bluuebunny/crossref_metadata_2025 huggingface dataset:
Flaws in the highlight real: fitstagram diptychs and the enactment of cyborg embodiment
Authors: Greene Amanda K.
Published: August 2020

This article inverts Donna Haraway’s proposition that ‘the ideologically charged question of what counts as daily activity, as experience, can be approached by exploiting the cyborg image’ by instead exploiting everyday experience to approach the contemporary cyborg. It utilises digital tools to compile a corpus of Instagram posts that foreground corporeal hybridity, and examines this social media data through the lenses of feminist STS, affect theory and digital studies. This strategy offers a new vantage on the cyborg by connecting it to concrete and ongoing user practices. To make these interventions, this project focuses specifically on a genre of post popularised by Instagram fitness (or fitstagram) influencers – diptych photographic montages that oppose imperfectly ‘real’ material bodies to unrealistically ‘perfect’ media bodies. Although they formally rely on binary logics (real v. perfect, offline v. online), the posts simultaneously deconstruct them in a number of ways. These repeated boundary transgressions reflect users’ lived experiences of hybrid online/offline corporeality and help forward a theory of cyborg embodiment that relies on quotidian practices as opposed to fixed products or identities. Moreover, close engagement with a final dataset of eighty-nine posts illuminates three particular modes of enacting the cyborg corpus on Instagram: occupation of multiple bodies, awareness of the analogue body and anxious boundary-work. This research extends the cyborg as a critical figure by situating it within a social media context, attending to its imbrication in everyday practices, and affirming female Instagram users as theorists of their cyborg selves.
What to expect when you’re expecting robots: Futures, expectations, and pseudo-artificial general intelligence in UK news
Authors: Brennen J Scott , Howard Philip N , Nielsen Rasmus K
Published: August 2020

Drawing on scholarship in journalism studies and the sociology of expectations, this article demonstrates how news media shape, mediate, and amplify expectations surrounding artificial intelligence in ways that influence their potential to intervene in the world. Through a critical discourse analysis of news content, this article describes and interrogates the persistent expectation concerning the widescale social integration of AI-related approaches and technologies. In doing so, it identifies two techniques through which news outlets mediate future-oriented expectations surrounding AI: choosing sources and offering comparisons. Finally, it demonstrates how in employing these techniques, outlets construct the expectation of a pseudo-artificial general intelligence: a collective of technologies capable of solving nearly any problem.
Associations Between Social Support and Social Media Use Among Young Adult Cisgender MSM and Transgender Women Living With HIV
Authors: Gerke Donald R. , Step Mary M. , Rünger Dennis , Fletcher Jesse B. , Brooks Ronald A. , Davis Nicholas , Kisler Kimberly A. , Reback Cathy J.
Published: August 2020

Social media platforms offer the opportunity to develop online social networks. Use of these platforms has been particularly attractive to younger sexual and gender minority individuals as well as those living with HIV. This cross-sectional study examined the perceived level of social support and associations with social media use among youth and young adult cisgender men who have sex with men (MSM) and transgender (trans) women living with HIV and examined these associations by gender identity. The study drew from baseline data collected from 612 cisgender MSM and 162 trans women enrolling in one of 10 demonstration sites that were part of a Health Resources and Services Administration Special Projects of National Significance initiative. The individual projects were designed to evaluate the potential for social media/mobile technology–based interventions to improve retention in care and HIV health outcomes. The data used in this study came from baseline surveys completed when participants enrolled in a site between October 2016 and May 2018. Results demonstrated that a significantly greater proportion of MSM than trans women participants reported the use of social media platforms (e.g., Facebook: MSM = 86%, trans women = 62%; Instagram: MSM = 65%, trans women = 35%). Furthermore, increased social media use improved perceptions of social support only among MSM participants (direct adjusted OR = 1.49) and not trans women participants (gender identity interaction term adjusted OR = 0.64). These results revealed that MSM participants perceived greater social benefit from the use of social media platforms than trans women, which could be a result of generalized online transphobia experienced by trans women. More nuanced data on various social media platforms, that is, anonymous versus profile-based, and group differences, are needed to better understand how social media platforms can be best utilized to optimize health care outcomes among sexual and gender minority youth and young adults living with HIV.
Conventional Radiotherapy and Stereotactic Radiosurgery in the Management of Metastatic Spine Disease
Authors: Zhang Hao-ran , Li Ji-kai , Yang Xiong-gang , Qiao Rui-qi , Hu Yong-Cheng
Published: August 2020

