bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Ethical Duty to Reduce the Ecological Footprint of Industrialized Healthcare Services and Facilities
Authors: Katz Corey 
Published: October 2021

Abstract
According to the widely accepted principles of beneficence and distributive justice, I argue that healthcare providers and facilities have an ethical duty to reduce the ecological footprint of the services they provide. I also address the question of whether the reductions in footprint need or should be patient-facing. I review Andrew Jameton and Jessica Pierce’s claim that achieving ecological sustainability in the healthcare sector requires rationing the treatment options offered to patients. I present a number of reasons to think that we should not ration health care to achieve sufficient reductions in a society’s overall consumption of ecological goods. Moreover, given the complexities of ecological rationing, I argue that there are good reasons to think that the ethical duty to reduce the ecological footprint of health care should focus on only nonpatient-facing changes. I review a number of case studies of hospitals who have successfully retrofitted facilities to make them more efficient and reduced their resource and waste streams.
Upper limb gangrene due to a subclavian arterial thrombosis associated with thoracic outlet syndrome following cervical spondylotic amyotrophy
Authors: Yamada Tsuyoshi , Kudo Toshifumi , Kawabata Atsuyuki , Yoshii Toshitaka 
Published: October 2021

Abstract
Thoracic outlet syndrome (TOS) refers to an abnormal compression of the subclavian vessels and the brachial plexus at the base of the neck or thoracic outlet. The authors described a novel case of a 66-year-old male with arterial TOS and unilateral upper rib dysplasia following cervical spine disease. Owing to the comorbidity of cervical spondylotic amyotrophy and a history of sloping shoulder due to rib dysplasia, TOS occurred, which subsequently led to subclavian arterial thrombosis and eventually resulted in the gangrene of the hand. Thrombectomy and surgical resection of the first and second ribs avoided the progression of further neurovascular disorder.
When treating a cervical spondylotic patient, concurrent TOS can be obscured by symptoms caused by cervical lesions, leading to difficulty in identifying the origin of these neurovascular findings. The possibility of subsequent thromboembolic events based on TOS should be considered, especially in cases with dysplasia of the upper ribs.
The costs of urban living: human–wildlife interactions increase parasite risk and self-directed behaviour in urban vervet monkeys
Authors: Thatcher Harriet R , Downs Colleen T , Koyama Nicola F 
Published: October 2021

Abstract
The urban landscape is a complex mosaic of costs and benefits for urban wildlife. Although many species may adapt and thrive in the urban mosaic, the complexity of this landscape can be stressful and have health implications for urban wildlife, raising concerns for zoonosis and biodiversity. In this study, we assessed how human–primate interactions influenced parasite risk and anxiety-related behaviour of urban vervet monkeys in KwaZulu-Natal, South Africa. Over 1 year, we collected and analysed faecal samples, assessing eggs per gram, species richness, and Shannon’s diversity index. In addition, using behavioural sampling, we recorded self-directed scratching behaviour, as an indicator of anxiety, and human–primate interactions, both positive (human-food consumption) and negative (human–monkey aggression). To assess parasite risk in the urban mosaic, we ran three models with our parasite measures as dependent variables. Results showed that negative human interactions significantly increased with eggs per gram, species richness, and Shannon’s diversity index and positive human interactions increased with both eggs per gram and species richness. Furthermore, eggs per gram significantly increased with higher scratching rate. We also tested the relationship between scratching and human interactions, finding that scratching significantly increased under higher rates of negative human incidents. Overall, results suggest that there are costs to urban living that increase anxiety-related behaviour and parasite risk despite increased food availability. Our findings are important for developing effective management strategies that focus on cohabitation rather than conflict, for the benefit of human and wildlife health.
Maternal selenium deficiency suppresses proliferation, induces autophagy dysfunction and apoptosis in the placenta of mice
Authors: Li Mengdi , Cheng Wanpeng , Zhang Lantian 
Published: October 2021

