bluuebunny/crossref_metadata_2025 huggingface dataset:
Autopsy Patients With Obesity or Metabolic Syndrome as Basic Cause of Death: Are There Pathological Differences Between These Groups?
Authors: Gonçalves Lucas Braz , Miot Helio Amante , Domingues Maria Aparecida Custódio , Oliveira Cristiano Claudino
Published: July 2018

Background:

The objectives of this study were the evaluation of pathological characteristics of patients with obesity or metabolic syndrome (MS) as basic cause of death, associating the autopsy findings with some clinical aspects and the abdominal adipose panicle thickness.

Methods:

A total of 88 autopsy cases were studied, divided into 2 groups based on the main cause of death: group 1 (n = 15) obesity and group 2 (n = 73) MS. Clinical summaries of autopsy requests, macroscopic findings, and histologic sections were reviewed.

Results:

The definition of obesity as the basic cause of death is associated with larger thickness of the abdominal adipose panicle, being 8.5 cm ( P = .001) the best measurement, according to the receiver operating characteristic curve. Hypertensive cardiopathy ( P = .001), ischemic cardiopathy ( P = .003), coronary ( P = .008)/systemic ( P = .005) atherosclerosis, and arterial ( P = .014)/arteriolar ( P = .027) nephrosclerosis are associated with the diagnosis of MS. Steatohepatitis is associated with the diagnosis of obesity ( P = .030); however, its association with the thickness of the abdominal adipose panicle is not statistically significant ( P = .211).

Conclusions:

In the context of an obese patient in autopsy, pathologist may use the information about abdominal adipose panicle associated with heart, kidney, and liver findings, even macroscopic ones, to decide the basic cause death between obesity and MS.
(Re)writing woman: Unshaming shame with Cixous
Authors: Beavan Katie
Published: July 2018

shame. shamed. shameful. body. my body.

practitioner’s body. scholar’s body. female body.

affect. embodied affects.

blushing. shrinking. averting my gaze.

feeling shame. writing shame.

féminine writing. feminist writing shame.

ruptured by Cixous.

blood. blood staining page. blood flows.

unpleasant. unruly. uncontained.

performing writing. writing performing.

performative. performing shame.

ethical moment. ethical resistance.

resisting agency. my agency.

movement through shame to the other.

(re)finding you, my body, our bodies, love,

loving, cor-po-real gen-er-os-ity, feeling joy,

feeling scholarship, leaky bodies, our bodies,

not knowing, not ever knowing,

Cixous,

feeling scholarship,

féminine writing, joy,

JOUISSANCE,living differently in organizations,

our organizations,

nourishing milk,

uncontained, connected, connecting,

féminine, feminist, flowing
Assessment tools of immediate risk of self-harm and suicide in children and young people: A scoping review
Authors: Carter Tim , Walker Gemma M , Aubeeluck Aimee , Manning Joseph C
Published: July 2018

There are increasing numbers of children presenting to paediatric hospital settings in mental health crisis. Typically, non-mental health professionals are responsible for the initial assessment of these children and are required to identify immediate physical and emotional health needs. To ensure the safety of these children, immediate risk of suicide and self-harm should be assessed. However, no standardized assessment tool is used in clinical practice, and for those tools that are used, their validity and reliability is unclear. A scoping review was conducted to identify the existing assessment tools of immediate self-harm and suicide risk. Searches of electronic databases and relevant reference lists were undertaken. Twenty-two tools were identified and most assessed acute risk of suicide with only four tools incorporating a self-harm assessment. The tools varied in number of items (4–146), subscales (0–11) and total scores (16–192). Half incorporated Likert-type scales, and most were completed via self-report. Many tools were subject to limited psychometric testing, and no single tool was valid or reliable for use with children presenting in mental health crisis to non-mental health settings. As such, a clinically appropriate, valid and reliable tool that assesses immediate risk of self-harm and suicide in paediatric settings should be developed.
Perceived adequacy of illumination and pedestrians’ night-time experiences in urban obscured spaces: A case of London
Authors: Kim Dong Hyun , Noh Kyung Binn
Published: July 2018

This paper discusses lighting for pedestrian in urban obscured spaces and how perceived adequacy of illumination (PAI) might enhance pedestrians’ night-time experiences. A conventional approach is to evaluate human responses under road lighting of different illuminance, but this alone does not enable an optimum light level to be identified. In this study, a total of 30 participants (19 females and 11 males) visited 10 different urban obscured spaces underneath bridges in London. Their night-time experiences such as feelings, suitability of a space, discomfort glare and facial recognition were compared with horizontal illuminance levels and percentages of PAI. The result indicates that horizontal illuminance was associated with perceived quality of facial recognition, perceived ratings of pleasantness and liveliness. However, higher lighting does not seem to result in higher qualities of other night-time experiences in uncontrolled environments. Spaces with higher percentage of PAI are more strongly associated with an increase in pedestrians’ perceptions of pleasantness, liveliness, suitability of spaces and ratings of facial recognition. Perceived level of discomfort glare was found not to be related with neither illuminance level nor PAI percentages. The paper suggests that PAI can be a moderate indicator of an overall night-time experience for pedestrians in obscured spaces.
Performance of a low-frequency hybrid vibration isolation platform for vibration-sensitive devices
Authors: Xie Xiling , Diao Jianchao , Xu Yinglei , Zhang Zhiyi
Published: July 2018

