bluuebunny/crossref_metadata_2025 huggingface dataset:
Neutrophil extracellular traps are a source of extracellular HMGB1 in lupus nephritis: associations with clinical and histopathological features
Authors: Whittall-García L P , Torres-Ruiz J , Zentella-Dehesa A , Tapia-Rodríguez M , Alcocer-Varela J , Mendez-Huerta N , Gómez-Martín D
Published: October 2019

Objective

This study aimed to analyze the expression of the high mobility group box-1 (HMGB1) protein in neutrophil extracellular traps (NETs) of patients with lupus nephritis (LN) and its association with clinical and histopathological features of the disease.

Methods

Twenty-three patients with biopsy-confirmed LN and 14 systemic lupus erythematosus (SLE) patients with active disease (SLE Disease Activity Index (SLEDAI) score ≥ 6) and no evidence of LN were included. Clinical and laboratory features were recorded. NETs and the expression of HMGB1 were assessed by confocal microscopy, and serum HMGB1 levels were measured by ELISA.

Results

In comparison to patients without kidney disease, patients with LN had a higher expression of HMGB1 in spontaneous (57 vs. 30.4; p = 0.027) and lipopolysaccharide (LPS)-induced (55.8 vs. 24.9; p = 0.005) NETs. We found a positive correlation between serum HMGB1 and the expression of HMGB1 in LPS-induced NETs ( r = 0.447, p = 0.017). The expression of HMGB1 in spontaneous NETs correlated with SLEDAI score ( r = 0.514, p = 0.001), anti-dsDNA antibodies ( r = 0.467, p = 0.004), the rate of glomerular filtration descent ( r = 0.543, p = 0.001), and diverse histopathological components of active nephritis in the kidney biopsy, such as the activity index ( r = 0.581, p = 0.004), fibrinoid necrosis ( r = 0.603, p = 0.002), and cellular crescents ( r = 0.486, p = 0.019).

Conclusions

In patients with SLE, NETs are a source of extracellular HMGB1. The expression of HMGB1 in NETs is higher among patients with LN, which correlates with clinical and histopathological features of active nephritis and suggest a possible role of this alarmin in the pathophysiology of kidney damage in SLE.
Interval estimation of proportion ratios for stratified bilateral correlated binary data
Authors: Xue Yuqing , Ma Chang-Xing
Published: October 2019

Confidence interval (CI) methods for the ratio of two proportions in the presence of correlated bilateral binary data are constructed for comparative clinical trials with stratified design. Simulations are conducted to evaluate the performance of the presented CIs with respect to mean coverage probability (MCP), mean interval width (MIW), and the ratio of mesial non-coverage probability to the distal non-coverage probability (RMNCP). Based on the empirical results, we suggest the use of the proposed CI method based on the complete score statistics (CS) for general applications. An example from a rheumatology study is used to demonstrate the proposed methodologies.
The Role of Peers and Siblings in Adolescent Sexual Decisions
Authors: Friedman Jennifer L. , Somers Cheryl L. , Mangus Lauren
Published: October 2019

The purpose of this study was to examine the contributions of peer and sibling relationships to adolescent sexual attitudes and behavior. Data were collected from a sample of 492 participants, ages 14 to 18 years, from a large suburban high school in the Midwest. The results revealed that more than half of the female participants were initiated into nonvirginity by experienced males, which provides some support for the social contagion theory. Perceived peer approval was the strongest predictor, with siblings also contributing. Some mediation analyses were significant as well. Implications for future research and practice are discussed.
Socioemotional and Autism Spectrum Disorder Screening for Toddlers in Early Intervention: Agreement Among Measures
Authors: Kamara Dana , Walton Katherine , Witwer Andrea N.
Published: October 2019

Identification of problems with socioemotional functioning is an important task in early childhood, particularly for children in early intervention (EI). However, socioemotional concerns raised by families may be under-identified in practice. In accordance with Division for Early Childhood (DEC) recommended practices, Part C providers could benefit from additional guidance on socioemotional screening and assessment, including additional research on available tools. Therefore, we examined agreement among three commonly used measures of socioemotional functioning in an EI sample ( N = 50). Overall, the measures did not have adequate agreement. We found substantial agreement between the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE, first edition) and the Brief Infant Toddler Social-Emotional Assessment (BITSEA), moderate agreement between the ASQ:SE and the Child Behavior Checklist (CBCL), and fair agreement between the BITSEA and CBCL. We also examined their potential to screen for autism spectrum disorder (ASD) by examining agreement with the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F). The BITSEA had substantial agreement with the M-CHAT-R/F, providing initial support for its use as an ASD screener. These findings are preliminary and further study in larger, more diverse samples would be beneficial. Evaluation of the sensitivity and specificity of these tools is also needed.
The Motivation and Opportunity for Socially Desirable Responding Does Not Alter the General Factor of Personality
Authors: Pelt Dirk H. M. , Van der Linden Dimitri , Dunkel Curtis S. , Born Marise Ph.
Published: October 2019

