bluuebunny/crossref_metadata_2025_split huggingface dataset:
“By the time she got sick it was just kind of too late”: A qualitative study on advanced care planning among bereaved lesbian, gay, and bisexual older women
Authors: Valenti Korijna G , Janssen Leah M , Enguidanos Susan , de Medeiros Kate 
Published: December 2021

Background: Lesbian, gay, and bisexual (LGB) older women have unmet communication needs around palliative and end-of-life care. Past research has found communication differences for LGB women patients. Consequently, older LGB women may experience healthcare communication barriers around advance care planning. Aim: To explore experiences of bereaved LGB older women to understand perspectives regarding advance care planning communication between clinicians, patients, and dyads. Design: Guided by queer gerontology as a theoretical framework, this qualitative descriptive study employed individual interviews with purposively recruited participants. Interviews were conducted in person using a semi structured protocol and analyzed using inductive thematic analysis. Setting/participants: Sixteen LGB women, age 60 years or older from across the United States who had lost a spouse/partner within the past 5 years. Results: Four main themes emerged from the transcripts, LGB older women: (1) experience unclear advance care planning communication and end-of-life care support from clinicians, (2) often avoid advance care planning discussions with spouse or partners, (3) lack of knowledge about palliative or end-of-life care, and (4) have more positive experiences when there is consistent communication with spouse or partner and clinicians during a spouse/partner’s illness and end-of-life. Discussion: While certain experiences and opinions may reflect those of non-LGB older adults, novel advance care planning barriers exist for LGB older women. Greater understanding among clinicians is needed regarding advance care planning conversations with LGB dyads. We recommend four improvements in training, recognition, acceptance, and dyad-based communication interventions.
What Are the Characteristics of the Parish Nursing Research Literature and How Can it Inform Parish Nurse Practice and Research in Canada? A Scoping Review
Authors: Millerd Elsie , Fisher Andrea , Lambert Jeanne M. , Pfaff Kathryn A. 
Published: December 2021

Background Parish nursing is a specialized branch of professional nursing that promotes health and healing by integrating body, mind and spirit as a practice model. Parish nurses contribute to the Canadian nursing workforce by promoting individual and community health and acting as system navigators. Research related to parish nursing practice has not been systematically collated and evaluated. Purpose This review seeks to explore, critically appraise and synthesize the parish nurse (PN) research literature for its breadth and gaps, and to provide recommendations for PN practice and research. Methods A scoping review was conducted using Levac and colleagues’ procedures and Arksey and O’Malley's enhanced framework. The CINAHL, ProQuest and PubMed databases were comprehensively searched for original research published between 2008 and 2020. The final sample includes 43 articles. The Mixed Methods Appraisal Tool was used to critically assess literature quality. Results There is a significant gap in PN research from Canada and non-U.S. countries. Methodological quality is varied with weak overall reporting. The literature is categorized under three thematic areas: (1) practice roles of the PN, (2) role implementation, and (3) program evaluation research. Research that evaluates health promotion program interventions is prominent. Conclusions More rigorous research methods and the use of reporting checklists are needed to support evidence-informed parish nursing practice. Building relationships among parish nurses, nursing researchers and universities could advance parish nursing research and improve evidence-based parish nursing practice. Research into the cost effectiveness, healthcare outcomes, and the economic value of PN practice is needed.
Dynamic failure analysis of static seals under pressure fluctuation in an ultrahigh-pressure water piston pump
Authors: Cheng Qian , Liu Yinshui , Wang Zhenyao , Wu Defa , Ma Yunxiang 
Published: December 2021

