bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating the dynamic characteristics of microwave-casted metal matrix composite material by using experimental modal analysis
Authors: Nandwani Sahil , Vardhan Sachit , Bahl Shashi , Yadav Adarsh Kumar , Samyal Rahul , Bagha Ashok Kumar
Published: March 2023

This paper proposes an experimental modal analysis technique to measure the dynamic characteristics of microwave-casted metal matrix composite (MMC). To fabricate MMC, silicon carbide (SiC) is reinforced into the SS202 matrix. The damping capacities of MMC at different reinforcements of SiC powder such as 0.05%, 0.1% and 0.2% are measured through experimental modal analysis. The main objective is to study the effect of reinforcement on the damping capacity of SS202. The domestic microwave oven with the specification of 2.45 GHz and 900 W power is used to cast the MMC material. The graphite split mold is used for in-situ microwave casting. The mechanical characterization in terms of micro-hardness and scanning electron microscopy (SEM) of MMC is also examined. From SEM imagining, complete diffusion of the SiC in SS matrix is observed for 0.05% of SiC reinforcement; however, incomplete diffusion is observed for 0.1% and 0.2% of SiC reinforcement. It is observed that the hardness of the SS202 is increasing with the decrease in the percentage of SiC powder. The experimental modal analysis is carried out by using SO Analyzer. The response model in terms of the frequency response function (FRF) curve is measured when the specimen is excited at impact excitations. The half power bandwidth method is used to calculate the damping factor of the material from the measured FRFs. It is observed that the damping capacity increases with the increase in percentage of SiC in SS202. SS202 with 0.05%, 0.1% and 0.2% SiC have the hardness value of 155.33 HV, 107.33 HV and 58.33 HV, respectively.
Analysis of the Colombian Constitutional Court's Transformative Approach to Conflict-Related Sexual Violence
Authors: Inguanzo Isabel , Rodríguez Rodríguez Angélica
Published: March 2023

This paper aims to assess whether the Colombian Constitutional Court has had a transformative approach to transitional justice in relation to conflict-related sexual violence. Building upon previous literature on feminist approaches to transitional justice, we carry out a content analysis of all 37 Autos related to conflict-related sexual violence issued by the Colombian Constitutional Court between 2008 and 2016. In doing so, we delve into how the high court identifies perpetrators and survivors of sexual violence, the causes that lead to sexual violence during conflict and displacement, and the measures they propose to eradicate this crime. Overall, while we find that critical decisions are transformative in most of the analysed dimensions, there remains some room for improvement.
The Sharing Economy: An Integrated Systematic Review Using TCCM and Bibliometric Analysis
Authors: Pandita Shailesh , Mishra Hari Govind , Bhat Aasif Ali , Mishra Ram Kumar , Singh Ramendra
Published: March 2023

The purpose of the paper is to review the diversified extant literature on the sharing economy using bibliometric analysis and theories, characteristics, context, and methodologies (TCCM) framework to summarize multiple diversified studies under one paper which provides not only insights into previous work but also benchmarks the evolution of this concept and its future scope. The study adopted the integrated research methodology based on the bibliometric and TCCM analysis. Bibliometric analysis is conducted through the following techniques: citation analysis, co-citation analysis and co-occurrence of keywords with the help of R-based bibliometrix and VOSviewer open-source software whereas the TCCM framework classified the literature into the following categories: theory, characteristics, context and methodology. Based on the bibliometric analysis of 846 research articles retrieved from the Scopus database for the period of the last ten years (2010–2020), the study found the most prominent authors, studies, journals and countries in the area of the sharing economy along with the most co-cited authors and journals. The theories prominently used in this area are clustered into six relevant themes which include communication and informational theories, socio-psychological theories, organizational level theories, research methodology-based theories, business economic theories, technological acceptance-based theories whereas outcome variables (consumer intention, experience, repeat purchases, satisfaction and loyalty) and their antecedents are also investigated in this study. This article makes recommendations for future research that will aid in the direction of further research into areas that are currently under-represented in the journal as well as new topics that are expected to grab the attention.
TAM Constructs Predicting the Use of Mainstream Social Networking Sites by College Students in Kuwait
Authors: Mesbah Hesham , Alfailakawi Yousef
Published: March 2023

This study applies the model of technology acceptance (TAM) to examine the factors that explain the adoption and intensity of use of Facebook, Twitter, Instagram and Snapchat among a sample of college students in Kuwait. The three constructs that represented the predictor variables are perceived ease of use (PEOU), perceived usefulness (PU) and social influence (SI). Structural equation modelling was applied to analyse the impact and covariance of TAM constructs. Gender was used as a control variable to explain the variance in using Snapchat and Instagram. An 18-item questionnaire was developed and administered to a sample of 919 students at Kuwait University. The results show that Facebook and Twitter were male-dominated, whereas Instagram and Snapchat were female-dominated in the sample. TAM constructs invariably affect the adoption and intensity of using social networking sites. The use of Facebook and Snapchat is significantly explained by PU and PEOU, while the use of Twitter and Instagram is predicted by PEOU. PEOU was the only construct that explained the variance in the use of Twitter. SI was strongly correlated with PEOU and PU.
Incidence and Clinical Features of Venous Thromboembolism in Inpatients with Mental Illness
Authors: Wang Zibin , Yang Yan , He Xinqi , Jiang Xia , Gao Xian , Liu Peng , He Zhaopeng , Zhang Like , Zhang Miao , Niu Xupeng , Liu Boyu , Zhang Lei , Li Zhongxin
Published: March 2023

Aims

We investigated the incidence and clinical features of venous thromboembolism (VTE) in inpatients with mental illnesses.

