bluuebunny/crossref_metadata_2025 huggingface dataset:
Mental Health Act 1983 assessments: The use of video technology
Authors: Williams John
Published: May 2022

Covid-19 requires practitioners to reflect on how they deliver health services. Using technology, in particular video technology, has increased, especially in primary care. This article considers the implications of technology for assessments under the Mental Health Act 1983. NHS Covid-19 guidance anticipated its use in assessments, but this was held to be unlawful. Is this the right decision or is it too restrictive an interpretation of the 1983 Act? The article argues that consideration should be given to the potential role, if any, of video technology in assessments and identifies some issues that need to be addressed. Use of these technologies should be part of the current review of the 1983 legislation.
Can vaccine adherence against Sars-CoV-2 become a criterion for access to medical care?
Authors: Cioffi Andrea , Cecannecchia Camilla
Published: May 2022

Vaccine hesitancy and anti-vax movements are increasing globally. Covid-19 pandemic has caused and causes emergency situations where available resources do not always meet the need for community care.

In this article, the authors analyse the bioethical and medico-legal implications of the possibility – in conditions of scarcity of resources – of selecting patients who must have access to medical care based on vaccination against Sars-CoV-2.
Standalone photovoltaic and battery microgrid design for rural areas
Authors: Nsengimana Cyprien , Kai Liu , Yuhao Cao , Li Lingling
Published: May 2022

The remote location and many islands in Africa are experiencing a big power shortage and blackouts and they greatly necessitate electric power from standalone photovoltaic microgri­d. In Rwanda, off-grid solar systems are at their infancy level and their affordability for the rural population requires thorough support and incentives. In this process, the Government of Rwanda (GoR) has set a program to subsidize the cost of the system in a rural household power access projects suit to their socio-economic metric known as ‘Ubudehe’ which would determine the required financial support from other poverty reduction programs in a country. The design of a standalone photovoltaic microgrid is aimed to find the cheapest way to go for either a single rural house or a group of 200 rural houses with similar load demand as a long-term solution to their local energy challenges. The models resulted in a Levelized cost of energy, least cost of energy (LCOE) of 1.51US$/kWh for a single home while the LCOE for the group of houses load equals 1.45US$/kWh. The net present cost (NPC) for a single home and multi-user load are respectively equal to 5,625US$ and 1,079,210US$. These results conclude the efficacy of the group sharing load demand model design to provide green energy solutions to the mid-and low-income rural population in Rwanda.
Helping Behavior of Older Adults during the Early COVID-19 Lockdown in Belgium
Authors: Dury Sarah , Brosens Dorien , Pan Honghui , Principi Andrea , Smetcoren An-Sofie , Perek-Białas Jolanta , De Donder Liesbeth
Published: May 2022

This study aimed to understand whether older adults not only received but also provided help during the first COVID-19 lockdown in Belgium, which factors motivated them to help, and whether older adults differed from younger age groups in terms of helping behavior and motives. Bivariate analyses were performed using data generated from an online cross-sectional survey in Belgium ( N = 1892).

The results showed that older adults who received help also provided it. This “interdependence” – mutual or reciprocal dependence – occurred regardless of age. In terms of motives for providing help, both older adults and their younger peers were primarily motivated by present-oriented and emotion-related motivation: older people were motivated to provide help by altruistic values and humanism, and enhancement motives linked to self-development.

Policy implications of these results entail: during crisis situations, make use of the bond between older adults and their neighbors, such as caring communities.
Transfusion policy in pediatric extracorporeal membrane oxygenation patients: Less could be more
Authors: Duarte Catarina Marques , Lopes Maria Inȇs , Abecasis Francisco
Published: May 2022

Objective

To evaluate a restrictive transfusion policy of red blood cells (RBC) and platelets in pediatric patients submitted to extracorporeal membrane oxygenation (ECMO).

Methods

Retrospective descriptive study of pediatric patients supported with ECMO, from January 2010 to December 2019. Hemoglobin, platelet, lactate and mixed venous oxygen saturation (SvO2) values of each patient while on ECMO, were collected. Transfusion efficiency and tissue oxygenation were statistically evaluated comparing pre-transfusion hemoglobin, lactate and SvO2 with post-transfusion values. Ranges of hemoglobin and platelets were established, and the number of transfusions registered. The bleeding complications and outcome were documented.

Results

Of a total of 1016 hemoglobin values, the mean value before transfusion was 8.6 g/dl. Hemoglobin and SvO2 increased significantly post-transfusion. Red blood cell transfusion varied with hemoglobin values: when hemoglobin value was less than 7 g/dl, 89% (41/46) were transfused but just 23% (181/794) when greater or equal to 7 g/dl. In the presence of active bleeding, the frequency of RBC transfusion increased from 32% to 62%, with hemoglobin between 7 g/dl and 8 g/dl. The mean value for platelet transfusion was 32 x 109/L. Thirty-eight (43%) platelet values between 20 x 109/L and 30x109/L, and 31 (40%) between 30 x 109/L and 40 x 109/L led to platelet transfusion; between 40 x 109/L and 50 x 109/L, only 7 (9%) prompted platelet transfusion. Comparing the 2010–2015 to 2016–2019 periods there was a decrease in RBC and platelet transfusion threshold with similar survival ( p = .528). Survival to discharge was 68%.

