bluuebunny/crossref_metadata_2025 huggingface dataset:
Automatic prosthetic‐parameter estimation from anteroposterior pelvic radiographs after total hip arthroplasty using deep learning‐based keypoint detection
Authors: Tseng Tsung‐Wei , Chen Yueh‐Peng , Yeh Yu‐Cheng , Kuo Chang‐Fu , Fan Tzuo‐Yau , Lin Yu‐Chih
Published: March 2022

Background

X‐ray is a necessary tool for post‐total hip arthroplasty (THA) check‐ups; however, parameter measurements are time‐consuming. We proposed a deep learning tool, BKNet that automates localization of landmarks with parameter measurements.

Methods

About 3072 radiographs from 3021 patients who underwent THA at our institute between 2013 and 2017 were used. We employed BKNet to perform landmark localization with parameter measurements in these radiographs. The performance of BKNet was assessed and compared with that of human observers.

Results

The 75‐percentile cut‐off errors were <0.5 cm in all key points. The Bland–Altman methods show the agreement between the predicted and ground truth parameters. Human and BKNet comparison revealed the model could match the repeatability for 7/10 of the parameters.

Conclusions

The accuracy of BKNet is equivalent to that of human observers, and BKNet was able to perform prosthetic‐parameter estimation from keypoint detection with superior cost‐effectiveness, repeatability, and timesaving compared to human observers.
Tunable Nanoporous Structures with Rose Petal Effect by Soft‐Template Electropolymerization of Benzotrithiophene Monomers
Authors: Sow Salif , Dihissou Salihu , Dramé Abdoulaye , Sene Aboubacary , Orange François , Dieng Samba Yandé , Guittard Frédéric , Darmanin Thierry
Published: March 2022

Here, various original benzotrithiophene‐based monomers are synthesized and studied for their capacity to form nanoporous structures by soft‐template electropolymerization in organic solvent while studying the influence of water (H2O). Here, nanoporous structures are especially observed in solvent saturated with H2O, while the substituent has in influence especially on the size of the porous structures. The highest hydrophobic properties Θw=141.1° are obtained with perfluorooctyl chains (BTT‐F8), which leads to a huge number of nanoporous structures of extremely small size. Moreover, the surfaces have also strong water adhesion comparable to rose petals or gecko foot and could be used in future applications in water harvesting systems.
Engineering of Surface Energy of Cell‐Culture Platform to Enhance the Growth and Differentiation of Dendritic Cells via Vapor‐Phase Synthesized Functional Polymer Films
Authors: Lee Minseok , Chun Dongmin , Park Seonghyeon , Choi Goro , Kim Yesol , Kang Suk‐Jo , Im Sung Gap
Published: March 2022

Although the dendritic cell (DC)‐based modulation of immune responses has emerged as a promising therapeutic strategy for tumors, infections, and autoimmune diseases, basic research and therapeutic applications of DCs are hampered by expensive growth factors and sophisticated culture procedures. Furthermore, the platform to drive the differentiation of a certain DC subset without any additional biochemical manipulations has not yet been developed. Here, five types of polymer films with different hydrophobicity via an initiated chemical vapor deposition (iCVD) process to modulate the interactions related to cell–substrate adhesion are introduced. Especially, poly(cyclohexyl methacrylate) (pCHMA) substantially enhances the expansion and differentiation of conventional type 1 DCs (cDC1s), the prime DC subset for antigen cross‐presentation, and CD8+ T cell activation, by 4.8‐fold compared to the conventional protocol. The cDC1s generated from the pCHMA‐coated plates retain the bona fide DC functions including the expression of co‐stimulatory molecules, cytokine secretion, antigen uptake and processing, T cell activation, and induction of antitumor immune responses. To the authors’ knowledge, this is the first report highlighting that the modulation of surface hydrophobicity of the culture plate can be an incisive approach to construct an advanced DC culture platform with high efficiency, which potentially facilitates basic research and the development of immunotherapy employing DCs.
Organic frameworks confined Cu single atoms and nanoclusters for tandem electrocatalytic CO2 reduction to methane
Authors: Zhao Qinglan , Wang Yian , Li Meng , Zhu Shangqian , Li Tiehuai , Yang Jixiang , Lin Ting , Delmo Ernest P. , Wang Yinuo , Jang Juhee , Gu Meng , Shao Minhua
Published: March 2022

The electrochemical reduction reaction of carbon dioxide (CO2RR) is considered to be an effective way to realize carbon neutrality. As a type of intensively studied materials, covalent organic frameworks (COFs) with a tunable pore structure and various functional groups are promising catalysts for CO2RR. Herein, COF synthesized by 2,6‐diaminoanthraquinone and 2,4,6‐triformylphloroglucinol is employed to assist the synthesis of electrocatalysts from Cu single atoms (SAs) to nanoclusters by controlling the electrodeposition. A tandem catalyst for CO2‐to‐CH4 conversion is thus achieved by the Cu nanoclusters dispersed among the isolated Cu SAs in the COF network. It is proposed that CO2 is first reduced to CO over the atomically isolated Cu SAs, followed by diffusion onto the neighboring Cu nanoclusters for further reduction into CH4. In addition, mechanistic analysis suggests that the coordinated K+ ions on the COF network promote the activation of CO2 and the adsorption of reaction intermediates, thus realizing the suppressed hydrogen evolution reaction and selective production of CH4. This study presents a new insight of COFs for the confined synthesis of a tunable SA to nanocluster electrocatalysts, disclosing the great potential of COFs in electrocatalysis.
Influence of the Ti Content on the Grain Stability and the Recrystallization Behavior of Nb‐Alloyed High‐Strength Low‐Alloyed Steels
Authors: Monschein Stefan , Ragger Katharina S. , Zügner Dominik , Fasching Josef , Schnitzer Ronald
Published: March 2022

