bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Anterior Cruciate Ligament Tears Treated Nonoperatively Versus With Reconstruction: Risk of Subsequent Surgery
Authors: Ding David Y. , Tucker Lue-Yen , Rugg Caitlin M.
Published: January 2022

Background:

Anterior cruciate ligament (ACL) tears can be devastating injuries, leading to joint instability, meniscal tears, and subsequent arthritis. It is unknown whether ACL reconstruction (ACLR) alters the natural history of joint degeneration in the ACL-deficient knee compared with nonoperative treatment, and few studies have examined outcomes in middle–aged patients.

Purpose:

The objective of this study was to compare the midterm risk of subsequent ipsilateral knee surgery in middle–aged patients after an ACL injury treated with initial conservative (nonoperative) management (CM) versus ACLR (operative management [OM]) within 6 months of the diagnosis.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

We performed an electronic database search from 2011 to 2012 for all patients aged 35 to 55 years with an initial diagnosis of magnetic resonance imaging—confirmed ACL tear. Patients who elected CM and those who underwent ACLR within 6 months of the diagnosis (OM) were identified. Index patient and clinical characteristics were collected from the health record. All patients were longitudinally observed until August 31, 2017. The primary outcome was subsequent ipsilateral knee surgeries, and secondary outcomes included contralateral knee surgeries, deep surgical–site infections, and venous thrombotic events.

Results:

The mean follow–up was 4.8 ± 0.6 years. The CM group included 463 patients (40.2%) and the OM group included 690 patients (59.8%). The mean ages were 43.9 ± 5.7 years and 42.7 ± 5.3 years for patients in the CM and OM groups, respectively ( P < .001). Obesity and smoking were significantly more common in the CM group. During the follow–up, 180 patients (38.9%) in the CM group underwent subsequent ipsilateral knee surgery compared with 73 (10.6%) patients in the OM group ( P < .001). The mean time to the first ipsilateral procedure was 0.9 ± 1.1 years in the CM and 2 ± 1.5 years in the OM group ( P < .001). Delayed ipsilateral ACLRs were performed in 81 patients in the CM group (17.5%); non-ACLR ipsilateral knee surgeries were performed in 156 patients in the CM group (33.7%). Contralateral knee surgery rates were similar. In a regression model, after controlling for age, sex, the Charlson Comorbidity Index score, and smoking status, it was found that normal body mass index and CM group were risk factors for undergoing subsequent knee surgery or ipsilateral non-ACLR surgery.

Conclusion:

Excluding delayed ACLR, subsequent ipsilateral knee surgeries were more common and occurred earlier in middle–aged patients with nonoperatively managed ACL tears compared with patients managed with reconstruction.
Fibre alignment and mechanical performance of carbon fibre Sheet Moulding Compounds under different preform compaction
Authors: Nega Biruk F , Pierce Robert S , Liu Linlin , Yi Xiaosu , Liu Xiaoling
Published: January 2022

This work investigates the effect of preform compaction on the mechanical performance and flow-induced fibre alignment of carbon fibre reinforced Sheet Moulding Compounds (SMCs). Two groups of panels have been compression moulded from reclaimed carbon fibre tows in vinyl-ester resin with low (0.5 MPa) and high (10 MPa) preform compaction pressure Additionally, a low-cost fibre orientation analysis method has been further improved in terms of reliability, and a novel flow assessment method has been developed for carbon fibre SMCs. This approach revealed greater fibre alignment with the flow direction in the lower faces of panels as a result of greater contact time with the heated mould and a lower charge viscosity at the time of pressing. As expected, greater fibre alignment in the flow direction was observed outside the initial charge coverage area in both types of panels, where the flow was greatest. Due to additional fibre flow during the high-pressure compaction stage, the mean degree of flow alignment in the high compaction panel was 47% higher than that of the low compaction panel. Improvements in the tensile stiffness (8%) and strength (32%) were also observed as a result of the high-pressure compaction stage and associated flow alignment.
A holistic overview on corn cob biochar: A mini-review
Authors: Wakudkar Harsha , Jain Sudhir
Published: January 2022

Corn cob is one of the agricultural waste materials subjected to improper burning, which creates pollution. It can be used for the production of green technologies for further applications. Carbonisation or slow pyrolysis could be promising alternative to burning. It has many applications, such as soil ameliorant, waste water treatment, carbon sequestration, composting, supercapacitor, fuel cell and biocomposites material. It motivated to investigate the suitability of corn cob as a potential material for biochar production and its application. The advanced form of analysis, such as thermogravimetric, scanning electron microscopy, surface area, Fourier transform infrared spectroscopy, nuclear magnetic resonance spectroscopy and Raman spectroscopy, is elaborated for in-depth knowledge of characteristics. The hypothesis is that if the available corn cob is used for biochar production, it will reduce the carbon dioxide (CO2) emission. On a global level, conversion of available corn cob into biochar is expected to reduce CO2 emission by 0.13 Gt per year. The reduction in CO2 emission also favours economy. If 1 tonne of biomass per year is converted into biochar, 0.82 tonnes of CO2 can be reduced per year and by considering the emission cost of Rs 1800 per tonne, the cost saving would be Rs 1476 per year. The presented mini-review article provides an outline of the state-of-art information on corn cob biochar and its novel application. It will be helpful to scientific domain to find new opportunities in biochar research and also the humanity will be benefitted due to reduction in greenhouse gases.
In vitro evaluation of freeze-drying chitosan-mineralized collagen/Mg–Ca alloy composites for osteogenesis
Authors: Zhang Zhenbao , Sun Xirao , Yang Jingxin , Wang Chengyue
Published: January 2022

