bluuebunny/crossref_metadata_2025 huggingface dataset:
Causal inference using observational intensive care unit data: a systematic review and recommendations for future practice
Authors: Smit J. M. , Krijthe J. H. , van Bommel J. , Labrecque J.A. , Komorowski M. , Gommers D.A.M.P.J. , Reinders M. J. T. , van Genderen M.E.
Published: October 2022

Aim

To review and appraise the quality of studies that present models for causal inference of time-varying treatment effects in the adult intensive care unit (ICU) and give recommendations to improve future research practice.

Methods

We searched Embase, MEDLINE ALL, Web of Science Core Collection, Google Scholar, medRxiv, and bioRxiv up to March 2, 2022. Studies that present models for causal inference that deal with time-varying treatments in adult ICU patients were included. From the included studies, data was extracted about the study setting and applied methodology. Quality of reporting (QOR) of target trial components and causal assumptions (ie, conditional exchangeability, positivity and consistency) were assessed.

Results

1,714 titles were screened and 60 studies were included, of which 36 (60%) were published in the last 5 years. G methods were the most commonly used (n=40/60, 67%), further divided into inverse-probability-of-treatment weighting (n=36/40, 90%) and the parametric G formula (n=4/40, 10%). The remaining studies (n=20/60, 33%) used reinforcement learning methods. Overall, most studies (n=36/60, 60%) considered static treatment regimes. Only ten (17%) studies fully reported all five target trial components (ie, eligibility criteria, treatment strategies, follow-up period, outcome and analysis plan). The ‘treatment strategies’ and ‘analysis plan’ components were not (fully) reported in 38% and 48% of the studies, respectively. The ‘causal assumptions’ (ie, conditional exchangeability, positivity and consistency) remained unmentioned in 35%, 68% and 88% of the studies, respectively. All three causal assumptions were mentioned (or a check for potential violations was reported) in only six (10%) studies. Sixteen studies (27%) estimated the treatment effect both by adjusting for baseline confounding and by adjusting for baseline and treatment-affected time-varying confounding, which often led to substantial changes in treatment effect estimates.

Conclusions

Studies that present models for causal inference in the ICU were found to have incomplete or missing reporting of target trial components and causal assumptions. To achieve actionable artificial intelligence in the ICU, we advocate careful consideration of the causal question of interest, the use of target trial emulation, usage of appropriate causal inference methods and acknowledgement (and ideally examination of potential violations) of the causal assumptions.

Systematic review registration

PROSPERO (CRD42022324014)
Accelerating alienation: gender and self-efficacy in the accelerator context
Authors: MacNeil Heatherjean , Schoonmaker Mary , McAdam Maura
Published: October 2022

Purpose

This study focuses on the lived experiences of early-stage women founders in a venture accelerator context. In particular, this work explores how gender shapes entrepreneurial self-efficacy (ESE) development in early-stage female founders in the venture accelerator context.

Design/methodology/approach

A qualitative, feminist-sensitive research methodology was utilized, with empirical evidence drawn from interviews with fifty one female founders and four accelerator managers located in four, competitive accelerator programs located in the Northeastern United States.

Findings

Study findings highlight how accelerators contribute to ESE development. Data also shows how the micro-processes related to masculinized discourse, culture, as well as mentorship and training, contribute to the “othering” and minimization of women during early-stage venture development.

Originality/value

This study contributes to the accelerator literature through a provision of insights into the ways a dominant, masculinized discourse and culture alienates female participants, making them feel “othered’, and resulting in a lack of fit with critical networking and funding opportunities. Second, this study builds on self-efficacy theory by applying a gender lens to the areas of mastery learning, vicarious learning, social persuasion and mental state, thus illuminating ways that the masculinization of these processes negatively disrupts the ESE development of female founders. Third, this study builds more broadly on the women's entrepreneurship literature by showing how masculine norms and culture ultimately impact upon the well-being of women in an early-stage entrepreneurship context.
How do dialogic interactions contribute to the construction of teachers' mathematical problem-solving knowledge? Construction of a conceptual framework
Authors: Clivaz Stéphane , Daina Audrey , Batteau Valérie , Presutti Sara , Bünzli Luc-Olivier
Published: October 2022

Purpose

The article presents the construction of a conceptual framework, which is rooted in mathematics education and in dialogic analysis. It aims to analyse how dialogic interactions contribute to constructing teachers' mathematical problem-solving knowledge. The article provides one example of this analysis.

Design/methodology/approach

The networking between a content analysis framework (Mathematical Knowledge for Teaching Problem-Solving) and a dialogic analysis framework (Lesson Study Dialogue Analysis) is presented. This leads to the construction of indicators to quantitatively and qualitatively code our data: five meetings during one lesson study cycle of a group of eight Swiss primary teachers, working on the teaching of problem-solving.

Findings

This article does not present empirical findings. The developed conceptual framework is the result presented.

Research limitations/implications

The presented framework allows modelling, on the one hand, the knowledge relating to the teaching and learning of problem-solving and, on the other hand, the analysis of interactions during a lesson study. The article does not contain the results of the research.

