bluuebunny/crossref_metadata_2025 huggingface dataset:
Extreme Miller cycle with high intake boost for improved efficiency and emissions in heavy-duty diesel engines
Authors: Garcia Erick , Triantopoulos Vassilis , Trzaska Joseph , Taylor Maxwell , Li Jian , Boehman André L
Published: December 2021

This study experimentally investigates the impact of extreme Miller cycle strategies paired with high intake manifold pressures on the combustion process, emissions, and thermal efficiency of heavy-duty diesel engines. Well-controlled experiments isolating the effect of Miller cycle strategies on the combustion process were conducted at constant engine speed and load (1160 rpm, 1.76 MPa net IMEP) on a single cylinder research engine equipped with a fully-flexible hydraulic valve train system. Late intake valve closing (LIVC) timing strategies were compared to a conventional intake valve profile under either constant cylinder composition, constant engine-out NOx emission, or constant overall turbocharger efficiency ([Formula: see text]) to investigate the operating constraints that favor Miller cycle operation over the baseline strategy. Utilizing high boost with conventional intake valve closing timing resulted in improved fuel consumption at the expense of sharp increases in peak cylinder pressures, engine-out NOx emissions, and reduced exhaust temperatures. Miller cycle without EGR at constant [Formula: see text] demonstrated LIVC strategies effectively reduce engine-out NOx emissions by up to 35%. However, Miller cycle associated with very aggressive LIVC timings led to fuel consumption penalties due to increased pumping work and exhaust enthalpy. LIVC strategies allowed for increased charge dilution at the baseline NOx constraint of 3.2 g/kWh, resulting in significant fuel consumption benefits over the baseline case without compromising exhaust temperatures or peak cylinder pressures. As Miller cycle implementation was shown to affect the boundary conditions dictating [Formula: see text], the LIVC and conventional IVC cases were studied at an equivalent [Formula: see text] point representative of high boost operation. With high boost, LIVC yielded reduced NOx emissions, reduced peak cylinder pressures, and elevated exhaust temperatures compared to the conventional IVC case without compromising fuel consumption.
Observing the impact of profession change on ‘habits of mind’: A factor oriented approach
Authors: Negi Tanuj , Jain Shashi
Published: December 2021

A common observation in Transformative Learning (TL) literature is the scarcity of ways to gauge the extent of personal transformation. This is despite a recorded history of more than four decades and the existence of multiple schools of thought in TL. Also, there has been insufficient exploration of the personal transformation of profession changers in the TL space. We believe it is important to operationalize the key concepts of the TL theory through quantitative methods to make way for newer insights. In this paper, using the case of profession changers from India, we extend Mezirow’s work on six types of ‘Habits of Mind’ beyond their original conceptualization by identifying constituent latent factors. We examine and establish the reliability and validity of these factors and recommend a factor-based scale approach for application.
The Neurophysiology Behind Trauma-Focused Therapy Modalities Used to Treat Post-Traumatic Stress Disorder Across the Life Course: A Systematic Review
Authors: Pierce Zachary P. , Black Jessica M.
Published: December 2021

This review presents the current state of understanding of trauma-informed modalities in light of current research in neuroscience, analyzing which brain structures and processes are impacted by these modalities. Studies included in the present review met the inclusion criteria of 1) addressing post-traumatic stress disorder (PTSD) in a specific population, 2) treatment of PTSD using any of the evidence-based trauma-informed modalities considered in this review, and 3) presenting functional magnetic resonance imagery (fMRI) data, derived from BOLD signals and voxel-compression maps, of brain structures impacted by these trauma-informed modalities. Articles for this review were collated through PubMed and MEDLINE, using key terms in descending order, such as ‘childhood trauma’, ‘adolescent trauma’, and ‘adulthood trauma’, to ‘PTSD’, ‘fMRI’, and so on, depending on the modality in question. Based on these criteria and research methods, 37 studies remained for inclusion in the present review. Among a number of critical findings, this review demonstrates that eye movement desensitization and reprocessing (EMDR) and mindfulness therapy effectively deactivate hindbrain regions implicated in the downregulation of autonomic nervous system (ANS) hyperarousal. This review also shows that trauma-focused cognitive behavioral therapy (TF-CBT) and EMDR activate the hippocampus, anterior cingulate cortex (ACC), medial prefrontal cortex (mPFC), and orbitofrontal cortex (OFC)—areas that are implicated in crucial cognitive, affective, and behavioral processes that aid trauma survivors in navigating their challenges.
Stakeholders’ Perspectives regarding Participation in Neuromodulation-Based Dementia Intervention Research
Authors: Dunn Laura B. , Kim Jane P. , Rostami Maryam , Mondal Sangeeta , Ryan Katie , Waraich Asees , Roberts Laura Weiss , Palmer Barton W.
Published: December 2021

