bluuebunny/crossref_metadata_2025 huggingface dataset:
Study on the mutual influence of surface roughness and texture features of rough-textured surfaces on the tribological properties
Authors: Gu Chunxing , Meng Xianghui , Wang Shuwen , Ding Xiaohong
Published: July 2020

In recent years, the efforts to better control friction and wear have focused on surface topography modification through surface texturing. To study the mutual influence of surface roughness and texture features, this paper developed one comprehensive mathematical model of mixed lubrication to study the tribological performance of the rough-textured conjunction. The typical ring-liner conjunction was chosen as the research object. In particular, the effects of skewness and kurtosis were considered based on the non-Gaussian distribution of asperity height. In this way, the influences of non-Gaussian distribution properties and surface texturing on the tribological performance were analyzed. The results show that the influences of skewness and kurtosis on the tribological performance are nontrivial and should not be neglected in the mixed lubrication. Compared to the Gaussian distribution, considering the non-Gaussian distribution can represent the physical rough surfaces more accurately. Surfaces with negative skewness were found to generally result in better tribological properties. Moreover, the tribological performance improved by surface texturing can also be improved or reduced by the effect of skewness and kurtosis. As a result, the optimization of surface texturing should take the effects of roughness parameters into account.
What does first-line therapy mean for paediatric multiple sclerosis in the current era?
Authors: Hacohen Yael , Banwell Brenda , Ciccarelli Olga
Published: July 2020

Paediatric multiple sclerosis (MS) is associated with higher relapse rate, rapid magnetic resonance imaging lesion accrual early in the disease course and worse cognitive outcome and physical disability in the long term compared to adult-onset disease. Current treatment strategies are largely centre-specific and reliant on adult protocols. The aim of this review is to examine which treatment options should be considered first line for paediatric MS and we attempt to answer the question if injectable first-line disease-modifying therapies (DMTs) are still an optimal option. To answer this question, we review the effects of early onset disease on clinical course and outcomes, with specific considerations on risks and benefits of treatments for paediatric MS. Considering the impact of disease activity on brain atrophy, cognitive impairment and development of secondary progressive MS at a younger age, we would recommend treating paediatric MS as a highly active disease, favouring the early use of highly effective DMTs rather than injectable DMTs.
‘She doesn’t think that happens’: When heterosexual men say no to sex
Authors: Meenagh Joni L
Published: July 2020

Dominant understandings of men’s sexuality claim that men are always up for sex; as such, research on heterosexual men’s sexual refusals is sparse. Drawing on interviews conducted with young people (aged 18–23) living in and around Melbourne, Australia, this article explores three young people’s experiences of men saying ‘no’ to a woman’s request for sex within an ongoing relationship. In each of these instances the refusal was, to some extent, not respected. This presents a challenge to men’s masculinity which then needs to be redressed through compensatory manhood acts. This article explores how the truth claims of hegemonic masculinity and the male sexual drive discourse are reproduced through men and women’s social interactions, and unpacks the implications of men’s sexual refusals not being heard for sexual ethics education programmes.
Physical restraint of children and adolescents in mental health inpatient services: A systematic review and narrative synthesis
Authors: Nielson Simon , Bray Lucy , Carter Bernie , Kiernan Joann
Published: July 2020

Physical restraint is regularly used in children and adolescent mental health care, often as a reactive behaviour management strategy. Physical restraint has been associated with physical injury, but psychological consequences are poorly understood. The aim of this systematic review was to examine physical restraint of children and adolescents in inpatient mental healthcare services. Healthcare databases were searched to identify English language publications discussing anyone aged ≤18 years who had experienced physical restraint as a mental health inpatient. No date restrictions were applied. Sixteen quantitative studies are included within this review. Most studies are retrospective in nature. Publications were appraised using the Critical Appraisal Skills Programme quality assessment tool. Common characteristics associated with children and adolescents who experience physical restraint include age, gender, diagnosis, and history. Most studies associate physical restraint with the management of aggression. Findings suggest that it may be a combination of patient (intrinsic) and environmental (extrinsic) factors which ultimately lead to children and adolescents experiencing restraint. This review confirms that little is known about children and adolescents’ first-hand experiences of physical restraint. Future research should address children and adolescents’ perceptions and first-hand experiences of physical restraint.
Low-cut, low-vacuum vitrectomy for releasing an embedded intraocular foreign body
Authors: Aruna SK , Ganne Pratyusha , Baskaran Prabu
Published: July 2020

Background

Removal of an embedded intraocular foreign body remains challenging due to the risks of bleeding and retinal damage. We present a novel technique to deal with this situation.

Case report

A 32-year man presented with two months of decreased vision in one eye (best corrected visual acuity of 20/200), a year after a workplace injury that necessitated surgery for an open globe injury. Examination revealed the sequalae of his previous surgery, a subtotal retinal detachment and an embedded intraocular foreign body close to inferior ora serrata at the 6 'o clock position confirmed by imaging. The other eye was normal. A pars plana vitrectomy was performed and the embedded intraocular foreign body was released from surrounding dense adhesions using the vitrectomy probe set at 1000 cuts/minute and 100 mm Hg vacuum, followed by fluid air exchange and endolaser with silicon oil injection. The retinal detachment settled well post-operatively, and at the end of one month, the patient had best corrected visual acuity of 20/60.

