bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating the appropriateness of elective surgery: The case of spinal fusion (arthrodesis)
Authors: Tozzi Valeria D , Pacileo Guglielmo , Ferrara Lucia
Published: September 2020

Introduction

Appropriateness is an essential element of quality of care. Several methods and tools have been developed to measure the appropriateness of care, however, none of these could be used to systematically support providers in keeping the appropriateness under control. Our study aimed to develop a framework to evaluate the appropriateness of care that took into account four dimensions of appropriateness: clinical dimension, equity, service delivery model, outcome.

Methods

We employed mixed-method approaches. These included a retrospective analysis of administrative data collected from Kinetika Sardinia (Italy) and a qualitative analysis of stakeholders’ experiences and perspectives aimed at supporting data collection, identification of improvement actions and definition of performance indicators. We used arthrodesis as a paradigmatic example of potentially inappropriate elective surgery.

Results

We collected data from 2,584 patients that underwent arthrodesis between January 1, 2010 and April 30, 2015. Based on the analysis and the exchanges with professionals, we identified 11 improvement actions. Monitoring and evaluation actions were finally conducted for 171 patients that underwent spinal fusion during the first semester of 2016 in order to assess if the improvement actions identified were put into practice and acquired desirable outcomes.

Conclusions

Our work provides a definition of appropriateness that goes beyond the clinical perspective and includes other perspectives (equity, service delivery and outcome); develops a framework and an approach that can be a valid help to systematically assess the appropriateness of elective surgery, adopt improvement actions, and monitor their impact; discusses what are the competencies necessary for measuring the appropriateness.
A ‘commonsense’ psychoanalysis: Listening to the psychosocial dreamer in interwar Glasgow psychiatry
Authors: Phelan Sarah
Published: September 2020

This article historicises a dream analytic intervention launched in the 1930s by Scottish psychiatrist and future professor of psychological medicine at the University of Glasgow (1948–73), Thomas Ferguson Rodger (1907–78). Intimate therapeutic meetings with five male patients are preserved within the so-called ‘dream books’, six manuscript notebooks from Rodger’s earlier career. Investigating one such case history in parallel with lecture material, this article elucidates the origins of Rodger’s adapted, rapport-centred psychotherapy, offered in his post-war National Health Service, Glasgow-based department. Oriented in a reading of the revealing fourth dream book, the article unearths a history of the reception and adaptation of psychoanalysis from within a therapeutic encounter and in a non-elite context. Situating Rodger’s psychiatric development in his Glasgow environment, it then contextualises the psychosocial narrative of the fourth book in relation to contrasting therapeutic commitments: an undiluted Freudianism and a pragmatic ‘commonsense’ psychotherapy, tempered to the clinical psychiatric, and often working-class, interwar Glasgow context. An exploration of pre-recorded dreams, transcribed free associations, and ‘weekly reports’ reveals that in practice, Rodger’s Meyerian attitude worked productively with Freudian techniques to ennoble the patient’s psychosocial testimony and personal wisdom. This psychotherapeutic eclecticism underpinned and made visible the patient’s concurrent faith in and resistance to psychoanalytic interpretation. Chronicling a collaborative route to psychotherapeutic knowledge within a discrete encounter, the article situates post-war treatment values in the interwar impasse of outpatient psychiatry.
Analysis and optimization for contact forces and transmission efficiency of an automotive ball joint
Authors: Feng Huayuan , Yin Zhihong , Shangguan Wen-Bin , Li Xihua , Luo Yong
Published: September 2020

Contact forces and transmission efficiency of an automotive ball joint constitute important design goals of an automotive drive shaft system, which affect transmission performances of the ball joint and the drive shaft system. In order to analyze contact forces and transmission efficiency more comprehensively, a multi-body dynamic model for calculating contact forces and transmission efficiency of a ball joint is established. The effectiveness of the multi-body dynamic model is validated through experiments of contact forces and transmission efficiency of a ball joint. Based on the developed multi-body dynamic model, influences of the articulation angle, the ball number and the track offset on contact forces between the ball and the cage, and between the ball and the track are analyzed. To enhance the analysis and optimization efficiency of transmission efficiency, a proxy model for the transmission efficiency loss late is established on the basic of the multi-body dynamic model. Influences of the ball radius, the articulation angle, the friction coefficient, the central angle of the cross section of the cage rib, and the contact stiffness and the force exponent of contact pairs on the transmission efficiency loss late are analyzed. Using Sobol’ global sensitivity analysis method, the sensitivity of the proxy model is analyzed and influences of various factors on the transmission efficiency loss late are further determined. According to sensitivity analysis results, the articulation angle, the friction coefficient and the force exponent are selected as design parameters, and the transmission efficiency loss late is optimized through a numerical example.
Libraries of Sanctuary
Authors: Vincent John , Clark Barry
Published: September 2020

This article looks at public libraries in the United Kingdom, starting with some historical background, and then concentrating on their current role in working towards becoming Libraries of Sanctuary.
Characteristic model–based adaptive fault-tolerant control for four-PMSM synchronization system
Authors: Gao Yang , Wu Yifei , Wang Xiang , Chen Qingwei
Published: September 2020

