bluuebunny/crossref_metadata_2025 huggingface dataset:
Skin necrosis following sclerotherapy. Part 1: Differential diagnosis based on classification of pathogenic mechanisms
Authors: Kang Mina , Yang Anes , Hannaford Patricia , Connor David , Parsi Kurosh
Published: May 2022

Background: Tissue necrosis is a significant but uncommon complication of sclerotherapy. The pathogenic mechanisms of this often-debilitating complication have been poorly described in the literature.

Purpose: To elucidate the pathological mechanisms, we propose a morphological approach to classify sclerotherapy-induced skin necrosis into two categories of round and stellate (star-like) necrosis.

Research Design: Comprehensive literature review was conducted.

Results: Round necrosis is typically caused by extravasation of sclerosants. It typically presents as an ulcer with smooth and non-geographic borders. Historically, extravasation has been cited as the main cause of sclerotherapy-related necrosis. While this may be the case with osmotic or irritant sclerosants, it is far less likely with the use of detergent agents particularly in the foam format.The more commonly encountered pattern of stellate necrosis is an ischaemic ulcer secondary to arterial/arteriolar occlusion. In contrast to round necrosis, stellate necrosis follows an intra-vascular injection of sclerosants such as an inadvertent intra-arterial injection. But more frequently, stellate necrosis may follow a perfectly executed intra-venous or intra-telangiectatic delivery of sclerosants. Several pathogenic pathways can be considered. The physiologic response of veno-arteriolar reflex vasospasm (VAR-VAS) is possibly the most frequent pathway. It follows a high-pressure injection of the sclerosant in a target vein resulting in a rapid rise of intravenous pressures which in-turn would trigger a sympathetic neuronal reflex vasospasm of the pre-capillary sphincters and a corresponding opening of the normally closed arterio-venous anastomoses (AVAs). This communication would allow entry of the sclerosing agent into the arteriolar side of the circulation resulting in arteriolar occlusion and infarction of the corresponding skin. Similarly, an intravenous administration of sclerosants in the vicinity of defective boundary valves or persistently open AVAs can result in the entry of detergent agents into the arteriolar side of the microvasculature causing an ischemic stellate ulcer.

Conclusions: In this first instalment of these two-part series, we review the pathogenic mechanisms of post-sclerotherapy necrosis. In the second instalment, we describe risk minimisation and management strategies.
Usability evaluation of a novel compact pneumatic compression device for the treatment of lymphoedema: Pilot study
Authors: Devitt Martin , Ramanan Dinesh , Armitstead Jeff , Zhu Xueling , Mackie Helen
Published: May 2022

Objective

To perform a preliminary usability evaluation of a novel, compact pneumatic compression device in patients with lymphoedema.

Methods

This open-label, single-arm trial had two phases: the first focused on the fitting of the pneumatic compression device (Aria FreeTM, Aria Health, San Diego CA, USA) and the second focused on evaluating the comfort of the entire system during a 45-min usage period. Both phases were conducted in a monitored clinical environment. Patients aged ≥18 years with a diagnosis of lower limb lymphoedema who had used a pneumatic compression device for ≥3 months were eligible. Patients rated subjective fit, comfort and usability on an 11-point Likert scale (where higher scores indicate better fit/comfort/usability). The truncated cone method was used to infer limb volume before and after therapy in phase 2.

Results

Twenty-four patients were screened, and 15 were enrolled (80% female; mean age 62 years); all completed both study phases. Patients rated the garment as easy to set up and fit (median score 6.5), and all reported that the therapy was comfortable (median score 10; p < 0.001 vs. reference score of 6). There was a 1.85% reduction in limb volume after device use for 45 min ( p = 0.018 vs. before therapy). No safety issues were identified.

Conclusions

The new pneumatic compression device fitted well, was easy to use and reduced leg oedema.
Facilitators and barriers in using comics to support family caregivers of patients receiving palliative care at home: A qualitative study
Authors: Haan Maaike M , van Gurp Jelle LP , Knippenberg Marjan , Olthuis Gert
Published: May 2022

Background:

Family caregiving at home is highly important for people receiving palliative treatment, but also a complex experience, subject to implicit social expectations. This study empirically explored the claim that comics benefit palliative care practice, through evaluating a graphic novel’s value as an aid in supportive conversations with family caregivers.

Aim:

To identify facilitators and barriers in using Naasten (Loved ones), a Dutch research-based graphic novel about family caregivers providing care at the end-of-life.

Design:

Qualitative study, following thematic content analysis.

participants:

Three focus groups with family caregiver consultants, palliative care volunteers, and healthcare professionals (total N = 23) who supported family caregivers; and individual telephone interviews with family caregivers to whom the book was presented ( N = 4).

Results:

Barriers and facilitators related to: (1) the family caregiver, (2) impact on the family caregiver, (3) impact on the conversation between the person who provides support and the family caregiver, (4) their relationship, and (5) the person who provides support. Naasten was reported as recognizable and supportive, and powerful in raising emotions, awareness and conversation. Barriers concerned the book’s impact due to its style and guidance of a conversation, and doubts about its surplus-value.

