bluuebunny/crossref_metadata_2025 huggingface dataset:
Spontaneous Cerebrospinal Fluid Rhinorrhea and Otorrhea: A Case Report and Literature Review
Authors: Li Shujuan , Lu Tao , Wang Yan , Guo Min , Ma Rongyue , Li Shuling , Ruan Biao
Published: February 2023

Spontaneous cerebrospinal fluid (CSF) leak is a condition that commonly presents with unilateral watery drainage from the nose or ear, tinnitus, and stuffy ears or hearing loss. Spontaneous CSF rhinorrhea and otorrhea together are rare. A 64-year-old woman presented at our department with complaints of clear watery rhinorrhea and hearing loss on the right side persisting for 10 months. Imaging and surgery were used to diagnose the condition. Through surgical treatment, she was eventually cured. Review of the literature has shown that patients with both nasal and aural CSF leaks are rare. When a patient presents with both unilateral watery drainage from both the nose and ear, a diagnosis of CSF rhinorrhea and otorrhea should be considered. This case report will benefit clinicians by providing more information to assist with diagnosing the disease.
Impact of Syrian Refugees on Male Immigrants’ Labor Market Outcomes in Jordan
Authors: Malaeb Bilal , Wahba Jackline
Published: February 2023

This article examines whether the Syrian refugee inflow to Jordan has displaced other immigrant workers in the Jordanian Labor Market. Using data from Jordan, before and after the Syrian refugee influx (in 2010 and 2016), we investigate whether male immigrants’ labor market outcomes, compared to male Jordanian nationals, were affected by Syrian refugees. We control for the geographic sorting of refugees within Jordan using an instrumental variable approach. We find that male immigrants were more likely to be underemployed (i.e., work in the informal sector, work fewer hours, and earn lower monthly wages) in areas with high concentration of Syrian refugees. These findings suggest that the main competition that occurred in the Jordanian Labor Market, between 2010 and 2016, was not between refugees and male Jordanian nationals, but between refugees and male immigrants. These results suggest that studies examining the impact of refugees on the labor market should consider the effects on immigrants who are likely to be more vulnerable than natives.
Language development of Chinese-speaking hearing-impaired children: The roles of home literacy resources and shared book reading
Authors: Chan Yi-Chih
Published: February 2023

The present study aimed to explore the specific components of home literacy resources (HLR) and parental behaviours during shared book reading (SBR) that may contribute to the language development of Chinese-speaking hearing-impaired children. A total of 90 Chinese-speaking hearing-impaired children aged 3 to 6 years, along with their parents, participated in this study. Following the design of previous studies, we required the parents to complete a questionnaire regarding HLR and parental SBR behaviours, and their hearing-impaired children received a standardised language test. The results showed that such HLR components as storybook capacity at home, weekly frequency of SBR, duration per SBR session, starting age of SBR, and the parental SBR behaviour, parent and child discussing opinions with each other, could significantly account for an additional portion of the variance in children's receptive, expressive, and overall language beyond the demographic variables. It is thus recommended that clinicians share this evidence-based information with parents who have hearing-impaired children to help their children develop language to their fullest potential.
Less exposed, more vulnerable? Understanding the sexual victimization of women with disabilities under the lens of victimological theories
Authors: Chopin Julien , Beauregard Eric , Deslauriers-Varin Nadine
Published: February 2023

This study aims to examine the sexual victimization process of individuals with disabilities using the interactional victimology theoretical framework. Specifically, we compare the victimological indicators of four different situations: victims were not disabled, victims were physically disabled, victims were psychologically disabled, and finally, victims were both physically and psychologically disabled. The sample used in this study consists of 1,077 cases of extrafamilial sexual assaults involving adult victims in France. Bivariate and multivariate analyses are performed to examine the differences between cases where victims were not disabled ( n = 500), victims were physically disabled ( n = 243), victims were psychologically disabled ( n = 276), and victims were both physically and psychologically disabled ( n = 58). Findings show that disability is a factor increasing the severity of sexual violence and that the type of disability affects the parameters of the victimization process. Moreover, results show that sexual victimization of persons with disabilities is more likely due to their vulnerability than to their exposure to risks. Both theoretical and practical implications related to the vulnerability concept are discussed.
We need to talk: The urgent conversation on chronic pain, mental health, prescribing patterns and the opioid crisis
Authors: Battaglia Marco , Groenewald Cornelius B , Campbell Fiona , Scaini Simona , De Koninck Yves , Stinson Jennifer , Quinn Patrick D
Published: February 2023

The opioid crisis’ pathways from first exposure onwards to eventual illnesses and fatalities are multiple, intertwined and difficult to dissect. Here, we offer a multidisciplinary appraisal of the relationships among mental health, chronic pain, prescribing patterns worldwide and the opioid crisis. Because the opioid crisis’ toll is especially harsh on young people, emphasis is given on data regarding the younger strata of the population. Because analgesic opioid prescription constitute a recognised entry point towards misuse, opioid use disorder, and ultimately overdose, prescribing patterns across different countries are examined as a modifiable hazard factor along these pathways of risk. Psychiatrists are called to play a more compelling role in this urgent conversation, as they are uniquely placed to provide synthesis and lead action among the different fields of knowledge and care that lie at the crossroads of the opioid crisis. Psychiatrists are also ideally positioned to gauge and disseminate the foundations for diagnosis and clinical management of mental conditions associated with chronic pain, including the identification of hazardous and protective factors. It is our hope to spark more interdisciplinary exchanges and encourage psychiatrists worldwide to become leaders in an urgent conversation with interlocutors from the clinical and basic sciences, policy makers and stakeholders including clients and their families.
Dynamic reorganization of cortical structure in multi-domain regions after capsular and pontine stroke
Authors: Liu Jingchun , Wang Caihong , Qin Wen , Guo Jun , Han Tong , Cheng Jingliang , Yu Chunshui
Published: February 2023

