bluuebunny/crossref_metadata_2025 huggingface dataset:
Medial Soft tissue and medial malleolus loss-the posterior tibial artery perforator technique combined with iliac crest autograft to Stabilize the ankle and cover Soft tissue defect: A case Series
Authors: Li Xiaodong , Yan Xiaowei , Xie Qiang , Gu Rui , Wang Zhixue , Liu Fei , Sui Lei , Yu Changyu , Wang Pei
Published: August 2022

Purpose

The purpose of this study was to investigate clinical efficacy of posterior tibial artery perforator technique combined with iliac crest autograft in treatment of medial soft tissue and medial malleolus loss.

Methods

This study involved 11 cases of medial soft tissue and medial malleolus loss from October 2011 to March 2016. Patients were treated with posterior tibial artery perforator technique combined with iliac crest autograft, and given routine treatment, such as rehydration, anti-inflammation, anticoagulation and vasodilation. Ankle function of patients was evaluated according to the American Orthopedic foot and ankle Association (AOFAS) ankle-hind foot scoring system.

Results

All flaps survived without bone exposure, and the appearance of skin flaps was satisfactory. There was one case of arterial crisis, one case of venous crisis, one case of skin edge necrosis and one case of incision infection. Wounds of the above patients were healed. Skin flap was soft and elastic without secondary contracture. The two-point discrimination of skin flap was 5–11 mm. The ankle range of motion was 10–60°. X-Ray showed that grafts healed within 8.6 months. According to AOFAS evaluation, four cases were excellent, four cases were good, and three cases were poor. The excellent and good rate was 72.8%.

Conclusions

In this study, posterior tibial artery perforator technique combined with iliac crest autograft was used to treat medial soft tissue and medial malleolus loss. The findings demonstrated that this treatment was reliable and efficacious.
Association between Clinical Simulation Design Features and Novice Healthcare Professionals’ Cognitive Load: A Systematic Review and Meta-Analysis
Authors: Lapierre Alexandra , Arbour Caroline , Maheu-Cadotte Marc-André , Vinette Billy , Fontaine Guillaume , Lavoie Patrick
Published: August 2022

Background

Clinical simulations are complex educational interventions characterized by several design features, which have the potential to influence cognitive load, that is, the mental effort required to assimilate new information and learn. This systematic review and meta-analysis explored the associations between simulation design features and cognitive load in novice healthcare professionals.

Methods

Based on the Joanna Briggs Institute methodology, a search was performed in five databases for quantitative studies in which the cognitive load of novice healthcare professionals was measured during or after a simulation activity. Each clinical simulation was coded to describe its design features. Univariate and multivariate mixed model analyses were performed to explore the associations between simulation design features and cognitive load.

Results

From 962 unique records, 45 studies were included and 27 provided enough data on subjective cognitive load (i.e., Paas Scale and NASA-Task Load Index scores) to be meta-analyzed. In the multivariate analysis for the NASA-Task Load Index scores, each repetition of a simulation using the same scenario resulted in a linear decrease in cognitive load. In contrast, technology-based instruction before or during a simulation activity was associated with higher cognitive load. In the univariate analyses, other features such as feedback and instructor presence were also statistically associated with cognitive load. Regarding the univariate analyses of the Paas Scale scores, simulator type, briefing, debriefing, and repetitive practice were statistically associated with cognitive load.

Conclusion

This is the first meta-analysis exploring the relationship between clinical simulation design features and novice healthcare professionals’ cognitive load. Although the findings show that several design features can potentially increase or decrease cognitive load, several gaps and inconsistencies in the current literature make it difficult to appreciate how such reciprocity influences novice healthcare professionals’ learning. These limitations are discussed and avenues for educators and further research are suggested.
Roles of Serious Game in Diabetes Patient Education
Authors: Ling Chen , Seetharaman Shriram , Mirza Lubna
Published: August 2022

Background

Diabetes affects many people across the world. Diabetes education plays a critical role in helping people with diabetes to perform diabetes self-management at home.

Intervention

We explored whether serious games can be used as a supplementary tool for diabetes education. Two online video games- the “Diabetic Dog” game and “Carb Counting with Lenny the Lion” game, were used for the study.

Methods

Fourteen patients with Type II diabetes were recruited from the Norman Diabetes Center by personal invitations. After initial training, the patients played the games a minimum of four times per week during the two-week study duration. Pre- and post-assessments of patients' diabetes knowledge and self-efficacy in diabetes self-management behaviors were performed using questionnaires, and an interview was conducted at the end to gauge the effectiveness of the game intervention.

Results

The results from the questionnaires show a general trend of improvement in patient diabetes knowledge and self-efficacy in diabetes self-management. A general trend of improvements in patients’ self-efficacy in controlling blood sugar level, handling abnormal blood sugar levels, taking insulin, and complying with a diabetes diet was observed. The interview results showed that the patients reinforced their diabetes knowledge and became more aware of their own lifestyles by playing diabetes educational games. They perceived the games as fun and easy to play. They also provided suggestions for the game design for diabetes education.

