bluuebunny/crossref_metadata_2025 huggingface dataset:
Inherently stable descending flight of a tailless flapping wing micro air vehicle by upward wing elevation
Authors: Roelandt Thomas , Vandepitte Dirk
Published: June 2023

Maneuverability of flapping wing fliers inevitably goes with inherent system instability. Inherent instability means that flapping wing systems require a flight controller and that these vehicles are prone to crashing. This work proposes a design feature to stabilize the descent of a flapping wing aerial vehicle. The vehicle is based on the KUlibrie, a flapping wing nano robot that is under development at KU Leuven. A computational study indicates that upwardly elevated wings provide inherently stable descending flight. The vehicle performs a free flight starting from different initial conditions. The system dynamics display convergence towards a limit cycle. Wing elevation and center of gravity position determine pitch and roll stiffness with respect to vertical descent and climb. The same effects that stabilize descent also destabilize climbing flight.
Risk Factors for Recalcitrant Chronic Rhinosinusitis in Non-Solid and Solid Transplant Recipients
Authors: Candelo Estephania , Darakjian Ashley , Avila-Castano Karol , Donaldson Angela
Published: June 2023

Objectives

Transplant patients are high risk for surgery due to their immunocompromised state. There is a paucity of evidence concerning the differences in incidence of chronic rhinosinusitis (CRS) in solid versus non-solid organ transplant. Our aim is to analyze the difference in incidence of CRS requiring endoscopic sinus surgery (ESS) between non-solid and solid transplant populations and determine if certain risk factors are associated with increased incidence of recalcitrant CRS in non-solid versus solid transplants.

Study Design

Retrospective cohort.

Setting

Multisite tertiary academic center.

Methods

This is a retrospective chart review of 1303 transplant recipients who were seen in our rhinologic clinic for CRS between 2017 and 2022. A total of 224 patients underwent ESS and were further analyzed for risk factors associated with recalcitrant disease requiring sinus surgery. Subgroup analysis based on solid and non-solid organ transplant was performed.

Results

Of the 224 patients in the study, 171/224 (76.3%) had solid transplants while 53/224 (23.6%) had non-solid transplants. 17.19% of all transplant recipients required ESS. The incidence of ESS in non-solid transplants was 28.2% versus 57% in solid transplant. The risk of recalcitrant CRS in solid transplant recipients was almost 1.78 times greater than those with non-solid organ transplant (95% CI, 1.27-2.54, p  =  0.0005). Individual factors such as certain immunotherapy drugs, pancytopenia, and rejection appear to correlate with the risk of ESS in both non-solid and solid organ transplant.

Conclusion

Risk of ESS was greater in the solid transplant recipients compared to those who received non-solid organ transplant.
Exploratory study on the use of bi-stable supports for the impact protection of point-fixed glazing systems
Authors: Bento Rebelo Hugo , Assunção Beatriz , Bedon Chiara , Amarante dos Santos Filipe
Published: June 2023

This paper is focused on the study of innovative bi-stable supports to improve the impact performance of point-fixed glass panels, for typical use in facades. To mitigate the effects of impact and reduce potential risk for people, the introduction of innovative, bi-stable, mitigation devices between the fixing system and the primary building structure is addressed. The proposed dissipative system is able to control and minimise the input force which is transmitted to the primary building, controlling the damage around the supports and preventing the detachment of the glass panels. Based on LS-Dyna Finite-Element (FE) models, the proposed protection system is designed to have a snap-through behaviour under impact. The performance of the system is quantified for two different glazing systems, which are numerically investigated under various impact configurations.
The Direction-encoded Neural Network: A machine learning approach to rapidly predict blast loading in obstructed environments
Authors: Dennis Adam A , Rigby Sam E
Published: June 2023

Machine learning (ML) methods are becoming more prominent in blast engineering applications, with their adaptability to new scenarios and rapid computation times providing key benefits when compared to empirical methods and physics-based approaches, respectively. However, ML approaches commonly used for blast analyses are regularly provided with inputs relating to domain-specific parameters, restricting their use beyond the initial problem set and reducing their generality. This article presents the ‘Direction-encoded Neural Network’ (DeNN); a novel way to structure an Artificial Neural Network (ANN) to predict blast loading in obstructed environments. Each point of interest (POI) is represented by the proximity to its surroundings and the shortest travel path of the blast wave in order to prime the network to learn the underlying physics of the problem. Furthermore, a bespoke wave reflection equation creates a zone of influence around each point so that obstacles are only captured in the network’s inputs if they would alter the path of the wave. It is shown that the DeNN can predict peak overpressures with mean absolute errors ∼5 kPa for unseen, complex domains of any shape or size, when compared to the results from physics-based numerical models with ∼30 times the solution time of the DeNN. The network is used to develop maps of likely human injury following detonation of a high explosive in an internal environment, with eardrum rupture levels being correctly predicted for over 93% of unseen test points. It is therefore highly suited for use in probabilistic, risk-based analyses which are currently impractical due to excessive computational cost.
Design, development, utility and usability testing of the EMPOWER-SUSTAIN Self-Management Mobile App© among primary care physicians and patients with metabolic syndrome
Authors: Daud Maryam Hannah , Yusoff Fakhrul Hazman , Abdul-Razak Suraya , Baharudin Noorhida , Mohamed-Yassin Mohamed-Syarif , Badlishah-Sham Siti Fatimah , Nikmat Azlina Wati , Isa Mohamad Rodi , Jamil Nursuriati , Nawawi Hapizah , Ramli Anis Safura
Published: June 2023

Objective

This study aimed to design, develop, assess and refine the EMPOWER-SUSTAIN Self-Management Mobile App© among primary care physicians (PCP) and patients with metabolic syndrome (MetS) in primary care.

