bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of wall cavity and fuel injection pressure on the performance of a non-reacting supersonic combustor
Authors: Talukder Mahbub , Mahian Abu , Aziz Sarfaraz , Ali Mohammad
Published: March 2024

This study numerically investigates the flow field of a non-reacting cavity-configured scramjet (Supersonic Combustion Ramjet) combustor at various fuel injection pressures by solving the 2D Reynolds-Averaged Navier-Stokes (RANS) equations, species transport equations, and Menter SST k-ω model. The aim of this research is to reveal the effects of wall cavity insertion and fuel injection pressure (FIP) on the crucial performance parameters i.e., fuel-air mixing efficiency (MxE), total pressure recovery (TPR), and mass-averaged Mach number (MAMN). Accordingly, two trapezoidal cavities of aspect ratio 7 are introduced on the opposite walls of a rectangular combustor. The combustor entrance is configured with rearward-facing steps and it intakes finite parallel air streams through finite-width inlets. Gaseous hydrogen jets are injected 30 mm downstream from the combustor entrance and 10 mm upstream from the cavity leading edge. FIP is varied according to the fuel-to-freestream pressure ratios (FFPR) of 4.5, 9.0, 13.5, and 18.0. The results of the cavity-configured combustor are then compared with the performance of the combustor in the absence of the wall cavities. The results delineate the change in flow structures with the inclusion of wall cavities and variation in FIP. Insight physics of mixing, total pressure loss, and MAMN in different regions of the combustor are studied and the results are quantified for comparison. MxE in a cavity-configured combustor does not monotonically increase with decreasing FFPR as found in the combustor without wall cavities. The shock-shear layer interactions (SSLIs) play a dominant role in mixing inside the cavity-configured combustor. The results also demonstrate that the insertion of wall cavities can increase fuel-air MxE through the formation of cavity recirculation zones. In the cavity-configured combustor, a maximum of 45% MxE is achieved for FFPR 4.5, which is 4% higher than the value obtained from the combustor without the cavities with an expense of 3% greater total pressure loss.
Effects of team-building on group cohesion, group efficacy, and individual academic performance in virtual learning environment
Authors: Yoon Pilhyoun , Han Sangsun , Kim Kibum
Published: March 2024

This study is based on the hypothesis that group cohesion and efficacy have significant effects on the academic performance of individuals in online (virtual) education environments no less than in-person education environments. To that end, this study explores the effectiveness of group activities in a virtual classroom environment using VC (Virtual Conferencing). It is based on a hypothesis that strong group cohesion and efficacy of a learning group influence the individual academic performance. The findings are as follows. First, team-building activities conducted in an online environment can further improve the level of group efficacy. Second, group cohesion formed in the online educational environment has a positive effect on the individual academic performance. Third, group efficacy amplified through online team-building activities mediate the relationship between group cohesion and individual academic performance. The results of the study support the hypothesis that psychological group variables can also affect the individual academic performance even in online educational environments. These findings will be helpful for researchers who are interested in designing educational collaborative activities and system development for computer-supported cooperative learning (CSCL).
Taking advantage of sampling designs in spatial small-area survey studies
Authors: Vergara-Hernández Carlos , Marí-Dell’Olmo Marc , Oliveras Laura , Martinez-Beneito Miguel Angel
Published: March 2024

Spatial small area estimation models have become very popular in some contexts, such as disease mapping. Data in disease mapping studies are exhaustive, that is, the available data are supposed to be a complete register of all the observable events. In contrast, some other small area studies do not use exhaustive data, such as survey based studies, where a particular sampling design is typically followed and inferences are later extrapolated to the entire population. In this article we propose a spatial model for small area survey studies, taking advantage of spatial dependence between units, which is the key assumption used for yielding reliable estimates in exhaustive data based studies. In addition, and in contrast to most survey-based spatial studies, we also take into account information on the sampling design and additional supplementary variables to obtain estimates in small areas. This makes it possible to merge spatial and sampling models into a common proposal.
Conducting Qualitative Research in Organizations Ethically: Organizationality as a Heuristic to Identify Ethical Challenges
Authors: Scheytt Carla , Pflüger Jessica
Published: March 2024

The consideration of research ethics to protect the research participants is a central element of empirical social research. Empirical research in organizations has certain characteristics: the research field is organized hierarchically and characterized by formal membership, specific control mechanisms, positive and negative sanctions, etc. Drawing on existing literature, we use the concept of “organizationality” to argue the characteristics of organizations lead to specific ethical challenges, for example dealing with layered field accesses, power asymmetries, and potentially strong sanctions. These challenges make it difficult to ensure confidentiality and non-maleficence and protect participants from risks. We present ethical challenges that typically arise at critical stages of the qualitative research process (planning, field access, the field, data storage, publication, and data archiving). This paper offers a heuristic to identify ethical challenges in qualitative organizational research. It extends the debate on research ethics in qualitative social research to organizational contexts, thereby bringing into focus the structural dimensions of harm.
CO2 is the contrast media to choose in patients with initial Chronic Kidney Disease undergoing endovascular aneurysm repair to prevent further renal function deterioration
Authors: Villani Flavio , Esposito Davide , Fargion Aaron T , Dorigo Walter , Falso Roberto , De Blasis Serena , Campolmi Marco , Belouafa Nabile , Pulli Raffaele
Published: March 2024

Objective

Even low quantities of iodine contrast media (ICM) could be responsible for exacerbation of a chronic kidney disease (CKD). Aim of this study was to determine whether it is more reasonable to perform endovascular aneurysm repair (EVAR) procedures in patients with initial CKD using CO2 rather than ICM to prevent further kidney deterioration.