To achieve higher strength and good hardenability and at the same time use the positive effects of thermomechanical controlled processing, the concept of Nb and Ti microalloyed steels is increasingly used for high‐strength low‐alloy (HSLA) steels with higher C contents. Herein, how the addition of Ti affects the grain growth and static recrystallization behavior of a Nb microalloyed HSLA steel with a C content of 0.23 wt% is investigated. For this reason, alloys with varying Ti and constant Nb content are produced and investigated by means of annealing and double‐hit deformation experiments. Atom probe tomography measurements reveal that the Nb concentration in the matrix decreases with increasing Ti content. Therefore, the static recrystallization behavior is steadily inhibited with decreasing Ti content, as more dissolved Nb is available for the formation of strain‐induced NbC precipitates. The annealing experiments show that the combined addition of Ti and Nb is most effective against grain coarsening, regardless of whether the Ti content is 90 or 180 ppm. To use the positive properties of Ti against grain coarsening and Nb to inhibit recrystallization, a middle content must be chosen when alloying Ti to HSLA steels with higher C content.
“The Darker Your Skin Color is, the Harder it is in Korea”: Discursive Construction of Racial Identity in Teaching Internationally
Authors: Lee Hakyoon , Jang Gyewon
Published: March 2022

Growing interest in international teaching programs has produced a surge of research on international language teaching (Menard‐Warwick, 2008). However, there are relatively few studies on the international teaching experiences of native English‐speaking teachers of color regarding their racial identity. To fill this gap, this longitudinal multi‐case study explores how three non‐White novice native English‐speaking teachers understood their racial and teacher identities during their international teaching in Korea. With a specific focus on their racial identity, how they make sense of their teaching and living experiences is examined in diverse contexts of their social interactions. The participants’ reflective and evaluative narratives from interviews were analyzed. The findings show that although their racial identity has a negative impact on their linguistic and professional identity that is denied by Korean society, the teachers utilized their own strategies for constructing a sense of belonging to the local and professional community. This study calls for a holistic, situated understanding of racial identity construction of non‐White native English teachers by urging further discussion of racism in the global ELT profession. This discussion encompasses the varying, pressing needs of expatriate English teachers from diverse backgrounds.
Skill versus Social Practice? Some Challenges in Teaching Digital Literacy in the University Classroom
Authors: Weninger Csilla
Published: March 2022

Digital literacy is viewed by many governments as an educational priority area, resulting in policies and curricula aimed at developing students’ digital literacy skills. This can present many challenges, including lacking teacher professional development, uneven digital infrastructure across school districts or unequal access to digital media among students. In this article, I focus on a different challenge that stems from differing definitions of digital literacy among educational researchers, teachers, and educational policy makers and the tensions that can arise from these differences for teachers who are tasked with developing learners’ digital literacy. Specifically, I discuss how I have merged a curricular mandate for a skills‐heavy digital literacy policy with my theoretical conviction of literacy as social practice in my teaching of a tertiary course on digital literacy. To do so, I first critically examine Singapore’s recent digital literacy curriculum reform with reference to a larger divide between conceptualizations of digital literacy as technical, decontextualized skills related to employability on the one hand and as social practice rooted in students’ lived experiences on the other. Second, I discuss my efforts at combining these two perspectives in teaching digital media literacy, highlighting how we can foster digital ‘skills’ and critical engagement with digital media while providing space for playful and creative communicative practice.
The role of water in environmental migration
Authors: Stoler Justin , Pearson Amber L. , Rosinger Asher Y. , Lee Alison Elizabeth , Bombardi Rodrigo , Brewis Alexandra , Keough Sara Beth , López‐Carr David , Shrader Cho‐Hee , Stauber Christine E. , Stevenson Edward G. J. , Sullivan Andrea , Tutu Raymond A.
Published: March 2022

Water has always been a driver of human mobility, migration, and displacement. But water is increasingly central to explaining environmental migration in the context of climate change. Most studies of the relationship between water and environmental migration are framed around punctuated, extreme weather events and disasters that either limit agricultural or livestock productivity or make a community physically unlivable. The chronic experiences of household water insecurity and poor water governance also shape migration decision‐making through a variety of social, political, and economic factors, but these relationships have received considerably less attention. This article provides an overview of punctuated and chronic water‐related triggers of environmental migration at the household level. We also offer a conceptual framework based on multiphasic response theory that highlights water's multiple roles in migration decision‐making. We close by reflecting on key gaps in the climate‐water‐migration literature, identifying research questions that might help us better understand these relationships, and considering the implications for sustainable development policies that could potentially ease pressures on water‐related displacement.
The Religious Experience of Ill Health in Late Sixteenth-Century Italy
Authors: Kuuliala Jenni
Published: March 2022

This chapter discusses the role of lived religion in interpreting and forming the experience of illness, disability, and pain. The focus is on two cultural scripts that were inherent to early modern Italian culture: miracles and witchcraft. By using canonization process records and records of the Roman Inquisition as the source, the analysis focuses on the ways the veneration of saints and the belief in miraculous healing as well as the idea that witchcraft could make a person ill played into the lived religion of the period.
Prayer and the Body in Lay Religious Experience in Early Modern Finland
Authors: Toivo Raisa Maria
Published: March 2022

