bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization of Atrial Substrate to Predict the Success of Pulmonary Vein Isolation: The Prospective, Multicenter MASH‐AF II (Multipolar Atrial Substrate High Density Mapping in Atrial Fibrillation) Study
Authors: Bergonti Marco , Spera Francesco Raffaele , Ferrero Teba Gonzalez , Nsahlai Michelle , Bonomi Alice , Tijskens Maxime , Boris Wim , Saenen Johan , Huybrechts Wim , Miljoen Hielko , González‐Juanatey Jose Ramón , Martínez‐Sande Jose Luis , Vandaele Lien , Wittock Anouk , Heidbuchel Hein , Valderrábano Miguel , Rodríguez‐Mañero Moises , Sarkozy Andrea
Published: December 2022

Background

Left atrial substrate may have mechanistic relevance for ablation of atrial fibrillation (AF). We sought to analyze the relationship between low‐voltage zones (LVZs), transition zones, and AF recurrence in patients undergoing pulmonary vein isolation.

Methods and Results

We conducted a prospective multicenter study on consecutive patients undergoing pulmonary vein isolation‐only approach. LVZs and transition zones (0.5–1 mV) were analyzed offline on high‐density electroanatomical maps collected before pulmonary vein isolation. Overall, 262 patients (61±11 years, 31% female) with paroxysmal (130 pts) or persistent (132 pts) AF were included. After 28 months of follow‐up, 73 (28%) patients experienced recurrence. An extension of more than 5% LVZ in paroxysmal AF and more than 15% in persistent AF was associated with recurrence (hazard ratio [HR], 4.4 [95% CI, 2.0–9.8],
P
<0.001 and HR, 1.9 [95% CI, 1.1–3.7],
P
=0.04, respectively). Significant association was found between LVZs and transition zones and between LVZs and left atrial volume index (LAVI) (both
P
<0.001). Thirty percent of patients had significantly increased LAVI without LVZs. Eight percent of patients had LVZs despite normal LAVI. Older age, female sex, oncological history, and increased AF recurrence characterized the latter subgroup.

Conclusions

In patients undergoing first pulmonary vein isolation, the impact of LVZs on outcomes occurs with lower burden in paroxysmal than persistent AF, suggesting that not all LVZs have equal prognostic implications. A proportional area of moderately decreased voltages accompanies LVZs, suggesting a continuous substrate instead of the dichotomous division of healthy or diseased tissue. LAVI generally correlates with LVZs, but a small subgroup of patients may present with disproportionate atrial remodeling, despite normal LAVI.
Social Deprivation and Post‐TAVR Outcomes in Ontario, Canada: A Population‐Based Study
Authors: Patel Raumil V. , Ravindran Mithunan , Qiu Feng , Manoragavan Ragavie , Sud Maneesh , Tam Derrick Y. , Madan Mina , Marcus Gil , Elbaz‐Greener Gabby , Mamas Mamas A. , Wijeysundera Harindra C.
Published: December 2022

Background

Transcatheter aortic valve replacement (TAVR)/intervention has become the standard of care for treatment of severe aortic stenosis across the spectrum of risk. There are socioeconomic disparities in access to TAVR. The impact of these disparities on postprocedural outcomes remains unknown. Our objective was to examine the association between neighborhood‐level social deprivation and post‐TAVR mortality and hospital readmission.

Methods and Results

We conducted a population‐based retrospective cohort study of all 4145 patients in Ontario, Canada, who received TAVR from April 1, 2017, to March 31, 2020. Our co‐primary outcomes were 1‐year postprocedure mortality and 1‐year postprocedure readmission. Using Cox proportional hazards models for mortality and cause‐specific competing risk hazard models for readmission, we evaluated the relationship between neighborhood‐level measures of residential instability, material deprivation, and concentration of racial and ethnic groups with post‐TAVR outcomes. After multivariable adjustment, we found a statistically significant relationship between residential instability and postprocedural 1‐year mortality, ranging from a hazard ratio of 1.64 to a hazard ratio of 2.05. There was a significant association between the highest degree of residential instability and 1‐year readmission (hazard ratio, 1.23 [95% CI, 1.01–1.49]). There was no association between material deprivation and concentration of racial and ethnic groups with post‐TAVR outcomes.

Conclusions

Residential instability was associated with increased risk for post‐TAVR mortality, and the highest quintile of residential instability was associated with increased post‐TAVR readmission. To reduce health disparities and promote an equitable health care system, further research and policy interventions will be required to identify and support economically and socially minoritized patients undergoing TAVR.
Proteolytic Degradation Is a Major Contributor to Bioprosthetic Heart Valve Failure
Authors: Kostyunin Alexander E. , Glushkova Tatiana V. , Lobov Arseniy A. , Ovcharenko Evgeny A. , Zainullina Bozhana R. , Bogdanov Leo A. , Shishkova Daria K. , Markova Victoria E. , Asanov Maksim A. , Mukhamadiyarov Rinat A. , Velikanova Elena A. , Akentyeva Tatiana N. , Rezvova Maria A. , Stasev Alexander N. , Evtushenko Alexey V. , Barbarash Leonid S. , Kutikhin Anton G.
Published: December 2022

Background

Whereas the risk factors for structural valve degeneration (SVD) of glutaraldehyde‐treated bioprosthetic heart valves (BHVs) are well studied, those responsible for the failure of BHVs fixed with alternative next‐generation chemicals remain largely unknown. This study aimed to investigate the reasons behind the development of SVD in ethylene glycol diglycidyl ether–treated BHVs.