Conclusions:

Emotionally impactful comics may support bereaved family caregivers, but should be introduced with care among current family caregivers, for example, ensuring a right fit, introduction, and follow-up—while taking into account a caregiver’s individual situation, needs, abilities, and affinity with the medium. Comics are preferably used in educational settings, contributing to professional awareness and tailored support of family caregivers.
Impacts of floods on Colombo during two decades: Looking back and thinking forward
Authors: Dahanayake Harsha D , Wickramasinghe Deepthi
Published: May 2022

This research contributes to the current debate on linking flood events and developmental pressure in urban areas. Colombo District has faced frequent flood events during the last two decades which disrupted the socio-economic and environmental setup. Colombo district is the economic hub and the administrative capital of Sri Lanka and it is the area with highest population density in the country. It has experienced rapid urbanization and Land Use Land Cover Changes (LULC) during recent past. The new infrastructure project developments, expansion of impervious spaces, disturbances to the drainage systems have increased the occurrence of floods. This study was carried out to identify areas with the highest flood damage and attempted to find out any the link between population and land use changes with flood impacts from 1999 to 2018. We used Satellite images, Remote Sensing Techniques and Weighted Overlay method in Geographical Information System to detect the LULC change and the flood vulnerability together with population and disaster related data. The results show that north and western parts of Colombo district were mostly affected by floods. The areas with high flood vulnerability have increased by 1.29% while moderately vulnerable areas have increased by 3.76%, and low vulnerable areas have decreased by 5.04%. The total settlements in Colombo district have increased by 20.08% and have had significant increase by 29.60% in the areas with high flood impacts. The results of the present study highlight the threat of unsustainable urban expansion on floods and call for prompt management action for resilience.
A Triple-Strand Anatomic Medial Collateral Ligament Reconstruction Restores Knee Stability More Completely Than a Double-Strand Reconstruction: A Biomechanical Study In Vitro
Authors: Miyaji Nobuaki , Holthof Sander R. , Bastos Ricardo P.S. , Ball Simon V. , Espregueira-Mendes João , Williams Andy , Amis Andrew A.
Published: May 2022

Background:

There are many descriptions of medial collateral ligament (MCL) reconstruction, but they may not reproduce the anatomic structures and there is little evidence of their biomechanical performance.

Purpose:

To investigate the ability of “anatomic” MCL reconstruction to restore native stability after grade III MCL plus posteromedial capsule/posterior oblique ligament injuries in vitro.

Study Design:

Controlled laboratory study.

Methods:

Twelve cadaveric knees were mounted in a kinematic testing rig to impose tibial displacing loads while the knee was flexed-extended: 88-N anteroposterior translation, 5-N·m internal-external rotation, 8-N·m valgus-varus, and combined anterior translation plus external rotation (anteromedial rotatory instability). Joint motion was measured via optical trackers with the knee intact; after superficial MCL (sMCL), deep MCL (dMCL), and posterior oblique ligament transection; and then after MCL double- and triple-strand reconstructions. Double strands reproduced the sMCL and posterior oblique ligament and triple-strands the sMCL, dMCL, and posterior oblique ligament. The sMCL was placed 5 mm posterior to the epicondyle in the double-strand technique and at the epicondyle in the triple-strand technique. Kinematic changes were examined by repeated measures 2-way analysis of variance with posttesting.

Results:

Transection of the sMCL, dMCL, and posterior oblique ligament increased valgus rotation (5° mean) and external rotation (9° mean). The double-strand reconstruction controlled valgus in extension but allowed 5° excess valgus in flexion and did not restore external rotation (7° excess). The triple-strand reconstruction restored both external rotation and valgus throughout flexion.

Conclusion:

In a cadaveric model, a triple-strand reconstruction including a dMCL graft restored native external rotation, while a double-strand reconstruction without a dMCL graft did not. A reconstruction with the sMCL graft placed isometrically on the medial epicondyle restored valgus rotation across the arc of knee flexion, whereas a reconstruction with a more posteriorly placed sMCL graft slackened with knee flexion.

Clinical Relevance:

An MCL injury may rupture the anteromedial capsule and dMCL, causing anteromedial rotatory instability. Persistent MCL instability increases the likelihood of ACL graft failure after combined injury. A reconstruction with an anteromedial dMCL graft restored native external rotation, which may help to unload/protect an ACL graft. It is important to locate the sMCL graft isometrically at the femoral epicondyle to restore valgus across flexion.
Low Back Pain, Psychiatric Disorders, and a Combination of Both Negatively Affect Hip Arthroscopy Outcomes in Servicemembers
Authors: Kearney Sean P.
Published: May 2022

Background:

Hip arthroscopy for femoroacetabular impingement (FAI) in athletes, including military servicemembers, has resulted in variable outcomes. The prevalence of low back pain (LBP) and psychiatric disorders (PSYs) is high among patients undergoing hip arthroscopy.

Purpose:

To determine the effect of LBP, PSYs, and the combination of both on outcomes in servicemembers treated arthroscopically for FAI.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

Between April 2016 and June 2020, a total of 108 consecutive active-duty servicemembers underwent hip arthroscopy by a single surgeon at a single military medical center. Servicemembers were grouped according to the presence of preoperative LBP (Group LBP), a PSY (Group PSY), or both (Group Both), and outcomes were compared with those of servicemembers without these comorbidities (Group None). The minimum follow-up was 6 months. The primary outcome measure was return to duty (RTD). Secondary outcomes included the Nonarthritic Hip Score (NAHS), Hip Outcome Score–Activities of Daily Living (HOS-ADL) subscale, and Hip Outcome Score–Sports (HOS-S) subscale.