Practical implications

The use of our framework can contribute to teacher educators' and facilitators' training by highlighting which types of intervention are favourable to the development of knowledge.

Originality/value

Our analysis involves a “systematic coding” approach. It allows a fine-grained analysis of the interactions in relation to the evolution of knowledge. Such a systematic approach offers the possibility of questioning the coded data in various ways.
Supplier-base concentration and efficiency: the moderating roles of R&D expenditure and market share
Authors: Han Zhaojun , Hu Miao , Zuo Yan , Jiang Shenyang
Published: October 2022

Purpose

This study addresses an important research question regarding how supplier-base concentration affects buyer efficiency. Drawing on the contradicting views of transaction cost theory (TCT) and resource dependence theory (RDT), the authors explore the main effect of supplier-base concentration on buyer efficiency and how this effect is contingent on buyers' characteristics (i.e. research and development (R&D) expenditure and market share).

Design/methodology/approach

Based on data collected from the Chinese manufacturing firms listed on National Equities Exchange and Quotations (NEEQ) between 2015 and 2019, the authors use a fixed-effect model as well as a two-stage least squares model to test the predictions.

Findings

The authors find that supplier-base concentration has a positive effect on buyer efficiency. In addition, when a buyer has higher levels of R&D expenditure and market share, the positive relationship between supplier-base concentration and buyer efficiency is strengthened.

Originality/value

This study contributes to a better understanding of the effect of supplier-base concentration. First, the authors provide theoretical and empirical evidence of the positive effect of supplier-base concentration on buyer efficiency. Second, the authors reveal the underlying mechanism of how to counter the potential drawbacks and benefit more from supply base reduction by introducing R&D expenditure and market share as contingencies.
Workplace pro-environmental behaviour: a review and bibliometric analysis
Authors: Zaidi Hiba , Azmi Feza Tabassum
Published: October 2022

Purpose

Pro-environmental behaviour (PEB) has always been one of the most critical topics in academia and industry. The primary goal of this study is to identify the current research progress and developmental trends of PEB by doing an exhaustive analysis of the existing literature. The study also aims to streamline the future research possibilities in PEB with the current research interests.

Design/methodology/approach

A total of 209 published articles from 1993 to 2021 were collected from the Scopus database and analysed using an integrated approach of bibliometric analysis, network analysis, and content analysis techniques. The bibliometric analysis was performed with the help of statistical program “R,” and further analysis was carried out using Gephi and VOS viewer software.

Findings

The systematic mapping of this field gives an exhaustive review of the available literature by identifying annual publication growth, most contributing authors, journals, emerging keywords, and themes. Sustainability was found to be the most contributing journal, and Paille was the topmost contributing author. The keywords such as corporate social responsibility, organizational citizenship behaviour towards the environment (OCBE), and green human resource management (HRM) were recently identified as the emerging niche in the literature. The content analysis findings give a robust roadmap for further research in this area.

Originality/value

This study enriches the literature on workplace pro-environmental behaviour by presenting a detailed, systematic, and exhaustive review of the existing publications using a combination of research methodology.
What innovations would enable hospitality in South Africa to rebuild?
Authors: Nyathela-Sunday Tshinakaho , Septoe Nina , Menze Celiwe Zorah , Banoobai-Anwar Ilhaam , Seager Beverley , Davids Nadia , Buser Cindy
Published: October 2022

Purpose

This paper aims to address the following questions: What is the impact of the pandemic on the hospitality industry in South Africa? Which innovations and strategies are in place to rebuild hospitality in South Africa?

Design/methodology/approach

This article emanates from the resent pandemic situation, and it is structured to include conceptual information drawn from the literature, empirical study and industry observation. These were conducted in 2020 and 2021 using, concepts from the literature, online questionnaires and observation to gather data about the impact of COVID-19 on hospitality operations across South Africa.

Findings

Historically literature shows that the hospitality industry positively impacts the economy and employment However, the pandemic greatly affected these contributions. The findings reported in the empirical study revealed that the pandemic affected business operations and employment and caused financial hardship for the industry.

Originality/value

There are relatively few studies that report on the issues relating to the pandemic and the hospitality industry in South Africa. This paper contributes to the literature regarding a pre-COVID-19 overview, the impact of the pandemic and the innovations and strategies in place to rebuild the hospitality industry.
Rural and traditional cafes and restaurants: a new emerging trend in domestic tourism
Authors: Obeidat Wlla
Published: October 2022

Purpose

The purpose of this paper is to analyze the latest phenomenon emerging from rural towns and villages, where a surge in traditional cafes and restaurants has spurred a new trend in sustainable tourism development. This phenomenon is linked to local efforts to mitigate the socio-economic impact of the COVID-19 pandemic and the series of lockdowns that accompanied it. This paper focuses on two critical lines of inquiry: (1) Where did the idea stem from? and (2) How has it developed to the extent that it now constitutes one of the few primary sources of income for underdeveloped communities?

Design/methodology/approach

Exploratory research was conducted in rural and urban areas where tourism is still developing. In depth, semi-structured interviews were conducted with a sample consisting of ten owners of rural and traditional cafes who consented to their participation in the study.

