bluuebunny/crossref_metadata_2025 huggingface dataset:
Home Healthcare Patients With Distinct Psychological, Cognitive, and Behavioral Symptom Profiles and At-Risk Subgroup for Hospitalization and Emergency Department Visits Using Latent Class Analysis
Authors: Min Se Hee , Song Jiyoun , Evans Lauren , Bowles Kathryn H. , McDonald Margaret V. , Chae Sena , Topaz Maxim
Published: June 2023

One-third of home healthcare patients are hospitalized or visit emergency departments during a 60-day episode of care. Among all risk factors, psychological, cognitive, and behavioral symptoms often remain underdiagnosed or undertreated in older adults. Little is known on subgroups of older adults receiving home healthcare services with similar psychological, cognitive, and behavioral symptom profiles and an at-risk subgroup for future hospitalization and emergency department visits. Our cross-sectional study used data from a large, urban home healthcare organization ( n = 87,943). Latent class analysis was conducted to identify meaningful subgroups of older adults based on their distinct psychological, cognitive, and behavioral symptom profiles. Adjusted multiple logistic regression was used to understand the association between the latent subgroup and future hospitalization and emergency department visits. Descriptive and inferential statistics were conducted to describe the individual characteristics and to test for significant differences. The three-class model consisted of Class 1: “Moderate psychological symptoms without behavioral issues,” Class 2: “Severe psychological symptoms with behavioral issues,” and Class 3: “Mild psychological symptoms without behavioral issues.” Compared to Class 3, Class 1 patients had 1.14 higher odds and Class 2 patients had 1.26 higher odds of being hospitalized or visiting emergency departments. Significant differences were found in individual characteristics such as age, gender, race/ethnicity, and insurance. Home healthcare clinicians should consider the different latent subgroups of older adults based on their psychological, cognitive, and behavioral symptoms. In addition, they should provide timely assessment and intervention especially to those at-risk for hospitalization and emergency department visits.
Psychosocial Outcomes in Children with Cleft Lip and/or Palate: Associations of Demographic, Cleft Morphologic, and Treatment-Related Variables
Authors: Crerand Canice E. , Conrad Amy L. , Bellucci Claudia Crilly , Albert Meredith , Heppner Celia E. , Sheikh Farah , Woodard Suzanne , Udaipuria Shivika , Kapp-Simon Kathleen A.
Published: June 2023

Objective

To determine associations of demographic, morphologic, and treatment protocol parameters with quality of life (QoL), appearance/speech satisfaction, and psychological adjustment.

Design

Observational study utilizing retrospective report of protocol variables and current outcome variables.

Setting

Six North American cleft treatment clinics.

Participants

Children, ages 8.0–10.99 years, with Cleft Lip ± Alveolus, Cleft Palate, Cleft Lip and Palate, and parents (N = 284).

Outcome Measures

Pediatric QoL Inventory (PedsQL): Parent, Child, Family Impact Module (FIM); Patient Reported Outcome Measurement Information System (PROMIS); Child Behavior Checklist (CBCL); CLEFT-Q.

Results

Outcome scores were average with few differences by cleft type. Multiple regression analyses yielded significant associations ( Ps < .05) between socioeconomic status, race, and age at assessment and parent- and self-reported measures. Females had higher PROMIS Depression (β=.20) but lower CBCL Affective (β = −.16) and PROMIS Stigma scores (β= −.24). Incomplete cleft lip was associated with lower PROMIS Depression, and more positive ratings of CLEFT-Q: Nose, Nostril, Lip Scar; CBCL Competence scores, (βs = −.17 to .17). Younger Age at Lip Closure was associated with higher CBCL School Competence (β= −.18). Younger Age at Palate Closure was associated with higher Child PedsQL Total, Physical, Psychosocial QoL, and better CLEFT-Q Speech Function (βs = −.18 to −.15). Furlow Palatoplasty was associated with more CBCL Externalizing Problems (β = .17) higher CBCL Activities (β = .16). For all diagnoses, fewer Total Cleft-Related Surgeries was associated with lower PROMIS Stigma and higher CBCL Total Competence and Activities (βs = −.16 to .15).

Conclusions

Demographic characteristics, lip morphology, and treatment variables are related to later psychological functioning.
Do Scandals Matter?
Authors: Rottinghaus Brandon
Published: June 2023

Political science research is conflicted about the impact of political scandals on survival in office. Scholars have found strong negative impacts to some scandals but others have found minimal or no effects. The literature has explored several consequences but no one work examines them collectively. This article examines presidential, gubernatorial, and Congressional scandals from 1972 to 2021 to assess the impact of scandal in a polarizing America. We find the negative consequences from scandals vary across time and institutions. Scandals in the Watergate era led to more resignations in Congress but fewer resignations of White House officials in the 1990s. During the Trump administration, White House officials did not survive in office at rates greater than past eras, demonstrating little support for the “Trump Effect.” However, politicians generally survived scandal more in the polarized era, hinting at the changing role of political scandals.
Influencing Enforcement: The Application of International Law in Independent Judiciaries—The Case of the Alien Tort Statute
Authors: Bayram A. Burcu , Miller Banks
Published: June 2023