Methodology

Using the software-development-life-cycle (SDLC) iterative model, storyboard and wireframe were drafted; and a mock prototype was designed to illustrate the content and function graphically. Subsequently, a working prototype was developed. Qualitative studies using the ‘think-aloud’ and cognitive-task-analysis methods were conducted for the utility and usability testing. Topic guide was based on the 10-Nielsen's-Heuristic-Principles. Utility testing was conducted among PCP in which they ‘thought-aloud’ while performing tasks using the mobile app. Usability testing was conducted among MetS patients after they were given the app for 3 weeks. They ‘thought-aloud’ while performing tasks using the app. Interviews were audio- and video-recorded, and transcribed verbatim. Thematic content analysis was performed.

Result

Seven PCP and nine patients participated in the utility and usability testing, respectively. Six themes (efficiency of use, user control and freedom, appearance and aesthetic features, clinical content, error prevention, and help and documentation) emerged. PCP found the mobile app attractive and relevant sections were easy to find. They suggested adding ‘zoom/swipe’ functions and some parts needed bigger fonts. Patients commented that the app was user-friendly, has nice interface, and straightforward language. It helped them understand their health better. Based on these findings, the mobile app was refined.

Conclusion

This app was produced using a robust SDLC method to increase users’ satisfaction and sustainability of its use. It could potentially improve self-management behaviour among MetS patients in primary care.
Developing and pre-testing a digital decision-tree smartphone application for smoking prevention and cessation among HIV care providers
Authors: Tamí-Maury Irene , Tundealao Samuel , Guzman Jenna , Noé-Díaz Valeri , Markham Christine , Vigil Karen
Published: June 2023

Objectives

The diagnosis and continuous care of chronic conditions such as HIV infection present potential teachable moments for delivering smoking prevention and cessation interventions for patients. We designed and pre-tested a prototype of a smartphone application(app), Decision-T, specifically designed to assist healthcare providers when providing personalized smoking prevention and cessation services to their patients.

Methods

We developed the Decision-T app based on transtheoretical algorithm for smoking prevention and cessation following the 5-A's model. We employed a mixed-methods approach among 18 HIV-care providers recruited from Houston Metropolitan Area for pre-testing the app. Each provider participated in three mock sessions, and the average time spent at each session was measured. We measured accuracy by comparing the smoking prevention and cessation treatment offered by the HIV-care provider using the app to that chosen by the tobacco specialist who designed the case. The system usability scale (SUS) was used to assess usability quantitatively , while individual interview transcripts were analyzed to determine usability qualitatively. STATA-17/SE and Nvivo-V12 were used for quantitative and qualitative analysis, respectively.

Results

The average time for completing each mock session was 5 min 17 s. The participants achieved an overall average accuracy of 89.9%. The average SUS score achieved was 87.5(±10.26). After analyzing the transcripts, five themes (app's contents are beneficial and straightforward, design is easy to understand, user's experience is uncomplicated, tech is intuitive, and app needs improvements) emerged.

Conclusions

The decision-T app can potentially increase HIV-care providers’ engagement in offering smoking prevention and cessation behavioral and pharmacotherapy recommendations to their patients briefly and accurately.
Are dental x-rays safe? Content analysis of English and Chinese YouTube videos
Authors: Yeung Andy Wai Kan , Parvanov Emil D , Horbańczuk Jarosław Olav , Kletecka-Pulker Maria , Kimberger Oliver , Willschke Harald , Atanasov Atanas G
Published: June 2023

Objective

This study provided a content analysis of English and Chinese YouTube videos related to dental radiation safety.

Method

The search string, entered in English and Chinese respectively, was: (dental x-ray safe). The searches were performed and exported with Apify YouTube scraper. By screening the resultant videos and their related videos (as recommended by YouTube), a total of 89 videos were screened. Finally, 45 videos (36 English and nine Chinese) were included and analyzed. The specific information regarding dental radiation was evaluated. The Patient Education Material Assessment Tool for Audiovisual Materials was used to assess understandability and actionability.

Results

There was no significant difference between the English and Chinese videos in terms of view count, like count, comment count, and video duration. Half of the videos explicitly reassured the audience that dental x-rays are safe. Two of the English videos specifically stated that dental x-rays do not cause cancers. Numerous analogies were made in regard to radiation dose, such as equivalence to taking a flight or eating some bananas. About 41.7% of the English videos and 33.3% of the Chinese videos mentioned that patients could be further protected from scatter radiation by wearing a lead apron and thyroid collar. Videos had a good understandability score (91.3) but a poor actionability score (0).