Methods

We retrospectively analyzed records of inpatients with mental illnesses and confirmed VTE at The First Hospital of Hebei Medical University between August 2018 and July 2022. We recorded demographic characteristics, psychosis-related conditions, and thrombus distribution.

Results

Among 12939 patients diagnosed with mental illness, 156 (1.21%) presented with VTE at the first visit or during the disease course. Crude VTE incidence varied significantly across mental illnesses, being highest in patients with organic mental disorders (5.20%), followed by emotional disorders (1.10%), and others ( P < 0.001). Distal and proximal deep venous thromboses (DVT) occurred in 79.17% and 20.84% of patients, respectively. The Hamilton Depression Scale (HAMD) score was higher in patients with proximal DVT than in those with distal DVT ( P < 0.001). On multivariate analysis, the HAMD score (odds ratio [OR] 1.173, confidence interval [CI] 1.100−1.251, P＜0.001) was a risk factor and the Hamilton Anxiety Scale (HAMA) (OR 0.862, CI 0.796−0.934, P＜0.001), a protective factor against DVT progression.

Conclusion

VTE is not rare in patients with mental illnesses and is most commonly associated with organic mental disorders. Psychosis-related DVT typically shows a significantly high incidence of distal DVT. Prevention and early treatment in patients with severe depression and distal DVT can prevent DVT aggravation.
Effect of phakic collamer intraocular lens with a central hole on structural tests measurements of retinal nerve fiber layer and macula
Authors: Cunha-Pachon Susy , Rodriguez-Una Ignacio , Rodriguez-Calvo Pedro P , Garcia Montserrat , Lozano-Sanroma Javier , Alvarez-Prada Manuel , Merayo-Lloves Jesus , Alfonso Jose F
Published: March 2023

Aim

To evaluate whether the Visian Implantable Collamer Lens with a central port (V4c ICL®; STAAR Surgical, Switzerland) affects the retinal nerve fibre layer (RNFL), macula and optic nerve head (ONH) measurements obtained by optical coherence tomography (OCT), and Heidelberg Retina Tomography (HRT).

Methods

This prospective study included myopic patients undergoing V4c ICL® implantation. RNFL thickness, macular thickness, ganglion cell analysis (GCA) and ONH main parameters were evaluated with RTVue OCT (Optovue Inc., USA) and Cirrus-HD OCT (Carl Zeiss Meditec, USA). ONH variables were also analysed with HRT-3 (Heidelberg Engineering, Germany). All measurements were performed before and 1 week and 12 months after the surgery.

Results

31 eyes of 31 patients (mean age 30.1 ± 5.5 years) were included. Comparing with preoperative values, no significant differences in average RNFL thickness were found with RTVue, while a slight increase (4.3 µm) was detected with Cirrus-HD (85.2 ± 10.3 µm, preoperatively) at 1-week postoperatively (89.5 ± 8.3 µm; p < 0.05). Those changes were not observed at the last follow-up visit (86.6 ± 8.6 µm; p = 0.41). Cirrus-HD detected that macular thickness was slightly higher 1 week after surgery, compared with the preoperative examination (3.4% increase; p = 0.04). That difference remained stable at the 12-month postoperative visit (p = 0.01). GCA showed no changes. The ONH analysis with Cirrus-HD determined that rim area (p = 0.03) as well as disc area (p = 0.04) significantly increased. HRT-3 found no significant changes affecting those variables.

Conclusions

The implantation of V4c ICL® did not induce a clinically significant impact on the results of the RNFL/ONH analysis with OCT and HRT.
The Effect of Input Flooding and Explicit Instruction on L2 Acquisition of English Inverse Scope
Authors: Wu Mien-Jen , Ionin Tania
Published: March 2023

This article investigates how different types of input and instruction can affect L1-Mandarin L2-English learners’ acquisition of English inverse scope. English quantifier–negation sentences such as All the kids didn’t climb the tree are ambiguous between a surface-scope reading (‘none of the kids climbed the tree’) and an inverse-scope reading (‘it is not the case that all the kids climbed the tree’), while the Mandarin equivalent only has the surface-scope reading. Inverse scope can be challenging even for advanced learners, due to its low frequency in naturalistic input and/or its complex form–meaning mapping. The present study implemented an intervention with inverse scope: learners received either input flooding (increased frequency) or explicit instruction (explicit explanations about form–meaning mappings). For learners receiving explicit instruction, acceptance of inverse scope increased significantly after instruction. In contrast, learners receiving input flooding did not show significant improvement; results from debriefing questionnaires indicated that learners in the input flooding group failed to either notice the target structure or further process the input. This suggests that input flooding alone is not as effective as explicit instruction in learning a property that has complex form–meaning mapping, such as inverse scope.
Analytical calculation method for predicting contact loads and structural strength of metallic gasket of subsea connectors under thermal loads
Authors: Zhang Kang , Cheng Huarong , Liu Junpeng , Wang Haining
Published: March 2023

