bluuebunny/crossref_metadata_2025 huggingface dataset:
Inside the penal voluntary sector: Divided discourses of “helping” criminalized women
Authors: Quinn Kaitlyn
Published: July 2019

Neoliberal austerity measures and welfare state retrenchment have meant that voluntary organizations around the globe are increasingly called upon to perform statutory social services. Despite a large and rising presence in criminal justice service delivery, volunteers and voluntary organizations have scarcely received scholarly analysis. This paper uses interviews, ethnography, and document analysis to explore the penal voluntary sector in Canada. Specifically, how individuals in the penal voluntary sector understand their roles in helping criminalized women and how these perspectives vary across different positions. This paper illuminates how agents occupying different helper positions cultivate divergent understandings of (and justifications for) the help they provide. Bourdieu’s field theory is mobilized to demonstrate how variegated discourses of helping co-exist, conflict, and impact the relational dynamics of the penal voluntary sector and its engagement with criminalized women.
Experimental investigation of the relationship between thermal barrier coating structured porosity and homogeneous charge compression ignition engine combustion
Authors: Powell Tommy , O’Donnell Ryan , Hoffman Mark , Filipi Zoran , Jordan Eric H , Kumar Rishi , Killingsworth Nick J
Published: July 2019

Heat transfer has a profound influence on homogeneous charge compression ignition combustion. When a thermal barrier coating is applied to the combustion chamber, the insulating effect magnifies the wall temperature swing, decreasing heat transfer during combustion. This enables improvements in both thermal and combustion efficiency without the detrimental impacts of intake charge heating. Increasing the temperature swing requires coatings with lower thermal conductivity and heat capacity. A promising avenue for simultaneously decreasing both thermal conductivity and capacity is to increase the porosity fraction. A proprietary solution precursor plasma spray process enables discrete organization of the porosity structure, called inter-pass boundaries, which in turn produces a step-reduction in thermal conductivity for a given porosity level. In this investigation, yttria-stabilized zirconia is used to create four different thermal barrier coatings to study the potential of structured porosity as means of improving the “temperature swing” behavior in a homogeneous charge compression ignition engine. The baseline coating is “dense YSZ,” applied using a standard air-plasma spray process. Next, significant reductions of the thermal conductivity are achieved by utilizing the solution precursor plasma spray process to create inter-pass boundaries with a moderate overall porosity. Performance, efficiency, and emissions are compared against both a baseline configuration with a metal piston and an air-plasma spray “dense YSZ” coating. Experiments are carried out in a single-cylinder gasoline homogeneous charge compression ignition engine with exhaust re-induction. Experiments indicate that incorporating structured porosity into thermal barrier coatings produces tangible gains in combustion and thermal efficiencies. However, there is an upper limit to porosity levels acceptable for homogeneous charge compression ignition engine application because an elevated porosity fraction leads to excessive surface roughness and undesirable fuel interactions. Comparison of the coatings showed the best results with coating thickness of up to 150  µm. Thicker coatings led to slower surface temperature response and attenuated swing temperature magnitude.
Co-effects of fuel research octane number and ethanol injection ratio on dual-fuel spark-ignition engine
Authors: Qian Yong , Feng Yuan , Jiang Chenxu , Li Zilong , Zhou Qiyan , Lu Xingcai
Published: July 2019

The combustion and emission characteristics of a dual-fuel spark-ignition engine with direct injection of gasoline surrogates and port injection of ethanol were studied. Toluene reference fuel with different research octane number namely TRF#1, TRF#2, TRF#3, TRF#4 and TRF#5 were employed as gasoline surrogates, in which TRF#1 with high octane number was to simulate commercial gasoline under direct-injection spark-ignition mode as comparison. For dual-fuel spark-ignition mode, the ethanol port-injection ratios were 21%, 25%, 29%, 32% and 35%, respectively. The results demonstrated that with the increase of the ethanol ratio, the knock-limited spark timing was advanced gradually. The emissions of hydrocarbon, ethane, propylene, isopentane, cyclohexane and aromatic hydrocarbons reduced while CO, NOx, ethylene, acetaldehyde and ethanol increased. Compared to TRF#1 in direct-injection spark-ignition mode, the indicated thermal efficiencies of dual-fuel spark-ignition mode were slightly lower under most test conditions. When direct injection of TRF#3, TRF#4, TRF#5 and the ethanol ratio was higher than 29%, some of the indicated thermal efficiencies of the engine were consistent with or higher than that of TRF#1 in direct-injection spark-ignition mode. Based on dual-fuel spark-ignition mode and with the assistance of port injection of ethanol, the indicated thermal efficiency of low research octane number fuels was comparable to that of TRF#1 in direct-injection spark-ignition mode.
Use of Digital Photography With Newcomer Immigrant and Refugee Youth to Examine Behaviors and Promote Health
Authors: Sastre Lauren R. , Wright Lauren D. , Haldeman Lauren
Published: July 2019