For ultrahigh-pressure piston pumps, in the reciprocating action of the piston, the fretting between the static face seal and the mating surface occurs with the change of the pressure in the piston chamber. This phenomenon will seriously affect the service life of the seal ring and lead to the failure of the pump. However, the failure of static seals used to seal ultrahigh-pressures is usually studied from the directions of shear, stress, or rubber material. These studies cannot explain the failure phenomenon of the sealing ring found in our experiment. This paper analyzed the failure of the face seal ring in a piston pump with a maximum pressure of 120 MPa. A two-dimensional axisymmetric finite element model was established based on the Mooney-Rivlin constitutive relation of the rubber material, and the fretting conditions of the sealing ring were analyzed. Combined with the wear scars observed by the scanning electron microscope the face seal ring’s dynamic failure mechanism on the ultrahigh-pressure piston pump was determined. A better sealing scheme was proposed and verified by the duration test of the pump, which provided a basis for the design of the sealing of the ultrahigh-pressure fluid with high-frequency fluctuations.
Gender Bias in Education Expenditure among Religious and Social Groups: A Case Study for Below Class 10 Level in West Bengal
Authors: Mitra Chayanika 
Published: December 2021

This article attempts to capture gender bias in education expenditure among the religious (Hindu, Muslim and others) and the social groups (SC, ST and General) in West Bengal. Oaxaca–Blinder decomposition technique is used to obtain gender bias for a specific demographic group. Further, an attempt has been made to identify the religious or social groups with the acute problem of gender bias. In this work, 71st round (January–June 2014) education expenditure data (individual level) provided by NSSO (National Sample Survey Office) is used. JEL: I24, R1, C55
Typologies of Posttraumatic Stress Disorder in the Bam Adult Population: 17 Years After Bam Earthquake
Authors: Rezapour Maysam , Amiri Hadis , Nakhaee Nouzar , Nekoei-Moghadam Mahmoud , Jahani Yunes , Riyahifar Sevda 
Published: December 2021

Posttraumatic stress disorder (PTSD) is one of the most important issues after earthquakes. Following the Bam earthquake, much of the literature has documented the prevalence and correlates of PTSD, but no study has evaluated predominant typologies of PTSD in this population. The present study aims to investigate PTSD typologies among adults exposed to the Bam earthquake after 17 years. The data were collected 17 years after the 2003 Bam earthquake using multistage cluster sampling, in a historical cohort study. In total, 917 people participated in the study. Latent class analyses (LCA) were conducted to identify predominant typologies of PTSD symptoms and associated correlates. The LCA identified four meaningfully different classes that were characterized based on the PTSD items. The common profile was class 1 with 36.1% of the study population, which reported medium on “Re-experiencing” and “avoidance” items and high for “dysphoria” item. Also, the results showed significant differences for marital status, death relative, and age across the four classes of PTSD. The results indicated after 17 years of the Bam earthquake, people who were exposed to this earthquake were divided into subgroups based on the severity and prevalence of PTSD symptoms. These findings highlighted the existence of experimental subgroups of PTSD symptoms following an earthquake, which can help us find those who are most in need of mental health services and also which can find specific interventions for any subgroups.
Medial rectus disinsertion for management of chronic complete sixth nerve palsy
Authors: Bagheri Abbas , Veisi Amirreza , Tavakoli Mehdi 
Published: December 2021

Purpose To report the outcomes of the medial rectus (MR) disinsertion procedure for the management of refractory esotropia (ET) with or without Abnormal head posture (AHP) in chronic complete sixth nerve palsy. Methods This is a retrospective case series of patients with sixth nerve palsy who suffered from residual ET and diplopia following the conventional strabismus surgeries and underwent MR disinsertion procedure between April 2017 and February 2020. This procedure was offered to the patients who declined to use prism and did not wish to perform surgery on the fellow eye. The demographic and clinical data, including sex, age, visual acuity, pre and postoperative angle of strabismus, duction limitations, results of forced duction and force generation tests, details of prior strabismus surgeries, orbital CT scan findings, and follow up duration were collected from the medical records. Results Six patients were enrolled in this study. Mean age was 35.0  ±  14.0 years, and mean follow-up was 15.3  ±  5.9 months. The ET at the Primary position (PP) was 35.0  ±  18.4 prism dioptre (PD) before MR disinsertion, which decreased to 14.2  ±  17.4 PD after MR disinsertion procedure. Four cases needed additional complementary surgeries to improve residual ET in PP. No case developed overcorrection. Abduction deficiency was −5.0  ±  1.3 before MR disinsertion, which improved to − 2.8  ±  0.5 units at last follow-up. The mean of induced adduction deficiency was − 2.9  ±  0.4 at last follow-up. Conclusions MR disinsertion can be considered in patients with chronic complete sixth nerve palsy and refractory diplopia when the conventional methods have failed.
Use and impact of virtual primary care on quality and safety: The public's perspectives during the COVID-19 pandemic
Authors: Neves Ana Luisa , van Dael Jackie , O’Brien Niki , Flott Kelsey , Ghafur Saira , Darzi Ara , Mayer Erik 
Published: December 2021