Identifying the effect of thermal loads that are caused by temperature differences of inner and outer fluids on the structural sealing performance and strength is a long-standing quest in the design of subsea connectors. However, the structural stress and sealing parameters of the gasket under thermal loads are difficult to analyze and calculate using the current theoretical method because the boundary conditions of the gasket’s geometry surface are contact constraints interacted by the gasket and hubs. This paper presents an analytical calculation method (ACM) that evaluates the thermal-structural coupling strength and sealing performance considering such special boundary conditions. The thermal load is converted into an equivalent compression load, that is, a concentrated force, and applied to the contact region of the gasket. Additionally, a thermal-structural coupling finite element model is proposed to verify the ACM and the results show good agreement. Taken together, this work contributes to the design of subsea connectors that more likely take thermal loads into account.
Targeted PEGylated Chitosan Nano-complex for Delivery of Sodium Butyrate to Prostate Cancer: An In Vitro Study
Authors: Zamanvaziri Ali , Meshkat Mahboobeh , Alazmani Soroush , Khaleghi Sepideh , Hashemi Mehrdad
Published: March 2023

Introduction: Cancer remains a challenging issue against human health throughout the world; As a result, introducing novel approaches would be beneficial for cancer treatment. In this research, sodium butyrate (Sb) is one of the effective anti-cancer therapeutics (also a potent survival factor for normal cells) that was used for prostate cancer suppression in the platform of modified chitosan (CS) nano-complex (polyethylene glycol (PEG)-folic acid (FA)-Sb-CS). Methods: Different analytical devices including Fourier transform infrared, dynamic light scattering, high-performance liquid chromatography, scanning electron microscopy, and transmission electron microscopy were applied for the characterization of synthetics. On the other hand, biomedical tests including cell viability assay, molecular and functional assay of apoptosis/autophagy pathways, and cell cycle arrest analysis were potentially implemented on human PC3 (folate receptor-negative prostate cancer) and DU145 (folate receptor-positive prostate cancer) and HFF-1 normal cell lines. Results: The quality of the syntheses was effectively verified, and the size range from 140 to 170 nm was determined for the PEG-CS-FA-Sb sample. Also, 75  ±  5% of drug entrapment efficiency with controlled drug release manner (Sb release of 54.21% and 74.04% for pHs 7.4 and 5.0) were determined for nano-complex. Based on MTT results, PEG-CS-FA-Sb has indicated 72.07% and 33.53% cell viability after 24 h of treatment with 9 mM on PC3 and DU145 cell lines, respectively, which is desirable anti-cancer performance. The apoptotic and autophagy genes overexpression was 15-fold (caspase9), 2.5-fold (BAX), 11-fold (ATG5), 2-fold (BECLIN1), and 3-fold (mTORC1) genes in DU145 cancer cells. More than 50% of cell cycle arrest and 45.05% of apoptosis were obtained for DU145 cancer cells after treatment with nano-complex. Conclusion: Hence, the synthesized Sb-loaded nano-complex could specifically suppress prostate cancer cell growth and induce apoptosis and autophagy in the molecular and cellular phases.
Coercion and crime: Convergences, divergences and ‘county lines’
Authors: Atkinson-Sheppard Sally , Dando Coral , Ormerod Tom , Robinson Bregetta
Published: March 2023

How can we understand coercion in a ‘county lines’ context? By drawing on data gathered with criminal justice practitioners, social workers, mothers of sons engaged in county lines and young people, this article draws on Colvin’s Differential Coercion Theory to argue that coercion in a county lines context is multifaceted; occurs on both interpersonal and impersonal levels and results in social-psychological deficits that create ‘spirals of coercion’. This article also considers divergences with Colvin’s theory which include ‘hyper-contexts’, the exertion of agency to acquire fast money and material gains and coercion online. The article concludes by reflecting on the implications for research, policy and practice.
Aorta pathology and pregnancy-related risks in adult congenital cardiac disease: does the aorta dilate during pregnancy?
Authors: Ceuppens Anne-Sophie , De Meester Pieter , Van De Bruaene Alexander , Voigt Jens-Uwe , Van Calsteren Kristel , Budts Werner , Troost Els
Published: March 2023

Background

Aortic dilatation and pregnancy are major concerns in women with aortopathy (AOP). This single-centre retrospective analysis focuses on the evolution of aortic diameters during and after pregnancy in women with Marfan syndrome (MS), Turner syndrome (TS) and bicuspid aortic valve (BAV) aortopathy.

Methods and results

Thirty-eight women who had one or more single pregnancies were included. The ascending aorta was measured during pregnancy and postpartum. During pregnancy, a significant increase of diameters of the sinus aortae (median 1.4 mm; [−1.3; 3.8]) and ascending aorta (median 2.1 mm; [0.0; 4.0]) was noted. Systemic hypertension gives dilation of the aorta, but it did not influence the overall trajectory during pregnancy.

