bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of Cognitive Performance on Musculoskeletal Injury Risk: A Systematic Review
Authors: Avedesian Jason M. , Forbes Warren , Covassin Tracey , Dufek Janet S.
Published: March 2021

Background:

While a large number of studies have investigated the anatomic, hormonal, and biomechanical risk factors related to musculoskeletal (MSK) injury risk, there is growing evidence to suggest that cognition is an important injury contributor in the athletic population. A systematic review of the available evidence regarding the influence of cognitive performance on MSK injury risk has yet to be published in the sports medicine literature.

Purpose/Hypothesis:

The purpose was to determine the effects of cognition on (1) MSK biomechanics during sports-specific tasks and (2) MSK injury occurrence in the athletic population. It was hypothesized that athletes with lower cognitive performance would demonstrate biomechanical patterns suggestive of MSK injury risk and that injured athletes would perform worse on baseline measures of cognition as compared with their noninjured counterparts.

Study Design:

Systematic review.

Methods:

PubMed and SPORTDiscus were searched from January 2000 to January 2020. Manual searches were performed on the reference lists of the included studies. A search of the literature was performed for studies published in English that reported MSK biomechanics as a function of cognitive performance and MSK injury occurrence after baseline measures of cognition. Two independent reviewers extracted pertinent study data in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2009 guidelines and assessed study quality using the Quality Assessment Tool for Observational Cohort and Cross-sectional Studies from the National Institutes of Health. A meta-analysis was not performed, owing to the heterogeneous nature of the study designs.

Results:

Ten studies met inclusion criteria: 4 cognition–MSK biomechanics studies and 6 cognition–MSK injury studies. All 4 cognition–MSK biomechanics studies demonstrated that worse performance on measures of cognition was associated with lower extremity MSK biomechanical patterns suggestive of greater risk for MSK injury. The majority of the cognition–MSK injury studies demonstrated that injured athletes significantly differed on baseline cognition measures versus matched controls or that cognitive performance was a significant predictor for subsequent MSK injury.

Conclusion:

Although the literature exploring cognitive contributions to MSK injury risk is still in its infancy, it is suggested that sports medicine personnel conduct baseline assessments of cognition—in particular, reaction time and working memory—to identify which athletes may be at elevated risk for future MSK injury.
Comparing Patient-Reported Outcome Measurements for Femoroacetabular Impingement Syndrome
Authors: Oji Nnaoma M. , Jansson Hayley , Bradley Kendall E. , Feeley Brian T. , Zhang Alan L.
Published: March 2021

Background:

There is much debate in the current literature with regard to the most appropriate hip-specific patient-reported outcome (PRO) measurement for assessment of femoroacetabular impingement syndrome (FAIS) and outcomes after surgical treatment. Despite systematic reviews assessing the validity of classic hip-specific PROs as well as newer PROs developed to target the young, active population, there lacks a direct comparison of the question content between each PRO.

Purpose:

To compare the question composition and degree of overlap between commonly used PROs for FAIS.

Study Design:

Cross-sectional study

Methods:

A literature review yielded the 6 most commonly cited PROs for assessment of FAIS: modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score (HOOS), Copenhagen Hip and Groin Outcome Score (HAGOS), Nonarthritic Hip Score (NAHS), international Hip Outcome Tool (iHOT-33), and Hip Outcome Score (HOS). Questions from each PRO were classified as identical, similar, or unique after pooled comparison, and the number of overlapping (identical or similar) questions between each PRO was determined. Questions were then classified into 5 domains: pain, symptoms, functional activities, sports, and quality of life, and variations in questions assessing each domain based on PRO were analyzed.

Results:

Analysis of 164 total questions from 6 PROs showed that 87 questions (53%) were identical between 2 or more PROs, 39 (24%) were similar, and 38 (23%) were unique. The iHOT-33 contained the highest number of unique questions, with 13 of 33 (39.4%), while the HOOS contained the lowest number of unique questions, with 3 of 40 (7.5%). The HOOS, HAGOS, and iHOT-33 contained questions assessing all 5 domains of patient outcomes; the NAHS did not evaluate quality of life; the mHHS only assessed pain, symptoms, and functional activities; and the HOS only assessed functional activities and sports.

Conclusion:

As there is a high percentage of overlapping (identical or similar) questions between the most commonly used hip-specific PROs for FAIS, multiple tests may be appropriate for use. The iHOT-33, HOOS, and HAGOS are well suited for the general population as they offer comprehensive assessments across all domains, while the HOS provides added focus to sports/activity assessments for athletes and highly active patients.
Accomplishing CAPE Domain 3 During APPE Rotations: Student Perceptions
Authors: Smith Susan M. , Sebaaly Jamielynn , Brennan Lisa , Haltom Wesley , Meade Lisa , Nisly Sarah A.
Published: March 2021

Introduction:

The purpose of this study is to examine student perceptions of accomplishment among 6 subdomains of Center for Advancement of Pharmacy Education (CAPE) Domain 3 “Approach to Practice and Care” outcomes in Advanced Pharmacy Practice Experiences (APPE) across distinct geographical regions.

