bluuebunny/crossref_metadata_2025 huggingface dataset:
Mobile applications for breast cancer survivorship and self-management: A systematic review
Authors: Kapoor Akshat , Nambisan Priya , Baker Elizabeth
Published: August 2020

The use of mobile technology and mobile apps has become pervasive in our daily lives for completing a variety of daily tasks. Mobile health (mHealth) apps can provide an accessible platform for self-management among breast cancer (BC) survivors, as they recover from not just the intensive cancer treatments, but also their associated side-effects. They also offer a means to learn about survivorship topics and connect with peer survivors online, irrespective of their geographical location. This study is an attempt to assess the availability and characterize the self-management features of free mobile apps for breast cancer survivors on the Google Play (Android) and Apple App Store (iOS). Out of 249 such apps for the Android, only eight satisfied initial criteria, while only one of 174 iOS apps that met inclusion criteria was included for further analysis. A content analysis of the nine apps that met inclusion criteria was conducted to assess the inclusion of the following mHealth self-management features derived from the Chronic Care Model: symptom tracking; survivorship education; information-sharing with family and/or caregivers; scheduling follow-up visits; personal alerts and reminders; and social networking. Survivorship education was found to be the most common self-management feature among the apps reviewed, followed by social networking. The results of this study highlight the dearth of available mHealth resources for BC survivors. Future efforts in app development should involve survivors and healthcare providers to ensure comprehensive resources that address their unmet needs are made more accessible.
Building knowledge for policy and practice based on service user and carer experiences: A case study of Scottish adult safeguarding research
Authors: Sherwood-Johnson Fiona , Mackay Kathryn
Published: August 2020

This article presents Scottish adult safeguarding as a case study to illuminate some challenges of building knowledge for policy and practice based on service user and carer voices. It draws on five of our own research projects that have evaluated implementation of Scottish adult safeguarding legislation and/or asked more exploratory questions about risk, safety and support.

Findings

We show how practical and ethical issues limited our more evaluative lines of inquiry. We then show how increasingly participative approaches led to studies that were more accessible and that connected more deeply with service users’ and carers' lives, but that also faced greater challenges in the translation of their findings back into the policy and/or practice environment.

Applications

We conclude with an argument for ongoing dialogue between policy-makers, professionals, service users and carers, researchers, educators and students about knowledge, its different forms and sources, its generation and its use.
The need for palliative and support care services for heart failure patients in the community
Authors: Ganz Freda DeKeyser , Roeh Keshet , Eid Muhammad , Hasin Tal , Harush Chen , Gotsman Israel
Published: August 2020

Background

Palliative care is a care option considered appropriate for those with heart failure, but is uncommon partially due to a lack of timely identification of those needing palliative care. A standard mechanism that triggers which heart failure patients should receive palliative care is not available. The Gold Standards Framework (GSF) identifies those needing palliative care but has not been investigated with heart failure patients.

Objectives

To describe palliative care provided in the community and determine whether the GSF can identify heart failure patients in need of palliative care.

Methods

Descriptive study. A total of 252 heart failure patients in the community completed a demographic characteristics questionnaire, the Edmonton symptom assessment scale-revised and the Minnesota living with heart failure questionnaire. Clinical data were collected from the medical chart and the primary physician completed the GSF prognostic indicator guidance.

Results

Participants had a mean age of 76.9 years (standard deviation 10.9), most at New York Heart Association level III (n = 152, 60%). Fewer than half received pain medications (n = 76, 30%), anxiolytics (n = 35, 14%), antidepressants (n = 64, 25%) or sleep medications (n = 65, 26%). Eight patients spoke with a psychologist or psychologist (3%). One had an advanced directive and 16 (6%) had a record of discussions with their family caregivers. Three (1%) had end-of-life discussions with their healthcare providers. Most healthcare providers responded ‘no’ to the ‘surprise question’ (n = 160, 63%). Sensitivity and specificity of the gold standards framework was poor.

Conclusions

Few community dwelling heart failure patients received most aspects of palliative care. The gold standards framework was not a good indicator of those who should receive palliative care.
Deep learning–based roadway crack classification with heterogeneous image data fusion
Authors: Zhou Shanglian , Song Wei
Published: August 2020

By providing accurate and efficient crack detection and localization, image-based crack detection methodologies can facilitate the decision-making and rehabilitation of the roadway infrastructure. Deep convolutional neural network, as one of the most prevailing image-based methodologies on object recognition, has been extensively adopted for crack classification tasks in the recent decade. For most of the current deep convolutional neural network–based techniques, either intensity or range image data are utilized to interpret the crack presence. However, the complexities in real-world data may impair the robustness of deep convolutional neural network architecture in its ability to analyze image data with various types of disturbances, such as low contrast in intensity images and shallow cracks in range images. The detection performance under these disturbances is important to protect the investment in infrastructure, as it can reveal the trend of crack evolution and provide information at an early stage to promote precautionary measures. This article proposes novel deep convolutional neural network–based roadway classification tools and investigates their performance from the perspective of using heterogeneous image fusion. A vehicle-mounted laser imaging system is adopted for data acquisition (DAQ) on concrete roadways with a depth resolution of 0.1 mm and an accuracy of 0.4 mm. In total, four types of image data including raw intensity, raw range, filtered range, and fused raw image data are utilized to train and test the deep convolutional neural network architectures proposed in this study. The experimental cases demonstrate that the proposed data fusion approach can reduce false detections and thus results in an improvement of 4.5%, 1.2%, and 0.7% in the F-measure value, respectively, compared to utilizing the raw intensity, raw range, and filtered range image data for analysis. Furthermore, in another experimental case, two novel deep convolutional neural network architectures proposed in this study are compared to exploit the fused raw image data, and the one leading to better classification performance is determined.
Reconstruction of cumulative daylight illumination fields from high dynamic range imaging: Theory, deployment and in-situ validation
Authors: Mardaljevic J , Cannon-Brookes S , Blades N , Lithgow K
Published: August 2020

