bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating uncertainty-based active learning for accelerating the generalization of molecular property prediction
Authors: Yin Tianzhixi , Panapitiya Gihan , Coda Elizabeth D. , Saldanha Emily G.
Published: November 2023

Deep learning models have proven to be a powerful tool for the prediction of molecular properties for applications including drug design and the development of energy storage materials. However, in order to learn accurate and robust structure–property mappings, these models require large amounts of data which can be a challenge to collect given the time and resource-intensive nature of experimental material characterization efforts. Additionally, such models fail to generalize to new types of molecular structures that were not included in the model training data. The acceleration of material development through uncertainty-guided experimental design has the promise to significantly reduce the data requirements and enable faster generalization to new types of materials. To evaluate the potential of such approaches for electrolyte design applications, we perform comprehensive evaluation of existing uncertainty quantification methods on the prediction of two relevant molecular properties - aqueous solubility and redox potential. We develop novel evaluation methods to probe the utility of the uncertainty estimates for both in-domain and out-of-domain data sets. Finally, we leverage selected uncertainty estimation methods for active learning to evaluate their capacity to support experimental design.
Discordance between chromatin accessibility and transcriptional activity during the human primed-to-naïve pluripotency transition process
Authors: Tu Zhifen , Bi Yan , Mao Tengyan , Wang Hong , Gao Shaorong , Wang Yixuan
Published: November 2023

Naïve pluripotent state can be obtained by several strategies from various types of cells, in which the cell fate roadmap as well as key biological events involved in the journey have been described in detail. Here, we carefully explored the chromatin accessibility dynamics during the primed-to-naïve transition by adopting a dual fluorescent reporter system and the assay for transposase-accessible chromatin (ATAC)-seq. Our results revealed critical chromatin remodeling events and highlight the discordance between chromatin accessibility and transcriptional activity. We further demonstrate that the differential epigenetic modifications and transcription factor (TF) activities may play a critical role in regulating gene expression, and account for the observed variations in gene expression despite similar chromatin landscapes.
ERK signaling waves via body-wall muscles guide planarian whole-body regeneration across long distances
Authors: Xiao Chenglu , Xiong Jing-Wei
Published: November 2023

Whole-body regeneration is a multifaceted process that reinstates a body to its initial three-dimension size and structure after resection injury. It is well-known that signaling waves such as calcium and extracellular signal-related kinase (ERK) signaling waves can efficiently transmit information between tissues or cells. However, the mechanisms responsible for coordinating wound responses over long distances are largely unexplored. A recent study has reported that the propagation of ERK signaling waves via longitudinal body-wall muscles play an essential role in wound response and whole-body regeneration in planarians, underscoring the significance of feedback interactions between spatially distinct tissues during whole-body regeneration over long distances. These findings not only address the central questions of regenerative biology but also have potential implications for regenerative medicine.
Racial Disparities in Receipt of Guideline-Concordant Care for Early-Onset Colorectal Cancer in the United States
Authors: Nogueira Leticia M. , May Folasade P. , Yabroff K. Robin , Siegel Rebecca L.
Published: November 2023

PURPOSE

Young individuals racialized as Black are more likely to die after a colorectal cancer (CRC) diagnosis than individuals racialized as White in the United States. This study examined racial disparities in receipt of timely and guideline-concordant care among individuals racialized as Black and White with early-onset CRC.

METHODS

Individuals age 18-49 years racialized as non-Hispanic Black and White (self-identified) and newly diagnosed with CRC during 2004-2019 were selected from the National Cancer Database. Patients who received recommended care (staging, surgery, lymph node evaluation, chemotherapy, and radiotherapy) were considered to have received guideline-concordant care. Odds ratios (ORs) were adjusted for age and sex. The decomposition method was used to estimate the relative contribution of demographic characteristics (age and sex), comorbidities, health insurance, and facility type to the racial disparity in receipt of guideline-concordant care. The product-limit method was used to evaluate differences in time to treatment between patients racialized as Black and White.

RESULTS

Of the 84,882 patients with colon cancer and 62,573 patients with rectal cancer, 20.8% and 14.5% were racialized as Black, respectively. Individuals racialized as Black were more likely to not receive guideline-concordant care for colon (adjusted OR [aOR], 1.18 [95% CI, 1.14 to 1.22]) and rectal (aOR, 1.27 [95% CI, 1.21 to 1.33]) cancers. Health insurance explained 28.2% and 21.6% of the disparity among patients with colon and rectal cancer, respectively. Individuals racialized as Black had increased time to adjuvant chemotherapy for colon cancer (hazard ratio [HR], 1.28 [95% CI, 1.24 to 1.32]) and neoadjuvant chemoradiation for rectal cancer (HR, 1.42 [95% CI, 1.37 to 1.47]) compared with individuals racialized as White.

