bluuebunny/crossref_metadata_2025 huggingface dataset:
Knowledge of autism gained by learning from people through a local UK Autism Champion Network: A health and social care professional perspective
Authors: Kirby Louise , Payne Katy-Louise
Published: May 2023

Few autistic adults perceive that health and social care professionals have good understanding of autism. The countywide Autism Champion Network evaluated here, is an equal partnership of both staff across sectors (Autism Champions) and individuals with lived experience. Autism Champions take knowledge gained back to their teams to support continuous development of services to meet autistic need. This evaluation aims to examine the professional Autism Champions’ perceptions of (1) the knowledge gained through their local network and (2) the enablers and potential challenges of disseminating and applying the acquired knowledge. Seven health and social sector professionals participated in semi-structured interviews with thematic analysis identifying the themes ‘Learning from People’, ‘Makes you think of things in a different light’ and ‘There’s so much going on . . . ’. Results indicated that knowledge of autism gained from networking outside their own team was used and valued more than the professional presentations. It included signposting, sharing resources, using contacts to answer questions, and informal learning from autistic people. These results have implications for developing learning for Tier 2 and above staff. In addition, they could inform the development of future Autism Champion Networks to expand professionals’ knowledge of autism to reduce health and social care inequalities.

Lay abstract

The Autism Act 10 Years On found few autistic adults thought health and social care professionals had a good understanding of autism. Autism training has been made law in the United Kingdom for health and social care staff to tackle health inequality. The county wide Autism Champion Network evaluated here is an equal partnership of interested staff across sectors (Autism Champions) and autistic experts by virtue of lived experience (Autism Advisory Panel). With knowledge flowing both ways, the Autism Champions take learning back to teams to support continuous development of services to meet autistic need. Seven health and social sector professionals from the Network participated in semi-structured interviews on sharing knowledge of autism gained with their teams. All participants provide care and support for autistic people, some working in specialist positions. Results showed that developing new relationships with people outside their own team to signpost to, answer questions and share resources, and informal learning from autistic people, was more valued and used in practice than information gained from presentations. These results have implications in developing learning for those who need above a basic knowledge of autism and may be useful for others considering setting up an Autism Champion Network.
Mathematics performance, response time, and enjoyment of eighth-grade autistic students and their general education peers
Authors: Wei Xin , Zhang Susu , Zhang Jihong , Yu Jennifer
Published: May 2023

For autistic students receiving special education services, little is known about their relative strengths, weaknesses, and enjoyment across different math content areas; their overall math interest and persistence are also not well-studied. Using the 2017 eighth-grade National Assessment of Education Progress data, this study finds, relative to general education peers with the same math proficiency level, autistic students scored higher and exhibited faster speed in solving visuospatial problems (e.g. identifying figures), but scored lower on math word problems with complex language or social context. Autistic students reported a higher level of enjoyment in solving math problems related to finding areas of shapes or figures but a lower level of persistence than their non-autistic, general education peers. Our work points out the need to help autistic students overcome their weaknesses in word problems and develop their mathematical persistence.
Synthesis of chemically exfoliated reduced graphene oxide from as-grated graphite rods recovered from used household batteries for utilization in tribological applications
Authors: Manokaran Senthilvel , Manikkavasagan Kavitha , Nesappan Saravanakumar , Meenakshisundaram Hareni
Published: May 2023

The research objective of this work is to reuse graphite rods recovered from used batteries and utilize them as an additive in SAE20W40 oil to improve the engine parts’ lubrication ability and wear resistance. The graphite rods are grated to obtain ultra-fine particles and then chemically exfoliated using an Improved Hummer's process that results in graphene oxide. Then, it is thermally reduced at 350 °C to yield reduced graphene oxide. Different ratios (0.25, 0.50, 0.75, and 1.00 wt.%) of as-grated graphite particles and reduced graphene oxide were dispersed in the above oil to form a colloidal solution and then used for tribological studies. The graphite particles and synthesized reduced graphene oxide were characterized using X-ray diffraction, Raman spectroscopy, and high-resolution transmission electron microscopy. X-ray diffraction data confirms the presence of graphite, graphene oxide, and reduced graphene oxide in the prepared powders and matches with the standard files. High-resolution transmission electron microscopy images reveal the presence of multilayer sheets with an interplanar distance of 0.34 nm having wrinkles, folds, and gas holes. The G and D band positions of Raman spectra prove the formation of oxygenated functional groups, and the ID/ IG ratio confirms the defects in graphene oxide and reduced graphene oxide. The viscosity of prepared lubricant increases by 35% and 21% for graphite and reduced graphene oxide, respectively. The results of tribological studies with 0.25 wt.% graphite and 0.5 wt.% reduced graphene oxide lubricants showed improvement in coefficient of friction by 32% and 36%, respectively. At these optimal concentrations, the specific wear rate dropped by 51% for reduced graphene oxide. Scanning electron microscopy/energy dispersive spectroscopy, images show that the nanolubricant's mending effect over the worn surface improves reduced graphene oxide added SAE20W40 oil tribological characteristics. From the results, reduced graphene oxide synthesized from as-grated graphite rods proves to be a low-cost, sustainable, and effective friction modifier for engine oils.
Human Observers Are Accurate in Judging Personal Relationships in Real-life Settings: A Methodological Tool for Human Observational Research
Authors: Liebst Lasse S. , Baggesen Lasse , Dausel Kasper L. , Pallante Virginia , Lindegaard Marie R.
Published: May 2023

