bluuebunny/crossref_metadata_2025 huggingface dataset:
Training non-mental health professionals to assess and manage suicide risk: Community level intervention for suicide prevention in Guatemala
Authors: Alonzo Dana , Popescu Marciana , Zubaroglu-Ioannides Pinar
Published: November 2020

Background:

Domestic violence, childhood physical and sexual abuse, and gang violence are prevalent and growing problems for Guatemalan youth, particularly in low socioeconomic (SES) areas. Resources in the community for psychosocial support are greatly lacking. Schools often serve as the main source of support for these highly vulnerable adolescents. Yet, many teachers lack the training to manage the psychological distress of their at-risk students and to properly engage, assess, and manage the psychological needs of their students. We developed a brief risk assessment and management training for teachers to address this gap.

Aims:

We present the acceptability and preliminary effectiveness of the training at increasing teacher’s knowledge and understanding of how to engage and work with their at-risk students around their thoughts and feelings of suicide.

Method:

Twenty-two teachers from a school in a low SES community in Guatemala participated in the training program. Mixed methods were used to explore effectiveness, acceptability, and satisfaction with the training. Primary outcomes assessed were changes in self-reported knowledge and understanding of engaging and working with students at risk of suicide.

Results:

Participants reported increased knowledge and understanding of all training targets ( p < .05). Acceptability was high as no participants dropped out and all participants rated the training as useful for their professional development, meeting their expectations, and as highly satisfying.

Conclusion:

Brief, focused training on suicidality can be effective and is acceptable to lay professionals. Further examination of the effectiveness of the training in a larger sample is required to assess the long-term impact of the training and its transportability to other communities.
Rationale and process transparency do not reduce perceived red tape: evidence from a survey experiment
Authors: Kaufmann Wesley , Ingrams Alex , Jacobs Daan
Published: November 2020

Red tape is a salient societal problem but there is a dearth of research on how perceived red tape can be reduced. Building on the transparency literature, we hypothesize that higher levels of rationale and process transparency will result in lower levels of perceived red tape. We test our reasoning using a survey experiment. Specifically, we have US citizens rate the level of red tape associated with the burdensome process of obtaining a driver’s license at the Department of Motor Vehicles. We find that providing rationale and process transparency to citizens does not influence perceived red tape. Hence, organizations are advised to look for more fine-grained approaches to reduce perceptions of unnecessarily burdensome rules, while realizing that a certain level of perceived red tape is likely an unavoidable part of bureaucratic functioning.

Points for practitioners

The findings from this study show that merely being transparent about the rationale and process of a burdensome rule is not enough to reduce perceived red tape. Rather, policymakers and managers are advised to gain a better understanding of the different causes of red tape (disentangling genuine concerns from unfounded rhetoric), develop coherent strategies that adequately balance the trade-offs between organizational goals and citizen red tape, and be transparent about these trade-offs.
Prospects of Compulsory English Education in South Korea: What Went Wrong and What Could Be Rectified
Authors: Lee Giseung
Published: November 2020

This article examines the conceivable rationales as to why Korean students’ English-speaking proficiency scores are not as outstanding as other international standardized test scores such as the Trends in International Mathematics and Science Study (TIMSS) and the Program for International Student Assessment (PISA). Despite the efforts of the Korean government to impose compulsory English education policies such as starting English education earlier and arranging for native English speakers to co-teach in English classes, the English knowledge of Koreans is still lacking. Without knowing the details of the English Program in Korea (EPIK) and the curriculum of English education, the Ministry of Education’s (MOE) strategies may sound ideal in terms of effective language pedagogical approach, yet in this article I examine why they are ineffective. I begin by analyzing the results of three tests: PISA, TIMSS, and the Test of English as a Foreign Language (TOEFL) to assess Korean students’ scholastic aptitudes. Next, I examine the current stage of compulsory English education in Korea according to the data from the MOE. Finally, prospects and recommendations are proposed on how the Korean compulsory English education could be improved based on the discovery of three critical drawbacks: insufficient instructional time, eligibility of EPIK, and the need for teacher evaluation.
The Floating Signifier of “Radicalization”: Correctional Officers’ Perceptions of Prison Radicalization
Authors: Schultz William J. , Bucerius Sandra M. , Haggerty Kevin D.
Published: November 2020

The number of people incarcerated for extremist actions has grown over the past decades. The resulting prospect of prison radicalization has contributed to widespread risk responsibilitization among prison staff. Low-level correctional officers now perceive themselves as being directly responsible for detecting radicalization on their units. Consequently, radicalization has become a meaningful topic for prison staff, one which shapes their daily actions and perceptions. However, officers’ understandings of radicalization may not conform with accepted definitions. Through 131 semistructured interviews with Canadian correctional officers, we demonstrate how radicalization functions as a floating signifier in prison, influencing officer thought and behavior in meaningful ways while eluding easy definition. Officers redefine radicalization to fit interpretive frames around religion and race, gang membership, and mental health, irrespective of whether stereotypical extremists exist in a given prison. We demonstrate how radicalization, when operating as a floating signifier, can significantly influence officers’ perceptions and front-line prison operations.
Exploring a Social Identity Theory of Shared Narrative: Insights from Resident Stories of Police Contact in Newark, New Jersey, and Cleveland, Ohio
Authors: Blount-Hill Kwan-Lamar
Published: November 2020