Conclusions

Some of the analogies and the claimed radiation dose were questionable. One Chinese video even wrongly stated that dental x-rays are nonionizing radiation. The videos generally did not mention their information sources or the underlying radiation protection principles.
Comparative Study Between Associate Degree Nursing and Bachelor of Science Students for Adopting Case-Based Learning in Medical-Surgical Nursing
Authors: Buxton Theresa , Wang Shu-Yi
Published: June 2023

Introduction

Despite the important gains of using case studies to engage and enhance student learning, research documenting student satisfaction of using online case studies is limited, especially a comparison between Associate Degree in Nursing (ADN) and Bachelor of Science in Nursing (BSN) programs. Comparisons in perception of enhanced learning using online case-based studies were explored between students enrolled in ADN and BSN programs during medical-surgical courses as case-based learning can be used to support clinical decision making when clinical placements are lacking.

Methods

A survey was administered during medical-surgical classes for 110 BSN students and 79 ADN students. Questions were asked about enhanced learning, individual case satisfaction, and overall satisfaction using online case studies. Using descriptive statistics and t-test analyses, results showed that ADN student's perceptions of the exercises were more positive, useful, and more applicable to education. However, no difference in enhanced learning was observed between the ADN and BSN groups.

Conclusion

Regardless of BSN or ADN student status, all nursing students expect their education to relate to both theory and practice in the clinical setting. Online case studies enhance and emphasize critical thinking to adapt to constantly changing, complex situations congruent with the American Association of Colleges of Nursing (AACN) Essentials Domain 1: knowledge for nursing practice and Domain 2: person-centered care.
Experiential Learning in an Online Setting: How Entrepreneurship Education Changed During the COVID-19 Pandemic
Authors: Vecchiarini Mariangela , Muldoon Jeffrey , Smith Douglass , Boling Ruben J.
Published: June 2023

In March 2020, when the World Health Organization declared COVID-19 a pandemic, more than 90% of the world’s student population went through an unprecedented and sudden transition to distance learning. Although this was a challenging time for instructors across all disciplines, entrepreneurship educators faced the unique dilemma of preserving the experiential nature of entrepreneurship education in the online environment. We look at how entrepreneurship educators addressed experiential learning through online education during the pandemic and some of the solutions adopted given the experiential, hands-on nature of entrepreneurship education. We review the first wave of literature on the topic, and we offer the results of a recent survey of entrepreneurship educators who are members of the United States Association for Small Business and Entrepreneurship (USASBE). In doing this, we have added to a growing literature on the shift of entrepreneurial education to an online setting.
The DIY careers of young classical musicians in neoliberal times
Authors: Prokop Rainer , Reitsamer Rosa
Published: June 2023

This article seeks to deepen our understanding of the do-it-yourself (DIY) careers of a younger generation of classically trained musicians in the context of the neoliberal transformation of higher music education and music labour markets. Drawing on 46 interviews with white middle-class students and graduates of the three public, state-funded higher music education institutions in Austria, we examine how these artists seek to advance their careers as orchestral musicians, soloists or chamber musicians and manage the entrepreneurialism, competitiveness and precariousness that underpin the classical music labour market. Our study shows that the musicians cultivate an entrepreneurial ethos, but also adopt alternative cultural practices that promote collectivity, solidarity and care for one another. In these processes, the DIY ethos takes on a double meaning: It is adapted by the young musicians to neoliberal rationality, while also being fundamental for initiating, organising and managing small DIY music projects, festivals and cultural initiatives.
Comut-viz: efficiently creating and browsing comutation plots online
Authors: Duan Qiaonan , Wang Weiyi , Feng Feiling , Jiang Xiaoqing , Chen Hao , Zhang Dadong , Zhang Tongyi
Published: June 2023

Background

Comutation plot is a widely used visualization method to deliver a global view of the mutation landscape of large-scale genomic studies. Current tools for creating comutation plot are either offline packages that require coding or online web servers with varied features. When a package is used, it often requires repetitive runs of code to adjust a single feature that might only be a few clicks in a web app. But web apps mostly have limited capacity for customization and cannot handle very large genomic files.

Results

To improve on existing tools, we identified features that are most frequently adjusted in creating a plot and incorporate them in Comut-viz that interactively filters and visualizes mutation data as downloadable plots. It includes colored labels for numeric metadata, a preloaded palette for changing colors and two input boxes for adjusting width and height. It accepts standard mutation annotation format (MAF) files as input and can handle large MAF files with more than 200 k rows. As a front-end only app, Comut-viz guarantees privacy of user data and no latency in the analysis.

Conclusions

Comut-viz is a highly responsive and extensible web app to make comutation plots. It provides customization for frequently adjusted features and accepts large genomic files as input. It is suitable for genomic studies with more than a thousand samples.
Metabolomics-based exploration the response mechanisms of Saussurea involucrata leaves under different levels of low temperature stress
Authors: Sun Qi , Ma Lihua , Zhu Xinxia
Published: June 2023

Background

Saussurea involucrata (Sik.) is alpine plant that have developed special adaptive mechanisms to resist adverse environmental conditions such as low temperature chilling during long-term adaptation and evolution. Exploring the changes of its metabolites under different temperature stresses is helpful to gain insight into its cold stress tolerance.