One limitation of the naturalistic observation method is that it is understudied how accurately personal relationships may be judged by observers in real-life settings. To assess this judgment accuracy, we observed 285 dyads of individuals in public places and then asked whether they were affiliated or strangers. We found that human observers were very accurate in judging peoples’ actual personal relationships. Moreover, several nonverbal cues, including direct interaction and age similarities, were identified as correlates of affiliation. We conclude that researchers may accurately judge personal relationships from nonverbal observational data and recommend that this should be utilized as a methodological tool in naturalistic observational studies.
Phototherapy: A Conventional Approach to Overcome the Barriers in Oncology Therapeutics
Authors: Quazi Mohzibudin Z , Park Joonyoung , Park Nokyoung
Published: May 2023

Cancer disease has outgrown a life-threatening disease. Having reference to preceding reports provided by the International Agency for Research on Cancer, an estimated 9.6 million deaths transpired from cancer worldwide in 2018. Similarly, about 18.1 million new cases of cancer are being reported. The rise in conventional treatments akin to surgeries, chemotherapies, and radiotherapies was enormously observed to eradicate cancer tumors. These studies have shown unfavorable side effects in clinical treatments. Drug resistivity and drug cytotoxicities are also major issues to overcome. Considering these, researchers are developing alternative methods that are robust, economical, and safe. The use of light for therapeutic purposes shows a great history in vitiligo treatment. The combination of an effective activating agent and phototherapy could result as the best alternative with a great outcome to minimize adverse effects on healthy tissues. The utilization of light in the deletion of tumors using photothermal agents, and photosensitizers, hence the phototherapies in oncology were discovered and rapidly involved in the advancement of clinical approach. Here, in this article, we tried to highlight the recent trends in phototherapy and reviewed different types of phototherapy methods in cancer treatments and their latest clinical, preclinical, and in vivo studies.
Combined ACT-Based Contingency Contracting Intervention for Aggressive Behavior and Psychologically Flexibility in an Adolescent With Comorbid Autism, Bipolar Disorder, and Schizophrenia
Authors: Burke Raymond , Sickman Elana , Belisle Jordan , Taylor Steve , Paliliunas Dana
Published: May 2023

Comorbid diagnoses including autism spectrum disorder, bipolar disorder, schizophrenia, and intellectual disability can present a variety of personal barriers and challenges to interventions that promote safety and autonomy. The current case study provides an overview of a 10-week intervention that included elements of Acceptance and Commitment Therapy and contingency contracting to target psychological flexibility and aggressive behavior in a 17-year-old presenting with these comorbid diagnoses. The treatment was fully individualized to include the client’s interests in Star Wars and focused on supporting the client’s self-identified valued outcomes associated with independent living. Prior to intervention, baseline data showed high levels of aggressive behavior in both frequency and duration, and low levels of psychological flexibility and adaptive behaviors were reported. Following implementation of the combined intervention, aggressive behavior reduced significantly below baseline levels, psychological flexibility improved, and the client engaged in a greater frequency of adaptive behaviors relative to baseline. Positive outcomes were also maintained 1-month and 1-year following the intervention. Implications of this case for clinicians and staff are discussed.
Readability of Online Patient Education Materials for Congenital Hand Differences
Authors: Baldwin Alexander J.
Published: May 2023

Background:

The aim of the study is to assess the readability of online patient education materials (PEMs) for congenital hand differences.

Methods:

The top 10 online, English-language PEMs for 10 conditions (polydactyly, syndactyly, trigger finger/thumb, clinodactyly, camptodactyly, symbrachydactyly, thumb hypoplasia, radial dysplasia, reduction defect, and amniotic band syndrome) were compiled and categorized by source and country. Readability was assessed using 5 tools: Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), and Simple Measure of Gobbledygook Index (SMOG). To account for the potential effect of each condition’s name in the aforementioned formulas, the analysis was repeated after replacing the name with a monosyllabic word/s.

Results:

The mean readability scores of the 100 PEMs were FRES 56.3, where the target was ≥80, FKGL 8.8, GFI 11.5, CLI 10.9, and SMOG 8.6, and the median grade score was 9.8, where the target grade was ≤6.9. Following adjustment, all readability scores improved significantly ( P < .001). Postadjustment scores were FRES 63.8, FKGL 7.8, GFI 10.7, CLI 9.1, and SMOG 8.0, and the median grade score was 8.6. Only 1 webpage met the target level using all tools. Two-sample t test for country of publication (the United States and the United Kingdom) demonstrated that PEMs originating from the United Kingdom were easier to read using the preadjustment CLI ( P = .009) and median grade metrics ( P = .048). A 1-way analysis of variance revealed no influence of condition or source on readability.

