bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of ‘Be Clear’ Treatment on Intelligibility in Adults with Post-Stroke Dysarthria: Acoustic-Perceptual Consequences
Authors: Srinivasan Sahana , Narayanan Swapna
Published: July 2024

Dysarthria is significantly prevalent in individuals with post-stroke etiology. Behavioral treatment remains the foundation of dysarthria treatment approaches. Clear speech is one recent compensatory treatment approach that has gained traction. The present study aimed to determine whether the ‘Be Clear’ treatment significantly improved speech intelligibility, formant centralization ratio (FCR), slopes of second formant transitions (F2 slope), vowel duration, speaking rates, and articulation rates in adults with post-stroke dysarthria. Ten Kannada-speaking participants in the age range of 30 to 66 years of age with post-stroke dysarthria were recruited for the present study. ‘Be Clear’ treatment was practiced over the duration of 16 one-hour sessions across 4 weeks. Participants demonstrated statistically significant improvements in word intelligibility and sentence intelligibility, FCR, F2 slope, vowel duration, speaking rates, and articulation rates following ‘Be Clear’ treatment. Future research could include other acoustic and perceptual measures to evaluate the efficacy of this treatment program on a larger sample size.
Educators’ Perceptions on the Involvement of Students With Complex Support Needs in PBIS: The Role of Educational Placement
Authors: Zagona Alison L. , Hara Motoaki , Loman Sheldon , Kurth Jennifer A. , Walker Virginia L.
Published: July 2024

Positive Behavioral Interventions and Supports (PBIS) is an evidence-based practice that promotes positive academic and behavioral outcomes for all students and is intended to support the needs of all students across three tiers of support. However, research suggests students with complex support needs have limited access to Tier 1 PBIS. Teachers’ perceptions of the appropriateness of PBIS to meet the needs of students with complex support needs has been hypothesized to impact the extent to which educators provide access to Tier 1. Using data from a national survey of 644 educators, we sought to determine the extent to which educational placement of students with complex support needs impacted teacher perception of the importance of providing Tier 1 PBIS. Our results suggest educators across placements agree students with complex support needs should be involved in PBIS, including acknowledgment systems and response and data plans. Educators differed in their ideas of how to teach school-wide rules and expectations and how to document behavioral violations. We discuss implications of these findings for research and practice.
Professional Networks and Self-Efficacy of Paraeducators Working with Students with Learning to Use Augmentative and Alternative Communication (AAC)
Authors: Biggs Elizabeth E. , Bumble Jennifer L. , Hacker Rebecca E. , Scotti Kendra E. , Cushing Caitlin E.
Published: July 2024

Paraeducators often work with special education teachers and school teams to support students with disabilities who have complex communication needs (CCN), including students who use augmentative and alternative communication (AAC) such as speech-generating devices. This study involved surveying 258 paraeducators working with students with disabilities who had CCN (grades PreK–12, along with community-based transition classrooms). Social network analysis was used to examine paraeducators’ professional networks and collaboration patterns, along with how paraeducator professional network size related to their self-efficacy beliefs about working with students with CCN. Findings revealed wide variability in the size and function of paraeducators’ professional networks and their self-efficacy beliefs. Paraeducators generally reported few mutual collaborative relationships with other professionals, receiving support more than they gave support. Many had small networks with few trusted collaborators. Paraeducators’ network size was the strongest predictor of self-efficacy beliefs, beyond their personal characteristics and whether they received AAC-related training. This study informs future research and practice by underscoring the need for paraeducators to work within well-connected teams, and by revealing ways social network analysis can be used to examine issues related to self-efficacy and collaboration.
“It Is No Big Deal!”: Fraud Diamond Theory as an Explanatory Model for Understanding Students’ Academic Fraudulent Behavior
Authors: Dias-Oliveira Eva , Morais Catarina , Pasion Rita , Hodgson Julia
Published: July 2024

The Fraud Diamond theory (rationalization, opportunity, motivation and perceived capability) has been widely used as a framework to explain criminal behavior. However, little is known about its application in an academic context. Research on the relationship between the prevalence of academic fraud (e.g., cheating on exams, plagiarizing essays) and students’ perceptions of the severity of such behaviors is also lacking. We surveyed 1,032 university students and asked them whether they engaged in fraudulent behaviors and how severe they thought these behaviors were. The results showed that motivation, rationalization, and perceived capability dimensions of the Fraud Diamond theory are important factors in predicting the prevalence of students’ academic fraudulent behavior, but not opportunity. We also found that the more students reported that they engaged in fraudulent academic behaviors, the less severe they perceived those behaviors to be. However, only rationalization emerged as a predictor of perceived severity. The results suggest that the more students are able to find justifications for their fraudulent behavior, the less severe they perceive those behaviors to be. Rationalization seems to explain, therefore, the tendency to disassociate moral values from dishonest behavior. Taken together, the study shows a vicious cycle between engaging in fraudulent academic behavior and the ability to justify these acts. Implications for Higher Education Institutions (HEIs) are discussed.
Can’t or Needn’t? Study on the Factors Influencing the Research Motivation of Young Museum Professionals Under the Attribution Theory in China
Authors: Yu Hui , Ma Yue , Zhao Xingyu
Published: July 2024

