bluuebunny/crossref_metadata_2025 huggingface dataset:
A Fractured School Community: Decolonizing Leaders Needed for Responsive Leadership
Authors: Briscoe Patricia , McIntosh Eleanor
Published: November 2022

In this case, Mary, a cisgender White principal, is struggling in a contentious school climate with a mostly White staff and a racially divided school community. A lunchroom incident highlighted the unaddressed conflict among students, families, and the community that can no longer be ignored. Her unresponsive leadership raises questions about the capacity of White school leaders to be culturally responsive. The authors present a decolonizing leadership framework and three activities, framed by transformative learning theory, that encourage participants to reflect on their biases and develop their understanding of what colonizing and decolonizing education means to their leadership.
Novel Automated Suturing Technology for Minimally Invasive Mitral Chord Implantation: A Preclinical Evaluation Study
Authors: Werner Paul , Rath Claus , Gross Christoph , Ad Niv , Gosev Igor , Amirjamshidi Hossein , Poschner Thomas , Coti Iuliana , Russo Marco , Mach Markus , Kocher Alfred , Laufer Guenther , Sauer Jude , Andreas Martin
Published: November 2022

Objective:

This study evaluated the ergonomics and time requirements of using a novel automated suturing and titanium fastener deployment technology for chordal replacement in human heart specimens in open and minimally invasive cardiac surgery (MICS) simulators.

Methods:

Five cardiac surgeons used novel, manually powered expanded polytetrafluoroethylene (ePTFE) suturing devices to automate suture placement between mitral leaflets and papillary muscles in explanted cadaver hearts, along with customized titanium fastener delivery devices to secure suture and trim suture tails. This mitral chordal replacement test was conducted using surgical models simulating open and MICS mitral repair access. The study was approved by the institutional ethical board.

Results:

After a brief introduction to this technique using plastic models, study surgeons performed 48 chordal replacements in human mitral valves, placing 18 in an open model and 30 in a right minithoracotomy model. The time range to complete a single chordal replacement was between 55 s and 8 min, with an overall mean duration of 3.6 ± 1.5 min. No difference in duration of implantation was recorded for the MICS and open sternotomy simulators used. Good control of suture delivery was reported in 95.8% ( n = 46) of leaflet aspect of the sutures and in 100% ( N = 48) of papillary muscle sutures.

Conclusions:

Automated mitral chordal ePTFE suturing simulated through open and MICS access demonstrated quality handling and accurate placement of sutures in human heart specimens. A clinical trial using this technology is currently ongoing. This innovation may present an important advance facilitating enhanced minimally invasive mitral valve repair.
Through a Comedic Glass, Darkly: Ethics, Humor, and Home Ownership in Spain’s Early Technocratic Years (1957–1963)
Authors: Jorza Diana Roxana
Published: November 2022

The current essay analyzes three oppositional film comedies produced during Franco’s totalitarian regime, after Spain transitioned to an Opus Dei technocratic rule and after the Ministry of Housing was created to solve the chronic lodging problems of the time. My analysis focuses on how La vida por delante/ Life Ahead (Dir. Fernando Fernán Gómez, 1958), El pisito/ The Little Apartment (Dir. Marco Ferreri, 1959), and El verdugo/ The Executioner (Dir. Luis García Berlanga, 1963) humorously critique the contemporaneous housing predicaments and the existing residential legislation. The article argues that these comedies effectively breach the hegemonically sanctioned thresholds of ethical, political, and aesthetic decorum of contemporaneous Spain by successfully resorting to an eminently materialistic, antimelodramatic discourse and to unsympathetic characters, prone to successive moral capitulations in their desperate chase for a decent housing and social advancement.
Promising practices and constraining factors in mobilizing community-engaged research
Authors: Lam Michelle , Mayuom Akech
Published: November 2022

This article describes a project involving 13 community focus groups on the topic of anti-racism and belonging where the researchers concluded each group with a robust discussion about how the group would prefer to receive the findings from the project. Analysis of this data, existing literature, and the practical experiences of the researchers revealed that while there are multiple “bridges” researchers can take to connect their research with community-level users, and although it is desirable to offer tailored approaches for specific audiences, there are significant barriers and challenges for truly effective engagement. By describing the various factors that determined which bridges were taken, we hope to help other community-based researchers imagine new ways of mobilizing knowledge, consider promising practices to guide the connection of knowledge to the community and shine a light on the very real constraints of time, budget, personnel, and university system considerations that impact knowledge mobilization decisions.
Probabilistic indicators of imperfect inspections used in modeling condition-based and predictive maintenance
Authors: Raza A , Ulansky V
Published: November 2022

