bluuebunny/crossref_metadata_2025 huggingface dataset:
Shared burdens: The General Average adjustment of the Jan Maria
Authors: Go Sabine C P J
Published: June 2021

The Jan Maria was a Dutch schooner that, in 1883, en route from the Baltic to its home port, was forced to jettison cargo during a fierce storm, which resulted in a General Average (GA) procedure. GA refers to a method that redistributes damages that were deliberately inflicted by the master, in order to save the ship and its cargo, among all those parties that benefited from the action. The report of this procedure of the Jan Maria has been preserved and is exceptional in its completeness. It offers a unique view on a complex procedure and also on the coping mechanisms of small-scale entrepreneurs in a volatile business environment. In this article, I will explain the principle and functioning of GA, and I will argue that, in spite of financial innovations like marine insurance, GA remained an important part of risk management.
Outcomes of Barotrauma in Critically Ill COVID-19 Patients With Severe Pneumonia
Authors: Gazivoda Victor P. , Ibrahim Mudathir , Kangas-Dick Aaron , Sun Arony , Silver Michael , Wiesel Ory
Published: June 2021

Background:

Pneumomediastinum and pneumothorax are complications which may be associated with barotrauma in mechanically ventilated patients. The current literature demonstrates unclear outcomes regarding barotrauma in critically ill patients with severe COVID-19. The purpose of this study was to examine the incidence of barotrauma in patients with severe COVID-19 pneumonia and its influence on survival.

Study Design and Methods:

A retrospective cohort study was performed from March 18, 2020 to May 5, 2020, with follow-up through June 18, 2020, encompassing critically ill intubated patients admitted for COVID-19 pneumonia at an academic tertiary care hospital in Brooklyn, New York. Critically ill patients with pneumomediastinum, pneumothorax, or both (n = 75) were compared to those without evidence of barotrauma (n = 206). Clinical characteristics and short-term patient outcomes were analyzed.

Results:

Barotrauma occurred in 75/281 (26.7%) of included patients. On multivariable analysis, factors associated with increased 30-day mortality were elevated age (HR 1.015 [95% CI 1.004-1.027], P = 0.006), barotrauma (1.417 [1.040-1.931], P = 0.027), and renal dysfunction (1.602 [1.055-2.432], P = 0.027). Protective factors were administration of remdesivir (0.479 [0.321-0.714], P < 0.001) and receipt of steroids (0.488 [0.370-0.643], P < 0.001).

Conclusion:

Barotrauma occurred at high rates in intubated critically ill patients with COVID-19 pneumonia and was found to be an independent risk factor for 30-day mortality.
A Multicomponent Home-Based Intervention for Neuropsychiatric Symptoms in People With Dementia and Caregivers’ Burden and Depression: A 6-Month Longitudinal Study
Authors: Mougias Antonis A. , Christidi Foteini , Kontaxopoulou Dionysia , Zervou Mariyanna , Kostoglou Dimitra , Vlami Maria Anna , Dimitriou Maria , Politis Antonis
Published: June 2021

Objectives:

Many people with dementia live in their home and require ongoing care, which is often provided by informal family caregivers. Thus, we examined the effectiveness of a multicomponent home-based intervention by evaluating its impact on a) neuropsychiatric symptoms of people with dementia and b) burden and depression of their caregivers.

Methods:

During the first 6 months of this prospective single-center study, we applied a home-based multicomponent intervention in 205 dyads of care-recipients and caregivers. In further analyzes, we included only dyads of caregivers and care-recipients with available data both at baseline and 6-month follow-up (N = 144). All assessments were conducted at home and included sociodemographic features, care-recipients’ clinical data, cognitive status (Mini-Mental State Examination), activities of daily living (Instrumental Activities of Daily Living; Katz Index of Independence in Activities of Daily Living), neuropsychiatric symptoms (Neuropsychiatric Inventory), and caregivers’ burden (Zarit Burden Inventory) and depression (Center for Epidemiological Studies-Depression).

Results:

We found significant decreases in the severity (pFDR = 0.002) and associated distress (pFDR = 0.001) of neuropsychiatric symptoms, as well as caregivers’ burden (pFDR = 0.004) and depressive symptoms (pFDR = 0.001). As expected, there was significant deterioration in care-recipients’ cognitive status (pFDR = 0.005) and measures of activities of daily living (pFDR < 0.005).

Conclusion:

Despite the progressive course of dementia, the home-based multicomponent intervention was effective in decreasing caregivers’ burden and depression and minimizing care-recipients’ neuropsychiatric symptoms’ severity and associated distress after 6 months. Our study highlights the establishment of home-based care units as an advantageous solution, specifically for family members seen to have a “taken-for-granted” role in dementia caring.
YPAR Dreams Deferred? Examining Power Bases for YPAR to Impact Policy and Practice
Authors: Bertrand Melanie , Lozenski Brian D.
Published: June 2021

Practitioners and scholars have argued that youth participatory action research (YPAR) challenges systemic injustice in education, as youth and adults research mechanisms of oppression and propose recommendations. However, oftentimes YPAR does not lead to new policies, as institutional decision-makers ignore youth’s moral pleas and empirical evidence. In this conceptual article, we propose a consideration of the ways in which YPAR can mobilize power bases using youth organizing and institutionally sanctioned decision-making. We argue that being attuned to power bases provides YPAR groups a more reliable means, in comparison to moral pleas, to move from YPAR findings to shifts in policy and practice.
Experimental determination of IGV preswirl effect on impeller blade vibration in an unshrouded centrifugal compressor
Authors: Zhao Xinwei , Li Hongkun , Yang Shuhua , Fan Zhenfang , Wang Yang
Published: June 2021