Methods

A retrospective analysis was performed at our institution to identify patients with preoperative CKD at initial stage (class G3a-G3b according to KDOQI-KDIGO classification) who underwent either CO2-EVAR or ICM-EVAR. Primary endpoint was renal function evaluation; secondary endpoints were technical success, perioperative complications, hospital stay, and reinterventions and overall mortality at follow-up.

Results

Both CO2-EVAR and ICM-EVAR groups were composed of 21 patients. There were no differences in demographics, anatomy, and comorbidities, apart from worse ASA score in CO2-EVAR group (100% vs 57.1%, p = .001). Preoperative serum creatinine and glomerular filtration rates (GFR) were comparable (1.73 vs 1.6 mg/dl, p = .082 and 39.71 vs 43.04 mL/min/1.73 m2, p = .935). At follow-up (16.7 ± 18.1 months), CO2-EVAR was not associated with significant changes in creatinine and GFR, whereas ICM-EVAR determined a significant increase in creatinine (1.6 mg/dl vs 1.91 mg/dl, p = .04) and decrease in GFR values (43 vs 37.9 mL/min/1.73 m2, p = .04), determining the need for dialysis in one patient.

Conclusions

ICM seems to be a determining factor in worsening renal function; therefore, an effort should be made to standardize the use of CO2 as the contrast medium of choice in patients with initial renal insufficiency undergoing EVAR.
An Augmented Vision of Our Medical and Surgical Future, Today?
Authors: Armstrong David G. , Bazikian Sebouh , Armstrong Alexandria A. , Clerici Giacomo , Casini Andrea , Pillai Anand
Published: March 2024

Incorporating consumer electronics into the operating room, we evaluated the Apple Vision Pro (AVP) during limb preservation surgeries, just as we evaluated Google Glass and FaceTime more than a decade ago. Although AVP’s real-time mixed-reality data overlay and controls offer potential enhancements to surgical precision and team communication, our assessment recognized limitations in adapting consumer technology to clinical environments. The initial use facilitated intraoperative decision-making and educational interactions with trainees. The current mixed-reality pass-through resolution allows for input but not for highly dexterous surgical interactions. These early observations indicate that while AVP may soon improve aspects of surgical performance and education, further iteration, evaluation, and experience are needed to fully understand its impact on patient outcomes and to refine its integration into clinical practice.
Application of wearables for remote monitoring of oncology patients: A scoping review
Authors: Cloß Katharina , Verket Marlo , Müller-Wieland Dirk , Marx Nikolaus , Schuett Katharina , Jost Edgar , Crysandt Martina , Beier Fabian , Brümmendorf Tim H , Kobbe Guido , Brandts Julia , Jacobsen Malte
Published: March 2024

Objective

This review aims to systematically map and categorize the current state of wearable applications among oncology patients and to identify determinants impeding clinical implementation.

Methods

A Medline, Embase and clinicaltrials.gov search identified journal articles, conference abstracts, letters, reports, dissertations and registered studies on the use of wearables in patients with malignancies published up to 10 November 2021.

Results

Of 2509 records identified, 112 met the eligibility criteria. Of these, 9.8% (11/112) were RCTs and 47.3% (53/112) of publications were observational. Wearables were investigated pre-treatment (2.7%; 3/112), during treatment (34.8%; 39/112), post-treatment (17.9%; 20/112), in survivors (27.7%; 31/112) and in non-specified or multiple treatment phases (17.0%; 19/112). Medical-grade wearables were applied in 22.3% (25/112) of publications. Primary objectives ranged from technical feasibility (8.0%; 9/112), user feasibility (42.9%; 48/112) and correlational analysis (40.2%; 45/112) to outcome change analysis (8.9%; 10/112). Outcome change was mostly investigated regarding physical activity improvement (80.0%; 8/10). Most publications (42.9%; 48/112) and registered studies (39.3%; 24/61) featured multiple cancer types, with breast cancer as the most prevalent specific type (22.3% in publications, 16.4% in registered studies).

