bluuebunny/crossref_metadata_2025 huggingface dataset:
Bounded or Boundless: A Case Study of Foreign Correspondents’ Use of Twitter During the 2019 Hong Kong Protests
Authors: Luqiu Luwei Rose , Lu Shuning
Published: February 2021

This study advances the understanding of journalists’ social media practices by examining the Twitter feeds of foreign correspondents working for Western legacy media during the 2019 Anti-Extradition Law Amendment Bill protests in Hong Kong. We found that these correspondents were more likely to use Twitter to report facts than to express their opinions and that they tended to interact with each other on Twitter far more frequently than with those outside their professional circle. Furthermore, the expression of personal opinions by the correspondents on Twitter appeared to encourage audience engagement. Finally, these personal opinions tended to be sympathetic to the protesters and critical of the handling of the protests by the authorities, especially the police. We argue that news media outlets have a moral obligation to free their journalists from constraints on the exercise of free speech on social media because doing so protects the freedom of the press on both the institutional and individual levels.
Case Reports of COVID 19 Recurrence
Authors: Caralis Panagiota
Published: February 2021

CASE REPORT OF COVID 19—Recurrence We describe as case series of 7 patients who presented with a recurrence of COVID 19 by PCR test an average of 94.9 days after their initial symptomatic presentation of illness. Patients had tested negative by PCR or had evidence of antibodies in between the 2 episodes. The majority of patients were asymptomatic on the second presentation and were found incidentally on prescreen for procedures, surgery. The subsequent positive COVID-19 PCR tests resulted in cancellations of clinic, procedures, surgery, and impacted patients’ home and employment status. Further studies are needed to understand the mechanisms and ultimate outcomes of these recurrences.
Sero-Prevalence of Hepatitis B Virus Infection and Associated Factors Among Pregnant Women Attending Antenatal Care Services in Gedeo Zone, Southern Ethiopia
Authors: Tadiwos Mhiret Belay , Kanno Girum Gebremeskel , Areba Abriham Shiferaw , Kabthymer Robel Hussen , Abate Zeleke Girma , Aregu Mekonnen Birhanie
Published: February 2021

Background:

Hepatitis B virus infection is a major public health problem worldwide and is a major cause of morbidity and mortality. This study aimed to assess the prevalence of hepatitis B virus infection and associated factors among pregnant mothers in the Gedeo Zone, southern Ethiopia.

Methods:

An institution-based cross-sectional study was conducted among 479 pregnant women visiting governmental and private health facilities in the Gedeo zone from January to April 2019. We selected study participants using systematic random sampling techniques. The Eugene strip test was used to determine hepatitis B virus infection among pregnant mothers. We collected the status of HIV of the pregnant women from the records. Other variables were collected from the mothers using interviewer-administered questionnaires. We used binary and multivariable logistic regression for the analysis. An adjusted odds ratios and their 95% confidence intervals (CIs) were calculated to determine the association between HBsAg sero-positivity and various factors. A P-value of less than .05 was considered significant.

Results:

This study revealed that the prevalence of hepatitis B virus infection among pregnant mothers was 9.2% in Gedeo Zone. A previous history of blood transfusion [AOR = 5.2, 95% CI: 2.1, 12.5], a previous history of hospital admission [AOR = 3, 95% CI: 1.4, 6.6], a history of having an abortion [AOR = 4.1, 95 % CI: 1.5, 11.7], the age of the pregnant women [AOR = 5.1, 95 % CI: 1.5, 18.0], and their HIV status [AOR = 8.1, 95 % CI: 1.9, 36.0] had a statistically significant association with HBsAg sero-positivity.

Conclusion:

Hepatitis B virus infection was found to have higher endemicity (9.2%) in Gedeo Zone which is higher than the national pooled prevalence which was 4.75%. The health facilities must implement early initiation of antenatal care services which incorporate the prevention and control of HBV in the Gedeo Zone.
How Many Proximal Screws Are Needed for a Stable Proximal Humerus Fracture Fixation?
Authors: Kim Hyojune , Shin Myung Jin , Kholinne Erica , Seo Janghyeon , Ahn Duckwoo , Kim Ji Wan , Koh Kyoung Hwan
Published: February 2021

Purpose:

This biomechanical study investigates the optimal number of proximal screws for stable fixation of a 2-part proximal humerus fracture model with a locking plate.

Methods:

Twenty-four proximal humerus fracture models were included in the study. An unstable 2-part fracture was created and fixed by a locking plate. Cyclic loading and load-to-failure tests were used for the following 4 groups based on the number of screws used: 4-screw, 6-screw, 7-screw, and 9-screw groups. Interfragmentary gaps were measured following cyclic loading and compared. Consequently, the load to failure, maximum displacement, stiffness, and mode of failure at failure point were compared.

Results:

The interfragmentary gaps for the 4-screw, 6-screw, 7-screw, and 9-screw groups were significantly reduced by 0.24 ± 0.09 mm, 0.08 ± 0.06 mm, 0.05 ± 0.01 mm, and 0.03 ± 0.01 mm following 1000 cyclic loading, respectively. The loads to failure were significantly different between the groups with the 7-screw group showing the highest load to failure. The stiffness of the 7-screw group was superior compared with the 6-screw, 9-screw, and 4-screw groups. The maximum displacement before failure showed a significant difference between the comparative groups with the 4-screw group having the lowest value. The 7-screw group had the least structural failure rate (33.3%).