The unshrouded impeller is widely used in industrial centrifugal compressors and normally operates at high tip speed and large volume flow. However, this type of impeller can be very sensitive to flow excitations such as IGV wake, and hence encounters the challenge of high dynamic stress. Due to the lack of experimental vibration data, this paper aims to enhance the understanding of the IGV preswirl effect. The real operating representative data from strain gauges is acquired during the experiment. The blade transient and quasi-steady response due to upstream IGV wake under different configurations are investigated and quantified. Results show that the blade response increases with larger positive regulation. And under specific operating conditions, the vibration of the blade is quite large, which is comparable with synchronize resonance. This increment is attributed to the aerodynamic loading change due to enhanced distortion of the inlet flow. Based on the current findings, accurate numerical prediction of the blade forced vibration for a large shift of inlet flow condition is also needed for more reliable operating of the impeller.
Demonstration of the protective effect of ghrelin in the livers of rats with cisplatin toxicity
Authors: Bademci R , Erdoğan MA , Eroğlu E , Meral A , Erdoğan A , Atasoy Ö , Erbaş O
Published: June 2021

Despite the various and newly developed chemotherapeutic agents in recent years, cisplatin is still used very frequently as a chemotherapeutic agent, even though cisplatin has toxic effects on many organs. The aim of our study is to show whether ghrelin reduces the liver toxicity of cisplatin in the rat model. Twenty-eight male Sprague Dawley albino mature rats were chosen to be utilized in the study. Group 1 rats (n = 7) were taken as the control group, and no medication was given to them. Group 2 rats (n = 7) received 5 mg/kg/day cisplatin and 1 ml/kg/day of 0.9% NaCl, Group 3 rats (n = 7) received 5 mg/kg/day cisplatin and 10 ng/kg/day ghrelin, Group 4 rats (n = 7) received 5 mg/kg/day cisplatin and 20 ng/kg/day ghrelin for 3 days. Glutathione, malondialdehyde (MDA), superoxide dismutase (SOD), plasma alanine aminotransferase (ALT) levels, and liver biopsy results were measured in rats. It was determined that, especially in the high-dose group, the MDA, plasma ALT, and SOD levels increased less in the ghrelin group as compared to the cisplatin group, and the glutathione level decreased slightly with a low dose of ghrelin, while it increased with a higher dose. In histopathological examination, it was determined that the toxic effect of cisplatin on the liver was reduced with a low dose of ghrelin, and its histopathological appearance was similar to normal liver tissue when given a high dose of ghrelin. These findings show that ghrelin, especially in high doses, can be used to reduce the toxic effect of cisplatin.
Neuro-psychiatric manifestations in patients with systemic lupus erythematosus: A systematic review and results from the Swiss lupus cohort study
Authors: Meier Aline L , Bodmer Nicolas S , Wirth Carla , Bachmann Lucas M , Ribi Camillo , Pröbstel Anne-Katrin , Waeber David , Jelcic Ilijas , Steiner Urs C ,   for the Swiss SLE Cohort Study (SSCS)
Published: June 2021

Objectives

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease associated with neuro-psychiatric (NP) manifestations. Frequency and patterns of neuro-psychiatric systemic lupus erythematosus (NPSLE) vary substantially between patients. We conducted a systematic review (SR) of the literature and examined prevalence and characteristics of NPSLE in the Swiss SLE cohort study (SSCS).

Methods

The SR search was performed between January 1999 and January 2020. We included prospective/cross-sectional studies focusing on NPSLE. We secured study characteristics, cohort compositions and frequencies of NP manifestations, assessed heterogeneity across reports and investigated sources of variation using meta-regression models. Regarding the SSCS, we reviewed all patients included and classified NP manifestations.

Results

The SR searches identified 530 studies. We included 22 studies in our meta-analysis, the mean frequency of NPSLE ranged from 10.6% to 96.4%. The frequency of NPSLE in the SSCS was 28.1%. Severe events including cerebrovascular insults, seizures and psychosis appeared in 7.1%, 5.3% and 6.5% respectively. There was a linear relationship between duration of SLE and cumulative incidence of NPSLE.

Conclusions

The spectrum of NPSLE is very broad. The diagnostic work-up and rates of reported manifestations varied substantially across studies. We call for concerted efforts and consensus regarding definitions of NPSLE that will facilitate accurate diagnosis and attribution to SLE, particularly with a view to timely intervention and patient outcomes.
Porcine teschovirus, sapelovirus, and enterovirus in Swiss pigs: multiplex RT-PCR investigation of viral frequencies and disease association
Authors: Stäubli Tamara , Rickli Charlotte I. , Torgerson Paul R. , Fraefel Cornel , Lechmann Julia
Published: June 2021

