bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring expanded interdisciplinary roles in goals of care conversations in a national goals of care initiative: A qualitative approach
Authors: Ma Jessica E , Haverfield Marie , Lorenz Karl A , Bekelman David B , Brown-Johnson Cati , Lo Natalie , Foglia Mary Beth , Lowery Jill S , Walling Anne M , Giannitrapani Karleen F
Published: June 2021

Background:

The United States Veterans Health Administration National Center for Ethics in Health Care implemented the Life-Sustaining Treatment Decisions Initiative throughout the Veterans Health Administration health care system in 2017. This policy encourages goals of care conversations, referring to conversations about patient’s treatment and end-of-life wishes for life-sustaining treatments, among Veterans with serious illnesses. A key component of the initiative is expanding interdisciplinary provider roles in having goals of care conversations.

Aim:

Use organizational role theory to explore medical center experiences with expanding interdisciplinary roles in the implementation of a goals of care initiative.

Design:

A qualitative thematic analysis of semi-structured interviews.

Setting/participants:

Initial participants were recruited using purposive sampling of local medical center champions. Snowball sampling identified additional participants. Participants included thirty-one interdisciplinary providers from 12 geographically diverse initiative pilot and spread medical centers.

Results:

Five themes were identified. Expanding provider roles in goals of care conversations (1) involves organizational culture change; (2) is influenced by medical center leadership; (3) is supported by provider role readiness; (4) benefits from cross-disciplinary role agreement; and (5) can “overwhelm” providers.

Conclusions:

Organizational role theory is a helpful framework for exploring interdisciplinary roles in a goals of care initiative. Support and recognition of provider role expansion in goals of care conversations was important for the adoption of a goals of care initiative. Actionable strategies, including multi-level leadership support and the use of interdisciplinary champions, facilitate role change and have potential to strengthen uptake of a goals of care initiative.
Evaluating the Association Between Artificial Sweetener Intake and Indicators of Stress and Anxiety
Authors: Miller Benjamin , Branscum Paul
Published: June 2021

The purpose of this study was to evaluate the association between non-nutritive sweetener (NNS) consumption and stress and anxiety, among a sample of college students. Two-hundred and twenty-seven students from a large mid-western university participated in this cross-sectional study. Students completed an online survey that evaluated NNS using a validated food frequency questionnaire. Stress and anxiety were evaluated using previously validated instruments. Most students reported very low/low/average concern for stress (63.9%), and had low/moderate anxiety (82.3%). Participants experiencing high and very high levels of stress had significantly higher NNS consumption compared to those with a very low and low risk, and concern for stress ( p < .046; d = 0.28). There was no difference however for NNS intake and anxiety. Reduction of artificial sweetener intake may be associated with stress levels among college students. However, more research is needed to examine any causal relationship between artificial sweetener intake and stress.
The Effect of Fantasy Context on Moral Action and Judgment
Authors: Ruedinger Brian , Barnes Jennifer
Published: June 2021

Research suggests individuals import real-world facts into fictional worlds based on the type of fact and fictional context. We examined the importation of real-world morality across fictional contexts. Undergraduate (Study 1) and MTurk (Study 2) participants were randomly assigned to read either a realistic or matching fantastical interactive narrative. At seven junctions, participants were presented with a choice between behaving morally and behaving immorally to advance their goals. In Study 3, an MTurk sample judged the actions of a character who behaved immorally. For Study 1, a gender by condition interaction was found, with males electing more immoral actions in the fantasy condition. For Study 2, no such effect was found. Nonetheless, in Study 3, participants judged immoral actions in the realistic condition as more immoral compared to the fantasy context. Across all studies, transportation predicted choosing fewer immoral actions and judging immoral actions more harshly.
Chemo-Rheological Characterization of the Effect of Iran Rock Asphalt on the Performance of Waste Bio-Oil Modified Asphalts
Authors: Ma Jianmin , Sun Guoqiang , Sun Daquan , Hu Mingjun , Lu Tong
Published: June 2021

This study aims to investigate the effect of Iran rock asphalt (IRA) on the rheological performance of waste bio-oil modified asphalt (WBMA). Three kinds of WBMA with bio-oil origins including soybean oil residue, castor oil residue, and waste cooking oil residue were blended with different dosages of IRA. The high-temperature performance of the three blended asphalt binders was evaluated using the temperature sweep test and multiple stress creep recovery (MSCR) test. The effect of IRA on the fatigue performance and low-temperature cracking resistance of the three WBMAs was evaluated using the linear amplitude sweep (LAS) test and the bending beam rheometer (BBR) test. A gel permeation chromatography (GPC) test was conducted to further understand the contribution of IRA to the overall rheological performance of different WBMAs. Results indicated that the high-temperature performance of the three WBMAs was enhanced significantly with the increase of IRA content. The predicted fatigue life from the LAS test showed that the incorporation of IRA extended the fatigue life of the three WBMAs at a lower strain level, while this effect was not profound at a higher strain level. Results from BBR test showed that IRA may increase the risk of low-temperature cracking and that the dosage of IRA should be limited to fulfill the requirements of the low-temperature performance. The GPC analysis revealed that the enhanced high-temperature performance and reduced low-temperature cracking resistance of WBMAs modified with IRA was mainly a result of the increased asphaltene concentration.
Peak and Per-Step Tibial Bone Stress During Walking and Running in Female and Male Recreational Runners
Authors: Meardon Stacey A. , Derrick Timothy R. , Willson John D. , Baggaley Michael , Steinbaker C. Ryan , Marshall Margaret , Willy Richard W.
Published: June 2021

Background:

Athletes, especially female athletes, experience high rates of tibial bone stress injuries (BSIs). Knowledge of tibial loads during walking and running is needed to understand injury mechanisms and design safe running progression programs.