Conclusion

The study showed that serious game intervention had good potential to be a useful supplement to clinic-based diabetes education in improving patient diabetes knowledge and increasing patient self-efficacy in diabetes self-management behavior.
Quality of Education From a Social Justice and Capabilities Perspective: The Case of Turkey
Authors: Sakız Halis , Çuhadar Pınar , Çirkin Zeynep
Published: August 2022

We explore how a social justice and capabilities perspective serves as a conceptual tool to understand the quality of education (QoE) in Turkey so that policy can be developed to make the education system inclusive of all learners, provide relevant education, and allow stakeholders’ democratic participation. We provide a critical discussion about the Turkish education system and continue with a critical analysis of the three interrelated dimensions of QoE from a social justice and capabilities perspective; that is, inclusive education, relevance, and democracy. Finally, we make recommendations to improve QoE in Turkey by strengthening social justice and developing appropriate capabilities in education.
Reflecting on Legal Responses to Intimate Partner Femicide in Scotland
Authors: McPherson Rachel
Published: August 2022

This article considers legal responses to intimate partner femicide in Scotland. It reflects on how the plea of provocation on the basis of infidelity has been used, pointing to misrepresentation of the relationship between domestic abuse and stalking. From there, findings from 57 intimate partner femicide cases are presented. These findings indicate problematic stereotypes in how intimate partner femicide cases are reported and the operation of the “love narrative” in sentencing. It is concluded that more must be done to label intimate partner femicide cases appropriately and that improvements are achievable within the current criminal justice framework.
Image-Based Sexual Abuse as a Means of Coercive Control: Victim-Survivor Experiences
Authors: Henry Nicola , Gavey Nicola , Johnson Kelly
Published: August 2022

Scholars and practitioners increasingly acknowledge the ways that abusive partners create, distribute, or threaten to distribute intimate images without consent, yet little empirical research has comprehensively explored image-based sexual abuse within intimate partner contexts. This article responds to this gap and reports on the findings of a study involving interviews with 29 women and one gender-diverse person who experienced image-based sexual abuse as part of a pattern of “coercive control.” The authors argue that abusive partners use intimate imagery as a means of exerting power and control, and as a tactic of intimidation, entrapment, and degradation. They note that law, policy, and practice responses should recognize the gendered nature of image-based sexual abuse and its growing use as a means of coercive control.
Which Aspects of Social Support Enhance Positive Mental Health in the Context of Intimate Partner Violence?
Authors: Pir Setayesh , Hashemi Ladan , Gulliver Pauline , McIntosh Tracey , Fanslow Janet
Published: August 2022

While there is evidence that social support can mitigate mental illness symptoms associated with intimate partner violence (IPV), there is a need to explore if social support can promote positive mental health. In this New Zealand (NZ) population-based study of women who had experienced physical and/or sexual violence ( n = 453), structural equation modeling (SEM) showed that most facets of social support (friends, family, and neighbors) had a significant correlation with each dimension of positive mental health, as measured by Keyes’ Mental Health Continuum Short Form (MHC-SF). Safety from IPV (no recent IPV experience) is a prerequisite before social support can assist women to attain positive mental health. Further work is required to ensure friends, family, and communities have the knowledge and resources to provide effective social support.
Towards an understanding of Io through Atuatanga
Authors: Rangiwai Byron
Published: August 2022

The debate concerning the authenticity of Io (personal name for the Supreme Being) is a complicated and extensive one. For some, Io is a fabricated reflection of the Christian God. For others, Io is a genuine Māori deity which can also be traced elsewhere in the Pacific. However, from a Māori theological perspective, hard lines and definitions regarding Māori spirituality are pointless. Following the Reverend Māori Marsden who posited that only Māori are capable of understanding Māori spirituality and Pā (Father) Henare Tate who developed a Māori theology based on Atua (God), tangata (people), and whenua (land), this article will develop a novel way of attempting to understand Io despite the ongoing debate about his authenticity.
Modulation of Breast Cancer Cell FASN Expression by Obesity-Related Systemic Factors
Authors: McClellan Bryan , Pham Tommy , Harlow Brittany , Lee Gabby , Quach Duan , Jolly Christopher , Brenner Andrew , deGraffenried Linda
Published: August 2022

Purpose:

The objective of this study is to determine the impact of exposure to obesity-related systemic factors on fatty acid synthase enzyme (FASN) expression in breast cancer cells.

Methods:

MCF-7 breast cancer cells were exposed to sera from patients having obesity or not having obesity and subjected to quantitative reverse transcription polymerase chain reaction (RT-qPCR). Subsequent MTT and colony-forming assays using both MCF-7 and T-47D cells exposed to sera and treated with or without FASN inhibitor, TVB-3166, were used. MCF-7 cells were then treated with insulin and the sterol regulatory element–binding protein (SREBP) processing inhibitor, betulin, prior to analysis of FASN expression by quantitative RT-qPCR and western blot. Insulin-induced SREBP-FASN promoter binding was analyzed by chromatin immunoprecipitation with an anti-SREBP antibody.