What explains the variation in the interpretation and enforcement of international law by domestic judges? Can independent judiciaries control the enforcement of countries’ commitments to international law? In this paper, we leverage a unique source of data—cases related to the Alien Tort Statute—to investigate how independent judges might be able to enforce international commitments to human rights without concern for whether the state (here the United States) has opted into the commitments in the first place. We show that behavioral factors in judicial decision making, and particularly those related to judicial ideological preferences, are potent predictors of judicial enforcement of international law. This implies that states with highly independent judiciaries are right to be worried about their abilities to control enforcement domestically, although we also find evidence that the U.S. government get a special degree of deference in these cases.
Keepers of Trauma: Rape Victim Advocates’ Secondary Traumatic Stress, Burnout, and Coping Techniques
Authors: Maier Shana L.
Published: June 2023

This qualitative research explores rape victim advocates’ secondary traumatic stress (STS), burnout, and coping strategies. Data reveal that the hardest parts of advocates’ work include feeling like they cannot help survivors, hearing survivors’ stories, and seeing the failings of the CJ and legal systems. Most advocates (81%) experience STS, evident in emotional and behavioral responses. Most advocates (71%) confirm that #MeToo and coverage of sexual violence in the news, social media, or television contribute to their STS. Fewer advocates (34%) experience burnout, which is attributed to workload. Advocates cope by reaching out to others (colleagues, friends, and family) and exercising.
Immune checkpoint inhibitor–related adverse events: Real-world experience from a single veterans’ affairs medical center
Authors: Benz Samantha , Sherman Katherine A , Dasanu Constantin A , Alvarez-Argote Juliana
Published: June 2023

Background

Immune checkpoint inhibitors (ICIs) are antineoplastic agents associated with a multitude of immune-related adverse events (irAEs). Available data from clinical trials include highly selective patient populations which may limit their applicability to real-world clinical practice.

Methods

We present a retrospective cohort study of cancer patients treated with ICI therapy at the Zablocki VA Medical Center between 2014 and 2021. Information on demographics, cancer diagnosis, type of therapy, treatment duration, comorbidities, irAE type, and overall survival were collected.

Results

We identified 187 patients who received at least one dose of ICI. About half the patients experienced at least one irAE, the most common categories being fatigue, pulmonary, and endocrine irAEs. Approximately half of the irAEs were diagnosed within the first three months of starting ICI therapy, and 60.38% of those who experienced irAEs discontinued ICI therapy. Patients who experienced endocrine or intestinal irAEs had a significantly longer overall survival.

Conclusion

Immune-related complications due to ICI therapy are common and can frequently lead to treatment discontinuation in the real-world setting. Endocrine and intestinal irAEs may correlate with improved survival. The ICI-treated patients who received palliative radiation therapy to the bone had less irAEs, possibly due to immunogenic cell death.
Abisko: Deep codesign of an architecture for spiking neural networks using novel neuromorphic materials
Authors: Vetter Jeffrey S. , Date Prasanna , Fahim Farah , Kulkarni Shruti R. , Maksymovych Petro , Talin A. Alec , Tallada Marc Gonzalez , Vanna-iampikul Pruek , Young Aaron R. , Brooks David , Cao Yu , Gu-Yeon Wei , Lim Sung Kyu , Liu Frank , Marinella Matthew , Sumpter Bobby , Miniskar Narasinga Rao
Published: June 2023

The Abisko project aims to develop an energy-efficient spiking neural network (SNN) computing architecture and software system capable of autonomous learning and operation. The SNN architecture explores novel neuromorphic devices that are based on resistive-switching materials, such as memristors and electrochemical RAM. Equally important, Abisko uses a deep codesign approach to pursue this goal by engaging experts from across the entire range of disciplines: materials, devices and circuits, architectures and integration, software, and algorithms. The key objectives of our Abisko project are threefold. First, we are designing an energy-optimized high-performance neuromorphic accelerator based on SNNs. This architecture is being designed as a chiplet that can be deployed in contemporary computer architectures and we are investigating novel neuromorphic materials to improve its design. Second, we are concurrently developing a productive software stack for the neuromorphic accelerator that will also be portable to other architectures, such as field-programmable gate arrays and GPUs. Third, we are creating a new deep codesign methodology and framework for developing clear interfaces, requirements, and metrics between each level of abstraction to enable the system design to be explored and implemented interchangeably with execution, measurement, a model, or simulation. As a motivating application for this codesign effort, we target the use of SNNs for an analog event detector for a high-energy physics sensor.
Experimental and numerical investigation of an innovative complex piston with enhanced free spray length for the heavy-duty engine applications
Authors: Betgeri Vikram , Pischinger Stefan , Schönfeld Sascha
Published: June 2023

The combustion and emission formation process in heavy-duty compression ignition engines are strongly influenced by the design of the piston bowl, the cylinder charge motion and the performance of the injection system. This paper proposes an innovative complex piston bowl design approach called as ’flower piston’ to improve the combustion process. It can be manufactured using the conventional machining approaches without use of still expensive additive manufacturing techniques. The flower piston features a scooped cavity with an intention of increasing the free fuel spray penetration. The potential of this innovative flower piston is evaluated using a validated 3D CFD model and compared with the results of single cylinder engine experiments at operating points with minimum fuel consumption. The results of the experimental investigations with the flower piston show an improvement in thermal efficiency in comparison to the conventional piston by up to 0.5%. This is due to a faster initial heat release and increased high pressure cycle work. However, the smoke emissions increased threefold due to fuel entrapment into the flower cavities, leading to formation of fuel-rich pockets. Also, the wall heat losses increased twofold with an increase in NOx raw emissions. With increased spray targeting angle, there was a drastic reduction in smoke emissions and an additional improvement in the thermal efficiency.
Nowhere to turn: A Black feminist autoethnography of interpersonal violence
Authors: Morrow So’Phelia
Published: June 2023

