bluuebunny/crossref_metadata_2025 huggingface dataset:
A Mixed-Methods Comparison of a National and State Opioid Overdose Surveillance Definition
Authors: Brathwaite Danielle M. , Wolff Catherine S. , Ising Amy I. , Proescholdbell Scott K. , Waller Anna E.
Published: November 2021

Objectives

We assessed the differences between the first version of the Centers for Disease Control and Prevention (CDC) opioid surveillance definition for suspected nonfatal opioid overdoses (hereinafter, CDC definition) and the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) surveillance definition to determine whether the North Carolina definition should include additional International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and/or chief complaint keywords.

Methods

Two independent reviewers retrospectively reviewed data on North Carolina emergency department (ED) visits generated by components of the CDC definition not included in the NC DETECT definition from January 1 through July 31, 2018. Clinical reviewers identified false positives as any ED visit in which available evidence supported an alternative explanation for patient presentation deemed more likely than an opioid overdose. After individual assessment, reviewers reconciled disagreements.

Results

We identified 2296 ED visits under the CDC definition that were not identified under the NC DETECT definition during the study period. False-positive rates ranged from 2.6% to 41.4% for codes and keywords uniquely identifying ≥10 ED visits. Based on uniquely identifying ≥10 ED visits and a false-positive rate ≤10.0%, 4 of 16 ICD-10-CM codes evaluated were identified for NC DETECT definition inclusion. Only 2 of 25 keywords evaluated, “OD” and “overdose,” met inclusion criteria to be considered a meaningful addition to the NC DETECT definition.

Practice Implications

Quantitative and qualitative trends in coding and keyword use identified in this analysis may prove helpful for future evaluations of surveillance definitions.
Using Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses in Real Time
Authors: Hallowell Benjamin D. , Chambers Laura C. , Rhodes Jason , Basta Melissa , Viner-Brown Samara , Lasher Leanne
Published: November 2021

Objective

No case definition exists that allows public health authorities to accurately identify opioid overdoses using emergency medical services (EMS) data. We developed and evaluated a case definition for suspected nonfatal opioid overdoses in EMS data.

Methods

To identify suspected opioid overdose–related EMS runs, in 2019 the Rhode Island Department of Health (RIDOH) developed a case definition using the primary impression, secondary impression, selection of naloxone in the dropdown field for medication given, indication of medication response in a dropdown field, and keyword search of the report narrative. We developed the case definition with input from EMS personnel and validated it using an iterative process of random medical record review. We used naloxone administration in consideration with other factors to avoid misclassification of opioid overdoses.

Results

In 2018, naloxone was administered during 2513 EMS runs in Rhode Island, of which 1501 met our case definition of a nonfatal opioid overdose. Based on a review of 400 randomly selected EMS runs in which naloxone was administered, the RIDOH case definition accurately identified 90.0% of opioid overdoses and accurately excluded 83.3% of non–opioid overdose–related EMS runs. Use of the case definition enabled analyses that identified key patterns in overdose locations, people who experienced repeat overdoses, and the creation of hotspot maps to inform outbreak detection and response.

Practice Implications

EMS data can be an effective tool for monitoring overdoses in real time and informing public health practice. To accurately identify opioid overdose–related EMS runs, the use of a comprehensive case definition is essential.
The Effect of Tourism Taxation on International Arrivals to a Small Tourism-Dependent Economy
Authors: Adedoyin Festus Fatai , Seetaram Neelu , Disegna Marta , Filis George
Published: November 2021

This paper examines the effects of tax policies on international tourist arrivals to the Maldives using the fully modified ordinary least squares (FMOLS) panel data method. The Maldives is chosen as a case study because the nation is heavily dependent on tourism and earn up to 70% of total government revenue in tourism tax. As expected, the estimated tax elasticities show that tourism tax adversely influences inbound travel, but significant differences across source markets are observed. Specifically, a 10% increase in tourism tax reduces demand by 5.4%. The degree of responsiveness of tourism demand to changes in taxes is essential for tourism policy since a change in the cost of visiting a destination resulting from a change in tourism tax policies affects inbound tourism demand. Consequently, the effectiveness of current fiscal policies is a matter of concern for attracting international tourists to the Maldives.
#presidentspartingwords at a Critical Juncture: Reclaiming the Autonomous Subject in Social Media Discourse on Coronavirus in Belarus
Authors: Kananovich Volha
Published: November 2021

This study explores #presidentspartingwords, a viral hashtag that accompanied the eulogy-like posts that social media users created about themselves in spring 2020 by satirically emulating president Alexander Lukashenko’s patronizing remarks about the first coronavirus victims in Belarus, an authoritarian post-Soviet country. The study examines how the online public used these discursive sites to challenge the governmentally sanctioned subject positions, which construct Belarusians as inapt dependents of the state, by articulating themselves as efficacious,autonomous agents. The study argues the coronavirus pandemic served as a “permissive condition” for critical juncture by disrupting thelogic of the official discourse in which Lukashenko is assigned the role of the major, if not the only, rhetor imbued with the legitimacy to speak on behalf of the Belarusian people. I argue that approaching the coronavirus as a potential critical juncture offers critical mediascholars a useful analytical category for theorizing the discursive conditionality of political change.
Walking the Talk of Social Equity? Street-Level Bureaucrats’ Decisionmaking About the Provision of Personal Resources
Authors: Lavee Einat
Published: November 2021

