bluuebunny/crossref_metadata_2025 huggingface dataset:
A Migratory Ecosystem: Legibility, Visibility, and the Role of Organizations in Ecuador
Authors: Russell S. Garnett , Rodríguez-Gómez Diana , Mantilla-Blanco Paula
Published: February 2025

With the highest number of displaced persons in history, migrants must navigate complicated systems to access rights and social services. In this article, we provide the perspective of organizational actors providing educational services to refugee and migrant populations in Ecuador. We draw on an analysis of 20 interviews with key informants to examine how global and national refugee and migratory policies shape the work of organizations. We find that organizations play an important role in navigating global and national policies around migration and education and in rendering the policies legible and the migrant populations visible. In addition, these organizations adapt an intersectoral approach, which points to the potential of education as an enabling right and also as an important link to other social services. We propose a migratory ecosystem framework for understanding the coexistence and overlap of multiple legal and policy categories and the implications for accessing social services.
Latent Freedom in Videogames
Authors: Nicoll Benjamin
Published: February 2025

Critical commentary about player freedom in videogames usually begins and ends with a critique of the ideology of free will. This focus misses a key way in which actual player freedom differs from the ideology of free will. Actual player freedom lies in the unconscious drive to fail rather than the capacity to make self-interested choices. When players satisfy their drive to fail, they experience a surplus of what Jacques Lacan calls jouissance, or enjoyment. Most videogames mystify our enjoyment by encouraging us to identify with fantasies of pleasure and mastery. But there are exceptions. Killer7 is an example of a game that exposes players to their enjoyment and, in so doing, draws attention to the freedom latent in the drive to fail.
THE INEQUALITIES IN EARLY CHILDHOOD CARIES ACROSS EUROPE
Authors: Twetman Svante
Published: February 2025

It is generally thought that early childhood caries (ECC) is a public health problem associated with impaired oral health-related quality of life and high costs for families and the society in general. There are numerous epidemiological studies available from various European countries and current ECC inequalities, not only across Europe but also within countries, are obvious. The burden of caries from different countries and regions can however not directly be compared with each other due to design, methodological and reporting issues. For example, there is no consensus on the definition of ECC, which age group(s) that should be examined, sample selection techniques, calibration and number of examiners, inclusion of non-cavitated early lesions, with or without bitewing radiographs, etc. On top of that, small children are not always cooperative, allowing proper cleaning and drying before the examinations. Consequently, it is not surprising to find that prevalence of ECC, assessed with the WHO-criteria, can vary from 86% in Kosovo to 15% in Italy. Likewise, the prevalence of severe ECC seems to range between 3 and 12% across Europe. The mean dmft is reported to vary 0.9 from 10.9. In spite of the abovementioned limitations, it is possible to trace an increasing tendency in the prevalence of ECC from the north-western to the south-eastern countries of Europe. Within all European countries however, there is a clear relationship between socio-economic inequalities and caries; children to low-income and low-educated parents with and without immigrant background display a higher risk of having caries lesions early in life. Poor and near poor 2-5 year-olds have on average 3 times higher dft than non-poor children and this association can be even stronger in the most developed countries. A further problem is that the majority of the disadvantaged children remain untreated. As a first step to combat existing caries inequalities in preschool children, it is important to better map and understand the disease as well as main socio-economic and behavioral determinants. The reporting of ECC (prevalence and severity) in epidemiologic studies must be standardized and the importance of including 3 and 5-year-old children in periodical examinations should be underlined. The adoption of a validated scoring system that allows proper staging of caries lesions is another key factor that should be adopted.
USE OF PUBLIC EMERGENCY DENTAL SERVICES BY CHILDREN IN TIRGUMURES, ROMANIA
Authors: SzÉkely M. , DÖrner K. , Nagy M. , Bors A. , Vass H.
Published: February 2025

In Romania, dental health services are provided mainly through user pays private practices and there is limited reimbursement of dental services for children from the government. The economic recession lead to substantial lack of insurance coverage for oral health care of low-income populations.

Aim: The aim of the study was to assess the impact of changes in the reimbursement of dental services on the demand for publicly funded emergency dental care for children provided by the Mures County Emergency Hospital, in the Mobile Emergency Service for Resuscitation and Extrication (MESRE), in Tirgu-Mures, Romania.

Methods: This four-year retrospective study was based on the analysis of patient’s dental records. Included in the study were all patients requesting emergency dental care at MESRE Dental Office in Tirgu- Mures since its establishment in 1st of February 2012. The study was approved by the Research Ethics Committee of the University of Medicine and Pharmacy of Tirgu-Mures. Data were analysed using SPSS v 17 for Windows descriptive statistics. Student t-test was used and the significance level was set at p<0.05.

Results: During the study period a total of 26949 patients were treated in the emergency dental office and the proportion of children (aged 0-18- years) was 5169 (19.2%). Compared to the first year of the service, the proportion of emergency dental care visits was significantly higher in all other years, particularly in the period when dental care for children was not reimbursed by the public system (p<0.05). However, the highest rate of emergency dental visits was observed in the last year 1524 (22.2%).

