bluuebunny/crossref_metadata_2025 huggingface dataset:
Utilization of Antibiotics for the Treatment of Urinary Tract Infections in End-of-Life Patients
Authors: Thomas Abigail , Davis Lacey , Dolan Allie , Prewett Rebecca
Published: August 2024

Purpose

The use of antibiotics for end-of-life patients is controversial; currently there is limited guidance on the use of antibiotics in hospice patients. The threat of antibiotic resistance, risk of adverse events, variable efficacy, and time to benefit in hospice patients makes their use divisive. Patients’ potential care needs are estimated using the palliative performance scale (PPS) with lower scores indicating more care is required. The purpose of this project is to examine the utilization of antibiotics for urinary tract infections (UTIs) in hospice patients.

Methods

This multi-center retrospective observational cohort study evaluated the prescribing of antibiotics in symptomatic vs asymptomatic hospice patients being treated for UTIs and assessed antibiotic initiation based on PPS of ≥30% or <30%. Patients included in this study were adults initiated on oral antibiotics for UTI. Exclusion criteria included antibiotics initiated prior to admission, prophylactic antibiotics, non-oral antibiotics, or if the patient revoked election of hospice.

Results

A total of 56 patients were prescribed antibiotics for UTIs during the 1-year study period. Half of the antibiotics were prescribed appropriately based on documented symptoms when starting the antibiotics. There was not a statistically significant difference between appropriate utilization based on PPS ≥30% or <30% using the Mann-Whitney U test ( P = 0.255).

Conclusion

The prescribing of antibiotics in end-of-life patients is not always appropriate regardless of the PPS. This may indicate that antibiotics are initiated in asymptomatic hospice patients, and the utilization of unnecessary medications presents the risk of adverse effects.
Achieving Education for Sustainable Education Learning Outcomes: An Integrated Model for Higher Education in the Global South
Authors: Anapey Gideon Mensah
Published: August 2024

As education for sustainable development learning outcomes are gaining traction in education, an integrated curriculum model that recognizes Indigenous cultural practices is imperative to align global development indicators with higher education curriculum. The study adopted a purposive sampling approach targeting 11 university students sharing their experiences on sustainability and core competencies. NVivo Version 10 was used for the narrative data coding and analysis with findings showing students’ ambivalence toward their curriculum outcomes and twenty-first-century skills development. In conclusion, as students exhibited high awareness about competency-based learning, curriculum developers in higher education institutions must be intentional about pedagogical approaches and sustainability targets.
Endogenous Dysregulation of Thromboinflammatory Biomarkers in End-Stage Renal Disease, and Their Amplification by Heart Failure
Authors: Robbin Vanessa , Bansal Vinod , Siddiqui Fakiha , Allen Madeline , Hoppensteadt-Moorman Debra , Kantarcioglu Bulent , Abulencia Emma , Magpoc Evangeline , Fareed Jawed , Syed Mushabbar
Published: August 2024

In patients with end-stage renal disease (ESRD), heart failure with reduced ejection fraction (HFrEF) is a common comorbidity. Thromboinflammatory processes in both conditions represent complex pathophysiology, demonstrated by dysregulation of thromboinflammatory biomarkers, and commonly resulting in the combined pathology of cardiorenal syndrome. We sought to investigate the effects of HFrEF on these biomarkers in patients with ESRD, and observe the relationship to mortality. Blood samples from 73 patients with ESRD (mean age 67 ± 13 years, 56% male) and 40 healthy controls were analyzed via enzyme-linked immunosorbent assay and other chromogenic methods for angiopoietin-2 (Ang2), endogenous glycosaminoglycans, fatty acid binding protein, interleukin-6, lipopolysaccharide, free fatty acids, NT-pro B-type natriuretic peptide, tumor necrosis factor α, vascular endothelial growth factor, and von Willebrand factor. Patients were stratified into those with or without HFrEF (EF < 50%). Patients had highly prevalent comorbidities including coronary artery disease 46%, diabetes 69%, hypertension 97%, and smoking 49%. Most biomarkers were upregulated in ESRD compared to controls. Patients with HFrEF and ESRD had greater interleukin-6 and NT-pro B-type natriuretic peptide and lesser lipopolysaccharide compared to ESRD only. Spearman correlations between most biomarkers were increased in HFrEF + ESRD over ESRD only. Ang-2 was associated with mortality in this cohort. The dysregulation of thromboinflammation in ESRD is somewhat amplified in comorbid HFrEF. Correlation among biomarkers in this cohort indicates the mechanisms of thromboinflammatory biomarker generation in ESRD and HFrEF share an integrative process. Ang2, interleukin-6, and lipopolysaccharide show promise as biomarkers for risk stratification among patients with both HFrEF and ESRD.
Development and Validation of a Predictive Model for Intracranial Haemorrhage in Patients on Direct Oral Anticoagulants
Authors: Liu Yuanyuan , Li Linjie , Li Jingge , Liu Hangkuan , Geru A , Wang Yulong , Li Yongle , Sia Ching-Hui , Lip Gregory Y. H. , Yang Qing , Zhou Xin
Published: August 2024

Background

Intracranial haemorrhage (ICH) poses a significant threat to patients on Direct Oral Anticoagulants (DOACs), with existing risk scores inadequately predicting ICH risk in these patients. We aim to develop and validate a predictive model for ICH risk in DOAC-treated patients.

