bluuebunny/crossref_metadata_2025 huggingface dataset:
Making Peace: A Narrative Study of a Bilingual Liaison, a School and a Community
Authors: Hones Donald F.
Published: February 2022

Schools today must address multiple levels of conflict in the lives of children and communities. This study explores the role of a bilingual liaison in helping to resolve conflicts and build bridges of understanding between schools and diverse communities. Using narrative inquiry to represent and interpret the narratives of Shou Cha, a Hmong community liaison, and his colleagues at the Center for Language, Culture and Communication Arts (CLCCA), special attention is given to the representation of subjects’ voices and narrative forms that engage readers aesthetically as well as critically. This study addresses the multiple conflicts affecting the lives of minority language students, their families, and schools, as well as the need to move from a schooling paradigm of discipline and punish (Foucault, 1979) to one of making peace. He examines the cultural roles played by Shou Cha as cultural healer (from Spindler & Spindler, 1990) and border crosser (Giroux, 1997), and suggests implications for researchers and educators.
Punctuated Legitimacy: A Theory of Educational Change
Authors: Gold Barry Allen
Published: February 2022

This research presents a theory of educational change grounded in 23 years of qualitative data that document the history of a public elementary school. The pattern of change observed supports the punctuated equilibrium theory of organizational change in which short periods of revolutionary change—usually the result of failed innovation—are followed by long periods of equilibrium or incremental change. Attempts to legitimate organizational and individual behavior—the dynamics of construction, erosion, loss, reconstruction, and maintenance of organizational legitimacy—explain the sequence of stages in the change process. The study concludes that punctuated legitimacy, which created the need to reestablish legitimacy, not rational administrative attempts to improve the programs and structure of the school, was the major factor that produced significant organizational change.
Treatment with apocynin selectively restores hippocampal arteriole function and seizure-induced hyperemia in a model of preeclampsia
Authors: Cipolla Marilyn J , Tremble Sarah , DeLance Nicole , Allison Dana , Johnson Abbie C
Published: February 2022

Preeclampsia (PE) is a hypertensive disorder of pregnancy associated with neurovascular dysfunction, cognitive impairment and increased seizure susceptibility. Here, we sought to determine if treatment of experimental PE (ePE) rats with apocynin could prevent hippocampal arteriolar (HA) dysfunction and impaired seizure-induced hyperemia within the hippocampus, a brain region central to cognition and seizure generation. Isolated and pressurized HAs from Sprague Dawley rats that were normal pregnant (Preg; n = 8), ePE (n = 8) or ePE treated with apocynin for 2 weeks of gestation (ePE + apo; n = 8) were compared. Hippocampal blood flow (n = 6/group) was measured using hydrogen clearance before and during seizure. Aorta elastin was quantified using histochemistry. ePE was associated with HA dysfunction including reduced contraction to endothelin-1 and diminished dilation to the endothelium-dependent vasodilator NS309 that was prevented by apocynin. However, apocynin had no effect on ePE-induced impairment of dilation to the nitric oxide donor sodium nitroprusside, but increased myogenic tone and substantially increased HA distensibility. Seizure-induced hyperemia was impaired in ePE rats that was restored by apocynin. Aorta from ePE rats had reduced elastin content, suggesting large artery stiffness, that was unaffected by apocynin. Thus, while apocynin partially prevented HA dysfunction, its restoration of functional hyperemia may be protective of seizure-induced injury during eclampsia.
The value of CT-based radiomics in early assessment of chemotherapeutic effect in patients with advanced lung adenocarcinoma: a preliminary study
Authors: Lin Xi , Wang Huaming , Chen Jiayou , Lu Tao , Zheng Dechun , Chen Ying , Chen Yunbin
Published: February 2022

Background

Computed tomography (CT) is the preferred method for evaluating the therapeutic effect of lung cancer. Radiomics parameters can provide a lot of supplementary information for clinical diagnosis and treatment.

Purpose

To investigate the value of radiomics features of CT imaging to predict and evaluate the early efficacy of chemotherapy in patients with advanced lung adenocarcinoma.

Material and Methods

A total of 101 patients with advanced lung adenocarcinoma were enrolled. Patients were classified into a response group and non-response group according to RECIST 1.1 standard. All patients underwent chest CT examination before and after two cycles of chemotherapy. A total of 293 radiomics features were calculated. The features between response group and non-response group were compared before and after chemotherapy. The diagnostic efficacy was evaluated using the receiver operating characteristic curve.

Results

The six pre-chemotherapy radiomics features were selected, with area under the curve (AUC), sensitivity, and specificity at 0.720, 68.3%, and 69.0% in the training group and 0.573, 50.0%, and 76.9% in the test group, respectively. The eleven post-chemotherapy radiomics features were selected, with AUC, sensitivity, specificity at 0.789, 75.6%, and 75.9% in the training group and 0.718, 61.1%, and 76.9% in the test group, respectively. The prognostic value of △f8, △f16, %f8, and %f16 were higher than the other features with AUCs of 0.787, 0.837, 0.763, and 0.877, respectively.

Conclusion

Radiomics is expected to provide more valuable information for evaluating the chemotherapy efficacy of lung adenocarcinoma.
Value of multi-slice spiral computerized tomography for diagnosis of synchronous colorectal carcinoma: a retrospective study
Authors: Yang Bin , Gan Zhonghua , Liu Shulan , Li Mingxia , Si Guangyan , He Qizhou
Published: February 2022

Objective

To compare the accuracy of multi-slice spiral computerized tomography (MSCT) with colonoscopy for diagnosing synchronous colorectal carcinoma (SCC).

