bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigating the potential of parallel hybrid-electric retrofit of narrow-body airliner for emission reduction
Authors: Jiang Tianhong , Liu Yaolong , Zheng Yao , Elham Ali
Published: November 2023

Due to the high power and energy demands of large aircraft and low energy density of batteries, parallel hybrid-electric propulsion (HEP) is an in-between solution to reduce carbon emissions instead of full-electric propulsion. Considering the long in-service time, parallel HEP retrofit of existing large commercial or transport aircraft is favorable for technical risks and economic values. To enhance the reliability of the analysis, a comprehensive parallel HEP retrofit study of a narrow-body airliner is carried out in this paper. At first, efficient and accurate aerodynamic and engine deck surrogate models are built to include multidisciplinary impacts. To capture the off-design performance, a detailed flight mission is modeled based on exact flight dynamic equations, which is solved in a time-stepping manner. Then, the hybridization levels and battery usage strategy are thoroughly investigated. Besides, fuel burn, carbon emissions, and total energy consumption performance is studied for fixed take-off weight and selected flight range scenarios. The results show that the total energy in flight can be reduced by 7.9% and fuel combustion and carbon emissions can be reduced by 13.2% for the 2000 km flight distance case compared to the reference case. The greenhouse gas (GHG) emission reductions are 3059.8 kg CO2, 1220.0 kg H2O, 0.1937 kg SO4, and 0.0387 kg soot. As our methods have incorporated reliable multidisciplinary data and off-design features, the results and conclusions on the parallel HEP retrofit of large aircraft for carbon emission reductions and sustainable aviation goals are more relevant.
Polyneuritis cranialis as a unique initial presentation of juvenile systemic lupus erythematosus: Case report
Authors: Tomoum Hoda , El-Owaidy Rasha , El-Zohiery Abeer
Published: November 2023

Cranial neuropathy is a rare presentation in juvenile (j) SLE and being multiple is even rarer. We describe here an adolescent girl presenting with polyneuritis cranialis (PNC) as an initial presentation of SLE which had not been reported before in literature. She presented with symptoms suggestive of bilateral abducent and hypoglossal neuropathy with nerve conduction studies showing partial axonal neuropathy of left facial and accessory nerves, 6 weeks after common cold. The condition was not associated with any other neurological or systemic manifestations nor features of Sjogren’s syndrome. Her condition responded well to pulsed methylprednisolone therapy and plasma exchange. After exclusion of the common causes and owing to the initial positive ANA results and mild proteinuria, renal biopsy was taken and revealed histopathological features of class III lupus nephritis for which mycophenolate mofetil was started at 1200 mg per m2. Our case highlights the importance of considering collagen disorders including SLE in the differential diagnosis of children presenting with PNC in order to allow adequate management and proper follow-up.
Perspectives on the role of the nurse ethicist
Authors: Jones Jenny , Ford Paul J , Birchley Giles , Monteverde Settimio
Published: November 2023

This paper offers four contrasting perspectives on the role of the nurse ethicist from authors based in different areas of world, with different professional backgrounds and at different career stages. Each author raises questions about how to understand the role of the nurse ethicist. The first author reflects upon their career, the scope and purpose of their work, ultimately arguing that the distinction between ‘nurse ethicist’ and ‘clinical ethicist’ is largely irrelevant. The second author describes the impact and value that a nurse in an ethics role plays, highlighting the ‘tacit knowledge’ and ‘lived experience’ they bring to clinical ethics consultation. However, the second author also warns that the ‘nurse ethicist’ must be cautious in their approach to avoid being viewed as a resource only for nurses. The third author questions the introduction of additional professional distinctions such as ‘nurse ethicist’ on the basis that distinctions threaten the creation of egalitarian healthcare systems, while also acknowledging that clinical ethicists ought not strive for objective attachment in their work. In direct contrast, the final author suggests that the nurse ethicist can play a pivotal role in highlighting and addressing ethical challenges that are specific to nurses. These four short pieces raise questions and point to concepts that will be expanded upon and debated throughout this special issue of Nursing Ethics.
In-service Training of Urban Local Body Functionaries for Swachh Bharat Mission (Urban)
Authors: Mani Shyamala K. , Roquaiya  , Masilamani R. J.
Published: November 2023

This paper is an empirical attempt to demonstrate the significance of capacity-building training which was conducted by the National Institute of Urban Affairs (NIUA) on behalf of the Ministry of Housing and Urban Affairs under the Swachh Bharat Mission-Urban (SBM-U). The paper focuses on sanitation and solid-waste management (SWM), two issues which are directly under the purview of urban local bodies (ULBs). The objectives of the SBM-U 1.0 are to make all cities and towns open defecation free and garbage free by 2 October 2019. Towards this end, NIUA has conducted training-cum-exposure workshops in 2016, 2017, 2018 and 2019 for ULBs. These comprise orientation, technical sessions as well as field visits. The pedagogy of these workshops is based on experiential learning theory (ELT), with suitable innovations, employed for educating through first-hand experience. An evaluation of the efficacy of the ELT model was carried out through a research questionnaire filled out by the participants during 2017–2018 and 2018–2019 of selected states and was analysed for the understanding and implementation of service-level processing parameters in their states.
Teachers’ Digital Literacy Ability to Improve Islamic Religion Education Learning in Islamic Boarding School
Authors: Malla Hamlan Andi Baso , Hamka  , Haryani Anies , Abu Ardillah , Nur Askar
Published: November 2023