In four-motor servo systems, actuator failures influence control performance seriously through huge inertia ratio changes and unknown disturbances. To solve this problem, an adaptive fault-tolerant control scheme based on characteristic modeling and extended state observer is proposed. First, an adaptive sliding mode observer is designed as fault detection part and offers motor information for controller. Second, to simplify complex dynamic model, this servo system is described by a second-order difference equation. This model integrates uncertainties into three time–varying characteristic parameters to reflect system status. Third, a discrete-time extended state observer is applied to restrain system error caused by actuator failure. Then, a fault-tolerant controller is designed based on characteristic model, and its stability is guaranteed in the sense of Lyapunov stability theorem. These four parts make up the adaptive control scheme and its effectiveness in system control, and fault tolerant is evaluated by both simulation and experiment results.
Designing and implementation of a novel online adaptive control with optimization technique in hard turning
Authors: Pourmostaghimi Vahid , Zadshakoyan Mohammad
Published: September 2020

Determination of optimum cutting parameters is one of the most essential tasks in process planning of metal parts. However, to achieve the optimal machining performance, the cutting parameters have to be regulated in real time. Therefore, utilizing an intelligent-based control system, which can adjust the machining parameters in accordance with optimal criteria, is inevitable. This article presents an intelligent adaptive control with optimization methodology to optimize material removal rate and machining cost subjected to surface quality constraint in finish turning of hardened AISI D2 considering the real condition of the cutting tool. Wavelet packet transform of cutting tool vibration signals is applied to estimate tool wear. Artificial intelligence techniques (artificial neural networks, genetic programming and particle swarm optimization) are used for modeling of surface roughness and tool wear and optimization of machining process during hard turning. Confirmatory experiments indicated that the efficiency of the proposed adaptive control with optimization methodology is 25.6% higher compared to the traditional computer numerical control turning systems.
Synthesis of PEGylated nanographene oxide as a nanocarrier for docetaxel drugs and anticancer activity on prostate cancer cell lines
Authors: Tas Ayca , Keklikcioglu Cakmak Nese
Published: September 2020

Graphene oxide (GO) has recently been considered one of the most promising carbon derivatives in nanotechnology. It has many excellent features such as tumor targeting ability, biocompatibility and low toxicity. Therefore, we conjugated docetaxel (DTX) to GO-PEG molecule and investigate its anticancer efficacy in prostate cancer cell line (DU-145). In order to obtain GO-PEG-DTX molecules, we conjugated the DTX via bonds to PEG chains pegylated to the GO surface. We also investigated the stability of GO-PEG-DTX in different biological fluids such as cell mediums, PBS and water in vitro conditions. GO-PEG-DTX has the highest zeta potential in water. In the current research SEM, UV-Vis, and FTIR analyses and zeta potential were utilized for the characterization of nano-sized GO-PEG-DTX. Anticancer efficacy of GO-PEG-DTX were then investigated in DU-145 prostate cancer cell line using MTT metod. The prostate cancer cells were treated by different concentrations of GO-PEG-DTX, GO-PEG, GO, and DTX (1–100 µg/ml) during 24, 48 and 72 h. The spectrophotometric analyzed values at 570 nm were recorded and analysed with Graphpad Prism7. IC50 growth inhibition values was determined. The data showed that the GO-PEG-DTX had a highly effective anticancer activity on prostate cancer cell lines after 24, 48 and 72 hours compared to other molecules. GO-PEG-DTX was found statistically significant in the DU-145 cell line (***p < 0.0001, **p < 0.001, and *p < 0.01). As a result, it can be said that PEGylated GO is an excellent nanocarrier system for the high anticancer activity of DTX. Loading of anticancer drugs using this type of graphene-based nano carrier and delivery to targeted tissues may find potential application in biomedicine.
Gene expression in rat placenta after exposure to di(2-ethylhexyl) phthalate
Authors: Xu Wan , Wu Hongyan , Shang Lixin
Published: September 2020

The organic compound di(2-ethylhexyl) phthalate (DEHP) is widely used as a plasticizer in many products. Exposure to DEHP has been reported to lead to adverse pregnancy outcomes by suppressing placenta growth and development. The aim of this study was to determine the gene expression profiles of rat placenta exposed to (DEHP) and identify genes crucial for the DEHP response. Three groups of Wistar rats were administered an intragastric dose of 1,000 mg/kg DEHP, 500 mg/kg DEHP, or corn oil, RNA was isolated from placenta tissue, and hybridization was performed. Gene expression profiles were analyzed by identifying functional enrichment, differentially expressed genes (DEGs), protein–protein interaction (PPI) networks and modules, and transcription factor (TF)-miRNA-target regulatory networks. We obtained 2,032 DEGs, including cytochrome P450, family 2, subfamily R, polypeptide 1 (CYP2R1), sterol O-acyltransferase 2 (SOAT2), and 24-dehydrocholesterol reductase (DHCR24) from the steroid biosynthesis pathway and somatostatin receptor 4 (SSTR4) and somatostatin receptor 2 (SSTR2) in the neuroactive ligand-receptor interaction pathway. The PPI network included 476 nodes, 2,682 interaction pairs, and three sub-network modules. Moreover, eight miRNAs, three TFs, and 176 regulatory pairs were obtained from the TF-miRNA-target regulatory network. CYP2R1, SOAT2, DHCR24, SSTR4, and SSTR2 may affect DEHP influence on rat placenta development.
The effect of ranitidine administration in graded dosage to the degree of liver damage: A study on Wistar rats with acute methanol intoxication
Authors: Nugrahanti MP , Armalina D , Partiningrum DL , Fulyani F
Published: September 2020