For preventing the fragile optical communication devices from malfunction caused by the low-frequency seismic excitation, a novel three-dimensional hybrid isolation platform is proposed in this paper. To isolate the horizontal and vertical vibrations simultaneously, the platform is designed as a combination of a rolling isolation system and four three-parameter isolators with active damping. By deriving the governing equations of the three-parameter isolators and the profile of the concave rolling surface, the dynamic model of the whole platform is constructed. Numerical results indicate that the isolation platform has an effective suppression of the horizontal and vertical vibrations. To verify the isolation performance of the hybrid isolation platform, an experiment is conducted in the targeting frequency range. Compared to the amplification factor of 6.2 dB of the three-parameter isolator, the test results exhibit that the hybrid isolation shows no amplification effect in the vertical direction, and the root mean square value of acceleration responses can be decreased by more than 65% in the frequency range of 0–32 Hz. In the horizontal direction, the reduction of the root mean square value of acceleration responses is up to 85% in the same frequency range.
‘Order’ and ‘civility’: Middle-class imaginaries of citizenship before the Syrian uprising
Authors: Anderson Paul
Published: July 2018

Are calls for civility necessarily elitist, serving to reproduce existing hierarchies of social and political power? Or, can they work to clear a space in which citizenship can be reimagined and new political demands can emerge? This article explores the contradictory politics of civility in pre-conflict Aleppo. Notions of incivility and disorder allowed Aleppo’s commercial middle classes to reimagine what citizenship might mean by expressing discontent with lethargic and repressive systems of government. However, the same language they mobilised to criticise the state also associated civility and order with a specifically bourgeois habitus, which was deployed to preserve existing domains of urban privilege and to entrench the social precedence of urban propertied elites over the dislocated rural poor. Calls for civility may be simultaneously elitist and emancipatory, envisaging new forms of citizenship and public life, while drawing their energy from sources that are implicated in other forms of hierarchy and exclusion. The article considers the implications of this analysis in relation to the outbreak of the Syrian uprising in 2011.
Multibody dynamic analysis of a gear transmission system in electric vehicle using hybrid user-defined elements
Authors: Liu Chao , Fang Zong-de , Liu Xuan , Hu Sheng-yang
Published: July 2018

Considering flexibility of the support shafts as well as bearing supports, the effect of meshing impact force and meshing stiffness on the dynamic behavior of a gear transmission system in electric vehicle is investigated in this paper using the proposed hybrid user-defined element method. First, a structured grid generation method is introduced to establish accurate mesh models of the pinion and gear teeth. Second, coupling the tooth mesh models and the flexible shafts as well as bearings, two finite element models are, respectively, constructed for the two helical gear pairs of the electric vehicle reduction unit to calculate the meshing impact force. Next, the basic mechanism of meshing impact is explained in detail according to the finite element results, and the impact force is determined as one of the main internal excitations substituted into the dynamic model established by the hybrid user-defined element method. Under 50 N m input torque and 12,010 r/min rotational speed of the input shaft, the simulation results by the hybrid user-defined element method indicate that the example system reaches a steady state and the vibrations primarily occur at the meshing frequencies. With an increment of 600 r/min of the input rotational speed, it is also concluded from the results that (1) the calculated impact force approximately presents linear growth with the increase of the input shaft rotational speed and (2) the root mean square values of the vibration acceleration generally grow with the increase of the speed.
Inventing a past: Corporate heritage as dialectical relationships of past and present
Authors: Brunninge Olof , Hartmann Benjamin Julien
Published: July 2018

In this commentary, we focus on invented corporate heritage, where organizations present falsified accounts of a corporate past. The extant corporate heritage literature has highlighted how the time frames of the past, present, and future (omni temporality) are merged in those organizations where there is trait constancy. Focusing on invented corporate heritage, we argue that this represents an extreme case of these dialectics, where present and future precede “the past,” or more appropriately “invented past.” Although lacking in authenticity, an invented corporate heritage may still be attractive to consumers since it can construct an aura of authenticity by delivering an enchanting experience to consumers, irrespective of its substantive genuineness. However, such inventions carry considerable risk since they represent a fabrication of the past.
Developing dementia: The existential experience of the quality of life with young-onset dementia – A longitudinal case study
Authors: Thorsen Kirsten , Dourado Marcia Cristina Nascimento , Johannessen Aud
Published: July 2018

Background

Cognition and the ability to take care of daily activities and oneself gradually declines among people with dementia. Studies are scarce, especially regarding how people with young-onset dementia (YOD) (<65 years) experience the quality of their lives with the progression of dementia. People with dementia living alone face special challenges.

Aim

To examine the experience of the quality of life with YOD as a single person.

