bluuebunny/crossref_metadata_2025 huggingface dataset:
Depression moderates the associations between beliefs about medicines and medication adherence in patients with rheumatoid arthritis: Cross-sectional study
Authors: Brandstetter Susanne , Riedelbeck Gertraud , Steinmann Mark , Loss Julika , Ehrenstein Boris , Apfelbacher Christian
Published: May 2016

The ‘necessity–concerns framework’ postulates that patients’ adherence behaviour is influenced by beliefs about the necessity and the concerns patients have regarding their prescribed medicines. We hypothesized that depression moderates the associations between beliefs about medicines and medication adherence among people with rheumatoid arthritis. Using multivariate logistic regression, we observed that people experiencing more depressive symptoms showed stronger associations between necessity beliefs and adherence as well as attenuated associations between concerns and adherence, respectively, in a cross-sectional sample ( N = 361). Thus, depression moderates the associations postulated in the ‘necessity–concerns framework’ in a differential way in people with rheumatoid arthritis.
Racism and white death penalty support
Authors: Bratina Michele P , Cox Amanda K , Fetzer Matthew D
Published: May 2016

Research indicates a significant, positive relationship between racial prejudice and death penalty support among white people. The racist punitive bias hypothesis has been proposed as a possible explanation for this relationship, indicating that racially prejudiced people might be more supportive of the death penalty because they perceive minority individuals to be criminal and, therefore, more likely to be subject to the punishment. This study attempted to test the validity of the racist punitive bias hypothesis using or with a convenience sample of U.S. residents. Path and regression analyses indicated a link between racial prejudice and white death penalty support, but did not support the racist punitive bias hypothesis. Policy implications and directions for future research are discussed.
Psychosocial predictors of emotional intelligence among police officers in Nigeria
Authors: Olugbemi Olukolade , Bolaji Adesanya
Published: May 2016

Policing requires the mastering of emotions and the application of psychological principles such as emotional intelligence in dealing with members of the public. However, the corporate image of the police has not been good worldwide and there is increasing need for research in this area. Studies on emotional intelligence among police officers are scarce and are needed to understand the problems confronting this important sector of society. Therefore, this study investigated the psychosocial determinants of emotional intelligence among police officers in Ibadan, Nigeria. A survey research design was employed, and data were collected through a standardized questionnaire, the Eysenck Personality Scale and the Emotional Intelligence Scale. Two hundred and fifty-eight police officers from four different police stations in the Ibadan metropolitan area were accessed through a purposive sampling technique. The results revealed that educational qualifications did not significantly influence the emotional intelligence of police officers ( F(8, 251) = .21, p > .05). There was a significant gender difference in emotional intelligence ( t(256) = 2.17, p < .05), with males scoring significantly higher ( X = 79.38, SD = 11.33) than their female counterparts ( X = 75.43, SD = 15.26). It was also found that there was no significant difference in emotional intelligence between older and younger police officers ( t(256) = .34, p > .05). Furthermore, the personality attributes extraversion, neuroticism and psychoticism did not significantly predict emotional intelligence jointly ( F(3, 256) = 1.65; p > .05), and only neuroticism significantly predicted emotional intelligence independently ( β = –.15, p < .05). Finally, there was no significant influence of the interaction of gender and the personality attribute of extraversion–introversion on emotional intelligence among Nigerian police officers in Ibadan. The study concluded that gender and the personality dimension of neuroticism are determinants of emotional intelligence and we recommend an emotional intelligence training programme for the Nigeria police.
When one of them is in our place: Early childhood settings as spaces of resistance
Authors: Arndt Sonja
Published: May 2016

When they come to us in our place, what happens, for them and for us? This article investigates conceptions of Otherness through the story of an immigrant early childhood teacher, seen as the stranger, foreigner, who comes to our place, our early childhood setting. It provokes and challenges orientations, towards teacher-foreigners in a teaching team, towards difference and towards considerations of our place, as culturally drenched in local knowledges, values and practices, as relationally complex and as a possible site of resistance. This article disturbs and complicates dominant constructions of the Other by positing teacher-subjects through a Kristevan lens as dynamic and constantly evolving. Tracings of Kristeva’s philosophical influences and treatments of Otherness help to present entangled historicised, contemporary and future insights into the recognition and marginalisation of teacher-foreigners. Finally, the teacher’s story becomes further challenged with Kristeva’s suggestion that each one of us is a foreigner inside, Other to ourselves, when they come to us, in our place.
Toona sinensis Inhibits Murine Leukemia WEHI-3 Cells and Promotes Immune Response In Vivo
Authors: Yang Hsin-Ling , Thiyagarajan Varadharajan , Liao Jiunn-Wang , Chu Yu-Lin , Chang Chia-Ting , Huang Pei-Jane , Hsu Chih-Jung , Hseu You-Cheng
Published: May 2016

