bluuebunny/crossref_metadata_2025 huggingface dataset:
Virtual care policy recommendations for patient-centred primary care: findings of a consensus policy dialogue using a nominal group technique
Authors: Shaw James , Jamieson Trevor , Agarwal Payal , Griffin Bailey , Wong Ivy , Bhatia R. Sacha
Published: September 2017

Background

The development of new virtual care technologies (including telehealth and telemedicine) is growing rapidly, leading to a number of challenges related to health policy and planning for health systems around the world.

Methods

We brought together a diverse group of health system stakeholders, including patient representatives, to engage in policy dialogue to set health system priorities for the application of virtual care in the primary care sector in the Province of Ontario, Canada. We applied a nominal group technique (NGT) process to determine key priorities, and synthesized these priorities with group discussion to develop recommendations for virtual care policy. Methods included a structured priority ranking process, open-ended note-taking, and thematic analysis to identify priorities.

Results

Recommendations were summarized under the following themes: (a) identify clear health system leadership to embed virtual care strategies into all aspects of primary and community care; (b) make patients the focal point of health system decision-making; (c) leverage incentives to achieve meaningful health system improvements; and (d) building virtual care into streamlined workflows. Two key implications of our policy dialogue are especially relevant for an international audience. First, shifting the dialogue away from technology toward more meaningful patient engagement will enable policy planning for applications of technology that better meet patients’ needs. Second, a strong conceptual framework on guiding the meaningful use of technology in health care settings is essential for intelligent planning of virtual care policy.

Conclusions

Policy planning for virtual care needs to shift toward a stronger focus on patient engagement to understand patients’ needs.
Ethiopian community health workers’ beliefs and attitudes towards children with autism: Impact of a brief training intervention
Authors: Tilahun Dejene , Fekadu Abebaw , Tekola Bethlehem , Araya Mesfin , Roth Ilona , Davey Basiro , Hanlon Charlotte , Hoekstra Rosa A
Published: September 2017

There is a severe shortage of services for children with autism in Ethiopia; access to services is further impeded by negative beliefs and stigmatising attitudes towards affected children and their families. To increase access to services, care provision is decentralised through task-shifted care by community health extension workers. This study aimed to examine the impact of a brief training (Health Education and Training; HEAT) for Ethiopian rural health extension workers and comprised three groups: (1) health extension workers who completed a basic mental health training module (HEAT group, N = 104); (2) health extension workers who received enhanced training, comprising basic HEAT as well as video-based training on developmental disorders and a mental health pocket guide (HEAT+ group, N = 97); and (3) health extension workers untrained in mental health (N = 108). All participants completed a questionnaire assessing beliefs and social distance towards children with autism. Both the HEAT and HEAT+ group showed fewer negative beliefs and decreased social distance towards children with autism compared to the untrained health extension worker group, with the HEAT+ group outperforming the HEAT group. However, HEAT+ trained health extension workers were less likely to have positive expectations about children with autism than untrained health extension workers. These findings have relevance for task-sharing and scale up of autism services in low-resource settings worldwide.
Finite element analysis and parametric study of continuous steel–concrete composite beams stiffened with post-tensioned tendons
Authors: El-Zohairy Ayman , Salim Hani , Shaaban Hesham , Mustafa Suzan , El-Shihy Ashraf
Published: September 2017

Externally post-tensioned tendons can cause an initial compressive stress in steel–concrete composite sections at the hogging moment region, and then a part of the tensile stress in the concrete flange can be relieved. This study presents a detailed finite element analysis of the nonlinear flexural response of continuous steel–concrete composite beams strengthened with externally post-tensioned tendons. The initial post-tensioning force is introduced as an initial strain in the truss element that used to simulate the external tendons. The accuracy of the finite element model is validated using existing experimental works. The effects of tendon eccentricity, longitudinal steel rebar ratio, and initial post-tensioning force on the beam behavior are explored. Furthermore, deterministic and stochastic shrinkage effects are carried out to obtain the long-term random responses of the strengthened beams as well as unstrengthened beams. However, the ultimate capacity of the strengthened beam increases only by 8%, the cracked moment redoubles, and an affirmative behavior over the unstrengthened beams is obtained. Also, a rapid decay in the long-term deformation of continuous steel–concrete composite beams is obtained at the early age while a linear decrease in the remaining part of the age occurs.
Calculation Method of shear strength of vertical stiffener connections to L-CFST columns
Authors: Zhang Wang , Chen Zhihua , Xiong Qingqing , Zhou Ting
Published: September 2017

Based on the low cyclic loading test results of vertical stiffener connections between L-shaped columns composed of concrete-filled steel tubes and steel beams, a simplified trilinear model to predict the shear strength versus the shear deformation response in panel zone is presented in this article. Considering the characteristics of the panel zone, the strength of the joints is determined by contributions from the web of steel tubes and internal short beams, core concrete diagonal struts and the steel frame yield hinge mechanism. Existing calculation methods, which are applicable to the vertical stiffener connection to L-shaped columns composed of concrete-filled steel tube, are summarized and modified in this article. In addition, the use of the proposed design equations led to excellent agreement with experimental shear strength for both corner and exterior vertical stiffener connections to L-shaped columns composed of concrete-filled steel tube.
Laparoscopic Roux-En-Y Gastric Bypass in Elderly Patients (60 Years or Older): A Meta-Analysis of Comparative Studies
Authors: Giordano S. , Victorzon M.
Published: September 2017

Background and Aims:

Elderly patient might experience an increased risk of complications after laparoscopic Roux-en-Y gastric bypass. We aimed to perform a meta-analysis of comparative studies on this issue in patients aged 60 years or older.