Socially desirable responding may affect the factor structure of personality questionnaires and may be one of the reasons for the common variance among personality traits. In this study, we test this hypothesis by investigating the influence of the motivational test-taking context (development vs. selection) and the opportunity to distort responses (forced-choice vs. Likert response format) on personality questionnaire scores. Data from real selection and assessment candidates (total N = 3,980) matched on gender, age, and educational level were used. Mean score differences were found between the selection and development groups, with smaller differences for the FC version. Yet, exploratory structural equation models showed that the overall factor structures as well as the general factor were highly similar across the four groups. Thus, although socially desirable responding may affect mean scores on personality traits, it does not appear to affect factor structures. This study further suggests that the common variance in personality questionnaires is consistent and appears to be little influenced by motivational pressures for response distortion.
Nonlocality of one-dimensional bilinear hardening–softening elastoplastic axial lattices
Authors: Picandet Vincent , Challamel Noël
Published: October 2019

The static behaviour of an elastoplastic axial lattice is studied in this paper through both discrete and nonlocal continuum analyses. The elastoplastic lattice system is composed of piecewise linear hardening–softening elastoplastic springs connected between each other via nodes, loaded by concentrated tension forces. This inelastic lattice evolution problem is ruled by some difference equations, which are shown to be equivalent to the finite difference formulation of a continuous elastoplastic bar problem under distributed tension load. Exact solutions of this inelastic discrete problem are obtained from the resolution of this piecewise linear difference equations system. Localization of plastic strain in the first elastoplastic spring, connected to the fixed end, is observed in the softening range. A continuous nonlocal elastoplastic theory is then built from the lattice difference equations using a continualization process, based on a rational asymptotic expansion of the associated pseudo-differential operators. The continualized lattice-based model is equivalent to a distributed nonlocal continuous elastoplastic theory coupled to a cohesive elastoplastic model, which is shown to capture efficiently the scale effects of the reference axial lattice. The hardening–softening localization process of the nonlocal elastoplastic continuous model strongly depends on the lattice spacing, which controls the size of the nonlocal length scales.

An analogy with the one-dimensional lattice system in bending is also shown. The considered microstructured elastoplastic beam is a Hencky bar-chain connected by elastoplastic rotational springs. It is shown that the length scale calibration of the nonlocal model strongly depends on the degree of the difference equations of each lattice model (namely axial or bending lattice). These preliminary results valid for one-dimensional systems allow possible future developments of new nonlocal elastoplastic models, including two- or even three-dimensional elastoplastic interactions.
The Impact of ADHD Treatment on Intimate Partner Violence in a Forensic Psychiatry Setting
Authors: Buitelaar Nannet J. L. , Posthumus Jocelyne A. , Bijlenga Denise , Buitelaar Jan K.
Published: October 2019

Objective: The current longitudinal impact of treatment of ADHD on intimate partner violence (ITAP) study aims to investigate whether decrease of ADHD symptoms is associated with reduction of intimate partner violence (IPV) frequency in IPV offenders with ADHD in a forensic psychiatry setting. Method: Of n = 209 offenders of IPV with ADHD, frequency of IPV and ADHD symptoms were assessed at the 8th, 16th, 24th, and 52nd weeks of their combined treatment for ADHD and IPV. Results: We observed a significant decrease of self-reported ADHD symptoms (large effect size, d ≥ 0.80) and all IPV outcomes (small, d > 0.20, to large, d > 0.80, effect sizes). The decrease in IPV was mainly associated with the decrease in ADHD symptoms. Conclusion: As IPV treatment alone is not effective in the reduction of IPV in forensic psychiatry, we now have strong indications that the combined treatment of adult ADHD and IPV is more effective in offenders with ADHD.
Granulomatous Appendicitis in the Pediatric Population
Authors: Wu Hao , Fuller Maren Y , Pogoriler Jennifer
Published: October 2019

Background

The clinical significance of a diagnosis of granulomatous appendicitis (GA) is not well established in the pediatric population.

Methods

Retrospective review of the etiology and histopathology of pediatric GA at 2 large pediatric institutions.

Results

Forty-three (0.4%) patients had GA at a median age of 12.1 years. Twenty-two (51%) had perforated appendicitis that was medically managed prior to interval appendectomy. Sixteen of 21 noninterval appendectomies were performed for clinically suspected acute appendicitis. Among them, 1 had Crohn’s disease identified during surgery. None of the other patients had a subsequent diagnosis of inflammatory bowel disease (median follow-up of 4 weeks). There were significantly more cases with mucosal-only granulomas as well as fewer serosal granulomas in the noninterval appendectomy specimens than the interval specimens ( P = .014). When performed, special stains for microorganisms did not contribute to clinical care. In the same time period, GA was seen in 6 (6%) of 94 bowel resections for Crohn’s disease.

