bluuebunny/crossref_metadata_2025 huggingface dataset:
A review of single stage and multistage power converters for doubly fed induction generator integrated with power grid
Authors: Soomro Mansoor , Memon Zubair Ahmed , Kumar Mahesh , Baloch Mazhar Hussain , Hussain Mirjat Nayyar , Kumar Laveet
Published: August 2024

The doubly fed induction generator (DFIG) is the most popular induction generator for onshore wind energy conversion system (WECS). Therefore, the purpose of research is to optimize power transfer from DFIG to power grid which requires frequency and voltage stability in power converters. Hence, the single-stage and multistage power converter topologies associated with grid-integrated DFIG are thoroughly examined in this work. In the single stage, a matrix converter and cycloconverter are used. Whereas, the multistage topologies include two-level back-to-back (2L-B2B) converter, Z-source converter, and multilevel converters. Furthermore, three-level neutral point clamped (3L-NPC) voltage source converters with battery energy storage systems (BESS) and modified superconducting fractional order terminal sliding mode controllers (MSTFOTSMC) have been used with multilevel converter both at rotor side converter (RSC) and grid side converter (GSC) for stabilized generated voltage and higher power output. The MATLAB simulation results demonstrate that the system effectively controls fluctuations in voltage and current thereby improving the power quality in unbalanced situations.
Can Geopolymer Be a Replacement for Portland Cement in Full-Depth Reclamation Projects? Short- and Long-Term Performance Analysis
Authors: Sachdeva Abhitesh , R.N G.D. Ransinchung , Kumar Praveen , Khan Meraj Alam
Published: August 2024

The fundamental concern of the full-depth reclamation (FDR) technique using Portland cement (FDR-PC) lies in its detrimental effect on the environment. Therefore, researchers are exploring alternative binders that are comparatively greener but compatible with FDR. This study evaluates both the strength and durability aspects of FDR incorporating geopolymer binder (FDR-GP) as an alternative to conventional FDR-PC. Various blends of fly ash (FA) and ground granulated blast furnace slag (GGBS) have been experimented with as geopolymer pre-cursors, ensuring that the additive content does not exceed 20% by weight of the total mix. Sodium hydroxide (NaOH) was utilized for the alkalinization in varying molarities to enhance the performance of the mixes. The experimental design was formulated to achieve a target 7-day unconfined compressive strength (UCS) strength of 4.95 MPa. This was obtained at a lower molarity (M) of 2 M and a 70% FA, 30% GGBS binder content. The mixes performed satisfactorily in both compression and flexure, along with excellent durability properties analyzed through wetting and drying tests. Furthermore, the long-term performance of FDR-GP mixes was investigated with regard to both UCS and flexural strength after 56, 161, and 238 days of curing. Thereafter, a comprehensive microstructural analysis was conducted to understand the fundamental changes in the matrix that influence mix performance. The outcome of this research confirms the potential of using FA/GGBS-based geopolymer as an alternative binder in FDR projects of flexible pavement, the mechanical and durability properties of which adequately satisfy the requirements as stipulated in various design standards.
The Effectiveness of Leukocyte-Poor Platelet-Rich Plasma Injections for Symptomatic Mild to Moderate Osteoarthritis of the Knee With Joint Effusion or Bone Marrow Lesions in a Japanese Population: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial
Authors: Yoshioka Tomokazu , Arai Norihito , Sugaya Hisashi , Taniguchi Yu , Kanamori Akihiro , Gosho Masahiko , Okuno Kosuke , Kikuchi Naoya , Hyodo Kojiro , Aoto Katsuya , Yamazaki Masashi
Published: August 2024

Background:

Intra-articular platelet-rich plasma (PRP) injections have been proposed for the treatment of knee osteoarthritis (OA); however, their effectiveness in Japanese patients remains unclear.

Purpose:

To investigate whether 3 intra-articular injections of leukocyte-poor PRP (LP-PRP) improve symptoms and joint function in symptomatic Japanese patients with mild to moderate knee OA.

Study Design:

Randomized controlled trial; Level of evidence, 1.

Methods:

Of 72 patients screened, 30 were included and randomized to receive LP-PRP (n = 15) or saline (placebo; n = 15) injections between March 2019 and February 2023. Patients attended a screening visit and 3 treatment visits at 1 week apart, followed by 3 follow-up visits (at 4, 12, and 24 weeks) after the initial treatment visit. The primary efficacy outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, whereas the secondary efficacy outcome measures were the proportion of patients showing a visual analog scale (VAS) improvement of ≥50%. Magnetic resonance imaging was performed to evaluate joint effusion and bone marrow lesions using the Whole-Organ Magnetic Resonance Imaging Score. Patients were followed for 24 weeks.

