bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy and tolerability of combination treatment of topiramate and greater occipital nerve block versus topiramate monotherapy for the preventive treatment of chronic migraine: A randomized controlled trial
Authors: Chowdhury Debashish , Mundra Ankit , Datta Debabrata , Duggal Ashish , Krishnan Anand , Koul Arun
Published: March 2022

Objective

To compare the efficacy and tolerability of combination treatment of topiramate and greater occipital nerve block to topiramate monotherapy in adult chronic migraine patients.

Background

Options for the preventive treatment of chronic migraine are limited and costly. Combination treatments do not have an evidence base yet.

Methods

This was a parallel group, 3 arms with 1:1:1 allocation ratio randomized controlled study in consecutive adult chronic migraine patients attending Headache Clinic in a tertiary care hospital. Patients received either topiramate monotherapy 100 mg/day (group A), or topiramate plus greater occipital nerve block with 40 mg lidocaine (2%) and 80mg (2 ml) methylprednisolone as the first injection followed by monthly injections of lidocaine for the next 2 months (group B) or topiramate plus greater occipital nerve block with 40 mg lidocaine (2%) injections monthly for 3 months (group C). The primary endpoint was the mean change in monthly migraine days at Month 3. Multiple secondary endpoints were assessed that included among others, achievement of ≥50% reduction in mean monthly headache days compared to baseline at Month 3 and assessment for any adverse events.

Results

One hundred and twenty-five patients were randomized; 41 to group A, 44 to group B, and 40 to group C. Efficacy assessments were done for 121 patients. Patients receiving combination treatment of topiramate and greater occipital nerve block with steroids and lidocaine and greater occipital nerve block with only lidocaine compared to topiramate monotherapy showed greater reductions in monthly migraine days at Month 3 (−9.6 vs −7.3 days; p = 0.003) and (−10.1 vs −7.3 days; p < 0.001) respectively. Greater proportion of patients in both the combination treatment groups (added greater occipital nerve block with and without steroid) achieved ≥50% reduction in mean monthly headache days [71.4% vs 39%; OR (95% CI) 3.9(1.6–9.8); p = 0.004] and [62.4% vs 39%; OR (95% CI) 2.7(1.1–6.7); p = 0.034] respectively, compared to those receiving topiramate monotherapy. Adverse effects between the groups were comparable although patients receiving combination treatment with added greater occipital nerve block reported transient adverse effects like post-injection dizziness, local site swelling, and pain. No serious adverse event was reported.

Conclusion

Combination treatments of topiramate with monthly injections of greater occipital nerve block were more effective in reducing monthly migraine days in chronic migraine than topiramate monotherapy at Month 3. Combination treatments were well tolerated.
Planning Land Use Constrained Networks of Urban Air Mobility Infrastructure in the San Francisco Bay Area
Authors: Yedavalli Pavan , Cohen Adam
Published: March 2022

Urban air mobility (UAM) is a concept envisioning safe, sustainable, affordable, and accessible air transportation for passenger mobility, cargo delivery, and emergency management within or traversing a metropolitan area. While the deployment of UAM will require a network of infrastructure (i.e., vertiports), this emerging concept could face a variety of barriers, such as local opposition, infrastructure costs, and multimodal integration. This paper presents a novel simulation methodology using k-medians clustering and sensitivity analysis to model potential vertiport locations in the San Francisco Bay Area. When controlling for land use characteristics (i.e., parcel size and zoning), the simulation and sensitivity analysis finds that as the number of vertiports increases, the average travel times of trips taken by UAM decrease. The analysis also identifies an inflection point of the number of vertiports at which UAM becomes competitive with driving. The analysis concludes that with respect to size, parcels of 2 acres or smaller are the only locations that allow UAM travel times to be competitive with driving. The paper concludes that neither quantitative nor qualitative factors alone will be sufficient to determine the feasibility of vertiports and overcome community concerns associated with vertiport siting. Metropolitan planning organizations, local governments, and other public agencies will likely need to augment technical analysis with robust stakeholder and community engagement throughout the planning process.
Detection of Residual Flocculant Concentrations in Construction Stormwater Runoff
Authors: Kazaz Billur , Perez Michael A. , Donald Wesley N. , Fang Xing , Shaw Joey N.
Published: March 2022

Flocculants provide an innovative solution for managing construction stormwater runoff with their efficiency in reducing turbidity in the effluent. With proper application and dosage, these chemicals improve the performance of sediment control practices in capturing fine-sized soil particles. Flocculants function by providing electromagnetic charges to attract soil particles into large molecular bridges of flocs. Following this process, suspended particle removal can be achieved through gravitational forces. Despite the benefits of using flocculants, their implementation may create a potential risk of polluting downstream waterbodies and harming aquatic life in case of a high residual concentration in discharge. Determining residual concentrations is challenging for practitioners because of a lack of field applicable testing methods that work across a variety of flocculant types. This study developed a field applicable methodology for detecting residual flocculant concentrations by using settling velocity as an identifier of flocculant concentration. In total, 14 products comprised of polyacrylamide, sodium montmorillonite, chitosan, agricultural gypsum, and alum-based products were evaluated. Known flocculant concentrations ranging from 0% to 30% of the manufacturer’s recommended dosage, were mixed with a fine soil passing through No. 200 sieve and allowed to settle in a graduated cylinder to record the settling velocity. Regression analysis was conducted on the experimental data to develop concentration versus settling velocity relationships which indicated that more than 90% of known concentration values are dependent on the settling velocity. The study provides a framework for practitioners to identify residual flocculant concentrations in field conditions by relating settling velocity with chemical concentrations.
A theoretical framework for explaining the paradox of university rankings
Authors: Kaidesoja Tuukka
Published: March 2022