Conclusion

GA is rare in pediatric patients, with interval appendectomy being the most common etiology and only rarely associated with Crohn’s disease. Granulomas in interval appendectomies tend to be serosal-based. Special stains for infectious organisms in GA are of low diagnostic yield and have little impact on clinical management.
Diaphragmatic fenestrations seen after peritoneal dialysis catheter placement: A rare cause of hydrothorax
Authors: Black Matthew , Arnold David , Mason David , Eidt John , Hohmann Stephen
Published: October 2019

This case report summarizes the clinical course of a patient who developed diaphragmatic fenestrations leading to hydrothorax after the initiation of peritoneal dialysis. We will discuss the interesting disease process in the setting of patient presentation, diagnosis, treatment, and outcome.
Helical stent (SUPERA™) and drug-coated balloon (Passeo–18 Lux™) for recurrent cephalic arch stenosis: Rationale and design of arch V SUPERA–LUX Study
Authors: Tang TY , Tan CS , Yap CJQ , Tan RY , Tay HH , Choke ETC , Chong TT
Published: October 2019

Background:

The treatment options for cephalic arch stenosis are limited and standard of care remains at crossroads – none are ideal and there is currently no gold standard. Endovascular techniques are now the preferred primary therapeutic option because they are minimally invasive and better tolerated by haemodialysis patients who have multiple comorbidities. However, conventional plain old balloon angioplasty, bare metal stenting and stent grafts all have their limitations. The aim of this trial is to evaluate whether the helical SUPERA™ stent (Abbott Vascular, Santa Clara, CA, USA), which has a higher degree of flexibility and resistance to compressive forces compared to traditionally laser-cut nitinol stents, combined with a drug-coated balloon (Biotronik Passeo-18 Lux™) to minimize the neointimal hyperplasia effect, can improve patency and reduce reintervention rates.

Methods and results:

Arch V SUPERA-LUX is a pilot investigator-initiated single-centre, single-arm prospective study. Twenty patients with a brachiocephalic fistula within 6 months of initial plain old balloon angioplasty for significant cephalic arch stenosis will be recruited for treatment with SUPERA and drug-coated balloon. The primary objectives are immediate angiographic and procedural success, primary patency and functional fistula at 1 week, 8 weeks, 6 and 12 months. The results from eight patients treated prospectively as proof of concept have shown primary patency of 83.3% at 1 year with 100% technical and procedural success rates. Enrolment for the Arch V SUPERA-LUX study is expected to be completed at the end of 2019.

Conclusion:

The Arch V SUPERA-LUX study is the first trial to evaluate whether SUPERA stent implantation and drug-coated balloon use can provide superior protection against restenosis compared to traditional angioplasty, bare metal stents and stent grafts in recurrent cephalic arch stenosis. Initial pilot results are encouraging but longer follow-up is required to truly test this technique.

Trial registration:

This study is registered on ClinicalTrials.gov NCT03891693.
Pathway Analysis of Global Metabolomic Profiles Identified Enrichment of Caffeine, Energy, and Arginine Metabolism in Smokers but Not Moist Snuff Consumers
Authors: Liu Gang , Lee Douglas P , Schmidt Eckhardt , Prasad GL
Published: October 2019

Existing US epidemiological data demonstrate that consumption of smokeless tobacco, particularly moist snuff, is less harmful than cigarette smoking. However, the molecular and biochemical changes due to moist snuff consumption relative to smoking remain incompletely understood. We previously reported that smokers (SMK) exhibit elevated oxidative stress and inflammation relative to moist snuff consumers (MSC) and non-tobacco consumers (NTC), based on metabolomic profiling data of saliva, plasma, and urine from MSC, SMK, and NTC. In this study, we investigated the effects of tobacco consumption on additional metabolic pathways using pathway-based analysis tools. To this end, metabolic pathway enrichment analysis and topology analysis were performed through pair-wise comparisons of global metabolomic profiles of SMK, MSC, and NTC. The analyses identified >8 significantly perturbed metabolic pathways in SMK compared with NTC and MSC in all 3 matrices. Among these differentially enriched pathways, perturbations of caffeine metabolism, energy metabolism, and arginine metabolism were mostly observed. In comparison, fewer enriched metabolic pathways were identified in MSC compared with NTC (5 in plasma, none in urine and saliva). This is consistent with our transcriptomics profiling results that show no significant differences in peripheral blood mononuclear cell gene expression between MSC and NTC. These findings, taken together with our previous biochemical, metabolomic, and transcriptomic analysis results, provide a better understanding of the relative changes in healthy tobacco consumers, and demonstrate that chronic cigarette smoking, relative to the use of smokeless tobacco, results in more pronounced biological changes, which could culminate in smoking-related diseases.
MOG-IgG myelitis coexisting with systemic lupus erythematosus in the post-partum setting
Authors: Bilodeau Philippe A , Kumar Vinayak , Rodriguez Andrew E , Li Clarence T , Sanchez-Alvarez Catalina , Thanarajasingam Uma , Zalewski Nicholas L , Flanagan Eoin P
Published: October 2019

Background:

Longitudinally extensive transverse myelitis (LETM) accompanying systemic lupus erythematosus (SLE) is often due to coexisting aquaporin-4-IgG seropositive neuromyelitis optica spectrum disorder but has not been associated with myelin oligodendrocyte glycoprotein-IgG (MOG-IgG).

Objective and methods:

Case report at an academic medical center.

Results:

A 32-year-old woman developed severe transverse myelitis (paraplegia) shortly after SLE onset in the post-partum period. Magnetic resonance imaging (MRI) revealed an LETM, cerebrospinal fluid showed marked inflammation, and testing for infections was negative. Serum live-cell-based assay for MOG-IgG was positive but aquaporin-4-IgG was negative.

