bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of task complexity, task sequence, and interlocutor familiarity on Chinese EFL learners’ self-repair in synchronous online interaction
Authors: Ren Wei , Wu Yiman , Peng Yuchen
Published: June 2023

This study investigates the effects of two task factors (i.e. task complexity and task sequence) and an interlocutor factor (i.e. interlocutor familiarity) on Chinese English as a foreign language (EFL) learners’ self-repair strategies during synchronous online task-based interaction. Four decision-making tasks were conducted to elicit oral interactions from 44 low-level proficiency EFL learners, who were required to complete the tasks in pairs in either a simple-to-complex sequence or a complex-to-simple sequence. Information about the learners’ familiarity with their partners was collected through interviews. Learners’ self-repair was analysed in terms of various recycling and replacement strategies. The results revealed that complex tasks facilitated learners in replacing items to solve problems, while the simple-to-complex task sequence enabled them to produce more self-repair by repeating or replacing items than the complex-to-simple task sequence. Interlocutor familiarity on its own did not influence the learners’ self-repair, but it had effects when combined with task sequence.
The role of diagnostic writing assessment in promoting Chinese EFL students’ learning autonomy: An action research study
Authors: Kong Jufang , Pan Mingwei
Published: June 2023

Writing is a productive language skill that is difficult to improve and derive confidence from. Despite the abundant studies on product, process, or genre approaches to teaching writing and teachers’ feedback, there is a paucity of research into English as a foreign language (EFL) students’ responsibility for writing improvement and diagnostic writing assessment feedback. The present study employed an action research approach to explore the role of diagnostic writing assessment in promoting Chinese upper-intermediate EFL students’ learning autonomy. Questionnaires, reflective journals, and portfolios were utilized to elicit data, which were analyzed within Benson’s three-dimension learning autonomy framework. It was revealed that the diagnostic writing assessment impacted all dimensions of learning autonomy, helping EFL students form realistic perceptions of their writing abilities, formulate approachable remedial learning goals, select appropriate learning methods and content, monitor learning processes, and evaluate learning outcomes. It was also found that teacher interventions could significantly enhance EFL students’ learning management. This study highlighted the role and tested the feasibility of adopting diagnostic writing assessment to facilitate EFL students’ autonomous learning.
Reflections on hypermobility: A study of business travelers during the COVID-19 pandemic
Authors: Unger Orit , Uriely Natan
Published: June 2023

The temporary cessation of air travel imposed by the COVID-19 pandemic provided business travelers with an opportunity to mentally “zoom out” and reflect on their suspended hypermobile lifestyle. The present study used these circumstances to reexamine three key issues in the literature pre-pandemic: (a) the costs and benefits of a hypermobile lifestyle; (b) the justification of business trips given the option of online meetings; and (c) the role of tourism in shaping the business trip experience. An interpretive analysis of in-depth interviews with grounded business travelers conducted at the height of the pandemic revealed that the lack of frequent travel improved work-life balance but evoked a longing for tourism-related experiences, such as change, novelty, and pleasure. Grounded business travelers also proclaimed that the lack of physical proximity to colleagues caused by the suspension of travel was followed by difficulties in generating new business relationships and nurturing creativity at work. The study presented the costs and benefits of immobility as a reverse image of hypermobility, reinforcing the notion of hypermobility as a stressful but exciting lifestyle. It showed that physical proximity with colleagues cannot be fully replaced by online meetings, supporting the opinion that stresses the need for business trips. By suggesting that tourism-related experiences serve as anchor points for the reconstruction of memories and longing in the minds of grounded business travelers, the study confirmed that tourism-related experiences are important components of business trips.
Curating the music city: The accommodation sector in Glasgow’s music tourism ecology
Authors: Ord Matthew , Behr Adam
Published: June 2023

Since becoming a UNESCO ‘City of Music’ in 2008, Glasgow has sought to develop the tourism potential of its music scene. As potential beneficiaries, accommodation providers have facilitated the development of music tourism initiatives within the city, strategically positioning themselves as ambassadors for the city’s music. This article considers how three Glasgow hotels ‘curate’ the musical life of the city, presenting themselves as facilitators of cultural experiences rather than mere service providers. We draw on interviews alongside an analysis of marketing discourse to show how this approach is reflected in the physical space of hotels, recruitment practices, and the language of promotional materials. Arguing that the packaging of musical experience often implies an instrumentalist understanding of music’s cultural value, we consider what it means for music to be re-imagined as an ‘experience’, and how music’s value as a resource for self-construction is articulated within the discourse of contemporary tourism.
A Literature Review of Mental Health Symptom Outcomes in U.S. Veterans and Servicemembers Following Combat Exposure and Military Sexual Trauma
Authors: Yancey James R. , Carson Chelsea N. , McGlade Erin C. , Yurgelun-Todd Deborah A.
Published: June 2023

