bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding Public Participation as a Mechanism Affecting Government Fiscal Outcomes: Theory and Evidence From Participatory Budgeting
Authors: Park Jinsol , Butler J S , Petrovsky Nicolai
Published: April 2022

This study aims to advance our knowledge about the role of public participation in formulating budgetary decisions of local governments. By focusing on participatory budgeting as a prominent form of public participation in the budgetary process, we posit that participatory budgeting serves two important roles in aligning the fiscal outcomes of local governments with citizen preferences: (1) increased transparency of the local budget and (2) improved budget literacy of citizens. This study investigates a link between participatory budgeting and the fiscal outcomes of local governments by utilizing data drawn from Korean local governments for seven fiscal years. Employing instrumental variable regression to address endogeneity, there is strong evidence that public participation and deliberation during the participatory budgeting process have a positive association with the fiscal balance. There is also weak evidence that the authority delegated to participatory budgeting participants affects the fiscal balance. The findings of this study imply that it is the quality of public participation that matters in holding the government accountable for its fiscal decisions.
Vulvovaginal candidiasis and asymptomatic vaginal colonization in Portugal: Epidemiology, risk factors and antifungal pattern
Authors: Fernandes Ângela , Azevedo Nuno , Valente Andreia , Dias Marisol , Gomes Ana , Nogueira-Silva Cristina , Henriques Mariana , Silva Sónia , Gonçalves Bruna
Published: April 2022

Vulvovaginal candidiasis (VVC) has been identified as a global issue of concern due to its clinical, social and economic implications. The emerging relevance of VVC makes it crucial to increase the knowledge on its epidemiological and etiological features in order to improve its prevention and treatment. Thus, this study aimed to reveal the incidence, microbiology, antifungal pattern and risk factors of VVC in Portugal. For that, high vaginal samples were collected from 470 symptomatic and asymptomatic participants; Candida spp. were identified with molecular techniques and their antifungal susceptibility was analyzed with E-tests. The results revealed an incidence of VVC among women with vulvovaginitis of 74.4%. Furthermore, 63.7% of asymptomatic women were colonized with Candida spp. Importantly, women with history of recurrent vaginal infections, those who use over-the-counter antifungals, oral contraceptive pills and non-cotton underwear were found to be at significantly higher risk of developing VVC. Candida albicans was the most common species (59%), followed by Candida glabrata (27%), in a total of eight distinct species, with similar distribution among colonized and infected participants. Of note, various isolates, especially of the most common species, showed low susceptibility towards fluconazole. In contrast, only few isolates showed low susceptibility towards caspofungin. Overall, this study suggests that the identification of species causing VVC and their antifungal susceptibility are urgently needed in clinical practice in order to improve the decision for the most adequate treatment. It also suggests that avoiding certain risk behaviors may prevent the development of VVC.

Lay Summary

Vaginal candidiasis (VVC) is a relevant infection worldwide. In this study, we identified several risk behaviors that may promote VVC and concluded that vaginal microbiologic analyses are urgently required in clinical practice in order to improve the prevention and treatment of this disease.
Formation and evolution of young massive clusters in galaxy mergers: the SMUGGLE view
Authors: Li Hui , Vogelsberger Mark , Bryan Greg L , Marinacci Federico , Sales Laura V , Torrey Paul
Published: April 2022

Galaxy mergers are known to host abundant young massive cluster (YMC) populations, whose formation mechanism is still not well-understood. Here, we present a high-resolution galaxy merger simulation with explicit star formation and stellar feedback prescriptions to investigate how mergers affect the properties of the interstellar medium and YMCs. Compared with a controlled simulation of an isolated galaxy, the mass fraction of dense and high-pressure gas is much higher in mergers. Consequently, the mass function of both molecular clouds and YMCs becomes shallower and extends to higher masses. Moreover, cluster formation efficiency is significantly enhanced and correlates positively with the star formation rate surface density and gas pressure. We track the orbits of YMCs and investigate the time evolution of tidal fields during the course of the merger. At an early stage of the merger, the tidal field strength correlates positively with YMC mass, λtid ∝ M0.71, which systematically affects the shape of the mass function and age distribution of the YMCs. At later times, most YMCs closely follow the orbits of their host galaxies, gradually sinking into the centre of the merger remnant due to dynamical friction, and are quickly dissolved via efficient tidal disruption. Interestingly, YMCs formed during the first passage, mostly in tidal tails and bridges, are distributed over a wide range of galactocentric radii, greatly increasing their survivability because of the much weaker tidal field in the outskirts of the merger system. These YMCs are promising candidates for globular clusters that survive to the present day.
Astrometric identification of nearby binary stars II: Astrometric binaries in the Gaia Catalogue of Nearby Stars
Authors: Penoyre Zephyr , Belokurov Vasily , Evans N Wyn
Published: April 2022

