bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Challenge of Evaluating Grand Strategy
Authors: Wohlforth William C. 
Published: September 2021

Abstract
This chapter demonstrates that evaluating grand strategy is central to the study of international relations, establishes just how big a challenge it is, and proposes principles for meeting that challenge in a rigorous manner. A grand strategy is a sustained, major intervention in a mind-bogglingly complex social world that aims to advance an actor’s interests over the long term. Evaluating such a strategy requires ruthless discipline in defining the actor’s interests, assessing its strategic environment, identifying plausible alternative strategies, and deploying theory and evidence to run grand counterfactual experiments to determine whether those strategies would better realize the actor’s interests. The chapter takes the reader through these steps, illustrating each with examples of best and worst practices from historical and contemporary grand strategy debates.
Teachers conceptualizing and developing assessment for skill development: Trialing a maker assessment framework
Authors: Lock Jennifer , Becker Sandra , Redmond Petrea 
Published: September 2021

AbstractA makerspace is a place where people create artifacts while sharing ideas, equipment, and knowledge. In so doing, makers develop a range of knowledge and skills, such as creativity, problem-solving, collaboration, and self-regulation, to help them achieve their goals. These skills are broadly touted as key for learning and transferable across disciplines and making contexts. This article will first review the state of play in the literature to assess skill development. Secondly, itreports on the trial of an assessment framework developed through a literature review and implemented in a maker learning environment with an elementary school context. Finally, the article concludes with implications for practice.
Increased incidence of inflammatory bowel disease on etanercept in juvenile idiopathic arthritis regardless of concomitant methotrexate use
Authors: van Straalen Joeri W , Krol Roline M , Giancane Gabriella , Panaviene Violeta , Ailioaie Laura Marinela , Doležalová Pavla , Cattalini Marco , Susic Gordana , Sztajnbok Flavio R , Maritsi Despoina , Constantin Tamas , Sawhney Sujata , Rygg Marite , Oliveira Sheila Knupp , Nordal Ellen Berit , Saad-Magalhães Claudia , Rubio-Perez Nadina , Jelusic Marija , de Roock Sytze , Wulffraat Nico M , Ruperto Nicolino , Swart Joost F 
Published: September 2021

Abstract

Objective
To describe risk factors for IBD development in a cohort of children with JIA.

Methods
JIA patients who developed IBD were identified from the international Pharmachild register. Characteristics were compared between IBD and non-IBD patients and predictors of IBD were determined using multivariable logistic regression analysis. Incidence rates of IBD events on different DMARDs were calculated, and differences between therapies were expressed as relative risks (RR).

Results
Out of 8942 patients, 48 (0.54% ) developed IBD. These were more often male (47.9% vs 32.0%) and HLA-B27 positive (38.2% vs 21.0%) and older at JIA onset (median 8.94 vs 5.33 years) than patients without IBD development. They also had more often a family history of autoimmune disease (42.6% vs 24.4%) and enthesitis-related arthritis (39.6% vs 10.8%). The strongest predictors of IBD on multivariable analysis were enthesitis-related arthritis [odds ratio (OR): 3.68, 95% CI: 1.41, 9.40] and a family history of autoimmune disease (OR: 2.27, 95% CI: 1.12, 4.54). Compared with methotrexate monotherapy, the incidence of IBD on etanercept monotherapy (RR: 7.69, 95% CI: 1.99, 29.74), etanercept with methotrexate (RR: 5.70, 95% CI: 1.42, 22.77) and infliximab (RR: 7.61, 95% CI: 1.27, 45.57) therapy was significantly higher. Incidence on adalimumab was not significantly different (RR: 1.45, 95% CI: 0.15, 13.89).

Conclusion
IBD in JIA was associated with enthesitis-related arthritis and a family history of autoimmune disease. An increased IBD incidence was observed for etanercept therapy regardless of concomitant methotrexate use.
Sodium Tanshinone IIA Sulfonate Attenuates Cigarette Smoke Extract-Induced Mitochondrial Dysfunction, Oxidative Stress, and Apoptosis in Alveolar Epithelial Cells by Enhancing SIRT1 Pathway
Authors: Guan Ruijuan , Yao Hongwei , Li Ziying , Qian Jing , Yuan Liang , Cai Zhou , Ding Mingjing , Liu Wei , Xu Jingyi , Li Yuanyuan , Sun Dejun , Wang Jian , Lu Wenju 
Published: September 2021

