bluuebunny/crossref_metadata_2025 huggingface dataset:
Bank-Lending Channel of Monetary Policy Transmission: Evidence from ASEAN
Authors: Hamid Fazelina Sahul , Yunus Norhanishah Mohd
Published: July 2019

This article examines the existence of a bank-lending channel in Association of Southeast Asian Nations (ASEAN) using a sample of 328 banks from 2009 to 2015. The findings confirm that a bank-lending channel is effective. In particular, we find that consumer loans and commercial loans are sensitive to changes in monetary policy, but mortgage and corporate loans are not. We also find that commercial banks are vulnerable to monetary policy changes, but both investment and Islamic banks are not. On the contrary, special purpose banks are able to overcome the effect of monetary policy tightening by supplying more loans. The effectiveness of a bank-lending channel in ASEAN also holds when we control for the differences in governance structure of the countries. Policymakers need to take these into consideration in designing an effective monetary policy.
Beyond the Card Reader: Anti-election Rigging Technology and National Security in Nigeria
Authors: Uzodike Ufo Okeke , Onapajo Hakeem
Published: July 2019

With the increasing spread of information technology in Africa, digitalisation of elections is gradually becoming a popular phenomenon in the continent. However, there has not been sufficient awareness on the potential dangers in the process of digitalising elections. In this regard, this article provides analysis of the connection between the use of technological model in elections and security using the Nigerian example. The article acknowledges the potency of the technological model to solve the problem of electoral malpractices and ultimately address issues concerning electoral violence over claims of fraud. Notwithstanding its usefulness, the article analyses the challenges associated with the technological model and how this represents a major security threat. In this regard, the key question is: does Nigeria have the technical capacity to manage effectively electronic devices that have the potential of being used to unleash massive electoral fraud that could completely undermine peaceful coexistence within its fragile and sensitive electoral context? Following this, the article advances a number of policy recommendations on the measures to put the technological model into an effective use in order to promote peaceful elections in Nigeria.
Book review: Sucha Singh Gill. 2019. Chasing High Growth Rate and Tryst with Inclusiveness: India During 2004–2014
Authors: Jain Varinder
Published: July 2019

Sucha Singh Gill. 2019. Chasing High Growth Rate and Tryst with Inclusiveness: India During 2004–2014. Chandigarh, India: Centre for Research in Rural and Industrial Development, xvi + 164 pp., ₹399, ISBN: 978-81-85835-91-8 (Hardback).
The effect of different optical zone diameters on the results of high-order aberrations in femto-laser-assisted in situ keratomileusis
Authors: Özülken Kemal , Kaderli Ahmet
Published: July 2019

Purpose:

To evaluate the postoperative high-order aberration differences of femto-LASIK surgery in 6.5 and 7 mm optic zones.

Patients and Methods:

We retrospectively reviewed 80 eyes of 40 patients with myopia or myopia with astigmatism who underwent femtosecond LASIK surgery. Q values, z3, 3 (h. trefoil), z3, –3 (v. trefoil), z3, 1 (h. coma), z3, –1 (vertical coma), z4, 0 (spherical aberration), z5, –1 (second other v. coma), aberration coefficients were evaluated 3 months after surgery. Central corneal thicknesses, intraocular pressures, patient ages and genders, optical zone diameters and ablation depths are collected from patients’ medical records.

Results:

The mean age was 28.4 ± 0.69 years (range, 20–47 years). Lower z4, 0 spherical aberrations and aberration coefficient values were associated with larger optical zones (7 mm) (z4, 0 spherical aberrations = 1.25, p = 0.01; coefficient value = –1.21, p < 0.01). Although a smaller optical zone (6.5 mm) was associated with an increase in most of the wave-front aberration variables, measurements were not statistically different between the two groups other than z4, 0 spherical aberrations and aberration coefficients.

Discussion:

LASIK treatment with 6.5 and 7 mm optical zones is safe and effective for correcting myopia and myopic astigmatism and has statistically similar visual outcomes. Moreover, larger optical zone (7 mm) was found to be associated with lower spherical aberration induction and smaller aberration coefficient values compared to 6.5 mm optical zone. This can be important for decision-making in femto-LASIK surgery for better postoperative results.
Immunotherapy for Cutaneous T-Cell Lymphoma: Current Landscape and Future Developments
Authors: Sivanand Arunima , Surmanowicz Philip , Alhusayen Raed , Hull Peter , Litvinov Ivan V , Zhou Youwen , Gniadecki Robert
Published: July 2019

