bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk Factors Associated With Bullying in Context of a Territory Exposed to Armed Conflict: A Cross-sectional Study
Authors: Salazar Flórez Jorge Emilio , Humberto Montoya Walter , Giraldo Cardona Luz Stella
Published: December 2023

School violence and bullying are current and problematic events during adolescence. They are likely to have a marked presence in places highly exposed to armed conflict and violent environments, representing a double public health problem. The study aims to estimate the prevalence of different types of school violence perpetrated and experienced by school adolescents in a community with a history of exposure to armed conflict. Two thousand one hundred eighty-five school adolescents from a municipality in Colombia (males = 54.1%, 14–16 years = 38.6%) participated in the study. Nine educational institutions were included. A systematic random sampling was designed, with a proportional allocation of 35% within each school year from sixth to eleventh grade. The School Coexistence and Circumstances Affecting it—ECECA survey was applied. The prevalence and risks of bully and bullying were estimated. RRa were calculated with the 95% confidence interval adjusted for the other confounding variables. Analyses were constructed from generalized linear models, under the Poisson family and a logarithmic link function. We found a 9.3% of bullying victimization and a 3.5% prevalence of bully. A higher risk of bully was found among males, persons between 10 and 14 years of age, residents of rural or urban dispersed areas, residents of violent neighborhoods, alcohol consumers at school, and victims of aggression in childhood (RRa > 1.0, p-values <.05). The risk of victimization of bullying was higher in students younger than 15 years old, as residents of urban areas, having a history of childhood aggression, suffering abuse by a close person, and as alcohol users at school. This study provides evidence of risk factors for aggression and bullying that have implications for possible prevention measures in multiple social domains, including the individual, the family, and the school environment.
Living Arrangements Predict Frequent Alcohol Consumption Among University Students: A Retrospective Cohort Study
Authors: Matsumura Yuichiro , Yamamoto Ryohei , Shinzawa Maki , Otsuki Naoko , Mizui Masayuki , Matsui Isao , Sakaguchi Yusuke , Nishida Makoto , Nakanishi Kaori , Ide Seiko , Ishibashi Chisaki , Kudo Takashi , Yamauchi-Takihara Keiko , Nagatomo Izumi , Moriyama Toshiki
Published: December 2023

Purpose

This study aimed to confirm the clinical impact of living arrangements on incidence of frequent alcohol consumption in university students.

Design

A retrospective cohort study.

Setting

A national university in Japan.

Subjects

17,774 university students.

Measures

The association between living arrangements on admission and the incidence of frequent alcohol consumption (≥4 days/week) was assessed using multivariable-adjusted Cox proportional-hazards models.

Results

Among 5,685, 692, and 5,151 male students living with family, living in the dormitory, and living alone, 5.0%, 6.2%, and 5.8% reported frequent alcohol consumption during the median observational period of 3.0 years, respectively. Living in the dormitory and living alone were identified as significant predictors of frequent alcohol consumption (multivariable-adjusted hazard ratios: 1.00 [reference], 1.39 [1.01-1.92], and 1.21 [1.03-1.42], respectively). On the contrary, living arrangements were not associated with the incidence of frequent alcohol consumption among of 6,091 female students, partly because of low incidence of frequent alcohol consumption (2.3%, 1.4%, and 2.6%, respectively).

Conclusions

Living arrangements predicted frequent alcohol consumption among male university students, whereas not among female university students.
Study on temperature field distribution state of carbon fiber reinforced polymer wound circular tube via electromagnetic induction heating
Authors: Gu Yunfei , Xu Jiazhong , Fu Tianyu , Zhang Hao
Published: December 2023

The variation of temperature fields during the winding process of CFRP (Carbon Fiber Reinforced Polymer) due to fiber winding is a key factor influencing its curing and shaping. Traditional heating methods result in energy wastage and environmental pollution during the heating process. Electromagnetic induction technology, as a non-contact, pollution-free, and efficient heating method, is playing an increasingly significant role in the process of heating and curing CFRP. This study focuses on two heating methods, internal and external, for CFRP wound circular tubes. It establishes finite element analysis models for induction heating with different coil structures. The heating mechanisms of different coil-induced CFRP wound circular tube models are explained, and the effects of external arc-shaped coils and external/internal annular coils on the temperature field distribution of CFRP wound circular tubes are investigated. By comparing simulations with experiments, the correctness of the numerical analysis model in this study is demonstrated. It offers viable heating methods for different conditions in industrial production, providing theoretical support and empirical data for the induction heating of CFRP wound circular tubes.
Higher education and sustainable creative cities: The development of creative and cultural ecosystems in the (new) capital city of Kazakhstan
Authors: Kim Sana , Comunian Roberta
Published: December 2023