Methods

Ultra-performance liquid chromatography and tandem mass spectrometry were used to analyze the metabolites in the leaves of Sik. under low different temperature stress conditions. Results: A total of 753 metabolites were identified, and 360 different metabolites were identified according to the Kyoto Encyclopedia of Genes and Genomes (KEGG) involved in the biosynthesis of secondary metabolites and amino acids and sugars. Sucrose and trehalose synthesis, glycolysis, tricarboxylic acid cycle, pentose phosphate pathway, glutamic acid-mediated proline biosynthesis, purine metabolism, amino acid metabolism, phenylpropane synthesis pathway metabolites all respond to low temperature stress. Under cold stress conditions, carbohydrates in Sik. leaves accumulate first than under freezing conditions, and the lower the temperature under freezing conditions, the less amino acids accumulate, while the phenolic substances increase. The expression of various substances in LPE and LPC increased more than 10-fold after low temperature stress compared with the control, but the content of LPE and LPC substances decreased after cold adaptation. In addition, purines and phenolics decreased and amino acids accumulated significantly under freezing conditions. Conclusion: The metabolic network of Sik. leaves under different low temperature stress conditions was proposed, which provided a reference for further exploration of the metabolic mechanism related to low temperature stress tolerance of Sik.
Near-miss hypoglycemia—reflections on perioperative glucose management guidelines in diabetics
Authors: Ahmad Rabeel , Naftalovich Rotem , Tewfik George , Eloy Jean Daniel , Rodriguez-Correa Daniel T.
Published: June 2023

Background

The American Society of Anesthesiologists (ASA) has an impressive array of professional perioperative guidelines but has not issued a guideline specific to perioperative blood glucose management and does not delve into the topic in their other guidelines.

Case report

We experienced a perioperative case that highlights the potential difficulty of glucose management in this setting. During anesthetic induction for an orthopedic foot surgery, as the medication was infusing, an IDDM 1 (insulin dependent diabetes mellitus type 1) patient expressed feeling that her blood sugar level was low. Her finger stick after induction showed severe hypoglycemia with a blood glucose of 34 mg/dL. The hypoglycemia was treated with intravenous glucose and further closely monitored.

Conclusions

This case led us to revisit the different perioperative guidelines and recommendations for diabetic patients and this manuscript aims to highlight the similarities and discrepancies among the different published recommendations. This case highlights the value of utilizing insulin pump infusions in the perioperative setting when available.
Flow diagram of the differential diagnosis and clinical decision making in a rare case of contrast-induced encephalopathy following cardiac catheterization: a case report
Authors: Sun Jiayin , Yuan Lichuang , Yu Hailiang , Yang Yanzhao , Zhou Zhiming , Jia Dean , Zhou Yujie , Yang Shiwei
Published: June 2023

Background

Contrast-induced encephalopathy (CIE) is considered as an uncommon complication following cardiac catheterization. Due to the varied manifestations, CIE has no formal diagnostic criteria. In fact, the incidence of CIE may be greatly underestimated because of the difficulty in its differential diagnosis with other cerebrovascular complications. Thus, making a flow diagram according to patients’ clinical symptoms and examinations after cardiac catheterization to help clinicians diagnose CIE is important and needed.

Case presentation

In this report, we describe a case of probable CIE in a 66-year-old Chinese man with hypertension who underwent cardiac catheterization with stents placement in the bifurcation lesion, during which 80 ml iopromide contrast was used. About 2 h following the procedure, the patient lost his consciousness suddenly and suffered from a status epilepticus. Malignant arrhythmias were not found through continuous electrocardiogram monitoring, but mild ST-segment elevation was displayed in leads I and aVL. The echocardiography, plasma glucose and electrolyte levels were normal. Emergency re-angiography with percutaneous transluminal coronary angioplasty was performed in the culprit lesion, which involved 60 ml iopromide contrast. However, the patient remained unconsciousness and epilepticus. Non-contrast computed tomography (CT) of the head showed cortical and subarachnoid enhancement as well as prolonged retention of contrast media in the middle cerebral artery. With supportive treatment of intravenous hydration, sedative and dehydrant, the patient recovered 3 h later and finally discharged without any neurological deficits.

Conclusions

CIE is an acute reversible encephalopathy induced by contrast media. It is exceptionally challenging to make the diagnosis of CIE following cardiac catheterization since there is a lack of consensus on the definition of CIE. Via this case we reviewed the related literatures, through which a flow diagram of the differential diagnosis and clinical decision making was given, which could help to differentiate CIE from other neurological complications following cardiac catheterization.
Emergency department-based injury surveillance information system: a conceptual model
Authors: Mirani Nader , Ayatollahi Haleh , Khorasani-Zavareh Davoud , Zeraatkar Kimia
Published: June 2023

Background

Injury data play a pivotal role in monitoring public health issues and Injury Surveillance Information Systems (ISIS) are useful for continuous data collection and analysis purposes. Since emergency department (ED) is usually the first place of referral for the injured people, the aim of this study was to develop a conceptual model for an ED-based ISIS.