A novel high-dynamic range camera-based approach to measure the cumulative daylight dose in historic/conservation spaces has been devised and tested in a real-world setting under normal viewing conditions. The technique derives illuminance from the high-dynamic range-acquired luminance at numerous patches of the wall surfaces visible in the high-dynamic range image. These patches serve as proxy illuminance meters, thereby allowing the prevailing illumination field across the entire visible wall to be derived using a Kriging algorithm. The technique was validated under both controlled and in-situ conditions over periods of several months and shown to have comparable accuracy to the illuminance logging devices commonly used in historic/conservation settings. The set-up comprising a consumer digital camera and tethered computer proved remarkably resilient and allowed for continuous monitoring periods of six months or more. Application in a real-world setting revealed operational practicalities that would not have been found in a controlled environment.
Pole Test and Ankle-Brachial Index by Using Doppler Ultrasound for Peripheral Arterial Disease in End-Stage Renal Disease Patients
Authors: Tungsrirut Nutthanun , Taptiang Krittitee , Charoenkarn Kairawee , Piyachon Pavarit , Srisittipoj Pitipong , Rerkasem Kittipan
Published: August 2020

Peripheral arterial disease (PAD) causes great disability in end-stage renal disease (ESRD). Pole test is a simplified test utilizing the basis of Doppler ultrasound invented to correct false elevation in ankle-brachial index (ABI) in diabetic patients with severe calcification of the tibial artery. However, the role of pole test in ESRD patients is still unclear. The aim of this study was to explore the sensitivity, specificity, and overall utility of pole tests in such patients. One hundred and four patients were recruited and examined with 3 tests: pole test, ABI, and toe-brachial index, the latter serving as the gold standard. Receiver operating characteristic analysis was performed using SPSS version 22.0. The sensitivity, specificity, and other diagnostic values of ABI and pole tests were calculated. There were 104 ESRD patients enrolled. Pole tests showed to have low probability to provide accurate results (area under the curve = 0.505, standard error = 0.042). Low sensitivity of ABI (34.96%) can be observed in ESRD patients. Specificity, positive predictive value, and negative predictive value of ABI in all cases were, respectively, 85.91%, 81.13%, and 43.26%. It is concluded that pole test accuracy seemed to be limited in ESRD patients. ABI was found to be confounded by medial arterial calcification, resulting in low sensitivity as well. The results of this study permit the observation that an optimal tool for screening peripheral arterial disease in ESRD patients remains to be discovered.
An Analytic Hierarchy Process approach using multiple raters for the selection of complex technologies
Authors: Wood James B , Mason Jessica L , Bianchini Alessandra
Published: August 2020

The Department of Defense utilizes complex technologies in numerous fields; each technology must comply with specific parameters and system capabilities. In this selection of a complex technology best meeting prescribed capabilities, the parameter set includes nine areas, which have sub-areas. To handle the complexity of the process, the team identified the Analytical Hierarchy Process (AHP), a methodology providing a reliable solution. The AHP produced an importance coefficient for each area and sub-area, which were combined in the final phase of the ranking process. Users and technical support personnel agreed that the selected system met the requirements, field operational needs, and maintenance requisites. The AHP approach represents a viable tool to handle group decisions in support of technology management and related selection processes.
Safety and Efficacy of Using Staplers and Vessel Sealing Devices for Laparoscopic Splenectomy: A Randomized Controlled Trial
Authors: Fathi Adel , Elmoatasembellah Mansour , Senbel Ahmed , Shahatto Fayez , Eldamshety Osama , Shetiwy Mosab , Abdel Wahab Khaled , Abouzid Amr , Setit Ahmed
Published: August 2020

Background. Laparoscopic splenectomy (LS) is considered the operation of choice on elective basis for managing patients with certain hematological disorders. Hemostatic control of the splenic pedicle is one of the crucial steps in LS. This study compares the safety and efficacy of using endoscopic staplers and vessel sealing devices to control the splenic pedicle in patients with nonsevere splenomegaly. Methods. Fifty-one consecutive patients with different blood disorders including idiopathic thrombocytopenic purpura (ITP), hypersplenism, and lymphoma were randomized for elective LS. Traditional steps of LS, via lateral approach, were followed, and pedicle control was done with either endovascular gastrointestinal anastomosis stapler (n = 26) or vessel sealing device (Ligasure) (n = 25). Results. No difference was noted with different splenic spans when using either methods of pedicle control ( P = .145). The volume of blood loss was higher in the Ligasure group compared to the staplers group (182 mL vs 131 mL, respectively), but was not statistically significant ( P = .249). Conversion to open was notably higher in the Ligasure group ( P = .034), but the intraoperative complications were comparable in both groups ( P = .357). Conclusion. The use of vessel sealing devices for splenic pedicle control has comparable surgical outcomes compared with the use of endoscopic staplers for LS, but with higher rate of conversion to open surgery.
Evaluation of the Seesaw Test as New Diagnostic Test for Thumb CMC Osteoarthritis
Authors: Arnold Denise M. J. , Gottlieb Rachel , Wilkens Suzanne C. , Garg Rohit , Nazzal Adam , Chen Neal C. , Lee Sang-Gil
Published: August 2020