This study aims to explain the ability of teachers’ digital literacy in the discipline of Islamic Religious Education at MTs Nahdlatul Khairaat Islamic Boarding School, Labuan, Donggala Regency. The type of research used is qualitative research using data collection techniques. The data analysis process in this study uses NVivo software. The results of this study indicate that the digital literacy skills of teachers in the discipline of Islamic Religious Education at MTs Nahdlatul Khairaat Labuan Islamic Boarding School have been going quite well, especially in terms of teachers’ understanding in using LCD projectors, utilization of information technology, and PowerPoint.
Parental Educational Levels and Occupations as Determinants of Their Children's Examination Integrity and Academic Performance
Authors: Ossai Moses C. , Ethe Nathaniel , Edougha Dennis E. , Okeh Onomiroro D.
Published: November 2023

This study examined the impact of parental levels of education and occupations on students’ examination integrity and academic performance. It was based on the Theory of Planned Behaviour. Expost-facto and survey research designs were used in the study. Data was collected with an Academic Integrity Measurement Instrument from 3214 sampled students and their academic performance in their last school examination was collected from their school authorities. The two-way ANOVA was used to run the analysis for determining the association or differences between parental level of education and occupations as independent variables and examination integrity and academic performance as dependent variables. It was found that fathers who have master’s degrees and mothers who have bachelor’s degree/HND exerted the greatest impact on their children's examination integrity. Fathers who belong to the military/police occupations and Mothers who are unemployed have the greatest impact on their children's examination integrity while parents who belong to the civil service and military/police occupations have the greatest impact on their children's academic performance. It was, therefore, concluded that parental levels of education and occupations significantly impact students’ examination integrity and academic performance and implications of these findings for adoption of proactive strategies against examination malpractices were discussed.
The relationship between the in situ flanking sound reduction index and the laboratory measured flanking normalized level difference
Authors: Mahn Jeffrey , Müller-Trapet Markus
Published: November 2023

From Gerretsen’s 1979 Applied Acoustics paper through four series of standards including ISO 12354 and ISO 10848, a significant amount of effort has gone into creating a standardized prediction method that uses standardized laboratory measured values to predict the apparent sound reduction index to demonstrate compliance with regulations. The terms and equations in the prediction method have evolved over time as researchers have evaluated the results of the prediction method, especially in the case of lightweight constructions for which statistical energy analysis is not well suited. To reflect the changes to other equations in the prediction method over the past 40 years, this paper suggests an update to the relationship in ISO 12354-1 between the in situ flanking sound reduction index and the laboratory measured flanking normalized level difference. The suggested changes are of importance for Type B elements such as timber and steel framed walls and floors for which the prediction of flanking transmission according to ISO 12354 requires the measurement of the level difference in laboratory flanking facilities.
Factor XI/XIa inhibitors for the prevention and treatment of venous and arterial thromboembolism: A narrative review
Authors: Prakash Swathi , Mares Adriana C , Porres-Aguilar Mateo , Mukherjee Debabrata , Barnes Geoffrey D
Published: November 2023

During the past decade, direct oral anticoagulants (DOACs) have advanced and simplified the prevention and treatment of venous thromboembolism (VTE). However, there remains a high incidence of bleeds, which calls for agents that have a reduced risk of bleeding. Factor XI (FXI) deficiency is associated with lower rates of venous thrombosis and stroke compared to the general population with a lower risk of bleeding. In conjunction with this, phase 2 studies have demonstrated safety and the potential for reduced thrombotic events with FXI inhibitors as compared to currently available medications. The aim of this review is to summarize key data on the clinical pharmacology of FXI, the latest developments in clinical trials of FXI inhibitors, and to describe the efficacy and safety profiles of FXI inhibitors for the prevention of venous and arterial thromboembolism.
Penetrating firearm tracheal injury with cardiac arrest due to tension pneumopericardium
Authors: Patel Takshaka , Dulak Deirdre , Sjoholm Lars Ola , Petrov Roman
Published: November 2023

Firearm-associated tracheal injuries occur infrequently and as such there is no standard approach. We present a case of tension pneumopericardium due to a firearm-associated tracheal injury which was successfully repaired through an anterior midline sternotomy approach. In hemodynamically unstable patients who cannot tolerate posterolateral approaches, the anterior midline sternotomy approach to the airway should be considered. We demonstrate that this approach can provide adequate access for decompression of tension physiology and repair of airway injury.
Storybook reading: Literacy and teacher knowledge in early childhood education
Authors: Williamson Joanna , Hedges Helen , Jesson Rebecca
Published: November 2023