Porcine teschovirus (PTV), sapelovirus (PSV-A), and enterovirus (EV-G) are enteric viruses that can infect pigs and wild boars worldwide. The viruses have been associated with several diseases, primarily gastrointestinal, neurologic, reproductive, and respiratory disorders, but also with subclinical infections. However, for most serotypes, proof of a causal relationship between viral infection and clinical signs is still lacking. In Switzerland, there has been limited investigation of the occurrence of the 3 viruses. We used a modified multiplex reverse-transcription PCR protocol to study the distribution of the viruses in Swiss pigs by testing 363 fecal, brain, and placental or abortion samples from 282 healthy and diseased animals. We did not detect the 3 viruses in 94 placental or abortion samples or in 31 brain samples from healthy pigs. In brain tissue of 81 diseased pigs, we detected 5 PSV-A and 4 EV-G positive samples. In contrast, all 3 viruses were detected at high frequencies in fecal samples of both healthy and diseased pigs. In healthy animals, PTV was detected in 47%, PSV-A in 51%, and EV-G in 70% of the 76 samples; in diseased animals, frequencies in the 81 samples were 54%, 64%, and 68%, respectively. The viruses were detected more frequently in fecal samples from weaned and fattening pigs compared to suckling piglets and sows. Co-detections of all 3 viruses were the most common finding. Based on clinical and pathology data, statistical analysis yielded no evidence for an association of virus detection and disease. Further research is required to determine if pathogenicity is linked to specific serotypes of these viruses.
A Meta-Analysis of Group Interventions for Trauma and Depression Among Immigrant and Refugee Children
Authors: Rafieifar Maryam , Macgowan Mark J.
Published: June 2021

Purpose:

A meta-analysis of group interventions to reduce post-traumatic stress symptoms (PTSS) and/or depression among refugee and immigrant children and adolescents.

Methods:

A systematic search was followed by independent reviews of each study for risk of bias. The meta-analysis pooled between- and within-condition effect sizes on PTSS and depression across studies using a random effects model.

Results:

The search yielded 16 studies utilizing eight interventions involving 976 participants. For all studies, within conditions, there were good effects on PTSS ( d = −0.66, 95% CI [−0.86, −0.46]) and depression ( d = −0.51, 95% CI [−0.79, −0.23]) with substantial heterogeneity. For studies with control groups, the between-group effect sizes yielded a small effect on PTSS ( d = −0.31, 95% CI [−0.65, 0.03]) with no significant effect on depression.

Conclusions:

The interventions helped to reduce PTSS and depression. Most studies lacked rigorous designs and provided little information on group variables needed for replication.
A Profile of the Michigan Hospice Nursing Association
Authors: Munsell Carol S.
Published: June 2021

This article describes the early planning and development of the Michigan Hospice Nursing Association. It discusses the growth ofthe organizationfrom the beginning in 1985 to the present time, including the association's objectives, philosophy, and standing committees. Specific issues affecting hospice nurses are recruitment and retention, stress management, benefits, the need for continuingeducation, and the implications of high-tech care in the home setting.
Evaluation of Maxillary Sinus Characteristics in Patients With Cleft Lip and Palate Using Cone Beam Computed Tomography
Authors: Paknahad Maryam , Pourzal Aida , Mahjoori-Ghasrodashti Mohammad , Khojastepour Leila
Published: June 2021

Objectives:

The detection of anatomical variation impairments in patients with cleft lip and palate (CLP) is crucial in combined orthodontic and maxillofacial surgical treatments. Therefore, this study aimed at evaluating the anatomical maxillary sinus characteristics, nasal septum deviation (NSD), and mucosal thickening of the maxillary sinus in patients with CLP using cone beam computed tomography (CBCT).

Design:

The CBCT images were classified into 3 groups of unilateral cleft lip and palate (UCLP; n = 40), bilateral cleft lip and palate (BCLP; n=14), and noncleft (control; n = 54). Subsequently, the maxillary sinus linear dimensions were assessed. Height, width, depth, infundibulum height, and ostium width were assessed as quantitative measures, whereas nasal septum deviation and mucosal thickening were assessed as qualitative measures. One-way analysis of variance and χ2 tests were utilized to identify any significant differences among the groups regarding the aforementioned variables.

Results:

Significant differences were observed among the groups regarding maxillary sinus height and depth, NSD, and mucosal thickening. Moreover, UCLP and BCLP groups showed higher incidence of NSD and mucosal thickening. However, the size of maxillary sinus height and depth was lower in the UCLP and BCLP groups.

Conclusion:

The results showed that BCLP and UCLP groups obtained lower maxillary sinus height and depth compared to the control group. On the other hand, incidence of the NSD and mucosal thickening was significantly higher in UCLP and BCLP groups than those in the control group.
COVID-19 Related Anxiety in Men With Localized Prostate Cancer at Tertiary Hospitals in Cape Town, South Africa
Authors: Irusen Hayley , Burger Henriette , Fernandez Pedro W. , Esterhuizen Tonya , Suliman Sharain , Seedat Soraya
Published: June 2021

Introduction:

The health profile of older adults places them at risk of infirmity and death from COVID-19 which may induce anxiety or exacerbate pre-existing anxiety. We examined COVID-19 related anxiety in men undergoing treatment for prostate cancer (CaP).

Method:

This study was conducted between July and September 2020. Sixty participants from a larger prospective, longitudinal study assessing depression, anxiety and health related quality of life in men with localized prostate cancer (DAHCaP) were included. COVID-19 related anxiety was measured at a single time point using, the Corona Virus Anxiety Scale (CAS). In addition, the following, the State-Trait Anxiety Inventory (STAI-S), the Connor-Davidson Resilience (CD-RISC) scale and Multidimensional Scale of Perceived Social Support (MSPSS) that form part of the DAHCaP study were used in the analysis. We extracted pre-pandemic data for the STAI-S.