Conclusion:

At least 7 screws would be optimal for proximal fragment fixation of proximal humerus fractures with medial comminution to minimize secondary varus collapse or fixation failure.

Level of Evidence:

Basic science study.
Sinus Surgery: Analysis of Videos Available Online
Authors: Uyesugi Arthur , Moldowan Shannon , Bradbrook Keighly , Schuman Theodore
Published: February 2021

Objectives

YouTube is the second most visited website in the world and can be a useful resource for patients to gain insight into surgical procedures. A multitude of studies have evaluated the quality of otolaryngology-specific healthcare information available on the YouTube platform, but to our knowledge, the online content regarding functional endoscopic sinus surgery available on this site has not been systematically evaluated.

Study Design

Cross sectional study.

Setting

Online.

Methods

YouTube was searched using the keywords “sinus surgery.” Variables including video length, total number of views, authorship (academic, private practice physician, patient, or third party), objective (advertisement, informative, or patient perspective), inclusion of intra-operative footage, and discussion of balloon sinuplasty were recorded and analyzed by a single reviewer.

Results

Two-hundred twenty-two videos met inclusion criteria, with a median length of 4 minutes, and a median of 3349 views. The majority of videos were informative (n = 145, 65%), narrated (n = 151, 68%), and did not mention balloon sinuplasty (n = 189, 85%) nor contain intra-operative footage (n = 116, 52%). Private practice physicians were the most common authors (n = 113, 51%), followed by patients (n = 70, 32%), third parties (n = 28, 13%) and academics (n = 11, 5%).

Conclusions

Sinus surgery is one of the most common ambulatory procedures performed. Online resources such as YouTube can be useful for improving health literacy and patient comfort with medical topics such as functional endoscopic sinus surgery, but it is important for clinicians and patients to understand that there is a spectrum in the authorship, content, and quality of sinus surgery related videos posted online.
The Association Between Attachment Patterns and Parenting Styles With Emotion Regulation Among Palestinian Preschoolers
Authors: Agbaria Qutaiba , Mahamid Fayez , Veronese Guido
Published: February 2021

In the current study, we investigated the contribution of attachment and parenting to emotion regulation among preschool children in Palestine. Specifically, we set out to test the hypothesis that both parenting styles and patterns of attachment would be associated with children’s emotion regulation abilities. The sample comprised 150 children from 10 public preschools in Northern Palestine. The preschoolers’ levels of emotion regulation were found to be associated with their parents’ parenting styles. More specifically, permissive and authoritative parenting styles were positively associated with emotion regulation and authoritarian and uninvolved parenting styles were negatively associated with emotion regulation. In addition, a statistically significant positive correlation was found between secure attachment and emotion regulation.
Developing Academic Leaders: Evaluation of a Leadership Development Intervention in Higher Education
Authors: Zulfqar Asia , Valcke Martin , Quraishi Uzma , Devos Geert
Published: February 2021

Leadership development is not considered as a core component in higher education policies specifically when we examine the higher education polices of developing countries. To fill this gap, an intervention is designed to evaluate the impact of a leadership development program in academic leaders. The prime objective of this intervention was to promote awareness among university deans and heads by adopting transformational leadership in their leadership practices. An experimental research design was adopted to map the effects of a 6-week intervention and to evaluate the variations in related six transformational leadership behaviors. Up to 37 academic deans and heads from public universities were involved in this research. Content analysis was carried out to analyze the collected data. Bloom’s taxonomy was adopted as a framework for the analysis. Three lower levels of Bloom’s taxonomy were used to identify the awareness indicators. An extensive increase in awareness levels was identified in relation to all six transformational leadership behaviors, and more specifically, a prominent progress was observed at the application level. In addition to implications and limitations, directions for future research were also discussed.
Research on the Innovation Imbalance Between Coastal and Inland Port Cities Along the Belt and Road: Based on the Three Helix Theory
Authors: Chen Zhen
Published: February 2021

Port cities will be the important growth poles along the Belt and Road, including coastal and inland ports. But the innovation stimulus driven by the Belt and Road Initiative on the coastal and inland port cities is imbalance. This research takes two groups of Chinese port cities as empirical objects, one has coastal port and the other has inland port, and then establishes a system dynamics model based on the theory of triple helix to analyze port cities’ innovation features. The empirical case shows that the positive stimulation of Belt and Road Initiative to innovation activities of coastal port cities is better than that of inland cities in general. If the decision makers of inland cities want to achieve innovation output like that of developed coastal areas, they need to encourage local universities and research institutes to conduct more market-oriented research on one hand. On the other hand, they need to cooperate with multinational companies; meanwhile, they need to provide more technical resources for local start-ups. In addition, stimulating local house prices and living pressure in a reasonable range can stimulate the innovation enthusiasm of existing R&D personnel, attract top talents to join in, and then drive the innovation output of the whole region.
Patient-Reported Outcomes After Complex Adult Spinal Deformity Surgery: 5-Year Results of the Scoli-Risk-1 Study
Authors: Zuckerman Scott L. , Cerpa Meghan , Lenke Lawrence G. , Shaffrey Christopher I. , Carreon Leah Y. , Cheung Kenneth M. C. , Kelly Michael P. , Fehlings Michael G. , Ames Christopher P. , Boachie-Adjei Oheneba , Dekutoski Mark B. , Kabeaish Khaled M. , Lewis Stephen J. , Matsuyama Yukihiro , Pellisé Ferran , Qiu Yong , Schwab Frank J. , Smith Justin S. ,   AO Spine Knowledge Forum Deformity and SRS Scoli-RISK-1 Study Group
Published: February 2021

Study Design:

Prospective cohort.

