bluuebunny/crossref_metadata_2025 huggingface dataset:
Water Law in Circular Economy: Ultra Vires Actions in Environmental Sector, or when Union Ambition Far Exceed its Abilities
Authors: Di Marco Antonio
Published: January 2022

Water management has an important role to play in the circular economy transition, through the water treatment and reuse. Its optimal and coherent regulation is also of vital common interest, since water knows no borders or lines artificially set out by the States and the dramatic overconsumption and pollution of freshwater are threatening irreparable damage to the world's ecosystems. However, States are reluctant to common regulations, which would have important economic impacts. International and regional organizations face with the fundamental principle of permanent sovereignty of States over natural resources. By analysing the European environmental competence, this study examines the role of Union water law in green economic transition. By investigating the interdependent relationships between the several elements of the water management, the essay suggests that territory use and economic town and country planning would be drawn into the scope of Treaties because of the integrated nature of water services. The case of water reuse illustrates limits and perspectives of the European objective to promote rational utilization of natural resources and combat climate change, introducing the idea according to which freshwater is a European res communis on which the sovereign right of European Union Member States over their own natural resources could be lawfully limited.
Standard of Care for Patients With Cleft Lip and Palate in India—A Questionnaire-Based Study
Authors: Batra Panchali , Sybil Deborah , Izhar Arisha , Batra Puneet , Thiruvenkatachari Badri
Published: January 2022

A national survey of cleft teams was undertaken to evaluate the current standard of care for patients with cleft lip and palate (CLP) in India as a part of Cleft Care India study.

This was a cross-sectional questionnaire-based study.

Cleft teams across India attending the 19th Annual Conference of the Indian Society of Cleft Lip and Palate were invited to complete the questionnaire. The questionnaire consisted of 18 questions that included demographics, institutional details, patient protocols, surgical technique, rehabilitation facilities, and accessibility. The data are descriptively reported.

A total of 112 centers completed the survey. Nongovernment organizations funded 87% of the cleft centers and 8% did not receive any funding. Only 39% of the centers had centralized cleft services providing multidisciplinary care. Speech therapy was provided either onsite or through referral at 90% of the centers, whereas audiology was provided only at 4% of centers. Feeding advice was routinely provided in 52% of centers. Millard technique was the most preferred technique for unilateral cleft lip repair (66%). The 2-flap technique (37%) and pharyngeal flap (48%) were the most common surgeries for cleft palate and pharyngoplasty, respectively. Although 54% of centers reported their patients to be interested in comprehensive care, 43% reported that their patients only wanted surgical correction.

There is wide diversity in access to cleft care and clinical practices across centers in India. Further work is needed to evaluate the quality of care by assessing outcomes of centers treating patients with CLP.
Evaluation of Dimension and Bridging of Sella Turcica and Presence of Ponticulus Posticus in Individuals With and Without Cleft: A Comparative Study
Authors: Mosavat Farzaneh , Sarmadi Sarvin , Amini Amirhesam , Asgari Mohadeseh
Published: January 2022

Objective

Sella turcica abnormalities such as sella turcica bridging (STB) have been observed frequently among patients with craniofacial anomalies. Ponticulus posticus (PP) is an important structure and its presence causes complications during surgeries. Due to the importance of these structures, this study aimed to evaluate the prevalence of STB, PP, and dimensions of the sella turcica in individuals with and without cleft.

Design

A cross-sectional study.

Setting

Orthodontic and Radiology Departments in a public dental school, Tehran, Iran.

Patients

Eighty-three lateral cephalograms of individuals with cleft and ninety-two cephalograms of class I individuals without cleft.

Main outcome measures

Length, depth, and maximum anterior–posterior diameter (APD) of sella turcica, presence of STB (classified as types 1, 2, and 3), and PP.

Results

In the group with cleft, 19.3% of individuals had type I, 65.1%, type II, and 15.7%, type III STB. In the group without cleft, 15.2% had type I, 73.9%, type II, and 10.9%, type III STB. In the group with cleft, 65.1% of individuals had no PP, 24.1%, incomplete, and 10.8%, complete PP while in the group without cleft, 56.5% had no PP, 29 31.5%, incomplete, and 12%, complete PP.

Conclusion

The sella turcica dimensions, STB, and PP prevalence were not significantly different between individuals with and without cleft. The sella turcica length and prevalence of STB and PP were not affected by age, sex, and cleft type. However, the depth and the APD were affected by age.
Diagnostic Protocols for Alveolar Clefting and Barriers to Acquiring Imaging: A Survey of ACPA-Approved Cleft Teams in the United States
Authors: Preston Kathryn , Chen Lucia , Brennan Tyler , Sheller Barbara
Published: January 2022

Objective

To report current diagnostic protocols, practices, and barriers related to imaging of alveolar clefting among American Cleft Palate-Craniofacial Association (ACPA)-approved cleft/craniofacial teams.

Methods

An electronic survey was sent to 162 ACPA-approved teams in the United States. Key items were team location, venue of orthodontic treatment, imaging modality(s) and access, barriers to imaging, billing, imaging protocols including team members involved in decisions pre- and post-alveolar bone grafting (ABG), and craniofacial fellowship status of team orthodontist(s).

