bluuebunny/crossref_metadata_2025 huggingface dataset:
Cerebrospinal Fluid Levels of 5-Hydroxyindoleacetic Acid in Parkinson’s Disease and Atypical Parkinsonian Syndromes
Authors: Kaiserova Michaela , Chudackova Monika , Prikrylova Vranova Hana , Mensikova Katerina , Kastelikova Anetta , Stejskal David , Kanovsky Petr
Published: October 2021

Background: Various cerebrospinal fluid (CSF) biomarkers are studied in Parkinson’s disease (PD) and atypical parkinsonian syndromes (APS). Several studies found reduced 5-hydroxyindoleacetic acid (5-HIAA), the main serotonin metabolite, in PD. There is little evidence regarding its levels in APS. Methods: We measured 5-HIAA in the CSF of 90 PD patients, 16 MSA patients, 26 progressive supranuclear palsy (PSP) patients, 11 corticobasal syndrome (CBS) patients, and 31 controls. We also compared the values in depressed and nondepressed patients. Results: There was a statistically significant difference in CSF 5-HIAA in PD and MSA compared to the control group (median in PD 15.8 μg/L, in MSA 13.6 μg/L vs. 24.3 μg/L in controls; p = 0.0008 in PD, p = 0.006 in MSA). There was no statistically significant difference in CSF 5-HIAA in PSP and CBS compared to the control group (median in PSP 22.7 μg/L, in CBS 18.7 μg/L vs. 24.3 μg/L in controls; p = 1 in both PSP and CBS). CSF 5-HIAA levels were lower in PD patients with depression compared to PD patients without depression (median 8.34 vs. 18.48, p < 0.0001). Conclusions: CSF 5-HIAA is decreased in PD and MSA. The CSF 5-HIAA levels in PSP and CBS did not differ from those of the control group. There was a tendency toward lower CSF 5-HIAA in MSA than in PD; however, the results did not reach statistical significance. These results may be explained by more severe damage of the serotonergic system in synucleinopathies (PD and MSA) than in tauopathies (PSP and CBS).
Selection Heuristics on Semantic Genetic Programming for Classification Problems
Authors: Sánchez Claudia N. , Graff Mario
Published: October 2021

Individual semantics have been used for guiding the learning process of Genetic Programming. Novel genetic operators and different ways of performing parent selection have been proposed with the use of semantics. The latter is the focus of this contribution by proposing three heuristics for parent selection that measure the similarity among individuals' semantics for choosing parents that enhance the addition, Naive Bayes, and Nearest Centroid. To the best of our knowledge, this is the first time that functions' properties are used for guiding the learning process. As the heuristics were created based on the properties of these functions, we apply them only when they are used to create offspring. The similarity functions considered are the cosine similarity, Pearson's correlation, and agreement. We analyze these heuristics' performance against random selection, state-of-the-art selection schemes, and 18 classifiers, including auto-machine-learning techniques, on 30 classification problems with a variable number of samples, variables, and classes. The result indicated that the combination of parent selection based on agreement and random selection to replace an individual in the population produces statistically better results than the classical selection and state-of-the-art schemes, and it is competitive with state-of-the-art classifiers. Finally, the code is released as open-source software.
Two new species of Megophrys Kuhl and Van Hasselt (Amphibia: Megophryidae) from Sumatra, Indonesia
Authors: MUNIR MISBAHUL , NISHIKAWA KANTO , HAMIDY AMIR , SMITH ERIC N.
Published: October 2021

We evaluated the taxonomic status of the genus Megophrys in Sumatra using molecular and morphological data. Mitochondrial phylogenetic inference and morphological data revealed two undescribed species, one in southern Sumatra—M. selatanensis sp. nov. and one in northern Sumatra—M. acehensis sp. nov. We also detected a potential cryptic species within M. parallela, but refrain from describing this lineage here due to insufficient data. Genetic variation within Sumatran Megophrys is highly structured and will require additional geographic sampling to understand the interplay between geography and genetics in Sumatran Megophrys.
Effect of Annealing Temperature on the Structural and Optical Properties of ZnO Thin Film Annealed with Novel Annealing Method
Authors: Lee Sihun , Kim Dongwan , Leem Jae-Young
Published: October 2021

Zinc oxide (ZnO) thin films were deposited on silicon substrates by a sol-gel spin-coating method. The films were annealed using a novel annealing method named thermal dissipation annealing (TDA) method, at temperatures varying from 400 °C to 600 °C. It was found that annealing
ZnO films using the TDA method forms nanosheet structures at the surface of the films. The formation of nanosheets could be attributed to a particle migration mechanism based on a temperature gradient, which was heavily influenced by the annealing temperature. Higher near-band-edge (NBE) emission
intensities were observed for the TDA-annealed ZnO films I compared to the as-grown film. The emission intensity was found to be dependent on the annealing temperature. Enhanced photoresponse properties were exhibited by the ZnO films annealed using the TDA method, suggesting that the TDA
method can be used to improve the performance of ZnO films in applications such as ultraviolet photodetection.
Changes in MJO Characteristics and Impacts in the Past Century
Authors: Cui Jingxuan , Li Tim
Published: October 2021

