bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost burden of chemotherapy for Indonesian healthcare insurance and social security/Jaminan Kesehatan Nasional (JKN) patients with non-Hodgkin lymphoma
Authors: Yulistiani Yulistiani , Abdissalam Erfan , Rahem Abdul , Hamidi Nur Fauzi , Utomo Febriansyah Nur
Published: June 2024

Background

Cancer is among the leading causes of death globally, posing a significant economic burden on the healthcare sector. Among other types of cancer in Indonesia, non-Hodgkin lymphoma (NHL) ranks fifth in terms of prevalence. Chemotherapy for NHL patients is funded by a national health insurance scheme through the National Healthcare Insurance and Social Security/Jaminan Kesehatan Nasional (JKN).

Objective

This study aimed to analyze cost burden of chemotherapy for JKN patients with NHL.

Data Source

A retrospective cross-sectional observational study was conducted among NHL patients receiving chemotherapy at a hospital in East Java, Indonesia in 2021. Data were collected from medical record documents and a total of 44 patient visits were recorded in this study.

Data Summary

The result showed that patient visits were dominated by females (55%), a significant proportion were aged 31 to 40 years (32%), and the majority were JKN participants in the Contribution Assistance Recipients/Penerima Bantuan Iuran (PBI) category (64%). The most chemotherapy regimen given was R-CHOP (68%) and the mean total cost for NHL patients was Indonesian Rupiah (IDR) 5,178,146. The highest mean cost burden was on chemotherapy drugs with a value of IDR 6,333,315. Based on the regimen, the highest cost burden was R-CHOP-Bleo with a mean cost of IDR 8,764,091.

Conclusion

Based on the results, the highest cost burden for chemotherapy among JKN patients with NHL in Indonesia was attributed to R-CHOP-Bleo regimen with a mean of IDR 8,764,091.
Evaluating Post-concussion Clinical Management of University-Aged Performing Artists: A Systematic Review
Authors: Memmini Allyssa K. , Bos Lauren N. , Maluski Kelleen , Ellsworth-Kopkowski Alexis , Savvidou Paola , Schuyten Kristen H.
Published: June 2024

Introduction:

Contemporary concussion literature has yet to establish appropriate clinical management guidelines to address the unique needs of performing arts populations, especially at the collegiate level. Therefore, the purpose of this investigation was to collate current evidence regarding post-concussion return to performance management among university-aged performing artists to generate broad clinical implications.

Methods:

The research team was comprised of two faculty members in the performing arts, one concussion researcher, and athletic trainer, two university librarians, and one physical therapy graduate student with expertise in post-concussion management among performing arts patients. Two librarians searched the literature using PubMed, Cochrane, SPORTdiscus, and Education Research Complete. Studies were eligible for preliminary inclusion if they were written in English, conducted in the United States, as well as published in a peer-reviewed journal. There were no restrictions on publication date due to the limited literature on this topic. The most recent search was conducted in July 2023.

Results:

Of the 18 studies identified during the search process, only 2 met the inclusion criteria. Broadly, this investigation identified common mechanisms of injury among stage crew/technicians and dancers who are of university-age. Furthermore, both studies identified several patients who opted to return to performing arts on their own volition. However, there were no studies that solely focused on the collegiate performing arts population and their return to performance procedures.

Conclusions:

Overall, these findings highlight a momentous gap in concussion literature regarding how to guide clinicians and academic teams when returning collegiate performing artists back to their performance environment(s). Thus, additional research is strongly warranted to understand the lived experiences of performing artists with concussion, as well as how to address specific coursework-related demands to support their recovery.
Benefits of early highly effective versus escalation treatment strategies in relapsing multiple sclerosis estimated using a treatment-sequence model
Authors: Smets Ide , Versteegh Matthijs , Huygens Simone , Wokke Beatrijs , Smolders Joost
Published: June 2024

Background:

Uncertainty about disproportionate impact on health care budgets limits implementation of early highly effective treatment (EHT) in multiple sclerosis (MS).

Objective:

To estimate cost-effectiveness of escalation versus EHT disease-modifying treatment (DMT) sequences.

Methods:

Using a health-economic approach, we analysed health benefits (relapse rate reduction, disability prevention), direct/indirect DMT and societal costs of escalation versus EHT DMT sequences. In scenario analyses, we allowed (1) earlier use of alemtuzumab (ALE) and (2) a single retreatment with cladribine (CLA).

Results:

In our model, we showed that the ratio between costs and quality-adjusted life years (QALYs) for the most cost-effective EHT and escalation sequence results into a similar net health benefit with higher costs and also higher QALYs associated with an EHT versus escalation strategy. Earlier use of ALE is more cost-effective than in later lines, even when aggravating the impact of its side-effects tenfold. Retreatment with CLA was more cost-effective in both escalation and EHT sequences.

