bluuebunny/crossref_metadata_2025 huggingface dataset:
Dental Arch Relationship Outcomes of 5-Year-Olds Born With Unilateral Cleft Lip and Palate Following the Centralization of Cleft Services
Authors: Alattar Batol K. , Ireland Anthony J. , Sandy Jonathan R. , Fowler Peter V.
Published: February 2025

To investigate the interdental arch relationship outcomes of 5-year-old children with unilateral cleft lip and palate (UCLP) before and after centralization of cleft services in the United Kingdom (UK) using the modified Huddart-Bodenham index (MHBI) and to investigate any differences in MHBI by cleft laterality.

Retrospective cross-sectional study.

Evaluation of three-dimensional study models of children with a complete UCLP.

All available 5-year-old orthodontic study models of participants with UCLP from the precentralization Clinical Standard Advisory Group (CSAG n = 107) and postcentralization cleft care UK (CCUK n = 195) studies. The models were also grouped by cleft laterality (left and right sided).

Differences between the interdental arch relationship outcomes were assessed using the MHBI. This index scored the buccal/palatal or labial/palatal relationships of 8 maxillary deciduous teeth with the opposing mandibular dentition. The anterior segment, buccal cleft segment, and noncleft segment scores were calculated and combined to calculate the MBHI total arch scores.

Inter and intraexaminer reliability demonstrated high levels of agreement. Statistically significant differences in the anterior segment, buccal noncleft segment, and total arch MHBI scores were found, with postcentralization CCUK performing better. Right-sided UCLP had statistically significantly better buccal cleft segments, but no differences were found for the other MBHI segments or total arch scores.

There were improved interdental arch relationships postcentralization of cleft services in the United Kingdom. Cleft laterality differences were limited to the buccal cleft segment with right-sided UCLP having better MBHI scores.
Fostering Team Resilience Through Stressor Exposure: An Identity-Based Model and the Role of Charismatic Leadership
Authors: Feng Xingyu , Long Tianyi , Han Ping
Published: February 2025

In today’s complex and turbulent business environment, it is increasingly important to understand how teams can build the ability to cope with and recover from adverse situations. Drawing on social identity theory and the self-enhancement prospect perspective, we propose that team resilience can be developed through exposure to team work stressors and the resulting identity-based mechanisms. Our model also examines the role of charismatic leadership in this process. Using a time-lagged, multisource survey of 167 teams in China, we found that team challenge stressors enhance team resilience capacity by fostering collective team identification, whereas team hindrance stressors undermine team resilience capacity by weakening this identification. Additionally, charismatic leadership strengthens the positive effects of challenge stressors on collective team identification and alleviates the detrimental impact of team hindrance stressors, ultimately enhancing team resilience capacity. The theoretical and practical implications of the study are discussed.
Impact of Hypoalbuminemia on Clinical Outcomes in Patients Receiving Cefazolin for Methicillin-Susceptible Staphylococcus aureus Bacteremia
Authors: Whitenack Kaylee M. , Ilges Dan , Epps Kevin L. , McGary Alyssa , Robinson John C.
Published: February 2025

Background:

Cefazolin is a preferred treatment option for methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. Recent studies have suggested a potential impact on clinical outcomes in patients with hypoalbuminemia treated with highly protein-bound antimicrobials.

Objective:

The purpose of this study was to determine if there are any differences in clinical outcomes between normoalbuminemic and hypoalbuminemic patients treated with cefazolin for bacteremia.

Methods:

A retrospective, multicentered cohort study of patients hospitalized between 2019 and 2023 with MSSA bacteremia treated with cefazolin for at least 24 hours prior to culture clearance. Patients were divided into hypoalbuminemia (serum albumin ≤2.5 mg/dL) or normoalbuminemia groups. The primary outcome was time to culture clearance.

Results:

Of 69 patients included (50 in normoalbuminemia group and 19 in hypoalbuminemia group), the most common sources of bacteremia were line-related, osteoarticular, and infective endocarditis. Deep-seated infections were present in 24% of the normoalbuminemia group and 58% of the hypoalbuminemia group. Patients with hypoalbuminemia had a significantly longer mean hospital length of stay (12 vs 7 days, P = 0.016). After adjusting for deep-seated infection, hypoalbuminemia was associated with increased time to culture clearance by 1.2 days ( P = 0.039). In-hospital mortality was significantly higher in the hypoalbuminemia group (26% vs 4%, P = 0.015).