The changes of the MJO behavior and its impact on global precipitation, precipitation extremes, and high-frequency variability during the past century (1901–2010) were investigated using the NOAA-20CR dataset. It was found that the MJO amplitude was significantly strengthened, while its eastward phase speed hardly changed. The impacts of the MJO on precipitation in South China (SC), northern Australia (AU), and California (CA) were investigated. The anomalous rainfall in the regions was strengthened from the early to late twentieth century, with the percentage increase ranging from 67% in AU to 14% in CA. A moisture budget analysis indicated that the enhanced precipitation was primarily attributed to the effect of anomalous wind while the effect of the mean moisture change was small. The impact of the local meridional wind anomaly was critical in SC, while in AU and CA the zonal wind component dominated. The precipitation extremes had a significant increase from the early to late twentieth century. The cumulative extreme precipitation amount increased by 140%–150% in SC and AU and by 100% in CA, and the number of the extreme days increased by 110% in SC and AU and 70% in CA. Such increases are consistent with the strengthening of the high-frequency (HF; with a period less than 10 days) variability across the globe. The pattern of percentage increase of the HF variability resembles the pattern of percentage increase of MJO-scale precipitation. This implies that the MJO teleconnection pattern could exert a large-scale control on the HF variability and weather extremes.

Significance Statement

The Madden–Julian oscillation (MJO), a dominant mode of tropical intraseasonal oscillations, plays an important role in affecting global weather and climate. To understand to what extent the MJO and associated teleconnections change with global warming, this study adopts an alternative approach by analyzing a century-long reanalysis dataset rather than the outputs of climate models that consist of large uncertainties due to poor MJO simulations. We found that MJO-induced tropical and midlatitude precipitation and associated extremes and high-frequency variabilities were strengthened during the past century while the global mean surface temperature increases approximately by 1°C. The results derived from the present study provide a basis for assessing the future MJO behavior and associated climate impacts and for improving the extended-range prediction of severe weather and climate extremes.
User Experience in Health & Medicine: Building Methods for Patient Experience Design in Multidisciplinary Collaborations
Authors: Kessler Molly M. , Breuch Lee-Ann K. , Stambler Danielle M. , Campeau Kari L. , Riggins Olivia J. , Feedema Erin , Doornink Sarah I. , Misono Stephanie
Published: October 2021

Health and medical contexts have emerged as an important area of inquiry for researchers at the intersection of user experience and technical communication. In addressing this intersection, this article advocates and extends patient experience design or PXD ( Melonçon, 2017 ) as an important framework for user experience research within health and medicine. Specifically, this article presents several PXD insights from a task-based usability study that examined an online intervention program for people with voice problems. We respond to Melonçon's call ( 2017 ) to build PXD as a framework for user experience and technical communication research by describing ways traditional usability methods can provide PXD insights and asking the following question: What insights can emerge from combining traditional usability methods and PXD research? In addressing this question, we outline two primary methodological and practical considerations we found central to conducting PXD research: (1) engaging patients as participants, and (2) leveraging multidisciplinary collaboration.
Romantic relationship dissolution on social networking sites: Self-Presentation and public accounts of breakups on Facebook
Authors: Fox Jesse , Frampton Jessica R. , Jones Elizabeth , Lookadoo Kathryn
Published: October 2021

Social media users post an endless stream of life updates, commentary, and other content. This online self-presentation constitutes a narrative that can be examined as a shared account. In this study, we tested the applicability of Duck’s model of relational dissolution (Duck, 1982; Rollie & Duck, 2006) to participants’ personal and public accounts of their romantic breakups on social networking sites (also referred to as social network sites). We adopted mixed methods (content analysis, survey, and interview) to examine emerging adults’ ( N = 97) account-making during romantic relationship dissolution and the role of social media, specifically Facebook, in the process. Over 3500 posts and comments from before and after users’ breakups were quantitatively and qualitatively content analyzed. Synthesizing these three data sources revealed patterns regarding users’ selective self-presentation in masspersonal channels. Their dissolution accounts were shaped by perceptions of Facebook’s social affordances, such as the visibility and persistence of posts, comments, and relational artifacts; social feedback (e.g., comments and “likes” from the online social network, usually for social support); conversational control (e.g., blocking and defriending); and network association, which created a diverse imagined audience and context collapse. Findings suggest that some of Duck’s relational dissolution model manifests on social media, particularly social, gravedressing, and resurrection processes. Users consider and capitalize on perceived affordances of computer-mediated communication channels to construct, curate, or avoid public accounts of their breakups. Our study also provides a methodological framework for investigating user experiences and selective self-presentation on social media over time synthesizing quantitative and qualitative methods.
The Use of Expert Elicitation among Computational Modeling Studies in Health Research: A Systematic Review
Authors: Cadham Christopher J. , Knoll Marie , Sánchez-Romero Luz María , Cummings K. Michael , Douglas Clifford E. , Liber Alex , Mendez David , Meza Rafael , Mistry Ritesh , Sertkaya Aylin , Travis Nargiz , Levy David T.
Published: October 2021

Background

Expert elicitation (EE) has been used across disciplines to estimate input parameters for computational modeling research when information is sparse or conflictual.