This article examines the role creative and cultural higher education plays in the top-down development of Astana – the new capital of Kazakhstan. Drawing on a mapping of higher education institutions in Kazakhstan’s old (Almaty) and new capital cities as well as qualitative interview data with creative and cultural practitioners, academics and policymakers, we explore the complex relationship between the development of higher education infrastructure and the broader development of the local creative and cultural ecosystem of the new capital. By exploring challenges and opportunities surrounding these developments within the new capital city, we draw some insight regarding the sustainable development of higher education and the creative and cultural ecosystem more broadly. We find that creative and cultural higher education plays an essential role in the development of the new capital city and its opportunity to lead as a creative and cultural capital. In turn, we argue that creative and cultural HE development cannot happen in isolation but needs to be planned and carried out as part of the more comprehensive creative and cultural ecosystem development, reinforcing the local creative and cultural economy and being shaped by it. It also needs to be seen as a long-term development strategy rather than a short-term solution to jump ahead in urban hierarchies. However, we warn that wider political influences may hinder the development of a genuinely independent creative and cultural higher education system.
Effect of flow on heat transfer between a translating plate and gas discharged from multiple inclined slot nozzles
Authors: Kang Can , Yin Jin , Wu Licheng , Wang Kangbing
Published: December 2023

The presented study aims to reveal flow and heat transfer characteristics as a translating aluminum plate is impinged by high-temperature gas discharged from inclined slot nozzles. The computational fluid dynamics (CFD) and the fluid-solid interaction (FSI) techniques were used to simulate the impingement process. A comprehensive comparison of flow, heat transfer, and structural parameters was implemented. The results indicate that twin vortices are produced between the two inclined nozzles. When the velocity ratio increases from 0.1 to 1.0, the vortex at the left expands, while the right one is compressed. Meanwhile, average Nusselt number and the pressure coefficient exhibit opposite variation tendencies. The highest average pressure coefficient of 0.45 arises at a velocity ratio of 0.5. As the plate-nozzle distance increases, characteristic flow structures are developed, and the distributions of temperature and the pressure coefficient are uniformized. The maximum Nusselt number decreases from 473 to 266 when the nondimensional plate-nozzle distance increases from 4 to 8. Large deformation occurs at the middle part of the plate. High equivalent stress is concentrated at the front and rear ends of the plate, which is insensitive to the velocity ratio and the plate-nozzle distance.
Effects of contralateral versus ipsilateral electroacupuncture for analgesia and rehabilitation after unilateral total knee arthroplasty: a randomized controlled trial
Authors: Huang Hai , Tang Kangmin , Song Xiuling , Zhao Ling , Liang Yongying , Xu Hui , Xiao Lianbo , Chen Yuelai
Published: December 2023

Purpose:

Total knee arthroplasty (TKA) is a treatment for advanced knee osteoarthritis. Since postoperative pain affects rehabilitation, this study aimed to determine whether electroacupuncture (EA) contralateral to the surgical site is more effective than ipsilateral EA or sham EA in terms of relieving postoperative pain and promoting post-TKA rehabilitation.

Methods:

In this parallel, single-blind randomized controlled trial, 114 patients undergoing unilateral TKA were assigned to the contralateral EA (EA on the contralateral side + sham EA on the ipsilateral), ipsilateral EA (EA on the ipsilateral + sham EA on the contralateral side), or sham EA (sham EA on both sides) groups (n = 38 each). Treatment was performed once daily on postoperative days 1–3. The visual analog scale (VAS) scores, additional opioid doses via patient-controlled analgesia (PCA) pump, Hospital for Special Surgery (HSS) knee scores, active/passive range of motion (AROM/PROM), swelling around the knee joint, and Hamilton anxiety scale (HAMA) scores were used for postoperative evaluation.

Results:

At 3 days postoperatively, the VAS scores, HSS scores, AROM/PROM, swelling around the knee, and HAMA scores in the contralateral EA and ipsilateral EA groups were significantly improved compared with baseline. In addition, VAS scores, HSS scores, PROM and swelling around the knee were significantly better in the contralateral and ipsilateral EA groups than in the sham EA group, but similar in the two true EA groups. Furthermore, PCA additional dose release was significantly higher in the sham EA group than in the two true EA groups (which did not significantly differ). At 10 days postoperatively, the HSS scores, AROM/PROM, and HAMA scores were better in the contralateral and ipsilateral EA groups than in the sham EA group, but similar in the two true EA groups.

Conclusion:

Contralateral EA is more effective than sham EA for treating postoperative pain following TKA, but has an analgesic effect similar to that of ipsilateral EA.

Trial registration number:

ChiCTR1800020297 (Chinese Clinical Trial Registry)
Nurturing moral community: A novel moral distress peer support navigator tool
Authors: Morley Georgina , Sankary Lauren R.
Published: December 2023

Moral distress is a pervasive phenomenon in healthcare for which there is no straightforward “solution.” Rhetoric surrounding moral distress has shifted over time, with some scholars arguing that moral distress needs to be remedied, resolved, and eradicated, while others recognize that moral distress can have some positive value. The authors of this paper recognize that moral distress has value in its function as a warning sign, signaling the presence of an ethical issue related to patient care that requires deeper exploration, rather than evidencing identification of the “right” course of action. Once the experience of moral distress is identified, steps ought to be taken to clarify the moral issue, and, if possible and reasonable, the patient’s values ought to be prioritized. This paper offers concrete actions steps, drawn from theory, which can be used in clinical practice to provide peer support or to facilitate self-reflection for morally distressed individuals. This approach empowers morally distressed individuals to explore ethical issues, identify concrete steps that can be taken, and mitigate feelings of powerlessness that are often associated with moral-constraint distress. The questions guide individuals and peers to reflect first on the micro-space and then more broadly on the institutional culture, facilitating meso- and macro-reflection and action.
Prioritizing E-service Quality Dimensions in E-tailing: Application of the Analytic Hierarchy Process
Authors: Ranjit Gayathri , Subramoniam Suresh , S. A. Binoosh
Published: December 2023

