bluuebunny/crossref_metadata_2025 huggingface dataset:
Journey of ethics – Conducting collaborative research with people with dementia
Authors: Thoft Diana Schack , Ward Alison , Youell Jane
Published: April 2020

This paper explores some of the ethical considerations of working collaboratively with people with dementia within research based upon the experiences, challenges and learning from three doctoral research studies. Focus is on the research relationship with participants and gatekeepers, the importance of setting and access, the power relations within the research and ways in which people with dementia can be supported to be active and have a voice in research. This sits within an ethical framework of principalist ethics and ethics of care to guide not only how research is planned ethically and with consideration of participants, but also how this can support decisions made in situ. The aim is to share, based upon these three studies, ways of managing and working through some of the ethical consideration to support researchers in their decisions in planning and conducting research with people with dementia as active collaborators.
Preliminary Findings on Self-Reported Voice Disorders in Urban Ghana: A Qualitative Description Study
Authors: Amponsah Clement , Tettevi Godwin , Gomado Leticia , Heitzman Alicia , Ziegler Aaron
Published: April 2020

This preliminary qualitative description study explored knowledge from urban Ghanaians about the nature and impact of their self-reported voice problem. Ten Ghanaians were screened for a self-reported voice disorder using the Voice Handicap Index–10 (VHI-10), and they also completed a structured interview with a speech-language therapist. Content analysis was completed from interview responses using quantification of data. Four out of 10 adult Ghanaians demonstrated high VHI-10 scores that indicated a self-reported voice disorder. Themes that emerged included a recurring problem with voice, multiple vocal impairments, limitations with participating in vocal activities, and other health problems. Lack of financial resources and little knowledge about voice disorders were barriers to accessing care. In summary, four adult Ghanaians with a self-reported voice disorder described multiple problems with their voice, limiting their participation in vocal activities. Implications of these preliminary findings include early identification and improving voice care access to avoid handicapping voice problems.
A multiple genomic data fused SF2 prediction model, signature identification, and gene regulatory network inference for personalized radiotherapy
Authors: He Qi-en , Tong Yi-fan , Ye Zhou , Gao Li-xia , Zhang Yi-zhi , Wang Ling , Song Kai
Published: April 2020

Radiotherapy is one of the most important cancer treatments, but its response varies greatly among individual patients. Therefore, the prediction of radiosensitivity, identification of potential signature genes, and inference of their regulatory networks are important for clinical and oncological reasons. Here, we proposed a novel multiple genomic fused partial least squares deep regression method to simultaneously analyze multi-genomic data. Using 60 National Cancer Institute cell lines as examples, we aimed to identify signature genes by optimizing the radiosensitivity prediction model and uncovering regulatory relationships. A total of 113 signature genes were selected from more than 20,000 genes. The root mean square error of the model was only 0.0025, which was much lower than previously published results, suggesting that our method can predict radiosensitivity with the highest accuracy. Additionally, our regulatory network analysis identified 24 highly important ‘hub’ genes. The data analysis workflow we propose provides a unified and computational framework to harness the full potential of large-scale integrated cancer genomic data for integrative signature discovery. Furthermore, the regression model, signature genes, and their regulatory network should provide a reliable quantitative reference for optimizing personalized treatment options, and may aid our understanding of cancer progress mechanisms.
KRT6A Promotes EMT and Cancer Stem Cell Transformation in Lung Adenocarcinoma
Authors: Yang Bin , Zhang Wei , Zhang Mengmeng , Wang Xuhong , Peng Shengzu , Zhang Rongsheng
Published: April 2020

Aim:

Keratin 6A is a type II cytokeratin which is important in forming nail bed, filiform papillae, the epithelial lining of oral mucosa, and esophagus; recently, keratin 6A was found hyperexpressed in different types of cancer. But, the biological function of keratin 6A in lung adenocarcinoma still remains unclear. Therefore, in current study, we investigated the biological role of keratin 6A in lung adenocarcinoma.

Methods:

By utilizing The Cancer Genome Atlas database, we investigated the expression profile of keratin 6A and its relationship with other clinical parameters in lung adenocarcinoma. The biological function of keratin 6A in lung adenocarcinoma was also investigated by using A549 and PC-9 lung cancer cell lines in vitro.

Results:

Our data indicate that, compared with normal lung tissue samples, keratin 6A was hyperexpressed in lung adenocarcinoma. Moreover, keratin 6A hyperexpression was positively correlated with lymph node positive and aggressive tumor T stage. Keratin 6A knockdown inhibited the cell proliferation, migration, and colony formation ability but not cell death in lung adenocarcinoma cells. In addition, we found keratin 6A exerted its phenotype via promoting cancer stem cells (CXCR4high/CD133high) transformation and epithelial–mesenchymal transition.

