bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Being a Visible Minority Matter? Predictors of Internationally Educated Nurses’ Workplace Integration
Authors: Covell Christine L. , Rolle Sands Shamel 
Published: July 2020

Study Background Nurses continue to migrate to Canada. Majority are visible minorities. Once employed, internationally educated nurses can struggle to integrate into their workplaces. A comprehensive understanding of factors that support internationally educated nurses’ workplace integration is lacking, limiting our ability to design appropriate policies and practices. Purpose The aim is to (1) examine internationally educated nurses’ perceptions of the extent to which they have integrated in their workplaces and the individual and contextual factors that supported their workplace integration, (2) explore whether internationally educated nurses’ perceptions differed by visible minority status, and (3) identify the key factors that predict internationally educated nurses’ workplace integration. Methods Cross-sectional survey of 1215 internationally educated nurses. All were immigrants, permanent residents, and employed as regulated nurses. Multiple linear regression was used to examine the influence of individual and contextual factors on perceived degree of workplace integration. Results Visible minority status had a large, statistically significant negative association with workplace integration ( ß = −0.236, p <  .001). Good relationships with coworkers ( ß =0.043, p <  .005), and continuing to develop nursing knowledge and skills ( ß =0.178, p <  .003), had statistically significant, positive associations with workplace integration. Conclusions Internationally educated nurses’ visible minority status can influence their workplaces. Providing education, managerial support, and mentorship fosters internationally educated nurses’ workplace integration.
Inclusive shelter provision in Mogadishu
Authors: Bonnet Charlotte , Bryld Erik , Kamau Christine , Mohamud Mohamed , Farah Fathia 
Published: July 2020

This article is based on a research project led by the International Institute for Environment and Development (IIED) on shelter in East Africa. It explores Mogadishu’s history, political settlements and variations in housing to inform more inclusive, affordable shelter interventions. MAIN FINDINGS: • Connection between urban poverty and internal displacement. Mogadishu’s informal settlements are inhabited by people displaced from other regions and poor urban residents. As the urban poor live in areas with high tenure insecurity and can be evicted without notice, there are migration flows both into the city and within Mogadishu itself. • Role of informal networks and relations. As access to land and shelter is governed by a complex system of formal and informal rules, having contacts with powerful actors in the informal settlements is key to finding shelter. • Vulnerabilities of women, people with disabilities, and young single men. In Somalia’s patriarchal society, the male-headed family is the fundamental social unit; people who fall outside this category are heavily disadvantaged when accessing housing.
How Should We Assess Pain: Do Patients Prefer a Quantitative or Qualitative Scale? A Study of Patient Preferences
Authors: Firdous Shagufta , Berger Andrea , Jehangir Waqas , Fernandez Carlos , Behm Bertrand , Mehta Zankhana Y. , Reddy Akhila , Davis Mellar 
Published: July 2020

Background: Pain perception is a subjective experience and is influenced by a variety of factors. Pain assessment tools, included the numeric pain rating scale (NRS) and the visual analog scale (VAS). A VAS qualitative (VASQ) scale asks patients their current pain level along a continuum of “Good Day,” “Average Day,” or “Bad Day.” We had patients complete both scales and asked them their preference and reason for their choice. Methods: We identified patients 18 years of age and older, seen by Palliative medicine at Geisinger, who had cancer-associated pain of at least one-month duration. Patients filled out the study questionnaire composed of 2 questions. Characteristics of patients who preferred the VASQ were compared to those who preferred the NRS using a 2-sample t tests or Wilcoxon rank-sum tests and Pearson χ2 or Fisher exact tests. The relationship between the NRS and the VASQ used the Pearson correlation coefficient. Results: One hundred forty-six patients completed the questionnaire, 52.1% were female; 63.7% preferred the NRS, 31.5% preferred the VASQ. Patients who preferred the NRS reported a higher NRS rating than patients who preferred the VASQ (mean NRS rating of 6.0 compared to 5.3) but the difference was not statistically significant ( P = .1531). Visual analog scale qualitative ratings were higher among patients who preferred the NRS, but the difference was not statistically different (mean rating of 5.2 vs 4.8, P = .3669). Conclusion: Patients preferred the NRS over VASQ for pain assessment. Patients tend to rate their pain at a higher level when using NRS compared to VASQ.
Vertical restrictive strabismus associated with proptosis: Similar clinical signs, different etiopathogenetic causes. A report of three patients
Authors: Savino Gustavo , Petrone Gianluigi , Volpe Giulio , Midena Giulia , Grimaldi Gabriela , Fiorentino Vincenzo , Maceroni Martina 
Published: July 2020

