bluuebunny/crossref_metadata_2025 huggingface dataset:
Art box deliveries: The experiences of people with dementia and their carers during the Covid 19 lockdown
Authors: Armstrong Christina , Archer Anji , Critten Valerie , Critten Sarah
Published: September 2022

Art workshops have been looked at before in terms of impact for people with dementia but never those conducted remotely during a pandemic lockdown. Two artists, working with local museums, provided Art workshops for people with dementia and their caregivers. Due to the first Covid 19 lockdown in the UK, the artists set up a weekly delivery service of Home Art Boxes to thirty-three people with dementia and their caregivers over a period spanning 11 months. The artists received funding from local organisations and the Community Lottery Fund. Thematic analysis of the feedback from the participants regarding the project and the artists themselves provided the data for this evaluation of the project. Seven main themes were identified: organisation of the project; community and connections; supporting the caregivers; enjoyment and enrichment; well-being and cognitive benefits of the projects; equipment and instructions; and drawbacks within the project. The participants’ feedback enabled the artists to improve the contents and instructions given each week so that they were able to adjust the activities for those people with dementia whose condition was declining. Implications are that remote Art workshops are possible during lockdown restrictions, but that personal communication is equally important.
Station-keeping of a ROV under wave disturbance: Modeling and control design
Authors: de Oliveira Éverton L , Donha Décio C , de T Fleury Agenor , de Barros Ettore A
Published: September 2022

Remotely Operated Vehicles (ROVs) working close to the sea surface are subjected to wave disturbances that affect their positioning. To treat this problem, we present a control scheme for the dynamic positioning of ROVs under wave disturbances and at low operation depths. The approach is composed of an Augmented Wave Filter (AWF) based on the Extended Kalman Filter (EKF) algorithm and an Adaptive-Model Predictive Control (A-MPC). The filter provides the optimal motion states and wave height estimation to the A-MPC, which calculates the control efforts based on the receding horizon approach. The scheme is tested through numerical simulations on the depth control of the Mandi II-ROV at the diving plane. The results are compared to those of a standard Proportional-Integral-Derivative (PID) controller. To perform realistic simulations, a detailed mathematical model is presented, considering the rigid body-motion, hydrodynamic and hydrostatic forces, thrusters dynamics, and onboard sensor measurements. The simulations are performed for different scenarios, considering the dynamic positioning in still waters and the station-keeping under wave disturbances for significant heights of 1 and 2 m. The controller robustness to parameter variation is assessed by using Monte-Carlo simulation. Results have shown improved performance for the A-MPC in terms of positioning errors, motion oscillations, and drift attenuation in comparison to a PID controller. The Monte-Carlo simulation reveals enhanced robustness to the A-MPC, which is associated with the greater variance for the control forces. Also, the filter performed very well in all the tests, producing an accurate estimate of the wave-induced height and providing an off-set free control.
Extending the lighting design objectives procedure for holistic lighting solutions
Authors: Cuttle C
Published: September 2022

The author has previously proposed a novel spreadsheet-based lighting design objectives procedure (LiDOs) that enables practitioners to reconcile interacting LiDOs relating to the spatial distribution of illumination within a space, and this procedure has been successfully adopted by several lighting design practices. This paper proposes that the procedure is developed into an extended computer-based lighting design tool (LiDOs2) that includes LiDOs relating to spectral and temporal illumination distributions, as well as spatial distribution. This would enable regulators to specify limiting values for basic indoor lighting objectives such as perceived adequacy of illumination while at the same time guiding practitioners to incorporate LiDOs that address characteristics of lighting chosen to suit specific applications. The LiDOs2 procedure would be capable of generating holistic lighting performance specifications that would enable practitioners to conduct informed searches for light sources and luminaires, and to determine layouts and control circuits with confidence that the specified combination of LiDOs would be achieved.
Psychometric Properties of Scores on the Mental Distress Response Scale among First-Generation College Students: Implications for Retention
Authors: Kalkbrenner Michael T. , Flinn Ryan E.
Published: September 2022

First-generation college students” (FGCS) are at risk for suffering from mental health issues, which have direct implication for their retention and academic success. Past investigators consistently find that college students are more likely to discuss mental health issues with their peers than with college personnel. The first step in peer-to-peer mental health support is screening students on campus to gain a baseline understanding of how they respond when encountering a peer in mental distress. The Mental Distress Response Scale (MDRS) is a screening tool for appraising students” responses to a peer in mental distress. Score validation is a crucial step, as FGCS are a unique college student population and the psychometric properties of instrumentation can vary between different populations. Psychometric testing yielded support for the validity of scores on the MDRS with FGCS. Findings have direct implications for aiding student affairs officials” universal screening efforts to support FGCS” mental health and retention.
Mortality Following Treatment With and Without Paclitaxel-Coated Devices in Dialysis Patients
Authors: Böhme Tanja , Noory Elias , Beschorner Ulrich , Jacques Börries , Bürgelin Karlheinz , Hofmann Vincent , Nührenberg Thomas , Neumann Franz-Josef , Zeller Thomas
Published: September 2022

Objectives:

To evaluate the mortality after treatment with a paclitaxel (PTX)-coated device and with uncoated devices of iliac, femoropopliteal, and below-the-knee lesions in dialysis patients.

