bluuebunny/crossref_metadata_2025 huggingface dataset:
Black-white mixed race young people in Ireland and their lived experiences of racialised exclusion
Authors: O’Malley Patti
Published: December 2021

The multiracial family and the existence of mixed race children have come to be a regular feature of Irish familial life. Yet, nation-building discourses have promulgated notions of ethnic and religious homogeneity with Irish identity being racialised exclusively as white. Moreover, to date, there has been a dearth of academic scholarship related to racial mixedness in the Irish context. Through in-depth interviews, this paper sets out, therefore, to provide empirical insight into the lives of fifteen black (African) – white (Irish) mixed race young people (aged 4 to 18) with a particular focus on their experiences of racialised exclusion. Indeed, findings suggest that, as in other majority white national contexts, the black-white mixed race young people are racialised as black in the Irish public domain and as such, are positioned as ‘racialised outsiders’. In fact, their narrative accounts shed light on everyday encounters saturated by ‘us-them’ racial constructs based on phenotype. Thus, these young people, who are not fully recognised as mixed race Irish citizens, are effectively deprived of a space in which to articulate their belonging within the existing statist (i.e. inside/outside) framework.
Child Sexual Abuse by Religious Authority Figures in Germany and Israel: The Experiences and Perceptions of Adult Survivors
Authors: Lusky-Weisrose Efrat , Kowalski Marlene , Tener Dafna , Katz Carmit
Published: December 2021

The current study is based on an in-depth thematic analysis of 20 interviews with German and Israeli adult survivors of child sexual abuse (CSA) by religious authority figures (RAF). This paper aims to explore survivors’ experiences within the Jewish ultra-Orthodox and Christian communities, as well as to draw comparisons between the abusive structures and disclosure in these two contexts. The results point to the complexity of CSA by RAF, which is embedded in the survivors’ perceptions of themselves as emotionally and cognitively captured by the perpetrators who are a symbol of a parent or God and faith. The participants expressed great concern regarding disclosing the abuse against the backdrop of familial, cultural, and community inhibitors, such as fear of social stigmatization, inability to recognize the abuse, and the taboo of sexuality discourse. The survivors’ traumatic experiences were intensified in light of negative social responses to disclosure and encounters with insensitive officials. A comparison of the cultures revealed differences regarding the nature of community life and educational institutions, which may have shaped the disclosure and recognition of the abuse. The study highlights the importance of comparative follow-up studies related to this phenomenon in order to examine its universal and unique cultural contexts.
Daily Reports of Aggressive Behaviors in Interpersonal Conflicts
Authors: Mumford Elizabeth A. , Taylor Bruce G. , Borowiecki Mateusz , Maitra Poulami
Published: December 2021

Interpersonal conflicts are inevitable, but the probability that conflicts involve aggressive behavior varies. Prior research that has tended to focus on victimization in intimate partnerships reported through retrospective designs. Addressing these limitations, the current study examines daily reports of behaving aggressively in any conflict across relationships in a sample of 512 young adults drawn from the nationally representative iCOR cohort. Respondent attitudes and affective measures were collected at the end of the daily data collection period. Regression methods were applied to examine the probability and frequency of aggression, investigating early and recent exposure to adversities, attitudes, self-control, affect and emotional states, and alcohol use behavior. Recent adversities and the propensity to endorse a defensive honor code attitude, consistent with theory and retrospective studies of aggression, predicted both prevalence and frequency of aggressive behavior. The associations of childhood maltreatment and self-control with the prevalence of behaving aggressively were as expected, but these constructs were significantly associated with the frequency of aggression with unexpected, inverse directionality. Moreover, respondents’ affect and other emotional states were only associated with the frequency, not the prevalence, of aggressive behavior. Overall, this daily data collection constructively distinguished risk and protective factors for behaving aggressively more often. Further research is needed to disentangle the extent to which affective states drive or is a consequence of frequent aggressive behavior.
Anticoagulation Changes Following Major and Clinically Relevant Nonmajor Bleeding Events in Non-valvular Atrial Fibrillation Patients
Authors: Feldeisen Thane , Alexandris-Souphis Constantina , Haymart Brian , Kong Xiaowen , Kline-Rogers Eva , Handoo Faheem , Scott Kaatz , Ali Mona , Kozlowski Jay , Shah Vinay , Krol Gregory , Froehlich James B. , Barnes Geoffrey D.
Published: December 2021

