bluuebunny/crossref_metadata_2025 huggingface dataset:
Extending the I-95 Rule-Based Incident Duration System With an Automated Knowledge Transferability Model
Authors: Huang Yen-Lin , Lin Yi-Ting , Chang Gang-Len
Published: March 2022

The rule-based incident duration prediction model (IDPM), covering Interstate highways I-95, I-495, and I-695, has been adopted by the Maryland Department of Transportation State Highway Administration in its daily responses to non-recurrent congestion. In light of its effectiveness and robustness in practice, expanding such a system to all other highways emerges as desirable but a challenging task, because of the need to integrate field operators’ expertise in generating prediction rules and the dependence on sufficient incident records for key parameter calibration. To circumvent such a data-demanding and time-consuming process for knowledge acquisition and refinement for extending the IDPM’s spatial coverage, this study has proposed a knowledge transferability analysis (KTA) method, featuring its automated process to assess, select, and transfer existing prediction rules to perform incident duration estimate for the new target highway. Evaluation of the proposed KTA with the incident records from Maryland I-70, using both transferred and customized local rules, reveals that it can achieve accuracy of 87% with the training dataset (i.e., 2016–2018) and 82% with the test dataset (i.e., 2019), comparable to the current system’s performance but demanding much fewer incident records for model calibration and significantly less effort for system expansion.
Circumferential Rim Augmentation Suture Around the Perimeniscal Capsule Decreases Meniscal Extrusion and Progression of Osteoarthritis in Rabbit Meniscus Root Tear Model
Authors: Park Do Young , Yin Xiang Yun , Chung Jun Young , Jin Yong Jun , Kwon Hyeon Jae , Lee Ga bin , Park Jin Ho , Min Byoung-Hyun
Published: March 2022

Background:

We recently analyzed the joint capsule adjacent to the medial meniscus and found that the perimeniscal joint capsule has collagen fiber orientation similar to that of circumferential meniscal fibers, potentially playing a role in preventing extrusion.

Purpose:

To analyze the meniscal extrusion prevention potential of the circumferential rim augmentation suture around the perimeniscal capsule in a rabbit root tear model and analyze the biomechanical function in a porcine cadaveric knee.

Study Design:

Controlled laboratory study.

Methods:

Rabbit medial meniscus root tear models were divided into 3 experimental groups: root tear, root tear and suture repair, and root tear and circumferential rim augmentation suture. As for the circumferential rim augmentation suture procedure, a suture was placed to circumscribe the outer rim of the medial meniscus and passed through bone tunnels located at the tibial insertion of each root. After 4 and 8 weeks, meniscal extrusion was analyzed by micro–computed tomography, gross morphology, and histologic analysis of the medial femoral cartilage. For biomechanical analysis, porcine knees were divided into groups similar to rabbit experiments. Tibiofemoral contact parameters were assessed using a pressure mapping sensor system after applying a load of 200 N on the knee joint.

Results:

The root tear and circumferential rim augmentation suture group showed less meniscal extrusion, less gap within the tear site, and less cartilage degeneration compared with other groups after 4 and 8 weeks of surgery in the rabbit root tear model. Biomechanical analysis showed the root tear and circumferential rim augmentation suture group had larger contact area and lower peak contact pressure compared with root tear and root tear and suture repair groups.

Conclusion:

The circumferential rim augmentation suture reduced the degree of meniscal extrusion while restoring meniscal function, potentially preventing progression of arthritis in a rabbit root tear model and porcine knee biomechanical analysis.

Clinical Relevance:

The circumferential rim augmentation suture may be a novel augmentation option during root tear treatment.
Bone Marrow Aspirate Concentrate Is Equivalent to Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis at 2 Years: A Prospective Randomized Trial
Authors: Anz Adam W. , Plummer Hillary A. , Cohen Achraf , Everts Peter A. , Andrews James R. , Hackel Joshua G.
Published: March 2022

Background:

Autologous platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMC) are being used clinically as therapeutic agents for the treatment of knee osteoarthritis.

Purpose/Hypothesis:

The purpose of this study was to compare the efficacy of BMC and PRP on pain and function in patients with knee osteoarthritis up to 24 months after injection. It was hypothesized that patients receiving BMC would have better sustained outcomes than those receiving PRP.

Study Design:

Randomized controlled trial; Level of evidence, 2.

Methods:

A total of 90 participants aged between 18 and 80 years with symptomatic knee osteoarthritis (Kellgren-Lawrence grades 1-3) were randomized into 2 study groups: PRP and BMC. Both groups completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and subjective International Knee Documentation Committee (IKDC) questionnaire before and 1, 3, 6, 9, 12, 18, and 24 months after a single intra-articular injection of leukocyte-rich PRP or BMC. A linear mixed-effects model was performed to quantify the effects over time and the difference between the groups. This model has the random effect for time to assess the extent in which the change over time differs from one person to another.