Methods:

Retrospective mortality analysis of dialysis patients with peripheral artery disease who underwent treatment of iliac, femoropopliteal, and/or infrapopliteal lesions with PTX-coated or uncoated devices.

Results:

Between 2010 and 2018, 1125 dialysis patients were treated with iliac and/or femoropopliteal and/or infrapopliteal lesions. In all, 359 patients were selected for this retrospective analysis. Of those, 122 patients were treated with uncoated devices without crossover to a PTX-coated device during follow-up and 237 patients were treated with a PTX-coated device. Mean follow-up time was 27.38±24.76 months (range=0–103). For the entire cohort, the overall mortality was 95.1% after uncoated treatment and 75.9% after PTX treatment (p<0.001). After propensity score matching (n=119), overall mortality was 95.0% after uncoated treatment and 78.2% after PTX treatment (p<0.001). For the entire cohort, multivariate logistic regression analysis revealed age (p=0.002) and critical limb ischemia (p<0.001) as independent predictors for mortality. PTX treatment was a protective factor for mortality (p<0.001).

Conclusion:

Mortality in dialysis patients is in general high and higher after use of uncoated devices compared with PTX-coated devices. Mortality predictors were risk factors and disease severity but not PTX treatment.

Clinical Impact

After the publication of Katsanos’s metaanalyses, the uncertainty regarding PTX device safety in peripheral interventions in patients mainly without end-stage renal insufficiency was initially considerable. The present study for the first time investigates the potential long-term mortality risk of dialysis patients following PTX device treatment of PAD. In contrast to a recent meta-analysis, this real-world study could show a better survival after PTX treatment in comparison to uncoated devices.
First Testing of Literature-Based Models for Predicting Increase in Body Weight and Adipose Tissue Mass After Kidney Transplantation
Authors: Schmid-Mohler Gabriela , Beckmann Sonja , Zala Patrizia , Huber Laura , Held Ulrike , Fehr Thomas , Wüthrich Rudolf Peter , Petry Heidi , Mueller Thomas F.
Published: September 2022

Introduction: Weight gain is a risk factor for poor clinical outcomes following kidney transplantation. Research Question: This study’s aim was a first testing of 2 models to identify patients early after kidney transplantation who are at risk for weight gain and increase in adipose tissue mass in the first year after kidney transplantation. Design: The literature-based models were evaluated on longitudinal data of 88, respectively 79 kidney transplant recipients via ordinary and Firth regression, using gains ≥ 5% in weight and adipose tissue mass respectively as primary and secondary endpoints. Results: The models included physical activity, smoking cessation at time of kidney transplantation, self-reported health status, depressive symptomatology, gender, age, education, baseline body mass index and baseline trunk fat as predictors. Area under the curve was 0.797 (95%-CI 0.702 to 0.893) for the weight model and 0.767 (95%-CI 0.656 to 0.878) for the adipose tissue mass model—showing good, respectively fair discriminative ability. For weight gain ≥ 5%, main risk factors were smoking cessation at time of transplantation (OR 16.425, 95%-CI 1.737-155.288) and better self-reported baseline health state (OR 1.068 for each 1-unit increase, 95%-CI 1.012-1.128). For the adipose tissue mass gain ≥ 5%, main risk factor was overweight/obesity (BMI ≥ 25) at baseline (odds ratio 7.659, 95%-CI 1.789-32.789). Conclusions: The models have potential to assess patients' risk for weight or adipose tissue mass gain during the year after transplantation, but further testing is needed before implementation in clinical practice.
Diabetic Foot Management: Education of Vascular Surgeons Remains a Priority
Authors: Argyriou Christos , Papanas Nikolaos , Georgiadis George S.
Published: September 2022

Diabetic foot ulcers remain difficult to heal, especially in the setting of peripheral arterial disease (PAD). Vascular surgeons are very important members of the multidisciplinary foot care team. To make the most of their potential, adequate education of vascular trainees on diabetic PAD remains a priority. This should include not only endovascular therapies but also open surgical approaches. Evaluation of trainees’ skills, as well as of the educational program itself, is also desirable. Finally, simulation-based training may prove a useful educational tool.
The Role of the Flexor Carpi Radialis Groove in Trapeziometacarpal Osteoarthritis
Authors: Mitchell Allison R. , Kerkhof Faes D. , Wadhwa Harsh , Ladd Amy L.
Published: September 2022

Background:

Thumb carpometacarpal (CMC) osteoarthritis (OA) is a common condition. The contribution of surrounding ligaments and tendons to the stability of the CMC joint is likely altered in OA. The flexor carpi radialis (FCR) tendon runs in the trapezial FCR groove and is often noted to be frayed during CMC arthroplasty. We hypothesized that decreased integrity of the FCR tendon is related to FCR groove morphology and is associated with increased severity of CMC OA.

Methods:

We examined 3-dimensional surface models based on computed tomography (CT) scans of explanted trapezia from patients who underwent thumb CMC arthroplasty. Fraying of the FCR tendon was rated intraoperatively. Measurements were taken of the FCR groove to evaluate its morphology. Preoperative thumb CMC radiographs for each patient were scored using the modified Eaton classification system and the Thumb Osteoarthritis Index. Differences in the tendon groups were examined, and multivariable linear regression models were used to test the association between tendon group and FCR groove measurement.