The high incidence of alcoholic poisoning in Indonesia is caused by the use of methanol as a surrogate ingredient of nonconforming alcohol. The product of methanol metabolism is toxic to the liver. Ranitidine has been studied as an antidote to reduce the effect of methanol toxicity. The present study aimed to assess the effect of ranitidine administration on the liver damage of Wistar rats with acute methanol intoxication. This research was an experimental study with randomized and posttest-only control group design. A total of 24 male Wistar rats divided into four groups, each consisting of six Rats. The control group (K0) served as a reference normal value. The control group (K1) was intoxicated with methanol 7 g/kg body weight (b.w.) through rat gavage tube. Treatment groups were intoxicated with methanol and 15 minutes after that, Ranitidine (30 mg/kg b.w. (P1) or 60 mg/kg b.w. (P2)) was given intraperitoneally. Ranitidine administration was proven to protect the liver tissue from damage due to methanol intoxication as was indicated from the histopathological examination. Ranitidine with dose 60 mg/kg b.w. is better in reducing the degree of liver tissue damage in acute methanol intoxication rats.
Ablation of small conductance calcium-activated potassium type-2 channel (SK2) delays occurrence of bupivacaine-induced cardiotoxicity in isolated mouse hearts
Authors: Chen H , Xia F , Chen X , Cai Y , Jin Z
Published: September 2020

Bupivacaine is frequently used for conducting regional anesthesia. When accidentally injected or excessively absorbed into circulation, bupivacaine can induce severe arrhythmia and potentially lead to cardiac arrest. The specific mechanisms underlying this cardiotoxicity, however, remain to be clarified. We transfected HEK-293 cells to express the small conductance calcium-activated potassium type-2 channel (SK2), and used a whole-cell patch clamp method in order to explore how bupivacaine affected these channels. We subsequently used SK2 knockout mice to explore the relevance of SK2 channels in bupivacaine-induced cardiotoxicity in isolating mouse hearts, mounting them on a Langendorff apparatus, and perfusing them with bupivacaine. Using this system, arrhythmia, asystole, and cardiac functions were monitored. We observed dose-dependent inhibition of SK2 channels by bupivacaine: half-maximal inhibitory concentration (IC50) value = 18.6 μM (95% CI 10.8–32.1). When SK2 knockout (SK2 −/−) or wild-type (WT) mice were perfused with Krebs-Henseleit buffer (KHB), we did not observe any instances of arrhythmia. When SK2 −/− mice or WT were perfused with KHB containing bupivacaine (40 μM), the time to arrhythmia (Tarrhythmia) and time to asystole (Tasystole) were both significantly longer in SK2 −/− mice relative to WT mice ( P < 0.001). Similarly, SK2 −/− mice exhibited a significantly longer time to 25%, 50%, and 75% reductions in heart rate (HR) and rate-pressure product (RPP) relative to WT mice following bupivacaine perfusion ( P < 0.001). These results reveal that bupivacaine was able to mediate a dose-dependent inhibition of SK2 channels in HEK-293 cells, and deletion of SK2 channels can delay bupivacaine-induced cardiotoxicity in isolated mouse hearts.
Bisphenol A as a risk factor for allergic rhinitis in children
Authors: Nalbantoğlu A , Çelikkol A , Samancı N , Günaydın NC , Nalbantoğlu B
Published: September 2020

Aim:

Bisphenol-A (BPA) is an endocrine disrupting compound and may exacerbate or induce allergic diseases. To the best of our knowledge, there is little evidence regarding the effects of BPA exposure on allergic rhinitis (AR) in children. In the present study, we sought to examine whether exposure to BPA in children is associated with AR.

Methods:

This study was designed as a case controlled clinical study. 140 children diagnosed as allergic rhinitis and 140 healthy children as control group were recruited. BPA, interleukin-4, interleukin-13, total IgE and interferon-gamma levels were determined. Skin prick tests were performed in patient group. Total nasal symptom score and ARIA classification were used to predict disease severity.

Results:

Serum IL-4, IgE and BPA levels of children with allergic rhinitis were found to be significantly higher than the control group. BPA and IL-4 levels were significantly higher in moderate to severe-persistent group. There was a positive correlation between total nasal symptom scores and Bisphenol A levels in children with allergic rhinitis.

