bluuebunny/crossref_metadata_2025 huggingface dataset:
The slow death of a dogma? The prohibition of legislative history in the 20th century
Authors: Magyar John J
Published: November 2020

It is commonly believed that the rule prohibiting reliance on legislative history as an aid to statutory interpretation was firmly in place in the United Kingdom, and indeed throughout the English-speaking common law jurisdictions of the world, long before the turn of the 20th century; and that the rule was set aside in the case of Pepper v Hart in 1992. However, an examination of the relevant cases and the canonical textbooks by Maxwell and Craies reveal that the rule was subject to a significant amount of disagreement at the turn of the 20th century, particularly with respect to the admissibility of commissioners’ reports to uncover the mischief of a statutory provision. This disagreement would not be completely resolved until the 1960s. With respect to other types of legislative history, there were prominent exceptional cases over the course of the 20th century; and there was a gradual acceptance of more types of legislative history as aids to statutory interpretation during the decades leading up to Pepper v Hart. Thus, the simple narrative description that the rule was firmly in place until it was set aside in 1992 must give way to a more complex narrative of disagreement and gradual decline. Meanwhile, as the rule lost traction in the United Kingdom over the course of the 20th century, a growing accumulation of justifications for the rule has been assembled, and an ongoing debate has been taking place about the efficacy of reliance on legislative history. Based upon the different trajectories followed in other English-speaking common law jurisdictions, and particularly the United States, the decline of the rule was not inevitable. It follows that the current state of affairs is likely to change over time.
Wanted: Heroic leaders to drive the transition to “business beyond usual”
Authors: Walls Judith L , Salaiz Ashley , Chiu Shih-Chi (Sana)
Published: November 2020

Business-as-usual is likely to drive us to an unsustainable world. To solve the problems human industrial activity has created, such as climate change, species extinction, and biodiversity loss, business leaders (CEOs, top managers, and boards of directors) must be central to the solution for corporate sustainability. In particular, “heroic” leaders are needed to transform their companies into business beyond usual. In this essay, we briefly outline what researchers already know about microfoundational or socio-cognitive and motivational underpinnings of leaders that affect corporate sustainability. However, gaps remain in our understanding of affective drivers and values of leaders. We question whether microfoundations research has the potential to understand true business transformation for positive deviance and suggest that positive organizational scholarship and research on sustainability change agents can provide insights. We next highlight how empirical and research design shortcomings might be addressed. Finally, we discuss how to identify, develop, and empower leaders with transformational potential so that we can proactively create heroic leaders rather than wait for them to magically appear.
The ‘spirit of the times’: Fast policy for educational reform in Finland
Authors: Hardy Ian , Heikkinen Hannu , Pennanen Matti , Salo Petri , Kiilakoski Tomi
Published: November 2020

This article examines the nature of neoliberal influences upon educational policy making in the Finnish education system in recent times. The article draws upon key policy documents, government reports, journal articles and media articles about reforms in the early childhood, basic/compulsory school and vocational education and training sectors to evidence these processes. Analytically, these reforms are understood as instances of what has been referred to as ‘fast policy’. Methodologically, we draw upon principles of zeitgeist analysis to reveal the features and effects of these fast policy influences as they relate to educational provision in Finland. These features and effects include intensification and fragmentation of educational reform processes, increased individualisation and decontextualization of the educational reform agenda, and a trend towards increased instability, privatisation and reduction in funding for educational provision. The article foregrounds the features and effects as reflective of the ‘spirit of the times’ in which such reforms are undertaken, and cautions against these fast policy effects for the problematic consequences they appear to be having upon policy making processes, educational outcomes in Finland and the ‘spirits’ of Finnish educators.
Parliamentary Communication Allowances: Good for Nothing?
Authors: Umit Resul
Published: November 2020

In many countries, members of parliament receive publicly funded allowances to communicate with the electorate. Some hope that ensuing parliamentary communication engages the people with politics and increases electoral participation. Others worry that such use of public funds might create an unfair advantage for incumbents and affect electoral results. Yet, the consequences of this practice remain unknown. Data from the UK House of Commons suggest that both the hopes and the worries are baseless: there is no evidence that parliamentary communication allowances increase electoral turnout or affect incumbents’ vote share. If these allowances are not effective, both parliaments and their members might want to reconsider their use and usefulness.
Local Data for Action: Statewide Dissemination of School Wellness Policy Evaluations in Wisconsin
Authors: Skalitzky Erin , Joyner Hilary , Weymouth Lindsay
Published: November 2020