Methods and Results

Ten ethylene glycol diglycidyl ether–treated BHVs excised because of SVD, and 5 calcified aortic valves (AVs) replaced with BHVs because of calcific AV disease were collected and their proteomic profile was deciphered. Then, BHVs and AVs were interrogated for immune cell infiltration, microbial contamination, distribution of matrix‐degrading enzymes and their tissue inhibitors, lipid deposition, and calcification. In contrast with dysfunctional AVs, failing BHVs suffered from complement‐driven neutrophil invasion, excessive proteolysis, unwanted coagulation, and lipid deposition. Neutrophil infiltration was triggered by an asymptomatic bacterial colonization of the prosthetic tissue. Neutrophil elastase, myeloblastin/proteinase 3, cathepsin G, and matrix metalloproteinases (MMPs; neutrophil‐derived MMP‐8 and plasma‐derived MMP‐9), were significantly overexpressed, while tissue inhibitors of metalloproteinases 1/2 were downregulated in the BHVs as compared with AVs, together indicative of unbalanced proteolysis in the failing BHVs. As opposed to other proteases, MMP‐9 was mostly expressed in the disorganized prosthetic extracellular matrix, suggesting plasma‐derived proteases as the primary culprit of SVD in ethylene glycol diglycidyl ether–treated BHVs. Hence, hemodynamic stress and progressive accumulation of proteases led to the extracellular matrix degeneration and dystrophic calcification, ultimately resulting in SVD.

Conclusions

Neutrophil‐ and plasma‐derived proteases are responsible for the loss of BHV mechanical competence and need to be thwarted to prevent SVD.
General Surgery Trainee Cases Over Time: Postgraduate Year Matters
Authors: Ore Ana Sofia , Liu Betty S. , Chen Hao W. , Kent Tara S. , Parsons Charles S. , Narula Nisha
Published: December 2022

Background

Trainees and attending surgeons alike have concerns about resident and fellow operative volume/breadth, competency, and overall readiness for practice. This is an important topic within surgical graduate medical education. Our goal was to analyze the change in general surgery trainee operative experience over time by postgraduate year.

Methods

Institutional operative records from two corresponding three-month time periods in 2009 and 2018 at the residency program’s main hospital site were reviewed. Cases assisted on by general, vascular, or thoracic surgery trainees were included. The number of cases per level, combination of trainees in each case, and categories of cases were compared over time.

Results

There were 1940 cases in 2009 and 1967 cases in 2018 over the respective time periods. The distribution of trainees was different (P < .001), with a similar number of PGY-1 and fellow cases, a decrease in PGY-2 and PGY-5 cases, and an increase in PGY-3 and PGY-4 cases. The number of cases with two trainees, double scrubbed cases, increased from 19.6% to 26.8% (P < .001). In addition, there were differences in the resident years that double scrubbed cases together, an increase in robotic and endovascular surgery, and a decrease in open cases.

Conclusions

This analysis of cases shows that resident operative volume over approximately a decade has been largely preserved, with some change in the distribution of cases based on trainee level, an increase in cases with more than one trainee, and a rise of minimally invasive surgery with a corresponding decrease in open cases.
Ernest Amory Codman and the End Result Idea in Surgical Quality
Authors: Nakayama Don K.
Published: December 2022

The quality movement in 21st century healthcare—quality, patient safety, and the value equation (value equals quality divided by cost)—had their start with Ernest Amory Codman (1869-1940), the quixotic surgeon who started it all a century before. He was on track for prosperity and success, given a Boston Brahmin pedigree and his impeccable credentials from Harvard College, its medical school, and the Massachusetts General Hospital.

In 1910, nearing 40, Codman instead detoured toward a revolutionary idea that he called the End Result system, the seemingly unachievable goal of reaching “perfection” in surgery: complete recovery without death, complications, or lasting disability. He scrutinized any case that fell short, seeking honest explanations and improvements so that his next case would more likely reach a perfect outcome.

The system that was so clear to him was audacious to his colleagues, who summarily rejected it. When Codman suspected greed and self-interest, he was ostracized from the Boston medical community. To apply his concepts, he opened a proprietary hospital called the End Result Hospital that drove him to insolvency.

His career never recovered from the debacle even when he later reached prominence as an authority on bone malignancies and shoulder pathology. When he died, his resting place went unmarked. As quality became central to healthcare at the end of the 20th century, Codman’s prescient End Result system was recognized as a fundamental contribution to medicine.
Ways to Navigate Sexual Minority and Latter-day Saint Identities: A Latent Profile Analysis
Authors: Lefevor G. Tyler , Meter Diana J. , Skidmore Samuel J.
Published: December 2022

