bluuebunny/crossref_metadata_2025 huggingface dataset:
Extended Total Temporomandibular Joint Replacement – A Feasible Option for Functional and Aesthetic Reconstruction of Mandibular Defects Involving the Temporomandibular Joint
Authors: Schlabe Juergen , Davies Rhodri O.H.L. , Aagaard Esben , Cousin Gary , Edwards Andrew Ian , McAlister Kenneth , Cascarini Luke
Published: May 2022

Study design: Retrospective case series.

Objective: Alloplastic temporomandibular joint replacement has been established as a standard technique for end- stage temporomandibular (TMJ) pathologies. Joint replacement when there are extensive mandibular defects remains a challenging clinical problem. Custom-made extended temporomandibular joint replacement is a feasible option but there is limited information about this emerging technique.

Methods: Included were all patients undergoing extended TMJ-replacements (TMJe), all operatrions were carried out by the senior author. Surgical technique was either single stage or two stage protocol. Surgical details and pitfalls and outcome of more than 2 years follow-up with reference to thirteen including twelve patients were recorded.

Results: The most common diagnosis was ameloblastoma of the mandibular ramus. Single stage or two stagge regime were carried out depending on resection requirements and involvement of teeth. Improved mouth opening of more than 30mm was achieved in 10 of 12 patients. One patient with previous TMJ replacement reported temporary weakness of the facial nerve, which resolved after 10 months.

Conclusions: The authors suggest a simplified anatomically based single-stage or two-stage regime, with both regimes achieved excellent anatomic reconstruction, facial appearance and function with low surgical morbidity. Custom-made extended temporomandibular joint protheses appear an advanced and reliable solution for reconstruction of combined complex mandibular defects including the temporomandibular joint. If surgical clearance of the pathology can be achieved, a single-stage regime is favoured.
Mathematical Modeling of Vessel Geometry and Circumference in Microvascular Surgery
Authors: Nedrud Stacey , Fleissig Yoram , Sanjuan-Sanjuan Alba , Bunnell Anthony , Fernandes Rui
Published: May 2022

Introduction

Microvascular anastomosis has traditionally been executed with a perpendicular transection through the vessel at the widest diameter to increase circumference and thus increase blood flow while decreasing resistance. In Chen’s 2015 article, it was suggested that an “open Y” would improve vessel size match, and Wei and Mardini discuss angled transections of the vessels. This project aims to explore the geometric configurations feasible at the anastomotic transection and mathematically model the resulting hypothetical increases in circumference.

Materials and Methods

The mathematical models were theoretically developed by our team. The formulas model increases in circumference of the transection at different distances in relation to the bifurcation of a blood vessel, as well as changes in circumference at different transection angulations. An in vitro exploration as to the anastomotic feasibility of each geometric cut was completed on ten poultry tissue specimens.

Results

The mathematical models demonstrated the change in vessel circumference, with multiple geometric designs calculated, best shown through diagrams. For example, if the vessel width is 1 mm, the distance from the increasing vessel diameter to the final bifurcation is 1 mm, and the bifurcation angle is 45°, the circumference of the transected vessel increases by 82.8%. Models of transections at different angulations, for instance 30°, 45°, and 60°, yield an increase in elliptical circumference of 8.0%, 22.5%, and 58.1%, respectively. Additional derivations calculate the elliptical circumference at any angle in a single vessel, and at any angle in a bifurcating vessel.

Conclusion

The theoretical and clinical aim of this project is to increase awareness of the anastomotic creativity and mathematically demonstrate the optimal anastomotic geometry, which has not been objectively explored to our knowledge. An in vivo study would further support clinical improvements, with the aim to map postoperative fluid dynamics through the geometric anastomoses.
Astragalus Polysaccharide Relieves Inflammatory Responses in Guinea Pigs with Allergic Rhinitis via Ameliorating NF-kB-Mediated Treg/Th17 Imbalance
Authors: He Xian , Liu Lei , Luo Xiaoqin , Zhu Jiali , Yang Haoxiang , Wang Jian , Chen Long , Zhong Lunkun
Published: May 2022

Background

Allergic rhinitis (AR) is regarded as a prevalent and non-infectious inflammation in nasal mucosa, and astragalus polysaccharide (APS) could mitigate inflammation.

Objectives

Herein, this study probed the specific mechanism of APS in inflammatory responses in AR.

Methods

Firstly, AR guinea pig models were established through the stimulation and sensitization of ovalbumin (OVA) and received APS treatment. Changes in nasal symptoms were assessed through counting the sneezing and rubbing times of guinea pigs. The change patterns of OVA-specific immunoglobulin-E (OVA-sIgE), OVA-specific immunoglobulin-G1 (OVA-sIgG1), tumor necrosis factor (TNF)-α, and interleukin (IL)-6 in guinea pig serum were identified. Meanwhile, the levels of IL-17, transforming growth factor (TGF)-β, IL-10, and forkhead box protein P3 (Foxp3) in the guinea pig tissues or serum were examined, and CD25+Foxp3+Treg or CD4+IL17+Th17 cell proportion was detected. Afterwards, nuclear factor-kappa B (NF-kB) expression in guinea pig nasal mucosa tissues were examined. Rescue experiments were designed to probe the role of NF-kB overexpression in inflammatory responses and Treg/Th17 imbalance in AR guinea pigs.