Conclusion and Relevance:

Limited research is available describing the relationship between serum albumin levels and clinical outcomes. Our study suggests patients with hypoalbuminemia treated with cefazolin for MSSA bacteremia have significantly longer time to culture clearance, increased mortality, and longer length of stay.
Factor Structure and Psychometric Properties of the Learning, Executive, and Attention Functioning (LEAF) Scale in Young Adults
Authors: Munroe Cory A. , Leckey Jennifer , Johnson Shannon A. , Jacques Sophie
Published: February 2025

The Learning, Executive, and Attention Functioning (LEAF) scale is a resource-friendly means of assessing executive functions (EFs) and related constructs (e.g., academic abilities) in children and adolescents that has been adapted for use with adults. However, no study in any population has investigated the factor structure of all LEAF EF items to determine whether items factor in a manner consistent with the originally proposed scale structure. Therefore, we examined LEAF scale responses of 546 young adults ( Mage = 20.05, SD = 2.17). Upon removing academic items following a preliminary factor analysis, we performed principal axis factoring on the remaining 39 EF items. The final model accounted for 61.75% of the total variance in LEAF EF items and suggested that these items assess six moderately correlated EF constructs in young adults. We constructed six updated subscales to help researchers measure these EFs in young adults using the LEAF scale, each of which uniquely and differentially predicted measures of self-reported impulsivity, academic difficulties, and learning-related disorder history. Overall, the LEAF promises to be an accessible means of assessing a range of EF constructs in young adults, particularly when updated subscale structures based on factor analysis are used.
Investigation of moderately large amplitude effect on nonlinear free vibrations of porous cylinders using multiple scale method
Authors: Daemi Hossein , Eipakchi Hamidreza , Mahboubi Nasrekani Farid
Published: February 2025

This study focuses on the nonlinear free vibrations analysis of porous cylindrical shells for general porosity distribution through thickness. The motion equations which are a system of four coupled nonlinear partial differential equations are extracted in the framework of Mirsky–Herrmann’s shear deformation theory and nonlinear von Karman relations. By employing the multiple-scale method, the system of equations is solved and an analytical solution is proposed for different orders of the equations. By utilizing a parametric study, the effect of different parameters on the nonlinear free vibration behavior of the porous cylinder is discussed. Moreover, the effect of different combinations of boundary conditions and different types of porosity distributions on the linear/nonlinear frequencies is studied. The results are compared with other references in the special cases. The nonlinear frequency behavior of porous cylinders may be hardening or softening and it depends on different conditions, for example, the porosity distribution and boundary conditions. The porosity affects significantly the natural frequency, allowing for substantial weight reduction without compromising frequency in certain cases.
“The Fact That He Was a Police Officer Was Probably My Number 1 Challenge”: Victim-Survivor Experiences of Officer-Involved Domestic Violence in Australia
Authors: Reeves Ellen , Fitz-Gibbon Kate , Meyer Silke , Walklate Sandra
Published: February 2025

Officer-involved domestic violence (OIDV) is an underexplored phenomena in Australia and internationally. While in recent years some Australian states have adopted OIDV-specific policies, there remains little research which examines the experiences of victim-survivors of OIDV. This article addresses that gap through an examination of the experiences of 17 OIDV victim-survivors. The findings contribute new insights into how OIDV impacts risk; barriers to help-seeking; experiences of reporting OIDV to the police; the risks associated with information sharing; and perpetrator and organizational accountability. These findings underscore the importance of further shaping policy to address OIDV in Australia, while highlighting the necessity for continued research in this area internationally.
A Responsible AI approach for designing resilient classifier to handle incomplete data
Authors: Utukuru Sairam , Krishna P Radha
Published: February 2025

Missing values can greatly affect analyses and decision-making in many fields. In the context of Responsible Artificial Intelligence (AI), ensuring the robustness of machine learning models is essential because Responsible AI emphasizes reliability and interpretability in decision-making processes. However, traditional imputation and ensemble learning methods often fail to preserve critical relationships between independent and dependent variables, introducing bias or noise into the data and undermining the development of robust classification models. To address these challenges, we propose a novel classification approach that aligns with Responsible AI principles. Our Resilient Decision Tree classifier is specifically designed to handle incomplete datasets. We employ subspace classifiers that operate on different non overlapping subsets of features without relying on imputation. By combining these subspace models into a weighted ensemble classifier, we enhance prediction accuracy for test datasets with missing values. The experimental results obtained on real-life and synthetic datasets demonstrate that our methodology produces an effective ensemble classifier.
The Clinical Impact of Heart Failure on the Postoperative Outcomes for Lung Cancer Patients Undergoing Lobectomy and Sublobar Resection by Video-Assisted Thoracic Surgery: A Propensity Score-Matched Analysis of 2016-2020 HCUP-NIS Data
Authors: He Xiaoying , Wu Weibin , Wang Yan , Xiao Jingyi , Feng Juanjuan , Hong Hua , Chen Yue , Huang Rong , Guan Hongyu , Li Hai
Published: February 2025

Background:

The clinical impact of heart failure (HF) on postoperative outcomes following video-assisted thoracic surgery (VATS) for lung cancer resection remains controversial. This study aimed to assess patient and hospital characteristics related to the type of surgery, as well as the independent impact of HF on surgical outcomes.

Methods:

We conducted a retrospective analysis using data from the National Inpatient Sample database. A total of 20 693 patients aged 18 years or older, diagnosed with lung cancer, and undergoing lobectomy or sublobar resection via VATS between 2016 and 2020 were included. Patients were stratified based on the presence of HF. The HF-present cohorts were matched to HF-absent controls using a 1:2 nearest-neighbor propensity score-matching (PSM) analysis. The matched cohorts were then compared across several endpoints, including mortality, length of stay (LOS), hospitalization costs, and postoperative complications.