Using a sample of 815 sexual minorities (SMs) with current or historical engagement with the Church of Jesus Christ of Latter-day Saints, we examined (a) how many empirically distinct ways there are to navigate SM and religious identities and (b) whether these ways were related to health. A latent profile analysis, which grouped participants by religious/spiritual (i.e., religious commitment, service attendance, Christian orthodoxy) and SM identity (i.e., outness, identity centrality, sexuality support) variables, yielded a three-group solution: engaged Latter-day Saint (LDS) individuals, moderately engaged LDS individuals, and lapsed LDS individuals. Participants in these three classes did not significantly differ in SM variables or in physical health, mental health, or life satisfaction. Engaged LDS participants reported less substance use and more meaning in life than lapsed LDS participants, likely due to their religious engagement.
Socioeconomic Status and the Changing Nature of School-to-Work Transitions in Egypt, Jordan, and Tunisia
Authors: Assaad Ragui , Krafft Caroline , Salemi Colette
Published: December 2022

The Middle East and North Africa region struggled to meet the employment aspirations of its increasingly educated youth in the aftermath of structural reforms. This article examines the evolution of initial labor market outcomes across pre- and post-reform cohorts of school leavers by education and socioeconomic status (SES) in Egypt, Jordan, and Tunisia. Results show that formal jobs for educated new entrants are increasingly allocated according to SES, as measured by parents’ education and father’s occupation, in Egypt and Tunisia, but not in Jordan. In Egypt and Tunisia, the quality of initial jobs deteriorated for educated new entrants, particularly among those with lower SES. This rising tide of inequality of opportunity in employment may have contributed to the Arab Spring uprisings and remains an important source of frustration for youth and their families.
Developing an adaptive FE model to reflect the effective mechanical properties in porous elastomeric materials
Authors: Nazari Ali Reza , Khanzadeh-Moradllo Mehdi
Published: December 2022

Simulation of the microstructure of materials is not usually an efficient approach to estimate the mechanical response in the macro-scale porous components. This paper establishes an adaptive numerical model which reflects the effective mechanical properties of the elastomeric foam materials in the macro-scale, based on the material response in local points. The proposed adaptive model is capable of characterizing the dominant state of stress at each section point and assigning the corresponding mechanical properties from a developed material library. This material library can propose different stress-strain responses of the foam material based on mechanical characterization experiments and using the best-fit energy functions. The material of study is an elastomeric foam with a blend of Polyethylene/Ethylene-vinyl acetate (PE-EVA). The efficiency and performance of the adaptive model were examined using two practical case studies, in which the material was exposed to multiaxial stress conditions (a foam beam and a composite sandwich beam with a foam core under a concentrated loading). The adaptive model accurately predicts the dominant response of the foam beam and composite sandwich beam under flexural loading conditions. However, the uniaxial hyperelastic material models, calibrated by the pure tensile or compressive response of the foam material, dramatically overestimate or underestimate the experimental results.
Peacekeeping, Mediation, and the Conclusion of Local Ceasefires in Non-State Conflicts
Authors: Duursma Allard
Published: December 2022

This article theorizes on how military and civilian components of peacekeeping operations contribute to the conclusion of local ceasefires in non-state conflicts involving armed opposition groups or communal groups. A mediation-based logic suggests that civilian peacekeeping staff can provide technical support aimed at resolving the conflict issues and engage with state officials to promote peace. A capabilities-based logic suggest that military peacekeepers can provide security during the negotiations, arrange logistics, and put military pressure on the conflict parties, which all should make the conclusion of a ceasefire more likely. The analysis supports both the capabilities-based and the mediation-based logic. An instrumental variable estimation helps to account for endogeneity. This article contributes to the literature on peacekeeping, mediation, and ceasefires through shifting the focus to non-state conflicts.
Mapping Conscience: Network Analysis Into the Differences in Maturation of Offending and Non-Offending Adolescents
Authors: de Brauw Maurits , Popma Arne , Peen Jaap , Peters Carel , Schalkwijk Frans
Published: December 2022

Conscience is a diagnostically relevant concept in forensic psychiatry, but often misinterpreted as an all-or-none phenomenon. We conceptualize the conscience as a psychic function in which elements like empathy, self-conscience emotions such as shame, guilt and pride, and moral orientation work together. The differences in conscience functioning can be described in terms of developmental levels of integration. We conducted network analyses on data collected via a questionnaire survey held among 52 offending and 243 non-offending juveniles. We displayed two networks: One representing the non-offenders’ normative and one representing the offenders’ defiantly maturing conscience. As was hypothesized, in the non-offenders network, almost all elements clustered into one clinically meaningful network, indicating integration of the different elements of the normative maturing conscience. In the offenders network, the correlations between the elements were sporadic, indicating a lack of integration of the defiantly maturing conscience. The difference between the two networks was more prominent for empathy and moral orientation than for self-conscious emotions. This research supports the theory of differences in maturation of conscience instead of being an all-or-none phenomenon and calls for further research, taking a deeper look at the significance of integration of the conscience and its implications for offending behaviour.
Life Course and Structural Migrations: Refining Migration Classifications
Authors: Schaeffer Peter V.
Published: December 2022

Migration is a major engine of demographic change for towns, regions, and whole countries. Traditionally, migrations have been divided into those caused by push or pull factors or classified by events that triggered them. In other words, push and pull factors are but one way to classify migration movements. This work distinguishes between life course and structural migrations. Life course migrations are linked to important events in people’s lives such as graduation, marriage, having children, job promotions, discharge from the military, or retirement and the motivation comes from the migrant. Structural migrations are caused by changes in the economic, social, political, or natural environment and, therefore, externally motivated. This classification scheme is compatible with and complementary to existing classifications and particularly those based on push and pull factors. It yields some additional insights for policy making, empirical research, and migration modeling.
Functions of background music among prisoners and staff in the Chinese prison workplace
Authors: Zhang Xiaoye
Published: December 2022