While public administration scholars argue that core values of social equity are exceedingly important in service provision, less is known of how these values are practised on the frontline in the contemporary public administration. Research points to a dual trend: together with practices aimed at increasing clients’ wellbeing, public service workers’ decisions about allocating public resources are guided by moral perceptions of worthiness, leaving behind the most weakened populations. The current study aims to decipher this duality, analyzing street-level bureaucrats’ decisionmaking about providing personal resources to low-income clients, in order to examine whether the pursuit of social equity is manifested in informal practices. Drawing on indepth qualitative interviews of social service providers in Israel, we found that decisionmaking about personal resource provision is grounded in two distinct sets of values. Alongside a pattern of providing resources to deserving clients, street-level bureaucrats also provide them to clients typically considered undeserving. These latter practices are aimed at decreasing social inequality, demonstrating that social service providers often walk the talk of social equity.
Inter-Port Competition and Cooperation Under Different Market Environments
Authors: Yuan Kebiao , Wang Xuefeng , Zhang Qiang
Published: November 2021

Aiming at the competition and cooperation decision-making problem between two ports in the same regional port group, this paper studies four kinds of dynamic game scenarios of two adjacent ports—namely, independent strategy–independent strategy (i.e., DD combinations), independent strategy–integrated strategy (i.e., DT combinations), integrated strategy–independent strategy (i.e., TD combinations), and integrated strategy–integrated strategy (i.e., TT combinations). By introducing port demand models and using the dynamic game method, the paper performs a comparative study of port service pricing, port demand, and port profit in different combinations of competition and cooperation. The results show that taking port profit as payment function, the equilibrium strategy of the leader port is the independent strategy, which is also the dominant strategy, while the independent strategy or integrated strategy of the follower port depends on the degree of service substitution provided by the two competing ports. When the degree of service substitution is low (0 < γ < 0.53), the equilibrium strategies of two competing ports are the DD combinations, but the equilibrium strategies can be improved by Pareto, and further analysis shows that TT combinations are the Pareto equilibrium strategies at this time. By contrast, when the degree of service substitution provided by the two competing ports is high (0.53 ≤γ < 1), the DT combinations are the equilibrium strategies of the two competing ports, which are also the Pareto equilibrium strategies at this time. The research shows that when the degree of service substitution of the two ports is low, to encourage the two ports to carry out differentiated development of service functions, it is conducive to promote the two ports to adopt the integrated cooperation strategies.
The Reliability of 3-T Magnetic Resonance Imaging to Identify Arthroscopic Features of Meniscal Tears and Its Utility to Predict Meniscal Tear Reparability
Authors: Strawbridge Jason C. , Schroeder Grant G. , Garcia-Mansilla Ignacio , Singla Amit , Levine Benjamin D. , Motamedi Kambiz , Jones Kristofer J. , Kremen Thomas J.
Published: November 2021

Background:

The ability to predict meniscus tear reparability based on preoperative magnetic resonance imaging (MRI) is desirable for postoperative planning; however, the accuracy of predictive methods varies widely within the orthopaedic and radiology literature.

Purpose/Hypothesis:

The purpose was to determine if the higher resolution offered by 3-T MRI improves the accuracy of predicting reparability compared with previous investigations using 1.5-T MRI. Our hypothesis was that a higher field strength of 3-T MRI would result in improved reliability assessments and predictions of meniscus tear reparability compared with previous studies utilizing a 1.5-T MRI platform.

Study Design:

Cohort study (diagnosis); Level of evidence, 2.

Methods:

A total of 44 patients who underwent meniscus repair were matched by age, sex, and body mass index to 43 patients who underwent partial meniscectomy. Overall, 2 orthopaedic surgeons and 2 musculoskeletal radiologists independently and blindly reviewed the preoperative MRI scans for all 87 patients. For each meniscus tear, reviewers evaluated the following criteria: tear pattern, tear length, tear distance from the meniscocapsular junction, tear thickness, and integrity of any inner meniscal fragment. The resultant data were then applied to 5 different approaches for predicting meniscal reparability.

Results:

The accuracy for all examined prediction methods was poor, ranging from 55% (3-point method) to 72% (classification tree method) among all reviewers. Interobserver reliability for examined criteria was also poor, with kappa values ranging from 0.07 (inner meniscal fragment status) to 0.40 (tear pattern).

