bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring the ethics of physical restraints: Students’ questioning
Authors: Tanaka Maki 
Published: January 2023

Background Physical restraints are routinely employed to ensure patient safety in Japanese acute care. Little is known about nursing students' perspectives and how they begin to question their value and knowledge in the face of restraint experiences in clinical practice. Objective To investigate nursing students’ questions about patient restraints and how they understand the ethics of the use of restraints in nursing. Research design Qualitative descriptive research using narrative analysis. Participants and research context Experiential data were generated and thematically analyzed from semi-structured interviews with 16 nursing students who had completed their bachelor’s degree program requirements. Ethical considerations The study was approved by academic and clinical ethics agencies. Participants provided written informed consent. Results Physical restraints were encountered in 16 incidents, 3 with children and 13 with older patients with dementia. Students struggled to comprehend the policies and protocols of restraint use and worried their use was primarily for security rather than therapeutic purposes. Five themes were identified: (1). Questioning the tension between person-centered care, patient autonomy, and restraints, (2). Questioning the nature of restraints in which participants analyzed the policies and protocols around restraint use, (3). Questioning the professional nursing self whereby students reflected on how restraint use challenged their nursing values, and (4). Questioning professional nursing practice, in which students explored how restraints fit within a nursing perspective and positioned themselves as patient advocates. Students encountering physical restraints should ask questions based on values of patient-centeredness, autonomy, and advocacy. There is a need for education that facilitates reflection and questioning so that it informs students’ ethical thinking which may enhance nurse advocacy to reduce restraint use. Conclusions Restraints provide contexts in which students must face tensions between nursing values and clinical reality. Further research on nursing education strategies within non-psychiatric settings is needed to reduce physical restraints.
Treatment of Asymmetric Crying Face by Fascia lata Grafting
Authors: Lei Bowen , Huang Qinghua , Li Binghang , Ma Hengyuan , Yang Bin 
Published: January 2023

Objective To evaluate and discuss the plastic surgery treatment of asymmetric crying face. Methods From 2019 to 2022, 60 patients with asymmetric crying face were treated by fascia lata grafting. We evaluated the postoperative improvement, summarized experiences and reviewed literatures about the treatment of asymmetric crying face. Results 59 patients showed varying degrees of improvement in the movement of the affected corner of mouth, and no complications were found during the follow-up period of 6 months to 24 months. Conclusions The cause of asymmetric crying face is still uncertain. Fascia lata grafting has shown a certain effect in the treatment of asymmetric crying face. This study evaluated this method with quite large sample. More researches are needed to explore the most appropriate treatment for asymmetric crying face.
Decrease in Prevalence of Cleft lip, Alveolus and Palate After Nationwide Introduction of the Second-Trimester Anomaly Scan in the Netherlands
Authors: Smit Johannes A. , Bax Caroline J. , Vermeij-Keers Christl , Trenning Bert A.H. , de Bakker Bernadette S. , Breugem Corstiaan C. 
Published: January 2023

Objective Some studies have suggested that introducing a second-trimester anomaly scan (SAS) leads to increased rates of termination of pregnancy (TOP) in fetuses with orofacial clefts (OFCs). The aim of this study was to evaluate the impact of a nationwide introduction of SAS on the prevalence of live births with OFCs in the Netherlands. Design Retrospective cohort study. Setting Tertiary setting. Population Included in the study were all patients diagnosed with OFCs as recorded in the “Dutch Association for Cleft Palate Anomalies” database between 1997 and 2019. Interventions Patients were divided into three categories: cleft lip with or without alveolus (CL/A), cleft lip, alveolus and palate (CLAP) and cleft palate (CP) based on anatomical landmarks at the first consultation. Main outcome measures Prevalence rates of OFCs before and after the nationwide introduction of the SAS on January 1, 2007 were compared. Result Overall, 1899 patients were diagnosed with CL/A, 2586 with CLAP and 2927 with CP. The prevalence of clefts before and after introduction of the SAS did not differ ( P = 0.85). The prevalence of CL/A decreased ( P = 0.04), and that of CLAP decreased ( P = 0.01) and that of CP increased ( P = 0.02). Conclusions This study demonstrates a significant decrease in the prevalence of CL/A and CLAP after introduction of the SAS. However, due to an increase in CP, the prevalence of all patients born with OFCs has not changed in the Netherlands between 1997 and 2019.
Comparison of the Paranasal Sinus Features of Paediatric Patients with and Without Cleft Palate: A CBCT Study
Authors: Tunç Hamit , Ünsal Gürkan 
Published: January 2023