AbstractEmphysema is one of the most important phenotypes for chronic obstructive pulmonary disease (COPD). Apoptosis in alveolar epithelial cells (AECs) causes the emphysematous alterations in the smokers and patients with COPD. Sirtuin 1 (SIRT1) is able to attenuate mitochondrial dysfunction, oxidative stress, and to modulate apoptosis. It has been shown that sodium tanshinone IIA sulfonate (STS), a water-soluble derivative of tanshinone IIA, protects against cigarette smoke (CS)-induced emphysema/COPD in mice. However, the mechanisms underlying these findings remain unclear. Here, we investigate whether and how STS attenuates AEC apoptosis via a SIRT1-dependent mechanism. We found that STS treatment decreased CS extract (CSE)-induced apoptosis in human alveolar epithelial A549 cells. STS reduced oxidative stress, improved mitochondrial function and mitochondrial membrane potential (ΔΨm), and restored mitochondrial dynamics-related protein expression. Moreover, STS promoted mitophagy, and increased oxidative phosphorylation protein levels (complexes I–IV) in CSE-stimulated A549 cells. The protective effects of STS were associated with SIRT1 upregulation, because SIRT1 inhibition by EX 527 significantly attenuated or abolished the ability of STS to reverse the CSE-induced mitochondrial damage, oxidative stress, and apoptosis in A549 cells. In conclusion, STS ameliorates CSE-induced AEC apoptosis by improving mitochondrial function and reducing oxidative stress via enhancing SIRT1 pathway. These findings provide novel mechanisms underlying the protection of STS against CS-induced COPD.
Investigating Relationships Between Preparedness for Practice, Grade Point Average, and Demographic Correlates Among Prelicensure Nursing Students
Authors: Wu Tsu-Yin , Raghunathan Vedhika , Fox Diane Porretta 
Published: September 2021

Abstract
Understanding the factors contributing to the clinical preparedness of nursing students provides essential information for their successful transition into the workforce. The aims of this study were to examine preparedness for practice with demographic factors, grade point average, and taking care of multiple patient caseloads. This study used a correlational design with 185 prelicensure nursing students in the midwestern United States. The results showed that self-reported clinical preparedness was associated with program type and externship experience. The findings contribute to nursing education by bringing new information that contributes to the understanding of students’ preparedness for practice.
Connecting Evidence-Based Practice and Clinical Practice Guidelines With Bachelor of Science in Nursing Students
Authors: Key Betty , Owings Clara R. , Ford Cassandra , Graves Barbara Ann , Robinson Trent 
Published: September 2021

Abstract
Research has demonstrated the ability of evidence-based practice (EBP) to enhance quality and reliability of health care, improve health outcomes, and reduce cost and health disparities. Nursing curricula often lack best practices for teaching EBP, as well as actual EBP course content, objectives, and activities, to advance student understanding of EBP. The unfortunate results are nurse graduates who do not value or perceive that they can use EBP. This study implemented an EBP assignment assessing clinical practice guidelines as a means of improving EBP beliefs in senior-level nursing students.
Psychometric Testing of a Theory-Based Measure to Evaluate Clinical Performance of Nursing Students
Authors: El Hussein Mohamed , McLarnon Matthew , Fast Olive 
Published: September 2021

Abstract

AIM
The aim of this study was to psychometrically test a clinical evaluation tool that measures instructors’ gut feelings for placing students on a learning contract.

BACKGROUND
Evaluators feel unprepared or hesitant to fail students who do not meet professional and clinical expectations.

METHOD
A multiphase process was used to determine the reliability and validity of the Gut Feelings Scale. The first phase focused on item generation, the second phase focused on content validity and feedback from expert raters, and the third phase focused on psychometric evaluation to streamline the item pool and explore validity.

RESULTS
Correlations and descriptive statistics for each subscale were calculated. Reliability analyses revealed relatively strong estimates of internal consistency; specifically, the reliability estimates surpassed our criteria of >.70.

CONCLUSION
This pilot study established the validity and reliability of the scale and found it to be a reliable tool to guide instructors’ evaluative decision-making.
Establishing Safety Parameters for Orthopaedic Cast Saw Blade Usage
Authors: McNeil Daniel S. , Trenholm J. Andrew I. 
Published: September 2021

Background:
The incidence of injuries from cast saws during cast removal ranges from 0.12% to 4.3%. With 1 second or less of exposure time, a temperature of 65°C can cause partial thickness burns. Despite numerous studies that recommend avoiding the use of a dull blade, there is no objective measure of what defines dullness.