Magnesium (Mg) alloy with good mechanical properties and biodegradability is considered as one of the ideal bone repair materials. However, the rapid corrosion of Mg-based metals can pose harm to the function of an implant in clinical applications. In this study, micro-arc oxidation coating was prepared on the surface of the Mg–Ca matrix, then the chitosan and mineralized collagen (nano-hydroxyapatite/collagen; nHAC) were immobilized on the surface of the MAO/Mg–Ca matrix to construct the CS-nHAC/Mg–Ca composites of different component proportions (the ratio of CS to nHAC is 2:1, 1:1, and 1:2, respectively). The corrosion resistance, osteogenic activity, and angiogenic ability were extensively investigated. The results indicated that the CS-nHAC reinforcement materials can improve the corrosion resistance of the Mg matrix significantly and promote the proliferation and adhesion of mouse embryo osteoblast precursor cells (MC3T3-E1) and human umbilical vein endothelial cells (HUVECs). In addition, the CS-nHAC/Mg–Ca composites can not only promote the alkaline phosphatase (ALP) activity and extracellular matrix mineralization of MC3T3-E1 cells but also enhance the migration motility and vascular endothelial growth factor (VEGF) expression of HUVECs. Meanwhile, the 2CS-1nHAC/Mg–Ca composite exhibited the optimum function characteristics compared with other samples. Therefore, considering the improvement of corrosion resistance and biocompatibility, the CS-nHAC/Mg–Ca composites are expected to be a promising orthopedic implant.
Negotiating identity by transnational Chinese students during COVID-19
Authors: Binah-Pollak Avital , Yuan Shiran
Published: January 2022

For some years now, there has been an increase in the number of Chinese students travelling abroad to pursue higher education. The outbreak of COVID-19 has created new challenges for international students around the world. Based on an analysis of online forums during the pandemic (January–July 2020), we focus on the challenges Chinese transnational students have been facing. From the state's point of view, being at the front of China's internationalization progress, the students are expected to have both a ‘vision of globalization’ (国际化视野) as well as a deep ‘Chinese feeling’ (中国情怀). However, in practice during the pandemic, the students found it extremely difficult to achieve a balance between their multiple identities. In this article, we argue that discrepancies between the students’ identities may be due to the pandemic having highlighted several existing conflicts that have so far received only meagre attention or were even overlooked.
Event-triggered formation control of n-link networked stochastic robotic manipulators
Authors: Azarbahram Ali , Pariz Naser , Naghibi-Sistani Mohammad-Bagher , Kardehi Moghaddam Reihaneh
Published: January 2022

This article proposes an event-triggered control framework to satisfy the tracking formation performance for a group of uncertain non-linear n-link robotic manipulators. The robotic manipulators are configured as a multi-agent system and they communicate over a directed graph (digraph). Furthermore, the non-linear robotic manipulator-multi-agent systems are subject to stochastic environmental loads. By introducing extra virtual controllers in the final step of the backstepping design, a total number of n event-triggering mechanisms are introduced independently for each link of all the robotic manipulator agents to update the control inputs in a fully distributed manner. More precisely, the actuator of each link of a particular agent is capable of being updated independent of other link actuator updates. A rigorous proof of the convergence of all the closed-loop signals in probability is then given and the Zeno phenomenon is excluded for the control event-triggered architectures. The simulation experiments finally quantify the effectiveness of proposed approach in terms of reducing the number of control updates and handling the stochastic environmental loads.
Landscape footprints of peopling and colonisation from the Late Bronze Age to Antiquity in the coastal hinterland of Emporion-Emporiae, NE Iberia.
Authors: Ejarque Ana , Julià Ramon , Castanyer Pere , Orengo Hector A , Palet Josep Maria , Riera Santiago
Published: January 2022

The Empordà plain attests to a remarkable mixture of Late-Holocene cultural exchanges and colonial processes. This includes the founding of Emporion, the earliest Greek colony in Iberia, and of the Roman city of Emporiae. This study aims at assessing landscape changes related to indigenous and colonial settlement in this unique scenario where the shaping of cultural landscapes occurred within a dynamic coastal ecosystem. We carried out a high-temporal resolution palaeoenvironmental study in Els Estanys, a palaeowetland located in the vicinity of Emporion-Emporiae. Palynological, sedimentological and geochemical indicators were coupled with available archaeological and archaeobotanical data-sets. Between 1100 and 800 cal BC, the settling of Urnfield Late Bronze societies resulted in the sustained clearance of woodlands and moderate agropastoral exploitation of coastal ranges. During this period, marine-influenced lagoonal areas were poorly exploited. During the Iron Age (800–450 cal BC), a threshold in the landscape construction of the area occurred with the first pastoral exploitation of lagoonal areas, intensified cereal cultivation, controlled burning, and enhanced deforestation following the settlement of Iberian groups. Greek colonisation (580–200 cal BC), did not trigger intensified farming exploitation or landscape clearance, nor did it imply the introduction of new land uses or crops in the hinterland. Exploitation of the latter continued relying on cereal cultivation and grazing, as before, suggesting the permanence of indigenous landscapes and practices in the hinterland. To the contrary, urban and periurban landscapes played a significant role in the construction of the colonial landscape with the introduction of olive groves likely as ornamental trees. Roman conquest and colonisation of the area constituted a new threshold in the occupation and management of the hinterland with (1) intensified rural settlement; (2) expansion of wet pastures and removal of littoral woodlands; (3) development of diversified cropping activities; and (4) development of mining and smelting activities.
On estimating a constrained bivariate random effects model for meta-analysis of test accuracy studies
Authors: Baragilly Mohammed , Willis Brian Harvey
Published: January 2022

