bluuebunny/crossref_metadata_2025 huggingface dataset:
Tethered Oral Tissue Release Among Breastfed Infants: Maternal Sources of Information and Treatment
Authors: Winkel Taylor , Wilson Jennifer , Spence Marsha , Colby Sarah , Springer Cary , Hedrick Mark , Kavanagh Katherine
Published: March 2023

Background:

Despite limited clinical consensus regarding surgery for tethered oral tissues (“tongue-tie”) for resolving breastfeeding-related issues, the procedure has been increasing in the United States. Greater understanding of maternal experiences with obtaining surgical release may help to improve breastfeeding outcomes.

Research Aim:

To explore experiences of breastfeeding mothers with infants having undergone “tongue-tie” surgery.

Method:

This online, cross-sectional, observational survey occurred between August and September 2020. Eligibility included being ≥ 18 years of age and previously or currently breastfeeding an infant with ≥ 1 tissue surgically released. Of 463 screens, 318 mothers were eligible and 115 consented. The final sample was 90.

Results:

The sample was predominantly white ( n = 86; 95%), non-Hispanic ( n = 84; 93%), married/cohabitating ( n = 85; 94%), and currently providing their own milk ( n = 81; 89%). Difficult latch was the primary reason for seeking help. Participants reported lingual ( n = 84; 93%), labial ( n = 79; 88%), and buccal ( n = 16; 17%) tissue-release, with 80% ( n = 73) reporting > 1 released. For each tissue released, > 80% ( n = 72) of participants felt “very confident” in their ability to correctly identify it and 97% ( n = 87) felt “very involved” and “strongly agreed” with surgical release. International Board Certified Lactation Consultants® were the most frequently identified source of information ( n = 45; 50%) and referrals ( n = 38; 42%), while pediatric dentists most frequently performed interventions ( n = 60; 67%).

Conclusions:

Participants reported being confident, involved, and in agreement with surgical release and lactation support professionals were frequent information and referral sources.
Board Gender Diversity and Nonprofit CEO Compensation: Implications for Gender Pay Gap
Authors: Lee Young-joo
Published: March 2023

This study examines how gender diversity on nonprofit boards relates to chief executive officer (CEO) compensation using data of 1,835 501(c)(3) organizations with the GuideStar Platinum Seal of Transparency. The analysis reveals a positive association between women’s representation on a governing board and female CEO compensation until women’s proportion reaches 82%. By contrast, there is a negative relationship between women’s representation on boards and male CEO compensation. Overall, the findings suggest that board gender diversity has distinctive implications for CEO compensation depending on CEO gender and that having more women on governing boards contributes to closing the gender pay gap for nonprofit executives. These findings can be applied to other dimensions of diversity, including racial and ethnic diversity.
Theoretical model and simulation of a twin-Screw multiphase pump with novel smooth screw rotors for gas-Oil mixed transportation
Authors: Pan Shiyang , Wang Jun , Zhao Xihao , Li Hongxin , Wang Zengli , Geng Maofei , Cui Dong
Published: March 2023

A pair of screw rotors, the core components of twin-screw multiphase pumps, primarily determine the pump performance. The conventional screw rotor contains unsmooth edges caused by unsmooth points in the cross-sectional profiles, which will lead to the abrasion, wear and fatigue near the unsmooth edges of the screw rotors during operation. For solving this problem, a novel pair of fully smooth screw rotors without unsmooth edges were proposed, and their cross-sectional profiles composed of the elliptical arcs and their conjugate curves were put forward. Parametric equations of the proposed screw rotor profiles were also derived, and then the effects of geometric parameters on the pump performance of the proposed screw rotors were discussed. Furthermore, the transient flow of the twin-screw multiphase pump with the proposed screw rotors were carried out by numerical simulations. The distributions of pressure and velocity in the proposed pump were obtained. The gap leakage and backflow velocity at each gap varying with time and location in the working process were also analyzed. The results indicate that the carryover of the proposed screw rotors is reduced by 90.49%, while its area utilization ratio is increased by 0.8%, and the length of the spatial contact curve is reduced by 25.71% in comparison with the conventional screw rotors. Thus, the superiority and feasibility of the proposed screw rotors are validated.
Notch Signaling-Modified Mesenchymal Stem Cell Patch Improves Left Ventricular Function via Arteriogenesis Induction in a Rat Myocardial Infarction Model
Authors: Maeda Shusaku , Kawamura Takuji , Chida Dai , Shimamura Kazuo , Toda Koichi , Harada Akima , Sawa Yoshiki , Miyagawa Shigeru
Published: March 2023

