Concise Narrative Research Articles

Airway misadventures in adult critical care: a concise narrative review of managing lost or compromised artificial airways.

Loss or compromise of artificial airways in critically ill adults can lead to serious adverse events, including death. In contrast to primary emergency airway management, the optimal management of such scenarios may not be well defined or appreciated. Endotracheal tube cuff leaks may compromise both oxygenation and ventilation, and supraglottic cuff position must first be recognized and distinguished from other reasons for gas leakage during positive pressure ventilation. Although definitive management involves tube exchange, if direct visualization is possible temporizing measures can often be considered. Unplanned extubation confers variable and context-specific risks depending on patient anatomy and physiological status. Because risk factors for unplanned extubation are well established, bundled interventions can be employed for mitigation. Tracheostomy tube dislodgement accounts for a substantial proportion of death and disability related to airway management in critical care settings. Consensus guidelines and algorithmic management of such scenarios are key elements of risk mitigation. Management of lost or otherwise compromised artificial airways is a key skill set for adult critical care clinicians alongside primary emergency airway management.

Application Of Contextual Methods To Improve Short Writing Ability For Class Ix Students Of Junior High School

Writing is an activity to express thoughts, ideas or opinions and solve problems through written language media. Short stories are works of fiction that are fictitious, narrative or short storytelling (the storyline is solid while the background and flashbacks are included in passing). Because of its short form, short stories demand a concise narrative, not specific details that are "less important" and are more protracted. The purpose of this study was to improve the ability to write short stories through students' contextual methods. The research method used in this research is the classroom action research method. Data collection techniques were carried out by giving tests, observations and documentation. The data analysis techniques used are: 1) Test data analysis 2) Observation Result Data (Observation) Documentation Result Data 3) Documentation Result Data, The data source of this research is the making of this student short story which will be the main study of the author. The results of this study concluded that there were 7 students who completed the first cycle and 25 students who completed the second cycle, the application of contextual methods to students' short story writing contains many benefits for readers by animating the students' writing spirit.

Chicana/o/x Educational Pipelines as Critical Race Heuristics: Tools for Pedagogy, Politicization, and Praxis

Background/Context: Since 2005, critical race theory (CRT) scholars have crafted educational pipelines that compare educational attainment across racial groups in the United States. These visual models offer concise pictorial narratives about the discrepancies that fall along racial lines, particularly the underperformance of Chicana/o/x students over the last two decades. Purpose/Objective/Research Question/Focus of Study: This article conceptualizes educational pipelines comparing the educational attainment of Chicana/o/x, White, Black, Asian, and Native students as critical race heuristics, or exegetic visual instruments and pedagogical tools used by CRT scholars to concisely depict structural inequities predicated on racial hierarchies. Critical race heuristics elicit understandings of systemic oppression, foster critical awareness, and inspire action. Population/Participants/Subjects: There were more than 100 participants in 16 focus groups, and 10 individual interviews were conducted. Research Design: This qualitative study relied on a critical race-grounded theory methodology. Data Collection and Analysis: Data were responses to the question, “If you could show this pipeline to anyone, who would it be and why?” Each researcher separately analyzed the data, then compared emerging patterns and observations in several rounds, drawing on tenets of CRT to inform their analysis. Findings/Results: Participant responses revealed how the heuristic prompted: (a) a conscientization about the factors contributing to the disparities, (b) a call for various forms of praxis to remedy the disparities made apparent by the image, and (c) an appreciation for the simplicity of the image to convey educational inequities. Conclusion/Recommendations: The critical race heuristic enabled participants to articulate a keen awareness of the institutional factors predicated along racial lines that result in disparities between Chicana/o/x students and other racial groups. Moreover, it motivated participants’ desire for intervention, as they conceived of various strategies, tactics, and policies that might abate the pressures that limit the educational attainment of Chicana/o/x students. Our findings give insight regarding how the critical race heuristic could teach preservice teachers, teachers, and administrators about entrenched race-based inequities; motivate faculty and administrators to work toward narrowing the gaps between racial groups; or anchor workshops for students of color in bridge programs, college preparatory programs, retention programs, and leadership training programs that would help them chart a course for educational success.

Soil Structure Interaction in High-Rise Buildings for Dynamic Loads

Soil-structure interaction(SSI) analysis is the study of the dynamic response of a structure as influenced by the interaction with the surrounding soil. The SSI response is sensitive to the characteristics of the soil, structures, and ground motion, as well as the depth of embedment. The concept of soil-structure interaction was introduced , and the research methods were discussed. This report presents a synthetic of the body of knowledge contained in SSI literature, which has been distilled into a concise narrative and harmonized under a consistent set of variables and units. Specific techniques are described by which SSI phenomena can be simulated in engineering practice, and recommendations for modeling seismic soil-structure interaction effects on building structures are provided. An attempt was made to summarize the all terms in this area of study.