Results:

An overall 84 patients completed questionnaires from baseline to 12 months; however, 17 patients (n = 9; PRP group) were lost to follow-up at 18 months and 25 (n = 13; PRP group) at 24 months. There were no statistically significant differences in IKDC ( P = .909; 95% CI, −6.26 to 7.03) or WOMAC ( P = .789; 95% CI, −6.26 to 4.77) scores over time between the groups. Both groups had significantly improved IKDC ( P < .001; 95% CI, 0.275-0.596) and WOMAC ( P = .001; 95% CI, −0.41 to −0.13) scores from baseline to 24 months after the injection. These improvements plateaued at 3 months and were sustained for 24 months after the injection, with no difference between PRP and BMC at any time point.

Conclusions:

For the treatment of osteoarthritis, PRP and BMC performed similarly out to 24 months. BMC was not superior to PRP.

Registration:

NCT03289416 (ClincalTrials.gov identifier).
French-Canadian Translation and Cultural Adaptation of the Clinical Opiate Withdrawal Scale: The COWS-FC
Authors: Bruneau Alice , Poirier Clarice , Bérubé Mélanie , Boulanger Aline , Gélinas Céline , Guénette Line , Lacasse Anaïs , Lussier David , Tousignant-Laflamme Yannick , Pagé M. Gabrielle , Martel Marc O. ,   On behalf of the Quebec Pain Research Network (QPRN) Strategic Initiative on Opioids
Published: March 2022

The assessment of opioid withdrawal symptoms is common in both clinical and research settings. The Clinical Opiate Withdrawal Scale (COWS) is among the most frequently used instruments for the assessment of signs and symptoms associated with opioid withdrawal. The COWS is a validated, clinician-administered instrument initially developed and validated for English-speaking populations. To date, however, the COWS has yet to be linguistically and culturally adapted for French-Canadian populations.

Objective

The main objective of the present study was to develop a French-Canadian translation and adaptation of the COWS (i.e., the COWS-FC) for the assessment of opioid withdrawal symptoms in clinical and research settings.

Methods

The French-Canadian translation and cultural adaptation of the COWS was performed following guidelines for the translation and cross-cultural adaptation of self-report measures. The steps consisted of (1) initial translation from English to French, (2) synthesis of the translation, (3) back-translation from French to English, (4) expert committee meeting, (5) test of the prefinal version among healthcare professionals and (6) review of final version by the expert committee. The expert committee considered four major areas where the French-Canadian version should achieve equivalence with the original English-version of the COWS. These areas were (1) semantic equivalence; (2) idiomatic equivalence; (3) experiential equivalence and (4) conceptual equivalence.

Results

Rigorous steps based on the guidelines for the translation and cultural adaptation of assessment tools were followed, which led to a semantically equivalent version of the COWS. After a pretest among healthcare professionals, members from the expert committee agreed upon slight modifications to the French-Canadian version of the COWS to yield a final COWS-FC version.

Conclusions

A French-Canadian translation and adaptation of the COWS (i.e., the COWS-FC) was developed. The COWS-FC could be used for the assessment of opioid withdrawal symptoms in clinical and research settings.
Cosmetogynecological Surgery With Local Anesthesia: Preliminary Experience
Authors: Pardo Jack , Solá Vicente , Guzmán Hernán , Oporto Isabel
Published: March 2022

Introduction:

Although cosmetic gynecological procedures have been reported since antiquity, recent expansion made the cosmetogynecology becomes a recognized subspecialty. Presently, minimally invasive surgeries allow some of them to be performed under local anesthesia (LA). We present our preliminary experience using LA, highlighting safety and advantages.

Methods:

A total of 246 surgeries under local anesthesia on 185 median age patients, 39 years old (range: 14-80) between July 2020 and July 2021 in a Chilean aesthetic gynecology center, were retrospectively reviewed.

Results:

The most common surgery was Labiaplasty Type I, covering 40% (n = 99). Twenty percent of all patients (n = 38) underwent multiple surgeries in one surgical act. Minor complications were observed in 8% (n = 20) of surgeries, with satisfactory resolutions, without complications inherent to the use of LA or vasoconstrictors. Patients reported high degree of satisfaction, even in cases followed by labiaplasty repair or minor complication. Labiaplasty-related costs were considerably reduced compared with usual anesthetic procedure in more complex centers.

Conclusion:

This is the first South American report of various aesthetic genital procedures carried out under local anesthesia. In our experience, local anesthesia provided safe and effective results.
Shared Race/Ethnicities of Prosecutor and Defendant: A Test of Competing Hypotheses Predicting Case Outcomes
Authors: Liu Lin
Published: March 2022

Diversifying prosecutors’ offices and hiring more minority prosecutors have been touted as promising initiatives to address racial disparities in prosecution. However, two theoretical perspectives—social identity and internalized racism—delineate contradictory predictions on the punitiveness of minority prosecutors. The social identity perspective maintains that minority prosecutors are likely to seek better outcomes for defendants of their own race/ethnicity, whereas internalized racism proposes that minority prosecutors will be punitive to defendants of their own race/ethnicity. The present study uses the most recent data from a large urban jurisdiction to test whether the effect of shared minority identities between prosecutors and defendants on case outcomes is consistent with the social identity or internalized racism perspectives. Results suggest that minority prosecutors tend to show leniency to defendants of their own race/ethnicity; however, they are punitive toward minority defendants of a different race/ethnicity. Policy implications and directions for future research are also discussed.
A comparison of analytical strategies for cluster randomized trials with survival outcomes in the presence of competing risks
Authors: Li Fan , Lu Wenhan , Wang Yuxuan , Pan Zehua , Greene Erich J , Meng Guanqun , Meng Can , Blaha Ondrej , Zhao Yize , Peduzzi Peter , Esserman Denise
Published: March 2022