Results:

Patients in the PRP group (mean age, 65.9 years) had a mean hip-knee-ankle angle of 5.1°, with 7 and 8 patients demonstrating Kellgren-Lawrence grade 2 and 3 knee OA, respectively. Patients in the placebo group (mean age, 67.9 years) had a mean hip-knee-ankle angle of 3.8°, with 6 and 9 patients showing Kellgren-Lawrence grade 2 and 3 knee OA, respectively. No significant differences were identified in any baseline factors. The percentage change in Western Ontario and McMaster Universities Osteoarthritis Index scores from baseline to 24 weeks was significantly different (P= .032) between the PRP (median, 75.9%; quantile 1 [Q1], 49.6; quantile 3 [Q3], 94.1]) and placebo (median, 27.7%; Q1, –9.4; Q3, 80.9]) groups. Overall, 73.3% and 28.6% of the PRP group and placebo group, respectively, exhibited an improvement in visual analog scale scores of ≥50%, with a significant improvement observed in the PRP group ( P = .027). Changes in bone marrow lesions from baseline to 24 weeks, as assessed on magnetic resonance imaging, significantly differed between groups ( P = .017), with no significant differences in other secondary endpoints.

Conclusion:

In Japanese patients with knee OA, 3 intra-articular LP-PRP injections led to clinical improvements at 24-week follow-up and significant functional improvements and pain relief after 24 weeks.
Vascular refilling in hemodialysis using feedback-controlled ultrafiltration profile
Authors: Broszeit Stefanie , Kron Joachim , Leimbach Til , Volkenandt John , Kron Susanne
Published: August 2024

Background:

The rate and the duration of ultrafiltration (UF) are considered the most important factors to affect vascular refilling. The aim of the study was to investigate whether a UF profile could improve the vascular refilling.

Methods:

Dialysis was delivered by a machine providing feedback control of ultrafiltration rates. Absolute blood volume (BV) was measured by dialysate bolus method. Vascular refilling volume ( Vref) was calculated as UF volume – Δ absolute BV.

Results:

In 40 patients, refilling fraction ( Vref/UF volume) was 30.5% in the first hour. Thereafter, refilling fraction steeply increased and reached maximum values in the third and fourth hour at about 95%. The cumulative refilling fraction was 68.5 ± 9.4% at the end. In 14 patients, refilling data from the feedback-controlled UF profile were compared to dialysis sessions with constant UF rates. In 12 of 14 patients, refilling fraction was significantly ( p = 0.013) higher in sessions with UF profile (71.6% vs 64.4%). There was a significant negative correlation ( r = -0.606; p = 0.002) between the blood volume to extracellular volume ratio and the refilling fraction. The sum of this ratio and the refilling fraction was 1.01 ± 0.06.

Conclusions:

Despite significant differences, a feedback-controlled UF profile has no advantage over the previous refilling studies with regard to the refilling fraction because vascular refilling seems to depend mainly on the ratio of BV to ECV. This would explain the different results in studies using BV guided UF feedback programs.
Energy poverty measurement and determinants in rural China: Does education inequality matter?
Authors: Wang Fu , Zha Donglan , Geng Hong , Zhang Chaoqun
Published: August 2024

Due to the pressing need to attain sustainable development goal 7, global attention on addressing energy poverty has increased. Improving rural education has been recognized as a strategy to mitigate energy poverty in rural China. However, the presence of education inequality remains a substantial challenge to energy poverty alleviation and underexamined. Our research aims to evaluate rural energy poverty levels systematically and investigate the impact of education inequality on rural energy poverty. This study begins by employing a novel weighting approach to develop a comprehensive indicator system, which accurately measures the extent of energy poverty in rural China. Subsequently, a panel fixed-effects model is utilized to analyze the causal impact of education inequality on rural energy poverty. Furthermore, the study explores the heterogeneity and potential mechanisms of education inequality on rural energy poverty. Findings reveal a decline in rural energy poverty from 2005 to 2020, and the nature of energy poverty has substantially transformed, with a greater prominence of using unclean and unaffordable energy sources. Education inequality increases rural energy poverty and indirectly affects it by reducing the income of rural residents. The influence of education inequality on rural energy poverty exhibits heterogeneity in both time and region. Policy recommendations are proposed for mitigating energy poverty and promoting education equality in rural areas.
School-Based Suicide Prevention Efforts: The Impact of School Nurse Exclusivity on Moral Distress
Authors: Tyndall Deborah E. , Pestaner Mitzi , Lewis Travis
Published: August 2024

School nurses are well-positioned to assess, identify, and refer children and adolescents who are at risk of suicide. This multiple-case study examined the personal, behavioral, and environmental factors that influence the role of the school nurse in youth suicide prevention and intervention. Purposive sampling was used to recruit two school nurses who were identified as unique cases. Data from interviews, surveys, and documents generated a cross-case analysis. Findings indicate that school-level exclusive practices, such as a lack of communication and collaboration, greatly influence the role and reach of school nurses. Further, dilemmas arising from environmental barriers hinder school nurse capacity to promote student safety and affect moral distress levels. Leveraging data to demonstrate the pivotal role of school nurses to support mental health equity and reduce disparities in youth suicide is crucial to developing inclusive and responsive suicide prevention programs.
On the Internet, No One Knows You’re an Activist: Patterns of Participation and Response in an Online, Opt-in Survey Panel
Authors: Hopkins Daniel J. , Gorton Tori
Published: August 2024