Conclusion

Significant aortic dilatation is noted during pregnancy in women with underlying AOP, even persisting in the long term. Pre-existing systemic hypertension is associated with larger aortic diameters prior to pregnancy. More research on a larger study population however is needed.
Affective infrastructures and political organisation
Authors: Nunes Rodrigo
Published: March 2023

In this commentary on Kai Bosworth's ‘What Is “Affective Infrastructure”?’, I seek to address some of the issues that he raises about the notion by fleshing it out in relation to the problem of political organisation in general, and to the concrete case of Brazilian far-right politics in particular. This leads to conclusions about the concept's generality, its distinction from similar notions such as ‘affective conditions’, its criteria of individuation and relation to a specific material support, and the conceptual pair potentia–postestas.
Common problems or different questions: A critique of ‘assetization’
Authors: Purcell Thomas F.
Published: March 2023

This commentary provides the contours of a Marxian critique of ‘assetization’. In doing so, the paper identifies a subjective approach to valuation and value which ties together Birch's and Ward's appeal to theoretical pluralism. The argument highlights how a focus on future-orientated valuation practices elide the question of class and production and, therefore, the very basis of rent and value. A call is made for geographers to better interrogate the relationship between rent and interest in the flurry of research around rentiership.
‘The plural of silo is not ecosystem’: Qualitative study on the role of innovation ecosystems in supporting ‘Internet of Things’ applications in health and care
Authors: Reidy Claire , A’Court Christine , Jenkins Wilfred , Jani Anant , Ramos Andrew , Morys-Carter Megan , Papoutsi Chrysanthi
Published: March 2023

Background

Internet of Things (IoT) innovations such as wearables and sensors promise improved health outcomes and service efficiencies. Yet, most applications remain experimental with little routine use in health and care settings. We sought to examine the multiple interacting influences on IoT implementation, spread and scale-up, including the role of regional innovation ‘ecosystems’ and the impact of the COVID-19 context.

Methods

Qualitative study involving 20 participants with clinical, entrepreneurial and broader innovation experience in 18 in-depth interviews, focusing primarily on heart monitoring and assistive technology applications. Data analysis was informed by the NASSS (non-adoption, abandonment, scale-up, spread, sustainability) framework.

Results

Interviewees discussed multiple tensions and trade-offs, including lack of organisational capacity for routine IoT use, limited ability to receive and interpret data, complex procurement and governance processes, and risk of health disparities and inequalities without system support and funding. Although the pandemic highlighted opportunities for IoT use, it was unclear whether these would be sustained, with framings of innovation as ‘disruption’ coming at odds with immediate needs in healthcare settings. Even in an ‘ecosystem’ with strong presence of academic and research institutions, support was viewed as limited, with impressions of siloed working, conflicting agendas, fragmentation and lack of collaboration opportunities.

Conclusions

IoT development, implementation and roll-out require support from multiple ecosystem actors to be able to articulate a value proposition beyond experimental or small-scale applications. In contexts where clinical, academic and commercial worlds collide, sustained effort is needed to align needs, priorities and motives, and to strengthen potential for good value IoT innovation.
Effects of Running on the Development of Knee Osteoarthritis: An Updated Systematic Review at Short-Term Follow-up
Authors: Dhillon Jaydeep , Kraeutler Matthew J. , Belk John W. , Scillia Anthony J. , McCarty Eric C. , Ansah-Twum Jeremy K. , McCulloch Patrick C.
Published: March 2023

Background:

Some studies have suggested that running increases the risk of knee osteoarthritis (OA), while others believe it serves a protective function.

Purpose:

To perform an updated systematic review of the literature to determine the effects of running on the development of knee OA.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A systematic review was performed by searching the PubMed, Cochrane Library, and Embase databases to identify studies evaluating the effect of cumulative running on the development of knee OA or chondral damage based on imaging and/or patient-reported outcomes (PROs). The search terms used were “knee AND osteoarthritis AND (run OR running OR runner).” Patients were evaluated based on plain radiographs, magnetic resonance imaging (MRI), and PROs (presence of knee pain, Health Assessment Questionnaire-Disability Index, and the Knee injury and Osteoarthritis Outcome Score).

Results:

Seventeen studies (6 level 2 studies, 9 level 3 studies, and 2 level 4 studies), with 7194 runners and 6947 nonrunners, met the inclusion criteria. The mean follow-up time was 55.8 months in the runner group and 99.7 months in the nonrunner group. The mean age was 56.2 years in the runner group and 61.6 years in the nonrunner group. The overall percentage of men was 58.5%. There was a significantly higher prevalence of knee pain in the nonrunner group ( P < .0001). Although 1 study found a significantly higher prevalence of osteophytes in the tibiofemoral (TF) and patellofemoral (PF) joints within the runner group, multiple studies found no significant differences in the prevalence of radiographic knee OA (based on TF/PF joint-space narrowing or Kellgren-Lawrence grade) or cartilage thickness on MRI between runners and nonrunners ( P > .05). One study found a significantly higher risk of knee OA progressing to total knee replacement among nonrunners (4.6% vs 2.6%; P = .014).