Purpose:

To examine tibial loads as a function of gait speed in male and female runners.

Study Design:

Controlled laboratory study.

Methods:

Kinematic and kinetic data were collected on 40 recreational runners (20 female, 20 male) during 4 instrumented gait speed conditions on a treadmill (walk, preferred run, slow run, fast run). Musculoskeletal modeling, using participant-specific magnetic resonance imaging and motion data, was used to estimate tibial stress. Peak tibial stress and stress-time impulse were analyzed using 2-factor multivariate analyses of variance (speed*sex) and post hoc comparisons (α = .05). Bone geometry and tibial forces and moments were examined.

Results:

Peak compression was influenced by speed ( P < .001); increasing speed generally increased tibial compression in both sexes. Women displayed greater increases in peak tension ( P = .001) and shear ( P < .001) than men when transitioning from walking to running. Further, women displayed greater peak tibial stress overall ( P < .001). Compressive and tensile stress-time impulse varied by speed ( P < .001) and sex ( P = .006); impulse was lower during running than walking and greater in women. A shear stress-time impulse interaction ( P < .001) indicated that women displayed greater impulse relative to men when changing from a walk to a run. Compared with men, women displayed smaller tibiae ( P < .001) and disproportionately lower tibial forces ( P≤ .001-.035).

Conclusion:

Peak tibial stress increased with gait speed, with a 2-fold increase in running relative to walking. Women displayed greater tibial stress than men and greater increases in stress when shifting from walking to running. Sex differences appear to be the result of smaller bone geometry in women and tibial forces that were not proportionately lower, given the womens’ smaller stature and lower mass relative to men.

Clinical Relevance:

These results may inform interventions to regulate running-related training loads and highlight a need to increase bone strength in women. Lower relative bone strength in women may contribute to a sex bias in tibial BSIs, and female runners may benefit from a slower progression when initiating a running program.
Defining Critical Glenoid Bone Loss in Posterior Shoulder Capsulolabral Repair
Authors: Arner Justin W. , Ruzbarsky Joseph J. , Midtgaard Kaare , Peebles Liam , Bradley James P. , Provencher Matthew T.
Published: June 2021

Background:

Although critical bone loss for anterior instability is well defined, a clinically significant threshold of posterior bone loss has not been elucidated.

Hypothesis:

Patients with failed arthroscopic posterior shoulder capsulolabral repair will have increased posterior glenoid bone loss with a defined critical threshold.

Study Design:

Case control study; Level of evidence, 3.

Methods:

Athletes older than 18 years with unidirectional posterior instability treated with arthroscopic repair were evaluated at 2-year minimum follow-up. Failure was defined as revision surgery, American Shoulder and Elbow Surgeons (ASES) score of <60, or subjective stability score of >5. Magnetic resonance imaging (MRI) measurements from 19 patients with failed arthroscopic posterior shoulder capsulolabral repair were compared with 56 patients whose surgery was successful. MRI measures included glenoid version, labral version, glenoid width, labral width, percentage bone loss using the circle technique, labral height, percent subluxation, and recently described measures of defect slope, bone loss angle, and defect length. The P value threshold was set at .05, and a multivariable logistic regression analysis was performed for evaluation of risk of surgical failure.

Results:

Smaller glenoid width and greater percentage glenoid bone loss (25.5 ± 0.68 mm vs 28.8 ± 0.47 mm; P < .001; 6.8% ± 0.64% vs 4.6% ± 0.43%; P = .008) were seen in those patients with failed surgery. There was no difference in glenoid version or other measurements between the failures and nonfailures. A cutoff of 11% glenoid bone loss resulted in a 10.4 times statistically higher surgical failure rate, while a 15% bone loss resulted in a 24.4 times statistically higher failure rate. Six patients had >11% bone loss (range, 11.1 to 19.3) and 1 patient had >15% bone loss.

Conclusion:

Risk factors for failure of arthroscopic posterior shoulder capsulolabral repair include smaller glenoid bone width and greater percentage of glenoid bone loss. A threshold of 11% posterior glenoid bone loss implicated a 10 times higher surgical failure rate, while a threshold of 15% led to a 25 times higher surgical failure rate. Surgical failure of posterior capsulolabral repair, however, is relatively rare as it is an overall successful intervention.
The Side Hustle Safety Net: Precarious Workers and Gig Work during COVID-19
Authors: Ravenelle Alexandrea J. , Kowalski Ken Cai , Janko Erica
Published: June 2021

