bluuebunny/crossref_metadata_2025 huggingface dataset:
Service-Delivery Competencies in Home and Community-Based Services Needed to Achieve Person-Centered Planning and Practices: A Systematic Review
Authors: Wong Jasin , Pedersen Jessica , Tennety Niveda , DuBois Lindsay , Chiu Rudyard , Shah Dhrumil , Malecki Glenn , Wafford Q. Eileen , Heinemann Allen W.
Published: November 2022

Home and community-based services (HCBS) assist people with disabilities and older adults to remain in their homes. Direct support professionals and care managers who facilitate the development of support plans need to employ person-centered approaches to ensure services are tailored to peoples’ needs and preferences. The aims were to identify the key competencies needed for delivery of person-centered supports and examine the relationship between HCBS and its’ outcomes in the United States. We used the competencies developed by the National Center on advancing Person-Centered Practices and Systems as a framework. We conducted a systematic review to identify the skills necessary to deliver person-centered HCBS. We coded 43 articles and identified seven competencies. Most frequently mentioned competencies related to culturally informed practice, cultivating connections, and promoting rights, choice, and control. Policy makers should create training standards for person-centered practices to ensure that people receiving HCBS live the lives they want.
Methodology for generating a general profile of asymmetrical rotors of twin-screw vacuum pumps with point meshing feature by a pre-defined sealing line
Authors: Hoang Minh-Thuan , Tran The-Van
Published: November 2022

The sealing line is one of the key influences on twin-screw rotor vacuum pump performance. The design of a rotor profile based on a sealing line for an asymmetrical rotor of a vacuum pump can be studied further to generate varied rotor profiles and improve pump performance. Therefore, this study proposes a mathematical model for a pre-defined sealing line to design and optimize varied rotor profiles of vacuum pumps. The general sealing line, pre-defined by explicit equations of straight lines and elliptic curves, is proposed to generate various rotor profiles with different numbers of lobes. The functions for parameter variables of the pre-defined sealing line are constructed and directly variated along the rotor length to form the screw rotor with a variable pitch and a variable cross-section. The proposed pre-defined sealing line is also applied in the optimal design of a rotor profile to enhance pump performance. Numerical examples are performed to verify the flexibility and practicability of the proposed method.
Magnetorheological fine finishing of steering rack bar for improving its functional operation
Authors: Singh Manpreet , Paswan Sunil Kumar
Published: November 2022

Fine-finished external cylindrical surfaces in automotive manufacturing parts are of great importance for improving their performance. A finely finished external surface of steering rack bar leads to a decrease in its response time. So, in this work, the rotating core-based magnetorheological (MR) finishing process has been performed on the external surface of steering rack bar to improve its performance. In this work, the process parameters have been optimized to fine-finish the current workpiece with minimized efforts. The optimum conditions of process parameters are depicted using full factorial central composite design (CCD) under response surface methodology technique. The maximum contribution to the response, i.e. % change in surface roughness value is found from current (15.28%) and rotational tool speed (8.66%). Using the optimum finishing parameters, the average surface roughness value of the steering rack bar external surface achieved was 30 nm from 550 nm with finishing time of 90 min. Also, the fine finishing of steering rack bar's external surface was confirmed by a comparative study of scanning electron microscopic and mirror images of initial and final finished surfaces conducted in this study. Thus, this study advocated that the current process can be beneficial for fine finishing of industrial components such as rocker arm shafts, vacuum pistons, and cylindrical punches.
Dealing with a New Normal ‘E-leadership’: A Study Using Bibliometric Analysis and Content Analysis
Authors: Aggarwal Saumya , Kumar Ajay
Published: November 2022

The study explores the concept of e-leadership and determines the different dimensions of leadership in the virtual environment. The paradoxes associated with the ‘e-leadership’ are identified. The different trends of research undertaken on the concept of ‘e-leadership’ are analyzed. The study is conducted using bibliometric and content analysis techniques. The Scopus database was used, and VOSviewer version 1.6.17 was used for analyzing the research trends. Three clusters emerged: Virtual leadership and virtual team performance, leadership and technology adoption, and the use of communication strategies in e-leadership. The article discusses different strategies that can lead to effective performance in a virtual environment. Leaders need to be synergistic, tech-savvy, prompt in their feedback, and trained in nonverbal communication strategies. E-leadership should be based on relationship orientation and not task orientation. The article gives possible future research directions by identifying the relationship across several variables like e-leadership, use of information and communication technologies, and effective communication channels.
Australia’s fiscal surplus: Child of a credit and real estate boom
Authors: Espinosa Eduardo Garzón , García Bibiana Medialdea , Hidalgo Esteban Cruz , Mato Carlos Sánchez
Published: November 2022