CONCLUSION

Patients with early-onset CRC racialized as Black receive worse and less timely care than individuals racialized as White. Health insurance, a modifiable factor, was the largest contributor to racial disparities in receipt of guideline-concordant care in this study.
Mechanism of Arcuate Kisspeptin Neuron Synchronization in Acute Brain Slices From Female Mice
Authors: Morris Paul G , Herbison Allan E
Published: November 2023

The mechanism by which arcuate kisspeptin (ARNKISS) neurons co-expressing glutamate, neurokinin B, and dynorphin intermittently synchronize their activity to drive pulsatile hormone secretion remains unclear in females. In order to study spontaneous synchronization within the ARNKISS neuron network, acute brain slices were prepared from adult female Kiss1-GCaMP6 mice. Analysis of both spontaneous synchronizations and those driven by high frequency stimulation of individual ARNKISS neurons revealed that the network exhibits semi-random emergent excitation dependent upon glutamate signaling through AMPA receptors. No role for NMDA receptors was identified. In contrast to male mice, ongoing tachykinin receptor tone within the slice operated to promote spontaneous synchronizations in females. As previously observed in males, we found that ongoing dynorphin transmission in the slice did not contribute to synchronization events. These observations indicate that a very similar AMPA receptor–dependent mechanism underlies ARNKISS neuron synchronizations in the female mouse supporting the “glutamate two-transition” model for kisspeptin neuron synchronization. However, a potentially important sex difference appears to exist with a more prominent facilitatory role for tachykinin transmission in the female.
Queer Spectrality and the Hope of Heterolingual Address
Authors: Dickinson Kristin
Published: November 2023

This article reads the final moment of Fatma Aydemir’s 2022 novel, Dschinns, as an instance of heterolingual address, which provides an alternative to the progressive logic of assimilation in both Germany and Turkey and the cyclicality of transgenerational trauma. Opening out onto the possibility of a forthcoming counter-address marked by queer spectrality, the novel prompts readers to engage in an open-ended process of community formation by rethinking their own modes of address and the myriad power structures that undergird them.
On Similarity in Contemporary German Jewish Literature
Authors: Garloff Katja
Published: November 2023

This essay calls for a theoretical discussion of the aesthetics and politics of comparison in contemporary German Jewish literature and beyond. It describes the tendency of recent German Jewish writers and thinkers to compare and connect the experiences of Jews to those of other minoritized groups. The essay briefly discusses several theoretical paradigms that spell out the political stakes of such comparisons, including touching tales (Leslie Adelson) and multidirectional memory (Michael Rothberg). It then draws attention to another modality of comparison that is particularly promising because of its purposive abstractness and its relevance for literary texts: similarity. Finally, the essay offers two examples of the productive use of similarity in recent German Jewish literature: Katja Petrowskaja’s Vielleicht Esther (which connects different instances of historical trauma) and Sasha Marianna Salzmann’s Außer sich (which weaves the experience of a Syrian refugee in Istanbul into a web of similar migratory movements).
A More Immanent Critique; or, Inside the House That Alexander Mitscherlich Built
Authors: Komska Yuliya
Published: November 2023

Frequently, to be an immigrant is to be submerged in one’s new physical and institutional settings, to be inside without feeling like an insider. The position is at odds with critique, which is traditionally predicated on distance. This article attempts to undo the contradiction between the two circumstances. From inside a unit that the preeminent postwar psychoanalyst and critic Alexander Mitscherlich helped plan for the developer Neue Heimat Städtebau in Emmertsgrund, outside Heidelberg in Germany’s southwest, it articulates a critique of his pedagogical foray into mass housing and urbanism. In the process, it stakes out a critical position for Germanists with immigrant backgrounds.
Decolonizing Reading Publics, Decompartmentalizing German Studies
Authors: Mani B. Venkat
Published: November 2023

This essay focuses on the contemporary German literary public spheres, zooming in on the relation between a republic and its reading public. In the fraught political topography of contemporary Germany, marked by the arrival and eventual acceptance of over one million Syrian refugees since 2015, the rise of the extreme right-wing party Alternatives for Germany, resurgence of discussion on German colonialism in Africa, and extended public debate around the controversial Humboldt Forum in Berlin, the essay centralizes questions of race, colonialism, and migration. Connecting these key terms with current debates on decolonizing and diversifying the literary canon, the essay argues that decolonization is a direction, not a destination; it is a method, not a product, and attempts to decolonize a national literary canon must be conducted in connection with the larger public spheres, indeed by decompartmentalizing the classroom and the society.
“The 62 Members of the Mickey Mouse Club”: Yearbook Impressions
Authors: Michell Kalani
Published: November 2023

This essay redirects attention to questions of reception in German-speaking contexts, instead of a limited stress on what is “produced” there. This not only affords us, German studies scholars at North American universities, an opportunity to take into account our own reception of imported European goods within our specific institutional and local cultural contexts. It also confirms what we so often claim in our teaching statements, namely, that our students play a key role in the meaning of these objects, not as mere “receivers” but as fellow interlocuters, since the questions asked about these objects structure them in the first place. The messiness of these transcultural European trade routes needs to be taken seriously so that the noise, mixed messages, and missed signals might become part of our objects of interpretation, instead of being relegated to the footnotes of standard histories.
Preface to a Philosophy by Which No One Can Live
Authors: Ruffin Jessica
Published: November 2023

This essay proposes an ethics for critical philosophies attuned to global white supremacy and its effects of violence, erasure, and precarity. The essay examines Arthur Schopenhauer as a potential forefigure for critical practices that aim to attend to the precarious survival of the global majority engulfed by white supremacy and racial capitalism. Through Denise Ferreira da Silva’s and Sara Ahmed’s philosophies of race, the essay carries out an autotheoretical dissection—tracing Ruffin’s own myopic relation to the white supremacist moralities that continue to thrive in critical interdisciplinary German studies. As a way out of the aporia that white supremacy enacts, the essay proposes an orientation away from what is thought to be life and toward a critical aesthetics that attends to the unsurviving.
The Call to Political Geography
Authors: Slobodian Quinn
Published: November 2023