Recent years have seen a dramatic increase in surveys of online respondents who participate absent random selection. Using an uncompensated, opt-in panel of 11,000 Pennsylvanians (2020–2022), we benchmark self-reports against vote histories, campaign contributions, election returns, and Census data. Ours is among the first such benchmarking exercises in more than a decade, a period when online survey research has transformed. It is also among the first analyzing a longitudinal panel. Our panelists are approximately balanced on partisanship; attrition is limited. Notably, respondents are very politically engaged, with high rates of turnout, campaign contributions, and rally attendance. Ethnic/racial minorities are under-represented. Political attitudes show high over-time stability, and an experiment uncovers few partisan differences in response rates. Such survey samples are cost-effective ways to track the views of highly engaged citizens over time, but less engaged citizens prove hard to recruit, even with supplemental efforts. Survey participation is itself a political behavior.
Lullabies and Universality: An Ethnographic Review
Authors: Aubinet Stéphane
Published: August 2024

Lullabies are commonly described as a universal musical genre among humans and a likely source of insights into the origins of music. This study explores the validity of these claims through a critical analysis of the ethnographic literature, starting with a literature review based on the Standard Cross-Cultural Sample. Lullabies emerged as a “near universal” when defined broadly as any type of singing used to soothe children, but neither as a “near universal” nor a “statistical universal” when defined strictly as a specific category of infant-directed songs. As Indigenous Peoples from America presented more societies with few or no lullabies than other regions did, a second review focused on this area was conducted, highlighting three cases: (1) the absence of lullabies among certain Native American communities, (2) the historical diffusion of repertoires in the Circumpolar North, and (3) cross-cultural convergences and entanglements between musical genres on the Pacific Northwest Coast (complemented with corresponding examples from Polynesia). In conclusion, while the act of singing to soothe children is a near universal, it also presents significant cross-cultural variability. Perspectives for future research are discussed.
Monkeypox-related ophthalmic disease (MPXROD): Monitoring the antiviral effect of tecovirimat with monkeypox virus detection in tear samples
Authors: Mitsios Andreas , Florou Zoi , Dastiridou Anna , Pavlaki Maria , Androudi Sofia
Published: August 2024

Introduction

Although monkeypox-related ophthalmic disease (MPXROD) is rare, visual impairing complications have been reported. At present, tecovirimat is the standard-of-care antiviral treatment. In this MPXROD case, the effect of tecovirimat was assessed with PCR analysis of tear samples and concurrent monitoring of inflammation with laser flare photometry (LFP).

Case description

The patient presented with a palpebral lesion and a corneal ulcer in his right eye, with complete absence of the corneal epithelium, high intraocular pressure and anterior uveitis. MPXV-DNA was detected in tear samples with real-time PCR (RT-PCR). A total volume of 0.5 ml tear-wash was aspirated from the inferior fornix, following instillation of saline onto the ocular surface. In addition, LFP was used to quantify inflammation in both eyes. Viral load in tear samples was detected prior to treatment initiation. In the left eye, tear samples tested negative for MPXV-DNA one week post-treatment while MPXV-DNA was still detected in the right eye, before reaching undetectable levels four weeks post-treatment. Objective quantification of anterior chamber inflammation through LFP demonstrated gradual decrease that was more pronounced in the affected right eye and coincided with the clinical improvement of the corneal ulcer.

Conclusions

This case of Mpox related corneal ulcer with associated uveitis manifests the feasibility of monitoring the antiviral effect of tecovirimat with virus detection in tear samples and LFP. Our observations indicate that tecovirimat resulted in viral load reduction in both eyes. RT-PCR MPXV detection in tear samples and LFP represent noninvasive tools that could assist with treatment response monitoring.
Construction and validation of a scale to assess knowledge, attitude, and practice regarding vascular protection anticipatory to the creation of an arteriovenous fistula
Authors: Luo Yan , Wang Fang , Duan Difei , Li Rao , Yang Xiaoling , Ma Dengyan , Yuan Li
Published: August 2024

Background:

The possibility of creating an arteriovenous fistula (AVF) depends on the existence of an arterial–venous network that is in good condition, defined by the size and elasticity of the blood vessels. The knowledge, attitudes, and practices (KAP) toward vascular protection play a crucial role in preserving the vascular network for patients with end-stage renal disease (ESRD), it is observed that there is a significant lack of tools to measure these variables. Thus, the aim of this study is to develop and validate a scale to assess KAP regarding vascular protection anticipatory to the creation of an arteriovenous fistula (the KAP-VPAC-AVF Scale).

Methods:

Initial item development was guided by a literature review and clinical experience, after which the items were improved and perfected through the Delphi process. The content of the scale was judged by an expert panel for content validity. In a convenience sample of 551 patients with ESRD, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to examine the instrument’s factor structure.

Results:

The KAP-VPAC-AVF Scale encompasses 11 items distributed over three factors: knowledge, attitude, and practice, demonstrated excellent internal consistency (Cronbach’s alpha = 0.917) and construct validity, as confirmed by CFA with satisfactory fit indices (χ2/ df = 2.394, RMSEA = 0.075, RMR = 0.049, CFI = 0.969, GFI = 0.936, AGFI = 0.892, TLI = 0.957, IFI = 0.970).

