bluuebunny/crossref_metadata_2025 huggingface dataset:
From the families we choose to the families we find online: media technology and queer family making
Authors: Andreassen Rikke
Published: January 2022

Since the mid-2000s, a number of Western countries have witnessed an increase in the number of children born into ‘alternative’ or ‘queer’ families. Parallel with this queer baby boom, online media technologies have become intertwined with most people’s intimate lives. While these two phenomena have appeared simultaneously, their integration has seldom been explored. In an attempt to fill this gap, the present article explores the ways in which contemporary queer reproduction is interwoven with online media practices. Importantly, the article does not understand online media as a technology that simply facilitates queer kinship; rather, it argues that online media technology is a reproductive technology in its own right. Drawing on empirical examples of media practices of kinning, such as online shopping for donor sperm and locating ‘donor siblings’ via online fora such as Facebook, the article analyses the merging and intersection of online media and queer kinship. These analyses serve as a foundation for an exploration of contemporary kinship and the development of a new theoretical framework for contemporary queer reproduction. Empirically, the examples are from single women’s (i.e. solo mothers) and lesbian couples’ family making. Using Weston's work on ‘chosen families’ as a backdrop for discussion, the article describes families of choice in light of new online kinship connections. In particular, the article focuses on online-initiated connections between donor siblings and how such connections can re-inscribe biology as important to queer kinship. Furthermore, it closely examines how media technology guides queer reproduction in particular directions and how technology causes becoming as a family.
Endovascular Treatment of Renal Artery Thrombosis in Living-Donor Kidney Transplant Recipient With Severe COVID-19 Disease
Authors: Veterano Carlos , Antunes Inês , Coelho Andreia , Silva Ivone , Almeida Rui , Pinto Pedro Sá
Published: January 2022

Purpose:

Coronavirus disease 2019 (COVID-19) patients have a higher prevalence of micro-and macrovascular thrombotic events. However, the underlying mechanism for the increased thrombotic risk is not completely understood. Solid organ transplant recipients infected with SARS-CoV-2 may have an exponential increase in thrombotic risk and the best management strategy is unknown.

Case Report:

A female kidney transplant recipient presented with allograft’s renal artery thrombosis after a recent COVID-19 infection. Due to the risk of kidney failure or exclusion, catheter directed thrombolysis was performed. Residual thrombus was excluded using an endoprosthesis with an excellent result. There were no adverse events and kidney function improved.

Conclusion:

This paper reports the endovascular treatment of renal artery thrombosis in a living-donor kidney transplant recipient with severe COVID-19 disease.
Investigation of Chemopreventive and Antiproliferative Potential of Dicliptera roxburghiana
Authors: Ahmad Bushra , Khan Muhammad Rashid , Shah Naseer Ali , Kondratyuk Tamara P. , Ahmed Nadeem , Pezzuto John M. , Gul Asma , Khattak Aishma
Published: January 2022

Context:

Carcinogenesis causes much human misery. It is a process involving multistage alterations. Medicinal plants are candidates for beneficial anticancer agents.

Objectives:

Investigation of anticancer proficiencies of the plant Dicliptera roxburghiana.

Material and methods:

Crude extract and derived fractions were inspected for their inhibitory potential against nuclear factor KB (NFκB), nitric oxide synthase inhibition, aromatase inhibition and induction of quinone reductase 1 (QR 1). Antiproliferative activity was determined by using various cancer cell lines for example hormone responsive breast cancer cell line MCF-7, estrogen receptor negative breast cancer cell line MDA-MB-231, murine hepatoma cells Hepa 1c1c7, human neuroblastoma cells SK-N-SH and neuroblastoma cells MYCN-2.

Results:

Ethyl acetate and n-butanol fractions of D. roxburghiana were strongly active against NFκB with IC50 of 16.6 ± 1.3 and 8.4 ± 0.7 µg/ml respectively with 100% survival. Chloroform fraction of the plant exhibited an induction ratio of 2.4 ± 0.09 with CD value of 17.7 µg/ml. Regarding the nitrite assay, the n-hexane fraction exhibited significant inhibition of NO activity with IC50 of 17.8 ± 1.25 µg/ml. The n-butanol fraction exhibited strong antiproliferative activity against IcIc-7 cell lines with IC50 values of 13.6 ± 1.91 µg/ml; against MYCN-2 a cytotoxic effect developed with dose dependence, with IC50 of 12.6 ± 1.24 µg/ml. In antiproliferative activity against SK-N-SH cell lines, chloroform, ethyl acetate and n-butanol fractions were efficiently active with IC50 values of 11.2 ± 0.84, 14.6 ± 1.71 and 16.3 ± 1.57 respectively.

