bluuebunny/crossref_metadata_2025 huggingface dataset:
Wait times and patient throughput after the implementation of a novel model of virtual care in an outpatient neurology clinic: A retrospective analysis
Authors: Rabinovitch Brenden Samuel , Diaz Patrick L , Langleben Amanda C , Katz Talia M , Gordon Tatyana , Le Kevin , Chen Frank Yizhao , Lewis Evan Cole
Published: December 2022

Introduction

Neurology wait times — from referral to consultation — continue to grow, leading to various adverse effects on patient outcomes. Key elements of virtual care can be leveraged to improve efficiency. This study examines the implementation of a novel virtual care model – Virtual Rapid Access Clinics – at the Neurology Centre of Toronto. The model employs a patient-centred care workflow, involving multidisciplinary staff and online administrative tools that are synthesized to expedite care and maintain quality.

Methods

Virtual Rapid Access Clinic efficacy was studied by determining average wait times and patient throughput, calculated from anonymous data that was extracted from the clinic patient database (n  =  1542). Comparative analysis focused on new patient consultations during the 12-month periods prior to (pre-Virtual Rapid Access Clinic, n  =  456) and following (post-Virtual Rapid Access Clinic, n  =  1086) Virtual Rapid Access Clinic implementation.

Results

After Virtual Rapid Access Clinic implementation, there was a mean 15-day wait time reduction, and a monthly average 52-patient increase in patient throughput. Wait time reductions and increased patient throughput were observed in all three Virtual Rapid Access Clinic sub-clinics – epilepsy, headache and concussion. Respectively, average wait times reduced significantly by 26.4 and 18.9 days and insignificantly by 1.1 days; monthly average patient throughputs increased by 235%, 95% and 161%.

Discussion

These findings demonstrated that the Virtual Rapid Access Clinic model of care is effective at reducing patient wait times and increasing patient throughput. While the Virtual Rapid Access Clinic presents a feasible model both during and after pandemic restrictions, further research exploring its scalability in other care contexts, potential changes in care quality and efficiency outside of pandemic restrictions must be performed.
What comes after fields, capitals, habitus? Suggestions for future cultural consumption research in Australia
Authors: Threadgold Steven
Published: December 2022

This article critically engages with the Australian Cultural Fields project and the book Fields, Capitals, Habitus to make suggestions as to what future research on consumption practices needs to consider, including the place of young people; increased material inequality and its implications for cultural production; the development of consumers participating in cultural production; and the importance of considering emotions and affect in Bourdieusian sociology.
Entrepreneurial leadership development in teams: A conceptual model
Authors: Ahmed Fida , Harrison Christian
Published: December 2022

Entrepreneurial leadership is an emerging paradigm of enquiry that has gained increased attention in research and practice in recent times. However, due to lack of conceptual clarity and theoretical foundations, various dimensions of entrepreneurial leadership competencies and their development specifically in group contexts lack theoretical and conceptual underpinning. This research seeks to narrow this gap by outlining a conceptual framework for team-based entrepreneurial leadership learning and development. According to the proposed model, developing entrepreneurial leadership skills is a dynamic and complex social process. Entrepreneurial leaders can gain knowledge and skills by participating in a variety of team-based learning activities, including peer observations, group-based experiential learning, self-regulated learning and team learning.
Understanding violent extremism: Risk and protective factors in a jihadi male detainee population in the Netherlands
Authors: Thijssen Gaby , Masthoff Erik , Sijtsema Jelle J. , Bogaerts Stefan
Published: December 2022

In recent years, the number of detainees confined for terrorism-related offenses has increased worldwide and across Europe. To understand the factors related to terrorism and its underlying motives, this study provides insights into violent extremism by assessing risk- and protective factors based on the Violent Extremism Risk Assessment-2R (VERA-2R) in 121 male jihadist residents in Dutch terrorism wings. Retrospective analyses of primary source data showed that one-third of the target group is strongly connected to ideologies justifying violence. The social context of the study sample was also related to violent extremism, whereas support from family members emerged as the most often observed protective factor. The current findings suggest that including meaningful risk and protective factors of detained male jihadists may benefit risk management strategies in prevention, intervention, and policy practices related to violent extremism.
Transcarotid Revascularization Timing and Early Postoperative Outcomes in Symptomatic Patients
Authors: Pineau Sylvestre , Fajardo Andres , Saqib Naveed U. , Tanaka Akiko , Motaganahalli Raghu L. , Keyhani Arash , Keyhani Kourosh , Wang Keisin S.
Published: December 2022

Objective

Carotid endarterectomy (CEA) performed several days after onset of symptoms has been shown to be optimal in preventing procedure-related stroke. Transcarotid artery revascularization (TCAR) is an alternative hybrid procedure to treat high-risk for CEA patients. In this investigation, our aim is to determine the effect of timing of TCAR in symptomatic patients.

Methods

Procedures were captured prospectively at 2 independent health systems from 2016-2022 within a carotid intervention database. A retrospective analysis of this database was performed to generate cohorts by time to revascularization from onset of symptoms, with the short-interval revascularization (SIR) group defined as having a time to revascularization between 2-5 days; and long-interval revascularization (LIR) group having a time to revascularization of 6-180 days. Univariate analysis was performed comparing the cohorts at an α of .05.

