bluuebunny/crossref_metadata_2025 huggingface dataset:
Fetal and Neonatal Autopsy in the Molecular Age: Exploring Tissue Selection for Testing Success
Authors: Doughty Elizabeth S. , Post Miriam D.
Published: December 2023

While conventional autopsy is the gold-standard for determining cause of demise in the fetal and neonatal population, molecular analysis is increasingly used as an ancillary tool. Testing methods and tissue selection should be optimized to provide informative genetic results. This institutional review compares testing modalities and postmortem tissue type in 53 demises occurring between 20 weeks of gestation and 28 days of life. Testing success, defined as completion of analysis, varies by technique and may require viable cells for culture or extractable nucleic acid. Success was achieved by microarray in 29/30 tests (96.7%), karyotype in 40/54 tests (74.1%), fluorescent in situ hybridization in 5/9 tests (55.6%), and focused gene panels in 2/2 tests (100%). With respect to tissue type, postmortem prepartum amniotic fluid was analyzed to completion in 100% of tests performed; compared to 84.0%, 54.5%, and 80.8% of tests using placenta, fetal only, and mixed fetal-placental tissue collection, respectively. Sampling skin (83.3%, in cases with minimal maceration) and kidney (75.0%) were often successful, compared to lower efficacy of umbilical cord (57.1%) and liver (25.0%). Addition of genetic testing into cases with anomalous clinical and gross findings can increase the utility of the final report for family counseling and future pregnancy planning.
Knowledge, attitude, and practice (KAP) towards glaucoma among new glaucoma patients and their first-degree relatives: A cross-sectional study in a tertiary eye care centre in Riyadh, Saudi Arabia
Authors: AlQahtani Ghadah Mohammed S , Al Zahrani Abdullah T , Ahmad Khabir , Albalawi Alaa Nukhaylan , Obeid Dana Ahmad , Al Shahwan Sami
Published: December 2023

Purpose

Glaucoma, a disease characterized by optic nerve damage and associated visual field defects, is the main cause of irreversible loss of vision, both globally and locally. Appropriate management of glaucoma involves early diagnosis in addition to early and continuous control of the disease to protect the optic nerve from further damage. This study aimed to assess the knowledge, attitude, and practice (KAP) towards glaucoma among patients making their first visit to the glaucoma clinics, at King Khaled Eye Specialist Hospital in Riyadh, and their first-degree relatives.

Methods

This cross-sectional study used self-administered questionnaires. Informed consent was obtained prior to questionnaire distribution. The questionnaire included four sections on sociodemographic data, and awareness, and KAP towards glaucoma.

Results

Overall, 120 participants were included in our study: 70 (58.3%) were glaucoma patients and 50 (41.7%) were first-degree relatives. Forty-four (62.9%) participants in the patient group and 39 (78%) in the relative group were men. Thirty-four (48.6%) patients were aged 41–65 years, whereas 41 (82%) relatives were aged 18–40 years. Thirty-six patients (52.2%) and 35 relatives (70%) had heard of the term ‘glaucoma’. The correct definition of glaucoma was selected by only 12 participants (17.1%) in the patient group and 4 (8.2%) in the relative group. Living outside the central region of Saudi Arabia and having a negative systemic medical history were associated with poorer knowledge of glaucoma definition (p < 0.05). Although 84.8% of patients believed that compliance with anti-glaucoma medications helps in disease control, only 22.7% reported good compliance. The correct method of instilling eye drops was stated by 43.9% of the patients, and good hospital visit habits were reported by 53.03%. Eighty percent of glaucoma patients strongly recommended that their first-degree relatives be screened for glaucoma.

Conclusion

Knowledge about glaucoma is still limited, and awareness programs need to be further activated to spread correct knowledge about the nature of glaucoma, the importance of compliance with treatment, the correct method of instilling eye drops, and the significance of screening at-risk individuals. Patient families should also be involved in educational programs.
Effects of CSF1R/p-ERK1/2 signaling pathway on RF/6A cells under high glucose conditions
Authors: Yuan Lin Hui , Zhang Li Jun
Published: December 2023

Objective

This study analyzed how high glucose affects CSF1R and p-ERK1/2 expression in RF/6A cells.

Methods

The cells were cultured as high glucose (HG) and normal control (C) groups, and CSF1R shRNA was introduced. Real time PCR was used to detect the expression of CSF1R and p-ERK1/2 mRNA. Western blot was used to detect the expression of CSF1R and p-ERK1/2 proteins. Cell Counting Kit 8 (CCK-8) method was used to detect cell proliferation, while flow cytometry was used to detect apoptosis in HREC.

Results

Real-time PCR showed significantly raised CSF1R mRNA expression in HG. CSF1R inhibition lowered HG + LV shCSF1R CSF1R mRNA levels. Western blotting revealed higher CSF1R and p-ERK1/2 protein expression in HG than in C. Their expression level dropped after CSF1R inhibition. The number of tube-forming cells was higher in HG than in C, which reduced after CSF1R suppression. Inhibiting CSF1R also decreased cell proliferation and raised apoptosis.

