bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is Rajan’s Hypothesis Confirmed by Empirical Evidence? A Critical Review
Authors: Xu Guangdong 
Published: April 2022

Based on experience in the United States in recent decades, Rajan (2010) argues that there is an inequality-debt-crisis nexus, that is, income inequality may contribute to banking crises by stimulating the accumulation of household debt. Whether and to what extent Rajan’s hypothesis has been confirmed (or refuted) by the literature is investigated in this study. It is shown that the validity of Rajan’s theory depends on the level of strictness of the standards that are established to estimate the extent of agreement between theory and evidence. This conditional validity can be attributed to the multidimensional nature of the inequality-debt-crisis nexus, which is overlooked by Rajan. JEL Classification: D31, E51, G21, G51
Novel Sublingual Analgesic Improves Patient Tolerance of Face and Body Radiofrequency Microneedling: A Split Face/Abdomen Study
Authors: Maningas Talon , Ramirez Henry , Martin Kindall 
Published: April 2022

Introduction: Radiofrequency (RF) microneedling requires minimal downtime; however, patients’ tolerance of the procedural pain can limit cosmetic results. The goal of this study was to determine the patient tolerance of RF microneedling with sufentanil sublingual tablet (SST) 30 μg and topical local anesthetic compared with topical local anesthetic alone. Materials and Methods: The study was a one-way crossover study of patients undergoing RF microneedling of the face or abdomen. Topical local anesthetic was applied 45 minutes prior to the initial procedure to one side of the face or abdomen (control side), followed by topical local anesthetic and SST administered 45 and 30 minutes, respectively, prior to the procedure on the opposite side (SST-treated side). The primary endpoint was patient completion of the procedure with additional endpoints of Richmond Agitation Sedation Scale scores, patient and provider satisfaction ratings, vital signs, oxygen saturation levels, and adverse events. Results: A total of 51 patients were enrolled averaging 44.8 ± 11.1 (SD) years of age. Forty-five percent of patients successfully completed the control side compared with 96% of patients successfully completing the SST-treated side ( P < .001). Patients were less restless or agitated during the SST-treated side (6%) compared with the control side (51%; P < .001). Patient and provider satisfaction scores were significantly improved with SST ( P < .001). Vital signs remained stable with SST treatment compared with the control side. Discussion: The SST is a safe and effective sublingual analgesic allowing patients to be awake and alert while increasing patient tolerance of RF microneedling as well as patient and provider satisfaction with the procedure. Conclusion: The SST is a novel analgesic that can be used in office-based settings with appropriate safety equipment available.
Posterior Antiglide Plating vs Lateral Neutralization Plating for Weber B Distal Fibular Fractures: A Systematic Review and Meta-analysis of Clinical and Biomechanical Studies
Authors: Deng Yi , Staniforth Thomas Lindsay , Zafar Mohammad Saqib , Lau Yeong Joe 
Published: April 2022

Background: Distal fibular fractures are extremely common, yet there remains controversy about which type of plating technique is the most appropriate. We aimed to compare clinical and biomechanical outcomes following posterior antiglide plating and lateral neutralization plating for Weber B distal fibular fractures. Methods: A systematic review and meta-analysis of the literature was conducted by two independent reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included all comparative studies of distal fibular fracture fixation with either a posterior antiglide plate or a lateral neutralization plate. Our primary outcome of interest was reoperation for hardware removal. Secondary outcomes included hardware discomfort, peroneal tendon irritation, infection, wound complications, and mechanical torque to failure. Results: A total of 1122 patients with Weber B ankle fractures were included across nine eligible clinical studies, and 76 cadaveric ankles were subject to testing across three eligible biomechanical studies. Meta-analyses revealed a two-fold greater odds of requiring removal of hardware in the lateral plating group compared to the posterior plating group (odds ratio [OR] 2.48, 95% CI 1.58 to 3.91, P < .0001), and a three-fold greater odds of experiencing hardware discomfort in the lateral plating group compared to the posterior plating group (OR 2.96, 95% CI 1.83 to 4.80, P < .0001). There were no significant differences in rates of peroneal tendon irritation, infection, wound complications, operative time, and torque to failure when comparing the two plating methods. Conclusion: The results of this review indicate that using posterior antiglide plating for distal fibular Weber B–type fractures is associated with significantly fewer reoperations due to hardware complications and less hardware discomfort compared to lateral neutralization plating. This technique does not appear to increase the risk of peroneal tendon irritation or increase operative time.
Clinical and Radiologic Results of a Human Bone Graft Screw in Tarsometatarsal II/+III Arthrodesis
Authors: Amann Pascal , Pastl Klaus , Neunteufel Elena , Bock Peter 
Published: April 2022

