bluuebunny/crossref_metadata_2025 huggingface dataset:
STC-PSSA: A New Model of Traffic Flow Forecasting Based on Spatiotemporal Convolution and Probabilistic Sparse Self-Attention
Authors: Zhang Hong , Chen Linbiao , Zhang Xijun , Cao Jie
Published: June 2024

Traffic flow forecasting is the foundation of the dynamic control and application of intelligent transportation systems (ITS). It is also of significant practical value in alleviating road congestion. Given the periodic and dynamic changes in trafﬁc ﬂow and the spatiotemporal coupling interaction of complex road networks, trafﬁc ﬂow forecasting is challenging and rarely yields satisfactory prediction results. To capture the dynamic spatiotemporal characteristics of traffic flow, a new model of traffic flow forecasting based on spatiotemporal convolution and probabilistic sparse self-attention (STC-PSSA) is proposed. It consists of a spatiotemporal graph convolution network (ST-GCN) module, a spatiotemporal convolution module (ST-Conv), and a probabilistic sparse attention module (PSSA). ST-GCN consists of the gated temporal convolutional network (G-TCN) and the graph convolution network (GCN), which are used to capture the temporal dependence and spatial correlation of the traffic flow, respectively. Multiple ST-GCNs are stacked to handle spatial features at various time levels. The ST-Conv captures intricate temporal dependence at the same location and dynamic spatial features at neighboring locations simultaneously. The PSSA combines dynamic spatiotemporal features and performs long-term forecasting efficiently. The experimental results demonstrate that the STC-PSSA model can accurately extract the dynamic spatiotemporal characteristics of traffic flow and outperforms the popular baseline methods in forecasting accuracy.
Biomechanical and Histological Study of Retrieved LARS Synthetic Ligaments
Authors: Blakeney William G. , Hayes Alex , Kop Alan , Parry Jeremy , Walsh Michael , Annear Peter , Pabbruwe Moreica
Published: June 2024

Background:

Synthetic grafts have been used for a number of years in anterior cruciate ligament (ACL) reconstruction surgery. One of the more recent additions to the stable of synthetic ligaments is the Ligament Augmentation and Reconstruction System (LARS) ligament.

Purpose:

To analyze the biomechanics and histology of LARS grafts retrieved due to failure of the device.

Study Design:

Descriptive laboratory study.

Methods:

A total of 22 LARS ligament grafts that were explanted from patients were sent for analysis. Five new, unused samples of the standard LARS ACL graft were also analyzed. Biomechanical testing was performed: ultimate tensile force, force versus displacement, and stress versus strain were recorded. Histopathological examination was performed looking for degree of fibrous tissue ingrowth as well as the presence of a foreign body reaction.

Results:

Of the 22 grafts retrieved, 14 were used for ACL grafts, 1 for a lateral collateral ligament graft, 2 for medial collateral ligament grafts, 4 for gluteal tendon augmentation, and 1 for a supraspinatus augmentation. A severe foreign body reaction was found in 86% of the grafts (18/22) and a mild foreign body reaction in the remaining 14% (4/22). Tissue ingrowth was minimal in the majority of ACL grafts; the other grafts showed moderate tissue ingrowth. Maximal tensile force was significantly higher for the new ACL grafts (mean ± SD, 1667 ± 845 N) compared with the retrieved grafts (897 ± 395 N; P < .05).

Conclusion:

This study demonstrated that the vast majority of retrieved LARS artificial ligaments had a florid foreign body reaction. There was minimal tissue ingrowth in ACL grafts and moderate ingrowth in other grafts. Retrieved grafts had a decreased ultimate tensile force, which increased their risk of rupture.

Clinical Relevance:

Surgeons should be cautious in choosing to use these grafts in reconstructive surgery for patients.
Combining finite-time control and prescribed tracking performance for uncertain PMSM driven steer-by-wire system with unknown disturbance
Authors: Liu Yan , Zhang Sucai , Wang Yongfu , Li Gang
Published: June 2024

To solve the uncertainties in permanent magnet synchronous motor (PMSM) driven steer-by-wire (SbW) system, a prescribed-performance-control (PPC) based finite-time fuzzy controller is proposed. Specifically, the dynamics of SbW system driven by PMSM is analyzed, and combine PPC technology to transform the tracking error coordinates. Then, the velocity signal is obtained from the sigmoid function-based tracking differentiator by using the position signal. To solve the problem of mismatched disturbance, fuzzy logic system (FLS) are used as a universal approximator to estimate the lumped nonlinear friction and other unknown functions, the boundary of lumped disturbance is estimated by the designed adaptive updating law. By fusing the designed virtual controller and the intermediate control law, the controller needs no precise parameters of system, under which the effect of uncertainty of control gain can be compensated completely. Finally, rigorous theoretical analysis based on the Lyapunov stability theory is provided to demonstrate the finite-time stability of the closed-loop system under consideration. Simulation and experiment results are presented to show the effectiveness of the developed control approach, and some comparisons are given to show the rapid and accurate position tracking control performance.
Exploring the effects of coworking in two European cities: Financialisation flows and consumption patterns in Athens and Berlin
Authors: Avdikos Vasilis , Papageorgiou Antigoni , Pettas Dimitris
Published: June 2024

