bluuebunny/crossref_metadata_2025 huggingface dataset:
Influencers’ Instagram imaginaries as a global phenomenon: Negotiating precarious interdependencies on followers, the platform environment, and commercial expectations
Authors: Richter Vanessa , Ye Zhen
Published: June 2023

Instagram has become a place of work for many content creators, including influencers; however, the inherent power imbalance between creator and platform dictating influencers’ success, requires creators to negotiate user expectations and the platform environment for their potential (commercial) success. Therefore, this article proposes approaching the influencer industry from the framework of platform imaginaries by developing a mixed qualitative method approach to visualize the precarity of Instagram influencers through their Instagram imaginaries with a cross-national comparison of US, German, and Japanese influencers. The results reflect a constant renegotiation of their own positions in relation to platform features and algorithms, follower interaction, as well as commercial partners, within three main imaginaries around Instagram’s use, namely, Instagram as a social space, Instagram as a workplace, and Instagram as a marketplace. The analysis highlights the interdependencies with and situatedness within Instagram’s platform environment, which need to be considered to understand the precarious working conditions of influencers.
Intergroup contact and intended actions in support of disadvantaged groups: The role of affective processes and feelings of solidarity
Authors: Özkan Zafer , Dhont Kristof , Abrams Dominic
Published: June 2023

Intergroup contact is a well-established basis of prejudice reduction. However, less is known about its potential to motivate people to act in support of disadvantaged groups. We investigated the associations of both positive and negative intergroup contact with action intentions for disadvantaged groups among members of ethnic majority groups from different intergroup contexts, including non-WEIRD samples. Furthermore, we tested the role of affective processes and feelings of solidarity as psychological processes explaining these associations. In three cross-sectional studies (total N = 962) from Greece, Thailand, and Turkey, positive and negative contact experiences were associated with, respectively, stronger and weaker intended actions. These associations were particularly pronounced for positive contact. Contact measures were also related to stronger intentions to donate and distribute money in favor of the disadvantaged group (Study 3). A three-wave longitudinal study conducted in the UK (Study 4, N = 603) confirmed the association for positive contact but not for negative contact. Feelings of solidarity emerged as the most consistent mediator, followed by outgroup empathy and, to a lesser extent, group-based anger. Together, these findings show that contact can be an important factor motivating advantaged group members to act in solidarity with disadvantaged groups, and highlight the mediating factors in this process.
Omnivorous cultural consumption and the co-creation of cultural products: Interactive versus participatory art
Authors: Bonazzi Michele , Cancellieri Giulia , Casarin Francesco
Published: June 2023

How do omnivorous consumers perceive co-creation in cultural consumption? In this article, we combine observation data on co-created cultural productions, focus groups and field interviews to investigate omnivorous consumers’ perceptions of artistic experiences characterized by different degrees of co-creation. We explored this topic in the context of co-creative theatre, an emergent theatrical genre that provides for the active involvement of omnivorous consumers in the staging of a theatrical performance. Our findings reveal new dimensions of what it means for omnivorous consumers to be culturally open by showing their perceptions of interactive and participatory art, two distinct co-creative artistic experiences. While interactive art encourages consumers to intervene in the artistic experience by following the precise direction of the professional artists on stage, participatory art entails an even more active and autonomous role of consumers in the design of the experience. Our findings indicate that there are differences between the way in which consumers perceive interactive art and participatory art and that two distinct dimensions of cultural consumption – novelty and authenticity – emerge from different co-creative dynamics. The observed co-creation experiences portray the transformation of the omnivorous consumers from spectators or visitors to co-authors of the experience and mark the dissolution of the existing boundaries between production and consumption.
Social bias, not time bias
Authors: Greene Preston
Published: June 2023

People seem to have pure time preferences about trade-offs concerning their own pleasures and pains, and such preferences contribute to estimates of people's individual time discount rate. Do pure time preferences also matter to interpersonal welfare trade-offs, including those concerning the welfare of future generations? Most importantly, should the intergenerational time discount rate include a pure time preference? Descriptivists claim that the intergenerational discount rate should reflect actual people's revealed preferences, and thus it should include a pure time preference. Prescriptivists claim that the intergenerational discount rate should be based on moral analysis, and thus they (often) claim that the rate of pure time preference should be zero. I argue that regardless of which view is correct, a focus on pure time preference is misplaced. First, the most plausible interpretation of descriptive preferences for intergenerational trade-offs is that people are socially biased and not time biased. Second, social bias is superior to time bias as a prescriptive reason to discount the welfare of future people. Third, recent advances in measuring social bias as a social discount rate make social bias a viable replacement for time bias in economic analyses of intergenerational welfare trade-offs.
Examining early childhood education through the lens of stakeholders: A statewide needs assessment
Authors: D’Amico Leigh Kale , Fan Xumei , Linder Sandra , Pawloski Tammy , White Kelley Mayer
Published: June 2023

