bluuebunny/crossref_metadata_2025 huggingface dataset:
Miscellaneous Writings (雜著)
Authors: Ivanhoe Philip J. , Wang Hwa Yeong
Published: July 2023

This section contains two works that don’t fit into any of the standard categories of traditional writing. The first is a fascinating record of the preferences and practices of her ancestors, which she compiled to keep them in her and other family member’s memories and to add more personal touches to the regular sacrifices made to them. The second piece is an exposition (seol 說). It was not listed in a separate expositions section within her extant writings but added here in a section of sundry writings.
Lost Works (拾遺)
Authors: Ivanhoe Philip J. , Wang Hwa Yeong
Published: July 2023

This section contains one poem that was “lost” in the sense of not being included in the original collection that served as the basis for The Extant Writings of Jeongildang.
Media and Emotions
Authors: Minich Matt , Tao Ran , Cascio Christopher N.
Published: July 2023

Although both neuroscience research and communication research have long been interested in the study of emotion, the use of neuroimaging methods to address questions about media and emotion remains novel. In this chapter, the authors highlight ways in which neural measures can be used to provide valuable new perspectives on the study of media and emotion. They offer a general overview of the questions neuroimaging is best suited to address, review current research on the way emotions manifest in the brain, and present several examples of recent work that has applied neuroimaging methods to examine the relationship between neural processes associated with emotions and media effects. Finally, they offer some promising directions for future research.
Social Media Use and Patterns of Emotional Experience
Authors: Nabi Robin L. , Wolfers Lara , King Jesse
Published: July 2023

Given the explosion in social media use since the early 2000s, scholars, parents, physicians, psychologists, and other vested parties have expressed concern over the effects such use might have on users, especially in terms of mental health. This chapter focuses specifically on the relationships between social media use and emotion-based experiences, which in turn relate to mental wellness. Key theoretical perspectives on why people respond emotionally to social media content, including cognitive appraisal theory and social comparison theory, are outlined. The extant literature on the ways in which repeated use of social media may contribute to both negative and positive emotional experiences is then reviewed, with particular focus on anxiety and depression as well as hope and inspiration. Mediating and moderating influences are also considered, with attention to issues related to the nature of social media use and the user’s life stage.
Media Use and Empathy
Authors: Mares Marie-Louise , Kong Susan S.
Published: July 2023

Some researchers have argued that population levels of empathy have declined and that media use is a contributing factor. Preoccupation with phones, the pursuit of likes on social media, the displacement of face-to-face interactions, violent game play, degraded affective cues on mediated platforms have all been considered as culprits. Other researchers have noted that some media use may foster empathy. Narratives can offer opportunities for perspective-taking or teach emotion recognition, instant messaging and other low-cue forms of mediated communication can stimulate intimate disclosures, and virtual reality can offer vivid encounters with others’ experiences. This chapter distinguishes empathy from related constructs and then overviews the evidence of media effects on core components of empathy (affective arousal, emotion understanding, and emotion regulation) and subsequent prosocial responses. Overall, the evidence suggests that some forms and contexts of media use may blunt empathic responding, while other media experiences may enhance it. However, numerous research gaps remain.
Emotion and Online Information Selection
Authors: Luong Kate T. , Knobloch-Westerwick Silvia
Published: July 2023

This chapter provides an overview of the theories and research on emotion-based online media selection. The authors first present the conceptualizations of different affective terms—namely affect, mood, and emotion—and how they differ from one another. They then review the four major theoretical frameworks in this area: mood management theory, mood adjustment theory, the selective exposure self- and affect-management model, and the emotions-as-frames model, followed by existing empirical research with a focus on the online context. Finally, gaps in the current literature are delineated; and, based on the three unique characteristics of online media—affordances, cues, and algorithms—and how they interact with the affect-driven selection process, future research directions are suggested.
Emotion, Information Sharing, and Social Media
Authors: Hasell Ariel , Nabi Robin L.
Published: July 2023

People have always been motivated to share emotional experiences with others, but social media have facilitated the expression and sharing of emotional experiences to mass and diverse audiences to an extent previously unimaginable. This chapter focuses specifically on individuals as sharers, creators, and receivers of information in social media, exploring how emotions initiate this process and to what effect. It examines theories of why emotions spread through social networks and identifies the broad theoretical functions of emotion-based sharing in social media, including motivations for sharing, like social support, persuasion, retribution, and shaming. It also reviews the effects of sharing emotional information on both senders and receivers and highlights important scholarly considerations for future research on the diffusion of emotionally charged information via social media.
Love Bombs and Twitter Terror
Authors: Aday Sean
Published: July 2023

This chapter examines the range of affective responses to terrorist media, focusing especially on digital media, and argues that these emotional effects are more complex than commonly assumed and vary by content type and target audience. It compares terrorist messages in mainstream news and online and theorizes about the emotional appeals and effects of each on sympathetic and unsympathetic audiences, both of which are targets of terrorist communication in different ways. Specifically, this chapter addresses four emotions—anger, fear, anxiety, and disgust—and shows how they are understood differently by terrorist sympathizers and potential sympathizers versus non-sympathizers. Finally, it explores how one might build on previous research to more fully conceptualize the role of emotion in terrorists’ online media.
American Shame and Real Freedom
Authors: Lebron Christopher J.
Published: July 2023