For ischemic cardiomyopathy (ICM) with limited therapeutic options, the induction of arteriogenesis has the potential to improve cardiac function through major restoration of blood flow. We hypothesized that transplantation of a Notch signaling-modified mesenchymal stem cell (SB623 cell) patch would induce angiogenesis and arteriogenesis in ischemic lesions, leading to improvement of left ventricular (LV) function in a rat ICM model. Two weeks after the induction of ischemia, SB623 cell patch transplantation into ICM rats (SB group, n = 10) or a sham operation (no-treatment group, n = 10) was performed. The LV ejection fraction was significantly improved at 6 weeks after SB623 cell patch transplantation ( P < 0.001). Histological findings revealed that the number of von Willebrand factor (vWF)-positive capillary vessels ( P < 0.01) and alpha smooth muscle actin (αSMA)- and vWF-positive arterioles with a diameter greater than 20 µm ( P = 0.002) was significantly increased in the SB group, suggesting the induction of angiogenesis and arteriogenesis. Moreover, rat cardiomyocytes treated with SB623 cell patch transplantation showed upregulation of ephrin-B2 ( P = 0.03) and EphB4 ( P = 0.01) gene expression, indicating arteriogenesis induction. In conclusion, SB623 cell patch transplantation improved LV function by inducing angiogenesis and arteriogenesis in a rat ICM model.
Mid-term follow-up results of gradual capitate lengthening for the treatment of stage IIIA Kienbock’s disease
Authors: Kariksiz Mesut , Karakoyun Ozgur
Published: March 2023

Purpose

This study aimed to evaluate the mid–term radiological and clinical results of gradual lengthening of capitate for the treatment of stage IIIA Kienbock’s disease.

Methods

We retrospectively reviewed nine patients (five females, four males) with Lichtman stage IIIA Kienbock’s disease who underwent gradual capitate lengthening at our hospital. Their clinical (range of motion (ROM), grip strength, visual analogue scale (VAS) value for pain, and Mayo wrist score (MWS)) and radiological outcomes (in terms of progression of arthritis and carpal height ratio) at the last follow-up were compared to the preoperative values.

Results

The mean age of the nine patients was 30 years (range: 20–38 years). The mean follow-up period was 73.8 (60–83) months. The average grip strength increased from 14.3 kg preoperatively to 22.3 kg at the last follow-up. The mean MWS increased from 58.8 preoperatively to 79.4 postoperatively. The mean VAS values decreased from the preoperative values: from 1.9 to 0.36 at rest, from 3.75 to 1.6 during mild effort, and from 5.35 to 3 during severe effort. The average carpal height ratio changed from 0.38 preoperatively to 0.53 postoperatively. None of the patients had any arthritic changes in their wrists.

Conclusion

Gradual lengthening of capitate offers satisfactory mid-term results for treating stage IIIA Kienbock’s disease.
Risks Associated With Posterior Ankle Hindfoot Arthroscopy Complications
Authors: Chinnakkannu Karthikeyan , Barbachan Mansur Nacime Salomao , Glass Natalie , Phisitkul Phinit , Amendola Annunziato , Femino John E.
Published: March 2023

Background:

The use of posterior ankle and hindfoot arthroscopy (PAHA) has been expanding over time. Many new indications have been reported in the literature. The primary objective of this study was to report the rate of PAHA complication in a large cohort of patients and describe their potential associations with demographical and surgical variables.

Methods:

In this IRB-approved retrospective comparative study, patients who underwent posterior ankle and/or hindfoot arthroscopy in a single institution from December 2009 to July 2016 were studied. Three fellowship-trained orthopaedic foot and ankle surgeon performed all surgeries. Demographic data, diagnosis, tourniquet use, associated procedures, and complications were recorded. To investigate a priori factors predictive of neurologic complication after PAHA, univariate and multivariable logistic regression was utilized. Where appropriate, sparse events sensitivity analysis was tested by fitting models with Firth log-likelihood approach.

Results:

A total of 232 subjects with 251 surgeries were selected. Indications were posterior ankle impingement (37%), flexor hallux longus disorders (14%), subtalar arthritis (8%), and osteochondral lesions (6%). Complications were observed in 6.8% (17/251) of procedures. Neural sensory lesions were noted in 10 patients (3.98%), and wound complications in 4 ankles (1.59%). Seven neurologic lesions resolved spontaneously and 3 required further intervention. In a multivariable regression model controlled for confounders, the use of accessory posterolateral portal was the significant driver for neurologic complications (odds ratio [OR] 32.19, 95% CI 3.53-293.50).

Conclusion:

The complication rate in this cohort that was treated with posterior ankle and/or hindfoot arthroscopy was 6.8%. Most complications were due to neural sensorial injuries (sural 5, medial plantar nerve 4, medial calcaneal nerve 1 ) and 3 required additional operative treatment. The use of an accessory posterolateral portal was significantly associated with neurologic complications. The provided information may assist surgeons in establishing diagnoses, making therapeutic decisions, and instituting surgical strategies for patients that might benefit from a posterior arthroscopic approach.