Conclusion:

In patients with SLE and LETM, MOG-IgG testing should be considered, in addition to AQP4-IgG.
Brand strategy scope and advertising spending: The more the better?
Authors: Sellers-Rubio Ricardo , Calderón-Martínez Aurora
Published: October 2019

Given the need to justify business management expenses, firms are very interested in measuring marketing performance. The objective of this article is to analyze mass media advertising investment from an efficient point of view in hotel chains. To accomplish the objective, this article applies a two-stage double bootstrap data envelopment analysis to the monetary resources allocated to the different advertising media by the main companies in the Spanish hotel sector. The authors further investigate the determinants of hotel advertising efficiency in terms of the number of brands in the hotel portfolio and the combination of advertising media used (i.e. Internet advertising). The results show a certain level of waste of advertising spending by hotel chains and that both brand portfolio scope and Internet advertising positively affect efficiency.
M1 macrophage is the predominant phenotype in coronary artery lesions following Kawasaki disease
Authors: Ohashi Ryuji , Fukazawa Ryuji , Shimizu Akira , Ogawa Shunichi , Ochi Masami , Nitta Takashi , Itoh Yasuhiko
Published: October 2019

Kawasaki disease (KD) is a systemic inflammatory process that affects the medium-sized arteries, causing various cardiovascular complications. However, it is not clear if the vascular sequelae following KD can predispose to the development of atherosclerosis later in life. Our aim was to examine the macrophage phenotypes in the coronary arteries forming giant aneurysms after KD to gain insight into the pathogenesis of vascular lesions in KD. We examined histological sections of the coronary arteries from five patients with KD who underwent coronary bypass grafting procedure as treatment for giant aneurysms and subsequent stenosis. Immunohistochemical expression of M1- and M2-macrophage markers was assessed to determine the macrophage phenotype of KD to compare with that of atherosclerosis in eight adult patients. All the KD specimens showed a mild to moderate degree of intimal thickening consisting of mature fibrous tissue and distortion of elastic fibers, mimicking the histological features of atherosclerosis. The total number of CD68 positive macrophages was higher in atherosclerosis than in KD specimens. Among the CD68 positive macrophages, the proportion of M1 phenotype, detected by CD86 or SOCS3, was higher in KD than in atherosclerosis. In contrast, the proportion of M2 phenotype, detected by CD163 or MRC1, was higher in patients with atherosclerosis. Despite similar histological features, KD and atherosclerosis appear to have a different immunological etiology for progression of the chronic vascular lesions. A further study enrolling a larger number of cases is required to delineate underlying mechanisms of vascular complications in KD.
Serving the White nation: Bringing internalised racism within a sociological understanding
Authors: Seet Adam Z.
Published: October 2019

In this article I examine the current definitions of internalised racism in the extant literature and suggest where they may be expanded upon in order to further our sociological understanding of the phenomenon. I draw upon data from a wider study that investigates how internalised racism manifests within the lived experiences of racialised subjects in Australia. By introducing a re-reading of Hage’s White nation thesis specifically from the perspective of the racialised subject, I demonstrate how there are polarising variations in how internalised racism manifests, specifically in its affective impacts. I argue that beyond the racialised subject’s experience of a manifestation of internalised racism, whether negatively or positively, is how they conceive of themselves as relationally dependent upon the dominant racial group’s appraisal of them.
Characterization and application of a selective coating for solar collectors from of the cashew nut shell liquid
Authors: Pinho Diego Caitano , Freire Francisco Nivaldo Aguiar , Araújo Felipe Alves Albuquerque , Dutra Kaio Hemerson , Teixeira Edwalder Silva , da Silva Maria Eugênia Vieira , Rocha Paulo Alexandre Costa
Published: October 2019

Solar energy is the most promising energy source, due to its great availability and applicability in thermal energy applications. However, researchers still experience technological and economical challenge, since many systems that use this energy still have low efficiency and high cost. In this way, the development of new materials and technologies to increase the efficiency of solar thermal collectors is both a challenge and a necessity. In this context, the objective of this work is to obtain and analyze selective surfaces for solar thermal collectors, using cashew nut shell liquid. The cashew nut shell liquid can be classified as technical or natural, depending on the mode of extraction of cashew liquid. An experimental bench was built to simulate a flat plate solar collector under real operating conditions. For comparative purposes, the tests were performed between the cashew nut shell liquid and the commercial surface (MRTiNOX). In order to verify the structure morphology and the chemical composition of the surface, analyzes were performed by scanning electron microscopy. In order to identify the presence of components after the sintering process, the infrared analysis technique was used. To analyze the surface absorbance, the ultraviolet–visible spectroscopy absorbance technique was used. With the tests in real conditions, it was possible to perform the temperature measurements, and later, with the energy balance, the absorptivity, emissivity, and efficiency were calculated. The technical cashew nut shell liquid presented efficiency of 42.86%, while the MRTiNOX, 41.8%. In contrast, natural cashew nut shell liquid obtained efficiency of 31.28%. Thus, the use of technical cashew nut shell liquid, a low-cost regional product, was presented as a viable and satisfactory solution for cost reduction in solar thermal collectors.
A crank-kinematics-based engine cylinder pressure reconstruction model
Authors: Dunne Julian F , Bennett Colin
Published: October 2019

