bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of the COVID-19 Pandemic on Surgical Practice in the Southeastern United States: Results of a Survey of the Membership of the Southeastern Surgical Congress
Authors: Richmond Bryan K. , Dean L. Scott , Farrell Timothy M.
Published: September 2020

Background

The coronavirus disease 2019 (COVID-19) pandemic dramatically altered the delivery of surgical care.

Methods

Members of the Southeastern Surgical Congress were surveyed regarding system adjustments, personal impact, and productivity losses. Subgroups were analyzed for disproportionate impact across practice models (academic/employed/private), practice communities (urban, suburban, rural), and practice case-mix categories (broad general surgery, narrow general surgery, specialty practice, hospital-based practice).

Results

135 respondents reported that 98.5% of surgeons and 97% of hospitals canceled elective cases. Practices and hospitals reduced staffing dramatically. Telemedicine was utilized by most respondents. Hospitals variably implemented system changes, developed tests, and set up diagnostic centers. Most surgeons anticipated resumption of practice and hospital activity by July 1, 2020. More than one-quarter reported worsened financial status and personal well-being. Interestingly, family/personal relationships were improved in more than one-third. Most surgeons anticipate reduced year-end case volumes, clinical productivity, and salary. In subgroup analyses, academic surgeons were more likely than employed and private-practice surgeons to use telemedicine and to work in hospitals with in-house COVID-19 testing. Private-practice surgeons expected decreased financial status, case volumes, relative value units (RVUs), and salary. More rural surgeons anticipate reduced salary than urban and suburban surgeons. Surgeons in narrow general surgery practice reported more furlough of employees than specialty surgeons, hospital-based surgeons, and broad-based general surgeons. Narrow-practice surgeons and specialists were more likely to report RVU reductions and improved family/personal relationships.

Discussion

The COVID-19 slowdown affected surgeons throughout the southeastern United States. Variations between different practice models, communities, and case-mix categories may help inform surgeons in the future.
Evaluation of Surgical Learning Curve Effect on Obstructive Sleep Apnea Outcomes in Upper Airway Stimulation
Authors: Larsen Christopher , Boyd Christopher , Villwock Mark , Steffen Armin , Heiser Clemens , Boon Maurits , Huntley Colin , Doghramji Karl , Soose Ryan J. , Kominsky Alan , Waters Tina , Withrow Kirk , Parker Noah , Thaler Erica , Dhanda Patil Reena , Green Katherine K. , Chio Eugene , Suurna Maria , Schell Amy , Strohl Kingman
Published: September 2020

Objective:

An increasing number of facilities offer Upper Airway Stimulation (UAS) with varying levels of experience. The goal was to quantify whether a surgical learning curve exists in operative or sleep outcomes in UAS.

Methods:

International multi-center retrospective review of the ADHERE registry, a prospective international multi-center study collecting UAS outcomes. ADHERE registry centers with at least 20 implants and outcomes data through at least 6-month follow-up were reviewed. Cases were divided into two groups based on implant order (the first 10 or second 10 consecutive implants at a given site). Group differences were assessed using Mann-Whitney U-tests, Chi-squared tests, or Fisher’s Exact tests, as appropriate. A Mann-Kendall trend test was used to detect if there was a monotonic trend in operative time. Sleep outcome equivalence between experience groups was assessed using the two one-sided tests approach.

Results:

Thirteen facilities met inclusion criteria, contributing 260 patients. Complication rates did not significantly differ between groups ( P = .808). Operative time exhibited a significant downward trend ( P < .001), with the median operative time dropping from 150 minutes for the first 10 implants to 134 minutes for the subsequent 10 implants. The decrease in AHI from baseline to 12-month follow-up was equivalent between the first and second ten (22.8 vs 21.2 events/hour, respectively, P < .001). Similarly, the first and second ten groups had equivalent ESS decreases at 6 months (2.0 vs 2.0, respectively, P < .001). ESS outcomes remained equivalent for those with data through 12-months.

Conclusions:

Across the centers’ first 20 implants, an approximately 11% reduction operative time was identified, however, no learning curve effect was seen for 6-month or 12-month AHI or ESS over the first twenty implants. Ongoing monitoring through the ADHERE registry will help measure the impact of evolving provider and patient specific characteristics as the number of implant centers increases.
Strangers in Hostile Lands: Exposure to Refugees and Right-Wing Support in Germany’s Eastern Regions
Authors: Schaub Max , Gereke Johanna , Baldassarri Delia
Published: September 2020

Does local exposure to refugees increase right-wing support? This paper studies a case uniquely suited to address this question: the allocation of refugees to the rural hinterlands of eastern Germany during the European refugee crisis. Similar to non-urban regions elsewhere, the area has had minimal previous exposure to foreigners, but distinctively leans towards the political right. Our data comprise electoral outcomes, and individual-level survey and behavioral measures. A policy allocating refugees following strict administrative rules and a matching procedure allow for causal identification. Our measurements confirm the presence of widespread anti-immigrant sentiments. However, these are unaffected by the presence of refugees in respondents’ hometowns: on average, we record null effects for all outcomes, which we interpret as supporting a sociotropic perspective on immigration attitudes. Masked by these overall null findings, we observe convergence: local exposure to refugees appears to have pulled both right- and left-leaning individuals more towards the center.
A multiscale framework for predicting the mechanical properties of unidirectional non-crimp fabric composites with manufacturing induced defects
Authors: Rouf Khizar , Worswick Michael J , Montesano John
Published: September 2020