This punch was not like other punches. John McGraw decided the black protester wasn’t welcome in his space. He assaulted him then yelled, “The next time we see him, we might have to kill him.” And Donald Trump was on the stage as this happened. The blow McGraw landed wasn’t unique because it was a sucker punch. Many such punches have been thrown and have landed in the history of human fisticuffs. It wasn’t wrong merely in its racist origins. Rather, it was awful and shameful because it was thrown by a white man at a black protester at a presidential rally for Donald Trump, who will surely go down in American history for shamelessly agitating for physical violence and discord in the name of American patriotism. In this regard, Trump is neither new nor original. What is shocking and galling is that in 2016 Trump and the culprit who landed the blow are able to operate with near impunity. Though the assaulter was eventually arrested, nothing has stopped Trump from reminding America, time and again, that the American way is both the racist and the violent way. But Trump does not stand alone.
Cultural Control against Social Control
Authors: Lebron Christopher J.
Published: July 2023

“We gonna be alright!” These four words were chanted by Black Lives Matters protesters on an overcast day late in July 2015 as they faced down an imposing Cleveland, Ohio police force. The chant seemed straightforward bravado, almost as if to signal to the police lined up against them that their wills were indomitable. That may be part of the story but isn’t the whole story.
Original Empire
Authors: Snow Jennifer C.
Published: July 2023

Early English settlements in North America brought the official Church of England along, with the monarch at its head, and did not make any division between political and religious governance and inclusion. Beginning with the Protestant Reformation the English came with very few conceptual options for the inclusion of religious others aside from violence. This chapter examines the earliest English contacts with Native Americans around Roanoke and Jamestown and religious/governmental efforts to incorporate them into “English” society, including the baptism of Manteo, the Anglo-Powhatan wars, and Pocahontas. Jamestown was also the site of the first record of enslaved Africans sold in North America, and the chapter investigates how enslavement shaped English ideas about the incorporation of others and religious and racial identity in early colonial efforts.
A Conventional Religion
Authors: Snow Jennifer C.
Published: July 2023

The colonial church had to reinvent itself during and after the American Revolution, particularly in terms of the episcopacy, which the American colonial church had never had. This chapter traces the missional challenges involved in creating a church polity in a new, disestablished situation, finding and defining the role of bishops, responding to the Great Awakening and the rise of Methodism, and the first free Black congregation in the Episcopal Church, St. Thomas African Philadelphia. At the end of this period, the Episcopal Church had the seeds of three missional visions: the high church, the low church or evangelical, and the liberating mission of the Black church, which was largely segregated from the white church by the decision of the Diocese of Pennsylvania to deny St. Thomas participation in the diocesan convention.
The Great Innovation
Authors: Snow Jennifer C.
Published: July 2023

The period immediately after the American Revolution was a time of shock and low energy for much of the new Episcopal Church. While other denominations were able to accompany new settlers into the western territories, the Episcopal Church struggled and lost members even where they had been successful. This chapter explores the challenges of voluntarism, denominational competition, and disestablishment; traces the near-collapse of the church in Virginia; and describes the development of new missional strategies and ideologies, dividing most white Episcopalians between the low church evangelical and the high church missional visions. In addition, this chapter describes the two important missional innovations in 1835: making the church identical with its mission organization rather than a voluntary auxiliary, as in other Protestant denominations, and creating the missionary bishop.
Turning Inward
Authors: Snow Jennifer C.
Published: July 2023

The Episcopal Church moved away from “foreign missions” after the Hocking Report, instead focusing on “domestic missions,” particularly suburban expansion. At the same time, the experience of Japanese Americans in the internment camps, and the church’s inability to do anything about it, gave white church leaders an increasing ability to discuss injustice in terms of race and to see standing against injustice as an important aspect of mission. While the suburban expansion into the white middle class narrowed future paths of expansion and increased the church’s collective expectation of cultural assimilation of nonwhite members, some leaders moved toward “urban mission” as a radical step, while Black Episcopalians continued as leaders in the fight against racism and in the early civil rights movement.
East of Delhi
Authors: Orsini Francesca
Published: July 2023

East of Delhi is a history of the multilingual literary culture of northern India. It takes a longue durée approach, from the beginnings of recorded vernacular literature in the late fourteenth century to its codification into separate, monolingual histories of Hindi and Urdu in the early twentieth century that syphoned off literature from folklore. It traces the languages and literary forms that circulated in and out of the region and in and across several communities of taste—courtly, devotional, and popular. In conversation with approaches of world literature, East of Delhi proposes a way of doing world literature that is attentive to texture and layers as well as circulation, to complexity and exclusions as well as canonization and reach, and to tastes and practices as well as normative ideas about literature.
The Spectral Mother
Authors: Landy Francis
Published: July 2023