The objective of this study is to prioritize the e-service quality dimensions in e-tailing that attract and retain customers which help e-tailers attain a competitive advantage in the market. Measurement and improvement of electronic service quality is of paramount importance for e-tailers. The Analytical Hierarchy Process (AHP) is used to rank the identified e-service quality dimensions in this research. The eight main dimensions in e-tailing identified through literature review were ranked using the AHP method. Delphi technique was used to obtain data from 10 experts who are consultants in the area of e-tailing to conduct AHP analysis. The results prioritized the e-service quality dimensions and their sub-factors and the results also revealed that privacy and security, customer service and system availability are the most important dimensions of e-service quality in e-tailing sector. The research’s conclusions aided in understanding the various priorities and related weights of the various aspects of e-service quality that were ultimately rated according to the weights. E-tailers can take necessary steps to monitor and improve performance on those dimensions that ultimately result in customer happiness, loyalty, and retention by prioritizing the service quality dimensions.
Decarbonisation through modernisation: The UK’s EV transition as a vehicle for industrial change
Authors: Jackson James
Published: December 2023

As the transport sector remains the only sector in the United Kingdom (UK) in which emissions continue to rise, electric vehicles (EVs) have become an increasingly prominent political subject. This article finds that far from simply a low carbon transition, the EV transition in the UK is a means to address the attendant frailties of its economic model. Drawing upon an original empirical dataset of 33 interviews alongside a document analysis, I show that decarbonising the UK automobile sector is tied to a process of industrial and economic modernisation. These findings reveal the contested features of the transition, as the desire to capitalise on broader shifts in the global automobile market is brought into opposition with Britain’s financialised political economy. Finally, it shows that the modernisation tenet of Ecological Modernisation, which has come to be routinely neglected in the literature, should be revisited in the context of Brexit, COVID-19 and economic crises.
Diagnosis and management of systemic mastocytosis in a community hematology setting
Authors: Dranitsaris George , Neuhalfen Heather , Peevyhouse Aaron , Powell Dakota , Miller Kerri , Green Teresa , Graff Tara
Published: December 2023

Background

Systemic mastocytosis (SM) is a rare and potentially severe hematologic disorder characterized by the clonal proliferation of mast cells (MCs) into various organs. The clinical manifestations of advanced SM are caused by the uncontrolled release of cytokines and vasoactive amines from MC and disease-induced organ dysfunction. Patients with SM typically present with symptoms such as flushing, pruritus, diarrhea, and headaches, but outcomes following active treatment have not been well characterized. In this study, the clinical characteristics, treatment patterns, and natural history of an SM patient cohort diagnosed and treated within a community hematology network in the United States is described.

Methods

We identified 105 patients who were diagnosed and managed in one of 19 community hematology clinics up to an index date of 1 October 2022. Data collection included patient and disease characteristics, baseline biochemistry and hematology, SM diagnostic criteria being met, biomarkers tested, CD2 and/or CD25 expression in MCs as well as serum tryptase levels at presentation. Data abstraction also included supportive care drugs and anticancer therapy used, treatment response, reason for discontinuation, and overall survival by disease subtype.

Results

A total of 105 SM patients were identified who met the inclusion criteria. The specific SM subtypes were indolent (47.6%), aggressive (9.5%), SM with an associated hematological neoplasm (19.0%), MC leukemia (1.9%), and subtype not documented (21.9%). Regardless of subtype, approximately 62% of patients did not receive SM-directed active therapy. Only 26% of patients with indolent systemic mastocytosis (ISM) received treatment compared to 65.6% with advanced subtypes. Relative to ISM cohort, the relative risk of death in patients with the advanced SM subtypes was approximately 15 times greater (hazard ratio = 15.0; 95% confidence interval: 3.3 to 66.5).

Conclusions

SM patients present with multiple underlying symptoms, within various disease subtypes that are difficult to diagnose in a timely manner. As a result, many patients do not receive active drug therapy for their disease. Therefore, greater disease awareness is required as well as new tools for earlier disease detection.
Wilderness Medical Society Clinical Practice Guidelines on Water Treatment for Wilderness, International Travel, and Austere Situations: 2024 Update
Authors: Backer Howard D. , Derlet Robert W. , Hill Vincent R.
Published: December 2023

To provide guidance to medical providers, wilderness users, and travelers, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for treating water in situations where the potability of available water is not assured, including wilderness and international travel, areas impacted by disaster, and other areas without adequate sanitation. The guidelines present the available methods for reducing or eliminating microbiological contamination of water for individuals, groups, or households; evaluation of their effectiveness; and practical considerations. The evidence base includes both laboratory and clinical publications. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according to the criteria published by the American College of Chest Physicians.
Evaluation of vitamin B12 levels among severe obese and obese adolescents
Authors: Demirtas Mehmet Semih , Kilicaslan Cengizhan , Erdal Huseyin
Published: December 2023

