bluuebunny/crossref_metadata_2025 huggingface dataset:
Lateral-Only Kirschner-Wire Fixation of Type-3 Supracondylar Humerus Fractures in Children with a Special Attention to Technical Issues
Authors: Hannonen J. , Pokka T. , Serlo W. , Sinikumpu J.-J.
Published: March 2020

Background and Aims:

Lateral-only Kirschner-wire pinning of supracondylar humerus fracture is superior in avoiding surgery-related ulnar nerve injury. Their disadvantageous effects on stability may be a consequence of inappropriate surgical techniques. We analyzed whether the surgeon’s preference for lateral-only fixation is associated with his or her orthopedic competence. We also analyzed the surgical technique–related risk factors of redisplacement.

Materials and Methods:

All children, aged <16 years, with a distal humerus fracture in 2000–2009 were preliminary included (N = 861). Altogether, 24 of the 165 type-3 supracondylar fractures were operated by lateral-only pinning. Loss of reduction in the follow-up was the main outcome, while the close characteristics of the surgical technique and treating surgeon’s orthopedic competence were the explanatory variables.

Results:

Orthopedic surgeons used lateral-only method in 23.5% of the type-3 fractures (N = 16/68), and other surgeons in 8.2% (N = 8/97)(difference = 15.3%, 95% confidence interval = 4.6%–27.6%, p = 0.005). One-third of the lateral-only treated fractures (29.2%, 95% confidence interval = 12.6%–51.1%) redisplaced. Lateral-entry pins that crossed at the level of the fracture were associated with failure (87.5%), while no patient with appropriate pin configuration failed (difference = 87.5%, 95% confidence interval = 52.1%–97.8%). A shorter distance (<5 mm) between the entry points of the pins was associated with redisplacement (80% vs. 15.8%, difference = 64.2%, 95% confidence interval = 16.1%–86.9%). Open reduction (p = 0.07), insufficient (<4 mm) bone contact (p = 0.28), monocortical pins (p = 0.569), low diverging angle (p = 0.13) or parallel pins (p = 1.0), residual coronal displacement (p = 1.0), >5° changed Bauman angle (p = 0.11), rotational displacement (p = 0.25), and the experience or specialty of the surgeon were not associated with redisplacement.

Conclusion:

Lateral-only pins resulted in poor stability in one in three of the patients. Appropriate configuration of the pins was associated with good fracture healing, but crossing the pins at the fracture level and introducing them close to each other were associated with redisplacement. Surgeons with more orthopedic competence selected lateral-only fixation more usually.
Journey to the centre of the world: Google Maps and the abstraction of cybernetic capitalism
Authors: Ström Timothy Erik
Published: March 2020

Across human history, many cultures have produced different ‘centres of the world’, with cartography often being bound up in the construction and representations of this axis mundi. A contemporary manifestation of these ancient phenomena can be seen in Google Maps, the most popular world-map ever made. Google use surveillance to present various types of customized centres-of-the-world, with their global representation being automatically tailored for specific subjects. This study uses engaged theory to analytically separate the levels of abstraction inherent in these processes, connecting empiric observations with large-scale historic transformations, with a focus on subjective and material changes in relation to the capitalist world-system. It is argued that the automated, atomizing processes bound up in Google Maps serve to projects intensifying abstractions into everyday social practice, thus reconstituting how space and time are experienced, as well as being intimately bound up with intensifying processes of capital accumulation and social control.
Children’s Responses to Maltreatment: Key Conclusions From a Systematic Literature Review
Authors: Katz Carmit , Tsur Noga , Nicolet Racheli , Carmel Nir , Klebanov Bella
Published: March 2020

Child maltreatment (CM) has received much research attention in recent years, leading to the enormous development of services provided to children worldwide. However, although the literature in the field of trauma studies recognizes that responses to trauma are of central importance, for a variety of reasons, the research on this subject is sparse. The current systematic literature review was therefore designed to characterize and analyze the existing knowledge on children’s responses to CM, while putting in focus all possible responses that will appear in the identified manuscripts. Key databases were explored using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and only six studies were identified as relevant to the focus of the current study. Utilizing thematic analysis, the results addressed four main themes: the studies’ methodologies, the terminology and responses that were explored in these studies, the abuse-related factors and contexts that were taken into account, and the consequences for the children (of their responses to the maltreatment). A key conclusion from this review is that concepts in this area, as well as theory, are considerably lacking. Promoting the development of theory regarding children’s responses to CM is urgently needed, as it will greatly impact clinical intervention, legal investigation, and the development of prevention programs.
“On a Positive Path”: School Superintendents’ Perceptions of and Experiences With Local School Wellness Policy Implementation and Evaluation
Authors: Asada Yuka , Hughes Alejandro , Read Margaret , Schwartz Marlene , Schermbeck Rebecca , Turner Lindsey , Chriqui Jamie
Published: March 2020