Purpose: To report the different uncommon pathogenesis of three cases of severe vertical restrictive strabismus associated with progressive unilateral proptosis with similar clinical features. Methods: Case series of three patients who presented to the Orbit Outpatient Service of Policlinico Gemelli with a history of left progressive unilateral proptosis, slowly worsening vertical strabismus and the left eye fixed in downward position. A thorough hematologic work up was performed. All patients underwent complete abdomen ultrasonography, orbital contrast enhanced magnetic resonance imaging, forced duction test under general anesthesia, and orbital biopsy. Results: Patients were 30, 60, and 46 years old respectively. MRI showed left inferior rectus enlargement in two cases and superior rectus enlargement in one case, with contrast enhanced combined muscle belly and tendon enlargement in all cases. Patients underwent forced duction test, muscle weakening (in two cases), and muscle biopsy with histopathologic examination. The superior rectus appeared infiltrated by an undifferentiated high-grade pleomorphic sarcoma, whereas the two inferior recti were positive for idiopathic orbital inflammatory disease with fibrosis areas and neuromuscular choristoma, respectively. Conclusion: Although proptosis and acquired vertical restrictive strabismus are most commonly associated with thyroid associated orbitopathy (TAO), they can also be a manifestation of many other conditions and the differential diagnosis can be particularly challenging. The three reported cases presented indeed with similar clinical features but had three distinct underlying orbital etiologies, two of which were extremely uncommon.
The Clinical Characteristics of Endometrial Cancer With Extraperitoneal Metastasis and the Value of Surgery in Treatment
Authors: Guo Jianbin , Cui Xiujuan , Zhang Xindong , Qian Haili , Duan Hua , Zhang Ying 
Published: July 2020

Objective: To describe the clinical and pathological features of endometrial carcinoma with extraperitoneal metastasis and examine whether surgery could improve the prognosis. Methods: The Surveillance, Epidemiology, and End Results database was used to analyze 730 patients who were diagnosed with extraperitoneal metastasis of endometrial cancer from 2010 to 2015, including metastasis to the lung, bone, or brain. Results: Of the 730 patients, 372 (50.96%) patients had single lung metastases, and 196(26.85%) patients had multiple organ metastases that included pulmonary invasion. Therefore, the lung was the most common target organ for extraperitoneal metastasis of endometrial cancer. In multivariate risk factor analysis, grade 3 tumor (odds ratio = 3.39, P < .001), positive peritoneal cytology (odds ratio = 2.02, P < .001), and cervical stromal invasion (odds ratio = 1.42, P = .030) were independent risk factors for extraperitoneal metastasis. Once metastasis occurred in the brain or multiple organs, the prognosis was often poor. Of the patients, 362 underwent surgery, and surgery was performed only for primary tumors of the reproductive organs in almost all patients (97.23%) with extraperitoneal metastasis. The median cancer-specific survival periods of patients with solitary pulmonary metastasis undergoing surgery and those without surgery were 23 (16.43-29.57) months and 9 (6.21-11.79) months, respectively ( P < .001), and survival superiority also existed in patients with bone metastasis (19 vs 8 months, P = .015) and multiple organs metastases (15 vs 4 months, P < .001). However, patients with brain metastasis had the same median survival period in the 2 groups (6 months, P = .146). Conclusions: The lung was the most common target organ for extraperitoneal metastasis in patients with endometrial cancer. Surgery was associated with improved survival in women with extraperitoneal metastasis, except for patients with brain metastasis.
Risk factor analysis of nosocomial lower respiratory tract infection in influenza-related acute respiratory distress syndrome
Authors: Chen Wei-Chih , Kao Kuo-Chin , Sheu Chau-Chyun , Chan Ming-Cheng , Chen Yu-Mu , Chien Ying-Chun , Peng Chung-Kan , Liang Shinn-Jye , Hu Han-Chung , Tsai Ming-Ju , Fang Wen-Feng , Perng Wann-Cherng , Wang Hao-Chien , Wu Chieh-Liang , Yang Kuang-Yao , Lin Meng-Chih 
Published: July 2020