While statistical methods for analyzing cluster randomized trials with continuous and binary outcomes have been extensively studied and compared, little comparative evidence has been provided for analyzing cluster randomized trials with survival outcomes in the presence of competing risks. Motivated by the Strategies to Reduce Injuries and Develop Confidence in Elders trial, we carried out a simulation study to compare the operating characteristics of several existing population-averaged survival models, including the marginal Cox, marginal Fine and Gray, and marginal multi-state models. For each model, we found that adjusting for the intraclass correlations through the sandwich variance estimator effectively maintained the type I error rate when the number of clusters is large. With no more than 30 clusters, however, the sandwich variance estimator can exhibit notable negative bias, and a permutation test provides better control of type I error inflation. Under the alternative, the power for each model is differentially affected by two types of intraclass correlations—the within-individual and between-individual correlations. Furthermore, the marginal Fine and Gray model occasionally leads to higher power than the marginal Cox model or the marginal multi-state model, especially when the competing event rate is high. Finally, we provide an illustrative analysis of Strategies to Reduce Injuries and Develop Confidence in Elders trial using each analytical strategy considered.
Bone Marrow Mesenchymal Stem Cells Overexpressing HIF-1α Prevented the Progression of Glucocorticoid-Induced Avascular Osteonecrosis of Femoral Heads in Mice
Authors: Zhang Xin-Xin , Liang Xu , Li Sen-Rui , Guo Kuang-Jin , Li Dai-Feng , Li Tian-Fang
Published: March 2022

Glucocorticoid (GC)-induced avascular osteonecrosis of femoral head (AOFH) is a devastating complication, and no cures are currently available for it. Previous studies have demonstrated that implantation of bone marrow mesenchymal stem cells (BMMSCs) may prevent the progression of pre-collapse AOFH. Based on previous observations, we hypothesized that GCs induce AOFH via the COX-2 (cyclooxygenase-2)–PGE-2 (prostaglandin E2)–HIF-1α (hypoxia-inducible factor-1α) axis, and that modification of BMMSCs may improve the efficacy of their implantation. BMMSCs isolated from wild-type (WT) mice were treated with dexamethasone (Dex) and the results showed that Dex repressed the expression of COX-2. Femoral head samples harvested from both WT and COX-2 knock-out (COX-2−/−) mice were subjected to micro–computed tomography and histological examinations. Compared with their WT littermates, COX-2−/− mice had larger trabecular separations, diminished microvasculature, and reduced HIF-1α expression in their femoral heads. In vitro angiogenesis assays with tube formation and fetal metatarsal sprouting demonstrated that Dex repressed angiogenesis and PGE-2 antagonized its effects. An AOFH model was successfully established in C57BL/6J mice. In vitro experiment showed that BMMSCs infected with Lentivirus encoding HIF-1α (Lenti-HIF-1α) resulted in a robust increase in the production of HIF-1α protein. Implantation of BMMSCs overexpressing HIF-1α into femoral heads of AOFH mice significantly reduced osteonecrotic areas and enhanced bone repair, thus largely preserving the structural integrity of femoral heads. Our studies provide strong rationales for early intervention with core decompression and implantation of modified BMMSCs for GC-induced AOFH, which may spare patients from expensive and difficult surgical procedures.
A Path to Inclusiveness – Peer Support Groups as a Resource for Change
Authors: Heitmann Ann Jeanette , Valla Lisbeth , Albertini Früh Elena , Kvarme Lisbeth G
Published: March 2022

Being bullied is associated with anxiety, depression symptoms, and long-term negative health outcomes. The aim of this qualitative pilotstudy was to explore bullied children's experiences of support groups and how participating in a group affected the children. The sample consisted of 24 children aged 11–13 years. Four of them were bullied, while 20 participated in support groups. Individual and focus group interviews were conducted. The main theme identified was that support groups provide an opportunity for change and can help children to be included among peers. The changes were achieved through encouragement and support from peers. The children participating in the support groups reported a feeling of being selected. The groups provided fellowship, and an opportunity for change. Both getting support from and being part of a support group contributed to inclusion, strength, and valuable experiences. The findings suggest that a systemic approach to bullying is advantageous.
A time-varying GARCH mixed-effects model for isolating high- and low- frequency volatility and co-volatility
Authors: Aghabazaz Zeynab , Kazemi Iraj , Nematollahi Alireza
Published: March 2022