Methods:

An 18-item electronic survey was distributed to 88 student pharmacists at a private university completing APPEs in 5 distinct regions and 2 concentrated learning experiences during their penultimate rotation. The survey assessed whether students had at least 1 opportunity to achieve Domain 3 outcomes. Students were prompted to report a percentage of perceived successful accomplishment of outcomes if they stated they had at least 1 opportunity for achievement.

Results:

Survey response rate was 52% (n = 46). Respondents reported a median accomplishment of at least 85% for each question. For 2 questions, respondents reported a median accomplishment of 99%. Students perceived successful accomplishment for most of the questions related to communication outcomes, while the lowest completion percentages were noted in outcomes related to patient advocacy (85%) and problem solving (88%). Student perceptions of accomplishment among the 6 subdomains were similar across regions and concentrated learning experiences.

Conclusions:

Students felt confident in accomplishing the outcomes associated with CAPE Domain 3. Regional assignments did not impact student perceptions of outcome accomplishment. Preceptors may play a pivotal role in providing students with opportunities to further polish their skills and increase confidence, specifically in the areas of patient advocacy and problem solving.
A Case Report of Hypoglycemia Following a Tramadol Overdose in a Non-Diabetic Patient
Authors: Weant Kyle A. , Clendening Alexander M. , Bush Jeffrey S.
Published: March 2021

Introduction:

Tramadol is an opioid analgesic that binds to mu-opioid receptors and inhibits the uptake of norepinephrine and serotonin. Through its activation of these receptors, it has potential to increase the utilization of glucose and/or decrease hepatic gluconeogenesis.

Case Report:

A 55-year-old male presents to the Emergency Department (ED) via Emergency Medical Services (EMS) following a self-reported overdose of alprazolam, lorazepam, acetaminophen with codeine, and tramadol. During EMS transport, the patient was found to be hypoglycemic with a glucose of 30 mg/dL and was administered 25 grams of intravenous (IV) dextrose 50% in water. The patient had no past medical history of diabetes mellitus, hypoglycemia, or hyperglycemia and was normoglycemic on his prior presentations to our facility 3 months and 2 years prior. Subsequent analysis found that the patient was negative for acetaminophen, ethanol, salicylates, tricyclics, and lithium. His urinalysis was positive for opiates and benzodiazepines. Upon arrival to the ED, the patient’s blood glucose was 131 mg/dL but subsequently dropped to 73 mg/dL, necessitating the initiation of continuous IV fluids containing dextrose. These fluids were discontinued 3.5 hrs later and the patient was discharged 16 days later.

Discussion:

This case illustrates that hypoglycemia can be a presenting symptom in patients with an acute overdose of tramadol with no previous history of glycemic dysregulation. Upon presentation it is important to closely monitor serum glucose concentrations to identify hypoglycemia early in order to initiate necessary hypoglycemia protocols.
Impact of a Pharmacist Intervention in the Emergency Department on the Appropriateness of Direct Oral Anticoagulants Prescribed in Venous Thromboembolism Patients
Authors: Bakey Kristen H. , Nguyen Cam-Tu N.
Published: March 2021

Background:

It is now widely accepted to manage low risk acute venous thromboembolism (VTE) in the outpatient setting with direct oral anticoagulants (DOACs). Although DOACs are straightforward to dose, they are high risk medications and not immune to medication errors. There is limited evidence that pharmacists’ intervention has an impact on DOAC discharge medication errors in the ED.

Objective:

To determine if pharmacist involvement reduced the rate of DOAC discharge medication errors in low risk VTE patients.

Methods:

This retrospective cohort study evaluated a clinical pharmacy service implemented prior to the study. Included patients were evaluated in 2 groups: the cohort with pharmacist involvement and the cohort without pharmacist involvement. The primary outcome was the rate of anticoagulation medication errors.

Results:

A total of 58 patients were evaluated. Of these patients, 14 had a pharmacist directly involved with their care in the ED while 44 patients did not. The rate of medication errors was lower when a pharmacist was involved, 7.1% (n = 1), compared to when a pharmacist was not involved, 36.4% (n = 16), (p = 0.046). All patients in the pharmacist involvement group received anticoagulation counseling prior to discharge compared to only 56.8% of patients in the non-pharmacist involvement group (p = 0.002).

Conclusion:

Our protocol for pharmacist involvement at the time of VTE diagnosis during an ED admission showed a reduced rate of anticoagulation medication errors when a pharmacist was involved. This benefit could potentially translate into improved outcomes such as readmission rates, patient safety outcomes, and hospitalizations.
Tocilizumab for the Critically Ill With Severe COVID-19: A Community Hospital Case Series
Authors: McKenzie Matt G. , Lee Yeunju (Michelle) , Mathew Julin , Anderson Megan , Vo Alison T. , Akinyele Samuel , Narayanan Malarvizhi
Published: March 2021

Objective:

To evaluate the use of tocilizumab in a community hospital setting for critically ill patients with severe COVID-19.

Design:

A retrospective case series

Setting:

Five community hospitals within 1 urban health system

Patients:

Adult patients whom received tocilizumab between March 27th, 2020 to April 30th, 2020 for severe COVID-19.

Interventions:

None.