Toona sinensis (TS) is one of the most popular vegetarian dishes in Taiwan. It has been shown to exhibit antioxidant, antiangiogenic, antiatherosclerotic, and anticancer properties. In this study, we demonstrated the ability of aqueous leaf extracts from TS to promote immune responses in BALB/c mice and to exhibit anti-leukemia activity in murine WEHI-3 cells. BALB/c mice were injected intravenously with WEHI-3 cells and then treated orally with TS (50 mg/kg). In vivo study showed that TS treatment reduced liver and spleen enlargement in WEHI-3 bearing mice compared with the untreated group. Furthermore, TS also decreased white blood cells (WBC), indicating inhibition of differentiation of the precursor of macrophages in WEHI-3 bearing mice. Treatment of WEHI-3 cells with TS (0-75 μg/mL for 24 hours) significantly reduced cell viability. Furthermore, TS treatment–induced late apoptosis was confirmed by Annexin-V/PI staining. Western blot analyses revealed that treatment of WEHI-3 cells with TS statistically increased the protein expression level of cytochrome c in the cytoplasm and activates caspase-3. Notably, TS treatment caused a dramatic reduction in Bcl-2 and increase in Bax protein levels. TS may disturb the Bcl-2 and Bax protein ratio and induce apoptosis. This reports confirms the antitumor activity of this nutritious vegetable potentially against leukemia.
Chrysin Increases the Therapeutic Efficacy of Docetaxel and Mitigates Docetaxel-Induced Edema
Authors: Lim Hyun-Kyung , Kim Kyoung Mee , Jeong Seong-Yun , Choi Eun Kyung , Jung Joohee
Published: May 2016

Docetaxel (DTX) is an effective commercial anticancer agent for chemotherapy in non–small cell lung cancer (NSCLC), breast cancer, gastric cancer, and prostate cancer, but its adverse effects including edema, neurotoxicity, and hair loss limit its application. To improve the chemotherapeutic efficacy of DTX and reduce adverse effects, combination therapy is one of the alternative methods. So chrysin, which has various biological activities including anticancer effects, was considered. In vitro, the combination of chrysin and DTX was investigated in A549 cells. Increased cytotoxicity, suppressed cellular proliferation, and induced apoptosis were observed with posttreatment of chrysin following DTX treatment. In vivo, chrysin enhanced the tumor growth delay of DTX and increased DTX-induced apoptosis in the A549-derived xenograft model. Furthermore, chrysin prevented DTX-induced edema in ICR mouse. These results indicated that chrysin strengthened the therapeutic efficacy of DTX and diminished the adverse effect of DTX, suggesting chrysin could be exploited as an adjuvant therapy for NSCLC.
Current Trends in Treatment of Kienböck Disease
Authors: Kolovich Gregory P. , Kalu Chidimma M. K. , Ruff Michael E.
Published: May 2016

Background: The cause and treatment of Kienböck disease is controversial. No treatment algorithm has been accepted. We surveyed US hand surgeons to determine trends and attitudes regarding the treatment of Kienböck disease. Methods: An online questionnaire was created focusing on specific treatments of Kienböck disease. The survey included 6 questions regarding the cause of disease, preferred vascularized bone grafting (VBG) procedure, and treatment of stages I, II, IIIA, and IIIB. Respondents were also asked to specify their geographic location of practice and the approximate number of years in practice. Results: A total of 338 of the 2781 surgeons contacted completed the survey for a response rate of rate of 12%. The majority of respondents believe ulnar-negative variance alone contributes to the development of Kienböck disease. For treatment of a young ulnar-neutral male with stage I disease who had failed immobilization and nonsteroidal anti-inflammatory drugs, most hand surgeons chose distal radius core decompression. There was no preferred treatment among respondents for treatment of a young ulnar-neutral female with stage II disease. For treatment of a 40-year-old ulnar-negative male with stage IIIA disease, most hand surgeons chose a radial shortening osteotomy. The preferred treatment among respondents for treatment of stage IIIB disease is a proximal row carpectomy. Conclusions: Our study demonstrated that most hand surgeons believe ulnar-negative variance largely contributes to Kienböck disease and the most commonly preferred VBG technique utilizes the fourth and fifth extensor compartment arteries.
Arthroscopic Trapeziectomy With Suture Button Suspensionplasty
Authors: Landes Genevieve , Gaspar Michael P. , Goljan Peter , Jacoby Sidney M. , Bachoura Abdo , Culp Randall W.
Published: May 2016

Background: Arthroscopic trapeziectomy with suture button suspensionplasty (ATBS) is a relatively new surgical option for the treatment of thumb carpometacarpal (CMC) osteoarthritis. Although ATBS has many potential benefits over alternative surgical treatments for CMC arthritis, little data exist regarding its safety and complication rates. The purpose of this study was to demonstrate that ATBS is associated with a low risk of complications within 1 year of surgery. Methods: A retrospective review of patients treated with ATBS by one senior hand surgeon over a span of 3 years was performed. Results: A total of 153 cases of ATBS were performed in 136 patients. Ninety-seven cases involved arthroscopic hemitrapeziectomies, and 56 involved arthroscopic complete trapeziectomies. There were 44 males and 92 females with a mean age of 62. Thirty-eight percent of the cases were graded as Eaton stage IV, 46% stage III, and 14% stage II CMC arthritis, while 3 cases (2%) were performed as revisions. Mean follow-up duration was 58 weeks. Mean preoperative key pinch strength of the affected versus the unaffected side was 92% compared with 95% postoperatively. Revision surgery was performed in 9 out of 153 cases (<6%). Of those 9 cases, 5 had additional minor bony debridement with subsequent improvement in pain, 3 had the implant repositioned due to button prominence, and 1 patient presented with osteomyelitis of the first and second metacarpals that was successfully treated with button removal and an antibiotic regimen. Conclusions: ATBS is a safe, minimally invasive procedure for treatment of symptomatic stages II through IV thumb CMC arthritis.
Increased Complications in Trapeziectomy With Ligament Reconstruction and Tendon Interposition Compared With Trapeziectomy Alone
Authors: Naram Aparajit , Lyons Keith , Rothkopf Douglas M. , Calkins Edward R. , Breen Thomas , Jones Marci , Shufflebarger John V.
Published: May 2016