Conclusions

Using a restrictive RBC and platelet transfusion policy was safe and allowed a good outcome in this case series. The presence of active bleeding was an important decision factor when hemoglobin was above 7 g/dl and platelets were above 30 x 109/L.
Implementation of perioperative breathing exercises and its effect on postoperative pulmonary complications and long-term prognosis in elderly patients undergoing laparoscopic colorectal surgery: A randomized controlled trial
Authors: Chen Jing , Peng Li-Hua , Min Su
Published: May 2022

Objective

This study was to investigate the impact of breathing exercises on recovery in elderly patients receiving laparoscopic colorectal surgery.

Design

A prospective randomized controlled trial.

Setting

University hospital.

Subject

A total of 264 elder patients undergoing laparoscopic colorectal surgery participated in this study.

Intervention

Patients in intervention group received respiratory-related exercises based on standardized enhanced recovery after surgery strategies from admission to 90 days after surgery. The control group received perioperative standardized enhanced recovery after surgery strategies without formatted breathing exercises.

Main measures

The primary outcome was the incidence of postoperative pulmonary complications. The secondary outcomes included 6-minute walking distance, surgery-related complications, length of stay, mortality postoperatively, and hospitalization costs.

Results

Completion rate of breathing exercise in intervention group was over 80% till 90 days postoperatively. The incidence of postoperative pulmonary complications was lower in breathing exercises group (17/132 [12.9%] vs. 43/132 [32.6%], p < 0.001). The mean value of 6-minute walking distance increased more in intervention group compared with baseline values preoperatively (44.2 ± 4.3 vs. 3.2 ± 0.2, p < 0.001). On 90 days postoperatively, the mean value of 6-minute walking distance in breathing exercises group increased by 18.8 m compared with its baseline (557.0 ± 133.5 vs. 538.2 ± 112.7, p = 0.022), while that of control group decreased by 53.2 m from baseline (481.9 ± 102.5 vs. 535.1 ± 123.4, p < 0.001). Patients who received breathing exercises had shorter length of stay and lower hospitalization costs ( p < 0.050).

Conclusions

Perioperative breathing exercises helped prevent postoperative pulmonary complications and improve long-term prognosis in elderly patients undergoing laparoscopic colorectal surgery.
How effective is virtual reality technology in palliative care? A systematic review and meta-analysis
Authors: Mo Jiping , Vickerstaff Victoria , Minton Ollie , Tavabie Simon , Taubert Mark , Stone Patrick , White Nicola
Published: May 2022

Background:

The efficacy of virtual reality for people living with a terminal illness is unclear.

Aim:

To determine the feasibility and effectiveness of virtual reality use within a palliative care setting.

Design:

Systematic review and meta-analysis. PROSPERO (CRD42021240395).

Data sources:

Medline, Embase, AMED, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials and Web of Science were searched from inception to March 2021. Search terms included ‘virtual reality’ and ‘palliative care’. Eligibility: (1) adult (>18 years old) with a terminal illness (2) at least one virtual reality session and (3) feasibility data and/or at least one patient outcome reported. The ROB-2 and ROBINS tools assessed risk of bias. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool assessed the quality of the evidence. Standardised mean differences (Hedges’s g) were calculated from the pre- and post-data. A DerSimonian-Laird random effects model meta-analysis was conducted.

Results:

Eight studies were included, of which five were in the meta-analysis. All studies had at least some concern for risk of bias. Virtual reality statistically significantly improved pain ( p = 0.0363), tiredness ( p = 0.0030), drowsiness ( p = 0.0051), shortness of breath ( p = 0.0284), depression ( p = 0.0091) and psychological well-being ( p = 0.0201). The quality of the evidence was graded as very low due to small sample sizes, non-randomisation methods and a lack of a comparator arm.

Conclusions:

Virtual reality in palliative care is feasible and acceptable. However, limited sample sizes and very low-quality studies mean that the efficacy of virtual reality needs further research.
Preferences of patients with palliative care needs and their families for engagement with service improvement work within the hospital setting: A qualitative study
Authors: Virdun Claudia , Luckett Tim , Lorenz Karl , Davidson Patricia , Phillips Jane
Published: May 2022

Background:

There is growing recognition of the importance of involving patients and families with lived experiences of illness in healthcare service quality improvement, research and implementation initiatives. Ensuring input from people with palliative care needs is important, but how to enable this is not well understood.

Aim:

To seek the perspectives of Australian patients with palliative care needs, and their family members, to elicit their views on how to best contribute to inpatient palliative care quality improvement initiatives.

Design:

An exploratory qualitative study, using semi-structured interviews.

Setting/participants:

Eligible participants were adult patients with palliative care needs receiving care within a hospital setting, and their family members. Recruitment occurred through: five hospitals in New South Wales, Australia; and snowballing.