Subcortical stroke may cause widespread structural changes to the cerebral cortex in multiple domains; however, the details of this process remain unclear. In this prospective observational study, we acquired two datasets to investigate the effect of lesion location on cortical structure. One was cross-sectional, comprising 269 patients with chronic stroke, either capsular stroke (CS) or pontine stroke (PS), and the other was longitudinal, comprising 119 patients with CS or PS. In the chronic-stage data, both CS and PS exhibited reduced cortical thickness in the precentral gyrus and increased cortical thickness and area in the frontal, temporal, occipital and insular cortices. Cortical thicknesses were correlated with motor outcomes in the precentral and lingual gyri, and early impairment of the corticospinal tract was associated with cortical thickness in the middle frontal gyrus. In the longitudinal dataset, CS showed gradually decreasing cortical thickness in the precentral gyrus, and both CS and PS showed gradually increasing cortical thickness and area in regions with significant structural reorganization. Subcortical stroke can therefore cause complex cortical structural changes in multi-domain regions involved in motor, primary and higher cognitive areas and have different evolution patterns depending on the subcortical level of the lesion affecting the motor pathways.
Preventive CGRP-targeted therapies for chronic migraine with and without medication-overuse headache
Authors: Alpuente Alicia , Torres-Ferrus Marta , Terwindt Gisela M.
Published: February 2023

Background:

Calcitonin gene-related peptide (CGRP) targeted therapies are an important breakthrough in migraine prevention. Randomized clinical trials, post-hoc analyses, and phase IV studies have demonstrated their efficacy and safety in chronic migraine patients, including those with concomitant medication-overuse and medication-overuse headache. Real world evidence studies support these findings and provide realistic endpoints for estimation of effect.

Methods and results

We have performed a narrative review including results from double-blind placebo-controlled randomized clinical trials and real-world evidence studies regarding efficacy of the CGRP(-receptor) monoclonal antibodies and CGRP-receptor antagonists (gepants) in patients with chronic migraine with concomitant medication overuse (headache). We have included patient profiles and main efficacy endpoints (monthly migraine days, monthly headache days, monthly acute medication days and percentage responder rates).

Conclusion

The results of this review show that CGRP monoclonal antibodies are effective in chronic migraine patients, also in those with medication overuse (headache). At the time of this review, atogepant clinical trials in chronic migraine have not been communicated. Direct comparative studies are needed for comparison with other treatment options.
Effects of Contralateral Trunk Tilt on Shoulder and Elbow Injury Risk and Pitching Biomechanics in Professional Baseball Pitchers
Authors: Escamilla Rafael F. , Slowik Jonathan S. , Fleisig Glenn S.
Published: February 2023

Background:

Baseball pitchers employ various contralateral trunk tilt (CTT) positions when pitching depending on if they have an overhand, three-quarter, or sidearm delivery. There are no known studies that have examined how pitching biomechanics are significantly different in professional pitchers with varying amounts of CTT, which may provide insight into shoulder and elbow injury risk among pitchers with different CTT.

Purpose:

To assess differences in shoulder and elbow forces and torques and baseball pitching biomechanics in professional pitchers with maximum 30° to 40° CTT (MaxCTT), moderate 15° to 25° CTT (ModCTT), and minimum 0° to 10° CTT (MinCTT).

Study Design:

Controlled laboratory study.

Methods:

In total, 215 pitchers were examined, including 46 pitchers with MaxCTT, 126 pitchers with ModCTT, and 43 pitchers with MinCTT. All pitchers were tested using a 240-Hz, 10-camera motion analysis system, and 37 kinematic and kinetic parameters were calculated. Differences in kinematic and kinetic variables among the 3 CTT groups were assessed with a 1-way analysis of variance ( P < .01).

Results:

Maximum shoulder anterior force and maximum elbow proximal force were significantly greater in ModCTT (403 ± 79 N) than MaxCTT (369 ± 75 N) and MinCTT (364 ± 70 N), while maximum elbow flexion torque and shoulder proximal force, respectively, were significantly greater in ModCTT (69 ± 11 N·m and 1176 ± 152 N, respectively) than MaxCTT (62 ± 12 N·m and 1085 ± 119 N, respectively). During arm cocking, maximum pelvis angular velocity was greater in MinCTT than MaxCTT and ModCTT, and maximum upper trunk angular velocity was greater in MaxCTT and ModCTT than MinCTT. At ball release, trunk forward tilt was greater in MaxCTT and ModCTT than MinCTT and greater in MaxCTT than ModCTT, while arm slot angle was less in MaxCTT and ModCTT than MinCTT and less in MaxCTT than ModCTT.