This project examined health behaviors of newly arrived immigrant and refugee youth through digital photography as part of a health promotion intervention. Students ( n = 23) aged 12 to 17 years at a school for newcomer youth in North Carolina used digital cameras to record dietary and physical activity behaviors, barriers, and promoters in their home environment. Eighteen participants completed individual photography projects that revealed consumption of soda, processed foods, limited calcium-rich foods, and limited evidence of physical activity. Photography project results and topics from nutrition education provided during the program were used to tailor health promotion resources. Students used digital cameras and props to create visual health-promoting materials (e.g., large posters for school hallways) that included and represented the wide range of cultures and ethnicities at the school. Facilitated discussion analysis revealed students preferred positive health promotion messages (health benefits of fruits and vegetables) versus negative (sugar or salt content of foods). Students reported they enjoyed using the cameras and developing materials and that as result of their experience they want to increase fruit and vegetable consumption, reduce sugar sweetened beverages, and increase physical activity. Digital photography shows promise as a tool to identify health behaviors and environmental barriers and to tailor health messages, especially with populations experiencing language, literacy, and/or cultural barriers.
Association Between Individual Components of Metabolic Syndrome and Cognitive Function in Northeast Rural China
Authors: Wang Xue , Luan Dechun , Xin Shimeng , Liu Yang , Gao Qian
Published: July 2019

Aim:

The aim of this article was to examine associations between metabolic syndrome and its individual components with cognitive function among rural elderly population in northeast China.

Methods:

Our study included 1047 residents aged older than 60 years in a northeast rural area. All were interviewed and data were obtained including sociodemographic and medical histories. Cognitive function was assessed by Mini-Mental State Examination. Metabolic syndrome was defined by NCEP-ATP III.

Results:

After adjusted for confounding factors, metabolic syndrome was inversely associated with cognitive function (odds ratio [OR] = 1.79; 95% confidence interval [CI]: 1.06-3.01) especially in participants aged less than 70 years old (OR = 2.60; 95% CI: 1.27-5.26). In addition, participants with metabolic syndrome had worse language function, which is a part of cognitive function (OR = 2.64; 95% CI: 1.39-5.00). Individual metabolic syndrome components, especially abdominal obesity and hyperglycemia, had significant association with cognitive function (OR = 0.72, 95% CI: 0.56-0.92 and OR = 1.41; 95% CI: 1.12-1.78, respectively).

Conclusions:

Abdominal obesity might be a protective factor for cognitive function. However, hyperglycemia might be a risk factor.
Freedom of Expression versus Diversity and Inclusion
Authors: Cushman Thomas
Published: July 2019

Without a movement toward a “rational middle,” one scholar believes the cultural fault lines exposed in the 2016 election will produce a repeat result in 2020.
Social Science Fiction, an Interview with Ada Palmer
Authors: Rojas Fabio
Published: July 2019

Fabio Rojas interviews historian and novelist Ada Palmer.
Freedom and the Iranian Women’s Movement
Authors: Mahmoudi Hoda
Published: July 2019

The women of Iran are intimately familiar with repression and segregation. Iran’s mandatory dress code—veiling—is but one of many restrictions that regulate and control women’s bodies and shape their sense of agency and freedom.
Freedom and Frustration: Rachel Dolezal and the Meaning of Race
Authors: Osuji Chinyere
Published: July 2019

Where ethnoracial boundaries are treated as rigid and real, their consequences are also rigid and real. But if Rachel Dolezal had lived in Brazil, she would have been just another negra frustrada.
A Love That Does Justice
Authors: Brown Myra
Published: July 2019

A photoessay on the Spritus Christi Race Convoy, a church caravan to uncover the civil rights fights of the past and force a way forward.
Broken Justice
Authors: Grau Amy Baumann
Published: July 2019

Amy Baumann Grau on Hard Bargains and Crook County.
Multiplicity in Movements: The Case for Redneck Revolt
Authors: Rothschild Teal
Published: July 2019

Teal Rothschild on the apparent contradictions of a working-class coalition.
Racial Impact Statements Are a Legislative Imperative
Authors: Lewis Jazz
Published: July 2019

Maryland Delegate Jazz Lewis on drafting-out disparities through the use of legislative racial impact statements.
Financial Education and Coaching: A Lifestyle Medicine Approach to Addressing Financial Stress
Authors: White Nicole D. , Packard Kathleen , Kalkowski Julie
Published: July 2019

Economic stability is a well-documented social determinant of health, and financial stress is an important driver for the health disparities observed in the poor. Persons under financial stress are more likely to engage in smoking, alcohol consumption, overspending, poor diet, and reduced exercise. Financial education and coaching is one strategy that can be used to reduce financial stress and potentially improve engagement in healthy lifestyle behaviors, quality of life, and objective health outcomes. A conceptual model describing the link between financial education/coaching and health is described along with preliminary data from a randomized controlled trial evaluating this intervention.
Reclamation of steel shots by acid leaching for powder metallurgy applications
Authors: Jie Yu Jun , Kamaruddin Shahrul , Mustapha Mazli , Siddiquee Arshad Noor , Al-Ahmari Abdulrahman , Khan Zahid A , Abidi Mustufa Haider , Gangil Namrata
Published: July 2019