Material and Methods:

A systematic literature search was performed. Medline, Cochrane Library, Embase, Scopus, and Google Scholar were searched until July 2016 for studies on outcomes of laparoscopic Roux-en-Y gastric bypass in elderly versus younger patients. Primary outcomes were mortality and overall complications. Secondary outcomes were length of hospital stay, excess weight loss percentage, effect on diabetes, hypertension, hyperlipidemia and obstructive sleep apnea. Heterogeneity across the studies was evaluated by the I2 test, and a random effects model was used. Results were expressed as mean difference and risk ratio (RR).

Results:

Seven studies involving 3128 patients were retrieved and included in this study. A significantly increased risk of mortality and overall complications was observed among patients older than 60 years compared with younger ones (RR, 6.12; 95% confidence interval 1.08–34.83; p = 0.04; RR, 1.51; 95% confidence interval 1.07–2.11; p = 0.02). Particularly, elderly patients experienced 1% increased risk of mortality and 3% increased risk of overall complications. Length of stay, diabetes, and obstructive sleep apnea remission rates were similar among the groups. Excess weight loss percentage was significantly greater among younger patients (mean difference, −3.44; 95% confidence interval −5.20, −1.68; p < 0.001), as were hypertension (RR, 0.57; 95% confidence interval 0.42–0.76; p < 0.001) and hyperlipidemia (RR, 0.61; 95% confidence interval 0.45–0.83; p = 0.002) remission rates.

Conclusion:

Laparoscopic Roux-en-Y gastric bypass in patients older than 60 years may be a risky bariatric surgery operation due to higher complications and mortality and may not be as effective as in patients younger than 60 years. Thus, older patients should be carefully counseled before this procedure for individual risk–benefit assessment.
Clinical Outcome after Plaster Cast Fixation for 10 Days Versus 1 Month in Reduced Distal Radius Fractures: A Prospective Randomized Study
Authors: Christersson A. , Larsson S. , Sandén B.
Published: September 2017

Introduction:

This study aimed to evaluate clinical results after plaster cast fixation for 10 days versus 1 month of moderately displaced and reduced distal radius fractures.

Material and Methods:

In a prospective randomized study, 109 patients with moderately displaced and conservatively treated distal radius fractures (age ≥50 years) were randomized 10 days after reduction to either removal of the plaster cast and immediate mobilization (active group) or to continued plaster cast fixation for another 3 weeks (control group). Grip strength, pincer strength, range of motion, and pain were assessed at 1, 4, and 12 months after reduction. Clinical outcome was evaluated using three functional assessment scores at 12 months.

Results:

Treatment failed in 3/54 (6%) patients in the active group. One of these patients had the plaster cast reinstituted because of feelings of instability. The fractures in the other two patients displaced severely after mobilization and were therefore treated surgically. For the remaining 51 patients in the active group, the range of wrist motion was slightly better at 1 month compared with the controls, but there were no differences in grip or pincer strength or pain at the 1-month follow-up. There were no differences between the active and control group in any outcome at 4 or 12 months, including functional assessment scores at 12 months.

Conclusion:

Treatment with mobilization 10 days after reduction of moderately displaced distal radius fractures resulted in a few treatment failures compared with none among controls. The only functional benefit for the remaining patients was a small and transient increase in range of motion at the 1-month follow-up. Plaster cast removal 10 days after reduction in moderately displaced distal radius fractures is therefore not recommended.
Effect of boosting system architecture and thermomechanical limits on diesel engine performance: Part II—transient operation
Authors: Galindo José , Climent Hector , Varnier Olivier , Patil Chaitanya
Published: September 2017

Nowadays, internal combustion engine developments are focused on efficiency optimization and emission reduction. Increasing focus on world harmonized ways to determine the performance and emissions on Worldwide harmonized Light vehicles Test Procedure cycles, it is essential to optimize the engines for transient operations. To achieve these objectives, the downsized or downspeeded engines are required, which can reduce fuel consumption and pollutant emissions. However, these technologies ask for efficient charging systems. This article consists of the study of different boosting architectures (single stage and two stage) with a combination of different charging systems like superchargers and e-boosters. A parametric study has been carried out with a zero-dimensional engine model to analyze and compare different architectures on the different engine displacements. The impact of thermomechanical limits, turbo sizes and other engine development option characterizations is proposed to improve fuel consumption, maximum power and performance of the downsized/downspeeded diesel engines during the transient operations.
Strategy and virtue: Developing strategy-as-practice through virtue ethics
Authors: Tsoukas Haridimos
Published: September 2017

