bluuebunny/crossref_metadata_2025 huggingface dataset:
Severe SARS-CoV-2 Pneumonia and Pneumomediastinum/Pneumothorax: A Prospective Observational Study in an Intermediate Respiratory Care Unit
Authors: Lorente-González Miguel , Terán-Tinedo José Rafael , Zevallos-Villegas Annette , Laorden Daniel , Mariscal-Aguilar Pablo , Suárez-Ortiz Miguel , Cano-Sanz Eduardo , Ortega-Fraile María Ángeles , Hernández-Núñez Joaquín , Falcone Adalgisa , Saiz-Lou Elena María , Plaza-Moreno María Cristina , García-Fadul Christian , Valle-Falcones Manuel , Sánchez-Azofra Ana , Funes-Moreno Clotilde , De-La-Calle-Gil Isabel , Navarro-Casado Rosalía , Carballo-López Daniel , Gholamian-Ovejero Soraya , Gallego-Rodríguez Berta , Villén-Villegas Tomás , Landete Pedro
Published: June 2023

Introduction

The occurrence of pneumomediastinum (PM) and/or pneumothorax (PTX) in patients with severe pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was evaluated.

Methods

This was a prospective observational study conducted in patients admitted to the intermediate respiratory care unit (IRCU) of a COVID-19 monographic hospital in Madrid (Spain) between December 14, 2020 and September 28, 2021. All patients had a diagnosis of severe SARS-CoV-2 pneumonia and required noninvasive respiratory support (NIRS): high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP). The incidences of PM and/or PTX, overall and by NIRS, and their impact on the probabilities of invasive mechanical ventilation (IMV) and death were studied.

Results

A total of 1306 patients were included. 4.3% (56/1306) developed PM/PTX, 3.8% (50/1306) PM, 1.6% (21/1306) PTX, and 1.1% (15/1306) PM + PTX. 16.1% (9/56) of patients with PM/PTX had HFNC alone, while 83.9% (47/56) had HFNC + CPAP/BiPAP. In comparison, 41.7% (521/1250) of patients without PM/PTX had HFNC alone (odds ratio [OR] 0.27; 95% confidence interval [95% CI] 0.13-0.55; p < .001), while 58.3% (729/1250) had HFNC + CPAP/BiPAP (OR 3.73; 95% CI 1.81-7.68; p < .001). The probability of needing IMV among patients with PM/PTX was 67.9% (36/53) (OR 7.46; 95% CI 4.12-13.50; p < .001), while it was 22.1% (262/1185) among patients without PM/PTX. Mortality among patients with PM/PTX was 33.9% (19/56) (OR 4.39; 95% CI 2.45-7.85; p < .001), while it was 10.5% (131/1250) among patients without PM/PTX.

Conclusions

In patients admitted to the IRCU for severe SARS-CoV-2 pneumonia requiring NIRS, incidences of PM/PTX, PM, PTX, and PM + PTX were observed to be 4.3%, 3.8%, 1.6%, and 1.1%, respectively. Most patients with PM/PTX had HFNC + CPAP/BiPAP as the NIRS device, much more frequently than patients without PM/PTX. The probabilities of IMV and death among patients with PM/PTX were 67.9% and 33.9%, respectively, higher than those observed in patients without PM/PTX, which were 22.1% and 10.5%, respectively.
Institutional Determinants of Co-Production: Norway as an Illustrative Case
Authors: Trætteberg Håkon Solbu , Enjolras Bernard
Published: June 2023

This article focuses on collective engagement through voluntary organizations to advance a theoretical understanding of the determinants of varying patterns of co-production, and we conduct an empirical investigation of how these determinants shape local-level co-productive relationships in Norwegian municipalities. We use a policy fields approach in which we compare four policy areas that each constitute an institutional field. The study uses a qualitative design, with data from 89 interviews in 12 municipalities. We find strong systematic differences between the fields, suggesting that the institutional space for local co-production is structured by national welfare policies and public management practices. We also identify feedback processes in co-production between the design and implementation stages of the policy process. We conclude that, unlike the often-prescriptive embrace of co-production in the literature and among policymakers, co-production is a more suitable organizational form in some service areas than others, depending on the institutional context.
Does intellectual property protection improve energy efficiency? Evidence from the impact of intellectual property income on energy intensity
Authors: Wang Qiang , Yang Xiaoli , Li Rongrong
Published: June 2023

This work aims to explore the impact of intellectual property income (a guarantee for promoting technological advance) on energy efficiency (indicating the technological advance) considering the mediation role of trade openness. To this end, this article uses the available data of 50 countries from 2000 to 2019 to study the influence of intellectual property income and trade openness. The Fully Modified Ordinary Least Square and Dynamic Ordinary Least Square methods are applied in this article to study the long-term relationship between different variables. The empirical results show that there is a mediation effect between intellectual property income and energy intensity. In other words, intellectual property income can not only directly affect energy intensity, but also indirectly affect energy intensity through trade openness. Fully considering the impact of regional heterogeneity, the countries are divided into high-income (HI) countries and middle-income (MI) countries. The results indicate there are noticeable regional differences in the impact of intellectual property income on energy intensity via the mediation effect of trade openness. The improvement of intellectual property income and trade openness benefits the HI countries most, but not for MI countries. Targeted policy implications are proposed to enable a reduction in energy intensity for countries at different income levels.
The positive association of education with the trust in science and scientists is weaker in highly corrupt countries
Authors: Alper Sinan , Yelbuz Busra Elif , Akkurt Sumeyra Bengisu , Yilmaz Onurcan
Published: June 2023