Acid leaching is extensively employed for extractive metallurgy, but its use on reclamation of shot blasting media has not been extensively studied. The parameters of acid leaching process such as rate of stirring, the leached material grain size, the solid (material) to liquid (acid) ratio, type of acid, concentration of acid, leaching temperature, and leaching duration govern the effectiveness of this process. The goal of this article is to investigate the effectiveness of acid leaching to recover the iron from used shot blasting media. Influence of varying leaching durations on the recovery percentage of iron from the used shot blasting media is investigated, and it is found that acid leaching can remove impurities from used shot blasting media and it can successfully recover 73.6% of iron on the particle surface level and 44.3% of iron overall. Hence, it is a feasible process for recovery of iron from used shot blasting media.
Control strategies for cleaning robots in domestic applications: A comprehensive review
Authors: Kim Jaeseok , Mishra Anand Kumar , Limosani Raffaele , Scafuro Marco , Cauli Nino , Santos-Victor Jose , Mazzolai Barbara , Cavallo Filippo
Published: July 2019

Service robots are built and developed for various applications to support humans as companion, caretaker, or domestic support. As the number of elderly people grows, service robots will be in increasing demand. Particularly, one of the main tasks performed by elderly people, and others, is the complex task of cleaning. Therefore, cleaning tasks, such as sweeping floors, washing dishes, and wiping windows, have been developed for the domestic environment using service robots or robot manipulators with several control approaches. This article is primarily focused on control methodology used for cleaning tasks. Specifically, this work mainly discusses classical control and learning-based controlled methods. The classical control approaches, which consist of position control, force control, and impedance control , are commonly used for cleaning purposes in a highly controlled environment. However, classical control methods cannot be generalized for cluttered environment so that learning-based control methods could be an alternative solution. Learning-based control methods for cleaning tasks can encompass three approaches: learning from demonstration (LfD), supervised learning (SL), and reinforcement learning (RL). These control approaches have their own capabilities to generalize the cleaning tasks in the new environment. For example, LfD, which many research groups have used for cleaning tasks, can generate complex cleaning trajectories based on human demonstration. Also, SL can support the prediction of dirt areas and cleaning motion using large number of data set. Finally, RL can learn cleaning actions and interact with the new environment by the robot itself. In this context, this article aims to provide a general overview of robotic cleaning tasks based on different types of control methods using manipulator. It also suggest a description of the future directions of cleaning tasks based on the evaluation of the control approaches.
Nonactic Acid Derivatives Isolated From Streptomyces werraensis IFM12104 in a Screening Program for BMI1 Promoter Inhibitory Activity
Authors: Yokoyama Yusuke , Arai Midori A. , Hara Yasumasa , Ishibashi Masami
Published: July 2019

Upon screening for compounds with B cell-specific Moloney murine leukemia virus region 1 (BMI1) promoter inhibitory activity, 3 nonactic acid derivatives (1-3) were isolated from Streptomyces werraensis IFM12104. Although spectral data of compound 1 were identical with those reported in literature for 4α-(3, 5-dihydroxy-heptyl)-3α-methyl-2-oxetanone (4), compound 1 was revealed to be homononactic acid by X-ray analysis. Compounds 2 and 3 were identified as bishomononactic acid and nonactic acid using spectral data. The 3 compounds 1 to 3 inhibited BMI1 promoter activities with IC50 values of 240, 160, and 180 μM, respectively.
Antioxidant and Antimelanogenesis Activities of Glyasperin A From Macaranga pruinosa Leaves
Authors: Arung Enos T. , Sinamabela Jhonner R. , Rosamah Enih , Kusuma Irawan W. , Kuspradini Harlinda , Alam Ahmed E. , Amen Yhiya , Tanaka Hiroyuki , Satria Dedi , Shimizu Kuniyoshi , Ishikawa Hiroya
Published: July 2019

In our effort to find materials for drugs and cosmetics from tropical natural resources, we screened 21 methanol extracts from 7 Macaranga trees species ( Macaranga bancana, Macaranga gigantea, Macaranga hulle ttii, Macaranga pruinosa, Macaranga tanarius, Macaranga trichocarpa, and Macaranga triloba) for antioxidant and antimelanogenesis. The antioxidant and melanogenesis (tyrosinase enzyme assay and melanin inhibitor in B16 melanoma) assays were used to determine the activities. The fractionation and the isolation of active compound were done by various chomatographic methods and the structure was determined by spectroscopic analysis data. We isolated a prenylated flavonoid, named Glyasperin A, from M. pruinosa leaf. This compound showed a potency as antioxidant and inhibited melanin in B16 melanoma but not tyrosinase activity. These results showed that the methanol leaf extracts of M. pruinosa could be developed for cosmetic applications especially as a skin whitening agent.
Changes in peripheral and central sensitization in patients undergoing occipital nerve stimulation
Authors: Wodehouse Theresa , Bahra Anish , Mehta Vivek
Published: July 2019

Introduction:

Central sensitization and impaired conditioned pain modulation (CPM) response have been reported to contribute to migraine progression. Migraine patients can present with allodynia possibly attributed to increased sensitivity of peripheral ends of nociceptors with both peripheral and central sensitization. Occipital nerve stimulation (ONS) works by stimulating the distal branches of C1, C2 and C3 possibly altering the nociceptive traffic to the trigemino-cervical complex, brainstem and supranuclear connections.

