bluuebunny/crossref_metadata_2025 huggingface dataset:
The mediatic dimension of images: visual semiotics faced with Gerhard Richter’s artwork
Authors: D’Armenio Enzo
Published: April 2022

In this article, the author endeavours to analyse Gerhard Richter’s photo-paintings for the way they build an intersemiotic dialogue between photography and painting. On the one hand, he tries to characterize the modalities of this dialogue and to provide an original interpretation of Richter’s work. On the other hand, he uses the special case of Richter’s work as a starting point for a conceptual renewal in the analysis of visual languages, notably with regard to semiotic approaches. In particular, the author aims to define the mediatic dimension of images, which is concerned with the substances, substrates and devices through which images are produced. He does this in order to integrate the achievements of visual semiotics in regard to the compositional dimension of colours, shapes and figures. He takes into account the way in which the material and the substances of expression of images impact the construction of meaning, in accordance with the hypothesis of a superposition of technical and semantic aspects. The confrontation with Richter’s production leads him to go beyond plastic and figurative readings as he proposes the concepts of technical formats and techno-perceptions of images. While the former concern the historical recognition of images on the basis of the devices having produced their substance – leading to identifications such as ‘early cinema images’, ‘smartphone images’, ‘surveillance camera images’, etc. – the latter concern the perceptive configurations resulting from the formative work of the technical devices.
The ethical performance of access and consent in ethnographic research on social work encounters with migrant-background service users
Authors: Kara Hanna , Jäppinen Maija , Nordberg Camilla , Riitaoja Anna-Leena
Published: April 2022

In this article, we contribute to an emerging body of literature concerning the often-overlooked topics of access and consent in research. We posit our understanding of access and consent as continuous ethical reflection and negotiation, conceptualised here as ethical performance, which is particularly valuable in research in institutional contexts defined by numerous power asymmetries. We draw empirically from research on street-level institutional encounters between social work practitioners and migrant-background service users in the Helsinki capital region. Access in this research was a multi-stage process including various stage-related negotiations, and the previous stages always influenced the stages that followed. Nevertheless, access and consent were always erratic and subject to revision. We describe how the need for ethical reflexivity arises in various concrete, often unpredictable, situations, and argue for the importance of paying explicit analytical attention to negotiations regarding access and consent.
A readability model of letters with various letter size, luminance contrast and adaptation luminance levels for seniors
Authors: Akashi Y , Kuno Y , Murakami K , Inatani M , Aoki T
Published: April 2022

In ageing societies, it is necessary to make the visual environment more appropriate for the elderly so that they can maintain visual performance as long as possible. To this end, we aimed at developing guidelines to determine appropriate adaptation luminance and luminance contrast for given letter sizes for the elderly. In this study, we first measured the contrast sensitivities of older participants. Second, we conducted an experiment in which the same participants evaluated the degrees of readability of Japanese sentences with various letter sizes, luminance contrasts and adaptation luminances. Based on the evaluations, we developed a readability model consisting of equal-readability-level contour lines that represent the average of older peoples’ readability scores. From the model, we found we could improve readability by increasing adaptation luminance while the adaptation luminance was lower than 200 cd/m2. However, an increase in luminance contrast became more helpful to improve readability than an increase in adaptation luminance when the adaptation luminance was higher than 200 cd/m2. We also found large individual deviations in readability evaluation among older participants depending on the contrast sensitivity. We divided the participants into three groups based on their contrast sensitivity levels and compared readability models among the three groups.
The ethical and legal considerations of young people and their parents using a hospital patient portal: Hospital Ethics Committee members perspectives
Authors: Sipanoun Pippa , Wray Jo , Oulton Kate , Gibson Faith
Published: April 2022

Background

In April 2019, our hospital transitioned to an electronic patient record system and patient portal (MyGOSH). MyGOSH enables young people aged 12 years or older and their parents to access results, documentation, appointments, and to communicate with their care team.

Aims

A focus group was conducted to explore the ethical and legal considerations of young people and their parents using a patient portal from the perspective of hospital Ethics Committee members.

Participants and research context

Members of the hospital Paediatric Bioethics Centre were recruited ( n = 7). Written informed consent was provided by all participants.

Research design

The focus group discussion was recorded, transcribed verbatim and analysed using thematic analysis.

Ethical considerations

Health Research Authority Research Ethics Committee (REC) Approval was granted by London Southeast REC (IRAS Project ID: 248793; REC Reference: 18/LO/1945).

Results

Four themes, and sub-themes, were identified: (1) granting access – complexities of assessing competence/capacity, exclusion from MyGOSH due to non-disclosure of diagnosis, and truth-telling; (2) inequalities resulting in inequities – complexities of inequity in access; (3) responding to change – providing support and managing expectations; (4) engagement, empowerment and understanding – data safety, empowering young people to take ownership of their health data, a one-size fits all system may not meet the needs of all families, and early engagement with young people/parents.