Level of Evidence:

Level III, retrospective comparative study.
Protective Orders for Male Perpetrators of Intimate Partner Violence: Differences Between Violators and Non-Violators
Authors: Herrera María J. , Amor Pedro J.
Published: March 2023

The goal of this study was to determine the profile of the aggressors of intimate partner violence (IPV), who tend to violate protective orders (POs). A cohort of 200 men convicted of IPV (120 violators and 80 non-violators of the POs) was studied. Male perpetrators were more likely to belong to the PO violator group when they had a prior criminal history, they inflicted more severe physical violence, they were drug users, and they had a low education level. Using the risk factors identified here when dealing with males who perpetrate IPV and taking appropriate measures may help to prevent revictimization.
The Market for Privacy: Understanding How Consumers Trade Off Privacy Practices
Authors: Eggers Felix , Beke Frank T. , Verhoef Peter C. , Wieringa Jaap E.
Published: March 2023

In recent years, firms’ privacy practices have received increasing attention from consumers. While firms largely see this development as a threat, as consumers might prohibit collection or use of data, we suggest that it can also represent an opportunity for firms. On the “market for privacy,” firms can gain a competitive advantage by differentiating and actively promoting preferred privacy practices. In this context, the authors study how consumers trade off five privacy elements, three relating to distributive fairness (i.e., information collection, storage, use) and two relating to procedural fairness (i.e., transparency, control). Moreover, they analyze how the impact of these elements differs among four industries that vary in information sensitivity and interaction intensity. By using discrete choice experiments, the authors show that all privacy elements matter to consumers, even when in a trade-off with price. In highly sensitive industries, differences in information collection and use matter more, while storage matters less, for differentiation. When consumers have less frequent interactions with companies, they require more transparency about their privacy practices. The authors demonstrate empirically that optimizing privacy practices can lead to robust changes in market shares (Study 1) and higher revenues in equilibrium (Study 2) when firms embrace the market for privacy.
What’s in a frame, what’s in a name?
Authors: Johnston Hank
Published: March 2023

This report reviews the development and organization of social movement research, the place frame analysis in the field, and its weak relationship with cognitive-linguistic approaches to frames and scripts. It considers the differences between frames and ideologies – the latter being a key social movement concept. It then presents a practical methodology to chart the content of frame schemas, with an emphasis on fealty to the original documents and their fine-grained, linguistically informed analysis. Close attention to empirical texts, sampled at different points in time or in response to hinge events, ideally provide the empirical basis for inferences made about frame content and can be useful in comparatively tracing changes in strategic framing. Strategic framing is the marketing or ‘spin’ sense of the term, capturing the adjustment of messages or their presentation to increase acceptability and/or persuasiveness. The frequency of this phenomenon and a focus on strategy has disengaged framing from its original cognitive-linguistic grounding. It will likely remain that that way for reasons less concerned with rules of evidence and analytical logic and more about the pragmatics of publication and the discursive organization of academic fields.
The right to higher education: A political theory
Authors: Martin Christopher
Published: March 2023

In The Right to Higher Education: A Political Theory, I argue that post-compulsory education should be an individual right in a liberal democratic society. Here, I respond to a series of criticisms of the right’s justification. I address objections relating to: the autonomy-based justification of the right and liberal neutrality, the right’s scope and limits, the fairness of full public funding for higher education, constraints on the right’s equality-promoting aims, and the meaning of the term ‘higher education’ under the right.
Pintura Mural para Recolectar Datos Sensibilizantes y Fomentar la Participación en la Investigación Entre los Latinos de EE. UU
Authors: Martinez-Hollingsworth Adrienne , Hernández Jacqueline , Edwards Cristina , Partlow Keosha
Published: March 2023

Proposito. Describir una intervención de murales implementadas con comunidad envecindarios Latinos para elevar conciencia de barreras delreclutamiento/retención de Latinos en EE. UU. en la investigación clínica,y aumentar acceso de los investigadores a conceptos de sensibilización críticos para el riguroso diseño de estudios. Fondo. Latinos en EE. UU. sufren desproporcionada de varias enfermedadescrónicas, pero son subrepresentados como investigadores y participantesen investigaciones financiadas por Institutos Nacionales de Salud. Faltade representación inhibe conciencia de necesidades Latinas para la saludy obstaculiza esfuerzos para abordar la falta de equidad en comunidadesdiversas. Las intervenciones de arte en comunidades Latinas siguensiendo reconocidas por capacidad a cerrar brechas e incrementar lacalidad y cantidad de asociaciones de investigación entre investigadores y Latinos. Método. Este artículo describe una intervención de murales puesta a prueba endos vecindarios mayormente Latinos entre 2016 y 2020. El método deldiseño fue guiado por prácticas de investigación participativas con lacomunidad enfocadas en Evaluación-Diagnóstico Planificación- Implementación-Evaluación. Resultados. Los murales abordaron muchos desafíos de participación que a menudo se asocian con la subrepresentación de los Latinos en la investigación académica y permitió entrevistas de sensibilización con miembros clave de la comunidad sobre temas de interés para investigación. Conclusión. Los métodos de investigación que reconocen las formas de arte tradicionales, como murales, crean espacio para generar confianza e iniciar interés en la participación en investigaciones, y aumentan acceso
Somebody to Lean On: Community Ties, Social Exchange, and Practical Help during the COVID-19 Pandemic
Authors: Horak Martin , Vanhooren Shanaya
Published: March 2023