In July 2020, rapper Megan Thee Stallion was shot by her then boyfriend Tory Lanez, a fellow rapper. The incident brought to the surface (again) a long, ongoing conversation about the experiences of Black women survivors of intimate partner violence, much like other high-profile cases (e.g., Tina Turner) have done before. Specifically, these cases show how Black men particularly can uphold patriarchal violence in intimate or romantic contexts. Moreover, these cases show the tensions that can arise when survivors seek help from law enforcement. For example, the idea of racial loyalty and not calling the police on a Black man and how this affects the options available to Black women. In other words, Black women often have nowhere to turn for help when they experience violence. In this article, I employ Black Feminist Autoethnography as a methodological framework to analyze a personal instance of road rage where I was attacked, to explore how Black women survivors make meaning of their experiences, the thought process behind their decision to involve the police, how Black men uphold patriarchal violence in non-intimate contexts, and how Black women resist or refuse to accept the violence. This analysis reveals the raced and gendered components underlying the private/public nature of interpersonal violence experienced by Black women and the relationship between intimate and non-intimate interpersonal violence. Implications for qualitative social work research and practice include the use of Black Feminist Autoethnography as a methodological framework to identify areas of empowerment, strength, and support for survivors of violence.
Where multilingualism and transnational education meet
Authors: Le Pichon Emmanuelle
Published: June 2023

This final paper contextualizes the presented empirical, theoretical, and methodological reflections in a broader European and international perspective. It formulates implications for further research on language and education as well as language policies in transnational contexts.
Party Discipline in Latin America: The Role of Party Ideology
Authors: Otero-Felipe Patricia , Ruiz Rodríguez Leticia M
Published: June 2023

Party discipline is an area that has received considerable attention in the party cohesion literature. While existing comparative research has predominantly focused on the institutional environment that impacts party discipline, we know less about its relationship with party-related variables. In this article, we explore the effect of party ideology on legislators’ perceptions of party discipline in Latin America. The difficulties for parliamentary groups to act cohesively in Latin America make party discipline and its study a major task. We argue that party ideology shapes the perceptions of legislators vis-à-vis their relative autonomy and the resulting ability of the party to be cohesive. To perform the analysis, we have constructed a database containing the responses of 1272 parliamentarians from 71 political parties in 17 countries across the 2011–2022 legislatures. In addition to party-related variables, we have included individual- and system-level variables. The results suggest that Latin American parliamentarians belonging to left-wing parties tend to conform to party discipline more frequently than those of the right wing.
Systematic Review With Meta-Analysis of Endovascular Versus Open Repair of Abdominal Aortic Aneurysm Repair in the Young
Authors: Kontopodis Nikolaos , Gavalaki Aikaterini , Galanakis Nikolaos , Kantzas Michalis , Ioannou Christos , Geroulakos George , Kakisis John , Antoniou George A.
Published: June 2023

Purpose:

The purpose of this study was to investigate which treatment method for abdominal aortic aneurysm (AAA), endovascular or open repair, has better outcomes in young patients.

Materials and Methods:

A systematic review was conducted to identify observational studies or randomized controlled trials (RCTs) that compared endovascular and open repair of intact AAA in young patients. MEDLINE, EMBASE, and CENTRAL were searched up to March 2022 using the Ovid interface. The risk of bias was assessed with the Newcastle-Ottawa scale (NOS), with a maximum score of 9, or version 2 of the Cochrane risk of bias tool. The certainty of evidence was assessed with the GRADE framework. Primary outcomes were perioperative, overall, and aneurysm-related mortality. Secondary outcomes were reintervention, hospital length of stay, and perioperative complications. Effect measures in syntheses were the odds ratio (OR), risk difference (RD), mean difference (MD), or hazard ratio (HR) and were calculated with the Mantel-Haenszel or inverse variance statistical method and random-effects models.

Results:

Fifteen observational studies and 1 RCT were included, reporting a total of 48 976 young patients. Definitions of young ranged from 60 to 70 years. The median score on the NOS was 8 (range: 4–9), and the RCT was judged to be high risk of bias. The perioperative mortality was lower after EVAR (RD: −0.01, 95% CI: −0.02 to −0.00), but the overall and aneurysm-related mortality was not significantly different between EVAR and open repair (HR: 1.38, 95% CI: 0.81 to 2.33; HR: 4.68, 95% CI: 0.71 to 31.04, respectively), as was the hazard of reintervention (HR: 1.50, 95% CI: 0.88 to 2.56). The hospital length of stay was shorter after EVAR (MD: −4.44 days, 95% CI: −4.79 to −4.09), and the odds of cardiac (OR: 0.22, 95% CI: 0.13 to 0.35), respiratory (OR: 0.17, 95% CI: 0.11 to 0.26), and bleeding complications were lower after EVAR (OR: 0.26, 95% CI: 0.11 to 0.64). The level of evidence was low or very low.