Spinal metastases are a common manifestation of malignant tumors that can cause severe pain, spinal cord compression, pathological fractures, and hypercalcemia, and these clinical manifestations will ultimately reduce the health-related quality of life and even shorten life expectancy in patient with cancer. Effective management of spinal bone metastases requires multidisciplinary collaboration, including radiologists, surgeons, radiation oncologists, medical oncologists, and pain specialists. In the past few decades, conventional radiotherapy has been the most common form of radiotherapy, which can achieve favorable local control and pain relief; however, it lacks precise methods of delivering radiation and thus cannot provide sufficient tumoricidal dose. The advent of stereotactic radiosurgery has changed this situation by using highly focused radiation beams guided by 3-dimensional imaging to deliver a high biologic equivalent dose to the target region, and the spinal cord can be identified and excluded from the target volume to reduce the risk of radiation-induced myelopathy. Separation surgery can provide a 2- to 3-mm safe separation of tumor and spinal cord to avoid radiation-induced damage to the spinal cord. Targets for separation surgery include decompression of metastatic epidural spinal cord compression and spinal stabilization without partial or en bloc tumor resection. Combined with conventional radiotherapy, stereotactic radiosurgery can provide better local tumor control and pain relief. Several scoring systems have been developed to estimate the life expectancy of patients with spinal metastases treated with radiotherapy. Thorough understanding of radiotherapy-related knowledge including the dose-fractionation schedule, separation surgery, efficacy and safety, scoring systems, and feasibility of combination with other treatment methods is critical to providing optimal patient care.
Outcomes of Inclusive Versus Separate Placements: A Matched Pairs Comparison Study
Authors: Gee Kathleen , Gonzalez Mara , Cooper Carrie
Published: August 2020

This quasi-experimental study focused on 15 pairs of children with extensive support needs, matched across 12 characteristics based on their first complete Individual Education Program (IEP) in the school district. One child in each pair was included in general education for 80% or more of their day from their first IEP to the most current IEP at the time of the study. The other child in the pair was placed in a separate special education class, and was served there from the first IEP to the last IEP. All children were observed over a typical school day with time-sampling data collected on the types of activities, the contexts, and the types of engagement that occurred. In addition, outcome data from the first IEP to the most current IEP in the district were analyzed across three variables: communication levels, literacy levels, and numeracy levels. Results indicated that students in the general education classrooms had a significant, large effect size as compared with their pairs in separate classrooms on several variables. In addition, students in the general education classrooms demonstrated highly significant levels of progress as compared with the students in separate classrooms. Implications related to placement, disability characteristics, progress, and policy are discussed.
Library Collection as a Source of Communal Heritage Reconstruction: Cataloging, Digitizing, and Interpreting the San/Bushmen Collection at the University of Botswana–Okavango Research Institute Library
Authors: haladze Olebogeng , Keitumetse Susan O.
Published: August 2020

Established in 1982, the University of Botswana (UB) library acquired various collections of missionaries, travelers, explorers, anthropologists, and colonial commissioners in its “Botswana Collection” section. One of these, the Heinz Collection, serves as the case study for this article and is evidence of the range of collections acquired from the library’s founding until 2010, when it ceased to be the sole national university in the country. The Heinz Collection documents the San/Bushmen/Basarwa’s (indigenous community in Botswana) way of life as documented by a former European civil servant. In researching the collection, the authors shed light on the collection’s significance and the cultural heritage of the indigenous San/Bushmen communities that Dr. Heinz lived among and documented during his lifetime. The collection illustrates the impact of social, economic, cultural, governance environments on a community’s way of life and, consequently, its cultural heritage.
Zone 0 Thoracic Endovascular Repair After Aortic Wrapping for Acute Aortic Syndrome
Authors: Suematsu Yoshihiro , Nishi Satoshi , Arima Daisuke , Yoshimoto Akihiro
Published: August 2020

We report a successful treatment of type A acute aortic syndrome (AAS)-associated aortic arch aneurysm in a 71-year-old man with major comorbidities. The ascending aorta was wrapped with artificial graft, and supra-aortic debranching was constructed. Then, Zone 0 thoracic endovascular aneurysm repair (TEVAR) with plug occlusion of the left subclavian artery was successfully performed. The patient was discharged in good physical condition without any complications. To our knowledge, this is the first reported case in the literature of successful Zone 0 TEVAR after ascending aorta wrapping and supra-aortic debranching with type A AAS associated with aortic arch aneurysm.
Oversizing Increases Pacemaker Implantation Rate After Sutureless Minimally Invasive Aortic Valve Replacement
Authors: Geršak Borut , Glauber Mattia , Bouchard Denis , Jug Jure , Solinas Marco
Published: August 2020

Objective

Cardiac conduction system disturbances potentially leading to permanent pacemaker implantation are significant postoperative complications after aortic valve replacement. The aim of this study was to assess the impact of sutureless prosthetic valve oversizing on permanent pacemaker implantation rate.

Methods

This multicenter retrospective study included 306 patients who underwent minimally invasive aortic valve replacement with the Perceval sutureless valve. Oversizing was determined by the implanted valve size indexed to body surface area. Data were analyzed with a multivariable logistic regression model.

Results

This study confirmed excellent postoperative results for minimally invasive aortic valve replacement with right anterior minithoracotomy approach and rapid deployment sutureless valves. Mortality rate was 1%. Eighteen (5.9%) patients received a new permanent pacemaker. Multivariable logistic regression model ( P = 0.05) found oversizing as significant risk factor ( P = 0.017) for permanent postoperative pacemaker implantation independent of patient age. There was a significant negative correlation between the indexed implanted valve size and the mean and peak postoperative transvalvular gradients ( P < 0.001).