Results:

In response to sera exposure (body mass index [BMI] >30) there was an increase in FASN expression in breast cancer cells. Furthermore, treatment with the FASN inhibitor, TVB-3166, resulted in a decreased breast cancer cell survival and proliferation while increasing apoptosis upon sera exposure (BMI >30). Insulin-exposed MCF-7 cells exhibited an increased FASN messenger RNA and protein expression, which is abrogated upon SREBP inhibition. In addition, insulin exposure induced enhanced SREBP binding to the FASN promoter.

Conclusions:

Our results implicate FASN as a potential mediator of obesity-induced breast cancer aggression and a therapeutic target of patients with obesity-induced breast cancer.
Where exactly between utopia and dystopia? A framing analysis of AI and automation in US newspapers
Authors: Cools Hannes , Van Gorp Baldwin , Opgenhaffen Michael
Published: August 2022

Over the last 60 years, media outlets have been covering emerging technologies like artificial intelligence (AI) and automation. This countrylevel study wants to give a nuanced overview of how these technologies were covered in US newspapers. First, a Latent Dirichlet allocation (LDA) topic modeling was conducted on articles on AI and automation in The New York Times and The Washington Post between 1985 and 2020. Second, an inductive manual framing analysis was conducted to distinguish the frames that both newspapers applied over time. Results from the topic modeling show that articles on AI and automation are most prominent within ‘Work’, ‘Art’, and ‘Education’. Concerning the manual framing analysis, the coverage has been more optimistic than pessimistic over time. However, when dystopian frames are considered, the results show that there has been more attention in the corpus on the impact of AI and automation on ethical conundrums involved with these technologies.
Fear of COVID-19, hotel employee outcomes and workplace health and safety management practices: Evidence from Sharm El-Sheikh, Egypt
Authors: Selem Kareem M , Ahmad Muhammad S , Belwal Rakesh , AlKayid Kholoud
Published: August 2022

This paper investigates the effect of fear of COVID-19 on employee turnover intention and depression, hypothesizing the mediating effect of psychological well-being and the moderating effect of workplace health and safety management practices. Data was gathered from 687 employees of five-star hotels in Sharm El-Sheikh using a structured survey instrument with time-lag approach. A partial least-square-based path modeling (PLS-PM) was applied to analyze the dataset. The findings reveal the partial mediation of psychological well-being in the relationships of fear of COVID-19 with both turnover intention and depression. While workplace safety and management practices significantly moderate the relationship between fear of COVID-19 and both turnover intentions, depression also mediates the relationship. The findings add to the existing literature on the effects of COVID-19 through the dual lenses of protection motivation theory and attribution theory. We can employ these findings to overcome issues of employee well-being in the hotel setting.
Navigating the promises and perils of researching emerging phenomena in strategy and organizations
Authors: O’Mahony Siobhan , Cohen Susan
Published: August 2022

Editors and reviewers often issue clarion calls for interesting research with novel theoretical contributions. In response to these calls, scholars often gravitate toward emerging phenomena—novel contexts lacking scholarly community or hot contexts with growing interest. However, simply examining novel and hot phenomena is insufficient to carve an “interesting” theoretical contribution. The promise of studying emerging phenomenon may be seductive, but doing so can also introduce under examined perils. We argue that novel and hot phenomena have distinct promises and perils that are under appreciated—with significant consequences for scholarly careers. Novel phenomena can provide first mover advantages to scholars and generate much interest but may constitute a lonely, risky journey if an appropriate theoretical community does not emerge. Hot topics attract significant attention, but can also be marked by conceptual confusion, fragmenting the accumulation of knowledge as scholars struggle to differentiate their work within a rapidly growing field. Yet, what is considered novel or hot is dynamic. Scholarly interest in novel phenomena can wax, ignite fascination, and become hot or wane with skeptical, uncertain acceptance, influencing both promises and perils. We contribute strategies to help strategy and organization scholars mitigate the perils and amplify the promises of theorizing from novel and hot phenomena.
Performance status: A key factor in predicting mortality in the first wave of COVID-19 in South-East Scotland
Authors: Mutch Callum P , Ross Daniella A , Bularga Anda , Nicola Rose Cave Roo , Chase-Topping Margo E , Anand Atul , Mills Nicholas L , Koch Oliver , Mackintosh Claire L , Perry Meghan R ,   DataLoch COVID-19 Collaborative
Published: August 2022

Background:

COVID-19 mortality risk factors have been established in large cohort studies; long-term mortality outcomes are less documented.

Methods:

We performed multivariable logistic regression to identify factors associated with in-patient mortality and intensive care unit (ICU) admission in symptomatic COVID-19 patients admitted to hospitals in South-East Scotland from 1st March to 30th June 2020. One-year mortality was reviewed.

Results:

Of 726 patients (median age 72; interquartile range: 58–83 years, 55% male), 104 (14%) required ICU admission and 199 (27%) died in hospital. A further 64 died between discharge and 30th June 2021 (36% overall 1-year mortality). Stepwise logistic regression identified age >79 (odds ratio (OR), 4.77 (95% confidence interval (CI), 1.96–12.75)), male sex (OR, 1.83 (95% CI, 1.21–2.80)) and higher European Cooperative Oncology Group/World Health Organization performance status as associated with higher mortality risk.