Results:

After PSM, the study included 1781 patients who underwent lobectomy and 1157 who underwent sublobar resection, with 594 and 386 patients, respectively, having concurrent HF. In both the lobectomy and sublobar resection groups, patients with HF demonstrated significantly higher in-hospital mortality rates ( P < .001), longer LOS ( P < .001), increased total hospital charges ( P < .001), and a greater risk for overall postoperative complications ( P < .001).

Conclusions:

Among patients with lung cancer undergoing VATS, the presence of HF is associated with an increased risk of postoperative complications. This finding underscores the necessity for enhanced monitoring and care for patients with HF should be treated during the postoperative recovery phase.
How face-to-face and online patient–provider communication associate with cervical cancer screening behaviors: The mediating roles of HPV awareness and cancer worry
Authors: Lai Yuyuan Kylie , Ye Jizhou Francis , Zhao Xinshu
Published: February 2025

Cervical cancer screening is a crucial cancer detection measure that can be facilitated by effective patient–provider communication (PPC). This study examined how face-to-face patient–provider communication (FPPC) and online patient–provider communication (OPPC) were associated with cervical cancer screening behaviors through the mediation of human papillomavirus (HPV) awareness and cancer worry. Using data from 3133 women in the Health Information National Trends Survey (HINTS 6, 2022), we applied structural equation modeling to examine our model. Results suggested that FPPC and OPPC positively correlated with screening behaviors. HPV awareness acted as a mediator in the relationship between OPPC and screening behaviors. Cancer worry mediated the association between FPPC/OPPC and screening behaviors but functioned differently: increased FPPC diminished cancer worry, whereas heightened OPPC augmented it. Only OPPC was linked to screening behaviors via sequential mediation of HPV awareness and cancer worry, underscoring the significance of promoting screening through cognition-affect mechanism in the digital era.
Exploring the effect of social media use on loneliness among older adults: A meta-analysis
Authors: Jin Jiahui , Kim Hye Kyung
Published: February 2025

With the global aging population, more research is needed on older adults’ mental health, particularly loneliness, a key psychological challenge resulting from life changes. While some researchers highlighted the potential of social media in reducing loneliness, the empirical findings remain unclear. This meta-analysis, including 19,134 observations, revealed no significant overall correlation between social media use and loneliness among older adults. To explore variability between studies, we conducted sensitivity analyses (excluding influential studies), subgroup analyses (based on age group, year of data collection, measure of social media use, and study region), and meta-regression with gender distribution as a moderator. Notably, a negative association was identified in the subgroup of studies conducted before COVID-19, indicating that social media may have helped reduce loneliness among older adults during that period. However, this benefit highlights that online networking cannot fully replace real-life social interaction.
Gender-based discrimination and its influence on mental health symptoms among people living with and without migraine: A case-control study
Authors: Thorsteinson Venezya H , Haczkewicz Kelsey M , Gallant Natasha L
Published: February 2025

Women are more likely than men to experience migraine and to endorse worse symptoms. Migraine is associated with anxiety, depressive and posttraumatic stress disorders. Women who experience migraine are also more likely to report a history of discriminatory experiences. This study investigated migraine characteristics, mental health outcomes and gender-based discrimination among women using a case-control study with a migraine and non-migraine sample. Two hundred ninety-two women completed an online survey with measures of migraine characteristics (as applicable), mental health symptoms, and gender-based discrimination. Women living with migraine experienced worse mental health symptoms and more gender-based discrimination than the non-migraine group. Migraine frequency and lifetime day-to-day discrimination significantly predicted anxiety, depression, and trauma symptoms, while anticipated discrimination significantly predicted trauma symptoms; lifetime day-to-day discrimination significantly predicted migraine-related reduction in productivity; and gender-based discrimination significantly predicted migraine-related social absences. These findings may be used to improve management of migraine among women.
Leveraging context-specific behavioral economic principles to enable patients to change their physical activity patterns
Authors: Barber Brittany V. , Vallis Michael , Kephart George , Martin-Misener Ruth , Rainham Daniel
Published: February 2025

This study explores how context-specific behavioral economic principles could be employed to tailor interventions to support patients’ efforts to modify day-to-day routines. Using adapted geo-ethnography techniques, interviews collected in-depth descriptions about facilitators and barriers to physical activity (PA), and contexts influencing decisions about day-to-day activities. Data were analyzed using the COM-B model for behavior change and MINDSPACE behavioral economic principles as coding frameworks. Twenty-nine patients (19 men, 10 women) aged 50–79 participated. Findings indicate patients were motivated and capable of increasing PA but were challenged to identify opportunities to adapt day-to-day routines for increasing PA. Patients described disrupting default routines, increasing commitments, changing the messenger, and introducing incentives as potentially useful behavioral economic principles to improve day-to-day decisions about increasing PA. Patients had insight into potential behavioral economic principles, although they were not previously educated, and were valuable partners in developing research and clinic-based behavioral economic intervention strategies.
Development and testing of timber-metal-hybrid materials for the side sill reinforcement of a battery electric vehicle
Authors: Heyner David , Feser Thomas , Schulze Maik , Siefkes Tjark , Beeh Elmar , Kohl Daniel
Published: February 2025