With the continuous deregulation of state functions in processes of neoliberal urban production, coworking spaces have emerged as autonomous actors in processes of urban development, as they appear to conglomerate flows of freelancers, startuppers, remote workers, digital nomads and financial capital from private investors and large corporations. As such, these actors could play an important role in the organisation of urban activities that could have multiple impacts on the urban economy. Tracing the effects of coworking spaces in metropolitan cities, this qualitative analysis is focused on coworking spaces in Athens and Berlin, two cities characterised by different development trajectories, socioeconomic and cultural contexts and positions within the European and global urban hierarchy. The results reveal that coworking spaces demonstrate high levels of adaptability to the specific characteristics of the urban contexts in which they are located and play a dual role by (1) shaping and channelling the consumption patterns of coworkers while also (2) operating as mediators and facilitators of multilevel private investment and financialisation processes.
Beliefs, Experiences, and Practices of Lady Health Workers in Facilitating Breastfeeding in Rural Communities in Pakistan
Authors: Singletary Nicola , Waqar Farooqi Zoha
Published: June 2024

Pakistan has extremely poor breastfeeding indicators: fewer than half of infants under 6 months are exclusively breastfed, only 20% of infants are breastfed within the first hour of life, and nearly half are never fed colostrum. The country’s high infant morbidity and mortality is in part due to this suboptimal infant feeding. A network of lady health workers (LHWs) employed by the government facilitate maternal and child health programs, including breastfeeding support in their communities. This study describes LHWs’ perspectives and experiences regarding breastfeeding. We conducted semi-structured interviews with 14 LHWs and used thematic qualitative analysis to code and analyze the data. Our research revealed that LHWs use their role as members of the community and involve influential members of the family to build trust. Frequent home visits beginning prenatally help them address misconceptions about infant feeding. While they have strong knowledge about the benefits of breastfeeding and the importance of colostrum, they demonstrate gaps in their knowledge regarding breast conditions, the safe preparation of human milk substitutes, the physiology of milk production, and supporting mothers who are separated from their baby. Future training should address these areas where LHWs lack knowledge to help mothers facilitate early and exclusive breastfeeding. With adequate training, LHWs are uniquely positioned to use their role as trusted members of the community to effectively counsel families on the importance of breastfeeding and support the clinical needs of women during the perinatal time.
Dangerous Variation or Patient-Centered Care? Palliative Care and Pain Providers’ Comfort, Experiences, and Approaches when Treating Cancer Pain With Coexisting Aberrant Behaviors
Authors: Hadler Rachel A. , Klinedinst Rachel , Jones Christopher A. , Bao Yuhua , Pathak Ravi , Zarrabi Ali J. , Rosa William E.
Published: June 2024

Background

Patients with cancer-related pain are at high risk for aberrant drug use behaviors (ADB), including self-escalation, diversion and concurrent illicit substance or opioid misuse; however, limited evidence is available to guide opioid prescribing for patients with life-limiting illness and concurrent or suspected ADB. We sought to characterize how specialists evaluate for and manage these high-risk behaviors in patients with cancer-related pain.

Methods

We conducted telephonic semi-structured interviews with palliative care and pain medicine providers. Participants discussed their own comfort and experience level with identifying and managing ADB in patients with life-limiting illness. They were subsequently presented with a series of standardized scenarios and asked to describe their concerns and management strategies.

Results

95 interdisciplinary pain and palliative care specialists were contacted; 37 agreed to participate (38.9%). Analysis of interview contents revealed several central themes: (1) widespread discomfort and anxiety regarding safe and compassionate opioid prescribing for high-risk patients, (2) belief that widely used risk-mitigation tools such as opioid contracts and urine drug screens provided inadequate support for decision-making, and (3) lack of institutional and organizational support and guidance for safe prescribing strategies. Most clinicians reported self-education regarding addiction and alternative prescribing/pain management strategies. Providers varied widely in their willingness to discontinue opioid prescribing in a patient with aberrant behavior and pain associated with life-limiting illness.

Conclusion

Providers caring for patients demonstrating ADB and cancer-related pain struggle to balance safe prescribing with symptom management. Increased guidance is needed regarding opioid prescribing, monitoring, and discontinuation in high-risk patients.
Psychometric Properties of the Diagnostic Interview for Sexual Dysfunctions in Women in a Symptom-Reporting Sample
Authors: Schwesig Rebekka , Borchardt Maike , Velten Julia , Hoyer Jürgen
Published: June 2024

