bluuebunny/crossref_metadata_2025 huggingface dataset:
Narrative Analysis: An Analysis of Evaluative Devices in Chinese JFL Learners’ Oral Narratives
Authors: Chen Zhen
Published: June 2023

Using the picture book “Frog, where are you?” (Mayer, 1969), this study investigated the frequency and linguistic forms of evaluative devices in narratives elicited from 29 Japanese native speakers and 28 upper-intermediate Chinese learners of Japanese. The findings show that the preferred evaluative devices style differed between Japanese native speakers’ and Chinese learners’ narratives. On the one hand, although Japanese native speakers provided more evaluative devices than Chinese learners of Japanese, the ratio of evaluative clause and evaluative expression was approximately 2:8 in the narratives of both. On the other hand, Japanese native speakers provided evaluative clauses from the characters’ perspectives to create multiple-voiced discourse, and used evaluative expressions such as modality expressions of value judgments to objectify the narration. To the contrary, Chinese learners of Japanese mainly provided information supplements in narrating event clauses, durative-descriptive clauses, and evaluative clauses, adding the expressivity of the language in narratives to ensure that the communication intentions were perceived by the audience.
Female Coming of Age: A Content Analysis Approach of Digital Humanities in Joyce Carol Oates’s Mudwoman (2012)
Authors: Chen Mi , Omar Noritah , Zainal Zainor Izat Binti , Awang Mohammad Ewan Bin
Published: June 2023

This study explores the theoretical basis and ways to realize the integration of contemporary digital technology and literary research, and looks forward to the analysis of the application of digital literary research by using Joyce Carol Oates’s novel Mudwoman (2012). The novel expresses great concern for the social crisis and the spiritual dilemma of human beings in contemporary America through the observation of the daily life of individuals in America. The previous research results of Mudwoman tend to make subjective judgments by traditional literary research methods, lacking relevant data support and innovative research perspectives and methods. In this study, we analyze the text of Mudwoman with a combination of content analysis based on digital humanities perspective. The results of this study reveal that M.R.’s coming of age is a path of identity search. In general, M.R. experiences childhood abandonment and kinship alienation, and the construction of her self-identity is fractured. It leads to the distress of interpersonal interactions in adulthood, aggravating her identity crisis. But with the help of kinship, she faces her past and predicament, returns to her spiritual home, reconciles with her past, and thus achieves the reconstruction of her identity.
Escaping Absurdity: The Incarnation of Magical Realism in Rawi Hage’s Carnival (2012)
Authors: Kacha Sabrina
Published: June 2023

This paper examines the various representations of magical realism in Rawi Hage’s Carnival (2012). It investigates the portrayal of the fictionalized imaginative situations in the novel. Further, it discusses Fly as an exilic individual who attempts to escape his chaotic and disordered society. Through his flying carpet, Fly overcomes his hardship and produces a new space for his own in order to realize what he desires. Besides, among the serious problems that face the exilic individual is the absurdist existential life in exile. Thereby, this research article explores how Fly uses a magical realist element to escape the absurdity of his existence in the diaspora. Hence, Albert Camus’ writings on absurdism and the absurdity of human existence are paramount in analyzing this character.
Literary Teaching Based on Information and Communication Technology (ICT): An Inquiry Approach
Authors: Djihadah Nuryati , Wasliman Iim , Mulyanto Agus , Fatkhullah Faiz Karim
Published: June 2023

This research aims to describe the management of ICT-based literary teaching with an inquiry approach at the Indonesian Language and Literature Education (PBSI) Study Programs at Universitas Islam Negeri Syarif Hidayatullah and Muhammadiyah University, both in Jakarta, Indonesia. This research used qualitative methods to study the problems, including interviews and direct observation techniques with visual documentation. The data were analyzed using qualitative interactive model techniques. The results reveal that in lesson planning the use of ICT and the inquiry approach is not discussed in detail even though their use is expected. In organizing learning, the categories of lecture content follow the RPS content, there is a grouping of students for discussion on a theme which is then presented. In the implementation, ICT-based learning is conducted with zoom meetings and assisted by WhatsApp group media. The application of the inquiry approach is conducted by group discussion on a theme which is then discussed. Lecturers play a role in guiding and directing students in conducting the steps of the inquiry approach. In the assessment stage, it is conducted with an authentic assessment-based assessment, performance assessment and written assessment.
Transitivity and Modality Analysis of Tedros Adhanom Ghebreyesus’s Speeches on Handling COVID-19
Authors: Muhassin Mohammad
Published: June 2023

