bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimal Reconstruction After Laparoscopic Distal Gastrectomy: A Single-Center Retrospective Study
Authors: Yan Yongjia , Wang Daohan , Liu Yubiao , Lu Li , Wang Xi , Zhao Zhicheng , Li Chuan , Liu Jian , Li Weidong , Fu Weihua
Published: April 2022

Objectives

Although laparoscopic distal gastrectomy has been widely used for distal gastric cancer, the best functional reconstruction type has not yet been established. Based on previous experience, we propose a modified uncut Roux-en-Y anastomosis. This study aimed to compare the outcomes of different intracorporeal anastomoses after laparoscopic distal gastrectomy.

Methods

From April 2015 to August 2020, the data of 215 patients who underwent laparoscopic distal gastrectomy was collected. The patients were divided into 4 groups according to the digestive tract reconstruction method, Billroth-I, Billroth-II, Roux-en-Y, and the modified uncut Roux-en-Y. Clinicopathologic characteristics, surgery details, short-term outcomes, and postoperative nutritional status were analyzed.

Results

The operation time of Billroth-I anastomosis was significantly shorter (216.2 ± 25.8 min, P < .001) than that of other methods. There was no difference in postoperative complications and OS among the 4 reconstruction methods. The incidences of esophagitis, gastritis, and bile reflux were significantly lower in the Roux-en-Y and uncut Roux-en-Y group (P < .001) 1 year after surgery. And the postoperative albumin and PNI levels in uncut Roux-en-Y group were higher than those in other groups(P < .05). On multivariate analysis, age and reconstruction type were independently related to esophagitis, gastritis, and bile reflux. Serum albumin and the prognostic nutritional index were significantly higher in the uncut Roux-en-Y group than other groups (P < .05).

Conclusions

All 4 reconstruction techniques are feasible and safe. The Roux-en-Y and uncut Roux-en-Y are superior to Billroth-Ⅰ and Billroth-Ⅱ+Braun in terms of reflux esophagitis, gastritis, and bile reflux. Uncut Roux-en-Y may result in better PNI than the others.
It is Really Not a Game: An Integrative Review of Gamification for Service Research
Authors: Ciuchita Robert , Heller Jonas , Köcher Sarah , Köcher Sören , Leclercq Thomas , Sidaoui Karim , Stead Susan
Published: April 2022

Gamification has attracted considerable practitioner attention and has become a viable tactic for influencing behavior, boosting innovation, and improving marketing outcomes across industries. Simultaneously, studies on the use of gamification techniques have emerged in diverse fields, including computer science, education, and healthcare. Despite the broad popularity of gamification in other fields, it has received only limited attention in the service literature. Moreover, the findings of extant studies on gamification in the service field are inconclusive and suggest an incomplete understanding of the employment of gamification in service contexts. Thus, this study aims to integrate the growing but scattered cross-disciplinary literature on gamification and to emphasize its relevance to service research. Specifically, we first conceptualize gamification for service and differentiate it from related concepts. Then, using a systematic literature review, we identify 34 empirical articles that reflect this gamification conceptualization and can be connected to relevant service research themes (e.g., customer participation, experience, and loyalty). Employing activity theory, we derive four higher-order functions of gamification: production, consumption, exchange, and distribution. Finally, we develop a research agenda to generate a better understanding of the central aspects within each of the identified gamification functions and stimulate future academic efforts on gamification in services.
Assessment of Indoor Levels of Carbon Monoxide Emission from Smoldering Mosquito Coils Used in Nigeria
Authors: Elehinafe Francis Boluwaji , Okedere Oyetunji Babatunde , Adesanmi Adewole Johnson , Jimoh Eniola Mistura
Published: April 2022

Mosquito coils are commonly burnt in indoor environments to drive away mosquitoes which are vectors for malaria parasites. The levels of carbon monoxide (CO) emitted and human health implications during smoldering of 5 different brands of mosquito coils commonly used in Nigeria were investigated in 4 microenvironments of different sizes. The experiments were done by taking a scenario of a sleeping arrangement and the farthest distance between the coil burning and an arbitrary bed position in 4 different bedrooms of different sizes in poor ventilation condition of closed doors and windows. With monitoring device, ALTAIR 5X portable gas analyzer, at the position of the bed, measurements were taking at 2 minutes interval from start to the end of burning of each coil. The emission profile was determined by making concentration-time plots of CO emission to determine its levels from the burning of each brand of the mosquito coils in each microenvironment. From the emission profile, coils A, C, and D showed that CO levels exceeded Nigeria’s Federal Ministry of Environment (FMEnv) and the World Health Organization (WHO) statutory limit of 9.0 ppm for indoor environments in each of the microenvironments between 3 and 7 hours after the burning commenced. It was concluded that the CO concentrations from smoldering mosquito coils is a function of the size of the microenvironment in which it is used. It was recommended that the size of a microenvironment be determined for consumption of a mosquito coil before it is released into the market.
Alternative legacies of authoritarianism: Pro-dictator bias in ideology
Authors: Kim-Leffingwell Sanghoon
Published: April 2022

