bluuebunny/crossref_metadata_2025 huggingface dataset:
Complications are Increased with the Need for an Abdominal-Assisted Kraske Procedure
Authors: Harvey Elizabeth H. , Young Michelle R. , Flanigan Thomas L. , Carlin Arthur M. , White Michael T. , Tyburski James G. , Weaver Donald W.
Published: November 2022

The Kraske procedure offers a sphincter-saving alternative for surgical correction of rectal disease. This study was performed to investigate the complication rate with the traditional (transsacral) Kraske procedure versus an abdominal-assisted Kraske approach (laparoscopic or open). We conducted a retrospective review of all patients undergoing the Kraske procedure at Harper University Hospital over a 10-year period. A total of 54 patients were identified. Indications for surgery included rectal carcinoma (43), large villous adenomas (6), and other (5). Average postoperative follow-up was 40 ± 25 months (mean ± SD). Complications included rectocutaneous fistulae (9), perineal infections (13), and incontinence (8). In patients requiring an abdominal-assisted approach for colorectal mobilization, the fistula rate was significantly higher (33% vs 3%; P = 0.007), as were the rates of perineal infections (33% vs 17%) and of initial incontinence (25% vs 7%). The laparoscopic-assisted approach significantly reduced the operating time (272 ± 72 minutes) compared to the open-assisted approach (498 ± 138 minutes) ( P < 0.001). The traditional Kraske procedure can be utilized in a safe, effective manner for treatment of rectal disease. Knowledge of the increased rate of complications with the abdominal-assisted Kraske approach can guide the patient and physician considering sphincter salvage.
Intraoperative Frozen Section of Sentinel Nodes: A Formal Decision Analysis
Authors: Chao Celia , Abell Troy , Martin Robert C.G. , Mcmasters Kelly M.
Published: November 2022

In the absence of data from randomized trials, a formal decision analysis was undertaken to quantify the relative value of the patients’ quality of life with regard to performing intraoperative frozen section (FS) versus permanent section (PS) analysis of the sentinel lymph node (SLN) for breast cancer. Assumptions for this analysis were based on data from 203 nodal basins where the prevalence of nodal metastasis was 26.1 per cent; the FS sensitivity was 68 per cent and FS false-positive rate was 0.7 per cent. DATA 4.0 was used to model the decision analysis. The two branches of the tree represent the two surgical options of either FS analysis intraoperatively, accompanied by immediate axillary dissection for positive nodes versus PS analysis followed by reoperative axillary dissection. The expected utility (EU) with the FS strategy is 0.9736; the EU for PS is 0.9732, suggesting no definite preference for either procedure. Overall, the toss-up is very robust. The decision to choose FS versus PS should be based on individual patient risk and preference because the decision analysis indicated that these two options are equivalent with respect to patient quality of life.
Modified Supracondylar Amputation of the Femur
Authors: Majeski James
Published: November 2022

The upper leg can be amputated at many levels starting with the through the knee amputation and ending with the hip disarticulation. The most common above the knee amputation is through the mid-femur, and this procedure is taught in most surgical programs in the United States. A new modification of the supracondylar amputation of the femur is herein described. A 20-year experience of over 200 procedures is reported using a new modification of the supracondylar amputation of the leg. Two deaths occurred, and a primary healing rate of 95 per cent was obtained. Revision to a higher level was required in only three patients. The advantages of the modified amputation procedure include short operative procedure, minimal blood loss, long femur stump, reduced pain, strong fascial closure, high rate of primary healing, and avoidance of a postoperative flexion contracture at the hip.
Clinical and Ultrasonographic Characteristics of Breast Metastases from Extramammary Malignancies
Authors: Yeh Chun-Nan , Lin Cheng-Hung , Chen Miin-Fu
Published: November 2022

Breast metastases from extramammary malignancies are uncommon, constituting about 2 per cent of all breast tumors. Breast metastasis may be confused with primary benign or malignant neoplasm of the breast. An accurate diagnosis of breast metastasis is important because the treatment and outcome of primary and secondary malignancies of the breast are completely different. The clinical features of 15 patients with breast metastases from extramammary malignancies, excluding lymphoma, between 1982 and 2001 were retrospectively reviewed. There were 2 male and 13 female patients, with ages ranging from 16 to 73 years (median, 48 years). Primary tumors in the 15 cases were 3 hepatocellular carcinomas, 2 gastric carcinomas, 2 malignant melanomas, 1 colon carcinoma, 1 lung adenocarcinoma, 1 ovarian carcinoma, 1 uterine leiomyosarcoma, 1 nasopharyngeal carcinoma, 1 esophageal squamous carcinoma, 1 embryonal rhabodomyosarcoma, and 1 cervical carcinoma. Bilateral breast involvement was observed in two patients. A solitary lesion was evident in 13 patients, with 6 in the right breast and 7 in the left. The interval between diagnosis of primary cancer and the discovery of breast metastasis ranged from 0 to 144 months (median, 12 months). The follow-up period of the primary tumor ranged from 7 months to 156 months (median, 17 months). Breast metastases were associated with disseminated metastatic disease in 14 of the 15 patients. Fourteen of the patients died within a year of breast metastasis diagnosis; median survival was 4 months. Breast metastases from extramammary malignancy are infrequent. Virtually any malignancy can metastasize to the breast. Breast metastasis usually indicates disseminated metastatic disease and a poor prognosis.
Solitary Fibrous Tumor of the Liver with Presenting Symptoms of Hypoglycemic Coma
Authors: Chithriki Mamata , Jaibaji Moneer , Vandermolen Ronald
Published: November 2022