Method

The study presents a longitudinal case study with in-depth interviews exploring the experiences of a person with YOD. Individual interviews were conducted seven times over a period of three years from 2014 to 2017.

Findings

We examined if and how seven themes concerning the quality of life and well-being were fruitful for understanding the experiences of dementia in the everyday life of a single individual. The study explored needs and challenges during the development of dementia, and how the person reacted over time, set in context. The themes significant for well-being are: identity, connectedness, security, autonomy, meaning, growth and joy.

Conclusion

The study shows how treatment, support, and services must be individualized when dementia develops in order to support identity, resources and mastering capacity, and promote well-being.
Widening the Antimafia Net: Child Protection and the Socio-Cultural Transmission of Mafia Behaviours in Calabria
Authors: Sergi Anna
Published: July 2018

This article explores proceedings by the Youth Tribunal of Reggio Calabria, Southern Italy, aimed at the protection of children in families where one or both parents are investigated for mafia offences. The findings show that preventing the transmission of mafia (‘ ndrangheta) culture in the local context has become an essential part of child protection measures. This article will argue that when discussing child protection in criminal families, it is necessary (a) to question the nature of the bonds of these families with the socio-cultural context, and (b) to concretely assess the way this context wishes to affect the family’s criminality.
Digital harassment and abuse: Experiences of sexuality and gender minority adults
Authors: Powell Anastasia , Scott Adrian J , Henry Nicola
Published: July 2018

Digital harassment and abuse refers to a range of harmful, interpersonal behaviours experienced via the internet, as well as via mobile phone and other electronic communication devices. Whereas much existing research has focused on the experiences of children and young people (including foremost ‘cyberbullying’), there have been few international studies on adult experiences of digital harassment and abuse. As such, little is currently known about the extent, nature and impacts of digital harassment and abuse on adult victims. In particular, there exists a significant gap in current research into sexual, sexuality and gender based digital harassment and abuse. This article draws on findings from a larger research project in which we surveyed 2956 Australian adults and 2842 British adults (aged 18 to 54) about their experiences of technology-facilitated sexual violence (TFSV). The data presented here focus on the experiences of sexuality diverse adults ( n = 282) who identified as lesbian, gay, bisexual or heterosexual, as well as gender diverse adults ( n = 90), including women, men and transgender individuals. Results suggest that transgender individuals experience higher rates of digital harassment and abuse overall, and higher rates of sexual, sexuality and gender based harassment and abuse, as compared with heterosexual cisgender individuals. Implications of the findings are discussed with respect to policy, prevention, and future research.
Banking malware and the laundering of its profits
Authors: Custers Bart HM , Pool Ronald LD , Cornelisse Remon
Published: July 2018

Banking malware is malicious software that aims to steal money from victims via manipulated bank transfers in online banking. This paper describes how the profits of banking malware are generated and subsequently laundered, with a particular focus on the use of bitcoins and other digital payment methods. Computers are infected with banking malware via phishing emails, in which people are persuaded in various ways to click on links or open attachments, or via exploit kits, programs that try to find weak spots in the security of computer systems. After infection, bank transfers of the online banking accounts of victims are manipulated via fake website screens (web injects). Behind the screens the amounts and beneficiaries of transactions are modified, emptying the victims’ bank accounts. In the next step, the banking malware profits are laundered. In this paper we describe two models that are used in particular (next to more traditional money laundering methods). The first model involves the use of money mules and a quick cash-out. The second model focuses on direct spending via (a) direct purchases of products via online shopping, (b) direct purchases of bitcoins via Bitcoin exchanges or (c) direct purchases of luxury goods. Bitcoins can be further laundered via so-called mixing services. All in all, these methods allow criminals to launder profits in relative anonymity and prevent seizure of the illegal profits.
Adolescent fear of crime: Testing Ferraro’s risk interpretation model
Authors: Krulichová Eva , Podaná Zuzana
Published: July 2018

The aim of this study is to broaden the scope of knowledge on fear of crime by examining if Ferraro’s risk interpretation model of fear of crime also holds true for the adolescent population. Using data on approximately 1500 Czech students in middle and grammar school, we test three different models. First, the classic model of fear of crime, applied originally to adults, is estimated. Second, the role of perceived school disorganization is examined, taking into account that adolescents spend a substantial part of the day at school. Finally, we propose an extension of Ferraro’s model by considering parental supervision as a factor influencing adolescent fear of crime through risk perception and avoidance behaviour. The results indicate that Ferraro’s original model of fear of crime can be appropriately applied to both adults and adolescents. Nevertheless, adolescent risk perception, which remains the most influential determinant of individual fear, seems to be influenced by stimuli stemming from the school rather than the neighbourhood environment. Furthermore, the relationship between parental supervision and fear of crime is mediated by avoidance behaviour, while no direct effect of parental supervision on risk perception and fear of crime was found in the data.
Gender issues and education: State of research in Brazil
Authors: Fortunato Ivan , Iorio Dias Ana Maria
Published: July 2018