Mycosis fungoides (MF) and Sézary syndrome (SS) are chronic, progressive primary cutaneous T-cell lymphomas (CTCLs) for which there are no curative treatments. Skin-directed therapies, such as phototherapy, radiation therapy, or topical nitrogen mustard, provide only short-term remissions. Numerous attempts with different chemotherapeutic regimes failed to achieve meaningful clinical responses. Immunotherapy seems to be a promising avenue to achieve long-term disease control in CTCL. There is compelling evidence indicating that MF and SS are immunogenic lymphomas, which can be recognized by the patient’s immune system. However, CTCL uses different strategies to impair host’s immunity, eg, via repolarizing the T-cell differentiation from type I to type II, recruiting immunosuppressive regulatory T-cells, and limiting the repertoire of lymphocytes in the circulation. Many currently used therapies, such as interferon-α, imiquimod, extracorporeal phototherapy, and allogeneic bone marrow transplant, seem to exert their therapeutic effect via activation of the antitumor cytotoxic response and reconstitution of the host’s immune system. It is likely that novel immunotherapies such as immune checkpoint inhibitors, cancer vaccines, and chimeric antigen receptor-T cells will help to manage CTCL more efficiently. We also discuss how current genomic techniques, such as estimating the mutational load by whole genome sequencing and neoantigen calling, are likely to provide clinically useful information facilitating personalized immunotherapy of CTCL.
The effect of radical right fringe parties on main parties in Central and Eastern Europe: Empirical evidence from manifesto data
Authors: Heinisch Reinhard , Saxonberg Steven , Werner Annika , Habersack Fabian
Published: July 2019

Do radical right fringe parties affect main parties in Central and Eastern Europe (CEE)? Using data from the Manifesto Project, we analyze the relationship between radical right fringe parties’ and main parties’ policy programs regarding sociocultural issues in six post-communist countries of CEE. Even though radical right fringe parties have participated in government in several of these countries, and in Hungary a fringe party has become the country’s second largest party, our analysis shows that the sociocultural issues in radical right fringe party manifestos do not systematically relate to the changes in main party manifestos regarding those issues. Even if some of the main parties in our study might often agree with the radical right fringe parties, our analysis shows that the latter do not directly influence the policy priorities of the main parties.
Legally a Lady
Authors: Ingersoll Hannah
Published: July 2019

In a period of ambiguous legal culture between the U.S. Civil War and the legal imposition of Jim Crow, court cases reveal Black women navigating race, class, and gender as they sought a seat in the Ladies’ Car and claimed their right to dignity within American society.
Perceived Gun Access and Gun Carrying Among Male Adolescent Offenders
Authors: Keil Spencer , Beardslee Jordan , Schubert Carol , Mulvey Edward , Pardini Dustin
Published: July 2019

Gun violence takes a significant toll on adolescents in the United States, and there is a lack of longitudinal research on perceptual factors that drive gun carrying. Notably, there is no information on the relationship between perception of gun accessibility and gun carrying. Using data collected between 2000 and 2006 in the Pathways to Desistance Study, we examine the effects of perceived access to guns in a sample of adolescent offenders. A generalized estimating equations approach tested the effect of perceived gun access along with other known risk factors for gun carrying across time. Even after adjusting for these other risk factors, perceived gun access was significantly related to future carrying. Our findings support self-reported gun availability as a significant, population-based risk factor related to gun carrying in high-risk youth. Further research on how perceived access mediates the decision to carry guns would be valuable for formulating effective gun policy.
Comparative evaluation of postoperative health status and functional outcome in patients treated with either proximal femoral nail or hemiarthroplasty for unstable intertrochanteric fracture
Authors: Ucpunar Hanifi , Camurcu Yalkin , Çöbden Adem , Sofu Hakan , Kis Mehmet , Demirel Huseyin
Published: July 2019

Purpose:

This study aimed to compare functional recovery and change in morbidity status from the preoperative levels among patients who underwent two different surgical treatments for unstable intertrochanteric fracture.

Methods:

This retrospective comparative study enrolled 140 patients (aged >80 years) who were referred to two hospitals. Of these, 64 were treated using proximal femoral nail (PFN) and 76 were treated using hemiarthroplasty (HA). To evaluate functional recovery, primary outcome measures were cumulative illness rating scale (CIRS) score to evaluate changes in morbidity status, activity of daily living (ADL) index, and mobility scores.

Results:

The proportion of patients who experienced increased CIRS scores in the HA group was higher at the 3-month follow-up ( p = 0.02) but similar at the 6-month follow-up ( p = 0.2) in comparison to the PFN group. Treatment with HA, American Society of Anesthesiologists scores of 3–4, and lower, preoperative ADL indexes were the major predictors of increased postoperative CIRS score. Impaired ambulatory ability and the need for walking aids were significantly higher in the PFN group at the 3-month follow-up ( p = 0.01 and p = 0.02, respectively) but similar at the 6-month follow-up with respect to the HA group. PFN treatment and high patient body mass index were the major predictors of decreased ambulatory ability at postoperative 3 months.

Conclusion:

HA has several advantages, including early mobilization and decreased dependency. However, it is associated with greater blood loss, a higher need for blood transfusion, and longer surgical duration than PFN, all of which are predisposing factors for significantly higher risk of reduced CIRS scores.
The WORC Index and Predicting Treatment Failure in Patients Undergoing Primary Arthroscopic Rotator Cuff Repair
Authors: Herring Matthew J. , White Melissa , Braman Jonathan P.
Published: July 2019

Background:

Rotator cuff tears are common injuries that are reliably treated with arthroscopic repair, producing good to excellent results. The Western Ontario Rotator Cuff (WORC) index is a validated disease-specific instrument used to assess patient outcomes; however, no study to date has correlated WORC index with treatment failure.

