bluuebunny/crossref_metadata_2025 huggingface dataset:
Coach approaches to practice design in performance tennis
Authors: Anderson Emma , Stone Joseph Antony , Dunn Marcus , Heller Ben
Published: June 2021

Research demonstrates the benefits of a more contemporary, ecological-dynamics led approach in sport coaching; however, traditional methods of practice design persist. Few studies have explored the intentions of performance tennis coaches as they design practice. This study explored performance tennis coach philosophies and approaches to practice design. Interviews took place with ten high performance coaches who worked within a national tennis performance network. A thematic analysis revealed that coach approaches to practice design were informed by 1) their experiential knowledge and 2) their beliefs regarding player development. Coaches emerged as learners, who developed their knowledge through unmediated, informal learning opportunities, for example reflective practice and ‘on the job' experience. Six coaches had played tennis professionally, valuing this as a learning experience that informed their own practice. Three common beliefs regarding player development emerged between participants: repeatable players, performing under pressure, and individualised practice. These beliefs formed practice design principles, which translated into a uniform implementation of drills (serial, blocked, repeated patterns of play) and the intuitive inclusion of representative practice designs and constraints manipulation. The findings from this study suggest that, although performance tennis coaches are aware of contemporary approaches to practice design, a traditional, information-processing approach to skill development dominates their design of practice tasks. This study documents approaches to practice design in elite tennis and contributes to a growing body of pedagogical research in performance sport.
Factors associated with the persistence of oral 5-aminosalicylic acid monotherapy in ulcerative colitis: a nationwide Norwegian cohort study
Authors: Fossmark Reidar , Olaisen Maya , Martinsen Tom Christian , Melberg Hans Olav
Published: June 2021

Background:

Oral 5-aminosalicylic acid (5-ASA) is the mainstay treatment of ulcerative colitis (UC) and therapy with oral 5-ASA is associated with beneficial outcomes. We have examined factors associated with the persistence of oral 5-ASA treatment in a national cohort of UC patients.

Methods:

Patients with newly diagnosed UC from 2010 to 2014 using oral 5-ASA monotherapy were identified by combining data from the Norwegian Patient Registry and the Norwegian Prescription Database. The median follow-up time was 1029 days. Drug persistence was defined as duration of oral 5-ASA preparation as monotherapy. Non-persistence of a oral 5-ASA preparation as monotherapy was defined as stopping oral 5-ASA, initiation of any further anti-inflammatory treatment including a course of glucocorticoids and a change to another oral 5-ASA preparation. Drug persistence was analyzed using the Kaplan–Meier method and influence of covariates on drug persistence was analyzed with the Cox proportional hazard model.

Results:

A total of 3421 patients were identified. The overall median 5-ASA drug persistence was 179 days. In univariate analyses, persistence was associated with preparation type and high-dose treatment, while oral glucocorticoid use or hospitalization around the start of oral 5-ASA were associated with shorter 5-ASA persistence. In multivariate analyses, oral glucocorticoids [HR 1.67 (1.54–1.80), p < 0.005] and hospitalization around start of 5-ASA [HR 1.23 (1.14–1.34), p < 0.005] were associated with non-persistence, whereas high dose (⩾3 g/day) 5-ASA was associated with longer persistence [HR 0.68 (0.65–0.71), p < 0.005].

Conclusion:

High-dose treatment with oral 5-ASA was associated with longer persistence of oral 5-ASA monotherapy, whereas the presence of factors indicating more severe disease around initiation of 5-ASA monotherapy was associated with a shorter persistence.
Largely varying patterns and trends of primary cancer-directed resection for gastric carcinoma with synchronous distant metastasis in Europe and the US: a population-based study calling for further standardization of care
Authors: Huang Lei , Jansen Lina , Verhoeven Rob H.A. , Ruurda Jelle P. , Van Eycken Liesbet , De Schutter Harlinde , Johansson Jan , Lindblad Mats , Johannesen Tom B. , Zadnik Vesna , Žagar Tina , Mägi Margit , Lagarde Sjoerd M. , Bastiaannet Esther , van de Velde Cornelis J.H. , Schrotz-King Petra , Brenner Hermann
Published: June 2021

Aims:

The role of resection remains debated in cases of metastatic gastric carcinoma (mGC). Some mGCs are technically resectable. At the population level, the real-world application of resection for mGC remains largely unclear in most Western countries. This large, population-based international investigation aimed to reveal the resection patterns and trends for mGC and the treatment-associated factors in Europe and the US.

Methods:

Data on cases with microscopically-confirmed primary invasive stomach carcinoma with distant metastasis were obtained from the nationwide cancer registries of the Netherlands, Belgium, Norway, Sweden, Estonia, and Slovenia and the US Surveillance, Epidemiology, and End Results-18 database. We calculated age-standardized rates of primary cancer-directed resection and assessed resection trends using linear regression. We investigated associations of treatment with patient and cancer factors using multivariable-adjusted log-binomial regression.

