bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonlinear radiations in chemically reactive Walter's B nanoliquid flow through a rotating cone
Authors: Gangadhar Kotha , Edukondala Nayak R , Venkata Subba Rao M , Chamkha Ali J
Published: June 2022

In this paper, the mechanism of radiative Walter's B nanofluid on a rotational cone under magnetic regime is examined. Time-dependent fluid flow caused by cone rotation includes implication theoretically and practically in engineering and applied sciences. Additionally, interesting characteristics of thermophoresis, Brownian motion, and chemical reactions are examined. Self-similar solutions are obtained by treating angular velocity as an inverse linear function of period toward too far from the cone. The Runge–Kutta–Fehlberg fourth–fifth procedure was used to replicate the performance of the course visually and obtain the numerical result of a reduced nonlinear system. Comparing the acquired result to previously published material is another significant aspect of the current investigation that serves to verify the outcome. The Brownian motion parameter is found to have conflicting influences on heat and mass transfer rates, along with temperature and concentration fields. The existence of chemical reactions, according to the research, may be more beneficial in developing reaction processes.
Older patients’ autonomy when cared for at emergency departments
Authors: Frank Catharina , Holmberg Mats , Jernby Elin Ekestubbe , Hansen Annika Sevandersson , Bremer Anders
Published: June 2022

Background

Older patients in emergency care often have complex needs and may have limited ability to make their voices heard. Hence, there are ethical challenges for healthcare professionals in establishing a trustful relationship to determine the patient’s preferences and then decide and act based on these preferences. With this comes further challenges regarding how the patient’s autonomy can be protected and promoted.

Aim

To describe nurses’ experiences of dealing with older patients’ autonomy when cared for in emergency departments (EDs).

Research design

This study adopted reflective lifeworld theory and a phenomenological design.

Participants and research context

A total of 13 open-ended interviews were performed with nurses working at two EDs in Sweden.

Ethical considerations

The study was reviewed by the Ethical Advisory Board in South East Sweden and conducted according to the Declaration of Helsinki. All participants gave consent.

Findings

Nurses’ experiences of dealing with older patients’ autonomy in EDs are characterized by moving in a conflicting uphill struggle, indicating obscure thoughts on how patient autonomy can be protected in an ethically challenging context. The phenomenon is further described with its meaning constituents: ‘Being hampered by prioritization under stress’, ‘Balancing paternalism and patient autonomy’, ‘Making decisions without consent in the patient’s best interests’ and ‘Being trapped by notions of legitimate care needs’.

Conclusion

Stressful work conditions and lacking organizational strategies in EDs contribute to nurses maintaining unjustified paternalistic care, regardless of the patient’s ability and medical condition, and questioning who has legitimacy for participating in decisions about care. The nurses’ protection and promotion of older patients’ autonomy is dependent on the opportunity, ability and willingness to create a patient relationship where the patient’s voice and preferences are valued as important. Consequently, strategies are needed to improve patient autonomy in EDs based on the idea of ‘relational autonomy’.
Ethical dilemmas and care actions in nurses providing palliative sedation
Authors: Kwon Sinyoung , Kim Miyoung , Choi Sujin
Published: June 2022

Background

Recently, palliative care is increasingly important, with an emphasis on the process of dying with dignity. However, nurses who care for such patients experience the associated ethical dilemmas.

Objective

To explore the meaning of nurses’ experiences in dealing with ethical dilemmas in relation to palliative sedation.

Research design

A qualitative research design was employed with a thematic analysis approach.

Participants and research context

Using purposive sampling, 15 nurses, working at palliative care units for at least 1 year, were recruited as participants. Data were collected using unstructured in-depth interviews, and data collection and analysis was performed simultaneously.

Ethical considerations

Ethical approval was obtained from the authors’ institutional review board. All participants provided informed consent. For the face-to-face interview, the South Korean standard COVID-19 quarantine guidelines, such as mandatory masking and social distancing, were followed.

Results

Dilemmas raised by patients, were related to concerns about appropriate drug dose; dilemmas raised by nurses, were related to passive care, sense of guilt for failure to predict death, and colleague’s disrespectful attitudes toward patients; dilemmas from patients’ families were related to demands for palliative sedation and reversal of those demands. Care actions to deal with ethical dilemmas comprised evidence-based care, person-centered thinking, reflecting on the death situation, compassion, providing explanation and help to family members.

