bluuebunny/crossref_metadata_2025_split huggingface dataset:
Resolution of high-output cardiac failure secondary to high flow radiocephalic fistula by precision banding under ultrasound guidance: A case report
Authors: Wan Ziming , Mboya Vincent N , Lai Qiquan , Tu Bo , Zhou Yu , Chen Ling , Chen Bo 
Published: August 2020

Background: The creation of dialysis shunt affects hemodynamic and cardiac function. High-output cardiac failure may occur if dialysis access volume flow is greater than 1500 to 2000 mls/min. To resolve symptoms of cardiac failure due to high flow dialysis shunt requires flow reduction procedure. We describe successful resolution of symptoms of heart failure due to excessive flow dialysis access by adopting precision banding, totally under vascular ultrasound guidance without angiography. Case: Hemodialysis adult patient uses the right arm radiocephalic fistula for 4 years. Recently, the patient presented with symptoms of high-output cardiac failure, including dyspnea, palpitations, fatigue, and orthopnea. The cardiac unit excluded all other causes of cardiac failure and referred the patient to our center for further evaluation. Ultrasonography revealed high blood volume flow measuring 3100 mls/min at brachial artery, marking high flow fistula and the underlying cause of cardiac failure. Juxta-anastomotic segment of fistula vein was identified; 3 mm diameter balloon was advanced to the juxta-anastomotic segment and maximally inflated. Two precision bandings were made on this segment, 1 to 2 cm apart with flow reduction to 691 mls/min. All steps of the procedure were done under ultrasound guidance without angiography. All symptoms were significantly alleviated immediately following the procedure. The patient was discharged after 48 h of monitoring. At 6 months, the patient was stable, no recurrence of high flow access, no signs or symptoms of cardiac failure, and the flow was 1119 mls/min. Conclusion: This case demonstrates that the precision banding procedure is feasible under ultrasound guidance, and the procedure is safe and effective in resolution of cardiac failure due to high flow radiocephalic fistula.
Acceptability and Feasibility of Group Interpersonal Therapy (IPT-G) for Depressed HIV+ Postpartum Adolescents Delivered by Community Health Workers: A Protocol Paper
Authors: Yator Obadia , Khasakhala Lincoln I , John-Stewart Grace , Kumar Manasi 
Published: August 2020

Introduction: Postpartum depression affects mothers at 4 to 6 weeks after delivery. Adolescent pregnancy can lead the expectant girl to drop out of school, receive poor obstetric care, and family support. Adolescent mothers are prone to severe postpartum depression as compared to older women. Early sexual initiation increases the risk of unintended pregnancies and potentially increases HIV exposure. WHO recommends Group interpersonal psychotherapy (IPT-G) as an evidence-based intervention for use in both primary care and community settings. We will assess the acceptability and feasibility of community health workers (CHWs), delivering IPT-G among postpartum adolescents (PPA) living with HIV. Method: This is a pilot feasibility study testing CHWs’ delivery of IPT-G to postpartum adolescents and young women living with HIV who will be attending the prevention of mother-to-child HIV transmission (PMTCT) clinics in 2 primary care health centers. Young women aged 15 to 24 years and 6 to 12 weeks postpartum will be eligible for participation. Our study is a two-arm intervention implementation study with one receiving group IPT and another one treatment-as-usual (TAU). We intend to treat the TAU group so that we will offer IPT-G post-intervention. There will be 2 groups running in the 2 facilities. Depression will be assessed using the Edinburgh postnatal depression scale (EPDS); those with EPDS >10 become eligible for the intervention. Besides, HIV-related stigma would be screened using HIV/AIDS Stigma Instrument (HASI–P), and social functioning rated using the World Health Organization’s Disability Assessment Schedule 2.0 (WHODAS 2.0). CHWs will deliver IPT-G for 8 sessions (1 session per week). The intervention group will receive immediate IPT-G, and the wait-list control group will receive deferred IPT-G as part of our intent to treat the group. Primary outcome measure and analysis: Descriptive statistics will be used to compare changes in depressive symptoms, HIV-related stigma, and social functioning between baseline and 8 weeks, and between 16 weeks and 24 weeks. The changes will be explored along with the differences between intervention and treatment as usual groups reporting effect sizes (Cohen’s d). Longitudinal continuous outcome variables across the time points will be analyzed using the Generalized Linear Model. For qualitative data, any emerging themes from KIIs and FGDs will be identified: framework matrixes, queries, and cross-tabulations will be used to analyze and interpret the data in view of assessing acceptability and feasibility of IPT-G. Ethics and dissemination The Kenyatta National Hospital-University of Nairobi approved this study of Nairobi Ethics and Research Committee (Approval No. P97/02/2018). The findings will be published in peer-reviewed journals and also shared with Kenya’s National AIDS Control Council.
Defining “the marijuana problem”: An Analysis of the Polish daily press, 2015–2016
Authors: Kępski Piotr 
Published: August 2020