Conclusion

Overall, under high glucose, CSF1R and p-ERK1/2 were highly expressed, leading to reduced cellular activity, and CSF1R inhibition helped alleviate this effect.
Performance analysis of tilting pad thrust bearing incorporating the surface roughness, texture and turbulence effect
Authors: Wang Lili , Zou Rui , Duan Jingdong , Chen Ming
Published: December 2023

In order to improve the lubrication performance of the friction pair, the effect of composite micro-texture on the lubrication performance of the tilting pad thrust bearing is studied. Based on the structural model of tilting pad thrust bearing considering composite micro-texture, the lubrication characteristics of thrust bearing with composite micro-texture parameters and tilting pad parameters are analyzed. At the same time, the theoretical model of tilting pad composite micro-texture bearing considering roughness and turbulence effect is established, and the performance of thrust bearing considering roughness and turbulence effect is studied. The results show that the performance of composite micro-textured bearings is better than that of single micro-textured bearings, the performance of tilting pad bearings is better than that of parallel pad bearings, and the performance of circular composite fish-shaped micro-textured tilting pad bearings is the best. The optimal bearing fulcrum position is near the inner diameter, and the optimal fulcrum circumferential inclination angle is about 27.5°. Considering the roughness and turbulence effect, the maximum pressure and bearing capacity of the bearing improves, and the friction coefficient significantly reduces.
Friction and wear study of metallic contacts under dry sliding conditions: A molecular dynamics simulation-based approach
Authors: Kumar Sudhanshu , Rajput Ashutosh , Paul Surajit Kumar , Tiwari Mayank , Prajapati Deepak Kumar
Published: December 2023

Sliding friction originating due to ploughing and adhesive wear significantly affects the performance of small-scale components, that is, nano-electromechanical systems/micro-electromechanical. To get a comprehensive understanding of the friction mechanisms, a comprehensive study of surface interactions at the nanoscale is crucial, particularly when dealing with nano-electromechanical and micro-electromechanical components. This study performed molecular dynamics simulation to explore the interactions between asperities (made of similar/dissimilar materials) at the nanoscale under dry sliding conditions. The research framework focuses on modelling the contact between two hemispherical asperities during dry sliding by considering three material combinations: soft-to-soft (Cu–Cu), hard-to-hard (Fe–Fe), and hard-to-soft (Fe–Cu). The study assesses plastic deformation and atomic wear at specific sliding speeds. Notably, the results indicate that the frictional force on the lower asperity increases as interference increases. Additionally, atomic wear rises with increased interference in the case of the Fe–Cu tribopair. Particularly high atomic wear is observed in the Cu–Cu tribopair due to the ease of slip within the face-centred cubic crystal structure of copper.
Analysing podcast intimacy: Four parameters
Authors: Adler Berg Freja Sørine
Published: December 2023

This article presents a case study study of a proposed analytical framework for dissecting and analysing intimacy in podcasts. The podcast medium is increasingly perceived as inherently intimate, but this discourse is still unprecise and has never been clearly outlined. It is furthermore essential to better define podcast intimacy because of its effective and widespread impact on podcasters and listeners. Over time, a self-reinforcing discourse and self-fulfilling prophecy of intimacy has built up around podcasts. Based on podcast literature (Berry, 2016; Euritt, 2023; Lindgren, 2021; Meserko, 2014; Spinelli and Dann, 2019; Swiatek, 2018) and podcast intimacy’s roots in, respectively, Web 2.0 and radio, four parameters for analysing podcast intimacy are outlined: Intimacy in listening, intimacy in what is said, intimacy in how it is said and intimacy in cross-media interactions – most significantly via social media. Each parameter contains several subcategories and questions for analysis which are collected in a schema. The schema is a tool for media researchers and students to identify how and why a podcast creates intimacy. It is also valuable for increasing the awareness of how podcasts work and impact the world. And it finally offers opportunities for podcast producers and publishers to learn more about how their podcast create intimacy and how they can attract listeners and followers through the creation of intimacy.
Impact of thermal swing piston top land coatings on gasoline engine performance and raw emissions
Authors: Fischer Marcus , Achenbach Jens , Pischinger Stefan
Published: December 2023

Upcoming legislations aim to significantly reduce carbon dioxide and hydrocarbon emissions compared to current regulations. Accordingly, options have to be evaluated to not only convert the raw emissions in a catalytic converter, but also to reduce the raw emissions from the combustion process in the first place. Therefore, thermal piston top land coatings, which lead to an oscillating piston surface temperature were investigated on a single cylinder research engine using a gasoline RON95E10 fuel. Measurements were conducted at a compression ratio of 12.2 and a long Miller intake event. In this manuscript the results achieved with yttria stabilized zirconia in comparison to an uncoated piston are displayed. Significant effects of the coatings on the indicated efficiency could be observed mainly at low engine speeds and loads due to the high share of fuel energy in the wall heat losses and incomplete combustion. At these operating points, the reduction of wall heat losses can almost be fully transferred into indicated efficiency, leading to an increase in indicated efficiency of 6.3% by the yttria stabilized zirconia coating. At higher engine speeds and loads, the advantage in indicated efficiency vanishes and a decrease of 0.5% can be observed. Near full load operation the indicated efficiency slightly lower. However, the effects of a thermal swing coating on combustion efficiency and wall heat losses strongly depend on the operation conditions.
Flow analysis of a control ball valve in a common rail fuel injector
Authors: Miao Xuelong , Chang Alexander B , Zheng Jinbao , Chen Xu , Guo Lixin , Xia Shaohua , Zhou Jian , Wang Congjin , Zhao Zhifeng , Xing Fudong , Di Yage
Published: December 2023