Conclusion:

The KAP-VPAC-AVF Scale is a scientific and effective assessment tool that can evaluate the KAP of ESRD patients regarding measures to preserve the vascular network.
Ultrasound-guided nitinol stent implantation to treat early restenosis of arteriovenous fistula: A 69-case study with 1-year outcome
Authors: Zheng Xuan , Xi Weiwei , Shen Xiang , Li Hua , Huang Yibiao , Lu Mingxi
Published: August 2024

Background:

To investigate the feasibility, methods and effects of interventional ultrasound in nitinol stent implantation to treat early restenosis after percutaneous transluminal angioplasty (PTA) in autogenous arteriovenous fistula (AVF).

Methods:

From April 2018 to December 2021, 69 patients with early restenosis of AVF received ultrasound-guided nitinol stent implantation (UNSI) and were followed-up. Imaging features of the stent and procedure by ultrasound were observed. The technical success rate, clinical success rate and incidence of complications were recorded and counted. Target lesion primary patency (TLPP), access circuit primary patency (ACPP) and access circuit secondary patency (ACSP) were estimated.

Results:

Ultrasonography can show the structure of the stent and guide the stenting process clearly. Both the technical and clinical success rates were 100%. Thirty-one patients had in-stent restenosis (ISR), which was treated by plain balloon (PB) PTA or drug coated balloon (DCB) PTA. The TLPP at 3, 6, 12 and 24 months were 100.0%, 94.2%, 63.4% and 39.6%, respectively. The ACPP at 3, 6, 12 and 24 months were 98.6%, 91.6%, 60.2% and 35.2%, respectively. The ACSP at 3, 6, 12 and 24 months were 98.6%, 98.6%, 95.6% and 93.8%, respectively. The TLPP of ISR after DCB PTA at 3, 6 and 12 months were 100.0%, 100.0% and 93.6%, respectively.

Conclusions:

This pilot study indicates ultrasonography can accurately guide nitinol stent implantation in AVF and this technique is a feasible and minimally invasive treatment for early restenosis after PTA with good short- and medium-term patency. DCB PTA may be used to deal with the ISR and is a way to prolong the patency of nitinol stent.
Bridge to security: Exploring unemployment insurance for solo self-employed in Estonia
Authors: Vallistu Johanna
Published: August 2024

The COVID-19 crisis highlighted the need for better access to unemployment insurance, particularly for solo self-employed workers. Traditionally seen as entrepreneurs bearing their own risks, the line between employment and entrepreneurship for solo self-employed has blurred, raising questions about adequate social protection. This shift is largely attributed to the rise of platform work, often linked with dependent self-employment and a precarious social security landscape for workers. In Estonia, where solo self-employment is increasingly common, access to unemployment insurance and the level of protection depends on the workers’ awareness and intent, as well as the approach adopted by task-mediating platforms in the case of platform workers. While the self-employed, including platform workers, can access insurance by opting for certain legal forms of work and making regular contributions, effective access remains limited. Low and irregular income poses eligibility challenges, and certain legal forms of self-employment can hinder access to benefits, despite eligibility through other means. In the long run, these challenges could undermine the sustainability of Estonia's social security system, emphasising the critical need for comprehensive reforms to ensure equitable access to unemployment insurance for all self-employed individuals, including those engaged in platform work.
‘Does this hurt?’: feminism, pain and the problem of reification
Authors: Cattien Jana
Published: August 2024

Feminist debates around sex have often revolved around the vexed question of whether women can achieve genuine pleasure under patriarchy. Some ‘sex-negative’ feminists have claimed that the entire debate around ‘pleasure under patriarchy’ rests on an ontological mistake: when women say that they experience sexual pleasure with men, what they mean by ‘pleasure’ is actually pain. On this view, pain is assumed to have an objective existence regardless of whatever the subject is experiencing. Positing such a gap between ‘feeling pain’ as a subjective state of affairs and ‘being in pain’ as an objective fact presupposes a ‘detectivist’ theory of subjectivity, whereby the subject is taken to relate to her pain as a reified object. Examining how detectivism has haunted different feminist traditions – from 1970s feminist consciousness-raising and MacKinnon's anti-sex feminism, to contemporary feminist critiques of liberal consent – I argue that a detectivist theory of subjectivity limits the critical horizon of a feminist politics of pain: it ends up politicising marginalised pain only at the cost of falsifying the subjective nature of pain itself.
Using Orthodromic Distance to Determine Homefield Advantage in Professional Bass Fishing Tournaments
Authors: Settlage Daniel M. , Settlage Madison E.
Published: August 2024

The home team is widely viewed as having an advantage in most team sports. Individual sports are less inclined to have homefield advantage, since they are contested on neutral sites with contestants from a wide variety of locales. Bass fishing differs from most individual sports as the venue fished is governed by local biological and climatological variation. Thus, there may be a homefield advantage that accrues to anglers living close to the venue where the tournament is held. In this paper we examine angler performance in the two premier bass fishing tournaments in the U.S.: the Bassmaster Elite Series and Major League Fishing's Bass Pro Tour. We find that angler performance in both tournaments is related to characteristics that measure experience, aptitude, and past success. In addition, we find evidence that angler performance suffers as distance to the lake increases, and this result holds after controlling for other angler characteristics.
Initial Experience With Ultra-High-Definition 3D Exoscope in Thyroid and Parathyroid Surgery
Authors: Bernes Steen , Lilja-Fischer Jacob , Petersen Niels Krintel , Udholm Nichlas , Reinholdt Kasper Basse , Londero Stefano , Kjærgaard Thomas , Rolighed Lars
Published: August 2024

Background

Operation with a 3D exoscope has recently been introduced in clinical practice. The exoscope consists of two cameras placed in front of the operative field. Images are shown on a large 3D screen with high resolution. The system can be used to enhance precise dissection and provides new possibilities for improved ergonomics, fluorescence, and other optical-guided modalities.