Conclusions

The low-cut, low-vacuum vitrectomy technique can be considered as a safe option for releasing the embedded intraocular foreign body in complex ocular trauma scenarios.
Chain tourism in post-disaster recovery
Authors: Zavar Elyse , Lavy Brendan L , Hagelman Ronald R
Published: July 2020

Post-disaster research relating to tourism tends to focus on broad economic measures that can miss local-scale actors and contemporaneous impressions by tourists and tourism-based business owners in places undergoing recovery from a disaster. Hurricane Harvey, a Category 4 storm, swept across coastal Texas in August 2017. Many of the communities affected by Harvey have economies largely based on family recreation. Interviews in Rockport–Fulton, Texas, with tourism-oriented business owners, staff, and tourists during the Independence holiday provide qualitatively robust accounts of the community’s first major summer event following Harvey and highlight the importance of social networks and place attachment to bringing tourists to the recovering area. Furthermore, we discuss the chain tourist’s role in the recovery of affected locations and consider strategies to draw on these social networks to increase the number of tourists visiting the recovering communities.
“Something is missing”: Melancholia and belonging in collective consumption
Authors: Wickstrom Alice , Denny Iain , Hietanen Joel
Published: July 2020

In this essay, we explore the limits of marketized belonging through Kristeva’s theorization of melancholia and desire. This allows us to problematize “joyful” accounts of societal re-enchantment and how “belonging” through collectives of consumption (such as neo-tribes, subcultures of consumption, and brand communities) is generally seen as a natural response to modernist rationalization and increased individualization. Instead, we argue that the scholarly understanding of collective forms of consumption has been premised upon paradoxical ground due to the notion of the subject-as-consumer as lacking often being implicitly reproduced, albeit theoretically neglected, allowing for the reproduction of romanticized ideals of marketized “communality.” We foreground how tensions between individuality and communality are negotiated within markets and argue that collective forms of consumption feed upon separation, fragmentation, and the suspension of “joy” rather than relationality and belonging. We propose that this allows for a better understanding of the desire to become through collective consumption and direct further attention toward questions related to liminality, detachment, loss, and exclusion.
Hybrid Open-Endovascular Repair in a Patient With Giant Contained Aortic Aneurysm Rupture
Authors: Lee David , Moore January , Almerey Tariq , Hakaim Albert , Farres Houssam
Published: July 2020

Contained rupture of an aortic aneurysm is a high-mortality condition that requires immediate repair. Open repair has been the gold standard; however, endovascular and hybrid open-endovascular repair techniques have also emerged as less invasive solutions to this vascular emergency. Here. we present a patient with a giant 14.0 cm contained rupture of a Thoracic aortic aneurysm and 7.4 cm juxtarenal abdominal aortic aneurysm who was successfully treated with hybrid open-endovascular repair.
The Trickle-Down Effect of Abusive Supervision: The Moderating Effects of Supervisors’ Task Performance and Employee Promotion Focus
Authors: Kim Seckyoung Loretta , Lee Soojin , Yun Seokhwa
Published: July 2020

Drawing on both social learning theory and conservation of resources theory, our research examines the trickle-down effect of abusive supervision across three hierarchical levels: managers, supervisors, and employees. Specifically, we investigate the positive relationship between abusive manager behavior and emotional exhaustion through abusive supervisor behavior. In addition, we explore supervisor task performance as a situational factor and employee promotion focus as an individual factor in the relationship between abusive supervisor behavior and emotional exhaustion. Using data from 190 supervisor–subordinate dyads, the results provide support for our trickle-down model of abusive supervision. Moreover, our results show that the positive relationship between abusive supervisor behavior and emotional exhaustion is stronger when supervisor task performance or employee promotion focus is high. Theoretical and applied implications are discussed.
Lysosomes, Autophagy, and Hormesis in Cell Physiology, Pathology, and Age-Related Disease
Authors: Moore Michael N.
Published: July 2020

Autophagy has been strongly linked with hormesis, however, it is only relatively recently that the mechanistic basis underlying this association has begun to emerge. Lysosomal autophagy is a group of processes that degrade proteins, protein aggregates, membranes, organelles, segregated regions of cytoplasm, and even parts of the nucleus in eukaryotic cells. These degradative processes are evolutionarily very ancient and provide a survival capability for cells that are stressed or injured. Autophagy and autophagic dysfunction have been linked with many aspects of cell physiology and pathology in disease processes; and there is now intense interest in identifying various therapeutic strategies involving its regulation. The main regulatory pathway for augmented autophagy is the mechanistic target of rapamycin (mTOR) cell signaling, although other pathways can be involved, such as 5′-adenosine monophosphate-activated protein kinase. Mechanistic target of rapamycin is a key player in the many highly interconnected intracellular signaling pathways and is responsible for the control of cell growth among other processes. Inhibition of mTOR (specifically dephosphorylation of mTOR complex 1) triggers augmented autophagy and the search is on the find inhibitors that can induce hormetic responses that may be suitable for treating many diseases, including many cancers, type 2 diabetes, and age-related neurodegenerative conditions.
Qualitative Data Collection in an Era of Social Distancing
Authors: Lobe Bojana , Morgan David , Hoffman Kim A.
Published: July 2020