Introduction With the onset of Coronavirus disease (COVID-19), primary care has swiftly transitioned from face-to-face to virtual care, yet it remains largely unknown how this has impacted the quality and safety of care. We aim to evaluate patient use of virtual primary care models during COVID-19, including change in uptake, perceived impact on the quality and safety of care and willingness of future use. Methodology An online cross-sectional survey was administered to the public across the United Kingdom, Sweden, Italy and Germany. McNemar tests were conducted to test pre- and post-pandemic differences in uptake for each technology. One-way analysis of variance was conducted to examine patient experience ratings and perceived impacts on healthcare quality and safety across demographic characteristics. Results Respondents (n = 6326) reported an increased use of telephone consultations ( + 6.3%, p < .001), patient-initiated services ( + 1.5%, n = 98, p < 0.001), video consultations ( + 1.4%, p < .001), remote triage ( + 1.3, p < 0.001) and secure messaging systems ( + 0.9%, p = .019). Experience rates using virtual care technologies were higher for men (2.4  ±  1.0 vs. 2.3  ±  0.9, p < .001), those with higher literacy (2.8  ±  1.0 vs. 2.3  ±  0.9, p < .001), and participants from Germany (2.5  ±  0.9, p < .001). Healthcare timeliness and efficiency were the dimensions most often reported as being positively impacted by virtual technologies (60.2%, n = 2793 and 55.7%, n = 2,401, respectively), followed by effectiveness (46.5%, n = 1802), safety (45.5%, n = 1822), patient-centredness (45.2%, n = 45.2) and equity (42.9%, n = 1726). Interest in future use was highest for telephone consultations (55.9%), patient-initiated digital services (56.1%), secure messaging systems (43.4%), online triage (35.1%), video consultations (37.0%) and chat consultations (30.1%), although significant variation was observed between countries and patient characteristics. Discussion Future work must examine the drivers and determinants of positive experiences using remote care to co-create a supportive environment that ensures equitable adoption and use. Comparative analysis between countries and health systems offers the opportunity for policymakers to learn from best practices internationally.
The household economic cost of caregivers: children with congenital heart diseases attending to Pediatric Hospital, Sri Lanka
Authors: Warnakulasooriya Pavithra Harshani , Kasturiaratchi Kaushalya 
Published: December 2021

Introduction Congenital heart disease is the commonest type of birth defect of which the estimated prevalence is around 8–12/1,000 worldwide. Caregivers of children with congenital heart diseases are easy victims of high economic burdens and economic instability. Objective The aim was to describe the household economic cost for a clinic visit, of primary caregivers having children with CHDs who are awaiting cardiac surgery attending a cardiology clinic at a major pediatric hospital in Sri Lanka. Methodology A descriptive cross-sectional study was conducted over three months among 427 samples of caregivers of children with congenital heart diseases at Cardiology clinic, Lady-Ridgeway Hospital Sri Lanka. A consecutive convenient sampling method was used to recruit the participant and economic cost was developed based on previous studies, surveys and opinions of an expert in economics. Results Out of caregivers, 75% were unemployed, and the median income was ₹30,000. The median direct cost per clinic visit was ₹1,800. A large proportion of direct cost was showed in traveling expenses. The median indirect cost was ₹1,000. Of the caregivers, 28.7% were falling into catastrophic expenditure during that particular month of the clinic visit. The mean waiting time per clinic visit was 53 minutes. Statistically significant association found distance with transport cost (Chi-square value = 25.14, df = 1, p & .001, OR = 3.4 (CI: 2.1–5.5). There was no statistically significant association between the income of the caregiver and expenditure (Chi-square value = 0, df = 1, p = .998, OR = 1 (CI: 0.678–1.473). Conclusions Assessment of economic burden and its associated factors is vital to recognize high-risk caregivers early, and improvement of monetary support methods.
Medical students positions regarding resource allocation in times of crisis
Authors: Minkin Levy Daniel , Sagy Iftach , Johansson Lipinski Lubianiker Margaret , Jotkowitz Alan 
Published: December 2021