Conclusion:

The greatest shoulder and elbow peak forces occurred in ModCTT, which occurs in pitchers who throw with a three-quarter arm slot. More research is needed to assess if pitchers with ModCTT are at a higher risk of shoulder and elbow injury compared with pitchers with MaxCTT (overhand arm slot) and MinCTT (sidearm arm slot), although in the pitching literature, excessive elbow and shoulder forces and torques have been shown to correlate with elbow and shoulder injuries.

Clinical Relevance:

The results from the current study will help clinicians better understand if differences in kinematic and kinetic measures differ with pitching, or if differences in force, torque, and arm position occur at different arm slots.
‘Could it be that, after all is said and done, we are Oedipus and the group of the Sphinx?’: Learning from Foulkes
Authors: Haude Volker
Published: February 2023

S.H. Foulkes’s paper concerning the Oedipus situation—published some 40 years ago—is still relevant in current group analytic practice. Main phrases of the Foulkes article, such as ‘regression’, ‘infantile sexuality’, ‘Oedipus conflict’, the ‘Sphinx-like mother’ and ‘transference’ are examined. Based on a case report about sexual pairing in group psychotherapy, the author depicts the course of events before analysing the enactment of the protagonists, the role of the group, somatic sufferings during the group process, boundary violations and countertransference factors, and discusses diagnostic and therapeutic implications as well as the need for further research on the special topic in group analytic psychotherapy.
Illustrating Resource Needs through Data Visualization: Creation of Life-Space Maps for Rural Veterans with Dementia and their Caregivers
Authors: Loup Julia , Smith Kate , Snow A. Lynn , Hilgeman Michelle M.
Published: February 2023

Rural-dwelling individuals with dementia and their caregivers face unique challenges compared to urban-dwelling peers. Barriers to accessing services and supports are common, and individual resources and informal networks available to support rural families can be difficult to track for providers and healthcare systems outside of the local community. This study uses qualitative data from rural-dwelling dyads, individuals with dementia ( n = 12) and informal caregivers ( n = 18), to demonstrate how rural patients’ daily life needs can be summarized through life-space map visualizations. Thirty semi-structured qualitative interviews were analyzed using a two-step process. First, rapid qualitative analysis was completed to generate daily-life needs of the participants’ home and community context. Next, life-space maps were developed to synthesize and visualize dyads’ met and unmet needs. Results suggest life-space mapping may offer a pathway for improved needs-based information integration for busy care providers and time-sensitive quality improvement efforts by learning healthcare systems.
Capitalism, Class Struggle and/in Academia
Authors: Das Raju J.
Published: February 2023

Class struggle is a necessary aspect of society. While ordinary people engage in struggles to improve their conditions, economically powerful people engage in struggles to defend their privileges. Thus, class struggle is from below and from above. And, class struggle occurs over interests and over ideas. To reproduce capitalism, it is not enough that resources be in the hands of the top 1%–10% thus economically forcing the vast majority to rely on wage work, or that police be used against their picket lines. It is also necessary that a large number of common people must possess ideas that make them accept the existing mechanisms of society as natural or as inherently good for all. But, these ideas are challenged too, which is how ideological class struggle from below happens. Academia is a major site of ideological struggle. Generally, professors propagate ideas that justify the reproduction of capitalism as it is or in slightly modified forms. These ideas can be challenged by students. The main aim of this article is to briefly discuss the nature of ideological class struggle in academia and to present a series of questions from the standpoint of the students who can oppose many of the ideas circulating in academia.
Are Hospice Google Ratings Correlated With Patient Experience Scores? Evidence from a National Hospice Study
Authors: Davlyatov Ganisher , He Mengying , Orewa Gregory , Qu Haiyan , Weech-Maldonado Robert
Published: February 2023

Background: Choosing hospice care for your loved ones is often challenging. Online ratings such as Google rating has become a go-to source for most consumers. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey for Hospice also provides quality information about hospice care to help patients and their families make decisions. Aim: To evaluate the perceived usefulness of publicly reported hospice quality indicators and compare hospice Google ratings with hospice CAHPS scores. Methods: A cross-sectional observational study was performed to test the relationship between Google ratings and CAHPS measures in 2020. We conducted descriptive statistics for all variables. Multivariate regressions were used to assess the relationship between Google ratings and the CAHPS scores of the sample. Results: Among our sample of 1,956 hospices, the average Google rating was 4.2 out of 5 stars. CAHPS score means ranged from 75 (Help for pain and symptoms) to 90 (Treating patients with respect) out of 100. Hospice Google ratings were highly correlated with hospice CAHPS scores. For-profit and chain-affiliated hospices reported lower CAHPS scores. Hospice operational time was positively associated with CAHPS scores. The percentage of minority residents in the community and residents’ educational level was negatively associated with CAHPS scores. Conclusions: Hospice Google ratings were highly correlated with patients' and families’ experience scores as measured by the CAHPS survey. Consumers can use information from both resources in making decisions about hospice care.
Parents’ Experience of the Diagnosis of Autism Spectrum Disorder: Opportunities for Marriage and Family Therapists
Authors: Befi Michelle , Bemmel Vincent , Samelson Doreen , Sneed Lindsey , Hoobing Jennifer
Published: February 2023

