bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact on monthly migraine days of discontinuing anti-CGRP antibodies after one year of treatment – a real-life cohort study
Authors: Gantenbein Andreas R , Agosti Reto , Gobbi Claudio , Flügel Dominique , Schankin Christoph J , Viceic Dragana , Zecca Chiara , Pohl Heiko
Published: May 2021

Objective

This study aims to analyse the effect of the discontinuation of anti-calcitonin gene-related peptide antibodies on monthly migraine days after 12 treatment months.

Background

Anti-calcitonin gene-related peptide antibodies have been a game changer in migraine prophylaxis. However, high treatment costs warrant reducing treatment duration to the essential minimum.

Methods

We collected data of patients with migraine who had received anti-calcitonin gene-related peptide antibodies and had received treatment for 12 months.

Results

We included 52 patients. The average number of monthly migraine days was 16 ± 7 days at baseline, 6 ± 6 in the third, and 5 ± 4 in the 12th treatment month. After treatment interruption, the number of monthly migraine days was 6 ± 4 days in the first month, 9 ± 4 days in the second, and 11 ± 5 days in the third month. Most patients (88.9%) restarted treatment.

Conclusion

Only little of the therapeutic effect of anti-calcitonin gene-related peptide antibodies outlasts their pharmacological effect. After treatment interruption, migraine frequency rose in most patients, and prophylaxis was required again in most cases. Limiting treatment to benefitting patients and confirming the need for prophylaxis periodically is reasonable. However, our data does not support the need for prescheduled treatment discontinuation after 12 months and a fixed duration of the treatment interruption of 3 months.
Help-Seeking Among Women of Haitian Descent in the Dominican Bateyes
Authors: Tull Peggy , Salusky Ida
Published: May 2021

People of Haitian descent in the Dominican Republic are at high risk of violence, including interpersonal violence, and experience multiple levels of structural oppression. However, limited research exists specifically about women of Haitian descent in this context, who are at unique risk for violence and marginalization given intersectional oppression related to antiblackness, xenophobia, and misogyny. It is unclear what resources and supports exist for women of Haitian descent living in the Dominican Republic, and whether women can effectively meet their needs through available supports. This study analyzed 25 life history interviews to understand help-seeking patterns to address self-defined needs among women of Haitian descent. Analysis focused on narratives of interpersonal violence, as most research on this issue focuses on experiences of women in the global north. Thematic analysis demonstrated that women navigate a variety of informal supports, primarily with other women in their kinship networks, to address different needs, including material, emotional, and interpersonal—but primarily to address needs related to pregnancy and childcare, interpersonal violence, and housing. Women also sought help from male family members and formal institutions, though less frequently compared to help-seeking from other women. Outcomes of help-seeking, including who provided effective help, conditions of support, and negative reactions varied. Implications of women’s patterns of help-seeking in this context, and how they compare to patterns within the larger help-seeking literature are discussed.
Social Support Networks and Foreign-Birth Status Associated With Obesity, Hypertension and Diabetes Prevalence Among 21-30 and 50-70 Year Old Adults Living in the San Francisco Bay Area
Authors: Cofie Leslie E. , Hirth Jacqueline M. , Lee Joseph G. L.
Published: May 2021

Purpose:

To examine whether social network characteristics of US-and foreign-born individuals are related to hypertension, diabetes and obesity prevalence.

Design:

Cross-sectional.

Setting:

Six San Francisco Bay Area counties.

Participants:

N = 1153 cohorts of young and older adults (21-30 and 50-70 years).

Measures:

Network structure and support measures were calculated using name elicitation and interpreter questions common in egocentric surveys. Hypertension and diabetes were self-reported, and overweight/obesity was determined using body mass index calculations. Foreign-birth status was based on country of birth.

Analysis:

Adjusted and unadjusted logistic regression models were used to examine associations between network characteristics and hypertension, diabetes and overweight/obesity. These relationships were tested for moderation by foreign-birth status, age and gender.

Results:

Higher percentages of family members (AOR = 4.16, CI: 1.61-10.76) and same-sex individuals (AOR = 3.41, CI: 1.25-9.35) in the composition of respondents’ networks were associated with overweight/obesity. Higher composition of family members (AOR = 3.54, CI: 1.09-11.48) was associated with hypertension. Respondents whose networks composed of higher numbers of advice individuals (AOR = 0.88, CI: 0.77-0.99), female respondents (AOR = 0.52, CI: 0.35-0.77) and foreign-born respondents (AOR = 0.54, CI: 0.32-0.92) were less likely to report overweight/obesity. Diabetes was associated with higher composition of individuals living within 5-minutes to respondents (AOR = 5.13, CI: 1.04-25.21).

Conclusion:

Family and network support members such as advice individuals could be potential targets for chronic disease prevention, particularly among older adults and immigrants.
Potentially Inappropriate Medication Usage in Older Adults in a Tertiary Academic Medical Center Emergency Department
Authors: Gardner Katelyn , Schwarz Kerry , Pearson Scott , Jacknin Gabrielle
Published: May 2021

Background:

The Beers Criteria® medications are potentially inappropriate medications (PIMs) recommended by the American Geriatric Society to be avoided or used with caution in adults 65 years and older. The usage of PIMs in the emergency department (ED) setting is not well characterized.