Methods

This study was completed in 2020 and the Delphi technique (three rounds) was used to determine the main components of an ED-based ISIS. The participants were selected using the purposive sampling method. A 5-point Likert scale questionnaire was used for data collection and data were analyzed using descriptive statistics.

Results

In the first, second, and third rounds of the Delphi study, 60, 44, and 28 experts participated, respectively. In the first and second rounds, most of the items including the personal data, clinical data, data sources, and system functions were found important. In the third round of the Delphi study, 13 items which did not reach a consensus in the previous rounds were questioned again and five items were removed from the final model.

Conclusion

According to the findings, various data elements and functions could be considered for designing an ED-based ISIS and a number of data sources should be taken into count to be integrated with this system. Although the conceptual model presented in the present study can facilitate designing the actual system, the final system needs to be implemented and used in practice to determine how it can meet users’ requirements.
Experiences of participants of a volunteer-supported walking intervention to improve physical function of nursing home residents – a mixed methods sub-study of the POWER-project
Authors: Weissbach Sabine , Rieckert Anja , Kersting Christine , Grede Nina , Donner-Banzhoff Norbert , Soennichsen Andreas , Vollmar Horst Christian , Otte Ina , Weimer Pia , Trampisch Ulrike Sonja
Published: June 2023

Background

Regular physical activity improves physical health and mental well-being and reduces the risk of falling in older adults. The randomized controlled “Prevention by lay-assisted Outdoor-Walking in the Elderly at Risk” POWER-study investigates whether volunteer-supported outdoor-walking improves physical function and quality of life in older people living independently or in nursing homes. This sub-study explores the experiences of older participants and volunteers in relation to their physical and psychosocial well-being as well as the challenges faced by both groups. A further aim was to explore volunteers’ experience with people living in nursing homes during the first pandemic lockdown (spring 2020).

Methods

The sub-study was designed as mixed-methods approach consisting of 11 individual semi-structured guide-based interviews (nursing home residents), two focus group interviews (volunteers), and a cross-sectional questionnaire survey (volunteers). The interviews were audiotaped, transcribed verbatim, and analyzed by content analysis as described by Kuckartz. Topics addressed in the interviews were triangulated by means of a questionnaire. The quantitative data were analyzed using descriptive statistics.

Results

Participants’ evaluation of the intervention was generally positive. Nursing home residents appreciated the social interaction associated with the assisted walking, which motivated them to take part regularly, provided a sense of safety, and caused pleasure on both sides. The impact on physical health status of the nursing home residents of this sub-study varied to a large degree as reported in interviews: in some cases, an improvement in physical performance, a decrease in physical complaints, and an improvement in gait or independence was reported. If not, reference was made to previous or sudden illnesses and the advanced age of the participants. Despite the COVID-19-lockdown and the associated restrictions, about 60% of contacts were still possible and participants planned to continue the assisted walks after the lockdown.

Conclusion

Volunteers have a positive effect on the quality of life, mobility, and general health of nursing home residents. Even more than the improvement of physical performance, social interaction was seen as helpful. Despite their advanced age, the nursing home residents were curious and open to new contacts. When removing the identified barriers, it might be possible to integrate this program into the long-term everyday life of nursing homes.

Trial registration

DRKS-ID: DRKS00015188, date of registration: 31.08.2018.
Effect of an antimicrobial stewardship program in the prevention of antibiotic misuse in patients with spinal cord injury undergoing minor urologic procedures: a single-group, quasi-experiment study
Authors: Alnajjar Lina I. , Alrashidi Nourah S. , Almutairi Njoud , Alshamrani Noura , Khan Omar S. , Ali Sajjad , Youssef Amira M , Binsuwaidan Reem
Published: June 2023

Background

Antimicrobial stewardship programs (ASPs) are an internationally recognized strategy for reducing antimicrobial resistance while maintaining patient safety. ASP activities include the restriction of broad-spectrum antibiotics, the establishment of hospital guidelines based on antibiograms, and the promotion of appropriate antibiotic use. This study aimed to determine whether the implementation of antimicrobial stewardship practices improved the effects of a peri-procedure antibiotic prophylaxis prescribed by urologists for patients with spinal cord injury/disease (SCI/D) undergoing minor urological procedures at a tertiary care hospital.

Methods

This single-group, quasi-experiment study included adult patients with SCI/D who required minor urological procedures (cystoscopy, cytobotox, cystolitholapaxy, and urodynamic study) and who were hospitalized between 2012 and 2020.

Results

In total, 233 patients were included in each of the pre- and post-ASP implantation groups. There was a significant reduction in antibiotic use among patients who received a pre-procedure antimicrobial prophylaxis in the post- compared to the pre-implementation group (45.9% vs. 24.46%, p < 0.0001), and there was a highly significant reduction in the post- compared to the pre-implementation group in the number who received a post-procedure prophylaxis (16.7% vs. 1.2%, p < 0.0001).

