bluuebunny/crossref_metadata_2025 huggingface dataset:
Within and Between Two Worlds: Conceiving, Measuring, and Applying Mixed-Ethnic Identity in Three Countries
Authors: Cleveland Mark
Published: October 2023

Accompanying the rising ethnic diversity of Western countries is a burgeoning number of mixed-ethnic unions and people with mixed-ethnic ancestry. These people do not fit neatly into one group or another. This ambiguity is compounded by the fact that their ethnic identity is affected by how they are perceived and labeled by others. Theories have been advanced to explain ethnic identity, and its corollaries for cognition, emotions, and consumer behaviors. However, aside from a handful of ethnographic studies, knowledge about how social identity of mixed-ethnic consumers is formed and shaped, and how it potentially affects consumer dispositions, remains largely uncharted. Using data gathered in three countries (Canada, United States, United Kingdom), and considering various ethnic mixture combinations, this article presents the development and validation of a multidimensional scale for measuring mixed-ethnic identity (MEI) and examines the relationships of the 13 MEI components to consumer dispositions commonly used to segment domestic and international markets. The consistency of the relationships between the MEI components and the established consumer dispositions are scrutinized. Implications for theory and practice are discussed.
Within-Person Test Score Distributions: How Typical Is “Normal”?
Authors: Buchholz Alison S. , Reckess Gila Z. , Del Bene Victor A. , Testa S. Marc , Crawford Jeffrey L. , Schretlen David J.
Published: October 2023

We evaluated within-person variability across a cognitive test battery by analyzing the shape of the distribution of each individual’s scores within a battery of tests. We hypothesized that most healthy adults would produce test scores that are normally distributed around their own personal battery-wide, within-person (wp) mean. Using cross-sectional data from 327 neurologically healthy adults, we computed each person’s mean, standard deviation, skew, and kurtosis for 30 neuropsychological measures. Raw scores were converted to T-scores using three degrees of calibration: (a) none, (b) age, and (c) age, sex, race, education, and estimated premorbid IQ. Regardless of calibration, no participant showed abnormal within-person skew (wpskew) and only 10 (3.1%) to 16 (4.9%) showed wpkurtosis greater than 2. If replicated in other samples and measures, these findings could illuminate how healthy individuals are endowed with different cognitive abilities and provide the foundation for a new method of inference in clinical neuropsychology.
Comparison Is the Thief of Joy? Introducing the Attitudes Towards Social Comparison Inventory
Authors: Schlechter Pascal , Meyer Thomas , Morina Nexhmedin
Published: October 2023

Social comparison has a significant impact on individuals’ motivation, affect, and behavior. However, we lack a scale that captures individual differences in attitudes toward social comparison. To address this gap, we developed the Attitudes Toward Social Comparison Inventory (ASCI) drawing on existing scales that tap into metacognitive beliefs about worrying, self-motives, beliefs about emotions, and the general comparative-processing model. We examined the psychometric properties of the ASCI in a longitudinal study ( N = 1,084), and a second ( N = 550) and third cross-sectional study ( N = 306). Through exploratory and confirmatory factor analyses, we identified a 12-item two-factor solution capturing positive and negative attitudes toward social comparison. The ASCI demonstrated measurement invariance across gender and time. The two factors were differentially and longitudinally associated with relevant constructs, including social comparison, metacognitive beliefs about worrying, depression, self-concept clarity, envy, and self-esteem. The ASCI facilitates comprehensive investigations of social comparison processes.
The Interpersonal Psychological Theory of Suicide in Italian University Students: Validation of the INQ-15 and the ACSS-FAD
Authors: Magliocca Sara , Romano Daniele , Joiner Thomas E. , Madeddu Fabio , Calati Raffaella , Zeppegno Patrizia , Gramaglia Carla
Published: October 2023

In the frame of the interpersonal psychological theory of suicide (IPTS), Interpersonal Needs Questionnaire (INQ-15) assesses thwarted belongingness (TB) and perceived burdensomeness (PB), related to suicidal ideation (SI); Acquired Capability for Suicide Scale–Fearlessness About Death (ACSS-FAD) measures this component which contributes to lethal self-harm. The objective was to evaluate the psychometric properties of INQ-15 and ACSS-FAD in a population of Italian university students. Since the Italian INQ-15 was already validated, we translated ACSS-FAD through a multistage procedure and administered both to 1,665 Italian university students. Factor analysis confirmed a two-factor-related model of INQ-15, one factor of ACSS-FAD, and good reliability for both. We proved the association between INQ-15 and current SI and between ACSS-FAD and lifetime suicidal planning and/or suicide attempt. The convergent and discriminant validities were in line with those of previous studies. Both tools are valid and reliable to assess the constructs associated with suicide outcomes according to IPTS.
Incidence and Bayesian Mapping of Myeloid Hematologic Malignancies in Sardinia, Italy
Authors: Broccia Giorgio , Carter Jonathan , Ozsin-Ozler Cansu , De Matteis Sara , Cocco Pierluigi
Published: October 2023

Background

The epidemiology of myeloid hematologic malignancies in Italy has been poorly investigated.

