bluuebunny/crossref_metadata_2025 huggingface dataset:
Linking modern pollen accumulation rates to biomass: Quantitative vegetation reconstruction in the western Klamath Mountains, NW California, USA
Authors: Knight Clarke A , Baskaran Mark , Bunting M Jane , Champagne Marie , Potts Matthew D , Wahl David , Wanket James , Battles John J
Published: January 2021

Quantitative reconstructions of vegetation abundance from sediment-derived pollen systems provide unique insights into past ecological conditions. Recently, the use of pollen accumulation rates (PAR, grains cm−2 year−1) has shown promise as a bioproxy for plant abundance. However, successfully reconstructing region-specific vegetation dynamics using PAR requires that accurate assessments of pollen deposition processes be quantitatively linked to spatially-explicit measures of plant abundance. Our study addressed these methodological challenges. Modern PAR and vegetation data were obtained from seven lakes in the western Klamath Mountains, California. To determine how to best calibrate our PAR-biomass model, we first calculated the spatial area of vegetation where vegetation composition and patterning is recorded by changes in the pollen signal using two metrics. These metrics were an assemblage-level relevant source area of pollen (aRSAP) derived from extended R-value analysis ( sensu Sugita, 1993) and a taxon-specific relevant source area of pollen (tRSAP) derived from PAR regression ( sensu Jackson, 1990). To the best of our knowledge, aRSAP and tRSAP have not been directly compared. We found that the tRSAP estimated a smaller area for some taxa (e.g. a circular area with a 225 m radius for Pinus) than the aRSAP (a circular area with a 625 m radius). We fit linear models to relate PAR values from modern lake sediments with empirical, distance-weighted estimates of aboveground live biomass (AGLdw) for both the aRSAP and tRSAP distances. In both cases, we found that the PARs of major tree taxa – Pseudotsuga, Pinus, Notholithocarpus, and TCT (Taxodiaceae, Cupressaceae, and Taxaceae families) – were statistically significant and reasonably precise estimators of contemporary AGLdw. However, predictions weighted by the distance defined by aRSAP tended to be more precise. The relative root-mean squared error for the aRSAP biomass estimates was 9% compared to 12% for tRSAP. Our results demonstrate that calibrated PAR-biomass relationships provide a robust method to infer changes in past plant biomass.
Paul’s Flesh: A Disabled Reading of Flesh/Spirit Dualism
Authors: Moore Kai D.
Published: January 2021

This article considers the Pauline construction of a “spiritual body” in 1 Corinthians 15 and his flesh/spirit dualism more generally in light of Paul’s probable disability. I suggest that this rhetoric functioned as a strategy for Paul to claim social power in his social context by deemphasizing his physical presence, and thus reflects a negotiation with cultural patterns of disability abjection rather than a meaningful part of Christian teaching. Because of the active harm done by these dualistic constructions, however unintentional such an interpretation may have been on Paul’s part, liberative Christian theologies must reject this framing and work to integrate not just “body” and spirit but also flesh and its more negative bodily associations such as weakness, pain, illness, and death.
Sacrifice and the Self: The Feminine Sacrificial Identity and the Case of Milada Horáková
Authors: Koci Katerina
Published: January 2021

This study aims to portray the self of the sacrificial subject, specifically the feminine sacrificial self. The Christian discourse on sacrifice is dominated by the scholarship of René Girard and his followers. This study briefly presents Girard’s approach and pinpoints its weaknesses in order to complement it with the work of Julia Kristeva and Jan Patočka. All these approaches, taken together, provide a complex picture of what the autonomous feminine sacrificial self looks like. Starting from thorough theoretical and analytical analyses of Girard, Kristeva and Patočka, this study then applies their insights through the particular example of the feminine sacrificial self of Milada Horáková. The example of this political prisoner and victim of a Stalinist showtrial in 1950s Czechoslovakia aptly illustrates the uniqueness of the feminine sacrificial self.
High density polyethylene/wood flour composite: Optimization of processing temperature, processing time and coupling agent concentration
Authors: Ranjbarha Zahra , Aberoomand-Azar Parviz , Mokhtari-Aliabad Javad , Mirmohammadi Seyed Amin , Saber-Tehrani Mohammad
Published: January 2021

Wood plastic composites (WPCs) consisting of high density polyethylene (HDPE) reinforced with high-loading (55 wt%) of wood flour (WF) were fabricated with melt-blending technique. In this compounding method, processing parameters such as different mixing temperatures (of 165, 180 and 195°C), mixing times (of 5, 10 and 15 minutes) and coupling agent contents (of 2 and 4 wt%) were evaluated. Prepared specimens were analyzed with tensile, Izod, shore D, DMTA, short-term creep, DSC, TGA, water absorption and water contact angle characterizations. Results revealed that mixing temperature of 180°C, mixing time of 10 minutes and coupling agent concentration of 4 wt% were found as the best processing conditions. The mentioned conditions provided enhanced dispersion of WF particles within the HDPE matrix, due to optimum viscosity of the polymer melt and effective residence time of compound in the mixer, and beside them efficient interfacial adhesion between WF and polymer matrix.
COVID-19 era healthcare ethics education: Cultivating educational and moral resilience
Authors: Wald Hedy S , Monteverde Settimio
Published: January 2021