Combat exposure (CE) and military sexual trauma (MST) are among the most common types of traumatic experiences faced by veterans and active duty servicemembers and, as such, have both garnered increased research focus over the past decades. However, there has not yet been a critical review of the literature to examine the distinct clinical presentations associated with different trauma types. This is particularly important, as understanding distinct clinical profiles could help researchers and clinicians refine treatment approaches based on trauma type. To address this question, we conducted a search of the available literature in PsycINFO and PubMed prior to October 2022. We identified 43 articles evaluating the distinct and overlapping clinical symptoms of CE and MST. Study findings were conceptually organized by psychiatric condition. In general, there was substantial variability in study methodology including sample size, composition, and operationalizations of CE and MST. Despite this variability, notable patterns emerged across studies. Specifically, MST and CE uniquely predicted posttraumatic stress disorder symptoms, MST was more related to depressive symptoms and suicidality than CE, and CE appeared to be more related to alcohol use and other externalizing behaviors. Gender also played a significant role in the relationship between CE, MST, and clinical variables across studies. This review suggests that individuals with a history of MST and CE likely have distinct clinical presentations and more research into these presentations could better inform assessment and treatment. Important methodological gaps in the literature are also discussed.
Qualitative and Quantitative Assessment of Invasive Surgery Skill Based on a Custom Training Simulator
Authors: Liang Shichao , Li Long , Yang Bin , Yuan Panpan , Li Shilong , Shi Yue , Gao Feng , Deng Yiming , Jiao Liqun , Chen Duanduan
Published: June 2023

Purpose:

Qualitative and quantitative assessment of interventional performance is a vital component in the evaluation of endovascular surgery skill training. We established a custom simulator with qualitative and quantitative metrics for endovascular performance training.

Methods:

The simulator included an in vitro silicone phantom, mock circulation loop, visual module, force-sensing module, and custom software for image and force data postprocessing. Two tasks to deliver the guidewire to the target location of the carotid artery were conducted by the expert (n=4), novice (n=6), and test (n=4) groups. Seven features with significant differences extracted from the expert and novice groups were applied for qualitative assessment using the support vector machine (SVM) and quantitative assessment using the Mahalanobis distance (MD).

Results:

Significant differences were observed in kinematic and force data between experts and novices during the intervention procedure. The median value of finished time for task 1 was 26.88 seconds for experts and 63.36 seconds for novices. The maximum speed for experts and novices was 32.79 and 7.43 cm/s, respectively. Moreover, the classified results depicted that the accuracy of qualitative assessment for task 1 and task 2 was 96.67% and 90%, respectively. As for the quantitative data, the residents had higher scores than individuals majored in biomedical engineering at 2 tasks (70.06±5.30 vs 41.81±6.58 for task 1, p=0.001).

Conclusions:

The proposed endovascular intervention skill training simulator provides qualitative and quantitative metrics on intervention performance skills and may be a useful tool in future interventional surgical training.

Clinical Impact

This simulator comprised an in-vitro silicone phantom, mock circulation loop, visual module, force-sensing module, and custom software for image and force data post-processing. Seven interventional performance features were used for qualitative assessment using the support vector machine and quantitative assessment using the Mahalanobis Distance. From the observations, we conclude that this endovascular intervention skill training simulator provides qualitative and quantitative metrics on intervention performance and may be a useful tool in future surgical training.
Epilepsy Surgery: A Story of Diminishing Returns Over Time? Think Differently and Think Again
Authors: Joshi Charuta
Published: June 2023

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The Role of Feral Swine in Human Aortic Infection With Brucella Species
Authors: Eidt John F. , Parrott Megan E. , Gucwa Angela L. , B Chu Tuan-Hung , Bettacchi Chris , MB Musser Jeffrey
Published: June 2023

Brucellosis is one of the most common zoonotic infections in the world. Human infections are the result of direct exposure to infected animals or ingestion of unprocessed dairy products. While Brucella sp. infection has largely been eliminated from commercial cattle and swine with aggressive vaccination, there is a significant prevalence of Brucella sp. infection in the expanding population of feral swine in the US. We report the surgical treatment of a ruptured mycotic aneurysm of the abdominal aorta due to Brucella suis in a woman living in a rural community with a large population of feral swine. Vascular surgeons should be aware that brucellosis can result in arterial infection and should be considered in the differential diagnosis in patients with a history of exposure to feral swine or the ingestion of unprocessed dairy products.
Excision of Atrial Myxoma Through a Totally Thoracoscopic Approach on the Fibrillating Heart
Authors: Kronenberger Rani , Bentala Mohamed , Devos Audrey , de Asmundis Carlo , La Meir Mark
Published: June 2023

Cardiac myxomas are the most common form of primary cardiac neoplasms. Although benign, they can be deleterious by causing embolic events and intracardiac obstruction. After complete surgical resection, the prognosis is excellent. Although isolated case reports performing video-assisted thoracotomy on the arrested heart have been published, median sternotomy with central cannulation remains the standard approach. We herein describe the case of a morbidly obese patient undergoing successful total resection of a left atrial myxoma using a completely thoracoscopic approach on the fibrillating heart.
A comparison of endovascular coil systems for the treatment of small intracranial aneurysms
Authors: Begley Sabrina L , White Timothy G , Shah Kevin A , Turpin Justin , Toscano Daniel , Dehdashti Amir R , Teron Ina , Link Thomas , Patsalides Athos , Woo Henry H
Published: June 2023

Background

Endovascular coiling of small, intracranial aneurysms remains controversial and difficult, despite advances in technology.