Renewed federal requirements for local school wellness policies highlighted the continued importance of supporting school districts as they implement and evaluate wellness initiatives. Superintendents—as school district leaders—play a critical role in wellness policy implementation and evaluation; however, to our knowledge, no studies examine their perspectives or experiences with the most recent federal rule or wellness initiatives more broadly. This study qualitatively examined superintendents’ perspectives, experiences, and recommendations with wellness policy implementation and evaluation. Focus groups ( n = 39) and follow-up interviews ( n = 14 of the focus group participants) were conducted with superintendents from March to July 2017. Coders organized and coded transcript data using Atlas.ti, Version 8 to facilitate thematic analysis. Superintendents had overall positive perceptions of wellness policies and reported that implementation improved over time. Most described wellness approaches beyond typical wellness policy domains, including social-emotional learning and staff wellness. Evaluation of wellness policies was noted to be a challenge, and superintendents requested more tools and resources, as well as opportunities to learn from “best practices.” Increased local and state accountability were recommended to facilitate motivation for other superintendents to engage with wellness. This study adds to the literature on a critical stakeholder in the school wellness field. Advocates and technical assistance providers can apply superintendents’ recommendations to engage more district leaders in these initiatives.
Clinical and Genetic Profile of Autism Spectrum Disorder–Epilepsy (ASD-E) Phenotype: Two Sides of the Same Coin!
Authors: Karunakaran Sudhakar , Menon Ramshekhar N. , Nair Sruthi S. , Santhakumar S. , Nair Muralidharan , Sundaram Soumya
Published: March 2020

The clinical phenotype of autism spectrum disorder and epilepsy (ASD-E) is a common neurological presentation in various genetic disorders, irrespective of the underlying pathophysiological mechanisms. Here we describe the demographic and clinical profiles, coexistent neurological conditions, type of seizures, epilepsy syndrome, and EEG findings in 11 patients with ASD-E phenotype with proven genetic etiology. The commonest genetic abnormality noted was CDKL5 mutation (3), MECP2 mutation (2), and 1p36 deletion (2). The median age of onset of clinical seizures was 6 months (range, 10 days to 11 years). The most common seizure type was focal onset seizures with impaired awareness, observed in 7 (63.6%) patients followed by epileptic spasms in 4 (30.8%), generalized tonic-clonic and atonic seizures in 3 (27.3%) patients each and tonic seizures in 2 (18.2%) patients and myoclonic seizures in 1 (9.1%) patient. Focal and multifocal interictal epileptiform abnormalities were seen in 6 (54.6%) and 5 (45.5%) patients, respectively. Epileptic encephalopathy and focal epilepsy were seen in 7 (63.6%) and 4 (36.4%) patients, respectively. The diagnostic yield of genetic testing was 44% (11 of 25 patients) and when variants of unknown significance and metabolic defects were included, the yield increased to 60% (15 of 25 patients). We conclude that in patients with ASD-E phenotype with an underlying genetic basis, the clinical seizure type, epilepsy syndrome, and EEG patterns are variable. Next-generation exome sequencing and chromosomal microarray need to be considered in clinical practice as part of evaluation of children with ASD-E phenotype.
Indoor positioning-based mobile resource movement data management system for smart factory operations management
Authors: Park Jin Sung , Lee Sung Jin , Jimenez Jesus , Kim Soo Kyun , Kim Jun Woo
Published: March 2020

The primary role of modern information and communication technology infrastructures in smart factory is to collect a wide range of digital data from manufacturing resources; however, many manufacturing companies still have significant trouble in collecting data relevant for operations management. Especially, it is difficult to collect data about movement of mobile resources, such as human operators and material handling equipment. Moreover, managers of manufacturing companies often have significant troubles in utilizing the raw data collected by information and communication technology infrastructures due to its complexities and vast amount. To fill these gaps, this article proposes indoor positioning-based mobile resource movement data management system, which can be used to collect and process the mobile resource movement data flexibly. The indoor positioning technologies enable to track the positions of physical objects in real time; however, they generate time series data for 3D coordinates of object position not suitable for practical use. Therefore, this article aims to integrate the indoor positioning technology with a specialized user application, which allows the users to define what kinds of data should be collected and how the raw data should be transformed.
Creating a Lifestyle Medicine Specialist Fellowship: A Replicable and Sustainable Model
Authors: Rea Brenda , Wilson April
Published: March 2020

As new specialties emerge in medicine, certification pathways must be defined and formalized. The Lifestyle Medicine Physician certification, including both experiential and educational pathways, have been in place for several years. Although raising competence across all specialties through the Lifestyle Medicine Physician Diplomates to a foundational level is essential, additional expertise must be attained to be a true Lifestyle Medicine Specialist as outlined by the American Board of Lifestyle Medicine. This column will describe how Loma Linda University Health (LLUH) created a Lifestyle Medicine Specialist Fellowship that meets the educational pathway requirements for the Lifestyle Medicine Specialist certification and how it can be replicated and sustained at other training sites across the nation.
Paradigmatic Shifts in Doctoral Research: Reflections Using Uncomfortable Reflexivity and Pragmatism
Authors: Woodley Helen , Smith Laura Mazzoli
Published: March 2020