Abstract
Selenium deficiency is thought to be associated with the occurrence of gestational complications. However, the underlying mechanism of selenium deficiency impairs placental function remains unclear. In this study, female mice were separately supplemented with a Se-deficient (0.02 mg/kg Se) or control diet (0.2 mg/kg Se) for 12 weeks before mating and throughout gestation. Maternal liver and placentas were collected at embryonic day 15.5 and analyzed for Se content. Oxidative stress status, proliferation capability, autophagy, and apoptosis of the placenta were determined. We found that maternal selenium deficiency decreased placental Se concentration and some antioxidant selenoproteins expressions. The concentrations of catalase and glutathione in selenium-deficient placentas were reduced, along with an increase in hydrogen peroxide (H2O2) content. Selenium deficiency inhibited the expression of proliferating cell nuclear antigen. Autophagosomes, autophagolysosomes, and upregulation of autophagy-related protein microtubule-associated protein 1 light chain 3 alpha II (LC3B), Beclin1, PTEN-induced putative kinase 1 (PINK1), and Parkin were found in the selenium-deficient trophoblasts. Autophagic substrate p62/sequestosome 1 was surprisingly increased, indicating autophagy flux dysfunction. Selenium deficiency increased expressions of B cell leukemia/lymphoma 2 associated X protein (Bax), cleaved caspase-9/-3, and decreased the B cell leukemia/lymphoma 2 (Bcl2) level. Moreover, typical apoptotic ultrastructure and apoptosis-positive cells were observed in the selenium-deficient placenta. Our results suggested that maternal selenium deficiency impaired placental proliferation, induced autophagy dysfunction and apoptosis via increasing oxidative stress, and the Akt/mechanistic target of rapamycin (mTOR) pathway involved in this process. This study revealed a novel mechanism by which maternal selenium deficiency caused impairment of the placenta.
Comparison of Pericranial Autograft and AlloDerm for Duraplasty in Patients With Type I Chiari Malformation: Retrospective Cohort Analysis
Authors: Hoffman Haydn , Bunch Katherine M , Paul Tyler , Krishnamurthy Satish 
Published: October 2021

Abstract

BACKGROUND
Pericranial autograft is a popular option for duraplasty during Chiari decompression with several theoretical advantages, but comparisons to other materials have yielded mixed results.

OBJECTIVE
To compare outcomes between pericranial autograft and AlloDerm (BioHorizons).

METHODS
Consecutive suboccipital craniectomies for patients with type I Chiari malformation (CM-I) over an 8-yr period at a single institution were identified. Exclusion criteria included revision surgeries and suboccipital decompressions without duraplasty. Outcomes included incisional cerebrospinal fluid (CSF) leakage, length of stay (LOS), wound complication, aseptic meningitis, syrinx improvement, and symptomatic improvement.

RESULTS
A total of 101 patients (70 females and 31 males) with a median (interquartile range) age of 17 yr (11-32) met the inclusion criteria. There were 51 (50%) patients who underwent duraplasty with pericranial autograft, and the remainder underwent duraplasty with AlloDerm. There were 9 (9%) patients who experienced a postoperative CSF leak. After adjusting for confounding factors, obesity (odds ratio [OR]: 4.69, 95% CI: 1.03-25.6) and use of AlloDerm (OR: 10.54, 95% CI: 1.7-206.12) were associated with CSF leak. Wound complication occurred in 8 (8%) patients but was not associated with graft type (P = .8). Graft type was not associated with LOS, syrinx improvement, or symptom improvement. Reoperations occurred in 10 patients with 4 in the autograft group and 6 in the AlloDerm group (P = .71).

CONCLUSION
In patients with CM-I, expansile duraplasty with AlloDerm was associated with greater odds of CSF leakage than pericranial autograft. Obesity was also associated with increased odds of CSF leakage.
Development of a New Image-Guided Neuronavigation System: Mixed-Reality Projection Mapping Is Accurate and Feasible
Authors: Koike Tsukasa , Kin Taichi , Tanaka Shota , Sato Katsuya , Uchida Tatsuya , Takeda Yasuhiro , Uchikawa Hiroki , Kiyofuji Satoshi , Saito Toki , Takami Hirokazu , Takayanagi Shunsaku , Mukasa Akitake , Oyama Hiroshi , Saito Nobuhito 
Published: October 2021

Abstract

BACKGROUND
Image-guided systems improve the safety, functional outcome, and overall survival of neurosurgery but require extensive equipment.

OBJECTIVE
To develop an image-guided surgery system that combines the brain surface photographic texture (BSP-T) captured during surgery with 3-dimensional computer graphics (3DCG) using projection mapping.