Background:

The seesaw test consists of flexion and extension of the thumb metacarpal on the trapezium, with continuous axial pressure to keep the metacarpal base reduced in the carpometacarpal (CMC) joint. We aim to evaluate this maneuver compared with the grind test.

Methods:

We prospectively enrolled 80 participants from March 2017 to March 2018 at a single institution, excluding those who had previous thumb surgery or pathology. Each participant underwent both seesaw and grind tests by 2 independent examiners. We included 24 patients with a mean age of 73 years in the CMC osteoarthritis group (Eaton stages 2-4) and 44 patients with a mean age of 66 years in the control group (Eaton stages 0 and 1). We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and multirater κ measure.

Results:

The seesaw test had a higher sensitivity than the grind test (42%-71% vs 13%-17%), but a lower specificity (82%-86% vs 91%-98%). The PPV was more consistent between examiners for the seesaw test (63%-68% vs 42%-80%), and the NPV was higher (73%-84% vs 66%-68%). There was a slight agreement between the attending surgeon and the fellow performing the grind test (κ = 0.08) and a moderate agreement between the attending surgeon and the fellow performing the seesaw test (κ = 0.59).

Conclusions:

The seesaw test is superior to the grind test, with a much higher sensitivity, slightly lower specificity, more consistent PPV, and slightly higher NPV. Therefore, the seesaw test could be a valuable addition or even replacement for the grind test, and we recommend considering it in daily practice.
Health system experiences of breast cancer survivors in urban South Africa
Authors: Lambert Madeleine , Mendenhall Emily , Kim Andrew Wooyoung , Cubasch Herbert , Joffe Maureen , Norris Shane A
Published: August 2020

Background:

Breast cancer is the most common cancer globally and among South African women. Women from socioeconomically disadvantaged South African communities more often present later and receive total mastectomy compared to those from more affluent communities who have more breast conserving surgery (which is less invasive but requires mandatory radiation treatment post-operatively). Standard chemotherapy and total mastectomy treatments are known to cause traumatizing side effects and emotional suffering among South African women; moreover, many women face limited communication with physicians and psychological support.

Objective:

This article investigates the experiences of women seeking breast cancer treatment at the largest public hospital in South Africa.

Methods

We interviewed 50 Black women enrolled in the South African Breast Cancer Study to learn more about their health system experiences with detection, diagnosis, treatment, and follow-up care for breast cancer. Each interview was between 2–3 hours, addressing perceptions, experiences, and concerns associated with breast cancer and comorbidities such as HIV and hypertension.

Results:

We found most women feared diagnosis, in part, because of the experience of chemotherapy and physical mutilation related to mastectomy. The importance of social support from family, religion, and clinical staff was fundamental for women coping with their condition and adhering to treatment and medication.

Conclusions:

These findings exemplify how interventions might promote early detection of breast cancer and better adherence to treatment. Addressing community perceptions of breast cancer, patient needs and desires for treatment, structural barriers to intensive therapies, and the burden of invasive treatments are imperative next steps for delivering better breast cancer care in Soweto and other resource-constrained settings.
The Role of Endoscopic Sinus Surgery in Children Undergoing External Drainage of Non-Medial Subperiosteal Orbital Abscess
Authors: Chorney Stephen R. , Buzi Adva , Rizzi Mark D.
Published: August 2020

Background

The extent of surgery required in the management of pediatric non-medial subperiosteal orbital abscess (SPOA) due to medically refractory complicated acute sinusitis is unknown.

Objectives

The primary objective is to compare operative outcomes of children treated with combined endoscopic sinus surgery (ESS) and external orbital drainage (EOD) versus those treated with EOD alone.

Methods

Retrospective case series from a tertiary children’s hospital analyzing outcomes in children requiring surgical management for acute sinusitis complicated by non-medial SPOA between November 2007 and September 2019.

Results

Sixteen children with a mean age of 9.4 years (95% CI: 7.3–11.4) met inclusion. Eleven (68.8%) underwent combined EOD and ESS, while five (31.2%) underwent EOD alone. Groups were similar in age, symptom duration, white blood cell count, C-reactive protein level, intraocular pressure, Lund-Mackay score, and abscess volume. There was no significant difference in median length of stay between patients treated with a combined approach versus those treated by EOD alone. Cultures identified non-beta-hemolytic Streptococcus species in 56.3% of patients, with Streptococcus intermedius representing the most common organism in 37.5%. In one case, ESS identified a pathogen not acquired via concomitant EOD, which did influence management. No child required a subsequent surgical procedure and there were no operative complications.