Discussion

Giving families portal access can increase engagement, empowering them to be more involved in care, yet poses challenges for all. Complexities exist in the assessment for portal access, and supporting and managing user expectations whilst providing an equitable service.

Conclusions

Ongoing support is required for all stakeholders following patient portal implementation to navigate the ethical and legal complexities, and to promote equity and portal utility for patient benefit.
Lifelong learning and African development
Authors: Biao Idowu
Published: April 2022

This article that is located within the alternative knowledge systems paradigm, discusses both the ancient and modern concepts of lifelong learning in relation to Africa’s development. It identifies ancient Greece’s education and African traditional education as two ancient lifelong learning typologies relevant to the current discussion. Ancient Greece’s education is a forerunner to modern education while African traditional education is one typology of education that remains relevant to African developmental aspirations. The modern concept of lifelong learning highlighted in this article is the one made popular by the United Nations Educational Scientific and Cultural Organisation (UNESCO). The article reviews the socialisation processes and worldviews prevalent within the West and Africa alongside the 50%, 40% and 7% Africa’s best primary, secondary and tertiary education success rates respectively and concludes that incongruity between the two socialisation processes and worldviews are responsible for this nearly two-century-old modest contribution of modern education to Africa’s development. Consequently, the article concludes that only a combination of both modern and African lifelong learning would expedite Africa’s socio-economic development.
Effectiveness of Digital Health Interventions in Reducing Bullying and Cyberbullying: A Meta-Analysis
Authors: Chen Qiqi , Chan Ko Ling , Guo Shaolingyun , Chen Mengtong , Lo Camilla Kin-ming , Ip Patrick
Published: April 2022

Bullying and cyberbullying bring adverse physical and psychological impacts on individuals and an economic burden for society. Scholars have developed anti-bullying intervention programs to combat these problems. This meta-analysis aims to examine and compare the effectiveness of digital health interventions (DHIs) in reducing bullying and cyberbullying. A comprehensive search was conducted using databases (PsycINFO, Social Service Abstracts, Sociological Abstracts, MEDLINE, ERIC, and EMBASE). Quasi-experimental and randomized controlled trials (RCTs) published before 31 January 2021 that reported the effects of DHIs in reducing bullying or cyberbullying were included. The 16 studies included in the synthesis reported overall random effect sizes (Cohen’s d) for bullying and cyberbullying reduction were 0.41 and 0.19, respectively. The results provide evidence on the effectiveness of DHIs, comparable to that of face-to-face interventions. The subgroup analysis revealed that the critical components of effective DHIs include training on bystander and bully–victim dual roles, coping skills, and interactive serious games. It highlights the promising effects of digital health approaches in bullying and cyberbullying interventions. Our review identifies avenues for future research on the development of more effective DHIs to reduce bullying and cyberbullying.
Measuring Violence Against Children: A COSMIN Systematic Review of the Psychometric Properties of Child and Adolescent Self-Report Measures
Authors: Meinck Franziska , Neelakantan Lakshmi , Steele Bridget , Jochim Janina , Davies Lynn M. , Boyes Mark , Barlow Jane , Dunne Michael
Published: April 2022

Research on violence against children (VAC) requires meaningful, valid, and reliable self-report by children. Many instruments have been used globally and decisions to select suitable measures are complex. This review identifies child and adolescent self-report measures that are most likely to yield valid, reliable, and comparable data in this field. A systematic review (PROSPERO: CRD4201706) was conducted using the 2018 Consensus-based Standards for the selection of health Measurement Instrument (COSMIN) criteria. Six electronic databases and gray literature were searched. Manuscripts published in English and describing the development and psychometric qualities of child/adolescent self-report instruments were included. Thirty-nine original instruments and 13 adaptations were identified in 124 studies. The quality of evidence ranged from “very low” to “high” depending on the measure and the psychometric properties assessed. Most measures were not widely used, and some have been applied in many settings despite limited evidence of their psychometric rigor. Few studies assessed content validity, particularly with children. The ACE, CTQ, CTS-PC, CECA, ICAST, and JVQ have the best psychometric properties. An overview of items measuring frequency, onset, duration, perpetrators, and locations is provided as well as an assessment of the practicalities for administration to help researchers select the instrument best suited for their research questions. This comprehensive review shows the strengths and weaknesses of VAC research instruments. Six measures that have sufficient psychometric properties are recommended for use in research, with the caveat that extensive piloting is carried out to ensure sufficient content validity for the local context and population.
Growing Pains in Esports Associationalism: Four Modes of National Esports Associational Development
Authors: Witkowski Emma
Published: April 2022