While structured clinical interviews are considered the gold standard for diagnosing mental disorders, respective instruments are still lacking in the field of sexual dysfunctions. The study evaluates the psychometric properties of the new Diagnostic Interview for Sexual Dysfunctions in Women (DISEX-F), which is based on the eleventh edition of the International Statistical Classification of Diseases (ICD-11) and the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), in a sample of 100 women with self-reported sexual problems. Participants were interviewed twice by trained diagnosticians with the DISEX-F. A third diagnostician evaluated the audio records of the initial interview. Participants also completed self-report measures of sexual functioning/distress and interview acceptance. The DISEX-F demonstrates excellent inter-rater reliability, good test-retest reliability, and strong convergent and discriminant evidence of validity. Furthermore, it achieves high acceptance among participants. Discordant diagnostic outcomes were especially linked to false differential diagnostic decisions and information variance in participants reporting. The results strongly support using the DISEX-F for women presenting with self-reported sexual problems in practice and research.
Readiness of Exercise Physiologists, Physiotherapists and Other Allied Health Professionals to Respond to Gender-Based Violence: A Mixed-Methods Study
Authors: Wheatley Lauren , Rosenbaum Simon , Mastrogiovanni Chiara , Pebole Michelle , Wells Ruth , Rees Susan , Teasdale Scott , McKeon Grace
Published: June 2024

Experiencing gender-based violence (GBV) is associated with health conditions that are common indications for referral to exercise physiologists, physiotherapists and other allied health professionals (AHPs). The readiness of AHPs to identify and respond to GBV is currently unknown. This study aimed to determine the readiness of AHPs to respond to a person who had experienced GBV. Participants completed the modified Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) and/or an interview. The AHPs felt underprepared, had low perceived knowledge and lacked confidence to respond to and support people who have experienced GBV, despite recognition of the importance and agreement of the relevance to AHPs’ practice.
International Cross-Temporal Meta-Analysis of Assortative Mating for Educational Attainment
Authors: Jensen Sebastian , Kirkegaard Emil
Published: June 2024

Previous studies have found a high degree of assortative mating for educational attainment (r = .56). However, this can be confounded by cohort effects or country effects, where certain nations may have more pronounced assortative mating than others. In addition, method variance regarding how educational attainment is measured may also result in heterogeneity of effect sizes. Effect sizes were gathered from various datasets and from academic literature, resulting in a large collection of effect sizes (k = 1498, n = 9,159,098), spanning 84 different countries. Assortative mating for educational attainment was stronger than what previous literature suggested (r = .66, [.64, .68]), largely due to the fact that assortative mating for educational attainment is stronger when latent methods are used. The strongest predictors of assortative mating for education between countries were individualism (r = −.61, p < .001) and HDI (r = −.56, p < .001). Assortative mating over time was found to vary by region. Capitalist Europe experienced an increase in assortative mating for education, while Communist Europe experienced a decrease. The United States had a non-linear trend in assortative mating for educational attainment, as it decreased from 1875 to 1926, increased from 1926 to 1945, decreased from 1945 to 1958, increased from 1958 to 1977, and decreased from 1977 onwards.
Encore ça change ...
Authors: Levinson Meira
Published: June 2024

‘Finding Consensus on Well-Being in Education’ is an ambitious and inspiring work in favor of establishing flourishing as the aim of education in classrooms and schools worldwide. The authors offer theories of action to explain how education for flourishing would be virtuously self-sustaining in its ideal state, how we could transition from current educational policies and practices to those that foster flourishing, and why schools currently impede student, teacher, and social flourishing. This commentary critically examines each theory of action, raising questions about the reasons that schools currently fail to promote flourishing and why and how they might do in the future. I argue that David Cohen’s classic essay ‘Plus Ça Change . . .’ provides important insight into why education for flourishing may take as long to develop and take to scale in the twenty-first century as Deweyan progressive education took (and is continuing to take) in the twentieth century. The kind of education that the authors of ‘Finding Consensus’ are calling for is hard and ambitious work that may take a very long time to get right – even as it is also well worth trying to do so.
Toward a Pedagogy of Critical and Social Imagination: The Arts in Adult Education
Authors: Kokkos Alexis , Fleming Ted
Published: June 2024

We present an argument for a higher priority for art in the educational system and “make a case” for the arts—to provide a rationale for its priority in adult education. This is the plan: to provide this rationale; to present practical guidelines for the processes of engaging in art that may be transformative and critical for individuals and for society; and to illustrate the powerful potential of art as a way of teaching for democratic citizenship. We move toward a Pedagogy of Social Imagination in Art and Adult Education by recounting a real-life empirical study of creating opportunities for transformative learning through engagements with art. John Dewey and Maxine Greene assist in outlining a rationale for exploring arts in adult education.
Indirect Duplex Ultrasound Diagnosis of Innominate Artery Occlusive Disease
Authors: Carrion Erika
Published: June 2024

Herein, we present a case study of a patient with suspected transient ischemic attacks who was referred to the vascular laboratory for an assessment of the extracranial cerebrovascular arteries. Duplex ultrasound revealed momentary flow reversal in the right common carotid artery and internal carotid artery. Reverse flow in the right vertebral artery and a dampened Doppler waveform in the right subclavian artery were suggestive of a subclavian steal syndrome. These findings were consistent with innominate artery (IA) stenosis or occlusion. This case study is confirmatory evidence that indirect sonographic techniques can reliably identify IA occlusive disease.
Low-Cost Innovations in Global Cardiac Surgery
Authors: Jamil Hera , Ranganathan Sruthi , Fissha Aemon B. , Vinck Eric E. , Vervoort Dominique
Published: June 2024