The aim of this study was to evaluate the effect of manufacturing induced in-plane tow misalignment and out-of-plane tow crimp on the mechanical properties of a heavy-tow unidirectional non-crimp fabric (UD-NCF) composite. The elastic constants and failure onset (strength) are predicted by employing a multiscale computational approach. Micro-scale finite element (FE) models that explicitly represent the fibers and matrix within the tow microstructure were used to predict the effective properties of the tow. Meso-scale FE models comprised of the homogenized tows and surrounding matrix were used to predict the properties of a UD NCF composite lamina. Four meso-scale models, identified as ideal, crimp, misalignment and real, were considered in this study. No manufacturing defects were represented in the ideal model, while out-of-plane crimp, in-plane misalignment and both out-of-plane crimp and in-plane misalignment were accounted for in the crimp model, misalignment model and real model, respectively. Predicted lamina stiffness based on the real model are found to be in an excellent agreement with available experimental data, which was not always the case for the other three models. The longitudinal and transverse strength predictions are found to be dependent on the chosen local failure criteria for each model. Max-stress and Puck’s fiber failure criteria provide an excellent estimate of longitudinal strength while the Puck’s inter-fiber failure and Tsai-Hill criteria predict transverse strength with good accuracy. The feasibility to accurately predict the mechanical properties of heavy tow non-crimp fabric composites by incorporating their inherent micro-structural defects is demonstrated in this study.
Evaluation of mechanical properties and EMI shielding effectiveness of long carbon fiber reinforced thermoplastic with different matrix
Authors: Roh Jeong U , Kwon Dong Jun , Guk Joong Seob , Kim Jin Gon , Lee Hyun Young , Park Sung Eun
Published: September 2020

In the present study, the difference of long carbon fiber reinforced thermoplastic (C-LFT) depending on the type of polymer resins at the same carbon fiber content (30 wt.%) was compared. The different types of C-LFT were made using five polymer resins such as polyamide 6, polyamide 6,6, polycarbonate, high density polyethylene and polypropylene. Tensile test, flexural test, and unnotched Izod impact test were carried out and the cause of difference in the mechanical properties was considered by analyzing the adhesion characteristics. Fracture appearance and work of adhesion between the fiber and the resin were observed. In addition, the difference and its cause in electromagnetic interference shielding effectiveness (EMI SE) was investigated. From the results, the polyamide 6 is most appropriate to the carbon fiber among the samples in the aspects of interfacial shear strength and fiber dispersion.
Fueling Factionalism? The Impact of Peace Processes on Rebel Group Fragmentation in Civil Wars
Authors: Duursma Allard , Fliervoet Feike
Published: September 2020

While peace processes increase the likelihood that a civil war is resolved, they can also complicate peace by increasing the risk of rebel fragmentation. In this article, we argue that negotiations exacerbate pre-existing structural and substantial divisions within rebel organizations, therefore increasing the likelihood of a rebel split. More specifically, we put forward a theoretical framework that specifies why factions within a rebel group may disagree with the onset of negotiations, the conclusion of a peace agreement, or the implementation of an agreement—and thus break away during the peace process. We empirically assess the merit of this framework by systematically comparing the impact of these phases in a peace process on the fragmentation of rebel organizations. Using data that more accurately reflect the moment a rebel split takes place than earlier studies, we find that peace processes have a greater substantial impact on rebel fragmentation than previously assumed.
Critically Appraising the Significance of the Oral Mycobiome
Authors: Diaz P.I. , Dongari-Bagtzoglou A.
Published: September 2020

Recent efforts to understand the oral microbiome have focused on its fungal component. Since fungi occupy a low proportion of the oral microbiome biomass, mycobiome studies rely on sequencing of internal transcribed spacer (ITS) amplicons. ITS-based studies usually detect hundreds of fungi in oral samples. Here, we review the oral mycobiome, critically appraising the significance of such large fungal diversity. When harsh lysis methods are used to extract DNA, 2 oral mycobiome community types (mycotypes) are evident, each dominated by only 1 genus, either Candida or Malassezia. The rest of the diversity in ITS surveys represents low-abundance fungi possibly acquired from the environment and ingested food. So far, Candida is the only genus demonstrated to reach a significant biomass in the oral cavity and clearly shown to be associated with a distinct oral ecology. Candida thrives in the presence of lower oral pH and is enriched in caries, with mechanistic studies in animal models suggesting it participates in the disease process by synergistically interacting with acidogenic bacteria. Candida serves as the main etiological agent of oral mucosal candidiasis, in which a Candida-bacteriome partnership plays a key role. The function of other potential oral colonizers, such as lipid-dependent Malassezia, is still unclear, with further studies needed to establish whether Malassezia are metabolically active oral commensals. Low-abundance oral mycobiome members acquired from the environment may be viable in the oral cavity, and although they may not play a significant role in microbiome communities, they could serve as opportunistic pathogens in immunocompromised hosts. We suggest that further work is needed to ascertain the significance of oral mycobiome members beyond Candida. ITS-based surveys should be complemented with other methods to determine the in situ biomass and metabolic state of fungi thought to play a role in the oral environment.
Input from Whom? Public Reactions to Consultation Measures
Authors: Kevins Anthony
Published: September 2020