University rankings have led to the following paradox. On one hand, global and national university rankings have an increasing impact on scientific research and higher education. On the other hand, a growing number of researchers have argued that university rankings are biased and methodologically flawed as well as documented their unintended consequences that are counterproductive to education and research activities in universities. In this article, I combine sociological and cognitive perspectives to develop a theoretical framework for explaining this paradox. The theoretical framework has four interrelated parts. The first is a distinction between three temporal stages through which university rankings commensurate universities. The second consists of an account of the social mechanisms through which university rankings generate reactive outcomes that tend to transform universities instead of just measuring their quality. The third is a league table metaphor that links the conceptual domain of team sports and the conceptual domain of universities and, I argue, provides a cognitive mechanism that shapes how many extra-academic actors, such as prospective students and policymakers, understand the results of university rankings. The fourth focuses on the affordances of the published league tables of university rankings that many extra-academic actors use for outsourcing part of their decision-making to the league tables. As a whole, this framework allows us to understand how the interrelated and materially mediated actions of different groups of actors give rise to and sustain the paradox of university rankings.
Digitally Mediated Mobilization in South Korea: Women’s March and Collective Identity Building Online
Authors: Moon Minyoung
Published: March 2022

This paper explores collective identity building in a feminist online community that in 2018 organized the largest women’s march in South Korean history. Drawing on qualitative and quantitative content analyses of the community’s bulletin boards, this study describes the process through which members of the community developed their cognitive boundaries and their interactional and emotional connections with one another. My finding shows that the language used in the community shifted over time as the participants came to distinguish themselves from other preexisting feminist communities. I argue that protocols set by the leadership team of this online community played an important role in collective identity construction by providing guidelines for boundary drawing and by promoting positive interactions among members. My research also discusses how this leadership operated as “hidden leaders” in shaping collective identity, by navigating the definition of “us” in the context of Korean feminism and encouraging solidarity building among anonymous participants.
Spectrum of Movement Disorders Among Children With Subacute Sclerosing Panencephalitis: A Cross-Sectional Study
Authors: Garg Divyani , Kakkar Vanshika , Kumar Ashna , Kapoor Dipti , Abbey Pooja , Pemde Harish , Mukherjee Sharmila B. , Sharma Suvasini
Published: March 2022

Background: Subacute sclerosing panencephalitis is a progressive devastating condition due to persistence of mutant measles virus, affecting children and adolescents, characterised by myoclonus, seizures, and neuropsychiatric issues. Movement disorders apart from myoclonus are reportedly uncommon. We aimed to describe frequency and proportion of movement disorders among children with subacute sclerosing panencephalitis, hypothesizing that these occur more frequently than previously reported. Methods: In this cross-sectional study, we enrolled children with subacute sclerosing panencephalitis between 1 month and 18 years of age who fulfilled the diagnosis of subacute sclerosing panencephalitis as per modified Dyken criteria, and examined them for movement disorders. We also assessed their clinical profile and disease severity via Jabbour staging and modified Rankin Scale score. We compared demographic, clinical, and laboratory features of children with and without movement disorders. Results: We enrolled 50 children (36 males; 72%) (age range 1.5-14 years). Of these, 28 (56%) had movement disorders. Among movement disorders, the most frequent was myoclonus (92%), followed by ataxia (9; 18%), chorea-athetosis (7; 14%), dystonia (6; 12%), tremor (4; 8%), repetitive behavior (4; 8%), and parkinsonism (3; 6%). Movement disorders were the presenting feature of subacute sclerosing panencephalitis among 7 children. There were no significant differences in clinical or laboratory features among children with and without movement disorders. Conclusions: Movement disorders were frequent in subacute sclerosing panencephalitis. Hyperkinetic disorders were dominant. Dystonia and chorea-athetosis occurred more commonly among nonmyoclonus movement disorders. Movement disorders may manifest even in earlier stages of subacute sclerosing panencephalitis and may be the heralding feature. Recognition of these features is important to plan management and reduce morbidity.
A Novel iOS Data Donation Approach: Automatic Processing, Compliance, and Reactivity in a Longitudinal Study
Authors: Baumgartner Susanne E. , Sumter Sindy R. , Petkevič Vladislav , Wiradhany Wisnu
Published: March 2022