Results:

Twenty-one percent had diabetes, 62.3% had hypertension and 24.6% had cardiac diseases, all known risk factors for severe COVID-19. Only 3% scored ≥9 on the CAS, indicating COVID 19 anxiety dysfunction. Half knew of family or friends that had contracted COVID-19 especially those scoring higher on the CAS ( P = 0.042). There was a significant decrease in STAI-S scores pre-pandemic to the pandemic phase (34.7 to 29.8, P = 0.003). No correlation was observed between CAS and STAI-S (rho = 0.08), CD-RISC (rho = −0.06) or MSPSS (rho = −0.15). There was a weak positive correlation between the CAS and monthly income (rho = 0.33; P = 0.010).

Conclusion:

COVID-19 did not induce significant anxiety in men being treated for CaP nor did it place an additional psychological burden, nor was there any correlation with state anxiety, resilience or social support.
Contagion Effect on Business Failure: A Spatial Analysis of the Hotel Sector
Authors: Vivel-Búa Milagros , Lado-Sestayo Rubén
Published: June 2021

This article analyzes the contagion effect on business failure, focusing on the Spanish hotel sector. The sample consists of 3,948 hotel micro-, small, and medium-sized enterprises in the 2012-2015 period and includes variables related to characteristics of the hotel and tourist destination. The results show that the contagion effect is significant, increasing the explanatory capacity of the model. Moreover, the results show that the analysis of the contagion effect should consider not only its simultaneous impact but also that deferred over time on the probability of failure. Thereby, this study found that after the initial shock, the contagion effect decreases and changes its sign from negative to positive in the fourth year.
Scale ultrasound-guided radial artery cannulation in infant: A randomized controlled trial
Authors: Yang Fei , Li Shangyingying , Chen Hang , Jiang Rui , Wang Xuanqin , Wang Weiping , Shi Yuan , Liu Lifei , Guo Hongjie , Ye Mao , Tu Shengfen , Wang Qiang , Wang Hong
Published: June 2021

Background:

Cannulation of the radial artery can be extremely challenging in infants. Scale ultrasound can provide accurate arterial location and guidance for operators. We hypothesized that scale ultrasound helps increase the initial success rate of radial artery cannulation in this population.

Method:

Seventy-six infants aged 0–3 months who needed arterial puncture after general anesthesia were randomly divided into two groups (1:1 ratio): the scale ultrasound group and the traditional ultrasound group. The primary endpoints were the success rate of the first attempt and the total success rate of arterial cannulation. The secondary endpoints were the time during arterial puncture and the incidence of vascular complications.

Results:

The success rate of the first attempt and the total success rate of arterial cannulation were 92.1% (35/38) versus 50% (19/38) and 100% (38/38) versus 86.8% (33/38) in the scale ultrasound and traditional ultrasound group ( p < 0.005), respectively. The median time to ultrasound location, needle entry into the radial artery, and successful cannulation in the scale ultrasound group were significantly shorter than those in the traditional ultrasound group: 10 (8.0, 17.2) s, 15 (11.7, 20) s, and 65 (53.8, 78.5) s vs 30 (26.5, 43.5) s, 35 (23, 51) s, and 224.5 (123.5, 356) s ( p < 0.001), respectively. The incidence of hematoma was higher in the traditional group ( p < 0.005).

Conclusions:

Scale ultrasound-guided radial arterial cannulation can significantly improved initial success rate and overall success rate, shorten puncture time in infant, compared with that achieved with the use of traditional ultrasound guidance.
Benchmarking European Home Care Models for Older Persons on Societal Costs: The IBenC Study
Authors: van Lier Lisanne I , van der Roest Henriëtte G , Garms-Homolová Vjenka , Onder Graziano , Jónsson Pálmi V , Declercq Anja , Hertogh Cees MPM , van Hout Hein PJ , Bosmans Judith E
Published: June 2021

This study aims to benchmark mean societal costs per client in different home care models and to describe characteristics of home care models with the lowest societal costs. In this prospective longitudinal study in 6 European countries, 6-month societal costs of resource utilization of 2060 older home care clients were estimated. Three care models were identified and compared based on level of patient-centered care (PCC), availability of specialized professionals (ASP) and level of monitoring of care performance (MCP). Differences in costs between care models were analyzed using linear regression while adjusting for case mix differences. Societal costs incurred in care model 2 (low ASP; high PCC & MCP) were significantly higher than in care model 1 (high ASP, PCC & MCP, mean difference €2230 (10%)) and in care model 3 (low ASP & PCC; high MCP, mean difference €2552 (12%)). Organizations within both models with the lowest societal costs, systematically monitor their care performance. However, organizations within one model arranged their care with a low focus on patient-centered care, and employed mainly generalist care professionals, while organizations in the other model arranged their care delivery with a strong focus on patient-centered care combined with a high availability of specialized care professionals.
Geriatric Education on Telehealth (GET) Access: A medical student volunteer program to increase access to geriatric telehealth services at the onset of COVID-19
Authors: Pichan Cayla M , Anderson Clare E , Min Lillian C , Blazek Mary C
Published: June 2021