Results

A total of 66 responses were received (40.7%). Responding teams were university-based (47%), hospital-based (42.4%), and independent clinics (10.6%). Orthodontic treatment for most patients was in private practice (53%). On-site 2-dimensional (2D) and 3-dimensional (3D) dental imaging capabilities were reported by 42% of teams; 29% have no on-site imaging. One or more barrier(s) to acquiring imaging were reported by 67%, with insurance challenges reported by 47%. Most teams bill medical payors for cleft-related dental imaging (58%). Pre- and post-ABG imaging was most frequently 3D (35% and 36%, respectively). Surgeons and orthodontists commonly evaluate ABG timing and outcome together (53%-65%). Periapical radiographs were included significantly more often in cleft imaging protocols by orthodontists with versus without fellowship training ( P = .011, P = .04).

Conclusions

Barriers to acquiring imaging are frequent. 3D is the most common imaging pre- and post-ABG. Our study endorses multi-level advocacy for improved medical insurance coverage of diagnostic cleft-related dental imaging to decrease barriers to providing timely care.
The Role of Problem-Solving Skills in Career Decision-Making Self-Efficacy and Vocational Outcome Expectations
Authors: Odacı Hatice , Çıkrıkçı Neslihan , İrem Değerli Fatma
Published: January 2022

The aim of this study was to determine the role of university students’ problem-solving skills in their career decision-making self-efficacy and vocational outcome expectations (VOE). The research study group comprised 327 female (70.6%) and 136 male (29.4%) students; a total of 463. Statistical analysis showed positive significant correlations between problem-solving points, career decision-making self-efficacy, and VOE. Additionally, problem-solving points explained 25% of variability in career decision-making self-efficacy and 17% of variation in VOE. The results were interpreted in comparison with literature findings and recommendations proposed for applications and similar research to be completed in the future.
Primary Intranodal Epithelioid Hemangioendothelioma with Molecular Confirmation
Authors: Vazzano Jennifer L. , Patton Ashley , Tinoco Gabriel , Iwenofu O. Hans
Published: January 2022

Epithelioid hemangioendothelioma (EHE) is a rare low-grade malignant vascular tumor with indolent biology, characterized by reciprocal t(1;3)(p36.6;q25) with resultant WWTR1::CAMTA1 gene fusion in the vast majority of cases, regardless of anatomic location. Only a small subset, exhibiting well formed vasoformative features will contain YAP1::TFE3 gene fusion. Primary intranodal EHE is exquisitely rare. We report a case in a 54-year-old male with persistent left groin mass with discomfort for nine months. A CT of the abdomen and pelvis showed a minimally enlarged left inguinal lymph node measuring 2.8 cm with no other masses or lymphadenopathy. PET/CT and MRI imaging of the abdomen showed no evidence of disease elsewhere. Sections showed an epithelioid vasoformative neoplasm, centrally necrotic and involving a lymph node. The cells were arranged in anastomosing cords with intracytoplasmic lumens, resembling “signet ring cells". By immunohistochemistry, the tumor cells were positive for vimentin, CD31, CD34, ERG and CAMTA1; and negative for AE1/3, CAM 5.2, KRT7, KRT20, desmin, actin, HMB-45 and S-100. Ki-67 proliferation index was estimated at <1%. Molecular studies including next generation sequencing (NGS) revealed the presence of WWTR1 :: CAMTA1 gene fusion, and fluorescence in situ hybridization for CAMTA1 (1p36.23) and WWTR1 (3p25.1) showed fusion signals, diagnostic of EHE. We highlight a rare occurrence of EHE in a lymph node exhibiting morphologic mimicry with metastatic carcinoma.
Keratin 7 and ERBB2 Negative Mammary Paget Disease Without an Underlying in Situ and Invasive Carcinoma
Authors: Ratiani Mariam , Farooq Ayesha , Jorns Julie , Sheinin Yuri
Published: January 2022

We report a unique case of a post-menopausal female who presented with a lesion on the areola. A biopsy of the lesion demonstrated a pagetoid intraepithelial neoplasm suggesting a differential diagnosis of mammary Paget disease and pagetoid Bowen disease. Excision of the lesion confirmed the diagnosis of mammary Paget disease with typical histological appearance. This case is extremely rare since both keratin 7 and ERBB2 were negative, and there was no evidence of underlying in situ or invasive carcinoma.
Findings From an Empirical Exploration of Evaluators’ Values
Authors: LaVelle John M. , Stephenson Clayton L. , Donaldson Scott I. , Hackett Justin D.
Published: January 2022

Psychological theory suggests that evaluators’ individual values and traits play a fundamental role in evaluation practice, though few empirical studies have explored those constructs in evaluators. This paper describes an empirical study on evaluators’ individual, work, and political values, as well as their personality traits to predict evaluation practice and methodological orientation. The results suggest evaluators value benevolence, achievement, and universalism; they lean socially liberal but are slightly more conservative on fiscal issues; and they tend to be conscientious, agreeable, and open to new experiences. In the workplace, evaluators value competence and opportunities for growth, as well as status and independence. These constructs did not statistically predict evaluation practice, though some workplace values and individual values predicted quantitative methodological orientation. We conclude by discussing strengths, limitations, and next steps for this line of research.
Effects of a New York Medicaid Care Management Program on Substance Use Disorder Treatment Services and Medicaid Spending: Implications for Defining the Target Population
Authors: Neighbors Charles J , Yerneni Rajeev , Sun Yi , Choi Sugy , Burke Constance , O’Grady Megan A , McDonald Rebecca , Morgenstern Jon
Published: January 2022

Aims:

We examined the effects of a statewide New York (NY) care management (CM) program for substance use disorder (SUD), Managed Addiction Treatment Services (MATS), on SUD treatment services’ utilization and spending among patients with a recent history of high Medicaid spending and among those for whom a predictive algorithm indicates a higher probability of outlier spending in the following year.

