bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 19184: Depression Mediates the Relationship Between Physical Activity and Quality of Life Among Patients With Coronary Heart Disease
Authors: szuba rochelle G , Hoffmann Thomas , Whooley Mary , Elnaggar Abdelaziz , Park Mijung , Johnson Julene , Park Linda G
Published: November 2023

Background:
Depression, a known comorbidity in coronary heart disease (CHD), is associated with adverse cardiac events, mortality, symptom burden, physical limitation, and poor quality of life (QOL). Evidence has shown that depression impedes self-care behaviors including, physical activity. Similarly, regular physical activity has been shown to lessen depressive symptoms and improve cardiovascular health. However, there is limited research to determine whether depressive symptoms mediate or moderate the association between physical activity and overall QOL in the older adult population living with chronic CHD.

Hypothesis:
Depression mediates the positive association between physical activity and QOL. Depression is a moderator of physical activity and QOL.

Objectives:
1) To determine the direct effect of depressive symptoms on physical activity and QOL; 2) to investigate the mediating effect of physical activity and depressive symptoms on QOL; and 3) to test the moderating effect of depressive symptoms on physical activity and QOL.

Methods:
This cross-sectional study collected 20-year follow-up survey data from 126 survivors from the Heart and Soul prospective cohort study of people living with CHD. Mediation testing was conducted using the steps described by Baron and Kenny.

Results:
Physical activity significantly predicted QOL (
β
=.133,
p
=.02) and significantly predicted depressive symptoms (
β
=-.1918,
p
=.0002); depressive symptoms significantly predicted QOL(
β
=-0.762,
p
<.0001). After depression was added to the model, the relationship between physical activity and QOL was no longer significant, indicating a mediating effect. The average causal mediation effect was statistically significant (.1463,
p
=.0002). Depression was not a moderator of physical activity and QOL (p>.05).

Conclusions:
This study demonstrated that depression mediated the effect of physical activity on QOL. The findings underscore the importance of addressing physical activity and depressive symptoms in interventions to improve the overall well-being and quality of life of individuals living with chronic CHD.
Health Care Access and Cardiovascular Risk Factor Management Among Working-Age US Adults During the Pandemic
Authors: Marinacci Lucas X. , Bartlett Victoria , Zheng ZhaoNian , Mein Stephen , Wadhera Rishi K.
Published: November 2023

BACKGROUND:

Low-income working-age US adults disproportionately experienced health care disruptions at the onset of the coronavirus disease 2019 pandemic. Little is known about how health care access and cardiovascular risk factor management changed as the pandemic went on or if patterns differed by state Medicaid expansion status.

METHODS:

Cross-sectional data from the behavioral risk factor surveillance system were used to compare self-reported measures of health care access and cardiovascular risk factor management among US adults aged 18 to 64 years in 2021 (pandemic) to 2019 (prepandemic) using multivariable Poisson regression models. We assessed differential changes between low-income (<138% federal poverty level) and high-income (>400% federal poverty level) working-age adults by including an interaction term for income group and year. We then evaluated changes among low-income adults in Medicaid expansion versus nonexpansion states using a similar approach.

RESULTS:

The unweighted study population included 80 767 low-income and 184 136 high-income adults. Low-income adults experienced improvements in insurance coverage (relative risk [RR], 1.10 [95% CI, 1.08–1.12]), access to a provider (RR, 1.12 [95% CI, 1.09–1.14]), and ability to afford care (RR, 1.07 [95% CI, 1.05–1.09]) in 2021 compared with 2019. While these measures also improved for high-income adults, gains in coverage and ability to afford care were more pronounced among low-income adults. However, routine visits (RR, 0.96 [95% CI, 0.94–0.98]) and cholesterol testing (RR, 0.93 [95% CI, 0.91–0.96]) decreased for low-income adults, while diabetes screening (RR, 1.01 [95% CI, 0.95–1.08]) remained stable. Treatment for hypertension (RR, 1.05 [95% CI, 1.02–1.08]) increased, and diabetes-focused visits and insulin use remained stable. These patterns were similar for high-income adults. Across most outcomes, there were no differential changes between low-income adults residing in Medicaid expansion versus nonexpansion states.

CONCLUSIONS:

In this national study of working-age adults in the United States, measures of health care access improved for low- and high-income adults in 2021. However, routine outpatient visits and cardiovascular risk factor screening did not return to prepandemic levels, while risk factor treatment remained stable. As many coronavirus disease-era safety net policies come to an end, targeted strategies are needed to protect health care access and improve cardiovascular risk factor screening for working-age adults.
Myeloid Cell Derived IL1β Contributes to Pulmonary Hypertension in HFpEF
Authors: Agrawal Vineet , Kropski Jonathan A. , Gokey Jason J. , Kobeck Elizabeth , Murphy Matthew B. , Murray Katherine T. , Fortune Niki L. , Moore Christy S. , Meoli David F. , Monahan Ken , Ru Su Yan , Blackwell Thomas , Gupta Deepak K. , Talati Megha H. , Gladson Santhi , Carrier Erica J. , West James D. , Hemnes Anna R.
Published: November 2023

BACKGROUND:

Pulmonary hypertension (PH) in heart failure with preserved ejection fraction (HFpEF) is a common and highly morbid syndrome, but mechanisms driving PH-HFpEF are poorly understood. We sought to determine whether a well-accepted murine model of HFpEF also displays features of PH, and we sought to identify pathways that might drive early remodeling of the pulmonary vasculature in HFpEF.