Conclusion:

MRI continues to be a poor predictor of meniscus tear reparability as assessed by arthroscopic criteria, even when using higher resolution 3-T scanners. Interobserver reliability in this setting can be poor, even among experienced clinicians.
Application of artificial intelligence to enhance collection of E-waste: A potential solution for household WEEE collection and segregation in India
Authors: Shreyas Madhav AV , Rajaraman Raghav , Harini S , Kiliroor Cinu C
Published: November 2021

Our society has undergone a massive technological revolution over the past decade and electronic appliances have now become ubiquitous. The increase in production of electronic products and the growing inherent need to own the latest technology available has led to a significant increase in the amount of E-waste produced each year. India generated 3.2 million tonnes of E-waste in 2020, with metropolitan cities like Mumbai, Delhi and Bangalore leading the list. Proper management and recycling of E-wastes are critical for the sustainability of any modern city today. While industrial and commercial collection of E-wastes has been in the spotlight, solutions for collection of E-wastes from individual households are limited. This article proposes the implementation of a mobile robot that identifies common electronic wastes based on transfer learning and serves as an attachment to existing municipality garbage trucks. The robot moves around, identifies electronic wastes and performs segregation of the identified material via its arm-based lift and storage mechanism. A convolutional neural network–based identification system has been employed for categorising the E-wastes and yields 96% accuracy. This is a first of its kind attempt, especially in India, to collect and segregate E-wastes from homes and individuals. The system will relieve unskilled labour from the hazardous process while providing a 20% decrease in costs over a 5-year period. The application of this article aims to provide a viable mobile solution for E-waste collection from households with minimal human intervention.
Using Augmented Reality and Modified Schema-Based Instruction to Teach Problem Solving to Students With Autism
Authors: Root Jenny R. , Cox Sarah K. , Davis Kathryn , Gonzales Sarah
Published: November 2021

Young adults with autism spectrum disorder (ASD) need both academic and social skills required to apply acquired knowledge and skills in real-world settings. This study evaluated the effects of a multicomponent intervention incorporating both Modified Schema-Based Instruction (MSBI) and video-based instruction delivered via augmented reality (AR) to teach the social and mathematical problem-solving skills needed to execute personal finance tasks in the community. Participants were four 21-year-old young adults with ASD enrolled in a public school transition program located on the campus of a technical college. Findings of the single-case multiple probe across participant design support a functional relationship between the multicomponent treatment package and the social and mathematical problem-solving skills of the young adults with ASD. Furthermore, participants were also able to self-correct errors after watching AR-triggered model videos. Generalization to a novel setting was tested. Results, implications, and suggestions for future research are discussed
Contrasting 4 Year Outcomes Associated With Introduction to Management Courses
Authors: Roldan Malu
Published: November 2021

Management faculty members have had a longstanding interest in the design of the Introduction to Management Course as it presents an opportune point to provide students with the foundational skills for success in their Management Studies. Since many Management majors take these courses during their freshman year in the university, the courses are, intentionally or not, also settings for helping students transition to the university both academically and socially. This paper reports on a study of the 4-year outcomes associated with this potential of Introduction to Management courses to help with students’ transition into university-level studies. Specifically, it contrasts 4-year graduation outcomes among three different Introduction to Management courses taken by a freshman business student cohort of a large, public, university. The study results show a course that focused on life skill building was associated with better 4-year graduation outcomes than theory-driven and business overview classes. Contrary to expectations, the study indicated that there were no significant differences among students enrolled in the classes in terms of other important student characteristics known to impact graduation rates, including underrepresented minority (URM) and first-generation status, SAT or ACT scores, self-reported GPA, and exposure to university-level URM student success and achievement programs.
Self-Care of African Immigrant Adults with Chronic Illness
Authors: Osokpo Onome Henry , Lewis Lisa M. , Ikeaba Uchechukwu , Chittams Jesse , Barg Frances K. , Riegel Barbara
Published: November 2021

This cross-sectional study aims to describe the self-care of adult African immigrants in the US with chronic illness and explore the relationship between acculturation and self-care. A total of 88 African immigrants with chronic illness were enrolled. Self-care was measured with the Self Care of Chronic Illness Inventory v3 and the Self-Care Self-Efficacy scale. Scores are standardized 0 to 100 with scores >70 considered adequate. Acculturation was measured using a modified standardized acculturation instrument and predefined acculturation proxies. The self-care scores showed adequate self-care, with the mean scores of 78.6, 77.9, and 75.6 for self-care maintenance, monitoring, and management. Self-care self-efficacy mean score was 81.3. Acculturation was not significantly associated with self-care. Self-care self-efficacy was a strong determinant of self-care maintenance ( p < .0001), monitoring ( p < .0001), and management ( p < .0001). The perception of inadequate income was a significant determinant of poor self-care management ( p = .03). Self-care self-efficacy and perceived income adequacy were better determinants of self-care than acculturation.
Changes in the Risk of Sexual Reoffending: The Role and Relevance of Perceived Self-Efficacy and Adult Attachment Styles in Correctional Treatment
Authors: Stück Elisabeth , Briken Peer , Brunner Franziska
Published: November 2021