Conclusion:

In conclusion, current study suggests that hyperexpressed keratin 6A in lung adenocarcinoma promotes lung cancer proliferation and metastasis via epithelial–mesenchymal transition and cancer stem cells transformation.
Relationships and interactions between school owners and school principals: A case study of a Norwegian school district programme
Authors: Forfang Hilde
Published: April 2020

The literature has revealed that high-performing districts establish collaborative working relations with school leaders as a part of the strategy to improve student achievement. This study was designed to investigate the relationships and interactions that school owners and principals in municipalities with high-performing school results employ at the district level in a part of rural Norway. The district subjected to the study was characterized by small municipalities with a few school administrative units, which can be a challenging context for school owners’ involvement and interaction with principals. The research design involved a collective case study and draws on data from surveys, interviews and local school policy documents. The findings suggest that the proximity between neighbouring professional actors seems to be important, and that rural school district actors should build systemic competence and a purposefully tailored infrastructure to reinforce interactions and relationships with the subordinated principals. Further, the findings highlight the advantage of collaborative governance across municipal boundaries and the significance of a trust-based professional network for inter-organizational learning to flourish.
Mechanisms of action of acute and subacute sphenopalatine ganglion stimulation for ischemic stroke
Authors: Hosseini Mersedeh Bahr , Saver Jeffrey L
Published: April 2020

Background

Sphenopalatine ganglion stimulation (SPG-Stim) for ischemic stroke, starting 8–24 h after onset and continuing through five days in a pooled analysis of two recent, randomized, sham-controlled trials, improved outcome of acute ischemic stroke patients with confirmed cortical involvement. As a neuromodulatory therapy, SPG-Stim differs substantially from existing pharmacologic (lytic and antiplatelets) and device (endovascular thrombectomy) acute ischemic stroke treatments.

Aim

Focused review of SPG anatomy, physiology, and neurovascular and neurobiologic mechanisms of action mediating benefit of SPG-Stim in acute ischemic stroke.

Summary of review

Located posterior to the maxillary sinus, the SPG is the main source of parasympathetic innervation to the anterior circulation. Preclinical and human studies delineate four distinct mechanisms of action by which the SPG-Stim may confer benefit in acute ischemic stroke: (1) collateral vasodilation and enhanced cerebral blood flow, mediated by release of neurotransmitters with vasodilatory effects, nitric oxide, and acetylcholine, (2) stimulation frequency- and intensity-dependent stabilization of the blood–brain barrier, reducing edema (3) direct acute neuroprotection from activation of the central cholinergic system with resulting anti-inflammatory, anti-apoptotic, and anti-excitatory effects; and (4) neuroplasticity enhancement from enhanced central cholinergic and adrenergic neuromodulation of cortical networks and nitrous oxide release stimulating neurogenesis.

Conclusion

The benefit of SPG-Stim in acute ischemic stroke is likely conferred not only by potent collateral augmentation, but also blood–barrier stabilization, direct neuroprotection, and neuroplasticity enhancement. Further studies clarifying the relative contribution of these mechanisms and the stimulation protocols that maximize each may help optimize SPG-Stim as a therapy for acute ischemic stroke.
Pre-existing Comorbidity Burden and Patient Perceived Stroke Impact
Authors: Sewell Katherine , Tse Tamara , Harris Elizabeth , Matyas Thomas , Churilov Leonid , Ma Henry , Davis Stephen M , Donnan Geoffrey A , Carey Leeanne M
Published: April 2020

Background

Pre-existing comorbidities can compromise recovery post-stroke. However, the association between comorbidity burden and patient-rated perceived impact has not been systematically investigated. To date, only observer-rated outcome measures of function, disability, and dependence have been used, despite the complexity of the impact of stroke on an individual.

Aim

Our aim was to explore the association between comorbidity burden and patient-rated perceived impact and overall recovery, within the first-year post-stroke, after adjusting for stroke severity, age, and sex.

Methods

The sample comprised 177 stroke survivors from 18 hospitals throughout Australia and New Zealand. Comorbidity burden was calculated using the Charlson Comorbidity Index. Perceived impact and recovery were measured by the Stroke Impact Scale index and Stroke Impact Scale overall recovery scale. Quantile regression models were applied to investigate the association between comorbidity burden and perceived impact and recovery.

Results

Significant negative associations between the Charlson Comorbidity Index and the Stroke Impact Scale index were found at three months. At the .25 quantile, a one-point increase on the Charlson Comorbidity Index was associated with 6.80-points decrease on the Stroke Impact Scale index (95%CI: −11.26, −2.34; p = .003). At the median and .75 quantile, a one-point increase on the Charlson Comorbidity Index was associated, respectively, with 3.58-points decrease (95%CI: −5.62, −1.54; p = .001) and 1.76-points decrease (95%CI: −2.80, −0.73; p = .001) on the Stroke Impact Scale index. At 12 months, at the .25 and .75 quantiles, a one-point increase on the Charlson Comorbidity Index was associated, respectively, with 6.47-points decrease (95%CI: −11.05, −1.89; p = .006) and 1.26-points decrease (95%CI: −2.11, −0.42; p = .004) on the Stroke Impact Scale index. For the Stroke Impact Scale overall recovery measure, significant negative associations were found only at the median at three months and at the .75 quantile at 12 months.