This article studies long-term, short-term volatility and co-volatility in stock markets by introducing modelling strategies to the multivariate data analysis that deal with serially correlated innovations and cross-section dependence. In particular, it presents an innovative mixed-effects model through a GARCH process, allowing for heterogeneity effects and time-series dynamics. We propose a non-parametric regression model of the penalized low-rank smoothing spline to present time trends into the variance and covariance equations. The strategy provides flexible modelling of the low-frequency volatility and co-volatility in equity markets. The decomposed low-frequency matrix was modelled using the modified Cholesky factorization. The Hamiltonian Monte Carlo technique is implemented as a Bayesian computing process for estimating parameters and latent factors. The advantage of our modelling strategy in empirical studies is highlighted by examining the effect of latent financial factors on a panel across 10 equities over 110 weekly series. The model can differentiate non-parametrically dynamic patterns of high and low frequencies of variance–covariance structural equations and incorporate economic features to predict variabilities in stock markets regarding time-series evidence.
Expiratory obstruction in patients with Duchenne muscular dystrophy under non-invasive ventilation: A step-by-step analysis of a new obstructive pattern
Authors: Léotard Antoine , Delorme Mathieu , Delord Vincent , Niel-Duriez Myriam , Orlikowski David , Annane Djillali , Prigent Hélène , Lofaso Frédéric
Published: March 2022

Purpose: Non-invasive ventilation (NIV) is the reference standard for managing chronic hypoventilation in patients with Duchenne muscular dystrophy (DMD). In these patients, upper airway obstruction under NIV may compromise efficacy and adherence. We aim to describe a novel pattern of expiratory obstructive events occurring during nocturnal barometric NIV. Methods: We retrospectively included all patients with DMD who underwent full-night polygraphy during NIV as part of their usual follow-up between May 2018 and July 2019. Results: We provide a step-by-step description of this previously undescribed pattern of obstruction. Expiratory obstructions lead to end-inspiratory breath-holding and impossibility to take another inspiratory breath with a barometric mode until expiration occurs. These events were observed in 4 (36%) of 11 DMD patients under barometric NIV. Conclusion: Expiratory obstructions may be common in DMD patients receiving NIV and should be sought out routinely. This previously undescribed variant of obstructive event must be identified.
Feasibility Study of 3D-VMAT-Based GRID Therapy
Authors: Zhang Xin , Griffin Robert J , Galhardo Edvaldo P , Penagaricano Jose
Published: March 2022

Background: Spatially fractionated radiotherapy (GRID) could effectively de-bulk tumor volumes for shallow and deep-seated locally advanced tumors. A new treatment planning method using the three-dimensional-volumetric modulated arc therapy (VMAT) technique combined with a novel, software-generated, virtual GRID block (VGB) was developed which allows better conformity plans (VMAT-GRID) and maintain the GRID dosimetric characteristics. The dosimetric metrics calculated via the valley/peak ratio ( Dmin/ Dmax), D90/ D10, gross tumor volume (GTV) mean dose ( Dmean), GTV equivalent uniform dose (EUD), and normal tissue maximum dose. Methods: Twenty-five patients with tumor volumes ranging between 71.6 cc and 4683 cc at various tumor sites were retrospectively studied. The prescription was 20 Gy to the maximum point of GTV in a single fraction, and the VMAT-GRID plan was generated using 6 MV/10 MV flattening-filter-free beams. Results: The optimized VGB was designed with the median center-to-center distance of 27 mm, and 9 mm for the median diameter of the opening area in this study. These 2 values can be used to design any optimized VGB, the final VGB may be modified to generate a patient-specific VGB. The median GTV mean dose was 918 (877- 938) cGy, and the median GTV EUD dose was 818 (597-916) cGy. In terms of dose inhomogeneity, the median valley-to-peak dose ratio was 0.07 (0.02-0.26); and the median ratio of D90/ D10 was 0.70 (0.38-0.94). For the organ-at-risk doses, there was a rapid dose drop-off in the normal tissue area immediately adjacent to the target, and the maximum global doses were all located inside the GTV. Conclusion: Our results indicated that the VMAT-GRID planning approach could successfully deliver dose with acceptable GRID dose metric while sparing the normal tissue especially in the region near the target due to the rapid dose drop-off and restricting maximum dose inside the target.
Skin Graft Donor Site Healing among Elderly Patients with Dermatoporosis – A Case Series
Authors: Seppälä Toni , Grünthal Vahur , Koljonen Virve
Published: March 2022

We reviewed donor site wound healing among morbid ≥65-year-old patients after split-thickness skin graft (STSG) harvesting. Patients were treated for a pretibial laceration or hematoma in Kymenlaakso Central Hospital, Finland, between 2015 and 2019. Twelve morbid patients with a mean Charlson Comorbidity Index of 7.1 (range 4-12) and a mean age of 80.6 years (range 69-91) were studied. Nine patients were female. Eight had a chronic cutaneous fragility syndrome, eg, dermatoporosis. All donor site areas were located on the thigh and were less than 2% TBSA. One donor site infection occurred. STSG integration on the pretibial wound bed was successful with all patients, and none of the patients needed further operative treatment. Graft thickness varied between 0.010 to 0.014 inches. STSG donor sites healed within the normal range of 21 days in 50% of patients. Among two patients, healing took 25 days, and among four, 37 to 97 days. All donor sites healed via local wound care without the need for regrafting. 4Our study indicates that harvesting STSG from elderly and morbid patients with poor skin condition is safe and does not result in significant complications. Prolonged donor site healing can occur, which can be managed with regular local wound care.
The Role of Community-Based Men’s Sheds in Health Promotion for Older Men: A Mixed-Methods Systematic Review
Authors: Foettinger Linda , Albrecht Birte Marie , Altgeld Thomas , Gansefort Dirk , Recke Carina , Stalling Imke , Bammann Karin
Published: March 2022

