bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes of Isolated Open Gastrocnemius Recession for the Treatment of Chronic Insertional Achilles Tendinopathy: A Retrospective Cohort Study
Authors: Purnell Jennifer , Johnson Anne Holly , Cody Elizabeth A.
Published: September 2023

Background:

Insertional Achilles tendinopathy (IAT) is a common condition causing pain and dysfunction. Patients with diabetes, hyperlipidemia, hypothyroidism, and obesity are at increased risk of developing IAT. These comorbidities also carry an increased risk of wound healing complications following surgery. Therefore, there is a need for alternative management strategies for this high-risk patient population. This study investigated the potential role of isolated GR in patients with chronic IAT.

Methods:

This study is a single-institution retrospective review of adult patients who underwent isolated GR to address chronic IAT with a minimum 1-year follow-up. Demographics, complications, radiographic findings, and preoperative and postoperative patient-reported outcome scores (PROs) were collected. The primary outcome was improvement in PROMIS scores from preoperative to postoperative. Secondary outcomes were complication and reoperation rates.

Results:

Sixteen patients underwent open GR with a mean follow-up of 2.7 years. Postoperative PROMIS domain scores improved significantly from preoperative scores for physical function, pain interference, pain intensity, and global physical function. Two patients (13%) underwent reoperation (open calcaneal exostectomy and tendon debridement) at a mean time of 7 months from gastrocnemius recession. One patient developed a postoperative hematoma that resolved with conservative management.

Conclusion:

This single-institution series reports on a small cohort of patients with chronic IAT treated with open GR. We found significant improvement in patient-reported outcomes. Rates of complication and reoperation were low. This study supports the potential use of isolated gastrocnemius recession in IAT patients who, because of age or medical comorbidities, may benefit from a less invasive surgery and faster rehabilitation.

Level of Evidence:

Level III, retrospective case control study.
Outcomes After Hallux Interphalangeal Joint Arthrodesis
Authors: Braswell Matthew J. , Hysong Alexander A. , Macknet David M. , Jones Carroll P. , Ford Samuel E. , Ellington J. Kent
Published: September 2023

Background:

Hallux interphalangeal joint arthrodesis (HIPJA) is indicated for a variety of pathologies. Despite high nonunion rates, techniques remain unchanged. The aim of this study is to examine nonunion and complication rates and describe risk factors for treatment failure.

Methods:

A query of an institutional database was performed to identify all patients undergoing HIPJA procedure over a 10-year period. Records were reviewed to the procedure, evaluate patient factors, indications, and radiographic/clinical arthrodesis. Radiographic union was defined as 2 cortical continuations or bridging at the arthrodesis site, absence of hardware failure, and the absence of lytic gapping of the arthrodesis. Clinical fibrous union was defined as radiographic nonunion with painless toe range of motion and physical examination consistent with fusion across the interphalangeal joint.

Results:

Two hundred twenty-seven primary HIPJA procedures were identified. Our cohort demonstrated a 25.5% nonunion rate (58/227) and 21.1% reoperation rate (48/227). Patients with diabetes were at higher risk for nonunion ( P = .014), but no significant differences were identified based on smoking status or diagnosis of inflammatory arthritis. No difference was seen between implant groups: single screw, multiple screws, screw plus other fixation, nonscrew fixation. Patients with prior hallux metatarsophalangeal joint arthrodesis did not have a significantly higher nonunion rate than patients without prior first metatarsophalangeal joint arthrodesis. Patients diagnosed with radiographic nonunion were at higher risk for reoperation ( P < .0001).

Conclusion:

Our cohort represents the largest single-center series of HIPJA procedures published to date. We found relatively high nonunion and reoperation rates with standard current techniques.

Level of Evidence:

Level III, retrospective case series.
Influence of Comorbidity Burden, Socioeconomic Status, and Race and Ethnicity on Survival Disparities in Patients With Cancer
Authors: Cooper Robert M. , Chao Chun , Mukherjee Amrita , Zhuang Zimin , Haque Reina
Published: September 2023

Purpose

The purpose of this study was to assess the association of comorbidity burden with overall survival, accounting for racial/ethnic and socioeconomic differences in patients with cancer.

Methods

In this retrospective cohort study, patients newly diagnosed with cancer between 2010 and 2018 were identified from a large health plan in southern California. Cancer registry data were linked with electronic health records (EHR). Comorbidity burden was defined by the Elixhauser comorbidity index (ECI). Patients were followed through December 2019 to assess all-cause mortality. Association of comorbidity burden with all-cause mortality was evaluated using Cox proportional hazards model. Crude and adjusted hazard ratio (HR, 95%CI) were determined.