A southeastern state engaged in a systematic landscape study to identify needs and priorities for young children and their families. Early childhood and research methods experts, representing five Institutions of Higher Education (IHE), along with equity and family engagement experts developed three strategies to collect data from various stakeholders throughout the state to inform the needs and priorities related to the education of young children. A total of 4615 parents/caregivers, organizational representatives, and community members participated in regional meetings, an online survey, and focus groups. A mixed-methods convergent study revealed the accessibility and affordability of high quality early care and education and kindergarten readiness as common priorities. Stakeholders also valued professional culture, empowering families, and support for children with special needs. This study also found that families of different sociodemographic backgrounds prioritized different aspects of early learning and education.
Conceptual knowledge of writing words and numbers: Developmental data from preschool children
Authors: Ralli Asimina M , Papoulidi Asimenia , Tsaoussi Despoina
Published: June 2023

Children’s conceptual knowledge of writing words and numbers is an important aspect of their cognitive development. Children use notations as representations that have a communicative value and begin to learn about formal differences between writing words and writing numbers at an early age before the onset of formal schooling. The aim of the present study was to examine preschool children’s conceptual knowledge of writing words and numbers in an ecologically valid task with communicative value. One hundred and twenty Greek-speaking preschool children between the ages of 3 and 6 years old were assessed on the identity card task, which examined their production of notations for words and numbers during their effort to communicate personal information to others. The results demonstrated a developmental trend in the type of notation children produced with the younger children providing more “ambiguous” notations, for both tasks implying writing words and numbers, while as they got older, they provided more “writing-like” notations for the tasks implying writing words and more “number-like” notations for the tasks implying writing numbers. Understanding when and how children differentiate their symbolic representations for words and numbers can inform both theory and practice by expanding our understanding of whether certain constraints characterize the developmental course of a specific notational system. The findings of the present study could be incorporated in educational practice and enhance children’s emerging literacy and numeracy skills.
Cultural Predictors of Self-Esteem Among Black Women With Criminal Justice Involvement and Herpes Simplex Virus
Authors: Malone Natalie , Dogan-Dixon Jardin N. , Thorpe Shemeka , Thrasher Shawndaya S. , Wheeler Paris , Stevens-Watkins Danelle , Oser Carrie B.
Published: June 2023

Black women have disproportionately alarming HSV-2 infection rates yet receive little attention in sexual health literature. Using a strengths-based resilience framework, this study sought to determine culturally relevant protective predictors of self-esteem for Black women who are justice-involved and have HSV-2. The authors conducted secondary data analysis on data from the “Black Women in the Study of Epidemics (B-WISE) Project,” a longitudinal prospective study investigating health disparities and health services utilization among Black women with justice involvement. At baseline, N = 151 Black women with HSV-2 who were incarcerated or on probation completed survey measures assessing self-esteem, ethnic identity affirmation and belonging, perceived social support, and John Henryism Active Coping. Hierarchical linear regression analyses revealed ethnic identity affirmation and belonging and John Henryism Active Coping were significant predictors of self-esteem at 6-month follow-up. Implications are provided for current health professionals.
The Effects of Pressure Gradient on Papilledema Improvement After Venous Sinus Stenting in Idiopathic Intracranial Hypertension
Authors: Yang Hongchao , Raynald  , Huo Xiaochuan , Tong Xu , Wang Zhengyang , Li Xiaoqing , Liu Lian , Wang Shuran , Miao Zhongrong , Mo Dapeng
Published: June 2023

Purpose:

This study aimed to evaluate the impact of the pressure gradient on papilledema after stenting in patients with idiopathic intracranial hypertension (IIH) patients and venous sinus stenosis (VSS).

Materials and Methods:

In this prospective cohort study, we examined 121 patients with IIH and VSS who underwent stenting. The papilledema Frisen grade at the 1-month follow-up was used as a grouping factor (favorable outcome: 0–1; unfavorable outcome: 2–5). We used multivariable logistic regression modeling to determine independent predictors of favorable outcome. The performance of the prediction model was evaluated using a receiver operating characteristic (ROC) analysis.

Results:

A total of 96 patients had papilledema grades 0 to 1, and 25 patients had papilledema grades 2 to 5. Patients with the first group had significantly lower gradient pressures preoperatively (15.2 mmHg vs. 21.4 mmHg, p=0.001) and postoperatively (2 mmHg vs. 3.3 mmHg, p=0.002) relative to those in the second group. Multivariate analysis indicated that preoperative pressure gradient (odds ratio [OR] = 1.119; 95% confidence interval [CI] = 1.034–1.211]) and postoperative pressure gradient (OR = 1.498; 95% CI = 1.147–1.957) were independent predictors of favorable outcome. In the ROC analysis, the cut-off pressure gradient for the highest sensitivity (0.44) and specificity (0.874) was 22.75 mmHg, with a Youden’s index of 0.314. Survival analysis demonstrated that patients with a preoperative pressure gradient <22.75 mmHg had more rapid improvement of papilledema than did those with a pressure gradient >22.75 mmHg (mean+SD: 2.639+0.382 [95% CI: 1.890–3.388] versus mean+SD: 3.882+0.884 [95% CI: 2.149–5.616]; p=0.004).