We examine the capacity to identify binary systems from astrometric deviations alone. We apply our analysis to the Gaia eDR3 and DR2 data, specifically the Gaia Catalogue of Nearby Stars. We show we must renormalize (R)UWE over the local volume to avoid biasing local observations, giving a Local Unit Weight Error (LUWE). We use the simple criterion of LUWE>2, along with a handful of quality cuts to remove likely contaminants, to identify unresolved binary candidates. We identify 22,699 binary candidates within 100 pc of the Sun (just under 10 per cent of sources in this volume). We find an astrometric binary candidate fraction of around 20 per cent for giant stars, 10 per cent on the Main Sequence and lower than 1 per cent for White Dwarfs. We also look for Variability Induced Movers, by computing the correlation between photometric variability and astrometric noise - and show that VIMs may dominate the binary population of sub-Solar mass MS stars. We discuss the possibility and limitations of identifying non-luminous massive companions from astrometry alone, but find that our method is insensitive to these. Finally, we compare the astrometric deviations of MS binaries to the simulated sample from paper I, which show excellent agreement, and compute the astrometric candidate binary fraction as a function of absolute magnitude.
A comprehensive Bayesian reanalysis of the SARAS2 data from the epoch of reionization
Authors: Bevins H T J , de Lera Acedo E , Fialkov A , Handley W J , Singh S , Subrahmanyan R , Barkana R
Published: April 2022

We present a Bayesian re-analysis of the sky-averaged 21-cm experimental data from SARAS2 using nested sampling implemented with polychord, spectrally smooth foreground modelling implemented with maxsmooth, detailed systematic modelling and rapid signal emulation with globalemu. Our analysis differs from previous analysis of the SARAS2 data through the use of a full Bayesian framework and separate modelling of the foreground and non-smooth systematics. We use the most up-to-date signal models, including Lyman-α and CMB heating parametrized by astrophysical parameters such as star formation efficiency, X-ray heating efficiency, minimal virial circular velocity of star forming galaxies, CMB optical depth, and the low energy cutoff of the X-ray spectral energy distribution. We consider models with an excess radio background above the CMB produced via radio emission from early galaxies and parametrized by a radio production efficiency. A non-smooth systematic is identified and modelled as both a frequency damped sinusoid introduced by the electronics and separately from the sky. The latter is modulated by the total efficiency of the antenna and marginally favoured by the data. We consider three different models for the noise in the data. The SARAS2 constraints on individual astrophysical parameters are extremely weak, however, we identify classes of disfavoured signals. We weakly disfavour standard astrophysical models with high Lyman-α fluxes and weak heating and more confidently disfavour exotic models with high Lyman-α fluxes, low X-ray efficiencies, and high radio production efficiencies in early galaxies.
Dynamical double black holes and their host cluster properties
Authors: Chattopadhyay Debatri , Hurley Jarrod , Stevenson Simon , Raidani Arihant
Published: April 2022

We investigate the relationship between the global properties of star clusters and their double black hole (DBH) populations. We use the code NBODY6 to evolve a suite of star cluster models with an initial mass of $\mathcal {O}(10^4)$M⊙ and varying initial parameters. We conclude that cluster metallicity plays the most significant role in determining the lifespan of a cluster, while the initial half-mass radius is dominant in setting the rate of BH exchange interactions in the central cluster regions. We find that the mass of interacting BHs, rather than how frequently their interactions with other BHs occur, is more crucial in the thermal expansion and eventual evaporation of the cluster. We formulate a novel approach to easily quantify the degree of BH-BH dynamical activity in each model. We report 12 in-cluster and three out-of-cluster (after ejection from the cluster) DBH mergers, of different types (inspiral, eccentric, and hierarchical) across the 10 N-body models presented. Our DBH merger efficiency is 3–4 × 10−5 mergers per M⊙. We note the cluster initial density plays the most crucial role in determining the number of DBH mergers, with the potential presence of a transitional density point (between 1.2 and 3.8 × 103 M⊙ pc−3) below which the number of in-cluster mergers increases with cluster density and above which the increased stellar density acts to prevent in-cluster BH mergers. The importance of the history of dynamical interactions within the cluster in setting up the pathways to ejected DBH mergers is also discussed.
Simulating high-time resolution radio-telescope observations
Authors: Luo Rui , Hobbs George , Yong Suk Yee , Zic Andrew , Toomey Lawrence , Dai Shi , Dunning Alex , Li Di , Marshman Tommy , Wang Chen , Wang Pei , Wang Shuangqiang , Zhang Songbo
Published: April 2022

We describe a new software package for simulating channelised, high-time resolution data streams from radio telescopes. The software simulates data from the telescope and observing system taking into account the observation strategy, receiver system and digitisation. The signatures of pulsars, fast radio bursts and flare stars are modelled, including frequency-dependent effects such as scattering and scintillation. We also simulate more generic signals using spline curves and images. Models of radio frequency interference include signals from satellites, terrestrial transmitters and impulsive, broadband signals. The simulated signals can also be injected into real data sets. Uses of this software include the production of machine learning training data sets, development and testing of new algorithms to search for anomalous patterns and to characterise processing pipelines.
Disc cloaking: Establishing a lower limit to the number density of local compact massive spheroids/bulges and the potential fate of some high-z red nuggets
Authors: Hon Dexter S-H , Graham Alister W , Davis Benjamin L , Marconi Alessandro
Published: April 2022