The COVID-19 pandemic crisis has had profound effects on global health, healthcare, and public health policy. It has also impacted education. Within undergraduate healthcare education of doctors, nurses, and allied professions, rapid shifts to distance learning and pedagogic content creation within new realities, demands of healthcare practice settings, shortened curricula, and/or earlier graduation have also challenged ethics teaching in terms of curriculum allotments or content specification. We propose expanding the notion of resilience to the field of ethics education under the conditions of remote learning. Educational resilience starts in the virtual classroom of ethics teaching, initially constituted as an “unpurposed space” of exchange about the pandemic’s challenging impact on students and educators. This continuously transforms into “purposed space” of reflection, discovering ethics as a repertory of orientative knowledge for addressing the pandemic’s challenges on personal, professional, societal, and global levels and for discovering (and then addressing) that the health of individuals and populations also has moral determinants. As such, an educational resilience framework with inherent adaptability rises to the challenge of supporting the moral agency of students acting both as professionals and as global citizens. Educational resilience is key in supporting and sustaining professional identify formation and facilitating the development of students’ moral resilience and leadership amid moral complexity and potential moral transgression—not only but especially in times of pandemic.
Newborn in Neonatal Intensive Care Unit: Parental Concerns
Authors: Dhingra Pardeep
Published: January 2021

Background:

Having a newborn baby admitted in the neonatal intensive care unit (NICU) can be a stressful experience for the parents.

Objectives:

This study was planned to know the following: 1. The concerns of parents whose babies were admitted in NICU 2. Parental satisfaction level about the services provided 3. Assessment of parents for their understanding and knowledge at discharge

Study Design:

Semiqualitative interview.

Participants:

Parents of 100 (56 M, 44 F) neonates.

Intervention:

We subjected them to a semiqualitative interview on the day of discharge of their newborn infant. Questionnaire consisted of parent’s understanding regarding NICU and health care providers, their perspective about the possible cause of illness in their baby along with competence and communication skills of health care providers. Parental satisfaction about the services was assessed by the short assessment of patient satisfaction (SAPS). They were assessed for their anxiety and depression levels by hospital anxiety and depression scale (HADS). They were assessed for their knowledge about care of baby at home after discharge by patient knowledge questionnaire (PKQ).

Results:

Parents of 44% babies had no prior idea about NICU and why babies need to be admitted. In total, 48% mothers and 36% fathers had clinically significant anxiety levels as assessed by HADS. Many parents complained about lack of communication about their babies illness, its cause, duration of treatment, and prognosis. Both parents scored the caregivers on borderline scores on the SAPS. At discharge only 13% knew the correct dose and duration of medicines prescribed. PKQ scores varied from 5 to 20. Almost all parents emphasized the need for more space, resting place for mothers, and better communication by doctors.

Conclusions:

This study reveals a significant communication gap between health care providers and parents. Concerns of parents have to be addressed to have their full participation in newborn care.
Situating the Local in Bilateralism: Assessing Local Impacts of the India–Bangladesh Enclave Exchange
Authors: Sen Surya Sankar
Published: January 2021

In its fundamental essence, bilateral relations outline a mechanism through which two countries seek to actualize their individual national interests through collaboration on select issues. Such conceptualizations often obscure the relevance of issues and narratives at local levels, which constitute the sites of its practicalization. The predominance of national interest-focused approaches in negotiating bilateral relations, particularly in the sphere of conflict management, often casts aside local narratives underlying the issues and conflicts it seeks to address. The resultant gap between the advocated and actual necessities of resolution at the ground may lead to the persistence and emergence of local tensions subsequent to its ‘settlement’ at the national and bilateral levels.

The bilateral resolution of the India–Bangladesh enclave issue presents an interesting case to engage with the conceptual and practical facets of this mechanism of state action and its impacts at the local level. Based on an ethnographic survey of local perceptions of residents of three enclaves in Cooch Behar district, West Bengal, this article will examine the impacts of national interest-based mediation in localized conflicts, to engage the problematic of the ‘local’s absence from bilateralism’s conceptualization in international relations.
Understanding the dynamics of inequity in collective bargaining: evidence from Australia, Canada, Denmark and France
Authors: Barton Ruth , Béthoux Élodie , Dupuy Camille , Ilsøe Anna , Jalette Patrice , Laroche Mélanie , Navrbjerg Steen Erik , Larsen Trine Pernille
Published: January 2021

Unions and collective bargaining are generally considered to be the main vehicles for ensuring equity at work. This article questions this assertion by examining distinct forms of inequity between workers in unionised workplaces and, more specifically, the role of collective bargaining in creating, maintaining, reducing or avoiding them. Based on a study conducted in Australia, Canada (Québec), Denmark and France, the situations of inequity examined are related to employment and working conditions, and favour one group of workers over another group of workers performing the same tasks in the same workplace. To better apprehend these dynamics and distinguish between different situations, we develop an analytical framework to capture them. Then, we focus on one example observable in each country: two examples of inequity based on date of hiring (Canada and Australia) and two based on employment status (France and Denmark), showing how the four ideal-type processes interact in each national context. Based on an analysis of these examples, we demonstrate the segmentation between core and non-core employees, along the lines of segmentation theory, but also within groups of insiders or core employees and the key factors that explain how the collective bargaining process can lead to inequity: time, balance of power, and workplace institutions.
Editorial Advisory Board Members on Reimagining Higher Education Internationalization and Internationalization of the Curriculum
Authors: Whitsed Craig , Burgess Madeline , Ledger Susan
Published: January 2021