Results

During the study period, 875 TCARs were captured, including 321 procedures performed in symptomatic patients. Of these, 84 had revascularization performed within 6 days after onset of symptoms (SIR) while 237 additional cases were completed 6 or more days after onset of symptoms (LIR). Baseline comorbidities were grossly similar between cohorts. Intraoperatively, SIR patients were less likely to develop bradycardia (4.8% vs 22.2%, P = .01) and experienced a shorter operative time (58 minutes vs 65 minutes, P = .02). Estimated blood loss, flow reversal time, radiation exposure, fluoroscopic time and contrast volume were identical between the groups. Length of stay in SIR patients was longer (1, IQR [1-3] vs 1, IQR [1-2] days, P < .01). Additionally, SIR patients seemed to trend toward a higher rate of reinterventions (3.6% vs .4%, P = .06). The incidence of ipsilateral or contralateral stroke, cranial nerve palsy, myocardial infarction, hematoma, stent thrombosis and death were statistically identical between the 2 groups.

Conclusion

Like the previous results established for CEA, symptomatic patients undergoing TCAR demonstrate similar outcomes if the procedure is performed 48 hours after the neurologic event.
Calcium-alkali syndrome as a rare cause of severe hypercalcemia requiring dialysis in early twin gestation
Authors: Beamish P , Mansour C , Druce I , O’Meara P
Published: December 2022

Hypercalcemia is rare in women of child-bearing age, and most cases are due to primary hyperparathyroidism. A 28-year-old woman, 14 weeks pregnant with dichorionic diamniotic twins, presented to hospital with vomiting, muscle cramps, and weakness. She had been taking calcium carbonate for gastric reflux and nausea from 5 weeks of gestation. Investigations revealed severe hypercalcemia, metabolic alkalosis, and renal injury. She was transferred to intensive care, receiving fluid resuscitation and subcutaneous calcitonin followed by dialysis. Investigations revealed suppressed PTH and PTH-related peptide, negative malignancy screening and low vitamin D level. Calcium and renal function quickly normalized and with cessation of calcium carbonate remained normal throughout the rest of pregnancy. Reports of calcium-alkali syndrome causing severe hypercalcemia are scarce, with most cases occurring later in gestation. This case represents a dramatic presentation requiring renal replacement therapy early in twin gestation.
A scoping review on early inflammatory bowel disease: definitions, pathogenesis, and impact on clinical outcomes
Authors: Estevinho Maria Manuela , Leão Moreira Paula , Silva Isabel , Laranjeira Correia João , Santiago Mafalda , Magro Fernando
Published: December 2022

Background:

Crohn’s disease (CD) and ulcerative colitis (UC) arise from a dysregulation of the balance between commensal microbiota and mucosal-associated immune system, in patients with genetic and environmental predisposition. Different pathophysiological mechanisms have been reported to influence disease history, with impact on disease phenotype and risk of complications.

Objectives:

This review aims to summarize the definitions of early CD and UC, analyze the underlying immunological mechanisms, and evaluate the impact of recognizing and treating early inflammatory bowel disease (IBD) on patients’ prognosis (short- and long-term outcomes).

Design:

To address this issue, we have performed a scoping review.

Data sources and methods:

Three online databases (MEDLINE, Web of Science, and ScienceDirect) were searched and the results were independently screened by two reviewers.

Results:

From 683 records identified, 42 manuscripts evaluating early IBD in adult patients were included. The ‘early CD’ concept was first described in 2008. Four years later, an international consensus proposed the definition of diagnosis up to 18 months, in patients without previous or current need for disease-modifying therapies. Several other definitions have been proposed; the ‘2 years since diagnosis’ is the most used, regardless of disease characteristics or medication. The amount of evidence on early UC is lower and more recent. Regarding early disease pathogenesis, most theories emphasize the prominent role of innate immunity, followed by early-Th1 adaptive response.

Conclusion:

The treatment of early CD seems to be crucial for the management of CD patients, impacting short-, medium-, and long-term outcomes. On the other hand, the early treatment of UC appears to be less advantageous, yet evidence comes from only a few retrospective studies.
Comparative effectiveness of natalizumab versus ocrelizumab in multiple sclerosis: a real-world propensity score–matched study
Authors: Pape Katrin , Rolfes Leoni , Steffen Falk , Muthuraman Muthuraman , Korsen Melanie , Meuth Sven G. , Zipp Frauke , Bittner Stefan
Published: December 2022

Background:

For treatment of relapsing-remitting multiple sclerosis (RRMS), a broad range of disease-modifying therapies (DMT) is available. However, few comparative effectiveness studies between different drugs have been performed.

Objectives:

This study aimed to compare the efficacy and treatment continuation of natalizumab and ocrelizumab in a real-world cohort of patients with relapsing-remitting multiple sclerosis (RRMS) from two German university hospitals.