For social scientists who are interested in understanding smartphone-usage patterns, as well as the causes and effects of smartphone use, it is crucial to get accurate estimates of smartphone and app usage. For this reason, we present a novel data donation approach based on screen video recordings of information provided by the iOS Battery Section. In this paper, we describe the Python script that can be used to process the data automatically. Moreover, we tested accuracy of the script, feasibility of the data collection method, as well as compliance and reactivity of the approach among a sample of 93 University students who participated in a 7-day mobile diary study. The findings of the study show that the approach works well, is very feasible and that the script resulted in accurate smartphone use data. Moreover, findings show that compliance rates were rather high, and no substantial signs of reactivity to the method occurred (i.e., participants did not change their smartphone behavior substantially while participating in this study). We therefore hope that the presented approach will encourage future researchers to use this or similar approaches to gain accurate smartphone use data in an ethical way.
Fragmented Capital and (the Loss of) Control over Posted Workers: A Case Study in the Belgian Meat Industry
Authors: Theunissen Anne , Zanoni Patrizia , Van Laer Koen
Published: March 2022

Based on the case of a Belgian meat processing company that relies on posted workers employed by two subcontractors, this study investigates how posting affects client capital’s ability to control labour. Analysed through a Labour Process Theory lens, the findings reveal that posting fragments capital and substantially reduces the client firm’s control over workers’ effort and mobility power. This is due to the low-cost, temporary nature of posting, the disembeddedness of posted workers and their stronger relations with their employer than with the client firm. Competing to control posted labour, both units of capital enact practices commonly associated with trade unions: client capital advocates for posted workers in its interactions with the subcontractor, and the subcontractor promotes posted workers’ reduction of effort and increased mobility against the interests of client capital. Because of their structural vulnerability, posted workers might leverage conflicts within capital to resist the harshest forms of exploitation.
Labour Commodification in the Employment Heartland: Union Responses to Teachers’ Temporary Work
Authors: McGrath-Champ Susan , Fitzgerald Scott , Gavin Mihajla , Stacey Meghan , Wilson Rachel
Published: March 2022

This article analyses the commodification of professional labour and union responses to these processes within the employment heartland. It explores the category of fixed-contract or ‘temporary’ employment using Australian public school teaching as the empirical lens. Established to address intensifying conditions of labour market insecurity, the union-led creation of the temporary category was intended to partly decommodify labour by providing intermediate security between permanent and ‘casual’ employment. However, using historical case and contemporary survey data, we discern that escalation of temporary teacher numbers and intensifying work-effort demands concurrently increased insecurity within the teacher workforce, constituting recommodification. The article contributes to scant literature on unions and commodification, highlighting that within the current marketised context, labour commodification may occur through contradictory influences at multiple levels, and that union responses to combat this derogation of work must similarly be multi-level and sustained.
Pulsation Analysis and Suppression Study of Pump-controlled Motor System Driven by Variable Frequency Permanent Magnet Synchronous Motor
Authors: Su Guoyong , Guo Yongcun , Deng Haishun , Hu Kun , Wang Pengyu , Wang Shuang , Cheng Gang
Published: March 2022

To improve the control accuracy and robustness of variable frequency pump-controlled motor systems, a mathematical model was built to depict the system pulsation caused by the non-uniform magnetic field of a permanent magnet synchronous motor (PMSM), the harmonic current of an inverter and the structure of a plunger pump. At the same time, system pulsations were mitigated by a novel control algorithm based on sliding mode control (SMC) and harmonic suppression compensation. In addition, the performance of the system was analysed under variable load and speed. Under low-speed and heavy-load conditions, the electromagnetic torque of the PMSM and the outlet pressure of the plunger pump fluctuated greatly by traditional controlling, with maximum deviations of 11.719 N•m and 4.63 MPa, respectively. By coordinating SMC and harmonic suppression compensation, the control algorithm reduced the electromagnetic torque and the outlet pressure of the plunger pump to 45% and 40% of the traditional pump-controlled motor system driven by variable frequency PMSM values, respectively. Furthermore, the pulsation coefficient of the PMSM output speed and the hydraulic motor output speed were both controlled within 0.2%.
Effect of Richardson number on double-diffusive mixed convective slip flow, Heat and Mass transfer of MHD Casson fluid
Authors: Nandeppanavar Mahantesh M , Kemparaju MC , Raveendra N
Published: March 2022

An analysis of the heat and mass transfer in a mixed-convective double diffusive flow with convective boundary conditions is carried out in this paper. The governing equations are solved numerically by using Runge-Kutta method with shooting procedure with Matlab software. An accuracy of the numerical procedure has been validated through a results of the current work when compared with prior available results in the literature. The values of shear surface stress, Nusselt and Sherwood number are increasing with increasing values of Prandtl number. The effect of Biot number [Formula: see text] on flow and heat transfer are also investigated and further it is observed that friction coefficient, Nusselt number and Sherwood number are increasing due to enhancing values of Biot number. In the present paper it is noticed that the increasing in estimations of Casson parameter slowdown the heat transfer rate and accelerates mass transfer rate. The results are in good agreement with existing findings The impact of pertinent constraints on distinct flow parameters are determined and analysed through tables and graphs.
A fast matrix generation method for solving entry trajectory optimization problems under the pseudospectral method
Authors: Li Zhaoting , Tang Xiangji , Zhang Hongbo , Tang Guojian
Published: March 2022