The development of more sustainable material solutions and the reduction of CO2-emissions in the production phase is one of the biggest challenges in current vehicle design. An approach to meet these requirements is the usage of renewable raw materials. Wood has excellent specific material properties comparable to aluminum and a negative CO2-footprint as CO2 is stored during growth. The usage of timber for vehicle structures has already been investigated in previous projects and certain disadvantages of wood were identified. Compared to metals the elongation to fracture is low causing a brittle material behavior. Another effect is an increasing load level for compression due to compaction. In the project “SuMatHrA” the usage of a timber-steel-hybrid material for a side sill reinforcement of a battery electric vehicle is investigated. The current design of this component for different car brands is an extruded aluminum profile. The main function of this component is to protect the battery during a side crash. The lightweight wood Albasia with a density of approximately 0.3 t/m³ was used for this project. The wood was processed to laminated veneer lumber (LVL) and hybridized with a thin steel sheet. The load was applied in fiber direction causing a crushing of the LVL. To validate the developed hybrid material an aluminum profile from a current production car was used as reference. In quasi static tests it could be shown that the specific energy absorption could be increased by up to 25% compared to the extruded aluminum profile.
Extensor Tendon Rupture After Distal Ulna Resection: A Multicenter Case Series
Authors: Wong Megan N. , Brown Chelsea R. , Vaghani Parth , Goyal Kanu S.
Published: February 2025

Background:

The Darrach procedure, comprising distal ulna resection, has been used to treat numerous wrist and distal radioulnar joint pathologies. Extensor tendon rupture from the proximal ulnar stump is a recognized, but lesser known postoperative complication. We present this case series of extensor tendon ruptures following Darrach procedures and their subsequent reconstructions to share different surgeon experiences with this complication.

Methods:

Patients with extensor tendon rupture after Darrach procedure were identified from contributing hand surgeon case logs. The treating surgeons shared demographic data and surgical case details pertinent to this study. A single patient experience is presented as the representative case, with the remaining patient experiences summarized in a table.

Results:

Seven patients were included. Nearly all patients underwent intraoperative capsular closure following distal ulna resection, and their extensor tendon ruptures were treated with revision surgeries.

Conclusion:

While rarely reported in the literature, treating surgeons should be aware of extensor tendon rupture as a possible complication after Darrach procedure.
Genetic diversity analysis of some Vaccinium species in the Black Sea region of Türkiye using iPBS markers
Authors: Gleku Olivet Delasi , Sultana Nusrat , Serçe Sedat
Published: February 2025

Background

The genus Vaccinium is economically significant for its highly nutritious berries. Türkiye hosts wild genetic resources of Vaccinium, primarily distributed along the Black Sea region. These species are valuable for crop improvement, local food security, and require urgent conservation efforts.

Objectives

This study analyzed the genetic diversity, population structure, and gene flow among wild Vaccinium species in Türkiye using iPBS retrotransposon markers.

Methods

A total of 22 individuals from three wild Vaccinium species ( V. arctostaphylos, V. myrtillus, V. uliginosum) and two domesticated cultivars were analyzed using 10 iPBS markers. Genetic diversity was assessed based on polymorphic bands, Shannon's index, and gene flow. Cluster analysis (UPGMA), principal component analysis (PCoA), and STRUCTURE analysis were performed to evaluate population structure.

Results

Out of 312 bands, 177 (56%) were polymorphic, with the highest bands (32) produced by iPBS2391. Low genetic diversity (Shannon's index = 0.14–0.2) and moderate gene flow (0.3) were observed. AMOVA revealed 49% of variance within individuals and 51% among species. Distinct clusters were identified, though some individuals showed high admixture and heterozygosity, forming separate clusters.

Conclusion

These findings provide insights into the genetic diversity and population structure of Turkish wild Vaccinium species, offering valuable information for conservation strategies and berry cultivation efforts worldwide.
Contextualizing Peace Journalism: Framing the Ethiopian Peace Deal in the International Media
Authors: Workineh Tadele Mognehodie , Taddese Esayas Teshome
Published: February 2025

This study aimed to assess the framing of the Ethio-Tigray peace deal held in Pretoria on 2nd November, 2022 in the international media. To this end, four international media outlets—Al Jazeera, BBC, CNN, and Reuters—were selected using purposive sampling method. The study examined all news items related to the peace deal between the Federal Government and Tigray Peoples Liberation Front of the Tigray Regional State. The news items were gathered from online sources of each media outlet for the period starting from July 24, 2022, to March 23, 2023. News Frame Content analysis, using Galtung's Peace Journalism Model, and Kempf's War versus Peace Discourse classification, were applied to examine the news segments. The results showed that the selected media outlets mainly focused on war narratives and utilized sensational frame strategies. However, conveying news about crises and crimes related to the peace deal might trigger adverse feelings among the parties.
Effect of Taurine Combined With Creatine on Repeated Sprinting Ability After Exhaustive Exercise Under Hot and Humid Conditions
Authors: Yu Peiqi , Fan Yongzhao , Wang Xiangyu , Wu Hao
Published: February 2025

Background:

Taurine (TAU) and creatine (Cr) are common ergogenic aids used by athletes to enhance performance; however, the effect of their combined supplementation, and on recovery in high temperature and humidity environments, has not been studied.