Conclusions

Most studies among oncology patients using wearables are focused on assessing the user feasibility of consumer-grade wearables, whereas rates of RCTs assessing clinical efficacy are low. Substantial improvements in clinically relevant endpoints by the use of wearables, such as morbidity and mortality are yet to be demonstrated.
Effectiveness of a diagnostic algorithm for dengue based on an artificial neural network
Authors: Ruiz Valdez Carmen Alicia , Alejo Martínez Olga María , Rocha Reyes Brenda Leticia , Hernández Bautista Porfirio Felipe , Cabrera Gaytán David Alejandro , Vallejos Parás Alfonso , Arriaga Nieto Lumumba , Jaimes Betancourt Leticia , Moctezuma Paz Alejandro , Rivera Mahey Mónica Grisel , Valle Alvarado Gabriel , Velez García Brenda Ivett
Published: March 2024

Introduction

Dengue is a disease with a wide clinical spectrum. The early identification of dengue cases is crucial but challenging for health professionals; therefore, it is necessary to have effective diagnostic instruments to initiate timely care.

Objective

To evaluate the effectiveness of an algorithm based on an artificial neural network (ANN) to diagnose dengue in an endemic area.

Methods

A single-center case–control study was conducted in a secondary-care hospital in Ciudad Obregón, Sonora. An algorithm was built with the official operational definitions, which was called the “direct algorithm,” and for the ANN algorithm, the brain.js library was used. The data analysis was performed with the diagnostic tests of sensitivity, specificity, positive predictive value (ppv), and negative predictive value (npv), with 95% confidence intervals and Cohen's kappa index.

Results

A total of 233 cases and 233 controls from 2022 were included. The ANN presented a sensitivity of 0.90 (95% CI [0.85, 0.94]), specificity of 0.82 (95% CI [0.77, 0.87]), npv of 0.91 (95% CI [0.87, 0.94]) and ppv of 0.81 (95% CI [0.76, 0.85]) and a kappa of 0.72. The direct algorithm had a sensitivity of 0.97 (95% CI [0.94, 0.99]), specificity of 0.96 (95% CI [0.92, 0.98]), npv 0.97 (95% CI [0.94, 0.98]), ppv 0.96 (95% CI [0.93, 0.98]) and kappa 0.93.

Conclusions

The direct algorithm performed better than the ANN in the diagnosis of dengue.
Remediated memory, digital witnessing and engagement: A qualitative analysis of the interactive documentary ‘The Space We Hold’
Authors: Fan Weikun
Published: March 2024

This paper sets out to study how creative documentary practices deconstruct traumatic memory, and then digitalise witnessing and engagement afforded by digital technology in the award-winning online interactive documentary The Space We Hold. Premised on culture memory studies and documentary studies, the social function of the documentary in reshaping narratives and forging public engagement has been discussed in this research. Interactive documentary becomes the unique visual artistic medium that allows the wider public to bear witness and emotionally experience the meaning of a traumatic past. This interactive project is reviewed as one site of memory to answer the main research question: ‘How does hypermediacy in an interactive documentary enable this non-linear storytelling structure to reframe the narrative and identity of a community that struggles for social justice?’. Along with presenting direct provocation through the innovative hypernarrative, this interactive documentary focuses on victims’ current lives, familial feelings and their contribution in pursuit of justice, showing depth in reflection and density in life. By exploring how The Space We Hold acts as a bear and agent to enhance audience engagement, I contend that the documentary is restyled as a space that allows individual memory to intertwine with collective memory through the combination of authorial expressivity and interactive participatory. In this pragmatic and reflexive approach to bear traumatic witness, we sense the constant battle between stigmatised communities and their reinterpreting narratives.
Determinants of Happiness Among Arab Youth: Evidence From a Youth Survey
Authors: Diab Anas , Fakih Ali
Published: March 2024

The paper aims to study the happiness among youth by elaborating on the determinants of happiness among the youth in the Arab region. The paper relies on a probit model using novel and unique data at a micro-level extracted from the SAHWA Youth Survey (2016). The dependent variable in all of the models was derived from a question on self-satisfaction from the survey. We examined six models containing a diverse set of variables. The survey covers five main nations which are Lebanon, Egypt, Algeria, Morocco, and Tunisia. The paper studies the effect of the socio-economic, household, labor market, and value-based characteristics on happiness. The main findings show that being male and the age factor are associated negatively with the happiness of youth in the Arab region. In addition, education, income, democracy, and gender equality are factors associated positively with the happiness of youth in the Arab region. Furthermore, the results show that the Arab identity is associated negatively with happiness of youth in the Arab region. The paper suggests some policy implications to support policymakers in fostering policies that can promote happiness among the youth in the Arab region.
Flipping the Online Classroom to Teach Statistical Data Analysis Software: A Quasi-Experimental Study
Authors: Althubaiti Alaa , Althubaiti Suha M.
Published: March 2024