Objectives This study is performed to compare the paranasal sinus volumes in paediatric unilateral cleft palate (UCP) and healthy patients. Methods Cone-beam computed tomography (CBCT) images of 80 patients (40 boys, 40 girls) with UCP and 80 healthy individuals (40 boys, 40 girls) were evaluated. Paranasal sinus volumes were segmented and measured using ITK-SNAP software. Descriptive statistics, Kolmogorov-Smirnov, paired sample t-test and student t-test were performed for statistical analysis. Results The volumes of ethmoid, frontal and sphenoid sinus on the cleft side were not significantly different than the non-cleft side (p>0.05) in UCP patients. Maxillary sinus volume of the cleft side in UCP patients was significantly lower than the non-cleft side (p<0.05). Mean maxillary sinus volume in UCP patients was 11825.23±509.95 mm3 at the cleft side and 13497.85±358.07 mm3 at the non-cleft side. While the mean volumes of ethmoid and sphenoid sinuses of patients with UCP were not significantly different from healthy individuals (p>0.05), the mean volumes of maxillary and frontal sinuses were significantly lower than healthy individuals (p<0.05). The mean maxillary sinus volume in UCP patients was 25323±597.8 mm3 and 26666±874.3 mm3 in the control group. The mean frontal sinus volume in UCP patients was 5633±323.1 mm3 and 5735±315.2 mm3 in the control group. Conclusions UCP caused a significant reduction in maxillary and frontal sinus volumes. The results of the current study show that paranasal sinus volumes in patients with UCP should be examined in more detail to make more risk-free and effective treatment plans.
Models for Predicting Velopharyngeal Competence Based on Speech and Resonance Errors and Velopharyngeal Area Estimation
Authors: Scarmagnani Rafaeli Higa , Lohmander Anette , Salgado Manoel Henrique , Fukushiro Ana Paula , Trindade Inge Elly Kiemle , Yamashita Renata Paciello 
Published: January 2023

Objective To develop tools for predicting velopharyngeal competence (VPC) based on auditory-perceptual assessment and its correlation with objective measures of velopharyngeal orifice area. Design Methodological study. Participants and Methods Sixty-two patients with repaired cleft palate, aged 6 to 45 years, underwent aerodynamic evaluation by means of the pressure-flow technique and audiovisual recording of speech samples. Three experienced speech-language pathologists analysed the speech samples by rating the following resonance, visual, and speech variables: hypernasality, audible nasal air emission, nasal turbulence, weak pressure consonants, facial grimacing, active nonoral errors, and overall velopharyngeal competence. The correlation between the perceptual speech variables and velopharyngeal orifice area estimates was analysed with Spearman's correlation coefficient. Two statistical models (discriminant and exploratory) were used to predict VPC based on the orifice area estimates. Sensitivity and specificity analyses were performed to verify the clinical applicability of the models. Results There was a strong correlation between VPC (based on the orifice area estimates) and each speech variable. Both models showed 88.7% accuracy in predicting VPC. The sensitivity and specificity for the discriminant model were 92.3% and 97.2%, respectively, and 96.2% and 94.4% for the exploratory model. Conclusion Two predictor models based on ratings of resonance, visual, and speech variables and a simple calculation of a composite variable, SOMA (Eng. “sum”), were developed and found to be efficient in predicting VPC defined by orifice estimates categories based on aerodynamic measurements. Both tools may contribute to the diagnosis of velopharyngeal dysfunction in clinical practice.
Unraveling a Major Burden of Orofacial Clefts Analyses: Classification of Cleft Palate Fistulas by Cleft Surgeons
Authors: Houkes Ruben P. , Smit Johannes A. , Lachkar N. , Tse Raymond , Breugem Corstiaan C. 
Published: January 2023