This study evaluated stakeholders’ perspectives regarding participation in two hypothetical neuromodulation trials focused on individuals with Alzheimer's disease and related disorders (ADRDs). Stakeholders (i.e., individuals at risk for ADRDs [ n = 56], individuals with experience as a caregiver for someone with a cognitive disorder [ n = 60], and comparison respondents [ n = 124]) were recruited via MTurk. Primary outcomes were willingness to enroll (or enroll one's loved one), feeling lucky to have the opportunity to enroll, and feeling obligated to enroll in two protocols (transcranial magnetic stimulation, TMS; deep brain stimulation, DBS). Relative to the Comparison group, the At Risk group endorsed higher levels of “feeling lucky” regarding both research protocols, and higher willingness to participate in the TMS protocol. These findings provide tentative reassurance regarding the nature of decision making regarding neurotechnology-based research on ADRDs. Further work is needed to evaluate the full range of potential influences on research participation.
Rates of Operative Management of Midshaft Clavicle Fracture in Adolescents Have Increased in Florida between 2005 and 2014
Authors: Wu Hao-Hua , Chopra Aman , Carrillo Laura A. , Callahan Matt , Swarup Ishaan
Published: December 2021

Background: It is not known if the adult literature on midshaft clavicle fracture treatment with open reduction internal fixation (ORIF) has influenced injury management in adolescents. Purpose: We sought to longitudinally evaluate the rates of operative management of adolescent midshaft clavicle fractures in the state of Florida. Methods: We conducted a retrospective review of data from the following Healthcare Cost and Utilization Project databases: the State Inpatient Database, the State Ambulatory Surgery and Services Database, and the State Emergency Department Database. Patients in Florida ages 10 to 18 years with midshaft clavicle fractures between 2005 and 2014 were identified along with data on age, sex, race/ethnicity, insurance type, treatment, and income percentile. We reviewed the data to identify trends in the rates of operative management of midshaft clavicle fractures. We then compared the rates of operative management between the first 3 years and the most recent 3 years (2005–2007 vs 2012–2014). Various demographic and socioeconomic factors were compared between patients treated with and without surgery. Descriptive statistics as well as univariate and multivariate analyses were performed. Results: There were 4297 midshaft clavicle fractures in adolescents identified between 2005 and 2014, and 338 (7.8%) of these fractures underwent operative management. There was a significant increase in the rate of operative management; it increased from 4.3% (n = 59) of the 1373 clavicle fractures that occurred between 2005 and 2007 to 11.2% (n = 130) of the 1164 clavicle fractures that occurred between 2012 and 2014. Patients with commercial insurance and patients who were older were more likely to undergo ORIF. Patients with Medicaid were more likely to undergo ORIF between 2012 and 2014 compared with patients with Medicaid between 2005 and 2007. Conclusions: Operative management rates of adolescent midshaft clavicle fractures have significantly increased in Florida over a decade; additional research is needed to understand these findings.
An Evaluation of 5-Year Web Analytics for HeadsUpGuys: A Men’s Depression E-Mental Health Resource
Authors: Ogrodniczuk John S. , Beharry Joshua , Oliffe John L.
Published: December 2021

The present study reports an evaluation of web analytics, over a 5-year period, for HeadsUpGuys.org , an eHealth resource for men with depression. Google Analytics, Search Console, and Tag Manager were used to monitor user activity over the course of the website’s first 5 years (June 15, 2015–June 15, 2020). Through this period, HeadsUpGuys had a total of 1,665,356 unique users, amounting to 1,948,481 sessions and 3,328,258 page views. Organic traffic accounted for the highest proportion (53.44%; n = 1,041,277) of website sessions. Four of the top 10 Google search queries that brought users to the website related to suicidality. Three countries (United States, United Kingdom, Canada) accounted for almost three-quarters (71.10%; n = 1,385,485) of the site’s traffic. Nearly three-quarters (73.35%; n = 1,429,285) of sessions occurred on a mobile device. The goal conversion rate for the Self Check was 60.27%. The average time on page was 2 min 53 s, with a bounce rate of 65.92%, and an exit rate of 57.20%. The goal conversion rate for the Stress Test was 52.89%. The average time on page was 4 min 8 s, with a bounce rate of 72.40% and an exit rate of 48.88%. The conversion rate for the final goal was 11.53%, indicating that approximately one in 10 visitors to the site had a session of at least 3 min. The findings illustrate the potential of eHealth resources to support men’s mental health and provide a real-world benchmark to help advance the men’s eHealth field.
Understanding female coaches’ and practitioners’ experience and support provision in relation to the menstrual cycle
Authors: Brown Natalie , Knight Camilla J
Published: December 2021

The study aimed to develop an understanding of female coaches’ and sport science practitioners’ experience and support provision in relation to the menstrual cycle when working with female athletes. Following receipt of institutional ethical approval, 14 female coaches and practitioners (32.9 ± 6.9 years) participated in individual semi-structured interviews. Following analysis, two themes were developed: (1) Knowledge and awareness and (2) Support and management. Overall, it appeared that participants varied in their understanding and awareness of the impact of the menstrual cycle on sport performance, somewhat influenced by their own personal experiences. Participants’ knowledge and awareness subsequently impacted the support they provided to female athletes. Additionally, individual experiences and perceived secrecy relating to the menstrual cycle impacted on the informational and emotional support participants provided. Together, the findings highlight the importance of all coaches and practitioners enhancing their knowledge and understanding regarding the menstrual cycle and proactively providing support to athletes. Education to enhance coaches’ and practitioners’ knowledge and understanding will help to create a more open and supportive environment in sport, hopefully allowing for personal discomfort regarding the menstrual cycle to be addressed.
When do businesses report cybercrime? Findings from a UK study
Authors: Kemp Steven , Buil-Gil David , Miró-Llinares Fernando , Lord Nicholas
Published: December 2021