The coronavirus disease 2019 pandemic placed an unprecedented demand on health systems to rapidly shift ambulatory in-person care to virtual care. Geriatric patients face more challenges with video visit access compared to younger patients due to discomfort with technology and less access to devices and internet. Medical students at the University of Michigan created an initiative to improve access to and comfort with video visits for geriatric patients. The program's goals were to (a) explore options for the delivery of personalized training to older adults, (b) create materials for volunteers to successfully navigate conversations with patients and caregivers, (c) provide patients one-to-one remote guidance while identifying and overcoming barriers—with practice sessions to increase comfort, (d) share with the larger health system, and (e) ensure program sustainability. Over a 10-week evaluation period, providers whose patients worked with our geriatric education on telehealth access volunteers had a video visit rate of 43% compared to 19.2% prior to participation in the program (adjusted odds ratio = 3.38, 95% confidence interval = 2.49, 4.59), ultimately providing a platform for geriatric patients to foster stronger connections with their providers, while increasing Michigan Medicine's overall proportion of video telehealth visits.
Towards finding a novel constant between local and bulk strength of friction stir processed aluminum alloys
Authors: Satyanarayana MVNV , Kumar Adepu , Kranthi Kumar K
Published: June 2021

Friction stir processing has gained remarkable success in producing ultrafine-grained structures and surface composites. In this context, the primary objective is to establish a linear relationship between local strength (i.e. hardness) and bulk mechanical strength (i.e. tensile strength) of friction stir processed aluminum alloys using experimental investigations on selected alloy system together with data reported in literature sources. Initially, authors generated a linear relation between hardness and strength of friction stir processed aluminum alloys under different cooling conditions. After friction stir processing, recrystallized fine grains were formed and better refinement was achieved in cooling-assisted friction stir processing. Irrespective of grain refinement, the strength and hardness of friction stir processed samples were found to be lower compared to the base metal due to the precipitation phenomenon during friction stir processing. At the same time, hardness and strength improved in cooling-assisted friction stir processing compared to natural-cooled friction stir processing due to better grain refinement going by the parameters of Hall–Petch equation. For friction stir processed samples, relevant constants were found using Hall–Petch equation. The experimental values of hardness and strength were well fitted with the formulated equations due to the formation of a homogeneous fine-grained structure. Also, two novel linear relations were successfully established between hardness and strength with proportionality constants of 1.9 and 2.7, respectively. On the other hand, it was also concluded that it is not possible to establish a linear relation between hardness and strength of surface composites due to structural inhomogeneity and agglomeration of reinforcement particles.
Questioning policy representations of women’s alcohol consumption: Implications for social work
Authors: Smith Tania L , Zufferey Carole , Bilic Snjezana , Loeser Cassandra
Published: June 2021

This study draws on Carol Bacchi’s What’s the problem represented to be? (WPR) framework, to deconstruct policy discourses of women’s alcohol consumption. It examines Australian policies such as in the National Alcohol Strategy (2019–2028) and Australian Guidelines to Reduce Health Risks from Drinking Alcohol ( NHMRC, 2009, 2020 ). It found that policy discourses particularly focus on the effects of women’s alcohol consumption as ‘harms’ to unborn children, by emphasising women’s assumed reproductive roles, such in pregnancy and when breastfeeding. Social policy tends to reproduce medicalising and normative gendered discourses about women’s alcohol consumption, with disempowering effects on women. This discourse analysis of drug and alcohol policies can contribute to broadening how social workers understand policy representations and the effects of policy discourses on women. The disciplinary power of the medicalisation and acceptable/unacceptable categorisation of women’s alcohol consumption means that women can internalise shame and stigma, which is often an obstacle for women attempting to seek assistance. More research is needed about how social workers can co-design policies and research projects with women of diverse sexualities and cultural backgrounds who have been subjugated by these policy discourses.
Multi-scale modelling of the damage behavior for 3D woven composites with variant structure
Authors: Zhong Hua , Yang Shuzi
Published: June 2021

In the process of fabricating a three-dimensional (3 D) woven perform, the variant structures introduced during adding and reducing tows, lead to changes of local tow orientation and woven pattern, which affects the mechanical response of 3 D woven composite. In this study, specimens with variant structure were manufactured by adding and reducing tow techniques, and representative unit cells of normal and variant structure were established by topological method. A multi-scale damage model was proposed to analyze the damage behaviors and predict the strength of 3 D woven composites with the user subroutine UMAT of ABAQUS/Standard. The results show that the variation of tensile modulus and strength between the experimental and simulation value were less than 4%. In addition, it is proved that the damage propagation of the macro-scale model with variant structure can be successfully captured.
Comparison of Clinical Outcomes With Drug Coated Balloons Versus Plain Balloon Angioplasty In Chronic Limb-Threatening Ischemia
Authors: John Joel Mathew , Samuel Vimalin , Selvaraj Dheepak , Premkumar Prabhu , Kota Albert A , Stephen Edwin , Mani Thenmozhi
Published: June 2021

Objective:

The use of drug coated balloon (DCB) for angioplasty has shown superior efficacy against plain balloons for treating complex infrainguinal arterial disease. We report and compare the clinical outcomes following application of DCB(Paclitaxel) and plain angioplasty (POBA) in our tertiary care centre.

Methods:

A retrospective, single centre analysis of 301 patients with chronic limb-threatening ischemia involving the infrainguinal segment was conducted between September 2014 and September 2018, after approval from the Institutional review board. We analyzed clinical outcomes by measuring postoperative ABI improvement, restenosis requiring reintervention procedure, minor and major amputations at the end of 18 months. . To find the association between the group variables (POBA and DCB) and other risk variables, Chi-square test/Fisher’s exact test was used. Multivariable logistic regression analysis was used.