Cardiovascular diseases are the leading cause of morbidity and mortality worldwide, costing the lives of 18 million people annually, with up to one-third being attributable to cardiac surgical conditions. Approximately 6 billion people do not have access to safe, timely, and affordable cardiac surgery, predominantly affecting populations living in low-middle income countries. Cardiac surgical care is costly, resulting in few centers in variable-resource contexts operating continuously or with the resources observed in higher-resource environments. As a result, innovations may be formally developed or informally adopted to bypass resource constraints and ensure care delivery. Innovations have been observed across the cardiac surgical care continuum and across settings, potentially benefiting both high-income countries, where growing health care costs are becoming unsustainable, and low- and middle-income countries, where competing health agendas may limit investments into cardiac surgery. This narrative review attempts to address the costs associated with cardiac surgery, placing an emphasis on frugal innovations in the perioperative and postoperative care spectrum.
Atherogenic indices in preeclamptic and eclamptic patients in North-Central Nigeria
Authors: Abdulkadir Zainab Ajoke , Ijaiya Munirdeen Aderemi , Adebara Idowu O
Published: June 2024

Microvascular, placental, haematological and lipid studies suggest striking similarities between preeclampsia/eclampsia and atherosclerosis.

Objective

To determine the lipid profile and atherogenic indices in preeclamptic/eclamptic patients and compare with normal pregnant women.

Methodology

Comparative cross-sectional study conducted in North Central Nigeria. The study population was preeclamptic/eclamptic patients and normal pregnant women. A total of 192 women, comprising 96 pregnant women with preeclampsia/eclampsia and an equal number of normotensive controls were recruited consecutively by purposive sampling. Lipid profiles were estimated and atherogenic indices were calculated.

Result

Coronary heart disease risk ratio (CRR) and atherogenic index of plasma (AIP) showed significantly increased atherogenic potentials in subjects compared to controls. Mean ± SD CRR of subjects was 0.28 ± 0.17, Mean ± SD CRR of controls was 0.44 ± 0.24 ( p = 0.001); Mean ± SD AIP of subjects was 0.32 ± 0.42 and mean ± SD AIP of controls was 0.16 ± 0.26 ( p = 0.003).

Conclusion

Atherogenic indices show increased atherogenic potentials in preeclamptic/eclamptics.
Surgical-orthodontic approach for correcting Vertical Maxillary Excess: Case report
Authors: Benkhalifa Mona , Tobji Samir , Moatemri Ramzi , Ben Amor Adel , Dallel Ines , Ben Amor Wiem
Published: June 2024

This report describes a patient with Vertical Maxillary Excess without open bite in whom surgical orthodontic treatment to reduce lower facial height remarkably improved function and facial esthetics. The patient was a 22-year-old male whose main concern was crowding and temporomandibular joint clicking sounds. The clinical and radiological findings led to the diagnosis of Vertical Maxillary Excess with a mild skeletal class II malocclusion. The proposed treatment plan comprised a bimaxillary surgery without premolar extractions. LeFort I osteotomy was planned to reposition the maxilla superiorly by 7–8 mm. This surgery was combined with a bilateral sagittal split osteotomy for mandibular anterior derotation to adjust the mandible to the occlusal and anteroposterior change. Postoperatively, the mandibular plane angle (GoGn-SN) was decreased by 4° and skeletal class I was achieved (ANB, 4°). In addition, lip incompetence was corrected and the excessive gingiva exposure upon smiling was significantly improved. The patient was satisfied with the treatment result and reported the temporomandibular joint clicking sounds disappearing after surgery.
Working (out) with fitness influencers – benefits for the fitness influencer, user health, and the endorsed brand: Key factors and the role of gender and brand familiarity
Authors: Durau Julia , Diehl Sandra , Terlutter Ralf
Published: June 2024

Objective

Fitness influencers have become important digital health communicators with regard to influencing consumer health behaviours, such as physical activity. We investigate how working (out) with these new communicators can generate benefits for the fitness influencer, user health, and endorsed brands. Based on the source credibility, social identity theory, and gender congruity research, this paper aims to identify the main factors that affect users’ attitudes toward the fitness influencer (influencer benefit), users’ exercise intentions (user health benefit) and their purchase intentions (brand benefit), considering user and influencer gender.

Methods

Two studies were conducted, both with male and female influencers and users. In study 1 (n = 496), the fitness influencer endorsed an unfamiliar brand, and in study 2 (n = 529) a familiar brand was endorsed. To test the proposed models and to estimate the path coefficients, structural equation modelling was performed.

Results

Key influencing factors were identified in the two studies: For attitude toward the influencer, source credibility is the most important; for exercise intention, parasocial interaction and attitude toward the behaviour are crucial; and purchase intention is largely predicted by the brand attitude. The studies revealed gender-congruent and non-congruent tendencies for female and male respondents, and different effects of unfamiliar and familiar brands.