In this paper, our goal is to present a recent overview of how gender issues have been investigated in Brazilian postgraduate studies. We hope, with the presentation of this scenario, to enable that gender studies continue to advance, but also that they find in teachers their strong allies in this important battle for a more egalitarian society. To achieve our purposes, the paper was developed in three sections. We start with a brief but broad review of the recent history of gender studies. About these, we focus on the relationship between education and gender, trying to emphasize how education can strengthen the difference between people, guiding their actions and materials in heteronormativity. In the sequence, we seek to highlight the current scenario of research on gender and education in Brazil, based on a mapping of the theses and dissertations recently defended. In the end, we hope to present teaching materials that promote the advancement of this important relationship between gender and education, with thoughts and teaching acting as the founding link.
Mobilizing public alternative schools for post-neoliberal futures: Legacies of critical hope in Philadelphia and Toronto
Authors: Maton Rhiannon M , Nichols T Philip
Published: July 2018

Starting in the late 1960s, alternative schools were established in many public school districts across North America. These programs tended to embrace humanizing ideals and sought to center self-expression, creativity, and non-hierarchical values in school governance models. While alternative schools persist today, many now embrace a range of historically situated values—often layering market-based ideals onto the language and structures of their humanizing commitments. This article explores the historical entanglements of public alternative schools, humanizing pedagogies, and market-based ideals in the Philadelphia and Toronto contexts in order to consider what structures of the past might be of use in reimagining public education for the future. In so doing, we argue that such programs, when augmented by a commitment to critical hope, offer generative possibilities for reimagining and redefining schools for the post-neoliberal future.
Case Study: A Transactional Analysis Model for a Single Mother and Her Adult Child With Bipolar Disorder
Authors: Carter David J.
Published: July 2018

This case study describes a transactional analysis model based on the strain of a single mother with an adult son suffering from bipolar I disorder. The study examines interaction patterns within the clinical setting; the therapeutic view examines contextual factors that affect this mother and her adult son through assessment and recovery with transactional analysis therapy. The 16-session therapeutic experience of a client and his mother is presented. The subjects in the case study were administered the Sixteen Personality Factor Questionnaire (16PF) assessment tool during the second and 16th sessions. There was a significant change from pretest to posttest stens scores regarding increased scores in emotional stability from 2 (extremely low) to 4 (average), rule consciousness from 1 (extremely low) to 3 (moderately low), openness to change from 6 (average) to 8 (moderately high), and self-control from 1 (extremely low) to 4 (average). Decreased scores included apprehension from 9 (extremely high) to 7 (average) and tension from 6 (average) to 3 (moderately low). Behavioral changes after a 1-month follow-up included taking the bus to sign up for a college class, taking his medication as prescribed, getting a part-time job in the kitchen at the Veteran Administration Medical Center, and developing a budget to manage his disability check.
A real-time interactive system of surface reconstruction and dynamic projection mapping with RGB-depth sensor and projector
Authors: Guo Yundong , Chu Shu-Chuan , Liu Zhenyu , Qiu Chan , Luo Hao , Tan Jianrong
Published: July 2018

Reconstruction and projection mapping enable us to bring virtual worlds into real spaces, which can give spectators an immersive augmented reality experience. Based on an interactive system with RGB-depth sensor and projector, we present a combined hardware and software solution for surface reconstruction and dynamic projection mapping in real time. In this article, a novel and adaptable calibration scheme is proposed, which is used to estimate approximate models to correct and transform raw depth data. Besides, our system allows for smooth real-time performance using an optimization framework, including denoising and stabilizing. In the entire pipeline, markers are only used in the calibration procedure, and any priors are not needed. Our approach enables us to interact with the target surface in real time, while maintaining correct illumination. It is easy and fast to develop different applications for our system, and some interesting cases are demonstrated at last.
Incidence and Reason for Readmission and Unscheduled Health Care Contact After Distal Radius Fracture
Authors: Sumner Kirsten , Grandizio Louis C. , Gehrman Max D. , Graham Jove , Klena Joel C.
Published: July 2018

Background: Understanding risk factors for readmission may help decrease the rate of these costly events. The purpose of this study is to define the incidence of 30-day readmission and unscheduled health care contact (UHC) after distal radius fracture (DRF). In addition, we aim to define risk factors for readmission and UHC. Methods: A retrospective review of patients who sustained a DRF at our trauma center was performed. We recorded baseline demographics, fracture characteristics, and treatment. Any UHC or readmission (including emergency department [ED] visits) was documented. Reasons for readmission and UHC were stratified by cause. We utilized a case-control design comparing patients readmitted within 30 days after DRF versus those who were not, as well as patients with and without UHC. Results: About 353 patients were identified. The 30-day incidence of readmission after DRF was 7% with 2% of patients readmitted for reasons related to their fracture. Twenty percent of patients had UHC within 30 days, most frequently due to pain. Patients with anxiety or depression and those with open fractures were more likely to be readmitted. Patients with UHC were younger, more likely to have depression or anxiety, and more likely to have undergone operative treatment. Conclusions: For patients sustaining DRF, we report a 30-day readmission rate of 7% with 20% of patients having UHC. Patients with depression or anxiety were more likely to be both readmitted and have UHC. Identifying risk factors for readmission during initial presentation may help reduce readmissions. Improving pain relief strategies early may aid in decreasing the burden of UHC.
Lubrication characteristics of gear after shot peening base on 25-pellet model
Authors: Mo Shuai , Zhu Shengping , Jin Guoguang , Gong Jiabei , Feng Zhanyong , Zhang Ting , Han Han
Published: July 2018