Results:

Patients who underwent treatment with plain balloon (POBA) and DCB(Paclitaxel) angioplasty were 246(81.7%) and 55(18.3%) respectively. Our study group was predominantly male (Male: Female = 6.7:1), most patients were more than 50 years of age (n = 251, 83.4%). Smoking (n = 199, 66.1%) and diabetes (n = 210, 69.8%) were the most common atherosclerotic risk factors. Postoperative Ankle Brachial Pressure Index (ABI) improvement were similar in both groups (POBA = 57.7%; DCB = 69.8%; p = 0.103). Minor and major amputations following POBA were 26% and 22%; and DCB were 12.7% and 16.4% respectively. Re-stenosis requiring a re-interventional procedure within 18 months was 15%, (n = 37) following POBA; and 12.7% (n = 7) following DCB (p = 0.661).

Conclusions:

This retrospective study shows similar clinical limb related outcomes following POBA and DCB at 18 months. However, our comparative analysis between the POBA and DCB groups was totally unadjusted and not adjusted for common confounders such as age and sex. Hence, for one to draw definitive conclusions leading to changes in clinical practice; a randomized, prospective study with a larger patient cohort is needed.
Exposing and re-placing leadership through workers inquiry
Authors: Smolović Jones Owain , Briley George , Woodcock Jamie
Published: June 2021

The literature on leadership place and space offers us an understanding of how the built environment, geography of location and socio-economic forces can coalesce to shape (and be shaped) by leadership practices. Missing thus far, however, is an account that constitutes leadership space and place through antagonism and struggle, crucial if we are to acknowledge the agency of workers in leadership practice. We therefore outline a workers inquiry approach that seeks to learn directly from the struggles of workers as they enact place and space through their particular, geographically situated practices. We do so through reading leadership studies, Marxist accounts of space and place, and workers’ inquiries dialectically to draw out two practices that can offer a framework for both understanding the contribution of workers inquiry approaches to leadership but also to inform future studies. Our first practice of exposing is the drawing to the surface by workers inquiry of the oppressiveness, contradictions and absurdities of leadership discourse and practices of capital as they shape the places and spaces within which workers are exploited. Re-placing, on the other hand, offers workers’ movements potentially emancipatory alternative forms of leadership, which re-shape and re-appropriate place and space.
Fatty infiltration in the intact supraspinatus tendon; a normal physiological response with increasing age and female gender
Authors: Wilson Ailsa , MacLean Simon BM
Published: June 2021

Background

Fatty infiltration and muscle atrophy of supraspinatus are used as markers of chronicity in rotator cuff tears and are known to both be independently related to poorer outcomes following surgical repair.1 We hypothesized that supraspinatus muscle atrophy and fatty infiltration increases with age irrespective of whether the rotator cuff is intact and therefore cannot be used as accurate markers for chronicity.

Method

Retrospective review of 280 patients who underwent 3.0 T shoulder MRI’s with either a normal scan or rotator cuff tear. Two independent observers reviewed the images. Data collected included intact rotator cuff tendons looking specifically at supraspinatus muscle height/length: suprascapular fossa ratio, tangent sign and Goutallier grade for fatty infiltration.

Results

There were 90 scans with intact rotator cuff tendons. Mean age was 51 years (range 17–86); 52 males, 38 females. On multiple regression analysis, there was a positive correlation of age with fatty infiltration and muscle atrophy on all parameters in the normal intact cuff. Females were significantly more likely than males to have a higher grade of fatty infiltration.

Conclusion

Age and female gender are risk factors for rotator cuff atrophy and fatty infiltration in patients with normal rotator cuffs. Therefore, these parameters should be used with caution by surgeons when deciding on tear chronicity and the potential to repair the torn rotator cuff.
Rocuronium as Neuromuscular Blockade in Tetanus Patients With Methamphetamine Use Disorder: A Case Report
Authors: Sarmiento Robert Joseph Cruz , Enriquez Clare Angeli G , Jalipa Francis Gerwin , Piamonte Bernadeth Lyn , Diestro Jose Danilo , Dioquino Carissa Paz , Goffi Alberto , Jamora Roland Dominic G.
Published: June 2021

Background:

Spasm control is essential in the management of tetanus. Benzodiazepines are administered as initial treatment of tetanic spasms; however, sedation may be difficult to attain among patients with methamphetamine use disorder. Neuromuscular blocking agents, which act on an entire different mechanism, can be given to induce paralysis.

Methods:

We describe 2 cases of patients with methamphetamine use disorder who were diagnosed with severe tetanus and our experience in the use of rocuronium to control their spasms. We performed a systematic review of the SCOPUS and PubMed databases for case reports and case series describing the use of rocuronium in tetanus patients who also have methamphetamine use disorder. We discussed the clinical features and treatment outcomes.

Results:

A total of 4 cases of patients with substance abuse disorder who had severe tetanus were reported in the literature, including the current cases. The mean age was 28.8 years; all of them male. Trismus, generalized limb and abdominal rigidity were the most common presentation. Three patients underwent emergency tracheostomy. Rocuronium was given as 0.008mg/kg bolus in 1 patient; 2 patients received an intravenous bolus dose of 0.6mg/kg. Infusion dose ranged from 5 to 10 mcg/kg/min. Spasms were controlled within 24-48 hours after giving rocuronium in 3 out of 4 patients. One patient died from complications of dysautonomia and immobility.