Methods

Initial experience with the ultra-high-definition (4K) 3D exoscope in thyroid and parathyroid operations. The exoscope (OrbEyeTM) was mounted on a holding system (Olympus).

Results

We used the exoscope in parathyroidectomy (N = 6) and thyroidectomy (N = 6). Immediate advantages and disadvantages were discussed and recorded. The learning curve for use of the exoscope may be shorter for surgeons with training in endoscopic or robotic procedures. There may be improved ergonomics compared with normal open-neck operations. Further, the optical guided operations can be used with fluorescence and have potential for different on-lay techniques in the future. The 4 K 3D image quality is state-of-art and is highly appreciated during fine surgical dissection and eliminates the need for loupes.

Conclusion

In several ways, using the ORBEYE™ in thyroid and parathyroid surgery provides the surgical team with a new and enhanced experience. This includes improved possibility for teaching, surgical ergonomics, and a 4K 3D camera with a powerful magnification system. However, it is not clear if utilization of these features would improve surgical outcomes. Furthermore, the ORBEYE™ lacks incorporation of parathyroid autofluorescence, and the current costs for the system do not facilitate general access to exoscope assisted operations.
Montenegrins in the Ottoman Empire as ‘Enemy Aliens’ during World War I (1914–1918)
Authors: Özcan Uğur
Published: August 2024

With the outbreak of World War I in 1914, the Ottoman Empire and Montenegro, which no longer shared a border due to the shifted territories following the Balkan Wars (1912–13), faced each other as belligerents in two different coalitions (the Entente and the Central powers). Throughout this process, Montenegrin citizens, both Muslim and non-Muslim, living in the Ottoman territories and working in various fields, suddenly found themselves as enemy subjects. This article analyses what it was like for Montenegrins living in the Ottoman territory during the war by assessing their legal status, naturalisation, internment and the security measures taken against them. In the light of Ottoman archival documents and within the framework of the concept of enemy aliens, this article examines just how the war affected these forgotten citizens of Montenegro – who have long been overlooked and overshadowed in scholarly works by the subjects of the Great Powers – and how the Ottoman administration treated them in the context of state security.
Type synthesis of 3-DOF spherical hybrid mechanisms with fixed centers of rotation
Authors: Shi Shuyang , Li Kai , Ma Zheng , Wang Huiqiang , Qiu Xuesong , Zhou Yulin
Published: August 2024

To improve the load-bearing capacity and the rotation range about the normal of the moving platform in a spherical parallel mechanism (SPM), a type synthesis method for spherical hybrid mechanisms (SHMs) with fixed centers of rotation is proposed by coupling a serial transmission chain with the central passive limb chain of the SPM near its center area. Based on the analysis of the spherical mechanism configuration’s research status with a fixed rotation center, a method for systematically synthesizing SHMs is given, and four types of limb chains are developed. The possible limb constraint systems provided by each type of limb chain are analyzed via screw theory, and the type synthesis of each type of limb chain is carried out. Screening rules are proposed to obtain the preferred limb chains from the limb chain configuration results. By selecting and permuting preferred limb chains based on the mechanism’s center position of rotation and the constraint type, a series of SHMs that rotate unrestricted about the normal of the moving platform are produced. Selecting the RBR-2RRR SHM as an example, its workspace, singularity, dexterity, and stiffness are analyzed to verify the effectiveness of the research. This work enriches the configuration types of SHMs and provides theoretical support for the design and applications of SHMs in engineering.
Being, exploring, and playing outdoors: Young children philosophize through Sámi pedagogical imagination and storytelling
Authors: Jannok Nutti Ylva , Johansson Viktor M.
Published: August 2024

This article discusses the pedagogical role of the imagination and forms of life in Sámi early childhood education. Following Nergård’s development of Wittgenstein’s notion “form of life” as an imaginative, pedagogical, and anthropological concept, the article will explore how Sámi children both use and transform forms of life in Sámi early childhood centers. The article explores scenes from a day spent outdoors with early childhood educators and children. The aim is to show how young Sámi children philosophize and articulate their world, and how listening to the children can be a decolonizing practice that challenges colonial assumptions in pedagogy, philosophy and society. The empirical data was collected through a pilot project and the subsequent project Sámi Children as Thought Herders. The data material contains photos, short films, sound records, and notes collected through ethnographic fieldwork conceived as Critical Utopian Action Research, which takes into account the social learning of all participants, here specifically the children, the educators and the researchers. Thus, these are spaces for a joint critique that resists colonially structured practices. The main findings are that, during outdoor activities, educators and children imaginatively perform, play and encounter outdoor spaces and aspects of Sámi forms of life. This is explored on the basis of scenes where young children imaginatively engaged with the forest environment. The educators’ storytelling and the storytelling tradition continued into the children’s own storytelling. The children created stories about a Stállo who lives in a rusty oil barrel they found in the forest, making traditional stories and forms of life come alive and transforming them. In reflecting upon these scenes, we argue for the pedagogical, performative, and philosophical importance of engaging with the ways that children’s imaginative play interacts with place.
Assessment of the Correlation Between Serum Phosphate Level and Muscle Strength as Measured by Handgrip Strength in Patients Treated With Hemodialysis
Authors: Ben-Noach Dror , Levy Dina , Raz Michal , Anbar Ronit , Schwartz Doron , Kliuk-Ben Bassat Orit
Published: August 2024