We report a patient with solitary fibrous tumor of the liver, a rare fibrous neoplasm which to our knowledge has been reported in only 21 patients in the English literature. Most frequently, solitary fibrous tumors arise in the thoracic cavity, particularly in the pleura. Hypoglycemia has rarely been associated with these mesenchymal tumors. The presentation of this patient with hypoglycemic coma without preceding symptomatology, to our knowledge, has never been reported.
Nodular Melanoma of the Face: A Rare Finding in African Americans
Authors: Beech Derrick J. , Harb William , Reed Jarvis
Published: November 2022

The incidence of melanoma has dramatically increased during the past several decades in the United States. Although the majority of cutaneous melanomas occur in Caucasians, African Americans are also susceptible to this malignancy. Cutaneous melanomas in African Americans typically occur on palms of the hands or soles of the feet. This report documents the rare occurrence of a nodular melanoma of the face in a dark-complexion African-American patient.
Improved Intraoperative Management of Anastomotic Bleeding during Aortic Reconstruction: Results of a Randomized Controlled Trial
Authors: Hagberg Robert C. , Safi Hazim J. , Sabik Joseph , Conte John , Block Jon E.
Published: November 2022

In a randomized controlled trial, the effectiveness of a polymeric surgical sealant (CoSeal) was compared to Gelfoam/thrombin for managing anastomotic bleeding after implantation of Dacron grafts during aortic reconstruction for nonruptured aneurysms. Each treatment was directly applied to the suture line after confirmation of anastomotic bleeding. The proportion of suture line sites that achieved immediate sealing and the proportion sealed within 5 minutes were determined among 37 experimental (59 sites) and 17 control subjects (27 sites). A significantly greater proportion of bleeding suture line sites treated with the polymeric sealant achieved immediate sealing following reestablishment of blood flow compared with control-treated sites [48 of 59 (81%) vs 10 of 27 (37%); P = 0.002]. The difference between treatment groups was maintained after 5 minutes with approximately 85 per cent (50 of 59) of CoSeal sites compared to just over one-half (14 of 27) of control sites demonstrating ultimate sealing ( P = 0.01). There were no adverse events related to the use of the polymeric sealant in this study. These results support the use of this novel sealant for the intraoperative management of anastomotic bleeding during aortic reconstruction procedures.
Geriatric All-Terrain Vehicle Trauma
Authors: Adams Bruce D. , Medeiros Regina , Dereska Paul , Hawkins Michael L.
Published: November 2022

More than 300 all-terrain vehicle (ATV) trauma deaths occur annually. Most experience to date focuses on the pediatric trauma. However, senior citizens constitute the fastest growing segment of ATV enthusiasts. We queried our trauma registry from January 1988 to December 2002 and found 200 total ATV accidents. There were 8 patients over age 60. We compared geriatric and nongeriatric riders for presentation and outcome data. The anatomic distribution of injury was similar. Younger patients were more likely to have used ethanol or drugs. Tachypnea and hypotension were generally absent at presentation. The geriatric patients had worse predictive physiologic scores. Clinical outcomes for the geriatric group trended toward longer hospital stays, and they had significantly worse functional outcomes. The geriatric group nonsignificantly trended toward a higher mortality (12.5% vs 3.45%). Our study reflects the recent national trend toward a dramatic rise in geriatric ATV-related trauma. We recommend that geriatric ATV safety programs be instituted.
Norepinephrine is a More Potent Inhibitor of Tumor Necrosis Factor over a Range of Doses than Dopamine
Authors: Morgan Joe Harris , Gamblin T. Clark , Adkins Jonathan R. , Groves Joshua R. , Dalton Martin L. , Ashley Dennis W.
Published: November 2022

In the current study, we test the hypothesis that norepinephrine has greater anti-inflammatory effects versus dopamine over a range of doses in a model of lipopolysaccharide (LPS)-stimulated cytokine release in human saphenous vein. Segments of saphenous vein were cut and separated into 1 mm x 1 mm squares and placed into two 24-well plates. These small segments of vessels were incubated in the presence of 20 μg/mL bacterial LPS, alone as a control or with 10x-6, 10x-5, 10x-4, 10x-3 concentration of dopamine or norepinephrine and LPS. The general linear models (GLM) statistical analysis for least squares means and adjustment for multiple comparisons was chosen to analyze the data. Both norepinephrine and dopamine were able to suppress the production of tumor necrosis factor (TNF) in a dose-dependent fashion. Over the range of doses, norepinephrine is a more potent inhibitor of TNF production than dopamine. This is a statistically significant linear trend ( P < .0001). Both norepinephrine and dopamine are powerful antiinflammatory agents. Norepinephrine is a more potent inhibitor of TNF than dopamine.
Incidence of Incisional Hernias in Patients Operated on for Aneurysm or Occlusive Disease
Authors: Liapis Christos D. , Dimitroulis Dimitrios A. , Kakisis John D. , Nikolaou Alexis N. , Skandalakis Panagiotis , Daskalopoulos Marios , Kostakis Alkiviadis G.
Published: November 2022