Background: For arthrodesis of the tarsometatarsal joints, there is the possibility of using a transplant screw made of allogenic human bone material (Shark Screw). This article investigates the clinical outcome and radiologic integration of the allogenic bone screw for arthrodesis of the tarsometatarsal joints II/+III. Methods: This is a prospective study involving 20 feet of 17 patients who received TMT II/+III arthrodesis with an allogenic bone screw. A visual analog scale (VAS pain and function), Foot Function Index (FFI), American Orthopaedic Foot & Ankle Society (AOFAS) midfoot score, and Foot and Ankle Outcome Score (FAOS) were used as measures to compare preoperative with postoperative results. Radiologic integration in the recipient bone was also evaluated. Results: A significant mean pre- to postoperative improvement of all evaluated scores has been observed ( P < .05) after a mean follow-up of 15.87 months (minimum 12 months, maximum 33 months). VAS score (pain) decreased from 7.6 to 1.4 points as well as a decrease of the VAS (function) from 7.25 to 1.8 points. Further, a reduction of the FFI from 62.3% to 16.7% and an increase from 29.7 to 79.9 points of the AOFAS was detected. Analyzing the FAOS score, in all surveyed subscales, there was an increase in the score (Symptoms: 55.2 to 85.6 points; Pain: 30.5 to 86.9 points; Function: 33.1 to 88.3 points; Quality of life: 27.8 to 79.7 points). Moreover, in all cases, a complete radiologic integration into the receiving bone was appreciated, and after a minimum follow-up time from 12 months, the screw in 19 feet (95%) was no longer distinguishable from the original bone. Conclusion: With these first results of the allogenic bone screw in TMT II/+III arthrodesis, a significant improvement from preoperative to postoperative was confirmed in the collected scores, and a full radiographic integration was demonstrated in all feet.
Reduced Modular Segregation of White Matter Brain Networks in Attention Deficit Hyperactivity Disorder
Authors: He Wenbo , Liu Weichen , Mao Min , Cui Xiaohong , Yan Ting , Xiang Jie , Wang Bin , Li Dandan 
Published: April 2022

Objective: Despite studies reporting alterations in the brain networks of patients with ADHD, alterations in the modularity of white matter (WM) networks are still unclear. Method: Based on the results of module division by generalized Louvain algorithm, the modularity of ADHD was evaluated. The correlation between the modular changes of ADHD and its clinical characteristics was analyzed. Results: The participation coefficient and the connectivity between modules of ADHD increased, and the modularity coefficient decreased. Provincial hubs of ADHD did not change, and the number of connector hubs increased. All results showed that the modular segregation of WM networks of ADHD decreased. Modules with reduced modular segregation are mainly responsible for language and motor functions. Moreover, modularity showed evident correlation with the symptoms of ADHD. Conclusion: The modularity changes in WM network provided a novel insight into the understanding of brain cognitive alterations in ADHD.
Oral Cladribine in Patients who Change From First-Line Disease Modifying Treatments for Multiple Sclerosis: Protocol of a Prospective Effectiveness and Safety Study (CLAD CROSS)
Authors: Tsivgoulis Georgios , Deftereos Spyros , Gobbi Claudio , Gulowsen Celius Elisabeth , Kulakowska Alina , Maniscalco Giorgia , Mendes Irene , Grigoriadis Nicolaos 
Published: April 2022