Methods

We used a validated database of 1974-2003 incident cases of hematologic malignancies among the resident population (all ages) of Sardinia, Italy, to describe the incidence of myeloid malignancies overall (N = 4389 cases) and by subtype. We investigated the time trend of acute myeloid leukemia (N = 1227 cases), chronic myeloid leukemia (N = 613 cases), and myelodysplastic syndrome (N = 1296 cases), and used Bayesian methods to explore their geographic spread, and Poisson regression analysis to estimate their association with environmental and socio-economic factors.

Results

The annual standardized (world population) incidence rate (IR) of myeloid malignancies over the study period was 6.5 per 100,000 (95% CI 6.2-6.7). Myelodysplastic syndromes were the most prevalent subgroup (IR = 1.7, 95% CI 1.5-1.8). Incidence of all myeloid malignancies combined increased sharply during the study period with an annual percent change (APC) of 10.06% (95% CI 9.51-10.61), 19.77% for myelodysplastic syndromes (95% CI 19.63-19.91), and 3.18% (95% CI 2.99-3.37) for acute myeloid leukemia. Chronic myeloid leukemia did not show an upward trend. Apart from sporadic excesses in small rural communities and the major urban area, there was no evidence of spatial clustering. The risk of myeloid malignancies increased with increasing prevalence of sheep breeding.

Conclusions

Our results might prompt further research on the local genetic and environmental determinants of myeloid hematologic malignancies.
Grade of Primary Cutaneous Leiomyosarcoma Dictates Risk for Metastatic Spread and Disease-Specific Mortality
Authors: Carr Michael J. , Sun James , Adams William A. , Dugan Michelle M. , Naqvi Syeda M. H. , Kim Youngchul , Messina Jane L. , Gonzalez Ricardo J. , Zager Jonathan S. , Mullinax John E.
Published: October 2023

Background and Objectives

Primary cutaneous leiomyosarcoma (cLMS), a rare, typically intradermal tumor, has previously been reported to exhibit an indolent course of disease with zero-to-low risk of local recurrence or distant metastasis. This study seeks to evaluate recurrence and survival of cLMS patients through study of its clinicopathologic and treatment characteristics.

Methods

All patients included underwent resection of primary cLMS at this institution between 2006 and 2019. A retrospective cohort study analysis of clinicopathologic characteristics, treatment, recurrence, and overall survival was performed. Data was assessed through descriptive statistics and outcome measures assessed by Cox proportional models and log-rank tests.

Results

Eighty-eight patients with cLMS were evaluated. The majority were men (n = 68, 77%) and Caucasian (n = 85, 97%), with median age at diagnosis of 66 years (range 20–96). 65% of tumors were located on the extremities, with a median size of 1.3 cm (range .3–15). Assessment revealed low (n = 41, 47%), intermediate (n = 29, 33%), and high (n = 18, 20%) grade tumors, demonstrating extension into subcutaneous tissue in 38/60 (60%), with 3 patients exhibiting extension into muscle (3%). All underwent resection as primary treatment with median 1 cm margins (range .5–2). With median follow-up of 27.5 months (IQR 8–51; range 1–131), no low-grade cases had recurrence or death while there was a recurrence rate of 19.1% (9/47) and death rate of 8.5% (4/47) in intermediate- to high-grade cases.

Conclusions

Primary tumor resection of cLMS provides excellent local control for low-grade tumors as no low-grade cases experienced recurrence. For patients with intermediate- to high-grade tumors, there is potential for local recurrence, distant metastasis, and death, and therefore surveillance following treatment is encouraged.
Biological aging in multiple sclerosis
Authors: Zhang Yinan , Atkinson Jeffrey , Burd Christin E , Graves Jennifer , Segal Benjamin M
Published: October 2023

Multiple sclerosis (MS) is most likely to adopt a progressive clinical course during middle age or beyond, and the number of older adults with MS is steadily increasing. Developing new strategies to manage progressive forms of MS, which do not respond to currently available disease-modifying therapies (DMTs), will require a deeper understanding of the mechanisms by which biological aging interacts with pathogenic pathways to propel disability accumulation. In experimental autoimmune encephalomyelitis (EAE), a widely used preclinical mouse model of MS, middle-aged animals experience a more severe and protracted clinical course than their younger counterparts. This exacerbated disease course is accompanied by persistent neuroinflammation. Clinical studies of age-related biomarkers, such as telomere length, senescence markers, and DNA methylation, suggest that biological aging is accelerated in people with MS compared with age- and sex-matched healthy controls. Furthermore, distinguishing biological age from chronological may afford more precision in determining aging effects in MS. Here we review the current literature on aging biology and its impact on MS pathogenesis. Future research on this topic may lead to the development of novel biomarkers and senotherapy agents that slow neurological decline in people with progressive MS by targeting relevant aging-related pathways.
Self-disclosure by adolescents in therapy for eating difficulties: A Q-Methodology study
Authors: Dunlop Rhiannon , Simonds Laura M , John Mary
Published: October 2023