This article discusses a doctoral study, completed by a then full-time teacher in a Pupil Referral Unit in the north of England, which shifted from a mixed-methods action research project to one that was largely autoethnographic in approach. This incorporated the use of fictionalized data. The aim of the project, both at conception and after the change of focus, was to inform the ongoing practice specifically related to the context of the setting. The former doctoral student and supervisor reflect upon the paradigmatic shift that this entailed, drawing upon a complex conceptualization of reflexivity, and pragmatism, to account for the underlying rationale and affordances of this shift. The uncomfortable realities that were experienced during the doctoral study as a result have given way to a different orientation on the project in the light of subsequent reflection. Consideration of a pragmatist understanding of language in relation to research ends has repositioned the nature of the paradigmatic shift. The confidence to change methodological approaches during a doctoral thesis is explored.
Fatigue and lethargy in palliative care
Authors: Landa Amarjodh
Published: March 2020

Fatigue is a particularly vague, yet significant symptom, which is commonly encountered in primary care. It affects a wide range of patients and has many causes. With an ageing population, fatigue is more likely to be multifactorial towards the end of a person’s life, and this can provide challenges in recognition and management. Patients are often incapacitated due to their fatigue and helping to manage it can lead to an improved quality of life. This article aims to briefly summarise the symptoms of fatigue, how to recognise it and the various causes. Current literature on the management of fatigue in end-of-life care, including pharmacological options, is critically reviewed.
Otorrhoea
Authors: Newton Mark , Tsirevelou Paraskevi
Published: March 2020

The discharging ear, also known as otorrhoea, is a common ear, nose and throat symptom and defined as drainage or flow exiting the ear. The discharge can be wax, blood, pus, mucus, or cerebrospinal fluid. The underlying cause can usually be determined from the history and physical examination. Most patients with otorrhoea can be managed within primary care and do not require referral or hospital admission. This article considers the common causes of a discharging ear, appropriate management, guidance for referral of patients to secondary care and some key take home points.
Patients recording their clinical consultations: A new challenge for medical ethics
Authors: Turley Dan P , Metcalfe Neil H
Published: March 2020

Patients can and do record their consultations in general practice. Data suggests that 19% of doctors have reported being recorded, with 40% of these being unaware at the time. Due to rapid advancements in technology in recent years, over three quarters of patients that attend clinical consultations have the ability to take audio or video recordings using internet-connected smartphones. This paper will look at the individual rights of both the doctor and the patient with regard to recording clinical consultations, assess the advantages and disadvantages that can result and ask whether the future of the doctor–patient relationship is threatened by this modern behaviour.
Towards a vertically separated broadband infrastructure: The potential role of voluntary separation
Authors: Queder Fabian
Published: March 2020

Public policymakers face the challenge of maintaining incentives for investments in fiber-to-the-premises (FTTP) infrastructure while simultaneously enabling effective competition. In that regard, the ability of vertically integrated operators to discriminate against downstream rivals is regarded as a major regulatory problem, especially as policing nondiscrimination obligations is notoriously difficult for vertically integrated operators. The European regulatory framework mandates functional separation to eliminate discrimination incentives. However, this measure comes with significant drawbacks and caveats and resembles a strong market and ownership intervention. The present article discusses how voluntary vertical separation can achieve the positive effect of a vertically separated industry structure without the need for strong market interventions. We use a discounted cash flow model to compare the financial attractiveness of wholesale-only and integrated business models for a greenfield FTTP rollout. We further discuss and test how public policymakers could positively affect the profitability of a wholesale-only business model. Based on our findings, we recommend public-policymakers and national regulation authorities to proactively define separation scenarios and respective ex ante regulation reductions precisely, to make adjustments to broadband state aid programs that favor wholesale-only providers, and to critically reflect the hampering effect volume and time discount wholesale tariff structures of incumbents have on the emergence of wholesale-only networks.
Patient-Reported Outcomes (PROs) in Acute Symptomatic Seizure (ASyS) Versus Patients With Established Epilepsy
Authors: Newey Christopher R. , Thompson Nicolas R. , George Pravin , Punia Vineet , Hantus Stephen , Lapin Brittany , Gomes Joao , Katzan Irene
Published: March 2020

Purpose:

Acute symptomatic seizures (ASyS) are common in critically ill patients. It is unknown how ASyS affect posthospitalization self-reported health compared to patients with established epilepsy.

Methods:

This is a retrospective cohort study from 2010 to 2018. Patients were identified by an institutional epilepsy database (Ebase). Patient-reported outcome measures (PROMs) were completed as part of standard of care and included the number of seizures in the prior 4 weeks, Liverpool Seizure Severity Scale (LSSS) ictal score, quality of life in epilepsy (QOLIE)-10, Patient Health Questionnaire-9 scales, and the PROM Information System Global Health (PROMIS-GH) scale. Mixed-effects models were created to adjust for age, sex, and race and to examine score trajectory over the 1 year after baseline.

Results:

A total of 15 311 established epilepsy patients and 317 patients with ASyS were identified. When compared to patients with epilepsy, patients with ASyS were older, mostly male, more often black, and had worse baseline scores on the QOLIE-10 ( P < .001), PROMIS-GH Physical Health ( P = .037), and LSSS Ictal ( P = .006) scales. Patient-Reported Outcomes Measurement Information System Mental and Physical Health T-scores were worse than the general population (T-score = 50) for patients with both ASyS (44 and 42.5, respectively) and epilepsy (44.2 and 44.6, respectively). After adjusting for age, sex, and race, patients with ASyS reported 38% fewer seizures ( P = .006) yet worse QOLIE-10 score ( P = .034). We found that scores improved over time for all PROMs except for PROMIS-GH Mental Health.