The enhancement of scientific research capabilities among museum personnel—personnel is a crucial aspect in driving the advancement of museums. However, it is observed that museum personnel in Chinese mainland, particularly the younger ones, have not demonstrated sufficient engagement in this regard. The objective of this paper is to investigate the underlying causes of this phenomena. This study employs in-depth interviews with a sample of 10 young museum personnel. The methodology is guided by Weiner’s Cognitive (attribution)-emotion-action model (CEAM) of motivation framework. The findings indicate that there are 14 elements that influence the motivation of museum personnel to engage in scientific research. These characteristics are associated with three aspects of attribution, namely Locus, Stability, and Controllability. Especially, the “external-stable-uncontrollable” and “external-unstable-uncontrollable” two attribution will serve as a catalyst for museums to enhance their efforts in optimizing the research willingness of their professionals, so facilitating the provision of sustained and immediate support.
Substitution or Complement: How Do Contractual and Relational Governance Shape Members’ Organizational Commitment to Farmer Cooperatives?
Authors: Zeng Lijun , Wan Junyi
Published: July 2024

Organizational commitment is key to sustainable development and the success of farmer cooperatives. The relationship and effectiveness of contractual and relational governance as important means of managing partnerships remain debatable, and their impact on organizational commitment is unclear, particularly in the context of farmer cooperatives. Based on transaction cost theory and social exchange theory, we investigate how contractual and relational governance affect members’ organizational commitment (MOC) under different market uncertainties. Using survey data of 239 farmer cooperatives in China, we examined the conceptual model utilizing hierarchical regression and bootstrapping techniques. The results showed that both contractual and relational governance have significant positive impacts on members’ continuance and affective commitment, but relational governance exerts more positive effects. Contractual governance can significantly promote relational governance; the two have complementary rather than substitute relationships. Moreover, relational governance mediates the link between contractual governance and members’ continuance/affective commitment, and this mediating role strengthens as market uncertainty increases. This study expands the literature on MOC from the perspective of alliance governance, and has important implications for cooperative governance mechanisms and partnership management.
Environmental Sustainability Education in Twelve Series of Chinese University English Language Textbooks
Authors: Liu Yanhong , An Lin , Chen Shan
Published: July 2024

Environmental issue is one of the public concerns pertaining to human welfare. English language education is supposed to take its part to contribute to the sustainable development. In this study, a corpus comprising 12 series of English language textbooks used in Chinese universities (48 volumes/books) was constructed to examine the extent to which the textbooks cover the content of environmental education, and how these topics are presented. The large volume dataset was explored by corpus linguistic tools and the in-depth discourse analysis and findings were reported and discussed within the theoretical framework of critical discourse analysis. The results suggested that some key environmental semantic domains, such as “Green issues” (e.g., nature, environment, ecology), “Substances and materials” (e.g., pesticide, chemical, carbon dioxide), “Science and technology” (e.g., technologies, nuclear, biotechnology), “Farming & Horticulture” (e.g., farming, crop, agriculture), “Living creatures” (e.g., endangered species, animals, wildlife) were evident. Some topics within these domains such as sustainable environmentalism, energy efficiency and sufficiency were presented and discussed critically. The textbooks are expected to help learners develop knowledge, competencies and futuristic attitudes needed to meet the sustainability challenges in various contexts.
Negative Results, Positive Outcome: A Case of Primary Livedoid Vasculopathy With an Elusive Laboratory Workup
Authors: Al-Obaidi Ahmed Dheyaa , Sabeeh Shireen Kh. , Mohammed Maab Jasim , Othman Assalah , Algburi Yousif Ahmed , Hashim Hashim Talib , Alhatemi Ahmed Qasim Mohammed , Al Hilali Zahraa , Al-attabi Bilal Riyadh Taresh , Al-Awad Abdullah
Published: July 2024

Livedoid vasculopathy (LV) is a chronic, recurrent thrombotic vasculopathy characterized by painful ulcerations on the lower extremities, which heal slowly and leave atrophic white scars known as “atrophie blanche.” This report presents the case of a 31-year-old woman with a 4-year history of recurrent painful ulcerations on her legs and feet. A skin biopsy revealed findings consistent with LV, and an exhaustive laboratory workup ruled out secondary causes such as thrombophilia, malignancies, autoimmune diseases, and peripheral arterial disease. The patient showed remarkable improvement with a treatment regimen of pentoxifylline, nifedipine, and warfarin, resulting in complete ulcer resolution and sustained remission over 5 months. Our case highlights the importance of a comprehensive diagnostic approach and a multidisciplinary treatment strategy in managing primary LV to achieve remission and prevent recurrence of skin ulcerations.
Confederate Monuments and Anti-Black Stereotypes in the U.S. South
Authors: O’Connell Heather A.
Published: July 2024

I advance understanding of Confederate monuments through a large-scale examination of the linkage between individual racial attitudes and the presence of a Confederate monument on public property with a “Lost Cause” inscription. I rely on restricted access General Social Survey data (2010–2014) and an extensive inventory of Confederate monuments located in counties across the U.S. South. The focal outcome provides insight into expressions of anti-Black stereotypes among non-Hispanic Whites; however, I include sensitivity analyses to provide context for this central dynamic. I find evidence of a relationship between Confederate monuments and greater anti-Black racial attitudes among non-Hispanic Whites. However, this result is confined to anti-Black stereotypes; no other outcome—regarding Black, Asian, or Hispanic Americans—exhibits a robust, direct relationship with the presence of a Confederate monument. I argue the observed relationship is driven by racialized cultural frames emphasizing the Black-White boundary that are linked to Confederate monuments with a “Lost Cause” inscription.
“White Privilege . . . Is Not an Organizing Strategy”: Shifting Frameworks in White People’s Antiracist Efforts
Authors: Russo Chandra
Published: July 2024

