bluuebunny/crossref_metadata_2025 huggingface dataset:
A Vortex Relocation Method for Improving Initial Conditions and Subsequent Predictions of Tornadoes
Authors: Xu Qin , Nai Kang , Wei Li , Snook Nathan , Wang Yunheng , Xue Ming
Published: December 2022

A time–space shift method is developed for relocating model-predicted tornado vortices to radar-observed locations to improve the model initial conditions and subsequent predictions of tornadoes. The method consists of the following three steps. (i) Use the vortex center location estimated from radar observations to sample the best ensemble member from tornado-resolving ensemble predictions. Here, the best member is defined in terms of the predicted vortex center track that has a closest point, say at the time of t = t*, to the estimated vortex center at the initial time t0 (when the tornado vortex signature is first detected in radar observations). (ii) Create a time-shifted field from the best ensemble member in which the field within a circular area of about 10-km radius around the vortex center is taken from t = t*, while the field outside this circular area is transformed smoothly via temporal interpolation to the best ensemble member at t0. (iii) Create a time–space-shifted field in which the above time-shifted circular area is further shifted horizontally to co-center with the estimated vortex center at t0, while the field outside this circular area is transformed smoothly via spatial interpolation to the non-shifted field at t0 from the best ensemble member. The method is applied to the 20 May 2013 Oklahoma Newcastle–Moore tornado case, and is shown to be very effective in improving the tornado track and intensity predictions.

Significance Statement

The time–space shift method developed in this paper can smoothly relocate tornado vortices in model-predicted fields to match radar-observed locations. The method is found to be very effective in improving not only model initial condition but also the subsequent tornado track and intensity predictions. The method is also not sensitive to small errors in radar-estimated vortex center location at the initial time. The method should be useful for future real-time or even operational applications although further tests and improvements are needed (and are planned).
Construal of Situational Risk and Outcomes—Exploring the Use of Weather Radar Displays with Residents of the Tampa Bay Region
Authors: Saunders Michelle E. , Ash Kevin D. , Collins Jennifer M. , Morss Rebecca E.
Published: December 2022

A radar display is a tool that depicts meteorological data over space and time; therefore, an individual must think spatially and temporally in addition to drawing on their own meteorological knowledge and past weather experiences. We aimed to understand how the construal of situational risks and outcomes influences the perceived usefulness of a radar display and to explore how radar users interpret distance, time, and meteorological attributes using hypothetical scenarios in the Tampa Bay area (Florida). Ultimately, we wanted to understand how and why individuals use weather radar and to discover what makes it a useful tool. To do this, construal level theory and geospatial thinking guided the mixed methods used in this study to investigate four research objectives. Our findings show that radar is used most often by our participants to anticipate what will happen in the near future in their area. Participants described in their own words what they were viewing while using a radar display and reported what hazards they expected at the study location. Many participants associated the occurrence of lightning or strong winds with “red” and “orange” reflectivity values on a radar display. Participants provided valuable insight into what was and was not found useful about certain radar displays. We also found that most participants overestimated the amount of time they would have before precipitation would begin at their location. Overall, weather radar was found to be a very useful tool; however, judging spatial and temporal proximity became difficult when storm motion/direction was not easily identifiable.

Significance Statement

The purpose of this study is to understand how and why individuals use weather radar and to discover what makes radar a useful tool. We were particularly interested to explore how distance and time are thought about when using radar. We found that radar is generally a useful tool for decision-making except when a storm event was stationary. Participants use their personal experiences and knowledge of past weather events when they use a radar display. We also discovered that deciding how much time is available before rain occurs is often overestimated. These findings are helpful to understand how individuals use weather radar to make decisions that may help us to better understand protective action behavior.
Embracing Market Liberalism? Community Structure, Embeddedness, and Mutual Savings and Loan Conversions to Stock Corporations
Authors: Schneiberg Marc , Goldstein Adam , Kraatz Matthew S.
Published: December 2022

Integrating research on communities with economic and organizational sociology, we analyze how organizations’ responses to marketization are shaped by their embeddedness in communities and the socio-associational structure of those communities. We address these relations via event-history analyses of mutual conversions to stock corporations among savings and loan associations (SLAs) in the United States, a population of depositor-owned and traditionally community-based banks that demutualized amid deregulation during the 1970s and 1980s. Consistent with accounts of social disorganization and declining social capital, SLA managers abandoned mutual for corporate enterprise as SLAs became less locally embedded, and where communities experienced disorganization and declining working- or cross-class associationalism. Yet conversions also depended on elite detachment, civic reorganization, bifurcation within communities, and “upwardly oriented” associations that helped SLA managers reorient SLAs from Main Street to Wall Street. Through this study, we look beyond networks, institutions, and categories to add communities and local associations to economic sociology’s toolkit for understanding the social foundations of firms and markets. We show how financialization coupled macro-level political-institutional dynamics of marketization with community-level dynamics of elite disconnection, class and ethno-racial fracture, and civic reorganization, while also shedding light on the contemporary fates of mutual and cooperative forms.
Conflicting Imperatives? Ethnonationalism and Neoliberalism in Industrial Relations
Authors: Preminger Jonathan , Bondy Assaf S.
Published: December 2022