For several years leading up to the 2008 financial crisis, Australia registered a public surplus, and this was generally interpreted as the result of responsible fiscal policy. However, since the outbreak of that crisis, no such fiscal balance has again been attained, giving rise to a range of explanations from the political incapacity of governments to the weak economic behaviour characterising the post-crisis era. Noteworthy in any case is that analysts have failed to cite the importance of a factor that was key to reaching pre-crisis surpluses: the vertiginous growth of private debt. This work argues that it was precisely the intense granting of bank loans and consequent increased demand from the private sector that boosted economic activity and led to the generation of public income sufficient to feed the fiscal surpluses of that period. Indeed, according to the proposals of Wynne Godley, this would have been the only way to register a public surplus in a context of current account deficits, typical of the Australian economy. This paper considers whether Australian private debt played a significant role in achieving fiscal surplus by way of a review of the Australian real estate boom and public accounts from the 1990s onward, also estimating an econometric model of autoregressive vectors to explore the link between these two variables. The results obtained appear to corroborate the hypothesis: severe private borrowing contributed to Australia’s fiscal surpluses. This finding has significant implications for budgetary policy.
Intestinal T-cell lymphoma in an Asian small-clawed otter: case report and literature review of lymphoma in the subfamily Lutrinae
Authors: Rebollada-Merino Agustín , Canales Rocío , Romani-Cremaschi Umberto , Rodríguez-Bertos Antonio
Published: November 2022

The Asian small-clawed otter ( Aonyx cinereus) is an endangered species that is common in zoologic collections. A 17-y-old female Asian small-clawed otter under human care, with a clinical history of chronic renal disease, was euthanized because of deteriorating health. Histologically, the jejunal wall was infiltrated by a monomorphic population of small neoplastic lymphocytes that expanded the lamina propria of the villi and crypts, and on rare occasions invaded the submucosa. The tumor was composed of T cells (CD3+) with a proliferation index of 16%. Based on the World Health Organization (WHO) Classification of Hematopoietic Neoplasms in Domestic Animals, this lymphoma was classified as an enteropathy-associated T-cell lymphoma (EATL) type 2. We also present here a review of the literature on intestinal lymphoma in the subfamily Lutrinae (otters).
Keeping the Connection Alive With Tender Care and Common Sense: A Phenomenological Study on Daughters’ Experiences of Having a Mother in a Nursing Home
Authors: Finster Úlfarsson Maria , Svavarsdóttir Margrét Hrönn , Thórarinsdóttir Kristín
Published: November 2022

The relationship between mother and daughter is exceptional when it comes to closeness and its impact on their whole life. Thus, a mother’s move to a nursing home is pivotal for both of them. The aim of this interpretative phenomenological study, using the Vancouver School of Doing Phenomenology, was to explore daughters’ experience of having a mother in a nursing home, its impact on the maternal relationship, and the daughters' need for education and support. Data were collected by 21 semi-structured interviews with 12 women who had mothers living in a nursing home. Keeping the connection alive with tender care and common sense encapsulates the interrelation between the daughters’ urge to hold on to the mother–daughter relationship and the rare consideration of education and support from health professionals. Responsibility and sense of duty paired with relief because the mother is in a safe place were accompanied by the daughters’ need for confirmation that the mother is well taken care of.
The Struggle Between Protecting Children From and Preparing Them for the Death of Their Parent: A Qualitative Study
Authors: Millar Rachel , Bell Mary , Casey Louise
Published: November 2022

Objectives

The aim of this study was to gain a greater understanding of communicating with children about parental terminal illness from the perspective of the surviving parents.

Methods

A qualitative descriptive study was conducted using semi structured interviews with eligible participants. Data was analyzed using thematic analysis.

Results

The results highlight the pressures experienced by surviving parents, grappling with trying to support their children’s needs on a practical and emotional level, while coping with the emotional upheaval of the impending death of their partner. The issue of communication with the children starts long before the terminal phase of illness and the results confirm that this is an ongoing process that continues after the death of the parent. The need for services to be more responsive to the diverse needs of families was also apparent as a key factor in supporting families during this time.

Conclusions

This research provides valuable insights into the complexity of communicating with children about terminal illness from the perspective of the surviving parents. It reveals diverse views and experiences in terms of approaching communication with children and illustrates the need for services to be acutely attuned to the unique needs of parents and children throughout the disease trajectory.
Endothelial Cell Activation and Thrombin Generation Assessment for the Risk of Severe Early Onset Preeclampsia. the ROADMAP-EOP Study
Authors: Van Dreden Patrick , Lefkou Eleftheria , Ka Aboubakar , Sfakianoudis Konstantinos , Rousseau Aurélie , Grusse Matthieu , Elalamy Ismail , Gerotziafas Grigoris T
Published: November 2022

Background

The ROADMAP-EOP study aimed to identify clinically relevant biomarkers of hypercoagulability for the identification of pregnant women at risk of early onset preeclampsia worsening.

Methods

The ROADMAP-EOP observational single center retrospective case–control study was conducted in Greece (Centre for Human Reproduction, Genesis Athens Clinic, Athens, Greece) from July 2020 to July and enrolled pregnant women diagnosed with EOP stratified in mild EOP group (n = 34) and severe EOP group (n = 15) as well as women with uncomplicated pregnancy (control group; n = 35). All women were assessed with thromboelastometry (ROTEM®), Calibrated Automated Thrombogram®, tissue factor activity (TFa), procoagulant phospholipid dependentclotting time (Procoag-PPL®), Proteins S (PS), TFPI, D-dimer, antithrombin (AT), thrombomodulin (TM), fibrinogen, prothrombin time (PT) and activated partial thromboplastin time (aPTT). The primary study end-point was severe earlyonset preeclampsia. Principal component analysis (PCA) was performed.