Results:

There were 136 patients who were categorized into 4 tendon groups: intact, minor fraying, fraying, and ruptured. There were no differences between the tendon groups on any measures.

Conclusions:

Our findings do not demonstrate a significant influence of FCR groove morphology on FCR tendon fraying in CMC arthroplasty patients. We also did not find a significant association between the FCR tendon state and degree of radiographic CMC OA. Further studies should investigate the in vivo FCR tendon to evaluate its tearing and inflammation in relation to basilar thumb pain.
Rethinking Elite Interviews Through Moments of Discomfort: The Role of Information and Power
Authors: Ntienjom Mbohou Léger Félix , Tomkinson Sule
Published: September 2022

Interviews with policy and political officials are central in social science research. While these actors are traditionally conceived as elites, holding similar or more power and information compared to the researcher, a growing body of research documents that elite constitutes a variable category. We argue that researchers can glimpse the dynamic nature of power and information elites hold in moments of discomfort that arise throughout interview research. These moments illustrate the shift that takes place when the expectations of the elites regarding the researcher’s perceived resources shape the conditions of the production of knowledge. We call for problematizing professional status as the main marker of elite category in fieldwork preparation and training, as labeling people on a single marker of identity shapes how researchers conceive and approach them. The article presents examples from three moments of discomfort by focusing on recruitment of and social interaction with officials working on diaspora policy in Cameroon.
Study on the short fatigue crack initiation and propagation behavior of 42CrMo
Authors: Xu Nan , Fu Zhiwei , Wang Yuan , Shen Xuehui
Published: September 2022

A micro-tensile fatigue test of 42CrMo alloy steel was carried out. The result shows that the crack initiation and propagation of the material could be characterized with randomness and localization. There existed two sorts of short fatigue crack propagation behaviors for the tested material, that is, self-propagation and joint propagation with other short cracks. A short fatigue crack growth rate function was built considering the propagation characteristics. Moreover, a simulation model of short fatigue crack evolution was built. Total three samples were tested and simulated. The experimental result was in good consistent with that from simulation, both showing that the crack growth rate accelerated first and then decelerated during propagation.
Potential mechanisms of some selected heavy metals in the induction of inflammation and autoimmunity
Authors: Anka Abubakar U , Usman Abubakar B , Kaoje Abubakar N , Kabir Ramadan M , Bala Aliyu , Kazem Arki Mandana , Hossein-Khannazer Nikoo , Azizi Gholamreza
Published: September 2022

Inflammation is a physiological event that protects tissues from infection and injury. Chronic inflammation causes immune cell over activation and sustained release of inflammatory cytokines and chemokines cause pathologic conditions including autoimmune diseases. Heavy metals exposure affects innate and adaptive immune systems through triggering inflammatory responses. It seems that extended inflammatory responses could accelerate heavy metal-induced autoimmunity. In the present review we discuss the exposure route and toxicity of Cadmium (Cd), Lead (Pb), Mercury (Hg), Vanadium (V) and Platinum (Pt) and their effects on inflammatory responses by innate and adaptive immune system and autoimmunity.
Distinguishing challenging and overchallenging jobs: Cognitive and affective skills mismatches and their impact on job satisfaction
Authors: Santiago-Vela Ana , Hall Anja
Published: September 2022

This study supplements the existing conceptualisation of skills mismatch based on cognitive evaluations (being underskilled or overskilled) with an affective aspect that captures how workers cope with skills (mis)match situations (feeling overchallenged or underchallenged) and an analysis of skills mismatch situations’ influence on job satisfaction of workers with higher education (HE) and vocational education and training (VET). Using the German BIBB/BAuA Employment Survey 2018, the results indicated that underskilling by itself was not negatively associated with job satisfaction; however, underskilling in combination with feeling overchallenged exerted a significant negative influence on job satisfaction. This corroborates the approach of differentiating challenging (i.e. non-detrimental) jobs from overchallenging jobs. Overskilling was associated with penalties regarding job satisfaction, whereas overskilling in combination with underchallenging jobs produced a remarkably larger negative impact on job satisfaction. Moreover, overskilled HE workers received larger penalties regarding job satisfaction than those received by overskilled VET workers.
Surgical management of pes planus in children with cerebral palsy: A systematic review
Authors: MacInnes Poppy , Lewis Thomas L , Griffin Cora , Martinuzzi Michela , Shepherd Karen L , Kokkinakis Michail
Published: September 2022

Purpose:

Pes planus (or flatfoot) is the most common deformity in children with cerebral palsy. There are several surgical interventions used to treat it: single calcaneal osteotomies, extra-articular arthrodesis, double calcaneal osteotomy, calcaneo-cuboid-cuneiform osteotomy, intra-articular arthrodesis, and arthroereisis. There is currently no evidence on optimal treatment for flatfoot in children with cerebral palsy. Our purpose is to systematically review studies reporting complications, recurrence rates, and radiological outcomes of the surgical management of flatfoot in children with cerebral palsy.