Conclusions:

The present study is the first to observe statistically significant relationship between BPA concentrations and allergic rhinitis in children. Also increased levels of BPA are associated with disease severity.
Understanding between-cluster variation in prevalence and limits for how much variation is plausible
Authors: Chatfield Mark D , Farewell Daniel M
Published: September 2020

In clinical trials and observational studies of clustered binary data, understanding between-cluster variation is essential: in sample size and power calculations of cluster randomised trials, for example, the intra-cluster correlation coefficient is often specified. However, quantifications of between-cluster variation can be unintuitive, and an intra-cluster correlation coefficient as low as 0.04 may correspond to surprisingly large between-cluster differences. We suggest that understanding is improved through visualising the implied distribution of true cluster prevalences – possibly by assuming they follow a beta distribution – or by calculating their standard deviation, which is more readily interpretable than the intra-cluster correlation coefficient. Even so, the bounded nature of binary data complicates the interpretation of variances as primary measures of uncertainty, and entropy offers an attractive alternative. Appealing to maximum entropy theory, we propose the following rule of thumb: that plausible intra-cluster correlation coefficients and standard deviations of true cluster prevalences are both bounded above by the overall prevalence, its complement, and one third. We also provide corresponding bounds for the coefficient of variation, and for a different standard deviation and intra-cluster correlation defined on the log odds scale. Using previously published data, we observe the quantities defined on the log odds scale to be more transportable between studies with different outcomes with different prevalences than the intra-cluster correlation and coefficient of variation. The latter increase and decrease, respectively, as prevalence increases from 0% to 50%, and the same is true for our bounds. Our work will help clinical trialists better understand between-cluster variation and avoid specifying implausibly high values for the intra-cluster correlation in sample size and power calculations.
Estimating model-based nonnegative population marginal means in application to medical expenditures covered by different health care policies – A study on Medical Expenditure Panel Survey
Authors: Tian Mingmei , Yu Jihnhee
Published: September 2020

The medical care expenditure is historically an important public health issue, which greatly impacts the government’s health policies as well as patients’ financial and medical decisions. In population health research, we commonly discretize a numeric attribute to a few ordinal groups to examine population characteristics. Oftentimes, the population marginal mean estimation by the ANOVA approach is inflexible since it uses pre-defined grouping of the covariate. In this paper, we propose a method to estimate the population marginal mean using the B-spline-based regression in a manner of a generalized additive model as an alternative for the ANOVA. Since the medical expenditure is always nonnegative, a Bayesian approach is also implemented for the nonnegative constraint on the marginal mean estimates. The proposed method is flexible to estimate marginal means for user-specified grouping after model fitting in a post-hoc manner, a clear advantage over the ANOVA approach. We show that this method is inferentially superior to the ANOVA through theoretical investigations and an extensive Monte Carlo study. The real data analysis using Medical Expenditure Panel Survey data assisted by some visualization tools demonstrates an applicability of the proposed approach and leads us some interesting observations that may be relevant to public health discussions.
Transplanted Antler Stem Cells Stimulated Regenerative Healing of Radiation-induced Cutaneous Wounds in Rats
Authors: Rong Xiaoli , Zhang Guokun , Yang Yanyan , Gao Chenmao , Chu Wenhui , Sun Hongmei , Wang Yimin , Li Chunyi
Published: September 2020

Radiation-induced cutaneous injury is the main side effect of radiotherapy. The injury is difficult to cure and the pathogenesis is complex. Mesenchymal stem cells (MSCs) serve as a promising candidate for cell-based therapy for the treatment of cutaneous wounds. The aim of the present study was to investigate whether antler stem cells (AnSCs) have better therapeutic effects on radiation-induced cutaneous injury than currently available ones. In this study, a rat model of cutaneous wound injury from Sr-90 radiation was used. AnSCs (1 × 106/500 μl) were injected through the tail vein on the first day of irradiation. Our results showed that compared to the control group, AnSC-treated rats exhibited a delayed onset (14 days versus 7 days), shorter recovery time (51 days versus 84 days), faster healing rate (100% versus 70% on day 71), and higher healing quality with more cutaneous appendages regenerated (21:10:7/per given area compared to those of rat and human MSCs, respectively). More importantly, AnSCs promoted much higher quality of healing compared to other types of stem cells, with negligible scar formation. AnSC lineage tracing results showed that the injected-dye-stained AnSCs were substantially engrafted in the wound healing tissue, indicating that the therapeutic effects of AnSCs on wound healing at least partially through direct participation in the wound healing. Expression profiling of the wound-healing-related genes in the healing tissue of AnSC group more resembled a fetal wound healing. Revealing the mechanism underlying this higher quality of wound healing by using AnSC treatment would help to devise more effective cell-based therapeutics for radiation-induced wound healing in clinics.
Bringing the world back in: Revolutions and relations before and after the quantum event
Authors: Grove Jairus
Published: September 2020