Narrative identity theorists have long held that individuals construct identities as a coherent tale of their past, present, and future selves. These life stories are structured along predictable scripts borrowed from cultural master narratives. Heretofore, legitimacy theorists have relied on social identity theory to explain legitimation processes. I propose integrating elements of narrative identity theory with social identity for a more complete legitimation theory. I analyze 92 in-depth interviews with individuals who encountered the police departments of Newark, New Jersey, and Cleveland, Ohio. Respondents’ narratives followed common narrative scripts, suggesting a shared master narrative guiding interpretations of police encounters. A significant proportion of the sample interpreted their views of the police from a group-based lens, while an equally significant proportion used alternative narratives. An integration of social identity, narrative identity, and current legitimacy theory holds promise for a more comprehensive model of legitimation and a more complete theory of self.
Effective dose in medicine
Authors: Martin C.J.
Published: November 2020

The International Commission on Radiological Protection (ICRP) developed effective dose as a quantity related to risk for occupational and public exposure. There was a need for a similar dose quantity linked to risk for making everyday decisions relating to medical procedures. Coefficients were developed to enable the calculation of doses to organs and tissues, and effective doses for procedures in nuclear medicine and radiology during the 1980s and 1990s. Effective dose has provided a valuable tool that is now used in the establishment of guidelines for patient referral and justification of procedures, choice of appropriate imaging techniques, and providing dose data on potential exposure of volunteers for research studies, all of which require the benefits from the procedure to be weighed against the risks. However, the approximations made in the derivation of effective dose are often forgotten, and the uncertainties in calculations of risks are discussed. An ICRP report on protection dose quantities has been prepared that provides more information on the application of effective dose, and concludes that effective dose can be used as an approximate measure of possible risk. A discussion of the way in which it should be used is given here, with applications for which it is considered suitable. Approaches to the evaluation of risk and methods for conveying information on risk are also discussed.
Notes from the Field: Dynamic Triaging Using Quality Improvement (QI) Methodology to Prevent the Admission of Asymptomatic COVID Positive Obstetric Patients in New Delhi, India
Authors: Puri Manju , Agrawal Swati , Singh Anuradha , Singh Lata , Aggarwal Kiran , Nain Shilpi , Chopra Kanika , Triveni G. S. , Kapur Aishwarya
Published: November 2020

A single undiagnosed COVID-19 positive patient admitted in the green zone has the potential to infect many Health Care Workers (HCWs) and other patients at any given time with resultant spread of infection and reduction in the available workforce. Despite the existing triaging strategy at the Obstetric unit of a tertiary hospital in New Delhi, where all COVID-19 suspects obstetric patients were tested and admitted in orange zone and non-suspects in green zone, asymptomatic COVID-19 positive patients were found admitted in the green zone. This was the trigger to undertake a quality improvement (QI) initiative to prevent the admission of asymptomatic COVID-19 positive patients in green zones. The QI project aimed at reducing the admission of COVID-19 positive patients in the green zone of the unit from 20% to 10% in 4 weeks’ time starting 13/6/2020 by means of dynamic triaging. A COVID-19 action team was made and after an initial analysis of the problem multiple Plan-Do-Study-Act (PDSA) cycles were run to test the change ideas. The main change ideas were revised testing strategies and creating gray Zones for patients awaiting COVID-19 test results. The admission of unsuspected COVID-19 positive cases in the green zone of the unit reduced from 20% to 0% during the stipulated period. There was a significant reduction in the number of HCWs, posted in the green zone, being quarantined or test positive for COVID-19 infection as well. The authors conclude that Quality Improvement methods have the potential to develop effective strategies to prevent spread of the deadly Corona virus.
Capacity building for proportionate climate policy: Lessons from India and South Africa
Authors: Upadhyaya Prabhat , Shrivastava Manish Kumar , Gorti Ganesh , Fakir Saliem
Published: November 2020

Countries must develop their capacity to credibly revise their nationally determined contributions (NDCs) proportionate to the global climate goal. This paper argues that long-lasting capacity is necessarily embedded in the institutions governing cooperation between state and non-state actors. This institutional capacity for cooperation is determined by the two interactive processes of conception and calibration, where the state plays a definitive role in mediating between competing interests. In conception, the state uses its discretionary power to set the long-term vision, whereas during calibration it exercises flexibility to accommodate concerns and capacity of other actors. We conclude that proportionality of policy response is better understood, and achieved, through the convergence of both these processes. Drawing on climate policy experiences of India and South Africa, we recommend that successful implementation and enhancement of NDCs would require a greater emphasis on capacity building for calibration in developing countries.
Strategies of right populists in opposing gender equality in a polarized European Parliament
Authors: Kantola Johanna , Lombardo Emanuela
Published: November 2020