Background: Patients with severe influenza-related acute respiratory distress syndrome (ARDS) have high morbidity and mortality. Moreover, nosocomial lower respiratory tract infection (NLRTI) complicates their clinical management and possibly worsens their outcomes. This study aimed to explore the clinical features and impact of NLRTI in patients with severe influenza-related ARDS. Methods: This was an institutional review board approved, retrospective, observational study conducted in eight medical centers in Taiwan. From January 1 to March 31 in 2016, subjects were enrolled from intensive care units (ICUs) with virology-proven influenza pneumonia, while all of those patients with ARDS requiring invasive mechanical ventilation and without bacterial community-acquired pneumonia (CAP) were analyzed. Baseline characteristics, critical-illness data and clinical outcomes were recorded. Results: Among the 316 screened patients with severe influenza pneumonia, 250 with acute respiratory failure requiring intubation met the criteria of ARDS, without having bacterial CAP. Among them, 72 patients developed NLRTI. The independent risk factors for NLRTI included immunosuppressant use before influenza infection [odds ratio (OR), 5.669; 95% confidence interval (CI), 1.770–18.154], extracorporeal membrane oxygenation (ECMO) use after ARDS (OR, 2.440; 95% CI, 1.214–4.904) and larger corticosteroid dosage after ARDS (OR, 1.209; 95% CI, 1.038–1.407). Patients with NLRTI had higher in-hospital mortality and longer ICU stay, hospitalization and duration on mechanical ventilation. Conclusion: We found that immunosuppressant use before influenza infection, ECMO use, and larger steroid dosage after ARDS independently predict NLRTI in influenza-related ARDS. Moreover, NLRTI results in poorer outcomes in patients with severe influenza. The reviews of this paper are available via the supplemental material section.
The Application of Double Elastic Band Exercise in the 90/90 Arm Position for Overhead Athletes
Authors: Tsuruike Masaaki , Ellenbecker Todd S. , Lauffenburger Connor 
Published: July 2020

Background: Traditional exercises performed with the shoulder in the position of 90° abduction and external rotation with elbow flexion (90/90) while using a single elastic band showed moderate activity of both the lower trapezius (LT) and infraspinatus (IS) muscle. The purpose of this study was to investigate activity of the teres minor (TMi) and the LT muscles during standing external rotation exercise with the shoulder in the 90/90 position with 2 elastic bands in both the frontal and the scapular plane. Hypothesis: TMi, IS, and LT muscle activities will vary depending on whether the shoulder is positioned in the frontal or scapular plane with the application of 2 elastic bands. Also, the serratus anterior (SA) and teres major (TMa) muscles will produce different muscular activity patterns during exercises performed with 2 elastic bands in the frontal plane compared with the TMi and LT muscles. Study Design: Controlled laboratory study Level of Evidence: Level 4. Methods: A total of 21 collegiate baseball players volunteered to participate. The electromyography (EMG) activities of the TMi, IS, LT, SA, TMa, middle deltoid (MD), posterior deltoid, and upper trapezius (UT) muscles were measured with the 90/90 arm position during both isometric and oscillation resistance exercises with 2 elastic bands oriented in the frontal and scapular planes. Results: A significant difference was observed in EMG activity of both the TMi and the LT muscles between single and double elastic band applications in the frontal plane ( P < 0.05). In contrast, EMG activity of the IS, SA, and TMa muscles was significantly increased in the scapular plane compared with the frontal plane ( P < 0.05). Conclusion: The standing 90/90 position effectively increased both TMi and LT muscle EMG activity with the double elastic band in the frontal plane while minimizing UT and MD muscle activity. EMG activity of the IS, SA, and TMa muscles increased with exercise in the scapular plane as compared with the frontal plane. Clinical Relevance: Oscillation movement under double elastic band application differentiated external rotator muscle and scapular muscle activities between the frontal and scapular plane during the 90/90 exercise in the frontal plane compared with the scapular plane. Clinicians can utilize each of the scapular and frontal positions based on their desired focus for muscular activation.
Sexual behaviors and its association with life skills among school adolescents of Mettu town, South West Ethiopia: A school-based cross-sectional study
Authors: Tesema Desalew , Tamirat Meseret , Tadele Afework 
Published: July 2020