Purpose:

To evaluate the WORC index as a predictor for successful treatment in arthroscopic rotator cuff repair. An additional purpose was to identify patient and tear characteristics associated with risk of treatment failure.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

This study reviewed a total of 500 patients who underwent arthroscopic rotator cuff repair with a minimum of 2-year follow-up. Patient charts were reviewed for treatment failures, defined as persistent or recurrent shoulder pain or weakness, leading to further workup and identification of a failure to heal or recurrent tear by magnetic resonance imaging. Patient demographic and comorbidity data were gathered and correlated with risk of failure. All patients completed WORC questionnaires, and scores were correlated with risk of treatment failure.

Results:

There were 28 (5.6%) treatment failures at a median 28 weeks (SD, 42 weeks) postoperatively. Patients claiming workers’ compensation were 3.21 times more likely (odds ratio; P = .018) to fail treatment. Posterior interval tears (those including infraspinatus) were 3.14 times more likely ( P = .01) to fail than anterior interval tears. Tear size was associated with treatment failure; the odds of failure was 3.24 for a 2-tendon tear and 5.83 for a 3-tendon tear ( P = .03). Tears involving the nondominant arm were associated with an increased risk of failure by a factor of 3.04 (95% CI, 1.01-9.11; P = .047). A WORC score ≥80 was associated with a 95% probability of treatment success at 1 year.

Conclusion:

After arthroscopic rotator cuff repair, patients with WORC scores ≥80 at 1 year have a 95% probability of successful treatment and likely do not benefit from continued follow-up visits. Furthermore, several risk factors were identified that may influence outcomes after rotator cuff repair, including workers’ compensation, location of tear, tear size, and hand dominance.
Static Lateral Tibial Plateau Subluxation Predicts the Grade of Rotatory Knee Laxity in ACL-Deficient Knees
Authors: Lian Jayson , Novaretti João V. , Sheean Andrew J. , Patel Neel K. , Popchak Adam , Musahl Volker
Published: July 2019

Objectives:

In anterior cruciate ligament-deficient (ACL-D) knees, injury pattern and bony morphology have been shown to influence both static anterior tibial subluxation relative to the femur and dynamic rotatory knee laxity. Therefore, the relationship between static anterior tibial subluxation and dynamic rotatory knee laxity was investigated. The goal of this study was to determine if static tibial subluxation as measured on magnetic resonance imaging (MRI) was associated with the grade of rotatory knee laxity in ACL-D knees.

Methods:

Two-hundred and fifty-eight knees underwent preoperative, image-guided assessment of lateral knee compartment translation during quantitative pivot shift (QPS). Subluxations of the medial and lateral tibial plateaus were measured on preoperative MRI in a subset of primary ACL-D knees meeting criteria for high-grade (QPS > 5.2 mm) and low-grade (QPS < 2.4 mm) rotatory laxity. Tibial subluxations on MRI were compared between patients with high- and low-grade rotatory laxity using pairwise t-test, and analyzed using uni- and multivariate logistic regression. Significance was set at p<0.05.

Results:

On MRI, greater anterior subluxation of the lateral tibial plateau was observed in patients with high-grade compared to low-grade rotatory knee laxity (4.5 mm vs. 2.3 mm; p<0.05). No similar relationship was observed for the medial tibial plateau (-0.9 mm vs. -0.4 mm; p>0.05). Univariate logistic regression demonstrated that static subluxation of the lateral tibial plateau was associated with high-grade rotatory knee laxity (Odds ratio [OR] 1.2; p<0.05). An optimal cut-off of 2.95 mm of static lateral tibial subluxation was associated with high-grade rotatory knee laxity (sensitivity: 75%; specificity: 63%). Lateral meniscus injury was the first variable to enter a multivariate regression analysis and proved to be most associated with high-grade rotatory knee laxity ([OR] 6.8; p < 0.05). When lateral meniscus injury was excluded from multivariate regression analysis, static anterior subluxation of the lateral tibial plateau alone was associated with high-grade rotatory knee laxity ([OR] 1.2; p<0.05).

Conclusion:

Data from this MRI study of two distinct rotatory knee laxity groups showed that static anterior subluxation of the lateral tibial plateau of 2.95 mm or greater was associated with high-grade rotatory knee laxity, and each millimeter increase of lateral tibial plateau subluxation was associated with a 1.2-fold odds of high-grade rotatory knee laxity. Anterior subluxation of the lateral tibial plateau on MRI was not independently associated with high-grade rotatory knee laxity in the presence of concomitant lateral meniscus injury. Static measurements made pre-operatively may aid in predicting high-grade rotatory knee laxity and refining the indications for individualized knee surgery.
Arthroscopic Treatment for Shoulder Instability with Glenoid Bone Loss Using Distal Tibia Allograft Augmentation: Two Year Outcomes
Authors: Ebnezar Rakesh , Wong Ivan H.
Published: July 2019

Objectives:

To analyse the clinico-radiologic outcomes of patients who underwent an all arthroscopic procedure to treat shoulder instability with glenoid bone loss using a distal tibial allograft; with a minimum 2 year follow-up.