Tailored meta-analysis uses setting-specific knowledge for the test positive rate and disease prevalence to constrain the possible values for a test's sensitivity and specificity. The constrained region is used to select those studies relevant to the setting for meta-analysis using an unconstrained bivariate random effects model (BRM). However, sometimes there may be no studies to aggregate, or the summary estimate may lie outside the plausible or “applicable” region. Potentially these shortcomings may be overcome by incorporating the constraints in the BRM to produce a constrained model. Using a penalised likelihood approach we developed an optimisation algorithm based on co-ordinate ascent and Newton-Raphson iteration to fit a constrained bivariate random effects model (CBRM) for meta-analysis. Using numerical examples based on simulation studies and real datasets we compared its performance with the BRM in terms of bias, mean squared error and coverage probability. We also determined the ‘closeness’ of the estimates to their true values using the Euclidian and Mahalanobis distances. The CBRM produced estimates which in the majority of cases had lower absolute mean bias and greater coverage probability than the BRM. The estimated sensitivities and specificity for the CBRM were, in general, closer to the true values than the BRM. For the two real datasets, the CBRM produced estimates which were in the applicable region in contrast to the BRM. When combining setting-specific data with test accuracy meta-analysis, a constrained model is more likely to yield a plausible estimate for the sensitivity and specificity in the practice setting than an unconstrained model.
‘New Age’ Preferential Trade Agreements and Global Value Chains: A Comparative Sectoral Analysis
Authors: Tokas Kalpana
Published: January 2022

The past three decades witnessed a simultaneous proliferation in the number of preferential trade agreements (PTAs) and the network of global value chains (GVCs). The rise in the number of PTAs has been accompanied by inclusion of ‘deeper’ provisions such as services, competition, intellectual property rights (IPR), etc. This study aims to explain the differential impact PTA ‘depth’ on trade in value added as well as the heterogeneous results observed across industries based on their distinctive characteristics. For this purpose, an augmented gravity equation with three-way fixed effects is estimated, using a relatively newer dataset for the time period 2000-2015 for 64 countries. The results conclude that the PTA ‘depth’ determined by nontariff and ‘behind-the-border’ provisions leads to greater participation of member countries in GVCs. Furthermore, it is shown that value added trade for a sector like automotive, which has higher product differentiation, intra-industry trade, IPR and FDI linkages is most impacted by the PTA ‘depth’.
Perceptions of Treatment Burden Among Caregivers of Elders With Diabetes and Co-morbid Alzheimer’s Disease and Related Dementias: A Qualitative Study
Authors: Vaughan Dickson Victoria , Melnyk Halia , Ferris Rosie , Leon Alejandra , Arcila-Mesa Mauricio , Rapozo Crystalinda , Chodosh Joshua , Blaum Caroline S.
Published: January 2022

Many older adults with diabetes (DM) have co-occurring Alzheimer’s Disease (AD) and AD-Related Dementias (ADRD). Complex treatment plans may impose treatment burden for caregivers responsible for day-to-day self-management. The purpose of this qualitative study was to describe caregiver perceptions of treatment burden for people with DM-AD/ADRD. Caregivers ( n = 33) of patients with DM-AD/ADRD participated in semi-structured interviews about their caregiver role and perceptions of treatment burden of DM-AD/ADRD management. Qualitative data were analyzed using content analysis (ATLAS.ti). Caregivers reported high levels of burden related to complex treatment/self-management for patients with DM-AD/ADRD that varied day-to-day with the patient’s cognitive status. Four themes were: (1) trajectory of treatment burden; (2) navigating multiple healthcare providers/systems of care; (3) caregiver role conflict; and (4) emotional burden. Interventions to reduce caregiver treatment burden should include activating supportive services, education, and care coordination especially, if patient treatment increases in complexity over time.
Promoting Continuous Professional Development of English Teachers Through Action Research
Authors: Dogan Cemile , Kirkgoz Yasemin
Published: January 2022

The current study adopts a mixed-method research design to foster English Language instructors’ attitude toward professional development, self-efficacy beliefs, and reflective thinking. Vygotsky's sociocultural theory constituted the base and the professional development program was designed accordingly.

The participants of the study were nine English Language instructors working at three different universities. Throughout the 16-week program, it was aimed to equip the participants with action research skills to conduct their own study in their own context according to their needs and/or interests. All the participants completed the Plan, Act, Observe, and Reflect stages of the Action Research Cycle.
Safety and Efficacy of Various Intravenous Insulin Infusion Rates in Patients With and Without Diabetes Presenting With Hypertriglyceridemia
Authors: Ibarra Francisco , Loi Kaitlyn , Vu Ann W.
Published: January 2022

Background

The use of IV insulin infusions in the acute management of hypertriglyceridemia has only been evaluated in small observational studies and case reports.