This study proposes mathematical models for assessing the probabilistic indicators of imperfect inspections conducted when performing condition-based and predictive maintenance. The inspections used in mentioned types of maintenance differ in decision rules regarding system operability at the time of checkup. Contrary to the previous studies, we present the decision rule for each type of inspection on the time axis, which allows the formulation of the set of mutually exclusive events at discrete times. The correct and incorrect decisions correspond to true-positive, false-positive, true-negative, and false-negative events. We propose general expressions for computing the probabilities of possible decisions for both types of inspection. The paper introduces the effectiveness indicators of condition-based and predictive maintenance such as average operating costs, total error probability, and a posteriori probability of failure-free operation. We illustrate the developed approach by calculating the probabilities of correct and incorrect decisions using a specific stochastic deterioration process. The results of the calculations verify that probabilities of correct and incorrect decisions for both types of inspection are very substantially time-dependent despite the large number of published studies where these probabilities are independent of time.
Long-term outcomes of anterior shoulder instability treated with open latarjet procedure – a systematic review of outcomes at a minimum 15-year follow-up
Authors: Davey Martin S , Hurley Eoghan T , Kilkenny Conor , Anakwenze Oke A , Klifto Christopher S , Mullett Hannan
Published: November 2022

Background

To systematically review the literature to evaluate the outcomes following an open Latarjet (OL) procedure at a minimum 15-year follow-up.

Methods

Two independent reviewers performed a literature search using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines using 3 databases. Only studies reporting outcomes of OL procedure with a minimum of 15 years of follow-up were included.

Results

Nine studies composed of 326 shoulders (78.2% males) in 313 patients were included (average age 26.9 ± 3.2 years (15–58)), with a mean follow-up of 271.9 ± 69.2 months (180–420) At a minimum 15-year follow-up, 93.5% (286 of 306) patients reported being satisfied with their OL procedure, whilst 86.8% (177 of 204) reported good/excellent outcomes at final follow-up. All nine of the included studies reported an overall rate of recurrent instability was 7.7%, with re-dislocations and subluxation at 3.4% and 5.8%, respectively. The rate of surgical revision was 5.15%; 3.5% of cases were revised for recurrent instability. Instability arthropathy was reported across all included studies as 41.0%.

Conclusion

The OL procedure results in satisfactory clinical outcomes, low rates of recurrent instability and surgical revision at a minimum 15-year follow-up. Although high levels of radiological instability arthropathy and residual pain are found over the same period, these appear stable from a minimum of 10-year follow-up data.

Level of Evidence

IV; a systematic review of all levels of evidence
Postural Variability in Piano Performance
Authors: Wong Grace K. , Comeau Gilles , Russell Donald , Huta Veronika
Published: November 2022

Variability is inevitable in human movement and posture, including piano performance, although little research has been conducted in this area. The purpose of this study was to determine if, when comparing individuals to themselves, pianists demonstrate consistent postural angles within a task across multiple measurements and to ascertain if, between various tasks, there are discernible task-related postural patterns. Fifteen pianists participated in this study. Each pianist returned for a total of three measurement sessions. The tasks they were required to perform at each session were quiet sitting, raising their hands on and off the keyboard, playing an ascending and descending scale, sight reading, and playing a piece in three expressive conditions (i.e., deadpan, projected, exaggerated). The following postural angles were calculated based on motion capture data collected during the performance of these tasks: craniovertebral angle, head tilt, head-neck-trunk angle, trunk angle, thoracic angle, thoracolumbar angle, and lumbar angle. The within-person variability ratio across the three measurements was calculated for each angle and across all tasks. Task-related patterns in angles were examined by comparing the same postural angle across different tasks. Results showed that there is a considerable amount of within-person variability, but not enough to be inconsistent over time. Task-related patterns indicate that reading a musical score or playing at the extreme ends of the keyboard tend to involve leaning closer to the instrument. Implications for future studies, intervention studies in particular, include taking more than a single baseline measurement to provide a more accurate picture of an individual pianist's typical posture.
Psychological Services to support probation in Northern Ireland and Malta
Authors: Avellino Chantal , O’Hare Geraldine , Scicluna Sandra
Published: November 2022

Two Probation Services, the Probation Board for N. Ireland and the Department of Probation and Parole in Malta, that directly employ Psychologists, have come together to write this article, describing how psychological services have been developed over the years to support and add value to the work of Probation services. This article will describe the development of the two services, the psychological assessments and the interventions they deliver, that enhance the work carried out by probation officers. The benefits of this specialist role within the wider justice system will also be considered. The authors will highlight key principles of good practice and the learning for probation services for the future.
Influenza and COVID-19 Vaccine Concerns and Uptake Among Patients Cared for in a Safety-Net Health System
Authors: Davis Terry C. , Vanchiere John A. , Sewell Michael R. , Davis Adrienne B. , Wolf Michael S. , Arnold Connie L.
Published: November 2022

Objectives:

To examine Influenza and COVID-19 vaccine concerns and uptake among adult patients in a Southern safety-net health system.

Methods:

Trained research assistants conducted a structured telephone interview from April to October 2021. Of 118 participants, mean age was 57.7 years, 63.6% were female, 55.1% were Black, 42.4% white, and 54.2% reported rural residence.