Background: In the treatment of basal joint arthritis of the thumb, recent studies suggest equivalent outcomes with regard to long-term pain, mobility, and strength, in patients undergoing either trapeziectomy alone or trapeziectomy with ligament reconstruction and tendon interposition (LRTI). The goal of this study was to investigate risk factors for complications in carpometacarpal (CMC) arthroplasty. Methods: We conducted a retrospective chart review of 5 surgeons at a single institution performing CMC arthroplasties from November 2006 to November 2012. A total of 200 thumbs in 179 patients underwent simple trapeziectomy with or without LRTI and with or without Kirschner wire stabilization, or a Weilby procedure. The average follow-up was 11.6 months (range = 1-69 months). Data collection included sex, age, history of smoking or diabetes, and any other surgeries performed on the hand at the time of arthroplasty. Furthermore, we collected outcomes involving any adverse events, paying attention to those necessitating reoperation, antibiotics, or those who developed complex regional pain syndrome. Results: Seventy hands had a postoperative complication. Ten of these complications were considered major, defined as requiring antibiotics, reoperation, or other aggressive interventions. On multivariate analysis, risk of total complications was significantly greater only in patients undergoing either trapeziectomy with LRTI or Weilby procedure in comparison with trapeziectomy with K-wire stabilization (odds ratio = 4.30 and 6.73, respectively). Conclusions: Patients undergoing trapeziectomy with LRTI or Weilby had a greater incidence of reported complications when compared with trapeziectomy alone. These results suggest an advantage of simple trapeziectomy; however, further study is warranted.
Variations in Postoperative Immobilization Following Common Hand Surgery Procedures
Authors: Diaz Roberto , Ebramzadeh Edward , Yao Jeffrey
Published: May 2016

Background: The aim was to investigate variations in the duration of postoperative immobilization for common hand surgery procedures and to determine whether there is any correlation between surgeon experience and duration of postoperative immobilization. Methods: An anonymous cross-sectional survey was sent to the American Society for Surgery of the Hand asking the following questions: (1) number of years in practice and (2) duration of immobilization for 16 common hand surgery procedures. A Pearson’s correlation coefficient was used to determine correlations between surgeon experience and duration of immobilization. Box plots were created to display the distribution and variability in postoperative immobilization per procedure among surgeons. Results: A total of 1126 respondents completed the survey, yielding a response rate of 40%. Procedures with a greater average duration of immobilization demonstrated the greatest variability. The largest variability overall was observed in intercarpal ligament repair with the majority of responses distributed between 4 and 10 weeks of immobilization. The smallest variability was observed following De Quervain’s release and Dupuytren’s fasciectomy. Only small correlations between surgeon experience and duration of immobilization were observed. Specifically, all Pearson correlation coefficients were less than .20. Conclusions: This study supports the hypothesis that large variations exist in the duration of immobilization following common hand surgery procedures. Only small correlations were found between surgeon experience and average duration of immobilization. The study suggests that there is a lack of evidence to guide postoperative immobilization for common hand surgery procedures and that prolonged immobilization may not be necessary for certain hand procedures.
Levels of Evidence for Hand Questions on the Orthopaedic In-Training Examination
Authors: Grandizio Louis C. , Huston James C. , Shim Stephanie S. , Graham Jove , Klena Joel C.
Published: May 2016

Background: Although analyses of the Orthopaedic In-Training Examination (OITE) subspecialty content domains have been performed, few studies have analyzed the levels of evidence (LoEs) for journal articles used as references to create OITE questions. We present an analysis of reference characteristics and question taxonomy for the hand surgery content domain on the OITE. We aim to determine whether level of evidence (LoE) for hand surgery questions have increased over a 15-year period. Methods: All questions and references in the hand surgery content domain on the OITE from 1995-1997 and 2010-2012 were reviewed. The taxonomic classification was determined for each question. Publication characteristics were defined for each reference, and each primary journal article was assigned a LoE. Results: A total of 129 questions containing 222 references met inclusion criteria: 76 questions from 1995-1997 and 53 from 2010-2012. The Journal of Hand Surgery American and European Volumes, Journal of Bone and Joint Surgery American and British Volumes, and the Journal of the American Academy of Orthopaedic Surgeons were the most frequently cited journals overall. Recent examinations were more likely to have Buckwalter T3 complex clinical management questions. There was a statically significant increase in the LoE used to create hand questions on the 2010-2012 compared with the 1995-1997 OITE. Conclusions: Primary journal articles cited on the hand surgery content domain of the OITE frequently included recent publications from both general and subspecialty journals. More recent examination questions appear to test clinical management scenarios. LoE for hand questions has increased over a 15-year period. Our results can be used as a guide to help prepare orthopedic residents for the OITE.
The Radial Artery’s Sacrifice in the Chinese Flap Is Not Deleterious to Patients
Authors: Costa Antonio C. , Viecili Leandro , Sambuy Marina T. C. , Rezende Marcelo R. , Chakkour Ivan
Published: May 2016