Most legislation neither affects nor interests citizens equally. But should this variation in interest and affectedness impact who gets to influence policy reforms? This article examines US public opinion on this issue using a national survey experiment varying both the policy outcome (a bill’s passage/failure) and the type of constituency input granted by elected representatives (none/constituency surveys/targeting interested constituents/targeting affected constituents). It then compares reactions across treatment groups, examining the impact of outcome favourability as well as external and internal political efficacy. Results suggest that granting constituents explicit policy influence consistently affected perceived responsiveness in the expected manner, but that the different consultation procedures had more varied effects on decision acceptance. Furthermore, where the procedures impacted decision acceptance, they pushed the reactions of both the pleased and the displeased towards more muted responses. Finally, similar ‘cushion effects’ were present when external and internal political efficacy were incorporated into the analysis.
Trajectory tracking control of 7-DOF redundant robot based on estimation of intention in physical human-robot interaction
Authors: Ye Lan , Xiong Genliang , Zeng Cheng , Zhang Hua
Published: September 2020

Collaborative robot has been widespread application prospect, such as homes, manufacturing, and health-care etc. In physical human-robot interaction, the external force appears inevitably in contact with environment or human, especially the interactive tasks such as trajectory tracking requirements and force compliance control. In this article, a method based on interaction intention estimation, which solve the problem of trajectory tracking accuracy and force compliance control in the same direction for the 7-DOF robot, is proposed. The increased virtual force depended on the manipuility performance index and inverse kinematic solution used the kinematic decoupling method based on the redundant angle avoid the singularity of redundant robot. Then, based on interactive intention estimation, a control strategy of variable impedance sliding mode theory in the presence of virtual force and contact force is proposed to achieve the trajectory tracking. We adopted hyperbolic tangent function to alleviate the chattering problem caused by switch function and validated the control system stability by Lyapunov theorem. Finally, Matlab simulations exhibit a 97.8% of high tracking accuracy amid the external force is 43% less than variable impedance parameters. It is therefore proved that the proposed method can achieve asymptotic tracking and the compliant behavior in physical human-robot interaction.
Provincialising smart urbanism in Taipei: The smart city as a strategy for urban regime transition
Authors: Chang I-Chun Catherine , Jou Sue-Ching , Chung Ming-Kuang
Published: September 2020

The appeal of revolutionising urban governance through information technologies has prompted cities across the globe to pursue smart city initiatives. The mainstream scholarship on these initiatives has mostly focused on technology and corporate-led urban development, and it also often privileges the experience of cities in the global North. Nevertheless, this mainstream understanding of the smart city may obscure emerging new power dynamics and locally contextualised processes associated with smart urban development, especially in cities at the global periphery. Inspired by post-colonial theories, this article makes the case for ‘provincialising’ smart urbanism by dislodging technology from the centre of analysis, accentuating perspectives of cities outside the locations where the smart city knowledge is traditionally produced and attending to power relationships. In our case study of Taipei, this provincialising approach helps unveil various logics, intentionalities, assemblages and power dynamics through which the smart city is employed as a political strategy to facilitate urban regime transition. We argue that the current non-affiliated Ko administration exploits the veneer of technological superiority and political neutrality of its smart city agenda to set a new growth agenda, form new development coalitions, establish new institutions and incorporate rising populist momentum into policy-making. Focusing on the politics of being smart, our findings illustrate how smart city experiments reshape power dynamics and regime formation through reorganising actors and interest groups, reconfiguring government institutions, reallocating resource distribution and, in the end, bolstering governing legitimacy.
Doing systematic reviews in Psychology
Authors: Laher Sumaya , Hassem Tasneem
Published: September 2020

Systematic reviews by virtue of being a pre-determined, transparent, and comprehensive plan and search strategy are fast gaining popularity in psychology in South Africa. A systematic review allows one to obtain a thorough overview regarding the recent developments and debates on a given topic with the addition of metacommentary. In South Africa, we have noted stark differences in the reporting of systematic reviews. Often studies are identified as systematic reviews but methodologically have failed to meet the rigorous criteria that characterise this method. This article aims to provide a guide for the novice researcher on conducting systematic reviews. We draw on a practical case study by Hassem and Laher where the systematic review method was used to establish the efficacy of online depression screening tools in the South African context as a practical illustration of the systematic review method. In so doing, the affordances and limitations of the systematic review method are discussed.
Management of Cerebrospinal Fluid Rhinorrhea in the Sphenoid Sinus Lateral Recess Through an Endoscopic Endonasal Transpterygoid Approach With Obliteration of the Lateral Recess
Authors: He Chao , Zhen Hong-Tao
Published: September 2020

Background:

Cerebrospinal fluid rhinorrhea in the sphenoid sinus lateral recess is a rare occurrence and poses unique challenges due to limited surgical access for surgical repair.