Conclusion:

Patient preferences and perspectives should be considered during shared decision-making process considering the available evidence. EVAR may be considered in young and fit patients with a suitable anatomy.

Protocol registration:

PROSPERO, CRD42022325051

Clinical Impact

Uncertainty surrounds the optimal treatment strategy for abdominal aortic aneurysm in young patients. Meta-analysis of some 48,976 young patients showed that endovascular aneurysm repair (EVAR) has a lower perioperative mortality and morbidity and a shorter hospital and intensive care unit stay than open surgical repair, but the overall and aneurysm-related mortality in the short to medium term are not significantly different between EVAR and open repair. EVAR can be considered in young patients.
Perspectives: How to Apply Motivational Interviewing for Older Adult Fall Prevention
Authors: Kiyoshi-Teo Hiroko , Lemon Erin , Dennis Andrea , Smith Robynnelle , Northup-Snyder Kathlynn
Published: June 2023

More than one in three adults age ≥65 fall each year, and fall-related deaths are increasing in the United States. Falls risks can be reduced when older adults are able to engage in series of behavior changes to reduce their high fall risk factors. However, older adults perceive their fall risks to be lower than clinically indicated and adherence rates for fall prevention recommendations are suboptimal. Motivational interviewing (MI), a validated patient-centered behavior change communication approach, is ideal for addressing these gaps and facilitating older adults’ engagement in fall prevention. The goal of this paper is to present practical tips to apply MI for fall prevention for clinicians who may not be familiar with MI. We draw on our experience from providing MI sessions to high fall risk older adults within a randomized controlled trial. We describe how we delivered MI sessions and practical lessons learned from this experience. We present how basic MI skills can be used for fall prevention using a case study, how an older adult may move through Stages of Change for fall prevention, and how to address strongly held beliefs about fall prevention.
The optimization design of pre-forming for forging automobile parts using Taguchi method based grey relational analysis
Authors: Chiang Ming-Yuan , Hu Jia-Wei , Hsiao Te-Ching , Tsai Ming-Chang , Huang Shyh-Chour
Published: June 2023

This study used finite element analysis software DEFORM-3D to analyze the preform formability and die stress in the pre-forming process of forging automobile transmission components. The preform and die materials used are AISI- 5120 alloy steel and JIS-SKD61 mould steel, respectively. This research investigated the phenomenon of folding defects in the preform at the end of the final forging process. First, as the die shape under the pre-formed channel was designed to change, its die shape was close to the final forged hole shape. Then, three quality characteristics were optimally analyzed by the Taguchi method for pre-formed passes, namely, “maximum tensile stress of the upper die, ”“maximum stretch stress of the lower die, ” and “ the degree of filling of the preform in the die cavity.” Then, this study applied grey correlation analysis to identify the experimental parameter configuration that could achieve a balance between the three quality characteristics, as compared with the results obtained by the Taguchi method. The results show that the lower die after the design change of the pre-forming pass can indeed improve the phenomenon of folding defects in the preform. In terms of the overall experimental data, the experimental data obtained by grey correlation analysis can balance the experimental results of the Taguchi method based on the optimization of the three quality characteristics. The experimental result of this set of parameters not only obtained the maximum tensile stress value of 716.614 MPa in the upper die but also considered the degree of the preform filling and maximum tensile stress in the lower die. The two values were 102.56% and 836.843 MPa. Although these two values are not optimal, compared to the data obtained by the Taguchi method, the preform was filled completely in this case. The maximum tensile stress value of the lower die is also the lowest.
Synthesis, crystal structures and magnetic properties of Pyrazole-Carboxylic acid complexes
Authors: Zhang Xiuqing , Zhou Chichi , Wen Qing , Chen Jiali , Song Jianfei , Liu Hanfu
Published: June 2023

Three new complexes, {[Ni2(3-PCA)2(DMAP)4(H2O)2]·2H2O}2, [Cu2(3-PCA)2(4-PP)2·2H2O]n, and [Cu2(4-PCA)2(2,2′-bpy)2·2H2O]n, are synthesized by the solvothermal method with pyrazole-3-carboxylic acid or pyrazole-4-carboxylic acid as the main ligands and 2,2′-bipyridine, 4-dimethylaminopyridine, or 4-phenylpyridine as auxiliary ligands. The crystal structures of the three complexes are determined by single-crystal X-ray diffraction, powder X-ray diffraction, thermogravimetric analysis, and Fourier transform infrared analysis. The magnetic detection proves that the three complexes are all antiferromagnetic.
Concussion education for New Zealand high school rugby players: A mixed-method analysis of the impact on concussion knowledge, attitudes and reporting behaviours
Authors: Salmon Danielle M. , Badenhorst Marelise , Brown James , Romanchuk Janelle , Kerr Zachary Yukio , Walters Simon , Clacy Amanda , Keung Sierra , Sullivan S. John , Register-Mihalik Johna , Whatman Chris
Published: June 2023