Objective

To evaluate the safety and efficacy of IV insulin infusions in the acute management of hypertriglyceridemia.

Methods

This was a retrospective chart review of adult patients who received an IV insulin infusion for the acute management of hypertriglyceridemia. The primary efficacy and safety outcomes were the number of patients who achieved a triglyceride level <500 mg/dL and experienced hypoglycemia (<70 mg/dL), respectively. A subgroup analysis was performed to compare outcomes between patients with and without diabetes, in addition to the IV insulin infusion rate received.

Results

In the total population (n = 51), there were no statistically significant differences between the insulin intensity groups in the number of patients who achieved TG levels <500 mg/dL. Compared to patients with a past medical history of diabetes, more patients without a past medical history of diabetes achieved triglyceride levels <500 mg/dL (14% vs 53%, respectively, P < 0.001). The number of hypoglycemic events observed in patients with and without a past medical history of diabetes were 5 (14%) and 4 (27%), respectively ( P = 0.023).

Conclusion and Relevance

Our findings suggest that patients who present with lower initial TG levels are more likely to achieve TG levels <500 mg/dL. To minimize the risk of hypoglycemia providers should consider prescribing a concomitant dextrose infusion and limiting IV insulin infusion rates ≤ 0.075 units/kg/h.
Oral Epithelial Dysplasia Grading Systems: A Systematic Review & Meta-Analysis
Authors: Khoury Zaid H. , Sultan Mohamed , Sultan Ahmed S.
Published: January 2022

This systematic review and meta-analysis aims to provide a robust qualitative and quantitative analysis of the different systems used to assess the grade of oral epithelial dysplasia (OED). This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyzes (PRISMA) statement. Six electronic databases were searched for primary research published over the past four decades. Overall quality and level of evidence were based on the Johns Hopkins Research Evidence Appraisal Tool, while evidence of heterogeneity was determined by the Q-statistic and I^2 statistic. Evidence of publication bias was determined using Egger's regression and the Rank correlation tests. A total of 170 records were identified. Only 9 primary research articles were included in the qualitative systematic review. Four studies (4/9) were included in the final quantitative meta-analysis. The grading systems analyzed included the WHO, binary, Ljubljana, Smith and Pindborg, Brothwell, and the oral intraepithelial neoplasia. The results demonstrate the binary system to be superior to the WHO system in grading OED, by providing better inter-observer agreement, however, the substantial error among the inter-observer κ values analyzed indicates the significance of this finding to be of minimal impact. Lack of reliable reproducibility of the grading systems and lack of common effect size (heterogeneity analysis) were noted.
Role of the Immunohistochemical ZEB1 Expression in Uterine Mesenchymal Neoplasms
Authors: Çelik Murat , Çelik Zeliha Esin
Published: January 2022

The distinction of mesenchymal tumors of the uterus is a frequent diagnostic challenge in gynecologic pathology. Especially, distinguishing low-grade endometrial stromal sarcoma (ESS) from leiomyoma or distinguishing low-grade ESS from high-grade ESS can be difficult. Epithelial-mesenchymal transition (EMT) is a physiological and pathological process in which epithelial cells lose their morphological features, become elongated and acquire mesenchymal traits. The signaling pathway of Zinc finger E-box binding homeobox 1 (ZEB1) is one of the most significant pathways involved in the EMT process and it has a crucial role in cancer progression, metastasis, and therapy resistance. We studied a series of 69 uterine mesenchymal neoplasms including 18 endometrial stromal sarcomas (10 cases of low grade and 8 cases of high grade endometrial stromal sarcomas), 26 leiomyosarcomas (8 cases of grade 1 and 19 cases of grade 2-3 leiomyosarcomas), 15 leiomyomas, and 10 rhabdomyosarcomas, using an antibody ZEB1. We graded the leiomyosarcomas depending on the FNCLCC grading system. It was observed that leiomyosarcoma was more intensely stained with ZEB1 than leiomyoma (P < 0.001) and high-grade ESS was significantly more intensely stained with ZEB1 protein than low-grade ESS (P < 0.004). It also was observed that high-grade leiomyosarcoma was significantly more intensely stained with ZEB1 protein than low-grade leiomyosarcoma (P < 0.000). Our data suggest that Zeb1 can be used to differentiate high-grade sarcomas from their low-grade counterparts as well as benign and malignant smooth muscle tumors of the uterus.
The Efficacy and Safety of Sacubitril/Valsartan in Heart Failure Patients: A Review
Authors: Zhang Rui , Sun Xiaotong , Li Ya , He Wenzheng , Zhu Hongguang , Liu Baoshan , Zhang Aiyuan
Published: January 2022