Aim: This study analyses discourses on marijuana in the Polish daily press and explores ways of defining “the marijuana problem” during a debate about legalisation of medical marijuana. Methods: 384 press articles published in three national newspapers in 2015–2016 were analysed. The method used was discourse analysis. The theoretical background was social constructionism, including Spector and Kitsuse’s four-stage constructionist model of defining social problems. Results: The study shows that marijuana problems were mainly constructed through criminal and politically medical discourses. In addition to celebrity and pop culture discourses, recreational marijuana use discourses and social problems discourses were identified. Discussion: The marijuana problem can be defined differently through various discourses. Definitions pertain to diverse marijuana meanings ranging from a negative marijuana-as-drug, through an ambivalent recreational marijuana up to a positively valued medical marijuana. The research pointed out that, from a discursive standpoint, the marijuana problem may be viewed as a complex network of relations between particular discourses, marijuana meanings, claim-makers and the media. Conclusion: Different definitions of the marijuana problem are constructed through a dynamic discursive and social process. Various claim-makers try to impose their meanings on marijuana. Mass media are not neutral. They also participate in defining the marijuana problem.
Prediction, pattern recognition and modelling of complications post-endovascular infra renal aneurysm repair by artificial intelligence
Authors: Kordzadeh Ali , Hanif Mohammad A , Ramirez Manfred J , Railton Nicholas , Prionidis Ioannis , Browne Thomas 
Published: August 2020

Objectives The study evaluates the plausibility and applicability of prediction, pattern recognition and modelling of complications post-endovascular aneurysm repair (EVAR) by artificial intelligence for more accurate surveillance in practice. Methods A single-centre prospective data collection on ( n = 250) EVAR cases with n = 26 preoperative attributes (factors) on endpoint of endoleak (types I–VI), occlusion, migration and mortality over a 13-year period was conducted. In addition to the traditional statistical analysis, data was subjected to machine learning algorithm through artificial neural network. The predictive accuracy (specificity and –1 sensitivity) on each endpoint is presented with percentage and receiver operative curve. The pattern recognition and model classification were conducted using discriminate analysis, decision tree, logistic regression, naive Bayes and support vector machines, and the best fit model was deployed for pattern recognition and modelling. Results The accuracy of the training, validation and predictive ability of artificial neural network in detection of endoleak type I was 95, 96 and 94%, type II (94, 83, 90 and 82%) and type III was 96, 94 and 96%, respectively. Endpoints are associated with increase in weights through predictive modeling that were not detected through statistical analytics. The overall accuracy of the model was >86%. Conclusion The study highlights the applicability, accuracy and reliability of artificial intelligence in the detection of adverse outcomes post-EVAR for an accurate surveillance stratification.
Clinical efficacy and safety of the PRO-glide device as a sUture-mediated ClosurE in Thoracic EndoVascular Aortic Repair in patients with previous groin intervention (from the PRODUCE-TEVAR Trial)
Authors: Çelik Ömer , Şahin Ahmet Anıl , Güner Ahmet , Demir Ali Rıza , Uzun Nedim , Ertürk Mehmet 
Published: August 2020