While social distancing measures are essential in limiting the impact of a pandemic, such measures are often less feasible for low-income groups such as precarious workers who continue to travel on public transit and are less able to practice social distancing measures. In this paper, based on in-depth remote interviews conducted from April 2020 through June 2020, with more than 130 gig and precarious workers in New York City, we find that precarious workers experience three main hurdles in regard to accessing unemployment assistance that can be broadly categorized as knowledge, sociological, and temporal/financial barriers. Drawing on worker interview responses, we have named these responses: (1) Didn’t Know, (2) Didn’t Want, and (3) Can’t Wait. These challenges have led workers to turn to gig and precarious work, further highlighting the inequities of the pandemic. As a result, for some workers, so-called “side hustles” have become their primary social safety net.
Cobalt-related interstitial lung disease or hard metal lung disease: A case series of Chinese workers
Authors: Du Xuqin , Liu Jie , Wang Yiran , Jin Mulan , Ye Qiao
Published: June 2021

Hard metal lung disease (HMLD) is rarely diagnosed and is caused by the occupational inhalation of hard metal dust, mainly cobalt. The diagnosis of HMLD is based on a thorough occupational dust exposure combined with clinical–radiological–histological findings. We present a series of four Chinese workers who had occupational exposure to cobalt acid lithium or cobalt and tungsten dust. Four patients all complained of intermittent cough, chest tightness, or shortness of breath on exertion. High-resolution computed tomography scans presented bilateral ground-glass attenuation, consolidations, and/or reticular opacities with diffuse small nodules. Histologic findings showed that interstitial inflammation and fibrotic lesions distributed peribronchioles. The infiltrations by macrophages as well as visible multinucleated giant cells indicated giant cell interstitial pneumonia (GIP). Cobalt was detectable in the lung tissues of two patients measured by inductively-coupled plasma mass spectrometry. The first patient was diagnosed with cobalt-related interstitial lung disease (ILD), while the others were HMLD. GIP is the classic pathology of cobalt-related ILD or HMLD. One of the patients showed spontaneous remission after the cessation of exposure, while the other three recovered within 6–32 weeks after avoiding occupational exposure and using corticosteroids. At follow-up, all four patients showed no recurrence. A multidisciplinary diagnostic panel including occupational cobalt exposure evaluation is beneficial to recognize cobalt-related ILD or HMLD and to indicate the necessity of prevention.
Choice and Trade-offs: Parent Decision Making for Neurotechnologies for Pediatric Drug-Resistant Epilepsy
Authors: Hrincu Viorica , McDonald Patrick J. , Connolly Mary B. , Harrison Mark J. , Ibrahim George M. , Naftel Robert P. , Chiong Winston , Alam Armaghan , Ribary Urs , Illes Judy
Published: June 2021

This qualitative study investigated factors that guide caregiver decision making and ethical trade-offs for advanced neurotechnologies used to treat children with drug-resistant epilepsy. Caregivers with affected children were recruited to semi-structured focus groups or interviews at one of 4 major epilepsy centers in Eastern and Western Canada and the USA (n = 22). Discussions were transcribed and qualitative analytic methods applied to examine values and priorities (eg, risks, benefits, adherence, invasiveness, reversibility) of caregivers pertaining to novel technologies to treat drug-resistant epilepsy. Discussions revealed 3 major thematic branches for decision making: (1) features of the intervention—risks and benefits, with an emphasis on an aversion to perceived invasiveness; (2) decision drivers—trust in the clinical team, treatment costs; and (3) quality of available information about neurotechnological options. Overall, caregivers’ definition of treatment success is more expansive than seizure freedom. The full involvement of their values and priorities must be considered in the decision-making process.
Critical Care Utilization and Outcomes of Interhospital Medical Transfers at Lower Risk of Death
Authors: Baig Saqib H. , Gorth Deborah J. , Yoo Erika J.
Published: June 2021

Purpose:

To evaluate utilization and mortality outcomes of interhospital transferred critically-ill medical patients with lower predicted risk of hospital mortality.

Materials & Methods:

Multisite retrospective cohort analysis of patients with Acute Physiology and Chronic Health Evaluation (APACHE) IV-a predicted mortality of ≤20% from 335 ICUs in 208 hospitals in the Philips eICU database between 2014-2015. Differences in length-of-stay (LOS) and mortality between transferred and local patients were evaluated using negative binomial logistic regression and logistic regression, respectively. Stratified analyses were conducted for subgroups of predicted mortality: 0%-5%, 6%-10%, 11%-15%, and 16%-20%.

Results:

Transfers had a higher risk of longer ICU and hospital LOS across all risk strata (IRR 1.12; 95% CI 1.09-1.16, P < 0.001 and IRR 1.11; 95% CI 1.07-1.14, P < 0.001 respectively). Mortality was higher among transfers, largely driven by the 6%-10% mortality risk strata (OR 1.30; 95% CI 1.09-1.54, P = 0.003).