According to the Risk-Need-Responsivity (RNR) model, treatment effectiveness increases when treatment addresses all three associated core principles. While researchers have focused on the risk and need principles, responsivity remains under-investigated. The theoretical foundation of the RNR model and former research indicates low perceived self-efficacy and inadequate adult attachment styles as potential responsivity factors that can impede treatment of the underlying risk factors. This study assesses firstly whether these factors predict treatment attrition, and secondly changes in the assessed risk of sexual reoffending. Participants were N = 146 men sentenced for sexual offenses in a German social-therapeutic correctional facility. Younger age, higher number of previous convictions, and higher scores on the interpersonal facet of the Psychopathy Checklist-Revised are associated with a higher risk of treatment attrition. Unemployment prior to incarceration was found to be an aggravating factor, whereas substance abuse emerged as a mitigating factor, according reducing the risk of reoffending. Neither pre-treatment self-efficacy nor attachment styles revealed as responsivity factors in this study. Future studies should examine if the consideration of these factors during treatment might impact treatment outcomes.
Comparison of antifungal activity of essential oils of clove, lemongrass and thyme for natural preservation of dried apricots
Authors: Debonne Els , Yilmaz Merve Silanur , Sakiyan Ozge , Eeckhout Mia
Published: November 2021

Currently, the majority of fresh apricots destined for the production of dried apricots undergo sulphur oxide fumigation before drying to protect the fruit against fungal spoilage. To eliminate the use of sulphite, packaging assisted with essential oil is a promising strategy to increase shelf-life of dried apricots since it does not impact its flavor characteristics. In this study, three essential oils were selected: clove, lemongrass and thyme. They were screened for antifungal activity against Eurotium spp. with different methods: micro- and macro-dilution and agar-diffusion. Growth/no-growth data were used to develop models for all three methods. Clove exerted the strongest antifungal activity with an inhibitory concentration of 0.075%, 0.035% and 0.05% through respectively micro-dilution, macro-dilution and agar diffusion. For thyme the following values were obtained: 0.775%, 0.070% and 0.100%. This means that the antifungal activity of thyme is 10 times lower in micro-dilution and 2 times lower in macro-dilution and agar diffusion compared to clove. Through micro-dilution, lemongrass was found to have the second highest antifungal activity (0.25%). When used in the volatile atmosphere of dried apricots and in macro-dilution, the antifungal activity of lemongrass was the lowest, with respective values of > 0.200% and 0.105% for G/NG prediction.
Development and validation of a one-step modelling approach for the determination of chicken meat shelf-life based on the growth kinetics of Pseudomonas spp
Authors: Tarlak Fatih , Pérez-Rodríguez Fernando
Published: November 2021

The main objective of the present study was to investigate the effect of storage temperature on aerobically stored chicken meat spoilage using the two-step and one-step modelling approaches involving different primary models namely the modified Gompertz, logistic, Baranyi and Huang models. For this purpose, growth data points of Pseudomonas spp. were collected from published studies conducted in aerobically stored chicken meat product. Temperature-dependent kinetic parameters (maximum specific growth rate ‘µ max’ and lag phase duration ‘ λ’) were described as a function of storage temperature through the Ratkowsky model based on the different primary models. Then, the fitting capability of both modelling approaches was compared taking into account root mean square error, adjusted coefficient of determination (adjusted-R2) and corrected Akaike information criterion. The one-step modelling approach showed considerably improved fitting capability regardless of the used primary model. Finally, models developed from the one-step modelling approach were validated for the maximum growth rate data extracted from independent published literature using the statistical indexes Bias (Bf) and Accuracy (Af) factors. The best prediction capability was obtained for the Baranyi model with Bf and Af being very close to 1. The shelf-life of chicken meat as a function of storage temperature was predicted using both modelling approaches for the Baranyi model.
Application of step and beat alignment approaches and its effect on gait in progressive multiple sclerosis with severe cerebellar ataxia: A proof of concept case study
Authors: Moumdjian Lousin , Moens Bart , Van Wijmeersh Bart , Leman Marc , Feys Peter
Published: November 2021

Background:

In a case report of a progressive multiple sclerosis with cerebellar impairments, we reported that synchronisation of steps to beats was possible only at −12% of usual walking cadence during 1 minute of walking.

Objectives and methods:

Here, we investigate the effect of synchronisation using two different alignment approaches on the patient’s gait pattern over 2 minutes of walking, compared to walking in silence.

Results and conclusion:

This proof of concept showed that the adaptive approach was successful resulting in an improved gait pattern compared to the other conditions, providing preliminary evidence to support a full-scale intervention study.
A co-designed telehealth-based model of care to improve attendance and completion to cardiac rehabilitation of rural and remote Australians: The Country Heart Attack Prevention (CHAP) project
Authors: Beleigoli Alline , Champion Stephanie , Tirimacco Rosy , Nesbitt Katie , Tideman Philip , Clark Robyn A
Published: November 2021

We aim to report the co-design of the implementation strategy of a telehealth-enabled cardiac rehabilitation model of care in rural and remote areas of Australia. The goal of this model of care is to increase cardiac rehabilitation attendance and completion by country patients with cardiovascular diseases.