Conclusions

The addition of ESS in the management of pediatric non-medial SPOA was not associated with a statistically different duration of hospitalization. Cultures from concomitant ESS rarely aided in diagnosis or antibiotic therapy. Further study should delineate the indications for ESS in these cases.
All diseased things are critics
Authors: Stormer Nathan
Published: August 2020

This essay argues that pathology as an analytical form functions as the ethical critique of mutual vulnerability. In the broad sense of assessing what is life-giving and life-taking, a sustained critical engagement with pathological forms circulating through public life positions the study of rhetoric as a kind of immunotherapy for democracy. In that sense, embracing pathology as a critical analytic accepts biopower (expansively construed) as the operative framework for politics, which would seem like a kind of surrender to life-under-assault as the landscape of power. However, if wounds and their pathologies are understood as ethically ambiguous, it is possible to envision the critical potential of pathologia not only as immunotherapeutic but also as constitutive of new configurations of being together. Contrasted with a conception of pathology that presupposes a fixed difference between vital and morbid conditions, it is suggested that pathology be more precisely considered as the ethically ambiguous project of defining vitality and life that is “more than normal.”
Impact of IL-10 gene polymorphisms and its interaction with environment on susceptibility to systemic lupus erythematosus
Authors: Wang Gui-Hong , Zuo Ting , Zuo Zheng-Cai
Published: August 2020

This study aims to explore the impact of interleukin (IL)-10 single nucleotide polymorphisms (SNPs) and its interaction with environment on the risk of systemic lupus erythematosus (SLE). Chi-square testing method was used to investigate whether the distributions for genotype of four SNPs were differed from Hardy-Weinberg equilibrium (HWE). Logistic regression was used to test the association between IL-10 SNPs and SLE risk. The best interaction combinations between IL-10 SNPs and environmental factors were assessed by generalized multifactor dimensionality reduction (GMDR). Both rs1800896-G and rs1800871-T alleles were associated with increased risk of SLE, the odds ratios (ORs) (95% confidence interval (CI)) for the two SNPs were 1.68 (1.25–2.09) and 1.47 (1.12–1.94), respectively. Then, we used the GMDR method to analyze the high-order interactions of four SNPs within IL-10 gene and environmental factors on SLE risk. We found a significant interaction combination (two-locus model with P = 0.001) between rs1800896 and smoking, after adjusting for gender, age, body mass index (BMI), and alcohol drinking. We also used two-variable stratified analysis by logistic regression to analyze the synergistic effect between two variables (rs1800896 and smoking), which had significant significance in GMDR model. We found that current smokers with rs1800896-AG or GG genotype have the highest SLE risk, compared with never smokers with the rs1800896-AA genotype, OR (95% CI) = 2.24 (1.52–3.58). The rs1800896-G and rs1800871-T alleles and interaction between rs1800896 and current smoking were all associated with increased risk of SLE.
Development of a Questionnaire to Assess Patient Priorities in Hip Fracture Care
Authors: Turner Naomi , Dinh Jennifer M. , Durham Jennah , Schroder Lisa K. , Ziegenfuss Jeanette Y. , Switzer Julie A.
Published: August 2020

Background:

Patient reported outcome measures (PROMs) are becoming well recognized as an important component of health care outcomes and determinants of value in patient-centered care. Yet, there is emerging recognition that guidance is lacking in the utilization of PROMs in hip fracture patients. The aim of this study was to collect input from hip fracture patients and their health care advocates as proxies to identify outcomes that are important and to gain insight into which ones are of greatest importance.

Methods:

A cross-section of patients aged 65 and older treated for hip fractures at a single level 1 trauma center within the previous 3 to 9 months was identified. Semistructured telephone interviews of patients and/or health care proxies were performed in 2 phases: (1) concept identification and conceptual framework development and (2) item generation and assessment of relative importance of health care outcomes. Each phase was completed by separate patient cohorts.

Results:

Sixty-four interviews were completed. Eighteen interviews with 13 patients and 5 proxies were completed for framework development. Forty-six interviews with 33 patients and 13 proxies were completed for the assessment of relative importance. Care team and communication were reported as important in hip fracture patients. Physical outcomes were ranked as most important by only 9% of respondents. “Having confidence that I/my loved one received the best care possible” was perceived as very important by 98% of respondents and “Having access to the surgeon” was perceived as very important by 76% of the respondents.

Conclusions:

In our study, communication between patients and care providers as well as collaboration among patients’ care providers ranked as the most important postoperative preferences in our cohort. Notably, physical outcomes were ranked as most important by only 9% of respondents.
The Impact of School Counseling Supervision on Practicing School Counselors’ Self-Efficacy in Building a Comprehensive School Counseling Program
Authors: Tang Angela
Published: August 2020

This quasi-experimental pretest/posttest study using the School Counseling Self-Efficacy Scale examined whether school-counseling-specific supervision increased self-efficacy related to school counseling best practice. The study included supervision of 24 practicing school counselors using the School Counseling Supervision Model framework. Supervision groups had significant increases in self-efficacy scores compared to nonparticipants ( p = .02), with a medium-to-large effect size ( d = .62). Findings suggest that school-counseling-specific supervision can increase school counselor self-efficacy related to professional practice.
Translation and Cross-Cultural Validation of Korean Version of the Menstrual Distress Questionnaire
Authors: Lee Yaelim , Sohng Kyeong-Yae
Published: August 2020