Results:

Among participants, 44.9% had received the influenza vaccine during the 2020 to 2021 season, and 66.1% had received the COVID-19 vaccine. Participants who received the influenza vaccine were more likely to report getting a COVID-19 vaccine compared to those who reported not getting a flu vaccine (81.1% vs 53.8%, P = .002). Black adults were significantly less likely than white adults (29.2% vs 46.0%, P = .048) and bordering on significance, males less likely than females (27.9% vs 41.3%, P = .054) to have reported receiving both vaccines. Of note, 25.4% of participants did not get either vaccine. The most common reasons for not getting the influenza vaccine were not being concerned about getting the flu (13.8%) and belief the vaccine gave them the flu (12.3%). The primary reasons for not getting a COVID-19 vaccine were concern about vaccine safety (22.5%), concern about side effects (20.0%), and belief they were not going to get sick (20.0%).

Conclusions:

These findings could help direct regional vaccine messaging and clinical communication to improve vaccine uptake among underserved populations.
Federally Qualified Health Center Penetration Associated With Reduced Community COVID-19 Mortality in Four United States Cities
Authors: Ford Mary M. , Allard Angela , Goldberg Jordan , Summers Cynthia
Published: November 2022

Background:

The COVID-19 pandemic has had significant impacts on health care access and delivery, with disparate effects across social and racial lines. Federally Qualified Health Centers (FQHCs) provide critical primary care services to the nation’s most underserved populations, including many communities hardest hit by COVID-19.

Methods:

We conducted an ecological analysis that aimed to examine FQHC penetration, COVID-19 mortality, and socio-demographic factors in 4 major United States cities: New York, New York; Chicago, Illinois; Detroit, Michigan; and Seattle, Washington.

Results:

We found the distribution of COVID-19 cases and mortality varied spatially and in magnitude by city. COVID-19 mortality was significantly higher in communities with higher percentages of low-income residents and higher percentages of racial/ethnic minority residents. FQHC penetration was protective against increased COVID-19 mortality, after model adjustment.

Conclusions:

Our study underpins the critical role of safety-net health care and policymakers must ensure investment in long-term sustainability of FQHCs, through strategic deployment of capital, workforce development, and reimbursement reform.
The Potential Risk Factors for Prolonged Length of Stay Despite an Enhanced Recovery After Surgery Protocol for Elderly Patients Undergoing Short-Level Lumbar Fusion Surgery
Authors: Cui Peng , Kong Chao , Wang Peng , Wang Shuaikang , Lu Shibao
Published: November 2022

Objective

To identify the risk factors associated with prolonged length of stay (LOS) despite an enhanced recovery after surgery (ERAS) protocol in short-level lumbar fusion surgery.

Methods

We gathered data for all patients undergoing short-level lumbar fusion surgery from January to November 2021. Given the discharge criteria, a threshold was set according to mean LOS, and two groups were spontaneously formed: LOS shorter than the threshold for discharge (control group, n = 114) and LOS longer or equal to the threshold for discharge (delayed group, n = 72). Preoperative metrics were compared to identify risk factors associated with prolonged LOS.

Results

A total consecutive 186 patients with complete medical records were enrolled (77 males and 109 females; mean age 71.08 ± 5.70 years). After dichotomization according to the threshold for discharge, there were 114 patients in control group and 72 in delayed group. Statistical analysis demonstrated that age ≥75 years ( P = .002), female sex ( P < .001), American Society of Anesthesiologists grade ≥ 3 ( P = .035), operation time ( P < .001), anesthesia time ( P < .001), ambulation time >1 day ( P = .027), removal of urinary catheter time >1 day ( P = .019), fusion levels ( P < .001), Clavien-Dindo grade > 1 ( P <.001) and allogeneic transfusion ( P = .009) were significantly related to prolonged LOS. Binary logistic regression revealed that age (odds ratio (OR) 5.149; 95% confidence interval (CI) 2.045-12.966, P = .001), sex (OR 5.185, 95% CI 2.183-12.317, P < .001) and Clavien-Dindo grade > 1(OR 15.936, 95% CI 5.220-48.652, P < .001) were independent risk factors of prolonged LOS.

Conclusions

In this retrospective study, we analyzed the potential risk factors associated with delayed LOS despite implementing ERAS, further, binary logistic regression exhibited that age ≥75 years old, female sex and Clavien-Dindo grade >1 were independently correlated with prolonged LOS.
How to Decide the Proportion of Online to Face-to-Face Components of a Blended Course? A Delphi Study
Authors: Alammary Ali Saleh
Published: November 2022