The flipped classroom (FC) is a pedagogical model with an active learning concept and a hybrid course design that reverses the typical lecture process. Given the widespread use of online delivery methods, there is a need to explore the FC in delivering statistics courses. This study employs a prospective quasi-experimental study design to evaluate the effectiveness of the flipped method and to compare it with the traditional method of teaching statistical data analysis software. Each of the 71 students enrolled in a medicine program was allocated to either a traditional classroom or a FC. The difference between the two teaching methods is evaluated using overall assessment performance as the main outcome measure. Our results show that the teaching method had a large and significant effect on assessment performance, with the FC method exhibiting a higher student overall performance than the traditional classroom. The data suggest integrating the FC in teaching statistical data analysis software is a helpful alternative to the traditional classroom. This study may serve as a guide and inspiration for educators in statistics courses to incorporate the concept of flipped learning, so as to engage students in a more active learning experience.
Artificial Intelligence and Decision-Making in Healthcare: A Thematic Analysis of a Systematic Review of Reviews
Authors: Khosravi Mohsen , Zare Zahra , Mojtabaeian Seyyed Morteza , Izadi Reyhane
Published: March 2024

Introduction

The use of artificial intelligence (AI), which can emulate human intelligence and enhance clinical results, has grown in healthcare decision-making due to the digitalization effects and the COVID-19 pandemic. The purpose of this study was to determine the scope of applications of AI tools in the decision-making process in healthcare service delivery networks.

Materials and methods

This study used a qualitative method to conduct a systematic review of the existing reviews. Review articles published between 2000 and 2024 in English-language were searched in PubMed, Scopus, ProQuest, and Cochrane databases. The CASP (Critical Appraisal Skills Programme) Checklist for Systematic Reviews was used to evaluate the quality of the articles. Based on the eligibility criteria, the final articles were selected and the data extraction was done independently by 2 authors. Finally, the thematic analysis approach was used to analyze the data extracted from the selected articles.

Results

Of the 14 219 identified records, 18 review articles were eligible and included in the analysis, which covered the findings of 669 other articles. The quality assessment score of all reviewed articles was high. And, the thematic analysis of the data identified 3 main themes including clinical decision-making, organizational decision-making, and shared decision-making; which originated from 8 subthemes.

Conclusions

This study revealed that AI tools have been applied in various aspects of healthcare decision-making. The use of AI can improve the quality, efficiency, and effectiveness of healthcare services by providing accurate, timely, and personalized information to support decision-making. Further research is needed to explore the best practices and standards for implementing AI in healthcare decision-making.
Biodiversity: A Bibliometric Analysis of Accounting, Economics, and Finance Journals
Authors: Guer Yasin , Mueller Lukas , Schiereck Dirk
Published: March 2024

Biodiversity conservation and ecosystem management are imperative for sustaining life on Earth. Despite the growing recognition of its importance outside the field of environmental sciences, biodiversity has been polemically criticized as a fad, arguing that it has become a passing trend in sustainable finance. To foster a comprehensive understanding, we provide a bibliometric analysis of 334 articles in accounting, economics, and finance (AEF) journals retrieved from the Web of Science database. We conduct science mapping and a co-citation analysis to portrait the scientific landscape and research foci. Consistent with previous studies, we find that mainstream AEF journals are largely silent on biodiversity. In addition, research from Asia is severely underrepresented.
Quality of care in Belgian general practices during the COVID-19 pandemic: results of the cross-sectional PRICOV-19 study
Authors: Van Poel Esther , Vanden Bussche Pierre , Pétré Benoît , Ponsar Cécile , Collins Claire , De Jonghe Michel , Donneau Anne-Françoise , Gillain Nicolas , Guillaume Michèle , Willems Sara
Published: March 2024

Background

The COVID-19 pandemic immensely impacted care provision, including quality of care in general practice. This paper aimed: (1) to assess how Belgian general practices acted upon the six dimensions of quality of care during COVID-19; (2) to study differences between the three Belgian regions; and (3) to benchmark the performance of the Belgian practices against the performance in other European countries.

Methods

The data collected from 479 Belgian practices during 2020–2021 using an online survey as part of the international cross-sectional PRICOV-19 study were analyzed. 

Hereby, descriptive statistics, chi-squared tests, and binary logistic regression analyses were performed. Thirty-four survey questions related to the six dimensions of quality of care were selected as outcome variables. The adjusted regression models included four practice characteristics as covariates: practice type, being a teaching practice for GP trainees, multidisciplinarity of the team, and payment system.

Results

Belgian practices made important organizational changes to deliver high-quality care during COVID-19. Most practices (n = 259; 56.1%) actively reached out to vulnerable patients. Limitations to the practice building or infrastructure threatened high-quality care in 266 practices (55.5%). Infection prevention measures could not always be implemented during COVID-19, such as using a cleaning protocol (n = 265; 57.2%) and providing a separate doctor bag for infection-related home visits (n = 130; 27.9%). Three hundred and sixty practices (82.0%) reported at least one safety incident related to a delayed care process in patients with an urgent condition. The adjusted regression analysis showed limited significant differences between the Belgian regions regarding the quality of care delivered. Belgian practices demonstrated varied performance compared to other European countries. For example, they excelled in always checking the feasibility of isolation at home but reported more patient safety incidents related to timely care than at least three-quarters of the other European countries.