The chapter concerns exile, both as a historical trauma and a metaphor for all human alienation. It begins with prefigurations of exile in Proto-Isaiah (chs 1–39), the vertiginous pun between the words for exile and revelation, and typological figures who proleptically embody the deportation, such as the king and the prophet. The rest of the chapter focuses on the mission of Cyrus as YHWH’s anointed in ch. 45, the displacement of the Davidic promise onto Israel, the servant and the prophet in chs 55.3–5 and 61.1–3, and the figure of Zion as the spectral mother in ch. 49. Zion is the mother whose dead children return to her; however, it is those very children who mourn for her. The message is that the dead come back to life, but that one cannot erase the past. Presiding over this change is the exiled, maternal figure of God.
The Popularization
Authors: Passie Torsten
Published: July 2023

Since the early 1980s, the popularity of MDMA has clearly risen. Independently of the activities of Shulgin, knowledge of MDMA spread across the country. The first recreational use documented by drug educators was in Oregon in the late 1970s, and they hypothesized that this drug could well enjoy future popularity. The year 1981 saw the publication of the first detailed article about MDMA in a widely distributed underground journal, followed by a few others. After all human research on psychedelics was stopped in the late 1960s, the Association for the Responsible Use of Psychedelic Agents (ARUPA) evolved as a loosely connected circle, which met at the Esalen Institute, an epicentre of the human potential movement, to promote the therapeutic use of MDMA. The move away from psychedelics to amphetamines by most drug users in the early 1970s also contributed to the popularity of MDMA. However, in spite of some early recreational use in a few nightclubs, MDMA did not really take off until a proselytizing MDMA aficionado began to sell the drug on a broader scale in bars and nightclubs of some Texan cities. As some groups began to see the profits to be made, they began to produce the drug in larger amounts, thus further stimulating demand. The history of two representative groups of underground manufacturers is described. Other parts of this chapter cover the press coverage in 1985 and the role of the Indian guru Rajneesh in the international distribution of MDMA.
Carbon isotope composition of respired CO2 in woody stems and leafy shoots of three tree species along the growing season: physiological drivers for respiratory fractionation
Authors: Salomón Roberto L , Rodríguez-Calcerrada Jesús , De Roo Linus , Miranda José Carlos , Bodé Samuel , Boeckx Pascal , Steppe Kathy
Published: July 2023

The carbon isotope composition of respired CO2 (δ13CR) and bulk organic matter (δ13CB) of various plant compartments informs about the isotopic fractionation and substrate of respiratory processes, which are crucial to advance the understanding of carbon allocation in plants. Nevertheless, the variation across organs, species and seasons remains poorly understood. Cavity Ring-Down Laser Spectroscopy was applied to measure δ13CR in leafy shoots and woody stems of maple (Acer platanoides L.), oak (Quercus robur L.) and cedar (Thuja occidentalis L.) trees during spring and late summer. Photosynthesis, respiration, growth and non-structural carbohydrates were measured in parallel to evaluate potential drivers for respiratory fractionation. The CO2 respired by maple and oak shoots was 13C-enriched relative to δ13CB during spring, but not late summer or in the stem. In cedar, δ13CR did not vary significantly throughout organs and seasons, with respired CO2 being 13C-depleted relative to δ13CB. Shoot δ13CR was positively related to leaf starch concentration in maple, while stem δ13CR was inversely related to stem growth. These relations were not significant for oak or cedar. The variability in δ13CR suggests (i) different contributions of respiratory pathways between organs and (ii) seasonality in the respiratory substrate and constitutive compounds for wood formation in deciduous species, less apparent in evergreen cedar, whose respiratory metabolism might be less variable.
The cultural politics of civic pride through Hull UK City of Culture 2017
Authors: Howcroft Michael
Published: July 2023

Purpose

This article explores the cultural politics of civic pride through Hull's year as UK City of Culture (UKCoC) in 2017. It unpicks some of the socio-political meanings and values of civic pride in Hull and critiques the ways in which pride, as an indicator of identity and belonging, was mobilised by UKCoC organisers, funders and city leaders. It argues for more nuanced and critical approaches to the consideration and evaluation of pride through cultural mega events (CMEs) that can take account of pride's multiple forms, meanings and temporalities.

Design/methodology/approach

A multidimensional, mixed methods approach is taken, incorporating the critical analysis of Hull2017 promotional materials and events and original interviews with a range of stakeholders.

Findings

The desire for socio-economic change and renewed identity has dominated Hull's post-industrial sense of self and is often expressed through the language of pride. This article argues that UKCoC organisers, cognisant of this, crafted and tightly controlled a singular pride narrative to create the feeling of change and legitimise the entrepreneurial re-branding of the city. At the same time, UKCoC organisers overlooked the opportunity to engage with and potentially reactivate the political culture of Hull, which like other “left behind” or “structurally disadvantaged” places, is becoming increasingly anti-political.