Conclusion:

A significant reduction in the pressure gradient appears to be strongly correlated with the success of VSS in patients with IIH. A higher preoperative pressure gradient may reduce stenting efficacy in patients with IIH.

Clinical Impact

Venous sinus stenting has the potential to yield substantial clinical advantages in individuals diagnosed with idiopathic intracranial hypertension with venous sinus stenosis. Nevertheless, a heightened preoperative pressure gradient could lead to less favorable results. Thus, the early adoption of venous sinus stenting is advised to avert additional irreversible clinical deterioration among idiopathic intracranial hypertension patients with venous sinus stenosis.
Yarn tension model and vibration analysis during unwinding of carbon fiber bobbins
Authors: Zhang Yujing , Yang Zhiguo , Wang Zhongwei , Li Xing , Meng Zhuo
Published: June 2023

A low-quality unwinding process of the unwinding machine can lead to downtime of the knitting machine and loss of fabric quality. To address this issue, we studied the tension and vibration of carbon fiber yarns during unwinding. Based on the theory of axially moving strings, the dynamic model of carbon fiber yarn was established during the unwinding process, bringing the parameters into the simulation. According to the simulation results, the yarn tension in the unwinding process is closely related to the spring preload, which needs control within a certain range. When the unwinding speed increases, the fluctuation amplitude, lateral vibration amplitude, and axial vibration amplitude of the yarn tension gradually increase, causing friction and wear of the carbon fiber yarn. By controlling factors such as spring preload, unwinding speed, and the number of bobbins unwound simultaneously, one can effectively control the yarn’s vibration and improve the quality of the yarn.
Development of the Observable Well-Being in Living With Dementia-Scale
Authors: Madsø Kristine G. , Pachana Nancy A. , Nordhus Inger H.
Published: June 2023

The Observable Well-being in Living with Dementia-Scale was developed to address conceptual and methodological issues in current observational scales for music therapy. Creative interventions may receive lowered scores, as existing instruments rely heavily on verbal behavior. Methods were (1) Systematic review of observational instruments: (2) field work with music therapy and sociable interactions to operationalize the items; (3) field testing assessing feasibility and preliminary psychometric properties; (4) focus groups with experts to investigate content validity; (5) final field test and revision. 2199 OWLS-ratings were conducted in 11 participants. Hypotheses of construct validity and responsiveness were supported (r = .33 −.65). Inter-rater reliability was good (84% agreement between coders, Cohen’s Kappa = .82), and intra-rater reliability was excellent (98% agreement, Cohen’s Kappa = .98). Focus groups with 8 experts supported the relevance of the items and suggested further refinements to increase comprehensiveness. The final field-tested OWLS showed improved inter-rater reliability and usability.
Racialized Hazardous Space: A Critical Race Urban-Environmental Sociology of Residential Security in the Depression Era
Authors: Liévanos Raoul S.
Published: June 2023

This article advances a novel “critical race urban-environmental sociology” (CRUES) approach that synthesizes Marxist and critical race theory to focus on the “production of racialized hazardous space” and “residential security” during the Great Depression in the U.S. It applies the CRUES lens to the work of Frederick M. Babcock, the economist who disseminated authoritative and racially discriminatory statements on residential security and neighborhood appraisals before and during his tenure at the Federal Housing Administration. The article shows how Babcock paralleled and intersected with strands of classic urban ecology to conflate racially segregated and environmentally hazardous neighborhoods and naturalize their devalued status. Using the CRUES lens, the article also frames the Home Owners’ Loan Corporation’s (HOLC) worst neighborhood rating in its 1930s Residential Security Surveys as racialized hazardous space, and advances a conceptual model for future research on how environmental hazards, racialized social “threats,” and other sociospatial factors conditioned HOLC hazardous grade assignments.
Head Injury and Antisocial Personality Features in a Sample of Juvenile Detainees
Authors: Laugalis Victoria , Connolly Eric J.
Published: June 2023

Previous research has reported high prevalence rates of head injury amongst juvenile justice involved youth and relations between head injury and different forms of offending. However, little is currently known about the extent to which head injury is associated with antisocial personality features – characteristics that are strongly correlated with adult antisocial personality disorder symptomatology. The current study aimed to address this void in the existing body of research by analyzing a longitudinal sample of juvenile detainees ( N = 881) to examine the relationship between head injury during childhood or early adolescence and a wide range of antisocial personality features in late adolescence. Results from a series of logistic regression models reveal that head injury is associated with impulsivity and aggression more than other features of antisocial personality. The implications of these results for juvenile justice intervention programming and avenues for future research are discussed.
Reconstruction and Resilience in Rwandan Education Programming: A News Media Review
Authors: Dickson Brandon A.
Published: June 2023