Conclusion:

Compared to patients with epilepsy, patients with ASyS had fewer seizures but worse epilepsy-specific quality of life. Independent of group status, scores generally improved over time.
Acute interstitial nephritis and drug-induced systemic lupus erythematosus due to chlorthalidone and amiodarone: A case report
Authors: Selamet Umut , Hanna Ramy M , Sisk Anthony , Abdelnour Lama , Ghobry Lena , Kurtz Ira
Published: March 2020

Drug-induced lupus erythematosus has features distinct from primary systemic lupus erythematosus. It can occur with a wide variety of agents that result in the generation of anti-histone or other types of antibodies. Systemic manifestations of drug-induced systemic lupus erythematosus may include renal dysfunction due to circulating immune complexes or due to other immune reactions to the culprit medication(s). Acute interstitial nephritis occurs due to DNA–drug or protein–drug complexes that trigger an allergic immune response. We report a patient who developed acute kidney injury, rash, and drug-induced systemic lupus diagnosed by serologies after starting chlorthalidone and amiodarone. A renal biopsy showed acute interstitial nephritis and not lupus-induced glomerulonephritis. It is important to note that systemic lupus erythematosus and acute interstitial nephritis can occur together, and this report highlights the role of the kidney biopsy in ascertaining the pathological diagnosis and outlining therapy in drug-induced lupus erythematosus.
Prognosis of patients receiving induction chemotherapy for locally advanced or lymph node metastatic bladder cancer
Authors: Le Goux Constance , Neuzillet Yann , Rouanne Mathieu , Gachet Julie , Staub Fabrice , Hervé Jean-Marie , Yonneau Laurent , Abdou Ali , Ghoneim Tarek , Théodore Christine , Lebret Thierry
Published: March 2020

Background:

Induction chemotherapy is recommended before surgery for unresectable muscle-invasive bladder cancer, locally advanced or lymph node disseminated disease. These patients’ prognoses cannot be extrapolated from data regarding neoadjuvant chemotherapy, which is performed in operable patients.

Objective:

We assessed the prognosis of patients undergoing induction chemotherapy for locally advanced or lymph node metastatic bladder cancer.

Methods:

We analysed patients with cT4NxM0 or cTxN+M0 bladder cancer treated by induction chemotherapy between 2006 and 2016. The tumour extension and node invasion was determined by imaging or histologically after upfront lymph node dissection. Clinical, biological, pathological and patient follow-up data were identified. Kaplan–Meier survival curves were compared by log rank test. Factors associated with the response to induction chemotherapy, operability of patients and survival were determined by multivariable logistic regression.

Results:

Among 70 patients included in the analysis, 51 (73%) showed response to induction chemotherapy. Progression-free and overall survival were improved in responder patients compared with non-responders ( P<0.0001 and P=0.025, respectively) and for patients who underwent surgery compared with non-operated patients (both P<0.001). On multivariable analysis, poor response was associated with chemotherapy other than methotrexate, vinblastine, doxorubicin and cisplatin ( P=0.016), operability with late response ( P=0.0024) and overall survival with surgery after induction chemotherapy ( P=0.0014).

Conclusions:

Surgery after induction chemotherapy with methotrexate, vinblastine, doxorubicin and cisplatin may improve prognosis with locally advanced or lymph node metastatic bladder cancer.

Level of evidence:

4
miR-142-5p regulates the progression of diabetic retinopathy by targeting IGF1
Authors: Liu Xiuming , Li Jianchang , Li Xiaofeng
Published: March 2020

As one of leading causes of blindness, diabetic retinopathy (DR) is a progressive microvascular complication of diabetes mellitus (DM). Despite significant efforts have been devoted to investigate DR over the years, the molecular mechanisms still remained unclear. Emerging evidences demonstrated that microRNAs (miRNAs) were tightly associated with pathophysiological development of DR. Hence, this study was aimed to illustrate the role and molecular mechanisms of miR-412-5p in progression of DR. Streptozotocin (STZ) treatment in rats and human retinal endothelial cell (HREC) models were used to simulate DR conditions in vivo and in vitro. Hematoxylin-eosin (HE) staining was used to demonstrate the morphology of retinal tissues of rats. Qualitative real-time polymerase chain reaction (qRT-PCR) detected miR-142-5p and vascular endothelial growth factor (VEGF) expression levels. Cell counting kit-8 (CCK8) assay and immunofluorescence (IF) measured the cell proliferation rates. Western blot tested the expression status of IGF1/IGF1R-mediated signaling pathway. Dual-luciferase reporter assays demonstrated the molecular mechanism of miR-142-5p. miR-142-5p level was down-regulated in retinal tissues of DR rats and high glucose (HG)-treated HRECs. Insulin-like growth factor 1 (IGF1) was identified as a direct target of miR-142-5p. The reduced miR-142-5p level enhanced HRECs proliferation via activating IGF/IGF1R-mediated signaling pathway including p-PI3K, p-ERK, p-AKT, and VEGF activation, ultimately giving rise to cell proliferation. Either miR-142-5p overexpression or IGF1 knockdown alleviated the pathological effects on retinal tissues in DR rats. Collectively, miR-142-5p participated in DR development by targeting IGF1/p-IGF1R signaling pathway and VEGF generation. This miR-142-5p/IGF1/VEGF axis provided a novel therapeutic target for DR clinical treatment.
Content and Correlational Analysis of a Corpus of MTV-Promoted Music Videos Aired Between 1990 and 1999
Authors: Osborn Brad , Rossin Emily , Weingarten Kevin
Published: March 2020