Discussion:

Poor functional baseline was the predominant independent risk factor for mortality in COVID-19. More than one-third of individuals had died by 1 year following admission.
Partisan Politics in the 21st Century South: The Fading Impact of Antebellum Slavery
Authors: Morris Irwin L.
Published: August 2022

Acharya, Blackwell, and Sen (2018) argue that antebellum slavery is directly related to racial conservatism and support for the Republican Party in the modern South. Yet during the last two decades, the South has begun a subtle but still very significant partisan shift to the left. Areas where population growth has stagnated (or actually declined) have tended to become more Republican; Democratic support has been bolstered by higher population growth. Significantly, local population growth and historic slave populations are largely unrelated. I examine the extent to which antebellum slavery influences county-level southern White partisanship and racial resentment during the second decade of the 21st century. Over the course of this time period, the impact of antebellum slavery evaporates. Not coincidentally, county-level population growth is strongly associated with increased Democratic identification and more progressive racial attitudes at or near the end of this time frame.
The Voices of Game Worlds: A Sociolinguistic Analysis of Disco Elysium
Authors: Kjeldgaard-Christiansen Jens , Hejná Míša
Published: August 2022

This article examines how vocal performances of characters can contribute to sociocritical storytelling in video games. We argue that the vocal performances of video game characters–and in particular their accents–can “fill in” the fictional story worlds of video games through associations with real people and places. These associations allow video games to evoke such social themes as are connected with accent, including privilege, conflict, class, and ethnicity. So evoked, these themes can then be critically examined. We apply this perspective in a sociolinguistic analysis of Disco Elysium, an expansive role-playing game in which the characters' vocal performances come to support the player's sociomoral orientation in the game world. Finally, we discuss a result of our analysis that runs counter to previous scholarship, namely that vocal stereotyping can serve to enhance, rather than to undermine, the player's critical apprehension of game worlds.
“This is Not Me” – A Critical Discussion About Methodological Issues Concerning Agency and Participatory Sense-Making in Qualitative Research with Children
Authors: Bjorbækmo Wenche Schrøder , Greve Anne , Asbjørnslett Mona
Published: August 2022

Participatory sense-making and agency are important methodological issues in qualitative research, especially that involving children. In this article we investigate and discuss how agency unfolds in three specific situations as recorded in the reflexive notes of two of the authors regarding their research with children with various medical diagnosis and disabilities. Using a combined autoethnographic and enactive phenomenological approach, the authors explore three particular moments where child participants registered disagreement with, or rejection of, the application to them of prevailing notions of ‘disability’. On the basis of the findings, the authors argue that the process of implementing and performing qualitative research implies a process of participatory sense-making in which participants' multi-level agentic capacity is the basis for understanding one another’s gestures and vocal expressions. The article illuminates how different bodies enable different individual embodied, embedded, emotive and enacted agentic expressions, and how power, understood as an extended agentic capacity, circulates in the co-existence between child and researcher in qualitative research. Researchers are urged to develop the willingness and ability to ‘dis-place’ themselves when working with child participants, so as to move towards the child with interest, respect, and openness to learning from them.
Magnetohydrodynamic hybrid nanofluid flow with the effect of Darcy–Forchheimer theory and slip conditions over an exponential stretchable sheet
Authors: Usman Muhammad , Amin Sahrish , Saeed Anwar
Published: August 2022

The characteristics of water-based hybrid nanofluid flow when passing over an exponentially stretchable sheet with velocity and thermal slip factors are presented. This article provides a concept for a hybridized fluid comprising copper and cobalt iron oxide nanoparticles (NPs) dispersed into a base fluid (water). In addition, physical observations of the heat absorption behavior, the Darcy effect, the thermal radiation, and viscous dissipation are also taken into account. Because of their strong thermophysical properties, copper and cobalt iron oxide NPs are used in a wide range of applications in the engineering and medical fields. To study the dynamics of these NPs, a system of partial differential equations (PDEs) has been generated that forms a highly nonlinear coupled model. The PDE system is converted into nondimensional ordinary differential equations (ODEs) with the aid of similarity replacements. The semi-analytical homotopy analysis method (HAM) is applied to the set of dimensionless ODEs obtained to find the solution. Two engineering parameters, the Nusselt number and the skin friction, are plotted versus various parameters of the hybridized fluid using bar charts. It was observed that the no-slip condition, the suction parameter, and the Darcy–Forchheimer medium enhanced the thermal profile of the hybridized fluid.
A new generalized shift-splitting method for nonsymmetric saddle point problems
Authors: Wei Tao , Zhang Li-Tao
Published: August 2022

Recently, Huang and Huang [ Journal of Computational and Applied Mathematics, 328 (2018) 381–399] proposed a modified generalized shift-splitting preconditioned (denoted by MGSSP) method for solving large sparse saddle point problems, and gave the corresponding theoretical analysis and numerical experiments. In this paper, based on the modified generalized shift-splitting preconditioned (MGSSP) method, we generalize the MGSSP algorithms and further present the new generalized shift-splitting preconditioned (NGSSP) method for nonsymmetric saddle point problems. Moreover, by similar theoretical analysis, we analyze the convergence conditions of the corresponding matrix splitting iteration methods of the NGSSP preconditioned saddle point matrices. In final, one example is provided to confirm the effectiveness.