This study evaluates news portrayals of resilience in the newly renewed Education for Sustainable Peace in Rwanda initiative. There remains a gap in understanding about how Rwanda's education approaches are portrayed and disseminated to the public by news media. This research uses an inductive coding analysis and layers Entman's framing theory to evaluate new media portrayals of resiliency in the reporting of domestic and international media outlets. This research demonstrates that there has been little media attention paid to Rwanda's education system outside of Rwanda, despite the newly revised programming. This research also finds that in media sources which do discuss Rwanda's education system, portrayals of approaches to resilience that have the potential for inclusivity are far more common than approaches which are top-down and exclusive. These findings serve to contribute to literature in both the context of Rwanda's place in global governance and the broader discussions of educational resiliency.
Does a Cognitive Network Contribute to Motor Recovery After Ischemic Stroke?
Authors: Lee Jungsoo , Kim Yun-Hee
Published: June 2023

Background

In stroke patients, preserved cognitive function plays a role in motor recovery, but there is insufficient evidence on the involved mechanisms. These mechanisms require investigation in the human brain, which is composed of large-scale functionally specialized networks.

Objective

In this study, we investigated the role of cognition-related networks on upper extremity motor recovery using neuroimaging data of subacute stroke patients.

Methods

This study retrospectively analyzed cohort data of 108 subacute ischemic stroke patients. All patients underwent resting-state functional MRI and motor function assessments using the Fugl-Meyer assessment (FMA) at 2 weeks after stroke onset. The FMA upper extremity (FMA-UE) score was obtained again at three months after stroke onset to assess motor recovery. To construct a resting-state network, cortical surface parcellation was performed using the Gordon atlas, which included 333 regions of interest, and 12 resting-state networks were extracted. Linear regression was used to identify the relationships between the FMA-UE recovery score and resting-state networks.

Results

Cognition-related networks were correlated with the FMA-UE recovery score, as were motor-related networks. Interaction effects between motor- and cognition-related network states existed in motor recovery. Specifically, cognition-related networks were associated with motor recovery in patients with a lower strength of motor-related networks.

Conclusions

These results suggested that the greater the damage to the motor network caused by stroke is, the more important the cognition-related networks are in motor recovery.
Association of Dual-Task Gait Cost and White Matter Hyperintensity Burden Poststroke: Results From the ONDRI
Authors: Pieruccini-Faria Frederico , Cornish Benjamin , Binns Malcolm , Fraser Julia , Haddad Seyyed M. H. , Sunderland Kelly , Ramirez Joel , Beaton Derek , Kwan Donna , Dilliott Allison A. , Scott Christopher , Sarquis-Adamson Yanina , Black Alanna , Van Ooteghem Karen , Casaubon Leanne , Dowlatshahi Dar , Hassan Ayman , Mandzia Jennifer , Sahlas Demetrios , Saposnik Gustavo , Tan Brian , Hegele Robert , Bulman Dennis , Ghani Mahdi , Robinson John , Rogaeva Ekaterina , Farhan Sali , Symons Sean , Nanayakkara Nuwan , Arnott Stephen R. , Berezuk Courtney , Holmes Melissa , Adamo Sabrina , Ozzoude Miracle , Zamyadi Mojdeh , Lou Wendy , Sujanthan Sujeevini , Bartha Robert , Black Sandra E. , Swartz Richard H. , McIlroy William , Montero-Odasso Manuel
Published: June 2023

Background

Acute change in gait speed while performing a mental task [dual-task gait cost (DTC)], and hyperintensity magnetic resonance imaging signals in white matter are both important disability predictors in older individuals with history of stroke (poststroke). It is still unclear, however, whether DTC is associated with overall hyperintensity volume from specific major brain regions in poststroke.

Methods

This is a cohort study with a total of 123 older (69 ± 7 years of age) participants with history of stroke were included from the Ontario Neurodegenerative Disease Research Initiative. Participants were clinically assessed and had gait performance assessed under single- and dual-task conditions. Structural neuroimaging data were analyzed to measure both, white matter hyperintensity (WMH) and normal appearing volumes. Percentage of WMH volume in frontal, parietal, occipital, and temporal lobes as well as subcortical hyperintensities in basal ganglia + thalamus were the main outcomes. Multivariate models investigated associations between DTC and hyperintensity volumes, adjusted for age, sex, years of education, global cognition, vascular risk factors, APOE4 genotype, residual sensorimotor symptoms from previous stroke and brain volume.

Results

There was a significant positive global linear association between DTC and hyperintensity burden (adjusted Wilks’ λ = .87, P = .01). Amongst all WMH volumes, hyperintensity burden from basal ganglia + thalamus provided the most significant contribution to the global association (adjusted β = .008, η2 = .03; P = .04), independently of brain atrophy.