Methods

We retrospectively reviewed data for 62 small aneurysms (<3.99 mm) in 59 patients. Occlusion rates, complications rates, and coil packing densities were compared between subgroups based upon coil type and rupture status.

Results

Ruptured aneurysms predominated (67.7%). Aneurysms measured 2.99 ± 0.63 mm by 2.51 ± 0.61 mm with an aspect ratio of 1.21 ± 0.34 mm. Brands included Optima (Balt) (29%), MicroVention Hydrogel (24.2%), and Penumbra SMART (19.4%) coil systems. Average packing density was 34.3 ± 13.5 mm3. Occlusion rate was 100% in unruptured aneurysms; 84% utilized adjuvant devices. For ruptured aneurysms, complete occlusion or stable neck remnant was achieved in 88.6% while recanalization occurred in 11.4%. No rebleeding occurred. Average packing density ( p = 0.919) and coil type ( p = 0.056) did not impact occlusion. Aspect ratio was smaller in aneurysms with technical complications ( p = 0.281), and aneurysm volume was significantly smaller in those with coil protrusion ( p = 0.018). Complication rates did not differ between ruptured and unruptured aneurysms (22.6 vs. 15.8%, p = 0.308) or coil types ( p = 0.830).

Conclusion

Despite advances in embolization devices, coiling of small intracranial aneurysms is still scrutinized. High occlusion rates are achievable, especially in unruptured aneurysms, with coil type and packing density suggesting association with complete occlusion. Technical complications may be influenced by aneurysm geometry. Advances in endovascular technologies have revolutionized small aneurysm treatment, with this series demonstrating excellent aneurysm occlusion especially in unruptured aneurysms.
7T magnetic resonance angiographic imaging of basilar artery perforator aneurysms – initial experience of a non-invasive alternative to DSA
Authors: Ramgren Birgitta , Wassélius Johan , Hansson Boel , Markenroth Bloch Karin
Published: June 2023

Background

Perforator aneurysms of the basilar artery (PABA) are rare causes of subarachnoid haemorrhage (SAH) and challenging to diagnose. We present two cases of SAH caused by PABA diagnosed by cone beam computed tomography angiography (CBCTA) and a novel non-invasive method – 7T magnetic resonance imaging (7T MRI).

Methods

Two patients with SAH, diagnosed with PABA, were imaged on day 9 and 13 after onset, respectively, with CBCTA and 7T MR angiography (MRA) performed on the day after and at follow-up at 3 months.

Results

All four 7T MRI examinations in the two patients were technically successful with fully diagnostic images. No endovascular treatment was performed and control with 7T MRA at 3 months showed no remaining aneurysms.

Conclusion

PABA can be imaged with 7T MRI – a novel non-invasive method, allowing non-invasive follow-up to monitor this rare cause of SAH.
Who owns your consent? How REBs give away participants’ agency
Authors: Aurini Janice , Iafolla Vanessa
Published: June 2023

We draw on three illustrative vignettes to examine how REBs manage participants’ agency in the context of qualitative research. We ask: Who owns a participant’s consent? Central to informed consent is the principle of Respect for Persons, which privileges the autonomy of individuals to make decisions about what happens (or not) to them. Yet, REBs sometimes require researchers to get permission from organizations to conduct research on their current and former members, even when the research is not about those organizations. Our aim is to raise awareness about the inherent contradictions of this practice and to consider guidelines for determining the appropriateness of involving organizations that may be tangentially connected to the research objectives or potential participants.
From Ethnic to High-End Cuisine: Recategorization and Status Change Among Restaurants in Global Cities
Authors: Lane Christel , Opazo M Pilar
Published: June 2023

This article examines the strategies used by individuals within cultural fields to make a transition from previously low-status categories to high-status categories, in order to rise in the status hierarchy. Using the case of gastronomy in the global cities of London and New York, we investigate how the once strict boundary between high-end and ethnic restaurants is being breached, leading to field transformations. An analysis of the process of recategorization undertaken by chefs and restaurateurs reveals how strategies of category detachment and emulation are employed simultaneously: on the one side, to achieve a distancing from those held to be lower in the culinary hierarchy (ethnic restaurants/chefs) and, on the other side, to emulate those perceived to be above them in status (high-end restaurants). A third strategy identified is horizontal differentiation within the category – initiated by newcomers to ensure distinction and further secure their membership to the higher status category. Our analysis reveals the agency of producers in enacting status change by a focus on mainly material practices, while showing that recategorization is made possible by external societal and cultural transformations.
Manifold Threats to White Identity and Their Political Effects on White Partisans
Authors: Pérez Efrén , Lee Jessica HyunJeong , Oaxaca Ana , Solano Cervantes Tania , García Rodríguez Jasmine , Lam Kimberly , McFall David
Published: June 2023