Conclusions

Future studies using different design methods are crucial to investigate which country and practice characteristics are associated with delivering high-quality care.
Frosted branch angiitis in a patient with systemic juvenile idiopathic arthritis: a case report
Authors: Garbrecht Jarret L. , Powell Zachary R. , McClard Cynthia K. , Noori Jila
Published: March 2024

Background

Frosted branch angiitis is a retinal vascular condition that is associated with a viral infection or autoimmune disorders like Crohn’s disease, systemic lupus erythematosus, and Behcet’s disease. Frosted branch angiitis presents with vascular inflammation, retinal edema, and severe retinal vascular sheathing. We present a case of systemic juvenile idiopathic arthritis, an autoinflammatory disease, presenting with frosted branch angiitis.

Report of Case

A 14-year-old female with systemic juvenile idiopathic arthritis and a history of bilateral anterior uveitis developed acute unilateral vision loss and was found to have frosted branch angiitis complicated by branch retinal vein occlusion. She underwent an extensive serology workup and aqueous viral PCR to rule out other possible autoimmune and viral etiologies for forested branch angiitis. She received systemic and intravitreal antiviral treatment due to positive CMV IgM initially. However, the clinical picture improved following the use of a higher dose of oral steroids and the switch of the immunosuppressive agent to a TNF-a inhibitor.

Conclusion

To our knowledge, this would be the first case in the literature demonstrating a systemic juvenile idiopathic arthritis patient presenting with frosted branch angiitis. Infectious causes still must be ruled out, especially CMV, as it is the most common cause of secondary frosted branch angiitis.
Reduced gray matter volume of the hippocampal tail in melancholic depression: evidence from an MRI study
Authors: Chu Zhaosong , Yuan Lijin , Lian Kun , He Mengxin , Lu Yi , Cheng Yuqi , Xu Xiufeng , Shen Zonglin
Published: March 2024

Background

Melancholic depression (MD) is one of the most prevalent and severe subtypes of major depressive disorder (MDD). Previous studies have revealed inconsistent results regarding alterations in grey matter volume (GMV) of the hippocampus and amygdala of MD patients, possibly due to overlooking the complexity of their internal structure. The hippocampus and amygdala consist of multiple and functionally distinct subregions, and these subregions may play different roles in MD. This study aims to investigate the volumetric alterations of each subregion of the hippocampus and amygdala in patients with MD and non-melancholic depression (NMD).

Methods

A total of 146 drug-naïve, first-episode MDD patients (72 with MD and 74 with NMD) and 81 gender-, age-, and education-matched healthy controls (HCs) were included in the study. All participants underwent magnetic resonance imaging (MRI) scans. The subregional segmentation of hippocampus and amygdala was performed using the FreeSurfer 6.0 software. The multivariate analysis of covariance (MANCOVA) was used to detect GMV differences of the hippocampal and amygdala subregions between three groups. Partial correlation analysis was conducted to explore the relationship between hippocampus or amygdala subfields and clinical characteristics in the MD group. Age, gender, years of education and intracranial volume (ICV) were included as covariates in both MANCOVA and partial correlation analyses.

Results

Patients with MD exhibited a significantly lower GMV of the right hippocampal tail compared to HCs, which was uncorrelated with clinical characteristics of MD. No significant differences were observed among the three groups in overall and subregional GMV of amygdala.

Conclusions

Our findings suggest that specific hippocampal subregions in MD patients are more susceptible to volumetric alterations than the entire hippocampus. The reduced right hippocampal tail may underlie the unique neuropathology of MD. Future longitudinal studies are required to better investigate the associations between reduced right hippocampal tail and the onset and progression of MD.
Proximal row carpectomy with interposition arthroplasty using both capsular flap and acellular human dermal matrix
Authors: Lee Dae-Hee , Seo Joong-Bae , Jung Jae-Uk , Yoo Jae-Sung
Published: March 2024

Background

In cases of wrist arthritis, proximal row carpectomy (PRC) has been widely utilized and shown favorable long-term outcomes. However, its applicability is limited in cases where arthritis extends to the lunate fossa or capitate. Recently, surgical approaches combining various methods of interposition arthroplasty have been introduced to overcome these drawbacks. The purpose of this study was to perform PRC and interposition arthroplasty with dorsal capsule and acellular dermal matrix(ADM),and analyze the clinical outcomes of these procedures.

Methods

Fourteen cases who underwent PRC and interposition arthroplasty using both dorsal capsular flap and ADM were retrospectively recruited. The researchers assessed the patients’ Visual Analog Scale (VAS) pain score, Disabilities of the Arm, Shoulder and Hand (DASH) scores, range of motion (ROM), retear, and radiocarpal distance (RCD).

Results

One year post-surgery, both the VAS pain scores, DASH scores, and ROM showed statistically significant improvement compared to before the surgery. Upon reviewing the radiological results, the postoperative mean RCD was 4.8 ± 0.8 mm and one year follow up mean RCD was 3.6 ± 0.5 mm at one year post-surgery. Moreover, in the one year follow-up, there was no observed failure of the allodermis graft in any of the cases.