Background While the percutaneous approach is increasingly preferred, suture-mediated closure devices have been put into clinical practice to close the femoral artery during procedures requiring a large-sized introducer. However, scar in the groin is considered a contraindication or an exclusion criterion for percutaneous procedures. The aim of our study was to investigate the outcomes and safety of Pro-Glide device as suture-mediated closure device in patients who underwent thoracic endovascular aortic repair with percutaneous femoral access ≥22 F who had previous groin intervention. Methods A total of 73 patients who underwent endovascular repair with percutaneous femoral access were retrospectively included in the study. Previous groin intervention was defined as history of open surgical access or large sheath insertion (>18 F) to femoral artery because of endovascular or valvular intervention. Patients were divided into two groups as who had previous groin intervention PGI (+) and had not PGI (−). Results A total of 73 patients [60 male (82.2%)] were included in the study. Seventeen patients had PGI, and 56 did not. When groups were compared in terms of sheath sizes, a significantly higher sheath sizes were used in PGI (+) patients (24.5 ± 1.1 F vs. 23.8 ± 0.9 F, p = 0.005). The overall success rate in the femoral approach with pre-close technique was statistically insignificant between two groups (94.1% vs. 96.4%, p = 0.55). One patient in PGI (+) group and two patients in PGI (−) had technical failure for percutaneous femoral approach. One patient (5.9%) in PGI (+) group and one patient (1.8%) in PGI (−) group had femoral complications after the procedures; however, there was no significant difference between the groups in terms of complications (5.9% vs. 1.8%, p = 0.13). Conclusion Pro-Glide device may be a safe and less invasive method for femoral access in patients with PGI and might not be considered as a contraindication for patients with history of PGI.
Adoption and impact of improved cookstoves in Lambayeque, Peru, 2017
Authors: Díaz-Vásquez Maribel A. , Díaz-Manchay Rosa J. , León-Jiménez Franco E. , Thompson Lisa M. , Troncoso Karin , Failoc-Rojas Virgilio E. 
Published: August 2020

Introduction: Approximately three billion people in Asia, Africa, and the Americas cook with biomass, cleaner cooking technologies with the potential to reduce household air pollution exposure. It is necessary to assess the adoption and long-term use of these stoves, measure perceived benefits among users, and use this information to provide feedback to programs that are implementing new cooking technologies. The aim of this study is to determine the level of adoption and impact of improved biomass cookstoves in the rural area of Lambayeque, Peru, in 2017. Methods: A descriptive cross-sectional study was conducted. A total of 52 homes were surveyed in the districts of Pacora and Íllimo where improved biomass stoves were introduced between 2005 and 2013. A questionnaire for the assessment of adoption and impact indexes proposed by the Global Alliance for Clean Cookstoves was applied. The STROBE checklist was used. Results: The mean number of years with the improved biomass cookstove was 9.1 (standard deviation: 2.9); 51.9% always used the improved stove, and 34.6% never used it due to destruction during the El Niño phenomenon in 2017. The median impact index was 5.62; 19.2% had a very good/good adoption. The median adoption index was 6.5; 25% had a very high/high impact. The use of the traditional or open fire biomass stove persisted in 61.5% of the houses. Conclusion: The adoption and impact of improved biomass cookstoves were acceptable, but traditional stove use persisted in more than half of the houses. Households used a mix of different stove technologies. Gas stoves were used more frequently for breakfast or dinner, while the traditional biomass stoves were used for larger lunchtime meals.
Complications and Radiographic Outcomes After Tibiotalocalcaneal Fusion With a Retrograde Intramedullary Nail
Authors: Levinson Joseph , Reissig Jessica , Schaheen emily , Lee Wonyong , Park Joseph 
Published: August 2020

