinal fluid (CSF) interleukin (IL)-6 is a known biomarker for NMOSD; however, its application in patients with SLE with brainstem and/or spinal cord lesions is unknown. Additionally, the breakdown of blood–brain barrier (BBB) integrity by autoantibodies is another mechanism of NMOSD; however, it is not elucidated in SLE. Therefore, this study was designed to clarify the use of CSF IL-6 and investigate whether autoantibodies contribute to BBB breaches and the development of brainstem and/or spinal cord lesions.

Methods

Data from patients with NPSLE who had NMOSD-like demyelinating lesions in the central nervous system (CNS), including brainstem and/or spinal cord lesions, were retrospectively analyzed. We retrospectively investigated the interval changes in CSF IL-6 and clinical and serological factors related to BBB permeability using CSF/serum albumin ratio (QAlb).

Results

Twelve patients with NPSLE who had demyelinating lesions in the brainstem and/or spinal cord were recruited. Before treatment, CSF IL-6 levels were 29.1 pg/mL and significantly decreased to 3.8 pg/mL by treatment ( p = 0.008). Before treatment, CSF IL-6 was significantly correlated with the anti-dsDNA antibody titer ( p = 0.027). Furthermore, before treatment, QAlb was significantly correlated with the serum anti-Smith antibody titer. In patients with atypical NMOSD who had specific lesions defined in the NMOSD diagnostic criteria but were negative for antiaquaporin four antibody, a significant correlation was observed between the serum anti-Smith antibody titer and CSF IL-6 ( p = 0.025) and QAlb ( p = 0.033) values before treatment.

Conclusion

CSF IL-6 could be a surrogating marker for disease activity, and serum anti-Smith antibody permeabilizes the BBB in patients with NPSLE, supporting the development of NMOSD-like CNS lesions.
Taking a chance: How likely am I to receive my preferred treatment in a clinical trial?
Authors: Walter Stephen D , Blaha Ondrej , Esserman Denise
Published: January 2023

Researchers should ideally conduct clinical trials under a presumption of clinical equipoise, but in fact trial patients will often prefer one or other of the treatments being compared. Receiving an unblinded preferred treatment may affect the study outcome, possibly beneficially, but receiving a non-preferred treatment may induce ‘reluctant acquiescence’, and poorer outcomes. Even in blinded trials, patients’ primary motivation to enrol may be the chance of potentially receiving a desirable experimental treatment, which is otherwise unavailable. Study designs with a higher probability of receiving a preferred treatment (denoted as ‘concordance’) will be attractive to potential participants, and investigators, because they may improve recruitment and hence enhance study efficiency. Therefore, it is useful to consider the concordance rates associated with various study designs. We consider this question with a focus on comparing the standard, randomised, two-arm, parallel group design with the two-stage randomised patient preference design and Zelen designs; we also mention the fully randomised and partially randomised patient preference designs. For each of these designs, we evaluate the concordance rate as a function of the proportions randomised to the alternative treatments, the distribution of preferences over treatments, and (for the Zelen designs) the proportion of patients who consent to receive their assigned treatment. We also examine the equity of each design, which we define as the similarity between the concordance rates for participants with different treatment preferences. Finally, we contrast each of the alternative designs with the standard design in terms of gain in concordance and change in equity.
Analysing Scaffolds in Learning Systems Concepts in School Biology
Authors: Singh Garima , Khunyakari Ritesh
Published: January 2023

Learning about components and processes of complex biological systems is challenging and requires abstraction through mediational tools such as text, visuals, models and visualisation experiences. The ‘systems concepts’ necessitate building coherent relations and anticipating consequences, requiring greater mediational support. This article reports findings from two components of a study. The first component involved a comparative analysis of textbooks and revealed weak links between visuals and other scaffolding tools such as activities and end-chapter exercises. Visuals in textbooks were found to be inadequate, inappropriate and often potential sources of confusion. The second component of the study involved drawing-based task that elicited learner struggles in internalising ideas about the human digestive system. The study calls for a refined understanding and use of mediational tools towards bridging the gaps between conceptual models and learners’ mental models. The study opens avenues for further inquiry that could support learning biology.
Design and analysis of unsymmetrical SSD based negative capacitance technique for vibration suppression
Authors: Ji Hongli , Zhang Rui , Zhang Chao , Liu Ruoyu , Wu Yipeng , Qiu Jinhao
Published: January 2023