Background Recently, the number of available disease modifying therapies for multiple sclerosis (MS) has increased. However, a proportion of patients treated with these agents continue to experience relapses and disease progression. Cladribine tablets, approved in 2017 for highly active relapsing MS, comprise a sparsely administered oral treatment which exerts its therapeutic effect through a reduction and subsequent repletion of the lymphocyte population. Purpose/Study Sample Here we describe the design of CLAD CROSS, a prospective, non-interventional, multicenter, Phase IV study in patients with a confirmed diagnosis of RRMS who switch from first-line disease modifying drugs (DMDs) to treatment with cladribine tablets in routine clinical practice. 242 adult patients will be recruited in 61 sites (6 countries) over 30 months and will be followed up for 2 years following prescription of cladribine tablets per the decision of the treating physicians. Research Design The primary endpoint is the change in annualized relapse rate (ARR) between the 12-month pre-baseline period and over the 12-month period before end of study. Secondary endpoints are the percentage of patients with 6-month disability progression or improvement at the end of the study, measured by the Expanded Disability Status Scale, Timed 25 Foot Walk and 9-Hole Peg Test scales and quality of life, treatment satisfaction, and healthcare resource utilization, measured through the MSIS-29, TSQM 1.4, and EQ-5D-3L scales, respectively. MRI lesions will be compared in the exploratory setting between the 12-month pre-baseline period, baseline, and at years 1 and 2. Adverse events will be monitored throughout the study. Interim analyses are pre-planned when 30% and 60% of patients will complete the 12-month follow-up visit. Conclusions CLAD CROSS will provide efficacy data on cladribine tablets, used as a follow-up treatment to first-line DMDs in the real-world setting, will further establish its safety profile and will collect information to support pharmacoeconomic studies.
Ventilating the blast lung: Exploring ventilation strategies in primary blast lung injury
Authors: Tollman Jaden , Ahmed Zubair 
Published: April 2022

Introduction Primary blast lung injury (PBLI) is the most common and fatal of all primary blast injuries. The majority of those with PBLI will require early intubation and mechanical ventilation, and thus, ventilation strategy forms a crucial part of any management plan. Methods: A comprehensive, but not systematic, PubMed and Google Scholar database search identified articles that contribute to our current understanding of ventilation strategies in PBLI for a narrative educational review. Results A PBLI ventilation strategy must strive to minimise all four of ventilator-associated lung injury (VALI), volutrauma, barotrauma and biotrauma. The three main ventilation strategies available are conventional low tidal volume (LTV) ventilation, airway pressure release ventilation (APRV) and high frequency oscillatory ventilation (HFOV). Conventional LTV ventilation together with a variable positive end-expiratory pressure (PEEP) and permissive hypercapnia has demonstrated reduced inflammation and mortality with a greater number of ventilator-free days. APRV has the potential to reduce dynamic strain, PaO2/FiO2 ratios, levels of applied mechanical power and extravascular lung water while encouraging spontaneous breathing. HFOV is able to effectively avoid VALI while curbing inflammation and histological lung injury, though not necessarily mortality. Conclusions: Presently, PBLI should largely be managed with conventional LTV ventilation alongside a variable PEEP and permissive hypercapnia with APRV and HFOV reserved as rescue strategies for where conventional LTV ventilation fails. Clinicians should additionally consider supplementing their strategy with adjunctive therapies such as prone positioning, inhaled nitric oxide and extracorporeal membrane oxygenation that may further reduce mortality and combat severe respiratory and/or cardiac failure.
Duplex Ultrasound Assessment of Radial Artery Access Site: Complications and Clinical Outcomes
Authors: Darwazeh Ghaleb A. , Starr Jean , Satiani Bhagwan 
Published: April 2022