Facilitating client self-disclosure is essential to therapeutic effectiveness. Given the long-term consequences of eating difficulties for adolescents, there is a need for more research on self-disclosure in this group. This study investigated factors likely to influence adolescents’ decisions to self-disclose during psychological therapy for eating difficulties using Q-methodology. Participants ( n = 28), recruited through child and adolescent mental health services in the UK, completed a task that involved sorting 47 statements to represent their viewpoint on self-disclosure. The 28 completed sorts were subjected to a by-participant factor analysis in order to identify distinct viewpoints in the sample. Three distinct factors were extracted. One factor emphasised the importance of therapist self-disclosure on decisions to disclose. In contrast, another factor placed more emphasis on the influence of eating disorder identity and readiness to change on disclosure decisions. The third factor placed emphasis on the quality of the therapeutic relationship and readiness to change as having most influence. Given the absence of a unifying factor representing what influences the decision to disclose, clinicians should ensure they explore with young people what might influence their decision to disclose.
Patient and caregiver experiences of living with dementia in Tanzania
Authors: Walker Jessica , Dotchin Catherine , Breckons Matthew , Fisher Emily , Lyimo Godrule , Mkenda Sarah , Walker Richard , Urasa Sarah , Rogathi Jane , Spector Aimee
Published: October 2023

Introduction: Tanzania is a low-income country with an increasing prevalence of dementia, which provides challenges for the existing healthcare system. People with dementia often don’t receive a formal diagnosis, and with a lack of formal healthcare, are often predominantly supported by family relatives. There are very few published data relating to lived experiences of people with dementia in Tanzania. This study aimed to understand people with dementia, and their caregivers’ experiences of living with dementia in Tanzania and the perceived needs of people with dementia.

Methods: Qualitative, semi-structured interviews were conducted with 14 people with dementia and 12 caregivers in Moshi, Tanzania. Interviews were audio-recorded, translated, transcribed and analysed using a Framework Analysis approach.

Results: Three sub-themes were identified within data describing the experience of ‘Living with Dementia in Tanzania’: ‘Deteriorations in Health’, ‘Challenges to living with Dementia in Tanzanian Culture’, and ‘Lack of Support’: people with dementia faced challenges due to social isolation, stigmatisation, and lack of caregiver knowledge on how best to provide support. Collectively, these impacted on both the physical and mental health of people with dementia. Misconceptions about dementia aetiology related to age, stresses of daily life and other co-morbidities. People with dementia were motivated to access treatment, exhibiting pluralistic health-seeking behaviours. There was an overall preference for non-pharmacological interventions over medication, with high levels of trust in medical professional opinions.

Conclusions: Living with dementia in Tanzania is influenced by both cultural and religious factors. More work is needed to target supplementary healthcare (with efforts to promote accessibility), support for caregivers and public health education about dementia to overcome existent misconceptions and stigma.
Guidelines for virtual early childhood and family learning: An equity, diversity, inclusion, and decolonization-informed systematic review of the literature
Authors: Heydon Rachel , Akiwenzie Elizabeth , Cooper Emma , Ghannoum Hanaa , Havord-Wier Danielle , Johns Bronwyn , MacAlpine Kelly-Ann , McKee Lori , Nagle Joelle , Neeganagwedgin Erica , Potts Danica Pawlick , Poczobut Sandra , Coelho Carla Ruthes , Stooke Anna , Tran Annie , Zhang Zheng
Published: October 2023

This article presents an equity-informed systematic review of research pertinent to the offering of virtual early childhood education programming to young children and their families. Findings are presented as guidelines which may shape the delivery of future programming within virtual contexts. These findings are organized within three major areas that were identified through the methodology: Building Connections and Fostering Online Relationships; Interactive Virtual Programming, Digital Tools, and Responsiveness; and Digital Technologies, Considerations for Access, Use, Professional Learning, and Safety. Findings highlight that developing inclusive, meaningful, and collaborative programs within virtual spaces is necessary for maximizing the learning opportunities and engagement of all children and families. Developing such services requires the careful negotiation and consideration of a range of worldviews, knowledges, priorities, and interests within unique families and contexts. Practice implications are drawn from the research, opportunities for pedagogical change are identified, and future research needs are provided.
The Development of a Community-Led Alaska Native Traditional Foods Gathering
Authors: Wark Kyle , Volkeimer Jo , Mortenson Ryan , Trainor John , Presley Jessica , Jauregui-Dusseau Alex , Clyma Kaylee R. , Jernigan Valarie Blue Bird
Published: October 2023

Traditional foods and foodways are a critical part of health and well-being for Alaska Native/American Indian (ANAI) peoples. However, many of these foods are being replaced by ultra-processed foods high in fat, sugar, and sodium. The cultural knowledge needed to gather, hunt, and fish to acquire these foods is not being passed down to younger generations, due to lingering effects of colonialism, leading to poor health outcomes among ANAI peoples. Southcentral Foundation (SCF) and the Center for Indigenous and Health Equity (CIIHE) are using community-based participatory research to identify and prioritize food sovereignty interventions to strengthen the transmission of cultural knowledge across generations and improve ANAI health. Through the implementation of a comprehensive landscape analysis and the development of a community advisory board, SCF has planned an Alaska Native Traditional Foods Gathering to highlight regional efforts to document, revitalize, and share cultural food knowledge and practices to build healthy communities.
Food Security and Food Sovereignty: The Difference Between Surviving and Thriving
Authors: Maudrie Tara L. , Nguyen Cassandra J. , Wilbur Rachel E. , Mucioki Megan , Clyma Kaylee R. , Ferguson Gary L. , Jernigan Valarie Blue Bird
Published: October 2023