Objectives

We conducted a systematic review to compare EE methods used to generate model input parameters in health research.

Data Sources

PubMed and Web of Science.

Study Eligibility

Modeling studies that reported the use of EE as the source for model input probabilities were included if they were published in English before June 2021 and reported health outcomes.

Data Abstraction and Synthesis

Studies were classified as “formal” EE methods if they explicitly reported details of their elicitation process. Those that stated use of expert opinion but provided limited information were classified as “indeterminate” methods. In both groups, we abstracted citation details, study design, modeling methodology, a description of elicited parameters, and elicitation methods. Comparisons were made between elicitation methods.

Study Appraisal

Studies that conducted a formal EE were appraised on the reporting quality of the EE. Quality appraisal was not conducted for studies of indeterminate methods.

Results

The search identified 1520 articles, of which 152 were included. Of the included studies, 40 were classified as formal EE and 112 as indeterminate methods. Most studies were cost-effectiveness analyses (77.6%). Forty-seven indeterminate method studies provided no information on methods for generating estimates. Among formal EEs, the average reporting quality score was 9 out of 16.

Limitations

Elicitations on nonhealth topics and those reported in the gray literature were not included.

Conclusions

We found poor reporting of EE methods used in modeling studies, making it difficult to discern meaningful differences in approaches. Improved quality standards for EEs would improve the validity and replicability of computational models.

Highlights

We find extensive use of expert elicitation for the development of model input parameters, but most studies do not provide adequate details of their elicitation methods. Lack of reporting hinders greater discussion of the merits and challenges of using expert elicitation for model input parameter development. There is a need to establish expert elicitation best practices and reporting guidelines.
Osteo-conductive hydrogel scaffolds of poly(vinylalcohol) with silk fibroin particles for bone augmentation: Structural formation and in vitro testing
Authors: Zhao Dan , Nuntanaranont Thongchai , Thuaksubun Nuttawut , Meesane Jirut
Published: October 2021

Bone augmentation is an effective approach to treat patients who have bone loss at the maxillofacial area. In this research, osteo-conductive hydrogel scaffolds of poly(vinylalcohol) (PVA) with silk fibroin particles (SFP) were fabricated. The SFP were formed by dropping a solution of silk fibroin into acetone at different volume ratios (v/v) of silk to acetone: 1:3 (SFP-3), 1:6 (SFP-6), 1:12 (SFP-12), and 1:24 (SFP-24). The various SFP solutions were mixed with a PVA solution before fabrication into hydrogels by freeze-thawing. Afterwards, the hydrogels were freeze-dried to fabricate the scaffolds. The particle size and charge, molecular organization, and morphology of the SFP were characterized and observed with dynamic light scattering, Fourier transform infrared spectroscopy, differential scanning calorimetry, and scanning electron microscopy (SEM). The morphologies of the hydrogel scaffolds were observed with SEM. Swelling percentage was used to assess the swelling behavior of the hydrogel scaffolds. The mechanical properties were also tested. The scaffolds were cultured with osteoblast cells to test the biological performance, cell viability and performance, alkaline phosphatase activity, calcium deposition, and total protein. The SFP-24 was the smallest in particle size. PVA hydrogel scaffolds with SFP-24 demonstrated low particle aggregation, good particle distribution within the scaffold, and a lower swelling percentage. PVA hydrogel scaffolds with SFP had higher mechanical stability than scaffolds without the SFP. Furthermore, the PVA hydrogel scaffold with SFP-24 had better biological performance. Finally, the results demonstrated that PVA hydrogel scaffolds with SFP-24 showed good osteo-conductive performance which is promising for bone augmentation.
Beyond the Hegemony of Neoliberal Ideas: Ideational Diversity and Policy Variegation in the Neoliberal State
Authors: Maron Asa
Published: October 2021

Sociologists commonly adopt a bifurcated understanding of the neoliberal state, showing how neoliberalism’s advance coincides with the growing authority of specific actors and ideas inside the bureaucratic state as others’ authority declines. This article complicates this view by probing the dynamics of non-neoliberal action inside the state, demonstrating the ways even demoted state actors can strategically muster power resources to forward distinct policy agendas. Taking a long-term perspective on social policy developments since the early 2000s, this article reviews the case of Israel, where neoliberal policies' new hegemony and adverse outcomes triggered counter-actions inside the state, ultimately leading to policy change. Paying particular attention to the role of ideas, this article argues that by rearticulating their policy mission to align with market conventions, non-neoliberal actors were able to persuade neoliberal actors to support their policy proposals, succeeding to advance creative policy alternatives under hostile political conditions. Highlighting this strategic capacity and ideational resilience and acumen in adapting to neoliberal critique reveals how demoted state actors can manage to sustain entrenched organizational goals and institutional motivations even as they help ease the adaptation of their historical mission to the neoliberal zeitgeist.
Comparative Study of Clevidipine to Nicardipine for Perioperative Hypertension in Patients Undergoing Cardiac Surgery
Authors: Colomy Veronika V. , Reinaker Travis S.
Published: October 2021