A Global Map of COVID-19 Vaccine Acceptance Rates per Country: An Updated Concise Narrative Review.

The delay or refusal of vaccination, which defines vaccine hesitancy, is a major challenge to successful control of COVID-19 epidemic. The huge number of publications addressing COVID-19 vaccine hesitancy necessitates periodic review to provide a concise summary of COVID-19 vaccine acceptance rates worldwide. In the current narrative review, data on COVID-19 vaccine acceptance rates were retrieved from surveys in 114 countries/territories. In East and Southern Africa (n = 9), the highest COVID-19 vaccine acceptance rate was reported in Ethiopia (92%), while the lowest rate was reported in Zimbabwe (50%). In West/Central Africa (n = 13), the highest rate was reported in Niger (93%), while the lowest rate was reported in Cameroon (15%). In Asia and the Pacific (n = 16), the highest rates were reported in Nepal and Vietnam (97%), while the lowest rate was reported in Hong Kong (42%). In Eastern Europe/Central Asia (n = 7), the highest rates were reported in Montenegro (69%) and Kazakhstan (64%), while the lowest rate was reported in Russia (30%). In Latin America and the Caribbean (n = 20), the highest rate was reported in Mexico (88%), while the lowest rate was reported in Haiti (43%). In the Middle East/North Africa (MENA, n = 22), the highest rate was reported in Tunisia (92%), while the lowest rate was reported in Iraq (13%). In Western/Central Europe and North America (n = 27), the highest rates were reported in Canada (91%) and Norway (89%), while the lowest rates were reported in Cyprus and Portugal (35%). COVID-19 vaccine acceptance rates ≥60% were seen in 72/114 countries/territories, compared to 42 countries/territories with rates between 13% and 59%. The phenomenon of COVID-19 vaccine hesitancy appeared more pronounced in the MENA, Europe and Central Asia, and Western/Central Africa. More studies are recommended in Africa, Eastern Europe and Central Asia to address intentions of the general public to get COVID-19 vaccination.

Demystifying Drought: Strategies to Enhance the Communication of a Complex Hazard

Abstract Drought is a complex phenomenon that is difficult to characterize and monitor. Accurate and timely communication is necessary to ensure that affected sectors and the public can respond and manage associated risks and impacts. To that end, myriad drought indicators, indices, and other tools have been developed and made available, but understanding and using this information can be a challenge for end users who are unfamiliar with the information or presentation or for decision-makers with expertise in areas outside of climate and drought. This article highlights a project that aimed to improve the usability and dissemination of drought information for North Carolina (NC) audiences by addressing specific needs for a better understanding of how drought is monitored, the climatic and environmental conditions that can cause or worsen drought, and the impacts occurring in NC’s different sectors and subregions. Conducted to support NC’s official, statewide drought monitoring process, the project’s methods and results have utility for other geographies and contexts. The project team designed an iterative process to engage users in the development, evaluation, refinement, and distribution of new resources. Featured products include the Weekly Drought Update infographic, which explains the factors used to determine NC’s drought status, and the Short-Range Outlook infographic, a synthesis of National Weather Service forecasts. Effective strategies included using stakeholders’ preferred and existing channels to disseminate products, emphasizing impacts relevant to different user groups (such as agriculture, forestry, and water resources) rather than indices, and employing concise narratives and visualizations to translate technical and scientific information.

Toward Data-Driven Optimal Control: A Systematic Review of the Landscape

This literature review extends and contributes to research on the development of data-driven optimal control. Previous reviews have documented the development of model-based and data-driven control in isolation and have not critically reviewed reinforcement learning approaches for adaptive data-driven optimal control frameworks. The presented review discusses the development of model-based to model-free adaptive controllers, highlighting the use of data in control frameworks. In data-driven control frameworks, reinforcement learning methods may be used to derive the optimal policy for dynamical systems. Attractive characteristics of these methods include not requiring a mathematical model of complex systems, their inherent adaptive control capabilities, being an unsupervised learning technique and their decision-making abilities, which are both an advantage and motivation behind this approach. This review considers previous reviews on these topics, including recent work on data-driven control methods. In addition, this review shows the use of data to derive system dynamics, determine the control policy using feedback information, and tune fixed controllers. Furthermore, the review summarises various data-driven methods and their corresponding characteristics. Finally, the review provides a taxonomy, a timeline and a concise narrative of the development of model-based to model-free data-driven adaptive control and underlines the limitations of these techniques due to the lack of theoretical analysis. Areas of further work include theoretical analysis on stability and robustness for data-driven control systems, explainability of black-box policy learning techniques and an evaluation of the impact of the extension of system simulators to include digital twins.