METHODS:

Eight-week-old male and female C57BL/6J mice received either N
γ
-nitro-L-arginine methyl ester and high-fat diet or control water and diet for 2, 5, and 12 weeks. The db/db mice were studied as a second model of HFpEF. Early pathways regulating PH were identified by bulk and single-cell RNA sequencing. Findings were confirmed by immunostain in lungs of mice or lung slides from clinically performed autopsies of patients with PH-HFpEF. ELISA was used to verify IL-1β (interleukin-1 beta) in mouse lung, mouse plasma, and also human plasma from patients with PH-HFpEF obtained at the time of right heart catheterization. Clodronate liposomes and an anti–IL-1β antibody were utilized to deplete macrophages and IL-1β, respectively, to assess their impact on pulmonary vascular remodeling in HFpEF in mouse models.

RESULTS:

N
γ
-nitro-L-arginine methyl ester/high-fat diet–treated mice developed PH, small vessel muscularization, and right heart dysfunction. Inflammation-related gene ontologies were overrepresented in bulk RNA sequencing analysis of whole lungs, with an increase in CD68
+
cells in both murine and human PH-HFpEF lungs. Cytokine profiling showed an increase in IL-1β in mouse and human plasma. Finally, clodronate liposome treatment in mice prevented PH in N
γ
-nitro-L-arginine methyl ester/high-fat diet–treated mice, and IL-1β depletion also attenuated PH in N
γ
-nitro-L-arginine methyl ester/high-fat diet–treated mice.

CONCLUSIONS:

We report a novel model for the study of PH and right heart remodeling in HFpEF, and we identify myeloid cell–derived IL-1β as an important contributor to PH in HFpEF.
Hemodynamic Effects of the Osmopressor Response: A Systematic Review and Meta‐Analysis
Authors: Oyewunmi Oyebimbola A. , Lei Lucy Y. , Laurin Jill K. H. , Morillo Carlos A. , Sheldon Robert S. , Raj Satish R.
Published: November 2023

Background

Rapidly consuming water may offer practical orthostatic hypotension therapy. However, its efficacy across disorders remains uncertain. This study aims to assess the impact of rapid 350‐ to 500‐mL water intake on systolic and diastolic blood pressure (BP) and heart rate (HR) through a systematic review and meta‐analysis.

Methods and Results

We systematically reviewed MEDLINE and Embase up to June 2023, including randomized controlled trials and prospective cohort studies. Using random‐effects meta‐analysis, we calculated pooled mean differences (MDs) for maximum hemodynamic effects of rapid 350‐ to 500‐mL water bolus consumption. Participants with orthostatic hypotension experienced increased systolic BP (MD, 24.18 [95% CI, 15.48–32.88]) and diastolic BP (MD, 11.98 [95% CI, 8.87–15.09]) with decreased HR (MD, −3.46 [95% CI, −5.21 to −1.71]). Similar results were observed in multiple system atrophy and pure autonomic failure subgroup analysis. Healthy participants showed modest increases in systolic BP (MD, 2.33 [95% CI, 1.02–3.64]) and diastolic BP (MD, 2.73 [95% CI, 1.15–4.30]), but HR changes were not significant (MD, −2.06 [95% CI, −5.25 to 1.13]). Water had no significant hemodynamic effects in patients with seated or supine postural tachycardia syndrome, although standing effects were unassessed. Our data do not exclude water's potential standing effect in postural tachycardia syndrome.

Conclusions

In patients with orthostatic hypotension, rapid water intake elevated short‐term systolic BP and diastolic BP, with mild HR reduction when seated or supine. Healthy participants exhibited similar but milder effects. However, patients with postural tachycardia syndrome did not experience these changes in seated or supine positions. Further research is needed to evaluate the promising impact of rapid water ingestion on patients with postural tachycardia syndrome in a standing position, which was not addressed in our study.
Benefits and Harms of Standard Versus Reduced‐Dose Direct Oral Anticoagulant Therapy for Older Adults With Multiple Morbidities and Atrial Fibrillation
Authors: Hayes Kaleen N. , Zhang Tingting , Kim Dae Hyun , Daiello Lori A. , Lee Yoojin , Kiel Douglas P. , Berry Sarah D. , Zullo Andrew R.
Published: November 2023

Background

Dose reduction of direct oral anticoagulant (DOAC) medications is inconsistently applied to older adults with multiple morbidities, potentially due to perceived harms and unknown benefits of standard dosing.

Methods and Results

Using 2013 to 2017 US Medicare claims linked to Minimum Data Set records, we conducted a retrospective cohort study. We identified DOAC initiators (apixaban, dabigatran, rivaroxaban) aged ≥65 years with nonvalvular atrial fibrillation residing in a nursing home. We estimated inverse‐probability of treatment weights for DOAC dose using propensity scores. We examined safety (hospitalization for major bleeding) and effectiveness outcomes (all‐cause mortality, thrombosis [myocardial infarction, stroke, systemic embolism, venous thromboembolism]). We estimated hazard ratios (HRs) and 95% CIs using cause‐specific hazard‐regression models. Of 21 878 DOAC initiators, 48% received reduced dosing. The mean age of residents was 82.0 years, 66% were female, and 31% had moderate/severe cognitive impairment. After estimating inverse‐probability of treatment weights, standard dosing was associated with a higher rate of bleeding (HR, 1.18 [95% CI, 1.03–1.37]; 9.4 versus 8.0 events per 100 person‐years). Standard‐dose therapy was associated with the highest rates of bleeding among those aged >80 years (9.1 versus 6.7 events per 100 person‐years) and with a body mass index <30 kg/m
2
(9.4 versus 7.4 events per 100 person‐years). There was no association of dosing with mortality (HR, 0.99 [95% CI, 0.96–1.06]) or thrombotic events (HR, 1.16 [95% CI, 0.96–1.41]).