One of the most prominent correlates of trust in science and scientists is education level, possibly because educated individuals have higher levels of science knowledge and thinking ability, suggesting that trusting science and scientists relies more on reflective thinking abilities. However, it is relatively more reasonable for highly educated individuals to suspect authority figures in highly corrupt countries. We tested this prediction in two nationally representative and probabilistic cross-cultural data sets (Study 1: 142 countries, N = 40,085; Study 2: 47 countries, N = 69,332), and found that the positive association between education and trust in scientists (Study 1) and science (Study 2) was weaker or non-existent in highly corrupt countries. The results did not change after statistically controlling for age, sex, household income, and residence. We suggest future research to be more considerate of the societal context in understanding how education status correlates with trust in science and scientists.
Possibilities and ethical issues of entrusting nursing tasks to robots and artificial intelligence
Authors: Ibuki Tomohide , Ibuki Ai , Nakazawa Eisuke
Published: June 2023

In recent years, research in robotics and artificial intelligence (AI) has made rapid progress. It is expected that robots and AI will play a part in the field of nursing and their role might broaden in the future. However, there are areas of nursing practice that cannot or should not be entrusted to robots and AI, because nursing is a highly humane practice, and therefore, there would, perhaps, be some practices that should not be replicated by robots or AI. Therefore, this paper focuses on several ethical concepts (advocacy, accountability, cooperation, and caring) that are considered important in nursing practice, and examines whether it is possible to implement these ethical concepts in robots and AI by analyzing the concepts and the current state of robotics and AI technology. Advocacy: Among the components of advocacy, safeguarding and apprising can be more easily implemented, while elements that require emotional communication with patients, such as valuing and mediating, are difficult to implement. Accountability: Robotic nurses with explainable AI have a certain level of accountability. However, the concept of explanation has problems of infinite regression and attribution of responsibility. Cooperation: If robot nurses are recognized as members of a community, they require the same cooperation as human nurses. Caring: More difficulties are expected in care-receiving than in caregiving. However, the concept of caring itself is ambiguous and should be explored further. Accordingly, our analysis suggests that, although some difficulties can be expected in each of these concepts, it cannot be said that it is impossible to implement them in robots and AI. However, even if it were possible to implement these functions in the future, further study is needed to determine whether such robots or AI should be used for nursing care. In such discussions, it will be necessary to involve not only ethicists and nurses but also an array of society members.
Obtaining Acid-sensitive Prosaikogenin F by Enzymatic Hydrolysis of Saikosaponin A
Authors: Zhu Yeting , Peng Jiangsong , Zhao Yaqin , Wu Mengru , Chen Suping , Shao Jiali , Wang Xubo , Xia Guohua , Shen Yuping
Published: June 2023

Background

Prosaikogenin F (PSF) has stronger anti-cancer bioactivity than saikosaponin A (SSA), however, it was hardly isolated due to its trace amount in the raw material of Radix Bupleuri (RB). In addition, the active chemical constituent was unstable under acidic conditions owing to a 13,28-epoxy-ether moiety at the D ring of its aglycone.

Objectives

This study was to develop an appropriate method for obtaining acid-sensitive PSF from SSA abundant in RB.

Materials and Methods

Enzymatic hydrolysis was employed and snailase was selected due to its good hydrolysis performance under nearly neutral circumstances. Hydrolysis conditions were then optimized by one-factor-at-a-time experimentation before response surface methodology (RSM) by Box-Behnken Design (BBD).

Results

The reaction system was constructed in Na2HPO4-NaH2PO4 buffer (pH 6.0) containing snailase/SSA (44:1) at 39°C, then the hydrolysis lasted for 12 h. Therefore, the highest conversion ratio of SSA was achieved at 100.0%.

Conclusion

The newly proposed method is eco-friendly for obtaining acid-sensitive PSF, which lays a solid foundation for its development to be an anti-cancer new drug.
Spaces of football and belonging for people seeking asylum: Resisting policy-imposed liminality in Italy
Authors: Genovesi Federico
Published: June 2023

As radical right parties capitalise on the salience of immigration among the Italian public, this paper explores solidarity grassroots football as a unique lens to investigate how people seeking asylum resist the effects of policies and discourses of exclusion, and develop senses of belonging in the microscale of their day-to-day lives. Sport and migration studies researchers have primarily considered policy-based questions (e.g. how can sport facilitate integration?). In shifting the focus from integration to belonging, this ethnographic study engages with the embodied and affective experiences of individuals seeking asylum. Employing the analytical framework for the study of belonging advanced by Yuval-Davis and integrated by Antonsich, four themes are discussed: the agency of people seeking asylum in appropriating football to nurture a positive sense of self; the emergence of the material environment of sporting activities as a space of belonging; the negotiation of belonging within and beyond the team; and the local neighbourhood as possible trait d’union between sport-specific attachments and belonging to the wider community. The article contends that involvement in solidarity grassroots football can provide people seeking asylum with opportunities for belonging that go beyond the momentary, and play a vital role in resisting the liminality imposed by autochthonic politics of belonging.
Communication Challenges in Social Board Games
Authors: Crabb Michael , Heron Michael
Published: June 2023

Background

Discussion-based communication scenarios are present in many aspects of life. These can range from conversations with friends in a social setting to formal consultation processes and focus groups used by industry and government. However, reliance on speech does not easily permit the fair and equitable involvement of people who face communication-based accessibility challenges.