Results

APS treatment reduced sneezing and rubbing times of AR guinea pigs and suppressed OVA-sIgE, OVA-sIgG1, TNF-α, and IL-6 levels in guinea pig serum, and meanwhile, increased CD25+Foxp3+Treg cell proportion while reduced CD4+IL17+Th17 cell proportion in AR guinea pig serum or tissues, in a dose-dependent manner. NF-kB was highly-expressed in AR guinea pigs and down-regulated after APS treatment. NF-kB overexpression facilitated inflammatory responses and Treg/Th17 imbalance in AR.

Conclusion

APS reduced Treg/Th17 imbalance via suppressing NF-kB expression, thereby ameliorating inflammatory responses in AR.
Efficacy and safety of cyclosporine A treatment in autoimmune cytopenias: the experience of two Italian reference centers
Authors: Fattizzo Bruno , Cantoni Silvia , Giannotta Juri Alessandro , Bandiera Laura , Zavaglia Rachele , Bortolotti Marta , Barcellini Wilma
Published: May 2022

Background:

Immune thrombocytopenia (ITP) and autoimmune hemolytic anemia (AIHA) show good responses to frontline steroids. About two-third of cases relapse and require second-line treatment, including rituximab, mainly effective in AIHA, and thrombopoietin-receptor agonists (TPO-RAs) in ITP, while the use of splenectomy progressively decreased due to concerns for infectious/thrombotic complications. For those failing second line, immunosuppressants may be considered.

Objectives:

The aim of this study was to evaluate the efficacy of cyclosporine treatment in patients with ITP and AIHA.

Design:

In this retrospective study, we evaluated the efficacy and safety of cyclosporine A (CyA) in ITP ( N = 29) and AIHA ( N = 10) patients followed at two reference centers in Milan, Italy.

Methods:

Responses were classified as partial [Hb > 10 or at least 2 g/dl increase from baseline, platelets (PLT) > 30 × 109/l with at least doubling from baseline] and complete (Hb > 12 g/dl or PLT > 100 × 109/l) and evaluated at 3, 6, and 12 months. Treatment emergent adverse events were also registered.

Results:

The median time from diagnosis to CyA was 35 months (3–293), and patients had required a median of 4 (1–8) previous therapy lines. Median duration of CyA was 28 (2–140) months and responses were achieved in 86% of ITP and 50% of AIHA subjects. Responders could reduce or discontinue concomitant treatment and resolved PLT fluctuations on TPO-RA. CyA was generally well tolerated, and only two serious infectious complications in elderly patients on concomitant steroids suggesting caution in this patient population.

Conclusion:

CyA may be advisable in ITP, which is not well controlled under TPO-RA, and in AIHA failing rituximab, particularly if ineligible in clinical trial.
Risperidone-induced neuroleptic malignant syndrome: a case report
Authors: Deng Ling , Qiu Zhi-Xin , Wang Mao-Yun
Published: May 2022

Neuroleptic malignant syndrome (NMS) is a rare illness that results from reactions to antipsychotics. However, the diagnosis of NMS is challenging due to its atypical clinical presentation and unclear pathogenesis. We report the case of a patient with NMS induced by irregular use of antipsychotics, especially risperidone (RSP). He had typical hyperthermia, muscle rigidity and rhabdomyolysis, which led to renal impairment. We carefully analysed the mechanism by which NMS occurred in this patient. An interesting aspect of the case is the synergistic involvement of risperidone, antidepressants, opioids and stress. Because of these complex predisposing factors, it is difficult to completely rule out the diagnosis of malignant hyperthermia (MH). In addition, the rare phenomenon of elevated lipase and amylase was observed in this patient.
Medical students in Karachi and COVID-19: Myths and facts
Authors: Jamil Omer Bin Khalid , Muhib Muhammad , Abbal Muhammad Anas , Ahmed Amna Muhammed , Khan Hafsa Hayat , khan Nabeela Yar
Published: May 2022

Objectives:

COVID-19 pandemic brought mortalities, morbidities, fear, and financial despair among people around the world. As it advanced, misinformation and myths about it caught wildfire, contributing to misbelief among the already shocked population. Medical students are the building blocks of the medical community and can provide a pivotal role in combating COVID-19 misinformation by delivering correct knowledge and awareness to the non-medical population of the country. Hence, it is important to assess their knowledge and perception of COVID-19 myths. Therefore, this study evaluates medical student’s knowledge regarding myths and misinformation related to COVID-19 infection and its vaccine. The study also assesses the belief of medical students on various conspiracy theories of COVID-19.

Methods:

An online cross-sectional survey was conducted among 401 undergraduate medical students of Karachi in June–August 2021. A validated, structured, and self-administrated questionnaire was used for data collection. The data were entered on an open EPI version 3.01 and Statistical Package of Social Science version 26 for analysis. A chi-square test was performed to identify determinant factors. All p-values less than 0.05 were considered significant.