Based on a case study of non-citizen Palestinian workers in the Israeli construction sector, this article explores the dynamic relationship between the exclusionary imperative of ethnonationalism and the inclusionary imperative of neoliberalism. The authors argue that these imperatives together constitute a heuristically useful framework that can help to explain the choices of social actors and the constraints on these choices, as well as the apparently contradictory developments that affect industrial relations institutions and the employment relationship more broadly. While neoliberalism generally weakens organized labor, the study shows how the dynamic between these two imperatives can open space for the inclusion of disenfranchised ethnonational groups within collective labor relations—a first step to political empowerment. The study thus re-asserts the importance of organized labor as a powerful actor able to engender progressive change, even for the “ethnonational other” under rigidly ethnonationalistic regimes.
Activism in the Digital Age: The Link Between Social Media Engagement With Black Lives Matter-Relevant Content and Mental Health
Authors: Marshall Iyanna C. , Hammer Lillian A. , Springfield Cassi R. , Bonfils Kelsey A.
Published: December 2022

Introduction: Research shows that participation in political activism on social media is linked to psychological stress. Additionally, race-based stress disproportionately affects minorities and is linked to greater psychological symptoms. Yet, the impact of the social media presence of Black Lives Matter (BLM) on mental health has yet to be meaningfully assessed.

Methods: This study assessed whether engagement with BLM-related social media vignettes was related to mental health symptoms in two non-clinical samples (total N = 389), using a mixed-methods design. Participants completed an online survey with social media vignettes, self-report inventories of mental health symptoms, and open-ended questions about experiences with and the impact of BLM.

Results: Correlations revealed that greater engagement with BLM-related social media posts was related to more severe mental health symptoms. Further, moderation analyses revealed that race significantly moderated the relationship between engagement and anxiety and trauma-related symptoms, such that these relationships were stronger for participants who identified as racial minorities. Qualitative analyses revealed that most participants who were engaged in mental health treatment had not discussed BLM-related topics with their providers, despite many participants reporting disrupted relationships and negative emotions due to exposure to BLM-related social media content.

Discussion: Taken together, results suggest that engagement with BLM-related content online is linked to increased mental health symptoms, but these issues are infrequently addressed in treatment. Future research should extend these findings with clinical samples, assess the comfort of therapists in addressing these topics in therapy, and develop interventions to improve mental health in digital activists.
Urinary bladder recurrences following ureteroscopic biopsies of upper tract urothelial cancers: a multi-centre observational study with genomic assessment for clonality
Authors: Anbarasan Thineskrishna , Nissar Sheikh , Turbitt Julie , Walls Kathryn , McLuckie Sarah , Clark Caroline , Bourdon Jean-Christophe , Tracey Joel , Bray Susan , Shamsuddin Atlaf , Alcorn Jason , Jain Sunjay , Hislop Robert , Biyani Chandra Shekhar , Nabi Ghulam
Published: December 2022

Background and aims

Urinary bladder recurrences (UBRs) after radical nephroureterectomy (RNUx) are a known challenge in patients with upper-tract urothelial cancers (UTUCs). We aim to assess factors associated with UBR and clonal-relatedness with resected UTUC.

Methods

Patients who underwent RNUx for UTUC between 1998 and 2015 in five institutions were identified. Clonal relatedness between primary UTUC and subsequent UBR in a sub-cohort was assessed using next-generation sequencing. A Kaplan–Meier curve was used to assess differences in UBR between two groups (with or without ureteroscopic biopsy).

Results

Of 267 patients with complete records, 73 (27.3%) had UBR during follow-up. The five-year UBR-free survival in all patients was 64.7%. The five-year UBR-free-survival was inferior in patients who underwent URS biopsy compared with patients who did not undergo ureteroscopic biopsy (49.9% vs 76.4%, p < 0.001). History of bladder tumour (HR, 95% CI; 2.94, 1.73–5.00, p < 0.001), ureteroscopic biopsy (HR, 95% CI; 2.21, 1.38–3.53, p = 0.001) and preoperative urine cytology ≥C3 (HR, 95% CI; 2.06, 1.24–3.40, p = 0.005) were independently associated with UBR. Patients with ureteroscopic biopsy (n = 3/5) showed identical mutational changes for common genes ( TP53 and FGFR3) between primary UTUC and subsequent UBR.