Conclusion:

In the short term, running is not associated with worsening PROs or radiological signs of knee OA and may be protective against generalized knee pain.
“I’m able to function better when I know there's a beginning and an end time”: Autistic adolescents’ experiences of lockdowns during the COVID-19 pandemic
Authors: Hamilton Lorna G. , Kelly Laura , Mesa Sue
Published: March 2023

Background and Aims

Survey research indicates that autistic children and young people experienced high levels of anxiety and isolation during lockdowns in response to the coronavirus disease 2019 (COVID-19) pandemic. Meanwhile, qualitative studies suggest that there may have been some benefits in the switch to home learning for this population. However, the majority of evidence to date comes from parent reports; the current study aimed to triangulate the perspectives of autistic youth and their parents in order to more fully understand the impact of periods of lockdown on education, relationships, and wellbeing.

Methods

Thirteen semistructured interviews were conducted (six with adolescents, seven with parents) to explore the experiences of a group of autistic youth aged 13–14 years (Year 9 of mainstream education in England) during a period of intermittent lockdown. Data were analysed using reflexive thematic analysis.

Results

Two broad themes capturing commonality and diversity in the adolescents’ experiences of lockdown were developed. (1) “Different stress, not less stress” encapsulates the finding that, despite the enforced removal from the school environment providing short-term relief, new stressors contributed to consistently high levels of anxiety for the young people throughout lockdown periods. Stressors included managing home-school within the family unit, navigating time without boundaries, and anxiety about the virus. (2) “A shrunken world” reflects the heightened impact of losing access to meaningful social relationships, extracurricular pursuits, and health-promoting activities for autistic youth.

Discussion

The early stages of the global response to the COVID-19 pandemic caused serious disruption to education for many children and young people globally; our findings provide further evidence that the impact was particularly salient for autistic youth in terms of social isolation, lost learning, and heightened anxiety.

Implications

These findings underscore the necessity of long-term support for the education, social needs, and mental health of autistic young people in the aftermath of lockdowns in response to COVID-19.
Sticking points: Incarcerated women's views on barriers to a prison needle exchange program
Authors: Giffin Lorielle , Berardi Luca , Bucerius Sandra M. , Haggerty Kevin
Published: March 2023

While prison needle exchange programs, or prison needle and syringe programs, have existed in different parts of the world since the 1990s, little is known about how currently incarcerated people perceive them—particularly in Canada, where such programs have only recently been implemented. This study explores incarcerated women's perceptions of a recently implemented prison needle exchange program using in-depth, semi-structured qualitative interviews with 56 federally incarcerated women in Western Canada. In particular, we explore the barriers that women perceive in accessing the prison needle exchange program. These perceived barriers contributed to our participants’ negative views of the prison needle exchange program as well as their overwhelming lack of support for its implementation. Our participants felt that the prison needle exchange program acts as an obstacle to sobriety and could increase different types of harm—including encouraging injection drug use and contributing to overdoses—within the prison. Participants also identified other barriers to using the prison needle exchange program, including a perceived lack of confidentiality/anonymity for users of the program and that the prison needle exchange program itself is structurally incompatible with the rules and operations of a prison system that continues to criminalize drugs. Using an implementation science framework, we argue that this situation accentuates the need for significant consultations with incarcerated people about the operation of such programs, and for funds to support other programs that target participant-identified root causes of substance misuse, such as programs that address past trauma and victimization. At the same time, we caution that some barriers may be inherent in how prisons are structured.
Identifying Aboriginal and Torres Strait Islander offenders and victims in judicial sentencing remarks
Authors: Clifford Sarah , Griffiths Kalinda E.
Published: March 2023

Judicial Sentencing Remarks (JSRs) have been utilised by several researchers, as a publicly available data source, to explore topics such as alcohol and other drug involvement in intimate partner homicide; the use of therapeutic jurisprudence; narratives of mitigation for Aboriginal offenders; and the identification and impact of trauma in the sentencing of homicide offenders (to name a few). There is inconsistency in the existing literature regarding the methodology for identifying offenders as Aboriginal and/or Torres Strait Islander. Appropriate and correct identification of Aboriginal and Torres Strait Islander peoples in the criminal justice system is important because of the distinct differences in how Aboriginal and Torres Strait Islander peoples experience the criminal justice system, including sentencing and punishment. We retrospectively developed a manual algorithm to identify offenders and victims as “Aboriginal and/or Torres Strait Islander”, “non-Aboriginal and/or Torres Strait Islander” or “Unknown”. This paper provides an overview of the development and the application of the algorithm and discusses the importance of transparency in Aboriginal and Torres Strait Islander identification processes when using JSRs as a data source.
A Single-cell Atlas Identifies Pretreatment Features of Primary Imatinib Resistance in Chronic Myeloid Leukemia
Authors: Krishnan Vaidehi , Schmidt Florian , Nawaz Zahid , Venkatesh Prasanna Nori , Lee Kian Leong , Ren Xi , Chan Zhu En , Yu Mengge , Makheja Meera , Rayan Nirmala Arul , Lim Michelle Gek Liang , Cheung Alice Man Sze , Bari Sudipto , Chng Wee Joo , Than Hein , Ouyang John , Rackham Owen , Tan Tuan Zea , Hwang William Ying Khee , Chuah Charles , Prabhakar Shyam , Ong S. Tiong
Published: March 2023