Discussion and Conclusion:

It was demonstrated that various fractions of D. roxburghiana displayed appreciable anticancer characteristics and could be a potent source for the development of anticancer leads.
Multi-day evaluation of space domain awareness architectures via decision analysis and multi-objective optimization
Authors: Vasso Albert R , Cobb Richard G , Colombi John M , Little Bryan D , Meyer David W
Published: January 2022

The US Government is the world’s de facto provider of space object cataloging data, but it is challenged to maintain pace in an increasingly complex space environment. This work advances a multi-disciplinary approach to better understand and evaluate an underexplored solution recommended by national policy in which current collection capabilities are augmented with non-traditional sensors. System architecting techniques and extant literature identified likely needs, performance measures, and potential contributors to a conceptualized Augmented Network (AN). Multiple hypothetical architectures of ground- and space-based telescopes with representative capabilities were modeled and simulated on four separate days throughout the year, then evaluated against performance measures and constraints using Multi-Objective Optimization. Decision analysis and Pareto optimality identified a small, diverse set of high-performing architectures while preserving design flexibility. Should decision-makers adopt the AN approach, this research effort indicates (1) a threefold increase in average capacity, (2) a 55% improvement in coverage, and (3) a 2.5-h decrease in the average maximum time a space object goes unobserved.
Standardization and Validation of the Flash Visual Evoked Potential-P2 Conversion Scores in the Diagnosis of Amnestic Mild Cognitive Impairment and Alzheimer's Dementia
Authors: Arruda James E , McInnis Madison C , Steele Jessica
Published: January 2022

Amnestic mild cognitive impairment (aMCI), which is characterized by normal daily activity, but a significant decline in episodic memory, is now widely accepted as a risk factor for the development of Alzheimer's dementia (AD). Research suggests that many of the same neuropathological changes associated with AD also occur in patients diagnosed with aMCI. A recent review of the literature revealed that the latency of the flash visual-evoked potential-P2 (FVEP-P2) may possess pathognomonic information that may assist in the early detection of aMCI. While standards exist for the recording of FVEP-P2, individual clinics often use recording parameters that may differ, resulting in latencies that may not generalize beyond the clinic that produced them. The present article illustrates the process by which the FVEP-P2 latency can be standardized across clinics using FVEP-P2 Conversion Scores. We then demonstrate the diagnostic accuracy of the newly developed scores. Method: In the present investigation, we used the previously unpublished data containing the FVEP-P2 latencies of 45 AD and 60 controls. Result: We were able to demonstrate the process by which individual clinics may first standardize FVEP-P2 latencies and then examine patient performance using FVEP-P2 Conversion Scores, providing clinicians with a richer context from which to examine the patient performance. Conclusion: Consistent with the findings of previous research, the findings of the present investigation support the use of the FVEP-P2 Conversion Scores in the diagnosis of AD. Future directions, including the modification of recording parameters associated with the FVEP-P2, are also discussed.
When to Choose Paroxetine Treatment in Skin-Picking Disorder: A Case Report
Authors: Arıkan Mehmet K. , Oba Muazzez Ç. , İlhan Reyhan , Mat Mehmet C.
Published: January 2022

Skin picking disorder (SPD) characterized by repetitive compulsive scratching in the absence of a primary skin disease is strongly associated with psychiatric comorbidities, including obsessive-compulsive disorder (OCD) and depression (MDD). Selective serotonin reuptake inhibitors (SSRIs) have been used in the treatment of SPD with variable success. Nevertheless, the optimum treatment choice for SPD is an issue for clinicians. This case report presents a 32-year-old female SPD patient treated with four-week paroxetine monotherapy. Based upon the clinical interview and standardized questionnaires, the patient was diagnosed with OCD with depressive features and Skin Picking Disorder. In addition to symptom severity scales, quantitative electroencephalography (qEEG) was also applied. Paroxetine treatment was started (titrated from 5 to 40 mg/day) and doubled each week. After four-week paroxetine monotherapy, OCD symptoms were diminished, and skin lesions were completely regressed leaving solely post inflammatory hyperpigmentation. Post-treatment qEEG assessment also showed a normalization of frontal alpha power and amplitude asymmetry. It can be concluded that if OCD includes SPD with abnormal EEG patterns; then the treatment success using paroxetine will be very high.
“I’m Going to be Successful Someday”: Women’s Personal Projects to Improve Their Lives, and Implications for Clarifying the Nature of Agency in Criminological Theories of Desistance
Authors: Hoskins Kayla M.
Published: January 2022

Women’s agency to construct prosocial lives remains understudied in criminology. This qualitative inquiry explores the nature and outcomes of women’s personal projects, which reflect their agency. In up to five interviews, 401 women on probation and parole explained efforts to improve their lives. Psychological theory on personal projects guided analysis that revealed information on project meaning and facilitators and barriers to project pursuit. Women shared a motivation to avoid trouble and establish prosocial lives. Outcomes were improved by social support and prosocial opportunities. Findings have implications for defining and analyzing agency in desistance research and for correctional responses to women.
The Impact of Clinical Practice Guidelines on Preoperative Antibiotic Administration for Carpal Tunnel Release
Authors: Mehta Saurabh , Court Tannor , Graf Alexander , Best Cameron , Havlik Robert
Published: January 2022