Qualitative researchers face unique opportunities and challenges as a result of the disruption of COVID-19. Although the pandemic represents a unique opportunity to study the crisis itself, social distancing mandates are restricting traditional face-to-face investigations of all kinds. In this article, we describe options and resources for researchers who find themselves needing to alter their study designs from face-to-face qualitative data collection to a “socially distant” method. Although technologies are constantly changing, we review the latest videoconferencing services available to researchers and provide guidance on what services might best suit a project’s needs. We describe options for various platforms and applications including information about enhanced security applications for researchers collecting sensitive patient health information. Concerns about these technologies including security of the platform and logistical needs such as computer equipment are also discussed. Special attention is given to ethical issues when transitioning research efforts to online venues.
A comparison of phase I dose-finding designs in clinical trials with monotonicity assumption violation
Authors: Abbas Rachid , Rossoni Caroline , Jaki Thomas , Paoletti Xavier , Mozgunov Pavel
Published: July 2020

Background/Aims

In oncology, new combined treatments make it difficult to order dose levels according to monotonically increasing toxicity. New flexible dose-finding designs that take into account uncertainty in dose levels ordering were compared with classical designs through simulations in the setting of the monotonicity assumption violation. We give recommendations for the choice of dose-finding design.

Methods

Motivated by a clinical trial for patients with high-risk neuroblastoma, we considered designs that require a monotonicity assumption, the Bayesian Continual Reassessment Method, the modified Toxicity Probability Interval, the Bayesian Optimal Interval design, and designs that relax monotonicity assumption, the Bayesian Partial Ordering Continual Reassessment Method and the No Monotonicity Assumption design. We considered 15 scenarios including monotonic and non-monotonic dose–toxicity relationships among six dose levels.

Results

The No Monotonicity Assumption and Partial Ordering Continual Reassessment Method designs were robust to the violation of the monotonicity assumption. Under non-monotonic scenarios, the No Monotonicity Assumption design selected the correct dose level more often than alternative methods on average. Under the majority of monotonic scenarios, the Partial Ordering Continual Reassessment Method selected the correct dose level more often than the No Monotonicity Assumption design. Other designs were impacted by the violation of the monotonicity assumption with a proportion of correct selections below 20% in most scenarios. Under monotonic scenarios, the highest proportions of correct selections were achieved using the Continual Reassessment Method and the Bayesian Optimal Interval design (between 52.8% and 73.1%). The costs of relaxing the monotonicity assumption by the No Monotonicity Assumption design and Partial Ordering Continual Reassessment Method were decreases in the proportions of correct selections under monotonic scenarios ranging from 5.3% to 20.7% and from 1.4% to 16.1%, respectively, compared with the best performing design and were higher proportions of patients allocated to toxic dose levels during the trial.

Conclusions

Innovative oncology treatments may no longer follow monotonic dose levels ordering which makes standard phase I methods fail. In such a setting, appropriate designs, as the No Monotonicity Assumption or Partial Ordering Continual Reassessment Method designs, should be used to safely determine recommended for phase II dose.
Human mesenchymal stem cells inhibit the differentiation and effector functions of monocytes
Authors: Maqbool Maryam , Algraittee Satar Jabbar Rahi , Boroojerdi Mohadese Hashem , Sarmadi Vahid Hosseinpour , John Cini Mathew , Vidyadaran Sharmili , Ramasamy Rajesh
Published: July 2020

Although monocytes represent an essential part of the host defence system, their accumulation and prolonged stimulation could be detrimental and may aggravate chronic inflammatory diseases. The present study has explored the less-understood immunomodulatory effects of mesenchymal stem cells on monocyte functions. Isolated purified human monocytes were co-cultured with human umbilical cord-derived mesenchymal stem cells under appropriate culture conditions to assess monocytes’ vital functions. Based on the surface marker analysis, mesenchymal stem cells halted monocyte differentiation into dendritic cells and macrophages and reduced their phagocytosis functions, which rendered an inability to stimulate T-cell proliferation. The present study confers that mesenchymal stem cells exerted potent immunosuppressive activity on monocyte functions such as differentiation, phagocytosis and Ag presentation; hence, they promise a potential therapeutic role in down-regulating the unwanted monocyte-mediated immune responses in the context of chronic inflammatory diseases.
Dose reduction and discontinuation of standard-dose regorafenib associated with adverse drug events in cancer patients: a systematic review and meta-analysis
Authors: Rizzo Alessandro , Nannini Margherita , Novelli Marco , Dalia Ricci Angela , Scioscio Valerio Di , Pantaleo Maria Abbondanza
Published: July 2020

Background:

Regorafenib (REG) is an oral multikinase inhibitor used in colorectal cancer, gastrointestinal stromal tumour and hepatocellular carcinoma. Several adverse events (AEs) are commonly reported during REG administration, and strategies for managing AEs in everyday clinical practice include supportive care, dose modifications and, when necessary, treatment withdrawal. We performed a systematic review and meta-analysis to assess the schedule treatment modifications of REG associated with AEs across randomized controlled clinical trials (RCTs).