Synchronized switch damping on negative capacitance (SSDNC), as one of the nonlinear synchronized switch damping (SSD) techniques, has been received much attention in recent years. The damping effect depends on the effective voltage on the piezoelectric actuator in SSDNC control. The applicable bipolar voltage of a piezoelectric element is unsymmetrical. However, the voltage on the piezoelectric actuator is applied symmetrically in SSDNC, which greatly wastes the driving capability. An unsymmetrical SSDNC (un-SSDNC) is proposed in this paper to further boost the voltage on the PZT actuator and make full use of the driving ability to improve the control performance. A bypass capacitor, two diodes and switches are attached to the SSDNC circuit to realize unsymmetrical bipolar voltage. The control logic of the switches is introduced and the switched voltage is derived as well as the control performance. Experiments and simulations were carried out to verify the designed circuit and the theoretical results of the switched voltage. The influence of the bypass capacitor on the switched voltage and the stability of the un-SSDNC system were investigated. The voltage ratio and control performance increase with increasing bypass capacitor, but too large of bypass capacitor will cause the problem of system stability.
Patient and Physician Perspectives in the Management of Immune Thrombocytopenia in Iran: Responses from the ITP World Impact Survey (I-WISh)
Authors: Eshghi Peyman , Abolghasemi Hassan , Akhlaghi Ali A. , Ashrafi Farzaneh , Bordbar Mohammadreza , Hajifathali Abbas , Hosseini Hamed , Mirbehbahani Nargesbeigom , Abedini Ayat , Shahsavarani Narges , Faranoush Mohammad
Published: January 2023

Data describing physicians’ and patients’ perspectives towards immune thrombocytopenia (ITP) management and impact of disease in Iran are limited. This ITP World Impact Survey was conducted between October 2019 and October 2020. Of the 114 patients included in the survey, 17 were aged ≤18 years. Forty-seven physicians, including 22 pediatric hematologists, participated in the survey. Fatigue and anxiety around stable platelet counts were frequent patient-reported symptoms at diagnosis and at survey completion. According to physicians, “watch-and-wait” was the preferred treatment option for mean (standard deviation) proportion of 50.1 (24.1) and 48.6 (21.8) of their adult and pediatric patients, respectively, following first diagnosis. Per adult and pediatric hematologists, the most prescribed treatments for newly diagnosed patients based on available answers were steroids (100%, n = 20/20; 89%, n = 16/18), respectively. Forty percent of adult (n = 10/25) and 38% of pediatric hematologists (n = 8/21) reported that ITP reduced patients’ quality of life. Energy levels (46%, n = 52/112) and ability to concentrate on everyday activities (42%, n = 47/113) were the most affected aspects of patients' lives. This I-WISh study in Iran underlined the negative impact of ITP on patients.
An adaptive feature extraction technique for ship-radiated noise based on weighted multiscale mathematical morphological filtering
Authors: Li Zhao-xi , Li Ya-an , Zhang Kai
Published: January 2023

Aiming at the problem of feature extraction of ship-radiated noise in complex marine environment, an adaptive weighted multiscale mathematical morphological filtering method is proposed. The weight coefficients of the structure elements of different scales in multiscale morphological filtering are determined adaptively by an improved particle swarm optimization algorithm, and the Teager energy kurtosis is used as the evaluation index of the filtered optimal signal to provide optimized weights for each scale. Finally, the optimized multiscale mathematical morphology filter with selective adaptive weights is bound and applied to the feature extraction of ship-radiated noise. The analysis results of simulated signal and measured ship-radiated noise show that this method has strong noise suppression and feature extraction ability, and the calculation is simple and fast, which provides an effective method for ship feature extraction.
Constructing Indigenous Psychological Theories From A Global Perspective: Taking Filial Piety Model As An Example
Authors: Yeh Kuang-Hui
Published: January 2023

Most nonwestern researchers regard the field of indigenous psychology as an intellectual movement across the globe to resist the hegemony of Western psychology in representation of the human mind, and in investigations of local mentality. Other than avoiding the hegemony of Western psychology, scholars may still wonder why they need to construct indigenous theories or conduct indigenous research. The answer usually is that existing theories and constructs (especially Western mainstream ones) cannot explain or clarify the local phenomena that they observe or want to talk about. They have to find a new way to describe the local phenomenon they want to describe. An indigenous (new) theory or construct is the solution; the local phenomenon is the basis of reality and needs to be explored and clarified, rather than applying existing theories and constructs. There are several ways to construct indigenous theories or conduct indigenous research. One of the most common ways is the emic approach. However, this paper wants to go a step further to distinguish two different approaches: reflective emic and reflexive etic approach. This paper elaborates on application of these two approaches and advocates a multiple paradigm perspective for constructing an indigenous psychological theory from a global perspective.
Acute Epididymo-Orchitis Complicated With Abscesses in Testis and Seminal Vesicles: A Case Report
Authors: Salama Nader , Hatem Alaa , Sirelkhatim Hassan Omer
Published: January 2023