We know relatively little about how to mobilize and sustain White involvement in politically impactful, antiracist collective action. Adding to the literature on the vexations of White people’s approaches to antiracism, this study takes the case of Showing Up for Racial Justice (SURJ), a national organization that seeks to bring a critical mass of U.S.-based White people into antiracist campaigns at a scale not previously attempted. It traces the shift from a White privilege analytic that has been dominant in many White-led antiracist spaces, often in ways that can be individualizing and depoliticizing, to a “mutual” or “shared” interest approach, which identifies White people’s own stake in dismantling White supremacy, though not without its own perils. Findings suggest that a mutual interest orientation prioritizes collective action over personal morality, holding important benefits for the recruitment, retention, and principled engagement of White people in racial justice struggles.
Book review: Rajesh Basrur, Subcontinental Drift: Domestic Politics and India’s Foreign Policy
Authors: Yadav Rishabh
Published: July 2024

Rajesh Basrur, Subcontinental Drift: Domestic Politics and India’s Foreign Policy. Georgetown University Press, 2023, 246 pp. ISBN: 9781647122850 (Paperback).
Home Price Change and Ethno-racial Residential Segregation: Temporal Relationships at the Metro Level
Authors: Mikulas Alex , Beck Brenden , Besbris Max
Published: July 2024

Although rates of residential racial segregation and home prices are undoubtedly related, the temporal nature of the relationship has rarely been studied. Using fixed effects models in a cross-lagged framework, we examine how prior changes in segregation and home prices at the metro level predict changes in the other. Our findings suggest that increases in home prices predict increasing racial segregation years later, but increases in segregation fail to predict subsequent change in home values. Metros that experience a 1 standard deviation increase in home prices experience an associated 0.25 standard deviation increase in Black-White segregation 10 years later and a 0.18 standard deviation increase 20 years later. No relationship is observed for Hispanic-White segregation. We discuss implications for understanding the economic underpinnings of segregation. Findings also offer insight into future segregation trends and illuminate how changes in the housing market may drive demographic trends more broadly.
Morphology and location of thrombus and sludge in patients with non-valvular atrial fibrillation
Authors: Cui Jing , Xia Shi-Jun , Tang Ri-Bo , He Liu , Guo Xue-Yuan , Li Song-Nan , Liu Nian , Sang Cai-Hua , Long De-Yong , Du Xin , Dong Jian-Zeng , Ma Chang-Sheng
Published: July 2024

Background

Stroke and thromboembolism in nonvalvular atrial fibrillation (NVAF) primarily arise from thrombi or sludge in the left atrial appendage (LAA). Comprehensive insight into the characteristics of these formations is essential for effective risk assessment and management.

Methods

We conducted a single-center retrospective observational of 176 consecutive NVAF patients with confirmed atrial/appendage thrombus or sludge determined by a pre-ablation transesophageal echocardiogram (TEE) from December 2017 to April 2019. We obtained clinical and echocardiographic characteristics, including left atrial appendage emptying velocity (LAAeV) and filling velocity (LAAfV). Data analysis focused on identifying the morphology and location of thrombus or sludge. Patients were divided into the solid thrombus and sludge groups, and the correlation between clinical and echocardiographic variables and thrombotic status was analyzed.

Results

Morphological classification: In total, thrombi were identified in 78 patients, including 71 (40.3%) mass and 7 (4.0%) lamellar, while sludge was noted in 98 (55.7%). Location classification: 92.3% (72/78) of patients had thrombus confined to the LAA; 3.8% (3/78) had both LA and LAA involvement; 2.7% (2/78) had LA, LAA and RAA extended into the RA, the remained 1.2%(1/78) was isolated to RAA. 98.0% (96/98) of patients had sludge confined to the LAA; the remaining 2.0% (2/98) were present in the atrial septal aneurysm, which protrusion of interatrial septum into the RA. The thrombus and sludge groups showed low LAAeV (19.43 ± 9.59 cm/s) or LAAfV (17.40 ± 10.09 cm/s). Only LA dimension ≥ 40 mm was independently associated with the thrombus state in the multivariable model.

Conclusion

This cohort study identified rare thrombus morphology and systematically summarized the classification of thrombus morphology. The distribution of thrombus and sludge outside limited to LAA was updated, including bilateral atrial and appendage involvement and rare atrial septal aneurysm sludge. LAAeV and LAAfV were of limited value in distinguishing solid thrombus from sludge.

Clinical Trial Number

ChiCTR-OCH-13,003,729.
Urinary microRNA-210-3p as a novel and non-invasive biomarker for the detection of pancreatic cancer, including intraductal papillary mucinous carcinoma
Authors: Imamura Taisuke , Komatsu Shuhei , Nishibeppu Keiji , Kiuchi Jun , Ohashi Takuma , Konishi Hirotaka , Shiozaki Atsushi , Yamamoto Yusuke , Moriumura Ryo , Ikoma Hisashi , Ochiai Toshiya , Otsuji Eigo
Published: July 2024

Background

This study aims to explore novel microRNAs in urine for screening and predicting clinical characteristics in pancreatic cancer (PC) patients using a microRNA array-based approach.