Although it is known that businesses report cybercrime to public authorities at a low rate, and this hinders prevention strategies, there is a lack of research on companies’ decisions to report cyber victimisation. This paper analyses the UK Cyber Security Breaches Survey to explore factors associated with cybercrime reporting by businesses. Results indicate that the type of cybercrime is relevant to the reporting decision, and that the likelihood of reporting increases when cybersecurity incidents generate negative impacts and when the company places high priority on cybersecurity. However, we find no association between having cybersecurity insurance and reporting. Finally, while having outsourced cybersecurity management is associated with reporting to anyone outside the organisation but not to public authorities, in-house cybersecurity teams seem more inclined to report to public authorities. Findings are discussed in relation to the role of the private cybersecurity sector and the criminal justice system in combatting cybercrime.
Question design and the construction of populist stances in political news interviews
Authors: Thornborrow Joanna , Ekström Mats , Patrona Marianna
Published: December 2021

This paper focuses on the relationship between journalism and right wing populist discourses in the context of broadcast news interviews. We analyse a specific feature of question design in which the public is invoked as a source of opinionated positions in adversarial interviewing. Analysing data from a range of socio-political contexts, we identify a shift in adversarial questioning along a scale of ‘soft’ populism, that is the attribution of views and concerns to a generic public ‘in crisis’, to ‘hard’ populism, where interviewers construct hypothetical scenarios in which populist positions are attributed to ‘some people’. We argue that the democratic role of journalists as public watchdogs, holding politicians and public figures accountable on behalf of the public, is challenged by this normalisation of populist moral order discourses in a routine journalistic practice, both drawing on and contributing to the propagation of populist agendas and anti-democratic populist rhetoric.
A destructible headform for the assessment of sports impacts
Authors: Stone Ben , Mitchell Sean , Miyazaki Yusuke , Peirce Nicholas , Harland Andy
Published: December 2021

Commercially available headforms, such as the Hybrid-III and EN 960 headforms, have been used effectively to investigate the mechanics of head impacts. These headforms may result in accelerations that are unrepresentative of a human head in some impact scenarios. This may be important when considering impacts that produce areas of high pressure, since skull deformation and resonance excitation may influence the dynamic response. The National Operating Committee on Standards for Athletic Equipment (NOCSAE) headform may produce a more suitable response during these types of impacts due to the more representative skull component. However, permanent deformation may occur in some unprotected impact scenarios, resulting in the entire headform needing to be replaced. This paper outlines the development of a novel, modular and destructible headform (LU headform) that can be used in potentially destructive testing, where individual components can be replaced. The LU headform was modelled after a UK 50th percentile male. The inertial properties of the LU headform were within 6% of those observed in humans. The skull simulant properties were within the range of values reported for human tissue in two build orientations, but lower in one build orientation. The lowest and highest resonance frequencies observed in the headform model were within 5% of those observed in humans. Drop and projectile tests were conducted in line with previous cadaver tests with the observed accelerations within the range reported for post-mortem human subjects. The LU headform offers a practical means of simulating head dynamics during localised unprotected impacts or in protected impacts where local deformation and/or resonance frequency excitation remains possible.
The annual adult asthma review
Authors: Shanghavi Shilen
Published: December 2021

Asthma is a chronic inflammatory lung condition characterised by variable respiratory symptoms (wheeze, shortness of breath, cough, and chest tightness) and variable expiratory airflow limitation, usually associated with airway inflammation. It affects 1-in-11 people in the UK and is the cause of over 75 000 hospital admissions per year. Given its prevalence, and the fact that patients are mainly cared for in the community, this article aims to highlight the need for a thorough annual asthma review and what that review entails. When carried out effectively, an asthma review will improve quality of life for those living with the condition, reduce their likelihood of hospital admission and reduce the cost to the NHS as a whole.
Acute asthma
Authors: Wong Johanna
Published: December 2021

Asthma is a common chronic condition, characterised by episodic acute exacerbations, which may require emergency treatment. According to Asthma UK, nationally 5 400 000 people are being treated for asthma; with life-threatening asthma attacks occurring every 10 seconds and three lives lost daily. In acute asthma, symptoms, including breathlessness, chest tightness, wheeze and cough, deteriorate progressively. Individuals with asthma symptoms often present to primary care and it is important that GPs can recognise and appropriately manage acute asthma. This article reviews the background, recognition and management of acute asthma in adults and children over the age of five, drawing on current guidelines.
An In Silico Head-to-Head Comparison of the Do-It-Yourself Artificial Pancreas Loop and Bio-Inspired Artificial Pancreas Control Algorithms
Authors: Armiger Ryan , Reddy Monika , Oliver Nick S. , Georgiou Pantelis , Herrero Pau
Published: December 2021

Background:

User-developed automated insulin delivery systems, also referred to as do-it-yourself artificial pancreas systems (DIY APS), are in use by people living with type 1 diabetes. In this work, we evaluate, in silico, the DIY APS Loop control algorithm and compare it head-to-head with the bio-inspired artificial pancreas (BiAP) controller for which clinical data are available.