Results:

Among 133,321 patients with gastric cancer, overall, 40,215 cases with mGC diagnosed between 2003–2017 were investigated. Age-standardized resection rates significantly declined over time in the US, Belgium, Sweden, and Norway (by 5–14%). Resection rates greatly differed from 5% to 16% in 2013–2014. Cases with older ages, cardia tumors, or tumors involving adjacent structures were significantly less often operated across most countries. Sex was not significantly associated with resection. Across countries the association patterns and strengths differed largely. With multivariable adjustment, resection rates decreased significantly in all countries except Slovenia and Estonia (prevalence ratio per year = 0.90–0.98), and the decreasing trends were consistently observed in various stratifications by age and location.

Conclusion:

In Europe and the US, resection patterns and trends largely varied across countries for mGCs, which were mostly less often resected in the early 21st century. Various resection-associated factors were shown, with greatly varying association patterns and strengths. Our report could aid to identify discrepancies in clinical practice and highlight the great need for further clarifying the role of resection in mGCs to enhance standardization of care.
Safety Recommendations for Forensic Laboratory Staff During COVID-19 Pandemic
Authors: Prajapati Suneel , Kaur Sukhminder
Published: June 2021

In the 21st century, the crime rate and viral infectious diseases are on peak and seems to be the real enemies of humanity. Forensic science and its various branches especially biology have a key role in modern-day justice. Forensic scientists and laboratory staffs are of great significance for elucidating the biological exhibits and generating the biological evidence which are required for criminal justice. Owing to the profession and like other medical health workers, forensic laboratory staffs are also at a greater risk in the era of COVID-19. Therefore, the safety of forensic laboratory staff is of utmost importance during this pandemic. The article emphasizes on the safety guidelines and regulations that need to be adopted by the forensic staff in connection with daily laboratory practices. Thus, the article may offer a reference or help one to implement COVID-19 advisory to forensic scientists and other laboratory staff working in forensic institutions and laboratories during the current pandemic.
“Behind each beautiful painting is a child longing to be free”: Deep visual listening and children’s art during times of crisis
Authors: Chávez Leyva Yolanda
Published: June 2021

“Deep visual listening and children’s art during times of crisis” explores a way to understand children’s art created amidst crisis as well as the meanings we can discern from it through the lens of the “Uncaged Art Tornillo Detention Center” exhibit. In 2018, the U.S. government opened a detention center to hold youth who either crossed the border by themselves or were separated from their families through Trump’s Zero Tolerance policy. The youth were from Central America and came seeking asylum. Fleeing profound poverty and violence, they came to save their lives. To deter asylum-seekers through a series of cruel policies, the United States detained the youth in militarized camps where they were under constant surveillance. They did not know when or if they would be released and experienced depression and trauma. An art project at the detention center resulted in their creating approximately 400 pieces, of which 30 survived. “Uncaged Art” exhibited these works in 2019. This article answers the question “What can we learn about the children, the anonymous artists who created the works, through visual listening?” Visual listening is a process that involves all our senses. Listening requires conscious action, unlike hearing which is automatic and is one of the first senses we develop while still in our mother’s womb. This methodology allows us to engage with children’s art in times of crisis more profoundly than simply seeing the artwork. There are two parts to this practice: deep listening and visual listening. Combined, they provide a powerful way to listen to the stories, the histories, the memories, and the emotions embodied by the art and brought to life by our reflections and understanding
Austerity is impeding children’s education: A qualitative study of the associations of food insecurity and school engagement in Ghana
Authors: Mohammed Abdul-Rahim
Published: June 2021

The latest round of fiscal austerity in Ghana has meant that the feeding rate paid to the service providers of Ghana’s school feeding programme is both frozen and unrealistically low. Accordingly, service providers adopt discretionary coping strategies. This qualitative case study, therefore, explores the impacts of austerity on children’s school engagement. Relying on semi-structured interviews with school children in two public primary schools, as well as two focus group discussions with the teachers in both schools, the study shows how the discretionary coping strategies adopted by the service providers impact school children’s food security, which might lead to disinterest in classroom activities and increases in absenteeism and truancy.
Mental health effect of COVID-19 pandemic among women who are pregnant and/or lactating: A systematic review and meta-analysis
Authors: Demissie Dereje Bayissa , Bitew Zebenay Workneh
Published: June 2021

Objectives:

The purpose of this study is to examine the effects of coronavirus disease 2019 pandemic on the prevalence of anxiety, depression, stress, insomnia, and social dysfunction among pregnant and/or lactating women and to measure the global pooled prevalence of mental health effects among these populations in the era of coronavirus disease 2019 pandemic.

Methods:

Comprehensive literature searching was conducted and studies published from 1 January 2020 to 30 September 2020 reporting the prevalence of anxiety, depression; stress, insomnia, and social dysfunctions were included. The pooled prevalence of anxiety, depression, stress, insomnia, and social dysfunctions was estimated using a random-effect model. In this study, all statistical analyses were performed using STATA (version 15) software.