While million-dollar prize-pools and mega-events dominate esports news, the somewhat elusive entities of national esports associations continue to develop as a critical underbelly. Associations prop up player mobility across all scales of modernisation and play an integral advocacy role for regional esports, providing situated responses to esports governance in society. However, national associations provide sector representation that is often polemic and unwelcome by grassroots, commercial and even state-level representatives. With the continued growth in everyday esports participation and calls for better regulatory frameworks, this article explores the emerging forms and challenges within esports associationalism under the four modes of public, industry, substitute, and early adopter associations. Through qualitative, mixed methods research, these modes are outlined as distinct associational forms with local mobilities, stakeholder pressures and infrastructural challenges involved for associational development and locally tailored esports governance.
Protocol of Process Evaluation of Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in India (SPRINT INDIA)Trial
Authors: Verma Shweta J. , Gulati Puja , Khatter Himani , Arora Deepti , Dhasan Aneesh , Sharma Meenakshi , Sylaja Padmavathyamma Narayanapillai , Pandian Jeyaraj D.
Published: April 2022

Background and aims

Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in India (SPRINT India) is a complex intervention delivered across 30 centres in 16 Indian states. The study delivers intervention in 12 languages in the form of workbook, videos and short messaging using cellular device and internet as a tool. Objectives of process evaluation are to assess whether trial was implemented as planned (fidelity and dose); whether, how and why the intervention is effective by looking at the stakeholders’ experiences (effectiveness); to assess reach of intervention in population (reach); how intervention fits into treatment plan to cause behavioural change when adopted (adoption); usefulness for target population and bring behaviour change (maintenance).

Methods

SPRINT India process evaluation is a prospective, multicentre study conducted with mixed-methods approach. Sample size of centres and stakeholders will be selected by maximum variance purposive sampling strategy. Centres will be stratified primarily for representing the 11 regional language in which the intervention is delivered. Qualitative data will comprise of interviews of patients, care givers and health professionals at these centres using semi structured interview guide. Quantitative data will comprise of all the randomised patients. Process evaluation framework is based on Realist and RE-AIM evaluation models presented according to Medical Research Council’s guidance. The four sections of the framework are context, trial implementation, mechanisms of impact and trial outcomes.

Results

Interviews of approximately 100 stakeholders and focus group interviews of health professionals and SPRINT India study central coordinating staff will be conducted. Analysis will be done using triangulation methodology. It will incorporate use of both quantitative and qualitative data, data collection techniques, data sources, evaluation models, stakeholders and researchers.

Conclusions

Process evaluation will identify efficacious factors in intervention package and consolidate use of secondary stroke semi-interactive stroke prevention package into practice and policy to prevent recurrent stroke.
Safeguards identification in computer aided HAZOP study by means of multilevel flow modelling
Authors: Wu Jing , Song Mengchu , Zhang Xinxin , Lind Morten
Published: April 2022

Multilevel Flow Modelling (MFM) was proposed as a knowledge representation method for Hazard and Operability Studies (HAZOPs). MFM reasoning software can facilitate the cause-consequence analysis during the HAZOP analysis of whole life cycle of the plant. Recent studies have further confirmed that MFM offers the opportunity to redeploy the insights achieved by the HAZOP team to assist an operator dealing with an abnormal event. However, past studies into MFM-based HAZOP have been lacking in the specification of the principle. This principle makes MFM possible to determine safeguards for studied hypothetical events. This paper proposes such principle, which further increases the application of computer aids in HAZOP studies. The paper provides an analysis and classification of different types of safeguards on the functional level and introduces the safeguards into MFM methodology. It further presents an MFM-specific barrier function and its reasoning rules. The safeguard representation and reasoning transparency explicitly the relationship between suitable safeguards and hypothetical events given knowledge about the complex interdependencies between process design, equipment design, safety barriers and instrumentation. Based on the principles developed, an existing MFM model of a typical oil and gas process module is extended with explicit safety functions and used as an example for utilizing the specified principle for identification of safeguards. Potential safeguards for the process module are produced as the results.
Simulation-based dynamic probabilistic risk assessment of an internal flooding-initiated accident in nuclear power plant using THALES2 and RAPID
Authors: Kubo Kotaro , Zheng Xiaoyu , Tanaka Yoichi , Tamaki Hitoshi , Sugiyama Tomoyuki , Jang Sunghyon , Takata Takashi , Yamaguchi Akira
Published: April 2022

Probabilistic risk assessment (PRA) is a method used to assess the risks associated with large and complex systems. However, the timing at which nuclear power plant structures, systems, and components are damaged is difficult to handle explicitly if the risk of an external event is evaluated using conventional PRA based on event trees and fault trees. A methodology coupling thermal-hydraulic analysis with external event simulations using Risk Assessment with Plant Interactive Dynamics (RAPID) is therefore proposed to overcome this limitation. A flood propagation model based on Bernoulli’s theorem was applied to represent internal flooding in the turbine building of the pressurized water reactor. Uncertainties were also taken into account, including the flow rate of the floodwater source and the failure criteria for the mitigation systems. The simulated recovery actions included the operator isolating the floodwater source and using a drainage pump; these actions were modeled using several simplifications. Overall, the results indicate that combining isolation and drainage can reduce the conditional core damage probability upon the occurrence of flooding by approximately 90%.
Putting the black in Britain back on the BBC
Authors: Barling Kurt
Published: April 2022