Conclusion

Nurses’ ethical dilemmas were pre-dominantly influenced by themselves, rather than by the patients or their families, especially if they felt they could not do their best for patients. The core concept of care actions to deal with the ethical dilemmas, was person-centered care and compassion. Then, how patients and their family members perceive person-centered care and compassion, should be further explored to improve palliative sedation.
Understanding Differences in Behaviour Patterns of Healthcare Service Elements Among Regions Applying Data Mining
Authors: Saha Partha
Published: June 2022

Maternal and child healthcare (MCH) has always been regarded as one of the important issues globally. The aim of this article is to find out all frequently occurring healthcare service elements along with their availability conditions and their interactions with other health system (HS) elements, when coverage of priority MCH intervention was either poor or moderate or good in any region. Association rule mining technique has been used to understand the probability of occurrences of different healthcare service elements among regions. Along with the proposed analytical framework, an interactive decision support system (DSS) has also been developed on a web platform, which would help healthcare policymakers to integrate the analytical framework easily in their processes of decision-making. The system has been developed by using Shiny package on R software. Data for all variables are collected for 584 Indian districts from the third phase of district-level household and facility survey. From results, it is observed that community healthcare services, sub-centre (SC)-level healthcare services and PHC-level healthcare services of a region are very much interlinked with each other, and their relationships define the healthcare condition of that region.
Presurgical Cleft Management of Infants: A Survey of ACPA Approved and International Cleft Palate and Craniofacial Teams
Authors: Jensen Sven W. C. , Jensen Emilija D. , Kaminer-Levin Gabriella , Caro Camila , Stevens Kyle
Published: June 2022

Objective

To characterize the presurgical infant orthopedics (PSIO) and gingivoperiosteoplasty (GPP) protocols across the American Cleft Palate-Craniofacial Association (ACPA) approved and international cleft palate (CP) and craniofacial teams.

Design

Cross-sectional survey.

Setting

ACPA approved and international CP and craniofacial teams.

Results

Respondents from 115 out of 215 ACPA approved and international CP and craniofacial teams permitted to contact (out of a total of 259 total teams) completed the survey (response rate  =  53.5%). There were 89 (77.4%) ACPA approved teams and the remaining international teams were mainly located in Europe (13.0%). Seventy-eight CP and craniofacial teams (67.8%) provided PSIO and 65 (83.3%) of these teams used alveolar molding (AM). Twenty-two CP and craniofacial teams (19.1%) provided GPP. A mean of 9.5  ±  2.6 different specialists were on the cleft team with the most common being orthodontists (97.4%), speech therapists (96.5%), and plastic/craniofacial surgeons (90.4%).

Conclusions

Most ACPA approved and ACPA registered international CP and craniofacial teams provided PSIO techniques by orthodontists using lip taping (LT) and AM, while few provide GPP.
The numerical calculation method based on equivalent frequency-independent time-domain damping model
Authors: Sun Panxu , Wang Shuxia , Wang Dongwei
Published: June 2022

In order to realize the time-domain analysis based on hysteretic damping model, the frequency-independent time-domain damping model of single degree of freedom (SDOF) system is constructed. Based on the assumed relationship of vibration responses, the equivalent frequency-independent time-domain damping model in complex domain and real domain are proposed. The characteristic that the dissipated energy in each cycle is not related to the vibration frequency of external excitation is retained for the two equivalent damping models. Combined with Newmark- β method, the corresponding numerical methods are obtained. The numerical examples show that the free vibration responses are stably convergent based on equivalent damping models. The numerical results of vibration responses of SDOF system due to earthquake wave have high calculation accuracy. Compared with equivalent frequency-independent time-domain damping model in real domain, the computational accuracy of equivalent frequency-independent time-domain damping model in complex domain is higher, and the computational efficiency is lower.
Evaluation of various fuel alternatives in terms of sustainability for the ship investment decision using single valued neutrosophic numbers with TOPSIS methods
Authors: Mollaoglu Mahmut , Bucak Umur , Demirel Hakan , Balin Abit
Published: June 2022

IMO has introduced regulations to improve fuel quality in the sector to reduce emissions from ships carrying the vast majority of world trade. As a result of these regulations, which were planned gradually, carbon-neutral shipping was targeted. In line with this goal, it was seen that ship operating companies tend to various alternatives to increase fuel quality. This study evaluated various fuel alternatives for ship investment decisions by employing the Technique for Order Preference By Similarity to Ideal Solution (TOPSIS) method under the Single Valued Neutrosophic Sets (SVNS) in terms of sustainability aspects. First, criteria that are specific to the ship investment decision under the aspects of sustainability and their weights were determined. Then, these weights were placed in the model to determine the most sustainable ship fuel produced within the scope of the study. Finally, alternatives determined in terms of fuel type, which is one of the items to be decided on ship investment, were listed according to their degree of sustainability. According to the findings, dual fuel and bio-fuel were selected as more sustainable bunker fuels for today. Technically, findings were evaluated, and the pros and cons of the related bunker fuels were revealed. In the light of the findings, evaluations were made on alternatives.
Incorrect categorisation of ambient light level at the time of a road traffic collision
Authors: Fotios S , Robbins CJ
Published: June 2022