Conclusions

Oversizing of sutureless prosthetic aortic valves is a risk factor for postoperative permanent pacemaker implantation. Proper sizing of Perceval is important to avoid complications and ensure optimal valve performance.
Long-term Outcome of Local Steroid Injections Versus Surgery in Carpal Tunnel Syndrome: Observational Extension of a Randomized Clinical Trial
Authors: Ly-Pen Domingo , Andreu José Luis , Millán Isabel , de Blas Gema , Sánchez-Olaso Alberto
Published: August 2020

Background: In a previous paper, we have demonstrated that: (1) local injection of corticosteroids for carpal tunnel syndrome (CTS) is as effective as decompressive surgery, at 1-year follow-up; and (2) surgery has an additional benefit in the 2-year follow-up. In this study, we assess the long-term outcomes of both therapies in an observational extension of the patients originally enrolled in our randomized clinical trial. Methods: Patients were included in an open, randomized clinical trial, comparing injections versus surgery in CTS. After the end of the clinical trial, patients received the treatment prescribed by their general practitioner or specialist. Therapeutic failure was defined as the need of any new therapeutic intervention on the involved wrist. Comparison between groups was made using Cox multiple regression analysis. Estimation of the accumulated incidence of new therapeutic failure was made considering the withdrawal as a competitive risk (Gooley’s test). Results: Of 163 randomized wrists at the beginning of the study, only 148 were available at the final follow-up. The mean follow-up was 6.3 and the median was 5.9 years. In the long-term follow-up, the accumulated incidence of therapeutic failure in the surgery group was 11.6% versus 41.8% in the injection group. The Cox multiple regression analysis showed a risk of failure associated with injection group of 4.5 (95% confidence interval [CI], 2.1-9.8; P < .0001). Conclusions: In long-term follow-up, surgery seems more effective than local corticosteroid injections in primary CTS. Nonetheless, about 58% of the patients in the injection group will not need further therapeutic interventions during the follow-up.
Dynamic modeling and performance assessment of single and double phase change material layer–integrated buildings in Mediterranean climate zone
Authors: Louanate Amal , Otmani Rabie El , Kandoussi Khalid , Boutaous M’Hamed
Published: August 2020

Nowadays, latent heat storage is becoming an imperative in building sector since it plays a crucial role in conserving energy through controlling the thermal comfort level. In this field, different storage systems based on phase change material show great performances in terms of energy saving, leading to a significant improvement of occupant thermal comfort. In this work, the thermal behavior and energy efficiency of a residential house incorporating various phase change materials (RT18HC, RT21HC, RT25HC, and RT28HC) in Mediterranean climate region were investigated via numerical simulations. EnergyPlus software was used to analyze the thermal performance of phase change materials applied to the interior wall surfaces of a simplified building model in El Jadida city. The integration of different single and double phase change material layers has been evaluated based on various concepts such as the average temperature fluctuation reduction and the monthly energy saving. The study showed that low melting point phase change material outperforms in terms of heating load, while phase change material with high melting temperature favors the cooling performance. Moreover, the results show that double-layer systems formed by two distinct phase change materials exhibit higher performance than a single phase change material layer throughout the whole year. The annual energy saving rate reaches 41.42% and 55.41% when using single and double phase change material layers, respectively. Finally, we opted for an optimum double-layer system for lower energy consumption in the selected city.
The decline of Asian Studies in the West and the rise of knowledge production in Asia: An autoethnographic reflection on mobility, knowledge production, and academic discourses
Authors: Kelley Liam C.
Published: August 2020

In recent years, the discipline of Asian Studies has struggled to adapt to a changing world and has seen a decline in student interest. A discourse about this issue has emerged that attributes this “crisis” in Asian Studies to various supposed faults in its forms of knowledge production, and that looks with hope to Asia for new forms of knowledge about the region. This paper takes issue with this discourse by employing an autoethnographic narrative to examine the ways in which mobility has affected the discipline of Asian Studies. It traces a path, followed by this author and many others, from an affective fascination with a foreign society to the professional production of knowledge. It then examines how this professional knowledge production has transformed under the influence of different forms of mobility (state-sponsored, private, and global digital), transformations that have led to the current “crisis” in Asian Studies.
Bittersweet: The Neuroscience of Ambivalent Affect
Authors: Vaccaro Anthony G. , Kaplan Jonas T. , Damasio Antonio
Published: August 2020

Ambivalent affective states, such as bittersweetness, nostalgia, and longing, which are felt as having both positive and negative aspects, are an important component of human experience but have received little attention. The most influential theoretical frameworks in affective neuroscience focus largely on univalenced states. As a result, it is not known whether ambivalent affect corresponds to a simultaneously positive and negative valenced state or whether it results from a rapid vacillation between positive and negative states. Here we hypothesize that ambivalent affect involves both mechanisms, that is, rapid vacillation and simultaneity of positive and negative affect, albeit at different neurobiological levels. Rapidly vacillating univalent emotions could give rise to an ambivalent feeling, a mechanism that depends on brainstem nuclei that facilitate rapid action programs of emotional behavior while inhibiting opposing behaviors. This reciprocal inhibition prevents organisms from simultaneously implementing responses to conflicting emotions but also allows for rapid switching between emotions triggered by counterfactual thinking and rapid reappraisal of situations. We propose that as these transitions occur and respective interoceptive information reaches the insular cortex, further processing of this “emotional moment” would allow separate emotional events to be experienced as one “mixed” and integrated feeling.
The ethics of COVID-19 tracking apps – challenges and voluntariness
Authors: Klar Renate , Lanzerath Dirk
Published: August 2020