An increasingly polarized European Parliament (EP) has become an important site of radical right populist opposition to gender equality. Through a qualitative analysis of populist interventions in EP plenary debates on gender equality in the 8th legislature (2014–2019), this article identifies the discursive strategies adopted by right populists to oppose gender equality. It contributes to scholarly debates on populisms and on gender and politics by respectively suggesting to the former the need to dedicate attention to gender equality as a central aspect in populist ideologies, and to the latter the importance of considering a variety of strategies of radical right opposition to gender equality. Radical right populist strategies include not only indirect but also direct opposition to gender equality and draw on old and traditional gender imaginaries packaged in novel populist ways.
Rule maker or rule taker? Brexit, finance and UK regulatory autonomy
Authors: James Scott , Quaglia Lucia
Published: November 2020

Given the integration of the City of London into the single market for financial services in the European Union (EU), theories of transnational governance would expect the United Kingdom (UK) to favour close regulatory alignment with the EU27 post-Brexit to maximise market access and financial stability. Surprisingly, however, the UK has consistently demanded regulatory flexibility in financial services and has accepted reduced market access. We argue that the explanation is twofold. First, UK preferences reflect the need to balance the competing demands of elected officials, the financial industry and financial regulators. Second, drawing on a bureaucratic politics perspective, we suggest that UK preferences have been strongly shaped by the importance to UK regulators of retaining autonomy over high-status policy competences. This article contributes to the broader literature on the politics of financial regulation by highlighting the added value of incorporating a bureaucratic politics perspective when explaining financial regulatory preferences.
Parental Academic Involvement in Cross-border marriage, Native and Immigrant Families: The Roles of Family Resources and Parental Expectations
Authors: Cheung Adam Ka-Lok , Park Hyunjoon
Published: November 2020

Migration patterns have become more complicated than before. The increase in cross-border marriage has increased the diversity of the student population. A simple distinction between native and immigrant students overly simplifies their diverse backgrounds. Analyzing data from PISA 2012, we attempt to fill the gap in the literature by comparing parental involvement between cross-border marriage, native, and immigrant families in Hong Kong, with a special focus on the roles of family resources and parental expectations. Our findings show that cross-border marriage families are significantly different from and sit between native families and immigrant families in terms of family resources, parental expectations, and parental involvement. Family resources play a greater role than parental expectations in the differences in parental involvement between cross-border marriage families, native families, and migrant families. This suggests that the disadvantages of cross-border marriage and immigrant families in parental involvement largely stem from a lack of family resources.
Winter Maintenance of Permeable Interlocking Concrete Pavement: Evaluating Opportunities to Reduce Road Salt Pollution and Improve Winter Safety
Authors: Marvin Jeffrey T. , Scott Jody , Van Seters Tim , Bowers Robert , Drake Jennifer Anne
Published: November 2020

Permeable interlocking concrete pavement (PICP) is a type of permeable pavement system that uses the joint spaces between pavers to drain water from the surface into an aggregate base and subbase layer below. Because of its ability to rapidly drain surface water, PICP has the potential to reduce the amount of ice formed on the surface during winter conditions compared with traditional impervious pavements. As a result, PICP may reduce the amount of road salt needed for de-icing paved surfaces and may also reduce the risk of pedestrian slipping and vehicle skidding throughout the winter. This study evaluates the performance of an outdoor PICP and asphalt test pad over two winter seasons in Vaughan, Ontario, Canada, by assessing differences in surface conditions, surface friction, and surface temperatures. The results of this study indicate that PICP provides equivalent or higher levels of safety compared with asphalt when treated with de-icing products at medium (0.049 kg/m2) or low (0.024 kg/m2) application rates. Re-freezing of melted snow and ice after sunset was observed on the asphalt surface creating black ice, but not on the PICP cells. Consequently, compared with asphalt pavements, PICP surfaces will require use of less de-icer and will have lower risk of slips and falls for pedestrians, and lower risk of skidding for vehicles throughout the winter.
Modeling Vehicle–Pedestrian Interactions using a Nonprobabilistic Regression Approach
Authors: Nassereddine Hiba , Santiago-Chaparro Kelvin R. , Noyce David A.
Published: November 2020

Understanding how vehicle drivers and pedestrians interact is key to identifying countermeasures that improve the safety of the interactions. As a result, techniques that can be used to evaluate the effectiveness of safety countermeasures and traffic control devices without the need to wait for the availability of crash data are needed. Using video, the interactions between right-turning vehicles and conflicting pedestrians were documented and quantified using vehicle and pedestrian position timestamps. Interactions documented were purposely narrow in scope to obtain a controlled dataset. Logged timestamps enabled the calculation of values such as time to complete a right turn and time for a pedestrian to reach a critical conflict point when a vehicle initiated a right turn. A nonprobabilistic regression model explaining the relationship between the calculated values was created. The model described the expected behavior of right-turning drivers: when drivers perceive the possibility of a pedestrian reaching a critical conflict point at the same time as them, they will modify their behavior, even if not coming to a complete stop. This behavior is not a surprise and has been previously documented in the literature. The primary contribution of this research is demonstrating that by analyzing a narrow set of interactions, clear and simple models that mostly explain the interactions between right-turning vehicles and pedestrians can be developed using nonprobabilistic linear regression techniques. An argument is made that the model parameters can be used to evaluate the effectiveness of traffic control devices.
Application of Connected and Automated Vehicles in a Large-Scale Network by Considering Vehicle-to-Vehicle and Vehicle-to-Infrastructure Technology
Authors: Hasibur Rahman Md , Abdel-Aty Mohamed
Published: November 2020

