bluuebunny/crossref_metadata_2025 huggingface dataset:
Aortic flow below and visceral circulation during aortic counterpulsation: Evaluation of an in vitro model
Authors: de Jong Monique MJ , Parise Orlando , Matteucci Francesco , Rutten Marcel , Devos Maxime , Romano Mario , Micali Linda Renata , Parise Gianmarco , Maessen Jos G , Gelsomino Sandro
Published: December 2020

Introduction:

This study aimed to test a computer-driven cardiovascular model for the evaluation of the visceral flow during intra-aortic balloon pump (IABP) assistance.

Methods:

The model includes a systemic and pulmonary circulation as well as a heart contraction model. The straight polyurethane tube aorta had a single visceral while four windkessel components mimicked resistance compliance of the brachiocephalic, renal and sub-mesenteric, pulmonary, and systemic circulation. Twelve flow probes were placed in the circuit to measure pressures and flows with the IABP on and off.

Results:

With the balloon off, the meantime to reach the steady state was 48 ± 16 s; with the balloon on, this figure was 178 ± 20 s. The stability of pressure and flow signals was obtained after 72 ± 11 min. The number of cycles of stability of the system was 93 [86–103]. Measurements were reliable either with samples of 10 or 20 beats. Bland Altman method demonstrated the reliability of measurements. Finally, all measurements were comparable to published in vivo data.

Conclusion:

The presented mock circulation was reliable and gave values with high accuracy both at baseline and during mechanical assistance. This system allows evaluation of the mesenteric flow during IABP, under different clinical/hemodynamic conditions. Nonetheless, its translational potential needs to be further evaluated
Clinical characteristics and outcomes of adults with peripheral extracorporeal membrane oxygenation in a developing country: A single center 8-year retrospective study
Authors: Pirompanich Pattarin , Patiyakul Napakul , Daorattanachai Kiattichai , Homvises Boonlawat , Tantiyavarong Pichaya
Published: December 2020

Introduction:

In our institute, we began using peripheral veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) in 2010, and peripheral veno-venous (VV) ECMO in 2015. This study aimed to describe clinical characteristics and outcomes in those patients.

Methods:

We reviewed retrospective data of adults receiving peripheral ECMO from January 2010 to December 2017 and divided it into two groups for analysis: VA- and VV-ECMO.

Results:

There were 28 patients in the VA group and 12 in VV. For VA, the mean (SD) age was 58.5 (17.2) years. The most common indication was cardiac arrest (12 patients, 42.9%); 15 patients (53.6%) were on intra-aortic balloon pump concomitantly. In the VV cohort, the mean age was 53.3 (16.2) years. Eleven (91.7%) patients had acute respiratory distress syndrome as an indication. The mortality rate of VA-ECMO was 85.7%, and VV was 58.3%.

Conclusion:

The mortality rate in our ECMO center was considerably higher than that in the international registry report. Improved team education, rigid patient selection criteria, and a reimbursement protocol should lead to ameliorated outcomes.

Trial Registration:

TCTR20190120001. Registered January 19, 2019
A new treatment paradigm for phlegmasia cerulea dolen: Single stage endovascular pharmacomechanical thrombectomy with venoplasty and stenting
Authors: Tan GuangMing , Yan Bryan PY
Published: December 2020

Background

Phlegmasia Cerulae Dolen (PCD) is potentially a lethal disease but there is currently no established treatment algorithm for it. The aim of this study was to assess the safety and effectiveness of single stage endovascular pharmacomechanical thrombectomy with venoplasty and stenting in the treatment of PCD.

Method

This was a retrospective single centre observational study of consecutive patients who underwent endovascular intervention for the treatment of PCD between June 2016 and March 2020. Clinical and procedural details were recorded. Procedural and clinical success rate, procedural complications, and 30 days mortality were reported.

Result

11 patients were treated during the study period. 2 (18.2%) had active malignancy. 63.6% were uncomplicated PCD on presentation. Common iliac vein compression or stenosis were demonstrated in all patients. Venous stents were implanted in all cases and procedures were successful in all cases. All patients had symptoms improvement at 72 hours post procedure. Other than 2 major bleeding complications, there was no other adverse event. The 30 days mortality was 18.2%. Active malignancy and the presence of anaemia were significantly associated with major complications.

Conclusion

Single stage endovascular thrombectomy and stenting was effective and safe in the treatment of patients with PCD. Common Iliac vein compression was a common underlying cause of PCD.
Risk factors for falling for people with Multiple Sclerosis identified in a prospective cohort study
Authors: Quinn Gillian , Comber Laura , McGuigan Chris , Hannigan Ailish , Galvin Rose , Coote Susan
Published: December 2020

Objective:

To identify risk factors for falling for people with Multiple Sclerosis.

Design:

Prospective cohort study.

Setting:

Neurology service in a tertiary hospital.

Subjects:

Participants were 101 people with Multiple Sclerosis and Expanded Disability Status Score of 3-6.5. One participant withdrew after the baseline assessment; data were analysed for 100 participants.

Interventions:

No intervention.