How does an authoritarian past shape voters’ left-right orientation? Recent studies investigate “anti-dictator bias” in political ideology, where citizens in a former right-wing (left-wing) dictatorship may display a leftist (rightist) bias in their ideological self-identification. In this paper, I provide evidence for a “pro-dictator bias” where citizens hold ideological positions close to those of the dictator, depending on their experiences prior to transition. In countries with high economic growth under dictatorship and without violent ruling party ouster, authoritarian successors could continue mobilizing the popular base and invoke positive sentiment on the past in democratic elections. Such positive sentiment can facilitate individual ideological orientation close to the ideological label of the former dictatorship. I test this hypothesis by combining individual- and country-level data covering 1985 to 2018 from 48 countries. I demonstrate that voters in countries with high economic growth during dictatorship and without violent party exit are more likely to have pro-dictator bias in ideology. I further show that voters in former developmental states show pro-dictator bias from the history of economic growth and more peaceful transition. The findings emphasize the role of pre-transition features in shaping alternative legacies on voter attitudes in post-authoritarian societies.
Dynamic amplification factor of multi-span simply supported beam bridge under traffic flow
Authors: Xia Cuipeng , Wang Bin , Luo Tingyuan , Min Quan , Sekulic Dragan , Li Yongle
Published: April 2022

Simply supported bridges occupy the majority of bridges. Compared with the flexible large span bridges, Dynamic Amplification Factor (DAF) of them is relatively large and attracts lots of studies. However, most of these studies are focused on the simplified condition that a single vehicle passes through a single span bridge. In general, the bridge bears complex traffic flow rather than a single vehicle. The vehicle type and dynamic loads on the bridge are thus dispersed. It is necessary to explore the multi-vehicle effects on the DAF caused by the complex traffic flow. Also, adjacent spans of a multi-span simply supported beam bridge may have continuous dynamic effects on the vehicles. In this regard, the DAF of a simply supported bridge considering the multi-vehicle and multi-span effects are explored numerically based on the coupling dynamic analysis of traffic flow and bridge, which can also consider the acceleration and deceleration of the vehicles. Cellular Automata (CA) method is used to simulate the traffic flow. It is found that the worse the driving condition of the road roughness, the greater the DAF. When road roughness is Class C, the DAF exceeds the values of American and Chinese codes. Under the action of traffic flow, DAF of the first span of the multi-span simply supported beam is larger than that of the span under the single vehicle. Only considering the effect of a single vehicle may underestimate the dynamic impact on the bridge. Sparse traffic flow has a larger DAF than moderate traffic flow and dense traffic flow in the statistic meaning of the multi-span, because the driving speed of sparse traffic flow is closer to the resonant speed of the bridge and the vibration disharmony of multi-vehicles is smaller. The greater the deceleration of the traffic, the greater the dynamic impact on the bridge.
Development of a mobile training app to assist radiographers’ diagnostic assessments
Authors: Toderis Liat , Vo Ace , Reychav Iris , Sayeed Lutfus , McHaney Roger , Guindy Michal
Published: April 2022

The current study reduced the time lag between performing a diagnostic assessment and identifying a critical finding in CT and MRI exams through improving radiographers’ abilities to identify those critical findings. Radiographers’ diagnostic assessments in CT and MRI exams were used to develop a mobile training application with the aim to improve radiographers’ awareness of critical findings. The current research used data analytics to examine radiographers’ interpretation of imaging studies from a privately owned medical group in Israel. During the project, the radiographers’ ability to identify critical findings improved. Implementation of the mobile training program yielded positive results where the knowledge gap was reduced and time to identify critical cases was decreased. Specifically, this study showed that radiographers can be trained in ways that enhance their involvement with radiologists to provide high quality services and improve treatment Ultimately, this gives patients higher quality of care and safer treatment.
Investigation of an efficient model-based fuel economy optimization methodology for diesel engines focusing on real world driving emission cycles
Authors: Karabıyık Egemen , Öncü Sinan , Samur Evren
Published: April 2022

Together with stringent emission standards, meeting fuel consumption, and performance targets have made engine calibration process complicated, lengthy, and costly. For this reason, it is crucial to develop an efficient methodology for the optimization of a diesel engine calibration. In this study, a novel automated fine tuning methodology using genetic algorithms and data driven models is proposed. Fuel consumption of a light commercial vehicle with 2.0-L diesel engine was optimized for a predefined Real Driving Emissions (RDE) cycle. During the optimization, tail pipe emission limits were maintained by taking the aftertreatment system efficiency into account. To this end, a representative engine control unit, internal combustion engine, and Selective Catalyst Reduction (SCR) system models were built by using empirical data and neural networks. Moreover, the effect of choosing different tailored optimization points for a predefined route was investigated by comparison of frequency and fuel consumption based weighting. The cost function, related to the optimization problem, was defined based on fuel consumption, performance, and mechanical limits of the engine, and in accordance with tailpipe emission limits defined by Euro 6d-Temp regulations. Compared to previous model-based calibration studies, tailpipe emissions, and regulation limits have been incorporated in this study in order to obtain more realistic calibrations. After testing different genetic algorithm configurations, the fuel efficiency over the predefined route was improved by 3.07% without violating any of the limits while the smoothness of the calibration maps was also preserved. This route specific calibration methodology is believed to have the potential to increase fuel economy in real world applications such as daily commuting routes or repetitive driving patterns for instance, operation vehicle use cases in factories, airports, and construction areas. As for further development, this can be achieved by running simulations and the optimization on cloud and updating the calibration remotely based on the selected route before the trip.
A Delicate Hand or Two-Fisted Aggression? How Gendered Language Influences Candidate Perceptions
Authors: Roberts Damon C. , Utych Stephen
Published: April 2022