Conclusions:

Certain EHT sequences are equally cost-effective to escalation sequences and are likely to result in more health at uncertain additional costs. The favourable cost–benefit ratio of CLA and ALE suggests that a wider application of affordable highly effective therapies could promote the cost-effectiveness both EHT and escalation approaches.
“Sexy but frightening”: Femme worldbuilding and feminist revenge
Authors: Westphal Tamar
Published: June 2024

Women-led revenge films are often lauded for feminist narratives and cathartic reversals of heteropatriarchal hegemony. However, many texts reify femmephobic systems of gender and power by construing violence and revenge as masculine, thus requiring heroines to adopt masculine tactics and weapons. Promising Young Woman (2020) breaks with genre conventions by constructing a world and protagonist that exemplify femme norms, values, and covert ways of operating. Drawing on queer and femme theoretical frameworks, I situate Promising Young Woman in a femme enclave of psychological thriller, positing it as an example of femme worldbuilding that explores how femme subjects assert power over their narratives.
Transgender HIV activism in Eastern Europe and Central Asia
Authors: Kirey-Sitnikova Yana
Published: June 2024

Eastern Europe and Central Asia (EECA) is a region with the fastest growing HIV epidemic in the world. Trans people are designated by UNAIDS as one of the key population groups susceptible to HIV. However, in 8 out of 12 EECA countries, they are not recognized as a key group by the state. This article explores HIV-related trans activism in EECA based on interviews with 13 activists. The participants’ goal was the construction of “trans” as a legible category with specific needs and its recognition by the state as a key population group susceptible to HIV distinct from other key groups, especially men having sex with men (MSM). Such recognition was thought to improve accessibility and acceptability of HIV services for trans people, especially trans women. In addition, HIV issues were strategically used to promote gender-affirming healthcare and legal gender recognition. Quantitative research (population size and HIV prevalence estimations) was extensively used to underpin advocacy. While the activists recognized the limitations of these quantification projects, they did not question “trans” as a discoverable and quantifiable category.
Exploring the variation in associations between socioeconomic indicators and non-communicable diseases in the Tromsø Study: an algorithmic approach
Authors: Svalestuen Sigbjørn , Sari Emre , Langholz Petja Lyn , Vo Chi Quynh
Published: June 2024

Aims:

We contribute to the methodological literature on the assessment of health inequalities by applying an algorithmic approach to evaluate the capabilities of socioeconomic variables in predicting the prevalence of non-communicable diseases in a Norwegian health survey.

Methods:

We use data from the seventh survey of the population based Tromsø Study (2015–2016), including 11,074 women and 10,009 men aged 40 years and above. We apply the random forest algorithm to predict four non-communicable disease outcomes (heart attack, cancer, diabetes and stroke) based on information on a number of social root causes and health behaviours. We evaluate our results using the classification error, the mean decrease in accuracy, partial dependence statistics.

Results:

Results suggest that education, household income and occupation to a variable extent contribute to predicting non-communicable disease outcomes. Prediction misclassification ranges between 25.1% and 35.4% depending on the non-communicable diseases under study. Partial dependences reveal mostly expected health gradients, with some examples of complex functional relationships. Out-of-sample model validation shows that predictions translate to new data input.

Conclusions:

Algorithmic modelling can provide additional empirical detail and metrics for evaluating heterogeneous inequalities in morbidity. The extent to which education, income and occupation contribute to predicting binary non-communicable disease outcomes depends on both non-communicable diseases and socioeconomic indicator. Partial dependences reveal that social gradients in non-communicable disease outcomes vary in shape between combinations of non-communicable disease outcome and socioeconomic status indicator. Misclassification rates highlight the extent of variation within socioeconomic groups, suggesting that future studies may improve predictive accuracy by exploring further subpopulation heterogeneity.
Quantification of the interactions between indoor environmental conditions and human thermal comfort and susceptibility in tropical coastal environments
Authors: Bera Mahadev , Das Sumanta , Nag Pranab Kumar
Published: June 2024

The indoor environment in most of the tropical coastal regions is associated with the residents’ health and well-being. However, limited studies reported on quantifying the interrelation between indoor environmental quality, thermal comfort and residents’ health risks in such climatic regions. Here, we evaluate indoor thermal comfort in coastal eastern India that falls under the ‘ Tropical Savanna’ climatic region. The perception survey was conducted to collect primary data in summer, monsoon, post-monsoon and winter across the year and the perception of warmth appeared to have a similar trend to direct and rational human thermal indices derived from a composite body heat exchange. Results indicate that indoor thermal stress significantly differed ( p < .05) between seasons and across study locations. The maximum summer and monsoon days lay in a warm to very hot zone. Additionally, most of the heat-related stress or disorders significantly differed ( p < .01) amongst different age groups of people. Finally, a principal component analysis using the human thermal indices yielded three groups of heat-related symptoms (a) physical fatigue and responses, (b) neural stressors and (c) hyperhidrosis disorder. Overall, results suggested that physical fatigue and responses arose predominantly from climate-induced thermal stress. The study recommends an effective bioclimatic design strategy following human-environment friendliness that can improve indoor thermal comfort in coastal eastern India.
Dynamic modeling and vibration characteristics analysis of cylinder with local defects in axial piston pump
Authors: Tang Hesheng , Wang Jialun , Ying Pingting , Kumar Anil
Published: June 2024