Conclusion:

Most online PEMs for congenital hand differences are written above the recommended reading level of sixth grade, even when adjusted for the effect of the condition’s name.
The Interpretive Interview. An Interview Form Centring on Research Participants’ Constructions
Authors: Scheibelhofer Elisabeth
Published: May 2023

One might be tempted to ask: Is discussing qualitative interviewing with yet another name tag on it once again old wine in a new bottle? In this contribution, I argue that describing our interviewing and data analysis still needs some reflection: It is a fine cuvée (ending the vinophile metaphor here) that you might want to get a taste of herewith: Discussing qualitative interviewing deepens the understanding of the kind of interviewing Kathy Charmaz proposed while building explicitly on its traditions within social scientific hermeneutics. Charmaz was kind enough to refer to my work – so it is my honour to proceed with my thinking following our time together in Vienna. In this paper, I will focus on the way of doing qualitative interviews that in the end leads to a data quality that, to the largest extent possible, fits our exigencies in interpretively oriented research. Put in a nutshell, we are seeking an interview form that puts the interview partners at the core of the communicative act and in the drivers’ seats of the interview situation. We thus end up with interview material that is rich in stories told and connections made at the free choice of the participants. This stands in contrast to the idea that qualitative interviews should always be based on interview guidelines. The latter can be clearly differentiated from the interpretive interview style proposed here – and is per se not a bad choice as long as it fits the overall methodology and the ensuing research interests.
Green space for public mental health: an ethnographic study of ecotherapy in Wales
Authors: Lord E
Published: May 2023

Aims:

In recent years, there has been a growing interest in the ways that human health intersects with exposure to nature. This article reports the findings of a research study investigating the experiences of people in South and West Wales who were engaged in a specific type of nature and health intervention: ecotherapy.

Methods:

Ethnographic methods were used to develop a qualitative account of the experiences of participants in four specific ecotherapy projects. Data collected during fieldwork included notes from participant observations, interviews with both individuals and small groups, and documents produced by the projects.

Results:

Findings were reported using two themes: ‘smooth and striated bureaucracy’ and ‘escape and getting away’. The first theme focused on how participants negotiated tasks and systems related to gatekeeping, registration, record keeping, rule compliance, and evaluation. It was argued that this was experienced differently along a spectrum between striated, in which it was disruptive to time and space, and smooth, in which it was much more discrete. The second theme reported on an axiomatic perception that natural spaces represented an escape or refuge; in terms of both reconnecting with something beneficial in nature, and also disconnecting from pathological aspects of everyday life. In bringing the two themes into dialogue, it could be seen that bureaucratic practices often undermined the therapeutic sense of escape; and that this was more acutely experienced by participants from marginalised social groups.

Conclusions:

This article concludes by reasserting that the role of nature in human health is contested and arguing for a greater emphasis on inequities in access to good quality green and blue space. Specific interventions like ecotherapy need funding models that avoid striated bureaucratic processes, and the stress associated with these. Inclusive models of ecotherapy practice could contribute to public health goals related to population engagement with healthy environments.
Secular authoritarian regimes and their Islamist rivals in the Middle East and North Africa: Emerging trends in Turkey's party system
Authors: Hassan Miaad
Published: May 2023

Secular nationalism grew over 50 years to become a compelling force for political, social, and cultural change in the Middle East and North Africa (MENA), but it was Islamism that rose to be its chief rival and, in many Middle East countries, eventually replaced it. The question is: why? And how did Islam gain political momentum? Since independence, the diktat of most single-party countries in MENA has been to implement modernization and secularization. Unlike the secular elites, which sought to overthrow colonialism and the monarchies, the early Islamic reformers sought to establish an Islamic state. MENA's secular regimes led to the massive institutionalization of national identity by nationalizing economies and education, to create a unified ideology from which people could draw a common identity. While eliminating competing ideologies, governments ignored the conservative right in the form of Islamism, which was not expected to pose a serious challenge to them. However, since MENA regimes were mostly authoritarian and forestalled a viable opposition, a social cleavage from below grew as an Islamic movement and eventually presented a serious challenge to them. This article provides an empirical analysis to support the argument that social cleavages in MENA have cultural implications that relate to identity rather than to territory. Hence, latent political cleavages, such as Islamism and ethnic nationalism, served as opportunities to reinforce or reactivate cleavages.
Critical Decision Making: Dysphagia
Authors: Chablaney Shreya , Brandt Lawrence J.
Published: May 2023