Conclusion

Comorbidity burden is independently associated with patient-rated perceived impact within the first-year post-stroke. The addition of patient-rated impact measures in personalized rehabilitation may enhance the use of conventional observer-rated outcome measures.
Eastern others: Homonationalism in the Flemish press
Authors: Dhoest Alexander
Published: April 2020

Jasbir Puar introduced the notion of ‘homonationalism’ to describe the increasing acceptance of sexual minorities in Western nations, leading to their incorporation in the national in-group which is increasingly opposed to homophobic ‘others’. While Muslims constitute the main out-group, other groups and nations are also targeted, in particular Russia and related countries in Central and Eastern Europe. Such discourses create a binary opposition between two homogenized parties, the uniformly LGBTQ-friendly in-group versus the uniformly homophobic ‘other’. While the literature on homonationalism mostly discusses politics in the U.S. and a number of other nation-states, this article explores homonationalism in a smaller sub-national region in Western Europe, Flanders, focusing on the press as a tool for spreading homonationalist discourse. Exploring three months of Flemish newspapers, this article identifies some instances of explicit homonationalism but more implicit homonationalism which does not explicitly mention the in-group but does paint a one-sided picture of Russia and related countries as homophobic.
Bicortical versus unicortical fixation of plated clavicular fractures: A biomechanical study
Authors: Zaidenberg Ezequiel E , Voor Michael , Pereira Enrique , Rossi Luciano A , Zaidenberg Carlos R
Published: April 2020

Purpose

To compare the biomechanical properties of three plate stabilization techniques for midshaft clavicle fractures: anatomical bicortical locking construct, anatomical unicortical locking construct, and reconstruction bicortical locking construct.

Methods

We analyzed superior plating of the clavicle using an anatomical clavicle plate (Acumed) with both bicortical or unicortical screw fixation and a locking reconstruction plate (DePuy-Synthes). Twenty-one fourth generation composite clavicles were used for non-destructive stiffness testing in axial loading, bending, and torsion. Fifteen composite clavicles and 17 foam clavicles were used for cyclic failure testing using a combined loading method that included all three loading modes.

Results

No significant differences were found between the three constructs in torsional stiffness nor in vertical bending loading. In axial loading, the anatomical bicortical locking construct was significantly stiffer than either anatomical unicortical locking construct or the reconstruction bicortical locking construct. The unicortical fixation was also significantly stiffer than the reconstruction bicortical locking construct. Regarding failure testing, there was not a significant difference between the bicortical and unicortical anatomical locking constructs; however, both were significantly stronger than bicortical screw fixation in the reconstruction plate.

Conclusion

Based on the biomechanical performance of these constructs, unicortical locked plate fixation may be a reasonable option in the treatment of displaced midshaft clavicle fracture fixation.
Comfortably Numb in the Midst of the Corona Crisis
Authors: Czarnocki Jan , Larue Theo
Published: April 2020

The coronavirus has taken the West by surprise. It has called into question basic assumptions about globalisation, how our society is organised, how safe we actually are and to what extent we control the world around us. The virus arrived when we were without the proper conceptual framework to deal with a new type of virus, and we could not have imagined how much of a social challenge it would represent. The novelty of the situation has made most of us feel strangely confused, numb and calm, and in many cases has left us not knowing what to do with ourselves. This satirical review seeks to put some distance and detachment between us and the situation and give us an outside perspective of what the corona crisis can teach us, both at the individual and social levels. Before the situation becomes the ‘new normal’, we should take the time to extract some lessons from this mess.
Clinical Recommendations for Managing the Impact of Insulin Adsorptive Loss in Hospital and Diabetes Care
Authors: Knopp Jennifer L. , Chase J. Geoffrey
Published: April 2020

Background:

Adsorption of insulin to infusion sets impacts patient therapeutic outcomes and, unaccounted for, may exacerbate persistent hyperglycemia or result in therapy-induced hypoglycemia. This article aims to provide recommendations for clinicians involved in intensive care and/or outpatient pump therapy contexts.

Methods:

A dynamic adsorption model is used to evaluate time-varying insulin concentration in the infusion set outflow. Hourly and daily percentage insulin loss to adsorption is examined for neonatal, pediatric, and adult intensive care patients, as well as outpatient children and adults weighing 30, 50, and 80 kg. A short review of preconditioning methods is included.

Results:

Insulin adsorption in outpatient pump therapy is most pronounced in the first hour, where as much as 80% of the intended insulin dose may be lost to adsorption. Subsequently, insulin adsorptive loss is typically negligible. Overall, extra care should be taken in the first 1-6 h of a new infusion set, particularly in children or teenagers. Typically, insulin adsorption in the adult intensive care unit is negligible unless infused at low flow rates (<2 mL/h). Insulin adsorption is significant in pediatric and neonatal intensive care, resulting in delivery concentrations as low as 5%-50% of that intended. Thus, it is recommended that preconditioning of insulin delivery lines be carried out prior to infusion initiation in this context. However, no preconditioning method completely removes adsorption, and care should still be taken in the first 1-6 h of insulin dosing.

Conclusions:

Recommendations made in this article are dependent on the insulin concentration and flow rate used in each clinical context.
Anti-inflammatory Effect of d-(+)-Cycloserine Through Inhibition of NF-κB and MAPK Signaling Pathways in LPS-Induced RAW 264.7 Macrophages
Authors: Kang Hyun-Kyu , Hyun Chang-Gu
Published: April 2020