Language and literacy are prioritised across education as tools for thinking with texts, and cultural tools to access participation in society, culture and learning. Teacher knowledge about ways to promote language and literacy are therefore critical. How might this intention play out in early childhood education, where longstanding beliefs about play and child-centred education have dominated Western provision? This paper explores teacher knowledge brought to playful storybook reading interactions between teachers and children aged 3–5 years in a qualitative study of two early childhood settings in Aotearoa, New Zealand. Teachers were explicitly and implicitly aware of specific teacher knowledge they brought to these interactions, prioritising knowledge of children and pedagogy while cognisant of language learning. The paper argues that blending Shulman’s seminal thinking about professional knowledge categories with tenets of early childhood pedagogy shows a way forward for thinking about teacher knowledge and professional learning that involves responsive, relational pedagogy in the context of story book reading. When teachers can confidently articulate and critically reflect on their pedagogies and decision-making, and are supported through professional learning and policy such as low teacher-child ratios, they might provide a sound foundation in the development of language and literacy for children.
On the meaning of bankruptcy: ‘Old–new’ lexicon in corporate insolvency law in the Commonwealth Caribbean
Authors: Blake Celia
Published: November 2023

Several jurisdictions in the Commonwealth Caribbean have undertaken reform and modernisation of their insolvency legislation. The dominant model for the new enactments has been Canada's federal statute, the Bankruptcy and Insolvency Act, RSC 1985, which has already been transplanted into six jurisdictions of the region. The transplantation has introduced lexicon which, while part of the vocabulary of the old statutes for personal insolvency, has, traditionally, been unfamiliar to the region's corporate insolvency law, hence the phrase, ‘“old–new” lexicon’, in the title. This article examines the meanings of some of this lexicon, particularly ‘bankruptcy’ and cognate terms, including ‘acts of bankruptcy’. The examination extends to the term ‘receiving order’, operationally related to bankruptcy. Legal interpretation of the terms is enriched in the discussion by insights from linguistics. While showing that the importation of these terms into the region's corporate insolvency law is semantically problematic, the article elucidates the signification of the terms. It points out that some of the ‘old–new’ terms may tend to reduce the efficacy in the contemplated lay administration of the statutes. It also warns that the ‘old–new’ lexicon threatens to undermine key goals of the reform exercise, suggesting a need for deeper scrutiny in the transplantation process.
The Family Context in Cybervictimization: A Systematic Review and Meta-Analysis
Authors: Lozano-Blasco Raquel , Barreiro-Collazo Alejandra , Romero-Gonzalez Borja , Soto-Sanchez Alberto
Published: November 2023

The use of Information and Communication Technologies is clearly widespread among adolescents from a young age. Although it poses a significant contribution at the academic, social, and emotional levels, it can also involve a set of important risks, including cyberbullying and, therefore, cybervictimization. Previous studies have pointed out the importance of family context since parental control and family communication emerge as contributors to this phenomenon. Therefore, the aim of the present study was to analyze the influence of family communication on cybervictims and the moderating role of different sociodemographic variables (age, gender, nationality, and culture), as well as social, emotional, and personality variables. In this context, a meta-analysis was performed with a random effects model, using a total meta-sample of 29,093 adolescents (mean age: 14.50 years) distributed in k = 20 samples belonging to nine studies on cybervictimization published in English in Q1 journals between 2015 and 2020. The results showed that family offensive communication is related to cybervictimization. This could be because the affected individuals often use social media to compensate for the deficiencies they perceive within their families, as well as to obtain support, which increases their time spent on the Internet and their exposure to this phenomenon. These findings highlight the need for family and community interventions, not only school-based or individual interventions.
Messaging White and Black Next of Kin in Advance to Promote Authorization for Tissue Donation
Authors: Siminoff Laura A. , Wilson-Genderson Maureen , West Sharon M. , Hasz Richard D. , Suplee Lawrence , Clarke John , Barker K. Laura , Mulvania Patricia A.
Published: November 2023

Introduction: Organ Procurement Organizations seek authorization for tissue donation from next-of-kin of deceased patients. Best practices for achieving contact and authorization are unknown, notably, authorization rates are lower for Black compared to White patients. Research Questions: Can next-of-kin (NOK) contact and authorization rates be improved if they are texted prior to telephone contact? Is a text message containing an infographic more effective, and does an infographic culturally tailored to Black families improve contact and authorization rates in the Black population? Design: This three-armed randomized trial compared (1) telephonic contact initiation (control condition); (2) generic text messaging prior to telephonic contact; and (3) text messaging one of two versions of an infographic prior to telephonic contact: (a) a generic infographic or (b) a culturally tailored infographic (sent to Black NOK only) at one Northeastern Organ Procurement Organization. Results: Tissue Donation Professionals (N = 47) and 2399 White and 745 Black NOK were included, of which 35.6% were registered donors. Authorization rates were much higher for White than Black (40.1% v 16.3%, P < 0.0001). The generic infographic resulted in significantly lower rates of contact for White NOK compared to the control condition 83.5% v 89.5%, P = 0.002), but study arm assignments were not otherwise associated with differences in contact or authorization rates. Conclusion: Although the analysis did not find a benefit for text messaging, it is possible that training for staff making requests and refining the content of the messaging could be more effective.
Intervention and Prevention of Dementia in the Greater Bay Area (GBA) of China
Authors: Weekes Brendan , Carthery-Goulart Maria Teresa
Published: November 2023