Results:

Overall knowledge score of participants about myths and misinformation related to COVID-19 and its vaccine was as follows: 166 (28.9) participants possess good knowledge, while 167 (41.6) and 118 (29.4) had moderate to poor knowledge, respectively. Senior students, vaccinated, and participants infected by COVID-19 had good to moderate knowledge. Overall, 139 (34.7) participants strongly disagree and 103 (25.7) participants somewhat disagree with conspiracy theories related to COVID-19. Absence of belief in the conspiracies is associated with vaccinated participants.

Conclusion:

The study shows that most medical students possess adequate knowledge of misinformation about COVID-19 and its vaccines, and have low belief in conspiracy theories of COVID-19.
Depression, anxiety, and diabetes-related distress in type 2 diabetes in primary care in Greece: Different roles for glycemic control and self-care
Authors: Kintzoglanakis Kyriakos , Gkousiou Anna , Vonta Paraskevi , Sagmatopoulos Agisilaos , Copanitsanou Panagiota
Published: May 2022

Objectives:

The psychological distress of people living with diabetes is increased and associated with poorer glycemic outcomes and self-care. We aimed to examine the frequency of depression, anxiety, and diabetes-related distress (DRD) of individuals with type 2 diabetes (T2D) in primary care (PC) and their comparative associations with clinical, self-care, and socio-demographic characteristics, testing for possible different roles on glycemic control and self-care.

Methods:

This is a cross-sectional study of 182 adults with a T2D diagnosis of at least six months, recruited between August 2019-March 2020 and May-October 2020, from an urban PC unit. Participants were screened for symptoms of depression (Patient Health Questionnaire-9 (PHQ-9)), anxiety (Generalized Anxiety Disorder-7 (GAD-7)), and DRD (Diabetes Distress Scale (DDS)). Clinical, self-care, and socio-demographic parameters were recorded.

Results:

The frequency of clinically significant symptoms of depression was 16.6%, (PHQ-9 score ⩾10), anxiety 17.7% (GAD-7 score ⩾10), and DRD 22.6% (DDS score ⩾2). All PHQ-9, GAD-7, and DDS scores intercorrelated, and higher scores were found to be associated with female gender, lower income, and prior diagnosis of depression. Higher PHQ-9 and GAD-7 scores were found to be associated with lower education, more hypoglycemia episodes, more blood glucose self-tests and antidepressant or benzodiazepine use. The retired/housewives scored significantly lower in GAD-7 and DDS compared to the unemployed participants. Higher DDS scores were associated with higher glycated hemoglobin, higher fasting plasma glucose, and insulin use. It was also noted that higher PHQ-9 scores were associated with lower uric acid levels and were significantly higher in the sedentary lifestyle group.

Conclusion:

DRD was associated with poorer glycemic outcomes while depressive symptoms were associated with lower physical activity perhaps sharing different roles for glycemic control and self-care. The psychological burden of individuals with T2D may be considered in PC.
Cataract extraction after inadvertent Nd:YAG laser capsulotomy in a phakic eye
Authors: Moshirfar Majid , Tukan Alyson N , Bundogji Nour
Published: May 2022

Inadvertent neodymium: yttrium–aluminum–garnet (Nd:YAG) capsulotomies are rare, with only one incident reported in the literature prior to the present case. We discuss the management of a phakic patient with a dense posterior subcapsular cataract who underwent yttrium–aluminum–garnet (YAG) capsulotomy for presumed posterior capsular opacification. Operative course involved cataract surgery with anterior vitrectomy for prolapsed lens fragments due to the disrupted posterior capsule. This patient experienced excellent visual outcomes postoperatively, with ultimate best-corrected visual acuity of 20/20. This case underscores the importance of thorough preoperative time out, including confirmation of patient’s understanding of the intended procedure.
Evaluating the impact of a novel telerehabilitation service to address neurological, musculoskeletal, or coronavirus disease 2019 rehabilitation concerns during the coronavirus disease 2019 pandemic
Authors: Brehon Katelyn , Carriere Jay , Churchill Katie , Loyola-Sanchez Adalberto , O’Connell Petra , Papathanasoglou Elisavet , MacIsaac Rob , Tavakoli Mahdi , Ho Chester , Manhas Kiran Pohar
Published: May 2022

Introduction

A novel telerehabilitation service provides wayfinding and self-management advice to persons with neurological, musculoskeletal, or coronavirus disease 2019 related rehabilitation needs.

Method

We utilized multiple methods to evaluate the impact of the service. Surveys clarified health outcomes (quality of life, self-efficacy, social support) and patient experience (telehealth usability; general experience) 3-months post-call. We analysed associations between, and within, demographics and survey responses. Secondary analyses described health care utilization during the first 6 months.

Results

Sixty-eight callers completed the survey (42% response rate). Self-efficacy was significantly related to quality of life, interpersonal support and becoming productive quickly using the service. Becoming productive quickly was significantly related to quality of life. Education level was related to ethnicity. Survey respondents’ satisfaction and whether they followed the therapist's recommendations were not significantly associated with demographics. Administrative data indicated there were 124 callers who visited the emergency department before, on, or after their call. The average (SD) frequency of emergency department visits before was 1.298 times (1.799) compared to 0.863 times (1.428) after.