This essay offers a capsule memoir of a part-time Germanist. It recounts the author’s experience of coming of age in the 1990s when it was salad days for All Things German in North America and the sheen of Weimar shone. This decade was followed by the years of the global war on terror and eventually the global financial crisis, when German studies seemed to lose the plot and many historians of German quietly exited the subfield. The essay concludes with a reflection on political geography as a way to engage with German history and the German contribution to the world of ideas. German history is dense with suggestive answers to the evergreen questions of what a state should be and what kind of world it should exist in.
Deutsche Rindergrammatik; or, The Once and Future Aurochs
Authors: Winthrop-Young Geoffrey
Published: November 2023

The essay compares the back-breeding of the extinct aurochs by the German zoologists Lutz and Heinz Heck with the reconstruction of past Germanic languages and mythologies by Jacob Grimm. It then points to similarities between current rewilding projects and the absorption of the Hecks’ back-breeding venture into the broader National Socialist vision of racial rewilding in the conquered eastern territories. Finally, it argues that the aurochs resurrection heralds the coming of a future age of total bioengineering.
Competition for H2A.Z underlies the developmental impacts of repetitive element de-repression
Authors: Meng Fanju W. , Murphy Kristin E. , Makowski Claire E. , Delatte Benjamin , Murphy Patrick J.
Published: November 2023

The histone variant H2A.Z is central to early embryonic development, determining transcriptional competency through chromatin regulation of gene promoters and enhancers. In addition to genic loci, we find that H2A.Z resides at a subset of evolutionarily young repetitive elements, including DNA transposons, long interspersed nuclear elements and long terminal repeats, during early zebrafish development. Moreover, increases in H2A.Z occur when repetitive elements become transcriptionally active. Acquisition of H2A.Z corresponds with a reduction in the levels of the repressive histone modification H3K9me3 and a moderate increase in chromatin accessibility. Notably, however, de-repression of repetitive elements also leads to a significant reduction in H2A.Z over non-repetitive genic loci. Genic loss of H2A.Z is accompanied by transcriptional silencing at adjacent coding sequences, but remarkably, these impacts are mitigated by augmentation of total H2A.Z protein via transgenic overexpression. Our study reveals that levels of H2A.Z protein determine embryonic sensitivity to de-repression of repetitive elements, that repetitive elements can function as a nuclear sink for epigenetic factors and that competition for H2A.Z greatly influences overall transcriptional output during development. These findings uncover general mechanisms in which counteractive biological processes underlie phenotypic outcomes.
Η ενίσχυση της κριτικής σκέψης διαμέσου της διδασκαλίας της αρχαίας ελληνικής γλώσσας και γραμματείας
Authors: Κυριακάκη Δέσποινα
Published: November 2023

Η παρούσα διατριβή ασχολείται με το θέμα της κριτικής σκέψης και της διδασκαλίας των Αρχαίων Ελληνικών από μετάφραση. Με βάση θεωρίες που διέπουν την κριτική σκέψη αλλά και τη μάθηση και τη διδασκαλία γενικότερα, διερευνάται η ενίσχυση της κριτικής σκέψης με τη χρήση διδακτικών παρεμβάσεων στο μάθημα των Αρχαίων Ελληνικών, οι οποίες εμπεριέχουν δραστηριότητες κριτικής σκέψης. Ως κείμενο αναφοράς αξιοποιείται το σύγγραμμα του Πλουτάρχου "Περὶ Παίδων Ἀγωγῆς" και συγκεκριμένα, αποσπάσματα από μετάφραση τα οποία αναφέρονται σε παιδαγωγικά ζητήματα, όπως οι παράγοντες της αγωγής, Παιδαγωγοί και Δάσκαλοι, τα μέσα της αγωγής (αμοιβές/ποινές), η αγωγή των εφήβων. Η έρευνα διεξήχθη σε μαθητές/τριες της Β΄ Τάξης Γενικού Λυκείου στην Αττική.
Intelligent wireless networks and robots for low-cost battery-less sensing and localization
Authors: Γιαννέλος Ευάγγελος
Published: November 2023