Recently, additional therapeutic potentials of classical antibiotics are gaining considerable attention. The discovery of penicillin in the 1920s had a major impact on the history of human health. Penicillin has been used for the treatment for fatal microbial infections in humans and has led to the discovery of several new antibiotics. d-(+)-Cycloserine (DCS) is an antibiotic isolated from Streptomyces orchidaceous and is used in conjunction with other drugs in the treatment of tuberculosis. However, there have been no studies on the anti-inflammatory effects of DCS in RAW 264.7 macrophage cell line. To investigate the anti-inflammatory effects of DCS, we examined the ability of DCS to inhibit the inflammatory responses in lipopolysaccharide (LPS)-induced RAW 264.7 macrophages in this study. Cell viability was analyzed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The cells were pretreated with various concentrations (2, 4, and 6 mM) of DCS, then treated with 1 μg/mL LPS to detect its anti-inflammatory effects. d-(+)-Cycloserine inhibited the production of nitric oxide (NO) in a concentration-dependent manner, and to some extent, inhibited the production of prostaglandin E2. Consistent with these findings, DCS suppressed the expression of pro-inflammatory cytokines such as interleukin (IL)-1β and IL-6. However, it had no effect on the expression of tumor necrosis factor-α. Western blot analysis demonstrated that DCS inhibited inducible nitric oxide synthase and suppressed cyclooxygenase type-2 (COX-2) expression. In addition, investigation of its effects on nuclear factor kappa B signaling showed that DCS inhibited phosphorylation of inhibitory kappa B-α (IκB-α) and increased intracellular IκB-α in a concentration-dependent manner. Furthermore, DCS inhibited the phosphorylation of LPS-induced extracellular signal-regulated kinase, however it did not affect phosphorylation of c-jun N-terminal kinase and p38. Further studies confirmed that the inhibition of phosphorylation of IκB-α was mediated through the inhibition of phosphoinositide 3-kinase/Akt (PI3K/Akt) pathway. To determine the applicability of DCS to the skin, cytotoxicity on HaCaT keratinocytes was measured following treatment with various concentrations (2, 4, 6, 8, and 10 mM) of DCS using MTT assay. These results suggest that DCS may be used as a potential drug for the treatment of inflammatory diseases.
Prevalence of Allergic Rhinitis and Associated Risk Factors in 6 to 12 Years Schoolchildren From Wuhan in Central China: A Cross-sectional Study
Authors: Tong Huan , Gao Ling , Deng Yuqin , Kong Yonggang , Xiang Rong , Tan Lu , Tao Zezhang , Xu Yu
Published: April 2020

Background

Over the past decade, the prevalence of allergic rhinitis (AR) in China increased and showed a trend of younger age. The clinical features of AR in primary schoolchildren are still not clear enough.

Objective

To investigate the prevalence and epidemiological characteristics of AR among 6- to 12-year-old children in the central region of China.

Methods

Children from 6 primary schools were randomly selected from urban area of Wuhan, which lies in the central region of China. The questionnaires were distributed by mobile APP and filled out by the children and their parents online together. AR was diagnosed by Score for Allergic Rhinitis. Logistic regression analysis was performed to assess the risk factors for AR.

Results

A total of 5550 valid questionnaires were returned for evaluation. The prevalence of AR among 6- to 12-year-old children in urban area of Wuhan was 28.6%. Multivariate analysis revealed that male (odds ratio [OR] = 1.521, 95% confidence interval [CI] = [1.335, 1.732]), family history of atopy (OR = 3.220, 95% CI = [2.818, 3.681]), previous food allergy (OR = 1.590, 95% CI = [1.302, 1.942]), air purifier (OR = 1.420, 95% CI = [1.240, 1.625]), exposure to dust (OR = 1.764, 95% CI = [1.410, 2.207]), maternal exposure to smoke during pregnancy (OR = 1.242, 95% CI = [1.047, 1.473]), living in towns (OR = 1.468, 95% CI = [1.043, 2.006]) or metropolis (OR = 1.629, 95% CI = [1.205, 2.201]) before 2 years old, frequent application of antibiotics are risk factors for AR, while daily outdoor time for more than 1 hour (OR = 0.770, 95% CI = [0.673, 0.881]) and breastfeeding for more than 6 months (OR = 0.799, 95% CI = [0.701, 0.910]) reduced the risk significantly.

Conclusions

We found an unexpectedly high prevalence of AR among primary schoolchildren aged 6 to 12 years in the central region of China. Both genetic and environmental factors were associated with the development of AR.
The trainer, the verifier, the imitator: Three ways in which human platform workers support artificial intelligence
Authors: Tubaro Paola , Casilli Antonio A , Coville Marion
Published: April 2020

This paper sheds light on the role of digital platform labour in the development of today’s artificial intelligence, predicated on data-intensive machine learning algorithms. Focus is on the specific ways in which outsourcing of data tasks to myriad ‘micro-workers’, recruited and managed through specialized platforms, powers virtual assistants, self-driving vehicles and connected objects. Using qualitative data from multiple sources, we show that micro-work performs a variety of functions, between three poles that we label, respectively, ‘artificial intelligence preparation’, ‘artificial intelligence verification’ and ‘artificial intelligence impersonation’. Because of the wide scope of application of micro-work, it is a structural component of contemporary artificial intelligence production processes – not an ephemeral form of support that may vanish once the technology reaches maturity stage. Through the lens of micro-work, we prefigure the policy implications of a future in which data technologies do not replace human workforce but imply its marginalization and precariousness.
You Set Me Up: Gendered Perceptions of Twitter Communication Among Black Chicago Youth
Authors: Patton Desmond Upton , Stevens Robin , Smith Lee Jocelyn R. , Eya Grace-Cecile , Frey William
Published: April 2020