Music listening is one of the most popular leisure activities in our lives, and it can also be found in prisons across the globe. However, most research on music in prison are concerned with its rehabilitative functions and not as an everyday activity. This study collected qualitative questionnaires and interview data from 14 prisons to illustrate the soundscape of music listening in Chinese prisons. The main access to music listening happens at the workspace and it is only available in the form of background music. This study considers the various functions of background music for both prisoners and officers. Music curation and access are about power and control, and it reveals a mostly hierarchical yet also dynamic pattern in the Chinese staff–prisoner relationship. Listening to music has also been found to be one of the coping mechanisms for officers and prisoners who share similar working conditions where conformity to authority is inevitable for all.
A Comparison of Ordered Categorical versus Discrete Choices within a Stated Preference Survey of Whole-Blood Donors
Authors: Sadique Zia , Cairns John , De Corte Kaat , Willis Sarah , Miners Alec , Bansback Nick , Grieve Richard
Published: December 2022

There are different stated preference (SP) approaches, including discrete choice experiments (DCEs). DCEs are a popular SP approach, but in some settings, alternative ways of framing survey questions may be more appropriate. The Health Economic Modelling Of Alternative Blood Donation Strategies (HEMO) study required choice tasks to be framed so that the study could estimate the effect of attribute levels on the frequency of a behavior—in this case, blood donation. SP questions were formulated to require ordered categorical responses from a single profile of attribute levels. However, it is unknown whether this way of framing SP questions leads to estimates of marginal rates of substitution (MRS) that are different from traditional DCE choices between 2 alternative profiles. The aim of this article is to compare estimates of relative preferences from SP questions requiring ordered categorical versus discrete choice responses. We compared relative preferences elicited from the 2 approaches for a common set of attributes and levels, formulated as choice tasks for 8,933 whole-blood donors. We found that the 2 forms of survey questions provided similar MRSs estimates. For example, respondents were willing to trade off only a small increase in travel time to receive a health report, irrespective of whether the choice given was binary (DCE response; approximately 3 min) or from an ordered category (about 8 min). The finding that any differences in the estimated MRSs are not of substantive importance offers some reassurance for policy makers in that estimates of relative preference may be robust to alternative ways of framing the survey questions. These findings can encourage future studies to frame choice tasks that align with the study’s objective.

Highlights

This article compares the relative preferences from stated preference (SP) questions requiring ordered categorical versus discrete choice responses. The approaches were contrasted for blood donation service characteristics that offer opportunities to donate blood. The estimates of relative preferences for alternative blood donation service characteristics were similar between the 2 forms of SP approach. This study illustrates how SP survey questions can be formulated to provide responses on an ordered categorical scale and to estimate marginal rates of substitution between different attributes, which can be compared with those derived from discrete choice experiment (DCE) choices. The article highlights the potential value of considering alternative choice framings rather than relying solely on DCEs.
Plasma advanced oxidation products as an additional tool in assessment of post-infarction heart failure
Authors: Cvetkovic Tatjana , Saric Sandra , Stefanovic Nikola , Stojiljkovic Vladana , Djordjevic Branka , Stojanovic Dijana , Cvetkovic Mina , Deljanin Ilic Marina
Published: December 2022

Objective

To define which oxidative stress markers could be used as diagnostic tools in the assessment of post-infarction heart failure (HF).

Methods

This observational study enrolled patients with HF that were divided into three subgroups (ejection fraction [EF] ≥ 50%; EF 40–49%; EF < 40%) and age- and sex-matched healthy control subjects. The plasma concentrations of advanced oxidation protein products (AOPP), thiobarbituric acid reactive substances, catalase activity and free thiols were determined in all participants.

Results

The study enrolled 81 patients with HF and 68 healthy control subjects. There were significant differences in the values ​​of oxidative stress markers between patients and controls. Oxidative stress parameters did not differ between the subgroups of patients, except for AOPP, which was significantly higher in the EF < 40% group. Univariate and multivariate logistic regression analyses showed an association between AOPP and HF in the EF ≥ 50% group, while receiver operating characteristic (ROC) curve analysis identified a cut-off value of 60.89 µmol/l for AOPP.

Conclusions

Based on the ROC curve analysis of AOPP and the higher significance in the multivariate analyses for patients with EF ≥ 50%, these current results suggest that AOPP could be a useful additional tool in the assessment of post-infarction HF.
Interventional treatment of keratoacanthoderma: a case report
Authors: Mei Dan , Song Lei , Gao Jin-Qi , Wu Jie
Published: December 2022