Results:

All servicemembers’ final duty status was confirmed, with a mean follow-up of 2 years (range, 6 months–4.3 years). The prevalence of preoperative LBP and PSY was 27% and 39%, respectively. RTD was 59% (10/17) in Group LBP, 10% (3/30) in Group PSY, 0% (0/12) in Group Both, and 47% (23/49) in Group None. Compared with Group None, the risk of discontinuing military service was statistically higher in Group PSY (relative risk [RR], 1.70 [95% CI, 1.41-1.99]) and Group Both (RR, 1.88 [95% CI, 1.62-2.15]) but not in Group LBP (RR, 0.78 [95% CI, 0.15-1.40]). The mean preoperative secondary outcomes all significantly improved postoperatively in Group None (NAHS, 58 to 75 [ P < .001]; HOS-ADL, 63 to 74 [ P < .001]; HOS-S, 44 to 57 [ P < .001]). Among the comorbid groups, the mean HOS-S did not significantly improve (Group LBP, 45 to 48 [ P = .71]; Group PSY, 36 to 44 [ P = .22]; Group Both 43 to 45 [ P = .75]), and <50% of these servicemembers achieved HOS-S meaningful clinical benefit metrics.

Conclusion:

Preoperative LBP, PSY, and a combination of both negatively affected outcomes after hip arthroscopy. Preoperative counseling is crucial in setting realistic outcome expectations.
Exploration of Demographic Differences in Past and Anticipated Future Care Experiences of Older Sexual Minority Adults
Authors: Singleton Mekiayla C. , Enguidanos Susan M.
Published: May 2022

Care experiences of sexual minority (SM) adults are largely characterized by the need for receiving care and providing care to their chosen family. This is due, in part, to the lack of family and social support and higher rates of health disparities. Using data from the “Maintaining Dignity: Understanding and Responding to the Challenges Facing Older LGBT Americans” AARP survey ( N = 1694), we examined factors associated with past and anticipated future care experiences among older SMs. Older SM individuals reported high rates of providing care (70%), anticipating future provision of care (71%), and needing care from a loved one (73%). Being older, identifying as female, and having a disability were highly associated with past care experiences. Being female, being in a relationship, and having better self-rated health were highly associated with future anticipated care experiences. These outcomes indicate the importance of having services that are inclusive in serving the SM community.
Suture Cheek Suspension Augments Periorbital Aesthetic Rehabilitation in Facial Nerve Palsy
Authors: Homer Natalie A. , Karlin Justin , Watson Alison H. , Somogyi Marie , Bratton Emily , Goldberg Robert A. , Nakra Tanuj
Published: May 2022

Purpose: Facial nerve palsy may lead to significant functional facial and ocular morbidity. Soft tissue resuspension may improve both functional and aesthetic defects. We have adapted a minimally invasive midface suspension, which may be easily combined with routine paretic periocular rehabilitation to optimize outcomes. Methods: A retrospective review of patients with unilateral facial nerve palsy who underwent midcheek release and suture suspension simultaneous with periocular surgical rehabilitation at 2 surgical centers was performed. A temporal incision was made and dissection carried along the deep temporalis fascia to the lateral orbital rim. Dissection was continued subperiosteally along the anterior face of the maxilla to the piriform aperture. In severe cases, a second incision via superior buccal sulcus was utilized to maximize cheek soft tissue mobilization. Through 3 separate stab incisions along the nasolabial fold each end of a 0-0 permanent braided suture on a Keith needle was used to engage and elevate cheek soft tissues, secured at the deep temporalis fascia. Results: Seven patients (mean age 69 years) with unilateral facial nerve palsy and symptomatic facial droop underwent midface suture suspension simultaneous to eyelid reconstruction. With an average follow-up of 8.7 months, all patients demonstrated lasting improvement in facial asymmetry and reported satisfaction with their results. There were no significant postoperative complications. Conclusions: Midfacial static soft tissue resuspension is an effective minimally invasive surgical option for static facial rehabilitation in patients with facial nerve paralysis that can be performed at the time of periocular rehabilitation to enhance functional and aesthetic outcomes.
Probing lubricated sliding wear properties of HDPE/UHMWPE hybrid bionanocomposite
Authors: Sharma Vidushi , Gupta Rajeev K , Kailas Satish V , Basu Bikramjit
Published: May 2022

