bluuebunny/crossref_metadata_2025 huggingface dataset:
Small Changes Make a Big Difference: The Impact of Visual Symbol Color Lightness on Destination Image
Authors: He Yun , Li Xiao , Zhong Ke
Published: May 2023

Visual symbols, such as logos, landmark pictures, and mascots, play a significant role in attracting tourists and improving destination images. However, only a few studies have examined how the basic visual elements of these symbols influence potential tourists’ responses to a destination. This study aims to investigate the role of color lightness in destination visual symbols. Through three experiments, we repeatedly found that lightened visual symbols nudged consumers to evaluate their destination better. Furthermore, positive mental imagery mediated this effect. Nonetheless, the positive effect of lightened visual symbols on destination images was diminished when informational interventions were present. Our study provides new theoretical insights into destination images research by highlighting the positive effect of a fundamental visual attribute—symbol lightness. We suggest that tourism practitioners can make a “big difference” to the destination image by making “small changes,” such as adjusting visual symbol lightness.
Differential Use of Mental Health Services by Race and Ethnicity in Prison
Authors: Casagrande Katlyn , Vaughan Adam D.
Published: May 2023

Research in community settings indicates that Black persons are less likely to receive mental health treatment than White persons. Research on whether these disparities persist in prisons is limited and fails to include other racial and ethnic groups, such as Latino persons. This study examines racial and ethnic differences in the use of mental health services among incarcerated persons. Using the 2016 Survey of Prison Inmates, logistic regression assessed the effects of race/ethnicity among those receiving mental health treatment while incarcerated. Results suggest Black and Multiracial/Other incarcerated persons were 15.8% and 15.0% more likely to participate in treatment than White incarcerated persons, respectively. No significant difference between Latino incarcerated persons and White incarcerated persons was found. The differences between racial/ethnic groups and participation in mental health treatment found in this study suggest that more attention needs to be paid to diversity in the accessibility of treatment in prisons.
Mobility of the educated: Taiwanese migrants in Dongguan and Jakarta
Authors: Lin Ping
Published: May 2023

Studies on migration, education and social mobility are usually discussed in three separate fields. This article presents the overlap of these three fields by discussing how Taiwanese migrants in Dongguan and Jakarta perceive the educational opportunities for their children and the ethnic-based status for themselves. The study finds that for people from middle- and working-class families, migration overseas to less developed countries is a good opportunity to obtain higher socio-economic status and an upward mobility path for their children. However, the opportunity also creates unexpected anxieties. The privileges that these migrants obtain and the anxieties they have illustrate opportunity traps for these middling migrants.
Just because I can’t say words, doesn’t mean I can’t have a choice
Authors: Keenan Amy
Published: May 2023

People with physical disabilities and age-appropriate cognitive levels of functioning can experience incredible frustration in their opportunities to express and communicate along with societal stigma and assumptions. Dramatherapy, and specifically Drama and Movement Therapy, can be an effective therapeutic method in providing a platform for these clients to find their voice through a range of techniques and stimulation. Providing ‘choice’, building a non-judgemental, trusting therapeutic relationship, along with enabling the client is an essential part of this process.

This article will discuss a Dramatherapist’s experience from an autoethnological perspective with her own limitations in using her voice, in relation to working and enabling non-verbal clients. This will further be supported by case studies, demonstrating working within an effective multidisciplinary team. Joint working will be discussed along with examples of a range of creative and adaptable techniques to assist the individual and their needs. The article will then discuss and conclude with how practitioners can assist these clients to find their voice, by supporting different ways of communication and importantly providing choice.
Relationship between patellofemoral joint morphology and chondromalacia patella
Authors: Öztürk Cansu , Güngör Özlem
Published: May 2023

Background

For the normal functioning of the patellofemoral joint (PF), the relationship between the patella and the trochlear groove must be compatible.

Purpose

To investigate the relationship between patellofemoral joint morphology (PFM) and patellar chondromalacia.

Material and Methods

Overall, 136 knees of patients aged 20–55 years examined between March 2020 and March 2021 were included in this study. In all patients, trochlear sulcus angle, trochlear sulcus depth, trochlear facet asymmetry, patella alta (Insall–Salvati [IS] index), and patellar facet asymmetry were measured. Of these cases, 66 knees with an abnormality detected in any of the measurements for PFM were included in the case group. Moreover, 70 knees with demonstrating normal PFM measurements were included in the control group.

Results

The incidence and grade of chondromalacia was higher in the case group than in the control group ( P < 0.001). Between the patients with and without chondromalacia trochlear sulcus angle (mean = 138.25° ± 10.02° vs. 132.58° ± 7.24°; P = 0.001), IS index (mean = 1.25 ± 0.21 vs. 1.16 ± 0.15; P = 0.014), patellar facet asymmetry (mean = 0.77 ± 0.09 vs. 0.73 ± 0.12; P = 0.039), trochlear sulcus depth (mean = 5.39 ± 1.42 mm vs. 6.27 ± 1.04 mm; P < 0.001), and trochlear facet asymmetry (mean = 0.67 ± 0.11 vs. 0.71 ± 0.09; P = 0.023) measurements, there was a significant difference.