The purpose of this study was to evaluate the incidence of postoperative incisional hernias after elective open abdominal aortic aneurysm (AAA) repair versus aortofemoral reconstruction. In this open prospective study, 281 patients who underwent elective open AAA or aortofemoral repair were included. All patients were evaluated by clinical examination 1 month after the operation, every 6 months for the next 5 years, and every year thereafter for the presence of an incisional hernia. Mean duration of follow-up was 63.7 months (range, 12–144 months). Seventeen patients (6.2%) were lost to follow-up. The development of a postoperative incisional hernia was recorded and analyzed with regard to the demographic data and the traditional risk factors for atherosclerosis. Statistical analysis was performed using the Kaplan-Meier method and the Cox regression analysis. The development of a postoperative incisional hernia after AAA surgical repair had an incidence of 16.2 per cent versus 7.4 per cent after aortofemoral reconstruction. Patients electively operated on for AAA have a 3.8-fold increase of developing a postoperative incisional hernia over patients operated on for peripheral occlusive disease (POD).
Treatment of Superior Mesenteric and Portal Vein Thrombosis with Direct Thrombolytic Infusion via an Operatively Placed Mesenteric Catheter
Authors: Kaplan Jonathan L. , Weintraub Sharon L. , Hunt John P. , Gonzalez Arturo , Lopera Jorge , Brazzini Augusto
Published: November 2022

Acute superior mesenteric vein (SMV) and portal vein (PV) thrombosis can be a complication of hypercoagulable, inflammatory, or infectious states. It can also occur as a complication of medical or surgical intervention. Management of mesenteric and portal vein thrombosis includes both operative and nonoperative approaches. Operative interventions include thrombectomy with thrombolysis; this is often employed for patients who present with signs of peritoneal irritation. Nonoperative approaches can be either noninvasive or invasive. Treatment with anticoagulation has been shown to be efficacious, though its rate of recanalization is not as high as with intravascular infusion of thrombolytics. Intravenous catheterization and thrombolytic infusion has the advantage of direct pharmacologic thrombolysis of clot, with decreased infusion required and the possibility to carry out dilation or thrombectomy concurrently. We report the use of recombinant tissue-plasminogen activator (rt-PA) infusion via an operatively placed multi side-hole catheter/5-Fr introducer sheath into the right portal and superior mesenteric vein clot, inserted through a small jejunal vein, in a patient who presented with acute gangrenous appendicitis and thrombosis of the main portal trunk and superior mesenteric vein. A temporary abdominal closure was maintained until 36 hours after the start of infusion of the rt-PA. At this time venous system had normal flow, with complete recanalization of the right portal and superior mesenteric veins.
In situ Femoral to Popliteal Bypass Graft Using Superficial Femoral Vein to Popliteal Vein
Authors: Pfeiffer Ralph Burton , Pfeiffer Ralph Burton , Esses Glenn E. , Watts Benny
Published: November 2022

During the evolution of vascular surgery as a specialty, many conduits have been used to revascularize the lower extremities. Superficial veins and prosthetic materials make up the majority of materials used to bypass diseased segments of native artery. The deep veins of the thigh have also been reported as alternatives for arterial bypass. However, the use of the in situ superficial femoral and popliteal vein bypass has not been reported to our knowledge in current literature. We report a 79-year-old white female with lower extremity rest pain who underwent an in situ femoral popliteal bypass graft for limb salvage.
The Open Peritoneal Cavity: Etiology Correlates with the Likelihood of Fascial Closure
Authors: Tsuei Betty J. , Skinner J. Chris , Bernard Andrew C. , Kearney Paul A. , Boulanger Bernard R.
Published: November 2022

The use of laparostomy in damage control surgery and uncontrolled intra-abdominal infection has been well described. We examined 71 patients who required laparostomy to see if trends in management and outcome could be identified based on the underlying disease state. The underlying etiology included gastrointestinal sepsis ( n = 25), pancreatitis ( n = 21), or trauma ( n = 25). Pancreatitis patients required more operations per patient ( P < 0.05). The likelihood and type of closure (fascial, mesh, or none) was related to the underlying etiology: trauma patients were more likely to have fascial closure ( P < 0.02), patients with GI sepsis were more likely to require mesh closure, and pancreatitis patients were more likely to have no formal closure ( P < 0.02). Only 29 per cent of patients achieved definitive fascial closure. Mortality in trauma patients was 20 per cent, 36 per cent for GI sepsis, and 43 per cent in patients with pancreatitis. Complications of laparostomy included enterocutaneous fistula (16.9%) and abscess formation (7%). Though the use of laparostomy has become more prevalent, it is still associated with significant hospital stay, morbidity, and mortality. In our study, the number of operations and likelihood of abdominal closure appears to correlate with the etiology of the underlying disease requiring use of laparostomy.
Primary Lymphoma of the Breast: A Case of Marginal Zone B-Cell Lymphoma
Authors: Giron Gladys L. , Hamlin Paul A. , Brogi Edi , Mendez Jane E. , Sclafani Lisa
Published: November 2022