Methods:

We performed a retrospective analysis of RRMS patients who initiated treatment with natalizumab or ocrelizumab between January 2016 and April 2019 at the German university hospitals of Mainz and Düsseldorf. Bayesian propensity score matching was conducted to correct for differences in baseline characteristics. Our primary outcome was no evidence of disease activity [NEDA-3: no relapses, no confirmed disability progression, and no magnetic resonance imaging (MRI) activity] and its subcomponents. Secondary outcomes included measurement of neurofilament light chain (NfL) in serum, analysis of premature discontinuation, and evidence of rebound activity in patients switching from natalizumab to ocrelizumab.

Results:

We identified 63 patients starting treatment with natalizumab and 76 patients starting with ocrelizumab. Binary logistic regression showed that treatment with natalizumab or a higher number of relapses in the previous year were independently associated with a higher risk for relapses. Patients receiving natalizumab had a higher probability of premature discontinuation of therapy ( p = 0.002). After propensity score matching of the two treatment arms, 55 patients remained per group. NEDA-3 after 30 months of follow-up was reached by 53.1% in the ocrelizumab group and 36.1% in the natalizumab group ( p = 0.177). Ocrelizumab was superior to natalizumab concerning the occurrence of relapses in log-rank test ( p = 0.019). NfL levels in serum were low under both treatments. Patients who switched from natalizumab to ocrelizumab showed no increased rebound activity.

Discussion:

This study provides class IV evidence that treatment of RRMS patients with ocrelizumab and natalizumab show comparable effectiveness in combined endpoints, while ocrelizumab might be more effective in preventing the occurrence of relapses.
Real-world outcomes from use of CDK4/6 inhibitors in the management of advanced/metastatic breast cancer in Asia
Authors: Low Jia Li , Lim Elaine , Bharwani Lavina , Wong Andrea , Wong Karmen , Ow Samuel , Lim Siew Eng , Lee Matilda , Choo Joan , Lim Joline , Chan Gloria , Walsh Robert John , Muthu Vaishnavi , Ngoi Natalie , Chong Wanqin , Tan Sing Huang , Lee Soo Chin
Published: December 2022

Background:

Oestrogen receptor positive, human epidermal growth factor receptor-2 (HER2) negative breast cancer (BC) is the most frequently diagnosed BC subtype. Combinations of cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) with anti-oestrogen therapy have led to improved survival compared with anti-oestrogen therapy alone for advanced/metastatic BC. The evaluation of CDK4/6i in the real-world facilitates treatment planning, insights into the incidence of drug toxicities, dose modifications including dose delays (DDs) and dose reductions (DRs) and improves prognostic accuracy in subgroups, for example geriatric patients, who are under-represented in clinical trials.

Methods:

This multi-centre study analysed retrospective and prospective data from 456 patients treated with CDK4/6i between January 2015 and December 2020. We examined patient characteristics, variation in prescribing practices, efficacy and toxicity outcomes.

Results:

In all, 456 patients were included in this study. The median age was 59 (range: 24–92). In total, 85 (19%) were ⩾70 years old. In all, 122 (27%) and 119 (26%) of patients were treated in the first-line and second-line settings, respectively. In total, 25 (5%), 31 (7%) and 145 (32%) of patients had brain, peritoneum and liver metastasis, respectively, at the time of CDK4/6i initiation. On univariate analysis, heavily pre-treated patients and those with distant metastases, involving the liver, brain or peritoneum, had significantly shorter progression-free survival (PFS) and 24-month overall survival (OS). Elderly patients (⩾70) had a shorter PFS; OS results were not mature. Majority of patients ( n = 362, 80%) initiated treatment with the United States FDA-approved starting dose of CDK4/6i. In all, 330 (72%) had at least one DD and 217 (48%) patients required at least one DR, but these dose modifications were not associated with poorer survival outcomes. Patients age ⩾70 were more likely to require dose modifications leading to a lower treatment dose. The most common reason for DD/DR was neutropenia (60%) and the incidence of febrile neutropenia was only 2%.

Conclusions:

Our study indicates CDK4/6i is effective and safe. Age ⩾ 70, distant metastases to liver, peritoneal or brain were negative prognostic factors. Age ⩾ 70 was associated with significantly increased requirement for dose modification; however, this did not impact survival outcomes. These findings provide reassurance that survival outcomes are not adversely affected in elderly patients when DD/DR is indicated.
Fabrication of immediately loaded implant-retained maxillary overdenture with flapless surgery using a CAD/CAM surgical guide: A technical report
Authors: Turkyilmaz Ilser , Gavras Joanna Nicolette
Published: December 2022

This report describes a digital workflow and two-year follow-up of an immediately loaded implant-retained overdenture using flapless surgery and a computer-aided design/computer-aided manufacturing (CAD/CAM) surgical guide. A prosthetically-driven approach, utilising a three-dimensional (3D) planning software and a CAD/CAM surgical guide, was used to place four implants in the edentulous maxillary arch of a 59-year-old male patient. All four implants were inserted through the surgical guide without raising soft tissue flaps. After placement, the patient was delivered an immediately loaded maxillary overdenture. Surgical implant placement was well tolerated by the patient, who reported no discomfort. Following a four-month period, a new implant-retained maxillary overdenture reinforced by a metal framework was fabricated and delivered to the patient. There were no adverse issues noted with neither the implants nor the maxillary overdenture during the two-year follow up period. The technique using the workflow described in this report may be a predictable and affordable alternative in the restoration of edentulous arches as compared to full-arch fixed restorations.
Frontal sinus pattern analysis for human identification using non-contrast computed tomography images: A Sri Lankan experience
Authors: Wickramasinghe Chathula , Vadysinghe Amal Nishantha , Kodikara Sarathchandra , Udupihilla Jeevani
Published: December 2022

Objective:

Morphometry of frontal sinuses has been studied extensively in many countries. However, these findings cannot be generalized due to genetic and environmental factors affecting the skeletal structure. The main aim of this study was to morphometrically analyze the frontal sinuses in patients who underwent non-contrast computed tomography (NCCT) skull imaging at Teaching Hospital Peradeniya and to assess its association with age and sex.