We investigate how threats to White identity operate among White Democrats and Republicans. We evaluate four identity threats that prior work has underexplored: distinctiveness threat (loss of unique ingroup attributes), power threat (perceiving outgroup collusion), morality threat (impugning an ingroup’s integrity), and meritocratic threat (questioning an ingroup’s advantages). We pinpoint which threats catalyze White identity among specific partisans—and with what political consequences. Leveraging a pre-registered experiment with 2,000 White Democrats and 2,000 White Republicans, we find most identity threats significantly catalyze White identity among all partisans at comparable intensity ( d = .20). However, among White Democrats, a heightened sense of racial identity generates more downstream opposition to pro-outgroup policies (e.g., pathway to immigrant citizenship) and greater support for pro-ingroup policies (i.e., legacy college admissions) than among White Republicans. These indirect effects are highly robust and underscore White identity’s viability as a key mechanism behind contemporary partisan politics.
Pink Aesthetics: Gummy Smiles and Gingival Recession
Authors: Wadia Reena
Published: June 2023

The ideal smile is one where there is harmony between the ‘white’ (tooth) and ‘pink’ (periodontal) aesthetics. The developments in the field of periodontology have enhanced aesthetic outcomes when managing excessive gingival exposure in a ‘gummy’ smile or excessive tooth exposure in gingival recession cases. This paper aims to outline the aetiology, classification, and management of both a ‘gummy’ smile and gingival recession, putting a spotlight on aesthetics.
The Digital Aesthetic Test Drive
Authors: Shepperson Andrea
Published: June 2023

The burgeoning public interest in techniques to enhance a smile has led to demand on clinicians that require important steps in the pre-treatment approval process. Digital dentistry provides a new level of planning and visualisation, improving clinical risk assessment and patient engagement. Dentists must acquire a sound understanding of aesthetic design parameters, including physiologic limitations, and must match patient expectations with clinical reality. Digital design offers flexibility not obtainable with the conventional analogue wax up. Multiple versions of a design can be viewed in a 2D or 3D simulation and accommodated efficiently in CAD software, with 3D printed models generated from each design. The ability to use a test drive or mock-up based on a 3D digital analysis and design, has created a new standard of care for treatment planning, providing an accurate and reversible preview before any definitive dentistry is done. It also places the responsibility for understanding biologic limitations of care on the general dentist, with the risk that digital planning may over-promise if not matched with underlying hard and soft tissue conditions. It improves interdisciplinary and laboratory communication and increases the predictability of the proposed treatment. The result is greater patient satisfaction and an improved informed consent process.
Longevity of Indirect and Direct Restorations in Anterior Teeth
Authors: Burke F. J. Trevor
Published: June 2023

It is the aim of this paper to present data on the survival of direct and indirect restorations in anterior teeth. Two sources of information are used: previously-published analysis of data from 1990 to 2006 from a 13 million restoration dataset from England and Wales; and evidence from published literature from 2011 to the time of writing (March 2022). The findings suggest that: (1) directly-placed resin composite materials may provide satisfactory survival of restorations in anterior teeth; (2) crowns provide better survival to re-intervention: however, crowning an incisor or canine tooth, as opposed to placement of a direct restoration, will lead to an earlier time to extraction of the restored tooth; (3) veneers perform more favourably than other restorations in terms of time to extraction of the restored tooth, but may have a less favourable time to re-intervention than crowns; (4) lithium disilicate crowns may be considered to perform satisfactorily with regard to time to re-intervention when placed in anterior teeth, but less satisfactorily in posterior teeth; and (5) operator factors influence survival of restorations.
Predictable Rehabilitation of Bone Deficiencies: Hygiene, Functional and Aesthetic Perspectives
Authors: Sethi Ashok , Kaus Thomas
Published: June 2023

The aim of this article is to describe a method for correcting bone deficiencies which may compromise aesthetic, functional or oral hygiene maintenance of implant supported restorations. The generic causes of these deficiencies are mentioned. The use of autogenous block bone grafts is described alongside methods for managing the hard and soft tissues at both the recipient and donor sites. The biomechanical advantage conferred with the use of grafts in reducing the crown:implant ratio is emphasised. The sources of intraoral bone grafts are identified and the risks of damage to adjacent anatomical structures and their avoidance are addressed.

The principles of healing are briefly described with an emphasis on the increasing predictability of contact healing, as opposed to gap healing.

The impact and inherent risks associated with the supplementary use of membranes for containment is also addressed.