During a community-wide crisis, practical help from others in the community can allow individuals to manage a variety of extraordinary household needs. In this article, we synthesize insights from research on disaster resilience, social support, social networks, and social exchange into a theoretical model of factors that shape individual access to help beyond the family. We suggest that community ties—local neighborhood, associational, and friend relationships—are significant avenues for accessing help and that helping behaviors in the community are structured by social exchange. We test this model in the early months of the COVID-19 pandemic, drawing on a survey of 4,234 Canadians and Americans. We find that all three kinds of community ties significantly increase the likelihood of receiving and giving help; that there is a strong, positive two-way correlation between giving help and receiving help; that relationships between community ties and helping behaviors are mediated by social exchange; and that individuals in extraordinary need tend to both receive and give more help than others. Our findings provide broad-based evidence for the importance of local social ties and social exchange processes in structuring access to practical help in times of extraordinary need.
Post-Pulmonary Embolism Impairment Six Months after Acute Pulmonary Embolism: A Prospective Registry
Authors: Alizadehasl Azin , Farrashi Melody , Naghsbandi Mona , Khansari Nakisa , Moosavi Jamal , Shafe Omid , Mohebbi Bahram , Bakhshandeh Hooman , Pouraliakbar Hamid Reza , Rezaei-Kalantari Kiara , Naghavi Batoul , Talakoob Hamed , Mohseni Salehi Maryam , Kaviani Raheleh , Amin Ahmad , Barco Stefano , Sadeghipour Parham
Published: March 2023

Background

Little evidence is available on post-pulmonary embolism impairment (PPEI), a recently defined complication of pulmonary embolism (PE) encompassing dysfunctional clinical and imaging parameters. In the present study, we sought to evaluate its frequency with a focus on the main components.

Methods

In this prospective registry, we included patients with a confirmed diagnosis of acute PE and focused on those with initial right ventricular (RV) dysfunction. Their baseline, pre-discharge, and 6 month follow-up clinical and imaging characteristics were recorded. The main study outcomes were incomplete RV functional recovery, exercise capacity limitations (based on the 6 minute walk test), and their combination, which defines PPEI, within six months of acute PE.

Results

Of 170 consecutive patients with a confirmed diagnosis of acute PE, 123 accepted to participate in the follow-up study, of whom 87 had initial RV dysfunction. The 6 month rates of incomplete RV functional recovery, signs of an intermediate-to-high echocardiographic probability of PH, and exercise limitations were observed in 58.6, 32.1, and 45.9%, respectively. A total of 22 (25.2%; 95% CI 15.5-34.4%) patients had PPEI. The RV/LV ratio and the fractional area change on discharge after acute PE were more often impaired among patients with incomplete RV recovery, exercise limitations, and a high probability of PH at 6 months. In contrast, an initial impaired RV diastolic function indices appeared to characterize patients with a limited exercise capacity at 6 months.

Discussion

PPEI affects one fourth of patients surviving acute PE with half of them presenting with RV dysfunction or exercise limitations.
Superficial Femoral Artery in-Stent Restenosis Treated with Paclitaxel-Coated Balloon Angioplasty – Results of Three-Year Follow-Up
Authors: Peclat de Oliveira Julio Cesar , Alvim Fiorelli Rossano Kepler , Rolim Maia Peclat Ana Paula , Peclat de Oliveira Lucas Maia , Oliveira Rafael , Belczac Sergio Quilici , Almeida Renato Santos , Dalio Marcelo Bellini , Joviliano Edwaldo Edner , Gutfilen Bianca
Published: March 2023

Background

In-stent restenosis remains a common and important complication after endovascular treatment of superficial femoral artery peripheral artery disease. It occurs in 14 to 35% of cases in 1 year and there is still no efficient treatment for this condition. Paclitaxel-coated balloons have shown promising results.

Objective

Investigate the 3 year results of superficial femoral artery in-stent restenosis treated with paclitaxel-coated balloon angioplasty, using the Lutonix™ 035 device.

Methods

We conducted a retrospective observational study with patients with symptomatic (Rutherford 2 to 5) superficial femoral artery in-stent restenosis, that were treated with paclitaxel-coated balloon angioplasty using the Lutonix™ 035 device, in a single center from January 2016 to December 2020. Duplex scan was used to follow the patients. Primary patency was obtained through Kaplan-Meier analysis. Mortality, and amputation rates were also evaluated.

Results

105 patients were included. Two patients had technical failure and required an additional stent, and were thus excluded. 103 patients were analyzed. Primary patency was 91.26, 80.47, and 67.71%, respectively, in the first, second, and third year after the procedure. There were no deaths 30 days after the procedure. There were no major amputations during the 3 year follow-up.

Conclusion

Paclitaxel-coated balloon angioplasty with the Lutonix™ 035 device was a safe and effective treatment to superficial femoral artery in-stent restenoses. The results were maintained along the 3 year follow-up.
The Legitimation Effects of Peacebuilding and Development Interventions—Strengthening Land Registration in Northern Uganda
Authors: van Leeuwen Mathijs , Nancy Kobusingye Doreen , Maiyo Joshua
Published: March 2023

Fostering legitimate authority has become a priority of the international peacebuilding and development community, notably in fragile states and conflict-affected settings. Yet, how peacebuilding and development interventions feed into legitimation practices of public authorities remains underexplored, let alone how interveners can strategize on this. Analysis of programs to support land registration in Northern Uganda brings out how interventions not just enhance the legitimacy of targeted authorities. Often unintentionally, they impact on struggles for legitimacy between different state and nonstate authorities and change their relative legitimacy. They do so by redistributing land governance roles and responsibilities; stimulating certain practices of land governance; and contributing to the discussion on legitimacy assessments. The conclusion argues for more sensitivity to legitimation effects of peacebuilding and development interventions.
Incidence of spontaneous intracranial hypotension in Olmsted County, Minnesota: 2019–2021
Authors: Pradeep Aishwarya , Madhavan Ajay A , Brinjikji Waleed , Cutsforth-Gregory Jeremy K
Published: March 2023

Background

As the myriad clinical and radiographic presentations of spontaneous intracranial hypotension are increasingly recognized, disease prevalence appears to rise. True incidence data remain insufficient. We sought to calculate the incidence of spontaneous intracranial hypotension among the residents of Olmsted County, Minnesota.