Methods

24,794 patients treated with a DOAC were identified in a province-wide electronic medical and health data platform in Tianjin, China. The cohort was randomly split into a 4:1 ratio for model development and validation. We utilized forward stepwise selection, Least Absolute Shrinkage and Selection Operator (LASSO), and eXtreme Gradient Boosting (XGBoost) to select predictors. Model performance was compared using the area under the curve (AUC) and net reclassification index (NRI). The optimal model was stratified and compared with the DOAC model.

Results

The median age is 68.0 years, and 50.4% of participants are male. The XGBoost model, incorporating six independent factors (history of hemorrhagic stroke, peripheral artery disease, venous thromboembolism, hypertension, age, low-density lipoprotein cholesterol levels), demonstrated superior performance in the development dateset. It showed moderate discrimination (AUC: 0.68, 95% CI: 0.64–0.73), outperforming existing DOAC scores (ΔAUC = 0.063, P = 0.003; NRI = 0.374, P < 0.001). Risk categories significantly stratified ICH risk (low risk: 0.26%, moderate risk: 0.74%, high risk: 5.51%). Finally, the model demonstrated consistent predictive performance in the internal validation.

Conclusion

In a real-world Chinese population using DOAC therapy, this study presents a reliable predictive model for ICH risk. The XGBoost model, integrating six key risk factors, offers a valuable tool for individualized risk assessment in the context of oral anticoagulation therapy.
On Good, Human, Autoethnographic Writing
Authors: Badley Graham Francis
Published: August 2024

Stimulated by a re-reading of On Human Geography in which Ron Johnston described his shift to an anarchic model of geographical writing, I began to reflect on his approach in comparison to my own semi-anarchic way of being an autoethnographic writer.
Lorlatinib experience in a patient with ALK + non-small cell lung cancer on hemodialysis: A case report
Authors: Gürbüz Ali Fuat , Eryılmaz Melek Karakurt , Yıldız Oğuzhan , Kaya Bahattin Engin , Araz Murat , Artaç Mehmet
Published: August 2024

Introduction

Lorlatinib is a potent third-generation anaplastic lymphoma kinase/c-ros oncogene 1 (ALK)/ROS1 oral tyrosine kinase inhibitor that has broad coverage of acquired resistance mutations and is currently indicated for the treatment of adult patients with metastatic non-small cell lung cancer (NSCLC) whose tumors are ALK-positive.

Case report

In this case, we aimed to present the safety and effectiveness of lorlatinib use in a patient diagnosed with ALK-positive metastatic NSCLC who underwent hemodialysis 3 days a week.

Management & Outcome

A 76-year-old female patient has been undergoing regular hemodialysis for about 2 years. A brain magnetic resonance imaging (MRI) was taken due to headache and a mass was detected. She was diagnosed with lung adenocarcinoma as a result of excisional biopsy. Positron emission tomography/ computed tomography (PET/CT) showed a mass in the hilar region of the left lung and multiple lymphadenopathy in the mediastinum. In February 2023, 100 mg lorlatinib was started daily. There was no significant regression in PET-CT and no brain MRI residue during follow-up. The patient has been continuing lorlatinib for approximately 1 year with almost complete response, with no side effects other than hypercholesterolemia.

Discussion

We presented our experience using lorlatinib in a patient with metastatic ALK + NSCLC undergoing hemodialysis. Although the dosage of lorlatinib in hemodialysis patients is still controversial, our case report indicates that 100 mg lorlatinib was safe in this patient.
On the existence of Rayleigh waves with full impedance boundary condition
Authors: Giang Pham Thi Ha , Vinh Pham Chi
Published: August 2024

The existence of Rayleigh waves (propagating in isotropic elastic half-spaces) with the tangential and normal impedance boundary conditions was investigated. It has been shown that for the tangential impedance boundary condition (TIBC), there always exists a unique Rayleigh wave, while for the normal impedance boundary condition (NIBC), there exists a domain (of impedance and material parameters) in which exactly one Rayleigh wave is possible and outside this domain a Rayleigh wave is impossible. In this paper, we consider the existence of Rayleigh waves with the full impedance boundary condition (FIBC) that contains both TIBC and NIBC. It is shown that the existence picture of Rayleigh waves for this general case is more complicated. It contains domain for which exactly one Rayleigh wave exists, domain where a Rayleigh wave is impossible, and domain for which all three possibilities may occur: two Rayleigh waves exist, one Rayleigh wave exists, and no Rayleigh wave exists at all. The obtained existence results recover the existence results established previously for the cases of TIBC and NIBC. The formulas for the Rayleigh wave velocity are derived. As these formulas are totally explicit, they are very useful in various practical applications, especially in the non-destructive evaluation of the mechanical properties of structures. In order to establish the existence results and derive formulas for the Rayleigh wave velocity, the complex function method, which is based on the Cauchy-type integrals, is employed.
Concussion Awareness Training Tool for Youth: Impact on Concussion Knowledge, Beliefs, and Reporting Intentions
Authors: Shepherd Heather A. , Galarneau Jean-Michel , Neill Matthew , Karmali Shazya , Turcotte Kate , Williamson Rylen A. , Cowle Stephanie , Macpherson Alison , Reed Nick , Schneider Kathryn J. , Belton Kathy L. , Gagnon Isabelle , Black Amanda M. , Emery Carolyn A. , Babul Shelina
Published: August 2024