Findings

Emerging trends such as rural and traditional cafes and restaurants can be a stable source of income for underserved communities in uncertain times. Local entrepreneurs often play a critical role in the development of sustainable rural tourism efforts as they have a better understanding of the needs of their own local community. Furthermore, their projects typically carry higher levels of authenticity and innovation with a greater ability to attract both local and international travelers.

Research limitations/implications

Taking into consideration the exploratory nature of this study, a small convenience sample was used.

Originality/value

This study highlights the importance of innovation in the tourism industry during precarious times, the most recent example of which was the global COVID-19 pandemic. This paper suggests that the industry can rely on new emerging trends to mitigate the loss of revenue from previous sources of tourism. Furthermore, the study showcases the importance of domestic tourism trends and how it can lead to an expansion in international tourism resources.
Rural tourism in India: case studies of resilience during crisis
Authors: Aithal Rajesh , Anil R.K. , Angmo Dechen
Published: October 2022

Purpose

This paper aims to study organisations involved in rural tourism during the COVID-19 crisis and draw out lessons for similar organisations.

Design/methodology/approach

A qualitative approach has been adopted to develop the case studies for the three organisations, and the popular crisis management model has been used to analyse their responses.

Findings

The three organisations studied responded well to survive the COVID-19 crisis, and, the responses were grouped into three broad themes, namely importance of a good team supporting the business, increased digital engagements and the need to diversify their customer bases.

Practical implications

Organisations working in tourism sector have been facing several crises concurrently. The findings of this study on rural tourism should hopefully provide feedback and guidance to face the future challenges that might emerge in the tourism sector.

Originality/value

This study would perhaps be one of the first to map the responses of organisations working in India during the COVID crisis, where rural tourism has slowly started to become a significant rural development strategy.
Exploring drivers of within‐field crop yield variation using a national precision yield network
Authors: Fincham William N. W. , Redhead John W. , Woodcock Ben A. , Pywell Richard F.
Published: October 2022

While abiotic drivers of yields represent important limiting factors to crop productivity, the role of biotic drivers that could be directly managed by farmers (e.g. agri‐environment schemes supporting key ecosystem services) remains poorly understood. Precision yield mapping provides an opportunity to understand the factors that limit agricultural yield through the interpretation of high‐resolution cropping data. This has the potential to inform future precision agricultural management, such as the targeted application of agrochemicals, promoting increased sustainability in modern agricultural systems.

We used precision yield measurements from a network of 1174 fields in England (2006–2020) to identify drivers of within‐field yield variation in winter wheat and oilseed rape. Potential drivers included climate, topography and landscape composition and configuration. We then explored relationships between in‐field yield patterns and local landscape context, including the presence of features associated with ecosystem benefits.

Proximity to the field edge was associated with reduced yields in 85% of wheat and 87% of oilseed fields. This translating to an approximate reduction of 10% in wheat and 18% in oilseed yields lost due to field edge effects.

We found evidence that reduced yields at the field edges were associated with biotic features of the surrounding landscape, including the occurrence of semi‐natural habitats. Specifically, agri‐environment scheme (AES) presence increased the rate at which yields at field edges approach those of the field centres. This suggests that AES occurrence within a landscape (rather than field adjacent) may increase edge effects. However, these trends are unclear and suggest interactions between drivers and the spatial and temporal scale of investigation.

Synthesis and applications. While we found evidence of landscape context mitigating against field edge effects, these were counterintuitive. For example, AES at a landscape scale appeared to increase the severity of edge effects. This study highlights a lack of environmental data at sufficiently high spatiotemporal resolution to match that of precision agriculture data. This mismatch is hindering the effective integration of precision agriculture data in an environmental policy and/or management context and potentially leading to unnecessarily poorly informed decisions related to AES deployment. This may limit environmental and economic benefits.
Being just their hands? Personal assistance for disabled people as bodywork
Authors: García‐Santesmases Andrea , López Gómez Daniel , Pié Balaguer Asun
Published: October 2022

Drawing on the notion of bodywork, we analyse the bodily aspects of personal assistance to expand the dialogue between medical sociology and disability studies. We aim to, firstly, overcome the lack of attention to the bodywork of personal assistant (PAs) in disability studies; secondly, explore the micropolitics of personal assistance and the role of independent living mandates in configuring this bodywork of PAs; and, thirdly, propose a more relational and material approach to the impairment/disability debate. This exploration is based on qualitative semi‐structured interviews with 23 PAs conducted in Spain between 2018 and 2020. Our research reveals that PAs’ bodywork implies performing their body as body‐absence, such as when they enact body‐tool and body‐prosthesis figurations, but also as body‐presence, for instance, as acting bodies and affected/affecting bodies in specific situations. Through their analysis, we foreground how PAs’ bodywork conveys normative ways of enacting the body and how these body figurations are not only challenged and negotiated but define the actual practice of personal assistance. To conclude, we stress on the theoretical contributions of our study towards both disability studies and medical sociology.
The (radical) role of belonging in shifting and expanding understandings of social inclusion for people labelled with intellectual and developmental disabilities
Authors: Reeves Paige , McConnell David , Phelan Shanon K.
Published: October 2022