Results:

There were a total of 19 studies included in the meta-analysis, of which 16, 14, 4, 2, and 2 studies were included in computing the pooled prevalence of anxiety, depression, stress, insomnia, and social dysfunction, respectively. The pooled prevalence of anxiety was 33% (95% confidence interval: 50%−61%), with significant heterogeneity between studies (I2 = 99.68%, p = 0.001). The pooled prevalence of depression was 27% (95% confidence interval: 9%−45%), with remarkable heterogeneity between studies (I2 = 99.29%, p = 0.001). Likewise, the pooled prevalence of stress was 56% (95% confidence interval: 30.07%−82.22%), with significant heterogeneity between studies (I2 = 98.8%, p = 0.0001). The pooled prevalence of social dysfunction was 24.3% (95% confidence interval: 13.41%−62.03%), with significant heterogeneity between studies (I2 = 97.5%, p = 0.0001) and finally, the pooled prevalence of insomnia was 33.53% (95% confidence interval: 3.05%−64.0%), with significant heterogeneity between studies (I2 = 99.6%, p = 0.0001).

Conclusions:

In this study, the mental health effects of the COVID-19 pandemic among pregnant and lactating women were found to be significant. Stress was the most common mental health problem in these population groups. Therefore, policymakers and health planners should give great emphasis to addressing maternal mental well-being during and after this global health crisis. Maternal mental health must be one of the international and national public health priority agendas to enhance the well-being of pregnant and lactating women. Besides, giving psychological support to pregnant and lactating women may reduce the long-term negative effects of this pandemic.
Pure primary yolk sac tumor of the endometrium tends to occur at a younger age: A case report and literature analysis
Authors: Ge Huijuan , Bi Rui
Published: June 2021

We present a case of primary yolk sac tumor of the endometrium. This rare tumor occurred in a 43-year-old woman with a pure primary yolk sac tumor. The tumor resembled yolk sac tumor morphology of the ovary. Tumor cells expressed SALL4, AFP, GPC-3, and AE1/AE3 and were focal positive for PAX8. EMA, ER, and PR, among others, were negative. We further analyzed 29 reported cases of this rare tumor in the literature. In total, 17 of 30 patients (57%) had pure endometrial yolk sac tumor, and 13 (43%) had a concomitant somatic neoplasm (endometrial adenocarcinoma was the most common). Although the average age was 52 years (range: 24–87 years), patients with pure yolk sac tumor were younger than those with concomitant somatic tumors, with a mean age of 44.41 years (24–68 years) versus 61.92 years (28–87 years), P = 0.008. Patients with endometrial yolk sac tumor combined with somatic tumor tend to have a slightly higher stage and a poor prognosis.
Psychological distress in patients undergoing urological surgery: A cross-sectional study
Authors: Murray Nuala , O’Connor Charles , Dempsey Rhona , Liew Sean , Richards Helen , Brady Ciaran , Sweeney Paul , Hennessey Derek
Published: June 2021

Purpose:

The purpose of this study was to evaluate the psychological distress of urological and uro-oncological patients undergoing surgery.

Methods:

Patients who presented to Mercy University Hospital from October 2019–May 2020 were consecutively recruited. Demographic and clinical characteristics including age, gender, marital status, type of surgery (uro-oncology or general urology), endoscopy or open surgery were gathered. Mood was evaluated using the Hospital Anxiety and Depression Scale prior to admission, prior to discharge and 6 weeks post-surgery.

Results:

A total of 118 participants (79.7% male) completed the Hospital Anxiety and Depression Scale prior to admission, prior to discharge and at 6 weeks post-surgery. Forty patients (33.9%) underwent uro-oncology-related surgery. At pre-admission 39 patients (33%) fell into a possible-probable clinical category for anxiety and 15 (12.7%) for depression. Older patients had significantly lower anxiety levels than younger patients ( p⩽0.01). There were no differences between patients undergoing uro-oncology or more general urology surgery and levels of anxiety or depression. Repeated measures analysis of variance with age as a covariate indicated no significant differences in Hospital Anxiety and Depression Scale anxiety scores over time. There was a statistically significant reduction in Hospital Anxiety and Depression Scale depression scores over the three assessment time points ( p=0.004).

Conclusion:

Over one-third of patients were experiencing moderate to severe levels of psychological distress pre-surgery – higher than levels previously reported in uro-oncological patients. Surprisingly, there was no difference in anxiety and depression scores in uro-oncology and urology patients. Psychological distress in both uro-oncology and more general urology patients should be considered in the surgical setting.

Level of evidence

Moderate
Incidental discovery of azoospermia on work-up of testicular tumour: a practice changing discovery
Authors: Abou Heidar Nassib
Published: June 2021

Testicular tumours are increasing in incidence, especially in developed countries. This incidence increases specifically in the subpopulation of infertile men. This case highlights a young man incidentally diagnosed with a subcentimetric testicular lesion, who was discovered to have concomitant azoospermia. The authors review management strategies in this challenging case, as treatment options for men with infertility and concomitant testicular tumours vary from men who are fertile.