As COVID-19 continues to spread, a variety of COVID-19 tracking apps (CTAs) have been introduced to help contain the pandemic. Deployment of this technology poses serious challenges of effectiveness, technological problems and risks to privacy and equity. The ethical use of CTAs depends heavily on the protection of voluntariness. Voluntary use of CTAs implies not only the absence of a legal obligation to employ the app but also the absence of more subtle forms of coercion such as enforced exclusion from certain social and work activities. The protection of individual rights to voluntary use can be enhanced through an ethics by design approach in the development of CTAs that treat the introduction of CTAs for what it is: a complete novelty that is being tested for the first time in democracies.
Robot-assisted double screw fixation of minimally displaced scaphoid waist fracture nonunions or delayed unions without bone graft
Authors: Guo Yang , Ma Wei , Tong Dedi , Liu Kun , Yin Yaobin , Yang Chen
Published: August 2020

We retrospectively reviewed 12 minimally displaced fractures of the scaphoid waist in 12 patients who developed delayed or nonunions with or without conservative treatment. Mean time between injury and surgery was 6 months (range 3–12). The fractures were stabilized with double screws, which were percutaneously inserted with robot assistance, and without bone grafting. All fractures united at a mean of 8 weeks (range 6–10) after surgery. The patients were followed-up at 6 months and 1 year. The patients recovered good wrist function. No major postoperative complications were reported, and the patients returned to their usual level of activity. Robot assistance gave a high degree of accuracy when placing the cannulated screws since only two attempts were needed for correct placement of the guide wires. We explain the high union incidence by patient selection, good stabilization and not disturbing the vascular supply.

Level of evidence: IV
Risk Factors of Overuse Shoulder Injuries in Overhead Athletes: A Systematic Review
Authors: Tooth Camille , Gofflot Amandine , Schwartz Cédric , Croisier Jean-Louis , Beaudart Charlotte , Bruyère Olivier , Forthomme Bénédicte
Published: August 2020

Context:

Shoulder injuries are highly prevalent in sports involving the upper extremity. Some risk factors have been identified in the literature, but consensus is still lacking.

Objectives:

To identify risk factors of overuse shoulder injury in overhead athletes, as described in the literature.

Data Sources:

A systematic review of the literature from the years 1970 to 2018 was performed using 2 electronic databases: PubMed and Scopus.

Study Selection:

Prospective studies, written in English, that described at least 1 risk factor associated with overuse shoulder injuries in overhead sports (volleyball, handball, basketball, swimming, water polo, badminton, baseball, and tennis) were considered for analysis.

Study Design:

Systematic review.

Level of Evidence:

Level 3.

Data Extraction:

Data were extracted from 25 studies. Study methodology quality was evaluated using the Modified Coleman Methodology Score.

Results:

Intrinsic factors, previous injury, range of motion (lack or excess), and rotator cuff weakness (isometric and isokinetic) highly increase the risk of future injuries. Additionally, years of athletic practice, body mass index, sex, age, and level of play seem to have modest influence. As for the effect of scapular dysfunction on shoulder injuries, it is still controversial, though these are typically linked. Extrinsic factors, field position, condition of practice (match/training), time of season, and training load also have influence on the occurrence of shoulder injuries.

Conclusion:

Range of motion, rotator cuff muscle weakness, and training load are important modifiable factors associated with shoulder injuries. Scapular dysfunction may also have influence. The preventive approach for shoulder injury should focus on these factors.
Proximal Median Neuropathy Following Anterior Shoulder Dislocation: The Use of Magnetic Resonance Neurography
Authors: Silsby Matthew , Robertson Alasdair , Yiannikas Con
Published: August 2020

Proximal median nerve injury is an uncommon consequence of anterior shoulder dislocation, especially occurring in isolation of other upper limb peripheral nerve injury. We report the case of an 82-year-old woman with a median nerve injury as detected by clinical and neurophysiological examination following a fall and anterior shoulder dislocation. Magnetic resonance neurography confirmed the diagnosis, but also detected asymptomatic brachial plexus and ulnar nerve involvement. Management was non-operative and there has been some improvement over several months. Our case expands the differential diagnosis for proximal median neuropathy and discusses the utility of neurography in cases of neural injury.
Arthroscopic Debridement and Autologous Micronized Adipose Tissue Injection in the Treatment of Advanced-Stage Posttraumatic Osteoarthritis of the Ankle
Authors: Shimozono Yoshiharu , Dankert John F. , Kennedy John G.
Published: August 2020

Objective

To evaluate the effect of intra-articular injection of autologous micronized adipose tissue (MAT) with ankle arthroscopic debridement in patients with advanced-stage posttraumatic osteoarthritis (PTOA) of ankle.

Design

A retrospective cohort study investigating patients treated with arthroscopic debridement and autologous MAT injection for ankle PTOA was performed. Patients with Kellgren-Lawrence (KL) grade 3 to 4 were included. Visual analogue scale (VAS), Foot and Ankle Outcome Scores (FAOS), and patient satisfaction were evaluated.