Results:

Fifty participants took part (21 patients and 29 family members). Results confirmed four themes: (1) Mechanisms for providing feedback about care quality need to be supportive and individualised; (2) The clinician-patient/family power imbalance makes real time feedback challenging to provide; (3) Willingness to contribute varies according to diagnosis, timing and role and (4) Face to face feedback is preferred for health service improvement work.

Conclusions:

Enabling meaningful consumer input to quality improvement requires careful consideration due to the unique requirements of the palliative care population. Embedding tailored outcome and experience measures to inform real-time care provision coupled with focussed opportunities for input into service improvement may best foster improvements in inpatient palliative care, founded in what matters most for people requiring this care.
Huge vulvar varicosities in pregnancy: case report and systematic review
Authors: Giannella Luca , Montanari Michele , Delli Carpini Giovanni , Di Giuseppe Jacopo , Ciavattini Andrea
Published: May 2022

The appearance of severe vulvovaginal varicosities (VVs) is challenging in pregnancy. The management of VVs may require a multidisciplinary approach, including radiologists, vascular surgeons, and obstetricians. We report a rare case of enormous VVs and pubic varicosities and summarize similar cases in the literature. A woman in her 20s with a full-term pregnancy visited our hospital for severe VVs and pubic varicosities. She had been in a spoke maternity unit where a cesarean section was scheduled. After a multidisciplinary evaluation, we offered her the chance to have a vaginal delivery (VD). The woman had an uneventful VD, and VVs disappeared after 40 days. A comprehensive literature search on this topic showed 11 cases of VVs during pregnancy (five VDs and six cesarean sections). The presence of VVs represented the indication for surgery in 70% of cases. Severe complications occurred in 20% of VDs vs. 50% of CSs. In pregnant women with VVs, the risk-benefit ratio suggests a chance of having VD.
Programmed multi-level ventilation in COVID-19-related acute respiratory distress syndrome: a multi-center retrospective observational study
Authors: Depta Filip , Török Pavol , G. Miller Andrew , Firment Peter , Leškanič Jozef , Porubän Adam , Halaš Pavol , Mandinec Stanislav , Filka Vladimír , Zajac Henryk , Gentile Michael A. , Zdravkovic Marko
Published: May 2022

Objective

We evaluated pressure-controlled ventilation (PCV) with multiple programmed levels of positive end expiratory pressure (programmed multi-level ventilation; PMLV) in patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS).

Methods

We conducted a multicenter, retrospective study from November 2020 to February 2021. PMLV was used with PCV in all patients with intensive care admission until improvement in oxygenation (fraction of inspired oxygen [FiO2] ≤0.50 and oxygen saturation [SpO2] >92%). The observed outcomes were improvement of hypoxemia, length of mechanical ventilation, partial pressure of carbon dioxide (PaCO2) stability, and adverse events.

Results

Of 188 mechanically ventilated patients with COVID-19-related ARDS, we analyzed 60 patients treated with PMLV. Hypoxemia improved in 55 (92%) patients, as measured by the change in partial pressure of oxygen/FiO2 and SpO2/FiO2 ratios on day 3 versus day 1, and in 32 (66%) ventilated patients on day 7 versus day 3. The median (interquartile range) length of mechanical ventilation for survivors and non-survivors was 8.4 (4.7–14.9) and 6.7 (3.6–10.3) days, respectively.

Conclusions

PMLV appears to be a safe and effective ventilation strategy for improving hypoxemia in patients with COVID-19-related ARDS. Further studies are needed comparing the PMLV mode with the conventional ARDS ventilatory approach.
Rise and fall of the (social) group
Authors: Armstrong David
Published: May 2022

This article maps the rise and fall of the idea of a (social) group across medicine in the context of contemporary analyses in psychology and sociology. This history shows the early 20th century emergence and growth of group medicine, group therapy and group comparisons. In recent decades, however, the idea that groups constituted the basic units of society has been replaced with the emergence of populations and systems that offer a more virtual and abstract context for individual relationships. This has implications for explanation itself as the demise of groups has changed the epistemological ground-rules for understanding identity formation and social change.
Blood Manipulation in Hezekiah’s Re-inauguration of the Temple in Chronicles
Authors: Ko Ming Him
Published: May 2022

According to 2 Chronicles 29.20–24, Hezekiah’s re-inauguration of the temple involved a purification offering for all Israel in which the blood manipulation did not include the sevenfold sprinkling of blood in front of the veil (Lev. 4.17) or daubing blood on the horns of the incense altar (Lev. 4.18), as stated in the prescriptive text of P. This article proposes that the apparent inconsistency can be explained by examining the Chronicler’s conception of YHWH as cosmic God and global king. The location of the divine presence tends to be in heaven for the Chronicler rather than from within the tabernacle, as illustrated in P. The difference in perspective constitutes a decisive theological reason for the Chronicler’s particular depiction of the blood manipulation in Hezekiah’s re-inauguration of the temple.
A Longitudinal Cohort Study of Youth Mental Health and Substance use Before and During the COVID-19 Pandemic in Ontario, Canada: An Exploratory Analysis
Authors: Sheikhan Natasha Y. , Hawke Lisa D. , Ma Clement , Courtney Darren , Szatmari Peter , Cleverley Kristin , Voineskos Aristotle , Cheung Amy , Henderson Joanna
Published: May 2022

Background

Youth mental health appears to have been negatively impacted by the COVID-19 pandemic. The impact on substance use is less clear, as is the impact on subgroups of youth, including those with pre-existing mental health or substance use challenges.