Background: Bleeding events are common complications of oral anticoagulant drugs, including both warfarin and the direct oral anticoagulants (DOACs). Some patients have their anticoagulant changed or discontinued after experiencing a bleeding event, while others continue the same treatment. Differences in anticoagulation management between warfarin- and DOAC-treated patients following a bleeding event are unknown. Methods: Patients with non-valvular atrial fibrillation from six anticoagulation clinics taking warfarin or DOAC therapy who experienced an International Society of Thrombosis and Haemostasis (ISTH)-defined major or clinically relevant non-major (CRNM) bleeding event were identified between 2016 and 2020. The primary outcome was management of the anticoagulant following bleeding (discontinuation, change in drug class, and restarting of same drug class). DOAC- and warfarin-treated patients were propensity matched based on the individual elements of the CHA2DS2-VASc and HAS-BLED scores as well as the severity of the bleeding event. Results: Of the 509 patients on warfarin therapy and 246 on DOAC therapy who experienced a major or CRNM bleeding event, the majority of patients continued anticoagulation therapy. The majority of warfarin (231, 62.6%) and DOAC patients (201, 81.7%) restarted their previous anticoagulation. Conclusion: Following a bleeding event, most patients restarted anticoagulation therapy, most often with the same type of anticoagulant that they previously had been taking.
Epistemic pluralism and the justification of conceptual strategies in science
Authors: Wegerhoff Daniel , Ward Tony , Dixon Louise
Published: December 2021

In recent years, epistemic pluralism has received considerable endorsement as an approach to constructing scientific explanations and pursuing empirical research programs. In this article, we briefly discuss the advantages of an epistemically pluralist approach before outlining our own model of epistemic pluralism. The model we present emphasizes the specific considerations that occur when determining and justifying the selection of conceptual strategies and how conceptual strategies work together to provide task-relevant insights. By clarifying these constraint relationships, we highlight the kinds of systematic considerations that must be taken into account when selecting conceptual strategies for research tasks. We present a case study based on gang research to demonstrate how such considerations occur and the epistemic and pragmatic benefits of doing so.
Factors affecting sleep quality in patients with systemic lupus erythematosus
Authors: Özer Serap , Kankaya Hülya , Gün Rabiye , Yeler Necla , Marangoz Özge , Bozça Hilal
Published: December 2021

Objective

This study aimed to assess the sleep quality and the factors affecting the sleep quality in patients with systemic lupus erythematosus (SLE).

Methods

This was a descriptive and cross-sectional study conducted in 105 patients with SLE who were admitted to the rheumatology polyclinic of a university hospital between May and July 2017. The data were collected using a “Patient Description Form” and the “Pittsburgh Sleep Quality Index (PSQI).”

Results

The total mean (standard deviation) PSQI score of the patients was 7.81 (3.11). Duration of disease, presence of comorbid diseases, side effects of drugs, and sleep disruption and related problems were identified as factors affecting sleep quality. The model of the regression showed that side effects of drugs, sleep disruption, and trouble falling asleep suffered higher PSQI score (bad sleep quality).

Conclusions

Results of this study showed that the sleep quality was generally poor in patients with SLE. Sleep quality was affected by some disease and sleep variables. Therefore, comprehensive sleep evaluation is necessary in the planning of treatment and care of SLE patients and to implement initiatives to improve sleep patterns in these patients.
Assessing Quality in Advance Care Planning Documentation: A Survey of Current Methods
Authors: Berkowitz Callie M. , Ma Jessica , Lowe Jared , Dolor Rowena J.
Published: December 2021

Background

High-quality advance care planning (ACP) documentation facilitates the communication of patients’ wishes as they progress in their disease course and travel between health care settings. No consensus exists regarding evaluation of documentation quality, and diverse strategies for assessing quality have been adopted in clinical ACP studies.

Methodology

We conducted a literature review in PubMed and via manual search to identify clinical studies that assessed ACP quality or completeness as an outcome measure over a 5-year period. Studies that treated ACP as a binary outcome variable (present or absent), studies that took place outside of the US, and studies in pediatric populations were excluded from review.

Results

We identified 11 studies for inclusion in our review. Across study methodologies, the following 8 quality domains were identified: discussion frequency, documentation accessibility, discussion timing, health care proxy, health goals or values, scope of treatment/code status, prognosis/illness understanding, and end of life (EOL) care planning. Each study assessed between 2 and 6 domains. Divergent methods for assessing quality domains were utilized, including manual qualitative analysis and natural language processing techniques.

Conclusion

Defining and measuring the quality of documentation is critical to developing ACP programs that improve patient care. Our review provides an adaptable framework centered around quality domains.
Truth Disclosure at the End of Life: A Qualitative Study of Internal Medicine Residents in the United Arab Emirates
Authors: Ibrahim Halah , Harhara Thana
Published: December 2021

Background

Respect for patient autonomy has become the guiding biomedical ethical tenet in the West; yet, moral values are contextual and culturally relevant. In the collectivist society of the Middle East, families and physicians have historically believed that concealing truth about a terminal illness is more ethical and compassionate. Recent studies reveal a trend toward truth disclosure.

Objective

To gain insight into resident experiences with, and barriers to, truth disclosure in terminally ill patients in the United Arab Emirates (UAE).

Methods

Focus group interviews were conducted with first through fourth year internal medicine residents and recent graduates at two large academic medical centers in the UAE. Qualitative thematic content analysis was used to identify themes related to communication and truth telling in end-of-life care.

Results

Residents revealed that non-disclosure of medical information in serious illness is a common practice in UAE hospitals. Barriers to truth telling include family objection, deficits in medical training, and inconsistently implemented institutional guidelines.