Conclusions: The results highlighted that dental services for children were influenced by changing state insurance schemes. The high demand for emergency dental care reflects the need for community based public dental care in Tirgu-Mures, Romania.
INFLUENCE OF PARENT’S EDUCATION ON SELF-PERCEIVED ORAL HEALTH IN CHILDREN
Authors: Sozovska-Stojanovikj E. , Getova B. , Stojanovikj P. , Janevska S. , Miloshevski N.
Published: February 2025

Parental socioeconomic characteristics are related to their children’s subjective perception on oral health.

Aim: To correlate the educational level of each parent, an individual-level indicator of socio-economic status (SES): with self-perceived oral health in a 12-year-olds in the region of Skopje.

Method: Cross-sectional design. The study sample was randomly drawn with a two-stage cluster sample from 12 year olds from the capital town of Macedonia-Skopje. The study was conducted in November- December 2015. Data were collected by the adapted and translated WHO Oral Health Questionnaire for children. Participation was voluntary and consent to participation was given by completing and returning the questionnaire. Of 307 questionnaires, 218 were returned. Since the questionnaire was used as a part of the National survey of oral health of 12 year olds in Macedonia, as part of an audit of the national programme, it did not require separate ethics approval. The data analysis was carried out by IBM SPSS Statistics 20.

Results: The study included 218 children (71% response rate) in total, 103(47.2%) male and 115(52.8%) female. Out of all the children who rated their teeth and gums health as excellent/very good, 66(71%), 77(67.5%) respectively, had mothers with a university degree. The children who rated their teeth and gums health as fair/poor, 84.7%, 85.7% respectively, had mothers with an education level below a university degree.

Conclusions: The mother’s educational level had an impact on children’s subjective perception of oral health. Children living with parents with higher educational level generally report better oral hygiene behaviors, access to health care and preventive interventions. The present study shows that parents educational level could be a useful individual SES indicator for oral health in children and health managers might use this factor when planning oral health promotion interventions.
CHANGES IN ADULTS’ HABITUAL VISITS TO A DENTIST
Authors: Torppa-Saarinen E.M. , Tolvanen M.M. , Lahti S.M. , Suominen A.L.
Published: February 2025

Aim: To evaluate changes in habitual use of dental services by gender and age groups in an adult population during 11 years in a nationally representative setting.

Methods: The data were collected by interviews as a part of the Health 2000 and Health 2011 programmes, during which 7,964 Finnish adults aged ≥ 30 years were surveyed. The Ethics Committees of the National Public Health Institute and University Hospital Region of Helsinki, Finland gave permission to these National Surveys. The participants were asked if they visited dentist: regularly for checkups, or only when having pain or other trouble, or never. The first option indicated habitual and the last two non-habitual visits to a dentist. The participants were categorized according to their year of birth: born 1971 of after, 1956-1970, 1946-1955 and 1945 or before. The changes were evaluated with cross-tabulation and the McNemar-test.

Results: 4,053 participants (51%) answered the question in both years. Habitual use of dental services was more common among women (66% in 2000 and 69% in 2011) than among men (53% in 2000 and 57% in 2011). The proportion of those reporting habitual visits changed according to age and gender as follows: among men born 1971 or later from 42% to 52% (p=0.009), among women born 1971 or later from 59% to 66% (p=0.057), among men born 1956-70 no change, 56% in both years (p=0.604), among women born 1956-70 from 70% to 72% (p=0.267), among men born 1946-55 from 54% to 64% (p<0.001), among women born 1946-55 from 70% to 72% (p=0.456), among men born 1945 or before from 59% to 55% (p=0.193) and among women born 1945 or before from 62% to 65% (p=0.223), i.e. the changes in habitual use were statistically significant only among men in two age groups.

Conclusions: The changes in habitual visits to a dentist were not substantial. Habitual service use was the pattern among the majority of adults in all age groups and among both genders during the 11 year period.

Partly supported by the Finnish Dental Society Apollonia.
CHILDSMILE DENTAL HEALTH SUPPORT WORKERS IMPACT ON CHILD DENTAL PARTICIPATION IN SCOTLAND
Authors: Hodgins F. , Conway D. , Gnich W. , Macpherson L. , Sherriff A.
Published: February 2025

Childsmile, a Scottish government funded national public health programme, aims to improve child oral health and reduce oral health inequality. Dental Health Support Workers (DHSWs) form one of the programme’s targeted strategies; primarily aiming to facilitate parents to access dental services for their children in the early years.

Aim: This study measured the impact DHSWs had on child registration and attendance with dental practice, investigating whether this was similar across social groups.

Method: National level data from three administrative health datasets were linked, including: 1) Child Health assessments (September 2010-December 2012) (n=111,909); 2) Health Informatics Centre data on DHSW contact with (referred) families (September 2010 -September 2012) (n=18,392), and 3) Management Information and Dental Accounting System data on dental participation (registration and/ or attendance) (September 2010-December 2013) (n=76,724). Analysis was undertaken through a secure research portal. Multivariable logistic regression models were used to analyse the effect of DHSW intervention on participation, and whether there was any modification of this effect according to area-based deprivation (using Scottish Index of Multiple Deprivation (SIMD) 2009). Survival analysis was used to analyse time to participation at dental practice. This study was NHS Privacy Advisory Committee (now the Public Benefit and Privacy Panel) approved.

