bluuebunny/crossref_metadata_2025 huggingface dataset:
Data as a Weapon: The Evolution of Hong Kong Protesters’ Doxing Strategies
Authors: Li Yao-Tai , Whitworth Katherine
Published: June 2022

In Hong Kong’s social unrest of 2019, protesters adopted a variety of strategies to express their demands, including demonstrations on the street, political consumerism, and vandalizing stores of retailers perceived to be ideologically opposed to the movement, among others. When the Hong Kong government began to more forcefully suppress and monitor the protest, data became a contentious object as well as a weapon in the repertoire of political struggle. Taking the protesters’ collective initiative of doxing the policemen and their families as an example, this article examines protesters’ engagement with data during the 2019 Hong Kong Anti-ELAB Movement. Specifically, we explore how movement participants adapted doxing practices in response to shifts in the political opportunity structure namely the passage of the National Security Law 2020 (NSL). This article investigates how the discourses, targets, strategies, and sentiments within the doxing changed following the introduction of the NSL. It also discusses the meanings and challenges of data activism and the contentious nature of doxing under different political opportunity structures.
Comparative study of unsteady flow mechanisms for swept and radially stacked rotors in a dual-stage counter-rotating compressor
Authors: Cao Zhiyuan , Zhang Fei , Zhang Xiang , Gao Xi , Liu Bo
Published: June 2022

Counter-rotating (CR) compressor is a potential configuration to increase the thrust-to-weight ratio of aero-engines. The present study numerically investigated a dual-stage CR compressor by solving unsteady Reynolds-averaged Naiver–Stokes equations. The unsteady flow mechanisms were analyzed and compared for swept and baseline (radially stacked) CR rotors. Both of these rotor configurations were numerically simulated for the entire design speed line. The unsteady flow field near the mid-span and blade tip characterized by tip leakage vortex (TLV) was analyzed in detail for both near peak efficiency (NPE) and near stall (NS) conditions. According to the results, blade loading of the second rotor (R2) was much higher than that of the first rotor (R1). Moreover, the blade loading was higher in the swept rotors in comparison with the baseline CR rotors. In both baseline and swept CR compressors, the potential effect of R2 on the static pressure distribution of R1 was more significant compared to the opposite effect. Under the NS condition, the potential effect was confined in the rear zone of R1 where the potential flow of R2 passed. Despite the obvious impact of wake-induced negative jet on the flow field of R2 blade passage, the static pressure of R2 blade exhibited no evident variation except at 90% spanwise position. Although the blade loading of the swept CR compressor was increased, the potential effect of R2 on R1 was considerably reduced due to growth of axial gap between R1 and R2. Since the blade sweep improved the flow field, the wake passing effect on R2 was more moderate compared to that of the baseline CR compressor. The perturbation velocity magnitude of the swept CR compressor was approximately half of that of the baseline CR compressor. The TLV of R2 was periodically disturbed, and therefore, low axial velocity patches were observed on the TLV trajectory of R2. In addition, the swept CR compressor exhibited smaller low axial velocity patches of TLV due to weaker aerodynamic interaction between R1 and R2.
Homophobia in Brazilian football: A critical discourse analysis of fans’ comments in online football forums
Authors: Nabono Martins Juliana
Published: June 2022

Football is one of the many fields where the display of orthodox masculinity, often related to sexism and homophobia, reaches its peak. Studies indicate that such behaviors negatively affect athletes who do not fit heteronormative standards and closeted gay players, who fear coming out due to an intimidating and toxic environment. Fans have been central to some empirical studies investigating homophobia in football; however, most research to date focuses on western countries. Through the lens of Critical Discourse Analysis, this paper examines how Brazilian football fans see the presence of openly gay players on a men's team. One hundred and fifty comments were collected from thirteen online football forums. The results indicate similarities in the responses provided by Brazilian fans compared to western studies. Although fans’ positive views towards the presence of openly gay players were expressed, homophobic opinions were also identified in this environment. Several fans also demonstrated no objection to the use of homophobic language. The present study is relevant to the existing literature as it aids in clarifying previous notions of homophobia in Brazilian football. At the same time, it problematizes and officially places Brazil on the map of studies on the topic.
Erōs, Ekstasis, and Silence in Dionysius’ Mystical Theology
Authors: Corry Patrick
Published: June 2022

Though medieval, modern, and contemporary interpreters often understand the “mystical union” described in Dionysius’ Mystical Theology in terms of love or eros, reference to love, affection, or desire is conspicuously absent from the text. Though this absence has been noted in recent scholarship, little attention has been paid to its significance, particularly in light of the significance of eros across the Corpus dionysiacum. After assessing the “affective” reading of Mystical Theology which directly imports the functions of divine and human love from the positive descriptions of Divine Names, I propose a reading which rather aims to recover the central place of eros in Mystical Theology precisely through reflection upon its absence. This interpretation will consider the significance of the hymnic, prayerful setting of Mystical Theology, and the precise grammar of Dionysius’ negative theology to give a textual argument for understanding “mystical union” as a unity of God and creature in love.
Identifying Plan Perceptions: Higher Education Institutions as Arts and Cultural Anchors
Authors: Ashley Amanda , Loh Carolyn G. , Durham Leslie , Kim Rose , Bubb Karen
Published: June 2022