Conclusion

The presence of at least one of the measures indicating pathology in PFM is associated with the presence and severity of chondromalacia.
The need for prophylactic hemodialysis to protect against nephrogenic systemic fibrosis in patients with end-stage renal disease receiving gadolinium-based contrast agents
Authors: Lee Yeonhee , Kim Junghoon , Kwon Soie , Jeong Jong Cheol , Joo Kwon Wook , Oh Kook-Hwan
Published: May 2023

Background

The risk of gadolinium (Gd)-based contrast agent (GBCA)-induced nephrogenic systemic fibrosis (NSF) in patients with end-stage renal disease (ESRD) and the efficacy of prophylactic hemodialysis (HD) for protection against NSF are not well understood or summarized in the literature.

Purpose

To determine the risk for NSF related to frequency and time per dialysis session after Gd-magnetic resonance imaging (MRI) by emphasizing the safety of Gd-MRI in patients with ESRD.

Material and Methods

This retrospective observational study identified all GBCA injections for MRI examinations performed at two tertiary referral hospitals between 2005 and 2020. All clinical data, including dialysis records and medical history, were investigated for each patient through 2021. The end of follow-up coincided with the last hospital visit.

Results

Overall, 1129 patients with ESRD underwent 1461 Gd-MRI scans (41.5% gadoterate, 39.4% gadobutrol, and 7.7% gadoxetate); a total of 958 patients with 1229 (84.1%) examinations underwent HD on the day of the MRI study, within 2.1 ± 2.0 h (range = 0.2–15.7 h) immediately after Gd exposure. In 53.4% of scans, frequent HD had been performed urgently and then twice more on consecutive days to prophylactically avoid NSF. No cases of NSF were identified during the follow-up period (mean = 81.7 ± 50.5 months) regardless of dose of HD.

Conclusion

No cases of NSF were reported in 1461 Gd-MRI examinations of 1129 inpatients with ESRD on HD. Our findings support the lack of benefit of frequent prophylactic HD being performed urgently within 4 h of the receipt of GBCA.
A Snapshot of Gay-Straight Alliance Clubs and Student Well-Being in Western Canadian High Schools
Authors: Di Stasio Maria , Alston Lauren , Harley Jason
Published: May 2023

Gay-Straight Alliance (GSA) clubs promote safer school environments for students. GSAs typically refer to student-led, teacher-supported school clubs that serve youth of diverse gender identities and sexual orientations. This study investigated the relationship between students’ awareness of school-based GSAs and their bullying experiences, mental health, self-determination, and relationships at school and home. Findings showed that LGBTQ2S+ students experienced higher rates of bullying and symptoms of depression and scored lower on self-determination subscales than cisgender heterosexual students. Interestingly, students who were aware of their school’s GSA club scored higher on the self-determination subscales regarding family relationships and lower on bullying compared to students who were unaware of their school’s GSA club. LGBTQ2S+ students had lower rates of comfort with their sexual orientation at home and school than their cisgender heterosexual students. Implications and future directions are discussed.
Use of Thalamus L-Sign to Differentiate Periventricular Leukomalacia From Neurometabolic Disorders
Authors: Yuzkan Sabahattin , Emecen Sanli Merve , Balci Merve , Cennetoglu Pakize , Kafadar Ihsan , Kocak Burak
Published: May 2023

Purpose

To assess the diagnostic value of the thalamus L-sign on magnetic resonance imaging (MRI) in distinguishing between periventricular leukomalacia and neurometabolic disorders in pediatric patients.

Methods

In this retrospective study, clinical and imaging information was collected from 50 children with periventricular leukomalacia and 52 children with neurometabolic disorders. MRI was used to evaluate the L-sign of the thalamus (ie, injury to the posterolateral thalamus) and the lobar distribution of signal intensity changes. Age, sex, gestational age, and level of Gross Motor Function Classification System (only for periventricular leukomalacia) constituted the clinical parameters. Statistical evaluation of group differences for imaging and clinical variables were conducted using univariable statistical methods. The intra- and inter-observer agreement was evaluated using Cohen's kappa. Univariable or multivariable logistic regression was employed for selection of variables, determining independent predictors, and modeling.

Results

The thalamus L-sign was observed in 70% (35/50) of patients in the periventricular leukomalacia group, but in none of the patients with neurometabolic disorder ( P < .001). The gestational age between groups varied significantly ( P < .001). Involvement of frontal, parietal, and occipital lobes differed significantly between groups ( P < .001). In the logistic regression, the best model included negative thalamus L-sign and gestational age, yielding an area under the curve, accuracy, sensitivity, specificity, and precision values of 0.995, 96.1%, 96%, 96.2%, and 96%, respectively. Both the lack of thalamus L-sign and gestational age were independent predictors ( P < .001).