High-speed heavy-load spiral bevel gears put forward high requirement for flexural strength; shot peening is a technique that greatly improves the bending fatigue strength of gears. During shot peening, a large number of fine pellets bombard the surface of the metal target material at very high speeds and let the target material undergo plastic deformation, at the same time strengthening layer is produced. Spiral bevel gear as the object of being bombarded inevitably brought the tooth surface micro-morphology changes. In this article, we aim to reveal the effect of microtopography of tooth shot peening on gear lubrication in spiral bevel gear, try to establish a reasonable description of the microscopic morphology for tooth surface by shot peening, to reveal the lubrication characteristics of spiral bevel gears after shot peening treatment based on the lubrication theory, and do comparative research on the surface lubrication characteristics of a variety of microstructures.
The impact of risk factor trends on intracerebral hemorrhage incidence over the last two decades—The Tromsø Study
Authors: Carlsson Maria , Wilsgaard Tom , Johnsen Stein Harald , Johnsen Liv-Hege , Løchen Maja-Lisa , Njølstad Inger , Bøgeberg Mathiesen Ellisiv
Published: July 2018

Background

Studies on the relationship between temporal trends in risk factors and incidence rates of intracerebral hemorrhage are scarce.

Aims

To analyze temporal trends in risk factors and incidence rates of intracerebral hemorrhage using individual data from a population-based study.

Methods

We included 28,167 participants of the Tromsø Study enrolled between 1994 and 2008. First-ever intracerebral hemorrhages were registered through 31 December 2013. Hazard ratios (HRs) for intracerebral hemorrhage were analyzed by Cox proportional hazards models, risk factor levels over time by generalized estimating equations, and incidence rate ratios (IRR) by Poisson regression.

Results

We registered 219 intracerebral hemorrhages. Age, male sex, systolic blood pressure (BP), diastolic BP, and hypertension were associated with intracerebral hemorrhage. Hypertension was more strongly associated with non-lobar intracerebral hemorrhage (HR 5.08, 95% CI 2.86–9.01) than lobar intracerebral hemorrhage (HR 1.91, 95% CI 1.12–3.25). In women, incidence decreased significantly (IRR 0.46, 95% CI 0.23–0.90), driven by a decrease in non-lobar intracerebral hemorrhage. Incidence rates in men remained stable (IRR 1.27, 95% CI 0.69–2.31). BP levels were lower and decreased more steeply in women than in men. The majority with hypertension were untreated, and a high proportion of those treated did not reach treatment goals.

Conclusions

We observed a significant decrease in intracerebral hemorrhage incidence in women, but not in men. A steeper BP decrease in women may have contributed to the diverging trends. The high proportion of untreated and sub-optimally treated hypertension calls for improved strategies for prevention of intracerebral hemorrhage.
Acute renal failure in an adult cat following oral administration of fosfomycin
Authors: Sakai Yohei , Yoshida Toshinori , Shibutani Makoto , Ohmori Keitaro
Published: July 2018

Case summary

A spayed female mixed breed cat of unknown age (presumably more than 9 years old), weighing 2.9 kg, was presented with a 4 day history of lethargy, anorexia and vomiting following oral administration of calcium fosfomycin (20 mg/kg q12h). A serum biochemical analysis revealed a dramatic increase in the levels of blood urea nitrogen (>140 mg/dl) and creatinine (15.3 mg/dl), and hypercalcaemia (13.1 mg/dl), hyperphosphataemia (13.3 mg/dl) and hyperkalaemia (6.1 mmol/l). The cat was hospitalised and treated with infusion therapy. However, the renal function and clinical signs did not improve with any treatment. The cat was euthanased upon the owner’s request. Histopathological analysis of the kidneys revealed acute tubular necrosis in the cortex.

Relevance and novel information

The present case report provides, for the first time, clinical and histopathological evidence for acute renal failure induced by oral administration of fosfomycin in an adult cat. It is highly advisable that fosfomycin should not be used in either young or adult cats.
Proximal–Distal Motor Control in Skilled Drummers: The Effect on Tapping Frequency of Mechanically Constraining Joints of the Arms in Skilled Drummers and Unskilled Controls
Authors: Eriksen Adrian D. , Lorås Håvard , Pedersen Arve Vorland , Sigmundsson Hermundur
Published: July 2018