Deciding the proportion of online to face-to-face components of a blended learning course is a complex problem that entails many decisions. These decisions are affected by different criteria related to the nature of the course, the educational institution, the teacher, and the students. The impact of these influential criteria on the design process is not always obvious. The aim of this study is to assist academics to design successful blended courses by investigating the impact of criteria that need consideration when deciding the proportion of online components of a blended course. A modified Delphi survey was used in this study. Eighteen experts with experience in instructional design and online teaching participated in the study. Findings indicate that technological aspects, that is, Availability of technology and Students’ access to technology, have a strong negative impact on the proportion of online to face-to-face components. On the other hand, students’ flexibility and convenience as well as the availability of a high level of institutional support should motivate academics to incorporate a high proportion of online components in their courses. The results also indicate that blended learning courses should have medium to high proportions of online components.
Cause-Related Marketing and Attitude Toward Corporate Image: An Experimental Study
Authors: Sebastian Francis , M.C. Minimol
Published: November 2022

In a world of attention scarcity, cause-related marketing strategies generate a substantially greater impact. The neurophysiological mechanisms that support favorable consumer attitudes toward cause-related marketing messages are, however, rather little understood. This study attempts to comprehend how a marketer may employ cause-related marketing initiatives to improve the company’s reputation as well as how program, company, and product identities affect consumers’ attitude toward the corporate image. Following the classical experimental design, this study uses four stimuli to investigate the effects of cause type and cause category on attitude toward corporate image. The four different stimuli used in this study are exposure to a negative corporate image of a fictitious brand, exposure to a negative corporate image with exposure to cause-related marketing message on Save Amazon Rainforest, exposure to a negative corporate image, and exposure to cause-related marketing message on Educate Homeless Children project, and exposure to a negative corporate image and exposure to cause-related marketing message on feeding the hungry homeless children with a description about the gravity of hunger among the poor homeless children of India. For this study, 1,171 urban Indian consumers were used as the sample. The study suggests that empathy-embedded cause-related marketing communications are characterized by primary need-based humanitarian causes. This study thus validates the mirror neuron hypothesis, which confirms that customer-centricity increases with the degree to which the communication content is similar to that of the respondent. A higher degree of customer-centricity results in a better advertisement attitude, which improves consumer attitude toward the corporate image.
Comparison of Clinical Outcomes and Complications Between Endoscopic and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Diseases: A Systematic Review and Meta-analysis
Authors: Guo Haiwei , Song Yuke , Weng Rui , Tian Han , Yuan Jiayao , Li Ying
Published: November 2022

Study design

Systematic review and meta-analysis.

Objective

Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a classic surgical procedure for the treatment of lumbar degenerative diseases (LDD). With the development of endoscopic technology, endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) can also achieve adequate decompression and interbody fusion. However, whether Endo-TLIF is superior to MIS-TLIF has not been adequately studied. In this systematic review and meta-analysis, we aimed to evaluate the treatment difference between Endo-TLIF vs MIS-TLIF.

Methods

We conducted a systematic review and meta-analysis of the studies to compare the clinical outcomes and complications associated with Endo-TLIF vs. MIS-TLIF for the treatment of LDD. A literature search was conducted using the PubMed, Embase, Cochrane Library and Scopus databases for studies published up to April 1, 2022. Both retrospective and prospective studies that compared between Endo-TLIF and MIS-TLIF were included.

Results

A total of 8 studies involving 581 patients were finally included in this meta-analysis. Endo-TLIF significantly prolonged the operation time, but reduced the blood loss amount and length of hospital stay. Moreover, Endo-TLIF was superior to MIS-TLIF on relief of back pain and functional recovery in the early postoperative period. However, there were no significantly differences in long-term clinical outcomes, fusion rate and incidence of complications between Endo-TLIF and MIS-TLIF.

Conclusions

Endo-TLIF was similar to MIS-TLIF in the long-term clinical outcomes, fusion and complication rates. Endo-TLIF prolongs the operation time, but shortens the length of hospital stay, and has the advantages of less surgical trauma, less blood loss, faster recovery, and early postoperative back pain relief.
Modic Changes of the Cervical and Lumbar Spine and Their Effect on Neck and Back Pain: A Systematic Review and Meta-Analysis
Authors: Lambrechts Mark J. , Issa Tariq Z. , Toci Gregory R. , Schilken Meghan , Canseco Jose A. , Hilibrand Alan S. , Schroeder Gregory D. , Vaccaro Alexander R. , Kepler Christopher K.
Published: November 2022

Study Design

Systematic Review.

Objectives

To systematically review the current literature and perform a meta-analysis on patients with cervical or lumbar spine Modic changes to determine if their baseline axial back pain and disability are comparable to patients without Modic changes.

Methods

A systematic review of the PubMed database was conducted in accordance with PRISMA guidelines. A meta-analysis was performed to compare the mean differences in back pain, leg pain, and disability based on the presence of cervical or lumbar spine Modic changes. A subgroup analysis of the different types of Modic changes was conducted to determine if Modic type affected back pain or disability.

Results

– After review of 259 articles, 17 studies were included for meta-analysis and ten studies were included for qualitative synthesis. In the lumbar spine, 10 high-quality studies analyzed Visual Analog Scale (VAS) back pain, 10 evaluated VAS leg pain, and 8 analyzed Oswestry Disability Index. VAS back pain (mean difference (MD), −.38; 95% CI, -.61 – .16) and Oswestry disability index (MD −2.52; 95% CI, −3.93 – −1.12) were significantly lower in patients without Modic changes. Modic change subtype was not associated with differences in patient-reported outcomes. Patients with cervical spine Modic changes did not experience more severe pain than those without MC.