We hypothesise that a model of care co-designed with stakeholders will address patients’ needs and preferences and increase participation. We applied the Model for Large Scale Knowledge Translation and engaged with patients, clinicians and health service managers across six local health networks in rural South Australia. They informed the design of a web-based cardiac rehabilitation programme and the delivery of the expanded telehealth service.

The stakeholders defined face-to-face, telephone, web-based or combinations as choices of mode of delivery to patients referred to cardiac rehabilitation. A case-managed programme supported by a web portal with an interface for patients and clinicians was considered more appropriate to the local context than a self-managed programme. A business model was developed to enable the sustainability of cardiac rehabilitation clinical assessments through primary care. The impact of the model of care on cardiac rehabilitation attendance/completion, clinical outcomes, patient-reported outcomes and patient-reported experiences and cost-effectiveness will be tested in a 12-month follow-up study.
Machine learning and social theory: Collective machine behaviour in algorithmic trading
Authors: Borch Christian
Published: November 2021

This article examines what the rise in machine learning (ML) systems might mean for social theory. Focusing on financial markets, in which algorithmic securities trading founded on ML-based decision-making is gaining traction, I discuss the extent to which established sociological notions remain relevant or demand a reconsideration when applied to an ML context. I argue that ML systems have some capacity for agency and for engaging in forms of collective machine behaviour, in which ML systems interact with other machines. However, ML-based collective machine behaviour is irreducible to human decision-making and thereby challenges established sociological notions of financial markets (including that of embeddedness). I argue that such behaviour can nonetheless be analysed through an adaptation of sociological theories of interaction and collective behaviour.
Quality Education or Defense of Accreditation? The Struggle of a University Professor Leading an Education Committee
Authors: Ito Hiroshi
Published: November 2021

This case illustrates Professor Saitoh’s struggles in a middle-management position leading an education committee called the Assurance of Learning (AOL) Committee at a business school in Japan. The committee assessed students’ learning outcomes and provided suggestions for curriculum improvement. The school was accredited by the Association to Advance Collegiate Schools of Business (AACSB), and AOL played an important role in defending that accreditation. However, some faculty members shared dissatisfaction with AOL for various reasons. This case may provide practical and theoretical implications in developing potential middle-level leaders managing committees in higher education.
Taking responsibility: Testimonial practices in Rithy Panh’s S21: The Khmer Rouge Killing Machine
Authors: Elander Maria
Published: November 2021

Genocide films have long contributed to public criminology’s exploration into ethics, responsibility and witnessing after atrocity. Whereas post-Holocaust theorisations of testimony have focused on victim testimony (and its limits), a recent wave of documentary films are instead centering on the perpetrators of atrocity. These are raising the question of how to engage with that shared by a person who experienced an atrocity not as its victim but as its perpetrator. This article examines this question through a close reading of Rithy Panh’s documentary film S21: The Khmer Rouge Killing machine (2003), a film that ‘compare[s] eye-witness accounts’ of a handful of men who all experienced notorious Khmer Rouge security centre S-21 either as its prisoners or its staff. I suggest that the confrontations and the bodily gestures by the former staff in S21 constitute forms of testimony, something which has implications for the understanding of both testimony and responsibility, as well as for the positionality of the spectator. The film, I suggest, provides a way to listen to the experiences of the perpetrators of the atrocity, without diminishing the suffering they caused.
Interposition Arthroplasty in the Treatment of End-Stage Hallux Rigidus: A Systematic Review
Authors: Di Caprio Francesco , Mosca Massimiliano , Ceccarelli Francesco , Caravelli Silvio , Di Ponte Marco , Zaffagnini Stefano , Ponziani Lorenzo
Published: November 2021

Purpose

Patients affected by moderate to severe hallux rigidus may opt for interposition arthroplasty to avoid the movement restrictions of arthrodesis and the complications related to prosthetic replacement. The propose of this article was to review the current literature about interposition arthroplasty to examine the overall outcomes and to evaluate the advantages and disadvantages of different types of technique, compared with more consolidated procedures.

Methods

A literature PubMed search was performed. Studies reporting the results of interposition arthroplasty in moderate to severe hallux rigidus were included. The data were pooled and weighted for number of patients in every study.

Results

The overall results for interposition arthroplasties are comparable to other alternatives for end-stage hallux rigidus, providing better plantar load distribution than arthrodesis and avoiding the drawbacks of prosthetic replacement. Among the various interposition arthroplasty techniques, the Modified Oblique Keller Capsular Interposition Arthroplasty technique preserves toe length and flexor hallucis brevis function, showing the highest satisfaction rate, with lowest metatarsalgia and revision rate.

Conclusion

Although long-term randomized controlled trials are lacking for interposition arthroplasty, it represents a valid alternative for the treatment of end-stage hallux rigidus also in the young active patient who wants to avoid a definitive intervention immediately.