City leaders easily recognize their local HEIs as economic anchors, often as part of an intentional “eds and meds” strategy. Universities have long been viewed by city governments as important arts and cultural patrons, presenters, and educators. However, it is not clear that local governments recognize HEIs as key players in arts and cultural economies to the fullest extent possible, nor that they see the possibilities for universities to act as arts and cultural anchors beyond their traditional roles. The local arts and cultural master plan is a key document in which we would expect to see city officials demonstrate this understanding and to advance strategies to capitalize on HEIs’ presence in their communities. Yet our analysis of these plans finds that they provide limited detail on and display a limited conceptualization of these institutions’ contributions to the city's arts scene and cultural economy, thereby missing important economic development opportunities.
The Role of Biomarkers in Hospitalized COVID-19 Patients With Systemic Manifestations
Authors: Schneider Michael
Published: June 2022

The following article aims to review COVID-19 biomarkers used in hospital practice. It is apparent that COVID-19 is not simply a pulmonary disease but has systemic manifestations. For this reason, biomarkers must be used in the management of diagnosed patients to provide holistic care. Patients with COVID-19 have been shown to have pulmonary, hepatobiliary, cardiovascular, neurologic, and renal injury, along with coagulopathy and a distinct cytokine storm. Biomarkers can effectively inform clinicians of systemic organ injury due to COVID-19. Furthermore, biomarkers can be used in predictive models for severe COVID-19 in admitted patients. The utility of doing so is to allow for risk stratification and utilization of proper treatment protocols. In addition, COVID-19 biomarkers in the pediatric population are discussed, specifically in predicting Multisystem Inflammatory Syndrome. Ultimately, biomarkers can be used as predictive tools to allow clinicians to identify and adequately manage patients at increased risk for worse outcomes from COVID-19. Both literature review and anecdotal evidence has shown that severe COVID-19 is a systemic disease, and understanding associated biomarkers are crucial for hospitalized patients’ proper clinical decision-making. For example, the cytokine storm releases inflammatory markers in different organ systems such as the pulmonary, hepatobiliary, hematological, cardiac, neurological, and renal systems. This review summarizes the latest research of COVID-19 that can help inform healthcare professionals how to better mitigate morbidity and mortality associated with this disease and provides information about certain systemic biomarkers that can be incorporated into hospital practice to provide more comprehensive care for hospitalized COIVD-19 patients.
Impact of Comorbidity Burden on Cardiac Implantable Electronic Devices Outcomes
Authors: Ajibawo Temitope , Okunowo Oluwatimilehin , Okunade Adeniyi
Published: June 2022

Background:

There is limited data on the impact of comorbidity burden on clinical outcomes of patients undergoing cardiac implantable electronic devices (CIED) implantation.

Objectives:

Our aim was to assess trends in CIED implantations and explore the relationship between comorbidity burden and outcomes in patients undergoing de novo implantations.

Methods:

Using the National Inpatient Sample database from 2000 to 2014, we identified adults ⩾18 years undergoing de novo CIED procedures. Comorbidity burden was assessed by Charlson comorbidity Index (CCI), and patients were classified into 4 categories based on their CCI scores (CCI = 0, CCI = 1, CCI = 2, CCI ⩾3). Annual implantation trends were evaluated. Logistic regression was conducted to measure the association between categorized comorbidity burden and outcomes.

Results:

A total of 3 103 796 de-novo CIED discharge records were identified from the NIS database. About 22.4% had a CCI score of 0, 28.2% had a CCI score of 1, 22% had a CCI score of 2, and 27.4 % had a CCI score ⩾3. Annual de-novo CIED implantations peaked in 2006 and declined steadily from 2010 to 2014. Compared to CCI 0, CCI ⩾3 was independently associated with increased odds of in-hospital mortality, bleeding, pericardial, and cardiac complications (all P < .05). Length of stay and hospital charges increased with increasing comorbidity burden.

Conclusions:

CCI is a significant predictor of adverse outcomes after CIED implantation. Therefore, comorbidity burden needs to be considered in the decision-making process for CIED implant candidates.
Media representation matters: The effects of exposure to counter-stereotypical gay male characters on heterosexual men’s expressions of discrimination
Authors: Galdi Silvia , Guizzo Francesca , Fasoli Fabio
Published: June 2022

Presence of gay men in mainstream media may have a positive impact on viewers’ attitude change. However, gay male characters are often stereotypically portrayed as feminine, and no research has yet explored audiences’ reactions to counter-stereotypical gay characters. Heterosexual Italian men ( N = 158) were exposed to a clip portraying (i) a stereotypical feminine gay male character, (ii) a counter-stereotypical masculine gay male character, or (iii) a nature documentary. Compared to the other conditions, exposure to the counter-stereotypical gay character increased discrimination toward gay men, in the form of anti-gay jokes, the higher the level of participants’ prejudice against gay men. Results further demonstrated that this effect was explained by reduced perceived stereotypicality of the character. Findings are in line with the social identity theory prediction that when gay men (outgroup) are perceived as too similar, and potentially threaten the group identity, heterosexual men would attempt to restore ingroup distinctiveness.
Characterization and size distribution of initial droplet concentration discharged from human breathing and speaking
Authors: Pan Shihai , Xu Chunwen , Yu Chuck Wah Francis , Liu Li
Published: June 2022