Toivo’s chapter systematizes prayer as experience on three levels, as everyday encounters, as social processes and as structures. It shows the material and the corporeal nature of the early modern prayer to play an essential part in the ways the religious experience of a prayer was simultaneously constructed and personalized and shared. Praying was ‘doing’ in a much more holistic sense than merely saying words or even less thinking thoughts to God. The body and the material surroundings of the prayer form a space where the experience takes place, even ‘a tool’ to experience with.
Extended Families as Communities of Religious Experience in Late Seventeenth-Century Eastern Finland
Authors: Kuha Miia
Published: March 2022

This chapter offers an interpretation of extended families as communities of experience in a rural area close to the eastern border of the Swedish realm. Through a case study of lower court records, Kuha examines the social and religious life in a 17th-century farm culminating in the crisis of an extended family. The chapter explores how practices of lived religion shaped the relationship of the community and the individual, and how experiences were negotiated within families and local communities. The analysis highlights the importance of protecting the boundaries of the household as well as the meaning of religious practices in creating cohesion within the community.
Visualization of the distal tibial plafond articular surface using four established approaches and the efficacy of instrumented distraction: a cadaveric study
Authors: Kleinertz Holger , Tessarzyk Marlon , Schoof Benjamin , Nüchtern Jakob Valentin , Püschel Klaus , Barg Alexej , Frosch Karl-Heinz
Published: March 2022

Purpose

Direct visualization is a very effective method in accomplishing adequate articular surface reconstruction in fracture repair. This study investigates distal tibial plafond articular surface visibility using the anteromedial, anterolateral, posteromedial, and posterolateral approaches, the effect of instrumented distraction on visibility, and which zones of the articular surface are visible for each approach.

Methods

The anteromedial, anterolateral, posteromedial, and posterolateral approaches to the distal tibial plafond were performed on 16 cadaveric ankle specimens. The articular surface visualization for each approach was marked using an electrocautery device with manual and instrumented distraction. Articular surface visualization was photographically documented. Digital axial segmentation and quantitative analysis of the visualized distal tibial plafond articular surface were performed.

Results

With manual distraction, distal tibial plafond articular surface visualization, expressed in percent of overall articular surface, was limited to 9% (SD ± 9) for the anteromedial, 24% (SD ± 18) for the anterolateral, 26% (SD ± 10) for the posteromedial, and 30% (SD ± 18) for the posterolateral approaches. Using instrumented distraction significantly improved articular surface visualization in all instances (p < 0.001). The anteromedial approach visible articular surface increased to 63% (SD ± 13), the anterolateral to 72% (SD ± 22), the posteromedial to 62% (SD ± 11), and the posterolateral to 50% (± 17).

Conclusion

This study demonstrates the efficacy of instrumented distraction when attempting surgical visualization of the distal tibial plafond articular surface. Knowledge of approach specific articular surface visibility may assist the surgeon in choosing the appropriate approach(es) based on case-specific distal tibial plafond fracture patterns.

Level of evidence

IV, cadaver study.
Atopische Dermatitis – Identifikation von Bedürfnissen der deutschen Bevölkerung mittels Internetsuchanfragen
Authors: Tizek Linda , Schielein Maximilian C. , Tizek Lucas , Zink Alexander
Published: March 2022

Hintergrund

Das Internet ist eine der wichtigsten Informationsquellen für gesundheitliche Themen für die Allgemeinbevölkerung. Deshalb kann die Analyse von Internetsuchmaschinen dabei helfen, die gesellschaftlichen Interessen und Bedürfnisse bezüglich Erkrankungen zu erfassen.

Ziel

Ziel dieser Studie war es, die Suchanfragen zu atopischer Dermatitis (AD) in Bezug auf Häufigkeit, Interessenschwerpunkt und zeitliches Auftreten in allen deutschen Bundesländern zu untersuchen, um mögliche regionale Unterschiede zu identifizieren.

Material und Methoden

Mithilfe des Google Ads Keyword Planner wurden AD relevante Keywords inklusive deren monatlichen Suchvolumens zwischen Januar 2017 und Dezember 2020 identifiziert, die in Interessenschwerpunkte unterteilt wurden.

Ergebnisse

Es wurden 1419 Keywords gefunden, die ein Suchvolumen von 14.817.610 Anfragen hatten. Das größte Suchvolumen hatte die Kategorie Allgemein (n = 5.970.840), jedoch wurden der Kategorie Lokalisation die meisten Keywords zugeordnet (n = 348). Rund 60 % der Keywords zu Lokalisation bezogen sich auf AD im Gesicht. Von allen Bundesländern hatten Bremen und Hamburg das größte Suchvolumen pro 100.000 Einwohner. Mit über 70 % war ein enormer Anstieg im Suchvolumen zu beobachten, der v. a. 2020 sichtbar wurde.

Diskussion

Durch diese Internetsuchmaschinenanalyse konnte verdeutlicht werden, welche AD-relevanten Aspekte von besonderer Bedeutung für die Bevölkerung waren, was dabei helfen kann, Informationskampagnen zielgerichtet anzupassen. Zudem unterstreicht die Studie die immer größer werdende Relevanz des Internets als Informationsquelle für gesundheitliche Themen.
Mental health service use among mothers involved in public family law proceedings: linked data cohort study in South London 2007–2019
Authors: Pearson Rachel J. , Grant Claire , Wijlaars Linda , Finch Emily , Bedston Stuart , Broadhurst Karen , Gilbert Ruth
Published: March 2022

Purpose

Mental health problems and substance misuse are common among the mothers of children who experience court-mandated placement into care in England, yet there is limited research characterising these health needs to inform evidence-based policy. In this descriptive study, we aimed to generate evidence about the type, severity, and timing of mental health and substance misuse needs among women involved in public family law proceedings concerning child placement into care (‘care proceedings’).