The differential diagnosis of dysphagia is broad. A thorough history and physical examination are of paramount importance in determining the etiology of the patient’s dysphagia and guiding their subsequent management. This article discusses our approach to the evaluation of a patient presenting with dysphagia.
A simple prognostic system in patients with myelofibrosis undergoing allogeneic stem cell transplantation: a CIBMTR/EBMT analysis
Authors: Tamari Roni , McLornan Donal P. , Ahn Kwang Woo , Estrada-Merly Noel , Hernández-Boluda Juan Carlos , Giralt Sergio , Palmer Jeanne , Gale Robert Peter , DeFilipp Zachariah , Marks David I. , van der Poel Marjolein , Verdonck Leo F. , Battiwalla Minoo , Diaz Miguel Angel , Gupta Vikas , Ali Haris , Litzow Mark Robert , Lazarus Hillard M. , Gergis Usama , Bashey Asad , Liesveld Jane , Hashmi Shahrukh , Pu Jeffrey J. , Beitinjaneh Amer , Bredeson Christopher , Rizzieri David , Savani Bipin N. , Abid Muhammad Bilal , Ganguly Siddhartha , Agrawal Vaibhav , Ulrike Bacher Vera , Wirk Baldeep , Jain Tania , Cutler Corey , Aljurf Mahmoud , Kindwall-Keller Tamila , Kharfan-Dabaja Mohamed A. , Hildebrandt Gerhard C. , Pawarode Attaphol , Solh Melhem M. , Yared Jean A. , Grunwald Michael R. , Nathan Sunita , Nishihori Taiga , Seo Sachiko , Scott Bart L. , Nakamura Ryotaro , Oran Betul , Czerw Tomasz , Yakoub-Agha Ibrahim , Saber Wael
Published: May 2023

To develop a prognostic model for patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) for myelofibrosis (MF), we examined the data of 623 patients undergoing allo-HCT between 2000 and 2016 in the United States (the Center for International Blood and Marrow Transplant Research [CIBMTR] cohort). A Cox multivariable model was used to identify factors prognostic of mortality. A weighted score using these factors was assigned to patients who received transplantation in Europe (the European Bone Marrow Transplant [EBMT] cohort; n = 623). Patient age >50 years (hazard ratio [HR], 1.39; 95% confidence interval [CI], 0.98-1.96), and HLA-matched unrelated donor (HR, 1.29; 95% CI, 0.98-1.7) were associated with an increased hazard of death and were assigned 1 point. Hemoglobin levels <100 g/L at time of transplantation (HR, 1.63; 95% CI, 1.2-2.19) and a mismatched unrelated donor (HR, 1.78; 95% CI, 1.25-2.52) were assigned 2 points. The 3-year overall survival (OS) in patients with a low (1-2 points), intermediate (3-4 points), and high score (5 points) were 69% (95% CI, 61-76), 51% (95% CI, 46-56.4), and 34% (95% CI, 21-49), respectively (P < .001). Increasing score was predictive of increased transplant-related mortality (TRM; P = .0017) but not of relapse (P = .12). The derived score was predictive of OS (P < .001) and TRM (P = .002) but not of relapse (P = .17) in the EBMT cohort as well. The proposed system was prognostic of survival in 2 large cohorts, CIBMTR and EBMT, and can easily be applied by clinicians consulting patients with MF about the transplantation outcomes.
Oxycodone vs. tramadol in postoperative parent-controlled intravenous analgesia in children: a prospective, randomized, double-blinded, multiple-center clinical trial
Authors: Li Siyuan , Xiong Hongfei , Jia Yingping , Li Zhengchen , Chen Yexi , Zhong Liang , Liu Feng , Qu Shuangquan , Du Zhen , Wang Yuxia , Huang Suxia , Zhao Yonghui , Liu Jing , Jiang Lihua
Published: May 2023

Background

Management of acute postoperative pain is one of the major challenges in pediatric patients. Oral oxycodone has shown good pain relief in postoperative pain relief in children, but no studies have investigated intravenous oxycodone in this context.

Objective

whether oxycodone PCIA can provide adequate and safe postoperative pain relief, in comparison to tramadol as reference opioid drug.

Design

a randomized, double-blind, parallel, multi-center clinical trial.

Setting

five university medical centers and three teaching hospitals in China.

Participants

patients aged 3-month-old to 6-year-old undergoing elective surgery under general anesthesia.

Intervention

patients were randomly allocated to either tramadol (n = 109) or oxycodone (n = 89) as main postoperative opioid analgesic. Tramadol or oxycodone were administered with a loading dose at the end of surgery (1 or 0.1 mg.kg–1, respectively), then with a parent-controlled intravenous device with fixed bolus doses only (0.5 or 0.05 mg.kg–1, respectively), and a 10-min lockout time.

Outcomes

the primary outcome was adequate postoperative pain relief, defined as a face, legs, activity, cry, and consolability (FLACC) score < 4/10 in the post-anesthesia care unit (PACU), with no need for an alternative rescue analgesia. FLACC was measured 10 min after extubation then every 10 min until discharge from PACU. Analgesia was currently conducted with the boluses of either tramadol or oxycodone if FLACC was ≥ 3, up to three bolus doses, after what rescue alternative analgesia was administered.

Results

tramadol and oxycodone provided a similar level of adequate postoperative pain relief in PACU and in the wards. No significant differences were either noted for the raw FLACC scores, the bolus dose demand in PACU, the time between the first bolus dose and discharge from PACU, analgesic drug consumption, bolus times required in the wards, function activity score, or the parents’ satisfaction. The main observed side effects in both groups were nausea and vomiting, with no difference between groups. However, patients in the oxycodone group showed less sedation levels and had a shorter stay in the PACU, compared with the tramadol group.

Conclusions

an adequate postoperative analgesia can be achieved with intravenous oxycodone, this with less side effects than tramadol. It can therefore be a choice for postoperative pain relief in pediatric patients.