Objective:

To report our experience of surgical repair of cerebrospinal fluid rhinorrhea in the sphenoid sinus lateral recess through an endoscopic endonasal transpterygoid approach with obliteration of the lateral recess. To evaluate the efficiency of this surgical procedure.

Methods:

A retrospective study. Twelve cases with cerebrospinal fluid rhinorrhea in the sphenoid sinus lateral recess were reviewed. Assisted by image-guided navigation, cerebrospinal fluid rhinorrhea was repaired through an endoscopic endonasal transpterygoid approach, with obliteration of the lateral recess. Complications and recurrence were recorded. Medical photographs were used.

Results:

This surgical approach provided a relatively spacious corridor to dissect the sphenoid sinus lateral recess and do postoperative surveillance. The repair area completely healed in 3 months after surgery. Cerebrospinal fluid rhinorrhea in the sphenoid sinus lateral recess was successfully repaired on the first attempt in all cases (100%). No main complications or recurrence was observed during a mean follow-up time of 40.3 months.

Conclusion:

The endoscopic endonasal transpterygoid approach gives appropriate access for the treatment of spontaneous cerebrospinal fluid rhinorrhea in the sphenoid sinus lateral recess. Multilayer reconstruction of a skull base defect with obliteration of the lateral recess is a reliable and simple method.
Is Preoperative Embolization Necessary for Carotid Paraganglioma Resection: Experience of a Tertiary Center
Authors: Gözen Emine Deniz , Tevetoğlu Fırat , Kara Sinem , Kızılkılıç Osman , Yener Haydar Murat
Published: September 2020

Purpose:

This study was designed to investigate whether preoperative embolization is a useful procedure to decrease blood loss and neurovascular complications for carotid body tumor (CBT) surgery or not.

Methods:

Medical records of our tertiary care center from 2012 to 2019 were scanned for patients who underwent surgery for CBT, retrospectively. Age, gender, complaint and head and neck examination findings at the time of presentation, preoperative complete blood count parameters, imaging records (cervical magnetic resonance imaging and carotid artery angiography), Shamblin classification, tumor size, intraoperative findings, and postoperative complications were noted.

Results:

A total of 26 patients were operated due to CBT between 2012 and 2019 in our clinic; preoperative arterial embolization was performed to 15 (57.7%) patients, and 11 (42.3%) patients were operated without embolization. Youngest patient was 24 years old, while oldest was 69 years and mean age was 44.35 ± 12.73. (embolization group: ages ranging between 24 and 64 with a mean of 41.5 ± 11.02 years; in nonembolization group: ages ranging between 26 and 69 with a mean of 48.1 ± 14.3). Embolization status was not significantly related to cranial nerve injury, vascular injury, overall complications, and hematocrit decrease. Arterial injury is more likely to occur with increasing Shamblin class ( r = .39; P = .04). Tumor size is not found to be significantly related to cranial nerve injury, vascular injury, overall complications, and hematocrit decrease, but cranial nerve injury and vascular injury were more likely to occur in large tumors ( r = .34; P = .089 and r = .34; P = .087, respectively). Age was significantly and negatively correlated to vascular injury ( r = −.51; P = .05). Vascular injury was significantly correlated with gender (male predominance: r = −.64; P = .000).

Conclusion:

Although preoperative arterial embolization is considered to attenuate the complication risk, we found that there was no significant difference among the patients with or without embolization.
Effects of Parenting Styles on Psychological Problems by Self Esteem and Gender Differences
Authors: Szkody Erica , Steele Ellen H. , McKinney Cliff
Published: September 2020

Current research supports the lasting effects of parenting styles on children and adolescents’ self-esteem, and internalizing and externalizing problems. Few studies have examined parenting style, self-esteem, and psychological problems together while considering gender. The current study explored the indirect effect of parenting style though self-esteem on emerging adult psychological problems as moderated by gender among 381 emerging adults. The most notable finding suggested that maternal authoritative parenting was related to higher levels of female self-esteem, which in turn related to lower levels of female psychological problems. Results indicated a relationship between higher levels of self-esteem and lower psychological problems. Findings from the current study contribute to research emphasizing the long-lasting effects of parenting style on emerging adult self-esteem and mental health, particularly among females.
Distinguishing relational turbulence, marital satisfaction, and parenting stress as predictors of ineffective Arguing among parents of children with autism
Authors: Brisini Kellie St.Cyr , Solomon Denise Haunani
Published: September 2020