Aim

This work aimed to understand the communication challenges present within social board games, how these challenges arise, and participants’ perceptions of the difficulties these challenges may cause.

Method

We conducted four social gameplay sessions to understand what parts of discussion may cause communication challenges and what techniques are commonplace in overcoming these.

Results

Our results highlight how group facilitation and conversation pacing are essential in promoting accessibility within discussion-type situations. Our analysis identified four themes that focused on speech and delivery, access strategies, viewing and position, balance of power, and awareness of others.

Conclusions

Communication within board game scenarios is a complex area that creates several intersectional accessibility challenges. These challenges can impact how group communication is facilitated, how pacing and delivery relate to overall group understanding, and how an awareness of accessibility is critical in developing inclusive environments.
A Teacher’s Guide to Technology-Based Self-Monitoring Strategies for Student Behavior
Authors: Bedesem Peña L. , Barber Brian R. , Rosenblatt Kara
Published: June 2023

Students with disabilities may demonstrate high rates of off-task behavior, resulting in poor academic achievement. To decrease students’ off-task behavior, teachers can identify student-guided supportive strategies to limit the amount of time they dedicate to behavior management. Moreover, when teachers use effective student-guided strategies that reflect high social validity, ease of use, and low intrusiveness, benefits are maximized and students will maintain their use of the strategy. This article provides step-by-step procedures for designing a technology-based self-monitoring (TBSM) strategy that increases the acceptability and continued use of standard self-monitoring procedures. Necessary adjustments to typical self-monitoring strategies considering technology-based delivery methods, including selecting and evaluating mobile applications, are introduced.
Standalone Performance Validity Tests May Be Differentially Related to Measures of Working Memory, Processing Speed, and Verbal Memory in Patients With Multiple Sclerosis
Authors: Lace John W. , Sanborn Victoria , Galioto Rachel
Published: June 2023

Cognitive functioning may account for minimal levels (i.e., 5%–14%) of variance of performance validity test (PVT) scores in clinical examinees. The present study extended this research twofold: (a) by determining the variance cognitive functioning explains within three distinct PVTs (b) in a sample of patients with multiple sclerosis (pwMS). Seventy-five pwMS ( Mage = 48.50, 70.6% female, 80.9% White) completed the Victoria Symptom Validity Test (VSVT), Word Choice Test (WCT), Dot Counting Test (DCT), and three objective measures of working memory, processing speed, and verbal memory as part of clinical neuropsychological assessment. Regression analyses in credible groups ( ns ranged from 54 to 63) indicated that cognitive functioning explained 24% to 38% of the variance in logarithmically transformed PVT variables. Variance from cognitive testing differed across PVTs: verbal memory significantly influenced both VSVT and WCT scores; working memory influenced VSVT and DCT scores; and processing speed influenced DCT scores. The WCT appeared least related to cognitive functioning of the included PVTs. Alternative plausible explanations, including the apparent domain/modality specificity hypothesis of PVTs versus the potential sensitivity of these PVTs to neurocognitive dysfunction in pwMS were discussed. Continued psychometric investigations into factors affecting performance validity, especially in multiple sclerosis, are warranted.
Revascularization of Peripheral Arteries in Patients with Intermittent Claudication Decreases Inflammatory Biomarkers
Authors: Poredoš Pavel , Poredoš Peter , Cevc Matija , Fareed Jawed , Boc Vinko
Published: June 2023

Patients with intermittent claudication have significantly higher levels of inflammatory biomarkers, particularly interleukins, which is also a consequence of exercise limitation. Physical activity, which is one of the preventive measures against atherosclerosis, is associated with a decrease in inflammatory biomarkers. Therefore, in our study, we investigated the effects of revascularization of peripheral arteries in patients with intermittent claudication on functional capacity and levels of inflammatory markers. The study included 26 patients with intermittent claudication who underwent percutaneous transluminal angioplasty (PTA). Before the procedure and 2–4 months after successful revascularization, the ankle-brachial index (ABI), functional capacity using the treadmill test, and the walking impairment questionnaire (WIQ) were determined. Inflammatory biomarkers were also measured before and after procedures. Successful revascularization was associated with an increase in intermittent claudication: 120 (20–315) versus 300 (100–1000 m), P < 0.001. Treadmill testing showed a significant increase in initial and maximal walking distance. After revascularization, ABI increased significantly (0.55 vs 0.82, P < 0.003). Improvement in functional performance was also demonstrated by WIQ. Two to three months after revascularization, some inflammatory biomarkers decreased significantly: fibrinogen, interleukin-6 (IL-6), and interleukin-8 (IL-8). The high-sensitivity C-reactive protein (hsCRP) and tumor necrosis factor-alpha (TNFα) also did not decrease significantly. The levels of some inflammatory markers: IL-6, TNFα, and fibrinogen were significantly related to the improvement in patients’ functional capacity. The results of our study show that successful revascularization of the lower limb arteries not only improves the functional capacity of patients with intermittent claudication, but also reduces the systemic inflammatory response and may have a preventive effect on local and concomitant other atherosclerotic diseases.
Fixed-time supper twisting disturbance observer and sliding mode control for a secure communication of fractional-order chaotic systems
Authors: Nguyen Quang Dich , Vu Dinh Dat , Huang Shyh-Chour , Giap Van Nam
Published: June 2023