Conclusions

The thalamus L-sign and gestational age may be useful in distinguishing between periventricular leukomalacia and neurometabolic disorders.
Natural convection flow of CNTs-ethylene glycol based micropolar nanofluid along a complex wavy surface
Authors: Shami Sumyya , Sajid Muhammad , Javed Tariq
Published: May 2023

The primary goal of this study is to perform the analysis of heat transfer in free convection flow of micropolar nanofluid along a complex roughened surface. A micropolar nanofluid is made by adding nanoparticles namely SWCNTs (single-walled carbon nanotubes) in ethylene glycol (EG) base micropolar fluid. A mathematical model for micropolar nanofluid can be developed in terms of nonlinear partial differential equations by extending Navier-Stokes equations along with micro inertia effects, angular momentum equation and Tiwari and Das model. After using the suitable transformation, the resulting nonlinear PDEs are made dimensionless and solved numerically using finite difference scheme. Micropolar nanofluids have a capability to improve the thermophysical properties and heat transportation capacity instead of base fluids. The impacts of numerous pertinent parameters on velocity, microrotation and temperature profiles also on physical quantities namely wall couple stress, local and average Nusselt numbers, total heat transfer and skin friction coefficient are discussed graphically. It is noted that total heat transfer rate becomes high in case of dominant amplitude of harmonic wave as compared to fundamental. It is also noted that total heat transfer rate decreases by increasing micropolar parameter and can be enhanced by adding SWCNTs in EG based micropolar fluid and that enhancement is reported approximately 27 and 26% in dominant amplitude of fundamental and harmonic waves as compared to ethylene glycol fluid.
The Overall Development of the Belt and Road Countries: Measurement and Assessment
Authors: Hu Biliang , Zhang Kunling
Published: May 2023

Based on a multidimensional assessment indicators system and a two-layer assessment model, this article measures and evaluates the overall development of China and the 148 countries that signed cooperation agreements with China to jointly build the Belt and Road (we refer to this group of countries as the Belt and Road Countries or simply BRCs henceforth) from 2015 to 2019 using panel normalization method. This research shows that the overall development of BRCs is generally on track, and most countries are showing an upward development trend, mainly Asian and African countries. Second, some features of the overall development of BRCs are clearly evident, such as (a) the economic development is not high enough but relatively stable; (b) the resource endowments are not excellent, but rich fossil fuels are concentrated in a few countries of BRCs; (c) the environment protection of the countries is reasonably well managed; (d) social development indicators of these countries are slightly lagging behind the world average. Third, certain challenges face this group of countries, for example, good governance, economic structural transformation, and industrialization need improvement. Finally, there is enormous potential for strengthening cooperation between BRCs, particularly in energy, manufacturing, green development, social development linking with the people’s livelihood improvement, and so on.
Analyzing the Influence of BRI Foreign Direct Investment on Governance: Perspective from Southeast Asian Countries
Authors: Liu Qian , Wang Yingying , Kang Ning
Published: May 2023

Promoting international economic cooperation plays a vital role in improving global governance. International cooperation benefits participating countries economically, and positively impacts their social development and national governance. Based on the micro survey data of eight Southeast Asian countries, this article analyzes the influence mechanism of the Belt and Road outward foreign direct investment (FDI) on the governance of the host countries. The article finds that China’s outward FDI, through its positive role in the host country’s economic and social development, leads to a positive perception among people in host countries regarding China’s influence locally. On the one hand, it enhances people’s sense of identity with China’s development. On the other hand, it contributes to people’s satisfaction with their local government, thereby improving national governance. The findings of this article offer theoretical insights for promoting high-level opening-up. When participating in global governance, one must pay attention to the real sense of gain in the host countries and their people, improve the governance and promote high-quality development of regional economic cooperation.
Mucosal Architectural Change is an Important Feature in Distinguishing Crohn's Disease From Others in Terminal Ileum Ulcer Biopsy
Authors: Zhong Tingting , Zhang Lizhi , Tang Wen , Wu Yanchuang , Pan Yipeng , Fu Yujuan , Xu Jiaqi , Cao Qian , Jiang Zhinong
Published: May 2023

Background

Besides Crohn's disease (CD), there are a variety of other causes that can also lead to ulcerations in the terminal ileum. The purpose of this study was to identify useful diagnostic features for CD when evaluating terminal ileum biopsies in patients with endoscopic finding of ulcers.

Methods

Five hundred and seventy-one patients with endoscopic finding of ulcers were included in this retrospective study. Five main histological features were analysed, which were crypt irregularity, mucosal thickening, villous stromal widening (including villous atrophy), granulomas, and pseudopyloric gland metaplasia. Clinical and pathological features were determined by uni- and multivariable logistic regression. Then another independent cohort of 99 patients was established for verifying this nomogram.

Results

The crypt irregularity, mucosal thickening, and villous stromal widening were combined to be considered as one new variable named mucosal architectural change which was an independent variable in diagnosing CD. We found that mucosal architectural change, age <40 years, the presence of granulomas, and the presence of pseudopyloric gland metaplasia were independent factors for the pathological diagnosis of CD. Then nomogram was developed, with receiver operating characteristic (ROC) curve (area under the ROC curve [AUC] = 0.927) in training sets, and ROC curve (AUC = 0.913) in validation sets.