Results

A total of 19 patients (19 ankles) were included (KL grade 3, 8 patients; grade 4, 11 patients). At a mean follow-up time of 14.3 months (range, 7-23 months), the mean FAOS subscales for pain and quality of life significantly increased from 48.8 and 20.1 preoperatively to 61.1 and 30.1 ( P = 0.029 and 0.048, respectively). The mean VAS score significantly improved from 6.1 to 3.8 (P = 0.003) at final follow-up. A total of 10.5% (2/19) of patients were very satisfied, 31.6% (6/19) satisfied, 26.3% (5/19) neutral, 21.1% (4/19) unsatisfied, and 10.5% (2/19) very unsatisfied with their outcomes. The overall FAOS score demonstrated a significant difference in pre- to postoperative change with 14.8 for KL grade 3 and 5.9 for KL grade 4 ( P = 0.048).

Conclusions

Autologous MAT injection is a safe and potentially beneficial procedure for advanced-stage ankle PTOA as an adjunct to arthroscopic debridement, although more than one-third of patients were unsatisfied with the procedure. This procedure may be more beneficial for KL grade 3 patients than grade 4 patients. However, future investigations are necessary to define the role of MAT for ankle PTOA.
Massive retroperitoneal haemorrhage after retrograde pyelogram in end-stage kidneys: A case report
Authors: Yang Xinyan , Gan Valerie Huei Li , Ng Lay Guat , Ho Henry Sun Sien , Aslim Edwin Jonathan
Published: August 2020

Severe retroperitoneal haemorrhage after retrograde pyelogram (RPG) is rare and has not been reported in the literature. One of the few indications for performing RPG in end-stage kidneys is evaluation of the upper urinary tract for malignancy. We present a rare case of massive retroperitoneal haemorrhage in a 58-year-old man, with a history of deceased donor kidney transplantation for end-stage kidney disease (ESKD), following bilateral RPG for the evaluation of urothelial cancer. The bleeding was successfully stopped with renal artery angioembolisation. This case demonstrates the importance of exercising extra caution when performing endoscopic procedures in patients with ESKD and keeping the intrarenal pressure as low as possible.
The effect of psychological resilience on functional outcomes in post-operative hip fracture patients in a Singapore community hospital
Authors: Tan Cheryl Yan Fang , Fang Andrew Hao Sen , Koh Eileen Yi Ling , Low Lian Leng
Published: August 2020

Background:

In Singapore, the number of hip fractures per year is projected to increase from 2500 to 9000 by 2050. Psychological factors are increasingly recognised as important predictors of healthy aging. While there are a growing number of studies examining resilience in different populations, there is a paucity of literature examining psychological resilience in individuals with hip fractures.

Objectives:

We aim to identify the association between high psychological resilience and improved functional outcomes in post-operative hip fracture patients in a Singapore Community Hospital, defined by a Conner-Davidson Resilience Scale 25 (CD-RISC 25) score of 62 and above.

Methods:

We conducted a pilot prospective cohort study in Bright Vision Community Hospital in Singapore. Post-operative elderly hip fracture patients were invited to participate in the study. Psychological resilience scores were measured on Day 1 of admission using CD-RISC 25. Functional outcomes were then tracked weekly for 21 days while participants underwent rehabilitation using the Modified Barthel Index (MBI).

Results:

High psychological resilience was found in 52.40% of the post-operative hip fracture participants in this study. Of those participants with high psychological resilience, 55% achieved functional independence ( n = 11), compared with 47.47% of participants with low psychological resilience ( n = 9) – although this result did not achieve statistical significance.

Conclusion:

One in two post-operative hip fracture patients had high psychological resilience, and our study suggests that patients with high psychological resilience can possibly achieve higher gains in functional scores and achieve functional independence.
Exploring mutual trust through the lens of an executing judicial authority: The practice of the Court of Amsterdam in EAW proceedings
Authors: Martufi Adriano , Gigengack Daila
Published: August 2020

In the groundbreaking decision Aranyosi and Căldăraru, the Court of Justice of the European Union (CJEU) recognised that in exceptional circumstances, the risk of a possible breach of the right not to suffer inhuman or degrading treatments may qualify as a ground to suspend a European arrest warrant (EAW) and, ultimately, bring the surrender procedure to an end. In this judgment (and in the subsequent decision in LM, dealing with the right to a fair trial), the Court has devised a two-tier test to assess the real risk of a violation of fundamental rights after surrender. Yet the Court has left significant discretion to executing authorities in conducting their assessment of risk, thus raising questions as to how the two-tier test would be implemented at the national level. To address some of these questions, this article examines the practice of the executing authority for the Netherlands (the District Court of Amsterdam) concerning decisions on EAWs that may entail a real risk for fundamental rights. To do so, we analyse the judicial reasoning of decisions issued between June 2016 and June 2020 which implement the tests designed by the CJEU in Aranyosi and LM. The results of this analysis indicate that the Court of Amsterdam has gradually shifted the emphasis from mutual trust to fundamental rights. However, the Dutch court resists automaticity and scrutinises the relevance of any information attentively. This attitude indicates a readiness to engage in a dialogue with the issuing authorities together with resistance to indulge in ‘blind trust’.
Trajectories of the heart rate characteristics index, a physiomarker of sepsis in premature infants, predict Neonatal ICU mortality
Authors: Zimmet Amanda M , Sullivan Brynne A , Moorman J Randall , Lake Douglas E , Ratcliffe Sarah J
Published: August 2020

Objective

Trajectories of physiomarkers over time can be useful to define phenotypes of disease progression and as predictors of clinical outcomes. The aim of this study was to identify phenotypes of the time course of late-onset sepsis in premature infants in Neonatal Intensive Care Units.