Quantum physics is being positioned as a new archive for addressing major theoretical problems in the field of international relations. Two of the major proponents of engaging quantum thinking within international relations, James Der Derian and Alexander Wendt, have argued that quantum thinking offers the possibility of a major paradigm shift in the field. Before we determine quantum’s revolutionary potential, the persistent and most pressing question for me is how to position quantum thinking among other kinds of and claims to knowledge. I want to horizontalize where different kinds of knowledge sit within the renewed attention to quantum theory. Rather than just horizontalize or flatten ontology, I want to see what happens when we place scientific and philosophical inquiry in dialogue, and what that conversation does to the authority and value of quantum thinking for the social sciences. The article reconstructs the dialogue between the first generation of quantum physicists and the philosophers who informed them. Rather than make an explicit argument about the philosophical debt of physics, I argue that a broad and highly interdisciplinary set of questions drove both fields well beyond the specific areas of expertise of any of these thinkers. I believe this adventure of ideas followed by physicists, philosophers, and social theorists alike offers us a way forward as the complexity of our contemporary global challenges confront us now with the necessity to think well beyond our disciplinary expertise.
Evaluation of properties of sulfur-based polymers obtained by inverse vulcanization: Techniques and challenges
Authors: Ghumman Ali Shaan Manzoor , Nasef Mohamed Mahmoud , Shamsuddin M Rashid , Abbasi Amin
Published: September 2020

Sulfur-based polymers are unique renewable materials that are receiving a growing attention. The utilization of elemental sulfur with a variety of monomers in their preparation in the absence of solvents using the inverse vulcanization are granting them green nature and unique properties. Several characterization techniques have been used to evaluate the properties of sulfur-based polymers. However, the complex structure and lack of solubility undermine the applicability of some standard characterization techniques in the usual manners. This article reviews the characterization methods used for the evaluation of various properties of sulfur-based polymers such as chemical, morphological, structural, thermal, rheological and mechanical properties, all of which vary depending on the type of comonomer involved in the reaction and heat treatment conditions. The successful applications of different characterization techniques including Fourier transform infrared spectroscopy (FTIR), Raman spectroscopy, nuclear magnetic resonance (NMR), scanning electron microscopy/X-ray energy dispersion (SEM-EDX), X-ray diffraction (XRD), mechanical tester, rheometer, thermal gravimetric analyzer (TGA) and differential scanning calorimetry (DSC) are discussed. The challenges to the evaluation of the properties of sulfur-based polymers and the innovative applications of the conventional techniques to overcome them are also deliberated.
Combined sulfur and peroxide curing systems applied in cross-linking of rubber magnets
Authors: Kruželák Ján , Kvasničáková Andrea , Dosoudil Rastislav , Hudec Ivan , Vilčáková Jarmila
Published: September 2020

In the present work, barium ferrite in constant loading was dosed to the rubber matrices based on NR, SBR and NBR. Sulfur, peroxide and mixed sulfur and peroxide curing systems were applied for cross-linking of rubber magnetic composites. The application of sulfur or peroxide curing system leads to the formation of different types of linkages between rubber chain segments. As the structure of the formed cross-links plays a significant role in determining the final properties of rubber articles, the main aim of the work was to use the combination of curing systems in order to suppress the disadvantages of both systems and possibly to highlight their benefits. The results showed that composition of curing system has considerable influence on cross-link density of composites, which was subsequently reflected in typical change of physical-mechanical properties and glass transition temperature. The tensile strength was improved with increasing amount of peroxide curing system. The reason can be attributed to the presence of co-agent zinc methacrylate, which exhibits strong adhesion to magnetic filler and thus it contributes to the improvement of compatibility and homogeneity on the interphase filler–rubber. On the hand, there was observed no influence of curing system composition or type of rubber matrix on magnetic characteristics of composites.
Evaluation of moisture diffusion as a threat to polymer/inorganic nanoparticles composites properties: Polystyrene/calcium sulfate nanocomposite as a case study
Authors: Besharat Farzaneh , Manteghian Mehrdad , Abdollahi Mahdi
Published: September 2020

The present study aims to investigate the water diffusivity into polystyrene/ calcium sulfate (PS/CaSO4) nanocomposite samples as a threat to the intended reinforcing properties. For this purpose, CaSO4 nanoparticles were synthesized through a chemical reaction using polyethylene glycol as the stabilizing agent. The polystyrene/calcium sulfate nanocomposites were fabricated through in situ polymerization of styrene monomer and stearic acid coated CaSO4 nanoparticles. SEM analysis was applied to determine the size and shape of the produced nanoparticles. In addition, TEM analysis was applied to study the general morphology and structure of the nanocomposites in order to confirm the PS/CaSO4 nanocomposites formation. FTIR analysis was employed to study the surface functions and bonds formation in both the surface treatment and nanocomposite preparation steps. Water diffusivity into the nanocomposites was evaluated through samples water exposure followed by calculation of the effective diffusion coefficients (Deff) using the diffusion equation given by Fick’s 2nd law. The calculation results have revealed that the obtained Deff values for water diffusivity in PS/CaSO4 (1.5 wt.%) and pure PS samples were 8.73 × 10−20 and 11.1 × 10−20 m2/s, respectively.
Homebirthing in the United Kingdom during COVID-19
Authors: Romanis Elizabeth Chloe , Nelson Anna
Published: September 2020