Objective:

To prospectively evaluate PROs up to 5-years after complex ASD surgery.

Methods:

The Scoli-RISK-1 study enrolled 272 ASD patients undergoing surgery from 15 centers. Inclusion criteria was Cobb angle of >80°, corrective osteotomy for congenital or revision deformity, and/or 3-column osteotomy. The following PROs were measured prospectively at intervals up to 5-years postoperative: ODI, SF36-PCS/MCS, SRS-22, NRS back/leg. Among patients with 5-year follow-up, comparisons were made from both baseline and 2-years postoperative to 5-years postoperative. PROs were analyzed using mixed models for repeated measures.

Results:

Seventy-seven patients (28.3%) had 5-year follow-up data. Comparing baseline to 5-year data among these 77 patients, significant improvement was seen in all PROs: ODI (45.2 vs. 29.3, P < 0.001), SF36-PCS (31.5 vs. 38.8, P < 0.001), SF36-MCS (44.9 vs. 49.1, P = 0.009), SRS-22-total (2.78 vs. 3.61, P < 0.001), NRS-back pain (5.70 vs. 2.95, P < 0.001) and NRS leg pain (3.64 vs. 2.62, P = 0.017). In the 2 to 5-year follow-up period, no significant changes were seen in any PROs. The percentage of patients achieving MCID from baseline to 5-years were: ODI (62.0%) and the SRS-22r domains of function (70.4%), pain (63.0%), mental health (37.5%), self-image (60.3%), and total (60.3%). Surprisingly, mean values ( P > 0.05) and proportion achieving MCID did not differ significantly in patients with major surgery-related complications compared to those without.

Conclusions:

After complex ASD surgery, significant improvement in PROs were seen at 5-years postoperative in ODI, SF36-PCS/MCS, SRS-22r, and NRS-back/leg pain. No significant changes in PROs occurred during the 2 to 5-year postoperative period. Those with major surgery-related complications had similar PROs and proportion of patients achieving MCID as those without these complications.
Surgical Planning for Adult Spinal Deformity: Anticipated Sagittal Alignment Corrections According to the Surgical Level
Authors: Lafage Renaud , Schwab Frank , Elysee Jonathan , Smith Justin S. , Alshabab Basel Sheikh , Passias Peter , Klineberg Eric , Kim Han Jo , Shaffrey Christopher , Burton Douglas , Gupta Munish , Mundis Gregory M. , Ames Christopher , Bess Shay , Lafage Virginie ,   on behalf of International Spine Study Group (ISSG)
Published: February 2021

Study Design:

Retrospective cohort study.

Objectives:

Establish simultaneous focal and regional corrective guidelines accounting for reciprocal global and pelvic compensation.

Methods:

433 ASD patients (mean age 62.9 yrs, 81.3% F) who underwent corrective realignment (minimum L1-pelvis) were included. Sagittal parameters, and segmental and regional Cobb angles were assessed pre and post-op. Virtual postoperative alignment was generated by combining post-op alignment of the fused spine with the pre-op alignment on the unfused thoracic kyphosis and the pre-op pelvic retroversion. Regression models were then generated to predict the relative impact of segmental (L4-L5) and regional (L1-L4) corrections on PT, SVA (virtual), and TPA.

Results:

Baseline analysis revealed distal (L4-S1) lordosis of 33 ± 15°, flat proximal (L1-L4) lordosis (1.7 ± 17°), and segmental kyphosis from L2-L3 to T10-T11. Post-op, there was no mean change in distal lordosis (L5-S1 decreased by 2°, and L4-L5 increased by 2°), while the more proximal lordosis increased by 18 ± 16°. Regression formulas revealed that Δ10° in distal lordosis resulted in Δ10° in TPA, associated with Δ100 mm in SVA or Δ3° in PT; Δ10° in proximal lordosis yielded Δ5° in TPA associated with Δ50 mm in SVA; and finally Δ10° in thoraco-lumbar junction yielded Δ2.5° in TPA associated with Δ25 mm in SVA and no impact on PT correction.

Conclusions:

Overall impact of lumbar lordosis restoration is critically determined by location of correction. Distal correction leads to a greater impact on global alignment and pelvic retroversion. More specifically, it can be assumed that 1° L4-S1 lordosis correction produces 1° change in TPA / 10 mm change in SVA and 0.5° in PT.
Civilian Gun Shot Wounds Associated With Spinal Injuries
Authors: Ge Laurence , Jubril Ayodeji , Mesfin Addisu
Published: February 2021

Study Design:

Retrospective

Objective:

To evaluate functional outcomes and characteristics associated with gunshot wound (GSW) to the spine.

Methods:

Patients with GSW to the spine managed at a Level 1 Trauma Center from January 2003 to December 2017 were enrolled. Patient demographics, diagnoses, level of injury, American Spinal Injury Association (ASIA) score, ambulatory status at follow-up, bowel and bladder function, clinical improvement, and mortality were evaluated. Clinical improvement was defined as a progression in ambulatory status category at latest follow up.