Clinical cases have been used to illustrate procedures and outcomes. Previously published data is referenced.
Dental Therapists’ Role in the Provision of Aesthetic Dentistry in Dental Practice
Authors: Baker Linzy , Valadas Marques Arabella , Blum Igor R.
Published: June 2023

Dental therapists have a vital role to play in the provision of dentistry in the UK. This article examines the role of dental therapists in carrying out aesthetic dentistry in the UK dental practice setting. Patient access through collaborative working, especially through a shared care model, referral, and direct access will be discussed. In addition, two clinical cases are presented to demonstrate the provision of aesthetic anterior dental restorations by dental therapists.
Successful treatment of acrodermatitis continua of Hallopeau with tildrakizumab: A case report
Authors: Nguyen Alex , D’Aguanno Kathleen , Ridha Zainab , Tsoukas Alexander , Netchiporouk Elena
Published: June 2023

Acrodermatitis continua of Hallopeau is a rare, localized variant of pustular psoriasis commonly associated with join disease and severe quality of life impairment. While there are no standard treatment guidelines, therapies used for psoriasis vulgaris are commonly tried. We report a case of severe acrodermatitis continua of Hallopeau in a patient with multiple comorbidities (advanced malignancy, recurrent empyema, psoriatic arthritis) where tildrakizumab lead to a rapid resolution of skin and joint disease which was maintained 1 year later. To date, there are only four cases reporting the use of IL-23 inhibitors class in acrodermatitis continua of Hallopeau and none for tildrakizumab. However, IL-23 inhibitors should be strongly considered among the treatment of choice for acrodermatitis continua of Hallopeau, especially in patients with ongoing malignancy and/or high risk of infections.
Adoption of Electric Vehicles: Purchase Intentions and Consumer Behaviors Research in Turkey
Authors: Durmus Senyapar Hafize Nurgul , Akil Murat , Dokur Emrah
Published: June 2023

Electric vehicles (EVs) hold promise for attaining sustainable development objectives and mitigating the effects of global climate change due to their substantial benefits, such as high energy efficiency and low carbon emissions. Research on purchase intentions and behaviors may accelerate the adoption of EVs. Considering that the number of studies on EVs increases in tandem with the size of the market and that mutual interaction supports this two-way growth, conducting studies on consumer behavior in this area in countries where the electric vehicle market is developing, such as Turkey, will provide valuable insights for both the industry and the government. In this study, published articles on the consumer behavior of current and potential purchasers of electric vehicles were analyzed on the axis of Turkey, and the trend of academic studies in the literature was systematized from a holistic standpoint. Co-citation, co-keyword, geographical, and thematic analysis were applied to articles about EV consumer behaviors published between 2004 and 2022 in journals indexed by WoS, Scopus, TR Index, and DergiPark. The results of this study can inform numerous inter-disciplinary studies and researchers on the consumer behavior of electric vehicles. The bibliometric analysis of academic studies on electric vehicle consumers not only closes the market’s knowledge gap and accelerates the adoption process by increasing consumer awareness, but also provides industry representatives and policymakers with insights for the expansion of the EV market.
Devakkooth: A Ritual Dance Art from an Islet in North Malabar
Authors: A Rithwik Sankar , Justin Babitha
Published: June 2023

Many rituals in North Malabar can be read as complex cultural spaces that articulate subaltern concerns to a certain extent. However, rituals also perpetuate hegemonic ideologies dictated by and embedded within the caste system. Theyyam, a traditional ritual art in North Malabar, carries ritualistic elements of worship and penance along with the convergence of various forms like dance, painting and music. In Theyyam, a traditional ritual art in North Malabar, the female impersonation of the Mother Goddess and female deities occurs in the transvestite ritualistic performances by men. Devakkooth, or the dance of the goddess, a ritual art performed in an islet or thuruth, is widely regarded as the only Theyyam performed by women from the Malaya community, where women impersonate the goddess. Devakkooth is different from other performing arts because of its performance style and self-reflexivity on the thuruth culture. This article discusses key aspects of Devakkooth: the myth, the song of the performance, body movements, geographical specialities and its cultural and ritualistic self-reflexivity. This paper explores the unique aspects of Devakkooth as a female performance artistic dance ritual.
Thromboembolism Triggered by a Combination of Electronic Cigarettes and Oral Contraceptives: A Case Report and Review of Literature
Authors: Fadeyi Olaniyi , Randhawa Anantbir , Shankar Abhirami , Garabetian Christine , Singh Harpreet , Topacio Antonio
Published: June 2023

Genetic predisposition, oral contraceptive (OCP) use, tobacco smoking, cancers, and trauma are well-known triggers for hypercoagulability and thromboembolism. Multiple reports have been published on the health risk of combining OCP and traditional cigarettes smoking in the context of thromboembolism. However, limited information is available on the health consequences of combining OCP use with electronic cigarettes. Here, we report a case of a young female patient with a past medical history of ovarian cysts and electronic cigarettes use who came into the hospital with a complaint of “recurrent seizures” and tachycardia. This patient was subsequently diagnosed with bilateral pulmonary emboli, subacute cerebrovascular accident (CVA), and possible patent foramen ovale. Therapeutic Lovenox was initiated. Reasons to educate young females on the risks of combining OCP and electronic cigarettes use were explained.
Cultural Intelligence and Trust in Global Virtual Teams
Authors: Wengel John
Published: June 2023

A lack of cultural intelligence (CQ) creates a lack of trust in global virtual teams (GVTs). Study findings examine how leaders demonstrate CQ, trust in GVTs, and provide strategies for organizations. This qualitative single-case study explores how leaders of US-based GVTs in the financial industry demonstrate CQ and trust and strategies to develop trust. This study applies the social interaction theory, uncovering group identity and behaviors. Participants included GVT members and leaders having at least 1 year of experience on a GVT. The emerging themes were demonstrating CQ, demonstrating trust, and strategies to build trust.
Barriers to the integration of palliative care in Ghana: evidence from a tertiary health facility
Authors: Okyere Joshua , Kissah-Korsah Kwaku
Published: June 2023

Background:

Integration of palliative care (PC) in cancer management is critical to improving the overall quality of life of cancer patients and their families. Nevertheless, only a few people in need of PC services actually receive them.

