bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Imaging Modalities in Diagnosis and Outcome of Otitis Media with Effusion in Cochelear Implant Candidates
Authors: Araz Server Ela , Kalaycik Ertugay Cigdem , Sunter Ahmet Volkan , Yigit Ozgur , Ture Muhammed , Sunnetci Eda
Published: November 2024

Objective: We investigated the accuracy of imaging modalities in diagnosis and outcome of otitis media with effusion by correlating the imaging findings with the preoperative otomicroscopic examinations, tympanometric results, and intraoperative findings in patients who underwent cochlear implant surgery. Methods: The results of the preoperative physical examination and intraoperative findings of patients younger than 18 years who underwent cochlear implant surgery at a single tertiary institution were recorded from their medical charts. Tympanometries, which were performed in maximum 1 week prior to imaging modalities, were analyzed. The high resolution computed tomography of temporal bone and magnetic resonance imaging of internal acoustic meati findings were reviewed. The mastoid cavity and middle ears were evaluated separately. Results: The data comprising of 280 ears were evaluated. The correlation between imaging findings and both physical examination and tympanometries were statistically significant (p = 0.000). The intraoperative findings supported this correlation. Conclusions: Our study showed that imaging modalities might detect the middle ear and mastoid cavity effusions. The severity of these changes may differ according to the severity of disease.
Squamous Metaplasia of Lactiferous Ducts (Zuska’s disease) of the Breast: Clinical and Histopathologic Manifestations
Authors: Abdelwahab Rewan M. , Aghazadeh Mohandesi Nessa , Sturgis Charles D. , Alavi Afsaneh
Published: November 2024

Squamous metaplasia of lactiferous ducts (SMOLD), also known as Zuska’s disease, is an uncommon, recurrent inflammatory fistulizing disease of the breast that strongly correlates with smoking in premenopausal patients .1 Clinical and imaging findings may overlap with other breast conditions/ SMOLD is well-recognized by breast pathologists, however, the dermatology literature on this condition remains scarce. In this retrospective study, we reviewed 29 patients with SMOLD diagnosed at Mayo Clinic. The mean age of the patient cohort is 50.3 with a range of 30 to 81 years. One patient (3.7%) had hidradenitis suppurativa of the retro-areolar area. Patient smoking history demonstrated prior/current smokers 37.9% (11/29), lifetime nonsmokers with significant secondhand exposure 6.9% (2/29), and unknown smoking status 3.4% (1/29). One patient had a personal history of invasive ductal carcinoma and 10.3% (3/29) had a history of breast cancer in a first-degree relative. The clinical presentation of the patient cohort includes areolar papules, nodules and draining tract/fistula 13.7% (4/29), pustular cyst/abscess on the breast 13.7% (4/29), breast mass 3.4% (1/29), pain breast discomfort/pain 13.7% (4/29), nipple retraction 3.4% (1/29), and asymptomatic with nipple calcifications on mammogram 3.4% (1/29). 77.8% (7/9) patients with bacterial cultures demonstrated polymicrobial growth. 37.9% (11/29) patients received at least one round of antibiotic therapy. 27.6% (8/29) patients underwent invasive intervention. Staphylococcus, Streptococcus, and Cutibacterium species were the most frequent causes of infection in our patient cohort. We confirm previous findings of strong association between SMOLD & current/former smoking status and a potential, novel correlation between extensive secondhand exposure and SMOLD development. While both medical and surgical interventions are employed in patient management, many patients ultimately require complete excision of the involved duct(s). Dermatologists should consider SMOLD in the differential diagnosis of patients presenting with breast abscess, fistulizing tracts with mass, and breast pain.
Behind Bars: Exploring Health and Geriatric Conditions among Incarcerated Older People in Mexican Prisons
Authors: Sanchez Garrido Natalia , Fernandez-Villa Julio Manuel , Borda Miguel Germán , Garcia-Peña Carmen , Perez Zepeda Mario Ulises
Published: November 2024

Introduction: The aging process of the incarcerated population is a growing concern, yet there are few data on older adults in this demographic group. Hence, this study sought to examine the health status of older adults who are incarcerated in Mexican prisons and its association with the duration of their imprisonment. Methods: This is a secondary analysis of the 2021 Mexico National Prisons Survey. We analyzed 50-year-old and older prisoners and performed a descriptive analysis of the sample’s age, sex, sociodemographic variables, and chronic conditions. Multivariate analysis stratified by age was performed to assess the effect of the time spent in prison on older prisoners’ health. Results: The mean age was 56.95 (±6.4 SD), and the mean duration of imprisonment was 8.93 years (±6.94 SD). Regarding health conditions, 17.80% had diabetes, 29.62% had hypertension, 10.33% had suicidal ideation, and 40.87% were visually impaired, 17.01% had hearing impairment, and 17.64% had mobility impairment. Multivariate analysis revealed that among categories of imprisonment duration, longer time imprisoned was associated with an increased risk of diabetes and hypertension for all groups but was not associated with mobility impairment or suicidal ideation except in the younger group. Conclusion: Longer periods of incarceration appear to be associated with a greater occurrence of diabetes and hypertension in older prisoners. Sensory impairments and suicidal ideation are mainly identified in younger prisoners, while mobility impairments do not appear to be influenced by the time spent in prison. Further research needs to be done in prisons, where the addition of physical performance tests and cognitive tests could help further study geriatric conditions in older prisoners.
A influência dos pontos-gatilho latente na lombalgia aguda e crônica: um estudo prospectivo longitudinal
Authors: Added Marco Aurélio Nemitalla , Freitas Diego Galace de , Added Caroline , Cazarini Junior Claudio , Fucs Patrícia Maria de Moraes Barros
Published: November 2024