Results

Of 153,270 patients included in the analysis, 29% died during the ensuing 10-year follow-up. Nearly 49% were patients of color, and 32% had an ECI > 4. After adjusting for age, sex, race/ethnicity, cancer stage, smoking status, insurance payor, medical center, year of cancer diagnosis, and cancer treatments, we observed a trend demonstrating higher mortality risk by decreasing socioeconomic status (SES) (P-trend<.05). Compared to patients in the highest SES quintile, patients in the lowest, second lowest, middle, and second highest quintiles had 25%, 21%, 18%, and 11% higher risk of mortality, respectively [(HR, 95%CI): 1.25 (1.21-1.29), 1.21 (1.18-1.25), 1.18 (1.15-1.22), and 1.11 (1.07-1.14), respectively]. When we additionally adjusted for ECI, the adjusted HRs for SES were slightly attenuated; however, the trend persisted. Patients with higher comorbidity burden had higher mortality risk compared to patients with ECI score = 0 in the adjusted model [(HR, 95%CI): 1.22 (1.17-1.28), 1.48 (1.42-1.55), 1.80 (1.72-1.89), 2.24 (2.14-2.34), and 3.39 (3.25-3.53) for ECI = 1, 2, 3, 4, and >5, respectively].

Conclusions

Comorbidity burden affects overall survival in cancer patients irrespective of racial/ethnic and SES differences. Reducing comorbidity burden can reduce some, but not all, of the mortality risk associated with lower SES.
Cultivating a Learning Environment to Support Diverse Gifted Students
Authors: Gilson Cindy M. , Lee Lindsay E.
Published: September 2023

Educators have the responsibility to meet the academic, social, and emotional needs of every child in their care, including students who are gifted or high-achieving from diverse backgrounds. For gifted students to thrive in the differentiated classroom, teachers can consider the ways in which they establish and promote positive affective, physical, and digital learning environments. This article introduces the Reciprocal Learning Environments Model in which we describe four teacher actions based on research and recommended best practices from the field of gifted education to cultivate a more positive classroom culture conducive to differentiation.
The Academic Year Governor’s Schools of Virginia: A Community of Learners
Authors: Cross Tracy L. , Cross Jennifer Riedl , Wiley Kristofor , Mishra Anyesha
Published: September 2023

High-ability and gifted students are well-served by a focus on the development of community. The Academic Year Governor’s Schools of Virginia were created with a formalized emphasis on the network of relationships built among the students, faculty, and the larger community. The power of these communities of learners was evident in a study of the Governor’s Schools. At a time when students are buffeted by stressors such as school shootings, pandemics, and war, a community of like-minded and caring peers and adults can provide support for their positive psychological development.
Book Choice and the Affective Economy of Literacy
Authors: Smith Jess , Nichols T. Philip
Published: September 2023

This article examines the familiar imperative for educators to cultivate affective attachments between students and reading—to foster love or ward off hate, for books. It considers the interplay of this affective economy with other “economies” of reading long theorized in literacy studies: the moral economy, promoting dominant social norms; and the political economy, prioritizing workers skilled to meet the needs of the state. We examine the relations among these economies through a study of “book choice”—practices intended to give students greater autonomy (and pleasure) in their reading. Using interviews and artifacts from three middle-school classrooms in the U.S. south using varied configurations of “book choice,” we report findings that suggest the affective aims of such programs often intermingled with moral and political economic directives. In conclusion, we suggest that attunement to these contradictions offers an alternate, and more capacious, orientation for literacy education and aesthetic response.
Piecemeal Modeling of the Effects of Joint Direct and Indirect Tax Reforms
Authors: Capéau Bart , Decoster André , Van Houtven Stijn
Published: September 2023

In this article, we elicit the assumptions needed for an assessment of a joint reform of personal income and indirect taxes in a consistent conceptual framework. One often lacks an encompassing model for both labor supply decisions in real world tax and benefit contexts and the allocation of disposable income to commodities. We characterize households’ labor supply decisions by a random utility random opportunity model of job choice. We illustrate the framework with a Belgian tax reform proposal that shifts the burden away from labor taxes to indirect taxation. We find substantial empirical evidence that, both from a distributional and from a budgetary perspective, it is important to account for the impact of indirect taxes on the labor supply decision of households. The cost recovery effects of the tax shift are negative. This is, among other things, explained by the income effect in our job choice model.
Quaternium-18 and Quaternium-18 Bentonite
Authors: Cherian Priya , Bergfeld Wilma F. , Belsito Donald V. , Klaassen Curtis D. , Liebler Daniel C. , Marks James G. , Peterson Lisa A. , Shank Ronald C. , Slaga Thomas J. , Snyder Paul W. , Fiume Monice , Heldreth Bart
Published: September 2023

The Expert Panel for Cosmetic Ingredient Safety reviewed newly available studies since their original assessment in 1982, along with updated information regarding product types and concentrations of use, and confirmed that Quaternium-18 and Quaternium-18 Bentonite are safe as cosmetic ingredients in the practices of use and concentration as described in this report.
Ethnoracist exclusion and anti-immigrant sentiment in Europe: A hybrid model analysis using the European Social Survey, 2002–2016
Authors: Ponce Aaron
Published: September 2023