Conclusions:

Interhospital transfer of critically-ill medical patients with lower illness severity is associated with higher ICU and hospital utilization and increased mortality. Better understanding of factors driving patient selection for and characteristics of interhospital transfer for this population will have an impact on ICU resource utilization, care efficiency, and hospital quality.
Effect of hydroxyapatite/alumina composite coatings using HVOF on immersion behavior of NiTi alloys
Authors: Widantha Komang W , Basuki Eddy A , Martides Erie , Prawara Budi
Published: June 2021

Hydroxyapatite (HA) coatings have been widely used to improve biocompatibility of metal alloys. This paper discusses the effect of hydroxyapatite (HA) and HA/alumina coated NiTi on their corrosion and dissolution behavior in Phosphate Buffer Saline (PBS) and Ringer’s lactate solutions. The HA was synthesized from biogenic method and used as initial powder in High-Velocity Oxygen Fuel (HVOF) spray technique for the deposition of two coating types, fully HA and HA + 15 wt.% alumina composite coating. The as-synthesized HA had irregular porous structure with relatively low Ca/P ratio of 1.52. Tafel polarization curves obtained from electrochemical test had showed that both coatings increased the corrosion resistance of the NiTi substrates significantly. The ICP-MS analysis results that indicated a low nickel dissolved in both solutions after immersion in 21 days had supported these findings. The nickel levels in the solutions from all samples, either bared substrate or coated samples, in fact below the maximum limit for allergies of the human body. Immersion testing showed the stability of HA and HA/alumina layers as a barrier which maintains its morphology in PBS solution but slightly changed in Ringers.
Re-enchanting Modernity in the East and West: Comparative Perspectives on the Legacy of 1968. An Author Meets Her Reviewers: A Symposium
Authors: Andělová Kristina , Bracewell Wendy , Gross Irena Grudzińska , Jasiewicz Krzysztof , Ost David , Witoszek Nina
Published: June 2021

This symposium offers EEPS audience insights to the process of peer review to which manuscripts submitted to the journal are subjected. It is composed of the original paper (titled “Re-enchanting Modernity in the East and West: Comparative Perspectives on the Legacy of 1968”), reviews and additional comments by the three reviewers, and the author’s response. It illustrates the variety of criteria typically used by reviewers – and editors – in their assessment of submitted research papers and essays, as well as the options available to their authors in response. The symposium is also a contribution to the ongoing debates on the topic of the manuscript in question: the legacies of the tumultuous year 1968 and the contributions of the generation defined by those events to the intellectual, political, and other dimensions of public affairs in the East and the West.
COVID-19 Experiences and Social Distancing: Insights From the Theory of Planned Behavior
Authors: Frounfelker Rochelle L. , Santavicca Tara , Li Zhi Yin , Miconi Diana , Venkatesh Vivek , Rousseau Cecile
Published: June 2021

Purpose:

The objective of this study is to identify the relationship between COVID-19 experiences, perceived COVID-19 behavioral control, social norms and attitudes, and future intention to follow social distancing guidelines.

Design:

This is a cross-sectional study.

Setting:

Participants responded to an on-line survey in June 2020.

Subjects:

The study included 3,183 residents within Quebec, Canada aged 18 and over.

Measures:

Measures include perceived COVID-19 related discrimination, fear of COVID-19 infection, prior exposure to COVID-19, and prior social distancing behavior. Participants self-reported attitudes, perceived behavioral control, and perceived norms related to social distancing. Finally, we measured social distancing behavioral intention.

Analysis:

We evaluated a theory of planned behavior (TPB) measurement model of social distancing using confirmatory factor analysis (CFA). The association between COVID-19 perceived discrimination, fear of infection, previous social distancing behavior, exposure to COVID-19, TPB constructs and behavioral intentions to social distance were estimated using SEM path analysis.

Results:

TPB constructs were positively associated with intention to follow social distancing guidelines. Fear of COVID-19 infection and prior social distancing behavior were positively associated with behavioral intentions. In contrast, perceived discrimination was negatively associated with the outcome. Associations between fear of COVID-19, perceived COVID-19 discrimination and behavioral intentions were partially mediated by constructs of TPB.

Conclusions:

COVID-19 prevention efforts designed to emphasize positive attitudes, perceived control, and social norms around social distancing should carefully balance campaigns that heighten fear of infection along with anti- discrimination messaging.
Investigation of laminar separation bubble over a supercritical airfoil in an incompressible flow
Authors: Tatar Massoud , Masdari Mehran , Tahani Mojtaba
Published: June 2021

Supercritical airfoils have an unknown behavior at incompressible flow regime and Reynolds numbers lower than those related to their design point at transonic condition. In this work, boundary layer transition is studied over a supercritical airfoil by means of hot-film and pressure measurements completed with numerical simulations. The experiments are performed at chord-based Reynolds number of [Formula: see text]and Mach number of [Formula: see text] at different angles of attack. Hot-film measurement over the upper surface of the supercritical airfoil is carried out and the transition points are computed using the standard deviation of the signals. The upper surface pressure is also recorded and a peak in its second derivative is presented as the transition point generated by the laminar separation bubble mechanism. Moreover, an appropriate time-frequency analysis is applied to the hot-film signals to get an insight into the spectral content and development of the transitional boundary layer structures. On the other hand, two numerical codes are employed and the transition points obtained from numerical simulations are compared with the experimental outcomes. Results express a rapid change of the bubble position over the upper surface, as the angle of attack is increased to the value of [Formula: see text]. Laminar separation bubble is observed in the surface pressure distribution data and is well identified using its second derivative along the streamwise direction. The spectral characteristics of the boundary layer are satisfactorily explored including the streamwise fluctuations within the laminar flow, intermittent behavior of the transitional zone and the wide range of the spectrum in turbulent flow, thanks to the time-frequency analysis. A promising agreement is observed between the transition points computed by both the numerical and experimental studies and confirms the accuracy of findings achieved by the second derivative of surface pressure data, hot-film measurements and the reliability of the employed numerical transition models for optimization studies.
Investigation on trim control of semi-planing amphibious cargo truck using experimental and numerical approaches
Authors: Sun Chengliang , Xu Xiaojun , Zou Tengan
Published: June 2021