The piston/cylinder pair suffers from excessive wear during the operation of axial piston pumps, and the local defects usually occur in the brass bush in the cylinder bore. Generally, the wear of cylinder is the main source of failure that affects the reliability of axial piston pumps. Thus, it is necessary to conduct an in-depth study on the vibration generated by the cylinder with local defects. Considering the effect of defect dimension, a novel time-varying displacement excitation model of the axial piston pump cylinder defect is proposed and establishes a 13 degrees of freedom lumped parameter dynamic model for cylinder fault. Then, investigating the effects of length and depth of the defect on the spectral amplitude and exploring the fault characteristic frequency of cylinder. Lastly, the model was validated on a test rig. The results demonstrate that the constructed model can predict the vibration caused by a locally defective cylinder with a frequency domain error of 0.69% and the fault characteristic frequency of cylinder is the same as its rotational frequency. Moreover, the defect length will influence the amplitude and duration of the cylinder-defect pulse waveform. The fault excitation amplitudes increase with the increase of defect depths.
A rule-based framework for capturing geometric characteristics in design: A study of façade analysis for acoustic behaviour in urban space
Authors: Tokaç İremnur , Heimes Anne , Vorländer Michael , Brell-Çokcan Sigrid
Published: June 2024

In urban acoustics, the design of built environment substantially impacts the environmental noise of our everyday lives, as the built environment constantly reflects the sounds of human or non-human actors in its vicinity. The effects produced by these reflected sounds significantly depend on the geometric characteristics of the surrounding building façades. Despite their impact, the façade characteristics are often excluded from urban acoustic simulation models. As a result, sound reflection and scattering that are specifically related to building façades remain largely unexplored in noise control at the urban scale. Inspired by computational design tools used for exploring room acoustics, we investigate how a computational approach enables the analysis of geometric characteristics of façades to simulate urban acoustics during early design processes. This paper introduces a rule-based characterisation framework that enables the representation of geometric façade characteristics and their relationships with acoustic constraints in the form of rules. Our first results showed how these rules allowed for capturing and reconstructing façade geometries based on the given acoustic constraints. We believe that this novel approach empowers designers to describe their initial design ideas in a formalism that can be dynamically adapted to various dimensions, such as urban acoustics, and to reconstruct the form throughout the design process.
No difference in midterm outcomes and complication rate between retroperitoneal and transperitoneal open aortic aneurysm repair in females
Authors: Sorour Ahmed A , Sharew Betemariam , Kuka Casey , Dong Siwei , Fulton Emma , Reinert Nathan J , Khalifeh Ali , Quatromoni Jon G , Rowse Jarrad W , Kirksey Lee , Lyden Sean P , Caputo Francis J
Published: June 2024

Objectives

Abdominal Aortic Aneurysms (AAA) in females are less prevalent, have higher expansion rates and experience rupture at smaller diameters than in males. Studies have compared outcomes of the retroperitoneal (RP) and transperitoneal (TP) approach in open aortic aneurysm repair (OAR) with conflicting results. No study to date has compared the two approaches solely in females. In this study we compare midterm outcomes of the RP and TP approach in females undergoing OAR.

Methods

Single-center, retrospective review of all females undergoing OAR from 2010 to 2021. Patients undergoing elective, symptomatic and ruptured OAR were included. The cohort was stratified by surgical approach RP versus TP and midterm outcomes were compared amongst the groups. Outcomes included mortality, graft related, and non-graft related complications.

Results

A total of 244 patients (RP n = 133; TP n = 111) were identified. Follow-up period was 28 ± 30.7 months. Baseline perioperative characteristics were similar except that more people in the RP group had ejection fraction ((EF) > 50% (82% vs 68%), p = .037). Patients who underwent RP repair had longer visceral/renal ischemia time ( p = .01), larger graft diameter (18 vs 16 mm; p = <0.001), were more likely to have a suprarenal clamp placed(70.5 vs 48.2; p < .001), and had decreased autotransfusion volume (611 vs 861 mL; p < .01) compared to those who underwent TP repair. Number of deaths was higher in the TP group during study follow-up period (36.4 vs 23.8; p = .035), but the difference of the time to event analysis was not significant. There was no difference in all-cause survival at 36 months between RP and TP (77.8 vs 76.8; p = .045). Overall midterm complications were 9.5% in both groups. Any graft related complication was 1.8% in TP versus 3% RP ( p = .69). In a multivariable model, after adjusting for age, urgency, smoking, prior aneurysm repair, and ASA level, the hazard ratio decreases with the RP approach, however this did not reach significance ( p = .052).