Results

The PCA analysis showed that a score composed of the lag-time, ttPeak and Procoag-PPL accurately predicted severe EOP (sensitivity 71.4%, specificity 61.8%, and AUC of the ROC analysis 0.953).

Conclusion

The pilot ROADMAP-EOP shows that activation of endothelial cells and blood hypercoagulability are driven events in the worsening of EOP. Among a large panel of biomarkers and coagulation assays, thrombingeneration test and procoagulant phospholipid dependent clotting time emerged as clinically relevant for the evaluation of the risk of severe EOP. This methodology for the development of a new clinic-biological risk assessment model for prompt identification of pregnant women at risk of severe EOP must be validated in a large multi-centerprospective study.
Harmonic current compensator in battery charger using hybrid intelligent controller
Authors: D Raheni T , Thirumoorthi P
Published: November 2022

This paper proposes a current-controlled hybrid power filter (CCHPF) to compensate source current harmonics produced by battery charger. Current harmonics are compensated by the voltage- and current-controlled active power filter, whereas in the proposed system, current-controlled hybrid power filter is used. CCHPF overcomes the limitation of voltage-controlled harmonic compensator, conventional proportional integral controller and the passive filter which has high power loss and which may deteriorate the system frequency with high harmonic attenuation. In the proposed control system, the super twisting sliding mode algorithm (STSMA) is used with a modified form of active power theory and cognitive emotional controller to compute the three-phase compensating current reference and the DC link current regulation. The compensated reference signal obtained by sliding mode controller is used to generate switching pulses to current-controlled active power filter (CCAPF) switches. The significant contribution of the proposed system includes the development of CCHPF and its control strategy based on PI- and emotional controller-tuned STSMA to reduce the harmonic distortion of the source current used in electric vehicle charging. The passive power filter is designed to eliminate fifth-order harmonic current. A major advantage of the super twisting sliding mode control algorithm is its adaptability and robustness, which will result in improved reference current tracking without causing chattering. CCHPF is widely used for compensating harmonics generated by electric vehicle battery chargers, UPS systems and industrial loads. The control technique is implemented in MATLAB Simulink environment for dynamic load conditions, and the obtained result compensates the harmonic current to a required level (total harmonic distortion of source current is 0.79%) satisfying IEEE 519-1992 standard.
The Abject Swearing at the Figure of the Stranger
Authors: Yan Dave
Published: November 2022

In this autoethnographic poetry, I express my sense of Ulysses syndrome, reflecting upon the past 12 years since I left my motherland—China. In reading Ahmed’s work, the human “I” is conceptualized as “the stranger,” reminiscent of the foreignness of the past, longing for an imagined life that he would live in. Yet, Kristeva’s pathologizing label of abjection horrifies its own existence of the human “I,” who cannot remember its youth and beauty, becoming an embodied Other. In his dreams, the abject “I” utters flights of poetry at the stranger by asking—how migration can be experienced as anything other than complication with all the mess, tension, and conflict it brings. In bringing the concept of abjection, it problematizes my understanding of be(com)ing the “figure of the stranger,” transforming the humanness that the human “I” represents in its wake.
Normal contact stiffness model for fractal surfaces considering scale dependence and friction behavior
Authors: Huang Gancai , Liu Chao , Xie Wenzhen , Jiang Dongxiang
Published: November 2022

The normal contact stiffness on rough surfaces has a significant impact on the interfacial dynamic characteristics of mechanical joints. Based on the fractal geometry theory, this work improves the contact stiffness modeling by considering the complete contact characteristics of multiple asperities and frictional factor. First, to include the property that the critical contact areas of asperities are scale-dependent, the model for the contact stiffness is formed on each scale and the relationship between total stiffness and load on rough surfaces is obtained by the summation of all length scale asperities. Second, friction factor is taken into account in the revised normal contact stiffness model, where a contact friction coefficient is introduced into the equation to incorporate the effects of friction force. Moreover, the influences of fractal dimension D and fractal roughness G on normal contact stiffness and friction coefficient are investigated. Through the comparison of numerical and experimental results, the revised model is shown to be more reasonable and presents higher consistency of the stiffness versus load curve than the original model. It is therefore concluded that a complete and more accurate model for normal contact stiffness is proposed in this work with precise modeling of scale-dependent contact characteristics and friction behavior taken into account, which is critical for exact estimation of rigidity of contact surfaces in industrial applications.
Lost but not blown away: How do losers of party leadership contests react?
Authors: Lingier Leen , Kern Anna , Wauters Bram
Published: November 2022

Many Western parties have opened up the process of leadership selection in order to increase the party’s attractiveness, but negative reactions of losers in such contests might undermine these efforts. It has extensively been documented that losers of elections or referendums become less supportive of the political system, but the question is whether such a winner-loser gap also occurs in the context of intra-party elections. We examine unique panel data collected before and after the leadership elections of the Flemish Christian-Democratic Party and Liberal-Democratic Party and investigate the difference in change in attitudes and behavior of party members who voted for the losing candidates and those who voted for the winner. Contrary to earlier research on candidate selection, we find that only decision acceptance differs between winners and losers, while there is no gap in support for the electoral process, party membership satisfaction, and members’ activity within the party.
Exploring memorable tourism experiences of senior tourists: An embodied cognitive perspective
Authors: Huang Jing , Chen Yanjun , Wang Jingna , Xing Danpu
Published: November 2022