Objective

This hypothesis-generating study examines the longitudinal evolution of youth mental health and substance use from before the COVID-19 pandemic to over one year into the pandemic among youth with pre-existing mental health or substance use challenges.

Method

A total of 168 youth aged 14–24 participated. Participants provided sociodemographic data, as well as internalizing disorder, externalizing disorder, and substance use data prior to the pandemic’s onset, then every two months between April 2020–2021. Linear mixed models and Generalized Estimating Equations were used to analyze the effect of time on mental health and substance use. Exploratory analyses were conducted to examine interactions with sociodemographic and clinical characteristics.

Results

There was no change in internalizing or externalizing disorder scores from prior to the pandemic to any point throughout the first year of the pandemic. Substance use scores during the pandemic declined compared to pre-pandemic scores. Exploratory analyses suggest that students appear to have experienced more mental health repercussions than non-students; other sociodemographic and clinical characteristics did not appear to be associated with mental health or substance use trajectories.

Conclusions

While mental health remained stable and substance use declined from before the COVID-19 pandemic to during the pandemic among youth with pre-existing mental health challenges, some youth experienced greater challenges than others. Longitudinal monitoring among various population subgroups is crucial to identifying higher risk populations. This information is needed to provide empirical evidence to inform future research directions.
The Organization of Networking and Gender Inequality in the New Economy: Evidence from the Tech Industry
Authors: Mickey Ethel L.
Published: May 2022

In the new economy, with shrinking organizational supports and increased precarity for professional workers, networking has intensified as an entrepreneurial career management strategy. Networking is embedded in the logic of new work organizations, but less attention has been paid to its impact on gender inequality. Through fifty interviews with workers from one tech company and nine months of observations, I ask: (1) In the new economy, with intense networking demands, how does gender structure the networking strategies of workers? And (2) How does the organization of networking contribute to gender inequality? I find that individuals draw on masculinity and femininity as they network in ways that reproduce gender status hierarchies. The structure and culture of networking disproportionately limit the careers of women compared to men by shaping their (1) networking approaches; (2) attitudes about networking; and (3) resources gained from networking. Men network by strategically socializing, confidently building informal relationships with other men through masculine activities and leveraging these relationships for key resources. Women cannot similarly access informal relationships, and so they engage in strategic networking, attending formal networking events that are less effective in providing career resources. Women embodying an elite, white femininity locate personal support in the company-sponsored women's network. However, this group reinforces organizational boundaries by gender and race. This article advances sociological literature on inequality in the new economy, drawing on gender theory to demonstrate how in elite, male-dominated industries like technology, networking contributes to the maintenance of gender inequalities.
Navigating Water Cooler Talks Without the Water Cooler: Uncertainty and Information Seeking During Remote Socialization
Authors: Woo DaJung , Endacott Camille G. , Myers Karen K.
Published: May 2022

Research on newcomer uncertainty and information seeking behaviors has largely assumed that newcomers could interact with and observe others in physical work settings. This study examined how organizational newcomers sought information during the early stages of the COVID-19 pandemic without such possibility. Drawing on in-depth interviews with 30 individuals who began jobs remotely between February and November 2020, we uncovered three major areas of uncertainty: workplace relationships, task/role performance, and organizational norms. Our findings demonstrate how these newcomers managed the uncertainties through six information seeking tactics: organizing virtual small talks; initiating unsanctioned in-person meetings; asking overt and targeted questions; utilizing digital repositories; unintentional limit testing; and anticipating future information seeking. We discuss implications for remote newcomer socialization and provide propositions for future research.
Numerical prediction of oil film shear cavitation inception considering groove structure
Authors: Xie Fangwei , Xu Chunjie , Zheng Xudong , Li Yongjie , Gao Kuidong , Agarwal Ramesh K , Liu Xiumei
Published: May 2022

The oil film between the friction disks of the hydro-viscous clutch is taken as the research object. Considering the groove structure of the friction disks, the mathematical model of the oil film flow field is established. The finite difference algorithm is utilized to solve the velocity, the pressure, and the pressure coefficient of the oil film. The incipient position of oil film shear cavitation under different groove structure parameters is carried out. The numerical results indicate that the groove has a great influence on the oil film velocity and pressure. The oil film cavitation inception occurs first in the upstream position of the groove area. The area fraction of cavitation inception is directly proportional to the width and depth of the groove and inversely proportional to the section parameter and inclination angle of the groove. This research provides an efficient and accurate method for predicting the oil film shear cavitation inception.
Metal additive manufacturing of commercial aerospace components – A comprehensive review
Authors: Kumar G. Ranjith , Sathishkumar M. , Vignesh M. , Manikandan M. , Rajyalakshmi G. , Ramanujam R. , Arivazhagan N.
Published: May 2022