Level of evidence

III (systematic review of level III-IV-V studies)
Outcomes Following Modified Broström for Chronic Lateral Ankle Instability With and Without Peroneal Tendon Exploration
Authors: Adams Bryan G. , Milam Brian P. , Drayer Nicholas J. , Winland Ama , Hood Debra , Ryan Paul M. , Robbins Justin
Published: November 2021

Background:

It is not known how peroneal tendon exploration influences results after modified Broström for lateral ankle instability. We propose peroneal exploration at the time of modified Broström will have similar outcomes as no peroneal exploration.

Methods:

A retrospective analysis was performed of patients undergoing modified Broström with and without peroneal exploration. Foot and Ankle Outcome scores and data regarding military retention were gathered and compared.

Results:

Seventeen patients were identified in the modified Broström only cohort and 24 in the peroneal exploration cohort. Patients had mean follow-up of 5 years in both cohorts. The mean FAOS in the modified Broström only cohort was 68 and 72 in the cohort with peroneal exploration (P = .541). When each FAOS subcategory was analyzed, no difference was identified in any subcategory. Eight of 17 patients (47%) in the modified Broström only cohort remained active duty compared with 8 of 24 patients (33%) in the modified Broström with peroneal exploration cohort (P = .518). One patient medically discharged in the modified Broström only cohort versus 6 in peroneal exploration cohort (P = .109). Overall satisfaction with the procedure was 12 of 17 (71%) in the modified Broström only cohort and 19 of 24 (79%) in the peroneal exploration cohort (P = .529).

Conclusions:

No significant difference was identified between patients undergoing modified Broström alone or modified Broström with peroneal exploration. There was no significant difference in return to duty, medical discharge or patient satisfaction.

Levels of Evidence:

Level III: retrospective case-control study with prospectively collected data
Global trends in chronic thromboembolic pulmonary hypertension clinical trials and dissemination of results
Authors: McInnis Micheal C. , Chow Clement T. , Boutet Alexandre , Mafeld Sebastian , Granton John , McRae Karen , Donahoe Laura , de Perrot Marc
Published: November 2021

Treatment options for chronic thromboembolic pulmonary hypertension (CTEPH) are rapidly expanding. The purpose of this study is to identify trends in CTEPH clinical trials and the publication of results. We performed a worldwide review of completed and ongoing clinical trials through searching the ClinicalTrials.gov database and the World Health Organization International Clinical Trials Registry Platform for “CTEPH” and related terms. Entries were classified as pharmaceutical/procedural interventions (Group 1), all other clinical trials (Group 2) and patient registries (Group 3). Trial characteristics and national affiliation were recorded. PubMed was searched for related publications. There were 117 clinical trials registry entries after removing duplicates and non‐target records. Group 1 comprised 29 pharmaceutical, 15 procedural, and four combined interventions starting in 2005, 2010, and 2016, respectively. Riociguat and balloon pulmonary angioplasty were the most frequent pharmaceutical and procedural interventions, respectively. The proportion of procedural trials increased over time from 0% of those in 2005–2009 to 29% in 2010–2014 and 54% in 2015–2020. There were 56 entries in Group 2 and 13 in Group 3. Japan was the most frequent national affiliation and the most frequent participating country, present in 28% of all trials. The proportion of entries with published results was highest with Group 3 (62%) and lowest with Group 1 (27%). Thirty percent of all publications occurred in 2020. In conclusion, CTEPH clinical trials are increasingly procedural based, with growth largely attributable to Japan and balloon pulmonary angioplasty. Most trials have not published, but results from balloon pulmonary angioplasty clinical trials are anticipated soon.
Epidemic Control and Resource Allocation: Approaches and Implications for the Management of COVID-19
Authors: Nyiwul Linus
Published: November 2021

The experience with COVID-19 underscores a classic public policy choice problem: how should policymakers determine how to allocate constrained budgets, limited equipment, under-resourced hospitals and stretched personnel to limit the spread of the virus. This article presents an overview of the general literature on resource allocation in epidemics and assess how it informs our understanding of COVID-19. We highlight the peculiarities of the pandemic that call for a rethinking of existing approaches to resource allocation. In particular, we analyse how the experience of COVID-19 informs our understanding and modelling of the optimal resource allocation problem in epidemics. Our delineation of the literature focuses on resource constraint as the key variable. A qualitative appraisal indicates that the current suit of models for understanding the resource allocation problem requires adaptations to advance our management of COVID-19 or similar future epidemics. Particularly under-studied areas include issues of uncertainty, potential for co-epidemics, the role of global connectivity, and resource constrained problems arising from depressed economic activity. Incorporating various global dimensions of COVID-19 into resource allocation modelling such a centralized versus decentralized resource control and the role of geostrategic interests could yield crucial insights. This will require multi-disciplinary approaches to the resource allocation problem.

JEL Classifications: I14, I18, E61, D60, H4, H12
MRI Findings of Early Osteoarthritis in Patients Who Sustained Septic Arthritis of the Knee After ACL Reconstruction
Authors: Meglic Uros , Salapura Vladka , Zupanc Oskar
Published: November 2021

Background:

Although a rare complication, septic arthritis (SA) after anterior cruciate ligament (ACL) reconstruction has potentially devastating consequences for the knee joint.