Methods:

Eligible studies included RCTs assessing standard dose REG versus placebo. Outcomes of interest included: AE-related permanent discontinuation, dose interruptions and dose reductions.

Results:

We retrieved all the relevant RCTs through PubMed/Med, Cochrane library and EMBASE: 7 eligible studies involving a total of 2099 patients (Regorafenib: 1362; placebo: 737) were included in our analysis. The use of REG was associated with higher incidence and risk of all outcomes of interest when compared with placebo. The incidences of permanent discontinuation, dose interruptions and dose reductions in patients receiving REG were 9.7%, 57.2% and 47%, respectively, versus 3.3%, 16.7% and 7.7% of placebo group; compared with placebo, the summary relative risks (RRs) of permanent discontinuation, dose interruptions and dose reductions in REG arm were 2.80 (95% CI 1.85–4.22), 3.21 (95% CI 2.59–3.99) and 6.02 (95% CI 3.28–11.03), respectively.

Conclusions:

Treatment with REG at the standard dose of 160 mg is associated with a significant increase in AE-related permanent discontinuation, dose interruptions and dose reductions. Prompt identification and management of AEs seem mandatory to obtain maximal benefit from REG treatment. In the current landscape, dose personalization of REG may have the potential to improve quality of life, minimize treatment discontinuation and maximize patient outcomes.
Yardstick Regulation in a Competitive Context? The Case of the Italian Airports
Authors: Avogadro Nicolò , Birolini Sebastian , Cattaneo Mattia , Malighetti Paolo , Morlotti Chiara , Redondi Renato
Published: July 2020

Over the past years, airport regulation has been generating a lot of interest in Europe, and despite the passing of Airport Charges Directive in 2009, there is ongoing debate on the need for introducing tighter airport regulations. The aim of the paper is twofold. First, acknowledging that regulation is usually applied in markets where competition is weak or absent, we evaluate the ex-ante need for price regulation in the air transport industry. By focusing on the Italian airport industry, our analysis provides evidence of a high level of competitive pressure faced by airports (both inside and outside the industry), suggesting that tighter price regulation may not be the optimal solution. Second, assuming that stricter regulation of the airport industry is necessary, we empirically investigate the applicability of yardstick regulation to the Italian airport system, outlining critical challenges and issues that may arise when applying benchmarking techniques in setting the optimum level of efficiency at regulated airports. According to current literature, applicability of empirical benchmarking techniques requires some basic research requirements to be met, such as high-quality data, a homogeneous production function, and a sufficient number of comparable observations. We find that both heterogeneity and the relatively small number of comparable airports, along with the complexity of gathering proper data, may compromise the applicability of a regulation scheme based on yardstick principles at the national level.
Red Economy, Blue Economy: How Media-Party Parallelism Affects the Partisan Economic Perception Gap
Authors: Dalen Arjen van
Published: July 2020

Partisan identities do not only shape people’s political attitudes, but also their perceptions of real-world developments. This is evident from the partisan economic perception gap: Government supporters have more positive economic perceptions than opposition supporters, especially when the economic situation is ambiguous. Recent research has shown that the size of this partisan gap varies across different contexts and that the state of the economy and working of political institutions are important moderators. Still, little is known about the influence of another important contextual variable: the degree of partisanship in the media system. Based on a theoretical discussion of partisan-motivated rationalization and the information environment, the paper tests the hypothesis that, due to selective exposure and exposure to more partisan content, people in partisan media systems have more polarized economic perceptions. A multilevel analysis of representative surveys in twenty-six European countries in 2014 shows that the partisan perception gap is, indeed, larger in countries with more polarized media systems, after controlling for other relevant country characteristics. People with the highest level of media consumption are most affected by media-party parallelism. The findings are relevant for worldwide discussions about posttruth politics, as they show that the media environment influences gaps in people’s perceptions of real-world developments.
How Does Substance Use Affect Personality Development? Disentangling Between- and Within-Person Effects
Authors: Kroencke Lara , Kuper Niclas , Bleidorn Wiebke , Denissen Jaap
Published: July 2020

Little is known about the effects of substance use on changes in broad personality traits. This 10-year longitudinal study sought to fill this void using a large, representative sample of the Dutch population ( N = 10,872), which provided annual assessments of drug use (tobacco, alcohol, sedatives, soft drugs, ecstasy, hallucinogens, and hard drugs), Big Five personality traits, life satisfaction, and self-esteem. Using multilevel models, we examined the longitudinal associations between drug use and personality both between and within persons. Results indicated that individuals with low levels of conscientiousness, life satisfaction, and self-esteem, as well as high levels of neuroticism, used more drugs on average (between-person effects). In contrast, we found little evidence for personality change following substance use (within-person effects). We discuss these findings in the context of previous empirical and theoretical work and highlight opportunities for future research.
Deep learning based detection of intracranial aneurysms on digital subtraction angiography: A feasibility study
Authors: Hainc Nicolin , Mannil Manoj , Anagnostakou Vaia , Alkadhi Hatem , Blüthgen Christian , Wacht Lorenz , Bink Andrea , Husain Shakir , Kulcsár Zsolt , Winklhofer Sebastian
Published: July 2020

Background

Digital subtraction angiography is the gold standard for detecting and characterising aneurysms. Here, we assess the feasibility of commercial-grade deep learning software for the detection of intracranial aneurysms on whole-brain anteroposterior and lateral 2D digital subtraction angiography images.