Ultra-high molecular weight polyethylene (UHMWPE) and its derivatives have been clinically used as an acetabular liner material in total hip joint replacement (THR) over last six decades. Despite significant efforts, the longevity of UHMWPE implants is still impaired due to their compromised tribological performance, leading to osteolysis and aseptic loosening. The present study aims to critically evaluate and analyze the tribological performance, of the next generation acetabular liner material, that is, a chemically modified graphene oxide (GO) reinforced HDPE/UHMWPE (HU) bionanocomposite (HUmGO), against stainless steel (SS 316L) counterface in lubricated conditions. This work also provides a performance comparative assessment of HUmGO with respect to medical grades, UHMWPE (UC) and crosslinked UHMWPE (XL-UC). Significant attempts have been made to correlate the tribological properties (frictional behavior, wear rate, wear debris shape and size, wear mechanism) with the physicomechanical conditions (contact stresses) at sliding contact and the variation in molecular architecture of different UHMWPE materials. Additionally, an emphasis is put forward to critically anlyze the nature of lubrication regime based on the bearing characterstic parameters. HUmGO exhibited a lower COF (0.07) and specific wear rate (2.86 × 10−8 mm3/Nm) than UC and XL-UC under identical sliding conditions. The worn surfaces on HUmGO revealed the signatures of less abrasive wear and limited deformation. Based on the estimated lambda (λ) ratio and Sommerfield number, all the investigated sliding contacts exhibited boundary lubrication. Taken together, the modified GO reinforced HDPE/UHMWPE bionanocomposite can be considered as a new generation biomaterial for the fabrication of acetabular liner for hip-joint prosthesis .
Exploring Collective and Multi-Audience Dissent in Organizational Meetings
Authors: Garner Johny T.
Published: May 2022

Organizations without healthy dissent stagnate from myopic thinking. Previous research has examined how employees might dissent to supervisors or coworkers, but little research has focused on how dissent might be expressed to multiple audiences simultaneously. Dissent conversations might happen only once or might be repeated over time, but the ways in which dissent processes unfold over time has also been neglected in past research. The present study examined biweekly meetings in the fundraising department of a nonprofit organization for 2 years to explore organizational dissent across time and to reveal possible nuances in the ways in which dissenters express disagreement. Results revealed several dissent topics repeated during the data collection period with mixed results—some of these topics were resolved whereas others were not. Two dissent conversations emerged as particularly meaningful events in the history of the department. At the same time, these data illustrated dissent expressed to multiple audiences (a single dissenter simultaneously talking to a supervisor and multiple coworkers) and dissent expressed by multiple dissenters. These forms of collective dissent extend previous models of organizational dissent that typically conceptualize a conversation between a single dissenter and a single dissent audience.
Research on a novel electro-hydraulic brake system and pedal feel control strategy
Authors: Ma Chengcheng , Wang Xuanyao , Xu Tongliang , Wang Jianye , Feng Peng
Published: May 2022

The existing electro-hydraulic brake system does not consider the adverse effect of the failure of the brake pedal feel simulator on the function of the braking system and the driving safety of the vehicle. To solve the above problems, a novel electro-hydraulic brake system is proposed. Firstly, the structural scheme and the working modes of the system are analyzed, and the electro-hydraulic brake system model is established, and a control strategy for the controlling of the wheel cylinder pressure is put forward. Then, the pedal feel control strategy is studied, which can simulate arbitrary pedal characteristics by controlling the output torque of the motor. Moreover, for the failure of the pedal travel sensor, a pedal displacement estimation method is proposed based on the pressure sensor information of the front chamber of the master cylinder. And for the failure of the pedal feel simulation motor, the pressure of the front chamber of the master cylinder is controlled by adjusting the opening of the pedal feel simulation valve to realize the simulation of the pedal feel. The simulation results based on CarSim/AMESim/Simulink show that the proposed electro-hydraulic brake system has fast pressure response speed and quick pressure tracking accuracy. The pedal characteristics are essentially unchanged before and after the failure of the pedal feel simulation motor or the pedal travel sensor.
Experimental study on spray cooling heat transfer enhancement using MWCNT and TiO2 hybrid nanofluid
Authors: Singh Sukhdeep , Kukreja Rajeev
Published: May 2022

In the present study, two nanofluids namely Multi-walled carbon nanotubes and Titanium dioxide dispersed in distilled water, have been used with three different concentrations; 0.1%, 0.2%, and 0.3% by volume, to investigate heat transfer enhancement in spray cooling applications. A square copper specimen of 10 mm2 has been spray cooled with a volumetric flux of 2.5 cm3/cm2s using a 0.4 mm diameter pressure nozzle. The results revealed that the average heat transfer coefficient and corresponding critical heat flux enhanced significantly at 0.2 vol% for both nanofluids in contrast to distilled water. The results showed an improvement of 21.9% and 26.3% in heat transfer coefficient for Multi-walled carbon nanotubes and Titanium dioxide nanofluid, respectively. The effect of hybrid nanofluid in various concentrations has also been investigated on heat transfer performance. The results obtained showed a maximum value of 425 W/cm2 for critical heat flux and 4.42 W/cm2K for heat transfer coefficient, with a heat transfer coefficient improvement of nearly 40.31% in comparison to distilled water. This results in an enhancement ratio of 1.6 for critical heat flux and 1.4 for heat transfer coefficient. In contrast to single nanoparticle nanofluid, the hybrid nanofluid indicated a moderate improvement in heat transfer coefficient of 11.7% and 7.8% for Multi-walled carbon nanotube and Titanium dioxide nanofluids, respectively. It has been observed that heat transfer performance was first enhanced and then declined as the volume fraction increased from 0.1% to 0.3% for all the nanofluids.
“Facilitating wife” and “feckless manchild”: Working mothers’ talk about divisions of care on Mumsnet
Authors: Ehrstein Yvonne
Published: May 2022