Background: A widely discussed subject, albeit with few associated studies and publications, centers on whether sacrifice of the radial artery to perform the radial forearm flap (RFF) is deleterious to the patient. The objective of this study was to assess, by questionnaire, the complications reported at the donor site, particularly those related to sacrifice of the radial artery. Methods: During the 2014 Symposium of the Brazilian Society of Reconstructive Microsurgery, surgeons were asked to answer a questionnaire on RFF cases and complications. Results: Results were collected from hand and plastic surgeons. Regarding the opinion of respondents on the deleteriousness of sacrificing the radial artery, most answered negatively, that is, no deleterious effects reported. No statistically significant difference was found between the level of experience and opinion on whether sacrificing the radial artery was deleterious. Conclusions: Beyond performing some procedures and following evolution within a specific service, it was decided to broaden the range of opinions and enlarge the casuistic by assessing the opinions of many specialists from the fields of hand surgery and plastic surgery. Data collected using the questionnaire were compared to determine the sequelae at the donor site and particularly whether sacrifice of the radial artery in RFF was deleterious to the patient. Although complaints at the donor site were frequently cited, no objective reports on morbidity following the sacrifice of the radial artery in RFF were provided.
Comparison of Barbed Sutures in Porcine Flexor Tenorrhaphy
Authors: Sull Alan , Inceoglu Serkan , August Alicia , Gregorius Stephen , Wongworawat Montri D.
Published: May 2016

Background: Barbed suture use has become more popular as technology and materials have advanced. Minimal data exist regarding performance of the 2 commercially available products, V-LocTM and StratafixTM in tendon repairs. The purpose of this study was to compare gap resistance and ultimate tensile strength of both suture materials and nonbarbed suture in a porcine ex vivo model. Methods: Porcine flexor tendons were harvested and divided into 3 groups of 10 of varying suture material (3-0 PDS™, 3-0 V- V-Loc 180™, or 3-0 Stratafix™). A modified 4-strand cruciate technique was used to repair each tendon. Knotless repair was performed using barbed suture, whereas a buried 6-throw square knot was done using conventional suture. A servohydrolic tester was used for biomechanical testing of linear 2-mm gap resistance and maximum tensile strength. Results: No difference was found in 2-mm gap resistance among the 3 groups. No difference was found in ultimate tensile strength between V-Loc™ (76.0 ± 9.4 N) and Stratafix™ (68.1 ± 8.4 N) repairs, but the ultimate strength of the PDS™ control group (83.4 ± 10.0 N) was significantly higher than that of Stratafix™. Conclusions: Barbed (knotless) and nonbarbed suture repairs demonstrate equivalent 2-mm gap resistance. Stratafix™ repairs show slightly inferior performance to nonbarbed repairs in ultimate tensile strength, although this occurred at gap distances far beyond the 2-mm threshold for normal tendon gliding. Both barbed and nonbarbed 4-strand cruciate flexor tendon repairs may require peripheral repair to withstand physiologic loads.
Predicting Fracture Risk for Enchondroma of the Hand
Authors: Riester Scott , Ramaesch Rishi , Wenger Doris , van Wijnen Andre , Kakar Sanjeev
Published: May 2016

Background: Enchondromas are benign cartilage tumors that can cause pathologic fractures involving the digits of the hand. The purpose of this study is to identify objective reproducible clinical criteria that are associated with fracture that can be used to guide clinical decision making. Methods: A total of 54 enchondroma cases involving the hand were retrospectively reviewed. Criteria examined included age, gender, the hand involved (left vs right), bone involved, the digit involved, and longitudinal percentage of the bone occupied by the lesion on anteroposterior (AP) radiographs. Results: There was a statistically significant difference between the fracture and nonfracture group in regard to age, the digit involved, bone involved, and the percentage of bone occupied by the lesion on AP radiographs. Conclusion: This investigation provides evidence that patient age, the affected finger, the affected bone, and the percentage of the bone occupied by the pathologic lesion on AP radiographs can be used to predict pathologic fracture risk for enchondromas.
Wide Awake Trigger Finger Release Surgery
Authors: Ketonis Constantinos , Kim Nayoung , Liss Frederic , Zmistowski Benjamin , Matzon Jonas , Leinberry Charles , Wang Mark , Jones Christopher , Abboudi Jack , Kirkpatrick William , Ilyas Asif M.
Published: May 2016

Background: Local anesthetics are routinely used in hand surgery for procedures such as trigger finger releases (TFRs). However, little is known as to the difference in efficacy and patient experience with various local anesthetics. We prospectively evaluated the efficacy of Lidocaine (L), Marcaine (M), and Exparel (E) to elucidate differences in pain scores and opioid consumption between these groups. Methods: All consecutive TFR performed over a 6-month period in 2014 at our institution were divided to receive Lidocaine, Marcaine, or Marcaine with postoperative Exparel. Pain levels, daily opioid consumption, and adverse reactions were recorded and analyzed for postoperative day (POD) 0-3. Results: A total of 154 patients were enrolled (L:53, M:50, E:51). The Lidocaine group reported the highest pain levels for POD 0-1. Marcaine pain levels were similar to Exparel on POD 0 but higher on POD 1. Opioid consumption on POD 0-1 was significantly different with E:27%, M:58% and L:59% as was the number of pills consumed (E:0.70, M: 1.08 and L:1.62). In addition, 50% of Exparel patients required no pain medications and experienced significantly less adverse reactions (E:4%, M:10%, L:13%). By POD 2-3, there were no statistical differences between the 3 groups. Conclusions: Patients treated with Marcaine attain better pain control than Lidocaine on POD 0-1but only patients who received Exparel maintained the lowest pain levels through POD 0-3 while using little-to-no opioid medications and with less adverse reactions than Lidocaine or Marcaine alone.
Geographic and Age-Based Variations in Medicare Reimbursement Among ASSH Members
Authors: Gaspar Michael P. , Kane Patrick M. , Honik Grace B. , Shin Eon K. , Jacoby Sidney M. , Osterman A. Lee
Published: May 2016