The purpose of this exploratory study was to understand how parents experience their child's autism spectrum disorder diagnosis and highlight opportunities for marriage and family therapists (MFTs) to apply their specific training and expertise to support these families. A thematic analysis was performed on data collected during the parents’ initial assessment to better understand the components of their experience. Four major themes emerged from the analysis: understanding, acceptance, coping, and emotion. Many subthemes were also identified across these major themes and while the majority of parents revealed positive experiences, a portion of parents expressed challenges with the diagnosis. Marriage and family therapists are equipped with specific training and expertise which can help identify difficulties in the diagnostic experience, help families improve their well-being through building resilience, and create a healthy environment for the treatment journey ahead in the context of individual, couples, or family therapy. We present recommendations for MFTs working with families with autistic children.
Addendum to “fourth-order tensor calculus operations and application to continuum mechanics”
Authors: Kellermann David C , Attard Mario M , O’Shea Daniel J
Published: February 2023

The authors provided a novel explicit expression for the dot derivative of an isotropic tensor function in the work by Kellermann et al. An alternate proof is provided in this addendum without the power series assumption.
Novel nucleus management technique in hypermature morgagnian cataracts with liquified cortex during phacoemulsification
Authors: Parkash Rohit Om , Gurnani Bharat , Kaur Kirandeep , Parkash Tushya Om , Vajpayee Rasik B , Baldev Vibha
Published: February 2023

Purpose

To describe a novel nucleus management technique of variable size mobile nucleus in Hypermature Morgagnian cataracts.

Methods

In this technique, under topical anesthesia, temporal tunnel incision and capsulorhexis were performed, and the capsular bag was inflated with 2% w/v hydroxypropylmethylcellulose. A chopper and phacoemulsification probe were used to consciously nudge the nucleus towards the capsular periphery (fornix) to immobilize the floating nucleus against the capsular bag recess. Firm nuclear impaling was achieved using longitudinal power in linear mode (range 0–70%), 650 mmHg vacuum, and aspiration flow rate of 42 ml/min. The nucleus was chopped by direct chop technique, total separation achieved, and fragments emulsified. Primary outcome measures included ease of nuclear holding, iatrogenic zonular stress/damage, posterior capsule tear, and endothelial cell loss.

Results

This technique was performed in 29 consecutive cases from June 2019 – December 2021, and no intraoperative or postoperative complications were noted. The average phacoemulsification time and cumulative dissipated energy (CDE) were nearly similar in all cases.

Conclusion

This technique would make phacoemulsification much safer in eyes with hypermature cataract and liquified cortex with lower complication rates and maintenance of better endothelial integrity.
Tildrakizumab in Complex Psoriatic Patients: An Experience in Emilia-Romagna (Italy)
Authors: Bardazzi Federico , Viviani Filippo , Piraccini Bianca Maria , Lasagni Claudia , Bigi Laura , Manfredini Marco , Pongetti Linda , Di Lernia Vito , Corazza Monica , Pepe Francesca
Published: February 2023

Background

IL-23 inhibitors are the latest class of biologic drugs approved for moderate-to-severe psoriasis.

Objectives

to investigate real-life safety and efficacy of tildrakizumab.

Methods

demographic data, medical history, psoriasis disease history, PASI, DLQI, BSA, NAPSI were recorded at weeks 0, 12, 24, 36.

Results

PASI, BSA, DLQI and NAPSI all decreased rapidly during the 36 week follow-up period. PASI score reduced from 12.28 to 4.65 by week 12, followed by a further decrease to 1.18 at week 36 Multiple logistic regression showed that smoking, BMI ≥30, ≥3 comorbidities, previous systemic traditional or biologic drugs, psoriatic arthritis nor difficult-to-treat areas influenced the reduction of PASI and NAPSI scores during treatment with tildrakizumab ( P > .05).

Conclusions

we assessed a good performance of tildrakizumab in patients with multiple comorbidities, multi-failure, elderly patients, and in subjects with psoriatic arthritis.
Entertaining information: Third-party influencers’ role in COVID-safety health communication
Authors: Cover Rob , Parker Lukas , Young Charlotte , Ostapets Katia
Published: February 2023

This paper discusses findings from a commissioned evaluation of an Australian government COVID-19 health campaign that utilised third-party influencers to increase the reach of health communication messages among culturally and linguistically diverse young people. Although the campaign was successful, interviews with select influencers and target audience members indicated that the ‘serious’ tone of the health messaging was less effective and less likely to be shared and that messages should be more ‘entertaining’. Analyses of data indicated three themes providing insights into how future campaigns may benefit from a focus that draws together health information and entertainment using models already constructed in the entertainment–education field: (1) Entertaining health messages have a stronger fit with influencers who are known for their entertainment value; (2) Entertaining messages are more memorable and more likely to be shared; (3) A balance between entertainment and the signifiers of trust and credibility such as government health authority logos overcomes trust issues in the context of current health disinformation and misinformation.
Proximal Hamate Reconstruction of Proximal Pole Scaphoid Nonunion: A Case Series and Analysis of Clinical Outcomes
Authors: Rodriguez-Fontan Francisco , Tucker Nicholas J. , Pflug Emily M. , Leversedge Fraser J. , Catalano Louis W. , Lauder Alexander
Published: February 2023

Background:

Small proximal pole scaphoid nonunions present a clinical challenge influenced by fragment size, vascular compromise, deforming forces exerted through the scapholunate interosseous ligament (SLIL), and potential articular fragmentation. Osteochondral autograft options for proximal pole reconstruction include the medial femoral trochlea, costochondral rib, or proximal hamate. This study reports the clinical outcomes of patients treated with proximal hamate osteochondral autograft reconstruction.