Objectives:

The purpose of this study is to evaluate the usage of PIMS in the ED.

Methods:

This is a single center retrospective observational study of a random sample of patients aged 65 and older who presented to the ED during a 6-month timeframe. The primary outcome was the incidence of ED readmissions in patients administered or prescribed a PIM compared with patients who were not prescribed or administered a PIM. Secondary outcomes included ED length of stay (LOS) and hospital admission.

Results:

Out of 192 patients, there was a total of 58 patients (30.2%) in the PIM group and 134 patients (69.8%) in the No PIM group. ED re-presentation within 30 days occurred in 10 patients (17%) in the PIM group vs 26 patients (19%) in the No PIM group (p = 0.88). The median ED LOS was 227 minutes vs 208 minutes (p = 0.1679). Hospital admission within 30 days occurred in 4 patients (7%) in the PIM group and 13 patients (10%) in the No PIM group (p = 0.725).

Conclusions:

This analysis did not show statistically significant differences between patients who received a PIM compared to those who received an alternative medication with regard to re-presentation, admission, and ED LOS. ED LOS trended towards being longer in the PIM group.
Disaggregating the Effects of Inequality on Informal Giving: Evidence From Pakistan
Authors: Fateh Ahmad Husnain , Majid Hadia
Published: May 2021

In this article, we outline the determinants of informal charitable giving and the link between giving and inequality. Arguing that inequality encompasses at least two competing effects—distrust and observed need for donations—we use a novel proxy to separate out the effect of the latter from the former on household’s magnitude of informal giving. Using data from the Pakistan Centre for Philanthropy’s 2014 Indigenous Individual Philanthropy Survey, we find that informal giving in Pakistan follows patterns like those observed in the literature for formal giving. We also find evidence for a positive relationship between observed need and the magnitude of person-to-person giving. Controlling for observed need, we find that the residual correlation between inequality and giving is negative, one explanation of which may be the positive link between inequality and decreased social cohesion and trust.
Exploiting the instability of eccentric tube robots for distal force control in minimally invasive cardiac ablation
Authors: Alfalahi Hessa , Renda Federico , Messer Conor , Stefanini Cesare
Published: May 2021

While the dilemma of motion tracking and force control in beating-heart surgery is previously addressed using active control architectures and rigid robotic actuators, this work leverages the highly controllable mechanical properties of concentric tube robots for intelligent, design-based force control in minimally invasive cardiac ablation. Briefly, cardiac ablation is the conventional procedure for treating arrhythmia patients, by which exposing the diseased cardiac tissue to Radio-Frequency (RF) energy restores the normal heart rhythm. Yet, the procedure suffers low success rate due to the inability of existing flexible catheters to maintain a consistent, optimal contact force between the tip electrode and the tissue, imposing the need for future repeat surgeries upon disease recurrence. The novelty of our work lies in the development of a statically-balanced compliant mechanism composed of (1) distal bi-stable concentric tubes and (2) a compliant, torsional spring mechanism that provides torque at tubes proximal extremity, resulting in an energy-free catheter with a zero-stiffness tip. This catheter is expected to maintain surgical efficacy and safety despite the chaotic displacement of the heart, by naturally keeping the tip force at an optimal level, not less and not more than the surgical requirement. The presented experimental results of the physical prototype, reflect the feasibility of the proposed design, as well as the robustness of the formulated catheter mathematical models which were uniquely deployed in the selection of the optimal design parameters.
The effect of hexagonal nano boron nitride on mechanical performances and machinability behaviors of basalt fabric reinforced epoxy composites
Authors: Gumus Fatma B , Ceritbinmez Ferhat , Yapici Ahmet
Published: May 2021

The aim of this work is to investigate the effect of the hexagonal nano boron nitride (h-BN) doped epoxy on the mechanical performances and machinability behaviors of basalt fiber (BF) composites. The h-BN has used as a dopant with a weight rate of 1 wt. %. The polymer composites were prepared by the vacuum bagging method and specimens were processed with abrasive water jet machining (AWJM) to analyze the machinability of the material. A circular hole with an 8 mm size was machined by abrasive water jet (AWJ) on the composite plate with a thickness of 2.3 ± 0.1 mm using the garnet size of 80 µm as an abrasive. Taper angle and circularity of machined hole, the entry-exit hole diameter, delamination, splintering, burring, thickness, and hardness were measured. Results indicate that cutting speed has a high influence on the taper angle and circularity respectively.
Comprehensive analysis for influence of complex coupling effect and controllable suspension time delay on hub-driving electric vehicle performance
Authors: Wu Hang , Zheng Ling , Li Yinong , Zhang Zhida , Liang Yixiao , Hu Yiming
Published: May 2021