Speech is one of the communication media that can be used to convey certain ideas and intentions of the speaker. The current study aims to analyze the use of transitivity and modality in Tedros Adhanom Ghebreyesus’s speeches on handling COVID-19 and interpret their meanings. Data comprises the transcripts of two speeches delivered at the media briefing on COVID-19 on 11 March 2020 and 1 April 2021 available on the World Health Organization website (www.who.int). The transcripts were then examined and evaluated using Halliday’s (1994) transitivity theory and Halliday's (1994) and Lock’s (1996) modality theories. The results reveal that the speeches made use of material, relational, mental, behavioral, verbal, and existential processes of transitivity, as well as potentiality/ability, obligation, usuality, inclination, and probability of modality. Depending on the contexts of speech, the use of transitivity and modality indicates certain interpretations of meaning. Moreover, this study contributes best practices to health socialization during the pandemic and gives a great impact on the public’s better understanding of how to properly handle COVID-19.
Exploring Stereotypes and Cultural References in Dubbed TV Comedies in the Spanish-as-a-Foreign-Language Classroom
Authors: Ogea Pozo María del Mar , Botella Tejera Carla , Bolaños García-Escribano Alejandro
Published: June 2023

Streaming video-on-demand (SVoD) platforms have recently set out to produce an ever-increasing number of non-English-language films and tv series distributed worldwide. These, in turn, have become the perfect vehicle for disseminating cultural realities other than those from English-speaking countries. In this article, we endeavour to analyse the presence of stereotypes and cultural references in the English-dubbed version of the Spanish tv series Valeria (Benítez, 2020–present) and the way they travel through dubbing. To this end, we conducted a comparative study in which seven video excerpts from the English-dubbed version and their original Spanish version were shown to 57 native English-speaking participants from a British higher education institution, who shared a similar knowledge of Spanish as a foreign language. Specifically, we explored the participants’ overall perception of humorous passages, their identification of cultural references, their informed opinion on the translation techniques applied (and alternatives given), and their self-assessment of the metacognitive effort required. The findings show two aspects of learners: (a) overall, these learners were eager to maintain stereotypes and cultural references used for humorous purposes in audiovisual comedies, and (b) their understanding of these items often relies on audiovisual support. The findings offer an initial examination of English speakers’ cognitive and evaluative perception of Spanish comedies that have been dubbed in English and can be useful for translator training purposes.
Subtitling the Mafia and the Anti-Mafia from Italian into English: An Analysis of Cultural Transfer
Authors: Uzzo Gabriele
Published: June 2023

Besides big Hollywood productions, like The Godfather trilogy, and video-on-demand productions, like The Sopranos, both filmed in English, new popular Italian productions, based on the linguistic and cultural representation of the Mafia and the Anti-Mafia, have gained momentum. Nonetheless, the body of academic research on the linguistic traits of the former is larger than research on the latter. This study aims to investigate how and by which strategies the lexicon and the culture-bound terms related to the concept of the Mafia and the Anti-Mafia are culturally transferred and subtitled from Italian into English. The TV series Vendetta: guerra nell’antimafia is used as the corpus for both a quantitative and a qualitative analysis. Results show that the translation of the Mafia and the Anti-Mafia for the purpose of audiovisual translation, through subtitling, is a simpler and less convoluted form of translation than written legal translation, aimed at conveying complex concepts in a simpler way.
Engaging English Audiences in the Dubbing Experience: A Matter of Quality or Habituation?
Authors: Sánchez-Mompeán Sofía
Published: June 2023

Although dubbing has traditionally been associated with the so-called dubbing countries, the advent of digitalisation and streaming is nowadays encouraging the consumption of dubbed content across territories unaccustomed to watching foreign fiction with dubs, such as the Anglophone market. Despite the effort put into drawing in a wide and satisfied audience in these countries, an unfavourable response from some viewers has called into question the quality of English dubbed versions and the odds of forging a consolidated dubbing industry in such regions. The main aim of this article is to offer insights into how poor quality and the lack of a long professional tradition might compromise engagement and cinematic illusion and into how the lack of exposure to this mode might have a negative impact on the way the dubbed content is received and enjoyed by English users. The article also intends to discuss the many ways in which quality and habituation affect the dubbing experi­ence. This is done by exploring both the potential constraints that impair the final version and the factors that encourage an amenable attittude to this mode amongst the audience, de­spite their inexperience as dubbing consumers. The conclusions stress the need to enhance English dubbing quality at different levels and the importance of habituation to make dubbing work from a cognitive, linguistic, and prosodic standpoint.
Sobrepeso y obesidad en adultos: aportes de un análisis geoespacial
Authors: Sánchez Monroy Cindy Caterine
Published: June 2023

Objetivo: Analizar geoespacialmente el comportamiento de las personas con sobrepeso y obesidad entre 18 y 64 años en Colombia en el 2015. Métodos: Se aplica un modelo de análisis geoespacial de distribución espacial trasversal con la última versión de la Encuesta Nacional de Situación Nutricional (ENSIN) de 2015 a escala departamental. Para lograrlo, se calculan las prevalencias a escala departamental de sobrepeso, obesidad clase I, II y III según el Índice de Masa Corporal (IMC) y la obesidad abdominal en mujeres y hombres de acuerdo con la circunferencia de cintura. Luego, se utiliza el índice de Moran Global, índice de Moran Local de Anselin y el G* Getis Ord para determinar los patrones de agrupaciones altas y bajas. Resultados: Los conglomerados locales ilustrados en los mapas de Anselin y G* Getis Ord demuestran que sus residuales están distribuidos normalmente en el espacio y el modelo de la autocorrelación espacial es aleatoria confirma que los factores que influyen en estas comorbilidades es ser afrocolombiano 13%, estar no afiliado y con contributivo el 26%, no tener actividad física y no tener parques cercanos el 13%. En el 2015, en Colombia y el índice de masa corporal, el 38.46 por cada 100 habitantes tienen sobrepeso; el 20.89 por cada 100 habitantes presenta obesidad y según la circunferencia de cintura 53.17 por cada 100 habitantes con obesidad abdominal. Conclusiones: los indicadores epidemiológicos y espaciales permitieron ser útiles para el análisis y visualizar el comportamiento geoespacial del sobrepeso y la obesidad en Colombia en el 2015.
The role of complete exomic sequencing in the administration of targeted drugs in patients with multiform glioblastoma
Authors: Kaminskiy A. V. , Zverev N. P. , Lyakhovets A. A. , Naskhletashvili D. R. , Gairyan M. A. , Isaev A. A. , Khmelkova D. N. , Plaksa I. L.
Published: June 2023