Methods:

A retrospective review identified patients treated with this surgery from 2 institutions with a minimum 6-month follow-up. Clinical outcomes included the Visual Analog Dcale pain score, 12-item Short-Form survey, abbreviated Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, wrist and forearm range of motion (ROM), radiographic assessment, and complications. We reviewed and compared these outcomes with those of the current published literature.

Results:

Four patients (mean age: 24 years, 75% men) with a 12.8-month average follow-up (range: 6-20 months) were included. Radiographic union was identified in all cases by 12 weeks (range, 10-12). The average wrist ROM was 67.5% flexion/extension and 100% pronation/supination compared with the contralateral side at the final follow-up. The mean QuickDASH score was 17.6 (SD, 13). No complications were identified.

Conclusions:

Proximal pole scaphoid nonunion reconstruction using autologous proximal hamate osteochondral graft demonstrated encouraging clinical and radiographic outcomes. Proximal hamate harvest involves minimal donor site morbidity without a distant operative site, uses an osteochondral graft with similar morphology to the proximal scaphoid, requires no microsurgical technique, and permits reconstruction of the SLIL using the volar capitohamate ligament.
Modified treatment in cerebral ischemia 1 versus modified treatment in cerebral ischemia 0 before endovascular stroke treatment in middle cerebral artery’s M1-occlusion: Predictor for revascularization success and outcome?
Authors: Jesser Jessica , Weyland Charlotte S , Potreck Arne , Neuberger Ulf , Breckwoldt Michael O , Chen Min , Schönenberger Silvia , Bendszus Martin , Möhlenbruch Markus A
Published: February 2023

Background

Little is known about the implications for revascularization success of target vessel occlusions (TVOs) with persisting antegrade perfusion before initiation of endovascular stroke treatment (EST) (modified treatment in cerebral ischemia (mTICI 1)) compared to a complete occlusion (mTICI 0). Here, we compared these two states of TVO.

Methods

Retrospective, single-center analysis of patients treated for M1-segment middle cerebral artery (MCA) occlusion with EST from January 2015 until May 2020 in a tertiary stroke center. Primary study endpoint was successful recanalization (mTICI 2c-3) after one thrombectomy attempt. Secondary endpoints were clinical outcome (modified Rankin Scale (mRS) 90 days after stroke onset), complication rate, and rate of underlying atherosclerotic disease. The two study groups were compared in univariate analysis including patient characteristics and procedural details.

Results

In this study, 422/581 patients (72.6%) presented with complete M1-occlusion compared to 159/581 (27.4%) with incomplete M1-occlusion. Neither did the recanalization success rate differ between the study groups nor the rate of complications (mTICI 0: 2.4%, mTICI 1: 0.6%, p = 0.304) or underlying atherosclerotic disease. Patients with incomplete initial occlusion showed a lower mRS at discharge (median interquartile range (IQR) mTICI 0: 4 (3–5) vs. mTICI 1: 3 (2–6), p = 0.014), but a comparable mRS 90 days after stroke onset (mTICI 0: 3 (2–6) vs. mTICI 1: 4 (2–6), p = 0.479).

Conclusion

Complete M1-occlusions (mTICI 0) and incomplete occlusions (mTICI 1) show the same recanalization success, comparable complication rate, and clinical outcome as well as the same rate of underlying atherosclerotic disease. Thus, incomplete M1-occlusions do not allow for an individualized interventional approach.
Sexual offences committed by members of the armed forces: Is the service justice system fit for purpose?
Authors: Herriott Charlotte , Wood Abigail D , Gillin Nicola , Fossey Matt J , Godier-McBard Lauren R
Published: February 2023

Recent policy reviews, academic research and high-profile media critiques have repeatedly emphasised the UK military as a hypermasculine culture, seemingly permissive of sexual violence, marked by high prevalence of sexual offences and an inadequate justice response. The service justice system has been characterised by low conviction rates and poor treatment of victim-survivors of sexual offences, prompting recommendation that rape should be tried in the civilian criminal justice system rather than the service justice system. Despite notable debate on this matter, the Ministry of Defence (MOD) ultimately rejected this recommendation in December 2021 and instead committed to implementing clear and meaningful change within the service justice system response to sexual offences. In light of this decision, this article interrogates available data about the current service justice system response to sexual offending, and lessons that may be learnt from the civilian criminal justice system, to highlight current obstacles to justice and outline areas in which further research and scrutiny is necessary.
Parkinson’s disease or multiple system atrophy: potential separation by quantitative susceptibility mapping
Authors: Marxreiter Franz , Lambrecht Vera , Mennecke Angelika , Hanspach Jannis , Jukic Jelena , Regensburger Martin , Herrler Juergen , German Alexander , Kassubek Jan , Grön Georg , Müller Hans-Peter , Laun Frederik B. , Dörfler Arnd , Winkler Juergen , Schmidt Manuel A.
Published: February 2023

Background:

Due to the absence of robust biomarkers, and the low sensitivity and specificity of routine imaging techniques, the differential diagnosis between Parkinson’s disease (PD) and multiple system atrophy (MSA) is challenging. High-field magnetic resonance imaging (MRI) opened up new possibilities regarding the analysis of pathological alterations associated with neurodegenerative processes. Recently, we have shown that quantitative susceptibility mapping (QSM) enables visualization and quantification of two major histopathologic hallmarks observed in MSA: reduced myelin density and iron accumulation in the basal ganglia of a transgenic murine model of MSA. It is therefore emerging as a promising imaging modality on the differential diagnosis of Parkinsonian syndromes.