Methods

We examined the trajectories of a validated continuous physiomarker, abnormal heart rate characteristics, using functional data analysis and clustering techniques.

Participants

We analyzed continuous heart rate characteristics data from 2989 very low birth weight infants (<1500 grams) from nine NICUs from 2004–2010.

Result

Despite the relative homogeneity of the patients, we found extreme variability in the physiomarker trajectories. We identified phenotypes that were indicative of seven and 30 day mortality beyond that predicted by individual heart rate characteristics values or baseline demographic information.

Conclusion

Time courses of a heart rate characteristics physiomarker reveal snapshots of illness patterns, some of which were more deadly than others.
Erectile dysfunction after robotic radical prostatectomy: Real-life impact of vacuum erection device clinic
Authors: Jones Patrick , Sandoval Barba Hector , Johnson Mark I , Soomro Naeem , Robson Wendy , Ferguson Jill , Aning Jonathan J
Published: August 2020

Introduction:

Post-radical prostatectomy erectile dysfunction (post-RPED) is a common and potentially devastating complication. The role of PDE5-inhibitors (PDE5-Is) in post-RPED is controversial and invasive pharmacological treatments are associated with poor long-term compliance. Vacuum erection devices (VEDs) are a non-pharmacological alternative. Little data regarding VED efficacy and associated patient satisfaction in post-RPED exists. This study aimed to investigate the outcomes of VED therapy in a post-robot assisted radical prostatectomy (post-RARP) population.

Methods:

All men who underwent RARP at a single centre between February 2015 and October 2017 attended a nurse-led holistic-needs-assessment (HNA) appointment at 10 weeks post-RARP. All men identifying ED as a concern at HNA were offered dedicated nurse-led post-RPED clinic and VED clinic appointments. A cross-sectional survey of patient reported outcomes in these men was performed.

Results:

In total 137/539 (25%) men reported ED as a concern at HNA. All 137 men attended the VED clinic, 124/137 (90%) responded to the survey. Commonest reason for choosing VED therapy was for combined psychological, penetration and lengthening purposes (48%). Median time from RARP to VED clinic and from VED clinic to survey was 122 days (range 56–595) and 462 days (range 66–932) respectively. At survey 88/124(70.9%) reported continued use of VED, 69/88 (78%) of this group perceived VED treatment to be successful. Of those who had stopped using VED, 7/36 (19%) felt it had been successful. Key reasons for discontinuation were either because men felt it ineffective (13/36 (37%)) or disliked the device (10/36 (29%)).

Conclusion:

VED therapy is an effective treatment for men with post-RARP ED that is well tolerated with good short- to medium-term compliance. Up to two-thirds of men may find overall satisfaction with their post-RPED after VED therapy. Level of Evidence: 3
Use and Reported Helpfulness of Cannabinoids Among Primary Care Patients in Vermont
Authors: Wershoven Nicole , Kennedy Amanda G. , MacLean Charles D.
Published: August 2020

Introduction: While cannabis has been medically legal in Vermont since 2004 and recreationally legal since 2018 there has been minimal published research regarding the use and practices in the adult population. This gap in understanding results in primary care providers having difficulty navigating conversations surrounding cannabinoid use. The purpose of this research was to identify current use and perceptions of cannabinoids, including Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), in adult primary care patients in Vermont. Methods: An anonymous written survey was given to 1009 Vermont primary care patients aged 18 years and older. All measures were patient-reported and included use of CBD and THC products, perceived helpfulness for certain medical conditions, knowledge of CBD and THC, perceived knowledge of their provider, and concerns regarding cannabis legalization. Results: 45% of adult primary care patients reported using cannabinoids in the past year. Only 18% of patients reported their provider as being a good source of information regarding cannabis. Of the patients who used cannabis in the past year, a majority reported it helpful for conditions such as anxiety and depression, arthritis, pain, sleep, and nausea. Conclusions: Primary care providers need to be knowledgeable about cannabinoids to best support patient care. In addition, with a significant number of patients reporting cannabinoids helpful for medical conditions common in primary care, it is important that research continue to identify the potential benefits and harms of cannabis.
Drive-through Satellite Testing: An Efficient Precautionary Method of Screening Patients for SARS-CoV-2 in a Rural Healthcare Setting
Authors: Molling Paul E. , Holst Tanner T. , Anderson Benjamin G. , Fitzgerald Kevin , Eddy Megan , Weber Bradley D. , Schwan Brenda , Heiderscheit Chris J. , Jagim Andrew R.
Published: August 2020