Men’s Sheds are a community-based health promotion concept which brings men together to engage in joint activities. Prior research reported beneficial effects on health and well-being of the participants; however, evidence is limited. The main objective of this systematic review is to provide an extensive overview of current research on the effectiveness of Men’s Sheds on self-rated health, social isolation, and well-being by applying a mixed-methods approach. In addition, this review aims to identify how to successfully transfer and implement the concept. Eligible for inclusion were all studies published in English, German, or French that specifically referred to the concept of Men’s Sheds. Four databases were searched for eligible studies, followed by a hand search on websites and reference lists. Methodological quality of included studies was assessed using checklists developed by the Joanna Briggs Institute. Following the convergent integrated approach, quantitative data were transformed and merged with qualitative data to conduct a thematic analysis. Overall, 35 qualitative, nine quantitative, and eight mixed-methods studies were included. We found evidence regarding benefits of shed participation on self-rated health, social isolation, and well-being. We identified three key characteristics of a successful Men’s Shed, including appropriate shed facilities, sufficient funding as well as a participant-driven management and organization of the shed. This mixed-methods systematic review provides a comprehensive overview of the evidence base concerning Men’s Sheds and highlights the need for longitudinal studies investigating causal relationships and gathering sufficient information on how to successfully transfer and implement the concept of Men’s Sheds in other countries.
The Art of Arriving: A New Methodological Approach to Reframing “Refugee Integration”
Authors: Mijić Ana , Parzer Michael
Published: March 2022

The main objective of the transdisciplinary and arts-based research project “The Art of Arriving: Reframing ‘Refugee Integration’” is to explore the transformative potential of the arts for the sociology of migration and integration. By creating a real-world laboratory where sociologists accompany artists as they create, and recipients while they interpret aesthetic expressions, the project focuses on the process of refugees’ arriving. The aim is to examine if and how the meaning-making processes involved in creating and interpreting art can foster alternative views about “refugee integration” and extend or even revise the traditional sociological toolkit for understanding integration. The article discusses the methodological implications of the planned transdisciplinary multimethod approach by paying particular attention to the different logics of knowledge production in science and the arts. Additionally, it sheds light on the benefits associated with the mutual translation between sociology and various fields of art, which is mediated through the process of creating and interpreting aesthetic expressions in the context of refugee migration.
Conflict in the international system in the time of Trump: Strategic narratives in White House daily newsletters
Authors: Leslie Faith , Roselle Laura
Published: March 2022

During the Trump administration, official daily newsletters served as an important form of communication between the President and his constituents. These newsletters provided an overview of how the Trump Administration perceived conflict in the international system, the role and characteristics of the United States and other actors, and policy priorities. These newsletters, 1600 Daily, West Wing Reads, and Resolute Reads, provided a unique and important data source for understanding the Trump administration’s strategic narratives on the international system, especially in the realm of conflict. This article analyzes 810 daily newsletters from March 2017 to March 2020 to assess the administration’s narratives about the international system and several areas of conflict including relations with North Korea, Russia, and China. As the past four years of the Trump presidency saw tensions increase in many areas of American foreign policy, it is necessary to understand the narratives that shaped the Trump administration’s combative approach to diplomacy. The authors find that the strategic narratives of the Trump administration took a unilateral, transactional, and zero-sum approach to foreign policy. The newsletters reflected a prioritization of conflict with long-held allies and a focus on competition with enemies who undermine US dominance in the international system, mainly China and Russia. Within this discussion of foreign policy, this research additionally found a significant emphasis on trade policy, set within a conflictual, mercantilist framework. These newsletters set out conflictual strategic narratives that sought to shape the international system.
Care, Attachments and Concerns
Authors: Mulligan Kevin
Published: March 2022

Müller's account of the way episodic emotions function depends on a contrast between these and what he calls cares, concerns and attachments and the claim that the latter are in several respects prior to the former. The account seems to attribute no normative features to the latter. But this is implausible. If a preference for liberty over social justice is a concern, it is justified if liberty really is more important than social justice.
Predicting Glycated Hemoglobin Through Continuous Glucose Monitoring in Real-Life Conditions: Improved Estimation Methods
Authors: Valenzano Marina , Cibrario Bertolotti Ivan , Grassi Giorgio , Broglio Fabio , Valenzano Adriano
Published: March 2022

Background:

The adoption of continuous glucose monitoring (CGM) already helps to improve glycemic control in diabetes. When coupled with appropriate data analysis techniques, CGM also provides dependable estimates for significant metrics, like glycated hemoglobin (HbA1c). Findings from the REALISM-T1D study can boost HbA1c estimation methods in diabetes care and stimulate their use in clinical practice.

Methods:

Continuous glucose monitoring data of 27 adults affected by type-1 diabetes were acquired by means of G6 (Dexcom, San Diego, CA) sensors for a time span of 120 days. Glycated hemoglobin laboratory assays were performed during the concluding follow-up visits. Data were then analyzed to derive estimates of assay results, taken as the gold standard.