Discussion

This study offers insights into the potential impact of the telerehabilitation service amidst pandemic restrictions. Usability measurements showed that callers were satisfied, corroborating literature from pre-pandemic contexts. The satisfaction and acceptability of the service does not supplant preferences for in-person visits. The survey sample reported lower quality of life compared with the provincial population, conflicting with pre-pandemic research. Findings may be due to added stressors associated with the pandemic. Future research should include population-level comparators to better clarify impact.
Toxic Social Media: Affective Polarization After Feminist Protests
Authors: Suarez Estrada Marcela , Juarez Yulissa , Piña-García C. A.
Published: May 2022

The objective of this article is to conceptualize affective polarization beyond partisan politics to instead analyze the ways in which women’s affective political participation is subject to toxic discipline. While a lot of focus has been placed on affective politics as mechanisms for governance, little has been done regarding affective polarization after feminist protest. In this article, we bridge two bodies of literature—affective politics and political polarization—by proposing the notion of affective polarization. We focused on the case of a series of feminist mobilizations that took place to fight back against the impunity of police violence in Mexico. We conducted a mixed-method approach that combines, on one hand, quantitative analysis of data strand tweets encompassing #EllasNoMeRepresentan (TheyDoNotRepresentMe) ( N = 17,698) and #EllasSiMeRepresentan (TheyDoRepresentMe) ( N = 6700) and, on the other hand, a qualitative analysis of 500 tweets of each hashtag. The results of the study revealed the existence of polarization that aims at disciplining the affective political participation of women. Almost half of our data contain negative sentiments. The toxic tweets include corrective threats, such as incitation to sexual violence, murder, hate against feminism, and patronizing discourses about how women should protest. We thus conclude that while it is true that social media has amplified feminist mobilization, it has also led to an increase of digital violence. With these findings, the article contributes to a better understanding of both feminist affective politics and its disciplining governing mechanisms in a patriarchal social media.
Atresia of the Midportion of the Coronary Sinus: A Case Report
Authors: Kaplan Bryan , Evans William N. , Restrepo Humberto , Rothman Abraham
Published: May 2022

A 12-year-old with a history of critical pulmonary stenosis and moderate right ventricular hypoplasia underwent neonatal pulmonary valve dilation, an aortopulmonary shunt, and an infant cavopulmonary anastomosis with aortopulmonary shunt takedown. During a diagnostic cardiac catheterization at 12 years of age, angiography showed interruption in the midportion of the coronary sinus, which required no intervention.
Anti-racism in Criminology: An Oxymoron or the way Forward?
Authors: Palmer Jane E. , Rajah Valli , Wilson Sean K.
Published: May 2022

Since the uprisings of 2020 in the aftermath of the police-perpetrated the murders of George Floyd and Breonna Taylor, universities – and some departments – have expressed their commitments to anti-racism in public statements. While statements are laudable, what matters most is how anti-racism is actualized in our classrooms, our syllabi, our departmental policies and practices, our research, and the discipline of criminology. In this paper, we outline the racist history of “criminality,” policing, prisons, and criminology, along with current manifestations of systemic racism in the criminal legal system. Against this backdrop, we aim to start a conversation about whether it is possible for the discipline to be proactively anti-racist or if this transformation is impossible due to the discipline's historical - and ongoing - complicity with racism. We also offer questions for criminology departments to consider if they seek to actively uproot present day racism within the discipline and the criminal legal system.
Students’ Actual Use of E-Learning in Higher Education During the COVID-19 Pandemic
Authors: Gurban Masouda A. , Almogren Abeer S.
Published: May 2022

The purpose of this study was to look at factors that might influence whether or not academics will use e-learning during the Corona Virus Disease 2019 (COVID-19) pandemic. The goal of this paper is to look into the effect of perceived interaction, educational materials, playfulness, perceived enjoyment, self-efficacy, perceived usefulness, and perceived ease of use on students’ attitudes toward and intentions to use e-learning in Saudi Arabia higher education during the COVID-19 pandemic, as well as the indirect impact of student satisfaction with their actual use of e-learning. The research model was evaluated using structural equation modeling (SEM) and route analysis, which were based on e-learning user data collected through a survey. Student happiness and desire to use e-learning both had a beneficial impact on actual use, according to the statistics. During the COVID-19 epidemic, perceived interaction and self-efficacy were shown to be the most important factors influencing perceived usefulness and ease of use, which affected students’ intentions and satisfaction with e-learning. The study’s participants were e-learning users from a government university in Saudi Arabia. Previous studies on e-learning in developing nations have seldom taken a holistic approach. This paper also aims to include a literature review of recent published studies in the field of e-learning usage during the COVID-19 outbreak.
The Impacts of Media Exposure on COVID-19 Preventive Behaviors Among Vietnamese People: Evidence Using Expanded Protection Motivation Theory
Authors: Truong Nguyen Xuan , Ngoc Bui Hoang , Ha Nguyen Thai
Published: May 2022