Background: The purpose of this study was to investigate how American Society for Surgery of the Hand (ASSH) members’ Medicare reimbursement depends on their geographical location and number of years in practice. Methods: Demographic data for surgeons who were active members of the ASSH in 2012 were obtained using information publicly available through the US Centers for Medicare and Medicaid Services (CMS). “Hand-surgeons-per-capita” and average reimbursement per surgeon were calculated for each state. Regression analysis was performed to determine a relationship between (1) each state’s average reimbursement versus the number of ASSH members in that state, (2) average reimbursement versus number of hand surgeons per capita, and (3) total reimbursement from Medicare versus number of years in practice. Analysis of variance (ANOVA) was used to detect a difference in reimbursement based on categorical range of years as an ASSH member. Results: A total of 1667 ASSH members satisfied inclusion in this study. Although there was significant variation among states’ average reimbursement, reimbursement was not significantly correlated with the state’s hand surgeons per capita or total number of hand surgeons in that given state. Correlation between years as an ASSH member and average reimbursement was significant but non-linear; the highest reimbursements were seen in surgeons who had been ASSH members from 8 to 20 years. Conclusions: Peak reimbursement from Medicare for ASSH members appears to be related to the time of surgeons’ peak operative volume, rather than any age-based bias for or against treating Medicare beneficiaries. In addition, though geographic variation in reimbursement does exist, this does not appear to correlate with density or availability of hand surgeons.
Evaluation of Cold Sensitivity, Pain, and Quality of Life After Upper Extremity Nerve Injury
Authors: Novak Christine B. , Mackinnon Susan E.
Published: May 2016

Background: The purpose of this study was to evaluate the relationship between reported cold sensitivity, pain, and impact on quality of life (QoL) after upper extremity nerve injury. Methods: This cross-sectional study included adults more than 6 months after an upper extremity nerve injury. Assessment included the Pain Evaluation Questionnaire (pain descriptors, questionnaire, pain intensity, impact on QoL), and Cold Intolerance Severity Scale (CISS). Statistical analyses evaluated the relationships between the Pain Evaluation Questionnaire, CISS, and independent variables. Results: There were 70 patients (mean age 42 ± 16 years). There were high levels of pain, cold sensitivity, and impact on QoL reported. Patients selecting the adjective “coldness” had significantly higher CISS scores ( P = .005), pain intensity ( P= .008), and impact on QoL ( P < .006). Impact on QoL and CISS ( r = .35) were moderately correlated. There were significant correlations ( P < .01) between the level of cold-induced pain and CISS ( r = .78), overall pain intensity ( r = .58), pain descriptor score ( r = .49), and impact on QoL ( r = .32). Conclusions: Cold-induced pain is associated with higher cold sensitivity scores and greater impact on QoL. Reporting a single descriptor “coldness” and ranking cold-induced symptoms were strongly associated with higher cold sensitivity scores and impact on health-related QoL. This may have important implications for quick screening to identify patients with cold sensitivity, and future studies in larger patient samples are necessary to provide additional evidence.
Using Decision Analysis to Understand the Indications for Unilateral Hand Transplantation
Authors: McClelland Brett , Novak Christine B. , Hanna Steven , McCabe Steven J.
Published: May 2016

Background: Upper extremity transplantation has been performed to improve quality of life, the benefit which must be traded off for the risk created by life-long immunosuppression. We believe the process of decision analysis is well suited to improve our understanding of these trade-offs. Method: We created a decision tree to include a branch point to illustrate the expected recovery of useful function in the transplant, using the best estimates for utility and probability that exist. Results: Our model revealed that when the probability of achieving a good result, graded as Chen level one or two is greater than 73%, transplantation is preferred over no transplantation. The decision is sensitive to the probability of major complications and the utility of a transplanted limb with minimal function. Conclusions: The results of this analysis show that under some circumstances given a high probability of satisfactory functional recovery, unilateral hand transplantation can be justified.
Proximal Scaphoid Pole Reconstruction Utilizing Ipsilateral Proximal Hamate Autograft
Authors: Elhassan Bassem , Noureldin Mohamed , Kakar Sanjeev
Published: May 2016

Background: Fractures of the proximal pole of the scaphoid can be difficult to heal because of its limited vascular supply. Furthermore, nonunion with avascular necrosis and secondary fragmentation makes surgical reconstruction a challenging procedure. Method: We describe a technique and report the outcome of a proximal hamate autograft to treat a proximal pole scaphoid nonunion with avascular necrosis. Results: At 3.5 years post reconstruction, the patient remains asymptomatic with union of his scaphoid reconstruction without any evidence of scapholunate instability. Conclusion: Proximal hamate autograft is a useful technique for addressing proximal pole scaphoid nonunions with avascular necrosis.
A randomized controlled trial of very early rehabilitation in speech after stroke
Authors: Godecke Erin , Armstrong Elizabeth A , Rai Tapan , Middleton Sandy , Ciccone Natalie , Whitworth Anne , Rose Miranda , Holland Audrey , Ellery Fiona , Hankey Graeme J , Cadilhac Dominique A , Bernhardt Julie
Published: May 2016

Rationale

The efficacy of rehabilitation therapy for aphasia caused by stroke is uncertain.

