bluuebunny/crossref_metadata_2025 huggingface dataset:
The changing picture of the housework gender gap in contemporary Chinese adults
Authors: Luo Meng Sha , Chui Ernest Wing Tak
Published: May 2019

Prior research has shown that time availability, relative resources, and gender perspective have great effects on couples’ division of housework, yet less attention has been paid to how the magnitude of these influences varies by cohort. By embedding the three dominant micro-level perspectives on housework in a macro-level context (i.e. cohort-level), this study examines each of the three perspectives’ explanatory powers for explaining the housework behaviors of two post-1976 cohorts: the early- and late-reform marriage cohorts. Regression results and Relative Importance analyses examining the three perspectives on housework show dissimilar effects for the two cohorts: the relative resources and gender perspectives better predict the housework gender gap in early-reform couples, while the time availability perspective better predicts the housework gender gap in late-reform couples. Specifically, the three most important predictors of the housework gender gap for the early-reform cohort are wife’s weekly paid work hours, wife’s proportion of couple’s income, and wife or her parents owning the house, while for the younger, late-reform cohort, the three most important predictors are wife’s employment, wife’s weekly paid work hours, and number of co-living children, suggesting that the relative resources perspective is weakened for the late-reform cohort. In addition, both the Relative Importance analyses and the Seemingly Unrelated Regression estimations reveal that although early-reform couples are likely to ‘do gender’ as a performance, this diminishes for late-reform Chinese couples. These changes indicate an uneven process regarding gender equality and the need to take cohort into account when testing the micro-level theoretical perspectives on the housework gap.
Correcting a rare Congenital Coronary Anomaly in an Adult—A Case Report
Authors: Duggan John , Parker William , Reoma Junewai L. , Richey Samuel , Huddleston Charles
Published: May 2019

Anomalous origin of the right coronary artery from the pulmonary artery is an extremely rare condition with an uncertain natural history. Here, we present an otherwise healthy active duty service member who was found to have anomalous right coronary artery arising from the pulmonary artery as an incidental discovery during a workup for possible pulmonary embolus. We describe a preoperative workup which showed dilation of the coronaries and evidence of ischemia. Operative technique for restoration of a two-vessel coronary system is described. Postoperative imaging demonstrated reduction in the coronary dilation and resolution of ischemia.
Compelling Interests and Substantial Burdens: The Adjudication of Religious Free Exercise Claims in U.S. State Appellate Courts
Authors: Martin Robert R.
Published: May 2019

Conflicts occasionally arise between individuals’ religious obligations and requirements of the state. In America, these conflicts are often resolved in the courts. A major debate over religious freedom in America centers on whether exemptions to acts of government which may interfere with people’s free exercise of religion are permissible. This article employs multivariate statistical analysis to model how the use of different legal tests to resolve free exercise disputes is linked to variation in likelihoods of claimant success in state appellate courts between 1997 and 2011. Claims adjudicated with balancing tests, such as those mandated by state and federal religious freedom “restoration” legislation, were more likely to lead to decisions favorable to religious free exercise claimants than those adjudicated with rational basis tests. Religious minorities’ claims are generally less likely to prevail than members of more common faiths, and claims brought by formal organizations are more likely to succeed than those brought by individuals.
Development and Validation of the Awareness of Privilege and Oppression Scale–2
Authors: McClellan Michael James , Montross-Thomas Lori Patricia , Remer Pamela , Nakai Yoshie , Monroe Addison D.
Published: May 2019

The two studies presented describe the revision process that led to the development of the Awareness of Privilege and Oppression Scale–2 (APOS-2) and efforts to evaluate the new measure’s reliability and construct validity. In Study 1, a 26-item measure was developed from data gathered from a sample of 484 undergraduate students. An exploratory factor analysis suggested a four-factor solution made up of awareness of racism, sexism, heterosexism, and classism was appropriate. In Study 2, confirmatory factor analysis suggested the proposed hierarchical four-factor solution was the best available fit of the data using a second sample of 520 undergraduate students. The observed Cronbach alpha reliability estimates for the final 26-item total score and subscale scores in the two presented studies were as follows: Total score (.89, .88), Awareness of Heterosexism (.82, .82), Awareness of Sexism (.76, .76), Awareness of Classism (.81, .82), and Awareness of Racism (.84, .80).
EFL Writers’ Reconstruction of Writing Beliefs in a Functional Linguistics-Based Curriculum: What Does the Trajectory Look Like?
Authors: Zhang Xiaodong
Published: May 2019

This case study explores how English-as-a-foreign language (EFL) learners reconstructed their writing beliefs when exposed to a systemic functional linguistics (SFL)–based writing curriculum. The study was conducted through qualitative content analyses of four EFL students’ interviews, journal entries, teacher/peer feedback, as well as their writing pieces collected in an argumentative writing classroom at a Chinese university. It shows that along with mediated instruction, the EFL writers overcame an array of factors in and outside of their classroom and gained more stabilized beliefs that conceptualized writing as a meaning-making process. In addition, the EFL writers gradually acted upon their new beliefs by attending to the concurrent roles of linguistic resources (e.g., grammar and vocabulary), meaning, and context when constructing writing. The study implicates that it is optimal for education administrators to promote meaning-making-based writing instruction through the tool of SFL to shape EFL writers’ beliefs and facilitate their effective construction of academic writing.
Ayurvedic Treatment of Acute Ischemic Stroke: A Prospective Observational Study
Authors: Harini J Aarthi , Luthra Avineet , Madeka Shrey , Shankar Prasan , Mandava Pitchaiah , Pervaje Ravishankar , Aaron Sanjith , Purushotham Archana
Published: May 2019