This research explores how editorial advisory board members across four highly ranked international higher education–focused journals understand higher education internationalization generally, and internationalization of the curriculum (IoC) specifically. Notionally, as gatekeepers, editorial advisory board members hold a powerful strategic position in the scholarly debates that characterize an active discipline, and can indirectly assert a strong influence over the academic direction of the field(s) to which they belong. All editorial advisory members for the journals Higher Education, Studies in Higher Education, Higher Education Research & Development, and the Journal of Studies in International Education were invited to contribute to this research with 25 ( N = 25, 30%) consenting to participate. Utilizing qualitative, semi-structured interviewing, participants discussed their views on higher education internationalization, IoC, and the importance of these in the contemporary university. Participants also discussed what dimensions of IoC need to be further addressed in higher education discourses and research, and opportunities and challenges they foresee concerning higher education internationalization now and into the future. Findings reveal, for participants, internationalization continues to be perceived as a multivocal, largely Anglo-European, and neoliberal enterprise which is at a crossroad, and needs to be reimagined for the betterment of all in society. Collectively, participants draw attention to a lack of criticality and problematization within higher education internationalization discourses, and highlighted the need for research, scholarship, and academic leaders to expand the focus of IoC to address future global challenges and needs.
Macroeconomic Uncertainty and Risk: Collective Optimism of Small-Business Owners
Authors: Patel Pankaj C. , Tsionas Mike
Published: January 2021

How small-business owners assess uncertainty and risk in the macroeconomic environment to report optimism toward their business activity is an important research question for policymakers and academics alike. Drawing on a monthly optimism index and a variety of uncertainty and volatility (risk) trackers from January 1986 to June 2017, in line with the expectation that business owners dislike uncertainty in economic policy, economic policy uncertainty may lower optimism. Business investment and sentiment volatility, however, contributed positively to optimism. The findings provide preliminary implications for policymakers in targeting indicators salient to the optimism index of small-business owners.
Pediatric Nurses’ Experiences in Caring for Non–English Speaking Patients and Families
Authors: Stephen Jennifer M.
Published: January 2021

Introduction:

Language barriers challenge patient- and family-centered care. Literature guiding pediatric nurses caring for patients and families with limited English proficiency in the inpatient setting is nonexistent. The purposes of this phenomenological study were to understand pediatric nurses’ experiences in caring for patients and families with limited English proficiency and to explore how nurses navigate the communication gap.

Method:

A purposive sample of 15 pediatric Registered Nurses at a large urban children’s medical center participated in face-to-face semistructured interviews. Verbatim transcribed interviews were analyzed line-by-line and categorized into themes.

Results:

Themes included personal framework of care, consequences of caring, starting off right, nurse sensing, verbal/nonverbal methods, and interpreters.

Discussion:

Nurses did not perceive differences in task-oriented care; they described compromised personal paradigms, held negative feelings, and utilized verbal/nonverbal communication methods. Future research is needed exploring patients’ and families’ perceptions regarding care by other language–speaking nurses.
Extraversion and Leadership Emergence: Differences in Virtual and Face-to-Face Teams
Authors: Wilson Jeanne M. , Fletcher Thomas D. , Pescosolido Tuck , Major Debra A.
Published: January 2021

This study addresses calls for a better understanding of how team interaction mode (e.g. virtual versus face-to-face) moderates the relationship between member attributes and emergent team processes. We use Mullen’s model of salience to explain conflicting predictions and results about the effects of extraversion on leadership emergence in virtual and face-to-face teams. Participants were randomly assigned to 27 four-person teams that met three times, engaging in an iterative decision-making task. Assessments of each member’s leadership influence were taken after each meeting, and transcripts were content-coded. Results show that interaction mode has an indirect moderating effect on the relation between extraversion and leadership emergence, fully explained by salience. As such, this study explains an important difference in patterns of leadership emergence between virtual and face-to-face teams.
Promoting Opioid Awareness Through a Union-Based Peer Training Model
Authors: Roelofs Cora , Sugerman-Brozan Jodi , Kurowski Alicia , Russell Leslie , Punnett Laura
Published: January 2021

Work factors, including physical job demands, appear to be risk factors for opioid overdoses. We collaborated with unions representing workers in high-risk occupations and offered resources to develop tailored educational interventions for their members. An ironworkers’ local, a statewide nurses’ union, and a Teamsters local union participated, at levels higher than we had anticipated. The three unions trained 285 workers, including apprentices, stewards, and those nearing retirement. Short surveys assessed pre- and post-training knowledge, attitudes, confidence in helping others, and related domains. Seventy percent of respondents reported heavy or very heavy physical demands at work, and one-half had experienced work-related pain. After training, participants reported more knowledge about opioids, less concern about stigma related to help-seeking, and more ability to provide help to a co-worker struggling with opioids. Peers with recovery experience provided a unique contribution to training. Tailored job-specific and peer-delivered educational interventions may be able to reduce the potential impact of opioids on working people.
Anthropometric Outcome of Primary Unilateral Cleft Lip Repair in Indonesia
Authors: Datusanantyo Robertus Arian , Hutagalung Magda Rosalina , Rizaliyana Sitti , Marzoeki Djohansjah
Published: January 2021

Objective:

This study aimed to measure and analyze the outcome of primary unilateral cleft lip repair.