Application of connected and automated vehicles (CAVs) is expected to have a significant impact on traffic safety and mobility. Although several studies evaluated the effectiveness of CAVs in a small roadway segment, there is a lack of studies analyzing the impact of CAVs in a large-scale network by considering both freeways and arterials. Therefore, the objective of this study is to analyze the effectiveness of CAVs at the network level by utilizing both vehicle-to-vehicle (V2V) and vehicle-to-infrastructure (V2I) communication technologies. Also, the study proposed a new signal control algorithm through V2I technology to elevate the performance of CAVs at intersections. A car-following model named cooperative adaptive cruise control was utilized to approximate the driving behavior of CAVs in the Aimsun Next microsimulation environment. For the testbed, the research team selected Orlando central business district area in Florida, U.S. To this end, the impacts of CAVs were evaluated based on traffic efficiency (e.g., travel time rate [TTR], speed, and average approach delay, etc.) and safety surrogates (e.g., standard deviation of speed, real-time crash-risk models for freeways and arterials, time exposed time-to-collision). The results showed that the application of CAVs reduced TTR significantly compared with the base condition even with the low market penetration level. Also, the proposed signal control algorithm reduced the approach delay for 94% of the total intersections present in the network. Moreover, safety evaluation results showed a significant improvement of traffic safety in the freeways and arterials under CAV conditions with different market penetration rates.
The Value of Statistics Contributing to Scoring in the NBA: A Quantitative Approach
Authors: Lackritz Jim , Horowitz Ira
Published: November 2020

We model three years of National Basketball Association (NBA) data to calculate the number of points generated from assists, offensive rebounds, and steals. We partition the data into eight groups based on the combinations of occurrences (or not) of these three statistics in a made basket. A linear programming model solves for the coefficients of each of the three statistics in each combination, and the weighted average of the coefficients by combination frequency produces a final value for the points generated by each statistic. A fraction of these points is assigned to the player that made the assist, offensive rebound, or steal, with the remaining portion of the points scored assigned to the scorer. A scale for total points accounted for by a player from points scored, assists, offensive rebounds, and steals is developed and used to compare the offensive production of a sample of NBA players from the 2018–2019 season.

JEL Classifications: C1, C3,C6, Z2
“Smile!”: Emotion Performance as a Strategy for Belonging in Junior High School
Authors: Whiting Erin Feinauer
Published: November 2020

This mixed-method research explores how students (ages 12–15) describe dispositional qualities for belonging and fitting in one junior high school. Inductive coding of open-ended responses about perceptions of belonging in school shows candor about the emotional performances and management of emotions for belonging at school. Recommendations for being authentic, nice, and friendly emerged as relevant for belonging. Findings suggest that students perform niceness and friendliness to conform to emotion norms while seeking to retain authenticity. Smiling in particular was referenced as a way to perform niceness and friendliness. Chi-square and binomial logistic regression analyses add context to how advice categories were distributed across status groups at the school. Students who speak a language other than English at home, or with minority religious affiliation were more likely to report a need for authenticity. Female as compared with male students were more likely to suggest each of the three dispositions for belonging in the school. The emotional work of students is noteworthy wherein there are potential sanctions for those not considered nice, or nice enough, and this work augments existing research on school belonging to add the often-missing student voices to enhance the corpus of research about belonging in adolescence.
Tail shapes lead to different propulsive mechanisms in the body/caudal fin undulation of fish
Authors: Song Jialei , Zhong Yong , Du Ruxu , Yin Ling , Ding Yang
Published: November 2020

In this paper, we investigate the hydrodynamics of swimmers with three caudal fins: a round one corresponding to snakehead fish ( Channidae), an indented one corresponding to saithe ( Pollachius virens), and a lunate one corresponding to tuna ( Thunnus thynnus). A direct numerical simulation (DNS) approach with a self-propelled fish model was adopted. The simulation results show that the caudal fin transitions from a pushing/suction combined propulsive mechanism to a suction-dominated propulsive mechanism with increasing aspect ratio ( AR). Interestingly, different from a previous finding that suction-based propulsion leads to high efficiency in animal swimming, this study shows that the utilization of suction-based propulsion by a high- AR caudal fin reduces swimming efficiency. Therefore, the suction-based propulsive mechanism does not necessarily lead to high efficiency, while other factors might play a role. Further analysis shows that the large lateral momentum transferred to the flow due to the high depth of the high- AR caudal fin leads to the lowest efficiency despite the most significant suction.
Hydrodynamics of the steam-water two-phase flows behind a pair of bluff cylinderical bodies inside and around the wake region
Authors: Khan Afrasyab , Sanaullah Khairuddin , Khan Shahzad Maqsood , Rigit Andrew Ragai Henry , Ullah Atta
Published: November 2020