MSC: 65F10, 65F15, 65F50
Model and simulation of the fuzzy reliability assessment of the electric vehicle motor
Authors: Zhou Xuesheng , Yang Jun , Wang Jian , Li Jingwei
Published: August 2022

The energy crisis has spurred the development of electric vehicles (EVs). As one of key components of EVs, the reliability of motor drive system directly affects the wide application of EVs. Due to the bad working environment and complex working mode, the reliability of the motor is more prominent. However, at present, there are few researches on the reliability of drive motor of EVs. Therefore, research on the reliability of electric vehicle motor drive system is of great significance. In this work, the reliability theory and prior motor reliability work were applied to the validity research of driving motor of EVs. Correlation studies were performed by using a permanent magnet synchronous motor. The failure modes of the driving motor and factors influencing reliability were examined considering the environment and motor to establish a fault tree model and analyze reliability weaknesses, including the winding insulation, bearings, and permanent magnets. The reliability of the motor was then modeled via MATLAB using a hybrid intelligent algorithm based on stochastic simulation and a neural network. The results showed that the model and the algorithm were effective. In addition, this work is helpful for electric vehicle designers to improve the reliability of electric vehicle motors.
Reliability of functional outcome measures in adults with neurofibromatosis 2
Authors: Mullin Rebecca Louise , Smith Rebecca , Wood Susan , Swampillai Angela , Afridi Shazia
Published: August 2022

Objective:

To determine inter- and intra-rater reliability of functional performance outcome measures in people with neurofibromatosis 2. To ascertain how closely objective and subjective measures align.

Methods:

Twenty-nine people with neurofibromatosis 2 were recorded performing the modified clinical test of sensory integration and balance, four square step test and modified nine-hole peg tests. Three raters scored each measure to determine inter-rater reliability. One rater scored the measures a second time to determine intra-rater reliability. Participants also completed a disease-specific quality of life questionnaire and dynamic visual acuity testing.

Results:

Inter-rater and intra-rater reliability scores (intra-class correlation coefficient) were excellent for all tests (intra-class correlation coefficient r ⩾ 0.9). The four square step test correlated with perceived walking challenges and modified clinical test of sensory integration and balance correlated with perceived balance challenges in a neurofibromatosis 2 quality of life patient report outcome measure.

Conclusion:

The modified clinical test of sensory integration and balance, four square step test and modified nine-hole peg tests are potentially useful measures for monitoring neurofibromatosis 2.
Bilateral cholesterol granulomas of the maxillary sinus with review of the literature
Authors: Wershoven Nicole , Miller Courtney , Gibson Pamela , Ciolino Allison , Rimash Tamara
Published: August 2022

Cholesterol granulomas are a common benign pathology classically found in the mastoid antrum and air cells of the temporal bone and less commonly found in the paranasal sinuses. We present a unique case of bilateral cholesterol granulomas of the maxillary sinus that is the second case to our knowledge reported in the literature. In an effort to provide an update about cholesterol granulomas of the paranasal sinuses, we examined the literature from January 2011 through 2021 in conjunction with a previous systematic review of the literature from 1970 to December 2010. This report reinforces that upon presentation, cholesterol granulomas can resemble multiple pathologies and histology is needed for diagnosis. This report should serve as an updated resource for otolaryngologists regarding cholesterol granulomas of the paranasal sinuses.
Critically ill patients with edema and ascites may experience subtherapeutic anti-factor Xa levels following abdominal subcutaneous enoxaparin treatment
Authors: Tharanon Vichapat , Kawamatawong Theerasuk
Published: August 2022

Enoxaparin is a low molecular weight heparin that is principally prescribed for the treatment and prevention of thromboembolic disorders. In clinical practice, the abdominal site for subcutaneous enoxaparin administration is most preferable because of its simplicity and safety. However, subcutaneous enoxaparin bioavailability in critically ill patients with ascites is uncertain. According to this case report, the bioavailability and absorption of subcutaneous enoxaparin was potentially impaired in a critically ill patient with ascites and local edema based on the therapeutic drug monitoring of anti-factor Xa levels.
Identifying the conceivable diplomatic outcomes of Sport Diplomacy initiatives
Authors: Abdi Kambiz , Fullerton Jami , Deheshti Mohammad , Kavand Reza , Monibi Hamidreza , Talebpour Mahdi
Published: August 2022