Design:

Observational cohort study.

Setting:

Surabaya Cleft Lip and Palate (CLP) Center, a major referral center for the Eastern part of Indonesia, affiliated with a tertiary center.

Patients, Participants:

From 69 patients who met the inclusion criteria, we excluded 31 patients who were more than 2 years of age and were operated on by junior residents under supervision.

Interventions:

We performed anthropometric measurements of the patients on photographs taken before, immediately after, and a year after the surgery.

Main Outcome Measure(s):

This study measured nasal width, vertical lip height, horizontal lip length, and philtral height ratios.

Results:

While nasal width and philtral height ratios decreased significantly ( P = .000 and P = .000, respectively) reaching symmetry immediately after surgery, the horizontal lip length, and vertical lip height ratios remained unchanged ( P = .862 and P = .981, respectively). A year after surgery, the nasal width and horizontal lip length ratios increased significantly ( P = .017 and P = .006, respectively), while philtral height and vertical lip height ratios remained unchanged ( P = .927 and P = .138, respectively). There was no difference in the ratios based on the initial size and completeness of the cleft.

Conclusion:

In Surabaya CLP Center, the symmetry of nasal width, philtral height, horizontal lip length, and vertical lip height were achieved by the unilateral cleft lip repair despite the initial size and completeness of the cleft.
Is Statin Use Associated With Risk of Thyroid Diseases? Results of a Retrospective Cohort Study
Authors: Trivedi Lakshya U. , Femnou Mbuntum Laurette , Halm Ethan A. , Mansi Ishak
Published: January 2021

Background:

Given the ubiquity of statin use and prevalence of thyroid diseases, such as thyroid cancer, hyperthyroidism, and thyroiditis, understanding their association deserves further attention.

Objective:

To examine the association between statin use and thyroid cancer, thyrotoxicosis, goiter, and thyroiditis.

Methods:

Using Tricare data, 2 propensity score (PS)-matched cohorts of statin users and nonusers were formed: (1) a PS-matched general cohort (all patients aged 30-85 years) and (2) a PS-matched healthy cohort (excluded patients with cardiovascular diseases or severe comorbidities). Outcomes were thyroid cancer, thyrotoxicosis, goiter, and thyroiditis. Odds ratios (ORs) and 95% CIs of outcomes were estimated using conditional regression analysis.

Results:

Of 43 438 patients, the PS-matched general cohort matched 6342 statin users to 6342 nonusers. The OR of thyroid cancer was 0.62 (95% CI = 0.39-0.996). There was no significant difference between statin users and nonusers in risk of thyrotoxicosis (OR = 0.88; 95% CI = 0.71-1.09), goiter (OR = 0.9; 95% CI = 0.77-1.03), or thyroiditis (OR = 0.78; 95% CI = 0.53-1.15). In the PS-matched healthy cohort (3351 statin users to 3351 nonusers), there was no difference between statin users and nonusers in any outcome. Limitations of the study include its retrospective observational design and use of administrative codes in outcomes ascertainment.

Conclusion and Relevance:

This study did not demonstrate any association of statins with harmful effects on thyroid diseases, which offers assurance to clinicians and patients. Furthermore, statin use appears to be associated with a decreased risk of thyroid cancer, but more studies are needed.
DFA concepts in a concurrent engineering environment: A white goods case
Authors: Setti Paulo Henrique Palma , Canciglieri Junior Osiris , Estorilio Carla Cristina Amodio
Published: January 2021

Due to the current and highly competitive industrial scenario, the technology-oriented organizations have been making routine adjustments to the conventional IPDP, in order to seek more profitable business models. Identifying the product functions, as well as its importance - perceived by the consumer - and being able to associate this information with manufacturability and assembly aspects, is fundamental to achieve more competitive, low-cost and higher quality products. This article objective is to evaluate this method concept, applying it in an industrial project. In order to assess the method within the complete integrated product development process (IPDP), the activities related to the conceptual and preliminary phases of the project delineated this article limits. This study selected a subgroup of the white goods industry, where first the traditional models of VE were applied in the conceptual design phase. Subsequently, the classic DFA models were applied in the preliminary design phase. Thus, it was possible to apply the proposed iterative method, where the alternatives generated with the DFA were cyclically re-evaluated, function by function, in the previous stage of value analysis. With this, this study came to the method assessment, its gains and limitations. Then, the original design was compared with the solution after the proposal application, without the method used. Finally, this study verified the influence of the method on the balance between the value and the cost of each function, in addition to the direct comparison of the solution final cost with the version without the method application. Among the results, this article presents a report showing the method viability, its particularities, impacts, and limitations.
Primary Clear Cell Sarcoma of the Ileum: A Case Report With Next-Generation Sequencing Analysis
Authors: Zhu Peipei , Zhang Tingting , Bi Ke , Wu Yunjin , Chen Xue , Zhang Haoyang , Huang Dandan , Zhang Long , Zeng Yu , Yi Xianghua
Published: January 2021