Conclusions

Modic changes in the lumbar spine are not associated with clinically significant axial low back pain severity or patient disability. Similar to the lumbar spine, Modic changes in the cervical spine are not associated with symptom severity, but they are associated with pain duration.
Situation Analysis of Healthcare Standards and Criteria That Contribute to the Care of Residents in Homes for Older People in Tanzania
Authors: Mathias Dr Victor , Stellenberg| Prof Ethelwynn L. , Heever Dr Mariana van der
Published: November 2022

Problems experienced in homes for older people in Tanzania highlighted the need for a situation analysis of healthcare standards to identify the baseline of care provided to residents in these homes. This study conducted a situation analysis of structure healthcare standards and associated criteria with the aim of contributing to improved quality of care for residents in homes for older people in Tanzania. Thirty-two homes for older people in Tanzania were audited using an audit instrument that included seven fields, 26 structure standards, and 262 associated criteria. The analysis showed that overall, the homes were non-compliant with healthcare structure standards and associated criteria. The Tanzanian Government should urgently introduce measures to address the missing standards and associated criteria.
A Mixed-Methods Description of the Home Physical Activity Environments of Racially/Ethnically Diverse and Immigrant/Refugee Children
Authors: Berge Jerica M. , Trofholz Amanda , Jacobs Nina , Tate Allan
Published: November 2022

Disparities in childhood obesity prevalence by race/ethnicity remain high. Physical activity is an important factor to consider, however little is known about how physical activity resources in the home environment and neighborhood differ by race/ethnicity. This study examines the physical activity environments in the homes and neighborhoods of diverse households using both quantitative and qualitative data. Home visits were conducted with 150 families, and accelerometry data was collected for both parents and children (5-7 years old). Qualitative interviews were also conducted with parents, which provided context to quantitative data. Racial/ethnic differences were found for physical activity, sedentary behavior, and family-level resources for physical activity ( P < .05). There were also differences by race/ethnicity in neighborhood physical activity promoters and perceived lack of neighborhood safety ( P < .05). This study is important in informing providers and future interventions of the varying promoters and barriers to optimal physical activity that exist across race/ethnicity.
Social Network Theory and Comedy: Insights from NBC’s The Office
Authors: Roth Adam R.
Published: November 2022

Television sitcoms frequently invoke social network concepts to highlight specific jokes or scenes. In this visualization, the author draws on data from NBC’s The Office to explore how show creator Greg Daniels and his writing staff leveraged a well-known social network concept in the overall development of their show. By identifying the presence of structural holes (i.e., the absence of ties between two or more network members), The Office produced multiple novel storylines in which different sets of characters who did not routinely interact were jointly forced into comedic situations. As evidenced through a network visualization—and interviews with the show’s writers—Greg Daniels was clearly thinking like a social network theorist in his careful development of one of the most successful sitcoms in television history.
From Manholes to Roboholes: A Technology-Based Solution for Sanitation Workers
Authors: Yuvraj  , Prakash Nirupama , Bala Poonam
Published: November 2022

Safai Karmachari Andolan informed the Supreme Court that in 2021 on a daily basis approximately 4.97 lakh dry toilets were serviced by animals and 7.94 lakh were serviced manually. An article in the Hindustan Times of 8 January 2021 ( India News, 2021) proposed that the government provides every manual scavenger 10 lakh so that each might liberate himself/herself from the occupation and adopt an alternate livelihood. In 1993, 2012 and 2013, three acts were proposed for reformation and rehabilitation of manual scavengers but little to no rehabilitation has occurred. There are scant government records of scavengers or sanitation workers available. According to the 2011 census, manual scavenging is categorized as a domain of unskilled work performed by unorganized labour. This article addresses the categorization of manual scavengers as sanitation workers, the social exclusion criteria for sanitation workers and how robotic technology can rehabilitate sanitation workers and uplift them socially. The article relies on semi-structured interviews conducted in two demographic regions of Haryana state in India where robotic technology is currently being used.
Chronic Sub-Clinical Systemic Metabolic Acidosis – A Review with Implications for Clinical Practice
Authors: Naude, MTech (Hom) David Francis
Published: November 2022