Reserve and resilience are recognized as essential for effective intervention and prevention of dementia. However, it is not known if these factors also protect against risk for dementia in the Greater Bay Area (GBA) of Mainland China. Studies of risk factors across regions of China provide an evidence base for future research in the GBA. However, population-based studies are rare and do not account for the cultural differences in levels of education, income, literacy and modifiable lifestyle factors. Critically, extant studies do not allow for differences in languages spoken across the region, which will bias results and potentially minimize true prevalence. Based on the conclusions reported in this Special Collection, research in the GBA should focus on resilience and reserve using preserved native language communication skills.
Chaplain, Can You Carry This Cross for Me? A Reflection on My First Year of CPE—Clinical Pastoral Education
Authors: Hanegraaff Christina Marie
Published: November 2023

What is the meaning of sacrament? How can a professional Orthodox Christian lay chaplain participate in sacramental ministry without the grace given by ordination? This piece on Christina Hanegraaff's first year as a Clinical Pastoral Education resident explores this question through reflecting on her experiences of entering into people's suffering and carrying their cross alongside them—a modern-day Simon of Cyrene.
Placating White Fragility for Indigenous Students and Communities
Authors: O’Shea Cailen , Hudson Dinorah , Suwak Katarina , Mackey Hollie
Published: November 2023

What should an educational leader passionate about all students do when they are told educational equity is not allowed in their district? What does a director of Indigenous education do when funding earmarked for Indigenous students is redirected to other school priorities? What should be done when the very teachers who need training in cultural responsivity are the strongest in opposition to learning about what makes their students unique and how they can adjust their instruction to meet their students’ needs? This paper examines how three Indigenous educational leaders are forced to balance Eurocentric district mandates and white fragility with the strengths and conditions of the Indigenous students and communities they serve. The authors highlight efforts for readers to gain a better understanding of the current state of public education for Indigenous students, families, and communities.
Green Lead Nanoparticles Induced Apoptosis and Cytotoxicity in MDA-MB-231 Cells by Inducing Reactive Oxygen Species and Caspase 3/7 Enzymes
Authors: Alsulami Wadyan Lafi , Ali Daoud , Almutairi Bader O. , Yaseen Khadijah N. , Alkahtani Saad , Almeer Rafa A. , Alarifi Saud
Published: November 2023

Nanoparticles are widely used in the pharmaceutical, agriculture, and food processing industries. In this study, we have synthesized green lead nanoparticles (gPbNPs) by using an extract of Ziziphus spina-christi leaves and determined their cytotoxic and apoptotic effect on the human breast cancer MDA-MB-231 cell line. gPbNPs were characterized by using X-ray diffraction (XRD), energy dispersive X-ray (EDX) scanning electron microscope (SEM), and transmission electron microscope (TEM). The toxicity of gPbNPs was determined on the MDA-MB-231 cell line using MTT and NRU assays and as a result cell viability was reduced in a concentration-dependent manner. MDA-MB-231 cells were more sensitive at the highest concentration of gPbNPs exposure. In this experiment, we observed the production of intracellular ROS in cells, and induction of caspase 3/7 was higher in cells at 42 µg/ml of gPbNPs. Moreover, the Bax gene was upregulated and the Bcl-2 gene was downregulated and increased caspase 3/7 activity confirmed the apoptotic effect of gPbNPs in cells. Our observation showed that gPbNPs induced cell toxicity, increased generation of intracellular ROS, and gene expression of Bcl-2 and Bax in the MDA-MB-231 cell line. In conclusion, these findings demonstrated that gPbNPs executed toxic effects on the MDA-MB-231 cell line through activating caspase 3/7 activity.
Disease activity 4.5 years after starting cladribine: experience in 264 patients with multiple sclerosis
Authors: Allen-Philbey Kimberley , De Trane Stefania , MacDougall Amy , Adams Ashok , Bianchi Lucia , Campion Thomas , Giovannoni Gavin , Gnanapavan Sharmilee , Holden David W. , Marta Monica , Mathews Joela , Turner Benjamin P. , Baker David , Schmierer Klaus
Published: November 2023

Background:

Cladribine is an effective immunotherapy for people with multiple sclerosis (pwMS). Whilst most pwMS do not require re-treatment following standard dosing (two treatment courses), disease activity re-emerges in others. The characteristics of pwMS developing re-emerging disease activity remain incompletely understood.

Objectives:

To explore whether clinical and/or paraclinical baseline characteristics, including the degree of lymphocyte reduction, drug dose and lesions on magnetic resonance imaging (MRI) are associated with re-emerging disease activity.

Design:

Service evaluation in pwMS undergoing subcutaneous cladribine (SClad) treatment.

Methods:

Demographics, clinical, laboratory and MRI data of pwMS receiving two courses of SClad were extracted from health records. To assess associations of predictor variables with re-emerging disease activity, a series of Cox proportional hazards models was fitted (one for each predictor variable).