Level of evidence: Not applicable for this multicentre audit.
Ischemic priapism due to coagulopathy of severe COVID-19 infection
Authors: Grimberg Dominic C , Tejwani Rohit , Allkanjari Armand , Forrester Michael T , Kraft Bryan D , Kaye Deborah R
Published: June 2021

Initially thought to be a primarily respiratory disease process, the hypercoagulable state associated with COVID-19 has been associated with myriad clinical sequelae. We report a case of stuttering ischemic priapism associated with COVID-19, and describe a management approach to achieve detumescence in patients undergoing ventilatory proning limiting penile access.

Level of evidence: Not applicable for this single center case report.
An Environmental Scan and Evaluation of Quality Indicators Across Canadian Kidney Transplant Centers
Authors: Glavinovic Tamara , Vinson Amanda J. , Silver Samuel A. , Yohanna Seychelle
Published: June 2021

Background:

Kidney transplantation is the optimal treatment for an individual requiring kidney replacement therapy, resulting in improved survival and quality of life while costing the health care system less than maintenance dialysis. Achieving and maintaining a kidney transplant requires extensive coordination of several different health care services. To improve the quality of kidney transplant care, quality metrics or indicators that encompass all aspects of the individual’s journey to transplant should be measured in a standardized fashion.

Objective:

To identify, categorize, and evaluate strengths and weaknesses of kidney transplant quality indicators currently being used across Canada.

Design:

An environmental scan of quality indicators being used by kidney organizations and programs.

Setting:

A 16-member volunteer pan-Canadian panel with expertise in nephrology, transplant, and quality improvement.

Sample:

Transplant programs, as well as provincial transplant and kidney agencies across Canada.

Methods:

Indicators were first categorized based on the period of transplant care and then using the Institute of Medicine and Donabedian frameworks. A 4-member subcommittee rated each indicator using a modified version of the Delphi consensus technique based on the American College of Physician/Agency for Healthcare Research and Quality criteria. Consensus ratings were subsequently shared with the entire 16-member panel for additional comments.

Results:

We identified 46 measures related to transplant care across 7 Canadian provinces (9 referral and evaluation, 9 waitlist activity and outcomes, 6 hospitalization for transplant surgery, 12 posttransplant care, 6 organ utilization, 4 living donor). We rated 24 indicators (52%) as necessary to distinguish high-quality from low-quality care, most of which measured effective (n = 10) or efficient (n = 6) care. Only 7 (15%) of 46 indicators evaluated person-centered or equitable care. Fourteen common indicators were measured by 5 of 7 provinces, 10 of which were deemed “necessary,” measuring safe (n = 2), effective (n = 5), efficient (n = 2), and equitable (n = 1) care.

Limitations:

The panel lacked patient and allied health representation.

Conclusions:

There are a large number of kidney transplant quality indicators currently being used in Canada, some of which are common across provinces and focus primarily on measuring effective care. Person-centered and equitable care indicators were lacking, and only half of these indicators were deemed “necessary” for quality improvement. Our results should complement ongoing work to achieve national consensus on the standardization of quality indicators in kidney transplantation.
Public space without the public: State and individuals in courtyard space in Dashilar, Beijing
Authors: Li Alin
Published: June 2021

This article discusses the meaning of public space and the problem of public reconstruction by means of sociological intervention through an experimental study of community formation and courtyard space rearrangement in the old neighborhood of Dashilar in Beijing. In the West, scholars regard public space as part of public life with political or social significance. In the courtyards of Dashilar, however, residents understand public space as important as a shared property of neighboring families that is separate from public life, as they are often acquainted with but alienated from one another. To grasp this different understanding of public space, this article first looks into the historical transformation of property rights in Dashilar. The courtyards in Dashilar have clearly been defined as state-owned urban space since the 1980s but have remained neglected in administration. Therefore, residents gradually encroached upon these courtyards that were owned by the state and divided them for private use. As this act of encroaching was rooted in the relationship between the state and the individual, the courtyards were not merely changed into privatized properties with specific functions, but became places for interactions between various actors. To reveal the complexity of these courtyards as public spaces, we discuss the expansion of private space by individuals in their daily life and the “public disturbances” initiated by temporary coalitions in space construction. This complexity of courtyards as public spaces can be well illustrated by two experiments of space rearrangement conducted in Dashilar. Both experiments introduced strong social interventions into space rearrangement: one attempted to rebuild social life in a courtyard, and the other worked on the public and private boundaries in a courtyard. The former experiment ended in failure while the latter was a success. The results of these two experiments tell us that public reconstruction is not just about rebuilding social interactions between people, but also about adjusting the state–individual relationship and establishing the rules of living together in public space.
Developmental Human Resource Configuration, Unique Human Capital, and Employee Innovative Work Behavior: A Multilevel Moderated Mediation Model
Authors: Chang Po-Chien , Zhang Man-Jing , Wu Ting
Published: June 2021