A study of the aerodynamic characteristics of aerosol expiration is important for understanding the size distribution of droplet concentration in COVID-19 disease transmission. This study measured the initial concentration and size distribution of droplets released during four breathing processes: nose breathing, mouth breathing, reading alphabets and counting numbers. Influencing factors on droplet generation were studied by statistical analyses. Significant differences in droplet concentration among the four breathing activities in pairs were found ( p < 0.001), except for reading alphabets and numbers ( p = 1). The droplet concentration during nose breathing ( p < 0.05), but not mouth breathing ( p = 0.136), of male subjects, was found significantly higher than that of female subjects. The droplet concentration generated by speaking during letters reading with special phonemes, for example, /i:/, was significantly ( p < 0.05) higher than reading letters without phonemes. The discharged droplet sizes from four breathing activities were dominated by small droplets ( dp < 1.037 μm of over 50% and dp < 2.642 μm of over 80%). Basically, no particles larger than 8 μm were detected by the aerodynamic particle sizer. The inference indicates a possible aerosol transmission of disease during non-symptomatic aerosol-producing activities such as breathing or speaking and may elucidate the disease transmission pathway of COVID-19.
Understanding Covid-19 emergency social security measures as a from of basic income: Lessons from Australia
Authors: Klein Elise , Cook Kay , Maury Susan , Bowey Kelly
Published: June 2022

This article examines the changes in social security measures introduced by the Australian government during the first wave of Covid-19 lockdowns in 2020. These measures were basic income-like in that they became both more unconditional and adequate for a reasonable standard of living. This was achieved through a significant supplementary payment, suspension of mutual obligation requirements, and the relaxation of eligibility criteria on a range of unemployment-related payments. Through drawing on the results of an online survey, we examine the impacts of these measures and find that they significantly helped to alleviate poverty and improve wellbeing. These gains were not insignificant for the individuals involved, and offer empirical insights into studies of basic income. While seeing the Australian government embrace more generous and basic income-like measures, we also note that during Covid-19 gendered and class inequalities increased. This reminds us that basic income is never a silver bullet and, alongside implementing basic income payments, there also needs to be a concerted effort to restructure economic relations more generally.
“Rethinking Tocqueville: White democracy or American democracy?”
Authors: Ikuta Jennie C
Published: June 2022

This piece makes two points about “Tocqueville: From America to Algeria.” First, while Bhambra and Holmwood rightly criticize the editorial practice of omitting the “Three Races” chapter from Tocqueville’s Democracy in America, this critique does not go far enough. Even in its unabridged form, Democracy in America is structured to include an extension discussion on race and colonialism while also obscuring its significance. Second, the authors’ critique of Tocqueville’s inability to imagine how Black Americans as free and equal could be included into a system of racialized possession as equals is misplaced.
Retreatment of previously flow diverted intracranial aneurysms with the pipeline embolization device
Authors: Lauzier David C , Cler Samuel J , Chatterjee Arindam R , Osbun Joshua W , Moran Christopher J , Kansagra Akash P
Published: June 2022

Background and Purpose

Flow diversion of intracranial aneurysms with the Pipeline Embolization Device (PED) is frequently performed, but the outcomes of retreatment for aneurysms that failed to occlude after prior treatment with PED have not been well studied. Here, we report the safety and efficacy of PED retreatment after initial failure to occlude.

Materials and Methods

Clinical and angiographic data from eligible patients were retrospectively assessed for demographics, aneurysm occlusion status, and clinical outcomes. Patients were included in this study if they underwent PED retreatment to treat an aneurysm that had previously been treated with PED.

Results

Retreatment of previously flow-diverted aneurysms with PED was performed in 42 cases. At final angiographic follow-up, angiographic improvement was observed after 45% (19/42) of retreatments and complete aneurysm occlusion was observed following 26% (11/42). Significant clinical complications occurred in 10% (4/42) of PED retreatments.

Conclusions

Retreatment of intracranial aneurysms with PED following initial failure to achieve aneurysm occlusion has a low rate of subsequent complete aneurysm occlusion.
Construction of a supramolecular framework consisting of cucurbit[8]uril and 1-(4-methoxyphenyl)piperazine
Authors: Zheng Jun , Zhang Lin , Chen Yuhe , Ma Yue , Dai Xue , Shi Li , Lu Yanli , Yang Xinan , Ma Peihua
Published: June 2022

We report the supramolecular self-assembly of cucurbit[8]uril(Q[8]) and 1-(4-methoxyphenyl)piperazine inclusion complex. The complex is cultured in 3 M hydrochloric acid solution under CdCl2 induction conditions to obtain a new crystal, the structure of which was characterized by X-ray single-crystal diffraction. The results show that the crystal belongs to the monoclinic crystal system with a C2/m space group. The host–guest interaction ratio of Q[8] and 1-(4-methoxyphenyl) piperazine is 1:2.
Levodopa–entacapone–carbidopa intestinal gel infusion in advanced Parkinson’s disease: real-world experience and practical guidance
Authors: Nyholm Dag , Jost Wolfgang H.
Published: June 2022