Memorable tourism experiences (MTEs) play an essential role in decision-making and revisit intentions. However, extant studies have provided limited investigation of MTEs in different groups, especially senior tourists. Thus, following embodied cognition theory, this research explores the components of senior tourists’ memorable experiences (SMTEs) with an emphasis on their body characteristics and uniqueness. Through in-depth interviews with 26 senior tourists in China, the findings show that SMTEs are the result of embodied, situational and cognitive interaction, which are related to sensory enjoyment, embodied barriers, emotional experiences, identity, control and serendipity. Interestingly, our study finds two types of interaction between sensory enjoyment and embodied barriers on shaping memory, discovering the positive role of seniors’ body state on shaping SMTEs. Findings also provide academic and practical implications to help understand senior tourists from a new perspective.
Intersection of food insecurity and moral experiences of those involved in paediatric healthcare: A scoping review of child, caregiver and healthcare provider perspectives
Authors: Taylor Amanda J , Baker Sabine , Gallegos Danielle
Published: November 2022

Food insecurity is a significant social and health issue for children in high-income countries and contributes to sub-optimal child outcomes. This scoping review examines how food insecurity intersects with the moral experiences of those involved in providing and receiving paediatric health care. Multiple databases were searched using a priori inclusion criteria, papers were screened by multiple reviewers. Searches yielded nine papers. Descriptive data was summarised and qualitative results extracted from included papers were analysed using inductive and deductive thematic analysis. Four main themes emerged: Food insecurity threatens caregiver and healthcare provider identity; is food insecurity the business of health? is screening for food insecurity surveillance or facilitating assistance? and the lived experience of navigating the tension of managing food insecurity and a child’s health condition. The moral experiences lens has magnified the countless everyday encounters in which values and beliefs about what is ‘right’ or ‘just’ can be realised or thwarted in the context of the intersection between healthcare and food insecurity. Review findings have implications relating to the inclusion of children’s voices in healthcare settings, healthcare practice and policy design, and the development and use of FI screening tools.
Primary oesophageal tuberculosis presenting with dysphagia: A rare scenario
Authors: Rasool Shahid , Rehman Ayman , Shafqat Umair
Published: November 2022

Dysphagia is a clinical manifestation with great consequences. Prompt and early diagnosis is the key to long-term management. Despite tuberculosis (TB) being common in developing countries, primary oesophageal TB is still a very rare disease. Oesophageal manifestations are almost exclusively a result of direct extension from adjacent mediastinal structures. We report a case of an immune-competent man presenting with dysphagia due to primary oesophageal TB.
Student Engagement and Retention of Adult Learners at Community Colleges
Authors: Spitzig Janet , Renner Blake J
Published: November 2022

This study aimed to examine the relationship between student engagement and student retention of adult learners at community colleges. The relationship between student retention and the five Community College Survey of Student Engagement (CCSSE) student engagement benchmarks (active and collaborative learning, student effort, academic challenge, student-faculty interaction, and support for learners) was examined using binary logistic regression. This study used secondary data from the CCSSE, including 26,326 adult students (25 and older) from the 2019 CCSSE cohort who were credential-seeking at the community college (participants from 588 colleges in 46 states). This study confirmed a positive relationship between student engagement of adult learners at community colleges and student retention. Individually, each of the CCSSE benchmarks increased the likelihood of student retention. As a combined model, academic challenge and support for learners were the only significant benchmarks. This research confirmed that student engagement strategies benefit adult learners at community colleges.
Race differences in iliofemoral vein stenting for chronic venous insufficiency
Authors: Cho Logan D , Bai Halbert , Collins Lucas C , Chen Jenny , Cooke Peter V , Kang Yeju , Vasan Vikram , Kim Jinseo , Gonzalez Christopher , Dionne Elyssa , Kim Sung Yup , Ting Windsor
Published: November 2022

Introduction

Major disparities in outcomes by race are present throughout vascular surgery, yet little has been published on iliac vein stent outcomes by race. This retrospective study assessed iliac vein stent outcomes by patient race.

Methods

Patients who underwent iliac vein stenting at a single institution for chronic venous insufficiency (CVI) from 2011 to 2021 were reviewed. Demographic, preoperative, perioperative, and postoperative data were collected. Self-reported race groups included Asian, Black, Hispanic, and White. Univariate differences were analyzed using χ2 tests for categorical variables and 1-way ANOVA for continuous variables. Outcomes included change in Venous Clinical Severity Score (VCSS) at interval timepoints relative to a preoperative baseline and reinterventions. Logistic regression models were used to determine the unadjusted and adjusted odds ratio (OR) of any minor and major reintervention. Multivariate regression models controlled for demographic and comorbidity characteristics.