Background

The western medical arsenal for treating stroke is rather limited, and the only treatments shown to improve outcomes are not accessible to most in the third world. Even in the developed world, many patients present too late to receive thrombolysis or thrombectomy. Stroke patients in India commonly use Ayurvedic therapies, but there are no published data regarding the efficacy or safety of these therapies, the latter being of particular concern in acute ischemic stroke (AIS).

Objective

To obtain preliminary data on the safety and efficacy of stand-alone whole-system Ayurvedic treatment in AIS.

Methods

We present here an observational study prospectively comparing outcomes in 2 cohorts of AIS patients treated with whole-system classical Ayurveda (n = 13) or conservative (nonthrombolytic, noninterventional) western biomedicine (n = 20).

Results

Pooled analysis of outcomes did not show statistically significant differences in mortality (15.38% vs 15%, P = 1.00), nonfatal adverse event rates (15.38% vs 30%, P = .4), or functional disability measures. A paired analysis performed using a matching algorithm to reduce baseline disparities between the cohorts also showed no statistically significant differences in outcomes.

Conclusions

The safety profiles of classical Ayurveda and conservative western biomedicine in AIS are similar. This is the first ever report of stand-alone Ayurvedic therapy in AIS. Our results support the conduct of a randomized controlled trial to study the efficacy of Ayurvedic treatment of AIS.
Reinvention Through CrossFit: Branded Transformation Documentaries
Authors: McCarthy Brigid
Published: May 2019

This article analyses a set of branded promotional documentaries from the CrossFit YouTube channel, which depict new participants as they transition into a CrossFit lifestyle. These documentaries share narrative elements of reality makeover television’s hybrid entertainment/educational format, deploying popular tropes of reinvention and personal empowerment through guided consumption. In focusing largely on participants dealing with chronic health issues, the documentaries reproduce dominant neoliberal ideologies about personal responsibility for health through fitness and construct CrossFit as a socially engaged brand with an inclusive fitness mission. These documentaries may also mitigate dominant, intimidating media images of high-performing CrossFit competitors who embody the brand image, as well as CrossFit’s reputation as an extreme fitness practice. This article takes Dawson’s (2017) position that CrossFit is a contemporary reinventive institution, which makes omnivorous demands of its adherents’ lives in exchange for personal transformation. In these documentaries, participants’ successful transition into exemplary CrossFit membership hinges not only on capitulation to these demands but recognition of them as desirable steps toward self-making and health. Reinvention is depicted as willing conformity to CrossFit values and behaviours, rather than simply the achievement of physical fitness, and those who successfully transform are constructed as aspirational embodiments of the brand.
Effect of the location of the split of the subscapularis on range of motion and stability of the glenohumeral joint following Latarjet or Trillat procedures
Authors: Nourissat G , Hooke A , Berglund L , Thoreson A , An KN , Werthel JD
Published: May 2019

Aim:

Compare the effect of Latarjet and Trillat procedures on glenohumeral stability and range of motion.

Background:

Little is known about the impact of the location of the sling effect on joint stability and range of motion.

Methods:

12 cadaveric shoulders were cleaned of soft tissue except for the subscapularis, conjoined tendon, and anterior capsule. A custom-made apparatus generating anterior humeral translation and joint compression was used. The machine applied compression load in the medial direction. The subscapularis and conjoint tendon were loaded. Internal/external range of motion and joint stability were assessed at 0°, 30° and 60° glenohumeral abduction. Range of motion was assessed by rotating the humeral shaft. Joint stability was assessed at maximum external rotation, translating the humerus. Specimen were tested in five conditions: 1) intact shoulder, 2) 6-mm bony glenoid defect (20% defect) 3) Trillat procedure, 4) Latarjet procedure with subscapularis split at the junction between its superior 2/3rds and inferior 1/3 rd, 5) Latarjet procedure with subscapularis split at the superior 1/3rds and inferior 2/3rds. Means were compared with a full factorial-repeated measures ANOVA with pairwise post hoc comparisons.

Results:

Peak translation force and stability ratio were significantly lower with the glenoid defect when compared to the intact and all the repaired conditions at all levels of glenohumeral abduction. The level of the subscapularis split had no significant influence on these values and no significant difference could be found between Trillat and Latarjet procedures. Range of motion in internal and external rotation were not significantly different between the different conditions.

Conclusions:

Joint stability and range of motion after a Latarjet are not impacted by the location of the subscapularis muscle split. Trillat and Latarjet techniques provide comparable stabilization of the joint, even in the presence of a critical bony defect of the glenoid.
Arthroscopic Anatomy of the posterolateral structures of the knee
Authors: Freychet Benjamin , Sonnery-Cottet Bertrand , Sanders Thomas L. , Kennedy Nicholas I. , Krych Aaron J. , Stuart Michael J. , Levy Bruce A.
Published: May 2019

Objectives

The purpose of this study was to describe an arthroscopic surgical approach to identify and expose the popliteus tendon (PT), posterior fibular head, Fibular collateral ligament (FCL), popliteal fibular ligament (PFL), biceps femoris tendon, and the peroneal nerve.