Results:

51 patients with GSW of the spine were identified. 48 (94.1%) were male and 3 (5.9%) were female, with a mean age of 27 years-old (range 15-56). 38 (74.5%) were Caucasian, 7 (13.7%) were African American, 1 (2.0%) Asian-American, and 5 (9.8%) were Other/Unknown. 46 (90.2%) patients had GSW related spinal fractures and 44 (86.3%) had neurological deficits. Among patients with neurologic deficits, 5 (9.8%) had Cauda Equina Syndrome, 1 (2%) had Brown-Sequard Syndrome, and 38 (74.5%) spinal cord injuries: ASIA A 26 (68.4%); ASIA B 3 (7.9%); ASIA C 7 (18.4%); ASIA D 2 (5.3%). At mean follow-up time of 4.2 years (SD 3.9), 27 (52.9%) patients were wheelchair bound, 11 (21.6%) were ambulating with assistance, and 13 (25.5%) had normal ambulation. ASIA grade (A or B) was significantly, P < 0.00001, associated with being wheelchair bound and having neurogenic bowel or bladder at follow-up.

Conclusions:

Most spinal GSW patients (70.6%) did not have any clinical improvement in ambulatory status and most injuries were ASIA A.
Predictive Effect of Intervertebral Foramen Width on Pain Relief After ACDF for the Treatment of Cervical Radiculopathy
Authors: Sun Baifeng , Xu Chen , Qi Min , Shen Xiaolong , Zhang Ke , Yuan Wen , Liu Yang
Published: February 2021

Study Design:

Retrospective cohort study.

Objective:

To investigate the relationship between the preoperative width of the intervertebral foramen (WIVF) and the pain relief in patients who underwent anterior cervical discectomy and fusion (ACDF) for the treatment of cervical radiculopathy.

Methods:

Patients were divided into 2 groups based on pain relief status at the 6-month follow-up (pain relief group: 430 patients; persistent pain group: 108 patients). Possible factors such as age, sex, body mass index (BMI), the symptom duration, the preoperative Japanese Orthopedic Association (JOA) scores, the canal stenosis status, and the graft material were obtained. The C2-C7 Cobb angle, disc space, and width and height of the intervertebral foramen were measured on X-ray and CT 3-dimension reconstruction. Multivariate logistic regression was performed to identify the factors that affected pain relief. A receiver operating characteristic (ROC) curve was drawn for the predictive factors to determine the optimal threshold for foreseeing persistent pain.

Results:

There were significant differences in the preoperative WIVF, symptom duration and ratio of disc space distraction between the 2 groups (each P < 0.05). The regression model showed that pain relief was negatively affected by the symptom duration and ratio of disc space distraction. Besides, an increase in the preoperative width of the intervertebral foramen (WIVF) could significantly decrease the possibility of persistent pain. Based on the ROC curve, the optimal threshold of preoperative WIVF was 4.35 mm.

Conclusion:

When the preoperative WIVF is equal to or less than 4.35 mm, the possibility of the occurrence of postoperative persistent pain significantly increased.
Sacrococcygeal Morphologic and Morphometric Risk Factors for Idiopathic Coccydynia: A Magnetic Resonance Imaging Study
Authors: Shams Ahmed , Gamal Osama , Mesregah Mohamed Kamal
Published: February 2021

Study Design:

Retrospective case-control study.

Objectives:

To evaluate the sacrococcygeal morphologic and morphometric features in idiopathic coccydynia using magnetic resonance imaging (MRI).

Methods:

MRI scans from 60 patients with idiopathic coccydynia were compared with scans of 60 controls. Assessment of coccygeal morphology included coccygeal segmentation, coccygeal types, bony spicules, sacrococcygeal joint fusion, and intercoccygeal joint fusion and subluxation. Morphometric parameters included coccygeal straight and curved lengths, coccygeal curvature index, sacrococcygeal and intercoccygeal joint angles, sacral straight and curved lengths, sacral curvature index, sacral angle, sacrococcygeal straight and curved lengths, sacrococcygeal curvature index, and sacrococcygeal angle.

Results:

The coccydynia group included 28 males and 32 females, with a mean age of 36.1 years. Type II coccyx and bony spicules were more common in coccydynia, P = 0.003 and 0.01, respectively. Sacrococcygeal joints were fused less commonly in coccydynia, P = 0.02. Intercoccygeal joint subluxation was more common in coccydynia, P = 0.007. The sacral angle was lower in coccydynia, P = 0.01. The sacrococcygeal curved length was higher in coccydynia, P < 0.001. The sacrococcygeal curvature index was lower coccydynia, P < 0.001. In females only, the coccygeal curvature index was lower in coccydynia patients, P = 0.04. In males only, the intercoccygeal angle was lower in coccydynia patients, P = 0.02.

Conclusions:

Type II coccyx, bony spicules, intercoccygeal joint subluxation were more common, and sacrococcygeal joint fusion was less common in coccydynia patients. Sacral angle and sacrococcygeal curvature index were lower, while sacrococcygeal curved length was higher in coccydynia patients.

Level of Evidence:

Level 3. Case-control study.
Additional effects of core stability exercises on pain and function of patients with patellofemoral pain: A randomized controlled trial
Authors: Tazesh Behnaz , Mansournia Mohammad Ali , Halabchi Farzin
Published: February 2021

Background/purpose:

Recently, there is more emphasis on the role of core muscles in pathogenesis and rehabilitation of patellofemoral pain (PFP). We aimed to investigate whether increased core muscle strength and endurance improve clinical outcomes.