Results:

Of n = 264 pwMS 236 received two courses of SClad and were included in the analysis. Median follow-up was 4.5 years (3.9, 5.3) from the first, and 3.5 years (2.9, 4.3) from the last SClad administration. Re-emerging disease activity occurred in 57/236 pwMS (24%); 22/236 received further cladribine doses (SClad or cladribine tablets) at 36.7 months [median; interquartile range (IQR): 31.7, 42.1], and 22/236 other immunotherapies 18.9 months (13.0, 30.2) after their second course of SClad, respectively. Eligibility was based on MRI activity in 29, relapse in 5, both in 13, elevated cerebrospinal fluid neurofilament light chain level in 3, deterioration unrelated to relapse in 4 and other in 3. Only 36/57 of those eligible for additional immunotherapy had received a reduced dose of SClad for their second treatment course. Association was detected between re-emerging disease activity and (i) high baseline MRI activity and (ii) low second dose of SClad.

Conclusion:

Re-emerging disease activity was associated with baseline MRI activity and low dose second course of SClad.
Acute and Chronic Effects of Blood Flow Restriction Training in Physically Active Patients With Anterior Cruciate Ligament Reconstruction: A Systematic Review
Authors: García-Rodríguez Pere , Pecci Javier , Vázquez-González Sergio , Pareja-Galeano Helios
Published: November 2023

Context:

Muscle atrophy and loss of knee function are common findings after anterior cruciate ligament (ACL) reconstruction. Rehabilitation through blood flow restriction (BFR) has gained clinical relevance when combined with low loads to improve these disorders in recent years.

Objective:

To evaluate the rehabilitation effectiveness of ACL reconstruction with the use of BFR on pain, functionality, strength, and muscle mass in physically active people.

Data Sources:

A search of PubMed, Web of Science, and MEDLINE was performed on March 31, 2023, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines.

Study Selection:

Randomized clinical trials with active adults who underwent ACL surgery were included. They had to compare conventional treatments with the use of BFR, reporting values of pain, functionality, strength, or cross-sectional area (CSA). Articles whose participants presented concomitant injuries and whose intervention combined the use of BFR with treatments other than resistance training were excluded.

Study Design:

Systematic review.

Level of Evidence:

Level 2.

Data Extraction:

Study design, population, cuff pressure, and main outcomes including strength, quadriceps CSA, pain, and functionality.

Results:

Six studies out of a total of 389 were included (152 participants; 90 men and 62 women). These included studies showed no differences on CSA or strength when comparing BFR training with high loads exercise. BFR has demonstrated improvements in knee functionality and pain compared with other interventions such as immobilization or high loads training.

Conclusion:

The use of low loads combined with BFR improves pain, strength, functionality, and CSA. In addition, knee pain reduction and functionality are greater with BFR compared with the use of high loads or immobilization.
The principle of purpose limitation in data-driven policing: A guiding light or an empty shell?
Authors: Te Molder Ruben , Fedorova Masha , Dubelaar Marieke , Lestrade Sjarai
Published: November 2023

Current technological developments fuel the need and opportunities for data-driven policing that criminal enforcement authorities are eager to employ. Data-driven policing implies a combined use of data collected through various methods and for various purposes and begs the question on the limits to be set for the re-use of data for criminal investigation and intelligence purposes. The purpose limitation principle as enshrined in the Law Enforcement Directive (LED) provides those limits. Looking at data-driven policing through the lens of the principle of purpose limitation, particularly two problems are visible. First, there is an inherent tension between data-driven policing and the principle of purpose limitation. In essence, one of the goals of purpose limitation is limiting the aggregation and re-use of personal data, whereas this aggregation and re-use of personal data is one of the main reasons for criminal law enforcement authorities to use data-driven policing methods. Second, the meaning of the principle of purpose limitation and the conditions for its application in criminal investigations are not clearly defined and the precise implications for national implementation of this principle are ambiguous. The paper aims to contribute to the debate on how the principle of purpose limitation can be implemented in national jurisdictions in a way that balances its important safeguarding function and the needs of law enforcement authorities. This is done by examining the meaning and rationale of the principle of purpose limitation within the legal framework of the LED as well as what guidance can be drawn from human rights case law from the ECtHR and the CJEU, as it is widely acknowledged the rationale of purpose limitation is rooted in the need to protect the individuals’ rights to privacy and to prevent abuse of power by the authorities.
Public relations recruitment as boundary-making: The client, the ‘fit’ and the disposability of diversity
Authors: Edwards Lee , Aulakh Sundeep
Published: November 2023

In this article we explore the ways in which specialist recruitment practices for the PR industry influence the pursuit of diversity in the profession. Drawing on interviews from an exploratory study of specialist PR recruitment in the UK, we combine Abbott’s theory of boundary-making between professional fields with existing research on the exclusionary dynamics of recruitment in professions, to explain how PR recruitment consolidates the focus on client and candidate ‘fit,’ and is likely to work in favour of preserving the dominance of middle-class, white and gendered identities in the profession. In this context, diversity is perceived as a risk rather than an opportunity and becomes a casualty of professional logic.
Patient safety competence of nursing students and affecting factors
Authors: Yılmaz Ayşegül , Erdem Özlem
Published: November 2023

Objectives

Patient safety competencies (PSC) of nursing students are, in particular, critical for quality and safe care. In the study, it was aimed to determine the PSC of nursing students and the factors affecting them.