Hypothesis:

Combined TUA and Cr will have greater effect on physiological indicators and repetitive sprint performance recovery after exhaustive exercise under hot and humid conditions than single supplementation or placebo.

Study Design:

Single-blind crossover randomized controlled study.

Level of Evidence:

Level 2.

Methods:

Participants (12 sports students) were assigned randomly to 1 of 4 supplementation intervention groups: placebo (P), taurine (T), creatine (C), or taurine + creatine (T+C). Exercise protocol included exhaustion tests and repeated sprinting exercises were conducted in a laboratory environment at 35 °C/65% relative humidity. Heartrate, blood lactate (BLa), tympanic temperature, thermal sensation, and rating of perceived exertion were monitored throughout. Heartrate variability, time to exhaustion (TTE), reaction time, and countermovement jump (CMJ) height were tracked before and after exhaustion exercise and before sprint exercise.

Results:

TTE was significantly higher in the T+C group than in the P group ( P = 0.04). BLa and tympanic temperature increased rapidly in all 4 conditions, then decreased gradually, and T group peak values were higher than those of P group ( P = 0.04; P < 0.01). CMJ decreased in the C and T+C groups ( P = 0.04; P = 0.04) after exhaustive exercise, unlike other groups ( P > 0.05). Indicators of repeated sprint exercise, peak power, mean power, and power decrement showed a decreasing trend within groups but no difference between groups ( P > 0.05).

Conclusion:

In this small student group, under hot and humid conditions, T+C supplementation significantly enhanced TTE.

Clinical Relevance:

TAU, Cr, and their combined supplementation do not significantly improve repeated sprint performance after exhaustive exercise under hot and humid conditions.
Breast cancer in a patient with neurofibromatosis type 1: A case report and review of literature
Authors: Canice Nwagbara Victor I , Ashindoitiang John A , Ugbem Theophilus Ipeh , Magam Dino N , Meremikwu Chibuike M , Nnalue Victor D , Asuquo Maurice E
Published: February 2025

Neurofibromatosis 1 (NF1) represents a cluster of clinical features based on the National Institute of Health(NIH) diagnostic criteria. It is a multi-systemic disease with progressive features characterized by variable expression. NF1 is associated with an increased risk of malignancies including breast cancer. Presented was a 56 year old woman with a painless lump in the right breast in the past 15 months. Clinical evaluation revealed features of NF1 and an advanced right breast cancer. Histologic evaluation revealed an invasive ductal carcinoma and she was offered a right modified radical mastectomy. Due to clinical presentation with discrete lesions, NF1 may be diagnosed at presentation with malignancy. Clinicians are urged to be familiar with the subtle features of NF1 for early diagnosis that is largely clinical. Institution of early breast cancer surveillance in patients with NF1 is recommended for early diagnosis and improved outcomes.
Whispers of hair: Untangling the narratives of Tenali and Bandhu in sony SAB’s Tenali Rama
Authors: Prateek  , Sanisetty Mohana Lasya
Published: February 2025

The folk stories of Tenali Rama (1480-1528), believed to be a courtier and poet in Vijayanagar king Krishna Deva Raya’s court, have inspired many adaptations in India. This study examines the Sony SAB adaptation Tenali Rama (2017-2020), arguing that by dovetailing Tenali’s voice with his shikha’s (the lock of hair named Bandhu), it highlights Hinduism’s tension between ascetic self-sacrifice and the pragmatic desires of a householder’s psyche. Working with the performance studies framework, the study investigates Tenali Rama’s garhasthya or householder identity. The first part draws on the critical investigation of David Shulman’s literary adaptation of Tenali Rama’s poetry to contend that the voices of Tenali and Bandhu in SAB’s adaptation are articulated through the dramatic devices of jester and vidhushaka. The second part engages with three scenes from the series to explain how Bandhu’s privileging of himself over Tenali’s ascetic quest provides a more complex version of Hinduism.
Tensions, Confrontations, and Consensus: WhatsApp Use in Kenyan Electoral Politics
Authors: Wefwafwa Job Allan , Wekesa Bob , Gagliardone Iginio
Published: February 2025