The near-absence of compact massive quiescent galaxies in the local Universe implies a size evolution since z ∼ 2.5. It is often theorized that such ‘red nuggets’ have evolved into today’s elliptical (E) galaxies via an E-to-E transformation. We examine an alternative scenario in which a red nugget develops a rotational disc through mergers and accretion, say, at 1 ≲ z ≲ 2, thereby cloaking the nugget as the extant bulge/spheroid component of a larger, now old, galaxy. We have performed detailed, physically motivated, multicomponent decompositions of a volume-limited sample of 103 massive ($M_*/\rm M_{\odot } \gtrsim 1\times 10^{11}$) galaxies within 110 Mpc. Many less massive nearby galaxies are known to be ‘fast-rotators’ with discs. Among our 28 galaxies with existing elliptical classifications, we found that 18 have large-scale discs, and two have intermediate-scale discs, and are reclassified here as lenticulars (S0) and elliculars (ES). The local spheroid stellar mass function, size–mass diagram and bulge-to-total (B/T) flux ratio are presented. We report lower limits for the volume number density of compact massive spheroids, nc, Sph ∼ (0.17–$1.2) \times 10^{-4}\, \rm Mpc^{-3}$, based on different definitions of ‘red nuggets’ in the literature. Similar number densities of local compact massive bulges were reported by de la Rosa et al. using automated two-component decompositions and their existence is now abundantly clear with our multicomponent decompositions. We find disc-cloaking to be a salient alternative for galaxy evolution. In particular, instead of an E-to-E process, disc growth is the dominant evolutionary pathway for at least low-mass ($1\times 10^{10}\lt M_*/\rm M_{\odot } \lessapprox 4 \times 10^{10}$) red nuggets, while our current lower limits are within an alluring factor of a few of the peak abundance of high-mass red nuggets at 1 ≲ z ≲ 2.
Exploration, explanation and exploitation of hydroxyls in zeolites
Authors: Dib Eddy , Clatworthy Edwin B , Cruchade Hugo , Medeiros-Costa Izabel C , Nesterenko Nikolai , Gilson Jean-Pierre , Mintova Svetlana
Published: April 2022

The precise location and role of all types of hydroxyls in zeolites are still enigmatic, and their control permits tailoring of novel properties increasing the efficiency of catalysts and adsorbents in industrial processes for cleaner energy.
Language and the Regulation of Marriage
Authors: Basu Srimati , Barrett Rusty
Published: April 2022

As marriage is central to cultural understandings of gender and sexuality, linguists have examined talk about marriage, the language of wedding invitations, and the language of ceremonies themselves. It is also common for the rite of marriage to align with changes in language use, such as linguistic exogamy or mother-in-law language. This chapter considers how such changes inflect gendered identity. The discussion outlines the ways in which the felicity of a marriage pronouncement as a performative is often independent of the actual words spoken as vows and examines the language associated with changes to marriage, including same-sex marriage. The review suggests that linguists pay closer attention to how language defines what is outside of marriage and how such definitions create inequalities by marginalizing and valorizing individuals through the institution itself.
‘It’s a crutch’: A qualitative exploration of UK police employees’ experiences of at-risk alcohol consumption or abstinence
Authors: Irizar Patricia , Jackson Leanne , Gage Suzanne H , Bell Sean , Piper Richard , Fallon Victoria , Goodwin Laura
Published: April 2022

One-third of UK police employees drink to at-risk levels, with both at-risk drinking and abstinence being associated with poor mental health. This research aimed to qualitatively explore police employees’ experiences of at-risk alcohol use or abstinence, their motivations for drinking/abstaining, and the organizational culture of drinking. Semi-structured telephone interviews with 16 UK serving police employees (12 at-risk drinkers, four abstainers) were conducted and analysed using thematic analysis. Five themes were identified. Participants described the ‘organizational culture of drinking and changes over time’, outlining a cultural shift. Motivations for drinking were reflected across two themes, ‘alcohol as a coping mechanism’ and ‘alcohol and socializing’, with an additional theme representing ‘motivations for abstinence/cutting down’. The final theme highlighted the ‘contrasting perceptions of available support’. Though the drinking culture is no longer as prominent, using alcohol socially and to cope, is normalized. The implications and recommendations for practice are outlined.
Blended-Learning Pain Neuroscience Education and Exercise in High School Students With Chronic Neck Pain: A Randomized Controlled Trial
Authors: Andias Rosa , Sa-Couto Pedro , Silva Anabela G
Published: April 2022

Objective

Pain neuroscience education (PNE) and exercise have emerged as potential interventions in adolescents with chronic pain; however, very few studies have explored their effectiveness. Blended-learning approaches combining face-to-face and online educational sessions have also emerged as facilitating methods of health education. This study aimed to compare the effectiveness of exercises and PNE versus exercise alone in adolescents with chronic neck pain (NP).

Methods

A randomized controlled trial with 6-month follow-up was conducted in 2 high schools. Over 8 weeks, a total of 127 adolescents with chronic NP were randomly allocated to either (1) perform functional and region-specific exercises, including generalized neuromuscular control, endurance, and strength exercises, as well as exercises targeting the deep neck flexor and extensor muscles and scapular stabilizer muscles; or (2) perform the same exercise-based intervention plus PNE. Pain intensity (primary outcome), disability, sleep, catastrophizing, fear of movement, self-efficacy, and knowledge of pain neuroscience were assessed at baseline, postintervention, and 6-month follow-up. Neck and scapular muscle endurance and pressure pain thresholds were assessed at baseline and postintervention. Patient’s Global Impression of Change was assessed postintervention and at 6-month follow-up.

Results

There was a significant decrease in pain intensity from baseline to postintervention and from baseline to follow-up in both groups, but there were no between-group differences or interactions between time and groups. These results were similar for the secondary outcomes, except for knowledge of pain neuroscience, for which a significant group and time interaction was found.