Conclusions

In this nationwide study of nursing home residents with nonvalvular atrial fibrillation, we found a higher rate of bleeding and little difference in effectiveness of standard versus reduced‐dose DOAC treatment. Our results support the use of reduced‐dose DOACs for many older adults with multiple morbidities.
Midterm Survival of Low‐Risk Patients Treated With Transcatheter Versus Surgical Aortic Valve Replacement: Meta‐Analysis of Reconstructed Time‐to‐Event Data
Authors: Sá Michel Pompeu , Jacquemyn Xander , Van den Eynde Jef , Serna‐Gallegos Derek , Chu Danny , Clavel Marie‐Annick , Pibarot Philippe , Sultan Ibrahim
Published: November 2023

Background

We performed a meta‐analysis of reconstructed time‐to‐event data from randomized controlled trials (RCTs) and propensity‐score matched (PSM) studies comparing transcatheter versus surgical aortic valve replacement (TAVR versus SAVR) to evaluate midterm outcomes in patients considered low risk for SAVR.

Methods and Results

Study‐level meta‐analysis of reconstructed time‐to‐event data from Kaplan–Meier curves of RCTs and PSM studies published by December 31, 2022 was conducted. Eight studies (3 RCTs, 5 PSM studies) met our eligibility criteria and included 5444 patients; 2639 patients underwent TAVR, and 2805 patients underwent SAVR. TAVR showed a higher risk of all‐cause mortality at 8 years of follow‐up (hazard ratio [HR] 1.22, [95% CI, 1.03–1.43],
P
=0.018). Up to 2 years of follow‐up, TAVR was not inferior to SAVR (HR, 1.08 [95% CI, 0.89–1.31],
P
=0.448); however, we observed a statistically significant difference after 2 years with higher mortality with TAVR (HR, 1.51 [95% CI, 1.14–2.00];
P
=0.004). This difference was driven by PSM studies; our sensitivity analysis showed a statistically significant difference between TAVR and SAVR when we included only PSM studies (HR, 1.41 [95% CI, 1.16–1.72],
P
=0.001) but no statistically significant difference when we included only RCTs (HR, 0.89 [95% CI, 0.69–1.16],
P
=0.398).

Conclusions

In comparison with TAVR, SAVR appeared to be associated with improved survival beyond 2 years in low‐risk patients. However, the survival benefit of SAVR was observed only in PSM studies and not in RCTs. The addition of data from ongoing RCTs as well as longer follow‐up in previous RCTs will help to confirm if there is a difference in mid‐ and long‐term survival between TAVR versus SAVR in the low‐risk population.
Uses of Social Determinants of Health Data to Address Cardiovascular Disease and Health Equity: A Scoping Review
Authors: McNeill Elizabeth , Lindenfeld Zoe , Mostafa Logina , Zein Dina , Silver Diana , Pagán José , Weeks William B. , Aerts Ann , Des Rosiers Sarah , Boch Johannes , Chang Ji Eun
Published: November 2023

Background

Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Prior research suggests that social determinants of health have a compounding effect on health and are associated with cardiovascular disease. This scoping review explores what and how social determinants of health data are being used to address cardiovascular disease and improve health equity.

Methods and Results

After removing duplicate citations, the initial search yielded 4110 articles for screening, and 50 studies were identified for data extraction. Most studies relied on similar data sources for social determinants of health, including geocoded electronic health record data, national survey responses, and census data, and largely focused on health care access and quality, and the neighborhood and built environment. Most focused on developing interventions to improve health care access and quality or characterizing neighborhood risk and individual risk.

Conclusions

Given that few interventions addressed economic stability, education access and quality, or community context and social risk, the potential for harnessing social determinants of health data to reduce the burden of cardiovascular disease remains unrealized.
Real‐World Systolic and Diastolic Blood Pressure Levels and Cardiovascular Mortality in Patients With Type 2 Diabetes—Results From a Large Registry Cohort in Asia
Authors: Seng Loraine Liping , Hai Kiat Troy Puar , Bee Yong Mong , Jafar Tazeen H.
Published: November 2023

BACKGROUND

Elevated blood pressure (BP) is associated with increased risk of cardiovascular mortality. However, there is ongoing debate whether intensive BP lowering may paradoxically increase the risk of cardiovascular disease (CVD), especially in patients with type 2 diabetes (T2D). We investigated the association of BP with risk of CVD mortality in patients with T2D.