Methods:

Five databases were searched to identify studies published from inception until July 2021, with keywords relating to flatfoot, cerebral palsy, and surgical interventions. We included prospective, retrospective, and comparative study designs in the English language. Data was extracted and tabulated in duplicate into Excel, and analysis was conducted using Python SciPy.

Results:

In total, 1220 studies were identified of which 44 met the inclusion criteria, comprising 2234 feet in 1364 patients with a mean age of 10.3 years and mean follow-up of 55.9 months. Radiographic outcomes showed improvement with all procedures; complications and recurrence rates were too poorly reported to compare. Only 6 (14%) studies were assessed as a low risk of bias. There was substantial heterogeneity of outcome measures.

Conclusion:

There is a lack of high-quality, comparative studies assessing the radiological outcomes, complications, and recurrence rates of surgical alternatives to treat flatfoot in children with cerebral palsy. There is currently no clear evidence on optimal surgical treatment.

Level of evidence:

IIa based on Oxford Centre for Evidence-based Medicine.
Impact of the Ukrainian War on South Korea’s diplomacy in Central Asia
Authors: Gu Ho Eom
Published: September 2022

Russia’s invasion of Ukraine will have political and economic impacts in Central Asia. Politically, first, Central Asian countries will strengthen cooperation with neighbouring regional powers such as India, Turkey and Iran to hedge their political and economic security. Second, while China’s influence in Central Asia will increase, SCO will be more economic cooperation organisation. Third, the future direction of Central Asian regionalism will be uncertain. Although it is unlikely, if Uzbekistan shows anti-Russian behaviour, regionalism in Central Asia may weaken. Fourth, it is unlikely that the US role will be expanded again in Central Asia after the Ukraine War. Economically, first, it is highly likely that the status and centripetal force of the Eurasian Economic Union will be weakened. Second, if Europe’s anti-Russian energy policy is strengthened and green energy policies are accelerated, the renewable energy policies of Central Asian carbon-centered energy producing countries such as Kazakhstan in particular can be accelerated. Third, if the logistical obstacles of TSR persist, the bypass logistics infrastructure going to Central Asia through India, Iran, Pakistan, etc. instead of through Russia will be activated. It seems inevitable to shift Korea’s diplomacy toward Central Asia to a certain level to organically link value-based diplomacy and economic security strategies. In this context, first, the existing diplomatic strategies and economic cooperation policies toward Central Asia must be freed from the tendency to view Central Asian countries only as a sphere of influence from Russia. Second, in a situation in which economic cooperation between Korea and Russia is inevitably severely curtailed due to western sanctions against Russia and geopolitical conflicts, it is necessary to strengthen economic cooperation with Central Asian countries as a means of circumventing economic cooperation with Russia. Third, there is a possibility that the northern policy of new governments may be weakened due to the Russia’s invasion of Ukraine, thus the cooperation with Central Asian countries may also shrink. It will be necessary to maintain and develop the previous government’s cooperation platform with Central Asian countries.
The citizen’s uprising in Sri Lanka: A watershed moment against racial capitalism
Authors: Fernando Jude
Published: September 2022

The Citizens’ Movement in Sri Lanka is a turning point in the country’s political history, encouraging similar movements in the South Asian region. Diverse socioeconomic and ideological constituencies within the movement are united in protesting economic hardships—particularly food and fuel shortages—that the majority of the movement’s stakeholders attribute to political culture. The movement is a reaction to the political crisis brought about by the economic crisis, and it believes that resolution must begin with a political revolution. The movement’s concrete achievements are unprecedented. It has radically transformed the culture of dissent. The movement succeeded in removing key members of the Rajapaksa family from power. It freed people from the fear of dissent and convinced them of the benefits of using culturally diverse methods to withstand state power. By bursting the bubble of racist ethno-religious nationalism, the movement has prompted discussions about the emancipatory possibilities of a broad range of issues. Although the movement’s stakeholders primarily focus on political regime and combating state suppression, the movement has reinvigorated conversations about the necessity of radical economic reforms. Agriculture must be brought to the center of the movement’s conversations to bring about positive synergy between political and economic reforms to sustain the movement and achieve its goals.
Controlled vitamin D delivery with injectable hyaluronic acid-based hydrogel for restoration of tendinopathy
Authors: Kim Da-Seul , Kim Jun Hyuk , Baek Seung-Woon , Lee Jun-Kyu , Park So-Yeon , Choi Bogyu , Kim Tae-Hyung , Min Kyunghoon , Han Dong Keun
Published: September 2022