School settings can influence child health, including physical activity and diet, through the promotion of high-quality wellness policies. Many studies have analyzed the quality of school wellness policies, but evidence is lacking regarding the dissemination of the policy evaluation results to school districts. This study describes the process the Wisconsin Health Atlas followed to disseminate tailored school wellness policy data reports and interactive dashboards to school districts throughout the state and the results of the statewide dissemination efforts. Prioritizing the translation of research to practice, the process included collaborating with key stakeholders and partners to provide formative feedback on the dissemination activities. The electronic and hard copy reports were disseminated to 232 districts through email and U.S. mail. Each district received a tailored report featuring an executive summary, local data for action, personalized policy recommendations, best practices, and a unique code to enter into interactive data dashboards to explore additional local, regional, and state-level data. In the utilization follow-up survey (20.3% response rate), respondents indicated that the report will help their district to improve the quality of their school wellness policy. Additionally, respondents who had used the report specified they used the data to identify areas for policy improvement and to support their triennial assessment, suggesting that districts value the technical support. To support school districts in improving the quality of school wellness policies, we recommend researchers prioritize collaborative dissemination efforts and provide actionable policy data when conducting school wellness policy evaluations.
Retrospective Matched Case-Control Study on the Use of CO2 Laser for the Treatment of Nonhealing Diabetic Foot Ulcers: The DULCIS-2 (Diabetic ULcer, CO2 Laser, and Infections) Study
Authors: Monami Matteo , Ragghianti Benedetta , Silverii Antonio , Scatena Alessia , Landi Letizia , Cosentino Claudia , Vitale Valentina , Mannucci Edoardo
Published: November 2020

Purpose

Infection, which is one of the possible complications of diabetic foot ulcers (DFUs), makes the treatment of ulcers challenging because of its negative impact on healing processes and the high prevalence of multiresistant germs. This study is aimed at verifying the effect of a surgical CO2 laser (which reduces the bacterial load and allows a more accurate debridement), as compared with the traditional lancets, on the healing rate of DFU.

Methods

The present case-control retrospective analysis was performed on patients with chronic (>6 months) DFU with Texas grade >1, treated with 80 W surgical CO2 laser (DEKA SmartXide2 C80, El.En. Group) and compared with a matched sample of patients with similar characteristics, who were treated with a traditional surgical approach. The debridement was performed trying to achieve the complete removal of nonviable tissues. The principal endpoint was the proportion of patients healed at 6 months. All analyses were carried out with SPSS 25.0. The study protocol was approved by the local ethical committee.

Results

This study included 118 patients (59 cases and 59 controls). At 6 months, the proportion of healing patients was 35% and 18% in cases and controls, respectively ( P = .034). The corresponding figure at 1 year was 62% and 38% ( P = .009), whereas no difference was observed at 1, 2, and 3 months. No serious adverse event was observed.

Conclusions

In this article, we show for the first time that CO2 laser treatment, in comparison with traditional surgical approaches, can be associated with an increased healing rate in patients with DFU.
Ankle-Brachial Index and Carotid Intima-Media Thickness Progression by Using Ultrasound Among Patients With HIV Infection Versus End-Stage Renal Disease
Authors: Rerkasem Amaraporn , Pongtam Sasinat , Ounjaijean Sakaewan , Kulprachakarn Kanokwan , Wongthanee Antika , Chaiwarith Romanee , Supparatpinyo Khuanchai , Salee Parichat , Arworn Supapong , Rerkasem Kittipan
Published: November 2020

Human immunodeficiency virus (HIV) and end-stage renal disease (ESRD) patients contributed to accelerated cardiovascular disease. Comparing the effect on atherosclerosis of the 2 diseases has never been explored. A prospective cohort study enrolled participants who were more than 18 years of age without stroke, coronary, and peripheral arterial disease events. Each HIV-infected person had continuously used antiretroviral therapy and ESRD and required intermittent hemodialysis. We assessed patients using the ankle-brachial index (ABI) and carotid intimal media thickness (CIMT) at enrollment, and 1 year later. The main outcome was the progression of ABI and CIMT per year. Demographic, comorbidities, and serum profiles were collected on entry. A total of 789 HIV-positive and 41 ESRD with HIV-negative patients were recruited. After adjusting for potential confounders at baseline, the ESRD die not significantly decrease ABI by 0.015 in 1 year (P=0 .252). The HIV-infected group had a significantly decreased ABI by 0.020 in 1 year (P < .001), but the reduced rate in the HIV-infected group was not statistically different from those in the ESRD group (P = 0.901). When adjusted for potential confounders, the ESRD had a significant increase of CIMT by 0.111 mm in 1 year (P<0.001). The HIV patients had a significant increase of 0.250 mm CIMT in 1 year (P<0.001). This progression rate was statistically greater in the HIV-infected group versus the ESRD group. HIV infection and ESRD had comparable rates of ABI and CIMT progression in our study. Then, early prevention in asymptomatic atherosclerosis should include not only patients with ESRD but also HIV-infected patients.
An Uncommon Case of Necrotizing Fasciitis and Septic Shock Caused by Vibrio vulnificus Infection–Related Freshwater Shrimp Stung
Authors: Sun Yi , Lin Yu-Ze , Chen Zeng-Gan
Published: November 2020

Vibrio vulnificus is a deadly marine pathogen that can cause necrotizing fasciitis, septic shock, and even death in severe cases. The relatively low incidence and atypical early-stage symptoms may hinder many physicians from carrying out surgical intervention effectively, thus leading to an increase of mortality in infected patients. This article reported a patient who developed necrotizing fasciitis and septic shock after the exposure to freshwater shrimp stabbed on the limb. By reviewing and analyzing previous studies, it was found out that the timing of surgery could have a significant impact on the patients for their necrotizing fasciitis caused by Vibrio vulnificus infection. The mortality among patients undergoing early-stage surgical treatment (≤12 hours from the time of admission) was significantly lower than that of patients undergoing late surgical treatment (>12 hours).
Sauve-Kapandji Remains a Viable Option for Distal Radioulnar Joint Dysfunction
Authors: Munaretto Nicholas , Aibinder William , Moran Steven , Rizzo Marco
Published: November 2020

Introduction

Dysfunction of the distal radioulnar joint (DRUJ) can be significantly debilitating. The Sauve-Kapandji (S-K) procedure can be indicated to address multiple etiologies of DRUJ dysfunction. The purpose of this study was to review our institution’s results performing the S-K procedure for DRUJ dysfunction in terms of clinical and radiographic outcomes, as well as complications and reoperations.