Methods:

A retrospective chart review of prospectively collected data was completed for patients who underwent arthroscopic stabilization with Bankart repair and allograft bony augmentation of the glenoid; by the same surgeon. Western Ontario Shoulder Instability Index (WOSI), Disability of the Arm Shoulder and Hand (DASH), Veterans Rand - 12 and MARX questionnaires were completed pre and post-operatively. Radiological assessment was performed with radiographs and CT scans obtained pre-operatively and at approximately one year post surgery.

Results:

A total of 41 patients (29 males, 12 females) with a mean age of 26 ± 9 years were included. An excellent safety profile was observed, with no intraoperative complications, neurovascular injuries, adverse events, bleeding, or infections. At 2- year follow-up, there was statistically significant improvement of the WOSI score when compared preoperatively (preoperative=62.6 ± 17.06; at 2-year=22.96± 12.92; p<0.001). The mean pre-operative bone loss was 30.32% (SD ± 7.90). There were no cases of non- union or partial union. No resorption of the graft (grade 0) was seen in 42% patients, whereas 42% and 16% of patients had grade 1 and grade 2 resorption; respectively. There was 100% healing at the interface between allograft and native glenoid. The mean sagittal dimension of the remaining allograft post-operatively was 5.10 ± 2.27 mm in the patients with ≥50% resorption which indicates there was still bone graft present and there was no complete resorption. Mean post-operative external rotation for the population was also observed to near full.

Conclusion:

Arthroscopic stabilization with DTA augmentation has an excellent outcome at 2-year follow-up; long-term follow-up studies are necessary for better assessment of outcomes.
The Timing of Corticosteroid Injections following Knee Arthroscopy Influence Infection Risk
Authors: Cancienne Jourdan M. , Casp Aaron Joseph , Kew Michelle Elizabeth , Carson Eric W. , Miller Mark D. , Werner Brian C.
Published: July 2019

Objectives:

Although some surgeons will offer an intra-articular corticosteroid injection to accelerate post-operative recovery and decrease inflammation and swelling following knee arthroscopy, there is a paucity of literature evaluating the safety of this practice. Therefore, the purpose of the present study was to examine any association between between the timing of postoperative corticosteroid injection following knee arthroscopy and infection.

Methods:

Private-payer (PP) and Medicare (MC) national insurance databases were queried for patients who underwent simple arthroscopic knee procedures, including partial meniscectomy and chondroplasty. Patients undergoing concomitant open or more complex procedures with grafts were excluded. Patients who received ipsilateral knee corticosteroid injections within 2, 4, 6, and 8 weeks postoperatively were then identified. Postoperative infection within 90 days after the injection was assessed using ICD-9 and CPT coding for all study groups and compared using a multivariate binomial logistic regression analysis. Adjusted odds ratios (OR) and 95% confidence intervals were calculated with p < 0.05 considered significant.

Results:

5,533 patients were identified and met inclusion criteria, including 725 that received an injection within 2 weeks, 1,236 patients that received within 4 weeks, 1,716 that received an injection within 6 weeks, and 1,856 patients that received an injection within 8 weeks postoperatively. In both the PP and MC datasets the rate of infection was significantly higher in the 2-week cohort compared to the 6 week (PP: OR 3.81, p = 0.012; MC: OR 9.36, p = 0.001) and 8 week (PP: OR 8.59, p = 0.003; MC: OR 7.80, p = 0.001) cohorts [Tables 1, 2]. The rate of infection was also higher in the 4-week cohort compared to the 6 week (PP: OR 2.54, p = 0.024; MC: OR 8.91, p = 0.001) and 8 week (PP: OR 5.64, p = 0.009; MC: OR 7.80, p = 0.001) cohorts [Tables 1,2]. There were no differences in infection rates between the 2 and 4 week cohorts in either dataset (PP: p = 0.278; MC: p = 0.861).

Conclusion:

The findings of the present study add to a growing body of evidence that discourages the use of corticosteroids in the perioperative period for knee arthroscopy due to the risk of infectious complications. There was a significant association between intra-articular knee corticosteroid injections within 4 weeks of surgery and an increased incidence of postoperative infection in both Medicare and private payer patients after knee arthroscopy compared to patients with steroid injections more than 4 weeks postoperatively. In the absence of any prospective studies on this topic, we caution against the use of steroid injections within one month following knee arthroscopy. [Table: see text][Table: see text][Table: see text][Table: see text]
Hamstring Graft Harvest Side Does Not Affect Performance or RTS Rates and Does Not Increase Risk for Future Hamstring Injuries Following UCL Reconstruction in Professional Baseball Players
Authors: Erickson Brandon J. , Chalmers Peter Nissen , D’Angelo John , Ma Kevin , Ahmad Christopher S. , Dines Joshua S. , Romeo Anthony A.
Published: July 2019

Objectives:

Ulnar collateral ligament reconstruction (UCLR) is a successful procedure in professional baseball players. It is unclear if hamstring tendon harvest side for UCLR alters a player’s risk of subsequent hamstring injuries. The purpose of this study was to compare, performance, return to sport (RTS) rate, and injury rates between professional baseball players with a history of UCLR using an ipsilateral (drive leg) hamstring autograft to those with UCLR using contralateral (landing leg) hamstring autograft. The authors’ hypothesized that players with prior UCLR using ipsilateral (drive leg) hamstring autograft will have the same RTS rate and performance upon RTS, but higher number of subsequent lower extremity injuries than those using contralateral (landing leg) hamstring autograft.