Conclusions

In poststroke, increased DTC may be an indicator of larger white matter damages, specifically in subcortical regions, which can potentially affect the overall cognitive processing and decrease gait automaticity by increasing the cortical control over patients’ locomotion.
Research in a Closed Political Context, COVID, and Across Languages: Methodological Lessons, Messages, and Ideas
Authors: Kazbekova Darzhan , Schewe Rebecca
Published: June 2023

This study offers a number of contemporary qualitative and mixed methods research lessons regarding cross-language research and research in closed social and political contexts such as post-Soviet countries, especially how such research may be adapted to disruptions like those posed by the COVID pandemic or other disasters. The lessons draw from a study of policy learning among government officials in Kazakhstan which illustrated several methodological strengths and weaknesses and generated a number of methodological recommendations. In particular, while the literature on best practices for research in closed contexts emphasizes deep interactions to develop trust, the COVID pandemic and other disruptions may force researchers to transition to online modalities and constrain options. We suggest strategies to overcome these limitations, including supplementing findings from interviews with content analysis or other multimethod approaches. Additionally, we argue that researchers in post-Soviet and post-colonial contexts must be particularly attuned to the challenges of cross-language research and the combination of local languages with the language of the colonial power. These lessons hold relevance for researchers working in a variety of contexts as they conduct research during times of disasters and geopolitical instability.
An improved active Kriging method for reliability analysis combining expected improvement and U learning functions
Authors: Wang Lingjie , Chen Yuqi
Published: June 2023

The reliability assessment of structures with multiple failure modes and small failure probability is challenging due to the time-consuming simulations required. Active learning Kriging methods for structural reliability with multiple failure modes have shown high computational efficiency and accuracy. However, selecting the appropriate sample and its failure mode to update the Kriging models remains a key problem. In this paper, we propose a new learning function and stopping criterion to further improve the efficiency of structural system reliability analysis. Firstly, we propose a new learning function that combines the expected improvement function and the U learning function. This function selects the most suitable samples, balancing the degree of expected improvement of samples to the limit state surface and the degree of misclassification probability of samples. Secondly, we propose a new stopping criterion that considers both the accurate construction of limit state surfaces and the probability of accurately predicting the signs of samples. This criterion avoids premature or late termination of the active learning process. Thirdly, the sequential MCS simulation method is employed in the active learning process to efficiently evaluate small failure probability problems. By analyzing four examples, we verify the accuracy and efficiency of the proposed structural reliability analysis method.
Dynamics of Social Experiences in the Context of Extended Lockdown
Authors: Tran Anh , Bianchi Valentina , Moeck Ella K. , Clarke Beth , Moore Isobel , Burney Skye J. H. , Koval Peter , Kalokerinos Elise K. , Greenaway Katharine H.
Published: June 2023

Social interaction and loneliness have received much research interest. However, the direction of their relationship is unclear—does social interaction shape loneliness, or does loneliness shape willingness to interact? We explored dynamics of these social experiences under exceptional circumstances: COVID-19 lockdowns, which were necessary for public health but impacted people’s social lives. We investigated the relationship between social interaction and loneliness in and out of lockdown in Australia. We used experience sampling methodology to follow 233 people across 1 week ( Mage=30; 8,495 surveys) in a period that spanned one of the longest lockdowns in the world. Although loneliness did not predict subsequent social interaction, having a social interaction predicted lower subsequent loneliness, particularly in (vs. out of) lockdown. These findings suggest social interactions may limit loneliness, especially during physical isolation. In short, times when we are apart from others may be times we benefit from interacting with them the most.
Family childhood spatial conflict: A case study of young children’s adaptation to family rules based on self-parenting diaries
Authors: Zheng Suhua
Published: June 2023

The family is often thought of as a private space. Relatively little research has been done on the childhood space of the family. Although the family is often considered a warm haven for children to grow up in, it is also a space for child-adult conflict. Based on the researcher’s self-parenting diary, this paper uses thematic analysis and discourse critique to explore a 4-year-old girl’s triggering, adapting, and even challenging of family rules in a Chinese family, in an attempt to demonstrate parent-child conflict in the family childhood space and explore its manifestations. The study found that families contain a variety of implicit rules, which are usually set and interpreted by parents. Four-year-olds differ from their parents in their understanding of family rules. Young children are predominantly passive adapters when it comes to health and hygiene; in play, they are allowed to show more agency and have more room for negotiation.
Re-imagining the ‘fields’ of fieldwork
Authors: Bruun Johanne M. , Guasco Anna
Published: June 2023

Fieldwork remains a cornerstone of geographical research. Echoing longstanding critiques, this brief intervention envisions a future of geographical thought and praxis where fieldwork is critically interrogated rather than assumed. Approaching the field as a spatial-analytical category, we point to the creative ways that geographers have engaged and connected with their varied fields of research. Through examining recent geographical works that question the presumed locations of the field, experiment with various creative methods, and bridge pedagogy-practice divides, this intervention asks where and how the future fields of fieldwork might be located, practiced, and extended.
A sustainable solution for the hospitality industry: The QR code menus
Authors: Ozturkcan Selcen , Kitapci Olgun
Published: June 2023