Main measures:

Outcome was rate of falls, and predictors were Timed Up and Go, Symbol Digit Modalities test, demographics and 15 self-report questions about various symptoms including fatigue, concentration, dual tasking, bladder and bowel control. Three-month prospective diaries recorded falls.

Results:

There were 791 falls reported over the 3-month period from a total of 56 fallers. Falls rate per person-year was 32.08 falls. Following multivariable regression analysis, the model with the greatest levels of clinical utility and discriminative ability (sensitivity 88% and area under the receiving operating curve statistic = 0.72, 95% CI 0.62–0.82), included the variables of history of a fall, not having visual problems, problems with bladder control and a slower speed on the Timed Up and Go.

Conclusion:

This study confirms the high incidence of falls for people with Multiple Sclerosis and provides a risk prediction model including fall history, problems with bladder control, not having visual problems and a slower Timed Up and Go speed that may be used to identify those at greater risk and in need of tailored falls prevention intervention.
Longitudinal relation between blood pressure, antihypertensive use and cerebral blood flow, using arterial spin labelling MRI
Authors: van Dalen Jan Willem , Mutsaerts Henri JMM , Petr Jan , Caan Matthan WA , van Charante Eric P Moll , MacIntosh Bradley J , van Gool Willem A , Nederveen Aart J , Richard Edo
Published: December 2020

Consistent cerebral blood flow (CBF) is fundamental to brain function. Cerebral autoregulation ensures CBF stability. Chronic hypertension can lead to disrupted cerebral autoregulation in older people, potentially leading to blood pressure levels interfering with CBF. This study tested whether low BP and AHD use are associated with contemporaneous low CBF, and whether longitudinal change in BP is associated with change in CBF, using arterial spin labelling (ASL) MRI, in a prospective longitudinal cohort of 186 community-dwelling older individuals with hypertension (77 ± 3 years, 53% female), 125 (67%) of whom with 3-year follow-up. Diastolic blood pressure, systolic blood pressure, mean arterial pressure, and pulse pressure were assessed as blood pressure parameters. As additional cerebrovascular marker, we evaluated the ASL signal spatial coefficient of variation (ASL SCoV), a measure of ASL signal heterogeneity that may reflect cerebrovascular health. We found no associations between any of the blood pressure measures and concurrent CBF nor between changes in blood pressure measures and CBF over three-year follow-up. Antihypertensive use was associated with lower grey matter CBF (−5.49 ml/100 g/min, 95%CI = −10.7|−0.27, p = 0.04) and higher ASL SCoV (0.32 SD, 95%CI = 0.12|0.52, p = 0.002). These results warrant future research on the potential relations between antihypertensive use and cerebral perfusion.
Characterisation of microvessel blood velocity and segment length in the brain using multi-diffusion-time diffusion-weighted MRI
Authors: Scott Lauren A , Dickie Ben R , Rawson Shelley D , Coutts Graham , Burnett Timothy L , Allan Stuart M , Parker Geoff JM , Parkes Laura M
Published: December 2020

Multi-diffusion-time diffusion-weighted MRI can probe tissue microstructure, but the method has not been widely applied to the microvasculature. At long diffusion-times, blood flow in capillaries is in the diffusive regime, and signal attenuation is dependent on blood velocity ([Formula: see text]) and capillary segment length ([Formula: see text]). It is described by the pseudo-diffusion coefficient ([Formula: see text]) of intravoxel incoherent motion (IVIM). At shorter diffusion-times, blood flow is in the ballistic regime, and signal attenuation depends on [Formula: see text], and not [Formula: see text]. In theory, [Formula: see text] could be estimated using [Formula: see text] and [Formula: see text]. In this study, we compare the accuracy and repeatability of three approaches to estimating [Formula: see text], and therefore [Formula: see text]: the IVIM ballistic model, the velocity autocorrelation model, and the ballistic approximation to the velocity autocorrelation model. Twenty-nine rat datasets from two strains were acquired at 7 T, with [Formula: see text]-values between 0 and 1000 smm−2 and diffusion times between 11.6 and 50 ms. Five rats were scanned twice to assess scan-rescan repeatability. Measurements of [Formula: see text] were validated using corrosion casting and micro-CT imaging. The ballistic approximation of the velocity autocorrelation model had lowest bias relative to corrosion cast estimates of [Formula: see text], and had highest repeatability.
Evolution of the stroke paradigm: A review of delayed recanalization
Authors: Camara Richard , Matei Nathanael , Zhang John H
Published: December 2020

While the time window for reperfusion after ischemic stroke continues to increase, many patients are not candidates for reperfusion under current guidelines that allow for reperfusion within 24 h after last known well time; however, many case studies report favorable outcomes beyond 24 h after symptom onset for both spontaneous and medically induced recanalization. Furthermore, modern imaging allows for identification of penumbra at extended time points, and reperfusion risk factors and complications are becoming better understood. Taken together, continued urgency exists to better understand the pathophysiologic mechanisms and ideal setting of delayed recanalization beyond 24 h after onset of ischemia.
First trimester diagnosis of body stalk anomaly complicated by ectopia cordis
Authors: Yang Yi , Wang Hong , Wang Zhenpeng , Pan Xuefeng , Chen Ying
Published: December 2020