For in-wheel driving vehicle electric vehicles (EVs), mechanical electromagnetic coupling effect caused by the air gap deformation in permanent magnet synchronous hub motor and intensified by the road excitation deteriorates the EVs performance. In this paper, after studying the numerical method for multi-field coupling problems of hub-driving vehicle under the coupled action of electromagnetic field and mechanical field. The experimental validation is investigated. The results indicate that the multi-field coupling effect in hub-driving motor worsens the dynamics performance of the vehicle. To enhance the vehicle performance, suppress mechanical electromagnetic coupling effect and, at same time, reduce the influence of controllable suspension time delay, a delay-dependent H∞ controller is designed based on Lyapunov theory. By applying the particle swarm optimization (PSO) algorithm and the linear matrix inequality theory, the desired output controller gain is derived. Numerical simulations reflect that the active suspension controller considering control time delay not only achieves the favorable riding comfort performance and restrains the coupling effect in hub driving motor but also ensures the suspension deflection and the safety performance requirement. Moreover, it maintains the closed-loop asymptotically stability regardless of t the variation on the sprung mass and control time delay.
Conversion Furlow Palatoplasty and the Use of Preoperative Video Nasendoscopy
Authors: Kaye Alison , Tracy Meghan , Noel-MacDonnell Janelle , Dent Kathryn
Published: May 2021

Objective:

To assess outcomes after conversion Furlow palatoplasty with and without routine preoperative flexible fiberoptic video nasendoscopy (FFVN).

Design:

Retrospective cohort study.

Setting:

Tertiary Children’s Hospital.

Patients:

Greater than 3 years of age with cleft palate and velopharyngeal insufficiency (VPI) after straight-line palatoplasty requiring secondary surgery performed with a Furlow palatoplasty.

Main Outcome Measures:

The number of children with and without routine FFVN prior to conversion Furlow palatoplasty for VPI after initial straight-line palatoplasty. Groups were compared for surgical timing, speech outcomes, and need for additional surgery after conversion Furlow palatoplasty.

Results:

Fifty-eight patients underwent preoperative FFVN versus 29 without. Mean age at FFVN was 73.8 (SD 34) months. Mean age for secondary palatal surgery by conversion Furlow palatoplasty was 81.5 (SD 34.8) months with FFVN versus 73.4 (SD 34.0) months without FFVN. There was a significant difference ( P < .001) for VPI diagnosis and time to surgery between the groups. Preoperative hypernasality ratings were similar between groups. Postoperatively 65.5% of FFVN and non-FFVN patients corrected to normal resonance. Only 6.9% of all patients rated moderate-severe hypernasality after surgery compared to 42.5% preoperatively. Of total, 5.7% of patients had unchanged hypernasality and only 1 patient rated worse. Seven patients ultimately required additional surgery in attempt to normalize their resonance.

Conclusions:

Routine preoperative FFVN does not offer any advantage for improved outcomes in children undergoing conversion Furlow palatoplasty after straight-line repair. Routine preoperative FFVN was associated with increased time to surgery after diagnosis of VPI compared to those without FFVN.
Otitis Media and Hearing Loss in Patients With Nonsyndromic Craniosynostosis: A Multicenter Study
Authors: Grewal Jeewanjot S. , Cohn Jason E. , Burdett Jacob , Tampio Alex , Licata Jordan , Davis Wellington J. , Tatum Sherard A. , Nicholas Brian D.
Published: May 2021

Objectives:

The objectives of this study were to: (1) determine the prevalence of otitis media with effusion in patients with nonsyndromic craniosynostosis; (2) determine the prevalence of hearing loss in patients with nonsyndromic craniosynostosis; and (3) identify potential patterns and outcomes in patients with nonsyndromic craniosynostosis.

Methods:

A retrospective chart review was conducted at 2 academic institutions, St Christopher’s Hospital for Children and SUNY Upstate Medical University, from January 2015 through August 2018, to identify patients having nonsyndromic craniosynostosis with a concurrent diagnosis of otitis media and/or hearing loss. The demographic data and categorical variables were analyzed using descriptive statistics and chi-square testing, respectively.

Results:

In the entire cohort of patients (N = 113, age range 0-123 months), 36% had otitis media with effusion on either history, physical examination, tympanometry, and/or imaging. Half (50%) of patients with coronal synostosis had otitis media with effusion compared to sagittal (40.7%), metopic (26.3%), multiple (25%), and lambdoid (0%). However, these differences were not statistically significant ( P = .190). Most patients had normal hearing (91%), while a minority had either conductive (7%) or sensorineural (2%) hearing loss.

Conclusion:

The presence of otitis media in our cohort of patients with nonsyndromic craniosynostosis appears to be at the upper limit of normal when compared to historical rates in normocephalic children. Synostosis subtype did not appear to predict the presence of otitis media. Only 9% of patients with nonsyndromic craniosynostosis were found to have a hearing loss.
From Public Participation to Constitutional Legitimacy: Evidence from Tunisia
Authors: Maboudi Tofigh , Nadi Ghazal P.
Published: May 2021