Conclusions

We found mucosal architectural change is very helpful in distinguishing CD from non-CD patients. In the context of small biopsy which may lack full scope of changes, the model developed by combining these key features is valuable in predicting a diagnosis of CD, especially in younger patients (age <40 years).
Introducing the Harm Reduction Collaboration Framework for Policy, Systems, and Environmental Change
Authors: Miller Devin , DeHerrera-Smith Dayna , Sharp Teresa A. , Gilbert Elizabeth D.
Published: May 2023

A revised way of thinking is essential for promoting harm reduction strategies and reducing the negative implications of injection drug use (IDU). Despite the growth of harm reduction approaches in the United States, there is limited guidance for designing and implementing multi-sector efforts that address the external determinants that promote and facilitate IDU. Current frameworks fail to acknowledge the individual’s role and influence in multi-sector change. To address the multifaceted nature of IDU, we must address the complex relationship between people who inject drugs (PWID) and their external environment. As part of a community–academic partnership, a framework was developed to address the gaps in current theoretical models and community practice. Our Harm Reduction Collaboration Framework (HRCF) accepts PWID as key stakeholders and presents a practical framework in which PWID and community organizations partner in decision making to influence policy, systems, and environmental change. We provide examples of two organizations that have made substantive changes in implementing harm reduction strategies in their communities by utilizing the HRCF.
Measuring Shifts in Mental Models in the Prevention of Childhood Obesity in Rural Australia
Authors: Felmingham Tiana , Bolton Kristy A. , Fraser Penny , Allender Steven , Brown Andrew D.
Published: May 2023

Group model building is a participatory workshop technique used in system dynamics for developing community consensus to address complex problems by consensus building on individual assumptions. This study examines changes in individual mental models of the complex problem of childhood obesity following participation in group model building (GMB), as part of a larger community-based system dynamics project. Data are drawn from GMB participants across six community sites in the Whole of Systems Trial of Prevention Strategies for Childhood Obesity (WHO STOPS) in rural and regional Victoria, Australia. Each community participated in two GMB sessions resulting in a causal loop diagram (CLD) of drivers of childhood obesity for each community. Presurvey and postsurvey captured participants’ perspectives before and after ( n = 25) participation in both GMB sessions and a blend of inductive and deductive qualitative content analysis was used to code individual responses. Three calculations were used to determine the number of responses, whether responses were a result of persuasion from others, and comparison of responses to those found in the CLD. Our study found participant mental models shifted during the course of the GMB sessions, with some responses persuaded by others and 75% of new insights identified in CLDs created by communities. The GMB process created a platform for participants to share ideas and learn from each other. In addition, participants listed new insights about childhood obesity in their community through developing CLDs.
How Do Customers React to Technology in the Hospitality and Tourism Industry?
Authors: Arici Hasan Evrim , Saydam Mehmet Bahri , Koseoglu Mehmet Ali
Published: May 2023

Growing scientific attention to technology has led to new guidelines for comprehending consumers’ experiences with the technology. Understanding the relationship between technology and consumers is crucial for advancing thought as well as practice in this subject. This study aims to look at the origins, significant subjects, scientific advances, and future advancements in customer reactions to technological research. To accomplish this aim, we ran analysis in R with the visualization tools VOSviewer and Biblioshiny in order to conduct a bibliometric study. Employing the Boolean strategy, journal articles were obtained from the Scopus database up to August 17, 2022. This research looked at customer reactions to technology literature from various angles, including citations, journals, keywords, and geographies. Then, bibliographic coupling, co-citation, and co-occurrence analysis were carried out. The analysis showed how customer reactions to technology literature have changed over the past 2 decades. This study provided insight into the role of technology adoption and COVID-19 in customer reactions to technology, and identified potential and constraints in this area.
Potential influence of extensive reading on controlled productive vocabulary
Authors: Sakurai Nobuko
Published: May 2023

This study explored a possible impact of extensive reading (ER) on vocabulary learning. Participants were 62 English majors who entered a private university in Japan in April 2019 and experienced ER for 13 months. They took the Productive Vocabulary Levels Test at the 2,000-word level 3 times: in April, December and May 2020. The outcomes of paired t-tests with Bonferroni correction revealed that participants achieved higher scores on the 2nd test, but their performance deteriorated on the final test. The model yielded by multiple regression analysis was comprised of the number of series participants read books from and the average percentage grade of MReader quizzes they passed, whose contribution to the post test scores was 14.1%. Follow-up tests were run between 12 students who retained or improved their scores on the delayed test and those who did not. It was found that these 12 participants read more constantly during the spring vacation. They also read more books from one graded reader series and books with fewer than 2,000 words, but read fewer 4,000-to-4,999-word-long books from April to December.
BAUS oncology guidance for implementing streamlining in cancer MDT meetings: Selecting standards of care and operational considerations
Authors: Lamb Benjamin W , Linton Kate D , Narahari Krishna
Published: May 2023