Gendered language is seemingly found everywhere in American politics. We test the impact that gendered language has on voter support for a candidate, using a validated dictionary of words rated as highly masculine or feminine. In three experimental studies, we find that the use of feminine language causes individuals to perceive political candidates as more liberal. Additionally, liberals tend to prefer candidates who use feminine language, and conservatives prefer candidates who use masculine language, regardless of the sex of the candidate. These effects are mostly mediated, however, by perceptions of candidate ideology caused by the use of language.
Application of 3-Dimensionally Printed Coplanar Template Improves Diagnostic Yield of CT-Guided Percutaneous Core Needle Biopsy for Pulmonary Nodules
Authors: Wang Hansheng , Ren Tao , Chen Peipei , Luo Guoshi , Wei Na , Tang Yijun , Wang Meifang
Published: April 2022

Background and Objective: Computed tomography-guided percutaneous lung biopsy is a commonly used method for clarifying the nature of nodules, masses or lung consolidation. However, the diagnostic yield of nodules needs to be improved when compared with masses during percutaneous lung biopsy. In recent years, 3D-printed coplanar templates have been gradually utilized in radioactive seed implantation for lung cancer treatment. However, there is little research on the application of 3D-printed coplanar templates in pulmonary nodules biopsy. Therefore, we conducted a single center and retrospective study to explore the application value of 3D-printed coplanar puncture template-assisted computed tomography-guided percutaneous core needle biopsy of small pulmonary nodules. Methods: 210 patients hospitalized in Taihe Hospital with pulmonary nodules underwent percutaneous core needle biopsy for histopathology diagnosis and were included in the study. 106 patients underwent conventional percutaneous lung biopsy (control group) and 104 patients underwent 3D-PCT-assisted percutaneous lung biopsy (3D-PCT group). The diagnostic yield and incidence of complications were recorded and compared between the two groups. Results: The overall diagnostic yield significantly improved in 3D-PCT group (95.2%) compared with Control group (87.7%) ( P < .05); the diagnostic yield for lung nodules smaller than 2 cm in the 3D-PCT group and the control group was 94.4% and 80.5%, respectively, ( P < .05). Incidence of pneumothorax (17.3% vs 18.9%) and pulmonary hemorrhage (7.7% vs 9.4%) were not significantly difference between the two groups ( P > .05). Conclusions: Studies indicated that application of 3-Dimensionally printed coplanar template improves diagnostic yield of CT-guided percutaneous core needle biopsy for pulmonary nodules, especially for pulmonary nodule smaller than 2 cm.
Comprehensive Evaluation of Carbon-Fiber-Reinforced Polyetheretherketone (CFR-PEEK) Spinal Hardware for Proton and Photon Planning
Authors: Shi Chengyu , Lin Haibo , Huang Sheng , Xiong Weijun , Hu Lei , Choi Isabelle , Press Robert , Hasan Shaakir , Simone Charles , Chhabra Arpit
Published: April 2022

Purpose: To evaluate a novel spine implant, carbon-fiber-reinforced polyetheretherketone (CFR-PEEK), for proton and photon treatment planning. Materials and Methods: We compared target coverage and sparing of organs-at-risk (OARs) for a spinal phantom with 4 different spine configurations: (a) normal (no implant); (b) Titanium; (c) CFR-PEEK; and (d) hybrid (CFR-PEEK with Titanium tulip head). The spinal phantom was imaged via computed tomography (CT) scan, and the iterative Metal Artifact Reduction (iMAR) CT set was used for planning. A representative spinal chordoma target and associated OARs were contoured. The prescription dose was 50 Gy to the initial target volume, followed by a 24 Gy boost, for which multi-field optimization (MFO) proton plans were developed with a 3 mm setup and 3.5% range uncertainties. For photon planning, volumetric modulated arc therapy (VMAT) plans were developed for the initial and boost plans. OAR dose constraints were set according to our institutional guidelines. Results: For the 4 spine configurations, the proton plans achieved similar nominal target coverage and OARs sparing. While evaluating coverage and OAR dose under uncertainty scenario analysis for initial clinical target volume (CTV) 50 Gy 95% and 90% coverage, higher means and the narrower band of doses variations were achieved for the normal and CFR-PEEK plans. Similarly, uncertainty analysis of spinal cord Dmax showed tighter distribution for normal and CFR-PEEK plans. Overall plan quality showed no significant difference for photon planning when compared to normal spine versus other inserts. However, for proton planning, there is a larger difference for the normal spine insert scenario versus the Titanium insert scenario. For each insert scenario comparison between photon and proton plans, there was a larger difference for OARs: heart and spinal cord. Conclusion: The CFR-PEEK implant has similar clinical properties to a normal spine for proton planning, allowing us to pass protons through the material and achieve superior target coverage and OAR sparing under nominal and uncertainty conditions.
Narrative Exposure Therapy: A Case for Use With Refugees via Telehealth With the use of an Interpreter
Authors: Olavarrieta Gabriela A. , Benuto Lorraine
Published: April 2022