Previous research in American Indian and Alaska Native (AI/AN) communities has documented high prevalence of food insecurity. Yet many AI/AN scholars and communities have expressed concerns that the dominant societal conceptions of food security are not reflective of the teachings, priorities, and values of AI/AN communities. Food security initiatives often focus on access to food and, at times, nutrition but little consideration is given to cultural foods, the spirituality carried through foods, and whether the food was stewarded in a way that promotes well-being not just for humans but also for plants, animals, land, and water. Despite the concerns of AI/AN communities that their needs are not centered in dominant societal food conceptualizations and food security programming, the food sovereignty efforts of AI/AN communities have captured national attention as a solution to modern food system inequities. Indigenous Food Sovereignty (IFS) is a holistic approach to food that incorporates values of relationality, reciprocity, and relationships. Fundamental differences exist between food security and food sovereignty, yet dominant society often reduces IFS as a solution to food security, rather than an entirely different food system that is predicated on values that contrast with that of dominant society. Despite calls to decolonize the definition and measurement of food security, we explore whether fixing the concept of food security is a worthy endeavor or whether efforts would be better spent supporting the resurgence and revitalization of AI/AN food values, food knowledge, and community food sovereignty initiatives.
Color Coded Care
Authors: Jackman Kevon-Mark
Published: October 2023

The work of physicians and healthcare workers in taking care of our family and loved ones, saving lives, are a sacred task. Still, we recognize through data, that our healthcare systems are contrarily filled with inequities and medical bias that results in harm. Often, these inequities are felt among minoritized and marginalized groups, or in the case of “Color Coded Care,” my mother, a retired nurse, ordained minister, wife, grandmother, and black woman. This original prose poetry piece highlights events that occurred during her 41 days of hospitalization in a neuro-intensive care unit in Florida. It is important to note that the content of this prose may trigger feelings of discomfort, particularly among providers who have taken the great Oath to give their patients the best care possible. However, it may also be a valuable and cathartic step toward repairing medical mistrust by bringing voice to experiences of healthcare related trauma. “Color Coded Care” is not an indictment, rather, it is a cry for the work that is being done to remove inequity and harmful medical bias from our healthcare systems. It is the hope for a more equitable tomorrow. “To view the original version of this poem, see the supplemental material section of this article online.”
From an Empty, to an Almost Full, and Eventually to a Never Full Glass: The Evolving Challenges of Medical Education
Authors: Koufakis Theocharis , Gouveri Evanthia , Doumas Michael , Papanas Nikolaos
Published: October 2023

It has traditionally been considered that the larger the amount of knowledge, the greater the competency of a physician. However, the vertiginously fast accumulation of novel knowledge in modern medicine raises the risk that students and residents get lost in the chaos of information to which they are exposed. Thus, it becomes evident that redefining the model of medical education (and possibly rethinking what a “good” doctor means) becomes inevitable. Current challenges in medical training include early engagement of medical students in research activities and evidence-based medicine procedures, as well as adoption of new technologies, such as artificial intelligence. Gradually, the paradigm of the competent physician will transform from the “one who knows well” to “one who knows well where to search for knowledge.” Given that person-centeredness remains an essential goal of medical education, supervision and assistance by academic staff are needed to ensure that the new training model has a positive impact on person-centered and doctor–patient relationships.
Chemotherapy Port Peal Away Sheath Embolisation and Removal With Endovascular Snaring
Authors: Tayebi Pouya , Ziaie Naghmeh
Published: October 2023

Chemotherapy port implantation is a common procedure for long-term intravenous access in cancer patients. While generally safe, complications can occasionally occur. This case report describes a rare complication of chemotherapy port placement, specifically peel away sheath embolisation, and its successful endovascular removal using snaring techniques. The purpose of this report is to highlight this uncommon complication and discuss the management strategy employed in our case.
The Emotional Impact and Coping Mechanisms Following Adverse Patient Events Among Canadian Vascular Surgeons and Trainees
Authors: Choi Sally HJ. , Yan Tyler D. , Misskey Jonathan , Chen Jerry C.
Published: October 2023

Background

This study’s objective is to evaluate the emotional experiences, coping mechanisms, and support resources for Canadian vascular surgeons and trainees following an adverse patient event or near miss.

Methods

This is a cross-sectional survey study of all Canadian Society for Vascular Surgery (CSVS) members from October to November 2021. We collected data on participant experiences with adverse events, their emotional responses, the coping mechanisms used, and their perceptions on available support resources.

Results

The survey was sent to 233 CSVS members yielding 66 responses. The majority (77%) of respondents had experiences with adverse event causing serious patient harm. The most common negative experience following an adverse event included feelings of negativity towards oneself, general distress, and anxiety about potential for future errors. The most common coping mechanism was seeking advice from a mentor or close colleague. Peers (82%) and senior colleagues (59%) were the most preferred sources of support. Most of the respondents would reach out to a mentor if they had 1, but 30% reported no mentor or close colleague for support.