This article considers a culturally marginalised yet consequential gendered discourse that positions women as “wife” alongside their role as mother in working women's talk about divisions of care on Britain's largest parenting site, Mumsnet. Unlike most previous research on Mumsnet that has focused on the construction and partial resistance of normative ideas of motherhood, this paper suggests that the increasingly politicised site is a space where a discourse of wifehood is drawn upon to account to some degree for experiences of domestic inequality. Using a critical discursive psychological approach to data from 14 online discussion threads posted on Mumsnet, the paper identifies two dominant, complementary constructions through which posters frame divisions of care. These are the position of the “facilitating wife”, enabling their male partners’ careers by taking on the bulk of domestic responsibility to the detriment of their own professional achievement and mental wellbeing; and the construction of partners as “feckless manchildren”, as an attempt to manage dissonances with their positioning as “wife” and related overburdening. I conclude that the relationships women form in the Mumsnet space allow them to articulate dissonant views and feelings about their co-existing domestic roles of wife and mother and associated divisions of care.
Examining the fabrics of match-fixing: The underground sport betting system
Authors: Tzeng Chien-Chun , Ohl Fabien
Published: May 2022

This study aims to examine the very fabrics of underground sport betting system that is associated with match-fixing. Mafia, syndicates, and bookmakers are the three levels of actors in the hierarchy. Having grassroots bookmakers as our particular focus, we examine their roles and networks, what regulates the system, and how the system functions. Thanks to our academic links with the mafia, we had access to bookmakers to carry out observations and 25 interviews. We rely on the social capital model in which structural, relational and cognitive dimensions are identified. Findings reveal that actors are empowered by their social capital to streamline their underground business. Far from the stereotype of a competitive market under the control and coercion of very powerful mafia, our observations of bookmakers, mainly women, show that they cooperate, trust each other, and have great autonomy in their activities. Because of their strong shared culture and networks, betting activities are considered acceptable in their own small community.
Home Palliative Care during the COVID-19 Pandemic: A Scoping Review
Authors: Mojtahedi Zahra , Shen Jay J
Published: May 2022

Palliative care (PC), which improves the quality of life for patients with serious illnesses, can be offered in multiple settings, such as the hospital, community, and home. The trend toward delivering PC at home has been recently accelerated during the COVID-19 pandemic. The pandemic has created challenges for patients with serious illnesses who have been proven to be susceptible to serious COVID-19 illnesses. This review of the literature presents research studies on home PC (HPC) during the pandemic. Databases (PubMed, Scopus, and Web of Science Core Collection) were searched. Twelve research/case studies were found to be relevant. These articles gathered information either through qualitative (surveys/interviews) methods or medical records. Most qualitative articles focused on perceived challenges and opportunities from HPC professionals’ perspectives. Adopting telehealth was frequently discussed as a key tool to adjust to the pandemic. In general, HPC professionals and patients had a positive attitude toward telehealth, and this attitude was much more pronounced among professionals than patients. Among HPC professionals, some reports indicated that their burnout rates reduced, and job satisfaction increased during the pandemic. Regarding clinical and cost outcomes, there is a gap in the literature on HPC during the pandemic. In conclusion, despite challenges, it seems that the pandemic has gifted some long-term opportunities for promoting HPC in combination with telehealth. COVID-19 will not be the last pandemic, and we should be prepared for the next one by updating policies and building concrete infrastructure for HPC.
The Financial Impact of Palliative Care and Aggressive Cancer Care on End-of-Life Health Care Costs
Authors: Davis Mellar P , Vanenkevort Erin A. , Elder Alexander , Young Amanda , Correa Ordonez Irina D. , Wojtowicz Mark J , Ellison Halle , Fernandez Carlos , Mehta Zankhana , Behm Bertrand , Digwood Glen , Panikkar Rajiv
Published: May 2022

Background

Medicare cancer expenditures in the last month of life have increased. Aggressive cancer care at the end-of-life (ACEOL) is considered poor quality care. We used Geisinger Health Plan (GHP) last month’s costs for cancer patients who died in 2018 and 2019 to determine the costs of and influence of Palliative Care (PC) on ACEOL.

Method

Patients with GHP ages 18-99 who died in 2018 and 2019 were included. Demographic, clinical characteristics, and Charlson Comorbid Index were compared across care groups defined as no ACEOL indicator, 1 or more than 1 indicator. Differences between groups were compared with Kruskal-Wallis tests and one-way ANOVA for 3 groups. Median two-sample tests and independent t-tests compared groups of 2. A P-value </= .05 indicated statistical significance.

Results

Of 608 eligible patients; 261 had no indicator, 133 had 1 and 214 > 1. There were incremental cost increases with each additional ACEOL indicator (p = < .0001). Palliative Care <90 days before death was associated with increased costs while consultations >90 days before death lowered cost (P < .0001) due to reduced chemotherapy in the last month. Completed ADs reduced cost by $4000.

Discussion

ACEOL indicators multiply costs during the last month of life. Palliative care instituted >90 days before death reduces chemotherapy in the last month of life and AD reduces health care costs.