Methods

We used the Toray® 3D-Gene microRNA array-based approach to compare urinary levels between PC patients and healthy volunteers.

Results

(1) Four oncogenic microRNAs (miR-744-5p, miR-572, miR-210-3p, and miR-575) that were highly upregulated in the urine of PC patients compared to healthy individuals were identified by comprehensive microRNA array analysis. (2) Test-scale analysis by quantitative RT-PCR for each group of 20 cases showed that miR-210-3p was significantly upregulated in the urine of PC patients compared to healthy individuals (P = 0.009). (3) Validation analysis (58 PC patients and 35 healthy individuals) confirmed that miR-210-3p was significantly upregulated in the urine of PC patients compared to healthy individuals (P < 0.001, area under the receiver operating characteristic curve = 0.79, sensitivity: 0.828, specificity: 0.743). We differentiated PC patients into invasive ductal carcinoma (IDCa) and intraductal papillary mucinous carcinoma (IPMC) groups. In addition to urinary miR-210-3p levels being upregulated in IDCa over healthy individuals (P = 0.009), urinary miR-210-3p levels were also elevated in IPMC over healthy individuals (P = 0.0018). Urinary miR-210-3p can differentiate IPMC from healthy individuals by a cutoff of 8.02 with an AUC value of 0.762, sensitivity of 94%, and specificity of 63%. (4) To test whether urinary miR210-3p levels reflected plasma miR-210-3p levels, we examined the correlation between urinary and plasma levels. Spearman’s correlation analysis showed a moderate positive correlation (ρ = 0.64, P = 0.005) between miR-210-3p expression in plasma and urine.

Conclusions

Urinary miR-210-3p is a promising, non-invasive diagnostic biomarker of PC, including IPMC.

Trial registration

Not applicable.
Patterns of self-medication and intention to seek pharmacist guidance among older adults during the COVID-19 pandemic in Macao: a cross-sectional study
Authors: Zheng Yu , Tang Pou Kuan , Hu Hao , Ung Carolina Oi Lam
Published: July 2024

Introduction

Self-medication was remarkably popular during the COVID-19 pandemic. In older populations, the risk of self-medication is higher. Pharmacists are well positioned to provide public health education and disease prevention. This study aims to explore the self-medication patterns and intention to seek pharmacist guidance among older adults in Macao.

Methods

A face-to-face cross-sectional survey was subsequently performed in March-April 2023 among older adults in Macao. The questionnaire was designed based on the Theory of Planned Behavior (TPB) framework. Multiple logistic regression was used to analyze predictors of self-medication behavior and multiple linear regression analysis to determine whether the TPB construct was the predictor of older adults’ intention to seek guidance from pharmacists.

Results

A total of 412 participants completed the questionnaire. The self-medication rate among older adults in Macao was 64.2%. The most commonly used types of medications were over-the-counter and traditional Chinese medicine, mainly from government anti-pandemic packages. The majority of individuals engaged in self-medication to treat COVID-19 symptoms or prevent COVID-19 infection. The prevalent reasons for self-medication were the perceived non-seriousness of the illness. 85 years old or older and university degree were significantly associated with self-medication behavior. Older adults had moderate intention to seek pharmacist guidance on medication use. The average scores (standard deviation) were 3.43 (1.10) for Attitude, 2.69 (0.99) for Subjective Norm, 3.56 (1.04) for Perceived Behavioral Control, and 3.07 (1.43) for Intention. Attitude, Subjective Norm, and Perceived Behavioral Control were all strong predictors of intention, which explained 53% of the variance in intention. In demographic factors, age was identified as a significant predictor of intentions.

Conclusions

Self-medication was widely practiced in Macao during the COVID-19 pandemic. To better control the risks associated with self-medication, the role of pharmacists is paramount. Enhancing the recognition and trust of pharmacists within society, modifying pharmacy management models, and strengthening pharmacists’ self-perception of their profession are all pivotal directions areas to further enhance their role.
Predictive value of serum MED1 and PGC-1α for bronchopulmonary dysplasia in preterm infants
Authors: Li Mengzhao , Sun Wenqiang , Fu Changchang , Xu Shuyang , Wang Chengzhu , Chen Huijuan , Zhu Xueping
Published: July 2024

Objective

This study aimed to predict the bronchopulmonary dysplasia (BPD) in preterm infants with a gestational age(GA) < 32 weeks utilizing clinical data, serum mediator complex subunit 1 (MED1), and serum peroxisome proliferator-activated receptor gamma coactivator-1alpha (PGC-1α).

Methods

This prospective observational study enrolled 70 preterm infants with GA < 32 weeks. The infants were categorized into two groups: non-BPD group(N = 35) and BPD group(N = 35), including 25 cases with mild BPD and 10 patients with moderate/severe subgroups. We performed multifactorial regression analysis to investigate the postnatal risk factors for BPD. Furthermore, we compared serum levels of biomarkers, including MED1 and PGC-1α, among infants with and without BPD at postnatal days 1, 7, 14, 28, and PMA 36 weeks. A logistic regression model was constructed to predict BPD’s likelihood using clinical risk factors and serum biomarkers.