Purpose:

To prospectively analyze, at a mean 4-year follow-up, subjective, clinical, radiographic, and magnetic resonance imaging (MRI) findings between patients with SA and those with no septic complication after ACL reconstruction.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

Of 2006 ACL reconstructions performed between 2004 and 2014, a total of 20 patients experienced SA. All patients were treated with arthroscopic irrigation and graft-retaining debridement immediately after diagnosis and at least 6 weeks of antibiotic treatment. After the exclusion process, 18 patients were included in the SA group and 20 in the control group. At final follow-up at a mean 48 months, a physical examination, KT-1000 arthrometer laxity test, Lysholm knee score, Tegner activity score, and International Knee Documentation Committee radiographic score were completed and then compared with preoperative data. The Boston-Leeds Osteoarthritis Knee Score was used for MRI evaluation at final follow-up to note chondral changes.

Results:

No significant differences between the SA and control groups were observed in pre- and perioperative variables that could indicate a higher incidence of early osteoarthritis (OA). Although range of motion and knee stability were not significantly different between the groups at final follow-up, the Lysholm score (mean ± SD, 79.8 ± 13.1 vs 90.9 ± 8.6; P < .01) and Tegner score (6.0 ± 1.1 vs 7.0 ± 1.4; P = .03) were significantly lower in the SA group as compared with the control group. MRI evaluation at final follow-up demonstrated a significantly higher degree of early knee OA in the SA group versus the control group. However, no differences in the degree of OA were seen on plain radiographs at final follow-up between the groups.

Conclusion:

MRI evaluation provided signs of worsened chondral state in the SA group, which could be associated with reduced functional outcome and return to sports. In contrast to radiograph analyses, MRI was excellent at distinguishing damage to the cartilage and can be useful in early follow-up evaluation of patients with SA after ACL reconstruction.
Seismic hazard analyses of the Metropolitan Water District Emergency Freshwater Pathway, California
Authors: Wong Ivan , Thomas Patricia , Lewandowski Nora , Unruh Jeffrey , Darragh Bob , Silva Walt , Majors Dennis
Published: November 2021

The Sacramento-San Joaquin Delta in central California is particularly susceptible to damage in a large earthquake due to the vulnerability of the levees that protect cities, farms, and infrastructure. The Delta is located adjacent to the seismically active San Andreas fault system and is also subject to strong ground shaking from numerous other seismic sources in central California, including faults within the Delta. We performed a probabilistic seismic hazard analysis (PSHA) to provide seismic design ground motions for the Metropolitan Water District (MWD) Emergency Freshwater Pathway. We have evaluated the appropriateness of the Next Generation of Attenuation (NGA)-West2 ground motion models for use in our analyses of the Delta, evaluated shear-wave velocity ( VS) data in the vicinity of the Pathway, and performed site response analyses. The latter was performed to compute the probabilistic hazard at the top of the peat at five sites along the Pathway. The sixth site was located outside the Delta and on firm soil. The probabilistic hazard for the six sites and for a range of return periods of engineering relevance were computed in the PSHA. For a return period of 2500 years, the peak horizontal ground acceleration (PGA) values on peat ranged from 0.40 g to 0.53 g. The seismic sources that control the hazard at these sites vary as a function of return period and spectral frequency, but in general, the closer the sites are to faults within the San Andreas fault system, the higher the hazard.
Associations between screen time, physical activity, and depressive symptoms during the 2019 coronavirus disease (COVID-19) outbreak among Chinese college students
Authors: Zhang Yi , Wu Xiaoyan , Tao Shuman , Li Shiyue , Ma Le , Yu Yizhen , Sun Guilong , Li Tingting , Tao Fangbiao
Published: November 2021

Background

The 2019 novel coronavirus disease (COVID-19) emerges in China, which spreads rapidly and becomes a public health emergency of international concern. Chinese government has promptly taken quarantine measures to block the transmission of the COVID-19, which may cause deleterious consequences on everyone’s behaviors and psychological health. Few studies have examined the associations between behavioral and mental health in different endemic areas. This study aimed to describe screen time (ST), physical activity (PA), and depressive symptoms, as well as their associations among Chinese college students according to different epidemic areas.

Methods

The study design is cross-sectional using online survey, from 4 to 12 February 2020, 14,789 college students accomplished this online study, participants who did not complete the questionnaire were excluded, and finally this study included 11,787 college students from China.