Ambient light level, one of the items recorded by police investigating a road traffic collision (RTC) was previously suggested to be incorrectly recorded in 5%–15% of cases. Significant erroneous categorisation of ambient light level, as suggested by the latter estimate, may lead to incorrect conclusions being drawn about the impact of light on RTCs which is critical where such data inform transport policy decisions. This study investigated the accuracy with which ambient light level was recorded in comparison to that determined using solar altitude at the time, date and location of the RTC. Data were drawn from the STATS19 database of RTCs in the UK for the period 2005 to 2015. Ambient light level was incorrectly reported in 103 021 (5.79%) of the 1 779 903 RTCs in that period. The percentage of errors was greater for RTCs occurring after dark than in daylight, and for RTCs where the scene was not attended by a police officer than those that were attended: ambient light level was incorrectly categorized in 8.72% unattended RTCs in darkness. The highest percentage of errors (57%) occurred within civil twilight; if these are omitted the overall percentage reduces to 2.81%, a similar error rate to that available for the determination of RTC location.
Incivility in Congressional Tweets
Authors: Ballard Andrew , DeTamble Ryan , Dorsey Spencer , Heseltine Michael , Johnson Marcus
Published: June 2022

Civility in political discourse is often thought to be necessary for deliberation and a healthy democracy. However, incivility is on the rise in political discourse in the United States—even from members of Congress—suggesting that political incivility may in fact be a tool to be used strategically. When and why, then, do members of Congress use incivility in their rhetoric? We develop and test expectations for the usage of political incivility by members of Congress on Twitter, using every tweet sent by a member of Congress from 2009–2020 coded for the presence of uncivil rhetoric via a novel application of transformer models for natural language processing. We find that more ideologically extreme members, those in safer electoral situations, and those who are in a position of political opposition are more likely to use incivility in their tweets, and that uncivil tweets increase engagement with members’ messages.
Safety of Complementary and Alternative Medicine (CAM) treatment among children and young adults who suffer from adverse effects of conventional cancer treatment: A systematic review
Authors: Mora Dana C. , Kristoffersen Agnete E. , Overvåg Grete , Jong Miek C. , Mentink Marit , Liu Jianping , Stub Trine
Published: June 2022

Background:

Complementary and Alternative Medicine (CAM) is widely used around the world to treat adverse effects derived from cancer treatment among children and young adults. Parents often seek CAM to restore and maintain the child’s physical and emotional condition during and after cancer treatment.

Objectives:

The objectives of this review were (i) to identify literature that investigates CAM use for treating adverse effects of conventional cancer treatment, (ii) to investigate the safety of the included CAM modalities, and (iii) to evaluate the quality of included studies.

Methods:

Five scientific research databases were used to identify observational, quasi-experimental, and qualitative studies from January 1990 to May 2021. Included studies investigated the use of CAM to treat adverse effects of cancer treatment in childhood cancer.

Results:

Fifteen studies were included in this review. Ten quasi-experimental, 3 observational studies (longitudinal/prospective), 2 qualitative studies, and 1 study with a quasi-experimental and qualitative arm were identified. Less than half (n = 6; 40%) of the studies included reported adverse effects for the CAM modality being studied. Among the studies that reported adverse effects, they were mostly considered as direct risk, as 13% reported mainly bleeding and bruising upon acupuncture treatment, and dizziness with yoga treatment. All adverse effects were assessed as minor and transient. CAM modalities identified for treating adverse effects of cancer treatment were alternative medical systems, manipulative and body-based therapies, biologically-based therapies, and mind-body therapies. CAM modalities were used to alleviate anxiety, pain, toxicity, prevent trauma, and improve health-related quality of life, functional mobility, and physical activity levels. All studies assessed scored 70% or above according to the Joanna Briggs Institute critical appraisal for study quality checklists.

Conclusion:

Most of the studies (58.3%) included in this review did not report adverse effects from CAM modalities used to treat adverse effects of cancer treatment in children and young adults. This lack of safety information is of concern because parents need to know whether the modality represents an extra burden or harm to the child. To improve awareness about safety in the field, a universal and uniform reporting system for adverse effects in CAM research is needed.
Global by the Seaside
Authors: Bueker Catherine Simpson , Rothschild Teal
Published: June 2022

In a small coastal vacation community heavily dependent upon foreign workers, in-depth interviews with employers, participant observations, and an analysis of social artifacts evidence patterns of neo-assimilation, in the form of fused cuisine on menus, altered attitudes towards native-born workers among employers, and in a small number of cases, intermarriage. Findings also illustrate employer engagement with the culture of their workers and a sophisticated understanding of the global dynamics of international migration and work.
Discontinuation rate of long-acting reversible contraceptives and associated factors among reproductive-age women in Butajira town, Central Ethiopia
Authors: Weldekidan Haregwa Asnake , Lemlem Semarya Berhe , Sinishaw Abebe Workinesh , Sori Seboka Abebe
Published: June 2022

Background:

Discontinuation of contraceptives without any change in fertility intention is often associated with unintended pregnancy which ends up with induced abortion and unplanned birth. Despite the Ethiopian government’s emphasis on the provision of long-acting contraceptive methods, little attention has been paid to the study of its discontinuation; particularly, no study has been reported in the study area. Thus, this study aimed to assess the discontinuation rate of long-acting reversible contraceptives and associated factors among reproductive-age women in Butajira town, Central Ethiopia, 2020.

Methods:

Community-based cross-sectional study was conducted from 1 April to 1 May 2020. A systematic random sampling method was used to select 227 women. Data were collected by a structured and pretested questionnaire. Epi-data (version 4.6.2) and Statistical Package for the Social Sciences (version 25) were used for data entry and analysis, respectively. A multivariable logistic regression model was used to predict the relation between dependent and independent variables. Finally, a significant statistical association was assured using an adjusted odds ratio at a 95% confidence interval and p value < 0.05.