Results

A total of 827 patients were included. Asian patients were younger and had a greater proportion of male patients, lower Body mass index (BMI), less smoking history, and fewer comorbidities. White patients were more likely to have a history of deep vein thrombosis (DVT). White patients presented with the most severe CVI symptoms as defined by both Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification and preoperative VCSS composite scores. There were no differences in acute DVT, number of stents deployed, and bilateral versus unilateral stent placement. Black patients had the longest average days of follow-up, followed sequentially by Hispanic, White, and Asian. Black patients had the most reinterventions, while Asian patients had the fewest. Asian patients were less likely to have a major reintervention. No differences in VCSS composite or change in VCSS were observed.

Conclusions

In patients with CVI, Asian patients presented younger and healthier, while White patients presented with the most severe symptoms. No differences were observed in VCSS outcomes, though Black patients had the most reinterventions.
Achilles tendon thickness normalized to body surface area as a marker of asymptomatic peripheral arterial disease
Authors: Genkel Vadim , Kuznetsova Alla , Lebedev Evgeniy , Salashenko Alexey , Pykhova Lubov , Sumerkina Veronika , Shaposhnik Igor
Published: November 2022

Objectives

The normalisation of Achilles tendon thickness (ATT) to anthropometric parameters may increase the diagnostic efficiency of the assessment of ATT. The aim of this study was to compare the diagnostic value of AT dimensions depending on their normalization to body surface area (BSA) in patients with asymptomatic peripheral arterial disease (PAD).

Methods

All patients underwent duplex scanning of the carotid arteries and the lower limb arteries. Asymptomatic PAD was defined as the presence of ≥50% stenosis in the carotid and/or lower limb arteries. ATT was measured using a longitudinal scan, width (ATW) and cross-sectional area (AT CSA), which was determined during a cross-sectional scan.

Results

The study included 369 patients, among whom asymptomatic PAD was detected in 18 (4.88%) patients. Only the ATT demonstrated diagnostic value for asymptomatic PAD. After normalizing the size of the AT to the BSA, the diagnostic performance of ATT, ATW and AT CSA became statistically significant. Among the studied parameters, only an increase in ATT/BSA >0.29 cm/m2 was associated with a significant increase in the odds ratio (OR) of asymptomatic PAD by 4.11 times (95% CI 1.08–15.7; p = .038) after adjustments.

Conclusion

An increase in ATT/BSA >0.29 cm/m2 predicted the presence of asymptomatic PAD with a sensitivity of 61.1% and a specificity of 77.9%. ATT/BSA values of less than 0.29 cm/m2 made it possible to exclude asymptomatic PAD with a probability of 97.5%. An increase in ATT/BSA >0.29 cm/m2 was associated with a 4.11-fold increase in the OR of asymptomatic PAD (95% CI 1.08–15.7).
Cultural modulation effects on the self-face advantage: Do Caucasians find their own faces faster than Chinese?
Authors: Lee Jasmine KW , Gregson Chantelle , Janssen Steve MJ , Estudillo Alejandro J
Published: November 2022

The self-face advantage (SFA) is reflected through a faster recognition of a self-face compared with familiar and unfamiliar faces. Nevertheless, as Westerners and East Asians tend to present differences in self-concept styles, it is possible that the SFA is modulated by culture. The present study explored this possibility using a visual search task. British Caucasians and Malaysian Chinese participants were asked to search for frontal view images of self, friend, and unfamiliar faces among an array of unfamiliar faces. Regardless of race, participants were more accurate and faster in searching for the own face and friend’s face compared with an unfamiliar face, with no differences in the search between the own and friend’s face, and these findings could not be accounted by the cultural differences in self-concept (i.e., operationalised by scores from the Independent and Interdependent Self-Concept Scale and the Horizontal and Vertical Individualism and Collectivism Scale). Altogether our results suggest that culture does not modulate the SFA and that this effect is better explained by a familiar face advantage.
Improving Care for People Living With Dementia and Diabetes: Applying the Human-Centered Design Process to Continuous Glucose Monitoring
Authors: Savoy April , Holden Richard J. , de Groot Mary , Clark Daniel O. , Sachs Greg A. , Klonoff David , Weiner Michael
Published: November 2022

People with Alzheimer’s disease or related dementias and diabetes mellitus (ADRD-DM) are at high risk for hypoglycemic events. Their cognitive impairment and psychosocial situation often hinder detection of hypoglycemia. Extending use and benefits of continuous glucose monitoring (CGM) to people with ADRD-DM could improve hypoglycemia detection, inform care, and reduce adverse events. However, cognitive impairment associated with ADRD presents unique challenges for CGM use. This commentary proposes applying the human-centered design process to CGM, investigating design solutions or interventions needed to integrate CGM into the health care of patients with ADRD-DM. With this process, we can identify and inform CGM designs for people with ADRD-DM, broadening CGM access, increasing detection and treatment of the silent threat posed by hypoglycemia.
Topical Intranasal Insulin Enhances Healing of Nasal Mucosa: An Experimental Animal Study
Authors: Külekci Çağrı , Özer Serdar , Önen Selin , Korkusuz Petek , Yılmaz Taner
Published: November 2022

Objective

Aim of this study was to evaluate the effect of topical intranasal insulin on healing of nasal mucosa in a rat model.