Perioperative management of severe brain injured patients.

Traumatic brain injury (TBI) is a leading cause of mortality and disability worldwide. Head injured patients may frequently require emergency neurosurgery. The perioperative TBI period is very important as many interventions done in this stage can have a profound effect on the long-term neurological outcome. This practical concise narrative review focused mainly on: 1) the management of severe TBI patients with neurosurgical lesions admitted to a spoke center (i.e. hospital without neurosurgery) and therefore needing a transfer to the hub center (i.e. hospital with neurosurgery); 2) the management of severe TBI patients with intracranial hypertension/brain herniation awaiting for neurosurgery; and 3) the neuromonitoring-oriented management in the immediate post-operative period. The proposals presented in this review mainly apply to severe TBI patients admitted to high-income countries.

The burden of sleep disordered breathing in children with sickle cell disease.

Children with sickle cell disease (SCD) have an increased risk of sleep disordered breathing (SDB) compared with the general pediatric population. There has been a growing research interest on this field in recent years, yet many questions regarding risk factors and clinical implications of SDB remain unclear. The aim of this review is to provide a concise narrative and systematic synthesis of the available evidence on the epidemiology, clinical presentation, complications, and management, of SDB in children with SCD. An electronic search was conducted on studies published from the 1st of January 2000 to the 31st of December 2020 in PubMed/Medline, Scopus, and Cochrane databases. All studies focusing on SDB in children with SCD aged from 0 to 20 years were included. Studies were eligible for inclusion if available in the English language. A quantitative synthesis of the included studies was performed. Only studies focusing on specific treatment outcomes were included in a meta-analytic process. A total of 190 papers were initially identified. After screening the title and abstract, 112 articles were evaluated for eligibility. At the end of the selection process, 62 studies were included in the analysis. Sleep disordered breathing is associated with worse neurological, neurocognitive, and cardiological outcomes, whereas the association with frequency or severity of vaso-occlusive pain events and acute chest syndrome was not clarified. Therapeutic interventions like adenotonsillectomy or oxygen supplementation may result in a significant increase in mean nocturnal oxygen saturation but effective clinical implications remain still unclear.

Congenital Aorto-Cardiac Connections (CACC) Revisited: Introduction of a Novel Anatomic-therapeutic Classification.

Abnormal congenital aorto-cardiac communications (CACC) are a heterogeneous constellation of anomalies that provide an abnormal connection between the aorta and other cardiac chambers or structures, including the atria, ventricles, the main pulmonary artery, and the coronary sinus. The current terminology of CACC has significant errors and shortcomings including inconsistent and interchangeable use of terms of fistula and tunnel and lack of an inclusive classification with practical information on therapeutic management. The aims of this study were threefold: firstly, to perform a concise narrative review of congenital pathologic connections between the aortic root and cardiac chambers which include rupture of congenital sinus of Valsalva aneurysm, aorto-left ventricular and less commonly right ventricular tunnels, coronary cameral fistulas, and aorto-atrial communications; secondly, to investigate the differentiating features of the so-called aorta right atrial tunnel (ARAT), with and without coronary artery take-off from the tunnel, and coronary cameral fistula (CCF) by applying a differential diagnostic assistance toolbox to two groups of patients with ARAT and CCF; and lastly, to propose a practical and inclusive anatomic-therapeutic classification for CACCs. The two main cornerstones of the proposed classification are the type of the connector between the aorta and cardiac chamber (hole versus passage) and the nature of the connecting passage ( anatomic versus extra-anatomic). We classified CACCs into three types. Depending on the intramural versus extramural course of the extra-anatomic connecting passage, type 3 is further subdivided into type 3A and type 3B.

Adrenal function/dysfunction in critically ill patients: a concise narrative review of recent novel insights.