There is a gap between the desired outcomes of social inclusion policy and the everyday experiences of people labelled with intellectual and developmental disabilities. Despite belonging rhetorically named in social inclusion policy and practice, belonging is often absent in the lives of people labelled with intellectual and developmental disabilities and remains undertheorised in its relationship to social inclusion. In this paper, we explore the role belonging might play in narrowing the gap between how social inclusion is theorised and how it is experienced. Drawing on critical disability and feminist relational theories, we outline a relational conceptualisation of belonging and use it to ‘crip’ the construct of social inclusion. Exploring the synergies and tensions that surface when social inclusion and belonging are held together as discrete but interconnected constructs, we name four conceptual shifts and expansions that allow us to see social inclusion differently. Through the centring of the experiences of people labelled with intellectual and developmental disabilities, we explore the ways belonging can help to reimagine inclusion from assimilationist, static, objective and formal towards inclusion as fluid, negotiated, (inter)subjective, (in)formal and intimate.
Democracy and schooling: The paradox of co-operative schools in a neoliberal age?
Authors: Woodin Tom , Gristy Cath
Published: October 2022

From the first co-operative trust school at Reddish Vale in Manchester in 2006, the following decade would witness a remarkable growth of ‘co-operative schools’ in England, which at one point numbered over 850. This paper outlines the key development of democratic education by the co-operative schools network. It explains the approach to democracy and explores the way values were put into practice. At the heart of co-operativism lay a tension between engaging with technical everyday reforms and utopian transformative visions of an educational future. A new arena of debate and practice was established with considerable importance for our understanding of democratic education within the mainstream.
Discovering disagreement: The story of an undergraduate Wartime Quartet reading group
Authors: McCallion Anne-Marie
Published: October 2022

This paper describes and analyses the experience of the participants of an undergraduate reading group on ‘The Wartime Quartet’. In the first section, I explain the set-up of the reading group. In the second section, I discuss what the participants shared and the trends we noticed in our experiences as women and marginalised genders studying undergraduate philosophy In the third section, I explain why the philosophy of the Quartet was itself vital to our development and how it enabled us to begin critically engaging with the material presented in our courses. My fourth section introduces a phenomenon I call disassociated disagreement (DD) and uses testimonies from former members of the reading group to illustrate why this phenomenon is central to understanding the confusion that sometimes presents in students of philosophy. I then discuss a strategy for combating DD and illustrate how students’ seeming confusion can provide a pathway to unique and insightful philosophical perspectives. I conclude by situating my discussion within the broader framework of research into women's representation in philosophy and close by arguing that the concept of DD can be a potent tool for encouraging more philosophy undergraduates who belong to marginalised groups to pursue further study.
Creating and sustaining democratic spaces in education
Authors: Haynes Joanna , Suissa Judith
Published: October 2022

This article explores the context for the accompanying suite of papers on creating and sustaining democratic spaces in education. Prompted by the centenary of Summerhill, the internationally famous democratic school founded in Suffolk, England, in 1921, by A.S. Neill, this collection of papers explores and broadens out the central questions at the heart of experiments in democratic education. We suggest that, at a time of distrust in and questioning of the central institutions of democratic government, and in the wake of challenges to the mainstream system of state schooling, these questions are more relevant than ever. We argue that detailed attention to the everyday practice of creating democratic spaces in a variety of educational and social contexts can highlight the myriad ways in which educators, students, families and communities can keep democratic values and principles alive, thereby enriching our discussions about the meaning and value of democratic education.
A closer look at disparities in earnings between white and minoritized dentists
Authors: Nasseh Kamyar , Frogner Bianca K. , Vujicic Marko
Published: October 2022

Objective

To examine the factors that account for differences in dentist earnings between White and minoritized dentists.

Data Sources

We used data from the American Dental Association's Survey of dental practice, which includes information on 2001–2018 dentist net income, practice ZIP code, patient mix between private and public insurance, and dentist gender, age, and year of dental school graduation. We merged the data on dentist race and ethnicity and school of graduation from the American Dental Association masterfile. Based on practice ZIP code, we also merged the data on local area racial and ethnic composition from the American Community Survey.

Study Design

We used a linear Blinder‐Oaxaca decomposition to assess observable characteristics that explain the gap in earnings between White and minoritized dentists. To assess differences in earnings between White and minoritized dentists at different points of the income distribution, we used a re‐centered influence function and estimated an unconditional quantile Blinder‐Oaxaca decomposition.

Data Extraction Methods

We extracted data for 22,086 dentists ages 25–85 who worked at least 8 weeks per year and 20 hours per week.

Principal Findings

Observable characteristics accounted for 58% of the earnings gap between White and Asian dentists, 55% of the gap between White and Hispanic dentists, and 31% of the gap between White and Black dentists. The gap in earnings between White and Asian dentists narrowed at higher quantiles of the income distribution.