Conclusions

Ureteroscopic biopsy of UTUC is a significant risk factor for UBR. Qualitative clonality assessment showed identical mutational signatures between primary UTUC and UBR.
Public Attitudes to Immigration in the Aftermath of COVID-19: Little Change in Policy Preferences, Big Drops in Issue Salience
Authors: Dennison James , Kustov Alexander , Geddes Andrew
Published: December 2022

How has the COVID-19 pandemic affected public attitudes toward immigration? Long-term evidence in Europe and the United States suggests attitudes to immigration are relatively stable and, in some cases, becoming more favorable with high volatility instead of the perceived importance of the issue. However, theoretically a global pandemic could exacerbate people's fears of outsiders or that migration may contribute to the disease. By contrast, attitudes could remain stable if their distal drivers prove to be robust enough to withstand the shock of COVID-19. We draw from Eurobarometer data from 2014 to 2021 across 28 European countries, weekly national survey data during the outbreak from the United States and individual panel data from the United Kingdom and Germany to find little systematic change in immigration preferences and no country-level correlation between the observed changes and the outbreak's severity. Instead, the perceived importance of immigration has consistently and significantly decreased. These findings suggest that, if COVID-19 is to have an impact on attitudes to migration, it is likely to emerge via longer-term means, such as early-life socialization and value change, rather than reactions to the immediate pandemic shock.
The Mediating Role of Relational and Transactional Psychological Contract Fulfilment on the Relationship between Strength of the HR Signals and Job Satisfaction
Authors: Bandyopadhyay Chiradip , Srivastava Kailash B. L.
Published: December 2022

The article is an employee-level, quantitative survey-based study investigating the relationship between HR signals and job satisfaction through the intermediary role of psychological contract (PC) fulfilment. Signalling theory and attributional theory provide the theoretical context to the study linking HR signals to job satisfaction. PC fulfilment has been viewed in terms of relational and transactional contract types. Analysis of the mediating ability of the two PC types reveals the differential extent of influencing the considered relationship. Primary data, in terms of employee responses from participating firms, have been collected through questionnaires. A two-step sampling process has been followed to select participating firms and respondents. Structural equation modelling has been carried out to examine the hypothesized relationships among the variables. The study contributes to the literature and has implications for practising managers. It provides evidence towards the attributional role of HR signals within firms. Moreover, it reveals a higher mediating effect by relational PC fulfilment than transactional PC fulfilment. Based on the study’s findings, practising managers need to pay closer attention to relational PCs than transactional PCs. The study contributes to a better understanding of the role of HR signals in manufacturing sector firms. The time, cost incurred for the survey and accessibility to firms for participation are some of the significant limitations affecting the study.
Assessing the impact of a health navigator on improving access to care and addressing the social needs of palliative care patients experiencing homelessness: A service evaluation
Authors: Robinson Lilian , Trevors Babici Leeann , Tedesco Alissa , Spaner Donna , Morey Trevor , Dosani Naheed
Published: December 2022

Background:

Health navigators are healthcare professionals who specialize in care coordination, case management, navigating transitions, and reducing barriers to care. There is limited literature on the impact of health navigators on community-based palliative care for people experiencing homelessness.

Aim:

We devised key performance indicators in nine categories with the aim to quantify the impact of a health navigator on the delivery of palliative care to patients experiencing homelessness.

Design:

Data were collected prospectively for all patient encounters involving a health navigator from July 2020 to 2021 and reviewed to determine the distribution of the health navigator’s role and the ways in which patient care was impacted.

Setting and participants:

This study was conducted in Toronto, Ontario with the Palliative Education and Care for the Homeless (PEACH) Program. At any one time, the PEACH health navigator served a total of 50 patients.

Results:

We identified five key areas of the health navigator role including (1) facilitating access (2) coordinating care (3) addressing social determinants of health (4) advocating for patients, and (5) counselling patients and loved ones. The health navigator role was split evenly between activities pertaining to palliative care for structurally vulnerable populations and community-based palliative care for the general population. To achieve high impact outcomes, a considerable investment of time and energy was required of the health navigator, speaking to the importance of adequate and sustainable funding.

Conclusions:

These findings underscore the potential for health navigators to add value to community-based palliative care teams, especially those caring for structurally vulnerable populations.
Visual assessment and quantitative analysis of bone marrow edema in young and middle-aged versus elderly patients with vertebral compression fracture by spectral CT
Authors: Yao Junpeng , Jiang Wanli , Zhang Hong , Fan Zijian , Zhang Wei , Zhuang Shunda , Wang Jianguo
Published: December 2022

Background

For the diagnosis of bone marrow edema (BME), spectral computed tomography (CT) has emerged as a promising technique.

Purpose

To study the different performances of spectral CT in the diagnosis of vertebral BME in young and middle-aged versus elderly patients.

Material and Methods

Magnetic resonance imaging (MRI) was used as the gold standard. To determine the existence of BME, spectral CT color-coded images of the vertebral bodies of 82 patients with vertebral compression fractures (VCFs) were visually inspected. A quantitative analysis of the spectral CT vertebral water concentration in the diagnosis of BME was performed using a receiver operating characteristic (ROC) curve. Patients were divided into two groups for comparison: the young and middle-aged group; and the elderly group.