Background: In 2015, the American Association of Plastic Surgeons (AAPS) published a consensus statement against the routine use of preoperative antibiotic prophylaxis to prevent surgical site infection in clean hand surgery. The American Academy of Orthopaedic Surgeons (AAOS) similarly cited “insufficient evidence” in its Appropriate Use Criteria guidelines to support the use of antibiotics in carpal tunnel surgery. Nonetheless, its administration remains a common practice during clean hand surgery. We sought to evaluate the impact of the above guidelines on preoperative antibiotic administration. Methods: An institutional review board–approved retrospective chart review of consecutive patients with carpal tunnel syndrome treated with open carpal tunnel release (CTR) at our institution was performed in the 2 years before and after publication of AAPS/AAOS guidelines. Patient demographics and surgical outcomes were reviewed. Incidence of antibiotic administration, patient demographics, and surgeon factors were collected. Results: A total of 770 primary open CTR procedures were performed in the studied years. In 2013 and 2014, 83.9% of patients received preoperative antibiotics. In 2017 and 2018, 48.2% of patients received preoperative antibiotics. Of the variables analyzed, immunosuppression, history of diabetes, and poorly controlled diabetes (A1c > 7) were found to be statistically significant in its positive correlation to prophylactic preoperative antibiotic use. Diabetes was not associated with surgical site infections. Conclusion: Patients were more likely to receive preoperative antibiotics before the publication of the AAPS/AAOS clinical practice guidelines. Patients with diabetes regardless of their glycemic control are more likely to receive preoperative antibiotics.
Magnetic Resonance Imaging to Investigate the Clinical Applicability of the Medial Femoral Trochlea Osteochondral Flap Within the Wrist
Authors: Daruwalla Jimmy H. , Skrok Jan , Pet Mitchell A. , Giladi Aviram M. , Higgins James P.
Published: January 2022

Background:

The medial femoral trochlea (MFT) osteochondral flap is employed for reconstruction of unsalvageable scaphoid proximal pole nonunions. The convex surface of the cartilage-bearing proximal trochlea is used to replace the similarly contoured proximal scaphoid and articulate with the concave scaphoid fossa of the radius. A magnetic resonance imaging (MRI) comparison of the shape of the MFT as it relates to the native proximal scaphoid has not been previously performed. Our study aimed to quantifiably compare the shape of the MFT, proximal scaphoid, and scaphoid fossa.

Methods:

Using imaging processing software, we measured radius of curvature of the articular segments in MRI scans of 10 healthy subjects’ wrists and knees.

Results:

Compared with the scaphoid fossa, average ratio of the radius of circumference of the proximal scaphoid was 0.79 and 0.78 in the coronal and sagittal planes, respectively. Compared with the scaphoid fossa, average ratio of the radius of circumference of the MFT was 0.98 and 1.31 in the coronal and sagittal planes, respectively. The radius of curvature of the MFT was larger than the proximal scaphoid, in the coronal and sagittal planes. In the coronal plane, the MFT radius of curvature is nearly identical to the scaphoid fossa, a closer match than the scaphoid itself. In the sagittal plane, the radius of curvature of the MFT was larger than the radius of curvature of the scaphoid fossa.

Conclusions:

Our data suggest that the radius of curvature, in the sagittal and coronal planes, of the MFT and proximal scaphoid is disparate.
Prescription Opioids and Patient-Reported Outcomes and Satisfaction After Carpal Tunnel Release Surgery
Authors: Shetty Pragna N. , Sanghavi Kavya K. , Mete Mihriye , Giladi Aviram M.
Published: January 2022

Background:

Amount of opioid use correlates poorly with procedure-related pain; however, prescription limits raise concerns about inadequate pain control and impacts on patient-reported quality indicators. There remain no consistent guidelines for postoperative pain management after carpal tunnel release (CTR). We sought to understand how postoperative opioid use impacts patient-reported outcomes after CTR.

Methods:

This is a pragmatic cohort study using prospectively collected data from all adult patients undergoing uncomplicated primary CTR over 17 months at our center. Patients were categorized as having received or not received a postoperative opioid prescription, and then as remaining on a prescription opioid at 2-week follow-up or not. Questionnaires were completed before surgery and at 2-week follow-up. We collected brief Michigan Hand questionnaire (bMHQ) score, Patient-Reported Outcomes Measurement Information System Global Health score, satisfaction, and pain score.

Results:

Of 505 included patients, 405 received a postoperative prescription and 67 continued use at 2-weeks. These 67 patients reported lower bMHQ, lower satisfaction, and higher postoperative pain compared to those that discontinued. Multivariable regressions showed that receiving postoperative prescriptions did not significantly influence outcomes or satisfaction. However, remaining on the prescription at 2 weeks was associated with significantly lower bMHQ scores, particularly in patients reporting less pain.

Conclusions:

Patients remaining on a prescription after CTR reported worse outcomes compared to those who discontinued. Unexpectedly, the widest bMHQ score gap was seen across patients reporting lowest pain scores. Further research into this high-risk subgroup is needed to guide policy around using pain and patient-reported outcomes as quality measures. Level of Evidence: Level III.
Analysis of preheating temperature field characteristics in selective laser sintering
Authors: Yang Zhiyong , Liu Xing , Zhang Zihao , Li Shuting , Fang Qiao
Published: January 2022