A fast matrix generation method based on correlations is proposed for the pseudospectral method (PSM) to solve the entry trajectory optimization problem. First, the optimization problem is analyzed to obtain some assumptions of performance indicators and constraints. Then, the chain rule and correlations among the variables are used to simplify the gradient calculations, resulting in a fast generation method for the gradient vector. Meanwhile, based on the previous assumptions, a fast generation method for the Jacobi matrix is derived semi-analytically using the correlation information among the variables. Finally, the trajectory optimization problem is studied using a typical aircraft. The results are verified via comparisons with the well-known GPOPS II software. Furthermore, the superiority of the proposed method in terms of the computational efficiency is demonstrated by comparing the relevant time indexes. The performance of the proposed method in calculating the Jacobian matrix and gradient matches that of the GPOPS, combined with a relatively short solution time.
Unravelling the Global Britain vision? International relationships and national identity in UK Government documents about Brexit, 2016–2019
Authors: Parnell Tamsin
Published: March 2022

In 2017, the UK Government revealed its vision for a ‘global’ post-Brexit Britain. Despite emerging interest in Global Britain discourses, there has been no diachronic discursive analysis of how the Global Britain vision shifts in relation to the changing socio-political context of Brexit. This article takes a diachronic, corpus-assisted critical discourse approach to UK Government documents published between 2016 and 2019. It reveals changing representations of Anglo-European relations prompted by rising political tensions over Brexit. Focussing on the key semantic domain of Personal Relationships, the paper reveals a move from positive portrayals of a transactional UK-EU relationship towards antagonism and uncertainty. The article illustrates that the increasing improbability of a stronger UK-EU partnership undermines the Global Britain narrative, threatening to position Britain as an international ‘outsider’ and ‘supplicant’.
Seeking safety from male partner violence in Turkey: Toward a context-informed perspective on women's decisions and actions
Authors: Yalcinoz-Ucan Busra
Published: March 2022

Women's stay/leave decision-making in violent relationships has become a subject of investigation in psychology over the last few decades. Despite making significant contributions to the understanding of how women's psychological processes shape their responses to violence, much of this research has lacked a contextualized approach. The present study aimed to provide a feminist context-informed examination of women's decision-making and safety-seeking processes. Twelve women who had experiences of violence in their marital relationships were interviewed individually. The study was carried out in Istanbul, Turkey, and all participants were socioeconomically disadvantaged women. A constructivist grounded theory approach was used for the data analysis. The results indicated that women's helplessness, beyond being a psychological construct, was a reality shaped by the conditions of marginalization in their lives. More than being related to the experience of psychological trauma, the women's narratives revealed the disempowering barriers associated with the lack of socioeconomic and institutional resources. Under these circumstances, regardless of their decisions to stay or leave, the women underlined their ongoing strategic efforts to ensure their safety, as mainly strengthened by the relational support available to them.
Reinforcement learning-based optimal fault-tolerant control for offshore platforms
Authors: Ziaei Amin , Kharrati Hamed , Salim Mina , Rahimi Afshin
Published: March 2022

This article investigates a novel reinforcement learning-based fault-tolerant control approach for steel-jacket offshore platforms. In the first step, the dynamic of the steal-jacket offshore platform with an active mass damper is considered, and the equivalent linear time-invariant model is obtained with the actuator fault. In fault-free conditions, an optimal controller is designed to keep the system stable under external wave force. Subsequently, in faulty conditions, the actuator fault is estimated by the fault observer. Next, by inserting the actuator fault estimation into the cost function, the fault-tolerant control problem transforms into the optimal control problem. The online policy iteration is used to minimize the new cost function. Finally, the final control law, which is a mixture of the nominal and the modified control law, stabilizes the offshore platform and improves its performance in the presence of the actuator fault without needing the complete knowledge of the offshore platform. The simulation results show the effectiveness of the proposed method.
Information literacy in the legal workplace: Current state of lawyers’ skills in Pakistan
Authors: Naveed Muhammad Asif , Shah Naveed Abbas
Published: March 2022

This study investigated the current state of information literacy (IL) skills among lawyers practicing at the District Bar Association of Sargodha, Punjab, Pakistan. A cross-sectional survey using a questionnaire was conducted to collect data from 297 lawyers. The questionnaire comprised 20 statements related to information literacy along with certain demographic variables. Each lawyer was personally visited in the assigned chamber by one of the researchers to record responses. Both descriptive (frequencies, percentages, mean scores, standard deviations) and inferential statistics (Pearson correlation coefficient, t-test, and one-way analysis of variance) were applied for data analysis in SPSS. The results showed that a large majority of lawyers participating in the survey never received any formal training concerning information literacy. However, most of these lawyers perceived IL skills as important in the context of their workplace especially in conducting legal research. These lawyers were more competent in the basic IL skills and less competent in advanced IL skills. In addition, the lawyers’ age, practical experience, practicing levels, computer proficiency, and English Language proficiency predicted their levels of IL skills. There was a critical need for the development of IL instruction programs for not only practicing lawyers but also for law students to improve their skills since these lawyers felt less competent with advanced levels of IL skills. It is hoped that the present study contributes to the existing body of WIL literature focusing especially on the role of IL in the context of legal work and outlining the current state of lawyers’ IL skills in Pakistan as no such study has appeared so far.
Physico-mechanical characterization of poly (butylene succinate) and date palm fiber-based biodegradable composites
Authors: Khlif Mohamed , Chaari Rania , Bradai Chedly
Published: March 2022