Η παρούσα διατριβή παρουσιάζει μια ολοκληρωμένη διερεύνηση της τεχνολογίας αναγνώρισης μέσω ραδιοσυχνοτήτων (RFID) σε συνδυασμό με τη ρομποτική, προβάλλοντας τις μετασχηματιστικές της δυνατότητες και τις εγγενείς της προκλήσεις. Στο επίκεντρο της έρευνάς μας βρίσκεται η αναλυτική μελέτη του μονοστατικού εντοπισμού με τη χρήση νέων τεχνικών που δεν αποτελούν αναγκαστικά μίμηση ενός ραντάρ συνθετικού διαφράγματος (SAR), σε έντονη αντίθεση με τις προϋπάρχουσες τεχνικές- αντ’ αυτού, η προσέγγιση που υιοθετήθηκε αξιοποιεί αραιές και χαμηλού εύρους ζώνης μετρήσεις φάσης με φίλτρα σωματιδίων κατάλληλα ζυγισμένα, έτσι ώστε να επιτυγχάνεται ανθεκτικότητα στην ανακλαστικότητα εσωτερικών χώρων. Ως αποτέλεσμα, επιτυγχάνεται κορυφαία επίδοση στον τριδιάστατο εντοπισμό θέσης χρησιμοποιώντας εμπορικές ετικέτες RFID Gen2 με μέσο απόλυτο σφάλμα 24 εκ. Βασιζόμενη σε αυτή τη θεμελιώδη εργασία, η έρευνα εμβαθύνει στις ιδιαιτερότητες του φαινομένου πολλαπλών διαδρομών διάδοσης λόγω ανακλάσεων, και συγκεκριμένα στις παραμορφώσεις που προκαλούνται από αυτές τις ανακλάσεις. Αξίζει να σημειωθεί ότι η διερεύνηση σε αυτό το πεδίο οδήγησε σε μια τεχνική που εκτιμά από κοινού τη θέση της ετικέτας, καθώς και του ανακλαστήρα της, με 5 εκ. ακρίβεια στον εντοπισμού του ανακλαστήρα- αυτή η (ίσως) πρωτοποριακή προσπάθεια ακολουθεί τους περιορισμούς χαμηλού εύρους ζώνης των υφιστάμενων, εμπορικών συστημάτων RFID. Επιπλέον, πραγματοποιήθηκε μελέτη του διστατικού/πολυστατικού εντοπισμού θέσης, προσφέροντας μια «ελλειπτική» εκτίμηση της κατεύθυνσης άφιξης (DoA), τεχνικές 2D/3D εντοπισμού βασιζόμενες σε ιδιαίτερες γεωμετρικές ιδιότητες και τις ιδιαιτερότητες της εφαρμογής τους σε συστήματα RFID. Οι τεχνικές αυτές προσφέρουν εκτιμήσεις με μέσο απόλυτο σφάλμα μόλις 5° και 9 εκ. για DoA και 2D εντοπισμό, αντίστοιχα.Μεταβαίνοντας στη συνέχεια στον τομέα των ασύρματων δικτύων αισθητήρων (WSN), η διατριβή μελετά τη συμβιωτική σχέση μεταξύ των RFID και των WSN, δίνοντας έμφαση σε βασικά ζητήματα σχετικά με τις αρχιτεκτονικές ανάγνωσης και τις επιπτώσεις τους σε πραγματικές εφαρμογές. Τα πειράματα περιλαμβάνουν τόσο μη επανδρωμένα εναέρια οχήματα (UAV), όσο και επίγεια συστήματα ανάγνωσης με πεζούς, χρησιμοποιώντας διστατικές και μονοστατικές αρχιτεκτονικές. Πρωταρχικό χαρακτηριστικό αυτής της έρευνας είναι η άρτια ενσωμάτωση των θεωρητικών μελετών σε απτές εφαρμογές, καταλήγοντας σε πραγματικά συστήματα έτοιμα για διάφορες εφαρμογές. Αυτό αποδεικνύεται από την ανάπτυξη ενός κινητού συστήματος ανάγνωσης και εντοπισμού ετικετών, ενοποιημένο με το ρομποτικό λειτουργικό σύστημα (ROS), το οποίο είναι ικανό να εντοπίζει ετικέτες RFID σε πολύπλοκα περιβάλλοντα όπως αποθήκες, βιβλιοθήκες και γραφεία. Περαιτέρω, η συνέργεια της ανάγνωσης μέσω UAV σε συνδυασμό με την τεχνολογία οπισθοσκέδασης αναδεικνύεται ως παράδειγμα καινοτομίας, σηματοδοτώντας νέους ορίζοντες στη γεωργία ακριβείας.
Historical changes in baby names in China
Authors: Ogihara Yuji
Published: November 2023

Based on previous research on names and naming practices, I propose three suggestions to Bao et al. (2021), which investigated historical changes in given names of Han Chinese in China between 1920 and 2005. Their study analyzed a one-shot cross-sectional survey conducted in 2005 and reported that unique names increased from 1920 to 2005. The authors concluded that China became more individualistic over time for the period. However, three questions have remained unanswered in Bao et al. (2021). First, were the samples of older birth cohorts truly representative? Second, did unique names increase only after the 1970s? Third, how are the historical changes in average name length interpreted? Answering these three questions would contribute to a further understanding of the historical changes in given names and their underlying psychological/cultural shifts in China.
Exploring the genetic landscape of neurotransmitter alterations in hypoxic-ischemic encephalopathy: A personalized medicine perspective
Authors: Gomez-Londoño Diego Mauricio , Trujillo-Arias Natalia , Cardona-Ramirez Natalia , Serrano Carolina , Restrepo-Restrepo Feliza , Garcia Arias Hernan Felipe , Estrada-Alvarez Jorge Mario , Porras-Hurtado Gloria Liliana
Published: November 2023

\textbf{Background:} Hypoxic-ischemic encephalopathy (HIE) is a neurological condition due to perinatal asphyxia, affecting brain areas with high metabolic rates and active myelination processes. The HIE has various origins and can be challenging to diagnose and treat. This study aimed to determine the origin of the clinical phenotype of patients who met the criteria for perinatal asphyxia at birth from personalized medicine. \textbf{Methods:} We evaluated 28 patients classified according to the SARNAT scale (i.e., clinical staging of HIE) and neurological anomalies by MRI scans. We used a next-generation sequencing panel for genes related to neurotransmitters and analyzed the statistical association between sequelae and other clinical variables using Fisher’s exact test. We also evaluated odds ratios (OR) with 95\% confidence intervals by binary logistic regression analysis adjusted for SARNAT, seizure, MRI scans, and genetic findings. \textbf{Results:} We identified 11 patients with neurotransmitter-related genetic alterations, such as glycine encephalopathy. Three had pathogenic variants (ALDH7A1, AMT, and SLC1A4), and eight had uncertain significance (TH, DBH, MYH2, CGH1, SLC6A5, ABAT, ALDH5A1, GLRB). One patient had 8p11.2 deletion, 14q11.2 deletion, and 10q11.22 duplication. Statistical analyses indicated that the presence or absence of mutations had a statistically significant association with sequelae (p-value = 0.054). Patients with a pathogenetic or uncertain mutation are associated with an increased risk of neurological sequelae (OR: 6.43; 95\% CI: 1.2 – 51.5; p-value = 0.044) regardless of clinical conditions such as the presence of seizures, severity of encephalopathy, alterations in the RMI or hypothermia therapy. \textbf{Conclusions:} Our findings suggest that neurotransmitter alterations are a critical factor significantly increasing the risk of HIE-related sequelae. Identifying these genetic alterations could lead to earlier and more precise diagnosis and treatment of HIE patients.
Effect of acute altitude exposure on physiological parameters and glucose metabolism in healthy lowland Peruvians
Authors: Fernandez - Rodriguez Lissett Jeanette , Bardales-Zuta Victor Hugo , Vásquez-Tirado Gustavo Adolfo , Avalos Alvarado Carlos , Schaefer Eva J , Hilario-Vargas Julio
Published: November 2023