From 1990 to 1999 MTV promoted a series of 288 music videos called “Buzz Clips”, designed to highlight emerging artists and genres. Such promotion had a measurable impact on an artists’ earnings and record sales. To date, the kinds of musical and visual practices MTV promoted have not been quantitatively analyzed. Just what made some videos Buzzworthy, and others not? We applied two phases of content analysis to this corpus to determine the most common sonic and visual signifiers in Buzz Clips, then processed the results of that content analysis using polychoric correlations. Our findings show high degrees of shared variance between certain pairs of musical and visual elements observed in the sample music videos. We interpret a number of these relationships in terms of their relevance to a performer’s perceived ethnicity and gender, showing how certain audiovisual features regularly accompany white men (e.g., electric guitar) while others regularly accompany women and performers of color (e.g. drum machines).
Patients’ Experiences With a Digital Primary Health Care Concept Using Written Dialogues: A Pilot Study
Authors: Johansson Anders , Larsson Monica , Ivarsson Bodil
Published: March 2020

Background: The changing health care environment promotes the adoption of new information technologies to connect patients and health care providers. However, individuals greatly vary in their ability to use new digital systems, and in their feelings regarding integrity and validation. Caregivers in southern Sweden plan to implement a new digital primary health care (DPHC) service, and patients’ experiences must be studied to guide the best possible implementation of this service. Purpose: To examine the patients’ experiences with DPHC using written dialogues. Method: Patients were consecutively recruited from June 2018 to April 2019. This prospective pilot study used questionnaires with fixed response options, summarized as index values (IV, 0-1.0) in the following domains: communication, technical functionality, and general experience of DPHC. Results: Participants included 286 patients with a mean age of 40 ± 15 years. The response rate was 49% (n = 140), including 40 men (29%) and 100 women (71%). Communication using DPHC was experienced as fairly good (IV, 0.58), technical functionality was experienced as good (IV, 0.80), and the general experience of DPHC was positive with an IV of 0.76. The overall experience of the concept (IV, 0.71), corresponds to a median satisfaction value of 8.0 (interquartile range, 6-9). The patients felt well-prepared and experienced reasonable time aspects. Of the responding patients, 81% would recommend DPHC to others, and a notable reason for satisfaction was availability. However, patients expressed some uncertainty regarding the physician’s ability to assess correct care needs. Conclusion: The patients in our pilot study described their satisfaction and expressed good experiences with the concept of DPHC using written dialogues.
Urinary retention after total joint arthroplasty of hip and knee: Systematic review
Authors: Cha Yong-Han , Lee Young-Kyun , Won Seok-Hyung , Park Jung Wee , Ha Yong-Chan , Koo Kyung-Hoi
Published: March 2020

Purpose:

Postoperative urinary retention (POUR) is a common complication after total joint arthroplasties (TJAs). The POUR is managed with urinary catheterization, which is associated with a risk of urinary tract infection and subsequent periprosthetic joint infection. The purpose of this review was to afford a comprehensive understanding of POUR and its management.

Methods:

We identified 15 original articles concerning POUR after TJA, which were published from January 2010 to February 2019. The diagnostic method, incidence, risk factors, and management of POUR of the 15 studies were reviewed.

Results:

The incidence of POUR was ranged from 4.1% to 46.3%. Ultrasound was used for the detection of POUR among the total of the 15 studies. The following factors of old age, male gender, benign prostatic hypertrophy, history of urinary retention, spinal/epidural anesthesia, excessive fluid administration, patient-controlled analgesia, the use of opiates, underlying comorbidities, and poor American Society of Anesthesiologists (ASA) grade were risk factors for POUR. Most of the studies did not use indwelling catheterization during surgery. The POUR patients were managed with intermittent catheterization. The most common volume criterion for bladder catheterization was 400 mL. In inevitable use of an indwelling catheter, it should be removed within 48 h.

Conclusions:

This review provided an up-to-date guide for the detection and management of POUR.

Level of Evidence:

Level III.
Postoperative radiologic outcome comparison between conventional and computer-assisted navigation total knee arthroplasty in extra-articular tibia vara
Authors: Cho Yongun , Shin Hun-Kyu , Kim Eugene , Park Jai Hyung , Park Se-Jin , Jang Taedong , Jeong Hwa-Jae
Published: March 2020

Purpose:

Total knee arthroplasty (TKA) is the definite treatment for osteoarthritis. Meanwhile, significant inherent extra-articular varus angulation is associated with abnormal postoperative hip–knee–ankle (HKA) angle. Computer-assisted navigation TKA (CAS-TKA) used in patients who have severe varus deformity. The purpose of this study was to compare postoperative radiologic outcome between CAS-TKA and conventional TKA for extra-articular tibia vara.