Methods

10 fresh human cadaveric knees were examined arthroscopically using standard anterior and posterior portals. The use of a transeptal approach with both posteromedial and posterolateral portals was required using a standard 30 degrees arthroscope. Optimal portal placement and specific technique and sequence for appropriate visualization of the PLC structures were tested and documented.

Results

In all specimens, all the PLC structures that we attempted to identify were successfully visualized. These included the PT, posterior fibular head, the FCL, the PFL, biceps femoris tendon, peroneal nerve, PT and FCL femoral attachments.

Conclusion

This study demonstrated that the identification and exposure of the PLC structures using an all arthroscopic approach can be successfully performed with precise portal placement. This technique may serve as a basis for arthroscopic treatment of PLC injuries.
Postoperative Mobilization After Superior Rotator Cuff Repair: Sling versus No-sling. A Randomized Controlled Trial: Sling versus no-sling after RCR
Authors: Tirefort Jérome , Schwitzguebel Adrien J. , Collin Philippe , Nowak Alexandra , Plomb-Holmes Chantal , Lädermann Alexandre
Published: May 2019

Objectives

Patients are commonly advised to wear a sling for 4–6 weeks after rotator cuff repair (RCR) despite negative effects of early immobilization and benefits of motion rehabilitation. The study aimed to compare clinical and radiographic outcomes up to 6 months following RCR with sling immobilization and without sling immobilization.

Methods

We randomized 80 patients scheduled for arthroscopic repair of small or medium superior rotator cuff tears into 2 equal groups: ‘sling’ and ‘no-sling’ groups. Passive mobilization was performed in both groups during the first 4 postoperative weeks followed by a progressive active mobilization. Patients were evaluated clinically at 10 days, 1.5, 3 and 6 months, and using ultrasound at 6 months. Uni- and multi-variable analyses were performed to determine if postoperative scores are associated with gender, age at surgery, immobilization, arm dominance, biceps procedure, resection of the distal clavicle, as well as preoperative scores.

Results

The two groups had similar preoperative patient characteristics, function, or adjuvant procedures. At 10 days, there was no difference in pain among the two groups (5.2±2.3 vs 5.2±1.9, p=0.996). In comparison to the sling group, the no-sling group showed greater external rotation (23.5±15.6 vs 15.3±14.6, p=0.017) and active elevation (110.9±31.9 vs 97.0±25.0, p=0.038) at 1.5 months, as well as better active elevation (139.0±24.7 vs 125.8±24.4, p=0.015) and internal rotation (>T12 in 50% vs 27.5%, p=0.011) at 3 months. Ultrasound revealed no differences at 6 months in tendon thickness anteriorly (p=0.472) or posteriorly (p=639), bursitis (p=1.000), echogenicity (p=0.422), or repair integrity (p=0.902). Multi-variable analyses confirmed that ASES score increased with patient age (beta, 0.60; p=0.009), SANE decreased with sling immobilization (beta, -6.3; p=0.014), and that pain increased with sling immobilization (beta, 0.77; p=0.022).

Conclusion

No immobilization after RCR is associated with better early mobility and functional scores in comparison to sling immobilization. Postoperative immobilization with slings may therefore not be required for patients treated for small or medium tears.
A prospective study of bone-tendon-bone ACL reconstruction with and without lateral extra-articular tenodesis: 19-year clinical and radiological follow-up
Authors: Castoldi Marie , Batailler Cécile , Gunst Stanislas , Neyret Philippe , Lustig Sébastien , Servien Elvire
Published: May 2019

Objectives

Anterior cruciate ligament (ACL) arthroscopic reconstruction with a patellar tendon graft (BTB) is a well-known and reliable surgical option for control of anterior laxity, at short and middle term. Most of those patients are young and practice sports, often at high level. Few studies have evaluated the long term effects of ACL reconstruction, and more specifically lateral tenodesis, on knee function. It has been shown that chronic anterior instability, when left untreated, evolves towards femorotibial osteoarthritis in the 10 to 20 years after ACL rupture. This study aims to compare long-term survival and femorotibial arthritis between ACL reconstruction with and without lateral tenodesis.

Methods

121 consecutive knees (120 patients) presenting with an ACL rupture between 1998 and 1999 were included in this prospective randomized monocentric study. For the 61 knees in group BTB, an isolated patellar tendon plasty with outside-in technique was performed. For 60 knees in group BTB-T, the intra-articular plasty was associated with a lateral tenodesis with gracilis tendon. Patients were reviewed at 1 year, 6 years and 19 years post-operatively.