Trial registration

The study was registered at www.chictr.org.cn (Registration number: ChiCTR1800016372; date of first registration: 28/05/2018; updated date:06/01/2023).
A survey on the availability of geriatric-friendly protocols, equipment and physical environment across emergency departments in Flanders, Belgium
Authors: Heeren Pieter , Lombaert Lotte , Janssens Petra , Islam Farah , Flamaing Johan , Sabbe Marc , Milisen Koen
Published: May 2023

Background

The acquisition of geriatric-friendly resources is an important part of adapting emergency department (ED) care to the needs of vulnerable older patients. The aim of this study was to explore the availability of geriatric-friendly protocols, equipment and physical environment criteria in EDs and to identify related improvement opportunities.

Methods

The head nurse of 63 EDs in Flanders and Brussels Capital Region was invited to complete a survey in collaboration with the chief physician of the ED. The questionnaire was inspired by the American College of Emergency Physicians Geriatric ED Accreditation Program and explored the availability, relevance and feasibility of geriatric-friendly protocols, equipment and physical environment. Descriptive analyses were performed. A region-wide improvement opportunity was defined as a resource that was never to occasionally (0–50%) available on Flemish EDs and was scored (rather or very) relevant by at least 75% of respondents.

Results

A total of 32 questionnaires were analysed. The response rate was 50.8%. All surveyed resources were available in at least one ED. Eighteen out of 52 resources (34.6%) were available in more than half of EDs. Ten region-wide improvement opportunities were identified. These comprised seven protocols and three physical environment characteristics: 1) a geriatric approach initiated from physical triage, 2) elder abuse, 3) discharge to residential facility, 4) frequent geriatric pathologies, 5) access to geriatric specific follow-up clinics, 6) medication reconciliation, 7) minimising ‘nihil per os’ designation, 8) a large-face, analogue clock in each patient room, 9) raised toilet seats and 10) non-slip floors.

Conclusions

Currently available resources supporting optimal ED care for older patients in Flanders are very heterogeneous. Researchers, clinicians and policy makers need to define which geriatric-friendly protocols, equipment and physical environment criteria should become region-wide minimum operational standards. Findings of this study are relevant to facilitate the development process of this endeavour.
Prevalence of carbapenemase-producing Enterobacteriaceae from human clinical samples in Ethiopia: a systematic review and meta-analysis
Authors: Alemayehu Ermiyas , Fiseha Temesgen , Gedefie Alemu , Alemayehu Tesfaye Nuhamin , Ebrahim Hussen , Ebrahim Endris , Fiseha Mesfin , Bisetegn Habtye , Mohammed Ousman , Tilahun Mihret , Gebretsadik Daniel , Debash Habtu , Gobezie Mengistie Yirsaw
Published: May 2023

Introduction

Carbapenemase-producing Enterobacteriaceae are by far the most public health and urgent clinical problems with antibiotic resistance. They cause longer hospital stays, more expensive medical care, and greater mortality rates. This systematic review and meta-analysis aimed to indicate the prevalence of carbapenemase-producing Enterobacteriaceae in Ethiopia.

Methods

This systematic review and meta-analysis was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Electronic databases like PubMed, Google Scholar, CINAHL, Wiley Online Library, African Journal Online, Science Direct, Embase, ResearchGate, Scopus, and the Web of Sciences were used to find relevant articles. In addition, the Joanna Briggs Institute quality appraisal tool was used to assess the quality of the included studies. Stata 14.0 was used for statistical analysis. Heterogeneity was assessed by using Cochran’s Q test and I2 statistics. In addition, publication bias was assessed using a funnel plot and Egger’s test. A random effect model was used to estimate the pooled prevalence. Sub-group and sensitivity analysis were also done.

Results

The overall pooled prevalence of carbapenemase-producing Enterobacteriaceae in Ethiopia was 5.44% (95% CI 3.97, 6.92). The prevalence was highest [6.45% (95% CI 3.88, 9.02)] in Central Ethiopia, and lowest [(1.65% (95% CI 0.66, 2.65)] in the Southern Nations and Nationalities People Region. In terms of publication year, 2017–2018 had the highest pooled prevalence [17.44 (95% CI 8.56, 26.32)] and 2015–2016 had the lowest [2.24% (95% CI 0.87, 3.60)].

Conclusion

This systematic review and meta-analysis showed a high prevalence of carbapenemase-producing Enterobacteriaceae. So, to alter the routine use of antibiotics, regular drug susceptibility testing, strengthening the infection prevention approach, and additional national surveillance on the profile of carbapenem resistance and their determining genes among Enterobacteriaceae clinical isolates are required.

Systematic review registration

PROSPERO (2022: CRD42022340181).
Neurologists’ lived experiences of communicating the diagnosis of a motor neurodegenerative condition: an interpretative phenomenological analysis
Authors: Anestis Eleftherios , Eccles Fiona J. R. , Fletcher Ian , Simpson Jane
Published: May 2023

Background

Receiving the diagnosis of a motor neurodegenerative condition (MNDC) can be a life-changing experience. Although several studies of individuals’ experiences have indicated dissatisfaction with aspects of how an MNDC diagnosis was communicated, few studies have addressed doctors’ experiences of breaking bad news for these conditions, especially from a qualitative perspective. This study explored UK neurologists’ lived experience of delivering an MNDC diagnosis.