Results: Preliminary results show that, across the whole population, 80.8% (n=14852/18392) of those who received a DHSW intervention participated at dental practice compared to 66.2% (n=61872/93517) who did not receive an intervention (OR=2.1, 95% CI [2.1 to 2.2], p<0.0001). This effect was slightly modified when stratified by area-based deprivation: In children living in the 20% most deprived areas of Scotland, participation was 77.6% (n=12417/20494) for those receiving the intervention vs. 60.6% (5908/7614) for those not. For those living in the 20% least deprived areas the figures were: 84.0% (1178/1403) vs. 69.8% (11607/16631), respectively (p for interaction=0.25). Survival analysis showed that the median age when a child first participated at dental practice was 9 months for those who received a DHSW intervention and 19 months for those who did not.

Conclusions: Participation rates at dental practice were higher for families who received the DHSW intervention, compared to those who did not, the effect only slightly stronger for those living in more deprived areas. Participation at dental practice was facilitated sooner for children receiving DHSW support. Ongoing work is addressing whether these benefits translate to a clinically important reduction in inequalities in oral health.
THE ROLE OF LEADERS IN PREVENTING HEALTH INEQUALITIES
Authors: Allen Y. , Shah S.
Published: February 2025

The aim of this literature review was to review the evidence for the importance of effective leadership and to identify key features of leadership that promote the reduction of health inequalities within healthcare systems.

Methods: The review used search and MeSh terms related to “leadership” and “health inequalities” and the PubMed search engine. Inclusion criteria were: published in the last 10 years and available in English.

Results: One thousand three hundred and eighty five papers were found, of which 52 papers were identified, by the sole reviewer, as relevant to leadership and health inequalities. The themes focussed on 11key areas of the role of leadership in reducing health inequalities. These included adequate representation amongst leaders to reflect the demographic distributions within populations. Gender inequality amongst leaders was identified as an area that could potentially have an impact of health inequalities within populations. The political impact on the wellbeing and inequalities present within populations highlighted the role of health and social care in partnership with political groups to reduce disparities and the need for collaborative working, from a political global perspective, to have a greater impact on worldwide health inequalities. The literature suggested that Community leaders within populations can empower communities, reduce health inequalities and promote social change. Community leaders can also act as leverage points in the wider public health agenda working with leaders within the health sector. Given that these inequalities are related to health and health outcomes, many papers discussed the role of clinical leadership across health professions and the responsibility to appropriately train and develop clinical leaders and to ensure leadership succession, sustainability and the legacy of programmes to reduce health inequalities. Key issues in the future are the continual change within health services and the need to ensure consistent leadership in relation to reducing inequalities through change, and having an understanding of digital enablers to reduce inequalities.

Conclusions: These results suggest that key features of good leaders are: inter-professional working and networking, political awareness, empowering others and a strong drive and vision with resilience. Drivers for the reduction of health inequalities included, political input and influence, representative workforce and leaders and inequalities within leadership roles, global and local collaboration, involvement of the third sector and community leadership, clinical leadership, succession planning for clinical leaders and a knowledge and understanding of the digital enablers to reduce health inequalities. However some health inequalities are ingrained and built into the health systems. Analysis via institutional theory suggests that leaders are required to promote change at all levels to tackle the underlying causes of health inequalities.
DENTAL CARIES: A PATENT ANALYSIS
Authors: Bencze Z. , Varga O.
Published: February 2025

Although there have been significant achievements in dental caries prevention and management in the European Union (EU), there is still a lot to be done. One approach to reduce caries prevalence is to promote novel technologies in prevention, diagnosis and treatment. The current EU Health Strategy supports and sets development of new technologies as a priority since new technologies can contribute to the efficiency and sustainability of health systems.

Aim: The aim of this work was to provide a patent landscape analysis to detect patterns of innovation in the area of caries research.

Methods: Patent analysis is a well-established method for studying development in a particular research area. In this study patents and patent applications were extracted from the Patbase, an international database from over 100 patent issuing authorities worldwide. The patents were searched combining different search terms related to dental caries in the titles, abstract, claims and examples of documents. Searches were limited to human necessities (CPC A61).

Results: The analysis was based on patenting activity trend, geographical distribution, research topics and patent holders. The patent search resulted in 2089 patent families with 12640 applications. The analysis of the place of patent filing resulted in 80 jurisdictions, with strong US dominance. To understand the technology focus, patents were grouped under three

concepts: prevention, diagnosis and treatment. The highest numbers of patented innovation was associated with a few directions in treatment research. The overall patenting trend showed an increase in filings up to 1992, then a second spike up to 2015. Although the main patent holder was the Colgate Palmolive Co. out of 1371 assignees, in the field of prevention Johnson and Johnson had an important role.