Results

The sensitivity and specificity for visual assessment were 83.7% and 98.3%, respectively, in the young and middle-aged group and 96.8% and 98.2%, respectively, in the elderly group. The elderly group had a higher sensitivity than the young and middle-aged group ( P < 0.05). With a threshold of 1046.2 mg/cm3, the ROC curve for the young and middle-aged group displayed an area under the curve (AUC) of 0.870, sensitivity of 86.0%, and specificity of 81.4%. The threshold of 1031.4 mg/cm3 yielded a sensitivity of 95.2% and a specificity of 98.4%, and the AUC of the elderly group was 0.997. The elderly group had a higher level of specificity than the young and middle-aged group ( P < 0.05).

Conclusion

Spectral CT can reliably diagnose BME in VCFs, and it performs better in elderly people than in young and middle-aged people.
The role of different paths of technological progress in improving China's energy efficiency
Authors: Shao Jun , Wang Lianghu
Published: December 2022

Improving energy efficiency is one of the most effective ways to address environmental constraints and achieve high-quality economic development. The existing literature suggests that technological progress has an important impact on energy efficiency, but ignores the role of different paths of technological progress. Herein, the impact of different technological progress paths on energy efficiency was analyzed using the dynamic panel data model and the threshold model based on the energy efficiency measurement using the Meta-frontier and Nonradial Directional Distance Function model. The findings of this study were as follows: (1) During the study sample period, a fluctuating upward trend was observed in China's energy efficiency, and there were significant differences in energy efficiency in different regions of China. (2) The energy efficiency in China could be significantly improved by domestic innovation and regional technology diffusion. Even though the imported technologies do not play a significant role in promoting energy efficiency and have no positive effect on the improvement of energy efficiency from the perspective of domestic technology absorption or foreign technology absorption. (3) The eastern and central regions of China improve their energy efficiency through domestic innovation. However, none of the technological progress paths in the western and low-energy-efficiency regions have played a positive role in promoting energy efficiency. (4) The effect of promoting domestic innovation and regional technology diffusion on energy efficiency is gradually increasing with human capital improvement, and the restriction of foreign technology import on energy efficiency has obviously decreased. In a nutshell, different paths of technological progress have differential effects on energy efficiency improvements. Based on the above results, this paper makes some targeted policy recommendations on the choice of technological progress paths to improve energy efficiency in different regions of China.
Signaling Theory in Entrepreneurship Research: A Systematic Review and Research Agenda
Authors: Bafera Julian , Kleinert Simon
Published: December 2022

A rapidly expanding body of entrepreneurship literature draws on signaling theory. Yet as the field grows, common understanding of the theory’s underlying constructs has become increasingly fuzzy and riddled with ambiguities. To establish a common ground for entrepreneurship scholars, we take stock of 172 articles in a systematic literature review and develop a taxonomy of signal constructs. In an effort to increase the clarity of signal constructs further, we apply this taxonomy to assess the signal constructs’ boundary conditions, relationships, and interplays with complementary theories in entrepreneurship contexts. Finally, we leverage the novel insights to identify promising opportunities for further theory-based developments in the field.
Fast-Track for Total Ankle Replacement: A Novel Enhanced Recovery Protocol for Select Patients
Authors: Usuelli Federico G. , Paoli Tommaso , Indino Cristian , Maccario Camilla , Di Silvestri Claudia Angela
Published: December 2022

Background:

Enhanced recovery after surgery programs, also called fast-track protocols, were developed and successfully applied in the last decade for hip and knee reconstruction. Specific fast-track protocols have not yet been applied to ankle prostheses. The aim of the study was to develop and validate an enhanced recovery protocol for total ankle replacement (TAR) evaluating the clinical and radiographic results. We hypothesize that on the basis of well-defined pre- and postoperative characteristics, the current knowledge on ankle replacement, and referring to hip and knee reconstruction, it is possible to identify a "patient type" to be safely eligible to a Fast-Track Protocol with at least comparable results and without increasing the complications risk.

Methods:

We identified 8 predictive variables that might affect the outcome of TAR. Those variables were the body mass index, the state of anxiety or depression, the functional preoperative status, ankle equinus, the coronal malalignment, the surgical time, the surgical accessory procedures, and the bone quality. These characteristics were evaluated for each patient with almost validated outcome tools attributing a specific score. Based on the score obtained, the patients were divided into 2 groups: the Standard Protocol group (Control Group) and the Fast-Track Protocol group (Study Group). The main difference between treatment of the 2 groups relates to the use of postoperative plaster casts: in the Fast-Track group the cast was removed the first day after surgery and walking was allowed in sports shoes assisted with crutches, whereas in the Standard Protocol group, the cast was removed after 3 weeks. Clinical and radiographic evaluation was performed for all patients preoperatively and postoperatively every 6 months.

Results:

A total of 163 patients received a score between 1 and 5 and were included in the control group (Standard Protocol); 47 patients received a score of 0 and were allocated to the study group (Fast-Track Protocol). Clinically, except for the preoperative American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale score, no statistically significant differences were recorded in the multiple comparisons between the 2 groups. No significant differences were found regarding complications.