Methods

Interpretative phenomenological analysis was used as the overarching method. Eight consultant neurologists working with patients with MNDCs took part in individual, semi-structured interviews.

Results

Two themes were constructed from the data: ‘Meeting patients’ emotional and information needs at diagnosis: a balancing act between disease, patient and organization-related factors’, and ‘Empathy makes the job harder: the emotional impact and uncovered vulnerabilities associated with breaking bad news’. Breaking the news of an MNDC diagnosis was challenging for participants, both in terms of achieving a patient-centred approach and in terms of dealing with their own emotions during the process.

Conclusions

Based on the study’s findings an attempt to explain sub-optimal diagnostic experiences documented in patient studies was made and how organizational changes can support neurologists with this demanding clinical task was discussed.
CPAP failure in the management of preterm neonates with respiratory distress syndrome where surfactant is scarce. A prospective observational study
Authors: Abdallah Yaser , Mkony Martha , Noorani Mariam , Moshiro Robert , Bakari Mohamed , Manji Karim
Published: May 2023

Background

The mainstay in the management of preterm neonates with respiratory distress syndrome (RDS) include early Continuous Positive Airway Pressure (CPAP), timely surfactant replacement and mechanical ventilation. Preterm neonates with RDS who fail CPAP are at higher risk for chronic lung disease as well as death. Unfortunately, in low resource settings CPAP may be the only treatment available for these neonates.

Objective

To determine the prevalence of CPAP failure among premature newborns with RDS and associated factors.

Methods

We conducted a prospective observational study over the first 72 h of life on 174 preterm newborns with RDS receiving CPAP at Muhimbili National Hospital (MNH). At MNH newborns with Silverman Andersen Score (SAS) of ≥ 3 are commenced on CPAP; surfactant and mechanical ventilation are very scarce. Study newborns not maintaining oxygen saturation > 90% or with SAS score ≥ 6 despite being on 50% oxygen and PEEP of 6 cmH2O and those with > 2 episodes of apnoea needing stimulation or positive pressure ventilation in 24 h were considered as CPAP failure. The prevalence of CPAP failure was determined as a percentage and factors associated were determined by logistic regression. A p-value of < 0.05 was considered significant and 95% confidence interval was used.

Results

Of the enrolled newborns, 48% were male and 91.4% were in-born. The mean gestational age and weight were 29 weeks (range 24–34 weeks) and 1157.7 g (range 800–1500 g) respectively. Of the mothers 44 (25%) received antenatal corticosteroids. Overall CPAP failure was 37.4% and among those weighing ≤ 1200g, it was 44.1% . Most failure occurred within the first 24 h. No factor was identified to be independently associated with CPAP failure. Mortality among those who failed CPAP was 33.8% and 12.8% among those who did not.

Conclusions

In resource limited settings like ours with low up take of antenatal corticosteroids and scarce surfactant replacement a significant portion of preterm neonates especially those weighing ≤ 1200 g with RDS fail CPAP therapy.
Children of parents with different severities of mental health conditions have higher risk of somatic morbidity: a Danish nationwide register-based cohort study
Authors: Renneberg Camilla Klinge , Brund René Børge Korsgaard , Heuckendorff Signe , Bech Bodil Hammer , Fonager Kirsten
Published: May 2023

Background

Children with the most severe parental mental health conditions have an elevated risk of numerous adversities including somatic morbidity. However, there is no knowledge concerning physical health in most children affected by parental mental health conditions. Therefore, the aim was to examine the association between different severities of parental mental health conditions and somatic morbidity in children of different age-groups and further explore the combinations of maternal and paternal mental health conditions on child somatic morbidity.

Methods

In this register-based cohort study, we included all children born in Denmark between 2000–2016 and linked parents. Parental mental health conditions were categorised into four severity groups (no, minor, moderate, and severe). Somatic morbidity in offspring was categorised into broad disease categories corresponding to the International Classification of Diseases. We estimated the risk ratio (RR) using Poisson regression, of the first registered diagnosis in different age-groups.

Results

Of the around 1 million children in the study > 14.5% were exposed to minor parental mental health conditions and < 2.3% were exposed to severe parental mental health conditions. Overall, the analyses revealed a higher risk of morbidity in exposed children across all disease categories. The strongest association was observed for digestive diseases in children aged < 1 year exposed to severe parental mental health conditions (RR: 1.87 (95% CI: 1.74–2.00). Generally, the risk of somatic morbidity increased the more severe the parental mental health conditions. Both paternal and especially maternal mental health conditions were associated with a higher risk of somatic morbidity. The associations were strongest if both parents had a mental health condition.