Does public participation in constitution-making processes enhance constitutional legitimacy? Using an original public opinion survey conducted in Tunisia shortly after the adoption of the 2014 Constitution, this article examines whether public participation in constitution-making activities enhances perceived constitutional legitimacy. The results show that participants are more likely to support the constitution and its institutions than non-participants. We argue that participation increases constitutional literacy among the general public and this increased knowledge impacts the respondents’ perception of the constitution. The empirical findings confirm normative assumptions of participatory model of the democratic theory and suggest that inclusive and participatory constitutional reform processes, in contrast to an elitist approach, are more likely to yield democratic constitutional outcomes which are supported by larger segments of the society.
Early weak fault diagnosis of rolling element bearing based on resonance sparse decomposition and multi-objective information frequency band selection method
Authors: Wang Hongchao , Du Wenliao
Published: May 2021

Vibration signals of rolling element bearing’s early weak fault are often submerged by some interference components. To extract early weak fault features accurately, a weak fault feature enhancement method of rolling element bearing based on resonance sparse decompositionand multi-objective information frequency band selection is proposed. This method makes full use of resonance sparse decomposition in filtering the interferences and multi-objective information frequency band selection in enhancing impulsive and cyclostationary features of rolling element bearing’s early weak fault simultaneously. First, resonance sparse decomposition is used as the preprocessing program of multi-objective information frequency band selection to filter the interferences (such as rotating frequency with its harmonics) of rolling element bearing’s early weak fault characteristic components. Then, the filtered components containing main fault information are analyzed by MIFBS to establish the best band-pass filter. Finally, the envelope spectrum analysis is applied on the filtered vibration signal, and the fault characteristic frequency with its harmonics is extracted. To achieve the optimal output parameters of multi-objective information frequency band selection, fusion indexes based on time- and frequency-domain estimators are proposed and used to balance the enhancement of impulsive and cyclostationary characteristics of rolling element bearing’s early weak fault signals. Compared with most of the existing methods mainly based on single time-domain estimators or frequency-domain estimators to improve performance spectral kurtosis, the proposed fusion indexes overcome their defects and could enhance the impulsive and cyclostationary features of rolling element bearing’s early weak fault simultaneously. Effectiveness of the proposed method is verified through simulation and experiment. Besides, its advantage over the other related methods is also presented.
Closed-system transfer device use with oncology biologics: A survey of Canadian healthcare practitioners
Authors: Khaira Manmeet , Guy Allison L
Published: May 2021

Introduction

Closed-system transfer devices (CSTDs) were introduced into clinical practice to protect healthcare practitioners (HCPs) from exposure to hazardous drugs. However, ambiguous guidelines have led to confusion as to when CSTD use is required, as institutes are instructed to maintain their own hazardous drug lists and determine the appropriate level of personal protective equipment for their staff. This study seeks to understand the current use of CSTDs by Canadian oncology HCPs, the influence of various stakeholders on their use and the challenges faced by HCPs surrounding the use of these medical devices.

Methods

The researchers compiled a set of questions to inform on the current use of CSTDs in clinical practice and administered an online survey to oncology HCPs across Canada.

Results

The results indicate that though CSTD use is common in Canadian oncology practice settings, there is variation in the extent of the use of these devices across provinces and with which products these devices are used. The survey results also show that the top challenges with the use of CSTDs include cost, lack of information on the compatibility of a CSTD with a drug product, and CSTD impact on drug quality. Many respondents are aligned that regulatory bodies are more likely to influence the use of CSTDs with specific drug products than drug manufacturers.

Conclusion

Guidelines for the application of CSTDs in clinical practice vary and are often ambiguous. Regulatory bodies are uniquely positioned to provide healthcare institutions with more clarity on when CSTD use is appropriate.
Quality of wheat breads enriched with flour from germinated amaranth seeds
Authors: Guardianelli Luciano M , Salinas María V , Puppo María C
Published: May 2021

Amaranth flour from germinated (GA) and non-germinated (A) seeds (0%-C, 5%, 15%, 25%) were mixed with wheat flour for breadmaking. Fermentation parameters of dough (time-tf, maximum volume-Vmax) were obtained. Specific volume (Vsp) of breads, crust color, texture and relaxation of crumb were analyzed. A high amount of germinated amaranth flour decreased Vmax and increased tf, obtaining breads with low Vsp and darkness crust. A firmed and chewy crumb, although with a more aerated structure (high area occupied by alveoli) was obtained. The GA25 bread presented the softer crumb. The elastic modulus-E1 of crumb increased and the relaxation time-T1 decreased with higher amounts of amaranth flour, suggesting the formation of a more structured crumb; mainly in the case of non-germinated amaranth flour. Wheat flour resisted the inclusion of 25% of germinated amaranth seeds (GA25) without substantial changes in bread quality.
The Interplay of Social Status and Trust: A Critical Review of Concepts, Operationalizations, and Findings
Authors: Dahlhaus Carolina , Schlösser Thomas
Published: May 2021

This review examines the relationship between a person’s social status and trust. Previous research has yielded differing results. On one hand, studies have repeatedly found positive correlations of different strengths between social status and trust; that is, persons with higher social status trust more than persons with lower social status. On the other hand, empirical evidence has also suggested a negative correlation between social status and trust; that is, persons with lower social status trust more than persons with higher social status. In addition to a systematic analysis of the various theoretical approaches and the respective study results, possible causes for these diverging empirical findings are discussed. With regard to the relationship between socioeconomic status and generalized trust, all studies reviewed show a positive correlation. Contradictory results can be found only in studies that investigated socioeconomic status and trust, measured as behavior. In addition to the different operationalizations of social status and trust, one potential cause for different results may be found in the fact that in experimental settings, the social status of the interaction partner is often known.
The Black Pill: New Technology and the Male Supremacy of Involuntarily Celibate Men
Authors: Preston Kayla , Halpin Michael , Maguire Finlay
Published: May 2021