The electronic control common rail fuel injection system is one of the key technologies being used in modern diesel engines to improve the engine performance. A numerical simulation was conducted to study the characteristics of the fuel flow around the ball valve in the common rail fuel injector. The lift of the control ball valve and static pressure of the flow field around the control ball valve were measured respectively. The simulation was performed with the measurements as boundary conditions such that the flow characteristics can be correlated with the valve lift and the pressure upstream of the ball valve. Simulation results showed that during the valve opening and closing, a high pressure area appeared below the ball valve, while cavitation appeared in the area around the control ball valve. Specifically, the cavitation mainly appeared around the sealing circle, and its upstream area and the conical surface from the entrance to a certain distance downstream. The flow throttling happened at the outlet orifice under the steady-state condition when the valve was at the maximum opening position. The cavitation around the control ball valve was more serious under higher rail pressure conditions. The formation and development of the cavitation was found to be depending on the lift position of the ball valve and pressure of the flow around the ball valve during the valve opening and valve closing. Higher value of void fraction appeared in the flow when the lift of the ball valve was at a larger opening position. It was found that cavitation around the ball valve will affect the consistency and stability of the fuel flow. And cavitation erosion found at the valve seat from a simplified durability test appeared to be close to the place where cavitation appeared from simulation. Therefore, it is suggested that simulation work can be used to examine if cavitation occurs in the flow path of the control ball valve inside the injector in design phase and make necessary changes on the design to prevent the cavitation and the resulting damages to the control ball valve in the injector.
Advancing Equity and Opportunities for STEM Students From Low-Income Backgrounds: Evaluating the Impact of a Collaborative Support Program on Academic Outcomes
Authors: Ajayi Alex A. , Soria Krista M. , Dupont Rebekah , Varma Keisha
Published: December 2023

This study examined the impact of a National Science Foundation-funded support program for academically promising STEM students from low-income backgrounds. The program operates as a collaborative consortium, bringing together three public community colleges and one private university, to support the retention and graduation of program scholars. Using propensity score matching, we compared 169 program scholars to 169 matched non-scholars with similar demographic, academic, and financial characteristics ( Mage = 24.82 years; 41% female; 60% students of color). Participation in the program was associated with favorable academic outcomes, with large to moderate effect sizes. Specifically, program scholars had significantly higher cumulative and STEM-specific grade point averages than their non-scholar counterparts. They also completed significantly more STEM courses and were less likely to withdraw from college than non-scholars. These findings underscore the potential of comprehensive and equity-oriented approaches to STEM education in facilitating academic success for STEM students, particularly those from low-income backgrounds.
“Usually, I Do Not Quarrel”: What Type of Ties Do We Find when We Ask about Conflicts Using a Name-generator Approach?
Authors: Adebahr Philip , Keim-Klärner Sylvia , Knabe André , Klärner Andreas
Published: December 2023

In a mixed-methods study on poverty in Germany, we conducted qualitative interviews and collected quantitative data on ego-centered networks using a name-generator approach and a single set of respondents. Based on the qualitative data, we first developed a typology of negative ties and then evaluated which of these ties the name generator (on conflicts) had measured. To some extent, the conflict name-generator (CNG) captured the complexity of the negative ties in the typology, but it captured only a small fraction of the negative ties mentioned in the narrative interviews and it missed some specific ones. Discussing the limitations of the CNG in the light of our typology of negative ties allows us to learn more about being nuanced in formulating appropriate questions for eliciting negative ties.
Teaching and Leading in the Age of Critical Race Theory Legislation: A Case of Self-Silencing in a School
Authors: Blosser Allison H. , Cavendish Leslie M.
Published: December 2023

This case centers on two early career educators: a principal and teacher struggling to address issues of diversity, equity, inclusion, and justice (DEIJ) in their school in the current political context of legislative attacks on critical race theory (CRT) and the simultaneous national Black Lives Matter movement. A talented teacher is reluctantly self-silencing out of fear and uncertainty when her students ask her questions related to DEIJ topics. Tired of feeling anxious and compromising her teaching, she seeks the advice of her principal. The case asks readers to consider implications for school leaders, teachers, students, parents, and teacher educators.
Combining Mixed Methods and Community-Based Participatory Research Approaches to Identify Neighborhood-Level Needs During the COVID-19 Pandemic
Authors: Guan Alice , Cruz Tessa , Sowell Jamaica , Mattias Brenda , Shah Aekta , Hassberg Analena Hope , Shariff-Marco Salma , Akom Antwi , DeRouen Mindy C.
Published: December 2023