A new inverse model is proposed for reconstructing steady-state and transient engine cylinder pressure using measured crank kinematics. An adaptive nonlinear time-dependent relationship is assumed between windowed-subsections of cylinder pressure and measured crank kinematics in a time-domain format (rather than in crank-angle domain). This relationship comprises a linear sum of four separate nonlinear functions of crank jerk, acceleration, velocity and crank angle. Each of these four nonlinear functions is obtained at each time instant by fitting separate m-term Chebyshev polynomial expansions, where the total 4 m instantaneous expansion coefficients are found using a standard (overdetermined) linear least-square solution method. A convergence check on the calibration accuracy shows that this initially improves as more Chebyshev polynomial terms are used, but with further increase, the overdetermined system becomes singular. Optimal accuracy Chebyshev expansions are found to be of degree m = 4, using 90 or more cycles of engine data to fit the model. To confirm the model accuracy in predictive mode, a defined measure is used, namely the ‘ calibration peak pressure error’. This measure allows effective a priori exclusion of occasionally unacceptable predictions. The method is tested using varying speed data taken from a three-cylinder direct-injection spark ignition engine fitted with cylinder pressure sensors and a high-resolution shaft encoder. Using appropriately filtered crank kinematics (plus the ‘calibration peak pressure error’), the model produces fast and accurate predictions for previously unseen data. Peak pressure predictions are consistently within 6.5% of target, whereas locations of peak pressure are consistently within ±2.7 °CA. The computational efficiency makes it very suitable for real-time implementation.
The value of longevity
Authors: Bognar Greg
Published: October 2019

Longevity is valuable. Most of us would agree that it’s bad to die when you could go on living, and death’s badness has to do with the value your life would have if it continued. Most of us would also agree that it’s bad if life expectancy in a country is low, it’s bad if there is high infant mortality and it’s bad if there is a wide mortality gap between different groups in a population. But how can we make such judgments more precise? How should we evaluate the harm of mortality in a population? Although philosophers have written a lot about the harm of death for individuals, very little work has been done on the harm of mortality for populations. In this article, I take the first steps towards developing a theory of the harm of population mortality. Even these first steps, I argue, lead to surprising results.
Globe’s encounters and the art of rolling: home, migration and belonging
Authors: Sheringham Olivia , Platun Janetka , McAvinchey Caoimhe , Blunt Alison
Published: October 2019

This article explores the multiple and multifarious encounters of and with Globe, a 1-metre-diameter copper spherical sculpture hosting four cameras that has been rolled by the artist Janetka Platun and others in London, Shrewsbury and Delhi. Situating Globe in relation to Janetka’s art practice and the wider ‘art of rolling’, and extending broader debates about globality, encounter and relational aesthetics, the article argues that Globe’s journeys generated ‘meaningful content’ beyond an aesthetic moment of interaction by inspiring people to share stories, ideas and reflections on home, migration and belonging through their encounters with her. Globe’s encounters were inspired by curiosity, often sparked by her materiality, mobility and ‘globe-ness’. Rather than merely act as a prompt for people to reflect on home, migration and belonging, Globe has also been marked by her own journeys and encounters, reflecting their unpredictable and often transformative nature.
“Spinning Their Wheels … ”—Influences That Shape How Nurse Educators Teach Social Justice
Authors: Valderama-Wallace Claire P. , Apesoa-Varano Ester Carolina
Published: October 2019

Despite institutional claims that social justice is a core professional nursing value, efforts to fulfill this claim remain uneven. The purpose of this study was to examine the circumstances that shape nursing educators' approaches to social justice. In-depth semi-structured interviews with 28 educators teaching theory courses in baccalaureate nursing programs shed light upon the influences that shape how educators integrate social justice. These include formative experiences, institutional factors, and curricular opportunities. Formative experiences include upbringing, educational background, and preparation to teach. Institutional factors consist of the type of institution, geographic location, and the specter of retention, promotion, and tenure. Finally, curricular opportunities and fit include the positioning of Community Health Nursing, fragmentation and tension between “content and context,” and the “driving force” of the National Council Licensure Examination for Registered Nurses (NCLEX). Findings indicate that the capacity to uphold the value of social justice is shaped by experiences across the lifespan, institutional policies, and practices related to faculty hiring, development, career advancement, as well as curricular vision. This study calls for a concerted effort to enact social justice nursing education.
Weaponized Patriotism and Racial Subtext in Kaepernick’s Aftermath: The Anti-politics of American Sports Fandom
Authors: Serazio Michael , Thorson Emily
Published: October 2019

The history of sports culture and fandom has long been as reactionary as it has been hospitable to progressive politics. As the most conspicuous recent example, NFL quarterback Colin Kaepernick’s U.S. anthem protest generated intense controversy with many critics claiming that sports and politics should, generally, not mix—a condemnation that ignores that context’s already pervasive militaristic nationalism. This article offers the first nationally representative examination of fans’ antipathy toward sports’ politicization through a critical textual analysis and inductive classification of their responses to the issue. Ostensibly “aracial” rebukes to that activism could nonetheless be characterized in lineage with historically stereotypical representations of and affronts to black athletes: as threatening to society, not intellectually equipped to engage, and illegitimate as leaders.
Coping with diabetes stress among adults in rural Dominican Republic: “I don’t think about it”
Authors: Sadeghzadeh Claire , Wallace Deshira D. , Gonzalez Rodriguez Humberto , Barrington Clare
Published: October 2019

Objectives

As type 2 diabetes prevalence increases across Latin America, understanding local approaches to coping with diabetes stress is essential to providing care that incorporates patients’ values and preferences. This study explored a local phenomenon, “ no le doy mente” (I don’t think about it), used by adults with type 2 diabetes in the Dominican Republic to cope with diabetes stress.