Previous studies have shown faster tapping speed and better tapping symmetry in drummers, compared with nondrummers. The present study investigated the effect on tapping frequency of mechanically constraining the joints of the arm on unimanual and bimanual drumming speed across drummers and nondrummers. Skilled drummers were compared with nondrummers on mean maximum tapping frequency under different conditions in which the joints of the arms were mechanically constrained. One condition, the free condition, allowed use of all three joints (shoulder, elbow, and wrist), and served as control. In the other two, joints were mechanically constrained in such a way that participants were allowed use of only the shoulder (proximal) or only the wrist (distal), respectively. Participants performed a rapid tapping task with drumsticks on a drum pad as fast as possible for 15 s. All conditions were performed both bimanually, unimanually with the left hand, and unimanually with the right hand. Drummers produced significantly higher mean tapping frequencies compared with nondrummers in the free bimanual, distal bimanual, and distal unimanual left conditions. No differences were observed in the proximal condition. The results suggest that the drummers acquire refined upper limb joint coordination patterns, especially in the more distal joints of the arm, compared with nondrummers.
Quality of Life in Patients Undergoing Spine Surgery: Systematic Review and Meta-Analysis
Authors: Nayak Nikhil R. , Stephen James H. , Piazza Matthew A. , Obayemi Adetokunbo A. , Stein Sherman C. , Malhotra Neil R.
Published: July 2018

Study Design:

Meta-analysis.

Objective:

Despite the increasing importance of tracking clinical outcomes using valid patient-reported outcome measures, most providers do not routinely obtain baseline preoperative health-related quality of life (HRQoL) data in patients undergoing spine surgery, precluding objective outcomes analysis in individual practices. We conducted a meta-analysis of pre- and postoperative HRQoL data obtained from the most commonly published instruments to use as reference values.

Methods:

We searched PubMed, EMBASE, and an institutional registry for studies reporting EQ-5D, SF-6D, and Short Form-36 Physical Component Summary scores in patients undergoing surgery for degenerative cervical and lumbar spinal conditions published between 2000 and 2014. Observational data was pooled meta-analytically using an inverse variance-weighted, random-effects model, and statistical comparisons were performed.

Results:

Ninety-nine articles were included in the final analysis. Baseline HRQoL scores varied by diagnosis for each of the 3 instruments. On average, postoperative HRQoL scores significantly improved following surgical intervention for each diagnosis using each instrument. There were statistically significant differences in baseline utility values between the EQ-5D and SF-6D instruments for all lumbar diagnoses.

Conclusions:

The pooled HRQoL values presented in this study may be used by practitioners who would otherwise be precluded from quantifying their surgical outcomes due to a lack of baseline data. The results highlight differences in HRQoL between different degenerative spinal diagnoses, as well as the discrepancy between 2 common utility-based instruments. These findings emphasize the need to be cognizant of the specific instruments used when comparing the results of outcome studies.
Non-Operative Management of Femoroacetabular Impingement: A Prospective Study
Authors: Pennock Andrew T. , Bomar James D. , Parvanta Kristina , Upasani Vidyadhar Vinayak
Published: July 2018

Objectives:

Little attention has been given to the non-operative management of femoroacetabular impingement (FAI) in the literature despite a rapidly expanding body of research on the topic. The purpose of the current project was to perform a prospective study utilizing a non-operative protocol on a consecutive series of patients presenting to our clinic with FAI.

Methods:

Between 2013 and 2016, patients referred to our clinic for hip pain that had a positive impingement sign were prospectively recruited in a non-operative FAI study. The protocol consisted of an initial trial of rest, physical therapy, and activity modification with a focus on avoidance of high hip flexion (Activity Mod group). Patients who remained symptomatic were then treated with an image-guided intra-articular steroid injection (Injection group). Patients with residual symptoms were then offered arthroscopic treatment (Surgery group). Outcome scores were collected at 12 and 24 months. Statistical analysis was performed to identify risk factors for failure of non-operative treatment.

Results:

129 symptomatic hips in 100 patients were enrolled. After our exclusion criteria were applied, 110 hips in 84 patients remained with a mean follow-up of 25.5 months. Eighty-one hips (73.6%) were managed with PT, rest, and activity modification alone. Thirteen hips (11.8%) required a steroid injection, but did not progress to surgery. Sixteen hips (14.5%) required arthroscopic management. All three groups saw similar improvements in modified Harris hip score (mHHS)(p=0.706) and non-arthritic hips score (NAHS)(p=0.712). Initial, and most recent, mHHS and NAHS can be found in Table 1. Labral tears were distributed similarly among the three groups (n=41, p=0.09) and saw similar improvements in outcomes (p>0.5) as hips without labral tears. The surgical patients attempted non-operative treatment for a mean of 8.8 months prior to surgical intervention. Delays in surgery were not associated with worse outcomes. Cam lesion size, acetabular coverage, and the presence of a labral tear were not associated with non-operative treatment failure (p=0.579).

Conclusion:

A large majority of adolescent patients presenting with FAI can be managed nonoperatively with significant improvements in outcomes scores and continuation of sport at a mean follow up of two years. This is the first prospective study evaluating the outcomes of a standardized non-operative protocol for the management of FAI. Our results show that a commitment to non-operative care can work for a large percentage of patients. We will be following these patients further into the future to examine the durability of these results. [Table: see text]
Tibial Tubercle Fractures in Children and Adolescents
Authors: Haber Daniel B. , Tepolt Frances , McClincy Michael P. , Kalish Leslie , Kocher Mininder S.
Published: July 2018

Objectives:

To report patient characteristics, fracture types, treatment methods, and clinical outcomes of children and adolescents treated for tibial tubercle fractures.