As Parkinson’s disease (PD) progresses, treatment needs to be adapted to maintain symptom control. Once patients develop advanced PD, an optimised regimen of oral and transdermal medications may no longer provide adequate relief of OFF periods and motor complications can emerge. At this point, patients may wish to consider a device-aided therapy (DAT) that provides continuous dopaminergic stimulation to help overcome these issues. Levodopa–entacapone–carbidopa intestinal gel (LECIG) infusion is a recently developed DAT option. The aim of this article is twofold: (1) to give an overview of the pharmacokinetics of LECIG infusion and clinical experience to date of its use in patients with advanced PD, including real-world data and patient-reported outcomes from a cohort of patients treated in Sweden, the first country where it was introduced, and (2) based on that information to provide practical guidance for healthcare teams starting patients on LECIG infusion, whether they are transitioning from oral medications or from other DATs, including recommendations for stepwise dosing calculation and titration. In terms of clinical efficacy, LECIG infusion has been shown to have a similar effect on motor function to standard levodopa–carbidopa intestinal gel (LCIG) infusion but, due to the presence of entacapone in LECIG, the bioavailability of levodopa is increased such that lower overall levodopa doses can be given to achieve therapeutically effective plasma concentrations. From a practical standpoint, LECIG infusion is delivered using a smaller cartridge and pump system than LCIG infusion. In addition, for patients previously treated with LCIG infusion who have an existing percutaneous endoscopic transgastric jejunostomy (PEG-J) system, this is compatible with the LECIG infusion system. As it is a relatively new product, the long-term efficacy and safety of LECIG infusion remain to be established; however, real-world data will continue to be collected and analysed to provide this information and help inform future clinical decisions.
Systemic Analysis of the Anticancer Effects of Sijunzi Decoction on Gastric Cancer Based on Network Pharmacology
Authors: Li Yuejun , Wang Hong , Liao Linli , Tang Ping , He Haihui , Liu Lingzhi , Yan Junfeng , Peng Qinghua
Published: June 2022

Objective:

Sijunzi decoction (SJZD) has been used for alleviating peptic ulcer or gastric discomfort, and treating spleen disorders since the Song Dynasty, but its pharmacological effect on human gastric cancer (GC) is still unclear. In this research, a network pharmacology-based strategy was applied to explore active ingredients, potential targets, and molecular mechanisms of SJZD against GC.

Methods:

The active compounds and potential targets of SJZD, as well as GC-associated gene targets, were retrieved from publicly available databases. Bioinformatics approaches were used to assess the network interaction, functional regulation, and signaling pathways between SJZD ingredients and GC targets. The anticancer effects of SJZD against GC were verified in vivo by a mouse subcutaneous model.

Results:

The results of network analysis showed that quercetin was the most active ingredient in SJZD. Several prominent target genes of SJZD were identified, such as AKT1 and STAT3. Gene ontology analysis revealed that the core anti-GC targets of SJZD included transcription factor activity and kinase activity. Pathway enrichment analysis indicated that GC patients could be benefited from SJZD treatment via modulation of signaling pathways related to endocrine system, cancer, and infectious disease. Furthermore, in vivo experiments showed that high-dose SJZD could inhibit GC xenograft tumor growth, reduce GC cell proliferation, induce GC cell apoptosis, and decrease the expression of p-AKT1 and p-STAT3.

Conclusions:

Taken together, our results suggest that SJZD can serve as an effective adjuvant therapeutic agent for GC patients.
Comparative study of Iselin’s technique for the treatment of Bennett’s fracture with large and small fragments
Authors: Bouaicha Walid , Jlidi Mohamed , Bellila Senda , Daas Selim , Ben Ammar Ahmed , Sbai Mohamed Ali , Khorbi Adel
Published: June 2022

Objective:

The thumb is very exposed to trauma due to its position and function. Fractures of the base of the first metacarpal bone are very frequent in hand traumatology. Most Bennett’s fractures are treated surgically. However, the optimal surgical approach is controversial. The aim of this study is to compare the results of closed reduction and percutaneous pinning in the treatment of Bennett’s fracture of the base of firsthand metacarpal in fractures with both small and large fragments.

Methods:

We studied retrospectively the data of 40 patients treated for a Bennett’s fracture in the department of orthopaedic and traumatologic surgery between January 2016 and December 2018. The purpose of this study was to compare the functional (pain, grip strength, first web space opening and thumb opposition) and radiological (quality of reduction and arthritic changes) results of the Iselin’s technique for the treatment of Bennett’s fractures in two groups of patients with large and small bone fragments according to the size of articular surface detached with the antero-medial fragment (superior or inferior to 25%).

Results:

The average age of the patients was 34 (range = 19–66) years. Males were by far the most affected (90%). We noted 24 cases of large fragment fractures (60%) and 16 cases of small fragment fracture (40%). An excellent overall functional result was found in 68.8% of cases of small fragment fractures versus 50% of cases of large fragment fractures. Radiological results were roughly similar.