Results

The average age of participants was 20.51 ± 1.88 years. 57.1% of the college students were male. In total, 25.9% of college students reported depression symptoms. ST > 4 h/day was positively correlated with depressive symptoms (β = 0.48, 95%CI 0.37–0.59). COVID-19ST > 1 h/day was positively correlated with depressive symptoms (β = 0.54, 95%CI 0.43–0.65), compared with COVID-19ST ≤ 0.5 h/day. Compared with PA ≥ 3 day/week, PA < 3 day/week was positively associated with depression symptoms (β = 0.01, 95%CI 0.008–0.012). Compared with low ST and high PA, there was an interaction association between high ST and low PA on depression (β = 0.31, 95%CI 0.26–0.36). Compared with low COVID-19ST and high PA, there was an interaction association between high COVID-19ST and low PA on depression (β = 0.37, 95%CI 0.32–0.43). There were also current residence areas differences.

Conclusions

Our findings identified that high ST or low PA was positively associated with depressive symptoms independently, and there was also an interactive effect between ST and PA on depressive symptoms.
Survey of knowledge, attitude and practice of healthcare professionals on dengue transmission, diagnosis and clinical classification
Authors: Giang Hoang Thi Nam , Sayed Ahmed M. , Dang Thao , Iqtadar Somia , Tuan Nguyen Minh , Khiem Nguyen Tuan , Viet Do Chau , Van Tran Thi Kim , Phuoc Nguyen Thanh , Dung Tran Thi Kim , Elhalwagy Esraa Ahmed , Vien Le Huu Linh , Triet Nguyen Minh , Tong Nguyen Thanh , Son Do Hong , Hung Lieu Chi , Tam Dong Thi Hoai , Hirayama Kenji , Huy Nguyen Tien
Published: November 2021

Background

To investigate the knowledge, attitudes, and practices of the healthcare professionals (HCPs) including physicians and nurses regarding dengue transmission, diagnosis and clinical classification using the warning signs of World Health Organization (WHO) 2009 classification.

Results

Out of 471 respondents from three countries, 80.9% of physicians and 74% of nurses did not receive previous training regarding the dengue infection. The majority of respondents could identify the primary dengue vector (86%), while only a third of HCPs knew the biting time of dengue mosquitoes. Only half of our respondents knew about immunity induced by serotypes; Moreover, half of our participants could determine the diagnostic tests. On the other hand, about 90% of the respondents took responsibility for talking to the patients about preventive measures. Our respondents also showed wide variations in definition of warning signs listed in the WHO 2009 classification. Multivariate analysis linked the impact of different cofactors including prior training on dengue infection, type of profession, frequency of taking care of dengue patients and country on how HCPs defined these warning signs.

Conclusions

This study could declare the variation in employing the warning signs listed in the WHO 2009 classification. We have figured that most of the HCPs did not take prior training on the dengue viral infection; Also, we found gaps in the knowledge regarding various topics in dengue fever. This paper recommends the gathering of efforts to establish the proper knowledge of dengue infection and the warning signs listed by the WHO.
Information needs and experiences from pregnancies complicated by hypertensive disorders: a qualitative analysis of narrative responses
Authors: Shree Raj , Hatfield-Timajchy Kendra , Brewer Alina , Tsigas Eleni , Vidler Marianne
Published: November 2021

Background

Incorporation of the patient voice is urgently needed in a broad array of health care settings, but it is particularly lacking in the obstetrical literature. Systematically derived information about patients’ experience with hypertensive disorders of pregnancy (HDP), most notably preeclampsia, is necessary to improve patient-provider communication and ultimately inform patient-centered care and research.

We sought to examine the information needs and experiences of individuals with pregnancies complicated by hypertensive disorders.

Methods

We conducted a qualitative content analysis of narrative-responses to an open-ended question from the Preeclampsia Registry (TPR), an online registry hosted by the Preeclampsia Foundation. Individuals were invited to enroll in TPR via social media, web searches, and newsletters. We restricted our analysis to participants who self-reported a history of HDP and responded to the open-ended question, “Is there any information that you could have had at the time of this pregnancy that would have been helpful?”. Available responses from July 2013 to March 2017 were included. Narrative responses were coded, reconciled, and thematically analyzed by multiple coders using an inductive approach. Our main outcome measures included participants’ expressed needs and additional concerns with respect to their HDP pregnancy.

Results

Of 3202 enrolled participants, 1850 completed the survey and self-reported having at least one pregnancy complicated by HDP, of which 895 (48.4%) responded to the open-ended question. Participants delivered in the United States (83%) and 27 other countries. Compared to non-responders, responders reported more severe HDP phenotypes and adverse offspring outcomes. We identified three principal themes from responses: patient-identified needs, management and counseling, and potential action. Responses revealed that participants’ baseline understanding of HDP, including symptoms, management, therapeutic strategies, and postpartum complications, was demonstrably lacking. Responders strongly desired improved counseling so that both they and their providers could collaboratively diagnose, appropriately manage, and robustly and continuously communicate to facilitate a partnership to address any HDP complications.

Conclusions

Participants’ responses regarding their HDP experience provide indispensable insight into the patient’s perspectives. Our study suggests that improved education regarding possible HDP complications and transparency about the consideration of HDP and its associated outcomes during an evaluation are needed, and efforts to implement these strategies should be sought.

Trial registration

The Preeclampsia Registry: NCT02020174