Conclusion:

Rocuronium demonstrates a potential role as neuromuscular blocking agent of choice for patients with chronic methamphetamine use disorder and severe tetanus. Management challenges and complications of severe tetanus were also highlighted in this study.
Same-Admission Microvascular Maxillofacial Ballistic Trauma Reconstruction Using Virtual Surgical Planning: A Case Series and Systematic Review
Authors: Knudson Sean A. , Day Kristopher M. , Kelley Patrick , Padilla Pablo , Collier Ian X. , Henry Steven , Harshbarger Raymond , Combs Patrick
Published: June 2021

Study Design:

Retrospective case series; systematic review.

Objective:

It is unknown whether the use of virtual surgical planning (VSP) to facilitate same-admission microsurgical reconstruction of the mandible following acute maxillofacial ballistic trauma (MBT) is sufficient to achieve definitive reconstruction and functional occlusion.

Methods:

A single-center retrospective analysis was conducted for patients who underwent microsurgical reconstruction of the mandible using VSP after acute MBT. The PubMed/MEDLINE, Embase, ScienceDirect, and Scopus databases were systematically reviewed using blinded screening. Studies were evaluated via thematic analysis.

Results:

Five patients were treated by same-admission and microsurgical reconstruction of the mandible using VSP. We observed an average of 16.4 ± 9.1 days between initial presentation and reconstruction, an average length of stay of 51.6 ± 17.9 days, 6.2 ± 2.8 operations, and 1.6 ± 0.9 free flaps per patient. Four types and 8 total flaps were employed, most commonly the anterior lateral thigh flap (37.5%). Care yielded complete flap survival. Each patient experienced at least 1 minor complication. All patients achieved centric occlusion, oral nutrition, and an approximation of their baseline facial aesthetic. Follow up was 191.0 ± 183.9 weeks. Systematic review produced 8 articles that adhered to inclusion criteria. Consensus themes in the literature were found for clinical goal and function of VSP when practicing MBT reconstruction, yet disagreement was found surrounding optimal treatment timeline.

Conclusions:

Same-admission microsurgical reconstruction after MBT is safe and effective to re-establish mandibular form and function. VSP did not delay reconstruction, given the need for preparation prior to definitive reconstruction.
Spontaneous chronic subdural hematoma due to cerebral cortical artery rupture: First case report and review of pertinent literature
Authors: Noufal Mazen , Liang Conrad W , Yanez Paulino , Calayag Mark
Published: June 2021

Introduction

Chronic subdural hematoma (CSDH) is generally attributed to pathological changes in the dural arterial system, which has led to growing utilization of middle meningeal artery (MMA) embolization in CSDH treatment. There are no case reports of CSDH due to cerebral cortical artery perforation.

Method

We report a case of spontaneous CSDH caused by cortical artery rupture that was identified on digital subtraction angiography and could be visualized on computed tomographic angiography (CTA). We also present a brief review of the pertinent literature.

Result

A 56-year-old man presented with daily headache for three weeks with no history of trauma. Neurologic exam was normal except for subtle left pronator drift. A computed tomography scan of the head showed a right CSDH with a midline shift. CTA was suspicious for a dilated vein in the subdural collection. Catheter cerebral angiogram demonstrated contrast extravasation from a small cortical branch of the middle cerebral artery with no aneurysm, arterial dissection, or vascular malformation. In retrospect, CTA findings represented contrast extravasation, not a dilated vein. Burr-hole mini-craniotomy was performed, and the hematoma was evacuated. The patient had complete clinical and radiographic recovery.

Conclusion

Ruptured cerebral cortical artery can cause CSDH. In atypical cases of CSDH, careful evaluation of selective internal carotid artery angiography is advised to look for alternative pathologies prior to proceeding with MMA embolization. CTA images may demonstrate active extravasation from a small cortical artery.
Postoperative abdominal free air: How much and when is enough? Report of two cases
Authors: Melemeni Aikaterini , Tympa Grigoriadou Aliki , Tsaroucha Athanasia
Published: June 2021

Postoperative intraperitoneal or ectopic free air may occur after abdominal surgery, gynecologic surgery, laparoscopic surgery, or endoscopic procedures and, in rare cases, represent gastrointestinal perforation, requiring emergency laparotomy. Evaluating patients with postoperative signs of bowel perforation may be difficult, especially when day-case laparoscopic or endoscopic surgery is performed, with the patient readily discharged from hospital. Delayed diagnosis of gastrointestinal perforation due to underestimation of postoperative free air is associated with a high morbidity and mortality rate. We report two cases of patients presenting with postoperative free air along with the clinical presentation and management.
Does the estimation of burn extent at admission differ from the assessment at discharge?
Authors: Holm Sebastian , Engström Olof , Petäjä Ida , Huss Fredrik
Published: June 2021

Introduction:

Estimation of total body surface area (TBSA) burnt and burn depth are among the most central parts of acute burn assessment/treatment as they determine the level and type of care needed. Traditional methods for determining burn extent on admission often lead to inaccurate estimations, especially in paediatric or overweight patients.

Aim:

To compare %TBSA at admission with validated %TBSA at discharge in different patient populations to investigate if significant over- or underestimation occurs.

Method:

This retrospective observational study is based on a patient registry of all the patients (n = 863) treated at the Uppsala University Hospital’s Burn Centre between 2010 and 2018. The patients were divided into subgroups based on age, gender, body mass index (BMI) and validated burn extent. The %TBSA estimated at admission was compared to the validated %TBSA in all groups separately.