As the concept of clear cell sarcoma–like tumor or malignant gastrointestinal neuroectodermal tumor (CCS-LT/MGNET) has been widely accepted, primary CCS of the gastrointestinal tract (CCS-GI) is becoming a rare entity. In this article, we describe a case of primary CCS-GI that occurred in the ileum of a 65-year-old male to further illustrate its rare occurrence. Similar to CCS of soft tissue (CCS-ST), the tumor was composed of spindled to epithelioid cells displaying fascicular, nested, or pseudopapillary arrangement. The tumor cells had large round to ovoid nuclei with vesicular chromatin and prominent nucleoli, containing eosinophilic to pale cytoplasm. In contrast to CCS-LT/MGNET, immunohistochemical study also showed variable positivity of HMB45, melan A, and MiTF besides the strong and diffuse staining of S100 protein and SOX10. Fluorescence in situ hybridization (FISH) using fusion probes identified EWSR1 and ATF1 genes rearrangement. Next-generation sequencing (NGS) analysis further revealed EWSR1 exons9/8- ATF1 exon4 and ATF1 exon3- EWSR1 exon11 fusion genes. CCS-GI and CCS-LT/MGNET possibly represent 2 related entities of the same spectrum, which differentiate along 2 different pathways.
The Neurobiology of Pathological Fatigue: New Models, New Questions
Authors: Kuppuswamy Annapoorna
Published: January 2021

The last decade has seen the emergence of new theoretical frameworks to explain pathological fatigue, a much neglected, yet highly significant symptom across a wide range of diseases. While the new models of fatigue provide new hypotheses to test, they also raise a number of questions. The primary purpose of this essay is to examine the predictions of three recently proposed models of fatigue, the overlap and differences between them, and the evidence from diseases that may lend support to the models of fatigue. I also present expansions for the sensory attenuation model of fatigue. Further questions examined here are the following: What are the neural substrates of fatigue? How can sensory attenuation, which underpins agency also explain fatigue? Are fatigue and agency related?
Meaning: A Postqualitative Inquiry That Is Not
Authors: Le Blanc Amana , Kaufmann Jodi
Published: January 2021

This article is a conversation between two qualitative researchers and many known and unknown virtuals, exploring the limitations, possibilities, and ethics of making meaning (in [post] [qualitative] research). This article. An intermingling. Meaning void. A lie. An illusion forced to the fore, meeting a blacksmith’s hammer. An illusion reified, a shard cutting deep. Meaning. It is not here. Nor is it there. It is not. Meandering through momentary instantiations to release to virtuals.
Vascular endothelial growth factor inhibitor induced hypertension: Retrospective analysis of the impact of blood pressure elevations on outcomes
Authors: Duco Marissa R , Murdock Joshua L , Reeves David J
Published: January 2021

Background

Vascular endothelial growth factor (VEGF) inhibitors are known to cause hypertension. The purpose of this study was to assess the impact of blood pressure (BP) elevations on outcomes in patients receiving VEGF inhibitors.

Methods

This retrospective chart review analyzed patients receiving treatment with VEGF inhibitors. The primary endpoint was time to progression (TTP) in those with or without significant increase in BP (increase in systolic BP greater than 20 mm Hg or greater than 10 mm Hg increase in diastolic BP). Secondary endpoints included treatment interruption, therapy discontinuation due to documented adverse effect, and time to BP elevation. Subgroup analyses were completed in those receiving bevacizumab and oral tyrosine kinase inhibitors.

Results

A total of 155 patients were included and 93 patients (60%) experienced a significant increase in BP. Median time to development of an elevated BP was 47 days. Patients with significant increases in BP had a longer median TTP compared to patients without (8.1 months vs 4.4 months, p = 0.002). No differences were present between groups in treatment interruption or discontinuation due to a documented adverse effect and outcomes were similar in those receiving bevacizumab and oral tyrosine kinase inhibitors. In the analysis of the impact of severity of BP elevations, those with severe BP elevations were more likely to have treatment interrupted but discontinuation rates were similar across groups.

Conclusion

Development of significant BP elevations may be a marker of therapeutic response to VEGF inhibitors and does not limit treatment duration, even in those with severe elevations.
Complementary and alternative medicine (CAM) in Turkish cutaneous melanoma patients: A prospective study from tertiary cancer center
Authors: Tas Faruk , Cinar Ebru , Erturk Kayhan
Published: January 2021

Background

Only a few studies assessed the prevalence and the predictors of complementary and alternative medicine (CAM) use specifically in melanoma patients. The aim of this study was to assess the extent of CAM use in Turkish melanoma patients.

Objective

To assess the extent of CAM use and to compare sociodemographic and clinical characteristics between users and non-users in melanoma patients.

Methods

One hundred melanoma patients who were seen in outpatient clinics were included in a survey using questionnaire on CAM use.