The main objective of this research was to study the influence of an enzymatic treatment process of date palm fibers on their chemical and morphological properties as well as the physical and mechanical characteristics of composites filled with raw and treated fibers. To this end, three extraction approaches were considered (a combination of xylanase and pectinase enzymes, xylanase enzymes followed by a pectinase one and pectinase enzyme followed by xylanase). Chemical and morphological analyses were performed on raw and treated fibers. The tensile test of the manufactured composites was achieved, using extrusion and injection molding process. These composites were also subjected to water absorption tests. The results showed that non-cellulosic components decreased after enzymatic treatments while the cellulose content increased significantly. The scanning electron microscope morphological analyses showed that the extraction with the combination of these enzymes is very effective as a fibrillation phenomenon. Composites with high rigidity were observed in the case of enzymatically treated fibers. These composites reveal a better moisture resistance compared to the untreated fibers.
Korean American Immigrant Women’s Perceived Breast Cancer Risk and Prevention Beliefs: A Qualitative Study
Authors: Lee Mi Hwa , Farr Deeonna , Lee Sohye
Published: March 2022

Introduction:

With the goal of informing culturally appropriate intervention strategies, the purpose of this qualitative study was to understand the Korean American immigrant women’s (KAIW) perceptions of breast cancer risk and how their perceived risk, along with normative breast cancer prevention beliefs, shaped their attitudes toward mammography.

Method:

Semi-structured individual interviews were conducted with 30 Korean women in Los Angeles County, Los Angeles, California. Braun and Clarke’s thematic analysis was used to code and analyze interview data.

Results:

Two major themes were identified: (a) perceived risk of breast cancer and attitudes to prevention (e.g., worried and using all means of prevention) and (b) influences on attitudes to breast cancer prevention (e.g., family members and friends’ cancer experiences).

Discussion:

Breast cancer prevention interventions for KAIW should target perceived breast cancer risk, social factors such as women’s family roles and social networks, and health information evaluation skills.
Ghosts of the Titanomachy: Structure, Commitment, Economics, and Risk as Causal Mechanisms in an Online Battle
Authors: Fielder James D.
Published: March 2022

Background

In January 2014 over seven thousand EVE Online players engaged in a 21-h battle that came to be known as the Battle of B-R5RB, in which an estimated $330,000 of virtual property was destroyed, calculated in real U.S. dollars as measured by time.

Aim

To discern why players were willing to commit time and resources to fight in a large-scale virtual battle, which in turn informs how players perceive risk and develop large-scale emergent political structures.

Method

Drawing from multiple case history and journalism reports on the Battle of B-R5RB, the author combines the inductive ideographic case study approach and process tracing method to uncover key causal mechanisms.

Results

The author inductively theorizes that the Battle of B-R5RB resulted from the Null-Sec’s anarchic structure, player commitment to their respective Corporations, measurable economic value, and risk associated with permanent loss. These mechanisms closely align with the offensive realism and anarchy.

Discussion and conclusion

The Battle of B-R5B is a relevant example of real-world emergent political behavior developing in a virtual world setting. Analysis of this single battle suggests that players are willing to project actual value onto virtual assets. Perception of value is magnified in virtual worlds lacking overt governance or security structures. Players must form groups to mitigate risk, and the greater the risk, the greater the commitment to the group.
New Insight into HIV-Related Psychological Distress: A Concept Analysis
Authors: Ma Haiqi , Bu Mengru , Zhai Huimin , Li Bing , Xiong Ling
Published: March 2022

Psychological distress is a frequently reported outcome measure in HIV research. However, because of its poor conceptualization, many studies only partially capture it because they focus solely on depression or anxiety based on symptoms. This study undertook a concept analysis of HIV-related psychological distress (HRPD) using Walker and Avant’s method. The findings include HRPD’s (a) attributes, including changes to emotional status, symptom burden, HIV disclosure distress and HIV-related stigma; (b) antecedents, including HIV-related stressors, cognitive appraisal of stressors and difficulty coping with the disease or treatment; and (c) consequences, including poor health outcomes and posttraumatic growth. Lazarus and Folkman’s theory and the conservation of resources theory were adapted to further understand HRPD. This article provides insight into HRPD and increases the awareness of how to screen and assess HRPD at an early stage. The findings indicate the need to develop specific and rigorous measures and to provide appropriate interventions.
An Algorithmic Approach for Deploying Buccal Fat Pad Flaps and Buccal Myomucosal Flaps Strategically in Primary and Secondary Palatoplasty
Authors: Qamar Fatima , McLaughlin Mariel M. , Lee Matthew , Pringle Aleshia J. , Halsey Jordan , Rottgers S. Alex
Published: March 2022

Objective

Recent publications have introduced the use of buccal myomucosal and fat pad flaps to augment palatal repairs with autologous tissue. We propose a workflow for intraoperative decision-making to introduce these adjuncts into standard palatoplasty procedures.