One area where, along with other UK broadcasters, the BBC has been seen to consistently fail to make headway is in its inadequate representation of minority groups within British society. This study fills a gap in the literature understanding black programming on the BBC. It assesses this programming through a qualitative analysis of the views of 94% of those who produced the current affairs programme Black Britain. It reviews some of the material that Black Britain put on air in this assessment, what impact the programme had on broadcasting diversity and why lessons learned were seemingly lost.
Effective application of corpus callosotomy in pediatric intractable epilepsy patients with mitochondrial dysfunction
Authors: Na Ji-Hoon , Kim Heung Dong , Lee Young-Mock
Published: April 2022

Background:

Whether epilepsy surgery, such as corpus callosotomy is effective in patients with pediatric intractable epilepsy with mitochondrial dysfunction is controversial, and there is a paucity of literature on this issue.

Objective:

This study aimed to assess and describe the effective application of corpus callosotomy for treating pediatric patients with intractable epilepsy with mitochondrial dysfunction in a single institution in Korea.

Methods:

This was a retrospective study of pediatric patients with intractable epilepsy and mitochondrial dysfunction who underwent corpus callosotomy in a single tertiary care center. Ten patients with intractable epilepsy with mitochondrial dysfunction were included, and 10 patients with intractable epilepsy with non-mitochondrial dysfunctions were included as a control group. The outcomes of corpus callosotomy in the two groups were evaluated and compared.

Results:

Corpus callosotomy was safely performed and was efficacious in reducing seizure frequency in both groups. The group with non-mitochondrial dysfunction showed slightly better treatment outcomes, with greater reductions in overall seizures, traumatic falling seizures, and electroencephalography improvements, but the differences in treatment effects were not statistically significant.

Conclusions:

Our study is meaningful as it identified the use of corpus callosotomy as a means to save lives and improve quality of life by reducing the frequency of seizures and those associated with traumatic falling in pediatric patients with intractable epilepsy with mitochondrial dysfunction. Larger multicenter studies are necessary to confirm the efficacy of the procedure.
Energy Transition in the Brazilian Electric Power System
Authors: Dutra Joisa , Menezes Flavio
Published: April 2022

This article summarizes key changes in market and regulatory governance arrangements in the electricity sector in Brazil over the last three decades. The Brazilian reform process during this period can be described as a series of attempts to move toward a market-driven system, interrupted by ad hoc interventions of a political nature or to respond to specific crises. This series of events reveals the pathway of a system that managed to significantly expand and diversify its electricity power mix by harnessing its renewable endowment. The historical role played by hydropower plants with reservoirs—along with a highly integrated electricity system—in smoothing production over time has been considerably diminished and will continue to be as climate change takes its toll. Thus, improvements in market and governance arrangements are required to promote a more diverse electricity mix, with variable renewable energy and demand management playing much more significant roles.
Anti-inflammatory, Antinociceptive, and Antitumorigenesis Activities of Terminalia Bellerica (Gaertn.) Roxb. in Animal Models
Authors: Na Takuathung Mingkwan , Jaijoy Kanjana , Soonthornchareonnon Noppamas , Sireeratawong Seewaboon
Published: April 2022

Previous pharmacological research has demonstrated that Terminalia bellerica (Gaertn.) Roxb. (TB) extract possesses several pharmacological activities. However, there is scant evidence documenting the therapeutic activities of TB extract on inflammation, pain, and cancers. Our study examined the in vivo anti-inflammation, antinociception, and antitumorigenesis effects of TB extract and investigated possible mechanisms for those effects. Anti-inflammation activities of TB extract were evaluated using ethyl phenylpropiolate (EPP)- and arachidonic acid (AA)-induced ear edema models, a cotton pellet-induced granulation formation model, and a carrageenan-induced hind paw edema model. An antinociceptive property of TB extract was assessed using a formalin-induced nociception test. An anticarcinogenesis effect was investigated using a 7,12-dimethylbenz( a) anthracene (DMBA) and 12- O-tetradecanoylphorbol-13-acetate (TPA)-induced tumorigenesis model. In the study, TB extract exhibited significant anti-inflammatory effects against EPP-induced ear edema and carrageenan-induced hind paw edema in rats. However, the TB extract showed insignificant inhibitory activity against AA-induced ear edema and cotton pellet-induced granuloma. A dose-dependent decrease in analgesic activity was observed with TB extract evidenced by decreased licking time in formalin-induced pain in mice in both the early and late phases. TB extract also significantly inhibited DMBA/TPA-induced mouse skin tumorigenesis. In conclusion, TB extract possesses anti-inflammatory, analgesic, and anticarcinogenesis properties which act, at least in part, through inhibitory effects of inflammatory mediator production.
Revisiting the use of proton magnetic resonance spectroscopy in distinguishing between primary and secondary malignant tumors of the central nervous system
Authors: Farche Milena K , Fachinetti Natalia O , da Silva Luciana RP , Matos Larissa A , Appenzeller Simone , Cendes Fernando , Reis Fabiano
Published: April 2022