This case presents a study of how QR code menus have emerged as a popular and sustainable solution for the hospitality industry in the wake of the COVID-19 pandemic. The case explores the environmental benefits of QR code menus in the restaurant industry by drawing on existing literature and examining how QR code menus can reduce paper waste, lower carbon footprint, and promote sustainable practices. The case also discusses how QR code menus contribute to several United Nations Sustainable Development Goals (SDGs), such as SDG 12 (Responsible Consumption and Production), SDG 13 (Climate Action), and SDG 17 (Partnerships for the Goals). The case concludes that QR code menus offer various benefits for restaurants and customers, such as reducing waste, enhancing customer experience, supporting local and organic food producers, and promoting responsible consumption and production. The case also suggests that QR code menus are not only a digital transformation tool but also a step towards creating a more eco-friendly and resilient restaurant industry.
A Diagnostic Dilemma “Cured” by Dialysis: An Educational Case Report
Authors: Chan Ryan J. , McCudden Christopher , McCormick Brendan , Zimmerman Deborah
Published: June 2023

Rationale:

The differential diagnosis for a patient with high-anion-gap metabolic acidosis (HAGMA) is broad; lactic acidosis is an important entity to screen for and treat. An elevated serum lactate is often used as a marker of inadequate tissue perfusion in critically ill patients but can also be indicative of decreased lactate utilization or poor hepatic clearance. Investigating for the underlying cause such as diabetic ketoacidosis, malignancy, or culprit medications is essential to establish the diagnosis and treatment plan.

Presenting concerns of the patient:

A 60-year-old man with a history of substance use and end-stage kidney disease treated with hemodialysis presented to hospital with confusion, altered level of consciousness, and hypothermia. Initial laboratory investigations were significant for a severe HAGMA with elevated serum lactate and β-hydroxybutyrate levels, but toxicology screen was negative, and there was no clear underlying precipitant. Urgent hemodialysis was arranged to mitigate his severe acidosis.

Diagnoses:

He had an initial single dialysis treatment for 4 hours, with posthemodialysis labs showing significant improvement in his acidosis, serum lactate level, and clinical status (cognition, hypothermia). Given this rapid resolution, a sample from his predialysis blood work was sent for analysis of plasma metformin and returned significantly elevated at 60 mcg/mL (therapeutic range 1-2 mcg/mL).

Interventions and outcomes:

On careful medication reconciliation in the dialysis unit, the patient stated he had never heard of the medication metformin, and there was no record of a filled prescription at his pharmacy. Given his living situation with shared accommodations, it was presumed that he had taken medications that were prescribed to a roommate. Several of his other medications including his antihypertensives were subsequently given after dialysis on dialysis days to improve adherence.

Teaching points:

Maintain a broad differential diagnosis for patients presenting with a clinical syndrome consistent with an acute toxicity even if no culprit medications are identifiable on history, especially in patients with a suggestive social history. Anion-gap metabolic acidosis (AGMA) is common in hospitalized patients but sometimes requires further history and/or confirmatory testing to elucidate the root cause underlying typical causes of AGMA such as lactic acidosis or ketoacidosis. The main treatment of metformin toxicity is resuscitation and supportive care; however, metformin’s biochemical properties make it readily dialyzable via either diffusion or convection. The Extracorporeal Treatments In Poisoning group recommends hemodialysis for metformin toxicity when there is a serum lactate >20 mmol/L, a blood pH <7.0, a failure of standard therapy, end-organ damage (hepatic or renal insufficiency), or a decreased level of consciousness.
Introducing the SMILE_PH method: Sense-making interviews looking at elements of philosophical health
Authors: de Miranda Luis
Published: June 2023

The present article is a primary introduction to the semi-structured interviewing method SMILE_PH, an acronym for Sense-Making Interviews Looking at Elements of Philosophical Health. Beyond grounding this new methodology theoretically (a work that is started here but will in the future necessitate several developments), the main motivation here is pragmatic: to provide the recent philosophical health movement with a testable method and show that philosophically-oriented interviews are possible in a manner that can be reproduced, compared, tested and used systematically with a population that has received no training in philosophy. The SMILE_PH approach was conceived by the author during an ethically approved pilot study focused on the philosophy of life of persons living with spinal cord injury (SCI), with the intention of rectifying the epistemic obstacles generated by rationalist, Socratic or unstructured ways of in-depth interviewing. The six-step structure of the method is also inspired by hundreds of individual dialogue sessions with philosophical counselees, led by the author between 2018 and 2022: the SMILE_PH method progressively gathers phenomenological data about 1 – our bodily sense, 2 – our sense of self, 3 – our sense of belonging, 4 – our sense of the possible, 5 – our sense of purpose and 6 – our philosophical sense.
A Phenomenological Study of Black Female Secondary School Counselors and Their Experiences With Self-Care
Authors: Wells Tommy , Archibald James
Published: June 2023