Strategy-as-practice research has usefully built on earlier strategy process research by taking into account the social embeddedness of strategy making. While such an approach has generated valuable insights, it has curiously left unexplored the moral dimension of practice. In this article, we show how the potential of strategy-as-practice research may be more fully realized if the moral dimension of practice is conceptualized through virtue ethics (especially MacIntyre’s version). Specifically, we first reconceptualize, through virtue ethics, the three main concepts of strategy-as-practice—practice, praxis, and practitioners—underscoring the inherently moral constitution of actions undertaken in strategy-related work. Moreover, we suggest that strategic management is viewed as a particular kind of practice (what we call “competitive institutional practice”), charged with “values articulation work” and “balancing work.” While the former articulates a good purpose for the organization, the latter seeks to care for both excellence and success through balancing “capabilities development work” with “differentiation work.” Illustrations are provided to support this argument, and several suggestions for further research are offered.
Recruitment and Retention of Homeless Youth in a Substance Use and HIV-risk Reduction Program
Authors: Garvey Rick , Pedersen Eric R. , D’Amico Elizabeth J. , Ewing Brett A. , Tucker Joan S.
Published: September 2017

Conducting intervention studies with homeless populations can be difficult, particularly in terms of retaining participants across multiple sessions and locating them for subsequent follow-up assessments. Homeless youth are even more challenging to engage due to substance use, mental health problems, wariness of authority figures, and frequent relocations. This article describes methods used to successfully recruit a sample of 200 homeless youth from two drop-in centers in Los Angeles, engage them in a four-session substance use and sexual risk reduction program (79% of youth attended multiple sessions), and retain 91% of the full sample at a three-month follow-up assessment. Our experience indicates that utilizing structured project materials and having a small dedicated staff are essential to recruitment and retention efforts for intervention studies with homeless youth. Using these and other nontraditional methods are likely necessary to engage this at-risk yet hard-to-reach population.
Performance Efficiency in NCAA Basketball
Authors: Bolen J. Brandon , Rezek Jon , Pitts Joshua D.
Published: September 2017

This study employs data envelopment analysis to examine the efficiency of men’s college basketball programs in producing competitive and academically successful teams. Employing inputs measuring team talent, academic ability and experience as well as a program’s basketball-specific expenditures and measures of coaching ability and experience, two efficiency measures are estimated, which rank teams according to their technical efficiency in producing each of the outputs desired by athletic departments and universities. These measures of efficiency are useful in allowing administrators to determine how their basketball programs compare to other programs across the country using a more holistic measure of success.
Combined use of stent-retriever and aspiration thrombectomy for cerebral venous sinus thrombosis involving the straight sinus: A case report
Authors: Taniguchi Syunsuke , Harada Kei , Kajihara Masahito , Fukuyama Kozo
Published: September 2017

Cerebral venous sinus thrombosis (CVST) is generally treated with anticoagulation therapy, however, endovascular therapy is considered for refractory cases. A 42-year-old woman presented with a progressive disturbance in consciousness, and diagnosed CVST in the straight sinus (SS). Recanalization of SS was achieved by emergent thrombectomy using aspiration catheter and stent-retriever system, and her level of consciousness improved immediately. The combined use of them aided the removal of the thrombus located in the SS.
Partial thrombosis of an anterior communicating artery aneurysm prior to endovascular coiling, with intra-procedural distal thrombus embolization
Authors: Guest Will , Sarma Dipanka , Marotta Thomas
Published: September 2017

Thromboembolic stroke from migration of thrombus formed in non-giant intracranial aneurysms is a recognized but rare event. We describe a case of partial thrombosis of a 7 mm anterior communicating artery aneurysm, which embolized to the right callosomarginal artery in the brief time interval between two sequential diagnostic angiograms performed as part of elective endovascular coiling, and before any instrumentation had been advanced into the intracranial circulation. To our knowledge, this is the first reported case of aneurysmal thrombus embolization observed angiographically in near real time.
Prognostic efficacy of circulating asymmetric dimethylarginine in patients with peripheral arterial disease: A meta-analysis of prospective cohort studies
Authors: Chu Renzhu , Yu Dawei , Chu Junyi , Lin Mingqiang , Yu Hongbo
Published: September 2017

Background

Asymmetric dimethylarginine is suggested to be a marker of poor prognosis in patients with atherosclerosis. However, the predictive role of circulating asymmetric dimethylarginine for clinical outcome in patients with peripheral arterial disease has not been determined.

Aims

To quantitatively assess the predictive value of circulating asymmetric dimethylarginine for clinical outcome in patients with peripheral arterial disease in a meta-analysis of prospective cohort studies.