Drawing on social exchange theory (SET), the purposes of this research are to investigate the effect that developmental human resource configuration (DHRC) has on employee innovative work behavior (IWB) and to examine the role that an empowerment climate plays in the relationship. The study assumes that knowledge workers perform IWB if they perceive the application of DHRC and the empowerment climate to support autonomy, information sharing, and team accountability. The data were collected from 37 R&D managers and 370 full-time R&D engineers, constituting 37 different high-tech companies in Guangdong province, China. Results show that a positive relationship between DHRC and IWB was found and was partially mediated by unique human capital. Findings also demonstrate that empowerment climates strengthen this relationship. The implications of the findings and future directions for research are further discussed.
Macrophage Activation Syndrome in Adults: A Retrospective Case Series
Authors: Warmoth Taylor , Ramesh Malvika , Iwuji Kenneth , Pixley John S.
Published: June 2021

Macrophage activation syndrome (MAS) is a form of hemophagocytic lymphohistocytosis that occurs in patients with a variety of inflammatory rheumatologic conditions. Traditionally, it is noted in pediatric patients with systemic juvenile idiopathic arthritis and systemic lupus erythematous. It is a rapidly progressive and life-threatening syndrome of excess immune activation with an estimated mortality rate of 40% in children. It has become clear recently that MAS occurs in adult patients with underlying rheumatic inflammatory diseases. In this article, we describe 6 adult patients with likely underlying MAS. This case series will outline factors related to diagnosis, pathophysiology, and review present therapeutic strategies.
Do Techniques for Hill-Sachs Remplissage Matter in Terms of Functional and Radiological Outcomes?
Authors: Pulatkan Anil , Kapicioglu Mehmet , Ucan Vahdet , Masai Mustafa Ngeiywo , Ozdemir Bulent , Akpinar Sercan , Bilsel Kerem
Published: June 2021

Background:

Different techniques are used for the remplissage procedure, including the double-pulley and mattress suture techniques. Both techniques have shown good results; however, it is unclear if one technique is superior.

Hypothesis:

The remplissage procedure using the double-pulley technique with 2 anchors would have superior functional and radiological outcomes compared with the mattress suture technique with a single anchor.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

This study included patients with anterior shoulder instability who were treated using arthroscopic Bankart repair combined with remplissage between 2012 and 2017. A structured questionnaire was used to gather information on the following metrics: Instability Severity Index Score, hyperlaxity, Sugaya index, presence of a Hill-Sachs defect, number of dislocations before surgery, sports participation, radiological measurement of the Hill-Sachs lesion, postoperative range of motion in both shoulders, Rowe score, Walch-Duplay score, American Shoulder and Elbow Surgeons score, and Filling Index Score of Remplissage grade according to magnetic resonance imaging scans at the last follow-up.

Results:

There were 41 patients included with a mean age of 30 ± 7 years who underwent the Hill-Sachs remplissage procedure using the double-pulley technique with 2 anchors (n = 21; group DA) or the mattress suture technique with a single anchor (n = 20; group SA). At the final follow-up, there were no significant differences between the groups regarding the Instability Severity Index Score ( P = .134), the Sugaya index ( P = .538), sports participation ( P = .41), the radiological measurement of the Hill-Sachs lesion ( P = .803), or the Rowe score ( P = .182). However, there were significant differences between the groups in the Walch-Duplay score ( P = .012), American Shoulder and Elbow Surgeons score ( P = .005), and Filling Index Score of Remplissage grade ( P = .015), favoring group DA, as well as differences in external rotation in a neutral position (external rotation loss: 9° ± 3° [group SA] vs 12° ± 3° [group DA]; P = .003) and at 90° of abduction (external rotation loss: 8° ± 3° [group SA] vs 11° ± 3° [group DA]; P = .006), favoring group SA.

Conclusion:

In the remplissage procedure, the double-pulley technique provided better filling of the lesion and improvement in functional scores, but external rotation was limited compared with the mattress suture technique.
Academic Ethical Awareness and Moral Sensitivity of Undergraduate Nursing Students: Assessment and Influencing Factors
Authors: Alnajjar, PhD Hend Abdu , Abou Hashish, PhD Ebtsam Aly
Published: June 2021