Background and purpose

Conventional magnetic resonance images (MRI) has limitations in distinguishing primary from secondary brain tumors. Proton magnetic resonance spectroscopy ( 1 H-MRS) allows evaluation of the concentration of metabolites in a brain lesion and, hence, better characterization of the tumor. Considering that an accurate diagnosis determines the choice of treatment, our purpose was to assess the usefulness of spectroscopy data for differentiating between primary and secondary brain neoplasms.

Materials and methods

We undertook a retrospective analysis of 61 MRI and 1 H-MRS images of patients with histologically confirmed tumors (30 primary tumors and 31 metastatic tumors). The metabolite ratios of Cho/Cr and NAA/Cr at short TE were determined from spectroscopic curves, with a single voxel positioned in the enhancing tumor. Additional variables analyzed along with the metabolites, like as age and gender, allowed the construction of a logistic regression model to predict the tumor’s nature. The statistical analysis was done using the R software (version 4.0.3 R Core Team, 2020).

Results

The mean NAA/Cr and Cho/Cr ratios were higher in secondary tumors, with a good correlation between NAA/Cr and Cho/Cr (r = 0.61). The mean age of patients with primary tumors was lower than for secondary tumors (43.9 vs 55.9, respectively). Receiver operating characteristic analysis yielded a cut-off value of 0.4 for the NAA/Cr ratio with an accuracy of 73.8%, a sensitivity of 73.3% and a specificity of 74.2% in predicting metastatic tumors.

Conclusion

The model was reasonable in predicting the nature of the tumor and provides an additional tool for analyzing brain tumors.
First clinical application of a novel T1 mapping of the whole brain
Authors: Müller Sebastian Johannes , Khadhraoui Eya , Voit Dirk , Riedel Christian Heiner , Frahm Jens , Ernst Marielle
Published: April 2022

Background

The aim of this study was to evaluate the reproducibility and clinical value of the novel single-shot T1 mapping method for rapid and accurate multi-slice coverage of the whole brain, described by Wang et al. 2015.

Methods

At a field strength of 3 Tesla, T1 mappings of 139 patients (51 of them without pathologic findings) and two repeats of five volunteers were performed at 0.5 mm in-plane resolution. Mean T1 values were determined in 18 manually segmented regions-of-interest without pathologic findings. Reproducibility of the repeated scans was calculated using mean coefficient of variations. Pathologies were grouped and separately evaluated.

Results

The mean age of the cohort was 49 (range 1–95 years). T1 relaxation times for ordinary brain and pathologies were in accordance with the literature values. Intra- and inter-subject reproducibility was excellent, and mean coefficient of variations were 2.4% and 3.8%, respectively.

Discussion

The novel rapid T1 mapping method is a reliable magnetic resonance imaging technique for identifying and quantifying normal brain structures and may thus serve as a basis for assessing pathologies. The fast and parallel online calculation enables a comfortable use in everyday clinical practice. We see a possible clinical value in a large spectrum of diseases, which should be investigated in further studies.
Three-dimensional morphometric analysis of the lateral clavicle and acromion: Implications for surgical treatment using subacromial support
Authors: Zenker Martin , Shamsollahi Javad , Galm André , Hoyen Harry A , Jiang Chunyan , Lambert Simon , Nijs Stefaan , Jaeger Martin
Published: April 2022

Objectives:

Dislocations and periarticular fractures of the acromioclavicular joint are common injuries of the shoulder girdle. When surgical intervention is indicated, subacromial support is one option to restore the alignment between scapula and the distal/lateral clavicle. Devices used for subacromial support rely on a form of subacromial ‘hook’. The shape, inclination and orientation of which is often mismatched to the anatomy of the inferior surface of the acromion, which may lead to painful acromial osteolysis and rotator cuff abrasion causing impingement. The primary goal of this study was to characterize the geometrical parameters of the acromion and distal clavicle, and their orientation at the acromioclavicular joint.

Methods:

Computed tomography scans of 120 shoulders were converted into digital three-dimensional models. Measurements of the acromion inclination and acromion width relative to the torsional angle as well as the clavicle depth were taken. A numerical optimization of the anatomical parameters (including torsional and inclination angles, height and width) was performed to find the combination of those parameters with the lowest interpatient variability.

Results:

The mean clavicle depth was found to be 11.1 mm. The mean acromion width was 27 mm. The combination of torsional and inclination angles with lowest interpatient variability was found at 80° and 16°, respectively.