Conclusion

The PRC and interposition arthroplasty with ADM demonstrated significantly improved clinical outcomes after surgery, showing a maintain of RCD without graft failure effectively.
Factors influencing the bariatric surgery treatment of bariatric surgery candidates in underdeveloped areas of China
Authors: Kong Xiangxin , Zhang Yuan , Li Ruoer , Yang Lei , Xian Yin , He Ming , Song Ke , Jia Aimei , Sun Qin , Ren Yixing
Published: March 2024

Background

From year to year, the proportion of people living with overweight and obesity in China rises, along with the prevalence of diseases linked to obesity. Although bariatric surgery is gaining popularity, there are still several issues with its promotion compared to Western nations. Since less developed places in China are more widespread due to disparities in the development of different regions, there has been little exploration of the factors that might be related to acceptance of bariatric surgery in these regions.

Methods

Patients who visited the Department of Gastrointestinal Surgery at the North Sichuan Medical College Affiliated Hospital from 2018 to 2022 and had obesity or other relevant metabolic problems were surveyed using a questionnaire. The relationship between demographic factors, socioeconomic status, and acceptance of bariatric surgery was analyzed.

Results

Of 334 patients, 171 had bariatric surgery. BMI, education level, marriage history, medical insurance, family support, and a history of type 2 diabetes were all linked to having bariatric surgery, according to a univariate analysis. In a multivariate analysis, BMI (P = 0.02), education (P = 0.02), family support (P<0.001), medical insurance coverage (P<0.001), and history of type 2 diabetes (P = 0.004) were all positively associated with a willingness to have bariatric surgery. Among 163 non-bariatric patients with obesity, 15.3% were not opposed to surgery but preferred trying medication first, 54.6% leaned towards medical therapy, and 30% were hesitant. Additionally, a majority of patients (48.55%) often lacked adequate knowledge about weight reduction therapy. Age, height, gender, smoking, drinking, family history of type 2 diabetes, education, and marital status did not significantly differ (P > 0.05).

Conclusions

Many patients are concerned about the safety of surgical treatment and the possibility of regaining weight. Due to the relatively high cost of bariatric surgery, they tend to choose medical treatment. To enhance the acceptance of bariatric surgery in underdeveloped regions of China, it is crucial to focus on disseminating knowledge about bariatric surgery, offer pertinent health education to the community, and foster support from patients’ families. The government should pay more attention to obesity and provide support in the form of medical insurance.
Translucency of recent zirconia materials and material-related variables affecting their translucency: a systematic review and meta-analysis
Authors: Yousry Mahinour , Hammad Ihab , Halawani Mohamed El , Aboushelib Moustafa
Published: March 2024

Background

Recent forms of translucent zirconia material have been developed, offering a wide range of options and varieties for enhancing aesthetics, making it a preferred choice in the field of prosthetic dentistry. However, there is insufficient understanding regarding the recent types of zirconia materials and their optical behavior. Understanding the variables that influence the translucency of zirconia and identifying strategies to enhance its esthetics are crucial.

Purpose

The current systemic review highlights a comprehensive understanding of different zirconia generations in relation to their optical characteristics and evaluates material-related variables affecting their translucency.

Methods

The present review studied in-vitro studies that evaluated the optical characteristics of different yttria content of yttria stabilized materials. The topics explored were: (1) the different zirconia material generations and their optical behavior; (2) material-related factors that affect their translucency. The research was restricted to online publication in the English language from July 1, 2010, to July 31, 2023, using PubMed, Scopus, and Science Direct resources. The search key terms and their combinations were “zirconia,” “translucent zirconia,” “cubic zirconia,” “highly translucent zirconia,” “yttria partially stabilized zirconia,” “monolithic zirconia,” “translucency,” “optical properties,” and “light transmission.”

Results

The data obtained from fifty-three studies addressed the optical characteristics of various zirconia generations. They reported that changing yttria content had a significant impact on translucency. Different kinds of zirconia ceramics of the same generation have varying translucencies. Achieving optimum aesthetics with monolithic zirconia is challenging due to factors related to material aspects such as the presence of additives, point defects, microstructure, thickness, phase distribution, and sintering conditions.

Conclusions

Newly developed monolithic dental zirconia ceramics have improved aesthetics and translucency. However, additional research is necessary to evaluate their performance and long-term durability.

Trial Registration

This systematic review was registered in PROSPERO, under number CRD42023474482.
Short-term effects of a new resistance exercise approach on physical function during chemotherapy after radical breast cancer surgery: a randomized controlled trial
Authors: Huo Ming , Zhang Xin , Fan Jialin , Qi Hao , Chai Xuemei , Qu Minghui , Shan Yuqi , Xie Hualong , Wang Chao
Published: March 2024

Background

Approximately 30% of post-operative breast cancer patients develop shoulder joint movement disorders affecting routine upper limb movement. This study discusses the impact of a neuromuscular joint facilitation (NJF) method on the physical function of breast cancer patients experiencing shoulder dysfunction during chemotherapy after radical surgery.