Conclusion

ASP implementation is a highly effective strategy for reducing the use of peri-procedure antimicrobial prophylaxes in patients with SCI/D injuries undergoing minor urological procedures.
Indigenous birth support worker (IBSW) program evaluation: a qualitative analysis of program workers and clients’ perspectives
Authors: Pandey Mamata , Smith Leanne , MacZek Nicole , Tomkins Angela , Sasakamoose JoLee
Published: June 2023

Background

The Indigenous Birth Support Worker (IBSW) Program provides Indigenous women with respectful, culturally safe, and trauma-informed care and supports women and families during labor and delivery. Located in the Jim Pattison Children’s Hospital (JPCH) Maternal Care Centre in Saskatoon, Saskatchewan, Canada, the program served 1023 clients between December 2019 and January 2021.

Methods

The study objective was to explore the perspectives of the IBSWs and program clients one year post-implementation. The research plan was developed in collaboration with the IBSW program director and manager, IBSWs, and partners from the First Nation and Métis Health departments within the health region. A focus group with four IBSWs and individual interviews with ten clients who received services were conducted using a qualitative research design.

Results

Thematic analysis revealed that clients greatly appreciated and respected the IBSWs’ cultural support and their compassionate, nonjudgmental, and safe care. IBSWs emphasized the importance of culturally safe and client-centered treatment, more effective pain management solutions, and that relationships with Elders and community healthcare personnel should be built and strengthened to improve pregnancy and postnatal care delivery. IBSWs desire to work with community healthcare providers to provide prenatal care and build relationships before delivery. IBSWs advocated for collaborative cooperation with community healthcare professionals and rural healthcare teams to enable a smooth care flow to and from communities.

Conclusion

The Indigenous Birth Support Worker (IBSW) Program provides safe and client-centred care to Indigenous women during pregnancy, labour, and postpartum, consistent with the six principles proposed by BC perinatal services. IBSWs advocate for and assist Indigenous women in obtaining quality healthcare, provide traditional and cultural support, and positively affect mental health. However, the evaluation has revealed that healthcare provider insensitivity towards Indigenous clients persists. There is a need for greater role clarity and collaboration with healthcare practitioners to ensure evidence-based healthcare of the highest standard. This requires a commitment to addressing systemic issues and implementing broader calls to action and justice proposed by the Truth and Reconciliation Commission Calls to Action, the Missing and Murdered Indigenous Women and Girls Calls for Justice, and the United Nations Declaration on the Rights of Indigenous Peoples. The IBSW program offers vital support to Indigenous women during childbirth, but it must be viewed in the context of ongoing colonialism and the need for reconciliation and decolonization, requiring genuine collaboration with Indigenous peoples.
Characterization of immune checkpoints expression and lymphocyte densities of iranian breast cancer patients; the co-expression status and clinicopathological associates
Authors: Pournabee Mohammadhossein , Keshavarz-Fathi Mahsa , Esmaeili Pooyesh , Mahdavi Sharif Pouya , Nili Fatemeh , Jahanbin Behnaz
Published: June 2023

Background

Breast malignancies are now the most common and deadliest type of neoplasms among women worldwide. Novel therapeutic approaches are needed to combat advanced stages of breast cancer. In this study, we aimed to investigate the expression and co-expression status of three immune checkpoints (PD-1, PD-L1, and LAG-3), as well as tumor-infiltrating lymphocytes (TIL) scores, and to further establish their potential correlations with clinicopathologic features.

Methods

We performed a retrospective study on 361 pathologic samples of breast cancer. Immunohistochemistry was performed to assess the status of the immune checkpoint markers, and H&E staining was used to score TILs. The correlations of the immune checkpoint markers of tumor cells and tumor-associated immune cells and TIL scores with clinicopathological characteristics were analyzed.

Results

Out of 361 assessed samples, LAG-3 was positive in 51%, while IC PD-L1 and TC PD-L1 were detectable in 36% and 8.9%, respectively. Moreover, both IC PD-L1 and LAG-3 stained positively in 24.4% of samples. IC PD-L1 expression was significantly higher in tumors with higher nuclear, mitotic, and overall grades and tubule formation. In addition, TC PD-L1 and LAG-3 exhibited a similar trend for higher overall grading. Tumors with positive estrogen- and progesterone-receptor (ER and PR) expression had significantly lower IC PD-L1 and TC PD-L1 staining, while LAG-3 positivity was more prevalent in HER2 positive samples. Tumors that were positive for these biomarkers had significantly higher Ki-67 scores. LAG-3 expression showed significant correlations with PD-1 and IC PD-L1 expression. Besides, the co-expression of LAG-3 and IC PD-L1 was significantly more encountered in luminal B and triple-negative subtypes, compared to the luminal A subtype. Regarding TILs, their scoring was significantly higher in ER and PR negative and HER2 positive samples. Intriguingly, samples with positive staining for LAG-3, IC PD-L1, and TC PD-L1 had significantly higher TIL scorings.

Conclusions

Immune checkpoints show differentially different levels of expression in certain molecular subtypes of breast cancer. Moreover, they reveal a meaningful correlation with each other, proliferation indices, and histologic grades. Finally, a sizable proportion of breast cancers co-express PD-L1 and LAG-3, which will make them appropriate targets for future combined ICIs.
Effect of preoperative pupil offset on corneal higher-order aberrations after femtosecond laser-assisted in situ keratomileusis
Authors: Liu Zhanglin , Zhao Yang , Sun Shengshu , Wu Yuan , Wang Guiqin , Zhao Shaozhen , Huang Yue
Published: June 2023

Background

This study aimed to investigate the relationship between multiple higher-order aberrations (HOAs) subgroups and pupil offset, as well as to analyze the factors affecting postoperative corneal HOAs in patients with different degrees of refractive errors.