Methods

This is a retrospective, matched cohort study using linked family court and mental health service records for 2137 (66%) of the 3226 women involved in care proceedings between 2007 and 2019 in the South London and Maudsley NHS Mental Health Trust (SLaM) catchment area. We compared mental health service use and risk of dying with 17,096 female-matched controls who accessed SLaM between 2007 and 2019, aged 16–55 years, and were not involved in care proceedings.

Results

Most women (79%) were known to SLaM before care proceedings began. Women had higher rates of schizophrenia spectrum disorders (19% vs 11% matched controls), personality disorders (21% vs 11%), and substance misuse (33% vs 12%). They were more likely to have a SLaM inpatient admission (27% vs 14%) or to be sectioned (19% vs 8%). Women had a 2.15 (95% CI 1.68–2.74) times greater hazard of dying, compared to matched controls, adjusted for age.

Conclusion

Women involved in care proceedings experience a particularly high burden of severe and complex mental health and substance misuse need. Women’s increased risk of mortality following proceedings highlights that interventions responding to maternal mental health and substance misuse within family courts should offer continued, long-term support.
Robotic weld groove scanning for large tubular T-joints using a line laser sensor
Authors: Cibicik Andrej , Njaastad Eirik B. , Tingelstad Lars , Egeland Olav
Published: March 2022

This paper presents a novel procedure for robotic scanning of weld grooves in large tubular T-joints. The procedure is designed to record the discrete weld groove scans using a commercially available line laser scanner which is attached to the robot end-effector. The advantage of the proposed algorithm is that it does not require any prior knowledge of the joint interface geometry, while only two initial scanning positions have to be specified. The position and orientation of the following scan are calculated using the data from two previous weld groove scans, so once initiated, the scanning process is fully autonomous. The procedure is a two-step algorithm consisting of the prediction and correction substeps, where the position and orientation of the sensor for the following scan are predicted and corrected. Such a procedure does not require frequent weld groove scanning for navigation along the groove. The performance of the proposed procedure is studied experimentally using an industrial-size T-joint specimen. Several cases of scanning motion parameters have been tested, and a discussion on the results is given.
Incidence of Liver Resection Following the Introduction of Caseload Requirements for Liver Surgery in Switzerland
Authors: Haak Fabian , Soysal Savas , Deutschmann Elisabeth , Moffa Giusi , Bucher Heiner C. , Kaech Max , Kettelhack Christoph , Kollmar Otto , von Strauss und Torney Marco
Published: March 2022

Background

Centralization of care is an established concept in complex visceral surgery. Switzerland introduced case load requirements (CR) in 2013 in five areas of cancer surgery. The current study investigates the effects of CR on indication and mortality in liver surgery.

Methods

This is a retrospective analysis of a complete national in‐hospital data set including all admissions between January 1, 2005, and December 31, 2015. Primary outcome variables were the incidence proportion and the 60‐day in‐hospital mortality of liver resections. Incidence proportion was calculated as the overall yearly number of liver resections performed in relation to the population living in Switzerland before and after the introduction of CR.

Results

Our analysis shows an increase number of liver resections compared to the period before introduction of CR from 2005–2012 (4.67 resections/100,000) to 2013–2015 (5.32 resections/100,000) after CR introduction. Age‐adjusted incidence proportion increased by 14% (OR 1.14 95 CI [1.07–1.22]). National in‐hospital mortality remained stable before and after CR (4.1 vs 3.7%), but increased in high‐volume institutions (3.6 vs 5.6%). The number of hospitals performing liver resections decreased after the introduction of CR from 86 to 43. Half of the resections were performed in institutions reaching the stipulated numbers (53% before vs 49% after introduction of CR). After implementation of CR, patients undergoing liver surgery had more comorbidities (88 vs 92%).

Conclusion

The introduction of CR for liver surgery in Switzerland in 2013 was accompanied by an increase in operative volume with limited effects on centralization of care.
The accuracy of Vesical Imaging-Reporting and Data System (VI-RADS): an updated comprehensive multi-institutional, multi-readers systematic review and meta-analysis from diagnostic evidence into future clinical recommendations
Authors: Del Giudice Francesco , Flammia Rocco Simone , Pecoraro Martina , Moschini Marco , D’Andrea David , Messina Emanuele , Pisciotti Lucia Martina , De Berardinis Ettore , Sciarra Alessandro , Panebianco Valeria
Published: March 2022

Purpose

To determine through a comprehensive systematic review and meta-analysis the cumulative diagnostic performance of vesical imaging-reporting and data system (VIRADS) to predict preoperative muscle-invasiveness among different institutions, readers, and optimal scoring accuracy thresholds.

Methods

PubMed, Cochrane and Embase were searched from inception up to May 2021. Sensitivity (Sn), Specificity (Sp) were first estimated and subsequently pooled using hierarchical summary receiver operating characteristics (HSROC) modeling for both cut-off ≥ 3 and ≥ 4 to predict muscle-invasive bladder cancer (MIBC). Further sensitivity analysis, subgroup analysis and meta-regression were conducted to investigate contribution of moderators to heterogeneity.