Conclusion

Exercise and exercise plus PNE were similarly effective in treating adolescents with chronic NP, and the results were maintained for up to 6 months. Further studies are needed to explore the effect of these interventions for longer follow-ups.
Guillain-Barré Syndrome Related and Unrelated to COVID-19: Clinical Follow-Up in the COVID-19 Era
Authors: Masuccio Fabio Giuseppe , Tipa Virginia , Invernizzi Marco , Solaro Claudio
Published: April 2022

Objective

COVID-19 has been associated with neurological complications such as Guillain-Barre syndrome (GBS). Several cases have been reported but without functional outcome data after intensive rehabilitation and medium-term follow-up.

Methods

In this observational study, patients were admitted in 2019 and 2020 to inpatient rehabilitation for GBS and were examined using the Barthel index, GBS-Disability Scale, and Medical Research Scale-sum score at admission, discharge, and at least 6 months after onset of symptoms. All the participants received personalized, goal-oriented inpatient rehabilitative treatment for the recovery of self-sufficiency in everyday life.

Results

Eleven people with GBS—3 cases related to COVID-19—were admitted in 2019 and 2020 to inpatient rehabilitation. Eight patients with GBS not related to COVID-19 experienced a high complication rate during inpatient rehabilitation, with 2 deaths due to sepsis. In this cohort, a higher prevalence than expected of acute motor axonal neuropathy was also detected. The COVID-19–related GBS group did not have any complications. After a mean of 10.11 months (SD = 4.46 months), 55.55% of patients regained autonomous walking.

Conclusion

COVID-19–related GBS appeared to have a better clinical outcome than GBS that was not COVID-19 related. A higher than usual prevalence of acute motor axonal neuropathy form was encountered. More follow-up studies are needed to understand whether the recovery of GBS related to COVID-19 might be different from that of GBS unrelated to COVID-19.

Impact

No data are currently available on the follow-up of GBS in the COVID-19 era and on the functional outcome of those patients. This study provides important information indicating that GBS related to COVID-19 might have a better clinical outcome than GBS unrelated to COVID-19.
Preparing Medical Students to Address Health Disparities Through Longitudinally Integrated Social Justice Curricula: A Systematic Review
Authors: Draper Julia K. , Feltner Cynthia , Vander Schaaf Emily B. , Mieses Malchuk Alexa
Published: April 2022

Purpose

The education of health care professionals is a contributing factor to persistent health disparities. Although medical students are expected to understand racism, classism, and other social and structural drivers of health (SDH), standardization and best practices for teaching these concepts are lacking. Some medical schools are adopting social justice curricula (SJC) that prioritize health equity in teaching students to recognize SDH and preparing them to address the consequent health disparities. This systematic review sought to evaluate how these schools have integrated SJC into their core teaching; the criteria they have used to measure success and to what extent these criteria are met; and best practices in planning, implementing, and evaluating SJC.

Method

The authors searched 7 databases for English-language studies published between January 2000 and April 2020, reporting on longitudinally integrated SJC at U.S. medical schools intended for all students. Quantitative and qualitative outcomes were synthesized and summarized.

Results

Searches identified 3,137 articles, of which 11 met inclusion criteria. Results demonstrated schools use a variety of teaching methods over a wide range of didactic hours to teach SJC concepts. Surveys and objective tests indicated students in SJC are generally satisfied and demonstrated improved knowledge and skills related to understanding and mitigating SDH, although findings related to changes in attitudes were equivocal. Evaluations at graduation and in residency demonstrated students who experience SJC are more prepared than their peers to work with patients who are underserved. Best practices in SJC included addressing the hidden curriculum, considering medical mistrust, and using tools like the Racial Justice Report Card and Tool for Assessing Cultural Competence Training.

Conclusions

These findings indicated SJC can prepare students to better address the root causes of health disparities. Future research should consider the long-term influences of these curricula on students, patients, and the community.
Remission and Relapse of Hypertension After Bariatric Surgery: A Retrospective Study on Long-Term Outcomes
Authors: Fisher David P. , Liu Liyan , Arterburn David , Coleman Karen J. , Courcoulas Anita , Haneuse Sebastien , Johnson Eric , Li Robert A. , Theis Mary Kay , Taylor Brianna , Fischer Heidi , Cooper Julie , Herrinton Lisa J.
Published: April 2022

Objectives:

To compare hypertension remission and relapse after bariatric surgery compared with usual care.

Background:

The effect of Roux-en-Y gastric bypass and sleeve gastrectomy on hypertension remission and relapse has not been studied in large, multicenter studies over long periods and using clinical blood pressure (BP) measurements.

Methods:

This retrospective cohort study was set in Kaiser Permanente Washington, Northern California, and Southern California. Participants included 9432 patients with hypertension 21–65 years old who underwent bariatric surgery during 2005–2015 and 66,651 nonsurgical controls matched on an index date on study site, age, sex, race/ethnicity, body mass index, comorbidity burden, diabetes status, diastolic and systolic BP, and number of antihypertensive medications.

Results:

At 5 years, the unadjusted cumulative incidence of hypertension remission was 60% (95% confidence interval [CI], 58–61%) among surgery patients and 14% (95% CI, 13–14%) among controls. At 1 year, the adjusted hazard ratio for the association of bariatric surgery with hypertension remission was 10.24 (95% CI, 9.61–10.90). At 5 years, the adjusted hazard ratio was 2.10 (95% CI, 1.57–2.80). Among those who remitted, the unadjusted cumulative incidence of relapse at 5 years after remission was 54% (95% CI, 51–56%) among surgery patients and 78% (95% CI 76–79%) among controls, although the adjusted hazard ratio was not significant (hazard ratio, 0.71; 95% CI, 0.46–1.08).