Objective The objective of this study was to investigate how cleft surgeons classify palatal fistulas. We focused on three different anatomical locations (ie, hard palate, soft palate, junction hard/soft palate) to analyze agreement/disagreement at various anatomical locations. Design Cross-sectional survey study. Participants Participants in an international webinar that focused on palatal fistula treatment were included. Intervention Participants were presented with a survey pre- and post-webinar. Main outcomes Frequency of used classification systems for classifying oronasal fistulas and the inter-rater reliability of the Pittsburgh classification system. Results A total of 141 participants completed the questionnaires prior to the webinar and 109 participants completed the survey after the webinar. In total, four classification systems were used (ie, Pittsburgh, Pakistan Comprehensive Fistula Classification [PCFC], anatomical and ‘other’). The Pittsburgh classification was the most commonly used system in all cases. However, Pittsburgh inter-rater reliability was low (κ = 0.136 pre-webinar, and κ = 0.174 post-webinar). Surprisingly, a substantial shift was observed from the anatomical to Pittsburgh classification after the webinar, indicating increased awareness of the usability of the Pittsburgh classification system. Conclusions This study demonstrates a large heterogeneity with regards to the classification of cleft palate fistulas. Interestingly, a shift was observed from the anatomical to Pittsburgh classification after the webinar. However, the inter-rater reliability for using the Pittsburgh classification was low. Classifying palatal fistulas in a homogenous fashion could enhance comparison of primary palate repair and could improve treatment of palatal fistulas.
Ageing changes in retinal outer nuclear layer thickness and cone photoreceptor density using adaptive optics-free imaging
Authors: Matlach Juliane , Mulholland Padraig , Cilkova Marketa , Chopra Reena , Shah Nilpa , Redmond Tony , Dakin Steven C , Garway-Heath David F , Anderson Roger S 
Published: January 2023

Purpose To investigate age-related changes of the outer nuclear layer (ONL) thickness and cone density, and their associations in healthy participants using a modified, narrow scan-angle Heidelberg Retina Angiograph (HRA2). Methods Retinal cones were imaged outside the fovea at 8.8° eccentricity and cone density was compared to ONL thickness measurements obtained by Spectral-Domain Optical Coherence Tomography (SD-OCT) at the same locations. Fifty-six eyes of 56 healthy participants with a median age (interquartile range, IQR) of 37 years (29–55) were included. Results Median (IQR) cone count was 7,472 (7,188, 7,746) cones/mm2 and median (IQR) ONL thickness was 56 (52, 60) µm for healthy participants. Both cone density and ONL thickness were negatively associated with age: cone density, R2 = 0.16 (F(1,54) = 10.41, P = 0.002); ONL thickness, R2 = 0.12 (F(1,54) = 7.41, P = 0.009). No significant association was seen between cone density and ONL thickness (R2 = 0.03; F(1,54) = 1.66, P = 0.20). Conclusion Cone density was lower, and ONL thinner, in older compared to younger participants, therefore, image-based structural measures should be compared to age-related data. However, cone density and ONL thickness were not strongly associated, indicating that determinants of ONL thickness measurements other than cone density measurements, and including measurement error, have a major influence.
Adapting the socio-cultural adaptation scale (SCAS-R) to Arabic: A study on the Syrian migrants living in Gaziantep province of Türkiye
Authors: Keser Ahmet , Yalçin Önder , Gökmen Yunus 
Published: January 2023

This study aims to investigate the validity, reliability, and Arabic language equivalence of the Socio-cultural Adaptation Scale (SCAS-R) created by Colleen Ward and Antony Kennedy (1999) and revised by Jessie Wilson (2013). A sample group of 424 Syrian Migrants (18 years and older) living in Gaziantep province of Türkiye from different neighborhoods, economic status, and socio-demographic backgrounds are included in the research, and the scale is examined via commonly used validity and reliability analysis methods. It is obtained that the Cronbach’s Alpha of the items is higher than 0.7 and the corrected item-total correlations are above the threshold value (0.2) in item analysis, nearly 69% of the total variance is explained by 5 factors in Exploratory Factor Analysis (EFA), and the Goodness of Fit Indexes (χ2/sd = 1.521, CFI = 0.958, and SRMR = 0.048) are within the good/acceptable range in Confirmatory Factor Analysis (CFA). It has been understood that the SCAS-R is a valid and reliable scale for Arabic culture. The results of this study may provide a valuable tool for policymakers, researchers, and humanitarian workers studying migration issues.
Acoustic optimization design of porous materials on sandwich panel under flow-induced vibration
Authors: Li Ye , Xiao Xinbiao , Zhang Yumei , Tang Zhao , Pan Aipeng 
Published: January 2023