Given the increase in cross-cultural studies, there is a need for adequately translated and validated study instruments. Using instruments translated into participants’ native language can lower barriers to study participation and increase study validity. The purpose of this study was to describe the translation and validation processes of the Korean version (MDQ-K) of the Menstrual Distress Questionnaire (MDQ). The MDQ was translated into Korean through a forward-and-backward translation process, followed by expert review and pilot testing among 100 bilingual Korean students. The equivalence of MDQ-K to MDQ was tested through bivariate Pearson’s correlations and paired t tests. The psychometric properties of the MDQ-K were evaluated through internal consistency and construct validity (confirmatory factor analysis). The reliability of the questionnaire was good (Cronbach’s α = .96). The results of confirmatory factor analysis revealed an acceptable model fit to the data. Overall, the MDQ-K demonstrated acceptable psychometric properties, although paired t tests found significant differences ( p < .05) between the MDQ and MDQ-K in the means of three items: “restlessness” (Item 22), “bursts of energy and activity” (Item 40), and “blind spots and fuzzy vision” (Item 46). Possible explanations for these discrepancies include the participants’ varying English proficiency levels, issues with understanding medical terminology, and absence of words with the same meanings in different languages. We also discussed possible deletion of questionnaire items through further factor analysis.
Resistance From Within: Power and Defiance in Montesquieu’s Persian Letters
Authors: Epley Sanders Jennifer
Published: August 2020

Montesquieu reflects on the intricacies of government, social customs, and identity in his epistolary novel titled Persian Letters (1721). For many of these topics, Montesquieu addresses the themes of power and agency, mainly in the context of despotism as symbolized by a seraglio in the book. This article uses the explanatory research method through a case analysis of “power” in the Persian Letters to facilitate a nuanced, gendered understanding of “power” as a concept. The case analysis incorporates and applies feminist perspectives on power, as well as a theoretical framework and empirical observations from Scott’s Weapons of the Weak (1985), to define and operationalize “despotic power” and “defiant power.”
Bicortical Laminar Screws for Posterior Fixation of Subaxial Cervical Spine: A Radiologic Analysis With Computed Tomography Images
Authors: Park Eugene J. , Min Woo-Kie , Sim Seungbo
Published: August 2020

Study Design:

Retrospective radiological analysis.

Objectives:

Translaminar screw (TLS) placement is one of the fixation techniques in the subaxial cervical spine. However, it can be difficult to use in small diameter of the lamina. This study proposed a novel bicortical laminar screw (BLS) and analyzed the related parameters using computed tomography (CT).

Methods:

Cervical CT images taken at our institution from January 2013 to March 2017 were used for measurement. On the axial images, the maximum screw length (MSL) and trajectory angle (TA) of BLS and TLS were measured, together with the distance from the midline (DM) to the BLS entry point and the lamina width (LW). On the parasagittal images, the height of the lamina (LH) was measured.

Results:

MSL of BLS and TLS were 21.00 and 20.97 mm, 19.02 and 20.91 mm, 18.45 and 21.01 mm, and 20.00 and 21.01 mm in C3, C4, C5, and C6, respectively. TA of the BLS and TLS were 21.24° and 34.90°, 19.05° and 34.22°, 18.65° and 33.61°, and 18.30° and 34.51° at C3, C4, C5, and C6, respectively. DM were 6.44, 5.77, 5.68, and 6.03 at C3, C4, C5, and C6, respectively. LW and LH were 3.52 and 12.44 mm, 2.87 and 12.49 mm, 2.76 and 12.42 mm, and 3.18 and 13.30 mm at C3, C4, C5, and C6, respectively.

Conclusion:

We suggest that BLS fixation is a feasible alternative option for posterior fixation to the lamina of the subaxial cervical spine. It may be especially useful when pedicle screw, lateral mass screw, and TLS are not appropriate.
Recombinant Human Bone Morphogenetic Protein–2 Use in Adult Spinal Deformity Surgery: Comparative Analysis and Healthcare Utilization at 24 Months’ Follow-up
Authors: Dietz Nicholas , Sharma Mayur , Kelly Michael , Ugiliweneza Beatrice , Wang Dengzhi , Osorio Joseph , Karikari Isaac , Drazin Doniel , Boakye Maxwell
Published: August 2020

Study Design:

Retrospective cohort study.

Objective:

Recombinant human bone morphogenetic protein–2 (rhBMP-2) is used to achieve fusion in adult spinal deformity (ASD) surgery. Our aim was to investigate the long-term impact of rhBMP-2 use for clinical outcomes and health care utilization in this patient population.

Methods:

We conducted an analysis using MarketScan to identify health resource utilization of rhBMP-2 use for ASD after surgical intervention compared to fusion without rhBMP-2 at 24 months’ follow-up. Outcomes assessed included length of stay, complications, pseudoarthrosis, reoperation, outpatient services, and health care payments.

Results:

Of 7115 patients who underwent surgery for ASD, 854 received rhBMP-2 and 6261 were operated upon without use of rhBMP-2. One month after discharge, the rhBMP-2 cohort had a nonsignificant trend in fewer complications (15.38%) than those who did not receive rhBMP-2 (18.07%), P = .0558. At 12 months, pseudoarthrosis was reported in 2.8% of cases with no BMP and 01.14% of cases with BMP, P = .0048. Average payments at 12 months were $120 138 for the rhBMP-2 group and $118 373 for the no rhBMP-2 group, P = .8228. At 24 months, payments were $141 664 for the rhBMP-2 group and $144 179 for the group that did not receive rhBMP-2, P = .5946.