This paper proposed a new disturbance observer (DO) based on the fixed-time supper-twisting algorithm (FTSTA) for rejecting perturbations of secure communication of the fractional-order chaotic systems (FOCSs). First, the FOCSs are remodeled into the Takagi–Sugeno fuzzy (TSF) system with the expectation of softening the calculations of the design of the controller and observer. Second, the synchronization control was designed based on the FTSTA sliding mode control (SMC). Third, a new DO for the secure communication system (SCS) of FOCSs was proposed to estimate the disturbance on public channels and uncertainty variations. Fourth, the stability of the proposed synchronization control was obtained by using the Lyapunov condition. Finally, to verify the correction of the proposed method, the MATLAB simulation with the use of FONCOM toolbox was used to meet the desired expectations of theoretically proposed method. There are, small reaching times, small steady-states, and most tested disturbances and parameters’ variations were compensated by the proposed DO.
An effective controller design strategy for higher order systems
Authors: Chandramouleeswaran Ganesh , Deivanayagam Pillai Nagarajan , Ramasamy Shanmugasundaram , Pudupalayam Sachithanandam Mayurappriyan , Iqbal Mustafa Mohamed
Published: June 2023

The recent methods that guarantee the stability of the reduced-order models are Mihailov stability, improved Pade approximation and truncation, improved generalized pole clustering, moment matching and salp swarm optimization. Further, these methods could overcome the limitations such as non-uniqueness, pole clustering, gain adjustment and difficulty to maintain the dominant roots in the lower order system for non-minimum higher order plants. This research emphasizes the design of the proposed compensating algorithm by using an additional open loop zero for the stable reduced-order models of large-scale single-input single-output linear time-invariant continuous time systems. The results of the proposed algorithm are compared with the existing compensating methods and the design is validated and illustrated numerically.
IgG4-Related Disease Mimicking Unilateral Urothelial Carcinoma: A Rare Case Report and Literature Review
Authors: Cheng Yu-Chieh , Chiang Chia-Ling , Huang Chien-Wei
Published: June 2023

Immunoglobulin G4-related disease (IgG4-RD) is an autoimmune-mediated disorder with heterogeneous multiorgan manifestations. Early identification and treatment of IgG4-RD are crucial for organ function recovery. Rarely, IgG4-RD manifests as a unilateral renal pelvic soft tissue mass that may be misdiagnosed as urothelial malignancy, resulting in invasive surgical intervention and organ damage. Here we present a 73-year-old man who had a right ureteropelvic mass with hydronephrosis detected by enhanced computed tomography. Right upper tract urothelial carcinoma and lymph node metastasis was highly suggested based on the image findings. However, IgG4-RD was suspected due to his past history of bilateral submandibular lymphadenopathy, nasolacrimal duct obstruction, as well as a high serum IgG4 level of 861 mg/dL. The ureteroscopy with tissue biopsy showed no evidence of urothelial malignancy. His lesions and symptoms improved after glucocorticoid treatment. Hence, a diagnosis of IgG4-RD was made, with the phenotype of classic Mikulicz syndrome with systemic involvement. The manifestation of IgG4-RD as a unilateral renal pelvic mass is rare and should be kept in mind. A ureteroscopic biopsy and serum IgG4 level measurement can help in the diagnosis of IgG4-RD in patients with a unilateral renal pelvic lesion.
BLDC motor torque ripple factor lowering and FOPID based motion control using DGOA algorithm
Authors: M Pandi Maharajan , S Arockia Edwin Xavier
Published: June 2023

The Brushless Direct Current (BLDC) motor has many benefits due to characteristics like its small size and precise speed regulation. Uncertainty problems are presented by the system’s slow Proportional-Integral (PI) controller response time as well as some BLDC motor operating circumstances. The proposed Fractional-Order Proportional-Integral-Derivative (FOPID) controller and Difference of Orientation Offset Gaussian (DOOG) Grasshopper Optimization Algorithm (GOA) (DGOA) function are used to mitigate torque ripples in BLDC motors and overcome these drawbacks. An adaptive parameter has been introduced to enhance the performance of the conventional GOA method, and the performance of the suggested DGOA is compared to the benchmark functions. The simulation of the driver with the suggested DGOA-FOPID results in an improvement in Torque Ripple Reduction and speed control is obtained that better torque ripple reduction and speed regulation have been achieved.
Straddlers not spiralists: Critical questions for research on fixers, local-foreign news work, and cross-border journalism
Authors: Blacksin Isaac , Mitra Saumava
Published: June 2023