Methods:

We applied difference-in-difference analyses with propensity score matching using NY Medicaid claims data and a state registry of SUD-treatment episodes from 2006 to 2009. A total of 1263 CM enrollees with high SUD treatment spending (>$10K) in the prior year and a matched comparison group were included in the analysis. Crisis care utilization for SUD (detoxification and hospitalizations), outpatient SUD treatment, and Medicaid spending were examined over 12 months among both groups. CM effects among predicted high-future-spending patients (HFS) were also analyzed.

Results:

CM increased outpatient SUD treatment visits by approximately 10.5 days (95% CI = 0.9, 20.0). CM crisis care and spending outcomes were not statistically different from comparison since both conditions had comparable pre-post declines. Conversely, CM significantly reduced SUD treatment spending by approximately $955 (95% CI = −1518, −391) and reduced days of detox utilization by about 1.0 days (95% CI = −1.9, −0.1) among HFS.

Conclusion:

Findings suggest that CM can reduce SUD treatment spending and utilization when targeted at patients with a greater likelihood of high future spending, indicating the potential value of predictive models to select CM patients.
Association Between Tryptophan Metabolites, Physical Performance, and Frailty in Older Persons
Authors: Al Saedi Ahmed , Chow Sharron , Vogrin Sara , Guillemin Gilles J , Duque Gustavo
Published: January 2022

Frailty is defined as a syndrome of physiological decline in late life, characterized by marked vulnerability to adverse health outcomes. A robust biomarker for frailty is still lacking. Tryptophan (TRP) metabolism through the kynurenine pathway (KP) plays essential roles in aging, the musculoskeletal system, and physical performance. In this study, we quantified 7 KP metabolites, including kynurenine (KYN), kynurenine acid (KYNA), quinolinic acid (QUIN), picolinic acid (PIC), 3-hydroxykynurenine (3-HK), 3-hydroxyanthranilic acid (3-HAA), and anthranilic acid (AA) using ultra-high-performance liquid chromatography and gas chromatography-mass spectrometry in the serum of 85 participants (median age 75; 65% female; 28 non-frail, 29 pre-frail, and 28 frail) at the Nepean Osteoporosis and Frailty (NOF) Study. We looked at the association between TRP metabolites and physical performance, sarcopenia, and frailty. After adjusting for age and sex, our results showed that KYN and KYN/TRP were associated with higher interleukin (IL)-6 levels ( r = .324 and r = .390, respectively). KYNA and its ratios to other products (mainly KYNA/KYN, KYNA/QUIN, and KYNA/PIC) were associated with a lower likelihood of frailty by Fried’s criteria (OR 0.93 [0.88, 0.98], P = .009) and Rockwood index ( r = −.241, P = .028) as well as a lower likelihood of sarcopenia (OR 0.88 [0.78, 1.00], P = .049). QUIN and QUIN/KYN showed an association with increased IL-6 ( r = .293 and .204 respectively), higher likelihood of frailty (OR 1.02 [1.00, 1.04], P = .029 and OR 6.43 [2.23, 18.51], P = .001 respectively) and lower physical function ( r = −.205 and r = −.292). In conclusion, different TRP metabolites have various associations with physical performance, frailty, and sarcopenia. Defining the underlying mechanisms may permit the development and validation of new biomarkers and therapeutics for frailty and musculoskeletal conditions targeting specific metabolites of the TRP catabolic pathway.
The pink line across digital publics: Political homophobia and the queer strategies of everyday life during COVID-19 in Turkey
Authors: Altay Tunay
Published: January 2022

COVID-19 has precipitated an increase in political homophobia in Turkey. This article focuses on the interlocking processes of LGBTQ marginalization and exclusion in Turkey with the purpose of uncovering how political homophobia is enforced, experienced, and navigated by LGBTQ people in Turkey during the COVID-19 pandemic. With the help of two critical conceptual tools, pink line and queer strategies, I first propose a multi-layered conceptualization of political homophobia that is drawn through (1) anti-LGBTQ boundary regimes that shape the everyday lives of LGBTQ people and (2) sexualized bordering processes that filter and block digital LGBTQ representation and visibility in Turkey’s digital publics. I then analyze the everyday strategic uses of digital platfroms by LGBTQ activists and community organizers in Turkey. Invested in this complexity, this article draws from the ethnographic data of 20 interviews with LGBTQ people whose lives have crossed paths in several digital LGBTQ groups during the pandemic. Henceforth I argue that these digital LGBTQ groups have facilitated ways of connectivity among LGBTQ people in Turkey which limit exposure to the COVID-19 virus while partially freeing them from the restrictive limits of the nation-state and its political homophobia.
Prototyping policy: Visualizing impact for better regulation
Authors: McNealy Jasmine E , Jen Dennis , Nguyen Stephanie
Published: January 2022