Design/Patients

A retrospective chart review of a single-surgeon series of patients undergoing primary and secondary palatoplasties performed between October 2017 and November 2020 was completed after Institutional Review Board approval.

Main Outcome Measures

Patient demographics, phenotype, operative details, and postoperative complications were recorded.

Results

Fifty-eight patients were included in a review. For those undergoing primary repair, 23.3% underwent a Furlow palatoplasty alone, 46.3% had a Furlow palatoplasty accompanied with acellular dermal matrix (ADM) and/or a buccal fat flap (BFF). A unilateral buccal myomucosal flap (BMMF) with or without augmentation with BFF or ADM was employed in 16.3% of the cases. Fourteen percent required a bilateral BMMF+/− ADM. Fistula occurrence was 2.3% (n = 1). For revisions, 27% underwent only a conversion Furlow palatoplasty, 26% had a conversion Furlow palatoplasty accompanied with ADM and/or a BFF, 33% had a unilateral BMMF or BMMF/ADM, and 14% required a bilateral BMMF+/− ADM.

Conclusions

In severe phenotypes or complicated cases, buccal fat flaps and myomucosal flaps may be utilized. This approach has mostly replaced the use of ADM over time. An algorithmic approach to palatoplasty allows surgeons to tailor the extent of surgery to the needs of each patient.
Return to Physical Activity Following Flatfoot Reconstruction
Authors: Fuller Robert M. , Eble Stephanie K. , Day Jonathan , Cororaton Agnes D. , Rajan Lavan , Deland Jonathan T. , Kumar Prashanth , Ellis Scott J.
Published: March 2022

Background:

Progressive collapsing foot deformity (PCFD) is a debilitating condition encompassing several interrelated, progressive deformities requiring a combination of reconstructive procedures. Few studies investigate returns to activity following flatfoot reconstruction, and existing studies only examine 1 or 2 of the numerous procedures employed. This study aims to provide the first generalizable assessment of returns to sports and physical activity following reconstruction surgery in patients with flexible flatfoot deformity.

Methods:

Patients aged 18-60 years who underwent reconstructive surgery between February 16 and May 19 for symptomatic flexible-stage flatfoot deformity were identified by registry review. Eighty-two of 113 eligible patients (73%) were reached at a mean 2.9 years (range, 2.0-5.4) of follow-up with mean age at surgery of 48.9 years (range, 18-59). Returns to physical activity were evaluated with a sports-specific survey. Clinical outcomes were evaluated with Patient-Reported Outcomes Measurement Information System (PROMIS) scores.

Results:

Patients reported participation in 21 specific sports and activities. One-fourth (25.6%) of patients (21/82) reported increased difficulty with physical activities postoperatively, 15.9% reported equal difficulty, and 58.5% (48/82) reported decreased difficulty. Median return times were 9-12 months for participation and 12-18 months to reach maximum preoperative participation levels. Improvements in Physical Function ( P= .001), Pain Interference ( P < .001), Pain Intensity ( P <.001), and Global Physical Health ( P = .004) were associated with increased satisfaction with respect to sports and physical activities.

Discussion:

This study investigated participation in specific sports and physical activities following flatfoot reconstruction. Our findings suggest mixed outcomes, where many patients reported life-changing improvements but many also experienced prolonged pain and difficulty after surgery. Some patients reported increased difficulty or inability to return to their preoperative maximum level of participation, indicating that flatfoot reconstructions can lead to athletic limitations.

Conclusion:

Although flatfoot reconstruction can be a powerful tool to increase patients’ capacity to engage in physical activity, in our cohort many patients had reduced physical activity outcomes.

Level of Evidence:

Level IV, retrospective case series.
Predictive Model of Early Death of Resectable Pancreatic Ductal Adenocarcinoma After Curative Resection: A SEER-Based Study
Authors: Liu Weikang , Ma Yongsu , Tang Bingjun , Qu Chang , Chen Yiran , Yang Yinmo , Tian Xiaodong
Published: March 2022

Objective

This study aims to determine the factors that predict early death and establish a predictive model for early death by analyzing clinical characteristics of patients with resectable pancreatic ductal adenocarcinoma (R-PDAC) who die early after radical surgery.

Materials and Methods

This was a retrospective study of patients who underwent radical surgical resection for R-PDAC in the Surveillance, Epidemiology, and End Results (SEER) database. Patients with overall survival ≤ 12 months were assigned as early death group and above 1 year as the late death group. Univariate and multivariate logistic regression was conducted to identify factors significantly associated with early death. An early death predictive model was constructed based on the identified independent risk factors.