The intersection of mixed methods and community-based participatory research (MMCBPR) provides a promising approach to address health inequities. Drawing from strengths of mixed methods (which provides multiple channels for individuals to share experiences) and community-based participatory research methods (which center and empower marginalized communities in research), MMCBPR allows for the development of impactful and relevant research. This article contributes to the field of mixed methods research by illustrating a novel application of MMCBPR to a pilot research study aimed at understanding community resources and needs during the COVID-19 pandemic. We demonstrate feasibility for MMCBPR methods assessing multilevel structural and social determinants of health during times of social, political, and economic uncertainty and highlight challenges experienced in adopting this approach.
Geographical heterogeneity in the disease characteristics and management of patients with inflammatory bowel disease, the preliminary results of a Chinese database for IBD (CHASE-IBD)
Authors: Wan Jian , Shen Jun , Wu Xiaoping , Zhong Jie , Chen Yan , Zhu Lanxiang , Miao Yinglei , Hu Naizhong , Chen Jie , Liang Jie , Wu Kaichun
Published: December 2023

Background:

The incidence of inflammatory bowel disease (IBD) is rapidly increasing in China, a vast country with significant geographical differences. The socioeconomic status of Eastern China is significantly higher than that of Western China.

Objectives:

This study aimed to describe the geographical heterogeneity in the characteristics and management of patients with IBD in both Eastern and Western China.

Design:

This was a multicenter, cross-sectional study.

Methods:

Patients with IBD with ages ⩾18 years up to 18 January 2023 were included in the analysis from the Chinese database for IBD. Logistic regression was used to identify risk factors associated with surgeries among patients with IBD.

Results:

Among 8305 patients with IBD, the ratio of ulcerative colitis (UC) to Crohn’s disease (CD) was 4.13 and 0.33 in Western and Eastern China, respectively. The median age at diagnosis of UC and CD was 40.69 and 28.58 years, respectively. There was a male predominance among patients with UC (54.3%) and CD (68.0%). The two regions exhibited a similar distribution of disease locations in UC. However, Western China had a higher proportion of L2 involvement (30.0% versus 19.1%) and more advanced disease behavior (B2 and B3) (48.8% versus 39.8%) than Eastern China. Patients with IBD in Western China received more 5-aminosalicylic acid and corticosteroids and fewer immunomodulators and biologicals. In terms of surgical risk, Eastern China [ versus Western China, odds ratios (OR): 5.36, 95% confidence intervals (CI): 2.96–9.68] was associated with a higher risk of surgery in UC, while Western China ( versus Eastern China, OR: 3.39, 95% CI: 2.37–4.86) was associated with a higher risk of surgery in CD.

Conclusion:

Geographical heterogeneity exists in the disease characteristics and management of IBD in Eastern and Western China. These findings have the potential to guide the formulation of location-specific strategies aimed at enhancing the long-term outcomes of patients with IBD.
Research hotspots for pediatric fractures from 2017 to 2022: A bibliometric and visual analysis via Citespace
Authors: Wang Huan , Yang Ya-ting , Lu Qing-da , Liu Chen-xin , Bai Huan-an , Wang Jia-ju , Jie Qiang
Published: December 2023

Objective:

This review provides guidance and ideas for researchers through a comprehensive and comparative analysis of the present state, trends, and hotspots in the pediatric fracture literature over the past 6 years.

Methods:

We used Citespace 6.1.R6 software to explore the country/region distribution, institutions, journals, keyword analysis, and co-cited references of the literature from Web of Science core database.

Results:

There are 6472 pieces of pediatric fracture–related literature, including 2962 from 2017 to 2019 and 3510 from 2020 to 2022. The country with the most papers is the United States, and US institutions and journals also have a pivotal position in this field. Research hotspots for pediatric fractures in 2017–2019: The topic with the most attention is bone mineral density leading to related bone diseases. Treatment for pediatric fractures, including supracondylar humeral fractures, Monteggia fractures, forearm fractures, knee fractures, and ankle fractures in children, is another topic of greater interest. Brain injuries and dental injuries in children due to abuse and trauma are also concerning issues. Research hotspots for pediatric fractures in 2020–2022: comparison with 2017–2019 revealed a relative decrease regarding ankle-related epiphyseal injuries, but there is a higher focus on the epidemiology of fractures in children, risk factors, and reasons for childhood trauma. We have confirmed through literature co-citations that the literature of high interest is also in these aspects.

Conclusion:

Researchers and clinicians can quickly learn about topics of interest through authoritative journals and highly cited literature and rapidly master the current status and frontiers of the field through study, providing ideas for future work.
Early Definitive Fixation of Talus Fractures Is Safe: A Retrospective Review
Authors: DeGenova Daniel T. , Miller Klay B. , Paulini Alex S. , Melaragno Anthony J. , Davis Trent , Hoffman Brett , Taylor Benjamin C.
Published: December 2023

Background

Talus fractures are often result of high energy mechanisms and can lead to devastating complications. Treatment is often operative; however, the appropriate timing of this has been debated. The purpose of this study is to determine the efficacy and safety of the early treatment of talus fractures.