Methods

Relevant studies were identified by systematically searching of PubMed and Embase databases. A random-effect model was used to synthesize the results. Sensitivity analyses by omitting one study at a time were performed to evaluate the robustness of the results.

Results

Six studies with 2535 peripheral arterial disease patients were included. Patients with higher circulating asymmetric dimethylarginine at baseline were associated with higher risk of all-cause mortality (adjusted hazard ratio: 1.63, 95% confidence interval: 1.28–2.06, I2 = 16%), and major adverse cardiovascular events (adjusted hazard ratio: 2.01, 95% confidence interval: 1.08–3.73, I2 = 78%) as compared with those with lower circulating asymmetric dimethylarginine at baseline. Specifically, every increment of 0.1 µmol/l of asymmetric dimethylarginine was associated with 18% (adjusted hazard ratio: 1.18, 95% confidence interval: 1.06–1.31) increased risk for all-cause mortality and 14% (adjusted hazard ratio: 1.14, 95% confidence interval: 1.04–1.25) increased risk for major adverse cardiovascular disease. Sensitivity analyses by omitting one study at a time did not significantly change the results.

Conclusion

Higher circulating asymmetric dimethylarginine at baseline may be associated with higher incidence of cardiovascular events and mortality in patients with peripheral arterial disease.
Shear wave elastography in the pronator quadratus muscle following distal radial fracture fixation: A feasibility study comparing the operated versus nonoperated sides
Authors: Burke Christopher J , Babb James S , Adler Ronald S
Published: September 2017

The aim of this study was to assess changes in shear wave velocity within the pronator quadratus muscle in patients following volar plate fixation for distal radial fractures compared to the contralateral nonoperated side. Shear wave velocity values were obtained in the short and long axis of the pronator quadratus muscle, which were analyzed separately. Patients were also stratified by age below or above 66 years. Statistical analysis was performed using paired sample Wilcoxon signed rank and t tests. Pearson and Spearman rank correlations were also used. Seventeen patients (nine women and eigth men; age range 33–82, mean 62.4 years) were prospectively assessed following open reduction volar plate fixation of distal radial fracture. A statistically significant reduction in the velocities of the treated versus the nontreated side was observed in the long axis of the muscle (3.29 versus 3.59 m/second; t test p = 0.035). The data provide evidence for shear wave elastography as a quantitative measure to assess postoperative changes in muscle and a potential tool to monitor the efficacy of rehabilitation.
The Enlightenment conceptions of pedagogy and global citizenship education: A Canadian case study
Authors: Asgharzadeh Alireza , Nazim Zabedia
Published: September 2017

Contemporary liberal education owes its existence to various educational ideas and pedagogical formulas that emerged from the 18th century intellectual movement known as the Enlightenment. Many Enlightenment conceptions, principles, and practices such as public schooling, equality of opportunity, freedom of expression, critical thinking, scientific methodology, empiricism, and rationality constitute the backbone of current liberal education. Despite this, in recent years, most of these Enlightenment legacies have come into sharp contrast with neoliberalization policies and practices that are plaguing the contemporary educational domains, in general, and the field of higher education, in particular. To what extent are the current institutions of higher learning able to cope with the onslaught of neoliberalization policies and practices? This article explores this question by juxtaposing relevant educational and pedagogical conceptions of the Enlightenment against some of the contemporary challenges and struggles in the field of education.
Social determinants of health: A pedagogical framework for advancing the Citizen Scholar
Authors: Velardo Stefania
Published: September 2017

The concept of the Citizen Scholar highlights the potential for universities to act as vehicles for social change by supporting the development of active, engaged graduates who are geared to respond to current and future global challenges. This demands a radical shift in teaching towards more interactive pedagogies, which may prove difficult for some educators and students who are comfortable with a traditional model of learning and ‘teaching to the test’. Despite these challenges, universities have a responsibility to bring about change in practice to prepare undergraduate students for the complex outside world. This article reports on a revised version of a 12-week Australian undergraduate course in health promotion that was delivered to 147 first-year students enrolled in a Bachelor of Education and/or Bachelor of Health Sciences degree. Significant revisions were made to the curriculum and modification of teaching methodology, with the aim of encouraging greater social awareness and students’ capacity for social change. In this article, I reflect on various teaching strategies employed to develop skills and proficiencies akin to the Citizen Scholar, with a particular emphasis on fostering critically health literate graduates who are empowered to create healthy, just societies. Strategies included the facilitation of discussions to ignite empathy, integrating problem-solving activities and building advocacy competencies. A collaborative, learner-directed approach is considered as a way forward for other university educators, as a way of disrupting previous pedagogic work that emphasises knowing ‘about’ social problems rather than ‘acting on’ them.
Groupness, cohesion, and intention to return to sport: A study of intact youth teams
Authors: Spink Kevin S , McLaren Colin D , Ulvick Jocelyn D
Published: September 2017