Involuntary celibates, or “incels,” are people who identify themselves by their inability to establish sexual partnerships. In this article, we use analytic abduction to qualitatively analyze 9,062 comments on a popular incel forum for heterosexual men that is characterized by extensive misogyny. Incels argue that emerging technologies reveal and compound the gender practices that produce involuntarily celibate men. First, incels argue that women’s use of dating apps accelerates hypergamy. Second, incels suggest that highly desirable men use dating apps to partner with multiple women. Third, incels assert that subordinate men inflate women’s egos and their “sexual marketplace value” through social media platforms. We argue that incels’ focus on technology reinforces essentialist views on gender, buttresses male domination, dehumanizes women, and minimizes incels’ own misogyny. We discuss findings in relation to theories of masculinity and social scientific research on the impacts of emerging technology.
The Variability and Determinants of Testosterone Measurements in Children: A Critical Review
Authors: Li Jessa Rose , Goodman Xan , Cho June , Holditch-Davis Diane
Published: May 2021

Aims:

This critical review aimed to summarize: (1) the variability and determinants of testosterone (T) measurements; and (2) reference values for the variability and determinants of T measurements in children.

Background:

As T is a representative androgen, it has been widely used to explain male vulnerability to child health and developmental problems. T measurements in children, however, have been challenging because of low levels, diurnal and episodic secretion patterns, limited quantity and quality of the samples, and inconsistent study findings.

Methods:

The search strategy used PubMed, CINAHL, Cochrane Library, Embase, Scopus, and Google Scholar. Studies published between 2008 through 2020 that examined factors influencing T measurement were included. The final 30 studies were selected using two appraisal forms. We extracted five categories of data from the reports.

Findings:

Variability and determinants of T measurement included assay methods, the source of samples, and child demographic and environmental characteristics. T levels were higher 1–3 months after birth and in males up to 1 year; fewer sex differences were found up to 10–12 years. Serum T levels measured by using liquid chromatography-mass spectrometry were most reliable because immunoassays overestimated the levels, especially in neonates. T levels were stable at different temperatures and durations of storage, although sample collection remained an ongoing challenge for researchers.

Conclusion:

Depending on the study aims and feasibility, mass-spectrometry, multi-methods, and multi-materials are the recent trends in T measurement. Immunoassays may be an option if the study aims for relative rather than absolute comparisons.
Ocular biomarkers and their role in the early diagnosis of neurocognitive disorders
Authors: Chalkias Ioannis-Nikolaos , Tegos Thomas , Topouzis Fotis , Tsolaki Magda
Published: May 2021

Given the fact that different types of dementia can be diagnosed only postmortem or when the disease has progressed enough to cause irreversible damage to certain brain areas, there has been an increasing need for the development of sensitive and reliable methods that can detect early preclinical forms of dementia, before the symptoms have even appeared. Ideally, such a method would have the following characteristics: to be inexpensive, sensitive and specific, Non-invasive, fast and easily accessible. The ophthalmologic examination and especially the study of the retina, has caught the attention of many researchers, as it can provide a lot of information about the CNS and it fulfills many of the aforementioned criteria. Since the introduction of the non-invasive optical coherence tomography (OCT) and the newly developed modality OCT-angiography (OCT-A) that can demonstrate the structure and the microvasculature of the retina and choroid, respectively, there have been promising results regarding the value of the ophthalmologic examination in the early diagnosis of Alzheimer’s disease. In this review paper, we summarize and discuss the ocular findings in patients with cognitive impairment disorders and we highlight the importance of the ophthalmologic examination to the diagnosis of these disorders.
Delivering A Digital Mental Health Service in Australian Secondary Schools: Understanding School Counsellors’ and Parents’ Experiences
Authors: O’Dea Bridianne , King Catherine , Achilles Melinda R , Calear Alison L , Subotic-Kerry Mirjana
Published: May 2021

This study examined school counsellors’ and parents’ experiences of a school-based digital mental health service (Smooth Sailing) that screened students’ mental health and provided automated psychological care. The Smooth Sailing service was offered to 4 secondary schools in New South Wales, Australia, for a 6-week trial period with 59 students taking part. The participating school counsellors (n = 4) completed a semi-structured interview to explore their experiences. Parents of students who had consented to being contacted (n = 37/59) were invited to complete an anonymous online survey about their child’s participation. Six parents completed the survey. The school counsellors expressed overall support for the service and cited the ease of service use, its ability to identify students at-risk, and the provision of psychoeducation to students as clear benefits. They identified some barriers to the service, such as parental consent and suggested strategies to improve uptake and engagement, such as incentives, more frequent screening and use with older students. Parents also reported positive experiences with the service, expressing appreciation for mental health screening in schools and a new system to connect them and their child to school counselling services. Taken together, these findings provide initial support for delivering the Smooth Sailing service in secondary schools.