Conclusions:

Bariatric surgery was associated with greater hypertension remission than usual care suggesting that bariatric surgery should be discussed with patients with severe obesity and hypertension. Surgical patients who experience remission should be monitored carefully for hypertension relapse.
Weight-Bearing Computed Tomography of the Foot and Ankle in the Pediatric Population
Authors: Holbrook Hayden S. , Bowers Alexander F. , Mahmoud Karim , Kelly Derek M.
Published: April 2022

Background:

Newer cone-beam computed tomography (CT) technology has grown in popularity for evaluation of foot and ankle pathology in the weight-bearing (WB) position. Many studies have demonstrated its benefits within the adult population, but there is a paucity of its use within the pediatric literature. The purpose of this study was to describe the indications and clinical findings of WBCT within a pediatric population.

Methods:

A retrospective cohort of 68 patients (86 extremities) who underwent WBCT for a variety of conditions were compared with 48 patients (59 extremities) who underwent traditional supine nonweight-bearing (NWB) CTs. Clinical indications, demographic data, radiation doses, and cost were obtained from the medical record. WBCTs were obtained in a private outpatient orthopaedic clinic, and the conventional NWBCTs were obtained within a hospital-based system.

Results:

The most common indications for obtaining a WBCT and NWBCT in our study were fracture, tarsal coalition, and Lisfranc injury. The average WBCT radiation dose was 0.63 mGy for patients <100 lbs and 1.1 mGy for patients >100 lbs undergoing WBCT. For NWBCTs, the average radiation dose was 7.92 mGy for patients <100 lbs and 10.37 mGy for patients greater than 100 lbs. There was a significant reduction in radiation dose for all patients who underwent WBCT (P<0.0001 vs. 0.002). The average reimbursement for NWBCTs was $505 for unilateral studies and $1451 for bilateral studies. The average reimbursement for the WBCTs was $345 for unilateral studies and $635 for bilateral studies.

Conclusions:

WBCT offers a new modality for studying complex foot and ankle pathoanatomy in the pediatric population at a reduced radiation exposure and reduced cost.

Level of Evidence:

Level III—a retrospective comparative study.
Interobserver Agreement and Reliability of Intrapartum Nonreassuring Cardiotocography and Prediction of Neonatal Acidemia
Authors: Li Zhuyu , Wang Yan , Cai Jian , Zhao Peizhen , Chen Hanqing , Liu Haiyan , Shen Lixia , Chen Lian , Li Shufang , Zhao Yangyu , Wang Zilian
Published: April 2022

Objective:

To evaluate the agreement and reliability of intrapartum nonreasurring cardiotocography (CTG) interpretation and prediction of neonatal acidemia by obstetricians working in different centers.

Methods:

A retrospective cohort study involving two tertiary hospitals (The First Affiliated Hospital of Sun Yat-sen University and Perking University Third Hospital) was conducted between 30th September 2018 and 1st April 2019. Six obstetricians from two hospitals with three levels of experience (junior, medium, and senior) reviewed 100 nonreassuring fetal heart rate (FHR) tracings from 1 hour before the onset of abnormalities until delivery. Each reviewer determined the FHR pattern, the baseline, variability, and presence of acceleration, deceleration, sinusoidal pattern, and predicted whether neonatal acidemia and abnormal umbilical arterial pH < 7.1 would occur. Inter-observer agreement was assessed using the proportions of agreement (Pa) and the proportion of specific agreement (Pa for each category). Reliability was evaluated with the kappa statistic (k-Light's kappa for n raters) and Gwet's AC1 statistic.

Results:

Good inter-observer agreement was found in evaluation of most variables (Pa > 0.5), with the exception of early deceleration (Pa = 0.39, 95% confidence interval (CI): 0.36,0.43). Reliability was also good among most variables (AC1 > 0.40), except for acceleration, early deceleration, and prediction of neonatal acidemia (AC1 = 0.17, 0.10, and 0.25, respectively). There were no statistically significant differences among the three groups, except in the identification of accelerations (Pa = 0.89, 95% CI: 0.83,0.95; Pa = 0.50, 95% CI: 0.41,0.60, and Pa = 0.35, 95% CI: 0.25,0.43 in junior, medium and senior groups, respectively) and the prediction of neonatal acidemia (Pa = 0.52, 0.52, and 0.62 in junior, medium and senior groups, respectively), where agreement was highest and lowest in the junior-level group, respectively. The accuracy and sensitivity of the prediction for umbilical artery pH < 7.1 were similar among the three groups, but the specificity was higher in the senior groups (93.68% vs. 92.53% vs. 98.85% in junior, medium and senior groups, P = 0.015).

Conclusion:

Although we found a good inter-observer agreement in the evaluation of the most basic CTG features and FHR category statistically, it was insufficient to meet the clinical requirements for “no objection” interpretation for FHR tracings. Further specialized training is needed for standardized interpretation of intrapartum FHR tracings.
CTGNet: Automatic Analysis of Fetal Heart Rate from Cardiotocograph Using Artificial Intelligence
Authors: Zhong Mei , Yi Hao , Lai Fan , Liu Mujun , Zeng Rongdan , Kang Xue , Xiao Yahui , Rong Jingbo , Wang Huijin , Bai Jieyun , Lu Yaosheng
Published: April 2022

Objective:

This study investigates the efficacy of analyzing fetal heart rate (FHR) signals based on Artificial Intelligence to obtain a baseline calculation and identify accelerations/decelerations in the FHR through electronic fetal monitoring during labor.