Measurements and Main Results

Sixteen patients in total were evaluated from the 5 community hospitals. The mean (± SD) age of the patients was 53.9 ± 9.2 years, 56% were men, and the most common comorbidities present on admission were hypertension (31%) and diabetes mellitus (25%). All patients received at least 1 other treatment modality for COVID-19 (steroids, hydroxychloroquine, or convaslescent plasma). Additionally, all patients on admission to intensive care units had severe COVID-19 with 56% requiring mechanical ventilation with a pre-tocilizumab median (IQR) Pao2: Fio2 of 84 (69 – 108.6), 19% requiring vasopressor support, and inflammatory markers (CRP, LDH, ferritin, and IL-6) were elevated. The median (IQR) tocilizumab dose was 400 mg (400-600) which correlated with a weight-based mean (± SD) dose of 5.4 mg/kg ± 1.3. Of the 16 patients that received tocilizumab, 8 (50%) were discharged home, 7 (44%) died, and 1 (6%) was still hospitalized at the end of data collection. Patients who died were more likely to be older 62 ± 2 years, female (57%), had a higher rate of mechanical ventilation (86%) and vasopressors (43%) use at baseline, and had a higher median (IQR) IL-6 level prior to tocilizumab administration 550 pg/mL (IQR 83-1924). There were no reported adverse drug reactions reported after the administration of tocilizumab for any patient.

Conclusions:

Our findings do not support the effectiveness of tocilizumab in treatment of severe COVID-19 infection in critically ill patients.
The Effect of Bundling Trade Association Monitoring and Female Board Representation on Loan Losses in Community Credit Unions
Authors: Ward Anne Marie , Forker John , Reilly Barry
Published: March 2021

Loan book management is important to community credit union survival, particularly in deprived localities. Consistent with agency theory, prior studies of credit unions report an association among individual monitoring mechanisms, trade association monitoring, and female board representation, respectively, and reduced loan losses. This study provides a more nuanced understanding by investigating the moderating influence of these monitoring mechanisms on the relationship between loan losses and deprivation and by considering the effect of bundle combinations of different levels of the two monitoring mechanisms on loan losses. The results reveal that credit unions subject to trade association monitoring have the lowest loan losses. However, in the absence of trade association monitoring, female board representation has a moderating effect on loan losses as deprivation increases. Finally, trade association monitoring and female board representation have a substitutive, rather than a complementary effect on loan losses.
Working Conditions in Global Value Chains: Evidence for European Employees
Authors: Nikulin Dagmara , Wolszczak-Derlacz Joanna , Parteka Aleksandra
Published: March 2021

This article investigates a sample of almost nine million workers from 24 European countries in 2014 to conclude how involvement in global value chains (GVCs) affects working conditions. We use employer–employee data from the Structure of Earnings Survey merged with industry-level statistics on GVCs based on the World Input-Output Database. Given the multidimensional nature of the dependent variable, we compare estimates of the Mincerian wage model with zero-inflated beta regressions focused on other aspects of working conditions (overtime work and bonus payments). Wages prove to be negatively related to involvement in GVCs: workers in the more deeply involved sectors have lower and less stable earnings, implying worse working conditions. However, they are also less likely to have to work overtime. We prove that the analysis of social implications of increasing involvement of countries in global production must compare wage effects of GVCs with other aspects of complex changes in workers’ well-being.
Emerging role of exosomes in arterial and renal calcification
Authors: Bano Shumaila , Tandon Simran , Tandon Chanderdeep
Published: March 2021

Exosomes are small, cell-derived vesicles of 30–100 nm that participate in cell-to-cell communication. They are released by many cells, such as dendritic cells (DC), lymphocytes, platelets, epithelial cells, endothelial cells (EC), and are found in most body fluids, including blood, saliva, urine, and breast milk. The exosomes released from cells within the cardiovascular system may contain either inhibitors of calcification in normal physiological conditions or promoters in the pathological environment [atherosclerosis (AS), and Chronic Kidney Disease (CKD)]. The exosomes of the vascular smooth muscle cells (VSMCs) are novel players in vascular repair processes and calcification. Several studies have shown that the cytoplasmic contents of exosomes are rich in a variety of proteins, nucleic acids, and lipids. Currently, exosomal micro RNAs and proteins are increasingly being recognized as biomarkers for the diagnosis of several diseases, including those of kidney and liver, as well as different types of cancer. In this review, we summarize recent advances in the role of exosomes in vascular calcification and their potential applications as diagnostic markers as well as a brief overview of the role of stem cell-derived exosomes in cardiovascular diseases.
Bio-sourced vinyl ester resin reinforced with microfibrillar cellulose: Mechanical and thermal properties
Authors: Desnoes Eric , Toubal Lotfi , Thibeault Dominic , Bouazza Amel Hadj , Montplaisir Daniel
Published: March 2021

New thermoset composite material made from cardanol-based resin blended with microfibrillar cellulose was compared to petroleum-based vinyl ester and glass-fiber-reinforced unsaturated polyester in terms of mechanical, thermal, rheological and surface properties of produced polymers and composites. The bio-sourced material was less resistant than the commercial vinyl ester but comparable to the unsaturated polyester resin. Microfibrillar cellulose increased the tensile strength and modulus but increased the resin viscosity and decreased the mixture homogeneity. The bio-sourced and commercial resins displayed similar hydrophobic behavior, and cellulose slightly decreased composite hydrophobicity. The glass transition temperature of the bio-sourced material was comparable to that of the unsaturated polyester. Thermal decompositions of composites and thermoset polymers were also similar. Cellulose and cardanol thus may be adequate as sustainable components in the composite materials industry.
What Informs Farmers’ Choice of Output Markets? The Case of Maize, Cowpea and Livestock Production in Northern Ghana
Authors: Adams Abdulai , Caesar Livingstone Divine , Asafu-Adjaye Nana Yamoah
Published: March 2021