Trial registration:

This trial was registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12617000977370).
The hospital telemedicine TELEMED database: Providing information on evidence-based telemedicine services to hospital managers and healthcare professionals
Authors: Kidholm Kristian , Svendsen Ida W , Yderstræde Knud , Ølholm Anne M , Rayce Kathrine , Kjølhede Tue
Published: May 2021

Background

Increased use of telemedicine in the healthcare system is a political goal in Denmark. Although the number of hospital patients using interventions such as the video consultation has increased in recent years only a small proportion of the outpatient and inpatient visits involve telemedicine. The TELEMED database ( https://telemedicine.cimt.dk/ ) has been launched at the Center for Innovative Medical Technology in Denmark to ensure that hospital managers and healthcare professionals have access to information about telemedicine services and their effectiveness. This article describes the development and the content of the TELEMED database.

Methods

A structured literature search was made in the PubMed Database for randomised controlled trials or observational studies with a control group that investigated the effect of telemedicine interventions for hospital patients. Data were extracted from each article on the clinical effectiveness, patient perceptions, economic effects and implementation challenges. As the database should only provide inspiration to healthcare professionals regarding possibilities for use of telemedicine, the risk of bias in the studies was not assessed.

Results

The literature search resulted in 2825 hits. Based on full text assessment, 331 articles were included for data extraction and assessment. These articles present telemedicine services used in 22 different medical specialities. Forty-eight percent of the studies found a positive, statistically significant clinical effect, while 47% showed no statistically significant difference. In 48% of the studies, patients’ experiences were examined and of these 68% found positive patient experiences. Fifty-four percent of the articles included information on the economic effects and, of these, 51% found reduction in healthcare utilization. In the majority of studies between two and four types of implementation challenges were found. Conclusions and recommendations: The TELEMED database provides an easily accessible overview of existing evidence-based telemedicine services for use by hospital managers and health professionals, who whish to to implement telemedicine. The database is freely available and expected to be continuously improved and broadened over time.
Non-Vaccination Stage Model (NVST): The decision-making process among Israeli ultra-orthodox Jewish parents
Authors: Popper-Giveon Ariela , Keshet Yael
Published: May 2021

Although vaccination uptake is high in most countries, pockets of suboptimal coverage remain, such as those observed among ultra-orthodox Jews in Israel and elsewhere, posing a threat to both individual and public immunity. Drawing on the Precaution Adoption Process Model (PAPM), this study proposes a Non-Vaccination Stage Model (NVSM) to analyze the decision-making process among Non-Vaccinating Parents (NVPs), focusing on the ultra-orthodox Jewish population of Israel. In-depth interviews were conducted with 10 Israeli ultra-orthodox Jewish NVPs (mothers). The interviews revealed five stages in the participants’ decision-making process: Being good mothers who vaccinate their children; Emergence of doubts regarding the risks of vaccination; Personal vaccination policy—hesitancy concerning vaccination; Decision not to vaccinate; Confirmation signs of what participants perceive as a wise decision. NVSM can help understand parents who consider non-vaccination to be healthier behavior and explore the various stages of their decision-making process. Differentiating among the various stages of NVPs’ decision-making processes enables application of different intervention approaches by policymakers and healthcare practitioners.
Literature review on hydrostatic vaginal and anorectal injuries caused by personal watercraft
Authors: Etienne Jean-Hubert , Rahili Mohamed Amine , Estran Mareva , Tahiri-Ghetemme Jellila , Benizri Emmanuel
Published: May 2021

Introduction

The use of personal watercrafts (PWCs) has increased in popularity, size and engine power over time. Hydrostatic injuries when the passenger falls into water and the pelvic floor is directly hurt by the water jet remain rarely reported in literature but potentially lethal. Perineal, gynaecological and rectosigmoid regions present significant points of anatomical weakness to the force vector of the water. Biomechanical aspects on water-associated injuries on PWC may include disruption of the perineal soft tissues, inefficient anal sphincter and hydrodynamic insufflation.

Methods

This is a study involving a literature review from 1972 to 2020 using suitable search terms to identify all hydrostatic PWC injuries following PRISMA guidelines. Data were extracted from suitable articles on mechanism of injury, injuries sustained, treatment and outcomes.

Results

Thirty-two patients with major perineal, gynaecological and/or digestive injuries due to hydrostatic PWC traumas were identified. Major risk factors were female gender (84.4%), young age (25.5 years), being a rear passenger and wearing a standard swimsuit (100%). The injuries were digestive tract only (81.3%), gynaecological only (46.9%) or combined (28.1%). The interdisciplinary surgical management must include a vaginal and anal exploration under general anaesthesia and an exploratory surgery. Vaginal repair (41.9%) may be associated with a transanal anorectal suturing for lacerations of the intraperitoneal rectum (40.6%). A defunctioning stoma was performed in 62.5% and consisted of a loop sigmoidostomy (43.5%) or Hartmann’s procedure (34.8%) depending on laceration complexity.