Methods:

This retrospective study included 300 NCCT skull images obtained by a multi-slice computed tomography(MSCT) scanner at the Teaching Hospital Peradeniya. This age- and sex-matched sample was selected using consecutive sampling and consists of seven age groups (20–29, 30–39, 40–49, 50–59, 60–69, 70–79, and 80–89). Right and left frontal sinus values (length, height, width of each sinus, and total width) were measured using the RadiaAnt DICOM Viewer 2020.2.3 software, and age and sex were obtained from the CT images. The association among the variables was analyzed using the t-test and binary logistic regression model.

Results:

In our study sample, 59% ( n = 177) were male and the mean age was 57.94 years. The means of left side sinus values were larger than right sinus values, which was statistically significant. A statistically significant association was seen between frontal sinus parameters and sex; those of males were higher than that of females. No significant association between the sinus size and age was observed.

Conclusion:

Morphometric analysis of frontal sinuses using NCCT images is useful for the sex differentiation of unknown bodies for medico-legal purposes. Furthermore, the mean sinus values specific to the current study population will also be helpful in ethnic differentiation.
Rupture of the right sinus of Valsalva aneurysm and formation of ventricular septal dissection and third-degree atrioventricular block: A case report
Authors: Yi Si-Yi , Zhou Can , Feng Jie , Zhan Wei-Sheng , Zhou Zheng , Yang Ying
Published: December 2022

Sinus of Valsalva aneurysm is a rare congenital or acquired cardiac structural abnormality. The sinus of Valsalva aneurysm refers to the local development defect of the aortic sinus wall. Under aortic hypertension, the sinus wall becomes thinner and expands outward. Its clinical manifestations range from asymptomatic to severe life-threatening complications caused by compression or rupture of important surrounding structures. A few cases of aortic aneurysm sinus with arrhythmias have been reported, including complete heart block. Here, we present the case of a 50-year-old male patient with recurrent syncope due to a third-degree atrioventricular block. We found a right sinus of Valsalva aneurysm that ruptured into the basal segment of the interventricular septum and formed a basal septal dissection on echocardiography, which could have caused a third-degree atrioventricular block. This case report highlights the importance of finding secondary etiologies in the sudden or transient onset of third-degree atrioventricular block and using echocardiography to evaluate patients with heart block.
A case report on secondary mesentero-axial gastric volvulus
Authors: Danushka PG Nadun , Jayasinghe Ravindri
Published: December 2022

Mesentero-axial gastric volvulus is a rare presentation to a surgical casualty unit with sinister complications and significant mortality and morbidity. Clinical assessment should be done with high suspicion in the case of an associated anatomical defect. Accurate diagnosis and timely intervention would drastically reduce morbidity and mortality. The present patient is a 63-year-old male with an acute and chronic presentation of a secondary mesentero-axial gastric volvulus with a large hiatal hernia who underwent open surgical repair with unremarkable postop recovery.
A case report of clinical implications of a delayed antiretroviral therapy switch in a patient with multiple treatment interruptions
Authors: Kakubu Mireille A Mpalang , Frans Kandali , Gibutai Nelson , Katoto Patrick DMC
Published: December 2022

The Namibia national antiretroviral therapy guidelines recommend that patients living with HIV who interrupt antiretrovirals and in the process disengage from care be restarted on their usual antiretroviral therapy regimen upon return. We introduce a 39-year-old male patient on first-line antiretroviral therapy, namely, tenofovir disoproxil fumarate, lamivudine and efavirenz, from 2015 to 2019 (4 years), who returned to care after the fourth episode of interrupting his treatment, though his adherence to antiretroviral therapy was deemed poor. Thus, he presented with severe immunosuppression and an AIDS-defining condition. Hence, he was switched to second-line antiretroviral therapy, treated with fluconazole for oesophageal candidiasis and reinitiated on cotrimoxazole prophylaxis. The client is currently clinically stable with a suppressed viral load. Medical and drug history taking with an emphasis on the previous history of treatment failure in patients returning to care are paramount in guiding the choice of future prescriptions of antiretrovirals. The multiple antiretroviral therapy interruptions from the patient and the delay in decision-making on the side of the clinician to switch treatments contributed to the emergence of an AIDS-defining condition.
Management of aortic occlusion in a morbidly obese smoker: A case report
Authors: Le Timothy N , Roberts David A , Kimyaghalam Ali , Singh Kuldeep
Published: December 2022