A stark divide often exists between a policy’s goals and its implementation. This policy “implementation gap,” signals a failure to take into consideration the complexity of a system or issue. Failure often results in policy that is a misfit for the issue of concern and is lacking in the hoped for remedial or preventative impacts. This study explores policy prototyping as a remedy for policy failures in bills aimed at privacy protection. After selecting three privacy-related bills, we created prototypes that represented one of many ways that privacy policy could be translated into features in online platforms. Using the prototypes, we conducted 41 semi-structured interviews to gather feedback and insights on the challenges with the laws. Our findings illustrate how different roles emphasize protections, harms, and word choice when communicating levers of change like civil rights protections in law to privacy design elements. This solidified the opportunities to better bridge policy and practice by outlining common and distinct bill themes.
Gestalt contexture and contested motives: Understanding video evidence in the murder trial of Officer Michael Slager
Authors: Watson Patrick G
Published: January 2022

This article is situated in ongoing discussions about the influx of images of police violence. To date, much scholarship has centred on Foucauldian notions of knowledge-power and sousveillance. Alternatively, I attend to how video evidence produces understanding of police violence in court through a case study of the murder trial of Officer Michael Slager who shot and killed Walter Scott in North Charleston, South Carolina. While audio and video direct evidence of the moments leading up to Slager's decision to shoot was presented, cross-examination focused more explicitly on post-shooting conduct as circumstantial evidence. This approach highlights an issue for video evidence, that what is to be settled at trial may not be directly re-presented in video. Gurwitsch's notion of Gestalt and Garfinkel's adaptation thereof are proposed as an alternative means of interrogating video evidence.
Shear strength of shear-critical rectangular hollow reinforced concrete columns: Experiments and analysis
Authors: Li Xingqian , Zhang Xizhi , Zhang Shaohua , Zhang Tianhe , Chen Kun , Dou Yubin
Published: January 2022

Rectangular hollow reinforced concrete (RC) columns have been used extensively for bridge structures. Inadequate transverse confinement and thin wall thickness lead to brittle shear failure, whilst limited studies have reported on the shear model. A hollow high-strength concrete and high-strength stirrups (HHSCS) column, which consisted of high-strength materials, were developed in this paper. The prior monotonic loading tests were conducted to investigate the shear performance on eight specimens. The test variables included aspect ratio, axial compression ratio, and transverse reinforcement ratio. The results revealed that all specimens experienced typical shear failure. On the basis of the modified truss-arch model, a theoretical formula was developed for estimating the shear strength of rectangular hollow RC columns. Also, six existing shear strength models were reviewed and compared with the proposed model using the test data including 37 shear-critical rectangular hollow RC columns. The comparison results showed that the proposed model provided high accuracy of shear strength whether shear-critical rectangular hollow RC columns with high-strength or normal-strength materials.
Digital detox tourism: Practices of analogization
Authors: Stäheli Urs , Stoltenberg Luise
Published: January 2022

Technological disconnectivity has turned into a tourist attraction in its own right: digital detox tourism celebrates temporary disconnection as a means for experiencing an “authentic” world. With pervasive digital media and a strong impetus to being available 24/7, this tourism has to answer not only the question of what has to be done to become disconnected, but also it has to highlight the pleasures disconnection may afford. Drawing on two case studies—a discourse analysis of self-organized unplugged travel writing and an ethnography of the detox event Camp Grounded—we argue that digital detox tourism relies heavily on staging and performing a distinction between the analog and the digital. The article introduces the notion “analogization” to capture practices, media, and infrastructure which support the creation and the blurring of this distinction. Thus, we argue that analogization, in contrast to digitalization, emphasizes that there is no “analog” per se.
Risk-taking in contests with heterogeneous players and intermediate Information—Evidence from handball
Authors: Neuberg Lena , Thiem Stefan
Published: January 2022

This paper analyzes the risk-taking behavior of heterogeneous players in dynamic contests with intermediate information. Using data from the first German Handball league, we measure risk-taking by substituting the goalkeeper for an additional field player. By differentiating between ex-ante and in-game heterogeneity, we show that underdogs and trailing teams are willing to take more risks and that favourites and underdogs react differently to interim information. Trailing underdogs choose riskier strategies than trailing favorites during a match. The increased overall risk-taking is indeed beneficial for underdogs, whereas favourites lose significantly more games as a result of increased risk-taking.
A Retrospectively Study: Diagnosis of Pathological Types of Malignant Lung Tumors by Dual-layer Detector Spectral Computed Tomography
Authors: Ma Xia , Xu Ming , Tian Xiao-Juan , Liu Yong-Li , Zhang Xin-Ri , Qiao Ying
Published: January 2022

Object: By retrospectively analyzing the energy spectrum of squamous cell carcinoma, adenocarcinoma, small cell lung cancer (SCLC), and pulmonary metastases that underwent dual-layer detector spectral computed tomography (DLCT) 3-phase scan of the chest, we explored the value of a multiparameter energy spectrum in the assessment of pathological types of lung tumors. Methods: Cases of squamous cell carcinoma ( n = 20), adenocarcinoma ( n = 24), SCLC ( n = 26), and metastases ( n = 14) were collected. Then the largest cross-sectional area (LCA) of the lesion, computed tomography (CT) values in the plain scan phase, arterial and venous phases (HU, HUa, and HUv), iodine concentration, and effective atomic number in the arterial and venous phases (ICa, ICv, Zeff[a], and Zeff[v]) were measured and compared among the nonsmall cell lung cancer (NSCLC), SCLC and metastases, and other 3 groups of SCLC, squamous cell carcinoma, and adenocarcinoma. Results: Only the LCA is statistically different among SCLC, NSCLC, and metastases ( P < .05). And the treated subgroup analysis did not show significant differences among the groups. However, the untreated subgroup analysis showed that there was a significant difference between NSCLC and metastases in LCA, SCLC and metastases in ICa, NSCLC and SCLC in HUv, NSCLC and SCLC in Zeff(v) ( P < .05). Conclusion: The energy spectrum parameters of DLCT have a certain clinical value in distinguishing NSCLC from SCLC in the Zeff(v) and distinguishing SCLC from metastases in the ICa.
A Rare Cause of Chronic Leg Ulcer in Childhood: Parkes-Weber Syndrome
Authors: Yüce Atamulu Kübra , Yaşar Durmuş Sevgi , Uylar Seber Tuğba
Published: January 2022