Originality/value

Through the case study of a relatively unresearched and under-represented city, this paper contributes to cultural policy literatures concerned with critically assessing the benefits and shortcomings of Cultural Mega Events and to a more specific field concerning Cities of Culture and the political cultures of their host cities. This paper also contributes to an emerging literature on the centrality of pride through the UK's post-Brexit Levelling Up agenda, suggesting that pride in place is becoming figured as a “universal theme” of the neoliberal city script.
Lessons learned in implementing the Low Birthweight Infant Feeding Exploration study: A large, multi‐site observational study
Authors: Vernekar Sunil S. , Somji Sarah , Msimuko Kingsly , Yogeshkumar S. , Nayak Rashmita B. , Nabapure Shilpa , Kusagur Varun B. , Saidi Friday , Phiri Melda , Kafansiyanji Eddah , Sudfeld Christopher R. , Kisenge Rodrick , Moshiro Robert , Tuller Danielle E. , Vesel Linda , Semrau Katherine E. A. , Dhaded Sangappa M. , Bellad Roopa M. , Mvalo Tisungane , Manji Karim
Published: July 2023

Objective

Globally, early and optimal feeding practices and strategies for small and vulnerable infants are limited. We aim to share the challenges faced and implementation lessons learned from a complex, mixed methods research study on infant feeding.

Design

A formative, multi‐site, observational cohort study using convergent parallel, mixed‐methods design.

Setting

Twelve tertiary/secondary, public/private hospitals in India, Malawi and Tanzania.

Population or Sample

Moderately low birthweight infants (MLBW; 1.50–2.49 kg).

Methods

We assessed infant feeding and care practices through: (1) assessment of in‐facility documentation of 603 MLBW patient charts; (2) intensive observation of 148 MLBW infants during facility admission; and (3) prospective 1‐year follow‐up of 1114 MLBW infants. Focus group discussions and in‐depth interviews gathered perspectives on infant feeding among clinicians, families, and key stakeholders.

Main Outcome Measures

The outcomes of the primary study were: (1) To understand the current practices and standard of care for feeding LBW infants; (2) To define and document the key outcomes (including growth, morbidity, and lack of success on mother's own milk) for LBW infants under current practices; (3) To assess the acceptability and feasibility of a system‐level Infant and Young Child Feeding (IYCF) intervention and the proposed infant feeding options for LBW infants.

Results

Hospital‐level guidelines and provision of care for MLBW infants varied across and within countries. In all, 89% of charts had missing data on time to first feed and 56% lacked discharge weights. Among 148 infants observed in‐facility, 18.5% were discharged prior to meeting stated weight goals. Despite challenges during COVID, 90% of the prospective cohort was followed until 12 months of age.

Conclusions

Enrolment and follow‐up of this vulnerable population required additional effort from researchers and the community. Using a mixed‐methods exploratory study allowed for a comprehensive understanding of MLBW health and evidence‐based planning of targeted large‐scale interventions. Multi‐site partnerships in global health research, which require active and equal engagement, are instrumental in avoiding duplication and building a stronger, generalisable evidence base.
Aspirin delays the onset of hypertensive disorders of pregnancy among nulliparous pregnant women: A secondary analysis of the ASPIRIN trial
Authors: Kavi Avinash , Hoffman Matthew K. , Somannavar Manjunath S. , Metgud Mrityunjay C. , Goudar Shivaprasad S. , Moore Janet , Nielsen Eleanor , Goco Norman , McClure Elizabeth M. , Lokangaka Adrien , Tshefu Antoinette , Bauserman Melissa , Mwenechanya Musaku , Chomba Elwyn , Carlo Waldemar A. , Figueroa Lester , Krebs Nancy F. , Jessani Saleem , Saleem Sarah , Goldenberg Robert L. , Das Prabirkumar , Patel Archana , Hibberd Patricia L. , Esamai Fabian , Bucher Sherri , Koso‐Thomas Marion , Silver Robert , Derman Richard J.
Published: July 2023

Objective

To assess the impact of low‐dose aspirin (LDA) starting in early pregnancy on delaying preterm hypertensive disorders of pregnancy.

Design

Non‐prespecified secondary analysis of a randomised masked trial of LDA.

Setting

The study was conducted among women in the Global Network for Women's and Children's Health's Maternal and Newborn Health Registry (MNHR) clusters, a prospective, population‐based study in Kenya, Zambia, the Democratic Republic of the Congo (DRC), Pakistan, India (two sites‐Belagavi and Nagpur) and Guatemala.

Population

Nulliparous singleton pregnancies between 6+0 weeks and 13+6 weeks in six low‐middle income countries (Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, Zambia) enrolled in the ASPIRIN Trial.

Methods

We compared the incidence of HDP at delivery at three gestational age periods (<28, <34 and <37 weeks) between women who were randomised to aspirin or placebo. Women were included if they were randomised and had an outcome at or beyond 20 weeks (Modified Intent to Treat).

Main Outcome Measures

Our primary outcome was pregnancies with HDP associated with preterm delivery (HDP@delivery) before <28, <34 and <37 weeks. Secondary outcomes included small for gestational age (SGA) <10th percentile, <5th percentile, and perinatal mortality.