Rates of PTSD and depression are as high as or higher among samples of refugees than in the general population. There have been few randomized controlled trials of trauma-focused therapies conducted with refugees. Additionally, there has been little research on the use of interpreters in psychotherapy with refugees, but across the studies included in a meta-analysis, a nonsignificant difference between studies that used an interpreter and those that did not was found. Due to COVID-19, mental health providers have had to adapt to the crisis by utilizing telemental health. Research on telemental health with refugee clients is limited, despite a recognition in the literature that telemental health can address some mental healthcare disparities. We review the case of a 26-year-old Afghani/Iranian bilingual diagnosed with post-traumatic stress disorder (PTSD) who presented with intrusive thoughts, panic attacks, nightmares, and flashbacks. Narrative Exposure Therapy (NET) was used with an interpreter via telehealth because it is effective in reducing symptoms of trauma in refugee populations. Treatment success for this case was reflected in the client’s self-reported reduction in symptoms. From this case study, we can conclude that (a) NET is a short-term, cost-effective means for providing trauma-focused care for refugees/asylum-seekers; (b) NET diminishes trauma symptoms with the use of an interpreter via telehealth; (c) a good relationship between therapist, interpreter, and client aids in the effectiveness of NET; and (d) clinician flexibility in the delivery of telemental health and interventions being utilized with refugee/asylum-seeker populations is imperative.
Increasing Sight-Phrase Reading with an iPad intervention for Two Students with Intellectual Disability
Authors: Aspiranti Kathleen B , Dula Mark E , Ebner Sara , Hilton-Prillhart Angela
Published: April 2022

Sight-word interventions are often implemented when students show delays in word recognition. However, few studies have investigated the effects of teaching sight words using phrases. The current study investigated the effects of a tablet-based flashcard intervention on the acquisition of sight phrases. A multiple-baseline design across word sets was used for two students with intellectual disability who were included in the general education classroom for the majority of the day. For each phrase, students used an iPad flashcard program and were prompted to see the phrase, say the phrase, tap the screen to hear the phrase, and then say the phrase again before moving on to the next phrase. Results showed that both students quickly acquired the ability to read the previously unknown sight phrases across three different sets of phrases. Discussion focuses on using tablet-based interventions for students with intellectual disability, particularly those included within a general education classroom.
The retention of proprioceptive information is suppressed by competing verbal and spatial task
Authors: Horváth Áron , Ferentzi Eszter , Ragó Anett , Köteles Ferenc
Published: April 2022

Proprioceptive information makes us able to perceive the position of our joints from an internal point of view. In the certain cases, proprioceptive information has to be stored in short-term memory, for example, during the learning of new motor skills or the assessment of proprioceptive accuracy. However, there are contradictory findings about the modality-specific storage of proprioceptive information in working memory. In this preregistered study, we applied the interference paradigm, assessing proprioceptive memory capacity in the subdominant elbow joint for 35 young individuals in five different experimental conditions: (a) without competing task/interference (baseline condition), (b) with motor interference, (c) with spatial interference, (d) with visual interference, and (e) with verbal interference. Proprioceptive span was lower in the verbal and spatial interference condition than in the baseline condition, whereas no significant differences were found for the motor and visual conditions. These results indicate that individuals use verbal and spatial strategies to encode proprioceptive information in short-term memory, and, in contrast to our expectation, the motor subsystem of working memory is not substantially involved in this process.
What drives changes in expressive social media use for generational cohorts?
Authors: Pang Natalie , Woo Yue Ting
Published: April 2022

Extant literature has often focused on digital citizenship amongst youths in particular instances and contexts, but is limited in addressing how such citizenship compare to other generational cohorts. Examining political expression as a particular form of actualising citizenship, the paper utilises a longitudinal approach to explore the effects of changes in political efficacy, media use, political knowledge, media trust and political talk on political expression – and the differences between generational cohorts over two general elections in Singapore. Findings indicate that while changes in mass media use, social media use, trust in instant messaging and personal communications and political talk were positively associated with changes in political expression as a whole, changes in political knowledge and trust in mass media negatively predicted political expression. With different effects observed for different generational cohorts of citizens, findings from the study contribute to deeper understandings of practices of actualising citizenship over time.
Wild hopes: Sourcing the political vocabulary of digital citizenship from the LIHKG forum
Authors: Erni John Nguyet , Zhang Yin
Published: April 2022