Methods

Forty-eight Wistar rats, weighing between 250 and 300 g and aged 10–12 weeks were used and randomized into two equal groups. 1.9 mm curette was introduced through the left nostril and 1.9 mm mucosa from the left nasal septum was curetted. Postoperatively, animals in the control group received 1 mL of physiologic saline, 3 times a day in a nasal irrigation fashion. Animals in the experimental group received 1 mL of 5 IU/mL regular insulin in saline solution. Subjects were sacrificed after 5, 10, and 15 days and macroscopic and histomorphometric evaluations were performed.

Results

There were no mucosal synechiae and septal perforation macroscopically. Histological examination revealed that the defect size reduction was 21% in the saline group versus 56% in the insulin group on the fifth day ( p = 0.006). There was 62% defect reduction in the saline group versus 79% in the insulin group on the 10th day ( p = 0.034). On the 15th day, only 67% of saline group animals had complete defect closure, whereas 100% of animals treated with insulin had complete closure (92% vs 100% mucosal defect reduction, p = 0.036). Both edema and inflammation were less in the insulin group on 15th day ( p = 0.006; p = 0.023, respectively).

Conclusion

The results from this study support the safety and efficacy of topical insulin on wound healing in the literature. This study could guide further experimental studies that examine human sinonasal wound healing.
Two cases of flow void sign of temporal bone metastasis from follicular thyroid carcinoma
Authors: Iritani Yukako , Kato Hiroki , Kaneko Yo , Shibata Hirofumi , Iinuma Ryota , Ogawa Takenori , Suzui Natsuko , Miyazaki Tatsuhiko , Matsuo Masayuki
Published: November 2022

This report describes CT and MRI findings of temporal bone metastasis from follicular thyroid carcinoma in two cases. Both of these had large, osteolytic, hypervascular masses of the temporal bone, accompanied by internal scattered bone fragments and extraosseous mass formation on unenhanced and contrast-enhanced CT images. In the first case, several dilated and tortuous vessels within the markedly hypervascular mass were observed on the arterial phase of dynamic contrast-enhanced CT images. Compared with the signal intensity of the cerebellum, temporal bone masses showed slightly hypo- to slightly hyperintense on T1-weighted images and slightly hypo- to moderately hyperintense on T2-weighted images. Both cases had flow voids in abnormally dilated vessels within the mass on T1- and T2-weighted images. Thyroid follicular carcinoma rarely metastasizes the temporal bone and presents with an osteolytic hypervascular mass with flow void sign.
Climate communication: How researchers navigate between scientific truth and media publics
Authors: Alinejad Donya , Van Dijck José
Published: November 2022

Recent attacks on scientific authority have intensified calls for climate scientists to seek out a more active stake in public engagement. Yet, today’s media landscape presents scientists with the challenge of gaining the epistemic trust of diverse audiences. This article qualitatively investigates how publicly engaged academic climate researchers imagine the public as they partake in various science communication practices. It finds that scientists’ strategies for securing public trust in their epistemic authority and defining their own public role vary with the media public they are addressing. Their communications reflect an oscillation between filling a “knowledge deficit” and communicating complex “truth tensions.”
Small Chondral Defects Affect Tibiofemoral Contact Area and Stress: Should a Lower Threshold Be Used for Intervention?
Authors: Koh Jason , Diaz Roberto Leonardo , Tafur Julio Castillo , Lin Ye , Echenique Diego Barragan , Amirouche Farid
Published: November 2022

Background:

Chondral defects in the knee have biomechanical differences because of defect size and location. Prior literature only compares the maximum stress experienced with large defects.

Hypothesis:

It was hypothesized that pressure surrounding the chondral defect would increase with size and vary in location, such that a size cutoff exists that suggests surgical intervention.

Study Design:

Controlled laboratory study.

Methods:

Isolated chondral defects from 0.09 to 1.0 cm2 were created on the medial and lateral femoral condyles of 6 human cadaveric knees. The knees were fixed to a uniaxial load frame and loaded from 0 to 600 N at full extension. Another defect was created at the point of tibiofemoral contact at 30° of flexion. Tibiofemoral contact pressures were measured. Peak contact pressure was the highest value in the area delimited within a 3-mm rim around the defect. The location of the peak contact pressure was determined.

Results:

At full extension, the mean maximum pressures on the medial femoral condyle ranged from 4.30 to 6.91 MPa at 0.09 and 1.0 cm2, respectively ( P < .01). The location of the peak pressure was found posteromedial in defects between 0.09 and 0.25 cm2, shifting anterolaterally at sizes 0.49 and 1.0 cm2 ( P < .01). The maximum pressures on the lateral femoral condyle ranged from 3.63 to 5.81 MPa at 0.09 and 1.0 cm2, respectively ( P = .02). The location of the peak contact pressure point was anterolateral in defects between 0.09 and 0.25 cm2, shifting posterolaterally at 0.49 and 1.0 cm2 ( P < .01). No differences in contact pressure between full extension and 30° of flexion were found for either the lateral or medial condyles.