Although studies around Sport Diplomacy (SD) are expanding rapidly, there is no specific agreement on the outcomes of SD initiatives. The purpose of this study is to identify the conceivable diplomatic outcomes of SD from the perspective of international public diplomacy and sport experts. Researchers used a fuzzy Delphi method, which is an advanced version of the qualitative Delphi method that employs statistics to determine the distance between the levels of consensus within the expert panel. Thirty online surveys were completed by the experts, who were selected through targeted sampling. The statistical population included public diplomacy and sports scholars, and the researchers identified about 200 individuals who qualified for the sampling population because of their academic studies in the fields of public, cultural, and sport diplomacy. After running two rounds of fuzzy Delphi, the SD outcomes were classified into two categories of explicit/specific outcomes and implicit/general outcomes. The results showed that the outcomes of “cross-cultural communication,” “mutual understanding,” “trust building,” “nation branding,” “country reputation,” “attraction,” and “co-option” were the most possible explicit/specific outcomes of SD initiatives undertaken by countries’ ministries of foreign affairs and related agencies. “Sport industry development,” “sport tourism development,” and “socio-economic development” were the most possible outcomes of the implicit/general efforts of SD initiatives undertaken by the sport federations, private sector, NGOs, and other institutions outside the formal diplomacy system. Co-option-A term derived from Nye's theory of soft power as the ultimate goal/outcome of SD endeavors is manifested in “Peace Building (Conflict Conciliation)” between hostile states/nations and “Peace Development” between friendly states/nations.
Ventral Hernia Reconstruction with GORE ENFORM Biomaterial
Authors: Hollins Andrew W. , Atia Andrew , Zhang Gloria , Mateas Catalin , Schmidt Michael , Fillipo Rebecca , Hope William W. , Levinson Howard
Published: August 2022

Introduction: Ventral hernia repair (VHR) is one of the most common surgeries performed in the United States. Degradable mesh is the recommended choice for patients presenting with high-risk co-morbidities or increased risk for infection. GORE® ENFORM BiomaterialTM is a biosynthetic degradable mesh that has recently been approved for use in ventral hernia reconstruction with no reports of its clinical outcomes. Methods: This study was a single surgeon case series. Patients were included in the study if they underwent VHR with GORE® ENFORM BiomaterialTM. The decision to use GORE® ENFORM BiomaterialTM was the senior surgeon’s decision based on the patient's center for disease control classification. Patient comorbidities, hernia characteristics, postoperative hernia recurrence, and surgical site occurrences (SSOs) were collected at in-patient follow-up appointments and chart review. Patients were asked to complete preoperative and postoperative patient-reported outcomes (PROs) using the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity short form 3a and the hernia-specific quality of life (HerQLes) survey. Results: A total of 15 patients were included in this study. The average length of follow-up was 315 days. Postoperatively, 26.7% of patients had an SSO with 4 surgical site infections. Two patients required an operative washout with mesh removal. One patient experienced hernia recurrence. Eight of the 15 patients completed preoperative and postoperative PROs. Conclusion: This is the first clinical study to report the outcomes of ventral hernia repair using ENFORM mesh. These results show that Enform mesh is an option to consider in complex ventral hernia reconstruction.
Using Virtual Learning to Develop Palliative Care Skills Among Humanitarian Health Workers in the Rohingya Refugee Response in Bangladesh
Authors: Doherty Megan , Lynch-Godrei Anisha , Azad Tasnim , Ladha Fatima , Ferdous Lailatul , Ara Rowsan , Richardson Kathryn , Groninger Hunter
Published: August 2022

Background

Palliative care is an essential component of health responses in humanitarian settings, yet it remains largely unavailable in these settings, due to limited availability of palliative care training for healthcare professionals. Online training programs which connect experts to clinicians in the field have been proposed as an innovative strategy to build palliative care capacity humanitarian settings.

Objective

To describe the implementation and evaluate the impact of delivering palliative care education using an established virtual learning model (Project ECHO) for healthcare clinicians working in the Rohingya refugee response in Bangladesh. Program acceptability and the impacts on learners’ self-reported knowledge, comfort, and practice changes were evaluated.

Methods

Using the Project ECHO model, an education program consisting of 7 core sessions and monthly mentoring sessions was developed. Each session included a didactic lecture, case presentation and interactive discussion. Surveys of participants were conducted before and after the program to assess knowledge, confidence, and attitudes about palliative care as well as learning experiences from the program.

Results

This virtual palliative care training program engaged 250 clinicians, including nurses (35%), medical assistants (28%) and physicians (20%). Most participants rated the program as a valuable learning experience (96%) that they would recommend to their colleagues (98%). Participants reported improvements in their knowledge and comfort related to palliative care after participation in the program, and had improved attitudes towards palliative care with demonstrated statistical significance (p < 0.05).

Conclusions

Virtual training is a feasible model to support healthcare providers in a humanitarian health response. Project ECHO can help to address the urgent need for palliative care in humanitarian responses by supporting healthcare workers to provide essential palliative care to the growing number of individuals with serious health-related suffering in humanitarian settings.
Absolute neutrophil count by Duffy status among healthy Black and African American adults
Authors: Merz Lauren E. , Story Charlotte M. , Osei Miriam A. , Jolley Katherine , Ren Siyang , Park Hae Soo , Yefidoff Freedman Revital , Neuberg Donna , Smeland-Wagman Robin , Kaufman Richard M. , Achebe Maureen O.
Published: August 2022