Relational turbulence theory suggests that relational turbulence causes pervasive patterns of dysfunctional communication in romantic relationships, such as an inability to resolve conflicts. Other research traditions link marital conflict to marital satisfaction and also exposure to stress. This study assesses the discriminant validity of relational turbulence by examining its association with reports of ineffective arguing, above and beyond the associations with marital satisfaction and parenting stress. The study tests the theoretical claims within the high stress context of parents raising children with autism spectrum disorder (ASD). Married, parents of children with ASD ( N = 298) completed measures of parenting stress specific to raising a child with ASD, marital satisfaction, relational turbulence, and ineffective arguing. Results provide evidence that relational turbulence is associated with perceptions of less effective arguing among these parents above and beyond the influence of parenting stress and marital satisfaction. Finally, implications for marriages, for parents of children with ASD, and for relational turbulence theory are discussed.
Does central sensitization affect hyperalgesia after staged bilateral total knee arthroplasty? A randomized controlled trial
Authors: Koh Hyun Jung , In Yong , Kim Eun Sung , Hwang Jae Woong , Kim Ji Yeong , Lim Soo Jin , Park Hue Jung
Published: September 2020

Objective

Osteoarthritis (OA) patients who undergo staged bilateral total knee arthroplasty (TKA) feel postoperative hyperalgesia in the second operated knee compared with the first knee. Ketamine is an important drug for central temporal summation and inhibition of secondary mechanical hyperalgesia. This study investigated whether central sensitization has a significant effect on hyperalgesia after consecutive operations.

Methods

Seventy-one of 80 OA patients were randomly allocated to the ketamine or saline group. A bolus of ketamine (group K) or saline (group C) (0.5 mg/kg) was injected before induction and at an infusion rate of 3 µg/kg/minute during surgery. A visual analog scale (VAS) was used to assess resting and moving pain and opioid consumption on postoperative days 1, 2, and 3.

Results

The difference in the VAS score between stages 1 and 2 (DV2-V1) was higher in the ketamine compared with the saline group. DV2-V1 for movement between the two groups was not inferior for all periods. Ketamine did not show a large analgesic effect on second-operated knee hyperalgesia in staged bilateral TKAs.

Conclusions

We could not confirm that hyperalgesia was only related to central sensitization with low-dose ketamine. Other factors might be also associated with the hyperexcitability of nociceptive stimuli. Clinical Research Information Service (CRIS) trial registry no: KCT0001481
Arthroscopic Biceps Tenodesis Outcomes: A Comparison of Inlay and Onlay Techniques
Authors: Haidamous Georges , Noyes Matthew P. , Denard Patrick J.
Published: September 2020

Background:

Arthroscopic biceps tenodesis (ABT) high in the groove can be achieved using an inlay or an onlay technique. However, there is little information comparing outcomes between the 2.

Purpose:

To compare postoperative healing and functional outcomes of ABT high in the groove performed using either an onlay or an inlay technique.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A retrospective study was performed on patients undergoing ABT at the articular margin (high in the groove) at a single center over a 2-year period. An inlay technique using an interference screw was performed during the first year, followed by an onlay technique using a knotless suture anchor during the second. Tendon healing, elbow flexion strength, functional outcome, and complications were evaluated at a postoperative minimum of 1 year.

Results:

A total of 37 patients with inlay and 53 with onlay ABTs were available for follow-up. There was no difference in range of motion, functional outcome scores, or elbow flexion strength between the groups. A postoperative popeye deformity was noted in 27% of patients in the inlay group as compared with 9.4% of the onlay group ( P = .028). Four patients (10.8%) in the inlay group required revision surgery (2 of which were biceps tenodesis related) as compared with 0% in the onlay group ( P = .015).

Conclusion:

An onlay technique using a knotless suture anchor for ABT at the top of the articular margin is an acceptable alternative to an inlay technique using an interference screw. The onlay technique was associated with lower rates of postoperative popeye deformity and revision surgery as compared with the inlay technique.
Whose Traditions Count? Questioning New Urbanism’s Traditional Neighborhood in the American South
Authors: Raciti Antonio
Published: September 2020

This article discusses the ontological underpinnings and normative assumptions of the New Urbanism paradigm by exploring how long-term residents explain differences in two historic neighborhoods in Memphis, Tennessee. By using an engaged research approach, it examines the production and transformation of space, questioning the meaning of traditions from the perspective of Black residents. Findings suggest that a paradigm of urbanism ought to be built on a systematic investigation of the people–space–time nexus, arguing that the intersection of urbanisms is a way to understand and act on phenomena of urbanization often overlooked by mainstream urban design approaches.
Collaborative Agency in Civic and Community Engagement: Narratives of College Students Working Toward Generative Partnerships
Authors: Thomas Elizabeth , Walton Marsha , Baker-Olson Anna , Blaber Isabelle , Parker Remi , Becton Michele
Published: September 2020

The development of democratic citizenship and youth leadership requires an ability to collaborate with others in ways that are jointly empowering. In this study, we sought to understand how students at an urban liberal arts college in the United States framed their own and others’ efficacy and responsibility in narrative accounts of situations they faced in civic and community engagement. We were interested in how young people learn and work alongside local stakeholders, rather than serve on behalf of people and communities considered to be in need. We aimed to gain insight into occasions in which collaborative agency emerged, or failed to emerge, in the coordinated activity of individuals engaged in the creation of intersubjectivity, shared commitments, and perceptions of group accomplishment. We collected narratives over a 4-year period from 123 Bonner Scholars, campus leaders whose scholarship includes a substantial weekly commitment to service. Our analysis of stories featuring or problematizing collaborative agency showed students grappling with limits of collaborative agency, but also generativity and interdependence. They described civic agency and leadership with other students, non-profit partners, and citizens. In some settings, we heard students striving for a collaborative solidarity, moving beyond collaborative agency toward relationships affording mutual empowerment.
Neuropathology of Septo-optic Dysplasia: A Report of 4 Autopsy Cases
Authors: Blackburn Jessica , Thomas Diana L. , Hughes Anna , Pierson Christopher R.
Published: September 2020