METHODS AND RESULTS

We used data on 83 721 patients with T2D from a multi‐institutional diabetes registry in Singapore from 2013 to 2019. BP was analyzed as categories and restricted cubic splines using Cox multivariable regression analysis stratified by preexisting CVD and age (<65 years versus ≥65 years). The primary outcome was CVD mortality, determined via linkage with the national registry. Among 83 721 patients with T2D (mean age 65.3 years, 50.6% women, 78.9% taking antihypertensive medications), 7.6 per 1000 person‐years experienced the primary outcome. Systolic BP had a graded relationship with a significant increase in CVD mortality at levels >120 to 129 mm Hg. Diastolic BP levels >90 mm Hg were significantly associated with CVD mortality in those aged ≥65 years. In addition, diastolic BP <70 mm Hg was associated with a significantly higher risk of CVD mortality in all patients.

CONCLUSIONS

In patients with T2D, clinic systolic BP levels ≥130 mm Hg or diastolic BP levels ≥90 mm Hg are associated with higher risk of CVD mortality. Diastolic BP <70 mm Hg is also associated with the risk of adverse CVD outcomes, although reverse causality cannot be ruled out.
High Sensitivity Troponin Level and Benefits of Chronic Total Occlusion Revascularization
Authors: Gold Daniel A. , Sandesara Pratik B. , Jain Vardhmaan , Gold Matthew E. , Vatsa Nishant , Desai Shivang R. , Hassan Malika Elhage , Yuan Chenyang , Ko Yi‐An , Alkhoder Ayman , Ejaz Kiran , Alvi Zain , Rahbar Alireza , Murtagh Gillian , Jaber Wissam A. , Nicholson William J. , Quyyumi Arshed A.
Published: November 2023

Background

The survival benefit of revascularization of chronic total occlusion (CTO) of the coronary arteries remains a subject of controversy. We measured high sensitivity troponin‐I (hsTn‐I) levels as an estimate of myocardial ischemia in patients with stable coronary artery disease, with the hypothesis that (1) patients with CTO have higher levels of hsTn‐I than patients without CTO, (2) hsTn‐I levels will predict adverse cardiovascular events in patients with CTO, and (3) patients with elevated hsTn‐I levels will have a survival benefit from CTO revascularization.

Methods and Results

In 428 patients with stable coronary artery disease and CTO undergoing coronary angiography, adverse event rates were investigated. Cox proportional hazards models and Fine and Gray subdistribution hazard models were performed to determine the association between hsTn‐I level and incident event rates in patients with CTO. HsTn‐I levels were higher in patients with compared with those without CTO (median 6.7 versus 5.6 ng/L,
P
=0.002). An elevated hsTn‐I level was associated with higher adverse event rates (adjusted all‐cause mortality hazard ratio, 1.19 [95% CI, 1.08–1.32];
P
=0.030) for every doubling of hsTn‐I level. CTO revascularization was performed in 28.3% of patients. In patients with a high (>median) hsTn‐I level, CTO revascularization was associated with substantially lower all‐cause mortality (adjusted hazard ratio, 0.26 [95% CI, 0.08–0.88];
P
=0.030) compared with those who did not undergo revascularization. In patients with a low (
<
median) hsTn‐I level, event rates were similar in those with and without CTO revascularization.

Conclusions

HsTn‐I levels may help identify individuals who benefit from CTO revascularization.
Standardized nomenclature for peripheral percutaneous cannulation of the pulmonary artery in extracorporeal membrane oxygenation: Current uptake and recommendations for improvement
Authors: Brewer J Michael , Broman L Mikael , Swol Justyna , Lorusso Roberto , Conrad Steven A , Maybauer Marc O
Published: November 2023

The rising application of extracorporeal membrane oxygenation (ECMO) has emphasized the need for consistent and standardized terminology, especially concerning peripheral percutaneous cannulation of the pulmonary artery (PPC-PA). The Extracorporeal Life Support Organization (ELSO) Nomenclature Task Force produced the ELSO Maastricht Treaty for extracorporeal life support (ECLS) Nomenclature to address this challenge. However, adherence to nomenclature recommendations has been poor in publications describing PPC-PA. We aim to describe common nomenclature errors and provide a user-guide for abbreviations that can be used by authors, reviewers, and journal staff to ensure properadherence to standardized nomenclature in publications describing PPC-PA.
Enhancing pulmonary function and arterial blood gas readings through immediate chest physiotherapy among extubated patients in ICU
Authors: Reshia Fadia Ahmed Abdelkader , Salameh Basma , Alsadaan Nourah , Alqahtani Mohammed , Ayed Ahmad , Kassabry Maysa Fareed , Abo Seada Asmaa Ibrahem
Published: November 2023

Objective

To examine the effect of immediate chest physiotherapy (ICPT) on pulmonary function and arterial blood gases among extubated patients.

Method

This prospective study enrolled patients aged 20–60 years who had been intubated for 48 h. They were randomly assigned to either a control or study group. The study group received ICPT by trained critical care nurses and physiotherapists, which included early mobilization, breathing exercises and airway clearance. The control group received standard nursing chest care (positioning, oral and endotracheal suctioning) without ICPT. Researchers evaluated participants using pulmonary function tests, arterial blood gas tests and mechanical ventilation parameters.

Results

The study enrolled 70 patients. There were no significant differences in the sociodemographic characteristics and medical data before intubation between the two groups except for preparatory education. After extubation, the vital capacity was significantly higher in the study group compared with the control group. There were also significant differences between the two groups in other lung function tests and arterial blood gas tests. After extubation, the total lung capacity, functional residual capacity and residual volume were significantly higher in the study group compared with the control group.