Obesity, whose prevalence is increasing globally, is malnutrition that causes micro/macronutrients and vitamin deficiencies in adolescents. Vitamin B12 plays a prominent role in the body systems such as remethylation, deoxidation, and DNA synthesis. We aimed to examine the relationship between severe obese/obese adolescents and vitamin B12 levels in this study. This study was conducted as a case–control study consisting of 44 obese and 40 healthy control adolescents aged 11–17 years. Obesity was diagnosed using body mass index (BMI) charts defined by the World Health Organization according to age and gender. Vitamin B12 deficiency was found to be 34.1% in the patient obesity group, while it was 12.5% in the control group (p = 0.02). Homeostatic Model Assessment for Insulin Resistance levels were found to be 3.09 (1.9–5.29) higher in the severely obese group (p < 0.001). The median level of vitamin B12 in the obese group was 173 (122.5–220.7) in the severe obese group, 197 (146.5–302.7) in the obese group, and 252.5 (192.8–302) in the control group (p = 0.021). We found that obesity has a 1.6-fold decreasing effect on vitamin B12 levels. This study shows the clinician the importance of monitoring BMI and vitamin B12 levels in obese adolescents, given the effects of vitamin B12 on neuronal migration, metabolic reactions, and many systems in the body. Further researches are needed to investigate the pathophysiology and effect of low vitamin B12 levels in obese adolescents.
Embracing the academic–practice gap: Knowledge collaboration and the role of institutional knotting
Authors: Grafström Maria , Jonsson Anna , Klintman Mikael
Published: December 2023

Collaboration between academia and practice is crucial for addressing complex societal challenges and generating new knowledge. However, bridging the perceived gap between these two domains has proven challenging due to differences in language, expectations, and time horizons. In this article, we question the usefulness of framing these differences as a gap and explores alternative approaches to fostering academic–practice collaboration. With the help of organizational institutionalism and theory on configurational boundary work, we propose the concept of “institutional knots” to temporarily ease tensions and reconcile differences between researchers and practitioners. Drawing on two case studies, we examine how temporary knotting activities can support and enable collaboration without undermining participants’ distinct expertise and professional roles. By embracing and understanding the gap from such a perspective, we argue that institutional knots provide an alternative metaphor and valuable framework for organizing and managing academic–practice collaboration. The findings contribute to the literature on how collaborations may be organized by offering a complementary understanding of the gap metaphor and providing practical insights for researchers and practitioners seeking to navigate and leverage their differences.
‘It’s a symbolic violence’: Autistic people’s experiences of discrimination at universities in Australia
Authors: Tan Diana Weiting , Rabuka Marion , Haar Tori , Pellicano Elizabeth
Published: December 2023

In recent years, the number of autistic people entering university has increased in Australia and worldwide. While an encouraging trend, autistic students’ completion rates remain much lower than non-autistic students in Australia. Perhaps unsurprisingly, numerous studies investigating autistic people’s experiences at universities have identified stigma and discrimination as a significant barrier facing autistic people in higher education. In this study, our team of autistic co-researchers and non-autistic researchers co-produced an in-depth qualitative study to understand the contexts and circumstances in which autistic people felt stigmatised or experienced discrimination at universities in Australia. We interviewed 21 autistic people who either had completed at least one university course, or were studying a university course, or had enrolled in but discontinued at least one university course in Australia. Using reflexive thematic analysis, we identified four themes: (1) ‘My disability is something that people just don’t have a clue about’, (2) ‘the system is really stacked against you’, (3) the onus is on autistic students, and (4) ‘grit and stubbornness’. Based on these findings, we suggested implementing Universal Design for Learning, neurodiversity-affirming and trauma-informed practices, together with a participatory approach to better design university curricula, processes, and support services for autistic students.

Lay Abstract

Autistic students experience many challenges at university. One significant barrier identified in past research was autistic students’ experiences of discrimination (i.e. being treat differently) and stigma (being judged differently). Our research team included both autistic and non-autistic researchers who designed a project to help explore autistic students’ experiences of stigma and discrimination at Australian universities. We interviewed 21 autistic students who went to a university – some had completed qualifications, and some had not. From our interviews, we identified four themes: (1) ‘My disability is something that people just don’t have a clue about’, (2) ‘the system is really stacked against you’, (3) the onus is on autistic students, and (4) ‘grit and stubbornness’. As a result, we recommended changes in the way courses are written and taught so that autistic people have opportunities that meet their ways of learning. It is also important for university staff to understand the impact of trauma experienced by autistic people and that universities work together with autistic people to design courses and supports that include autistic ways of learning, accessible university processes and identify support needs.
Ultrasound Particle Image Velocimetry to Investigate Potential Hemodynamic Causes of Limb Thrombosis After Endovascular Aneurysm Repair With the Anaconda Device
Authors: Mirgolbabaee Hadi , van de Velde Lennart , Geelkerken Robert H. , Versluis Michel , Groot Jebbink Erik , Reijnen Michel M. P. J.
Published: December 2023

Purpose:

To identify potential hemodynamic predictors for limb thrombosis (LT) following endovascular aneurysm repair with the Anaconda endograft in a patient-specific phantom.