Methods

We retrospectively analyzed all consecutive patients admitted to our institution with colorectal carcinoma between 19 September 2014 and 31 January 2020. Data on SCC patients who had undergone MSCT and colonoscopy were analyzed. Information on tumor location, tumor size, missed diagnosis by MSCT or colonoscopy, T stage, pathological type, and reasons for missed diagnosis was recorded and used to assess the diagnostic accuracies of MSCT and colonoscopy.

Results

Twenty-three cases met the inclusion criteria. MSCT plus colonoscopy had a significantly higher diagnostic accuracy (93.5%) than colonoscopy alone. There were significant differences in missed diagnosis rates of proximal cancer (34.8%) and distal cancer (4.3%) by colonoscopy. For MSCT, the missed diagnosis rate for tumors with a median long diameter of 1.25 cm (interquartile range 0.80, 1.50) was significantly lower than that for larger tumors (long diameter 4.00 cm; 3.00, 6.00).

Conclusions

MSCT is a valuable diagnostic tool for SCC that can effectively minimize the missed diagnosis rate of primary tumors when combined with colonoscopy.
Imagining a ‘Jewish atom bomb’, constructing a scientific diaspora
Authors: Rabinowitz Or , Abramson Yehonatan
Published: February 2022

The nexus between transnational mobilization and Science and Technology Studies (STS) offers a productive platform for studying the formation of scientific activism, the influence of mobilization on scientific developments, and the ways science is used to achieve government goals. Integrating concepts from both sets of literature – particularly national sociotechnical imaginaries and socio-spatial positionality – this article explores how Dr Chaim Weizmann, a prominent chemist and a Zionist leader, attempted to construct and mobilize a ‘scientific diaspora’. Empirically, the article draws on new archival evidence, revealing the hitherto unknown early efforts of the Zionist movement to acquire nuclear reactor and utilize the Jewish involvement in the American nuclear project for political leverage abroad. Theoretically, rather than beginning the analysis with a scientific-diasporic network that was ready to be mobilized, we trace the selective and tailored practices employed by Weizmann to animate the Jewish connection among nuclear scientists and professionals.
Chemical and Rheological Characterization of Asphalt Binders: A Comparison of Asphalt Binder Aging and Asphalt Mixture Aging
Authors: Barghabany Peyman , Zhang Jun , Mohammad Louay N. , Cooper Samuel B. , Cooper Samuel B.
Published: February 2022

The objective of this study was to compare the chemical and rheological properties of asphalt binders recovered from aged asphalt mixtures with the corresponding aged asphalt binders used in those mixtures. Seven plant-produced asphalt mixtures, with unmodified and polymer modified asphalt binders and varying reclaimed asphalt pavement (RAP) content, were compacted and aged in a conventional oven at 85°C for zero (unaged), five, or 10 days. Asphalt binders were extracted and recovered from each aging level for chemical and rheological characterization. Seven blends of virgin asphalt binder and RAP binder were constituted to be similar to those used in the seven plant-produced asphalt mixtures. Subsequently, each asphalt binder blend was aged by rolling thin film oven (RTFO) and pressure aging vessel (PAV) for chemical and rheological characterization. Chemical and rheological characterization included Fourier transform infrared spectroscopy, high and intermediate temperature performance grade (PG), frequency sweep, and linear amplitude sweep (LAS) tests. Asphalt mixtures aged for five and 10 days resulted in asphalt binders that were less aged than similar ones aged by PAV when measured by LAS fatigue parameter ALAS, frequency sweep Glover Rowe (G-R) parameter, and intermediate temperature PG. However, unaged asphalt mixtures yielded asphalt binders with similar properties to those aged in RTFO as measured by high temperature PG. Correlation analysis between asphalt binder and asphalt mixture aging revealed that the G-R parameter has the highest coefficient of correlation among parameters. Further, new aging indices were introduced to capture the effect of polymer modification on aging susceptibility.
Order-Dispatching Strategy Induced by Optimal Transport Plan for an Online Ride-Hailing System
Authors: Lei Dechao , Wu Yuanshan
Published: February 2022

Order-dispatching strategy is fundamental for online ride-hailing systems in three major ways. First, it should be capable of effectively matching hundreds of orders to thousands of vehicles in less than 1 min, whereas both orders and vehicles are geographically widely distributed. Second, it should decide how to fairly allocate profit among participators. Third, it should unify interests of present and future. Conflicts always exist within the three objectives. We observe that the system is dynamically balanced during fine-tuned time intervals. Based on this observation, we propose a novel dispatching strategy capable of juggling the three objectives. By applying optimal transport theory, we demonstrate that, under appropriate presumptions, this dispatching strategy is ruled by the optimal transport plan realizing the Wasserstein distance between distributions of orders and vehicles. Furthermore, we develop a kit of methodological and algorithmic tools which has substantial and sensible advantages in characterizing and optimizing the system.
Adaptation and Preliminary Validation of a Positive Psychology Assessment Tool: Character Strengths Semantic Differential Scale
Authors: Kaya Cahit
Published: February 2022