Methods:

All players between 2010-2015 who underwent UCLR using hamstring autograft were included. Surgical details of their procedure were recorded using operative reports. Players with a hamstring UCLR were compared within group to compare grafts taken from the drive leg vs. landing leg.

Results:

Overall, 191 players underwent UCLR using hamstring autograft (58 [30%] landing/contralateral and 133 [70%] ipsilateral/drive leg). The docking technique was more common in the contralateral/landing leg group while the figure-of-8 technique was more common in the ipsilateral/drive leg group (p>0.001). More patients in the ipsilateral/drive leg group underwent concomitant treatment of the ulnar nerve than the contralateral/landing leg group (p<0.001). No difference existed in return to sport (RTS) rates, or timing of RTS between groups. No differences in subsequent ipsilateral or contralateral hamstring injuries between players who underwent UCLR using hamstring from the ipsilateral/drive leg or contralateral/landing leg was seen (p=1.000; p=0.460 respectively). No difference in overall upper or lower extremity injury rates existed between groups.

Conclusion:

No difference in RTS rate, performance upon RTS, or subsequent hamstring, lower extremity, or upper extremity injury rates existed between players who underwent UCLR using hamstring autograft from the ipsilateral/drive or contralateral/landing leg.
The Timing of Corticosteroid Injections after Shoulder Arthroscopy Affects Postoperative Infection Risk
Authors: Kew Michelle Elizabeth , Cancienne Jourdan M. , Christensen James E. , Werner Brian C.
Published: July 2019

Objectives:

To examine the association between the timing of post-operative corticosteroid injections with rates of post-operative infection in arthroscopic shoulder procedures.

Methods:

Private-payer and Medicare national insurance databases were queried for patients who underwent arthroscopic rotator cuff repair, debridement, or subacromial decompression. Patients who underwent corticosteroid injections within 1 month, 2 months, 3 months, or 4 months post-operatively were identified and compared to a matched control group that underwent the same surgeries without a postoperative steroid injection. ICD-9 and CPT codes were used to identify rates of post-operative infection within 90 days after injection for the study groups and controls. Multivariate binomial logistic regression analysis was used to compare groups and adjusted odds ratios (OR) and 95% confidence intervals were calculated with p< 0.05 considered significant.

Results:

A total of 3,946 patients were identified, including 264 patients who received an injection within 1 month after surgery, 471 within 2 months, 1,037 within, 1,874 within 4 months, and 2,640 matched controls. Compared to controls, patients who underwent a corticosteroid injection within 1 month postoperatively had a significantly higher rate of infection (PP: OR 2.63, p=0.014; MC: OR 11.2, p<0.0001). There were no differences in infection rates at all other time points: (p =0.264 -0.835).

Conclusion:

This study adds to the evidence suggesting caution when administering injections in the immediate post-operative period following arthroscopic shoulder surgery. Although causality cannot be determined on the basis of this administrative database review, we found a significant association between intra-articular ipsilateral corticosteroid injections administered 1 month post-operatively and an increased rate of post-operative infection, in both a Medicare and private payer patient cohort, when compared to a control patient group. [Table: see text][Table: see text]
Impact of a Quality Improvement Infection Risk Reduction Program on Pathogen Presence in High School and Collegiate Athletic Training Room Facilities
Authors: LaBelle Mark W. , Knapik Derrick M. , Voos James Everett
Published: July 2019

Objectives:

Athletic training rooms have a high prevalence of bacteria, including multidrug resistant organisms, increasing the risk for both local and systematic infections in athletes. There is limited data outlining formal protocols or standardized programs to reduce the bacterial and viral burden in training rooms as a means of decreasing infection rate at the collegiate and high school levels. The purpose of this study is to implement established hygiene principles to high school and collegiate athletic training rooms to reduce bacterial and viral burden using a quality improvement infection control program. The authors hypothesize that implementation of such a program will reduce bacterial and viral counts in athletic training rooms over the course of one academic year.

Methods:

Two high school and two college athletic training rooms were studied over the course of one academic year. A three-phase protocol, including introduction of disinfectant products, implementation of posters and checklists, and student-athlete and athletic trainer education was implemented at the four schools. Multiple surfaces in athletic training rooms were swabbed at four time points throughout the investigation, corresponding with each phase of protocol implementation (Image 1). Bacterial and viral burden from swabs were analyzed for overall bacterial aerobic plate count (APC), influenza viral load and the presence of multidrug resistant organisms such methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococcus (VRE).

Results:

Overall bacterial load, as measured by APC, was reduced by 94.7% (95% CI [72.6, 99.0], p = 0.003) over the course of the investigation following protocol implementation. Image 2 demonstrates the downward trend in bacterial load averaged across all surfaces sampled over the course of the study. MRSA and VRE were found on 24% of surfaces prior to intervention and were reduced to 0% by the end of the study. Influenza was initially detected on 25% of surfaces with no detection following intervention. No cases of athletic training room acquired infections were reported during the study period.