Conclusion

The use of ICPT improved both pulmonary function and arterial blood gases.
Is comprehensiveness in making strategic decisions always helpful?
Authors: Chanda Sasanka Sekhar , Ray Sougata
Published: November 2023

Extant research provides incongruous answers to the question whether higher comprehensiveness in making strategic decisions is always desirable. To motivate a resolution, we study outcomes of decision-comprehensiveness by modeling strategic decision-making as an emergent process, accomplished through learning by managers over time for organizations focusing on exploration or exploitation, over short or long time horizons, in stable and changing environments. Three out of the eight resultant scenarios favor higher comprehensiveness, and two favor lower comprehensiveness. The remaining three scenarios call for a more nuanced consideration of the comprehensiveness construct. Our research enriches managerial decision-making by highlighting circumstances where higher comprehensiveness is beneficial or detrimental to the quality of a strategic decision.

JEL Classification: D70, D81, D91
Extracorporeal blood purification with Oxiris® filter in critically ill patients with COVID-19 requiring continuous renal replacement therapy
Authors: Abdelaty Mohamed , Mohamed Adham , Saad Mohamed O , Mitwally Hassan , Alkadi Mohamad M , Hashim Ahmed , Al Malki Hassan , Ali Husain S , Mohamed Ahmed Soliman , Mustafa Emad , Alalawi Abdulaziz , Elshafei Moustafa , Othman Muftah , Khatib Mohamad , Ibrahim Abdul-Salam
Published: November 2023

Introduction:

Severe COVID-19 is associated with a dysregulated immune response that usually leads to cytokine release syndrome. This study aimed to compare the use of extracorporeal blood purification therapy (Oxiris®) versus standard continuous renal replacement therapy (CRRT) in critically-ill patients with severe COVID-19.

Methods:

This was a national, multicenter, retrospective study of patients with COVID-19 admitted to the intensive care unit (ICU) between March and October 2020 who required CRRT. Patients were categorized into two groups: Oxiris® CRRT and standard CRRT. The primary outcome was the number of patients alive and ventilator-free at 30-days post-CRRT treatment. Key secondary endpoints included change in inflammatory markers, Sequential Organ Failure Assessment (SOFA) scores, and PaO2/FiO2 ratio at 24- and 72-h post Oxiris® initiation.

Results:

Thirty-five patients received Oxiris® CRRT and 23 patients received standard CRRT. The primary outcome was 31.4% in the Oxiris® group versus 4.3% in the standard CRRT group (adjusted odds ratio 5.97, 95% confidence interval [CI], 0.64–55.6; p = 0.117). In the Oxiris® group, interleukin-6 (IL-6) concentrations significantly decreased at 24 and 72-h ( p = 0.033) and PaO2/FiO2 ratio significantly increased at 24 and 72 h after Oxiris® initiation ( p = 0.001). There was no significant change in SOFA scores at 24- and 72-h after Oxiris® initiation.

Conclusion:

The number of patients alive and ventilator-free at 30-days was higher in the Oxiris® group than that in the standard CRRT group; however, the difference did not reach statistical significance after adjusting for the baseline severity of illness. There was a significant reduction in IL-6 and significant improvement in PaO2/FiO2 ratio after Oxiris® CRRT initiation.
The Making of the Afghan Emirate
Authors: Katju Vivek
Published: November 2023

Bette Dam, Looking for The Enemy: Mullah Omar and the Unknown Taliban (HarperCollins, 2021). Pp. 352, ₹362. ISBN-10: 9354892795. ISBN-13: 978-9354892790.

Carter Malkasian, The American War in Afghanistan (London, OPU, 2023). Pp. 600, $24.95. ISBN: 9780197645499.
Yuki Kihara's Paradise Camp as a potential Fa’afafine museum: Fabulous cohabitation in a shared world
Authors: Yu Liang-Kai , Steinbock Eliza
Published: November 2023

This article examines critical ethnographic and archival elements of Paradise Camp, Yuki Kihara's highly celebrated Aotearoa New Zealand national pavilion at the Venice Biennial in 2022. Through its scenography that in Kihara's words is “fa’afabulous,” consisting of archival collages drawn from museum collections and staged photography made after Gauguin's paintings in collaboration with queer Sāmoan communities, we argue that Kihara's heavily annotated version of a so-called paradise assembled within Paradise Camp offers a ‘potential museum’ that reconnects the missing links between colonial registrations of the past with today's queer Sāmoan lives. This queer Indigenous reconfiguration of a fabulous paradise, which refuses imperial understandings of Pacific people and geographies, seems central to Paradise Camp's queer ‘camp’ effects, much like an eye roll that dethrones authority. Therefore, we propose that such an artist-fabulated museum lays claims to an Oceanic sovereignty, and broadly fosters a shared world for Fa’afafine and queer Pasifika peoples.
Caring Masculinities in Theory and Practice: Reiterating the Relevance and Clarifying the Capaciousness of the Concept
Authors: Roberts Steven , Prattes Riikka
Published: November 2023