A dor lombar é um importante problema de saúde pública e estudos apontam que todas as pessoas que sofrem de dor na coluna apresentam pontos-gatilho. Objetivo: Analisar o nível dor de pacientes com dor lombar aguda e crônica que quando assintomáticos apresentava pontos-gatilho latente, comparado com os níveis de dor de pacientes com dor lombar aguda e crônica que quando assintomáticos não apresentava pontos-gatilho. Método: 96 indivíduos de ambos os sexos entre 18 - 60 anos participaram de um estudo transversal com avaliador cego. Foram analisados o nível de dor, função, atividade física, cinesiofobia, algometria e mensurada a força do músculo glúteo máximo e médio do membro dominante e não dominante, no momento que os participantes estavam assintomáticos e após desenvolverem dor lombar aguda e crônica. Para análise estatística consideramos valores de significância igual ou menor que 0,05. Resultados: Foi observado diferenças significativas entre os grupos na intensidade da dor, funcionalidade, algometria, na dinamometria do músculo glúteo máximo do membro não dominante e da dinamometria do glúteo médio de ambos os membros na lombalgia aguda e diferença significativa da dinamometria do glúteo máximo de ambos os membros na lombalgia crônica. Conclusão: Indivíduos assintomáticos com pontos-gatilho latente nos músculos paravertebrais lombares apresentam pior intensidade da dor e outros desfechos quando desenvolvem dor lombar aguda comparados com indivíduos que não apresentam pontos-gatilho no momento que estão assintomáticos e na lombalgia crônica observamos diminuição da força do glúteo máximo quando comparado com indivíduos com lombalgia aguda.
Inter-rater reliability of a new instrument for measuring isometric strength of toe flexor muscle
Authors: Silva Roberta de Oliveira e , Santos Mylena Meire dos , Freire Larissa Alves Moreira , Carvalho Leonardo César
Published: November 2024

The assessment of toe flexor muscle strength is an important factor in the analysis of the muscles that contribute to sustaining the longitudinal plantar arch. Intrinsic muscles have several functions such as providing support and stabilization to the arches of the foot, shock absorption, and rigidity for the transmission of forces and postural stability. Objective: To evaluate the reliability of a device to measure the isometric strength of the toe flexor muscles individually. Method: Methodological study with a quantitative approach to assess the reliability of the instrument for evaluating the maximum voluntary isometric strength of the flexor muscles of the toes individually. 20 feet of healthy volunteers were evaluated in two moments: initial evaluation performed by evaluator 1 and evaluation after one week performed by evaluator 2, to test the interclass reliability through the statistical test of Intraclass Correlation Coefficient (ICC). Results: The results showed excellent ICC in all toes with values ranging between 0.805 and 0.921. Toe 4 had the lowest standard error of measurement (SME) and minimal detectable change (MMD), demonstrating lower collection error and greater sensitivity. Conclusion: The proposed instrument is reliable for measuring the intrinsic flexor muscle strength of the foot, being an alternative for evaluating it in different populations, as it presents good reliability and reproducibility at an affordable cost, and can be used in future clinical studies and clinical practice.
Hierarchical clustering of the demographic, clinical profile and handgrip strength of patients after distal radius fracture
Authors: Simão Amanda Santos , Borges Juliana Valentino , Andrade Jessyca Alves de , Grecco Marco Aurélio Sertório , Gasparini Andrea Licre Pessina , Fernandes Luciane Fernanda Rodrigues Martinho
Published: November 2024

Objective: The aim of this study was to identify the profiles of patients after distal radius fracture treatment grouped according to demographic and clinical factors, and grip strength on the fracture contralateral side. Method: This was a retrospective and cross-sectional single-center study that included 141 patients with unilateral distal radius fractures treated at a public hospital by the physical therapy service. Results: Demographic and clinical data from all patients included in this study were collected from patients' medical records. Grip strength was assessed between 8 and 10 weeks after the fracture. We performed an exploratory multivariate analysis using Multiple Correspondence Analysis (MCA) followed by Agglomerative Hierarchical Cluster Analysis (AHC). Numerical values of coordinates of all the dimensions obtained in MCA were used as input variables in the cluster analysis and the perceptual map of hierarchical clustering (Dendrogram) was obtained. We highlighted three groups based on cluster analysis. One group included men, aged 18 to 59 years, with fractures either on the right or left side, trauma caused by traffic accidents or other causes, surgical treatment and normal grip strength on the contralateral side. The second group had women, aged 60 to 90 years, fracture resulting from falls from their own height, conservative treatment and intermediate grip strength on the contralateral side. The third group had only the weak grip strength on the contralateral side. Conclusion: This cluster analysis revealed three profiles of patients during the early period after distal radius fracture treatment.
WMH Contributions to Cognitive Impairment: Rationale and Design of the Diverse VCID Study
Authors: DeCarli Charles , Rajan Kumar B. , Jin Lee-Way , Hinman Jason , Johnson David K. , Harvey Danielle , Fornage Myriam , Beiser Alexa , Gonzalez Hector , Kukull Walter , Barnes Lisa , Elahi Fanny , Rajan Kumar B. , Croff Raina , Kramer Joel , Weickenmeier Johannes , Tudorascu Dana , Albert Marilyn , Craft Suzanne , Jicha Gregory , Wolk David A. , Paulson Henry , Brewer James , Asthana Sanjay , Seshadri Sudha , Brickman Adam , Chui Helena Chang , Nelson Amy , Savitz Sean , Saykin Andrew , Geldmacher David , Masurkar Arjun , Rundek Tatjana , Maillard Pauline , Knaack Alex
Published: November 2024