Results:

This study revealed that the discontinuation rate of long-acting reversible contraceptives was 50 (22.5%; 95% confidence interval: 17.8–27.2). The main reason for discontinuation was facing side effects 26(52%); from these menstrual disruption 19 (73.1%) was the main reason. Time consumed to reach the health facility (adjusted odds ratio: 6.16, 95% confidence interval: 1.46–25.97), desire to have more children (adjusted odds ratio: 5.3, 95% confidence interval: 1.13–24.81), and counseled about the benefit of long-acting reversible contraceptives (adjusted odds ratio: 0.08, 95% confidence interval: 0.02–0.39) were predictors of discontinuation of long-acting reversible contraceptives.

Conclusions and Recommendations:

This study showed that the discontinuation rate was high when compared to Ethiopian Demographic Health Survey 2016. Routine pre-insertion counseling about the benefits and side effects of long-acting reversible contraceptives by healthcare providers is highly recommended. In addition, we recommend further trials using larger sample sizes on predictors of discontinuation of long-acting reversible contraceptives.
Liquid chromatography–mass spectrometry analysis of mauveine extracted from silk fabrics: A Victorian dress in Gunnersbury Park and Museum and a modern Charles Rees bow tie
Authors: Plater M John , Raab Andrea
Published: June 2022

Fibres from a purple 1860s Victorian-era silk dress were extracted and analysed by liquid chromatography–mass spectrometry. The analysis was predominantly mauveine A and mauveine B with lesser amounts of other mauveine chromophores. The mauveine provenance of the dress was confirmed and the authenticity of the mauveine established as from WH Perkins Greenford factory by comparison with museum standards. Fibres from a 25-year-old silk bow tie were also analysed by liquid chromatography–mass spectrometry, which analysed as predominantly mauveine A with a much smaller amount of mauveine B. Strips of silk were dyed with museum-stored mauveine, and after leaving for 6 months in the light or the dark, the same liquid chromatography–mass spectrometry mauveine analysis shows that mauveine B was not degrading to mauveine A on silk.
Group draw with unknown qualified teams: A lesson from the 2022 FIFA World Cup draw
Authors: Csató László
Published: June 2022

The draw for the 2022 FIFA World Cup has been organised before the identity of three winners of the play-offs is revealed. Seeding has been based on the FIFA World Ranking released on 31 March 2022 but these three teams have been drawn from the weakest Pot 4. We show that the official seeding policy does not balance the difficulty levels of the groups to the extent possible: a better alternative would have been to assign the placeholders according to the highest-ranked potential winner, similar to the rule used in the UEFA Champions League qualification. Our simulations reinforce that this is the best strategy in general to create balanced groups in the FIFA World Cup.
Inconsistency between objective and subjective comparisons of sleep quality is found between sea level and moderate terrestrial altitude (2,320m) in high-performance swimmers
Authors: Astridge Daniel , McKenna Michael , Campbell Adrian , Turner Anthony P
Published: June 2022

It is popular for high-performance athletes to attend training camps at natural moderate altitude (1800–2500m), which may have direct and indirect effects on the quantity and quality of sleep athletes obtain. This can potentially influence the ability to maximise training responses and optimise recovery from exercise. This study aimed to compare objective and subjective markers of sleep quality between sea level (SL) and moderate altitude (ALT) in a sample of 14 (male n = 5, female n = 9) high-performance collegiate swimmers. Sleep was objectively (wristwatch actigraphy) and subjectively (Athlete Sleep Screening Questionnaire; ASSQ) assessed at SL and an ALT of 2,320m. A significant increase ( p = 0.028, d = 0.76) in the ‘sleep difficulty score’ calculated from the ASSQ was identified from SL (4.9 ± 1.7 au) to ALT (6.6 ± 2.3 au), with a greater number of the swimmers judged to have a more severe clinical sleep problem at ALT. Of the seven sleep characteristics assessed objectively, there were no significant differences identified between the two environments. Sleep disruption was found to substantially improve following rest/recovery days while at ALT. Although this study highlights possible inconsistencies between objective and subjective measures of sleep quality while at ALT, any suggestion of reduced sleep quality should be considered seriously. Practically, the present study demonstrates the importance of, at altitude, using both objective and subjective measures to monitor athlete sleep quality, and ensuring training schedules are carefully periodised, incorporating rest or recovery days within intense training blocks for optimal sleep quality to be achieved.
Intestinal strictures in Crohn’s disease: a 2021 update
Authors: Lin Xiaoxuan , Wang Yu , Liu Zishan , Lin Sinan , Tan Jinyu , He Jinshen , Hu Fan , Wu Xiaomin , Ghosh Subrata , Chen Minhu , Liu Fen , Mao Ren
Published: June 2022