Background:

Sarcopenia, commonly observed in patients treated with hemodialysis, correlates with low serum phosphate levels. Although normophosphatemia is desired, dietary phosphate restriction is difficult to achieve and may result in undesirable protein restriction.

Objective:

We aimed to evaluate whether hyperphosphatemia is associated with higher muscle strength in patients receiving hemodialysis treatment.

Design:

A single-center prospective observational study.

Setting:

Ambulatory prevalent patients undergoing hemodialysis treatments in a dialysis unit of a tertiary hospital.

Patients:

Participants included prevalent patients treated with hemodialysis. All patients were above 18 years. Only patients with residual kidney function below 200 mL/24 hours were included to avoid bias.

Measurements:

Muscle strength was measured by handgrip strength (HGS). Each patient repeated 3 measurements, and the highest value was recorded. Handgrip strength cutoffs for low muscle strength were defined as <27 kg in men and <16 kg in women. Biochemical parameters, including serum phosphate level, were driven from routine monthly blood tests. Hyperphosphatemia was defined as serum phosphate above 4.5 mg/dL.

Methods:

Handgrip strength results were compared to nutritional, anthropometric, and biochemical parameters—in particular phosphate level. Long-term mortality was recorded.

Results:

Seventy-four patients were included in the final analysis. Handgrip strength was abnormally low in 33 patients (44.5%). Patients with abnormal HGS were older and more likely to have diabetes mellitus and lower albumin and creatinine levels. There was no correlation between HGS and phosphate level ( r = 0.008, P = .945). On multivariable analysis, predictors of higher HGS were body mass index and creatinine. Diabetes mellitus and female sex predicted lower HGS. Hyperphosphatemia correlated with protein catabolic rate, blood urea nitrogen, and creatinine. On multivariable analysis, predictors of hyperphosphatemia were higher creatinine level, normal albumin level, and heart failure. During mean follow-up time of 7.66 ± 3.9 months, 11 patients died. Mortality was significantly higher in patients with abnormally low HGS compared with normal HGS (odds ratio = 9.32, P = .02).

Limitations:

A single-center study. All measurements were performed at one time point without repeated assessments. Direct dietary intake, degree of physical activity, and medication compliance were not assessed.

Conclusion:

Hyperphosphatemia correlated with increased protein intake as assessed by protein catabolic rate in patients treated with hemodialysis; however, neither correlated with higher muscle strength as measured by HGS. Trial registration: MOH 202125213
Research on the Effect of Corporate Environmental Responsibility on Corporate Sustainability and the Mediator Effect of Corporate Environmental Strategy
Authors: Wang Qinghai , Li Gaoyong
Published: August 2024

Corporate sustainability development has emerged as a significant concern globally. However, there is an inherent conflict between the corporate’s goals of maximization of profit and achievement of sustainable development. The increasing environmental responsibility offers a solution to reconcile this contradiction. Therefore, this paper aims to empirically investigate the influence of corporate environmental responsibility on corporate sustainable development and the mediator effect of corporate environmental strategy based on the nature of strategy that it can transform temporary and one-sided-focused activities into chronical and holistic actions. The study conducted two stages of data collection, gathering a total of 324 data sets from China in 2022, which were subsequently analyzed. The findings demonstrate that corporate environmental responsibility has a significant positive impact on corporate sustainable development, with corporate environmental strategy playing a crucial intermediary role. And this research offers theoretical contribution by extending literature on sustainable development and provides significant managerial implications.
Assessing climate change vulnerability: A village level analysis of the Indian west coast
Authors: Kasthala Sindhuja , Devanathan Parthasarathy , Krishnan Narayanan , Inamdar Arun B. , Punyamoorty Vineet
Published: August 2024

The Indian west coast is under constant threat from climate change-induced hazards. Various social, economic, and infrastructural disparities along the coast cause significant variations in climate vulnerability. Current literature assesses vulnerability either over (1) a large area with poor spatial resolution or (2) a local area with better spatial resolution. The former assessments provide more comprehensive and broad insights into large spatial trends of vulnerability, while the latter provide more accurate and specific inputs needed by the local governments for effective intervention. However, there is a lack of studies that assess vulnerability simultaneously at a high-resolution and over a large geographic area, due to inadequacies in existing methodologies and difficulty in data management and analysis. This is a key gap that we address in our paper. We assess climate vulnerability of the entire Indian west coast at the village level, and propose a novel machine-learning based methodology tailored for high-resolution assessment over large geographic areas. This helped us produce the first high-resolution (i.e. village-level) climate vulnerability map of the entire Indian west coast. We found that the state of Maharashtra has the highest number of vulnerable villages and the state of Kerala has the least number of vulnerable villages. We collate and utilize a large dataset of 112 indicators describing socioeconomic characteristics, infrastructure and availability of financial services, among other aspects, to obtain a comprehensive picture of vulnerability. We analyze geospatial trends and attribute high vulnerability to specific indicators, which will help in effective decision-making at the village level.
Advancing Equity in Health Care Among Dalits and Tribal People in India: The Progress, Current Realities, and the Way Forward
Authors: Kuttiatt Vijesh Sreedhar , Rahul Arya , Choolayil Anoop , Kumar Ashwani
Published: August 2024