Selective laser sintering technology has broad application prospects in the manufacture of small batch parts with complex structure. In the sintering process, the preheating efficiency and temperature of powder layer determine the processing quality. A method of preheating powder by lamp radiation and tropical heat conduction is proposed in this paper. The thermal radiation model is established, and the angle coefficient is introduced to describe the proportion of radiation energy on the surface of powder layer. Based on the geometric characteristics of the powder cylinder, the heat conduction process is simplified to one-dimensional heat conduction along the radial direction, and the heat conduction model is established. The coupled temperature field under two actions is obtained by combining the heat radiation model with the heat conduction model. The uniformity coefficient [Formula: see text]/[Formula: see text] of the temperature field is defined to represent the uniformity of the preheating temperature field of the powder layer. By comparing the uniformity coefficient [Formula: see text], a more uniform temperature field can be obtained when the height coefficient is 1.8 under combined action. The validity of the model is verified by a comparative experiment with processed water atomized iron powder. Constructing uniform temperature field can effectively reduce the deformation of parts and improve the forming quality.
Research on seismic ground motion parameters applicable to the safety of rectangular shallow tunnel
Authors: An Dong , Chen Zheng , Cui Guangyao
Published: January 2022

The objective of this paper is to optimize the selection of seismic ground motion intensity indexes in the seismic fortification of urban shallow-buried rectangular tunnels. This paper takes a shallow-buried rectangular tunnel in a city as the research object, uses ABAQUS to establish a finite-infinite element coupling model, and selects 70 typical seismic ground motions for dynamic calculation. Using dynamic time history analysis method to study the seismic response of tunnel lining structure in terms of internal force, minimum safety factor and strain energy, and analyze their correlation with 15 seismic ground motion parameters. Selecting the seismic ground motion parameters with strong correlation, good effectiveness, and high credibility for safety evaluation. The research results show that: Peak acceleration (PGA) has a weak correlation with the seismic response of tunnel lining structures, and PGA as an independent seismic ground motion intensity index has greater uncertainty in the seismic fortification of tunnels; Peak displacement (PGD), Root-mean-square velocity (RMSV), Root-mean-square displacement (RMSD), and Specific energy density (SED) can be used as independent seismic ground motion intensity index, The linear regression model is used to evaluate the safety of the lining structure, and finally the evaluation result is verified by the incremental dynamic analysis method (IDA), which shows that the evaluation result is accurate. The research results can provide reference for the preliminary design of seismic fortification of rectangular shallow tunnels.
Initiation of hemodialysis at one month following fistulogram in patients with advanced kidney disease
Authors: Wilson Eelin , Sacknovitz Yoni , Dalmia Varun , Sanon Omar , Hatch Ayesha , Dauer Marc , Scher Larry , Lipsitz Evan , Koleilat Issam
Published: January 2022

Objective

Previous studies have demonstrated that low contrast volume used in access-related interventions had limited effects on the progression of chronic kidney disease (CKD) after fistulography, but studies are limited and heterogeneous. We sought to evaluate the rate of and factors associated with progression to dialysis (HD) within 1 month after fistulography for patients with advanced CKD.

Methods

A single-institution retrospective cohort analysis of patients with CKD stage IV and V, not yet on HD, undergoing fistulography from 1 January 2014 to 31 December 2018 was performed. The primary outcome was progression to HD within 1 month. Additional variables and the association with the primary outcome such as medical comorbidities, contrast type or volume were assessed.

Results

A total of 34 patients underwent 41 fistulograms prior to HD initiation. Progression to HD within 1 month of fistulogram occurred in seven patients (all CKD V). The mean time between fistulogram and HD was 271 days for 31 of 34 patients who ultimately progressed to HD. Those with CKD IV began HD in 549 days on average, while those with CKD V began HD in 190 days on average. Three patients had not initiated HD at a mean of 539 days of follow-up. The only factors associated with progression to HD within 1 month included use of isovue ( p = .005) and elevated contrast volume, with a mean of 40 mL ( p = .027).

Conclusion

Although none of the patients with CKD IV required HD within 1 month after fistulogram, the use of larger iodinated contrast volume was associated with progression to HD within 1 month of fistulography for patients with CKD V. Further studies should investigate the safety of iodinated and alternative (e.g., carbon dioxide) contrast media in fistulography or duplex-based HD access procedures for CKD patients, especially CKD V, not yet on HD.
MRI and CT imaging biomarkers of cerebral amyloid angiopathy in lobar intracerebral hemorrhage
Authors: Schwarz Ghil , Banerjee Gargi , Hostettler Isabel C , Ambler Gareth , Seiffge David J , Ozkan Hatice , Browning Simone , Simister Robert , Wilson Duncan , Cohen Hannah , Yousry Tarek , Al-Shahi Salman Rustam , Lip Gregory Y H , Brown Martin M , Muir Keith W , Houlden Henry , Jäger Rolf , Werring David J
Published: January 2022

Background:

Cerebral amyloid angiopathy (CAA), a common cause of intracerebral hemorrhage (ICH), is diagnosed using the Boston criteria including magnetic resonance imaging (MRI) biomarkers (cerebral microbleeds (CMBs) and cortical superficial siderosis (cSS). The simplified Edinburgh criteria include computed tomography (CT) biomarkers (subarachnoid extension (SAE) and finger-like projections (FLPs)). The underlying mechanisms and diagnostic accuracy of CT compared to MRI biomarkers of CAA are unknown.