Parkes Weber syndrome is a rare congenital vascular disease characterized by capillary venous, arterio-venous and lymphatic malformations accompanied by bone or soft tissue hypertrophy in the affected body area. Lymphatic insufficiency and venous ulcers may occur as a result of increased venous pressure, caused by arterio-venous shunts. Parkes Weber syndrome is an infrequent cause of leg ulcers in childhood. Since arterio-venous malformations can lead to serious complications, it is important to recognize and start treatment immediately.
Parallel VINS-Mono algorithm based on GPUs in embedded devices
Authors: Lu Quan , Xu Jianli , Hu Likun , Shi Minghui
Published: January 2022

Traditional visual-inertial simultaneous localization and mapping algorithms are usually designed based on CPUs, and they cannot effectively utilize the parallel computing function of GPUs if they are directly transplanted to an embedded board with a GPU module. However, the computing power of embedded devices is limited. It is unreasonable for the visual-inertial simultaneous localization and mapping algorithm to occupy most CPU computing resources while the GPU is idle. In this article, a parallelization scheme for the VINS-Mono algorithm based on GPU parallel computing technology is proposed. Based on the compute unified device architecture, the construction and solution of the incremental equation are parallelized in the nonlinear optimization process of the algorithm, and the parallelization methods provided by cuSOLVER and cuBLAS are used to carry out the marginalization of the algorithm. In addition, the program for the detection and matching of image feature points in the process of optical flow tracking is rewritten in the algorithm to realize the parallelization of optical flow tracking. After parallelization, the algorithm is found to run well on a heterogeneous computing model composed of a CPU and GPU and can fully exploit the parallel computing power of the GPU. The proposed method was tested on an NVIDIA’s Jetson TX2 module and compared with the VINS-Mono algorithm; the speeds of the construction and solution of the incremental equation were found to be the same, but the optical flow tracking and marginalization speed of the proposed scheme exhibited improvements of about 1.5–1.7 times and 1.9 times, respectively.
Management of non-variceal upper gastrointestinal bleeding: role of endoscopic ultrasound-guided treatments
Authors: Han Chaoqun , Ling Xin , Liu Jun , Lin Rong , Ding Zhen
Published: January 2022

Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common type of upper gastrointestinal emergency with high risk of life-threatening conditions. Nowadays some standard guidelines for the treatments of NVUGIB have been established based on endoscopic therapies, including injection of glues or sclerosing agents, coiling, band ligation, and thermal therapies. Nevertheless, some patients are refractory to standard endoscopic treatments. We have noticed that endoscopic ultrasound (EUS)–guided treatments have been performed by some endoscopists in certain conditions. This review aims to evaluate the role of EUS-guided treatments in the management of NVUGIB. We performed a MEDLINE/PubMed search, and relevant studies were extracted and examined. According to the existing literature, the most common lesions were Dieulafoy’s lesion, pancreatic pseudoaneurysms, and gastrointestinal stromal tumors. EUS-guided treatments mainly include injection, mechanical therapies, and combined therapies, and seem to be a promising technique in the management of NVUGIB, especially for refractory bleeding.
Incidence, clinical spectrum, and immunotherapy of non-ischemic cerebral enhancing lesions after endovascular therapy
Authors: Bayas Antonios , Christ Monika , Berlis Ansgar , Naumann Markus , Ertl Michael , Joachimski Felix , Müller Mona , Welzel Julia , Ann Gerdes Lisa , Seelos Klaus , Maurer Christoph
Published: January 2022

Background:

Symptomatic and asymptomatic delayed non-ischemic cerebral enhancing (NICE) lesions in magnetic resonance imaging (MRI) have been reported as a rare complication after endovascular therapy (EVT) in recent years with incidence rates between 0.05% and 0.9% in most studies. Information on long-term clinical course and immunotherapies is scarce or has not been reported in detail in the literature.

Objective:

Aims of our study were to assess the incidence of NICE lesions in patients after cerebral EVT over a period of more than 12 years, describe clinical and EVT characteristics, and immunotherapies applied.

Methods:

A retrospective chart review of all patients treated by endovascular therapy for symptomatic or asymptomatic aneurysms at the University Hospital of Augsburg from May 1, 2008 to December 31, 2020 was performed. Patients were identified retrospectively and followed-up prospectively where appropriate. In addition, one case treated at another institution was included.

Results:

Five out of 746 patients, 0.67%, developed NICE lesions after EVT, all with non-ruptured aneurysms and all symptomatic upon detection of NICE lesions by MRI. In total, the disease course of 6 female patients is reported. Symptoms occurred after a mean time of 15 days (±13.42, SD) after EVT with headache (6/6 patients), focal neurological signs (6/6 patients), epileptic seizures (2/6 patients) and cognitive deficits (3/6 patients). All 6 patients received glucocorticosteroids (GCS), 1/6 azathioprine (AZA), 4/6 mycophenolate mofetil (MMF), 1/6 methotrexate (MTX), 1/6 rituximab (RTX), 2/6 cyclophosphamide (CYC) and 3/6 tocilizumab (TCZ). A treatment response could be observed for GCS, TCZ and MMF (in two of four cases), RTX and AZA did not result in disease stabilization.