Social media has enhanced culturally grounded debates and ethnicity-based exclusionism during Kenya’s WhatsApp group deliberations. These practices are often more pronounced during elections when WhatsApp becomes a social media platform of choice for various groups. Exclusionism takes at least two vectors. On the one hand, tensions and confrontations emerge as electoral deliberations proceed. On the other hand, consensus on WhatsApp spaces also emerges during the electoral deliberations as in-groups forge common ground. To analyze the splits in elections-based deliberations on WhatsApp, the article starts with an interrogation of how history and culture inform the Kenyan people’s use of WhatsApp space for electoral deliberations. Among others, the people use the platform to resolve perceived and real political injustices perpetrated in the society by previous governments, resulting in tensions and confrontations. The article argues that the origin of the tensions is the fact that most African people have dual “citizenship,” whereby they simultaneously belong to their ethnic communities while being part of the broader Kenyan nation. It theoretically engages Ekeh and Langmia to argue that the people concurrently fall into the primordial publics and civic publics, leading to dialectical tensions, confrontation, and consensus between the two categorizations. These tensions, confrontations, and consensuses spill over into the WhatsApp groups, with electoral deliberations registering the peak in these splits. The case of the Bungoma County and its linkage to the broader Kenyan nation serve as the site for empirical data. The method for data collection is qualitative. The article uses participant observation and face-to-face interviews to investigate how the people’s historical and cultural values inform their use of WhatsApp space during electoral deliberations. The findings reveal how the people’s historical and cultural values shape their use of WhatsApp space. The implication of the research is to explore the African people’s cultural adaptation of technology and to invite more Afrocentric theorization on technology adaptation in African societies.
Understanding Older Adults’ Intention to Use Telehealth: A Qualitative Study Using the UTAUT Framework
Authors: Fleischer Anne , Lowman Joneen , Strader Kristen
Published: February 2025

Introduction/Objectives:

As healthcare embraces telehealth, a need exists to understand factors that promote older adults’ telehealth usage, including the influence of age-related sensory impairments. The objective of this study was to describe older adults’ perceptions of telehealth and factors they considered before using telehealth within the framework of The Unified Theory of Acceptance and Use of Technology (UTAUT).

Methods:

This descriptive qualitative study collected data through semi-structured interviews. Twenty-four older adults were randomly selected from a pool of 103 participants who completed the initial UTAUT survey study. Individual interviews were conducted by telephone. Reflective thematic analysis was used to identify themes within the UTAUT construct that influence older adults’ use of telehealth.

Results:

Older adults identified preparedness, receptiveness, and willingness to use telehealth as important overarching factors to consider when using telehealth. These are connected to the UTAUT constructs: facilitating conditions, social influence, effort expectancy, and performance expectancy.

Conclusions:

This study supports UTAUT as an appropriate framework for assessing telehealth readiness and predicting behavioral intention to use telehealth. Our findings provide limited evidence that sensory impairments do not impact telehealth readiness unless the individual lacks appropriate adaptations.
Determining Patient Panel Size in Primary Care: A Meta-Narrative Review
Authors: Abu Dabrh Abd Moain , Farah Wigdan H. , McLeod Heidi M. , Biazar Parisa , Mohabbat Arya B. , Munipalli Bala , Garofalo Rachel , Stroebel Robert J. , Shah Nilay , Angstman Kurt B. , Presutti Richard J. , Farford Bryan , Horn Jennifer L. , Allen Summer V. , Perlman Adam I. , Chong Lau Ana Lucia , Prokop Larry J. , Murad M. Hassan
Published: February 2025

The optimal patient panel size (PPS) in primary care and the factors determining it remain unclear. We conducted a meta-narrative review of the literature to evaluate factors influencing PPS and assess its association with patient outcomes. A comprehensive search of electronic databases was performed from inception through December 2023, focusing on original studies reporting factors used to determine PPS and related outcomes (eg, clinical outcomes, process measures, and resource utilization). A total of 48 studies were included, identifying 7 key factors influencing PPS. Smaller panels were associated with improved patient satisfaction, continuity of care, and health promotion, while clinical outcomes, utilization, and costs showed minimal impact by PPS. Panel size was primarily associated with patient age, sex, comorbidities, and practice type and structure. Community-based centers typically managed smaller panels, often staffed by female clinicians and serving socioeconomically disadvantaged populations with greater health needs than hospital-based practices. Female clinicians were also independently associated with managing smaller panels, higher quality care indicators, fewer emergency department visits, and improved patient satisfaction. Determining the ideal PPS is a multifaceted process influenced by practice setting, patient demographics, and clinician characteristics. While practice-related factors showed limited association with PPS, patient-reported outcomes were more closely linked to it. Primary care practices should tailor panel sizes to their patient populations, emphasizing a patient-centered approach and ensuring adequate infrastructure support to optimize care delivery.
An Evaluation of the Decline in Primary Care Physician Visits, 2010 to 2021
Authors: Jetty Anuradha , Ezran Marie , Huffstetler Alison N. , Jabbarpour Yalda
Published: February 2025

Introduction:

Primary care is the backbone of the United States healthcare system, yet it continues to be underfunded and inaccessible to many. Previous studies explored primary care visit patterns until 2016, leaving gaps in our understanding of how recent factors like state Medicaid expansions, the Coronavirus Disease 2019 (COVID-19) pandemic, and population growth have influenced these patterns. Hence, the objective of the current study was to analyze the trends in primary care visits provided by outpatient clinicians over time and by visit type and contextualize study findings within the changing healthcare landscape.