As awareness of dementia increases, more individuals with minor cognitive complaints are requesting clinical assessment. Neuroimaging studies frequently identify incidental white matter hyperintensities, raising patient concerns about their brain health and future risk for dementia. Moreover, current US demographics indicate that ≈50% of these individuals will be from diverse backgrounds by 2060. Racial and ethnic minority populations bear a disproportionate burden of vascular risk factors magnifying dementia risk. Despite established associations between white matter hyperintensities and cognitive impairment, including dementia, no study has comprehensively and prospectively examined the impact of individual and combined magnetic resonance imaging measures of white matter injury, their risk factors, and comorbidities on cognitive performance among a diverse, nondemented, stroke-free population with cognitive complaints over an extended period of observation. The Diverse VCID (Diverse Vascular Cognitive Impairment and Dementia) study is designed to fill this knowledge gap through 3 assessments of clinical, behavioral, and risk factors; neurocognitive and magnetic resonance imaging measures; fluid biomarkers of Alzheimer disease, vascular inflammation, angiogenesis, and endothelial dysfunction; and measures of genetic risk collected prospectively over a minimum of 3 years in a cohort of 2250 individuals evenly distributed among Americans of Black/African, Latino/Hispanic, and non-Hispanic White backgrounds. The goal of this study is to investigate the basic mechanisms of small vessel cerebrovascular injury, emphasizing clinically relevant assessment tools and developing a risk score that will accurately identify at-risk individuals for possible treatment or clinical therapeutic trials, particularly individuals of diverse backgrounds where vascular risk factors and disease are more prevalent.
Cerebral Infarct Growth: Pathophysiology, Pragmatic Assessment, and Clinical Implications
Authors: Pensato Umberto , Demchuk Andrew M. , Menon Bijoy K. , Nguyen Thanh N. , Broocks Gabriel , Campbell Bruce C.V. , Gutierrez Vasquez Diego A. , Mitchell Peter J. , Hill Michael D. , Goyal Mayank , Ospel Johanna M.
Published: November 2024

Cerebral ischemic injury occurs when blood flow drops below a critical level, resulting in an energy failure. The progressive transformation of hypoperfused viable tissue, the ischemic penumbra, into infarction is a mechanism shared by patients with ischemic stroke if timely reperfusion is not achieved. Yet, the pace at which this transformation occurs, known as the infarct growth rate (IGR), exhibits remarkable heterogeneity among patients, brain regions, and over time, reflecting differences in compensatory collateral flow and ischemic tolerance. We review (1) the pathophysiology of infarct growth, (2) the advantages and pitfalls of different approaches of IGR measurement, (3) research gaps for future studies, and (4) the clinical implications of stroke progressor phenotypes. The estimated average IGR in patients with acute large vessel occlusion stroke is 5.4 mL/h although there is wide variability based on ischemic stroke subtype, occlusion location, presence of collaterals, and patient baseline status. The IGR can be calculated using various pragmatic strategies, mostly either quantifying the extension of the infarct at a particular time and dividing this measure by the time that elapsed from symptom onset to imaging assessment or by using collateral blood flow status as a radiological surrogate marker. The IGR defines a spectrum of clinical stroke phenotypes, often dichotomized into fast and slow progressors. An IGR ≥10 mL/h and the perfusion metric hypoperfusion intensity ratio ≥0.5 are commonly used definitions of fast progressors. A nuanced understanding of the IGR and stroke progressor phenotypes could have clinical implications, including informing prognostication, acute decision-making in peripheral-to-comprehensive transfer patients eligible for thrombectomy, and selection for adjuvant neuroprotective agents.
Translating Indian Algebra in the Seventeenth Century: ʿAtāʾollāh Roshdi’s Persian Version of Bhāskara II’s Bījagaṇita
Authors: Karimian Zeinab
Published: November 2024