METHODS
Patients who underwent initial surgery with brain tumors were prospectively enrolled. The texture of the 3DCG (3DCG-T) was obtained from 3DCG under similar conditions as those when capturing the brain surface photographs. The position and orientation at the time of 3DCG-T acquisition were used as the reference. The correct position and orientation of the BSP-T were obtained by aligning the BSP-T with the 3DCG-T using normalized mutual information. The BSP-T was combined with and displayed on the 3DCG using projection mapping. This mixed-reality projection mapping (MRPM) was used prospectively in 15 patients (mean age 46.6 yr, 6 males). The difference between the centerlines of surface blood vessels on the BSP-T and 3DCG constituted the target registration error (TRE) and was measured in 16 fields of the craniotomy area. We also measured the time required for image processing.

RESULTS
The TRE was measured at 158 locations in the 15 patients, with an average of 1.19 ± 0.14 mm (mean ± standard error). The average image processing time was 16.58 min.

CONCLUSION
Our MRPM method does not require extensive equipment while presenting information of patients’ anatomy together with medical images in the same coordinate system. It has the potential to improve patient safety.
The clinical effect of glucose meter selection upon the detection of neonatal hypoglycemia
Authors: Parker Kayla , Lyon Martha E , Kyle Barry D , Strueby Lannae , Inman Mark 
Published: October 2021

Abstract
Neonatal hypoglycemia is a common, transitional metabolic state that may lead to poor neurodevelopmental outcomes if unrecognized or managed inadequately. Given its frequency of presentation and immense clinical significance, a myriad of clinical practice guidelines have been published outlining appropriate screening, diagnosis, and treatment principles—many endorsing the use of glucose point-of-care testing (POCT). Unfortunately, the well-intended ‘march’ toward POCT, with bedside glucose meters as screening devices in the NICU, has resulted in unintended consequences with critical implications: a lack of international traceability to the ‘gold’ standard glucose method by POCT devices, under-recognition of POCT limitations, and a reliance upon a technology primarily driven to detect hyperglycemia in the adult population as opposed to neonatal hypoglycemia. As providers continue to advocate for improved POCT, there must be robust communication between providers and the clinical laboratory in the selection, standardization, and interpretation of glucose POCT to ensure optimal neonatal glucose detection.
Pediatric hypertension screening and recognition in primary care clinics in Canada
Authors: Ding Linda , Singer Alexander , Kosowan Leanne , Dart Allison 
Published: October 2021

Abstract

Objectives
Screening for hypertension in children is recommended by pediatric consensus guidelines. However, current practice is unknown. We evaluated rates of blood pressure assessment and hypertension recognition in primary care.

Methods
This retrospective cohort study evaluated electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network between 2011 and 2017. Children aged 3 to &lt;18 years with at least one clinical encounter were included. Screening, follow-up, and hypertension recognition rates were evaluated. Descriptive statistics and multivariate logistical regression were used to determine patient and provider characteristics associated with increased screening and recognition of pediatric hypertension.

Results
Among 378,002 children, blood pressure was documented in 33.3% of all encounters, increasing from 26.7% in 2011 to 36.2% in 2017; P=0.007. Blood pressure was documented in 76.0% of well child visits. Follow-up visits occurred within 6 months for 26.4% of children with elevated blood pressure, 57.1% of children with hypertension, and within 1 month for 7.2% of children with hypertension. Patient factors associated with increased blood pressure screening include being overweight (OR 2.15, CI 2.09 to 2.22), having diabetes (OR 1.69, CI 1.37 to 2.08), chronic kidney disease (OR 7.51, CI 6.54 to 8.62), increased social deprivation (OR 1.10, CI 1.09 to 1.11), and urban residence (OR 1.27, CI 1.15 to 1.4). Overall prevalence of hypertension was 1.9% (n=715) and of those, 5.6% (n=40) had recognized hypertension. Factors associated with increased recognition include male sex, overweight, and hyperlipidemia.