The literature on anti-immigrant sentiment analyzes generalized threat—rooted in a mix of cultural and economic anxieties—but relies on a theoretical foundation based on the study of race. This is puzzling since research on immigration attitudes has developed theoretical and empirical blind spots regarding the relevance of race-ethnicity. This study engages with race theories to show that racialization and symbolic racism constitute a primary axis along which a substantial subset of the European public views immigrants. Using five waves of the European Social Survey (2002–2016) and matched country-level data, the study finds that excluding immigrants based on race-ethnicity distinguishes a sizeable minority in most countries, and is also not isolated to any one region. Further, results provide evidence for the racialization of certain immigrant groups through greater associations between these groups’ presence and anti-immigrant sentiment. Strong and consistent reactions to the Muslim foreign-born population stand out. Finally, ethnoracist exclusionists are the primary agents of such racialization as they exhibit the strongest reactions to racialized groups, having the highest anti-immigrant sentiment. Findings are discussed within the context of assumptions underlying classical threat theories, the cultural, religious, and racialized aspects of anti-Muslim sentiment, and the global and local manifestations of race.
Special section – The moral legitimatisation of money and debt in consumer society
Authors: Arnould Eric , Soila Tuomas , Hietanen Joel , Huotari Ilmari , Pantzar Mika
Published: September 2023

This introduction to the special section brings into focus how little interest the marketing and consumer research academies have shown in money and debt: both philosophically and historically. When recognised explicitly, money and debt continue to be treated largely as 'givens' – epiphenomena morally embedded in consumer culture and rarely questioned. We assess how this situation has come about in these fields' theoretical lineages and anticipate future directions of inquiry. We also introduce our three contributions and weave them into the narrative of our story.
“I am not Your English Teacher”: Leadership for Addressing Xenophobia and Racism in the Wake of Demographic Change
Authors: Miranda Chandler Patton , Brezicha Kristina
Published: September 2023

This case asks educational leadership students to consider how immigrant students new to a quickly changing community may interpret subtle messaging of unbelonging and overt xenophobic hostility. Despite her best intentions, the principal in this case struggles to connect with the Latinx students and families who were recent arrivals to the community and school. The authors ask future school leaders to consider how to make a school environment more inclusive for immigrant students and other students who may be marginalized for their differences.
In the Eye of the Transcriber: Four Column Analysis Structure for Qualitative Research With Audiovisual Data
Authors: Mohammed Sarah S. , Knowles Laura A. , Cummings Jorden A.
Published: September 2023

For the past thirty years, qualitative psychology researchers have focused on the study of written or spoken word while relegating the study of visual communications to children or those deemed unable to speak (Reavey, 2021, p. 2). Thus, the discipline now pays much attention to the collection and analysis of spoken or written words but significantly less to visual and auditory expressions of experience (Reavey, 2021, p. 3), and most transcription methods for psychology researchers are those designed for interviews that only capture the spoken word. However, these transcription methods have yet to account for the current context of ubiquitous, technologically mediated interactions. People from diverse groups use social media platforms such as YouTube and TikTok to interact using speech, audio and video. While they offer rich data for qualitative psychology researchers, the tools to capture such multimodal expressions are still in early stages of development within the discipline (Marshall et al., 2021). In this article, we present a transcription structure that allows for the recording of both speech and visual elements in audiovisual content. Inspired by methods from communications and visual anthropology, the Four Column Analysis Structure (or, FoCAS) allows for the simultaneous analysis of both audio and visual data by allowing for the transcription of four dimensions: (1) timestamp, (2) setting, (3) scene, and (4) audio. Based on its application in two completed studies and one study in progress, we describe the development of the FoCAS, how to set it up, transcription conventions, and how to analyze qualitative data using all four columns. We additionally discuss sampling considerations and the advantages and disadvantages of the structure. By expanding the amount of meaningful data that can be captured by qualitative transcription, we hope the FoCAS can be used to create more multidimensional, rigorous analyses of audiovisual data.
Framing femicide in the news, a paradoxical story: A comprehensive analysis of thematic and episodic frames
Authors: Aldrete Mariana , Fernández-Ardèvol Mireia
Published: September 2023

Femicide is a worldwide problem. Studies of femicide discourses have found embedded discriminatory ideologies that could help to legitimize gender-based violence (GBV) at individual and social levels. This paper aims to contribute to the research on femicide and news frames. Studies of thematic and episodic frames tested their differential effects, but they did not examine the content. We propose a three-level methodology, distinguishing between thematic and episodic frames, conducting an in-depth examination of issue-specific frames, and adding the notion of substantiveness to analyse the results. We created a dataset of 2528 news articles from Mexican mainstream media, coded through qualitative content analysis. The proposal can be applied in many cultural contexts and opens up opportunities for comparative studies of femicide. Our results reveal that thematic pieces are focussed on non-intimate partner violence (IPV) femicides. Episodic pieces are more diverse but with a tendency to individualize the problem and attribute responsibility to the victims.
Obstetric racism and perceived quality of maternity care in Canada: Voices of Black women
Authors: Boakye Priscilla N , Prendergast Nadia , Bandari Bahareh , Anane Brown Eugenia , Odutayo Awura-ama , Salami Sharon
Published: September 2023

Background:

Obstetric racism in healthcare encounters impact on access to quality maternal healthcare for Black childbearing women yet remains underexplored in Canada. Understanding the experiences of Black Canadian women is critical to inform policy and create targeted interventions to address obstetric racism and advanced maternal health equity.