Methods

Patients aged 18 years or older who underwent definitive operative stabilization of their talus fracture at a single urban level 1 trauma center were retrospectively reviewed. Patients were split into 2 groups based on their time to definitive fixation: ≤ or >24 hours. Pertinent demographic, surgical, and follow-up data were collected and analyzed.

Results

A total of 108 fractures were treated with 65 in the ≤24 hours fixation group and 43 in the >24 hours fixation group. Fractures involving the talar neck were the most commonly treated fracture pattern followed by the body and the head. There was no difference between the 2 groups in length to full weight bearing, union, or time to union. Open fracture was found to be the only significant risk factor for nonunion in both groups. There was no significant difference in infection or arthrodesis rates between the 2 groups.

Conclusion

Definitive treatment of talus fractures within 24 hours from presentation is both safe and effective with equal outcomes and without increased complications when compared with those injuries that undergo delayed or staged definitive fixation.

Level of Evidence:

Level III
Perceptions and Acceptance of Cashless Gambling Technology: An Empirical Study of U.S. and Australian Consumers
Authors: Kim Jungsun (Sunny) , Lucas Anthony F.
Published: December 2023

There is a paucity of theory-driven research investigating the factors influencing consumer acceptance of cashless gambling technology. Thus, the purpose of this study is to explore whether the six constructs in the Unified Theory of Acceptance and Use of Technology 2 (i.e., performance expectancy, effort expectancy, social influence, facilitating conditions, hedonic motivation, and price-value) significantly influence intention to use cashless gambling technology. This work further examined important determinants of performance expectancy and effort expectancy, based on the Technology Acceptance Model 3. Survey responses were collected from U.S. consumers who had gambled at a land-based casino in the United States, and Australian consumers who had gambled at a club/casino in Australia in the preceding 12 months. The data were analyzed via confirmatory factor analysis and structural equation modeling. We found that social influence and price-value significantly influenced the intention to use cashless gambling technology. Performance expectancy was found to be an important predictor of behavioral intention. The results identified effort expectancy and hedonic motivation as key determinants of performance expectancy. Facilitating conditions and hedonic motivation were found to be significant determinants of effort expectancy. Our findings reveal new avenues of exploration in the emerging field of cashless technology within the hospitality/gaming sector. Finally, this study provides recommendations for hospitality/gaming operators and vendors seeking to enhance customer perceptions and acceptance of cashless technology.
Therapy for patients with chronic phase-chronic myeloid leukemia previously treated with ⩾2 tyrosine kinase inhibitors: a systematic literature review
Authors: Atallah Ehab , Saini Lovneet , Maegawa Rodrigo , Rajput Tanvi , Corbin Regina , Viana Ricardo
Published: December 2023

Background:

ATP-competitive tyrosine kinase inhibitors (TKIs) are the current standard of care for patients with chronic phase-chronic myeloid leukemia (CP-CML) in the first-line and second-line (2 L) setting. Treatment after 2 L is not clearly established.

Objective:

The objective of this study was to summarize the available evidence to compare the efficacy and safety of interventions in the treatment of CP-CML patients who had received ⩾2 prior TKIs.

Design:

A systematic literature review was performed.

Data source and methods:

A systematic literature review (SLR) of studies published until May 2021, reporting clinical outcomes in adult patients with CP-CML who had received ⩾ 2 prior TKIs was performed. Studies were identified through the database searches via Ovid platform (Embase, MEDLINE Epub Ahead of Print, In-Process and Other Non-Indexed Citations, and Cochrane Central Register of Controlled Trials), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), bibliographic search of relevant reviews, and proceedings from the previous 3 years of the key conferences in the field of oncology.

Results:

Our search identified 38 relevant studies. Among the identified studies of the current third-line treatments, the major molecular response (MMR) rate for ponatinib was 19.0–66.7%, 23.3–25.5% for asciminib, 19.2% for omacetaxine, and 13.2% for bosutinib at 6 months. The complete cytogenetic response (CCyR) rate was 21.4–64.8% for ponatinib, 38.7–40.8% for asciminib, 18–24.2% for bosutinib, and 16.1% for omacetaxine at 6 months.

Conclusion:

The findings from current SLR demonstrated the lack of data for patients with CML treated with ⩾2 TKIs. TKIs such as asciminib, ponatinib, and bosutinib are valid options for those patients. Further research is needed to identify the best treatment option for patients with CML receiving later lines of therapy.
Efficacy of complement inhibitors for patients with paroxysmal nocturnal hemoglobinuria: a systematic review and meta-analysis
Authors: Lee Jiyeon , Lee Haeseon , Kim Siin , Suh Hae Sun
Published: December 2023

Background:

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired hematological disease. The development of complement inhibitors such as eculizumab, ravulizumab, and pegcetacoplan has revolutionized the management of PNH, leading to improvements in overall survival and quality of life for patients.

Objectives:

This systematic review aims to provide comprehensive evidence of the efficacy of complement inhibitors in relation to treatment duration.

Design:

This is a systematic review and meta-analysis.

