bluuebunny/crossref_metadata_2025 huggingface dataset:
An examination and proposed theoretical model of risk and protective factors for bereavement outcomes for family members of individuals who engaged in medical aid in dying: A systematic review
Authors: Singer Jonathan , Daum Courtney , Evans Amelia , Schneider Sydnie , Vugrin Margaret , Loggers Elizabeth
Published: May 2023

Background:

Medical Aid in Dying is an end-of-life option that allows a physician to provide a patient with a prescription to end their life. Though Medical Aid in Dying intends to reduce suffering for a patient, opponents argue Medical Aid in Dying may increase suffering for the family members during bereavement. To better understand the bereavement outcomes for family members/friends following Medical Aid in Dying, an exhaustive review of the risk and protective factors for bereavement outcomes is warranted.

Aim:

This systemic review aimed to identify studies that examined bereavement outcomes of family members of individuals who engage in Medial Aid in Dying, identify risk and protective factors for bereavement outcomes, and propose a theoretical model to enhance conceptual clarity.

Design:

A mixed-method systematic review.

Data sources:

Ten databases were searched on June 16, 2021 and later conducted two updates (latest April 25, 2022).

Results:

Thirteen articles met inclusion criteria. Risk and protective factors were identified pre-Medical Aid in Dying and risk factors post-Medical Aid in Dying. Few studies compared bereavement outcomes for family members of individuals utilizing Medical Aid in Dying to family members who lost someone to natural loss.

Conclusions:

This study provides equivocal results about the effects of Medical Aid in Dying on family members following the loss. The theoretical model outlines potential risk and protective factors. This model provides a greater understanding of possible universal risk and protective factors for family members of individuals who engaged in Medical Aid in Dying.
A category contingent aftereffect for faces labelled with different religious affiliation is seen 7 days after adaptation
Authors: Foglia Victoria , Rutherford M.D.
Published: May 2023

Visual adaptation occurs after a prolonged exposure to a stimulus. The duration of aftereffects differs across stimuli type, and face aftereffects may be especially long lasting. The current study investigates adaptation decay of category contingent opposing aftereffects. Specifically, we tested whether naïve undergraduate participants’ adaptation to photos of faces with explicit religious labels, differed from that of participants who had adapted to the same faces 7 days previously. We also tested whether 7-day old category-contingent opposing aftereffects interfere with the ability to re-adapt to a new condition. In Session 1, undergraduates made attractiveness preference selections before and after adapting to two groups of distorted faces. Participants then returned 7 days later to re-assess the attractiveness of the same faces. Participants were then adapted to the two groups of faces distorted in the opposite direction. Adaptation strength was stronger in Session 1 than in Session 2, although adaptation strength was not related to pre-adaptation selections. Week-old aftereffects interfered with the creation of aftereffects in the opposite direction 7 days later.
Are Telecommuters’ and Non-Telecommuters’ Daily Time-Use Behaviors Different? An Episode-Level Model for Non-Mandatory Activities
Authors: Khaddar Shivam , Fatmi Mahmudur Rahman , Nikodym Trevor
Published: May 2023

Telecommuters (individuals working from home), and non-telecommuters (individuals working at the workplace) might have significantly different daily time-use patterns. For example, telecommuters might be able to engage in more episodes of non-mandatory activities such as recreation and pick-up/drop-off of children, as many telecommuters have a relatively flexible work arrangement in relation to their work location and schedule. This study aims to explore the non-mandatory activity engagement and duration decisions of these two worker profiles at a disaggregated-episode level. To do so, a multiple discrete continuous extreme value with ordered preferences (MDCEV-OP) model is adopted, using the 2018 travel survey data from the Central Okanagan region of British Columbia, Canada. This model accounts for multiple occurrences of each activity type (i.e., episodes) along with their corresponding durations. In doing so, the model adopts a logical ordering ensuring that the jth episode is not predicted without the occurrence of the ( j–1)th episode of an activity type. The model results reveal that telecommuters are more likely to engage in higher episodes of non-mandatory activities, compared with non-telecommuters. For instance, female teleworkers are found to be more likely to participate in higher episodes of activities associated with household-related responsibilities such as shopping. In contrast, female non-telecommuters are associated with participating in more episodes of personal business-related activities. The findings of this study provide important behavioral insights into the activity-time-use patterns of telecommuters and non-telecommuters, which can be utilized to develop more effective and equitable travel demand management plans, policies, and models.
Women’s Vulnerability on Public Transport
Authors: Miti Masuma Mollika , Prema Afia Jahin , Raihan Md Asif , Hossain Moinul
Published: May 2023

Women are moving forward with males across all domains in today’s modern world. However, women are yet to experience the same priority. Public transport (PT) is one of the many areas where they very often encounter challenges. When it comes to regularly using PT, women suffer the most. Even though it is mainly women who are at risk of harassment on PT, policymakers frequently ignore this fact in a male-dominated society. This study’s primary goal is to identify the main factors contributing to women being harassed on PT from a female and male perspective. Additionally, the most vulnerable mode from the viewpoint of harassment and safety measures arising from harassment were examined. This study assessed 1,600 responses from a questionnaire survey with a balanced gender distribution. Results were predicted using the Bayesian belief network (BBN). The study explored the most likely contributing causes to harassment in transportation environments and, notably, the respondents identified a male-dominated culture as the primary source of harassment. Regardless of gender or location, a bus is regarded as the PT mode on which women are most vulnerable. Rail is always preferred over other PT when traveling long distances. In conclusion, several policies have been proposed. The researchers suggest a “5P” policy in light of the respondents’ comments, prior research, and the current environment. A safe, dependable PT system can be ensured by implementing new technologies, updating design, and providing drivers and staff with appropriate training.
Design and analysis of a novel cantilevered metamorphic mechanism deployable in plane
Authors: Wang Shoufei , Zhao Yong
Published: May 2023