In this study, porous sound-absorbing materials used as a lining in double-panel structure applications (such as high-speed train body structures) to limit flow-induced vibration interior noise were studied, and acoustic optimization design was performed. First, in the wavenumber domain, the cross-spectrum Corcos model was used to characterize the dynamic hydrodynamic pressure of turbulence. Biot’s theory is used to model the porous materials. The transmission loss (TL) of the sandwich panel were also determined based on the model superposition method. Three types of sandwich panel structures were considered: air–air (A–A), bonded-bonded (B–B), and bonded-air (B–A). The TL of the three structure types under hydrodynamic pressure was used to evaluate the suppression of flow-induced vibration interior noise in porous materials. The effects of flow velocity, thickness and density of the porous material, and three types of polyimide foam on the TL characteristics of the sandwich panel were investigated. The results show that the flow velocity has a significant influence on the TL of the sandwich panel. The TL of the sandwich panel decreases by 3–4 dB when the flow velocity increases by 100 km/h The B–A configuration has satisfactory sound insulation performance at most frequencies. With an increase in material thickness, the TL of the sandwich panel structure first increases and then decreases, and the material density mainly affects the TL of the structure at intermediate and high frequencies. Based on the objectives of maximizing the average transmission loss (TLavg) and minimizing the structural weight, the acoustic optimization design of the B–A structure was performed, and the balance between the two objective functions was achieved by a nondominated sorting genetic algorithm (NSGA-Ⅱ). The TLavg s of the sandwich panel structure increased by 5.2 dB when the total mass of the structure was decreased by 0.2 kg.
Embedding Ecopreneurial Behaviour: Proposed Social Marketing Interventions From Value-In-Behaviour Perceptions of Plastic Waste Ecopreneurs
Authors: Muposhi Asphat , Mugwati Miriam , Mawere Rukudzo 
Published: January 2023

Background Plastic waste is a growing social and environmental problem in developing economies due to poor waste management infrastructure and improper disposal behaviours. This study explores how ecopreneurship can be embedded as a long-term strategy for managing plastic waste in Zimbabwe. Focus of the Article This study focuses on Zimbabwe, a developing country that is grappling with plastic waste. Value-in-behaviour perceptions of plastic waste ecopreneurs were explored. Research Questions This study attempts to answer the following questions: (1) What are the specific set of values that motivate ecopreneurs to start ecopreneurial ventures in Zimbabwe? (2) What are the challenges confronting ecopreneurs in Zimbabwe? (3) What is the potential role of social marketing as a strategy intervention to embed ecopreneurial behaviour in Zimbabwe? Importance to the Social Marketing Field This study extends the value-in-behaviour theory to deepen the current understanding of the relationship between ecopreneurship and social marketing in the context of a developing economy. Methods A qualitative research method was employed. Twenty-one in-depth interviews were conducted with ecopreneurs in Zimbabwe involved in plastic waste collection, recycling and eco-innovations. Interview data was analysed using thematic analysis. Findings Economic value, social value and ecological value emerged as the major value perceptions that motivate ecopreneurs. Funding, limited availability of plastic waste management infrastructure, low market value affixed to eco-innovations, derogatory connotations associated with waste collection and lack of community based support in sorting plastic waste were identified as the major stumbling blocks. Recommendations for Research or Practice Social marketing interventions for embedding ecopreneurial behaviour in Zimbabwe are proposed. Ecopreneurship may be promoted by disseminating educational messages that emphasize on economic, social and ecological benefits. Challenges confronting ecopreneurs such as lack of funding and plastic waste management infrastructure need to be addressed. Limitations This study focused only on ecopreneurs in plastic waste management. Thus, the findings cannot be generalised to ecopreneurs involved in other forms of ecopreneurship. Secondly, the study was conducted in a developing economy where waste collection infrastructure is limited.
The effects of high-definition transcranial direct current stimulation on pain modulation and stress-induced hyperalgesia
Authors: Toufexis Constantino , Macgregor Molly , Lewis Aidan , Flood Andrew 
Published: January 2023