Many people of African ancestry have lower absolute neutrophil counts (ANCs) without increased risk for infection. This is associated with the Duffy-null phenotype (nonexpression of the Duffy antigen on red blood cells), which is commonly found in those of African descent. Currently, there are no studies that compare the ANC of individuals with Duffy-null phenotype to those with Duffy non-null phenotypes within a self-identified Black population. The aim of this study was to assess the impact of Duffy status on ANCs based on complete blood counts with differential and Duffy testing in a healthy population of self-identified Black individuals at a single primary care center. This study found that 66.7% (80 of 120) of Black individuals have the Duffy-null phenotype and that there is a significant difference in ANCs between Duffy-null and Duffy non-null individuals (median, 2820 cells per μL vs 5005 cells per μL; P < .001). Additionally, 19 of 80 (23.8%) Duffy-null individuals had an ANC of <2000 cells per μL compared with no (0) Duffy non-null individuals. The Duffy-null phenotype is clinically insignificant; however, inappropriate reference ranges can propagate systemic racism. Therefore, we advocate for the development of Duffy-null–specific ANC reference ranges as well as replacing the term benign ethnic neutropenia with Duffy-nullassociated neutrophil count.
Role of miRNA dysregulation in sepsis
Authors: Formosa Amanda , Turgeon Paul , dos Santos Claudia C.
Published: August 2022

Background

Sepsis is defined as a state of multisystem organ dysfunction secondary to a dysregulated host response to infection and causes millions of deaths worldwide annually. Novel ways to counteract this disease are needed and such tools may be heralded by a detailed understanding of its molecular pathogenesis. MiRNAs are small RNA molecules that target mRNAs to inhibit or degrade their translation and have important roles in several disease processes including sepsis.

Main body

The current review adopted a strategic approach to analyzing the widespread literature on the topic of miRNAs and sepsis. A pubmed search of “miRNA or microRNA or small RNA and sepsis not review” up to and including January 2021 led to 1140 manuscripts which were reviewed. Two hundred and thirty-three relevant papers were scrutinized for their content and important themes on the topic were identified and subsequently discussed, including an in-depth look at deregulated miRNAs in sepsis in peripheral blood, myeloid derived suppressor cells and extracellular vesicles.

Conclusion

Our analysis yielded important observations. Certain miRNAs, namely miR-150 and miR-146a, have consistent directional changes in peripheral blood of septic patients across numerous studies with strong data supporting a role in sepsis pathogenesis. Furthermore, a large body of literature show miRNA signatures of clinical relevance, and lastly, many miRNAs deregulated in sepsis are associated with the process of endothelial dysfunction. This review offers a widespread, up-to-date and detailed discussion of the role of miRNAs in sepsis and is meant to stimulate further work in the field due to the potential of these small miRNAs in prompt diagnostics, prognostication and therapeutic agency.
Cortical spreading depression can be triggered by sensory stimulation in primed wild type mouse brain: a mechanistic insight to migraine aura generation
Authors: Hanalioglu Sahin , Taskiran-Sag Aslihan , Karatas Hulya , Donmez-Demir Buket , Yilmaz-Ozcan Sinem , Eren-Kocak Emine , Gursoy-Ozdemir Yasemin , Dalkara Turgay
Published: August 2022

Background

Unlike the spontaneously appearing aura in migraineurs, experimentally, cortical spreading depression (CSD), the neurophysiological correlate of aura is induced by non-physiological stimuli. Consequently, neural mechanisms involved in spontaneous CSD generation, which may provide insight into how migraine starts in an otherwise healthy brain, remain largely unclear. We hypothesized that CSD can be physiologically induced by sensory stimulation in primed mouse brain.

Methods

Cortex was made susceptible to CSD with partial inhibition of Na+/K+-ATPase by epidural application of a low concentration of Na+/K+-ATPase blocker ouabain, allowing longer than 30-min intervals between CSDs or by knocking-down α2 subunit of Na+/K+-ATPase, which is crucial for K+ and glutamate re-uptake, with shRNA. Stimulation-triggered CSDs and extracellular K+ changes were monitored in vivo electrophysiologically and a K+-sensitive fluoroprobe (IPG-4), respectively.

Results

After priming with ouabain, photic stimulation significantly increased the CSD incidence compared with non-stimulated animals (44.0 vs. 4.9%, p < 0.001). Whisker stimulation also significantly increased the CSD incidence, albeit less effectively (14.9 vs. 2.4%, p = 0.02). Knocking-down Na+/K+-ATPase (50% decrease in mRNA) lowered the CSD threshold in all mice tested with KCl but triggered CSDs in 14.3% and 16.7% of mice with photic and whisker stimulation, respectively. Confirming Na+/K+-ATPase hypofunction, extracellular K+ significantly rose during sensory stimulation after ouabain or shRNA treatment unlike controls. In line with the higher CSD susceptibility observed, K+ rise was more prominent after ouabain. To gain insight to preventive mechanisms reducing the probability of stimulus-evoked CSDs, we applied an A1-receptor antagonist (DPCPX) to the occipital cortex, because adenosine formed during stimulation from ATP can reduce CSD susceptibility. DPCPX induced spontaneous CSDs but only small-DC shifts along with suppression of EEG spikes during photic stimulation, suggesting that the inhibition co-activated with sensory stimulation could limit CSD ignition when K+ uptake was not sufficiently suppressed as with ouabain.