A case of primary marginal zone B-cell lymphoma in an elderly female patient is presented. Primary breast lymphomas are rare, comprising less than 1 per cent of all breast malignancies. These tumors have no clinical, pathologic, or radiologic pathognomonic features to distinguish them from breast adenocarcinoma. The diagnosis is usually made with an excisional biopsy, and more extensive surgery should be avoided. Delivery of radiation therapy and chemotherapy is tailored according to the histologic grade, stage of disease, and overall patient condition. This report summarizes the current knowledge reflected in the literature.
Laparoscopic Appendectomy after 30 Weeks Pregnancy: Report of Two Cases and Description of Technique
Authors: Barnes Stephen L. , Shane Matthew D. , Schoemann Mark B. , Bernard Andrew C. , Boulanger Bernard R.
Published: November 2022

Appendicitis and pregnancy are both common conditions, and when they co-exist, both the general surgeon and obstetrician are presented with unique challenges. Acute appendicitis is the most common cause of the acute abdomen during pregnancy, effecting 0.1–0.3 per cent of pregnancies each year. With an estimated 4 million deliveries per year in the United States, there are potentially as many as 12,000 cases of acute appendicitis to be managed by the general surgeon during pregnancy (Eur J Surg 1992;158:603–6; Curr Surg 2003;60:164–73). Laparoscopic appendectomy has become a routine procedure and is now widely performed in North America. Although laparoscopic appendectomy has been discussed during pregnancy, limited data is available on the role of laparoscopic appendectomy in the third trimester of pregnancy. In fact, some authors have advocated a gestational age of 26–28 weeks to be the upper gestational limit for successful completion of laparoscopic surgery (Obstet Gynecol Surg 2001;56:50–9). In this paper, we present two recent cases of successful laparoscopic appendectomy during late pregnancy without immediate complication to mother or fetus and a description of our operative technique.
Outcomes of Laparoscopic versus Open Appendectomy
Authors: Carbonell Alfredo M. , Burns Justin M. , Lincourt Amy E. , Harold Kristi L.
Published: November 2022

Controversy remains regarding which approach is better, laparoscopic appendectomy (LA) or open appendectomy (OA). A 5-year retrospective review of patients undergoing appendectomy was performed to compare the outcomes of LA and OA using standard statistical methods ( P < 0.05). LA was performed in 207 and OA in 100 patients (conversion 6.7%). Females underwent LA more frequently than males (81.7% vs 51.9%; P = 0.0001). LA patients were older (30.2 years vs 25.7 years; P = 0.03), with no differences in body mass index (BMI) (27.9 kg/m2vs 25.5 kg/m2; P = 0.06) or operative times (51.1 minutes vs 51.5 minutes; P = 0.84).’ LA patients required less analgesics (19.2 mg vs 31.5 mg; P = 0.01), and shorter hospital stays (27.2 hours vs 53.1 hours; P = 0.0001). Operating room charges were higher for LA ($3839 vs $2528; P = 0.0001), with no difference in total hospital charges ($8801. vs $9147; P = 0.14). Complications between LA and OA were similar (3.6% vs 8%; P = 0.12). Converted patients were older, required more analgesia, and had higher morbidity, length of stay, and hospital charges. LA is the procedure of choice for appendicitis regardless of age, sex, BMI, or degree of appendiceal inflammation. LA is as safe and quick to perform as OA with lower analgesic requirements, length of stay, and no difference in total charges.
Reduced Social Morbidity of Laparoscopic Appendectomy in Children
Authors: Tantoco Joselito G. , Levitt Marc A. , Hollands Celeste M. , Brisseau Guy F. , Caty Michael G. , Glick Philip L.
Published: November 2022

Laparoscopic appendectomy has not been uniformly adopted by pediatric surgeons. Our children's hospital adopted laparoscopic appendectomy due to perceived benefits to patients and their families. We hypothesized that laparoscopic appendectomy in children resulted in less social morbidity than those undergoing open appendectomy. A questionnaire focused on a set of postoperative variables affecting the patient's and the family's return to normal activities. Families expressed their answers as a range of days. Five different ranges were assigned a numerical value for 10 different social morbidity variables. The numerical values were analyzed using Pearson χ2 test; statistical significance was defined as P < 0.05. The response rate was 55 per cent (134 of 244). Seventy-four had open and 47 laparoscopic appendectomy with a comparable incidence of acute and perforated appendicitis. Children undergoing laparoscopic appendectomy had shorter hospital stays and earlier resumption of feeding, return to school, return to pain-free walking and stair climbing, and resumption of normal activities including gym. Additionally, they had fewer wound problems, shorter duration of oral pain medication usage, and their parents returned to work quicker than the open group. All these were statistically significant. Laparoscopic appendectomy results in significantly reduced social morbidity for children and their families.
Language Barrier Leads to the Unnecessary Intubation of Trauma Patients
Authors: Bard Michael R. , Goettler Claudia E. , Schenarts Paul J. , Collins Beth A. , Toschlog Eric A. , Sagraves Scott G. , Rotondo Michael F.
Published: November 2022