Introduction: The radial artery is often utilized for invasive hemodynamic monitoring as well as an access site for arterial and cardiac catheterization. Complications requiring intervention, although uncommon, may have implications for future utilization of this site and harvesting for coronary bypass. We aimed to better define the occurrence and the risk factors associated with radial artery access (RAA). Methods: Patients referred for upper extremity arterial duplex (UEAD) examinations with clinical findings suspicious for complications after RAA between 2008 and 2016 were reviewed. Electronic medical records and vascular laboratory records were reviewed for demographics and peri-procedural data. Results: The radial artery was used for 19,253 arterial lines, and 13,402 cardiac catheterizations during the study period at our institution. During this time, a total of 131 patients were referred to our vascular laboratory for UEAD based on abnormal clinical findings after RAA. Sixty-two (47%) patients had undergone radial artery catheter (A-line) placement for hemodynamic monitoring, and 69 (53%) had left heart catheterization (LHC). Six patients required surgical intervention: 5 after A-line and 1 after LHC. A-line was more frequently associated with a positive UEAD finding compared with LHC (79% vs 57%, P = .007). Among patients with A-lines, there was no significant relationship between presence of a positive UEAD finding and the specialty or level of training of the operator, the number of attempts, the usage of ultrasound guidance, or catheter indwelling time. There was also no significant relationship between a positive UEAD finding and the size of sheath (5Fr vs 6Fr) among patients who underwent LHC. Conclusions: A positive UEAD finding in patients with clinically apparent complications after RAA is uncommon, and the need for surgical intervention is similarly infrequent. Follow-up UEAD studies may be useful to determine long-term patency of the radial artery and usability for future access or for coronary artery bypass grafting.
Bridging the gap between research and clinical care: strategies to increase staff awareness and engagement in clinical research
Authors: Shepherd Maggie , Endacott Ruth , Quinn Helen 
Published: April 2022

Background Research active hospitals have better patient outcomes and improvements in healthcare are associated with greater staff engagement in research. However, barriers to research activity include inadequate knowledge/training and perceptions that research is a specialist activity. Nursing is an academic discipline but the infrastructure supporting nursing research worldwide is variable and sustaining clinical academic careers remains challenging. The National Institute of Health Research 70@70 Senior Nurse Research Leader programme provides dedicated time to increase clinical academic opportunities and foster a research culture across England; we describe initiatives developed by one National Institute of Health Research 70@70 leader to increase clinical staff engagement in research. Aim The purpose of this work was to develop initiatives to facilitate clinical research opportunities and bridge the gap between clinical care and research. Methods New strategies were developed in one health service to increase clinical staff engagement in research activity. This included: (a) Chief Nurse Research Fellows: clinical staff undertaking bespoke research training to identify local clinical research priorities, (b) an exemplar nurse-led Embedding Research In Care unit to pioneer innovation, evaluation and research participation supported by a research facilitator and (c) a Clinical Academic Network for nursing, midwifery and allied healthcare professionals to aid collaborative working. Results The first cohort of Chief Nurse Research Fellows have successfully completed a bespoke training programme and, with mentoring, developed projects to tackle clinical problems. The Embedding Research In Care unit initiative was configured and the first Embedding Research In Care unit has been awarded. A Clinical Academic Network group of 25+ nurses, midwives and allied health professionals was established and provides peer support and mentoring. Conclusions This multi-faceted approach has successfully supported research training/engagement, enabled career development and identified nurses/midwives with potential to undertake clinical academic careers. A range of strategies, such as those described in this paper, are required to successfully bridge the gap between clinical care and research and provide additional opportunities for clinical staff to become engaged in a research active career.
A survey on work status and competencies of Clinical Research Nurses in China
Authors: Hao Peng , Wu Linda , Liu Yanfei 
Published: April 2022