Objective: The primary objective of this study was to compare the efficacy of clevidipine to nicardipine in the treatment of perioperative acute hypertension in patients undergoing cardiac surgery. Methods: This was a single-center retrospective study which included patients who received either clevidipine or nicardipine. Patients were followed for the duration of study drug infusion or for a maximum of 48 hours. Outcomes assessed included the percent of time spent within patient specific goal blood pressure, incidence of hypertensive events per patient, safety outcomes, and cost of medication treatment. Results: There were 201 cardiac surgeries performed between August 2018–January 2019 and July 2019–February 2020. Sixty-seven patients met our inclusion criteria of receiving either clevidipine (n = 29) or nicardipine (n = 38). The median percent of time spent within goal blood pressure range for clevidipine was 55.2% compared to 36.4% for nicardipine treatment ( P = .036). The median number of hypertensive episodes per patient was 3 for clevidipine and 2 for nicardipine ( P = .211). There were no identified differences in safety outcomes such as hypotension, vasopressor use, serum creatinine elevation, tachycardia, and atrial fibrillation. The median cost of treatment required for the observed 48-hour period with clevidipine was $128.58 compared to $55.74 for nicardipine ( P < .001). Conclusion: Our findings suggest that patients undergoing cardiac surgery on clevidipine had better perioperative blood pressure control compared to nicardipine, with a negligible increase in cost, and no observed difference in safety.
Evaluation of Hospitalized Patient Outcomes in COVID-19 Infection for Continued versus Discontinued Use of Preadmission Antiplatelet Regimen
Authors: Antoniello Angela , Brophy Alison , Opsha Yekaterina
Published: October 2021

Objective

In SARS-CoV-2 (COVID-19) infection, it is unclear if continuation of preadmission antiplatelet regimens upon hospitalization will improve hypercoagulability outcomes. Methods: This retrospective cohort study analyzed adult patients hospitalized with confirmed COVID-19 infection for a 6-week period from March 13, 2020, to April 27, 2020. Preadmission antiplatelet regimen continuation for less than 75% of admission was compared to continuation for at least 75% of admission. Pregnancy, either death or withdrawal of care within 24 hours of admission, and admission beyond the studied timeframe were excluded. The primary endpoint was difference in World Health Organization COVID-19 Ordinal Scale for Clinical Improvement values (World Health Organization [WHO] scores) between maximum score during admission to that upon discharge. Secondary endpoints were mechanical ventilation requirement, mortality, radiologically confirmed venous thromboembolism, major bleeding, and length of stay. Results: This study included 171 patients. Patients failing to continue antiplatelet regimens for at least 75% of admission (n = 76) had significantly worse WHO score differences than those who did (n = 95) (median −1 vs 2; P < .05). Mechanical ventilation requirement (57% vs 27%; P < .05) and mortality (58% vs 29%; P < .05) also favored antiplatelet continuation. All other endpoints were not significantly different. Conclusion: Significantly improved WHO scores, mechanical ventilation requirement, and mortality occurred in patients continuing preadmission antiplatelet regimens in COVID-19 infection. Future prospective studies of COVID-19 patients with consistently collected baseline hypercoagulability markers (platelets, D-dimer, fibrinogen, and coagulation studies) and similar severe disease risk factors are required to confirm potential benefits of antiplatelet therapy during hospitalization.
Finite element modeling of an energy storing and return prosthetic foot and implications of stiffness on rollover shape
Authors: Cavallaro Lorenzo , Tessari Federico , Milandri Giovanni , De Benedictis Carlo , Ferraresi Carlo , Laffranchi Matteo , De Michieli Lorenzo
Published: October 2021

Energy storing and return (ESAR) prosthetic feet showed continuous improvements during the last 30 years. Despite this, standard guidelines are still missing to achieve an optimal foot design in terms of performances. One of the most important design parameters in ESAR feet is the Rollover Shape (RoS). This represents the foot Center of Pressure (CoP) path in a shank-based coordinate system during stance. RoS objectively describes the foot behavior according to its stiffness, which depends on foot geometry and material. This work presents the development of a finite element modeling methodology able to predict the stiffness characteristic of an ESAR foot and its RoS. The validation of the model is performed on a well-known commercially available prosthetic foot both in bench tests and realistic walking scenario. The obtained results confirm an error of +6.1% on stiffness estimation and +10.2% on RoS evaluation, which underlines that the proposed method is a powerful tool able to replicate the mechanical behavior of a prosthetic foot.
Bacteremia in systemic lupus erythematosus: Risk factors, clinical and microbiological characteristics, and outcomes in the largest single-center retrospective cohort in Japan
Authors: Kogami Masahiro , Abe Yoshiyuki , Shimada Yosuke , Hori Satoshi , Tada Kurisu , Yamaji Ken , Tamura Naoto
Published: October 2021

Background

In patients with systemic lupus erythematosus (SLE), infections, especially bacteremia, can occur throughout the course of the disease and are often fatal. We evaluated the characteristics of patients with bacteremia and SLE.