Aims:

This observational study explores peripheral and central sensitization in patients undergoing percutaneous ONS.

Methods:

Following local regulatory approval, 13 patients undergoing ONS with dual Octrode 90 cm leads and rechargeable implantable pulse generator (IPG) (St Jude) were recruited to have quantitative sensory testing (QST) pre- and post-procedure 2 weeks, 1, 3, 6 and 12 months.

Results:

Patients with intractable migraine demonstrated impaired CPM (mean baseline pressure pain thresholds (PPTs): 61.98 kPa vs 48.01 kPa cuff inflated) prior to ONS, reverting to an efficient CPM response within 2 weeks following ONS implant (68.9 kPa vs 104.5 kPa cuff inflated) and continuing positively over the next 12 months. In contrast, no statistical difference was observed in PPTs.

Conclusion:

This is the first reported observation highlighting the effects on central sensitization following ONS. A consistent and sustained improvement in CPM was observed in contrast to PPT’s where there was no difference. Normalisation of the CPM response following ONS indicates that the treatment may reduce central sensitization in the migraine population.
Respiratory syncytial virus: diagnosis, prevention and management
Authors: Barr Rachael , Green Christopher A. , Sande Charles J. , Drysdale Simon B.
Published: July 2019

Respiratory syncytial virus (RSV) is responsible for a large burden of disease globally and can present as a variety of clinical syndromes in children of all ages. Bronchiolitis in infants under 1 year of age is the most common clinical presentation hospitalizing 24.2 per 1000 infants each year in the United Kingdom. RSV has been shown to account for 22% of all episodes of acute lower respiratory tract infection in children globally. RSV hospitalization, that is, RSV severe disease, has also been associated with subsequent chronic respiratory morbidity. Routine viral testing in all children is not currently recommended by the United Kingdom National Institute for Health and Care Excellence (NICE) or the American Academy of Pediatrics (AAP) guidance and management is largely supportive. There is some evidence for the use of ribavirin in severely immunocompromised children. Emphasis is placed on prevention of RSV infection through infection control measures both in hospital and in the community, and the use of the RSV-specific monoclonal antibody, palivizumab, for certain high-risk groups of infants. New RSV antivirals and vaccines are currently in development. Ongoing work is needed to improve the prevention of RSV infection, not only because of the acute morbidity and mortality, but also to reduce the associated chronic respiratory morbidity after severe infection.
Piercing the corporate veil: Towards a better assessment of the position of transnational oil and gas companies in the global carbon budget
Authors: Choquet Pierre-Louis
Published: July 2019

In recent years, research in climate science has increasingly emphasized the need to reduce fossil fuel supply in order to avoid an overshoot of the global carbon budget and to meet the Paris Agreement target to keep global warming ‘well below 2°C’. This article aims to outline a balanced appreciation of the particular responsibility held by transnational oil and gas companies in the global challenge to organize an equitably managed decline in fossil fuel extraction. It does so by focusing on a case study. The latter consists of the stylized reconstruction of the internal social dynamics that shape the power structure of the French firm Total and of questioning its ability to make investment decisions aligned with the imperative to preserve the stability of the climate system, as its public position makes clear. The persistence of short-termed compensation schemes in the higher corporate hierarchy impedes the elaboration and implementation of deep decarbonization strategies at the firm level. These would imply a significant upscaling of investments in renewable energy and/or carbon-capture storage technologies, in order to avoid the foreseeable destruction of corporate jobs linked to oil and gas extraction in an increasingly carbon-constrained world.
A Primary Care Emergency Service Reduction Did Not Increase Office-Hour Service Use: A Longitudinal Follow-up Study
Authors: Lehto Mika , Mustonen Katri , Kantonen Jarmo , Raina Marko , Heikkinen Anna-Maria K. , Kauppila Timo
Published: July 2019

This study, conducted in a Finnish city, examined whether decreasing emergency department (ED) services in an overcrowded primary care ED and corresponding direction to office-hour primary care would guide patients to office-hour visits to general practitioners (GP). This was an observational retrospective study based on a before-and-after design carried out by gradually decreasing ED services in primary care. The interventions were ( a) application of ABCDE-triage combined with public guidance on the proper use of EDs, ( b) cessation of a minor supplementary ED, and finally ( c) application of “reverse triage” with enhanced direction of the public to office-hour services from the remaining ED. The numbers of visits to office-hour primary care GPs in a month were recorded before applying the interventions fully (preintervention period) and in the postintervention period. The putative effect of the interventions on the development rate of mortality in different age groups was also studied as a measure of safety. The total number of monthly visits to office-hour GPs decreased slowly over the whole study period without difference in this rate between pre- and postintervention periods. The numbers of office-hour GP visits per 1000 inhabitants decreased similarly. The rate of monthly visits to office-hour GP/per GP did not change in the preintervention period but decreased in the postintervention period. There was no increase in the mortality in any of the studied age groups (0-19, 20-64, 65+ years) after application of the ED interventions. There is no guarantee that decreasing activity in a primary care ED and consecutive enhanced redirecting of patients to the office-hour primary care systems would shift patients to office-hour GPs. On the other hand, this decrease in the ED activity does not seem to increase mortality either.
Acceptance and Penetration of Bitcoin: The Role of Psychological Distance and National Culture
Authors: Abraham Juneman , Sutiksno Dian Utami , Kurniasih Nuning , Warokka Ari
Published: July 2019