Conclusion

In a 12-year period of OAR in females, TP and RP results were comparable at midterm analysis. The RP approach appeared to be used more often for OAR requiring suprarenal clamping. Although the TP group had increased mortality, the difference of the time to event analysis was not significant. Midterm postoperative complications in both groups were low. This suggests that both approaches are safe in the female population and decision should be driven by anatomy and surgeon’s preference.
An evaluation of the impact of the Irish Rugby Football Union Coach Education Framework on the coach–athlete dyad across the age and stage spectrum in rugby union
Authors: Smith Kevin , Burns Con , O’Neill Cian , Quinn Noreen , Winkelman Nick , Wilkie Matthew , Coughlan Edward K
Published: June 2024

The purpose of this research was to evaluate the implementation of the novel Irish Rugby Football Union Coach Education Framework (CEF) on coach–athlete interactions and perceptions. Participants were coaches (n = 4) and athletes (n = 54) from two rugby union teams. Coaches were observed pre-intervention and post-intervention of an education workshop based on the CEF and had nine training sessions video-recorded and analysed using the Coach Analysis and Intervention System (CAIS). Their perceptions of their relationship with their athletes were measured using the Coach–Athlete Relationship Questionnaire (CART-Q). Athlete perceptions of their coaches’ behaviours were measured using the Coaching Behaviour Scale for Sport (CBS-S). CAIS results revealed coaches increased the use of ‘Management’ and ‘Feedback’ behaviours ( p < 0.05) post-CEF, without altering prominent high-volume behaviours (e.g. ‘Instruction’). Coaches utilised similar time proportions for CAIS ‘Practice’, ‘Playing’ and ‘Management’ states, respectively, with no significant change post-CEF. CART-Q and CBS-S results revealed predominantly positive perceptions between coaches and athletes for both pre-CEF and post-CEF. Coach education is a non-linear learning process requiring consistent application over long periods of time, however, the alteration in coach behaviours post-CEF, coupled with the largely positive perceptions of both agents of the coach–athlete dyad, is an encouraging step forward for the further implementation of the CEF.
The medically complex pregnant patient
Authors: Sri Kumaran Shalini , Phang Chee Chin
Published: June 2024

In our contemporary society, where medical advancements occur daily, many women with complex medical conditions are becoming pregnant and successfully carrying pregnancies to term. We report a case of a complicated, unplanned pregnancy in a newly initiated haemodialysis patient. The patient presented with breathlessness and was discovered to be 13 weeks pregnant while also being diagnosed with bilateral pulmonary embolisms. Unfortunately, she later developed pregnancy-induced complications that required her to remain hospitalised throughout her entire pregnancy. This case illustrates the complex care needed to manage a pregnant woman with multiple co-morbidities. It emphasises the importance of pre-pregnancy counselling and optimizing care among women of childbearing age who have complex medical backgrounds. Such awareness is crucial for both physicians and obstetricians.
Narrative historical review of scratch-and-sniff books and their key storytelling features
Authors: Spence Charles , Kucirkova Natalia , Campbell Janine , Gao Yang , Brooks Jas
Published: June 2024

This conceptual paper examines the use of odours and scents in books to enhance storytelling and engage readers. While books often possess a distinctive smell linked to their material production, the intentional use of scents in books is rare. Our study focuses on scratch-and-sniff books, examining their narrative purposes and contributions to young children's literature. We conduct a narrative historical review, supplemented by a systematic search of databases, online catalogues and lists, to identify a collection of these scented books. Through this review, we explore the extent to which these books represent a unique category of children's picture books, investigating how their features align with theoretical understandings of quality characteristics in children's literature and the role of olfactory cues in storytelling. We address why most scented books target younger readers and discuss possible reasons for the absence of scented books for an adult readership. This intriguing asymmetry contrasts the use of scent in other media (such as film, theatre or virtual reality), often directed toward adults. In addition, this review sheds light on the innovative use of scents in books and their impact on reader immersion and narrative experience. Finally, we consider possible future uses of scent in the context of digital books (ebooks).
Seeking ambidexterity through hyperautomation: What next for GBA logistics in their evolution from local labour entrepreneurs to global players in logistics
Authors: Birkbeck Andrew , Weston Pip
Published: June 2024

Based in the Northwest of England, GBA Logistics (GBA) is a global logistics provider focussing on the transportation of goods. Founded in 1987 as GBA Services, this family firm has transformed from being a provider of labour for local companies, to a major player within the national and international logistics sector, now ranking in the top 50 operators in the UK. Starting as a sole trader, GBA became a limited company in 2000 and now employs around 400 staff across 16 locations in the UK and Europe. Working in a highly competitive, dynamic environment, the company constantly faces the challenge of optimising its existing services whilst needing to explore new opportunities to meet the changing demands of its clients. Balancing these two opposing requirements is known as organisational ambidexterity. Part of GBA’s strategic response to this challenge, is to explore how it can employ advanced technologies such as artificial intelligence and robotic process automation to enhance its efficiency and effectiveness, whilst identifying novel ways to adapt to market conditions. The application of these emerging technologies to automate and optimise operations is known as hyperautomation. For GBA, striking a balance between offering standardisation versus a customised service to customers is increasingly crucial to its success. However, this family firm’s underlying culture of entrepreneurial spirit and adaptability together with its commitment to remain relevant and competitive in logistical services means it is keen to explore how it can exploit hyperautomation to achieve its aim of organisational ambidexterity.
Gamification preferences in nutrition apps: Toward healthier diets and food choices
Authors: Berger Michelle , Jung Carolin
Published: June 2024

Background

Unhealthy eating habits are costly and can lead to serious diseases such as obesity. Nutrition apps offer a promising approach to improving dietary behavior. Gamification elements (GEs) can motivate users to continue using nutrition apps by making them more enjoyable, which can lead to more positive behavioral changes regarding dietary choices. However, the effects of users’ preferences and individual characteristics on gamified systems are not yet understood. Current calls for research suggest that personalized gamified systems might lead to user satisfaction, continuous app use, and—ultimately—long-term improvements in diet.