A significant number of natural and industrial phenomena exist, where steam-water, two-phase flows face resistance due to the cylindrical shaped bodies. It is useful to explore such flows for their direct relevance to the steam driven industrial processes having Direct Contact Condensation (DCC) as the core phenomena for heat, mass, and momentum transfer. An experimental setup has been fabricated to study the influence of twin, different sized cylinders with a gap between them on the formation of wake region as the steam-water flow past the cylinders. Hot and cold wire sensors were used to measure the fluctuations in the velocity and temperature respectively of the flow within the wake and the region surrounding wake. The diameter of the smaller cylinder was fixed as 0.5 cm and the dimensions of the larger cylinder was varied from 1, 1.5 and 2.0 cm. Values for the fluctuating velocity were measure for all the cases and based on these measurements, the turbulent normal stresses and Reynolds shear stresses were determined. The asymmetry of the wake region increases by raising the gap between the two cylinders as the wake region aligned to the smaller cylinder has been deflected larger than the wake aligned to the larger cylinder. The wake asymmetry signified the possible effect of buoyancy on the thermal and momentum diffusivities, which was emphasized here through the measured values of turbulent normal and Reynolds stresses.
Early Effects of the COVID-19 Pandemic on Relationship Satisfaction and Attributions
Authors: Williamson Hannah C.
Published: November 2020

How has the COVID-19 pandemic affected intimate relationships? The existing literature is mixed on the effect of major external stressors on couple relationships, and little is known about the early experience of crises. The current study used 654 individuals involved in a relationship who provided data immediately before the onset of the pandemic (December, 2019) and twice during the early stages of the pandemic (March and April, 2020). Results indicate that relationship satisfaction and causal attributions did not change over time, but responsibility attributions decreased on average. Changes in relationship outcomes were not moderated by demographic characteristics or negative repercussions of the pandemic. There were small moderation effects of relationship coping and conflict during the pandemic, revealing that satisfaction increased and maladaptive attributions decreased in couples with more positive functioning, and satisfaction decreased and maladaptive attributions increased in couples with lower functioning.
A large-scale study exploring understanding of the national premarital screening program among Jordanians: Is an at-risk marriage a valid option for Jordanians?
Authors: Al-Eisawi Zaynab , Jacoub Khaldun , Alsukker Akram
Published: November 2020

Detecting carrier couples through premarital screening implementation is an effective way of controlling thalassaemia. The aim of this study was to investigate the knowledge of university students towards premarital screening and their possible involvement in an at-risk marriage. Students ( n = 976) were chosen randomly from Jordanian universities. The questionnaire consisted of three sections: socio-demographical data, the students’ knowledge about the screening programme, and finally their beliefs and future decisions related to it. Most (90%) participants were aware of the premarital screening availability. Females had significantly better understanding of premarital screening compared to males. Despite the majority of the participants not wanting to go ahead with at-risk marriages, 23% would not be deterred from marrying their anticipated partner and believed engaging in at-risk marriage was a valid idea. We suggest providing more effective educational programmes, genetic counselling and free prenatal diagnosis for at-risk couples.
Proteomic Profiling Reveals the Ambivalent Character of the Mesenchymal Stem Cell Secretome: Assessing the Effect of Preconditioned Media on Isolated Human Islets
Authors: Brandhorst Heide , Brandhorst Daniel , Abraham Anju , Acreman Samuel , Schive Simen W. , Scholz Hanne , Johnson Paul R.V.
Published: November 2020

Previous studies in rodents have indicated that function and survival of transplanted islets can be substantially improved by mesenchymal stem cells (MSC). The few human islet studies to date have confirmed these findings but have not determined whether physical contact between MSC and islets is required or whether the benefit to islets results from MSC-secreted proteins. This study aimed to investigate the protective capacity of MSC-preconditioned media for human islets. MSC were cultured for 2 or 5 days in normoxia or hypoxia before harvesting the cell-depleted media for human islet culture in normoxia or hypoxia for 6–8 or 3–4 days, respectively. To characterize MSC-preconditioned media, proteomic secretome profiling was performed to identify angiogenesis- and inflammation-related proteins. A protective effect of MSC-preconditioned media on survival and in vitro function of hypoxic human islets was observed irrespective of the atmosphere used for MSC preconditioning. Islet morphology changed markedly when media from hypoxic MSC were used for culture. However, PDX-1 and insulin gene expression did not confirm a change in the genetic phenotype of these islets. Proteomic profiling of preconditioned media revealed the heterogenicity of the secretome comprising angiogenic and antiapoptotic as well as angiostatic or proinflammatory mediators released at an identical pattern regardless whether MSC had been cultured in normoxic or hypoxic atmosphere. These findings do not allow a clear discrimination between normoxia and hypoxia as stimulus for protective MSC capabilities but indicate an ambivalent character of the MSC angiogenesis- and inflammation-related secretome. Nevertheless, culture of human islets in acellular MSC-preconditioned media resulted in improved morphological and functional islet integrity suggesting a disbalance in favor of protective factors. Further approaches should aim to eliminate potentially detrimental factors to enable the production of advanced clinical grade islet culture media with higher protective qualities.
The role of the London Hospital in the development of the treatment of spinal injury
Authors: Silver JR
Published: November 2020