Objective:

The study explored the barriers to the successful integration of PC in cancer management in Ghana.

Design:

The design was an exploratory descriptive qualitative research design.

Methods:

In all, we conducted 13 interviews with service providers (7), patients (4) and caregivers (2). An inductive thematic analysis was carried out. Data were managed using QSR NVivo 12.

Results:

Our study reveals the different levels of barriers that adversely affect the successful integration of PC and cancer management. Emerging from the findings are patient- and family-level barriers (denial of the primary diagnosis and understanding of PC and financial constraints), service provider–level barriers (healthcare providers’ misunderstanding of PC and late referrals), and institutional and policy-level barriers (infrastructural and logistical constraints, non-inclusion of PC in the National Health Insurance Scheme, low staff strength).

Conclusion:

We conclude that different levels of barriers are encountered in the integration of PC in cancer management. There is a need for policymakers to develop comprehensive guidelines and protocols for the integration of PC into cancer management. These guidelines should address the various levels of factors that serve as barriers to PC integration. The guidelines should also emphasise the importance of early referral for PC and educate service providers on the benefits of PC for patients with life-limiting illnesses. Our findings underscore a need to include PC services and medication in the benefits package of the health insurance scheme to reduce the financial burden on patients and their families. In addition, continuous professional training of all cadre of service providers is needed to facilitate PC integration.
A ground motion model for orientation-independent inelastic spectral displacements from shallow crustal earthquakes
Authors: Aristeidou Savvinos , Tarbali Karim , O’Reilly Gerard J
Published: June 2023

The peak inelastic displacement of a single-degree-of-freedom (SDOF) system is an efficient ground motion (GM) intensity measure (IM) for estimating seismic demands in structures and infrastructures. Most ground motion models (GMMs) that predict this IM are developed to estimate the arbitrary or geometric mean of the horizontal GM components obtained from the two as-recorded orientations. In this study, the median and maximum directional inelastic spectral displacements, denoted as Sdi,RotD50 and Sdi,RotD100, respectively, were considered as IMs to develop GMMs. These orientation-independent measures of horizontal motion were calculated by rotating the GMs through all non-redundant rotation angles and have the advantage of removing the sensor orientation as a contributor to overall uncertainty. To do this, several SDOF systems were considered using a subset of the NGA-West2 database to fit GMMs for these IMs. A set of functional forms was developed using a mixed-effects regression approach. The predictor variables were the elastic period, T, the strength ratio, R, and a set of seismological GM causal parameters (i.e. magnitude, distance, soil condition, and so on). Comparison with existing GMMs that consider either inelastic spectral displacement or directionality is provided to highlight key differences and developments. In addition, the response directionality, defined as the ratio Sdi,RotD100/ Sdi,RotD50, was observed to be notably impacted by the strength ratio and elastic period, which has not been discussed in the literature to date. Overall, this GMM has the advantage of quantifying ground motion intensity via an efficient IM in Sdi, which can better highlight some fundamental issues surrounding the directionality of GMs and allow for more informative risk estimates.
Incidence, clinical presentation, risk factors, outcomes, and biomarkers in de novo late acute GVHD
Authors: Akahoshi Yu , Spyrou Nikolaos , Hogan William J. , Ayuk Francis , DeFilipp Zachariah , Weber Daniela , Choe Hannah K. , Hexner Elizabeth O. , Rösler Wolf , Etra Aaron M. , Sandhu Karamjeet , Yanik Gregory A. , Chanswangphuwana Chantiya , Kitko Carrie L. , Reshef Ran , Kraus Sabrina , Wölfl Matthias , Eder Matthias , Bertrand Hannah , Qayed Muna , Merli Pietro , Grupp Stephan A. , Aguayo-Hiraldo Paibel , Schechter Tal , Ullrich Evelyn , Baez Janna , Beheshti Rahnuma , Gleich Sigrun , Kowalyk Steven , Morales George , Young Rachel , Kwon Deukwoo , Nakamura Ryotaro , Levine John E. , Ferrara James L. M. , Chen Yi-Bin
Published: June 2023