Players who lack the knowledge to recognise the signs and symptoms of concussions may be less likely to disclose their injury. New Zealand Rugby's Community Concussion Initiative includes an interactive education session highlighting peer-recognition of concussions. This mixed-method study examined the effect of an education session on high school players’ concussion knowledge and attitudes as well as the impact of player demographics on these variables. Focus groups were used to explore player experiences. The RoCKAS-ST was used to measure concussion knowledge/attitudes before and after the education session. Multiple linear regression examined associations between demographic variables, including school decile (relative wealth of the geographic region the school serves), and pre-education concussion knowledge/attitudes scores. Wilcoxon signed-rank tests compared pre-concussion and post-concussion knowledge/attitudes scores. Qualitative data were analysed via thematic analysis. Overall, 532 players completed questionnaires; 75 players participated in focus groups. Pasifika players had lower concussion knowledge than NZ Europeans ( p < .001). Mid-decile schools had higher concussion attitudes scores than low decile schools ( p < .001). Pre-education and post-education session concussion attitudes and knowledge scores did not differ significantly, suggesting the one-off education session was not successful in improving these outcomes. Players identified: (i) the education session to be valuable, but some uncertainties remained; (ii) the importance of player comfort, interaction and comprehension; (iii) the need for role models, real stories and regular content refreshers. Requests for presenter diversity, support and easily understood information were more prominent in Māori/Pasifika and low-decile groups. Greater consideration of these factors is necessary in the development of education interventions.
Killer cell immunoglobulin-like receptor (KIR) genes and their HLA ligands in a Brazilian population
Authors: Cardozo Daniela Maira , Marangon Amanda Vansan , Guimarães Fernando , Marques Silvia , Lieber Sofia , Delamain Márcia , Aranha Francisco , Visentainer Jeane Eliete Laguila , Souza Cármino Antonio de
Published: June 2023

Killer cell immunoglobulin-like receptors (KIR) exhibit extensive diversity, giving rise to different KIR profiles in populations worldwide. This study aimed to investigate the distribution of KIR genes and HLA ligands in a population from Campinas, southeastern Brazil (n  =  292), and to compare their results with other populations. A comprehensive analysis of population-specific genes, genotype, and haplotype frequencies of KIR may facilitate a better understanding of their evolution and role in immunity. The genotyping of 16 KIR genes and HLA class I alleles was performed by the reverse sequence-specific oligonucleotide methodology using the Luminex platform (One Lambda, Inc., Canoga Park, CA). The framework genes were present in all individuals, with the most common non-framework KIR genes detected being KIR2DP1(96.6%), KIR2DL1(95.5%), KIR3DL1(94.5%), KIR2DS4(93.8%) and KIR2DL3(87.3%). KIR2DS1, KIR2DS3, KIR2DS5, and KIR3DS1 presented frequencies below 40%. KIR2DL2, KIR2DL5, and KIR2DS2 showed intermediate frequencies (between53% and 58%). The activating gene KIR2DS5 was the least common in this population (30.8%). Forty-five KIR profiles were found with the commonest being the homozygous A haplotype (27.4%). The distribution of KIR genes in the Brazilian population is similar to Caucasian European and Euro-descendant populations.
Brief communication: global temporal trends in the efficacy of clarithromycin-based regimens for the treatment of Helicobacter pylori infection
Authors: Moss Steven F. , Chey William D. , Daniele Patrick , Pelletier Corey , Jacob Rinu , Tremblay Gabriel , Hubscher Elizabeth , Leifke Eckhard , Malfertheiner Peter
Published: June 2023

Background:

Helicobacter pylori eradication rates achieved with clarithromycin-based triple therapies are declining due to antibiotic resistance, but data regarding temporal changes in efficacy with these eradication therapies are scarce.

Objective:

To evaluate the efficacy of clarithromycin-based triple eradication regimens over time.

Design:

A comprehensive literature review and time-trend analysis.

Data sources and methods:

Bibliographies of recently published systematic literature reviews were searched and supplemented with a targeted literature review conducted using Medline and Embase databases and ProQuest from conception to May 2021. Studies reporting H. pylori eradication rates of clarithromycin-based triple therapies were included and temporal trends were estimated using a random-effects model.

Results:

Eradication rates for triple therapies containing proton pump inhibitors (PPIs), clarithromycin, and amoxicillin showed a significant decline over the past 23 years ( p = 0.0315). However, this decline was not significant when eradication rates achieved with vonoprazan-based triple therapy were included ( p = 0.3910).

Conclusion:

Vonoprazan-based triple therapy partially mitigated the decline in eradication rates seen with PPI-based triple therapy, likely due to more powerful acid suppression of vonoprazan.
Mepolizumab as an effective treatment in a case of hypophysitis in eosinophilic granulomatosis with polyangiitis
Authors: Chen Jessy , Alexander Tobias , Walter-Rittel Thula , Ziagaki Athanasia , Siffrin Volker
Published: June 2023

Granulomatosis or eosinophilic granulomatosis with polyangiitis (GPA/EGPA) can affect multiple organs resulting in heterogeneous symptoms and phenotypes. Pituitary gland dysfunction rarely occurs in GPA (1–3%) and even less in EGPA (two case reports). Here, we report a case of a 51-year-old female patient with a four-year history of EGPA who presented with new polydipsia and polyuria. Laboratory testing and magnetic resonance imaging (MRI) confirmed pituitary gland dysfunction caused by a hypophysitis. Therapeutic adjustment with a switch from dupilumab to mepolizumab resulted in a decrease in clinical symptoms, inflammation in MRI, and normalization of C-reactive protein in serum. This case underlines hypophysitis as a rare organ involvement also in EGPA. Moreover, this case demonstrates the responsiveness of neuroinflammatory manifestations to the recently approved anti-interleukin-5 monoclonal antibody mepolizumab as a new potential treatment option.
Quality of Life and Public Policy Development for Tourism Destinations
Authors: Berbekova Adiyukh , Uysal Muzaffer , George Assaf A.
Published: June 2023