Methods:
Plaster and fiberglass casts were collected and measured after removal from patients in the clinic. A series of slabs were constructed based on these measurements. To simulate our emergency department setting, a Stryker 940 cast saw without an attached vacuum was used to split plaster slabs. A thermocouple was used to directly measure the 940-23 ion-nitride saw blade temperature after each use. To simulate our orthopaedic clinic setting, a Stryker 940 cast saw with an attached vacuum was used to split fiberglass and plaster slabs. Three blades were tested in each setting, bivalving 50 slabs each.

Results:
For the plaster slabs split without a vacuum, average blade temperature of the 3 blades reached 65°C on the 42nd cast. However, the individual blades exceeded 65°C on the 33rd, 31st, and 38th casts, respectively. For the fiberglass and plaster slabs split with a vacuum, average blade temperature reached a maximum of 57.5°C in the first 50 trials. Extrapolating from this data, the blade is predicted to exceed 65°C on the 104th cast.

Conclusions:
When a Stryker 940 cast saw without vacuum is used to cut plaster casts, the ion-nitride blade should be changed frequently, at minimum after 60 casts have been split, or 30 casts have been bivalved. When a Stryker 940 cast saw with vacuum is used to remove fiberglass and plaster casts, the ion-nitride blade should be changed after removing 103 casts. A cast saw with an attached vacuum should be used whenever possible to minimize the risk of burning patients.

Clinical Relevance:
Determine how often a cast saw blade should be changed to minimize risk of burning patients.
Surgical Treatment With Titanium Elastic Nail (TEN) for Failed Conservative Treatment of Acute Monteggia Lesions in Children
Authors: Ozturk Tahir , Erpala Firat , Zengin Eyup C. , Gedikbas Mete , Eren Mehmet B. 
Published: September 2021

Background:
This study evaluated the results of intramedullary osteosynthesis with titanium elastic nail (TEN) in the surgical treatment of Monteggia lesions in children aged 12 and under.

Methods:
Patients who underwent surgery with the TEN method between 2013 and 2019 were screened retrospectively. The inclusion criteria were patients who failed conservative treatment, a history of acute trauma (<14 d after injury), age 12 years and under, patients who underwent intramedullary osteosynthesis with TEN when surgical treatment is required, a follow-up period of over 12 months, absence of congenital upper extremity and bone anomalies, and no history of trauma to the ipsilateral elbow. For functional classification, the Grace and Eversmann Criteria were used to evaluate union, pronation, and supination, while the Mayo Elbow Performance Score was used to assess overall elbow function and limitations.

Results:
Thirty-eight patients (26 male/12 female) were included in the study. The median age was 8.0 (6 to 10) years old and follow-up period was 26.0 (16 to 39) months. The mean value of the Mayo Elbow Performance Score was 97.1, 32 cases were excellent and 6 cases had good results. While the average age was 9.4 years in patients with mobility limitations, it was 7.1 years in patients without mobility limitations. Statistically, less movement restriction was observed in patients of younger age.

Conclusion:
Length unstable ulnar fracture pattern for Monteggia lesions and those with secondary loss of reduction, intramedullary stabilization of the ulna fracture with TEN helps to achieve good functional and radiologic outcomes.

Level of Evidence:
Level III.
Validity, Responsiveness, and Reliability of the ACL-QOL in an Adolescent Population
Authors: Marien Meaghan , Lafave Mark R. , Hiemstra Laurie A. , Heard Sydney Mark , Buchko Gregory M. , Kerslake Sarah 
Published: September 2021

Background:
The anterior cruciate ligament quality of life (ACL-QOL) score is a disease-specific patient-reported outcome measure that assesses patients with ACL deficient and reconstructed knees. The ACL-QOL has demonstrated validity, responsiveness, and reliability in adult populations but has yet to be specifically evaluated in adolescent patients. The purpose of this study was to assess the validity, responsiveness, and reliability of the ACL-QOL in an adolescent population.