Conclusions
Rates of hypertension screening and recognition are low in primary care settings in Canada, suggesting pediatric hypertension should be a priority for implementation and dissemination of interventions.
Prevalence of Walking Limitation After Acute Stroke and Its Impact on Discharge to Home
Authors: Louie Dennis R , Simpson Lisa A , Mortenson W Ben , Field Thalia S , Yao Jennifer , Eng Janice J 
Published: October 2021

Abstract

Objective
The purpose of this study was to provide contemporary estimates of the prevalence of lower extremity motor impairment and walking limitation after first-ever stroke and to characterize the predictive nature of early walking ability for being discharged home after acute hospitalization.

Methods
In this cohort study, data were collected from a metropolitan acute care hospital in Canada at admission for 487 adults with first-ever acute ischemic or hemorrhagic stroke. Lower extremity motor impairment and walking limitation were measured using the National Institutes of Health Stroke Scale and AlphaFIM, respectively. Parallel multivariable logistic regression models were built to predict discharge home after acute hospitalization compared with further hospitalization.

Results
For patients surviving a first-ever stroke, 44.1% presented with some degree of lower extremity motor impairment and 46.0% were unable to walk. In a multivariable model built around a binary classification of walking (Nagelkerke R2 = 0.41), those with any ability to walk at admission (with or without therapist assistance) had 9.48 times greater odds of being discharged home (odds ratio = 9.48, 95% CI = 6.11–14.92) than those who were unable. In a parallel multivariable model built around an ordinal classification of walking (Nagelkerke R2 = 0.49), patients had 2.07 times greater odds (odds ratio = 2.07, 95% CI = 1.82–2.38) of being discharged home for each increment on a 6-point walking scale (total dependence to complete independence) assessed at acute admission.

Conclusion
Approximately one-half of patients with first-ever stroke present with lower extremity weakness and walking limitation. Early walking ability is a significant predictor of returning home after acute hospitalization, independent of stroke severity. Discharge planning may be facilitated early after stroke with the familiar assessment of walking ability.

Impact
An early assessment of walking function within days of stroke admission can help to streamline discharge planning.

Lay Summary
Nearly one-half of all individuals who experience a first-time stroke have walking difficulty when they arrive at the hospital. The severity of the walking limitation can predict whether a patient will eventually be discharged home or go on to further hospitalization.
Reopening after lockdown: the influence of working-from-home and digital device use on sleep, physical activity, and wellbeing following COVID-19 lockdown and reopening
Authors: Massar Stijn A A , Ng Alyssa S C , Soon Chun Siong , Ong Ju Lynn , Chua Xin Yu , Chee Nicholas I Y N , Lee Tih Shih , Chee Michael W L 
Published: October 2021

AbstractStudy ObjectivesCOVID-19 lockdowns drastically affected sleep, physical activity, and wellbeing. We studied how these behaviors evolved during reopening the possible contributions of continued working from home and smartphone usage.MethodsParticipants (N = 198) were studied through the lockdown and subsequent reopening period, using a wearable sleep/activity tracker, smartphone-delivered ecological momentary assessment (EMA), and passive smartphone usage tracking. Work/study location was obtained through daily EMA ascertainment.ResultsUpon reopening, earlier, shorter sleep and increased physical activity were observed, alongside increased self-rated stress and poorer evening mood ratings. These reopening changes were affected by post-lockdown work arrangements and patterns of smartphone usage. Individuals who returned to work or school in-person tended toward larger shifts to earlier sleep and wake timings. Returning to in-person work/school also correlated with more physical activity. Contrary to expectation, there was no decrease in objectively measured smartphone usage after reopening. A cluster analysis showed that persons with relatively heavier smartphone use prior to bedtime had later sleep timings and lower physical activity.ConclusionsThese observations indicate that the reopening after lockdown was accompanied by earlier sleep timing, increased physical activity, and altered mental wellbeing. Moreover, these changes were affected by work/study arrangements and smartphone usage patterns.
The substratum rule—where to now?
Authors: Alexander Stephen , Lewis Paul 
Published: October 2021