Background

Concussion education is recommended to increase concussion knowledge, beliefs, and reporting intentions. The Concussion Awareness Training Tool for Youth (CATT-Youth) is a 40-minute e-Learning module developed for high school–aged youth.

Aim

The aim of the study was to evaluate changes in concussion knowledge, beliefs, and reporting intentions in high school youth from Calgary, Canada, following completion of the CATT-Youth

Methods

This study used a modified stepped-wedge trial design. High school classes were randomly assigned to an intervention (Ix) or delayed intervention (DIx) group. Ix group participants completed a pre-CATT survey immediately followed by the CATT-Youth, then a post-CATT survey 2 to 6 weeks later. DIx group participants completed two pre-CATT surveys 2 to 6 weeks apart, with the CATT-Youth completed immediately following the second pre-CATT, then a post-CATT survey 2 to 6 weeks later. The pre-/post-CATT survey encompassed 11 subtests evaluating concussion knowledge, beliefs, and reporting intentions. Independent mixed linear regression models were conducted to examine changes in scores for each subtest.

Results

Participants included 454 high school students: five Ix schools (16 classes, n = 323) and two DIx schools (six classes, n = 131). The CATT-Youth significantly increased general concussion knowledge, Ix δ = 0.546/8 (95% confidence interval [CI] = [0.243, 0.849]), DIx δ = 0.728/8 (95% CI = [0.389, 1.106]), and beliefs about capabilities, Ix δ = 2.462/28 (95% CI = [1.086, 3.838]), DIx δ = 3.219/28 (95% CI = [1.594, 4.844]) for both groups. For some subtests, improvements were noted in the DIx group only.

Conclusion

The CATT-Youth module improved concussion knowledge and beliefs about capabilities for students in both groups. Future studies should explore the utility of the CATT-Youth in changing knowledge, beliefs, and reporting intentions in high school students.
Use of a silicone shield to protect the optical cylinder following osteo- and osteo-odonto-keratoprosthesis (O/OKP) procedures
Authors: Goren Lee , Yassur Iftach , Goldblum David , Achiron Asaf , Bahar Irit , Livny Eitan
Published: August 2024

Purpose

To describe the placement of a silicone shield to protect the optical cylinder following osteo-keratoprosthesis or osteo-odonto-keratoprosthesis (O/OKP) procedures in four patients.

Methods

In this retrospective observational study, we reviewed all patients who underwent O/OKP in our tertiary medical centre. We found four patients in whom a protective cellphone silicone shield (VisionGuard+, Zagg, Utah, USA) was cut with a 3 mm dermal punch and placed on the polymethyl methacrylate (PMMA) optical cylinder of an O/OKP 3–4 months after implantation to either correct or prevent abrasions.

Results

The first patient presented with a severely abraded OOKP optic that reduced BCVA from 6/6 to 6/20. The shield smoothed the optical surface and filled minor scratches, leading to BCVA improvement to 6/9. In the subsequent three patients, the optic was relatively clear, and the shield was used as a preventive measure. In two patients, the shield fell off after a few weeks and was replaced.

Conclusions

Placing a protective silicone shield on the optical cylinder of an O/OKP can prevent permanent abrasions and, in an already scratched polymethyl methacrylate (PMMA) optic cylinder, improve vision by smoothing the surface. This intervention can be clinically significant, considering that the optical cylinder cannot be removed after implantation.
Retinal Reactive Astrocytic Tumor and Astrocytic hamartomas in patient with Neurofibromatosis type 1: Case Report and Literature review
Authors: Hadjistilianou Theodora , Carnicci Alberto , D’Alessandro Carlo , De Francesco Sonia , Fruschelli Mario
Published: August 2024

Introduction

Neurofibromatosis type I, also known as Von Recklinghausen disease, is a common phakomatosis affecting 1 in 2500–3000 live births; it may be associated with several common ocular findings, including Lisch nodules, plexiform neurofibromas, optic pathway gliomas, retinal astrocytic hamartomas and choroidal nodules.

Case description

This report illustrates clinical evidence of simultaneous presence of retinal reactive astrocytic tumor (RRAT) and two retinal astrocytic hamartomas (RAH) in a 15 y/o patient with NF1, referred to our attention because of an asymptomatic fundus mass in his right eye of recent onset.