Originating from the truss topology optimization of a cantilever beam model loaded at a single point at the end, this article introduces a novel cantilevered metamorphic mechanism that can transform between the space truss and the plane state. Firstly, by eliminating triangular sub-structures within the cantilevered truss, it accomplishes the truss-mechanism transformation and synthesizes the metamorphic mechanism with three configurations. Secondly, the product of exponentials is utilized to establish forward kinematics models, and we analyze the locations and velocities of three key nodes. Thirdly, for the dimensional synthesis of structure parameters and with the help of the space model, we draw performance atlases of the input transmission index. Finally, the case study is carried out based on a specific mechanism, and it finds that this metamorphic mechanism shows excellent kinematic performance. This work provides an important theoretical basis for engineering applications, and the metamorphic mechanism has great application potential in many fields such as aerospace, marine engineering, and robotics. Furthermore, this research will also inspire researchers to develop other metamorphic mechanisms.
Comparison of 4 agar gel immunodiffusion kits for serologic detection of equine infectious anemia virus antibodies
Authors: Bannai Hiroshi , Kambayashi Yoshinori , Nemoto Manabu , Yamanaka Takashi , Tsujimura Koji
Published: May 2023

Using 85 sera collected from horses that had been experimentally infected with equine infectious anemia virus (EIAV) and 200 field sera collected from racehorses in Japan, we compared 4 agar gel immunodiffusion (AGID) kits for serologic detection of EIAV antibodies from Idexx, VMRD, IDvet, and the National Engineering Research Center of Veterinary Biologics, China (NECVB). The positive control lines were sufficiently clear in all kits for evaluation to be made, with slight differences in sharpness: NECVB was the sharpest, followed by VMRD, IDvet, and Idexx. The test results for all 285 samples agreed among the 4 kits, with 62 positives and 223 negatives. The sensitivities and specificities of VMRD, IDvet, and NECVB compared with the Idexx kit were 100%, and the kappa coefficient values between the kits were 1.0 for all combinations. We concluded that the testing capacity of these 4 kits was virtually identical.
Detection of Chlamydia abortus in aborted chorioallantoises of horses from Western Canada
Authors: Ricard R. Madison , Burton Jaidyn , Chow-Lockerbie Betty , Wobeser Bruce
Published: May 2023

Chlamydiae are reported to cause abortion in several species, however the association between Chlamydia sp. and equine abortions is poorly understood. A zoonotic transfer event of C. psittaci from aborted equine tissues in Australia has emphasized the need to better understand the prevalence of this pathogen in equine populations. The prevalence of chlamydia in equine abortions in North America has not been investigated thoroughly. We examined 99 formalin-fixed, paraffin-embedded placental samples submitted between 2009 and 2020 from equine abortions in Western Canada using chlamydia-specific 16S rRNA conventional PCR testing; 26 of 99 submissions tested positive for chlamydial DNA. Most of these submissions ( n = 17) had no final diagnosis noted on their original pathology reports. DNA sequencing identified 22 of the 26 cases as C. abortus; 21 of the 22 C. abortus–positive samples were positive on chlamydial immunohistochemistry. These findings contrast with studies in Europe that found a low prevalence of chlamydiae using similar methodology. The high prevalence of the potentially zoonotic C. abortus identified in our study suggests that more substantial biosecurity protocols may be warranted for equine foaling, abortion, and stillbirth in Western Canada to prevent zoonotic transfer of the pathogen.
Special Issue on Application of Implementation Science to Improve Outcomes for Students With Disabilities: Synthesis and Future Directions
Authors: Morando Rhim Lauren , Ward Caryn
Published: May 2023

Over the last 20 years, researchers examining the education of students with disabilities have made a concerted effort to develop evidence-based practices (EBP) and enact policies to promote and support their usage to raise expectations and improve outcomes. However, the promised results of EBP are still elusive. This special issue illustrates the potential and impact of using implementation science across various educational contexts to develop enabling conditions for leaders and educators to support the use of evidence. We summarize the special issue’s articles on the use of implementation science to support progress toward obtaining outcomes for students with disabilities. Specifically, key takeaways from each article and connections between articles are made. The summary concludes with key recommendations for policymakers, education agencies at each level of the system, and our practitioners who make use of implementation science methods and practices.
Bictegravir/Emtricitabine/Tenofovir Alafenamide in a Multicentre Cohort: Real-Life Experience From Spain
Authors: Torralba Miguel , Rodríguez Gema , González Gasca Francisco Javier , Cuadra Fernando , Barberá José , Geijo Paloma , Silva Andrea , García María Isabel , Ostaiza Marcos Alexander , García Pérez Ana María , Arroyo Esther , Larrubia Juan Ramón , Gutiérrez Almudena , Porras María Lourdes , Calvo Sánchez Henar , Peña-Asensio Julia , Arias Julio Gabriel , Mendoza Inés
Published: May 2023

Background:

The evaluation of bictegravir, emtricitabine, and tenofovir alafenamide (BIC/FTC/TAF) in clinical trials has shown high rates of virological suppression but information about its use in real-life settings is scarce.