Methods:

The Python version of the Loop control algorithm called PyLoopKit was employed for evaluation purposes. A Python-MATLAB interface was created to integrate PyLoopKit with the UVa-Padova simulator. Two configurations of BiAP (non-adaptive and adaptive) were evaluated. In addition, the Tandem Basal-IQ predictive low-glucose suspend was used as a baseline algorithm. Two scenarios with different levels of variability were used to challenge the algorithms on the adult (n = 10) and adolescent (n = 10) virtual cohorts of the simulator.

Results:

Both BiAP and Loop improve, or maintain, glycemic control when compared with Basal-IQ. Under the scenario with lower variability, BiAP and Loop perform relatively similarly. However, BiAP, and in particular its adaptive configuration, outperformed Loop in the scenario with higher variability by increasing the percentage time in glucose target range 70-180 mg/dL (BiAP-Adaptive vs Loop vs Basal-IQ) (adults: 89.9% ± 3.2%* vs 79.5% ± 5.3%* vs 67.9% ± 8.3%; adolescents: 74.6 ± 9.5%* vs 53.0% ± 7.7% vs 55.4% ± 12.0%, where * indicates the significance of P < .05 calculated in sequential order) while maintaining the percentage time below range (adults: 0.89% ± 0.37% vs 1.72% ± 1.26% vs 3.41 ± 1.92%; adolescents: 2.87% ± 2.77% vs 4.90% ± 1.92% vs 4.17% ± 2.74%).

Conclusions:

Both Loop and BiAP algorithms are safe and improve glycemic control when compared, in silico, with Basal-IQ. However, BiAP appears significantly more robust to real-world challenges by outperforming Loop and Basal-IQ in the more challenging scenario.
Optic Flow: A History
Authors: Niehorster Diederick C.
Published: December 2021

The concept of optic flow, a global pattern of visual motion that is both caused by and signals self-motion, is canonically ascribed to James Gibson's 1950 book “ The Perception of the Visual World.” There have, however, been several other developments of this concept, chiefly by Gwilym Grindley and Edward Calvert. Based on rarely referenced scientific literature and archival research, this article describes the development of the concept of optic flow by the aforementioned authors and several others. The article furthermore presents the available evidence for interactions between these authors, focusing on whether parts of Gibson's proposal were derived from the work of Grindley or Calvert. While Grindley's work may have made Gibson aware of the geometrical facts of optic flow, Gibson's work is not derivative of Grindley's. It is furthermore shown that Gibson only learned of Calvert's work in 1956, almost a decade after Gibson first published his proposal. In conclusion, the development of the concept of optic flow presents an intriguing example of convergent thought in the progress of science.
Role of the Dorsal Posterior Parietal Cortex in the Accurate Perception of Object Magnitude in Peripheral Vision
Authors: Jurkiewicz Tristan , Salemme Romeo , Froment Caroline , Pisella Laure
Published: December 2021

Following superior parietal lobule and intraparietal sulcus (SPL-IPS) damage, optic ataxia patients underestimate the distance of objects in the ataxic visual field such that they produce hypometric pointing errors. The metrics of these pointing errors relative to visual target eccentricity fit the cortical magnification of central vision. The SPL-IPS would therefore implement an active “peripheral magnification” to match the real metrics of the environment for accurate action. We further hypothesized that this active compensation of the central magnification by the SPL-IPS contributes to actual object’ size perception in peripheral vision. Three optic ataxia patients and 10 age-matched controls were assessed in comparing the thickness of two rectangles flashed simultaneously, one in central and another in peripheral vision. The bilateral optic ataxia patient exhibited exaggerated underestimation bias and uncertainty compared to the control group in both visual fields. The two unilateral optic ataxia patients exhibited a pathological asymmetry between visual fields: size perception performance was affected in their contralesional peripheral visual field compared to their healthy side. These results demonstrate that the SPL-IPS contributes to accurate size perception in peripheral vision.
Understanding the clinical utility of favipiravir (T-705) in coronavirus disease of 2019: a review
Authors: Srinivasan Kritika , Rao Mana
Published: December 2021