When arterial serum pH remains near the lower pH limit of 7.35 for protracted periods of time, a low-grade, sub-clinical form of acidosis results, referred to in this review as chronic, sub-clinical, systemic metabolic acidosis (CSSMA). This narrative review explores the scientific basis for CSSMA, its consequences for health, and potential therapeutic interventions. The major etiology of CSSMA is the shift away from the ancestral, alkaline diet which was rich in fruit and vegetables, toward the contemporary, acidogenic ‘Westernized’ diet characterized by higher animal protein consumption and lack of base forming minerals. Urine pH is reduced with high dietary acid load and may be a convenient marker of CSSMA. Evidence suggests further that CSSMA negatively influences cortisol levels potentially contributing significantly to the pathophysiology thereof. Both CSSMA and high dietary acid load are associated with the risk and prognosis of various chronic diseases. Clinical trials show that CSSMA can be addressed successfully through alkalizing the diet by increasing fruit and vegetable intake and/or supplementing with alkaline minerals. This review confirms the existence of a significant body of evidence regarding this low-grade form of acidosis as well as evidence to support its diverse negative implications for health, and concludes that CSSMA is a condition warranting further research.
Multidimensional trajectories of multimorbidity, functional status, cognitive performance, and depressive symptoms among diverse groups of older adults
Authors: Quiñones Ana R , Nagel Corey L , Botoseneanu Anda , Newsom Jason T , Dorr David A , Kaye Jeffrey , Thielke Stephen M , Allore Heather G
Published: November 2022

Background

Inter-relationships between multimorbidity and geriatric syndromes are poorly understood. This study assesses heterogeneity in joint trajectories of somatic disease, functional status, cognitive performance, and depressive symptomatology.

Methods

We analyzed 16 years of longitudinal data from the Health and Retirement Study (HRS, 1998-2016) for n = 11,565 older adults (≥65 years) in the United States. Group-based mixture modeling identified latent clusters of older adults following similar joint trajectories across domains.

Results

We identified four distinct multidimensional trajectory groups: (1) Minimal Impairment with Low Multimorbidity (32.7% of the sample; mean = 0.60 conditions at age 65, 2.1 conditions at age 90) had limited deterioration; (2) Minimal Impairment with High Multimorbidity (32.9%; mean = 2.3 conditions at age 65, 4.0 at age 90) had minimal deterioration; (3) Multidomain Impairment with Intermediate Multimorbidity (19.9%; mean = 1.3 conditions at age 65, 2.7 at age 90) had moderate depressive symptomatology and functional impariments with worsening cognitive performance; (4) Multidomain Impairment with High Multimorbidity (14.1%; mean = 3.3 conditions at age 65; 4.7 at age 90) had substantial functional limitation and high depressive symptomatology with worsening cognitive performance. Black and Hispanic race/ethnicity, lower wealth, lower education, male sex, and smoking history were significantly associated with membership in the two Multidomain Impairment classes.

Conclusions

There is substantial heterogeneity in combined trajectories of interrelated health domains in late life. Membership in the two most impaired classes was more likely for minoritized older adults.
Validation of the STOP-Bang questionnaire as a preoperative screening tool for obstructive sleep apnea: a systematic review and meta-analysis
Authors: Hwang Mark , Nagappa Mahesh , Guluzade Nasimi , Saripella Aparna , Englesakis Marina , Chung Frances
Published: November 2022

Background

Obstructive sleep apnea (OSA) is a common disorder that is highly associated with postoperative complications. The STOP-Bang questionnaire is a simple screening tool for OSA. The objective of this systematic review and meta-analysis is to evaluate the validity of the STOP-Bang questionnaire for screening OSA in the surgical population cohort.

Methods

A systematic search of the following databases was performed from 2008 to May 2021: MEDLINE, Medline-in-process, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, Journals @ Ovid, Web of Science, Scopus, and CINAHL. Continued literature surveillance was performed through October 2021.

Results

The systematic search identified 4641 articles, from which 10 studies with 3247 surgical participants were included in the final analysis. The mean age was 57.3 ± 15.2 years, and the mean BMI was 32.5 ± 10.1 kg/m2 with 47.4% male. The prevalence of all, moderate-to-severe, and severe OSA were 65.2, 37.7, and 17.0%, respectively. The pooled sensitivity of the STOP-Bang questionnaire for all, moderate-to-severe, and severe OSA was 85, 88, and 90%, and the pooled specificities were 47, 29, and 27%, respectively. The area under the curve for all, moderate-to-severe, and severe OSA was 0.84, 0.67, and 0.63.

Conclusions

In the preoperative setting, the STOP-Bang questionnaire is a valid screening tool to detect OSA in patients undergoing surgery, with a high sensitivity and a high discriminative power to reasonably exclude severe OSA with a negative predictive value of 93.2%.

Trial registration

PROSPERO registration CRD42021260451.
Association between cervical artery dissection and spinal manipulative therapy –a medicare claims analysis
Authors: Whedon James M , Petersen Curtis L , Li Zhongze , Schoelkopf William J , Haldeman Scott , MacKenzie Todd A , Lurie Jon D
Published: November 2022

Background

Cervical artery dissection and subsequent ischemic stroke is the most serious safety concern associated with cervical spinal manipulation.