Results

Serum levels of MED1 on the first postnatal day, PGC-1α on the 1st, 7th, and 28th days, and PMA at 36 weeks were significantly lower in the BPD group than in the non-BPD group (P < 0.05). Furthermore, the predictive model for BPD was created by combing serum levels of MED1 and PGC-1α on postnatal day 1 along with clinical risk factors such as frequent apnea, mechanical ventilation time > 7 d, and time to reach total enteral nutrition. Our predictive model had a high predictive accuracy(C statistics of 0.989) .

Conclusion

MED1and PGC-1α could potentially serve as valuable biomarkers, combined with clinical factors, to aid clinicians in the early diagnosis of BPD.
Cadaveric analysis of surgical techniques and working space for retroperitoneal tumors as model for improving resection of neuroblastoma
Authors: Cernaianu Grigore , Franke Greta , Kühne Nora Elena , Meurer Miriam , Trobs Ralf-Bodo , Eifinger Frank , Dübbers Martin , Scaal Martin , Vahdad Reza
Published: July 2024

Purpose

Neuroblastoma, the most common extracranial solid tumor in children under 5 years, often surrounds visceral arteries. This study aimed to analyze the working space provided by standardized surgical techniques at key arterial landmarks in adult cadavers.

Methods

We assessed in eight adult cadavers the mobilization of the left colon, spleen and pancreas, right colon, duodenum and mesenteric root, access to the bursa omentalis. The average working space score (AWSS) was evaluated at the left and right renal artery, left and right side of the coeliac trunk, superior mesenteric and common hepatic artery. The score was defined as: (0) vessel not visible, (1) working space at the vessel ≤ 1x diameter of the aorta, (2) < 3x the diameter of the aorta, (3) ≥ 3x diameter of the aorta.

Results

The maximum AWSS of 3 was achieved at key vascular landmarks through specific mobilization techniques.

Conclusion

Additional mobilization of spleen, pancreas and mesenteric root and access to the bursa omentalis increase surgical working space at major visceral arteries. The results of our investigation provide surgeons with a useful guide to prepare for abdominal neuroblastoma resection.
The effect of whitening toothpastes on the color stability and surface roughness of stained resin composite
Authors: Gömleksiz Seda , Okumuş Ömer Faruk
Published: July 2024

Background

This study aimed to investigate the effect of whitening toothpastes on the color stability and surface roughness of resin composites stained with coffee and cigarette smoke.

Methods

Seventy-two disk-shaped specimens (6 × 2 mm) of suprananohybrid resin composite were randomly divided into two groups and exposed to coffee and cigarette smoke (n = 36). After staining, the samples randomly divided into four groups according to whitening toothpastes and were brushed for 4 min: Opalescence Whitening (OW); Colgate Optic White (COW); Curaprox Black is White (CPX) and, distilled water (control) (n = 9). Color was measured with spectrophotometer at the initial, after staining, and after brushing, and surface roughness was measured with profilometer at the initial and after brushing. A surface morphology analysis was examined using scanning electron microscopy and atomic force microscopy. The obtained data were statistically analyzed. (p < 0.05).

Results

Cigarette smoke caused a significantly higher color change than coffee in the resin composite (p < 0.05). Brushing with hydrogen peroxide and silica-containing whitening toothpaste showed significant differences in color change (p < 0.05). The lowest whitening effect was found in activated charcoal-containing toothpaste. While all toothpastes increased the degree of surface roughness of resin composites, the highest roughness was caused by whitening toothpastes containing activated charcoal. (p < 0.05).

Conclusions

The color stability and surface properties of resin composites can be affected by brushing them with whitening toothpaste. The utilization of whitening toothpaste containing hydrogen peroxide can be considered a safe method for increasing the whiteness of discolored resin composites.
First-line managers’ experience of guideline implementation in orthopaedic nursing and rehabilitation: a qualitative study
Authors: FJORDKVIST Erika , HÄLLEBERG NYMAN Maria , WINBERG Madeleine , JOELSSON-ALM Eva , ELDH Ann Catrine
Published: July 2024

Background

First-line managers have a unique role and potential in encouraging the use of evidence-based clinical practice guidelines (CPGs) and thus serve the provision of safe patient care. In acute and planned hospital care, effective yet safeguarded nursing procedures are a necessity. Little is currently known about how first-line managers engage in supporting the adoption of evidence-based nursing care and about what barriers and enablers there are for implementation of CPGs in the orthopaedic care context.

Purpose

To investigate first-line managers’ experience of clinical practice guideline implementation in orthopaedic care.

Methods

This qualitative interview study included 30 first-line nursing and rehabilitation managers in 17 orthopaedic units in Sweden. A deductive content analysis, with the Ottawa Model of Implementation Leadership as a guide, was employed.

Results

To the first-line managers, any guideline implementation required them to balance contexts, including their outer context (signified by the upper-level management and decision-makers) and their inner context, including staff and patients in their unit(s). Acting in response to these contexts, the managers described navigating the organization and its terms and conditions; using relations-, change-, and task-oriented leadership, such as involving the staff; motivating the change by emphasizing the patient benefits; and procuring resources, such as time and training. Even though they knew from past experience what worked when implementing CPGs, the first-line managers often encountered barriers within the contexts that hampered successful implementation.