Conclusion: Patenting activity was found to have been intense in the last 10-15 years. Private sector companies dominate a wide variety of types of research, including the field of prevention.
KNOWLEDGE OF ORAL CANCER RISK FACTORS AMONG LITHUANIANS
Authors: KŠČenaviČiŪtĖ V. , Puriene A. , Zaleckas L. , Rasteniene R.
Published: February 2025

Morbidity of oral oropharyngeal cancer and a lack of knowledge of risk factors is a concern in Lithuania. The aim of present study was to assess the knowledge of oral cancer risk factors among Lithuanians.

Methods: An anonymous pretested 20-item survey was distributed to all patients who were examined in four hospitals of Lithuania during oral cancer prevention events on 2016, February 22-26. The Lithuanian Bioethics Committee stated that approval for the study was not required. The survey included questions about background characteristics, unhealthy behaviours and risk factors for oral cancer. The collected data were analysed using SPSS v21.0. Spearman’s rank order correlation, ANOVA tests were used. The significance level was set at p<0.05.

Results: 803 people participated in events of Mouth Cancer Action Week and a convenience sample of 724 completed the survey; response rate 90.2%. Male to female ratio: 1:2.6. Average age of the patients was 57.5 ± 16.6 years. 537 (74.2%) were from urban areas. The majority of respondents had university level education (n=357, 49.1%). 324 (44.6%) were workers and 334 (45.9%) were pensioners. Patients agreed smoking (86.8%), older age (63%), alcohol consumption (56.3%), sunlight exposure (47.3%), lip and buccal mastication (40%), HPV (33.7%), low consumption of fruits and vegetables (33.1%) were risk factors of oral cancer. Only 18 (2.5%) respondents agreed that they have enough information about oral cancer. The mean knowledge seemed to be medium (3.62 ± 1.86 from a maximum score of 7). Socioeconomic status and alcohol consumption were associated with level of oral cancer primary prevention knowledge (p=0.02, p=0.03 respectively). Better knowledge was found in patients who receive dental treatment in private clinics (p=0.005).

Conclusions: A gap in oral cancer risk factors knowledge was found among Lithuanian patients, preventive programs and educational measures may decrease the prevalence of unhealthy behaviours and oral cavity malignancies.
REPORTED INTERNET AND COMPUTER USE AMONG SENIOR DENTAL STUDENTS, TEHRAN
Authors: Bonabi M.
Published: February 2025

Computers and the internet has revolutionised all aspects of medicine and dentistry, and internet and social networks are now common among young doctors. The aim of this study was to evaluate information technology (IT) literacy among senior dental students of Tehran, Iran.

Method: A questionnaire was constructed based on previous literature and some researcher- made questions. After checking for reliability and validity, we collected data on self-reported internet and computer use. The ethics committee of Tehran University of Medical Sciences (TUMS) approved the survey. All numerical data were entered and analysed using the Statistical Package for Social Sciences (SPSS version 18). Initial descriptive statistics were expressed as frequency, mean and standard deviation. A regression model served for statistical analysis.

Results: In total 218 questionnaires out of 250 were returned for an overall response rate of 85%. The student score for computer use ranged between 7 and 28 with a mean of 18.6(±4) out of a maximum of 28. Also their score for internet searching ranged between 6 and 24 with a mean of 15.3(±4) out of a maximum of 24. Among students 67% (n=145) searched daily in Medline, 73% (n=160) used search engines such as Google. Most, 81% (n=176) of students had skills in windows, 72% (n=157) in advanced web searching, 77% (n=168) in Microsoft Office software and 16% (n=34) in SPSS. In the regression model we found that internet searching is related to computer use with a relation coefficient of 0.607 among respondents (p<0.001).

Conclusion: Considering the mean scores, senior dental students’ IT literacy is not sufficient and most of the students reported the need to gain more searching skills. This suggests more training and providing better infrastructure to promote their IT literacy.
Spontaneous hemoperitoneum in the second trimester of pregnancy with a favorable outcome: a case report
Authors: Fu Lirong , Zhang Li , Xu Lijuan , Xu Peirong , Liu Kai , Ding Zhuyun
Published: February 2025

Spontaneous hemoperitoneum in pregnancy is extremely rare but may cause severe hemorrhage, resulting in a high rate of mortality. We report a case of a primigravid woman who complained of middle-upper abdominal pain. She was admitted to our department at 24 + 6 weeks of in vitro fertilization gestation with a surgical history of endometriosis. The patient’s non-specific presentation posed diagnostic difficulties and intestinal obstruction was initially suspected. Emergent computed tomographic findings showed massive free abdominal fluid, which was suspected to have arisen from the left ovary or uterus. During an emergency exploratory laparotomy, she had interrupted suturing of a ruptured left uterine subserosal vein performed. Computed tomographic imaging is more helpful for isolating the source of bleeding than ultrasound. Prompt action of an exploratory laparotomy can result in favorable outcomes for the mother and newborn in spontaneous hemoperitoneum in pregnancy.
Analysis of angiotensin-converting enzyme (ACE), ACE2, and their genetic polymorphisms in patients with acute aortic dissection and coronary heart disease
Authors: Li Yang , Xiao Zongwei
Published: February 2025

Background

This study aimed to elucidate the distinctions between the expression levels of angiotensin-converting enzyme (ACE) and ACE2, as well as their genetic polymorphisms, in patients with acute aortic dissection (AD) and coronary heart disease (CHD).