Body stalk anomaly is a rare abnormality characterized by an abdominal wall defect with evisceration of abdominal organs, severe kyphoscoliosis, and a very short or absent umbilical cord. Ectopia cordis (EC) is a rare, lethal anomaly characterized by complete or partial malpositioning of the heart outside of the thorax. A 28-year-old healthy primigravida was referred to our department to undergo a nuchal translucency thickness scan at 12 weeks’ gestation. The scan revealed typical features of body stalk anomaly and EC. Given the lethal condition of the fetus, the patient opted for termination of the pregnancy. Body stalk anomalies, especially those complicated by EC, are universally lethal for the affected fetus. Selective termination should be recommended to avoid possible complications that can arise during pregnancy. Additionally, the future parents should be informed that because the condition is not associated with chromosomal abnormalities, there is no increased risk of recurrence.
Power-setpoint extremum seeking control for maximizing wind power capture of turbine and farm operation
Authors: Kumar Devesh , Li Yaoyu , Wu Zhongyou
Published: December 2020

In this paper, we propose a power-setpoint based Extremum Seeking Control (ESC) framework for model-free Region-2 controls for maximizing the power capture for turbine and farm operation, without dependency on wind measurement. As a major obstacle for retrofitting wind turbine/farm controls is that only the power setpoint is accessible, the power-setpoint based ESC framework is proposed with a back-calculation anti-windup structure. If increasing the power demand cannot further increase actual power output, the anti-windup structure automatically holds the power demand setpoint. For farm operation, the proposed method is integrated into the Delay-compensated Nested-loop ESC. The proposed method is evaluated by simulations on the SimWindFarm platform for both single-turbine and farm operation scenarios. The results demonstrate the capability of tracking the achievable optimum power for turbine and farm operation, with only reasonable increase of some loads. The proposed method promises an easy-to-implement model-free retrofitting control strategy for enhancing wind energy capture.
A Socio-ecological Framework for Understanding Workplace Violence in China’s Health Sector: A Qualitative Analysis of Health Workers' Responses to an Open-ended Survey Question
Authors: Wu Dan , Wang Yun , Yang Sheng Zhi , Wang Nan , Sun Kai Sing , Lam Tai Pong , Zhou Xu Dong
Published: December 2020

Workplace violence (WPV) in the health sector is a global public health issue. The magnitude of WPV is a particular concern in China’s health system. To examine the potential causes of WPV, we analyzed 3,045 qualitative responses to an open-ended question in a survey with health workers in the Zhejiang province, China. We adapted a four-level socio-ecological framework (societal/systemic, community/organizational, interpersonal, and individual) to thematically analyze the data. Ten sub-themes emerged. Within the societal/systemic level, we identified three sub-themes: (a) lack of legislation against WPV, (b) suboptimal accessibility and affordability of health services due to maldistributed health resources, commercialized health services, and inadequate health insurance, and (c) unregulated mass media reports. Within the community/organizational level, three sub-themes emerged: (a) lack of supportive health facility leadership, (b) inaction by government authorities, and (c) inefficient law enforcement agencies. Within the interpersonal level, two sub-themes were identified: (a) poor provider–patient communication and (b) distrust between health workers and patients. Finally, we identified the personal characteristics of health workers (e.g., competence and professionalism) and patients (e.g., sociodemographic background and expectations/satisfaction) as two individual-level sub-themes.

We recognized interactions among different levels. The weak state of Chinese legislation in this area and lack of high-level political will and guidance (societal/systemic) has left health facilities and law enforcement agencies (community/organizational) unclear about how to address WPV. The maldistribution of quality health resources (societal/systemic) has led to overcrowded outpatient clinics at higher-level care facilities (community/organizational). In light of the insufficient government funding and profit-oriented health services (societal/systemic), health workers were motivated to seek profits by providing unnecessary services, which compromised their professionalism (individual). Provider–patient relationships deteriorated (interpersonal), and patients sometimes held unrealistically high expectations associated with high medical expenses (individual). We propose multisectoral prevention strategies to address WPV in the health sector at all levels using a socio-ecological framework.
Multimorbidity as a Risk Factor of Elder Abuse/Mistreatment in India: A Cross-Sectional Study
Authors: Sathya T , Nagarajan R. , Selvamani Y.
Published: December 2020