Results

A total of 9695 patients were analyzed, and the total incidence of early death was 30.72%. Multivariable analysis showed that factors significantly associated with early death included age at diagnosis, race, marital status, tumor location, tumor size, tumor grade, number of positive lymph nodes, number of examined lymph nodes, positive lymph node ratio, chemotherapy, and radiotherapy. The predictive model showed good discrimination with a C-index of 0.722 (95% confidence interval: 0.711-0.733) and convincing calibration.

Conclusions

We developed a predictive model that may be easily applied to patients with R-PDAC after radical resection to predict the chance of death within 1 year. For patients with high risk of early death, neoadjuvant therapy should be considered. Even after radical resection, more aggressive adjuvant chemotherapy (with or without combined radiotherapy) must be used to minimize the chance of early death.
Common—Reading—Placing—Writing
Authors: Badley Graham Francis
Published: March 2022

I create here another sort-of-life text, a narrative in which I suggest ways in which we could or should practice human approaches to reading and writing. I patch together scraps recovered from the rubbish heap of my own personal and professional history.
Do You Have a Dick? The Emergence of a Transgender Woman From a Stolen Past
Authors: Edington Elizabeth J.
Published: March 2022

The purpose of this narrative study is to understand the experience of a transgender woman through the process of self-discovery in contrast to a society often in opposition to transness in a rural town in the Rocky Mountain region. The findings of this study illustrate the perseverance of gender identity despite personal and cultural obstacles. The results provide further evidence of gender identity as personal, persistent, developing, and undeniable. The alternative writing of this story is designed to capture the unique story of a young woman whose trans community has been overlooked by traditional research writing.
Lacrimal imaging findings in fellow asymptomatic eyes of unilateral epiphora
Authors: Macri Carmelo , Shapira Yinon , Selva Dinesh
Published: March 2022

Aims

To investigate the prevalence of subclinical anatomical and functional abnormalities of lacrimal drainage in fellow asymptomatic eyes of unilateral epiphora using dacryocystography and dacryoscintigraphy.

Methods

Retrospective case note review of lacrimal imaging of adult patients presenting to a hospital Oculoplastic clinic with unilateral epiphora over 10 years.

Results

A total of 172 patients with unilateral epiphora were included. The median age was 67 (range 18–96 years). A dacryoscintigraphy (DSG) abnormality was present in 54 (42%) asymptomatic eyes, and dacryocystography (DCG) abnormality in 10 (10%). The most common finding on DSG was no delay in 76 eyes (58%), and most common DSG abnormality was post sac delay in 51 (39%) eyes. The most common finding on DCG was no obstruction in 88 (90%) eyes, and the most common DCG abnormality was post sac stenosis (7.1%). Of the 92 asymptomatic eyes with both DCG and DSG, 53 (57%) showed neither an obstruction on DCG or delay on DSG, and 28 (30%) showed a post sac delay on DSG and no abnormality on DCG.

Conclusion

Greater than a third of asymptomatic eyes displayed post sac delay on DSG, frequently without accompanying anatomical obstruction on DCG. Subclinical DSG delay in asymptomatic eyes may represent physiological variation in tear transit time, subclinical lacrimal drainage dysfunction or anatomical stenosis undetected by DCG. Furthermore, the DSG results of fellow asymptomatic eyes in unilateral epiphora may not represent a normal standard that can be utilised for comparison. Further investigation with dacroyendoscopy, the use of control eyes, and long term follow up is required.
Primary total hip arthroplasty in patients older than 90 years of age: a retrospective matched cohort study
Authors: Kurapatti Mark , Patel Vaidehi , Arraut Jerry , Oakley Christian , Rozell Joshua C , Schwarzkopf Ran
Published: March 2022

Introduction:

Advanced age is considered a major risk factor for postoperative complications in total hip arthroplasty (THA). Consequently, older patients undergoing THA may require more detailed pre-procedural examinations and more healthcare resources postoperatively than younger patients. The purpose of this study was to compare discharge parameters and complication rates of THA in patients ⩾90 years old to those <90 years old.

Methods:

A retrospective review of 14,824 THA patients from 2011 to 2021 at a high-volume, urban academic centre was conducted. Patients ⩾90 years old were propensity-matched to a control group of patients aged <90 years old. Patient demographics, surgical time, hospital length of stay (LOS), discharge disposition, and 90-day revision, readmission, and mortality rates were collected. Demographic differences and outcomes were assessed using chi-square and independent sample t-tests.

Results:

After propensity matching, the average age in the younger cohort (YC, n = 54) was 75.81 ± 7.89, and 91.61 ± 1.73 for the older cohort (OC, n = 54). The OC had a longer LOS than the YC (mean 3.90 vs. 3.06 days; p = 0.031). Discharge disposition significantly differed ( p = 0.007); older patients were more likely to be discharged to skilled nursing facilities (33.3% vs. 14.8%) or acute rehabilitation centres (14.8% vs. 3.7%) and less likely to be discharged to prior place of residence (home self-managed/home with services, 51.9% vs. 79.6%). There was no significant difference in surgical time (93.87 ± 29.75 vs. 96.09 ± 26.31 min; p = 0.682), 90-day revision rate (3.7% vs. 0%; p = 0.153), 90-day readmission rate (9.4% vs. 3.7%; p = 0.543), and 90-day mortality rate (1.9% vs. 1.9%; p = 1.000).