Conclusion:

In selected patients, it is possible to apply an enhanced recovery protocol of rehabilitation, focused on immediate weightbearing and mobilization without any plaster or boot.

Level of Evidence:

Level II, prospective comparative study.
Vasoproliferative retinal tumors: Clinical presentation and treatment outcome
Authors: Kiri Hardik , Raval Vishal , Ali Hasnat , Das Anthony Vipin , Kaliki Swathi
Published: December 2022

Objective

To study the clinical presentation and treatment outcomes of patients with vasoproliferative retinal tumor (VPRT) in India.

Methods

Retrospective study of 50 eyes in 47 patients.

Results

Of the 50 eyes, 25 (50%) were primary and 25 (50%) were secondary. Common ocular pathologies related to secondary VPRT included retinal detachment (n = 8, 32%) and Coats disease (n = 7, 28%). Overall, the mean age at presentation was 35 years (range; 3–74 years) and included 30 (64%) males and 17 (36%) females. The lesions were unilateral in 44 (94%) patients. Secondary retinal features included intra/subretinal exudation (n = 41, 82%), vascularity (n = 32, 64%), subretinal fluid (n = 21, 42%), retinal neovascularisation (n = 9, 18%) and vitreous hemorrhage (n = 8, 16%). Thirty-four eyes (68%) underwent cryotherapy, of which 16 eyes (47%) received adjunct intravitreal anti-VEGF (12 eyes) or corticosteroid injection (4 eyes). Primary surgery included vitrectomy with/without encirclage and cryotherapy (n = 12, 24%) and plaque brachytherapy (n = 3, 6%). At last follow-up (mean 9.7 months, range 3–67 months), 42 eyes (84%) had complete tumor regression with no improvement in visual outcomes when comparing presenting and final best corrected visual acuity. Comparing primary versus secondary VPRT, secondary VPRT presented a decade earlier (31 vs 40 years), needed surgical intervention (48% vs 20%), had poor tumor control (72% vs 92%) and worse visual outcomes ( p < 0.05).

Conclusion

VPRTs commonly present as a unilateral lesions in the adult population with equal prevalence of primary and secondary variants. Compared with primary VPRT, secondary VPRTs require surgical treatment and are associated with poor visual outcome.
Dear Health Promotion Scholar: Letters of Life From, for, and About Black Women in Academia
Authors: Wright LaNita S. , Iwelunmor Juliet , Sims Jeanetta D.
Published: December 2022

Black women are change agents actively working within their power to combat systemic racism in academia, while constantly battling injustices. Understanding lived realities and experiences of racial ethnic minority women as “outsiders within” is crucial for confronting long-standing racism embedded within academic spaces. Institutions may be outwardly addressing racial injustice, and perpetuating injustices internally, whether known or unknown. Using a relational dialectics framework and letter writing style, the purpose of this commentary is to describe the complexities present in experiences of Black women as they navigate academia as change agents, from the perspectives of tenure track and tenured faculty members in predominately White institutions. Black women academics contend with the push and pull of being in relationship with students, colleagues, and predominately White institutions; these tensions illuminate the experience of both/and-ness creating a constant presence of uncertainty/certainty, pushing/pivoting, and conforming/disrupting among others. Black women faculty are actively working to overcome barriers in research and practice and actively recognizing how racism is acting in academic settings. Black women are dealing with their own personal/professional situations, while also advocating interpersonally through mentorship, institutionally through incorporating underrepresented voices in research/practice, and strategically through addressing policies prompting action. This commentary shares the breadth, scope, and uniqueness of Black women experiences in higher education. This article concludes with implications for practice, including utilizing dialectic introspection to illuminate Black women, disrupting the norm by utilizing letters to center Black women, and building collectives to foster connections.
Psychometric Properties of a New Measure of Upper Limb Performance in Post-Stroke Individuals: Trunk-Based Index of Performance
Authors: Piscitelli Daniele , Baniña Melanie C. , Lam Timothy K. , Chen Joyce L. , Levin Mindy F.
Published: December 2022

Background

Several measures of upper limb (UL) motor tasks have been developed to characterize recovery. However, UL performance and movement quality measures in isolation may not provide a true profile of functional recovery.

Objective

To investigate the measurement properties of a new trunk-based Index of Performance (IPt) of the UL combining endpoint performance (accuracy and speed) and movement quality (trunk displacement) in stroke.

Methods

Participants with stroke (n = 25, mean time since stroke: 18.7 ± 17.2 months) performed a reaching task over 3 evaluation sessions. The IPt was computed based on Fitts’ Law that incorporated endpoint accuracy and speed corrected by the amount of trunk displacement. Test–retest reliability was analyzed using intraclass correlation coefficient (ICC) and Bland–Altman plots. Standard error of measurement (SEM) and Minimal Detectable Change (MDC) were determined. Validity was investigated through the relationship between IPt, Fugl–Meyer Assessment (FMA-UE), and Action Research Arm Test (ARAT), as well as the ability of IPt to distinguish between levels of UL motor impairment severity.