Aims and hypothesis

The Very Early Rehabilitation of Speech (VERSE) trial aims to determine if intensive prescribed aphasia therapy (VERSE) is more effective and cost saving than non-prescribed, intensive (usual care-plus) and non-intensive usual care (UC) therapy when started within 15 days of stroke onset and continued daily over four weeks. We hypothesize that aphasia therapy when started very early after stroke and delivered daily could enhance recovery of communication compared with UC.

Sample size estimates

A total of 246 participants (82 per arm) will provide 80% power to detect a 4.4% improvement on aphasia quotient between VERSE and UC plus at a significance level of α = 0.05.

Setting

Acute-care hospitals and accompanying rehabilitation services throughout Australia, 2014–2017.

Design

Three-arm, prospective, randomized, parallel group, open-label, blinded endpoint assessment (PROBE) trial.

Participants

Acute stroke in previous 14 days and aphasia diagnosed by aphasia quotient (AQ) of the Western Aphasia Battery (WAB).

Randomization

Computer-generated blocked randomization procedure stratified by aphasia severity according to Western Aphasia Battery, to one of three arms.

Intervention

All participants receive UC—usual ward-based aphasia therapy. Arm 1: UC—no additional therapy; Arm 2: UC-plus usual ward-based therapy; Arm 3: VERSE therapy—a prescribed and structured aphasia therapy program. Arms 2 and 3 receive a total of 20 additional sessions (45–60 min, provided daily) of aphasia therapy. The additional intervention must be provided before day 50 post stroke.

Study outcome measures

The aphasia quotient of Western Aphasia Battery at 12 weeks post stroke. Secondary outcomes include discourse measures, the Stroke and Aphasia Quality of Life Scale-39 and the Aphasia Depression Rating Scale at 12 and 26 weeks.

Economic evaluation

Incremental cost-effectiveness ratios at 26 weeks will be reported.

Discussion

This trial is designed to test whether the intensive and prescribed VERSE intervention is effective in promoting maximum recovery and preventing costly health complications in a vulnerable population of survivors of stroke. It will also provide novel, prospective, aphasia specific cost-effectiveness data to guide future policy development for this population.
Scrub typhus in pregnancy: Maternal and fetal outcomes
Authors: Rajan Sudha J , Sathyendra Sowmya , Mathuram Alice J
Published: May 2016

Scrub typhus is an important unrecognized cause for undifferentiated acute febrile illness in India associated with poor fetal outcomes. Maternal and fetal outcomes among pregnant patients with scrub typhus presenting to a tertiary care university teaching hospital from January 2010 to July 2012 were studied. Scrub typhus was diagnosed by clinical criteria along with scrub ELISA positivity or an eschar. In total, 33 of 738 patients (4.5%) who were diagnosed with scrub typhus were pregnant; 57.6% were in the third trimester, 27.3% in the second, and only 15.2% in the first trimester; 69.7% required admission to intensive care. Mortality was low (3%, n = 1) compared to 12.2% mortality reported previously. All patients were treated with Azithromycin. Poor fetal outcome was observed in 51.5% of these pregnancies with fetal loss occurring in 42.4% and preterm childbirth in 9.1%. Scrub typhus complicating pregnancy is associated with a poor fetal outcome despite treatment with Azithromycin. A majority require intensive care treatment for survival.
Transplantation of Chemically Processed Decellularized Meniscal Allografts
Authors: Gelse Kolja , Körber Ludwig , Schöne Martin , Raum Kay , Koch Peter , Pachowsky Milena , Welsch Götz , Breiter Roman
Published: May 2016

Objective

The aim of this study was to evaluate the chondroprotective effect of chemically decellularized meniscal allografts transplanted into the knee joints of adult merino sheep.

Methods

Lateral sheep meniscal allografts were chemically processed by a multistep method to yield acellular, sterile grafts. The grafts were transplanted into the knee joints of sheep that were treated by lateral meniscectomy. Joints treated by meniscectomy only and untreated joints served as controls. The joints were analyzed morphologically 6 and 26 weeks after surgery by the macroscopical and histological OARSI (Osteoarthritis Research Society International) score. Additionally, the meniscal grafts were biomechanically tested by cyclic indentation.

Results

Lateral meniscectomy was associated with significant degenerative changes of the articular cartilage of the lateral joint compartment. Transplanted lateral meniscal allografts retained their integrity during the observation period without inducing significant synovitis or foreign body reactions. Cellular repopulation of the grafts was only present on the surface and the periphery of the lateral meniscus, but was still completely lacking in the center of the grafts at week 26. Transplantation of processed meniscal allografts could not prevent degenerative changes of the articular cartilage in the lateral joint compartment. Compared with healthy menisci, the processed grafts were characterized by a significantly reduced dynamic modulus, which did not improve during the observation period of 26 weeks in vivo.

Conclusion

Chemically decellularized meniscal allografts proved their biocompatibility and durability without inducing immunogenic reactions. However, insufficient recellularization and inferior stiffness of the grafts hampered chondroprotective effects on the articular cartilage.
Mediastinal mass diagnosed by endobronchial ultrasound as recurrent hepatocellular carcinoma in a post-liver transplantation patient
Authors: Alraiyes Abdul Hamid , Tunsupon Pichapong , Kheir Fayez , Salerno Daniel A
Published: May 2016

Objective:

We presented a rare case of recurrent hepatocellular carcinoma after liver transplant manifested as an isolated mediastinal mass.