Results

Among the 11 976 pregnancies, LDA did not significantly lower HDP@delivery <28 weeks (relative risk [RR] 0.18, 95% confidence interval [CI] 0.02–1.52); however, it did lower HDP@delivery <34 weeks (RR 0.37, 95% CI 0.17–0.81) and HDP@delivery <37 weeks (RR 0.66, 95% CI 0.49–0.90). The overall rate of HDP did not differ between the two groups (RR 1.08, 95% CI 0.94–1.25). Among those pregnancies who had HDP, SGA <10th percentile was reduced (RR 0.81, 95% CI 0.67–0.99), though SGA <5th percentile was not (RR 0.84, 95% CI 0.64–1.09). Similarly, perinatal mortality among pregnancies with HDP occurred less frequently (RR 0.55, 95% CI 0.33–0.92) in those receiving LDA. Pregnancies randomised to LDA delivered later with HDP compared with those receiving placebo (median gestational age 38.5 weeks vs. 37.9 weeks; p = 0.022).

Conclusions

In this secondary analysis of a study of low‐risk nulliparous singleton pregnancies, early administration of LDA resulted in lower rates of preterm HDP and delivery before 34 and 37 weeks but not in the overall rate of HDP. These results suggest that LDA works in part by delaying HDP.
National context and the transfer of transgender diversity policy: An institutional theory perspective on multinational corporation subsidiaries in Pakistan
Authors: Ahmad Sabeen Imran , Ozturk Mustafa Bilgehan , Tatli Ahu
Published: July 2023

Deploying institutional theory to analyze the transfer of transgender diversity policy in Pakistan, our research highlights the crucial influence of national context with respect to the development and implementation of transgender‐supportive equality measures in multinational corporation subsidiaries. Based on semi‐structured interviews with 4 government officials, and 30 managers, HR leads, and diversity officers working in subsidiary organizations, our thematic analysis highlights how regulatory institutions, normative and cognitive institutions, and institutional distance inform the conditions of possibility for the transfer and execution of diversity policy across national boundaries. Moreover, by highlighting the inadequacy of etic understandings of diversity categories and practices in settings where social structures and ideologies can be different, we argue that utilizing an emic approach is essential in the global diversity field. Our research emphasizes the value of context‐sensitive research instead of generic, and universalistic, applications of ‘Western’ diversity understandings.
Pediatric outpatient experiences of senior nursing students: A qualitative study
Authors: Xie Hong , Luo Dan , Li Xue , Zhang Jianhua , Kang Bingyao
Published: July 2023

Objectives

This study aimed to explore the experiences of senior nursing students working in a pediatric outpatient clinic.

Methods

This study adopted a descriptive phenomenological approach, through semi‐structured interviews. Purposive sampling was used to select 12 senior nursing students in the pediatric outpatient clinic of West China Second University Hospital, Sichuan University, China, from August 2020 to March 2021. The collected data were analyzed using the Colaizzi method.

Results

Four themes were identified in this study: knowledge and skills (triage, emergency care), communication (courage, communication skills), value re‐evaluation (understand of outpatient nurses, judgment of outpatient nurses), and outpatient feelings (satisfaction, empathy, pressure).

Conclusion

Pediatric outpatient internships have a positive impact on senior nursing students. Research has found that constructing a nursing clinical practice pathway in pediatric outpatient clinics helps teachers and students clarify the objectives and content of internships, and the “shadow teaching” model is conducive to nursing students' empathy and thinking. In addition, outpatient internship experience can help students gain communication courage.
Restoration as reconnection: A relational approach to urban stream repair
Authors: Samuelson Logan , Blue Brendon , Thomas Amanda
Published: July 2023

Urban stream environments have been significantly altered through processes of colonisation and urbanisation. In Te Whanganui‐a‐Tara Wellington, Aotearoa New Zealand, there is growing interest in peeling back layers of the city to reconnect with waterways. More‐than‐human geographies can play a critical role in contributing to these efforts, guiding understandings of what it means to restore and live alongside urban streams. In our case study of the Waimapihi Stream, we explore one community's ideas and practices of restoration and how they envision a thriving place through the notion of stream daylighting. The Waimapihi shows us that restoration activities are both product and process of co‐creating an ontologically plural space for the renegotiation of what stream restoration means.
Associations between self-reported healthcare disruption due to covid-19 and avoidable hospital admission: evidence from seven linked longitudinal studies for England
Authors: Green Mark A , McKee Martin , Hamilton Olivia KL , Shaw Richard J , Macleod John , Boyd Andy , Katikireddi Srinivasa Vittal
Published: July 2023

Objectives

To examine whether there is an association between people who experienced disrupted access to healthcare during the covid-19 pandemic and risk of an avoidable hospital admission.

Design

Observational analysis using evidence from seven linked longitudinal cohort studies for England.

Setting

Studies linked to electronic health records from NHS Digital from 1 March 2020 to 25 August 2022. Data were accessed using the UK Longitudinal Linkage Collaboration trusted research environment.

Participants

Individual level records for 29 276 people.

Main outcome measures

Avoidable hospital admissions defined as emergency hospital admissions for ambulatory care sensitive and emergency urgent care sensitive conditions.