Conclusions:

Delayed NICE lesions are a rare complication after EVT, requiring immunotherapies in all patients reported here. Physicians should be aware of this disorder in case of new symptoms or contrast enhancing lesions after EVT.
Safety and efficacy of SHR4640 combined with febuxostat for primary hyperuricemia: a multicenter, randomized, double-blind, phase II study
Authors: Tang Honghu , Cui Beibei , Chen Yiyu , Chen Lin , Wang Zhihong , Zhang Ning , Yang Yanlan , Wang Xiaodong , Xie Xiangliang , Sun Lingyun , Dang Wantai , Wang Xianyang , Li Runzi , Zou Jianjun , Zhao Yi , Liu Yi
Published: January 2022

Background:

To evaluate the safety, tolerability, and efficacy of SHR4640, a highly selective urate transporter-1 inhibitor, in combination with febuxostat, in patients with primary hyperuricemia.

Methods:

In this randomized, double-blind, parallel-controlled phase II study, patients whose fasting serum uric acid (sUA) levels were ⩾ 480 μmol/L at screening with gout or sUA levels were ⩾ 420 μmol/L lasting for at least 3 months without gout, either with sUA levels ⩾ 540 μmol/L at screening or sUA levels ⩾ 480 μmol/L with comorbidities at screening, were enrolled. Patients were randomized (1:1:1) to receive SHR4640 10 mg plus febuxostat 80 mg, SHR4640 10 mg plus febuxostat 40 mg, and SHR4640 5 mg plus febuxostat 20 mg orally once daily. The primary end point was the incidence of treatment-emergent adverse events (TEAEs).

Results:

A total of 93 patients were randomized and received treatment. TEAEs occurred in 55.9% of patients. The incidence of TEAEs was comparable among all the groups. Serious TEAEs occurred in one patient (1.1%), with no deaths observed. The proportion of patients who achieved the target sUA levels by week 4 was 79.3%, 96.6%, and 75.0% in the SHR4640 10 mg plus febuxostat 80 mg, SHR4640 10 mg plus febuxostat 40 mg, and SHR4640 5 mg plus febuxostat 20 mg groups, respectively. The mean percent reduction of sUA was 59.7%, 63.7%, and 41.8%, respectively.

Conclusion:

SHR4640 plus febuxostat exhibited a tolerable safety profile and substantial sUA lowering activity in patients with primary hyperuricemia.

Registration:

www.chinadrugtrials.org.cn ; CTR 20192429
A Geospatial Analysis of the Rhinologist Workforce in the United States
Authors: Hassanin Samir , Kshirsagar Rijul S. , Steele Toby O. , Liang Jonathan
Published: January 2022

Background

Six percent of practicing otolaryngologists identified by the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) are rhinologists. This is the first study to investigate both the distribution of rhinologists in the United States and the sociodemographic characteristics that may predict their practice locations.

Objective

We aim to describe the geospatial distribution of the rhinology workforce and analyze sociodemographic characteristics associated with practice distribution.

Methods

We conducted a cross-sectional study of 662 rhinologists queried from the 2020 American Rhinologic Society (ARS) database. Rhinologist practice addresses were compared with ZIP code tabulation area (ZCTA) sociodemographic data from the 2010 US Census Bureau and from the 2014 to 2018 American Community Surveys. Geospatial mapping and multivariate statistics were employed to visualize rhinologist practice locations and analyze which community characteristics were associated with greater densities of rhinologists in ZCTAs.

Results

The largest and smallest densities of rhinologists were in coastal areas and in the Central and Midwestern US, respectively. Population characteristics that significantly predicted a higher number of practicing rhinologists included: greater percentage of non-citizens and greater educational attainment (p < 0.001). Population characteristics that significantly predicted a lower number of practicing rhinologists included: greater percentage of self-identified white/Caucasians, median household income, and greater percentage of population aged 65 or older (p < 0.001).

Conclusion

Disparities in healthcare access in the US is evident and applies to rhinologic subspecialty care. Through visual geospatial analysis, we demonstrate the distribution of rhinologists and the population characteristics that may be predictive of whether patients have access to rhinological care.
Loading during Midstance of Gait Is Associated with Magnetic Resonance Imaging of Cartilage Composition Following Anterior Cruciate Ligament Reconstruction
Authors: Bjornsen Elizabeth , Schwartz Todd A. , Lisee Caroline , Blackburn Troy , Lalush David , Nissman Daniel , Spang Jeffrey , Pietrosimone Brian
Published: January 2022

Objective

A complex association exists between aberrant gait biomechanics and posttraumatic knee osteoarthritis (PTOA) development. Previous research has primarily focused on the link between peak loading during the loading phase of stance and joint tissue changes following anterior cruciate ligament reconstruction (ACLR). However, the associations between loading and cartilage composition at other portions of stance, including midstance and late stance, is unclear. The objective of this study was to explore associations between vertical ground reaction force (vGRF) at each 1% increment of stance phase and tibiofemoral articular cartilage magnetic resonance imaging (MRI) T1ρ relaxation times following ACLR.