Objective

The aim was to determine the most preferred GEs in nutrition apps and to define clusters of GEs preferences in terms of personality and socio-demographic characteristics.

Methods

We surveyed 308 people to measure their preferences regarding GEs in nutrition apps and applied best-worst scaling to determine the most preferred GEs. Furthermore, we used cluster analysis to identify different user clusters and described them in terms of personality and socio-demographic characteristics.

Results

We determine that GEs most favored are goals, progress bars, and coupons. We revealed three distinct user clusters in terms of personality and socio-demographic characteristics. Based on the individual factors of openness and self-perception, we find that significant differences exist between the preferences for leaderboards and coupons.

Conclusion

We contribute by shedding light on differences and similarities in GE preferences relating to specific contexts and individual factors, revealing the potential for individualized nutrition apps. Our findings will benefit individuals, app designers, and public health institutions.
Summary of the best evidence on self-management support schemes for patients with inflammatory bowel disease based on mobile health systems
Authors: Ren Chenfei , Zhou Yunxian , Cai Qian , Zhou Mi
Published: June 2024

Objective

Self-management support services can improve patients’ self-management ability. This study summarized the best evidence on a self-management support scheme for patients with inflammatory bowel disease based on a mobile health system to accurately describe the current status of the field and provide recommendations for healthcare workers.

Methods

Two researchers retrieved studies from computer decision support systems, guideline websites, official association websites, and databases from the establishment of the database until October 2023. The quality of the included studies was independently evaluated by two authors using the Appraisal of Guidelines for Research and Evaluation Instrument II and the 2016 version of the corresponding evaluation standards of the Australian Joanna Briggs Institute Evidence-based Health Care Center. The classification of evidence and recommendation level adopted the 2014 version of the Australian Joanna Briggs Institute evidence pregrading and recommending level system.

Results

Fifteen studies were included, comprising one guideline, two expert consensuses, four systematic reviews, four quasi-experimental studies, and four qualitative studies. The overall quality of the included studies was moderate to high. Thirty-six pieces of best evidence were compiled for seven elements, namely, mobile health system type and functional support; mobile health system application preparation; health information recording, uploading, and presentation; zoning management of diseases and early warning of the active period; support related to health education; healthcare support team formation and services; and virtual communities.

Conclusions

Our study evaluated the quality of the included studies and summarized a self-management support scheme for patients with inflammatory bowel disease based on a mobile health system. The main scheme was divided into 7 parts and 36 items, which can be used as a reference for healthcare workers so that they can provide more comprehensive and scientific self-management support services for patients with inflammatory bowel disease through mobile health systems.
Surgical Repair of Common Arterial Trunk With Ventriculoarterial Septal Defect and Dual Orifice Truncal Valve
Authors: Al Kindi Hamood , Mohsen Abdullah , Kandachar Pranav , Al Balushi Abdullah , Mohamed Alaa M. , Maddali Madan , Tretter Justin T. , Anderson Robert H.
Published: June 2024

We present a case of a rare example of a ventriculo-arterial septal defect found in a patient with a common arterial trunk, with balanced aortic and pulmonary components, but with separate valvar orifices within the common truncal valve. We managed the lesion using a two-patch approach. Performing a palliative procedure to relieve the elevated right ventricular pressure aided in the preservation of the pulmonary component of the common valve. We validated the success of the technique using postoperative computerized tomography and four-dimensional flow magnetic resonance imaging.
Revisiting the Scope of Section 35ABB of the Income Tax Act
Authors: Deb Rajat
Published: June 2024

The Supreme Court (SC), on 16 October 2023, observed that licence fees paid by telecom companies under the New Telecom Policy 1999 would be a capital expenditure under section 35ABB of the Income Tax Act, 1961. Quashing the judgments of high courts of Delhi, Bombay and Karnataka, the SC ruled that the nomenclature and mode of payment have no relevance as such payment relates to the licence fee, an integral part of the licence agreement to remain in the business. It ruled under the New Telecom Policy 1999 that there is no basis to reclassify the variable portion of the licence fee as revenue expenditure; instead, both fixed and variable fees are homogeneous and are capital expenditures. Moreover, a single transaction cannot be artificially bifurcated into capital and revenue components by mere consideration of payment mode, posing a challenge for the sector already confronting significant financial stress. However, the Telecommunication Act enacted in December 2023 attempts to address multiple challenges of the sector, but grey areas still need to be addressed, which could lead to future litigation. Against those backdrops, the study attempts to assess the impact of the ruling connecting with the New Act on the sector.
Knee Extensor Torque Steadiness and Quadriceps Activation Variability in Collegiate Athletes 4, 6, and 12 Months After ACL Reconstruction
Authors: Cobian Daniel G. , Oppenheim Zachary R. , Roehl Tyler J. , Joachim Mikel R. , Heiderscheit Bryan C.
Published: June 2024

Background:

Quadriceps performance after anterior cruciate ligament reconstruction (ACLR) is typically characterized by peak force/torque, but the ability to generate consistent knee extensor torque may be clinically meaningful.