Methods:

Patients age 19 and under treated for tibial tubercle fractures at a single institution from 1995 to 2015 were identified and their medical records were retrospectively reviewed. Clinical and radiographic outcomes were reported for patients with a minimum follow up of 6 months. Associations were tested using Fisher’s exact test.

Results:

Two-hundred thirty seven tibial tubercle fractures were identified in 229 patients; 198 (86%) male. There were 139 (59%) left sided injuries. Mean age was 14.3 years (range 4.9 - 19.8). Mean body mass index (BMI) was 25. Osgood-Schlatters was identified in 72 (30%) cases and was most commonly associated with Ogden type I fractures (p<0.001). Two-hundred and four (86%) fractures occurred while participating in athletics, most commonly basketball (87, 43%). Of the 228 cases for which mechanism of injury was identified, 69 (30%) occurred while landing, 60 (26%) resulted from a direct blow to the knee, and 51 (22%) occurred while jumping. Ogden III fractures were most common (96, 41%) followed by Ogden I fractures (67, 28%). Initial treatment was surgical for 158 (67%) fractures, of which 58 (37%) underwent reoperation, 53 (34%) for hardware removal. Ogden I fractures were most commonly treated non-operatively (91%) and Ogden II-V fractures were most commonly treated operatively (89%, p<0.001). Elevated BMI was associated with Ogden II-V fractures (p=0.003) and injuries requiring operative treatment (p<0.001). Compartment syndrome was identified in 4 (2%) injuries and required emergent fasciotomy. Prophylactic anterior and/or lateral fasciotomy was performed in 35 (15%) operatively treated injuries. Of the 117 (49%) patients for whom minimum 6-month follow up was documented, 103 (88%) returned to sports; among those treated operatively (87), 2 (2%) developed symptomatic limb length discrepancy, 1 (1%) developed tibial recurvatum, and 6 (7%) developed post-operative infection. At last follow up, 39 (45%) of surgical patients reported pain at the tibial tubercle, 23 (26%) reported pain with squatting, and 13 (15%) had patellar tendonitis. Thirty-seven (43%) complained of hardware prominence.

Conclusion:

Tibial tubercle fractures occur most commonly in adolescent male athletes and are associated with basketball, elevated BMI, Osgood-Schlatters, and a risk of compartment syndrome. Following treatment, most patients return to sport. As the largest single series of tibial tubercle fractures reported, this study provides valuable insight into injury epidemiology, relationship with Osgood Schlatters, and clinical outcomes.
Focal Periphyseal Edema (FOPE): A Newly Reported Cause of Knee Pain in Adolescent Athletes
Authors: Wu Mark , Bixby Sarah , Kramer Dennis E. , Heyworth Benton E.
Published: July 2018

Objectives:

To elucidate the clinical and radiologic features of focal periphyseal edema (FOPE) of the knee, a newly reported cause of knee pain in adolescent athletes, which as been described primarily in only the radiologic literature to date.

Methods:

Medical records were reviewed of all patients <19 years old diagnosed with knee FOPE by magnetic resonance imaging (MRI) at a tertiary care pediatric referral center. Clinical history and physical exam findings were recorded to assess whether “symptomatic FOPE” was the cause of the patient’s presenting complaints (i.e. no other identifiable etiology for knee pain) or whether the MRI finding was possibly “incidental FOPE” (i.e. other etiologies of knee pain were evident). Radiologic features, including location, size, and concentration and concomitant pathology were analyzed.

Results:

56 patients (mean age, 13.9, range 9-16 years, 96% self-reported athletes) with 60 affected knees were included. Females were more common than males (59% vs. 41%, p=0.159). FOPE cases were followed for a mean of 6.1 months (sd,6.8). The primary sport was a repetitive, high-impact sport in 47 patients (90%), most common of which was soccer (27%), basketball (25%), and competitive running/cross-country/track (17%). On MRI, there were 86 distinct knee FOPE zones in patients, the vast majority of whom were undergoing at least early physeal closure. More instances (n=52,60%) were identified in the distal femur than the proximal tibia (n=34,39%) and proximal fibula (n=1,1%). The mean transverse diameter was 10.4 mm (sd,5.6). Ten (17%) knees were clearly classified into “symptomatic FOPE,” and 50 (83%) knees were classified into “incidental FOPE.” Of the concomitant diagnoses reported clinically and/or radiologically, as detailed in Table 1, the majority were overuse-type conditions, such as patellar tendonitis, osteochondritis dissecans, or medial plica syndrome. Patients with symptomatic FOPE lesions (15.3 mm, sd 8.9) had significantly larger lesions than those with incidental FOPE lesions (9.5 mm, sd 4.3)(p=.021). All patients with symptomatic FOPE underwent spontaneous resolution with only physical therapy/conservative measures.