Septo-optic dysplasia (SOD) is defined by the presence of 2 or more features in a diagnostic triad: (1) optic nerve hypoplasia, (2) pituitary dysfunction, and (3) midline forebrain anomalies. SOD arises due to diverse pathogenetic mechanisms including acquired and genetic factors, and it shows considerable clinical and phenotypic variability. Our knowledge of SOD is incomplete in part because of a paucity of published neuropathology data, so we reviewed the autopsy neuropathology of 4 SOD patients. All patients met SOD criteria according to the triad. Additional neuropathologic findings included malformations involving non-forebrain structures and possible secondary phenomena. Autopsies demonstrate that SOD patients often have additional neuropathologic findings beyond the triad and we feel that use of the term SOD-complex appropriately underscores this diversity and its likely clinical impact. This study suggests that autopsies enhance our understanding of SOD and may be an asset in performing needed clinical and phenotypic correlation studies.
Breastfeeding Among Mothers Who Have Experienced Childhood Maltreatment: A Review
Authors: Channell Doig Amara , Jasczynski Michelle , Fleishman Jamie L. , Aparicio Elizabeth M.
Published: September 2020

Background

Current breastfeeding recommendations focus on the physical benefits of breastfeeding but do not take into account the influence of a history of childhood maltreatment on mothers’ experiences breastfeeding. A better understanding of this relationship is important to be able to better support mothers during this critical time.

Research aim

To review current research that examined how women’s personal experiences of childhood maltreatment has affected their breastfeeding outcomes and experiences.

Methods

A scoping review was conducted to evaluate current literature on breastfeeding and childhood maltreatment. We screened 275 articles, of which eight met the sample selection criteria and were included in this review. These articles were analyzed based on common themes that emerged: Breastfeeding intention, initiation, duration, and exclusivity; medical conditions associated with breastfeeding; and participants’ experiences related to breastfeeding.

Results

History of childhood maltreatment was associated with decreased and shorter duration of breastfeeding. Participants’ experiences of breastfeeding varied: Some found it empowering, and others experienced great distress while breastfeeding. Challenges during this period included managing touch, struggling with the power differential between providers and participants, and coping with trauma symptoms (e.g., dissociation).

Conclusions

For some participants, it was possible to breastfeed successfully after childhood maltreatment, but others found the experience extremely difficult, even traumatizing. There is a need for a trauma-informed approach to lactation care for women with a childhood maltreatment history.
Methods and Success Factors of Induced Lactation: A Scoping Review
Authors: Cazorla-Ortiz Gemma , Obregón-Guitérrez Noemí , Rozas-Garcia Maria Rosa , Goberna-Tricas Josefina
Published: September 2020

Background

Induced lactation enables a woman who has not given birth to breastfeed a child. Lactation may be induced through both pharmacological and non-pharmacological methods, although the desired outcome cannot always be achieved.

Research Aims

The aims of this scoping review was to assess the different methods used to induce lactation, as well as the factors related to sucking the breast effectively and the production of human milk.

Methods

We searched five databases from June 2019–February 2020 for studies referring to methods and factors related to breast suckling and/or the volume of milk produced after inducing lactation, using the following search terms and Boolean operators: breastfeeding AND induced lactation AND adoptive mothers OR surrogate mothers OR female homosexuality OR non-gestating. The final review included a total of 24 articles.

Results

Pharmacological methods were not always used to produce milk, although breast stimulation was essential. The age of the child, interference due to bottle feeding, breast stimulation, and the support received were important factors in the induction of lactation. There were several factors that may account for the differences between developing and higher income countries in methods of induced lactation and the amount of milk that study participants produced. There was no consensus over whether previous pregnancy and/or breastfeeding experience influenced induced lactation.

Conclusion

Health professionals need to have adequate knowledge about induction methods, the preferences of each woman, and the reasons for inducing lactation, to provide proper assistance. However, the lack of standardization about induction of lactation makes it difficult.
Statin Associated Autoimmune Myonecrosis: Case Report With Delayed Onset and Treatment Challenges
Authors: Barrons Robert , Woods J. Andrew , Humphries Ryan
Published: September 2020

Purpose:

A case of delayed statin associated autoimmune myopathy (SAAM) is presented along with review of clinical findings and treatment strategies.