While the role of the London Hospital in delineating diseases of the nervous system is widely accepted, its role in developing the speciality of spinal injuries in the United Kingdom has not been acknowledged. The pioneering efforts of Henry Head and George Riddoch provided the foundation for the successful treatment of patients with spinal injuries. Julian Holland-Hibbert, a trustee of the London Hospital and himself a paraplegic, by his magnificent unselfish effort made sure that patients with a spinal injury could live independent, fulfilled lives in society.
Gay male athletes’ coming-out stories on Outsports.com
Authors: White Adam J , Magrath Rory , Emilio Morales Luis
Published: November 2020

For two decades, Outsports.com – the world’s first website dedicated to the LGBT+ community’s experiences in sport – has provided sexual minority athletes with the opportunity to share their stories. In this research, we examine the published coming-out narratives of 60 out gay male athletes across a variety of different sports. Our analysis indicates that, prior to coming-out, many of these athletes felt the need to adopt an identity predicated on masculine stereotypes, thus distancing themselves from homosexuality. Upon coming-out to teammates, however, most of these athletes experienced acceptance and inclusivity which, in turn, led to improved health and wellbeing. Additionally, we document the changing nature of homosexually themed language on these men’s sports teams. Finally, we recognize the importance of mediums such as Outsports in providing athletes across the world the opportunity to share their coming-out stories. Accordingly, this research advances a body of evidence documenting sport’s growing inclusivity for the LGBT+ community.
Culturally Sensitive Care: Definitions, Perceptions, and Practices of Health Care Professionals
Authors: Claeys Ann , Berdai-Chaouni Saloua , Tricas-Sauras Sandra , De Donder Liesbeth
Published: November 2020

Introduction

Research highlights that patients from ethnic minority groups often receive lower quality of care. This study contributes to the knowledge and understanding of culturally sensitive care and explores health care professionals’ definitions and perceptions of this concept and how they deliver this in practice.

Method

This qualitative study conducted a total of six focus groups ( n = 34) and four in-depth interviews with six categories of health care professionals in Belgium. Thematic content analysis was used.

Results

The results indicate that the concept of culturally sensitive care is perceived quite narrowly. Professionals are likely to portray their own frame of reference and find it challenging to show empathy with patients with a different background. Othering (micro-racism by defining “the other”) is a powerful example.

Discussion

The discussion reveals the significance of increasing cultural awareness and understanding, sensitizing about current narrow perceptions, and enhancing culturally sensitive care in the Belgian health care setting.
Enforced Separations: A Qualitative Examination of How Latinx Families Cope With Family Disruption Following the Deportation of a Parent
Authors: Lovato Kristina , Abrams Laura S.
Published: November 2020

During the past two decades, U.S. immigration policies have been tightened resulting in increased deportations of unauthorized persons residing in the United States. This qualitative phenomenological study is theoretically grounded in family systems theory. In-depth, semi-structured interviews were conducted with Latinx youth ( n = 8) and their remaining caregivers, specifically mothers ( n = 8) who had recently experienced the deportation of the child’s father. Findings from the analysis revealed that following the deportation of a parent, families (a) modified family structures and relied upon extended familial support, (b) experienced familial tensions, (c) experienced financial difficulties and housing instability, and (d) retreated from social life, including drastically shrinking social networks. Implications for practice include developing culturally based, trauma-informed interventions for Latinx families affected by deportation.
Off-label Use for Direct Oral Anticoagulants: Valvular Atrial Fibrillation, Heart Failure, Left Ventricular Thrombus, Superficial Vein Thrombosis, Pulmonary Hypertension—a Systematic Review
Authors: Brokmeier Hannah , Kido Kazuhiko
Published: November 2020

Objective:

To evaluate clinical literature for direct oral anticoagulants (DOACs) therapy for non–Food and Drug Administration approved indications.

Data Sources:

Articles from MEDLINE, Cochrane Library, Google Scholar, and OVID databases were reviewed from 1946 through September 4, 2020.

Study Selection and Data Extraction:

Fully published studies assessing DOACs for atrial fibrillation (AF) with valvular heart disease (VHD), heart failure (HF), left ventricular thrombus (LVT), superficial vein thrombosis (SVT), or pulmonary hypertension (PH) were evaluated.