In the 2019 Anti-Extradition Law Amendment Bill resistance movement, Hong Kong netizens used a popular digital platform known as LIHKG (連登) as a communicative center to exchange time-based information, express outrage or solidarity, and assemble decentered actions of agitation. There was an implied sense that LIHKG was facilitating a “wild” mode of politics oriented toward agitation, disturbance, and chaos. This paper examines its “wild politics” and asks: how might we trace the evolution of a complex political vernacular capable of creating a chaotic form of organizing, and what did this vocabulary tell us about the latent meanings, desires, and identity-making of the networked protesters? Utilizing the LDA topic-modelling method, we analyzed a large corpus of discussion threads on LIHKG to develop a customized domain-specific thematic repertoire, and revealed a “language in the wild” as part of a cultural archive that embodied the netizens’ ambivalent hopes.
What it takes to be a “Good” correctional officer: Occupational fitness and co-worker expectations from the perspective of correctional officer recruits in Canada
Authors: Cassiano Marcella Siqueira , Bennett Brittany Ann , Andres Elizabeth , Ricciardelli Rosemary
Published: April 2022

Selecting individuals who are the right “fit” for correctional work is not an easy task for prison administrators because of the dangerous nature of correctional work and the centrality of prison employees in the prisoner’s rehabilitation process. We analyze fitness for correctional work from the employee’s perspective, complementing the scholarship focused on the employer’s view. We measure occupational fitness in terms of co-worker expectations, analyzing 104 semi-structured interviews conducted with Federal Canadian Correctional Officer recruits in 2018/2019. Recruits in our sample expected a correctional officer to be accountable, reliable, and confident. Understanding the mind-set of new hires provides insights into the correctional officer role and allows employers to align employer-employee expectations, as well as review training and recruitment, which can improve the employee well-being and reduce turnover rates.
Researching inside police custody in four jurisdictions: ‘Getting in’, ‘getting on’, ‘getting your hands dirty’ and ‘getting through it’
Authors: Skinns Layla
Published: April 2022

As a unique criminal justice organisation, the police present challenges, but also opportunities for those who research them. These are examined, in terms of getting in, getting on, getting your hands dirty and getting through it, using data collected as part of a comparative multi-method study of police custody in large cities in Australia, England, Ireland and the United States in 2007 and 2009. As this research took place on the cusp of the proliferation of research with the police, retrospective examination of field notes is used to reflect on how the research process is influenced not just by one’s social origins but also by the culture of academia and the politics of knowledge production. It is argued that while research with the police is becoming the norm, research on the police is still of value as part of a diverse police research agenda.
The association between plate location and hardware removal following ulna shortening osteotomy: a cohort study
Authors: Teunissen Joris S. , Al Shaer Sanharib , van der Heijden Brigitte P.A. , Selles Ruud W. , Hovius Steven E.R. , Zöphel Oliver T. ,   on behalf of the Hand Wrist Study Group
Published: April 2022

Hardware removal after ulna shortening osteotomy is common. We evaluated the association between plate location and hardware removal rate in 326 procedures in 321 patients with a median follow-up of 4.3 years (IQR 3.3) and corrected for confounding variables and did survival analyses. Complications were scored using the International Consortium for Health Outcome Measurement complications in Hand and Wrist Conditions tool. The 1-year and 5-year reoperation rates for hardware removal were 21% and 46% in the anterior group versus 37% and 64% in the dorsal group. Anterior plate placement was independently associated with a decreased immediate risk of hardware removal. Higher age, male sex and treatment on the dominant side were also associated with a reduced risk of hardware removal. We did not find a difference in hardware removal rates between freehand or jig-guided ulna shortening osteotomies. We noted perioperative problems in 3% of the procedures and complications in 20%.

Level of evidence: III
Application of fucoidan as treatment for cardiovascular and cerebrovascular diseases
Authors: Wang Ke , Xu Xueli , Wei Qiang , Yang Qiong , Zhao Jiarui , Wang Yuan , Li Xia , Ji Kai , Song Shuliang
Published: April 2022

Fucoidan is a marine polysaccharide. In recent years, fucoidan has attracted wide-scale attention from the pharmaceutical industries due to its diverse biological activities such as lipid-lowering, anti-atherosclerosis, and anticoagulation. This review clarifies the pharmacological effects of fucoidan in the treatment of human cardiovascular and cerebrovascular diseases. Fucoidan exerts a hypolipidemic effect by increasing the reverse transport of cholesterol, inhibiting lipid synthesis, reducing lipid accumulation, and increasing lipid metabolism. Inflammation, anti-oxidation, and so on have a regulatory effect in the process of atherosclerosis endothelial cells, macrophages, smooth muscle cells, and so on; fucoidan can not only prevent thrombosis through anticoagulation and regulate platelet activation, but also promote the dissolution of formed thrombi. Fucoidan has a neuroprotective effect, and also has a positive effect on the prognosis of the cardiovascular and cerebrovascular. The prospects of applying fucoidan in cardio-cerebrovascular diseases are reviewed to provide some theoretical bases and inspirations for its full-scale development and utilization.
Prolonged shoulder dysfunction after coronavirus disease vaccination: A case of shoulder injury related to vaccine administration
Authors: Aldosary Ahmad Hamad
Published: April 2022