Conclusion:

There is a high interpatient variability in the morphology of the inferior surface of the acromion. Subacromial support using a ‘hook’ can be optimized for contact surface area, which should lead to fewer complications after the restoration of acromioclavicular orientation using acromial support strategies.
Evaluation of tumor-prostheses over time: Complications, functional outcome, and comparative statistical analysis after resection and reconstruction in orthopedic oncologic conditions in the lower extremities
Authors: Holm Christina Enciso , Soerensen Michala Skovlund , Yilmaz Müjgan , Petersen Michael Mørk
Published: April 2022

Objectives:

Previous multicenter studies report variable outcomes and failure rates after tumor-prosthetic reconstructions. The purpose of this study was (1) to evaluate implant survival, limb survival, and functional outcome in a cohort of patients who underwent resection of primary malignancies or aggressive benign bone tumors and reconstruction with modern tumor-prostheses in the lower extremities and (2) to provide comparison to a historical cohort on previous generations of tumor-prostheses from the same center.

Methods:

A longitudinal retrospective single-center study of 72 consecutive patients (F/M = 30/42), mean age = 44 (range = 7–84) years with bone, soft tissue sarcoma adjacent to bone (n = 69), and aggressive benign bone tumors (n = 3) having surgery between 2006 and 2016 with bone resection and reconstruction with tumor-prostheses were compared to a historical cohort from1985 to 2005. Revisions were classified as major and minor revisions. Causes of failure were classified according to the Henderson classification. Fine and Gray competing risk analysis was used for assessing cumulative incidence for implant revision and limb amputation. Functional outcome was evaluated with Musculoskeletal Tumor Society Score system.

Results:

Forty-seven patients were alive at the end of the study. Mean follow-up was 6 years (range = 2–13 years). Ten-year cumulative risk of major revision was 18% (95% confidence interval = 9%–28%). Deep infection and recurrence of tumor caused most revisions in modern tumor-prostheses. Ten-year cumulative incidence of limb amputation was 11% (95% confidence interval = 3%–18%). According to the Henderson classification, the overall predominant failure mode was non-mechanical (n = 20, 51%). Mean Musculoskeletal Tumor Society Score was 20 (67%) (range = 0–30).

Conclusion:

A minimum of 2 years follow-up with modern modular tumor-prostheses demonstrated a relatively low risk of implant failure and amputation and also an acceptable functional outcome. No statistical difference of, implant survival, limb survival and functional outcome between tumor-prostheses over two time periods was observed, possibly explained by Type 2 error.
Computational Fontan Analysis: Preserving Accuracy While Expediting Workflow
Authors: Liu Xiaolong , Aslan Seda , Kim Byeol , Warburton Linnea , Jackson Derrick , Muhuri Abir , Subramanian Akshay , Mass Paige , Cleveland Vincent , Loke Yue-Hin , Hibino Narutoshi , Olivieri Laura , Krieger Axel
Published: April 2022

Background: Postoperative outcomes of the Fontan operation have been linked to geometry of the cavopulmonary pathway, including graft shape after implantation. Computational fluid dynamics (CFD) simulations are used to explore different surgical options. The objective of this study is to perform a systematic in vitro validation for investigating the accuracy and efficiency of CFD simulation to predict Fontan hemodynamics. Methods: CFD simulations were performed to measure indexed power loss (iPL) and hepatic flow distribution (HFD) in 10 patient-specific Fontan models, with varying mesh and numerical solvers. The results were compared with a novel in vitro flow loop setup with 3D printed Fontan models. A high-resolution differential pressure sensor was used to measure the pressure drop for validating iPL predictions. Microparticles with particle filtering system were used to measure HFD. The computational time was measured for a representative Fontan model with different mesh sizes and numerical solvers. Results: When compared to in vitro setup, variations in CFD mesh sizes had significant effect on HFD ( P  =  .0002) but no significant impact on iPL ( P  =  .069). Numerical solvers had no significant impact in both iPL ( P  =  .50) and HFD ( P  =  .55). A transient solver with 0.5 mm mesh size requires computational time 100 times more than a steady solver with 2.5 mm mesh size to generate similar results. Conclusions: The predictive value of CFD for Fontan planning can be validated against an in vitro flow loop. The prediction accuracy can be affected by the mesh size, model shape complexity, and flow competition.
Teaching the Modified Single-Patch Technique for Complete Atrioventricular Septal Defect
Authors: Stephens Elizabeth H. , Backer Carl L.
Published: April 2022