Methods

A retrospective review of S-K procedures performed at 2 institutions between 1998 and 2017 with a minimum of 1-year follow-up was performed. Preoperative and postoperative visual analog scale (VAS) pain, grip strength, and wrist range of motion were reviewed. Radiographs were reviewed for DRUJ healing, carpal translation, and radiocarpal degenerative changes.

Results

The cohort included 35 patients. The mean age was 51 years. The mean follow-up was 49.5 months. The postoperative range of motion was unchanged in regard to pronation, supination, and wrist extension. There was a decrease in wrist flexion from 43 degrees to 34 degrees. Successful union was noted in 100% of the wrists. There was 1 case (2.8%) of progressive ulnar translation and 4 major complications (11.3%).

Conclusion

The S-K procedure has several theoretical benefits compared to other procedures for DRUJ dysfunction with results of this study demonstrating excellent pain relief, improved postoperative grip strength, retained wrist pronation, supination, and extension, high rate of successful arthrodesis and low rate of major complications.

Level of Evidence

Level IV
Use of Low-Dose Recombinant Factor Ⅶa for Uncontrolled Perioperative Bleeding
Authors: Chang Zhi-gang , Chu Xin , Chen Wen , Hu Jun-hua , Gong Ji-wu , Liu Da-dong , He Qing , Feng Zhe , Xiao Shi-rou , Liu Ya-lin
Published: November 2020

Background:

Recombinant activated factor VIIa (rFVIIa) is a prohemostatic agent initially approved for use in hemophilia patients and has also been used for a diverse range of off-label indications in the context of massive uncontrolled blood loss; however, no convincing evidence exists regarding the optimal dose of rFVIIa to treat uncontrolled bleeding in surgical patients.

Aim:

To evaluate the effects and safety of a very low dose of rFⅦa in patients with uncontrolled perioperative bleeding in the surgical intensive care unit (ICU).

Methods:

55 patients from Beijing Hospital, who received rFⅦa between July 2004 and November 2018 for uncontrolled perioperative bleeding were included. The controls were matched for age, sex, severity, and operation type. The baseline demographics, survival, changes in bleeding and transfusion, coagulation parameters and complications were analyzed.

Results:

A low dose of rFⅦa (2.0∼3.6 mg, with a median dose of 39.02 μg/kg) appears to be effective in controlling massive hemorrhage (with an effective rate of 74.55%), and can reduce volume of red blood cell transfusion, improve coagulation status, while has a relatively low risk of thromboembolic complications (3.6%).

Conclusion:

In patients with uncontrolled perioperative bleeding, a low dose of rFⅦa could be used when traditional methods are ineffective.
Making sense of the rise and fall of Jeremy Corbyn: Towards an ambiguity-centred perspective on authentic leadership
Authors: Whittle Andrea
Published: November 2020

When Jeremy Corbyn was first elected as leader of the Labour party in 2015, he was framed in the media as a new type of authentic political leader. Corbyn seemed to represent everything that a typical politician was not: honest, straight talking, principled and someone who always stayed true to his beliefs. In the aftermath of the December 2019 general election and the worst defeat for the Labour party since 1935, this article takes stock of how authenticity featured in the media discourse during Corbyn’s tenure as a party leader. Three competing discourses are identified. The first discourse categorised Corbyn as authentic and framed his authenticity as a leadership strength. The second discourse framed Corbyn as inauthentic. The third discourse framed Corbyn’s authenticity as a leadership problem. The study reveals a deeply ambivalent and contradictory set of discourses of authenticity that circulated in the media and highlights the ideological function performed by these competing discourses, which juxtapose ideas and ideals of personal authenticity against ideas and ideals about what constitutes effective political leadership. The article concludes by advancing an ambiguity-centred approach (Alvesson M and Spicer A (eds) (2010) Metaphors We Lead By: Understanding Leadership in the Real World. London: Routledge) to understanding authentic leadership, where authenticity is understood as a set of ambiguous and competing discursive attributions made within a contested social and political context.
The role of cholecalciferol deficiency in the pathogenesis of polycystic ovary syndrome
Authors: Safi Aigul , Orazov Mekan , Kalinchenko Svetlana
Published: November 2020

Objectives:

to evaluate and compare clinical presentations, medical history, and laboratory data of patients with polycystic ovary syndrome, including vitamin 25(OH)D3 level.