Methods

We conducted 19 qualitative in-depth interviews with adults with type 2 diabetes (10 men, 9 women) recruited from one rural clinic. Using an inductive analytic approach including iterative coding, memos, and matrices, we identified reasons, strategies, and perceived benefits of not thinking about type 2 diabetes among participants.

Results

Participants described not thinking about diabetes as an active process to maintain a sense of normalcy despite significant life changes following diagnosis. They avoided thinking about diabetes by staying busy, proactively managing type 2 diabetes through diet and medication, and turning to their faith. Participants perceived that enacting no le doy mente helped to protect their overall health and well-being.

Discussion

Future research should investigate provider perceptions of no le doy mente to align patient and provider communication and mindfulness-based stress reduction as a way to support people with type 2 diabetes avoid dwelling on negative thoughts about diabetes.
Protective Effects of Oroxylin A on Oxygen-Glucose Deprivation/Reperfusion-Induced PC12 Cells by Activating the Sonic Hedgehog Signal Pathway
Authors: Gao Yanhong , Li Rui , Sun Hua , Li Jianmei , He Bing , Xiao Sa , Li Liping , Wang Junling
Published: October 2019

Ischemic stroke is a leading cause of human death. The injury that is induced by oxygen-glucose deprivation/reperfusion in stroke remains unsolved. This study first investigated the effects of oroxylin A on oxygen-glucose deprivation/reperfusion-induced PC12 cells. This was performed by dividing the cells into a control group, an oxygen-glucose deprivation and reperfusion (OGD/R) group, a solvent control group, and experimental groups treated with different concentrations of oroxylin A. Cell viability was evaluated by Cell Counting Kit-8 assay. Relevant indicators of oxidant stress were detected by using the appropriate kits. Western blot was applied to detect the expressions of inflammatory cytokine and proteins of the signaling pathway. Oroxylin A pretreatment exerted anti-oxidative, anti-apoptotic, and anti-inflammatory effects in oxygen-glucose deprivation/reperfusion-induced PC12 cells, thus indicating it as a new avenue for stroke treatment and providing references for future studies.
Development of a Modular Cadaveric Endoscopic Orbital Surgery Model
Authors: Banks Catherine , Husain Qasim , Sacks Raymond , Freitag Suzanne K. , Bleier Benjamin S.
Published: October 2019

Introduction

Endoscopic orbital surgery requires the acquisition of unique skill set including endoscopic bimanual dissection of intra/extraconal lesions adherent to orbital fat and neurovascular structures. Our goal was to develop a modular cadaveric model used to train surgeons to resect orbital pathology within any desired orbital compartment.

Methods

Expansile superabsorbent polymer (SAP) beads (2 mm) were soaked in Omnipaque™ (Iohexol) solution for 15 minutes prior to transcaruncular orbital implantation using 10-gauge angiocath. Insertion depth was designed to implant beads in predetermined intraconal compartments corresponding to established orbital tumor stages. Beads were left to expand in situ over a period of 1 to 5 hours. Computed tomography scans were performed using the FUSION image guidance protocol. Model utility and learning curves were assessed by quantifying resection time over 8 sequential attempts.

Results

All 24 beads were successfully implanted in 8 orbits corresponding to CHEER stage II to IV lesions (n = 3 per orbit). Beads expanded from 2 mm to an average of 5.2 mm within 1 hour. During expansion, the beads interpolated into the adjacent fascia similar to in vivo tumors. Average insertion time was 5:53 minutes per orbit (range, 3:24–10:33 min) and average time to bead identification was 10:47 minutes. Across all beads, dissection times decreased in a nonsignificant manner over 8 consecutive attempts.

Conclusion

The directed implantation of expansile SAP beads in this cadaveric model accurately replicates the approach, identification, and resection of isolated orbital lesions. This orbital model can assist the endoscopic surgical team to develop further knowledge and technical skill sets to approach orbital lesions. Further ongoing studies to validate this model are currently underway.
The influence of personal values and patient intoxication on nurses concerns about opioids: results of a prospective cross-sectional multi-centre study
Authors: Heckroth Antje , Pludra Vanessa , Johannssen Christian , Guest Charlotte , Wiedermann Frauke , Bantel Carsten
Published: October 2019

Background:

Nurses are the main administrators of opioids in hospitals and enjoy some autonomy when using them to manage pain. Nevertheless evidence suggests they exercise this freedom restrictively with the reasons for this self-limitation remaining unclear. Nurses are influenced by personal and professional values and by patients’ attributes. Intoxicated patients pose a particular challenge. This study therefore investigated whether cautious attitudes towards opioids were aggravated in intoxicated patients and influenced by personal values.