Metal additive manufacturing (AM) has matured and grown from its infancy in the research stage to the fabrication of new and advanced components for its supreme applications. AM is a lead for the advanced manufacturing processes with an increased and advanced potential to revolutionize the manufacturing domain. It could exhibit a progressive change in the project and design paradigms. In the past decade, the use of metal AM process in the aerospace industry to build, repair various components for military applications and several outer space vehicle fabrications have occupied higher potential among various other manufacturing industries. In addition to it, many studies have made it a more versatile, common, and safer technology for the design and fabrication of components with the introduction of novel processes, materials, technologies, cost efficiency, and process design. In the present review article, the use of advanced aluminum alloys in the AM of fuselage, horizontal stabilizer, and high and low wings has gained increased advantages in the aerospace industry. Various components of wings and fuselage with its merits and demerits in AM processing are discussed. The outstanding issues in AM process and steps to overcome with post-processing techniques are elaborated. Finally, the future scope and research directions of the AM process involved in the fabrication of selected components are discussed.
‘Notre Chine’ : China’s shifting position within Marguerite Duras’s Cycle indochinois
Authors: McElhinny Paul
Published: May 2022

This essay takes Marguerite Duras’s presentation of Sino-French relations as a case study to re-examine and call into question postcolonial theorizations of China’s shifting position vis-à-vis the West. I use two understudied essays by Duras, which describe her childhood travels to Yunnan, a Chinese province that borders Indochina, and her views on the Tiananmen Square protests. In each iteration of Duras’s Cycle indochinois, spanning almost four decades, she significantly alters her depictions of Chinese characters and settings – namely that of the Chinese lover and Cholon. I explore how Duras utilizes her memories of China as a thread to connect and re-interpret different parts of her personal life while also reflecting the regional interplay between China and France in continental Southeast Asia, as well as China’s growing power within the world economic system. I contend that the personal anxiety Duras projects towards China’s so-called ‘rise’ in her late-career signals a contemporary re-balancing of Franco-Chinese cross-cultural representations as the author’s engagement with the country shifts from that of a mythical, timeless civilization to a geopolitical and historical reality.
For a fluid approach to Céline Sciamma's Portrait of a Lady on Fire
Authors: Bacholle Michèle
Published: May 2022

This paper argues that Céline Sciamma's Portrait of a Lady on Fire (2019) goes beyond the lesbian or queer categorization that critics have often hastily reduced it to. Set in pre-revolutionary France, Portrait is a film from 'the 2019th century' (Sciamma) that addresses contemporary issues (consent, patriarchal and heteronormative order, women's silencing, women's desire and sexuality). It offers a reflection on 'fluid' time and historicizes and archives both disappeared women artists and same-sex women's relations in French painting and cinema. Sciamma reeducates her spectators’ (male) gaze, precludes voyeurism and the objectification and fetishization of her heroines’ bodies, bestows agency upon them, and displays equality and respect in both form and content. Despite its Queer Palme award at Cannes, Portrait calls for a qualifier better suited to our changing times, as this fluid approach attempts to show.
Working in hospitality and catering in Greece and the UK: Do trade union membership and collective bargaining still matter?
Authors: Papadopoulos Orestis , Ioannou Gregoris
Published: May 2022

Existing literature suggests that terms and conditions of employment are universally poor in hospitality and catering. Based on fieldwork comprising more than 70 semi-structured in-depth interviews conducted in the UK and Greece in 2018 and 2019, this article maps the field in the two countries and discusses the key parameters that structure working conditions, pay determination, and the impact of trade unionism and absence thereof. Poor working conditions and precariousness are prevalent in both contexts as expected, but surprisingly wages and other terms and conditions at least for a significant section of the hospitality workforce are comparatively better in Greece. An explanation for these findings is suggested with reference to the tradition of collective bargaining in hotels in Greece which partially survived the 2008 crisis and the legal reforms that followed. Trade unionism, despite its weakening and discrediting, has left its mark as a tradition contributing to the emergence of formal labour-based initiatives and more broadly to maintaining an openness to collectivism and collective action, more so than in the UK context. This combination of the distinct institutional and sectoral features of the Greek case and worker agency has served to ameliorate the context and content of employment for substantial sections of the hospitality workforce.
Model-free screening for variables with treatment interaction
Authors: Bizuayehu Shiferaw B , Xu Jin
Published: May 2022

Precision medicine is a medical paradigm that focuses on making effective treatment decision based on individual patient characteristics. When there are a large amount of patient information, such as patient’s genetic information, medical records and clinical measurements, available, it is of interest to select the covariates which have interactions with the treatment, for example, in determining the individualized treatment regime where only a subset of covariates with treatment interactions involves in decision making. We propose a marginal feature ranking and screening procedure for measuring interactions between the treatment and covariates. The method does not require imposing a specific model structure on the regression model and is applicable in a high dimensional setting. Theoretical properties in terms of consistency in ranking and selection are established. We demonstrate the finite sample performance of the proposed method by simulation and illustrate the applications with two real data examples from clinical trials.
Colorectal cancer mortality after randomized implementation of FIT-based screening - a nationwide cohort study
Authors: Njor Sisse Helle , Larsen Mette Bach , Søborg Bo , Andersen Berit
Published: May 2022

Objective

Evidence of reduction in colorectal cancer (CRC) mortality following CRC screening based on the faecal immunochemical test (FIT) is insufficient. This study aimed to analyse if CRC mortality was reduced after implementing FIT-based screening.