Conclusion

Cancer health care costs increase with indicators of ACEOL. Palliative care consultations >90 days before death; ADs reduce cancer health care costs.
The Use of Rehearsal to Enhance Special Educator Teacher Preparation
Authors: Thoele Jillian M. , Sayeski Kristin L.
Published: May 2022

Teacher educators can use rehearsal to enhance special education teacher candidates’ mastery of foundational teaching practices. Rehearsals (i.e., brief practice teaching segments) are conducted within college and university courses and are intentionally different from field-based or clinical practice. The use of rehearsal reflects a practice-based approach to teacher preparation that can be incorporated within special education instructional methods and behavior management courses. This article provides an overview of what rehearsal is and how teacher educators can incorporate rehearsals within their courses using an explicit instruction framework. The article concludes with a sample lesson illustrating how special education teacher educators can use rehearsal to teach candidates how to increase opportunities to respond using a student-response routine.
Is Online Peer Support Helpful in Widowhood? The Lived Experiences of Young Parents
Authors: Holmgren Helle
Published: May 2022

With the technological development in general, grief support has now gained a foothold on the internet with a huge variety of offers for bereaved individuals. However, researchers disagree whether this is mainly helpful or unhelpful in grief. The aim of this article was to examine how spousally bereaved individuals with dependent children had experienced the use of an online peer support group following bereavement. To the majority of respondents (83%, n = 70) the group had been immensely helpful. Thematic analysis of participant responses to open-ended questions resulted in three different themes: Identification, Good advice, and Changes in group use over time. The study underlines a need for a renewed focus on how we organize the support for parentally bereaved families in Denmark, and in particular, how the access to information and sources of support following a loss are made available across the board. Finally, the results testify to the fact that online peer support in grief is a means of seeking support in its own right.
Clear Cell Papillary Renal Cell Tumors: A Study of 42 Tumors with Emphasis on the Fibrous Capsule, Cystic Component, and GATA3 Immunohistochemistry
Authors: da Paz Alexandre Rolim , de Souza Maiara Ferreira , Santana Camila Maria de Moura , Athanazio Daniel Abensur
Published: May 2022

Clear cell papillary renal cell tumor is a common and sometimes underdiagnosed renal cell neoplasm. Its proper recognition is important because its diagnosis implies a remarkably high probability of indolent behavior. This study aimed to evaluate the frequency of a fibrous capsule, a cystic component, and a GATA3 expression in clear cell papillary renal cell tumors. We assessed 419 renal cell neoplasms from three institutions located in northeastern Brazil and identified 42 clear cell papillary renal cell tumors (from 39 patients), which were the fourth most common renal cell neoplasm. These tumors commonly exhibited fibrous capsules (all showed complete or partial capsules) and cystic component (93%). Eighteen out of 42 tumors (43%) showed some expression of GATA3, and weak and focal staining was common among the positive tumors. Clear cell papillary renal cell tumor must always be included in the differential diagnosis of predominantly cystic renal cell neoplasms. As GATA3 is inconsistently expressed in clear cell papillary renal cell tumors, it is not useful in this diagnosis.
A Case-Control Study of 3D vs 2D Weightbearing CT Measurements of the M1-M2 Intermetatarsal Angle in Hallux Valgus
Authors: Day Jonathan , de Cesar Netto Cesar , Burssens Arne , Bernasconi Alessio , Fernando Celine , Lintz François
Published: May 2022

Background:

Weightbearing computed tomography (WBCT) 3-dimensional measurements may be reliable in assessing hallux valgus (HV). The objective of this study was to compare 2D and 3D WBCT measurements of the M1-M2 intermetatarsal angle (IMA) in patients with HV and in healthy controls. We hypothesized that 2D and 3D IMA measurements would correlate and have similar reliability in both HV and controls.

Methods:

Retrospective multicenter comparative study included WBCT scans from 83 feet (41 HV, 42 controls). IMA was measured on digitally reconstructed radiographs (DRR-IMA). 3D angle (3D-IMA) and its projection on the weightbearing plane (2D-IMA) were calculated from 3D coordinates of the first and second metatarsals. Intraobserver reliability and intermethod correlations were calculated using intraclass correlation coefficients (ICCs).

Results:

Intraobserver reliability was very strong for DRR-IMA (0.95) and 3D-IMA (0.99). Intermethod correlation between the 3 modalities in HV patients ranged from moderate (DRR vs 2D, 0.48; DRR vs 3D, 0.48) to very strong (2D vs 3D, 0.91). Similarly, intermethod correlation in the control group ranged from moderate (DRR vs 2D, 0.56; DRR vs 3D, 0.60) to very strong (2D vs 3D, 0.92).

Conclusion:

Measurements for IMA are similar using DRR, 3D and 2D projected angles, with very strong intraobserver reliability and moderate to very strong intermethod correlations. This is the first head-to-head comparison between these measurement modalities in HV. Further investigations are warranted before formulating guidelines for the clinical use of 3D angles.

Level of Evidence:

Level III, case-control study.
Reliability of Fifth Metatarsal Base Fracture Classifications and Current Management
Authors: Michalski Max P. , Ingall Eitan M. , Kwon John Y. , Chiodo Christopher P.
Published: May 2022

Background:

Classification of fifth metatarsal base fractures has been a source of confusion since originally described by Jones in 1902. Zone classifications have been described but never evaluated for reliability. The most recent classification, metaphyseal vs meta-diaphyseal, may be unknown to many surgeons. The purpose of this study was to evaluate reliability of American Orthopaedic Foot & Ankle Society (AOFAS) members classifying fifth metatarsal base fractures and current management of these fractures.