Methods:

In total, 81 patients were examined. The patient group included 51 patients with signs of polycystic ovary syndrome. The control group included 30 healthy women without signs of polycystic ovary syndrome, comparable according to gender and age to the patient group. Polycystic ovary syndrome was verified based on the diagnostic Rotterdam and international polycystic ovary syndrome guidelines’ criteria. The levels of cholecalciferol were determined by mass spectrometry (ng/mL). At the second stage of the study, the patient group with polycystic ovary syndrome was divided into two subgroups depending on the waist circumference and compared with each other by the level of insulin, low-density lipoproteins, triglycerides, anti-Mullerian hormone, follicle-stimulating hormone, and luteinizing hormone. Statistical analysis was carried out using the parametric t-test for two-independent samples with equal or different variance. For nominal data—Pearson’s chi-test, when the means are not calculated and a test is carried out for the presence of a relationship between the nominal variables.

Results:

Patients with polycystic ovary syndrome and without polycystic ovary syndrome did not have a statistically significant difference in 25(OH)D3 level. Statistically significant differences in the level of 25(OH)D3 were found in women with polycystic ovary syndrome with the waist circumference ⩾80 cm. In these subgroups, differences in insulin, low-density lipoprotein, and triglycerides levels were also revealed.

Conclusion:

The correlation of the 25(OH)D3 level does not differ in the groups of patients with polycystic ovary syndrome and without polycystic ovary syndrome, but significantly correlates with the metabolic profile of patients.
A comparison of the nationally important infection prevention and control documents in NHS England and NHS Scotland
Authors: Curran Evonne T , Burnett Emma , Robinson Jude , Loveday Heather
Published: November 2020

Background:

The devolution of health to Scotland in 1999, led for the first time in the NHS, to different priorities and success indicators for infection prevention and control (IPC). This project sought to understand, compare and evaluate the national IPC priorities and available indicators of success.

Aim:

To identify the national IPC priorities alongside national indicators of success.

Methods:

Critical analysis of nationally produced documents and publicly available infection-related data up to March 2018.

Findings:

For both NHS Scotland and England the local and national IPC priorities are evidenced by: (1) people being cared for in an IPC-safe environment; (2) staff following IPC-safe procedures; and (3) organisations continuously striving not just to attain standards, but to improve on them. If national agencies that produce data were also charged with using a Continuous Quality Improvement (CQI) model, then there would be further opportunities to detect and improve on successes.
Electoral process in Africa: The impact of COVID-19 and challenges for the EU
Authors: Slim Héla
Published: November 2020

The COVID-19 pandemic is having a considerable impact on global economic and intercontinental geopolitical relations, and is thus significantly reshaping our world. The coronavirus crisis is also affecting democracy and the electoral process in Africa, with important implications for the rule of law, democracy and security. While 2020 started as a pivotal year for African Union–EU relations, the coronavirus has disrupted the agenda and raises questions about the repercussions of the pandemic on not only EU foreign policy but also cooperation between the two continents.
Chemical Constituents of Tagetes patula and Their Neuroprotecting Action
Authors: Liu Linlin , Luo Simin , Yu Miao , Metwaly Ahmed M. , Ran Xiaoku , Ma Chunyan , Dou Deqiang , Cai Decheng
Published: November 2020

Two novel flavonoids (1, 2) and 3 known compounds (3-5) were isolated from the flowers and whole plant of Tagetes patula L., and their structures were elucidated by means of ultra-high performance liquid chromatography with electrospray ionization, coupled to quadrupole-time-of-flight/mass spectrometry, 1H and 13C-nuclear magnetic resonance (NMR), as well as 2-dimensional-NMR (heteronuclear single quantum correlation and heteronuclear multiple bond correlation) and chemical methods. In addition, all the compounds were examined for their neuroprotective action on the injury of SH-SY5Y cells induced by glutamate, indicating that the protective effect of these compounds on glutamate-induced SH-SY5Y cell was marigold biflavone > patuletin > quercetin > kaempferol-3- O-β-d-glucoside > patuletin-3- O-α-l-arabinopyranoside. Thus, it could be concluded that flavonoids played a key role in the neuroprotective action of T. patula.
Where Does Power Go When No One Wants It: Two New Academics Grapple With the Hierarchies Implicit Within Conference Spaces
Authors: Erb Jess Anne-Louise , Bittinger Ryan Paul
Published: November 2020

In this article, we provide a dialogical piece of writing inspired by our performative conversation, presented at the European Congress of Qualitative Inquiry 2019. Emboldened by our activist stance that conference presentations and writings can resist arborescent models that dictate the “right” sort of academic, we seek an active engagement with such hierarchical power structures. By engaging in experiential accounts provided through transcript excerpts from conversations, we show how grappling with concepts like power, hierarchy, and insider/outsider groups within a conference space is alive and complicated. Coming to realize that we are already becoming part of an in-group within this prestigious space, we push against the walls of comfort to show our own resistance to power—while also realizing that denying power is exactly the opposite from what we want academics to do.
Qualitative Responses/Recovery in Repressive Times
Authors: Alexander Bryant Keith , Douglas Kitrina
Published: November 2020