One of the most important works in the field of medieval Indian mathematics corresponding to algebra is Bījagaṇita (Seed Calculation), a Sanskrit treatise by the famous mathematician and astronomer Bhāskara II (or Bhāskarācārya, c. 1114–aft. 1183). This paper is a general overview of the Tarjoma-ye Bij ganet (The Translation of the Bījagaṇita, 1634), a Persian text composed by the mathematician ʿAtāʾollāh Roshdi (or Rashidi), who served at the court of the Mughal emperor Shāh Jahān (r. 1628–58). The translation is divided into an introduction, subdivided in six chapters (bāb), and five books (maqāla). After discussing both Bhāskara II and Roshdi, I compare the latter’s translation with the original Sanskrit text on the basis of available English translations. I will also demonstrate how an intermediate language, which played an important role in the connection of South Asian scientific sources, facilitated this translation.
ʿAbd Al-Jabbār and Bāqillānī on the Meaning of Miracles (Muʿjizāt): a Study of Convergences and Divergences
Authors: Jaffer Tariq
Published: November 2024

This article presents the technical terminology, concepts, and theological principles developed by Bāqillānī and ʿAbd al-Jabbār in Kitāb al-Bayān and the Mughnī (respectively). It traces the convergences and divergences in their approaches to the word muʿjiz and describes the parallel methodological processes through which they critique postulates established by the “language users or experts” (ahl al-lugha). I argue that we can better understand how the meaning of the word muʿjiz was contested in medieval Islam and how its semantic range was established by reading Muʿtazilī (ʿAbd al-Jabbār) and Ashʿarī-Sunnī (Bāqillānī) texts alongside one another. An examination of how claims to the authority over the meaning of the word muʿjiz are made and the social significance of such claims are also central themes of this study.
Unearthing the Genizah of the Jewish Community in Figuig
Authors: Gillot Laurence , Olszowy-Schlanger Judith
Published: November 2024

Within the framework of an agreement with the National Institute of Sciences of Archaeology and Heritage (INSAP) of Morocco and with the Municipality of Figuig, a multidisciplinary team of Moroccan and French researchers, led by Saghir Mabrouk (INSAP), Laurence Gillot (MCF Paris Cité, UMR 8210 ANHIMA), and André Del (Paris Val-de-Seine School of Architecture, EVCAU) has carried out inventory, research and valorization of the heritage of the oasis of Figuig since 2005. In this context, excavations were conducted in the mellah of the qsar Loudaghir, one of the quarters inhabited by the Jewish community which left in 1970. The discovery of manuscripts in the genizah of the mellah has led archaeologists to refer to palaeographers and epigraphists to inventory, study and preserve these manuscripts. This article accounts for the dialogue established between archaeology and philology.
Should I Be Worried? Worry in Dunhuang Divination
Authors: Zhao Lu
Published: November 2024

The emotional aspect of divination has rarely been systematically addressed in the history of Chinese divination. Focusing on divination manuals from Dunhuang 敦煌, this article examines the interaction between emotions, especially worry, and divination in medieval China. It explores, on the one hand, how worry in the medieval context drove individuals to seek divinatory practices. On the other hand, it examines how the divination manuals used worry and other emotive words as part of their technical language to measure uncertainty. Surveying different usages of the terms for worry in these manuals, the article argues that the language of worry was part of the terminology of Dunhuang divination, serving as a heuristic to help the inquirers sense the level of auspiciousness and uncertainty of future scenarios. The article will also show that emotional words form a unique layer of terminology that conveys to inquirers a specific sense of auspiciousness.
ProbSevere Version 3: Improved Exploitation of Data Fusion and Machine Learning for Nowcasting Severe Weather
Authors: Cintineo John L. , Pavolonis Michael J. , Sieglaff Justin M.
Published: November 2024

National Oceanic and Atmospheric Administration (NOAA)/Cooperative Institute for Meteorological Satellite Studies (CIMSS) ProbSevere, or the “probability of severe” models, provide next-hour probabilistic guidance on severe weather in the United States (large hail, strong wind gusts, and tornadoes) using machine learning and meteorological data from remotely sensed platforms and short-term numerical weather models. ProbSevere has been widely used by NOAA’s National Weather Service (NWS) since 2016. ProbSevere version 3 employs multiplatform, multiscale storm object identification and tracking to collect storm features and then uses gradient boosting decision trees to make predictions of convective hazards from the extracted predictors. ProbSevere v3 was trained, validated, and tested on data from 2018 to 2023. Results demonstrate improved performance over ProbSevere v2 for the majority of the United States across all seasons, spanning a wide range of meteorological regimes. The greatest improvements are for the hail, wind, and any severe models, whereas the tornado model demonstrated modest improvement. ProbSevere v3 models were evaluated by NWS forecasters in simulated real-time experiments from 2021 to 2023. The majority of forecasters preferred ProbSevere v3 over v2 due to improved confidence in predictions and greater lead times for the issuance of severe weather warnings. An analysis of predictor importance revealed several radar, lightning, satellite, and numerical model fields that strongly contribute to the model predictions, which is consistent with past research and knowledge of severe thunderstorm forecasting. This reinforces the importance of environmental data fusion for nowcasting severe weather associated with midlatitude convection.