Total occlusion of the abdominal aorta is a rare and life-threatening event. Risk factors most commonly include coagulopathy, vasculitis, trauma, abdominal aortic aneurysms, aortic thromboembolism, and aortic dissection. The most common complications include severe ischemic manifestations in the lower extremities, spinal cord, or viscera. Thus, management is largely dependent on presumed etiology. We present a case of a morbidly obese 52-year-old female with a past medical history of hypertension, diabetes mellitus, peripheral vascular disease, and coronary artery disease with a smoking history of three packs per day for over 10 years. The patient first presented to our emergency department with bilateral lower extremity paresthesia and pain at rest. Further evaluation through computed tomography angiogram thus revealed infrarenal occlusion of the abdominal aorta and bilateral common iliac arteries; the patient was treated with an aorto-femoral bypass without further sequelae. Our case report details the associated risk factors of acute on chronic aortic occlusion and its management.
Naturalizing digital and quality of life in chronic diseases: Systematic review to research perspective into technological advancing and personalized medicine
Authors: Cilli Eleonora , Ranieri Jessica , Guerra Federica , Ferri Claudio , Di Giacomo Dina
Published: December 2022

The increasing of chronic diseases and related health management are the main clinical and public health challenges. The long-term nature and the need for continuous monitoring in chronic disease management gave rise to early technological innovations (mobile Health) to improve care management plans, therapeutic adherence, and psychological support to the patient. This review aimed to map the literature on the impact of the use of wearable device on quality of life in patients with chronic diseases. We performed a systematic search of MEDLINE through PubMed, Web of Science, and Scopus of all scientific literature published until January 2022. Based on inclusion and exclusion criteria, a total of 10 papers were included. This review pointed out the relevant focus on the use of wearable device in chronic disease patients highlighting the wearable device impact on several domains including quality of life, Self-Efficacy, Self-Management, and feelings on patients with chronic diseases. The available scientific literature related to the impact of the use of wearable device on quality of life and psychological features in patients with chronic diseases, general underline a need to develop professional healthcare guidelines and tailored intervention on patients with a chronic condition, using mobile Health solutions and trying to fill the lack of knowledge about the topic.
Association between brain volume and disability over time in multiple sclerosis
Authors: Moridi Thomas , Stawiarz Leszek , McKay Kyla A , Ineichen Benjamin V , Ouellette Russell , Ferreira Daniel , Muehlboeck J-Sebastian , Westman Eric , Kockum Ingrid , Olsson Tomas , Piehl Fredrik , Hillert Jan , Manouchehrinia Ali , Granberg Tobias
Published: December 2022

Background

Most previous multiple sclerosis (MS) brain atrophy studies using MS impact scale 29 (MSIS-29) or symbol digit modalities test (SDMT) have been cross-sectional with limited sets of clinical outcomes.

Objectives

To investigate which brain and lesion volume metrics show the strongest long-term associations with the expanded disability status scale (EDSS), SDMT, and MSIS-29, and whether MRI-clinical associations vary with age.

Methods

We acquired MRI and clinical data from a real-world Swedish MS cohort. FreeSurfer and SPM Lesion Segmentation Tool were used to obtain brain parenchymal, cortical and subcortical grey matter, thalamic and white matter fractions as well as T1- and T2-lesion volumes. Mixed-effects and rolling regression models were used in the statistical analyses.

Results

We included 989 persons with MS followed for a median of 9.3 (EDSS), 10.1 (SDMT), and 9.3 (MSIS-29) years, respectively. In a cross-sectional analysis, the strength of the associations of the MRI metrics with the EDSS and MSIS-29 was found to drastically increase after 40–50 years of age. Low baseline regional grey matter fractions were associated with longitudinal increase of EDSS and physical MSIS-29 scores and decrease in SDMT scores and these atrophy measures were stronger predictors than the lesion volumes.

Conclusions

The strength of MRI-clinical associations increase with age. Grey matter volume fractions are stronger predictors of long-term disability measures than lesion volumes.
The role of the specialist mental health probation officer
Authors: Morick Yvonne , Heitz Katharina
Published: December 2022

Individuals on probation have a high prevalence of health problems when compared to the general population. For them it is often difficult to access health treatment. Thus, improvement of mental health and access to mental health services could increasingly become a role of the probation officer. In Europe, there is less data about the use of specialty mental health probation (SMHP) than in the United States (US). In a survey for the Council of Europe, Brooker and Monteira (2021) summarized the practices of probation services and prisons among European countries. The authors alluded to useful initiatives in German states. One example is Baden-Wurttemberg, where some probation officers are trained to be mental health specialists ( Brooker and Monteira 2021 : 16). The main difference between the SMHP model in the US and the model in Baden-Wurttemberg is that the specialist in mental health in Baden-Wurttemberg does not necessarily care exclusively for individuals with mental illnesses, but rather serves as a source of expert knowledge to colleagues and assists with case consultations. Thus, the probation officer does not focus exclusively on one topic (mental health) and can take a holistic view of each individual case.
Does Secondary Antibiotic Prophylaxis Improve Clinical Outcomes in Adult Rheumatic Heart Disease Patients Post-Valve Replacement?
Authors: Al-Jazairi Abdulrazaq S , Althobaiti Ahlam M , Marek Josef , Devol Edward B , Al Halees Zohair , Mohty Dania , Fadel Bahaa M
Published: December 2022

Background

Secondary prevention of recurrent rheumatic fever in individuals with rheumatic heart disease (RHD) requires continuous antibiotic prophylaxis. However, the impact of antibiotic prophylaxis on the outcome of patients with severe RHD who underwent heart valve replacement is unknown. The objective of the study was to assess the relationship between the use of antibiotics as secondary prophylaxis in RHD patients who underwent valve replacement and clinical outcomes including mortality, reoperation, and valve-related hospitalization.