This current case report describes a 56-year-old male patient with a skin mass on his lip that had been growing for 1 year. The pathological findings demonstrated that the epidermis was characterized by hyperkeratosis, hyperplasia and hypertrophy and was formed in the shape of a crater. The skin on both ends had developed into a ball-like growth that resembled a volcanic cone. There was invasive growth of heterotype squamous epithelium and a small number of inflammatory cells infiltrating the dermis. Immunohistochemistry demonstrated an increase in P16 (the focus, +) and the hot spot Ki-67 index. The diagnosis was of tumour-like hyperplasia, malignancy and moderate-to-severe dysplasia confirming that it was keratoacanthoma. The patient underwent surgical resection and was discharged from hospital, but the tumour returned. Paclitaxel and cisplatin were administered intraoperatively and bilateral lingual artery perfusion chemoembolization was undertaken six times. This procedure led to an excellent postoperative recovery and discharge from hospital. Tumour therapy was regarded as successful. The patient’s medical history included acute lymphoblastic leukaemia L1 and long-term immunosuppressant use. After a 6-month period of follow-up, he died from systemic organ failure as a consequence of having too many ailments.
Treponema spp. spirochetes and keratinopathogenic fungi isolated from keratomas in donkeys
Authors: Paraschou Georgios , Cook Joanna M. , Priestnall Simon L. , Evans Nicholas J. , Staton Gareth J. , Paterson Gavin K. , Winkler Betina , Whitbread Trevor J.
Published: December 2022

Keratoma is an aberrant keratin mass thought to originate from epidermal horn-producing cells interposed between the stratum medium of the hoof wall and the underlying third phalanx. The cause is unknown, although the presence of keratomas is frequently associated with chronic irritation, focal infection, or trauma. A total of 167 donkeys with keratomas were presented in this study. The diagnosis of a keratoma was based on clinical signs, radiography, and histopathologic examination. Surgical excision was attempted on all donkeys with lameness unless euthanasia was advised. Histopathologic examination, including Giemsa, periodic acid Schiff, and Young’s silver special histochemical stains, was performed and showed the presence of fungal hyphae and spirochete bacteria within the degenerate keratin. Polymerase chain reaction (PCR) for treponeme bacteria was performed on 10 keratoma lesions and 9 healthy pieces of hoof (controls). All healthy donkey tissues were negative for the 3 recognized digital dermatitis (DD) treponeme phylogroups, whereas 3 of 10 (30%) donkey keratoma samples were positive for one of the DD treponeme phylogroups. Routine fungal culture and PCR for fungi were performed on 8 keratoma lesions and 8 healthy pieces of hoof (controls). Keratinopathogenic fungi were detected in 1 of 8 (12.5%) keratomas, while only non-keratinopathogenic, environmental fungi were detected in 8 control healthy hoof samples. This is the first time the DD treponemes phylogroup and keratinopathogenic fungi have been detected in keratomas. Further studies are required to assess the significance of this finding.
Quantitative methods II: Big theory
Authors: Franklin Rachel
Published: December 2022

In this second report on quantitative methods, I consider the foundational triumvirate that underpins the sub-discipline: data, methods, and theory. I argue that, although ‘big data’ and, more recently, ‘big code’ may have captured the limelight, theory is invaluable and should not be disregarded. Showcasing the integral role of theory in quantitative human geography, I identify three kinds of useful theory (old school, enduring and conceptual) and, along the way, highlight beneficial ways in which they contribute to our thinking about data and methods. Throughout, I emphasize that theory is a crucial component of contemporary and future quantitative methods development.
Haematopoietic cytopenia associated with cyclin-dependent kinase 4/6 inhibitors: A real-world study of data from the food and drug administration adverse event reporting system database
Authors: Ren Xiayang , Yan Cilin , Tian Le , Cui Xiangli
Published: December 2022

Objective

The haematopoietic cytopenia (HC) of the cyclin-dependent kinase (CDK)4/6 inhibitors was evaluated using the Food and Drug Administration Adverse Event Reporting System (FAERS).

Method

Data from 1 January 2015 to 31 December 2021 has been retrieved from the FAERS database. Disproportionality analysis and Bayesian analysis were utilized in the data mining. The reporting odds ratio (ROR) with 95% confidence interval (CI) for HC was calculated for each CDK 4/6 inhibitor agent. Clinical features of the patients were collected and compared between death outcome and non-death outcome groups. Time to onset (TTO), proportion of deaths, life-threatening and hospitalizations of CDK 4/6 inhibitors-associated HC were also studied.

Results

A total of 17,235 cases of HC associated with CDK 4/6 inhibitors were identified with a median age of 65 years (interquartile range [IQR] 57–73). Palbociclib appeared the strongest signal, with the highest (ROR 9.64, 95% CI 9.46–9.83), followed by ribociclib (ROR 6.38, 95% CI 6.04–6.73) and then abemaciclib (ROR 2.72, 95% CI 2.49–2.97). Patients aged 18–64 had a higher proportion of deaths than those aged 65–84 (12.21% vs. 9.91%, p = 0.001). In Africa and Asia, the proportions of deaths were higher (31.65% and 26.13%, respectively). The median TTO was 26 days (IQR 14–65) for abemaciclib, 33 days (IQR 15–134) for palbociclib and 23 days (IQR 14–69) for ribociclib, respectively. The highest proportion of deaths, life-threatening and hospitalizations all occurred in abemaciclib (13.00%, 5.42% and 44.04%, respectively).