Data sources and methods:

A thorough literature search was conducted in MEDLINE, EMBASE, and the Cochrane Library up to 3 May 2022. We included all prospective interventional studies including single-arm trials. The primary outcomes of interest were lactate dehydrogenase (LDH) levels, hemoglobin (Hb) concentrations, transfusion avoidance, and Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F) scores.

Results:

Our study included a total of 27 studies, comprising 5 randomized controlled trials and 11 single-arm trials, with a total of 912 patients with PNH. We stratified the studies according to treatment duration, based on the most frequently reported period of 26 weeks. Our analysis showed that treatment-naïve patients who received complement inhibitors had a pooled estimate of a decrease in LDH levels from baseline by −1462.0 U/L (95% CI: −1735.6 to −1188.5) for treatment ⩽26 weeks and −1696.5 U/L (95% CI: −2122.7 to −1270.2) for treatment >26 weeks. The mean Hb levels were increased by 1.4 g/dL (95% CI: 0.5–2.3) and 1.9 g/dL (95% CI: 0.7−3.1) in each group. Treatment with any complement inhibitor prevented the need for transfusion in at least 50% of patients with PNH in all treatment periods. Clinically meaningful improvements in FACIT-F were observed both before and after 26 weeks, with a pooled estimate of 6.8 (95% CI: 6.0−7.6) and 9.5 (95% CI: 7.0−12.0), respectively.

Conclusion:

Our findings suggest that complement inhibitors can result in positive treatment outcomes and sustained benefits for patients with PNH.
Acute Esophageal Necrosis or Black Esophagus in the Setting of Diabetic Ketoacidosis
Authors: Alsakarneh Saqr , Jaber Fouad , Mittal Anika , Abughazaleh Saeed , Abboud Yazan , Campbell John
Published: December 2023

Acute esophageal necrosis (AEN) or black esophagus is a rare cause of mortality in patients with gastrointestinal bleeding. We present a case of a 54-year-old female who presented with diabetic ketoacidosis (DKA) and developed melena eventually attributed to AEN. The esophagogastroduodenoscopy (EGD) identified severe inflammation with black discoloration consistent with acute esophageal necrosis in the middle and lower esophagus. The patient was managed with intravenous pantoprazole and total parenteral nutrition (TPN) until she was able to tolerate an adequate diet. Black esophagus should be added to the differential diagnosis of patients with DKA who develop gastrointestinal bleeding. This need is stressed by the fact that early treatment is essential to reducing complications and mortality associated with the condition.
Let’s Influence That Attitude Before It’s Formed: Inoculation Against Reactance to Promote DEI Training
Authors: Gans Roger , Monica Zhan Mengqi
Published: December 2023

Despite annual investments of $8 billion by U.S. organizations on diversity, equity, and inclusion (DEI) training, many DEI programs are derailed by resistance from members whose attitudes and behaviors the programs are intended to address. The current study tested the effectiveness of a narrative-based inoculation strategy designed to mitigate resistance attributable to psychological reactance. Participants ( N = 273) were randomly exposed to either a single-message assignment-to-DEI-training notification or a dual-message inoculation condition in which they received a pro-DEI-training message before receiving the assignment-to-DEI-training notification. The inoculation condition produced lower levels of reactance and greater positive attitude change in favor of DEI training, with reactance mediating the effects of the message conditions on change in attitude toward DEI training and political ideology moderating the effects of reactance. The results contribute to the field by demonstrating the potential utility of inoculation strategies for promoting DEI training and other organizational initiatives.
Guardianship: The Implications of Resident Physician Perceptions of Caring for Incapacitated Older Adults Without Advocates
Authors: Wang Linda , Morphew Jared , Vitale Caroline , Mullan Patricia , Zietlow Kahli
Published: December 2023

As the incidence of dementia rises, increased utilization of surrogate decision-makers, including legal guardians, is anticipated. This manuscript presents an analysis of resident physicians’ experiences and perceptions regarding requirements, roles, and responsibilities of caring for older adults in need of, or already under, legal guardianship. This is a cross-sectional study, conducted at a tertiary academic medical center. A survey was sent, via Qualtrics, to all emergency medicine, family medicine, internal medicine, general surgery, and medicine-pediatric resident physicians. Eighty-eight out of three hundred thirty-three (26.4%) eligible residents physicians completed the survey. Most (98.9%) reported caring for patients under guardianship, yet many resident physicians reported significant uncertainty regarding the roles and responsibilities of guardianship, including its potential benefits and limitations. They also displayed misconceptions and overconfidence about guardians’ abilities to facilitate disposition, ensure financial security, and assign code status, among other matters. Our study highlights the importance of structured and directed education on the topic of guardianship for medical trainees.
Estimating the Health Care Expenditure to Manage and Care for Type 2 Diabetes in Nepal: A Patient Perspective
Authors: Dahal Padam Kanta , Rawal Lal , Ademi Zanfina , Mahumud Rashidul Alam , Paudel Grish , Vandelanotte Corneel
Published: December 2023