The positive benefits for youth participating in sport have been well documented. Yet, keeping athletes returning to sport has been a concern. While various factors have been examined to explain this attrition, facets of the sport group experience have started to emerge. From a group perspective, it has been established that athlete intentions to return to a sport team the following season are positively associated with perceived team cohesion. While cohesion is a key group construct, other group factors are worthy of examination. The purpose of the current study was to build upon the research base by examining whether the relationship between cohesion and intention to return would be moderated by another group factor—the level of groupness ascribed to the team. At the end of a competitive season, youth soccer athletes ( N = 156) completed measures of task cohesion, groupness, and intention to return to their team in the future. Results revealed that the task cohesion-intention to return relationship was significantly moderated by groupness, p = .03. Simple slopes analysis revealed that the strongest relationship between task cohesion and intention to return occurred under conditions of lower groupness. These initial results indicated that intention to return was highest when the team was perceived as higher in task cohesion, regardless of groupness perceptions. However, when the team was perceived to be lower in task cohesion, those who perceived their team as being more like a group indicated a greater willingness to return to the team in the future.
The Day of the Young Combatant, generational struggles in the memory field of post-dictatorship Chile
Authors: Badilla Rajevic Manuela
Published: September 2017

This article explores the multilayered struggles within the memory field in post-dictatorship Chilean society by investigating the Day of the Young Combatant, a commemoration of the murder of two young brothers perpetrated by police officers in 1985. Every 29 March, people born after the end of the dictatorship—members of the post-dictatorship generation—commemorate through cultural activities and violent riots. Since the murder, the commemoration has evolved from local and unofficially recognized to a large-scale, violent event that takes place every year in working-class neighborhoods of Santiago. This article analyzes the contested ways of recalling the murder of these brothers and the multilevel struggle that the post-dictatorship generation engages in to expand the field of memory at three levels: narratives, territories, and practices. It illustrates the multilayered process for negotiating the meanings and time frames to narrate not only the dictatorial past but also the political transition.
Memory, place and gender: Armagh Stories: Voices from the Gaol
Authors: McLaughlin Cahal
Published: September 2017

The film Armagh Stories: Voices from the Gaol (2015)1 is a documentary film edited from the Prisons Memory Archive2 and offers perspectives from those who passed through Armagh Gaol, which housed mostly female prisoners during the political conflict in and about Northern Ireland, known as the Troubles. Armagh Stories is an attempt to represent the experiences of prison staff, prisoners, tutors, a solicitor, chaplain and doctor in ways that are ethically inclusive and aesthetically relevant. By reflecting on the practice of participatory storytelling and its reception in a society transitioning out of violence, I investigate how memory, place and gender combine to suggest ways of addressing the legacy of a conflicted past in a contested present.
Success of scaphoid nonunion surgery is independent of proximal pole vascularity
Authors: Rancy Schneider K. , Swanstrom Morgan M. , DiCarlo Edward F. , Sneag Darryl B. , Lee Steve K. , Wolfe Scott W. ,   Scaphoid Nonunion Consortium
Published: September 2017

We followed 35 consecutive patients with scaphoid nonunions in a prospective longitudinal registry. All nonunions were treated with curettage, non-vascularized autogenous grafting and headless screw fixation. Preoperative magnetic resonance imaging, intraoperative bleeding points and histopathological analysis of cancellous bone in the proximal pole were recorded as measures of viability. Healing was categorized as ≥50% bony bridging on computed tomographic images in the plane of the scaphoid. Nine of 23 proximal poles demonstrated ischaemia on magnetic resonance imaging but none were interpreted as infarcted. Twenty-eight of 33 were found to have impaired vascularity as assessed by intraoperative bleeding. Fourteen of 32 demonstrated ≥50% trabecular necrosis and four of 33 demonstrated ≥50% tissue necrosis on histopathological analysis. Thirty of 33 demonstrated focal or robust remodelling activity. Despite pathological evidence of impaired vascularity in over half of the patients, 33 of the 35 scaphoids had healed by 12 weeks. We conclude that proximal pole infarction is decidedly rare and that vascularized bone grafting is seldom required.

Level of evidence: IV
Breast cancer screening among women in Namibia: explaining the effect of health insurance coverage and access to information on screening behaviours
Authors: Kangmennaang Joseph , Mkandawire Paul , Luginaah Isaac
Published: September 2017

Objectives:

Breast cancer contributes substantially to morbidity and mortality in Namibia as is the case in most countries in Sub-Saharan Africa (SSA). However, there is a dearth of nationally representative studies that examine the odds of screening for breast cancer in Namibia and SSA at large. This paper aims to fill this gap by examining the determinants of breast cancer screening guided by the Health Belief Model.

Methods:

We applied hierarchical binary logit regression models to explore the determinants of breast cancer screening using the 2013 Namibia Demography and Health Survey (NDHS). We accounted for the effect of unobserved heterogeneity that may affect breast cancer, testing behaviours among women cluster level. The NDHS is a nationally representative dataset that has recently started to collect information on cancer screening.