Conclusion:

All surgical techniques aim to restore the articular congruence to the best, maintain the opening of the first web space and obtain a stable and painless trapezo-metacarpal joint. The Iselin’s technique is simple, inexpensive and easy to perform even by inexperienced surgeons. It yields satisfactory results in most cases of Bennett’s fracture regardless of the size of the fragment.
The Japanese prime minister and the executive institutional setting
Authors: Shinoda Tomohito
Published: June 2022

This article explores the institutional arrangements surrounding the Japanese prime minister and offers an analysis of the core executive style in accordance with the classifications introduced by Dunleavy and Rhodes. The constitutional arrangement was set out to establish a ‘prime ministerial government’ in Japan. However, Japanese bureaucrats, who feared strong individual authority, instead sought to create a ‘cabinet government’ which exercises strong authority as a collective body. In addition, two developments weakened the prime minister’s power over the cabinet, namely the ceremonial role of cabinet meetings and strong factionalism within the ruling party, which led to a ‘bureaucratic coordination model’. Since the 1990s, institutional reforms have shifted the Japanese core executive towards a ‘prime ministerial government’.
Congenital Cytomegalovirus Knowledge, Practices, and Beliefs Among Primary Care Physicians and Newborn Hospitalists
Authors: Pesch Megan H. , Muldoon Kathleen M.
Published: June 2022

Background:

Congenital cytomegalovirus (cCMV) affects 1 in every 200 United States infants, at present there are 9 states which mandate newborn cCMV screening. With more infants being diagnosed, more children will need continuing care from providers who are knowledgeable about cCMV.

Objectives:

To examine pediatric provider knowledge, practices, and beliefs around cCMV.

Methods:

Primary care and newborn hospitalist pediatricians (N = 103) from Michigan, who “regularly care for infants” were invited to participate in a survey about their cCMV-related knowledge, clinical practices, and beliefs.

Results:

Respondents had low knowledge of typical cCMV presentation and sequelae, with mixed knowledge of screening and testing standards. Most (68%) reported rarely/never screening for cCMV, though 71% strongly agreed/agreed that primary care providers should test for cCMV. Most (90%) strongly agreed/agreed that infants who fail/refer on their newborn hearing screen should be tested for cCMV, yet 81% expressed not being comfortable diagnosing and managing cCMV. Most (72%) felt that cCMV was not sufficiently covered in their medical training; almost all respondents endorsed interest in learning more.

Conclusions:

Primary care and newborn hospitalists in this study expressed mixed knowledge about, infrequent practice of and low comfort with screening and caring for children with cCMV. This may present a prime opportunity for education and clinician support by professional organizations.
The Role of School Connectedness in Mitigating the Impact of Victimization on Life Satisfaction
Authors: Carney JoLynn V. , Kim Jungnam , Kim Hyunhee , Guo Xiuyan , Hazler Richard J.
Published: June 2022

Despite the pervasiveness of bullying, less is known about the protective factors that could mitigate the effect of victimization on life satisfaction. We investigated the role of school connectedness as a mediator in the association between victimization and life satisfaction. Participants included 1284 elementary school students. The results from the structural equation modeling suggested that peer victimization has negative impacts on children’s life satisfaction both directly and indirectly through lowered level of school connectedness. we address implications school counseling practice.
Progression of Symptomatic Partial-Thickness Rotator Cuff Tears: Association With Initial Tear Involvement and Work Level
Authors: Ko Sang-Hun , Jeon Young-Dae , Kim Myung-Seo
Published: June 2022

Background:

Partial-thickness rotator cuff tears (PTRCTs) often progress to full-thickness rotator cuff tears (FTRCTs). Thus, it is important to analyze the risk factors for tear progression to determine the proper timing of repair.

Purpose:

To identify the risk factors associated with progression of PTRCT.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

Included were 89 patients diagnosed with PTRCT on magnetic resonance imaging (MRI) scans who underwent nonoperative treatment at the authors’ institution between August 2012 and August 2019. Patient characteristics, shoulder stiffness (compared with the contralateral shoulder); work level (classified as high [heavy manual labor], medium [manual labor with less activity], and low [sedentary activity]); and radiological factors including initial tear size, acromion type (flat, curved, hooked, or heel-shaped), and initial tear involvement (as a percentage of the rotator cuff tendon footprint length) were analyzed to assess their association with tear progression, defined as >20% increase in tear involvement.

Results:

The mean MRI follow-up period was 22.3 ± 17.2 months (median, 16.1 months; range, 6.4-89.5 months), and tear progression was observed in 12 patients (13.5%). In these 12 patients, tear involvement increased by 60% of the rotator cuff footprint, while mediolateral (ML) and anteroposterior (AP) tear sizes progressed by 1.1 and 1.8 mm, respectively. Univariate regression analysis showed that shoulder stiffness ( P = .031), work level ( P = .001), initial tear involvement ( P < .001), ML and AP tear sizes ( P < .001 and P = .005, respectively), and acromion type ( P = .003) were significantly associated with tear progression. Multivariate regression analysis showed that initial tear involvement (odds ratio [OR], 1.053; 95% CI, 1.006-1.102; P = .026) and high work level (OR, 15.831; 95% CI, 1.150-217.856; P = .039) were independent risk factors for tear progression. The cutoff value for initial tear involvement was 47.5% (sensitivity, 81.8%; specificity, 85.7%).