Conclusion

This case, in addition to considering NF1 as one of the ocular conditions associated with secondary RRAT, underlines the importance of early referral and continuous ophthalmological follow-up in preventing possible complications that could cause significant visual impairment in patients with NF1.
Non-exudative choroidal and macular neovascularizations: An overview
Authors: Berni Alessandro , Sacconi Riccardo , Zucchiatti Ilaria , Querques Lea , Prascina Francesco , Bandello Francesco , Querques Giuseppe
Published: August 2024

Non-exudative choroidal and/or macular neovascularizations (NV) represent nowadays a common finding in different retinal disorders. The introduction of non-invasive techniques such as structural optical coherence tomography (OCT) and OCT angiography (OCTA) allowed for easy detection and follow-up of non-exudative NVs. Recognized as a distinct entity, these lesions demonstrate a high variability in terms of pathophysiology, morphology, and prognostic implications. In the absence of a consensus regarding correct classification of subtypes of non-exudative NVs, accurate management through strict follow-up strategies and prompt treatment is required. In this review we offer a comprehensive overview of the non-exudative NV spectrum in various retinal diseases aiming to provide a deeper insight into this clinical entity.
Recombination Events Among SARS-CoV-2 Omicron Subvariants: Impact on Spike Interaction With ACE2 Receptor and Neutralizing Antibodies
Authors: Arbi Marwa , Khedhiri Marwa , Ayouni Kaouther , Souiai Oussema , Dhouib Samar , Ghanmi Nidhal , Benkahla Alia , Triki Henda , Haddad-Boubaker Sondes
Published: August 2024

The recombination plays a key role in promoting evolution of RNA viruses and emergence of potentially epidemic variants. Some studies investigated the recombination occurrence among SARS-CoV-2, without exploring its impact on virus-host interaction. In the aim to investigate the burden of recombination in terms of frequency and distribution, the occurrence of recombination was first explored in 44 230 Omicron sequences among BQ subvariants and the under investigation “ML” (Multiple Lineages) denoted sequences, using 3seq software. Second, the recombination impact on interaction between the Spike protein and ACE2 receptor as well as neutralizing antibodies (nAbs), was analyzed using docking tools. Recombination was detected in 56.91% and 82.20% of BQ and ML strains, respectively. It took place mainly in spike and ORF1a genes. For BQ recombinant strains, the docking analysis showed that the spike interacted strongly with ACE2 and weakly with nAbs. The mutations S373P, S375F and T376A constitute a residue network that enhances the RBD interaction with ACE2. Thirteen mutations in RBD (S373P, S375F, T376A, D405N, R408S, K417N, N440K, S477N, P494S, Q498R, N501Y, and Y505H) and NTD (Y240H) seem to be implicated in immune evasion of recombinants by altering spike interaction with nAbs. In conclusion, this “in silico” study demonstrated that the recombination mechanism is frequent among Omicron BQ and ML variants. It highlights new key mutations, that potentially implicated in enhancement of spike binding to ACE2 (F376A) and escape from nAbs (RBD: F376A, D405N, R408S, N440K, S477N, P494S, and Y505H; NTD: Y240H). Our findings present considerable insights for the elaboration of effective prophylaxis and therapeutic strategies against future SARS-CoV-2 waves.
Environmental Infrastructure Maintenance Bottlenecks in Healthcare Facilities and Coping Strategies Among Healthcare Workers in Niger
Authors: Tantum Lucy K , Mahamane Ezechiel , Bauza Valerie , Mahamadou Kairou Oudou Bilo , Sanoussi Elisha Y , Salzberg Aaron , Anderson Darcy M
Published: August 2024

Infrastructure for water, sanitation, hygiene, cleaning, and waste management is essential for supporting safe environmental conditions in healthcare facilities. Routine maintenance is important for preventing infrastructure breakdowns, but few studies have examined healthcare facility maintenance practices. This study documented environmental maintenance tasks in healthcare facilities in Niger, described bottlenecks to maintenance, and assessed strategies for coping with breakdowns. At 34 rural healthcare facilities in Niger, we conducted quantitative surveys to assess frequency of maintenance tasks and held qualitative interviews with healthcare facility staff to understand bottlenecks to maintenance. On at least a monthly basis, 4% of healthcare facilities inspected their water source and pump for the purpose of detecting and replacing worn parts, 15% inspected water taps and basins, and 29% inspected incinerators. Healthcare facility staff described barriers to accessing government funds for maintenance. Instead, they paid out of their own salaries or raised funds through appeals to community members or revenue generation initiatives. Other bottlenecks included ill-defined management responsibilities and difficulty of finding skilled technicians for maintenance. Findings highlight opportunities to support healthcare facilities in budgeting, advocacy, and training skilled technicians. Initiatives to install infrastructure at healthcare facilities will be more sustainable if they are accompanied by postconstruction planning, training, and funding for maintenance.
Navigating the ‘Triangle of Death’: A Multidisciplinary Approach in Severe Multi-Trauma Management
Authors: Zhang Yushan , Jian Fuxia , Wang Liang , Chen Hao , Wu Zhengbin , Zhong Shili
Published: August 2024