A 54 year old male presented with proximal extremity weakness, difficulty ambulating, and dysphagia. Symptoms began when restarting atorvastatin 40 mg daily for a recent NSTEMI, following 10 years of statin use, interrupted after diagnosis of NASH. Relevant labs included CK of 13,618 IU/L, ALT/ AST of 568/407 IU/L, while additional liver, renal, and toxicology tests were normal. Following treatment response to prednisone 40 mg daily for 3 days, outpatient testing for anti-HMGCR antibodies was ordered. Twelve days from discharge, the patient was readmitted for myalgia and dysphagia, CK = 6042 IU/L, ALT/AST = 360/112 IU/L, and positive anti-HMGCR antibodies. Newly diagnosed with SAAM, symptoms improved with methylprednisolone and intravenous immunoglobulin (IVIG), continuing outpatient as daily prednisone and monthly IVIG. Four days later, the patient relapsed with worsened weakness and dysphagia, CK = 5812 IU/L, and ALT/AST = 647/337 IU/L. After response to methylprednisolone and rituximab, the patient was discharged on a corticosteroid taper, biweekly rituximab, and monthly IVIG. Two weeks later, a final admission involved a syncopal episode and fall, with a CK = 1461 IU/L. Treatment included IVIG, rituximab, and corticosteroid taper, which lead to remission for greater than 6 months.

Conclusion:

Statin associated autoimmune myopathy occurred when restarting atorvastatin, following 10 years of statin use. Clinical findings and positive anti-HMGCR antibodies confirmed the diagnosis. Recurrent relapses required triple combination therapy including addition of rituximab to achieve remission.
The effects of theoretical models of materials and die on finite element predictions in a forging process of aluminum scroll
Authors: Song HN , Kim YS , Joun MS
Published: September 2020

In this paper, the effects of theoretical models of materials and dies on finite element (FE) predictions of a hot forging process are presented, to provide process design engineers and researchers with some useful insight into the theoretical approaches on which they rely. The material was assumed to be rigid-viscoplastic or rigid-thermoviscoplastic and the dies were assumed to be rigid or elastic. The problem of die fracture occurring during the hot forging of aluminum fixed scroll was studied. This process is particularly sensitive to theoretical models, mostly because the die-stress component causing the die fracture has a relatively weak relationship with the forming load. A fully thermo-mechanically coupled FE analysis considered die elastic deformation and was first conducted to reveal die fracture with emphasis on the maximum die stress and forming load. The predictions for four simulated cases using different theoretical assumptions of the material and die were then compared. These were also compared with experiments, undertaken to observe the relationship between maximum die stress component and forming load, to reveal the effects of material and die models in FE predictions. The differences in forming load, die stress and their variation with time among the four cases were clarified quantitatively for different die and material models, to provide some insight into metal forming for engineers and researchers.
Unilateral facial erythematous patch as the presenting sign of systemic lupus erythematosus
Authors: Ha Dae-Lyong , Lee Gi-Wook , Shin Kihyuk , Kim Hoon-Soo , Ko Hyun-Chang , Kim Byung-Soo , Kim Moon-Bum
Published: September 2020

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that can have many cutaneous manifestations including malar rash, discoid rash or oral ulcer. Isolated unilateral involvement of face is uncommon in SLE. It lacks typical clinical features of LE, and may impose a diagnostic challenge for clinicians. Herein we report a case of 62-year-old woman presenting with a 2-year history of erythematous patches on left cheek and eyelid. Initially, she was diagnosed as having recurrent blepharitis or cellulitis that did not respond to conventional treatment with ophthalmic medicaments. As time went by, the patches spread to her left cheek, and she was referred to our dermatologic department. Histopathologic examination was consistent with LE. Further physical and laboratory tests have found that she had oral ulcers, proteinuria, thrombocytopenia and abnormal titer of anti-nuclear antibody satisfying the diagnosis of SLE. From this case, we think unilateral erythematous patches on face could be a rare manifestation of SLE and more intention should be paid to this type of patients, because unilateral facial symptom may mimic other dermatoses.
A Bayesian hierarchical change point model with parameter constraints
Authors: Li Hong , Benitez Andreana , Neelon Brian
Published: September 2020

Alzheimer’s disease is the leading cause of dementia among adults aged 65 or above. Alzheimer’s disease is characterized by a change point signaling a sudden and prolonged acceleration in cognitive decline. The timing of this change point is of clinical interest because it can be used to establish optimal treatment regimens and schedules. Here, we present a Bayesian hierarchical change point model with a parameter constraint to characterize the rate and timing of cognitive decline among Alzheimer’s disease patients. We allow each patient to have a unique random intercept, random slope before the change point, random change point time, and random slope after the change point. The difference in slope before and after a change point is constrained to be nonpositive, and its parameter space is partitioned into a null region (representing normal aging) and a rejection region (representing accelerated decline). Using the change point time, the estimated slope difference, and the threshold of the null region, we are able to (1) distinguish normal aging patients from those with accelerated cognitive decline, (2) characterize the rate and timing for patients experiencing cognitive decline, and (3) predict personalized risk of progression to dementia due to Alzheimer’s disease. We apply the approach to data from the Religious Orders Study, a national cohort study of aging Catholic nuns, priests, and lay brothers.
Medical conditions of Omer Seyfettin (1884–1920), the father of Turkish short stories, enshrined as a mystery
Authors: Tekiner Halil , Yale Steven Howard , Yale Eileen Scott , Doganay Mehmet
Published: September 2020