Methods:

In a randomized controlled trial, 60 patients (M/F: 25/35, age = 32.28 (5.9) years) with PFP were randomly allocated into two groups of routine exercise (control) and combined core plus routine exercise (intervention). Home exercise was scheduled at least 5 times/week for 12 weeks. We assessed the outcomes of pain (Visual analogue scale) and function (Anterior knee pain score) before and immediately after interventions.

Results:

Significant improvements were reported in both groups (P < 0.001). There were significant between-group differences in both outcomes in favor of the intervention (Pain: 12.4, CI 95%: 7.1–17.8, P < 0.001; Function: 6.4, CI 95%: 2.2–10.5, P = 0.003).

Conclusion:

Outcome improvements were significantly greater in intervention group. Inclusion of core stability exercises may lead to additional benefits.
Masquelet’s induced membrane technique for the reconstruction of post-traumatic, open-grade distal femur fracture with bone defect
Authors: Musa Rameez A , Shah Darshan U , Makwana Vipul R , Hadiya Arvind K , Shah Parth K , Bhavsar Neel M
Published: February 2021

Introduction:

Reconstruction of complex, open-grade distal femur fracture with bone defect presents an orthopaedic surgeon with a distinctive challenge as they are often associated with contaminated, compromised soft tissue and poor host condition. Conventional techniques like vascularized fibula transfer, autologous bone grafting or distraction osteogenesis focus mainly over bone union without taking infection control into consideration. The aim of this study is to evaluate the outcome of induced membrane technique in the reconstruction of open distal femur fracture with bone defect.

Methods:

10 such patients were retrospectively evaluated. Union was considered when a minimum of two cortices were seen on a radiograph. Knee Society Score was used to evaluate the functional outcome.

Results:

The average length of the defect was 5.7cm (3–10 cm) with mean interval period between the two stages being 42.7 days (34–51 days). Internal fixation was carried out in all cases. In 7 patients we used a mixture of cancellous autograft and cancellous allograft mixed in a ratio of 3:1. In the remaining 3 patients we used only cancellous autograft. Radiological union was achieved in all patients with mean union time of 8.5 months (7–11 months). Mean knee score was 79 (69–86) and mean function score was 71.5 (60–80).

Conclusion:

The induced membrane technique is an economical, technically less demanding technique for reconstruction of distal femur fracture with bone defects. The results are reproducible with a high success rate and without the need of any special instrumentation. It bestows infection control and prevents graft resorption. Long reconstructive period and donor site morbidity are matters of concern.
Religious populism in Pakistani Punjab: How Khadim Rizvi’s Tehreek-e-Labbaik Pakistan emerged
Authors: Sabat Ahmad , Shoaib Muhammad , Qadar Abdul
Published: February 2021

Khadim Rizvi’s open manifestation of religion helped him become one of the most popular leaders of Barelvi-Sunni Muslims in Pakistani Punjab. He emerged as the leader of a moral community during a crisis. After a series of protests and negotiated agreements with the federal and provincial governments, he was able to translate his support into electoral power. In the 2018 election, his TLP bagged 1.8 million votes (National Assembly seats) from Punjab. It was the first instance in recent political history when a newcomer religious party finished third in the province. No religious party had been able, in the last three elections (2008, 2013, 2018), to impact elections in Punjab as the TLP did in 2018.
Does Commodity Derivatives Function Effectively? A lengthy Discussion
Authors: Rout Bhabani Sankar , Das Nupur Moni , Rao K. Chandrasekhara
Published: February 2021

The present work has been designed to intensely investigate the capability of the commodity futures market in achieving the aim of price discovery. Further, the downside of the cash and futures market and transfer of the risk to other markets has also been studied using VaR, and Bivariate EGARCH. The findings of the work point that the metal commodity derivative market helps in the efficient discovery of price in the spot market except for nickel. But, in the case of the agricultural commodities, the spot is found to be leading and thus there is no price discovery except turmeric. On the other hand, the volatility spillover is bidirectional for both agri and metal commodities except copper, where volatility spills only from futures to spot. Further, the effect of negative shock informational bias differs from commodity to commodity, irrespective of metal or agriculture.
Revisiting the Trimodal Agrarian Structure as a Social Differentiation Analysis Framework in Zimbabwe: A Study
Authors: Mazwi Freedom , Muchetu Rangarirai G. , Mudimu George T.
Published: February 2021

The study of social differentiation in the countryside is often dominated by the deployment of classical analytical frameworks. This article quantitatively explores social differentiation at the sub-national level (Chiredzi and Zvimba districts in Zimbabwe), through the use of the trimodal agrarian structure (TMAS) framework. It addresses the question of whether variables outlined in TMAS (land sizes, labor, and credit) stimulate social differentiation patterns across various settlement models, which emerged after Zimbabwe’s land reform program. If so, what groups or clusters emerge and what are the differentials at the local level? Through statistical factor and cluster analysis, this article reveals that the TMAS variables do explain social differentiation even at the sub-national level. Land sizes, access to capital, and ownership of cattle are key factors in explaining this differentiation. Beyond the variables presented by the TMAS, we argue that agroecological zones and crop type are also instrumental in shaping social differentiation. From the evidence presented, it is difficult to visualize inter-cluster mobility because of various reasons, which include state-based tenure.
Personal protective equipment usage, recycling and disposal among spine surgeons: An Asia Pacific Spine Society survey
Authors: Chiu Chee Kidd , Chan Chris Yin Wei , Cheung Jason Pui Yin , Cheung Prudence Wing Hang , Gani Siti Mariam Abd , Kwan Mun Keong
Published: February 2021

Purpose:

In this study we investigated on the personal protective equipment (PPE) usage, recycling, and disposal among spine surgeons in the Asia Pacific region.