The "fight or flight" response to critical illness relies on increased cortisol availability, traditionally attributed to several-fold-increased cortisol production via hypothalamus-pituitary-adrenal-axis activation. Recent studies provided evidence against this concept with clinical implications. First, high cortisol availability during critical illness is driven by suppressed cortisol binding and reduced cortisol breakdown rather than increased cortisol production. This implies reduction of hydrocortisone doses when prescribed in ICU. Second, plasma ACTH is low, explained by feedback inhibition by peripherally driven high free cortisol and/or other central glucocorticoid-receptor ligands. Third, ICU patients have elevated plasma concentrations of the ACTH-precursor hormone, pro-opiomelanocortin, because of impaired pituitary processing into ACTH, and pro-opiomelanocortin could drive some adrenocortical cortisol production in face of low ACTH. Fourth, in prolonged critically ill patients, endogenously suppressed ACTH, aggravated by exogenous corticosteroids, associates with poor outcome. In long-stay ICU patients, central adrenal insufficiency may occur due to lack of trophic ACTH signaling. Finally, the Cosyntropin test is not suitable to assess adrenocortical reserve in ICU patients as the test is confounded by increased cortisol distribution volume. These insights necessitate further research focusing on the need, if any, of treating ICU patients with corticosteroids, and timing thereof, outside indications for pharmacological anti-inflammatory drugs.

Utilizing Light Cure Units: A Concise Narrative Review.

The use of photo-curable resin composite restorations is an essential treatment modality in modern dental practice. The success and longevity of these restorations depend on achieving predictable and effective polymerization. Understanding the dynamics of the polymerization and the effect of light cure units (LCUs) on this process is paramount. The goal of this concise narrative review is to provide a simplified presentation of basic principles of composite chemistry, polymerization reactions, and photo-curing with relevant terminologies. Clinical guidelines for choosing and maintaining LCUs, as well as safety precautions and factors under the control of the clinician are listed. Finally, clinical recommendations of LCUs’ usage and monitoring are included to aid practitioners in achieving predictable polymerization during the placement of direct resin composite restorations.

Use of Glucocorticoids and Risk of Venous Thromboembolism: A Narrative Review.

Glucocorticoids are potent anti-inflammatory agents that are widely used for the treatment of many inflammatory, autoimmune, and neoplastic disorders. However, their beneficial effect is associated with several side effects, including an increased risk of cardiovascular complications, such as myocardial infarction and stroke. Whether their use also contributes to a procoagulant state, and therefore increases the risk of venous thromboembolism (VTE), is still a matter of debate. As an increased risk of venous thrombotic events is described in patients with Cushing's syndrome, which is characterized by endogenous hypercortisolism, it is reasonable to speculate that the chronic administration of glucocorticoids may induce a hypercoagulable state. However, it seems virtually impossible to separate the role of the drug from the underlying condition, which itself predisposes to the development of VTE. Actually, some evidence suggests that the use of exogenous glucocorticoids for the treatment of underlying disease and its exacerbations may further amplify the risk of VTE. Moreover, a procoagulant state has also been reported in healthy participants receiving oral glucocorticoids versus placebo. We have performed a concise narrative review on available data on the influence of exogenous glucocorticoids on hemostasis and their clinical impact on the risk of VTE.

Интертекстуальный план стихотворения Валерия Перелешина «Красные листья под инеем»

The purpose of this study is to examine the poetic text is the bright representative of the “Eastern branch” of Russian emigration (1920s–1940s) Valery Pereleshin, in his work associated with the perception of the image system “second Motherland”, China, and in the course of analysis to identify the uniqueness of the incarnation of the motives of the ancient Chinese pretext (in particular Du Mu) in a poem by Russian immigrant. The scientific novelty of the work consists in referring to the little-known texts of poets of the “Harbin-Shanghai” region, in an attempt to find ways to introduce Russian poets to the foreign cultural tradition. The results showed that the Russian poet-emigrant Pereleshin quite freely handles the Chinese pretext and departs from the imagery of a concise compressed narrative, characteristic of the Tang classic Du Mu. However, Russian literature brings rich imagery, additional poetic vividness, and an inner meaning close to the Russian mentality to Pereleshin’s original text.

HTX-011 (bupivacaine and meloxicam) for the prevention of postoperative pain -clinical considerations.

HTX-011 is an extended-release, dual-acting local anesthetic consisting of bupivacaine (sodium-channel blocker) and low-dose meloxicam (non-steroidal anti-inflammatory drug [NSAID]) applied needle-free during surgery. Introducing low-dose meloxicam addresses the limited efficacy of liposomal bupivacaine in acidic inflamed tissues and allows enhanced analgesic effects over three days. It has great promise to be an extremely effective postoperative pain regimen and produce an opioid-free surgical recovery, as it has consistently significantly reduced pain scores and opioid consumption through 72 h. This manuscript provides an updated, concise narrative review of the pharmacology, clinical efficacy, safety and tolerability of this drug and its applications to prevent postoperative pain.

Coronavirus disease 2019 (COVID-19) pathogenesis: a concise narrative review.

SARS-CoV-2 is the third zoonotic coronavirus. Since December 2019, it has spread through the globe and infects more than four million patients (as of May 10th, 2020). The disease was named coronavirus disease 2019 (COVID-19) by the World Health Organization (WHO). It involves many organs and systems in the human organism. We aimed to describe the pathogenesis of the COVID-19.