Background: Adolescents need to have adequate life skills along with personal and social competencies to build responsible adults for healthy behavior. Works of literature agree that life skills improve adolescent’s cognitive, social, and emotional skills; however, there is a paucity of evidence on the association of life skills with sexual behaviors. Therefore, this study aimed to determine the association of life skills with sexual behavior among school adolescents aged 15–19 years in Mettu Town, South West Ethiopia. Methods: School-based cross-sectional study was employed among 372 school adolescents from 15 to 25 April 2016. A list of school adolescents aged 15–19 years old from students’ register was taken as a sampling frame. Then, simple random sampling was employed using computer-generated random numbers for final study participants’ selection. A pretested self-administered questionnaire was used. The data were entered into Epidata version 4.1 and analyzed using SPSS version 20. A bivariable and multivariable logistic regression analysis was carried out. Results: Ninety-one (24.5%) adolescents ever practiced sexual intercourse, of which 19.1% of them were exposed to risky sexual behaviors. Unfavorable life skill dimensions, that is, social (adjusted odds ratio = 3.71; 95% confidence interval = 1.64, 8.38), coping with emotions (adjusted odds ratio = 3.114; 95% confidence interval = 1.286, 7.542), and cognitive (adjusted odds ratio = 2.835; 95% confidence interval = 1.288, 6.239), were found to be statistically significant associations with risky sexual behaviors, after controlling for confounders, that is, use of psychoactive substance (adjusted odds ratio = 6.73; 95% confidence interval = 2.27, 19.87) and urban adolescents who dwell in a rental house (adjusted odds ratio = 4.05; 95% confidence interval = 1.59, 10.33) as compared to those living with families. Conclusion: Developing life skills helps adolescents make more reasoned and intentional choices sexually, which will result in fewer unwanted pregnancies, less sexually transmitted disease, and stronger relationships.
Combining diabetic foot and retinopathy screening: A step in the right direction? – a feasibility study
Authors: Lewis Jane EA , Morris Keith , Powell Thomas , Thomas Rebecca L , Owens David R 
Published: July 2020

Objectives: Peripheral artery disease is a major cardiovascular disease affecting more than 200 million people globally and up to 4 times more frequent in the diabetic population. It can lead to lower extremity amputations or revascularisation and is associated with an increased risk of myocardial infarction, stroke and early mortality. This novel cross-sectional study aimed to explore the feasibility and acceptability of incorporating diabetic foot screening at routine diabetic retinopathy screening appointments. Methods: Participants underwent foot screening during the interval between pupil dilatation and retinal photography as part of the eye screening procedure. Lower limb arterial assessment included ankle brachial index, pulse volume waveform and protective light touch sensation. Results: Of 364 participants invited, 88% (n = 321) met the inclusion criteria. About 26.4% (n = 86) had asymptomatic peripheral artery disease and 3% (n = 10) had peripheral sensory neuropathy. Binary logistical regression analysis identified age (p < 0.005), existing coronary heart disease (p < 0.005) and gender (p = 0.03) as predictors of peripheral artery disease. Conclusion: Incorporating foot examination during eye screening appointments is feasible and was well received by participants and staff alike. Undiagnosed early peripheral artery disease was evident in a third of the study population emphasising the benefit of introducing foot surveillance into eye screening appointments for the early identification of lower limb arterial disease and peripheral sensory neuropathy.
Diagnosis and clinical outcome following surgical resection of an intracranial grade III anaplastic gemistocytic astrocytoma in a cat
Authors: Murthy Vishal D , Liepnieks Molly L , Roy Melissa A , Woolard Kevin D , Sturges Beverly K , Li Chai-Fei 
Published: July 2020

Case summary A 10-year-old Maine Coon cat was presented for acute onset seizures and cerebrothalamic signs. An intracranial mass, suspected to be a meningioma, was diagnosed on MRI and surgically excised. Histopathology appeared consistent with an atypical meningioma. However, following rapid regrowth of the neoplasm, the patient was humanely euthanized 3 months later. On post-mortem histopathology, the neoplasm was diagnosed as a grade III anaplastic gemistocytic astrocytoma. Relevance and novel information Gemistocytic astrocytomas are rare brain tumors in the feline patient. This case represents the first report of a feline grade III anaplastic gemistocytic astrocytoma in the cerebrum of a cat with surgical excision and recurrence. The challenging nature of ante-mortem diagnosis and the guarded prognosis, despite surgical intervention, are presented in this report.
Spiritual Development as an Educational Goal
Authors: Moulin-Stożek Daniel 
Published: July 2020