Objective:

The aim of this study was to explore the experiences of obstetric racism and its influence on perceived quality of maternity care among Black women in Toronto, Canada.

Design:

Qualitative research was conducted using a critical qualitative inquiry approach.

Methods:

We conducted a semi-structured interviews with 24 Black women who were pregnant and/or have given birth in the last 3 years. The interviews explored their experiences seeking care during pregnancy/childbirth and perceived quality of care.

Results:

Two themes were generated through the process of thematic analysis: (1) Manifestations and Impacts of Obstetric Racism and (2) Strategies for Addressing Obstetric Racism. Narratives of being dismissed, objectified, dehumanized, trauma and paternalism were reflected in the accounts of the participants. These experiences undermined the quality of care, hindered therapeutic relationships and contributed to mistrust.

Conclusion:

Black women understood the nature and impact of obstetric racism as it relates to the quality of maternal health care, their safety, and well-being. Participants recommended the need for anti-Black racism training specific to caring of Black childbearing women and increasing Black healthcare provider representation in perinatal settings as strategies to address obstetric racism. Investment in Black maternal health research is urgently needed to generate meaningful evidence to inform policy and interventions to advanced maternal health equity.
Response prediction by mutation- or methylation-specific detection of ctDNA dynamics in pretreated metastatic colorectal cancer
Authors: Doleschal Bernhard , Kirchweger Patrick , Schwendinger Simon , Kupferthaler Alexander , Burghofer Jonathan , Webersinke Gerald , Jukic Emina , Wundsam Helwig , Biebl Matthias , Petzer Andreas , Rumpold Holger
Published: September 2023

Background:

Serial analysis of circulating tumor DNA (ctDNA) levels is a promising tool for both relapse prediction in the curative setting, as well as predicting clinical benefit from systemic treatment in metastasic colorectal cancer (mCRC). Most data in this context are derived from treatment naive patients.

Objective:

To predict progressive disease (PD) as early as possible through monitoring of changes in ctDNA levels during systemic treatment in pretreated patients with mCRC.

Design:

A prospective, single-center, observational study.

Methods:

Patients treated beyond first-line were prospectively included between February 2020 and September 2021. Blood for ctDNA detection was taken before every treatment cycle from start of treatment until first restaging by CT-scan. ctDNA was detected by mutation- (mut-ctDNA) and methylation-specific ddPCR. Receiver Operating Characteristic (ROC)-analysis was used to describe sensitivity and specificity for prediction of PD at restaging for all time points.

Results:

A total of 42 patients were included who all carried a mutation in tumor tissue. Detection rate of mut-ctDNA was 88.1% and 74.4% for meth-ctDNA. Absolute ctDNA levels before treatment were prognostic in terms of overall survival. Levels of ctDNA were significantly higher in patients with PD at restaging. Median time from start of treatment to restaging was 93 days (95% CI 88.8–96). After a median of 19 days of treatment (95% CI 16.1–20.2), a decline of either mutation- or methylation-specific ctDNA levels of ⩽58% predicted PD at restaging with a sensitivity/specificity of 92.9/85.7% and 85.7/100%, respectively. Median time to restaging was 66 days (95% CI 56.8–75.2). There was no significant increase of sensitivity/specificity at later time points of ctDNA measurements.

Conclusion:

Monitoring early changes of ctDNA levels either by mut- or meth-ctDNA allows for early prediction of PD in pretreated patients with mCRC. This has the potential to complement RECIST-based treatment assessment with the aim to switch potentially insufficient treatments as early as possible, which is of particular interest in higher treatment lines.
Futures Triangle: A Method Examined
Authors: Mercer Ralph
Published: September 2023

This contribution to the Futures Triangle special edition aims to open dialogue with the reader about what lies ahead for the Futures Triangle method and Futures Studies in general. The subsequent paragraphs explore how viewing the Futures Triangle through the lenses of new philosophies and approaches could impact the traditional concepts of Futures Studies.
The effects of advanced maternal age on perinatal mortality in Ethiopia: A systematic review and meta-analysis
Authors: Bekele Gemechu Gelan , Yohannes Roga Ephrem , Gonfa Dajane Negesse , Yami Amare Tesfaye , Fekene Daniel Belema , Kabale Wogene Daro
Published: September 2023

Background:

Pregnancy in women over the age of 35 years is considered advanced maternal age. The relationship between advanced maternal age and the risk of perinatal mortality is still controversial. As a result, this systematic review and meta-analysis were carried out to clarify the relationship between advanced maternal age and perinatal mortality in Ethiopia.

Methods:

The following electronic databases were used for this systematic review and meta-analysis: PubMed, Web of Science, Scopus, Science Direct, Google Scholar, HINARI, and African Journals Online up to March 2022. Addis Ababa, Gondor, and Jimma University research repositories were also searched. A random-effects model was used to pool study-specific odds ratios.