Methods:

A cross-sectional survey was carried out among spine surgeons in Asia Pacific. The questionnaires were focused on the usage, recycling and disposal of PPE.

Results:

Two hundred and twenty-two surgeons from 19 countries participated in the survey. When we sub-analysed the differences between countries, the provision of adequate PPE by hospitals ranged from 37.5% to 100%. The usage of PPE was generally high. The most used PPE were surgical face masks (88.7%), followed by surgical caps (88.3%), gowns (85.6%), sterile gloves (83.3%) and face shields (82.0%). The least used PPE were powered air-purifying respirators (PAPR) (23.0%) and shoes/boots (45.0%). The commonly used PPE for surgeries involving COVID-19 positive patients were N95 masks (74.8%), sterile gloves (73.0%), gowns (72.1%), surgical caps (71.6%), face shields (64.4%), goggles (64.0%), shoe covers (58.6%), plastic aprons (45.9%), shoes/boots (45.9%), surgical face masks (36.5%) and PAPRs (21.2%). Most PPE were not recycled. Biohazard bins were the preferred method of disposal for all types of PPE items compared to general waste.

Conclusions:

The usage of PPE was generally high among most countries especially for surgeries involving COVID-19 positive patients except for Myanmar and Nepal. Overall, the most used PPE were surgical face masks. For surgeries involving COVID-19 positive patients, the most used PPE were N95 masks. Most PPE were not recycled. Biohazard bins were the preferred method of disposal for all types of PPE.
Management of post-operative discitis following discectomy in a tertiary-level hospital
Authors: Ahsan Md Kamrul , Hasan Md Sariful , Khan Md Shahidul Islam , Sakeb Najmus
Published: February 2021

Purpose:

To perform retrospective analysis of 75 post-operative disc space infections after open lumbar discectomy (OLD) and to assess the outcome of their medical and surgical management in a tertiary-level hospital.

Methods:

Records of 50 men and 25 women aged 26–65 (mean, 42.53) years who underwent treatment for post-operative discitis (POD) after single level OLD at L3–4 (n = 8), L4–5 (n = 42), L5–S1 (n = 25) level. The POD was diagnosed according to specific clinical signs, laboratory and radiographic investigations and all of them received initial intravenous antibiotics (IVA) for at least 4–6 weeks followed by oral ones. Successful responders (n = 55) were considered in Group-C and remainder [Group-S (n = 20)] were operated at least after 4 weeks of failure. Demographic data, clinical variables, hospital stay, duration of antibiotic treatment and post-treatment complications were collected from the hospital record and assessment before and after treatment were done by using visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score. Comprehensive outcome was evaluated by modified criteria of Kirkaldy-Willis.

Results:

The mean follows up was 36.38 months. Significant improvement of mean VAS and JOA score was achieved in both conservative (76.36% satisfactory) and operative (90% satisfactory) groups although the difference was statistically insignificant.

Conclusion:

Although insignificant, early surgical intervention provided better results (e.g. functional outcomes, length of hospital stay and duration of antibiotic treatment therapy) than conventional conservative treatment in post-operative discitis.
Systemic Inflammatory Response Syndrome Secondary to Nitrofurantoin
Authors: McGarry Molly R. , Wagner Meredith W. , Wall Barry M.
Published: February 2021

Nitrofurantoin is considered optimal treatment for acute uncomplicated cystitis by the Infectious Diseases Society of America and is being increasingly recommended due to microbial resistance to sulfamethoxazole/trimethoprim and various fluoroquinolone antibiotics. Adverse effects of nitrofurantoin are generally considered mild, with gastrointestinal complaints being the most common. However, there have been isolated case reports describing a more severe systemic inflammatory response syndrome–like reaction, which leads to diagnostic challenges and treatment complications. We report the case of a patient with repeat episodes of systemic inflammatory response syndrome secondary to nitrofurantoin, which was initially attributed to recurrent urinary tract infections.
Relationship Between Upper Limb Injuries and Hip Range of Motion in Elementary and Junior High School Baseball Players
Authors: Hamano Noritaka , Shitara Hitoshi , Tajika Tsuyoshi , Kuboi Takuro , Ichinose Tsuyoshi , Sasaki Tsuyoshi , Kitagawa Takanori , Kobayashi Hiroki , Yamamoto Atsushi , Kobayashi Tsutomu , Takagishi Kenji , Chikuda Hirotaka , Endo Fumitaka , Kamiyama Masataka , Shimoyama Daisuke , Takanime Shuhei , Miyamoto Ryosuke , Nakase Kurumi
Published: February 2021

Background:

Shoulder and elbow injuries are major problems in baseball players. Tightness of the upper extremities has been reported as a risk factor for shoulder and elbow injuries in elementary and junior high school baseball players. However, few studies have been conducted on the relationship between decreased hip range of motion (ROM) and shoulder and elbow injuries.