Intestinal strictures remain one of the most intractable and common complications of Crohn’s disease (CD). Approximately 70% of CD patients will develop fibrotic strictures after 10 years of CD diagnosis. Since specific antifibrotic therapies are unavailable, endoscopic balloon dilation and surgery remain the mainstay treatments despite a high recurrence rate. Besides, there are no reliable methods for accurately evaluating intestinal fibrosis. This is largely due to the fact that the mechanisms of initiation and propagation of intestinal fibrosis are poorly understood. There is growing evidence implying that the pathogenesis of stricturing CD involves the intricate interplay of factors including aberrant immune and nonimmune responses, host-microbiome dysbiosis, and genetic susceptibility. Currently, the progress on intestinal strictures has been fueled by the advent of novel techniques, such as single-cell sequencing, multi-omics, and artificial intelligence. Here, we perform a timely and comprehensive review of the substantial advances in intestinal strictures in 2021, aiming to provide prompt information regarding fibrosis and set the stage for the improvement of diagnosis, treatment, and prognosis of intestinal strictures.
Shoulder pain: Is the outcome of manual therapy, acupuncture and electrotherapy different for people with high compared to low pain self-efficacy? An analysis of effect moderation
Authors: Rugg Bradley , Khondoker Mizanur , Chester Rachel
Published: June 2022

Background

High baseline pain self-efficacy (PSE) predicts a better outcome for people attending physiotherapy for musculoskeletal shoulder pain. A potential contributing factor is that PSE moderates the relationship between some treatment modalities and outcome. Our aim was to investigate whether there is a difference in outcome between participants with high compared to low PSE receiving manual therapy, acupuncture, and electrotherapy.

Methods

Participants were stratified into high or low baseline (i) PSE, (ii) shoulder pain and disability index (SPADI), and (iii) did or did not receive the treatment. Whether the effect of treatment differs for people with high compared to low PSE was assessed using the 95% confidence interval of the difference of difference (DoD) at a 5% significance level ( p < 0.05).

Results

Six-month SPADI scores were consistently lower (less pain and disability) for those who did not receive passive treatments compared to those who did (statistically significant less pain and disability in 7 of 24 models). However, DoD was statistically insignificant.

Conclusion

PSE did not moderate the relationship between treatment and outcome. However, participants who received passive treatment experienced equal or more pain and disability at 6 months compared to those who did not. Results are subject to confounding by indication but do indicate the need for further appropriately designed research.

Level of Evidence

Level of evidence II-b.
Perioperative HER2 targeted treatment in early stage HER2-positive breast cancer
Authors: Hong Joohyun , Park Yeon Hee
Published: June 2022

Although human epidermal growth factor receptor 2 (HER2)-positive breast cancer was associated with poor prognosis, it has been changed after the development of trastuzumab. There has been great progress in perioperative HER2-targeting treatment, and investigations of several novel drugs and their combinations are ongoing. Adjuvant trastuzumab with or without pertuzumab for 1 year in combination with concomitant chemotherapy has become a standard treatment in high-risk node-negative tumors or node-positive HER2-positive early breast cancer patients without residual disease or who have not received neoadjuvant treatment. For low-risk HER2-positive early breast cancer patients, adjuvant paclitaxel and 1-year trastuzumab are possible alternatives. For residual disease after neoadjuvant treatment, adjuvant trastuzumab emtansine (T-DM1) for 14 cycles is a standard treatment. Non-anthracycline chemotherapy with dual anti-HER2 targeting of trastuzumab and pertuzumab represents one of the preferred neoadjuvant regimens to achieve higher pathologic complete response (pCR) rates and better clinical outcomes. Further research is needed to develop and validate potential biomarkers to predict pCR, which could help escalate or de-escalate anti-HER2 therapy. Trials incorporating novel agents such as T-DM1, trastuzumab deruxtecan (T-DXd), and immune checkpoint inhibitors and trying to de-escalate treatments in neoadjuvant setting are ongoing. In the future, tailored treatments such as no adjuvant therapy, various HER2-directed therapies alone with chemotherapy, combinations of various HER2-directed therapies and chemotherapy, addition of immune checkpoint inhibitors, and omission of surgery will be individualized in HER2-positive early breast cancer patients.
Biopsy-Proven Amyloid-Beta Related Angiitis with Unusual Presentation and Long-Term Follow-Up
Authors: Gupta Navnika , Galla Krishna , Pichler Michael R. , McComb Rodney D. , Helvey Jason T. , Fayad Pierre
Published: June 2022