Methods

This study included 162 female patients who have unilateral breast cancer in a cancer hospital in China. They developed shoulder joint mobility disorders during chemotherapy within 1–3 months postoperatively. These patients were divided into three groups: NJF, conventional rehabilitation (conventional group), and control groups. The clinical examination included the maximum passive and active range of motion (ROM) of the shoulder (flexion, extension, abduction, adduction, and external and internal rotation). Other evaluations included a pain score using a visual analog scale (VAS), grip strength, and supraspinatus muscle thickness. All tests were evaluated pre-and post-intervention.

Results

The NJF group showed a significant increase in all shoulder ROM angles post-intervention. In the conventional group, all other ROM values increased significantly, except passive external rotation ROM. In the control group, all other ROM values increased significantly, except passive and active external rotation ROM. All three groups had decreased VAS scores, increased grip strength, and supraspinatus muscle thickness post-intervention during active abduction. In the control group, the supraspinatus contraction rate decreased significantly at 60° and 90° abduction post-intervention compared to that at pre-intervention.

Conclusion

This study revealed that NJF during chemotherapy had positive clinical intervention effects, improving shoulder joint mobility disorders, pain, grip strength, and external rotation following radical breast cancer surgery.

Clinical trial registration

Chinese Clinical Trial Registry; https://www.chictr.org.cn/ (ChiCTR2300073170), registered (03/07/2023).
Utilizing the physical green care environment to support activities of daily living for nursing home residents: a focused ethnographic case study
Authors: Cremer Svenja , Rosteius Katharina , Zwakhalen Sandra M.G. , Verbeek H. , Bleijlevens Michel H.C. , de Boer Bram
Published: March 2024

Background

The nursing home residents’ ability to carry out Activities of Daily Living (ADLs) is influenced by the physical care environment. One emerging area of interest in scientific research is the green care environment within nursing home care, where agricultural activities such as gardening and animal care are integrated alongside daily care. Previous research has neglected to explore how these environments can be employed to enhance ADL performance. This study, therefore, explores how a green care environment, specifically one with an animal shelter, can be used to support nursing home residents in their ADLs.

Methods

A focused ethnographic case study was conducted in one nursing home. Data was collected employing participatory observations, informal conversations, and semi-structured interviews, which we analyzed by employing a thematic analysis.

Results

Overall, 25 residents were observed for a total time of 89h, and interviews were conducted with 10 staff members. The nursing home integrates activities in the green care environment into daily care for a broad scope of residents. The analysis revealed four themes: (1) The (in)visibility of ADL, (2) Reciprocal care dynamics: Fostering ADL performance through connection and teamwork, (3) Seized and missed opportunities for meaningful integration of ADL in the physical green care environment, and Theme (4) Professional fulfillment and ADL task obligation: Views from staff and management.

Conclusions

This physical green care environment carries the potential to enhance the residents’ daily activities and foster better staff-resident relationships. Yet, there are varying views among staff and management regarding its integration into the residents’ lives and care.
Optimizing integration of community-based management of possible serious bacterial infection (PSBI) in young infants into primary healthcare systems in Ethiopia and Kenya: successes and challenges
Authors: Tiruneh Gizachew Tadele , Odwe George , Kamberos Alexandra Haake , K’Oduol Kezia , Fesseha Nebreed , Moraa Zipporah , Gwaro Hellen , Emaway Dessalew , Magge Hema , Nisar Yasir Bin , Hirschhorn Lisa R.
Published: March 2024

Background

Ethiopia and Kenya have adopted the community-based integrated community case management (iCCM) of common childhood illnesses and newborn care strategy to improve access to treatment of infections in newborns and young infants since 2012 and 2018, respectively. However, the iCCM strategy implementation has not been fully integrated into the health system in both countries. This paper describes the extent of integration of iCCM program at the district/county health system level, related barriers to optimal integration and implementation of strategies.

Methods

From November 2020 to August 2021, Ethiopia and Kenya implemented the community-based treatment of possible serious bacterial infection (PSBI) when referral to a higher facility is not possible using embedded implementation research (eIR) to mitigate the impact of COVID-19 on the delivery of this life-saving intervention. Both projects conducted mixed methods research from April-May 2021 to identify barriers and facilitators and inform strategies and summative evaluations from June-July 2022 to monitor the effectiveness of implementation outcomes including integration of strategies.

Results

Strategies identified as needed for successful implementation and sustainability of the management of PSBI integrated at the primary care level included continued coaching and support systems for frontline health workers, technical oversight from the district/county health system, and ensuring adequate supply of commodities. As a result, support and technical oversight capacity and collaborative learning were strengthened between primary care facilities and community health workers, resulting in improved bidirectional linkages. Improvement of PSBI treatment was seen with over 85% and 81% of estimated sick young infants identified and treated in Ethiopia and Kenya, respectively. However, perceived low quality of service, lack of community trust, and shortage of supplies remained barriers impeding optimal PSBI services access and delivery.