This phenomenological study aimed to explore the self-care practices of Black female secondary school counselors serving in public school districts in central Indiana. Eight participants were recruited through purposive sampling and participated in semistructured interviews. Findings indicate that participants engage in various self-care practices but experience challenges in their school counseling roles that serve as barriers to self-care. Themes that emerged include (a) the struggle to engage in self-care, (b) school counselor role as a reminder for self-care, (c) Black identity related to personal boundaries, and (d) institutional barriers to self-care. The discussion highlights the importance of self-care for Black female secondary school counselors and the challenges they face. We explore implications for Black female school counselors, school counselors overall, school administrators, and school counselor training programs. Finally, we suggest future research in the self-care practices of Black female school counselors in different contexts.
Fiscal Policy and Economic Stabilization Dynamics in Sub-Saharan Africa: A New Evidence from Panel VEC Model and Hodrick-Prescott Filter Cyclical Decomposition
Authors: Nkalu Chigozie Nelson , Agu Chike Cletus
Published: June 2023

This study investigates the dynamics of fiscal policy and economic stabilization using a panel dataset from Sub-Saharan Africa (SSA) sourced from the World Development Indicators (WDI) between 1985 and 2019. The study utilized a panel vector error correction model (VECM) rather than panel vector autoregression (PVAR) after ascertaining the presence of cointegrating equations (existence of long-run relationships). Also, both homogenous and heterogeneous panel unit root processes were utilized to test the panel data’s stationarity before estimating the panel VECM. Again, the cyclical decomposition (Hodrick-Prescott Filter) is adopted in examining the effect of fiscal policy on economic stabilization across countries in SSA. Essentially, the VECM estimation result reveals that both government expenditure (GEX) and total reserves (TRS) have significant long-run relationships but are not substantial enough to stimulate economic growth and stability in the short run. Simultaneously, the Hodrick-Prescott Filter’s (HP-filter) cyclical decomposition confirms the non-stability of economic growth and stabilization in SSA over time. In line with other numerous policy recommendations, the SSA countries’ governments should improve on the policies targeted toward controlling the financial (fiscal) leakages to ensure more robust economic stabilization in the region through increases in total revenue and reserves both in the short and long-run.

JEL Classification Codes: E62, E63, F38, F41, H50.
Using Autoethnographic Writing to Teach Critical Thinking in Health Behavior Theory Courses
Authors: Adamson Brynn , DiFilippo Kristen , Frasca Elizabeth , Clarke Caitlin Vitosky
Published: June 2023

Critical thinking is an important skill in all academic disciplines, but it can be difficult to develop assessments that adequately evaluate how critical thinking has changed over the period of a semester. In the context of health promotion, it is essential to prepare learners to appraise health information and misinformation, identify health disparities and work to address them, engage in health promotion practices that are culturally sensitive, theoretically driven, evidence-based, and acknowledge the role of social determinants of health and health behaviors. Health Behavior Theory is a fundamental subject taught in health promotion programs. While a large part of this subject matter involves the learning of health behavior theory, it presents an opportunity where critical thinking can be fostered through embodied pedagogy. Since students have had years of exposure to health information, as well as personal and observed experiences with health behavior, students come with many preconceived notions about the subject matter. In this article, we describe the use of a scaffolded experience of embodied behavior change and self-reflection, culminating in the creation of an autoethnography as a pedagogical experience which can support critical thinking in learners. We describe the development, implementation, and evaluation of the autoethnography assignment. As an embodied pedagogy, the autoethnography experience provides students with valuable insight into the difficulties of behavior change on an individual level while connecting individual experiences with social discourses that influence diverse meanings related to health behavior.
Entrepreneurial Learning Based on the Zone of Proximal Development
Authors: Oliveira Juliano C. , Cassandre Marcio P. , Elias Sara R. S. T. A.
Published: June 2023

In this article, we establish a dialogue between the education and entrepreneurial learning literatures to explore entrepreneurship education and practice. Our aim is to understand how entrepreneurial learning unfolds, based on the concept of the Zone of Proximal Development (ZPD). We adopt a constructivist approach to explore entrepreneurial learning, grounded in Cultural-Historical Theory. A combination of narrative research, focus group, storytelling, and theatrical images comprises our methodological approach, which draws from 34 virtual meetings with 10 undergraduate students who are also startup founders in Brazil. Our results show that, in addition to knowledge that is systematized by the university, entrepreneurial learning at university encompasses social relationships and is rooted in the experiential heritage acquired by students before entering university. Significantly, we show that the ZPD is built through interactions with entrepreneurship educators, but also key actors (family members, professional acquaintaces, experienced entrepreneurs, peer student entrepreneurs). Moreover, we spotlight the importance of intentionally planning the activities of student entrepreneurs within the learning context.
The Impact of Disparities on Minimally Invasive Esophagectomy After the 2014 Affordable Care Act Expansion: A Retrospective Analysis
Authors: Badrinathan Avanti , Syphan Thomas A. , Bassiri Aria , Linden Jessica , Alvarado Christine E. , Sinopoli Jillian , Tapias Vargas Leonidas , Towe Christopher W.
Published: June 2023