Conclusions:

In ASD surgery, use of rhBMP-2 was not associated with increased complications or reoperations at index hospitalization and 1-month follow-up. Overall payments, including index hospitalization, readmissions, reoperations, and outpatient services were not different compared to those without the use of rhBMP-2 at 12 months and 24 months after discharge.
Failure Rates of 5-Strand and 6-Strand vs Quadrupled Hamstring Autograft ACL Reconstruction: A Comparative Study of 413 Patients With a Minimum 2-Year Follow-up
Authors: Attia Ahmed Khalil , Nasef Hazem , ElSweify Kareem Hussein , Adam Mohammed A. , AbuShaaban Faris , Arun Kariyal
Published: August 2020

Background:

Anterior cruciate ligament reconstruction (ACLR) with hamstring autograft has gained popularity. However, an unpredictably small graft diameter has been a drawback of this technique. Smaller graft diameter has been associated with increased risk of revision, and increasing the number of strands has been reported as a successful technique to increase the graft diameter.

Purpose:

To compare failure rates of 5-strand (5HS) and 6-strand (6HS) hamstring autograft compared with conventional 4-strand (4HS) hamstring autograft. We describe the technique in detail, supplemented by photographs and illustrations, to provide a reproducible technique to avoid the variable and often insufficient 4HS graft diameter reported in the literature.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

We retrospectively reviewed prospectively collected data of all primary hamstring autograft ACLRs performed at our institution with a minimum 2-year follow-up and 8.0-mm graft diameter. A total of 413 consecutive knees met the study inclusion and exclusion criteria. The study population was divided into 5HS and 6HS groups as well as a 4HS control group. The primary outcome was failure of ACLR, defined as persistent or recurrent instability and/or revision ACLR.

Results:

The analysis included 224, 156, and 33 knees in the 5HS, 6HS, and 4HS groups, respectively. The overall ACLR failure rate in this study was 11 cases (8%): 5 cases for 5HS, 3 cases for 6HS, and 3 cases for 4HS. No statistically significant differences were found among groups ( P = .06). The mean graft diameter was 9 mm, and the mean follow-up was 44.27 months.

Conclusion:

The 5HS and 6HS constructs have similar failure rates to the conventional 4HS construct of 8.0-mm diameter and are therefore safe and reliable to increase the diameter of relatively smaller hamstring autografts. We strongly recommend using this technique when the length of the tendons permits to avoid failures reportedly associated with inadequate graft size.
Bridge over Troubled Water: Explicating the Perspectives of the Stakeholders on the Urbanization of Heritage Properties—The Case of Intramuros and Filipino–Chinese Friendship Bridge
Authors: Duarte Hansley Eunice M. , Garcia Grace Nicole V. , Lejano Alyssa Bianca T. , Magpantay Ana Mariela M. , Saavedra Alodia Lorraine A. , Virtucio April Faye G. , Mercado Jame Monren T.
Published: August 2020

This qualitative case study article explicated the perspectives of the stakeholders regarding the urbanization of heritage properties, specifically the old, walled area of Intramuros in the city of Manila with respect to the construction of the Filipino-Chinese Friendship Bridge (or the bridge). This study begins with a documentation analysis involving the collection of researches related to the subject and in-depth interviews with the different stakeholders, specifically the national and local government, the private sectors and the host community in Intramuros and Binondo. The case study approach is incorporated in the study to discern the issues arising from the subject site, while a thematic analysis is used as the most suitable technique to analyse the findings. The outcomes reveal the different viewpoints of the stakeholders concerning the matters in constructing the Filipino–Chinese Friendship Bridge between Intramuros and Binondo. In this context, authorities such as the government and non-governmental organizations (NGOs) should establish regulations that seek to protect and conserve the different heritage properties, as well as balance the demands for rapid urbanization. Due to the urban development, the integrity and significance of heritage properties are being compromised, which may result in the degradation of the local properties’ identity and culture.
Postoperative Complications in Obese Patients After Tracheostomy
Authors: Barrera Shelby C. , Sanford Evan J. , Ammerman Sarah B. , Ferrell Jay K. , Simpson C. Blake , Dominguez Laura M.
Published: August 2020

Objective

To determine the prevalence of varying classes of obesity in patients undergoing tracheostomy and the associated complication rates as compared with nonobese patients.

Study Design

A retrospective chart review was performed from 2012 to 2018 on all patients who underwent open tracheostomy by the Department of Otolaryngology–Head and Neck Surgery.

Setting

All tracheostomies were performed at a single tertiary care center.

Methods

Patients were classified by body mass index (BMI) according to the World Health Organization classification system: underweight (<18.5), normal‐overweight (18.5‐29.9), class I (30‐34.9), class II (35‐39.9), and class III (>40). Charts were reviewed for patient demographic information, Charlson Comorbidity Index score, surgical indication, operative time, tracheostomy tube type, and postoperative complications.