This article intends to stimulate conversation and critical thinking about the concept of ‘caring masculinities’ and its ongoing relevance to the field of critical studies of men and masculinities (CSMM). Caring masculinities is subject to debate around its theoretical premises, its potential as a feminist concept, and the limits of the empirical evidence base that underpins the concept and its associated implications. We respond to some of these ongoing critical conversations, in part by suggesting that the concept is sometimes deployed in ways that depart from or even possibly misconstrue the concept. Highlighting the nuance, capaciousness, and clarity of the concept, as theorised by Karla Elliott, we substantiate the argument by drawing on emerging data from our ongoing research with men in front-line, low paid care-work in Australia, thus, including men who have so far largely been excluded from studies on caring masculinities.
What Do They Suffer? An Examination of Personal, Program, and Environmental Factors Impacting Nontraditional Undergraduate Students’ Dropout
Authors: Kim JoHyun
Published: November 2023

Using university student database systems and an online survey, this study examined relationships and impacts of personal, program, and environmental variables regarding nontraditional students’ program dropouts. Results of the logistic regression supported that several variables related to students’ demographic backgrounds, especially age and academic experiences, contributed to better predicting of nontraditional students’ dropout. Findings from the online survey administered to the dropout students only further supported the idea that personal (financial and family-related challenges) and academic variables (availability of courses and program expectations) were major contributors to program departure. Implications for administrators and suggestions for future research are discussed.
An unusual stroke mimic: A case report
Authors: Adjei Prosper , Amponsah Gordon M , Atenebano Michael
Published: November 2023

Hypokalaemic paralysis is a rare disorder characterized by rapid onset of symmetrical flaccid skeletal muscle weakness in the presence of reduced serum potassium levels. It is categorized as primary or secondary depending on the aetiology. Asymmetric or unilateral muscle weakness in hypokalaemic patients is a rare presentation. In patients with comorbid cardiovascular risk factors, this atypical manifestation can mimic acute stroke. Only a few of such cases have been reported in the literature. This report discusses the case of a 46-year-old hypertensive Ghanaian woman who presented to a District Hospital with sudden-onset right-sided flaccid weakness and a high blood pressure. Acute stroke was ruled out with computed tomography scan of the brain. Further laboratory evaluation demonstrated reduced serum potassium level, which was corrected with subsequent dramatic resolution of the muscle weakness.
Awareness, knowledge, attitude, and skills regarding telemedicine among Syrian healthcare providers: A cross-sectional study
Authors: Swed Sarya , Alibrahim Hidar , Bohsas Haidara , Aljabali Ahmed , Hamouda Hagar Mahmoud , Sawaf Bisher , albuni Mhd Kutaiba , Battikh Elias , Ahmed Safaa MA , Sharif Ahmed Eman Mohammed , Motawea Karam R , Abdelazeem Basel , Shoib Sheikh , Rakab Amine , Hafez Wael
Published: November 2023

Background

After the widespread of coronavirus disease (COVID-19) around the globe, it was imperative to establish preventative measures to restrict the virus's transmission. The purpose of this research was to present an overview of the awareness, knowledge, attitude, and abilities of Syrian physicians about telemedicine technology.

Methods

An online cross-sectional study was conducted from April 1 to May 15, 2022. The questionnaire was taken from published study, and the inclusion criteria consist the Syrian doctors who worked in hospitals during the COVID-19 pandemic, mainly those who had direct contact with patients.

Results

Among 385 responses, 52.72% of them were females, 83.9% of them were aged less than 30 years old, and 66% were working in the governmental sector; 66% of participants have moderate knowledge about using computers and the internet, 80% have heard about telemedicine. Despite that, 95.1% of participants have not attended any training workshop on telemedicine, and most of them have reported no availability of a telemedicine unit in their department. Only 31.7% participants have shown high awareness of telemedicine. Furthermore, no significant correlation was identified between the academic level with the age and telemedicine awareness, knowledge, attitude, or computer skills. Despite that, there was an obvious correlation between age and computer skills ( P-value < 0.05). There was a significant correlation between the medical specialty and awareness, and computer abilities, especially the anesthesiology (88.5 ± 5.2), (84 ± 8.7), respectively. Spearman's rho test showed mild positive significant association in various subscales (awareness and experience, experience and skills, knowledge and attitude, knowledge and skills, and attitude and skills).

Conclusion

The study results demonstrate that most of the participating clinical doctors have a neutral view of telemedicine, even though they do not know much about it and do not have considerable experience with it. It is practical to educate and train academic staff, practicing physicians, residents and medical students within the clinical stages about telemedicine.
Assessing ChatGPT’s Educational Capabilities and Application Potential
Authors: Yang (杨晓哲) Xiaozhe , Wang (王晴晴) Qingqing , Lyu (吕霁月) Jiyue
Published: November 2023

Purpose

ChatGPT is a generative artificial intelligence (AI) technology that can solve multiple complex tasks. ChatGPT-4 can facilitate educational empowerment in China through technology to understand and generate Chinese text. Although ChatGPT's benefits have been widely discussed, its educational capabilities have not been systematically assessed. This study provides evidence of and insights into the educational applications of AI tools in China.

Design/Approach/Methods

This study uses various tests to systematically assess the latest iteration of the AI chatbot ChatGPT-4, including the Watson-Glaser Critical Thinking Appraisal (WGCTA), Five Core Competencies Questionnaire, and written test of China's 2022 National Teacher Certificate Examination (NTCE).