Materials and Methods:

A thin-walled flow phantom, based on a patient’s aortic anatomy and treated with an Anaconda endograft, that presented with a left-sided LT was fabricated. Contrast-enhanced ultrasound particle image velocimetry was performed to quantify time-resolved velocity fields. Measurements were performed in the same phantom with and without the Anaconda endograft, to investigate the impact of the endograft on the local flow fields. Hemodynamic parameters, namely vector complexity (VC) and residence time (RT), were calculated for both iliac arteries.

Results:

In both limbs, the vector fields were mostly unidirectional during the peak systolic and end-systolic velocity phases before and after endograft placement. Local vortical structures and complex flow fields were observed at the diastolic and transitional flow phases. The average VC was higher (0.11) in the phantom with endograft, compared to the phantom without endograft (0.05). Notably, in both left and right iliac arteries, the anterior wall regions corresponded to a 2- and 4-fold increase in VC in the phantom with endograft, respectively. RT simulations showed values of 1.3 to 6 seconds in the phantom without endograft. A higher RT (up to 25 seconds) was observed in the phantom with endograft, in which the left iliac artery, with LT in follow-up, showed 2 fluid stasis regions.

Conclusion:

This in vitro study shows that unfavorable hemodynamics were present mostly in the limb that thrombosed during follow-up, with the highest VC and longest RT. These parameters might be valuable in predicting the occurrence of LT in the future.

Clinical Impact

This in-vitro study aimed to identify potential hemodynamic predictors for limb thrombosis following EVAR using ultrasound particle image velocimetry (echoPIV) technique. It was shown that unfavorable hemodynamic norms were present mostly in the thrombosed limb. Owing to the in-vivo feasibility of the echoPIV, future efforts should focus on the evaluation of these hemodynamic norms in clinical trials. Thereafter, using echoPIV as a bedside technique in hospitals becomes more promising. Performing echoPIV in pre-op phase may provide valuable insights for surgeons to enhance treatment planning. EchoPIV is also applicable for follow-up sessions to evaluate treatment progress and avoid/predict complications.
Unspooling the Thread: VIP Interneurons Linked With Autism Spectrum Disorder Behaviors but Not Seizures in Dravet Syndrome
Authors: Miralles Raquel , Patel Manoj K.
Published: December 2023

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Percutaneous Aortoiliac Thromboendarterectomy for Acute Limb Ischemia
Authors: Dunlap Eleanor , Conway Robert , Conway Lauren , Fox Charles , Nagarsheth Khanjan
Published: December 2023

Aortoiliac occlusive disease (AIOD) can occur from either chronic, progressive atherosclerotic disease, acute on chronic thrombosis or acute arterial embolism, and can all result in limb ischemia. Bypass surgery had long been the gold standard for treatment for AIOD, however, with advances in endovascular techniques, minimally invasive treatment of aortoiliac lesions has become the first line choice of management in many cases. Herein, we describe a case of utilizing the Inari ClotTriever to perform aortoiliac mechanical thrombectomy and the ARTIX thrombectomy system to perform an embolectomy the superficial femoral artery, highlighting new therapies to treat AIOD.
Development of a resource-use measure to capture costs of diabetic foot ulcers to the United Kingdom National Health Service, patients and society
Authors: Cullen Katherine , Jones Mari , Sheehan Christina , Game Frances , Vedhara Kavita , Fitzsimmons Deborah
Published: December 2023

Background:

Diabetic foot ulcers (DFUs) add a significant burden to the lives of people with diabetes in the United Kingdom. They can have a considerable impact on a patient’s daily life, with treatment requiring frequent changes of dressings and clinic attendances. Nurses and other allied health professionals (AHPs) within the community provide most wound care representing the primary cost driver.

Aims:

To collaboratively explore key resource use related to the management of DFUs to develop, and pilot, a participant-reported measure to inform economic evaluations.

Methods:

A literature search and semi-structured interviews determined health and non-health resource use in management of DFUs. A consensus view of the selected items was established in a modified Delphi study and further tested for acceptability and validity in a pilot study.

Results:

Primary care consultations with a podiatrist or orthotist, district nurse visits, out-of-hours and emergency care, scans and investigations, and consumables provided in clinics were rated as the most important resource use items.

Conclusions:

This work has informed the development of a measure that captures resource use considered important by the people most affected by DFUs; patients, family members and carers, and the healthcare professionals key to DFU management.
‘And then there was silence’: shaping practice through the experience of parents’ emotions
Authors: Levy Sharon
Published: December 2023

Background:

Spina bifida, the most common Neural Tube Defect occurring around 28 days following conception, is often discovered in a routine ultrasound examination. Nurses offer continuous support for families who care for children with disabilities, associated with this diagnosis.

Aim:

To articulate and analyse parents’ recollection of the emotions they experienced when they were informed by professionals that their unborn baby may have neurological disabilities.