Conclusion

Educational and policy interventions are needed to improve physician-patient communication, decrease patient-family-physician tension, and alleviate trainee moral distress.
Effectiveness and Cost-Benefit of an Elementary School-Based Telehealth Program
Authors: Long Michael W. , Hobson Sharon , Dougé Jacqueline , Wagaman Kerrie , Sadlon Rachel , Price Olga Acosta
Published: December 2021

Utilization of telehealth in school-based health centers (SBHCs) is increasing rapidly during the COVID-19 pandemic. This study used a quasi-experimental design to evaluate the effect on school absences and cost-benefit of telehealth-exclusive SBHCs at 6 elementary schools from 2015–2017. The effect of telehealth on absences was estimated compared to students without telehealth using negative binomial regression controlling for absences and health suite visits in 2014 and sociodemographic characteristics. The sample included 7,164 observations from 4,203 students. Telehealth was associated with a 7.7% (p = 0.025; 95% CI: 1.0%, 14%) reduction in absences (0.60 days/year). The program cost $189,000/yr and an estimated total benefit of $384,995 (95% CI: $60,416; $687,479) and an annual net benefit of $195,873 (95% CI: −$128,706; $498,357). While this cost-benefit analysis is limited by a lack of data on total healthcare utilization, the use of telehealth-exclusive SBHCs can improve student health and attendance while delivering cost savings to society.
Mutual interference and its effects on searching efficiency between predator–prey interaction with bifurcation analysis and chaos control
Authors: Ishaque Waqas , Din Qamar , Taj Muhammad
Published: December 2021

In this paper, we study the dynamic of the predator–prey model based on mutual interference and its effects on searching efficiency. The parametric conditions, existence, and stability for trivial and boundary equilibrium points are studied. Also, it has shown that by applying the center manifold theorem and bifurcation theory, system undergoes Neimark–Sacker bifurcation across the neighborhood of a positive fixed point. Moreover, due to the bifurcation and chaos which objectively exist in a system, three chaos control strategies are designed and used. Moreover, to validate our theoretical and analytical discussions, numerical simulations are applied to show complex and chaotic behavior. Finally, theoretical discussions are validated with experimental field data.
Understanding Escalation Through Intimate Partner Homicide Narratives
Authors: Kafonek Katherine , Gray Andrew C. , Parker Karen F.
Published: December 2021

The study aims to expand our understanding of escalation from intimate partner violence to intimate partner homicide (IPH) by exploring the known circumstances leading up to a lethal event. The study draws on qualitative data from law enforcement reports and coroner/medical examiner reports within the National Violent Death Reporting System to identify themes preceding and surrounding IPH incidents. Findings support the utility of risk assessments in identifying escalation while illustrating the complex ways that violence between current or former intimate partners can escalate to lethality, particularly the role of separation and the use of firearms.
The Task Matters: A Scoping Review on Reading Comprehension Abilities in ADHD
Authors: Parks Kaitlyn M.A. , Moreau Christine N. , Hannah Kara E. , Brainin Leah , Joanisse Marc F.
Published: December 2021

Objective:

A broad range of tasks have been used to classify individuals with ADHD with reading comprehension difficulties. However, the inconsistency in the literature warrants a scoping review of current knowledge about the relationship between ADHD diagnosis and reading comprehension ability.

Method:

A comprehensive search strategy was performed to identify relevant articles on the topic. Thirty-four articles met inclusion criteria for the current review.

Results:

The evidence as a whole suggests reading comprehension is impaired in ADHD. The most prominent effect was found in studies where participants retell or pick out central ideas in stories. On these tasks, participants with ADHD performed consistently worse than typically developing controls. However, some studies found that performance in ADHD improved when reading comprehension task demands were low.

Conclusion:

Results suggest that performance in ADHD depends on the way reading comprehension is measured and further guide future work clarifying why there are such discrepant findings across studies.
Transient central retina artery occlusion in patients undergoing intravitreal anti vegf injections
Authors: Damasceno Nadyr A , Yannuzzi Nicolas A , Maia Mauricio , Eid Farah Michel , Flynn Harry W , Damasceno Eduardo F
Published: December 2021

Purpose

To evaluate the occurrence of transient central retinal artery occlusion following intravitreal anti-vascular endothelial growth factor injection.

Methods

Prospective, observational study of 807 patients (807 eyes) who were given intravitreal injections of ranibizumab or aflibercept to treat any cause of retinal vascular diseases between 1 January 2017 and 30 November 2018 at the Federal Fluminense University Hospital in Niteroi, and a private facility in Rio de Janeiro, Brazil. Patients who did not present transient central retinal artery occlusion were excluded.