This study analyses the main determinants of output market choices by rural farmers in northern Ghana amidst growing concerns of lack of lucrative markets for smallholder farmers. Using recent survey data collected from 448 households, the study applied the multinomial logistic regression (MLR) model with village markets as the base outcome. The findings revealed that association membership, access to storage facilities, openness to new production and marketing methods, access to financial services, knowledge of sustainable intensification (SI) practices, access to guaranteed market, availability of quality market services and distance to output market would likely influence the choice of a farmer to sell at a farm gate over village markets. Access to extension services was found significant in influencing farmers’ decisions to sell by the roadside. Also, gender, association membership, access to processing facilities, availability of quality market services and distance to output market would likely influence the choice of a farmer to do private sales. Furthermore, association membership, access to processing facilities, access to extension services and market information significantly influences the decision of farmers to use other market outlets (e.g., regional/district markets). The study concludes that the choice of market outlet used by farmers depends much on institutional and channel-specific characteristics. These findings have policy implications for the development of market policies, providing rural market infrastructure services, promoting SI practices and strengthening extension service delivery.
Socio-economic- and Gender-based Differentials in Choice of Sustainable Mode of Transport: Evidence from Jaipur, India
Authors: Saigal Taru , Vaish Arun Kr. , Rao N. V. M.
Published: March 2021

Climate change, fuelled by the growing transportation sector, is a pressing global challenge. There is a need to promote such a system of transportation, which is not only efficient but also sustainable. Using descriptive statistics complemented with a logit model of choice probabilities implemented on survey data from a city in a developing country, this study aims to examine the impact ‘of different socio-economic factors on the choice of sustainable modes of transport while also highlighting how these choices are different for men and women—the group of working population, those with the highest level of education, the group which is the most socio-economically well-off and the population of men most unlikely to prefer sustainable modes of transport. The study emphasizes the need to incorporate the varying demands of different socio-economic groups while formulating transportation policies so as to hamper neither the goal of sustainability nor the goal of women empowerment.
Sale of goods made to the consumer’s specifications at a trade fair: ab initio no right of withdrawal: Case C-529/19 Möbel Kraft, EU:C:2020:846
Authors: Steennot Reinhard
Published: March 2021

Within the European Union, consumers concluding contracts with traders either at a distance or outside the traders’ premises are generally entitled to withdraw from the contract. However, in certain cases, enumerated in article 16 of the Consumer Rights Directive, the right of withdrawal does not apply. One of the exceptions to the right of withdrawal concerns contracts relating to the supply of goods that are made to the consumer’s specifications or that are clearly personalized. In Möbel Kraft, the ECJ decided that a trader may rely on this exception from the outset and not only after he has begun to produce the goods.
Pathologic and immunohistochemical findings in an outbreak of systemic toxoplasmosis in a mob of red kangaroos
Authors: Carossino Mariano , Bauer Rudy , Mitchell Mark A. , Cummings Charles O. , Stöhr Anke C. , Wakamatsu Nobuko , Harper Kimberly , Langohr Ingeborg M. , Schultz Kendra , Mitchell Maria S. , Howe Daniel K. , Balasuriya Udeni B. R.
Published: March 2021

Toxoplasma gondii is a zoonotic protozoan pathogen that infects many endothermic vertebrates, including humans; the domestic cat and other felids serve as the definitive host. Macropodids are considered highly susceptible to toxoplasmosis. Here, we describe the clinical, pathologic, and immunohistochemical findings of an outbreak of systemic toxoplasmosis in a mob of 11 red kangaroos ( Macropus rufus), with high morbidity (73%) and mortality (100%) rates. Affected animals had either severe and rapidly deteriorating clinical conditions or sudden death, which was correlated with widespread necrotizing lesions in multiple organs and intralesional T. gondii organisms identified via MIC3-specific immunohistochemistry and confirmed by REP529-specific rtPCR. Quantification of parasites demonstrated the highest parasite density in pulmonary parenchyma compared with other tissues. Our study highlights the continued importance of this severe condition in Australian marsupials.
The Lived Experience of Learning Mindfulness as Perceived by People Living With Long-Term Conditions: A Community-Based, Longitudinal, Phenomenological Study
Authors: Mathews Gillian , Anderson Charles
Published: March 2021

While a considerable research base demonstrates the positive effects of 8-week secular mindfulness courses, it remains unclear to what degree their participants continue to engage with mindfulness practices; and there is a dearth of published reports on longer-term mindfulness interventions. Studies have also tended to focus on clinical “effectiveness,” with less attention given to participants’ own construal and expectations of mindfulness. To address these gaps, the study reported here implemented a year-long mindfulness program for a group of 20 individuals with long-standing health conditions who gradually transitioned to self-guiding. Their experiences, expectations, and understanding of mindfulness were investigated through the lens of descriptive phenomenology. The findings revealed that mindfulness practice did bring therapeutic improvement but that it was a multi-faceted process where an individual’s intentionality toward practice was key, with a clear division between those pursuing an “embodied integrated” mindfulness and those viewing it as a stress management tool.
Decisions and Dilemmas: The Context of Prioritization Dilemmas and Influences on Staff Members’ Prioritization Decisions in Residential Aged Care
Authors: Ludlow Kristiana , Churruca Kate , Ellis Louise A. , Mumford Virginia , Braithwaite Jeffrey
Published: March 2021