Results:

The results show that women who have health insurance coverage (odds ratio (OR) = 1.62, p ≤ 0.01), maintain contact with health professionals (OR = 1.47, p = 0.01), and who have secondary (OR = 1.38, p = 0.01) and higher (OR = 1.77, p ≤ 0.01) education were more likely to be screened for breast cancer. Factors that influence women’s perception of their susceptibility to breast cancer such as birthing experience, age, region and place of residence were associated with screening in this context.

Conclusions:

Overall, the health belief model predicted women’s testing behaviours and also revealed the absence of relevant risk factors in the NDHS data that might influence screening. Overall, our results show that strategies for early diagnosis of breast cancer should be given major priority by cancer control boards as well as ministries of health in SSA. These strategies should centre on early screening and may involve reducing or eliminating barriers to health care, access to relevant health information and encouraging breast self-examination.
Does structural integrity following rotator cuff repair affect functional outcomes and pain scores? A meta-analysis
Authors: Haque Aziz , Pal Singh Harvinder
Published: September 2017

Background

To assess whether the integrity of rotator cuff repairs has an impact on functional outcomes, as well as pain scores, after surgery.

Methods

Systematic review and meta-analyses performed for Level Ι, ΙΙ and ΙΙΙ studies that presented functional outcome scores and radiological assessment of integrity following rotator cuff repair. Extracted data included patient demographics, functional outcome scores [Constant Score, University of California at Los Angeles (UCLA) shoulder score, American Shoulder and Elbow Surgeons (ASES) shoulder score, visual analogue scale (VAS) Pain score], as well as assessment of repair integrity on radiological investigations. A meta-analysis was performed using weighted means and a random effects model.

Results

Twelve studies were included in the final analysis. Average re-tear rate for the 800 included patients was 22% at a mean follow-up of 27.5 months after surgery. Patients with intact repairs had a significantly higher Constant Score (8.61 points, p < 0.00001), UCLA shoulder score (2.96 points, p < 0.0001) and ASES shoulder score (9.49 points, p < 0.0006). Patients with intact repairs also reported lower pain VAS Pain scores by 0.62 points ( p < 0.0004)

Conclusions

Our results show better functional outcome and pain scores in patients with intact rotator cuffs at follow-up when compared to those that have re-torn. This difference is equivalent to the published Minimal Clinically Important Difference for the ASES but not Constant Scores. This review has also highlighted that shoulder strength in patients with intact cuff repairs is likely to be greater than in patients with a failed repair.
Recent Exposure to Hypoglycemia Increases Glucose Variability Following a Hyper/Hypoglycemic Metabolic Challenge in T1D
Authors: Fabris Chiara , Farhy Leon S. , Anderson Stacey M. , Nass Ralf M. , Kovatchev Boris P. , Breton Marc D.
Published: September 2017

Aims:

In type 1 diabetes (T1D), repeated hypoglycemic episodes may reduce hormonal defenses and increase the risk for severe hypoglycemia. In this work, we investigate the effect of a structured hyper/hypoglycemic metabolic challenge on the postintervention glucose variability in T1D subjects studied at home.

Methods:

Thirty T1D subjects using insulin pump were monitored with blood glucose meters (SMBG) during a 1-month observation period. After 2 weeks of monitoring, participants were admitted at the University of Virginia Clinical Research Unit to undergo an 8-hour metabolic challenge. The intervention was designed to create hyperglycemia shortly followed by hypoglycemia, mimicking a real-life scenario of underbolused meal followed by overcorrection. After the intervention, subjects were monitored for 2 more weeks. Glycemic variability was assessed before and after the challenge using the low blood glucose index (LBGI). Glucagon counterregulation (GCR) response to induced hypoglycemia was also measured. LBGI variation and GCR were linked to prior exposure to hypoglycemia.

Results:

Subjects significantly exposed to hypoglycemia in the 2 weeks before the intervention had a significant increase of postchallenge LBGI ( P < .001) and lower GCR response ( P < .05). Recent occurrence of hypoglycemia and number of years not using an insulin pump were identified as significant predictors of postchallenge LBGI ( P < .001).

Conclusion:

Glycemic swings, a common result of suboptimal insulin treatment, have a significant impact on future (days) glycemic control in T1D subjects with a recent history of hypoglycemia, as measured in the field. Choice of past insulin therapy may also mediate this effect.
Visfatin level in children and adolescents with autoimmune thyroiditis
Authors: Farghaly Hekma Saad , Metwalley Kotb Abbass , Ahmed Faisal-Alkhateeb , Raafat Duaa Mohamed , El-Asheer Osama , Ali Ahmed Mahmood , Bahdawy Ahlam , Zahran Asmaa Mohamed
Published: September 2017

Background:

This study aims to assess the levels of visfatin in children and adolescents with autoimmune thyroiditis (AIT) and its relationship with disease-related variables.

Methods

The study included 84 children and adolescents with AIT and 84 healthy subjects. Measurements of fasting glucose, insulin, thyroid-stimulating hormone (TSH), free thyroxin (FT4), antithyroid peroxidase antibodies (TPOAb) and antithyroglobulin antibody (TgAb) were completed, with assessment of visfatin levels.