Background: High altitude exposure triggers a series of physiological changes to maintain homeostasis. Although longer-term (days to years) acclimatization processes are well studied, less is known about the physiological changes upon rapid ascent. We took advantage of Peru’s geography to measure the first physiological changes following rapid transport from a low to a high-altitude environment among lowlanders. Methods: Blood glucose, insulin, C-peptide, and salivary cortisol among healthy lowland Peruvians were measured before and after glucose ingestion at 40 m and upon arrival at 3470 m. Resting heart rate, blood oxygen saturation, and blood pressure were also monitored. Results: At high altitude, we find a significant (p<0.05) increase in heart rate and a decrease in blood oxygen saturation and salivary cortisol. Additionally, baseline levels of blood glucose, plasma C-peptide, and cortisol were reduced (p<0.05). Blood glucose, plasma insulin, and plasma C-peptide returned to baseline or below faster at high altitude after glucose ingestion. Conclusions: Although many overlapping environmental and physiological factors are present in the high-altitude environment, the first steps of acclimatization in this population appear to be caused by increased energy expenditure and glucose metabolism to maintain oxygen homeostasis until the longer-term acclimatization mechanisms become more significant.
The importance of emotional intelligence for students in departmental educational organizations
Authors: Kornilova Tat’yana , Gontsova Olesya , Lebedeva Maria
Published: November 2023

This article discusses the importance of emotional intelligence for students in departmental educational organizations. The essence of the concept being studied is revealed, and some research in the field of studying the phenomenon is reflected. The article presents the results of an empirical study aimed at studying the level of formation of emotional intelligence among students at the Vologda Institute of Law and Economics of the Federal Penitentiary Service of Russia and educational organizations of the Ministry of Internal Affairs of the Russian Federation, interpreted the results obtained and made appropriate conclusions. The acquired information makes it possible to conclude that many students at departmental institutes are characterized by an average and also a high indicator of the degree of formation of emotional intelligence, as well as its parts. We find it correct to introduce into the general educational course of departmental universities certain pedagogical conditions intended for the formation and development of the construct under study.
Nonregular Employment and Payout Policy: Evidence from the Massachusetts Independent Contractor Law
Authors: Hwang JiHoon , Kahle Kathleen M.
Published: November 2023

Compared with regular employees, independent contractors (ICs) offer labor flexibility and cost savings to their employers. Using a difference-in-differences design around the 2004 Massachusetts law that discourages IC usage, we find that this exogenous decrease in IC usage makes treated firms’ earnings more sensitive to changes in sales, increases labor-related expenses, and reduces profitability. Firms subsequently reduce share repurchases. The decrease is more pronounced for firms with high operating leverage and financial constraints. Our results are robust to entropy balancing. We conclude that IC usage affects firms’ operating leverage and profitability, which in turn, influence payout policy.

This paper was accepted by Victoria Ivashina, finance.

Supplemental Material: The data files and online appendix are available at https://doi.org/10.1287/mnsc.2022.00103 .
Mental illness stigmatisation among Malaysian adults: a systematic review
Authors: Rajagopal Violet , Stephenson John , Ousey Karen
Published: November 2023

Background:

Stigmatisation is considered a ‘second illness’ for people with a mental illness and is highly prevalent in Malaysia. Stigmatisation negatively impacts wellbeing, recovery and productivity. Addressing stigmatisation is integral towards people attaining a higher quality of life.

Aim:

To explore mental illness stigmatisation in Malaysian adults.

Method:

A systematic literature review was conducted using thematic analysis to synthesise and categorise evidence. Five key themes emerged, providing insight into mental health stigmatisation.

Findings:

Cultural beliefs, limited knowledge of mental health and lack of education on mental health were factors influencing stigmatisation. Stigmatisation significantly affected the wellbeing and functioning of people with a mental illness. Interventions such as contact-based education effectively reduce stigmatising attitudes manifested by healthcare providers.

Conclusion:

Establishing mental health literacy, encouraging patient contact, promoting mental health awareness and strengthening mental health policies could reduce mental illness stigmatisation and its impact in Malaysia. Future research is warranted to investigate the impact on physical wellbeing and anti-stigmatising strategies targeting the general public.
THE PREVALENCE AND PROFILE OF AFRICAN PATIENTS WITH OS ACROMIALE THAT PRESENT WITH SHOULDER PAIN AT A TERTIARY HOSPITAL IN PRETORIA, SOUTH AFRICA
Authors: Mulaudzi Nthambeleni Priscilla , Mzayiya NL , Rachuene PA
Published: November 2023

Os acromiale is a developmental defect caused by failure of fusion of the anterior epiphysis of the acromion between the ages of 22 and 25. The prevalence of os acromiale in the general population ranges from 1.4% to 15%. Os acromiale has been reported as a contributory factor to shoulder impingement symptoms and rotator cuff injuries, despite being a common incidental observation. In this retrospective study, we examined the prevalence of os acromiale in black African patients with shoulder pain.