We sought to identify the key dynamics in the relationship between social media and violence by identifying new mechanisms that elucidate how Internet banging becomes offline violence through the perceptions of the Black and Latino boys and men. We conducted 33 interviews with Black and Latino boys and men aged 14–24 who live in Chicago, have experience with gang violence, and are social media users. In our investigation of the use of social media by boys and young men to navigate neighborhood violence, we uncovered a recurring narrative about gender relationships in violence. Male participants often attributed escalations of violence to girls and young women, beginning with online communications that migrated to face-to-face meetings. They described girls and young women as the precipitators of violence through “set-up” meetings that began under the guise of romance, dating, and courtship. This study provides an in-depth examination of how males perceive girls and young women as unique threats to their personal safety, a narrative we must engage with in order to further current violence prevention efforts. Future research is needed to examine the lived experiences of young women, their experience with and exposure to social media-related gang violence, and their view of social media behaviors of men that may lead to violence.
Sliding or Nonsliding Arthroscopic Knots for Shoulder Surgery: A Systematic Review
Authors: Morrissey Caellagh D. , Houck Darby A. , Jang Esther , McCarty Eric C. , Bravman Jonathan T. , Seidl Adam J. , Wolcott Michelle L. , Vidal Armando F. , Frank Rachel M.
Published: April 2020

Background:

Knot tying is a crucial component of successful arthroscopic shoulder surgery. It is currently unknown whether sliding or nonsliding techniques result in superior clinical outcomes.

Purpose:

To assess the clinical outcomes of arthroscopic sliding knot (SK)– versus nonsliding knot (NSK)–tying techniques during arthroscopic shoulder surgery, including rotator cuff repair, Bankart repair, and superior labral anterior-posterior (SLAP) repair.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A systematic search of the PubMed, Embase, and Cochrane Library databases was performed using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. All English-language literature published between 2000 and 2018 reporting clinical outcomes utilizing SK- or NSK-tying techniques during rotator cuff repair, Bankart repair, and SLAP repair with a minimum 24-month follow-up was reviewed by 2 independent reviewers. Information on type of surgery, knot used, failure rate, patient satisfaction, and patient-reported outcomes was collected. Patient-reported outcome measures included the Constant-Murley score, Rowe score, and visual analog scale for pain. Study quality was evaluated using the modified Coleman Methodology Score.

Results:

Overall, 9 studies (6 level 3 and 3 level 4) with a total of 671 patients (mean age, 52.8 years [range, 16-86 years]; 65.7% male; 206 SK and 465 NSK) were included. There were 4 studies that reported on Bankart repair in 148 patients (63 SK and 85 NSK), 3 on SLAP repair in 59 patients (59 SK), and 2 on rotator cuff repair in 464 patients (84 SK and 380 NSK). Also, 6 studies compared knot-tying with knotless techniques (3 Bankart repair studies and 3 SLAP repair studies), while the studies reporting the outcomes of SLAP repair evaluated SK-tying techniques only. The failure rate for Bankart repair was 3.2% (2/63) for SKs and 4.7% (4/85) for NSKs. The failure rate for rotator cuff repair was 2.4% (2/84) for SKs and 6.3% (24/380) for NSKs. The failure rate for SLAP repair was 11.9% (7/59). Because of inconsistencies in outcomes and procedures, no quantitative analysis was possible. The mean modified Coleman Methodology Score for all studies was 65.1 ± 8.77, indicating adequate methodology.

Conclusion:

The literature on clinical outcomes using SKs or NSKs for shoulder procedures is limited to level 4 evidence. Future studies should be prospective and focus on comparing the use of SKs and NSKs for shoulder procedures to elucidate which arthroscopic knot results in superior clinical outcomes.
Early Return to Play After Intramedullary Screw Fixation of Acute Jones Fractures in Collegiate Athletes: 22-Year Experience
Authors: Watson Scott , Trammell Amy , Tanner Stephanie , Martin Steven , Bowman Larry
Published: April 2020

Background:

There is disagreement among team physicians, without conclusive evidence, as to when high-level athletes with a Jones fracture should be allowed to return to play after being treated operatively with an intramedullary screw.

Purpose:

To report our experience of early return to sport in collegiate athletes after intramedullary screw fixation of Jones fractures.

Study Design:

Case series; Level of evidence, 4.

Methods:

We identified all collegiate athletes with an acute fracture at the base of the fifth metatarsal treated by 1 of 2 orthopaedic surgeons with intramedullary screw fixation over a 22-year period (1994-2015), and we performed a retrospective review of their records. Fixation consisted of a single intramedullary screw. Athletes were allowed to bear weight as tolerated in a walking boot immediately postoperatively and return to play as soon as they could tolerate activity. Patients were contacted to complete patient-reported outcome scores that included the Foot and Ankle Ability Measure (FAAM) score, a brief survey specific to our study, and follow-up radiographs.