Methods

Our institution is a quaternary care center for spontaneous intracranial hypotension evaluation and provides primary neurologic care for local residents. All patients who were evaluated at our institution from 2019 to 2021 for spontaneous intracranial hypotension were reviewed, and cases of spontaneous intracranial hypotension with advanced imaging work-up using digital subtraction myelography or dynamic computed tomography myelography were identified. Patients who were residents of Olmsted County were identified.

Results

Fourteen patients with spontaneous intracranial hypotension were identified in Olmsted County during the study period, all of whom were adults and underwent our institution's standard spontaneous intracranial hypotension work-up. In Olmsted County, the incidence of spontaneous intracranial hypotension was 3.8 per 100,000 adult population, including 3.2 per 100,000 adult females and 2.5 per 100,000 adult males. Seven of 14 patients (50%) had a cerebrospinal fluid-venous fistula.

Conclusion

This study uniquely presents the incidence rate of spontaneous intracranial hypotension in the general population of Olmsted County, Minnesota. Spontaneous intracranial hypotension is more common in women than men and has an overall incidence roughly equivalent to that of aneurysmal subarachnoid hemorrhage in Olmsted County, a widely known neurologic condition. Approximately half the cases of spontaneous intracranial hypotension are due to cerebrospinal fluid-venous fistulas, which generally require specialty expertise for diagnosis and treatment.
Heterogeneity of surrogate outcome measures used in critical care studies: A systematic review
Authors: Verghis Rejina , Blackwood Bronagh , McDowell Cliona , Toner Philip , Hadfield Daniel , Gordon Anthony C , Clarke Mike , McAuley Daniel
Published: March 2023

Background:

The choice of outcome measure is a critical decision in the design of any clinical trial, but many Phase III clinical trials in critical care fail to detect a difference between the interventions being compared. This may be because the surrogate outcomes used to show beneficial effects in early phase trials (which informed the design of the subsequent Phase III trials) are not valid guides to the differences between the interventions for the main outcomes of the Phase III trials. We undertook a systematic review (1) to generate a list of outcome measures used in critical care trials, (2) to determine the variability in the outcome reporting in the respiratory subgroup and (3) to create a smaller list of potential early phase endpoints in the respiratory subgroup.

Methods:

Data related to outcomes were extracted from studies published in the six top-ranked critical care journals between 2010 and 2020. Outcomes were classified into subcategories and categories. A subset of early phase endpoints relevant to the respiratory subgroup was selected for further investigation. The variability of the outcomes and the variability in reporting was investigated.

Results:

A total of 6905 references were retrieved and a total of 294 separate outcomes were identified from 58 studies. The outcomes were then classified into 11 categories and 66 subcategories. A subset of 22 outcomes relevant for the respiratory group were identified as potential early phase outcomes. The summary statistics, time points and definitions show the outcomes are analysed and reported in different ways.

Conclusion:

The outcome measures were defined, analysed and reported in a variety of ways. This creates difficulties for synthesising data in systematic reviews and planning definitive trials. This review once again highlights an urgent need for standardisation and validation of surrogate outcomes reported in critical care trials. Future work should aim to validate and develop a core outcome set for surrogate outcomes in critical care trials.
Variation in hepatic segmental portal venous pulsed wave Doppler flow distribution in patients with NAFLD: A pilot study
Authors: Verma Ashish , Kumar Ishan , Indal Manish , Shukla Sunit , Singh Pramod Kumar , Shukla Ram Chandra
Published: March 2023

Purpose:

To evaluate the segmental variations in portal venous pulsed wave colour Doppler flow velocity in patients with moderate to severe non-alcoholic fatty liver disease in comparison with healthy controls

Materials and Methods:

In this prospective, observational, case–control study, the maximum velocity of all the segmental branches of portal vein were evaluated on colour Doppler in patients with moderate to severe non-alcoholic fatty liver disease, and the values were compared between three groups (1) Healthy controls ( n = 30), (2) non-alcoholic fatty liver disease group, that is moderate to severe fatty liver without features of portal hypertension ( n = 32) and (3) non-alcoholic steatohepatitis-portal hypertension group, that is those non-alcoholic fatty liver disease patients with features of portal hypertension ( n = 13).

Results:

Compared to controls, non-alcoholic fatty liver disease group showed a lower velocity in all the eight segments of liver. The ratio of segment 2 to segment 7 peak portal vein maximum velocity was significantly higher in non-alcoholic fatty liver disease (1.03 ± 0.21) compared to controls (0.90 ± 0.17) and even higher in non-alcoholic steatohepatitis-Portal hypertension group (1.83 ± 0.40) with p value of 0.003.