Amyloid-beta related angiitis (ABRA) is a rare central nervous system inflammatory and vasculitic process. It is seen in patients with cerebral amyloid angiopathy (CAA) and thought to be mediated by an autoimmune reaction against cerebrovascular β-amyloid. We describe the case of a patient with ABRA with clinical information and brain imaging over a 10-year period. The patient was hospitalized in 2018 for altered mental status, paranoia and hallucinations. Her symptoms started in 2009 with an episode of vertigo and loss of consciousness. From 2011-2019, she had multiple episodes of transient focal neurological deficits with overall cumulative progressive decline in cognition and functional status. Retrospective and comparative reviews of brain magnetic resonance imaging (MRI) from 2009-2019 showed waxing and waning vasogenic cerebral edema with overall progression of white matter hyperintensities and peripheral micro-hemorrhages consistent with inflammatory CAA. Re-examination of a brain biopsy from 2009 showed ABRA, and immunostaining was positive for β-amyloid. She was treated with intravenous steroids with minimal symptomatic improvement. She was lost to our follow-up after hospital discharge. We describe the temporal progression of ABRA through serial brain imaging over a 10-year period. To our knowledge, this is the longest published follow-up duration of ABRA. The patient in our case had severe cognitive impairment and disability despite treatment with steroids.
Liver scaffolds obtained by decellularization: A transplant perspective in liver bioengineering
Authors: Dias Marlon Lemos , Paranhos Bruno Andrade , Goldenberg Regina Coeli dos Santos
Published: June 2022

Liver transplantation is the only definitive treatment for many diseases that affect this organ, however, its quantity and viability are reduced. The study of liver scaffolds based on an extracellular matrix is a tissue bioengineering strategy with great application in regenerative medicine. Collectively, recent studies suggest that liver scaffold transplantation may assist in reestablishing hepatic function in preclinical diseased animals, which represents a great potential for application as a treatment for patients with liver disease in the future. This review focuses on useful strategies to promote liver scaffold transplantation and the main open questions about this context. We outline the current knowledge about ex vivo bioengineered liver transplantation, including the surgical techniques, recipient survival time, scaffold preparation before transplantation, and liver disease models. We also highlight the current limitations and future directions regarding in vivo bioengineering techniques.
Medication for opioid use disorder at hospital discharge is not associated with intravenous antibiotic completion in post-acute care facilities
Authors: Traver Edward C. , Ching Patrick R. , Narayanan Shivakumar
Published: June 2022

Background:

People with opioid use disorder and severe infections may complete their prolonged courses of outpatient parenteral antimicrobial therapy at a post-acute care facility due to adherence and safety concerns. We hypothesized that treatment with medications for opioid use disorder, such as methadone and buprenorphine, would increase antibiotic completion in these facilities.

Methods:

We performed a retrospective cohort study of people with opioid use disorder and severe infections who were discharged from the University of Maryland Medical Center to a post-acute care facility to complete intravenous antibiotic therapy. The primary outcome was completion of outpatient parenteral antimicrobial therapy. We compared the rate of antibiotic completion between patients prescribed and not prescribed medication for opioid use disorder at discharge from the acute care hospital.

Results:

A total of 161 patient encounters were included; the mean age was 43.4 years and 56% of patients were male. In 48% of the encounters, the patient was homeless and in 68% they recently injected drugs. The most common infectious syndrome was osteoarticular (44.1%). Medication for opioid use disorder was prescribed at discharge in 103 of 161 encounters and was newly started in 27 encounters. Similar rates of outpatient parenteral antimicrobial therapy completion were found in those who received (65/103) and did not receive (33/58) medication for opioid use disorder at discharge (odds ratio: 1.29; 95% confidence interval: 0.68–2.54; p = 0.44).

Conclusion:

Medication for opioid use disorder prescription at discharge was not associated with completion of outpatient parenteral antimicrobial therapy in a post-acute care facility. Our study is limited by possible selection bias and infrequent initiation of medication for opioid use disorder, which may have minimized the effect on antibiotic completion.
Alcohol use disorder and its associated factors among residents in Southern Ethiopia during the era of COVID-19
Authors: Endashaw Hareru Habtamu , Kaso Abdene Weya , Debela Berhanu Gidisa , Abebe Lulu , Sisay W/tsadik Daniel , Kassa Abebe Reta , Kassaw Chalachew
Published: June 2022

Objectives:

To determine the prevalence of alcohol use disorder and associated factors among residents of Dilla town, Gedeo zone, Southern Ethiopia, 2021.

Methods:

A community-based cross-sectional study was conducted among 666 randomly selected participants. Interview-assisted structured questionnaire was used to collect data, and alcohol use disorder identification test was employed to measure alcohol use disorder. The data were entered in to Epi info version 7 and exported in to SPSS version 25 for analysis. Both bivariate and multivariate binary logistic regression analysis were used to identify significant factors related with alcohol use disorder. In the multivariate model, variables with p value < 0.05 were considered as a statistical significant factor for the outcome variable. Finally, adjusted odds ratio with 95% confidence interval was computed to assess the strength of association.

Results:

The magnitude of alcohol used disorder during the past year was 30.6% (95% confidence interval: 25.5%–35.7%). Being male (adjusted odds ratio = 8.33, 95% confidence interval: (4.34, 15.98)), age of less than 33 years old (adjusted odds ratio = 1.78, 95% confidence interval: (1.06, 3.00)), current cigarette smoking (adjusted odds ratio = 2.49, 95% confidence interval: (1.42, 4.37)), current khat chewing (adjusted odds ratio = 6.23, 95% confidence interval: (3.8, 9.92)), high level of psychological distress (adjusted odds ratio = 7.69, 95% confidence interval: (4.16, 14.28)) and poor social support (adjusted odds ratio = 2.30, 95% confidence interval: (1.27, 4.18)) were significantly associated with alcohol use disorder.