Airway evaluation in trauma patients is performed immediately upon patient contact, with communication being a vital component to this exam. Language and communication barriers may lead to the unnecessary placement of an artificial airway with resultant patient risk and elevation of health care costs. The objective of our study was to evaluate potentially preventable intubations in Spanish-speaking patients. A 9-year retrospective review was performed using the National Trauma Registry for The American College of Surgeons (NTRACS) database. We evaluated patients intubated on arrival to the trauma center and remaining intubated for less than 48 hours. Deaths were excluded. Patients who typically speak English were compared with patients who typically speak Spanish. Mechanism of injury (MOD, hypotension during resuscitation (HDR), illicit substance use, alcohol use, mean Glasgow Coma Score (GCS), mean Injury Severity Score (ISS), payer source, and hospital cost were compared. Forty-nine per cent and 38 per cent of Spanish and English speaking individuals, respectively, were intubated for less than 48 hours ( P = 0.072). MOI, HDR, ISS, illicit substance use, alcohol use, and payer source were similar. GCS was statistically higher in the Spanish-speaking group (14 vs 12; P = 0.004). Language and communication barriers lead to potentially preventable intubations in trauma patients.
Predictors of Mortality in Trauma Patients
Authors: Macleod Jana B.A. , Lynn Maurico , Mckenney Mark G. , Jeroukhimov Igor , Cohn Stephen M.
Published: November 2022

The purpose of this study was to ascertain risk factors for death from trauma. The large cohort allows for simultaneous evaluation of known mortality risk factors along with controlling for factors to assess the influence of each independently. Individually, base deficit, temperature, hypotension, age, and injury severity have been shown to be associated with an increased risk of death. However, in the English literature, there is no data on the independent predictive power and interaction of these risk factors. A review of trauma registry parameters from 1995 to 2000 was used. Demographics, injury severity, physiological and hematological parameters, and time data were evaluated in a univariate analysis. Variables significantly associated with mortality were entered into a stepwise backward multiple logistic regression. There were 1276 deaths (8.9%) with 25 per cent of the deaths within 3 hours. The top four predictors of mortality in this group were partial thromboplastin time (OR 3.37, 95% CI: 2.51–4.52), positive head computed tomography result (OR, 2.47; 95% CI, 1.95–3.04), initial hemoglobin (OR, 1.69; 95% CI, 1.23–2.31), base deficit (OR, 1.62; 95% CI, 1.29–2.04), and trauma resuscitation bay systolic blood pressure (OR, 1.45; 95% CI, 1.11–1.88). We conclude that prognostic indicators of all-cause mortality after trauma, which remain independent in the presence of all other factors and are potentially treatable, included low hemoglobin, elevated prothrombin and partial thromboplastin time, low scene and trauma bay systolic pressure, and elevated base deficit. The independent indicators of mortality, which are untreatable, included head injury, increasing age, and Injury Severity Score.
Retrospective Analysis of Traumatic Bladder Injury: Does Suprapubic Catheterization Alter Outcome of Healing?
Authors: Margolin Daniel J. , Gonzalez Richard P.
Published: November 2022

The role of suprapubic catheters in traumatic bladder injuries is not well defined. Current literature suggests that suprapubic catheters are only necessary with large intraperitoneal bladder ruptures. The purpose of this study is to show that all bladder injuries can be managed with transurethral catheterization alone with a similar leak rate, morbidity, and healing time. Retrospective analysis was done of all patients with traumatic bladder injuries at a level I urban trauma center from June 1992 through June 2003. Medical records were reviewed and data analyzed according to type of bladder catheterization (i.e., transurethral or suprapubic). All patients with urethral injuries were excluded. Fifty-six patients met inclusion criteria. Twenty-seven patients suffered penetrating bladder injuries, and 29 bladder injuries were secondary to blunt trauma. Forty-seven patients were treated with transurethral catheter drainage, two were treated with suprapubic catheters, and seven were treated with both transurethral and suprapubic catheters. Forty patients had follow-up cystograms prior to catheter removal. Of the 47 patients treated with transurethral drainage alone, 3 (6%) developed urinary leaks. Of the 9 patients with suprapubic catheters, 2 (22%) developed urinary leaks. The mean time to removal of transurethral catheters was 15 days. The mean time to removal of suprapubic tubes was also 15 days. All study patients successfully healed their bladder injuries regardless of catheterization method. Suprapubic catheter drainage may increase morbidity without improving healing time. These results effectively support the decision to use transurethral catheter drainage alone in all patients with traumatic bladder injuries.
Chylous Ascites after Nephrectomy for Trauma
Authors: Knight Colin G. , Omert Laurel
Published: November 2022

Chylous ascites has many etiologies including malignancy, infection, and inflammation. Management of this condition varies from conservative treatment to surgery. We present a case of chylous ascites after laparotomy for trauma and review the pathophysiology, etiology, diagnosis, and treatment options for this condition.
Nonoperative Management of Neonatal Splenic Rupture
Authors: Driscoll Karen , Benjamin Louis C. , Gilbert James C. , Chahine A. Alfred
Published: November 2022