Objectives:

To assess QSM on high-field MRI for the differential diagnosis of PD and MSA.

Methods:

We assessed 23 patients (nine PDs and 14 MSAs) and nine controls using QSM on 3T and 7T MRI scanners at two academic centers.

Results:

We observed increased susceptibility in MSA at 3T in prototypical subcortical and brainstem regions. Susceptibility measures of putamen, pallidum, and substantia nigra reached excellent diagnostic accuracy to separate both synucleinopathies. Increase toward 100% sensitivity and specificity was achieved using 7T MRI in a subset of patients. Magnetic susceptibility correlated with age in all groups, but not with disease duration in MSA. Sensitivity and specificity were particularly high for possible MSA, and reached 100% in the putamen.

Conclusion:

Putaminal susceptibility measures, in particular on ultra-high-field MRI, may distinguish MSA patients from both, PD and controls, allowing an early and sensitive diagnosis of MSA.
Containment of COVID-19 outbreak at a veterans affairs community living center
Authors: Dousa Khalid M , Hmiel Laura , Klonowski Brian , Zabarsky Trina F , Pyatt Kimberly , Stiefel Usha , Donskey Curtis J , Jump Robin LP
Published: February 2023

Asymptomatic and pre-symptomatic staff and residents likely contribute to widespread transmission of COVID-19 in long-term care settings. Here, we describe the successful containment of a COVID-19 outbreak on one floor of a 163-bed Veterans Affairs (VA) Community Living Center (CLC). Testing using nasopharyngeal swabs with a rapid turn-around-time identified 3 of 28 (11%) residents and 2 of 41 (5%) healthcare personnel (HCP) with COVID-19. Both HCP likely worked on the floor while pre-symptomatic. When one HCP reported a cough to the secondary (employee) screening clinic, she was erroneously advised to work. Protocols to limit the risk for HCP to import COVID-19 were reinforced with Community Living Center staff as well as with personnel in secondary screening. Further, the CLC implemented an expanded screening tool that assessed residents for typical and atypical symptoms of COVID-19. No further cases of COVID-19 were detected on the CLC floor in the subsequent 6 weeks. Swift recognition and response helped contain the outbreak and prevent further COVID-19 infections among other residents and staff.
Social media advertising for clinical studies: Ethical and data protection implications of online targeting
Authors: Mühlhoff Rainer , Willem Theresa
Published: February 2023

Social media advertising has revolutionised the advertising world by providing data-driven targeting methods. One area where social media advertising is just gaining a foothold is in the recruitment of clinical study participants. Here, as everywhere, social media advertising promises more yield per money spent because the technology can better reach highly specialised groups. In this article, we point out severe societal risks posed by advertising for clinical studies on social media. We show that social media advertising for clinical studies in many cases violates the privacy of individual users (R1), creates collective privacy risks by helping platform companies train predictive models of medical information that can be applied to all their users (R2), exploits the weaknesses of existing guidelines in (biomedical) research ethics (R3) and is detrimental to the quality of (biomedical) research (R4). We argue that the well-intentioned promises, which are often associated with the use of social media advertising for clinical studies, are untenable from a balanced point of view. Consequently, we call for updates of research ethics guidelines and better regulation of Big Data and inferential analytics. We conclude that social media advertising – especially with vulnerable patient populations – is not suitable as a recruitment tool for clinical studies as long as the processing of (even anonymised) social media usage data and the training of predictive models by data analytics and artificial intelligence companies is not sufficiently regulated.
TikTok’s Queer Potential: Identity, Methods, Movements
Authors: Duguay Stefanie
Published: February 2023

This commentary piece considers TikTok’s queer potential in terms of the platform’s use and subversion for the purposes of queer movements and worldmaking. It considers how TikTok’s affordances, features, and algorithmic functionalities both facilitate and hamper the expression of lesbian, gay, bisexual, transgender, queer and other diverse (LGBTQ+) identities and the formation of queer publics. As such, it proposes that queer methodologies, invoking multiple approaches infused with an ethics of care and attention to platform specificity, can be applied to examine the hurdles TikTok poses for LGBTQ+ people as well as how individuals appropriate the app for their purposes. By considering how queer identities, publics, and methods play out on TikTok, it becomes possible to locate the app’s existing and potential role in the realization of queer movements and futures.
Impact of Occupation on 12-Month Outcomes After Anterior Cruciate Ligament Reconstruction in Male Patients
Authors: Kirby Julia C. , Whitehead Timothy S. , Webster Kate E. , Feller Julian A. , McClelland Jodie A. , Klemm Haydn J. , Devitt Brian M.
Published: February 2023

Background:

The impact of a physically demanding occupation on clinical outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR) is largely unknown.