The coronavirus disease of 2019 (COVID-19) has caused significant morbidity and mortality among infected individuals across the world. High transmissibility rate of the causative virus – Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) – has led to immense strain and bottlenecking of the health care system. While noteworthy advances in vaccine development have been made amid the current global pandemic, most therapeutic agents are repurposed from use in other viral infections and are being evaluated for efficacy in COVID-19. Favipiravir, an orally administered drug originally developed in Japan against emerging influenza viral strains, has been shown to have widespread application and safety across multiple ribonucleic acid (RNA) viral infections. With a strong affinity toward the viral RNA-dependent RNA polymerase (RdRp), favipiravir could be a promising therapy against SARS-CoV-2, by targeting downstream viral RNA replication. Initial trials for usage in COVID-19 have suggested that favipiravir administration during initial infection stages, in individuals with mild to moderate infection, has a strong potential to improve clinical outcomes. However, additional well-designed clinical trials are required to closely examine ideal timing of drug administration, dosage, and duration, to assess the role of favipiravir in COVID-19 therapy. This review provides evidence-based insights and throws light on the current clinical trials examining the efficacy of favipiravir in tackling COVID-19, including its mechanism, pharmacodynamics, and pharmacokinetics.
Republicans are more optimistic about economic mobility, but no less accurate
Authors: Grossmann Matt , Hamann Kayla , Lee Jennifer , Levy Gabrielle , Nyhan Brendan , Wu Victor
Published: December 2021

Do Americans overestimate economic mobility? Using representative surveys of the public and local government officials, we assess claims of widespread misperceptions about economic mobility by measuring the accuracy of participants’ perceptions of both relative and absolute mobility. Republican members of the public and government officials are more optimistic than are Democrats about poor children’s chances of reaching the highest income quintile (relative mobility) and earning more than their parents (absolute mobility). Democrats also rate race and family wealth as more important to children’s chances than do Republicans. However, partisan tendencies to overestimate or underestimate mobility are roughly symmetric despite differences in optimism; we only observe small and inconsistent differences in belief accuracy by party for both the public and local officials. Finally, accuracy is no greater for perceptions of state and local mobility than at the national level.
Exploring hospital nurses’ transitional medication management for older patients with multi-morbidity: An ethnographic study
Authors: Kollerup Mette Geil , Laursen Birgitte Schantz
Published: December 2021

Transitional medication management, in which individual needs are balanced against organizational priorities, is crucial for safe discharge processes. The aim of this study was to explore hospital nurses’ transitional medication management in the discharge of older patients with multi-morbidity. Using an ethnographic approach the data were collected through participant observations at a mixed medical ward at a Danish university hospital for two weeks. The participants were five registered nurses, responsible for nursing care of 23 patients with multi-morbidity and planned for discharge. The data comprised field notes that were analysed using iterative processes of domain, taxonomic and component analysis. The reporting adhered to the COREQ checklist. Hospital nurses’ transitional medication management was characterized by unpredictability and inconsistency in patient situations, fragmentation and discontinuity in working processes and complexity in communication systems. Special attention to nurses’ needs assessment skills and clinical decision making in caring for patients with multi-morbidity in a single focused healthcare system is required.
Belt and Road projects in Tajikistan: Opportunities to strengthen the ties between Pakistan and Tajikistan
Authors: Rashid Dr. Muhammad Imran , Iqbal Mehran , Nawab Muhammad Waqas
Published: December 2021

Belt and Road Initiative (BRI) projects in Tajikistan are significant due to Tajikistan's geostrategic importance in the region. Tajikistan has channeled its geo-strategic values and established diplomatic and economic relations with regional and extra-regional states. China and Tajikistan's diplomatic relations were started in 1997, which marked another milestone when countries resolved their border disputes bilaterally in 2021. Since China introduced its BRI, its existing diplomatic relations with Tajikistan have changed to close economic ties. Hence, it uplifted the pace of existing economic projects between China and Tajikistan, with the introduction of new projects, some branded as BRI projects, and others are complementing it. In this scenario, China through the BRI provides an opportunity for Pakistan and Tajikistan to enhance and strengthen their economic and diplomatic ties. Both Pakistan and Tajikistan need a great deal of cooperation for further progress of both states in contemporary times. It is important to identify the ongoing process in the region to pinpoint the future policy options for further development. This article analyzes the geostrategic importance of Tajikistan and its relations with regional and extra-regional states. It also focusses on the concluded, ongoing, and planned projects regarding enhancing the geostrategy of the states that are in line with the BRI. Further, it explores the existing Pakistan–Tajikistan relations and new prospects, along with the challenges in future prospects.
Leveraging Interdisciplinary Teams for Pre-Visit Planning to Improve Pneumococcal Immunization Rates Among Internal Medicine Subspecialty Practices
Authors: Shafer Rebecca , Kearns Christina , Carney Maria , Sagar Ankita
Published: December 2021

Background:

Despite the ready availability of pneumococcal vaccines and recommendation of vaccination by Center for Disease Control and Prevention (CDC), the immunization rates among adults less than 65 years of age with chronic and immunocompromised conditions remain low.

Methods:

This interventional (cohort) study aimed to improve the pneumococcal vaccination rate for patients with an increased risk of pneumococcal disease by utilizing a three-pronged approach. This included: (1) clinician education webinar, (2) pre-visit counseling performed by registered nurses, targeted toward patients with upcoming appointments, to address vaccination status, and (3) modified pre-visit interdisciplinary team huddle with clinicians and registered nurses to review which patients are amenable to vaccination at the time of visit and those who may benefit from re-engagement and further motivational interviewing. After the completion of the 10-week intervention, study organizers reviewed the percent of patients with completed pneumococcal vaccinations.