Neonatal injury of the spleen is an uncommon but serious condition. Although the standard management of children with splenic injury is nonoperative, there is scant evidence in the literature to support handling neonates in the same way. We report a case of neonatal splenic rupture that was managed nonoperatively. A 3.6-kg full-term female born vaginally became tachycardic and pale on the second day of life. She had a distended abdomen and a hemoglobin of 5.8 g/dL. Her blood pressure remained within normal limits. She was transfused 20 cc/kg packed red blood cells. CT scan showed a grade V splenic rupture. Coagulopathy workup was negative. The assumption was that she had a ruptured spleen secondary to a traumatic delivery. She remained stable after the transfusion. It took 32 weeks for a CT scan to show complete healing. Traditionally, neonatal splenic rupture has been treated with splenectomy or splenorrhaphy. The first case of a neonate to be treated nonoperatively was reported in 2000. Our patient is only the second reported case. We chose to follow her with imaging to document healing and to rule out a tumor, as epidermoid cysts and hemangioendotheliomas can cause neonatal splenic rupture. We also review the literature to try to gain some insight into the management of this rare problem.
Fast-Speech-Induced Hypoarticulation Does Not Considerably Affect the Diachronic Reversal of Complementary Length in Central Bavarian
Authors: Jochim Markus , Kleber Felicitas
Published: November 2022

This study investigated a sound change in progress by which the Central Bavarian dialect feature of complementary length between consonant and the preceding vowel is giving way to the unrestricted combination possibility of long (Vː) and short (V) vowels with following longer fortis (Cː) and shorter lenis (C) stops, respectively. This 2 × 2 system is also found in the standard variety of German. While previous studies have regarded any such findings of convergence toward Standard German as being a result of language contact, the present study specifically tested the possibility of fast-speech-induced hypoarticulation being a system-internal driver of this change. The focus of this study was on acoustic cues to the postvocalic stop. Following the apparent-time paradigm, acoustic analyses of 10 younger and 10 older dialect speakers revealed that (1) younger dialect speakers produced both VC and VːCː (both formerly illegal in the dialect), but (2) older dialect speakers produced only VːCː sequences with duration patterns similar to those of the control group of 10 Standard German speakers. Analyses of various dependent variables further showed (3) the (apparently) delayed emergence of aspiration as an additional cue to the fortis–lenis contrast in Western Central Bavarian particularly in younger dialect speakers, (4) no considerable effect of speech rate on the dispersion of and overlap between any of the four vowel-plus-stop combinations, and (5) the irregular spread of this change that appears to be gradual. As such, the findings support a model of linguistic change that also accounts for gradual changes in dialect borrowing.
The prevalence of depression, anxiety, stress and their relationship to length of service in the UK police force
Authors: Gullon-Scott Paul , Longstaff Laura
Published: November 2022

Policing is considered a highly stressful role, and police officers are at risk of mental health issues during their service. This is an area which has gained increasing attention in recent years, but further research, using validated measures, is needed to help identify other factors that are important and ensure further development as well as evidence-based, bespoke intervention. The current study sought to explore the general prevalence of stress, depression and anxiety in a UK sample of police officers, to examine whether length of service moderates the effects of stress, depression and anxiety, and whether certain personality traits protect against these. A self-report questionnaire was completed by 177 serving UK police officers from 10 different regions. Results revealed clinical levels of anxiety and depression, and comorbid presentations of major depression and anxiety, at rates significantly higher than reported in the general population. Results indicated officers are most at risk of experiencing stress during the first 15 years of their service, and that officers’ stress was organisational rather than trauma related. Additionally, officers higher in traits of extraversion and lower in neuroticism reported lower anxiety. The results of these findings are discussed, and suggestions have been made based on the current findings.
Capital’s welfare dependency: Market failure, stalled regeneration and state subsidy in Glasgow and Edinburgh
Authors: Gray Neil , Kallin Hamish
Published: November 2022

Comparing case studies of long-term, large-scale urban regeneration projects in Glasgow and Edinburgh, Scotland, this paper brings together two addendums to the rent gap model in the shape of the ‘reputational gap’ and the ‘state subsidy gap’. These neologisms are mobilised to clarify the risk-laden centrality of the state’s role in both the formation and potential closure of rent gaps in large-scale areas of disinvestment and devalorisation. Whilst such projects often appear as expressions of capital’s state-mediated extractive power over the built environment, we consider them as examples of capitalist failure or fragility – for even with striking levels of public subsidy to address ‘market failure’ the land and property market has not been reinvigorated according to plan. This highlights the need, we argue, for further critical scrutiny of failed or stalled urban regeneration projects as a means of foregrounding the instability, rather than the omnipotence, of contemporary urban capitalism.
From fear and vulnerability to fortitude: sustaining psychological well-being in the face of the COVID-19 pandemic
Authors: Padmanabhanunni Anita , Pretorius Tyrone B
Published: November 2022