Conclusion

Children with different severities of parental mental health conditions experience a higher risk of somatic morbidity. Although children with severe parental mental health conditions had the highest risk, children with minor parental mental health conditions should not be neglected as more children are exposed. Children with both parents having a mental health condition were the most vulnerable to somatic morbidity and maternal mental health conditions were more strongly associated with somatic morbidity than paternal. More support and awareness of families with parental mental health conditions is highly needed.
The effect of nintedanib on lung functions and survival in idiopathic pulmonary fibrosis: real-life analysis of the Czech EMPIRE registry
Authors: Štefániková Marianna , Doubková Martina , Ovesná Petra , Šterclová Martina , Lacina Ladislav , Žurková Monika , Plačková Martina , Bartoš Vladimír , Janíčková Ivana , Bittenglová Radka , Anton Jan , Sýkorová Ľubica , Lošťáková Vladimíra , Musilová Pavlína , Šuldová Hana , Mokošová Radka , Didyk Jurij , Šišáková Lenka , Lisá Pavlína , Lněnička Jaroslav , Dařičková Hana , Doležel Daniel , Pšikalová Jana , Tyl Richard , Králová Renata , Vašáková Martina Koziar
Published: May 2023

Introduction

The antifibrotic drug nintedanib is used for the treatment of idiopathic pulmonary fibrosis (IPF). We analysed the effect of nintedanib on antifibrotic treatment outcome in real-world cohorts of Czech EMPIRE registry.

Patients/methods

Data of 611 Czech IPF subjects, 430 (70%) treated with nintedanib (NIN group), 181 (30%) with no-antifibrotic treatment (NAF group) were analysed. The influence of nintedanib on overall survival (OS), pulmonary function parameters as forced vital capacity (FVC) and diffusing lung capacity for carbon monoxide (DLCO), as well as GAP score (gender, age, physiology) and and CPI (composite physiological index) were investigated.

Results

During 2 year follow-up we observed that nintedanib treated patients had longer OS, compared to those treated with no-antifibrotic drugs (p < 0.00001). Nintedanib reduces risk of mortality over no-antifibrotic treatment by 55% (p < 0.001). We have observed no significant difference in the rate of FVC and DLCO decline between the NIN and NAF group. Changes within 24 months from baseline in CPI were not significant between the groups (NAF and NIN).

Conclusion

Our real-practice study showed the benefit of nintedanib treatment on survival. There were no significant differences between NIN and NAF groups in changes from baseline in FVC %, DLCO % predicted and CPI.
How much the leg length has changed after the MOUKA through measurement of the full length radiographs? Beware of splicing error
Authors: Xie Tianlang , Jiao Xufeng , Yao Xiaomei , Li Zheng , An Shuai , Cao Guanglei
Published: May 2023

Background

Leg length change after knee arthroplasty is one of the most concerned problems for patients and doctors. However, as there was only one literture focused on the leg length change after unicompartmental knee arthroplasty, we aimed to clarify the leg length change after medial mobile-bearing unicompartmental knee arthroplasty (MOUKA) using a novel double calibration method.

Methods

We enrolled patients who underwent MOUKA and had taken full-length radiographs in a standing position prior to and at 3 months after the operation. We eliminated the magnification by a calibrator and corrected the longitudinal splicing error by measuring the femur and tibia lengths before and after operation. Perceived leg length change was collected 3 months after operation. Bearing thickness, preoperative joint line convergence angle, preoperative and postoperative varus angles, flexion contracture and Oxford knee score (OKS) were also collected.

Results

From June 2021 to February 2022, 87 patients were enrolled.76 (87.4%) of them showed an increase with an average of 0.32 cm (range from -0.30 cm to 1.05 cm) in leg length change. The lengthening was strongly correlated with the degree of varus deformity and its correction value (r = 0.81&0.92, P < 0.01). Only 4 (4.6%) patients perceived leg length lengthening after operation. There was no difference in OKS between the patients who had an increase in leg length and those who had a decrease (P = 0.99).

Conclusions

Majority of patients only experienced a slight increase in leg length after MOUKA, and such an increase did not affect patients’ perception and short-term function.
Influence of thickness and surface conditioning on fracture resistance of occlusal veneer
Authors: Essam Noha , Soltan Hassan , Attia Ahmed
Published: May 2023

Background

The purpose of the current study was to assess the impact of restoration thickness, surface conditioning and the interaction between them on the fracture resistance of CAD/CAM fabricated lithium disilicate occlusal veneers.

Methods

A total of 42 maxillary molars were prepared to receive CAD/CAM fabricated lithium disilicate occlusal veneer either with 0.5 mm (n = 21) or 1 mm (n = 21) thickness. Each main group was divided into 3 subgroups (n = 7), according to surface treatment, HF acid (HF-1, HF-0.5), acidulated phosphate fluoride (APF-1, APF-0.5) and Monobond etch & prime (MON-1, MON-0.5). Multilinik N (Ivoclar-Vivadent) adhesive resin cement was used for bonding according to the manufacturer instructions. One hour after bonding, specimens were stored in water bath for 75 days followed by cyclic loading fatigue for 240,000 cycles to simulate clinical situation. Finally, specimens were fractured under compressive load in (N) using a universal testing machine. Two and one-way ANOVA and Post Hoc Tukey test were used for statistical analysis.

Results

The means ± SD (N) fracture load for each group were calculated. MON-1 group showed the highest fracture load (1644.7 ± 155.3) followed by HF-1 group (1514.6 ± 212.5). Meanwhile, APF-0.5 showed the lowest fracture load (962 ± 249.6).