Results:

In this 10-week rapid cycle initiative, a total of 482 patients were eligible for vaccination. During the intervention phase, 370 patients were contacted and of these 38% of patients were amenable to receiving a vaccine during the pre-visit counseling, 5% were previously vaccinated, 18% were not amenable, and 38% were unreachable prior to visit. This initiative resulted in a 43% increase in the vaccination rate in this cohort.

Conclusions:

The significant increase in vaccination rate supports the utilization of a framework in the multidisciplinary approach to pre-visit planning in non-primary care specialties and other vaccination efforts, especially emerging diseases such as COVID-19. Future directions of study include the efficacy of telemedicine counseling with a same-day appointment for vaccination, co-location of registered nurses within the practice sites, as well as the use of other ancillary staff (such as medical office assistants) to engage patients in pre-visit planning.
Calcification Causing Failure of Tissue Engineered Bovine Pericardium After Aortic Valve Repair
Authors: Patukale Aditya A , Davies Janene , Marathe Supreet , Alphonso Nelson , Venugopal Prem
Published: December 2021

CardioCel® is bovine pericardium which is subjected to a novel tissue engineering process (ADAPT®) to reduce cytotoxicity and retard calcification while maintaining strength and elasticity. We present a case where CardioCel® showed rapid degeneration and calcification after repair of an aortic valve.
Research Practices and Needs Among Spine Surgeons Worldwide
Authors: Germscheid Niccole , Cheung Jason P. Y. , Neva Marko H. , Öner F. Cumhur , Kwon Brian K. , Valacco Marcelo , Awwad Waleed , Sciubba Daniel M. , Lewis Stephen J. , Rhines Laurence D. , Yoon S. Tim , Alini Mauro , Grad Sibylle , Fisher Charles G. , Samartzis Dino
Published: December 2021

Objective

Resource allocation to research activities is challenging and there is limited evidence to justify decisions. Members of AO Spine were surveyed to understand the research practices and needs of spine surgeons worldwide.

Methods

An 84-item survey was distributed to the AO Spine community in September of 2020. Respondent demographics and insights regarding research registries, training and education, mentorship, grants and financial support, and future directions were collected. Responses were anonymous and compared among regions.

Results

A total of 333 spine surgeons representing all geographic regions responded; 52.3% were affiliated with an academic/university hospital, 91.0% conducted clinical research, and 60.9% had 5+ years of research experience. There was heterogeneity among research practices and needs across regions. North American respondents had more research experience ( P = .023), began conducting research early on ( P < .001), had an undergraduate science degree ( P < .001), and were more likely to have access to a research coordinator or support staff ( P = .042) compared to other regions. While all regions expressed having the same challenges in conducting research, Latin America, and Middle East/Northern Africa respondents were less encouraged to do research ( P < .001). Despite regional differences, there was global support for research registries and research training and education.

Conclusion

To advance spine care worldwide, spine societies should establish guidelines, conduct studies on pain management, and support predictive analytic modeling. Tailoring local/regional programs according to regional needs is advised. These results can assist spine societies in developing long-term research strategies and provide justified rationale to governments and funding agencies.
Racial Disparity in Immediate Breast Reconstruction; a Gap That is not Closing
Authors: Malekpour Mahdi , Devitt Sean , DeSantis Joseph , Kauffman Christian
Published: December 2021

Background: Immediate breast reconstruction (IBR) is offered as part of the standard-of-care to females undergoing mastectomy. Racial disparity in IBR has been previously reported with a longstanding call for its elimination, though unknown if this goal is achieved. The aim of this study was to examine the current association between race and IBR and to investigate whether racial disparity is diminishing. Methods: Data was extracted from the National Cancer Database (NCDB) from 2004 to 2016. All variables in the database were controlled so that the comparison would be made solely between Black and White females. We also analyzed the trend in racial disparity to see if there has been a change from 2004 to 2016 after several calls for healthcare equality. Results: After propensity score matching, 69,084 White females were compared to 69,084 Black females. There was a statistically significant difference between the rate of IBR and race (23,386 [33.9%] in White females vs 20,850 [30.2%] in Black females, P-value  < .001). Despite a twofold increase in the rate of IBR in both White and Black females, a persistent gap of about 4% was observed over the study period, which translates to more than 2,500 Black females not receiving IBR. Conclusions: Using the NCDB database, a racial disparity was identified for IBR between White and Black females from 2004 and 2016. Unfortunately, the gap between the groups remained constant over this 13-year period.
Exploring Linkages Between Workplace Spirituality and Occupational Stress Among Indian Police Personnel
Authors: Jalan Stuti , Garg Naval
Published: December 2021

The inclusion of spirituality at workplaces has yielded significant advantages for the employees and the organisations. The present study probes the optimistic facet of workplace spirituality (WPS) to identify its linkages with one of the most daunting issues for organisations, occupational stress (OS). Police officers from Himachal Pradesh, a hilly state in Northern India, were approached and responses were collected from 385 participants. The study utilises the three-dimensional WPS measure conceptualised by Milliman et al. (2003) . Sense of community and value alignment was found to be explaining significant variance in occupational stress. The findings demonstrate the importance of embracing WPS as an effective tool for alleviating OS, thereby augmenting the performance and morale and guiding strategy formulation of future human resource development activities.
Knowledge and Impact of COVID-19 on Middle-Aged and Older People Living with HIV in Lima, Peru
Authors: Diaz Monica M. , Cabrera Diego M. , Gil-Zacarias Marcela , Ramirez Valeria , Saavedra Manuel , Cárcamo Cesar , Hsieh Evelyn , Garcia Patricia J.
Published: December 2021