It is widely recognised that multidisciplinary team meetings (MDTMs) are the cornerstone of cancer practice in the United Kingdom and many countries around the world. While MDTMs offer several key benefits to patients, healthcare professionals and cancer registration, data and audit services, in the United Kingdom they have over time become too large, onerous and ‘transactional’ often discussing cases that have a pre-determined management plan. In response to this growing problem, National Health Service (NHS) England and NHS Improvement produced an multidisciplinary team (MDT) streamlining document as a guide to encourage MDTM to consider a ‘Standard of Care’ (SoC) approach to conditions with a predictable agreed management plan based on national, regional cancer network or local cancer unit protocols. This would then enable more meaningful discussion of complex cases with in the MDT. This document did not gain much traction and had little impact on UK urological cancer MDTM. As a result, The British Association of Urological Surgeons (BAUS) was approached by the NHS Getting It Right First Time (GIRFT) Leads in 2021 to promote an SoC-based streamlining to urological cancer MDT working. Having consulted widely with colleagues, cancer networks and cancer delivery teams, the BAUS Section of Oncology sought views from its membership during a dedicated MDTM session in the Sections of Oncology Meeting, December 2021. From this extensive engagement with stakeholders, we have put together the following guidance for use as a framework to facilitate the agreement of local policies in the interests of supporting the needs of patients and MDTs.

Level of evidence: level 5 (Expert opinions based on non-systematic reviews of results or mechanistic studies)
Arthralgia of menopause - A retrospective review
Authors: Blumer Janice
Published: May 2023

Arthralgia is a common complaint around the time of menopause in many women. It is estimated that over 50% of women experience arthralgia or arthritis at the time of menopause. The complex of symptoms has been linked to the joint and tendon response to the decline in sex hormones as well as sarcopenia, or loss of muscle volume associated with aging. The diagnosis of “arthritis of menopause” has been identified since 1925, but treatments have been symptomatic at best. 1 , 2 Joint synovium and cartilage interaction with estrogen is well documented. This article reviews the literature regarding the current approaches to treatment of arthralgia of menopause.
Deleterious consequences: How Google's original sociotechnical affordances ultimately shaped ‘trusted users’ in surveillance capitalism
Authors: Ridgway Renée
Published: May 2023

Google dominates around 92% of the search market worldwide (as of November 2022), with most of its revenue derived from search advertising. However, Google's hegemony over search and the resulting implications are not necessarily accidental, arbitrary or (un)intentional. This article revisits Brin and Page's original paper, drawing on six of their key innovations, concerns and design choices ( counting citations or backlinks, trusted user, advertising, personalization, usage data, smart algorithms) to explain the evolution of Google's hypertext search engine technologies through ‘moments of contingency’, which led to corporate lock-ins. Underpinned by analyses of patents, statements and secondary sources, it elucidates how early Google considerations and certain affordances not only came to shape the web ( backlinks, trusted user, advertising) but subsequently facilitated contemporary surveillance capitalism. Building upon Zuboff's ‘Big Other’, it describes the ways in which Google as an infrastructure is intertwined with Big Data's platformization and the ad infinitum collection of usage data, beyond just personalization. This extraction and refinement of usage data as ‘behavioural surplus’ results in ‘deleterious consequences’: a ‘habit of automaticity,’ which shapes the trusted user through ‘ubiquitous googling’ and smart algorithms, whilst simultaneously generating prediction products for surveillance capitalism. Advancing Latour's ‘predicting the path’ of technological innovation, this cause-and-effect story contributes a new taxonomy of Google sociotechnical affordances to critical STS, media history and web search literature.
The role of mobile health in prevention, diagnosis, treatment and self-care of COVID-19 from the healthcare professionals’ perspectives
Authors: Montazeri Mahdieh , Galavi Zahra , Ahmadian Leila
Published: May 2023

Background

To facilitate disease management, understanding the attitude of healthcare professionals regarding the use of this tool can help mobile health (mHealth) program developers develop appropriate interventions.

Aims

To assess the perspective of healthcare professionals regarding the contribution of mobile-based interventions in the prevention, diagnosis, self-care, and treatment (PDST) of COVID-19.

Methods

This is a survey study conducted in 2020 in Iran with 81 questions. In this study mHealth functionalities were categorized into four dimensions including innovative, monitoring and screening, remote services, and education and decision-making. The data were analyzed using descriptive statistics, ANOVA, and the Kruskal–Wallis test to compare the attitudes of the different job groups.

Results

In total, 123 providers participated, and 87.4% of them reported that mHealth technology is moderate to most helpful for the management of COVID-19. Healthcare professionals believed that mHealth technology could be most helpful in self-care and least helpful in the diagnosis of COVID-19. Regarding the functionalities of the mobile application, the results showed that the use of patient decision aids can be most helpful in self-care and the use of computer games can be least helpful in treatment. The participants believed that mHealth is more effective in monitoring and screening dimensions and less effective in providing remote services.