Conclusion

Adverse patient events and near misses have serious negative impact on the lives of Canadian vascular surgeons and trainees. Peers and senior colleagues are the most desired source for support, but this is not universally available. Organized efforts are needed to bring awareness in our vascular surgery community on the ubiquitous nature and detrimental effects of adverse events.
Mild Stroke, Serious Problems: Limitations in Balance and Gait Capacity and the Impact on Fall Rate, and Physical Activity
Authors: Roelofs Jolanda M. B. , Zandvliet Sarah B. , Schut Ingrid M. , Huisinga Anouk C. M. , Schouten Alfred C. , Hendricks Henk T. , de Kam Digna , Aerden Leo A. M. , Bussmann Johannes B. J. , Geurts Alexander C. H. , Weerdesteyn Vivian
Published: October 2023

Background

After mild stroke persistent balance limitations may occur, creating a risk factor for fear of falling, falls, and reduced activity levels. Objective. To investigate whether individuals in the chronic phase after mild stroke show balance and gait limitations, elevated fall risk, reduced balance confidence, and physical activity levels compared to healthy controls.

Methods

An observational case-control study was performed. Main outcomes included the Mini-Balance Evaluation Systems Test (mini-BEST), Timed Up and Go (TUG), 10-m Walking Test (10-MWT), and 6-item version Activity-specific Balance Confidence (6-ABC) scale which were measured in 1 session. Objectively measured daily physical activity was measured for 7 consecutive days. Fall rate in daily life was recorded for 12 months. Individuals after a mild stroke were considered eligible when they: (1) sustained a transient ischemic attack or stroke longer than 6 months ago, resulting in motor and/or sensory loss in the contralesional leg at the time of stroke, (2) showed (near-) complete motor function, that is, ≥24 points on the Fugl-Meyer Assessment—Lower Extremity (range: 0-28).

Results

Forty-seven healthy controls and 70 participants after mild stroke were included. Participants with stroke fell more than twice as often as healthy controls, had a 2 point lower median score on the mini-BEST, were 1.7 second slower on TUG, 0.6 km/h slower on the 10-MWT, and had a 12% lower 6-ABC score. Intensity for both total activity (8%) as well as walking activity (6%) was lower in the participants with stroke, while no differences were found in terms of duration.

Conclusions

Individuals in the chronic phase after a mild stroke demonstrate persistent balance limitations and have an increased fall risk. Our results point at an unmet clinical need in this population.
Leading to Disrupt the School-to-Prison Pipeline
Authors: Cotman Ann Marie
Published: October 2023

The school-to-prison pipeline (STPP) describes in shorthand the problematic relationship between some students’ school experiences and their subsequent incarceration. One summer, in response to vocal concerned parents, a suburban school board adopted a zero-tolerance policy for smoking and vaping. Through the combined effects of the zero-tolerance approach, exclusionary punishments, the presence of SROs (school resource officers), racially disproportionate disciplinary practices, and a culturally nonresponsive school setting, 90 students were introduced to the criminal justice system in one school year. This case helps school leaders examine the elements of the STPP and how they work together to damaging effect. The questions and activities will guide readers to develop multiple ways to forestall and/or repair STPP supporting policies and practices.
Preoperative Anemia Is Associated With Worse Postoperative Outcomes After Open Reduction Internal Fixation of Distal Radius Fractures
Authors: Schmerler Jessica , Olson Jarod T. , Prasad Niyathi , LaPorte Dawn
Published: October 2023

Background:

Preoperative anemia has been shown to be associated with complications after numerous orthopedic procedures. No studies to our knowledge have examined its impact on outcomes after open reduction internal fixation (ORIF) of distal radius fracture (DRF). We hypothesized that patients with preoperative anemia would have increased likelihood of adverse outcomes, and likelihood would increase with severity of anemia.

Methods:

A total of 14 136 patients underwent ORIF for DRF over 2012-2021, identified in the National Surgical Quality Improvement Program database. Patients were classified by World Health Organization criteria as nonanemic (hematocrit >36% for women, >39% for men), mildly anemic (hematocrit 33%-36% for women, 33%-39% for men), or moderately to severely anemic (hematocrit <33% for women or men). Multivariable regressions adjusted for age, sex, race, and comorbidities statistically different between anemic and nonanemic patients were used to examine the effect of anemia on postoperative outcomes.

Results:

Mildly anemic patients had significantly longer length of stay and were significantly more likely to experience readmission and sepsis ( P < .05 all). Moderately to severely anemic patients had significantly longer length of stay and were significantly more likely to experience readmission, postoperative transfusion, septic shock, and any adverse event ( P < .05 all).