Results

80 patients were contacted with a minimum follow-up of 19 years. 43 patients had a clinical examination and the 37 other patients were evaluated through a telephone questionnaire. We had standard X-rays for 45 patients and laximetry (TELOS™) for 42 patients. 41 patients (34%) were lost to follow-up. 16 knees (20%) had experienced a graft failure, 5 of which had had an iterative ACL plasty. The difference between group BTB (27.5%) and group BTB-T (13.2%) concerning graft failure was not statistically significant (p = 0.38). 32 patients (71%) had femorotibial osteoarthritis (IKDC grade C or D). There was no difference between groups BTB and BTB-T concerning medial femorotibial osteoarthritis. Lateral femorotibial osteoarthritis was significantly increased in groupe BTB-T (59%) compared to group BTB (21%) and to the contralateral knee (5%). 36 patients (45%) had had a lateral or medial meniscectomy. Mean subjective IKDC score was 81.8/100, comparable between groups BTB and BTB-T. 67% still practiced pivot sports.

Conclusion

At 19 years follow-up after patellar tendon ACL plasty, lateral tenodesis did not significantly improve graft survival in our study. Lateral femorotibial osteoarthritis was significantly increased in patients with a lateral tenodesis. However, a follow-up bias may be that lesions of the lateral meniscus were more frequent in BTB-T patients for whom we obtained X-rays. Functional scores were stable at over 80/100 and two thirds of patients still practiced pivot sports. ACL graft survival was 80% at 20 years follow-up.
Accuracy Of Open-Wedge High Tibial Osteotomies: Comparison Of Radiologic Outcomes Between 2 Techniques Using Hernigou’s Table Vs Conventional Method
Authors: Nicolau Xavier , Bonnomet François , Favreau Henri , Adam Philippe , Ehlinger Matthieu
Published: May 2019

Objectives

Long-term outcomes of patients who suffer from medial osteoarthritis, who were treated with a medial open-wedge high tibial osteotomies (HTO) depend on the final hip-knee-ankle angle (HKA) obtained after surgery. A 2 to 4° postoperative valgus objective is usually admitted. Many surgical techniques are described to reach this target range. The purpose of this study was to compare the accuracy of the post-surgical correction achieved compared to the predetermined correction goal of two different surgery technique: Hernigou’s table (HT) vs conventional method (CM).

Methods

In this retrospective monocentric study, 38 patients who were managed with an open-wedge HTO for medial osteoarthritis were included, from 01/2009 to 01/2014: 21 were treated using the « HT » and 17 using a « CM ». There were 24 men and 14 women, with a median age of 48 [31; 61] years old, and a median BMI of 30 [25; 40] kg/m2. There was one single operator for each group, expert in the surgical technique used. The intended correction was individually defined for each patient. The surgical accuracy, where small values represent greater accuracy, was defined as the absolute deviation of the intended correction from the achieved correction, measured on the average HKA angle on postoperative long-leg alignment films with bipodal weight bearing.

Results

The median intended correction was 13° [10; 18] and 10° [5; 17] in the « CM » and « HT » respectively. The median surgical accuracy was 2,63° [0,2; 6,4] for « CM » compared to 0,9° [0,1; 3,7] for « HT » with statistical significance (p=0,02). In the conventional group, there were 65% (11/17) of outliers (>2° from the intended correction) compared to 29% (6/21) in the « HT » group, with statistical significance (p=0,048). One revision in « HT » groups was needed for nonunion, with consolidation achieved,

Conclusion

For coronal plane corrections, Hernigou’s table method was shown to have a greater accuracy to reach the intended correction. Unidimensional radiological analysis, however, becomes disgraced by the advent of three-dimensional planning or navigation, but remains an accessible and simple means of planning.
Posturography table is a good test to evaluate the anterior cruciate Ligament reconstruction?
Authors: Wein Frank , Peultier Laetitia , Mainard Didier , Perrin Philippe
Published: May 2019

Introduction:

The success of anterior cruciate ligament reconstruction (ACLR) is assessed using subjective and functional scores, as well as measurements of knee laxity. The latter is often quantified using instrumented laximetry devices, which measure ‘static’ anterior tibial translation, though recent studies suggested more comprehensive “dynamic” analyses such as jump tests. To facilitate and improve dynamic stability analyses, a proprioception table was adapted to evaluate knees before and after ACLR, though the accuracy and pertinence of its measurement have not yet been demonstrated.

Objectives:

To determine whether proprioceptive analysis following ACLR provides meaningful and helpful information to guide surgeons and physiotherapists with postoperative rehabilitation and return to sports.

Methods:

We conducted a prospective study, on a population of 50 amateur or professional sports patients, who received ACLR by the one surgeon (FW). Preoperative and 6-months assessments included GnRB laxity analysis and proprioceptive dynamic stability analysis, with evaluation of the bearing area under 6 different conditions: open eyes (C1), closed eyes (C2), vision distorted by virtual reality headset (C3), open eyes on unstable support (C4), closed eyes on unstable support (C5) and distorted vison on unstable support (C6); a calculation of the C4/C1 ratio enabled appreciation of visual compensations in the proprioceptive capacity, and dependence on visual inference (low ratios indicate greater recourse to visual afference). A complementary analysis of muscular strength by isokinetic assessment was also performed at 6 months followup.