Methods:

A retrospective review of postoperative HKA on standing lower extremity views was conducted in patients who underwent TKA by a single surgeon from 2010 to 2018, including knee with conventional TKA ( n = 83) and CAS-TKA ( n = 246). Extra-articular tibia vara was assessed by measuring the metaphyseal–diaphyseal angle (MDA) of the tibia in preoperative standing lower extremity view. Postoperative alignment was assessed by measuring the HKA in postoperative standing lower extremity view.

Results:

There was no significant difference in age ( p = 0.063), gender ( p = 0.628), body mass index ( p = 0.426), preoperative range of motion ( p = 0.524), preoperative HKA ( p = 0.306), preoperative MDA ( p = 0.523), or postoperative HKA ( p = 0.416) between the two groups (conventional TKA and CAS-TKA). There was no significant difference in postoperative alignment for cases with MDA ≤4° ( p = 0.351) or MDA >4° ( p = 0.866) in each group. There was a positive correlation between preoperative HKA and postoperative HKA in the CAS-TKA group ( p < 0.001, r = 0.243). However, there was no significant correlation between preoperative HKA and postoperative HKA in the conventional TKA group ( p = 0.732).

Conclusions:

There was no significant difference in postoperative alignment between conventional TKA and CAS-TKA in extra-articular tibial vara even for cases with MDA >4°.
Living With the Burden of Pseudobulbar Affect: A Qualitative Analysis of the Effects of Education on Patient Experience
Authors: Turell Wendy , Roc Anne , Pioro Erik , Howson Alexandra
Published: March 2020

Pseudobulbar affect (PBA) is associated with several neurological diseases and is underrecognized in clinical practice; however, PBA symptoms are often attributed to psychiatric or mood disorders rather than to neurological etiology. Until recently, there were no US Food and Drug Administration therapies approved for treating this condition, and there are currently few resources to support patients in the recognition and self-management of PBA symptoms. We evaluated the impact of a virtual education symposium on patient knowledge and self-efficacy via qualitative interviews. This evaluation of education impact provides unique insight into the experience of managing PBA symptoms; suggests that there is extensive need for educational resources to support patients with PBA and enable them to engage effectively with their providers; and affirms that online learning is an effective mechanism for delivering education to patients that enables them to more effectively self-manage symptoms in the context of chronic neurological conditions such as PBA.
Patient and Family Experience in a Multidisciplinary Clinic for Children With Single-Ventricle Heart Disease
Authors: Wolfe Kelly R , Kelly Sarah L , Liptzin Deborah R , Brigham Dania , Rafferty Carey , Younoszai Adel K , Di Maria Michael V
Published: March 2020

Children with single-ventricle heart disease (SVHD) are at risk for morbidity across multiple organ systems. A single-ventricle multidisciplinary clinic (SVMDC) may address complex health-care needs by providing access to, and coordination among, pediatric subspecialties. However, the patient and family experience of multidisciplinary care for SVHD remains unexplored. We e-mailed a 26-question survey to families after an SVMDC visit, which included evaluation with subspecialists from cardiology, pulmonology, gastroenterology, neuropsychology, and pediatric psychology, as well as social activities during clinic. Responses were anonymized to protect privacy, and data were analyzed quantitatively and qualitatively. Over 3 years, 22% (27/122) of families completed the survey. Overall, families’ experiences were positive, with 100% reporting that they would recommend the SVMDC to others. Qualitative themes emerged regarding logistics, multidisciplinary care, key takeaways from clinic, and connection-making with other families. A multidisciplinary clinic demonstrated overall acceptability and perceived benefit to families of children with SVHD. Considerations for mixed experiences regarding financial commitment and connection-making among parents are discussed, as are the benefits of the synergy achieved through multidisciplinary care.
Using The New Yorker Magazine’s Cartoon Caption Contest to Stimulate Creative Group Problem Solving: An In-Class Exercise
Authors: Keiser John D.
Published: March 2020

Three staples of management and organizational behavior classes are units on creativity, problem solving, and group decision making. This article presents an experiential exercise in creative problem solving in which the participants attempt to create a cartoon caption both individually and in small groups. The cartoons all come from The New Yorker magazine’s weekly Cartoon Caption Contest. The exercise allows the participants to get some experience in creative problem solving and decision making as group members. In addition to introducing these topics, the exercise proves to be a lighthearted way for students to get to know one another and helps create an interactive class environment during the semester.
Teaching “Shock Pathophysiology” by Flipped Classroom: Views and Perspectives
Authors: Rehman Rehana , Hashmi Satwat , Akbar Rozmeen , Fatima Syeda Sadia
Published: March 2020

Flipped classroom (FCR) is an active learning pedagogical method in which the students prepare prior to class using different modalities, for example, reading materials and videos, and afterward spend the time in class discussing the content and reinforcing the concepts. We chose to replace one problem-based case on “Shock” with flipped-style teaching in the respiration circulation module of a private medical university. Our objective was to use the clinical presentation of “Shock” to open a window to interrelate basic science concepts of cardiovascular physiology and pathology. It aimed to merge the case-based discussion with small-group discussions in the form of FCR activity. The qualitative study gives an overview of comments of facilitators, observers, and leadership of the Department and University obtained during focus group discussions and in-depth interviews. Thematic analysis of responses emphasized the importance of FCR as an effective teaching learning modality, which can be made more effective by careful selection of topic and provision of facilities to support technology-enhanced learning. The discussions with facilitators, observers, and leadership revealed its usefulness through student’s engagement and increased participation to build learning of the key concepts. Student satisfaction in these activities can be enhanced by construction of knowledge acquired in non–face-to-face component with substantial pre-reading materials, videos, peer discussions, quizzes, and prompt feedback.
The Legacy of Elisabeth Maria Redelstein, RN
Authors: Wogu Chigemezi-Nnadozie
Published: March 2020