Conclusion:

Tear progression was observed in 14% of patients with PTRCT in this study. To predict tear progression, evaluating the tear involvement during initial MRI is essential. The risk of tear progression increased with initial tear involvement >47.5% and a heavy work level.
Prelicensure Nursing Students’ Reflections on Institutional Response to the 2020 COVID-19 Crisis
Authors: Iheduru-Anderson Kechinyere C. , Foley Jo Anne
Published: June 2022

The study aimed to describe how prelicensure student nurses perceive academic support and their institutions’ response during the 2020 COVID-19 crisis. The shift to online learning caused by the COVID-19 pandemic disrupted every aspect of higher education, including pre-licensure nursing students. Prelicensure nursing education is one of the most stressful programs in higher education. In a period of great uncertainty, it becomes essential to explore how prelicensure nursing students perceive academic support from their institutions. A qualitative descriptive design was employed for the study. Thematic analysis was used to analyze data obtained from 16 semi-structured interviews. Six themes resulted from the data: Disorganization leading to chaos; technology and technical challenges; stress and frustration; am I prepared to be a nurse?; not having money; mental health matters. This study validates the experiences of nursing students. Students’ obstacles during the pandemic should be identified and mitigated to promote learning and academic success.
Three-dimensional printing in ophthalmology and eye care: current applications and future developments
Authors: Fakhoury Yazan , Ellabban Abdallah A. , Attia Usama , Sallam Ahmed , Elsherbiny Samer
Published: June 2022

Three-dimensional (3D) printing uses a process of adding material in a layer-by-layer fashion to form the end product. This technology is advancing rapidly and is being increasingly utilized in the medical field as it becomes more accessible and cost-effective. It has an increasingly important role in ophthalmology and eyecare as its current and potential applications are extensive and slowly evolving. Three-dimensional printing represents an important method of manufacturing customized products such as orbital implants, ocular prostheses, ophthalmic models, surgical instruments, spectacles and other gadgets. Surgical planning, simulation, training and teaching have all benefitted from this technology. Advances in bioprinting seem to be the future direction of 3D printing with possibilities of printing out viable ocular tissues such as corneas and retinas in the future. It is expected that more ophthalmologists and other clinicians will use this technology in the near future.
Assessment of Outcomes After Decompressive Craniectomy—An Institutional-Based Study from India
Authors: Karri Madhavi , Ramasamy Balakrishnan , Varghese Angel P.
Published: June 2022

Background:

Decompressive craniectomy (DC) is a life-saving treatment modality for acute malignant strokes. We aimed to identify the risk factors and assess the long-term functional outcome in patients with malignant stroke undergoing DC.

Methods:

We conducted an ambispective study on patients (>18 years) undergoing DC between January 2016 and January 2019. Demographic data, stroke risk factors, clinical characteristics, and serial imaging findings were collected. We measured the functional outcomes using the National Health Stroke Scale (NIHSS), Glasgow Coma Scale (GCS), modified Ranking Scale (mRS), and Barthel index (BI) at 3, 6, and 12 months postoperatively. We did univariate and multivariate regression analyses for the independent variables and outcomes.

Results:

On admission, the 93 patients (70 males) had a mean GCS of 11.77 (standard deviation [SD]: 2.90) and a mean NIHSS score of 13.65 (SD: 4.41). Diabetes (odds ratio [OR]: 1.76; 0.67-4.46, 95% confidence interval [CI]) and ischemic heart disease (OR: 4.50; 1.44-14.07, 95% CI) showed a positive correlation with the outcome. Forty patients underwent surgery within 48 h of stroke onset, while 53 patients were operated on after 48 h. Twenty-two (23.66%) patients died during the study period, and 55 patients (59.14%) had an mRS score <2 one year after the stroke.

Conclusions:

DC can produce favorable outcomes in patients with malignant strokes, and early aggressive intervention helps improve the prognosis and quality of life. Only a few studies were reported on the results of DC in stroke, much less from developing countries like India.
Stress hyperglycemia is predictive of clinical outcomes in patients with spontaneous intracerebral hemorrhage
Authors: Li Sijia , Wang Yu , Wang Wenjuan , Zhang Qian , Wang Anxin , Zhao Xingquan
Published: June 2022

Background

Stress hyperglycemia is a common condition in patients suffering from critical illness such as spontaneous intracerebral hemorrhage (ICH). Our study aimed to use glucose-to-glycated hemoglobin (HbA1c) ratio to investigate the impact of stress hyperglycemia on clinical outcomes in patients with ICH.

Methods

A sample of eligible 586 patients with spontaneous intracerebral hemorrhage from a multicenter, hospital-based cohort between 2014 and 2016 were recruited in our study. Stress hyperglycemia was evaluated by the index of the glucose-to-HbA1c ratio that was calculated by fasting blood glucose (mmol/L) divided by HbA1c (%). Patients were divided into two groups based on the median of the glucose-to-HbA1c ratio. The main outcomes were poor functional outcomes (modified Rankin Scale score of 3–6) at discharge and 90 days. Multivariable logistic regression and stratified analyses were performed to explore the association of stress hyperglycemia with poor prognosis of ICH.

Results

On multivariable analysis, higher glucose-to-HbA1c ratio (≥1.02) was independently correlated with poor functional outcomes at discharge (adjusted OR = 3.52, 95%CI: 1.98–6.23) and 90 days (adjusted OR = 2.27, 95%CI: 1.38–3.73) after adjusting for potential confounding factors. The correlation between glucose-to-HbA1c ratio and worse functional outcomes still retained in patients with or without diabetes mellitus.