Conclusion

Pragmatic eIR identified shared and unique contextual challenges between and across the two countries which informed the design and implementation of strategies to optimize the integration of PSBI management into the health system during the COVID-19 pandemic. The eIR participatory design also strengthened ownership to operationalize the implementation of identified strategies needed to improve the health system’s capacity for PSBI treatment.
Patient flow in emergency departments: a comprehensive umbrella review of solutions and challenges across the health system
Authors: Samadbeik Mahnaz , Staib Andrew , Boyle Justin , Khanna Sankalp , Bosley Emma , Bodnar Daniel , Lind James , Austin Jodie A. , Tanner Sarah , Meshkat Yasaman , de Courten Barbora , Sullivan Clair
Published: March 2024

Background

Globally, emergency departments (EDs) are overcrowded and unable to meet an ever-increasing demand for care. The aim of this study is to comprehensively review and synthesise literature on potential solutions and challenges throughout the entire health system, focusing on ED patient flow.

Methods

An umbrella review was conducted to comprehensively summarise and synthesise the available evidence from multiple research syntheses. A comprehensive search strategy was employed in four databases alongside government or organisational websites in March 2023. Gray literature and reports were also searched. Quality was assessed using the JBI critical appraisal checklist for systematic reviews and research syntheses. We summarised and classified findings using qualitative synthesis, the Population-Capacity-Process (PCP) model, and the input/throughput/output (I/T/O) model of ED patient flow and synthesised intervention outcomes based on the Quadruple Aim framework.

Results

The search strategy yielded 1263 articles, of which 39 were included in the umbrella review. Patient flow interventions were categorised into human factors, management-organisation interventions, and infrastructure and mapped to the relevant component of the patient journey from pre-ED to post-ED interventions. Most interventions had mixed or quadruple nonsignificant outcomes. The majority of interventions for enhancing ED patient flow were primarily related to the 'within-ED' phase of the patient journey. Fewer interventions were identified for the 'post-ED' phase (acute inpatient transfer, subacute inpatient transfer, hospital at home, discharge home, or residential care) and the 'pre-ED' phase. The intervention outcomes were aligned with the aim (QAIM), which aims to improve patient care experience, enhance population health, optimise efficiency, and enhance staff satisfaction.

Conclusions

This study found that there was a wide range of interventions used to address patient flow, but the effectiveness of these interventions varied, and most interventions were focused on the ED. Interventions for the remainder of the patient journey were largely neglected. The metrics reported were mainly focused on efficiency measures rather than addressing all quadrants of the quadruple aim. Further research is needed to investigate and enhance the effectiveness of interventions outside the ED in improving ED patient flow. It is essential to develop interventions that relate to all three phases of patient flow: pre-ED, within-ED, and post-ED.
Breast cancer screening among Medicare Advantage enrollees with dementia
Authors: Raver Eli , Xu Wendy Y. , Jung Jeah , Lee Sunmin
Published: March 2024

Background

The decision to screen for breast cancer among older adults with dementia is complex and must often be individualized, as these individuals have an elevated risk of harm from over-screening. Medicare beneficiaries with dementia are increasingly enrolling in Medicare Advantage plans, which typically promote receipt of preventive cancer screening among their enrollees. This study examined the utilization of breast cancer screening among Medicare enrollees with dementia, in Medicare Advantage and in fee-for-service Medicare.

Methods

We conducted a pooled cross-sectional study of women with Alzheimer’s disease and related dementias or cognitive impairment who were eligible for mammogram screening. We used Medicare Current Beneficiary Survey data to identify utilization of biennial mammogram screening between 2012 and 2019. Poisson regression models were used to estimate prevalence ratios of mammogram utilization and to calculate adjusted mammogram rates for Medicare Advantage and fee-for-service Medicare enrollees with dementia, and further stratified by rurality and by dual eligibility for Medicare and Medicaid.

Results

Mammogram utilization was 16% higher (Prevalence Ratio [PR] 1.16; 95% CI: 1.05, 1.29) among Medicare Advantage enrollees with dementia, compared to their counterparts in fee-for-service Medicare. Rural enrollees experienced no significant difference (PR 0.99; 95% CI: 0.72, 1.37) in mammogram use between Medicare Advantage and fee-for-service Medicare enrollees. Among urban enrollees, Medicare Advantage enrollment was associated with a 21% higher mammogram rate (PR 1.21; 95% CI: 1.09, 1.35). Dual-eligible Medicare Advantage enrollees had a 34% higher mammogram rate (PR 1.34; 95% CI: 1.10, 1.63) than dual-eligible fee-for-service Medicare enrollees. Among non-dual-eligible enrollees, adjusted mammogram rates were not significantly different (PR 1.11; 95% CI: 0.99, 1.24) between Medicare Advantage and fee-for-service Medicare enrollees.

Conclusions

Medicare beneficiaries age 65–74 with Alzheimer’s disease and related dementias or cognitive impairment had a higher mammogram use rate when they were enrolled in Medicare Advantage plans compared to fee-for-service Medicare, especially when they were dual-eligible or lived in urban areas. However, some Medicare Advantage enrollees with Alzheimer’s disease and related dementias or cognitive impairment may have experienced over-screening for breast cancer.