Methods:

We included 140 survivors of spontaneous lobar supratentorial ICH with both acute CT and MRI. We assessed associations between MRI and CT biomarkers and the diagnostic accuracy of CT- compared to MRI-based criteria.

Results:

FLPs were more common in patients with strictly lobar CMB (44.7% vs 23.5%; p = 0.014) and SAE was more common in patients with cSS (61.3% vs 31.2%; p = 0.002). The high probability of the CAA category of the simplified Edinburgh criteria showed 87.2% (95% confidence interval (CI): 78.3–93.4) specificity, 29.6% (95% CI: 18.0–43.6) sensitivity, 59.3% (95% CI: 38.8–77.6) positive predictive value, and 66.4% (95%: CI 56.9–75.0) negative predictive value, 2.3 (95% CI: 1.2–4.6) positive likelihood ratio and 0.8 (95% CI 0.7–1.0) negative likelihood ratio for probable CAA (vs non-probable CAA), defined by the modified Boston criteria; the area under the receiver operating characteristic curve (AUROC) was 0.62 (95% CI: 0.54–0.71).

Conclusion:

In lobar ICH survivors, we found associations between putative biomarkers of parenchymal CAA (FLP and strictly lobar CMBs) and putative biomarkers of leptomeningeal CAA (SAE and cSS). In a hospital population, CT biomarkers might help rule-in probable CAA (diagnosed using the Boston criteria), but their absence is probably not as useful to rule it out, suggesting an important continued role for MRI in ICH survivors with suspected CAA.
Cerebral hemodynamic effects of early blood pressure lowering after TIA and stroke in patients with carotid stenosis
Authors: Mazzucco Sara , Li Linxin , McGurgan Iain J , Tuna Maria Assuncao , Brunelli Nicoletta , Binney Lucy E , Rothwell Peter M
Published: January 2022

Background:

Effects of early blood pressure (BP) lowering on cerebral perfusion in patients with moderate/severe occlusive carotid disease after transient ischemic attack (TIA) and non-disabling stroke are uncertain.

Aims:

We aimed to evaluate the changes in transcranial Doppler (TCD) indices in patients undergoing blood pressure lowering soon after TIA/non-disabling stroke.

Methods:

Consecutive eligible patients (1 November 2011 to 30 October 2018) attending a rapid-access clinic with TIA/non-disabling stroke underwent telemetric home blood pressure monitoring (HBPM) for 1 month and middle cerebral artery velocities measurements ipsilateral to carotid stenosis on TCD ultrasound in the acute setting and at 1 month. Hypertensive patients (HBPM ⩾ 135/85) underwent intensive BP-lowering guided by HBPM unless they had bilateral severe occlusive disease (⩾ 70%). Changes in BP and TCD parameters were compared in patients with extracranial moderate/severe carotid stenosis (between 50% and occlusion) versus those with no or mild (< 50%) stenosis.

Results:

Of 764 patients with repeated TCD measures, 42 had moderate/severe extracranial carotid stenosis without bilateral severe occlusive disease. HBPM was reduced from baseline to 1 month in hypertensive patients both with versus without moderate/severe carotid stenosis (−12.44/15.99 vs −13.2/12.2 mmHg, respectively, p-difference = 0.82), and changes in TCD velocities (4.69/14.94 vs 2.69/13.86 cm/s, respectively, p-difference = 0.52 for peak systolic velocity and 0.33/7.06 vs 1.75/6.84 cm/s, p-difference = 0.34 for end-diastolic velocity) were also similar, with no evidence of greater hemodynamic compromise in patients with stenosis/occlusion.

Conclusion:

There was no evidence of worsening of TCD hemodynamic indices in patients with moderate/severe occlusive carotid disease treated with BP-lowering soon after TIA/non-disabling stroke, suggesting that antihypertensive treatment in this group of patients is safe in the acute setting of TIA clinics.
Triple Therapy Prevention of Recurrent Intracerebral Disease Events Trial: Rationale, design and progress
Authors: Anderson Craig S , Rodgers Anthony , de Silva H Asita , Martins Sheila Ouriques , Klijn Catharina JM , Senanayake Bimsara , Freed Ruth , Billot Laurent , Arima Hisatomi , Thang Nguyen Huy , Zaidi Wan Asyraf Wan , Kherkheulidze Tinatin , Wahab Kolawole , Fisher Urs , Lee Tsong-Hai , Chen Christopher , Pontes-Neto Octavio , Robinson Thompson , Wang Jiguang , Naismith Sharon , Song Lili , Schreuder Floris H , Lindley Richard I , Woodward Mark , MacMahon Stephen , Al-Shahi Salman Rustam , Chow Clara K , Chalmers John
Published: January 2022

Background:

Patients who suffer intracerebral hemorrhage (ICH) are at very high risk of recurrent ICH and other serious cardiovascular events. A single-pill combination (SPC) of blood pressure (BP) lowering drugs offers a potentially powerful but simple strategy to optimize secondary prevention.

Objectives:

The Triple Therapy Prevention of Recurrent Intracerebral Disease Events Trial (TRIDENT) aims to determine the effects of a novel SPC “Triple Pill,” three generic antihypertensive drugs with demonstrated efficacy and complementary mechanisms of action at half standard dose (telmisartan 20 mg, amlodipine 2.5 mg, and indapamide 1.25 mg), with placebo for the prevention of recurrent stroke, cardiovascular events, and cognitive impairment after ICH.