Results

Among 4069 injections, only 18 patients (0.44%) presented transient central retinal artery occlusion, 14 mild cases (77.7%), and 4 severe cases (22.3%). The clinical factors associated with more severe cases of transient central retinal artery occlusion were the duration of the transient central retinal artery occlusion ( p = 0.001), number of prior injections ( p = 0.01), and a positive carotid Doppler test ( p = 0.01). Twelve cases (66.6%) had positive carotid artery obstruction (atheroma plaque size ≥70%) while 6 cases (33.3%) had negative carotid artery obstruction (atheroma plaque size <70%). The age group >60 years old ( p = 0.06), cup/disc ratio >0.6 ( p = 0.06), and pseudophakic lens status were also factors with association with transient central retinal artery occlusion, although did not meet criteria for statistical significance. The only patient who experienced a recurrent episode of transient central retinal artery occlusion had diabetic macular edema, positive carotid Doppler test, and cup/optic disc ratio >0.6.

Conclusion

Transient central retinal artery occlusion is a rare adverse event that can appear in patients with retinal vascular disease receiving anti-vascular endothelial growth factor therapy. The atheroma plaque size and the number of prior injections can be associated with the severity of the event.
Expression of SCO1 and SCO2 after form-deprivation myopia in Guinea pigs
Authors: Zhou Guimei , Lan Changjun , Yang Qin , Zhong Weiqi , Gu Zhiming , Xiang Xiaoling , Mao Yumei , Liao Xuan
Published: December 2021

Purpose

The retina is a highly energy-consuming tissue associated with visual development, and the reduced quality of retinal imaging can be related to myopia. Synthesis of cytochrome c oxidase 1 ( SCO1) and synthesis of cytochrome c oxidase 2 ( SCO2) are involved in ATP (adenosine triphosphate) synthesis and energy metabolism. This study aimed to observe the morphologic changes and investigate the expression of SCO1 and SCO2 induced by form-deprivation myopia (FDM) in the retina and sclera of guinea pigs.

Methods

Thirty-six 3-week-old male guinea pigs were randomly assigned to one of two groups: (1) the model group (n  =  18), in which the right eyes were covered by a thin opaque balloon as FDM group, and the left eyes were uncovered and served as the contralateral control group; (2) the blank control group (n  =  18), in which bilateral eye received no manipulation. Eyeballs were enucleated for histological analysis. The retina and sclera of the guinea pigs were separated to determine the protein and mRNA expression levels of SCO1 and SCO2, respectively.

Results

After four weeks of form deprivation (FD), the refractive degree and axial length increased significantly ( P < 0.001). The retinal and scleral tissues were moderately thinner, and the ganglion cells and the cells of inner and outer nuclear layers in the retina became fewer. Compared with the contralateral control group ( P < 0.001) and the blank control group ( P < 0.001), the collagen content of the sclera became less in the FDM group. The protein and mRNA expression levels of SCO1 and SCO2 in the FDM group were significantly lower than those in the contralateral control group and the blank control group ( P < 0.05).

Conclusions

The morphologies of the retina and sclera were changed, and the expression of SCO1 and SCO2 at the protein and transcription levels was significantly reduced in the FDM group. Given these changes, SCO1 and SCO2 genes may be involved in myopic progression.
Impact of dermoscopy-aided pediatric teledermatology program on the accessibility and efficiency of dermatology care at community health centers
Authors: Calafiore Rebecca , Khan Aziz , Anderson Daren , Wu Zhao Helen , Lu Jun
Published: December 2021

Background

There are few studies focusing on pediatric teledermatology, and the impact of a large-scale pediatric teledermatology program on the accessibility and efficiency of dermatology care remains unclear. This study evaluated the impact of a state-wide implementation of a store-and-forward teledermatology program augmented by the incorporation of dermoscopy in pediatric patients visiting community health centers.

Methods

It was a descriptive, retrospective cohort study of 876 pediatric dermatology referrals.

Results

In the traditional referral system, only 60 patients (17.6%) were seen by dermatologists with average waiting times of 75 days due to limited access. In comparison, with an implementation of dermoscopy-aided teledermatology, all 536 teledermatology referrals received dermatological care within 24 h, of which only 64 (12%) patients requires face-to-face (F2F) consultation. Patients referred for F2F consultation via eConsults had a much lower no-show rate as compared to the traditional referral system (39% vs. 71%). Side by side comparison between general population and pediatric population has demonstrated shared features in efficiency and access improvement but revealed specific characteristics of pediatric teledermatology in terms of diagnosis and treatment.