Results:

As has been published before, we also found that the %TBSA in paediatric patients was more often overestimated as were the smaller injuries, whereas larger injuries were often underestimated. BMI did not clearly affect the estimations and there was no clear difference between the genders in estimated %TBSA.

Conclusion:

Inaccurate estimations of %TBSA are common, particularly for paediatric patients and small or large injuries. We recommend a careful accurate approach when calculating %TBSA in the paediatric population to avoid over- and under-resuscitation. Increased education and training are recommended to improve accurate estimation in the future.

Lay Summary

The correct estimation of both extent and depth of burn is very important. This assessment guides the lever of care needed, the necessary amount of fluid resuscitation, the predicted outcome and more. It has been proven notably difficult to correct assess, especially the extent of a burn. Despite different tools as the “Rule of Nine” (body area divided into multiples of 9% body surfaces), the “Rule of Palm” (Patient’s palm, fingers included, approximates 1% of body surfaces), the Lund & Browder chart (detailed, age-specific body areas) and different more technical solutions. Often inaccurate estimations are done which thus affect the treatment. This depth and extent estimation is usually performed when the patient is admitted. However, it is known that burns change appearance during the first few days of care. In our Burn Center we have also performed this estimation when the patient is discharged. At this point it is known the true extent and depth of the initial burn. In this retrospective observational study, we compared the burn extent estimated on admission with the one on discharge to investigate whether the initial assessment is accurate. This study highlights the issue of frequent inaccurate burn extent estimations, especially in subgroups as overweight patient or pediatric patients.
Quality of life in SSc-ILD patients: Understanding the impact of the ILD and the needs of the SSc-ILD patients and their need for caregivers in France
Authors: Allanore Yannick , Constans Joel , Godard Dominique , de Pouvourville Gerard , Bouee Stephane , Jeanbat Viviane , Teissier Clement , Le Lay Katell , Chollet Julien , Hachulla Eric
Published: June 2021

Objectives:

The objectives of this study were to describe the impact of systemic sclerosis associated interstitial lung disease, on quality of life, to estimate the correlation between quality of life and severity of lung disease and to assess the impact of interstitial lung disease on caregivers.

Methods:

Seven investigators included systemic sclerosis associated interstitial lung disease patients from December 2019 to April 2020. Sociodemographics and clinical data were collected. Patients reported outcomes and questionnaires were used with 1 generic patients reported outcome (EQ-5D-5L), 1 specific PRO (Brief Interstitial Lung Disease) and 2 self-reported questionnaires on impact of SSc complications and impact on caregivers. The correlation between forced vital capacity and EQ-5D-5L score was estimated with a multivariate linear regression model adjusted on several covariates.

Results:

In all, 89 patients were included. 26.4% were males, mean age was 58.2 ± 14.5 years. Mean EQ-5D-5L score = 0.79 ± 0.22 (median = 0.85). Mean EQ-5D-5L visual analog scale score = 60.8 ± 20.4 (median = 61.5). Mean King’s Brief Interstitial Lung Disease score = 58.4 ± 12.7 (median = 58.0). After adjustment on covariates, a significant correlation between forced vital capacity and EQ-5D-5L score was found with an increase of 0.003 of the EQ-5D-5L score for a 1% increase of FVC (p = 0.0096). No significant correlation between forced vital capacity and the EQ-VAS and King’s Brief Interstitial Lung Disease score were found. The impact of SSc on other organs was significantly correlated with EQ- 5D-5L score, respectively, for the impact scores on the lung system (p = 0.0003), heart system (p = 0.0182), Raynaud’s syndrome (p = 0.0015), digestive system (p = 0.0032), joints/muscles (p = 0.0003), skin (p < 0.0001), kidney (p = 0.0052) and gastro-oesophageal reflux (p = 0.0063). Significant correlations between King’s Brief Interstitial Lung Disease score and lung system (p < 0.0001), heart system (p < 0.0001), digital ulcers (p = 0.058), digestive system (p < 0.0001), kidney (p = 0.0004), skin (p = 0.0499) and gastro-oesophageal reflux (p = 0.0033) scores were found 68.5% of patients reported their need for a caregiver to help them in their daily life activities.

Conclusion:

Our study highlighted the strong burden of systemic sclerosis associated interstitial lung disease` for patients, especially with an impact on quality of life, on other organs manifestations and need for caregivers in their daily life.
Ascending aorta aneurysm in scleroderma
Authors: Chintala Bhavya , Duggal Lalit , Jain Neeraj
Published: June 2021

Ascending aorta aneurysm in scleroderma can be ascribed to its macrovascular involvement which is very less elucidated. We here describe a 56-year-old female with rapidly progressive diffuse cutaneous scleroderma. She presented with skin thickening involving all four limbs, thorax and abdomen. She had other features like arthritis, Raynaud’s phenomena, dyspnoea, heaviness of chest, and dysphagia. On investigation, she was strongly positive for antinuclear antibody and Scl 70. Imaging revealed interstitial lung disease (nonspecific interstitial pneumonia pattern) and a fusiform dilatation of ascending aorta of 6.5 cm. Patient was offered surgical correction for aneurysm, for which she refused. To the best of our knowledge, our case report adds up to the few cases of ascending aorta aneurysm in scleroderma available in world literature.