The nexus between tourism and quality of life (QoL) has been widely discussed in the literature. There is an extensive research that examines the connection between tourism activities and QoL. Although the existing studies converge in that QoL and well-being should be incorporated and made a central aspect of tourism policies and strategies, the current literature lacks an integrated comprehensive approach to how QoL can be incorporated into tourism decision-making. Tourism decision-making organizations have yet to integrate QoL into the assessment of important strategy-related benchmarks (e.g., performance, tourism satellite accounts, demand, and resource integration). Thus, the objective of this article is to offer a conceptual framework integrating QoL and tourism public policy. The suggested model provides guidelines regarding the implementation of QoL at different stages of policy development. The framework will provide a guide for tourism destinations in formulating and implementing policies with a focus on improving the community’s QoL.
Physical Frailty and Functional Status in Patients With Advanced Chronic Kidney Disease: A Systematic Review
Authors: Karnabi Priscilla , Massicotte-Azarniouch David , Ritchie Lindsay J. , Marshall Shawn , Knoll Greg A.
Published: June 2023

Background:

With an aging population and growing number of patients with chronic kidney disease (CKD), integrating the latest risk factors when deciding on a treatment plan can result in better patient care. Frailty remains a prevalent syndrome in CKD resulting in adverse health outcomes. However, measures of frailty and functional status remain excluded from clinical decision making.

Objective:

To examine the degree to which different measures of frailty and functional status are associated with mortality, hospitalization, and other clinical outcomes in patients with advanced CKD.

Design:

Systematic review.

Setting:

Observation studies including cohort study, case-control study, or cross-sectional study examining frailty and functional status on clinical outcomes. There were no restrictions on type of setting or country of origin.

Patients:

Adults with advanced CKD, including both types of dialysis patients.

Measurements:

Data including demographic information (e.g., sample size, follow-up time, age, country), assessments of frailty or functional status and their domains, and outcomes including mortality, hospitalization, cardiovascular events, kidney function, and composite outcomes were extracted.

Methods:

A search was conducted using databases Medline, Embase, and Cochrane Central Register for Controlled Trials. Studies were included from inception to March 17, 2021. The eligibility of studies was screened by 2 independent reviewers. Data were presented by instrument and clinical outcome. Point estimates and 95% confidence intervals from the fully adjusted statistical model were reported or calculated from the raw data.

Results:

A total of 117 unique instruments were found among 140 studies. The median sample size of studies was 319 (interquartile range, 161-893). Most studies focused on incident and chronic dialysis patient populations, with only 15% of studies examining non-dialysis CKD patients. Frailty and lower functional status were associated with an increased risk for adverse clinical outcomes such as mortality and hospitalization. The 5 individual domains of frailty were also found to be associated with poor health outcomes.

Limitations:

Meta-analysis could not be performed due to significant heterogeneity between studies and methods used to measure frailty and functional status. Many studies had issues with methodological rigor. Selection bias and the validity of data collection could not be ascertained for some studies.

Conclusion:

Frailty and functional status measures should be integrated to help guide clinical care decision making for a comprehensive assessment of risk for adverse outcomes among patients with advanced CKD.

Registration (PROSPERO):

CRD42016045251
Embedding digital sleep health into primary care practice: A triangulation of perspectives from general practitioners, nurses, and pharmacists
Authors: Cheung Janet MY , Menczel Schrire Zoe , Aji Melissa , Rahimi Matthew , Salomon Helena , Doggett Iliana , Glozier Nicholas , Bartlett Delwyn J. , Wong Keith , Grunstein Ronald R. , Gordon Christopher J.
Published: June 2023

Introduction

While digital health interventions (DHIs) can potentially address the unmet needs for sleep health services, little is known about their implementation in practice. The current study aimed to explore primary care health providers’ attitudes and beliefs towards DHIs for sleep and implementation into practice.

Methods

A cross-sectional online survey was administered to Australian primary care health professionals: general practitioners (GPs), community nurses, and community pharmacists. Semi-structured interviews were conducted within a sub-sample of participants exploring their experiences with DHIs and perceived barriers/facilitators for embedding DHIs into primary care. Semi-structured interviews were thematically analysed using the framework approach to contextualise survey findings.

Results

Ninety-six surveys were returned (GPs  =  36, nurses = 30, and pharmacists = 30) and 45 interviews conducted (GPs  =  17, nurses = 14, and pharmacists  =  14). From the survey, GPs were more likely to endorse familiarity ( p  =  0.009) and use ( p < 0.001) of sleep DHIs in clinical practice than pharmacists and nurses. GPs were more interested in utilising the diagnostic features within a sleep DHI ( p  =  0.009) compared to other professionals. Thematic analysis of the interviews revealed three major themes, contextualised by profession: (1) Scope for DHIs in Current Practice, (2) Practice Gaps and Training Needs, and (3) Envisioning a Model of Care Using Sleep DHIs. While DHIs can potentially improve care, greater clarity of care pathways and reimbursement structures are needed for integration into practice.