In the context of no prescriptive medications and lack of sufficient vaccine, COVID-19 preventive behaviors were a top priority, particularly for developing countries. This study aimed to determine how the media influenced preventive behaviors of Vietnamese people against COVID-19. A mixed method was conducted, including qualitative research by a focus group with 11 participants and quantitative research by cross-section with 609 respondents. The results showed that media exposure was directly associated with increased perceived severity, perceived vulnerability, perceived self-efficacy, and knowledge about COVID-19 and indirectly associated with COVID-19 preventive behaviors. There were slight differences in the impacts of media on mediating constructs and preventive behaviors by generation, and no significant differences among subgroups by gender, place of residence, and educational level. This finding offered some implications that communication practice should specifically prioritize improving knowledge on COVID-19, its severity and vulnerability. Furthermore, public awareness towards threat appraisal, coping appraisal, and active conduction COVID-19 preventive behaviors.
The Status of Women in Kurdish Society and the Extent of Their Interactions in Public Realm
Authors: Alizadeh Hooshmand , Kohlbacher Josef , Mohammed Sara Qadir , Vaisi Salah
Published: May 2022

Apart from the traditional Kurdish gender regime, which originates from the Kurdish tribal structure and which to some extent restricts the visibility of women in society, the status of Kurdish women is considered to be relatively high in comparison with that of their neighbors, since Kurdish women enjoy relative tolerance in society. This includes the possibility of reaching high professional positions, their presence in public spaces, and entertaining guests in the absence of their husbands. Certain socio-economic and political transformations took place in recent decades, which improved Kurdish women’s social standing, turning it into a symbol representing fundamental change in the gender role model in the Middle East. Although there are some studies on the status of Kurdish women in different individual Kurdish regions throughout the Middle East, not many reviews have compared the four parts of Kurdistan simultaneously, and there are hardly any specific analyses dealing with Kurdish women’s interactions in public spaces. This review aims to investigate the status of women in Kurdish society in different Kurdish regions according to a comparative approach. Although the path of Kurdish female emancipation was initiated first in the region of Rojhalat in 1946 and the Kurdish region of Iraq was granted some opportunities toward national liberation in 1991, the Bakur in Turkey can be considered a successful movement, establishing a sustained approach to the liberation of Kurdish women from patriarchal structures. During the Rojava Revolution in northern Syria, this movement proved itself able to build an indigenous alternative to Western-type egalitarian societies.
Motivation for Ecopreneurial Behavior (MEB): Scale Development and Validation
Authors: Guleria Deepa , Kaur Gurvinder
Published: May 2022

The study helps in construct development for identifying motivators for adopting ecopreneurial behavior in StartUps. The study aims to address the limitations of previous studies that we are unable to suggest any such scale. The extensive literature review helped in forming initial statements. These statements underwent a few rounds of expert consultation and helped in identifying 20 statements. The exploratory factor analysis on a sample of 140 StartUps, suggested three major motivations that lead to ecopreneurial behavior. Later, confirmatory factor analysis using 160 respondents helped in offering a reliable and valid scale to evaluate these motivations in another sample of Startups to adopt ecopreneurial behavior. The study initiates to fill the gap of empirical contribution in the field of ecopreneurship and would help in the expansion of this field globally by identifying factors that are responsible for adopting ecoprenuerial behavior and foresee its linkages further.
Lateral Lumbar Interbody Fusion With rhBMP-2 can Achieve High Fusion Rates in Adult Spine Deformity Surgeries
Authors: Singh Vishwajeet , Oppermann Marcelo , Evaniew Nathan , Soroceanu Alex , Nicholls Fred , Jacobs W. Bradley , Thomas Ken , Swamy Ganesh
Published: May 2022

Study design

An ambispective, observational study of the prospective, institutional adult spine deformity (ASD) database.

Objectives

The study investigates the clinical and radiographic fusion rates with lateral interbody approach and rhBMP-2 in multiple-level lumbar fusion in the ASD population. Previous studies have reported over 10% pseudoarthrosis rate with multiple segment fusions. Lateral lumbar interbody fusion (LLIF) allows multiple-level, less-invasive access to the anterior lumbar spine. We hypothesized that fusion rates with lateral approach with rhBMP-2 use are superior to the published data on lumbar fusion in ASD patients.

Methods

The institutional ASD database was searched to identify eligible patients with two or more levels of LLIF (T12-L5), >4 levels of posterior instrumentations and >2 years of follow-up between the years 2010 and 2018. Antero-posterior and lateral 36-inch standing radiographs for each patient and computed tomography scans in select patients were studied to ascertain fusion status and patients were divided into two groups based on fusion status.

Results

The study included 179 patients with a mean age of 65.3 years and 74% female patients. The median number of interbody fusions was performed at 3 (IQR 3-4) levels. The mean follow-up duration was 4.4 years (SD = 1.9). 169 patients (94.5%) had successful arthrodesis, while 10 patients (5.5%) had radiological pseudoarthrosis at one level. Of the 10 patients, 8 (4.4%) were either clinically asymptomatic or had manageable back pain. Two patients (1.1%) required revision surgery for symptomatic pseudoarthrosis.