Setting

The Danish national CRC screening programme.

Methods

This nationwide cohort study included residents aged 50–71 years invited to the prevalence round of the screening programme. Invitation order was decided by randomising on birth month; the first two birth months to be invited were classified as invited and the five last were classified as not-yet-invited and given a pseudo invitation data. Follow-up was from (pseudo)invitation date until 31 December 2017, emigration or death. Relative risk (RR) of CRC death was calculated with 95% confidence intervals (CIs).

Results

A total of 897,812 residents were included (29% invited and 71% not-yet-invited). The median follow-up was 3.3 years. The RR of CRC death at end of follow-up was 0.83 (95% CI 0.66; 1.03) among those invited to screening compared with those not yet invited. For men aged 60–71 years, this RR was 0.68 (95% CI 0.49; 0.94). For those participating in screening compared with a similar group of not-yet-invited residents, the RR was 0.71 (95% CI 0.46–1.08). For male participants aged 60–71 years, this RR was 0.49 (95% CI 0.27−0.89). For women and men aged 50–59 years, RRs were small and statistically non-significant.

Conclusion

This nationwide study showed that even within a median follow-up of only 3.3 years, implementing FIT-based CRC screening reduced CRC mortality among older men.
Healthcare Financing in West Bengal
Authors: Bose Mampi
Published: May 2022

The article analyses patterns and trends of healthcare financing in West Bengal. The aim is to understand the direction to which the public health system of the state heads. Real per capita expenditure on health remains almost stagnant in West Bengal during most of the 14th Finance Commission period. The state has shifted its focus from primary and preventive care and has been promoting insurance-based healthcare model, Swasthya Sathi, which might put the population of the state at the risk of being exposed to high medical expenses in absence of a sound public health system. Going by the past experience of healthcare financing in West Bengal, allocation of resources for Swasthya Sathi was contingent on the union government’s allocation of resources for Rashtriya Swasthya Bima Yojana, and later for Pradhan Mantri Jan Arogya Yojana. This means that if allocation for Prandhan Mantri Jan Arogya Yojana is reduced by the centre, allocation for Swasthya Sathi might also fall. For a sound public health system, it is important to allocate resources adequately on public health so that it benefits the poor and socially deprived population.
Co-Occurrence of Sociocultural Elements and Self-Direction in Learning Situations: A Police Organization Case Study
Authors: Lemmetty Soila , Collin Kaija
Published: May 2022

Adult’s self-direction and self-directed learning (SDL) have become topics in the discussion of work-related adult learning and an autonomous approach, emphasizing responsibility and independence, has received increasing attention in studies of learning. In the context of SDL, in contrast, the importance of the learning environment and community has received less empirical attention. The aim of this article is to increase the understanding of the co-occurrence of sociocultural elements and self-direction in learning situations at work. From a practical viewpoint, it is important to understand both, the sociocultural and self-directed nature of different learning situations at daily work, so that organizations and workplaces can develop the practices that support learning and self-directedness in the work environment and create appropriate expectations for individual self-direction. In this study, we examined the elements of sociocultural learning and self-direction in police organization. The content analysis focused on interviews with 26 police officers, examining their descriptions of learning situations. The findings show that in learning situations at work, individual responsibility alternates with collectivity, peers, supportive supervisory work, and tools. The theoretical and practical implications of the findings are highlighted.
Continuous Challenges: Case Study of a Sustainable University Adult Education Graduate Program
Authors: Collins Royce Ann , Zacharakis Jeff
Published: May 2022

Through their history, adult education graduate programs have flourished and dwindled and sustainability always seems to be in jeopardy. This case study examines one program’s growth, decline, and continuous rebirth in the competitive higher education market and academic stratification. Throughout its 55 years of existence, faculty have risen from the ranks to embrace an entrepreneurial spirit and leadership. Through flexibility and diversification, the program has evolved to meet the needs of the current learners. This model is sustainable if all faculty focus on the program first and their own professional reputations second.
‘Inoculate Boys Against Toxic Masculinity’: Exploring Discourses of Men and Masculinity in #Metoo Commentaries
Authors: Waling Andrea
Published: May 2022

This article examines what discourses and assumed subject positions have emerged about men and masculinity in #MeToo debates. Using feminist critical discourse analysis and an exploratory approach to analyze 163 media articles, five key framings are noted: men are victims of masculinity requiring intervention, men are positioned as inherently ‘good’ or ‘bad’, boys and men are lost and need to be found, men are performative in their ‘awakenings’, and men’s take up of protector or allyship roles may in fact be attempts to be false heroes. The findings of this work note several tensions and contradictions that highlight an overall lack of coherency and agreement regarding men’s engagements with, and roles in, the #MeToo movement. These contradictions and tensions have implications for thinking about gender equality and gendered violence prevention initiatives.
Minority Language Recognition and Political Trust in Authoritarian Regimes
Authors: Kao Jay C. , Liu Amy H. , Wu Chun-Ying
Published: May 2022