Character strengths are a protective factor against psychological symptoms. However, there is a lack of research that has investigated the psychometric properties of abbreviated character strengths scales. The purpose of this study was to adapt and validate the Character Strengths Semantic Differential Scale (CS-SDS) with a sample of 235 college students. Using the back-translation method, the CS-SDS was translated from English into Turkish and then adapted. Next, exploratory factor analysis was conducted to determine the factorial structure of the Turkish version of CS-SDS (T-CS-SDS). The results indicated that the T-CS-SDS had a four-factor structure, namely, leadership, humanity, wisdom, and vitality. Significant moderate correlations were found for the character strengths factors with perceived stress, depression, and life satisfaction. Cronbach’s alpha coefficients for the factors were above .70. This is the first study that supported the use of the T-CS-SDS as a positive psychology assessment tool to design and implement innovative interventions to increase the well-being of college students.
Effects of Game-Based Learning on Students’ Achievement in Science: A Meta-Analysis
Authors: Lei Hao , Chiu Ming Ming , Wang Danyi , Wang Chenxin , Xie Tongwei
Published: February 2022

This meta-analysis examines the effects of game-based learning (GBL), compared with traditional instructional methods, on the science achievement of students, ranging from primary school to university. Results from the 41 primary studies of 6256 participants showed heterogeneity among effect sizes. The random effects model results showed a positive effect (g = .705, 95% CI = [.603, .807], p < .001), suggesting that students learned substantially more via GBL than traditional instruction. Additionally, moderation analysis found that the link between GBL and science achievement was stronger (a) among students in Eastern countries than Western countries; (b) among primary school students than undergraduates, junior or senior secondary school students; (c) on quizzes, final exams, and course grades than assignment scores; (d) for interventions between 4 hours and 1 week, smaller for those less than 4 hours, and smallest for those over 1 week; and (e) slightly in later publication years.
Major power politics and non-violent resistance movements
Authors: Kalin Ilker , Lounsbery Marie Olson , Pearson Frederic
Published: February 2022

Non-violent movements are rarely confined to the borders of the societies in which they take place. International actors are prone to take a side in the face of such resistance. Yet knowledge is limited on external actors’ effects on outcomes of non-violent protests abroad. Thus, we zero in on the strategic logic behind major powers’ involvement decisions regarding such movements, and the impact those decisions have on campaign outcomes. We find that major powers tend to undermine non-violent movements when target states are strategically important; we find also an indirect link between major power support for movements and security force defections in target states, thus improving success prospects for the protestors. Our research adds a dyadic international dimension to the question of external support during non-violent resistance movements and expands the current knowledge base regarding the identity and direction of support.
Palliative Care Penetration Among Hospitalizations with Acute Pulmonary Embolism: A Nationwide Analysis
Authors: Elkaryoni Ahmed , Darki Amir , Bunte Matthew , Mamas Mamas A. , Weinberg Ido , Elgendy Islam Y.
Published: February 2022

Background: Integration of palliative care in the management of critical illnesses has been linked with a better quality of life for patients and their families. Yet, there is a paucity of data regarding the role of palliative care for acute pulmonary embolism (PE) hospitalizations which is a leading cause of cardiovascular death in the United States. Methods: Using the Nationwide Inpatient Sample years 2005–2015, acute PE hospitalizations were identified by using ICD-9-codes. The primary outcome was the trends of palliative care penetration during acute PE hospitalizations and the main secondary outcome was the factors associated with palliative care utilization. Results: Among 505,485 acute PE hospitalizations, 15,522 (3.1%) had a palliative care encounter. Hospitalizations with high-risk PE versus non-high-risk PE showed a higher utilization for palliative care (7.6% vs. 2.7%, P < 0.001). The annual trends of palliative care penetration among hospitalizations with PE showed a rising pattern (0.6% in 2005 vs. 5.6% in 2015, Ptrend<0.001). A similar trend was observed among those with high-risk PE (0.8% in 2005 vs. 12.8% in 2015, Ptrend<0.001). The trends of palliative care utilization among cancer and non-cancer admissions increased over time (1.3%in 2005 to 15.5% in 2015 vs. 0.5% in 2005 to 3.9% in 2015, both P-trends<0.001). Some racial and regional disparities were identified among the predictors of palliative care utilization. Conclusions: Palliative care penetration among acute PE hospitalizations remains suboptimal even among high-risk PE, and cancer hospitalizations, but has been increasing in recent years. Future studies are needed to investigate the barriers for palliative care utilization and narrowing this gap among admissions with acute PE.
Sustainability of Palliative Care Principles in the Surgical Intensive Care Unit Using a Multi-Faceted Integration Model
Authors: Cralley Alexis , Madsen Helen , Robinson Caitlin , Platnick Carson , Madison Stefani , Trabert Teresa , Cohen Mitchell , Cothren Burlew Clay , Sauaia Angela , Platnick K. Barry
Published: February 2022