Conclusion

This is the largest known series of ASD patients investigating the fusion rates with multiple-level LLIFs. LLIF along with rhBMP-2 can achieve high fusion success across interbody fusion levels in multi-segmental ASD surgeries.
Foreign Institutional Ownership and Its Impact on Investment Efficiency in Manufacturing Firms: Evidence from Indian Capital Market
Authors: Banerjee Souvik , Mohanti Debaditya
Published: May 2022

This article explores the impact of foreign institutional investor’s (FII) ownership on the investment efficiency of Indian manufacturing firms. In this article, unbalanced panel data is used, in total, 21,214 firm-year observations of 1,205 companies listed in Centre for Monitoring Indian Economy (CMIE) COSPI (CMIE Overall Share Price Index) are taken into account. The data range is from 2001 to 2019. This research article considers investment-investment opportunities sensitivity as the proxy for investment efficiency, where investment opportunities are measured Tobin’s Q. As per our findings FII’s ownership impacts investment efficiency in a negative way. It is further found that this inverse relationship between FII’s ownership and investment efficiency is more pronounced in resource abundant firms, compared to the resource constrained firms. In this study both fixed as well as random effect models are developed incorporating robust standard error, additionally system generalized method of moments (GMM) model as well as two step Heckman model are also used to check the robustness of the findings.

This study adds to the existing literature as a pioneering study on impact of FII’s ownership on firm’s investment efficiency in the context of India, a large emerging market economy.
Depression and Anxiety in Youth and Young Adults Living with HIV: Frequency and Associated Factors in Thai Setting
Authors: Chantaratin Sasitorn , Trimetha Kawita , Werarak Peerawong , Lapphra Keswadee , Maleesatharn Alan , Rungmaitree Supattra , Wittawatmongkol Orasri , Phongsamart Wanatpreeya , Kongstan Nantaka , Khumcha Benjawan , Chokephaibulkit Kulkanya
Published: May 2022

Integrative mental health care in HIV patients is an important contributor to successful therapy. This is a cross-sectional study in youth and young adults who attend routine HIV clinic at a tertiary care centre in Bangkok. We recruited 100 youth and 130 young adults living with HIV to evaluate the frequency of depression and anxiety and associated sociodemographic including sexual orientation and health-related behaviours. Overall, about a fifth of the participants had significant depression or anxiety. Interestingly, we found different factors associated with depression in youth and young adults living with HIV. Loss of their father, loss of close relatives or friends, and being unemployed or school exclusion were the factors associate with depression in youth; while dangerous alcohol use, feeling discriminated against and having lipodystrophy were factors in young adults. The understanding of the frequency and different associated factors can inform more effective prevention and treatment strategies.
Descriptive Epidemiology of Complete ACL Tears in the Skeletally Immature Population: A Multicenter Investigation of the Pluto Study
Authors: Hutchinson LE , Christino MA , Pennock AT ,   PLUTO Study Group, Kocher MS
Published: May 2022

Background:

ACL injuries are being seen with increased frequency in pediatric and adolescent patients. Understanding patient and injury characteristics as well as treatment strategies are important to help guide future surgical decisions in the care of these young patients.

Hypothesis/Purpose:

To report the demographic characteristics and descriptive epidemiology of a large cohort of skeletally immature patients with complete ACL tears through a prospective, multicenter study.

Methods:

At 10 geographically diverse institutions in the United States, consecutive skeletally immature patients diagnosed with complete ACL tears between January 2016 and April 2020 were enrolled. Treatment was provided by one of 23 participating orthopedic surgeons. Patient demographics, including chronological and skeletal age, sex, race, ethnicity, as well as anthropometric measures, mechanism of injury, and ACL treatment type were collected.

Results:

748 skeletally immature patients were included in the final cohort; the mean chronological age was 12.3 years, and 62.3% were male. Mean skeletal age (13.2 years) was on average 0.9 years higher than mean chronological age (p<0.001). The median BMI percentile for the cohort was 71st (IQR, 45-88), and 10.8% were classified as obese (≥95th percentile). 5.3% reported a previous ipsilateral knee injury, and 32.5% had a family history of ACL injuries. Sport was the predominant mechanism of injury (89.4%), with non-contact injuries the most common (61.5%). When stratified by sex, non-contact injury was significantly higher in females (68.3%) than males (57.4%) (p=0.005). The most common sport resulting in an ACL tear among males was football (41.2%) and among females was soccer (44.2%) (p<0.001). 99.9% percent of skeletally immature patients were treated surgically by one of four reconstruction techniques: transphyseal (52.7%), partial transphyseal (7.1%), all-epiphyseal (13.1%), and the physeal sparing iliotibial band (ITB) technique (27.0%). One patient underwent non-operative treatment. The most common surgical techniques for patients with a bone age younger than 13 years were physeal sparing with ITB (56.7%) and all-epiphyseal (21.8%), while in patients with a bone age of 13 years and older, transphyseal (71.1%) and physeal sparing with ITB (11.9%) were most common (p<0.001).