Results:

A total of 26 acute Jones fractures were treated in 25 collegiate athletes (mean age, 20 years; range, 18-23 years). Overall, the athletes returned to play at an average of 3.6 weeks (range, 1.5-6 weeks). Three screws were removed for symptomatic skin irritation. There was 1 refracture after screw removal that was done after radiographic and clinical documentation of fracture union, which was treated with repeat cannulated percutaneous screw fixation. One screw was observed on radiographs to be broken at 1 year postoperatively, but the fracture was healed and the athlete was playing National Collegiate Athletic Association Division I sports without symptoms and continued to play professionally without symptoms. Of 25 athletes, 19 completed the FAAM at an average follow-up of 8.6 years (range, 1.5-20.0 years). They reported scores of 94.9% (range, 70.2%-100%) for the activities of daily living subscale and 89.1% (range, 42.9%-100%) for the sports subscale. Follow-up radiographs were obtained, and no nonunion, malunion, or additional hardware complications were identified.

Conclusion:

Athletes with acute Jones fractures can safely be allowed to return to play after intramedullary screw fixation as soon as their symptoms allow, without significant complications. In our experience, this is usually within 4 weeks from injury.
Dental Care and Oral Health under the Clouds of COVID-19
Authors: Ren Y.F. , Rasubala L. , Malmstrom H. , Eliav E.
Published: April 2020

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused much anxiety and confusion in the community and affected the delivery of vital health care services, including dental care. We reviewed current evidence related to the impact of SARS-CoV-2/COVID-19 on dental care and oral health with the aim to help dental professionals better understand the risks of disease transmission in dental settings, strengthen protection against nosocomial infections, and identify areas of COVID-19–related oral health research. When compared with other recent pandemics, COVID-19 is less severe but spreads more easily, causing a significantly higher number of deaths worldwide. Protection of dental patients and staff during COVID-19 is challenging due to the existence of patients who are infectious yet asymptomatic. Dental professionals are ill prepared for the pandemic, as they are not routinely fitted for the N95 respirators now required for preventing contagion during dental treatments. Biological and clinical evidence supports that oral mucosa is an initial site of entry for SARS-CoV-2 and that oral symptoms, including loss of taste/smell and dry mouth, might be early symptoms of COVID-19, presenting before fever, dry cough, fatigue, shortness breath, and other typical symptoms. Oral health researchers may play a more active role in early identification and diagnosis of the disease through deciphering the mechanisms of dry mouth and loss of taste in patients with COVID-19. Rapid testing for infectious diseases in dental offices via saliva samples may be valuable in the early identification of infected patients and in disease progress assessment.

Knowledge Transfer Statement:

This commentary provides a timely evidence-based overview on the impact of COVID-19 on dental care and oral health and identifies gaps in protection of patients and staff in dental settings. Oral symptoms are prominent before fever and cough occur. Dental professionals may play an important role in early identification and diagnosis of patients with COVID-19.
Hypersexuality in a Bangladeshi Female: A Case Report
Authors: Arafat S. M. Yasir , Kar Sujita Kumar
Published: April 2020

Hypersexuality has been a debated disorder, which has not been able to secure its place into the classificatory systems. This article was aimed to report a female with hypersexuality in Bangladesh. Mrs X, a 20-year-old married lady, presented with the complaints of irritability, low mood, sleep disturbances for last one month. As per Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria and mental state examination findings, she was labeled as a case of major depressive disorder and borderline personality disorder. Her early childhood was uneventful, and she got married 2 years back after having a love relationship with the person. Immediately after her marriage, she was used to enjoy sex for 5 to 6 hours daily as she used to enjoy 5 to 6 orgasms per day. The couple enjoyed their sex daily, even the in the days of menstruation. For last one year her husband stopped daily intercourses as well as the duration of the intercourses was also decreased below 1 hour. Subsequently, the lady felt disturbances and used to demand sex more time as well as orgasms daily. She used to consume pornography, masturbate, and started extramarital relationship for sexual activity. She enjoys her persistent thoughts, fantasies regarding sex; however, she became frustrated when she was not getting expected duration and expected number of orgasms. She asked her husband to divorce her as he was not being able to have intercourses for 5 to 6 hours daily. This is the first reported case of hypersexuality in a sexually conservative country like Bangladesh which may open the whole hidden problem.
Marital Satisfaction and Satisfaction With Life: Mediating Role of Sexual Satisfaction in Married Women
Authors: Bilal Ahmad , Rasool Samina
Published: April 2020

Background: Marital satisfaction is an integral part of the life of Pakistani women. Married women cannot get satisfied with their lives without marital satisfaction. But previous studies hint at the possible role of sexual satisfaction in addition to marital satisfaction to bring about overall satisfaction with life in married women.

Aims: This study was designed with an objective to assess the mediating role of sexual satisfaction in marital satisfaction as a predictor and satisfaction with life as an outcome in married Pakistani women. Previous studies have demonstrated a possible link among marital satisfaction, sexual satisfaction, and satisfaction with life.

Settings and Design: One hundred married women of childbearing age (18-48 years, M = 29 years) were recruited by a convenient sampling method from the three hospitals of Bahawalpur in the South Punjab state of Pakistan.

Methods and Material: Three questionnaires (a) Kansas Marital Satisfaction Scale; (b) Index of Sexual Satisfaction, and (c) Satisfaction with Life Scale, were administered to collect the data.

Statistical Analysis: The results were analyzed by the Statistical Package for the Social Sciences (IBM, USA), version 25, and Process Macro, version 3.4, and expressed in the form of descriptive statistics (mean, standard deviation, and frequencies), mediation analysis, analysis of co-variance, analysis of variance and t test.