Objective(s): Understanding patient goals of care is essential in any setting, and especially so in an urban, safety net trauma centers’ Surgical Intensive Care Units (SICU). This underscores the need for implementation of palliative care principles and practices, such as identification of surrogate decision makers, goals-of-care discussions, and CPR directives, in the SICU. Methods: A pragmatic, quality improvement study utilizing a retrospective, pre- and post-intervention continuum analysis. Interventions included a surgeon champion, resident education, and an electronic medical record template, called the Advanced Care Planning (ACP) Note, for use on daily rounds. We reviewed the charts of all adults admitted to the SICU before, during, and after these interventions to identify the incidence of surrogate decision maker documentation by SICU residents. Results: There was an early and enthusiastic adoption in ACP note utilization by SICU residents over the study period. Rates of documenting surrogate decision makers increased throughout the study period ( p < 0.0001). Having an ACP note in the chart was associated with significantly higher rates of documented surrogate decision makers ( p < 0.0001). Conclusions: Through the integration of targeted education, standardization of an electronic medical record tool for palliative care documentation, and incorporation of palliative care goals into daily rounding ICU checklists, we significantly increased identification of surrogate decision makers in the SICU of our urban Level One trauma center. Chart review from one year post-intervention showed sustained commitment to the use of the ACP note and identification of surrogate decision makers
US Food and Drug Administration Facilitated Pediatric Approval Programs: Application to Pediatric Neurological Disorders
Authors: Cruz Emily Da , Rahim Faraan , Lemmon Monica , Mikati Mohamad A.
Published: February 2022

Crucial time is often lost while waiting for approval of therapies for pediatric neurological disorders, many of which have aggressive manifestations with devastating effects. There are logistical, ethical, and financial impediments that face the studies needed to determine efficacy and safety of therapies in children. In this article, the authors present the Food and Drug Administration’s programs aimed at facilitating the development of pediatric drugs, focusing on their application to pediatric neurological disorders. They also provide examples of drugs that received, or are currently enrolled in, these programs. Reflecting upon the commonalities of drugs receiving these designations, the authors highlight underlying ethical issues related to pediatric drug development and emphasize the need for structured incentives to stimulate approval and production of drug therapies for pediatric neurology patients. By consolidating information that applies to drug approval of pediatric neurological disorders, stakeholders in drug development can enhance treatment development for these disorders.
The incorporation of β-tricalcium phosphate nanoparticles within silk fibroin composite scaffolds for enhanced bone regeneration: An in vitro and in vivo study
Authors: Jing Tienan , yi liu  , Xu Li , Chen Cen , Liu Fan
Published: February 2022

To investigate the osteogenesis of β-tricalcium phosphate nanoparticles-incorporated silk fibroin (SF/β-TCP) composite scaffolds, SF-based scaffolds with different β-TCP proportion (2/1, 1/1, and 1/2) were fabricated by freeze-drying technology in the present study. Structural and physicochemical properties of SF-based scaffolds were evaluated by using scanning electron microscope, X-ray diffraction, Fourier transformed infrared spectroscopy (ATR-FTIR) and transmission electron microscope. Biocompatibility and osteogenesis of SF/β-TCP scaffolds were investigated by using bone marrow mesenchymal stem cells (BMSCs). Eight New Zealand rabbits were selected, while four 8-mm-diameter calvarial defects were created in each rabbit to place SF/β-TCP scaffolds. The harvested specimens at 4 and 12 weeks were used to evaluate the bone forming ability by micro-CT and histological examination. The results suggested incorporation of β-TCP displayed flake-like pore morphology with proper pore sizes. With the increasing proportion of β-TCP, composite scaffolds exhibited higher compressive strength, lower swelling ratio and degradation rate, as well as enhanced biomineralization capacity. Alkaline phosphatase activity and collagen type I expression levels of BMSCs were significantly increased in the presence of β-TCP nanoparticles. All composite scaffolds with different β-TCP proportion had good bone formation ability at 12 weeks. Among them, SF/β-TCP (1/2) scaffold exhibited the favorable osteogenesis capability which had great potential for applications in bone regeneration.
Intersubjectivity in the nursery: A case-study from Denmark
Authors: Gitz-Johansen Thomas
Published: February 2022

This paper reports from a study of intersubjectivity in a Danish nursery (“vuggestue”) for the 0-3 year olds. The study uses psychoanalytic infant observation. The concept of intersubjectivity is introduced from developmental psychology. Intersubjective moments depend on the adults’ mental participation in children’s interests and reactions. We know from developmental psychology that for children intersubjectivity is developmentally important and often joyful. The study shows how moments of play, sharing new experiences, participation in creative work, as well as mundane situations are potentially rich intersubjective moments. The study also shows how competence in verbal language expands the possibilities of intersubjective sharing.
A qualitative study on relationships and perceptions between managers and clinicians and its effect on value-based healthcare within the national health service in the UK
Authors: Ng Sze May
Published: February 2022

One of the main drivers for change towards delivering value-based healthcare is to improve clinical and managerial culture and engagement within organisations. The relationships between clinicians and managers in an organisation are often considered to be either an enabler or disabler towards successful engagement to develop strategies towards better value healthcare. Successful engagement is dependent on effective and transformational leadership that can impact on organisational value in healthcare. The aim of this research was to explore the relationships, behaviours and perceptions between managers and clinicians towards value-based healthcare in the National Health Service in the United Kingdom. A qualitative research methodology of semi-structured in-depth interviewing on a sample consisting of hospital consultants, senior managers and board executives from a diverse group were conducted. A thematic analysis was used to analyse the data using a systematic approach. The study findings identified areas of potential barriers to engagement for clinicians and managers which were related to regulatory burden, financial challenges and workforce shortages. Key recommendations on what will be required to improve clinicians and managers engagement and the leadership approaches towards improving value-based healthcare are discussed.
Prediction of centrifugal compressor instabilities for internal combustion engines operating cycle simulation
Authors: Minchev Dmytro S , A Gogorenko Oleksiy , Varbanets Roman A , Moshentsev Yuryi L , Píštěk Vaclav , Kučera Pavel , Shumylo Oleksandr M , Kyrnats Vladyslav I
Published: February 2022