Results

9742 participants (weighted percentage 35%, adjusted for sample structure of longitudinal cohorts) self-reported some form of disrupted access to healthcare during the covid-19 pandemic. People with disrupted access were at increased risk of any (odds ratio 1.80, 95% confidence interval 1.39 to 2.34), acute (2.01, 1.39 to 2.92), and chronic (1.80, 1.31 to 2.48) ambulatory care sensitive hospital admissions. For people who experienced disrupted access to appointments (eg, visiting their doctor or an outpatient department) and procedures (eg, surgery, cancer treatment), positive associations were found with measures of avoidable hospital admissions.

Conclusions

Evidence from linked individual level data shows that people whose access to healthcare was disrupted were more likely to have a potentially preventable hospital admission. The findings highlight the need to increase healthcare investment to tackle the short and long term implications of the pandemic, and to protect treatments and procedures during future pandemics.
Evaluating trends in private equity ownership and impacts on health outcomes, costs, and quality: systematic review
Authors: Borsa Alexander , Bejarano Geronimo , Ellen Moriah , Bruch Joseph Dov
Published: July 2023

Objective

To review the evidence on trends and impacts of private equity (PE) ownership of healthcare operators.

Design

Systematic review.

Data sources

PubMed, Web of Science, Embase, Scopus, and SSRN.

Eligibility criteria for study selection

Empirical research studies of any design that evaluated PE owned healthcare operators.

Main outcome measures

The main outcome measures were impact of PE ownership on health outcomes, costs to patients or payers, costs to operators, and quality. The secondary outcome measures were trends and prevalence of PE ownership of healthcare operators.

Data synthesis

Studies were classified as finding either beneficial, harmful, mixed, or neutral impacts of PE ownership on main outcome measures. Results across studies were narratively synthesized and reported. Risk of bias was evaluated using ROBINS-I (Risk Of Bias In Non-randomised Studies of Interventions).

Results

The electronic search identified 1778 studies, with 55 meeting the inclusion criteria. Studies spanned eight countries, with most (n=47) analyzing PE ownership of healthcare operators in the US. Nursing homes were the most commonly studied healthcare setting (n=17), followed by hospitals and dermatology settings (n=9 each); ophthalmology (n=7); multiple specialties or general physician groups (n=5); urology (n=4); gastroenterology and orthopedics (n=3 each); surgical centers, fertility, and obstetrics and gynecology (n=2 each); and anesthesia, hospice care, oral or maxillofacial surgery, otolaryngology, and plastics (n=1 each). Across the outcome measures, PE ownership was most consistently associated with increases in costs to patients or payers. Additionally, PE ownership was associated with mixed to harmful impacts on quality. These outcomes held in sensitivity analyses in which only studies with moderate risk of bias were included. Health outcomes showed both beneficial and harmful results, as did costs to operators, but the volume of studies for these outcomes was too low for conclusive interpretation. In some instances, PE ownership was associated with reduced nurse staffing levels or a shift towards lower nursing skill mix. No consistently beneficial impacts of PE ownership were identified.

Conclusions

Trends in PE ownership rapidly increased across almost all healthcare settings studied. Such ownership is often associated with harmful impacts on costs to patients or payers and mixed to harmful impacts on quality. Owing to risk of bias and frequent geographic focus on the US, conclusions might not be generalizable internationally.

Systematic review registration

PROSPERO CRD42022329857.
Prevalence of burnout and mental health problems among medical staff during the COVID-19 pandemic: a systematic review and meta-analysis
Authors: Zhu Hongjin , Yang Xiaoyun , Xie Shiqi , Zhou Jianrong
Published: July 2023

Objective

The COVID-19 pandemic has had a significant impact on the burnout and mental health of medical staff. This meta-analysis aims to provide additional (and updated) evidence related to burnout and mental health problems among medical staff using a broader data pool.

Design

Systematic review and meta-analysis.

Data sources

PubMed, Embase, Cochrane Library, CNKI, Wanfang data and three preprint databases (SSRN, bioRxiv and medRxiv) were searched from 1 January 2020 to 17 May 2021.

Eligibility criteria

We included observational studies investigating the prevalence of burnout and mental health problems among medical staff during the COVID-19 pandemic, including cross-sectional study, cohort study and case–control study.

Data extraction and synthesis

Two independent reviewers used a self-designed form to extract the primary data. The Joanna Briggs Institute quality appraisal tool was used to assess the quality of selected studies. Heterogeneity among studies was assessed by I2statistic. A random-effects model was used to pool the prevalence. Subgroup analysis was performed to explore between-group differences.

Results

250 studies were included, with a sample of 292 230 participants from 46 countries. The pooled prevalence of burnout, anxiety, depression, insomnia, stress, post-traumatic stress disorder symptoms and somatic symptoms was 43.6% (95% CI 36.3% to 51.2%), 37.1% (95% CI 34.7% to 39.7%), 37.6% (95% CI 35.0% to 40.4%), 43.7% (95% CI 39.1% to 48.5%), 41.3% (95% CI 35.1% to 47.9%), 30.6% (95% CI 23.6% to 38.5%) and 25.0% (95% CI 16.7% to 35.6%), respectively. Subgroup analysis showed a higher prevalence of anxiety, depression and insomnia in frontline workers than in non-frontline workers, and a higher prevalence of anxiety in females than males. Mild cases accounted for the most significant proportion of the outcomes except for stress.