Methods

This descriptive cross-sectional, relationship-seeking, and comparative study was conducted between February 1st and May 15th, 2022. The sample of the study consisted of 441 students studying at three universities. The data were collected online using the Sociodemographic Data Form and PSC Self-Evaluation Tool.

Results

In institutions where the study was conducted, students rated their level as above moderate in the PSC. Those aged 23 and over, and those who had received education on patient safety in patient care and drug administration were found to have a higher level of PSC. When the scores that all students obtained from the overall scale and its subscales were compared, it was determined that students of University C had statistically higher overall and subscale scores than those in the other two universities.

Conclusion

The assessment of PSC and the determination of the influencing variables may shed light on the regulations to be conducted in this regard. Patient safety courses should be included in the nursing curriculum as a compulsory course in two semesters at basic and advanced levels.
Empiric Esophageal Dilation for the Treatment of Non-Obstructive Dysphagia
Authors: Macmillan Katherine , Protopapadakis Yianni , Abrams Gary A. , Sunkavalli Madhusudhan
Published: November 2023

Background:

Non-obstructive dysphagia is a commonly encountered clinical problem.

Methods:

We retrospectively analyzed a single tertiary hospital system electronic database from January 2021 to October 2021 for patients undergoing EGD with dilation using ICD-10 codes 43248 and 42450.

Results:

Of the 411 patients meeting inclusion criteria, 75% of these patients had improvement with empiric dilation. The presence of a superficial mucosal tear post dilation was statistically significant.

Conclusion:

Empiric dilation is a useful tool for patients with non-obstructive dysphagia.
Cultural Beliefs and Practices in Self-Management of Diabetes Among Pnar Women in Meghalaya, India
Authors: Muksor Alacrity , Parmar Daksha
Published: November 2023

Purpose:

The purpose of the study was to explore the cultural beliefs and practices of the Pnar tribe in terms of their self-management of diabetes.

Methods:

A qualitative study design using an ethnographic approach was adopted to understand the experiences of the Pnar women with type 2 diabetes. Around 60 women living with diabetes across 20 villages in the Thadlaskein rural block were interviewed in the Pnar language. Thematic analysis was employed to identify the pattern related to beliefs and cultural practices in the self-management of diabetes across the data set.

Results:

Misconceptions related to diet, such as all vegetables grown underground need to be avoided and bitter herbs and vegetables are good for blood glucose control, were reported. Participants used home remedies and complementary and alternative medicine to bring down their blood glucose levels. Participants believe that diabetes is an episodic or short-term illness and can be cured through herbal medicine. Participants reported that consuming atta or round flat bread made of wheat flour instead of rice caused “acidity.”

Conclusions:

Misconceptions are barriers to disease management, which are often shaped in people’s minds by culture. Therefore, health care service providers must know what people think about diabetes and its management. Accordingly, information related to diabetes should be disseminated to the masses for effective management of diabetes.
Community voices on climate, peace and security: A social learning approach to programming environmental peacebuilding
Authors: Medina Leonardo , Ensor Marisa O. , Schapendonk Frans , Sieber Stefan , Pacillo Grazia , Laderach Peter , Hellin Jon , Bonatti Michelle
Published: November 2023

Approaches to operationalising the linkages between climate, peace and security are increasingly demanded by international organisations. Yet, there is a limited understanding of what effective programming practices that address climate-related security risks entail. Critical voices argue that programme designs often rely on analyses that ignore structural and cultural realities on the ground, leading to technocratic understandings of risks, and prescriptions for action that do not relate to people’s experiences, perceptions and values. Advised by social learning theory, this study developed and evaluated a participatory appraisal method to guide the design of environmental peacebuilding programming strategies meant to address climate-related security risks. The method was evaluated across nine rural locations in Kenya, Senegal and Guatemala, involving 221 participants. Based on a critical evaluation of the method, opportunities and challenges for the use of social learning approaches to advise environmental peacebuilding programming are discussed. Results indicate that appraisal processes of collective reflection can support jointly articulated and context-relevant understandings of climate-related security risks. This shared knowledge can then support local communities in the design of climate adaptation strategies that potentially contribute to sustainable peacebuilding. Settings characterised by low political legitimacy and the unwillingness of conflictive actors to engage in dialogue are identified as barriers for the development of feasible programming strategies.
Trogocytosis drives red blood cell antigen loss in association with antibody-mediated immune suppression
Authors: Cruz-Leal Yoelys , Norris Peter A. A. , Gil Gonzalez Lazaro , Marjoram Danielle , Wabnitz Hanna , Shan Yuexin , Lazarus Alan H.
Published: November 2023