Methods:

A survey was emailed to AOFAS members including radiographs of 18 fifth metatarsal base fractures. Demographic information was collected in addition to evaluation of the radiographs. Interrater reliability was assessed for each measurement: presence of Jones fracture, zone classification, and metaphyseal vs metaphyseal-diaphyseal, using Fleiss kappa. After 3 weeks, a second email was sent to the members asking to retake the survey to evaluate intrarater reliability. Respondents were asked which region is a Jones fracture, which classification is used, if symptomatic zone 2 and 3 fractures are treated similarly, and what fractures are operative in healthy symptomatic acute fractures.

Results:

A total of 223 AOFAS members, with a median time in practice of 12 years (range 0-50), completed the initial survey. Eighty members (36%) repeated the survey for intrarater comparison. Interrater reliability was moderate for Jones and zone classification but substantial for the 2-zone metaphyseal/meta-diaphyseal classification. The median intrarater kappa was 0.78, 0.75, and 0.78 for Jones, zone, and metaphyseal/meta-diaphyseal respectively. Seventy percent of respondents treat zones 2 and 3 similarly, and approximately 60% consider an acute symptomatic fracture identified as Jones, zone 2 or zone 3 operative.

Conclusion:

A 2-zone system may be the best available classification for fifth metatarsal base fractures given high interrater reliability and 70% of AOFAS members treat zones 2 and 3 in similar fashion.

Level of Evidence:

Level III, diagnostic study.
What Does it Mean to be Homeless? How Definitions Affect Homelessness Policy
Authors: Sullivan Andrew Alfred
Published: May 2022

Government agencies use varying criteria in defining homelessness. While scholars debate over and use different definitions of homelessness, little research has explored the impacts the definition has on perceived problem severity and the types of communities receiving aid. I first explore four definitions of child and youth homelessness used by United States’ federal agencies. I then use panel data for school districts, which report homelessness by subgroup, to analyze how the definition of homelessness changes its prevalence and leads to disparate impacts. I find the definition of homelessness including students living doubled-up leads to a higher growth rate. Definitions also change which districts have high rates of homelessness and characteristics of these districts, suggesting resources following students experiencing homelessness go to different types of communities. Scholars should consider how a problem is defined, differences in the measurement used between studies, and how the definition affects where resources go.
Erythema nodosum after azacitidine in a patient with acute myeloid leukemia
Authors: Nasrollahi Elham , Giubellino Alessio , Rashidi Armin
Published: May 2022

Introduction

Nodular skin lesions in patients with acute myeloid leukemia (AML) raise clinical suspicion for leukemia cutis versus fungal infections. Here, we report a rare case of treatment-related erythema nodosum (EN) in a patient with AML.

Case Report

Approximately 5 weeks after the initiation of sorafenib and one week after azacitidine initiation, a 32-year-old man with primary refractory AML presented with several painful red nodules on the lower extremities. Histological examination established a diagnosis of EN.

Management and Outcome

Treatment with topical and oral steroids led to complete resolution of the nodules. However, once the dose of steroids was reduced, the lesions rapidly recurred. Higher dose steroids were reinitiated, again with a resolution of the nodules, confirming steroid responsiveness of the underlying process.

Discussion

Given the onset of lesions one week after the initiation of azacitidine and 5 weeks after the initiation of sorafenib, azacitidine was considered the more likely culprit. Only 2 cases of EN-like eruption after azacitidine and 1 case after sorafenib have been reported. Although fungal infections and leukemia cutis are the top differentials considered for skin nodules in a patient with AML, EN should be considered as an alternative diagnosis. Correct diagnosis is critical because it will guide treatment.
Thinking through cultures and psychologies: Robert Levine’s life and work, and a discipline’s ongoing project
Authors: Rich Grant J
Published: May 2022

The article provides an assessment and overview of the life's work and career of Robert Levine, the leading psychologist anthropologist. His personal biography, awards, career, and accomplishments are described, along with his professional contributions. Special attention is devoted to his contributions to the cross-cultural examination of human development, including his advocacy and thinking regarding the utilization of mixed methods (qualitative and quantitative) and multidisciplinary (e.g., psychology, anthropology, demography, sociology, psychiatry, psychoanalytic) approaches. Attention is also given to description of his contributions to the history of psychological anthropology, to the intersection of culture and psyche, to person-centered studies of the Gusii in Kenya, and to comparative studies of human development, in India, Asia, Africa, and beyond. A critical assessment of the relevance of his fifty year career for culture and psychology today is offered.
The janus-faced nature of radical voting: Subjective social decline at the roots of radical right and radical left support
Authors: Bolet Diane
Published: May 2022