Objective:

To evaluate the effectiveness, safety, durability, and predictive variables of therapeutic failure of BIC/FTC/TAF in a real-life cohort.

Methods

This observational, retrospective, multicentered cohort study included treatment-naive (TN) and treatment-experienced (TE) adult patients living with HIV (PLWH) who started treatment with BIC/FTC/TAF from January 1, 2019, to January 31, 2022. Treatment effectiveness (based on intention-to-treat [ITT], modified ITT [mITT], and on-treatment [OT]), tolerability, and safety were evaluated in all patients who started BIC/FTC/TAF antiretroviral therapy.

Results:

We included a total of 505 PLWH of whom 79 (16.6%) were TN and 426 (83.4%) were TE. Patients were followed up for a median (interquartile range [IQR]) of 19.6 (9.6-27.3) months, and 76% and 56% of PLWH reached month 6 and month 12 of treatment, respectively. Rates of TN PLWH with HIV-RNA <50 copies/mL in the OT, mITT, and ITT groups were 94%, 80%, and 62%, respectively, after 12 months of BIC/FTC/TAF treatment. Rates of TE PLWH with HIV-RNA <50 copies/mL were 91%, 88%, and 75% at month 12. The multivariate analysis revealed that neither age, sex, CD4 cell count <200 cells/μL, or viral load >100 000 copies/mL were associated with therapeutic failure.

Conclusion and relevance:

Our real-life data showed that BIC/FTC/TAF is effective and safe for use in the treatment of both TN and TE patients in clinical practice.
Immunosuppressant adherence in adult outpatient hematopoietic cell transplant recipients
Authors: McCune Jeannine S , Armenian Saro H , Nakamura Ryotaro , Shan Haoyue , Kanakry Christopher G , Mielcarek Marco , Gao Wei , Mager Donald E
Published: May 2023

Introduction

Medication nonadherence continues to be challenging for allogeneic hematopoietic cell transplant (HCT) recipients. The risk and severity of chronic graft-versus-host disease (GVHD) are associated with low immunosuppressant concentrations (which can be improved with model-informed precision dosing (MIPD)) and with immunosuppressant nonadherence (which can be improved with acceptable interventions).

Methods

With the goals of improving adherence and achieving therapeutic concentrations of immunosuppressants to eliminate GVHD, we characterized the feasibility of using the Medication Event Monitoring (MEMS®) Cap in adult HCT recipients.

Results

Of the 27 participants offered the MEMS® Cap at the time of hospital discharge, 7 (25.9%) used it, which is below our a priori threshold of 70%. These data suggest the MEMS® Cap is not feasible for HCT recipients. The MEMS® Cap data were available for a median of 35 days per participant per medication (range: 7–109 days). The average daily adherence per participant ranged from 0 to 100%; four participants had an average daily adherence of over 80%.

Conclusions

MIPD may be supported by MEMS® technology to provide the precise time of immunosuppressant self-administration. The MEMS® Cap was used by only a small percentage (25.9%) of HCT recipients in this pilot study. In accordance with larger studies using less accurate tools to evaluate adherence, immunosuppressant adherence varied from 0% to 100%. Future studies should establish the feasibility and clinical benefit of combining MIPD with newer technology, specifically the MEMS® Button, which can inform the oncology pharmacist of the time of immunosuppressant self-administration.
Antithrombotic and hemostatic stewardship: Evaluation of romiplostim for treatment of thrombocytopenia at a large academic medical center
Authors: Wong Adrian , Ahuja Tania , Cirrone Frank , Xiang Elaine
Published: May 2023

Romiplostim is indicated for immune thrombocytopenia (ITP), though is often used off-label for other indications such as chemotherapy-induced thrombocytopenia (CIT) and thrombocytopenia post hematopoietic stem cell transplantation (HSCT). Although romiplostim is FDA approved at a starting dose of 1 mcg/kg, it is often initiated at 2–4 mcg/kg depending on the severity of thrombocytopenia in clinical practice. Given the limited data, but interest in higher doses of romiplostim for indications other than ITP, we aimed to assess our inpatient romiplostim utilization at NYU Langone Health.

This was a single-center, retrospective review of 84 adult patients from January 2019 to July 2021. The top three indications were ITP (51, 60.7%), CIT (13, 15.5%), and HSCT (10, 11.9%). The median initial romiplostim dose was 3.8 mcg/kg (range, 0.9–10.8). 51% of patients achieved a platelet count of ≥50 × 109/L by the end of week 1 of therapy. For patients achieving goal platelets by the end of week 1, the median dose of romiplostim was 2.4 mcg/kg (range, 0.9–10.8). There was 1 episode of thrombosis and 1 episode of stroke.