Introduction

Nursing students are exposed to ethically challenging conditions in their future workplaces; hence, they must be ethically knowledgeable and morally sensitive to provide patients with holistic care based on sound ethical decision-making skills. Objectives: This study aimed to assess nursing students’ perception of their academic ethical awareness and moral sensitivity and determine the relationship between these variables. Methods: We conducted a descriptive correlational research study with a convenient sample of nursing students (N = 246) in a Saudi University nursing college. Data were collected using the Academic Ethical Awareness Questionnaire and Moral Sensitivity Questionnaire. We used descriptive statistics, ANOVA, and regression analyses. Results: Nursing students exhibited moderate academic ethical awareness and moral sensitivity. The regression analysis showed that academic ethical awareness can substantially predict 28.8% of the explained moral sensitivity variance ( p < 0.001). Nursing students were aware that the violation of patients’ respect or confidentiality and cheating in examinations were unethical behaviors. However, they showed low ethical awareness toward plagiarism behaviors. Furthermore, they reported higher moral sensitivity for patient-oriented care and professional responsibility and did not experience conflict. Academic level and integrated classroom and clinical learning experiences seemed to positively impact students’ academic ethical awareness. Conclusion: The findings provide a basis for monitoring nursing students’ professional misconduct so that they maintain integrity and adhere to academic ethics guidelines. Constant exertions for fostering nursing ethics courses with inspiring learning content and innovative instructional material are vital in improving nursing students’ academic integrity and ethical care.
Exploring the development and maintenance of therapeutic relationships through e-Health support: A narrative analysis of therapist experiences
Authors: Wood Matthew J , Wilson Hannah MN , Parry Sarah L
Published: June 2021

Objective:

Amid COVID-19 disruptions, e-therapy has become even more essential and has rapidly expanded across statutory, private and third sectors to meet growing demands for digital mental health support. A challenge in digital therapeutic care is how to develop and maintain a supportive, collaborative therapeutic relationship, built upon mutual trust and respect; intrinsic values of relationships that are often implied through complex non-verbal cues. Online practitioners are eager to learn how to adapt to online delivery, although platform-specific training is limited. The aim of the current study was to focus upon the therapist experience of online therapeutic relationships with young people, exploring a range of factors through their perspectives, including the impact of anonymity.

Methods:

Eight e-therapy practitioners were recruited from Kooth, an online mental health service. Narrative interviews undertaken via Skype facilitated reflective conversational one-to-one discussions, based upon the practitioners’ individual experiences, led by the interviewee. Following transcription and anonymisation, a narrative analysis was undertaken to explore participants’ experiences, perspectives and reflections.

Results:

Four analytic layers arose from the narratives, which explored the challenging learning experience of translating existing therapeutic skills to online working, rapidly building therapeutic relationships, managing risk in the online therapeutic relationship, and techniques for maintaining a digital therapeutic relationship.

Conclusion:

The study provides novel insights into the flexibility and adjustments therapists can make to improve online interventions and delivery through the development and maintenance of positive therapeutic relationships. Recommendations are also made in relation to platform-specific training, communicative adaptations, risk management and practitioner support.
Retrofitting an emergency approach to the climate crisis: A study of two climate emergency declarations in Aotearoa New Zealand
Authors: Nissen Sylvia , Cretney Raven
Published: June 2021

In the last year, hundreds of climate emergency declarations have been made by local and national governments around the world. Instigated through grassroots activism, these declarations have become a focus of aspirations for radical climate action. However, concerns have also raised been about the desirability of emergency declarations in responding to the climate crisis, including at a local scale. In this paper we consider the enactment of emergency declarations by two local government authorities in Aotearoa New Zealand that have recent experience with multiple crises. Drawing on in-depth interviews with activists, councillors and officials, our findings show that adopting the ‘international language’ of climate emergency can be a source of hope but also tension. In particular, we highlight the struggle of local practitioners to overlay an emergency approach, something that is already contested in response to sudden onset disasters, with the scale, complexity and temporality of climate change. Our analysis suggests that retrofitting an emergency approach to the climate crisis at the local scale has the potential to reproduce status quo politics, and calls for a greater understanding of the diversity of approaches to emergency in climate politics.
Monitoring streets through tweets: Using user-generated geographic information to predict gentrification and displacement
Authors: Chapple Karen , Poorthuis Ate , Zook Matthew , Phillips Eva
Published: June 2021

The new availability of big data sources provides an opportunity to revisit our ability to predict neighborhood change. This article explores how data on urban activity patterns, specifically, geotagged tweets, improve the understanding of one type of neighborhood change—gentrification—by identifying dynamic connections between neighborhoods and across scales. We first develop a typology of neighborhood change and risk of gentrification from 1990 to 2015 for the San Francisco Bay Area based on conventional demographic data from the Census. Then, we use multivariate regression to analyze geotagged tweets from 2012 to 2015, finding that outsiders are significantly more likely to visit neighborhoods currently undergoing gentrification. Using the factors that best predict gentrification, we identify a subset of neighborhoods that Twitter-based activity suggests are at risk for gentrification over the short term—but are not identified by analysis with traditional census data. The findings suggest that combining Census and social media data can provide new insights on gentrification such as augmenting our ability to identify that processes of change are underway. This blended approach, using Census and big data, can help policymakers implement and target policies that preserve housing affordability and protext tenants more effectively.
Choroidal thickness alterations in idiopathic acute retinal vasculitis
Authors: Kumar Ashok , Ambiya Vikas , Mishra Sanjay Kumar , Jhanwar Mayank
Published: June 2021

Background:

To evaluate changes in sub-foveal choroidal thickness in patients with acute idiopathic retinal vasculitis compared with age-matched healthy subjects and unaffected fellow eyes.