This case report details the challenging management of a 45-year-old male construction worker who suffered severe multiple injuries after a fall and subsequent collision with cement mixers. The patient presented with extensive injuries, including amputation, fractures and internal bleeding, leading to a state known as the ‘triangle of death’. Despite the initial grim prognosis, evidenced by an ISS score of 28 and a mortality risk coefficient of 89.56%, the patient was successfully resuscitated and managed through a multidisciplinary approach. This included damage control resuscitation, emergency vascular interventions and targeted temperature management for brain protection. The patient’s recovery highlights the effectiveness of comprehensive trauma management and the critical role of coordinated care in severe multi-trauma cases.
Impact and tangential composite fretting wear of Zr-4 alloy tubes under random loading conditions
Authors: Zhang Jinmeng , Peng Jinfang , Li Bo , He Jifan , Liu Jianhua , Xu Xiaojun , Zhu Minhao
Published: August 2024

The fuel rod casing tube is a crucial component in pressurized water reactor (PWR) nuclear power plants. Flow-induced vibrations in the circulating water can result in complex alternating fretting wear between the casing tube and the positioning lattice frame. Existing research on fretting wear has primarily focused on unidirectional wear, with limited investigation into composite fretting wear under complex working conditions. This study conducted impact and tangential composite fretting wear tests on Zr-4 alloy tubes under varying constant and random impact loads to examine fretting wear behavior. The findings show that the peak friction coefficients in the impact and tangential composite fretting wear tests were consistent across the three constant load conditions, with higher peak friction coefficients observed under random load conditions and a longer time required to reach these peaks during micromotion tests. Comparative analysis revealed that random impact and tangential composite fretting wear caused the most severe damage. Under constant load conditions, wear damage became more severe with increasing load, transitioning from oxidized and adhesive wear to a peeling layer as the load intensified in the impact and tangential composite fretting wear tests.
Experiences of siblings and parents of children with congenital heart disease and exploration of siblings’ support needs
Authors: Schamong Alice Sarah , Seven Ümran Sema , Folkerts Ann-Kristin , Brockmeier Konrad , Kalbe Elke
Published: August 2024

Research with siblings of children with congenital heart disease (CHD) is scarce, although more than one-third of them experience limitations on their quality of life. This interview study aims to explore the diagnosis-associated experience of German siblings of children with CHD, their interest in a potential intervention, and potential key topics and contextual conditions of such an intervention. Interviews with 10 siblings aged 10 to 21 and a respective parent were conducted from August to October 2021, resulting in 20 interviews. Negative experiences associated with CHD included concerns regarding hospitalization, health deterioration, and the death of the child with CHD, as well as burdens including reduced family activities, less parental attention and support, and extended family meals. Positive experiences included perceived positive consequences of CHD, such as strong family cohesion and empathy toward people with chronic illnesses. Furthermore, siblings experienced enhanced coping mechanisms, such as having conversations with friends and family about the high prevalence of CHD and successful treatment or using distractions such as entertainment or study. Siblings’ reported interest in a future intervention included empathy, peer support, and studying medical information on CHD. These findings should be used for counseling and developing tailored interventions to support these siblings.
Lived religion and digital homemaking: The case of Indonesian marriage migrants
Authors: Budiman Rita
Published: August 2024

The article examines the intersection between two key fields in which international migrants respond to displacement and negotiate a sense of home: digital media and religion. The example chosen is the vlogging strategies used by Indonesian marriage migrants to navigate complex religious relationships with their followers and weave these into wider homemaking practices. The vlog analysis and in-depth interviews with the Indonesian marriage migrants in France and Belgium show that religion is an important element in constructing a sense of home in new locations. However, the immediacy of vlogs exposes them to religious expectations from followers back in Indonesia. As a result, homemaking is shaped by a complex interplay between the feelings of belonging and alienation in relation to their followers. Using vlogs, the marriage migrants seek to maintain control over their sense of home by building a mediated form of religious tolerance with their followers through adapted religious expressions in the vlogosphere.
Putting patients at the center of health information exchange design: An exploration of patient preferences for data sharing
Authors: Jabour Abdulrahman M
Published: August 2024

Background: Despite the many benefits of Health Information Exchange (HIE), Studies reported patients concerns about the privacy and security of sharing their health information. To address these concerns, it is important to understand their needs, preferences, and priorities in the design and implementing HIE systems. Objective: The aim of this study is to investigate patients’ preferences for HIE consent option and examine the extent to which they are comfortable sharing the different parts of their medical records. Method: A self-administered survey was conducted. The survey was administrated online and the total number of respondents was 660 participants. Results: The most popular option selected by participants for sharing HIE information was to share information with their permission once when they register (33.3%) followed by the option to share their information temporarily on demand during their clinical visit (23.8%). The types of information which participants were willing to share the most were general data such as age, weight, height, and gender, followed closely by data needed for medical emergency. In contrast, the information which participants were less likely to share were data related to financial status or income, followed by data related to sexual disease, and mental illnesses.
Study on sporty exhaust sound of economical vehicle under acceleration
Authors: Yang Liang , Jia Xiaoli , Liao Xiangning , Zhang Jiangsheng , Chu Zhigang
Published: August 2024