Conclusions:

Preoperative anemia is associated with increased likelihood of adverse outcomes after ORIF for DRF, and likelihood increases with severity of anemia. Surgeons should monitor patients for preoperative anemia and endeavor to identify the source of and, if safe and possible, correct the anemia preoperatively or manage and educate patients postoperatively.
Investigation of cavitation phenomenon with different fuel temperatures in diesel nozzles
Authors: Cao Tianyi , He Zhixia , Wang Jianquan
Published: October 2023

Two-phase cavitating flow in the diesel nozzle has been widely concerned by researchers for a long time. Most of the attention has been paid to irregular geometry-induced cavitation, while the research on string cavitation induced by vortex is relatively less. The two cavitating patterns often occur simultaneously in the nozzle, which are still not understandable for their interaction characteristics. In this paper, it is analyzed that the characteristics of string cavitation and geometry-induced cavitation in the transparent nozzle based on the visual scale-up test bench. In the study of hole-to-hole string cavitation, it is found that when needle lifts elevate, geometry-induced cavitation and hole-to-hole string cavitation are observed all together under the same working condition. The development and stability of hole-to-hole string cavitation are further improved with the increase of fuel temperature. The geometry-induced cavitation and string cavitation interact with each other, that is, geometry-induced cavitation at the nozzle inlet interrupts the hole-to-hole string cavitation inception. The tail of hole-to-hole string cavitation is disturbed by cloud cavitation shedding after its developing into the nozzle hole, leading to fracture in serious cases. At high temperatures, there is a periodic transformation between the needle-originated string cavitation and hole-to-hole string cavitation.
Estimating counterfactual placebo HIV incidence in HIV prevention trials without placebo arms based on markers of HIV exposure
Authors: Zhu Yifan , Gao Fei , Glidden David V , Donnell Deborah , Janes Holly
Published: October 2023

Introduction

Developing alternative approaches to evaluating absolute efficacy of new HIV prevention interventions is a priority, as active-controlled designs, whereby individuals without HIV are randomized to the experimental intervention or an active control known to be effective, are increasing. With this design, however, the efficacy of the experimental intervention to prevent HIV acquisition relative to placebo cannot be evaluated directly.

Methods

One proposed approach to estimate absolute prevention efficacy is to use an HIV exposure marker, such as incident rectal gonorrhea, to infer counterfactual placebo HIV incidence. We formalize a statistical framework for this approach, specify working regression and likelihood-based estimation approaches, lay out three assumptions under which valid inference can be achieved, evaluate finite-sample performance, and illustrate the approach using a recent active-controlled HIV prevention trial.

Results

We find that in finite samples and under correctly specified assumptions accurate and precise estimates of counterfactual placebo incidence and prevention efficacy are produced. Based on data from the DISCOVER trial in men and transgender women who have sex with men, and assuming correctly specified assumptions, the estimated prevention efficacy for tenofovir alafenamide plus emtricitabine is 98.1% (95% confidence interval: 96.4%–99.4%) using the working model approach and 98.1% (95% confidence interval: 96.4%–99.7%) using the likelihood-based approach.

Conclusion

Careful assessment of the underlying assumptions, study of their violation, evaluation of the approach in trials with placebo arms, and advancement of improved exposure markers are needed before the HIV exposure marker approach can be relied upon in practice.
Statistical rules for safety monitoring in clinical trials
Authors: Martens Michael J , Logan Brent R
Published: October 2023

Background/Aims

Protecting patient safety is an essential component of the conduct of clinical trials. Rigorous safety monitoring schemes are implemented for these studies to guard against excess toxicity risk from study therapies. They often include protocol-specified stopping rules dictating that an excessive number of safety events will trigger a halt of the study. Statistical methods are useful for constructing rules that protect patients from exposure to excessive toxicity while also maintaining the chance of a false safety signal at a low level. Several statistical techniques have been proposed for this purpose, but the current literature lacks a rigorous comparison to determine which method may be best suitable for a given trial design. The aims of this article are (1) to describe a general framework for repeated monitoring of safety events in clinical trials; (2) to survey common statistical techniques for creating safety stopping criteria; and (3) to provide investigators with a software tool for constructing and assessing these stopping rules.

Methods

The properties and operating characteristics of stopping rules produced by Pocock and O’Brien-Fleming tests, Bayesian Beta-Binomial models, and sequential probability ratio tests (SPRTs) are studied and compared for common scenarios that may arise in phase II and III trials. We developed the R package “stoppingrule” for constructing and evaluating stopping rules from these methods. Its usage is demonstrated through a redesign of a stopping rule for BMT CTN 0601 (registered at Clinicaltrials.gov as NCT00745420), a phase II, single-arm clinical trial that evaluated outcomes in pediatric sickle cell disease patients treated by bone marrow transplant.

Results

Methods with aggressive stopping criteria early in the trial, such as the Pocock test and Bayesian Beta-Binomial models with weak priors, have permissive stopping criteria at late stages. This results in a trade-off where rules with aggressive early monitoring generally will have a smaller number of expected toxicities but also lower power than rules with more conservative early stopping, such as the O-Brien-Fleming test and Beta-Binomial models with strong priors. The modified SPRT method is sensitive to the choice of alternative toxicity rate. The maximized SPRT generally has a higher number of expected toxicities and/or worse power than other methods.