Methods

A cohort of 86 patients was enrolled, comprising 34 individuals with acute AD (encompassing Stanford types A and B), 18 with ascending aortic aneurysm, 21 with CHD, and 13 healthy controls. Aortic tissue samples were procured from 44 patients during surgical interventions.

Results

Statistically significant differences were observed in ACE and ACE2 expression levels among the ascending aortic aneurysm, CHD, and control groups ( p < 0.05). However, the expression of ACE messenger ribonucleic acid (mRNA) in the aortic wall was significantly higher in the AD group than in the ascending aortic aneurysm and CHD groups ( p < 0.05). Additionally, the expression of ACE2 mRNA and the ACE/ACE2 ratio in the aortic wall were significantly different in the AD group compared with the ascending aortic aneurysm and CHD groups ( p < 0.05).

Conclusion

Plasma ACE levels, and the gene expressions of ACE and ACE2, are markedly reduced in patients with acute AD. The observed imbalance in ACE and ACE2 expressions may play a pivotal role in the pathogenesis of AD.
Unveiling the Journey to Community Reintegration: Results from a Qualitative Study with Sexual Offenders on Parole
Authors: Cardoso Ana Rita , Quintas Jorge , Santos Gilda
Published: February 2025

After serving a prison sentence, sex offenders embark on a community reintegration process, where they usually face several barriers that might negatively affect their successful return to society. Results from semi-structured interviews conducted with sex offenders revealed that participants perceive the economic difficulties, the nature of the crime, and the stigma as the main social factors hindering their community reintegration process. Additionally, prison and parole support are described as insufficient, lacking focus on the specific needs of the participants to act as an effective help. On the contrary, housing and affective relationships were not perceived as major obstacles to a successful reintegration. These findings highlight the need for policies that promote economic opportunities, reduce stigma, and enhance both prison-based and post-release support to facilitate a more effective reintegration process.
Integrating Traffic Conflict Frequency and Severity Indicators to Estimate Pedestrian Safety Performance Functions for Signalized Intersections
Authors: Hasanpour Maryam , Persaud Bhagwant , Milligan Craig
Published: February 2025

Assessing intersection safety for pedestrians based on crashes can be challenging because of the paucity of crashes. This is why surrogate measures of safety, typically traffic conflicts, have been used as an alternative approach for such assessments. Insufficient sample size has also presented a challenge in developing conventional safety performance functions (SPFs) for estimating pedestrian crash frequency in a variety of Highway Safety Manual applications. This challenge can also be resolved with the surrogate measures approach, in that these measures can logically capture the effects of geometric and operational variables that influence safety, thereby providing a useful complementary approach for developing SPFs, especially where sample sizes are small. This paper develops SPFs for pedestrian crashes at signalized intersections based on traffic conflicts, and in the process, it advances the methodology for this approach. Machine learning was used to develop a data-driven safety index that integrates frequency and severity indicators. This index was developed to classify conflicts into groups using a database of pedestrian conflicts derived from video observations at 44 intersections in five Canadian cities. The frequencies of conflicts in these groups, and crashes at these intersections, were then utilized to estimate SPFs. The results are promising in that they demonstrate the potential of using machine learning to estimate SPFs using surrogate measures. The approach is especially important given the focus on pedestrian crashes in Vision Zero plans and the reality that crash samples are typically too small for estimating pedestrian SPFs that directly capture the effects of multiple variables.
Association between systemic coagulation-inflammation index and proximal upper-extremity arteriovenous graft thrombosis in hemodialysis patients
Authors: Cetintas Demir , Guven Hakan
Published: February 2025

Introduction:

To the best of our knowledge, the potential predictive association between systemic coagulation-inflammation index (SCI) and arteriovenous graft (AVG) thrombosis following proximal upper-extremity AVG surgery has not yet been investigated. Thus, in this study, we investigated the predictive value of SCI on postoperative early-term AVG thrombosis in patients undergoing proximal upper-extremity AVG surgery for hemodialysis access.

Methods:

A total of 118 hemodialysis patients undergoing proximal upper-extremity AVG surgery were enrolled to this retrospective observational cohort study. The patients were categorized into two groups in accordance with whether postoperative early-term AVG thrombosis developed; as thrombosed AVG group ( n = 37) and non-thrombosed AVG group ( n = 81). Basic clinical features and laboratory test results of the patients were recorded and compared between the groups.

Results:

Patients in thrombosed AVG group were significantly older than those in non-thrombosed AVG group. The mean WBC and neutrophil counts were significantly lower whereas the mean fibrinogen and median SCI values were significantly higher in thrombosed AVG group compared to non-thrombosed AVG group. In terms of other basic clinical features and laboratory tests, there were no significant differences between both groups in univariate analyses. In multivariate logistic regression analysis, only age and SCI maintained their statistical significance and thus were accepted as independent predictors of AVG thrombosis. ROC analysis demonstrated that SCI of 47 g/L constituted the optimum cut-off value with 94.6% sensitivity and 88.9% specificity rates in predicting AVG thrombosis.