Popularly known as “the China Nurse,” Elisabeth Redelstein was one of the most influential missionary nurses the Seventh-day Adventist Church ever had. Her life of service included her caring for patients in the United States, China, and Taiwan. Her devotion to work led her into friendship with the ruling family of China in the 1930s. Her zeal for health empowerment, including educating nurses in China and Taiwan, arose from her passion for women’s emancipation. Her commitment to the gospel and evangelization led her to engage in relief, social intervention, and rehabilitation efforts in Germany following the Second World War.
Positivist, constructivist and critical approaches to international human resource management and some future directions
Authors: Primecz Henriett
Published: March 2020

International human resource management has become a mature discipline in the last 30 years. As a sub-discipline of social sciences, international human resource management is characterised by paradigmatic divisions. The aim of this review article is to map the presence of three dominant social science paradigms in the field. Four major journals which publish relevant studies of international human resource management have been analysed in order to give an overview of the paradigmatic state of play. After investigating 1649 articles, it is evident that positivist studies prevail, whereas constructivist works are in a minority. Critical approaches to international human resource management are largely absent in these journals. This paper presents examples of each type of research and explains the decisive characteristics of each paradigm. Finally, future directions are outlined: (1) more paradigm reflexivity is required, (2) non-mainstream (namely, constructivist and even critical) research is needed, and (3) new paradigmatic directions are recommended. Newly introduced paradigms or multiparadigm studies should be undertaken.
Theoretical investigation of porous hydrostatic journal bearing under micropolar fluid lubrication
Authors: Bhattacharjee Biplab , Chakraborti Prasun , Choudhuri Kishan
Published: March 2020

The features of micropolar fluid (a non-Newtonian fluid)–lubricated short single-layered porous hydrostatic journal bearing are analyzed theoretically by an iterative method. To investigate hydrostatic journal bearing characteristics, a modified Reynolds equation in the case of micropolar fluid is derived and solved numerically. The obtained results in this work are validated by comparing the same with previously published results with Newtonian and non-Newtonian lubricants in the form of design charts. The static stiffness and load-carrying capacity of the investigated bearing are 80% and 75% higher than conventional hydrostatic bearings. The porous hydrostatic journal bearing exhibits more economical performance as it requires 40% low flow rate and low pump power, and it generates 50% less heat in contrast with other hydrostatic bearings.
Kidney transplant in multiple myeloma, the challenges, and potentials
Authors: Leung Nelson
Published: March 2020

Kidney failure is a common sequela of multiple myeloma. Tremendous progress in this disease over the past two decades has resulted in more than doubling of the median survival. Despite that, patients with irreversible kidney failure still have inferior outcomes as compared to those with intact kidney function. Kidney transplantation in these patients remains controversial. In this issue of Journal of Onco-Nephrology, two groups of clinicians caring for these patients debate the pros and cons of kidney transplantation in this population. The improvement of overall survival to 7.7 years in patients under the age of 65 years is a strong arg for kidney transplantation. In addition, the use of fluorescent in situ hybridization in risk assessment and minimal residual disease assessment for hematologic response could substantially improve patient selection for kidney transplantation. On the other hand, myeloma remains incurable and kidney failure itself is a high-risk feature. Despite advances, kidney transplantation in myeloma patients continues to present challenges with multiple myeloma relapse, rejection, and infection resulting in higher number of graft loss and death. Whether kidney transplant should be performed in patients with multiple myeloma currently remains debatable, but it may not be long before overall survival and disease control improve to the point where withholding kidney transplantation would be unethical. The questions in preparation for that day are should myeloma patients be held to the same metrics as patients without myeloma and if no, then what would be an acceptable overall and graft survival? Once the answers have been agreed upon by the experts and the governing bodies for transplantation, then proper clinical trials can be designed so that benefits can be optimized and precious resources not be wasted.
Human megakaryocytic microparticles induce de novo platelet biogenesis in a wild-type murine model
Authors: Escobar Christian , Kao Chen-Yuan , Das Samik , Papoutsakis Eleftherios T.
Published: March 2020