The Special Section documents the resonance of the cancelation of ICQI 2020 in three movements. First, the coming together of long-time participants through electronic means for a short performative video that featured collaborative voices speaking to the power and importance of critical qualitative research in repressive times. Second, documenting on May 21, 2020, on what would have been the first day of the conference, a Zoom gathering was held with nearly 30 scholars from around the world, who would have converged on the University of Illinois-Urbana campus–responding together in a virtual but all-together real community space to share thoughts, feelings, outpourings, promises, and possibilities of critical qualitative research in repressive times. Third, a short sampling of performative scholarships reflecting on both themes of anticipated ICQI panels and emergent commentaries on world politics, COVID-19, the environment, revolution, resistance, and hope.
Clinical and Epidemiological Characterization of Neurological Consults: When a Neurological Evaluation Is Requested
Authors: Corrêa Karin Mitiyo , de Rezende Filho Flávio Moura , Abrantes Fabiano Ferreira , de Andrade João Brainer Clares , Barsottini Orlando G. P. , Pedroso José Luiz
Published: November 2020

Background and Objectives:

Medical consultation by a specialist physician consists of an evaluation to review diagnosis and management of patients with some neurological conditions referred from other specialty wards. This mode of care delivery has gained relevance in the field of neurology and adequate training on it is valuable, allowing neurologists to provide state-of-the-art management to patients with neurological manifestations. The present study aimed to characterize neurology consults and to discuss the roles of the neurologist within a hospital setting.

Methods:

A prospective analysis of neurological consultations provided to inpatients of a university hospital in São Paulo, Brazil, was performed from September 2016 to September 2017. These patients were followed by the principal investigator, who was not involved in their care.

Results:

We evaluated data from 117 female and 106 male inpatients with a mean age of 53.8 ± 2.4. The medical specialties that most frequently requested neurological consultations were Internal Medicine (17%), Cardiology (11.2%) and Pulmonology (9.4%). The main reasons for a neurology consultation request were seizures (15.6%); decreased level of consciousness (8.9%) and confusion (7.1%). The most frequent diagnosis in patients receiving a neurology consult were stroke (10.2%); hypoxic-ischemic encephalopathy (5.3%) and sepsis (2.2%).

Conclusion:

Our findings show the growing importance of the role of neurologists within hospital settings as many medical conditions present with neurological manifestations and the significance of the neurohospitalist model of care.
Risk factors for 30‐day readmission in adults hospitalized for pulmonary hypertension
Authors: Bhattacharya Priyanka T. , Hameed Asif M. Abdul , Bhattacharya Shubhadeep T. , Chirinos Julio A. , Hwang Wei‐Ting , Birati Edo Y. , Menachem Jonathan N. , Chatterjee Saurav , Giri Jay S. , Kawut Steven M. , Kimmel Stephen E. , Mazurek Jeremy A.
Published: November 2020

Readmissions for pulmonary hypertension are poorly understood and understudied. We sought to determine national estimates and risk factors for 30‐day readmission after pulmonary hypertension‐related hospitalizations. We utilized the Healthcare Cost and Utilization Project Nationwide Readmission Database, which has weighted estimates of roughly 35 million discharges in the US. Adult patients with primary International Classification of Disease, Ninth Revision, Clinical Modification diagnosis codes of 416.0 and 416.8 for primary and secondary pulmonary hypertension with an index admission between 2012 and 2014 and any readmission within 30 days of the index event were identified. Predictors of 30‐day readmission were identified using multivariable logistic regression with adjustment for covariates. Results showed that the national estimate for Primary Pulmonary Hypertension vs Secondary Pulmonary Hypertension‐related index events between 2012 and 2014 with 30‐day readmission was 247 vs 2550 corresponding to a national readmission risk estimate of 17% vs 18.3%, respectively. The presence of fluid and electrolyte disorders, renal failure, and alcohol abuse were associated with increased risk of readmission in Primary Pulmonary Hypertension, while factors associated with Secondary Pulmonary Hypertension readmissions included anemia, congestive heart failure, lung disease, fluid and electrolyte disorders, renal failure, diabetes, and liver disease. The median cost of Primary Pulmonary Hypertension admissions and readmissions were $46,132 (IQR: $25,384–$85,647) and $41,604.50 (IQR: $22,481.50–$84,420.50), respectively. The median costs of Secondary Pulmonary Hypertension admissions and readmissions were $34,893 (IQR: $19,670–$66,143) and $36,279 (IQR: $19,059–$74,679), respectively. In conclusion, approximately 19% of Primary Pulmonary Hypertension and Secondary Pulmonary Hypertension hospitalizations result in 30‐day readmission, with significant costs accrued during the index hospitalization and readmission. With evolving clinical terminology and diagnostic codes, future study will need to better clarify underlying factors associated with readmissions amongst pulmonary hypertension sub‐types, and identify methods and procedures to minimize readmission risk.
Perio-Endo Lesions: A Guide to Diagnosis and Clinical Management
Authors: Sonde Nargis , Edwards Malcolm
Published: November 2020

Dentists are likely to encounter lesions that have both periodontal and endodontic aetiological components; the so called ‘perio-endo lesions’. A thorough examination with appropriate investigations remains pivotal to diagnosing a perio-endo lesion. Correct diagnosis of such lesions is therefore important as it enables the most suitable clinical management to be treatment planned. It is still recommended that for the treatment of perio-endo lesions, initial endodontic therapy is completed.
Complications in Endodontics
Authors: Bhuva Bhavin , Ikram Omar
Published: November 2020