Methods:

A two-version questionnaire was developed. Each presented a case vignette describing a patient in acute pain who was either intoxicated or not intoxicated. Questionnaires contained identical case statements inquiring about concerns regarding opioids, preferred analgesics and statements about opioids and personal values. They were distributed prospectively in a cross-sectional, multi-centre design. Equal distribution of both questionnaires was achieved through randomization of wards. Regression analysis was employed to determine predictors for responses to the case statements.

Results:

In total, n = 374 (26%) nurses returned questionnaires, 85% were female, 39% worked in surgery and 64% had >10 years experience. A total of 78% were concerned using opioids in the intoxicated patient and 70% preferred non-opioids instead. Most nurses agreed familiarity with an opioid gives them more confidence and they were more concerned in patients with a history of drug abuse. They neither associated opioids with helping patients to die nor with drug abuse. The majority endorsed value statements representing ‘universalism’, ‘hedonism’ and ‘benevolence’ while disagreeing with ‘power’ and ‘stimulation’. Nurses concerns were predicted by values indicating ‘conformity’ and ‘achievement’.

Conclusion:

Nurses were concerned giving opioids to intoxicated patients and preferred non-opioids instead. These concerns were predicted by personal values representing ‘Conservation’ (‘conformity’) and ‘Self-Enhancement’ (‘achievement’). Therefore, stigmatizing mental models likely contribute to nurses’ reluctance to use opioids. Interestingly, personal ambition might protect nurses from discriminatory thoughts and practice.
Multidisciplinary perceptions of working with children and their parents in small rural and remote Australian hospitals
Authors: Smyth Wendy , Al Mamun Abdullah , Shields Linda
Published: October 2019

This study elicited perceptions of nurses, doctors and allied health staff in rural and remote health facilities, about working with children and parents. This was a quantitative study using ‘Working with Families’, a validated and well-tested questionnaire, in the setting of seven rural and remote hospitals in North Queensland, Australia. The participants were 123 health professionals from the seven hospitals. The ‘Working with Families’ questionnaire consists of demographic characteristics and two questions about working with children and with their parents. Scores were compared and correlations sought with demographic characteristics. Scores were as follows (1 = least positive, 5 = most positive): working with children: 3.35 (95% confidence interval [CI] 3.22, 3.47), with parents 3.79 (95% CI 3.66, 3.92), mean difference –0.44 (95% CI –0.54, –0. 53; p < 0.001). No significant relationships occurred between scores and demographics. Family-centred care is the cornerstone of paediatric healthcare. People work in paediatrics and child health because they like children. Respondents were more positive about working with children than with parents. If staff find working with parents more difficult, the implementation of family-centred care may theoretically be negatively affected. Support and education about family-centred care and the newly emerging model, child centred care, may assist in overcoming less positive attitudes.
Evaluation of the Metastatic Spine Disease Multidisciplinary Working Group Algorithms as Part of a Multidisciplinary Spine Tumor Conference
Authors: Rudra Soumon , Lauman Mary K. , Stowe Hayley , Henke Lauren E. , Wallace Adam N. , Roach Michael C. , Huang Jiayi , Tsien Christina I. , Bradley Jeffrey D. , Santiago Paul , Buchowski Jacob M. , Jennings Jack W. , Robinson Clifford G.
Published: October 2019

Study Design:

Retrospective cohort study.

Objective:

The Metastatic Spine Disease Multidisciplinary Working Group Algorithms are evidence and expert opinion–based strategies for utilizing radiation therapy, interventional radiology procedures, and surgery to treat 5 types of spine metastases: asymptomatic spinal metastases, uncomplicated spinal metastases, stable vertebral compression fractures (VCF), unstable VCF, and metastatic epidural spinal cord compression (MESCC). Evaluation of this set of algorithms in a clinical setting is lacking. The authors aimed to identify rate of treatment adherence to the Working Group Algorithms and, subsequently, update these algorithms based on actual patient management decisions made at a single-institution, multidisciplinary, spine tumor conference.

Methods:

Patients with metastatic spine disease from primary non-hematologic malignancies discussed at an institutional spine tumor conference from 2013 to 2016 were evaluated. Rates of Working Group Algorithms adherence were calculated for each type of metastasis. Based on the reasons for algorithm nonadherence, and patient outcomes in such cases, updated Working Group Algorithms recommendations were proposed.

Results:

In total, 154 eligible patients with 171 spine metastases were evaluated. Rates of algorithm adherence were as follows: asymptomatic (67%), uncomplicated (73%), stable VCF (20%), unstable VCF (32%), and MESCC (41%). The most common deviation from the Working Group Algorithms was surgery for MESCC despite poor prognostic factors, but this treatment strategy was supported based on median survival surpassing 6 months in these patients.

Conclusions:

Adherence to the Working Group Algorithm was lowest for MESCC and VCF patients, but many nonadherent treatments were supported by patient survival outcomes. We proposed updates to the Working Group Algorithm based on these findings.
Personalizing Decision-Making for Patients Choosing Contralateral Prophylactic Mastectomy: A Utility Analysis of Genetic Factors and the Relative Risk of Breast Cancer
Authors: Campwala Insiyah , Yoo June , Gupta Subhas
Published: October 2019

Introduction:

There has been an increasing trend of patients with breast cancer electing to undergo contralateral prophylactic mastectomy (CPM), despite the lack of evidence showing long-term survival benefit. We aim to quantify the tiered amount of genetic and surgical complication risk deemed necessary to justify CPM.