Abstract
In Representation of Rysaffe Fiduciaires Sarl [2021] JRC 230 (Rysaffe), the Royal Court of Jersey has handed down a judgment which provides important clarification in relation to the scope of a trustee’s powers to amend and to add beneficiaries. This is the first time that the Royal Court has considered the substratum rule in the context of a trustee wishing to exercise a power to add a beneficiary. This decision is of particular note coming as it does in the wake of the decision of the Court of Appeal in Bermuda to reject the substratum rule in Grand View Private Trust Company Limited v Wong & Ors Civil Appeal No. 5A of 2019.
Influenza Virus Associated Pediatric Acute Respiratory Distress Syndrome: Clinical Characteristics and Outcomes
Authors: Yener Nazik , Üdürgücü Muhammed , Yılmaz Resul , Kendirli Tanıl , Tekerek Nazan Ülgen , Evren Gültaç , Arı Hatice Feray , Yıldızdaş Dinçer , Demirkol Demet , Pişkin Ethem , Duyu Muhterem , Dalkıran Tahir , Akçay Nihal , Yalındağ Öztürk Nilüfer , Yeşilbaş Osman , Bozan Gürkan , Gurbanov Anar , Albayrak Hatice 
Published: October 2021

Abstract

Background and Objective
The aim of this multicenter retrospective study was to determine the clinical characteristics, treatment approaches and the course of pediatric acute respiratory distress syndrome (PARDS) which developed associated with the influenza virus in the 2019–20 season.

Methods
Patients included 1 month to 18 years who were diagnosed with PARDS associated with the influenza virus in the 2019–20 season.

Results
Sixty-seven patients were included in the study. The mean age of the patients was 64.16 ± 6.53 months, with 60% of the group &lt;5 years. Influenza A was determined in 54 (80.5%) patients and Influenza B in 13 (19.5%). The majority of patients (73.1%) had a comorbidity. Fifty-eight (86.6%) patients were applied with invasive mechanical ventilation, Pediatric Acute Lung Injury Consensus Conference classification was mild in 5 (8.6%), moderate in 22 (37.9%) and severe in 31 (52.5%) patients. Ventilation was applied in the prone position to 40.3% of the patients, and in nonconventional modes to 24.1%. A total of 22 (33%) patients died, of which 4 had been previously healthy. Of the surviving 45 patients, 38 were discharged without support and 7 patients with a new morbidity.

Conclusion
Both Influenza A and Influenza B cause severe PARDS with similar characteristics and at high rates. Influenza-related PARDS cause 33% mortality and 15.5% morbidity among the study group. Healthy children, especially those aged younger than 5 years, are also at risk.
A Quantitative Research Study Protocol to Advance Simulation Science in Nursing Education
Authors: Cantrell Mary Ann , Mariani Bette , Lengetti Evelyn 
Published: October 2021

Abstract

AIM
This article describes a quantitative simulation study protocol and identifies important methodological considerations for future high-level, rigorous quantitative simulation studies.

BACKGROUND
Quantitative simulation research studies have been found to be lacking in their conceptualization, study design, and measurement of outcomes, with small samples and lack of rigor in overall study methods.

METHOD
This protocol reflects research priorities of organizations that drive simulation science and nursing education, published standards of simulation best practice, and use of research methodology within and outside the simulation literature, which includes psychometrically sound instruments and outcomes of importance to cognitive and simulation science.

RESULTS
The protocol was a multisite, longitudinal study, guided by the integrative model of clinical judgment, with a high degree of intervention fidelity to measure the study outcomes of clinical judgment and clinical competence.

CONCLUSION
To advance simulation science, rigorous study protocols, reflective of the one described in this article, are needed.
Active Learning: A Concept Analysis With Implications for Nursing Education
Authors: Franco-Tantuico Monina A. 
Published: October 2021

Abstract

AIM
The aim of this study was to understand the concept of active learning and its potential use in nursing academia.

BACKGROUND
The demands for innovative teaching-learning strategies in higher education increased in the past decade to foster higher level of thinking. The nurse educator must prepare students entering the nursing profession, which mandates safe patient care, using a pedagogical learning process such as active learning.

METHOD
The Walker and Avant method guided this concept analysis.

RESULTS
The attributes of the concept are learner-centered; dynamic, meaningful, and engaging learning environment; bidirectional collaborative interaction between educator and learner; and ongoing constructive and nonjudgmental feedback. The identified antecedents include the educator’s active learning expertise and the learner’s capacity for higher order thinking.

CONCLUSION
Nurse educators are responsible for providing effective learning environments based on a sound pedagogical approach. Active learning’s desirable outcomes call for educator support as experts in implementation.