Red blood cell (RBC) alloimmunization to paternal antigens during pregnancy can cause hemolytic disease of the fetus and newborn (HDFN). This severe and potentially fatal neonatal disorder can be prevented by the administration of polyclonal anti-D through a mechanism referred to as antibody-mediated immune suppression (AMIS). Although anti-D prophylaxis effectively prevents HDFN, a lack of mechanistic clarity has hampered its replacement with recombinant agents. The major theories behind AMIS induction in the hematologic literature have classically centered around RBC clearance; however, antigen modulation/loss has recently been proposed as a potential mechanism of AMIS. To explore the primary mechanisms of AMIS, we studied the ability of 11 different antibodies to induce AMIS, RBC clearance, antigen loss, and RBC membrane loss in the HOD (hen egg lysozyme–ovalbumin–human Duffy) murine model. Antibodies targeting different portions of the HOD molecule could induce AMIS independent of their ability to clear RBCs; however, all antibodies capable of inducing a strong AMIS effect also caused significant in vivo loss of the HOD antigen in conjunction with RBC membrane loss. In vitro studies of AMIS-inducing antibodies demonstrated simultaneous RBC antigen and membrane loss, which was mediated by macrophages. Confocal live-cell microscopy revealed that AMIS-inducing antibodies triggered RBC membrane transfer to macrophages, consistent with trogocytosis. Furthermore, anti-D itself can induce trogocytosis even at low concentrations, when phagocytosis is minimal or absent. In view of these findings, we propose trogocytosis as a mechanism of AMIS induction.
Entirely noninvasive outcome prediction in central nervous system lymphomas using circulating tumor DNA
Authors: Heger Jan-Michel , Mattlener Julia , Schneider Jessica , Gödel Philipp , Sieg Noëlle , Ullrich Fabian , Lewis Richard , Bucaciuc-Mracica Teodora , Schwarz Roland F. , Rueß Daniel , Ruge Maximilian I. , Montesinos-Rongen Manuel , Deckert Martina , Blau Tobias , Kutsch Nadine , Balke-Want Hyatt , Weiss Jonathan , Becker Kerstin , Reinhardt H. Christian , Hallek Michael , Borchmann Peter , von Tresckow Bastian , Borchmann Sven
Published: November 2023

State-of-the-art response assessment of central nervous system lymphoma (CNSL) by magnetic resonance imaging is challenging and an insufficient predictor of treatment outcomes. Accordingly, the development of novel risk stratification strategies in CNSL is a high unmet medical need. We applied ultrasensitive circulating tumor DNA (ctDNA) sequencing to 146 plasma and cerebrospinal fluid (CSF) samples from 67 patients, aiming to develop an entirely noninvasive dynamic risk model considering clinical and molecular features of CNSL. Our ultrasensitive method allowed for the detection of CNSL-derived mutations in plasma ctDNA with high concordance to CSF and tumor tissue. Undetectable plasma ctDNA at baseline was associated with favorable outcomes. We tracked tumor-specific mutations in plasma-derived ctDNA over time and developed a novel CNSL biomarker based on this information: peripheral residual disease (PRD). Persistence of PRD after treatment was highly predictive of relapse. Integrating established baseline clinical risk factors with assessment of radiographic response and PRD during treatment resulted in the development and independent validation of a novel tool for risk stratification: molecular prognostic index for CNSL (MOP-C). MOP-C proved to be highly predictive of outcomes in patients with CNSL (failure-free survival hazard ratio per risk group of 6.60; 95% confidence interval, 3.12-13.97; P < .0001) and is publicly available at www.mop-c.com. Our results highlight the role of ctDNA sequencing in CNSL. MOP-C has the potential to improve the current standard of clinical risk stratification and radiographic response assessment in patients with CNSL, ultimately paving the way toward individualized treatment.
A prospective multi-institutional study of eculizumab to treat high-risk stem cell transplantation–associated TMA
Authors: Jodele Sonata , Dandoy Christopher E. , Aguayo-Hiraldo Paibel , Lane Adam , Teusink-Cross Ashley , Sabulski Anthony , Mizuno Kana , Laskin Benjamin L. , Freedman Jason , Davies Stella M.
Published: November 2023

High-risk, complement mediated, untreated transplant-associated thrombotic microangiopathy (hrTMA) has dismal outcomes due to multi-organ dysfunction syndrome (MODS). The complement C5 blocker eculizumab shows promising results in hrTMA, but has not been prospectively studied in hematopoietic stem cell transplant (HCT) recipients. We performed the first multi-institutional prospective study in children and young adults to evaluate eculizumab as an early targeted intervention for hrTMA/MODS. We hypothesized that eculizumab would more than double survival in HCT recipients with hrTMA, compared to our prior study of prospectively screened, untreated hrTMAs serving as historical controls. HrTMA features (elevated terminal complement (sC5b-9) and proteinuria measured by random urine protein/creatinine ratio (≥1mg/mg)) were required for inclusion. The primary endpoint was survival at 6 six-months from hrTMA diagnosis. Secondary endpoints were cumulative incidence of MODS 6 months after hrTMA diagnosis and 1-year posttransplant survival. Eculizumab dosing included intensive loading, induction, and maintenance phases for up to 24 weeks of therapy. All 21 evaluated study subjects had MODS. Primary and secondary study endpoints were met by demonstrating survival of 71% (P < .0001) 6 months after hrTMA diagnosis and 62% 1 year after transplant. Of fifteen survivors, 11 (73%) fully recovered organ function and are well. Our study demonstrates significant improvement in survival and recovery of organ function in hrTMA using an intensified eculizumab dosing and real time biomarker monitoring. This study serves as a benchmark for planning future studies that should focus on preventative measures or targeted therapy to be initiated prior to organ injury. This trial was registered at www.clinicaltrials.gov as #NCT03518203.
How accessibility to schools is not (just) a transport problem: the case of public school choice in the city of Malmö, Sweden
Authors: Nichols Aaron , Ryan Jean
Published: November 2023