Primary resistance to tyrosine kinase inhibitors (TKI) is a significant barrier to optimal outcomes in chronic myeloid leukemia, but little is known about the factors contributing to response heterogeneity. Using scRNA-sequencing, we identified eight statistically significant features in pretreatment bone marrow mononuclear cells which correlated with either sensitivity (major molecular response or MMR) or extreme resistance to imatinib (eventual blast crisis transformation). Employing machine-learning, we also identified LSC and NK gene expression profiles predicting imatinib response with >80% accuracy, including zero false positives for predicting BC. A canonical erythroid-specifying (TAL1/KLF1/GATA1) regulon was a hallmark of LSCs from patients with MMR and was associated with erythroid progenitor (ERP) expansion in vivo (p<0.05), and a marked 2-10-fold (6.3-fold in Group A vs 1.09-fold in Group C) erythroid over myeloid bias in vitro. Notably, ERPs demonstrated exquisite TKI sensitivity compared to myeloid progenitors (p<0.001). These LSC features were lost with progressive resistance, and in patients who transformed, MYC- and IRF1-driven inflammatory regulons became evident. Patients with MMR also exhibited a 56-fold expansion (p<0.01) of a normally rare subset of hyperfunctional adaptive-like NK cells (CD57+NKG2C+) which diminished with progressive resistance, while patients destined for BC accumulated inhibitory NKG2A+ NK cells favoring NK cell tolerance (through HLA-E binding on target cells). Finally, we developed a parsimonious set of antibodies to validate our scRNA-seq findings. This panel will be useful in prospective studies of primary resistance, and assessing the contribution of predetermined versus acquired factors in TKI response heterogeneity.
Self-reported skills and self-confidence in point-of-care ultrasound: a cross-sectional nationwide survey amongst Finnish emergency physicians
Authors: Hannula Ossi , Hällberg Ville , Meuronen Anna , Suominen Olli , Rautiainen Suvi , Palomäki Ari , Hyppölä Harri , Vanninen Ritva , Mattila Kalle
Published: March 2023

Background

The use of point-of-care ultrasound (POCUS) is increasing. Numerous investigators have evaluated the learning curves in POCUS, but there are no published studies on how emergency physicians perceive their own competence level with this skill.

Methods

A nationwide survey amongst Finnish emergency physicians was conducted. The respondents reported their use of POCUS and how it has affected their clinical decision-making. The number of POCUS examinations performed was compared to the self-assessed skill level with different applications. Cut-off values were determined for the number of examinations required to acquire a good self-assessed skill level in each POCUS application. The correlation between self-confidence and the self-estimated skill level was analyzed. Several different statistical methods were used, such as Student’s t-test, Pearson’s correlation test, Loess method and ROC curve analysis.

Results

A total of 134 out of 253 Finnish emergency medicine specialists and residents (52%) responded to the survey. The most commonly used POCUS applications were POCUS-assisted procedures, pleural effusion and pneumothorax, inferior vena cava and lower extremity deep venous thrombosis. The initial rate of perceived skill acquisition was very steep with the curve flattening with greater skill and more experience. The number of examinations performed to reach a self-assessed good competence varied from seven to 75 with different applications. The lowest cut-off point for self-assessed good competence was obtained for rapid ultrasound for the shock and hypotension-protocol and the highest for focused cardiac examinations. There was an excellent correlation between self-confidence and the self-assessed skill level.

Conclusions

The Finnish emergency practitioners’ self-assessed development of POCUS skills parallels the previously published learning curves of POCUS. The correlation of self-confidence and the self-assessed skill level was found to be excellent. These findings add information on the development of perceived POCUS skills amongst emergency physicians and could complement a formal performance assessment.
Guillain-Barré syndrome AMSAN variant in a 90-year-old woman after COVID-19: a case report
Authors: Sidoli Chiara , Bruni Adriana Antonella , Beretta Simone , Mazzola Paolo , Bellelli Giuseppe
Published: March 2023

Background

Guillain-Barré syndrome (GBS) is an inflammatory disease of the peripheral nervous system characterized by rapidly evolving polyneuropathy caused by autoimmune demyelination and/or axonal degeneration. Since SARS-CoV-2 outbreak, several GBS cases following exposure to coronavirus disease-2019 (COVID-19) have been reported in literature, raising the concern of the latter being a potential trigger event for GBS.