Conclusions

Greater proportions of deaths occurred in Africa and Asia. HC may occur early in any CDK 4/6 inhibitor regimen. Abemaciclib had the highest proportion of deaths, life-threatening and hospitalizations. Health care workers should be more concerned about CDK 4/6 inhibitors. The higher proportions of serious events, including deaths, from Africa and Asia, as well as for abemaciclib, deserve further investigations through additional pharmacoepidemiological approaches.
Aide and Client Safety “Should Go Hand-In-Hand”: Qualitative Findings From Home Care Aides, Clients, and Agency Leaders
Authors: Brouillette Natalie M. , Markkanen Pia K. , Quinn Margaret M. , Galligan Catherine J. , Sama Susan R. , Lindberg John E. , Karlsson Nicole D.
Published: December 2022

Retention of the home care (HC) aide workforce is essential to meet the needs of our aging population. Some studies suggest that improving HC safety could increase job retention. This study objective was to explore qualitatively the connection between aide and client safety and factors impacting this care relationship. Data consisted of audio-recorded, verbatim responses to open-ended questions of two focus groups with aides ( n = 10), two in-person interviews with HC agency managers, and 37 phone interviews with those working in (aides, n = 16; managers, n = 12) and receiving (clients, n = 9) HC. Clients reported home layout and accessibility as safety concerns. Aides and managers reported that client family members can make the care job more challenging. The aide-client connection was affected by communication style, family and HC agency support, allotted care time, and job task boundaries. Interventions that address the safety of both clients and aides can influence HC job satisfaction and retention.
An Empirical Investigation of the Different Levels of Gamification in an Introductory Programming Course
Authors: Imran Hazra
Published: December 2022

Adding gaming elements to conventional teaching methodologies has gained a lot of attention because of its ability to incorporate an engaging, motivating, and fun-based environment. As a result, learners' dedication and performance are also better. Unfortunately, current gamification models do not consider the effect of different levels of gamification. Therefore, this study provides deeper insight into the three levels of gamification on the motivation, engagement, and performance of 450 undergraduates enrolled in an online course. The level of gamification is experimentally manipulated based on different gaming elements and the presentation of learning content. The outcomes were measured at three points. Quantitative methods were used to analyze defined measures, and qualitative methods were used to analyze open-ended measures. The results revealed no change in outcomes between all groups during pre-course and mid-course assessments. However, motivation, engagement, and performance are improved in gamified environments, and these effects are more noticeable towards the end of the course. It was discovered that the gamification level was a significant determinant of motivation and performance but not engagement, which highlights the importance of implementing gamification in educational platforms. The gamification appeared to be a pedagogically profound way of engaging students in the online course. The whole setup triggered the learner’s motivation to learn and perform in the course. We conclude that gamification does help in motivation, engagement and performance if considered properly. Thus, educators and educational institutions seeking to enhance student motivation and performance may look at the ‘right level’ of gamification as an appropriate methodology.
Corneal sustained delivery of hyaluronic acid from nanofiber-containing ring-implanted contact lens
Authors: Akbari Elham , Imani Rana , Shokrollahi Parvin , Heidari keshel Saeed
Published: December 2022

Dry eye syndrome, as a persist corneal epithelial defect (PED), is an inconvenient ocular disorder that is generally treated by high-dosage, conventional eye drops. Addressing low efficacy and rather restricted bioavailability of the conventional eye drops, drug-eluting contact lenses (CLs) are widely used as alternatives in ophthalmic drug delivery applications. In the present study, a nanofiber-containing ring implant poly (vinyl alcohol) (PVA) hydrogel is designed as a carrier for hyaluronic acid (HA) delivery. hyaluronic acid is physically encapsulated in a nanofiber-containing ring-shaped hydrogel with a 2 mm width that is implanted in the final CLs hydrogel. The designed CL has 59% porosity, 275% swelling ratio and undergoes no weight loss at physiological conditions in14 days. In-vitro release studies were performed on the CLs with and without nanofibers. The results showed that nanofiber incorporation in the designed CL was highly influential in decreasing burst release and supported sustained release of HA over 14 days. In addition, nanofiber incorporation in the designed system strengthened the lens, and the young modulus of the PVA hydrogel increased from 6 to 10 kPa. Cell viability study also revealed no cell cytotoxicity and cell attachment. Overall, the study demonstrated the effective role of nanofibers in the physical strengthening of the CL. Also, the designed system holds promise as a potential candidate for HA delivery over an extended period for treating dry eye syndrome.
Does Legal Change Induce Behavioral Change in Domestic Violence Against Women?
Authors: Schneider Rodrigo , Piazza Kelly Senters
Published: December 2022

In this paper, we study the effectiveness of the Brazilian “Maria da Penha” Law—a law that imposed criminal sanctions on and promoted rehabilitation programs for known perpetrators of acts of domestic violence exclusively against women, issued restraining orders against perpetrators, required perpetrators to surrender firearms, and established police units uniquely trained to address violence against women. Using difference-in-difference analyses estimated with data on Brazilian monthly assault-related hospitalizations and with gender as treatment variable, we find that the law contributed to a 22% reduction in assault-related hospitalizations among women as compared with men. Our data is collected from the Brazilian public healthcare system named Sistema Único de Saúde, which provides public information on detailed records of hospitalizations in Brazil. We provide robustness checks of our analyses and examine heterogeneous effects of the law. With respect to the latter, we deduce that the effectiveness of the law in reducing assault-related hospitalizations among women was especially pronounced in municipalities where women are most vulnerable to domestic violence. We conclude with a discussion of our results, with an eye to policy implications and areas for future research.
Recent research developments of textile flexible structures with high puncture resistance: A review
Authors: Liang Chunling , Hu Jiayun , Zou Ting , Zhang Yan , Li Yuanyuan , Wang Ping
Published: December 2022