Methods

We evaluated the association between cervical spinal manipulation and cervical artery dissection among older Medicare beneficiaries in the United States. We employed case-control and case-crossover designs in the analysis of claims data for individuals aged 65+, continuously enrolled in Medicare Part A (covering hospitalizations) and Part B (covering outpatient encounters) for at least two consecutive years during 2007–2015. The primary exposure was cervical spinal manipulation; the secondary exposure was a clinical encounter for evaluation and management for neck pain or headache. We created a 3-level categorical variable, (1) any cervical spinal manipulation, 2) evaluation and management but no cervical spinal manipulation and (3) neither cervical spinal manipulation nor evaluation and management. The primary outcomes were occurrence of cervical artery dissection, either (1) vertebral artery dissection or (2) carotid artery dissection. The cases had a new primary diagnosis on at least one inpatient hospital claim or primary/secondary diagnosis for outpatient claims on at least two separate days. Cases were compared to 3 different control groups: (1) matched population controls having at least one claim in the same year as the case; (2) ischemic stroke controls without cervical artery dissection; and (3) case-crossover analysis comparing cases to themselves in the time period 6–7 months prior to their cervical artery dissection. We made each comparison across three different time frames: up to (1) 7 days; (2) 14 days; and (3) 30 days prior to index event.

Results

The odds of cervical spinal manipulation versus evaluation and management did not significantly differ between vertebral artery dissection cases and any of the control groups at any of the timepoints (ORs 0.84 to 1.88; p > 0.05). Results for carotid artery dissection cases were similar.

Conclusion

Among Medicare beneficiaries aged 65 and older who received cervical spinal manipulation, the risk of cervical artery dissection is no greater than that among control groups.
Protocol for a randomised controlled trial evaluating the effectiveness of a CBT-based smartphone application for improving mental health outcomes in adolescents: the MobiliseMe study
Authors: Li S. H. , Achilles M. R. , Subotic-Kerry M. , Werner-Seidler A. , Newby J. M. , Batterham P. J. , Christensen H. , Mackinnon A. J. , O’Dea B.
Published: November 2022

Background

Depression is a leading cause of disability in adolescents, however few receive evidence-based treatment. Despite having the potential to overcome barriers to treatment uptake and adherence, there are very few CBT-based smartphone apps for adolescents. To address this gap, we developed ClearlyMe®, a self-guided CBT smartphone app for adolescent depression and anxiety. ClearlyMe® consists of 37 brief lessons containing core CBT elements, accessed either individually or as part of a ‘collection’. Here, we describe the protocol for a randomised controlled trial aiming to evaluate the effect of ClearlyMe® on depressive symptoms and secondary outcomes, including engagement, anxiety and wellbeing, when delivered with and without guided support compared to an attention matched control.

Methods

We aim to recruit 489 adolescents aged 12-17 years with mild to moderately-severe depressive symptoms. Participants will be screened for inclusion, complete the baseline assessment and are then randomly allocated to receive ClearlyMe® (self-directed use), ClearlyMe® with guided SMS support (guided use) or digital psychoeducation (attention-matched control). Depressive symptoms and secondary outcomes will be assessed at 6-weeks (primary endpoint) and 4-months post-baseline (secondary endpoint). Engagement, conceptualised as uptake, adherence and completion, will also be assessed 6-weeks post-baseline. Mixed-effects linear modelling will be used to conduct intention-to-treat analyses to determine whether reductions in depressive symptoms and secondary outcomes are greater for conditions receiving ClearlyMe® relative to control at 6-weeks and 4-months post-baseline and greater for intervention adherers relative to non-adherers. To minimise risk, participants will be encouraged to use the Get Help section of the app and can also opt to receive a call from the team clinical psychologist at baseline, and at the 6-week and 4-month post-baseline assessments when reporting suicidal ideation.

Discussion

This is the first clinical trial examining a CBT smartphone app specifically designed for adolescent depression. It will provide empirical evidence on the effects of ClearlyMe® on depressive symptoms when used with and without guided support.

Trial registration

Australian New Zealand Clinical Trials Registry (ACTRN12622000131752).

Universal trial number

U1111-1271-8519.
The efficacy and safety of esketamine in the treatment of major depressive disorder with suicidal ideation: study protocol for a randomized controlled trial
Authors: Liu Haiyan , Lan Xiaofeng , Wang Chengyu , Zhang Fan , Fu Ling , Li Weicheng , Ye Yanxiang , Hu Zhibo , Chao Ziyuan , Ning Yuping , Zhou Yanling
Published: November 2022

Background

Major depressive disorder (MDD) is a high risk factor for suicide, with up to 20% of MDD patients attempting suicide during their lifetime. Current treatments for MDD are slow onset of action, low efficiency, and the inability to control suicidal behaviors quickly and effectively. Intravenous ketamine has been shown to have a rapid but transient antidepressant effect, but there is still lack evidence on the efficacy and safety of intravenous esketamine in reducing suicidal ideation and depressive symptoms in MDD patients with suicidal ideation. We designed a study to investigate the effect of short-term repeated intravenous infusion of esketamine three times in MDD patients with suicidal ideation.