Results

A total of 387 patients (mean ± SD BMI, 31.3 ± 14.2) were identified per the inclusion/exclusion criteria. Of patients with BMI >30 (n=153), 34.6% were categorized as obesity class I, 29.4% as class II, and 35.9% as class III. The most common indication for tracheostomy was malignancy in nonobese patients (41.5%) and respiratory failure for obese patients (58.2%). Operative time was significantly longer in obese patients, and most of these patients required an extended‐length tracheostomy tube. Patients with a BMI >40 had higher rates of multiple postoperative complications or death (P =. 009). Underweight patients also had a higher rate of complication than normal‐overweight patients (P =. 016).

Conclusion

Class III and underweight patients had higher rates of postoperative complications, which should be taken into consideration during perioperative counseling.
Development of new or worsening headache after cochlear implant activation: A hypothesis-generating pilot study of incidence, timing, and clinical factors
Authors: Riggins Nina , Chae Ricky , Levin Morris , Ehrlich Annika , Sawhney Henna , Polite Colleen , Goadsby Peter J
Published: August 2020

The objectives of the study are to investigate the incidence of new or worsening headache after cochlear implant (CI) surgery and activation and to determine whether there are predictors of associated headache. We performed a cross-sectional survey of patients who had CI surgery. The frequency and severity of headache, onset of headache relative to surgery and device activation, medication use, family history, headache triggers, and accompanying cranial autonomic symptoms were recorded and analyzed. Thirty-seven subjects were enrolled. In the time period after CI surgery but before CI activation, none reported a new headache and four (11%) reported a worsening headache. After CI activation, six (16%) developed new headache and five (14%) developed worsening headache. These 11 subjects also experienced a significantly higher mean of 6.3 headache days/month following CI activation ( p < 0.009). Providers should be aware that new or worsening headache can be reported following CI activation, although not immediately following CI surgery.
Assessing the Quality of Life in Patients With Polyarthralgia Based on 25-Hydroxycholecalciferol Levels
Authors: Baral Tejaswini , Laxmi D. Vijaya , Pedada Mounika , Ganta Neelima Krishna Veni , Feroz Wasim
Published: August 2020

Background

Vitamin D deficiency is widespread, yet it is the most underdiagnosed and undertreated nutritional deficiency and has a very crucial clinical importance in today’s medical field.

Objective

To assess quality of life in patients with polyarthralgia based on 25-hydroxycholecalciferol (25-(OH)D) levels, which will help understand the importance of vitamin D in a broader sense.

Methodology

Our panel study was carried out in the department of orthopedics of a tertiary care hospital in southern India between October 1, 2018, and February 28, 2019. A total of 114 patients with polyarthralgia from the outpatient department were included in the study.

Results

In our study, there was a predominance of female patients (77.2%). Overall, 92.10% of our study population were aged between 21 and 60 years. The highest percentage of low vitamin D status was detected in unexplained polyarthralgia cases (52.63%), who did not have any comorbid condition except a low serum level of 25-(OH)D level. There was a strong association between quality of life, before and after supplementation of vitamin D ( P < .0001), for every domain of the 36-item Short Form Survey.

Conclusion

The 36-item Short Form Survey analysis showed that the patients with polyarthralgia whose serum level of 25-(OH)D was found below the optimal range had dramatic improvement in their symptoms after vitamin D supplementation. Based on the findings of our study, we strongly recommend screening for vitamin D deficiency in those who are at risk, as features of low vitamin D are mostly reversible with proper supplementation.
Sonography of Knee Effusion
Authors: Li Tony Y.
Published: August 2020

Objective:

A review of the anatomy of the synovial recesses of the knee is important to better understand the different effusion presentations, update the diagnosis criteria of knee effusion based on the measured synovial recesses and discuss the differentiation of some effused recesses from other lesions around the knee.

Method:

This review focuses on the anatomy of the synovial recesses of the knee and classifies them into three groups (anterior, parameniscal, and posterior recesses), as well as provides an overview on the etiology of knee effusion, its sonographic detection, and diagnosis criteria.

Results:

Knee effusion is a very common pathological finding in sonography of the knee. The unique joint structure of the knee provides the possibility to host complex synovial recesses. Fluid in some of the synovial recesses is valuable for the diagnosis of knee effusion, while in certain situations, some recesses may impose diagnostic uncertainty. Knowledge of these synovial recesses is essential to avoid diagnostic pitfalls.

Conclusion:

This review provides an important discussion of the differentiation of some recesses effusions from other lesions around the knee.
Germline IKAROS dimerization haploinsufficiency causes hematologic cytopenias and malignancies
Authors: Kuehn Hye Sun , Niemela Julie E. , Stoddard Jennifer , Mannurita Sara Ciullini , Shahin Tala , Goel Shubham , Hintermeyer Mary , Heredia Raul Jimenez , Garofalo Mary , Lucas Laura , Singh Smriti , Tondo Annalisa , Jacobs Zachary , Gahl William A. , Latour Sylvain , Verbsky James , Routes John , Cunningham-Rundles Charlotte , Boztug Kaan , Gambineri Eleonora , Fleisher Thomas A. , Chandrakasan Shanmuganathan , Rosenzweig Sergio D.
Published: August 2020