This article challenges current trends in the study of fixers and other forms of “local-foreign news work” through discussion of questions crucial to future investigations. Responding to Kotišová and Deuze’s call to complicate the existing “repertoire of concepts, theories, and epistemic categories” now in use in scholarship on fixing (2022: 1172), we provide theoretical frameworks relevant to, but thus far unutilized by, this scholarship. Considering local-foreign news work as a process of straddling political, cultural, and epistemic boundaries allows us to interrogate the conceptual binaries operating in the relevant research, such as west/nonwest, local/foreign, fixer/journalist. By engaging the liminality of local journalistic labor, this article brings into relief dynamics often obscured in current studies, namely, the impact of race and gender identities, and the post-colonial contexts within which much local-foreign news work takes place. Attention to these dynamics challenges the conceptual divisions upon which studies of cross-border journalism often rely, while revealing the consequential – and boundary-defying – positionality of local news workers. Finally, examination of the “cosmopolitanism” of local-foreign news work, and the “situatedness” of the knowledge produced by local news workers, serves to thicken scholarship on the topic in ways that deactivate essentialisms, deepen empirical foundations, and address problematic configurations of power critical to the study of news production today. By diversifying the research queries we pose, and the theoretical perspectives we employ, future research can better account for the dynamism of local-foreign news work in the contemporary global news landscape.
Liquid chromatography separation and identification of new oxidative degradation impurity in edoxaban tosylate hydrate drug substance by using liquid chromatography with tandem mass spectrometry
Authors: Alluri Chandramohan , Sharma G. Veera Raghava
Published: June 2023

Edoxaban is an anti-coagulant medication and a director factor Xa inhibitor. A novel reverse phase liquid chromatography–mass spectrometry compatible method developed for separation and identification of new oxidative degradation impurities in edoxaban tosylate hydrate drug substance. The separation of three oxidative degradation impurities was achieved by using YMC Triart phenyl (250  ×  4.6) mm, 5 µm column with mobile phase containing gradient elution of mobile phase-A as 10 mM ammonium acetate and mobile phase-B as acetonitrile:methanol (1:1)% (v/v). The flow rate of the mobile phase is 0.7 mL/min with a column temperature of 40 °C and detection wavelength of 290 nm. Edoxaban tosylate hydrate shows significant degradation in oxidative stress conditions and forms three oxidative degradation products. The degradation products were identified and characterized by using a high-resolution mass spectrometry quadrupole-time of flight mass detector. The three oxidative degradation impurities of Edoxaban drug substance were well resolved with each other and along with Edoxaban drug substance peak. Among the three oxidative degradation impurities di-N-oxide impurity was the new oxidative degradation impurity identified for the first time and a novel reverse-phase high-performance liquid chromatography method was developed for separation of the three oxidative degradation impurities.
A conceptual framework for financial education
Authors: Yuning Tang
Published: June 2023

The purpose of this article is to explain the construction of, and potential uses of, a conceptual framework for financial literacy education that has been constructed upon key information drawn from literature reviews of financial literacy education as presented in countries with developed or developing policies and practice in the area. The framework was devised as part of a wider research project that was designed to compare the context of the needs for, and the approaches to, constructing financial literacy education policy and practice in China with that of developments in other countries. The full research was conducted for a PhD thesis and the comparative aspects will be presented in a later article but, as the conceptual framework may well be of use or interest to other researchers in the field, it is described and explained as the main focus of this article.
Leiomyosarcoma Presenting as Rupture With a Type II Endoleak After Thoracic Endovascular Aortic Repair
Authors: Kojima Takenori , Shuto Takashi , Hongo Norio , Miyamoto Shinji
Published: June 2023

Endovascular stent-graft therapy is a commonly performed procedure for aortic lesions worldwide and complications unique to stent grafts, such as postoperative endoleaks, are well known. However, as this treatment modality becomes more popular, physicians should carefully monitor for other unexpected complications, which may not always be related to the graft. This study presents a case of leiomyosarcoma of the aorta that developed during follow-up for a type II endoleak (T2EL) after thoracic endovascular aortic repair. The presence of the T2EL hindered the diagnosis of the sarcoma at an early stage. These findings suggest that an apparent aneurysm that grows suddenly during follow-up after stent grafting should raise the index of suspicion for a neoplasm as well as an endoleak.
Factors Influencing Compliance to Follow-Up After Endovascular Aneurysm Repair
Authors: Özdemir-van Brunschot Denise , Zerellari Romina , Tevs Maria , Holzhey David , Botsios Spiridon
Published: June 2023

Objectives

Regular follow-up after endovascular repair of aortic aneurysm is necessary to detect endoleak and/or migration of the stentgraft. However, absence or incomplete compliance to follow-up is common in this patient population. In this study we will analyse the frequency of non-compliance to post-EVAR follow-up and explore the underlying reasons.

Methods

All patients undergoing EVAR for infrarenal aortic aneurysm between 1st January 2011 and 31st December 2020 were included in this retrospective study. Absence of compliance to FU was defined as not showing up at the out-patient clinic; incomplete FU was defined as a surveillance gap of >18 months.