Conclusions

Working (out) with fitness influencers can improve user attitudes toward the influencer, increase users’ exercise intentions, and increase brand purchase intentions, for both unfamiliar and familiar brands. Some gender congruity and some gender incongruity effects exist. The paper discusses important implications for theory and practice.
The evolution of health system planning and implementation of maternal telehealth services during the COVID-19 Pandemic
Authors: Aijaz Monisa , Bozkurt Burcu , Planey Arrianna Marie , Cilenti Dorothy , Khairat Saif , Shea Christopher M
Published: June 2024

Background

Differential access to healthcare is associated with disparities in maternal outcomes. Telehealth is one approach for improving access to maternal services. However, little is known regarding how health systems leverage telehealth to close the access gap.

Objective

This study examines how health systems have approached decisions about using telehealth for maternal services before and during the COVID-19 public health emergency and what factors were considered.

Methods

We conducted semi-structured interviews with 15 health system leaders between July and October 2021 and June and August 2022. We used a rapid analysis followed by a content analysis approach.

Results

Five health systems did not provide maternal telehealth services before the PHE due to a lack of reimbursement. Two health systems provided limited services as research endeavors, and one had integrated telehealth into routine maternity care. During the PHE, all transitioned to telehealth, with the primary consideration being patient and staff safety. At the time of the interview, key considerations shifted to patient access, patient preferences, patient complexity, return on investment, and staff burnout. However, several barriers impacted telehealth use, including coverage of portable devices and connectivity. These issues were reported to be common among underinsured, low-income, and rural patients. Health systems with particularly advanced capabilities worked on approaches to fill access gaps for these patients.

Conclusion

Some health systems prioritized telehealth to improve access to high-quality maternal services for patients at the highest risk of adverse outcomes. However, policy and patient-level barriers to equitable implementation of these services persist.
The impact of automatic history-taking software on data quality in the cardiology outpatient clinic: Retrospective observational study
Authors: Erden Ismail , Sen Arda , Erden Ibrahim Emre
Published: June 2024

Background

Healthcare delivery now mandates shorter visits despite the need for more data entry, under-mining patient–provider interaction. Furthermore, enhancing access to the outcomes of prior tests and imaging conducted on the patient, along with accurately documenting medication history, will significantly elevate the quality of healthcare service delivery.

Objective

To enhance the efficiency of clinic visits, we have devised a patient–provider portal that systematically gathers symptom and clinical data from patients through a computer algorithm known as Automated Assessment of Cardiovascular Examination (AACE). We intended to assess the quality of computer-generated Electronic Health Records (EHRs) with those documented by physicians.

Methods

We conducted a cross-sectional study employing a paired-sample design, focusing on individuals seeking assessment for active cardiovascular symptoms at outpatient adult cardiovascular clinics. Participants initially completed the AACE, and subsequently, in the first protocol, patients were subjected to routine care without providing the AACE forms to examining physicians. In the second protocol, the AACE form was presented to the physician before the examination, and participants were subjected to routine care. We assessed the impact of AACE forms generated through computerized history-taking method on the examination, considering various clinical outcomes and satisfaction surveys.

Results

We included non-randomized eligible patients who visited seven general cardiology outpatient clinics between September 18, 2023, and October 27, 2023. These clinics were staffed by the same physicians who were unaware of the content and details of the study. A total of 762 patients (394 patients in protocol 1 and 368 patients in protocol 2) were included in the study. The mean overall impression score for computer-generated EHRs was higher versus physician EHRs (4.2 vs. 2.6; p < .001). Our study demonstrated that EHRs created by physicians’ exhibit inaccuracies or deficiencies in various pieces of information. In the second protocol, in which the AACE form was presented to the physician before the examination, it was determined that the examination time was shorter, the number of tests requested, and the number of new drugs prescribed were less.

Conclusions

We observed that the patient–provider portal, systematically collecting symptom and clinical data from patients through a computer algorithm known as AACE, yielded records that were of higher quality, more comprehensive, better organized, and more relevant compared to those documented by physicians.
Does Higher Grade Indicate More Complex Language Usage? Exploring Syntactic Complexity Development Among High School EFL Learners
Authors: Wang (王威然) Weiran , Qin (秦文娟) Wenjuan , Wang (王琳艺) Linyi
Published: June 2024

Purpose

This article aims to investigate the longitudinal Syntactic Complexity (SC) development of English as a Foreign Language (EFL) learners and the variations by grade level.

Design/Approach/Methods

This study conducts a longitudinal analysis of SC development among 199 high school EFL learners in eastern China. The corpus contains 920 argumentative essays on scientifically and socially contentious topics. We employ the Second Language Syntactic Complexity Analyzer (L2SCA) to examine syntactic features in these essays through 11 computerized indices measuring different dimensions of SC (i.e., coordination, subordination, phrasal complexity). Multi-level regression analyses are used to depict SC development and cross-level interactions are investigated to examine variations by grade.

Findings

Results suggest that all SC indices except T-units per sentence exhibit varying growing trends. The results align with Biber's hypothetical stages of syntactic development, indicating learners’ progression toward greater subordination and phrasal complexity. Negative cross-grade interactions suggest that lower-grade students show heightened improvements in phrasal sophistication over time.