Methods:

This prospective observational study included 36 eyes of 23 acute idiopathic retinal vasculitis patients (group V) which included a sub-group of 10 eyes of 10 patients with unilateral vasculitis (group UV), and 50 eyes of 25 healthy subjects (group N). The assessment involved demographics, systemic examination, comprehensive ocular examination, fundus photography with/without fundus fluorescein angiography, and spectral domain–optical coherence tomography with enhanced depth imaging.

Results:

There was significant difference between the mean sub-foveal choroidal thickness in groups V and N (V: 338.86 ± 28.72 um; N: 296.72 ± 19.45 μm; p < 0.001). The eyes of patients with unilateral vasculitis compared with unaffected fellow eyes had no significant difference in best corrected visual acuity (group UV: median = 0.2; range = (0.0–0.3) and group N: median = 0.2; range = (0.0–0.3); p = 0.35) but the sub-foveal choroidal thickness was significantly increased in the involved eye (group UV: 333.5 ± 16.68 um; group N: 284.4 ± 15.68 um; p ⩽ 0.001). The BCVA was significantly lower in the eyes with anterior chamber inflammation (median = 0.2; range = (0.0–0.3) and; median = 0.1; range (0.0–0.3); p = 0.002), but there was no statistically significant difference in sub-foveal choroidal thickness measurement between the two groups of vasculitis patients with and without anterior chamber inflammation (334.3 ± 18.85 um and 336 ± 31.56 um; p = 0.22).

Conclusion:

The sub-foveal choroidal thickness increases during active inflammation in eyes with idiopathic retinal vasculitis compared with unaffected fellow eyes and healthy control eyes. Thus, measurement of the sub-foveal choroidal thickness on optical coherence tomography with enhanced depth imaging can serve as a non-invasive modality in the diagnosis and monitoring of acute idiopathic retinal vasculitis.
Management of glaucoma in pregnancy – balancing safety with efficacy
Authors: Kumari Rashmi , Saha Bhawesh Chandra , Onkar Abhishek , Ambasta Anita , Kumari Akanchha
Published: June 2021

Glaucoma and pregnancy is an uncommon combination, but it constitutes a very challenging situation for the treating doctor. The challenge is not only controlling the intraocular pressure and preventing glaucoma progression in the mother, but also having to deal with her mental stress and anxiety regarding the safety of her child. The situation is further worsened by the lack of definite guidelines as to how to deal with such patients. Relative rarity of glaucoma in this population restricts any large prospective randomized clinical trials or any large systematic studies. Moreover, none of the existing anti-glaucoma medications is absolutely safe in pregnancy. Current practice patterns depend on some case reports, a few observational studies and a few animal studies that attempt at determining the safety and efficacy of the available medicines. These are then prescribed on the basis of their relative safety in any particular stage of pregnancy or lactation. Newer medications that were released recently in 2018, such as Vyzulta and Rhopressa, presently have limited data to support their safety for use during pregnancy. Laser trabeculoplasty, conventional filtration surgery (of course without anti-metabolites), and minimally invasive glaucoma surgery represent a few non-pharmacological management options. Surgical procedures such as trabeculectomy and tube-shunts or collagen matrix implants, and newer minimally invasive glaucoma surgery procedures such as the gelatin stents are currently being explored and may prove to be viable solutions for severe glaucoma during pregnancy, although they too have their own inherent drawbacks. Management of glaucoma during pregnancy and lactation requires careful consideration of the disease status, gestational stage, US Food and Drug Administration classification and guidelines, and potential benefits and limitations of the various therapeutic modalities. This review focuses on the importance of a multidisciplinary team approach, starting with preconception planning and counseling, determining the treatment options depending on the stage of glaucoma and of pregnancy, and emphasizes the involvement of the patients, their obstetrician, and pediatrician through active discussion regarding the various medical, laser, or surgical modalities currently available or under exploration for use during pregnancy and lactation. The ultimate aim is to achieve an optimal balance between the risks and benefits of any type of intervention, and to customize treatment on an individual basis in order to achieve the best outcomes for both mother and fetus.
Stool pattern is associated with not only the prevalence of tumorigenic bacteria isolated from fecal matter but also plasma and fecal fatty acids in healthy Japanese adults
Authors: Watanabe Daiki , Murakami Haruka , Ohno Harumi , Tanisawa Kumpei , Konishi Kana , Todoroki-Mori Kikue , Tsunematsu Yuta , Sato Michio , Ogata Yuji , Miyoshi Noriyuki , Kubota Naoto , Kunisawa Jun , Wakabayashi Keiji , Kubota Tetsuya , Watanabe Kenji , Miyachi Motohiko
Published: June 2021

Background

Colibactin-producing Escherichia coli containing polyketide synthase (pks+E. coli) has been shown to be involved in colorectal cancer (CRC) development through gut microbiota analysis in animal models. Stool status has been associated with potentially adverse gut microbiome profiles from fecal analysis in adults. We examined the association between stool patterns and the prevalence of pks+E. coli isolated from microbiota in fecal samples of 224 healthy Japanese individuals.