Method:

Qualitative study, using participatory visual narrative method, engaging parents caring for young children with Spina bifida.

Results:

The emotions parents described, surfacing at the point of diagnosis, and the crafted stories they shared, demonstrated the significance and the long-lasting impact of their experience. Disclosing sensitive information and the way it is shared has a significant role in shaping how families adjust to caring for disabled children.

Conclusion:

Role and care transitions of parents who choose to keep their babies, despite their impending disability, is a lengthy and complex process. Nurses should be aware of and informed by the origin story, to offer appropriate support throughout this period. Policies to promote integration with services delivered by ‘not for profit’ organisations will benefit family-focused and person-centred care.
Medication management in general surgical patients made nil by mouth perioperatively: A quality improvement study
Authors: Zwaal Suseela , Hammad Ahmed
Published: December 2023

Perioperative medication management in patients who are nil by mouth for surgery or endoscopy is often suboptimal. Inappropriate medication management can prolong postoperative recovery and increase morbidity and mortality. This quality improvement study, carried out in general surgical patients at an 800-bed general hospital, aimed to improve perioperative medication management in accordance with the recommendations of the UK Clinical Pharmacy Association Handbook of Perioperative Medicine. Increasing awareness and educating general surgical team members, including doctors and non-medical prescribers, about perioperative medication management led to a non-significant improvement in medication management. However, a statistically significant improvement was achieved when nursing staff were also included. This study highlights the importance of involving different members of the multidisciplinary team in perioperative medication management.
Five historical innovations that have shaped modern urological surgery
Authors: Patel Ravi , Desai Chaitya , Acharya Radhika , Raveshia Dimit , Shah Saumil , Panesar Harrypal , Patel Neil , Singh Rohit
Published: December 2023

Throughout history, many innovations have contributed to the development of modern urological surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern urological surgery: External shockwave lithotripsy, transurethral resection of prostate, cystoscope, perioperative prostate-specific antigen and robotic surgery. The selection of innovations for inclusion in this article was meticulously determined through expert consensus and an extensive literature review. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of urological surgery and their ongoing relevance in contemporary and perioperative practice.
Ultrasound-based Accuro system versus traditional palpation technique for neuraxial anaesthesia: A systematic review and meta-analysis of randomised controlled trials
Authors: Sharapi Mahfouz , Afifi Eslam , Al Mawla Aya Mustafa , Yassin Mazen Negmeldin Aly , Awwad Sara Adel , El-Samahy Mohamed
Published: December 2023

Introduction

This review evaluates the efficacy and safety of Accuro, a handheld ultrasound device, compared to the palpation technique for neuraxial anaesthesia. Accuro provides real-time imaging guidance, potentially improving accuracy and efficiency.

Methods

A comprehensive search across six electronic databases identified randomised clinical trials comparing Accuro with palpation for neuraxial anaesthesia. Risk ratios or mean differences with 95% confidence intervals (CIs) were calculated using a random-effects model. Bias risk was evaluated using the Cochrane Risk of Bias tool.

Results

Five studies (n=369) met the inclusion criteria. Accuro showed a favourable risk ratio for first insertion success (1.44 [95% CI [1.01, 2.05], p=0.05]). It significantly reduced needle skin passes (MD −0.63; 95% CI [−1.05, −0.21]; p<0.01), but not needle redirection (MD −1.31; 95% CI [−2.71, 0.11]; p=0.07). Procedure time was shorter in palpation (MD 127.82; 95% CI [8.68, −246.97]; p=0.04). Four studies had a low risk of bias; one had some concerns.

Conclusion

Accuro can potentially improve success rates and reduce skin passes in neuraxial anaesthesia. Further trials with larger samples are needed, especially in patients with anticipated difficulties.
Comparing preoperative fasting and ultrasound-measured intravascular volume status in elective surgery, enhanced recovery patients versus inpatient, urgent surgery patients and the ability of IVC collapsibility to predict post-induction hypotension
Authors: Wrobel Jacob R , Magin Justin C , Williams David , An Xinming , Acton Jacob D , Doyal Alexander S , Jia Shawn , Krakowski James C , Serrano Ricardo , Grant Stuart A , Flynn David N , McLean Duncan J
Published: December 2023

Hypotension following induction of general anaesthesia has been shown to result in increased complications and mortality postoperatively. Patients admitted to the hospital undergoing urgent surgery are often fasted from fluids for significant periods compared to elective patients subject to Enhanced Recovery After Surgery protocols despite guidelines stating that a two-hour fast is sufficient. The aim of this prospective, observational study was to compare fasting times and intravascular volume status between elective surgery patients subject to enhanced recovery protocols and inpatient, urgent surgery patients and to assess differences in the incidence of post-induction hypotension. Fasting data was obtained by questionnaire in the preoperative area in addition to inferior vena cava collapsibility index, a non-invasive measure of intravascular volume. Blood pressure readings and drug administration for the ten minutes following induction were obtained from patients’ charts. Inpatients undergoing urgent surgery were fasted significantly longer than enhanced recovery patients and had lower intravascular volume. However, no difference was found in the incidence of post-induction hypotension.
Efficiency and perceived safety of foot and ankle procedures performed on the preoperative stretcher versus operating room table
Authors: Lause Gregory E , Parker Emily B , Farid Alexander , Smith Jeremy T , Chiodo Christopher P , Martin Elizabeth A , Bluman Eric M
Published: December 2023

Background:

Foot and ankle surgeons often perform minor surgeries on the preoperative stretcher instead of the operating room table. We examined whether stretcher-based and operating room table-based procedures differed with respect to operating room efficiency and staff perceptions.