Conclusions

PWC-related hydrostatic injuries are still rare but associated with a mortality rate of 6.3% which rises to 25% if initial haemodynamic instability was present. Expert guidelines such as adding an automated engine shut-off switch for the rear passenger and wearing a protective and safety clothing should be more widely respected.
The wandering bullet: An unusual case of paradoxical embolization involving the neck, aortic arch, and iliac artery
Authors: Naidoo Sashelin , Botes Jaco , Janson Jacques , Keyser Zamira , Burke Jonathan
Published: May 2021

Paradoxical intravascular bullet embolism involving the aortic arch (AA) is a rare and highly lethal condition. We describe an unusual case of a civilian gunshot injury to the neck. A bullet entered in the neck, injured the internal jugular vein (IJV), and then continued into the lumen of the common carotid artery (CCA). The bullet traveled under its own momentum and against the flow of blood, along the carotid and brachiocephalic vessels, finally lodging in the wall of the lesser curvature of the AA. The injury tract resulted in an arterial-venous fistula between IJV and CCA and a pseudoaneurysm of the AA. Open surgical repair of the neck and AA was complicated by secondary distal embolization of the bullet, requiring an embolectomy.
An octagonal split ring resonator-based double negative metamaterial for S-, X- and Ku-band applications
Authors: Idrus Ismatul N , Faruque Mohammad RI , Abdullah Sabirin , Islam Mohammad T , Khandaker Mayeen U , Nebhen Jamel
Published: May 2021

This study aimed to produce a miniaturised double negative metamaterial with a lower resonance frequency. Therefore, a new combination of a multi-circular ring connected with octagonal shape ring metamaterial was developed on a 9 × 9 mm2 dielectric substrate material with a thickness of 1.6 mm, named the Flame Retardant 4 (FR-4). While the selected frequency ranged between 0 and 18 GHz for the unit and array metamaterial design. Numerical simulation was used for the design and analysis of the proposed metamaterial. A few analysis were performed to validate the performance of the new design including the analyses of the different dimensions of the substrate and varying widths of the split gaps. The proposed design structure manifested resonance frequencies at S, X and Ku-bands. The resonance frequency at S-band (3.31 GHz) and X-band (8.60 GHz) presented double-negative (DNG) metamaterial behaviour while X-band (11.93 GHz) and Ku-band (12.99 GHz) presented single-negative (SNG) medium characteristics. The simulation and measured results almost coincided with each other. The compactness of the proposed design was proven by the effective medium ratio (EMR) of 10.07. In conclusion, the miniaturised structure can be accredited for satellite communication and radar applications.
Investigating anode off-gas under spark-ignition combustion for SOFC-ICE hybrid systems
Authors: Ran Zhongnan , Longtin Jon , Assanis Dimitris
Published: May 2021

Solid oxide fuel cell – internal combustion engine (SOFC-ICE) hybrid systems are an attractive solution for electricity generation. The system can achieve up to 70% theoretical electric power conversion efficiency through energy cascading enabled by utilizing the anode off-gas from the SOFC as the fuel source for the ICE. Experimental investigations were conducted with a single cylinder Cooperative Fuel Research (CFR) engine by altering fuel-air equivalence ratio (ϕ), and compression ratio (CR) to study the engine load, combustion characteristics, and emissions levels of dry SOFC anode off-gas consisting of 33.9% H2, 15.6% CO, and 50.5% CO2. The combustion efficiency of the anode off-gas was directly evaluated by measuring the engine-out CO emissions. The highest net-indicated fuel conversion efficiency of 31.3% occurred at ϕ  = 0.90 and CR = 13:1. These results demonstrate that the anode off-gas can be successfully oxidized using a spark ignition combustion mode. The fuel conversion efficiency of the anode tail gas is expected to further increase in a more modern engine architecture that can achieve increased burn rates in comparison to the CFR engine. NOx emissions from the combustion of anode off-gas were minimal as the cylinder peak temperatures never exceeded 1800 K. This experimental study ultimately demonstrates the viability of an ICE to operate using an anode off-gas, thus creating a complementary role for an ICE to be paired with a SOFC in a hybrid power generation plant.
Limit prison guards in the ICU during the coronavirus pandemic
Authors: Altshuler Ellery
Published: May 2021

In a time when controlling the spread of the virus in the United States requires drastic measures to limit the number of people coming in and out of intensive care units (ICU), the presence of prison guards is not justified. Transfers from American prisons to hospitals have increased dramatically during the pandemic and with each prison patient comes a cohort of prison guards. The theoretical benefits of having prison guards–such as preventing escape, protecting staff, and stopping unwanted visitation–are minimal: critically ill prisoners are chained to their bed and pose minimal threat to the staff or flight risk. Unwanted visitation is already heavily regulated by the hospital. The risks of having more people in the ICU are significant during the pandemic: more potential exposures for staff, other patients, and the guards themselves. In order to limit the spread of the virus, the number of prison guards in the ICU should be limited.
Ethical leadership, psychological empowerment and caring behavior from the nurses’ perspective
Authors: Dehghani-Tafti Mojtaba , Barkhordari-Sharifabad Maasoumeh , Nasiriani Khadijeh , Fallahzadeh Hossein
Published: May 2021

Background

Care is the basis of the nursing profession and nurse’s caring behavior is one of the important factors in patient satisfaction. On the other hand, psychological empowerment can improve the provision of care services, and leaders have a significant impact on the behavior of followers. This study determined the correlation between ethical leadership, psychological empowerment, and caring behavior from nurses’ perspective.