Difficulties encountered during endodontic treatment can be a cause of frustration for both clinician and patient. Complications such as iatrogenic perforation, ledge formation, canal blockage, instrument separation and untreated anatomy may impact the outcome of endodontic treatment. Clinicians should understand how each of these complications can occur, be prevented and predictably rectified. It is also important for clinicians to understand the impact of a specific complication on treatment prognosis and to appreciate how this may differ in each case. There may be scenarios where a complication does not significantly affect the prognosis, whereas in other situations, the same complication will be detrimental to the outcome of treatment. An appreciation of the clinical factors which determine prognosis is important, so that the correct intervention is chosen, and the patient is correctly informed of the likely sequelae.
Renal outcomes of treatment with telmisartan in patients with stage 3–4 chronic kidney disease: A prospective, randomized, controlled trial (JINNAGA)
Authors: Kitamura Mineaki , Arai Hideyuki , Abe Shinichi , Ota Yuki , Muta Kumiko , Furusu Akira , Mukae Hiroshi , Kohno Shigeru , Nishino Tomoya
Published: November 2020

Objectives:

Although angiotensin II receptor blockers are effective for patients with chronic kidney disease, dose-dependent renoprotective effects of angiotensin II receptor blockers in patients with moderate to severe chronic kidney disease with non-nephrotic proteinuria are not known. Our aim was to elucidate the dose-dependent renoprotective effects of angiotensin II receptor blockers on such patients.

Methods:

A multicenter, prospective, randomized trial was conducted from 2009 to 2014. Patients with non-nephrotic stage 3–4 chronic kidney disease were randomized for treatment with either 40 or 80 mg telmisartan and were observed for up to 104 weeks. Overall, 32 and 29 patients were allocated to the 40 and 80 mg telmisartan groups, respectively. The composite primary outcome was renal death, doubling of serum creatinine level, transition to stage 5 chronic kidney disease, and death from any cause. Secondary outcomes included the level of urinary proteins and changes in the estimated glomerular filtration rate.

Results:

There was no difference in the primary outcome (p = 0.78) and eGFR (p = 0.53) between the two groups; however, after 24 weeks, urinary protein level was significantly lower in the 80 mg group than in the 40 mg group (p < 0.05). No severe adverse events occurred in either group, and the occurrence of adverse events did not significantly differ between them (p = 0.56).

Conclusion:

Our findings do not demonstrate a direct dose-dependent renoprotective effect of telmisartan. The higher telmisartan dose resulted in a decrease in the amount of urinary protein. Even though high-dose angiotensin II receptor blockers may be preferable for patients with stage 3–4 chronic kidney disease, the clinical importance of the study results may be limited. The study was registered in the UMIN-CTR ( https://www.umin.ac.jp/ctr ) with the registration number UMIN000040875.
Self-rated health and psychological health among hypertensive patients in Palestine
Authors: Menawi Wafaa , Najem Taghreed , Khalil Aziza , Suleiman Jiyana , Dabas Areej , Abdullah Rasmiyya Amer , Shareef Noor , Khraiwesh Taghreed
Published: November 2020

The study has investigated the self-rated psychological health of hypertensive patients in Palestine. To that end, a stratified random sample of 502 hypertensive patients (aged ⩾ 18 years) was asked to complete a validated Arabic version of the General Health Questionnaire (GHQ-28). After collection, the data were analyzed using descriptive statistics, Mann–Whitney U test and logistic regression. In this study, it was found the mean scores for GHQ were statistically higher for females than males ( p < 0.05). The females were found to be 1.701 (95% CI = 1.025–2.823) times more at risk of psychological disorders compared to males. In conclusion, improvement of social determinants of hypertensive patients can make a difference in their psychological/mental health.
What They Learned Won’t Go Away: The Impacts of an International Exchange Program on Chinese Teacher Candidates’ Understanding of and Practice in Science Education
Authors: Zhou (周国强) George , Wang (王佩玉) Peiyu , Liu (刘天) Tian , Zhang (张俊义) Junyi , Li (李远蓉) Yuanrong , Fu (付成茵) Chengyin , Wu (吴淑娥) Shue
Published: November 2020

Purpose:

The Canadian university where this study took place has established an international exchange program in teacher education with a large Chinese university. This study was designed to examine how the international exchange program influenced Chinese science teacher candidates’ understanding of science education and how such learning impacted their teaching in China.

Design/Approach/Methods:

The study adopted a qualitative research design with interview and reflective journal as the main approaches for data collection.

Findings:

Participants greatly appreciated the opportunity of exchange. They reported an improved understanding of Canadian school education and its science curriculum and pedagogy, which changed many aspects of their original values about the relationship between the teacher and students, classroom environment, and so on. Although they faced many constraints to implement what they learned from the exchange in Chinese science classrooms, what they learned had never been forgotten. Participants tried to apply them here and there at the level they could control.