Conclusion:

Our study demonstrates the occurrence of flow redistribution occurring in cases of non-alcoholic fatty liver disease patients with the left lobe receiving higher portal venous flow. This flow redistribution was even more pronounced in a subset of non-alcoholic fatty liver disease patients who developed features of portal hypertension.
Effects of exercise-based pulmonary rehabilitation on severe/very severe COPD: a systematic review and meta-analysis
Authors: He Wenqing , Wang Jiajia , Feng Zhenzhen , Li Jiansheng , Xie Yang
Published: March 2023

Objective:

Pulmonary rehabilitation (PR) has been considered to be an effective treatment method for various respiratory diseases. However, the effects of exercise-based PR on patients with severe/very severe chronic obstructive pulmonary disease (COPD) are unclear. This review aimed to investigate the effects of exercise-based PR on patients with severe/very severe COPD.

Methods:

PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov databases were searched from inception to December 23, 2022, without language restrictions. Randomized controlled trials (RCTs) investigating the effects of exercise-based PR on patients with severe/very severe COPD were included. Study selection, data extraction, and risk of bias assessment were conducted independently. RevMan software (version 5.3) was used for meta-analysis. The quality of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation system.

Results:

Six studies (263 patients) were identified. Compared with the control group, the 6-min walking distance [MD = 52.91, 95% CI (3.80, 102.03)], the St. George’s Respiratory Questionnaire total scores [MD = −7.70, 95% CI (−14.32, −1.08)] and the Borg scale scores [MD = −0.68, 95% CI (−1.28, −0.08)] in the experimental group improved, respectively. The St. George’s Respiratory Questionnaire and Borg scale scores were rated as ‘moderate quality’ and ‘low quality’, respectively, and the 6-min walking distance was rated as ‘very low quality’.

Conclusions:

Exercise-based PR may improve the exercise capacity, quality of life and dyspnea of patients with severe/very severe COPD, which can be regarded as an adjuvant treatment. High quality and large sample RCTs are needed.

Registration:

This systematic review and meta-analysis protocol was prospectively registered with PROSPERO (No. CRD42022294085).
Knowledge, attitude, and practice on antibiotics use among healthcare workers: A cross-sectional study in Niger state, Nigeria
Authors: Abubakar Bala , Sárváry Attila
Published: March 2023

Introduction

Antibiotic resistance is a public health concern in Nigeria and the world, and healthcare workers contributed to the upsurge of antibiotic resistance in hospital settings. This study focused on the knowledge, attitude, and practice (KAP) of antibiotic use and the frequency of prescriptions of antibiotics from the list of WHO Model Essentials Antibiotics (AWaRe) (in the last 6 months) among healthcare workers and established the determining factors in six hospitals in Niger state, Nigeria.

Methodology

A KAP survey was conducted in Niger State, Nigeria, from March to June 2022. A structured self-administered, pretested questionnaire was distributed to six hospitals in the state following a stratified random sampling considering the staff capacity, the population of the city, and patients’ patronage.

Results

A total of 350 questionnaires distributed, and 313 (89.4%) completed and returned from the six hospitals. The median scores were knowledge (75%), attitude (69%), practice (62%), and self-reported prescription (70%), and respondents with good scores were knowledge [195 (62.3%)], attitude [185 (59.1%)], practice [201 (64.2%)], and prescription [117 (37.4%)]. In multivariate analysis, older respondents are more likely to have a good prescription ( p = 0.006), and prior antimicrobial training improved their knowledge ( p < 0.001), attitude ( p = 0.007), and prescription pattern ( p = 0.009). All the study participants had prescribed one or more of the most prescribed antibiotics; Amoxicillin clavulanate (Access group, 96.5%), Amoxicillin (Access group, 95.9%), and Metronidazole (Access group, 95.7%).

Conclusions

The study suggests that antibiotic education for healthcare workers and antimicrobial stewardship programs are significant interventions to mitigate antibiotic overuse in the state.
A Retrospective Cohort Analysis of Two Computerized Insulin Infusion Protocols
Authors: Lalani Benjamin , Gosselin Kevin , Penno Ruth , Puryear Bruce , Rilo Horacio , Lalani Atul
Published: March 2023

Objective:

The primary objective of this analysis was to compare the safety and efficacy of a novel computerized insulin infusion protocol (CIIP), the Lalani Insulin Infusion Protocol (LIIP), with an established CIIP, Glucommander.

Methods:

We conducted a 10-month retrospective analysis of 778 patients in whom LIIP was used (August 18, 2020 to June 25, 2021) at six HonorHealth Hospitals in the Phoenix metropolitan area. These data were compared with Glucommander that was used at those same hospitals from January 1, 2018 to August 17, 2020, n = 4700. Primary end points of the project included average time to euglycemia and average time in hyperglycemia (>180 mg/dL) and hypoglycemia (<70 mg/dL). Additional subgroup analysis was done to evaluate CIIP performance in patients in whom maintenance of euglycemia was more challenging.