Globally, elder abuse/mistreatment is a common form of violence against the elderly. This study examines the association between multimorbidity and abuse/mistreatment among the elderly population (60+) in India. Cross-sectional data from the United Nations Population Fund (UNFPA)’s “Building Knowledge Base on Population Aging in India” (BKPAI, 2011) was analyzed. We generated a multimorbidity variable by combining 20 self-reported diagnosed chronic diseases. Bivariate analysis was used to understand the sample distribution and prevalence estimation of elder abuse/mistreatment by multimorbidity and state. Furthermore, multilevel mixed-effect logistic regression was used to examine the association between multimorbidity and elder abuse/mistreatment. The overall prevalence of elder abuse/mistreatment in the study population is 11.4%. The prevalence of elder abuse/mistreatment among elderly with no chronic diseases is 6.01% which increases to 22.7% among elderly with four or more chronic diseases. Furthermore, the result from the multilevel mixed-effect logistic regression showed a close association between multimorbidity and elder abuse. Elderly with two, three, and four or more chronic diseases are 3.02 (CI = 2.33, 3.91, p < .000), 4.16 (CI = 3.02, 5.74, p < .000), and 5.06 (CI = 3.50, 7.31, p <.000) times more likely to experience abuse/mistreatment than elderly with no chronic diseases, respectively. In specific, this association is stronger for the elderly population residing in the urban areas. Furthermore, economic status and educational attainment have a protective role in determining elder abuse/mistreatment in India. In conclusion, multimorbidity has emerged as a significant risk factor of elder abuse/mistreatment in India. Measures to prevent elder abuse should consider the role of multimorbidity.
Design and optimization of oven vacuum bag (OVB) processing for void air removal in high-performance thermoplastic composites
Authors: Zhang Danning , Heider Dirk , Gillespie John W
Published: December 2020

Oven vacuum bag processing is an emerging process to manufacture high quality thermoplastic parts with void reduction using vacuum consolidation only. This paper models void air removal as a combination of through-the-thickness gas diffusion and in-plane airflow through the interlayer region for a flat plate of finite in-plane dimensions consisting of an arbitrary number of layers. A finite difference model assumes Fickian diffusion, simplifies the microstructure of the multi-layer prepreg stack and allows evaluation of various material and process conditions (inter- and intra-layer void content, temperature and pressure cycle, etc.) on the through-thickness diffusion behavior of the volatiles. In-plane airflow in the intra-layer is modeled using Darcy’s flow and requires high permeability of the interface created by the porous volume in between adjacent layers and the ability to vent the gas at the part edge. The dual mechanism model evaluates part geometries and processing cycles to reduce void content equivalent to autoclave parts with previously generated material properties of AS4/APC2 carbon PEEK prepreg. The modeling results based on the proposed mechanism shows that processing with through-the-thickness diffusion and standard processing cycles limits part thickness to five layers or less for APC2 while in-plane gas reduction can be used to make large parts of up to 10 m in the in-plane direction independent of part thickness. Very large parts require the addition of an intermediate lower temperature dwell cycle where diffusivity is high but interlayer permeability is unaffected allowing gas flow to the part edges for an extended period of time. The edge vent approach ensures a robust process even for as received materials with significant void variability often seen in thermoplastic prepreg tapes.
A methodology for the customization of hinged ankle-foot orthoses based on in vivo helical axis calculation with 3D printed rigid shells
Authors: Ferraresi Carlo , De Benedictis Carlo , Bono Loris , Del Gaudio Federica , Ferrara Laura , Masiello Fabiana , Franco Walter , Maffiodo Daniela , Leardini Alberto
Published: December 2020

This study aims to develop techniques for ankle joint kinematics analysis using motion capture based on stereophotogrammetry. The scope is to design marker attachments on the skin for a most reliable identification of the instantaneous helical axis, to be targeted for the fabrication of customized hinged ankle-foot orthoses. These attachments should limit the effects of the experimental artifacts, in particular the soft-tissue motion artifact, which affect largely the accuracy of any in vivo ankle kinematics analysis. Motion analyses were carried out on two healthy subjects wearing customized rigid shells that were designed through 3D scans of the subjects’ lower limbs and fabricated by additive manufacturing. Starting from stereophotogrammetry data collected during walking and dorsi-plantarflexion motor tasks, the instantaneous and mean helical axes of ankle joint were calculated. The customized shells matched accurately the anatomy of the subjects and allowed for the definition of rigid marker clusters that improved the accuracy of in vivo kinematic analyses. The proposed methodology was able to differentiate between subjects and between the motor tasks analyzed. The observed position and dispersion of the axes were consistent with those reported in the literature. This methodology represents an effective tool for supporting the customization of hinged ankle-foot orthoses or other devices interacting with human joints functionality.
HIV-vacuolar myelopathy: an unusual early presentation in HIV
Authors: Leffert Jacob , Purushothaman Rangarajan , Vilanilam George Koshy , Stanley Marc , Kothari Atul
Published: December 2020

Human immunodeficiency virus (HIV)-vacuolar myelopathy is a late presentation of HIV infection and rarely the presenting symptom. Treatment of HIV-vacuolar myelopathy involves anti-retroviral therapy, but neurological deficits are devastating if diagnosis is delayed. We present a rare case of a patient who presented with HIV-vacuolar myelopathy as the initial presentation in a case of newly diagnosed HIV. The case emphasizes the importance of a high index of suspicion and diagnosis for better outcomes in HIV-vacuolar myelopathy.
High prevalence of comorbidities and use of concomitant medication in treated people living with HIV in Germany – results of the BESIDE study
Authors: Funke B , Spinner CD , Wolf E , Heiken H , Christensen S , Stellbrink HJ , Witte V
Published: December 2020