Originality/Value:

There are many reported studies in the literature about Chinese international students on Western campuses. However, research on Chinese students who participate in international exchange programs is very rare. The findings of this study can inform policymakers and education practitioners about student international exchange programs and benefit future exchange participants.
Comparison of Patient and Proxy Assessment of Patient-Centeredness in the Care of Coronary Heart Disease: A Cross Sectional Survey Using the PACIC-S11.1
Authors: Vennedey Vera , Peltzer Samia , Shukri Arim , Müller Hendrik , Jessen Frank , Albus Christian , Stock Stephanie
Published: November 2020

Introduction:

When making medical care more patient-centered, surveys on patients’ and their relatives’ experiences can be helpful in identifying opportunities for improvement. In cases where the targeted patients are unable to express their own perspective, for example, due to them being too young or suffering from severe impairments, proxies can serve as substitutes. Proxies are frequently used in care planning and consent. Nevertheless, it is unclear whether patients’ assessments of how patient-centered their medical care is are similar to those of their proxies. This study aims to assess the level of consistency between patients’ and their proxies’ assessments using an adapted version of the Patient Assessment of Chronic Illness Care (PACIC) short form questionnaire.

Methods:

In a cross-sectional study, patients with coronary heart disease were recruited at cardiologists’ offices, rehabilitation clinics and hospitals. Participants were surveyed with regard to the perceived level of patient-centeredness during their care using an adapted version of the German PACIC short form (PACIC-S11.1). Correlations in the assessments made by each patient and their respective proxy were analyzed. On the level of the patients group and the relatives group differences between mean ratings for each item were compared using paired t-tests.

Results:

In total, 74 pairs of patients and proxies submitted the completed questionnaire. On the level of the individual patient/proxy pairs, no correlation, or significant but low correlation, was found between the ratings. On the group level, patients’ and their proxies’ item ratings were similar in the interpretation of averages, but still demonstrated statistically significant differences. Overall, patients rated their care as more patient-centered than their proxies did.

Conclusion:

The study shows that, on the individual level, proxies’ ratings do not necessarily reflect the patients’ assessment of PCC. On the group level, the assessments of relatives regarding PCC are similar to those of the patients.

Trial registration

German clinical trials register (Deutsches Register Klinischer Studien, DRKS) Registration Number: DRKS00012434 (URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012434 )
Social Media Policies Within the Financial Sector in South Africa
Authors: van den Berg Amanda , Struwig Miemie
Published: November 2020

The main purpose of this article is to explore the social media policies of financial institutions in South Africa. Owing to the advances in technology, businesses are exposed to many opportunities but also risks in social media platforms. For the study, a thematic framework was considered to analyze social media policies, which included risk and relationship building, brand image and reputation, stakeholders and communities, disciplinary action and compliance as well as professional and personal guidelines. A qualitative document analysis of social media policies of select South African Johannesburg Stock Exchange (JSE) listed financial institutions was then conducted. For the data analysis, a thematic document analysis using a consensual qualitative research process was applied. The results showed that all the financial institutions appreciated the value and opportunities provided by social media and ensured strict compliance to their social media policies. However, there were some financial institutions that did not focus on relationship building, did not mention brand image and reputation, did not include all stakeholders, and did not suggest personal guidelines in their social media policies.
Average Lumbar Hounsfield Units Predicts Osteoporosis-Related Complications Following Lumbar Spine Fusion
Authors: St. Jeor Jeffery D. , Jackson Taylor J. , Xiong Ashley E. , Freedman Brett A. , Sebastian Arjun S. , Currier Bradford L. , Fogelson Jeremy L. , Bydon Mohamad , Nassr Ahmad , Elder Benjamin D.
Published: November 2020

Study Design:

Retrospective Study.

Objective:

To compare methods of assessing pre-operative bone density to predict risk for osteoporosis related complications (ORC), defined as proximal junctional kyphosis, pseudarthrosis, accelerated adjacent segment disease, reoperation, compression fracture, and instrument failure following spine fusions.

Methods:

Chart review of primary posterior thoracolumbar or lumbar fusion patients during a 7 year period. Inclusion criteria: preoperative dual-energy x-ray absorptiometry (DXA) test within 1 year and lumbar CT scan within 6 months prior to surgery with minimum of 1 year follow-up. Exclusion criteria: <18 years at time of index procedure, infection, trauma, malignancy, skeletal dysplasia, neuromuscular disorders, or anterior-posterior procedures.

Results:

140 patients were included. The average age was 67.9 years, 83 (59.3%) were female, and 45 (32%) had an ORC. There were no significant differences in patient characteristics between those with and without an ORC. Multilevel fusions were associated with ORCs (46.7% vs 26.3%, p = 0.02). Patients with ORCs had lower DXA t-scores (-1.62 vs -1.10, p = 0.003) and average Hounsfield units (HU) (112.1 vs 148.1, p ≤ 0.001). Multivariable binary logistic regression analysis showed lower average HU (Adj. OR 0.00 595% CI 0.0001-0.1713, p = 0.001) was an independent predictor of an ORC. The odds of an ORC increased by 1.7-fold for every 25 point decrease in average HU.

Conclusions:

The gold standard for assessing bone mineral density has been DXA t-scores, but the best predictor of ORC remains unclear. While both lower t-scores and average HU were associated with ORC, only HU was an independent predictor of ORC.
Prevalence and Definition of Multilevel Lumbar Developmental Spinal Stenosis
Authors: Lai Marcus Kin Long , Cheung Prudence Wing Hang , Samartzis Dino , Cheung Jason Pui Yin
Published: November 2020

Study Design:

Cross-sectional study.

Objectives:

To define multilevel lumbar developmental spinal stenosis (DSS) using a composite score model and to determine its prevalence.