COVID-19 has had an unprecedented worldwide impact, and Peru has had one of the highest COVID-19 case rates despite implementation of an early strict nationwide quarantine. Repercussions on Peru's healthcare system may impact vulnerable populations, particularly people with HIV (PWH). We explored knowledge of COVID-19 and the socioeconomic and health impact of the pandemic among middle-aged and older PWH. A cross-sectional telephone survey was administered to 156 PWH age ≥40 years receiving care in one of two large HIV clinics in Lima, Peru. The majority of PWH (age 52 ± 7.7 years, 41% female, 65% completed secondary school or less) were knowledgeable regarding COVID-19 symptoms and prevention methods. Nearly half of those employed prior to the pandemic reported job loss. Female sex (unadjusted prevalence ratio [PR] 1.85 [95%CI 1.27-2.69]), low educational level (PR 1.62 [1.06-2.48]) and informal work (PR 1.58 [1.06-2.36]) were risk factors for unemployment but not in adjusted models. Increased anxiety was reported in 64% and stress in 77%. COVID-19 has had a substantial socioeconomic and mental health impact on PWH living in Lima, Peru, particularly those with lower educational levels and informal workers. Efforts are needed to ensure continued medical care and socioeconomic support of PWH in Peru.
The Intersecting Consequences of Race-Gender Health Disparities on Workforce Engagement for Older Workers: An Examination of Physical and Mental Health
Authors: Jason Kendra , Erving Christy L.
Published: December 2021

The dramatic growth of older adults’ labor participation over the past 25 years, including women and people of color, is reshaping the American labor force. The current study contributes new knowledge concerning why individuals over age 50 years may be working longer despite negative impacts of deteriorating physical and mental health associated with aging. Inquiries regarding who continues to work and why can be answered, in part, by addressing how workforce engagement and health are shaped by notable social inequities along the dimensions of age, race, and gender. Guided by cumulative advantage/disadvantage and intersectionality frameworks, we examine whether having multiple chronic conditions (MCC)—two or more physical conditions—and depression affect workforce participation. Using multinomial logistic regression models, we analyze the 2014–2016 waves of the Health and Retirement Study ( N = 4250). Findings reveal that having multiple chronic illnesses increase the likelihood of labor force exit, especially among workers who also have depression. We also discover intersectional nuances which illuminate complex race-gender dynamics related to health and work processes in later life. We conclude with recommendations for workplace policy that promote the retention of older workers with chronic illness and depression and aim to decrease disparities in older workers’ work engagement.
A Pipeline to Increase Public Health Diversity: Describing the Academic Enrichment Components of the Summer Public Health Scholars Program
Authors: Joyner Danielle M. , Faris Eman , Hernández Diana , Moon Howard Joyce , Fullilove Robert E. , Cohn Elizabeth G. , Odlum Michelle , Mitchell Dennis , Hutcherson Hilda
Published: December 2021

A public health workforce that reflects the increasing diversity of the U.S. population is critical for health promotion and to eliminate persistent health disparities. Academic institutions must provide appropriate education and training to increase diversity in public health professions to improve efforts to provide culturally competent care and programs in the most vulnerable communities. Reaching into the existing talent pool of diverse candidates at the undergraduate level is a promising avenue for building a pipeline to advanced training and professional careers in the field of public health. The Summer Public Health Scholars Program (SPHSP) at the Columbia University Irving Medical Center (CUIMC) is a 10-week summer internship program with a mission to increase knowledge and interest in public health and biomedical sciences. Funded by the Centers for Disease Control and Prevention’s (CDC) Undergraduate Public Health Summer Programs, sponsored by the CDC’s Office of Minority Health and Health Equity, SPHSP aims to pipeline underrepresented students into public health graduate programs and careers by providing mentorship, academic enrichment, professional development, and field-based placements. The SPHSP is uniquely positioned to offer scholars a program that exposes them to core public health training components through the joint effort of all four CUIMC schools: public health, dentistry, nursing, and medicine. Here, we describe the program’s academic enrichment components, which provide advanced and multifaceted public health training opportunities. We discuss the impacts of the program on student outcomes and lessons learned in developing and refining the program model.
Qualitative Examination of Shared Decision-Making in Canada’s Largest Health System: More Work to be Done
Authors: Guirguis Micheal , Thompson Erin , Miller Jenna , Sommer Ryan , Curran-Cook Danielle , Kaba Alyshah
Published: December 2021