Heart failure (HF) is one of the leading causes of morbidity and mortality worldwide. Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor, has been approved for the treatment of HF. At present, there have been few systematic and detailed reviews discussing the efficacy and safety of sacubitril/valsartan in HF. In this review, we first introduced the pharmacological mechanisms of sacubitril/valsartan, including the reduction in the degradation of natriuretic peptides in the natriuretic peptide system and inhibition of the renin-angiotensin system. Then, we summarized the efficacy of sacubitril/valsartan in HF patients with reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF) including the reduction in risks of mortality and hospitalization, reversal of cardiac remodeling, regulation of biomarkers of HF, improvement of the quality of life, antiarrhythmia, improving renal dysfunction and regulation of metabolism. Finally, we discussed the safety and tolerability of sacubitril/valsartan in the treatment of HFrEF or HFpEF. Compared with ACEIs/ARBs or placebo, sacubitril/valsartan showed good safety and tolerability, although the risk of hypotension might be high. In conclusion, the overwhelming majority of studies show that sacubitril/valsartan is effective and safe in the treatment of HFrEF patients but that it has little benefit in HFpEF patients. Sacubitril/valsartan will probably be a promising anti-HF drug in the near future.
Experimental study on axial compression buckling of glass fiber reinforced plastics solid pole with circular cross-section
Authors: Si Jianhui , Qiu Shixiong , Feng Shuyang , Chen Jiebin , Wang Zhenshan
Published: January 2022

Glass fiber reinforced plastics are widely used in civil engineering because of their advantages such as light weight, high strength, good pollution resistance, and corrosion resistance. This study investigated the buckling bearing capacity, failure characteristics, and slenderness ratios of GFRP solid bars with circular cross-sections subjected to axial compression. A total of 18 specimens were categorized into six groups. The slenderness ratios ranged from 57 to 123. It was found from experiments that the instability mode of the specimens was extreme point instability, and a bearing capacity platform phenomenon was observed when overall lateral instability occurred. The failure mode was axial and transverse tearing failure of the material in the middle of the specimen. During buckling, the tensile side was transformed from the compression of the resin matrix to tension in the fibers. The elastic modulus of glass fiber was much lower than that of the resin matrix. After tension occurred, increased deformation led to a rapid increase in lateral bending, which resulted in the phenomenon of the bearing platform. At ultimate deformation, brittle failure of the specimen occurred. The buckling load of the specimen decreased sharply with an increase in the slenderness ratio, and stress ratios decreased from 34.95% to 6.73%. It is suggested that the slenderness ratio not exceed 80. Finally, based on experimental results, a practical method for calculating the stable bearing capacity of solid GFRP poles is proposed.
Materialism, autonomy, intersectionality: revisiting Virginia Woolf through the Wages for Housework perspective
Authors: Nakai Asako
Published: January 2022

Virginia Woolf's 1938 essay Three Guineas contends that the material basis is indispensable for women not only to survive but also to voice their political opinions. Woolf proposes three strategies for women to take. First, women should assert their right to have access to independent income, and for this purpose they should demand that the state pay for their reproductive work that often limits their opportunity to do waged work. Second, they must object to the very wage system which is indeed in complicity with patriarchy, and through which women are doubly exploited as unwaged or under-waged workers. And third, women must remain outside male-dominated movements and must organise an autonomous group even if they share the same cause with male workers; intersectional association will be possible only when each exploited group empowers itself and regains its own voice. This article examines how this highly materialist aspect of Woolf's feminism was revisited by the Wages for Housework movement in the 1970s. By so doing, it argues that despite its facade of literary modernism and alleged elitism, Woolf's text contributes to real-life movements and continues to inspire people of different class backgrounds in different times. Discovering the connection between Woolf and Marxist feminism alters our way of seeing the history of feminist theory: the history is never a linear progress from one wave to another but a complex and interwoven narrative, in which once-forgotten ideas can travel across time and space, resurging as new ideas in different contexts.
The positioning of dual qualification studies in Finnish upper secondary education and government policy since the 1980s
Authors: Lietzén Outi
Published: January 2022

This article explores the positioning of dual qualifications (DQs) in the Finnish education policy and the education system since the late 1980s. The analysis is carried out in the context of academic-vocational divide. At the end of the 1980s, Finland questioned the functionality of the strict academic-vocational divide in post-compulsory education, and a unified upper secondary education was initiated. DQ was the result of two contradictory political discourses: the aim to make education system more equal and the 1990s’ market oriented education policy. In the 2000s, although segregation at the upper secondary level was strengthened, the DQ simultaneously became an established study route. However, in 2007 due to changes in political power, the DQ was repositioned on the periphery of education policy and academic-vocational divide became stronger. The main focus as regards the functions of DQs until the end of the 2010s was on efforts to enhance the use of educational resources and improve the possibilities for individual and flexible education choices. The aim of the current government, elected in 2019, is to strengthen cooperation at upper secondary level, which is also expected to include DQs. However, the actualisation might be mitigated by the educational reforms of the previous government.
Stents With Torsional Strength for Superficial Femoral Artery Disease: The Prospective Q3-Registry
Authors: Thieme Marcus , Arjumand Jarwed , Spanagel Markus , Tepe Gunnar , Blessing Erwin , Kroeg Bernd , Reichert Viktor , Betge Stefan , Wickenhöfer Ralph , Teßarek Jörg , Ingwersen Maja , Krankenberg Hans
Published: January 2022

Purpose:

This postmarketing surveillance study aimed to assess effectiveness and safety of a peripheral self-expanding stent with high torsional strength (POLARIS stent) for the treatment of de novo superficial femoral artery (SFA) lesions in the routine clinical practice.