We found that higher than FDA-recommended initial doses should be considered to achieve a platelet response. It appears to be safe to initiate romiplostim as higher doses, and to increase doses by greater increments than 1 mcg/kg in order to achieve a platelet response. Future prospective studies are needed to confirm the safety and efficacy of romiplostim in off-label indications and should evaluate clinical outcomes such as bleeding and need for transfusions.
Indigenous relationality: definitions and methods
Authors: Wildcat Matt , Voth Daniel
Published: May 2023

The following seeks to advance relational research methods by providing more specificity in how relationality is defined, and by engaging commonly held refrains on relational research. Responding to concerns about Indigenous relationality being pan-Indigenous, we suggest a three-part framework that defines Indigenous relationality. First, relationality as a defining aspect of global Indigeneity; second, relational understandings that emerge from specific Indigenous nations and third, relationality as manifest within inter-Indigenous connections. Building on our definitional work, we argue that three common refrains within relational research methods should be extended. First, researchers should be able to balance a slippage between the particular context of Indigenous nations and the general context of Indigenous relationality. Second, we have to do more than simply value relationships, and consider how we use relationality for critical thinking. Finally, ensuring accountability within Indigenous research requires us to revisit how we analyze the concept of community.
The Role and Mechanism of Long Non-Coding RNA HOTAIR in the Oncogenesis, Diagnosis, and Treatment of Head and Neck Squamous Cell Carcinoma
Authors: Xiang Yuandi , Hua Qingquan
Published: May 2023

The most frequent malignant tumor of the head and neck is head and neck squamous cell carcinoma (HNSCC), which has a high frequency, a poor prognosis in the late stages, and subpar therapeutic results. As a result, early HNSCC diagnosis and treatment are urgently needed; however, there are no good diagnostic biomarkers or efficient therapeutic targets at this time. The long-stranded non-coding RNA HOTAIR may be important in the pathogenesis of cancer, according to recent research. By interactions with DNA, RNA, and proteins, it has been demonstrated that HOTAIR, a >200 nucleotide RNA transcript, plays a role in the biological processes of many types of tumor cells, including proliferation, metastasis, and prognosis of HNSCC. Hence, this review discusses HOTAIR’s function and molecular mechanisms in HNSCC.
Vibroacoustic analysis of multi-layered micro-perforated plates coupled to an acoustic enclosure
Authors: El kharras Brahim , Garoum Mohammed , Bybi Abdelmajid
Published: May 2023

A vibroacoustic study of multi-layered micro-perforated plates (MPP) coupled to an enclosure cavity excited by internal and external acoustic excitations is presented. Most previous research centered on the multi-layered MPPs structure itself, the absorption and transmission performances were often calculated or tested in a simple acoustic environment. In a more realistic setting, the surrounding systems may affect the efficiency of MPPs. The proper modeling of the MPPs within acoustic enclosures requires careful study. The break-out sound from an enclosure via multi-layered MPP and the energy transmission of the structure into an acoustic enclosure undergoing exterior excitation are studied with an emphasis on the use of MPP in acoustic enclosures to suppress specific resonances of the enclosure. Therefore, an analytical formulation is proposed to model the behavior of the coupled system to address this issue. Using a modified Fourier series for the acoustic pressure, the continuity of the normal velocities at the interfaces of the plate or the MPP and the acoustic medium is assured accurately. A modified variational form for the acoustic and structure medium yields a completely coupled vibroacoustic system. Comparison with the finite element method (FEM) and available literature findings prove the efficacy and precision of the current approach. The effect of important parameters on the vibroacoustic behavior of multi-layered MPPs structure connected to an acoustic enclosure is examined. These parameters include micro-perforation of the plate, hole diameter, air gap thickness, acoustic enclosure dimensions, and the insertion of absorbent material in the gap.
Slack resources and employee-centered corporate social responsibility in restaurant companies
Authors: Vaughan Yue , Rhou Yinyoung , Koh Yoon , Singal Manisha
Published: May 2023

Although the importance of superior stakeholder relationships in the Corporate Social Responsibility (CSR) initiatives is well-established in the literature, research on the antecedents of such investments on salient stakeholders, like employees, and in particular industry contexts is lacking. In this paper, we explore an important antecedent of employee-centered CSR initiatives in the restaurant industry, that is, slack resources. We consider the restaurant industry an ideal context for this study due to the prevalence of limited slack resources, and the salience of employees for customer service, satisfaction, and eventual firm performance. Using a panel dataset of 430 observations of publicly traded firms in the USA, we find that slack resources contribute to socially responsible policies towards employees, yet slack resources do not alleviate any employee-related concerns in the restaurant sector. The findings on the differential effect of slack resources on employee-centered CSR initiatives and concerns provide practical implications and directions for future research.
The idea of evolution in digital architecture: Toward united ontologies?
Authors: Kamaoğlu Melih
Published: May 2023