Conclusions

Compared to other minoritized dentists, Black dentists have the largest earnings disparities relative to White dentists. While the level of the explained component of the disparity for Black dentists is comparable to the explained part of the disparities for other minoritized dentists, the excess percentage of the unexplained component for Black dentists accounts for the additional amount of disparity that Black dentists experienced. Persistent income disparities could discourage minoritized dentists from entering the profession.
Adaptive evolution in the Saccharomyces kudriavzevii Aro4p promoted a reduced production of higher alcohols
Authors: Tapia Sebastián M. , Pérez‐Torrado Roberto , Adam Ana Cristina , Macías Laura G. , Barrio Eladio , Querol Amparo
Published: October 2022

The use of unconventional yeast species in human‐driven fermentations has attracted a lot of attention in the last few years. This tool allows the alcoholic beverage industries to solve problems related to climate change or the consumer demand for newer high‐quality products. In this sense, one of the most attractive species is Saccharomyces kudriavzevii, which shows interesting fermentative traits such as the increased and diverse aroma compound production in wines. Specifically, it has been observed that different isolates of this species can produce higher amounts of higher alcohols such as phenylethanol compared with Saccharomyces cerevisiae. In this work, we have shed light on this feature relating it to the S. kudriavzevii aromatic amino acid anabolic pathway in which the enzyme Aro4p plays an essential role. Unexpectedly, we observed that the presence of the S. kudriavzevii ARO4 variant reduces phenylethanol production compared with the S. cerevisiae ARO4 allele. Our experiments suggest that this can be explained by increased feedback inhibition, which might be a consequence of the changes detected in the Aro4p amino end such as L26Q24 that have been under positive selection in the S. kudriavzevii specie.
Assessing land‐use/water‐quality relationships across contrasting geologic areas in New Jersey
Authors: Procopio Nicholas A. , Zampella Robert A.
Published: October 2022

In all, 13 stream water‐quality parameters, including specific conductance (SC), pH, dissolved oxygen (DO), dissolved organic carbon (DOC), three nutrients, and six major ions were compared between the northern bedrock and southern coastal plain regions of New Jersey, USA and related to watershed‐disturbance gradients characterized by the percentage of urban land, impervious surface (IS), agriculture, and altered land (sum of urban land and agriculture) in the watersheds. SC, DO, calcium, magnesium, sodium, and chloride concentrations were greater in the north. DOC was higher and pH was lower in the south. Nutrient, potassium, and sulfate concentrations did not differ between regions. Regional water‐quality differences are attributed to geologic setting and land use. Except for DO in southern streams, all water‐quality parameters were related to urban land, agriculture, or both. Significant correlations between urban land and IS and water‐quality variables were similar in both regions with differences in unitless correlation coefficients ranging from 0.00 to 0.06. Compared to urban land and agriculture, relationships between most water‐quality variables and altered land were stronger in the south. The extent of urban and agricultural lands in the watersheds did not differ by region. Altered land was correlated with urban land in both regions and with agriculture only in the south. Although focused on New Jersey, this study has broader implications for watershed planning.
The year of the tiger and the year of tiger genomes!
Authors: Khan Anubhab
Published: October 2022

Tigers are endangered apex predators. They typify endangered species because they are elusive, rare, and face numerous threats across their range. Tigers also symbolize conservation. However, it is very difficult to study tigers because of their stated nature. Also, tiger conservation is a geopolitically sensitive topic, making it difficult to use the studies to propose evidence‐based management that allows their recovery, especially in the context of conservation genetics. Zhang et al. (Mol. Ecol. Resour., 2022) have created very valuable and rare resources to aid the community in conserving tigers. First, they present chromosome level genome assemblies of a South China tiger and an Amur tiger. Second, they present whole genome sequences of 16 captive South China tigers. Additionally, by using the assemblies they model the demographic history of these populations, estimate inbreeding and the potential threats they face in captivity. This approach is particularly important because genetic management is now the only remaining option for South China tigers, because they are extinct in the wild. In other words, captive individuals are our only hope for some day restoring the wild populations of South China tigers.
Frailty assessment tools and associated postoperative outcomes in older patients undergoing elective surgery: A prospective pilot study
Authors: Rabelo Luis G. , Bjornsdottir Anna , Jonsdottir Anna B. , Einarsson Sveinn G. , Karason Sigurbergur , Sigurdsson Martin I.
Published: October 2022

Background

There is a need for a feasible tool to assess the risk of frailty prior to surgery. We aimed to identify the ratio of abnormal results for three clinically applicable screening tools to assess the risk of frailty, and their association with adverse outcomes in a cohort of elderly surgical patients.

Methods

In this prospective pilot study, patients ≥65 years undergoing preoperative evaluation for elective surgery were included and subjected to three frailty screening tests; Program of Research to Integrate Services for the Maintenance of Autonomy 7‐item questionnaire (PRISMA7), Timed Up and Go (TUG), and Clock Drawing Test (CDT). The primary outcome was the incidence of abnormal testing, and secondary outcomes were the association between abnormal tests and mortality, readmission, delirium, surgical complications and non‐home discharge.