Conclusions

This study showed that healthcare professionals believed that mHealth technology could have a better contribution to self-care for patients with COVID-19. Therefore, it is better to plan and invest more in the field of self-care to help patients to combat COVID-19. The results of this study revealed which mhealth functionalities work better in four domains of prevention, treatment, self-care, and diagnosis of COVID-19. This can help healthcare authorities to implement appropriate IT-based interventions to combat COVID-19.
Prevalence of Asymptomatic Talar Bone Marrow Edema in Professional Ballet Dancers: Preliminary Data From a 2-Year Prospective Study
Authors: Miskovsky Shana , Khambete Pranav , Faraji Navid , Harlow Ethan R. , Ina Jason , Mengers Sunita , Voos James
Published: May 2023

Background:

Compared with symptomatic bone marrow edema (BME) associated with stress fractures, asymptomatic BME seen on magnetic resonance imaging (MRI) is a phenomenon that has been described in high-level athletes and is thought to be related to bone adaptation to biomechanical loading unique to each sport. However, the prevalence, natural history, and management of these lesions remain poorly understood, particularly in dance, which places tremendous stress on the feet and ankles.

Purposes/Hypothesis:

The purposes of this study were to (1) determine the prevalence of asymptomatic BME in the talus before the start of the performance season, (2) identify contributing demographic and training factors, and (3) compare the radiological evidence of talar BME with validated functional foot and ankle scores. We hypothesized that talar BME would be highly prevalent among asymptomatic professional dancers.

Study Design:

Case series; Level of evidence, 4.

Methods:

A total of 14 professional ballet dancers (6 female and 8 male; mean age, 24 years) were included in this 2-year prospective study. For each participant, we recorded complete medical and surgical history along with scores on the Foot and Ankle Ability Measure (FAAM) and the Foot and Ankle Disability Index. Bilateral foot and ankle 3.0-T MRI scans without contrast were completed before the start of the performance season and were evaluated for BME of the talus using the Fredericson criteria.

Results:

Evidence of talar BME was seen in 15 of the 28 (54%) ankles examined and in 9 of 14 (64%) dancers. We found that 6 dancers demonstrated bilateral talar BME, 3 dancers demonstrated unilateral BME, and 5 dancers demonstrated no evidence of BME. The most common location of BME was the posterior talus, seen in 8 of 15 (53%) ankles. No statistically significant differences were noted in dancers with versus those without talar BME with regard to functional scores, demographic characteristics, or weekly training hours.

Conclusion:

Asymptomatic talar BME was highly prevalent (64%) in professional ballet dancers and tended to occur posteriorly. Long-term clinical and radiographic follow-up is necessary to determine the natural history of these lesions.
Training Residents for the Future: A Virtual Care Rotation for Emergency Medicine
Authors: Hall Justin N , Costello Lorne L
Published: May 2023

OBJECTIVES

Virtual care (VC) is increasingly becoming a part of emergency medicine (EM) physician workflows, yet no formal digital health curricula exist within Canadian EM training programs. The objective was to design and pilot a VC elective rotation for EM residents to help address this gap and better prepare them for future VC practice.

METHODS

The current work describes the design and implementation of a 4-week VC elective rotation for EM residents. The rotation consisted of VC shifts, medical transport shifts, one-on-one discussions with various stakeholders, weekly thematic articles, and a final project deliverable.

RESULTS

The rotation was well received by all stakeholders, and the quality of feedback and one-on-one teaching were highlighted as strengths. Future work will consider the optimal delivery timing of this type of curricula, whether all EM residents should receive basic training in VC, and how our current findings may be generalizable to other VC sites.

CONCLUSION

A formal digital health curriculum for EM residents supports competency development for delivering VC as part of future EM practice.
Leveraging identity to overcome temporal and financial limitations in rapid ethnography in criminological research
Authors: Aqil Nauman , Petrich Katharine , Gundur RV
Published: May 2023

With limited time and funding, scholars who deploy qualitative methodologies to examine deviance and criminogenic contexts, such as ethnography, must leverage sources of capital which reduce time-arcs and costs needed for qualitative research. Traditional ethnographic projects require both significant time and funding; accordingly, several authors have indicated the utility of “rapid ethnographies”, which require less time in the field and funding. By reflecting on three rapid ethnographies, we show how identity is simultaneously a property that informs how research unfolds and a capital that can be leveraged to compensate for temporal and financial deficits. In short, we show that rapid ethnography can be conducted ethically and that identity can counterbalance deficits in monetary and temporal capital when identity is carefully considered in the pre-planning and execution of a rapid ethnographic project.
Surgical Approach to Full Thickness Cartilage Defect With Patellar Instability: Combined Matrix-Associated Chondrocyte Implantation (MACI) and Medial Patellofemoral Ligament (MPFL) Reconstruction
Authors: Coladonato Carlo , Wilson Sean M. , Freedman Kevin B.
Published: May 2023

Background:

Cartilage injury in the setting of acute patellar dislocation is a devastating condition that can lead to decreased quality of life and can progress to early osteoarthritis of the knee if not treated adequately.