Background: Shared Decision-Making (SDM) is an inclusive approach where patients and providers work in partnership to make health care decisions that are grounded in clinical best practice and align with patient preferences and values. Despite a growing recognition that SDM can lead to improved outcomes and reductions in unnecessary health investigations, tensions exist between patient agency and a historically paternalistic model of health care. As an evolving ideology, the Research Team sought to better understand the current state, challenges, and implementation opportunities of SDM practices across the health system. Methods: This study used a cross-sectional quality improvement design utilizing semistructured interviews to gather information from focus group participants. Five open-ended, qualitative questions were used to generate discussion on the perceptions of SDM and its role in clinical appropriateness in a variety of clinical contexts in our health system. A total of 12 focus groups (n = 95 participants) representative of patients and families, leaders, physicians, and frontline clinicians were engaged in the study. Results: Through a consensus-based approach, study results identified 4 recommendations based on 4 themes: Time, Communication, System Design, and Clinical Appropriateness. Conclusion: There are no easy solutions to the challenges of enabling SDM; however, success will be dependent upon recognizing the importance of patient agency, while maintaining an inclusive and continuous stakeholder engagement with both patients and providers. Implementation of the 4 recommendations at the organizational level highlighted in this study can serve as a road map for other health care institutions and will require a gradual approach to transform the general principles of SDM into tangible solutions to meet the emerging needs at both the local and system level.
Assessment of proton-pump inhibitor use at a tertiary teaching hospital in Nigeria
Authors: Okoro Roland Nnaemeka , Abdullahi Kasim , Dayar Dauda Ayuba
Published: December 2021

Background:

Proton-pump inhibitor (PPI) is a widely used medication class globally. Because of its good safety profile, there is a huge likelihood of inappropriate use.

Objectives:

To determine the prevalence of PPI use and indications, describe its pattern of usage, and identify factors associated with inappropriate prescriptions at a federal tertiary teaching hospital in Maiduguri, Nigeria.

Methods:

PPI prescriptions were retrospectively assessed in the General Outpatients’ Department (GOPD) and Gastroenterology Unit (GITU) of a teaching hospital. Relevant data for the study were extracted from the patients’ medical records. Chi-square or Fisher’s exact tests where appropriate were used to identify factors associated with inappropriate PPI prescriptions. A p < 0.05 was considered to be significant.

Results:

PPIs were prescribed to 73.3% (220/300) of patients, while inappropriate prescriptions were noted in 91.4% (201/220) of these patients. Epigastric pain (49.5%) was the most common PPI indication, while omeprazole was the highest prescribed (53.4%). Nearly all inpatients (98.2%), those with epigastric pain (95.7%), and patients who were prescribed intravenous PPIs had more inappropriate PPI prescriptions compared to others.

Conclusion:

This study revealed a high prevalence of PPI use and inappropriate prescriptions at the study hospital. As a result, these findings highlight the importance PPI-based stewardship program at the study hospital.
Coats’ disease: trends and long-term treatment outcomes in a tertiary referral centre
Authors: Oli Avadhesh , Balakrishnan Divya , Jalali Subhadra
Published: December 2021

Background:

The long-term treatment outcomes in Coat’s disease – particularly in the era of newer pharmacotherapies such as anti-vascular endothelial growth factor (VEGF) agents and depot steroids – are poorly understood.

Aim:

To describe the clinical features and treatment outcomes of 148 eyes with Coats’ disease assessed in a referral centre over 30 years.

Materials and methods:

We conducted a retrospective chart review of patients diagnosed with Coats’ disease between 1 June 1987 and 31 July 2017. The demographic, clinical and treatment data were collected and long-term functional and anatomical outcomes were analysed based on the treatment either with conventional therapy (cryo/laser) or along with adjuvants like intravitreal steroids or anti-VEGFs.

Results:

The mean age at presentation was 15.22 years (median 11). Familial exudative vitreoretinopathy was the most common referral diagnosis, 76/148 (51.5%), followed by Coats’ disease, 37/148 (25%), and retinoblastoma, 35/148 (23.6%). Stage 3B was most common at presentation (31.8%), followed by 2B (22.3%) and 2A (16.9%). A total of 107 patients were treated either with conventional therapy or in combination with adjuvants. The mean follow-up period was 24.95 months. The visual acuity improved from baseline logMAR 2.17 (Snellen-20/2958) to logMAR 1.88 (Snellen-20/1517) at final follow-up ( p = 0.004). The improvement in visual acuity was better when the presenting BCVA was <1 logMAR (Snellen 20/200), p = 0.004. No statistically significant change in BCVA was noted between conventional and adjuvant groups, p = 0.5. However, the final anatomical outcome was good in 78/99 (78.8%) in the conventional group and 45/49 (91.8%) in the adjuvant group, respectively ( p = 0.046).

Conclusion:

In this series of patients with Coats’ disease over three decades, the use of intravitreal steroids or anti-VEGFs as adjuvants resulted in better anatomical outcomes. A better baseline visual acuity, lower stage of the disease, and older age at presentation were found to be the factors leading to favourable visual outcomes.

In the current series of 148 eyes with Coats’ disease, adjuvant treatment with intravitreal steroids or anti-VEGFs resulted in better outcomes as compared with conventional cryotherapy or laser photocoagulation alone. Patients with Coats’ disease who had presented with better visual acuity at baseline, lower stage of the disease and older age had better final visual outcomes.