COVID-19 has significantly impacted all aspects of maternity services in the United Kingdom, exacerbating the fact that choice is insufficiently centred within the maternity regime. In this article, we focus on the restrictions placed on homebirthing services by some National Health Service Trusts in response to the virus. In March 2020, around a third of Trusts implemented blanket policies suspending their entire homebirth service. We argue that the failure to protect choice about place of birth during the pandemic may not only be harmful to birthing people’s physical and mental health, but also that it is legally problematic as it may, in some instances, breach human rights obligations. We also voice concerns about the possibility that in the absence of available homebirthing services people might choose to freebirth. While freebirthing (birthing absent any medical or midwifery support) is not innately problematic, it is concerning that people may feel forced to opt for this.
Ethical conflicts in nursing: An interview study
Authors: Usberg Gerli , Uibu Ere , Urban Reet , Kangasniemi Mari
Published: September 2020

Background:

A growing body of evidence about nurses’ ethical conflicts has been added to nursing science in recent decades, but no research has been done in Estonia. Ethical conflicts are a cultural and context sensitive phenomenon, so the historical, legal, social, economic and political backgrounds and position of nursing have had an impact on ethical conflict experiences.

Aim:

Describe nurses’ experiences of ethical conflicts.

Method:

A qualitative, descriptive study was conducted among nurses (n = 21) in May-October 2018 in Estonia. The data were collected in the form of semi-structured individual interviews and analysed using the inductive content analysis method.

Ethical considerations:

Due to the sensitive nature of the research topic, only individual interviews were carried out.

Findings:

Nurses’ ethical conflicts were related to situations that violated the rights, safety or well-being of the patient or relatives, caused them suffering, were against their will or threatened nurses’ dignity and professionalism through a variety of practices, attitudes and relationships. The insufficiency of patient care and professional collaboration emerged as important sources of nurses’ ethical conflicts and were connected to historical and societal factors.

Conclusions:

In order to achieve good quality of care, nurses need to have appropriate education and organisational support to carry out ethical daily care. More research is needed to understand the multidimensional cultural and contextual knowledge of ethics and nurses’ ethical conflicts.
Treatment decision-making for older adults with cancer: A qualitative study
Authors: Gong Ni , Du Qianqian , Lou Hongyu , Zhang Yiheng , Fang Hengying , Zhang Xueying , Wu Xiaoyu , Meng Ya , Zhang Meifen
Published: September 2020

Background:

Independent decision-making is one of the basic rights of patients. However, in clinical practice, most older cancer patients’ treatment decisions are made by family members.

Objective:

This study attempted to analyze the treatment decision-making process and formation mechanism for older cancer patients within the special cultural context of Chinese medical practice.

Method:

A qualitative study was conducted. With the sample saturation principle, data collected by in-depth interviews with 17 family members and 12 patients were subjected to thematic analysis.

Ethical considerations:

The study was approved by the ethics committees of Sun Yat-sen University. All participants provided verbal informed consent after being told their rights of confidentiality, anonymity, and voluntary participation. They had the right to refuse to answer questions and could withdraw at any time.

Results:

Three themes emerged: (1) complex process; (2) transformation of family decision-making power; and (3) individual compromise. Family members inevitably had different opinions during the long process of treatment decision-making for older cancer patients. The direction of this process could be regarded as an extension of the family power relationship. The patient usually compromised the decision to survive, which was made by family members.

Conclusion:

This study describes the treatment decision-making process of older cancer patients in the context of Chinese culture. The reasons underlying this process are related to the views on life and death and family values. An individual is a part of the family, which is often seen as the minimal interpersonal unit in Chinese society. It is significant that while emphasizing patient autonomy in the decision-making process, health professionals should also pay attention to the important roles of culture and family.
Causes of the plagiarism: A grounded theory study
Authors: Abbasi Parvin , Yoosefi-Lebni Javad , Jalali Amir , Ziapour Arash , Nouri Parichehr
Published: September 2020

Background:

Plagiarism is an ethical and academic issue, which is affected by several factors.

Objectives:

This study is an attempt to introduce a model for elaborating on the causes of plagiarism in Iran.

Research design:

The study was carried out as a grounded theory study.

Participants and research context:

Data were collected through in-depth semi-structured interviews with 32 university professors and postgraduate students at Iranian universities of medical sciences. The participants were selected through purposeful and theoretical sampling. Data analysis was done following Strauss et al.’s work. To ensure study rigor, Lincoln and Guba’s measures were used.

Ethical considerations:

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Results:

A conceptual model of the causes of plagiarism was developed based on analyzing and coding the data. The main core of the model was the emergence of plagiarism, and other cores were (1) causal condition: lack of skills, pressure by education system, and lack of awareness; (2) intervening factors: technological advances, legal gaps, and lack of efficient supervision; (3) ground factors: personal traits and attitudes of the academic community; (4) strategy and interventions: role model, supervision, national/international coordination, and higher awareness; (5) outcomes: regeneration of plagiarism and negative attitudes toward Iranian authors in the world academic communities.