Methods:

A review of breast cancer–affiliated genetic mutations and morbidity rates of breast cancer surgery from a single institution was compiled. A survey using a utility analysis was created. Severity of breast cancer genetic risk and morbidity risk warranting CPM was quantified and evaluated.

Results:

A total of 143 surveys were submitted by women of the general population. Data analysis confirmed previous predictions that at a hypothetical increased risk of contralateral breast cancer (CBC), about twice the proportion of women will elect CPM. With over 10 times the baseline risk and no surgical complications, 98.6% of women chose CPM. There was a decrease in affirmative responses with increasing morbidity. This decrease was least prominent at higher genetic risk, illustrating that when women are at a higher risk of CBC, the surgical morbidity rate has less of an impact on their decision for CPM.

Conclusion:

At increased risk of CBC, women are likely to elect for CPM. We anticipate that these findings will encourage the growing use of personalized medicine, with the potential to tailor breast cancer treatment plans for each patient’s personal genetic profile.
Osteochondral Autologous Transplantation for Treating Patellar High-Grade Chondral Defects: A Systematic Review
Authors: Donoso Rodrigo , Figueroa David , Espinoza Jaime , Yañez Claudio , Saavedra Jamil
Published: October 2019

Background:

Patellar cartilage defects account for 34.6% of defects found during routine arthroscopy. These defects pose a challenge in orthopaedic surgery because they have been associated with worse outcomes after surgical repair compared with other chondral lesions within the knee.

Purpose:

To systematically review the literature for evidence on results of osteochondral autologous transplantation (OAT) for the management of isolated patellar cartilage high-grade defects (International Cartilage Repair Society [ICRS] grade 3-4).

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A systematic review of the literature was performed to find studies that addressed outcomes regarding OAT to treat patellar high-grade cartilage defects (ICRS grade 3-4). Studies addressing patient-reported outcomes, return to sports, or magnetic resonance imaging (MRI) at follow-up after isolated OAT procedures for patellar cartilage defects were included.

Results:

A total of 5 studies were included in this review. We were not able to perform a meta-analysis as no studies had available data. A total of 102 patients who received an isolated OAT for a patellar chondral defect were included in these 5 studies. All patients showed significant improvement at final follow-up based on the following patient-reported outcome scores: Lysholm, International Knee Documentation Committee, Kujala, Tegner, and 36-Item Short Form Health Survey. We found that 4 studies used MRI during the first postoperative year to assess osteochondral plug integration and positioning. The results demonstrated that most plugs were integrated and correctly positioned when evaluated at follow-up, conducted on average after 12 months. Whether patients were able to return to sports was queried in 2 of the included studies, revealing that patients could return to their previous level in most cases (Tegner score, 5-9 at 2 years after surgery).

Conclusion:

Results indicate that OAT is a safe and reliable technique to treat patellar high-grade osteochondral defects, allowing for significant improvement in patient-reported outcomes and return to sports.
Imaging markers associated with the development of post-stroke depression and apathy: Results of the Cognition and Affect after Stroke – a Prospective Evaluation of Risks study
Authors: Douven Elles , Staals Julie , Freeze Whitney M , Schievink Syenna HJ , Hellebrekers Danique MJ , Wolz Robin , Jansen Jacobus FA , van Oostenbrugge Robert J , Verhey Frans RJ , Aalten Pauline , Köhler Sebastian
Published: October 2019

Introduction

It has been suggested that the development of post-stroke apathy (PSA) and depression (PSD) may be more strongly associated with generalised brain pathology, rather than the stroke lesion itself. The present study aimed to investigate associations between imaging markers of lesion-related and generalised brain pathology and the development of PSA and PSD during a one-year follow-up.

Patients and methods

In a prospective cohort study, 188 stroke patients received 3-Tesla MRI at baseline (three months post-stroke) for evaluation of lesion-related, vascular, and degenerative brain pathology. Presence of lacunes, microbleeds, white matter hyperintensities, and enlarged perivascular spaces was summed to provide a measure of total cerebral small vessel disease (cSVD) burden (range 0–4). The Mini International Neuropsychiatric Interview and Apathy Evaluation Scale were administered at baseline and repeated at 6- and 12-month follow-up to define presence of PSD and PSA, respectively.

Results

Population-averaged logistic regression models showed that global brain atrophy and severe cSVD burden (score 3–4) were significantly associated with the odds of having PSA (ORGEE 5.33, 95% CI 1.99–14.25 and 3.04, 95% CI 1.20–7.69, respectively), independent of stroke lesion volume and co-morbid PSD. Medium cSVD burden (score 2) was significantly associated with the odds of having PSD (ORGEE 2.92, 95% CI 1.09–7.78), independent of stroke lesion volume, co-morbid PSA, and pre-stroke depression. No associations were found with lesion-related markers.

Conclusions

The results suggest that generalised degenerative and vascular brain pathology, rather than lesion-related pathology, is an important predictor for the development of PSA, and less strongly for PSD.