Methods

We enrolled 160 patients (316 eyes) aged ≥ 18 years who had undergone femtosecond laser-assisted in situ keratomileusis (FS-LASIK) treatment. Based on the relationship between the preoperative pupil offset and the postoperative ΔHOAs, all patients were divided into two groups: group I (pupil offset ≤ 0.20 mm) and group II (pupil offset > 0.20 mm). All of the eyes had low to high myopia with or without astigmatism (manifest refraction spherical equivalent (MRSE) < -10.00 D). Uncorrected distance visual acuity, corrected distance visual acuity, MRSE, pupil offset, central corneal thickness, corneal HOAs, vertical coma (Z3−1), horizontal coma (Z31), spherical aberration (Z40), trefoil 0° (Z33), and trefoil 30° (Z3−3) over a 6 mm diameter central corneal zone diameter were evaluated preoperatively and at 1 and 3 months postoperatively.

Results

Our result revealed significant differences in postoperative corneal total root mean square (RMS) HOAs, RMS vertical coma, RMS horizontal coma, RMS spherical aberration, and RMS trefoil 30° between group I and group II. ΔMRSE was found to be an effective factor for ΔRMS HOAs (R2 = 0.383), ΔRMS horizontal coma (R2 = 0.205), and ΔRMS spherical aberration (R2 = 0.397). In group II, multiple linear regression analysis revealed a significant correlation between preoperative pupillary offset and Δtotal RMS HOAs (R2 = 0.461), ΔRMS horizontal coma (R2 = 0.040), and ΔRMS trefoil 30°(R2 = 0.089). The ΔRMS vertical coma effect factor is the Y-component, and the factor influencing ΔRMS spherical aberration was ΔMRSE (R2 = 0.256).

Conclusion

A small pupil offset was associated with a lower induction of postoperative corneal HOAs. Efforts to optimize centration are critical for improving surgical outcomes in patients with FS-LASIK.
Comparison of epidemiologic factors and eye manifestations of twin children with controls
Authors: Rajavi Zhale , Sabbaghi Hamideh , Hasani Reza , Behradfar Narges , Abdi Saeid , Kheiri Bahareh , Haseli-Mofrad Azadeh
Published: June 2023

Purpose

The present study was aimed to compare the epidemiological and ocular findings of twin children in comparison with non- twin age matched individuals as their control.

Methods

In this cross sectional study, a total of 90 twins (180 cases) were compared with 182 non- twin matched children. All the study participants were examined by a comprehensive ophthalmic examination including measurement of the best corrected visual acuity (BCVA), cycloplegic refraction, ocular deviation, strabismus as well as the anterior and posterior ophthalmic examinations. Demographic information of children were collected by using an organized questionnaire. Monozygotic twins were considered if there were similarity of their phenotypic characteristics and gender, otherwise the twins were considered as dizygotic.

Results

The mirror- image twins (MIT) was defined according to the laterality of symmetrical ocular characteristics of twins. In this study, the mean age of the study participants was 7.08±4.42 and 7.58±3.99 years in twins and non-twins groups, respectively (P=0.253). Among the twins, 27 (30%) were monozygotic. Refractive form of MIT was seen in 5 twins (2.8%). The spherical refractive error was more hyperopic in twins compared to non- twins (P=0.041). BCVA in the twin group (0.07±0.16LogMAR) was significantly worse than non-twins (0.03±0.08LogMAR, P < 0.001) and higher percentage of them were amblyopic (37.2% versus 10.4%, P=0.005). Twin and controls had strabismus in 17.2% and 1.6%, respectively (P < 0.001). Regarding the comparison between mono- and dizygotic twins, more significant percentage of monozygotic twins had amblyopia (P=0.004) and strabismus (P=0.047). Multivariate analysis showed significant correlation among low gestational age and female gender, low birth weight and seizure.

Conclusion

Female sex, less gestational age, low birth weight, amblyopia and strabismus were significantly higher in twins. Therefore, it is important to check their refractive error, amblyopia and strabismus to prevent their further complications.
Psychiatric and non-psychiatric population vulnerabilities in time of a crisis: the unsuspected aggression factor
Authors: Martin Sylvia , Oltra Anna , Del Monte Jonathan
Published: June 2023

Objectives

In March 2020, France faced a health crisis due to the COVID-19 outbreak that, like previous infectious disease crises, involved high psychological and emotional stress, a series of factors that influenced the ongoing mental health crisis.

Methods

We recruited 384 respondents to complete an online questionnaire during the second month of isolation: 176 psychotherapy recipients (68 were currently attending psychiatric care) and 208 healthy controls. We measured demographic characteristics, impulsivity, aggression, hopelessness, suicidal risk, and the global level of anxiety and depression in order to estimate potential discrepancies in clinical measures across these populations.