Humans have always sought to grasp nature’s working principles and apply acquired intelligence to artefacts since nature has always been the source of inspiration, solution and creativity. For this reason, there is a comprehensive interrelationship between the philosophy of nature and architecture. After Charles Darwin’s revolutionary work, living beings have started to be comprehended as changing, evolving and developing dynamic entities. Evolution theory has been accepted as the interpretive power of biology after several discussions and objections among scientists. In time, the working principles of evolutionary mechanisms have begun to be explained from genetic code to organism and environmental level. Afterwards, simulating nature’s evolutionary logic in the digital interface has become achievable with computational systems’ advancements. Ultimately, architects have begun to utilise evolutionary understanding in design theories and methodologies through computational procedures since the 1990s. Although several studies about technical and pragmatic elements of evolutionary tools in design, there is still little research on the historical, theoretical and philosophical foundations of evolutionary understanding in digital architecture. This paper fills this literature gap by critically reviewing the evolutionary understanding embedded in digital architecture theories and designs since the beginning of the 1990s. The original contribution is the proposed intellectual framework seeking to understand and conceptualise how evolutionary processes were defined in biology and philosophy, then represented through computational procedures, to be finally utilised by architectural designers. The network of references and concepts is deeply connected with the communication between natural processes and their computational simulations. For this reason, another original contribution is the utilisation of theoretical limits and operative principles of computation procedures to shed light on the limitations, shortcomings and potentials of design theories regarding their speculations on the relationship between natural and computational ontologies.
Acceptance and Commitment Therapy for Anger, Irritability, and Aggression in Children, Adolescents, and Young Adults: A Systematic Review of Intervention Studies
Authors: Byrne Gary , Cullen Clare
Published: May 2023

The onset of childhood disruptive behaviors is one of the most common presenting difficulties to clinics worldwide. Acceptance and commitment therapy (ACT) has shown to be effective in the reduction of anger and aggression among adults, however to date there has been no systematic review that has examined the effectiveness of ACT in addressing anger and aggression among children, adolescents, and young adults. The current systematic review aimed to evaluate the methodological standing and effectiveness of the peer-reviewed literature of ACT on anger and aggression for this population. PsycINFO, PubMed, and MEDLINE databases were searched systematically in June 2022 to identify studies in English published on the use of ACT for anger and aggression in children, adolescents, and young adults. Seven studies met the inclusion criteria with a combined sample of 305 participants across the interventions. The most common outcome measures used were self-report ratings of anger among participants. Studies were characterized by poor methodological rigor and findings were mixed as regards the effectiveness of ACT in addressing anger and aggression in this population. Some evidence suggests that group ACT may be effective in reducing self-report measures of anger, but no firm conclusions can be drawn from the extant literature due to the heterogeneous nature of the studies, and limited information about ACT protocols and treatment delivery. Further higher-powered studies comparing ACT to treatment as usual or waitlist are needed to clarify what ACT may add as a treatment to anger and aggression in this population.
Combining Worlds: A Mixed Method for Understanding Learning Spaces
Authors: McCrone Luke , Kingsbury Martyn
Published: May 2023

Understanding student interaction in learning spaces is an ongoing challenge. The move away from didactic lecture delivery towards more active and hybrid learning renders this challenge ever more difficult. Researching pedagogic use of informal learning space, which is not formally timetabled or controlled, is always challenging because it is interacted with only transiently by both students and teachers. This paper introduces a mixed methods, phenomenological approach used in recent research to investigate campus learning spaces in face-to-face learning contexts. The full mixed methods approach combined space occupancy monitoring data with naturalistic ethnographic observation, field interviews and, where appropriate, more formal in-depth interviews to provide an effective way of understanding student and teacher engagement with learning spaces. Convergent use of these qualitative and quantitative methods yielded data which informed the application of subsequent methods, and the investment of researcher, pedagogic and infrastructural resource. In this paper we argue that as learning outside of formal teaching spaces increases, these mixed methods enable better, more efficient monitoring of pedagogic use of informal learning spaces. The mixed method can be adapted depending on the question being addressed and has the potential to inform resource allocation and investment into pedagogic and infrastructural change.
Case report of cavernous haemangioma in the supraorbital region in the extraconal space: A rare location
Authors: Maheshwari Sandip
Published: May 2023

Introduction:

Cavernous haemangioma is the most common benign non-infiltrative neoplasm of the orbit. Most cavernous haemangiomas are intraconal and lateral in location.

Case report:

We present a rare case of a cavernous haemangioma with an unusual location in the supraorbital region of the orbit, presenting with soft tissue swelling.

Discussion:

Cavernous haemangiomas are the most common benign non-infiltrative neoplasms of the orbit and have a slowly progressive mass effect. A slowly progressive proptosis is the typical presenting symptom. Extraocular muscle impairment and impaired visual function are seen with large lesions and with lesions located at the orbital apex. Most cavernous haemangiomas are typically intraconal and lateral in location. Extraconal and medial locations are uncommon. Ultrasound, computed tomography and magnetic resonance imaging are useful imaging techniques for the evaluation of such tumours. Treatment of the tumour is surgical excision. Complete excision is generally accomplished as the tumour is well-encapsulated with relatively few feeding vessels.
Cardiovascular benefits and risks associated with calcium, vitamin D, and antiresorptive therapy in the management of skeletal fragility
Authors: Kittithaworn Annop , Toro-Tobon David , Sfeir Jad G
Published: May 2023

Osteoporosis affects one in every five women over the age of 50 worldwide. With a rapidly ageing population, the prevalence of fragility fractures, considered a largely preventable consequence of osteoporosis, is expected to increase. Age is also a major risk for cardiovascular disease and mortality, thus highlighting the importance of cardiovascular profiling of osteoporosis interventions. Although calcium and vitamin D are essential for a healthy bone metabolism, excessive supplementation may be associated with increased risk. Conversely, early pre-clinical data have suggested a possible cardiovascular benefit from bisphosphonate therapy. This review evaluates the evidence behind the cardiovascular benefits and risks that may be associated with osteoporosis therapy.
Big ideas, small data: Opportunities and challenges for data science and the social services sector
Authors: Dimas Geri Louise , Goldkind Lauri , Konrad Renata
Published: May 2023