Data Synthesis:

Our review showed that DOACs are safe to use in patients with AF and VHD except for mitral stenosis or mechanical heart valve. Rivaroxaban 2.5 mg twice daily should be used with caution in patients with HF with reduced ejection fraction until further evaluation is performed. Four retrospective studies for DOAC use in patients with LVT showed conflicting results. One phase 3 randomized controlled trial showed noninferiority of rivaroxaban to fondaparinux for SVT treatment. The use of DOACs for pulmonary arterial hypertension was not evaluated in any clinical study, but 2 retrospective studies for the use of DOACs in patients with chronic thromboembolic PH (CTEPH) showed similar efficacy between DOACs and warfarin.

Relevance to Patient Care and Clinical Practice:

This review provides clinicians with a comprehensive literature review surrounding DOAC use in common off-label indications.

Conclusion:

DOACs can be considered for AF complicated by VHD except for mitral stenosis or mechanical valve replacement. DOACs (especially rivaroxaban) are considered as an alternative therapy for SVT and CTEPH. Further prospective studies for DOAC uses are needed for HF or LVT.
Netarsudil for the Treatment of Open-Angle Glaucoma and Ocular Hypertension: A Literature Review
Authors: Gonzalez Lipton E. , Boylan Paul M.
Published: November 2020

Objective:

To evaluate netarsudil’s role as first-line therapy for the treatment of open-angle glaucoma (OAG) and ocular hypertension (OHT).

Data Sources:

A literature search utilizing MEDLINE and CINAHL was performed using netarsudil and AR-13324 as keywords. Studies published from January 1970 to September 2020 were eligible.

Study Selection and Data Extraction:

For inclusion, articles were required to be published in English and participants enrolled in phase I, II, or III clinical trials. Articles were excluded if netarsudil was coformulated with another medication. Preclinical research, case reports, case series, review articles, citations without an abstract, and newsletters were excluded.

Literature Review:

The search retrieved 97 unique citations; 90 results were excluded, and 7 studies were included for analysis.

Relevance to Patient Care and Clinical Practice:

In all, 20 years elapsed between the Food and Drug Administration’s approvals of distinct medications to treat OAG. Existing first-line therapies target the uveoscleral pathway, which is responsible for a small amount of aqueous humor outflow. Rho kinase inhibitors target the trabecular pathway, which is responsible for 90% of aqueous humor outflow; thus, Rho kinase inhibitors may significantly reduce intraocular pressure and improve clinical outcomes for patients with OAG or OHT.

Conclusions:

Evidence demonstrates that netarsudil is inferior to prostaglandin analogues and noninferior to topical β-blockers in the treatment of OAG and OHT. Hyperemia is a common adverse drug reaction, which often resolves after medication discontinuation. Additional phase III clinical trials and evidence-based guidelines are necessary to determine netarsudil’s position in OAG and OHT management.
The Role of Weightbearing Computed Tomography Scan in Hallux Valgus
Authors: Mahmoud Karim , Metikala Sreenivasulu , Mehta Samir D. , Fryhofer George W. , Farber Daniel C. , Prat Dan
Published: November 2020

Background:

Hyperpronation of the first metatarsal in hallux valgus (HV) is poorly understood by conventional weightbearing radiography. We aimed to evaluate this parameter using weightbearing computed tomography (WBCT) and to understand its association with other standard measurements.

Methods:

Retrospective evaluation of WBCT and weightbearing radiographs (WBXRs) was performed for 20 patients with HV feet and 20 controls with no such deformity. Axial computed tomography images of both groups were compared for the first metatarsal pronation angle (alpha angle) and tibial sesamoid subluxation (TSS) grades. The HV angle (HVA), first-second intermetatarsal angle (IMA), first metatarsal-medial cuneiform angle (MMCA), Meary’s angle, and calcaneal pitch (CP) angle of the study and control groups were compared on both WBXR and the corresponding 2-dimensional images of WBCT. All measurements were independently performed by 1 musculoskeletal radiology fellow and 1 foot and ankle surgical fellow. Measurements were averaged and interobserver reliability was calculated.

Results:

The HV group demonstrated significantly higher values for TSS grade ( P < .001) but not for alpha angle ( P = .121) compared with controls. Likewise, significantly elevated HVA and IMA were noted in the HV group on both imaging modalities, while no such differences were observed for the CP angle. Higher MMCA and Meary’s angle in the HV group were evident only on WBXR (MMCA, P = .039; Meary’s, P = .009) but not on WBCT (MMCA, P = .183; Meary’s, P = .171). Among all, the receiver operating characteristic (ROC) curves demonstrated the greatest area under the curve (AUC) for HVA, followed by IMA. The alpha angle performed only just outside the range of chance (AUC, 0.65; 95% CI, 0.52-0.69). The Pearson’s correlations of the alpha angle, in the HV group, revealed a significant linear relationship with TSS grade and with HVA on WBXR, and only trended toward a weak linear relationship with IMA and with HVA on WBCT.

Conclusion:

The alpha angle, a measure of abnormal hyperpronation of the first metatarsal, was an independent factor that may coexist with other parameters in HV, but in isolation had limited diagnostic utility. “Abnormal” alpha angles were even observed in individuals without HV. Increases in IMA and MMCA were not necessarily associated with similar increases in alpha angle, despite moderate correlations with TSS grade and HVA on WBXR. Nevertheless, the WBCT was a useful method for assessing hyperpronation and guiding surgical management in individual cases.