Results and conclusion

Non-compliance to follow-up was 35.9% (175 patients). In the multivariate analysis the patients who came with a ruptured aneurysm and patients who needed secondary therapy in the first 30 days more often did not comply with the FU protocol ( P = .03 and P < .01). Other studies have confirmed the low attendance to follow-up after EVAR.
Hybrid Approach for Treatment of a Symptomatic Giant Splenic Artery Aneurysm
Authors: Connors Kevin , Allen Rebecca , Snyder Mackenzie , Gibson Glen , Jeyabalan Geetha
Published: June 2023

A 56-year-old female presented with a symptomatic giant fusiform mid-splenic artery aneurysm (7.3 x 6.4 cm). The patient underwent hybrid management of the aneurysm with endovascular embolization of the aneurysm and inflow splenic artery followed by laparoscopic splenectomy with control and division of the outflow vessels. The patient had an uneventful post-operative course. This case demonstrates the safety and efficacy of an innovative, hybrid management of a giant splenic artery aneurysm with endovascular embolization and laparoscopic splenectomy that spares the pancreatic tail.
3D-shape formation of blood vessels based on computer aided design system
Authors: Abdul-Ameer Hussam K
Published: June 2023

This paper proposes and tests a computerized approach for constructing a 3D model of blood vessels from angiogram images. The approach is divided into two steps, image features extraction and solid model formation. In the first step, image morphological operations and post-processing techniques are used for extracting geometrical entities from the angiogram image. These entities are the middle curve and outer edges of the blood vessel, which are then passed to a computer-aided graphical system for the second phase of processing. The system has embedded programming capabilities and pre-programmed libraries for automating a sequence of events that are exploited to create a solid model of the blood vessel. The gradient of the middle curve is adopted to steer the vessel’s direction, while the cross-sections of the blood vessel are formed as a sequence of circles lying in planes that are orthogonal to the gradients of the middle curves. The radii for the circles are estimated as a distance between the intersection points of the blood vessel edges with the orthogonal plane to the middle curve gradient. The system then uses these circles and the middle curve gradients to produce a solid volume that represents the 3D shape of the blood vessel. The method was tested and evaluated using different cases of angiogram images, and showed a reasonable agreement between the generated shapes and the tested images.
Reshaping consent so we might improve participant choice (II) – helping people decide
Authors: Davies Hugh , Munday Rosie , O’Reilly Maeve , Gilmour Hamilton Catriona , Ardahan Arzhang , Kolstoe Simon E , Gillies Katie
Published: June 2023

Research consent processes must provide potential participants with the necessary information to help them decide if they wish to join a study. On the Oxford ‘A’ Research Ethics Committee we’ve found that current research proposals mostly provide adequate detail (even if not in an easily comprehensible format), but often fail to support decision making, a view supported by published evidence. In a previous paper, we described how consent might be structured, and here we develop the concept of an Information and Decision Aid (IDA) that can support decision making and be used to guide the dialogue between researcher and potential participant. Our proposal requires limited changes to current processes or paperwork and would provide an easily accessible document for others that the potential participant might approach for advice. It could later be integrated with the Informed Consent Form to ensure all matters of concern to the individual participant have been addressed before consent is formally signed off.
Associations between pre-stroke physical activity levels and health-related quality of life 3 months after stroke: A registry-based study (part of PAPSIGOT)
Authors: Reinholdsson Malin , Palstam Annie , Jood Katarina , S Sunnerhagen Katharina
Published: June 2023

Background:

Whether pre-stroke physical activity is associated with health-related quality of life after stroke has been sparsely investigated.

Aims:

To explore associations between pre-stroke physical activity and health-related quality of life 3 months after stroke onset.

Methods:

A consecutively collected cohort study with data from registries. Included were adult patients with first stroke in the period 2014–2018 who were hospitalized at any one of the three stroke units in Gothenburg, Sweden. Pre-stroke physical activity was assessed with the Saltin–Grimby Physical Activity Level Scale (SGPALS) after hospital admission for acute stroke. Health-related quality of life was assessed with the EuroQoL 5 Dimensions 5 Level Version (EQ-5D-5L) 3 months after stroke. Data were analyzed with the Kruskal–Wallis test and binary logistic regression.

Results:

Data were included from 2044 patients; 91% had ischemic stroke, 46% were female, and mean age was 73 years, with mild stroke severity median National Institute of Health Stroke Scale (NIHSS) of 2. Patients who were pre-stroke physically active reported better overall health-related quality of life by the EQ-5D-5L index value, all the domains in EQ-5D-5L, and the EuroQoL-Visual Analogue Scale (EQ-VAS) compared with pre-stroke physically inactive patients (all p < 0.001). Better health-related quality of life 3 months after stroke was associated with pre-stroke light and moderate physical activity: adjusted odds ratio (95% confidence interval), 1.9 (1.5–2.3) and 2.3 (1.5–3.4), respectively.