The social services sector, comprised of a constellation of programs meeting critical human needs, lacks the resources and infrastructure to implement data science tools. As the use of data science continues to expand, it has been accompanied by a rise in interest and commitment to using these tools for social good. This commentary examines overlooked, and under-researched limitations of data science applications in the social sector—the volume, quality, and context of the available data that currently exists in social service systems require unique considerations. We explore how the presence of small data within the social service contexts can result in extrapolation; if not properly considered, data science can negatively impact the organizations data scientists are trying to assist. We conclude by proposing three ways data scientists interested in working within the social services sector can enhance their contributions to the field: refining and leveraging available data, improving collaborations, and respecting data limitations.
Elucidating the Ruling Relations of Nurses’ Work in Labor and Delivery: An Institutional Ethnography
Authors: Kelly Paula , Snow Nicole , Quance Maggie , Porr Caroline
Published: May 2023

Obstetrics is a well-known area for malpractice and medical-legal claims, specifically as they relate to injuries the baby suffers during the intrapartum period. There is a direct implication for nurses’ work in labor and delivery because the law recognizes that monitoring fetal well-being during labor is a nursing responsibility. Using institutional ethnography, we uncovered how two powerful ruling discourses, namely biomedical and medical-legal risk discourses, socially organize nurses’ fetal surveillance work in labor and delivery through the use of an intertextual hierarchy and an ideological circle.
Prevalence and Associated Risk Factors for Anemia in Pregnant Women in White Nile State, Sudan: A Cross-Sectional Study
Authors: Elmugabil Abdelmageed , Adam Ishag
Published: May 2023

Introduction

Anemia during pregnancy can lead to several adverse maternal and perinatal outcomes. Despite preventive measures, anemia during pregnancy remains a threatening health problem, especially in sub-Saharan African countries.

Objective

We aimed to determine the prevalence of, and factors associated with, anemia among pregnant women at Rabak Maternity Hospital, Sudan.

Methods

We conducted a cross-sectional study involving pregnant women who presented to Rabak Maternity Hospital from September to December 2021. Questionnaires were completed via face-to-face interviews to gather both obstetric and sociodemographic information (i.e., age, parity, history of miscarriage, education, level of antenatal care), and hemoglobin levels were estimated. A logistic regression analysis was performed.

Results

The median (interquartile range) of the age and parity of the 208 women enrolled in the study was 25 (21.0–30.0) years and 2 (1–4), respectively. Forty-five (21.6%) women did not use iron-folic acid during the index pregnancy. Eighty-eight (42.3%) women had anemia, and four (1.9%) had severe anemia. In the univariate analysis, age, parity, history of miscarriage, interpregnancy interval, education, and antenatal care level were shown not to be associated with anemia. A higher number of women with anemia did not use iron-folic acid during the index pregnancy than those without anemia (29/80 [33.0%] vs. 16/120 [13.3%], respectively, p = .001). Not taking iron-folic acid was found to be associated with anemia in the multivariate analysis (adjusted odds ratio = 3.19, 95% confidence interval = 1.60–6.63).

Conclusion

Anemia was found to be a major health problem among the pregnant women in this study. There is no clear evidence across the women with anemia that their anemia stems from lack of using iron-folic acid (in fact, some women used iron-folic acid and they were anemic). There is a possibility that using iron-folic acid may prevent anemia in this part of Sudan.
Climate of Online e-Learning During COVID-19 Pandemic in a Saudi Medical School: Students’ Perspective
Authors: Salih Karimeldin MA , Elnour Suaad , Mohammed Nahid , Alkhushayl Abdullah M. , Alghamdi Ali A , Eljack Ibrahim A. , Al-Faifi Jaber , Ibrahim Mutasim E
Published: May 2023

INTRODUCTION

The circumstances of the COVID-19 lockdown offered an opportunity to develop remote educational strategies in medical education.

OBJECTIVES

To assess medical students’ experiences with online e-learning (OeL) satisfaction, intellectual environment, and communication during the COVID-19 pandemic.

METHODS

A cross-sectional study was conducted at the College of Medicine, University of Bisha, Saudi Arabia. A self-administered questionnaire (21 items) was used to evaluate OeL in three domains of satisfaction (nine items), intellectual environment (seven items), and communication (five items). Students from years one to six were invited to fill out the questionnaire form with five-point Likert scale responses. Descriptive statistics, one-way analysis of variance (ANOVA), and independent t-test were used to evaluate the association between variables.