Introduction. Glioblastoma is the most common primary malignant glial tumor of the brain in adult patients. Median overall survival for this pathology varies between 3 and 12 months, and only 5 % of patients live for more than 5 years. Current treatment methods allow to slightly increase lifespan of the patients with glioblastoma but not in all cases.

Aim – to determine the utility of full exome sequencing of biopsy materials of patients with glioblastoma using expanded gene panel for prescription of new targeted therapy.

Materials and methods. The study included 28 patients with glioblastoma multiforme. Foundation One CDx assay was performed using DNA extraction from a paraffin block and next-generation sequencing. In total, 4 classes of genomic changes in 324 genes, introns of 34 genes taking part in rearrangements, as well as microsatellite instability and tumor mutation load were evaluated. For every tumor profile, individual therapy options were identified in accordance with the current knowledge, references for the relevant scientific studies were included. From some patients, feedback was received allowing to evaluate the dynamics of their condition and changes in therapy after the performed study.

Results. Genes in which mutations are the most common were identified: EGFR – in 11 patients, CDKN2A – in 13, TP53 – in 9, TERT (frequent mutations in TERT gene promoters с.-124C>T and c.-146C>T) – in 15, MTAP – in 10. Mean mutation level was 4.5 mutations/ MB and tumors did not have microsatellite instability. For 6 patients, appropriate targeted therapy was identified.

Conclusion. Sequencing using an extended gene panel is justified and recommended for patients with glioblastoma multiforme for selection of new targeted therapy.
Experience of following up couples affected by hiv and planning pregnancy with use of assisted reproductive technologies in sverdlovsk region
Authors: Posokhova Larisa A. , Rosyuk Elena A. , Shtanova Alexandra A.
Published: June 2023

Objective. To analyze the structure of discordant (DC) and concordant (CC) pairs and outcomes of assisted reproductive technologies (ART) without taking into account the correlation of antiretroviral therapy in the Regional Center for AIDS during 2021.
Materials and methods. A retrospective analysis of medical records of 210 couples who were consulted at the State Healthcare Institution "RC AIDS" was conducted in order to obtain a conclusion from the medical commission on the possibility of carrying out the ART procedure. The following data were analyzed: channel of infection in men and women, age composition, stage of HIV infection, duration of ART use, ART outcomes.
Results. The procedures using ART are carried out in the same percentage as both DC and CC pairs. The outcomes of the ART procedure in PrEP: 2 women (6.9 %) had miscarriage,4 (13.8 %) regression of pregnancy,23 (79.3 %) childbirth; in CC 1 woman (7.7 %) had miscarriage, in the remaining 12 (92.3 %) the procedure was completed with childbirth.
Conclusions. As a result of implementing the procedure with ART,35 children were born, not a single case of HIV infection in children was registered.
Clinical characteristics of intestinal mixed infections
Authors: Cherenova Lelya P. , Zakayev Kamil Yu. , Matsui Anna V. , Cherenova Valentina K.
Published: June 2023

Objective. To study the features of the clinical picture of mixed intestinal infections in patients treated at the Regional Infectious Clinical Hospital named after A.M. Nichoga in the period from 2017 to 2021.
Materials and methods. The clinical picture was studied in 55 patients with mixed intestinal infection who were treated at the Regional Infectious Hospital named after A.M. Nichoga (Astrakhan).
Results. Mixed intestinal infections in most cases were registered in the summer-autumn period (51 % 92.7 %) in the form of sporadic morbidity. Epidemiological anamnesis data show that the majority of patients drank unboiled water, swam in the river, where they accidentally swallowed water, consumed food products of questionable quality, chicken meat, eggs insufficiently heat-treated, unwashed vegetables and fruit. Four patients arrived in Astrakhan from amoebiasis-endemic regions (Uzbekistan, Turkmenistan, Turkey, Egypt); 51 patients (92.7 %) had a moderate form of the disease,4 patients (7.3 %) a severe form. The clinical picture of mixed intestinal inflections was characterized by the symptoms of shigellosis and salmonellosis.
Two patients, diagnosed shigellosis + amoebiasis had manifestations of ulcerative colitis complicated by intestinal bleeding; 2 patients, diagnosed salmonellosis + amoebiasis, developed dehydration shock. The treatment of patients with a severe form was carried out in the Intensive Care Unit and Resuscitation Unit of the Regional Infectious Clinical Hospital.
Conclusions. The clinical picture of mixed bacterial intestinal infections and intestinal amoebiasis is mainly determined by the symptoms of shigellosis and salmonellosis and is manifested by the phenomena of intoxication, dehydration and the development of colitic and gastroenterocolitic syndromes.
On applying “economical technologies” in children’s polyclinic
Authors: Kochergina E. A. , Trefilov R. N. , Shinkarik Irina G. , Minaeva N. V.
Published: June 2023