Materials and Methods:

Consecutive patients with symptomatic de novo SFA occlusive disease who underwent POLARIS stent implantation were enrolled into the prospective, multicenter, observational postmarket surveillance study. Primary outcome measure was freedom from clinically driven target lesion revascularization (cdTLR) at 12 months. Main secondary outcomes were procedural success, primary clinical improvement, and freedom from major adverse cardiovascular and limb events (MACLE) throughout 24 months.

Results:

A total of 199 participants (70±11 years, 70.4% men) were included in the study at 9 German sites from December 2014 to August 2018. Half of them (52.6%) were current smokers, 37.6% had diabetes, and 25.0% were obese. Most participants suffered from intermittent claudication (88.4%). Mean lesion length was 98±83 mm, 43.5% of lesions were occluded, and 27.3% were severely calcified. Freedom from 12 months cdTLR was 94.4% (95% confidence interval [CI], 90.6–98.2). At 24 months, freedom from cdTLR was 88.7% (95% CI, 83.0–94.4). Procedural success was achieved in 96.2% of participants. Primary clinical improvement occurred in 87.5% and 85.4% of participants at 12 and 24 months, respectively. Freedom from MACLE was 94.8% (95% CI, 91.4–98.1) and 93.8% (95% CI, 89.9–97.6) at 12 and 24 months, respectively.

Conclusions:

Treatment of SFA occlusive disease in a real-world setting using the POLARIS stent with high bidirectional torsional strength is efficacious and does not raise any safety concern in the medium term. The study is registered with ClinicalTrials.gov (Identifier: NCT02307292).
Validation of a Novel Smartphone-Based Electronic Data Capture System Following Surgical Fixation of Distal Radial Fractures
Authors: Scollan Joseph P. , Emara Ahmed K. , Chughtai Morad , Jin Yuxuan , Styron Joseph F.
Published: January 2022

Background:

Large prospective institutional data provide the opportunity to conduct level II and III studies using robust methodologies and adequately powered sample-sizes, while circumventing limitations of retrospective databases. We aimed to validate a prospective data collection tool, the Orthopaedic Minimal Data Set Episode of Care (OME), implemented at a tertiary North American health care system for distal radial fracture (DRF) open reduction and internal fixation (ORIF).

Methods:

The first 100 DRF ORIFs performed after OME inception (February 2015) were selected for this validation study. A blinded review of the operative notes and charts was performed, and extracted data of 75 perioperative DRF ORIF procedure variables were compared with OME collected data for agreement. Outcomes included completion rates and agreement measures in OME versus e﻿lectronic medical record (EMR)-based control datasets. Data counts were evaluated using raw percentages and McNemar tests. Cohen (κ) and concordance correlation coefficient analyzed categorical and numerical variable agreement, respectively.

Results:

Overall, OME demonstrated superior completion and agreement parameters versus EMR-based retrospective review. Nine data points (12.0%) demonstrated significantly higher completion rates within the OME dataset ( P < .05, each), and 88% (66/75) of captured variables demonstrated similar completion rates. Up to 80.0% (60/75) of variables either demonstrated an agreement proportion of ≥0.90 or were solely reported in the OME. Of 33 variables eligible for agreement analyses, 36.4% (12/33) demonstrated almost perfect agreement (κ > 0.80), and 63.6% (21/33) exhibited almost perfect or substantial agreement (κ > 0.60).

Conclusions:

The OME is a valid and accurate prospective data collection tool for DRF ORIF that is reliably able to match or supersede traditional retrospective chart review. Future investigations could use this tool for large-scale analyses investigating peri/intraoperative DRF ORIF variables.
Functional Outcomes of Flexor Tendon Repair in the Fingers: A Comparison of Wide-Awake Local Anesthesia No Tourniquet Versus Traditional Anesthesia
Authors: Townsend Clay B. , Henry Tyler W. , Matzon Jonas L. , Seigerman Daniel , Sodha Samir C. , Beredjiklian Pedro K.
Published: January 2022

Background:

Flexor tendon lacerations in the fingers are challenging injuries that can be repaired using the wide-awake local anesthesia no tourniquet (WALANT) technique or under traditional anesthesia (TA). The purpose of our study was to compare the functional outcomes and complication rates of patients undergoing flexor tendon repair under WALANT versus TA.

Methods:

All patients who underwent a primary flexor tendon repair in zone I and II without tendon graft for closed avulsions or open lacerations between 2015 and 2019 were identified. Electronic medical records were reviewed to record and compare patient demographics, range of motion, functional outcomes, complications, and reoperations.

Results:

Sixty-five zone I (N = 21) or II (N = 44) flexor tendon repairs were included in the final analysis: 23 WALANT and 42 TA. There were no statistical differences in mean age, length of follow-up, proportion of injured digits, or zone of injury between the groups. The final Quick Disabilities of the Arm, Shoulder, and Hand score in the WALANT group was 17.2 (SD: 14.4) versus 23.3 (SD: 18.5) in the TA group. There were no statistical differences between the groups with any final range of motion (ROM) parameters, grip strength, or Visual Analog Scale pain scores at the final follow-up. The WALANT group was found to have a slightly higher reoperation rate (26.1% vs 7.1%; P = .034) than the TA group.