Previous studies showed that a number of factors play roles in influencing Bitcoin penetration and acceptance, both at country and individual level, such as trust, perceived risk, security threat, perceived benefit, perceived ease of use, as well as macro-technological and socioeconomic factors. This present study aimed at finding theoretical models at the macro- and microlevels that are able to explain the penetration and acceptance. Study 1 examined hypotheses on the predictive relationship between national cultural orientation and Bitcoin penetration involving 60 countries. Study 2, using a construal level perspective, tested the predictive strength of psychological distances against Bitcoin acceptance, involving 565 Indonesians ( Mage = 28.88 years, SDage = 12.482 years). The results showed that national culture of individualism, uncertainty avoidance, and long-term orientation are able to predict the penetration. Spatial/physical distance, social distance, and hypothetical distance are able to predict the acceptance. This research is pivotal in obtaining the fundamental factors of community vulnerability in accepting and endorsing new e-money, i.e. Bitcoin. Monetary policy is expected to consider cultural and psychological factors in intervening against economic–technological disruptive innovations developing among societies.
Riskier Tests of the Validity of the Bifactor Model of Psychopathology
Authors: Watts Ashley L. , Poore Holly E. , Waldman Irwin D.
Published: July 2019

We advanced several “riskier tests” of the validity of bifactor models of psychopathology, which included that the general and specific psychopathology factors should be reliable and well represented by their respective indicators and that including a general factor should improve on the correlated factor model’s external validity. We compared bifactor and correlated factors models of psychopathology using data from a community sample of youth ( N = 2,498) whose parents provided ratings on psychopathology and theoretically relevant external criteria (i.e., personality, aggression, antisociality). Bifactor models tended to yield either general or specific factors that were unstable and difficult to interpret. The general factor appeared to reflect a differentially weighted amalgam of psychopathology rather than a liability for psychopathology broadly construed. With rare exceptions, bifactor models did not explain additional variance in first-order psychopathology symptom dimensions or external criteria compared with correlated factors models. Together, our findings call into question the validity of bifactor models of psychopathology and the p factor more broadly.
Baseline endometriosis-associated pain burden: Data from 1600+ women enrolled in elagolix clinical trials
Authors: Leyland Nicholas , Estes Stephanie J , Eichner Samantha , Soliman Ahmed M , Mai Yabing , Snabes Michael C , Taylor Hugh S , Surrey Eric S
Published: July 2019

Background:

The daily pain burden experienced by women with endometriosis has not been well studied.

Objective:

To characterize baseline pain among women with moderate-to-severe endometriosis-associated pain enrolled in phase 3 studies of elagolix, an oral, nonpeptide gonadotropin-releasing hormone antagonist.

Study design:

Data were pooled from the screening phase of two randomized, double-blind, placebo-controlled clinical trials. After cessation of endometriosis medications, patients entered the screening phase during which symptoms (dysmenorrhea, nonmenstrual pelvic pain, and dyspareunia) and rescue medication use were recorded daily in electronic diaries. Endometriosis-associated pain was also scored using the Numeric Rating Scale (range 0–10). Baseline was defined as the last 35 days during the screening period.

Results:

Endometriosis-associated pain was reported by the 1686 study participants on most days during the baseline interval. Pain was often moderate or severe, with a mean Numeric Rating Scale score of 5.6 ± 1.7. Women reported dysmenorrhea an average of 8.1 ± 3.0 days (97.9% ± 7.0% of menstruating days), nonmenstrual pelvic pain on 20.5 ± 5.4 days (90.3% ± 15.8% of nonmenstruating days), and dyspareunia on 8.7 ± 8.0 days (81.7% ± 29.7% of sexually active days). When they occurred, dysmenorrhea, nonmenstrual pelvic pain, and dyspareunia were frequently moderate or severe in intensity. Women were free of pelvic pain for an average of 2.4 ± 3.9 days during the 35-day evaluation interval.

Conclusion:

Among women with untreated moderate-to-severe endometriosis pain, the daily burden of pain was extensive, both during menstruation and on nonmenstruating days.
An analysis of the causes of transient paraplegia during percutaneous vertebral augmentation under local anesthesia: A case series of 12 patients
Authors: Shi Guan , Feng Fei , Hao Chen , Pu Jia , Li Bao , Tang Hai
Published: July 2019

Background:

Percutaneous vertebral augmentation (PVA) under local anesthesia has been widely used to treat osteoporotic vertebral compression fractures and vertebral body tumors. However, the occurrence of spinal cord or nerve root dysfunction may result in poor prognosis for patients. The aim of this study was to analyze the causes of transient paraplegia in 12 patients undergoing PVA.

Methods:

The medical records of 12 patients with transient paraplegia during PVA in our hospital were analyzed. Data, including operation, vertebral, anesthetic dose, operation time, recovery time, and follow-up, were extracted.