Due to demographic changes in people living with HIV (PLHIV), physicians are challenged with age-related comorbidities and their management. In the absence of comprehensive data collection, the burden of comorbidities and co-medication in addition to antiretroviral therapy (ART) remains unclear for the German real-world setting. BESIDE was an observational, cross-sectional study evaluating the prevalence of comorbidities and use of co-medication in treated PLHIV. Regional distribution of study centers (n = 20), consecutive patient recruitment, and age-stratified sampling in alignment with national epidemiologic data aimed to ensure a representative sample (n = 453). The overall prevalence of comorbidities was 91.2%; 31.6% of patients had ≥4 comorbidities. The most common diagnoses were vitamin D deficiency (29.1%), depressive episode (27.8%), arterial hypertension (16.3%), and hypercholesterolemia (10.8%). 83.7% of patients were on co-medication; 21.2% taking ≥4 medications. The most common medications or supplements were vitamins (31.6%), anti-inflammatory agents (16.1%), renin–angiotensin system agents (12.1%), acid suppressants (11.7%), lipid modifying agents (10.8%); 1.3% of patients were on co-medication that should not be co-administered with ART, 41.5% on co-medication with potential for drug–drug interactions. The prevalence of comorbidities and use of co-medication among treated PLHIV in Germany is consistently high and increases across age groups, illustrating the complexity of HIV care involving appropriate ART selection.
Welfare conditionality and democratic citizenship in Norway
Authors: Bugge Hanna
Published: December 2020

This article studies how welfare conditionality affects democratic citizenship. Scholars make diverging predictions because reforms can both impair and stimulate political action. So far, evidence from the US and the UK lends support to the negative claim that conditionality leads to political withdrawal. Whereas prior studies mostly have relied on cross-sectional data, this study offers a more thorough assessment of causality by utilizing a longitudinal design. I exploit local variation for data on policy implementation. Moreover, the study contributes by addressing other issues, such as context sensitivity and policy scope. In contrast to prior work, I study democratic citizenship in a context where the stated requirements and benefits granted in return are described as enabling, and sanctions considered to be lenient. Moreover, I move beyond personal welfare experiences and include welfare recipients’ family members. The analysis indicates that programme effects on political interest and political trust depend on the extent of conditional requirements. Programme effects are mainly negative among claimants and their family members, but the negative effect diminishes and eventually turns positive when conditions extend.
Taking Skills Seriously: Toward an Integrative Model and Agenda for Social, Emotional, and Behavioral Skills
Authors: Soto Christopher J. , Napolitano Christopher M. , Roberts Brent W.
Published: December 2020

Success in life is influenced by more than cognitive ability and opportunity. Success is also influenced by social, emotional, and behavioral (SEB) skills: a person’s capacities to maintain social relationships, regulate emotions, and manage goal- and learning-directed behaviors. In this article, we propose an integrative model that defines SEB skills as capacities (what someone is capable of doing) rather than personality traits (what someone tends to do) and identifies five major skill domains: social engagement, cooperation, self-management, emotional resilience, and innovation. We then argue that operational measures of SEB skills should reflect rather than obscure the distinction between skills and traits. Finally, we propose an agenda for future work by highlighting open questions and hypotheses about the assessment, development, and outcomes of SEB skills as well as interventions and public policy targeting these skills.
The emerging geography of European financial centres: Fragmentation in the European Union and concentration in the UK?
Authors: Heneghan Martin , Hall Sarah
Published: December 2020

The United Kingdom’s (UK) withdrawal from the European Union (EU) will reshape the geography of European finance. From January 2021, the UK will no longer be able to sell financial services cross-border into the EU’s Single Market as it has done as a Member State. Through what are called passporting rights, these financial services exports from London to the EU have been central to London’s competitiveness as an international financial centre and the wider importance of financial services in the UK’s political economy. They have also provided a range of financial services to businesses and individuals in Europe. In this commentary, we examine the implications of Brexit for the financial services sector and for conceptual understandings of finance in economic geography and cognate social sciences. We argue that at the European scale, Brexit is giving rise to growing fragmentation of financial services to a range of European financial centres. Meanwhile, within the UK, finance is likely to become more concentrated in London as renewed processes of spatial concentration that have characterised previous economic shocks develop. Our analysis shows that that in order to understand these seemingly diverging geographies it is necessary to understand financial services as both economic and political practices.
Walking the line? An investigation into elite athletes’ sport-related use of painkillers and their willingness to use analgesics to train or compete when injured
Authors: Overbye Marie
Published: December 2020

Pain and injuries are inevitable occupational hazards and health risks in athletes’ working lives. The sport-related use of analgesics with and without injury is widespread. Taking analgesics to compete while injured is conceptualised as a sickness presenteeism problem. This study examines the complexity of the sport-related use of analgesics in elite sport. A mixed-method design was adopted consisting of a survey ( n=775) and interviews ( n=21) with elite athletes. Many athletes reported a sport-related use of analgesics. Analgesics had commonly been used to enable an injured athlete to: compete in an important match; train during an important period; qualify for an important match/final; and keep one’s position on the team or have one’s contract prolonged. In particular, team-sport athletes had experience of such use. Apart from the therapeutic use of analgesics, they were sometimes integrated into different routines: for example, enhancing performance, avoid lowering performance, aiding recovery, training/competing injured and prophylactic use. Simultaneously, many had refrained from using or sought to minimise their sport-related use of analgesics; reasons were related to: trust in/feeling the body, side-effects, knowledge and social norms. Social norms and interaction with support personnel played a key role. Physiotherapists and doctors often advised athletes on analgesics, but self-administered use was widespread. How risk cultures manifested themselves varied greatly between sports, and gender differences were scarce. Although ‘absenteeism’ is also present, a majority of athletes would be willing to ‘walk the line’, using analgesics to compete when injuries may threaten their career or sporting success.
A Comparative Analysis of the Government and NGOs in Delivering Quality Services for the Rural People of Pakistan: Community Perspectives
Authors: Khan Mohsin , Kasmi Jetnor , Saboor Abdul , Ali Iftikhar
Published: December 2020