Conclusions

Normal brain is well protected against CSD generation. For CSD to be ignited under physiological conditions, priming and predisposing factors are required as seen in migraine patients. Intense sensory stimulation has potential to trigger CSD when co-existing conditions bring extracellular K+ and glutamate concentrations over CSD-ignition threshold and stimulation-evoked inhibitory mechanisms are overcome.
Evaluation of the use of individualized patient care plans in frequent emergency department visitors with pain complaints
Authors: Blind Fred , Melton James , Karp Juliana , Oldano Karen , Homa Karen , Blanco Alexandra , Leoni Reanna , Pazanese Anthony
Published: August 2022

Background

Pain is one of the most common complaints that patients present to the emergency department for; emergency medicine providers are tasked with providing appropriate pain relief while simultaneously limiting the risk of personal and societal harm that may result from opioid misuse. The Lakeland Regional Medical Center developed a medical management program that identified frequent emergency department visitors with a chief complaint of pain. Individualized care plans were developed for these patients. A retrospective review was then conducted to assess the efficacy of these care plans in reducing the number of emergency department visits for pain-related complaints by the patients entered into the medical management program.

Results

There were 294 patients; 65% were male, and the median age was 41 (interquartile range: 33 to 51). A total of 80% percent of the patients were white, and the payors were as follows: 53% were self-pay, 42% were government programs, and 5% had private insurance. The three most common chronic pain complaints were 39% abdominal pain, 24% back/neck pain, and 23% headache/migraine (patients could have more than one area of pain). A total of 60% of the patients had a primary care provider, and another 18% had a pain management provider in addition to primary care.

Post plan admissions were significantly reduced to a median of 1 (IQR 0 to 3) with the Wilcoxon signed-rank test’s p-value of less than 0.001.

Conclusion

The authors describe their experience with a quality improvement initiative that identifies frequent emergency department visitors with a chief complaint of pain and provides individualized care plans to these patients. The goals of the program are to improve patient’s quality and consistency of care, through interventions that eliminate the prescribing of opioids while providing non-opioid alternatives.
Target antigens for Hs-14 monoclonal antibody and their various expression in normozoospermic and asthenozoospermic men
Authors: Capkova Jana , Margaryan Hasmik , Kubatova Alena , Novak Petr , Peknicova Jana
Published: August 2022

Background

Poor semen quality is one of the main causes of infertility. We have generated a set of monoclonal antibodies to human sperm and used them to investigate sperm quality. Some of these antibodies found differences in the expression of proteins between normal sperm and pathological sperm displaying severe defects. One of them was the Hs-14 antibody.

The aim of this paper was to determine the target protein of the Hs-14 monoclonal antibody and to investigate the expression of the Hs-14-reacting protein on the sperm of asthenozoospermic men with sperm motility defect and of healthy normozoospermic men.

Methods

Indirect immunofluorescence, one-dimensional and two-dimensional polyacrylamide gel electrophoresis, immunoblotting and mass spectrometry.

Results

The Hs-14 antibody binds fibronectin, β-tubulin and valosin-containing protein - new name for this protein is transitional endoplasmic reticulum ATPase (TERA). Since the Hs-14 reaction with TERA remained the strongest at the highest antibody dilution, and Hs-14 consistently labelled the same spot or band as the monospecific anti-TERA antibody on immunoblots, we assume that TERA is an Hs-14-specific protein. Binding of fibronectin and β-tubulin might represent nonspecific cross-reactivity or Hs-14 reaction with similar epitopes of these proteins.

A significant difference (P < 0.001) in immunofluorescence staining with Hs-14 was found between the normozoospermic and asthenozoospermic men.

Conclusion

The Hs-14 antibody enables discrimination between sterile or subfertile asthenozoospermic and fertile normozoospermic men. Decreased levels of TERA in men can be used as a biomarker of reduced fertility.
Testosterone and gonadotropins but not SHBG vary with CKD stages in young and middle aged men
Authors: Hylander Britta , Lehtihet Mikael
Published: August 2022

Background

The aim of this study was to assess the effects chronic kidney disease (CKD) had on sex hormones and lipids in a subgroup of men between 18 and 50 years old with CKD 1–5 stage without diabetes and not treated with hemodialysis.

Methods

Data were collected from 101 men with different CKD stages.

Results

Higher CKD stage (lower function) had a significant negative linear trend on total testosterone level (p < 0.01) and free testosterone level (p < 0.01), with a significant increase of luteinizing hormone (LH) (p < 0.01), and prolactin (p < 0.01), while SHBG remained unchanged between the CKD stages. Triglycerides but not total cholesterol, HDL –cholesterol or LDL-cholesterol increased with higher CKD stage. A negative correlation was observed between BMI, SHBG and free testosterone (p < 0.01 for both) but not with other sex hormones. Age per se was related to a significant decrease of total and free testosterone level (p < 0.01 for both) even after correction for BMI.

Decreased levels of total testosterone and estimated free testosterone levels had a significant correlation with an increased level of triglyceride levels (p <0.01).

Conclusions

Our results indicate that CKD stage per se is a factor affecting testosterone levels in combination with age in men between 18 and 50 years old with CKD 1–5 stage, not treated with hemodialysis.

With increased CKD stage there was a significant increase in LH level and a pattern of hypergonadotropic hypogonadism. SHBG remained unchanged between the CKD stages.