Conclusions

Because the goal is to minimize the number of patients exposed to and experiencing toxicities from an unsafe therapy, we recommend using the Pocock or Beta-Binomial, weak prior methods for constructing safety stopping rules. At the design stage, the operating characteristics of candidate rules should be evaluated under various possible toxicity rates in order to guide the choice of rule(s) for a given trial; our R package facilitates this evaluation.
Do recruitment SWAT interventions have an impact on participant retention in randomised controlled trials? A systematic review
Authors: Arundel Catherine E , Clark Laura
Published: October 2023

Background

Evidence-based methods for randomised controlled trial recruitment and retention are extremely valuable. Despite increased testing of these through studies within a trial, there remains limited high-certainty evidence for effective strategies. In addition, there has been little consideration as to whether recruitment interventions also have an impact on participant retention.

Methods 

A systematic review was conducted. Studies were eligible if they were randomised controlled trials using a recruitment intervention and which also assessed the impact of this on retention at any time point. Searches were conducted through MEDLINE, EMBASE, Cochrane Library, and the Northern Ireland Hub for Trials Methodology Research SWAT Repository. Two independent reviewers screened the search results and extracted data for eligible studies using a piloted extraction form.

Results

A total of 7815 records were identified, resulting in 10 studies being included in the review. Most studies (n = 6, 60%) focussed on the information given to participants (n = 6, 60%), with two (20%) focussing on incentives, and two focussing on trial design and recruiter interventions. Due to intervention heterogeneity, none of the interventions could be meta-analysed. Only one study found any statistically significant effect of letters including a photograph (odds ratio: 5.40, 95% CI 1.12–26.15, p = 0.04).

Conclusion

Assessment of the impacts of recruitment strategies, evaluated in a SWAT, on retention of participants in the host trial remains limited. Assessment of the impact of recruitment interventions on retention is recommended to minimise future research costs and waste.
Design of a clinical trial using generalized pairwise comparisons to test a less intensive treatment regimen
Authors: Backer Mickaël De , Sengar Manju , Mathews Vikram , Salvaggio Samuel , Deltuvaite-Thomas Vaiva , Chiêm Jean-Christophe , Saad Everardo D , Buyse Marc
Published: October 2023

Background/Aims

Showing “similar efficacy” of a less intensive treatment typically requires a non-inferiority trial. Yet such trials may be challenging to design and conduct. In acute promyelocytic leukemia, great progress has been achieved with the introduction of targeted therapies, but toxicity remains a major clinical issue. There is a pressing need to show the favorable benefit/risk of less intensive treatment regimens.

Methods

We designed a clinical trial that uses generalized pairwise comparisons of five prioritized outcomes (alive and event-free at 2 years, grade 3/4 documented infections, differentiation syndrome, hepatotoxicity, and neuropathy) to confirm a favorable benefit/risk of a less intensive treatment regimen. We conducted simulations based on historical data and assumptions about the differences expected between the standard of care and the less intensive treatment regimen to calculate the sample size required to have high power to show a positive Net Treatment Benefit in favor of the less intensive treatment regimen.

Results

Across 10,000 simulations, average sample sizes of 260 to 300 patients are required for a trial using generalized pairwise comparisons to detect typical Net Treatment Benefits of 0.19 (interquartile range 0.14–0.23 for a sample size of 280). The Net Treatment Benefit is interpreted as a difference between the probability of doing better on the less intensive treatment regimen than on the standard of care, minus the probability of the opposite situation. A Net Treatment Benefit of 0.19 translates to a number needed to treat of about 5.3 patients (1/0.19 ≃ 5.3).

Conclusion

Generalized pairwise comparisons allow for simultaneous assessment of efficacy and safety, with priority given to the former. The sample size required would be of the order of 300 patients, as compared with more than 700 patients for a non-inferiority trial using a margin of 4% against the less intensive treatment regimen for the absolute difference in event-free survival at 2 years, as considered here.
A study of error reporting by nurses: the significant impact of nursing team dynamics
Authors: Munn Lindsay Thompson , Lynn Mary R , Knafl George J , Willis Tina Schade , Jones Cheryl B
Published: October 2023

Background:

Error reporting is crucial for organisational learning and improving patient safety in hospitals, yet errors are significantly underreported.

Aims:

The aim of this study was to understand how the nursing team dynamics of leader inclusiveness, safety climate and psychological safety affected the willingness of hospital nurses to report errors.

Methods:

The study was a cross-sectional design. Self-administered surveys were used to collect data from nurses and nurse managers. Data were analysed using linear mixed models. Bootstrap confidence intervals with bias correction were used for mediation analysis.

Results:

Leader inclusiveness, safety climate and psychological safety significantly affected willingness to report errors. Psychological safety mediated the relationship between safety climate and error reporting as well as the relationship between leader inclusiveness and error reporting.