Staff members in residential aged care facilities (RACFs) make prioritization decisions to determine which aspects of care are most important and thus should be attended to first. Prioritization can potentially result in substandard care if lower priority tasks are delayed or left undone, known as “missed care.” This study investigated the contexts in which prioritization dilemmas arise in RACFs and the influences on prioritization decision-making. Thirty-two staff members participated in a think-aloud task during a prioritization activity, a demographic questionnaire, a post-sorting interview, and a semi-structured interview. Data were analyzed using inductive content analysis. Prioritization dilemmas occurred in response to high workloads, inadequate staffing, unexpected events, and conflicting demands. Seven influences on prioritization decision-making were identified. In some instances, these influences were seen to be in conflict, making prioritization decision-making challenging. Efforts to prevent missed care should consider the influences on staff members’ decision-making and aim to reduce prioritization dilemmas.
Artefactual Epithelial Displacement in a Papilloma with Extensive Usual Duct Hyperplasia Mimics a Solid Papillary Carcinoma with Invasive Growth
Authors: François Aline , Galant Christine , Berlière Martine , Van Bockstal Mieke R.
Published: March 2021

Mammary solid papillary carcinoma and usual duct hyperplasia (UDH) of the breast are morphological look-alikes, characterized by cellular streaming, solid growth, and a lack of high-grade nuclear atypia. Here, we report a challenging papillary lesion in the breast of a 48-year-old woman that presented with a double pitfall. A core needle biopsy showed a solid papillary proliferation of epithelial cells with oval to round overlapping nuclei, surrounded by a sclerotic stroma. This distorted lesion contained peripheral clefts and cellular streaming, without high-grade nuclear atypia. Immunohistochemistry showed diffuse heterogenous immunoreactivity for estrogen receptor and cytokeratin 5, and no immunoreactivity for chromogranin and synaptophysin. The immunohistochemical profile distinguished this sclerosed papilloma with extensive UDH from a solid papillary carcinoma. The lumpectomy specimen revealed a second challenge, where multiple epithelial islets without surrounding myoepithelial cells were observed near the papilloma, mimicking an invasive carcinoma. These islets displayed the same immunohistochemical profile as the sclerosed papilloma and they were surrounded by steatonecrosis and reactive fibroblasts, indicating epithelial displacement within the biopsy needle tract. A sclerosed papilloma with extensive UDH is a morphologically challenging mimic of a solid papillary carcinoma. Immunohistochemistry is helpful to distinguish both entities from one another. Extensive epithelial displacement in the biopsy tract made this case particularly challenging, as the displaced epithelial islets mimicked an invasive carcinoma. Pathologists should be aware of this uncommon double pitfall to prevent misdiagnosis.
Mesenteric and Retroperitoneal Mucinous Cystic Neoplasms: A Case Series
Authors: Van Treeck Benjamin J. , Horton Rachel K. , Lee Hee Eun , Rosty Christophe , Pai Rish K. , Graham Rondell P.
Published: March 2021

Aims. Mucinous cystic neoplasms (MCNs) are cystic neoplasms with mucinous epithelium surrounded by ovarian-like stroma. Extraovarian MCN occurring in the liver and pancreas have been well characterized. However, only rare case reports of MCN arising outside of these locations have been reported. MCNs arising in unusual locations should enter the differential diagnosis of mucinous intra-abdominal tumors and must be distinguished from more common mimics. Therefore, we aimed to examine a series of MCNs of the retroperitoneum and mesentery to characterize the clinicopathologic features of this entity. Methods and results. Seven MCNs arising in the abdominal mesentery or retroperitoneum were retrospectively identified. A clinicopathologic, histologic, and immunohistochemical (keratin 7, keratin 19, keratin 20, calretinin, inhibin-α, steroidogenic factor-1 (SF-1), estrogen receptor (ER), progesterone receptor (PR), PAX8, CDX2, and CD10) analysis was performed. All 7 MCNs were from females with a median age of 41 years old and a median size of 8 cm. All cases demonstrated mucinous with or without concomitant non-mucinous epithelium overlying spindle cell ovarian-like stroma. Luteinized cells were noted. The epithelium was positive for keratin 7 and keratin 19 in all 7 cases, while the stroma expressed ER, PR, and SF-1 in all cases stained. Calretinin was focally positive in the stroma of 3 of 7 cases, while inhibin-α was focally expressed in 5 of 6 cases. Conclusions. These results highlight the clinicopathologic, histologic, and immunophenotypic similarities between MCNs of the mesentery, retroperitoneum, pancreas, and liver. Overlapping features suggest a common histogenesis for all MCNs, which could include periductal fetal mesenchyme, aberrant migration of primordial germ cells, or abnormal differentiation or metaplasia of the embryonic coelomic epithelium.
Organizational Learning for Environmental Sustainability: Internalizing Lifecycle Management
Authors: Bianchi Guia , Testa Francesco , Boiral Olivier , Iraldo Fabio
Published: March 2021