Methods:

We retrospectively reviewed medical records of patients undergoing minor foot and ankle surgery at an ambulatory surgery centre. We collected ‘time to start’, the duration between patient arrival in the operating room and incision time, and ‘time to exit’, the duration between procedure end time and patient exit from the operating room. Staff were surveyed regarding their perceptions of stretcher-based and operating room table-based procedures.

Results:

‘Time to start’ was significantly shorter for stretcher-based procedures, but ‘time to exit’ was not. Seventeen (81%) staff members thought stretcher-based procedures increased operating room efficiency. Thirteen (62%) thought stretcher-based procedures bettered staff safety. Nineteen (91%) thought stretcher-based procedures were equivalent to or better than operating room table-based procedures for patient safety. Most (67%) would recommend stretcher-based procedures.

Conclusion:

We found small but significant time savings associated with stretcher-based procedures. Without adapting surgical scheduling practices, the impact of stretcher-based procedures on overall operating room efficiency is questionable. Nevertheless, the majority of OR staff think stretcher-based procedures increase OR efficiency and are safer for staff.

Level of Evidence:

Level IV, Retrospective case series.
Effects of Increasing Pitch Count on Pitch Type Ball Metrics and Release Height in High School Softball Pitchers
Authors: Downs Talmage Jessica , Friesen Kenzie B. , Fava Anthony , Everhart Kate , Oliver Gretchen D.
Published: December 2023

Background:

Softball research has investigated changes in physical characteristics, mechanics, and ball speed as elements of fatigue. However, the influence of pitch volume on ball metrics is unclear. The purpose of this study was to investigate the influence of pitch volume on ball performance and release metrics in softball pitchers across different pitch types.

Hypothesis:

As pitch volume increased, there would be a decrease in ball metrics of the fastball and changes in breaking pitches would be observed earlier than the fastball or changeup.

Study Design:

Descriptive laboratory study.

Level of Evidence:

Level 5.

Methods:

A total of 21 (15.4 ± 1.6 years; 1.6 ± 0.2 m; 76.0 ± 17.2 kg) softball pitchers participated. Procedures consisted of participants pitching a simulated game consisting of 100 pitches, taking a 30-minute break, and then throwing 12 pitches to simulate the first inning of a doubleheader. Participants randomly threw each pitch type (fastball, changeup, curveball, or dropball). Ball performance and release metrics were measured using a Rapsodo portable pitch tracker.

Results:

A 3 (time) by 4 (pitch type) multivariate analysis of variance revealed that pitch speed was significantly higher in the first inning compared with the last inning and the doubleheader inning. The fastball, curveball, and dropball revealed a significant difference in pitch speed between timepoints. Specifically, the curveball and dropball first-inning pitch speed was significantly greater than the last and doubleheader inning. Alternatively, the fastball had a significant increase in pitch speed from the last inning to the doubleheader inning.

Conclusion:

The typical 30-minute break given between games for doubleheaders may be sufficient recovery time for the fastball but not for the curveball and dropball.

Clinical Relevance:

The Rapsodo device is an accessible method of tracking ball performance and pitch release metrics and could be helpful in identifying when a pitcher may be experiencing performance detriments in response to increasing pitch count.
Adding Neurofeedback Training to Neuromuscular Training for Rehabilitation of Chronic Ankle Instability: A 3-Arm Randomized Controlled Trial
Authors: Yalfani Ali , Azizian Masoud , Gholami-Borujeni Behnam
Published: December 2023

Background:

Neurofeedback training (NFT) can aid in the treatment of the abnormal patterns of the brain brought on by physical injury, enhancing cognitive and behavioral abilities. The present study aimed to compare the effectiveness of combining neuromuscular training (NMT) and NFT (NMT+NFT) with NMT alone in rehabilitating athletes with chronic ankle instability (CAI).

Hypothesis:

NMT+NFT will be more effective than NMT alone.

Study Design:

A 3-arm, single-blind randomized controlled trial.

Level of Evidence:

Level 2.

Methods:

A total number of 62 athletes, aged 18 to 25 years, with CAI, participated in this study. The study subjects were allocated randomly to 3 groups: 21 cases in the control group, 21 cases in the combination group (CG) receiving NMT+NFT, and 20 cases in the neuromuscular group (NG) practicing NMT alone, undergoing exercises related to their groups for 8 weeks. Data were recorded and analyzed before and after the 8-week training program. The primary outcome measures were postural sway indices; secondary outcomes included ankle proprioception and biopsychosocial indices.