Results:

A total of 18 articles, including a total of 45,541 participants, were included in the meta-analysis. A total of 11 cross-sectional, 2 case-control, and 5 cohort studies were included. The overall pooled estimate indicates that women with advanced maternal age had a 1.58 higher risk of perinatal mortality compared to women in the younger age group (odds ratio = 1.58; 95% Confidence Interval: 1.13–2.03). The subgroup analysis also revealed that there were differences in the effect size as the geographical region differed. The result showed that the odd of perinatal mortality was highest in the Oromia region and lowest in the Southern Nations Nationalities and Peoples’ Region.

Conclusion:

The overall pooled estimate indicates that women with advanced maternal age had a 1.58-fold higher risk of perinatal mortality. Even though this risk could also be increased with other comorbid diseases, it is important for healthcare providers and other concerned stakeholders to be aware of the increased risks associated with advanced maternal age and provide different intervention programs designed to create awareness and provide counseling services to couples who seek to have a child in their later ages about the risks of advanced maternal age pregnancy on perinatal mortality and other adverse pregnancy outcomes.
Review: Machine learning in precision pharmacotherapy of type 2 diabetes—A promising future or a glimpse of hope?
Authors: Zou Xiantong , Liu Yingning , Ji Linong
Published: September 2023

Precision pharmacotherapy of diabetes requires judicious selection of the optimal therapeutic agent for individual patients. Artificial intelligence (AI), a swiftly expanding discipline, holds substantial potential to transform current practices in diabetes diagnosis and management. This manuscript provides a comprehensive review of contemporary research investigating drug responses in patient subgroups, stratified via either supervised or unsupervised machine learning approaches. The prevalent algorithmic workflow for investigating drug responses using machine learning involves cohort selection, data processing, predictor selection, development and validation of machine learning methods, subgroup allocation, and subsequent analysis of drug response. Despite the promising feature, current research does not yet provide sufficient evidence to implement machine learning algorithms into routine clinical practice, due to a lack of simplicity, validation, or demonstrated efficacy. Nevertheless, we anticipate that the evolving evidence base will increasingly substantiate the role of machine learning in molding precision pharmacotherapy for diabetes.
Sponsorship Disclosure in Social Media Influencer Marketing: The Algorithmic and Non-Algorithmic Barriers
Authors: Musiyiwa Ruvimbo , Jacobson Jenna
Published: September 2023

The growth of social media influencer marketing has created sophisticated opportunities for deceptive marketing practices to proliferate online. While sponsorship disclosures alert consumers to the commercial nature of social media content and are required in different jurisdictions around the world, many influencer ads do not incorporate disclosures that comply with applicable laws. Building on Bourdieu’s theory of field as the theoretical lens, this research examines the disconnect between formal regulation and on-the-ground influencer marketing practices in Canada by investigating the current barriers to compliant sponsorship disclosure. Using semi-structured interviews with influencer relations professionals, who play an intermediary role between brands and influencers, the research explicates the (1) algorithmic challenges (e.g., algorithmic deprioritization or shadowbanning) and (2) non-algorithmic challenges (e.g., lengthy disclosure processes) to maintaining high disclosure standards. The research identifies the strategies influencer intermediaries can use to achieve upfront and conspicuous disclosure in a social media landscape where the algorithmic determinants of success are unpredictable, and the adaptation of applicable legal frameworks is traditionally slow.
Count Me Too: Sentiment Analysis of Roman Sindhi Script
Authors: Alvi Muhammd Bux , Mahoto Naeem Ahmed , Reshan Mana Saleh Al , Unar Mukhtiar , Elmagzoub M. A. , Shaikh Asadullah
Published: September 2023

Social media has given voice to people around the globe. However, all voices are not counted due to the scarcity of lexical computational resources. Such resources could harness the torrent of social media text data. Computational resources for rich languages such as English are available. More are being developed, meanwhile strengthening and enhancing the current ones. However, Roman Sindhi, a resource-poor writing style, is a phonetically rich language lacking computational resources, creating a working space for researchers. This work attempts to develop lexical sentiment resources that will help calculate the public opinion expressed in Roman Sindhi and bring their point of view into the limelight. This work is one of the initial efforts to develop lexical Roman Sindhi sentiment dictionary resources to help detect sentiment orientation in a text. Furthermore, it also developed two interfaces to leverage the lexical resources—a Roman Sindhi to English translator (RoSET) that translates a Roman Sindhi feature into an equivalent English word and a Roman Sindhi rule-based sentiment scorer ( RBRS3) that assigns sentiment score to a Roman Sindhi script features. The results obtained from the developed system accommodated the bilingual dataset (Roman Sindhi + English) more adequately. An increase of 20.8% was recorded for positive sentence detection, and a 16% increase was obtained for negative sentences, whereas neutral sentences were marginalized to a lower number (59.31% decrease). The resultant system makes those public voices expressed in the Roman Sindhi script get counted, which otherwise are in vain.
Valid and Reliable Measures of Generalized Trust: Evidence from a Nationally Representative Survey and Behavioral Experiment
Authors: Robbins Blaine G.
Published: September 2023