Background The dorsolateral prefrontal cortex (DLPFC) has been implicated in the modulation of pain-related signals. Given this involvement, manipulation of the DLPFC through transcranial direct current stimulation (tDCS) may influence internal pain modulation and decrease pain sensitivity. Acute stress is also thought to affect pain, with increased pain sensitivity observed following the presentation of an acute stressor. Methods A total of 40 healthy adults (50% male), ranging in age from 19 to 28 years ( M = 22.13, SD = 1.92), were randomly allocated to one of two stimulation conditions (active and sham). High-definition tDCS (HD-tDCS) was applied for 10 min at 2 mA, with the anode placed over the left DLPFC. Stress was induced after HD-tDCS administration using a modified version of the Trier Social Stress Test. Pain modulation and sensitivity were assessed through the conditioned pain modulation paradigm and pressure pain threshold measurements, respectively. Results Compared to sham stimulation, active stimulation produced a significant increase in pain modulation capacity. No significant change in pain sensitivity and stress-induced hyperalgesia was observed following active tDCS. Conclusion This research shows novel evidence that anodal HD-tDCS over the DLPFC significantly enhances pain modulation. However, HD-tDCS had no effect on pain sensitivity or stress-induced hyperalgesia. The observed effect on pain modulation after a single dose of HD-tDCS over the DLPFC is a novel finding that informs further research into the utility of HD-tDCS in the treatment of chronic pain by presenting the DLPFC as an alternative target site for tDCS-induced analgesia.
Endocrine and multiple sclerosis outcomes in patients with autoimmune thyroid events in the alemtuzumab CARE-MS studies
Authors: Dayan Colin M. , Lecumberri Beatriz , Muller Ilaria , Ganesananthan Sashiananthan , Hunter Samuel F. , Selmaj Krzysztof W. , Hartung Hans-Peter , Havrdova Eva K. , LaGanke Christopher C. , Ziemssen Tjalf , Van Wijmeersch Bart , Meuth Sven G. , Margolin David H. , Poole Elizabeth M. , Baker Darren P. , Senior Peter A. 
Published: January 2023

Background Alemtuzumab is an effective therapy for relapsing multiple sclerosis. Autoimmune thyroid events are a common adverse event. Objective Describe endocrine and multiple sclerosis outcomes over 6 years for alemtuzumab-treated relapsing multiple sclerosis patients in the phase 3 CARE-MS I, II, and extension studies who experienced adverse thyroid events. Methods Endocrine and multiple sclerosis outcomes were evaluated over 6 years. Thyroid event cases, excluding those pre-existing or occurring after Year 6, were adjudicated retrospectively by expert endocrinologists independently of the sponsor and investigators. Results Thyroid events were reported for 378/811 (46.6%) alemtuzumab-treated patients. Following adjudication, endocrinologists reached consensus on 286 cases (75.7%). Of these, 39.5% were adjudicated to Graves’ disease, 2.5% Hashimoto's disease switching to hyperthyroidism, 15.4% Hashimoto's disease, 4.9% Graves’ disease switching to hypothyroidism, 10.1% transient thyroiditis, and 27.6% with uncertain diagnosis; inclusion of anti-thyroid antibody status reduced the number of uncertain diagnoses. Multiple sclerosis outcomes of those with and without thyroid events were similar. Conclusion Adjudicated thyroid events occurring over 6 years for alemtuzumab-treated relapsing multiple sclerosis patients were primarily autoimmune. Thyroid events were considered manageable and did not affect disease course. Thyroid autoimmunity is a common but manageable adverse event in alemtuzumab-treated relapsing multiple sclerosis patients. ClinicalTrials.gov Registration Numbers: CARE-MS I (NCT00530348); CARE-MS II (NCT00548405); CARE-MS Extension (NCT00930553)