Implementing a substantial environmental strategy that addresses all phases of the product lifecycle is a complex and demanding challenge that most organizations fail to convincingly overcome. Based on a case study of five frontrunner companies located in Italy and Norway, this study explores the factors that promote, or hinder, the learning process underlying the implementation of substantial measures for lifecycle management and how this can contribute to further internalizing environmental sustainability throughout the organization. The article contributes to the literature on organizational learning and environmental sustainability by showing, from a dynamic perspective, the enablers of organizational learning required for internalizing lifecycle management in organizations. A new framework for environmental sustainability based on the 4Is (intuiting, interpreting, integrating, and institutionalizing) organizational learning model is put forward in line with the concept of lifecycle management. Managerial implications are also discussed.
Visualizing Health Equity: Qualitative Perspectives on the Value and Limits of Equity Images
Authors: Willen Sarah S. , Walsh Colleen C. , Williamson Abigail Fisher
Published: March 2021

Background

Health educators and advocacy groups often use side-by-side visual images to communicate about equity and to distinguish it from equality. Despite the near-ubiquity of these images, little is known about how they are understood by different audiences.

Aims

To assess the effectiveness of an image commonly used to communicate about health equity.

Method

In 167 interviews with health stakeholders in Greater Cleveland, Ohio, in 2018 to 2019, a commonly used health equity image was shown to participants, who were asked to interpret its meaning. Interviewees included 21 health professionals, 21 clinicians, 22 metro-wide decision makers, 24 community leaders, and 79 community members.

Results

About two thirds of our socioeconomically, racial/ethnically, educationally, and professionally diverse sample said the equity image helped clarify the distinction between “equality” and “equity.” Yet less than one third offered an interpretation consistent with the image’s goals of foregrounding not only injustice but also a need for systemic change. Patterns of misinterpretation were especially common among two groups: ideological conservatives and those of lower socioeconomic status. Conservatives were most likely to object to the image’s message.

Conclusions

Equity images are widely used by public health educators and advocates, yet they do not consistently communicate the message that achieving equity requires systemic change. In this moment of both public health crisis and urgent concern about systemic racism, new visual tools for communicating this crucial message are needed.
Indigenous Made in Africa Evaluation Frameworks: Addressing Epistemic Violence and Contributing to Social Transformation
Authors: Chilisa Bagele , Mertens Donna M.
Published: March 2021

Transformative change is needed if the world is to achieve the sustainable development goals. Such change requires attention to culture, ethics, and values. We discuss the need to be responsive to the voices of Indigenous scholars in terms of the assumptions that guide methodological choices in the evaluation of international initiatives. We describe an Indigenous paradigmatic framework and then narrow the focus to a Made in Africa approach to evaluation that is designed to redress the epistemic violence perpetrated by the use of a Western cultural lens to determine evaluation approaches.
Changes in retinal vascular diameters in senior and geriatric cats in association with variation in systemic blood pressure
Authors: Enache Andra-Elena , Dietrich Ursula M , Drury Oscar , Trucco Emanuele , MacGillivray Tom , Syme Harriet , Elliott Jonathan , Chang Yu-Mei
Published: March 2021

Objectives

Early diagnosis of arterial hypertension is essential to prevent target organ damage. In humans, retinal arteriolar narrowing predicts hypertension. This blinded prospective observational study investigated the retinal vessel diameters in senior and geriatric cats of varying systolic blood pressure (SBP) status and evaluated retinal vascular changes in hypertensive cats after treatment.

Methods

Cats with a median age of 14 years (range 9.1–22 years) were categorised into five groups: group 1, healthy normotensive (SBP <140 mmHg; n = 40) cats; group 2, pre-hypertensive (SBP 140–160 mmHg; n = 14) cats; group 3, cats with chronic kidney disease (CKD) and normotensive (n = 26); group 4, cats with CKD and pre-hypertensive (n = 13); and group 5, hypertensive cats (SBP >160 mmHg, n = 15). Colour fundus images (Optibrand ClearView) were assessed for hypertensive lesions. Retinal vascular diameters and bifurcation angles were annotated and calculated using the Vascular Assessment and Measurement Platform for Images of the Retina annotation tool (VAMPIRE-AT). When available, measurements were obtained at 3 and 6 months after amlodipine besylate treatment.

Results

Ten hypertensive cats had retinal lesions, most commonly intraretinal haemorrhages and retinal exudates. Arteriole and venule diameters decreased significantly with increasing age (–0.17 ± 0.05 pixels/year [ P = 0.0004]; –0.19 ± 0.05 pixels/year). Adjusted means ± SEM for arteriole and venule diameter (pixels) were 6.3 ± 0.2 and 8.9 ± 0.2 (group 1); 7.6 ± 0.3 and 10.1 ± 0.4 (group 2); 6.9 ± 0.2 and 9.5 ± 0.3 (group 3); 7.4 ± 0.3 and 10.0 ± 0.4 (group 4); and 7.0 ± 0.3 and 9.8 ± 0.4 (group 5). Group 1 arteriole and venule diameters were significantly lower than those of groups 2 and 4. Group 2 arteriole bifurcation angle was significantly narrower than those of groups 1 and 3. Post-treatment, vessel diameters decreased significantly at 3 and 6 months in seven hypertensive cats.