Epididymo-orchitis is a common intra-scrotal inflammation among males that causes swelling of the epididymis and testis. In the era of modern antibiotics, complications associated with this condition are now rare. Herein, we report a 28-year-old man with acute epididymo-orchitis complicated by the formation of several abscesses involving the left testis and seminal vesicles. The literature review showed this patient as the first case with such extensive complications following epididymo-orchitis. Initial antimicrobial therapy was unable to resolve the condition. The management necessitated surgical intervention, which included MRI-guided aspiration of the seminal vesicle abscesses and testicular sparing drainage of the testicular abscess.
Living with liminality: Reconceptualising music careers education and research
Authors: Canham Nicole
Published: January 2023

One of the many lessons of the COVID-19 pandemic has been the nature of it: it has been, and still is, an evolving situation in which there are many questions, but not always immediate or easy answers. Some of the pandemic experience has been shared, as almost 1.6 billion learners’ educations have been disrupted and teachers have reported increased work-related stress, anxiety, and burnout. Billions of dollars in music industry income have been lost and patterns of music engagement and consumer spending appear to be significantly altered. Other aspects of the pandemic have highlighted deep inequalities. The vulnerability of creative workers at a policy level, for example, reflects the precarity of a specific group of people, and the enormous complexity and uncertainty that shapes their personal and professional circumstances. Although some musicians have reveled in the opportunity to reinvent themselves through new sites for their work, for many, work in music has gone from challenging to untenable resulting in altered priorities. In this paper, I explore the pandemic experience through the concept of liminality and offer three approaches for framing a paradigm shift in music careers education and research: things to think about, things to leave behind, and things to do differently.
Feminism contested and co-opted: Women, agency and politics of gender in the Greek and Greek-Cypriot far right
Authors: Kamenou Nayia
Published: January 2023

The literature on the gender dimension of far-right politics has established the constitutive role of gender and women’s involvement in the far right. However, knowledge about how far-right women negotiate and condition their agency within their parties and how they relate to gender, gender equality and feminism remains limited. This article builds on literature on conservative and far-right women’s agency, and on feminism’s employment by the far right. Based on interviews with female politicians and seasoned activists of the Greek Golden Dawn and the Greek-Cypriot National Popular Front, it examines how highly engaged far-right women construct their political agency at the intersections of often contradictory discourses and how, in doing so, they impact understandings of gender, gender equality and feminism. The analysis of the interview material identifies three different formulations of political agency the participants refer to: radical motherhood; female political militancy/political militant femininity and troubling of far-right gender roles. I argue that these different formulations of political agency show how, by using elements of feminism, far-right women construct flexible and versatile far-right gender discourses, which challenge gender essentialist positions that their parties convey. Moreover, they challenge delineations of far-right women’s political agency based on the compliance/(feminist) resistance dichotomy and expose the processes through which far-right women contest feminism by drawing on it. The article further argues that these formulations of political agency and far-right gender discourses may contribute to the far right’s appeal among women with diverse views on gender, gender equality, feminism and politics, as they may respond to an array of interests and demands that can be made from many different positions. Therefore, beyond contributing to discussions about the role of women, gender and feminism in far-right politics, the article demonstrates the importance of studying far-right women’s views for gaining a well-rounded understanding of this issue.
Just noticeable difference of loudness through building wall of masonry and drywall
Authors: Cerigliano Francisco , Sato Shin-ichi
Published: January 2023

In this study, the just noticeable difference (JND) of loudness with respect to sound transmission through walls corresponding to a weighted noise reduction index Rw of 43 dB is investigated. Two types of walls typically used in Argentina are evaluated. One is masonry composed of solid autoclaved aerated concrete bricks with a thickness of 25 cm, and the other is a drywall composed of two 12.5 mm plasterboards with a 25 cm air chamber in between them, filled with glass wool. The JND is determined using the method of constant stimuli for both ascending and descending variations. The source signals used are two types of vacuum-cleaner sounds and two music signals. Online tests are conducted owing to restrictions imposed by the COVID-19, and the presentation level of the stimuli is adjusted based on the sensation level of each individual. Responses from 148 different listeners show no significant difference in the subjective responses among the source signals. Regarding the masonry, the JND values are 3.02 and 1.62 cm for the ascending and descending variations, respectively (corresponding Rw difference of 2 and 1 dB), whereas they are 4.55 and 1.26 cm for the drywall, respectively (1 dB for both).
Piloting a novel medical student virtual discharge counseling process in the time of the COVID-19 pandemic
Authors: Leybov Victoria , Ross Joshua , Smith Silas W , Ciardiello Amber , Maheshwari Sana , Caspers Christopher , Wittman Ian , Kuhner Christopher , Stark Stephen , Conroy Nancy
Published: January 2023

Background

During the COVID-19 pandemic, we identified a gap in adequate discharge counseling for COVID-19 patients in the Emergency Department. This was due to high patient volumes and lack of patient education regarding a novel disease. Medical students were also restricted from clinical areas due to safety concerns, compromising their clinical experience. We piloted a novel program in which medical students served as virtual discharge counselors for COVID-19 patients via teleconference. We aimed to demonstrate an impact on patient care by examining the patient bounce back rate as well as assessing medical student education and experience.