Methods:

A total of 43,888 cardiotocograph(CTG) records of female patients in labor from January 2012 to December 2020 were collected from the NanFang Hospital of Southern Medical University. After filtering the data, 2341 FHR records were used for the study. The ObVue fetal monitoring system, manufactured by Lian-Med Technology Co. Ltd., was used to monitor the FHR signals for these pregnant women from the beginning of the first stage of labor to the end of delivery. Two obstetric experts together annotated the FHR signals in the system to determine the baseline as well as accelerations/decelerations of the FHR. Our cardiotocograph network (CTGNet) as well as traditional methods were then used to automatically analyze the baseline and acceleration/deceleration of the FHR signals. The results of calculations were compared with the annotations provided by the obstetric experts, and ten-fold cross-validation was applied to evaluate them. The root-mean-square difference (RMSD) between the baselines, acceleration F-measure (Acc.F-measure), deceleration F-measure (Dec.F-measure), and the morphological analysis discordance index (MADI) were used as evaluation metrics. The data were analyzed by using a paired t-test.

Results:

The proposed CTGNet was superior to the best traditional method, proposed by Mantel, in terms of the RMSD.BL (1.7935 ± 0.8099 vs. 2.0293 ± 0.9267, t = −3.55 , P = 0.004), Acc.F-measure (86.8562 ± 10.9422 vs. 72.2367 ± 14.2096, t = 12.43, P <0.001), Dec.F-measure (72.1038 ± 33.2592 vs. 58.5040 ± 38.0276, t = 4.10, P <0.001), SI (34.8277±20.9595 vs. 54.8049 ± 25.0265, t = −9.39, P <0.001), and MADI (3.1741 ± 1.9901 vs. 3.7289 ± 2.7253, t = −2.74, P = 0.012). The proposed CTGNet thus had significant advantages over the best traditional method on all evaluation metrics.

Conclusion:

The proposed Artificial Intelligence-based method CTGNet delivers good performance in terms of the automatic analysis of FHR based on cardiotocograph data. It promises to be a key component of smart obstetrics systems of the future.
Evolving Frameworks for the Foundation and Practice of Electronic Fetal Monitoring
Authors: Evans Mark I. , Britt David W. , Evans Shara M. , Devoe Lawrence D.
Published: April 2022

Since the 1970s, electronic fetal monitoring (EFM) also known as cardiotocography (CTG) has been used extensively in labor around the world, despite its known failure to help prevent many babies from developing neonatal encephalopathy and cerebral palsy. Part of EFM's poor performance with respect to these outcomes arises from a fundamental misunderstanding of the differences between screening and diagnostic tests, subjective classifications of fetal heart rate (FHR) patterns that lead to large inter-observer variability in its interpretation, failure to appreciate early stages of fetal compromise, and poor statistical modeling for its use as a screening test. We have developed a new approach to the practice and interpretation of EFM called the fetal reserve index (FRI) which does the following: (1) breaking FHR components down into 4 components, (heart rate, variability, accelerations, and decelerations); (2) contextualizing the metrics by adding increased uterine activity; (3) adding specific maternal, fetal, and obstetric risk factors. The result is an eight-point scoring metric that, when directly compared with current American College of Obstetricians and Gynecologists EFM categories, even in version 1.0 with equal weighting of variables, shows that the FRI has performed much better for identifying cases at risk before damage had occurred, reducing the need for emergency deliveries, and lowering overall Cesarean delivery rates. With increased data, we expect further refinements in the specifics of scoring that will allow even earlier detection of compromise in labor.
A Nonexercise Estimate of Cardiorespiratory Fitness Using a Symptom Questionnaire and Clinical Variables
Authors: Myers Jonathan , Chan Khin , Tan Isabelle M. C. , Bail Nicholas , Kamil-Rosenberg Shirit , Zell Hunter , Waheed Tabbasum , Mathew Pooja
Published: April 2022

Purpose:

Cardiorespiratory fitness (CRF) has recently been recognized as a risk factor for mortality, but it is not routinely measured in clinical settings. The purpose of this study was to assess a nonexercise method to estimate CRF (eCRF) and its association with mortality in a clinically referred population.

Methods:

A symptom tool, termed the Veterans Specific Activity Questionnaire (VSAQ), and nonexercise clinical variables were obtained from 1545 clinically referred subjects (60 ± 13 yr), and followed for a mean of 5.6 ± 4.2 yr. The VSAQ along with nonexercise clinical and historical variables was used to develop a multivariate model to predict achieved CRF from maximal exercise testing. Proportional hazards analysis was used to assess the association between measured and eCRF and all-cause mortality.

Results:

The eCRF model was significantly associated with achieved CRF (multiple R = 0.67, P < .001). Mean achieved CRF from maximal treadmill testing and eCRF were similar (8.6 ± 5.0 metabolic equivalents [METs] vs 8.7 ± 4.7 METs respectively, P = .27). Achieved CRF and eCRF performed similarly for predicting mortality. After full adjustment, each 1 MET higher increment in achieved CRF and eCRF was associated with 19% and 26% reductions in mortality risk, respectively. Compared with the lowest fit group (<5 METs), the highest CRF groups (>11 METs) had 88% and 87% lower risks for mortality for achieved CRF and eCRF, respectively.