Purpose/Hypothesis:

The purpose of this study was to evaluate knee extensor torque steadiness and quadriceps activation variability in collegiate athletes 4 to 12 months after ACLR. It was hypothesized that between-limb asymmetries in torque steadiness and activation variability would be observed and that steadiness would be associated with activation variability and peak knee extensor torque symmetry.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

A total of 30 National Collegiate Athletic Association Division I athletes completed maximal voluntary isometric contractions 4, 6, and 12 months after ACLR. Torque and surface electromyography of the superficial quadriceps were recorded. Torque steadiness was calculated as the mean difference between initial and low-pass filtered torque signals and was expressed as a percentage of peak torque. Quadriceps activation variability was calculated similarly and was expressed as a percentage of peak electromyography. Linear mixed models were used to assess change in torque steadiness and activation variability over time. Associations between torque steadiness of the operated limb, activation variability, and quadriceps strength symmetry were evaluated using the Spearman correlation coefficient.

Results:

Limb-by-time interactions were detected for torque steadiness and activation variability ( P < .001), with reductions (improvements) in limb steadiness and activation variability observed with increasing time since surgery. Between-limb differences in torque steadiness and activation variability were observed at 4 and 6 months postoperatively ( P < .05). Significant associations between operated limb torque steadiness and quadriceps activation variability were observed at 4 months ( P < .001) and 6 months ( P < .01). Torque steadiness of the operated limb was associated with peak knee extensor torque symmetry at 4 months ( rS = −0.49; P < .01) and 6 months ( rS = −0.49; P < .01).

Conclusion:

In collegiate athletes, impaired knee extensor torque steadiness of the operated limb and associated abnormal quadriceps activation patterns were observed 4 to 12 months after ACLR, and the consistency of knee extensor torque production was associated with greater quadriceps strength asymmetries, particularly 4 to 6 months after surgery. Operated limb torque steadiness and activation variability improved from 4 to 12 months after ACLR. Clinical assessment of knee extensor torque steadiness after ACLR may improve prognosis and specificity of rehabilitation efforts.
China’s ‘Liquid’ Warfighting Shift and Its Implications for Possible Future Conflict
Authors: Swan Ryan R. , Mutschler Max
Published: June 2024

Some suggest that remote, precision strike warfare is a Western phenomenon motivated by aversion to high troop casualties among democratic leaders subject to re-election. Others contend that it is the result of a global transition in the way of modern war towards ‘liquid warfare’, centred around the disruption of adversary networks in the increasingly integrated and high-tech battlespace. This article advances the debate by applying the liquid warfare hypothesis to China’s post-1993 military reforms. It finds (a) that China’s development and embrace of its prevailing ‘systems destruction warfare’ concept constitutes a liquid shift in its warfighting approach, dispelling the contention that such transformations are necessarily linked with democratic political systems; and (b) that the liquidification of China’s warfighting approach has immediate implications for possible regional conflict scenarios, particularly those involving the United States, making them mutually costlier and susceptible to rapid escalation.
Book review: Bajpai, Kanti, India Versus China: Why They Are Not Friends
Authors: Kumar Dharmendra
Published: June 2024

Bajpai, Kanti, India Versus China: Why They Are Not Friends. New Delhi: Juggernaut Books, 2021, 284 pp. (hardcover). ISBN: 9789391165086
Book review: Elizabeth C. Economy, The World According to China
Authors: Çifçi Orhan
Published: June 2024

Elizabeth C. Economy, The World According to China>. Cambridge: Polity Press, 2022, 304 pp. (hardback). ISBN: 9781509537495
Fixed-duration pirtobrutinib plus venetoclax with or without rituximab in relapsed/refractory CLL: the phase 1b BRUIN trial
Authors: Roeker Lindsey E. , Woyach Jennifer A. , Cheah Chan Y. , Coombs Catherine C. , Shah Nirav N. , Wierda William G. , Patel Manish R. , Lamanna Nicole , Tsai Donald E. , Nair Binoj , Wang Chunxiao , Zhao Xiang , Liu Dan , Radtke David , Chapman Sonya , Marella Narasimha , McNeely Samuel C. , Brown Jennifer R.
Published: June 2024