Purpose/Hypothesis:

This study aimed to prospectively examine the relationship between hip ROM and throwing-related shoulder and elbow injuries in elementary and junior high school baseball players. The hypothesis was that players with unrestricted ROM in the hip would have a reduced risk of upper extremity injuries.

Methods:

The study included 263 baseball players (mean ± SD age, 10.5 ± 1.3 years; range, 7-14 years). The following physical parameters were assessed: (1) hip flexion ROM measured in the supine position and (2) hip internal and external rotation in the prone position. After the season, players completed questionnaires regarding shoulder and/or elbow injuries. For comparison, the players were classified as injured (not able to play for ≥8 days because of shoulder and/or elbow problems) or noninjured.

Results:

During the season, 52 players had shoulder and/or elbow injuries. When the injured and noninjured groups were compared, hip flexion on the dominant side (121.5° ± 12.0° vs 126.7° ± 9.8°, respectively; P < .01), hip flexion on the nondominant side (119.6° ± 11.7° vs 126.0° ± 9.9°, respectively; P < .01), and internal rotation on the dominant side (52.5° ± 11.3° vs 56.8° ± 10.8°, respectively; P = .01) were significantly reduced in the injured group.

Conclusion:

We identified preseason decreases in flexion bilaterally and internal rotation on the dominant side as risk factors for shoulder and elbow injuries in elementary and junior high school baseball players. Further studies are required to prevent disabilities in elementary and junior high school baseball players through development of prevention and intervention programs.
Clinical Outcomes and Return to Play in Youth Overhead Athletes After Medial Epicondyle Fractures Treated With Open Reduction and Internal Fixation
Authors: Cain E. Lyle , Liesman W. Gage , Fleisig Glenn S. , Grosz Lindsay E. , Hart Karen , Axe Michael J. , Wilk Kevin E. , Emblom Benton A. , Dugas Jeffrey R.
Published: February 2021

Background:

There is limited literature regarding outcomes after operative treatment of displaced medial epicondyle avulsion fractures in adolescent athletes. Most studies have had a relatively small sample size and have not assessed return to play of the overhead athlete.

Purpose:

To examine return to play and outcomes of youth overhead athletes who underwent open reduction and internal fixation (ORIF) with screw fixation.

Study Design:

Case series; Level of evidence, 4.

Methods:

Charts and radiographs were queried between January 2003 and June 2018 for young overhead athletes (age, <17 years) who underwent ORIF for displaced medial epicondyle fracture. Patients with open fracture or concomitant injury were excluded. Radiographs from postoperative follow-up visits were examined for radiographic union. Eligible patients were asked to provide responses to the American Shoulder and Elbow Surgeons Standardized Assessment Elbow questionnaire and Kerlan-Jobe Orthopaedic Clinic questionnaires as well as questions regarding return to play.

Results:

Overall, 29 patients were included in the study; the mean age at surgery was 14.7 years (range, 12.9-16.5 years). There were 25 baseball players, 3 football quarterbacks, and 1 tennis player. Of the 23 patients with available images at least 3 months after surgery, 96% demonstrated radiographic union at last follow-up. Imaging for the 1 patient with nonunion was taken 3 months after ORIF, and it is unknown if he eventually had union. All patients (100%) were successfully contacted to complete questionnaires at a mean follow-up of 4.8 years (range, 1.0-13.5 years). The mean KJOC score was 93.0, and the mean scores for the American Shoulder and Elbow Surgeons Elbow questionnaire were 8.9, 35.6, and 9.8 for pain, function, and satisfaction, respectively. One overhead athlete did not return to play, while the other 28 returned at a mean 7 months after surgery. No patient underwent revision ORIF, 1 underwent hardware removal, and 1 underwent ulnar nerve transposition. No players underwent ulnar collateral ligament reconstruction after primary ORIF of the medial epicondyle.

Conclusion:

ORIF of displaced medial epicondyle fractures is a reliable and successful procedure in adolescent overhead athletes with high demands, with relatively low risk of major complications, reinjury, or reoperation.
Is There an Association Between Authors’ Conflicts of Interest and Outcomes in Clinical Studies Involving Autologous Chondrocyte Implantation?
Authors: Mayo Benjamin C. , Ravella Krishna C. , Onsen Leonard , Bobko Aimee , Schwarzman Garrett R. , Steffes Matthew J. , Miller Adam , Hutchinson Mark R.
Published: February 2021

Background:

Autologous chondrocyte implantation (ACI) is an increasingly popular technique for the treatment of articular cartilage defects. Because several companies have financial interests in ACI, it is important to consider possible conflicts of interest when evaluating studies reporting outcomes of ACI.

Purpose:

To determine whether there is an association between authors’ financial conflicts of interest and the outcomes of ACI studies.

Study Design:

Cross-sectional study.

Methods:

A search of PubMed and MEDLINE databases for “autologous chondrocyte implantation” was performed. Clinical studies published after 2012 through May 15, 2019, and in English were included. Studies were determined to have financial conflicts of interest if any contributing author had relevant conflicts, either self-reported in the published study’s disclosures section or reported online in the American Academy of Orthopaedic Surgeons Disclosure database or the Centers for Medicare & Medicaid Services Open Payments database. The outcomes of each study were rated as favorable, equivocal, or unfavorable based on predefined criteria and then tested for association with conflicts of interest through use of the Fisher exact test.