Case presentation

We report the case of a 90-year-old Caucasian woman who was admitted to our hospital because of fatigue, worsening gait and leg strength, dysphonia, dysarthria and dysphagia, started 3 weeks after being exposed to COVID-19. Based on clinical presentation GBS was suspected, so she performed a lumbar puncture and electromyography, which confirmed the diagnosis of acute motor and sensory axonal neuropathy (AMSAN) variant. We administered high dose of intravenous immunoglobulin with slight neurological improvement. However, after 2 weeks of hospitalization with maximization of care, her physical condition worsen, manifesting severe frailty. The patient was discharged with home support services for managing parenteral nutrition and intense scheduled physiotherapy. A few days later, the patient experienced a further decline in her clinical condition and died at home.

Conclusions

To the best of our knowledge, we report the oldest woman with GBS AMSAN variant after COVID-19 described in the existing literature. Our case supports further research aimed at improving recognition, characterization and prompt management of neurological diseases related to COVID-19 in older patients.
A case of limb shaking transient ischaemic attack due to internal carotid artery dissection: an unusual presentation of fibromuscular dysplasia
Authors: Si Lei , Tu Jing , Lei Hui , Ji Liya , Zhang Zhiyong , Liu Zhiqin
Published: March 2023

Background

Fibromuscular dysplasia (FMD) has a high prevalence of associated nontraumatic carotid artery dissection, which could further result in transient ischaemic attack (TIA) or stroke. Limb shaking TIA is an unusual form of TIA that is commonly discribed in elderly patients with atherosclerotic backgrounds, while there are limited data about it in patients with FMD. Furthermore, discussions of limb shaking TIA in nonelderly patients are scarce.

Case presentation

An Asian 47-year-old female presented with intermittent involuntary movement of the left upper limb accompanied by neck torsion. The episode stopped soon after changing to the supine position. On native source images of time-of-flight magnetic resonance angiography (TOF-MRA), the right internal carotid artery showed a "dual lumen sign" with an intimal flap. On contrast-enhanced magnetic resonance angiography and sagittal black-blood T1WI, an intravascular haematoma with irregular lumen stenosis was observed, which overall indicated right internal carotid artery dissection. Digital subtraction angiography showed the characteristic “string-of-beads” appearance in the left internal carotid artery, and the presence of this sign pointed to the diagnosis of FMD. The patient was finally diagnosed with limb shaking TIA due to internal carotid dissection with fibromuscular dysplasia. The patient was prescribed dual anti-platelet therapy. The limb shaking vanished soon after admission with no reoccurrence in the three-month follow-up.

Conclusions

This case demonstrates that limb shaking TIA can present in patients with FMD. Limb shaking TIA in nonelderly patients can be caused by multiple diseases, and more detailed patient guidance is required in clinical practice.
Digital technologies for mental health improvements in the COVID-19 pandemic: a scoping review
Authors: Li Jinhui
Published: March 2023

Digital technologies have been used to support mental health services for two decades, but the COVID-19 pandemic created a particular opportunity for greater utilization and more data-driven assessment of these digital technologies. This research aims to offer a scoping review of the characteristics and effectiveness of digital interventions that were employed to improve mental health in the real context of COVID-19 pandemic. A combination of search terms was applied for automatic search of publications in the relevant databases. The key features of included studies were extracted, including the intervention, participant, and study details. A total of 20 eligible studies were included in the final review, which were conducted across different geographic regions and among diverse cultural groups. Among them, fourteen studies mainly reported the impact of digital technologies on general population, while only one published study developed specific interventions for the isolated COVID-19 depressed patients in hospitals. Digital technologies identified in this review were mainly developed via web-based and mobile-based platforms, such as social networking and video conferencing applications. But less than half of them were aligned with theoretical approaches from standardized psychological treatments. Most of the studies have reported positive effects of digital technologies, either on improving general mental and emotional well-being or addressing specific conditions (e.g., depression, stress, and anxiety). This scoping review suggests that digital technologies hold promise in bridging the mental health-care gap during and after the COVID-19 pandemic, and calls for more rigorous studies to identify pertinent features that are likely to achieve more effective mental health outcomes.
Effects of a shared decision making intervention for older adults with multiple chronic conditions: the DICO study
Authors: Pel-Littel Ruth E. , Buurman Bianca M. , van de Pol Marjolein H. , Twisk Jos W. R. , Tulner Linda R. , Minkman Mirella M. , Scholte op Reimer Wilma J. M. , van Weert Julia C. M.
Published: March 2023

Background

To evaluate the effects of a shared decision making (SDM) intervention for older adults with multiple chronic conditions (MCCs).

Methods

A pragmatic trial evaluated the effects of the SDMMCC intervention, existing of SDM training for nine geriatricians in two hospitals and a preparatory tool for patients. A prospective pre-intervention post-intervention multi-center clinical study was conducted in which an usual care group of older patients with MCC and their informal caregivers was included before the implementation of the intervention and a new cohort of patients and informal caregivers after the implementation of the intervention. SDM was observed using the OPTIONMCC during video-recorded consultations. Patient- and caregivers reported outcomes regarding their role in SDM, involvement, perceived SDM and decisional conflict were measured. The differences between groups regarding the level of observed SDM (OPTIONMCC) were analyzed with a mixed model analysis. Dichotomous patient-reported outcomes were analyzed with a logistic mixed model.