Results

Twenty-seven patients used at least one type of CAM, the majority of which were herbs (73%). Turmeric (curcumin) was the most popular herb that was used alone or in conjunction with various other herbs (41%). Living in rural areas was significantly associated with CAM use (p = 0.02). The most common reason for CAM use was intent to cure of the disease (52%). The primary source of information about CAM was a close friend or a family contact (44%). CAMs were generally used together with conventional anticancer treatment modalities (64%) and they were ingested on a regular base (72%). CAMs could easily be acquired at regular herbal stores (88%). The patients experienced almost no adverse effects with CAM use; and most cases (71%) had confidence in CAM. About half of the patients consulted with their physicians about CAM use.

Conclusion

Minority, nearly one fourth of the melanoma cases used at least one type of CAM, the majority of which were herbs and turmeric (curcumin) was the most popular agent.
Association of the Healthcare Effectiveness Data and Information Set (HEDIS) Follow-Up Care Measures and Medication Adherence Among Medicaid Insured Children with ADHD
Authors: Earla Jagadeswara Rao , Abughosh Susan , Chen Hua
Published: January 2021

Objectives:

To assess the association of HEDIS C&M phase follow-up measure with ADHD medication adherence.

Methods:

A retrospective study was conducted using Medicaid data (2014–2016) of children initiated with ADHD medication. Patients were categorized as meeting the C&M follow-up measure or not according to the HEDIS specifications. Medication adherence was measured using both Proportion of Days Covered (PDC) & Group-Based Trajectory Modeling (GBTM). The association of medication adherence with HEDIS measure was assessed using Chi-square test.

Results:

Nearly all (97%) children with PDC≥0.7 and 72% of patients following the late decliner adherence trajectory met the HEDIS C&M follow-up criteria. In contrast, none of the children with PDC<0.7 and only two following rapid and slow decliner trajectories met the criteria.

Conclusion:

ADHD medication adherence, regardless of how it was measured, clearly differentiated children with and without C&M phase follow-up, which essentially questions the implication of HEDIS C&M phase follow-up care measure.
Picturing Participation: Catalyzing Conversations About Community Engagement in HIV Community–Based Organizations
Authors: Switzer Sarah , Chan Carusone Soo , McClelland Alex , Apong Kamilah , Herelle Neil , Guta Adrian , Strike Carol , Flicker Sarah
Published: January 2021

Community engagement is considered a cornerstone of health promotion practice. Yet engagement is a fuzzy term signifying a range of practices. Health scholarship has focused primarily on individual effects of engagement. To understand the complexities of engagement, organizations must also consider relational, structural, and/or organizational factors that inform stakeholders’ subjective understandings and experiences. Community engagement processes are not neutral; they can reproduce and/or dismantle power structures, often in contradictory or unexpected ways. This article discusses diverse stakeholders’ subjective experiences and understandings of engagement within the HIV sector in Toronto, Canada. In our study, a team of community members, service providers, and academics partnered with three HIV community–based organizations to do this work. We used photovoice, a participatory and action-oriented photography method, to identify, document, and analyze participants’ understandings at respective sites. Through collaborative analysis, we identified seven themes that may catalyze conversations about engagement within organizations: reflecting on journey; honoring relationships; accessibility and support mechanisms; advocacy, peer leadership, and social justice; diversity and difference; navigating grief and loss; and nonparticipation. Having frank and transparent discussions that are grounded in stakeholders’ subjective experiences, and the sociopolitical and structural conditions of involvement, can help organizations take a more intersectional and nuanced approach to community engagement. Together, our findings can be used as a framework to support organizations in thinking more deeply and complexly about how to meaningfully, ethically, and sustainably engage communities (both individually and collectively) in HIV programming, and organizational policy change. The article concludes with questions for practice.
Myocardial Calcification and the Demise of an Infant With Surgically Treated Hypoplastic Left Heart Syndrome
Authors: Reyes Barron Cynthia , Katzman Philip J
Published: January 2021

A term female infant with hypoplastic left heart syndrome underwent Norwood palliation including aortic and pulmonary amalgamation with arch reconstruction, atrial septectomy, and right ventricle to pulmonary artery conduit. Postoperatively, she experienced hypoxemia and lactic acidosis although echocardiogram showed adequate conduit function. She was placed on veno-arterial extracorporeal membrane oxygenation (ECMO) on postoperative day two with improvement. ECMO decannulation was attempted with subsequent cardiac arrest and ultimate failure to resuscitate, eleven days after surgery. Autopsy confirmed clinical findings and evidence of surgical intervention with a patent conduit and neo-aorta. Multiple subendocardial right ventricular dystrophic calcifications involving the outflow tract were identified grossly and histologically with foci of associated myonecrosis. Myocardial calcification may lead to abnormal heart wall motion by increasing rigidity and compromising myocyte function or compromising the conduction system. In this patient, right ventricular turbulence caused by systolic and diastolic flow patterns, including mild tricuspid regurgitation, may have played a role in inducing dystrophic calcification along with surgery and ECMO dependence. Compromised myocyte function from calcifications, right ventricular hypertrophy, lung immaturity, and persistent pulmonary hypertension were likely sources of cardiac strain leading to the patient’s demise. This case represents a previously unreported complication of hypoplastic left heart syndrome treatment.
Differentiating Biliary Atresia From Idiopathic Neonatal Hepatitis: A Novel Keratin 7 Based Mathematical Approach on Liver Biopsies
Authors: Misra Sunayana , Majumdar Kaushik , Sakhuja Puja , Jain Priyanka , Singh Lavleen , Kumar Praveen , Dubey AP
Published: January 2021

Background and Aims

Differentiating biliary atresia (BA) from idiopathic neonatal hepatitis (INH) is vital in routine pediatric practice. However, on liver biopsy, few cases offer a diagnostic challenge to discriminate these entities with certainty. Bile ductular reaction (DR), intermediate hepatobiliary cells (IHBC) and extra-portal ductules (EPD) indicate progenitor cell activation, as a response to various hepatic insults. The present study aims to quantify DR, IHBC and EPD by Keratin 7 (CK7) immunohistochemistry (IHC) in BA and INH and to devise a mathematical approach to better differentiate the two, especially in histologically equivocal cases.