Conclusions:

A multivariable nonexercise model featuring a symptom questionnaire combined with clinical variables that are readily available during a typical clinical encounter had a reasonably strong association with achieved CRF and exhibited prognostic characteristics that were similar to achieved CRF.
Accuracy of newer intraocular lens power formulas in short and long eyes using sum-of-segments biometry
Authors: Shammas H. John , Taroni Leonardo , Pellegrini Marco , Shammas Maya C. , Jivrajka Renu V.
Published: April 2022

Purpose:

To analyze the accuracy of newer intraocular lens power formulas in long and short eyes measured using the sum-of-segments biometry.

Setting:

Private practice, Lynwood, California.

Design:

Retrospective observational study.

Methods:

595 patients scheduled for cataract surgery had their eyes measured using the sum-of-segments biometry. The expected residual refractions were calculated using Barrett Universal II (B II), Barrett True Axial Length (BTAL), Emmetropia Verifying Optical (EVO), Hill-RBF, Hoffer QST, Holladay 2, Holladay 2-NLR, K6, Kane, Olsen, PEARL-DGS, T2, and VRF formulas and compared with the traditional Haigis, Hoffer Q, Holladay 1, and SRK/T formulas.

Results:

In the 102 long eyes, all new formulas had a mean absolute error (MAE) equal or lower than the traditional formulas, ranging from 0.29 to 0.32 diopter (D). In the 78 short eyes, BTAL, EVO, Hoffer QST, K6, Olsen, and PEARL-DGS formulas had the lowest MAE (0.33 D, 0.33 D, 0.31 D, 0.36 D, 0.32 D, and 0.32 D, respectively), whereas all traditional formulas exceeded 0.36 D.

Conclusions:

All new formulas performed equal or better than the traditional formulas with the sum-of-segments biometry. The best overall results in the short and long eyes as well as in the very short and very long eyes were noted with the BTAL, EVO, Hoffer QST, K6, Olsen, and PEARL-DGS formulas, closely followed by the B II and Kane formulas.
Perceptions of Parent Stressors in the Neonatal Intensive Care Unit Among the General Public and Healthcare Professionals
Authors: Pritchard Verena E. , Rizkallah Sarah
Published: April 2022

Objectives:

Intervention efforts to improve the psychosocial well-being of parents with an infant in the neonatal intensive care unit (NICU) are high priority. This study assessed public and healthcare professionals' perceptions of prominent NICU stressors to highlight areas where NICU parents are in need of further support. Relations with sample characteristics were also examined to establish the generalizability of known parent demographic/sociofamilial risk factors.

Methods:

A cross-sectional design was used to assess public (n = 96) and staff (n = 55) responses on the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU).

Results:

The public perceived parental stress as being low to moderate. This was significantly lower than the staff estimate and highly comparable with past parent reports. Staff communication was perceived as most stressful by the public with this influenced by gender and education. Staff with more NICU experience were more likely to overestimate parental stress, particularly those working at the highest care level.

Conclusions:

Collectively, these findings highlight preconceived anxiety around staff communication and behaviors and indicate that education on the potential for traumatic unit experiences to influence staff-parent communication may be important.
Engaging Parents of Fragile Infants in the Design and Appraisal of Health Literature
Authors: Wyles Christina , Gephart Sheila M. , Nunez Francesco
Published: April 2022

What Was Observed or Investigated:

The increased morbidity of diverse infants is unacceptable, and methods to reduce necrotizing enterocolitis (NEC) in their communities are needed. This article discusses the importance of the Español toolkit; provides a backstory of how the Español toolkit came about and how it was verified and validated; and concludes with impressions from involving parents in the research process.

Subjects and Methods:

After research evidence was translated from English into Spanish, a cross-sectional exploratory, descriptive, mixed-methods study was conducted, guided by the knowledge translation into practice (Translating Research Into Practice [TRIP]) framework. Twenty bilingual English-Spanish parents of fragile infants evaluated the NEC-Zero Español toolkit from a single neonatal intensive care unit.

Results and Conclusions:

The NEC-Zero Español toolkit was found to be easy-to-use and useful and provided information that can be used to augment information sharing. Having access to health information offers a meaningful way to start a conversation and may even impact positive behaviors such as breastfeeding promotion. To lessen Spanish speakers' linguistic barriers, providing materials in Spanish can help meet their information needs and initiate conversations with healthcare providers. This is particularly important because Hispanic infants are at high risk for NEC.
Refocusing the Conduct of Maternal Mortality Research in Black Pregnant Populations
Authors: Amore Alexis Dunn
Published: April 2022

Introduction:

Maternal morbidity and mortality rates are on the rise in the United States, particularly among Black populations. Recently, there has been an uptick in research funding to identify and address root causes, particularly among at-risk groups. However, given the historical trauma experienced by Black populations in research settings, novel approaches built firmly on ethical principles and grounded in a framework of reproductive justice are necessary to minimize harm and center the research process on maintaining the dignity and respect of research participants.

Methods:

Ethical principles as outlined by the American Nurses Association, Black Mamas Matter Alliance, and federal research guidelines are reviewed within the context of conducting maternal mortality-focused research. In addition, community developed research frameworks and methodologies are presented and discussed within the research context.