Conclusion:

Several factors affect plagiarism. Among the approaches to attenuate plagiarism in Iranian academic communities are improving self-esteem and self-efficacy in Iranian researchers, emphasizing on quality rather than quantity of published works, discouraging boasting attitudes in the practitioners, denouncing intense competition among researchers, and introducing clear laws and severe punishments for plagiarism.
Does Country Risk Affect Banking Efficiency: Empirical Evidence from Turkey and Selected Countries from the European Union
Authors: Al-Gasaymeh Anwar , Samarah Miral R.
Published: September 2020

This study explores the readiness of the Turkish banking sector for its accession to the European Union (EU). Obviously, the job is not finished yet, with the challenges of introducing country risk variables and their impact on banking efficiency. Although efficiency analysis remains an important issue in economic studies to answer whether the Turkish banking sector is ready for the accession to the EU. Therefore, this study aims to investigate the impact of country risk levels on banking efficiency in Turkey and the EU in recent years, using stochastic frontier analysis for a parametric technique for the period 2010–2018. In the second stage, efficiency measures are used to investigate the effect of country risk and macroeconomic variables, applying the generalized method of moments. The results suggest that the banking sector operating in a country with low risk tends to perform more efficiently.
Chenab Limited: Company in Decline
Authors: Bashir Muntazar
Published: September 2020

Chenab Limited (Chenab) was a very large vertically integrated textile company in Pakistan whose operations included the entire textile chain from cotton spinning to textile weaving and finished products such as garments. The company had enjoyed considerable success in the years 2000–2007, but the economic conditions deteriorated from 2008 until 2013 for the textile industry. It was faced with electricity and natural gas shortage as well as inflationary conditions in Pakistan; these issues, together with stiff foreign competition, had seriously affected the financial health of the company.
A nonlinear dynamic model of magnetorheological elastomers in magnetic fields based on fractional viscoelasticity
Authors: Zhu Guanghong , Xiong Yeping , Li Zigang , Xiao Ling , Li Ming , Bai Xianxu ‘Frank’
Published: September 2020

As smart materials, magnetorheological elastomers (MREs) have been broadly applied in the field of intelligent structures and devices. In order to mathematically represent the dynamic behavior in a wide range of strain amplitude, excitation frequency and magnetic field; a nonlinear model with a fractional element was developed for MREs in a linear viscoelastic regime. The identification of model parameters was realized through fitting experimental data of dynamic moduli measured in shear mode, and the identified parameters exhibited good repeatability and consistency to reflect the rationality of this nonlinear dynamic model. Considering material elasticity and viscosity, the dependence of model parameters on strain amplitudes and magnetic fields was analyzed to interpret the dynamics of MREs. The fitted results displayed an excellent agreement with the experimental results on the dependence of dynamic moduli on strain amplitudes and magnetic fields. Using the predictor-corrector approach, predicted results on the stress-strain hysteresis loop were calculated based on identified parameters to further validate the proposed model by comparing with experimental results and predicted results of the revised Bouc-Wen model. This proposed model is expected to facilitate the dynamic analysis and simulation of MRE based vibration systems with a high precision accuracy.
Escape Room Blueprint: Central Orientation Contagion Crisis
Authors: McLaughlin Jill L. , Reed Jessica A. , Shiveley Jody , Lee Stephanie
Published: September 2020

Background:

Turnover rate for new graduate nurses at a midwestern community hospital was 30% for the first two years. Central clinical orientation for new hire registered nurses and care assistants was heavily executed via didactic format. Feedback from instructors suggested boredom and disengagement of learners during these sessions. Post central orientation evaluations resulted in 49% of attendees feeling not “very confident” to apply skills in clinical practice.

Methods:

Clinical educators created an escape room to improve learner satisfaction, interprofessional communication, and confidence in applying skills in practice. A convenience sample of twenty-three (23) registered nurses and care assistants participated in an escape room, Contagion Crisis, covering basic knowledge of infection control, emergency response, restraints, and drug calculation.

Results:

Average Likert scores on the post survey for satisfaction and communication were 4.67 and 4.0 respectively. Confidence in applying skills to practice averaged 4.72. Subjective feedback from participants included enjoyment of a fun, non-pressure environment.

Conclusion:

Multiple clinical disciplines can use this escape room, as it covers topics from central hospital orientation. Learners preferred the escape room format versus a high-fidelity simulation, due to it being less “high stakes” and not a judgement of individual performance.
The Assessment of Pain and Barriers to Pain Management: A Content Analysis From a National Sample of Hospice Psychosocial Assessments Completed by Social Workers
Authors: Ware Orrin D. , Cagle John G.
Published: September 2020