Centrifugal compressors, which serve the purpose of internal combustion engines (ICE) supercharging, have a region of unstable operation. The compressor instabilities can be distinguished as rotating stall, mild, or deep surge, depending on the compression system parameters. All these types of compressor operation should be avoided for engine durability and long service life. Therefore, it is important to provide fast, stable, and correct prediction of compressor instabilities at ICE operating cycle simulation. The experimental research was conducted for an aircraft engine compressor to measure compressor performance map in the region of unstable operation, which is usually never provided by the manufacturer, and to study the compression system operation in the mild and deep surge modes. A mathematical model was developed, based on the Moore-Greitzer approach together with the modified equation of the compressor outlet pipe airflow acceleration, and integrated into the Blitz-PRO service for ICE steady and transient operation simulation. It is shown that the suggested mathematical model correlates well with the experimental data for the compressor testbench case. The application of the developed mathematical model provides fast and stable calculations and prediction of the type of compression system instability.
Experiences of critical care nurses during the early months of the COVID-19 pandemic
Authors: Moore Dorothy James , Dawkins Denise , Hampton Michelle DeCoux , McNiesh Susan
Published: February 2022

Background:

Critical care nurses have risked their lives and in some cases their families through hazardous duty during the COVID-19 pandemic and have faced multiple ethical challenges.

Research/aim:

The purpose of our study was to examine how critical care nurses coped with the sustained multi-faceted pressures of the critical care environment during the unchartered waters of the COVID-19 pandemic. It was anticipated that our study might reveal numerous ethical challenges and decision points.

Research design:

A qualitative descriptive study, utilizing an interpretivist paradigm.

Participants and research setting:

Critical care nurses, working in either intensive care units or emergency departments (N = 11) who were primarily from Northern California hospitals. Individual in-depth ZOOM® session interviews, guided by semi-structured questions, were used to collect data. Interviews lasted between 18 and 59 min, with an average length of 33 min. Session interviews were transcribed and analyzed.

Ethical considerations:

This study was approved by the researchers’ university Institutional Review Board.

Findings:

Five main themes emerged: Fear of the Unknown, Adapting to Practice Changes and Challenges, Patient Advocacy and Moral Distress, Isolation and the Depersonalization of Care, and Professionalism and a Call to Duty.

Discussion and conclusion:

Fear of becoming ill or bringing COVID-19 home to their families was a constant source of anxiety for nurses. There were numerous changes in policy and challenges to standard practice protocols, including most notably shortages in personal protective equipment, which nurses navigated resourcefully. Most nurses interviewed were motivated by a sense of professional duty. The nurses experienced some moral distress in their inability to advocate as they might like for their patients, especially at end of life. Infection control requirements for isolation.
Determinants of Innovation Frequency in SMEs: Evidence from Ambattur Industrial Cluster
Authors: Kumar Praveen , Manjula P. S.
Published: February 2022

Cluster-based industrial development has been pursued by policymakers in India. It emphasised an innovation-led path to development because of its potential of generating high-quality and technologically advanced jobs with decent wages. Continuous innovation is one of the main factors which can sustain competitive advantage in small and medium enterprises (SMEs). Hence in this article, we study how innovation frequency is influenced by various factors such as entrepreneurial characteristics, firm and its linkages with various stakeholders. The study was conducted among 160 randomly selected SMEs from the database of primary Association of Ambattur Industrial Cluster Members, AIEMA-Ambattur Industrial Estate Manufacturers Association. Primary data was collected through a structured questionnaire given to the decision-makers of each SME unit. Multinomial logistic regression was carried out on the data with innovation frequency as the dependent variable. The result of the study showed that factors such as entrepreneurial intention, entrepreneur type, firm’s life cycle, firm’s age, firm’s investment level and linkage with research institutions have a highly significant effect on innovation frequency and factors such as entrepreneur education, firm’s ownership structure, industry type, firm’s size and linkages with customers, government, universities, technical institutions also have a positive significant effect of increasing the innovation frequency.
Suicide-related crisis presentations to a rural emergency department: A retrospective cohort study
Authors: MacDermott Sean , Sutton Keith , Motorniak David , Bredhauer Jacqueline , Wright Fiona , Whyte Merryl , van Vuuren Julia , Spelten Evelien
Published: February 2022

Objective

The study sought to investigate the profile and characteristics of suicide-related crisis presentations and factors associated with repeat presentations to a rural hospital Emergency Department (ED).

Method

This retrospective cohort study examined suicide-related crisis presentation data from a rural ED for the years 2008–2018 inclusive. Descriptive statistical analyses included demographic characteristics and trends over time. Factors associated with increased likelihood to re-present to the ED for suicide-related crisis were identified using Odds Ratio analyses.

Results

First Nations People, adolescents and young adults were at increased risk of presentation. Suicidal crisis presentations had increased well beyond that which might be accorded to the catchment’s population increase and almost a third of presentations involved individuals re-presenting in suicide-related crisis. Repeat presentation was positively associated with younger age, less acute triage category, discharge to the community and leaving the ED before/during treatment.