Objective To compare the perspectives of medical students in the preclinical and clinical phases of medical training on the issue of rationing scarce medical resources in times of crisis. Methods Questionnaire-based cross-sectional study. Results A total of 201 participants took part in the study, with 100 participants in the preclinical phase group, and 101 in the clinical phase group. A multivariable analysis found that just 14.9% (n = 34) of the clinical phase students were willing to give a short-supplied blood unit to the first-arrived patient to the emergency department when more patients are expected compared to 63.9% in the preclinical group (n = 62) ( p < 0.001, OR = 0.75 95% CI: 0.029−0.192). Seventy-four percent (n = 74) of the clinical phase students were found to be willing to remove a patient from a respirator to allocate it to an ill child compared to 35.7% (n = 35) in the preclinical phase group ( p < 0.001, OR = 4.168 95% CI: 1.931−8.998). Of the clinical phase group, 46.6% (n = 41) were willing to allocate a short supplied flu medicine to a patient with poor prognosis compared to 57.7% (n = 56) in the preclinical phase group ( p = 0.04, OR = 0.457 95% CI: 0.216−0.966). Conclusion Clinical exposure during training may affect the way medical students make ethical decisions, independent of age, sex, as well as marital and parental status.
Median Nerve and Carpal Tunnel Morphology Before and After Endoscopic Carpal Tunnel Release: A 6-Year Follow-up Study
Authors: Grandizio Louis C. , Rocha Daniela F. Barreto , Beck John D. , Hostmeyer Sean , Chorney Matthew L. , Udoeyo Idorenyin F. , Malone W. James , Klena Joel C. 
Published: December 2021

Background: Our purpose was to describe structural and morphological features of the median nerve and carpal tunnel on magnetic resonance imaging (MRI) studies obtained before, immediately after, 6 weeks after, and 6 years after endoscopic carpal tunnel release (ECTR). Methods: In this prospective cohort study, 9 patients with a diagnosis of carpal tunnel syndrome (CTS) underwent ECTR. Standardized MRI studies were obtained before ECTR, immediately after ECTR, and 6 weeks and 6 years after surgery. Structural and morphological features of the median nerve and carpal tunnel were measured and assessed for each study with comparisons made between each time point. Results: All 9 patients had complete symptom resolution postoperatively. On the immediate postoperative MRI, there was a discrete gap in the transverse carpal ligament in all patients. There was retinacular regrowth noted at 6 weeks in all cases. The median nerve cross-sectional area and the anterior-posterior dimension of the carpal tunnel at the level of the hamate increased immediately after surgery and these changes were maintained at 6 years. Conclusions: We defined structural and morphological changes on MRI for the median nerve and carpal tunnel in patients with continued symptom resolution 6 years after ECTR. Changes in median nerve and carpal tunnel morphology that occur immediately after surgery remain unchanged at mid-term follow-up in asymptomatic patients. Established imaging criteria for CTS may not apply to postoperative patients. Magnetic resonance imaging appears to be of limited clinical utility in the workup of persistent or recurrent CTS.
A comparison of caregiver burden between long-term care and developmental disability family caregivers
Authors: Pattison Alison , Torres Elissa , Wieters Lori , Waldschmidt Jennifer G. 
Published: December 2021