Results:

The LIIP had a faster time to euglycemia (191 vs 222 minutes, P < .001) and similar time in hypoglycemia (2.79 vs 2.76 minutes, P = .50) for all patients, when compared with Glucommander. Similar observations were made for the following subgroups: diabetic ketoacidosis/hyperosmolar hyperglycemic state (DKA/HHS) patients, COVID-19 patients, patients on steroids, patients with ≥60 glomerular filtration rate (GFR), patients with renal insufficiency, and patients with sepsis.

Conclusions:

The LIIP is a safe and effective CIIP in managing intravenous insulin infusion rates. Utilization of LIIP resulted in reduced time to euglycemia, P < .001, when compared with Glucommander and did not cause increased hypoglycemia during the project period. Contributing factors to the success of LIIP may include improved clinical workflow, learnability and ease of use, compatibility with the Epic electronic health record (EHR), and its unique, dynamic and adaptive algorithm.
An Electronic Health Record Intervention to Limit Viral Testing of Cerebrospinal Fluid
Authors: Lyman Kyle A. , Madill Evan , Thatikunta Prateek , Threlkeld Zachary D. , Banaei Niaz , Gold Carl A.
Published: March 2023

Meningitis and encephalitis are neurologic emergencies that require immediate management and current guidelines recommend empiric treatment with broad-spectrum antimicrobials. Cerebrospinal fluid (CSF) testing algorithms are heterogeneous and largely institution-specific, reflecting a lack of consensus on how to effectively identify CSF pathogens while conserving resources and avoiding false positives. Moreover, many lumbar punctures (LPs) performed in the inpatient setting are done for noninfectious workups, such as evaluation for leptomeningeal metastasis. As such, tailoring CSF testing to clinical context has been a focus of multiple prior reports and several healthcare systems have focused on efforts to limit low-yield diagnostic testing when a positive result is unlikely. To curb ordering viral PCRs when pre-test probability is low, some peer institutions have implemented pleocytosis criteria for virus-specific polymerase chain reaction (PCR) tests from CSF. In this report, we retrospectively analyzed the diagnostic testing of CSF from patients who had an LP while admitted to a single, large academic medical center and found that many cases of Herpes Simplex Virus (HSV) meningoencephalitis were diagnosed by non-neurologists. The rate of positive virus-specific PCR tests was very low, and tests were frequently ordered in duplicate with a multiplexed meningitis/encephalitis PCR panel (M/E panel, BioFire, Salt Lake City, UT). We designed and implemented a systems-level intervention to promote a revised stepwise testing algorithm that minimizes unnecessary tests. This intervention led to a significant reduction in the number of low-yield virus-specific PCR tests ordered without implementing a policy of cancelling virus-specific PCRs.
Questions and Answers: Research Related to the Teaching of String Technique
Authors: Mishra Jennifer
Published: March 2023

The purpose of this study was to review research studies in the area of string technique and pedagogy. Nearly 50 research reports were reviewed and categorized into those concerned with predictions of success in a string program, class organization, and the development of right- and left-hand position. Results of various studies were reported and implications for teaching were discussed.
String Programs in Low Socioeconomic Level School Districts
Authors: Smith Camille M.
Published: March 2023

This study examined string programs in low socioeconomic level school districts where more than twenty-five percent of the children fell below the U.S. Census poverty level. The preliminary findings revealed a 28 percent decrease in the number of such districts that offered strings during the five-year period from 1994 (100) to 1999 (72). Questionnaires were sent to the remaining 72 districts that still had viable string programs with a response rate of 83.3 percent (60). The findings indicated that 90 percent of the districts offered orchestra at the high school level, 85 percent offered strings at the middle school level, and 70 percent offered beginning string classes at the elementary school level. It was also found that as school district size increased, strings were offered primarily in either performing arts or academically gifted schools. Findings related to string program funding indicated that one-third to one-half of the districts with less than 10,000 students or more than 30,000 students used outside funding sources to pay the teachers’ salaries and provide instruments. Among the outside funding sources identified were 1) private foundation grants, 2) corporate grants, 3) state arts grants, 4) federal government Title I funds, and 5) magnet school desegregation funds.
Attitudes of Non-String Playing, Pre-Service Teachers towards Teaching Strings
Authors: Mishra Jennifer
Published: March 2023

The purpose of this study was to investigate attitudes of instrumental pre-service teachers, whose primary instrument was not a bowed string instrument, towards teaching strings. Nineteen Music Education majors enrolled in a required string methods class at a mid-western university answered open-ended questions designed to elicit attitudes and confidence towards teaching strings. The pre-service teachers were comfortable with limited string teaching, specifically, teaching one string class only as a part of a teaching position that involved primarily teaching band. Responsibility for a string program was outside the comfort zone of most pre-service teachers. Students felt their greatest strength was general musical ability, and greatest weaknesses were lack of knowledge about stringed instruments and ability to perform on these instruments. An important finding is that many of the students who had already completed the string techniques class still felt they lacked sufficient knowledge and technical ability to teach strings. Future investigtions are necessary to discover if these are wide-spread attitudes and whether they can be affected by classes, observations, and/or field experiences in an orchestral setting.
Performance Practice of Violin Vibrato: An Artist-Level Case Study
Authors: Allen Michael L. , Geringer John M. , MacLeod Rebecca B.
Published: March 2023