Purpose: To inform current international debates about educating for wholeness and purpose, this article gives a critical analysis of spiritual development as a goal of state-funded schooling in England and Wales. Design/Approach/Methods: The analysis follows a history of ideas approach. Relevant texts are examined to understand how notions of “spiritual” and “development” were first combined and introduced into mass education, and how they have changed over time. Findings: The concept of spiritual development blends scientific conceptions of human development with a holistic, but ambiguous formative principle. This expedient, even paradoxical ideal, has resulted in confusion among practitioners and allowed for some considerable shift in policy. Originality/Value: Spiritual development in the English context provides a paradigmatic case by which to explore the integration of formative goals in the curriculum. While in some respects the English tradition of spiritual development represents something of its time and its unique cultural context, its underlying assumptions resonate with renewed international interest for educating for meaning and purpose.
Effect of Leg Length–Evening Device on Perceived Balance in Patients Wearing a Controlled Ankle Motion Boot
Authors: Mehraban Nasima , Idarraga Alexander J. , Wu Kevin J. , Patel Milap S. , Vora Anand M. , Kadakia Anish R. , Lee Simon , Hamid Kamran S. , Bohl Daniel D. 
Published: July 2020

Background: Patients are often made weightbearing as tolerated (WBAT) in a controlled ankle motion (CAM) boot for the management of various foot and ankle conditions. The CAM boot causes a leg length discrepancy (LLD) between the booted (longer) and contralateral (shorter) lower extremities. This discrepancy can potentially cause balance problems, undue strain on joints, and discomfort in patients. We hypothesized that a leg length–evening orthotic placed on the plantar aspect of the contralateral shoe improves balance among patients who are WBAT in a CAM boot. Methods: Patients made WBAT in a CAM boot were randomized to either the leg length–evening orthotic intervention group or to a control group in which patients wore a normal shoe of their choice. Patients were followed for 2 weeks and asked a series of questions pertaining to balance and pain experienced at their knees, hips, and back. Balance was the primary outcome and was scored from 0 (no difficulty with balance) to 10 (great difficulty with balance). Of 107 subjects enrolled and randomized, 95 (88.8%) completed the study, satisfying the a priori sample size requirement of 94 patients. There were no differences in baseline characteristics between groups ( P > .05 for each). Results: Intervention patients reported less difficulty with balance than control patients (intention-to-treat analysis: 2.0±1.5 vs 3.2±1.8, P = .001; as-treated analysis: 2.1±1.7 vs 3.0±1.7, P = .009). Intervention and control patients did not differ with respect to pain experienced at their knees, hips, or back, or in a composite total pain score ( P > .05 for each). Conclusion: This multicenter randomized controlled trial found that adding a limb length–evening orthotic to the plantar aspect of the contralateral shoe in a patient that is WBAT in a CAM boot improved patient-reported self-assessment of balance. The trial was powered to identify a difference in the primary outcome measure of balance and may have been insufficiently powered to identify differences in knee, hip, back, or total pain. Level of Evidence: Level II, prospective comparative study.
Influence of excess alumina on mullite synthesized from pyrophyllite by spark plasma sintering
Authors: Sule Rasidi , Sigalas Iakovos 
Published: July 2020

AbstractThe influence of excess Al2O3 on 3:2 mullite produced from α-Al2O3 and pyrophyllite powder was examined. A mixture consisting of 28 wt.% dehydroxylated pyrophyllite and 72 wt.% α-Al2O3 was milled in an attrition mill. The milled powders were sintered by spark plasma sintering (SPS) at 1600°C for 10, 20 and 30 min. Subsequently, the samples were heated at 1350°C for 2 h to determine the influence of the excess Al2O3 on the microstructure. No glassy phase was detected in the sample containing 72 wt.% Al2O3 and sintered at 1600°C for 20 min. The sample with 72 wt.% Al2O3 had greater hardness and fracture toughness compared to 3:2 mullite. The greatest hardness and fracture toughness of 12.43 GPa and 2.71 MPa m–0.5, respectively, were obtained in the sample containing 72 wt.% Al2O3 sintered at 1600°C for 20 min.