Results:

There was a significant improvement in proprioception table stability at 6 months compared to the preoperative condition at the C4 (470 vs 440 mm2), C5 (1710 vs 1315 mm2) and C6 (1330 vs 1210 mm2) assessments. For 32 patients evaluated by GnRB, differential laxity at 6 months was less than 5 mm at 200 N, and isokinetic muscle strength measurement was less than 20% different between the knee healthy and the operated knee, or between quadriceps and hamstrings. Proprioceptive quality was variable, with significant visual offsets in some cases (C4/C1 ratio, 0.5 to 16.2).

Conclusion:

Patients, who have good results in laximeter tests and isokinetic muscle strength measurement, may have a poor proporioception quality with significant visual offsets. The proprioception analysis at 6 months following ACLR could therefore be important to consider rehabilitation and sports recovery.
Influence of a posteromedial meniscocpsular injury on the tibiofemoral joint laxity: A cadaveric study
Authors: Bernardini Isabelle , N’Dele Daniel , Accadbled Franck
Published: May 2019

Objectives

Up to 61% of meniscal tears can be associated with ACL ruptures. These lesions lead to anterior and rotary laxity increase. Posterior peripheral meniscocaspsular tear of medial meniscus is also called ramp lesion. Prevalence of this kind of lesion is 9% to 17% in adults and up to 23% in pediatric popultation. The aim of this study was to determined anterior laxity of cadaveric ACL deficient knees. Hypothesis was to find a correlation between size of ramp lesion and laxity in order to determine a threshold of size for which reparation is mandatory.

Methods

Twelve fresh cadaveric knees were explored for the study. Two knees was excluded because they presented major lesions of osteoarthritis and ACL and meniscal tears. 10 remaining knees were from 3 males and 2 females. Mean age at time of death was 86 years old. Dynamic laximetry with GNRB device was made in several conditions: Knee without any intervention, full of water knee, after ACL rupture and after ACL rupture and increasing sizes of ramp lesions up to 30 mm. Anteroposterior laxity was measured at each time with 3 kind of loading charge (134 N, 200 N and 250 N).

Results

After ACL section only, tibiofemoral joint anterior laxity was significatively increased. Mean increasing was 156% whatever is the loading force. No statistical laxity difference was find between knees with ACL tears only and knees with ACL and meniscal tears for each size of ramp lesions. Increasing size of ramp lesion was not correlated to increasing of laxity. We could not be able to determine a threshold for ramp lesion reparation.

Conclusion:

GNRB® is a valid device of knee laxity measure, escpecially for ACL deficient knee. Despite use of this performing tool, we can’t confirm our hypothesis. Stephen et al in 2015 have shown, with cadaveric study, significant increase of anterior tibial translation and rotary laxity in knees with extended ramp lesions. There is no data about a ramp lesion size threshold with clinical relevance. GNRB gives reliable measures of laxity in ACL deficient knees. We could not find a threshold size of ramp lesion which increase tibial anterior laxity. Cadaveric rotary laxity has to be also studied to find this threshold.
Survey of Osteopathic Medical Students Regarding Physician Shadowing Experiences Before and During Medical School Training
Authors: Langenau Erik , Frank Sarah B , Calardo Sarah J , Roberts Michael B
Published: May 2019

Introduction:

Shadowing a physician is an observational experience which includes a student observing a licensed healthcare provider caring for patients. Shadowing is commonly done by students before and during medical school, but little is known about the nature or extent of these extra-curricular observational experiences.

Objective:

We hypothesized that shadowing experiences were common yet variable. We investigated the prevalence, nature, and perceived value of medical student experiences with shadowing physicians (both before and during medical school).

Methods:

This survey-based study was non-experimental with a cross-sectional convenience sample of osteopathic medical students about their shadowing experiences before and during medical school. The survey was sent to all matriculated osteopathic medical students (OMS1-4) for the 2017 to 2018 academic year from two medical schools: Philadelphia College of Osteopathic Medicine (PCOM) (1084 total students) and PCOM-Georgia (554 total students). The final survey instrument included three sections: demographics (6 questions), pre-medical shadowing experiences (21 questions), and medical student shadowing experiences (24 questions).

Results:

Respondents (357) identified themselves as OMS1 (96), OMS2 (89), OMS3 (73), OMS4 (95) and other (2, OMS5) with enrollment at PCOM-Philadelphia (242) and PCOM-Georgia (115). Among survey respondents, 339 (95.5%) reported shadowing a physician as a pre-medical student, and 110 (30.8%) reported shadowing (outside of their required clinical rotations) a physician during medical school. Requirements to participate were inconsistent; fewer than 50% of shadowing experiences required Health Insurance Portability and Accountability Act of 1996 (HIPAA) training, proof of vaccination, or purified protein derivative (PPD) documentation. In addition to observation, pre-medical and medical students, respectively, participated in history taking (44 [13%], 47 [42.7%]), physical examinations (45 [13.3%], 44 [40%]) and procedures (13, [3.8%], 20 [18.2%]) during their shadowing experiences. Motivations to participate in shadowing varied between pre-medical and medical student experiences, but both groups mentioned their desire to learn more about a particular discipline, obtain letters of recommendation, and gain patient care experience. Students recommended both pre-medical (273 [80.5%]) and medical school (93 [84.5%]) shadowing to future students.