Methods

This program was piloted in a tertiary care Emergency Department. Medical student volunteers served as virtual discharge counselors. Students were trained in discharge counseling with a standardized protocol and a discharge script. Eligible patients for virtual discharge counseling were 18 years old or greater with a diagnosis of confirmed or suspected COVID-19 and no impediment precluding them from participating in a telemedicine encounter. Counseling was provided via secure teleconference in the patient's preferred language. Counseling included diagnosis, supportive care with medication dosing, quarantine instructions, return precautions, follow up, and time to ask questions. Duration of counseling was recorded and medical students were anonymously surveyed regarding their experience.

Results

Over an 18-week period, 45 patients were counseled for a median of 20 min. The 72-hr ED revisit rate was 0%, versus 4.2% in similarly-matched, not counseled COVID-19 patients. 90% of medical students believed this project increased their confidence when speaking with patients while 80% indicated this was their first telemedicine experience.

Conclusion

Our pilot discharge program provided patients with an extensive discharge counseling experience that would not otherwise be possible in an urban ED setting and demonstrated benefit to patient care. Medical students received a safe clinical experience that improved their communication skills.
Education guidelines, frameworks and resources for building virtual care capacity: An integrative review
Authors: Palesy Debra , Forrest Gail , Crowley Margaret E
Published: January 2023

Introduction

Despite its reported benefits, the accelerated adoption of virtual care since the COVID-19 pandemic has occurred without critical consideration of clinician education and training. This integrative review aims to better understand the necessary education guidelines, frameworks and resources for building the confidence and capability of the workforce for virtual care delivery.

Methods

Whittemore and Knafl's (2005) five-stage methodological framework informed this review. Using a clearly articulated search strategy and reporting process, over 8000 pieces of literature were analysed. A final 46 publications comprising 26 scholarly papers and 20 pieces of grey literature were included for review.

Results

A set of key curriculum inclusions under three domains: clinical, administrative and technical are proposed. Many publications emphasise a domain-specific approach as the most effective means of translating virtual care knowledge and skills to practice. A number of new domain frameworks have been tailormade for specific disciplines, while well-established frameworks such as the ACGME, CanMEDS, AAMC and IPEC have been adapted for virtual care education. Virtual care checklists, clinical champions and models that involve frontline clinicians, content experts and care recipients are considered useful resources for virtual care education.

Discussion

Moving beyond the COVID-19 pandemic, virtual care education for current and future clinicians requires a cohesive, interprofessional approach. This approach should be rigorously evaluated as part of a continuous quality improvement process.
Vibration alleviation for wind turbine gearbox with flexible suspensions based on modal interaction
Authors: Peng Jiale , Bian Yushu , Tian Dongbo , Liu Peng , Gao Zhihui
Published: January 2023

Wind turbine drivetrains play a fundamental role in converting wind power into electrical energy. The gearbox is one of the most important and expensive components in a wind turbine drivetrain. Since flexible suspensions mounted on the gearbox are mainly designed for isolating vibration transfer to other turbine components, the gearbox itself still suffers from complicated whole-body vibration. In view of this, a vibration absorption method based on modal interaction is put forward to alleviate the whole-body vibration of the wind turbine gearbox with flexible suspensions. A vibration absorber with adjustable control parameters is utilized to establish modal coupling with the wind turbine gearbox. Internal resonance is analyzed and used to construct a modal interaction mechanism between the vibration absorber mode and the controlled gearbox mode. With the help of modal interaction, the vibration energy of the controlled gearbox mode is successfully absorbed by the vibration absorber mode and effectively dissipated by the damping of the vibration absorber mode. Through numerical simulations and virtual prototyping simulations, its vibration alleviation performance is verified. Since the proposed method is designed in terms of the controlled mode of the wind turbine gearbox rather than external excitations, it is suitable for applications in a complicated working environment. Besides, the proposed method aims to transfer and dissipate vibration energy through nonlinear modal interaction rather than suppress vibration via external energy, and thus can effectively deal with strong vibration problems. More importantly, it can easily work together with the existing vibration isolation method and further alleviate the whole-body vibration of the gearbox. This research will contribute to improving the reliability and service life of wind turbine gearboxes.
The quality and reliability of the Internet as a source of information for hypodontia patients
Authors: Goodrum Emma , Johal Ama
Published: January 2023

Objectives:

The aim of this study was to determine the quality, reliability and usability of information on the Internet regarding hypodontia.