Pirtobrutinib is a highly selective, noncovalent (reversible) Bruton tyrosine kinase inhibitor (BTKi). Patients with relapsed or refractory (R/R) chronic lymphocytic leukemia (CLL) were treated with fixed-duration pirtobrutinib plus venetoclax (PV) or pirtobrutinib plus venetoclax and rituximab (PVR) in this phase 1b trial. Prior covalent BTKi therapy was allowed, but not prior treatment with venetoclax. Patients were assigned to receive PV (n = 15) or PVR (n = 10) for 25 cycles. Most patients (68%) had received prior covalent BTKi therapy. At the data cutoff date, the median time on study was 27.0 months for PV and 23.3 months for PVR. Overall response rates were 93.3% (95% confidence interval [CI], 68.1-99.8) for PV and 100% (95% CI, 69.2-100.0) for PVR, with 10 complete responses (PV: 7; PVR: 3). After 12 cycles of treatment, 85.7% (95% CI, 57.2-98.2) of PV and 90.0% (95% CI, 55.5-99.7) of PVR patients achieved undetectable minimal residual disease (<10-4) in peripheral blood. Progression-free survival at 18 months was 92.9% (95% CI, 59.1-99.0) for PV patients and 80.0% (95% CI, 40.9-94.6) for PVR patients. No dose-limiting toxicities were observed during the 5-week assessment period. The most common grade ≥3 adverse events (AEs) for all patients included neutropenia (52%) and anemia (16%). AEs led to dose reduction in 3 patients and discontinuation in 2. In conclusion, fixed-duration PV or PVR was well tolerated and had promising efficacy in patients with R/R CLL, including patients previously treated with a covalent BTKi. This trial was registered at www.clinicaltrials.gov as #NCT03740529.
Unravelling the complex interplay of factors behind exercise limitations and physical inactivity in COPD
Authors: Tang Clarice Y. , Bernstein Bruce , Blackstock Felicity , Blondeel Astrid , Gershon Andrea , Gimeno-Santos Elena , Gloeckl Rainer , Marques Alda , Spruit Martijn A. , Garvey Chris , Morgan Mike , Nici Linda , Singh Sally J. , Troosters Thierry
Published: June 2024

Exercise limitation and physical inactivity are known treatable traits for people with COPD. Maximising exercise capacity and keeping people physically active improves health status and survival rates among people with COPD. However, managing these two treatable traits can be extremely challenging for clinicians due to the complex intersectionality of factors influencing an individual's capacity, opportunity and motivation to engage in physical activity. This review presents the complex factors influencing exercise capacity (“can do”), levels of physical activity (“do do”) and sedentary behaviours amongst people with COPD and provides practical recommendations on how clinicians can address some of these factors in practice. Most importantly, it highlights the importance of referring to pulmonary rehabilitation as a way to improve exercise capacity among people with COPD.
ERRFI1 exacerbates hepatic ischemia reperfusion injury by promoting hepatocyte apoptosis and ferroptosis in a GRB2-dependent manner
Authors: Zhao Hang , Mao Huizi
Published: June 2024

Background

Programmed cell death is an important mechanism for the development of hepatic ischemia and reperfusion (IR) injury, and multiple novel forms of programmed cell death are involved in the pathological process of hepatic IR. ERRFI1 is involved in the regulation of cell apoptosis in myocardial IR. However, the function of ERRFI1 in hepatic IR injury and its modulation of programmed cell death remain largely unknown.

Methods

Here, we performed functional and molecular mechanism studies in hepatocyte-specific knockout mice and ERRFI1-silenced hepatocytes to investigate the significance of ERRFI1 in hepatic IR injury. The histological severity of livers, enzyme activities, hepatocyte apoptosis and ferroptosis were determined.

Results

ERRFI1 expression increased in liver tissues from mice with IR injury and hepatocytes under oxygen-glucose deprivation/reoxygenation (OGD/R) conditions. Hepatocyte-specific ERRFI1 knockout alleviated IR-induced liver injury in mice by reducing cell apoptosis and ferroptosis. ERRFI1 knockdown reduced apoptotic and ferroptotic hepatocytes induced by OGD/R. Mechanistically, ERRFI1 interacted with GRB2 to maintain its stability by hindering its proteasomal degradation. Overexpression of GRB2 abrogated the effects of ERRFI1 silencing on hepatocyte apoptosis and ferroptosis.

Conclusions

Our results revealed that the ERRFI1-GRB2 interaction and GRB2 stability are essential for ERRFI1-regulated hepatic IR injury, indicating that inhibition of ERRFI1 or blockade of the ERRFI1-GRB2 interaction may be potential therapeutic strategies in response to hepatic IR injury.
Video livestreaming from medical emergency callers’ smartphones to emergency medical dispatch centres: a scoping review of current uses, opportunities, and challenges
Authors: Magnusson Carin , Ollis Lucie , Munro Scott , Maben Jill , Coe Anthony , Fitzgerald Oliver , Taylor Cath
Published: June 2024

Background

Timely dispatch of appropriate emergency medical services (EMS) resources to the scene of medical incidents, and/or provision of treatment at the scene by bystanders and medical emergency lay callers (referred to as ‘callers’ in this review) can improve patient outcomes. Currently, in dispatch systems worldwide, prioritisation of dispatch relies mostly on verbal telephone information from callers, but advances in mobile phone technology provide means for sharing video footage. This scoping review aimed to map and identify current uses, opportunities, and challenges for using video livestreaming from callers’ smartphones to emergency medical dispatch centres.