The first documented case of COVID-19 in the United States occurred on January 30th, 2020. Soon after, a global pandemic was declared in March 2020 with each state issuing stay at home orders based on population, risk for community transmission and current number of positive cases. A priority for each region was to develop efficient systems for testing large patient volumes in a safe manner to reduce the risk of community transmission. A community based United States health care system in the upper mid-west implemented a drive through testing site in an attempt to divert suspected cases of COVID-19 away from larger patient areas while protecting staff and patients. This commentary outlines the planning, work flow and challenges of implementing this drive through testing site in a rural community setting.
Glad Tidings? Personal Witnessing, Religiosity, and Mental Health among U.S. Adults
Authors: Walker Mark H. , Drakeford Leah , Stroope Samuel
Published: August 2020

A growing body of research has documented connections between religious involvement and mental health. However, religion is complex and multidimensional. Religious witnessing, the interpersonal sharing of religious faith, is an important religious practice that has received little attention. Religious witnessing is a relatively unconventional behavior in contemporary American society, yet it can promote social interaction and belonging and has implications for personal identity and sense of self-worth. Using data from a 2010 national random sample (N = 1,342) of U.S. adults, we examine associations between religious witnessing and mental health and the moderating role of public and private religiosity. Mental health is measured using three classes of psychiatric symptoms (general anxiety, social anxiety, and paranoia). Results show that witnessing is related to positive mental health among more highly religious individuals and negative mental health among less religious individuals. Drawing from identity theory and authenticity research, we argue that the contingent impact of religious witnessing on mental health can be explained by (1) participation in social contexts and groups conducive to religious self-expression and (2) the interplay between witnessing, private religiosity, and feelings of authenticity.
Comparison of early results of total knee replacement performed with Zimmer iASSIST versus conventional technique
Authors: Lai Ho Yeung Cyrus , Tang Yan Ho Bruce , Wong Hok Leung
Published: August 2020

Background:

Zimmer iASSIST knee is an accelerometer-based navigation system with the aim of achieving better alignment in total knee arthroplasty (TKA). We have started using this system since early 2016. This is a retrospective case–control study, which aims to compare the radiological alignment, operation time, and blood loss of TKAs performed using the iASSIST system and those using conventional techniques.

Materials and Methods:

42 TKAs using Zimmer iASSIST and 44 TKAs using conventional instrumentation were recruited. The overall coronal alignment and the coronal and sagittal alignment of the femoral and tibial component were compared. For coronal alignment, additional analysis of the absolute deviation from neutral mechanical axis was performed to avoid canceling out of varus/valgus deviation. The number of outliers, operation time, and blood loss in terms of maximal hemoglobin drop were also compared.

Results:

When comparing the alignment of the iASSIST group with the conventional group, there were no significant differences ( p > 0.05) in the number of outliers, mean coronal alignments, mean deviation from neutral coronal mechanical axis (2.9° vs. 2.9°), and femoral component flexion angle (4.9° vs. 4.7°). The difference in the mean tibial component posterior slope was significant (5.7° vs. 7.1°, p < 0.05). The mean operation time was significantly longer by 13 min ( p < 0.05) in the iASSIST group. There were no significant differences in the mean hemoglobin drop between the two groups.

Conclusion:

The results demonstrated no significant differences in terms of coronal radiological alignment, femoral flexion angle, outliers, and blood loss between iASSIST and conventional technique. There was a small but statistically significant difference in tibial posterior slope. The iASSIST group needed a longer operation time.
Public Expenditure and Economic Growth: Evidence from the Developing Countries
Authors: Ahuja Deepti , Pandit Deepak
Published: August 2020

Regardless of theoretical grounds that presumed a positive relationship between government spending and economic growth, the extant research on this nexus is inclusive. This article re-examines the relationship between public expenditure and economic growth using more copious panel data set covering 59 countries in 1990–2019. Our empirical results confirm the unidirectional causality between economic growth and government expenditure where the causation runs between public spending and GDP growth. The results at large support the Keynesian framework that asserts the importance of government expenditure in stimulating economic growth. Further, the analysis reveals that after considering all the control variables such as trade accessibility, investment and inflation public spending positively affects economic growth. With regards to control variables, it was found that investment has a significant and positive bearing on economic growth. Evidence from the regression estimates further displays that trade openness encourages evolution in developing countries. However, population growth and unemployment have a detrimental effect on economic growth.
Addressing Hypertension in Patients With Psoriasis: Review and Recommendations
Authors: deShazo Rosemary A. , Secrest Aaron M. , Armstrong April W. , Duffin Kristina Callis
Published: August 2020

Importance:

Patients with psoriasis are at an increased risk of hypertension, and when present, hypertension is more severe in patients with psoriasis. However, hypertension often goes underdiagnosed and undertreated in this population, which can contribute to increased overall morbidity and mortality.

Objective:

To review the relationship between psoriasis and hypertension and provide practical screening and treatment recommendations for dermatologists to address hypertension in patients with psoriasis.

Evidence Review:

PubMed and MEDLINE databases were searched for hypertension and psoriasis. Consensus was reached by the authors based on published work and clinical experience for recommendations on screening, monitoring, diagnosis, and treatment of hypertension in patients with psoriasis.