Conclusion:

Our study revealed for the first time in the literature that SCI independently predicted postoperative early-term AVG thrombosis in hemodialysis patients undergoing proximal upper-extremity AVG surgery.
A Case Series Study of Airway Pressure Release Ventilation in Patients with Intracranial Pathologies and Acute Respiratory Failure
Authors: Schmidt Leon , Lamb Keith , Jankovic Dragan , Kalasauskas Darius , Kosterhon Michael , Ringel Florian , Kerz Thomas
Published: February 2025

Background: Airway Pressure Release Ventilation (APRV) is an alternate mode of ventilation in acute respiratory failure (ARF), but there is inconsistent data to support its use over other modes of ventilation. Because of increased intrathoracic pressure for most of the respiratory cycle, a negative impact of APRV on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) has been hypothesized. We evaluated the effects of APRV ventilation, with particular attention to ICP, CPP and ICP-directed therapy, in a real-world cohort of neuro-ICU patients. Methods: Retrospective single-center analysis from January 2021 to December 2023 of neurosurgical ICU patients with ICP monitoring. APRV was used as a rescue mode at the physician's discretion when the Horovitz index (PaO2/FIO2 ratio) fell below 150 despite optimized conventional ventilation. Results: Between 2021 and 2023, APRV was utilized in 29 patients undergoing a total of 60 episodes. Forty patients (66.7%) were female, median age was 49.5 (Q1 34; Q3 61.25) years.

After transition to APRV, mean FiO2 decreased by 4.3% (t = 3.5, p < .001) and mean PaO2 increased by 22.7 mm Hg (t = 4.2, p < .001). The Horovitz index improved by 44.6 mm Hg (t = 4.9, p < .001). Mean compliance did not differ after transition to APRV (−1.5 ml/mbar, t = −0.9, p = .4).

During the APRV episode, mean ICP was 1.2 mm Hg lower (t = 2.6, p = .01), while mean CPP was 1.6 mm Hg higher (t = −0.9, p = .4) and the intensity of ICP-directed therapy (TIL) was significantly lower (X2 = 92.771, p < .001). Conclusion: APRV was hemodynamically tolerated in 29 out of 33 patients, and was safe with regard to ICP, CPP, and the intensity of ICP-directed therapy. Oxygenation was increased by APRV. 4 out of 33 patients would not tolerate APRV for hemodynamic reasons, APRV therefore was stopped immediately.
Association of Number of Oral bacteria with Ventilator-Associated Pneumonia and Delirium in Patients in the Intensive Care Unit
Authors: Arimizu Chika , Akahoshi Tomohiko , Jinno Teppei , Furuta Michiko , Ohashi Ayako , Takamori Shinnosuke , Wada Naohisa
Published: February 2025

Objectives

Ventilator-associated pneumonia (VAP) and delirium are major complications among patients in the intensive care unit (ICU). The impact of oral bacterial count on these conditions is not well understood. This study aimed to explore the association between oral bacterial load and the incidence of VAP and delirium in ICU patients.

Methods

In this single-center longitudinal study, 130 patients admitted to the ICU from September 2022 to May 2023 were included. Oral bacteria counts on the tongue were quantified, and assessments of oral health using the Oral Health Assessment Tool (OHAT) and oral moisture levels were also conducted. We examined the associations between oral bacterial count, OHAT scores, and oral moisture with the incidence of VAP and delirium.

Results

The incidence rates of VAP and delirium were 31.4% and 35.4%, respectively. Patients with a high oral bacterial load (≥5.0 × 107 CFU/mL) at ICU admission had a higher likelihood of developing VAP (odds ratio [OR] 7.43, 95% confidence interval [CI] 1.68-32.87) and delirium (OR 3.30, 95% CI 1.04-10.44) compared with those with lower bacterial counts (<1.0 × 107 CFU/mL). No significant associations were found between OHAT scores and oral moisture and the occurrence of VAP or delirium.

Conclusion

A higher oral bacterial count at ICU admission was associated with increased incidences of VAP and delirium.
Recognizing the role of occupation in social prescribing
Authors: Rose Ivory
Published: February 2025

MeSH terms: Social Determinants of Health, Occupational Therapy, Health Equity, Loneliness, Quality of Life, Lifestyle, Social Interaction, Social Medicine.
Exploring Discharge Preparedness of Patients With Stroke: A Qualitative Descriptive Study
Authors: Pourliaka Tatiana , Tsiakiri Anna , Proios Hariklia
Published: February 2025

Aim: This study aimed to explore the experiences and perceptions of patients in a rehabilitation center who had experienced a stroke, regarding their concerns about discharge and life after stroke. Methods: A qualitative descriptive design was used and unstructured interviews were conducted with 100 patients with stroke. Reflexive thematic analysis was employed to identify recurring patterns and themes in the data, ensuring an in-depth understanding of the participants’ experiences. Results: Three themes were generated from the analysis: (a) general post-hospitalization concerns, (b) concerns regarding the ability to handle activities of daily living, and (c) post-discharge aspirations and goals. Conclusions: This study sheds light on the diverse perspectives of patients with stroke regarding discharge from rehabilitation centers. A person-centered approach for patients with stroke is an important step for coordinating discharge planning. Developing a personalized care plan for meeting patients’ needs is critical to address fundamental care issues.
PEDI: Towards Efficient Pathway Enrichment and Data Integration in Bioinformatics for Healthcare Using Deep Learning Optimisation
Authors: Manoharan Hariprasath , Selvarajan Shitharth
Published: February 2025