In recent years, with the popularity of firearms and ammunition, body armor materials have undergone a great development. Body armor is commonly used to provide protection against ballistic threats, and its use has increased as people become increasingly aware of protecting their own lives. Compared with the traditional body armor materials, fabrics made of high-performance fibers are not only lightweight and convenient, but also process good protective performance. The purpose of this study is to obtain textiles with higher puncture resistance, by reviewing the progress of rapidly changing and advancing field of high-performance textiles with puncture resistance, which is introduced into four methods: shear thickening fluids (STFs), coating and impregnation, composition and structural optimization, respectively. The content of the manuscript provides a comprehensive perspective for new researchers in relevant fields for subsequent design of protective clothing.
Development and characterization of a recycled nylon fiber reinforced and nano-fly ash hybridized high impact performance polypropylene composite for sustainability
Authors: Maurya Atul Kumar , Manik Gaurav
Published: December 2022

The pursuit of a renewable and recyclable material to reduce carbon footprint is the need of the hour for a safe and secure future of flora and fauna. This study explores the reinforcement potential of pre-treated recycled nylon fiber (NF) with CaCl2, NaOH and silane in a polypropylene (PP) matrix. Silane coating over the fiber surface was confirmed from FTIR and surface morphology. Interfacial interactions among NF and PP were further strengthened by adding nano-structured cetrimonium bromide (CTAB) treated fly ash (FA). A positive hybridization effect of FA was observed on such hybrid composites, apparent from an increment of ∼29% in tensile, ∼49% in flexural, and ∼970% in notched Izod impact strength. FE-SEM analysis showed good dispersion and distribution of reinforcements into the base matrix, establishing excellent interfacial adhesion. DSC analysis showed an increase in crystallization temperature (∼125°C) and a decrease in melting temperature of all the composites, while TGA confirms a reduction in the activation energy of all the composites.
Nonlinear thermo-mechanical buckling and postbuckling of sandwich FG-GPLRC spherical caps and circular plates with porous core by using higher-order shear deformation theory
Authors: Le Ngoc Ly , Bui Tien Tu , Duong Thi Ngoc Thu , Dang Thuy Dong , Vu Minh Duc , Nguyen Thi Phuong
Published: December 2022

The main aim of this research is to establish the algorithm for nonlinear thermo-mechanical buckling of sandwich functionally graded graphene platelet reinforced composite (FG-GPLRC) shallow spherical caps and circular plates with porous core under external pressure and/or uniformly distributed thermal load according to the higher-order shear deformation theory considering the von Karman nonlinearities. Sandwich spherical caps and circular plates are made by the porous core and two FG-GPLRC coatings and are assumed to be rested on an elastic foundation modeled by the Pasternak model. The equilibrium equation system in the form of nonlinear algebra can be approximately obtained using the Ritz energy method. The critical buckling loads and postbuckling curves can be explicitly determined. The effects of material parameters, geometrical parameters, porous core, and elastic foundation on thermo-mechanical buckling of sandwich spherical caps and circular plates with porous core and FG-GPLRC coatings are investigated and discussed in detail in the numerical investigation section.
Resveratrol and lycopene ameliorate contrast-induced nephropathy in a rabbit model
Authors: Fragkiadoulaki Eirini , Tsatsakis Aristides , Nikitovic Dragana , Georgiadis Georgios , Kalogeraki Alexandra , Kaloudis Konstantinos , Alegkakis Athanasios , Karzi Vasiliki , Mamoulakis Charalampos
Published: December 2022

Oxidative stress appears to possess a central role in CIN pathophysiology. Resveratrol (Res) and lycopene (Lyc) are strong natural antioxidants evaluated in a limited number of CIN animal studies in vivo. The aim of the study was to evaluate the potential renoprotective effects of Res/Lyc in a CIN rabbit model. Twenty-four adult male New Zealand white rabbits were equally assigned into four groups: control (saline), CIN (intravenous iopromide; 7.5 g iodine/kg), Res + CIN (per os Res; 5 mg/kg), and Lyc + CIN (per os Lyc; 4 mg/kg). Serum Cr (sCr); symmetric/asymmetric dimethylarginine (SDMA/ADMA); oxidative stress biomarkers: malondialdehyde; total antioxidant capacity; catalase; glutathione) were evaluated in blood samples at three time points: right after (0 h); 24 h; 48 h after iopromide/saline administration. CD20+/CD3+ lymphocytes were determined (48 h). All animals were sacrificed at 48 h and both kidneys collected. Oxidative stress biomarkers were measured in renal tissue. sCr and SDMA/ADMA levels increased significantly in CIN compared to all groups. Oxidative stress secondary to CIN in blood/kidneys was suppressed by Res/Lyc. B and T lymphocytes decreased significantly in CIN compared to all groups. The present study provides emerging evidence that Res/Lyc ameliorate CIN by modulating oxidant/antioxidant balance in blood/renal tissue and by inhibiting vasoconstriction/blood cytotoxicity.
Impact of COVID-19 on Referral Patterns and Service Delivery for an Integrated Behavioral Health Program
Authors: Glaze Kelly , Sward Ashley , Lenne Eline , Brown Samantha , Rogers Lindsey , Frankel Karen A. , Klawetter Susanne
Published: December 2022