Background As the United States’ population ages and health concerns rise, the family caregiver occupation will continue to be an integral part of the health care system. Aims It is important to examine the burden that family caregivers experience so they can seek out additional training and services to maintain their own well-being. The researchers examined caregiver burden from a perspective of developmentally disabled and long-term care. Methods The researchers examined difference in Zarit scores, guilt, burden and personal strain for 72 caregivers of people with developmental disability (DD) or people with long-term care (LTC) needs. The researchers also examined differences in these based on whether the individual was caregiving for family or “others”. Results For DD, there were significant differences in Zarit, role strain and personal strain; caring for others has significantly lower scores on these. Role strain was significantly higher than personal strain, which was significantly higher than guilt for both LTC and DD groups. Conclusions Given these findings, it is important to support family caregivers first and foremost with role strain, especially for those caring for family members with DD. This support could be given through personal counselling, caregiver training, non-profit social service resources, and support groups for family caregivers.
Family Planning Practices in Kerala: A Critical Appraisal Using National Family Health Survey Data
Authors: Ramesh Reshma , Prajitha Kannamkottapilly Chandrasekharan 
Published: December 2021

Background Adequate attention to family planning can not only reduce poverty and hunger in countries with high birth rates but also avert maternal and childhood deaths. Kerala, the southernmost state of India, has achieved its replacement level fertility rate far ahead of India. The study aims to analyze the contraceptive prevalence of the state over the years and also at the district level and the choices of different family planning methods in the state. Methodology This study is a secondary data analysis using the available information from the National Family Health Survey (NFHS) available from “The demographic health survey program’s data distribution system.” Results The contraceptive prevalence rate (CPR) of Kerala showed an initial increase followed by a sudden fall by more than 10% in 10 years period during the 2015 survey, thereafter stabilized in 2019. Among the modern contraceptive methods, the most commonly used method consistently over the years was female sterilization (46.6%) and the least common method was male sterilization (0.1%). The unmet needs in family planning in the state varied across the districts from as high as 19.3% to 5.6% though it was reduced by 1.2 percentage units as compared to NFHS-4 data. Conclusion The findings contradict the assumption that the use of modern spacing techniques will increase with female literacy and a higher standard of living. Female-oriented nature of family planning practices in the state should be revisited and strategies should be brought to bring equal participation of males and females. Districts with reduced CPR should be prioritized and region-specific policy recommendations are necessary to address specific needs.
Implications of the School Day on Health Behaviors for Children With Type 1 Diabetes: A Survey of Parent Perspectives During the COVID-19 Pandemic
Authors: March Christine A. , Siminerio Linda M. , Muzumdar Radhika H. , Libman Ingrid M. 
Published: December 2021

Purpose The purpose of this study is to survey parents of youth with type 1 diabetes during the COVID-19 pandemic with school closures to better understand the implications of the school day on health care behaviors. Methods A cross-sectional, online survey was distributed to parents of youth with type 1 diabetes ≤19 years of age in a large, academic diabetes center. Questions encompassed perceived changes in management behaviors and plans for return to school. Subgroup analysis compared parent responses by child’s age, reported stressors, and socioeconomic markers. Results Parents reported a worsening in their child’s diabetes health behaviors during school closures compared to what they perceived during a regular school day before the pandemic. More than half of parents reported feeling that their child was unable to maintain a normal routine, with particular implications for snacking between meals, daily physical activity, and sleep habits. Families with adolescents or those experiencing multiple pandemic-related stressors reported greater challenges. In open-ended responses, families highlighted difficulty in balancing school, work, and diabetes care and expressed concerns about the mental health repercussions of school closures for their children. Nearly half of parents reported being at least moderately worried about return to school, whereas only a minority reported seeking guidance from their diabetes provider. Conclusions Parent-reported disruptions of school-day routines frequently had adverse consequences for diabetes management in this population. These findings highlight the importance of a school-day routine for children with type 1 diabetes; during closures, families may benefit from mitigating strategies to maintain effective habits.