We retrospectively reviewed the clinical records, radiographs, and magnetic resonance imaging (MRI) scans of 119 patients who presented with atraumatic and minor traumatic shoulder pain at a single institution over a one-year period. Anteroposterior, scapula Y-view, and axillary view plain images were initially evaluated for the presence of os acromiale, and this was corroborated with axial MRI image findings. Patients with verified os acromiale had their medical records reviewed to determine their first complaint and the results of their clinical examination and imaging examination.

Radiographs and MRI on 24 patients (20%) revealed an osacromiale. This cohort had a mean age of 59.2 years, and there were significantly more females (65%) than males. Meso-acromion was identified as the most prevalent type (n=11), followed by pre-os acromion (n=7). All patients underwent bilateral shoulder x-rays, and 45 percent of patients were found to have bilateral meso- acromion. Most patients (70%) were reported to have unstable os acromiale with subacromial impingement symptoms, and nine patients (36%) had confirmed rotator cuff tears based on clinical and Mri findings. Surgery was necessary for 47% of the 24 patients with confirmed Os acromiale (arthroscopic surgery, n=7; open surgery, n=1) in order to treat their symptoms

The prevalence of os acromiale in our African patients with atraumatic shoulder symptoms is greater than that reported in the general population. Os acromiale is a rare condition that should always be considered when evaluating shoulder pain patients.
THE MUSCULOSKELETAL PROFILE OF FEMALE ADOLESCENT ELITE WATER POLO PLAYERS AND THE FACTORS AFFECTING THROWING PERFORMANCE
Authors: de Wet Japie , Gray Janine , Verwey Lianne , Dey Roopam , du Plessis JP , Vrettos Basil , Roche Stephen
Published: November 2023

The musculoskeletal (MSK) profiles of water polo players and other overhead athletes has been shown to relate to injury and throwing performance (TP). There have been no robust studies conducted on the MSK profiles and the variables affecting TP amongst female, adolescent, elite water polo players.

A prospective quantitative cohort design was conducted amongst eighty-three female adolescent, elite water polo players (range 14–19 years). All participants filled out the Kerlan-Jobe Orthopaedic Clinic questionnaire, followed by a battery of screening tests aimed to identify possible MSK factors affecting TP. Pain provocation tests, range of motion (ROM), upward scapula rotation (USR), strength and pectoralis minor length measurements were all included. Participants also performed throwing speed (TS) and throwing accuracy (TA) tests.

All the data collected were grouped together and analysed using SPSS 28.0. The condition for statistical significance was set as p <0.05. Multi-collinearity was tested for among variables to find out inter-variable correlations. Finally, a multiple regression analysis was performed.

The mean KJOC score was 82.55 ± 14.96. 26.5% tested positive for at least one of the impingement tests. The MSK profile revealed decreased internal rotation ROM, increased external rotation ROM, a downwardly rotated scapula, weak external rotators, weak serratus anterior strength, strong lower trapezius and gluteus medius strength and a shorter pectoralis minor length all on the dominant side.

Age, pectoralis minor length, upper trapezius and serratus anterior strength as well as upward scapula rotation were all positively correlated with TS, while sitting height, upper trapezius and serratus anterior strength and glenohumeral internal rotation ROM were positively correlated with TA.

Multiple MSK parameters were found to be related to TS and TA in elite, adolescent water polo players.
LONG-TERM HEALTH OUTCOMES OF PAEDIATRIC MULTIFOCAL MUSCULOSKELETAL SEPSIS: A 15-YEAR REVIEW
Authors: Crawford Haemish , Mcdonald Anna , Boyle Matthew , Byrnes Catherine
Published: November 2023

This study aimed to identify long-term physical and psychosocial health outcomes in children with overwhelming musculoskeletal sepsis.

Children admitted to the Paediatric Intensive Care Unit (PICU) from 1st January 2002 to 31st December 2017 with a musculoskeletal focus of infection were identified. A medical notes review was completed to determine survival and morbidity. Present-day clinical assessment of the musculoskeletal and respiratory systems along with questionnaires on health-related quality of life, mental health and sleep were performed.

70 patients were identified over 15 years. Seven children died acutely (five Pasifika and two Māori children) indicating 10% mortality. Recurrence/chronic infection affected 23%. Growth disturbance affected 18%. The hip joint and proximal femur suffered the worst long-term complications. Children under 2 years most at risk of long-term disability. No patients had chronic respiratory illness beyond 90 days. Fifteen children had symptoms of acute neurological impairment, three of whom had permanent acquired brain injury. Twenty-six survivors (41%) were assessed a mean of 8.2 years (SD 4.5, range 2– 18 years) after discharge. Health-related quality of life scores were on par with normative data. All patients who underwent pulmonary function tests had normal results. Six patients and eight parents screened positive for moderate to severe post-traumatic stress disorder.

Paediatric multifocal musculoskeletal sepsis can result in complex illness with multi-organ complications for some children. Māori and Pasifika children are most at risk. Children under 2 years and those with proximal femur and/or hip involvement are most likely to have chronic musculoskeletal sequelae and permanent disability. Other outcomes are favourable with no evidence of chronic lung disease or mean reduced quality of life. A period of rehabilitation for children with identified acquired brain injury should be part of discharge planning.
COMPARISON OF VISUAL ESTIMATIONS OF DISTAL RADIUS FRACTURE RADIOLOGICAL PARAMETERS BETWEEN DIFFERENT LEVELS OF ORTHOPAEDIC DOCTORS
Authors: Naidoo Vishad , Du Plessis Jason , Milner Brenda
Published: November 2023

Distal radius fractures are common in South Africa. Accurate, decisive radiographic parameter interpretation is key in appropriate management. Digital radiographic facilities are rare in the public setting and goniometer usage is known to be low, thus, visual estimates are the primary form of radiographic assessment. Previous research associated orthopaedic experience with accuracy of distal radius fracture parameter estimation but, oftentimes, doctors treating orthopaedic patients are not experienced in orthopaedics.