Shoulder pain is a common symptom after intramuscular vaccination. However, only a few cases of shoulder joint injury have been reported after coronavirus disease 2019 vaccination. A 52-year-old woman experienced clinically significant pain in the left shoulder joint after receiving the first dose of a coronavirus disease 2019 vaccine. She neglected the shoulder pain, hoping that it would spontaneously improve without medical attention. However, the pain continued with obvious limitations in shoulder movement and function. After 8 months, she presented to the outpatient clinic with a frozen left shoulder. Such rare consequences of vaccinations, known as shoulder injury related to vaccine administration, can be prevented by using an appropriate needle gauge and length according to the patient’s sex and weight with the correct injection site away from shoulder structures.
Primary hyperparathyroidism presenting with sudden onset paraplegia
Authors: Zainordin Nur Aisyah , Mohd Azraai Awla , Mohamad Shah Fatimah Zaherah , Abdul Ghani Rohana
Published: April 2022

A 48-year-old female with long-standing type 2 diabetes mellitus presented with acute onset of bilateral lower limb weakness. She had been previously well and denied any constitutional symptoms. Physical examinations revealed generalized lower limb weakness with bilateral lower limb hypotonia, power of 0 over 5, reduced deep tendon reflexes, and loss of peripheral sensations up to the level of T10. Upper limb functions were normal. Rectal examination showed a lax anal tone and reduced anal grip. Blood investigations showed elevated serum alkaline phosphatase, corrected serum calcium, and parathyroid hormone. Magnetic resonance imaging of the spine revealed an expansile mass at the posterior element of the ninth thoracic vertebrae, causing spinal compression with possible impingement of the right T9 exiting spinal nerve. An urgent surgical decompression and tissue biopsy were performed for stabilization of the spine. Intraoperative findings included spinal cord compression secondary to an epidural tumour mass extending from T9 to T10 disc levels. Histopathological analysis showed a giant cell tumour of the spine. A 99mTc Sestamibi-SPECT parathyroid scintigraphy showed an ectopic parathyroid adenoma at the left suprasternal region. A diagnosis of Brown tumour secondary to ectopic parathyroid adenoma was made. She underwent an exploratory parathyroidectomy procedure with removal of the ectopic parathyroid gland, which resulted in a normalization of the serum calcium and parathyroid hormone. Unfortunately, her lower limb functions did not return to normal, and she remained paraplegic at 6 months postoperatively.
Can multi-parametric magnetic resonance imaging and prostate-specific antigen density accurately stratify patients prior to prostate biopsy?
Authors: Hogan Donnacha , Yao Henry Han-I , Kanagarajah Abbie , Ogluszko Cindy , Tran Phillip Vinh Phu , Dundee Phil , O’Connell Helen Elizabeth
Published: April 2022

Objective:

This study examines the diagnostic accuracy of multi-parametric magnetic resonance imaging (mpMRI) in a high-volume centre to potentially stratify patients prior to prostate biopsy.

Methods:

All biopsy naïve patients who had mpMRI prostate and transperineal biopsy of prostate (TPBx) in 2017 and 2018 were included. There were no exclusion criteria. All patients, regardless of the mpMRI result, underwent systematic template biopsy under general anaesthesia with cognitive target biopsy if indicated. Clinicopathological data were extracted from medical records. The primary outcome was the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of mpMRI prostate in the detection of prostate cancer (PCa) compared with template TPBx.

Results:

In total, 140 patients were included. Overall, 57.1% had a positive biopsy. A higher Prostate Imaging-Reporting and Data Systems (PI-RADS) score was associated with a higher risk of diagnosing clinically significant PCa (International Society of Urological Pathology (ISUP) ⩾ 2) ( p < 0.001). The sensitivity, specificity, NPV, and PPV of mpMRI in detecting clinically significant PCa with a PI-RADS ⩾ 3 lesion, was 95% (95% confidence interval (CI) 83.0–99.3%), 41% (95% CI 31.3–51.3%), 95.3% (95% CI 84.2–99.4%) and 39.2% (95% CI 29.4–49.6%), respectively. Combining this with prostate-specific antigen density (PSAD) of <0.15 further improved the NPV to 100% (86.3–100). Binomial logistic regression to understand the effects of PSA, DRE and PI-RADS score on predicting clinically significant PCa (ISUP ⩾ 2) found increasing PSA (odds ratio (OR) 1.06, (95% CI 1.00–1.11, p = 0.022)) and PI-RADS (OR 3.17, (95% CI 1.94–5.18, p < 0.001)) to be significant predictors. Malignant DRE was not a significant predictor ( p = 0.087).

Conclusion:

This study demonstrates that the high sensitivity and NPV of mpMRI combined with PSAD may play a pivotal role in stratifying men for prostate biopsy and help avoid biopsy and its associated morbidity in select patients.

Level of Evidence:

2b (Oxford Centre for Evidence-Based Medicine: Levels of Evidence)
Teleconsultation versus traditional clinical assessment of patients undergoing circumcision: A retrospective cohort study
Authors: Natale Joseph , Pascoe John , Horn Charles , Coode-Bate Jack , Dickinson Andrew
Published: April 2022

Objective:

To determine whether standalone teleconsultation is an effective alternative to face-to-face assessment of patients requiring circumcision. To determine what environmental and efficiency benefits may arise as a result of service alteration.