Objective. To analyze the work of childrens polyclinic within the framework of the projects Economical Production. An active prevalence and introduction of economical production concerns different spheres of human productive activities including office processes, service, management, social sphere and healthcare service.

Materials and methods. The project Organization of entering stream of patients, visiting a district pediatrician at reception days for conditionally ill children was realized as the first one aimed at improvement of work of childrens polyclinic.

Results. In April 2017, economical technologies in the sphere of community health protection were introduced in Perm Krai to improve the most problematic processes in the activity of polyclinics. Economic technologies help to raise the availability, quality and safety of medical care at the expense of creating optimal logistics of patients streams, organization of ergonomics of working space, effective use of medical technique and equipment. An important element of success regarding the economical production is involvement of workers in improvement of processes as well as devotion of the head of organization to design work. It was shown at the example of childrens polyclinic how the improvement projects were realized; the standards of the improved processes of other medical institutions were introduced.

Conclusions. One of improvement projects, its stages and the list of countermeasures for elimination of the causes of the revealed problems is described in details; the results of the other realized projects are presented. The major part of solutions regarding the improvement within the framework of economical production in the sphere of public healthcare are organizational and do not require additional material costs.
The AACE 2022 Guideline: An Academic Appraisal
Authors: Bhattacharya Saptarshi ,   Department of Endocrinology, Indraprastha Apollo Hospitals, New Delhi, India, Kalra Sanjay ,   Department of Endocrinology, Bharti Hospital, Karnal, India,   University Center for Research & Development, Chandigarh University, Chandigarh, India
Published: June 2023

The American Association of Clinical Endocrinology (AACE) 2022 guideline provides comprehensive and evidence-based guidance on contemporary diabetes management. The statement reiterates the importance of person-centred, team-based care for optimum outcomes. The recent strides to prevent cardiovascular and renal complications have been aptly incorporated. The recommendations on virtual care, continuous glucose monitors, cancer screening, infertility and mental health are relevant. However, focused discussions on non-alcoholic fatty liver disease and geriatric diabetes care could have been helpful. Outlining targets for prediabetes care is a notable addition and is likely to be the most effective strategy in addressing the rising burden of diabetes.
Insulin Icodec Weekly: A Basal Insulin Analogue for Type 2 Diabetes
Authors: Bajaj Harpreet S ,   LMC Diabetes & Endocrinology, Brampton, Ontario, Canada, Goldenberg Ronald M ,   LMC Diabetes & Endocrinology, Concord, Ontario, Canada
Published: June 2023

Insulin icodec is a once-weekly basal insulin analogue in late-phase clinical development. Similar efficacy and safety of icodec to once-daily basal insulin analogues have been reported in over 4,200 participants with type 2 diabetes from three phase II and five phase III trials. Indeed, glycated haemoglobin reduction was superior for icodec among insulin-naïve participants (ONWARDS 1, 3 and 5) and in those switching from a daily basal insulin in ONWARDS 2, with the latter trial demonstrating improved diabetes treatment satisfaction scores with insulin icodec versus insulin degludec.
Lecanemab: The Price of a Breakthrough
Authors: Wimo Anders ,   Department of Neurobiology, Care and Society, Karolinska Institutet Solnavägen, Solna, Sweden, Jönsson Linus ,   Department of Neurobiology, Care and Society, Karolinska Institutet Solnavägen, Solna, Sweden, Johansson Gunilla ,   Department of Neurobiology, Care and Society, Karolinska Institutet Solnavägen, Solna, Sweden, Winblad Bengt ,   Department of Neurobiology, Care and Society, Karolinska Institutet Solnavägen, Solna, Sweden
Published: June 2023

On 6 January 2023, the amyloid beta-targeting antibody lecanemab was approved by the US Food and Drug Administration for the treatment of mild cognitive impairment due to Alzheimer’s disease (AD) and mild AD dementia via its Accelerated Approval pathway. However, two important questions need to be highlighted: What is the appropriate patient population to receive treatment? How much should healthcare systems be prepared to pay for the drug? The healthcare infrastructure is not prepared for the expected huge demands for diagnostics and eventual treatment, especially given the suggested list price and a potentially large population of people with mild cognitive impairment due to AD and mild AD dementia. A lower price point would allow wider access to the treatment and reduce disparities in health equity.
Early Administration of Sacubitril/Valsartan is Associated with more Rapid NT-proBNP Recovery in High-Risk Patients Hospitalized for Acute Heart Failure
Authors: Lupi Alessandro , Ferrari Irene , Persampieri Simone , Ariotti Sara , Pace Doranna , Gaudio Giovanni , Guasti Luigina , Ponti Roberto
Published: June 2023