Results and Conclusion: The unstandardized indirect effects yielded a significant mediation (IE = 0.4757, SE = 0.1786, P < .05, LL = 0.1736, UL = 0.8681). The sexual satisfaction fully mediated the relationship between marital satisfaction and satisfaction with life in married women. It was concluded that married women cannot get marital satisfaction and satisfaction with life without a satisfied sexual life.
Female Sexual Dysfunction and Schizophrenia: A Clinical Review
Authors: Lodha Pragya , Sousa1, Avinash De
Published: April 2020

Female sexual dysfunction (FSD) is understudied and unexplored in clinical practice. There is a need for psychiatrists to acknowledge the same and explore this symptom in patients with schizophrenia. The following article is a clinical review that looks at various facets of FSD in relation to schizophrenia. The various types of FSD seen in schizophrenia are elaborated and factors that affect the same are discussed. The role of various factors and antipsychotic-induced FSD is also discussed. The role of estrogens in women with schizophrenia from a clinical and sexual perspective, the role of oral contraceptives in schizophrenia, schizophrenia and pregnancy related complications along with menopause, and its effect on schizophrenia and sexual function in these patients are discussed. The neurobiology of FSD is explored briefly along with the role of female sexuality in recovery and enhancing outcome in schizophrenia is also elaborated. The victimization of female patients with schizophrenia and future research needs in FSD in schizophrenia are laid out.
What Do We Know About LGBTQIA+ Mental Health in India? A Review of Research From 2009 to 2019
Authors: Wandrekar Jagruti R. , Nigudkar Advaita S.
Published: April 2020

Background: The period from 2009 to 2019 has seen a lot of conversation about issues of LGBTQIA+ (lesbian, gay, bisexual, transgender, queer/ questioning, intersex, asexual, and others) individuals in India, but they continue to be a group showing poor health equity.

Objective: This descriptive content review attempted to explore 5 questions: what is the nature of existing research on mental health of LGBTQIA+ individuals, what are the pathways that contribute to mental health issues, whether the existing health facilities mitigate or facilitate these pathways, what are the interventions proposed for this group, and what are the gaps in research that can be addressed in the next decade.

Method: “Mental health aspects” were described as variables relevant to understanding individuals’ cognitions, emotions, and behavior. We searched for literature in online journal databases, in archives of the most prominent journals, on websites of prominent LGBTQIA+ organizations, and through cross-referencing of papers obtained. The data were abstracted and coded into themes and subthemes. We found 22 reviews and reports, 4 viewpoints and comments, 7 editorials, 1 conference proceeding, and 60 original articles.

Conclusions: Prevalence studies reveal that LGBTQIA+ individuals were found to show high rates of mental health concerns, and that the adapted minority stress model may be a crucial pathway for the same. Lived experiences, factors related to mental well-being, and societal attitudes have also been studied. Intervention studies are relatively fewer, and certain subgroups of LGBTQIA+ identities are less represented in research. Gaps in research were identified and recommendations for research in the coming decade were proposed.
Sexual Dysfunction and Marital Relationship in Women With Schizophrenia in Comparison with Caregivers: A Hospital-based Study
Authors: Kantipudi Suvarna Jyothi , Suresh Navina , Ayyadurai Poornima , Ramanathan Sathianathan
Published: April 2020

Background: Sexual dysfunction is common in females with schizophrenia and is attributed to multiple causes, including individual psychopathology and antipsychotics. Understanding the impact of relationship satisfaction on sexual functioning is not widely studied in schizophrenia. Women caregivers also experience sexual problems and were not studied in the past.

Aim: To assess the nature and occurrence of sexual dysfunction in women with schizophrenia in comparison to caregivers of males without severe mental disorder.

Methods: A cross-sectional study was conducted. A total of 30 women with schizophrenia were recruited as cases and 26 age-matched controls were recruited from female caregivers. All subjects were assessed using standardized tools such as Female Sexual Function Index (FSFI) and Relationship Assessment Scale along with sociodemographic questionnaire.

Results: There was a significant difference in FSFI scores and relationship scores between women with schizophrenia and caregiver control subjects. The relationship quality was better in patients with schizophrenia when compared to caregivers unlike sexual functioning.

Conclusion: Sexual functioning in women is a complex phenomenon. A holistic biopsychosocial approach is necessary to understand women’s sexual function.
Eltrombopag for patients with moderate aplastic anemia or uni-lineage cytopenias
Authors: Fan Xing , Desmond Ronan , Winkler Thomas , Young David J. , Dumitriu Bogdan , Townsley Danielle M. , Gutierrez-Rodrigues Fernanda , Lotter Jennifer , Valdez Janet , Sellers Stephanie E. , Barranta Ma Evette , Shalhoub Ruba N. , Wu Colin O. , Albitar Maher , Calvo Katherine R. , Young Neal S. , Dunbar Cynthia E.
Published: April 2020