Methods:

A 62-year-old man was referred for evaluation of atypical chest pain and abnormal finding of a computed tomography of the chest. He had history of chronic hepatitis C liver cirrhosis and hepatocellular carcinoma underwent orthotopic liver transplant as a curative treatment three years earlier.

Results:

The computed tomography of the chest demonstrated paratracheal mediastinal lymphadenopathy. He subsequently underwent endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA). The right paratracheal lymph node station 4R was sampled. Rapid on-site cytology evaluation demonstrated recurrent metastatic hepatocellular carcinoma.

Conclusion:

Pulmonologist should be cognizant of diagnostic utility of EBUS-TBNA in this clinical setting as more transplant patients on immunosuppressive medications with enlarged mediastinal lymphadenopathy of unknown origin will be referred for further evaluation.
Knowledge, Attitude, and Practice of Parents Regarding Antibiotic Usage in Treating Children’s Upper Respiratory Tract Infection at Primary Health Clinic in Kuala Lumpur, Malaysia
Authors: Teck Koh Chee , Ghazi Hasanain Faisal , Bin Ahmad Mohd Ikhwan , Binti Abdul Samad Nuraqilah , Ee Yu Karen Lai , Binti Ismail Nurul Farhana , Bin Esa Muhammad Amirul Aizat
Published: May 2016

Objectives:

To assess the knowledge, attitude, and practice of parents regarding antibiotic usage for treating upper respiratory tract infection (URTI) among children.

Methods:

A cross-sectional study was conducted among 320 randomly selected parents attending a primary health clinic using self-administered questionnaires.

Results:

About two-thirds (69.1%) of the parents had poor knowledge level. Only 25.2% and 21.6% of the parents could correctly identify amoxicillin and penicillin as the treatment of children’s URTI. However, about two-thirds (67.5%) of the parents were aware of the antibiotic resistance caused by overuse of antibiotics. A significant association was noted between the father’s and mother’s educational level and family income with the knowledge level. Only mother’s educational level depicted a significant association with the attitude.

Conclusion:

The knowledge of parents regarding antibiotic usage for URTI was poor. More numbers of health promotions and educational campaigns are required to help parents understand about antibiotic usage.
Demonstration of the test-retest reliability and sensitivity of the Lower Limb Functional Index-10 as a measure of functional recovery post burn injury: a cross-sectional repeated measures study design
Authors: Ryland Margaret E. , Grisbrook Tiffany L. , Wood Fiona M. , Phillips Michael , Edgar Dale W.
Published: May 2016

Background

Lower limb burns can significantly delay recovery of function. Measuring lower limb functional outcomes is challenging in the unique burn patient population and necessitates the use of reliable and valid tools. The aims of this study were to examine the test-retest reliability, sensitivity, and internal consistency of Sections 1 and 3 of the Lower Limb Functional Index-10 (LLFI-10) questionnaire for measuring functional ability in patients with lower limb burns over time.

Methods

Twenty-nine adult patients who had sustained a lower limb burn injury in the previous 12 months completed the test-retest procedure of the study. In addition, the minimal detectable change (MDC) was calculated for Section 1 and 3 of the LLFI-10. Section 1 is focused on the activity limitations experienced by patients with a lower limb disorder whereas Section 3 involves patients indicating their current percentage of pre-injury duties.

Results

Section 1 of the LLFI-10 demonstrated excellent test-retest reliability (intra-class correlation coefficient (ICC) 0.98, 95 % CI 0.96–0.99) whilst Section 3 demonstrated high test-retest reliability (ICC 0.88, 95 % CI 0.79–0.94). MDC scores for Sections 1 and 3 were 1.27 points and 30.22 %, respectively. Internal consistency was demonstrated with a significant negative association (rs = −0.83) between Sections 1 and 3 of the LLFI-10 (p < 0.001).

Conclusions

This study demonstrates that Section 1 and 3 of the LLFI-10 are reliable for measuring functional ability in patients who have sustained lower limb burns in the previous 12 months, and furthermore, Section 1 is sensitive to changes in patient function over time.
Nuclear PKC-θ facilitates rapid transcriptional responses in human memory CD4+ T cells through p65 and H2B phosphorylation
Authors: Li Jasmine , Hardy Kristine , Phetsouphanh Chan , Tu Wen Juan , Sutcliffe Elissa L. , McCuaig Robert , Sutton Christopher R. , Zafar Anjum , Munier C. Mee Ling , Zaunders John J. , Xu Yin , Theodoratos Angelo , Tan Abel , Lim Pek Siew , Knaute Tobias , Masch Antonia , Zerweck Johannes , Brezar Vedran , Milburn Peter J. , Dunn Jenny , Casarotto Marco G. , Turner Stephen J. , Seddiki Nabila , Kelleher Anthony D. , Rao Sudha
Published: May 2016