Patients and Methods:

All cases listed for circumcision during first UK lockdown (1 February to 30 September 2020) were reviewed. Cases were collated from operative lists, theatre logs and secretarial records. Cancellations and rationale were recorded. Local audit approval was granted for conduct of this study. Statistical analysis was conducted in JASP.

Results:

A total of 101 patients were listed for circumcision during the study period. The overall odds of cancellation was 0.063. There was no significant difference in odds of cancellation between telephone clinic and face-to-face clinic odds ratio 0.371 (confidence interval (CI): 0.039–3.46). Telephone clinic could achieve a per-patient cost reduction of £81 and a total reduction in CO2 emissions of 637 kg.

Discussion:

This is the first study to demonstrate teleconsultation as a suitable method to list patients for circumcision without a face-to-face appointment. The COVID pandemic has accelerated transformational change in outpatient service design instigated by the National Health Service (NHS) Long-Term plan. The environmental and efficiency savings demonstrated suggest sustainable change beyond the pandemic.

Level of Evidence:

Level 3 (cohort study)
Philosophical hermeneutics as an interpretive framework in the analysis of Colin Kaepernick’s NFL protest
Authors: Muhammad E. Anthony , Thomas Cynthia
Published: April 2022

One of the more polarizing issues that captivated society in recent years was the controversy surrounding National Football League (NFL) athletes kneeling during the playing of the National Anthem. Initiated by NFL quarterback Colin Kaepernick as a display of protest against police brutality, kneeling during the anthem sparked a firestorm of controversy and a national debate. In this study the controversy and the two men behind it will be analyzed through the lens of Hans-Georg Gadamer’s philosophical hermeneutics. Specifically, this study will highlight how Colin Kaepernick and Army veteran Nate Boyer experienced a fusion of horizons that produced the kneeling protest. Additionally, the current study seeks to illuminate both the utility of philosophical hermeneutics as an interpretive framework and the potentialities of dialog between polar opposites who earnestly seek to understand the other.
Using Learner Analytics to Explore the Potential Contribution of Multimodal Formative Assessment to Academic Success in Higher Education
Authors: Kohnke Lucas , Foung Dennis , Chen Julia
Published: April 2022

Blended learning pedagogical practices supported by learning management systems have become an important part of higher education curricula. In most cases, these blended curricula are evaluated through multimodal formative assessments. Although assessments can strongly affect student outcomes, research on the topic is limited. In this paper, we adopted a learning analytics approach to explore student engagement with formative assessments and the power of these assessments to predict student outcomes in an English for Academic Purposes courses in a Hong Kong university. The study retrieved the data logs from 7,815 students and used the data to analyze student engagement with the formative assessments. The results suggested that the students put effort into completing the assessments. The degree to which assessments predict learning outcomes depend on students’ level of subject knowledge and their understanding of the relevance of the assessments. This study showed that learning analytics provided reliable evidence for understanding students’ engagement and identifying at-risk students. Therefore, learning analytics research has the potential to inform pedagogical practice.
Youth-Centered Clinics: The Voices of Adolescent Sesotho-Speaking Girls From Mangaung, South Africa
Authors: Marais Lochner , Brown Jennifer L. , Sharp Carla , Sales Jessica M. , Lenka Molefi , Rani Kolisa , Cloete Jan
Published: April 2022

Youth-centered health services have become a global practice and South Africa is no exception. This paper describes a project conducted in Mangaung in 2018 using cultural consensus modeling. We conducted 25 interviews and used a combination of hermeneutics, phenomenology theory, and thematic analysis. Our research found that girls in our sample have confidentiality concerns associated with the stigma of attending a clinic and cannot talk openly about sex and HIV. Themes related to negative experiences included the lack of confidentiality, the stigma of HIV, the lack of professional neutrality, failure to understand adolescents, poor service, systemic problems (long queues), and administrative problems. Positive themes included believing that clinics could help prevent pregnancy, provide information, create a safe space, and help with moral support. Moreover, some interviewees reported that services were good and that they provided products and support that were not available from home. However, many said they had to attend public clinics because they could not afford private alternatives. Some said the clinics offered a safe space and staff have positive attitudes. In the absence of discussions about sex at home, the clinics ultimately perform an important function, but systemic problems remain. More can be done by schools and households to reduce the stigma associated with sex and HIV.
Is Final Fusion Necessary for Growing-Rod Graduates: A Systematic Review and Meta-Analysis
Authors: Ahuja Kaustubh , Ifthekar Syed , Mittal Samarth , Bali Shiv K. , Yadav Gagandeep , Goyal Nikhil , Sudhakar P. Venkata , Kandwal Pankaj
Published: April 2022

Study Design

Systematic review and meta-analysis.

Objectives

The need for definitive fusion for growing rod graduates is a controversial topic in the management of Early-onset scoliosis (EOS) patients. The authors performed a systematic review and meta-analysis on the available literature to evaluate the outcomes of growing rod graduates undergoing final fusion or observation with implants in-situ.

Methods

An extensive literature search was carried out aimed at identifying articles reporting outcomes in growing rod graduates. Apart from the study characteristics and demographic details, the extracted data included Cobb’s correction, trunk height parameters, and revision rate. The extracted data was analyzed and forest plots were generated to draw comparisons between the observation and fusion groups.