Generalized trust has been one of the most frequently examined constructs since researchers first introduced measures of it in the 1940s. Despite its significance, there is a growing consensus that traditional measures of generalized trust are prone to measurement invalidity and nonequivalence, calling into question sociological knowledge about generalized trust. In this article, I advance trust research in sociology by (1) refining two new self-report measures of generalized trust—the Stranger Face Trust scale (SFT) and the Imaginary Stranger Trust scale (IST)—and (2) assessing their empirical performance on a nationally representative probability sample (N = 1,264). I compare the reliability and validity of SFT, IST, and traditional measures of generalized trust across a range of measurement validation tests. Results suggest that SFT provides the most accurate and consistent measure of generalized trust.
Validity of the UCEEM in use: How Does it Triangulate with Qualitative Data in Measuring the Effect of an Educational Intervention?
Authors: Jones Alexander , Hartley James , Jones Nicola
Published: September 2023

Objectives

Improving medical student placements relies on being able to reliably evaluate how students experience clinical learning environments. The Undergraduate Clinical Education Environment Measure (UCEEM) is an increasingly used validated tool designed to allow such evaluations. This study aims to further characterize how the UCEEM relates to qualitative evaluation.

methods

Students on placement at one hospital were invited to complete the UCEEM before and after the implementation of an innovative new placement structure. Additionally, focus groups were employed to collect qualitative data on their experiences. a novel protocol to triangulate the output of the UCEEM with the qualitative data was developed.

Results

The UCEEM showed good internal consistency (Cronbach's Alpha 0.79-0.91) and internal correlation. Implementation of the intervention created significant improvements in the overall UCEEM scores ( P = .008) and in the “Learning in and through work and quality of supervision” ( P = .048), “Preparedness for student entry” ( P = .033) and “Workplace interaction patterns and student inclusion” ( P = .039) domains. The triangulation of qualitative data with UCEEM output showed that the UCEEM allowed evaluation of some perceptions not reached through open questioning. However, mixed interpretations of UCEEM items by students led to the conflation of themes and challenges in deriving the meaning behind the score. This appeared to be the case for 14 of the 24 UCEEM items.

Conclusion

This investigation adds to the literature supporting the UCEEM as a validated tool. It also elucidates the limitations and relationships to qualitative data that investigators need to be aware of in its use.
Multi-Institutional Journal Club as a Component of Diversity, Equity, and Inclusion Curricula in Residency Programs
Authors: Liang Jonathan L , Lee Samuel J , Lopez Francis J , Poliak-Tunis Michelle
Published: September 2023

Topics of diversity, equity, and inclusion (DEI) are an integral component of post-graduate medical education. However, it is currently unclear the extent to which physical medicine and rehabilitation residency programs have incorporated a DEI curriculum into their training programs. Here, a novel, multi-institutional DEI journal club is described. This journal club format can be an important component of the DEI curriculum as it provides non-local perspectives and insights into specific issues and allows for a simple way to introduce DEI training in programs currently without such training. The virtual format also provides further opportunities for discussion and networking.
Caste Discrimination Among Indian Diaspora in the USA
Authors: Kumar Shailendra
Published: September 2023

The large and prosperous Indian diaspora in the USA has earned the epitaph of ‘model minority’, but it obscures the spectre of caste discrimination within. The caste has travelled with the Indians across the globe and keeps rearing its ugly head of discrimination within the community. The article explores the emergence of the Indian diaspora and presence of caste discrimination in the USA. The recent case of caste discrimination against Cisco (MNC) and its Indian employees in California has opened the Pandora box. Since caste is not recognized under any American law, the case has been filed under Civil Rights Act, 1965, which forbids discrimination on the basis of religion, ancestry, national origin/ethnicity and race/colour. Hence, Cisco case is the first opportunity in the United States for caste to be incorporated as a protected legal category at par with race, religion ethnicity and so on. Moreover, it situates the case within larger global Dalit rights movements, their efforts to incorporate caste within the ambit of racism at various international forums and its inclusion as a protected characteristics within the Equality Act, 2010, of the United Kingdom. These efforts are to challenge the caste hegemony at both local and global levels and strive for its eradication.
Reduction of Posterior Malleolus Fractures With Open Fixation Compared to Percutaneous Treatment
Authors: Haws Brittany E. , Karnyski Steven , DiStefano David A. , Soin Sandeep P. , Flemister Adolph S. , Ketz John P.
Published: September 2023

Background:

Operative decision making between approaches to posterior malleolus reduction remains a challenge. The purpose of this study is to compare the quality of reduction between percutaneous and open reduction of posterior malleolus fractures and to identify factors associated with malreduction.

Methods:

Operatively managed ankle fractures that included posterior malleolus fixation were reviewed. Fracture characteristics were determined on preoperative CT scans. Initial postoperative radiographs were used to measure reduction of the posterior malleolus articular surface and graded as satisfactory (<2 mm step-off) or malreduced (≥2 mm step-off). Final postoperative PROMIS scores and 1-year complications were compared between percutaneous and open cohorts. A multivariate stepwise regression model was used to evaluate predictors for malreduction.