Results

Out of 99 patients, 41%, 37%, and 43% had abnormal PRISMA7, TUG, and CDT screening, respectively. Postoperative delirium was more likely to occur in patients with abnormal TUG screening (19% vs. 3%, p = .011) and CDT (17% vs. 2%, p = .019). When analyzing screening tool combinations, patients with abnormal PRISMA7 and TUG had a higher rate of non‐home discharge (38% vs. 17%, p = .029); and patients with abnormal TUG and CDT had a higher rate of postoperative delirium (25% vs. 3%, p = .006) and any surgical complication (58% vs. 38%, p = .037); and patients with abnormal results from all three tools had a higher rate of postoperative delirium (21% vs. 5%, p = .045) and non‐home discharge (42% vs. 18%, p = .034).

Conclusion

Approximately 40% of elderly surgical patients have abnormal PRISMA7, TUG, and CDT screening tests for frailty, and they are associated individually or in combination with increased risk of adverse postoperative outcomes. The results will aid in designing studies to further risk‐stratify patients at risk of frailty and attempt to modify associated outcomes.
Alcohol‐related dysmorphic features as predictors of neurodevelopmental delay in infants and preschool‐aged children: Results from a birth cohort in Ukraine
Authors: Bandoli Gretchen , Coles Claire , Kable Julie , Jones Kenneth Lyons , Delker Erin , Wertelecki Wladimir , Yevtushok Lyubov , Zymak‐Zakutnya Natalya , Granovska Iryna , Plotka Larysa , Chambers Christina ,   the CIFASD
Published: October 2022

Background

Cardinal and non‐cardinal dysmorphic features are associated with prenatal alcohol exposure (PAE); however, their association with neurodevelopment is less clear. The objective of this study was to determine whether alcohol‐related dysmorphic features predict neurodevelopmental delay in infants and toddlers.

Methods

We analyzed a prospective pregnancy cohort in western Ukraine enrolled between 2008 and 2014. A dysmorphology examination comprising body size and three cardinal and 14 non‐cardinal dysmorphic features was performed at approximately 6 to 12 months of age. PAE was self‐reported and operationalized as absolute ounces of alcohol per day around the time of conception. Neurodevelopment was assessed at 6 to 12 months with the Bayley Scales of Infant Development‐II (BSID‐II), and at 3.5 to 4.5 years of age with the Differential Ability Scales‐II, the Child Behavior Checklist, and multiple measures that were used to create an executive functioning factor score. We performed logistic regression to predict children's neurodevelopment from dysmorphic features, growth measures, sex, and PAE.

Results

From an analytic sample of 582 unique children, 566 had BSID‐II scores in infancy, and 289 completed the preschool battery. Models with all cardinal and non‐cardinal dysmorphic features, growth measures, sex, and PAE performed better than models with subsets of those inputs. In general, models had poor performance classifying delays in infancy (area under the curve (AUC) <0.7) and acceptable performance on preschool‐aged outcomes (AUC ~0.75). When the sample was limited to children with moderate‐to‐high PAE, predictive ability improved on preschool‐aged outcomes (AUC 0.76 to 0.89). Sensitivity was relatively low for all models (12% to 63%), although other metrics of performance were higher.

Conclusion

Predictive analysis based on dysmorphic features and measures of growth performed modestly in this sample. As these features are more reliably measured than neurodevelopment at an earlier age, the inclusion of dysmorphic features and measures of growth in predictive models should be further explored and validated in different settings and populations.
All alcohol exposure counts ‐ testing parental, older sibling, best friend and peer exposure on young adolescent drinking in a seven‐wave longitudinal study
Authors: Cook Megan , Smit Koen , Kuntsche Emmanuel
Published: October 2022

Aims

Role models around the adolescent, including parents, peers, best friends and older siblings, all act in ways to socialize the adolescent into alcohol use. This study aims to examine the effect of exposure to siblings’ drinking alongside the more traditionally examined role models on alcohol use among adolescents.

Design

A longitudinal study followed adolescents (45.6% male) who completed a questionnaire every 6 months over 3 years (seven in total).

Setting

Netherlands

Participants

This resulted in 5112 observations clustered in 765 participants aged between 10 and 16 years.

Measurements

We examined three alcohol use measures: alcohol use in the last 6 months, in the last 4 weeks and binge drinking in the last 4 weeks—both cross‐sectionally at each time‐point and their change from one time‐point to the next in a series of multi‐level logistic regression models.

Findings

Results revealed a non‐significant difference in any of the exposure or alcohol use variables between those with or without older siblings. Higher exposure to sibling drinking was significantly associated with all alcohol use outcomes: use in the last 6 months, odds ratio (OR) = 1.54, 95% confidence interval (CI) = 1.25–1.91; last 4 weeks, OR = 2.04, 95% CI = 1.60–2.60; and binge drinking, OR = 2.35, 95% CI = 1.82–3.05. When adding the other role models (i.e. peers, mothers, fathers and best friends), the significant association between siblings’ exposure and adolescents’ alcohol use remains.

Conclusions

It would appear that, after adjustment for the effect of role models, adolescents who are exposed to more sibling drinking are more likely to have drunk alcohol during the past 6 months and past 4 weeks and also to binge drink.
The association between objectively measured exposure to tobacco outlets and smoking cognitions: a study among non‐smoking adolescents in four Dutch cities
Authors: van Deelen Tessa R. D. , de Vet Gabriëlle , Zijp Anne , van den Putte Bas , Kunst Anton E. , Kuipers MirteA. G.
Published: October 2022

Aims

Exposure to tobacco products and advertising at the point of sale may be associated with pro‐smoking cognitions. However, previous studies on this topic measured exposure based on self‐report and did not include European countries. The aim of this study was to assess the association between objectively measured exposure to tobacco outlets and non‐smoking adolescents' smoking attitudes, beliefs and norms.