Speed on water is a key indicator of amphibious vehicles. However, due to the inherent non-streamlined configuration, when reaching a certain velocity, the resistance acting on the vehicle hull is so large and the maximum speed on water is hard to be further enhanced. Moreover, the trim gets so larger that leads the stern submerged into water when speed up. In order to solve this problem of a semi-planing amphibious cargo truck, this paper proposed a method by installing interceptors, hydrofoils, and combination of them on the stern. Experimental tests and numerical studies were performed respectively, and the numerical results were in good agreement with experiment. In what continues, the effect of interceptors, hydrofoils, and combination of them on trim and resistance was investigated. The results showed that the interceptor had a better effect than hydrofoil when height is not so big, but the effect got more and more powerful with interceptor height increasing, finally lead to an excessive trim control. Combination of interceptor with hydrofoil in suitable size were beneficial to trim control and resistance reduction.
Full coverage cutting path planning of robotized roadheader to improve cutting stability of the coal lane cross-section containing gangue
Authors: Zhang Deyi , Liu Songyong , Jia Xinqing , Cui Yuming , Yao Jian
Published: June 2021

The purpose of this work is to improve the cutting stability of robotized roadheader through the full coverage cutting path planning of the coal lane cross-section containing gangue. Cutting gangue will bring serious pick wear and severe vibration, which will reduce the service life of robotized roadheader. Therefore, the strategy that avoiding the gangue and cutting the remaining coal-rock was recommended. Firstly, the environment grid map of the cross-section containing gangue was established and the grid attribute was assigned. To describe the arbitrary position of gangue, a random generation method was developed. On this basis, the combination of biologically inspired neural network (BINN) and floating template method was proposed to overcome the shortcomings of traditional BINN and the full coverage cutting path planning simulation was carried out. The simulation shows a better result that the average repetition rate is approximately 10% under the condition that the cutting coverage rate is more than 95%. Finally, the cutting experiment of the coal-rock sample containing gangue on the robotized roadheader cutting platform was performed. Based on the infrared thermography and cutting signal obtained by the previous round cutting, the cutting path of the second round was planned and the cutting experiment was conducted. The experiment results show that the cutting temperature rise and the cutting vibration of the second round cutting can be effectively reduced by approximately 60% and 90%, which demonstrated that the cutting stability of the cross-section containing gangue can be effectively improved by the cutting path planning strategy of avoiding gangue.
Driving Employee Engagement Through Five Personality Traits: An Exploratory Study
Authors: Ansari Jamal Abdul Nasir
Published: June 2021

An attempt has been tried to explore the personality factors in predicting employee engagement among the middle-level employees in the IT industry. Based on an empirical investigation of 383 middle-level employees working in IT firms, the researcher cognizes their perception of various personality-related factors extraversion, agreeableness, conscientiousness, neuroticism, and openness to experience. The present study was exploratory in nature. A variance-based structural equation model (SEM) approach was adopted for the measurement of the model. The study confirmed that personality-related factors extraversion, conscientiousness neuroticism, and openness to experience significantly related to employee engagement. In addition to this extraversion, conscientiousness, neuroticism, openness to experience significantly predicted employee engagement, contrary, the insignificant effect was seen of agreeableness on employee engagement. Grounded to this study, it is strongly recommended that individual possess the extraversion, neuroticism, openness to experience, and conscientiousness qualities seen to be more engaged in their job while agreeableness person is seen to be less engaged. The corporate entity herein suggested that to keep the talented and valuable employees, must strategically think about these factors. To the best of my belief, this is the first and foremost article that address the personality-related factors in predicting employee engagement in the Indian context.
Study Abroad and Engagement at the Local and Global Levels: The Stories Behind the Numbers
Authors: Jon Jae-Eun , Fry Gerald W.
Published: June 2021

In this study, we address the question of whether and how the internationalization of higher education, particularly its study abroad aspect, has contributed to the common good. Much of the past discussion on study abroad impact has been largely concentrated on outcomes at the personal level. Using qualitative data from the Study Abroad for Global Engagement project, this study analyzes how former study abroad participants contributed to the global common good at the levels of local, glocal, and global communities. The findings show that many chose to practice global engagement, such as civic engagement, philanthropic activities, social entrepreneurship, and voluntary simplicity, for the common good, as the result of study abroad. This article concludes with discussion of implications for research, theory, policy, and practice.
Evaluation of 1,2-O-dilauryl-rac-glycero glutaric acid-(6′-methylresorufin) ester (DGGR) and 1,2-diglyceride lipase assays in dogs with naturally occurring hypercortisolism
Authors: Linari Guido , Dondi Francesco , Segatore Sofia , Vasylyeva Kateryna , Linta Nikolina , Pietra Marco , Leal Rodolfo O. , Fracassi Federico
Published: June 2021