This work presents an enhanced identification procedure utilising bioinformatics data, employing optimisation techniques to tackle crucial difficulties in healthcare operations. A system model is designed to tackle essential difficulties by analysing major contributions, including risk factors, data integration and interpretation, error rates and data wastage and gain. Furthermore, all essential aspects are integrated with deep learning optimisation, encompassing data normalisation and hybrid learning methodologies to efficiently manage large-scale data, resulting in personalised healthcare solutions. The implementation of the suggested technology in real time addresses the significant disparity between data-driven and healthcare applications, hence facilitating the seamless integration of genetic insights. The contributions are illustrated in real time, and the results are presented through simulation experiments encompassing 4 scenarios and 2 case studies. Consequently, the comparison research reveals that the efficacy of bioinformatics for enhancing routes stands at 7%, while complexity diminish to 1%, thereby indicating that healthcare operations can be transformed by computational biology.
Analysis of dynamic response coefficients of micropolar lubricated partial arc journal bearings
Authors: Sharma Sanyam , Sharma Gaurav
Published: February 2025

This paper concentrates on examining the dynamic response coefficients of partial arc journal bearings of 120° and 180° partial angle, working with micropolar fluid. A MATLAB code is developed to solve Modified Reynolds’ equation with finite element method. Dynamic response coefficients are computed and presented for the different lubricant parameters and working eccentricities. The computed results illustrate that these input parameters improve the dynamic performance of the partial arc journal bearing system. The presented results provide data for non dimensional stiffness and damping coefficients. These response coefficients may be effectively utilized by the designers in future, for computing the stability and thermal analysis of partial journal bearing system.
Facilitators of Leadership Among Latina Nurse Leaders
Authors: Canli Ursula , Aquino Elizabeth
Published: February 2025

Introduction: The lack of diversity in the nursing workforce, especially in nursing leadership, remains an ongoing challenge for healthcare organizations. Only about 9% of the nursing workforce is Latinx, and few serve in leadership positions. This study aims to learn about the facilitating factors that have supported Latina nurse leaders in their ascension into leadership roles. Methods: Using a qualitative descriptive study approach, Latina nurse leaders were individually interviewed about their nursing journeys. A conventional thematic content analysis approach was used to identify common themes. Results: Seventeen Latina nurse leaders shared their experiences. The themes that emerged included: understanding one's purpose (desire to lead, serve as a role model), transformative experience (familial influence, service to others, other leaders that look like me), and cultivating intentional networks (mentorship, core group of people that you trust, finding commonality or connection). Conclusion: Findings from this study underscore the factors that facilitate the leadership development and success of Latina nurses. Understanding the facilitators is important for nurturingLatina nurse leaders, enabling organizations and institutions to provide effective support. Additionally, sharing leadership stories can inspire and guide the next generation of Latina leaders, aiding them in their own leadership journeys.
The perception and value of performance analysis within elite academy football: A comparison between phases
Authors: Dhillon Chloe L. , Nicholls Scott B. , Woodward Jon
Published: February 2025

The originality of study ascertained coaches’ engagement and integration of Performance Analysis (PA) practice across the Foundation (FP), Youth Development (YDP), and Professional Development (PDP) phases within elite academy youth football. Sixty-five (65) coaches (experience 5.5 ± 4.0) completed an online survey focusing upon their utilisation and access to analysis tools, recollection and reflective practice, communication and professional relationship, suggested improvements and current value of PA services. Likert scales (Always, Usually, Sometimes, Rarely, No Access) were used to facilitate comparison. Analysis was undertaken using Kruskal-Wallis and Dunn's post hoc tests to identify differences in response provision between academy phases. The engagement and integration of PA practices varied significantly across phases due to time, resources, and buy-in. PA usage progressed from FP to PDP, with greater integration and more sophisticated tools becoming prevalent towards the latter stages of a player's academy journey. Overall satisfaction with PA services was high, but clear improvement areas were highlighted, particularly around Independent Learning Plans (ILP) and the presence of analysts during training sessions across all phases. Despite the introduction of the Elite Player Performance Plan (EPPP), the study's significance highlights insufficient guidance on how PA should be distributed across phases. This has led to a disproportion of PA across phases with the potential benefits for the FP and YDP being under realised.
Potential predictors of efficacy outcomes following tofacitinib dose reduction in patients with ulcerative colitis in stable remission: a post hoc analysis of outcomes from the RIVETING study
Authors: Torres Joana , D’Haens Geert R. , Regueiro Miguel , Santana Genoile , Panés Julian , Vermeire Séverine , Gardiner Sean , Kulisek Nicole , Modesto Irene , Su Chinyu , Lawendy Nervin , Mundayat Rajiv , Paulissen Jerome , Dubinsky Marla C.
Published: February 2025

Background:

Tofacitinib is an oral Janus kinase inhibitor for the treatment of ulcerative colitis (UC).