Results:

A total of 79 studies met the inclusion criteria. Nearly all studies were of level 3 or 4 evidence. Conflicts of interest were established in 51.90% of studies (n = 41). Conflicts that were not self-reported by the authors were discovered in 18% of studies. The level of evidence was not associated with conflict of interest. No statistically significant difference was found in the rate of favorable outcomes between studies with conflicts (92.68%) and those with no conflicts (81.58%) ( P = .126). Publications by US authors were more likely to have financial conflicts of interest ( P = .003).

Conclusion:

Favorable results were reported in a majority of studies involving ACI. No statistical association was found between the frequency of favorable outcomes and the presence of financial conflicts of interest, country of authorship, or level of evidence. There was a trend toward more favorable outcomes in studies with conflicts of interest. Additionally, nearly 20% of publications had possible conflicts found online that were not self-reported. It is critical for orthopaedic surgeons to judiciously evaluate published studies and consider financial conflicts of interest before performing ACI techniques on patients.
Systematic Review of Orthopaedic and Sports Medicine Injuries and Treatment Outcomes in Women's National Basketball Association and National Basketball Association Players
Authors: Allahabadi Sachin , Su Favian , Lansdown Drew A.
Published: February 2021

Background:

Athletes in the Women’s National Basketball Association (WNBA) and National Basketball Association (NBA) are subject to high injury rates given the physical demands of the sport. Comprehensive data regarding injury patterns and rates in these athletes are limited.

Purpose:

To summarize available data on orthopaedic and sports medicine–related injuries through 2020 in professional female and male basketball players.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A search was conducted using PubMed and Embase through April 5, 2020, to identify injury studies regarding WNBA and NBA players. Studies were included if the injury or surgery was considered a direct consequence of game play including musculoskeletal/orthopaedic, concussion, ophthalmologic, and craniomaxillofacial injuries. Systematic reviews, screening studies, or studies without sufficient WNBA or NBA player subgroup analysis were excluded.

Results:

A total of 49 studies met inclusion criteria, 43 (87.8%) of which detailed musculoskeletal injuries. The lower extremity represented 63.3% of studies. A majority (59.2%) of studies were level 4 evidence. The source of data was primarily comprehensive online search (n = 33; 67.3%), followed by official databases (n = 11; 22.4%). Only 3 studies concerned WNBA athletes compared with 47 that concerned NBA athletes. The lowest return-to-play rates were cited for Achilles tendon repairs (61.0%-79.5%). Variability in return-to-play rates existed among studies even with similar seasons studied.

Conclusion:

The majority of literature available on orthopaedic and sports medicine–related injuries of NBA and WNBA athletes is on the lower extremity. The injuries that had the greatest effect on return to play and performance were Achilles tendon ruptures and knee cartilage injuries treated using microfracture. The reported outcomes are limited by heterogeneity and overlapping injury studies. There are limited available data on WNBA injuries specifically.
The Role of the Acromioclavicular Ligament in Acromioclavicular Joint Stability: A Cadaveric Biomechanical Study
Authors: Kurata Shimpei , Inoue Kazuya , Hasegawa Hideo , Shimizu Takamasa , Iida Akio , Kawamura Kenji , Omokawa Shohei , Mahakkanukrauh Pasuk , Tanaka Yasuhito
Published: February 2021

Background:

Acromioclavicular (AC) joint dislocation is evaluated using the radiologically based Rockwood classification. The relationship between ligamentous injury and radiological assessment is still controversial.

Purpose/Hypothesis:

To investigate how the AC ligament and trapezoid ligament biomechanically contribute to the stability of the AC joint using cadaveric specimens. The hypothesis was that isolated sectioning of the AC ligament would result in increased instability in the superior direction and that displacement >50% of the AC joint would occur.

Study Design:

Controlled laboratory study.

Methods:

Six shoulders from 6 fresh-frozen cadavers were used in this study. Both the scapula and sternum were solidly fixed on a customized wooden jig with an external fixator. We simulated distal clavicular dislocation with sequential sectioning of the AC and coracoclavicular (CC) ligaments. Sectioning stages were defined as follows: stage 0, the AC ligament, CC ligament, and AC joint capsule were left intact; stage 1, the anteroinferior bundle of the AC ligament, joint capsule, and disk were sectioned; stage 2, the superoposterior bundle of the AC ligament was sectioned; and stage 3, the trapezoid ligament was sectioned. The distal clavicle was loaded with 70 N in the superior and posterior directions, and the magnitudes of displacement were measured.

Results:

The amounts of superior displacement averaged 3.7 mm (stage 0), 3.8 mm (stage 1), 8.3 mm (stage 2), and 9.5 mm (stage 3). Superior displacement >50% of the AC joint was observed in stage 2 (4/6; 67%) and stage 3 (6/6; 100%). The magnitudes of posterior displacement were 3.7 mm (stage 0), 3.7 mm (stage 1), 5.6 mm (stage 2), and 9.8 mm (stage 3). Posterior displacement >50% of the AC joint was observed in stage 3 (1/6; 17%).

Conclusion:

We found that the AC ligaments contribute significantly to AC joint stability, and superior displacement >50% of the AC joint can occur with AC ligament tears alone.

Clinical Relevance:

The AC ligament plays an important role not only in horizontal stability but also in vertical stability of the AC joint.