1,2-O-dilauryl-rac-glycero glutaric acid-(6′-methylresorufin) ester (DGGR) lipase activity has been proposed as a faster and less expensive test used in the diagnosis of acute pancreatitis (AP) compared to canine pancreatic lipase immunoreactivity (cPLI), which is considered the most sensitive and specific serum test available for dogs. Elevations in lipase activity have been observed in dogs with naturally occurring hypercortisolism (HC) and in those treated with exogenous steroids, which complicates the diagnosis of AP in dogs with HC. We compared lipase activity measured by DGGR and 1,2-diglyceride (1,2-DiG) assays in 22 dogs with HC, 22 with AP, and 22 healthy dogs. The dogs with HC had no clinical signs or ultrasonographic findings consistent with AP. DGGR lipase activity was elevated in 64% and 73% of the dogs with HC and AP, respectively, and in 18% of healthy dogs. 1,2-DiG lipase activity was high in 23% and 36% of the dogs with HC and AP, respectively, and in 5% of the healthy dogs. Both DGGR and 1,2-DiG lipase activities were significantly different between the healthy dogs and the other 2 groups, whereas no differences were detected between the dogs with HC and those with AP. Our results support a lack of specificity for both DGGR and 1,2-DiG lipase activity assays in aiding the diagnosis of AP in dogs with HC.
Alimentary squamous cell carcinoma in psittacines: 12 cases and review of the literature
Authors: Gonzalez-Astudillo Viviana , Mete Aslı , Navarro Mauricio A. , Uzal Francisco A. , Asin Javier
Published: June 2021

Squamous cell carcinoma (SCC), which is a neoplasm that usually arises from the integument, is reported uncommonly in pet birds. Only a few reports of SCCs in the alimentary tract of birds, including psittacines, have been published, and a detailed description of the pathology is not available in the literature. We present here 12 cases of alimentary SCC in psittacines. The average age of the birds was 22.2 y (range: 15–29 y), and affected species included 4 Amazon parrots ( Amazona sp.), 3 cockatiels ( Nymphicus hollandicus), 3 macaws ( Ara sp.), 1 conure ( Eupsittula sp.), and 1 Senegal parrot ( Poicephalus sp.). Frequent clinical complaints included regurgitation, dysphagia, dyspnea, lethargy, and/or weight loss. SCC primarily affected the oral cavity in 6 of 12 cases, the crop alone in 2 of 12 cases, the crop and esophagus in 1 of 12 cases, the proventriculus alone in 1 of 12 cases, and the crop, esophagus, and proventriculus in 2 of 12 cases. Histologically, alimentary SCCs were locally invasive and often resulted in mucosal ulceration. Although there were no metastases in any of our cases, poor clinical outcomes were frequent and associated most commonly with complete effacement of the alimentary segment and severe inflammation with opportunistic bacterial infection. Our review of the literature records commonly affected species, variability of gross presentations and clinical signs, plausible etiologies, and current diagnostic developments.
Trends and Predictors of Palliative Care Consultation Among Patients Admitted for LVAD: A Retrospective Analysis From the Nationwide Inpatient Sample Database From 2006-2014
Authors: Quelal Karol , Olagoke Olankami , Shahi Anoj , Torres Andrea , Ezegwu Olisa , Golzar Yasmeen
Published: June 2021

Background:

Left ventricular assist devices (LVADs) are an essential part of advanced heart failure (HF) management, either as a bridge to transplantation or destination therapy. Patients with advanced HF have a poor prognosis and may benefit from palliative care consultation (PCC). However, there is scarce data regarding the trends and predictors of PCC among patients undergoing LVAD implantation.

Aim:

This study aims to assess the incidence, trends, and predictors of PCC in LVAD recipients using the United States Nationwide Inpatient Sample (NIS) database from 2006 until 2014.

Methods:

We conducted a weighted analysis on LVAD recipients during their index hospitalization. We compared those who had PCC with those who did not. We examined the trend in palliative care utilization and calculated adjusted odds ratios (aOR) to identify demographic, social, and hospital characteristics associated with PCC using multivariable logistic regression analysis.

Results:

We identified 20,675 admissions who had LVAD implantation, and of them 4% had PCC. PCC yearly rate increased from 0.6% to 7.2% (P < 0.001). DNR status (aOR 28.30), female sex (aOR 1.41), metastatic cancer (aOR: 3.53), Midwest location (aOR 1.33), and small-sized hospitals (aOR 2.52) were positive predictors for PCC along with in-hospital complications. Differently, Black (aOR 0.43) and Hispanic patients (aOR 0.25) were less likely to receive PCC.

Conclusion:

There was an increasing trend for in-hospital PCC referral in LVAD admissions while the overall rate remained low. These findings suggest that integrative models to involve PCC early in advanced HF patients are needed to increase its generalized utilization.
Review of the Efficacy and Safety of Lemborexant, a Dual Receptor Orexin Antagonist (DORA), in the Treatment of Adults With Insomnia Disorder
Authors: Waters Kristin
Published: June 2021

Objective

To provide an overview of the efficacy and safety of lemborexant in the treatment of insomnia disorder by assessing the currently available literature.

Data Sources

A literature search of PubMed was performed (2010 to March 2021) using the following search terms: lemborexant, sleep, orexin

Study Selection and Data Extraction

All relevant English-language studies were reviewed and considered, with a focus on phase 3 trials.