Beyond Antoni: A Surgeon's Guide to the Vestibular Schwannoma Microenvironment.

Introduction Vestibular schwannomas (VS) are histologically benign tumors arising from cranial nerve VIII. Far from a homogenous proliferation of Schwann cells, mounting evidence has highlighted the complex nature of the inflammatory microenvironment in these tumors. Methods A review of the literature pertaining to inflammation, inflammatory molecular pathways, and immune-related therapeutic targets in VS was performed. Relevant studies published up to June 2020 were identified based on a literature search in the PubMed and MEDLINE databases and the findings were synthesized into a concise narrative review of the topic. Results The VS microenvironment is characterized by a dense infiltrate of inflammatory cells, particularly macrophages. Significantly higher levels of immune cell infiltration are observed in growing versus static tumors, and there is a demonstrable interplay between inflammation and angiogenesis in growing VS. While further mechanistic studies are required to ascertain the exact role of inflammation in angiogenesis, tumor growth, and Schwann cell control, we are beginning to understand the key molecular pathways driving this inflammatory microenvironment, and how these processes can be monitored and targeted in vivo . Conclusion Observational research has revealed a complex and heterogeneous tumor microenvironment in VS. The functional landscape and roles of macrophages and other immune cells in the VS inflammatory infiltrate are, however, yet to be established. The antiangiogenic drug bevacizumab has shown the efficacy of targeted molecular therapies in VS and there is hope that agents targeting another major component of the VS microenvironment, inflammation, will also find a place in their future management.

Ageing, sex, obesity, smoking and COVID-19 - truths, myths and speculations.

In early December 2019, in the city of Wuhan in Hubei Province, China, the first infections by a novel coronavirus were reported. Since then, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has been spreading to other cities and countries becoming the global emerging epidemiological issue and quickly reaching the status of a pandemic. Multiple risk factors of disease severity and mortality have been identified so far. These include old age, male sex, smoking, and obesity. This concise narrative review highlights the important role of these factors in the pathobiology and clinical landscape of Coronavirus Disease 2019 (COVID-19). We especially focused on their significant role in disease severity and mortality. However, in spite of intensive research, most of the presented pieces of evidence are weak and need further verification.

Hallucinations in Older Adults: A Practical Review.

Older adults experience hallucinations in a variety of social, physical, and mental health contexts. Not everyone is open about these experiences, as hallucinations are surrounded with stigma. Hence, hallucinatory experiences in older individuals are often under-recognized. They are also commonly misunderstood by service providers, suggesting that there is significant scope for improvement in the training and practice of professionals working with this age group. The aim of the present article is to increase knowledge about hallucinations in older adults and provide a practical resource for the health and aged-care workforce. Specifically, we provide a concise narrative review and critique of (1) workforce competency and training issues, (2) assessment tools, and (3) current treatments and management guidelines. We conclude with a brief summary including suggestions for service and training providers and future research.

Life-Threatening Infectious Complications in Sickle Cell Disease: A Concise Narrative Review.

Sickle cell disease (SCD) results in chronic hemolytic anemia, recurrent vascular occlusion, insidious vital organ deterioration, early mortality, and diminished quality of life. Life-threatening acute physiologic crises may occur on a background of progressive diminishing vital organ function. Sickle hemoglobin polymerizes in the deoxygenated state, resulting in erythrocyte membrane deformation, vascular occlusion, and hemolysis. Vascular occlusion and increased blood viscosity results in functional asplenia and immune deficiency in early childhood, resulting in life-long increased susceptibility to serious bacterial infections. Infection remains a main cause of overall mortality in patients with SCD in low- and middle-income countries due to increased exposure to pathogens, increased co-morbidities such as malnutrition, lower vaccination rates, and diminished access to definitive care, including antibiotics and blood. Thus, the greatest gains in preventing infection-associated mortality can be achieved by addressing these factors for SCD patients in austere environments. In contrast, in high-income countries, perinatal diagnosis of SCD, antimicrobial prophylaxis, vaccination, aggressive use of antibiotics for febrile episodes, and the availability of contemporary critical care resources have resulted in a significant reduction in deaths from infection; however, chronic organ injury is problematic. All clinicians, regardless of their discipline, who assume the care of SCD patients must understand the importance of infectious disease as a contributor to death and disability. In this concise narrative review, we summarize the data that describes the importance of infectious diseases as a contributor to death and disability in SCD and discuss pathophysiology, prevalent organisms, prevention, management of acute episodes of critical illness, and ongoing care.