Late acute graft-versus-host disease (GVHD) is defined as de novo acute GVHD presenting beyond 100 days after allogeneic hematopoietic cell transplantation (HCT) without manifestations of chronic GVHD. Data are limited regarding its characteristics, clinical course, and risk factors because of underrecognition and changes in classification. We evaluated 3542 consecutive adult recipients of first HCTs at 24 Mount Sinai Acute GVHD International Consortium (MAGIC) centers between January 2014 and August 2021 to better describe the clinical evolution and outcomes of late acute GVHD. The cumulative incidence of classic acute GVHD that required systemic treatment was 35.2%, and an additional 5.7% of patients required treatment for late acute GVHD. At the onset of symptoms, late acute GVHD was more severe than classic acute GVHD based on both clinical and MAGIC algorithm probability biomarker parameters and showed a lower overall response rate on day 28. Both clinical and biomarker grading at the time of treatment stratified the risk of nonrelapse mortality (NRM) in patients with classic and late acute GVHD, respectively, but long-term NRM and overall survival did not differ between patients with classic and late acute GVHD. Advanced age, female-to-male sex mismatch, and the use of reduced intensity conditioning were associated with the development of late acute GVHD, whereas the use of posttransplant cyclophosphamide–based GVHD prevention was protective mainly because of shifts in GVHD timing. Because overall outcomes were comparable, our findings, although not definitive, suggest that similar treatment strategies, including eligibility for clinical trials, based solely on clinical presentation at onset are appropriate.
Impact of detectable monoclonal protein at diagnosis on outcomes in marginal zone lymphoma: a multicenter cohort study
Authors: Epperla Narendranath , Zhao Qiuhong , Karmali Reem , Torka Pallawi , Shea Lauren , Oh Timothy S. , Anampa-Guzmán Andrea , Reves Heather , Tavakkoli Montreh , Greenwell Irl Brian , Hansinger Emily , Umyarova Elvira , Annunzio Kaitlin , Sawalha Yazeed , Christian Beth , Thomas Colin , Barta Stefan K. , Geethakumari Praveen Ramakrishnan , Bartlett Nancy L. , Grover Natalie S. , Olszewski Adam J.
Published: June 2023

Given the paucity of data surrounding the prognostic relevance of monoclonal paraprotein (M-protein) in marginal zone lymphoma (MZL), we sought to evaluate the impact of detecting M-protein at diagnosis on outcomes in patients with MZL in a large retrospective cohort. The study included 547 patients receiving first-line therapy for MZL. M-protein was detectable at diagnosis in 173 (32%) patients. There was no significant difference in the time from diagnosis to initiation of any therapy (systemic and local) between the M-protein and no M-protein groups. Patients with M-protein at diagnosis had significantly inferior progression-free survival (PFS) compared with those without M-protein at diagnosis. After adjusting for factors associated with inferior PFS in univariate models, presence of M-protein remained significantly associated with inferior PFS (hazard ratio, 1.74; 95% confidence interval, 1.20-2.54; P = .004). We observed no significant difference in the PFS based on the type or quantity of M-protein at diagnosis. There were differential outcomes in PFS based on the first-line therapy in patients with M-protein at diagnosis, in that, those receiving immunochemotherapy had better outcomes compared with those receiving rituximab monotherapy. The cumulative incidence of relapse in stage 1 disease among the recipients of local therapy was higher in the presence of M-protein; however, this did not reach statistical significance. We found that M-protein at diagnosis was associated with a higher risk of histologic transformation. Because the PFS difference related to presence of M-protein was not observed in patients receiving bendamustine and rituximab, immunochemotherapy may be a preferred approach over rituximab monotherapy in this group and needs to be explored further.
Donor bone marrow–derived macrophage engraftment into the central nervous system of patients following allogeneic transplantation
Authors: Loeb Anisha M. , Pattwell Siobhan S. , Meshinchi Soheil , Bedalov Antonio , Loeb Keith R.
Published: June 2023

Hematopoietic stem cell transplantation is a well-known treatment for hematologic malignancies, wherein nascent stem cells provide regenerating marrow and immunotherapy against the tumor. The progeny of hematopoietic stem cells also populate a wide spectrum of tissues, including the brain, as bone marrow–derived macrophages similar to microglial cells. We developed a sensitive and novel combined immunohistochemistry (IHC) and XY fluorescence in situ hybridization assay to detect, quantify, and characterize donor cells in the cerebral cortices of 19 female patients who underwent allogeneic stem cell transplantation. We showed that the number of male donor cells ranged from 0.14% to 3.0% of the total cells or from 1.2% to 25% of microglial cells. Using tyramide-based fluorescent IHC, we found that at least 80% of the donor cells expressed the microglial marker ionized calcium-binding adapter molecule-1, consistent with bone marrow–derived macrophages. The percentage of donor cells was related to pretransplantation conditioning; donor cells from radiation-based myeloablative cases averaged 8.1% of microglial cells, whereas those from nonmyeloablative cases averaged only 1.3%. The number of donor cells in patients conditioned with busulfan- or treosulfan-based myeloablation was similar to that in total body irradiation-based conditioning; donor cells averaged 6.8% of the microglial cells. Notably, patients who received multiple transplantations and those with the longest posttransplantation survival had the highest level of donor engraftment, with donor cells averaging 16.3% of the microglial cells. Our work represents the largest study characterizing bone marrow–derived macrophages in patients after transplantation. The efficiency of engraftment observed in our study warrants future research on microglial replacement as a therapeutic option for disorders of the central nervous system.
Mild COVID-19 has no detrimental effect on semen quality
Authors: Edimiris Philippos , Doehmen Cornelius , Müller Lisa , Andrée Marcel , Baston-Buest Dunja Maria , Buest Sebastian , Adams Ortwin , Krüssel Jan-Steffen , Bielfeld Alexandra Petra
Published: June 2023

Background

As of today, the effect of coronavirus disease 2019 (COVID-19) on male fertility remains unclear. Studies published so far have partly contradictory results, likely due to very small sample sizes and heterogeneous populations.