Background. This study aimed to estimate the health care expenditure for managing type 2 diabetes (T2D) in the community setting of Nepal. Methods. This is a baseline cross-sectional study of a heath behavior intervention that was conducted between September 2021 and February 2022 among patients with T2D ( N = 481) in the Kavrepalanchok and Nuwakot districts of Nepal. Bottom-up and micro-costing approaches were used to estimate the health care costs and were stratified according to residential status and the presence of comorbid conditions. A generalized linear model with a log-link and gamma distribution was applied for modeling the continuous right-skewed costs, and 95% confidence intervals were obtained from 10,000 bootstrapping resampling techniques. Results. Over 6 months the mean health care resource cost to manage T2D was US $22.87 per patient: 61% included the direct medical cost (US $14.01), 15% included the direct nonmedical cost (US $3.43), and 24% was associated with productivity losses (US $5.44). The mean health care resource cost per patient living in an urban community (US $24.65) was about US $4.95 higher than patients living in the rural community (US $19.69). The health care costs per patient with comorbid conditions was US $22.93 and was US $22.81 for those without comorbidities. Patients living in rural areas had 16% lower health care expenses compared with their urban counterparts. Conclusion. T2D imposes a substantial financial burden on both the health care system and individuals. There is a need to establish high-value care treatment strategies for the management of T2D to reduce the high health care expenses.

Highlights

More than 60% of health care expenses comprise the direct medical cost, 15% direct nonmedical cost, and 24% patient productivity losses. The costs of diagnosis, hospitalization, and recommended foods were the main drivers of health care costs for managing type 2 diabetes. Health care expenses among patients living in urban communities and patients with comorbid conditions was higher compared with those in rural communities and those with without comorbidities. The results of this study are expected to help integrate diabetes care within the existing primary health care systems, thereby reducing health care expenses and improving the quality of diabetes care in Nepal.
Qualitative Findings of a Nominal Group Process to Identify Critical Factors in New LIC Implementation
Authors: Eddings Stacy K. , Brown Laura L. , Godin Steven
Published: December 2023

OBJECTIVES

Medical schools considering longitudinal integrated clerkships (LICs) have access to literature that provides recommendations for planning, implementation, and sustainability. However, LIC development and implementation remain notoriously challenging. University of Utah’s LIC development process was informed by the documented experiences of long-established LIC programs. A literature gap was identified pertaining to more recently implemented LICs. The aim of this study was to explore the experiences of faculty in the early stages of LIC development.

METHODS

Thirteen representatives from eight LICs implemented after 2015 participated in 2 Zoom focus groups (5 participated in the first and the other 8 participated in the second). Participants were asked questions to assess key supports, barriers, and recommendations. Following the focus groups, participants were asked to rank the responses based on their level of importance.

RESULTS

Highest ranked supports included stakeholder and partner involvement; a dedicated coordinator or team; and strong, committed leadership. Highest ranked barriers included difficulty recruiting preceptors and clinical sites; underestimation of the amount of work required to coordinate the LIC; and challenges in providing the needed faculty development. Top recommendations for new LICs included investing in the needs of clinical partners; staffing or assigning a dedicated coordinator early in the development and implementation process; and frequent communication with all stakeholders.

CONCLUSION

Despite variation among the types of new LICs represented, there was consensus among participants on the importance of key supports, barriers, and recommendations. Knowledge of these factors can help new schools plan and allocate resources during their LIC development process. Participants found the focus group process and follow-up discussions useful and have formed an ongoing workgroup which meets quarterly.
Assessing Progress in Nutrition: Proposing a Sub-district Tool for Monitoring and Governance
Authors: Raghuraman Gayathri , Rao Madhusudhan B.V. , Prasad Sridhar R.
Published: December 2023

A lot of data is collected at state, district, block, and village levels across India as part of the monitoring and evaluation process for various government schemes ongoing in the country. Under the department of Women and Child Development in Karnataka a lot of data on children under 6 years of age and pregnant and lactating women is collected by Aanganwadi workers in the state. Although the current process of data collection, its analysis and interpretation require much more fiscal and human investment, it continues to generate large amounts of data. Interpretation of these data occur largely at the national and sub-national levels ignoring district and sub-district level variations in health and nutrition indices. Rarely are the results of this data analysis shared with district and sub-district level officials as they are not involved in policy formation. These officials also do not have training in data analysis and its interpretation and hence unable to use the vast sets of information available to them. This article is an effort to develop a monitoring and evaluation tool that uses easily available, taluk level data, from various sources to compute a cumulative nutrition index that can serve as a dipstick for monitoring nutrition status by block/district level officials.
Beyond computation: Assessing in-service mathematics teachers’ conceptual understanding of fraction division through problem posing
Authors: Yao Yiling , Jia Suijun , Cai Jinfa
Published: December 2023

Problem posing has long been recognized as a critically important teaching method and goal in the area of mathematics education. However, few studies have used problem posing to assess in-service teachers’ mathematical understanding. The present study investigated in-service teachers’ mathematical understanding of fraction division, which is often considered challenging content in elementary school, from three angles: computation, drawing, and problem posing. Two studies involving 66 and 193 primary and middle school teachers were conducted to reveal the in-service teachers’ mathematical understanding and whether drawing and problem posing affected each other. Although the in-service teachers rarely had the opportunity to pose mathematical problems in their daily teaching, they were able to pose mathematical problems in this study. In addition, problem-posing tasks were more useful in diagnosing the in-service teachers’ conceptual understanding than were computation or drawing. Thus, problem posing seems to have contributed to their conceptual understanding of fraction division on the drawing task.
Sonographers’ Perception of Administrative Support and Resources for Burnout Prevention
Authors: McCalla-Henry Rose , Mathieson Kathleen
Published: December 2023

Objective:

The purpose of this study was to explore the occupational burnout levels among a cohort of sonographers practicing in the United States and their perception of administrative support and resources for burnout prevention.