RESULTS

Out of 237 participants, 96.6% (158 male and 71 female) responded to the questionnaire. Most students (86.5%) preferred the blackboard for their e-learning. The mean total scores were 30.18 ± 6.9 out of 45 for satisfaction, 19.67 ± 5.4 out of 25 for communication 25.43 ± 5.1 out of 35 for the intellectual environment. Over 50% of the students rated moderate scores on satisfaction and intellectual environment domains. About 85% of the students rated moderate scores in the communication domain. Male students rated higher significant scores than female students for satisfaction (31.3 ± 6.3 vs 27.6 ± 7; P < .001) and intellectual environment (26.3 ± 4.32 vs 3.5 ± 6.1; P < .001). There were no significant differences in students’ responses to the tested domains related to GPA level. Significantly higher levels of scores for satisfaction (33.3 ± 5.6 vs 28.8 ± 6.9; P < .001) and communication (21.2 ± 4.5 vs 18.9 ± 5.7; P = .019) were obtained by clerkship students than pre-clerkship.

CONCLUSIONS

Medical students’ experiences with e-learning are encouraging, which might be more effective with continuous training programs for students and tutors. Although OeL is an acceptable methodology, further studies are needed to analyze its impact on the target learning outcomes and students’ academic achievement.
Predicting risk of AF in ischaemic stroke using sinus rhythm ECG abnormalities: A meta-analysis
Authors: Berry-Noronha Alexander , Bonavia Luke , Wilson Duncan , Eranti Antti , Rasmussen Maria Uggen , Sajadieh Ahmad , Kreimer Fabienne , Gotzmann Michael , Sahathevan Ramesh
Published: May 2023

Objective:

To identify ECG changes in sinus rhythm that may be used to predict subsequent development of new AF.

Method:

We identified prospective and retrospective cohort or case control studies evaluating ECG patterns from a 12-lead ECG in sinus rhythm taken in hospital or community predicting subsequent development of new AF. For each identified ECG predictor, we then identify absolute event rates and pooled risk ratios (RR) using an aggregate level random effects meta-analysis.

Results:

We identified 609,496 patients from 22 studies. ECG patterns included P wave terminal force V1 (PTFV1), interatrial block (IAB) and advanced interatrial block (aIAB), abnormal P wave axis (aPWA), PR prolongation and atrial premature complexes (APCs). Pooled risk ratios reached significance for each of these; PTFV1 RR 1.48 (95% CI 1.04–2.10), IAB 2.54 (95% CI 1.64–3.93), aIAB 4.05 (95% CI 2.64–6.22), aPWA 1.89 (95% CI 1.25–2.85), PR prolongation 2.22 (95% CI 1.27–3.87) and APCs 3.71 (95% CI 2.23–6.16). Diabetes reduced the predictive value of PR prolongation.

Conclusion:

APC and aIAB were most predictive of AF, while IAB, PR prolongation, PTFV1 and aPWA were also significantly associated with development of AF. These support their use in a screening tool to identify at risk cohorts who may benefit from further investigation, or following stroke, with empirical anticoagulation.
Advancement of Periosteal and Capsular Complexes With or Without Augmentation Using a Free Graft From Lower Extensor Retinaculum: A Comparative Study With Propensity Score Matching
Authors: Sugimoto Kazuya , Isomoto Shinji , Miura Kimio , Hyakuda Yoshinobu , Ota Yuichi , Taniguchi Akira , Tanaka Yasuhito
Published: May 2023

Background:

This study compared the outcome of the L-shaped (L-AD) advancement of the periosteal and capsular complexes with or without augmentation using a free graft of the lower extensor retinaculum (AUG) in patients with chronic lateral ankle instability.

Methods:

A matched pair analysis was performed of retrospectively collected medical records of patients undergoing lateral ankle ligament repair who had completed at least 2 years of follow-up. Patients who underwent L-AD with AUG and patients undergoing L-AD alone were matched for age, sex, stress radiography findings, and body mass index. Patients with general joint laxity, osteoarthritic changes in the ankle, and subtalar symptoms and who underwent simultaneous surgical treatment for conditions other than that for lateral ankle ligament were excluded. A total of 46 patients were included in the study (23 patients in each group). Clinical outcome scores and postoperative mechanical instability were compared.

Results:

The median American Orthopaedic Foot & Ankle Society (AOFAS) score improved significantly ( P < .001) from 72 to 97 in the L-AD alone group and from 77 to 100 in the L-AD with AUG group. The mean (±SD) talar tilt angles improved significantly from 11.1 to 4.7 degrees postoperatively ( P < .001) in the L-AD alone group vs 9.7 to 5.2 degrees ( P < .001) in the L-AD with AUG group. The mean anterior drawer distances were improved significantly postoperatively from 6.4 to 4.7 mm ( P < .001) in the L-AD alone group, and from 6.5 to 4.5 mm ( P < .001) in the L-AD with AUG group.

Conclusion:

The L-AD technique significantly improved AOFAS scores and mechanical instability of ankles with chronic lateral instability with a very low complication rate. Additional augmentation using a free graft showed no advantages in the ankle with a talar tilt of <20 degrees.