Results:

Overt hypothyroidism was diagnosed in 58 cases, while subclinical hypothyroidism was diagnosed in 26 of the studied patients. Total studied cases, overt and subclinical subgroups had significantly higher levels of TSH, HOMA-IR, TPOAb, TgAb and visfatin and significantly lower FT4 level compared with the control. Spearman correlation analysis revealed that visfatin was correlated positively with BMI, homeostasis model assessment (HOMA-IR), TSH and TPOAb, while inversely correlation with FT4. In logistic regression analysis, visfatin was correlated only with TPOAb.

Conclusions:

This preliminary study provides evidence of significantly higher level of visfatin in children and adolescents with AIT. Visfatin might have a potential role in the pathogenesis of AIT, which needs to be validated by measuring immunological responses in children and adolescents with AIT.
The nature of E-learning adoption by stakeholders of a university in Africa
Authors: Ansong Eric , Boateng Richard , Boateng Sheena L , Anderson Augustus B
Published: September 2017

Studies looking at the nature of technology adoption from a multi-dimensional perspective have remained below expectation especially in African countries. This study, therefore, sought to explore the nature of e-learning adoption in the University of Ghana using a multi-stakeholder approach. A quantitative survey approach was adopted for this study. The three major categories of stakeholders (students, instructors and e-learning administrators) responded to a questionnaire on the nature of their engagement with the Sakai Learning Management System of the University of Ghana. The data were analysed using the descriptive statistics. The analysis revealed that e-learning was yet to receive a university-wide adoption and again it was discovered that, the prevalent activity on the e-learning platform was “viewing marks and grades.” And some of the activities were less popular with the users of the e-learning system. For instance, “Detecting and fishing out cheating and plagiarism in students’ or researchers’ work” was the least popular activity on the e-learning platform. The originality of the study lies in the multi-faceted (student, lecturers/instructors and e-learning administrators) approach to the study of e-learning adoption in an African country. The study concludes with a discussion of implications and future research directions.
Disrupting the dissertation: Linked data, enhanced publication and algorithmic culture
Authors: Tracy Frances , Carmichael Patrick
Published: September 2017

This article explores how the three aspects of Striphas’ notion of algorithmic culture (information, crowds and algorithms) might influence and potentially disrupt established educational practices. We draw on our experience of introducing semantic web and linked data technologies into higher education settings, focussing on extended student writing activities such as dissertations and projects, and drawing in particular on our experiences related to undergraduate archaeology dissertations. The potential for linked data to be incorporated into electronic texts, including academic publications, has already been described, but these accounts have highlighted opportunities to enhance research integrity and interactivity, rather than considering their potential creatively to disrupt existing academic practices. We discuss how the changing relationships between subject content and practices, teachers, learners and wider publics both in this particular algorithmic culture, and more generally, offer new opportunities; but also how the unpredictability of crowds, the variable nature and quality of data, and the often hidden power of algorithms, introduce new pedagogical challenges and opportunities.
Evolution of Korea’s mobile technologies: A historical approach
Authors: Jin Dal Yong
Published: September 2017

This paper is to document the evolution of Korea’s mobile technologies. By using a historical approach, which is useful to determine the causes behind the changing processes of new technology, we examine the presmartphone era, focusing on the growth of mobile technologies before the successful launch of Korea’s smartphones in 2009. We divide the presmartphone era into four major periods, including the early mobile technologies period (between the 1980s and 1996), the CDMA period (between 1996 and the early 2000s), the Internet Platform for Interoperability (WIPI) period (2001–2007), and the iPhone period (between 2007 and 2009) before the introduction of locally made smartphones. We investigate multiple causes that led to the rise of the smartphone, both technologies and systems, surrounding the development of the early smartphones by analyzing not only power relations between several major players, such as the government, corporations, and global forces, but also the crucial role of mobile users as customers. We also map out the relationship between socioeconomic transitions and accompanying changes in mobile technologies, which are becoming part of contemporary smartphone technologies.
A large proportion of fecal immunochemical test-positive participants in colorectal cancer screening is symptomatic
Authors: de Klerk Clasine M , van der Vlugt Manon , Bossuyt Patrick M , Dekker Evelien
Published: September 2017

Background

Symptomatic invitees are advised not to participate in colorectal cancer (CRC) screening but to directly consult their general practitioner (GP), because fecal immunochemical test (FIT) sensitivity for cancer is not optimal. This recommendation may not always be followed in daily practice. We evaluated how many FIT-positive participants had CRC-related symptoms and whether the presence of symptoms was associated with the presence and location of CRC/advanced neoplasia.

Methods

We prospectively collected data on CRC-related symptoms in all FIT-positive participants in the Dutch CRC screening program, referred to our endoscopy centers between 2014 and 2016, and evaluated whether symptoms were associated with detected CRC/advanced neoplasia at colonoscopy.