Conclusions:

This study represents one of the first clinical studies reporting outcomes of flexor tendon repairs performed under WALANT. Overall, we found no difference in rupture rates, ROM, and functional outcomes following zone I and II flexor tendon repairs when performed under WALANT versus TA.
Ultrasound Measurements of the Median Nerve at the Distal Wrist Crease Correlate With Electrodiagnostic Studies
Authors: Aloi Nicholas F. , Cluts Landon M. , Fowler John R.
Published: January 2022

Background: Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy and is commonly evaluated using electrodiagnostic studies (EDSs). Ultrasound (US) has emerged as a potentially easier and more comfortable alternative to EDSs. The purpose of this study is to evaluate whether measurements of the cross-sectional area (CSA) of the median nerve via US correlate with the severity rating of CTS based on EDSs. Methods: A retrospective review of patients aged 18 years or older who underwent US and EDSs of the median nerve for CTS was performed. Sensory nerve action potential, distal motor latency, and compound muscle action potential were measured, and severity was graded on American Association of Neuromuscular and Electrodiagnostic Medicine guidelines. Cross-sectional area of the median nerve was measured via US at the wrist crease. Results: There was a significant association between increasing CSA and increasing EDS severity ( P < .0001). The mean CSA for normal, mild, moderate, and severe CTS was 7.48 ± 2.00, 10.36 ± 2.53, 12.01 ± 3.64, and 14.34 ± 4.77 mm2, respectively. The area under the curve demonstrated the ability of median nerve CSA to discriminate between normal and abnormal EDSs with an optimal cutoff CSA of ≥10 mm2, as well as, the ability to discriminate between mild CTS and moderate to severe CTS at a cutoff CSA of greater than or equal to 12 mm2. Conclusions: The results of this study show that US measurements of the median nerve at the distal wrist crease discriminate between normal and abnormal EDSs, and between mild CTS and moderate to severe CTS.
The “Fight Bite” Saline Joint Loading Test: Effectiveness in Detecting Simulated Traumatic Metacarpophalangeal Arthrotomies
Authors: Chughtai Morad , Scollan Joseph P. , Emara Ahmed K. , Brej Ben , Steckler Andrew , Churchill Jessica L. , Ferre Alexandra , Saluan Paul , Styron Joseph F.
Published: January 2022

Background: The saline load test is routinely used to recognize other joints’ traumatic arthrotomies; however, there are currently no studies evaluating the novelty of this test for metacarpophalangeal joints (MCPJs). This study aimed to investigate the effectiveness and sensitivity of saline load testing in identifying the traumatic arthrotomies of the MCPJs using human cadavers. Methods: This was a cadaveric study of 16 hands (79 MCPJs). Traumatic arthrotomies were created using 11-blade stab-incisions, followed by blunt probing into the joint on the radial or ulnar side of the flexed MCPJs. A 3-mL syringe was used to inject intra-articular methylene-blue-dyed saline from the contralateral side. The volume at saline extravasation was recorded. Test sensitivity and factors influencing extravasation volume were assessed. Results: The mean (range) volume injected to identify arthrotomy of all MCPJs was 0.18 mL (0.1-0.4 mL). The mean volume to identify MCPJ arthrotomy of the thumb, index, long, ring, and small fingers was 0.16 mL (0.1-0.3 mL), 0.19 mL (0.1-0.3 mL), 0.21 mL (0.1-0.4 mL), 0.17 mL (0.1-0.3 mL), and 0.16 mL (0.1-0.3 mL), respectively. Cadaver age, laterality, and joint range of motion were not significantly associated with the injected volume at extravasation( P > .05, each). Injection volumes of 0.3 and 0.32 mL were required to detect arthrotomies at 95% and 99% sensitivities across all MCPJs. None of the MCPJs required > 0.4 mL to detect arthrotomy. Conclusions: Saline joint loading volumes to detect traumatic arthrotomy were similar for all MCPJs. Injection volumes of 0.32 mL is suggested for 99% sensitivity. Our findings provide the first report, to our knowledge, on intra-articular injection volumes expected to detect an arthrotomy of MCPJ. This is critical for further validation using in vivo clinical studies.
The influence of different game formats on technical actions and playing time parameters – A study with under-7 and under-9 soccer players in a competitive context
Authors: Bergmann Fynn , Braksiek Michael , Meier Christopher
Published: January 2022

Soccer competitions in childhood should ensure a high involvement of all players regardless of their talent. The purpose of the present study was to compare soccer players’ technical actions and playing time parameters in 7v7 in comparison to 3v3 (on mini-goals without goalkeepers; under-7) and 5v5 (on 1.65 × 5 m. goals with goalkeepers; under-9) game formats in a competitive context. Using a quasi-experimental within-subject design, tournaments with under-7 ( n = 42) and under-9 ( n = 43) players were conducted. Technical actions and playing time parameters were rated. Based on the total number of technical actions in 7v7, median splits of the samples were conducted to compare differences between high-involved (dominant) and low-involved (non-dominant) players. No differences in the effective playing time comparing game formats within the age groups were found. In total, 7884 technical actions were rated. In both age groups, the total number of technical actions was higher in the smaller game formats. In under-7, the number of technical actions in all variables was higher in 3v3. In under-9, the number of technical actions was also higher in 5v5 except for unsuccessful passes as well as successful 1v1 situations. More unsuccessful 1v1 situations were found in 7v7. Concerning the total number of technical actions, both dominant and non-dominant players in both age groups performed more technical actions in small-sided games. Due to the higher involvement of the children, better conditions for the acquisition of soccer-specific skills in the smaller game formats compared to 7v7 game formats can be concluded.
The influence of the field orientation on physical demands in soccer small-sided games
Authors: Luchesi Marcelo S. , Couto Bruno P. , Gabbett Tim J. , Praça Gibson M. , Oliveira Mariana P. , Sayers Mark G.L.
Published: January 2022