Methods:

The Medical Expenditure Panel Survey data (2010-2021) were used to examine trends in the total number and share of ambulatory, preventive, acute, and chronic care visits and investigate sociodemographic factors associated with a given clinician visit. The outcome variable was the clinician type: Primary Care Physicians (PCPs), Internal Medicine (IM) subspecialists, and Nurse Practitioners or Physician Assistants or Registered Nurses (NP/PA/RNs). Explanatory variables included gender, age, race/ethnicity, education, region of respondent’s residence, income-to-poverty ratio, insurance coverage, number of chronic conditions, and survey year. Univariate, bivariate, and multinomial logistic regression analyses were performed.

Results:

The visits led by PCPs and IM subspecialists declined by 43% and 23% between 2010 and 2021, respectively. However, visits led by NP/PA/RNs increased by 98%. From 2010 to 2021, the proportion of preventive care visits provided by PCPs, IMs, and NP/PA/RNs increased by 25%, 7%, and 4%, respectively. PCPs provided fewer acute and chronic care visits in 2021 than in 2010. Regression analyses illustrated that relative to Non-Hispanic White patients, non-White patients had a higher likelihood of seeing PCPs. Patients reporting 1 chronic condition were more likely to obtain care from an IM or NP/PA/RN than a PCP. In contrast, those with 2 or more chronic conditions had a greater propensity to see PCP than NP/PA/RN.

Conclusion:

Despite a growing need for primary care services, the decrease in visits to PCPs is concerning and requires further examination. The declining trends in acute and chronic care visits raise questions as to whether primary care, in its current form, can continue to provide its essential attributes and services.
Native Tricuspid Valve Endocarditis Delayed Glenn Procedure: A Case Report
Authors: Argo Madison B. , Hermsen Joshua L. , Lamers Luke , Wilhelm Mike , Bergstrom Charles , Anagnostopoulos Petros V.
Published: February 2025

Infective endocarditis in infants with congenital heart disease is exceedingly rare and thus, treatment guidelines and expected outcomes are understudied. We present a 3-month-old girl diagnosed with native tricuspid valve endocarditis at the time of her pre-Glenn cardiac catheterization. She had resultant tricuspid valve and right ventricular dysfunction. After initiating intravenous antibiotics, she underwent an operation including a bidirectional Glenn, Sano shunt extirpation, tricuspid valve repair, and central pulmonary artery stent insertion. At 9 months postoperatively, the patient continues to do well with good right ventricular and tricuspid valve function. Surgical treatment of infective endocarditis may be performed during a Glenn operation with satisfactory short-term results.
Improved Biomechanical Performance of Tibial Spine Fracture Repair With Suture and Anchor Fixation in Pediatric Cadaveric Knees
Authors: Johnstone Thomas M. , Hollyer Ian , McFarlane Kelly , Alayeh Amin , Tompkins Marc , Ganley Theodore , Yen Yi-Meng , Ellis Henry B. , Chan Calvin K. , Green Daniel W. , Sherman Seth L. , Shea Kevin G.
Published: February 2025

Background:

Prior studies in porcine and adult human bone suggest that suture fixation is superior to screw fixation of pediatric tibial spine fractures (TSFs). However, we have previously demonstrated that 2-suture repair was biomechanically comparable with 2-screw repair in human pediatric cadaveric knees.

Purpose:

To evaluate whether TSF fixation with sutures attached to anchors placed in stronger metadiaphyseal bone would produce biomechanically superior repair to 2-screw and 2-suture constructs.

Study Design:

Controlled laboratory study.

Methods:

Six pediatric cadaveric knees were acquired. We applied the same TSF creation protocol used in our previous study, then repaired the fractures by passing 2 No. 2 FiberWire sutures through the fracture fragment and the base of the anterior cruciate ligament, with sutures passed through bony tunnels and secured to two 2.8-mm anchors in the metadiaphyseal cortex. This construct of suture plus suture anchor (suture anchor group) underwent the same biomechanical loading protocol used in our prior study, in which pediatric knees were randomly assigned to either screw fixation (n = 6; fractures reduced with two 4.0-mm cannulated screws and washers) or suture fixation (n = 6; fractures repaired as in the suture anchor group except the sutures were tied across a metaphyseal bony bridge after their exit from the bony tunnels). All specimens were mounted in flexion and biomechanically tested with cyclic loading followed by a load-to-failure test. New data were statistically compared with the prior study’s results.

Results:

The suture anchor group had a median age of 9.00 years, while the screw and suture groups had identical median ages (8.50 years). All groups had an identical number of samples of each laterality. The ultimate failure load differed significantly across fixation methods ( P = .006), primarily driven by higher ultimate failure loads in the suture anchor group (225.50 ± 46.46 N) when compared with the screw group (143.52 ± 41.97 N; P = .01) and suture group (135.35 ± 47.94 N; P = .009).