Method:

A survey of patients with hypodontia revealed seven key search terms favoured by patients: Hypodontia; Congenitally missing teeth; Missing teeth; Gaps in teeth; Cure of missing teeth; Information on missing teeth; and Treatment of missing teeth. These were entered into four search engines: Google; Ask; Wikipedia; and NHS Choices. Relevant websites were assessed for their overall demographics, author type, country of origin and rank within the search engine. They were then analysed using five validated assessment tools. Intra-examiner reliability was assessed, and statistical analysis of the data was undertaken.

Results:

Good intra-examiner reliability was observed. A total of 48 websites were included for analysis from an initial 1718. There was no relationship between the ranking of a website on a search engine and the quality of information it contained. When medical search terminology was used, it resulted in websites of better quality than layperson search terms. Most websites were produced by general dental or specialist dental practices but the quality of these was poorer than those developed by private companies and medical organisations. The country of origin was primarily the USA and UK; however, this had no relationship to website quality. Overall, the majority of websites scored poorly for the validated tools and none scored well across multiple tools. A statistical analysis showed a positive relationship between the LIDA and DISCERN instruments but no other correlation between other validated tools was found.

Conclusion:

The quality and reliability of information on the Internet regarding hypodontia is generally poor. There is a need for a reliable online hypodontia resource that can be recommended for patient use.
Experimental measurements of soot formation in fuel-rich homogeneous mixtures using an optical rapid compression machine
Authors: Gross Joseph R , Dempsey Adam B , Kempf John R , Allen Casey M
Published: January 2023

Advanced combustion strategies are necessary for the use of more environmentally sustainable fuels than traditional diesel. Alcohol fuels and alcohol/gasoline blends are of particular interest as they are readily available in the marketplace. Heavy-duty engines typically use compression ignited, conventional diesel mixing controlled combustion. Mixing controlled combustion features a non-premixed diffusion flame with a wide range of local equivalence ratios, leading to potentially high rates of soot formation. This work studies the sooting behavior of iso-octane and ethanol as a function of equivalence ratio. Measurements are carried out in a rapid compression machine (RCM) and are reported for pre-ignition conditions of 10–30 bar and temperatures of 650–800 K. Theoretical equilibrium and bulk gas temperatures are calculated for both fuels. These data are used to identify the critical equivalence ratio, the lowest equivalence ratio where soot is detected with a single-pass laser extinction diagnostic. The critical equivalence ratio for iso-octane varies between 1.82 and 1.77 for compressed pressures of 10 and 20 bar, respectively. Ethanol, sometimes considered sootless, had a critical equivalence ratio between 2.37 and 2.12 for compressed pressures of 20 and 30 bar, respectively. When characterizing soot formation by oxygenated equivalence ratio, the critical equivalence ratios for ethanol approach those of iso-octane. This suggests the oxygenated nature of alcohol fuels reduces sooting tendency, but other factors such as fuel molecular structure and morphology may play a role. It was observed that ethanol will form soot at equivalence ratios only slightly higher than iso-octane, which could have implications in mixing controlled combustion. It was seen for both fuels that soot formation is pressure sensitive, with the critical equivalence ratio being inversely proportional to compressed pressure and the rate of soot formation. Future work will investigate the sooting behavior of gasoline/ethanol blends.
Experiences of culture and cultural negotiations among Russian-speaking migrants: National habitus and cultural continuity dilemmas in child-rearing
Authors: Akifeva Raisa , Fozdar Farida , Baldassar Loretta
Published: January 2023

How migrants negotiate and adjust to new cultural settings and how they transmit culture to their children are key questions for migration researchers. This paper explores how culture is experienced and negotiated among Russian-speaking migrants, drawing on interviews and observation data collected in Perth, Australia, and Madrid, Spain, together with online forum data and documents. Analysis reveals that long-term socio-historical processes taking place within the post-Soviet space generate certain similarities among its inhabitants. These shared features, which Norbert Elias (1996) called ‘national habitus’, include internalised dispositions and behavioural patterns evident and reproduced in everyday life, such as hygiene and healthcare practices, norms of conduct in public places, and practices and beliefs related to the control of children’s behaviour and discipline. Many migrants come to realise that they are bearers of these similarities only in the process of the migration experience. This process of recognition of their habitus, including realising the cultural nature of certain standards of behaviour perceived as ‘civilised’ and ‘rational’ in the past, and the making of decisions about what is important to keep and what is not, we refer to as ‘cultural continuity dilemmas’. Participants resolve these dilemmas in three main ways: reinforcing their cultural classification systems through condemnation or attempts to correct; adopting the new standards; or adjusting perceptions to find a compromise. In these processes, certain practices and norms may come to be recognised as Soviet in both positive and negative senses, as being acceptable, or outdated remnants of a totalitarian system. Solving such dilemmas creates a unique combination of practices, forming a common cultural hybridity and generating new awareness of cultural and national identities.
Stories, crisis, and meaning-making: storying possibility and community in the terrain of cultural struggle
Authors: Harris Dylan M
Published: January 2023