BACKGROUND: in patients hospitalized for heart failure with reduced ejection fraction (HFrEF), randomized controlled trials have demonstrated some advantages in starting sacubitril/valsartan before discharge. However, information about the effects of sacubitril/valsartan use in the acute phase of HfrEF hospitalizations is limited. AIM: To evaluate clinical, biomarker, and echocardiographic effects of starting sacubitril/valsartan in real-world HFrEF patients before discharge. METHODS: retrospective analysis of 124 consecutive patients (58.9% males, 75.6±11.4 years) hospitalized for HFrEF. In 36, sacubitril/valsartan was started before discharge (Group A); in the remaining 88, at the 1-month follow-up visit (Group B). The primary endpoint was time-averaged NT-proBNP level reduction from admission to discharge. RESULTS: Group A showed a worse baseline clinical risk profile (diabetes: 47.2 vs. 20.7%, p=0.007; coronary artery disease: 66.7 vs. 22.7%, p<0.001; systolic blood pressure: 118.0±20.8 vs. 132.9±22.9 mmHg, p=0.001; left ventricular ejection fraction: 28.5±5.5 vs. 32.1±7.6%, p<0.0004). Nevertheless, the time-averaged mean NT-proBNP reduction was significantly higher in group A patients (ratio of change -0.30, 95% CI -0.40 to -0.21, <0.0001 vs. group B). Creatinine and K+ levels did not change significantly during the hospital stay. Multivariate analysis suggested diabetes, coronary artery disease, higher systolic blood pressure, and the need for inotropic support as independent predictors for in-hospital sacubitril/valsartan treatment. CONCLUSIONS: in real-world patients, starting sacubitril/valsartan in-hospital rather than waiting for further stabilization was associated with a more considerable reduction of NT-proBNP levels at discharge, with an excellent safety profile. These data confirm randomized trials results, extending them to higher-risk real-world HFrEF patients.
Using a Reconciliation Module to Change Minds about COVID-19
Authors: Hubble Gabriella , Willis Jordan , Abele Jessica , Bourne Dalton , Lawrence Olivia , Patterson David , Rockwood Mark , Rousseau Grant , Shumway Spencer , Tolman Ethan , Zollinger Tailor , Jensen Jamie
Published: June 2023

Scientific skepticism surrounding COVID-19 precautionary behaviors was a leading controversy during the pandemic. A reconciliation module has been shown to help individuals accept scientific data while still maintaining core beliefs. This module, commonly used in evolution education research, consists of taking measures to reduce conflict, emphasize the nature of science, and teach students the facts. The aim of this research was to evaluate the impact of this module on college students’ willingness to follow COVID-19 precautions in order to increase the awareness and implementation of these behaviors. We created a reconciliation module consisting of videos made by local community members. This module was then incorporated into a survey, where participants indicated if they changed their minds from the videos, and if they found the presenter respectful or relatable. There were also open-ended questions where students were able to expand on their responses. We found that the most indicative reason why students changed their view on the controversy of COVID-19 was that the presenter communicated new information to the student that they did not previously know, or cleared up something they did not understand. Investigating if presenters were relatable or not, the most common response was that the presenter was relatable due to a shared ideology between the presenter and student. Given the results, we propose that helping students understand scientific information is a key step in addressing controversial topics in science. However, this information is most influential when the instructor is perceived to be relatable. We discuss how instructors can apply these findings to help students whose cultural background differs from their own.
Update on the Role of Adequate Vitamin D Provision for Avoiding Insulin Resistance and its Sequelae [Type 2 Diabetes and Cardiovascular Disease]
Authors: Boucher Barbara
Published: June 2023

Type 2 diabetes prevalence is increasing, reaching ‘pandemic’ proportions globally, and associated with increasing obesity rates. Concomitantly, vitamin D deficiency persists world-wide and is worsened by obesity because it reduces hepatic 25-hydroxylation of vitamin D, which reduces circulating 25(OH)D availability to target tissues; these include islet beta cells, since vitamin D is essential for adequate insulin responses to hyperglycemia. Increased insulin resistance increases type-2 diabetes risks and precedes its development by decades, reflecting changes in hepatic and muscle function that are corrected experimentally by activated hormonal vitamin D [calcitriol]; similarly, abnormal insulin resistance can be corrected in humans by correcting vitamin D deficiency using oral supplementation. Since vitamin D deficiency and inadequacy persist world-wide despite various guidelines on vitamin D intake, the possibility that correcting deficiency would contribute to reducing T2DM risks through beneficial effects on pancreatic islet beta cells and on the metabolic disorders contributing to insulin resistance through vitamin D inadequacy warrants consideration. If this is the case, then ensuring vitamin D adequacy in populations at high risk of Type-2 diabetes would be a valuable adjunct to other measures being taken to reduce that risk such as increased exercise and weight reduction. It would also reduce cardiovascular disease risks, well known to increase with insulin resistance, with or without concomitant Type-2 diabetes. Cardiovascular disease risks themselves can be reduced by adequately correcting deficiency and are lower with higher lifetime circulating 25-hydroxyvitamin D in deficient subjects from Mendelian randomization analysis. This report, therefore, reviews the evidence for increased insulin resistance as a risk factor for Type-2 diabetes, the beneficial effects of correcting vitamin deficiency on insulin resistance, Type-2 diabetes and cardiovascular risks, some basic mechanisms accounting for those benefits, the reasons for the persistence of vitamin D inadequacy globally and how best that problem could be corrected.
A Multi-State Analysis of the Fiscal and Social Impact of Commercial Insurance Coverage for Recreational Prostheses in the United States
Authors: Kehoe Shaneis , Cain Jeffrey , Montgomery Angela , Mitsou Lindi
Published: June 2023