Results

Test–retest reliability was excellent (ICC = .908, 95% CI: 0.807-0.96). Bland–Altman did not show systematic differences. SEM and MDC95 were 14% and 39%, respectively. Construct validity was satisfactory. The IPt showed low-to-moderate relationships with FMA-UE ( R2 ranged from .236 to .428) and ARAT ( R2 ranged from .277 to .306). IPt scores distinguished between different levels of UL severity.

Conclusions

The IPt showed evidence of good reliability, and initial validity. The IPt may be a promising tool for research and clinical settings. Further research is warranted to investigate its validity with additional comparator instruments.
Exceptional exceptions: The case of the Working Time Directive
Authors: Barnard Catherine
Published: December 2022

The application of the Working Time Directive (WTD) 2003/88 has caused serious issues in those sectors needing 24 hours a day/seven days a week cover (24/7). Employers have explored whether they can take advantage of the opt-out from the 48-hour working week in Article 22 or rely on the range of derogations in the Directive. Of particular interest, however, is the use of the exceptions. These exceptions apply, for example, ‘where characteristics peculiar to certain specific public service activities, such as the armed forces or the police, or to certain specific activities in the civil protection services inevitably conflict’ with the WTD. The interpretation of the provisions on exceptions has led to a number of important cases, cases which will be considered in the article. I wish to argue that, consistent with its earlier approach, the Court has maintained that the WTD will, in principle, apply to workers, even in those sectors requiring 24/7 cover. With this as its starting premise, the Court has then set the bar high for when it will accept that any of the exceptions will apply. The Court has even indicated, in the Slovenian Army case, that the Directive will apply to the military, much to the consternation of some Member States, albeit developing a new carve out for ‘military commitment’ activities. The Court also pays close attention to the text of the exceptions to ensure that employers are not misusing them. I will argue that the exceptions are indeed exceptional.
Association between ABO blood groups and postoperative pain in children after adenotonsillectomy: a prospective cohort study
Authors: Shen Longyuan , Wu Jianwen , Xiao Quansheng , Hong Mingyan , Wang Shengzhao , Wang Jingti , Luo Qichen , Lin Xiongda , Lian Jianfeng , Xu Yibin , Guo Guoqing , Wu Junzheng
Published: December 2022

Background

It has been known that ABO blood groups are linked to the phenotypes of certain diseases; however, and the relationship between ABO blood groups and postoperative pain have not been extensively studied, especially in children. This study was to investigate whether there would be an association between the four major ABO blood groups and postoperative pain, as indicated by the differences in pain scores and rescue fentanyl requirements among blood groups in children after adenotonsillectomy.

Methods

A total of 124 children, aged 3–7 years, ASA I or II, and undergoing elective adenotonsillectomy were enrolled in the study. Postoperative pain was evaluated using the Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) and the rescue fentanyl requirement in post anesthesia care unit (PACU) was analyzed. Pediatric Anesthesia Emergence Delirium (PAED) score and the duration of PACU were recorded. The postoperative nausea and vomiting (PONV) within 24 h were documented.

Results

Among four blood type groups, no significant differences were observed regarding surgery time, and the gaps of fentanyl given at the anesthesia induction and the first rescue fentanyl injection in PACU. However, patients from AB and B blood groups had significantly higher pain score at initial CHEOPS assessment and consequently, higher consumption of rescue fentanyl during PACU stay. A significantly higher percentage of patients had received > 1 μg/kg rescue fentanyl. Higher PAED scores were also observed in AB and B blood groups.

Conclusion

Paediatric patients with AB and B blood type had higher postoperative CHEOPS pain score and required significantly more fentanyl for pain control than those with A and O blood type after T&A. The initial scores of PAED in patients with AB and B blood type were also higher than that in patients with A and O blood type.
Comparison of anterior corneal aberrations measured by Scheimpflug and Placido Disc System for myopes
Authors: Lou Wei , Du Wei , Jin Haiying , Hu Ying
Published: December 2022

Background

To ascertain the agreement of corneal aberrations obtained from the Pentacam and the KR-1W in myopic populations and to investigate the influence of the level of myopia as well as the laterality on the agreement.

Methods

In this observational study, a rotating Scheimpflug camera (Pentacam AXL) and a Hartmann-Shack wavefront analyzer with Placido-disc topographer (KR-1W) were used to measure the aberrations of myopes in the anterior corneal surface by one experienced operator. All examinations were computed across a 6 mm diameter. Six subgroups were generated according to the degree of myopia (mild, moderate, and severe myopia) and the laterality of eyes (right and left eyes).