Memory T cells are characterized by their rapid transcriptional programs upon re-stimulation. This transcriptional memory response is facilitated by permissive chromatin, but exactly how the permissive epigenetic landscape in memory T cells integrates incoming stimulatory signals remains poorly understood. By genome-wide ChIP-sequencing ex vivo human CD4+ T cells, here, we show that the signaling enzyme, protein kinase C theta (PKC-θ) directly relays stimulatory signals to chromatin by binding to transcriptional-memory-responsive genes to induce transcriptional activation. Flanked by permissive histone modifications, these PKC-enriched regions are significantly enriched with NF-κB motifs in ex vivo bulk and vaccinia-responsive human memory CD4+ T cells. Within the nucleus, PKC-θ catalytic activity maintains the Ser536 phosphorylation on the p65 subunit of NF-κB (also known as RelA) and can directly influence chromatin accessibility at transcriptional memory genes by regulating H2B deposition through Ser32 phosphorylation. Furthermore, using a cytoplasm-restricted PKC-θ mutant, we highlight that chromatin-anchored PKC-θ integrates activating signals at the chromatin template to elicit transcriptional memory responses in human memory T cells.
Psoriasis in children and young people: Presentation
Authors: Watkins Jean
Published: May 2016

Psoriasis is a common chronic inflammatory disease of the skin, which may also be associated with arthritis and increases the risk of development of a number of co-morbidities. Early diagnosis enables the professional to advise and treat the condition and sometimes forestall or delay the onset of some of the possible complications. This article will concentrate on the causes of psoriasis and some of the possible presenting symptoms.
Looking at the role of the school nurse in paediatric concussion management in the United States
Authors: Gillooly Diane R , Perron Tracy
Published: May 2016

This article outlines the importance of early recognition and management of concussion, and the school nurse's role in this in the US, with a particular focus on the state of New Jersey. The authors look at some of the issues, including a lack of training/information and non-compliance with legislation.
Psychosis: The importance of early diagnosis and referral
Authors: Thornton Stephanie
Published: May 2016

It is crucial that professionals working with young people understand psychosis and the importance of early diagnosis and referral.
The use of common medications during breastfeeding
Authors: Shah Chetan , Devit Reena , Wong Madeline
Published: May 2016

The management of medicines while breastfeeding is outlined by Chetan Shah, Reena Devit, and Madeline Wong
Building your presence in class
Authors: Oxtoby Kathy
Published: May 2016

Presence in the classroom – it is that special something that makes the best teachers. Kathy Oxtoby seeks advice on how young teachers can develop their own presence and gravitas in front of students
Pain and pleasures of the look: The female gaze in Malaysian horror film
Authors: Izharuddin Alicia
Published: May 2016

Female ghosts and other supernatural entities, including the pontianak, in Malaysian horror cinema are excessive psychosocial articulations of traditional Malay femininity gone awry. In Malay ghost stories, the pontianak is a vengeful spirit. She is the ghostly reincarnation of a pregnant woman who dies before or during the birth of her child and who then seeks vengeance on the living for causing the gruesome death that kills her and her unborn child. Since biological reproduction is the primary determinant of a woman’s social value in traditional Malay societies, the double death is devastatingly cruel. The pontianak thus embodies the horror of abject femininity associated with thwarted womanhood. Another recurring theme in Malaysian horror cinema relates to women possessed by evil spirits. Typically portrayed as lacking in emotional restraint, and therefore given to hysterical behaviour, such women are thought to be particularly vulnerable. Malaysian horror cinema has been adept at depicting psychosocial horrors of feminine excesses as such that transgress otherwise restrictive social and customary expectations for Malay femininity. This article examines the horror of abject femininity in two contemporary Malaysian films by female film-makers: Shuhaimi Baba’s Pontianak Harum Sundal Malam/Pontianak of the Tuber Rose (2004) and Zarina Abdullah’s Chermin/Mirror (2007). Both films collectively provide a spine-chilling commentary on female–female relations and motherhood that puts to play the female gaze and the monstrous feminine. This article argues that the themes of failed motherhood, death and the abject are salvaged by strong mother–daughter relations and the female gaze, making the two films a women-oriented rejoinder to spirit possession and the misogynistic tale of the pontianak.
‘Friending’ Jet Li on Facebook: The Chinese celebrity persona in online social networks
Authors: Lau Dorothy
Published: May 2016

In recent years, well-known martial arts movie actor Jet Li has attained phenomenal success through star-powered philanthropy, even establishing his own worldwide humanitarian charity, One Foundation. With the advent of participatory Web-based culture, cyberspace becomes an emergent locus of constructing and reinventing Li’s star image. This article investigates Li’s celebrity-philanthropist image in cyberspace and its signification. The analysis focuses on Facebook Pages, an organized virtual space displaying content including user interactions and microblogging known as a timeline. This article argues that Facebook presents a new and promising venue for users to negotiate Li’s ‘polysemic’ personae as martial arts master and philanthropist juxtapose, parallel and contradict each other in a decidedly nationalist vs cosmopolitan manner. Li’s national-yet-cosmopolitan personality not only yields an image of a viable global player in the entertainment arena but also serves as a text of linked significations opened up for users’ relentless (re)making, revisiting and interrogating, complicating the meaning of Chinese celebrities in the milieu of globalcyber culture.
Review
Authors: Henderson Brian
Published: May 2016

INHABITING MULTIPLE WORLDS: IMMERSIVE LITERACY PRACTICES AND GAMING CULTURE: COMPUTER GAMES AND TECHNICAL COMMUNICATION: CRITICAL METHODS & APPLICATIONS AT THE INTERSECTION, JENNIFER DEWINTER AND RYAN M. MOELLER (EDS) (2014) 1st ed., Burlington, VT: Ashgate Publishing Company, 314 pp., ISBN: 9781472426406, h/bk, $119.95 (USD)