Indications:

Matric-associated chondrocyte implantation (MACI) with concomitant medial patellofemoral ligament reconstruction (MPFLR) is indicated for young, high-demand patients with a symptomatic, full-thickness chondral lesions >2 cm2 that have failed an initial trial of conservative management or are found to have evidence of extensive cartilage damage or loose body that is not amenable to fixation.

Technique Description:

The MACI technique requires a 2-stage procedure. An initial diagnostic arthroscopy aids in characterization of the chondral lesion with regard to lesion size, depth, and morphology. Hyaline cartilage was harvested and autologous chondrocytes are seeded onto a MACI scaffold to grow. At the second stage, an MPFLR is planned alongside MACI. First a midline incision is made. Notably, instead of performing the capsulotomy at this stage, we proceed with the dissection for the MPFLR first creating a plane between layer #2 and #3 for easier graft retrieval later. The defect site is prepared, and the MACI graft is seated in the defect and secured. Medial patellofemoral ligament reconstruction is then begun by fixing the preloaded semitendinosus allograft to the patella. Shottle point is confirmed via fluoroscopy and dissection down to the femoral condyle is performed. The graft is retrieved between the 2 layers that were dissected earlier in the procedure and fixed within the femoral tunnel. Finally, the synovial layer is closed deep to the MPFL graft and the vastus medialis oblique (VMO) layer is closed superficial to it before closing the wound in the standard fashion.

Results:

The MACI procedure demonstrates high rates of satisfaction for relief of pain and significant improvements in clinical outcomes with generally low incidence of complications. Matric-associated chondrocyte implantation has been shown to be superior to microfracture in the treatment of larger (>3 cm2) symptomatic articular defects at 5 years.

Discussion/Conclusion:

Matric-associated chondrocyte implantation procedure with concomitant MPFLR should be considered in indicated patients with full thickness cartilage defects that are not amenable to fixation.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Expanding our sense of the possible: Ten theses for possibility studies
Authors: Meretoja Hanna
Published: May 2023

By exploring our sense of the possible as a narratively mediated phenomenon, this essay brings possibility studies in dialogue with interdisciplinary narrative studies. It suggests that (1) the possible is entangled with actual life worlds that are heterogeneous spaces of possibility, (2) the possible is crucial to our temporal existence as being in the world with others, (3) narratives shape our sense of the possible, (4) possibility studies can contribute to strengthening our narrative agency, (5) narrative imagination has transformative power, (6) fiction can explore worlds as spaces of possibility, foster perspective awareness, and expand our sense of the possible, (7) the possible exists through processes of interpretation, and hence (narrative) hermeneutics is relevant to possibility studies, (8) our relationship to cultural models of sense-making is a possibility relationship, (9) possibility studies can bring to dialogue memory studies, futures studies and narrative studies, and (10) possibility studies should articulate and evaluate the ethico-political affordances and dangers of different discourses of the possible.
Pembrolizumab in Relapsed or Refractory Primary Mediastinal Large B-Cell Lymphoma: Final Analysis of KEYNOTE-170
Authors: Zinzani Pier Luigi , Thieblemont Catherine , Melnichenko Vladimir , Bouabdallah Krimo , Walewski Jan , Majlis Alejandro , Fogliatto Laura Maria , Martin Garcia-Sancho Alejandro , Christian Beth , Gulbas Zafer , Özcan Muhit , Perini Guilherme Fleury , Ghesquieres Herve , Shipp Margaret A. , Thompson Seth , Chakraborty Samhita , Marinello Patricia , Armand Philippe
Published: May 2023

Previous analyses of the phase 2 KEYNOTE-170 (NCT02576990) study demonstrated effective antitumor activity and acceptable safety of pembrolizumab 200 mg given every 3 weeks for up to 35 cycles (~2 years) in patients with relapsed/refractory (R/R) primary mediastinal B-cell lymphoma (PMBCL) whose disease progressed after or who were ineligible for autologous stem cell transplantation. End points included objective response rate (ORR), progression-free survival (PFS), and duration of response (DOR) by investigator per 2007 Response Criteria; overall survival (OS); and safety. In this final analysis, median duration of follow-up was 48.7 months (range, 41.2-56.2). ORR was 41.5% (complete response, 20.8%; partial response, 20.8%). Median DOR was not reached; no patients who achieved complete response had progressed at the data cutoff. Median PFS was 4.3 months; 4-year PFS rate was 33.0%. Median OS was 22.3 months; 4-year OS rate was 45.3%. At the data cutoff, 30 patients (56.6%) had any-grade treatment-related adverse events (AEs); the most common were neutropenia, asthenia, and hypothyroidism. Grade 3 or 4 treatment-related AEs occurred in 22.6% of patients; no grade 5 AEs occurred. After 4 years of follow-up, pembrolizumab continued to provide durable responses, with promising trends for long-term survival and acceptable safety in R/R PMBCL.
Highly-multiplexed and efficient long-amplicon PacBio and Nanopore sequencing of hundreds of full mitochondrial genomes
Authors: Karin Benjamin R. , Arellano Selene , Wang Laura , Walzer Kayla , Pomerantz Aaron , Vasquez Juan Manuel , Chatla Kamalakar , Sudmant Peter H. , Bach Bryan H. , Smith Lydia L. , McGuire Jimmy A.
Published: May 2023