Methods

This study features a randomized, double-blind, placebo-controlled trial (RCT) comparing short-term repeated intravenous infusions of esketamine with placebo as a supplement to conventional antidepressants with an intervention period of 6 days and one infusion every other day, followed by 4 weeks of follow-up. These methods support the examination of the efficacy, safety, tolerability, and mechanism of action of short-term repeated intravenous infusions of esketamine in MDD patients with suicidal ideation.

Discussion

This is the first RCT to explore the efficacy and safety of short-term repeated infusion of esketamine on suicidal ideation and depressive symptoms in MDD patients with suicidal ideation. If proven effective and tolerated, it will provide evidence for rapid and effective treatment of suicidal ideation and depressive symptoms in MDD individuals with suicidal ideation.

Trial registration

Chinese Clinical Trial Register, ChiCTR2000041232. Registered 22 December 2020.
Identifying geographical inequalities of maternal care utilization in Ethiopia: a Spatio-temporal analysis from 2005 to 2019
Authors: Seboka Binyam Tariku , Mamo Tizalegn Tesfaye , Mekonnen Tensae
Published: November 2022

Introduction

Inequalities in maternal care utilization pose a significant threat to maternal health programs. This study aimed to describe and explain the spatial variation in maternal care utilization among pregnant women in Ethiopia. Accordingly, this study focuses on identifying hotspots of underutilization and mapping maternal care utilization, as well as identifying predictors of spatial clustering in maternal care utilization.

Methods

We evaluated three key indicators of maternal care utilization: pregnant women who received no antenatal care (ANC) service from a skilled provider, utilization of four or more ANC visits, and births attended in a health facility, based the Ethiopian National Demographic and Health Survey (EDHS5) to 2019. Spatial autocorrelation analysis was used to measure whether maternal care utilization was dispersed, clustered, or randomly distributed in the study area. Getis-Ord Gi statistics examined how Spatio-temporal variations differed through the study location and ordinary Kriging interpolation predicted maternal care utilization in the unsampled areas. Ordinary least squares (OLS) regression was used to identify predictors of geographic variation, and geographically weighted regression (GWR) examined the spatial variability relationships between maternal care utilization and selected predictors.

Result

A total of 26,702 pregnant women were included, maternal care utilization varies geographically across surveys. Overall, statistically significant low maternal care utilization hotspots were identified in the Somali region. Low hotspot areas were also identified in northern Ethiopia, stretching into the Amhara, Afar, and Beneshangul-Gumuz regions; and the southern part of Ethiopia and the Gambella region. Spatial regression analysis revealed that geographical variations in maternal care utilization indicators were commonly explained by the number of under-five children, the wealth index, and media access. In addition, the mother’s educational status significantly explained pregnant women, received no ANC service and utilized ANC service four or more times. Whereas, the age of a mother at first birth was a spatial predictor of pregnant who received no ANC service from a skilled provider.

Conclusion

In Ethiopia, it is vital to plan to combat maternal care inequalities in a manner suitable for the district-specific variations. Predictors of geographical variation identified during spatial regression analysis can inform efforts to achieve geographical equity in maternal care utilization.
Bidirectional genetic overlap between bipolar disorder and intelligence
Authors: Shang Meng-Yuan , Wu Yong , Zhang Chu-Yi , Qi Hao-Xiang , Zhang Qing , Huo Jin-Hua , Wang Lu , Wang Chuang , Li Ming
Published: November 2022

Background

Bipolar disorder (BD) is a highly heritable psychiatric illness exhibiting substantial correlation with intelligence.

Methods

To investigate the shared genetic signatures between BD and intelligence, we utilized the summary statistics from genome-wide association studies (GWAS) to conduct the bivariate causal mixture model (MiXeR) and conjunctional false discovery rate (conjFDR) analyses. Subsequent expression quantitative trait loci (eQTL) mapping in human brain and enrichment analyses were also performed.

Results

Analysis with MiXeR suggested that approximately 10.3K variants could influence intelligence, among which 7.6K variants were correlated with the risk of BD (Dice: 0.80), and 47% of these variants predicted BD risk and intelligence in consistent allelic directions. The conjFDR analysis identified 37 distinct genomic loci that were jointly associated with BD and intelligence with a conjFDR < 0.01, and 16 loci (43%) had the same directions of allelic effects in both phenotypes. Brain eQTL analyses found that genes affected by the “concordant loci” were distinct from those modulated by the “discordant loci”. Enrichment analyses suggested that genes related to the “concordant loci” were significantly enriched in pathways/phenotypes related with synapses and sleep quality, whereas genes associated with the “discordant loci” were enriched in pathways related to cell adhesion, calcium ion binding, and abnormal emotional phenotypes.

Conclusions

We confirmed the polygenic overlap with mixed directions of allelic effects between BD and intelligence and identified multiple genomic loci and risk genes. This study provides hints for the mesoscopic phenotypes of BD and relevant biological mechanisms, promoting the knowledge of the genetic and phenotypic heterogeneity of BD. The essential value of leveraging intelligence in BD investigations is also highlighted.