The effect of Affordable Care Act Medicaid expansion on access to minimally invasive esophagectomy (MIE) is unknown. We hypothesize that greater Medicaid coverage resulting from ACA expansion would be associated with improved access to MIE, and performed an analysis of the National Cancer Database, comparing MIE rates in Medicaid expansion states to non-expansion states. MIE was more common in expansion states (30.37%vs 23.88%, P < .001). A multivariable difference-in-differences analysis, however, suggested no effect in MIE rate due to Medicaid expansion. This finding suggests that access to care is more complex than access to insurance. Further study is required to characterize disparities in access to MIE.
The possibilities of disruption: Serendipity, accidents and impasse driven search
Authors: Ross Wendy
Published: June 2023

This article challenges the traditional view of progress as a linear trajectory from ignorance to knowledge, arguing that creative cognition involves an extended and dynamic system of non linear possibility generation. It emphasises the importance of an externalist approach which takes into account the role of objects in the environment in shaping cognition. Accidents are seen as a key trigger for creative thinking, as they disrupt planned cognitive trajectories and introduce novel elements into the cognitive ecosystem, leading to new possibilities that were previously inconceivable. However, how we filter these opportunities is rarely explored. The feeling of impasse, when problem-solvers are stuck and unable to find a solution, is also explored as an important generative state for creativity. While this state may be unpleasant, research suggests that persevering through it can lead to a sense of ‘aha’ and may be actively sought out by creatives. The article concludes that further research is needed to fully understand the relationship between aversive states, chance and human imagination in order to understand creative thinking.
Fetal Bowel Dilatation Associated With LCHAD Deficiency: A New Sonographic Finding
Authors: Vieira Vanessa , Sousa Filipa , Ramos Fabiana , Nunes Elsa , Branco Miguel
Published: June 2023

A long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency constitutes a very rare autosomal recessive disease, affecting long fatty acids’ metabolism. In the prenatal period, it is difficult to suspect this diagnosis in the absence of family history, as there are no specific sonographic signs of this disease. A 32-year-old pregnant woman was receiving follow-up care, as she was a carrier for Duchenne muscular dystrophy (DMD). The fetus was female, and the pregnancy progressed normally until 29th week of gestation. At that time, the fetal bowel had noted dilatation with mild hyperechogenicity. Fetal surveillance was conducted with sequential sonograms. Labor was induced at 36 weeks, due to pre-eclampsia. The newborn presented with poor weight gain and hypoglycemic episodes. Neonatal screening revealed the diagnosis of an LCHAD deficiency. Prenatal diagnosis of LCHAD is usually performed by genetic testing when there is a family history. However, only a few sonographic signs have been described in association with this disease, such as fetal bowel hyperechogenicity or cardiomyopathy. This is the first case study to report a prenatal sonographic finding of bowel dilatation in a fetus with LCHAD deficiency, and one of the few to report fetal bowel hyperechogenicity.
Nrf2 sensitizes ferroptosis through L-2-hydroxyglutarate-mediated chromatin modifications in sickle cell disease
Authors: Xi Caixia , Pang Junfeng , Zhi Wenbo , Chang Chang-Sheng , Siddaramappa Umapathy , Shi Huidong , Horuzsko Anatoli , Pace Betty , Zhu Xingguo
Published: June 2023

Sickle cell disease (SCD) is a chronic hemolysis, constant oxidative stress, and systemic hypoxia condition, and undergoes significant metabolic alterations. However, little is known about the correlation between metabolic alterations and those pathophysiological symptoms. Here we report that Nrf2, a master regulator of cellular antioxidant responses, regulates the production of the metabolite L-2-hydroxyglutarate (L2HG) to mediate epigenetic histone hypermethylation for gene expression involved in metabolic, oxidative and ferroptosis stress responses in SCD. Mechanistically, Nrf2 was found to regulate the expression of L-2-hydroxyglutarate dehydrogenase (L2hgdh) to mediate L2HG production under hypoxia. Gene expression profile analysis indicates that reactive oxygen species (ROS) and ferroptosis response are the most significantly affected signaling pathways after Nrf2 ablation in SCD. Nrf2 silencing and L2HG supplementation sensitize human sickle erythroid cells to the ROS and ferroptosis stresses. The absence of Nrf2 and accumulation of L2HG significantly affect histone methylation for chromatin structure modification and reduce the assembly of transcription complexes on downstream target genes to regulate ROS and ferroptosis responses. Furthermore, pharmacological activation of Nrf2 was found to render protective effects against ROS and ferroptosis stresses in SCD mice. Our data suggest a novel mechanism by which Nrf2 regulates L2HG levels to mediate SCD severity through ROS and ferroptosis stress responses and targeting Nrf2 is a viable therapeutic strategy to ameliorate SCD symptoms.