Conclusions and relevance

Increased age was associated with reduced vascular diameters. Longitudinal studies are required to assess if vessel diameters are a risk indicator for hypertension in cats.
Efficacy of NSAIDs versus radiotherapy for heterotopic ossification prophylaxis following total hip arthroplasty in high-risk patients: a systematic review and meta-analysis
Authors: Shapira Jacob , Yelton Mitchell J , Chen Jeffery W , Rosinsky Philip J , Maldonado David R , Meghpara Mitchell , Lall Ajay C , Domb Benjamin G
Published: March 2021

Background:

The aims of this systematic review were: (1) to investigate the prophylactic effect of radiotherapy (RT) and NSAIDs in high-risk patients following total hip arthroplasty (THA); and (2) to compare the efficacy of non-selective and COX-II selective NSAIDs in preventing post-THA HO, utilising a meta-analysis of randomised control studies.

Methods:

The PubMed, Embase, and Cochrane Databases were searched for articles regarding HO following THA in March 2019. Studies were included if they contained data regarding HO incidence after THA or contained data regarding HO prophylaxis comparison of NSAIDs and/or RT in terms of dosage or duration.

Results:

24 studies reported on populations that were not at high-risk for HO. These studies reported between 47.3% and 90.4% of their patient populations had no HO formation; between 2.8% and 52.7% had mild formation; and between 0.0% and 10.4% had severe formation. A total of 13 studies reported on populations at high-risk for HO. Studies analysing RT in high-risk patients reported between 28.6% and 97.4% of patients developed no HO formation; between 1.9% and 66.7% developed mild HO formation; and between 0.0% and 11.9% developed severe HO formation. Studies analysing NSAID treatment among high-risk populations reported between 76.6% and 88.9% had no HO formation; between 11.1% and 23.4% had mild HO formation, and between 0.0% and 1.8% had severe HO formation. 9 studies were identified as randomised control trials and subsequently used for meta-analysis. The relative risk for COX-II in developing any HO after THA was not significantly different compared to non-selective NSAIDs (RR 1.00; CI, 0.801–1.256; p = 0.489).

Conclusions:

NSAIDs prophylaxis for HO may have better efficacy than RT in high-risk patients following THA. Non-selective and COX-II selective NSAIDs have comparable efficacy in preventing HO. Factors such as medical comorbidities and side-effect profile should dictate the prophylaxis recommendation.
The impact of failed novel technology and technical errors on the revision burden in total hip arthroplasty: what percentage of revision hip arthroplasty was potentially avoidable?
Authors: Brown Matthew L , Dunn Justin M , Early Samuel , Challa Sravya , Ezzet Kace A
Published: March 2021

Background:

Despite the high success rate of total hip arthroplasty (THA), new implant technologies continue to be developed. Although potentially useful, such novel developments may result in unintended consequences, leading to revision surgery, often prematurely. In several instances, new technology that appeared promising was later found to be inferior to existing technology and resulting in early revision surgery. Additionally, technical surgical errors may also lead to early revisions. Some have argued that revisions related to such phenomena are potentially avoidable. The present analysis investigates to what extent the contribution of “failed new technology” and “technical errors” contributes to the revision burden and to the need for premature revision arthroplasty.

Methods:

We retrospectively analysed 432 revision THAs and categorised them as either “late revisions” based on survivorship of 10 years or “premature revisions”. Among both cohorts, we determined what percentage of revisions were potentially avoidable and due to failed novel technologies and technical errors, and what percent were “unavoidable”.

Results:

Of the 432 revisions, 267 (62%) were considered premature and 38% were considered late. Of the premature revisions, 108 were considered potentially avoidable (81 failed novel technologies, 27 technical errors).

Conclusions:

Our data demonstrates that new technology and surgical techniques can result in premature failure of THA. Surgeons should take caution when incorporating new implant technology or surgical techniques into their practice.
Doctor when can I drive? A systematic review and meta-analysis of return to driving after total hip arthroplasty
Authors: Patel Purva V , Giannoudis Vasileios P , Palma Samantha , Guy Stephen P , Palan Jeya , Pandit Hemant , Van Duren Bernard H
Published: March 2021

Background/Objective:

Advice given to patients on driving resumption after total hip arthroplasty (THA) is inconsistent. Due to a lack of clear guidelines, surgeons’ recommendations range between 4–8 weeks after surgery to resume driving. Delays in driving return can have detrimental social and economic impact. However, it is important to ensure patients only resume driving once safe. This study presents a systematic review and meta-analysis of driving simulation studies after THA to establish when patients can safely return to driving postoperatively.

Methods:

A systematic review and meta-analysis using PRISMA guidelines was undertaken. Titles and abstracts were screened for inclusion, data was extracted, and studies assessed for bias risk. Review Manager, was used for statistical analysis. Values for brake reaction time (BRT) were included for meta-analysis.