Results

In total, n = 20 studies from 2019 to 2021 with n = 2477 patients by n = 53 genitourinary radiologists met the inclusion criteria. Pooled weighted Sn and Sp were 0.87 (95% CI 0.82–0.91) and 0.86 (95% CI 0.80–0.90) for cut-off ≥ 3 while 0.78 (95% CI 0.74–0.81) and 0.94 (95% CI 0.91–0.96) for cut-off ≥ 4. The area under the HSROC curve was 0.93 (95% CI 0.90–0.95) and 0.91 (95% CI 0.88–0.93) for cut-off ≥ 3 and ≥ 4, respectively. Meta-regression analyses showed no influence of clinical characteristics nor cumulative reader’s experience while study design and radiological characteristics were found to influence the estimated outcome.

Conclusion

We demonstrated excellent worldwide diagnostic performance of VI-RADS to determine pre-trans urethral resection of bladder tumor (TURBT) staging. Our findings corroborate wide reliability of VI-RADS accuracy also between different centers with varying experience underling the importance that standardization and reproducibility of VI-RADS may confer to multiparametric magnetic resonance imaging (mpMRI) for preoperative BCa discrimination.
Clinical impact of changes in mitral regurgitation severity after medical therapy optimization in heart failure
Authors: Pagnesi Matteo , Adamo Marianna , Sama Iziah E. , Anker Stefan D. , Cleland John G. , Dickstein Kenneth , Filippatos Gerasimos S. , Inciardi Riccardo M. , Lang Chim C. , Lombardi Carlo M. , Ng Leong L. , Ponikowski Piotr , Samani Nilesh J. , Zannad Faiez , van Veldhuisen Dirk J. , Voors Adriaan A. , Metra Marco
Published: March 2022

Background

Few data are available regarding changes in mitral regurgitation (MR) severity with guideline-recommended medical therapy (GRMT) in heart failure (HF). Our aim was to evaluate the evolution and impact of MR after GRMT in the Biology study to Tailored treatment in chronic heart failure (BIOSTAT-CHF).

Methods

A retrospective post-hoc analysis was performed on HF patients from BIOSTAT-CHF with available data on MR status at baseline and at 9-month follow-up after GRMT optimization. The primary endpoint was a composite of all-cause death or HF hospitalization.

Results

Among 1022 patients with data at both time-points, 462 (45.2%) had moderate-severe MR at baseline and 360 (35.2%) had it at 9-month follow-up. Regression of moderate-severe MR from baseline to 9 months occurred in 192/462 patients (41.6%) and worsening from baseline to moderate-severe MR at 9 months occurred in 90/560 patients (16.1%). The presence of moderate-severe MR at 9 months, independent from baseline severity, was associated with an increased risk of the primary endpoint (unadjusted hazard ratio [HR], 2.03; 95% confidence interval [CI], 1.57–2.63; p < 0.001), also after adjusting for the BIOSTAT-CHF risk-prediction model (adjusted HR, 1.85; 95% CI 1.43–2.39; p < 0.001). Younger age, LVEF ≥ 50% and treatment with higher ACEi/ARB doses were associated with a lower likelihood of persistence of moderate-severe MR at 9 months, whereas older age was the only predictor of worsening MR.

Conclusions

Among patients with HF undergoing GRMT optimization, ACEi/ARB up-titration and HFpEF were associated with MR improvement, and the presence of moderate-severe MR after GRMT was associated with worse outcome.

Graphical abstract
Pediatric morphometric study to guide the optimized implantation of the Osia® 2 implant system
Authors: Posta Balint , Perenyi Adam , Szabo Linda , Nagy Roland , Katona Gabor , Csakanyi Zsuzsanna , Rovo Laszlo , Bere Zsofia
Published: March 2022

Purpose

Continuous technological advances result in the availability of new bone conduction hearing implants, of which their suitability for pediatric patients is of major concern. The CochlearTMOsia® 2 is a new active osseointegrated steady-state implant system that uses digital piezoelectric stimulation to treat hearing loss. The implant in the United States was approved for patients aged 12 years and above, whereas the CE mark is independent of age, the only requirement is body weight of at least 7 kg. Therefore, further clinical studies are required to assess device characteristics in younger patients. The aim of our study was to perform a morphometric study among 5–12-year-old children, and to develop a surgical protocol for Osia 2 system implantation based on these findings.

Methods

We examined retrospectively cranial CT scans of 5–12-year-old patients from our clinical database. We measured the bone and soft-tissue thickness in the region of interest, and the position of the sigmoid sinus. 3D printed temporal bones were also used for planning.

Results

Soft-tissue thickness varied between 3.2 ± 0.5 mm and 3.6 ± 0.6 mm and bone thickness varied between 3.5 ± 1.1 mm and 4.7 ± 0.3 mm. The sigmoid sinus was located 1.3 ± 0.2 cm posterior to the ear canal, and the anterior distance was 4.8 ± 0.9 to 7.1 ± 1.1 mm.