In a time of multiple, competing, and nested crises, the draw to storytelling is intuitive. Stories help us make sense of the world around us. People are drawn to stories because of their emphasis on community, and the way they create possibilities when it feels like there are none. This paper builds upon geographic research on storytelling, articulating how stories are critical for creating meaning in light of crises. Based on 14 months of fieldwork with storytellers in Appalachia and Alaska, two regions facing profound social, climatic, and economic change and with culturally rich storytelling traditions, research for this paper discusses the practice of storytelling, as told by storytellers, and how different approaches to storytelling help address the climate crisis specifically with notes for crises more broadly. Further, considering calls to use storytelling to address climate change, this paper examines and critiques the stories that are currently being told and valued. Finally, this paper outlines the kinds of stories that could be told to address crises, noting specifically how stories are sites of cultural and political struggle.
A Collaborative Pilot to Support Patients With Diabetes Through Tailored Food Box Home Delivery
Authors: Kempainen Sarah , Cutts Diana B. , Robinson-O’Brien Ramona , De Kesel Lofthus Alexandra , Gilbertson David T. , Mino Rebecca
Published: January 2023

We conducted a randomized, controlled prospective pilot study to determine feasibility and impact of food bank and health system collaboration to home-delivered food to adults with type 2 diabetes mellitus experiencing food insecurity. Treatment group received biweekly, ethnically tailored, home-delivered food for 24 weeks. Analysis included intervention feasibility and impact on healthcare utilization, HbA1c, and other health-related measures. Intervention was feasible and successful with high levels of participant satisfaction. At baseline, participants with highest HbA1c reported poorer health, lower medication adherence and self-care, and higher diabetes distress and medicine for food tradeoffs. At 24 weeks, treatment group reported improved food security and health status. There were no differences in HbA1c or healthcare utilization measures between the two groups. It is feasible for a community food bank and nearby hospital to successfully collaborate and provide supplemental food staples to food insecure adults with type 2 diabetes and improve food insecurity and health status. Public policy efforts should utilize and expand this strategy with the goal of improving health and reducing health disparities. Future work could include more comprehensive food support focused on those with poorest glycemic control, and expanded, coordinated interventions directed at other social determinants of health. Future programming and policies should be cocreated with community input to ensure greatest success.
Multimodal assessment of political corruption worsening national poverty: Evidence of mediating and moderating effects from global panel data
Authors: Zang Leizhen , Zhang Bingqian , Xiong Feng
Published: January 2023

Political corruption is one of the structural factors aggravating national poverty, on which there is a consensus. However, it remains controversial what factors constrain the causal mechanisms by which political corruption worsens national poverty. This paper analyzed this using different models with the global panel data of 117 counties from 1992 to 2017, including the instrumental variable model. The authors found that: (1) There was a significant positive correlation between political corruption and national poverty, (2) Political corruption exacerbating national poverty was constrained by primary education and the Gini index, which played a mediating role, (3) The level of foreign direct investment and public services moderated the relationship between political corruption and national poverty. Finally, the authors discussed the potential implications beyond national poverty for theory, method, and policy.
Management of Anticoagulation Therapy in ECMO-Associated Ischemic Stroke and Intracranial Hemorrhage
Authors: Prokupets Rochelle , Kannapadi Nivedha , Chang Henry , Caturegli Giorgio , Bush Errol L. , Kim Bo Soo , Keller Steven , Geocadin Romergryko G. , Whitman Glenn J. R. , Cho Sung-Min , Acton Matthew , Rando Hannah , Alejo Diane , Calligy Kate , Anderson Scott , Shou Benjamin , Sussman Marc , Wilcox Christopher , Zhang Lucy , Brown Patricia , Peeler Anna
Published: January 2023

Objective:

Despite the common occurrence of extracorporeal membrane oxygenation (ECMO)–associated acute ischemic stroke (AIS) and intracranial hemorrhage (ICH), there are little data to guide optimal anticoagulation management. We sought to describe antithrombotic therapy management after stroke and outcomes.

Methods:

A retrospective analysis was conducted of venoarterial (VA) and venovenous (VV) ECMO patients treated at a tertiary care center from June 2016 to February 2021. Patients with image-confirmed diagnosis of AIS or ICH while receiving ECMO were included for study with data collected regarding anticoagulation management and clinical outcomes.

Results:

Overall, 216 patients (153 VA-ECMO, 63 VV-ECMO) were included in this study. Of the 153 patients on VA-ECMO, 13 (8.4%) had AIS and 6 (3.9%) had ICH. Of the 63 patients on VV-ECMO, none had AIS and 5 (7.9%) had ICH. One patient (9%) received anticoagulation reversal after ICH. Anticoagulation was discontinued and later resumed in all 5 ICH survivors (median cessation time, 30 h) and 1 of 2 (50%) AIS survivors (median cessation time, 96 h). While off anticoagulation, 2 of 11 patients (18%) had thromboembolic events and none had new AIS. Upon resumption, there were no cases of hemorrhagic transformation of AIS or ICH expansion. There was no difference in in-hospital mortality between patients with ICH and those without in both the VA-ECMO and VV-ECMO cohorts nor between VA-ECMO patients with AIS and those without.