Conclusion

Coordinated store-and-forward teledermatology platform with incorporation of dermoscopy between large community care network and dermatology provider can greatly improve access to pediatric dermatology care especially in underserved population. The efficiency of teledermatology in access improvement for pediatric population is comparable with adult population in eConsults. There are also unique features and challenges in pediatric teledermatology that require further research.
Dynamics research of Fangzhu’s nanoscale surface
Authors: Wu Pinxia , Ling Weiwei , Li Xiumei , He Xichun , Xie Liangjin
Published: December 2021

In this paper, we mainly focus on a fractal model of Fangzhu’s nanoscale surface for water collection which is established through He’s fractal derivative. Based on the fractal two-scale transform method, the approximate analytical solutions are obtained by the energy balance method and He’s frequency–amplitude formulation method with average residuals. Some specific numerical experiments of the model show that these two methods are simple and effective and can be adopted to other nonlinear fractal oscillators. In addition, these properties of the obtained solution reveal how to enhance the collection rate of Fangzhu by adjusting the smoothness of its surfaces.
Beyond existential and neoliberal explanations of consumers’ embodied risk-taking: CrossFit as an articulation of reflexive modernization
Authors: Thompson Craig J , Isisag Anil
Published: December 2021

This study analyzes CrossFit as a marketplace culture that articulates several key dimensions of reflexive modernization. Through this analysis, we illuminate a different set of theoretical relationships than have been addressed by previous accounts of physically challenging, risk-taking consumption practices. To provide analytic clarity, we first delineate the key differences between reflexive modernization and the two interpretive frameworks—the existential and neoliberal models—that have framed prior explanations of consumers’ proactive risk-taking. We then explicate the ways in which CrossFit’s marketplace culture shapes consumers’ normative understandings of risk and their corresponding identity goals. Rather than combatting modernist disenchantment (i.e., the existential model) or building human capital for entrepreneurial competitions (i.e., the neoliberal model), CrossFit enthusiasts understand risk-taking as a means to build their preparatory fitness for unknown contingencies and imminent threats. Our analysis bridges a theoretical chasm between studies analyzing consumers’ proactive risk-taking behavior and those addressing the feelings of anxiety and uncertainty induced by the threat of uncontrollable systemic risks.
Rwandan solutions to Rwandan problems: Heritage decolonization and community engagement in Nyanza District, Rwanda
Authors: Bolin Annalisa , Nkusi David
Published: December 2021

Highlighting the rural district of Nyanza in Rwanda, this article examines community relations to heritage resources. It investigates the possibilities for more ethical, engaged models of heritage management which can better deliver on agendas of decolonization and development. Our research finds that Nyanza’s heritage stakeholders highly value heritage’s social and economic roles, but communities are also significantly alienated from heritage resources. In seeking to bridge this gap, heritage professionals utilize a discourse of technocratic improvement, but community leaders emphasize ideas of ownership, drawing on higher state-level discourses of self-reliance and “homegrown solutions.” They mobilize the state’s own attempts to filter developing, decolonizing initiatives through Rwandan frameworks to advocate for communities’ right to participate in heritage. This local agency offers a roadmap for utilizing favorable aspects of existing governance to push heritage management toward community engagement and decolonization.
Probability of detection, localization, and sizing: The evolution of reliability metrics in Structural Health Monitoring
Authors: Falcetelli Francesco , Yue Nan , Di Sante Raffaella , Zarouchas Dimitrios
Published: December 2021

The successful implementation of Structural Health Monitoring (SHM) systems is confined to the capability of evaluating their performance, reliability, and durability. Although there are many SHM techniques capable of detecting, locating and quantifying damage in several types of structures, their certification process is still limited. Despite the effort of academia and industry in defining methodologies for the performance assessment of such systems in recent years, many challenges remain to be solved. Methodologies used in Non-Destructive Evaluation (NDE) have been taken as a starting point to develop the required metrics for SHM, such as Probability of Detection (POD) curves. However, the transposition of such methodologies to SHM is anything but straightforward because additional factors should be considered. The time dependency of the data, the larger amount of variability sources and the complexity of the structures to be monitored exacerbate/aggravate the existing challenges, suggesting that much work has still to be done in SHM. The article focuses on the current challenges and barriers preventing the development of proper reliability metrics for SHM, analyzing the main differences with respect to POD methodologies for NDE. It was found that the development of POD curves for SHM systems requires a higher level of statistical expertise and their use in the literature is still limited to few studies. Finally, the discussion extends beyond POD curves towards new metrics such as Probability of Localization (POL) and Probability of Sizing (POS) curves, reflecting the diagnosis paradigm of SHM.
Rethinking individual autonomy in medical decision-making for young adults reliant on caregiver support: A case report and analysis
Authors: Zagouras Alexia , Ellick Elise , Aulisio Mark
Published: December 2021

There is a gap in the clinical bioethics literature concerning the approach to assessment of medical decision-making capacity of adolescents or young adults who demonstrate diminished maturity due to longstanding reliance on caregiver support, despite having reached the age of majority. This paper attempts to address this question via the examination of a particular case involving assessment of the decision-making capacity of a young adult pregnant patient who also had a physically disabling neurological condition. Drawing on concepts from adolescent bioethics and feminist critiques of bioethical theory, we argue that limited life experience, secondary to a disabling neurological condition, can result in a lack of adult-like capacity even in a patient who is legally an adult. In such cases, it may be that autonomy, to the extent that it is to be relevant and meaningful, must be viewed through a relational lens. Furthermore, clinicians may avoid unjustifiably paternalistic practices by working with the patient help her gain a better appreciation of the consequences of her decision, thereby calling forward her capacity rather than resorting to being directive in counseling. We conclude that lessons from this case can be used to approach ethically complex instances of medical decision-making in adult patients with normal cognition but diminished experiential maturity.
On challenges to respect for autonomous decision making in primary care
Authors: Spicer John , Ahluwalia Sanjiv , Shah Rupal
Published: December 2021