Conclusions

This study illustrates the importance of flagging, follow-up and support of rural repeat presenters to reduce further suicidal behaviours and presentation. Findings support the need for culturally safe and appropriate interventions and follow-up services. It is recommended to extend approach this to non-ED settings.
A One-Year Follow Up Study on Disability in Mental Health Nursing Practice
Authors: Hernando-Merino Elena , Baca-García Enrique , Barrigón Maria Luisa
Published: February 2022

Disability is common in patients with mental disorders, and therapeutic approaches should promote functional recovery to achieve the highest quality of life. This study reports changes in WHODAS 2.0 scores at 1 year of follow-up among patients receiving care from a single mental-health nurse in a community setting in Spain and compare these changes by diagnosis (SMI vs. CMI). Baseline and 1-year follow-up scores were compared. For all participants, we collected sociodemographic information, clinical diagnosis, and disability scores according to WHODAS 2.0. Participating patients received the usual, non-manualized nursing intervention. Our sample comprised 133 patients, 75 of whom were assessed after 1 year. All patients had improved WHODAS 2.0 scores (difference of 9.20 ± 2.42; p < .001) in all domains except those domains related to work (“Life activities”) and relationships (“Getting along”). Furthermore, almost half of the patients studied were no longer undergoing treatment with the nurse at 1-year follow-up.
Anthropometry Based Growth and Body Composition in Infants with Complex Congenital Heart Disease
Authors: Irving Sharon Y. , Ravishankar Chitra , Miller Mary , Chittams Jesse , Stallings Virginia , Medoff-Cooper Barbara
Published: February 2022

Background:

Infants with congenital heart disease (CHD) often have poor growth and altered body composition (fat and muscle accretion).

Aim:

Describe growth patterns in infants with CHD using interval weight, length, head circumference (HC), triceps (TSF), subscapular skinfolds (SSSF), and mid-upper arm circumference (MUAC) measurements.

Subjects and Methods:

A total of 120 infants enrolled: 48% healthy and 58% with CHD (45% single ventricle [SV]; 55% two ventricle [2V] physiology). Weight, length, HC, TSF, SSSF, and MUAC measured at 3-, 6-, 9-, and 12-months of age.

Results:

CHD infants had lower weight, length, and HC z-scores at 3-, 6-, and 9-months. At 9-months, infants with SV physiology had larger TSF and SSSF z-scores over 2V and healthy infants. Overall MUAC z-scores were smaller at 3- and 6-months in infants with CHD.

Conclusison:

Infants with CHD have a complex pattern of growth. Longitudinal growth and body composition measurements provide information to better understand this pattern.
The Impact of Race and Ethnicity on Surgical Risk and Outcomes Following Palatoplasty: An Analysis of the NSQIP Pediatric Database
Authors: Halsey Jordan N. , Asti Lindsey , Kirschner Richard E.
Published: February 2022

Objective

To determine how race and ethnicity affect palatoplasty 30-day outcomes.

Design

Retrospective review.

Patients/setting

The 2012 to 2019 National Surgical Quality Improvement Program (NSQIP) Pediatric database was used to identify patients ≤ 2 years who underwent primary palatoplasty. We compared demographics, comorbidities, and 30-day outcomes among different racial and ethnic groups. Logistic regression was used to determine independent risk factors for adverse events.

Main outcome measures

Increased risk for adverse events and postoperative surgical outcomes, including complications, readmission, and prolonged length of stay.

Results

A total of 8537 patients were identified in the database. African-American patients had the highest proportion of premature infants and infants with a BMI < 15% at the time of repair. Asian patients underwent palatoplasty at a later age compared to other races (12.7 months vs 11.7-12.1 months). Postoperatively, the odds of a complication were significantly higher in Asian patients (aOR = 1.73, 95% CI: 1.17-2.57) and other/unknown patients (aOR = 1.40, 95% CI: 1.05-1.86), but not among African American (aOR = 1.02, 95% CI: 0.70-1.47) or Hispanic (aOR = 0.93, 95% CI: 0.69–1.26) patients. Other/unknown patients were more likely to require postoperative ventilation (aOR = 2.34, 95% CI: 1.38-3.95). The odds of readmission were highest in Asian and other/unknown patients. African American, Hispanic, and other/unknown patients were more likely than Caucasian patients to be hospitalized > 2 days postoperatively.

Conclusion

This study highlights ethnic differences in presentation and 30-day outcomes following palatoplasty. Further evaluation of disparities in cleft care should be performed to improve healthcare access and surgical outcomes.
Abemaciclib: The First FDA-Approved CDK4/6 Inhibitor for the Adjuvant Treatment of HR+ HER2− Early Breast Cancer
Authors: Raheem Farah , Ofori Henry , Simpson Lacey , Shah Vishal
Published: February 2022

Objective:

To review the new indication of cyclin-dependent kinase (CDK4/6) inhibitor abemaciclib for the adjuvant treatment of hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2−), axillary lymph node (LN) positive early breast cancer (EBC) at high risk of recurrence and a Ki-67 ≥20%.

Data Sources:

A literature search was performed through PubMed, ClinicalTrials.gov, and Food and Drug Administration (FDA) website (February 1, 2018, to December 23, 2021) to identify relevant information.

Study Selection and Data Extraction:

Human and animal studies related to pharmacology, pharmacokinetics, efficacy, and safety of abemaciclib were identified.