Methods

A scoping review of relevant published literature between 2007 and 2023 in the English language, searched within MEDLINE; CINAHL and PsycINFO, was descriptively synthesised, adhering to the PRISMA extension for scoping reviews.

Results

Twenty-four articles remained from the initial search of 1,565 articles. Most studies were simulation-based and focused on emergency medical dispatchers’ (referred to as ‘dispatcher/s’ in this review) assisted video cardiopulmonary resuscitation (CPR), predominantly concerned with measuring how video impacts CPR performance. Nine studies were based on real-life practice. Few studies specifically explored experiences of dispatchers or callers. Only three articles explored the impact that using video had on the dispatch of resources. Opportunities offered by video livestreaming included it being: perceived to be useful; easy to use; reassuring for both dispatchers and callers; and informing dispatcher decision-making. Challenges included the potential emotional impact for dispatchers and callers. There were also concerns about potential misuse of video, although there was no evidence that this was occurring. Evidence suggests a need for appropriate training of dispatchers and video-specific dispatch protocols.

Conclusion

Research is sparse in the context of video livestreaming. Few studies have focussed on the use of video livestreaming outside CPR provision, such as for trauma incidents, which are by their nature time-critical where visual information may offer significant benefit. Further investigation into acceptability and experience of the use of video livestreaming is warranted, to understand the potential psychological impact on dispatchers and callers.
Determinants of and interventions for Proton Pump Inhibitor prescription behavior: A systematic scoping review
Authors: van Gestel L. C. , Adriaanse M. A. , Kanis S. L , Mensink-Bout S. M. , Schoones J. W. , Numans M. E. , Kiefte-de Jong J. C. , van den Brink G.
Published: June 2024

Background

Proton Pump Inhibitors (PPI) are frequently prescribed. Long-term use is associated with side-effects and patients often lack a valid indication. Inappropriate PPI prescribing thus needs to be addressed. This review aims to scope 1) what determinants are studied as reasons for PPI prescribing, 2) what strategies are used for changing PPI (de)prescribing, and 3) whether important determinants are addressed in these interventions.

Methods

We searched eight databases for papers on determinants of physician PPI prescribing. Studies were included if they were conducted in a Western country and focused on oral PPIs for an adult population. By following the Behaviour Change Wheel, we extracted information regarding PPI prescribing behavior, behavioral determinants and intervention strategies.

Findings

We included 74 papers. Most focused on the determinants knowledge and beliefs about consequences. The latter was consistently related to PPI prescribing. Results for knowledge were mixed. Most interventions used education or enablement (e.g., algorithms, quality check improvements, involvement of pharmacists) as strategies. Enablement consistently improved PPI prescribing, while results for education were mixed.

Interpretation

There is an overemphasis on reflective processes in studies on PPI prescribing. Future research should comprehensively identify behavioral determinants, focusing on reflective and impulsive processes, such that interventions can address the most important determinants.
Investigating the relationship between health literacy and preconceptual care components during the first 14 weeks of pregnancy: a cross-sectional study
Authors: Sajjadian Fatemeh , Amiri-Farahani Leila , Haghani Shima , Pezaro Sally
Published: June 2024

Background and Aim

Preconceptual care aiming to improve health is influenced by various factors including health literacy. Considering the importance and necessity of high quality preconceptual care, this study aimed to determine the relationship between health literacy and receiving components of preconceptual care prior to pregnancy.

Methods

This cross-sectional study included 693 participants with pregnancies of less than 14 weeks gestation referred to health centers and gynecologists in Shiraz city, Iran. Multi-stage sampling was done from May 2021 to February 2022 in 18 comprehensive urban health centers and 20 gynecology offices via proportional allocation method. The data collection tool comprised a questionnaire consisting of 3 parts: (1) individual and fertility characteristics, (2) information related to the components of preconceptual care and (3) health literacy for Iranian adults. This was completed by individual participants via the self-reporting method.

Results

The majority of participants were between 30 and 34 years old. They also identified as women with a university education and were predominantly unemployed. The mean health literacy of participants was 76.81%. Health literacy obtained the highest mean score in the dimension of ‘understanding’ and the lowest mean score in the dimension of ‘access’. The frequency of preconceptual counseling, folic acid supplement consumption, exercise, blood testing, dental visits, genetic counseling, Pap smear testing and rubella, diphtheria, and hepatitis vaccinations prior to pregnancy was 66.8%, 53.8%, 45.6%, 71.86%, 44.44%, 12%, 53.4%, 10.83%, respectively. Many (> 64%) received preconceptual care at specialist gynecology offices. Results demonstrated that health literacy had a statistically significant relationship with preconceptual care, folic acid consumption, exercise and dental care, (p < 0.001), along with blood testing and Pap smear testing (p < 0.05).

Conclusion

Overall, our results demonstrate that despite health literacy being optimal, uptakes of some components of preconceptual care are low. As such, it will be important to further raise awareness of the importance of preconceptual care for people prior to pregnancy as a priority in health promotion and education.