Findings:

Hypertension is more prevalent, and often more severe, in the psoriasis population. This review summarizes recommendations for annual hypertension screening in patients with psoriasis, as well as diagnostic cutoffs and initial therapies for dermatologists to consider. Referral to primary care for continued hypertension management and additional referral recommendations based on comorbidities are described.

Conclusions and Relevance:

Psoriasis is a common dermatologic diagnosis in the United States. Dermatologists should be fully aware of appropriate screening, diagnosis, and initial management of hypertension in this population to help improve morbidity and mortality.
American Society of Hematology 2020 guidelines for treating newly diagnosed acute myeloid leukemia in older adults
Authors: Sekeres Mikkael A. , Guyatt Gordon , Abel Gregory , Alibhai Shabbir , Altman Jessica K. , Buckstein Rena , Choe Hannah , Desai Pinkal , Erba Harry , Hourigan Christopher S. , LeBlanc Thomas W. , Litzow Mark , MacEachern Janet , Michaelis Laura C. , Mukherjee Sudipto , O’Dwyer Kristen , Rosko Ashley , Stone Richard , Agarwal Arnav , Colunga-Lozano L. E. , Chang Yaping , Hao QiuKui , Brignardello-Petersen Romina
Published: August 2020

Background:

Older adults with acute myeloid leukemia (AML) represent a vulnerable population in whom disease-based and clinical risk factors, patient goals, prognosis, and practitioner- and patient-perceived treatment risks and benefits influence treatment recommendations.

Objective:

These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about management of AML in older adults.

Methods:

ASH formed a multidisciplinary guideline panel that included specialists in myeloid leukemia, geriatric oncology, patient-reported outcomes and decision-making, frailty, epidemiology, and methodology, as well as patients. The McMaster Grading of Recommendations Assessment, Development and Evaluation (GRADE) Centre supported the guideline-development process, including performing systematic evidence reviews (up to 24 May 2019). The panel prioritized clinical questions and outcomes according to their importance to patients, as judged by the panel. The panel used the GRADE approach, including GRADE’s Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment.

Results:

The panel agreed on 6 critical questions in managing older adults with AML, mirroring real-time practitioner-patient conversations: the decision to pursue antileukemic treatment vs best supportive management, the intensity of therapy, the role and duration of postremission therapy, combination vs monotherapy for induction and beyond, duration of less-intensive therapy, and the role of transfusion support for patients no longer receiving antileukemic therapy.

Conclusions:

Treatment is recommended over best supportive management. More-intensive therapy is recommended over less-intensive therapy when deemed tolerable. However, these recommendations are guided by the principle that throughout a patient’s disease course, optimal care involves ongoing discussions between clinicians and patients, continuously addressing goals of care and the relative risk-benefit balance of treatment.
Timing of high-dose methotrexate CNS prophylaxis in DLBCL: an analysis of toxicity and impact on R-CHOP delivery
Authors: Wilson Matthew R. , Eyre Toby A. , Martinez-Calle Nicolas , Ahearne Matthew , Parsons Katrina E. , Preston Gavin , Khwaja Jahanzaib , Schofield Jeremy , Elliot Johnathon , Mula Kh Almurtadha , Shah Nimish , Cheung Cheuk-Kie , Timmins Matthew A. , Creasey Thomas , Linton Kim , Smith Jeffery , Fox Christopher P. , Miall Fiona , Cwynarski Kate , McKay Pamela
Published: August 2020

High-dose methotrexate (HD-MTX) is increasingly used as prophylaxis for patients with diffuse large B-cell lymphoma (DLBCL) at high risk of central nervous system (CNS) relapse. However, there is limited evidence to guide whether to intercalate HD-MTX (i-HD-MTX) between R-CHOP-21 (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone given at 21-day intervals) or to give it at the end of treatment (EOT) with R-CHOP-21. We conducted a retrospective, multicenter analysis of 334 patients with DLBCL who received CNS prophylaxis with i-HD-MTX (n = 204) or EOT HD-MTX (n = 130). Primary end points were R-CHOP delay rates and HD-MTX toxicity. Secondary end points were CNS relapse rate, progression-free survival, and overall survival. The EOT group had more patients with a high CNS international prognostic index (58% vs 39%; P < .001) and more concurrent intrathecal prophylaxis (56% vs 34%; P < .001). Of the 409 cycles of i-HD-MTX given, 82 (20%) were associated with a delay of next R-CHOP (median, 7 days). Delays were significantly increased when i-HD-MTX was given after day 9 post–R-CHOP (26% vs 16%; P = .01). On multivariable analysis, i-HD-MTX was independently associated with increased R-CHOP delays. Increased mucositis, febrile neutropenia, and longer median inpatient stay were recorded with i-HD-MTX delivery. Three-year cumulative CNS relapse incidence was 5.9%, with no differences between groups. There was no difference in survival between groups. We report increased toxicity and R-CHOP delay with i-HD-MTX compared with EOT delivery but no difference in CNS relapse or survival. Decisions on HD-MTX timing should be individualized and, where i-HD-MTX is favored, we recommend scheduling before day 10 of R-CHOP cycles.