There is currently a lack of studies exploring how transport investments and school admission policies in a city can affect the distribution of accessibility to schools. The aim of this study is to investigate if, for whom, and the ways in which, accessibility to schools can change following (1) a change to the city’s public school admission policy and (2) investments in public transport infrastructure and adjustments to the public transport system. We draw on the case of Malmö, Sweden to examine the potential effects of these changes. This study is focused specifically on those in grades 7–9 (aged approximately 13–15), a group whose independent mobility is starting to take form. A geospatial analysis was carried out in order to compare the change in demographic makeup between school catchment areas (real and hypothetical) before and after the changes were made. The geospatial analysis utilises a cumulative opportunity accessibility model that takes into account typical public transport travel times both before and after these new measures were implemented. Findings indicate that the (hypothetical) school catchment areas have been redistributed to a considerable extent following both interventions, but particularly following the change to the public school admission policy. These redistributions have in turn resulted in changes in the socio-economic characteristics of the hypothetical school catchment areas. While the redistribution of school catchment areas could potentially change the socio-economic composition of schools in Malmö, the effects are not equally distributed throughout the city. While the addition of the new train line was the main focus of this study, it was found that other changes in the public transport system between 2018 and 2019 also played a role in determining which schools students could and could not access. The findings from this study highlight the importance of carefully considering the interaction of different effects when assessing policy alternatives.
How well did the consensus methods apply in the guideline development of traditional Chinese medicine: a web-based survey in China
Authors: Liang Changhao , Yin Guanxiang , Lin Ziyi , Cui Jing , Wang Yaqi , Liu Siqi , Yin Dingran , Liu Pengwei , Su Xiangfei , Rong Hongguo , Wang Cheng , Sun Feng , Fei Yutong
Published: November 2023

Background and objective

Consensus methods are crucial in developing clinical guidelines. Different methods, such as the Delphi and nominal group techniques, are commonly used, but there is a lack of detailed instructions on how to implement them effectively. The survey aims to explore the opinions and attitudes of the chair, panel and working group on the critical elements of the consensus methods during guideline development.

Methods

We used a cross-sectional design to conduct this study and sent a structured questionnaire to stakeholders, including the chair, panel members, and working group participants, through the popular mobile phone application WeChat.We selected participants using a combination of purposive and snowball sampling. The questionnaire gathered information on demographics, experiences, opinions, and concerns regarding consensus methods and guideline development.

Results

The sample comprised 290 participants representing 31 provinces or municipalities. Among them, the most significant number of respondents (n = 107, 36.9%) were from Beijing. Most participants, specifically 211 (72.76%), held senior professional titles, while 186 (64.14%) adhered to ongoing guidelines. The Delphi method was the most commonly used consensus method (n = 132, 42.31%), but the respondents had only a preliminary understanding of it (n = 147, 47.12%). The consensus process also revealed the insufficiency of involving pharmacoeconomists, patients, and nurses.

Conclusions

Consensus methods have to be standardised and used consistently in the guideline development process. The findings of this study offer insights into diverse roles and more effective ways to apply the consensus process during guideline development.
Risk factors of additional surgery after non-curative endoscopic submucosal dissection for early gastric cancer
Authors: Sun Feng , Huang Yibo , Sun Yan , Wang Xingzhou , Ai Shichao , Guan Wenxian , Wang Meng
Published: November 2023

Background

The criteria for surgical intervention after non-curative endoscopic submucosal dissection (ESD) of early gastric cancer are unclear. We aimed to clarify the risk factors for residual cancer and lymph node metastasis after non-curative ESD and to identify recommendations for additional surgery.

Methods

We collected data on 133 consecutive patients who underwent additional surgery after non-curative ESD of early gastric cancer at Nanjing Drum Tower Hospital from January 2013 to July 2022. Univariate and multivariate analyses were performed to seek risk factors of residual cancer and lymph node metastasis.

Results

The incidence rates of residual cancer and lymph node metastasis were 13.5% (18/133) and 10.5% (14/133), respectively. There was neither residual tumor nor lymph node metastasis in 104 (78.2%) cases. Multivariate analyses elucidated that horizontal margin was an independent risk factor for local residual cancer, whereas lymphatic infiltration was an independent risk factor for lymph node metastasis. Patients with mixed histological types were more likely to suffer lymph node metastasis and further undergo additional surgery after non-curative ESD than pure histological type.

Conclusions

Additional gastrectomy with lymph node dissection was strongly recommended in patients with lymphatic infiltration after non-curative ESD of early gastric cancer. Patients with mixed histological type have a high propensity for lymph node metastasis and should be treated as a separate subtype.