Conclusion:

Shadowing remains a common and important tool for students to learn about patient care, medicine and careers. The nature of each shadowing experience and participation requirements are quite variable. Measures to ensure patient safety, confidentiality, liability and supervision are inconsistently applied. Promoting guidelines, as well as codes of conduct, for shadowing could serve as a helpful resource for students, academic advisors and supervising clinicians.
Joys of Christmas
Authors: Jodha Vijay S.
Published: May 2019

This photo essay captures some of the female entrepreneurs who operate from the footpaths of Connaught Place—New Delhi’s oldest and toniest shopping district, around Christmas. Notwithstanding their unusual appearance, each woman embodies the many challenges common to labour in unorganized sector in India and the world.
Topical and Intravenous Tranexamic Acid Are Equivalent in Decreasing Blood Loss in Total Shoulder Arthroplasty
Authors: Budge Matthew
Published: May 2019

Introduction

Tranexamic acid (TXA) has been shown to be an effective modality to decrease blood loss in total shoulder arthroplasty (TSA). However, the most effective method of TXA administration remains controversial. The purpose of this study was to directly compare the use intravenous and topical TXA to determine which regimen was more effective in improving postoperative hemoglobin (Hb), transfusion rates, and patient outcomes after primary TSA.

Methods

We conducted a retrospective review of 3 sequential cohorts of patients undergoing primary TSA with no TXA, intravenous TXA, or topical TXA. Postoperative data collection included daily Hb levels (g/dL), transfusions, thromboembolic events, length of stay, and discharge disposition. One-way analysis of variance was used to compare data between the 3 groups with post hoc Tukey honestly significant difference test for differences between pairs.

Results

Average change in Hb was 2.36 g/dL in the IV TXA group and 2.27 g/dL in the Topical TXA group which was not statistically significant ( P = .69). Average change in Hb in the control group was 3.27 g/dL which was significant when compared to both TXA groups ( P < .01). There were no transfusions or thromboembolic events in either TXA group. In the control group, there were 2 transfusions which was not statistically significant ( P = .09). There was no significant difference in the discharge disposition or days in hospital between the 2 groups receiving TXA ( P = .33).

Conclusion

Intravenous and topical TXA are equivalent in improving postoperative Hb in TSA.
Investigations on size-effect dependent strain and temperature in micro turning near to the cutting edge
Authors: Mandal Soumen , Hanumaiah Naga
Published: May 2019

This research presents an investigation for understanding machining physics by assessing temperature and strain near (126 µm) to the cutting edge of tool tip in micro-turning process. Fiber Bragg grating (FBG) sensors were attached near to the cutting edge of the micro-turning tool and experiments with varying depth of cut were conducted to record the strain and temperature simultaneously on an indigenous developed micro-machining centre ‘Multi-Fab’. It was observed that with varying depth of cut different mechanisms that is, cutting, ploughing and slipping were dominant due to size-effect. In slipping the temperature and strain fluctuates around a fixed value due to elastic deformation of the work. The recorded strain and rise in temperature during cutting operation were found to be about four times and twice, respectively as compared to ploughing. Material hardness and rate of heat dissipation also play a major role in strain and temperature near to the cutting edge as validated from the experiments. The observations found from the experiments can enable appropriate process control in micro turning by monitoring strain and temperature near to the cutting edge.
Superhydrophobic surfaces review: Functional application, fabrication techniques and limitations
Authors: Manoharan Kapil , Bhattacharya Shantanu
Published: May 2019

Over the years, researchers have been working to mimic the nature by inducing superhydrophobic properties into a variety of material surfaces so that they exhibit non-wetting properties. Many diverse applications have been found in the fields, such as space and aerospace, defence, automotive, biomedical applications and engineering, sensors, apparels, and so on. Superhydrophobic surfaces repel water generally due to their surface texture or chemical properties. In this article, we focus on the functional applications of the superhydrophobic surfaces, and state-of-the-art fabrication technologies and processes, and the limitations of these processes to generate the superhydrophobic surfaces have been developed over the years.
Sustaining a Multitiered System of Supports for English Learners in Rural Community Elementary Schools
Authors: Hoover John J. , Soltero-González Lucinda , Wang Chao , Herron Shelley
Published: May 2019

A 5-year model demonstration project designed to improve literacy instruction and special education referrals for English learners (ELs) in grades K–3 in three rural community elementary schools was completed with specific attention to sustainability 1 year after implementation. The model, which was developed and implemented through a university–school district collaborative partnership, incorporated sustainability as a critical component. Findings show that the sustainability component (a) embedded into project development, (b) periodically revisited during project implementation, and (c) personalized by participating schools developing their own sustainability plans proved to be a successful approach to maintaining select literacy best practices and improved referrals of ELs. A minimum of 80% of classroom teacher participants reported 1 year after project implementation that key aspects of the project continued to be beneficial or very beneficial for delivering their classroom instruction to ELs. Each of the five multitiered system of supports (MTSS) for EL model components was somewhat addressed, with several being mostly addressed 1 year after implementation in all three elementary schools. Also, the culturally and linguistically responsive referral was maintained. Project sustainability findings are shared and discussed along with recommendations for educators to apply in their MTSS models in rural elementary schools with high populations of ELs with and without disabilities.
Self-Poisoning in Adolescents
Authors: White H. C.
Published: May 2019