Design

Twenty-three individuals (47.82% female, 22.1 ±4.1 years old) with unilateral ACLR participated in a gait assessment and T1ρ MRI collection at 12.25 ± 0.61 months post-ACLR. T1ρ relaxation times were calculated for the articular cartilage of the weightbearing medial and lateral femoral (MFC, LFC) and tibial (MTC, LTC) condyles. Separate bivariate, Pearson product moment correlation coefficients ( r) were used to estimate strength of associations between T1ρ MRI relaxation times in the medial and lateral tibiofemoral articular cartilage with vGRF across the entire stance phase.

Results

Greater vGRF during midstance (46%-56% of stance phase) was associated with greater T1ρ MRI relaxation times in the MFC ( r ranging between 0.43 and 0.46).

Conclusions

Biomechanical gait profiles that include greater vGRF during midstance are associated with MRI estimates of lesser proteoglycan density in the MFC. Inability to unload the ACLR limb during midstance may be linked to joint tissue changes associated with PTOA development.
Do Women Withhold Honest Sexual Communication When They Believe Their Partner’s Manhood is Threatened?
Authors: Jordan Jessica A. , Vandello Joseph A. , Heesacker Martin , Larson-Konar Dylan M.
Published: January 2022

We explored whether women who perceive that their partners’ manhood is precarious (i.e., easily threatened) censor their sexual communication to avoid further threatening their partners’ masculinity. We operationalized women’s perceptions of precarious manhood in a variety of ways: In Study 1, women who made more money than their partners were twice as likely as those who did not to fake orgasms. In Study 2, women’s higher perceptions of partners’ precarious manhood indirectly predicted faking orgasms more, lower sexual satisfaction, and lower orgasms rate through greater anxiety and less honest communication. In Study 3, women who imagined a partner whose masculinity was insecure (vs. secure) were less willing to provide honest sexual communication, via anxiety. Together, the studies demonstrate a relationship between women’s perceptions of partner insecurity, anxiety, sexual communication, and sexual satisfaction.
Predictors of adverse outcome in the first and second waves of the COVID-19 pandemic: results from a UK centre
Authors: Martin Christopher A. , Pan Daniel , Hills George , Modha Deborah , Patel Prashanth , Gray Laura J. , Jenkins David R. , Barton Linda , Jones William , Brunskill Nigel J. , Haldar Pranab , Khunti Kamlesh , Pareek Manish
Published: January 2022

Background/Aims: Data concerning differences in demographics/disease severity between the first and second waves of COVID-19 are limited. We aimed to examine prognosis in patients presenting to hospital with COVID-19 amongst different ethnic groups between the first and second waves in the UK.Methods: In this retrospective cohort study, we included 1763 patients presenting to a regional hospital centre in Leicester (UK) and compared those in the first ( n = 956) and second ( n = 807) waves. Admission National Early Warning Scores, mechanical ventilation and mortality rate were lower in the second wave compared with the first.Results: Thirty-day mortality risk in second wave patients was approximately half that of first wave patients [adjusted hazard ratio (aHR) 0.55, 95% confidence interval (CI) 0.40–0.75]. In the second wave, Black patients were at higher risk of 30-day mortality than White patients (4.73, 1.56–14.3). Conclusion: We found that disporportionately higher risks of death in patients from ethnic minority groups were not equivalent across consecutive waves of the pandemic. This suggests that risk factors for death in those from ethnic minority groups are malleable and potentially reversible. Our findings need urgent investigation in larger studies.
Molecular detection of polycystic kidney disease in Persian and Persian-related breeds in Iran
Authors: Moazezi Ghavihelm Ali , Jamshidi Shahram , Ashrafi Tamai Iraj , Zangisheh Mahsa
Published: January 2022

Objectives

This study was aimed at detecting feline autosomal dominant polycystic kidney disease in a population of Persian and Persian-related breeds by a molecular method in Iran.

Methods

Buccal swab samples were collected from 47 cats and examined with a touchdown PCR method. Additionally, partial sequencing was performed in two cats with bilateral renal cysts.

Results

Twenty-two cats (46.8%) were diagnosed as heterozygous for this mutation. Sequence analysis of two cats showed C to A point mutation in the PKD1 gene, as in previous studies.

Conclusions and relevance

Prevalence of this disease is high in Iran, highlighting the need for molecular screening tests before including cats in breeding programmes.
Remote probation by phone in France and Scotland during the 2020 lockdown
Authors: Herzog-Evans Martine , Sturgeon John
Published: January 2022

This paper is part of a wider investigation which explores what happened to probation services in France and in Scotland during the national lockdown put in place as a response to the Covid-19 pandemic. Qualitative interviews with 29 French and 27 Scottish probation staff took place, the authors wishing to capture the lived experience of practicing probation at this unprecedented time. Whilst the study captures the initial disorientation of probation staff and a general lack of institutional and individual readiness for lockdown, it also documents adaptability, creativity and an optimism for what technology could offer state probation practitioners that is less visible in studies that were carried out following the easing of lockdown restrictions. It shows that the ways in which institutions and practitioners responded to the crisis was determined by institutional and cultural heritage, professional values and management practice.
Breaking the Ice of Erectile Dysfunction Taboo: A Focus on Clinician–Patient Communication
Authors: Al-Shaiji Tariq F.
Published: January 2022