Conclusion

Primary care health professionals highlighted the training, care pathway and financial models required to realise the potential for translating findings from efficacy studies for DHIs into primary care to optimise sleep health.
Elementary School Counselors’ Experiences Working With Children Affected by Parental Substance Use
Authors: Sylvestro Hallie M. , Glance Dorea E. , Ripley Dana , Stephenson Rachel
Published: June 2023

Despite widespread effects of parental substance use on children, little is known about the experiences of school counselors working with this student population. We examine the experiences of elementary school counselors working with school-aged children affected by parental substance use. Eight school counselors participated in semistructured interviews, which we analyzed using consensual qualitative research. Participants described significant contact with the population in question. Findings suggest that elementary school counselors utilize multitiered interventions but need additional training and job support to meet the prevalent needs of this student population. We provide implications for school counseling practice, research, and counselor training.
Factors Affecting Employees Use and Acceptance of Remote Working During the COVID-19 Pandemic: Evidence From the Jordanian Insurance Sector
Authors: Khatatbeh Ibrahim N. , Alshurafat Hashem , Al Shbail Mohannad Obeid , Jamaani Fouad
Published: June 2023

Remote working during the COVID-19 pandemic comes as an “enforced experiment,” where companies and individuals have turned to work from home to preserve business continuity. Drawing on a theoretical framework that integrates the Theory of Reasoned Action (TRA), Social Capital Theory (SCT), and Technology Acceptance Model (TAM), this research uses a sample of 134 survey responses to assess the factors affecting the acceptance and use of remote work during the COVID-19 pandemic among workers of the insurance industry in Jordan. The results suggest that social trust, perceived usefulness, and perceived ease of use can help elevate employee’s acceptance and use of remote work, whereas social norms have no significant effect. Considering these results, we further discuss implications and recommendations for the insurance sector.
The Validity of Violence Risk Assessment in Young Adults: A Comparative Study of Juvenile and Adult Risk Assessment Tools
Authors: Kleeven Anneke T. H. , de Vries Robbé Michiel , Mulder Eva A. , Popma Arne
Published: June 2023

Few studies have addressed the application of violence risk assessment for individuals transitioning from youth to adulthood. For 202 young adults released from Dutch juvenile justice institutions this study investigated the predictive validity and potential disparities in impact of juvenile risk assessment tools (i.e., SAVRY [Structured Assessment of Violence Risk in Youth], and SAPROF-YV [Structured Assessment of Protective Factors for violence risk-Youth Version]), and comparable adult risk assessment tools (i.e., HCR-20V3 [Historical Clinical Risk management-20 Version 3], and SAPROF [Structured Assessment of Protective Factors for violence risk]). Assessments with juvenile and adult risk assessment tools yielded similar predictive validity for violent and non-violent recidivism. Risk and protective factors related to treatability, parents, community participation, resilience, and personality showed individual predictive validity. These findings offer flexibility when applying risk assessment in clinical practice. The choice between youth and adult assessment tools should be made considering the individual’s developmental stage.
Reproductive Oppression Enters the Twenty-First Century: Pressure to Use Long-Acting Reversible Contraception (LARC) in the Context of “LARC First”
Authors: Eeckhaut Mieke C. W. , Hara Yuko
Published: June 2023

The common emphasis on the superior pregnancy protection of long-acting reversible contraception (LARC) may result in medical providers’ pressuring women, especially those belonging to groups experiencing reproductive disciplining, to use LARC. The authors consider reports of having felt pressured to get or keep LARC in the 2021 Delaware and Maryland Survey of Women (1,058 current users and 1,788 ever users of LARC) and examine variation in these outcomes by women’s sociodemographic characteristics. The results reveal a high prevalence of both pressure to get (26 percent of current users) and keep (11 percent of ever users) LARC overall and among young (<25 years) mothers in particular. In addition, pressure to keep LARC is more common among economically disadvantaged, unmarried, and Hispanic women. These findings reveal that in the context of “LARC first” and enduring stratified reproduction, LARC pressure is common, particularly among groups that have long been targets of reproductive disciplining.
“Retrograde Plaque/Flap Lift-and-Shift” Technique to Exclude Coronary Artery Aneurysm at the Proximal Cap of Chronic Total Occlusion of the Right Coronary Artery: A Case Report
Authors: Annam Sharath Reddy , Krishna Anil , Ali Amjad
Published: June 2023

With growing expertise and evolving hardware chronic total occlusion (CTO) percutaneous coronary intervention (PCI) success and safety has been improved remarkably. The nuances of CTO wiring help operators to find novel solutions to the complications created during percutaneous coronary interventions. Accidental coronary perforations caused during CTO interventions can be sealed by wiring from other side and shifting interposing plaque or flap onto perforation. We report a case of saccular aneurysm around the proximal cap formed by antegrade wire escalation in earlier failed percutaneous coronary interventions, which is excluded by “retrograde plaque lift and shift.”
The current status of emergency departments in secondary emergency medical institutions in Japan: a questionnaire survey
Authors: Sera Toshiki , Otani Norio , Bannai Hideo , Hasegawa Takanori , Umemura Takehiro , Honda Hideki , Kimura Akio
Published: June 2023

Background

While emergency medicine (ER)-based emergency care is prevalent in many countries, in Japan, the “department-specific emergency care model” and the “emergency center model” are mainstream. We hypothesized that many secondary emergency medical institutions in Japan have inadequate systems. Using a questionnaire, we investigated the status of and problems in the emergency medical services system in secondary emergency medical institutions in Japan. Until date, there has not been an exhaustive survey of emergency facilities on a countrywide scale. The main objective of this study was to investigate problems in the Japanese emergency medical services system and thereby improve optimal care for emergency patients.