Material and methods

Seven hundred and six digital subtraction angiography images were included from a cohort of 240 patients (157 female, mean age 59 years, range 20–92; 83 male, mean age 55 years, range 19–83). Three hundred and thirty-five (47%) single frame anteroposterior and lateral images of a digital subtraction angiography series of 187 aneurysms (41 ruptured, 146 unruptured; average size 7±5.3 mm, range 1–5 mm; total 372 depicted aneurysms) and 371 (53%) aneurysm-negative study images were retrospectively analysed regarding the presence of intracranial aneurysms. The 2D data was split into testing and training sets in a ratio of 4:1 with 3D rotational digital subtraction angiography as gold standard. Supervised deep learning was performed using commercial-grade machine learning software (Cognex, ViDi Suite 2.0). Monte Carlo cross validation was performed.

Results

Intracranial aneurysms were detected with a sensitivity of 79%, a specificity of 79%, a precision of 0.75, a F1 score of 0.77, and a mean area-under-the-curve of 0.76 (range 0.68–0.86) after Monte Carlo cross-validation, run 45 times.

Conclusion

The commercial-grade deep learning software allows for detection of intracranial aneurysms on whole-brain, 2D anteroposterior and lateral digital subtraction angiography images, with results being comparable to more specifically engineered deep learning techniques.
Burkholderia pseudomallei presenting with appendicular abscess: A great mimicker
Authors: Salmuna Zeti Norfidiyati , Hussin Azura , Wan Sulong Wan Addyana Binti
Published: July 2020

We present an atypical presentation of melioidosis, which was an appendicular abscess in a man with newly diagnosed Type 2 diabetes mellitus, which has never been reported before worldwide.
Breaking the distance: Dialogues of care in a time of limited geographies
Authors: Iacovone Chiara , Gris Alberto Valz , Safina Astrid , Pollio Andrea , Governa Francesca
Published: July 2020

In this commentary, we reflect on the limitations, somber difficulties, and possibilities of new geographies of care that have emerged as a result of our limited personal geographies during the time of COVID-19.
Effects of exercise rehabilitation training on patients with pulmonary hypertension
Authors: Zhang Xiaojun , Xu Danyan
Published: July 2020

Pulmonary hypertension (PH) comprises a group of pathophysiological syndromes characterized by elevated pulmonary artery pressure and pulmonary vascular resistance, which lead to right ventricular overload, and even right heart failure. PH has a poor prognosis and severely leads to a decline in quality of life. Historically, patients with PH were advised to limit their physical activity. However, an increasing number of studies have reported the safety and efficacy of exercise rehabilitation training in PH. This review briefly examined and summarized the effects of exercise rehabilitation training on PH patients reported in the recent literature. The findings of the reviewed studies indicate that exercise rehabilitation training in PH patients has beneficial effects in terms of exercise capacity and quality of life, vascular and right ventricle remodelling, inflammatory response, muscular function and oxidative stress. However, the underlying mechanisms and appropriate exercise strategies (e.g. the duration and intensity of exercise) still need to be explored. In conclusion, exercise rehabilitation training of the appropriate intensity and frequency can improve the prognosis and quality of life of PH patients. The training should be monitored by professional staff and be provided as an adjunct to pharmacological treatment. Larger clinical trials are required to confirm the safety and efficacy of exercise rehabilitation training in PH.
Anomalous Origin of the Circumflex Coronary Artery From the Right Pulmonary Artery Associated With Anomalous Aortic Origin of the Right Coronary Artery: A Case Report of Surgical Treatment
Authors: Sekelyk Roman , Kozhokar Dmytro , Kurkevych Andrii , Motrechko Oleksandra , Yemets Illya
Published: July 2020

We present a patient with the extremely rare coexistence of two distinct coronary artery malformations: anomalous aortic origin of the right coronary artery from the left aortic sinus with intramural course and anomalous origin of the circumflex coronary artery from the right pulmonary artery. Surgical reimplantation of the anomalous left circumflex coronary artery to the aorta and unroofing of the intramural portion of the anomalous right coronary artery were performed.
IVC Stent to Improve Ventricular Assist Device Filling Following Pediatric Cardiac Transplant
Authors: Adesokan Akintayo I. , McCheyne Alan , Crossland David S.
Published: July 2020