Despite overwhelming evidence that physical activity is critical for health [1][2], prosthetic devices designed for recreational activities such as running, biking, and swimming are excluded from the vast majority of insurance coverage plans in the United States. Unlike devices designed for walking, recreational prosthetic devices are specifically designed for recreational activities. Using walking-specific devices for recreation has been shown to fail under excessive strain and cause long-term physical and behavioral negative side effects [3][4]. Exceptions in coverage for these devices currently exist in the United States’ Veteran healthcare system, or are undergoing revision through various state legislative initiatives. Maine and New Mexico recently passed bills into law, while Colorado (CO), Connecticut (CT), and Illinois (IL) have bills in process applicable to commercial insurance plans [5]. The objective of this policy review is to analyze current applicable policies, available actuarial data and 2022 US Census population data to determine the fiscal and social impact of bills under consideration during the 2023 Legislative Session [6][7]. As a result, the increased per month per member (PMPM) to cover these devices was calculated to estimate the relevant state’s fiscal impact: CO: House Bill (HB) 23-1136 is conservatively calculated at $0.01- $0.08 CT: planned fall 2023 proposed bill is conservatively calculated at $0.01- $0.11 IL: Illinois Senate Bill (SB) 2195 is conservatively calculated at $0.01 - $0.37 These estimated costs are less than 0.04% of the annual average amount spent on healthcare (per capita) in the United States ($10,000) [8]. Despite spending the highest amount per capita among first-world countries, the United States has the lowest life expectancy. This disparity highlights the need to reconsider preventative health services not currently covered, likely attributing to the high cost per capita in the US. Based on these findings, expanding insurance coverage to recreational prosthetic devices in Colorado, Connecticut, and Illinois would result in potential short and long term physical and behavioral health benefits as relevant social impacts. Consequently, the current definition of "medical necessity" should be expanded by the commercial insurance industry based on recent research [9].
New Perspectives in Peripheral Nerve Surgery for Neuropathic Pain
Authors: Zuniga John , Neal Timothy
Published: June 2023

Background and Aims: Neuropathic pain can occur following intentional or unintentional peripheral nerve injury. The purpose of this review was to determine in patients who have post-traumatic trigeminal neuropathic pain or required ablative mandibular operations with transection of the nerve, do those who undergo immediate or early surgical interventions, when compared to those whose nerves are not repaired or delayed, have a decreased or increased risk for resolving neuropathic pain? Methods: Two single-site and one multi-site retrospective observatory studies of patients who had neuropathic pain prior to operative treatment of the injured nerve and in patients who underwent resection of the mandible for benign or malignant disease with either no repair or immediate repair were analyzed for the presence or absence of neuropathic pain at 6 months post-surgery. The primary predictor variable in the surgical treatment of neuropathic pain pre-existing surgery was the time from injury to repair and the preoperative pain intensity rated by Visual Analogue Scale (VAS). The primary predictor variable in the study of intentional transected nerve was the immediate repair or no repair of the nerve at the time of resection. Results: There was statistically significant difference in the primary outcome based on time from injury to repair. When the time to surgery was less than 200 days, the percentage of patients with no neuropathic pain was greater than 60%. There was a significant difference in mean VAS between those who had no neuropathic pain (6.4,SD 2.68) and those with recurrence (7.75,SD 1.95). Following mandibular resection there was statistically significant difference between the immediate repair and no repair group. Post-hoc logistic regression modeling showed an inverse relationship between the immediate repair and the incidence of chronic postoperative pain and neuropathic pain with an odd ratio <1. Conclusions: In patients with neuropathic pain, earlier diagnosis and treatment, including peripheral nerve surgery, should be considered with the best outcomes when operative interventions occur within 200 days of the injury and pain intensity are mild or moderate on VAS scales. The immediate repair of an intentionally transected trigeminal nerve appears to reduce and possibly eliminate the development of neuropathic and chronic postoperative pain compared to avoiding nerve repair.
Building knowledge broker capacities during the regional research project: lessons learnt from the West African Health Organisation
Authors: Sombie Issiaka , Ermel Johnson , Virgil Lokossou , Moukaila Amadou , AJC Aissi
Published: June 2023