Methods

A total of 98 cases were categorized on biopsy as BA, INH or equivocal histology, favoring BA or INH. CK7 DR mean, IHBC mean and EPD mean values were compared between BA and INH. A formula was derived to help distinguish these two entities, the cut-off value, sensitivity and specificity of which were determined by receiver operating characteristic (ROC) curve. This formula was applied and validated on histologically equivocal cases.

Results

Univariate logistic regression revealed significant difference between BA and INH with respect to CK7 DR and CK7 EPD mean (p < 0.001 in both); however, CK7 IHBC mean was not significant (p = 0.08). On multivariate logistic regression, only CK7 DR had significant impact on diagnosis (p < 0.001). A formula: (CK7 DR) 2  + (CK7 EPD)/(CK7 IHBC) was derived to help distinguish BA from INH. Cut off value of 10.5 and above, determined by ROC curve, favored a diagnosis of BA (sensitivity= 93.4%, specificity= 94.6%). Histologically equivocal and discrepant cases could be correctly categorized using this formula.

Conclusions

Formula using CK7 IHC parameters may aid pathologists better distinguish BA from INH, especially in histologically equivocal cases.
Biphasic Postnatal Umbilical Cord Shortening
Authors: Manci Elizabeth A , Alvarez Sejal Shah , McClellan Steven B , Campbell Pamela Moore , Dasaraju Sandhya , Winkler Carey L , Shah Arvind K
Published: January 2021

Introduction

Variations in postnatal length of refrigerated, unfixed umbilical cords were studied over time to elucidate natural changes and times of stability.

Methods

Length was measured in 132 cords following severance, repeated at varying timed intervals and studied by analysis of variance and regression analysis.

Results

Data show immediate rapid initial phase shortening (mean 4.2+/-3.9 cm SD); an interval of lengthening; stable length at hours 3-4 following severance, a slower second phase shortening (mean 1.5+/-0.7 cm SD) beginning at 5 hours and peaking at 12 hours; and gradual lengthening to stable length after 23 hours. Overall, there was a significant net mean decrease of 3.49+/-2.29 cm SD. Shortening was greatest for intact long cord segments (p=0.0001), as much as 11 cm. Two highly significant models for predicting umbilical cord length at delivery (OL) were determined using the post-delivery lengths (Length) measured at different times following delivery (Hours), as follows: At ≤ 3 hours following delivery: OL=1.02xLength cm+1.11xHours At >3 hours following delivery: OL=1.07xLength+0.44xHours-0.01x(Hours)2

Conclusion

Cord lengths stabilized between hours 3-4 and after 23 hours following severance. Phase one shortening resembles vasoconstriction; phase two resembles rigor mortis. The models allow prediction of the original umbilical cord length at delivery, regardless of the time of measurement.
Lessons from the Departed: A Planned Behavior Approach to Understand Travelers’ Actual Physician-Assisted Suicide Behavior
Authors: Goh Edmund , Wen Jun , Yu Chung-En
Published: January 2021

Traveling to die in another country is a morbid, but pertinent, topic that remains underresearched in tourism. This project aims to address this research gap by examining the underlying motivations of actual individual travelers who have travelled to Switzerland as their final life destination to commit physician-assisted suicide (PAS). Using documentaries from major news channels, content analysis was conducted to systematically examine interviews conducted with actual PAS travelers ( n = 26) before they ended their life legally through PAS in Switzerland. An extension of the theory of planned behavior with anticipated guilt was commissioned as the theoretical lens to investigate the actual behavior of travelers who have committed PAS. A total of three key attitudes, three social groups, and four perceived constraints were identified. Results identified putting an end to suffering and to die with dignity as key attitudinal items influencing PAS behavior. The reference groups of family and relatives emerged as key salient normative groups. With regard to perceived difficulties, lack of access to facilities and high financial costs were key constraints in the decision to commit PAS. A key contribution of this research found evidence of anticipated guilt as an additional theory of planned behavior variable in actual PAS behavior.
Why Not Travel to Malaysia? Variations in Inbound Tourists’ Perceptions toward Halal-Friendly Destination Attributes
Authors: Azali Mohamed , Kamal Basha Norazlyn , Chang Yee-Shan , Lim Xin-Jean , Cheah Jun-Hwa
Published: January 2021