Poor ventricular assist device filling is often seen in patients supported with the Berlin Heart Excor. Caval stenosis is an uncommon complication following the bicaval approach to orthotopic heart transplantation. We report the case of a five-year-old female patient post heart transplantation whose poor right ventricular assist device filling immediately resolved following management of caval stenosis.
Most High-Intensity Transient Signals Are Not Associated With Specific Surgical Maneuvers
Authors: Twedt Max H. , Hage Benjamin D. , Hammel James M. , Ibrahimye Ali N. , Shukry Mohanad , Qadeer Ahsan , Eskridge Kent M. , Truemper Edward J. , Bashford Gregory R.
Published: July 2020

Background:

Mortality after congenital heart defect surgery has dropped dramatically in the last few decades. Current research on long-term outcomes has focused on preventing secondary neurological sequelae, for which embolic burden is suspected. In children, little is known of the correlation between specific surgical maneuvers and embolic burden. Transcranial Doppler ultrasound is highly useful for detecting emboli but has not been widely used with infants and children.

Methods:

Bilateral middle cerebral artery blood flow was continuously monitored from sternal incision to chest closure in 20 infants undergoing congenital heart defect repair or palliative surgery. Embolus counts for specific maneuvers were recorded using widely accepted criteria for identifying emboli via high-intensity transient signals (HITS).

Results:

An average of only 13% of all HITS detected during an operation were correlated with any of the surgical maneuvers of interest. The highest mean number of HITS associated with a specific maneuver occurred during cross-clamp removal. Cross-clamp placement also had elevated HITS counts that significantly differed from other maneuvers.

Conclusions:

In this study of infants undergoing cardiac surgery with cardiopulmonary bypass, the great majority of HITS detected are not definitively associated with a specific subset of surgical maneuvers. Among the measured maneuvers, removal of the aortic cross-clamp was associated with the greatest occurrence of HITS. Future recommended research efforts include identifying and confirming other sources for emboli and longitudinal outcome studies to determine if limiting embolic burden affects long-term neurological outcomes.
Isolated Right Superior Cava Drainage to the Left Atrium: An Uncommon Etiology of Cyanosis
Authors: Hammouda Amr Y. , Bleiweis Mark S. , Chandran Arun , Steiner Matthew B.
Published: July 2020

Anomalous superior vena cava drainage is a rare congenital cardiac defect where the right superior vena cava anomalously drains into the left atrium causing a right to left shunt. We present a case of a 17-day-old male who presented with cyanosis without respiratory distress and was found to have a right superior vena cava draining anomalously into the left atrium.
A Review of the Surgical Management of Anomalous Connection of the Right Superior Caval Vein to the Morphologically Left Atrium and Biatrial Drainage of Right Superior Caval Vein
Authors: Chowdhury Ujjwal Kumar , Anderson Robert H. , George Niwin , Singh Sukhjeet , Sankhyan Lakshmi Kumari , Gayatri Sushama B. , Malik Vishwas , Gharde Parag , Sengupta Sanjoy
Published: July 2020

The present perspective is a synthesis of published investigations in the setting of anomalous connection of the right superior caval vein to the morphologically left atrium or biatrial drainage of the right caval vein. We identified 57 suitable cases from 97 investigations, reviewing the clinical presentation, diagnostic modalities utilized, surgical techniques used, and their outcomes. Clinical presentation, radiographic findings, saline contrast echocardiography, computed tomographic angiocardiography, radionuclide perfusion scan, magnetic resonance imaging, and angiocardiography provided the diagnostic information and were used to define the disease entities before surgery. We have also addressed several issues concerning the influence of the so-called heterotaxy: the establishment of the diagnosis, the variation in clinical presentation, and subsequent management. For the overall group of patients undergoing either surgical intervention or transcatheter treatment with an Amplatzer vascular plug, the operative mortality remains high at 9.5%. We submit that an increased appreciation of these disease entities will contribute to improved future surgical management.
Unusual Case of Common Arterial Trunk With Atresia of the Right Pulmonary Artery and Aortopulmonary Collaterals
Authors: Kozik Deborah , Dydynski Philip , Austin Erle , Alsoufi Bahaaldin
Published: July 2020

We describe a two-year-old African girl with late diagnosis of unusual case of common arterial trunk with two separate pulmonary artery branch origins from the ascending aorta, hypoplastic right pulmonary artery that becomes atretic and reconstitutes at hilum, and three aortopulmonary collaterals providing right lung blood supply. She underwent single-stage intracardiac repair and unifocalization of collaterals.
The Destiny of Postoperative Residual Ventricular Septal Defects After Surgical Repair in Infants and Children
Authors: Bibevski Steve , Ruzmetov Mark , Mendoza Laura , Decker Jonathan , Vandale Breanna , Jayakumar Kaimal A. , Chan Kak Chen , Bove Edward , Scholl Frank G.
Published: July 2020

Purpose:

Residual ventricular septal defects (rVSDs) of small size are commonly seen on transesophageal echocardiography after surgical repair. This study aimed to determine the destiny of rVSD found on intraoperative echocardiogram.

Methods:

Patients undergoing surgical repair of VSD as the primary procedure with available intraoperative and discharge echocardiograms between 2007 and 2017 were reviewed. Presence of an rVSD on intraoperative echo triggered review of discharge echo and of subsequent follow-up echocardiograms.