Originality/Value

The study portrays the developmental patterns of SC within and across grade levels, highlighting both group trends and individual variability in language development. It conceptualizes SC as a multidimensional construct and informs more precise measurement of SC features in writing assessment and instruction.
The Impact of Intergovernmental Cooperation and Local Fiscal Autonomy on Environmental Regional Governance: Evidence From China Yangtze River Delta Urban Agglomeration
Authors: Li Zhichao , Li Yilin
Published: June 2024

Previous research on regional environmental pollution acknowledge that cross-level government cooperation plays an important role in controlling regional environmental pollution. However, the balance between local fiscal autonomy and governance costs has received little attention. To fill this research gap, this paper argues a model of local fiscal autonomy moderating the efficiency of environmental governance, which provides a basis for studying the effect of local fiscal autonomy on intergovernmental cooperative environmental governance. We collected the data set of the China Yangtze River Delta urban agglomeration, using Tobit regression model to evaluate the effect of local fiscal autonomy on cooperative arrangements and the moderating effect. The results show that higher local fiscal autonomy will positively affect vertical intervention actions and improve the efficiency of environmental governance. In addition, we found that more special funding for environmental projects will weaken the performance of horizontal cooperation on regional environmental governance.
“We Are Seahorses”: A Classroom Thought Experiment to Explore the Social Construction of Gender Roles
Authors: Weidner C. Ken
Published: June 2024

Gender roles reinforce societal and interpersonal norms and expectations that affect individuals in and out of the workplace. The causes and effects of gender roles are often unexamined or even avoided in college classes and corporate settings. However, exploring the social construction of gender in a safe learning environment can result in a better understanding of the impact of gender roles on individuals’ thinking and behavior. I present here a novel classroom “thought experiment” in which learners can explore gender roles and the inferences they and others draw based on assumptions about gender. Gender often intersects with other dimensions of diversity, and the novelty of the “Seahorses” experience can prompt deep reflection and discussion, serving as a reference point both later in a course and long after its conclusion.
Second-dose intravenous thrombolysis with tenecteplase in alteplase-resistant medium-vessel-occlusion strokes: A retrospective and comparative study
Authors: Chausson Nicolas , Olindo Stéphane , Laborne François-Xavier , Aghasaryan Manvel , Renou Pauline , Soumah Djibril , Debruxelles Sabrina , Altarcha Tony , Poli Mathilde , L’Hermitte Yann , Sagnier Sharmila , Toudou-Daouda Moussa , Aminou-Tassiou Nana Rahamatou , Bentamra Leila , Benmoussa Narimane , Alecu Cosmin , Imbernon Carole , Smadja Léonard , Ouanounou Gary , Rouanet François , Sibon Igor , Smadja Didier
Published: June 2024

Introduction:

In intracranial medium-vessel occlusions (MeVOs), intravenous thrombolysis (IVT) shows inconsistent effectiveness and endovascular interventions remains unproven. We evaluated a new therapeutic strategy based on a second IVT using tenecteplase for MeVOs without early recanalization post-alteplase.

Patients and methods:

This retrospective, comparative study included consecutively low bleeding risk MeVO patients treated with alteplase 0.9 mg/kg at two stroke centers. One center used a conventional single-IVT approach; the other applied a dual-IVT strategy, incorporating a 1-h post-alteplase MRI and additional tenecteplase, 0.25 mg/kg, if occlusion persisted. Primary outcomes were 24-h successful recanalization for efficacy and symptomatic intracranial hemorrhage (sICH) for safety. Secondary outcomes included 3-month excellent outcomes (modified Rankin Scale score of 0–1). Comparisons were conducted in the overall cohort and a propensity score-matched subgroup.

Results:

Among 146 patients in the dual-IVT group, 103 failed to achieve recanalization at 1 h and of these 96 met all eligible criteria and received additional tenecteplase. Successful recanalization at 24 h was higher in the 146 dual-IVT cohort patients than in the 148 single-IVT cohort patients (84% vs 61%, p < 0.0001), with similar sICH rate (3 vs 2, p = 0.68). Dual-IVT strategy was an independent predictor of 24-h successful recanalization (OR, 2.7 [95% CI, 1.52–4.88]; p < 0.001). Dual-IVT cohort patients achieved higher rates of excellent outcome (69% vs 44%, p < 0.0001). Propensity score matching analyses supported all these associations.

Conclusion:

In this retrospective study, a dual-IVT strategy in selected MeVO patients was associated with higher odds of 24-h recanalization, with no safety concerns. However, potential center-level confounding and biases seriously limit these findings’ interpretation.