Results

Of 527 FIT-positive participants, 314 had advanced neoplasia, of which 41 had CRC. Overall, 246 (47%; 95% confidence interval (CI) 0.42–0.51) reported CRC-related symptoms. A change in bowel habits (odds ratio (OR) 2.86, CI 1.23–6.62) and visible blood in stool (OR 8.65, CI 2.34–32.0) were associated with the detection of CRC at colonoscopy. We did not observe significant associations between evaluated symptoms and advanced neoplasia.

Conclusions

A large proportion of FIT-positive screening participants have CRC-related symptoms. This suggests that current instructions do not retain symptomatic screening invitees from participation and awareness of CRC-related symptoms is inadequate.
Differential diagnosis of multiple sclerosis in Latin America
Authors: Fragoso YD , Elso FG , Carrá A
Published: September 2017

Improvement of multiple sclerosis (MS) diagnoses leads to earlier and correct disease management. The differential diagnostic workup for MS comprises a large variety of medical conditions. There are general guidelines and criteria for diagnosing MS worldwide, but awareness of regional differences needs to be kept in mind. Latin American patients who are screened for MS diagnoses may require an approach that is not exactly the same as that used for patients in North America, western Europe or Asia. In the present review, the conditions that are important for the differential diagnoses of MS in Latin America are reviewed. They include infections, metabolic diseases, nutritional deficits and other autoimmune conditions that physicians in charge of these patients need to be familiar with.
Application of the McDonald criteria in Latin America
Authors: Patrucco Liliana
Published: September 2017

The diagnosis of multiple sclerosis (MS) is based on neurological symptoms and signs, alongside evidence of dissemination of central nervous system (CNS) lesions in space and time. In the absence of a sensitive and specific diagnostic test, diagnostic criteria are needed for diagnosing MS. The caveat to the application of the McDonald criteria is that alternative diagnoses must be excluded. The prevalence, clinical phenotype and the differential diagnosis of MS may have variations in different populations, especially in Latin America (LATAM). Considering that MS diagnostic criteria were developed with data gathered largely from adult Caucasian European and North American populations, their applicability and accuracy in ethnical/genetic diverse populations may be affected. There are scarce data in our region about the reliability of MS criteria.
Disease-modifying therapies in multiple sclerosis in Latin America
Authors: Skromne-Eisenberg Eli , Ordoñez-Boschetti Laura , Treviño-Frenk Irene
Published: September 2017

The treatment of multiple sclerosis (MS) has become increasingly complex during the last 10 years, mainly because of the advent of new and more potent disease-modifying therapies (DMTs). In Latin America, the therapeutic repertoire available for MS treatment is similar to the one in the rest of the world, but the high costs of these drugs, in conjunction with the limited resources of the social security health systems, makes the treatment of MS more difficult. For neurologists in Latin America, providing personalized MS treatment has become a challenge. We present a review of the status of the DMT in Central and South America, benefits as well as limitations for providing full access to these medications in Latin America.
MS in self-identified Hispanic/Latino individuals living in the US
Authors: Amezcua Lilyana , Oksenberg Jorge R , McCauley Jacob L
Published: September 2017

Self-identified Hispanic/Latino individuals living with multiple sclerosis (MS) in the continental United States (US) are a diverse group that represents different cultural and ancestral backgrounds. A marked variability in the way MS affects various subgroups of Hispanics in the US has been observed. We reviewed and synthesized available data about MS in Hispanics in the US. There are likely a host of multifactorial elements contributing to these observations that could be explained by genetic, environmental, and social underpinnings. Barriers to adequate MS care in Hispanics are likely to include delivery of culturally competent care and social and economic disadvantages. Considerable efforts, including the formation of a national consortium known as the Alliance for Research in Hispanic Multiple Sclerosis (ARHMS), are underway to help further explore these various factors.
Epidemiology of neuromyelitis optica in Latin America
Authors: Alvarenga MP , Schimidt Sergio , Alvarenga RM Papais
Published: September 2017

A major development over the past two decades was the recognition of recurrent neuromyelitis optica (NMO) as a particular central nervous system disorder different from multiple sclerosis (MS). Here we reviewed the epidemiology of NMO in Latin America (LATAM). A predominance of a mixed population is found in this region. Recurrent NMO in black women was described in the Caribbean Islands and in Rio de Janeiro. The prevalence of NMO in LATAM varied from 0.37/100,000 (Volta Redonda city) to 4.2/100,000 inhabitants (Caribbean Islands). NMO differs significantly from MS with respect to gender, ethnicity, morbidity and genetic susceptibility. An association of the HLA DRB1*03 alleles with NMO was described in the French Antilles, Ribeirão Preto, Rio de Janeiro and Mexico. It is not common to find familial forms of NMO. NMO represents 11.8% of all inflammatory idiopathic diseases in South America (SA). In SA, the highest frequency of NMO occurs in African Brazilian young women. The overall relative frequency of NMO among MS cases in this region was 14%, decreasing following a north-south gradient, which parallels the percentage of nonwhite people.