Methods:
Between 2010 and 2015, questionnaires from 294 consecutive adolescent patients consented for an ACL reconstruction were collected from an orthopaedic sport medicine clinic. The ACL-QOL was administered preoperatively, and at 6, 12, and 24 months following primary ACL reconstruction. To assess content validity, the Cronbach α and floor and ceiling effects were measured. Question reading level was measured with an online tool (https://readable.com/). Responsiveness was assessed with a 1-way analysis of variance to compare the preoperative and postoperative time periods. A test-retest strategy with completion of the ACL-QOL twice within 3 weeks was used to assess reliability using an intraclass correlation coefficient (ICC 2,k) and the SEM.

Results:
The ACL-QOL demonstrated high content validity with a Cronbach αbetween 0.93 and 0.97, with no evidence of floor or ceiling effects at any study time point. The mean readability grade level was calculated to be 6.9, along with a readability score of 68. The ACL-QOL scores revealed a statistically significant improvement over time (P<0.001) with a Cohen d of 0.56, indicating a large effect size. Test-retest reliability revealed an ICC (2,k) of 0.997 (95% confidence interval=0.992-0.999).

Conclusions:
The ACL-QOL demonstrated content validity, responsiveness to change, and reliability in an adolescent ACL reconstruction population. The readability of the ACL-QOL is acceptable for adolescents with an ACL injury. The ACL-QOL is a valid, responsive, and reliable patient-reported outcome measure that can be used in an adolescent population with ACL deficiency or following ACL reconstruction.

Level of Evidence:
Level III.
How Much Opioid Do Kids Actually Need? A Prospective Study of Analgesic Prescribing and Postdischarge Opioid Use Among Pediatric Patients With Operative Fractures
Authors: Keil Lukas G. , Sullivan Mikaela H. , Dadoo Sahil , Stillwagon Matthew R. , Vergun Anna D. 
Published: September 2021

Background:
Analgesic guidelines are lacking for most operative pediatric fractures, and little is known about postdischarge opioid use or pain control. We hypothesized that opioid/acetaminophen/non-steroidal anti-inflammatory drugs (NSAID) prescribing would vary, pain would be well controlled, and postdischarge opioid use would be low.

Methods:
This prospective cohort study included nonpolytraumatized patients aged 17 years and below with operative fractures at a level 1 trauma center from August 1, 2019 to March 31, 2021. Supracondylar humerus fractures were excluded since they have been studied extensively. Information regarding injury/surgery/analgesics were collected. Discharged patients were called on postoperative days (POD) 1/3/5. Parents/guardians were asked about analgesic use and pain over the preceding 2 days. Complications, pain control, and opioid refills were recorded after first follow-up.

Results:
All 100 eligible patients were included. Mean age was 10.1 years (range: 1.8 to 17.8 y). Common fracture types were humeral condyle/epicondyle (28%), radius/ulna (15%), and femoral shaft (13%). Opioids were prescribed to 95% of patients with mean 14 doses (range: 2 to 45). Acetaminophen/NSAIDs were prescribed to 74% and 60% of patients, respectively. Eleven patients were excluded from telephone follow-up (7 non-English speaking, 3 prohibitive social situations, 1 inpatient POD1 to 5). Telephone follow-up was completed for 87/89 eligible patients (98%). Mean pain scores declined from 3.7/10 POD1 to 2.4/10 POD5. Opioids were taken by 50% POD1, 20% POD5. Acetaminophen/NSAID was given before opioid 82% of the time. By POD5, mean total doses of opioid taken postdischarge was 2.3; mean proportion of prescribed opioid doses taken was 22%; and 97% of patients took ≤8 opioid doses postdischarge. Two patients were evaluated early due to poor pain control which improved with cast changes. Pain was well controlled or absent at follow-up in 97% of patients.

Conclusions:
Pain is consistently well controlled after operative pediatric fractures. Nearly all were prescribed opioids, while acetaminophen/NSAIDs were inconsistently prescribed and used. Opioid prescriptions are written for 4 to 5 times the amount needed. Prescribing ≤8 doses of opioid is adequate for acute pain through POD5 in 97% of patients. Poorly controlled pain should prompt early evaluation for possible complications.