Conclusion:

Pre-stroke physical activity is associated with better health-related quality of life 3 months after stroke. For the domains of mobility, self-care, and pain/discomfort, physical activity with higher intensity is even more beneficial.
Barriers in inflammatory bowel disease care in Central and Eastern Europe: a region-specific analysis
Authors: Prokopič Michal , Gilca-Blanariux Georgiana , Lietava Peter , Trifan Anca , Pietrzak Anna , Ladic Agata , Brinar Marko , Turcan Svetlana , Molnár Tamás , Bánovčin Peter , Lukáš Milan
Published: June 2023

Inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis, are chronic immune-mediated diseases with a high incidence and prevalence in Europe. Since these are diseases with associated disability, they require complex management and the availability of high-quality healthcare resources. We focused on the analysis of IBD care in selected countries of Central and Eastern Europe (Croatia, the Czech Republic, Hungary, Moldova, Poland, Romania and Slovakia) targeting the availability and reimbursement of diagnostic and therapeutic modalities, the role of IBD centers and also education and research in IBD. As part of the analysis, we created a questionnaire of 73 statements organized in three topics: (1) diagnostics, follow-up and screening, (2) medications and (3) IBD centers. The questionnaire was filled out by co-authoring IBD experts from individual countries, and then the answers and comments on the questionnaire were analyzed. We identified that despite the financial burden, which still partially persists in the region, the availability of some of the cost-saving tools (calprotectin test, therapeutic drug monitoring) differs among countries, mainly due to variable reimbursement from country to country. In most participating countries, there also remains a lack of dedicated dietary and psychological counseling, which is often replaced by recommendations offered by gastroenterologists. However, there is adequate availability of most of the currently recommended diagnostic methods and therapies in each participating country, as well as the implementation of established IBD centers in the region.
Electronic patient-reported outcomes in clinical kidney practice (ePRO Kidney): a process evaluation of educational support for clinicians
Authors: Schick-Makaroff Kara , Klarenbach Scott , Kwon Jae-Yung , Cohen S. Robin , Czupryn Joanna , Lee Loretta , Pauly Robert , MacRae Jennifer M. , Forde Bruce , Sawatzky Richard
Published: June 2023

Background:

Patient-reported outcomes (PROs) are increasingly mandated in kidney care to incorporate patients’ perspectives.

Objectives:

We assessed whether educational support for clinicians using electronic (e)PROs could enhance person-centered care.

Design:

A process evaluation, using a mixed methods longitudinal comparative concurrent design was undertaken of educational support to clinicians on routine use of ePROs. In two urban home dialysis clinics in Alberta, Canada, patients completed ePROs. At the implementation site, clinicians were provided with ePROs and clinician-oriented education via voluntary workshops. At the non-implementation site, neither were provided. Person-centered care was measured using the Patient Assessment of Chronic Illness Care-20 (PACIC-20).

Methods:

Longitudinal structural equation models (SEMs) compared change in overall PACIC scores. The interpretive description approach, using thematic analysis of qualitative data, further evaluated processes of implementation.

Results:

Data were collected from questionnaires completed by 543 patients, 4 workshops, 15 focus groups, and 37 interviews. There was no overall difference in person-centered care throughout the study, including after delivery of workshops. The longitudinal SEMs revealed substantial individual-level variability in overall PACIC trajectories. However, there was no improvement at the implementation site and no difference between the sites during both the pre- and post-workshop periods. Similar results were obtained for each PACIC domain. Qualitative analysis provided insights into why there was no substantial difference between sites: (1) clinicians wanted to see kidney symptoms, not quality of life, (2) workshops were tailored to clinicians’ educational needs, not patients’ needs, and (3) variable use of ePRO data by clinicians.

Conclusion:

Training clinicians on use of ePROs is complex and likely only part of what is required to enhance person-centered care.

Registration:

NCT03149328. https://clinicaltrials.gov/ct2/show/NCT03149328
Predictors of adverse safety events and unscheduled care among an outpatient parenteral antimicrobial therapy (OPAT) patient cohort
Authors: Billmeyer Kaylyn N. , Ross Jennifer K. , Hirsch Elizabeth B. , Evans Michael D. , Kline Susan E. , Galdys Alison L.
Published: June 2023

Background:

Select circumstances require outpatient parenteral antimicrobial therapy (OPAT). The potency of OPAT agents presents an increased risk of adverse events and unscheduled medical care. We analyzed these outcomes among OPAT recipients as part of the implementation of a collaborative OPAT program.

Methods:

Adult patients discharged home from an academic hospital with OPAT between January 2019 and June 2021 were included in this retrospective cohort; participants discharged between June 2020 and June 2021 were part of the collaborative OPAT program. Patients with cystic fibrosis were excluded. Data on patient characteristics and outcomes were collected from electronic medical records by two reviewers. Multivariable analysis was conducted to identify predictors of vascular access device (VAD) complications, adverse drug events (ADEs), and OPAT-related emergency department (ED) visits and rehospitalizations.

Results:

Among 265 patients included in the cohort, 57 (21.5%) patients experienced a VAD complication; obesity [odds ratio (OR): 3.32; 95% confidence interval (CI): 1.38–8.73; p = 0.01) and multi-drug therapy (OR: 2.56; 95% CI: 1.21–5.39; p = 0.01) were associated with an increased odds of VAD complication. Eighty-two (30.9%) participants experienced an ADE; 30 (11.3%) experienced a severe/serious ADE. Lipo/glycopeptide receipt, (OR: 5.28; 95% CI: 1.89–15.43; p < 0.01) and Black/African American race (OR: 4.85; 95% (CI): 1.56–15.45; p < 0.01) were associated with an increased odds of severe/serious ADE. Inclusion in the OPAT collaborative was associated with a decreased odds of severe/serious ADE (OR: 0.26; 95% CI: 0.08–0.77; p = 0.01). Fifty-eight (21.9%) patients experienced an OPAT-related ED visit and 53 (20.0%) experienced an OPAT-related rehospitalization. VAD complication (OR: 2.37; 95% (CI): 1.15–4.86, p = 0.02) and ADEs (OR: 2.19; CI: 1.13–4.22; p = 0.02) were associated with OPAT-related ED visits. ADE was associated with 90-day OPAT-related rehospitalization (OR: 3.21; (CI): 1.59–6.58; p < 0.01).