Significance Statement

This study details the updates made to a U.S.-wide, real-time, probabilistic severe-weather guidance system aimed to improve forecaster confidence and the accuracy of the U.S. National Weather Service severe weather warnings. An evaluation of the system demonstrated improved performance over the operational predecessor, which was driven by radar, ground-based lightning, satellite, and numerical model data sources.
Factors Behind Chinese Citizen Support to Implementation of Social Credit Policy
Authors: Putra Gilang D. , Sunarko Bagus Sigit , Purwanto Agung
Published: November 2024

The social credit system was implemented in China by the Xi Jinping government officially in 2020. In implementing this policy, there are many arguments that argue this policy has the potential to cause human insecurity from the Chinese people because this policy is widely considered to be used as a tool to control people’s behaviour. Even so, this policy has high support from the Chinese people as evidenced by the high support for the implementation of the social credit system, and the high participation of the Chinese people in the trial of the social credit system in different provinces. Using disciplinary power theory, this article analyses what factors influence public support for the implementation of social credit policies by the Chinese government. This article also looks at how the Chinese government’s efforts in shaping obedience in Chinese society through the implementation of social credit policies. This article argues that the Chinese government succeeded in utilising appropriate means to make people support the implementation of the social credit policy even though the policy has the potential to cause human insecurity.
Improving field education for social work in Vietnam: Intern supervisors’ perspectives of the current state and potential solutions
Authors: Aikawa Megan , Han Meekyung , Nguyen Trang T , Dinh Linh , Bui Minh Thanh
Published: November 2024

Research has identified challenges associated with the implementation of competency-based social work field education in Vietnam. However, there is limited information available from intern supervisors, who have unique perspectives at the crux of social work training and service delivery. An exploratory phenomenological qualitative approach was used to explore their experiences and perceptions through online interviews. Four categories were identified: diverse implementation of a common framework, rudimentary expectations and activities, challenges to implementation, and opportunities for improvement. These findings suggest that a multidimensional approach is needed, including improved collaborations between field agencies and universities to empower students, intern supervisors, and faculty.
Estimating the Distance Between Map Points May Be Related to Forms of Representing the Map´s Scale
Authors: Campos-Juanatey Diego , Lado Mario , Campos Alfredo
Published: November 2024

The way a map scale is represented plays a key role in comprehending it. In this research, we examined the relationships between the form of representation of the map’s scale (numerical scale, linear graphic scale and circular graphic scale), the user’s gender, and the distance between two map objects on user estimates of the distance between two objects on the map (i.e., a 5, 10, 15 and 20-min walk). We gave 183 college students 84 maps of three types: 28 numerical scale, 28 linear graphic scale, and 28 circular graphic scale. Each map presented varied distances to be estimated. We assessed the participants’ accurate hits, errors, and their hits minus errors in these distance estimations. Participants had both more hits and more errors on circular scale maps than on linear or numerical scale maps, and the distances between objects and gender also significantly related to the estimated e distance. Both the type of scale and the distance between objects influenced the number of hits minus the number of errors.
The Many Faces of Guilt: A Review Mapping Unique and Overlapping Expressions in OCD and Depression
Authors: Ganguly Oindrila , Tarafder Sreemoyee
Published: November 2024

Background:

Guilt, a complex emotional experience pervading many lives, takes on an intricate form when intertwined with psychiatric conditions. As a multifaceted concept, guilt represents a key diagnostic feature in depression and is an integral part of obsessive compulsive disorder (OCD).

Methods:

This systematic review aimed to synthesize empirical research on the varied dimensions of guilt across these two mental illnesses, where guilt is emphasized as a pathognomonic factor. A systematic computer-based literature search was conducted, using a rigorous set of eligibility criteria and specific keyword combinations to ensure relevant and exhaustive coverage of the topic. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a comprehensive literature search spanning multiple databases identified 12 eligible studies on guilt in OCD and 8 in depression.

Findings:

The findings revealed 20 distinct guilt constructs measured across the two disorders. Notably, 5 unique guilt subtypes and 15 themes for OCD and 6 exclusively studied guilt for depression emerged, reflecting potential disorder-specific manifestations of guilt.

Conclusion and Implication:

Delineating such guilt profiles holds the potential to untangle the role of guilt in the onset, perpetuation, and clinical course of OCD and depression. This comprehensive mapping of guilt constructs provides an empirical foundation for elucidating disorder-specific pathways influenced by guilt, thereby informing the development of targeted psychological interventions tailored to the distinct guilt patterns underpinning these debilitating conditions.
A pendulum or a stopped clock? Rupture, continuity and political change in English sub-national government under Labour
Authors: Nurse Alexander , Sykes Olivier
Published: November 2024

This article discusses the most recent round of sub-national (i.e. local and regional) policy development under the incoming (2024) Labour Government. It unpacks the policy landscape which has tentatively emerged since the Starmer Government has taken office, and addresses the implications, questions and challenges which are immediately apparent. It suggests that, rather than simply tearing down the previous structures of sub-national governance, the incoming Labour Government is attempting to deepen those structures. Nevertheless, it therefore also concludes that many of the shortcomings and unanswered questions of the Conservative approach of the last decade therefore remain. The paper unpacks what this might mean for practitioners and researchers working in this area, contributing to emerging reflection on how the new government might be more effective in addressing the key challenges facing the United Kingdom.
Embedded Ethics and the “Soft Impacts” of Technology
Authors: Tigard Daniel W. , Braun Maximilian , Breuer Svenja , Fiske Amelia , McLennan Stuart , Buyx Alena
Published: November 2024