The aim of the article was to understand how its project entitled "moving maternal, newborn and child evidence into policy in West Africa" funded under the Canadian initiative has helped the West African Health Organisation to better build its role as a knowledge broker in West Africa. A case study approach was adopted to allow for the validation or otherwise of stated hypotheses using context, actor, process, and outcome data. WAHO as a HPRO has been able through the Moving Maternal Newborn and Child Health Evidence into policy in West Africa project to play the role of KB through strengthening collaboration between policy makers and researchers, generating knowledge for a better understanding of the evidence use environment in the field of maternal and child health, and finally through the implementation of actions to create an enabling environment for the use of evidence to influence health policy and practice. Weaknesses were noted and mostly corrected in the implementation process. The commitment of senior management and other stakeholders, the implementation of the project using the strengths of the institution, the collaboration with regional experts, the provision of additional human resources and the use of evidence in planning project activities facilitate this capacity building. The experience gained enabled the organisation during the COVID-19 pandemic to continue to facilitate the use of evidence for decision making by policy makers in West Africa.
How Understanding Our Multi-Dimensional Humanity Clarifies Medical Ethics
Authors: Lisanti Christopher , Galante Sebastian , Betts Allen
Published: June 2023

Medical ethics is increasingly culturally subjective. A clear understanding of medical ethics must be grounded in a clear philosophy of medicine and philosophical anthropology. Philosophically, medicine is a profession dedicated to the patient’s health. A better understanding of health or wholeness will lead to better healing. Health or wholeness is best understood as well-functioning. The philosophical and anthropological biopsychosocial-spiritual model informs the roots of well-functioning. These four interrelated dimensions must be balanced and work in harmony, ultimately aimed at the basic goods (e.g., health, life, and personal integrity among others) and should be strived for but never harmed. This holistic approach helps determine the primary cause of unwellness while also explaining that biologic healing frequently relies as much on the other dimensions as the biologic treatment. Historically, physicians refined their skills ensuring that the best biologic means addressed the most well-defined biological diseases. This dimension-specific philosophical framework formed the basis of a physician’s diagnostic investigation. If the source of unwellness was primarily in another dimension, then appropriate therapeutic referrals to dimension-specific experts were offered. This framework prevented or corrected egregious excesses due to medicalization of social issues. Traditional boundaries of medicine are now challenged by contraceptives, elective abortion, cosmetic procedures, and euthanasia/physician-assisted suicide, steering medicine away from treating biologic problems with biologic solutions towards treating psychologic and/or social problems with biologic solutions. Countries now inconsistently require their physicians to provide biologic means aimed at specific psychologic and/or social goals to advance sexual and/or economic goals, the country’s laws, or patient autonomy. This is conceptually flawed requiring special exemptions from the profession of medicine while also resulting in biologic harm, damage to the basic goods, and negative psychologic and/or social effects, while transforming medicine into a commodity. Physicians have an ethical obligation to provide effective biologic means to treat biologic diseases while promoting healing and wholeness among all four dimensions. On the other hand, physicians have no obligation to use biologic means for non-biologic problems. This multi-dimensional model with dimension-specific therapies is conceptually consistent, socially agnostic, empirically sound, and provides a clearer understanding of medical ethical obligations.
Mental Health 911: Advocating for the Integration of Behavioral Health Services in Pediatric Hospital Emergency Departments
Authors: Schauss Eraina , Allen Sydnie , Li Chi , Hawes Kiersten , Neal Mary , Loveless Courtney , McHugh Nicole , Zettler Haley , Burgess Melanie , Rashed Jihan , Ahern Brian
Published: June 2023

The coronavirus disease pandemic of 2019 has led to increased concern in mental health needs among pediatric populations. As the number of pediatric mental health emergency department visits have increased, so has the need for integrated behavioral health services in hospitals. This paper describes a standard of mental health care and the benefits of providing mental health services in pediatric hospital settings. The Trauma Mental Health Counseling Program, Hurt-2-Healing (H2H™) was developed and implemented in a Level-1 pediatric hospital and has served a total of 1,523 pediatric trauma patients and their caregivers since 2021. This program established a new hospital-based standard of mental healthcare for pediatric trauma patients and their caregivers. A questionnaire was developed to evaluate the efficacy of the Hurt-2-Healing program within domains such as openness to seeking counseling, psychoeducation, helpfulness of counseling, and ability to cope with the traumatic injury. The majority of (83%) patients/caregivers had no previous counseling experience prior to hospital admittance. Questionnaire responses indicated that after receiving mental health services, caregivers felt more aware of their children’s mental health needs and reported being more open to seeking future mental health counseling services for their child. Further, most respondents were in strong agreement that receiving mental health counseling services during the hospital stay was helpful. These results highlight the need for, and benefit of, providing a standard of care integrating behavioral health services in pediatric hospitals.
Regulatory Trends in the Nonclinical Development of Viral Vector-Based Gene Therapies: A Benchmark Analysis of Approved Products
Authors: Rousseau Cécile , Beurdeley Arnaud , Revaud Déborah , Voisin Emmanuelle , Chiavaroli Carlo
Published: June 2023