Conclusions

Although first-line managers know how to effectively implement CPGs, an organization’s terms and conditions can limit their opportunities to fully do so. Organizational awareness of what supports and hinders first-line managers to offer implementation leadership can enhance opportunities to alter behaviours and conditions for the benefit of CPG implementation.

Trial registration

The study was registered as NCT04700969 with the U.S. National Institutes of Health Clinical Trials Registry on 8 January 2021.
The potential of gene delivery for the treatment of traumatic brain injury
Authors: Dooley James , Hughes Jasmine G. , Needham Edward J. , Palios Katerina A. , Liston Adrian
Published: July 2024

Therapeutics for traumatic brains injuries constitute a global unmet medical need. Despite the advances in neurocritical care, which have dramatically improved the survival rate for the ~ 70 million patients annually, few treatments have been developed to counter the long-term neuroinflammatory processes and accompanying cognitive impairments, frequent among patients. This review looks at gene delivery as a potential therapeutic development avenue for traumatic brain injury. We discuss the capacity of gene delivery to function in traumatic brain injury, by producing beneficial biologics within the brain. Gene delivery modalities, promising vectors and key delivery routes are discussed, along with the pathways that biological cargos could target to improve long-term outcomes for patients. Coupling blood-brain barrier crossing with sustained local production, gene delivery has the potential to convert proteins with useful biological properties, but poor pharmacodynamics, into effective therapeutics. Finally, we review the limitations and health economics of traumatic brain injury, and whether future gene delivery approaches will be viable for patients and health care systems.
Refining the Schistosoma haematobium recombinase polymerase amplification (Sh-RPA) assay: moving towards point-of-care use in endemic settings
Authors: Donnelly Owain , Mesquita Silvia , Archer John , Ali Said M. , Bartonicek Zikmund , Lugli Elena B. , Webster Bonnie L.
Published: July 2024

Background

Urogenital schistosomiasis is caused by the parasitic trematode Schistosoma haematobium. Sensitive and specific point-of-care diagnostics are needed for elimination of this disease. Recombinase polymerase amplification (RPA) assays meet these criteria, and an assay to diagnose S. haematobium has been developed (Sh-RPA). However, false-positive results can occur, and optimisation of reaction conditions to mitigate these is needed. Ease of use and compatibility of DNA extraction methods must also be considered.

Methods

Using synthetic DNA, S. haematobium genomic DNA (gDNA), and urine samples from clinical cases, Sh-RPA reactions incorporating different betaine concentrations (0 M, 1 M, 2.5 M, 12.5 M) and the sample-to-water ratios were tested to determine effects on assay specificity and sensitivity. In addition, five commercial DNA extraction kits suitable for use in resource-limited settings were used to obtain gDNA from single S. haematobium eggs and evaluated in terms of DNA quality, quantity, and compatibility with the Sh-RPA assay. All samples were also evaluated by quantitative polymerase chain reaction (qPCR) to confirm DNA acquisition.

Results

The analytical sensitivity of the Sh-RPA with all betaine concentrations was ≥ 10 copies of the synthetic Dra1 standard and 0.1 pg of S. haematobium gDNA. The addition of betaine improved Sh-RPA assay specificity in all reaction conditions, and the addition of 2.5 M of betaine together with the maximal possible sample volume of 12.7 µl proved to be the optimum reaction conditions. DNA was successfully isolated from a single S. haematobium egg using all five commercial DNA extraction kits, but the Sh-RPA performance of these kits varied, with one proving to be incompatible with RPA reactions.

Conclusions

The addition of 2.5 M of betaine to Sh-RPA reactions improved reaction specificity whilst having no detrimental effect on sensitivity. This increases the robustness of the assay, advancing the feasibility of using the Sh-RPA assay in resource-limited settings. The testing of commercial extraction kits proved that crude, rapid, and simple methods are sufficient for obtaining DNA from single S. haematobium eggs, and that these extracts can be used with Sh-RPA in most cases. However, the observed incompatibility of specific kits with Sh-RPA highlights the need for each stage of a molecular diagnostic platform to be robustly tested prior to implementation.

Graphical Abstract
Stevens–Johnson syndrome-toxic epidermal necrolysis overlap in a patient taking quetiapine and famotidine: a case report
Authors: Su Chi-Sheng , Kao Chi-Lan
Published: July 2024

Background

Stevens–Johnson syndrome-toxic epidermal necrolysis (SJS-TNE) overlap is a rare skin disorder characterized by erythema, blisters, extensive exfoliation, epidermal detachment, the involvement of multiple mucosae, and positive Nikolsky’s sign. SJS-TEN has a high mortality rate. Our case involves a rare occurrence of drug-induced Stevens–Johnson syndrome-toxic epidermal necrolysis overlap with a delayed onset in the setting of quetiapine and famotidine therapy.

Case presentation

An 82-year-old Taiwanese female was admitted to our hospital for decreased urine output, generalized edema, and multiple skin blisters and bedsores. With further spread of the lesions, multiple ruptured bullae with shallow erosions on the face, trunk, and limbs and mucosal involvement affected 20% of the total body surface area. Nikolsky’s sign was positive. A diagnosis of Steven–Johnson syndrome was highly suspected. One month prior, she had started famotidine and quetiapine. Intravenous methylprednisolone treatment was initiated, which ameliorated the skin lesions after 3 days. However, new lesions developed after only 1 day of methylprednisolone tapering. The patient died 12 days after admission.