Conclusions

Our morphometric studies showed that patients aged 5–12 have different anatomical dimensions compared to adults, but that implantation of the Osia 2 system is feasible in these patients using an altered implant positioning recommended by our data. The Cochlear™ Osia® 2 is, therefore, an option for hearing rehabilitation in younger pediatrics.
Reported thresholds of self-motion perception are influenced by testing paradigm
Authors: Pleshkov M. , Rondas N. , Lucieer F. , van Stiphout L. , Janssen M. , Guinand N. , Perez-Fornos A. , Demkin V. , van Rompaey V. , Kingma H. , van de Berg R.
Published: March 2022

Background/objective

Different testing paradigms have been proposed to investigate perceptual self-motion thresholds. They can differ regarding the amount of possible motions that patients have to choose from. Objective of this study was to compare the two-option paradigm and twelve-option paradigm, to investigate whether reducing the choice options significantly influences the reported thresholds of self-motion perception of healthy subjects.

Methods

Thirty-three volunteers with no prior vestibular complaints were included and sequentially tested with both paradigms at a random sequence. Perceptual self-motion thresholds were measured using a hydraulic motion platform in the absence of external visual and auditory cues. The platform delivered twelve different movements: six translations and six rotations. Each subject had to report the correct type and direction of movements. Thresholds were determined by a double confirmation of the lowest threshold, in combination with a double rejection of the one-step lower stimulus. Perceptual self-motion thresholds of both paradigms were compared using the mixed model analysis.

Results

The twelve-option paradigm showed significantly higher reported thresholds for yaw rotations and translations left, right and down (p < 0.001), compared to the two-option paradigm. No statistical difference was found for rolls and translations up. No significant gender effect, learning effect and carry-over effect were present in any of the applied motion directions.

Conclusion

Reported thresholds of self-motion perception of healthy subjects are influenced by the testing paradigm. The twelve-option paradigm showed significantly higher thresholds than the two-option paradigm. Results obtained with each testing paradigm should, therefore, be compared to paradigm-specific normative data.
The Cologne-Mecklenburg-Vorpommern DMEK Donor Study (COMEDOS) — design and review of the influence of donor characteristics on Descemet membrane endothelial keratoplasty (DMEK) outcome
Authors: Schrittenlocher Silvia , Matthaei Mario , Bachmann Björn , Cursiefen Claus
Published: March 2022

Background

Posterior lamellar keratoplasty and especially Descemet membrane endothelial keratoplasty (DMEK) are gaining interest worldwide. Little is known about the influence of donor factors on DMEK outcome. Here we provide an overview of the existing peer-reviewed literature on this topic and present the design of the upcoming cooperation study COMEDOS (Cologne-Mecklenburg-Vorpommern DMEK Donor Study).

Methods

A literature search of PubMed and MEDLINE was conducted to retrieve articles published between September 2013 and May 2021. Seventeen peer-reviewed articles were selected. Design and concept of the prospective COMEDOS are outlined.

Results

Main interest parameters were the donor diabetes mellitus status, age, and lens status. There is a large heterogeneity regarding the sample size, study design, and investigated parameters. There seems to be a consensus that younger donors are associated with tighter rolls, a more difficult preparation, and unfolding setting. Diabetic donors seem to increase the risk of tissue tearing due to adherences and result more frequently in preparation failure. The COMEDOS aims not only to analyze the diabetes status of the donor, but also to correlate all donor systemic comorbidities and their ophthalmologic history to the DMEK clinical outcome. Furthermore, a correlation of Descemet membrane lamella preparation and surgery outcome is planned.

Conclusion

Currently, there is a lack of knowledge regarding the effect and impact of donor tissue characteristics on DMEK outcome and complications. An in-depth investigation is planned by the upcoming COMEDOS to close this knowledge gap.
Risk factors for shoulder disorders among French workers: prospective cohort study
Authors: Bodin Julie , Garlantézec Ronan , Descatha Alexis , Evanoff Bradley , Thomas Thierry , Roquelaure Yves
Published: March 2022

Objectives

Shoulder disorders are common in the working population. This longitudinal study aimed to explore the relationships between personal factors and occupational organisational, psychosocial, and biomechanical factors and the incidence of shoulder disorders.

Methods

A total of 3710 workers in the Pays de la Loire region (Loire Valley area, France) were randomly included by their occupational physician in the Cosali cohort between 2002 and 2005. All workers completed a self-administered questionnaire about personal factors and work exposure, and using a standardised physical examination, occupational physicians diagnosed shoulder disorders. Between 2007 and 2010, 1611 workers were re-examined by their occupational physician. The 1,320 workers free of shoulder disorders at baseline were studied. A conceptual model was developed in which relationships between organisational, psychosocial, biomechanical, and personal factors at baseline and the incidence of shoulder disorders were assumed. Structural equation modelling was used to test the model.

Results

Shoulder disorders were directly associated with biomechanical factors and age but not with psychosocial factors. However, skill discretion and psychological demand influenced shoulder disorders indirectly through biomechanical factors. Exposure to a work pace dependent on an automatic rate and to a work pace dependent on customers’ demands were associated with biomechanical and psychosocial factors, but not directly to shoulder disorders.