IKAROS is a transcription factor forming homo- and heterodimers and regulating lymphocyte development and function. Germline mutations affecting the IKAROS N-terminal DNA binding domain, acting in a haploinsufficient or dominant-negative manner, cause immunodeficiency. Herein, we describe 4 germline heterozygous IKAROS variants affecting its C-terminal dimerization domain, via haploinsufficiency, in 4 unrelated families. Index patients presented with hematologic disease consisting of cytopenias (thrombocytopenia, anemia, neutropenia)/Evans syndrome and malignancies (T-cell acute lymphoblastic leukemia, Burkitt lymphoma). These dimerization defective mutants disrupt homo- and heterodimerization in a complete or partial manner, but they do not affect the wild-type allele function. Moreover, they alter key mechanisms of IKAROS gene regulation, including sumoylation, protein stability, and the recruitment of the nucleosome remodeling and deacetylase complex; none affected in N-terminal DNA binding defects. These C-terminal dimerization mutations are largely associated with hematologic disorders, display dimerization haploinsufficiency and incomplete clinical penetrance, and differ from previously reported allelic variants in their mechanism of action. Dimerization mutants contribute to the growing spectrum of IKAROS-associated diseases displaying a genotype-phenotype correlation.
Altered levels of salivary and plasma pain related markers in temporomandibular disorders
Authors: Jasim Hajer , Ghafouri Bijar , Gerdle Björn , Hedenberg-Magnusson Britt , Ernberg Malin
Published: August 2020

Background

Different pain syndromes may be characterized by different profiles of mediators reflecting pathophysiological differences, and these alterations may be measured in a simple saliva sample. The aims of the current study were to compare concentration of glutamate, serotonin (5-HT), nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and substance P (SP) in saliva and plasma from a well-defined group of patients with chronic temporomandibular disorders myalgia (TMD-myalgia) with a group of pain-free controls, and further investigate the relationship between these markers and clinical characteristics.

Methods

Patients diagnosed according to the diagnostic criteria for TMD (n = 39), and matched healthy pain-free controls (n = 39) were included. Stimulated whole saliva and plasma samples were collected in the morning. Glutamate was analysed using a colorimetric assay, and 5-HT and SP were analysed by commercially available ELISA. Levels of NGF and BDNF were determined using multiplex electrochemiluminescence assay panel.

Results

Patients expressed higher salivary and plasma levels of glutamate (saliva: 40.22 ± 13.23 μmol/L; plasma: 30.31 ± 18.73 μmol/L) than controls (saliva: 33.24 ± 11.27 μmol/L; plasma: 20.41 ± 15.96 μmol/L) (p < 0.05). Salivary NGF (0.319 ± 0.261 pg/ml) and BDNF (3.57 ± 1.47 pg/ml) were lower in patients compared to controls (NGF: 0.528 ± 0.477 pg/ml; BDNF 4.62 ± 2.51 pg/ml)(p’s < 0.05). Contrary, plasma BDNF, was higher in patients (263.33 ± 245.13 pg/ml) than controls (151.81 ± 125.90 pg/ml) (p < 0.05). 5-HT was undetectable in saliva. Neither plasma 5-HT, nor SP levels differed between groups. BDNF and NGF concentrations correlated to levels of psychological distress (p < 0.0005).

Conclusion

The higher levels of salivary and plasma glutamate in patients with TMD-myalgia compared to controls strengthens its importance in the pathophysiology of TMD-myalgia. However, the lack of correlation to pain levels question its role as a putative biomarker. Patients with TMD-myalgia further had lower levels of salivary NGF and BDNF, but higher plasma BDNF. These results and their correlations to psychological distress warrant further investigations.
Optogenetic stimulation of the motor cortex alleviates neuropathic pain in rats of infraorbital nerve injury with/without CGRP knock-down
Authors: Islam Jaisan , KC Elina , Oh Byeong Ho , Kim Soochong , Hyun Sang-hwan , Park Young Seok
Published: August 2020

Background

Previous studies have reported that electrical stimulation of the motor cortex is effective in reducing trigeminal neuropathic pain; however, the effects of optical motor cortex stimulation remain unclear.

Objective

The present study aimed to investigate whether optical stimulation of the primary motor cortex can modulate chronic neuropathic pain in rats with infraorbital nerve constriction injury.

Methods

Animals were randomly divided into a trigeminal neuralgia group, a sham group, and a control group. Trigeminal neuropathic pain was generated via constriction of the infraorbital nerve and animals were treated via selective inhibition of calcitonin gene-related peptide in the trigeminal ganglion. We assessed alterations in behavioral responses in the pre-stimulation, stimulation, and post-stimulation conditions. In vivo extracellular recordings were obtained from the ventral posteromedial nucleus of the thalamus, and viral and α-CGRP expression were investigated in the primary motor cortex and trigeminal ganglion, respectively.

Results

We found that optogenetic stimulation significantly improved pain behaviors in the trigeminal neuralgia animals and it provided more significant improvement with inhibited α-CGRP state than active α-CGRP state. Electrophysiological recordings revealed decreases in abnormal thalamic firing during the stimulation-on condition.

Conclusion

Our findings suggest that optical motor cortex stimulation can alleviate pain behaviors in a rat model of trigeminal neuropathic pain. Transmission of trigeminal pain signals can be modulated via knock-down of α-CGRP and optical motor cortex stimulation.