Often the government and the non-governmental organisations (NGOs) are criticised for their poor performances in delivering services particularly in rural areas. However, there has been limited research on the assessment of their relative performances in service delivery as well as on the perceptions of people on the quality of such service delivery. This study examines the relative performances of NGOs and the governmental development interventions that provide basic services including public health, education, drinking water and sanitation. The study explains the impact of agricultural extension services and infrastructure such as access to roads and markets on the rural people and measures the satisfaction level of the rural community. For this purpose, 225 households (HHs) in 8 villages of Phalia Tehsil, district Mandi Bahauddin, Punjab, Pakistan were first surveyed in 2010 and then in 2014 using a structured questionnaire. The findings reveal different satisfaction levels of HHs, with most of them expressing less satisfaction on government service delivery compared with NGOs. They reveal satisfaction over the performance of NGOs in health, drinking water supplies and agriculture extension services. Further, the study shows an increasing satisfaction of people on access to road, transport, agri-market and price of agri-commodities by the government.
Occlusal and Functional Improvement of Patients With Midfacial Hypoplasia Corrected Using Intraoral Tooth-Borne Mid-Maxillary Osteodistractors at Teaching Hospital-Karapitiya, Sri Lanka
Authors: Perera Wattage Kathya Leoni , Jayawardana Ranatunga Arachchige Don Tilan Madujith , Pathirage Sumith Loku , Dias Dayanath Kumara , Dasanayaka D. A. R. K.
Published: December 2020

Objective:

Mid-maxillary osteodistraction (MMOD) is a novel technique. This study seeks to assess the occlusal and functional improvement of patients with midfacial hypoplasia secondary to cleft lip and palate.

Design:

This was done as a retrospective study at the Regional Cleft Centre of the Teaching Hospital-Karapitiya (THK).

Participants:

A total of 81 patient records were accessed on those who underwent MMOD with a tooth-borne intraoral device from January 1, 2007, to December 31, 2016, at THK.

Methods:

Records of the patients included pre- and post-treatment lateral cephalograms, study models, speech assessments, and photographs.

Results:

An advancement ranging from 5 to 12 mm (mean, 8.14 mm) was achieved in all patients; 80% (n = 63) and 87.65% (n = 71) showed improvement in consonant production and quality of speech. These were statistically significant (P < .05). With regard to the Peer Assessment Rating score assessing the occlusal improvement, 97.6% showed an improvement whereas only 2 patients showed no improvement. There was a significant improvement in sella (S), nasion (N), and point A (SNA) angle; point A, the nasion, and point B (ANB) angle; and the maxillary length over the treatment period (P < .05). The change in the ANB angle and maxillary length significantly differed between genders with males having a comparatively higher improvement. The profile improvements were noteworthy on the profile photographs.

Conclusion:

This relatively novel approach to maxillary advancement by maxillary distraction using a combined surgical and modified orthodontic technique has proven to be successful. This protocol and the technique have improved function, occlusion, and the aesthetics.
Cleft Care Readability: Can Patients Access Helpful Online Resources?
Authors: Wasserburg J. Roscoe , Sayegh Farah , Sanati-Mehrizy Paymon , Graziano Francis D. , Taub Peter J.
Published: December 2020

Objective:

The present study identifies and analyzes online patient resources for cleft lip with or without cleft palate to survey the online educational landscape relative to the recommended difficulty set by the National Institutes of Health (NIH) and American Medical Association (AMA).

Methods:

An internet search of “cleft palate,” “cleft lip,” and 12 similar inputs were entered into a search engine. The first 50 links for each search term were identified, collected, and reviewed individually for relevance and accessibility. The content of the websites was analyzed with Readability Studio Version 2019.1. The following readability metrics were utilized in this study: (1) Coleman-Liau (grade levels), (2) New Dale-Chall, (3) Flesch-Kincaid, (4) Flesch Reading Ease, (5) FORCAST, (6) Fry, (7) Gunning Fog, (8) New Fog Count, (9) Raygor Readability Estimate, and (10) Simple Measure of Gobbledygook.

Results:

In no combination of search terms did any collection of links provide information within the mid-seventh grade levels recommended by the NIH. The analysis of 143 unique websites in the “Cleft Palate” group showed a readability level appropriate to high school students. The analysis of 144 unique websites in the “Cleft Lip” group showed a readability level appropriate for eighth grade students with 6 months of class complete.