Findings

The WGCTA results suggest that ChatGPT requires strong critical thinking. Compared with the other four competencies, the tool showed a lower aptitude for creativity. Regarding its educational applications, ChatGPT performed well on the 2022 NTCE written test. As technology enhances, ChatGPT and similar AI tools have potential applications in China for lesson planning, student self-learning, classroom interaction, and checking assignments.

Originality/Value

This study systematically tested ChatGPT at a logical level and assessed its core competencies and educational applications. The study innovatively used 2022 NTCE data to test ChatGPT, with results providing support for the application of generative AI in future curricula and instruction in China.
Does Major Depression Differentially Affect Daily Affect in Adults From Six Middle-Income Countries: China, Ghana, India, Mexico, Russian Federation, and South Africa?
Authors: Panaite Vanessa , Cohen Nathan
Published: November 2023

Much of the research on how depression affects daily emotional functioning comes from Western, Educated, Industrialized, Rich, and Democratic (WEIRD) countries. In the current study, we investigated daily positive affect (PA) and negative affect (NA) and PA and NA variability in a cross-cultural sample of adults with a depression diagnosis ( N = 2,487) and without a depression diagnosis ( N = 31,764) from six middle-income non-WEIRD countries: China, Ghana, India, Mexico, Russian Federation, and South Africa. Across countries, adults with depression relative to adults without depression reported higher average NA and NA variability and lower average PA but higher PA variability. Findings varied between countries. Observations are discussed within the context of new theories and evidence. Implications for current knowledge and for future efforts to grow cross-cultural and non-WEIRD affective science are discussed.
Hybrid Repair of a Medial Meniscus Mid-Body Radial Tear
Authors: Franciozi Carlos E. , Mameri Enzo S. , Schumacher Felipe C. , Credidio Marcos V. , Kubota Marcelo S. , Luzo Marcus V.
Published: November 2023

Background:

Meniscal radial tears are associated with altered contact mechanics, as they have the potential to disrupt the meniscal hoop stress mechanism. In prior studies, radial tears are associated with higher grade of cartilage damage, as well as higher rate and severity of meniscal extrusion in knees with a radial tear relative to other types of tears. Improved understanding of the meniscus biological potential together with modern developments in surgical technique has paved the way for the current emphasis on repairing even radial tears.

Indication:

Large or complete radial tears of the meniscus without prohibitive joint space narrowing or severe cartilage damage.

Technique Description:

A hybrid technique of meniscal radial repair is described, combining (1) 2 transtibial pullout cinch-loop sutures, (2) 2 inside-out vertical rip-stop sutures and 2 oblique sutures in a “cross-tag” configuration, and (3) 1 horizontal mattress all-inside suture. The repair is biologically augmented with a notch marrow-venting procedure.

Results:

Recent evidence has demonstrated significant biomechanical benefit in terms of increased load to failure and construct strength when adding transtibial tunnel augmentation to radial repairs. In addition, rip-stop sutures decrease the chance of cut-out relative to nonreinforced repairs. Those biomechanical advancements are reflected in excellent patient-reported outcomes as well as healing rates following radial repair.

Discussion/Conclusion:

We present a hybrid technique encompassing the most biomechanically effective novel radial repair techniques, backed by excellent clinical outcomes following radial repair in the current literature.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Tibial-Sling Triangular Medial Collateral Ligament Reconstruction With Posterior Oblique Ligament Limb
Authors: Franciozi Carlos E. , Mameri Enzo S. , Gracitelli Guilherme C. , Schumacher Felipe C. , Credidio Marcos V. , Canuto Sérgio , Kubota Marcelo S.
Published: November 2023

Background:

While most medial-sided knee injuries can be managed conservatively, high-grade injuries of the posteromedial corner have been reported to have less than optimal outcomes with conservative approaches, resulting in residual valgus and rotational instability. Consensus among experts postulates that treatment should be based on reconstructing both the superficial medial collateral ligament (sMCL) and the posterior oblique ligament (POL). We present a modified technique of a tibial-sling anatomic MCL reconstruction with a POL limb.

Indications:

High-grade injuries of the posteromedial corner, specifically injuries with medial joint gapping in extension or grade 3 medial-sided tears.

Technique Description:

The MCL is reconstructed with a semitendinosus autograft in a tibial sling, created by converging perpendicular bone tunnels at its anatomic tibial insertion, and fixed to a femoral tunnel in the isometric point just posterior and proximal to the medial epicondyle with the knee at 30° of flexion. That same single femoral tunnel will be shared by the two strands of the semitendinosus graft and a limb of gracilis autograft to reproduce the POL, passed through a tibial tunnel in the posteromedial margin of medial tibial condyle, and fixed in extension.

Discussion/Conclusion:

As recent evidence suggests that medial reconstruction should be preferred over repair, due to favorable complication and failure rates, we describe a technique that is both anatomic-based, reproducing the 2 main medial knee structures (sMCL, POL), and also cost-saving, with decreased need of fixation devices.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Full-Thickness Peroneus Longus Tendon Autograft Harvest
Authors: Franciozi Carlos E. , Mameri Enzo S. , Schumacher Felipe C. , Credidio Marcos V. , Kubota Marcelo S. , Luzo Marcus V.
Published: November 2023

Background:

Despite extensive evidence of excellent biomechanical and clinical outcomes of ligament reconstructions with bone-patellar tendon-bone, hamstring tendon, and quadriceps tendon autografts, these are not without limitations, including knee-related donor site morbidity, decreased range of motion, and potential for anterior knee pain. Therefore, researchers have explored other options, including the peroneus longus (PL) autograft.