Level of Evidence:

Level III, retrospective comparative study.
Preoperative Patient-Reported Outcome Measures Relationship With Postoperative Outcomes in Flexible Adult-Acquired Flatfoot Deformity
Authors: Conti Matthew S. , Caolo Kristin C. , Nguyen Joseph T. , Deland Jonathan T. , Ellis Scott J.
Published: November 2020

Background:

Previous studies have demonstrated that procedure-specific thresholds using preoperative patient-reported outcome scores may be used to predict postoperative outcomes. The primary purpose of this study was to determine if preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) thresholds could be used to predict which patients would clinically improve at 2 years postoperatively following reconstruction of their flexible adult-acquired flatfoot deformity (AAFD).

Methods:

PROMIS physical function, pain interference, and depression scores were prospectively collected preoperatively and at a minimum of 2 years postoperatively for 75 feet with flexible AAFD. Minimal clinically important differences (MCIDs) were calculated to establish significant postoperative improvement. Receiver operating characteristic curves and area under the curve analyses were employed to determine whether preoperative PROMIS scores could be used to predict postoperative outcomes.

Results:

The PROMIS physical function receiver operating characteristic curve analysis (area under the curve = 0.913, P < .001) found that a preoperative PROMIS physical function score greater than 45.7 resulted in a 14.3% probability of achieving the MCID, whereas a preoperative score of less than 40.8 had a 97.7% probability of achieving the MCID. A preoperative PROMIS pain interference score (area under the curve = 0.799, P < .001) less than 54.1 had only a 23.1% probability of achieving the MCID at 2 years postoperatively.

Conclusions:

Preoperative PROMIS physical function and pain interference scores could be used to predict postoperative improvement in patients with flexible AAFD. These results may help surgeons counsel patients regarding the anticipated benefit of surgery.

Level of Evidence:

Level III, retrospective comparative series.
Improving direct pharmacist counseling rates for oral oncolytic medications at an outpatient oncology clinic
Authors: Hayes Dylan J , Moore John E
Published: November 2020

Background

Due to the increasing prevalence of oral oncolytic utilization for patients with malignancy, implementation of strategies for increased monitoring and patient safety have become a necessity. Our focus was on the American Society of Clinical Oncology’s Quality Oncology Practice Initiative (QOPI) standards of care, standard 2.3, and its requirement for patient counseling prior to first administration of oral oncolytic therapy.

Objective

To assess the implementation of a workflow improvement strategy to determine its effect on the number of patients reached for pharmacist counseling prior to first dose of oral oncolytic medications.

Methods

In this quasi-experimental quality improvement study, we formed a multidisciplinary group to develop and implement a workflow improvement process. This process was focused on a redistribution of workflow and the implementation of new technology within EPIC Beacon.

Results

A total of 86 patients were identified as eligible for counseling (38 pre-intervention, 48 post-intervention). There was a statistically significant increase in number of eligible patients counseled in the post-intervention period as compared to the pre-intervention period (100% vs. 86.84%; 95% CI = –0.212, –0.205; P = 0.017). There were no significant differences observed in the number of patients counseled in-person or patients counseled prior first dose.

Conclusion

Our intervention showed a 100% rate of counsel in the post-intervention period. Further work needs to be done to improve the number of these patients we reach prior to them taking their first dose of medication, as well as the number of patients we are able to counsel face-to-face.
Improved Executive Function in Adults Diagnosed With Attention-Deficit/ Hyperactivity Disorder as Measured by the Brown Attention-Deficit Disorder Scale Following Treatment With SHP465 Mixed Amphetamine Salts Extended-Release: Post Hoc Analyses From 2 Randomized, Placebo-Controlled Studies
Authors: Brown Thomas E. , Chen Jie , Robertson Brigitte
Published: November 2020

Objective:

Assess executive function (EF) improvement with SHP465 mixed amphetamine salts (MAS) extended-release in adults with attention-deficit/hyperactivity disorder (ADHD) using responder analyses of the Brown Attention-Deficit Disorder Scale (BADDS).

Methods:

Post hoc analyses examined data from placebo-controlled SHP465 MAS dose-optimization (12.5–75 mg) and fixed-dose (25–75 mg) studies. Treatment response was assessed using two definitions (BADDS total score at endpoint <50 [no EF impairment] vs. ≥50 [impaired]; BADDS total score at endpoint relative to the in-treatment 90% CI range for baseline total score [below the range = improved]).

Results:

Response rates (SHP465 MAS vs. placebo) favored SHP465 MAS (all nominal p < .0001) in the dose-optimization (BADDS <50: 41.9% vs. 19.2%; below 90% CI range: 57.4% vs. 29.6%) and fixed-dose (BADDS <50: 51.9% vs. 16.7%; below 90% CI range: 70.6% vs. 32.3%) studies.

Conclusion:

Improvement in EF measured by BADDS response rates was approximately 2-fold greater with SHP465 MAS than placebo.