Conclusions:

Early cessation and judicious resumption of anticoagulation appeared feasible in the cohort of patients with ECMO-associated AIS and ICH.
Use of optical coherence tomography in selected patients with recurrent cryptogenic stroke: A case series and technical discussion
Authors: Radu Răzvan Alexandru , Cagnazzo Federico , Derraz Imad , Dargazanli Cyril , Gascou Grégory , Lefevre Pierre-Henri , Arquizan Caroline , Costalat Vincent
Published: January 2023

Background

Despite advances in secondary stroke prevention during the last several years, cryptogenic stroke remains associated with a high risk of recurrence. Studies have shown that the recurrence risk is higher in patients with large artery disease in which complex carotid plaques and carotid WEBs are identified.

Methods

This is a case series of six patients with cryptogenic recurrent stroke in which conventional imaging and extensive workup did not identify an etiology. Intravascular optic coherence tomography (OCT) was performed using a ballon-guided flow-arrest technique to identify possible covert carotid lesions.

Results

We present six cases in which, with the help of OCT, we identified three carotid WEBs with associated thrombosis and two ulcerated carotid artery plaques. Four patients were subsequently treated with endovascular stent placement without complications. OCT permitted the distinction between complicated carotid artery plaque and carotid WEB.

Conclusion

Intravascular OCT is a feasible and safe approach to identifying patients with covert carotid wall abnormalities, like carotid WEBs and ulcerated plaques, that are amenable to carotid stenting to reduce recurrent stroke risk.
Usefulness of the placebo lead-in design for clinical trials with binary outcomes
Authors: Homma Gosuke , Daimon Takashi
Published: January 2023

Background:

In placebo-controlled clinical trials to develop new drugs for the treatment of psychiatric or neurological disorders, a high and sometimes greater-than-expected placebo response makes it difficult to show the superiority of an investigational drug over a corresponding placebo. To avoid such difficulty, a placebo lead-in design has been presented, but its usefulness has been open to discussion. Although the statistical properties of the placebo lead-in design are investigated in the context of continuous outcomes, whether these properties can be generalized for binary or ordinal cases remains unclear.

Methods:

We investigate whether the placebo lead-in design is useful in clinical trials with binary outcomes through mathematical formulae and a numerical investigation. Specifically, we compare the proportion of placebo responders, the drug–placebo difference, and the effect size between two populations: one enriched for placebo nonresponders and the other comprising the all-comers.

Results:

Under positive correlation of the data between the lead-in stage and the randomized stage for both treatment groups, we mathematically show that the proportion of responders in the population enriched for placebo nonresponders is less than that in the all-comers population, and whether the placebo lead-in design increases the drug–placebo difference depends on the variances of outcomes in both treatment groups as well as the correlations of the outcomes between two stages. Further, through a numerical investigation, we show that whether the placebo lead-in design increases the effect size strongly depends on the magnitude of the correlations and their difference.

Conclusion:

If the correlation of the placebo–placebo group is much higher than that of the placebo–drug group, the placebo lead-in design is advantageous in most cases but has an impact on an estimand in placebo nonresponders. Therefore, we do not recommend using the placebo lead-in design for clinical trials with binary outcomes.
Lack of transparent reporting of trial monitoring approaches in randomised controlled trials: A systematic review of contemporary protocol papers
Authors: Hsieh Shao-Fan , Yorke-Edwards Victoria , Murray Macey L , Diaz-Montana Carlos , Love Sharon B , Sydes Matthew R
Published: January 2023

Background:

Monitoring is essential to ensure patient safety and data integrity in clinical trials as per Good Clinical Practice. The Standard Protocol Items: Recommendations for Interventional Trials Statement and its checklist guides authors to include monitoring in their protocols. We investigated how well monitoring was reported in published ‘protocol papers’ for contemporary randomised controlled trials.

Methods:

A systematic search was conducted in PubMed to identify eligible protocol papers published in selected journals between 1 January 2020 and 31 May 2020. Protocol papers were classified by whether they reported monitoring and, if so, by the details of monitoring. Data were summarised descriptively.

Results:

Of 811 protocol papers for randomised controlled trials, 386 (48%; 95% CI: 44%–51%) explicitly reported some monitoring information. Of these, 20% (77/386) reported monitoring information consistent with an on-site monitoring approach, and 39% (152/386) with central monitoring, 26% (101/386) with a mixed approach, while 14% (54/386) did not provide sufficient information to specify an approach. Only 8% (30/386) of randomised controlled trials reported complete details about all of scope, frequency and organisation of monitoring; frequency of monitoring was the least reported. However, 6% (25/386) of papers used the term ‘audit’ to describe ‘monitoring’.