Conclusions:

The information presented to patients on cleft care is too complex and well above the recommended 7th-grade reading level target set forth by the NIH and AMA, which hinders functional health literacy.
Revisiting Senatorial Courtesy and the Selection of Judges to the U.S. Courts of Appeals
Authors: Howard Nicholas O. , Hughes David A.
Published: December 2020

We examine how elite attitudes and institutional rules and norms affect appointments to lower federal courts. Using voting data from 1,339 U.S. Courts of Appeals cases, we estimate new ideological measures for 475 individual circuit judges appointed between 1913 and 2008. We find that both presidential and home-state senators’ preferences strongly predict judicial ideology. While we find evidence that conditions of senatorial courtesy can constrain presidents from nominating like-minded individuals for lower court vacancies, this trend peaked during the 1960s and has been eroding ever since.
Patterns of complementary and alternative medicine use among Tunisian cancer patients
Authors: Toukabri Imen , Said Azza Ben , Hamdi Adel , Mokrani Amina , Gabsi Azza , Ayed Wiem Ben , Tounsi Karawen , Limayem Imen
Published: December 2020

Introduction

The use of complementary and alternative medicine (CAM) among cancer patients is prevalent worldwide as cancer patient are perpetually seeking for a way to improve their quality of life and to cure their disease. Unfortunately, the majority ignore the danger that can resort when they use CAM currently with conventional therapies. The purpose of this study is to assess prevalence and predictors of CAM use in cancer patients.

Methods

Cross-sectional study using a questionnaire administered to cancer patients, who were attending Salah Azaiz institute, Tunis, Tunisia. The study took place from September to December 2018.

Results

In 222 cancer patients, the overall prevalence of CAM use was 40.54%. On univariate analysis, patients who had university education level were less likely to use CAM (p = 0.05). Based on multivariate analysis, CAM users had more likely metastatic tumor (p = 0.047; OR = 1.913).It is reported that the majority of the population used herbal medicine. The most common herbal products consuming by patients, included Ephedra foeminea (51.8%), Annona muricata (12%) and Curcuma longa L. (10.84%).The main source of information was entourage (family, friends, hospital entourage) (74.44%).The majority of CAM users (61.11%) reported to consume CAM currently with conventional therapies.

Conclusion

This survey revealed a high prevalence of CAM use. The most common type of CAM use is herbal products. Some of the used herbal products are known to interact with conventional anticancer medication. This emphasizes the importance of patients disclosure of CAM use to health professionals in order to avoid herb-medications interactions.
Birds of a Feather: An Examination of ADHD Symptoms and Associated Concerns in Partners of Adults with ADHD
Authors: Steele Christina M. , Wymbs Brian T. , Capps R. Elizabeth
Published: December 2020

Objective:

Adults often select romantic partners who behave like they do (i.e. assortative mating). However, little is known about whether assortative mating is common among adults with attention-deficit/hyperactivity disorder (ADHD) and whether it is related to associated problems.

Method:

About 94 adults without ADHD, 43 adults with childhood ADHD histories but without current symptoms or impairment (ADHD-Desist), 27 adults with childhood ADHD histories and elevated current symptoms and impairment (ADHD-Persist) rated their partners’ ADHD symptoms and their own associated problems (e.g., intimate partner violence, financial difficulties).

Results:

The ADHD-Persist group reported that their partners exhibited more ADHD symptoms than the ADHD-Desist group and those without ADHD. Adults in the ADHD-Persist group who had partners with elevated ADHD symptoms endorsed high intimate partner violence and financial difficulties.

Conclusion:

Assortative mating appears to be common among adults with ADHD, especially those with persistent symptoms, and to increase risk of additional problems.
Committing to Continuity: Primary Care Practices During COVID-19 in an Urban Brazilian Neighborhood
Authors: Pingel Emily S. , Llovet Alexandra , Cosentino Fernando , Lesser Jeffrey
Published: December 2020

Decreased engagement in preventive services, including vaccination, during the COVID-19 pandemic represents a grave threat to global health. We use the case of the Bom Retiro Public Health Clinic in São Paulo, Brazil, to underscore how continuity of care is not only feasible, but a crucial part of health as a human right. The long-standing relationship between the clinic and neighborhood residents has facilitated ongoing management of physical and mental health conditions. Furthermore, we demonstrate how the clinic’s history of confronting infectious diseases has equipped it to adapt preventive services to meet patients’ needs during the pandemic. Our academic–community partnership used a multidisciplinary approach, relying on analysis of historical data, ethnographic data, and direct clinical experience. We identify specific prevention strategies alongside areas for improvement. We conclude that the clinic serves as a model for continuity of care in urban settings during a pandemic.
Destination Brand Positioning Theme Development Based on Consumers’ Personal Values
Authors: Kotsi Filareti , Pike Steven
Published: December 2020