Conclusions

Stress hyperglycemia, calculated by glucose-to-HbA1c ratio, was independently correlated with worse functional outcomes at discharge and 90 days in patients with ICH. Moreover, glucose-to-HbA1c ratio, might not only be used as a simple and readily available index to predict clinical outcomes of ICH but also provide meaningful insight into future analysis to investigate the optimal range of glucose levels among ICH patients and develop tailored glucose-lowering strategies.
Adherence and quality of life assessment in patients with asthma treatment with budesonide/formoterol via the Elpenhaler device: the COMPLETE study
Authors: Exarchos Konstantinos P. , Rovina Nikoletta , Krommidas George , Latsios Dimitrios , Gogali Athena , Kostikas Konstantinos
Published: June 2022

Background

Asthma is a chronic inflammatory disease of the airways that causes recurring episodes of wheezing, breathlessness, chest tightness and coughing. Inhaled drugs on a daily basis are the cornerstone of asthma treatment, therefore, patient adherence is very important.

Methods

We performed a multicenter, open, non-interventional, observational, prospective study of 716 adult patients diagnosed with asthma receiving FDC (Fixed-dose combination) budesonide/formoterol via the Elpenhaler device. We assessed the adherence to treatment at 3 and 6 months (based on the MMAS-8: 8-item Morisky Medication Adherence Scale), the quality of life and change in forced expiratory volume in 1 s (FEV1) from baseline to follow-up.

Results

Approximately 80% of the patients showed medium to high adherence throughout the study. The mean (SD) MMAS-8 score at 6 months was 6.85 (1.54) and we observed a statistically significant shift of patients from the low adherence group to the high adherence group at 6 months. Moreover, after 6 months of treatment with FDC budesonide/formoterol, we observed an increase in the patients’ quality of life that as expressed by a change 2.01 (95%CI 1.93–2.10) units in Mini AQLQ (p < 0.0001) that was more pronounced in the high adherence group. The same trend was also observed in terms of spirometry (mean FEV1 2.58 L (0.85) at the end of the study, increased by 220 mL from baseline) with a higher improvement in the medium and high adherence groups.

Conclusions

Treatment with FDC of budesonide/formoterol via the Elpenhaler device was associated with improvement in asthma-related quality of life and lung function over 6 months that were more prominent in patients with higher adherence.

Trial registration: 2017-HAL-EL-74 (ClinicalTrials.gov Identifier: NCT03300076).
Characteristics and factors associated with mortality in palliative patients visiting the Emergency Department of a large tertiary hospital in Thailand
Authors: Monsomboon Apichaya , Chongwatcharasatit Trisuchon , Chanthong Pratamaporn , Chakorn Tipa , Prapruetkit Nattakarn , Surabenjawong Usapan , Limsuwat Chok , Chaisirin Wansiri , Ruangsomboon Onlak
Published: June 2022

Background

The characteristics and outcomes of palliative patients who visited the Emergency Department (ED) in Thailand, a country in which no standard palliative care system existed, have not been comprehensively studied. We aimed to report the characteristics of ED palliative patients and investigate factors associated with mortality.

Methods

A prospective observational study was conducted at Siriraj Hospital, Bangkok, Thailand, between March 2019 and February 2021 by means of interviewing palliative patients and/or their caregivers and medical record review. Palliative patients with either incurable cancer or other end-stage chronic diseases were included.

Results

A total of 182 patients were enrolled. Their mean age was 73 years, 61.5% were female, and 53.8% had incurable cancer. Of these, 20.3% had previously visited the palliative clinic. Approximately 60% had advanced directives, 4.9% had a living will, and 27.5% had plans on their preferred place of death. The most common chief complaint was dyspnea (43.4%), and the main reason for ED visits was ‘cannot control symptoms’ (80%). At the ED, 17% of the patients had been seen by the palliative care team, and 23.1% died. Although 51% were admitted, 48.9% could not survive to discharge. Cancer, having received morphine, a palliative performance scale > 30, and ED palliative consultation were independently associated with hospital mortality.

Conclusion

The recognition and utilization of palliative care were largely inadequate, especially for non-cancer patients. An improvement and promotion in the palliative care system from the ED through home care are mandatory to improve the quality of life of palliative patients.
Factors associated with uptake of contraceptives among HIV positive women on dolutegravir based anti-retroviral treatment-a cross sectional survey in urban Uganda
Authors: Mbabazi Leah , Nabaggala Mariah Sarah , Kiwanuka Suzanne , Kiguli Juliet , Laker Eva , Kiconco Arthur , Okoboi Stephen , Lamorde Mohammed , Castelnuovo Barbara
Published: June 2022

Background

In May 2018, following the preliminary results of a study in Botswana that reported congenital anomalies in babies born to HIV-positive women taking dolutegravir drug, the WHO issued a teratogenicity alert. However, there are scarce data on the impact of this guidance on contraceptive uptake among women taking dolutegravir. We assessed the uptake of contraceptives in HIV-positive women of reproductive age on dolutegravir regimens.