Methods

We retrospectively compared outcomes of adult patients who underwent heart valve replacement for RHD at our institution from 1990 through 2014 and who received secondary antibiotic prophylaxis (prophylaxis group) with those who did not receive prophylaxis (nonprophylaxis group) using propensity score matching analysis.

Results

A total of 1094 patients (56% females, median age 40 years, range 31-53 years) were included with a median follow-up of 9.6 years (range 2.9-12.6 years). Antibiotic prophylaxis was prescribed in 201 patients (18%). Propensity score matching analysis demonstrated no significant difference in overall survival (95% [92%-98%] vs 97% [95%-99%], respectively; P = .7), valve-related hospitalization-independent survival (72% [range 65%-78%] vs 81% [range 76%-88%]; P = .25), and redo valve surgery-independent survival [76% [range 70%-83%] vs 75% [range 72%-79%]; P = .41) at 10-year follow-up in the nonantibiotic prophylaxis versus the antibiotic prophylaxis group.

Conclusion

Secondary antibiotic prophylaxis among adult RHD patients following valve replacement is not associated with improved clinical outcomes.
Factors Affecting Social and Financial Efficiency of MFIs: DEA and Tobit Approach
Authors: Chauhan Swati
Published: December 2022

This study aims to examine the factors that affect the social and financial efficiency of Indian Microfinance Institutions (MFIs). Relative efficiency of 38 non-banking financial companies (NBFC)-MFIs has been measured using the non-parametric data envelopment analysis (DEA) approach. The determinants of social and financial efficiency of MFIs have been identified using censored Tobit regression. The study findings indicate that NBFC-MFIs are financially more efficient than social. Regression analysis results reveal that age and size are important variables of financial efficiency while leverage and size are social efficiencies. This may be the first extensive study measuring the determinants of efficiency on financial and social dimensions separately for Indian NBFC-MFIs. This study contributes to the scarce literature by providing the role of efficiency in the sustainability of MFIs in the long run.
Teaching and Engaging Adult Law Learners in a Singapore Business Law Class—A Reflection of Legal Teaching Strategies
Authors: Cheong Ben Chester
Published: December 2022

In an environment that aims to promote lifelong and adult learning, legal education needs to be acutely aware of the different skill and learning aptitudes among adult students as well as their motivation and interest. I present a case study of a first-year undergraduate law course, law of business organisation, at the Singapore University of Social Sciences where I used various adult teaching techniques, a strategy of gamification, and digital tools to engage and spark an interest in my law classroom. Overall, students have found the approach successful in cultivating their interests and developing their practical skills. The findings speak to broader concepts of active engagement and developing their practical knowledge to aid law students in their learning and future careers. Albert Einstein once said that ‘it is the supreme art of the teacher to awaken joy in creative expression and knowledge’. 2 The article is divided into five parts, the first part provides an overview of the pedagogy of adult teaching and learning, the second part provides an overview of generic curriculum approaches at the law school, the third part covers the tailored approach to teach adult learners, the fourth part examines in further detail specific teaching methods for a business law module which I am course leader for, and the fifth part explores the effectiveness of these teaching methods.
Dissent in Reality: A Commentary on Representations of Organizational Dissent on Undercover Boss
Authors: Helens-Hart Rose , Haugen Jenna , Lloyd Robert
Published: December 2022

Reality television that allegedly takes us inside organizations provides researchers with abundant data to consider how culture industries narrate and shape understandings of (un)idealized work practices. Within this context, we explored organizational dissent on the reality television show Undercover Boss. Recent research has theorized how dissent is a co-constructed process between dissenters and recipients. A challenge to exploring this process, however, is witnessing dissent as it unfolds over time and between supervisors and subordinates. Through a qualitative content analysis of eight seasons of Undercover Boss, we examined how the dissent life cycle was depicted. We determined beneath displays of exemplary employees and redeemed bosses vowing their commitment to employee concerns, a more problematic narrative existed. Despite attempts to highlight how employees can provide insightful, quality feedback, the program privileged showing bosses’ authority, business acumen, and how they facilitated and framed dissent messages. Dissent interactions ultimately supported executive business interests and demonstrated dysfunctional dissent processes.
Critical Study on the Legal Policies Relating to Education: With Special Reference to Trafficked Children Living in Childcare Institutions
Authors: Sharma Neha , Dansana Prayas
Published: December 2022