Tendinopathy is a term used to describe tendon disorders that are marked by pain and a loss of function. Recent studies demonstrated that inflammation plays an important role throughout the broad spectrum of tendinopathy. Conventional treatments such as steroid injections, analgesics, and physical modalities simply give pain relief and do not alter the disease progression without the tendon regeneration effect. Tenocytes are responsible for maintaining the tendon matrix and understanding how they function is essential to studying new treatments for tendinopathy. Our previous study showed the protective effects of vitamin D (Vit D) on damaged tenocytes. Besides its well-known effects on bone metabolism, the non-classical action of Vit D is the pleiotropic effects on modulating immune function. In the present study, we developed a Vit D delivery system with hyaluronic acid (HA), which is one of the major components of the extracellular matrix that has anti-inflammation and wound-healing properties. A novel Vit D delivery system with cross-linked HA hydrogel (Gel) and Tween 80 (T80), Vit D@Gel/T80, could be a new regeneration technique for the treatment of tendinopathy. Vit D@Gel/T80 reduced TNF-α induced damage to human tenocytes in vitro. In an animal study, the Vit D@Gel/T80 injected group demonstrated tendon restoration features. As a result, this Vit D@Gel/T80 system might be a local injection material in the treatment for tendinopathy.
The British menopause society consensus statement on the management of estrogen deficiency symptoms, arthralgia and menopause diagnosis in women with treated for early breast cancer
Authors: Marsden Jo
Published: September 2022

This guidance document by the British Menopause Society provides an overview of the management of women experiencing estrogen deficiency symptoms and arthralgia following a breast cancer diagnosis. It is now recommended breast cancer patients are referred to health care professionals with an expertise in menopause for management of such symptoms, which in turn often involves liaison with patients’ breast cancer teams.1 However, as many women initially present to primary health care professionals for advice, this statement is aimed to support the latter in such consultations by providing information about symptom aetiology, current management strategies and controversies and identifying useful practice points. This is an updated version of the 2018 consensus statement prepared by Miss Jo Marsden Consultant Breast Surgeon, King’s College Hospital, London, (retired), Mr Mike Marsh, Consultant Gynae-endocrinologist, King’s College Hospital, London, Dr Anne Rigg, Consultant Medical Oncologist, Guy’s and St Thomas' Hospital, London.
Accuracy of telephone screening tools to identify dementia patients remotely: systematic review
Authors: Riley Charlotte Olivia , McKinstry Brian , Fairhurst Karen
Published: September 2022

Summary

The COVID19 pandemic highlighted the need for remote diagnosis of cognitive impairment and dementia. Telephone screening for dementia may facilitate prompt diagnosis and optimisation of care. However, it is not clear how accurate telephone screening tools are compared with face-to-face screening. We searched Cochrane, MEDLINE, Embase, Web of Science, PubMed and Scopus for all English language papers published between January 1975 and February 2021 which compared telephone screening for dementia/ mild cognitive impairment and an in-person reference standard, performed within six-weeks. We subsequently searched paper reference lists and contacted authors if data were missing. Three reviewers independently screened studies for inclusion, extracted data, and assessed study quality using an adapted version of the Joanna Briggs Institute's critical appraisal tool. Twenty-one studies including 944 participants were found. No one test appears more accurate, with similar validities as in-person testing. Cut-offs for screening differed between studies based on demographics and acceptability thresholds and meta-analysis was not appropriate. Overall the results suggest telephone screening is acceptably sensitive and specific however, given the limited data, this finding must be treated with some caution. It may not be suitable for those with hearing impairments and anxiety around technology. Few studies were carried out in general practice where most screening occurs and further research is recommended in such lower prevalence environments.
The relationship between the orthopedic job market and sports medicine fellowship applications between 2010 and 2017
Authors: Hoof Marcus A , Brown Symone M , Miskimin Cadence B , Mulcahey Mary K
Published: September 2022

Objectives: More than 90% of graduating orthopedic residents pursue at least one year of fellowship training. There are no studies to date that examine the trends for sports medicine positions in the orthopedic job market. The purpose of this study was to evaluate trends in orthopedic sports medicine positions using postings from four orthopedic journals. Methods: Print advertisements for job positions in three American orthopedic journals ( Journal of Bone and Joint Surgery, Journal of the American Academy of Orthopaedic Surgeons, and American Journal of Sports Medicine) between 2010 and 2017 were reviewed. The results were compared to sports medicine fellowship match trends. Results: Between 2010 and 2017, there were a total of 403 postings for orthopedic sports medicine positions, 186 in Journal of Bone and Joint Surgery, 113 in Journal of the American Academy of Orthopaedic Surgeons, and 52 in American Journal of Sports Medicine. There was a 43% decline in print sports medicine advertisements from 2010 to 2015. The number of job advertisements for sports medicine positions remained consistent (approximately 10%) from 2010 to 2015, then dropped to 2.1% (57/2698) and 1.4% (66/4735) in 2016 and 2017, respectively. Conclusion: There is no direct correlation between job positions advertised in orthopedic journals and sports medicine fellowship positions offered. Additionally, there has been an increase in job advertisements requiring fellowship training, indicating an increased demand for sub-specialty trained orthopedic surgeons. Lastly, the drop in total orthopedic advertisements in the years proceedi ng 2015 may serve as a harbinger for the transition to largely online content, and job postings in journals may not be the most reliable source of job opportunities, but further investigation should be done in relation to this topic.
Technical Aspects and Common Pitfalls of Norwood With Modified Blalock Taussig Shunt
Authors: Juaneda Ignacio , Chiostri Benjamin , Kreutzer Christian
Published: September 2022