Results

Of the 11 included studies, 6 were case-control and 5 were case series. The authors did not find any significant difference between the 2 groups with respect to the pre-index and final Cobb’s correction, T1-T12 or T1-S1 height gain in either over-all, or sub-analysis with case-control studies. The meta-analysis showed a significantly higher revision rate in patients undergoing a definitive fusion procedure.

Conclusion

The current analysis revealed comparable outcomes in terms of correction rate and gain in the trunk height but a lesser need of revisions in observation sub-group. The lack of good quality evidence and the need for prospective and randomized trials was also propounded by this review.
A Systematic Review on the Effect of Common Medications on Platelet Count and Function: Which Medications Should Be Stopped Before Getting a Platelet-Rich Plasma Injection?
Authors: Kao David S. , Zhang Stephanie W. , Vap Alexander R.
Published: April 2022

Background:

Platelet-rich plasma (PRP) exerts its effect through the release of growth factors and cytokines from the platelet concentrate. Certain medications may affect platelet count or function, resulting in decreased efficacy of PRP injections.

Purpose:

To systematically review the literature regarding common medications and their effects on platelets to establish guidelines for which medications should be stopped before obtaining a PRP injection.

Study Design:

Systematic review; Level of evidence, 2.

Methods:

This review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A search for studies assessing the effect of common medications on platelet count or platelet function was performed of the PubMed, Cochrane Library, Web of Science, and OpenGrey databases. Inclusion criteria were as follows: drug studied was aspirin, acetaminophen, a nonsteroidal anti-inflammatory drug (NSAID), a statin, or gabapentin; human participants; and article in the English language. Risk of bias was assessed using the Cochrane Risk of Bias tool and the Risk of Bias in Non-randomised Studies—of Interventions tool.

Results:

A total of 1711 studies were identified through the initial search, with 20 studies meeting all inclusion criteria. No studies involving gabapentin met all inclusion criteria. Patients treated with aspirin (268 patients) or acetaminophen (13 patients) showed a significant decrease in platelet aggregation. Statin therapy (73 patients) did not result in a significant decrease in platelet aggregation. Patients who took NSAIDs (172 patients) demonstrated significantly decreased platelet aggregation only when treated with nonselective formulations. Those treated with cyclooxygenase (COX)-2–selective NSAIDs showed no significant difference in platelet aggregation. Treatment with aspirin, acetaminophen, statins, or NSAIDs did not lead to a significant decrease in platelet count.

Conclusion:

Aspirin, acetaminophen, and nonselective NSAIDs should be considered for suspension before a PRP injection because of their potential to diminish the effects of the injection. COX-2–selective NSAIDs and statins do not need to be withheld before a PRP injection.
How do Professionals in Municipal Health and Welfare Relate to Bereaved Persons During the Acute Phase of a Drug-Related Death? A Qualitative Study
Authors: Løseth Hilde-Margit , Selseng Lillian B. , Dyregrov Kari , Mellingen Sonja
Published: April 2022

This study aims to broaden our knowledge of how professionals in municipal health and welfare relate to bereaved persons during the acute phase of a drug-related death. A reflexive thematic analysis was applied to six focus group interviews with 27 first responding personnel in Norway. The article describes the complexity and simultaneousness of the professional response. Three main themes were identified: (a) establishing contact, (b) diverse, supportive assistance, and (c) a complex helping context. The analysis showed that experiences from previous encounters and the deceased’s illicit drug use affected many of the professionals’ assessments, and implied an evaluation of the bereaved as not in need of emergency services or psychosocial follow-up. Professionals should be trained to understand drug-related death as a sudden and unnatural death, and to initiate immediate psychosocial crisis intervention. There is a need for further research on the perspective of professionals in the health and welfare services on the drivers and barriers to support (bereaved persons) during the acute phase.
Intensive Care Experiences of Postoperative Patients
Authors: Dığın Figen , Kızılcık Özkan Zeynep , Kalaycı Eda
Published: April 2022

Objective: The aim of this study is to examine the intensive care experience of postoperative patients. Methods: This descriptive study was conducted between February and May 2021 with the participation of 75 surgical intensive care patients. Data were collected using the patient identification form and The Intensive Care Experiences Scale (ICES). Shapiro-Wilks test, Mann-Whitney U, Kruskal-Wallis H test, Bonferroni Corrected Mann-Whitney U test, and Spearman correlation analysis were used in analyzing the data. Results: The mean patient age was 62.8 ± 14.9 year (min: 23 and max: 95); 53.3% (n = 40) were male. The patients’ mean length of stay in the intensive care unit was 1.4 ± 1.0 days. The mean ICES score of the patients was 57.4 ± 3.9. It was found that the patients’ mean scores of the “satisfaction with care” subscale varied according to the surgical procedure applied, connection to mechanical ventilation, and status of seeing other individuals receiving treatment. Conclusions: Patients’ intensive care experiences were partially positive. Being aware of the patients’ experiences, supporting them in biopsychosocial aspects, and being in contact will contribute to the improvement of their postsurgical intensive care experience.