This study advances the decline of Parent-Relative Subjective Social Status (PRSSS) as a reconciling factor among radical right and radical left supporters. While self-employed workers, men and rural residents perceive socioeconomic decline relative to their parents and support the radical right, the well-educated, urbanites and low-income individuals are likely to feel similar decline given the rising levels of unemployment and social inequality. These structural changes may push the latter to support a party which stresses income inequality, a catchcry of the radical left. Using a 2017 Eurobarometer Survey, logistic regressions show positive associations between low PRSSS (versus equal or high PRSSS) and support for right- and left-wing radicalism in 28 European countries. The traditional attitudes of each group magnify the PRSSS effects on radical support: these are reinforced by anti-immigrant support for the radical right and by preference for redistribution for the radical left.
Ethical judgments of esports spectators regarding cheating in competition
Authors: Johnson Mark R , Abarbanel Brett
Published: May 2022

Esports contests at the highest levels frequently involve millions of dollars in prize money and spectatorship numbers in six or seven figures. Given these opportunities for financial success and public visibility, players have found ways to cheat in esports competitions. We draw on over one thousand qualitative survey responses from esports viewers to examine how spectators perceive cheating, both “cheating to win” (attempting to secure an illegitimate victory) or “cheating to lose” (profit or advancement is secured by throwing a match). We show that spectators hold complex views ranking different forms of cheating, displaying varying levels of understanding of the esports ecosystem, and conceptualising cheating as often more a matter of rule breaking than ethical transgression. We conclude that esports viewers’ perspectives are heavily informed by their own play, and the opacity of certain elements of professionalised esports, with implications for the long-term sustainability of esports as a cultural form.
The judicialisation of discrimination in the Indonesian constitutional court
Authors: Ibrahim Mohammad
Published: May 2022

Following the post-Soeharto constitutional reform from 1999 to 2002, the Indonesian Constitutional Court was established with powers, inter alia, to review the constitutionality of national legislation. The constitutional amendments also incorporated a constitutional Bill of Rights, which includes the right to be free from discrimination on any ground and the right to protection against discrimination under Article 28I(2) and the right to equality before the law under Article 28D(1). However, the Constitution does not specify an enumerated list of grounds against which discrimination is prohibited. This article examines a body of constitutional jurisprudence in Indonesia, an Asian civil law country with no formal system of precedent. It seeks to determine the extent to which the Indonesian Constitutional Court has protected the citizens' fundamental rights of equality and against discrimination. Through describing and analysing three court decisions on the principles of equality and non-discrimination, this article argues that the Indonesian Constitutional Court, in its early years of operation, took these principles seriously. Nevertheless, in its later decisions, the Court departed, albeit not explicitly, from its earlier ruling by relying on ‘the belief in One God’ and ‘the religious values consideration’ under Articles 29(1) and 28J of the Constitution to restrict the fundamental rights of equality and non-discrimination. Consequently, the Court has unjustifiably held that discrimination is not prohibited insofar as it is in accord with religious orthodoxy.
Surveillance for jugular venous thrombosis in astronauts
Authors: Pavela James , Sargsyan Ashot , Bedi Deepak , Everson Aaron , Charvat Jacqueline , Mason Sara , Johansen Benjamin , Marshall-Goebel Karina , Mercaldo Sarah , Shah Ronak , Moll Stephan
Published: May 2022

Background:

Thrombosis of the left internal jugular vein in an astronaut aboard the International Space Station was recently described, incidentally discovered during a research study of blood flow in neck veins in microgravity. Given this event, and the high incidence of flow abnormalities, the National Aeronautics and Space Administration (NASA) instituted an occupational surveillance program to evaluate astronauts for venous thrombosis.

Methods:

Duplex ultrasound of the bilateral internal jugular veins was conducted on all NASA astronauts terrestrially, and at three points during spaceflight. Respiratory maneuvers were performed. Images were analyzed for thrombosis and certain hemodynamic characteristics, including peak velocity and degree of echogenicity.

Results:

Eleven astronauts were evaluated with matching terrestrial and in-flight ultrasounds. No thrombosis was detected. Compared to terrestrial ultrasound measurements, in-flight peak velocity was reduced and lowest in the left. Six of 11 astronauts had mild–moderate echogenicity in the left internal jugular vein during spaceflight, but none had more than mild echogenicity in the right internal jugular vein. Two astronauts developed retrograde blood flow in the left internal jugular vein.

Conclusion:

Abnormal flow characteristics in microgravity, most prominent in the left internal jugular vein, may signal an increased risk for thrombus formation in some individuals.
Populist everyday politics in the (mediatized) age of social media: The case of Instagram celebrity advocacy
Authors: Kissas Angelos
Published: May 2022

This article is interested in populism outside the master frame of institutional politics (populist parties/leaders), considering, instead, the populist potential of celebrities’ everyday politics on social media. To understand this potential, the article suggests, we need to understand how celebrities are compelled by today’s mediatized communicative ecosystem to perform themselves as ordinary advocates for people-victims. We need to examine how the performative logic that this ecosystem forces into platforms accommodates certain emotional claims to ordinariness and normative-moral claims to advocacy—who is (un)worthy of a place in the victimized people that celebrities should advocate for. The article does so by analyzing two paradigmatically different case studies: Lady Gaga’s legacy-status and Greta Thunberg’s influencer-style performances of celebrity advocacy on Instagram. The analytical discussion leads to contemplating the mediatized populist politics of everyday politics that both perform, despite their differences, and its ambivalent relationship with liberal democracy (centrist moderation and neoliberal consolidation).