This research note reports an investigation into the personal values that are salient to consumers when considering stopover destinations during long-haul travel. The findings, from personal interviews using the Repertory Test and laddering analysis, present destination marketers with potential brand positioning themes based on personal values. One of the greatest challenges facing destination marketers is developing a succinct brand positioning theme representative of a multiattributed entity that effectively differentiates from competing places offering similar attributes and benefits. It is argued that the development of a brand identity based on personal values, which subsume a myriad of attributes and benefits, has the potential to appeal to a broader range of travelers. This study, in the context of international stopover destinations for Greek travelers, replicated a similar investigation undertaken in the context of Australian domestic short-break holidays. The commonality between the findings of the two studies supports the development of a proposition that a relatively small number of personal values are relevant across different destination travel contexts. This could represent a solution to the challenge of developing a brand positioning theme that will be relevant across different markets and will appease the diversity of stakeholders at the destination.
The Mediating Effects of Community Support For Sustainable Tourism, Community Attachment, Involvement, and Environmental Attitudes
Authors: Orgaz-Agüera Francisco , Castellanos-Verdugo Mario , Acosta Guzmán José Alberto , Cobeña Mar , Oviedo-García María de los Ángeles
Published: December 2020

Community attachment is a key factor for both the perceptions and the attitudes of residents including the tourism activities within it. Besides, residents’ participation in the tourism development process influences their support for the development of tourism activities. Finally, the environmental attitudes of residents are essential for the sustainability of natural resources. A total of 722 structured questionnaires to residents of the city of Santiago de los Caballeros gathered information about community attachment, environmental activity, support for tourism, perceptions, and involvement toward the natural resources of the Yaque del Norte River (the longest of the Dominican Republic). The results, using partial least squares, showed the relevant relations between the variables researched and offer a new framework on which to reflect, for the assessment of the relations between community attachment and support for sustainable tourism, together with the involvement and the attitudes of the community.
Progressive development of large choroidal excavation in neovascular age-related macular degeneration
Authors: Arrigo Alessandro , Mansour Ahmad , Viganò Chiara , Gorgoni Francesca , Bandello Francesco , Battaglia Parodi Maurizio
Published: December 2020

Purpose:

Focal choroidal excavation (CE) is an unusual concavity in the choroid without posterior staphyloma or scleral ectasia and with pathogenesis is still unknown. In this article we present a case of de novo progressive focal choroidal excavation associated with exudative age-related macular degeneration (AMD).

Methods:

This study was designed as a descriptive case report based on clinical and imaging data collected during patient’s observation and follow-ups.

Results:

A 67-year-old man with systemic hypertension and hypercholesterolemia, with a previous diagnosis of bilateral AMD complicated by already treated macular neovascularization, underwent our attention to perform follow-up visits. Over the 5-year follow-up, the left eye remained stable, requiring no further treatments and disclosing a BCVA of 0.0 LogMAR. On the contrary, the right eye showed several exudation recurrences, requiring further anti-VEGF injections. Structural OCT detected the progressive development of a focal CE, which gradually enlarged converting into a large CE. Structural OCT examinations reported even growing defects of the Bruch’s membrane. Despite the evident progression of the CE, BCVA disclosed stable values over the 5-years follow-up (1.0 LogMAR), with a worsening of metamorphopsia.

Conclusion:

Large CE may be a complication of neovascular AMD. Bruch’s membrane abnormalities, including thickness and reflectivity changes, detectable on structural OCT, can be considered early biomarkers of potentially developing CE.
Is choriocapillaris the early target in acute maculopathy secondary to hand, foot, and mouth disease? A case report
Authors: Talli Pietro Maria , Bendo Edlira , Pedrotti Emilio , Pazzaglia Alberto
Published: December 2020

Purpose:

To report the case of a 33-year old man who disclosed the first case of bilateral ocular involvement of hand, foot, and mouth disease (HFMD) with a different stage of the disease in each eye.

Methods:

Retrospective case report.

Results:

The study included a patient who incurred in a bilateral HFMD maculopathy. During 6 months follow-up period persistent abnormalities in fundus examination and in OCT scans were reported.

Conclusion:

We consider that our case shows that choriocapillaris is the primary target of HFMD maculopathy, for this reason we consider that ICGA is mandatory for early diagnosis and an effective treatment.
Metal-on-metal total hip arthroplasty: does increasing modularity affect clinical outcome?
Authors: Ilo Kevin C , Hothi Harry S , Skinner John A , Hart Alister J
Published: December 2020

Background:

Modularity of metal-on-metal (MoM) implants has come under scrutiny due to concerns regarding additional sources of metal debris. This study is a retrieval analysis of implants from the same manufacturer with the same MoM bearing surface. The difference between the implants was presence or absence of modular junctions.

Methods:

This is a retrospective study of 31 retrieved implants from 31 patients who received a Conserve Wright Medical MoM hip prosthesis. The 31 implants consisted of 16 resurfacings and 15 implants with modular junctions; 4 conventional THAs and 11 modular-neck THAs.

Results:

43% of pre-revision MRI scans performed on resurfacing implants and 91% performed on the modular implants illustrated evidence of an adverse local tissue reaction. There was no difference in pre-revision blood metal ion levels or bearing surface wear between the resurfacings and modular implants. The neck-head tapers of the modular group showed low levels of material loss. However, the neck-stem tapers showed increased severity of corrosion and material loss

Conclusions:

The modular implants had an increased incidence of adverse local tissue reaction. This could be related to the presence of modular junctions, particular the neck-stem junction which showed increased susceptibly to corrosion