Methods:

This was a cohort study of 2385 openly recruited subjects with lumbosacral (L1-S1) MRIs. All subjects with previous spinal surgery or spinal deformities were excluded. The anteroposterior (AP) vertebral canal diameter was measured by two independent observers. Any associations between level-specific vertebral canal diameter and subject body habitus were analysed with non-parametric tests. Three or more stenotic levels, equivalent to a composite score of 3 or more, were considered as multilevel DSS. The median values of these subjects’ AP canal diameters were used to construct the multilevel DSS values. Receiver operating characteristic analysis was utilized to determine the ability of these cut-off values to screen for DSS by presenting their area under curve, sensitivity and specificity.

Results:

Subject body habitus was poorly correlated with AP vertebral canal diameter. Multilevel DSS was identified as L1<19 mm, L2<19 mm, L3<18 mm, L4<18 mm, L5<18 mm, S1<16 mm with 81%–96% sensitivity and 72%–91% specificity. The prevalence of multilevel DSS in this cohort was 7.3%.

Conclusions:

Utilizing a large homogeneous cohort, the prevalence of multilevel DSS is determined. Our cut-offs provide high diagnostic accuracy. Patients with multiple levels that fulfil these criteria may be at-risk of spinal canal compressions at multiple sites.

Level of Evidence:

III
Significance of Vertebral Body Sliding Osteotomy as a Surgical Strategy for the Treatment of Cervical Ossification of the Posterior Longitudinal Ligament
Authors: Lee Dong-Ho , Park Sehan , Hong Chul Gie , Kim Shinseok , Cho Jae Hwan , Hwang Chang Ju , Yang Jae Jun , Lee Choon Sung
Published: November 2020

Study Design:

Retrospective cohort study.

Objectives:

Vertebral body sliding osteotomy (VBSO) has previously been reported as a technique to decompress ossification of the posterior longitudinal ligament (OPLL) by translating the vertebral body anteriorly. This study aimed to evaluate the radiological and clinical efficacies of VBSO and clarify the surgical indications of VBSO for treating myelopathy caused by OPLL.

Methods:

Ninety-seven patients with symptomatic OPLL-induced cervical myelopathy treated with VBSO or laminoplasty who were followed up for more than 2 years were retrospectively reviewed. Cervical alignment, range of motion, fusion, modified K-line (mK-line) status, and minimum interval between ossified mass and mK-line (INT(min)), and the Japanese Orthopaedic Association (JOA) score were assessed. Patients in the VBSO group were compared with those who underwent laminoplasty.

Results:

Cervical lordosis and INT(min) significantly increased in the VBSO group. All patients in the VBSO group assessed as mK-line (-) preoperatively were assessed as mK-line (+) postoperatively. However, in the LMP group, the mK-line status changed from (+) preoperatively to (−) postoperatively in 3 patients. Final JOA score (p = 0.02) and JOA score improvement (p = 0.01) were significantly higher in the VBSO group. JOA recovery ratio (p = 0.03) and proportion of patients with a recovery rate ≥50% were significantly higher in the VBSO group (p < 0.01).

Conclusions:

VBSO is an effective surgical option for OPLL-induced myelopathy, demonstrating favorable neurological recovery and lordosis restoration with low complication rates. It is best indicated for kyphotic alignment, OPLL with a high space-occupying ratio, and OPLL involving ≤3 segments.
Neurological Complications and Recovery Rates of Patients With Adult Cervical Deformity Surgeries
Authors: Kim Han Jo , Yao Yu-Cheng , Shaffrey Christopher I. , Smith Justin S. , Kelly Michael P. , Gupta Munish , Albert Todd J. , Protopsaltis Themistocles S. , Mundis Gregory M. , Passias Peter , Klineberg Eric , Bess Shay , Lafage Virginie , Ames Christopher P. ,   International Spine Study Group (ISSG)
Published: November 2020

Study Design:

Retrospective cohort study.

Objective:

This study aims to report the incidence, risk factors, and recovery rate of neurological complications (NC) in patients with adult cervical deformity (ACD) who underwent corrective surgery.

Methods:

ACD patients undergoing surgery from 2013 to 2015 were enrolled in a prospective, multicenter database. Patients were separated into 2 groups according to the presence of neurological complications (NC vs no-NC groups). The types, timing, recovery patterns, and interventions for NC were recorded. Patients’ demographics, surgical details, radiographic parameters, and health-related quality of life (HRQOL) scores were compared.

Results:

106 patients were prospectively included. Average age was 60.8 years with a mean of 18.2 months follow-up. The overall incidence of NC was 18.9%; of these, 68.1% were major complications. Nerve root motor deficit was the most common complication, followed by radiculopathy, sensory deficit, and spinal cord injury. The proportion of complications occurring within 30 days of surgery was 54.5%. The recovery rate from neurological complication was high (90.9%), with most of the recoveries occurring within 6 months and continuing even after 12 months. Only 2 patients (1.9%) had continuous neurological complication. No demographic or preoperative radiographic risk factors could be identified, and anterior corpectomy and posterior foraminotomy were found to be performed less in the NC group. The final HRQOL outcome was not significantly different between the 2 groups.

Conclusions:

Our data is valuable to surgeons and patients to better understand the neurological complications before performing or undergoing complex cervical deformity surgery.