Advanced technologies, such as artificial intelligence (AI) and robotics, are increasingly common, but often come with significant tradeoffs and effects which may elude initial observations. Among these, the term “soft impacts” has come to signify the qualitative implications of a technological device or intervention. How can these sorts of effects be addressed, and what role do they have in the development phases of emerging technologies? In this paper, we outline our interdisciplinary Responsible Robotics project, which harnesses and builds upon an embedded ethics framework. We describe the embedded ethics approach, summarize some of its challenges, and highlight a key benefit. In short, by addressing the so-called “soft impacts” of technology, embedded ethics may stand to benefit not only the users of emerging systems, but also the developers. Although confirming this with a great degree of confidence will call for substantive longitudinal studies, we believe the aims and current roll-out of the embedded ethics approach provide grounds for optimism concerning the intended benefits described here. Accordingly, the mere prospect of increasing social and ethical sensitivity in development settings can serve to encourage a wider adoption of embedded ethics programs worldwide.
Satisfactory Clinical Outcomes After Latissimus Dorsi Tendon Transfer for Irreparable Posterosuperior Massive Rotator Cuff Tears: A 10- to 20-Year Follow-up
Authors: Kany Jean , Madoki Alexandre , Duerinckx Quentin , Miranda Luis Alfredo , van Rooij Floris , Saffarini Mo , Grimberg Jean
Published: November 2024

Background:

Latissimus dorsi tendon transfer (LDTT) leads to good clinical outcomes and recovery of function. A previous study have evaluated the outcomes of LDTT at a minimum 10-year follow-up and found durable improvements in shoulder function and pain relief but observed that shoulders with fatty infiltration of the teres minor muscle and insufficiency of the subscapularis muscle tended to have inferior results.

Purpose:

To evaluate the outcomes of LDTT with a minimum follow-up of 10 years in a sizeable cohort for the treatment of irreparable posterosuperior massive rotator cuff tears (mRCTs).

Study Design:

Case series; Level of evidence, 4.

Methods:

Patients who underwent LDTT for irreparable mRCTs between 2004 and 2013, performed by the same senior surgeon, were included in this study. All intraoperative and postoperative complications, as well as whether patients required conversion to reverse shoulder arthroplasty (RSA), were noted. At a minimum follow-up of 10 years, an independent observer collected range of motion measurements and clinical scores, including those for the Constant score, the Subjective Shoulder Value, and a visual analog scale for pain; the subacromial space was also assessed.

Results:

A total of 143 patients (147 shoulders) that underwent LDTT, with a minimum follow-up of 10 years, were included; of these, 24 patients (24 shoulders, 16%) were lost to follow-up, 1 patient (1 shoulder, 0.7%) died 9 years after the index procedure for reasons unrelated to shoulder surgery, and 18 patients (18 shoulders, 12%) required conversion to RSA, of which 6 underwent conversion at ≥6 years after LDTT. The remaining 101 patients (104 shoulders), including 3 patients who were scheduled to undergo RSA, were assessed at a mean time of 12.3 ± 2.2 years (range, 10-20 years) after index LDTT, comprised 52 men (53 shoulders) and 49 women (51 women) and had a mean age of 61.6 ± 8.0 years (range, 39-81 years) at the time of index surgery. Complications were noted in 14 shoulders, of which 4 required a reoperation. The Constant score improved by 34.2 ± 11.7 points, the adjusted Constant score by 43.5 ± 15.3 points, and the Subjective Shoulder Value score by 50.4 ± 16.4 points. The subacromial space decreased by 0.3 ± 2.0 mm.

Conclusion:

At a minimum follow-up of 10 years, LDTT for the treatment of irreparable posterosuperior mRCTs led to satisfactory clinical scores. Of the 147 shoulders that underwent LDTT, 18 (12%) required conversion to RSA.
Subscapularis Muscle Radiographic Integrity and Patient-Reported Outcomes Following Arthroscopic Anatomic Glenoid Reconstruction With Distal Tibial Allograft
Authors: Castillo de la Peña Jose , Chalmers Peter N. , Ma Jie , Wong Ivan
Published: November 2024

Background:

Shoulder stabilization surgery has evolved over time, and bony augmentation procedures on the glenoid side are being performed more often. The Latarjet procedure modifies subscapularis anatomy because the conjoined tendon divides the subscapularis muscle fibers through a split/takedown, which has structural and functional implications. Arthroscopic anatomic glenoid reconstruction (AAGR) re-creates anatomy. This technique uses the Halifax portal to deploy and fix a distal tibial allograft (DTA) through the rotator interval, thus preserving the subscapularis anatomy.

Purpose/Hypothesis:

The purpose was to analyze the radiographic properties of the subscapularis muscle after AAGR. It was hypothesized that the subscapularis muscle structure remains preserved postoperatively.

Study Design:

Case series; Level of evidence, 4.