Conclusion:

This multicenter, prospective study is the first to describe the characteristics of an exclusively skeletally immature cohort with complete ACL tears. Almost all patients were injured during sports, surgical treatment was overwhelmingly the treatment of choice, and preferred surgical techniques varied based on skeletal age.
Change in Body Weight and Body Mass Index of Adolescents and Adults From Pre-Surgery to Post-Anterior Cruciate Ligament Reconstruction
Authors: Triplett Ashley N. , Woeber Nathan A. , Pivarnik James M. , Wilcox Christopher L. , Currie Katharine D. , Kuenze Christopher M.
Published: May 2022

Background:

Physical activity (PA) participation can moderate weight status and body mass index (BMI), with reduced PA being associated with weight gain and elevated BMI. Previous studies have observed lower PA engagement among individuals with a history of anterior cruciate ligament reconstruction (ACLR) when compared to their uninjured peers. This reduction in PA may be due to activity limitations during rehabilitation and failure of some patients to return to sport. Limited evidence has also shown an increase in body weight and BMI following surgery that may remain elevated in adolescent patients up to 2 years post-ACLR. Overall, body weight and BMI changes from pre-surgery to post-ACLR for adolescents and adults are not well-understood.

Purpose:

The purpose of this study was to assess change in body weight and BMI from pre-surgery to 6 months post-ACLR in adolescent and adult patients.

Methods:

A retrospective chart review was conducted including adult (age ≥20) and adolescent (ages 13-19) patients who underwent primary, unilateral ACLR and were previously enrolled in a prospective cohort study. BMI was calculated [weight (kg)/ height (m2)] for all adult participants and BMI percentile was calculated for all participants under the age of 20 to account for changes in growth and maturation during adolescence. Pre-surgery to 6-months post-ACLR values for body mass, absolute BMI, and BMI percentile were compared using paired sample t-tests. Statistical significance was established a priori as α≤0.05.

Results:

One hundred and 16 adolescents with ACLR (67 female; age= 16.7 ± 1.6yrs, months since surgery= 6.2 ± 0.7) and 63 adults (29 female; age= 27.2 ± 7.4yrs, months since surgery= 6.4 ± 0.7) participated. Adolescent participants experienced a significant increase in body mass (pre-ACLR= 70.1 ± 15.1kg, post-ACLR= 72.4 ± 16.9kg; p<0.001) and BMI percentile (pre-ACLR= 65 ± 25, post-ACLR= 67 ± 25; p=0.02) from pre-surgery to 6 months post-ACLR. Adult patients also experienced a significant increase in body mass (pre-ACLR= 80.2 ± 19.9kg, post-ACLR= 82.1 ± 20.1kg; p<0.001) and BMI (pre-ACLR= 26.1 ± 4.5kg/m2, post-ACLR= 26.7 ± 4.9kg/m2; p=0.006).

Conclusion:

Adults and adolescents experienced an increase in body weight and BMI in the 6 months following ACLR. Revising rehabilitation to extend beyond traditional musculoskeletal strengthening to include focus on incorporation and maintenance of healthy lifestyle behaviors related to diet and PA should be considered to help patients with ACLR to minimize the potential for negative long-term effects of weight gain following surgery.
Injury Characteristics Among Pediatric Athletes Who did and did not Undergo a CT Scan Following Concussion
Authors: Worrall Hannah M. , Miller Shane M. , Chung Jane S. , Stokes Mathew A. , Tow Stephanie , Cullum C. Munro , Jones Jacob C.
Published: May 2022

Background:

CDC and AAP guidelines discourage routine neuroimaging following concussion, as CT scans are only indicated if severe intracranial injury is suspected. Validated prediction rules such as Pediatric Emergency Care Applied Research Network (PECARN) criteria have decreased the number of unnecessary pediatric head CTs; however, are still commonly performed following pediatric sport-related concussion (SRC).

Hypothesis/Purpose:

To determine differences in injury characteristics and outcomes in athletes who did and did not undergo head CT following SRC.

Methods:

Data were prospectively collected from participants enrolled in the North Texas Concussion Network Registry (ConTex) between August 2015-May 2021. Participants aged 5-18 diagnosed with SRC and presenting within 30 days were included. Participants were separated into 2 groups based on whether they had a CT scan following SRC: CT (negative scan) and no CT. Positive CTs were excluded. Groups were matched in age and time to presentation (≤14, >14-30 days). Demographics, concussion-related details, and 3-month outcome variables were analyzed including days to symptom resolution (≤30 vs >30 days) and return-to-play (RTP).

Results:

324 participants were included: 162 in each group. There were no significant differences between the groups in sex, race, ethnicity, or previous concussion history. Differences in injury-related characteristics are reported in Table 1. Participants in the CT group were more likely to be participating in unorganized events (p=0.05), and less likely to continue playing following SRC (p=0.003) than the no CT group. The CT group more frequently reported head to surface mechanism of injury than the no CT group. Significantly higher rates of loss of consciousness (LOC), amnesia, and vomiting following SRC were reported in the CT group. At 3-months post-SRC, the no CT group reported RTP a week sooner than the CT group (28.8±22.3 vs 35.7±27.3 days, p=0.019). However, there was no difference in prolonged recovery (>30 days: 29.6 vs 40.5%, p=0.07) or overall RTP rates (91.9 vs 85.8%, p=0.09) between the no CT and CT groups.