Studies in Great Britain concerning intentional self-harm in adolescents have been few (Haldane and Haider, 1967; Leese, 1969). Such behaviour amongst teenagers is now common, and usually takes the form of self-poisoning with drugs; in fact it is probably becoming commoner, although the reasons for this are not altogether clear. The present survey concerns 50 consecutive patients aged between 14 and 19 years, admitted to the General Hospital, Birmingham, following self-harm behaviour in 1970 and 1971. The lower age limit for the group was determined by hospital admission policy, since children under 14 are admitted elsewhere in the city. All the patients had taken drug overdoses, and none had used other methods of self-harm, such as wrist-slashing. All cases classified as intoxication or poisoning within these age limits admitted to the hospital during the relevant period were scrutinized, and care was taken to make sure that no cases of intentional self-harm were being overlooked amongst so-called accidental poisoning. All patients in the intentional self-poisoning group were interviewed by the psychiatrist within 24 hours of regaining full consciousness. Information was obtained in a standard form covering specific aspects of the history. The parents (when available and willing) were seen either by medical staff or by a social worker in an open-ended interview. The Eysenck Personality Inventory (EPI) and Raven's Progressive Matrices test were administered by the psychiatrist at a later date, when all drug effects had worn off.
Psychiatry, Systems Theory, Education, and Change
Authors: Jones Maxwell
Published: May 2019

How far are the traditional skills of psychiatry relevant to the everyday problems of our time? Or, put differently, do the goals of psychiatry reach beyond identifying someone as mentally ill and treating such an individual?
Self-harm in midlife: analysis using data from the Multicentre Study of Self-harm in England
Authors: Clements Caroline , Hawton Keith , Geulayov Galit , Waters Keith , Ness Jennifer , Rehman Muzamal , Townsend Ellen , Appleby Louis , Kapur Nav
Published: May 2019

Background

In England suicide rates are highest in midlife (defined as age 40–59). Despite a strong link with suicide there has been little focus on self-harm in this age group.

Aim

To describe characteristics and treatment needs of people in midlife who present to hospital following self-harm.

Method

Data from the Multicentre Study of Self-harm in England were used to examine rates over time and characteristics of men and women who self-harm in midlife. Data (2000–2013) were collected via specialist assessments or hospital records. Trends were assessed by negative binomial regression models. Comparative analysis used logistic regression models for binary outcomes. Repetition and suicide mortality were assessed by Cox proportional hazards models.

Results

A quarter of self-harm presentations were made by people in midlife (n = 24 599, 26%). Incidence rates increased over time in men, especially after 2008 (incidence rate ratio [IRR] 1.07, 95% CI 1.02–1.12, P < 0.01), and were positively correlated with national suicide incidence rates (r = 0.52, P = 0.05). Rates in women remained relatively stable (IRR 1.00, 95% CI 1.00–1.02, P = 0.39) and were not correlated with suicide. Alcohol use, unemployment, housing and financial factors were more common in men; whereas indicators of poor mental health were more common in women. In men and women 12-month repetition was 25%, and during follow-up 2.8% of men and 1.2% of women died by suicide.

Conclusion

Self-harm in midlife represents a key target for intervention. Addressing underlying issues, alcohol use and economic factors may help prevent further self-harm and suicide.

Declaration of interest

K.H. and N.K. are members of the Department of Health's National Suicide Prevention Advisory Group. N.K. chaired the National Institute for Health and Care Excellence (NICE) guideline development group for the longer-term management of self-harm and the NICE Topic Expert Group which developed the quality standards for self-harm services. N.K. also chairs the NICE guideline committee for the management of depression. All other authors declare no conflict of interest.
The Problem-Oriented Medical Record and Psychiatry
Authors: Hayes-Roth Frederick , Longabaugh Richard , Ryback Ralph
Published: May 2019

The psychiatric hospital can be viewed as a social system which is evolving slowly by attempting to improve. In order to systematically study and learn about itself the mental hospital and its care providers need continuous pertinent information. Yet, at present the psychiatric hospital is not organized in a way that readily allows isolation of problems or systematic learning from prior experience (8). In that sense, the hospital is a non-system which lacks an information system necessary for meaningful feedback to the decision-makers of the institution (7).
A Study of Depersonalization in Students
Authors: Myers D. H. , Grant G.
Published: May 2019

Some patterns of deranged function—epilepsy, schizophrenia—have been enshrined as diseases; others, such as depersonalization, have, by and large, escaped this fetter. This is perhaps why there has been no difficulty in accepting that depersonalization, being a pattern of disordered function, can occur in conditions of very different aetiology. It is seen in temporal lobe epilepsy (12), temporal lobe migrane (22), depression (8), LSD intoxication (20), schizophrenia (1), phobic anxiety states (15), sleep deprivation (2) and the hypnagogic state. Shorvon (21) reported cases of depersonalization occurring in the apparent absence of other psychiatric disorder, and Davison (4) investigated in detail seven such cases. Finally the occurrence of depersonalization in people not attending psychiatric or neurological clinics is now well attested (13, 5, 18, 6).
The Relationship between Genetic and Precipitating Factors in Depressive Illness
Authors: Pollitt John
Published: May 2019