Design

This cross‐sectional study combined survey data with Global Positioning Systems data using geographic information system.

Setting

The four Dutch cities of Amsterdam, Eindhoven, Haarlem and Zwolle.

Participants

We retrieved data of 308 13 to 17‐year‐old non‐smoking adolescents, mainly girls (61%), adolescents attending pre‐university secondary education (71%) and without smoking friends (58%).

Measurements

Exposure was measured with a smartphone app registering for 2 weeks how often participants were within 10 m of a tobacco outlet. We distinguished between outlets without visible tobacco promotion (i.e. supermarkets), with only internal visibility and with both internal and external visibility. Participants' reported smoking cognitions were dichotomised into pro‐smoking or anti‐smoking. We applied multi‐level logistic regression analyses and adjusted for age, sex, educational level and smoking friends.

Findings

On average, adolescents were exposed to 1.18 (SD = 1.23) tobacco outlets per day. Higher exposure to tobacco outlets was associated with higher odds of pro‐smoking injunctive norm ( OR = 1.35, 95% CI = 1.04–1.75). Associations with attitude (OR = 1.12, 95% CI = 0.91–1.38), social beliefs (OR = 1.15, 95% CI = 0.93–1.43), health beliefs (OR = 1.18, 95% CI = 0.97–1.44) and descriptive norm (OR = 1.15, 95% CI = 0.91–1.44) were also positive, but non‐significant. Overall, associations were strongest for outlets with internal visibility, for instance, for injunctive norm (OR = 1.37, 95% CI = 1.03–1.81).

Conclusions

Global Positioning Systems‐measured exposure to tobacco outlets was associated with pro‐smoking cognitions among non‐smoking adolescents in the Netherlands.
Testing the importance of individual nest‐site selection for a social and group‐living vulture
Authors: Johnson Thomas Frederick , Murn Campbell
Published: October 2022

Nest‐site selection by species is expected to be adaptive and lead to improved breeding productivity, but in some settings, there exist mismatches between preferred nesting habitat and breeding productivity. We tested the expectation that nest‐site selection is adaptive in a sample of 63 nests of a long‐lived social species that breeds and forages in groups: the critically endangered white‐backed vulture (Gyps africanus). By studying breeding groups in the same area, we controlled for landscape‐level effects on habitat selection and investigated how fine‐scale nest‐site characteristics affect breeding productivity. We developed models to assess how nine characteristics of nest sites selected by breeding vultures compared with 70 random trees and tested associations between these characteristics and breeding productivity. White‐backed vultures selected nest sites in taller trees (>7 m), but neither tree height nor any other nest‐site characteristics had a clear effect on breeding productivity. Vultures selected nest trees closer to each other than random trees, and the associations between nest density, nearest neighbour distance and breeding success were all positive. These positive associations and the absence of an observable effect between nest‐site characteristics and breeding productivity suggest that for this semi‐colonial breeder, the social imperative of proximity to conspecifics (i.e., nesting near other vultures and group foraging) may be more important than individual nest‐site selection.
Anaesthesia for vascular emergencies – a state of the art review
Authors: Boucher N. , Dreksler H. , Hooper J. , Nagpal S. , MirGhassemi A. , Miller E.
Published: October 2022

In this state‐of‐the‐art review, we discuss the presenting symptoms and management strategies for vascular emergencies. Although vascular emergencies are best treated at a vascular surgical centre, patients may present to any emergency department and may require both immediate management and safe transport to a vascular centre. We describe the surgical and anaesthetic considerations for management of aortic dissection, aortic rupture, carotid endarterectomy, acute limb ischaemia and mesenteric ischaemia. Important issues to consider in aortic dissection are extent of the dissection and surgical need for bypasses in addition to endovascular repair. From an anaesthetist's perspective, aortic dissection requires infrastructure for massive transfusion, smooth management should an endovascular procedure require conversion to an open procedure, haemodynamic manipulation during stent deployment and prevention of spinal cord ischaemia. Principles in management of aortic rupture, whether open or endovascular treatment is chosen, include immediate transfer to a vascular care centre; minimising haemodynamic changes to reduce aortic shear stress; permissive hypotension in the pre‐operative period; and initiation of massive transfusion protocol. Carotid endarterectomy for carotid stenosis is managed with general or regional techniques, and anaesthetists must be prepared to manage haemodynamic, neurological and airway issues peri‐operatively. Acute limb ischaemia is a result of embolism, thrombosis, dissection or trauma, and may be treated with open repair or embolectomy, under either general or local anaesthesia. Due to hypercoagulability, there may be higher numbers of acutely ischaemic limbs among patients with COVID‐19, which is important to consider in the current pandemic. Mesenteric ischaemia is a rare vascular emergency, but it is challenging to diagnose and associated with high morbidity and mortality. Several peri‐operative issues are common to all vascular emergencies: acute renal injury; management of transfusion; need for heparinisation and reversal; and challenging postoperative care. Finally, the important development of endovascular techniques for repair in many vascular emergencies has improved care, and the availability of transoesophageal echocardiography has improved monitoring as well as aids in surgical placement of endovascular grafts and for post‐procedural evaluation.
Efficacy of biofeedback therapy for faecal incontinence in an Asian population
Authors: Ng Wee Kiat Daniel , Chok Aik Yong , Ng Yvonne Ying‐Ru , Seow‐En Isaac , Tan Emile Kwong‐Wei
Published: October 2022