Data Synthesis

The efficacy and safety of lemborexant in the treatment of insomnia disorder in adults was demonstrated in 2 phase 3 trials. Lemborexant significantly reduced latency to persistent sleep compared with placebo. The first study also demonstrated a significant reduction compared with the active control zolpidem ER. Somnolence and headache were relatively common, but the marked adverse effects associated with other medications commonly used to treat insomnia, such as cognitive and psychomotor impairment and complex sleep-related behaviors, were not observed.

Relevance to Patient Care and Clinical Practice

Although nonpharmacological therapy is considered first-line treatment for insomnia disorder, pharmacological treatment is most commonly utilized. Lemborexant is a viable pharmacological treatment option for patients who are unable to tolerate the adverse effects associated with the most commonly prescribed medications for insomnia, such as benzodiazepines and sedative-hypnotics (Z drugs). This is especially true for geriatric patients, who may be more sensitive to these adverse effects.

Conclusion

Lemborexant can be recommended to treat insomnia disorder when pharmacological treatment is warranted. It has demonstrated efficacy in clinical trials and is likely better tolerated than most currently available treatment options.
Impact of Interferons and Biological Drug Inhibitors of IL-2 and IL-6 on Small-Molecule Drug Metabolism Through the Cytochrome P450 System
Authors: White C. Michael , Sicignano Dakota J. , Smith Kimberly
Published: June 2021

Objective:

Assess the impact of interferons and interleukin (IL)-2 and IL-6 inhibitors on cytochrome P450 (CYP) drug metabolism in human subjects.

Data Sources:

PubMed search from 1980 to March 31, 2021, limited to human subjects and English language via search strategy: (biological drug names) [AND] (cytochrome [OR] CYP metabolism).

Study Selection and Data Extraction:

Narrative review of human studies assessing biological drugs in select classes that affect CYP drug metabolism.

Data Synthesis:

Exogenous interferons suppress CYP1A2 (theophylline, caffeine, antipyrone) clearance by 20% to 49% in patients; have minimal impact on CYP3A4 (midazolam and dapsone), CYP2C9 (tolbutamide), or CYP2C19 (mephenytoin) metabolism; and increase CYP2D6 (debrisoquine, dextromethorphan) metabolism. Biological IL-2 inhibitors (basiliximab, daclizumab) have no effect on metabolism via CYP1A2 (caffeine), CYP2C9 (s-warfarin), CYP2C19 (omeprazole), CYP2D6 (dextromethorphan), and CYP3A4 (midazolam, tacrolimus) but may enhance CYP3A4 (cyclosporin) metabolism over time. IL-6 inhibitors (sirukumab, tocilizumab, sarilumab) significantly enhance metabolism via CYP2C9 (s-warfarin), CYP2C19 (omeprazole), and CYP3A4 (simvastatin, midazolam) and reduce metabolism via CYP1A2 (caffeine).

Relevance to Patient Care and Clinical Practice:

Patients using interferons, IL-2, or IL-6 blocking drugs at steady state with CYP substrates could have altered drug metabolism and experience adverse events. With interferons and biological anti-inflammatory drugs, some isoenzymes will be inhibited, whereas others will be enhanced, and the magnitude of the effect can sometimes be significant. In clinical practice, clinicians may consider these metabolic changes as an additive effect to a patient’s entire disease and medication profile when determining risk/benefit of treatment.

Conclusions:

Interferon therapy or inflammatory suppression via IL-2 or IL-6 can alter steady-state concentrations of CYP-metabolized small-molecule drugs.
Squamous Metaplasia in a Borderline Phyllodes Tumor—an Undocumented Histological Finding in Male Breast: Report of a Case and Review of Literature
Authors: Panigrahi Chinmayee , Jha Shilpy , Kumar Pankaj , Mishra Tushar S. , Sasmal Prakash K. , Adhya Amit K.
Published: June 2021

Phyllodes tumor is a paradigm of fibroepithelial neoplasm that accounts for <1% of the breast neoplastic lesions usually detected in females and uncommonly in the male breast. The World Health Organization classifies the tumor into benign, borderline, and malignant based on the predefined morphological criteria. Squamous differentiation in phyllodes tumor is epithelial metaplasia, which has been occasionally documented in English literature. We report the first undocumented case of a recurrent borderline phyllodes tumor with cystic squamous metaplastic change in a 32-year-old male patient. The histology was that of a fibroepithelial neoplasm with the typical leaf-like projections and cystic spaces lined by squamous epithelium containing keratin debris. The purpose of presenting this case is to elucidate the pathogenesis and discuss other malignant and benign breast lesions that may be included in the differential diagnosis when evaluating a breast lesion with squamous metaplasia, particularly in the context of fine-needle aspirates.
Real world use of FLT3 inhibitors for treatment of FLT3+ acute myeloid leukemia (AML): A single center, propensity-score matched, retrospective cohort study
Authors: Bazzell Brian G , Marini Bernard L , Benitez Lydia L , Bixby Dale , Burke Patrick , Pettit Kristen , Perissinotti Anthony J
Published: June 2021

Background

Patients diagnosed with acute myeloid leukemia with a FLT3 mutation (FLT3+ AML) have historically had poor outcomes. While the addition of the FLT3 inhibitors to induction therapy has been shown to improve survival outcomes in FLT3+ AML, interactions and overlapping toxicities between FLT3 inhibitors and standard of care medications used during induction therapy (e.g. azole antifungals, anthracyclines) and logistical barriers have complicated their use. To avoid these concerns, our institution has opted to defer initiation of midostaurin until after completion of induction therapy. However, to our knowledge no study confirming the effectiveness of this strategy for real world FLT3 inhibitor use has been published.