Conclusion:

Adverse safety events and OPAT-related unscheduled care occurred often in our cohort. A structured OPAT program that includes ID pharmacist antibiotic reconciliation may reduce rates of ADEs.
Evaluating the utility of daily speech assessments for monitoring depression symptoms
Authors: Gumus Melisa , DeSouza Danielle D , Xu Mengdan , Fidalgo Celia , Simpson William , Robin Jessica
Published: June 2023

Objective

Depression is a common mental health disorder and a major public health concern, significantly interfering with the lives of those affected. The complex clinical presentation of depression complicates symptom assessments. Day-to-day fluctuations of depression symptoms within an individual bring an additional barrier, since infrequent testing may not reveal symptom fluctuation. Digital measures such as speech can facilitate daily objective symptom evaluation. Here, we evaluated the effectiveness of daily speech assessment in characterizing speech fluctuations in the context of depression symptoms, which can be completed remotely, at a low cost and with relatively low administrative resources.

Methods

Community volunteers ( N = 16) completed a daily speech assessment, using the Winterlight Speech App, and Patient Health Questionnaire-9 (PHQ-9) for 30 consecutive business days. We calculated 230 acoustic and 290 linguistic features from individual's speech and investigated their relationship to depression symptoms at the intra-individual level through repeated measures analyses.

Results

We observed that depression symptoms were linked to linguistic features, such as less frequent use of dominant and positive words. Greater depression symptomatology was also significantly correlated with acoustic features: reduced variability in speech intensity and increased jitter.

Conclusions

Our findings support the feasibility of using acoustic and linguistic features as a measure of depression symptoms and propose daily speech assessment as a tool for better characterization of symptom fluctuations.
Electronic consultation accessibility influence on patient assessments: A case–control study with user-generated tags of physician expertise
Authors: Yu Haiyan , Chiu Ya-Ling , Wang Jying-Nan , Yu Jiang , Hsu Yuan-Teng
Published: June 2023

Objective

In online health communities (OHCs), patients often list their physicians’ expertise by user-generated tags based on their consulted diseases. These expertise tags play an essential role in recommending the match of physicians to future patients. However, few studies have examined the impact of the accessibility of e-consults on patient assessments using marking of the physicians’ expertise in OHCs. This study aims to investigate what are the patient assessments of the physicians’ expertise if they have e-consult accessibility.

Methods

Through a case–control study, this article examined the effect of e-consult accessibility on patient-generated tags of physician expertise in OHCs. With data collected from the Good Doctor website, the samples consisted of 9841 physicians from 1255 different hospitals widely distributed in China. The breadth of voted expertise (BE) is measured by the number of consulted disease-related labels marked by a physician's served patients (SP). The volume of votes (VV) is measured by the number of a physician's votes given by the SP. The degree of voted diversity (DD) is measured by the information entropy of each physician's service expertise (labeled and voted by patients). The data analysis of e-consult accessibility is conducted by estimating the average treatment effect on the DD of physicians’ expertise.

Results

For the BE, its mean was 7.305 for the case group of physicians with e-consults accessible (photo and text queries), while the mean was 9.465 for the control for physicians without e-consults. For the VV, its mean was 39.720 for the case group, while the mean was 84.565 for the control. For the DD, its mean on patient-generated tags was 2.103 for the case group, which is 0.413 lower than the control group.

Conclusion

The availability of e-consults increases the concentration on physician expertise in the patient-generated tags. e-Consults reinforce the increment of the already-received physician expertise (reflected in tags), reducing the tag information diversity.
Formation and Implementation of Public Health Policy Toward Salt Reduction in Food Consumption
Authors: Opasanant Paralee , Sukwong Panpimol
Published: June 2023

This action research aimed to study the processes of public health policy toward salt reduction in food consumption. The processes were divided into 3 cycles as follows: 1) Public health policy formation; 2) Development of the policy to reduce dietary salt; and 3) Evaluation of the efficiency of the policy. Participants from the first group involved in policy formation; and a total number of 320 participants were recruited in the study with the criteria of a) age 18 years and above, b) having hypertension or at risk of having high blood pressure; c) overweight; and d) having underlying diseases such as diabetes and hyperlipidemia. The second group was government officials involved in policy development to reduce salt consumption, including the head of the village, assistants of the village head, community leaders, public health personnel, village health volunteers, and a group of housewives. In total, 50 participants were recruited to the study. The results showed that people with hypertension could better control blood pressure which increased from 36.02, 25.6, and 39.06% (in 2018-2020) to 47.32%; and community people could manage their health prevention and control toward non-communicable diseases. Analyzing a return on investment (ROI) found that the ROI was 49.7%; and a social return on investment (SROI) was found that every $1 invested could generate a return of $3.45.