Results:

One hundred four patients were analyzed. The mean age and weight for the entire cohort were 1.4 ± 2.9 years (median, 5.4 months; range, 29 days to 14 years) and 8.8 ± 9.9 kg (median, 5.1 kg; range, 2.7-58 kg), respectively. Sixty (57%) patients had rVSD at discharge, with mean size of residual VSD of 1.38 ± 0.92 mm (mode, 0.6; median, 2.2 mm; range, 0.5-3.9 mm). The mean follow-up time was 3.7 ± 3.1 years (range, 1 month to 9.3 years). Among those with rVSD at discharge, a residual shunt persisted in 73% at one-month follow-up. On follow-up at three years postdischarge, of the 60 patients with early rVSD, 6 had a persistent rVSD (10%) with a mean diameter of 3.0 ± 0.8 mm (range, 2.4-3.9 mm).

Conclusions:

Residual VSD after surgical repair is detected frequently on postoperative echocardiogram. The presence of rVSD was not associated with any preoperative, intraoperative, or postoperative factors. By three years of follow-up, only six patients continued to demonstrate rVSD with a mean diameter of 3 mm, suggesting that defects 3 mm or greater may be less likely to close spontaneously after three years.
Remote ALCAPA Repair—Total Arterial Reconstruction Using Free Aortic Graft Technique
Authors: Peng Ed , Al-Haideri Hazim , Dreisbach John G.
Published: July 2020

A late presenting anomalous left coronary artery from pulmonary artery (ALCAPA) with remote origin may be associated with several technical caveats due to distance for coronary transfer and inadequate autologous tissues for reconstruction. A technique using full circumferential aortic wall as a free graft that is sutured as a posterior hood on an anterior pulmonary arterial flap is used to achieve reconstruction of a neo-left coronary that is tension free, with laminar flow and without the use of any prosthetic material. The technique with potential modifications described could potentially be applied to any variant of ALCAPA to achieve total arterial reconstruction to yield an optimal long-term outcome.
High-Risk Reoperative Sternotomy—How We Do It, How We Teach It
Authors: Pahwa Siddharth , Stephens Elizabeth H. , Dearani Joseph A.
Published: July 2020

With the increasing number of congenital heart disease patients living into adulthood and requiring reoperations, learning a safe and efficient reoperative sternotomy is essential. This article provides insight into the successful reoperative sternotomy, including preoperative evaluation, assessing risk for cardiac injury and preparations to take depending on the level of risk, safeguards taken before and during the sternotomy, and pearls and pitfalls in managing untoward events.
Framing Dementia Care Practices: The Politics of Early Diagnosis in the Making of Care
Authors: Ursin Gøril
Published: July 2020

Dementia diagnosis is complex and hot topic. It is a public health priority, which highlights the need for early diagnosis. This is regarded as “the policy of diagnosis” and is explored and unfolded as a matter of fact in this article. The article draws on a practice theory as a research approach and shows how different modes of diagnosis frame certain care practices. Three different orderings are elaborated: the knowing, the governing, and the relational orderings. Two of these individualize and isolate the care for people with dementia, while the third ordering enacts diagnosis by connecting people, things, and places. An ethnographic approach is used drawing on interviews with 15 families of people with dementia and professional careers. The article contributes to a wider understanding of how “the policy of diagnosis” shapes some possible way to live with the disease and at the same time closes others.
Posterior Minimally Invasive Transpedicular Approach for Giant Calcified Thoracic Disc Herniation
Authors: Shedid Daniel , Wang Zhi , Najjar Ahmad , Yuh Sung-Joo , Boubez Ghassan , Sebaaly Amer
Published: July 2020

Study Design:

Retrospective case series.

Objective:

Posterior surgery for thoracic disc herniation was associated with increased morbidity and mortality and new minimally invasive approaches have been recommended for soft disc herniation but not for calcified central disc. The objective of this study is to describe a posterolateral microscopic transpedicular approach for central thoracic disc herniation.

Methods:

This is a single center retrospective review of all the cases of giant thoracic calcified disc herniation as defined by Hott et al. Presence of myelopathy, percentage of canal compromise, T2 hypersignal, ASIA score, and ambulatory status were recorded. This posterolateral technique using a tubular retractor was thoroughly described.

Results:

Eight patients were operated upon with a mean follow-up of 16 months. Mean canal compromise was 61%. Mean operative time was 228 minutes and mean operative bleeding was 250 mL. There were no cases of dural tear or neurologic degradation.

Conclusion:

This is the first report of posterior minimally invasive transpedicular approach for giant calcified disc herniation. There were neither cases of neurological deterioration nor increased rate of dural tears. This technique is thus safe and could be recommended for treatment of this rare disease.
Incidence, prevalence, and outcomes of systemic malignancy with bone metastases
Authors: Jiang Wenli , Rixiati Youlutuziayi , Zhao Bingqing , Li Yongcheng , Tang Chuangang , Liu Jun
Published: July 2020

Purpose:

Evidence on the incidence, prevalence, and outcomes of bone metastases among patients with systemic malignancy is limited. This study aimed to evaluate it using the Surveillance, Epidemiology, and End Results (SEER) database.