Discussion:

Monitoring information was reported in only approximately half of the protocol papers. Suboptimal reporting of monitoring hinders the clinical community from having the full information on which to judge the validity of a trial and jeopardises the value of protocol papers and the credibility of the trial itself. Greater efforts are needed to promote the transparent reporting of monitoring to journal editors and authors.
Safeguarding social justice and equality: Exploring Finnish youths’ ‘Intergroup Mindsets’ as a novel approach in the prevention of radicalization and extremism through education
Authors: Benjamin Saija , Koirikivi Pia , Salonen Visajaani , Gearon Liam , Kuusisto Arniika
Published: January 2023

As part of citizenship education, the prevention of radicalization and extremism through education (PVE-E) is an urgent initiative of global educational policy. According to research, radicalized individuals, despite the ideology held, have mindsets that challenge equality and social justice. In this light, this study examines the intergroup mindsets of Finnish students aged 16–19 in vocational institutions through a mixed methods research survey ( n = 383). Three distinct intergroup mindsets were found in a profile analysis. The findings demonstrate that the intergroup mindsets of the students are predominantly egalitarian, open-minded, and inclusive. However, there are also students whose mindsets are anti-egalitarian and pro-dominance, and for whom Finnishness is a marker of borders and social exclusion. If intensified and manipulated, the views of these youth may become radicalized with serious implications for national security and societal cohesion.We argue that in PVE-E, the focus on critical thinking must be complemented with transformative approaches that support the development of mindsets based on social justice and equality.
Reliability assessment of consecutive k-out-of-n systems with two types of dependent components
Authors: Ozkut Murat
Published: January 2023

This paper is about the reliability modeling of a linear consecutive k-out-of- n system that consists of two types of dependent components. The survival function and mean time to failure of such a system are expressed using copulas. Extensive numerical findings are provided for Clayton and Gumbel-type copulas. The survival and mean time to failure behaviors are explored in connection with the value of Kendall’s correlation coefficient.
Pustular psoriasis of pregnancy: A rare cause of placental insufficiency
Authors: McStay Daniel , McBride Sandy , Hill Sharleen , Sutton Jonathan , Saleem Amber , Singh Vinita
Published: January 2023

Generalised pustular psoriasis of pregnancy (GPPP) is a rare dermatosis that presents in the third trimester. It merits careful clinical assessment given the difficulty in diagnosis, impact on maternal health and association with placental insufficiency. We present a case of generalised pustulosis in a pregnant woman at 30 weeks' gestation and describe the clinico-pathological challenges in obtaining a diagnosis of GPPP. Furthermore, we provide evidence from cardiotocography and ultrasound of evolving fetal compromise and describe how intensive management can facilitate a positive maternal–fetal outcome.
Utility of early colonoscopy for acute lower gastrointestinal bleeding: a retrospective cohort study
Authors: Lahat Adi , Klang Eyal , Rahman Nisim , Halabi Nitzan , Avidan Benjamin , Barda Noam
Published: January 2023

Background:

Early colonoscopy (within 8–24 h) is recommended in different guidelines for acute lower gastrointestinal bleeding (LGIB). Despite this recommendation, evidence for its effectiveness are conflicting, and early colonoscopy is often not performed.

Objectives:

We aimed to evaluate the utility of early colonoscopy by examining the findings during the procedure, and by comparing in-hospital and long-term outcomes between patients who did and did not undergo early colonoscopy.

Design:

This is a retrospective cohort study based on the electronic medical records of a large tertiary hospital in Israel.

Methods:

All patients hospitalized with acute LGIB to acute wards between 2012 and 2022 were included. First, structured and free-text procedure notes from patients who did undergo early colonoscopy were examined. Second, we compared in-hospital and long-term outcomes between patients who did and did not undergo early colonoscopy while adjusting for possible confounders using multivariable regression of the type appropriate for each outcome.

Results:

Overall, 953 patients were included, of which 90 underwent early colonoscopy. The majority (54%) were found insufficiently prepared. Common findings were diverticulosis (38%) and colon polyps (20%). The procedure was effective for hemostasis in only 13% of the cases. Early colonoscopy was not significantly associated with increased survival (exponentiated coefficient = 1.19, 95% CI: 0.76, 1.87), decreased length of hospitalization (exponentiated coefficient = 1.08, 95% CI: 0.97, 1.21), or increased blood hemoglobin at discharge (coefficient =−0.27, 95% CI: −0.58, 0.03).

Conclusions:

Early colonoscopy was often not effective and was not associated with significantly improved outcomes.