Results

The study included 245 eyes of 170 participants. For certain anterior corneal aberrations, statistically significant differences existed between the Pentacam and the KR-1W (allP < .05). The values of Zernike (Z)(2,0), Z(2,2), Z(3,1), and Z(4,0) varied in all levels of myopia regardless of the laterality, with the values of the Pentacam constantly larger than the KR-1W in the measurement of Z(2,0), Z(2,2), and Z(4,0). For 2nd to 6th aberrations, both instruments correlated poorly to moderately. The width of limits of agreement between the two instruments was clinically too wide (> 0.1 μm) for aberrations closely correlated with visual quality, including Z(3, ± 3), Z(3, ± 1), and Z(4,0), and almost all aberrations, indicating poor agreement.

Conclusions

In clinical practice, the Pentacam based on Scheimpflug technology and the KR-1W based on Placido Disc System are not interchangeable in measuring anterior corneal aberration for myopes regardless of myopia degree and the laterality, suggesting that a consistent instrument should be selected for surgical design as well as follow-up.
Multimodal intervention in 8- to 13-year-old French dyslexic readers: Study protocol for a randomized multicenter controlled crossover trial
Authors: Harrar-Eskinazi Karine Louna , De Cara Bruno , Leloup Gilles , Nothelier Julie , Caci Hervé , Ziegler Johannes C. , Faure Sylvane
Published: December 2022

Background

Developmental dyslexia, a specific and long-lasting learning disorder that prevents children from becoming efficient and fluent readers, has a severe impact on academic learning and behavior and may compromise professional and social development. Most remediation studies are based on the explicit or implicit assumption that dyslexia results from a single cause related to either impaired phonological or visual-attentional processing or impaired cross-modal integration. Yet, recent studies show that dyslexia is multifactorial and that many dyslexics have underlying deficits in several domains. The originality of the current study is to test a remediation approach that trains skills in all three domains using different training methods that are tailored to an individual’s cognitive profile as part of a longitudinal intervention study.

Methods

This multicenter randomized crossover study will be conducted in three phases and will involve 120 dyslexic children between the ages of 8 and 13 years. The first phase serves as within-subject baseline period that lasts for 2 months. In this phase, all children undergo weekly speech-language therapy sessions without additional training at home (business-as-usual). During the second phase, all dyslexics receive three types of intensive interventions that last 2 month each: Phonological, visual-attentional, and cross-modal. The order of the first two interventions (phonological and visual-attentional) is swapped in two randomly assigned groups of 60 dyslexics each. This allows one to test the efficacy and additivity of each intervention (against baseline) and find out whether the order of delivery matters. During the third phase, the follow-up period, the intensive interventions are stopped, and all dyslexics will be tested after 2 months. Implementation fidelity will be assessed from the user data of the computerized intervention program and an “intention-to-treat” analysis will be performed on the children who quit the trial before the end.

Discussion

The main objective of this study is to assess whether the three types of intensive intervention (phase 2) improve reading skills compared to baseline (i.e., non-intensive intervention, phase 1). The secondary objectives are to evaluate the effectiveness of each intervention and to test the effects of order of delivery on reading intervention outcomes. Reading comprehension, spelling performance and reading disorder impact of dyslexic readers are assessed immediately before and after the multimodal intervention and 2 months post-intervention.

Trial registration

ClinicalTrials.gov, NCT04028310. Registered on July 18, 2019.
Characteristics of medicine use for children with asthma in China: a nationwide population-based study
Authors: Wu Ping , Xu Baoping , Shen Adong , Zeng Huasong , Shen Kunling
Published: December 2022

Objective

To analyze the asthma medication use in Chinese children of different age groups, regions, and levels of cities in China, based on the 2015 Healthcare Insurance Data in China.

Methods

The China Healthcare Insurance Research Association (CHIRA) database was searched for children from 0 to 14 years old diagnosed as asthma based on the “J45” and “J46” coded in ICD-10. A cross-sectional study design was employed.

Results

A total of 308,550 children were identified, all of whom were treated under the coverage of healthcare insurance. Among them, 2,468 children were eligible for inclusion in the present study. Compared with the current status of asthma care in European and American countries, under the guidelines for the diagnosis and treatment of asthma in China, the use percentages of ICS and short-acting β2 receptor agonist in children with asthma in China were lower, but the use percentages of oral corticosteroids, long-acting β2 receptor agonist, and theophylline (especially intravenous theophylline) were higher, especially in the Central and West China.

Conclusion

The asthma medication use was attributed to many factors, thus efforts are still needed to further popularize the GINA programs and China's guidelines for asthma diagnosis and treatment, especially in the Central and West China.
Acute limb ischemia in an adolescent with COVID-19 and systemic scleroderma: a case report
Authors: Milan Mark Jason D. C. , Dans Leonila F. , Torres-Ticzon Vanessa Maria F.
Published: December 2022

Background

Juvenile Scleroderma is a rare autoimmune disease of the connective tissue. Its concurrence with COVID-19 can lead to limb ischemia as both disease entities are pro-inflammatory and pro-thrombotic. To date, there is no case report describing the symptomatology and course of disease in patients with juvenile Scleroderma and COVID-19.