The edifice of the Indian Constitutional order, which is rooted in the ideals of social justice, liberty, equality, and dignity of individual, secures the basic fundamental rights of its citizen without any discrimination. In spite of constitutional guarantees to its citizenry, vulnerable sections of Indian societies are subjected to various forms of exploitation. Amongst those, children are the most susceptible, due to societal indifference, and lack of compassion and empathy, which resulted in large-scale child trafficking in India. Phenomena of child trafficking and its volume pose a serious question about efficacy of existing policies and programmes against it. In India, there are ‘Child Care Institutions’ (CCIs) to look after the well-being and rehabilitation of such children. Unfortunately, not much attention has been paid to strengthening such homes. Under the existing framework, responsibility has been cast on CCIs to oversee the overall growth and development of such institutionalised children. Appropriate education is their only crutch on which they can overcome their physical and psychological trauma and suffering. From the present study, it is evident that educational rights of such children are imperative for the restoration of their life in the true sense. Measures for improving their life are suggested thereof.
Violence capital: On the framing and construction of a policy problem
Authors: Eriksson Maria , Ekström Veronica , Vainik Anne-Lie , Kassman Anders
Published: December 2022

Criminal law is directed at distinct individual actions and is therefore less suited for combating patterned, repeated, and collective actions. In an attempt to overcome such problems, the concept of violence capital was introduced in an amendment to the Swedish Criminal Code in 2016. The current study aims at initiating an academic debate and theory development regarding violence capital, through critical engagement with the empirical case of how the concept of violence capital was constructed when it was introduced in Swedish criminal policy and criminal law. The legal reform seems to mainly rest on the work of a specific group within the Swedish Council of Crime Prevention. Furthermore, violence capital comes across as a somewhat “slippery” concept without links to wider academic debates. The study highlights the fact that such a fundamental form of social action as violence has been absent in the academic line of thought regarding different forms of capital. Also, there is a gap between common sense ways of understanding patterns of violence and their cumulative effects and researcher models. As the concept seems to be largely unknown outside of the Swedish language media and policy debates, to be relevant to wider academic debates, the concept needs to be more clearly defined and theorized. Further developed, the concept of violence capital has the potential to shed light upon the process whereby individual acts may accumulate collective, transferable resources.
Government nation building and memetic reactions: Different visions of the UK in COVID-19 related communication
Authors: Way Lyndon CS , O’Halloran Kay L
Published: December 2022

The UK government uses news conferences, press releases, official websites, mainstream and social media to provide advice and information about the COVID-19 pandemic. This information has become ‘source material’ for social media users to react to government announcements in ‘digital popular culture’; that is, memes and short videos shared on social media. Close examinations of both reveal how different views of the nation are articulated whilst giving and reacting to pandemic information and advice. Here, we analyse a sample of official government webpages on COVID-19 announcements and reactions to these in digital popular culture. We employ Multimodal Critical Discourse Studies to understand how the modes of lexica and images work individually and together to articulate views on the nation. Through such an analysis, we reveal not only what the public ‘receive’ from the government, but also broadly held ideas and beliefs by the public on the nation.
An Unrelenting Epidemic of Violence: Trends of Homicide Mortality in Mexico, 1998–2020
Authors: Dávila-Cervantes Claudio Alberto , Pardo-Montaño Ana Melisa
Published: December 2022

The primary objective was to analyze the trend of premature homicide mortality in Mexico between 1998 and 2020 for females and males at national and state levels. Using data on deaths from Mexico's vital statistics, we estimated homicide age-standardized death rates and trends of years of life lost (YLL). To estimate the premature homicide mortality trends, we conducted a joinpoint regression analysis. In 2020, Mexico reached the maximum number of homicides in the past decades (36,773 homicides), which was more than four times the number of homicides in 2007. Homicide premature mortality increased since 2008 and in 2020 was almost double than at the turn of the century. YLL homicide rates for males were higher than for females in all age groups. Homicide premature mortality peaked between the ages of 20 and 44 years for males and 20 and 34 years for females. The trends in homicide mortality in Mexico's states were not homogeneous. Mortality studies are critical in the descriptive epidemiology of violence. Current public policies have failed to ensure the safety of the country's citizens and to decrease homicide and crime rates and should focus on premature mortality, as well as addressing the structural causes of the problem.
Biology and therapeutic targeting of molecular mechanisms in MPNs
Authors: How Joan , Garcia Jacqueline S. , Mullally Ann
Published: December 2022

Myeloproliferative neoplasms (MPNs) are clonal hematopoietic stem cell disorders characterized by activated Janus kinase (JAK)–signal transducer and activator of transcription signaling. As a result, JAK inhibitors have been the standard therapy for treatment of patients with myelofibrosis (MF). Although currently approved JAK inhibitors successfully ameliorate MPN-related symptoms, they are not known to substantially alter the MF disease course. Similarly, in essential thrombocythemia and polycythemia vera, treatments are primarily aimed at reducing the risk of cardiovascular and thromboembolic complications, with a watchful waiting approach often used in patients who are considered to be at a lower risk for thrombosis. However, better understanding of MPN biology has led to the development of rationally designed therapies, with the goal of not only addressing disease complications but also potentially modifying disease course. We review the most recent data elucidating mechanisms of disease pathogenesis and highlight emerging therapies that target MPN on several biologic levels, including JAK2-mutant MPN stem cells, JAK and non-JAK signaling pathways, mutant calreticulin, and the inflammatory bone marrow microenvironment.
The cholesteryl-ester transfer protein isoform (CETPI) and derived peptides: new targets in the study of Gram-negative sepsis
Authors: Pérez-Hernández Eréndira G. , De la Puente-Díaz de León Víctor , Luna-Reyes Ismael , Delgado-Coello Blanca , Sifuentes-Osornio José , Mas-Oliva Jaime
Published: December 2022