Born in 1884 in Balıkesir, Turkey, Ömer Seyfettin was a leading figure among modern Turkish short story writers whose death in 1920 at the age of 36 led to long-term speculations about his fatal illness. In order to pay homage to his memory in the centennial of his death and to shed light on his later medical condition, this paper seeks to reexamine his last days from a medico-historical perspective. Our findings indicate that there was a notable decline in his health occurring after 1917 when he was confined to social isolation. A carbuncle was diagnosed in his posterior neck when he was 35-years of age and not satisfactorily treated. In late February 1920, he developed progressive symptoms over two weeks consisting initially of a headache, followed by fever, delirium, hallucinations, and diplopia. These clinical signs and symptoms are clinically suggestive of a septic encephalopathy presumably caused by staphylococcus aureus infection secondary to the carbuncle, or perhaps by one of the myriad causes of viral meningoencephalitis.
Tradition–Technology Wedlock: The Paradoxical Modernisation of Matrimony
Authors: Sen Sucharita
Published: September 2020

The advent of online matrimony ushered in a new era of matchmaking in the wake of globalisation. This paper aims to examine the impact of globalisation on Hindu–Bengali matrimony. The study attempts to find out the impact of online matrimony on marriages in Kolkata. On the basis of personal interviews and content analysis of advertisements in newspapers and online matrimonial websites, the study shows the impact of globalisation on the institution of marriage. The paper argues that globalisation has not made potential changes in the process of selection of prospective brides and grooms. The newspapers and online portals function as the twin matchmakers in contemporary Kolkata, with little difference from the way traditional matchmakers used to work. The paper examines the fate and impact of technology when introduced in deeply entrenched traditional social institutions. The increase in the pool of selection of mates has reinforced patriarchal ties with globalisation adjusting itself in a tradition-bound society, putting tradition and technology in a curious and cumbersome paradox.
Variants of SMAD1 gene increase the risk of colorectal cancer in the Bangladeshi population
Authors: Karmokar Priyanka Florina , Shabnaz Samia , Aziz Md. Abdul , Asaduzzaman Md. , Shahriar Mohammad , Bhuiyan Mohiuddin Ahmed , Mosaddek Abu Syed Md , Islam Mohammad Safiqul
Published: September 2020

Colorectal cancer is the fourth most common type of malignancy worldwide that may develop due to the accumulation of several genetic variations. Different single nucleotide polymorphisms of SMAD1 gene are assumed to be linked with increased colorectal cancer risk. The current case-control study was conducted to verify the association of genetic polymorphisms of SMAD1 (rs11100883 and rs7661162) with colorectal cancer in the Bangladeshi population. This study was performed on 275 colorectal cancer patients and 300 healthy volunteers using polymerase chain reaction–restriction fragment length polymorphism method. The odds ratios were adjusted for age and sex with logistic regression analysis. In case of SMAD1 rs11100883 polymorphism, GA heterozygous genotype, GA + AA (dominant model), and minor allele “A” were significantly associated with colorectal cancer (adjusted odds ratio = 1.55, 95% confidence interval = 1.09–2.20, p = 0.014; adjusted odds ratio = 1.59, 95% confidence interval = 1.13–2.23, p = 0.008; and odds ratio = 1.35, 95% confidence interval = 1.06–1.73, p = 0.015, respectively) and the significance exists after the Bonferroni correction. Again, single nucleotide polymorphism rs7661162 showed significant association with an elevated colorectal cancer risk for AG heterozygous genotype, AG + GG (dominant model), AG versus AA + GG (overdominant model), and minor allele “G” (adjusted odds ratio = 1.78, 95% confidence interval = 1.24–2.56, p = 0.002; adjusted odds ratio = 1.68, 95% confidence interval = 1.18–2.39, p = 0.004; adjusted odds ratio = 1.76, 95% confidence interval = 1.23–2.53, p = 0.002; and odds ratio = 1.47, 95% confidence interval = 1.08–2.00, p = 0.014, respectively) and significance withstands after the Bonferroni correction. No significant age and gender differences between cases and controls were observed. In silico, gene expression analysis showed that the SMAD1 mRNA level was downregulated in the colon and rectal cancer tissues compared to healthy tissues. In conclusion, our findings indicate that SMAD1 rs11100883 and rs7661162 polymorphisms are responsible for increasing the susceptibility of colorectal cancer development in the Bangladeshi population.
ECT in the time of the COVID-19 pandemic
Authors: Ramakrishnan Venkata Subramanian , Kim Young Kwang , Yung Wanda , Mayur Prashanth
Published: September 2020

Objective:

The recent and ongoing COVID-19 pandemic outbreak has placed a huge burden on healthcare systems worldwide. This emergent situation applies invariably to mental health services, and policy makers have issued new directives to adequately deal with this crisis. The COVID-19 outbreak poses special challenges to the administration of electroconvulsive therapy (ECT) since the anaesthetic induction is an aerosol-generating process. The report provides a narrative account of modifications to the ECT practice at a tertiary care psychiatric hospital to mitigate the risk of COVID-19 transmission.

Conclusion:

We emphasise two main modifications: use of personal protective equipment (PPE) during the ECT and modifications in the anaesthetic procedure to mitigate potential transmission.