Methods

In this retrospective single-center observational study, we analyzed bacteremia in 65 patients with SLE. We compared the group that survived to the group that died. To compare demographic and clinical characteristics between groups, the Mann–Whitney U test was used for non-normally distributed variables. Categorical variables were compared using Fisher’s exact test.

Results

The median observation period was 39 (interquartile range: 6–74) months. The median age was 54 (43–64) years. Patients consisted of six males and 59 females. In 49 cases, the patient survived. In 16 cases, the patient died. The dead group was older, with lower Glasgow Coma Scale scores, higher sequential organ failure assessment (SOFA) scores, and lower fibrinogen levels.

Conclusion

When physicians encounter patients with suspected bacteremia, they should pay attention to the consciousness assessment and SOFA score, and be aware of infections caused by common microorganisms and opportunistic infections.
Acute Febrile Illness as a Manifestation of Cytomegalovirus Infection in Extremely Low-Birth Weight Babies—A Case Series
Authors: Joseph Rufina , Perumalla Bhavani Deepthi , Sethuraman Giridhar , Devi Usha
Published: October 2021

Cytomegalovirus (CMV) infection in extremely low-birth weight infants (ELBW) is associated with significant morbidity and mortality. Our case series elaborates the profile and outcomes of 5 ELBW neonates with likely postnatal CMV infection. All babies were on mothers’ own milk and had a history of receiving leuko-reduced packed red blood cells. The mean age at diagnosis was 64 days. Hepatosplenomegaly was present in 4 cases. Along with other features warranting testing for CMV, unusually all the 5 neonates had fever spikes at the time of deterioration. Three cases had thrombocytopenia. Atypical clinical feature in the form of papular lesions, which healed with hyperpigmentation, was noted in a neonate. The fever subsided after starting treatment with valganciclovir. All babies developed bronchopulmonary dysplasia requiring prolonged respiratory support. Two babies expired. Duration of treatment with valganciclovir ranged from 6 weeks to 6 months. Survivors were developmentally normal on follow-up with normal hearing and ophthalmic examination. Febrile spikes with worsening of pre-existing morbidities could be an important clue to acquired CMV infection.
The Coming Out Experience of Latino Gay Men
Authors: Gerena Carlos E.
Published: October 2021

Coming out to family, especially parents, can be very daunting. How parents react to their child’s disclosure can have a significant impact on the individual’s self-esteem, mental health, and ability to tolerate adversity. Moreover, an individual’s culture may influence this process further. A modified phenomenological inquiry was used to understand the lived experiences of 15 Latino gay men after coming out to their families, specifically fathers, and whether their disclosure affected their mental health and substance use behaviors. Participants reported fear of being rejected by their families, particularly their fathers, once coming out. These men reported drinking alcohol to cope with the anxieties of being out to their families. Findings suggest that cultural norms influence the coming out process for the men in this study. Implications for research and practice are discussed.
Inclusion of Waste Pickers Into Municipal Waste Management Systems: A Comparison Between Colombia and Brazil
Authors: Calderón Márquez Ana Julieth , Silva de Souza Lima Cano Nathalia , Rutkowski Emília Wanda
Published: October 2021

This article aims to identify and comprehend the challenges and strengths behind public policies on integrating waste pickers (WPs) within waste management systems in Colombia and Brazil. In both, WPs started to come together and found organisations and external agents such as NGOs began to support organised groups of WPs. After 10 years of judicial court actions in Colombia, WPs organisations were finally recognised in legislation, while in Brazil, they were recognised in 2007 in one of the national policies through lobby. Today, there are almost 700 WPs organisations formalised in Colombia and 1700 in Brazil. Their public policies’ main achievements and challenges are exposed to supply knowledge to other countries interested in this theme. A Roadmap for the organisation and formalisation of WPs within waste management systems was created. This constitutes a source of information for policymakers in other emerging economies to address this in their territories.
Union Rates of Talar Neck Fractures With Substantial Bone Defects Treated With Autograft
Authors: McMurtrie J. Thompson , Patch David A. , Frazier Mason B. , Wills Bradley W. , Prather John C. , Viner Gean C. , Hill Margie J. , Johnson Michael D.
Published: October 2021

Background:

This study evaluated the union rate of talar neck fractures with substantial bone defects treated acutely with autologous tibial bone graft during primary osteosynthesis.

Methods:

A case series at a level 1 trauma center was performed to identify consecutive patients who underwent operative fixation of talar neck fracture with autograft ( Current Procedural Terminology codes 28445 and 20902) between 2015 and 2018. “Substantial bone defect” was defined as a gap greater than 5 mm in the sagittal plane and greater than one-third of width of the talar neck in the coronal plane. Postoperative foot computed tomographic (CT) scans were obtained for all patients. Primary outcome was union, and secondary outcomes were malunion, avascular necrosis (AVN), post-traumatic arthritis (PTA), and patient-reported outcomes (PROs).