As it is often the case with innovative technologies, regulatory agencies are highly demanding in product safety demonstration from those pioneering breakthrough therapy products. Since the first historically approved gene therapy medicinal product (Gencidine in 2003) by the Chinese National Medicinal Products Administration, gene therapy medicinal products have slowly been emerging in other regions, as illustrated by the first European-approved gene therapy medicinal product (Glybera in 2012) and the first US-approved product (Imlygic in 2015). From then, with the rise of new molecular technologies (e.g., non-viral and viral vector systems), an exponential growth of gene therapies development could be gauged with, for example, the approval of more than thirty gene therapies between 2016-2022. Using a method based on Preferred Reporting Items for Systematic reviews and Meta-Analyses principle, throughout different literature databases, this review is restricted to the evaluation of viral vector-based gene therapy medicinal products (VV-GTMPs). It also considered relevant guidelines and public assessment reports issued by the EMA and / or the FDA on the products these agencies approved. Then, a benchmark was performed to help stakeholders to identify regulatory trends and to design appropriate nonclinical programs establishing the benefit / risk ratio for patients to be enrolled in clinical trials. The analysis was focused on the nonclinical activities (pharmacology, biodistribution / persistence / shedding, and toxicology) performed by Applicants / Sponsors. As of 30 March 2023, 18 VV-GTMPs have been authorized by the EMA and 14 by the FDA to treat either orphan diseases or limited number of oncology patients. The majority of these therapies are based on adeno-associated or retroviral viruses (often lentiviruses able to transfect hematopoietic CD34+ cells or T-cells). Based on an analysis of the ongoing clinical trials, there is now a trend for developing gene therapies for larger patient populations. In conclusion, given the VV-GTMPs diversity and targeted indications, a “one-size fits all” nonclinical development plan cannot be considered by default. Instead, individual, risk-based, tailored nonclinical development programs appear more appropriate to assess such products, taking into consideration the lessons learned from the past. In such fast-evolving environment, regulatory agencies need to adapt their evaluation process very rapidly.
Silenced Solutions: The Importance of COVID-19 Therapeutics and the Fight Against Suppression
Authors: Black Shaun
Published: June 2023

COVID-19 disease is caused by the Betacoronavirus, SARS-CoV-2. This virus gave rise to 676 million confirmed cases with 6.9 million deaths worldwide by early 2023. After first appearing in Wuhan, China in late 2019, the virus has mutated into seven successive major forms with progressive increases in infectivity: Alpha, Beta, Delta, Omicron, and Omicron variants BA.4, BA.5, and XBB.1.5. Liposomal mRNA vaccines have been developed against SARS-CoV-2. Many of these received Emergency-use Authorization, and all have been highly promoted by civil authorities and the media. On the other hand, therapeutics against COVID-19 have been developed, but some of these have been severely suppressed, even by reliance on retracted papers. Our laboratory found that chlorpheniramine maleate, an over-the- counter antihistamine, was active against the Coronavirus through drug-database searches, molecular modeling, and a preliminary retrospective clinical-study. The manuscript that described this work was rejected by several journal editors without peer review, thus providing further direct evidence for suppression of small-molecule therapeutics. Epidemiologic study of death statistics in the VAERS database showed that 19,710 people lost their lives after COVID-19 vaccination; mortality from all other common vaccines does not sum to even 20% of this staggering value. The vaccine has also been responsible for significant morbidity. A consensus has begun to develop among physicians and scientists that COVID-19 disease and vaccination both result in chronic symptoms in many people, now called “Long COVID” or “Long-hauler’s syndrome”. Thus, vaccination does not appear to be a reasonable approach to combat COVID-19 disease. In view of this, development, testing, and approval or repurposing of therapeutics is imperative, especially as we observe recent increases in mortality due to COVID-19 Omicron XBB.1.5. Chlorpheniramine maleate, an over-the-counter medication, is uniquely positioned to serve as a broad-spectrum antiviral against SARS-CoV-2 and other viruses in this post- pandemic age.
Deforestation-induced the EKC framework: The role of corruption control and trade openness in Southeast Asia
Authors: Destiartono Mohamad Egi , Ekananda Mahjus
Published: June 2023

Reducing the deforestation rate and formulating sustainable forest governance are still challenging for Southeast Asia. This empirical research intends to explore the dynamic connection between GDP, trade openness, corruption, and deforestation within the EKC framework by considering controls over agriculture and population. This article uses panel data from nine countries from 1996 to 2018. Pooled Mean Group (PMG) procedure and Dumitrescu-Hurlin (DH) causality tests were applied to examine the variables’ long-term relationships and the direction of the causality. This article also features the unit root and cointegration tests. The estimation supports the EKC hypothesis that the nexus between economic growth and deforestation forms an inverted-U curve. The turning point of the per capita GDP is USD 26785, i.e., the advanced stage of development. Other findings are that trade openness is a driver of deforestation, while control of corruption is an effective instrument to reduce the deforestation rate in the long run. Deforestation will still occur in Southeast Asia because only Brunei Darussalam has passed the turning point. However, implementing development programs while reducing the deforestation rate can be done because the bidirectional causality between GDP and deforestation is not confirmed. Improving trade regulations and governance is a necessary scheme to reduce deforestation rates in the future.