Conclusions

This study highlights that identifying the risks of burnout and mental health problems and adopting preventive interventions are priorities for policymakers and medical staff to avoid long-term occupational, health and social impacts.

PROSPERO registration number

CRD42021254425.
PerIoperative iNflammatory reSponse assessment In hiGH-risk patienTs undergoing non-cardiac surgery (INSIGHT): study protocol of a prospective non-interventional observational study
Authors: Pichler Alexander , Kurz Andrea , Eichlseder Michael , Graf Alexandra , Eichinger Michael , Taschner Alexander , Kabon Barbara , Fleischmann Edith , Reiterer Christian
Published: July 2023

Introduction

Increased inflammatory processes after non-cardiac surgery are very common. The association between postoperative inflammation and the occurrence of cardiovascular complications after non-cardiac surgery are still not entirely clear. Therefore, we will evaluate the association between postoperative inflammation and the occurrence of major cardiovascular complications in patients at-risk for cardiovascular complications undergoing non-cardiac surgery. We will further evaluate the association of postoperative inflammation and days-at-home within 30 days after surgery (DAH30), the incidence of acute kidney injury, postoperative N-terminal probrain natriuretic peptide (NT-proBNP) concentrations and neurocognitive decline.

Methods and analysis

In this multicentre study, we will include 1400 patients at-risk for cardiovascular complications undergoing non-cardiac surgery. Our primary aim is to evaluate the association of postoperative maximum C-reactive protein concentration and the occurrence of a composite of five major cardiovascular complications (myocardial infarction, myocardial injury after non-cardiac surgery, new onset of atrial fibrillation, stroke and death) within 30 days after surgery using a Mann-Whitney-U test as well as a logistic regression model. As our secondary aim, we will evaluate the association of a composite of three inflammatory biomarkers (interleukin 6, procalcitonin and copeptin) on the occurrence of our composite of five cardiovascular complications within 30 days and 1 year after surgery, acute kidney injury, DAH30and NT-proBNP concentrations using linear or logistic regression models. We will measure inflammatory biomarkers before surgery, and on the first, second, third and fifth postoperative day. We will check medical records and conduct a telephone survey 30 days and 1 year after surgery. We evaluate neurocognitive function, using a Montreal Cognitive Assessment, before and 1 year after surgery.

Ethics and dissemination

This study was approved by the ethics committees at the Medical University of Vienna (2458/2020) and at the Medical University of Graz (33-274 ex 20/21).

Trial registration number

NCT04753307.
Meta-review of the barriers and facilitators to women accessing perinatal mental healthcare
Authors: Webb Rebecca , Uddin Nazihah , Constantinou Georgina , Ford Elizabeth , Easter Abigail , Shakespeare Judy , Hann Agnes , Roberts Nia , Alderdice Fiona , Sinesi Andrea , Coates Rose , Hogg Sally , Ayers Susan
Published: July 2023

Perinatal mental health (PMH) problems are common and can have an adverse impact on women and their families. However, research suggests that a substantial proportion of women with PMH problems do not access care.

Objectives

To synthesise the results from previous systematic reviews of barriers and facilitators to women to seeking help, accessing help, and engaging in PMH care, and to suggest recommendations for clinical practice and policy.

Design

A meta-review of systematic reviews.

Review methods

Seven databases were searched and reviewed using a Preferred Reporting Items for Systematic Reviews and Meta Analyses search strategy. Studies that focused on the views of women seeking help and accessing PMH care were included. Data were analysed using thematic synthesis. Assessing the Methodological Quality of Systematic Reviews-2 was used to assess review methodology. To improve validity of results, a qualitative sensitivity analysis was conducted to assess whether themes remained consistent across all reviews, regardless of their quality rating.

Results

A total of 32 reviews were included. A wide range of barriers and facilitators to women accessing PMH care were identified. These mapped across a multilevel model of influential factors (individual, healthcare professional, interpersonal, organisational, political and societal) and across the care pathway (from decision to consult to receiving care). Evidence-based recommendations to support the design and delivery of PMH care were produced based on identified barriers and facilitators.

Conclusion

The identified barriers and facilitators point to a complex interplay of many factors, highlighting the need for an international effort to increase awareness of PMH problems, reduce mental health stigma, and provide woman-centred, flexible care, delivered by well trained and culturally sensitive primary care, maternity, and psychiatric health professionals.

PROSPERO registration number

CRD42019142854.
Cost-effectiveness of tenofovir prophylaxis during pregnancy for the elimination of mother-to-child transmission of the hepatitis B virus: real-world analysis from Thailand
Authors: Janekrongtham Chawisar , Punsuwan Niramon , Thitichai Phanthanee , Lertpiriyasuwat Cheewanan , Pan-ngum Wirichada , Poovorawan Kittiyod , Jantarapakde Jureeporn , Tangkijvanich Pisit
Published: July 2023

Objective

Despite implementing hepatitis B immunoglobulin (HBIG) and vaccination, data suggest it would not be sufficient to reach the elimination targets. Tenofovir disoproxil fumarate (TDF) has been added to the Thai national standards of care for prevention of transmission of the hepatitis B virus during birth. To optimise national strategies in Thailand, we assessed TDF’s effectiveness for prevention of mother-to-child transmission and conducted cost-effectiveness analyses of different TDF-based strategies.