Level of Evidence:

Level III, retrospective case-control series.
Things are only fine until they are not! Personal risk management in the newborn nursery and neonatal intensive care unit
Authors: Bengtsson Bengt-Ola S.
Published: May 2023

Most neonatologists will be named as a defendant in a medical malpractice lawsuit during their careers. Most are until it happens likely poorly prepared for the process. This article reviews common and uncommon situations that can result in adverse outcomes and potential liability for neonatologists and newborn providers and discusses ways to mitigate this risk in advance. The ramifications of a medical malpractice lawsuit and whether to settle the case out of court or going to trial, followed by potential review by the State's Medical Board are discussed. Finally, knowledge of the process before, rather than after it happens, may help to reduce the stress and uncertainty that naturally follows for the individual involved.
Health Disparities and Precision Oncology in Foregut Malignancies
Authors: Dowell Eleanor M. , Wang David H.
Published: May 2023

Health disparities exist in incidence, treatment, and survival of esophageal and gastric cancer based on socioeconomic and minority racial/ethnic group status. How socioeconomic and minority status affect access and utilization of precision oncology in foregut malignancies is not well understood. Based on other cancer types, multiple intrinsic and extrinsic factors influence utilization of cancer genetic testing, participation in precision oncology clinical trials, and access to molecularly targeted therapies. As precision oncology becomes more common in the treatment of foregut malignancies, health equity will require ongoing identification of sources of disparities and proposal of practical solutions.
Comparative effect of deliberate hypotensive anesthesia using nitroglycerine vs. phentolamine on event related potentials and cognitive functions in patients undergoing septoplasty: a randomized controlled trial
Authors: Fathy Wael , Hussein Mona , Magdy Rehab , Soliman Hanan H , Elmoutaz Hatem , Meshref Alaa A , Sabry Reem M , Elgaly Marwa A , Fawaz Mohammed , Kassim Dina Y
Published: May 2023

Background

Postoperative cognitive dysfunction is a noteworthy complication of deliberate hypotensive anesthesia. The aim of this work was to compare the effect of deliberate hypotensive anesthesia using nitroglycerine versus phentolamine on event-related potentials and cognitive function in patients undergoing septoplasty surgery.

Methods

This prospective randomized controlled trial was conducted on 80 patients indicated for septoplasty under general anesthesia; 40 patients received intra-operative Nitroglycerine and 40 patients received intra-operative Phentolamine. Cognitive assessment (using Paired Associate Learning test (PALT) and Benton Visual Retention test (BVRT)) and P300 recording were done for all included patients pre-operatively and one week postoperatively.

Results

The scores of PALT and Benton BVRT significantly declined one week following surgery in both Nitroglycerine and Phentolamine groups. There was no statistically significant difference between Nitroglycerine and Phentolamine groups in the postoperative decline in either PALT or BVRT (P-value = 0.342, 0.662 respectively). The values of P300 latency showed a significant delay one week following surgery in both Nitroglycerine and Phentolamine groups (P-value ≤ 0.001, 0.001), but in Nitroglycerine group, the delay is significantly higher than in Phentolamine group (P-value = 0.003). The values of P300 amplitude significantly decreased one week following surgery in both Nitroglycerine and Phentolamine groups (P-value ≤ 0.001, 0.001), but there was no statistically significant difference between Nitroglycerine and Phentolamine groups (P-value = 0.099).

Conclusion

Phentolamine is preferred over nitroglycerin in deliberate hypotensive anesthesia because it has less harmful effect on cognitive function than nitroglycerin.
Depth of anesthesia, temperature, and postoperative delirium in children and adolescents undergoing cardiac surgery
Authors: Köditz H. , Drouche A. , Dennhardt N. , Schmidt M. , Schultz M. , Schultz Barbara
Published: May 2023

Background

After pediatric cardiosurgical interventions, postoperative delirium can occur, which can be associated with undesirable consequences during and after the hospital stay. It is therefore important to avoid any factors causing delirium as far as possible. Electroencephalogram (EEG) monitoring can be used during anesthesia to individually adjust dosages of hypnotically acting drugs. It is necessary to gain knowledge about the relationship between intraoperative EEG and postoperative delirium in children.

Methods

In a dataset comprising 89 children (53 male, 36 female; median age: 0.99 (interquartile range: 0.51, 4.89) years) undergoing cardiac surgery involving use of a heart–lung machine, relationships between depth of anesthesia as measured by EEG (EEG index: Narcotrend Index (NI)), sevoflurane dosage, and body temperature were analyzed. A Cornell Assessment of Pediatric Delirium (CAP-D) score ≥ 9 indicated delirium.

Results

The EEG could be used in patients of all age groups for patient monitoring during anesthesia. In the context of induced hypothermia, EEG monitoring supported individually adjusted sevoflurane dosing. The NI was significantly correlated with the body temperature; decreasing temperature was accompanied by a decreasing NI.

A CAP-D score ≥ 9 was documented in 61 patients (68.5%); 28 patients (31.5%) had a CAP-D < 9. Delirious patients with an intubation time ≤ 24 h showed a moderate negative correlation between minimum NI (NImin) and CAP-D (rho = -0.41, 95% CI: -0.70 – -0.01, p = 0.046), i.e., CAP-D decreased with increasing NImin. In the analysis of all patients’ data, NImin and CAP-D showed a weak negative correlation (rho = -0.21, 95% CI: -0.40 – 0.01, p = 0.064). On average, the youngest patients had the highest CAP-D scores (p = 0.002). Patients with burst suppression / suppression EEG had a longer median intubation time in the intensive care unit than patients without such EEG (p = 0.023).

There was no relationship between minimum temperature and CAP-D score.

Conclusions

The EEG can be used to individually adjust sevoflurane dosing during hypothermia. Of the patients extubated within 24 h and classified as delirious, patients with deeper levels of anesthesia had more severe delirium symptoms than patients with lighter levels of anesthesia.