Methods:

We collected patients diagnosed with solid malignant tumors deriving outside of the bone, hematologic malignancies, Kaposi sarcoma, lymphoma, and myeloma from the SEER database (from 2010 to 2013). The incidence, prevalence, and outcomes of these systemic malignancies with bone metastases were then analyzed.

Results:

A total of 67,605 patients with bone metastases at cancer diagnosis were included. The highest rate of bone metastases was observed in patients with small-cell lung cancer at the time of alternative primary site cancer diagnosis. Among 226,816 cases with metastatic disease, cases with breast cancer (65.58%), and prostate cancer (89.60%) had a high incidence proportion (>10%) of identified bone metastases. Patients with additional bone metastases resulting from prostate cancer, breast cancer, and testis cancer presented the best survival time.

Conclusions:

Incidence and prognosis differ considerably among bone metastases with different primary malignancy sites. These results may encourage appropriate application of bone imaging.
The Predicament of Caring: Work Interferences and Health of Family Caregivers of Persons With Multiple Chronic Conditions
Authors: Williams Allison , Sethi Bharati
Published: July 2020

Providing caregiving to family members with multiple chronic conditions (MCCs) can interfere with employment status and have a negative impact on caregivers’ well-being. The qualitative analysis of 13 Canadian employees who were also simultaneously providing unpaid care (carer-employees) identified three themes that highlight work interference, negative impacts on well-being, and workplace culture. The findings call for employers to provide health promotion strategies and a supportive workplace culture that reduce workplace interference while being responsive to the unique needs of carer-employees.
Regulating Australia’s Participation in the Orphanage Industry
Authors: Doore Kathryn E. van
Published: July 2020

Orphanages harness the goodwill of volunteers, visitors and donors to generate funding. However, in recent years, evidence has emerged that in some cases children are being recruited or trafficked into orphanages in order to generate profit from this goodwill. This is known as the ‘orphanage industry’, and the recruitment of children into orphanages for the purpose of profit and exploitation is ‘orphanage trafficking’.

Australia is reported to be the largest funder of residential care for children in South East Asia. In 2017, Australia became the first government in the world to consider orphanage trafficking as a form of modern slavery. This article traces the evolution of the recognition of orphanage trafficking broadly, and then focusses on recommendations made by the Australian government following the release of its 2017 Hidden in Plain Sight Report. This article analyses the emerging policy and legislative reforms that are being undertaken by the Australian government and recommends further development to ensure that funding and finances are appropriately directed to divest from orphanages and instead support burgeoning care reform in the South Asian region. Finally, the article responds to critiques of the Australian government’s standpoint on orphanage trafficking as it relates to the over-reliance on institutional care and provides clarification on why a criminal justice response to orphanage trafficking is appropriate.
Moving Towards Family Solutions: An Introduction to an Immersive Simulation Workshop
Authors: Wilkea Nicole , Pop Delia , Oswald Elli , Howard Amanda , Morgan1 Meredith
Published: July 2020

Residential care organisations, such as children’s homes, are well-positioned to reshape their programmes to support family-based models of care. However, new models bring unknown factors, making organisations hesitant to transition programmes. To alleviate concerns and support transition, researchers developed an experiential workshop mirroring the conditions of an organisation transitioning to family care. Workshop participants are guided through a series of activities and discussions detailing the transition of a fictional programme to a family-based model of care. The workshop focuses on six key components: engagement, case management, families, asset transitions, measurement and fundraising. The workshop also gives participants the opportunity to create a personalised plan for their programme. The goal of the current article is to present this workshop framework and share the free Facilitator’s Toolkit ( https://cafo.org/ovc/sim-lab/ ).
Children Displaced: Deinstitutionalisation of Child Care Institutions in Tibetan Exile Settlements in Dharamshala, India
Authors: Nair Pradeep
Published: July 2020

This study assesses the present situation of the deinstitutionalisation and alternative care arrangements in exile settlements concerning various cultural and socio-structural factors. It explores how elements of social structure and culture operate to transform the residential care institutions to community-based alternative care arrangements for 10,000 young Tibetans uprooted from Tibet and presently settled in India. Their day-to-day problems of repatriation and resettlement in an unfamiliar demography with distinct ethnic values are pushing them to the margins. The dependence of these children on their exile government, the host community and the uncertainty of going back to their country makes them depressed, dependent and vulnerable to trauma and negligence. The study uses cross-sectional, descriptive, exploratory and qualitative methods. Primary data were collected through in-depth, semi-structured interviews. Open-ended questions were used for interviews in order to gain in-depth information from the respondents. Twenty-five informants were selected on a purposive basis to facilitate a focus on information-rich cases that illuminate the research questions. The selection criteria of informants apply to their professional experience of deinstitutionalisation in Tibetan settlements, professionals having experience of heading care institutions, officials of the Central Tibetan Administration, people from non-government organisations, development agencies and government officials who were a part of the interventions. Respondents from both state and non-state agencies were selected for the study to avoid bias.