Exhaust sound quality is an important part of vehicle performance. In this paper, the sporty exhaust sound quality of an economical vehicle equipped with a 4-cylinder and 4-stroke engine is evaluated, analyzed, and improved under acceleration. Firstly, a sporty feeling evaluation method with engine speed divided is proposed, and the influence of exhaust sound order components on sporty exhaust sound is analyzed. The results show that while the A-weighted sound pressure level (ASPL) of Order 2 is lower and the ASPLs of Orders 4 and 6 are higher, the exhaust sound is sportier. Then, a hybrid predicted model of vehicle sporty exhaust sound under acceleration is established based on convolutional neural network (CNN) and support vector regression (SVR) algorithm. The relative errors between the predicted results of CNN-SVR hybrid model and the subjective evaluation results are limited within 2%, which indicates that the CNN-SVR hybrid prediction model achieves a high accuracy in assessing the sporty feeling of exhaust sound. Finally, considering the frequency ranges corresponding with the above order components under the practical accelerating condition, a strategy is proposed to enhance the sporty feeling of exhaust sound by reducing the sound energy within 100 Hz and increasing the sound energy within 100–450 Hz. Based on this strategy, a muffler with different structure is selected and installed on the economical vehicle, and the sporty feeling of exhaust sound is 0.63 points higher than before.
The colonial labour question: Trade and social expenditure in interwar Africa
Authors: Becker Bastian , Schmitt Carina
Published: August 2024

Access to education and health care are core development goals of the United Nations since its inception. Today, almost all countries have education and health systems in place. In former colonies, the historical roots of these systems can often be traced back to colonial times. In this article, we argue that spending on social services for the local population was seen as a necessary condition to expand the trade-based colonial economy especially in the initial stage of social services dating back to the interwar period. Using novel data on health and education expenditure in 35 former British and French African colonies during the height of their empires (1919–39), we show that trade volumes account for a large share in the variance of expenditure on education but not health services, and that present-day expenditures partly reflect these patterns. Our results suggest that similar mechanisms are at play within the two empires and differences between them are in degree rather than in kind.
Experiences of African American caregivers providing care for family living with Alzheimer’s disease: A descriptive phenomenological study
Authors: Carson LaGaryion , McFarlane Judith
Published: August 2024

This study aimed to describe how African American family caregivers of people living with Alzheimer’s disease manage caregiving. A qualitative study design using a descriptive phenomenological approach was used to understand the lived experiences of African American family caregivers. Fifteen individual semi-structured and in-depth interviews were conducted via telephone or videoconference between January and June 2023 to address the research question. Guided by Swanson’s theory of caring, the data transcribed verbatim from the audio-recorded interviews were analyzed using Colaizzi’s methodology. Eight themes emerged from the data: (a) Parenting all over again, (b) Self-sacrifice, (c) Caring for the caregiver, (d) Connecting to God, (e) Responsibility to care, (f) Trapped, (g) Beyond exhaustion, and (h) Loss of self. The findings of the study indicate that African American family caregivers of people living with Alzheimer’s disease often experience physical, mental, and emotional exhaustion while managing care. Thus, there is a considerable need for greater support, health promotion, and development of appropriate interventions to alleviate the challenges experienced so that they can continue in their caregiving role with some respite.
Sex Differences in the Etiology of Victimization in Adulthood
Authors: Joyner-Carpanini Bridget , Beaver Kevin M.
Published: August 2024

Until relatively recently, the study of victimization has been largely outside the purview of behavioral geneticists and evolutionary psychologists. Recent victimology research, however, has shown that genetic and evolutionary forces are connected to the risk of victimization. The current study expands on these findings by examining whether genetic influences differentially explain victimization in males and females. To do so, we use a sample of sibling pairs drawn from the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 4,244). The analyses revealed no significant quantitative sex differences in the etiology of adult victimization. However, the results of this study do highlight the importance of accounting for genetic factors when studying the etiology of specific types of adult victimization. We conclude by discussing the implications of the current study for future research.
Understanding Gender Inequality in Political Self-Efficacy in Early Adolescents: Different Measures, Different Gender Gaps
Authors: Hoskins Bryony , Carrasco Diego
Published: August 2024

Research has shown a persistent gender gap in political self-efficacy across most Western countries. Nevertheless, the regularity in these findings masks the diversity in the measures used to capture this construct and little reflection has been undertaken on the extent that changing the measures has on the size and the direction of the gender gap. This article tests on students aged 14 in 38 countries using the IEA International Civic and Citizenship Education Study, the extent that self-efficacy in the domain of politics is a unidimensional measure and if different gender gaps can be found between self-efficacy measures capturing partisan politics compared to broader citizenship self-efficacy measures. The findings show that it is only partisan political self-efficacy measures where there is a significant gender gap and where girls are disadvantaged. This is the case for 37 out of 38 countries and robust when controlling for different levels of political knowledge. When a broader measure of citizenship self-efficacy is used, there are much less gender differences, and when there is a significant difference, girls outperform boys in 14 out of 38 countries. These contrary findings are similar in the same study when comparing the measures on interest in politics and interest in social issues.
Patient-important outcomes in type 2 diabetes: The paradigm of the sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists
Authors: Kintzoglanakis Kyriakos , Diamantis Christos , Mariolis Anargiros , Paschou Stavroula A
Published: August 2024