The caste system and resulting social exclusion are important social determinants of health inequity in India. This article critically analyzes the influence of the caste system on health inequity in India, starting with a historical perspective and moving to the current status. The article argues that the caste system has deprived Dalits and tribal people in India of achieving health equity. The programs to promote health are often disease-specific and not culturally informed, leading to poor attention at the policy level to the intersecting disadvantages that make Dalits and tribal communities vulnerable, resulting in poor health. The authors suggest strengthening and promoting primary care, improving health access for Dalit and tribal populations, and the need for pivotal changes in the medical education system, shifting the emphasis from specialized care to training family physicians to be oriented toward community health needs, keeping health equity in perspective.
Clinical manifestations and immune markers of non-HIV-related CMV retinitis
Authors: Passarin Olga , Hoogewoud Florence , Manuel Oriol , Guex-Crosier Yan
Published: August 2024

Background

Since the HIV epidemic in the 1980s, CMV retinitis has been mainly reported in this context. CMV retinitis in persons living with HIV is usually observed when CD4 + cells are below 50 cells/mm3. This study aims to describe the immune markers of non-HIV-related CMV retinitis as well as to describe its clinical manifestations and outcomes.

Methods

Retrospective chart review of consecutive patients with CMV retinitis not related to HIV seen at the uveitis clinic of Jules Gonin Eye Hospital between 2000 and 2023. We reported the clinical manifestations and outcomes of the patients. We additionally assessed immune markers during CMV retinitis (leukocyte, lymphocyte, CD4 + cell and CD8 + cell counts as well as immunoglobulin levels).

Results

Fifteen patients (22 eyes) were included. Underlying disease was hematologic malignancy in 9 patients, solid organ transplant in 3 patients, rheumatic disease in 2 patients and thymoma in one patient. The median time between the onset of underlying disease and the diagnosis of retinitis was 4.8 years. Lymphopenia was observed in 8/15 patients (mild = 3, moderate = 4, severe = 1), and low CD4 counts were observed in 9/12 patients, with less than 100 cells/mm3 in 4 patients. Hypogammaglobulinemia was detected in 7/11 patients. Retinitis was bilateral in 7/15 patients, and severe visual loss was frequent (5/19 eyes). Disease recurrence was seen in 7/13 patients at a median time of 6 months after initial diagnosis. No differences in immune markers were observed in patients with vs. without recurrence.

Conclusion

CMV retinitis is a rare disorder that can affect patients suffering any kind of immunodeficiency. It is associated with a high visual morbidity despite adequate treatment. CD4 + cell counts are usually higher than those in HIV patients, but B-cell dysfunction is common.
Starting continuous improvement; creating a common understanding of stroke care delivery in a general hospital
Authors: Fjermeros Are , Berg Geir Vegard , Holtskog Halvor , Benders Jos
Published: August 2024

Background

Continuous improvement is based on fostering practitioners’ suggestions to modify their own work processes This improvement strategy is widely applied in healthcare but difficult to maintain. The cross-disciplinary nature of many care processes constitutes an extra impediment.

Methods

The study had an explorative design with a qualitative single-case approach. The case presents a project to improve the treatment of patients with thrombotic stroke. Data was obtained via hands on involvement, documents, observations, and interviews with participants in a cross-functional improvement group. A thematic analysis method was employed.

Results

Through learning how tasks were carried out in other disciplines, the participants developed a common understanding of why it took so long to provide treatment to stroke patients. These insights were used to implement practical changes, leading to immediate improvements in stroke care delivery. The results were fed back so that successes became visible. Participants’ understandings of the local context enabled them to convince peers of the rationale of changes, setting in motion a permanent improvement structure. The participants considered that mapping and then assessing the entire workflow across disciplines were relevant methods for improving the quality of patient care.

Conclusion

Starting an improvement project in a cross disciplinary environment requires deep engagement on the part of professionals. A quintessential prerequisite is therefore the realization that the quality of care depends on cross-disciplinary cooperation. A facilitated learning arena needs to (1) create insights into each other’s colleagues’ tasks and process interdependencies, (2) increase understanding of how the distribution of tasks among specialist units affects the quality of care, and (3) frequently report and provide feedback on results to keep the process going.
Enhanced anti-tumor effects by combination of tucatinib and radiation in HER2-overexpressing human cancer cell lines
Authors: Amrell Lukas , Bär Eric , Glasow Annegret , Kortmann Rolf-Dieter , Seidel Clemens , Patties Ina
Published: August 2024

Background

Tucatinib (TUC), a HER2-directed tyrosine kinase inhibitor, is the first targeted drug demonstrating intracranial efficacy and significantly prolonged survival in metastatic HER2-positive breast cancer (BC) patients with brain metastases. Current treatments for brain metastases often include radiotherapy, but little is known about the effects of combination treatment with TUC. Therefore, we examined the combined effects of irradiation and TUC in human HER2-overexpressing BC, non-small cell lung cancer (NSCLC), and colorectal cancer (CRC) cell lines. For the latter two, a standard therapy successfully targeting HER2 is yet to be established.