The Stage 1 Norwood procedure is the first of 3 stages in the surgical palliation of hypoplastic left heart syndrome and certain other single ventricle lesions with systemic outflow obstruction. In this article, we address some technical aspects and common pitfalls of the Norwood procedure with systemic to pulmonary shunt for HLHS palliation. We report our results with the Norwood with Blalock Taussig shunt in a cohort of 44 patients over a 7-year period in 2 institutions in Argentina. The results of the Norwood procedure have improved significantly through the understanding and refinement of the surgical techniques. Procedures must be technically perfect since residual lesions are poorly tolerated. Norwood with a modified Blalock Taussig shunt can be performed with low mortality and may provide excellent long-term outcomes.
Hypoplastic Left Heart Syndrome: Definition, Morphology, and Classification
Authors: Jacobs Jeffrey P.
Published: September 2022

This manuscript will provide information about hypoplastic left heart syndrome (HLHS) and related malformations, including definitions, morphology, and classification, based on the 2021 International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Revision of the International Classification of Diseases (ICD-11). HLHS is defined as “a spectrum of congenital cardiovascular malformations with normally aligned great arteries without a common atrioventricular junction, characterized by underdevelopment of the left heart with significant hypoplasia of the left ventricle including atresia, stenosis, or hypoplasia of the aortic or mitral valve, or both valves, and hypoplasia of the ascending aorta and aortic arch.” Functionally univentricular heart is defined as “a spectrum of congenital cardiac malformations in which the ventricular mass may not readily lend itself to partitioning that commits one ventricular pump to the systemic circulation, and another to the pulmonary circulation.” The Norwood operation is synonymous with the term “Norwood (Stage 1)” and is defined as (1) creation of an aortopulmonary connection and neoaortic arch construction resulting in univentricular physiology and (2) creation of a controlled source of pulmonary blood flow with a calibrated systemic-to-pulmonary artery shunt, a right ventricle to pulmonary artery conduit, or rarely, a cavopulmonary connection. The goals of the Norwood (Stage 1) Operation are creation of (1) unobstructed systemic blood flow via aortopulmonary connection and neoaortic arch construction, (2) unobstructed coronary blood flow, (3) unobstructed flow across the atrial septum, and (4) controlled pulmonary blood flow.
Imaging for Hypoplastic Left Heart Syndrome
Authors: Pedra Simone R. F. Fontes
Published: September 2022

Hypoplastic left heart syndrome is a complex congenital heart defect with clinical presentation in the neonatal period. Echocardiography is the main diagnostic tool and allows detailed examination of the underlying anatomy and physiology and both pre and postnatally. In the following pages, key information regarding the evaluation of the interatrial septum, cardiac valves, right ventricular function, and ductal and aortic arches will be discussed in a systematic fashion allowing decision regarding the possible therapeutic strategies.
Hypoplastic Left Ventricle: Left Ventricular Recruitment With Hybrid Approach
Authors: Akintürk Hakan , Yörüker Uygar , Müller Matthias , Schranz Dietmar
Published: September 2022

Decision-making for biventricular repair (BVR) or univentricular palliation is challenging in neonates with hypoplastic left heart complex (HLHC). Hybrid strategy can be used successfully to achieve BVR in some of these patients. Between June 1998 and January 2022, 342 patients with a diagnosis of HLHS/variants, ductal-dependent lower body circulation with two ventricles, or HLHC with borderline left ventricle (LV) underwent initial bilateral pulmonary artery banding and ductal stenting in our institution. Among these 342 patients, 224 patients were defined as HLHS/variants and underwent univentricular palliation. 118 patients were determined to have borderline LV and hypoplastic left ventricular structures (HLHC, n = 48) or ductal-dependent lower body circulation with two ventricles (n = 70) considered suitable for BVR. 48 patients had multilevel obstructions including both aortic and mitral valve hypoplasia, aortic arch hypoplasia, and borderline LV. These were considered to have HLHC. These 48 HLHC patients are the subject of this report. Neonatal hybrid palliation at a median age of seven days was performed in 48 patients and 46 patients underwent BVR at a median age of 156 days. In 46 patients who underwent BVR, hospital mortality was not observed. The median follow-up was 66 months, with no late mortality. Heart transplant-free survival at 5, 10, and 15 years was 95.7%. 12 patients (26%) required reoperation and 9 (19.5%) required catheter reinterventions. Hybrid palliation may increase the chances for biventricular circulation in patients with borderline LV and small left-sided structures. Giessen hybrid approach as a left ventricular recruitment strategy achieves excellent early and long-term results.
Journey Toward Improved Long-Term Outcomes After Norwood-Sano Procedure: Focus on the Aortic Arch Reconstruction
Authors: Sano Shunji , Sano Toshikazu , Kobayashi Yasuyuki , Kotani Yasuhiro , Kouretas Peter C. , Kasahara Shingo
Published: September 2022