Results:

A total of 120 patients were included. Open reduction was performed in 91 (75.8%) compared with 29 (24.2%) who underwent percutaneous reduction. Malreduction (≥2-mm articular step-off) occurred in 11.7% of patients. Malreduction rates were significantly higher with percutaneous fixation than open fixation (24.1% vs 7.7%, P = .02). Multiple fragments and those with ≥5 mm of displacement demonstrated higher malreduction rates with percutaneous fixation ( P < .05 for both), whereas single fragments and those with <5 mm of displacement experienced similar malreduction rates with percutaneous or open fixation. Initial displacement ≥5 mm (relative risk [RR] = 3.8, 95% CI = 1.2-11.5, P = .02) and percutaneous treatment (RR = 4.1, 95% CI = 1.6-10.5, P < .01) were identified as independent risk factors for malreduction. There were no significant differences in 1-year complication rates or final PROMIS scores between groups.

Conclusion:

Open reduction of the posterior malleolus may lead to improved fracture reduction compared to percutaneous reduction without significant increase in complications. Open fixation improves reduction among fractures with multiple fragments or ≥5 mm of displacement, whereas fractures with a single fragment or <5 mm of displacement achieve similar reductions regardless of approach. Initial displacement ≥5 mm and percutaneous reduction are independent risk factors for malreduction.

Level of evidence:

Level III, therapeutic.
A Case Report of Primary Angioplasty: The Triple Whammy!
Authors: Mondal Sudipta , Pant Bhagwati Prasad , Abhilash Sreevilasam P
Published: September 2023

Congenital anomalies involving coronary artery origin are rare, with an incidence of 0.24%–1.3%. We present a case of inferior wall ST-elevation myocardial infarction in which an emergency coronary angiogram showed occlusion of the right coronary artery. However, we were unable to cannulate the left main coronary artery during the event. Interpretation of the infarct-related artery was complicated by the right arm-left arm lead reversal in electrocardiogram, adding to the dilemma in localizing the culprit vessel, namely right versus left circumflex coronary artery-related myocardial infarction. A computed tomography coronary angiogram subsequently showed the left main coronary artery having abnormal origin from the right sinus of Valsalva with inter-arterial course and no lesions in the left circumflex.
Geospatial assessment of the convergence of communicable and non-communicable diseases in South Africa
Authors: Cuadros Diego F , Moreno Claudia M , Tomita Andrew , Singh Urisha , Olivier Stephen , Castle Alison , Moosa Yumna , Edwards Johnathan A , Kim Hae-Young , Siedner Mark J , Wong Emily B , Tanser Frank
Published: September 2023

Introduction

Several low-and middle-income countries are undergoing rapid epidemiological transition with a rising burden of non-communicable diseases (NCDs). South Africa (SA) is a country with one of the largest HIV epidemics worldwide and a growing burden of NCDs where the collision of these epidemics poses a major public health challenge.

Methods

Using data from a large nationally representative survey, the South Africa Demographic and Health Survey (SADHS 2016), we conducted a geospatial analysis of several diseases including HIV, tuberculosis (TB), cardiovascular, respiratory, and metabolic diseases to identify areas with a high burden of co-morbidity within the country. We explored the spatial structure of each disease and associations between diseases using different spatial and visual data methodologies. We also assessed the individual level co-occurrence of HIV and the other diseases included in the analysis.

Results

The spatial distribution for HIV prevalence showed that this epidemic is most intense in the eastern region of the country, mostly within the Gauteng, Mpumalanga, and Kwazulu-Natal provinces. In contrast, chronic diseases had their highest prevalence rates the southern region of the country, particularly in the Eastern and Western Cape provinces. Individual-level analyses were consistent with the spatial correlations and found no statistically significant associations between HIV infection and the presence of any NCDs.

Conclusions

We found no evidence of geospatial overlap between the HIV epidemic and NCDs in SA. These results evidence the complex epidemiological landscape of the country, characterized by geographically distinct areas exhibiting different health burdens. The detailed description of the heterogenous prevalence of HIV and NCDs in SA reported in this study could be a useful tool to inform and direct policies to enhance targeted health service delivery according to the local health needs of each community.
Telomeric repeat-containing RNA is dysregulated in acute myeloid leukemia
Authors: Catto Luiz Fernando B. , Zanelatto Leonardo C. , Donaires Flavia S. , de Carvalho Vinicius S. , Santana Bárbara A. , Pinto André L. , Fantacini Daianne , de Souza Lucas Eduardo B. , Fonseca Natasha P. , Telho Bruno S. , Ayrosa Madeira Maria Isabel , Barbosa Pagnano Katia Borgia , Firmato Ana Beatriz , Fagundes Evandro Maranhão , Higashi Marcia , Nunes Elenaide Coutinho , Traina Fabiola , Lobo de F. Pontes Lorena , Rego Eduardo M. , Calado Rodrigo T.
Published: September 2023