Erectile dysfunction is a common yet complex problem facing men and their partners worldwide. It continues to be an under reported issue despites its high prevalence and negative impact as well as the availability of successful treatment. One of the main reasons for such a problem is the stigma surrounding it as a complaint and the deep-seated fear to discuss it. This paper aims to highlight the reasons behind the taboo and dilemma behind erectile dysfunction reporting and discusses means to overcome this stigma focusing on clinician–patient communication.
To Be(Ar) Or Not to Be(Ar) – Jones Dilemma?
Authors: Andrews Nicholas A. , Singh Neha , Agarwal Abhinav , Hughes Austin , Jacob Roshan , Harrelson Whitt , Rallapalle Vyshnavi , Shah Ashish
Published: January 2022

Category:

Midfoot/Forefoot

Introduction/Purpose:

Jones fracture is the fracture of the base of 5th metatarsal and is a commonly encountered in the clinical setting. Its management has always been a subject of great debate with paucity of consensus on post- operative weight bearing protocols. We aim to evaluate the efficacy of early weight bearing in the post-operative management of Jones fracture and assess its association with radiological union and patient reported outcomes.

Methods:

Retrospectively, patients undergoing fixation of Jones fracture from January 2011 to December 2020 were identified. Radiographic follow-up of at least 8 weeks was required for inclusion yielding 40 patients. Patients were grouped by early weight bearing (EWB) as tolerated (26 patients) and non-weight bearing (NWB) for 2 weeks followed by partial weight bearing (14 patients). Medical records were reviewed for demographic variables, associated comorbidities, type of surgical construct used, fracture type, mode of injury and union. Delayed union was defined as patients without radiographic evidence of union at 12.5 weeks. Patients completed PROMIS physical function, PROMIS pain interference, and FFI scoring postoperatively.

Results:

The mean age was 42.83+- 17.03 years with a female gender predominance (n=23; 57.5%) and an average BMI of 32.2 +- 8.7. Thirteen (50%) in the EWB and 5 (43%) in NWB groups experienced delayed radiological union (>12 weeks) and this did not differ by group. There was one nonunion in the NWB group and none in the EWB group. The number of wound complications did not vary by group. Seventeen patients completed postoperative FFI and PROMIS scores at a median of 40 months (41.5 IQR). The FFI and PROMIS scores did not differ by group. In the EWB group, the median PROMIS scores were physical function 43.7 (6.7 (IQR)) and pain interference 52.8 (10.1) compared to physical function 44.0 (11.6) and pain interference 55.2 (11.8) in the NWB group. The median total FFI score in the EWB group was 20.0 (27) compared to 32 (32) in the NWB group.

Conclusion:

The EWB group exhibited comparable results to the NWB group after surgical fixation of Jones fracture. Importantly, PROMIS scores indicate both groups had comparable functional outcomes at long term follow up and were within a standard deviation of the general population of the United States (Score of 50 with SD of 10) for both pain and function. While further investigation is required, EWB may have equivocal results in terms of union, wound complications, and functional outcomes while allowing for early mobilization after Jones fracture fixation.
Non-Operative Management of Chronic Achilles Tendon Ruptures: Short Term Outcomes
Authors: Arshad Zaki , Bhatia Maneesh
Published: January 2022

Category:

Hindfoot; Sports; Trauma

Introduction/Purpose:

The incidence of Achilles tendon rupture in the United States is approximately 2.6 per 100,000 person years, with a significant increase in incidence over recent years reported. Should the acute rupture not be diagnosed promptly, as is the case in up to 20% of patients, the injury may be termed chronic. A number of operative treatment strategies for chronic Achilles ruptures have been described, including v-y tendinous flap, flexor hallucis longus tendon transfer, peroneus brevis graft and free gracilis transfer. Despite the extensive investigation of non-operative treatment in acute ruptures, there is a lack of similar research into chronic injuries. This article aims to address this gap in the literature, reporting treatment results of patients treated conservatively after being deemed unfit for operative intervention.

Methods:

A retrospective review of all patients receiving non-operative treatment for chronic Achilles ruptures, in the senior author's clinic between December 2014 and May 2019 was performed. A chronic injury was defined as occurring when there was a delay of at least 28 days between initial injury and start of treatment. Patients with a minimum final follow up of less than 6 months were excluded. All patients were managed according to the previously described Leicester Achilles Management Protocol (LAMP), an eight-week functional dynamic regime with use of a VACOped boot (OPED, Valley, Germany). Formal physiotherapy treatment was also provided following completion of the LAMP. Hospital records were searched for relevant data including patient age and sex, side of injury, time between injury and start of treatment and post-treatment Achilles tendon total rupture score (ATRS).

Results:

A total of 17 consecutive patients with a minimum follow up of 6 months were managed non-operatively during the stated time period. The cohort included eight males and nine females with a mean age of 63.4 14.3 years. The right side was injured in five cases, with the left side affected in 12. The mean time from initial injury to start of treatment was 43.9 days (range 30 - 102 days). The mean ATRS at 6 months post treatment was 53+-17.8. A total of 10 patients were also available for follow up at 12 months. The mean ATRS in these patients at 12 months was 73 +-15.2.

Conclusion:

The mean 12-month ATRS of 73 achieved is lower than figures of 89-92.5 reported in previous studies describing operative treatment. However, our results indicate that good outcomes may be achieved using a non-operative protocol in patients who decline or are unfit for surgery. Recent research reports that the mean age of Achilles rupture has increased by 0.721 years every five years, since 1953. It could therefore be likely that an increasing number of patients suffering chronic Achilles ruptures may be unfit for surgical treatment. It is important that further research into the non-operative treatment of these patients is conducted.