The disadvantage of right ventricle-to-pulmonary artery (RV-PA) shunt is the need for more unplanned interventions to address stenosis in the shunt or branch pulmonary arteries, as compared to the modified Blalock-Taussig shunt group. Ring-enforced RV-PA PTFE conduit and dunk technique minimized these complications and right ventricle (RV) damage. Aortic arch obstruction increases afterload and leads to ventricular dysfunction and tricuspid regurgitation; therefore, most surgeons prefer to use homograft, autologous pericardium, or bovine pericardium to reconstruct the neoaorta. Artificial materials decrease the elastic properties, increase wall stiffness, and decrease the distensibility of the aorta; and as a result, RV function gradually deteriorates. This inelastic reconstructed aorta may be one of the reasons why long-term outcomes after the Fontan procedure are worse in hypoplastic left heart syndrome (HLHS) patients, in comparison to non-HLHS. Reconstruction of the neoaorta without any patch materials, or at least techniques that largely minimize the use of non-autologous materials, will offer a further refinement of our ability to optimize ventriculoarterial coupling and thereby long-term RV function.
Utility of the Modified 5-Items Frailty Index to Predict Complications and Mortality After Elective Cervical, Thoracic and Lumbar Posterior Spine Fusion Surgery: Multicentric Analysis From ACS-NSQIP Database
Authors: Camino-Willhuber Gaston , Choi Jeffrey , Holc Fernando , Oyadomari Sarah , Guiroy Alfredo , Bow Hansen , Hashmi Sohaib , Oh Michael , Bhatia Nitin , Lee Yu-Po
Published: September 2022

Study design

Retrospective review of multicentric data.

Objectives

The modified 5-item frailty index is a relatively new tool to assess the post-operative complication risks. It has been recently shown a good predictive value after posterior lumbar fusion. We aimed to compare the predictive value of the modified 5-item frailty index in cervical, thoracic and lumbar surgery.

Methods

The American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) Database 2015-2020 was used to identify patients who underwent elective posterior cervical, thoracic, or lumbar fusion surgeries for degenerative conditions. The mFI-5 score was calculated based on the presence of 5 co-morbidities: congestive heart failure within 30 days prior to surgery, insulin-dependent or noninsulin-dependent diabetes mellitus, chronic obstructive pulmonary disease or pneumonia, partially dependent or totally dependent functional health status at time of surgery, and hypertension requiring medication. Multivariate analysis was used to assess the independent impact of increasing mFI-5 score on the postoperative morbidity while controlling for baseline clinical characteristics.

Results

53 252 patients were included with the mean age of 64.2 ± 7.2. 7946 suffered medical complications (14.9%), 1565 had surgical complications (2.9%), and 3385 were readmitted (6.3%), 363 died (.68%) within 30 days postoperative (6.3%). The mFI-5 items score was significantly associated with higher rates of complications, readmission, and mortality in cervical, thoracic, and lumbar posterior fusion surgery.

Conclusion

The modified 5-item frailty score is a reliable tool to predict complications, readmission, and mortality in patients planned for elective posterior spinal fusion surgery.
Risk Factors, Incidence and Mortality of Vertebral Artery Injury in Patients Undergoing Anterior Cervical Corpectomy: A Retrospective Large National Data Base Study
Authors: Godil Jamila , Smith Spencer , Wright Christina , Yoo Jung U.
Published: September 2022

Study Design

Retrospective Cohort Study

Objective

To determine the incidence of vertebral artery injury (VAI), risk factors, intervention, associated complications, and mortality in patients undergoing anterior cervical corpectomy.

Methods

We performed a retrospective review of the incidence of VAI during anterior cervical corpectomy using the PearlDiver database from 2010-2017. The CPT code 63 081 to identify corpectomy patients. Patient data extracted included, incidence of VAI, demographic factors, intervention, and future complications of death and stroke. The risk were calculated compared with those patients who did not have VAI.

Results

26 126 patients were identified to have undergone cervical corpectomy. Multivariate analysis of risk factors showed that younger age and male sex were associate with higher rate of injury (t = -11.5; P < .0001 and t = 3.8; P = .0001, respectively). Vertebral artery injuries occurred in 78 patients at an incidence of .3%. 11 (14%) VAI patients had a cerebral infarction compared with 1705 (7%) for non-VAI patients (OR = 2.13; 95% CI = [1.18 – 3.85; P = .0179]) during the follow up period. 1-year mortality rates were higher in patients who suffered a VAI (14%) compared to those who did not suffer a VAI (4%; OR = 3.85; CI = [2.04 – 7.14]; P < .0001).

Conclusion

Consequence of VAI may not be known for months following the injury. Although the same admission mortality is rare with this injury, there is a significant increase in post-discharge complications. This study suggests that further investigations into long term health risk of VAI is needed.
Impact of Workplace Spirituality on Employee Well-Being: The Mediating Role of Organizational Politics
Authors: Khatri Puja , Gupta Pragya
Published: September 2022