Conclusion:

In this series of 56 patients with knee FOPE, the majority of cases arose in athletes approaching skeletal maturity, participating in high impact sports, and in conjunction with other knee overuse injuries. Caregivers of adolescent athletes must be aware of this newly described condition with unique, characteristic findings on MRI. For patients with atraumatic knee pain of unclear etiology who are approaching skeletal maturity, FOPE should be considered and may be treated with conservative measures and reassurance of spontaneous resolution with rest and continued growth.
Reduction of Hip Arthroscopy Post-Operative Pain Using Ultrasound-guided Fascia-Iliaca Block: A Prospective Randomized Control Trial
Authors: Glomset John Larson , Kim Eugene J. , Tokish John M. , Renfro Suzanne D. , Seckel Tyler B. , Adams Kyle J. , Folk Jason
Published: July 2018

Objectives:

Ultrasound guided fascia-Iliaca blocks have been used for pain control following hip arthroscopy. There is little evidence regarding their effectiveness in comparison to other pain control modalities in hip arthroscopy patients.

To compare efficacy of ultrasound guided fascia iliac block with intra-articular ropivacaine in controlling pain after hip arthroscopy.

Methods:

Between 2015 and 2017, 95 patients undergoing hip arthroscopy were randomly assigned to 2 groups. The first group received an ultrasound-guided fascia-iliaca block with 50-60mLs of 0.35% ropivacaine. The second group received intra-articular injection of 20 mL of 0.5% ropivacaine at the completion of the surgical case. Primary outcomes were post-operative pain scores in the recovery room, at PACU discharge, at 2 weeks, 6 weeks, and 3 months. Secondary outcomes included intraoperative and PACU narcotic usage (converted to morphine equivalent use) as well as readmission rates, PACU recovery time and postoperative nausea and vomiting (PONV).

Results:

Postoperative pain across all points did not significantly differ between the 2 groups. Intraoperative and PACU narcotics did not differ significantly between the 2 groups. Readmission rates, PACU recovery time and PONV did not significantly differ between the 2 groups. There were no associated complications in either group.

Conclusion:

Ultrasound guided fascia iliaca block for hip arthroscopy had no clinical advantage when compared to one time intra-articular ropivacaine injection. Furthermore, an intraarticular injection decreases costs and is a safe and more efficient modality for postoperative pain control following hip arthroscopy.
Health diagnosis improvement in remote community health centers through telemedicine
Authors: Galván Pedro , Velázquez Miguel , Rivas Ronald , Benitez Gualberto , Barrios Antonio , Hilario Enrique
Published: July 2018

Introduction:

Information and communication technologies (ICTs) applied to the healthcare offer multiple advantages for diagnostic services and remote consultations. However, evidence on the diagnosis improvement in rural communities is limited. The usability of telemedicine to improve the coverage of diagnostic services in Paraguay was investigated.

Methods:

The goal of this descriptive study was to evaluate whether a telemedicine system implemented in remote public regional and district hospitals in Paraguay over a period of 3 years from 2014 to 2016 could facilitate the universal coverage of diagnostic services in rural communities.

Results:

In the study period, 182,406 remote diagnoses from 54 hospitals through a telemedicine system were performed. Of the total, 37.31% (68,085) corresponded to tomography, 62.00% (113,059) to electrocardiogram (ECG), 0.68% (1243) to electroencephalogram (EEG), and 0.01% (19) to ultrasound (US). Tomography was performed in 12 hospitals: 54.4% corresponded to head injuries, 13.8% to chest, and the rest to other anatomical regions. ECG was carried out in 52 hospitals; and in 62.1% of the cases, the results were normal; 12.5% unspecified arrhythmias; and 10.4% sinus bradycardia among the most frequent pathologies. EEG diagnosis showed history of seizure (54.3%), evolutionary control (14.0%), and headache (11.5%) among the most frequent diagnoses. All 19 US studies corresponded to prenatal control.

Conclusion:

These results showed that telemedicine may enhance the diagnostic services in rural communities, thus reducing the number of referrals and optimizing human and financial resources.
Cesarean Scar Pregnancy: A Case Series of Diagnosis, Treatment, and Results
Authors: Younes Grace , Goldberg Yael , Lavie Ofer , Kedar Reuven , Segev Yakir
Published: July 2018

The aim was to collect cases of cesarean scar pregnancy (CSP) and describe the evolution of diagnosis, treatment modalities, and outcome. A retrospective cohort study was conducted of patients who had been diagnosed with CSP. Treatment decision was made according to the type of CSP, levels of beta human chorionic gonadotropin (hCG), and estimated vascularity. Forty cases with CSP were recorded. Overall success of the primary treatment was recorded among 30 of 40 cases (75%) and significantly correlated with degree of vascularity, type of CSP, and beta hCG levels. The treatment methods included serial methotrexate in 20 cases; 15 of them (75%) were successful. In this specific group, we found type 2 scar and high vascularity to be significantly associated with treatment failure. In conclusion, cases with type 2 CSP, high vascularity, and high beta hCG levels should be considered high risk, and extra caution should be taken in choosing treatment modality and follow-up.