Conclusion:

A uniform infection control protocol implemented in the athletic training room of four secondary schools was effective in reducing bacterial and viral burden, including multidrug resistant organisms, over the course of one academic year. Future investigations will focus on expanding this protocol to a larger number of schools with broader demographics.
Using Telemedicine to Pre-Screen Sports Medicine Patients in the Ambulatory Setting Reduces Wait Times and Maximizes Provider-Patient Interaction
Authors: Atanda Alfred , Leyden Kathryn , Student Medical
Published: July 2019

Objectives:

Gathering of background information during a clinic visit can be time-consuming. Some medical specialties have workflows that pre-screen patients ahead of time to minimize delays. Having background information ahead of time may decrease delays and ensure that the visit is focused on physical examination, diagnosis, and treatment. We have used telemedicine to treat established patients to reduce cost and resource utilization, while maintaining high levels of patient satisfaction. It is conceivable that telemedicine could also be used to pre-screen new patients prior to their in-person clinic visit. The goal of the current study was to evaluate whether utilizing telemedicine to pre-screen new patients to our sports medicine clinic would reduce time in the exam room waiting and being seen, and overall clinic times.

Methods:

From June 2018 through August 2018, we utilized videoconferencing telemedicine to pre-screen all new patients to a pediatric sports medicine clinic with a chief diagnosis of knee pain. Visits were performed by full-time telemedicine pediatricians who were provided appropriate training and an intake form describing which questions should be asked. All visits utilized the American Well software platform (Boston, USA) and were performed on the patient’s personal device. During the subsequent in-person visit, the overall timing of the visit was recorded including: time checked in, time waiting in waiting room, time waiting in exam room, time spent with provider, and time-checked out, were all recorded. Similar time points were recorded for matched control patients that did not undergo telemedicine pre-screening and were seen in the traditional manner. Inclusion criteria included: being brand new to the practice and unilateral knee pain.

Results:

There were eight pre-screened patients and ten control patients in this cohort. Compared to controls, pre-screened patients spent less time in the exam room (19 min vs. 31 min), higher percentage of the exam room time with the provider (58% vs. 34%), higher percentage of the overall visit time with the provider (29% vs. 19.5%), and less time for the overall visit (39 min vs. 52 min).

Conclusion:

Pre-screening patients to obtain background information can decrease exam room waiting time and overall visit time and maximize time during the visit spent with the provider. In addition, it could potentially be used to increase throughput through the clinic and improve patient satisfaction scores.
Partial-thickness Rotator Cuff Tear Itself Did Not Cause Shoulder Pain Or Muscle Weakness In Baseball Players
Authors: Mihata Teruhisa , Morikura Rei , Fukunishi Kunimoto , Fujisawa Yukitaka , Kawakami Takeshi , Hasegawa Akihiko , Neo Masashi
Published: July 2019

Objectives:

Rotator cuff tears are common shoulder injuries in baseball players. In some severe tears (i.e. through more than 50% of the cuff’s thickness), conservative treatment does not work well, and surgical treatment is sometimes chosen in an effort to ensure return to play. In contrast, some partial thickness rotator cuff tears do not cause shoulder symptoms, even during throwing motion. The objective of this study was to assess whether partial thickness rotator cuff tears cause shoulder pain and muscle weakness in baseball players.

Methods:

We studied 87 university baseball players (age: 19.5±0.8 years; baseball career: 11.5±1.6 years). Rotator cuff tendons were ultrasonographically examined (Fig 1), then divided into 4 groups; (1) no tear, (2) supraspinatus tendon tear, (3) infraspinatus tendon tear, (4) both supraspinatus and infraspinatus tendons tear. Current shoulder pain and shoulder muscle strength (Dominant/Non-dominant) in abduction, external rotation, and internal rotation were compared using Chi square test and t-test.

Results:

Forty-one (47%) players were diagnosed with articular-sided partial-thickness rotator cuff tears using ultrasonography. Nineteen tears were in the supraspinatus, 13 in the infraspinatus, and 9 in both the supraspinatus and the infraspinatus. Tear depth was 4.6±2.3 mm in the supraspinatus and 6.2±3.6 mm in the infraspinatus. There was no significant difference in rate of shoulder pain (p=0.96) and muscle strength among four groups (p=0.15 - 0.70).

Conclusion:

In this study, articular-sided partial-thickness rotator cuff tears did not cause shoulder pain and muscle weakness in university baseball players. Most of articular-sided partial-thickness rotator cuff tears are tears of the superior capsule but not the rotator cuff tendons, because the superior capsule is attached in the articular half of the greater tuberosity. Therefore, most so-called articular-sided partial-thickness rotator cuff tears may not be pathological tendon tear.
Goals and Adverse Effects: Rate of Concordance Between Patients and Providers
Authors: Duckworth Katharine E. , Morrell Robert , Russell Gregory B. , Powell Bayard , Canzona Mollie , Lichiello Stephanie , Riffle Olivia , Tolbert Aimee , McQuellon Richard
Published: July 2019

PURPOSE:

Adequate understanding of the goals and adverse effects of cancer treatment has important implications for patients’ decision making, expectations, and mood. This study sought to identify the degree to which patients and clinicians agreed upon the goals and adverse effects of treatment (ie, concordance).