Despite the societal increase in mental health disorders during the initial stages of the COVID-19 pandemic, many individuals were able to cope effectively with new mental health challenges. The heterogeneity in responses to adversity underscores the influence of protective factors in promoting coping behaviour. The current study investigates fortitude as a potential protective resource by examining the potential direct, mediating, and moderating roles of fortitude in the relationship between perceived vulnerability to disease, fear of COVID-19, and indices of psychological well-being. Participants ( n = 355) were schoolteachers who completed the Perceived Vulnerability to Disease Questionnaire, Fear of COVID-19 Scale, Fortitude Questionnaire, UCLA Loneliness Scale, trait scale of the State-Trait Anxiety Inventory, Beck Hopelessness Scale, and the Center for Epidemiological Studies Depression Scale. Path analysis indicated that fortitude had a health-sustaining effect that was evident in its association with all indices of psychological well-being. Fortitude also mediated the relationship between perceived vulnerability to disease and depression, anxiety, and loneliness. In addition, fortitude moderated the relationship between fear of COVID-19 and depression. The significant moderating and mediating effects of fortitude on psychological outcomes support its potential for counterbalancing the negative mental health impacts of COVID-19. Interventions aimed at enhancing fortigenic appraisals of self and others may prove beneficial in promoting psychological well-being.
Modifications to Risk Aversion in High Gain Situations
Authors: MacKay J.A. , Lerche I. , Rose P.R.
Published: November 2022

The classical Cozzolino formula for risk aversion, which determines the optimum working interest that should be taken in an exploration opportunity, suffers from the disadvantage that the predicted optimum working interest decreases for opportunities which have increasing high gain potential, independently of the success chance, while the predicted risk adjusted value tends towards a constant limit, which is independent of anticipated costs and depends only on the corporate risk tolerance and the success probability. For low gain opportunities the classical risk formula does an adequate job of assessing optimum working interest. Modifications are given to the method which, for low gain opportunities, reduce to the classical risk adjusted behaviors but which, for high gain opportunities, provides a predicted optimum working interest which increases with increasing gain.

A practical procedure is provided for using these modifications in a simple manner to differentiate between high gain (good-risk) opportunities versus low gain (bad-risk) opportunities. Numerical illustrations indicate graphically the changes in risk aversion brought about by the required modifications.
Establishment of a Quantitative Index for Evaluation of Caprock Sealing, and Application to the SHONGLIAO Basin, China
Authors: Pang X. , Fu G. , Jiang Z. , Lerche I.
Published: November 2022

Using basin modelling principles and methods, this paper puts forward a quantitative and comprehensive index (comprising the influence of a series of geological factors) to evaluate the sealing ability of a caprock, to establish the index with a computer modelling system, and to illustrate its value by application to the Shongliao Basin.

The advantage of the Cap Rock Index (CRI) is that it can be used to calculate the oil and gas columns that could be sealed by a caprock, to identify and grade caprocks, to recover sealing changes, and to evaluate the critical points at which caprocks start to seal oil and also gas in the geohistory evolution of a basin.
Sedimentary Shattering as Hydrocarbon Migration Avenues in Salt-floored Basins: A New Migration Paradigm
Authors: Lowrie A. , MacKenzie M.G. , Guderion E. , Talbert F.E.
Published: November 2022

The salt-floored basin concept as applied to the Louisiana offshore, with its total dependence on laterally migrating salt, provides a dynamic view of geologic evolution. Salt domes, ridges, and massifs move basinward at rates of one to ten cm/yr, causing extensive fracturing, thermal anomalies, and under- and over-pressured horizons. The ever-enlarging sedimentary wedge contains its own tectonics; principally basin-spanning shelf-edge growth faults that sole out in shale layers. Advancing salt tongues can create counter-regional and local growth faults that terminate in the semi-plastic salt. Additional stresses, some by basement faulting, are also active within the salt-floored passive margin.

A geologically reasonable conclusion, derived from the abundance of tectonics, is that the sediments may be thought of as shattered. Porous flowage would be reminiscent of that through a colander, not a sieve. Given the possibility of such massive shattering, it is obligatory to prepare a different paradigm relative to hydrocarbon migration. The now decades old notion that most, if not all, hydrocarbons migrate along regional faults must be modified. The shattered sedimentary wedge becomes a conduit for hydrocarbon migration with some concentration of hydrocarbon flow along regional faults, however intermittent that may be. The sedimentary shattering may be so extensive that a new paradigm need be applied to hydrocarbon migration.
The risk of harm whilst waiting for varicose veins procedure
Authors: Bootun Roshan , Burrows Mandy , Chowdhury Mohammed M , Stather Philip W , Al-Jundi Wissam
Published: November 2022

Introduction

Varicose veins (VV) negatively impact quality of life (QoL) and have risks of major complications including bleeding, ulceration and phlebitis. During the COVID-19 pandemic, the VSGBI (Vascular Society of Great Britain and Ireland) and GIRFT (Get It Right First Time) classified VVs as lowest priority for intervention.

Objective

This study aims to determine harm caused and the impact on the QoL on patients waiting for their VVs procedures for more than 1 year.

Methods

This was a prospective study conducted at the Norfolk and Norwich University Hospital (NNUH). Patients with VVs awaiting intervention for >1 year were included in the study. Patients with CEAP C6 disease were considered to be too high risk to be invited for treatment during the Covid-19 pandemic. Patients were sent QoL questionnaires and underwent a telephone consultation to assess harm. Both generic (EQ-VAS and EQ-5D) and disease-specific (AVVQ and CIVIQ-14) instruments were utilised. There were no control groups available for comparison.