Results:

Twelve patients with 12 fractures were included in the series, with an average length of follow-up of 26 months (range: 7-55) The average age was 34 years (17-59), and the most common mechanism of injury was motor vehicle crash. The Hawkins classification of the fractures was 4 type II (2 type IIA and 2 type IIB) (33%) and 8 type III (67%). Four fractures (33%) were open fractures. Union was achieved in 11 patients (92%). There was 1 malunion (8%). AVN was identified on postoperative CT scans in 11 patients (92%). Three of these 11 eventually showed collapse. Ten patients (83%) had radiographic evidence of some degree of ankle PTA, and 12 patients (100%) had radiographic evidence of some degree of subtalar PTA. Average Patient-Reported Outcomes Measurement Information System–Short Form score was 37 (32-45) and average Foot and Ankle Ability Measure activities of daily living and sports subscale scores were, respectively, 61 (31-87) and 31 (0-71), respectively. Average visual analog scale score was 5 (0-10), and average Foot Function Index was 49 (7-89). SF-36 scores showed fair to poor outcomes in the majority of patients.

Conclusion:

In this relatively small series, tibial autograft in primary osteosynthesis of comminuted talar neck fractures with substantial bone defects is associated with excellent union rates and low malunion rates. Despite high union rates, secondary outcomes of AVN with or without collapse, ankle and subtalar PTA, and relatively low PROs were common.

Level of Evidence:

Level IV, case series.
The Feline Cardiomyopathies: 2. Hypertrophic cardiomyopathy
Authors: Kittleson Mark D , Côté Etienne
Published: October 2021

Practical relevance:

Hypertrophic cardiomyopathy (HCM) is the most common form of feline cardiomyopathy observed clinically and may affect up to approximately 15% of the domestic cat population, primarily as a subclinical disease. Fortunately, severe HCM, leading to heart failure or arterial thromboembolism (ATE), only occurs in a small proportion of these cats.

Patient group:

Domestic cats of any age from 3 months upward, of either sex and of any breed, can be affected. A higher prevalence in male and domestic shorthair cats has been reported.

Diagnostics:

Subclinical feline HCM may or may not produce a heart murmur or gallop sound. Substantial left atrial enlargement can often be identified radiographically in cats with severe HCM. Biomarkers should not be relied on solely to diagnose the disease. While severe feline HCM can usually be diagnosed via echocardiography alone, feline HCM with mild to moderate left ventricular (LV) wall thickening is a diagnosis of exclusion, which means there is no definitive test for HCM in these cats and so other disorders that can cause mild to moderate LV wall thickening (eg, hyperthyroidism, systemic hypertension, acromegaly, dehydration) need to be ruled out.

Key findings:

While a genetic cause of HCM has been identified in two breeds and is suspected in another, for most cats the cause is unknown. Systolic anterior motion of the mitral valve (SAM) is the most common cause of dynamic left ventricular outflow tract obstruction (DLVOTO) and, in turn, the most common cause of a heart murmur with feline HCM. While severe DLVOTO is probably clinically significant and so should be treated, lesser degrees probably are not. Furthermore, since SAM can likely be induced in most cats with HCM, the distinction between HCM without obstruction and HCM with obstruction (HOCM) is of limited importance in cats. Diastolic dysfunction, and its consequences of abnormally increased atrial pressure leading to signs of heart failure, and sluggish atrial blood flow leading to ATE, is the primary abnormality that causes clinical signs and death in affected cats. Treatment (eg, loop diuretics) is aimed at controlling heart failure. Preventive treatment (eg, antithrombotic drugs) is aimed at reducing the risk of complications (eg, ATE).

Conclusions:

Most cats with HCM show no overt clinical signs and live a normal or near-normal life despite this disease. However, a substantial minority of cats develop overt clinical signs referable to heart failure or ATE that require treatment. For most cats with clinical signs caused by HCM, the long-term prognosis is poor to grave despite therapy.

Areas of uncertainty:

Genetic mutations (variants) that cause HCM have been identified in a few breeds, but, despite valiant efforts, the cause of HCM in the vast majority of cats remains unknown. No treatment currently exists that reverses or even slows the cardiomyopathic process in HCM, again despite valiant efforts. The search goes on.
Fighting silence covert warfare and the uphill battle against the unsaid
Authors: Schweiger Elisabeth
Published: October 2021

Silences around drone warfare and similar covert state practices have often been encountered as a hurdle that hinders us from understanding and interrogating government acts. Scholars as well as human rights actors have opposed silences in a struggle for greater transparency and have called on governments to speak. Through the case study of drone warfare, this paper analyses the productive role of silences and the political struggle to oppose it. Analysing 125 non-governmental organisation (NGO) reports, UN documents and policy papers, this article investigates how silences are encountered, interpreted and opposed by Western human rights actors. This shows that silence is not encountered as a discrete unit but as interdependent layers of denial, partial withholding of information, redactions, delays, lack of oversight and so on. Situated within unequal power relations, I show how the battle against the unsaid is itself based on what has (not) been heard in Western constructions of drone warfare and risks further enabling violent practices. Discussing ways of subverting the workings of silence, the paper not only contributes to academic literature on covert warfare and silence but also speaks to the practical dilemmas faced by non-state actors who are advocating for more transparency.
Pain-related disability, PTSD symptoms, and mood among a comorbid chronic pain and PTSD sample prior to and during the COVID-19 pandemic
Authors: Reed David E , Cobos Briana , Lehinger Elizabeth A , Nabity Paul S , Vail Kenneth E , McGeary Donald D
Published: October 2021