METHODS:

Patients completed a demographic questionnaire, the National Comprehensive Cancer Network Distress Thermometer, the Medical Outcomes Study Social Support Survey, the Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction-General questionnaire, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being questionnaire, and a 13-item questionnaire about the goals and adverse effects of treatment. Providers completed a 12-item questionnaire.

RESULTS:

One hundred patients (51 female) and 34 providers participated (questionnaire return rate mean difference, 5 days; SD, 16 days). Patient and provider dyads agreed 61% of the time regarding the intent of treatment. In cases of nonagreement, 36% of patients reported more optimistic therapy goals compared to providers. Patients and providers agreed 69% of the time regarding the patient’s acknowledgement and understanding of adverse effects. Patients who reported an understanding of likely adverse effects endorsed significantly lower distress scores (mean, 2.5) than those who endorsed not understanding associated adverse effects (mean, 4.1; P = .008).

CONCLUSION:

Timely data capturing of patient-provider dyadic ratings is feasible. A significant discrepancy exists between a substantial percentage of patients’ and providers’ views of the intent and adverse effects of treatment. Patients were almost always more optimistic about the intent of treatment. Higher rates of distress were noted in cases of discordance. Providers may benefit from conversational feedback from patients as well as other integrated feedback systems to inform them about patient understanding.
Tremor
Authors: Louis Elan D.
Published: July 2019

PURPOSE OF REVIEW

Tremor may be defined as an involuntary movement that is rhythmic (ie, regularly recurrent) and oscillatory (ie, rotating around a central plane) and may manifest in a variety of ways; accordingly, tremor has a rich clinical phenomenology. Consequently, the diagnosis of tremor disorders can be challenging, and misdiagnoses are common. The goal of this article is to provide the reader with straightforward approaches to the diagnosis and treatment of tremors.

RECENT FINDINGS

Focused ultrasound thalamotomy of the ventral intermediate nucleus of the thalamus is an emerging and promising therapy for the treatment of essential tremor.

The evaluation should start with a detailed tremor history followed by a focused neurologic examination, which should attend to the many subtleties of tremor phenomenology. Among other things, the history and examination are used to establish whether the primary tremor is an action tremor (ie, postural, kinetic, or intention tremor) or a resting tremor. The clinician should then formulate two sets of diagnoses: disorders in which action tremor is the predominant tremor versus those in which resting tremor is the predominant tremor. Among the most common of the former type are essential tremor, enhanced physiologic tremor, drug-induced tremor, dystonic tremor, primary writing tremor, orthostatic tremor, and cerebellar tremor. Parkinson disease is the most common disorder of resting tremor. This article details the clinical features of each of these disorders, as well as those of additional tremor disorders.
Tardive Syndromes
Authors: Friedman Joseph H.
Published: July 2019

PURPOSE OF REVIEW

This article reviews the history, nosology, clinical features, epidemiology, and treatment of tardive syndromes.

RECENT FINDINGS

The major advance in the field of tardive syndromes has been the development and US Food and Drug Administration (FDA) approval of two vesicular monoamine transporter type 2 inhibitors, valbenazine and deutetrabenazine, for treating tardive syndromes. These medications are derivatives of tetrabenazine and reduce dyskinetic movements by reducing dopamine stimulation. Treatment is not curative, and the medications reduce, or “mask,” symptoms but presumably without adding to the long-term risk of increased involuntary movements believed to accrue from suppressive treatment with dopamine receptor–blocking drugs. A confounding advance has been the accumulation of data finding that second-generation antipsychotics, also known as atypical antipsychotics, may not be safer than first-generation antipsychotics in causing tardive syndromes. The public health risk of tardive syndromes may actually have increased as some second-generation antipsychotics, widely promoted to both doctors and patients, are increasingly used as antidepressants.

Tardive syndromes remain a public health risk. Second-generation antipsychotics have not been proven to have less risk than first-generation drugs in causing tardive syndromes and are nevertheless being used more widely to treat depression, bipolar disease, and insomnia. Symptomatic treatment for tardive syndromes is available, although expensive.
Movement Disorders in Children
Authors: Pearson Toni S. , Pons Roser
Published: July 2019

PURPOSE OF REVIEW

This article provides an overview of the clinical features and disorders associated with movement disorders in childhood. This article discusses movement disorder phenomena and their clinical presentation in infants and children and presents a diagnostic approach to suspected genetic disorders with a focus on treatable conditions.

RECENT FINDINGS

Technologic advances in molecular genetic testing over the past decade continue to lead to the discovery of new diseases. This article discusses the clinical presentation and early experience with treatment for several recently described genetic forms of infantile-onset and childhood-onset dystonia and chorea.