There is no standard or widely effective treatment of patients with moderate aplastic anemia (MAA) or hypo-productive uni-lineage cytopenias (UC). Eltrombopag (EPAG), a small molecule thrombopoietin mimetic, has previously been shown to result in durable multi-lineage hematologic responses with low toxicity in patients with refractory severe aplastic anemia (SAA). Its safety and efficacy in MAA are unknown. This prospective phase 2 study enrolled previously untreated and treated MAA and UC patients with clinically relevant cytopenias. EPAG was administered at doses escalating from 50 to 300 mg/d. Hematologic responses were assessed at 16 to 20 weeks. Responding patients were continued on EPAG until reaching defined robust or stable blood counts. EPAG was reinstituted for relapse. Thirty-four patients were enrolled between 2012 and 2017, including 31 with MAA and 3 with UC. Seventeen patients responded in at least 1 eligible lineage by the primary end point. A striking improvement in anemia was observed in a patient with Diamond-Blackfan anemia. EPAG was well tolerated, and it was discontinued for robust or stable blood counts in 12 of 17 patients after a median of 8 months. A majority required re-initiation of EPAG for declining counts, and all regained response. Two of 34 patients developed non–chromosome 7 bone marrow cytogenetic abnormalities while taking EPAG, without dysplasia or increased blasts. Somatic mutation allele frequencies in cancer genes did not increase overall on EPAG. EPAG is a well-tolerated oral treatment of cytopenias in patients with MAA/UC. This trial was registered at www.clinicaltrials.gov as #NCT01328587.
Comparison of clinical outcomes in patients who underwent Gamma Knife radiosurgery for parasellar meningiomas with or without prior surgery
Authors: Hu Yan-jia , Xie Yue-bing , Zhang Li-feng , Ding Chang , Chen Jing
Published: April 2020

Background

Parasellar meningioma is a common benign tumour in brain. Both surgery and radiosurgery are important treatment modalities for this tumour. The study was designed to investigate whether prior surgery would affect treatment outcomes of patients with parasellar meningiomas after management with Gamma Knife radiosurgery.

Methods

A total of 93 patients who received Gamma Knife surgery were included in this retrospective study. There were 30 males and 63 females, with a median age of 48.6 years (range, 15.2–78.7 years). Prior surgery was performed in 45 patients. The median tumor volume was 5.02 cm3 (range 1.07–35.46 cm3) and median marginal dose was 12 Gy (range 10–15 Gy). The mean imaging follow-up and clinical follow-up periods were 40.7 and 52.7 months, respectively.

Results

In the group without prior surgery, 31 patients had improvement of preexisting symptoms; and in the group with prior surgery, 20 patients were noted to improve. The difference in symptom improvement between the two groups reached statistical significance (P = 0.009). Patients with prior surgery were more likely to have stable symptoms after Gamma Knife surgery (P = 0.012). Tumor recurrence was reported in 8 patients out of 45 patients with prior surgery, and 3 patients out of 48 patents without prior surgery (P = 0.085). After Gamma Knife surgery, 5 and 4 patients in two groups developed new neurological symptoms, respectively (P = 0.651). Cox regression analysis identified follow-up period as prognostic factor of progression-free survival. Ordinal logistic regression analysis identified surgery prior to Gamma Knife surgery as an unfavorable factor of symptom change.

Conclusion

Gamma Knife radiosurgery provided long-term effective tumor control and better symptom recovery compared with those with prior surgery. Patients with surgery before Gamma Knife radiosurgery were more likely to have stable symptoms. Further analyses indicated that long follow-up is essential to determine the efficacy of radiosurgery for parasellar meningiomas. Further study needs to include more patients with longer follow-up to draw a more solid conclusion.
Pilot implementation of elder-friendly care practices in acute care setting: a mixed methods study
Authors: Arain Mubashir Aslam , Graham Laura , Ahmad Armghan , Cole Mollie
Published: April 2020

Background

Frail older patients are at risk of experiencing a decline in physical and cognitive function unrelated to the reason for admission. The Elder-Friendly Care (EFC) program was designed to improve the care, experiences, and outcomes of frail older adults. The project supported 8 Early Adoption Sites (EAS) in a large Canadian healthcare organization by providing multiple strategies, educational opportunities, and resources. The purpose of this study was to assess the usefulness of EFC educational materials and resources, staff practice changes and perceptions in pilot sites, and readiness for scale and spread.

Methods

The study was conducted from May 2017 to June 2018 using a mixed-methods approach incorporating the Kirkpatrick Model of Training/Evaluation. A total of 76 Direct Care Staff participated in the staff survey, which assessed their awareness of, satisfaction with, and utilization of EFC principles, resources, and practices. Additionally, 12 interviews were conducted with staff who were directly involved in site implementation of EFC.

Results

Most survey participants were aware (86%, n = 63) of the EFC program, and 85% (n = 41) indicated they or their site/unit had implemented EFC. Out of these 41 participants, the most common practice changes identified were: incorporating alternatives to restraint (81%, n = 33), decreased use of pharmacological restraint (78%, n = 32), and patient and family care planning (76%, n = 31). Participants that attended all 3 EFC Learning Workshops (LWs) were significantly more likely to recommend the EFC Toolkit to others (87% versus 40%; χ2 = 8.82, p < 0.01) compared to participants attending less than 3 EFC LWs. Interview participants indicated that the program was well structured and flexible as sites/units could adopt changes that suited their individual sites, needs, contexts, and challenges.

Conclusions

The educational materials and resources used for the EFC project are useful and appreciated by the Direct Care Staff. Further, participants perceive the EFC intervention as effective in creating positive practice change and useful in reducing hospital-related complications for older patients. Future implementation will investigate the impact of EFC on system-level outcomes in acute care.