Conclusion:

A large percentage of respondents in our sample had an alcohol use disorder. Alcohol use problems were linked to being men, under the age of 33 years old, current khat chewing, current cigarette smoking, a high level of psychological distress, and poor of social support. As a result, early screening, public health intervention programs and establishing appropriate referral linkages with mental health facilities are recommended.
Pressure ulcer prevention knowledge, practices, and their associated factors among nurses in Gurage Zone Hospitals, South Ethiopia, 2021
Authors: Tesfa Mengist Shegaw , Abebe Geletie Haimanot , Zewudie Bitew Tefera , Mewahegn Agerie Ayinalem , Terefe Tamene Fetene , Tsegaye Amlak Baye , Tadesse Betelhem , GebreEyesus Fisha Alebel , Tsehay Tadesse , Solomon Mamo , Chekole Temere Bogale , Geze Tenaw Shegaw , Mesfin Yibeltal
Published: June 2022

A pressure ulcer is a localized skin injury and underlying tissue, usually as a result of friction or pressure against the surface of the skin. The global mortality rate of pressure ulcers was above 60% for hospitalized patients who wait 1 year of hospital stay. Nurses are the primary responsible body and forefront line care providers for the prevention of pressure ulcers, so nurses’ knowledge and practices are the major rollers to handling this preventable problem.

Objective:

To assess pressure ulcer prevention knowledge, practices, and their associated factors among nurses in Gurage Zone Hospitals, South Ethiopia, 2021.

Methods:

A cross-sectional study was conducted in Gurage Zone hospitals from May to June 2021. Data were collected using a structured self-administered paper questionnaire from 372 participants using a simple random sampling procedure, and the collected data were checked for their completeness and entered into Epi-data version 4.6 and exported to SPSS version 26 for analysis.

Results:

In this study, 176 (49%) of nurses have good knowledge and 210 (58.5 %) of nurses have good practices. Variables having masters and above (adjusted odds ratio = 2.075; confidence interval: 1.886, 4.861), using guideline (adjusted odds ratio = 1.617; confidence interval: 1.017, 2.572), and cooperativeness of patients (1.859; confidence interval: 1.066, 3.242) was significantly associated with nurses prevention knowledge. Being divorced (adjusted odds ratio = 3.002; confidence interval: 1.023, 4.219), degree nurse (adjusted odds ratio = 2.639; confidence interval: 1.388, 3.051), workload (adjusted odds ratio = 0.480; confidence interval: 0.245–0.939), unproportioned nurse to patient ratio (adjusted odds ratio = 0.480; confidence interval: 0.158–0.747), patient cooperativeness (adjusted odds ratio = 1.859; confidence interval: 1.066–3.242), and nurses having good knowledge (adjusted odds ratio = 1.684; confidence interval: 1.078–2.632) statistically significant with prevention practices.

Conclusion:

The overall level of pressure ulcer prevention knowledge and practice of nurses were good. Qualification of nurses’ degree and above, use of pressure ulcer prevention guidelines, over workload, unproportionate nurse-to-patient ratio, and patient cooperativeness were statistically significant factors for pressure ulcer prevention knowledge and practices. Therefore, health managers should provide continuous professional development, and ensure proportionated nurse-to-patient ratio allocation policy.
Impact of Donation Physicians on Deceased Organ Donation: A Systematic Review
Authors: Squires Janet E. , Aloisio Laura D. , Santos Wilmer John , Cho-Young Danielle , Taljaard Monica , Gritters Nills , Dhanani Sonny , Knoll Gregory
Published: June 2022

Background:

An emerging strategy to increase deceased organ donation is to use dedicated donation physicians to champion organ donation. We sought to conduct a systematic review of the effectiveness of donation physicians in improving organ donation outcomes.

Objective:

A systematic review was conducted following Cochrane principles. MEDLINE, Embase, and CINHAL databases were searched from inception to March 26, 2020.

Methods:

Quantitative studies examining the effects of donation physicians on all deceased organ donation outcomes were considered for inclusion. Review articles, editorials and opinion articles, and case studies were excluded. Study selection was completed independently by 2 team members; all discrepancies were resolved by consensus. Two team members independently extracted data from studies.

Results:

A total of 1017 studies were screened, and 12 met inclusion criteria. Included studies were published between 1994 and 2019. Half used an interrupted time series design (n = 6; 50%), 3 (25%) were cohort studies, and 3 (25%) used a before-and-after study design. Outcomes (reported in greater than 50% of included articles) included consent/refusal rate (n = 8; 67%), number of potential donors (n = 7; 58%), and number of actual donors (n = 7; 58%). Across studies and design types, there was an increase in potential organ donors ranging from 8% to 143% (Mdn = 33%), an increase in actual organ donors from 15% to 113% (Mdn = 27%), an increase in donor consent rate from −3% to 258% (Mdn = 12%), and an increase in deceased donor transplants from 13% to 24% (Mdn = 19%) following the introduction of donation physicians.