While authoritarian regimes are often characterized by their civil liberty restrictions, some dictatorships acknowledge the ethnolinguistic diversity of their population. Are minorities in multiethnic authoritarian states more likely to trust the government when their language is recognized? In this paper, we argue while recognition of a group’s language improves trust in democracies through a substantive representation mechanism, the same cannot be said in authoritarian regimes. Instead, recognition is a mere symbolic gesture. Such window-dressing efforts call attention to the horizontal inequality between hegemon and minority groups—and such, minority language recognition is associated with negative political trust. We test our argument with the World Values Survey. By identifying which minority groups have been afforded linguistic recognition, we find evidence of a significant—but negative—link between recognition and political trust.
A Qualitative Inquiry of Improved Alliance in Hispanic Families Paired with Hispanic Therapists in Functional Family Therapy
Authors: Jacob Charles J. , Robbins Michael , Turner Charles
Published: May 2022

Functional Family Therapy (FFT) is an evidence-based family intervention that has demonstrated efficacy in reducing rates of re-offense and engagement with the justice system among diverse samples, including Hispanic youth and families. Past research (i.e., Flicker et al., 2008) found that Hispanic therapists matched with Hispanic clients in FFT experienced more positive outcomes than their White counterparts. We conducted a qualitative analysis of session notes completed by three Hispanic FFT therapists treating 33 Hispanic families (99 sessions) with positive outcomes. Grounded theory analysis elicited nine codes related to therapist behaviors. Implications regarding administration of FFT with Hispanic families are discussed.
The Reclamation of Self: Kinship and Identity in Transnational Colombian Adoptee First Family Reunions
Authors: Branco Susan F. , Stella Sanna , Langkusch Amelia
Published: May 2022

In this qualitative study the researchers interviewed 17 adult transnational Colombian adoptees in reunion with their Colombian first families. Through thematic analysis methodology three themes emerged: (1) first family influences, (2) navigating between families, and (3) identity reclamation. Participants in the study described the impact reunion had on their perceptions of family and their identities. The Competencies for Working with Transracial Adoptees and the Transracial Adoption Kinship Network (TrAKN) served as a framework to discuss implications for adoptees and family counselors.
HPV Associated Squamous Cell Carcinoma in the Rectal Tonsil
Authors: Desai Ketav , Baskovich Brett , Alkhasawneh Ahmad , Mohamed Khaled , Omman Reeba , Gopinath Arun
Published: May 2022

Mucosa-associated lymphoid tissue has been reported throughout the gastrointestinal tract including rectum. Rarely, a nodular proliferation of predominantly submucosal lymphoid tissue in the rectum has been documented as rectal tonsil. Here we report a patient with HPV-associated squamous cell carcinoma of the rectal tonsil, presenting as a polyp. Previously, rare reports of HPV-associated lymphoepithelial carcinoma have been reported in the literature. We are presenting an extremely rare occurrence and emphasizing the importance of appropriate nomenclature based on the pathogenesis of the neoplasm.
Placental Pathology After SARS-CoV-2 Infection in the Pre-Variant of Concern, Alpha / Gamma, Delta, or Omicron Eras
Authors: Shanes Elisheva D. , Miller Emily S. , Otero Sebastian , Ebbott Rebecca , Aggarwal Raveena , Willnow Antonia S. , Ozer Egon A. , Mithal Leena B. , Goldstein Jeffery A.
Published: May 2022

Objectives. The goal of this study is to describe placental pathology after infection with SARS-CoV-2 before the predominance of variants of concern (pre-VOC) and during eras of predominant transmission of the Alpha & Gamma (co-circulating), Delta, and Omicron variants. Methods. We used county-level variant data to establish population-level variant proportions, SARS-CoV-2 PCR to identify cases, and IgG serology to exclude latent infections from controls and histopathologic examination to identify placental pathology. Results. We report findings in 870 placentas from pregnancies complicated by SARS-CoV-2 including 90 with infection in the Alpha/Gamma era, 60 from the Delta era and 56 from the Omicron era. Features of maternal vascular malperfusion (MVM), including decidual arteriopathy, were significantly more frequent after SARS-CoV-2 infection. The risk of these findings varied over time, with the highest rates in the Delta era. Increased COVID-19 severity and the presence of comorbidities strengthened these associations. Conclusion. MVM is a feature of SARS-CoV-2 infection in pregnancy. Lesion frequency changed with the predominant circulating virus and should be considered with new variants.
Adenoid Cystic Carcinoma, Solid-Basaloid Subtype of the Breast: A Case Report
Authors: Hara Yuki , Yamaguchi Rin , Yano Hiroshi , Iwasaki Keisuke
Published: May 2022