Background Tibiotalocalcaneal (TTC) arthrodesis is a salvage reconstructive procedure for ankle and subtalar arthritis and deformity. This study aims to identify fusion rates and complications of TTC arthrodesis procedures performed at our institution using a specific retrograde intramedullary nail. Additionally, we analyzed the subpopulation that sustained an intramedullary nail break. Methods A retrospective review was conducted of 45 patients who underwent 47 TTC arthrodesis procedures with intramedullary fixation using the Phoenix nail at our institution from October 2010 to September 2017. Patient age, body mass index, sex, smoking status, diabetes diagnosis, peripheral vascular disease, thyroid disease, inflammatory arthritis, steroid use, prior ankle fractures and procedures, fusion rates, nail diameter, time to hardware failure, preoperative coronal plane deformity, and return to work were obtained. Results Successful fusion was confirmed in 79% of tibiotalar, 70% of subtalar, and 66% of combined tibiotalar and subtalar joints. Eight of 47 (17%) TTC nails suffered nail breakage postoperatively. Although statistical analysis was not performed due to the small population size, patients with nail failure had lower rates of tibiotalar (38% vs 87% of patients without nail failure) and combined tibiotalar/subtalar fusion (25% vs 74%). Ten percent of patients without nail breakage required revision surgery, compared to 75% of patient with nail breakage. Conclusion This study describes TTC arthrodesis outcomes at our institution. It demonstrates a high complication rate using a specific retrograde intramedullary nail, including nail breakage and non-union. Further analysis and improvement in technique and implant design may decrease revision rates and improve outcomes. Levels of Evidence: Therapeutic, Level IV
Fusion Versus Joint-Sparing Reconstruction for Patients With Flexible Flatfoot
Authors: Whitelaw Kathryn , Shah Shivesh , Hagemeijer Noortje C. , Guss Daniel , Johnson Anne H. , DiGiovanni Christopher W. 
Published: August 2020

Aims Passively correctible, adult-acquired flatfoot deformities (AAFD) are treated with joint-sparing procedures. Questions remain as to the efficacy of such procedures when clinical deformities are severe. In severe deformities, a primary fusion may lead to predictable outcomes, but risks nonunion. We evaluated pre- and postsurgical flexible AAFD patients undergoing joint-sparing or fusion procedures, comparing reoperation and complication rates. Methods We identified patients with flexible AAFD between January 1, 2001 and 2016. Exclusion criteria were incomplete medical record, rigid AAFD, and prior flatfoot surgery. Patient demographics, pre- and postsurgical radiographic measurements, surgery performed, and postoperative complications were evaluated by bivariate analysis, comparing joint-sparing versus fusion procedures. Results Of 239 patients (255 feet) (mean follow-up 62 ± 50 months), 209 (87%) underwent joint-sparing reconstructions, 30 (12.6%) underwent fusions. Fifty-four (24.1%) feet underwent joint-sparing reconstruction with reoperation versus 11 (35.5%) in fusion patients ( P = .17). Radiographic improvement in talonavicular angle, talar first-metatarsal (anteroposterior view), and Meary’s angle was higher in fusion patients ( P < .001, P < .001, and P = .003, respectively). Discussion More nonunion reoperations among fusion patients were offset by reoperations in joint-sparing patients. Fusion uniquely corrected Meary’s angle. Nonunion is of less concern for joint-sparing versus fusion for patients with severe flexible AAFD. Degree of deformity versus advantage of joint motion should improve decision making. Levels of Evidence: Level IV: Retrospective case series
Subtalar Arthroereisis as an Adjunct Procedure Improves Forefoot Abduction in Stage IIb Adult-Acquired Flatfoot Deformity
Authors: Bernasconi Alessio , Argyropoulos Miltiadis , Patel Shelain , Ghani Yaser , Cullen Nicholas , Singh Dishan , Welck Matthew 
Published: August 2020