We investigated performance practice of vibrato with an artist-level violinist whose credits include positions as concertmaster of the New York Philharmonic, Cincinnati Symphony, and the Dallas Symphony Orchestra. The main questions of this case study were to determine mean width, rate, and directional intent of an artist-level violinist. Additionally the present study sought to determine if an artist-level violinist consistently initiated vibrato in an upward or downward direction and whether vibrato was used continuously when performing slurs. We measured pitch levels of vibrated and non-vibrated tones, direction and magnitude of change when initiating vibrato, and duration of non-vibrato when performing slurs. Analyses indicated that the mean rate of the artist-level violin vibrato was approximately 5.7 Hz in first position and 6.3 Hz in fifth position. The mean width of vibrato was approximately 40 cents in first position and 108 cents in fifth position. Pitch oscillations during vibrato were alternations both above and below the conceived pitch, rather than oscillations only above or only below the conceived pitch. The artist initiated vibrato toward the scroll (in a downward direction) and stopped vibrating during the transition between slurred notes. Mean duration of non-vibrato portions of slurred notes was (33 seconds). Implications for future research are discussed.
Review of String Orchestra Literature: Educational Articles appearing in Peer-Reviewed Journals from 1980–2007
Authors: Nolan Karin K. , Mazon Wendy , Lopez David F. , Cullen Shawn , Sonmezler Ahmet , Curry Jane
Published: March 2023

This literature review summarizes recent string orchestra literature pertaining to findings, implications, and future research suggestions for school orchestra programs and private instruction. String education literature chosen for this review appeared in peer-reviewed, music education journals since 1980, resulting in 59 summaries. Twelve emergent themes were explored, and studies relevant to these topics were selected for inclusion in this review. Summaries are presented and organized by those 12 themes: (1) status of orchestra programs, (2) string-teacher training programs, (3) teaching styles, (4) vibrato and left-hand technique, (5) bowing and articulation, (6) intonation, (7) body issues, (8) concert programming, (9) adjudication/evaluation, (10) extra-musical effects of string classes, (11) community partnerships, and (12) important historical figures. From this review of string literature, it is the authors’ hope readers apply these reported findings in their teaching, identify areas in need of more research, and continue to engage in meaningful string research.
The relations between the European Public Prosecutor’s Office and the Member States that do not participate in the enhanced cooperation
Authors: Giuffrida Fabio
Published: March 2023

The first of June 2021 marked the start of the operational activities of the European Public Prosecutor’s Office (EPPO). Established by Regulation (EU) 2017/1939 (‘EPPO Regulation’), the EPPO is the European Union body competent to investigate, prosecute and bring to judgment the perpetrators of criminal offences affecting the Union’s financial interests. The EPPO was established by means of enhanced cooperation. At the time of writing, five Member States do not participate in the EPPO: Denmark, Ireland, Poland, Hungary and Sweden. The effective action against crimes affecting the Union budget requires however smooth cooperation between the EPPO and its counterparts not only in the Member States that participate in the enhanced cooperation, but also in the non-participating Member States. This contribution delves into such cooperation and the several issues it raises, first providing for some introductory remarks on the choice of some Member States not to join the enhanced cooperation on the EPPO. It then analyses the two main provisions of the EPPO Regulation concerning the EPPO’s relations with non-participating Member States, Article 99 and, most importantly, Article 105. Finally, this contribution shortly addresses the relevant role played by Eurojust in this context.
Fatty liver disease in children (MAFLD/PeFLD Type 2): unique classification considerations and challenges
Authors: Hegarty Robert , Kyrana Eirini , Fitzpatrick Emer , Dhawan Anil
Published: March 2023

In children, fatty liver disease is a group of disorders that often overlaps with inherited metabolic disorders (IMDs), which requires prompt diagnosis and specific management. Metabolic dysfunction–associated fatty liver disease (MAFLD) or, formerly, non-alcoholic fatty liver disease (NAFLD) is the hepatic component of a multisystemic disease that requires a positive criteria in metabolic dysfunction for diagnosis. However, in children, the diagnosis of MAFLD is one of the exclusions of an IMD [paediatric fatty liver disease (PeFLD) type 1] including the possibility that an IMD can be identified in the future following investigations that may be negative at the time. Therefore, while children with fatty liver with metabolic dysfunction could be classified as MAFLD (PeFLD type 2) and managed that way, those who do not fulfil the criteria for metabolic dysfunction should be considered separately bearing in mind the possibility of identifying a yet undiagnosed IMD (PeFLD type 3). This concept is ever more important in a world where MAFLD is the most common cause of liver disease in children and adolescents in whom about 7% are affected. The disease is only partially understood, and awareness is still lacking outside hepatology and gastroenterology. Despite its increasing pervasiveness, the management is far from a one-size-fits-all. Increasing complexities around the genetic, epigenetic, non-invasive modalities of assessment, psychosocial impacts, therapeutics, and natural history of the disease have meant that an individualised approach is required. This is where the challenge lies so that children with fatty liver are considered on their own merits. The purpose of this review is to give a clinical perspective of fatty liver disease in children with relevance to metabolic dysfunction.