Methods

We performed a single center, propensity-score matched, retrospective cohort study characterizing efficacy and safety of our strategy for use of FLT3 inhibitors in the treatment of FLT3+ AML. The primary outcome was median event-free survival (EFS), while secondary endpoints included median overall survival (OS), overall response rate (ORR), 30-day mortality, duration of neutropenia, duration of thrombocytopenia, consolidation cycle delays, documented infections, and all-cause hospital readmission.

Results

A total of 83 FLT3+ AML patients treated with intensive induction therapy were included in the study, of whom 48 were propensity-score matched and analyzed. Baseline characteristics were similar between the patients who received a FLT3 inhibitor after induction therapy and the historical control arm. Median EFS was not significantly different but compared favorably between the FLT3 inhibitor cohort and historical controls (not reached vs 8 months, p = 0.343) with 18-month EFS of 54% and 43% for the two cohorts, respectively. Similarly, no significant differences were noted with regard to median OS (not reached vs 28.7 months, p = 0.752), ORR (79.2% vs 79.2%), or safety outcomes between groups.

Conclusion

Compared to historical controls, addition of a FLT3 inhibitor to intensive chemotherapy post-induction may improve EFS or OS in a real world patient cohort with longer follow-up and a larger sample size. The omission of midostaurin in induction allowed for the use of an azole antifungal and the intensification of anthracycline dose may have contributed to high remission rates in both groups.
Potential Pitfalls in Wastewater Phosphorus Analysis and How to Avoid Them
Authors: Rosario Praveen , Viswash Ramya , Seenivasan Thamayanthi , Ramalingam Sudha , Sellgren Katelyn L , Grego Sonia , Trotochaud Lena
Published: June 2021

Due to the increasing adoption of nutrient discharge regulations, many research groups are stepping into new territory with phosphorus (P) measurements. Accurate reporting of P concentrations in effluent from novel wastewater treatment technologies is critical for protecting both environmental and human health. Analysis of P in wastewater is prone to pitfalls because of the (1) variety of chemical forms of P in wastewater (orthophosphate, condensed P, and organic P), (2) availability of different chemical assays for measuring different P forms, and (3) different conventions in the units for reporting P. Here, we present a case study highlighting how these pitfalls affect analysis and interpretation of P measurements. We show that, when used appropriately, commercially-available kits are indeed accurate tools for evaluating reactive P and total P concentrations. For both standard solutions and real wastewater, we systematically remove steps from the total P protocol to show how protocol deviations affect the results. While standard solutions are important for validating analytical methods, commercially-available wastewater standard solutions only contain P as orthophosphate (reactive P). We therefore demonstrate options for making a mixed-P standard solution containing acid-hydrolyzable and/or organic P compounds that can be used to validate both reactive P and total P assays.
‘Social media comes with good and bad sides, doesn’t it?’ A balancing act of the benefits and risks of social media use by young adults with long-term conditions
Authors: Wilson Ceri , Stock Jennifer
Published: June 2021

Young adults are frequent users of social media, but the help and hindrance of social media for living well with long-term conditions (LTCs) in young adulthood is little-researched. The aim of this paper was to explore the experiences of social media use amongst young adults with LTCs. Interviews with 15 young adults with LTCs explored their experiences of using social media more broadly and in relation to online health communities. Social media came with both ‘good and bad sides’ which required a balancing act to manage (overarching theme), as reflected in the following subthemes: (1) Relationships: reducing social isolation versus need for face-to-face contact; (2) Comparisons: normalising versus negative (upward) comparisons; (3) Community: fitting in versus feeling left out; (4) Emotions: inspiring versus distress contagion; and (5) Knowledge: exchanging useful information versus fear of decline. The findings highlight the importance of young adults’ self-reflection/awareness of social media’s impact on their wellbeing, identifying when limited or increased use may be preferable. Whilst there is a ‘good’ to social media such as increased feelings of belonging and connection, this should not be the sole focus of future self-management interventions; as its use also contributes to feelings of distress, fear and not fitting in, and participants desire face-to-face contact.
Play by design: The porn-viewing room in Taiwanese and Korean men’s sex saunas
Authors: Jones Shawn Suyong Yi
Published: June 2021

This article discusses the relationship between play and space through the examination of the porn-viewing room of men’s sex saunas in Taiwan and South Korea. In these spaces, varying notions of play and playfulness are encouraged and experienced. Through an examination of the spatial layout of the room, the content of the videos exhibited therein, and the physical manifestation of the enveloping cultural context, I consider how the intersection of these three elements serve to guide bodily pleasures by encouraging some forms of sexual pleasure over others. If the sauna is analogous to a playground, then the porn-viewing room is a piece of playground equipment that sets out to guide players to engage in acceptable use through its design, without necessarily accounting for the ways in which the equipment can be co-opted for other forms of pleasure. Ultimately, I seek to situate the question of what bodies can experience in terms of sexual pleasure in a specific setting and subsequently consider how the cultural context may influence the forms of pleasures experienced in these spaces.