Results:

Bland-Altman (BA) plots show that smart interpolation to patch missing data and a wise choice of interstitial glucose (IG) weighting function, besides a proper mean interstitial glucose (MIG) to HbA1c regression equation, improve HbA1c estimation quality with respect to methods relying on MIG alone. A decrease in the BA plot-related variance of differences with respect to the gold standard confirms the improvement. Wilcoxon signed-rank tests on the bias-compensated mean squared error (MSE) with respect to conventional MIG-based methods show that the improvement is statistically significant with a confidence level better than 95% ( P = .0179).

Conclusions:

Improved HbA1c estimation methods result in better HbA1c prediction quality with respect to those based on MIG alone, thus providing quick, but still relatively accurate feedback to diabetologists. They alleviate the discordances reported in literature and, with further improvements, may become a viable complement/alternative to HbA1c assays.
T2 Relaxation Time Changes in the Distal Femoral Condylar Cartilage of Children and Young Adults with Discoid Meniscus
Authors: Yoon Haesung , Lim Hyun Ji , Kim Jisoo , Park Kun-Bo , Kim Hyun Woo , Lee Mi-Jung
Published: March 2022

Objective

To investigate compositional changes in the distal femoral condylar cartilage (FCC) of children and young adults with and without discoid meniscus by T2 relaxation time mapping.

Design

We retrospectively reviewed knee magnetic resonance images including sagittal T2 maps of distal FCC performed in patients with or without discoid meniscus. Combined meniscal pathology such as degeneration or tears was also reviewed. Regions of interest were selected, and T2 relaxation time profiles were generated according to medial and lateral and FCC and according to weight-bearing and non-weight-bearing FCC. Nonparametric comparison tests using median values were performed.

Results

Seventy-nine knees from 73 patients (2-20 years) including 45 knees with lateral discoid meniscus (discoid group) were studied. T2 values of FCC showed negative correlation with age in both the discoid and nondiscoid groups ( P < 0.01), except for medial weight-bearing FCC. In the discoid group, T2 relaxation times of lateral weight-bearing FCC (median, 46.5 ms) were lower than those of lateral non-weight-bearing (median, 53.2 ms; P < 0.001) and medial weight-bearing (median, 50.5 ms; P = 0.012) FCC. Lateral weight-bearing FCC also showed lower T2 values than other areas in patients with meniscal pathology in the discoid group. However, T2 relaxation times did not differ between the discoid and nondiscoid groups in patients without meniscal pathology.

Conclusions

Children and young adults with discoid meniscus have lower T2 relaxation times in lateral weight-bearing FCC compared with non-weight-bearing or medial FCC, suggesting compositional changes have occurred in these patients.
Exceptionally high creatine kinase levels in risperidone-induced neuroleptic malignant syndrome: A case report
Authors: Ozaal Siddiqa , Katulanda Gaya
Published: March 2022

Neuroleptic malignant syndrome is a rare, fatal antipsychotic-induced idiosyncratic reaction characterised by hyperthermia, altered consciousness, autonomic instability and rigidity with elevated creatine kinase levels and leukocytosis. Neuroleptic malignant syndrome and antipsychotics are significant causes for elevated creatine kinase among the extensive list of differential diagnoses. Risperidone is an atypical antipsychotic drug with anti-serotonergic and anti-dopaminergic properties which has a wide range of side effects, including neuroleptic malignant syndrome. Though the rise in creatine kinase in neuroleptic malignant syndrome is commonly around 2000 to 15,000 IU/L due to myonecrosis, ischaemia and heat production, normal creatine kinase levels in neuroleptic malignant syndrome were also reported. Up to now, only two cases have been reported with creatine kinase levels of more than 50,000 IU/L in neuroleptic malignant syndrome, but neither of them was risperidone-induced. We report the first case of an exceptional rise in creatine kinase levels more than 250-fold in a 16-year-old girl following low-dose risperidone-induced neuroleptic malignant syndrome.
Cases of catastrophic anti-phospholipid syndrome in systemic lupus erythematosus: An experience
Authors: Hegde Arun , Dorji Thinley , Asturkar Vikram , Yangzom Sonam , Bhanu Kovilapu Uday
Published: March 2022

Anti-phospholipid syndrome is an autoimmune disorder characterized by episodes of arterial and/or venous thrombosis and/or pregnancy morbidity in the presence of anti-phospholipid antibodies. Catastrophic anti-phospholipid syndrome is an accelerated form of the disease with rapid involvement of multiple organ systems often posing a diagnostic challenge. There is a paucity of literature on the myriad presentations of catastrophic anti-phospholipid syndrome owing to the orphan nature of the disease. We present three cases of catastrophic anti-phospholipid syndrome in patients with systemic lupus erythematosus that presented with episodes of thrombosis involving both arterial and venous systems and multisystem organ failure. Timely diagnoses were made based on a high index of suspicion and were managed with a combination of systemic glucocorticoids, cyclophosphamide, plasmapheresis, intravenous immunoglobulin and other supportive measures. However, despite providing the standard of care, we encountered a poor outcome in two of these patients, highlighting the high mortality associated with catastrophic anti-phospholipid syndrome.
Early Response of Primary Care Practices to COVID-19 Pandemic
Authors: Keppel Gina , Cole Allison M. , Ramsbottom Mary , Nagpal Stuti , Hornecker Jaime , Thomson Claire , Nguyen Viet , Baldwin Laura-Mae
Published: March 2022

Introduction:

The emergence of the COVID-19 pandemic and subsequent public health mitigation strategies resulted in rapid and significant changes to delivery of primary care. The field of primary care faced an unprecedented dual challenge of providing routine care to patients while ensuring patient and staff safety and managing patients with a highly transmissible disease. This study describes how a diverse group of primary care practices addressed these challenges at the start of the COVID-19 pandemic, in Spring 2020.