Conclusions:

Black pregnant people have reported mistreatment during clinical encounters; therefore, intentional protections to promote safety must be considered in the research setting. Ethical principles must be considered when designing and implementing research initiatives focused on addressing maternal mortality risk in Black communities.
Clinical Uniform Management and Contact Nursing Care to Children Under the Age of 3
Authors: Lomba Lurdes , Pereira Ana Laura , Oliveira Rafaela , da Luz Abreu Inês , Stein Backes Dirce , Graveto João
Published: April 2022

Introduction

Nurses' clinical uniforms and scrubs may become a vehicle for the transmission and contamination of pathogenic microorganisms. This study aims to identify the relationship between nursing care, in which there is contact between the clinical uniforms or scrubs, and patients up to 3 years old, the way nurses manage their uniforms, and the microorganisms present.

Method

A quantitative, descriptive–correlational, cross-sectional study was conducted with a sample of 24 pediatric nurses, who filled out demographic surveys and from whom microbiological collections of their clinical uniforms were obtained. In this study, clinical uniforms refer to uniforms, specialized clothing, scrubs, laboratory coats, or whatever is worn by the pediatric nurse who is providing hands-on patient care.

Results

Factors contributing to contamination of clinical clothing (e.g., therapeutic procedures, holding, feeding, hygiene care) were analyzed. The methods for reusing and/or sanitizing the uniforms were studied. The nurses' uniforms had the following microorganisms found: Staphylococcus aureus (58.3%), Bacilli group (41.7%), and Streptococcus bacteria (41.7%), with a higher percentage of microorganisms in the abdomen and left thorax regions. A statistically significant relationship was found between contact during nursing care for the infant and the risk of microbiological contamination in the modified kangaroo method (clothed nurse holding infant to chest) and holding for comfort, transport, or restraint.

Discussion

Proper management of clinical clothing requires special care in its handling by pediatric nurses and the need to standardize practices and adapt behaviors to minimize the risk of contamination. The use of disposable personal protection equipment and the daily changing of uniforms and scrubs are recommended. Institutions should ensure proper management of uniforms.
Diagnostic accuracy of contrast-enhanced ultrasound for microvascular invasion of hepatocellular carcinoma
Authors: Chen Yanli , Qiao Haiyan , Lian Zhaoan , Li Chunlin , Xiang Yi
Published: April 2022

Background:

Microvascular invasion is an independent risk factor for the recurrence of hepatocellular carcinoma (HCC). Early detection and timely treatment can reduce the recurrence and prolong the overall survival of HCC. Contrast-enhanced ultrasound (CEUS) has been validated for their predictive potential of microvascular invasion in HCC patients, although the conclusion remains controversial. Therefore, a meta-analysis is necessary to be conducted to validate the diagnostic value of CEUS for microvascular invasion in HCC, thus supporting guideline development and clinical practice.

Methods:

Relevant studies reporting the potential diagnostic value of CEUS for microvascular invasion in HCC patients published before February 2022 will be searched in the PubMed, EMBASE, Cochrane Library, and Web of Science. Data will be extracted by 2 researchers independently. The risk of bias will be assessed by the Quality Assessment of Diagnostic Accuracy Studies-2. All of the above statistical analysis will be carried out with Stata 14.0.

Results:

The results of this study will be published in a peer-reviewed journal.

Conclusion:

This study will comprehensively evaluate the diagnostic accuracy of CEUS for microvascular invasion in HCC patients, thus providing high-quality evidence to support clinical practice and guideline development.
Effect of traditional Chinese medicine Bailing capsule on renal anemia in maintenance hemodialysis patients
Authors: Li Yan-Lin , Cheng Fang , Chen Yan , Wang Jun , Xiao Zeng-Dong , Li Bin
Published: April 2022

Background:

Renal anemia (RA) is one of the most common complications in patients with end-stage renal disease, and it is also one of the reasons for the decline of quality of life and functional status in patients with end-stage renal disease. Traditional treatment methods often fail to achieve satisfactory therapeutic effects, so it is very necessary to find effective adjuvant treatment methods. Bailing capsule (BLC), a traditional Chinese medicine, which has been widely used in the treatment of RA in maintenance hemodialysis patients, but a systematic review of the efficacy and safety of this drug is currently lacking. Therefore, this study used meta-analysis to evaluate the efficacy and safety of BLC in the treatment of RA, in order to provide guidance for finding effective auxiliary methods for the treatment of RA in maintenance hemodialysis patients (MHP).

Methods:

Using the computer to retrieve PubMed, EMbase, Cochrane Library, CNKI, VIP Database, WANFANG Database, SinoMed from 1990 to 2021 and collecting the clinical randomized controlled trial and retrospective cohort study of BLC in the treatment of RA in MHP. Two researchers independently read and screened the literature, followed by evaluating the retrospective cohort studies that met the selection criteria using the Newcastle-Ottawa Scale (NOS) scale. The randomized controlled trial used the Cochrane manual standards to assess the risk of bias, and the RevMan 5.3 software was used to conduct a meta-analysis of the result data.

Results:

This study will use the method of meta-analysis to evaluate the clinical efficacy and incidence of adverse reactions of BLC in the treatment of RA in MHP through the primary and secondary outcome indicators.

Conclusion:

The results of this study will help clinicians find safe and effective adjuvant therapy in the treatment of RA in MHP.

OSF registration number:

DOI 10.17605/OSF.IO/732KP (https://osf.io/732kp).