Methods

This cross-sectional descriptive study was conducted in 2019. A total of 200 nurses were selected by stratified random sampling. Data were collected with ethical leadership, caring behavior and psychological empowerment questionnaires and analyzed with descriptive statistics (mean and standard deviation, frequency distribution) and inferential statistics (Pearson correlation coefficient, regression, and t-test) using SPSS20.

Results

The findings showed a significant correlation between ethical leadership, psychological empowerment (P < 0.001, r = 0.24) and caring behavior of nurses (P < 0.001, r = 0.25). Also, there was a significant correlation between psychological empowerment and nurses’ caring behavior (P = 0.002, r = 0.21). The regression analysis showed that ethical leadership and psychological empowerment are a predictor of caring behavior of nurses.

Conclusion

Applying an ethical leadership style by nursing managers can lead to nurses’ improved psychological empowerment and caring behaviors and ultimately, patient care quality. Thus, considering guidelines at the team and organizational levels and programs such as providing workshops and periodic counseling to cultivate ethical nurse leadership can lead to better caring behavior.
Clot imaging characteristics predict first pass effect of aspiration—first approach to thrombectomy
Authors: Waqas Muhammad , Li Weizhe , Patel Tatsat R , Chin Felix , Tutino Vincent M , Dossani Rimal H , Ren Zeguang , Guerrero Waldo R , Borlongan Cesario V , Pressman Elliot , Snyder Kenneth , Davies Jason M , Ley Elad I , Ionita Ciprian N , Siddiqui Adnan H , Mokin Maxim
Published: May 2021

Background

The value of clot imaging in patients with emergent large vessel occlusion (ELVO) treated with thrombectomy is unknown.

Methods

We performed retrospective analysis of clot imaging (clot density, perviousness, length, diameter, distance to the internal carotid artery (ICA) terminus and angle of interaction (AOI) between clot and the aspiration catheter) of consecutive cases of middle cerebral artery (MCA) occlusion and its association with first pass effect (FPE, TICI 2c-3 after a first attempt).

Results

Patients ( n = 90 total) with FPE had shorter clot length (9.9 ± 4.5 mm vs. 11.7 ± 4.6 mm, P = 0.07), shorter distance from ICA terminus (11.0 ± 7.1 mm vs. 14.7 ± 9.8 mm, P = 0.048), higher perviousness (39.39 ± 29.5 vs 25.43 ± 17.6, P = 0.006) and larger AOI (153.6 ± 17.6 vs 140.3 ± 23.5, P = 0.004) compared to no-FPE patients. In multivariate analysis, distance from ICA terminus to clot ≤13.5 mm (odds ratio (OR) 11.05, 95% confidence interval (CI) 2.65–46.15, P = 0.001), clot length ≤9.9 mm (OR 7.34; 95% CI 1.8–29.96, P = 0.005), perviousness ≥ 19.9 (OR 2.54, 95% CI 0.84–7.6, P = 0.09) and AOI ≥ 137°^ (OR 6.8, 95% CI 1.55–29.8, P = 0.011) were independent predictors of FPE. The optimal cut off derived using Youden’s index was 6.5. The area under the curve of a score predictive of FPE success was 0.816 (0.728–0.904, P < 0.001). In a validation cohort ( n = 30), sensitivity, specificity, positive and negative predictive value of a score of 6–10 were 72.7%, 73.6%, 61.5% and 82.3%.

Conclusions

Clot imaging predicts the likelihood of achieving FPE in patients with MCA ELVO treated with the aspiration-first approach.
Leadership and school self-evaluation in Irish-medium immersion: A roadmap for success
Authors: Ceallaigh TJ Ó , Shéaghdha Aoife Ní
Published: May 2021

While research on Irish-medium immersion education (IME) has heralded benefits such as cognitive skills, academic achievement and language and literacy development, many studies have also identified challenges to its successful implementation. Immersion-specific research-validated tools can help school leaders navigate the school self-evaluation journey, critically review and evaluate the quality of aspects of their school’s provision and plan for improvement. This paper reports on one theme, leadership, from a larger study, Quality indicators of best practice in Irish-medium immersion (Ó Ceallaigh and Ní Shéaghdha, 2017). Qualitative in nature, the study was guided by the following research question: What are IME educators’ perceptions of best practices in IME?. The study explored 120 IME educators’ perceptions of best practice in IME to inform the development of IME quality indicators. Individual interviews and focus group interviews were utilised to collect data. Data analysis revealed particular themes related to best IME leadership practices. Findings in turn informed the design of an evidence-informed school self-evaluation tool for IME settings. The various functions of the tool will be explored with a particular emphasis on building teaching and leadership capacity in IME through the school self-evaluation process.