Background

Mitochondrial genome sequences have become critical to the study of biodiversity. Genome skimming and other short-read based methods are the most common approaches, but they are not well-suited to scale up to multiplexing hundreds of samples. Here, we report on a new approach to sequence hundreds to thousands of complete mitochondrial genomes in parallel using long-amplicon sequencing. We amplified the mitochondrial genome of 677 specimens in two partially overlapping amplicons and implemented an asymmetric PCR-based indexing approach to multiplex 1,159 long amplicons together on a single PacBio SMRT Sequel II cell. We also tested this method on Oxford Nanopore Technologies (ONT) MinION R9.4 to assess if this method could be applied to other long-read technologies. We implemented several optimizations that make this method significantly more efficient than alternative mitochondrial genome sequencing methods.

Results

With the PacBio sequencing data we recovered at least one of the two fragments for 96% of samples (~ 80–90%) with mean coverage ~ 1,500x. The ONT data recovered less than 50% of input fragments likely due to low throughput and the design of the Barcoded Universal Primers which were optimized for PacBio sequencing. We compared a single mitochondrial gene alignment to half and full mitochondrial genomes and found, as expected, increased tree support with longer alignments, though whole mitochondrial genomes were not significantly better than half mitochondrial genomes.

Conclusions

This method can effectively capture thousands of long amplicons in a single run and be used to build more robust phylogenies quickly and effectively. We provide several recommendations for future users depending on the evolutionary scale of their system. A natural extension of this method is to collect multi-locus datasets consisting of mitochondrial genomes and several long nuclear loci at once.
Utilization of five data mining algorithms combined with simplified preprocessing to establish reference intervals of thyroid-related hormones for non-elderly adults
Authors: Zhong Jian , Ma Chaochao , Hou Li’an , Yin Yicong , Zhao Fang , Hu Yingying , Song Ailing , Wang Danchen , Li Lei , Cheng Xinqi , Qiu Ling
Published: May 2023

Background

Despite the extensive research on data mining algorithms, there is still a lack of a standard protocol to evaluate the performance of the existing algorithms. Therefore, the study aims to provide a novel procedure that combines data mining algorithms and simplified preprocessing to establish reference intervals (RIs), with the performance of five algorithms assessed objectively as well.

Methods

Two data sets were derived from the population undergoing a physical examination. Hoffmann, Bhattacharya, Expectation Maximum (EM), kosmic, and refineR algorithms combined with two-step data preprocessing respectively were implemented in the Test data set to establish RIs for thyroid-related hormones. Algorithm-calculated RIs were compared with the standard RIs calculated from the Reference data set in which reference individuals were selected following strict inclusion and exclusion criteria. Objective assessment of the methods is implemented by the bias ratio (BR) matrix.

Results

RIs of thyroid-related hormones are established. There is a high consistency between TSH RIs established by the EM algorithm and the standard TSH RIs (BR = 0.063), although EM algorithms seems to perform poor on other hormones. RIs calculated by Hoffmann, Bhattacharya, and refineR methods for free and total triiodo-thyronine, free and total thyroxine respectively are close and match the standard RIs.

Conclusion

An effective approach for objectively evaluating the performance of the algorithm based on the BR matrix is established. EM algorithm combined with simplified preprocessing can handle data with significant skewness, but its performance is limited in other scenarios. The other four algorithms perform well for data with Gaussian or near-Gaussian distribution. Using the appropriate algorithm based on the data distribution characteristics is recommended.
An ensemble machine learning approach to predict postoperative mortality in older patients undergoing emergency surgery
Authors: Lee Sang-Wook , Lee Eun-Ho , Choi In-Cheol
Published: May 2023

Background

Prediction of preoperative frailty risk in the emergency setting is a challenging issue because preoperative evaluation cannot be done sufficiently. In a previous study, the preoperative frailty risk prediction model used only diagnostic and operation codes for emergency surgery and found poor predictive performance. This study developed a preoperative frailty prediction model using machine learning techniques that can be used in various clinical settings with improved predictive performance.

Methods

This is a national cohort study including 22,448 patients who were older than 75 years and visited the hospital for emergency surgery from the cohort of older patients among the retrieved sample from the Korean National Health Insurance Service. The diagnostic and operation codes were one-hot encoded and entered into the predictive model using the extreme gradient boosting (XGBoost) as a machine learning technique. The predictive performance of the model for postoperative 90-day mortality was compared with those of previous frailty evaluation tools such as Operation Frailty Risk Score (OFRS) and Hospital Frailty Risk Score (HFRS) using the receiver operating characteristic curve analysis.

Results

The predictive performance of the XGBoost, OFRS, and HFRS for postoperative 90-day mortality was 0.840, 0.607, and 0.588 on a c-statistics basis, respectively.

Conclusions

Using machine learning techniques, XGBoost to predict postoperative 90-day mortality, using diagnostic and operation codes, the prediction performance was improved significantly over the previous risk assessment models such as OFRS and HFRS.