Scientific studies of the families of depressed patients have shown that the risk of development of similar illnesses for close relatives is greater when the illness of the index case began relatively early in life than when it began later. These studies have included both manic-depressive and single episode endogeneous depressions, and no account has been taken of the mode of precipitation of the illnesses. It has been postulated that (a) the penetrance of the gene may be lower in those families with late onset of depression, and (b) that depressive illness may be of diverse aetiology, so that genetically determined forms appear earlier in life and those which are not genetically determined occur later (Hopkinson and Ley 1969).
Intravenous Diazepam in Drug-Induced Dystonic Reactions
Authors: Korczyn Amos D. , Goldberg Gerald J.
Published: May 2019

Acute dystonic reactions, including oculogyric crises, were once thought to be pathognomonic of encephalitis lethargica, but the clinical use of the phenothiazines has led to the recognition that similar symptoms can be produced by these drugs. Some phenothiazines, such as trifluoperazine, fluphenazine, prochlorperazine and perphenazine (Ayd, 1960; Christian and Paulson, 1958; Hollister, 1957; Waugh and Metts, 1960), are thought to cause these effects more frequently, especially when given parenterally. Other non-phenothiazine tranquillizers, for example haloperidol, also produce these reactions. not un-commonly. Certain patients, particularly the young and perhaps the genetically predisposed, are more likely to be affected.
Changes in the Conviction Rate for Indecent Exposure
Authors: Rooth Graham
Published: May 2019

Indecent exposure is the second commonest sexual offence in England and Wales. The offenders responsible usually fall into the clinical group known as exhibitionists. Exhibitionism is one of the less well understood sexual disorders, and is virtually confined to males. It is characterized by the urge to expose the genitals to members of the opposite sex in a more or less public situation.
Self-Assembled Liquid-Crystalline Ion Conductors: Odd-Even Effects of Flexible Spacers Binding a Carbonate Moiety and an Aliphatic Rod-Like Core on Phase Transition Properties and Ion Conductivities
Authors: Mizumura Yurika , Högberg Daniel , Arai Kenichiro , Sakuda Junji , Soberats Bartolome , Yoshio Masafumi , Kato Takashi
Published: May 2019

Liquid-crystalline compounds consisting of mesogenic cores linked to cyclic carbonates through flexible spacers have been developed. These liquid crystals form complexes with lithium salts and self-assemble into nanostructures with well-defined ion pathways. It is found that the type and length of the intramolecular spacer affects the liquid crystallinity and ion conductivity of the materials. Mesogenic compounds based on alkylene-based spacers show odd-even effects on the liquid-crystalline properties of the compounds. The liquid crystals based on spacers with an even number of carbon atoms show liquid crystallinity in wider temperature ranges and higher ion conductivities as compared to the liquid crystals based on spacers with an odd number of carbon atoms. On the other hand, liquid crystals based on polar oligooxyethylene spacers are observed to show liquid-crystallinity in wider temperature ranges and higher ion conductivities as compared to the alkylene-based liquid crystals. The liquid crystals with more polar and more flexible spacers, that is, oligooxyethylene groups show higher ion conductivities than those of the liquid crystal with alkylene spacers. This enhanced behavior may be due to the increase in the fluidity of the ionic pathways. These findings may provide us with new designs of self-assembled ion conductors.
Discrete Midpoint Convexity
Authors: Moriguchi Satoko , Murota Kazuo , Tamura Akihisa , Tardella Fabio
Published: May 2019

For a function defined on the integer lattice, we consider discrete versions of midpoint convexity, which offer a unifying framework for discrete convexity of functions, including integral convexity, L♮-convexity, and submodularity. By considering discrete midpoint convexity for all pairs at ℓ∞-distance equal to 2 or not smaller than 2, we identify new classes of discrete convex functions, called locally and globally discrete midpoint convex functions. These functions enjoy nice structural properties. They are stable under scaling and addition and satisfy a family of inequalities named parallelogram inequalities. Furthermore, they admit a proximity theorem with the same small proximity bound as that for L♮-convex functions. These structural properties allow us to develop an algorithm for the minimization of locally and globally discrete midpoint convex functions based on the proximity-scaling approach and on a novel 2-neighborhood steepest descent algorithm.
Perspectives on Strategies to Foster Inclusion Through Sports: Advantages, Disadvantages, and Considerations for Implementation
Authors: Grandisson Marie , Marcotte Justine , Milot Élise , Allaire Anne-Sophie , Lamontagne Marie-Eve
Published: May 2019

This article presents the results of a study on the perspectives of stakeholders from mainstream and specialized sports settings on seven strategies that could boost the impact of sports on social inclusion of people with intellectual disability. These strategies are: 1) developing Unified Sports, 2) conducting activities to raise awareness, 3) providing training to coaches, 4) using shadows, 5) developing a peer-support structure, 6) having a resource person available when needed, and 7) facilitating engagement in nonplaying roles. The perspectives of 28 stakeholders regarding the advantages, disadvantages, and considerations for implementation of the different strategies were gathered in discussion groups. Findings could help diversify opportunities for athletes with intellectual disability and develop programs and policies that contribute to building inclusive communities through sports.