Data Synthesis:

Addition of abemaciclib to standard of care endocrine therapy (ET) for patients with high-risk clinicopathologic features and Ki-67 ≥20% demonstrated 30% reduction in the risk of developing invasive disease and distant recurrence. At 15.5 months, abemaciclib + ET demonstrated a significant improvement in invasive disease-free survival (IDFS) vs ET alone (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.60-0.93, P = 0.01). At 27 months, IDFS benefit was maintained (HR, 0.70; 95% CI, 0.59-0.82, P < 0.0001). Diarrhea occurred in more than 80% of patients in the abemaciclib arm.

Relevance to Patient Care and Clinical Practice:

This review describes the clinical applicability of adjuvant abemaciclib for patients with HR+, HER2− EBC at high risk for recurrence.

Conclusion:

Adjuvant abemaciclib significantly reduces the risk for early development of invasive disease and distant recurrence in patients with HR+, HER2− node positive EBC. Longer follow-up is needed to determine the impact of adjuvant abemaciclib on late disease recurrence and survival outcomes.
Intermittent Versus Continuous Infusion Dosing of Intravenous Proton Pump Inhibitors for Upper Gastrointestinal Bleeding
Authors: Leung Thomas , Kedzior Sonya , Moore Kerry , Bierman Jesse , Coralic Zlatan
Published: February 2022

Background:

Proton pump inhibitor (PPI) continuous infusions or intermittent boluses are used for the treatment of upper gastrointestinal bleeding (UGIB). Intermittent boluses are easier to give and are of lower cost without affecting clinical outcomes.

Objective:

To compare the rate of rebleeding between intermittent bolus and continuous infusion PPI therapy.

Methods:

We performed a retrospective, multicenter review of patients with UGIB receiving either continuous or intermittent PPI therapy. During the study period, due to drug and supply shortages, each institution implemented policies preferring intermittent PPI bolus therapy. We performed bivariate and multivariable comparisons of the 2 treatment strategies, with the primary outcome of interest being incidence of rebleeding. Additional variables of interest included intensive care unit (ICU) and hospital lengths of stay, discharge disposition, and in-hospital mortality.

Results:

Compared with intermittent bolus dosing (n = 209), patients receiving continuous infusion PPI (n = 237) were associated with a higher rate of rebleeding (33.8% vs 23.0%; P = 0.012); however, no difference was detected in multivariable analysis: adjusted odds ratio, 1.50 (95% confidence interval, 0.91-2.50). There was no difference in median hospital or ICU length of stay, discharge disposition, or in-hospital mortality. Correlatively, patients receiving continuous infusion therapy were more likely to have liver disease (29.1% vs 20.1%; P = 0.028), alcohol use disorder (28.3% vs 16.3.%; P = 0.003), history of lower gastrointestinal bleeding (6.4% vs 1.9%; P = 0.021), variceal bleeding (6.3 vs 2.4%, P = 0.045), and be admitted to the ICU (65.0% vs 32.5%, P = 0.00).

Conclusions:

Introduction of intermittent PPI bolus UGIB treatment via change in hospital policy was not associated with higher rates of rebleeding. However, continuous PPI therapy may have been perceived as more effective as it was used more commonly in high-risk patients.
Ibuprofen-Associated Hypokalemia and Metabolic Acidosis: Systematic Literature Review
Authors: Man Anca M. , Piffer Arianna , Simonetti Giacomo D. , Scoglio Martin , Faré Pietro B. , Lava Sebastiano A. G. , Bianchetti Mario G. , Milani Gregorio P.
Published: February 2022

Objective:

Ibuprofen is a widely used nonsteroidal anti-inflammatory drug, which has been occasionally associated with hypokalemia and metabolic acidosis. The objective of this report is to analyze the literature on this issue and to address the underlying pathophysiology.

Data Sources:

Excerpta Medica, the National Library of Medicine, and Web of Science were searched from inception to July 16, 2021.

Study Selection and Data Extraction:

Papers reporting individually documented humans on ibuprofen with hypokalemia, acidosis, or both were retained. Data were extracted using a checklist.

Data synthesis:

For the final analysis, we evaluated 41 reports describing 50 cases (26 males and 24 females; 36 adults and 14 children) with often profound hypokalemia, acidosis, or both after ingestion of ibuprofen. Twenty-six cases were acute and 24 long term. Hypokalemia and acidosis occurred not only after ingestion of very high doses but also after ingestion of moderately high or even normal doses of ibuprofen. Laboratory values consistent with an excessive urinary potassium excretion or an altered urinary acidification were often disclosed in most cases. Discontinuation of ibuprofen resulted in a resolution of hypokalemia and acidosis within days in 47 cases. The course was lethal in 3 cases.

Relevance to Patient Care and Clinical Practice:

This review highlights potentially fatal side effects of ibuprofen and can help doctors who are confronted with such a situation.