A cross-sectional questionnaire including four distal radius fracture radiographs administered to 149 orthopaedic doctors at three Johannesburg teaching hospitals. Participants grouped into ranks of: consultants (n=36), registrars (n=41), medical officers (n=20) and interns (n=52). Participants visually estimated values of distal radius fracture parameters, stated whether they would accept the position of the fractures and stated their percentage of routine usage of goniometers in real practice.

The registrar group was most accurate in visually estimating radial height, whilst the interns were least accurate (p=0.0237). The consultant, registrar and medical officer groups were equally accurate in estimating radial inclination whilst the intern group was the least accurate (p<0.0001). The consultant and registrar group were equally accurate at estimating volar tilt, whilst the medical officer and intern groups were least accurate (p<0.0001). The Gwet's AC agreement was 0.1612 (p=0.047) for acceptance of position of the first radiograph, 0.8768 (p<0.0001) for the second, 0.8884 (p<0.0001) for the third and 0.8064 (p<0.0001) for the fourth. All groups showed no difference in goniometer usage, using them largely 0–25% of practice (p=0.1937).

The study found that accuracy in visual estimations of distal radius fracture parameters was linked to orthopaedic experience but not linked to routine practice goniometer usage, which was minimal across all groups. Inter-rater agreement on acceptability of fracture position is potentially dependent on severity of deviation from acceptable parameters.
CLASSIFYING OPEN TIBIA AND FEMUR FRACTURES USING THE ORTHOPAEDIC TRAUMA SOCIETY (OTS) OPEN FRACTURE CLASSIFICATION SYSTEM IN A SETTING WITH HIGH INCIDENCE OF CIVILIAN GUNSHOT FRACTURES
Authors: Lunga Zamalunga , Laubscher Maritz , Held Michael , Magampa Ramanare , Maqungo Sithombo , Ferreira Nando , Graham Simon
Published: November 2023

Objectives

Open fracture classification systems are limited in their use. Our objective was to classify open tibia and femur fractures using the OTS classification system in a region with high incidence of gunshot fractures.

One hundred and thirty-seven patients with diaphyseal tibia and femur open fractures were identified from a prospectively collected cohort of patients. This database contained all cases (closed and open fractures) of tibial and femoral intramedullary nailed patients older than 18 years old during the period of September 2017 to May 2021. Exclusion criteria included closed fractures, non-viable limbs, open fractures > 48 hours to first surgical debridement and patients unable to follow up over a period of 12 months (a total of 24). Open fractures captured and classified in the HOST study using the Gustilo-Anderson classification, were reviewed and reclassified using the OTS open fracture classification system, analysing gunshot fractures in particular.

Ninety percent were males with a mean age of 34. Most common mechanism was civilian gunshot wounds (gsw) in 54.7% of cases. In 52.6% of cases soft tissue management was healing via secondary intention, these not encompassed in the classification. Fracture classification was OTS Simple in 23.4%, Complex B in 24.1% and 52.6% of cases unclassified.

The OTS classification system was not comprehensive in the classification of open tibia and femur fractures in a setting of high incidence of gunshot fractures. An amendment has been proposed to alter acute management to appropriate wound care and to subcategorise Simple into A and B subdivisions; no soft tissue intervention and primary closure respectively. This will render the OTS classification system more inclusive to all open fractures of all causes with the potential to better guide patient care and clinical research.
REMOVAL OF RETAINED BULLETS FROM THE HIP JOINT IN CIVILIAN GUNSHOT INJURIES
Authors: Maqungo Sithombo , Antoni Anna , Swanepoel Stefan , Nicol Andrew , Kauta Ntambue , Laubscher Maritz , Graham Simon
Published: November 2023

Removal of bullets retained within joints is indicated to prevent mechanical blockade, 3rd body wear and resultant arthritis, plus lead arthropathy and systemic lead poisoning. The literature is sparse on this subject, with mostly sporadic case reports utilizing hip arthroscopy. We report on the largest series of removal of bullets from the hip joints using open surgical.

We reviewed prospectively collected data of patients who presented to a single institution with civilian gunshot injuries that breached the hip joint between 01 January 2009 and 31 December 2022.

We included all cases where the bullet was retained within the hip joint area. Exclusion criteria: cases where the hip joint was not breached, bullets were not retained around the hip area or cases with isolated acetabulum involvement.

One hundred and eighteen (118) patients were identified. One patient was excluded as the bullet embedded in the femur neck was sustained 10 years earlier. Of the remaining 117 patients, 70 had retained bullets around the hip joint. In 44 patients we undertook bullet removal using the followingsurgical hip dislocation (n = 18), hip arthrotomy (n = 18), removal at site of fracture fixation/replacement (n = 2), posterior wall osteotomy (n = 1), direct removal without capsulotomy (tractotomy) (n = 5).

In 26 patients we did not remove bullets for the following reasons: final location was extra-capsular embedded in the soft tissues (n=17), clinical decision to not remove (n=4), patients’ clinical condition did not allow for further surgery (n= 4) and patient refusal (n=1). No patients underwent hip arthroscopy.