To gain a deeper understanding of the impact of COVID-19 on male fertility, we performed a prospective case–control study, in which we examined the ejaculate of 37 subjects, including 25 subjects in the acute phase of mild COVID-19 and 12 subjects who did not suffer from COVID-19. Determination of semen parameters, severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) qPCR, and infectivity analysis were performed in the acute phase of the disease and in series.

Results

Semen parameter values did not differ significantly between subjects with mild COVID-19 and the control group. The serial examination of semen parameters revealed no significant changes between 4, 18, and 82 days after the onset of symptoms. SARS-CoV-2 RNA or infectious particles could not be detected in any ejaculate.

Conclusion

Mild COVID-19 seems to have no detrimental effect on semen parameter values.
Nanoliposomal VEGF-R2 peptide vaccine acts as an effective therapeutic vaccine in a murine B16F10 model of melanoma
Authors: Zahedipour Fatemeh , Zamani Parvin , Mashreghi Mohammad , Astaneh Mojgan , Sankian Mojtaba , Amiri Atefeh , Jamialahmadi Khadijeh , Jaafari Mahmoud Reza
Published: June 2023

Background

The vascular endothelial growth factor receptor-2 (VEGFR-2) plays an important role in melanoma development and progression. Peptide vaccines have shown great potential in cancer immunotherapy by targeting VEGFR-2 as a tumor-associated antigen and boosting the immune response against both tumor cells and tumor endothelial cells. Despite this, the low efficiency of peptide vaccines has resulted in moderate therapeutic results in the majority of studies. Enhancing the delivery of peptide vaccines using nanoliposomes is an important strategy for improving the efficacy of peptide vaccines. In this regard, we designed VEGFR-2-derived peptides restricted to both mouse MHC I and human HLA-A*02:01 using immunoinformatic tools and selected three peptides representing the highest binding affinities. The peptides were encapsulated in nanoliposomal formulations using the film method plus bath sonication and characterized for their colloidal properties.

Results

The mean diameter of peptide-encapsulated liposomes was around 135 nm, zeta potential of − 17 mV, and encapsulation efficiency of approximately 70%. Then, vaccine formulations were injected subcutaneously in mice bearing B16F10-established melanoma tumors and their efficiency in triggering immunological, and anti-tumor responses was evaluated. Our results represented that one of our designed VEGFR-2 peptide nanoliposomal formulations (Lip-V1) substantially activated CD4+ (p < 0.0001) and CD8+ (P < 0.001) T cell responses and significantly boosted the production of IFN-γ (P < 0.0001) and IL-4 (P < 0.0001). Furthermore, this formulation led to a significant decrease in tumor volume (P < 0.0001) and enhanced survival (P < 0.05) in mice.

Conclusion

Our findings suggest that the nanoliposomal formulation containing VEGFR-2 peptides could be a promising therapeutic vaccination approach capable of eliciting strong antigen-specific immunologic and anti-tumor responses.
Multivariate analysis of seed chemical diversity among wild fenugreek (Trigonella monantha C. A. Mey.) ecotypes
Authors: Hasaroeih Neda Esamaeilinejad , Ghanavati Farangis , Moradi Foad , Kohpalkani Jahangir Abbasi , Rahimizadeh Majid
Published: June 2023

Background

Wild fenugreek (Trigonella monantha), a multi-purpose annual plant, has traditionally been used as a food, forage, and medicinal plant. However, the knowledge of the diversity of its chemical characteristics is limited. In this study, 40 wild fenugreek ecotypes collected from their natural habitats in Iran and grown together in field conditions, were analyzed for their seed chemical properties.

Results

The ecotypes were cultivated in a randomized complete block design (RCBD) with three replications. The results of ANOVA revealed a significant difference among the ecotypes for all measured characters (P < 0.01). The results showed a high level of diversity among the ecotypes based on the measured characters, including antioxidant activity (48.19 to 86.85%), phenol (0.82 to 1.51 mg gallic acid per g dry weight), flavonoid (1.07 to 3.11 mg quercetin per g dry weight), trigonelline (0.02 to 0.08 mmol/l), 4-hydroxyisoleucine (0.197 to 0.906 mg/g), sucrose (0.13 to 3.77 mM), glucose (1.07 to 12.1 mM), and fructose (13.3 to 45.5 mM). The cluster analysis divided the ecotypes into four groups and the PCA analysis showed that the three first components explained 73% of the total variance among the ecotypes. Also, heat map correlation revealed that many positive and negative correlations were observed among the measured characters. The results did not show a relationship between the amounts of compounds and the place of sample collection.

Conclusions

The present study suggests considerable diversity in the seed chemical compositions of the wild fenugreek ecotypes. Therefore, many ecotypes could be useful for medicinal purposes, as well as for human nutrition.