Materials and Methods:

This study used a quantitative descriptive design with a cross-sectional online survey administered to the Society of Diagnostic Medical Sonography members. The survey consisted of demographic information, administrative support questions, and burnout measurements using the validated Oldenburg Burnout Inventory.

Results:

A total of 1393 sonographers participated in the study. The results of this sonographer cohort indicated that 55.7% experienced moderate burnout. Although 30.9% reported feeling their employers cared for their well-being, 36.6% of respondents indicated no administrative support, and 30.7% said their administration did not provide resources to help them cope.

Conclusion:

Occupational burnout levels among this cohort of sonographers was moderate and could increase without adequate intervention. Addressing sonographer burnout and managing stressors will help organizations to retain staff, continue providing quality patient care, and maintain patient outcomes.
Asthma exacerbations and eosinophilia in the UK Biobank: a genome-wide association study
Authors: Edris Ahmed , Voorhies Kirsten , Lutz Sharon M. , Iribarren Carlos , Hall Ian , Wu Ann Chen , Tobin Martin , Fawcett Katherine , Lahousse Lies
Published: December 2023

Background

Asthma exacerbations reflect disease severity, affect morbidity and mortality, and may lead to declining lung function. Inflammatory endotypes (e.g.T2-high (eosinophilic)) may play a key role in asthma exacerbations. We aimed to assess whether genetic susceptibility underlies asthma exacerbation risk and additionally tested for an interaction between genetic variants and eosinophilia on exacerbation risk.

Methods

UK Biobank data were used to perform a genome-wide association study of individuals with asthma and at least one exacerbation compared to individuals with asthma and no history of exacerbations. Individuals with asthma were identified using self-reported data, hospitalisation data and general practitioner records. Exacerbations were identified as either asthma-related hospitalisation, general practitioner record of asthma exacerbation or an oral corticosteroid burst prescription. A logistic regression model adjusted for age, sex, smoking status and genetic ancestryviaprincipal components was used to assess the association between genetic variants and asthma exacerbations. We sought replication for suggestive associations (p<5×10−6) in the GERA cohort.

Results

In the UK Biobank, we identified 11 604 cases and 37 890 controls. While no variants reached genome-wide significance (p<5×10−8) in the primary analysis, 116 signals were suggestively significant (p<5×10−6). In GERA, two single nucleotide polymorphisms (rs34643691 and rs149721630) replicated (p<0.05), representing signals near the NTRK3 and ABCA13 genes.

Conclusions

Our study has identified reproducible associations with asthma exacerbations in the UK Biobank and GERA cohorts. Confirmation of these findings in different asthma subphenotypes in diverse ancestries and functional investigation will be required to understand their mechanisms of action and potentially inform therapeutic development.
Chronic cough associated with COPD exacerbation, pneumonia and death in the general population
Authors: Landt Eskild M. , Çolak Yunus , Nordestgaard Børge G. , Lange Peter , Dahl Morten
Published: December 2023

Background

Chronic cough affects up to 10% of the general population and was previously perceived as a comorbidity of underlying conditions, but is nowadays classified as a disease in its own entity that could confer increased risk of morbidity and mortality. We tested the hypothesis that chronic cough is associated with increased risk of COPD exacerbation, pneumonia and all-cause mortality in the general population.

Methods

We identified 2801 individuals with chronic cough, defined as cough lasting >8 weeks, among 44 756 randomly selected individuals from the Copenhagen General Population Study, and recorded COPD exacerbations, pneumonia and all-cause mortality during follow-up.

Results

During up to 5.9 years of follow-up (median 3.4 years), 173 individuals experienced COPD exacerbation, 767 experienced pneumonia and 894 individuals died. Individuals with chronic coughversusthose without had cumulative incidences at age 80 years of 12%versus3% for COPD exacerbation, 30%versus15% for pneumonia, and 25%versus13% for death from all causes. After adjustment for age, sex and smoking, individuals with chronic coughversusthose without had adjusted hazard ratios of 4.6 (95% CI 2.9–7.2) for COPD exacerbation, 2.2 (1.7–2.7) for pneumonia and 1.7 (1.4–2.0) for all-cause mortality. Among current smokers aged >60 years with airflow limitation, those withversuswithout chronic cough had an absolute 5-year risk of 10%versus4% for COPD exacerbation, 16%versus8% for pneumonia and 19%versus12% for all-cause mortality.

Conclusion

Chronic cough is associated with higher risks of COPD exacerbation, pneumonia and death, independent of airflow limitation and smoking.