Results:

Among the 12 patients, ranging in age from 62 years to 83 years, with a mean age of 74 years, 8 were females and 4 were males. The average anesthetic dose injected per vertebral body was 6.38 ml. Patients required an average of 218.75 min to recover sensation and movement completely. However, the amount of anesthetic injected into each vertebral body was not related to the time required for complete recovery. Follow-up showed that all patients had regained normal bilateral sensation and motor function. Postoperative visual analog scale and Oswestry Disability Index values of the 12 patients were significantly improved compared with preoperative values.

Conclusion:

The complication of transient paraplegia was caused by local anesthetic drugs infiltrating into the spinal canal and inhibiting nerve conduction in the spinal cord.
Medial Patellofemoral Ligament Reconstruction in Skeletally Immature Patients: A Systematic Review and Meta-analysis
Authors: Shamrock Alan G. , Day Molly A. , Duchman Kyle R. , Glass Natalie , Westermann Robert W.
Published: July 2019

Background:

Given the proximity of the medial patellofemoral ligament (MPFL) femoral insertion to the distal femoral physis in skeletally immature patients, multiple techniques for femoral graft fixation have been described.

Purpose:

To systematically review the literature and evaluate outcomes and complications following MPFL reconstruction in skeletally immature patients.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A comprehensive literature search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines through use of the PubMed, Embase, and Cochrane Central databases. All original, English-language studies reporting outcomes or complications following MPFL reconstruction in skeletally immature patients were included. Skeletally mature patients were excluded. Data regarding demographics, surgical technique, graft type, outcomes, and complications were recorded. Study quality was assessed by use of the modified Coleman methodology score. Statistical analysis was performed through use of chi-square and weighted mean pooled cohort statistics, where appropriate, with significance set at P < .05.

Results:

7 studies that entailed 132 MPFL reconstructions (126 patients) met the inclusion criteria. Females comprised 57.9% of the cohort (73 females), and the mean age was 13.2 years (range, 6-17 years). Mean postoperative follow-up was 4.8 years (range, 1.4-10 years). All of the grafts used were autograft, with gracilis tendon (n = 80; 60.6%) being the most common. Methods of femoral fixation included interference screw (n = 52; 39.4%), suture anchor (n = 51; 38.6%), and soft tissue pulley around the medial collateral ligament or adductor tendon (n = 29; 21.9%). Pooled Kujala scores improved from 59.1 to 84.6 after MPFL reconstruction. The total reported complication rate was 25.0% (n = 33) and included 5 redislocations (3.8%) and 15 subluxation events (11.4%). No cases of premature physeal closure were noted, and there were 3 reports of donor site pain (2.3%). Neither autograft choice ( P > .804) nor method of femoral fixation ( P > .416) influenced recurrent instability or overall complication rates.

Conclusion:

These findings suggest that MPFL reconstruction in skeletally immature patients is a viable treatment option, with significant improvement in patient-reported outcomes and redislocation event rates of less than 5% at nearly 5-year follow-up. Further high-quality research is needed to determine optimal graft options and surgical technique while considering recurrent instability, donor site morbidity, and potential injury to the adjacent physis.
Return to Sport and Exercise Following Repair of the Pectoralis Major Tendon
Authors: Liu Joseph , Gowd Anirudh K. , Garcia Grant Hoerig , Manderle Brandon J. , Beletsky Alexander K. , Nicholson Gregory P. , Cole Brian J. , Forsythe Brian , Verma Nikhil N.
Published: July 2019

Objectives:

Outcomes following repair of the pectoralis major muscle (PMM) is often prone to the ceiling effect due to the high functional demand of those that sustain this injury. A thorough evaluation of return to exercise and sport is beneficial to set patient expectations.

Methods:

A prospectively maintained institutional database was retrospectively reviewed for all patients undergoing PMM repair since 2010 with minimum 24-month follow-up. Patients were surveyed over phone with regard to preoperative and postoperative participation in sports, level of intensity, and maximum weight repetitions of barbell bench press, dumbbell bench press, dumbbell fly, and consecutive push-ups. American shoulder and elbow (ASES) and single assessment numeric evaluation (SANE) scores were also collected preoperatively and at final follow-up.

Results:

Forty-four patients (73.3%) were available for final follow-up. All patients were male. Mean follow-up was 51.1 ± 24.1 months. Mean age was 39.6 ± 8.8 and mean BMI was 28.6 ± 3.5. The dominant side was affected in 20/44 cases. The injury mechanism was reported to be during weightlifting in 59.1%, during sport in 20.5%, during work in 13.6%, and during accidental trauma in 6.8% of patients. There were statistically significant improvements in both ASES and SANE (p<0.001, respectively). Return to sport at any level was achieved by 43/44 (97.7%) patients, while 22/44 patients (50.0%) reported returning to sport at same or better intensity as pre-injury status. On average, there was a 23.3 ± 45.6% decrease in 1RM barbell bench press, 14.7 ± 62.3% decrease in 5RM barbell bench press, 24.3 ± 21.8% decrease in 1RM dumbbell bench press, 35.7 ± 32.1% decrease in 1RM dumbbell fly, and 15.6 ± 39.8% decrease in consecutive push-ups able to be performed (Figure 1). Seventeen patients (38.6%) reported degree of apprehension that affected their ability to lift weights. When accounting for all preoperative variables, history of surgery to the opposite shoulder (OR: 0.600, 95% CI: 0.389, 0.925) and acute repairs (OR: 0.745, 95% CI: 0.559, 0.993) were associated with decreased likelihood to return to sport at same or better level of intensity. Injury sustained during sport was associated with greater likelihood of returning to sport at same or better level (OR: 2.231, 95% CI: 0.389, 0.925) (Table 1).