Conclusion

Stevens–Johnson syndrome-toxic epidermal necrolysis is a rare skin disorder. Although it is mainly acute and has a high mortality rate, delayed onset can still occur. Quetiapine and famotidine are generally safe and effective for treating geriatric and gastrointestinal problems, but rare drug hypersensitivity reactions can lead to debilitating consequences. Therefore, increased clinical awareness and the initiation of supportive care are imperative. Optimal management guidelines are still lacking, and confirmation of developed guidelines through randomized controlled trials is needed. Collaboration for better management strategies is warranted.
Micronutrient deficiency, dietary diversity, and sociodemographic and lifestyle determinants of dietary diversity among pregnant slum-dwelling women in Pune, India
Authors: Deshpande Swapna , Mandlik Rubina , Khadilkar Anuradha V. , Bhawra Jasmin , Kinnunen Tarja I.
Published: July 2024

Background

Increasing dietary diversity is a sustainable solution to combat micronutrient deficiencies. Given the large slum population in urban India, double burden of malnutrition, nutritional transition among slum-dwellers, and limited studies focusing on dietary intake and diversity among pregnant slum-dwellers, this study aimed to 1) describe macro- and micronutrient intakes and compare them with guidelines, 2) describe dietary diversity and intake of unhealthy foods and, 3) investigate the sociodemographic and lifestyle determinants of adequate dietary diversity among pregnant slum-dwellers in Pune, Maharashtra, India.

Methods

This study presents cross-sectional data of 454 pregnant slum-dwelling women completing mid-pregnancy visit collected from a larger cohort study. Sociodemographic and lifestyle data were collected at baseline (< 12 weeks gestation). Dietary data (24-h dietary recall) were collected in mid-pregnancy (23 ± 2 weeks). Nutrient intakes were compared with the Estimated Average Requirements (EAR) for pregnant Indian women. Dietary diversity score (DDS, range 0–10) and unhealthy food (sweet snacks, sweet beverages, fried and salty food) group score (range 0–3) were calculated as per FAO guidelines. Multivariate logistic regression was conducted to examine determinants of adequate dietary diversity (DDS ≥ 5).

Results

The average age of women was 25 (4.5) years. The median (Q1, Q3) total energy and protein intakes were 1771 (1456, 2185) kcal/d and 44.7 (34.7, 55.0) g/d, respectively. Total energy and protein were consumed as per EAR by 37% and 54% of women, respectively. Forty percent of women exceeded the recommended energy intake from carbohydrates. Diets of slum-dwelling women were lacking in multiple micronutrients (especially iron, zinc, riboflavin, thiamine, folate). The mean DDS was 4.2 ± 1.2 and 36.5% of the women had DDS ≥ 5. All women consumed mainly cereal-based starchy staples; 80% consumed pulses and legumes, and 60% consumed other vegetables. Fifty-nine percent of women consumed ≥ 2 unhealthy food groups. Higher educational and occupational status of the primary earning members of the family and lower parity were determinants of adequate dietary diversity.

Conclusion

The diets of pregnant slum-dwelling women were lacking in numerous micronutrients. Dietary counselling programs need to be tailored to the socioeconomic backgrounds of pregnant slum-dwelling women and involve their family members to improve reach and effectiveness.
Perceptions, experiences, and motivation of COVID-19 vaccine trial participants in South Africa: a qualitative study
Authors: Nkosi Thandeka , Mulopo Chanelle , Schmidt Bey-Marrié
Published: July 2024

Background

The informed consent process is an important step in conducting ethical clinical trials, as it ensures that research participants are aware of their rights and responsibilities in clinical trials. This study explored participants’ perceptions, experiences and the factors motivating their participation in a COVID-19 vaccine trial in South Africa.

Methods

This descriptive qualitative study was conducted among twenty-five adult participants (18 to 64 years old) who participated in a COVID-19 vaccine trial in South Africa. Three focus group discussions and fifteen semi-structured interviews were carried out. Data were collected at a Clinical Research Site located in Prince Mshiyeni Memorial Hospital, in Umlazi Township, Durban, South Africa, where the COVID-19 vaccine trial participants were initially enrolled. Data were analysed iteratively using a thematic analysis approach.

Results

Four key findings emerged: 1) Participants who experienced an event (such as tested positive for COVID-19) during the clinical trial were more likely to talk about the informed consent more thoroughly compared to the other participants. 2) Participants understood the purpose of informed consent process better when it was repeated multiple times throughout the course of the trial. 3) Where participants did not recall or understand various elements of the informed consent, participants were likely to create their own interpretations. 4) Factors influencing participations in trials were reimbursement for participation, access to health care, protection of family members, and ability to socialize without fear of COVID-19.