Purpose/Hypothesis:

The purpose of this study was to assess the influence of occupation on 12-month outcomes after ACLR in male patients. It was hypothesized that patients undertaking manual work would not only have better functional outcomes in terms of strength and range of motion but also higher rates of joint effusion and greater anterior knee laxity.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

From an initial cohort of 1829 patients, we identified 372 eligible patients aged 18 to 30 years who underwent primary ACLR between 2014 and 2017. Based on a preoperative self-assessment, 2 groups were established: patients engaged in heavy manual occupations and those engaged in low-impact occupations. Data were collected from a prospective database including effusion, knee range of motion (using side-to-side difference), anterior knee laxity, limb symmetry index for single hop and triple hop, International Knee Documentation Committee (IKDC) subjective score, and complications up to 12 months. Because of the significantly lower rate of female patients undertaking heavy manual occupations compared to low-impact occupations (12.5% and 40.0%, respectively), data analysis was focused on male patients. Outcome variables were assessed for normality, and statistical comparisons were made between the heavy manual and low-impact groups using either an independent-samples t test or the Mann-Whitney U test.

Results:

Of 230 male patients, 98 were included in the heavy manual occupation group, and 132 were included in the low-impact occupation group. Patients in the heavy manual occupation group were significantly younger than those in the low-impact occupation group (mean age, 24.1 vs 25.9 years, respectively; P < .005). There was a greater range of active and passive knee flexion in the heavy manual occupation group than in the low-impact occupation group (mean active, 3.38° vs 5.33°, respectively [ P = .021]; mean passive, 2.76° vs 5.00°, respectively [ P = .005]). There was no difference in effusion, anterior knee laxity, limb symmetry index, IKDC score, return-to-sport rate, or graft rupture rate at 12 months.

Conclusion:

At 12 months after primary ACLR, male patients engaged in heavy manual occupations had a greater range of knee flexion, with no difference in the effusion rate or anterior knee laxity, compared with those engaged in low-impact occupations.
Good Things (About Bad Behavior) Come in Small Packages: Using the Short Story “Great Experiment” to Teach Business Ethics
Authors: Comer Debra R. , Holbrook Robert L.
Published: February 2023

We present a fictional short story about embezzlement, “Great Experiment” by Jeffrey Eugenides, as a resource for management classes. We begin by providing a brief description of the story, in which a decent and law-abiding 40-something man’s lack of professional success and envy of his wealthy neighbors contribute to his decision to accept a coworker’s invitation to participate in an embezzlement scheme to steal money from their employer. Then, we discuss how to use the story to prompt students to identify the antecedents and consequences of illegal, unethical behavior and consider ways organizations can prevent such behavior. We also suggest other ways to use this resource.
Early post-endovascular treatment contrast extravasation on dual-energy CT is associated with clinical and radiological stroke outcomes: A 10-year single-centre experience
Authors: Pinckaers Florentina ME , Mentink Max MG , Boogaarts Hieronymus D , van Zwam Wim H , van Oostenbrugge Robert J , Postma Alida A
Published: February 2023

Objective:

To determine the association between early post-endovascular treatment (EVT) contrast extravasation (CE) on dual-energy CT (DECT) and stroke outcomes.

Methods:

EVT records in 2010–2019 were screened. Exclusion criteria included the occurrence of immediate post-procedural intracranial haemorrhage (ICH). Hyperdense areas on iodine overlay maps were scored according to the Alberta Stroke Programme Early CT Score (ASPECTS), thus forming a CE-ASPECTS. Maximum parenchymal iodine concentration and maximum iodine concentration relative to the torcula were recorded. Follow-up imaging was reviewed for ICH. The primary outcome measure was the modified Rankin Scale (mRS) at 90 days.

Results:

Out of 651 records, 402 patients were included. CE was found in 318 patients (79%). Thirty-five patients developed ICH on follow-up imaging. Fourteen ICHs were symptomatic. Stroke progression occurred in 59 patients. Multivariable regression showed a significant association between decreasing CE-ASPECTS and the mRS at 90 days (adjusted (a)cOR: 1.10, 95% CI: 1.03–1.18), NIHSS at 24–48 h (aβ: 0.57, 95% CI: 0.29–0.84), stroke progression (aOR: 1.14, 95% CI: 1.03–1.26) and ICH (aOR: 1.21, 95% CI: 1.06–1.39), but not symptomatic ICH (aOR 1.19, 95% CI: 0.95–1.38). Iodine concentration was significantly associated with the mRS (acOR: 1.18, 95% CI: 1.06–1.32), NIHSS (aβ: 0.68, 95% CI: 0.30–1.06), ICH (aOR: 1.37, 95% CI: 1.04–1.81) and symptomatic ICH (aOR: 1.19, 95% CI: 1.02–1.38), but not stroke progression (aOR: 0.99, 95% CI: 0.86–1.15). Results of the analyses with relative iodine concentration were similar and did not improve prediction.