Background

Faecal incontinence (FI) is a debilitating condition which reduces quality of life (QOL). Conservative management with education, pelvic floor exercise and pharmacological agents are first‐line treatment. Following which, biofeedback therapy (BFT) is recommended. Although well described in the West, existing literature on its efficacy in Asian populations remains sparse. The primary aim of our study is to evaluate the efficacy of BFT in improvement of symptoms, QOL and overall satisfaction in our Asian population.

Methods

Patients with moderate FI in Singapore General Hospital between 2012 and 2016 were enrolled. Rockwood FI quality of life scale (FIQL) and Wexner scale were used to evaluate QOL across four domains, and symptom severity respectively. They were scored at baseline and again after four sessions of BFT, with an additional overall satisfaction score (OSS).

Results

A total of 137 patients were included. Mean age was 62 years and 72.3% were female. Majority demonstrated improvement in Wexner score (68.6%) and FIQL (65%). Sixty‐five patients (47.4%) reported improvement in both. Positive correlation was found between Wexner score and OSS (r = 0.206), and Wexner score and FIQL across all four domains. Only one FIQL domain—coping/behaviour, showed statistically significant correlation with OSS (r = 0.263).

Conclusion

BFT is effective in our Asian population in both symptom reduction and improving QOL. Wexner score demonstrated low correlation with FIQL and OSS—suggesting that FI requires a multi‐dimensional approach beyond symptom treatment, of which ability to cope appears crucial. BFT, consistent with the biopsychosocial model, shows benefit in this regard.
Systemic and T cell‐associated responses to SARS‐CoV‐2 immunisation in gut inflammation (STAR SIGN study): effects of biologics on vaccination efficacy of the third dose of mRNA vaccines against SARS‐CoV‐2
Authors: Woelfel Simon , Dütschler Joel , König Marius , Graf Nicole , Oikonomou Vasileios , Krieger Claudia , Truniger Samuel , Franke Annett , Eckhold Annika , Forsch Kristina , Wyss Jacqueline , Krupka Niklas , Albrich Werner , Frei Nicola , Geissler Nora , Schaub Peter ,   STAR SIGN Study Investigators, Friedrich Matthias , Misselwitz Benjamin , Korte Wolfgang , Bürgi Justus J. , Brand Stephan
Published: October 2022

Background

Immunosuppressed patients with inflammatory bowel disease (IBD) experience increased risk of vaccine‐preventable diseases such as COVID‐19.

Aims

To assess humoral and cellular immune responses following SARS‐CoV‐2 booster vaccination in immunosuppressed IBD patients and healthy controls.

Methods

In this prospective, multicentre, case–control study, 139 IBD patients treated with biologics and 110 healthy controls were recruited. Serum anti‐SARS‐CoV‐2 spike IgG concentrations were measured 2–16 weeks after receiving a third mRNA vaccine dose. The primary outcome was to determine if humoral immune responses towards booster vaccines differ in IBD patients under anti‐TNF versus non‐anti‐TNF therapy and healthy controls. Secondary outcomes were antibody decline, impact of previous infection and SARS‐CoV‐2‐targeted T cell responses.

Results

Anti‐TNF‐treated IBD patients showed reduced anti‐spike IgG concentrations (geometric mean 2357.4 BAU/ml [geometric SD 3.3]) when compared to non‐anti‐TNF‐treated patients (5935.7 BAU/ml [3.9]; p < 0.0001) and healthy controls (5481.7 BAU/ml [2.4]; p < 0.0001), respectively. In multivariable modelling, prior infection (geometric mean ratio 2.00 [95% CI 1.34–2.90]) and vaccination with mRNA‐1273 (1.53 [1.01–2.27]) increased antibody concentrations, while anti‐TNF treatment (0.39 [0.28–0.54]) and prolonged time between vaccination and antibody measurement (0.72 [0.58–0.90]) decreased anti‐SARS‐CoV‐2 spike antibodies. Antibody decline was comparable in IBD patients independent of anti‐TNF treatment and antibody concentrations could not predict breakthrough infections. Cellular and humoral immune responses were uncoupled, and more anti‐TNF‐treated patients than healthy controls developed inadequate T cell responses (15/73 [20.5%] vs 2/100 [2.0%]; p = 0.00031).

Conclusions

Anti‐TNF‐treated IBD patients have impaired humoral and cellular immunogenicity following SARS‐CoV‐2 booster vaccination. Fourth dose administration may be beneficial for these patients.