Background

Sepsis is a syndrome where the dysregulated host response to infection threatens the life of the patient. The isoform of the cholesteryl-ester transfer protein (CETPI) is synthesized in the small intestine, and it is present in human plasma. CETPI and peptides derived from its C-terminal sequence present the ability to bind and deactivate bacterial lipopolysaccharides (LPS). The present study establishes the relationship between the plasma levels of CETPI and disease severity of sepsis due to Gram-negative bacteria.

Methods

Plasma samples from healthy subjects and patients with positive blood culture for Gram-negative bacteria were collected at the Intensive Care Unit (ICU) of INCMNSZ (Mexico City). 47 healthy subjects, 50 patients with infection, and 55 patients with sepsis and septic shock, were enrolled in this study. CETPI plasma levels were measured by an enzyme-linked immunosorbent assay and its expression confirmed by Western Blot analysis. Plasma cytokines (IL-1β, TNFα, IL-6, IL-8, IL-12p70, IFNγ, and IL-10) were measured in both, healthy subjects, and patients, and directly correlated with their CETPI plasma levels and severity of clinical parameters. Sequential Organ Failure Assessment (SOFA) scores were evaluated at ICU admission and within 24 h of admission. Plasma LPS and CETPI levels were also measured and studied in patients  with liver dysfunction.

Results

The level of CETPI in plasma was found to be higher in patients with positive blood culture for Gram-negative bacteria that in control subjects, showing a direct correlation with their SOFA values. Accordingly, septic shock patients showing a high CETPI plasma concentration, presented a negative correlation with cytokines IL-8, IL-1β, and IL-10. Also, in patients  with liver dysfunction, since higher CETPI levels correlated with a high plasma LPS concentration, LPS neutralization carried out by CETPI might be considered a physiological response that will have to be studied in detail.

Conclusions

Elevated levels of plasma CETPI were associated with disease severity and organ failure in patients  with Gram-negative bacteraemia, defining CETPI as a protein implicated in the systemic response to LPS.
Phospho-heavy-labeled-spiketide FAIMS stepped-CV DDA (pHASED) provides real-time phosphoproteomics data to aid in cancer drug selection
Authors: Staudt Dilana E. , Murray Heather C. , Skerrett-Byrne David A. , Smith Nathan D. , Jamaluddin M. Fairuz B. , Kahl Richard G. S. , Duchatel Ryan J. , Germon Zacary P. , McLachlan Tabitha , Jackson Evangeline R. , Findlay Izac J. , Kearney Padraic S. , Mannan Abdul , McEwen Holly P. , Douglas Alicia M. , Nixon Brett , Verrills Nicole M. , Dun Matthew D.
Published: December 2022

Global high-throughput phosphoproteomic profiling is increasingly being applied to cancer specimens to identify the oncogenic signaling cascades responsible for promoting disease initiation and disease progression; pathways that are often invisible to genomics analysis. Hence, phosphoproteomic profiling has enormous potential to inform and improve individualized anti-cancer treatment strategies. However, to achieve the adequate phosphoproteomic depth and coverage necessary to identify the activated, and hence, targetable kinases responsible for driving oncogenic signaling pathways, affinity phosphopeptide enrichment techniques are required and often coupled with offline high-pressure liquid chromatographic (HPLC) separation prior to nanoflow liquid chromatography–tandem mass spectrometry (nLC-MS/MS). These complex and time-consuming procedures, limit the utility of phosphoproteomics for the analysis of individual cancer patient specimens in real-time, and restrict phosphoproteomics to specialized laboratories often outside of the clinical setting. To address these limitations, here we have optimized a new protocol, phospho-heavy-labeled-spiketide FAIMS stepped-CV DDA (pHASED), that employs online phosphoproteome deconvolution using high-field asymmetric waveform ion mobility spectrometry (FAIMS) and internal phosphopeptide standards to provide accurate label-free quantitation (LFQ) data in real-time. Compared with traditional single-shot LFQ phosphoproteomics workflows, pHASED provided increased phosphoproteomic depth and coverage (phosphopeptides = 4617 pHASED, 2789 LFQ), whilst eliminating the variability associated with offline prefractionation. pHASED was optimized using tyrosine kinase inhibitor (sorafenib) resistant isogenic FLT3-mutant acute myeloid leukemia (AML) cell line models. Bioinformatic analysis identified differential activation of the serine/threonine protein kinase ataxia-telangiectasia mutated (ATM) pathway, responsible for sensing and repairing DNA damage in sorafenib-resistant AML cell line models, thereby uncovering a potential therapeutic opportunity. Herein, we have optimized a rapid, reproducible, and flexible protocol for the characterization of complex cancer phosphoproteomes in real-time, a step towards the implementation of phosphoproteomics in the clinic to aid in the selection of anti-cancer therapies for patients.