There is a knowledge gap when treating comorbid chronic pain and posttraumatic stress disorder (PTSD) during the COVID-19 pandemic. Addressing this gap, 169 individuals (57.4% female), aged 39.8 years were recruited based on levels of pain-related disability and PTSD symptoms. Participants were assessed prior to, and during, the COVID-19 pandemic. Improvements in pain-related disability were marginally attenuated for the comorbid group, compared to the chronic pain group. Results show that some condition-specific symptoms may not have been affected by the COVID-19 pandemic. Cautious interpretation is warranted due to only two time points and the lack of a diverse sample.
Predictors of children’s physical activity in the early years foundation stage
Authors: Woodfield Lorayne , Tatton Allison , Myers Tony , Powell Emma
Published: October 2021

The physical activity (PA) of young children is critical to their future activity, health and development, however, little is known about how the organisation of early years foundation stage (EYFS) settings impacts upon children’s PA. This study aimed to measure the PA of children in Nursery and Reception classes and to explore their PA according to learning context. Participants were 191 EYFS children (boys = 89; girls 102; Mean age M = 4.6, SD = 0.7 years) from six schools in the West Midlands, UK. Systematic observation was used to record children’s PA, learning context, adult interaction and location throughout the EYFS day. A total of 8740 observed intervals occurred. Children spent two thirds of their time being stationary (65.8% and 69.8% for Nursery and Reception respectively). Results of beta regression revealed the strongest predictors of vigorous PA (VPA) to be the learning contexts of ‘role play’, ‘physical’, ‘construction’ and being ‘outside’. Adult interaction had a negative association with moderate to vigorous PA (MVPA), and girls have 16.36% lower odds of engaging in VPA and 19.4% higher odds of engaging in stationary behaviour than boys. In order to support children’s learning and development, teaching strategies and the organisation of the EYFS environment should be adapted to increase children’s, especially girls’, active learning and to reduce sedentary time.
Superficial Tissue Swabs Versus Deep Tissue Samples in the Detection of Microbiological Profile of Infected Diabetic Foot Ulcerations
Authors: Camilleri Attard F. , Gatt A. , Formosa C.
Published: October 2021

This study aimed to determine the most accurate microbiological test for the detection of micro-organisms in infected diabetic foot ulcerations in people living with type-2 Diabetes. For 20 eligible patients, a superficial tissue swab and a deep tissue sample were taken during a regular appointment at a Diabetes out-patient's Podiatry Clinic. Two specimens were collected from each wound for microbial culturing after debridement. Infected foot ulcerations were graded according to the Wagner's classification as per clinical protocol. This study found a significant difference [p = 0.028] between the two different samples. The deep tissue sample was found to be more accurate in identifying micro-organisms than the superficial swabs, although the latter is more widely used in clinical practice. Further studies are warranted to provide more evidence to clinicians on the best method to adopt when swabbing different types of diabetic foot ulcerations with different wound classification since, it is clearly still a matter of debate how to detect wound infection.
The Terror That Strikes at Night: A Reflection on Overnight On-Call Shifts
Authors: Collura Nicholas
Published: October 2021

Responsibility for the overnight on-call pager can be nerve-wracking, particularly to CPE students and those who are new to chaplaincy. This reflection attempts to reframe the terror we may associate with night-time and draws on the spirituality of John of the Cross in offering encouragement to those who wish to do this work with greater openness, equanimity, or courage.
Design of placebo-controlled randomized trials of anticancer agents: Ethical considerations based on a review of published trials
Authors: Doussau Adélaïde , Agarwal Isha , Fojo Tito , Tannock Ian F , Grady Christine
Published: October 2021

Background

Limited information exists about the design of placebo-controlled cancer trials. Through a systematic review of trials published in 2013, we describe placebo use in randomized trials testing anticancer agents and analyze strategies that increase exposure to the experimental regimen.

Methods

Trials were classified as add-on (placebo in combination with standard treatment) or placebo-only. Strategies to allow more than half of the participants to receive the experimental regimen were reviewed. The risk–benefit ratio of receiving the experimental agent was considered favorable if the difference in primary outcome was significant (p ≤ 0.05), neutral if there was no significant difference in the primary outcome and the experimental agent did not add substantial toxicity, and unfavorable otherwise.

Results

Eighty trials were included (32,694 participants). Most trials were add-on (69%). The risk–benefit outcome was favorable, neutral, and unfavorable to the experimental agent in 52%, 32%, and 16% of placebo-only trials and 25%, 53%, and 22%, respectively, of add-on trials. Four strategies increased exposure to the experimental regimen: one-way crossover (23%), uneven randomization (21%), three-arms (13%), and randomized discontinuation design (4%); these strategies were used more often in placebo-only trials.