Results

A nationwide questionnaire survey involving 4063 facilities (all government-approved emergency medical facilities certified by prefectural governors) in Japan was conducted. Of the facilities that responded, all secondary emergency facilities were included in the analysis. Responses from 1289 facilities without a tertiary emergency medical care center were analyzed. Among them, 61% (792/1289) had ≤ 199 beds, and 8% were emergency department specialty training program core facilities. Moreover, 42% had an annual patient acceptance number of ≤ 500, 19% did not calculate the number of acceptances, 29% had an acceptance rate of ≥ 81%, and 25% had an acceptance rate of 61–80%. Pregnant women (63%) and children (56%) were the major types of patients that affected the acceptance rate. Factors affecting facilities with a response rate of 81% or higher were “hospitals designated for residency training” and “facilities making some efforts to improve the quality of emergency care and the emergency medical system” (logistic analysis, P < .001).

Conclusion

Relevant authorities and core regional facilities should consider and implement specific measures for regions and hospitals with a shortage of emergency medicine specialists and physicians (e.g., development of ER-based emergency medicine and provision of education). This study may lead to further improvement in the optimal care of emergency patients through the nationwide establishment of the proposed measures as well as through grouping and integrating the structures and systems in emergency and other medical facilities.
Integrating Omics and CRISPR Technology for Identification and Verification of Genomic Safe Harbor Loci in the Chicken Genome
Authors: Dehdilani Nima , Goshayeshi Lena , Yousefi Taemeh Sara , Bahrami Ahmad Reza , Rival Gervier Sylvie , Pain Bertrand , Dehghani Hesam
Published: June 2023

Background

One of the most prominent questions in the field of transgenesis is ‘Where in the genome to integrate a transgene?’. Escape from epigenetic silencing and promoter shutdown of the transgene needs reliable genomic safe harbor (GSH) loci. Advances in genome engineering technologies combined with multi-omics bioinformatics data have enabled rational evaluation of GSH loci in the host genome. Currently, no validated GSH loci have been evaluated in the chicken genome.

Results

Here, we analyzed and experimentally examined two GSH loci in the genome of chicken cells. To this end, putative GSH loci including chicken HIPP-like (cHIPP; between DRG1 and EIF4ENIF1 genes) and chicken ROSA-like (cROSA; upstream of the THUMPD3 gene) were predicted using multi-omics bioinformatics data. Then, the durable expression of the transgene was validated by experimental characterization of continuously-cultured isogenous cell clones harboring DsRed2-ΔCMV-EGFP cassette in the predicted loci. The weakened form of the CMV promoter (ΔCMV) allowed the precise evaluation of GSH loci in a locus-dependent manner compared to the full-length CMV promoter.

Conclusions

cHIPP and cROSA loci introduced in this study can be reliably exploited for consistent bio-manufacturing of recombinant proteins in the genetically-engineered chickens. Also, results showed that the genomic context dictates the expression of transgene controlled by ΔCMV in GSH loci.
Frequency of prothrombin time-international normalized ratio monitoring and the long-term prognosis in patients with mechanical valve replacement
Authors: Geng Le , Gu Jiaxi , Li Minghui , Liu Hong , Sun Haoliang , Ni Buqing , Gu Weidong , Shao Yongfeng , Li Mingfang , Chen Minglong
Published: June 2023

Background

The study aimed to assess the correlation between the monitoring frequency of PT-INR and the long-term prognosis in patients with mechanical heart valve (MHV) replacement after discharge.

Methods

This single-center, observational study enrolled patients who underwent MHV replacement and discharged from June 2015 to May 2018. Patients or their corresponding family members were followed with a telephone questionnaire survey in July-October 2020. Based on monitoring intervals, patients were divided into frequent monitoring (FM) group (≤ 1 month) and less frequent monitoring (LFM) group (> 1 month). The primary endpoint was the composite of thromboembolic event, major bleeding or all-cause death. The secondary endpoints were thromboembolic event, major bleeding or all-cause death, respectively.

Results

A total of 188 patients were included in the final analysis. The median follow-up duration was 3.6 years (Interquartile range: 2.6 to 4.4 years). 104 (55.3%) patients and 84 (44.7%) patients were classified into the FM group and the LFM group, respectively. The FM group had a significantly lower incidence of the primary endpoint than the LFM group (3.74 vs. 1.16 per 100 patient-years, adjusted HR: 3.31 [95% CI 1.05–10.42, P = 0.041]). Secondary analysis revealed that the risk of thromboembolic events and all-cause death were also reduced in the FM group.

Conclusions

The management of warfarin treatment in patients after MHV replacement remains challenging. Patients with less frequent monitoring of PT-INR might have worse clinical prognosis than those with frequent PT-INR monitoring.