Conclusions:

CE-ASPECTS and iodine concentration are both associated with short- and long-term stroke outcomes. CE-ASPECTS is likely a better predictor for stroke progression.
Implementing measurable goals for diversity, equity, and inclusion in Clinical and Translational Science Awards leadership
Authors: Taylor Monica M , Fernandez Claudia SP , Dave Gaurav , Brandert Kathleen , Larkin Suzanna , Mollenkopf Katherine , Corbie Giselle
Published: February 2023

Charting a benchmarking strategy is recommended to measure improvements in equal leadership opportunities for minorities and women in the Clinical Translational Science Awards Consortium (CTSAs). Academic institutions that support diversity, equity, and inclusion (DEI) initiatives should demonstrate a willingness to track their progress with established metrics. In the fall of 2020, the CTSAs convened a virtual conference, which started a dialogue on developing measurable objectives to ensure accountability for DEI goals. Using qualitative and quantitative data from breakout sessions, the authors analyze participant responses to the following recommendation, “ develop a common metric and dashboard with regular reporting on diversity in CTSA leadership, with an emphasis on increasing female and Black Indigenous, People Of Color (BIPOC) representation to 30% each,” to understand the impact and challenges associated with implementing metrics within CTSAs. Thematic analysis revealed that white supremacist culture and demographic composition are obstacles to establishing metrics. Participants expressed uncertainty about the perception of token roles. Additionally, participants believed that DEI targets can increase diversity in perspectives and approaches to translational science. Implications for CTSAs include establishing CTSA-wide benchmarks for DEI initiatives, which includes a baseline of the existing DEI climate to assess institutional norms and measurable objectives to track progress.
Phosphodiesterase 4B inhibition: a potential novel strategy for treating pulmonary fibrosis
Authors: Kolb Martin , Crestani Bruno , Maher Toby M.
Published: February 2023

Patients with interstitial lung disease can develop a progressive fibrosing phenotype characterised by an irreversible, progressive decline in lung function despite treatment. Current therapies slow, but do not reverse or stop, disease progression and are associated with side-effects that can cause treatment delay or discontinuation. Most crucially, mortality remains high. There is an unmet need for more efficacious and better-tolerated and -targeted treatments for pulmonary fibrosis. Pan-phosphodiesterase 4 (PDE4) inhibitors have been investigated in respiratory conditions. However, the use of oral inhibitors can be complicated due to class-related systemic adverse events, including diarrhoea and headaches. The PDE4B subtype, which has an important role in inflammation and fibrosis, has been identified in the lungs. Preferentially targeting PDE4B has the potential to drive anti-inflammatory and antifibrotic effectsviaa subsequent increase in cAMP, but with improved tolerability. Phase I and II trials of a novel PDE4B inhibitor in patients with idiopathic pulmonary fibrosis have shown promising results, stabilising pulmonary function measured by change in forced vital capacity from baseline, while maintaining an acceptable safety profile. Further research into the efficacy and safety of PDE4B inhibitors in larger patient populations and for a longer treatment period is needed.
New trends in pulmonary hypertension
Authors: Cullivan Sarah , Gaine Sean , Sitbon Olivier
Published: February 2023

Pulmonary hypertension (PH) is a prevalent disease of the pulmonary vasculature that is characterised by considerable morbidity and mortality. Substantial efforts have been made in recent years to improve disease recognition, diagnosis and management, and this is reflected in current guidelines. The haemodynamic definition of PH has been revised and a definition for exercise PH has been provided. Risk stratification has been refined and the importance of comorbidities and phenotyping have been highlighted. These changes provide an opportunity to potentially identify pulmonary vascular disease at an earlier stage and to enhance patient-centred, goal-orientated treatment decisions. A promising fourth treatment pathway for pulmonary arterial hypertension and potential targeted therapies for group 3 PH are on the horizon, concepts which seemed inconceivable only a few years ago. Beyond medication, there is a greater appreciation for the importance of supervised training in stable PH and the possible role of interventional therapies in select cases. The landscape of PH is changing and it is characterised by progress, innovation and opportunities. In this article, we highlight some of the new trends in PH, with a specific focus on the revised European Society of Cardiology/European Respiratory Society 2022 guidelines for the diagnosis and management of PH.
A case of Aicardi-Goutières syndrome caused by TREX1 gene mutation
Authors: Chenhan Zheng , Jun Shao , Yang Ding , Linliang Yin , Xiaowen Gu , Chunya Ji , Xuedong Deng
Published: February 2023

Aicardi-Goutières syndrome (AGS) is a rare genetic disorder involving the central nervous system and autoimmune abnormalities, leading to severe intellectual and physical disability with poor prognosis. AGS has a phenotype similar to intrauterine viral infection, which often leads to delays in genetic counseling. In this study, we report a case with a prenatal diagnosis of AGS. The first fetal ultrasound detected bilateral lateral ventricle cystic structures, and fetal MRI was performed to identify other signs. The right parietal lobe signal showed cerebral white matter abnormalities, and fetal brain development level was lower than that of normal fetuses of the same gestational age. Whole-exome sequencing revealed that the fetus carried the TREX1:NM_033629.6:exon2:c.294dup:p. C99Mfs*3 variant, suggesting that the c.294dup mutation of the TREX1 gene was the pathogenic mutation site, and the final comprehensive diagnosis was AGS1. In this article, we also reviewed the previous literature for possible phenotypes in the fetus and found that microcephaly and intrauterine growth retardation may be the first and most important markers of the intrauterine phenotype of AGS.