Design:

An international, double-blind, placebo-controlled, randomized trial in adults with ICH and mild-moderate hypertension (systolic BP: 130–160 mmHg), who are not taking any Triple Pill component drug at greater than half-dose. A total of 1500 randomized patients provide 90% power to detect a hazard ratio of 0.5, over an average follow-up of 3 years, according to a total primary event rate (any stroke) of 12% in the control arm and other assumptions. Secondary outcomes include recurrent ICH, cardiovascular events, and safety.

Results:

Recruitment started 28 September 2017. Up to 31 October 2021, 821 patients were randomized at 54 active sites in 10 countries. Triple Pill adherence after 30 months is 86%. The required sample size should be achieved by 2024.

Conclusion:

Low-dose Triple Pill BP lowering could improve long-term outcome from ICH.
A new gamma degradation process with random effect and state-dependent measurement error
Authors: Esposito Nicola , Mele Agostino , Castanier Bruno , Giorgio Massimiliano
Published: January 2022

In this paper, a new gamma-based degradation process with random effect is proposed that allows to account for the presence of measurement error that depends in stochastic sense on the measured degradation level. This new model extends a perturbed gamma model recently suggested in the literature, by allowing for the presence of a unit to unit variability. As the original one, the extended model is not mathematically tractable. The main features of the proposed model are illustrated. Maximum likelihood estimation of its parameters from perturbed degradation measurements is addressed. The likelihood function is formulated. Hence, a new maximization procedure that combines a particle filter and an expectation-maximization algorithm is suggested that allows to overcome the numerical issues posed by its direct maximization. Moreover, a simple algorithm based on the same particle filter method is also described that allows to compute the cumulative distribution function of the remaining useful life and the conditional probability density function of the hidden degradation level, given the past noisy measurements. Finally, two numerical applications are developed where the model parameters are estimated from two sets of perturbed degradation measurements of carbon-film resistors and fuel cell membranes. In the first example the presence of random effect is statistically significant while in the second example it is not significant. In the applications, the presence of random effect is checked via appropriate statistical procedures. In both the examples, the influence of accounting for the presence of random effect on the estimates of the cumulative distribution function of the remaining useful life of the considered units is also discussed. Obtained results demonstrate the affordability of the proposed approach and the usefulness of the proposed model.
Outcomes of day case shoulder replacement surgery in a stand-alone day care unit in the United Kingdom
Authors: Elgalli Mosab , Hind Jamie , Lahart Ian , Sidhu Gur Aziz Singh , Athar Sajjad , Ashwood Neil
Published: January 2022

Background:

This review aims to compare the outcomes for day case shoulder replacement with in-patient shoulder replacement surgery in a district general hospital.

Methods:

Seventy-three patients had 82 shoulder arthroplasty procedures. Forty-six procedures were undertaken in a dedicated stand-alone day-case unit and 36 were undertaken as in-patient cases. Patient were followed up at 6 weeks, 6 months and annually.

Results:

There was no significant difference between the outcomes of shoulder arthroplasty procedures performed in the day case or in-patient settings making this a safe option for surgical care in a unit with an appropriate care pathway. Six complications in total were observed, three in each group. Operation time was statistically shorter for day cases by 25.1 min (95% CI - 36.5 to −13.7; d = −0.95, 95% CI −1.42 to 0.48). Estimated marginal means (EMM) revealed lower post-surgery oxford pain scores in day cases (EMM = 3.25, 95% CI 2.35, 4.16) compared with inpatients (EMM = 4.65, 95% CI 3.64 to 5.67). Constant shoulder scores were higher in day cases versus inpatients.

Conclusion:

Day case shoulder replacement is safe with comparable outcomes to routine inpatient care for patients up to ASA 3 classification with high satisfaction and excellent functional outcomes.
Treatment of Chronic Ankle Instability in the Military Population: A Systematic Review
Authors: Goodrich Ezra , Vopat Bryan , Herda Ashley
Published: January 2022

Background

The high incidence of ankle sprain within the military sets the stage for prevalent chronic ankle instability. The purpose of this review was to compare and evaluate chronic ankle instability treatment strategies in the military population.

Methods

Electronic databases were systematically searched in accordance with the Preferred Reporting Items for Systematic Reviews guidelines for English-language, human studies with a military patient population that had been diagnosed with and treated for chronic ankle instability. Exclusion criteria were animal, cadaver, and review studies and case reports.

Results

Eight studies met the inclusion criteria, representing 695 military service members—625 males (89.9%) and 70 females (10.1%)—and 4 treatment strategies: Broström-related procedures, modified Watson-Jones procedure, Colville’s technique, and anatomic lateral ligament reconstruction using semitendinosus tendon allograft. The percentage of satisfactory outcomes was 100% for Colville’s technique, and ranged from 73.2% to 94.7% for Broström-related procedures and 72% to 80% for the modified Watson-Jones procedure. Mean American Orthopaedic Foot and Ankle Society scores, anterior drawer displacement, talar tilt, and visual analogue scale scores were also reported.