Results

275 patients were identified (37.1% male) with median time on waiting list of 60 weeks (IQR 56–65). 19 patients (6.9%) came to major harm, including phlebitis (3.6%), bleeding (1.8%) and ulceration (1.8%). Fifty-two patients (18.9%) had minor harm, including worsening pain (12.7%) and swelling (6.2%). 6.9% reported psychological harm. Rising CEAP stage was also associated with worsening level of harm in patients with C5-6 disease ( p < 0.0001). Only 8.7% stated they would decline surgery during the pandemic. 104 QoL questionnaires were returned. Median EQ-VAS and EQ-5D was 75 (IQR: 60–85) and 0.685 (0.566–0.761), respectively. Median AVVQ score was 23.2 (14.9–31.0) and CIVIQ-14 score was 33 (21–44). ConclusionsThis study highlights the impact of delaying VVs surgery during a pandemic. A significant rate of both major and minor as well as psychological harm was reported. In addition, VVs had a significant detriment to quality of life.
Acculturative Stress and Psychological Distress Among Latinx Youth: Moderating Role of Family Cohesion and Conflict
Authors: Pimentel Eliana C. , Delbasso Claudia A. , Kuperminc Gabriel P.
Published: November 2022

This study examined family cohesion and conflict as moderators of associations between discrimination stress and adaptation stress and psychological distress among Latinx youth. Participants included 199 Latinx adolescents (Mage = 13.68). Seventy nine percent were immigrants and 73% had family origins in Mexico. Discrimination stress and adaptation stress had differential associations with psychological distress and with indices of family functioning. Hierarchical regression analysis found significant interactions of family cohesion with both adaptation and discrimination stress. High levels of family cohesion protected against negative effects of discrimination stress. Although high levels of family cohesion were associated with less distress overall, family cohesion appeared to potentiate negative effects of adaptation stress. Results suggest a complex relation of family cohesion with Latinx youths’ emotional well-being, pointing to the need for research examining the role of extra-familial support resources for helping those youth overcome acculturative stress.
Feedback in the instrumental music lesson: A qualitative study
Authors: de Bruin Leon R
Published: November 2022

This study focuses on the role of feedback in teaching with particular emphasis on its effect on learner performance, motivation, and self-regulation. A critical account of feedback and applicable models highlight conceptual guidelines of how individual, relational, and environmental factors can impact on the utility of feedback as a performance changing device, and reasons for theory–practice disjunction. A qualitative methodology investigated 25 instrumental music teachers in Victoria, Australia, realizing the effect of studio teaching feedback on students from teachers’ perspectives and recollections of their studio teaching practice. Knowledge and skills, positive attribution, and music and relational qualities are reported through these reflections of feedback, feed-up, and feed-forward approaches to student engagement. The study highlights positive feedback encounters are typified by learner engagement and teacher–student relationality, contesting the traditional, behaviorist “feedback ritual” and teacher-centered approaches in the music lesson. The study offers implications for purposeful and structured learning opportunities, and cyclical engagement that builds impactful feedback episodes and feedback design that factors in the influence of context, culture, and differentiated relationships in learning. The study encourages educators to consider balance of “drill and thrill,” where feedback is embedded as an influential pedagogical/relational device, rather than discreet episodes of educators “telling” learners about their performance.
The role of cooperation networks in the craft beer business in Portugal: A collaborative entrepreneurship perspective
Authors: Costa Paula , Franco Mário
Published: November 2022

From a collaborative entrepreneurship perspective, this study aims to understand the functioning of craft breweries’ cooperation networks. To this end, a qualitative approach was adopted, and more specifically, the case study method. The case studied here is a craft beer network in the region of Porto, Portugal. Data collection was through documentary analysis, social networks and semi-structured interviews with various people belonging to the selected network. Content analysis led to the conclusion that in this type of cooperation network, the actors involved are not only the micro-brewers, but also sellers (bar owners), consumers and disseminators. The empirical evidence shows that this type of network is central to these actors since they use it as a support to gain knowledge and as a platform for advertising and socializing. This cooperation network is also essential for business development and the feeling of belonging is very important for all involved. This study contributes to understanding how cooperation networks function in the craft beer business, identifying the reasons, success factors and advantages/benefits that can be achieved in this type of network. A theoretical framework is also proposed as a benchmark for this type of network in other geographical contexts.
Patterns of alliances and acquisitions: An exploratory study
Authors: Choi Byungchul , Gang KwangWook
Published: November 2022

This study examined how firms combine alliances and acquisitions in an exploration/exploitation framework. By conducting cluster analysis on a sample of 1270 acquisitions made by 836 firms, we first identified the patterns in alliance and acquisition activities undertaken by these firms. Five distinct patterns were identified: (I) low alliance–low acquisition, (II) low alliance–high acquisition, (III) high alliance–low acquisition, (IV) high alliance–high acquisition, and (V) medium alliance–very high acquisition. Next, we analyzed the different ways in which the two modes were interlinked within these five patterns for exploration/exploitation. Patterns III and IV appeared to involve both exploration/exploitation and mutually reinforce exploration/exploitation. In contrast, in the remaining patterns, the two modes appeared to be more loosely coupled with each other, with a focus on exploitation.