Conclusions:

Donation physicians have the potential to significantly improve deceased organ donation. Further implementation and evaluation of donation physician programs is warranted. However, implementation should be undertaken with a clear plan for a methodologically rigorous evaluation of outcomes.
Biomechanical Evaluation of 4 Suture Techniques for Hip Capsular Closure
Authors: Murata Yoichi , Fukase Naomasa , Brady Alex W. , Douglass Brenton W. , Bryniarski Anna R. , Dornan Grant J. , Utsunomiya Hajime , Uchida Soshi , Philippon Marc J.
Published: June 2022

Background:

The most reliable suture technique for capsular closure after a capsulotomy remains unknown.

Purpose:

To determine which suture technique best restores native stability after a 5-cm interportal capsulotomy.

Study Design:

Controlled laboratory study.

Methods:

Ten human cadaveric hip specimens were tested using a 6-degrees-of-freedom robotic arm in 7 states: intact, capsular laxity, 5-cm capsulotomy, standard suture, shoelace, double shoelace, and Quebec City slider (QCS). Rotational range of motion (ROM) was measured across 9 tests: flexion, extension, abduction, abduction at 45° of flexion, adduction, external rotation, internal rotation, anterior impingement, and log roll. Distraction (ie, femoral head translation [FHT]) was measured across a range of flexion and abduction angles.

Results:

When compared with the native state, the 5-cm capsulotomy state showed the largest laxity increases on all tests, specifically in external rotation ROM (+13.4°), extension ROM (+11.5°), and distraction FHT (+4.5 mm) ( P < .001 for all). The standard suture technique was not significantly different from the 5-cm capsulotomy on any test and demonstrated significantly more flexion ROM than the double shoelace suture (+1.41°; P = .049) and more extension ROM (+5.51°; P = .014) and external rotation ROM (+6.03°; P = .021) than the QCS. The standard suture also resulted in significantly higher distraction FHT as compared with the shoelace suture (+1.0 mm; P = .005), double shoelace suture (+1.4 mm; P < .001), and QCS (+1.1 mm; P = .003). The shoelace, double shoelace, and QCS techniques significantly reduced hip laxity when compared with the 5-cm capsulotomy state, specifically in external rotation ROM (respectively, –8.1°, –7.8°, and –10.2°), extension ROM (–6.3°, –7.3°, and –8.1°), and distraction FHT (–1.8, –2.2, and –1.9 mm) ( P ≤ .003 for all). These 3 techniques restored native stability (no significant difference from intact) on some but not all tests, and no significant differences were observed among them on any test.

Conclusion:

Hip capsule closure with the standard suture technique did not prevent postoperative hip instability after a 5-cm capsulotomy, and 3 suture techniques were found to be preferable; however, none perfectly restored native stability at time zero.

Clinical Relevance:

The shoelace, double shoelace, and QCS suture techniques are recommended when closing the hip capsule.
Performance and Return to Sport After Meniscal Repair in Professional Baseball Players
Authors: Erickson Brandon J. , Chalmers Peter N. , D’Angelo John , Ma Kevin , Rowe Dana , Cohen Steven B. , Dugas Jeffrey R.
Published: June 2022

Background:

Meniscal repair is an effective treatment option for certain meniscal injuries to preserve meniscal function and limit the progression of knee osteoarthritis. Outcomes after meniscal repair in professional baseball players are not well documented.

Purposes/Hypothesis:

The purposes of this study were to determine performance and return to sport (RTS) in professional baseball players after meniscal repair and compare the results of medial versus lateral meniscal repair. It was hypothesized that there would be a high RTS rate, with no difference in the rate or timing of RTS between players who underwent medial versus lateral meniscal repair.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

All professional baseball players who underwent meniscal repair between 2010 and 2017 were identified using the Major League Baseball Health and Injury Tracking System database. Descriptive information and performance data (before and after injury) for each player were recorded. The rate and timing of RTS were then compared between players who underwent medial versus lateral meniscal repair.

Results:

Included were 31 patients (mean age, 24 ± 3 years). There were 6 players (19%) who had failed repair, underwent subsequent meniscectomy within 2 years of meniscal repair, and were thus excluded from the performance analysis. Of the remaining 31 players, 68% returned to the same or a higher level of play, and 6% of players returned to a lower level of play. Most repair procedures (60%) were performed using the all-inside technique, and 72% of players underwent lateral meniscal repair. The mean time missed was 187 ± 67 days, and the mean time to RTS at full competitive play was 209 ± 84 days. There were no significant differences in the rate or timing of RTS between players who underwent medial versus lateral meniscal repair ( P ≥ .999 and P = .574, respectively). Pitchers saw a decrease in usage but no change in performance after meniscal repair. For batters, most metrics were unchanged, but there was a significant decrease in base stealing and on-base percentage after surgery.

Conclusion:

The RTS rate after meniscal repair in Major League Baseball players was 74% at a mean of 209 days; 19% of players had failed repair and underwent subsequent meniscectomy within 2 years of repair. No difference in the rate or timing of RTS was observed between players who underwent medial versus lateral meniscal repair.