Conclusion:

Full-thickness chondral defects bilaterally had a significant increase in contact pressure between defect sizes of 0.49 and 1.0 cm2. The location of the maximum contact pressures surrounding the lesion also varied with larger defects. Contact area redistribution and cartilage stress change may affect adjacent cartilage integrity.

Clinical Relevance:

Size cutoffs may exist earlier in the natural history of chondral defects than previously realized, suggesting a lower threshold for intervention.
Reducing Racial Disparities in Maternal Healthcare: A Midwifery Focus
Authors: LoGiudice Jenna A.
Published: November 2022

When compared with other developed nations, the United States (U.S.) has the highest maternal mortality rate. Furthermore, in the U.S. Black women are dying during pregnancy or the postpartum period at a rate three times higher than that of white women. This disparity points to the question of why inequities in maternal healthcare exist and, of critical importance, what is being done to combat them. The stark reality is that systemic racism is at the core of these health disparities and must be addressed by both the individuals providing care and the healthcare systems themselves. The underpinnings of systematic racism in maternal healthcare, as well as ways to both dismantle this racism and move forward with constructive changes, are explained in this practice update. Specifically, the positive impact that midwifery care has on maternal health outcomes will be discussed.
High Reproducibility of a Novel Fixed Anterior Drawer Test for Diagnosing Ankle Instability
Authors: Murahashi Yasutaka , Teramoto Atsushi , Takahashi Katsunori , Watanabe Kota , Yamashita Toshihiko
Published: November 2022

Category:

Ankle

Introduction/Purpose:

The manual traditional anterior drawer test (ADT) is essential for the treatment decision of chronic ankle instability, but have been pointed out of comparatively low reproducibility and accuracy, especially in less experienced hands. To clarify the inter-examiner reproducibility, we compared the actual distance of anterior translation between the junior and senior examiner in the ADT. We also evaluate the diagnostic abilities of the traditional ADT and a novel modified ADT, fixed ADT.

Methods:

Thirty ankles were included in this study and the ankle instability was defined by the stress radiography. All subjects were performed two methods of manual ADT by junior and senior examiner, and judged the ankle instability in a blinded fashion. The anterior drawer distance was calculated from the lengthening measured by the capacitance-type sensor device.

Results:

The amount of anterior translation of junior examiner was significantly lower than senior examiner in the traditional ADT (3.3 vs. 4.5 mm, p=0.016), while, there was no significant difference between two examiners in the fixed ADT (4.6 vs. 4.1 mm, p=0.168). The inter-examiner reliability of fixed ADT was higher than traditional ADT. In the junior examiner, the diagnostic accuracy of the fixed ADT was higher than that of traditional ADT (sensitivity, 0.40 vs. 0.80; specificity, 0.75 vs. 0.80, respectively).

Conclusion:

Fixed ADT may have advantage for a simple manual test of ankle instability as a method with less error between examiners.
Prediction of Distal Tibial Articular Extension in Tibial Shaft Fractures
Authors: Myatt Darren , Mason Lyndon W. , Stringer Howard , Fischer Benjamin
Published: November 2022

Category:

Trauma; Ankle

Introduction/Purpose:

Diaphyseal tibial fractures account for approximately 1.9% of all adult fractures. A recent registry review in Finland found an annual incidence of 15.6 per 100,000 person-years in males and 11.5 per 100,000 person-years in women. There are several studies which have demonstrated a high proportion of diaphyseal tibial fractures have ipsilateral occult posterior malleolus fractures, this ranges from 22-92.3%. Recent work by Hendrickx et al has highlighted distal third and spiral tibial shaft fracture patterns as independent predictors of occult posterior malleolus fracture.

Methods:

Objectives Our primary outcome in this study was to identify any factors that could predict articular extension in tibial shaft fractures. Study Design & Methods A retrospective review of a prospectively collected database was performed at Liverpool University Hospitals NH Foundation Trust between 1/1/2013 and 9/11/2020. The inclusion criteria were patients over the age of 16, with a diaphyseal tibial fracture and who underwent a CT of the affected lower limb. The articular fracture extension was categorised into either posterior malleolar (PM) or other fracture.

Results:

764 diaphyseal tibial fractures were analysed, of these 300 had a CT and could be included. There were 127 intra- articular fractures. Of these, 83 (65.4%) cases were PM and 44 were other fractures. On univariate analysis, the PM fractures were associated with fibular spiral (p=-016) fractures and no fracture of the fibular (p=.003), lateral direction of the tibial fracture (p=.04), female gender (p=.002), AO classification 42B1 (p=.033) and an increasing angle of tibial fracture. However, on multivariate regression analysis the only significant factor was a high angle of tibia fracture. Other distal tibia fracture extensions were associated with no fracture of the fibular (p=.002), medial direction of tibia fracture (p=.004), female gender (p=.000), and AO classification 42A1 (p=.004), 42A2 (p=.029), 42B3 (p=035) and 42C2 (p=.032). On multivariate analysis. the lateral direction of tibia fracture, and AO classification 42A1 and 42A2 were significant factors.