The newfound knowledge in type 2 diabetes (T2D) during the past decade for the sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) is wealthy in favorable results for key patient-important outcomes including morbidity, mortality and health-related quality of life (HRQoL). The SGLT-2i and GLP-1RA offer cardiovascular and renal protection beyond their glucose lowering effect, reduce body weight and hypoglycemia and improve diabetes-related distress, physical function and HRQoL. Along with the fixed-ratio combinations of basal insulin/GLP-1RA, they make feasible a regimen simplification and de-escalation from high dose and multiple injections of insulin reducing treatment burden. Besides cardiorenal risk reduction, the SGLT-2i and GLP-1RA reduce the incidence of depression, cognitive decline, respiratory disease, gout, arrhythmias and other co-occurring conditions of T2D, namely multimorbidity, which frequently complicates T2D and adversely affects HRQoL. The alleviation of multimorbidity by the pleiotropic effects of the SGLT-2i and GLP-1RA, could improve patients’ HRQoL. The use of the SGLT-2i and GLP-1RA should be increased within a shared decision-making in which they are reframed as cardiorenal risk-reducing medications with the potential to lower blood glucose. By improving outcomes that patients may highly perceive and value, the SGLT-2i and GLP-1RA may facilitate the contemporary person-centered management of T2D.
Expanding Bystander Behavioral Approaches to Address Racial Violence in Health Research, Pedagogy, and Practice
Authors: Ameen Khadijah , Airhihenbuwa Collins
Published: August 2024

A bystander to racial violence is conventionally thought of as someone who witnesses an overt act of racial oppression at the interpersonal level, such as police brutality. However, racial violence in health research, pedagogy, and practice often shows up more covertly, like through epistemic injustice, deficits-based framing, and racial essentialism. We aim to expand how we think about bystanders and perpetrators of racial violence within health institutions, and how antiracism bystander behavioral approaches can be deployed to intervene against such violence. Existing public health antiracism frameworks, such as the Public Health Critical Race Praxis and the PEN-3 Cultural Model, offer valuable constructs and processes through which health practitioners, researchers, and academics can disrupt racial violence. Such antiracism frameworks are well suited to provide individuals within public health and health care with the knowledge, skills, and efficacy to intervene as engaged bystanders against racism within their contexts. To illustrate how constructs within antiracism frameworks can be applied by bystanders in various health settings, we outline case examples of antiracism bystander interventions across three scenarios. The more bystanders there are within health institutions that are equipped with antiracism tools, the more likely normative behaviors uplifting White supremacy within these institutions can be disrupted and health equity can be actualized.
Culturally Safe Care Barriers and Facilitators in Organ Transplantation and Donation According to First Nations and Health Professionals in Quebec, Canada
Authors: Borwick Kimberly , Loignon Christine , Viscogliosi Chantal , Courtois Bibiane , Battista Marie-Claude , D’Aragon Frédérick
Published: August 2024

Introduction: First Nations are most at risk of developing end-stage kidney disease. Kidney transplantation is the best treatment option for these patients; however, First Nations donors are underrepresented. The aim of this study was to describe and understand barriers and facilitators of culturally safe organ transplantation and donation from the perspective of First Nations and Health Professionals in the Province of Quebec, Canada. Methods/Approach: This was a qualitative descriptive study using the decolonizing Two-Eyed Seeing approach. The sample consisted of First Nations people and health professionals living in Quebec, Canada, who have had an experience of organ transplantation or donation. Semi-structured interviews were conducted between May and September 2021 with 11 people, including 5 healthcare professionals and 6 First Nations people. Findings: This study enrolled 11 participants. Several individual and contextual factors influencing culturally safe organ transplantation and donation among First Nations people were identified: language barrier, impacts of relocation, lack of knowledge about transplantation, mistrust of the healthcare system, family support and accompaniment, and transplant testimonials. Discussion: This study identified several avenues for reinforcing culturally safe transplantation and donation among First Nations, including the presence of a companion in medical consultations, focusing on access to culturally safe accommodation and sharing transplant testimonials. Further work in partnership with First Nations is needed to improve access to culturally safe organ transplantation
A Mixed Method Study in Young Children Participating in Clinical Research During A Kidney Transplantation Trajectory
Authors: Voet Marieke , Lucker Guusje , Malagon Ignacio , Schaaijk Nienke Maas-van , Cornelissen Elisabeth A.M. , Engels Yvonne
Published: August 2024

Introduction

Regulations designed to protect children participating in clinical research often restrict the availability of research data necessary for the development of age-specific therapies and drug dosing. Few data exist on how children experience participation in clinical research, and studies investigating young children undergoing an intensive medical treatment are lacking.

Methods

Mixed methods with semi-structured interviews and DISCO-RC questionnaires were used to explore young children's and their parents’ experiences in clinical research participation during a kidney transplantation trajectory.