Conclusion

This review demonstrates that the Bröstrom procedure has consistently satisfactory outcomes within the military population, and Colville’s technique is another promising option for this patient population but would require additional studies to support this claim.

Levels of Evidence:

Level IV
Accuracy of CT-Derived Patient-Specific Instrumentation for Total Ankle Arthroplasty: The Impact of the Severity of Preoperative Varus Ankle Deformity
Authors: Umbel Benjamin D. , Hockman Taylor , Myers Devon , Sharpe B. Dale , Berlet Gregory C.
Published: January 2022

Background

Significant preoperative varus tibiotalar deformity was once believed to be a contraindication for total ankle arthroplasty (TAA). Our primary goal was to evaluate the influence of increasing preoperative varus tibiotalar deformity on the accuracy of final implant positioning using computed tomography (CT)-derived patient-specific guides for TAA.

Methods

Thirty-two patients with varus ankle arthritis underwent TAA using CT-derived patient-specific guides. Patients were subcategorized into varying degrees of deformity based on preoperative tibiotalar angles (0°-5° neutral, 6°-10° mild, 11°-15° moderate, and >15° severe). Postoperative weightbearing radiographs were used to measure coronal plane alignment of the tibial implant relative to the target axis determined by the preoperative CT template. Average follow-up at the time of data collection was 36.8 months.

Results

Average preoperative varus deformity was 6.06° (range: 0.66°-16.3°). Postoperatively, 96.9% (30/31) of patients demonstrated neutral implant alignment. Average postoperative tibial implant deviation was 1.54° (range: 0.17°-5.7°). Average coronal deviation relative to the target axis was 1.61° for the neutral group, 1.78° for the mild group, 0.94° for the moderate group, and 1.41° for the severe group (P = .256). Preoperative plans predicted 100% of tibial and talar implant sizes correctly within 1 size of actual implant size. Conclusion. Our study supports the claim that neutral postoperative TAA alignment can be obtained using CT-derived patient-specific instrumentation (PSI). Furthermore, final implant alignment accuracy with PSI does not appear to be impacted by worsening preoperative varus deformity. All but one patient (96.9%) achieved neutral postoperative alignment relative to the predicted target axis.

Level of Evidence:

Level IV, Clinical Case Series
Weight Location Moderates Weight-Based Self-Devaluation and Perceived Social Devaluation in Women
Authors: Barlev Michael , Ko Ahra , Krems Jaimie A. , Neuberg Steven L.
Published: January 2022

Overweight and obese (“heavyweight”) people devalue themselves because, it has been proposed, they are socially devalued. However, for women, social valuation depends not only on how much weight they carry but also on where on their bodies they carry it. Here, we investigated whether weight-based self-valuation and perceived social valuation similarly depend on body shape. Study 1, using a nationally representative sample from National Health and Nutrition Examination Survey (NHANES; N = 1,093 reproductive-aged women), showed that, controlling for body fat, weight labeling (by self and others) and wanting to lose weight depended on body shape. Study 2, in a direct test of predictions using an undergraduate sample of women ( N = 215), showed that with increased body fat, women with an abdominal weight distribution reported more self-devaluation (e.g., lower self-esteem) and perceived social devaluation (e.g., higher perceived weight discrimination); women with a gluteofemoral weight distribution, however, were shielded—partially or fully—from these adverse effects of increased body fat.
A case report on penile duplication: A rare congenital anomaly
Authors: Nouman Ali Rao , Irfan Sohaib , Irfan Wajiha , khan Attiq-ur-rehman , Irfan Muhammad , Khalid Butt Muhammad
Published: January 2022

Introduction: Penile duplication or penile diphallia is a rare congenital anomaly that is mainly associated with renal, anorectal or vertebral anomalies, that is, spina bifida. This condition was first described by Johannes Jacob Wecker in 1609 in Italy.

Problem: Its incidence is extremely rare, about one in millions. The aetiology of this condition is unknown up till now; however, it is considered that defect of genital tubercle leads to the formation of diphallia.

Methods: The condition is diagnosed clinically, and management depends on the appearance of genitalia and the associated anomalies as well as after taking into account the social and ethical considerations. Most of the time, management involves surgical incision of the non-functioning penis.

Results: In this case report, a child of age 10 years presented with double penis since childhood. The child was evaluated clinically and radiologically for any other associated abnormalities, and his non-functional urethra was surgically removed.

Level of evidence: Level IV
Can managerialism promote organisational transformation in private universities?
Authors: Kazuyuki Maeda
Published: January 2022

Used as a method of university reform, new public management (NPM) involves an ideology of managerialism that conflicts with collegiality and causes ‘hybridisation’. In management organisations, when organisational goals are not shared at the individual level, this adjustment mechanism shifts to the organisational level. This study aimed to examine whether there are coordination mechanisms at the organisational level in universities by focussing on those in Japan, particularly private universities that require autonomous management. Multi-level analysis results revealed that although there is hybridisation associated with increased managerial pressure, there are no organisational-level mechanisms to reduce conflict. In conclusion, the authors point out the difficulty of organising private universities based on managerialism and suggests that university reform in Japan may be ‘hollowing out’ in the public sector as well. Further, the study emphasises the importance of undertaking a comparative study of governance arrangements in China’s private universities in the future.
Do Clinical Outcomes and Failure Rates Differ in Patients With Combined ACL and Grade 2 MCL Tears Versus Isolated ACL Tears?: A Prospective Study With 14-Year Follow-up
Authors: Lucidi Gian Andrea , Agostinone Piero , Grassi Alberto , Di Paolo Stefano , Dal Fabbro Giacomo , Bonanzinga Tommaso , Zaffagnini Stefano
Published: January 2022

Background:

A combined injury to the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) is a common injury pattern encountered during clinical practice. Recent systematic reviews have found no consensus on the optimal method of managing this combined ligament injury pattern, and no long-term studies with modern techniques are available in the literature.