Level of Evidence:
Level II—prospective comparative study.
Organ Dose Reconstruction Applicable for a Japanese Nuclear Worker Cohort: J-EPISODE
Authors: Furuta Hiroshige , Sato Kaoru , Nishide Akemi , Kudo Shin’ichi , Saigusa Shin 
Published: September 2021

Abstract
An evaluation of cancer risk based on organ-absorbed dose is underway for the Japanese Epidemiological Study on Low-Dose Radiation Effects (J-EPISODE), which has analyzed health effects in association with radiation exposure evaluated with the personal dose equivalent H
p(10). Although the concept of effective dose and its operational definition of H
p(10) are widely used for radiological protection purposes, effective dose is not recommended for epidemiological evaluation. Organ-absorbed dose was instead adopted for the IARC 15-Country Collaborative study (15-Country study), the International Nuclear Workers Study (INWORKS), the Mayak worker study, and the Life Span Study (LSS) of atomic bomb survivors. The reconstruction method in J-EPISODE followed in principle the approach adopted in the 15-Country Study. As part of the approach of J-EPISODE, a conversion factor from photon dosimeter reading to air kerma was developed using dosimeter response data, which were measured by the experiment using an anthropomorphic phantom, and it was confirmed that the 15-Country study’s assumption of photon energy and geometry distribution in a work environment applied to Japanese nuclear workers. This article focuses on a method for reconstructing the conversion factor from photon dosimeter reading to organ-absorbed photon dose for a Japanese nuclear worker cohort. The model for estimating the conversion factor was defined under the assumption of a lognormal distribution from three concerned bias factors: (1) a dosimeter reading per air kerma, i.e., dosimeter response; (2) an organ-absorbed dose per air kerma; and (3) a factor relating to the differences in dose concepts and calibration practices between the roentgen dosimeter era and the present. Dosimeter response data were cited from the companion paper. Data on organ-absorbed photon dose per air kerma were estimated using a voxel phantom with the average Japanese adult male height and weight. The bias factor for the recorded dose in the roentgen era was defined, considering the backscatter radiation from the human body. The estimated values of organ-absorbed photon dose per air kerma were almost the same as those in ICRP Publication 116, revealing that the effect of differences in body size was almost negligible. The conversion factors from dosimeter reading to organ-absorbed dose were estimated by period (the roentgen era or from then), nuclear facility type (nuclear power plant or other), dosimeter type, and tissue or organ. The estimated conversion factors ranged from 0.7 to 0.9 (Gy Sv−1). The estimated cumulative organ-absorbed photon dose for the participants of J-EPISODE demonstrated that organ-absorbed dose values were approximately 0.8 times the recorded doses if neglecting dose-unit differences. J-EPISODE reconstructed an organ-absorbed dose conversion factor and will evaluate the risk of cancer mortality and morbidity using the organ-absorbed dose in the future.
Fecal Microbiota Transplantation and Medical Therapy for Clostridium difficile Infection
Authors: Singh Tanveer , Bedi Prabhjot , Bumrah Karandeep , Gandhi Darshan , Arora Tanureet , Verma Nikita , Schleicher Mary , Rai Manoj P. , Garg Rajat , Verma Beni , Sanaka Madhusudhan R. 
Published: September 2021

Goals:
The aim was to assess the effectiveness of fecal microbiota transplantation (FMT) against medical therapy (MT).

Background:
FMT has shown good outcomes in the treatment of Clostridium difficile infection (CDI). We aimed to conduct a systematic review and meta-analysis to compare the effectiveness of FMT versus MT for CDI.

Study:
We performed a comprehensive search to identify randomized controlled trials comparing FMT against MT in patients with CDI. Outcomes of interest were clinical cure as determined by the resolution of diarrhea and/or negative C. difficile testing. Primary CDI is defined as the first episode of CDI confirmed endoscopically or by laboratory analysis. Recurrent C. difficile infection (RCDI) is defined as laboratory or endoscopically confirmed episode of CDI after at least 1 course of approved antibiotic regimen.

Results:
A total of 7 studies with 238 patients were included in meta-analysis. Compared with MT, FMT did not have a statistically significant difference for clinical cure of combined primary and RCDI after first session [risk ratio (RR): 1.52, 95% confidence interval (CI): 0.90, 2.58; P=0.12; I
2=77%] and multiple sessions of FMT (RR: 1.68; CI: 0.96, 2.94; P=0.07; I
2=82%). On subgroup analysis, FMT has statistically higher rate of response than MT (RR: 2.41; CI: 1.20, 4.83; I
2=78%) for RCDI. However, for primary CDI there is no statistically significant difference between FMT and MT (RR: 1.00; CI: 0.72, 1.39; I
2=0%).

Conclusion:
As per our analysis, FMT should not be utilized for every patient with CDI. It is more effective in RCDI, but the results were not significant in patients with primary CDI.