Results

Our results indicate that the group currently undergoing psychiatric care was prone to loneliness and social isolation. Regarding clinical and nonclinical population, there were differences in suicidal risk, depression, anxiety, and hopelessness but mainly in aggression. Regression analysis also demonstrated that aggression surprisingly influenced anxiety levels. Patients undergoing therapy compared with patients who were not displayed differences only in suicidal risk, anxiety, and hopelessness, with those undergoing therapy having higher scores. The outpatient group undergoing therapy had a significantly lower level of impulsivity. Moreover, the regression to predict anxiety and depression levels from correlated factors highlighted the potentially heightened role of aggression in predicting anxiety in the clinical group.

Conclusion

New research into stress reactions should assess other clinical signals, such as aggression, and examine preventive mental health interventions in times of crisis.
Prospective association between perceived stress and anxiety among nursing college students: the moderating roles of career adaptability and professional commitment
Authors: Dong Chaoqun , Xia Lin , Zhao Chengjia , Zhang Xiaoxian , He Ju , Zhang Guohua , Zhang Jingjing
Published: June 2023

Background

Anxiety may stay with nursing students throughout their internship and even persist afterwards. Although many studies have explored the effects of perceived stress on anxiety, the relationship between pre-internship perceived stress and post-internship anxiety levels has not been clarified. In addition, none had focused on the moderating roles of career adaptability and professional commitment between perceived stress and anxiety. This study aims to investigate the influence of pre-internship perceived stress on the post-internship anxiety level of nursing college students, and to analyze the moderating effects of career adaptability and professional commitment on their relationships.

Methods

A longitudinal study design was employed. Full-time nursing college students from a Chinese medical university were recruited by convenient sampling. All surveys were conducted via Wen Juan Xing (www.wjx.cn), a widely used web-based survey platform in China. Two waves of surveys were collected in the pre-internship and post-internship periods, with an interval of one year. Among 823 nursing students recruited, 692 students completed all two waves of the survey (response rate: 84.08%). Participants completed a series of questionnaires examining general demographic characteristics, perceived stress, anxiety, career adaptability, and professional commitment both before and after the internship. The bias-corrected bootstrap technique of the Hayes PROCESS macro (Model 2) was used to test the moderation effect.

Results

Pre-internship perceived stress was positively associated with post-internship anxiety (β = 0.474, p < 0.001). Career adaptability would mitigate the effect of perceived stress on anxiety (β = -0.009, p < 0.01, 95% CI = [-0.013, -0.004]), and this influence became stronger for nursing college students with higher levels of career adaptability. Instead, the professional commitment would enhance the effect of perceived stress on anxiety (β = 0.004, p < 0.05, 95% CI = [0.001, 0.009]).

Conclusions

Adequate career adaptability was key to alleviating anxiety among nursing interns. Nursing educators and clinical nursing managers should pay attention to cultivating the career adaptability of nursing college students in order to help them successfully achieve identity transformation and career development. Meanwhile, it is crucial to guide them to develop appropriate professional commitment.
A U-shaped protection of altitude against mortality and infection of COVID-19 in Peru: an ecological study
Authors: Baquerizo-Sedano L. , Goni L. , Sayón-Orea C. , González-Muniesa P.
Published: June 2023

Background

The COVID-19 pandemic has affected the world in multiple ways and has been a challenge for the health systems of each country. From the beginning, risk factors for the severity and mortality of the disease were considered, as the spread of the virus was related to the living conditions of each population.

Methods

In this ecological study we have evaluated the role of geography, precisely the altitude above sea level in the incidence and mortality of COVID-19 in Peru. Incidence and mortality data were taken from the open-access database of the government of Peru until March 2021. COVID-19 cases and COVID-19 mortality were treated as cases/density population and 1000 x cases/inhabitants while altitude was treated as continuous and as a categorical variable divided in 7 categories. The relationship between COVID-19 cases or deaths for COVID-19 and altitude as continuous variable was determined using Spearman correlation test. Meanwhile when altitude was considered as a categorical variable, Poisson regression or negative binomial analyses were applied.

Results

A significant inverse correlation was found between COVID-19 cases by population density and altitude (r=-0.37 p < 0.001). By altitude categories, the lowest risk for infection was observed between 3,000 and 3,500 m (IRR 0.08; 95% CI 0.05,0.12). Moreover, we found an inverse correlation between altitude and COVID-19 mortality (r=-0.39 p < 0.001). Also, the lowest risk for mortality was observed between 3,000 and 3,500 m (IRR 0.12; 95%CI 0.08; 0.18). Similar results were found when analyses were adjusted for inhabitants and stratified by sex.

Conclusion

This study reports an inverse relationship between COVID-19 incidence and mortality with respect to the altitude of residence, particularly, a u-shaped protection is shown, with a highest benefit between 3000 and 3500 m. The possibility of using hypoxia as an alternative treatment requires more complex studies that should allow knowing the physiological and environmental mechanisms of the protective role.
The state of loneliness and social isolation research: current knowledge and future directions
Authors: Taylor Harry Owen , Cudjoe Thomas K.M. , Bu Feifei , Lim Michelle H.
Published: June 2023

In this editorial, we consider the current state of loneliness and social isolation research around the world, including knowledge gaps in the empirical literature.