We present a rare tumor of adenoid cystic carcinoma, solid-basaloid subtype of the breast. Solid-basaloid adenoid cystic carcinoma may have a worse prognosis than classical adenoid cystic carcinoma. A 70-year-old woman presented with a mass in her left breast. Malignancy was suspected on imaging and confirmed via core needle biopsy. Left breast partial mastectomy and sentinel lymph node biopsy were performed. Histologically, the tumor was composed of basaloid cells with hyperchromatic nuclei and frequent mitotic figures, as are small-cell neuroendocrine carcinomas. Immunohistochemical analysis of the tumor cells showed high expression of KIT and CD10 and focal expression of keratin 7. Synaptophysin, chromogranin A, estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 were not expressed. This patient should be followed up carefully for distant metastases and recurrences.
Adherence to oral anti-cancer therapies in older patients is similar to that of younger patients
Authors: Lory Pauline , Perche Louise , Blanc Julie , Fouquier Bastian , Giroux Audrey , Thomassin Amélie , Devaux Madeline , Renaudin Amélie , Di Martino Cyril , Quipourt Valérie , Bengrine-Lefèvre Leïla , Schmitt Antonin
Published: May 2022

Introduction

The use of oral anti-cancer therapies is becoming increasingly common in the management of cancers, raising the question of adherence. The objective of this study was to assess adherence to oral anti-cancer therapies, as well as the impact of various factors that may influence it.

Methods

Patients starting oral chemotherapy (tyrosine kinase inhibitor or cytotoxic) were followed up for 3 months using a medication diary, which was given to the patient by the pharmacist during a multidisciplinary consultation. Adherence was assessed using the diary, as well as by counting the tablets they brought back.

Results

One hundred and fifty patients were included in the study. The main oral chemotherapy agents prescribed were palbociclib (23.3%), everolimus (18.7%), and capecitabine (13.3%). The adherence at the end of the 3 months, by means of dose intensity (i.e. percent of the dose prescribed that has been taken), was 95.5%. No significant difference in adherence was found based on age, sex, family circumstances, health status, co-medication, type of oral therapy, tumor location, number of previous treatment lines, or presence of toxicity. The main reasons for non-adherence were forgetting (50%) and toxicity (21%). Fifty-seven patients prematurely discontinued the study: 40.3% for toxicity and 36.8% for disease progression.

Conclusion

Adherence in this study is high in comparison to literature, which can be explained by close multidisciplinary follow-up. Moreover, no significant difference was observed between younger and older patients.
Long-term follow-up and future direction on the management of chronic lymphocytic leukemia/small lymphocytic leukemia
Authors: Hanna Kirollos S , Fijalka Andrew , Watson Ian , Brown Olivia , Ojulu Apiew
Published: May 2022

Objective

Chronic lymphocytic leukemia and small lymphocytic lymphoma remain the most prevalent adult leukemia in Western countries. Novel therapeutics have established long-term efficacy and have changed the landscape in patient management. In contrast, novel approaches pose opportunities for patients to be treated for finite durations. In this manuscript, we highlight long-term safety and efficacy data with Bruton's tyrosine kinase inhibitors and combination BCL2 + anti-CD20 therapies. We also offer key considerations for treatment selection and outline ongoing trials which may continue to expand therapeutic options and approaches.

Data sources

An electronic search of the PubMed database was performed to obtain key literature in chronic lymphocytic leukemia and small lymphocytic lymphoma published using the following search terms: chronic lymphocytic leukemia/small lymphocytic lymphoma, Richter syndrome, and histologic transformation. The search results were narrowed by selecting studies in humans published in English. Results were confined to the following article types: Clinical Trial, Phase II; Clinical Trial, Phase III; Clinical Trial, Phase IV; Guideline; Randomized Controlled Trial; Meta-Analysis; Systematic Reviews; and Validation Studies.

Data summary

Chronic lymphocytic leukemia and small lymphocytic lymphoma are different manifestations of the same disease and are managed in much the same way. Bruton's tyrosine kinase inhibitors have demonstrated long and durable efficacy benefits in patients with newly diagnosed chronic lymphocytic leukemia/small lymphocytic lymphoma and in the relapsed/refractory setting. Despite these benefits, long terms adverse events have posed challenges for patients and have led to treatment discontinuations. Additionally, the use of monotherapy Bruton's tyrosine kinase inhibitor's requires chronic use of the medications leading to added financial implications. BCL2 inhibition with venetoclax in combination with anti-CD20 monoclonal antibodies has offered a novel and finite treatment approach in frontline and relapsed chronic lymphocytic leukemia/small lymphocytic lymphoma. Ongoing clinical trials are in investigating this modality further to enhance durable responses utilizing a combination Bruton's tyrosine kinase inhibitor's and BCL2 inhibitors.

Conclusion

The treatment armamentarium of chronic lymphocytic leukemia/small lymphocytic lymphoma continues to evolve. Despite the long term, durable responses with Bruton's tyrosine kinase inhibitor's, it is likely that finite treatment durations could become the standard of care as a result of continued, long-term responses.