Methods:

A retrospective review was performed comprising a consecutive series of patients treated with AAGR with DTA between November 2012 and April 2021 for traumatic anterior shoulder instability with glenoid bone loss. Patients were excluded if they had posterior instability, glenoid fracture, missing pre- or postoperative computed tomography (CT) scans, or only CT arthrogram available. Radiographic variables measured on CT scans included estimates of subscapularis muscle volume, subscapularis/infraspinatus muscle ratio, and fatty infiltration according to the Goutallier classification. Pre- and postoperative Western Ontario Shoulder Instability index scores were collected as a secondary outcome of this study.

Results:

Ninety-three patients were included in the study with a clinical follow-up of 2.3 ± 1.5 years (mean ± SD). The subscapularis volume increased from 185.91 ± 45.85 mL preoperatively to 194.1 ± 49.0 mL postoperatively ( P = .006). The subscapularis to infraspinatus muscle ratio showed a significant increase from 0.96 ± 0.27 to 1.05 ± 0.30 after surgery ( P = .002). All patients had a Goutallier stage of 0 before and after surgery. The Western Ontario Shoulder Instability scores showed a significant improvement from 64.8 ± 15.5 preoperatively to 28.2 ± 24.0 postoperatively ( P < .001).

Conclusion:

Patients who undergo AAGR with DTA for traumatic shoulder instability with glenoid bone loss have a preserved subscapularis muscle volume with no fatty infiltration, while showing a significant improvement in clinical outcomes.
Effect of Patient Resilience on Functional Outcomes After Anterior Cruciate Ligament Reconstruction
Authors: Hanna Adeeb Jacob , Davis Gaston , Muchintala Rahul , He Alice , Bryan Sean , Tjoumakaris Fotios P. , Freedman Kevin B.
Published: November 2024

Background:

Previous studies have examined the relationship between patient resilience and functional outcome scores after anterior cruciate ligament reconstruction (ACLR). However, past studies have failed to explore the longitudinal relationship between preoperative resilience and functional outcomes 2 years after ACLR.

Purpose:

To evaluate the relationship between preoperative patient resilience and functional outcomes 2 years after ACLR.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Patients were identified who underwent ACLR for anterior cruciate ligament tears between January and June 2020 at a single institution. Those who completed the Brief Resilience Scale preoperatively as part of routine patient questionnaires were considered for inclusion. Patients were contacted a minimum of 2 years after ACLR to complete the short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-JR), Single Assessment Numeric Evaluation (SANE), International Knee Documentation Committee (IKDC) Subjective Knee Form, and visual analog scale (VAS). Outcomes were compared among patients with low resilience (LR), normal resilience (NR), and high resilience (HR), as defined in a previous study.23

Results:

A total of 81 patients were included in the final analysis, with 14 patients in the low preoperative resilience group, 54 in normal, and 13 in high. The mean age of the cohort was 32.0 years, and there were no significant differences in age, sex, race, graft type, or psychiatric comorbidities among the resilience groups. Significantly increased postoperative KOOS-JR scores were observed in patients in the HR group as compared with those in the NR and LR groups (94.8, 86.7, and 79.6, respectively; P = .031). There were also significantly increased postoperative SANE scores in patients in the HR group versus those in the NR and LR groups (92.3, 83.5, and 69.2; P = .012). Patients with high preoperative resilience achieved the IKDC Patient Acceptable Symptom State at significantly higher rates ( P = .003). No significant differences were observed in postoperative VAS ( P = .364), IKDC ( P = .072), or change in IKDC ( P = .448) over time among resilience groups. Postoperatively, 30 patients (37.0%) changed resilience groups, with 13 moving down and 17 moving up in category (low, n = 12; normal, n = 55; high, n = 14).

Conclusion:

Preoperative resilience correlated with KOOS-JR and SANE scores 2 years after ACLR but did not correlate with VAS, IKDC, or change in IKDC over the same period. Resilience was not static, with changes in resilience observed from initial to final evaluations. Resilience is not a strong predictor of postoperative patient-reported outcomes after ACLR.
Clinical Correlates of Antipsychotic Plasma Levels with Long-Acting Paliperidone: Corrélats cliniques des concentrations plasmiques de palipéridone à libération prolongée
Authors: Zipursky Robert B. , Agid Ofer , Kiang Michael , Remington Gary
Published: November 2024

Objectives

The majority of patients with schizophrenia experience dramatic improvement in psychotic symptoms when treated with antipsychotic medication. Maintenance treatment can prevent relapses but problems with medication adherence limit effectiveness. Long-acting injectable antipsychotics (LAIs) provide an opportunity to establish adherence but challenges remain in ensuring that the dose selected is therapeutic. Therapeutic drug monitoring has not been established as valuable for LAIs in the maintenance treatment of schizophrenia. This exploratory study was undertaken to describe plasma paliperidone levels in outpatients treated with the LAI paliperidone palmitate and to determine whether paliperidone levels are associated with subjective experience on medication and side effects.

Methods

Twenty-one outpatients with schizophrenia receiving treatment with LAI paliperidone consented to participation in this study. Blood samples were obtained for measurement of paliperidone and prolactin levels at the first visit. A second paliperidone level was obtained at the time of the next injection for 18 of the participants. Clinical rating scales were administered at the first visit to assess illness severity, attitudes regarding medication, subjective well-being and side effects.