Understanding the morphology of atrioventricular septal defects and learning the operative strategies for their repair is one of the more difficult tasks for congenital cardiac surgery residents to master. The modified single-patch technique for several reasons lends itself to being a strategy that is relatively easy to teach residents. It has shorter cross-clamp and bypass times than the standard two-patch technique, which allows more time for the instructor to safely take the resident through the case. The steps of the operation are quite standard and broadly applicable to the wide variety of cardiac morphologies found in children with atrioventricular septal defects. The purpose of this review is to carefully point out the technical details of each step of the modified single-patch technique focusing on teaching the resident surgeon. The ease of teaching this excellent technique is just another reason to use the modified single-patch technique.
Cardiopulmonary Exercise Test Outcomes in Fontan Patients With Right Versus Left Single Ventricle Morphology
Authors: Dhauna Janeet , Aboulhosn Jamil , Lluri Gentian
Published: April 2022

Background: Congenital heart defects (CHDs) palliated with Fontan surgery often result in a functional single ventricle that is either a morphologically right or left ventricle, and much less commonly undefined. Given this departure from normal physiology, especially for systemic right ventricle Fontan patients, our study sought to compare cardiopulmonary exercise test (CPET) results of adult patients with single right ventricle (SRV) and single left ventricle (SLV) morphology. Methods: Of 237 Fontan patients from the Ahmanson/UCLA Adult Congenital Heart Disease Center database, 135 patients met the inclusion criteria and were split into 2 groups: SRV (n = 44) and SLV (n = 91). Data were collected on baseline demographics, cardiac history, and CPET results. The 2 groups were compared using unpaired t-test, Mann-Whitney, or Chi-square test. Results: Regarding baseline demographics, SRV patients underwent CPET at a slightly younger age than the SLV group (26.5 ± 6.2 vs 29.6 ± 8.5 years, P = .03). There were no significant differences in CPET parameters (including peak heart rate, oxygen saturation, and maximum VO2/kg) between the SRV and SLV groups. When evaluated subsequent CPET at 3 to 4 years, there was no difference in CPET peak heart rate, peak oxygen saturation, and maximum VO2/kg between the 2 groups. Conclusions: This single-center retrospective analysis suggests that dominant single ventricle morphology may not be associated with an appreciable difference in exercise performance in adult survivors with a Fontan palliation.
Meandering Retrosternal Course of Right Coronary Artery: Partially Empty Right Atrioventricular Groove
Authors: Pandey Niraj Nirmal , Nagulakonda Sravan , Shaw Manish , Jagia Priya , Roy Ambuj
Published: April 2022

We report a case of a 35-year-old man with a dilated ascending aorta and a unique meandering retrosternal course of the right coronary artery (RCA) resulting in a partially empty right atrioventricular groove. The aortic root showed an exaggerated clockwise rotation, resulting in an anteriorly directed RCA ostium and the RCA, instead of entering the right atrioventricular groove, traversed caudally in the subepicardial space over the anterior surface of the right ventricle directly posterior to the sternum.
Towards a More Realistic Appraisal of Complications Following Staged Lateral Lumbar Interbody Fusion: A Single Institution Series
Authors: Godolias Periklis , Frieler Sven , Tataryn Zachary L. , McBride Paul , Nunna Ravi , Ghayoumi Pouriya , Charlot Kaarina , Tran Angela , Al-Awadi Hamzah , Gerstmeyer Julius R. , Ruetten Sebastian , Chapman Jens R. , Oskouian Rod J.
Published: April 2022

Study Design

Retrospective cohort study.

Objectives

With steadily increasing implementation of far lateral approaches in spine surgery, surgeons can utilize the advantages of different approaches synergistically to ensure an optimal patient outcome. Our single institution study aimed to assess the complication rates of patients who underwent a lateral interbody fusion as the index procedure and additional anterior or posterior instrumentation as part of a planned staged surgical reconstruction effort.

Methods

This study was approved by our institutional review board (STUDY2021000113). We included 576 patients who received a lateral lumbar interbody fusion (LLIF) as the index procedure followed by transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF) or anterior lumbar interbody fusion (ALIF) between 2016 and 2020. Primary outcomes were complications identified during the initial inpatient stay, which were categorized into approach-related and secondary complications. Secondary outcomes tracked up to 6 years post-surgery.

Results

The overall complication rate was 19.2% (10.5% approach related, 8.7% secondary complications). Significant intraoperative hemorrhage (mean 659.3 mL vs 131.4 mL, P < .01) was the most common approach related complication with an incidence of 4%, followed by temporary hip flexor weakness in 2.6%. A permanent (femoral) nerve damage was verified in 1 patient. The most common secondary complication was impaired wound healing in 12 patients (2.1%). We identified a 7.1% (41 of 576 patients) rate of revision surgery, on average after 372 days (±34 days).