The current study examines the enhancing impact of workplace spirituality (SAW) on employee well-being (EWB) and the mediating role of perceptions of organizational politics (POPS). This study uses a cross-sectional study approach to collect data from 536 working professionals in Delhi-NCR. SPSS version 21.0 and PLS SEM software (Smart PLS 3) were used for descriptive and inferential data analysis. The EWB construct was treated as a first-order reflective, second-order formative construct since all the dimensions identified in the study capture different facets of EWB and collectively define the construct. A significant but weak direct effect of POPS on EWB (β = –0.158, p < .05) was observed. However, the indirect effect of the two variables was found to be insignificant (β = 0.033, p > .05). This observation indicated a direct-only non-mediation effect (Zhao et al., 2010). Furthermore, this is a pioneer research-establishing linkage between the three variables, SAW, EWB and organizational politics, which have not been taken together in any earlier studies. It establishes that workplaces that implement spiritual practices would be able to counter any harmful effects of self-serving political behaviours by reinforcing performance-based behaviours and enhancing EWB.
Epo-IGF1R cross talk expands stress-specific progenitors in regenerative erythropoiesis and myeloproliferative neoplasm
Authors: Hsieh Hsi-Hsien , Yao Huiyu , Ma Yue , Zhang Yuannyu , Xiao Xue , Stephens Helen , Wajahat Naureen , Chung Stephen S. , Xu Lin , Xu Jian , Rampal Raajit K. , Huang Lily Jun-shen
Published: September 2022

We found that in regenerative erythropoiesis, the erythroid progenitor landscape is reshaped, and a previously undescribed progenitor population with colony-forming unit-erythroid (CFU-E) activity (stress CFU-E [sCFU-E]) is expanded markedly to restore the erythron. sCFU-E cells are targets of erythropoietin (Epo), and sCFU-E expansion requires signaling from the Epo receptor (EpoR) cytoplasmic tyrosines. Molecularly, Epo promotes sCFU-E expansion via JAK2- and STAT5-dependent expression of IRS2, thus engaging the progrowth signaling from the IGF1 receptor (IGF1R). Inhibition of IGF1R and IRS2 signaling impairs sCFU-E cell growth, whereas exogenous IRS2 expression rescues cell growth in sCFU-E expressing truncated EpoR-lacking cytoplasmic tyrosines. This sCFU-E pathway is the major pathway involved in erythrocytosis driven by the oncogenic JAK2 mutant JAK2(V617F) in myeloproliferative neoplasm. Inability to expand sCFU-E cells by truncated EpoR protects against JAK2(V617F)-driven erythrocytosis. In samples from patients with myeloproliferative neoplasm, the number of sCFU-E-like cells increases, and inhibition of IGR1R and IRS2 signaling blocks Epo-hypersensitive erythroid cell colony formation. In summary, we identified a new stress-specific erythroid progenitor cell population that links regenerative erythropoiesis to pathogenic erythrocytosis.
Immune thrombocytopenia and pregnancy: an exposed/nonexposed cohort study
Authors: Guillet Stéphanie , Loustau Valentine , Boutin Emmanuelle , Zarour Anissa , Comont Thibault , Souchaud-Debouverie Odile , Costedoat Chalumeau Nathalie , Pan-Petesch Brigitte , Gobert Delphine , Cheze Stéphane , Viallard Jean Francois , Morin Anne-Sophie , Sauvetre Gaetan , Cliquennois Manuel , Royer Bruno , Masseau Agathe , Terriou Louis , Fieschi Claire , Lambotte Olivier , Girault Stéphane , Lioger Bertrand , Audia Sylvain , Sacre Karim , Lega Jean Christophe , Langlois Vincent , Benachi Alexandra , Orvain Corentin , Devidas Alain , Humbert Sebastien , Gambier Nicolas , Ruivard Marc , Zarrouk Virginie , Ebbo Mikael , Willems Lise , Segaux Lauriane , Mahevas Matthieu , Haddad Bassam , Michel Marc , Canoui-Poitrine Florence , Godeau Bertrand
Published: September 2022

The risk of immune thrombocytopenia (ITP) worsening during pregnancy and neonatal ITP (NITP) have never been prospectively studied. We included 180 pregnant and 168 nonpregnant women with ITP in a prospective, multicenter, observational cohort study. A total of 131 pregnant women with ITP were matched to 131 nonpregnant women with ITP by history of splenectomy, ITP status (no response, response, complete response), and duration. Groups were followed for 15 months. The primary outcome was the first occurrence of ITP worsening defined by a composite end point including bleeding events and/or severe thrombocytopenia (<30 × 109/L) and/or ITP treatment modification. We also studied the recurrence of ITP worsening and the incidence of NITP and risk factors. The first occurrence of ITP worsening did not differ between pregnant and nonpregnant women with ITP (53.4 per 100 person-years [95% confidence interval {CI}, 40.8-69.9] vs 37.1 [95% CI, 27.5-50.0]; hazard ratio {HR}, 1.35 [95% CI, 0.89-2.03], P = .16). Pregnant women with ITP were more likely to have recurrence of severe thrombocytopenia and treatment modification (HR, 2.71 [95% CI, 1.41-5.23], P = .003; HR, 2.01 [95% CI, 1.14-3.57], P = .017, respectively). However, recurrence of severe bleeding events was not different between groups (P = .4). Nineteen (14%) neonates showed NITP <50 × 109/L. By multivariable analysis, NITP was associated with a previous offspring with NITP and maternal platelet count <50 × 109/L within 3 months before delivery (adjusted odds ratio, 5.55 [95% CI, 1.72-17.89], P = .004 and 4.07 [95% CI, 1.41-11.73], P = .009). To conclude, women with ITP do not increase their risk of severe bleeding during pregnancy. NITP is associated with NITP history and the severity of maternal ITP during pregnancy. These results will be useful for counseling women with ITP.