Conclusion:

Patients undergoing repair of the PMM are expected to have significant improvements in function of the shoulder. Yet, roughly 50% achieve return to preoperative intensity of sport and there are significant reductions in ability to weightlift. Patients should be counseled to appropriately set expectation prior to surgery and rehabilitation. [Figure: see text][Table: see text]
Opioid Use is Reduced in Patients Treated with NSAIDS After Arthroscopic Shoulder Instability Repair: A Randomized Study
Authors: Thompson Kamali A. , Klein David S. , Gonzalez-Lomas Guillem , Alaia Michael Joseph , Strauss Eric Jason , Jazrawi Laith M. , Campbell Kirk A.
Published: July 2019

Objectives:

The current opioid epidemic necessitates physicians to seek ways to decrease patients’ requirements of narcotic medications without sacrificing their postoperative comfort level. This study evaluated patients’ pain following arthroscopic shoulder instability repair and compared the use of narcotic medications between patients prescribed NSAIDs with rescue opioid prescription to those prescribed opioids alone. We hypothesized there would not be a significant difference in postoperative pain and addition of NSAIDs would result in decreased opioid use.

Methods:

Forty patients scheduled to undergo an arthroscopic shoulder instability repair were randomized to receive Ibuprofen 600 mg and a 10-pill rescue prescription of Percocet 5/325 mg (n=20) or Percocet 5/325 mg (n=20). Primary outcomes were the amount of Percocet tablets used in the first week and VAS on postoperative day (POD) 1, 4, and 7. Statistical analysis was done using independent t-tests and bivariate analysis for correlation. Findings were considered significant at p<0.05.

Results:

Forty patients with a mean age of 35.08 (± 8.48)were enrolled between December 2017 and May 2018. The total amount of opioid consumption was statistically significantly lower in the multimodal group compared to the opioid group (p <0.04) as well as Percocet consumption between POD 0-4 (p <0.04). There were no significant differences in VAS at any point between the two groups. One patient in the Ibuprofen cohort experienced dizziness on POD 1. Two patients in the Percocet cohort experienced nausea and vomiting on POD 1 and POD 4.

Conclusion:

Multimodal analgesia using NSAIDs with an opioid rescue prescription has resulted in significant reduction in postoperative narcotic consumption. As both cohorts showed similar pain levels, it is possible to alleviate postoperative pain with lower amounts of opioids than are currently being prescribed. The public health crisis of opioid abuse requires an immediate solution beginning with the reduction of post-operative narcotics distribution.
The Incidence of Chronic Opioid Use Following Arthroscopic Rotator Cuff Repair and Patient Opioid Education
Authors: Weekes Danielle G. , Feldman Jenna A. , Campbell Richard E. , DeFrance Michael , Tjoumakaris Fotios P. , Austin Luke
Published: July 2019

Objectives:

Opioids are commonly prescribed for pain management following Arthroscopic Rotator Cuff Repair (ARCR). While their efficacy outweighs their risks in the short term, chronic opioid use is associated with significant adverse effects, such as dependence, endocrine imbalance or respiratory depression. The rate of chronic opioid use and dependence following ARCR is unknown. The purpose of this study is to determine the rate of chronic opioid use following ARCR and establish the effect of preoperative opioid education on reducing chronic consumption. A secondary aim is to determine if any correlation exists between chronic opioid use and shoulder functionality.

Methods:

A prospective, randomized study of 140 patients undergoing ARCR was performed with a minimum follow-up of 24 months. Patients were randomized to receive preoperative opioid education (risks of abuse, dependence, etc.) or no education. State registry database opioid prescription data monitoring software were utilized to search for all opioid prescriptions following ARCR in our patient population and this was compared to our electronic medical database for accuracy/discrepancy. The total number of opioid prescriptions and number of tablets was determined as well as time from surgery to most recent prescription. Patients were contacted to determine a shoulder Single Assessment Numeric Evaluation (SANE) score and Visual Analog Scale (VAS) pain score. Categorical data was analyzed via chi-squared tests as appropriate. Numeric data was analyzed using t-tests as appropriate.

Results:

Forty-five patients (32%) continued to fill opioid prescriptions chronically following ARCR. Seventeen (38%) of these patents received pre-operative opioid educated, whereas twenty-eight (62%) did not (p=0.05). Sixty percent of patients with a history of pre-operative opioid use continued to take opioids, while 23% of opioid naive patients continued (p< 0.01). There was no significant difference in SANE (p= 0.53) or VAS (p= 0.65) scores between the education and control group. Patients taking opioids prior to surgery had worse SANE scores (71.28) than the non-users (86.28), p< 0.01.