Results

From two outpatient geriatric clinics 216 patients with MCCs participated. The mean age was 77.3 years, and 56.3% of patients were female. No significant difference was found in the overall level of SDM as measured with the OPTIONMCC or in patient-reported outcomes. However, at item level the items discussing ‘goals’, ‘options’, and ‘decision making’ significantly improved after the intervention. The items discussing ‘partnership’ and ‘evaluating the decision-making process’ showed a significant decrease. Fifty-two percent of the patients completed the preparatory tool, but the results were only discussed in 12% of the consultations.

Conclusion

This study provides scope for improvement of SDM in geriatrics. Engaging older adults with MCCs and informal caregivers in the decision making process should be an essential part of SDM training for geriatricians, beyond the SDM steps of explaining options, benefits and harms. More attention should be paid to the integration of preparatory work in the consultation.
Service availability and readiness to provide comprehensive emergency obstetric and newborn care services in post-conflict at North Wollo Zone hospitals, Northeast Ethiopia: mixed survey
Authors: Tiruneh Misganaw Guadie , Fenta Eneyew Talie , Delie Amare Mebrat , Masresha Seteamlak Adane , Mustofa Semira Muhidin , Kidie Atitegeb Abera , Kodo Tsion Kokeb , Anagaw Tadele Fentabil
Published: March 2023

Introduction

Countries with humanitarian crises and fragile conditions contribute to 61% of the global burden of maternal mortality. Emergency Obstetric and Newborn Care (EmONC) services reduce direct obstetric complications, which cause approximately 70–80% of maternal deaths and 10% to 15% of neonatal deaths. Therefore, this study was aimed to assess the service availability and readiness to provide comprehensive emergency obstetric and newborn care services in post-conflict at North Wollo Zone hospitals, Northeast Ethiopia.

Methods

A facility-based mixed cross-sectional study design was conducted from May 10 to May 25, 2022, among North Wollo zone hospitals. Quantitative data were collected by using structured interviewer-administered questionnaires with observation and record review, entered by using Epi Data Version 4.6, and exported to SPSS 25 for analysis. Qualitative data were collected by key informant interviews and analyzed through thematic analysis. A descriptive data analysis was done to analyze the study variables.

Results

Only three of the six hospitals (Woldia, Shediho Meket, and Saint Lalibella) performed all signal functions of comprehensive emergency obstetric and newborn care in the preceding three months. Cesarean section was the least performed signal function in post-conflict. The overall readiness to provide comprehensive emergency obstetric and newborn care services was 77.7%. Only one of the six hospitals had sufficient blood without interruption, and three of the six facilities had done screening for hepatitis B, HIV, and syphilis. Lack of supplies, equipment, and drugs were the challenges for the performance of EmONC signal functions.

Conclusions

Post-conflict availability and readiness for comprehensive emergency obstetric and newborn care services in the North Wollo Zone was suboptimal. Shortage of medical supplies, equipment and emergency transportation was the challenges to provide these services. Thus, the hospital decision makers should strengthen leadership commitment, which focuses on recovering and rebuilding the destructed hospitals with resource mobilization and support.
Development and Evaluation of Rehabilitation Service Areas for the United States
Authors: Reistetter Timothy A. , Dean Julianna M. , Haas Allen M. , Prochaska John D. , Jupiter Daniel C. , Eschbach Karl , Kuo Yong-Fang
Published: March 2023

Background

Geographic areas have been developed for many healthcare sectors including acute and primary care. These areas aid in understanding health care supply, use, and outcomes. However, little attention has been given to developing similar geographic tools for understanding rehabilitation in post-acute care. The purpose of this study was to develop and characterize post-acute care Rehabilitation Service Areas (RSAs) in the United States (US) that reflect rehabilitation use by Medicare beneficiaries.

Methods

A patient origin study was conducted to cluster beneficiary ZIP (Zone Improvement Plan) code tabulation areas (ZCTAs) with providers who service those areas using Ward’s clustering method. We used US national Medicare claims data for 2013 to 2015 for beneficiaries discharged from an acute care hospital to an inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), long-term care hospital (LTCH), or home health agency (HHA). Medicare is a US health insurance program primarily for older adults. The study population included patient records across all diagnostic groups. We used IRF, SNF, LTCH and HHA services to create the RSAs. We used 2013 and 2014 data (n = 2,730,366) to develop the RSAs and 2015 data (n = 1,118,936) to evaluate stability. We described the RSAs by provider type availability, population, and traveling patterns among beneficiaries.

Results

The method resulted in 1,711 discrete RSAs. 38.7% of these RSAs had IRFs, 16.1% had LTCHs, and 99.7% had SNFs. The number of RSAs varied across states; some had fewer than 10 while others had greater than 70. Overall, 21.9% of beneficiaries traveled from the RSA where they resided to another RSA for care.

Conclusions

Rehabilitation Service Areas are a new tool for the measurement and understanding of post-acute care utilization, resources, quality, and outcomes. These areas provide policy makers, researchers, and administrators with small-area boundaries to assess access, supply, demand, and understanding of financing to improve practice and policy for post-acute care in the US.