The clinical spectrum of pediatric movement disorders is broad and heterogeneous, ranging from acute or transient self-limited conditions to conditions that cause profound lifelong motor disability. Most movement disorders in childhood are chronic, and the large number of rare, genetic conditions associated with pediatric movement disorders can pose a significant diagnostic challenge. Recognition of distinctive diagnostic clues in the history and examination can facilitate the diagnosis of potentially treatable disorders.
Chorea
Authors: Termsarasab Pichet
Published: July 2019

PURPOSE OF REVIEW

This article provides an overview of the approach to chorea in clinical practice, beginning with a discussion of the phenomenologic features of chorea and how to differentiate it from other movement disorders. The diagnostic approach, clinical features of important acquired and genetic choreas, and therapeutic principles are also discussed. Practical clinical points and caveats are included.

RECENT FINDINGS

C9orf72 disease is the most common Huntington disease phenocopy, according to studies in the European population. Anti-IgLON5 disease can present with chorea. The role of immunotherapies in Sydenham chorea has increased, and further clinical studies may be useful. Benign hereditary chorea is a syndrome or phenotype due to mutations in several genes, including NKX2-1, ADCY5, GNAO1, and PDE10A. New-generation presynaptic dopamine-depleting agents provide more options for symptomatic treatment of chorea with fewer adverse effects. Deep brain stimulation has been performed in several choreic disorders, but features other than chorea and the neurodegenerative nature should be taken into consideration. Studies on genetic interventions for Huntington disease are ongoing.

Clinical features remain crucial in guiding the differential diagnosis and appropriate investigations in chorea. Given the complexity of most choreic disorders, treating only the chorea is not sufficient. A comprehensive and multidisciplinary approach is required.
The Death of Welfare Economics
Authors: Igersheim Herrade
Published: July 2019

The death of welfare economics has been declared several times. One of the reasons cited for these plural obituaries is that Kenneth Arrow’s impossibility theorem, as set out in his pathbreaking Social Choice and Individual Values in 1951, has shown that the social welfare function—one of the main concepts of the new welfare economics as defined by Abram Bergson (Burk) in 1938 and clarified by Paul Samuelson in the Foundations of Economic Analysis—does not exist under reasonable conditions. Indeed, from the very start, Arrow kept asserting that his famous impossibility result has direct and devastating consequences for the Berg-son-Samuelson social welfare function, though he seemed to soften his position in the early eighties. On his side, especially from the seventies on, Samuelson remained active on this issue and continued to defend the concept he had devised with Bergson, tooth and nail, against Arrow’s attacks. The aim of this article is precisely to examine this rather strange controversy, which is almost unknown in the scientific community, even though it lasted more than fifty years and involved a conflict between two economic giants, Arrow and Samuelson, and, behind them, two distinct communities—welfare economics, which was on the wane, against the emerging social choice theory—representing two conflicting ways of dealing with mathematical tools in welfare economics and two different conceptions of social welfare.
Care Communities
Authors: Schaffer Talia
Published: July 2019

The feminist philosophy of “ethics of care” has been important for disability studies inasmuch as it helps us see caregiving as widespread and admirable, rather than as a failure of autonomy. Care ethicists usually imagine care as either an institutional situation or an intimate dyad. However, in “Critical Care,” I add a third case in a midrange scale: the care community. The care community is a voluntary social formation, composed of friends, family, and neighbors, that coalesces around someone in need. It is my contention that by exploring the care community, we can make important aspects of care visible and rethink care relationships. What we see in care communities is a process, rather than a preset care structure, and that fluidity allows us to interrogate the conditions under which care can develop and the dynamics of extended care. I use Victorian fiction to showcase care communities, since novels of this period are marked by ubiquitous spontaneous small groups forming around people who are ill or hurt, but I also make a case that care communities continue to exist today, particularly among queer communities and people of color, performing a vital function in our ordinary lives. Finally, I argue that care communities can help us fundamentally rethink disability as a need like any other need rather than an inherent identity. Eva Feder Kittay has argued that care relations are the foundation of civic society; in that case, disability and the care community that arises in response to it are not marginalized cases but are what, profoundly, makes social life possible.
After Marginalization
Authors: Hartblay Cassandra
Published: July 2019

Contemporary social thought frequently posits sociopolitical exclusion as marginalization. This article argues that marginalization relies on a spatial metaphor that conceptualizes social exclusion as always already configured in relation to center and periphery. Suggesting that this reliance on marginalization as a way of understanding sociopolitical exclusion limits political thought, this article calls for a renewed attention to actual material configurations of social exclusion. Considering ethnographic research with adults with mobility and speech disabilities in Petrozavodsk, Russia, and representation of disability in contemporary Russian film, the concept of marginalization is demonstrated to be insufficient to analyze the actual spatial segregation of people with disabilities in contemporary Russia in the digital era. The spatial metaphor of marginalization fails to describe the way that interlocutors with mobility impairments are at once segregated and included in sociopolitical life in the digital era, when civic life unfolds in cyberspace. Drawing on ethnographic interviews and observation, this article proposes pixelization as a descriptor of the specific spatial pattern of sociopolitical exclusion of people with mobility and speech impairments in Petrozavodsk, characterized by material segregation in family apartments combined with intricate enabling connection to various publics via digital networks. Spatial metaphors for social difference matter for the kinds of alternate presents and futures that might be envisioned, challenging the presumption that ableism’s power comes from limiting political participation in public space defined by a liberal democratic agora.