Conclusion:

Almost a third of patients will chronically use opioids following ARCR, including 23% of opioid naive patients. Preoperative opioid use is strongly associated with chronic opioid utilization, as well as decreased shoulder function 2 years after ARCR. Preoperative opioid education significantly decreased the rate of chronic opioid use; however, there is no effect on long-term shoulder function. [Table: see text]
Functional Results and Outcomes After Repair of Partial Proximal Hamstring Avulsions at Mid-term Follow-up
Authors: Arner Justin W. , Frieman Halle , Bradley James P.
Published: July 2019

Objectives:

Although surgical outcomes of complete hamstring avulsions are well established, the literature evaluating partial proximal hamstring repair is limited to a single study of 17 patients at short-term follow-up. Therefore, assessment of postsurgical outcomes in active patients after primary repair of acute and chronic partial proximal hamstring tears was performed.

Methods:

Thirty-seven patients with partial tears of the proximal hamstring origin treated with surgical fixation by a single surgeon were reviewed at 2-year minimum follow-up. All patients failed a minimum of 6 months of initial nonoperative treatment. Patient-reported outcome scores included Lower Extremity Functional Score (LEFS), Marx activity rating scale, custom LEFS and Marx scales, and total proximal hamstring score.

Results:

Nine male and 25 female (total=37) patients with an average age of 46.4 years (range=16-65) were reviewed at average 6.6 year (range=2-12.5) follow-up. Average postoperative LEFS was 96 (range=79-100) with custom LEFS being 91 (range=39-100). The mean Marx score was 12.7 (range=4-16). Marx custom score demonstrated no disability with activities of daily living. Mean total proximal hamstring score was 95 (range=69-100). No difference in any outcome measures were seen when comparing acute vs. chronic repairs. No patient underwent future hamstring surgery. No patients reported symptoms of numbness in the operative extremity at rest while 1 patient had a superficial stitch abscess treated with antibiotics alone. All (37/37) were satisfied with surgery, 83.7% reported they could participate in strenuous activity, and 94.6% estimated their strength to be >75% while 62.2% to be 100% of their contralateral side.

Conclusion:

Both acute and chronic anatomic surgical repair of partial proximal hamstring avulsions leads to successful functional outcomes, a high rate of return to athletic activity, and low complication rate at 6.6-year follow-up. Non-operative treatments should first be attempted including physical therapy with platelet rich plasma (PRP) injections as a possible adjunct.
Meniscus Repair Outcomes with and without Bone Marrow Aspiration Concentrate
Authors: Massey Patrick Allan , Zhang Andrew , Stairs Christine Bayt , Hoge Stephen , Carroll Trevor , Hamby Ashley Marie
Published: July 2019

Objectives:

The purpose of the current study is to review the results of meniscus repairs with and without bone marrow aspiration concentrate (BMAC). It is hypothesized that with BMAC, meniscus repair outcomes will be improved when compared to without BMAC at 1 year after surgery.

Methods:

This is a prospective case control study performed from August 2014 until August 2017. Patients were included if they had a meniscus repair performed with no history of prior meniscus surgery to the operative knee. Patients were excluded if there was a full thickness cartilage tear or International Cartilage Repair Society (ICRS) Grade IV cartilage tear not treated in a single staged surgery. Patients were also excluded if they did not reach the one year follow-up, had a multi-ligamentous knee injury requiring multiple staged procedures. From August 2014 until November 2015, patients had meniscus repair without BMA. Menisci were all repaired arthroscopically using inside-out, outside-in and all-inside techniques. After November 2015, all meniscus repairs were augmented with BMAC. In the BMAC group, all bone marrow was obtained from the ipsilateral femur during the time of surgery. The Biocue BMAC system (Zimmer Biomet, Warsaw Indiana) was used for bone marrow aspiration and BMAC was injected directly into the tear site after repair. Numerical data such as VAS, lysholm and IKDC was analyzed using a 2 sample T-test. Categorical data such as sex, tear location, type of tear and zone of tear were analyzed using a chi-square.

Results:

A total of 150 patients were initially included in the study. The average age in the control group was 26.3 versus 29.4 in the BMAC group (P=0.27). Thirty seven percent of the control group had an ACL reconstruction versus 40% in the BMAC group (P= .77). The control group improved from an average pain level of 6.1 to 1.2 and the BMAC group improved from an average pain level of 5.9 to 0.7 at the 1 year end point. Both the control group and BMAC group improved with respect to pain with no difference at the 1 year end point (P=.19). There was, however a significantly larger reduction in pain at the 6 week and 3 month time point with BMAC compared to the control group (P=.02 and P=.02 respectively). At the 1-year follow-up, the mean lysholm score improved from 43 to 92 in the control group and 43 to 90 in the BMAC group. The mean IKDC score improved from 37 to 87 in the control group and 36 to 83 in the BMAC group at the one year follow-up.

Conclusion:

Meniscus repair outcomes were improved at 6 weeks and 3 months post-operatively, when BMAC is used to augment meniscus repair compared to repair without BMAC. Both groups, control group and BMAC meniscus repair group had improved outcomes at 1 year post-operatively with respect to VAS, lysholm and IKDC, with no difference in complication rate.