Conclusions

This study identified the complex direct and indirect relationships between occupational factors and shoulder disorders. Our data confirmed our conceptual causation model: organisational and psychosocial factors were associated with biomechanical factors, while biomechanical factors were associated with the incidence of shoulder disorders.
Sudden neonatal death in individuals with medium-chain acyl-coenzyme A dehydrogenase deficiency: limit of newborn screening
Authors: Mütze Ulrike , Nennstiel Uta , Odenwald Birgit , Haase Claudia , Ceglarek Uta , Janzen Nils , Garbade Sven F. , Hoffmann Georg F. , Kölker Stefan , Haas Dorothea
Published: March 2022

Medium-chain acyl-coenzyme A dehydrogenase (MCAD) deficiency is the most common disorder of mitochondrial β-oxidation of fatty acids resulting in hypoketotic hypoglycemia, hepatopathy, and often fatal outcome in undiagnosed children. Introduction of tandem mass spectrometry–based newborn screening programs in the late 1990s has significantly reduced morbidity and mortality in MCAD deficiency; however, neonatal death in individuals with early disease manifestation and severe hypoglycemia may still occur. We describe the fatal disease course in eight newborns with MCAD deficiency, aiming to raise awareness for early clinical symptoms and the life-saving treatment, and promote systematic post-mortem protocols for biochemical and genetic testing, necessary for correct diagnosis and counselling of the family if unexpected death occurred in the neonatal period.

Conclusion: Early newborn screening and awareness for clinical symptoms is lifesaving in MCAD deficiency, which may present with fatal neonatal crisis. Systematic post-mortem diagnostic protocols are needed for sudden neonatal deaths.

What is Known:• Medium-chain acyl-coenzyme A dehydrogenase (MCAD) deficiency identified by newborn screening has an excellent outcome.• Fatal neonatal crises occur in the first days prior to screening.

What is New:• Poor feeding, no monitoring of blood glucose, and homozygosity of the common gene variant (c.985A > G) are major risk factors for fatal neonatal crisis in MCAD deficiency.• Post-mortem diagnostic protocols are indispensable for correct diagnosis and counselling of the family if unexpected death occurred in the neonatal period.
Variability in Swallowing Biomechanics in Infants with Feeding Difficulties: A Videofluoroscopic Analysis
Authors: Fuller Laura , Miles Anna , Dharmarathna Isuru , Allen Jacqui
Published: March 2022

Clinicians performing feeding evaluations in infants often report swallow variability or inconsistency as concerning. However, little is known about whether this represents pathological incoordination or normal physiologic variance in a developing child. Our retrospective study explored quantitative videofluoroscopic measures in 50 bottle-fed infants (0–9 months) referred with feeding concerns. Our research questions were as follows: Is it possible to assess swallow to swallow variability in an infant with feeding concerns, is there variability in pharyngeal timing and displacement in infants referred for videofluoroscopy, and is variability associated with aspiration risk? Measures were taken from a mid-feed, 20-s loop recorded at 30 frames per second. Each swallow within the 20-s loop (n = 349 swallows) was analysed using quantitative digital measures of timing, displacement and coordination (Swallowtail™). Two blinded raters measured all swallows with strong inter-rater reliability (ICC .78). Swallow frequency, suck-swallow ratio, residue and aspiration were also rated. Variability in timing and displacement was identified across all infants but did not correlate with aspiration (p > .05). Sixteen infants (32%) aspirated. Across the cohort, swallow frequency varied from 1 to 15 within the 20-s loops; suck-swallow ratios varied from 1:1 to 6:1. Within-infant variability in suck-swallow ratios was associated with higher penetration-aspiration scores (p < .001). In conclusion, pharyngeal timing and displacement variability is present in infants referred with feeding difficulties but does not correlate with aspiration. Suck-swallow ratio variability, however, is an important risk factor for aspiration that can be observed at bedside without radiation. These objective measures provide insight into infant swallowing biomechanics and deserve further exploration for their clinical applicability.
Exercise in allogeneic bone marrow transplantation: a qualitative representation of the patient perspective
Authors: Abo Shaza , Parry Selina M. , Ritchie David , Sgro Gabriella , Truong Dominic , Denehy Linda , Granger Catherine L.
Published: March 2022

Purpose

Exercise is emerging as a vital aspect of care to alleviate the physical and psychosocial symptom burden associated with allogeneic bone marrow transplantation (BMT). Understanding the patient perspective regarding exercise is important to move towards implementation. This study aimed to characterise experiences and views regarding participation in an exercise program in adults receiving treatment for haematological disease with allogeneic BMT.

Methods

Individual semi-structured interviews were conducted with 35 participants from either an early- or late-commencing supervised group-based exercise program. Using an inductive, conventional approach to qualitative content analysis data were independently analysed by two researchers.

Results

Six major themes and 33 sub-themes were identified: this encompassed motivation, physical opportunity and capability to exercise; psychosocial effects of group-based exercise; experienced impact of participation in an exercise program; and intervention design considerations. Key barriers to exercise included symptom severity and fluctuating health and distance or difficult access to an exercise facility or equipment, whilst facilitators included encouragement from staff; peer support in the group-based setting; flexibility; education; and ability to measure change.

Conclusion

This study highlights the importance of a flexible approach to exercise with consideration of individual symptoms and preferences. The perceived psychological impact of exercise should not be underestimated; future exercise programs should be designed in partnership with patients, with consideration of group-based activities to reduce social isolation if this is feasible in the treatment context. Intervention design should also acknowledge the individual’s physical and psychological capability, opportunity and automatic and reflective motivation to direct and sustain exercise behaviours following BMT.
Experimentelle Untersuchung des Abwälzverhaltens von Beveloidverzahnungen mit lokal angepassten Verzahnungsdaten entlang der Zahnbreite
Authors: Marino Daniel , Bachmann Matthias , Binz Hansgeorg
Published: March 2022