Methods:

A cross-sectional electronic survey of representatives from primary care practices in the WWAMI region Practice and Research Network (WPRN). Survey topics included clinical workforce, operations, and use of telemedicine in the first 3 months of the COVID-19 pandemic.

Results:

To safely manage patients with COVID-19 symptoms all clinics modified operations; 81.3% diverted patients with respiratory symptoms to a telemedicine evaluation, 68.8% diverted these patients to be seen in-person at another location, and 75% made in-clinic changes to maintain safety. The set of operational changes employed by clinics was diverse. To continue to provide routine patient care, all clinics employed telemedicine. Over 80% of clinics had never used telemedicine prior to March 2020.

Conclusions:

A diverse group of primary care clinics all rapidly implemented a variety of operational adaptations to address patient needs and maintain patient and staff safety at the onset of the COVID- 19 pandemic. Telemedicine, together with other measures, provided critical pathways for maintaining delivery of care.
Cerebral Infarction During Cervical Veno-Arterial Extracorporeal Membrane Oxygenation in Children: Can it be Predicted?
Authors: Patukale Aditya , Powell Jennifer , Marathe Supreet , Karl Tom , Alphonso Nelson , Venugopal Prem
Published: March 2022

Veno-arterial extra-corporeal membrane oxygenation (VA ECMO) in children is often established by cannulation of the right carotid artery and the right internal jugular vein. Cerebral infarction which is sometimes seen in such cases may be secondary to an incomplete circle of Willis. We present 3 cases with VA ECMO using cervical cannulation who suffered cerebral infarction which may be attributed to an incomplete circle of Willis.
Topic Modeling of the Pakistani Economy in English Newspapers via Latent Dirichlet Allocation (LDA)
Authors: Ahmed Fasih , Nawaz Muhammad , Jadoon Aisha
Published: March 2022

This research paper explores aspects of the Pakistani economy using the Latent Dirichlet Allocation (LDA) technique. The data based on 3,000 articles were collected from two Pakistani English newspapers, Dawn and The News, (2015–2020), through Lexis Nexis database. The headlines of the news articles relevant to Pakistan’s economy, were taken into account. By employing the data-driven approach of the grounded theory, it is found that changes in policies, security preference, textile industry, the shift of energy, inflation, growth and investment, mega projects, sustainable democracy and poverty control need to be focused to overcome the challenges of Pakistan’s economy. It also reveals that mega projects like the China Pakistan Economic Corridor (CPEC) are called to boost Pakistan’s economy. The results show that smooth trading would help reduce poverty in the country.
Performance Funding: Exam Results, Stakes, and Washback in Danish Schools
Authors: Bukh Per Nikolaj , Christensen Karina Skovvang , Poulsen Morten Lund
Published: March 2022

High-stakes testing is meant to create a positive washback effect on student learning. Performance funding can raise stakes. However, it is not often used, and its washback is uncertain. The purpose of this paper is to examine performance-funding programs based on students’ exam results. We study principals’ perceptions and interpretations of how this influenced stakes and washback effects of the exit exams. For that purpose, we selected four schools based on theoretical sampling criteria. The empirical data comprise semi-structured interviews with management over the 2-year program and documents describing the performance-funding program. The findings indicate that implementing performance funding increases stakes and has washback effects, but that stakes depend partly on the principal’s choices. Although the consequences were unintended, the program and its effects were mostly perceived as positive. The paper shows how unintended consequences call for careful consideration of the pros and cons of accountability systems when high-stakes test-based funding mechanisms are introduced.
The Need for Social Support During Unintended Pregnancy Decision-Making: A Qualitative Analysis of In-Depth Interviews With Young People in California
Authors: Mahanaimy Moria , Moseson Heidi
Published: March 2022

Most pregnancies among young people in the United States are unintended. Previous analyses of unintended pregnancies have typically been restricted by outcome, focusing either on those who had an abortion or those who gave birth. We conducted in-depth interviews with 25 young women in the San Francisco Bay Area who experienced at least one unintended pregnancy at or before age 25, regardless of pregnancy outcome, allowing us to identify themes across both abortion and birth. We asked participants about their decision-making process regarding the pregnancy resolution, with a focus on the role of social support. We present results from secondary analysis of interview transcripts, utilizing reflexive thematic analysis. Most, but not all, participants reported a short decision-making timeline, yet described an unmet need for social support during and after the decision-making process. Researchers and advocates should explore ways to increase support tailored to young people experiencing an unintended pregnancy.
Bouncing back? Kangaroo-human resistance in contemporary Australia
Authors: Chao Sophie
Published: March 2022