TERRA (telomeric repeat-containing RNA) is a class of long noncoding RNAs transcribed from subtelomeric and telomeric regions. TERRA binds to the subtelomeric and telomeric DNA–forming R-loops (DNA-RNA hybrids), which are involved in telomere maintenance and telomerase function, but the role of TERRA in human cells is not well characterized. Here, we comprehensively investigated for the first time TERRA expression in primary human hematopoietic cells from an exploratory cohort of patients with acute myeloid leukemia (AML), patients with acute lymphoblastic leukemia (ALL), patients with telomere biology disorder (TBD), and healthy subjects. TERRA expression was repressed in primary human hematopoietic cells, including healthy donors, patients with ALL, and patients with TBD, irrespective of their telomere length, except for AML. A second cohort comprising 88 patients with AML showed that TERRA was overexpressed in an AML subgroup also characterized by higher R-loop formation, low TERT and RNAseH2 expression, and a paucity of somatic splicing factor mutations. Telomere length did not correlate with TERRA expression levels. To assess the role of TERRA R-loops in AML, we induced R-loop depletion by increasing RNAseH1 expression in 2 AML cell lines. Decreased TERRA R-loops in AML cell lines resulted in increased chemosensitivity to cytarabine. Our findings indicate that TERRA is uniformly repressed in primary human hematopoietic cells but abnormally expressed in an AML subset with low telomerase.
Protein S antibody as an adjunct therapy for hemophilia B
Authors: Wilson Hope P. , Pierre Aliyah , Paysse Ashley L. , Kumar Narender , Cooley Brian C. , Rudra Pratyadipta , Dorsey Adrianne W. , Polania-Villanueva Diana , Chatterjee Sabyasachi , Janbain Maissaa , Velez Maria C. , Majumder Rinku
Published: September 2023

Hemophilia B (HB) is caused by an inherited deficiency of plasma coagulation factor IX (FIX). Approximately 60% of pediatric patients with HB possess a severe form of FIX deficiency (<1% FIX activity). Treatment typically requires replacement therapy through the administration of FIX. However, exogenous FIX has a limited functional half-life, and the natural anticoagulant protein S (PS) inhibits activated FIX (FIXa). PS ultimately limits thrombin formation, which limits plasma coagulation. This regulation of FIXa activity by PS led us to test whether inhibiting PS would extend the functional half-life of FIX and thereby prolong FIX-based HB therapy. We assayed clotting times and thrombin generation to measure the efficacy of a PS antibody for increasing FIX activity in commercially obtained plasma and plasma from pediatric patients with HB. We included 11 pediatric patients who lacked additional comorbidities and coagulopathies. In vivo, we assessed thrombus formation in HB mice in the presence of the FIXa ± PS antibody. We found an accelerated rate of clotting in the presence of PS antibody. Similarly, the peak thrombin formed was significantly greater in the presence of the PS antibody, even in plasma from patients with severe HB. Furthermore, HB mice injected with PS antibody and FIX had a 4.5-fold higher accumulation of fibrin at the thrombus induction site compared with mice injected with FIX alone. Our findings imply that a PS antibody would be a valuable adjunct to increase the effectiveness of FIX replacement therapy in pediatric patients who have mild, moderate, and severe HB.
VWF–ADAMTS13 axis dysfunction in children with sickle cell disease treated with hydroxycarbamide vs blood transfusion
Authors: Fogarty Helen , Ahmad Azaz , Atiq Ferdows , Doherty Dearbhla , Ward Soracha , Karampini Ellie , Rehill Aisling , Leon Gemma , Byrne Ciara , Geoghegan Rosena , Conroy Helena , Byrne Mary , Budde Ulrich , Schneppenheim Sonja , Sheehan Ciara , Ngwenya Noel , Baker Ross I. , Preston Roger J. S. , Tuohy Emma , McMahon Corrina , O’Donnell James S.
Published: September 2023

Previous studies have reported elevated von Willebrand factor (VWF) levels in patients with sickle cell disease (SCD) and demonstrated a key role for the VWF-ADAMTS13 axis in the pathobiology of SCD vaso-occlusion. Although blood transfusion is the gold standard for stroke prevention in SCD, the biological mechanisms underpinning its improved efficacy compared with hydroxycarbamide are not fully understood. We hypothesized that the improved efficacy of blood transfusion might relate to differences in VWF–ADAMTS13 axis dysfunction. In total, 180 children with a confirmed diagnosis of SCD (hemoglobin SS) on hydroxycarbamide (n = 96) or blood transfusion (n = 84) were included. Despite disease-modifying treatment, plasma VWF and VWF propeptide were elevated in a significant proportion of children with SCD (33% and 47%, respectively). Crucially, all VWF parameters were significantly higher in the hydroxycarbamide compared with the blood transfusion cohort (P < .05). Additionally, increased levels of other Weibel-Palade body–stored proteins, including factor VIII (FVIII), angiopoietin-2, and osteoprotegerin were observed, indicated ongoing endothelial cell activation. Children treated with hydroxycarbamide also had higher FVIII activity and enhanced thrombin generation compared with those in the blood transfusion cohort (P < .001). Finally, hemolysis markers strongly correlated with VWF levels (P < .001) and were significantly reduced in the blood transfusion cohort (P < .001). Cumulatively, to our knowledge, our findings demonstrate for the first time that despite treatment, ongoing dysfunction of the VWF–ADAMTS13 axis is present in a significant subgroup of pediatric patients with SCD, especially those treated with hydroxycarbamide.