Results

Stool patterns were determined through factorial analysis using a previously validated questionnaire that included stool frequency, volume, color, shape, and odor. Factor scores were classified into tertiles. The prevalence of pks+E. coli was determined by using specific primers for pks+E. coli in fecal samples. Plasma and fecal fatty acids were measured via gas chromatography-mass spectrometry. The prevalence of pks+E. coli was 26.8%. Three stool patterns identified by factorial analysis accounted for 70.1% of all patterns seen (factor 1: lower frequency, darker color, and harder shape; factor 2: higher volume and softer shape; and factor 3: darker color and stronger odor). Multivariable-adjusted odds ratios (95% confidence intervals) of the prevalence of pks+E. coli for the highest versus the lowest third of the factor 1 score was 3.16 (1.38 to 7.24; P for trend = 0.006). This stool pattern exhibited a significant positive correlation with fecal isobutyrate, isovalerate, valerate, and hexanoate but showed a significant negative correlation with plasma eicosenoic acid and α-linoleic acid, as well as fecal propionate and succinate. No other stool patterns were significant.

Conclusions

These results suggest that stool patterns may be useful in the evaluation of the presence of tumorigenic bacteria and fecal fatty acids through self-monitoring of stool status without the requirement for specialist technology or skill. Furthermore, it may provide valuable insight about effective strategies for the early discovery of CRC.
Case report of homozygous E200D mutation of PRNP in apparently sporadic Creutzfeldt-Jakob disease
Authors: Hassan Ahamad , Campbell Tracy , Darwent Lee , Odd Hans , Green Alison , Collinge John , Mead Simon
Published: June 2021

Background

Inherited prion diseases are rare autosomal dominant disorders associated with diverse clinical presentations. All are associated with mutation of the gene that encodes prion protein (PRNP). Homozygous mutations with atypical clinical phenotypes have been described but are extremely rare.

Case presentation

A Chinese patient presented with a rapidly progressive cognitive and motor disorder in the clinical spectrum of sCJD. Investigations strongly suggested a diagnosis of CJD. He was found to carry a homozygous mutation at PRNP codon 200 (E200D), but there was no known family history of the disorder. The estimated allele frequency of E200D in East Asian populations is incompatible with it being a highly penetrant mutation in the heterozygous state.

Conclusion

In our view the homozygous PRNP E200D genotype is likely to be causal of CJD in this patient. Homotypic PrP interactions are well known to favour the development of prion disease. The case is compatible with recessively inherited prion disease.
Investigating partner involvement in pregnancy and identifying barriers and facilitators to participating as a couple in a digital healthy eating and physical activity intervention
Authors: Rhodes Alexandra , Smith Andrea D. , Llewellyn Clare H. , Croker Helen
Published: June 2021

Background

Maternal obesity and excessive gestational weight gain are associated with adverse maternal and foetal health outcomes. Interventions targeting dietary and physical activity behaviours during pregnancy have typically been directed at women only. A digital intervention targeting couples could encourage expectant parents to support each other in improving energy balance (dietary and physical activity) behaviours.

Aims

This study aimed to investigate the role partners play in pregnant women’s energy balance behaviours, and to identify barriers and facilitators to participating as a couple in a digital intervention to encourage healthy eating and physical activity in pregnancy.

Methods

A qualitative design combined online focus groups and telephone interviews. Three focus groups were held with men (n = 15) and one mini focus group (n = 3) and 12 telephone interviews were conducted with women. Participants were either in the last trimester of pregnancy or had a baby under 18 months old. Most were from more deprived population groups where prevalence of maternal obesity is higher. Data were analysed thematically. Barriers and facilitators to participating as a couple in a digital intervention were mapped to the COM-B model and the Theoretical Domains Framework.

Results

Four main themes were identified; partner involvement and support; partner understanding of good energy balance behaviours; couple concordance of energy balance behaviours; partner influence on her energy balance behaviours. Most facilitators to participating in a digital intervention as a couple fell within the Reflective Motivation domain of COM-B. Men were motivated by the desire to be supportive partners and good role models. Women were motivated by their belief that partner involvement would improve their success in achieving goals and enhance couple-bonding. Other facilitators included concordance in dietary behaviours (Physical Opportunity), healthcare practitioner recommendation, perceptions of pregnancy as ‘ours’ (Social Opportunity) and feeling supported and involved (Automatic Motivation). Barriers were rarely mentioned but included potential for partner conflict, perceptions of pregnancy as ‘hers’ and economic constraints.

Conclusions

An opportunity exists to harness partner support to improve maternal energy balance behaviours. Barriers and facilitators to participating in a digital intervention as a couple indicate its potential to benefit emotional and relationship wellbeing in addition to physical health.