The emergence and rapid spread of COVID-19 led to unprecedented changes for families and systems of care. This study sought to understand the needs of families participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) before and during the pandemic and considers the impact remote service delivery has on access to an integrated behavioral health intervention to support the psychosocial needs of children and caregivers. Needs for referral varied significantly pre- and post-pandemic onset. Analyses revealed that significantly more referrals were made regarding social determinants of health after the onset of COVID-19 (13.8%) compared with prior to the COVID-19 pandemic (4.1%, p < .05). Providers’ transition to telehealth services sufficiently served WIC families.
Response Rates to Methylnaltrexone in Hospitalized Cancer Patients
Authors: Harris David , Kalir David , Chevalier Cory , Dobbie Krista , Fielding Flannery , Lagman Ruth , Makhoul Ahed , McInnes Susan , Najafi Sina , Neale Kyle , Rybicki Lisa , Robbins-Ong Melanie , Neuendorf Kathleen
Published: December 2022

Context: Methylnaltrexone is a peripherally-acting mu-opioid receptor antagonist studied in both cancer and non-cancer patients with opioid-induced constipation (OIC), but mostly in the outpatient setting. For adult hospitalized cancer patients with OIC, its effectiveness is unknown. Objectives: Describe the efficacy of methylnaltrexone for OIC in the inpatient setting, defined as bowel movement (BM) within 24 hours of methylnaltrexone administration. Methods: We performed a single-center, retrospective chart review of all hospitalized, adult patients with a cancer diagnosis who received methylnaltrexone from the palliative care team between January 1st, 2012 and July 1st, 2019. Results: We identified 194 patients. The mean age was 59, 50.5% were male and 88% were white. 192 patients (98%) received the 8 mg dose subcutaneously. The median oral morphine equivalent (OME) was 135 mg (IQR 70-354 mg). 45% (95% confidence interval, 38-53%) had a BM within 24 hours. Higher OME was correlated with successful BM, with a response in 93% (86/92) of patients receiving ≥150 OME and 2% (2/102) of patients receiving <150 OME ( P < .0001). Prior laxative use did not predict response at 24 hours whether these were osmotic laxatives (40.7% vs 47.1%, P = .52), stimulant laxatives (45.7% vs 45.2%, P > .99), or stool softeners (44.7% vs 46.1%, P = .89). Conclusion: Methylnaltrexone has a high response rate when used as treatment for OIC in hospitalized adult cancer patients, especially for patients taking ≥150 OME.
Evaluation of Direct Medical Costs and Associated Factors Within the Last 30 days of Life of Hospitalized Cancer Patients
Authors: Ito Suffert Soraya C. , Motke Bruna B. , Linhares Armani B. , Vargens André F. , Alano Tainá S. , Lutz Andreas T. , Boff Borges Rogério , Bica Claudia G. , Vargas Alves Rafael José
Published: December 2022

Background: An estimated 9.6 million people died from cancer globally in 2018, which is a reflection of the quality of patients’ end-of-life care and its costs. Aim: To estimate direct medical costs of the last 30 days of oncology patients admitted to an inpatient clinic and to evaluate factors associated with medical costs at the end of life. Design: Cost-of-illness study with data from a retrospective cohort. Setting/Participants: We included patients aged 18 and older who were diagnosed with incurable cancer and who were admitted to a tertiary hospital in Brazil between January 1, 2018 and December 31, 2019. Results: Our sample included 109 patients with an average age of 69 (61‒76). The median overall survival was 4.3 (.9‒12.9) months. The median cost per patient per day related to hospitalization was BRL 119 (73‒181)/United States dollars [USD] 21 (13‒33). The cost of medication was BRL 66 (40‒105)/USD 12 (7‒19), representing 55.46% of costs while that of materials and supplies was BRL 30 (18‒49)/USD 5 (3‒9). In the multivariate analysis, when the limitation of interventions was recorded in the medical record, the median cost is reduced by BRL 50 (USD 9) per patient per day. Conclusions: The median cost per patient per day was BRL 119 (73‒181). The recording of limitations of therapeutic interventions in the medical record was a predictor variable that influenced the final medical cost of patients, suggesting that medical practice and decision-making in end-of-life care impact costs.
Qualitative Investigation of Educator and Parent Experiences of Education Services During COVID-19
Authors: Fettig Angel , Zulauf-McCurdy Courtney , Choi Gounah , McManus Mischa
Published: December 2022

The COVID-19 pandemic has resulted in a worldwide disruption of education service systems. A significant gap has emerged in understanding the impact of these changes to both educational services and child development. The current qualitative study presents interviews with early childhood educators and parents to capture their experiences with educational service delivery for young children with disabilities during the pandemic. The study included nine early childhood educators and nine parents with children between the ages of 3 and 6 who received preschool special education services during the pandemic. Themes that emerged from the interviews include changes to the modality and intensity of services, barriers and challenges related to service delivery, and benefits resulting from shifts to educational services. All findings will be discussed with an eye toward informing future practice related to family-centered services.