Primary health care is characterised by timely and appropriate health care access, delivered continuously over time to a specific population, providing a comprehensive service, with coordination of care for those that need it. Practitioners deal with a multiplicity of clinical issues within longitudinal relationships, embedded in the context of families and communities. We propose that these aspects of primary care have a bearing on how matters of decision making are considered and implemented. Further, the standard account of autonomous decision making is not wholly adequate when applied to clinician–patient encounters in primary care. We add considerations of the impact of illness (however defined) and self-identity as also relevant to a more measured and full account. The context of primary care is quite different from that of secondary care. Although there are generalists who work in hospitals, we argue that this aspect and the other attributes of primary care generate special ethical considerations. One of these is how autonomy, or more fully, how respect for the principle of autonomy is considered and operationalised in community practice. In this study, we describe some theoretical aspects of autonomy and seek to apply, and challenge, these aspects in the context of clinical work in primary care. In doing so we will review the descriptors of primary care: why in essence it is different from other contexts of clinical work.
Bedside rationing in cancer care: Patient advocate perspective
Authors: Gonzato Ornella
Published: December 2021

Rationing in healthcare remains very much a taboo topic. Before COVID-19, it rarely received public attention, even when it occurred in everyday practices, mainly in the form of implicit rationing, as it continues to do today. There are different definitions, types and levels of healthcare rationing, according to different perspectives. With the aim of contributing to a more coherent debate on such a highly emotional healthcare issue as rationing, here are provided a number of reflections from a patient advocate perspective which are specifically focused on bedside rationing, the most troublesome level, both for patients and clinicians, particularly in regard to cancer care. Oncology, with its numerous expensive therapies and increasing number of patients, is undeniably one of the main areas contributing to the increase in healthcare costs. However, the fixed budgets of today's publicly financed health systems cannot allow unlimited access to the potentially beneficial treatments to all patients. Bedside rationing constitutes the last phase of many decision-making processes occurring at different interrelated levels (macro-levels), both inside and outside healthcare systems, which implicitly and inevitably result in a bottleneck determined by the upstream decisions themselves. Shifting from implicit to explicit bedside rationing essentially means moving from a paternalistic to a citizen-before-patient approach; this implies, first of all, a cultural change. Practical bedside rationing is an ethically complex topic, but one that needs to be urgently addressed in a transparent and open debate. In this scenario, the oncological community – patients, patient advocates and clinicians – can and should play an important role.
Should medical students perform pelvic exams on anaesthetised patients without explicit consent?
Authors: Bell Chloe , Emmerich Nathan
Published: December 2021

There have been many reports of medical students performing pelvic exams on anaesthetised patients without the necessary consent being provided or even sought. These cases have led to an ongoing discussion regarding the need to ensure informed consent has been secured and furthermore, how it might be best obtained. We consider the importance of informed consent, the potential harm to both the patient and medical student risked by the suboptimal consent process, as well as alternatives to teaching pelvic examinations within medical school. The subsequent discussion focuses on whether medical students should perform pelvic examinations on anaesthetised patients without personally ensuring that they have given their explicit consent. Whilst we question the need to conduct pelvic examinations on anaesthetised patients in any circumstance, we argue that medical students should not perform such exams without personally securing the patients informed consent.
Commissioning Clinical Spaces During a Pandemic: Merging Methodologies of Human Factors and Simulation
Authors: Fuselli Tara , Raven Amanda , Milloy Shaunna , Barnes Sue , Dubé Mirette , Kaba Alyshah
Published: December 2021

Objectives:

The objective of this case study is to demonstrate the value of applying tabletop and simulation techniques to highlight high-risk, high-impact outcomes and organizational recommendations in the commissioning of a new clinical spaces.

Purpose/Aim:

Generalizability of lessons learned from this case study aim to support other health organizations in commissioning of clinical spaces during communicable disease outbreaks.

Background:

COVID-19 challenged our healthcare system, requiring teams to prepare in a short span of time. Bridging expertise of human factor and simulation teams provided a novel, interdisciplinary, and timely approach to evaluate and commission spaces.

Methods:

Human factors and simulation teams were enlisted to conduct an evaluation of a new space prior to readiness for delivery of safe patient care. An adapted tabletop evaluation and subsequent systems integration simulation was conducted. The goal of the tabletop exercise was to identify and define processes and risks to tested in the physical space using simulation.

Results:

Applying both human factors science and systems simulation proactively identified the highest risk, highest impact outcomes, validated existing processes and allowed for refining of potential solutions and recommendations of the new space. A strong working relationship between teams fostered an opportunity to share information, debrief, evaluate, and adapt methods while applying timely changes based on emergent findings.