Zur Übertragung von Drehmoment und Drehzahl in beliebiger Achsanordnung eignen sich bei kleinem Achswinkel bis 30° Beveloidverzahnungen. Besonders die windschiefe Achslage bietet dabei Potenzial, Bauraum und Gewicht aufgrund eines möglichst direkten Leistungsfluss zu realisieren. Beveloidradpaarungen in nicht paralleler Achslage haben jedoch den Nachteil, dass aufgrund der geneigten Grundzylinder nur ein punktförmiger Kontakt vorliegt. Der auftretende Ease-Off kann ausschließlich durch komplexe Zahnflankenmodifikationen kompensiert werden, um so das Übertragungsverhalten zu verbessern. Zum Überprüfen der Wirksamkeit solcher Modifikation sind simulative Zahnkontaktanalysen unumgänglich. Zusätzlich sind Abwälzversuche erforderlich, um die simulativen Ergebnisse abzusichern. Durch Beveloidverzahnungen mit lokal angepassten Verzahnungsdaten entlang der Zahnbreite kann ein konjugierter Eingriff angenähert werden, was ein voll ausgebildetes Tragbild mit geringem Drehfehler in Kontaktsimulationen zeigt. In diesem Bericht sollen die vielversprechenden Ergebnisse der Kontaktsimulationen in Abwälzversuchen validiert werden. Zunächst wird mithilfe des Versuchskonzepts das Vorgehen definiert, um die Prüfstandsversuche durchzuführen und die erzielten Ergebnisse am Prüfstand mit den Simulationsergebnissen abzugleichen. Die exemplarisch ausgelegte Prüfverzahnung wird mittels Fünf-Achs-Fräsen gefertigt und kann mit drei Mikrogeometrien am Umfang verteilt ausgeführt werden. Zwei Ansätze zur Definition der Mikrogeometrien werden vorgestellt, mit denen ausgehend vom konjugierten Eingriff eine gezielte Positionierung und Skalierung des Tragbilds möglich ist. Die tatsächliche Zahnflankengeometrie wird topografisch vermessen und kann in Kontaktsimulationen untersucht werden. Der Vergleich zwischen diesen Simulationsergebnissen und den am Prüfstand ermittelten Ergebnissen zeigt beim Tragbild und lastfreien Drehfehlerverlauf eine hohe Übereinstimmung. Der Vergleich zwischen den Prüfstands- und Simulationsergebnissen validiert die analytische Berechnungsmethode zur Auslegung und Optimierung von Beveloidverzahnungen mit lokal angepassten Verzahnungsdaten entlang der Zahnbreite.
Downstream Modification of Mercury in Diverse River Systems Underscores the Role of Local Conditions in Fish Bioaccumulation
Authors: Emmerton Craig A. , Drevnick Paul E. , Serbu Jessica A. , Cooke Colin A. , Graydon Jennifer A. , Reichert Megan , Evans Marlene S. , McMaster Mark E.
Published: March 2022

Fish consumption advisories for mercury (Hg) are common in rivers, highlighting connections between landscape sources of Hg and downstream fluvial ecosystems. Though watershed conditions can influence concentrations of Hg in smaller streams, how Hg changes downstream through larger rivers and how these changes associate with Hg concentrations in fish is not well understood. Here we present a continuum of concentrations and yields of total mercury (THg) and methylmercury (MeHg) from small tributary systems draining diverse western Canadian headwater landscapes through to major transboundary rivers. We associate these downstream patterns with THg concentrations in tissues of resident fish in major rivers. Mean concentrations and yields of unfiltered THg from over 80 monitored tributaries and major rivers were highly variable in space ranging from 0.28 to 120 ng L−1 and 0.39 to 170 µg ha−1 d−1, respectively. Using spatial data and a hierarchical cluster analysis, we identified three broad categories of tributary catchment conditions. Linear mixed modeling analysis with water quality variables revealed significantly lower THg concentrations in tributaries draining cordillera-foothills (geometric mean: 0.76 ng L−1) regions relative to those draining forested (1.5 ng L−1) and agriculturalized landscapes (2.4 ng L−1), suggesting that sources and mobility of THg in soils and surface waters were different between landscapes. However, these concentration differences were not sustained downstream in major rivers as local sources and sinks of THg in river channels smoothed differences between landscape types. Extensive fish tissue monitoring in major rivers and ANCOVA analysis found that site-specific, river water THg and MeHg concentrations and local catchment conditions were stronger associates of THg concentrations in fish than broader trends in rivers within and across landscape classes. Consequently, site-specific, targeted monitoring of THg and MeHg concentrations in water and fish is a preferred study design when assessing regional-level patterns in fish tissue concentrations.
Looking into the black box of “Medical Innovation”: rising health expenditures by illness type
Authors: Breyer Friedrich , Lorenz Normann , Pruckner Gerald J. , Schober Thomas
Published: March 2022

There is agreement among health economists that on the whole medical innovation causes health care expenditures (HCE) to rise. This paper analyzes for which diagnoses HCE per patient have grown significantly faster than average HCE. We distinguish decedents (patients in their last 4 years of life) from survivors and use a unique dataset comprising detailed HCE of all members of a regional health insurance fund in Upper Austria for the period 2005–2018. Our results indicate that among decedents in particular, the expenditures for treatment of neoplasms have exceeded the general trend in HCE. This confirms that medical innovation for this group of diseases has been particularly strong over the last 15 years. For survivors, we find a noticeable growth in cases and cost per case for pregnancies and childbirth, and also for treatment of mental and behavioral disorders. We discuss whether these findings contradict the widespread interpretation of cost-increasing innovations as “medical progress” and offer some policy recommendations.