This article explores how human and animal agencies shape the socio-ecological lifeworlds of kangaroos as cultural icons, native wildlife, problematic pests, and commercial meat in contemporary Australia. Kangaroos’ resistance to Western, colonial ways of knowing and ordering the world fundamentally challenged the classificatory logic and foundations of early natural science. Kangaroos’ biological and behavioral resistance to domestication and farming – the traditional loci of animal exploitation – speaks to their inherent wildness, at the same time as it reveals their complicated dependence on ecosystems adapted for introduced livestock. Meanwhile, kangaroos’ resistance to government-endorsed population control programs, and the contested logic of (over)abundance that justifies kangaroo culling, both challenges and legitimates human calculations of who and what “counts” as worth conserving or killing. In tandem, the sensorial and symbolic valences of kangaroo flesh, compounded with the growing voices of animal welfare movements, generate visceral and political resistance to kangaroo meat as an unpalatable foodstuff. The article further centers the polysemic valences of kangaroos as a form of resistance to symbolic unity and coherence. Existing as many things at once, kangaroos eschew classification and treatment as any one thing. Instead, their ontology multiplies across the many epistemologies vying to determine kangaroos’ actual being and future becoming. The article concludes by assessing the opportunities and challenges of centering resistance and its diverse epistemic, vitalist, symbolic, and carnal manifestations to understand animal lifeways and deathways amidst entrenched capitalist and colonial regimes, whose reproduction depends on the production of the non-human as “killable.”
The Feasibility and Acceptability of a Community-Developed Health Insurance and Financial Toolkit for Emerging Adults With Type 1 Diabetes
Authors: Blanchette Julia E. , Allen Nancy A. , Litchman Michelle L.
Published: March 2022

Purpose:

The purpose of the study was to assess the feasibility and acceptability of a financial stress and health insurance education toolkit developed by a community advisory board for emerging adults, ages 18 to 25, with type 1 diabetes.

Methods:

This study is a longitudinal, randomized controlled trial that enrolled 39 emerging adults with type 1 diabetes. Participants randomized to the intervention group were given access to the T1D Financial Toolkit, an online financial and health insurance education toolkit, over 30 days. For the present analysis, feasibility was assessed by enrollment and attrition. Optional, qualitative interviews were conducted upon the conclusion of the intervention to evaluate feasibility, acceptability, satisfaction, and key recommendations for improvement.

Results:

Of the 39 participants who enrolled, 36 completed the study. The intervention period had 100% completion in both the control and intervention groups. Eleven participants from the intervention group completed interviews. Participants described few challenges accessing the toolkit and were highly satisfied with the intervention aesthetics, display, and content. Key recommendations included integrating more applied problem-solving into the experience of watching the videos.

Conclusions:

The T1D Financial Toolkit is a financial and health insurance education intervention tailored to emerging adults with type 1 diabetes. This resource is feasible, acceptable, and satisfactory. Diabetes care and education specialists can utilize this tool in practice to provide relevant, developmentally tailored education to emerging adults with type 1 diabetes, prompt applied problem-solving, reduce barriers to self-management, and improve psychosocial outcomes.
Impacts of Skeletal Anterior Open Bite Malocclusion on Speech
Authors: Keyser Mary Morgan Bitler , Lathrop Hillary , Jhingree Samantha , Giduz Natalie , Bocklage Clare , Couldwell Sandrine , Oliver Steven , Moss Kevin , Frazier-Bowers Sylvia , Phillips Ceib , Turvey Timothy , Blakey George , White Ray , Zajac David , Mielke Jeff , Jacox Laura Anne
Published: March 2022

Introduction: Articulation problems are seen in 80% to 90% of dentofacial deformity (DFD) subjects compared with 5% of the general population, impacting communication and quality of life, but the causal link is unclear. We hypothesize there are both qualitative (perceptual) and quantitative (spectral) differences in properties of stop (/t/ or /k/), fricative (/s/ or /ʃ/), and affricate (/tʃ/) consonant sounds and that severity of anterior open bite (AOB) jaw disharmonies correlates with degree of speech abnormality. Methods: To test our hypotheses, surgical orthodontic records and audio recordings were collected from DFD patients (n = 39 AOB, 62 controls). A speech pathologist evaluated subjects, and recordings were analyzed using spectral moment analysis (SMA) to measure sound frequency distortions. Results: Perceptually, there is a higher prevalence of auditory and visual speech distortions in AOB DFD patients when compared to controls. Quantitatively, a significant ( P < .01) increase in the centroid frequency (M1) was seen in the /k/, /t/, /tʃ/, and /s/ sounds of AOB subjects compared to the controls. Using linear regression, correlations between AOB skeletal severity and spectral distortion were found for /k/ and /t/ sounds. Conclusions: A higher prevalence of qualitative distortions and significant quantitative spectral distortions in consonant sounds were seen in AOB patients compared to controls. Additionally, severity of skeletal AOB is correlated with degree of distortion for consonant sounds. These findings provide insight into how the surgical and/or orthodontic treatment of AOB may impact speech.