Background The clinical trials industry in China has enjoyed robust growth; the demand for qualified personnel to conduct clinical trials with higher quality has increased. The Clinical Research Nurse has emerged as a new workforce in China. Aims This study aimed to examine the current work status of Clinical Research Nurses in China and to investigate their competencies in knowledge and behavior associated with this profession. Methods An online survey was analyzed. The current work status of Clinical Research Nurses in China was characterized. In addition, their competencies were self-assessed across nine competency categories and the “contribution to science” domain, based on the International Association of Clinical Research Nurses Scope and Standards of Practice. Results A total of 638 eligible questionnaires were included in the final analysis. Of whom, 98.28% (627/638) were females. The mean age was 35 years (range: 22–64 years). Over 80% of whom were working at the largest Chinese cities and the majority (78.2%) held a Bachelor’s degree in nursing. The average time of clinical research experience was 5.67 years. Three quarters of the 638 had an annual income of <150,000 Yuan RMB. The average weekly working time was 45.46 h; clinical trial-related work accounted for 62.68% of their workload. There were some gaps between the Clinical Research Nurses’ self-assessed competencies in knowledge and behavior, with the widest gaps along the ethical principles, leadership and professional development, protocol compliance, and document management categories. Conclusion This is the first large-scale survey of Clinical Research Nurses in China. Our results profile this emerging workforce as a population of young, moderately trained/experienced, predominantly female nurses working in the largest Chinese cities. They performed well on most knowledge/behavior parameters; still, gaps exist. Therefore, there is a pressing need to enhance professional education and training for Clinical Research Nurses in China.
Midwifery research in areas of deprivation and need: the MeRIDiAN project
Authors: Whitehouse Claire L , Raven Jamie-Louise , Keable Joanna , Parslow-Williams Siobhan , Smith Hazel A 
Published: April 2022

Background Areas with high levels of deprivation often have the lowest numbers of research participation. In January 2020, a maternity research service was established at a UK National Health Service (NHS) Trust incorporating a project monitoring equity of access to pregnant people from areas of deprivation and need. Aims The aim is to monitor maternity research opportunities for pregnant people in areas of deprivation and need. Method A collaborative working group was established. Using the Index of Multiple Deprivation levels (IMD) levels; 1–4 were considered ‘areas in need’. Data were collected over a 12-month period from January 2020. Results Fifty-four pregnant people (3.1%), out of 1762 who delivered during 2020, were recruited to one of three research studies (‘Big Baby’, ‘POOL’ and ‘PAN-COVID’). The majority of pregnant people (65.9%) who delivered a baby were in IMD levels 1–4. Recruitment within IMD levels 1–4: ‘PAN-COVID’ at 86.7%, followed by ‘Big Baby’ with 77.3% and ‘POOL’ at 70.6%. COVID-19 pandemic presented challenges which impacted research delivery, including availability of research studies. Conclusion This project was founded due to concerns that pregnant people from areas of need would be under-represented in research. We have found that this has not occurred. Recommendations are being put in place to ensure equity of access for all.
Multi-professional perceptions of clinical research delivery and the Clinical Research Nurse role: a realist review
Authors: Tinkler Linda , Robertson Steven , Tod Angela 
Published: April 2022

Introduction & Background The delivery of clinical research and the Clinical Research Nurse (CRN) role is fundamental to the wider health agenda, yet both remain misunderstood outwith research teams. Methods A realist review was conducted to identify factors that influence how clinical research is perceived by healthcare professionals operating outside NHS clinical research teams. Keyword searches were undertaken across four healthcare databases including grey literature, with iterative snowball searching. Data were extracted from 42/387 sources. Coding generated 3664 extracts of text across 160 themes. Theories generated were presented as ‘If-Then’ statements. Results Thirteen theory statements described factors that may influence how clinical research is perceived by healthcare professionals operating outside clinical research teams across three contextual levels: • Micro: Individual characteristics/behaviours/CRN perceptions • Meso: Interpersonal relationships at the interface between CRN roles and healthcare delivery • Macro: Systemwide/infrastructural/cultural issues impacting clinical research delivery. Conclusion Factors at micro, meso and macro level contexts may influence how clinical research is perceived by healthcare professionals operating outside clinical research teams. This has the potential to affect the success of clinical research delivery. Meso level theories regarding the perceptions of healthcare professionals outwith research teams may provide insight. Empirical testing of one such theory is underway.