Background Our aims were (a) to determine whether subtalar arthroereisis (STA) as adjunct procedure improved radiographic correction of stage IIb adult-acquired flexible flatfoot deformity (AAFD); (b) to assess the STA-related complication rate. Methods A retrospective analysis of 22 feet (21 patients) diagnosed with stage IIb AAFD treated by medializing calcaneal osteotomy (MCO), flexor digitorum longus (FDL) transfer, spring ligament (SL) repair with or without Cotton osteotomy and with or without STA in a single institution was carried out. Seven measurements were recorded on pre- and postoperative (minimum 24 weeks) radiographs by 2 observers and repeated twice by 1 observer. Inter- and intraobserver reliabilities were assessed. The association of demographic (gender, side, age, body mass index) and surgical variables (Cotton, STA) with radiographic change was tested with univariate analysis followed by a multivariable regression model. Results Excellent inter- and intraobserver reliabilities were demonstrated for all measurements (intraclass correlation coefficient range, 0.75-0.99). Gender, side, Cotton osteotomy, and STA were included in the multivariable analysis. Regression showed that STA was the only predictor of change in talonavicular coverage angle (TNCA) ( R2 = 0.31; P = .03) and in calcaneo–fifth metatarsal angle (CFMA) ( R2 = 0.40; P = .02) on dorsoplantar view. STA was associated to a greater change in TNCA by 10.1° and in CFMA by 5°. Four patients out of 12 STA complained of sinus tarsi pain after STA, and removal of the implant resolved symptoms in 3 of them. Conclusion In this series, STA as an adjunct procedure to MCO, FDL transfer, SL repair in the treatment of stage IIb AAFD led to improvement in correction of forefoot abduction. STA-related complication and removal rates were 33%. Levels of Evidence: Level IV: Retrospective cohort study
National Survey about awareness of Primary Immunodeficiency Disorders among Primary Care Physicians in Saudi Arabia: Protocol and Challenges
Authors: AlFattani Areej , Rabhan Fatimah , AlAssaf Lujain , Alghammas Amal , De Vol Edward 
Published: August 2020

Introduction: Primary Health Care Centers (PHCC) are the first contact health facility to which patients in Saudi Arabia can go to seek help. Primary Immunodeficiency Disorders (PIDD) are of various types and severities, and they are associated with a delay in diagnosis. Early diagnosis of PIDD helps to improve the quality of life of affected children and prevent permanent consequences such as organ damage and disability. In this study, we present a protocol of a national survey that assesses awareness among PHCC physicians about diagnosing PIDD and the challenges associated with the execution of this protocol. Methods: This cross-sectional survey used stratified multistage sampling and systematic random selection of PHCC from a list of PHCC affiliated centers under the Ministry of Health (MOH) in Saudi Arabia. The survey was conducted through phone calls to the selected physicians. Data collection started in April 2020, and it is still ongoing. Conclusion: In Saudi Arabia, this study will provide baseline data about PHCC physicians’ levels of awareness of the diagnosis of PIDD. This will help policy-makers in designing educational courses or programs to increase awareness levels among physicians. The protocol could be used to study other health outcomes at a national level.
Clinical Teaching Effectiveness of Undergraduate Student Nurses in the United Arab Emirates
Authors: AlMekkawi Mohamad , Qatouni Firas , Al Amoor Hussam , Alayed Bassam , El Najm Mohamad 
Published: August 2020

Introduction Clinical supervision is a crucial aspect of developing nursing students' knowledge, skills, and professional attitudes. The characteristics of clinical instructors have a significant role in the progress and transition of students into their future professional roles. Objective The study aimed to examine the behaviors of effective clinical instructors as perceived by nursing students and faculty members in the UAE. Methods The study followed a cross-sectional quantitative research design to explore nursing students' and faculty members' perceptions of clinical instructors' effective behaviors that facilitate students' clinical practice. Data were collected from a convenience sample of 147 nursing students and 17 faculty members who completed an online version of the study survey at four nursing programs in the UAE. Results Students rated personality ( M = 4.96, SD = 1.91) and teaching ability ( M = 4.94, SD = 1.96) as the highest behaviors for effective clinical instructor. They perceived effective clinical instructor to be organized ( M = 5.19, SD = 1.88), shows self-confidence ( M = 5.16, SD = 1.84), able to answer questions ( M = 5.16, SD = 1.90), emphasizes what is crucial to learn ( M = 5.11, SD = 1.81), and takes responsibility for his/her actions ( M = 5.11, SD = 1.90). While faculty members perceived effective clinical instructor to encourage a climate of mutual respect ( M = 5.56, SD = 1.27), be approachable ( M = 5.47, SD = 1.32), demonstrates clinical skill and judgment ( M = 5.53, SD = 1.46), takes responsibility for his/her actions ( M = 5.53, SD = 1.37), and be a good role model ( M = 5.47, SD = 1.32). Conclusion Understanding clinical instructors' effective behaviors and supporting them during students' clinical experiences inspire a productive teaching-learning environment that is crucial to improve students' motivation, expand their learning opportunities and improve their hands-on skills.