Conclusions:

These data highlight the potential of ibuprofen to occasionally induce hypokalemia and acidosis of renal origin. Discontinuation of ibuprofen results in a resolution within days.
Malignant Adenomyoepithelioma of the Breast and Associated Epithelial-Myoepithelial Carcinoma; A Rare Case Report
Authors: Jameel Zena , Kiluk John , Rosa Marilin
Published: February 2022

Adenomyoepithelioma comprises a spectrum of lesions with variable morphology and clinical behavior, presenting at a wide age range. The most common presenting symptom is palpable abnormality. Mammographic abnormalities include focal asymmetries, masses and microcalcifications. Adenomyoepithelioma is a biphasic neoplasm characterized by proliferation of epithelial and myoepithelial cells. Adenomyoepitheliomas can be benign, atypical and malignant (adenomyoepithelioma with carcinoma). Malignant transformation occurs in either one or both cellular components leading to the development of invasive carcinoma. Invasive carcinoma types include invasive breast carcinoma of no special type, invasive lobular carcinoma, invasive carcinoma of special types, myoepithelial carcinoma, metaplastic carcinoma and biphasic carcinoma such as epithelial-myoepithelial carcinoma. While the majority of classic adenomyoepitheliomas have a benign clinical course and can be treated by local excision, local recurrence and distant metastasis have been reported. In malignant cases, treatment is determined by the associated carcinoma to include radiotherapy after breast conserving surgery and sentinel lymph node biopsy or axillary lymph node dissection, as indicated. Herein we report a case of a 62 year old woman who was found to have focal asymmetry on screening mammogram. She underwent a core biopsy of the lesion which showed atypical epithelial-myoepithelial neoplasm and excision was recommended. Upon excision, a diagnosis of malignant adenomyoepithelioma with associated epithelial-myoepithelial carcinoma was rendered with negative margins. The patient declined additional surgery for sentinel lymph node biopsy and declined adjuvant therapy. Six months after surgery, the patient is doing well with no complains. A follow-up mammogram and ultrasound of the axilla showed no abnormalities.
Imaging Findings and First Metatarsal Rotation in Hallux Valgus
Authors: Najefi Ali-Asgar , Katmeh Rateb , Zaveri Amit Kamal , Alsafi Mohammad Khalid , Garrick Frances , Malhotra Karan , Patel Shelain , Cullen Nicholas , Welck Matthew
Published: February 2022

Background:

Failure to identify and correct malrotation of the first metatarsal may lead to recurrent hallux valgus deformity. We aimed to identify the proportion of hallux valgus patients with increased first metatarsal pronation using weightbearing computed tomography (WBCT) and to identify the relationship with conventional radiographic measurements.

Methods:

WBCT scans were analyzed for 102 feet with a hallux valgus angle (HVA) and intermetatarsal angle (IMA) greater than or equal to 16 and 9 degrees, respectively. Metatarsal pronation angle (MPA), alpha angle, sesamoid rotation angle (SRA), and sesamoid position were measured on standardized coronal WBCT slices. Pronation was recorded as positive. Hindfoot alignment angle (HAA) was assessed using dedicated software. Pearson correlation and multiple regression analyses were used to assess differences between groups.

Results:

Mean HVA was 29.8±9.4 degrees and mean IMA was 14.1±3.7 degrees. Mean MPA was 11.9±5.8 (range 0-26) degrees and mean alpha angle was 11.9±6.8 (range −3 to 29) degrees. In a previous study, we demonstrated the upper limit of normal MPA as 16 degrees and alpha angle as 18 degrees. Based on these criteria, we identified abnormal metatarsal pronation in 32 feet (31.4%). We found a strong positive correlation between SRA and HVA/IMA ( R = 0.67/0.60, respectively, P < .001). IMA and HAA weakly correlated with MPA and alpha angle (IMA: R = 0.26/0.27, respectively, P < .01; HAA: R = 0.26/0.27, respectively, P < .01). Regression analyses suggested that increasing IMA was the most significant radiographic predictor of increased pronation. In this cohort, there was no correlation between HVA or sesamoid position and MPA / alpha angle (HVA: P = .36/.12, respectively, sesamoid position, P = .86/.77, respectively).

Conclusion:

In this cohort of 102 feet that met plain radiographic criteria for hallux valgus deformity, first metatarsal pronation was found abnormal in 31.4% of patients. We found a weak association between the IMA and hindfoot valgus, but not the HVA.
Offloading Plantar Pressures in Healthy Adults: Stirrup Cast vs Total Contact Cast
Authors: Al Khalifa Ahmed , Al Khalifa Muneera , Khan Ryan M. , Awoke Adam , Cherry Ahmed , Halai Mansur , Daniels Timothy R.
Published: February 2022

Background:

Diabetic foot ulcers are associated with significant morbidity and mortality while posing a challenge for healthcare professionals. Offloading is considered the mainstay of treatment. Total contact casting (TCC) is widely used but does not effectively offload the hindfoot. Some studies suggest that a metal stirrup is effective at offloading midfoot and hindfoot ulcers. The primary purpose of this study is to compare the offloading mechanism of TCC to a stirrup cast.

Methods:

A pilot observational study assessing 12 healthy volunteers who underwent casting with a TCC or stirrup cast. A sensor (Pedar; Novel GmbH) that measures maximum force, peak pressure, and contact time and area of each foot region, was placed inside the cast to assess the offloading mechanisms of the 2 interventions.

Results:

We measured a reduction in all plantar foot loading parameters from the TCC to the stirrup cast. The highest reductions of 85% to 96% (±5%-13%) were noted in maximum force and peak pressure under the forefoot ( P < .0001) and found reductions in maximum force, the contact area of all regions of the foot, peak pressure and contact time of the forefoot and midfoot, and contact area of the hindfoot ( P < .05).

Conclusion:

In this experimental trial of healthy adults, the stirrup cast was more effective than the TCC by offloading the foot mostly in the forefoot and midfoot.