Trial Registration

ClinicalTrials.gov Identifier: NCT05809921
Risk Rationalities in Welfare State Policy and Practice in Indonesia: A Phenomenological Study of National Health Insurance in a Rural Community
Authors: Majid Muhammad Abdul , Susetiawan * , Nurhadi * , Yuda Tauchid Komara
Published: June 2024

The body of research examining the welfare systems of the Global South has expanded, yet there remains a lack of knowledge regarding the implications of modernising the welfare system in rural agrarian societies. A research gap in this area led us to conduct a live-in observation and 17 interviews with peasants in Merjosuro village—a rural area in Central Java, Indonesia—to examine how farmers’ rationality affects the perception of social risks and the decision-making process regarding health risks management. The study has two key findings. The first finding reveals that differences in the rationality of risk between policymakers and the Merjosuro community are the reason why the community does not participate in the National Health Insurance (JKN). The second finding indicates that the monthly contributory system promoted by JKN is incompatible with the livelihoods in an agrarian society characterised by unstable and irregular income depending on harvest time. Overall, the case in Merjosuro highlights the understudied phenomena of expanding modern-formal social policies within more traditional community-based informal welfare arrangements, which were found to have limited the pace of transformation of the welfare state expansion in the examined case. Additionally, the study has practical implications for rethinking contextualised designs of welfare state policies and practices for the Global South.
A qualitative study on the relationship between leadership and clinical skills in paramedicine and the promotion of patient safety
Authors: Lockhart Adrian , Walker Tony , Bowles Kelly-Ann
Published: June 2024

This study aims to investigate and describe the relationship between acquired leadership capability and clinical performance in the out-of-hospital environment (OOH) and to identify and explore those key themes that might influence a relationship between paramedic leadership aptitude and patient safety. This study employed a qualitative descriptive design using a combination of purposive and convenience sampling. Data collection occurred via semi-structured interviews conducted over teleconference. Qualitative thematic analysis was chosen with an inductive orientation, semantic focus of meaning, and experiential framework taken to coding and theme generation. This methodology facilitated the discovery and analysis of the participant's personal experiences with the interconnectedness of leadership and clinical skills and the associated implications to patient safety. Data was collected from seven registered paramedics, all of whom were working for public sector ambulance services as specialist, advanced care paramedics. Five primary themes emerged: (1) discovery of human factors, (2) knowledge growth is formal and informal, (3) working smarter, (4) leadership expectations and usefulness and (5) transparency of errors. These themes underpin the importance of, and provide constructive insights into, the relationship between leadership and clinical skills in paramedicine and the impact on patient safety. This research has identified that those non-technical skills (NTS) including that of leadership employed in paramedicine are inextricably linked and of equal importance to those technical clinical skills The assessment of a paramedic's NTS against a required standard in a similar way to a technical skill, is important when considering practice competency policies moving forward.
Complete chloroplast genome structural characterization of two Aerides (Orchidaceae) species with a focus on phylogenetic position of Aerides flabellata
Authors: Tao Kaifeng , Tao Lei , Huang Jialin , Duan Hanning , Luo Yan , Li Lu
Published: June 2024

Background

The disputed phylogenetic position of Aerides flabellata Rolfe ex Downie, due to morphological overlaps with related species, was investigated based on evidence of complete chloroplast (cp) genomes. The structural characterization of complete cp genomes of A. flabellata and A. rosea Lodd. ex Lindl. & Paxton were analyzed and compared with those of six related species in “Vanda-Aerides alliance” to provide genomic information on taxonomy and phylogeny.

Results

The cp genomes of A. flabellata and A. rosea exhibited conserved quadripartite structures, 148,145 bp and 147,925 bp in length, with similar GC content (36.7 ~ 36.8%). Gene annotations revealed 110 single-copy genes, 18 duplicated in inverted regions, and ten with introns. Comparative analysis across related species confirmed stable sequence identity and higher variation in single-copy regions. However, there are notable differences in the IR regions between two Aerides Lour. species and the other six related species. The phylogenetic analysis based on CDS from complete cp genomes indicated that Aerides species except A. flabellata formed a monophyletic clade nested in the subtribe Aeridinae, being a sister group to Renanthera Lour., consistent with previous studies. Meanwhile, a separate clade consisted of A. flabellata and six Vanda R. Br. species was formed, as a sister taxon to Holcoglossum Schltr.

Conclusions

This research was the first report on the complete cp genomes of A. flabellata. The results provided insights into understanding of plastome evolution and phylogenetic relationships of Aerides. The phylogenetic analysis based on complete cp genomes showed that A. flabellata should be placed in Vanda rather than in Aerides.
Multi-arm multi-stage (MAMS) randomised selection designs: impact of treatment selection rules on the operating characteristics
Authors: Choodari-Oskooei Babak , Blenkinsop Alexandra , Handley Kelly , Pinkney Thomas , Parmar Mahesh K. B.
Published: June 2024

Background

Multi-arm multi-stage (MAMS) randomised trial designs have been proposed to evaluate multiple research questions in the confirmatory setting. In designs with several interventions, such as the 8-arm 3-stage ROSSINI-2 trial for preventing surgical wound infection, there are likely to be strict limits on the number of individuals that can be recruited or the funds available to support the protocol. These limitations may mean that not all research treatments can continue to accrue the required sample size for the definitive analysis of the primary outcome measure at the final stage. In these cases, an additional treatment selection rule can be applied at the early stages of the trial to restrict the maximum number of research arms that can progress to the subsequent stage(s).