Conclusion:

Pediatric athletes who underwent CT following SRC exhibited significantly different injury-related characteristics compared to those who did not, but the differences observed did not impact symptom resolution or return-to-play. While LOC and vomiting differences align with the PECARN prediction rules and likely contribute to decision to perform CT, the additional differences of participating in an unorganized event, head-to-surface impact, and amnesia are not part of PECARN criteria. Further research is needed to discover which variables may contribute to unnecessary head CTs following SRC. [Table: see text]
Higher Student Confidence in their Schools’ Academic Support Associated with Lower Adverse Academic Concern Following Concussion
Authors: Halstead Mark , Snedden Traci , Valovich Tamara , Wilson Julie , Master Christina , Grady Matthew , Fazekas Matt , Santana Jonathan , Zaslow Tracy , Miller Shane , Howell David ,   the PRiSM Concussion Research Interest Group
Published: May 2022

Background:

Concussion may cause physical and cognitive deficits that can affect the ability of students to perform at their typical academic level in school. Symptomatic students and their parents have previously reported concern about the impact of concussion on school performance. However, student confidence in their school’s ability to support return to school and its relationship with recovery time and overall academic concern has not been investigated.

Hypothesis/Purpose:

To determine if student confidence in their school’s ability to support return to school following concussion is associated with recovery time and other academic concerns.

Methods:

Student-athletes were enrolled in the Sport Concussion Outcomes in Pediatrics (SCOPE) study by a physician or athletic trainer across seven sites. Students and their parent/guardian completed the Concussion Learning Assessment and School Survey (CLASS) along with other standardized assessments. Participants were grouped based on responses to the CLASS question about confidence in their school’s ability to support return to school (very confident vs. not/mildly/moderately confident). Symptom resolution time, initial symptom severity, academic outcomes and parent-reported expected academic supports were evaluated using separate Chi-squared analyses.

Results:

A total of 141 patients were included; 72 (51%) reported being very confident in their school’s ability to support return to school. There was no significant difference in time to symptom resolution between groups (p = 0.84; mean difference= 0.9 days [95% CI= -7.4, 9.2]). The group who was very confident in school support reported a significantly lower initial symptom severity (p <0.001; mean difference= 0.12 [95% CI= 0.05, 0.18]). A higher proportion of those who felt very confident in school support reported no concern about concussion affecting school learning and performance (Table 2; 36% vs 10%, p=0.005). A lower proportion of those who felt very confident in their school support felt the concussion might affect their grades compared to those who expressed no/mild/moderate confidence in school support (Table 2; 56% vs 23%, p=0.001).

Conclusion:

In this multi-center study, although there was no difference in symptom resolution between groups, students who reported being very confident in their schools’ ability to support return to school had a lower initial symptom severity, expressed less concern about the concussion affecting their school learning, performance, and grades. These findings support recommendations for a collaborative team to assist students returning to school following concussion. [Table: see text][Table: see text]
Concussion Profile Screen Ocular Subtype Score and Objective Findings of Oculomotor Dysfunction in Pediatric Concussion Patients
Authors: Thirunagari Prem Kumar , Sarva Saikaashyap , Rieiro Hector , Polec Tanya , Bell Matthew , Pita Monica , Maes Luke , Harris Delaney , Streeter Leslie , Minor Jon , Mortazavi Mo
Published: May 2022

Background:

Visual abnormalities and oculomotor dysfunction are common findings in pediatric concussion patients. Not only are these symptoms reported by patients subjectively, but they can be measured objectively using clinical tools including oculomotor tracking (OMT) devices.

Purpose:

To identify trends between levels of subjective visual symptoms and objective oculomotor findings on OMT.

Methods:

Retrospective cohort of 65 patients (12-21 years old) from 11/05/20 to 6/10/21. Each visit, the concussion clinical profile (CP) screen was completed, which has a total score (0-89) and a weighted ocular subtype score (0-3) based on five vision focused questions in the screen. At the same visit, the OMT device (250 Hz video-eye tracker inside a headset) measured various biodata including microsaccade (MS) magnitude, vertical and horizontal saccadic latency. Near point convergence (NPC) was measured by a physician. Patients were classified into low grade (n=48) or high grade (n=17) using an ocular subtype score threshold of 1.5. A paired two sample t-test was used to compare both groups objective OMT data.

Results:

The low grade group had an average MS magnitude of 1.06 degrees, an average vertical saccadic latency of 217.49 ms, an average horizontal saccadic latency of 198.16 ms, and a physician measured NPC of 8.75 cm. The high grade group had an average MS magnitude of 1.21 degrees, an average vertical saccadic latency of 234.37 ms, an average horizontal saccadic latency of 202.24 ms, and a physician measured NPC of 13.82 cm ( Table 1 ). T-tests for MS magnitude and NPC revealed statistically significant differences between the two groups for both variables (p= 0.02 and p=0.003, respectively). The t-test for vertical latency had a p-value of 0.06. The low grade group had an average CP score of 9.3 while the high grade group had an average CP score of 43.7 with a statistically significant difference.

Conclusion:

Patients who report high grade visual symptoms on CP screen ocular subtype score show trends of higher MS magnitudes and saccadic latencies on OMT and higher NPC on exam. Furthermore, low grade patients report significantly lower CP scores compared to high grade patients suggesting visual abnormalities play a central role in overall symptom burden. Further studies are needed to confirm this trend and to evaluate the role of vision on the overall clinical picture of pediatric concussion patients. [Table: see text]