Conclusions:

Although THA patients over 90 years of age had a longer LOS and differing discharge disposition, these patients had similar complications compared to their younger counterparts. Thus, our study supports similar efficacy of THA in patients 90 years and older relative to younger THA candidates.
Utilization of Prognostic Biomarker Soluble Urokinase Plasminogen Activator Receptor in the Emergency Department: A Tool for Safe and More Efficient Decision-making
Authors: Holstein Ria M , Mäkinen Marja T , Castrén Maaret K , Kaartinen Johanna M
Published: March 2022

Introduction:

Risk stratification in the emergency departments (EDs) is in critical need for new applications due to ED overcrowding and hospitalization of older people. We aimed to evaluate the expediency, efficiency and safety of a prognostic biomarker, soluble urokinase plasminogen activator receptor (suPAR), as a tool for the risk assessment of patients arriving at the ED.

Methods:

We performed a comparative cross-sectional study in 2 emergency departments (EDs), suPAR measurements being incorporated into routine blood sampling in the intervention ED. The primary outcome was the number of discharges from the ED. The importance of the outcomes was examined by appropriate multi- or bivariate analysis.

Results:

The absolute and relative number of discharges were similar between the intervention and control groups [121 (55.3%) vs 62 (55.9%)]. No significant differences between the groups were seen in the length of stays in the ED. Patients with low suPAR values were more likely discharged and patients with high suPAR values more likely admitted to hospital. Two admitted patients with low suPAR values could have been discharged safely.

Conclusion:

The utilization of suPAR did not increase the risk for neither positive nor negative outcomes. Low suPAR values could be potential in discharging more patients safely. Instead of unselected patient populations, the benefits of suPAR measurements in the ED could emerge in the assessment of a more precisely determined and selected group of patients.
Film Thickness in Elastohydrodynamically Lubricated Slender Elliptic Contacts: Part II – Experimental Validation and Minimum Film Thickness
Authors: Wolf Marius , Sperka Petr , Fryza Josef , Fatemi Arshia
Published: March 2022

In the first paper of this series, a new formula for central film thickness of slender contacts has been proposed. In this paper, interferometry measurement of the film thickness in slender elliptic contacts is performed for comparison with film thickness distribution of EHL simulation. The new film thickness formula presented in part I of this paper series is successfully validated by comparison with the experimental data. State-of-the-art minimum film thickness formulas are compared with the experimental results and results obtained through a multilevel EHL solver. Significant deviation of the analytical minimum film thickness formulas regarding both numerical and experimental results is given. Therefore, an alternative approach for calculation of minimum film thickness via the film thickness ratio with central film thickness is proposed, which yields promising results for moderately slender elliptic EHL contacts.
Effect of siponimod on magnetic resonance imaging measures of neurodegeneration and myelination in secondary progressive multiple sclerosis: Gray matter atrophy and magnetization transfer ratio analyses from the EXPAND phase 3 trial
Authors: Arnold Douglas L , Piani-Meier Daniela , Bar-Or Amit , Benedict Ralph HB , Cree Bruce AC , Giovannoni Gavin , Gold Ralf , Vermersch Patrick , Arnould Sophie , Dahlke Frank , Hach Thomas , Ritter Shannon , Karlsson Göril , Kappos Ludwig , Fox Robert J ,   for the EXPAND Clinical Investigators
Published: March 2022

Background:

Magnetic resonance imaging (MRI) measurements of gray matter (GM) atrophy and magnetization transfer ratio (MTR; correlate of myelination) may provide better insights than conventional MRI regarding brain tissue integrity/myelination in multiple sclerosis (MS).

Objective:

To examine the effect of siponimod in the EXPAND trial on whole-brain and GM atrophy, newly formed normalized magnetization transfer ratio (nMTR) lesions, and nMTR-assessed integrity of normal-appearing brain tissue (NABT), cortical GM (cGM), and normal-appearing white matter (NAWM).

Methods:

Patients with secondary progressive multiple sclerosis (SPMS) received siponimod (2 mg/day; n =1037) or placebo ( n = 523). Endpoints included percentage change from baseline to months 12/24 in whole-brain, cGM, and thalamic volumes; change in nMTR from baseline to months 12/24 in NABT, cGM, and NAWM; MTR recovery in newly formed lesions.

Results:

Compared with placebo, siponimod significantly reduced progression of whole-brain and GM atrophy over 12/24 months, and was associated with improvements in brain tissue integrity/myelination within newly formed nMTR lesions and across NABT, cGM, and NAWM over 24 months. Effects were consistent across age, disease duration, inflammatory activity subgroups, and disease severity.

Conclusion:

Siponimod reduced brain tissue damage in patients with SPMS as evidenced by objective measures of brain tissue integrity/myelination. This is consistent with central nervous system (CNS) effects observed in preclinical models. ClinicalTrials.gov number: NCT01665144.