Case presentation

An adolescent with acute limb ischemia presented with a history of generalized hypo-and-hyperpigmented skin lesions and mild, non-productive cough. She tested positive for SARS-CoV-2 on nasopharyngeal swab RT-PCR. Further work-up revealed elevated anti-phospholipid antibodies, anti-nuclear antibody, and D-dimer; low Protein S activity; and evidence of peripheral arterial disease on imaging studies. She was started on peripheral vasodilators, Methotrexate, and anticoagulation. Close monitoring of the affected limbs and other organs involved was done. Control of limb ischemia was achieved after 4 months of regular Cyclophosphamide infusion. Continued multi-disciplinary care was ensured for this patient.

Conclusion

There is evolving knowledge about the interplay of COVID-19 hyperinflammatory state and rheumatologic disorders. COVID-19 is thought to exacerbate cutaneous manifestations of autoimmune disorders via antigen protein mimicry and cytokine imbalance. Moreover, COVID-19 is characterized by complex hematopathologic processes that put a patient in a hypercoagulable state. Elevated D-dimer can be seen in both COVID-19 and systemic sclerosis owing to their pro-thrombotic sequela. There is scarcity of data on the association of Protein S activity with COVID-19 and systemic sclerosis. More studies need to be carried out to ultimately arrive at a consensus on thrombosis prophylaxis for patients with Scleroderma and COVID-19.
Development of the core of an ICF-based instrument for the assessment of work capacity and guidance in return to work of employees on sick leave: a multidisciplinary modified Delphi study
Authors: de Wind Astrid , Donker-Cools Birgit H. P. M. , Jansen Lyanne , Luymes Clare H. , van der Burg-Vermeulen Sylvia J. , Oomens Shirley , Anema Johannes R. , Schaafsma Frederieke G.
Published: December 2022

Background

Several occupational health disciplines are involved in return to work guidance, implying that good interdisciplinary collaboration is important. A shared conceptual framework and a common language for the assessment of work capacity and guidance in return to work is expected to be at the benefit of appropriate and sustainable employability of sick employees. The International Classification of Functioning, Disability and Health (ICF) can be considered a shared conceptual framework and is also promising in terms of a common language. The purpose of the current study is to reach multidisciplinary consensus among occupational health professionals on the content of an ICF-based instrument for the assessment of work capacity and guidance in return to work.

Methods

To obtain multidisciplinary consensus we conducted a modified Delphi study among twelve occupational health experts, including four occupational physicians, four insurance physicians and four labour experts. The study included two e-mail rounds and two virtual meetings. In the consecutive rounds the experts assessed ICF items as well as a list of non-ICF-based work-related environmental factors on their relevance for the assessment of the work capacity and guidance in return to work together with their interpretability.

Results

The four consecutive Delphi rounds resulted in 20 items that are minimally needed for the assessment of the work capacity and return to work possibilities of employees on sick leave. The final list included six items on personal functioning, seven items on social functioning and seven items on physical functioning.

Conclusions

This set of items forms the core of an ICF-based instrument, which is expected to facilitate interdisciplinary and intradisciplinary communication because of the use of a shared conceptual framework. As such, it should be of help in the guidance in return to work of employees on sick leave and contribute to appropriate and sustainable employability.
Development, outcome and costs of a simulation-based neurosurgery bootcamp at the national level
Authors: Bakhshi Saqib Kamran , Ahmad Rida , Merchant Asma Altaf Hussain , Noorali Ali Aahil , Abdul Rahim Komal , Shaikh Namra Qadeer , Afzal Noreen , Lakhdir Maryam Pyar Ali , Shamim Muhammad Shahzad , Haider Adil Hussain
Published: December 2022

Introduction

With a growing interest in simulation-based training to develop clinical proficiency, bootcamps have been utilized for imparting basic skills to medical trainees. While considerable research on the topic exists in high income countries, no such neurosurgical teaching standards have been employed in Low- and Middle-Income Countries.

Methods

We conducted a cross-sectional study to explore the effectiveness of first low-cost, multi-center regional neurosurgery bootcamp in South Asia. Twenty-two participants attended the bootcamp and practiced 12 hands-on skills over the course of 2 days. Burr-holes and craniotomies were done on 3D printed skulls. Lumbar drain insertion was practiced on a purpose-built lumbar puncture mannequin. For laminectomy, we used an in-house designed simulation. The modified Objective Structured Assessment of Technical Skills tool was utilized for skills Assessment. Feedback from faculty and residents was collected via a standard 5-point Likert scale.

Results

Only one participant (4.55%) had previously attended a neurosurgical skills workshop. Comparison of outcomes on 1st and 3rd attempts of cranial and spinal skills showed a significant improvement in all 14 domains assessed (p <0.05). Positive feedback was received ranging from 3.9 up to 4.8 on a 5-point Likert scale. Overall cost per participant culminated to $145, significantly lower than previously reported data.

Conclusion

Our findings report the effectiveness of sustainable, low-cost training models which can be easily reproduced elsewhere. These indigenously designed simulators can be modified for variable difficulty level and serve as an effective educational strategy in improving learners’ skills, knowledge and confidence.