Conclusions:

These combined methodologies are important tools that can be learned and applied to healthcare commissioning of new clinical spaces in the identification of high-risk, high-impact outcomes affecting staff and organizational preparedness and safety.
Tricuspid valve endocarditis following over-the-counter intravenous injection of skin-whitening products
Authors: Sani Huzairi , Zulkufli Nada S , Gan Yi L , Nadzir Ainur F , Kasim Sazzli
Published: December 2021

Intravenous drug use, central catheters and intracardiac devices are known predispositions to right-sided infective endocarditis (IE). We report a case of tricuspid IE caused by Acinetobacter seifertii and Enterobacter bugandensis as a result of intravenous use of skin-whitening products bought online. Clinical implications and pharmaceutical regulations are briefly discussed.
Safety assessment method of steel protective structure against large-scale debris flow
Authors: Kokuryo Hiroshi , Horiguchi Toshiyuki , Ishikawa Nobutaka
Published: December 2021

Recently, steel pipe open type protective structures (steel open dams) have been damaged because of large-scale debris flow resulting from torrential rainfall based on abnormal climate. This article proposes a safety assessment method for the load-carrying capacity of a steel open dam against large-scale debris flow load (level II load) using the energy constant law. First, the safety assessment method of steel open dams is proposed that the ultimate strength must be larger than the required strength against the level II load, which is determined by using the energy constant law. Second, the load-carrying capacities of three types of steel open dams with different structural shapes against the front and eccentric debris flow loadings are investigated by a push-over analysis. Finally, the safety assessments on load-carrying capacities against the front and eccentric debris flow loading are confirmed and the strength reduction by the eccentric loading is examined for three steel open dams.
Competence of clinical nurse educators in university hospitals: A cross-sectional study
Authors: Kaarlela Veera , Mikkonen Kristina , Pohjamies Netta , Ruuskanen Susanna , Kääriäinen Maria , Kuivila Heli-Maria , Haapa Toni
Published: December 2021

The role of clinical nurse educators is essential in improving the quality of mentoring, supporting students’ learning and professional development during clinical training. The purpose was to explore the competence profiles of clinical nurse educators and background factors associated with these profiles. Data of this cross-sectional study were collected from clinical nurse educators ( n = 19) at Finnish university hospitals, using two instruments measuring the competence of healthcare educators. Data were analysed with K-means clustering and two profiles were identified based on sum variables. Significance between the differences of Profile 1 and Profile 2 was evaluated by comparing independent groups. The STROBE checklist was used as the reporting guideline for the manuscript. Educators’ competence varied between intermediate (2.50–3.49) and high (≥ 3.50) levels, and self-assessment of the Profile 1 was average higher than those in Profile 2. The results can be used to identify and develop the competence of clinical nurse educators and to consolidate the role and position of clinical nurse educators within healthcare education.
Woody species composition and community types of Hangadi Watershed, Guji Zone, Ethiopia
Authors: Tamiru Berhanu , Soromessa Teshome , Warkineh Bikila , Legesse Gudina , Belina Merga
Published: December 2021

Background

Hangadi watershed is endowed with the only virgin forest in Odo shakisso harbouring high biodiversity, but it has been suffered from anthropogenic activities. This study was conducted to investigate composition and community diversity of woody species in restoration for posterity. Satellite images of 1988, 2008, and 2018 were used to classify and analyse trends of deforestation. For both woody species and topsoil (0–30 cm), 20 m × 20 m, 100 plots laid at every 300 m along line transects, 1 km apart from each other. In each sample plot, woody species ≥ 3 m were counted, Shannon–wiener diversity index, cluster analysis and ordination were computed.

Results

Agroforestry is found to be the dominant land use/land cover class followed by forest and cultivated land. A total of 61 woody species belonging to 34 families; 8.2% of the species were endemic to Ethiopia. The highest number of species was recorded from families Euphorbiaceae and Rubiaceae (5 species, 8.2%), Rutaceae, Celastraceae, and Oleaceae (3 species, 5.08%) followed by Flacourtiaceae, Meliaceae, Araliaceaae, Myrsinaceae, Moraceae, Boraginaceae, Asteraceae, Spontaceae, Lauraceae and Sapindaceae (2 species each). Four woody plant communities were identified using free statistical software R version 3.1.1. The canonical correspondence analysis result showed that EC, pH, OM, altitude, C:N, CEC, sand, silt, AvP, and TN significantly affected species distribution in the watershed.

Conclusion

Local people involved in cutting mature woody species for timber production, making farm implements and, cultivated land expansion. Protection of woody species diversity of forest and coffee systems with low biodiversity value conservation concepts are recommended to be executed jointly by local people and stakeholders.
Plasma metabolomic profiling of hypertrophic cardiomyopathy patients before and after surgical myectomy suggests postoperative improvement in metabolic function
Authors: Wolter Nicole L. , LeClair Madison J. , Chin Michael T.
Published: December 2021

Background

Hypertrophic cardiomyopathy (HCM) is a common inherited heart disorder complicated by left ventricle outflow tract (LVOT) obstruction, which can be treated with surgical myectomy. To date, no reliable biomarkers for LVOT obstruction exist. We hypothesized that metabolomic biomarkers for LVOT obstruction may be detectable in plasma from HCM patients.