Conclusion

A minority of participants received placebo alone and strategies to increase experimental exposure were used commonly. Fewer than half of the studies had favorable outcomes, thus defending the use of placebo controls, when there is no established treatment. Strategies that increase patient exposure to experimental agents rather than placebo may expose them to non-beneficial, sometimes toxic, experimental agents.
The Integrative Complexity of Online User Comments Across Different Types of Democracy and Discussion Arenas
Authors: Jakob Julia , Dobbrick Timo , Wessler Hartmut
Published: October 2021

This study is the first to compare the integrative complexity of online user comments across distinct democratic political systems and in discussion arenas with different primary use functions. Integrative complexity is a psycho-linguistic construct that is increasingly used by communication scholars to study the argumentative quality of political debate contributions. It captures the sophistication of online user comments in terms of differentiation and integration, mapping whether a post contains different aspects or viewpoints related to an issue and the extent to which it draws conceptual connections between these. This study investigates user contributions on the public role of religion and secularism in society between August 2015 and July 2016 from Australia, the United States, Germany, and Switzerland. In each country, it analyzes user posts from the (a) website comment sections and (b) public Facebook pages of mainstream news media, from the (c) Facebook pages of partisan collective actors and alternative media, and from (d) Twitter. Almost as many user contributions implicitly or explicitly differentiate various dimensions of or perspectives on an issue as express unidimensional, simplistic thoughts. Conceptual integration, however, is rare. The integrative complexity of online user comments is higher in consensus-oriented than in majoritarian democracies and in arenas that are used primarily for issue-driven, plural discussions rather than preference-driven, like-minded debates. This suggests that the accommodative public debate cultures of consensus-oriented political systems and interactions with individuals who hold different positions promote more argumentatively complex over simple online debate contributions.
The Causal Relationships Between Corruption, Investments and Economic Growth in GCC Countries
Authors: Belloumi Mounir , Alshehry Atef Saad
Published: October 2021

This paper investigates the impact of corruption on economic growth and investments in the Gulf Cooperation Council countries over the period 2003 to 2016 using the panel vector error correction model and the panel fully modified ordinary least squares method developed by Pedroni. We find that there is at least one cointegration relationship between the variables. The results of Granger causality tests indicate that corruption does not cause economic growth, foreign and domestic investments in the short run. Moreover, we find that there is strong long run unidirectional causality running from corruption to economic growth, foreign direct investment, domestic investment, and domestic credit. Estimation of the panel fully modified ordinary least squares model indicates that corruption has a negative impact on economic growth whereas a positive influence on domestic investment. Hence, the policy implication resulting from this study is that the improvement of corruption perception index in Gulf Cooperation Council countries is not without a positive impact on economic growth in the long run for these countries even not for domestic investments.
Education, Financial Stress, and Trajectory of Mental Health During the COVID-19 Pandemic
Authors: Jiang Yanping , Zilioli Samuele , Balzarini Rhonda N. , Zoppolat Giulia , Slatcher Richard B.
Published: October 2021

In this preregistered study, we examined educational disparities in the trajectory of mental health during the COVID-19 pandemic and whether such educational disparities would be mediated by financial stress associated with the pandemic. Data were drawn from the Love in the Time of COVID project ( N = 2,204; four waves collected between March and June 2020). Results suggested educational disparities in eudaimonic well-being, negative affect, and psychological distress and showed significant associations between lower education and worse mental-health outcomes at baseline. However, education did not amplify mental-health disparities over time and exhibited no associations with the rates of change in mental health. Financial stress mediated the associations between education and mental health at baseline, and there were no temporal variations in the mediation effect. These results highlight persistent educational disparities in mental health, and such educational disparities may be partially explained by financial stress associated with the COVID-19 pandemic.
CGRP monoclonal antibodies in migraine: an efficacy and tolerability comparison with standard prophylactic drugs
Authors: Vandervorst Fenne , Van Deun Laura , Van Dycke Annelies , Paemeleire Koen , Reuter Uwe , Schoenen Jean , Versijpt Jan
Published: October 2021

Background

Several drugs are available for the preventive treatment of both episodic and chronic migraine. The choice of which therapy to initiate first, second, or third is not straightforward and is based on multiple factors, including general efficacy, tolerability, potential for serious adverse events, comorbid conditions, and costs. Recently, a new class of migraine preventive drugs was introduced, i.e. monoclonal antibodies against calcitonin gene-related peptide (CGRP) or its receptor.

Methods

The present article summarizes the evidence gathered with this new migraine preventive drug class from randomized placebo-controlled clinical trials. It further puts this into perspective next to the evidence gained by the most widely used agents for the prevention of episodic and chronic migraine with an emphasis on efficacy and the robustness with which this efficacy signal was obtained.

Results

Although being a relatively new class of migraine preventive drugs, monoclonal antibodies blocking the CGRP pathway have an efficacy which is at least comparable if not higher than those of the currently used preventive drugs. Moreover, the robustness of this efficacy signal is substantiated by several randomized clinical trials each including large numbers of patients. In addition, because of their excellent tolerability and with long-term safety data emerging, they seem to have an unprecedented efficacy over adverse effect profile, clearly resulting in an added value for migraine prevention.

Conclusions

Balancing the data presented in the current manuscript with additional data concerning long term safety on the one hand and cost issues on the other hand, can be of particular use to health policy makers to implement this new drug class in the prevention of migraine.