Conclusion

Overall, the findings show that the informed consent process should be regarded as an ongoing process rather than a once-off event that only happens at the start of a clinical trial. An understanding of participants’ perspectives, experiences, and motivations for participating in clinical trials, can help trial staff strengthen the consent documents and processes.
Labor Market Effects of Credit Constraints: Evidence from a Natural Experiment
Authors: Kumar Anil , Liang Che-Yuan
Published: July 2024

We exploit the 1997 and 2003 constitutional amendments in Texas—allowing home equity loans and lines of credit for nonhousing purposes—as natural experiments to estimate the effect of easier credit access on the labor market. Using state-level as well as micro data, we find that easier access to housing credit led to a notably lower labor force participation rate between 1997 and 2007. Our findings are remarkably robust to improved synthetic control methods based on insights from machine learning. Our research shows that negative labor market effects of easier credit access are important for assessing its stimulative impact on overall growth. (JEL C45, G21, G51, J16, J22)
Gender Differences in Preferences for Meaning at Work
Authors: Burbano Vanessa , Padilla Nicolas , Meier Stephan
Published: July 2024

Scholars have examined whether preferences for job characteristics help explain why men and women sort into different occupations but have overlooked preferences for meaning at work. We first document gender differences in preferences for meaning in a large-scale survey covering individuals in 47 countries. We then conduct a choice-based conjoint analysis of a cohort of MBA students at a leading business school to study gender differences in preferences for meaning compared to other job attributes. We show that gender differences in preferences for meaning at work are widespread and partly explain gender differences in behavioral outcomes, including industry of work. (JEL D91, I23, J16, J24, J28)
Government Transfers and Votes for State Intervention
Authors: Albanese Giuseppe , de Blasio Guido , Incoronato Lorenzo
Published: July 2024

Government transfers might have long-lasting consequences on electoral outcomes. We study a regional policy implemented in Italy over the second half of the twentieth century and leverage variation in transfers to show that parties promoting more state intervention in the economy performed better in the targeted areas relative to places that were not subsidized, decades after the end of the policy. This effect does not seem to mirror long-term differences in the economic performance of treated and control areas, which were small, nor other attitudes within the electorate. (JEL D72, H76, I38, N34, N44, R53)
Comparative analysis of the clinical effects of different thoracoscopic resection in the treatment of Stage I Non-Small Cell Lung Cancer
Authors: Jiang Hao , Wu Tong , Qie Peng , Wang Huien , Zhang Baoxin
Published: July 2024

Objective: To compare and analyze the clinical effects of thoracoscopic lobectomy and segmentectomy in stage I non-small cell lung cancer (NSCLC).
Method: This was a retrospective study. Eighty patients with stage I NSCLC treated in Cangzhou People’s Hospital from December 2019 to January 2022 were randomly divided into the segmentectomy group and lobectomy group, with 40 cases in each group. Further comparative analysis was carried out focusing on perioperative indexes, maximum ventilation volume (MVV), forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), VAS score of postoperative pain and complications.
Result: There was no significant difference in the number of dissected lymph nodes and extubation time between the two groups (p>0.05). The operation time was longer, while intraoperative blood loss was less and the stay of stay in hospital was shorter in the segmentectomy group significantly than those in the lobectomy group (p<0.05). Furthermore, no significant difference was observed in MVV%, FVC% and FEV1% between the two groups before operation (p>0.05). Meanwhile, the segmentectomy group had evidently lower VAS scores at 1 d, 3 d and 5 d postoperatively than those in the lobectomy group (p<0.05). Besides, there was a much lower total incidence of complications in the segmentectomy group than that in the lobectomy group (p<0.05).
Conclusion: Compared with lobectomy, thoracoscopic segmentectomy is more effective in the treatment of stage I NSCLC, with less bleeding and mild pain, which can alleviate pulmonary function injury and reduce postoperative complications that is conducive to the improved prognosis of patients.
doi: https://doi.org/10.12669/pjms.40.8.9124
How to cite this: Jiang H, Wu T, Qie P, Wang H, Zhang B. Comparative analysis of the clinical effects of different thoracoscopic resection in the treatment of Stage INon-Small Cell Lung Cancer. Pak J Med Sci. 2024;40(8):---------. doi: https://doi.org/10.12669/pjms.40.8.9124
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Impact of entrepreneurial orientation on micro and small enterprises
Authors: Ferreira Neto Macário Neri , Arruda Cavalcante Forte Sérgio Henrique
Published: July 2024

The impacts of entrepreneurial orientation on performance present important research, however, theoretical gaps were identified. This essay intends to fill these gaps, proposing an integrated model in Micro and Small Enterprises (MSEs) that combines entrepreneurial orientation, absorption capacity, ambidexterity, innovative performance and performance. We advocate a framework that integrates all five buildings. We also suggest that the model be tested using structural equation modeling. By filling the theoretical gap, the visualization of the proposed theoretical model encourages MSEs to improve their entrepreneurial orientations, aiming to capture external knowledge to innovate their actions, aiming at a better performance.
Ventos fortes fazem bons marinheiros
Authors: Lazarini Junior Silvano , Vieira Marinho Sidnei , Guerreiro Borges Rodrigo
Published: July 2024

O caso para ensino retrata a expansão da Credifoz e o dilema relacionado a seleção de um perfil de liderança para suas unidades. Possui enredo verídico com elementos fictícios. Cada tópico é apresentado informações relacionadas ao dilema do crescimento em sua área de atuação com liderança de pessoas. O objetivo é refletir sobre a liderança em ambiente competitivo e desafiador, com equipes em estágios distintos de desenvolvimento alinhado a uma filosofia baseada em princípios do cooperativismo. Para utilizar em disciplinas de gestão e desenvolvimento de lideranças na graduação e pós-graduação em administração e no desenvolvimento de gestores em outras organizações.