Objectives:

To investigate potential predictors of efficacy in RIVETING.

Design:

This post hoc analysis included patients with UC in stable remission (⩾6 months) on tofacitinib 10 mg twice daily (BID) maintenance therapy (⩾2 years of treatment), who received tofacitinib 5/10 mg BID in RIVETING.

Methods:

Achievement of modified Mayo (mMayo) remission, remission (based on total Mayo score), partial Mayo score (PMS) remission, and modified PMS (mPMS) remission at month (M)6 was analyzed by baseline characteristics, duration of PMS remission at RIVETING entry, biomarkers, and patient-reported outcomes (PROs) to identify factors associated with achieving/maintaining efficacy outcomes, including following dose reduction.

Results:

Seventy patients received tofacitinib 5 mg BID. At M6, PMS remission was maintained in 66.7%, 60.0%, 82.4%, 75.0%, and 90.0% of patients with baseline PMS remission durations of 6 to ⩽12, >12 to ⩽24, >24 to ⩽36, >36 to ⩽48, and >48 months, respectively. Patients in mMayo remission at M6 had smaller increases in PMS at M1 compared with those not in mMayo remission at M6, while numerically higher proportions of patients with a stool frequency subscore/rectal bleeding subscore/mPMS of 0 at M1/M3 achieved most efficacy endpoints at M6 compared with patients with respective subscores >0. Maintenance of mMayo remission was independent of the number of tumor necrosis factor inhibitors failed and/or prior corticosteroid use. In multivariable models (which included tofacitinib 10 mg BID data), endoscopic subscores (1 vs 0) at RIVETING baseline were significantly associated with lower odds of mMayo remission at M6 (odds ratio, 0.33; 95% confidence interval, 0.11–0.94; p = 0.0379).

Conclusion:

Prior duration of remission/baseline endoscopic subscore may help guide tofacitinib dose reduction, while PROs may be useful early indicators of efficacy. Close monitoring of patients following dose reduction could identify those unlikely to achieve/maintain efficacy. Trial registration: ClinicalTrials.gov: NCT03281304.
Breast cancer image analysis utilizing feature fusion-based hybrid classification network influenced by adaptive u-net with generative adversarial segmentation network
Authors: Kalavathi Rathlavath , Swamy Das M
Published: February 2025

Nowadays, breast cancer is a very dangerous sickness among women though well-timed identification relatively enhances the rate of survival. To win over the breast tumor, an effective diagnosis mechanism is very necessary. The removal of tumor cells from the affected area stay as challenging. Classifying the breast tumor is very challenging for pathologists because of the tumor cell's heterogeneous nature. Hence, it is important to adopt an efficient breast tumor classification architecture employing a deep learning strategy. It supports the premature detection of breast cancer and proper treatments that help to prolong the chances of patients’ survival. Initially, the segmentation procedure is executed in the input images using an Adaptive U-Net Generative Adversarial Network (AUNet-GAN). Moreover, the variables of AUNet-GAN are tuned employing the Enhanced Golf Optimization Algorithm (EGOA). The major principle of segmentation is to change its illustration into a meaningful format of the image. Further, the segmented images are fed to the Feature Fusion-based Hybrid Network (FFHNet)-aided classification of the breast cancer model. This classification process is utilized to attain better benign and malignant. Later, several experimental observations are executed to estimate the efficacy rate of the designed method over the baseline models and also diverse efficacy metrics like accuracy, False Negative Rate (FNR), Prevalence Threshold (PT), dice coefficient, etc. The accuracy of the offered approach for datasets 1 and 2 is 94.30 and 95.44. Accordingly, the accuracy values of the existing works like CNN, ResNet, RNN, and VGG16 for dataset 1 are 89.33, 91.70, 91.70, and 90.99 and also for dataset 2 is 89.54, 82.91, 90.99, and 92.75. Thus, the empirical outcomes of this study help to provide proper treatment for breast cancer and the usage of classifiers efficiently improves the accuracy and strength of detection for breast cancer models.
Feeling out of it: Displacement, disengagement and dispossession in experiences of brain fog
Authors: Bissell David
Published: February 2025

This article is an attempt to establish the significance of being ‘out of it’ for geographical thought that both troubles and broadens how we think about bodily experience, as well as an invitation to geographers to take this thinking forward in pluralistic ways. The first part situates being out of it in relation to three classic geographical concepts – place, practice, and power. It explains how experiences of being out of it create opportunities for rethinking displacement, disengagement, and dispossession as affective concerns, beyond their more familiar political economy purview. The second part explores one specific manifestation of being out of it by drawing on a literary account of brain fog to broaden geographical understandings of displacement, disengagement, and dispossession as specifically cognitive affective concerns. Attending to this overlooked form of embodiment complicates how we think about subjectivity in geography, it spurs ethical dilemmas about how to respond to those who are out of it, and it raises fundamental questions about what it is to participate in social, political and economic life.