The importance of halal tourism has prompted countries and business operators to place more emphasis on this lucrative sector. The purpose of this study is to investigate the effects of halal-friendly destination attributes on inbound tourists’ behavioral intention in the context of Malaysia. Furthermore, a comparative analysis was conducted to investigate the similarities and differences between Chinese and Indonesian Muslim tourists. A total of 666 observations were collected using surveys and the data sets were analyzed via partial least squares structural equation modeling. The empirical results show that both countries have indicated variations in terms of preferences for social environment, services, and facilities. We contribute to the knowledge on the constitutive attributes of the halal-friendly destination, while providing theoretical explanations for the differences among Muslim tourists in the Asian markets. Finally, directions for future research are proposed.
Comparison of the effect of isopropyl alcohol and chlorhexidine solution rinses on body temperature of female cats undergoing sterilization surgery
Authors: Kreisler Rachael E , Douglas Michelle L , Harder Karissa N
Published: January 2021

Objectives

Isopropyl alcohol 70% as a rinse agent for chlorhexidine scrub has been shown to decrease body temperature more quickly than chlorhexidine solution in mice prepared aseptically prior to surgery. For this reason, some high-quality, high-volume (HQHV) surgical sterilization clinics use chlorhexidine solution rather than alcohol. We sought to determine if temperature upon entry to recovery, heat loss per kg and rate of temperature decline during surgery were different between cats rinsed with chlorhexidine solution vs 70% isopropyl alcohol following surgical scrub, and if there were significant predictors of recovery temperature.

Methods

Female cats admitted for surgery to trap–neuter–return (TNR) clinics at a veterinary college were assigned chlorhexidine solution or alcohol rinse agents via block randomization. Veterinary students and veterinarians performed spay surgeries using HQHV techniques. In recovery, heat support and reversal agents were available for cats with a low body temperature or that were slow to recover. Baseline values, outcome variables and duration of each stage (preparation, surgery, recovery) were assessed using Wilcoxon rank-sum and t-tests. Recovery temperature was evaluated using random effects multiple linear regression.

Results

The recovery temperature, heat loss per kg, heat loss per min, need for reversal and need for heat support in recovery were not significantly different between rinse groups. Weight <2.3 kg, body condition score <4, duration of surgery and postinduction temperature were predictors of recovery temperature. The rate of heat loss in the first 30 mins of surgery was slightly lower for cats in the alcohol rinse group and the recovery duration was shorter for cats weighing less <2.3 kg in the alcohol rinse group.

Conclusions and relevance

There were no clinically meaningful differences in body temperature between chlorhexidine and alcohol rinses. Both chlorhexidine solution and isopropyl alcohol 70% are appropriate rinse agents for aseptic preparation of feline spay surgeries.
Surgical management of consecutive exotropia: Long-term outcomes
Authors: Ceylan Osman Melih , Oğuz Yeşim Gedik , Ayyıldız Önder , Köksal Serkan , Yumuşak Erhan , Mutlu Fatih Mehmet
Published: January 2021

Purpose:

To compare lateral rectus recession (LRc) and medial rectus advancement (MRadv) for correction of consecutive exotropia (CXT).

Methods:

Of the 43 exotropic patients 20 of them underwent LRc (group 1) and 23 of them underwent MRadv (group 2). Postoperative exodrift, strabismic angle, dose effect relationship were compared with minimum 2 years follow‑up.

Results:

An average dose-effect in group 2 is higher than group 1 in the early postoperative period, however there was no significant difference at the second year follow-up (p=0,109). An average exodrift after 2 year follow-up was 6,6±7,12 PD in group 1, and 8,13±7,45 PD in group 2. Postoperative overall success rate was 50% in group 1 and 65% in group 2 at the last follow-up. The success rates were not significantly different between the groups (chi-square, p =0.31).

Conclusion:

Although there was no statistically significant difference at the last follow-up, better results were obtained with MRadv than LRc in the treatment of CXT.
Diagnosis of optic nerve head drusen using enhanced depth imaging optical coherence tomography
Authors: Gili Pablo , Kim-Yeon Naon , de Manuel-Triantafilo Sofía , Modamio-Gardeta Laura , Leal-González Mercedes , Yangüela Julio
Published: January 2021

Purpose:

To evaluate the efficacy of Enhanced Depth Imaging Optical Coherence Tomography (EDI-OCT) in differentiating between optic nerve head drusen (ONHD) and optic disc oedema (ODE).

Methods:

This was a cross-sectional study of 140 patients: 83 patients with ONHD (49 hidden and 34 visible), 20 patients with pseudopapilloedema (without drusen), and 37 patients with ODE. EDI-OCT of the optic nerve was performed, selecting one high-resolution line from the HD 5-line raster protocol. Two observers blindly evaluated the presence of a hyporeflective core surrounded by a hyperreflective margin or border. The sensitivity, specificity, predictive values and posttest probability were evaluated as well as the inter-observer agreement (k).

Results:

EDI-OCT demonstrated a sensitivity of 92% (95% CI: 83%–96%), a specificity of 96% (95% CI: 87%–99%), with a positive predictive value of 97% and a negative predictive value of 89%. The inter-observer agreement was as remarkable as k = 0.8985 (95% CI 0.8252–0.9718). A positive EDI OCT increases the posttest probability to 97% (95% CI: 91%–99%); when negative, the posttest probability is reduced to 12% (95% CI: 6%–21%).

Conclusion:

EDI-OCT allowed for differentiation between ONHD and ODE with high sensitivity and specificity.