Platelet transfusions are used to treat idiopathic or drug-induced thrombocytopenia. Platelets are an expensive product in limited supply, with limited storage and distribution capabilities because they cannot be frozen. We have demonstrated that, in vitro, human megakaryocytic microparticles (huMkMPs) target human CD34+ hematopoietic stem and progenitor cells (huHSPCs) and induce their Mk differentiation and platelet biogenesis in the absence of thrombopoietin. In this study, we showed that, in vitro, huMkMPs can also target murine HSPCs (muHSPCs) to induce them to differentiate into megakaryocytes in the absence of thrombopoietin. Based on that, using wild-type BALB/c mice, we demonstrated that intravenously administering 2 × 106 huMkMPs triggered de novo murine platelet biogenesis to increase platelet levels up to 49% 16 hours after administration. huMkMPs also largely rescued low platelet levels in mice with induced thrombocytopenia 16 hours after administration by increasing platelet counts by 51%, compared with platelet counts in thrombocytopenic mice. Normalized on a tissue-mass basis, biodistribution experiments show that MkMPs localized largely to the bone marrow, lungs, and liver 24 hours after huMkMP administration. Beyond the bone marrow, CD41+ (megakaryocytes and Mk-progenitor) cells were frequent in lungs, spleen, and especially, liver. In the liver, infused huMKMPs colocalized with Mk progenitors and muHSPCs, thus suggesting that huMkMPs interact with muHSPCs in vivo to induce platelet biogenesis. Our data demonstrate the potential of huMkMPs, which can be stored frozen, to treat thrombocytopenias and serve as effective carriers for in vivo, target-specific cargo delivery to HSPCs.
Protocol for the EARCO Registry: a pan-European observational study in patients with α1-antitrypsin deficiency
Authors: Greulich Timm , Altraja Alan , Barrecheguren Miriam , Bals Robert , Chlumsky Jan , Chorostowska-Wynimko Joanna , Clarenbach Christian , Corda Luciano , Corsico Angelo Guido , Ferrarotti Ilaria , Esquinas Cristina , Gouder Caroline , Hećimović Ana , Ilic Aleksandra , Ivanov Yavor , Janciauskiene Sabina , Janssens Wim , Kohler Malcolm , Krams Alvils , Lara Beatriz , Mahadeva Ravi , McElvaney Gerry , Mornex Jean-François , O'Hara Karen , Parr David , Piitulainen Eava , Schmid-Scherzer Karin , Seersholm Niels , Stockley Robert A. , Stolk Jan , Sucena Maria , Tanash Hanan , Turner Alice , Ulmeanu Ruxandra , Wilkens Marion , Yorgancioğlu Arzu , Zaharie Ana , Miravitlles Marc
Published: March 2020

Rationale and objectives

Alpha-1 antitrypsin deficiency (AATD) is a genetic condition that leads to an increased risk of emphysema and liver disease. Despite extensive investigation, there remain unanswered questions concerning the natural history, pathophysiology, genetics and the prognosis of the lung disease in association with AATD. The European Alpha-1 Clinical Research Collaboration (EARCO) is designed to bring together researchers from European countries and to create a standardised database for the follow-up of patients with AATD.

Study design and population

The EARCO Registry is a non-interventional, multicentre, pan-European, longitudinal observational cohort study enrolling patients with AATD. Data will be collected prospectively without interference/modification of patient's management by the study team. The major inclusion criterion is diagnosed severe AATD, defined by an AAT serum level <11 µM (50 mg·dL−1) and/or a proteinase inhibitor genotype ZZ, SZ or compound heterozygotes or homozygotes of other rare deficient variants. Assessments at baseline and during the yearly follow-up visits include lung function testing (spirometry, body plethysmography and diffusing capacity of the lung), exercise capacity, blood tests and questionnaires (symptoms, quality of life and physical activity). To ensure correct data collection, there will be designated investigator staff to document the data in the case report form. All data will be reviewed by the EARCO database manager.

The EARCO Registry aims to understand the natural history and prognosis of AATD better with the goal to create and validate prognostic tools to support medical decision-making.
ERS International Congress, Madrid, 2019: highlights from the General Pneumology Assembly
Authors: Vanfleteren Lowie E.G.W. , Blervaque Léo , Franssen Frits M.E. , Daines Luke , Kocks Janwillem W.H. , Honkoop Persijn J. , Poberezhets Vitalii
Published: March 2020

This article contains highlights and a selection of the scientific advances from the European Respiratory Society's General Pneumology Assembly that were presented at the 2019 European Respiratory Society International Congress in Madrid, Spain. The most relevant topics from the different groups will be discussed, covering a wide range of areas including rehabilitation and chronic care, general practice and primary care and M-health and E-health. In this review, the newest research and actual data as well as award-winning abstracts and highlight sessions will be discussed.
Investigating Size-Dependent Conductive Properties on Individual Si Nanowires
Authors: Hu X. F. , Li S. J. , Wang J. , Jiang Z. M. , Yang X. J.
Published: March 2020

Periodically ordered arrays of vertically aligned Si nanowires (Si NWs) are successfully fabricated by nanosphere lithography combined with metal-assisted chemical etching. By adjusting the etching time, both the nanowires’ diameter and length can be well controlled. The conductive properties of such Si NWs and particularly their size dependence are investigated by conductive atomic force microscopy (CAFM) on individual nanowires. The results indicate that the conductance of Si NWs is greatly relevant to their diameter and length. Si NWs with smaller diameters and shorter lengths exhibit better conductive properties. Together with the I–V curve characterization, a possible mechanism is supposed with the viewpoint of size-dependent Schottky barrier height, which is further verified by the electrostatic force microscopy (EFM) measurements. This study also suggests that CAFM can act as an effective means to explore the size (or other parameters) dependence of conductive properties on individual nanostructures, which should be essential for both fabrication optimization and potential applications of nanostructures.