Pain is a multidimensional symptom frequently experienced by hospice patients that is physical, psychological, social, emotional, and spiritual. Medicare regulations require hospices to complete a psychosocial assessment with content such as patient/family adjustment to illness. Furthermore, pain barriers such as concerns about addiction, and fatalism are recognized impediments to high quality pain management. National data concerning whether hospice social workers are paying attention to issues related to patient pain is minimal. Addressing this gap, we randomly sampled 248 hospices nationally and requested a blank copy of their social work psychosocial assessment and reviewed its pain-related content. A total of 105 hospices (response rate 42.3%) provided an assessment for review. Descriptive statistics summarize agency characteristics and whether pain assessment content and pain barrier content were present. Analyses examined whether pain assessment content was included based on agency characteristics. Of the 105 participating agencies, most were non-profit (60%) and located in the South (30.5%). Less than half (47.6%) of the agencies included pain assessment content in their assessment. No associations were observed between having pain assessment content and agency characteristics. None of the assessments included content about 3 barriers to pain management: tolerance, overdose, stigma, and fatalism. Few agencies included other barriers to pain management: addiction (1%), burden (1%), non-adherence (3.8%) and stoicism (18.1%). Agencies which had pain assessment content mostly included other dimensions of pain: psychological (80%), emotional (74%), and social (78%). Hospice social workers can do more to assess and address pain concerns—especially psychological, social, and emotional dimensions.
The Experience of Participating in an 8-Week Mindfulness Based Stress Reduction plus Sleep Retraining Course among Women Living with Multiple Sclerosis
Authors: Sessanna Loralee , Nisbet Patricia , Alanazi Nouf , Lorissaint Deborah , Auerbach Samantha L. , Chang Yu-Ping , Lorenz Rebecca A.
Published: September 2020

Adult women with multiple sclerosis (MS) can benefit from innovative mindfulness-based interventions designed and structured with understanding and consideration of the multifaceted challenges these women face on a daily basis. The purpose of this qualitative descriptive study was to explore the experience of participating in an online or traditional onsite 8-week, once a week, Mind Body Stress Reduction combined with Sleep Retraining course among women living with MS to establish online course acceptability. Braun and Clarke’s Reflexive Thematic Analysis method was used to analyze focus group interview data. Time and length for both courses was found acceptable, camaraderie and interconnectedness were essential, having choice regarding course delivery format was important, and being provided with organized learning materials at the course start in a binder or packet was considered imperative. Acceptability was established for both the online and onsite formats.
Response to Achieving Consensus in the Measurement of Psychological Adjustment to Cleft Lip and/or Palate at Age 8+ Years
Authors: Harrison Conrad J. , Dalton Louise , Goodacre Timothy E. E. , Swan Marc C.
Published: September 2020

In this letter, we discuss the recently published paper by Stock et al, entitled Achieving Consensus in the Measurement of Psychological Adjustment to Cleft Lip and/or Palate at Age 8+ Years.
Rimegepant Orally Disintegrating Tablet for Acute Migraine Treatment: A Review
Authors: DeFalco Alicia Potter , Lazim Rachel , Cope Nathan E.
Published: September 2020

Objective

To review the pharmacology, pharmacokinetics, efficacy, safety, and place in therapy of rimegepant for treatment of migraine.

Data Sources

A comprehensive PubMed and Cochrane search (1985 to May 2020) was performed utilizing the keywords rimegepant, Nurtec, orally disintegrating tablet, migraine, migraine headache, migraine disorder, calcitonin gene-related peptide, and calcitonin gene-related peptide antagonist. Additional data were obtained from the references of identified articles, manufacturer’s product labeling and website, ClinicalTrials.gov, and governmental sources.

Study Selection and Data Extraction

All English-language trials evaluating oral rimegepant were included for this review.

Data Synthesis

Rimegepant orally disintegrating tablet (ODT) is Food and Drug Administration approved for the treatment of migraine. According to data from 3 phase 3 randomized controlled trials, rimegepant has been shown to significantly improve freedom from pain at 2 hours after the dose and freedom from the most bothersome symptom 2 hours postdose. Additional outcomes improved include freedom from photophobia and phonophobia at 2 hours postdose and pain relief 2 hours after the dose. Adverse effects of rimegepant include nausea, urinary tract infection, and dizziness.

Relevance to Patient Care and Clinical Practice

Orally disintegrating rimegepant provides a novel mechanism of action for the treatment of acute migraine. When patients experience inadequate relief from other therapies, have contraindications to triptans, or are unable to tolerate the adverse effects of triptans, rimegepant is a promising therapeutic option.

Conclusion

Rimegepant ODT is an efficacious migraine treatment option with a novel mechanism of action, convenient dosage form, and limited adverse effect profile.
TRENDS: The Influence of Personalized Knowledge at the Supreme Court: How (Some) Former Law Clerks Have the Inside Track
Authors: Black Ryan C. , Owens Ryan J.
Published: September 2020

When arguing at the U.S. Supreme Court, former High Court law clerks enjoy significant influence over their former justices. Our analysis of forty years of judicial votes reveals that an attorney who formerly clerked for a justice is 16 percent more likely to capture that justice’s vote than an otherwise identical attorney who never clerked. What is more, an attorney who formerly clerked for a justice is 14 to 16 percent more likely to capture that justice’s vote than an otherwise identical attorney who previously clerked for a different justice. Former clerk influence is substantial, targeted, and appears to come from clerks’ personalized information about their justices. These results answer an important empirical question about the role of attorneys while raising normative concerns over fairness in litigation.