With adequate pre-operative imaging and surgical planning, safe surgical removal of retained bullets in the hip joint can be achieved without the use of hip arthroscopy; using the traditional open surgical approaches of arthrotomy, tractotomy and surgical hip dislocation.
GUNSHOT-INDUCED FRACTURE OF THE PROXIMAL FEMUR: OUTCOMES OF MANAGEMENT AT A TERTIARY HOSPITAL IN SOUTH AFRICA
Authors: Mokoena Thabo
Published: November 2023

Gunshot-induced fractures of the proximal femur typically present with severe comminution and bone loss. These fractures may also be associated with local damage to soft tissue, neurovascular structures and injuries to abdominal organs. The aim was to evaluate the outcomes of civilian gunshot injuries to the proximal femur at a major trauma center in South Africa

A retrospective review of all patients who sustained gunshot-induced proximal femur fractures between January 2014 and December 2017 was performed. Patients with gunshot injuries involving the hip joint, neck of femur or pertrochanteric fractures were included. Patient demographics, clinical- treatment and outcome data were collected. Results are reported as appropriate given the distribution of continuous data or as frequencies and counts.

Our study included 78 patients who sustained 79 gunshot-induced proximal femur fractures. The mean age of patients was 31 ± 112, and the majority of patients were male (93.6%). Pertrochantenteric fractures were the most common injuries encountered (73.4%). Treatment included cephalomedullary nail (60.8%), arthrotomy and internal fixation (16.4%) and interfragmentary fixation with cannulated screws (6%). One case of complete neck of femur fracture had fixation failure, which required conversion to total hip arthroplasty. The overall union rate was 69.6%, and 6.3% of patients developed a fracture-related infection in cases who completed follow-up.

The study shows an acceptable union rate when managing these fractures and a low risk of infection. As challenging as they are, individual approaches for each fracture and managing each fracture according to their merits yield acceptable outcomes.
THE DIRECT COSTS OF HIP FRACTURE CARE IN SOUTH AFRICA: A PUBLIC HEALTHCARE SYSTEM PERSPECTIVE
Authors: Paruk Farhanah , Cassim Bilkish , Mafrakureva Nyasha , Lukhele Mkhululi , Gregson Celia , Noble Sian
Published: November 2023

Fragility fractures are an emerging healthcare problem in Sub-Saharan Africa and hip fractures (HFs) are associated with high levels of morbidity, prolonged hospital stays, increased healthcare resources utilization, and mortality. The worldwide average healthcare cost in the first-year post HF was US$43,669 per patient in a 2017 systematic review, however there are no studies quantifying fracture-associated costs within SSA. We estimated direct healthcare costs of HF management in the South African public healthcare system.

We conducted a prospective ingredients-based costing study in 200 consecutive consenting HF patients to estimate costs per patient across five regional public sector hospitals in KwaZulu-Natal (KZN). Resource use including staff time, consumables, laboratory investigations, radiographs, operating theatre time, surgical implants, medicines, and inpatient days were collected from presentation to discharge. Counts of resources used were multiplied by relevant unit costs, estimated from KZN Department of Health hospital fees manual 2019/20, in local currency (South African Rand, ZAR). Generalised linear models were used to estimate total covariate adjusted costs and cost predictors.

The mean unadjusted cost for HF management was ZAR114,179 (95% CI; ZAR105,468–125,335). The major cost driver was orthopaedics/surgical ward costs ZAR 106.68, contributing to 85% of total cost. The covariate adjusted cost for HF management was ZAR114,696 (95% CI; ZAR111,745–117,931). After covariate adjustment, total costs were higher in patients operated under general anaesthesia compared to surgery under spinal anaesthesia and no surgery.

Direct healthcare costs following a HF are substantial: 58% of the gross domestic per capita (US$12,096 in 2020), and six-times greater than per capita spending on health (US$1,187 in 2019) in SA. As the population ages, this significant economic burden to the health system will increase. Further research is required to evaluate direct non-medical, and the indirect costs incurred post HF.
EVALUATION OF THE SELF-DRILLING, SELF-TAPPING SCHANZ PIN THREAD PATTERNS ON THE NEAR CORTEX WHEN INSERTED IN BONE WITHOUT PRE-DRILLING
Authors: Mkhize Emmanuel Nkosinathi , Blake Craig
Published: November 2023

The external fixator is an invaluable device when treating acute complex trauma and in limb reconstruction. It is therefore important to ensure its efficient and safe application to avoid complications. A lot of research has been done to evaluate the factors around external fixator stability, pin site infections and more is still being done to understand pin loosening. The purpose of this study was to evaluate other factors that may contribute in external fixator pin loosening. The aim was to evaluate if the different Schanz pin insertion techniques contribute to pin loosening.

Two tibia diaphyses from two cadavers were each divided into three sections. Three different drilling techniques were repeated in each of the sections. A total of 36 Schanz pins were inserted and a section cut out of the bone in front of the pins was done allowing visual inspection of the pin hole for features of thread stripping. These features were predefined as thread pattern disruption, smoothening and shallow imprint on the cortex.

Evidence of pin thread stripping was seen in all of the pin insertion techniques. The first method where the hole was pre-drilled and pin inserted with the drill showed 100% thread stripping. The second method of pre-drilling and hand insertion showed the least amount with 16.7% of pin stripping noted and 66.7% pin thread stripping was observed when inserting the pin with power without pre-drilling the pilot hole using the third method.

Different pin insertion techniques result in varying amounts of pin thread stripping. The most amount of thread stripping occurs when a Schanz pin is inserted with power after pre-drilling. This finding, although not measured scientifically, supports the current recommendation of pre-drilling and manual insertion of the pin. In future, more scientific measurement are necessary to quantify these findings and assess their clinical significance.