Conclusions

We recorded an overall complication rate of 19.2% for staged adult deformity corrective surgeries utilizing far lateral interbody fusions at several lumbar levels followed by a more comprehensive posterior surgical reconstruction.
Where smart meets sustainability: The role of Smart Governance in achieving the Sustainable Development Goals in cities
Authors: Giuliodori Andrea , Berrone Pascual , Ricart Joan Enric
Published: April 2022

Sustainable Development Goals (SDGs) seek to achieve economic, social, and environmental progress globally. However, trade-offs among these three pillars might occur, particularly in the context of cities. We argue that these trade-offs exist because the traditional factors of production for economic welfare are not always relevant to the other dimensions of city sustainability. Consequently, additional factors are needed to facilitate the progress of the 2030 agenda. We make a case for smart governance, a factor that we associate with the quality of governance. We explore these ideas by examining the economic, social, and environmental dimensions of 128 cities worldwide. Our results indicate that the traditional factors of production (labor, land, and capital) are positively associated with the economic dimension but weakly associated with the social and environmental dimensions. However, smart governance is positively associated with the various dimensions of urban sustainability.

JEL CLASSIFICATION: Q01; Q28; Q53; Q56; O18; Z13
Partnering With Stakeholders to Inform the Co-Design of a Psychosocial Intervention for Prenatally Diagnosed Congenital Heart Disease
Authors: Sood Erica , Gramszlo Colette , Perez Ramirez Alejandra , Braley Katherine , Butler Samantha C , Davis Jo Ann , Divanovic Allison A , Edwards Lindsay A , Kasparian Nadine , Kelly Sarah L , Neely Trent , Ortinau Cynthia M , Riegel Erin , Shillingford Amanda J , Kazak Anne E
Published: April 2022

Input from diverse stakeholders is critical to the process of designing healthcare interventions. This study applied a novel mixed-methods, stakeholder-engaged approach to co-design a psychosocial intervention for mothers expecting a baby with congenital heart disease (CHD) and their partners to promote family wellbeing. The research team included parents and clinicians from 8 health systems. Participants were 41 diverse parents of children with prenatally diagnosed CHD across the 8 health systems. Qualitative data were collected through online crowdsourcing and quantitative data were collected through electronic surveys to inform intervention co-design. Phases of intervention co-design were: (I) Engage stakeholders in selection of intervention goals/outcomes; (II) Engage stakeholders in selection of intervention elements; (III) Obtain stakeholder input to increase intervention uptake/utility; (IV) Obtain stakeholder input on aspects of intervention design; and (V) Obtain stakeholder input on selection of outcome measures. Parent participants anticipated the resulting intervention, HEARTPrep, would be acceptable, useful, and feasible for parents expecting a baby with CHD. This model of intervention co-design could be used for the development of healthcare interventions across chronic diseases.
The Helicopter Transports of Patients Critically ill with COVID-19
Authors: Ejderlöf Jennifer , Engström Åsa
Published: April 2022

Objective

The aim of our study was to describe specialist nurses’ experiences with the helicopter transport of patients critically ill with COVID-19.

Method

Our study followed a descriptive qualitative design anchored in the naturalistic paradigm and was based on qualitative content analysis. The study followed the consolidated criteria for reporting qualitative research.

Results

Six semi-structured interviews were conducted with specialist nurses who have cared for patients critically ill with COVID-19 during helicopter transport. The analysis of the interviews resulted in three themes—designing new routines before transport, working under new conditions and post-transport and reflections—with 11 categories. The goal of the intensive care transport of patients with COVID-19 was twofold: to prevent the spread of infection by using personal protective equipment and to prevent the contamination of the helicopter.

Conclusion

For the nurses, working in personal protective equipment created a feeling of distance from patients that compromised patient–nurse intimacy. Our results suggest that ensuring the sufficiency of equipment required in the event of major accidents and pandemics is critical.
The Impact of Pre-Round Meetings on the Clinical Learning of Nurses and Doctors on Hospital Wards: A Qualitative Study
Authors: Kleiven Ole T. , Sjursen Irene , Kyte Lars
Published: April 2022

Introduction

The pre-round meeting is an interprofessional gathering conducted in conjunction with the ward round in many hospitals. Here, nurses, doctors and eventually allied health clinicians discuss clinical issues before attending to the patients. This study focused on the learning aspects of the pre-round meeting, and it is, to our knowledge, the first study to explore the impact of pre-round meetings on learning in a clinical setting.

Objectives

To improve our understanding of the impact pre-round meetings has on clinical learning among the nurses and doctors who attend them.

Method

A qualitative study. Focus group interviews were conducted. Participants comprised of 9 doctors and 13 nurses from two different hospitals in Norway. The participants represented both surgical and non-surgical departments

Results

This study showed that the pre-round meeting is an arena with a high learning potential. Learning takes place in the discussion that arises when different professions meet. Both nurses and doctors emphasized that the pre-round meeting is both a conscious learning arena and an arena where learning is a by-product. Several factors interfered with the utilization of its learning potential.

Conclusion

The pre-round meeting is an arena with high learning potential. However various factors can influence this potential. The study highlights the importance of being aware of the learning potential in the pre-round meeting, to achieve higher-level learning objectives. A collaborative environment, continuity, competence, and availability of the staff and structured pre-round meetings are essential elements for achieving higher-level learning objectives.