Results

Paliperidone levels were highly correlated at the two time points (ρ = .85; P < .001). Mean paliperidone level at the first visit was 34.9 ng/ml and ranged from 5.1 to 73.9 ng/ml. Higher paliperidone levels were correlated with higher prolactin levels (ρ = 0.59, P < .01) and lower sexual desire (ρ = −.58, P < .01).

Conclusions

We demonstrated that paliperidone levels can be measured reliably in patients receiving LAI paliperidone. Higher plasma levels were associated with higher prolactin levels and reduced sexual desire but not with measures of subjective experience on medications or other side effects. Measurement of paliperidone levels in patients treated with paliperidone palmitate may have the potential to minimize the dose of medication prescribed and, in turn, the severity of sexual side effects.
Multiscale modeling for mechanical property estimation of polymer matrix composites with nano- and micro-scale reinforcements
Authors: Nagaraja Abhilash M , BR Abhiram , Ramesh Chiranthan , Ghosh Debraj , Gururaja Suhasini
Published: November 2024

The current work proposes a combined atomistic-continuum numerical modeling to analyze the constitutive response of a novel polymer composite consisting of multiscale reinforcement. This composite consists of unidirectional carbon fibers in a polymer matrix along with two nanoscale reinforcements: (i) a “fuzzy” interphase consisting of radially aligned carbon nanotubes (CNT) around the carbon fiber and (ii) additional CNTs randomly dispersed in the polymer matrix. While radially aligned CNTs on fiber surface improve the fiber-matrix interfacial bonding, randomly dispersed CNTs enhance the matrix toughness. This special arrangement at multiple length scales demands a multiscale homogenization procedure, which is developed in this work. At the atomistic length scale, CNT embedded in polymer matrix is modeled using molecular dynamics (MD) simulations. The effective elastic properties of CNT dispersed matrix and fuzzy interphase are obtained using appropriate unit cells with periodic boundary conditions (PBCs). At the continuum length scale, the composite material microstructure is modeled as a repeating unit cell (RUC) with the elastic properties of CNTs derived from the atomistic scale. The novelty of this work lies in developing a three-phase RUC with PBCs to analyze this unique hybrid composite. Extensive parametric studies have been conducted to assess the influence of CNT content in the matrix and interphase, and volume fraction of the primary fiber reinforcement on the effective elastic properties. Results indicate a 60%–80% enhancement of transverse elastic properties with CNT reinforcement in addition to fiber reinforcement.
Patient Safety: Acknowledging Acute Angioedema Following Cosmetic Injections
Authors: Kantor Nicole B. , Keamy Jean E.
Published: November 2024

To report a case of acute angioedema following hyaluronic acid filler and onabotulinumtoxinA injection in an individual with allergies, recent viral vaccination, and polymyalgia rheumatica. This is a retrospective case report. A 63-year-old female with a history of allergies, asthma, and polymyalgia rheumatica on lisinopril presented with angioedema 4 hours following facial filler injection and botulinum toxin injection. The patient was successfully treated with epinephrine, diphenhydramine, and methylprednisolone. Although cosmetic injections are commonly performed, clinicians must be vigilant about rare, yet serious side-effects such as angioedema. This case underscores the importance of thoroughly evaluating medical histories before cosmetic injections and addressing patient concerns after the procedure.
Integer estimation of inner-cell values in RxC ecological tables
Authors: Pavía Jose M.
Published: November 2024

The estimation of the inner entries of a set of related RxC contingency tables when only the margins are known poses one of the most difficult problems in the field of the social sciences, present in many areas from marketing to quantitative history; being particularly prevalent in political science and sociology. With dozens of methods proposed to solve this, (almost) all of them have been devised to infer conditional proportion distributions, despite interior values of contingency tables being integers. This paper develops, within the linear programming framework, a new algorithm to output integer solutions, and assesses it using real data from more than 500 elections where actual cross-distributions of votes are known. Although the new approach is proposed with the expectation that more accurate solutions would be obtained by narrowing the search space from a continuous to a discrete simplex space, the results attained suggest that the use of a pure integer approach does not lead to more accurate solutions. The recommendation is therefore to integer-adjust decimal solutions when the focus is on counts. Interested practitioners can easily use the new models as they have been programmed in the R-package lphom.
From perpetual pilots to sustainable transformation: Scaling up geriatric care
Authors: Elliott Jacobi , Heckman George , Chalmers Karli , Omana Humberto , Hiebert Brad , Kane Sheri-Lynn
Published: November 2024

With an ageing population, there is an increasing need to focus on the care of older adults, particularly those who are more medically complex. Frail older adults are more likely to require care from multiple providers across multiple settings. It is well recognized that the current Canadian healthcare system is not well-designed for this complex population. To address the health system challenges, healthcare leaders are rapidly developing and implementing programs to better support the ageing population. Unfortunately, this often means that organizations are implementing and scaling health and social care programs with limited evidence or understanding of the specific context in which it was implemented. Drawing on regional experiences, this article will explore challenges and offer solutions related to the implementation, spread, and scale of healthcare programs for older adults.