Research design and methods

We retrospectively reviewed medical records of mother and infant pairs whose mothers were positive for hepatitis B e-antigen (HBeAg) and received TDF to prevent maternal transmission of viral hepatitis B during 2018–2020. Based on the available data on transmission rate, we also applied a decision tree to estimate the cost-effectiveness of different TDF-based strategies to eligible mothers. These included: (1) HBIG for all hepatitis B virus (HBV) exposed infants; (2) HBIG for only infants of HBeAg-positive mothers (‘HBIG for e-positive’) and (3) without HBIG to infants (‘HBIG-free’). The incremental cost-effectiveness ratio between the different strategies and baseline intervention without TDF was calculated. The one-way sensitivity analysis was used to adjust prevalence of HBeAg-positive mothers, cost of HBIG, cost of TDF and transmission rate.

Results

Of 223 infants enrolled, 212 (95.0%) received HBIG, while 11 (5.0%) did not. None of the infants had chronic HBV infection. The most cost-saving intervention was ‘HBIG-free’ followed by ‘HBIG for e-positive’. The one-way sensitivity demonstrated that the results were reasonably robust to changes. The cost-saving was greater with a higher hepatitis B virus surface antigen (HBsAg) prevalence. The HBIG-free strategy remained best at 0%–1.4% transmission rates, meeting the additional target for eliminations.

Conclusion

The study is the first cost-effectiveness analyses to provide evidence supporting an HBIG-free strategy in an antiviral era. This approach should be considered to prevent mother-to-child transmission in resource-constrained settings, particularly in countries with a high HBsAg prevalence.
Effectiveness of humanitarian health interventions: a systematic review of literature published between 2013 and 2021
Authors: Doocy Shannon , Lyles Emily , Tappis Hannah , Norton Alexandra
Published: July 2023

Objectives

To provide a thorough mapping of the current quality and depth of evidence examining the effectiveness of health interventions in humanitarian settings in low and middle-income countries published in peer-reviewed journals since 2013.

Methods

We searched MEDLINE, Embase and Global Health for English language peer-reviewed literature published from May 2013 through April 2021 to analyse the strength of evidence on health interventions’ effectiveness in humanitarian settings in low and middle-income countries across nine thematic areas. Quality was assessed using standardised criteria and critical appraisal tools based on study design.

Results

A total of 269 publications were included in this review. The volume of publications increased since the first Elrha Humanitarian Health Evidence Review in 2013, but non-communicable diseases and water, sanitation and hygiene remain the areas with the most limited evidence base on intervention effectiveness in addition to injury and rehabilitation. Economic evaluations continued to constitute a small proportion (5%) of studies. Half of studies had unclear risk of bias, while 28% had low, 11% moderate and 11% high risk of bias. Despite increased diversity in studied interventions, variations across and within topics do not necessarily reflect the health issues of greatest concern or barriers to quality service delivery in humanitarian settings.

Conclusions

Despite an increasing evidence base, the challenge of implementing high-quality and well-reported humanitarian health research persists as a critical concern. Improvements in reporting and intervention description are needed as are study designs that allow for attribution, standard indicators and longer term follow-up and outcome measures. There is a clear need to prioritise expansion of cross-cutting topics, namely health service delivery, health systems and cost-effectiveness.

PROSPERO registration number

CRD42021254408.
Quality of life and relapse of Opioid Use Disorder: a scoping review protocol
Authors: Namatovu Angella , Akatusasira Rita , Kaggwa Mark Mohan
Published: July 2023

Introduction

Quality of life (QoL) greatly influences the outcomes of patients with mental illnesses and there is evidence that there is an association between QoL and the relapse of Opioid Use Disorder (OUD). However, no reviews elucidate the relationship between QoL and the relapse of OUD. This document provides a scoping review protocol that aims to systematically chart and synthesise the published, unpublished and grey literature about the relationship between QoL and relapse of OUD.

Methods and analysis

The enhanced six-stage methodological framework for scoping reviews of Arksey and O’Malley will be used. The main research question guiding the review will be: What is the relationship between QoL and relapse of OUD? Peer-reviewed and non-peer-reviewed articles, reports, and policy documents will be eligible to be included in the review with no limits on publication date. PubMed, PsycINFO, Google Scholar, Scopus, OVID and Cochrane Library will be among the databases searched. We shall identify grey literature from Google Scholar, ProQuest database, Grey Source Index, Open Grey and OpenDOAR. The reporting of the review will follow the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Criteria for evidence inclusion and exclusion will be used during literature screening and mapping.

Ethics and dissemination

Patients and the public will not be involved in the interpretations of the findings, therefore, we shall not seek approval from an ethics committee. Results will be disseminated through publication in a peer-reviewed, scientific journal, conference presentations.