Findings

Nine children and their parents were interviewed. Children's median age at kidney transplantation was 4 years (IQR 4,7); age at interview was 7 years (IQR 6,9). Thematic content analysis of interviews revealed that most children were unaware of having participated in a study. Both children and their parents frequently were unaware whether procedures were standard care or research related. The additional burden attributed to study participation varied from not at all to heavy in combination with intensive medical treatment. Positive experiences included kind healthcare professionals, effective distraction techniques, educational aspects, contributing to science and extra check-ups. Most reported negative experiences were conflicting communication, spending much time in the hospital, missing school and suboptimal planning. Venous puncture was stressful for all children, whereas the discomfort of other procedures varied.

Conclusion

Pediatric clinical research design should focus on education and fun during research procedures, smart planning, consistent communication, close collaboration between clinical and research team and age appropriate distraction techniques.
Mean Pressure Gradient and Fractional Flow Reserve at A Superficial Femoral Artery Dissection after Drug-Coated Balloon Angioplasty
Authors: Kobayashi Taira , Fujiwara Takashi , Hamamoto Masaki , Okazaki Takanobu , Okusako Ryo , Yamaguchi Tomokazu , Sugawara Naohide , Tomota Mayu , Takahashi Shinya
Published: August 2024

Objectives

Residual dissection is a concern in endovascular treatment with a DCB, and there is limited knowledge of hemodynamics at a dissection lesion. Therefore, the objective of this study is to evaluate the mean pressure gradient (MPG) and fractional flow reserve (FFR) at a residual dissection after DCB angioplasty for the superficial femoral artery (SFA).

Methods

A total of 59 cases with residual SFA dissection treated with DCB angioplasty at a single center were analyzed retrospectively. The dissection was classified into 6 types (A-F). The primary endpoints were MPG and FFR at a residual dissection lesion after DCB angioplasty, using evaluation with a pressure wire.

Results

The median lesion length was 70 (40-130) mm with 24% popliteal involvement, and 11 cases (18%) had chronic total occlusion. A completion angiogram revealed dissection of types A (n = 33, 56%), B (n = 18, 31%), C (n = 7, 12%), and D (n = 1, 2%). The median MPGs in type A, B, and C cases were 0 (0-2), 0 (0-4), and 3 (0-6) mmHg, with a significant lower in type C cases than in type A cases (A vs C, P = .021). The median FFRs in type A, B, and C cases of 1.0 (.98-1.00), 1.0 (.96-1.00), and .98 (.95-1.00) did not differ significantly among dissection types (A vs B, P = .86; A vs C, P = .055; B vs C, P = .15).

Conclusions

This is the first report of hemodynamics at a SFA dissection. The results suggest that low-grade dissection (types A or B) does not affect MPG and FFR at a SFA lesion. This indicates that a bailout stent may be unnecessary for patients with dissection of types A or B. A further investigation is needed to determine whether a scaffold is required for a SFA lesion with type C dissection.
Occupational Stress in Healthcare Professionals in Spain: A Multicenter Study
Authors: González-Pascual Montserrat , Pérez-Ferreiro Mónica , Rodríguez de Castro Susana , Cerro-González María del Carmen , Recio-Vivas Ana María
Published: August 2024

Introduction: Occupational stress significantly impacts healthcare professionals in the Spanish public hospital system. This study, conducted from April to June 2022, focuses on analyzing stress levels using the Nursing Stress Scale through an online survey. Methods: A cross-sectional study was carried out using an online survey from April to June 2022 in four hospitals. The Nursing Stress Scale was used to comprehensively assess stress levels among healthcare professionals. Results: The findings revealed a substantial contrast in stress outcomes based on personal circumstances. Healthcare professionals in stable partnerships and with children exhibited lower stress levels, acting as protective factors during the pandemic. Conversely, those engaged in rotating shifts, especially those working over 60 h per week, showed a sevenfold increase in high-stress probability (p < 0.05). Temporary contract holders and those with heightened exposure to COVID-19 reported elevated stress levels, highlighting the complex dynamics impacting the mental well-being of healthcare workers. Conclusions: Findings emphasize the necessity for targeted interventions to safeguard healthcare professionals’ well-being, focusing on the psychological consequences of factors like rotating shifts and extended working hours. Protective elements such as stable partnerships and parenthood could serve as a foundation for initiatives supporting work-life balance, potentially involving government policies and hospital management.
Exploring Spiritually Integrated Psychotherapy as a Modality: How it is Evolving in the Ontario, Canada Context and the Relevance of Contributions from the Fields of Theology and Spiritual Care
Authors: Schmidt A.E. , O’Connor T.S.J.
Published: August 2024

This paper surveys the current understanding of spiritually integrated psychotherapy (SIP) and connects the historical role of religious training to better understand how SIP is developing as a psychotherapy modality in Ontario, Canada. The paper clarifies how SIP is defined and proposes three levels of practice: spiritually conscious therapy, spiritually informed therapy, and spiritually integrated therapy. As evidence-based and practiced-based literature expands, more consensus is needed in how SIP terminology is used.