Results:

14 articles met the inclusion criteria. Of these, 7 measured BRT and were included in the meta-analysis. Pooled means of both right and left THA showed BRT around or above preoperative baseline at 1 week, 2 weeks and 3 weeks, and below baseline at 6 weeks, 12 weeks, 32 weeks and 52 weeks. Of these, the pooled means at 6, 32, and 52 weeks were significant ( p < 0.05). Studies not meeting meta-analysis inclusion criteria were included in a qualitative analysis, examining self-reported postoperative driving return times which ranged from 6 days to over a year or in rare cases, never. Majority of patients ( n = 960) self-reported driving return within approximately 6 weeks (pooling of mean values 32.9 days).

Conclusions:

The mean return to driving time recommended in the literature was 4.5 weeks. Based upon BRT meta-analysis, a return to baseline braking performance was noted at 6 weeks postoperatively. However, driving is a complex skill, and patient recommendation should be individualised based on factors such as vehicle transmission type, THA technique, surgical side, medication and comorbidities.
Mediating power? Delegation, pooling and leadership selection at international organisations
Authors: Heinzel Mirko
Published: March 2021

The selection of the executive heads of international organisations represents a key decision in the politics of international organisations. However, we know little about what dynamics influence this selection. The article focuses on the nationality of selected executive heads. It argues that institutional design impacts the factors that influence leadership selection by shaping the costs and benefits of attaining the position for member states’ nationals. The argument is tested with novel data on the nationality of individuals in charge of 69 international organisation bureaucracies between 1970 and 2017. Two findings stand out: first, powerful countries are more able to secure positions in international organisations in which executive heads are voted in by majority voting. Second, less consistent evidence implies that powerful countries secure more positions when bureaucracies are authoritative. The findings have implications for debates on international cooperation by illustrating how power and institutions interact in the selection of international organisation executive heads.
Experimental study of moment carrying behavior of typical Tibetan timber beam-column joints
Authors: Guo Ting , Yang Na , Yan Huichun , Bai Fan
Published: March 2021

This study aimed to investigate the moment carrying behavior of typical Tibetan timber beam-column joints under monotonic vertical static load and also evaluate the influence of length ratio of Gongmu to beam (LRGB) and dowels layout on the structural performance of the joint. Six full-scale specimens were fabricated with same construction but different Gongmu length and dowels position. The moment carrying performance of beam-column joints in terms of failure mode, moment resistance, and rotational stiffness of joints were obtained via monotonic loading tests. Test results indicated that all joints are characterized by compressive failure perpendicular to grain of Ludou. Additionally, it was found that greater LRGB leads to greater initial rotational stiffness and maximum moment of the joint by an increase of restraint length for beam end; however, offsetting dowels toward column resulted smaller stiffness and ultimate bending moment of joints, particularly, offsetting Beam-Gongmu dowels toward column changed the moment-rotation curve pattern of the beam-column joint, accompanied by a hardening stiffness at last phase. Furthermore, a simplified trilinear model was proposed to represent the moment-rotation relationship of the typical Tibetan timber beam-column joint.
Experimental study on the fire resistance of concrete filled steel tube reinforced concrete (CFSTRC) column-RC beam frames
Authors: Xu Lei , Bao Yan-Hong
Published: March 2021

To reveal the temperature characteristics and mechanical properties of frame structures with concrete filled steel tube reinforced concrete (CFSTRC) columns under fire, the fire resistance of four planar frames consisting of CFSTRC columns and reinforced concrete (RC) beams subjected to ISO-834 standard fire was tested in this study. The test parameters included the column fire load ratio, beam fire load ratio, and beam-to-column linear stiffness ratio. In the test, the temperatures of the column, beam, and slab cross-sections in the joint and nonjoint zones were measured, and the fire resistance, beam and column deformation curves, and failure modes of the frame were investigated. The experimental results showed that the concrete volume was the main factor affecting the temperature distribution on each typical cross-section of the frame: the temperatures at the measuring points of the beam and column in the joint zone were significantly lower than the temperatures at the corresponding points in the nonjoint zone, and the concrete outside the steel tube significantly slowed the propagation of temperature to the steel tube and its concrete core. Hence, there was only a small loss of the bearing capacity of steel tube and the core concrete inside the steel tube. The column fire load ratio, beam fire load ratio, and beam-to-column linear stiffness ratio have obvious influences on the fire resistance: the larger the column fire load ratio or beam fire load ratio, the smaller the fire resistance; and the larger the beam-to-column linear stiffness ratio, the larger the fire resistance.
Development of healthcare use across contemporary retirement pathways: results from a register based cohort study
Authors: König Stefanie , Kelfve Susanne , Motel-Klingebiel Andreas , Wetzel Martin
Published: March 2021

Aim:

We aimed to understand the interplay between retirement pathways and healthcare use in the postponed and structurally changing context of retirement.

Methods:

Based on Swedish register data on income and healthcare use, we applied combined sequence and cluster analysis to identify typical pathways into retirement and analysed their relation to healthcare use developments.

Results:

We detected five distinct pathways into retirement. Level of healthcare use was significantly higher for the pathway via disability pensions. We saw an overall increase in healthcare use across the retirement process that was related to age rather than to the different pathways.

Conclusions:

Level of healthcare use at the beginning of the retirement process may be related to selection into different pathways of retirement. We did not find clear evidence across several healthcare measures that different pathways lead to different developments in healthcare use.