Methods

Nine HER2-overexpressing (BC: BT474, ZR7530, HCC1954; CRC: LS411N, DLD1, COLO201; NSCLC: DV90, NCI-H1781) and three control cell lines (BC: MCF7, HCC38; NSCLC: NCI-H2030) were examined. WST-1 assay (metabolic activity), BrdU ELISA (proliferation), γH2AX assay (DNA double-strand breaks (DSB), Annexin V assay (apoptosis), and clonogenic assay (clonogenicity) were performed after treatment with TUC and/or irradiation (IR). The relevance of the treatment sequence was analyzed exemplarily.

Results

In BC, combinatorial treatment with TUC and IR significantly decreased metabolic activity, cell proliferation, clonogenicity and enhanced apoptotis compared to IR alone, whereby cell line-specific differences occurred. In the PI3KCA-mutated HCC1954 cell line, addition of alpelisib (ALP) further decreased clonogenicity. TUC delayed the repair of IR-induced DNA damage but did not induce DSB itself. Investigation of treatment sequence indicated a benefit of IR before TUC versus IR after TUC. Also in CRC and NSCLC, the combination led to a stronger inhibition of metabolic activity, proliferation, and clonogenic survival (only in NSCLC) than IR alone, whereby about 10-fold higher concentrations of TUC had to be applied than in BC to induce significant changes.

Conclusion

Our data indicate that combination of TUC and IR could be more effective than single treatment strategies for BC. Thereby, treatment sequence seems to be an important factor. The lower sensitivity to TUC in NSCLC and particularly in CRC (compared to BC) implicates, that tumor promotion there might be less HER2-related. Combination with inhibitors of other driver mutations may aid in overcoming partial TUC resistance. These findings are of high relevance to improve long-time prognosis especially in brain-metastasized situations given the intracranial activity of TUC.
Knowledge, attitude, and perception about Marburg virus in healthcare workers of India
Authors: Mehta Vini , Negi Sapna , Mathur Ankita , Obulareddy Vishnu Teja , Shaik Riyaz Ahamed , Ahmed Mohammed Shakil , Miraj Mohammed
Published: August 2024

Background

The recent Marburg virus outbreaks in Equatorial Guinea and Tanzania in March 2023 have sparked fears about potential worldwide spread. Thus, assessing healthcare workers’ (HCW) knowledge of the disease is critical, particularly in India, where the healthcare system is underfunded and understaffed and already has an immense burden of infectious illnesses.

Methods

We carried out a cross-sectional web-based survey among 300 healthcare workers including doctors, nurses, and pharmacists. The Google survey form was circulated online via email. To recruit participants, a convenience sample technique was utilized. Descriptive and logistic regression was applied to analyse data.

Results

50.9% were aware of Marburg virus disease, and 60.5% had a favourable attitude towards Marburg virus disease (MARVD) control and prevention. Bleeding was cited as the most common clinical symptom of MARVD by 53.3% of participants. Regarding the mode of transmission, 51.6% were aware of how MARVD is spread. Almost all HCWs (99%) claimed they would accept an approved vaccine for themselves, however, the readiness to receive experimental treatments was less certain. The logistic regression model showed gender [female—OR: 2.8 (1.75 to 3.5), p = 0.001] and job roles [pharmacist—OR: 4.1 (2.9 to 7.2), P < 0.001] as predictors of poor KAP about MARVD.

Conclusion

Although there was a high degree of awareness about MARVD, there were notable knowledge gaps and differences in attitudes among healthcare professionals. This underlines the importance of customized training programs for each group to increase healthcare workers’ knowledge of MARVD.
An uncommon encounter: crossed fused renal ectopia with singular ureter: a case report
Authors: Dahal Prajwal , Dawadi Kapil , Tamang Ongden Yonjen , Parajuli Sabina , Dhakal Natasha
Published: August 2024

Background

Crossed fused renal ectopia (CFRE) is a common congenital anomaly where one kidney is positioned abnormally on the opposite side of the midline, often fused with the other kidney. However, single ureter draining crossed fused renal ectopia is a rare occurrence.

Case report

Here, we report a case of crossed fused renal ectopia with a single ureter in a 46-year-old Nepali male who presented with history of lithuria. Computed tomography revealed that the left kidney was situated on the right side and fused with the right kidney. The renal pelvises of both kidneys were fused, and a single ureter, located on the right side, was draining both kidneys into the bladder. The patient was advised to have regular follow-ups.

Conclusion

Crossed fused renal ectopia with a single ureter represents a rare renal anomaly. Asymptomatic patients can typically be managed conservatively. Regular follow-up is recommended to monitor renal function, calculus formation, infections, and malignant changes.