Conclusion:

The findings of the study emphasise the importance of nursing team dynamics to error reporting and suggest that psychological safety is especially important to error reporting.
Traditional media versus new media: Between trust and use
Authors: Fotopoulos Stergios
Published: October 2023

The article explores if and to what extent traditional media, namely TV, radio and the printed press, are still more popular than new media when it comes to news consumption within the EU. It also looks at the level of trust in different news sources across EU member states. The article is based on the results of a pertinent Eurobarometer survey and a Reuters Institute study. According to these sources, television is one of the forms of media most used to access news, followed by online news platforms and radio. Trust in the mainstream broadcast and print media is also higher than in online news platforms and social media channels. The findings seek to feed both the public discussion and academic dialogue on media consumption and trust, and convey some compelling empirical data and analysis.
Sentiment analysis model for Airline customers’ feedback using deep learning techniques
Authors: Samir Heba Allah , Abd-Elmegid Laila , Marie Mohamed
Published: October 2023

Sentiment analysis (SA) has recently developed an automated approach for assessing sentiment, emotion, and these reviews or opinions to extract relevant and subjective information from text-based data. Analyzing sentiment on social networks, such as Twitter, has become a powerful means of learning about the users’ opinions and better understanding and satisfaction. However, it consumes time and energy to disperse and collect surveys from clients, often inaccurate and inconsistent, and evaluating and improving the accuracy of the methods in sentiment analysis is being hindered by the challenges encountered in Natural Language Processing (NLP). This paper uses NLP, text analysis, biometrics, and computational linguistics to detect and extract replies, moods, or emotions from Skytrax Airline Customers' Feedback SACF data. This research uses deep learning models to analyze various approaches applied to small SACF to solve sentiment analysis problems. We applied word embedding (Glove embedding models) to improve the sentiment classification performance of a series of datasets extensively utilized for feature extractions. Finally, a comparative study has been conducted on the SACF data analysis utilizing deep learning (DL)for evaluating the performance of the different models and input features, which is Recurrent Neural Networks (RNN), long short-term memory (LSTM), Gated Recurrent Unit (GRU), 1D Convolutional Neural Networks (CONV1D), and Bidirectional Encoder Representations from Transformers (BERT) for application to big datasets in 2019. This approach was assessed using each classification technique; the precision, recall, f1-score, and accuracy metrics for sentiment analysis have been identified. And The results show that LSTM outperforms in classification accuracy; the outcome was 91%.
Subungual Glomus Tumor of the Hallux A Report of 4 Cases
Authors: Nishikawa Danilo Ryuko Cândido , Duarte Fernando Aires , Saito Guilherme Honda , Santos Ianara da Silva , Filho Vicente Mazzaro , Mendes Alberto Abussamra Moreira , Cabral Matheus Gomes , Prado Marcelo Pires
Published: October 2023

This study reports the clinical outcomes and evolution of 4 patients with subungual glomus tumor (GT) of the hallux treated with tumor excision. Preoperatively, all patients had pain of intensity 9 or 10. Three were sensitive to cold and had stabbing pain, and one reported pulsatile pain. No patient presented nail alterations. There were no bone alterations on radiographic images and diagnostic suspicion of GT was supported by magnetic resonance images. Surgical treatment was indicated due to severe pain and functional limitation. The GT excision was performed by removing the nail through an L-shaped incision in the nail bed. After surgery, they all showed clinical improvement with return to previous activities and had no difficulty in wearing regular shoes. Three patients were pain-free and one had occasional stabbing pain of intensity 2. Half of them had nail changes. There has been no recurrence so far. Thus, we found that resection of subungual GT of the hallux was effective for the clinical improvement of patients.

Level of Evidence: IV, case reports.
Assessment of challenges and opportunities for wildlife conservation in Wenchi highlands, central Ethiopia
Authors: Legese Kabeta , Bekele Afework
Published: October 2023

Background and Research Aims

Biodiversity loss is a recent global crisis largely due to intense anthropogenic pressures. A study was conducted in Wenchi highlands in the late 2020 and early 2021 to explore the major challenges and opportunities for biodiversity conservation.

Methods

Data were collected using semi–structured questionnaires, focus group discussions and direct observations from four relatively accessible highland villages. The questionnaires were administered to 395 randomly selected household farmers based on their accessibility, presence of natural forest remnants and proximity to an iconic Lake Wenchi.

Results

The types of natural resource utilizations (χ2=87.94, df=4, P < 0.05) and the attitudes of the local community varied among the respondents (χ2=110.92, df=2, P < 0.05). The majority of the respondents used the natural resources as sources of firewood (70.19%) and for cattle grazing (63.51%). Most of the community members (56.47%) had a positive attitude towards biodiversity conservation. Only 12.14% had no idea about biodiversity conservation. The study also identified land-use changes, exotic plantations, soil erosion, illegal land grabbing, and burning of ericaceous belts as the major conservation challenges in the area. The severity level of conservation threats also varied significantly (χ2=243.519, df=6, P < 0.05). Overgrazing, firewood collection and land-use changes were the most serious biodiversity challenges. A unique topographic beauty, rich floras and faunas, recent global and regional recognitions, positive outlooks of the local people, and ecotourism development projects in the area were the main possible conservation opportunities.

Conclusion

Anthropogenic activities severely threatened Wenchi montane forests and wildlife therein. Potential conservation opportunities in the area, however, opens up the door for future conservation actions.

Implications for conservation

Wenchi highlands face severe conservation threats and need urgent conservation priorities and actions.