Methods

We conducted metabolomic profiling on plasma samples of 18 HCM patients before and after surgical myectomy, using a commercially available metabolomics platform.

Results

We found that 215 metabolites were altered in the postoperative state (p-value < 0.05). 12 of these metabolites were notably significant after adjusting for multiple comparisons (q-value < 0.05), including bilirubin, PFOS, PFOA, 3,5-dichloro-2,6-dihydroxybenzoic acid, 2-hydroxylaurate, trigonelline and 6 unidentified compounds, which support improved organ metabolic function and increased lean soft tissue mass.

Conclusions

These findings suggest improved organ metabolic function after surgical relief of LVOT obstruction in HCM and further underscore the beneficial systemic effects of surgical myectomy.
Incidence of heart valve disease in women treated with the ergot-derived dopamine agonist bromocriptine
Authors: Clausen Marianne F. , Rørth Rasmus , Torp-Pedersen Christian , Westergaard Lucas Malta , Weeke Peter E. , Gislason Gunnar , Køber Lars , Fosbøl Emil , Kristensen Søren Lund
Published: December 2021

Background

Ergot-derived dopamine agonists are thought to induce fibrotic changes in cardiac valve leaflets. We sought to determine the incidence of heart valve disease in women treated with bromocriptine compared with age and sex matched controls from the background population.

Methods

In nationwide Danish registries we identified female patients treated with bromocriptine in the period 1995–2018. Patients were included at date of second redeemed prescription and were matched 1:5 with controls from the background population based on age, sex and year of inclusion by use of incidence density sampling. The outcomes were hospital admission for or outpatient diagnosis of heart valve disease, and death as competing risk. Incidence rates, cumulative incidence curves, and adjusted cox-proportional hazard models adjusted for cardiovascular risk factors were used to assess outcomes in bromocriptine users versus controls.

Results

A total of 3035 female bromocriptine users and 15,175 matched controls were included. Median age at inclusion was 32 years (Q1–Q3, 28–37 years). Both bromocriptine users and controls had few comorbidities and low use of concomitant pharmacotherapy. Within 10 years of follow-up, 11 patients (0.34%, 95% CI 0.13–0.55%) and 44 controls (0.29%, 95% CI 0.20–0.37) met the primary endpoint of heart valve disease, p = 0.63. The adjusted cox regression analysis yielded a hazard ratio of 0.96 (95% confidence interval (CI) 0.55–1.69, p = 0.89).

Conclusions

Treatment initiation with ergot-derived dopamine agonist bromocriptine in younger women with few comorbidities, was associated with a low absolute long-term risk of heart valve disease, not significantly different from the risk in age and sex matched population controls. Thus, indicating a low clinical yield of pre-treatment echocardiographic screening in this patient population in accordance with current guidelines.
Elevated lipoprotein(a) and lipoprotein-associated phospholipase A2 are associated with unfavorable functional outcomes in patients with ischemic stroke
Authors: Jiang Xue , Xu Jie , Hao Xiwa , Xue Jing , Li Ke , Jin Aoming , Lin Jinxi , Meng Xia , Zheng Lemin , Wang Yongjun
Published: December 2021

Background

The association of lipoprotein(a) [Lp(a)] and stroke functional outcomes was conflicting. The aim of the study was to clarify whether high Lp(a) is associated with unfavorable functional outcomes in patients with ischemic stroke.

Methods

A total of 9709 individuals from the third China National Stroke Registry cohort were recruited. Plasma level of Lp(a) at admission was measured with enzyme-linked immunosorbent assay. The cut-off was set at the median for Lp(a). Functional outcome was assessed using the modified Rankin scale (mRS) at 3 months and 1 year after ischemic stroke. The association between Lp(a) and functional outcomes was evaluated using a logistic regression model.

Results

The median age was 63.0 years, and 31.1% participants were women. Patients in higher Lp(a) group had higher incidences of unfavorable functional outcomes at 3 months. In logistic regression model, elevated Lp(a) levels were associated with unfavorable functional outcomes at 3 months (Q4 vs. Q1: odds ratio 1.33, 95% confidence interval 1.11–1.61). Subgroup analysis showed that in the lower Lp-PLA2 group, Lp(a) level was not associated with functional outcomes, but in the higher Lp-PLA2 group, Lp(a) level was significantly associated with functional outcomes. After grouped by different levels of Lp(a) and Lp-PLA2, the Lp(a) high/ Lp-PLA2 high group showed the highest incidence of unfavorable functional outcomes at 3 months and 1 year.

Conclusions

Elevated Lp(a) level is associated with unfavorable functional outcomes in patients with ischemic stroke. The increment in both Lp(a) and Lp-PLA2 are associated with unfavorable functional outcomes at 3 months and 1 year after ischemic stroke.