The aim of this study was to compare the physical demands of SSG with either greater length (SSGlength) or width (SSGwidth) with official soccer matches. Sixteen Brazilian U-20 national-level soccer players participated in two sessions with SSGlength (4v4, 40 m length and 26 m width) and two sessions with SSGwidth (4v4, 26 m length and 40 m width). External and internal load variables were monitored and compared to official games (12.8 ± 8.9 games per player). Data were standardized to the time and compared between the experimental conditions by a one-way analysis of variance (ANOVA) with repeated measures (level of significance set at p < 0.05). The effect size was calculated by the partial ETA squared (ɳ p2). Results showed that the total distance covered during SSGlength was significantly higher compared to official matches (8.1%; p = 0.001) and SSGwidth (5.2%; p = 0.049). Highest values were registered in the matches when compared to SSGlength and SSGwidth for high-speed distance, sprint distance, maximal speed and number of sprints. The number of accelerations was significantly lower during official matches than SSGwidth (36.5%; p = 0.002) and SSGlength (45.0%; p < 0.001). The number of high-speed actions was higher in official games when compared to SSGwidth (47.1%; p < 0.001). No differences were found between matches and SSGlength ( p = 0.059). We concluded that the physical demands of the 4v4 SSGs adopted in this study were different from the physical demands of official match play. The use of a field with a greater width rather than length does not appear to make the physical demands of the SSG more similar to the official games.
Attention graph: Learning effective visual features for large-scale image classification
Authors: Cui Xuelian , Zhang Zhanjie , Zhang Tao , Yang Zhuoqun , Yang Jie
Published: January 2022

In recent years, the research of deep learning has received extensive attention, and many breakthroughs have been made in various fields. On this basis, a neural network with the attention mechanism has become a research hotspot. In this paper, we try to solve the image classification task by implementing channel and spatial attention mechanism which improve the expression ability of neural network model. Different from previous studies, we propose an attention module consisting of channel attention module (CAM) and spatial attention module (SAM). The proposed module derives attention graphs from channel dimension and spatial dimension respectively, then the input features are selectively learned according to the importance of the features. Besides, this module is lightweight and can be easily integrated into image classification algorithms. In the experiment, we combine the deep residual network model with the attention module and the experimental results show that the proposed method brings higher image classification accuracy. The channel attention module adds weight to the signals on different convolution channels to represent the correlation. For different channels, the higher the weight, the higher the correlation which required more attention. The main function of spatial attention is to capture the most informative part in the local feature graph, which is a supplement to channel attention. We evaluate our proposed module based on the ImageNet-1K and Cifar-100 respectively. Through a large number of comparative experiments, our proposed model achieved outstanding performance.
Abatacept (Cytotoxic T Lymphocyte Antigen 4-Fragment Crystallizable) Reduces Allergic Inflammation of Ovalbumin-Sensitized Mice.
Authors: Chung Jaein , Choi Mi-Ra , Kim Min Gyu , Park Soo Kyoung , Kim Yong Min
Published: January 2022

Background

Abatacept (Aba) is a cytotoxic T-lymphocyte antigen-4 and fragment crystallizable fusion protein. Aba blocks B7/Cluster of differentiation 28 - cytotoxic T-lymphocyte antigen-4 costimulatory pathway, inhibits cluster of differentiation 4+ T-cell activation, and is used as an anti-inflammatory drug.

Objectives

We conducted this study to assess the effectiveness of Aba in the treatment of allergic rhinitis (AR) in a mouse model.

Methods

We divided 40 four-week-old BALB/c mice into four groups: control group ( n = 10), positive control group (AR, n = 10), Aba group (AR + Aba, n = 10), and dexamethasone group (AR + Dex, n = 10). Mice in each group were challenged intranasally with daily ovalbumin (OVA) administration. Episodes of sneezing and nose rubbing were counted. Mice were sacrificed on day 42 and cytokines were measured in nasal lavage fluid. Nasal mucosae of five mice from each group were used for reverse transcriptase-polymerase chain reaction and western blot assay. Samples were collected from five mice from each group for histological analysis.

Results

Symptoms of AR significantly improved in the AR + Aba and AR + Dex groups compared with the AR group. Fewer eosinophils and goblet cells were seen in the AR + Aba and AR + Dex groups compared with the AR group. Both the AR + Aba and AR + Dex groups showed a significant decrease in nasal T helper 2 cytokine levels, including interleukin (IL)-4, IL-5, IL-13 and T cell activation related IL-17A, and interferon gamma (IFN- γ). Total immunoglobulin (Ig) E and OVA-specific IgG1 levels were also significantly lower in the AR + Aba and AR + Dex groups. OVA-specific IgE level was also significantly lower in the AR + Aba than AR group.

Conclusions

Aba suppresses allergic inflammation and appears to be a good treatment for AR.