Results:

NMT+NFT was more effective than NMT alone in terms of improving postural control during single- and 2-legged standing positions under the conditions of eyes closed and eyes open, proprioception at 20° of plantar flexion, as well as anxiety and depression in athletes with CAI. However, the findings revealed that NMT+NFT and NMT alone could both improve such indices.

Conclusion:

NMT+NFT as a treatment protocol improved postural control, ankle proprioception, anxiety, and depression greater than NMT alone.

Clinical Relevance:

A combined protocol of NFT and NMT led to greater improvement compared with NMT alone. NFT was recommended as an adjunct therapy in the rehabilitation of athletes suffering from CAI.
Association of brain arterial diameters with demographic and anatomical factors in a multi-national pooled analysis of cohort studies
Authors: Del Brutto Victor J , Khasiyev Farid , Liu Minghua , Spagnolo-Allende Antonio , Qiao Ye , Melgarejo Arias Jesus D , Guzman Vanessa A , Igwe Kay C , Sanchez Danurys L , Andrews Howard , Morales Clarissa D , Farrell Meagan T , Bassil Darina T , Seshadri Sudha , Wagner Ryan G , Mngomezulu Victor , Manly Jennifer , Elkind Mitchell SV , Berkman Lisa , Romero Jose R , Maestre Gladys E , Del Brutto Oscar H , Brickman Adam M , Venketasubramanian Narayanaswamy , Chen Christopher , Robert Caroline , Hilal Saima , Rundek Tatjana , Wasserman Bruce A , Gutierrez Jose
Published: December 2023

Background and Purpose

Brain arterial diameters are markers of cerebrovascular disease. Demographic and anatomical factors may influence arterial diameters. We hypothesize that age, sex, height, total cranial volume (TCV), and persistent fetal posterior cerebral artery (fPCA) correlate with brain arterial diameters across populations.

Methods

Participants had a time-of-flight MRA from nine international cohorts. Arterial diameters of the cavernous internal carotid arteries (ICA), middle cerebral arteries (MCA), and basilar artery (BA) were measured using LAVA software. Regression models assessed the association between exposures and brain arterial diameters.

Results

We included 6,518 participants (mean age: 70 ± 9 years; 41% men). Unilateral fPCA was present in 13.2% and bilateral in 3.2%. Larger ICA, MCA, and BA diameters correlated with older age (Weighted average [WA] per 10 years: 0.18 mm, 0.11 mm, and 0.12 mm), male sex (WA: 0.24 mm, 0.13 mm, and 0.21 mm), and TCV (WA: for one TCV standard deviation: 0.24 mm, 0.29 mm, and 0.18 mm). Unilateral and bilateral fPCAs showed a positive correlation with ICA diameters (WA: 0.39 mm and 0.73 mm) and negative correlation with BA diameters (WA: −0.88 mm and −1.73 mm). Regression models including age, sex, TCV, and fPCA explained on average 15%, 13%, and 25% of the ICA, MCA, and BA diameter interindividual variation, respectively. Using height instead of TCV as a surrogate of head size decreased the R-squared by 3% on average.

Conclusion

Brain arterial diameters correlated with age, sex, TCV, and fPCA. These factors should be considered when defining abnormal diameter cutoffs across populations.
CT predictors of sub-centimeter occult lymph node metastases in oral cavity squamous cell carcinoma: A case-control study
Authors: Morisada Megan V , Bewley Arnaud F , Broadhead Kenneth , Assadsangabi Reza , Paydar Alireza , Birkeland Andrew C , Abouyared Marianne , Qi Lihong , Ivanovic Vladimir
Published: December 2023

Background

For patients with oral cavity squamous cell carcinoma (OCSCC) without evidence of nodal metastasis (cN0) on pre-operative evaluation, there are no clear guidelines who should undergo elective neck dissection (END) versus clinical surveillance.

Objective

To identify CT imaging characteristics of sub-centimeter lymph nodes that would help predict the likelihood of nodal metastases on pathology.

Methods

Retrospective review of cN0 OCSCC patients at a tertiary academic medical center was performed. Inclusion criteria included elective neck dissection, pre-operative CT imaging and presence of metastatic disease within lymph nodes. Control group consisted of patients without nodal metastases on pathology. CT features that were evaluated included asymmetric size, disrupted fatty hilum, asymmetric number, presence of cortical nodule, cortical nodule size, and round/oval shape. We evaluated the associations between CT LN features and the presence of metastases using multi-level mixed-effects logistic regression models. Model evaluation was performed using 5-fold cross-validation. The positive predictive value (PPV) and negative predictive value (NPV) were calculated.

Results

26 patients in each study and control groups were included. Three-level mixed-effects logistic regression models indicated round/oval shape (OR = 1.39, p = .01), asymmetric number (OR = 7.20, p = .005), and disrupted fatty hilum (OR = 3.31, p = .04) to be independently predictive in a 3-variable model with sensitivity = 38.0%, specificity = 92.0%, and PPV = 93.8%.

Conclusions

In cN0 OCSCC patients undergoing END, round/oval shape, asymmetric number, and disrupted fatty hilum of lymph nodes on pre-operative CT imaging are novel and highly predictive of occult nodal disease.