Conclusion:

Distal tibia articular extension occurs in almost half of tibial shaft fractures. A number of factors were associated with the extension, however multivariate analysis did not create a suitable prediction model. Nevertheless, rotational tibia fractures with a high angle of fracture should have a low threshold of further investigation with a CT prior to surgical intervention.
Hallux Valgus Interphalangeus Measurement: Comparison of the Two Radiographic Methods
Authors: Nebhani Nimesh , Heyes Gavin , Molloy Andrew P. , Mason Lyndon W.
Published: November 2022

Category:

Midfoot/Forefoot

Introduction/Purpose:

To determine the reliability of Delta PP (difference in medial and lateral proximal phalanx wall length) compared to HIA (hallux interphalangeal angle) in the assessment of HVI (hallux valgus interphalangeus) in both pre and postoperative radiographs.

Methods:

This was a retrospective observational study of 186 feet with hallux valgus. The number of cases required to adequately power the study was 128. Preoperative and postoperative hallux alignment were evaluated by two different radiological parameters, Delta PP and HIA. Inter-observer variability was assessed independently by two authors and compared using a intraclass correlation coefficient.

Results:

The intra-class correlation coefficient was more than 0.8 for all parameters, thus both HIA and Delta PP measurement provide reliable and reproducible data. Mean HIA significantly increased following surgical correction of hallux valgus. In comparison, the mean Delta PP decreased after correction. This postoperative increase in HIA indicates that pre-operative HIA underestimates the magnitude of HVI and therefore is an inaccurate tool for measuring HVI's contribution to the TVDH (total valgus deformity of the hallux) and to preoperative planning. However, the Delta PP was a greater determinant of the phalanx deformity's contribution to the TVDH.

Conclusion:

The outcome of our study shows that both HIA and Delta PP are reproducible when assessing the hallux valgus interphalangeus deformity, however, Delta PP quantifies the amount of correction obtained more precisely. The additional benefit of measuring the Delta PP is that it allows for accurate planning in determining the dimensions of the medial based wedge of the Akin osteotomy that needs to be resected.
ATFL All Inside Arthroscopic Repair: Clinical and Functional Outcomes
Authors: Nunes Gustavo A. , Carvalho Kepler , Mansur Nacime SB
Published: November 2022

Category:

Arthroscopy

Introduction/Purpose:

The arthroscopic techniques used to treat chronic lateral ankle instability have developed greatly in recent years. The purpose of this work is to present clinical and functional results of patients with chronic ankle instability submitted to surgical treatment by all-inside arthroscopic repair of the anterior talofibular ligament (ATFL).

Methods:

This is a series of cases of 18 consecutive patients who underwent the all-inside arthroscopic ATFL repair technique, a surgical treatment for chronic lateral ligament instability of the ankle, after the failure of conservative treatment performed for 6 months. The evaluation was made using the American Orthopaedic Foot and Ankle Score (AOFAS), visual analog pain scale (VAS), anterior drawer and talar tilt tests. Surgical complications and patient satisfaction indices were also evaluated.

Results:

All 18 patients were evaluated for a mean follow-up period of 12 months. There was an improvement in the AOFAS (p< 0.001), with the mean improving from 69.6 points to 98.1, and in the mean VAS score, from 5.0 to 0.5 points (p < 0.001). All ankles were stable, as assessed by the anterior drawer test and talar tilt test. The only complication found was neurapraxia of the superficial fibular nerve in one patient (5%). All of the patients classified the treatment as good or excellent and returned to daily and sports activities without limitations.

Conclusion:

Treatment of chronic ankle ligament instability by the all inside arthroscopic ATFL repair technique was able to restore ankle stability and showed good clinical results and high satisfaction rates.
Minimally Invasive Chevron Akin (MICA) Osteotomy for Severe Hallux Valgus
Authors: Nunes Gustavo A. , Carvalho Kepler , Ferraz Gabriel F. , Filho Miguel V. Pereira , Pinto Roberto Zambelli de A.
Published: November 2022

Category:

Bunion

Introduction/Purpose:

The minimally invasive Chevron Akin (MICA) osteotomy have been widely used treating hallux valgus (HV). The purpose of this study was to present a case series of patients with severe HV undergoing surgical treatment using the MICA procedure, and to evaluate the clinical and radiographic outcomes

Methods:

Sixty consecutive feet (52 patients) undergoing MICA for severe HV were included. Patients were assessed pre and postoperatively. Clinically evaluation was realized by visual analogue pain scale (VAS) and American Orthopaedic Foot & Ankle Society Score (AOFAS). Radiographic assessments included measurement of hallux valgus angle (HVA), intermetatarsal angle (IMA), metatarsal (MT) length and plantar offset of MT head.

Results:

The mean age was 59.9 years and follow-up were 18.5 months. The average AOFAS increased from 41.2 to 90.9 points and the VAS decreased from 8.1 to 1.3 at the last follow up. Average HVA decreased from 41.2° to 11.6° and IMA reduced from 17.1° to 6.8°. Average shortening of the first metatarsal and the plantar offset of MT head was 3.9 mm and 2.8 mm respectively. There was significant improvement (p<0.001) in all clinical and radiographic parameters (p<0.001). The most observed complication was hardware discomfort, observed in four feet (6.6%).

Conclusion:

The MICA technique is a safe and reproducible method to treat severe HV.