Methods

We conducted a cross-sectional survey from April 2019 to July 2019 in five government health facilities in central Uganda, where dolutegravir-based regimens were offered as the preferred first-line antiretroviral treatment. We randomly selected 359 non-pregnant women aged 15–49 years taking dolutegravir-based regimens and interviewed them using semi-structured interviewer-administered questionnaires. We collected data on demographics, contraceptive use, individual, social, and health system factors. We described patients’ characteristics using descriptive statistics and assessed factors associated with contraceptive uptake using a modified Poisson regression model.

Results

A total of 359 women were included in the study. The mean age was 37 years (standard deviation = 6.8) and overall contraceptive uptake was 38.4%. The most utilized method was injectable method at 58.4% followed by condoms (15%), intrauterine device (10.7%), pills (6.4%), implants (5.4%), and sterilization (0.7%). Predictors for contraceptive uptake were parity of 3–4 children (Adjusted Prevalence Ratio (APR) = 1.48, 95% confidence interval (CI): 1.14, 1.92) in reference to those with 1–2 children. There was reduced contraceptive uptake in women of the age range 40–49 years (APR = 0.45, CI: 0.21–0.94) compared to those aged 15–24 years. Unemployed women were less likely to use contraceptives (APR: 0.6, CI: 0.42- 0.94) than the formally employed. Contraceptive uptake was lower among women who did not discuss family planning with their partners (APR = 0.39, CI: 0.29–0.52) than those who discussed family planning with their partners and women who did not receive family planning counseling (APR = 0.56, CI: 0.34–0.92) than those who received family planning counselling.

Conclusion

We observed a low-level uptake of contraceptives, with injectables as the most used method. Family planning counseling and partner discussion on family planning were associated with contraceptive uptake among the women who used dolutegravir-based regimens. There is a need for more strategies to integrate FP services and increase male involvement in HIV care programs.
Using art to raise awareness of breastfed children with medical complexity
Authors: Hookway Lyndsey
Published: June 2022

Background

Current infant feeding support is often targeted at establishing breastfeeding in healthy term infants, or supporting lactation for preterm infants in the neonatal setting. Breastfeeding presents different challenges for children beyond the neonatal period who have a medical complexity. The tendency to focus on breastfeeding as a preventative public health intervention overlooks the fact that mothers and children with medical complexity often require additional and targeted support to continue to breastfeed. Despite this identified need, there is very little research, policy or clinically specific teaching within paediatrics that is nuanced enough to support this vulnerable population.

Raising awareness of breastfed children with medical complexity in paediatrics

While research, policy and embedded Baby Friendly Health Initiative (BFHI) standards in both the maternity and neonatal directorates exists, paediatrics is a separate discipline and contrastingly, has very little lactation support infrastructure. To this end, a doctoral study was commenced aiming to identify the differences for this vulnerable and largely overlooked group. One of the related outputs of the ongoing research is the use of creative methods to raise awareness. This commentary highlights a project with an artist to develop a series of portraits alongside a book and health professional education to increase awareness of these children’s needs.

Conclusions

The breastfeeding needs and challenges of children in the paediatric setting are unique and require additional awareness, creativity and skills to support optimal infant and young child breastfeeding. Using art can connect professionals to the lived experiences of families trying to persevere through medical complexity.
Exploring e-psychonauts perspectives towards cocaine effects and toxicity
Authors: Assi Sulaf , Keenan Aidan , Al Hamid Abdullah
Published: June 2022

Background

According to the World Drug Report, cocaine is the second most used drug globally after cannabis. Online discussion forums enable the understanding of authentic drug users’ experience as it is anonymous. Therefore, this study determined the uses, effects and toxicity of cocaine from the perspectives’ of e-psychonauts.

Methods

A qualitative study was conducted using six popular discussion forums. From these discussion forums, 1229 posts from 50 threads were subject to thematic analysis. Hence, the information from these threads were examined carefully for patterns and codes among the data. The codes were then collated into subthemes and themes.

Results

The four main themes emerging from the study were related to cocaine characteristics and use, e-psychonauts’ knowledge and experience, desired effects and adverse events. The main characteristic associated with cocaine use was purity that was highest in the US being nearest to the source. The most common cutting agent encountered in cocaine samples was levamisole that increased the chances of immunosuppression and cardiovascular toxicity. Purity depended on the source of purchase that included street dealers, dark web and surface web. Hence, e-psychonauts recommended purchase of cocaine from known dealers rather than websites with unknown sources. E-psychonauts mainly used cocaine in social context and parties or to self-medicate against anxiety and depression. Effects desired from cocaine use were mainly euphoria and increased energy. However, tachycardia and myocardial infarction were the main adverse events. It is noteworthy to mention that myocardial infarction was idiosyncratic and was often lethal. Myocardial infarction was more often reported when cocaine was combined with alcohol due to the production of cocaethylene. Social harm was also reported as a consequence for the use of cocaine that resulted in homelessness and broken relationships.

Conclusion

Online discussion forums allowed the understanding of e-psychonauts’ experience with cocaine use. Not only it informed about the sources and modalities of use of cocaine but also about the adverse events and social harm associated with cocaine use. The present findings serve as useful information for practitioners and healthcare professionals dealing with cocaine users.