This article provides guidelines on how to implement treatment selection within the MAMS framework. It explores the impact of treatment selection rules, interim lack-of-benefit stopping boundaries and the timing of treatment selection on the operating characteristics of the MAMS selection design.

Methods

We outline the steps to design a MAMS selection trial. Extensive simulation studies are used to explore the maximum/expected sample sizes, familywise type I error rate (FWER), and overall power of the design under both binding and non-binding interim stopping boundaries for lack-of-benefit.

Results

Pre-specification of a treatment selection rule reduces the maximum sample size by approximately 25% in our simulations. The familywise type I error rate of a MAMS selection design is smaller than that of the standard MAMS design with similar design specifications without the additional treatment selection rule. In designs with strict selection rules - for example, when only one research arm is selected from 7 arms - the final stage significance levels can be relaxed for the primary analyses to ensure that the overall type I error for the trial is not underspent. When conducting treatment selection from several treatment arms, it is important to select a large enough subset of research arms (that is, more than one research arm) at early stages to maintain the overall power at the pre-specified level.

Conclusions

Multi-arm multi-stage selection designs gain efficiency over the standard MAMS design by reducing the overall sample size. Diligent pre-specification of the treatment selection rule, final stage significance level and interim stopping boundaries for lack-of-benefit are key to controlling the operating characteristics of a MAMS selection design. We provide guidance on these design features to ensure control of the operating characteristics.
The impact of long-term care interventions on healthcare utilisation among older persons: a scoping review of reviews
Authors: Balqis-Ali Nur Zahirah , Jawahir Suhana , Chan Yee Mang , Lim Amanda Wei-Yin , Azlan Ummi Wahidah , Shaffie Sal Sabila Mohd , Fun Weng Hong , Lee Shaun Wen Huey
Published: June 2024

Background

As the ageing population grows, the demand for long-term care (LTC) services will rise, concurrently amplifying healthcare utilisation. This review aims to examine and consolidate information on LTC interventions that influence healthcare utilisation among older persons.

Methods

A scoping review was performed through a systematic search in PubMed, EBSCO CINAHL, EBM Reviews - Cochrane Database of Systematic Reviews, Embase, APA PsycInfo, EBM Reviews - Health Technology Assessment, and EBM Reviews - NHS Economic Evaluation Database. Systematic reviews with meta-analyses published between 1 January 2010 and 2 June 2022 among older persons aged 60 and above were included. The characteristics of LTC interventions were mapped to the World Health Organization (WHO) Healthy Ageing Framework. The effect sizes of healthcare utilisations for LTC interventions were recalculated using a random-effects model. The methodological quality was assessed with the AMSTAR-2 checklist, while the quality of evidence for each association was evaluated using GRADE.

Results

Thirty-seven meta-analyses were included. The most prominent domain of the healthy ageing framework was managing chronic conditions. One hundred twelve associations between various LTC interventions and healthcare utilisations were identified, with 22 associations impacting healthcare utilisation. Four interventions were supported by suggestive or convincing evidence. Preventive home visits were found to reduce hospital admission (OR: 0.73, 95% CI: 0.59, 0.91,p = 0.005), caregiver integration during discharge planning (OR: 0.68, 95% CI: 0.57, 0.81,p < 0.001), and continuity of care (OR: 0.76, 95% CI: 0.61, 0.95,p = 0.018) reduced hospital readmission, and perioperative geriatric interventions reduced the length of hospital stay (MD: -1.50, 95% CI: -2.24, -0.76,p < 0.001). None of the associations impacted emergency department visits, medication use, and primary care utilisations with convincing evidence. Most reviews received low methodological quality.

Conclusion

The findings suggest that LTC interventions could benefit from transitioning to a community-based setting involving a multidisciplinary team, including carers. The spectrum of services should incorporate a comprehensive assessment to ensure continuous care.
The association between uric acid and erectile dysfunction in US adults: NHANES 2001–2004
Authors: jun Wang Yi , he Chen Ying , Fan Lai lai
Published: June 2024

Background

—Recent evidence suggests that hyperuricemia may act as independent risk factors for erectile dysfunction (ED), in addition to the already established factors. The current evidence supporting this relationship remains insufficient.

Methods and results

—A total of 3,810 participants from the NHANES pool between 2001 and 2004 were included in our study, comprising 1,093 individuals with ED and 2,717 individuals without ED. Univariable and multivariable logistic regression analyses were conducted to examine the relationship between uric acid (UA) and the prevalence of ED. In the fully adjusted model, no significant association was observed between UA and ED (OR = 1.02, 95% CI: 0.84–1.24), and no significant differences were noted among the various UA levels (p = 0.5). In our sensitivity analyses, employing a stricter definition for ED, no significant results were found in the fully adjusted model (OR = 0.85, 95% CI: 0.60–1.19). Furthermore, no significant differences were observed among the various UA levels (p = 0.083).

Conclusions

—Our study did not establish a correlation between UA levels and ED. Nonetheless, further research with larger sample cohorts is required to verify these findings.