Conclusion

CAD/CAM fabricated lithium disilicate occlusal veneers can be used with a thickness of 0.5 mm instead of conventional crowns. Monobond etch & prime is recommended as a surface treatment for CAD/CAM fabricated lithium disilicate occlusal veneer due to biological hazards of Hydrofluoric acid.
Gender-based violence against women during the COVID-19 pandemic: recommendations for future
Authors: Ostadtaghizadeh Abbas , Zarei Mozhdeh , Saniee Nadia , Rasouli Mohammad Aziz
Published: May 2023

Background

Gender-based violence (GBV) includes any physical, sexual, psychological, economic harms, and any suffering of women in the form of limiting their freedom in personal or social life. As a global crisis, COVID-19 has exposed women to more violence, which requires serious actions. This work aims to review the most critical dimensions of the GBV against women, effective factors on it, and strategies for combating it during the COVID-19 pandemic in order to provide recommendations for future pandemics.

Methods

This study was conducted based on PRISMA-ScR. First, PubMed, Embase, Scopus, Web of Science, ProQuest, and Google Scholar were searched in April 2021 with no time limitation and location using the related keywords to COVID-19 and GBV. The searched keywords were COVID-19, gender-based violence, domestic violence, sexual violence, women, violence, abuse, and their synonyms in MESH and EMTREE. Duplicates were removed, titles and abstracts were screened, and then the characteristics and main results of included studies were recorded in the data collection form in terms of thematic content analysis.

Results

A total of 6255 records were identified, of which 3433 were duplicates. Based on inclusion criteria 2822 titles and abstracts were screened. Finally, 14 studies were eligible for inclusion in this study. Most of these studies were conducted in the United States, the Netherlands, and Iran, mostly with interventional and qualitative methods.

Conclusions

Strengthening ICT infrastructure, providing comprehensive government policies and planning, government economic support, social support by national and international organizations should be considered by countries worldwide. It is suggested that countries provide sufficient ICT infrastructure, comprehensive policies and planning, economic support, social support by collaboration between national and international organizations, and healthcare supporting to manage incidence of GBV against women in future pandemics.
Diallyl disulfide alleviates hypercholesterolemia induced by a western diet by suppressing endoplasmic reticulum stress in apolipoprotein E-deficient mice
Authors: Kim Hyun Ju , Kim Mijeong
Published: May 2023

Background

The endoplasmic reticulum (ER) plays a pivotal role in maintaining cellular metabolic homeostasis. ER stress refers to the accumulation of misfolded proteins, which can trigger an unfolded protein response for survival or death in the cells. Diallyl disulfide (DADS), a major active compound in garlic, has many health benefits for patients with metabolic diseases, especially cardiovascular or fatty liver diseases. However, its role in attenuating hypercholesterolemia by suppressing ER stress remains unknown. Therefore, in this study, we determined whether DADS supplementation could reduce ER stress in apolipoprotein E-deficient (ApoE−/−) mice fed a Western-type diet (WD).

Methods

ApoE−/− mice were fed either a WD alone or a WD supplemented with 0.1% DADS for 12 weeks (n = 10). Levels of plasma total cholesterol, triglyceride, leptin, and insulin were determined. Western blotting was performed to measure protein levels involved in ER stress markers. Histology and Immunostaining were performed on aortic root sections to confirm the effect of DADS on histology and expression of ER chaperone protein GRP78.

Results

The metabolic parameters showed that increases in fat weight, leptin resistance, and hypercholesterolemia were reversed in DADS-supplemented mice (p < 0.05). In addition, DADS ameliorated not only the protein of ER stress markers, phospho-eukaryotic initiation factor 2 subunit alpha and C/EBP homologous protein in the liver (p < 0.05) but also glucose-related protein 78 localization in the aorta.

Conclusions

This indicates that DADS inhibits diet-induced hypercholesterolemia, at least in parts by regulating ER stress markers. DADS may be a good candidate for treating individuals with diet-induced hypercholesterolemia.
Clinical ethics consultation documentation in the era of open notes
Authors: Childers Chad , Marron Jonathan , Meyer Elaine C. , Abel Gregory A.
Published: May 2023

Background

In 2021, federal rules from the 21st Century Cures Act mandated most clinical notes be made available in real-time, online, and free of charge to patients, a practice often referred to as “open notes.” This legislation was passed to support medical information transparency and reinforce trust in the clinician-patient relationship; however, it created additional complexities in that relationship and raises questions of what should be included in notes intended to be read by both clinicians and patients.

Main Body

Even prior to open notes, how an ethics consultant should document a clinical ethics consultation was widely debated as there can be competing interests, differing moral values, and disagreement about pertinent medical information in any given encounter. Patients can now access documentation of these discussions through online portals which broach sensitive topics related to end-of-life care, autonomy, religious/cultural conflict, veracity, confidentiality, and many others. Clinical ethics consultation notes must be ethically robust, accurate, and helpful for healthcare workers and ethics committee members, but now also sensitive to the needs of patients and family members who can read them in real-time.

Conclusion

We explore implications of open notes for ethics consultation, review clinical ethics consultation documentation styles, and offer recommendations for documentation in this new era.