Indication:

Anterior cruciate ligament (ACL) reconstruction (both primary and revision), as well as multiligament reconstruction, particularly in areas where access to allografts is limited.

Surgical Technique:

A 3-cm longitudinal skin incision is placed 2 fingerbreadths (or 3 cm) proximal to the tip of the lateral malleolus, and 3 mm posterior to the fibula. The PL and peroneus brevis tendons are identified and isolated, followed by a tenodesis at the distal limit of the incision. The PL is whipstitched proximal to the tenodesis site, and then incised between the tenodesis and whipstitched portion. A closed tendon stripper is inserted and advanced proximally until the PL graft is released.

Discussion/Conclusion:

PL autograft harvest has been shown to generate thicker and longer grafts relative to the semitendinosus, with demonstrated efficacy in terms of both biomechanical and clinical outcomes. Current literature points largely to a good safety profile, although there is still conflicting evidence in terms of foot and ankle morbidity and no mid- to long-term follow-up data available.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form.
Occurrence of passion fruit woodiness disease in the coastal lowlands of Kenya and screening of passion fruit genotypes for resistance to passion fruit woodiness disease
Authors: Asande Lydia K. , Ombori Omwoyo , Oduor Richard O. , Nchore Shem B. , Nyaboga Evans N.
Published: November 2023

Background

Passion fruit (Passiflora edulis [Sims]) is an important economic fruit crop in Kenya, grown for domestic, regional and international markets. However, passion fruit production is constrained by both biotic and abiotic stresses. Passion fruit woodiness disease (PWD) complex is the most injurious viral disease responsible for yield losses of up to 100%. In East Africa, it is caused by potyviruses. The most effective way to manage PWD is by using resistant cultivars. The objectives of this study were to determine the occurrence of passion fruit woodiness disease in selected counties at the Coastal lowlands of Kenya and screen farmer preferred passion fruit genotypes for resistance to PWD.

Results

In the present study, it was established that all surveyed farms in Kwale and Kilifi counties displayed passion fruit woodiness virus disease symptoms. The highest disease incidence of 59.16% and 51.43% was observed at Kilifi and Kwale counties, respectively. A significant difference (p < 0.05) in symptom severity was observed within the tested genotypes with purple and banana passion fruits having the highest and lowest AUDPC values, respectively, both under greenhouse and field conditions. ACP ELISA assays using universal potyvirus antiserum (Agdia Inc., Elkhat, IN) confirmed that the observed characteristic symptoms of woodiness disease were as a result of potyvirus infection.

Conclusions

The findings herein indicate that PWD is widespread in both Kilifi and Kwale counties with low to moderate disease incidence and severity. The observed prevalence, incidence and severity levels of PWD in Kwale and Kilifi counties could be aggravated by poor management practices such as non-sterilization of pruning tools, intercropping with target crops and crop rotation with the same target crops. Response of passion fruit genotypes to woodiness viruses was genotype dependent. There is need to sensitize farmers on the cause and spread of PWD and management strategies in order to increase production and enhance the quality of fruits.
Missing data imputation, prediction, and feature selection in diagnosis of vaginal prolapse
Authors: FAN Mingxuan , Peng Xiaoling , Niu Xiaoyu , Cui Tao , He Qiaolin
Published: November 2023

Background

Data loss often occurs in the collection of clinical data. Directly discarding the incomplete sample may lead to low accuracy of medical diagnosis. A suitable data imputation method can help researchers make better use of valuable medical data.

Methods

In this paper, five popular imputation methods including mean imputation, expectation-maximization (EM) imputation, K-nearest neighbors (KNN) imputation, denoising autoencoders (DAE) and generative adversarial imputation nets (GAIN) are employed on an incomplete clinical data with 28,274 cases for vaginal prolapse prediction. A comprehensive comparison study for the performance of these methods has been conducted through certain classification criteria. It is shown that the prediction accuracy can be greatly improved by using the imputed data, especially by GAIN. To find out the important risk factors to this disease among a large number of candidate features, three variable selection methods: the least absolute shrinkage and selection operator (LASSO), the smoothly clipped absolute deviation (SCAD) and the broken adaptive ridge (BAR) are implemented in logistic regression for feature selection on the imputed datasets. In pursuit of our primary objective, which is accurate diagnosis, we employed diagnostic accuracy (classification accuracy) as a pivotal metric to assess both imputation and feature selection techniques. This assessment encompassed seven classifiers (logistic regression (LR) classifier, random forest (RF) classifier, support machine classifier (SVC), extreme gradient boosting (XGBoost) , LASSO classifier, SCAD classifier and Elastic Net classifier)enhancing the comprehensiveness of our evaluation.

Results

The proposed framework imputation-variable selection-prediction is quite suitable to the collected vaginal prolapse datasets. It is observed that the original dataset is well imputed by GAIN first, and then 9 most significant features were selected using BAR from the original 67 features in GAIN imputed dataset, with only negligible loss in model prediction. BAR is superior to the other two variable selection methods in our tests.

Concludes

Overall, combining the imputation, classification and variable selection, we achieve good interpretability while maintaining high accuracy in computer-aided medical diagnosis.