Conclusion:

TSF fixation with sutures tied to metadiaphyseal suture anchors provided significantly stronger repair than 2-suture and 2-screw constructs.

Clinical Relevance:

The suture anchor fixation method for TSF may offer enhanced stability and durability to reduce the risk of postoperative complications while improving functional patient outcomes.
Validating the Contemporary Business Soft Skills Instrument
Authors: Heikkinen Sami , Myyryläinen Heidi
Published: February 2025

Recent workplace transformations have heightened the importance of soft skills, yet validated instruments for measuring these competencies remain limited. This study validates a comprehensive instrument measuring contemporary business soft skills using data from 294 participants representing 38 nationalities. Factor analysis revealed a robust 10-factor structure explaining 62.4% of the variance, with reliability coefficients ranging from .775 to .877. Results indicate the integration of traditionally distinct competencies and the emergence of new factorial combinations. The validated instrument provides a reliable tool for assessing soft skills in modern workplace contexts, particularly valuable for virtual and cross-cultural environments. The findings support more precise soft skills communication between employees, employers, educators, and students.
Systematising safety: Developing integrated safety management systems in healthcare
Authors: Macrae Carl
Published: February 2025

Background

After several decades of sustained effort, patient safety remains a difficult challenge. A range of policy interventions and organisational activities now focus on patient safety issues, but these are often developed as stand-alone interventions or are implemented in isolation. This contrasts to the approach taken in other safety-critical sectors, where safety is built on carefully organised and tightly integrated safety management systems (SMS) that bring together all the fundamental activities of understanding, implementing, monitoring and improving safety in organisations.

Methods

This article considers the organising principles that underpin SMS in a range of other sectors, and explores and describes the key functions and activities that are of particular relevance to healthcare. Strategies in other safety-critical sectors are reviewed, emerging thinking in healthcare is described and the relevance of policy and legislation are considered.

Results

SMS are the foundation of safety in sectors from aviation to food production, but healthcare does not yet have a well-specified and widely shared view on what constitute the fundamental principles, activities and functions necessary to support integrated systems of safety management. This critical issue is increasingly being recognised by national health agencies, and the journey towards developing integrated SMS in healthcare represents the next phase in the systemic improvement of patient safety.

Conclusion

The development of healthcare SMS can be informed by the experiences of safety-critical sectors that have travelled this path before; by emerging thinking and exploration in healthcare organisations; and by revisiting the legislative and policy context that shapes patient safety.
Patient leadership and partnerships accelerate therapies for SCN8A and other developmental and epileptic encephalopathies
Authors: Conecker Gabrielle , Hecker JayEtta , Hammer Michael F.
Published: February 2025

Families are a driving force in accelerating the understanding and science of SCN8A. The urgency felt by families facing the absence of treatments for their children makes them uniquely positioned to advance therapies through advocacy, data sharing, and partnerships. The International SCN8A Alliance (Alliance) brings families together to collaborate on advancing the science of SCN8A. The Alliance hosts SCN8A scientific meetings – facilitating coordination and collaboration among clinicians, researchers, industry, and the SCN8A community; funds early investigators to support research – building a new generation of investigators; builds and maintains a robust and dedicated International SCN8A Registry (Registry) providing longitudinal data on the natural history of the disorder and leading to over two dozen publications; cultivates partnerships with key stakeholders to accelerate innovation and progress including a Research Consortium, Global Clinicians Network, and the first global Consensus on the Diagnosis and Treatment of SCN8A; coordinates global community engagement by hosting families in virtual meetings in multiple languages and uniting advocates from across all epilepsies to call for more strategic and expanded investment in the epilepsies; builds and hosts the Global SCN8A Leaders Alliance ( Leaders Alliance) promoting coordination and collaboration among leaders of SCN8A organizations worldwide; and advances a Global SCN8A Research Roadmap ( Research Roadmap) – convening leading stakeholders in the SCN8A community to identify research priorities and accelerate progress toward better care, treatments, and outcomes. The outsized impact of small family advocacy organizations demonstrates that patient advocates can be effective agents in accelerating new therapeutics through maximizing their power to convene diverse stakeholders around a shared vision grounded in patient/caregiver priorities, maintaining a core focus on improving outcomes that are most important to families, and recognizing the importance of being bold, thinking big, and collaborating across disease areas.
The Ross Procedure in Adults
Authors: Laurin Charles , Notenboom Maximiliaan L. , Chen Lilyanne , Williams Elbert E. , El-Hamamsy Ismail
Published: February 2025

The ideal aortic valve substitute in adults remains a matter of intense debate. With the advent of transcatheter procedures, the concept of lifetime management of aortic valve disease has gained further momentum. The Ross procedure represents the only replacement option that ensures long-term viability of the aortic valve substitute. This provides unique biological and hemodynamic benefits, which have translated into clinically relevant benefits for patients. In recent years, better understanding of the technical nuances of the operation and recognition of the importance of surgical expertise have further improved outcomes. The current review provides a comprehensive examination of the current role of the Ross procedure in adults in contemporary practice, including indications, technical elements and special considerations.