Purpose:

To compare 2 groups of patients who underwent isolated ACL reconstruction in terms of failures and clinical scores at long-term follow-up. In the first group were patients with isolated ACL tears (ACL group), while the second was composed of patients with combined ACL and MCL grade 2 tears (ACL + MCL group).

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A total of 57 patients (37 in the ACL group and 20 in the ACL + MCL group) underwent isolated ACL reconstruction with a double-bundle technique between January and December 2005. Patients were contacted for scores on the International Knee Documentation Committee subjective form, Western Ontario and McMaster Universities Osteoarthritis Index, and Tegner activity scale as well as data regarding ipsilateral or contralateral revision ACL surgery. A 2-way analysis of variance for repeated measures was used to statistically assess the differences between the groups.

Results:

Overall, 49 patients (86%) completed the survey and were therefore included in the study. The minimum follow-up was 14.6 years (range, 14.1-15.2 years). There was a significant reduction in both groups of all the outcome scores between the intermediate and final-follow-up. The number of failures was 3 of 31 (9.7%) in the ACL group and 1 of 18 (5.5%) in the ACL + MCL group; this difference was not significant. Moreover, there were no clinical differences between the groups in terms of graft failures, contralateral lesions, and clinical scores.

Conclusion:

At 14-year follow-up, no clinical difference or increased failure rate was observed between the study groups, suggesting that isolated ACL reconstruction could represent an appropriate treatment for a combined ACL and MCL grade 2 lesion.
A Qualitative Examination of Perceived Stigma and its Sources Among Adolescents Living With HIV in Western Kenya
Authors: Callen Grant , Chory Ashley , Sang Festus , Munyoro Dennis , Aluoch Josephine , Scanlon Michael , Enane Leslie , McHenry Megan , Wools-Kaloustian Kara , Apondi Edith , Vreeman Rachel
Published: January 2022

Introduction. Adolescents (10-19 years) living with HIV (ALWH) face unique challenges in controlling HIV long-term, including stigma and perception of stigma within their communities. Methods. We conducted a qualitative investigation of the sources of perceived HIV-related stigma with ALWH in western Kenya. Forty-six ALWH on ART, aware of their status, and engaged in care were enrolled. Interviews explored perceived stigma by probing the individuals and experiences that adolescents identify as causing or perpetuating their ongoing fears. Results. Participants (54% male, mean age 17.4) reported ongoing fears of stigmatization related to friends and peers not living with HIV. They described previous enacted and first-hand observations of stigma, most often occurring in pre-adolescence, by age mates or peers at school as the most common cause for their ongoing fears. Conclusions. Perceived stigma is prevalent among ALWH and develops from experiences in pre-adolescence. Anti-HIV stigma interventions addressing educators and children in school settings to combat perceived stigma at its source should be investigated.
Determinants of Crop Diversification in Bangladesh: An Econometric Analysis
Authors: Azad Abul Kalam
Published: January 2022

This study aims to investigate the factors that influence household behaviour in cultivating the diversified crops on their cultivable land in Bangladesh. Cragg’s alternative tobit model has been applied to a unique rural household level dataset to find the catalysts of crop diversification. The results obtained portrayed a mixed impression of crop diversification in the country. The estimated results have revealed that the male head of household, the accessibility of information, a greater number of farming parcels and the availability of hired labour seem to govern the decision of a farming household to participate in non-rice crop production, while factors such as the total amount of land, agricultural extension service and irrigation facilities influence rice cultivation. Moreover, the findings obtained from the same Cragg’s alternative tobit model estimation for the Aman, Boro and Aus seasons have also revealed a similar depiction of crop diversification in Bangladesh.
Using theory and reflexivity to preserve methodological rigour of data collection in qualitative research
Authors: Jamie Kimberly , Rathbone Adam Pattison
Published: January 2022

This paper examines the place of theory in qualitative medical research. While theory’s place in research planning and data analysis has been well-established, the contribution of theory during qualitative data collection tends to be overlooked. Yet, data collection is not an asocial or apolitical process and requires reflection and analysis in and of itself. Therefore, drawing on an exemplar case study research project which focused on patients’ use of medicines, the paper argues that engaging with theory to think reflexively, throughout a project but particularly during the process of data collection can ensure the rigour and trustworthiness of qualitative data. In this case study, we draw on sociologist Erving Goffman’s theoretical framework of the dramaturgical metaphor to address the multiplicity of roles that healthcare practitioners undertaking qualitative research have to occupy and navigate. Rather than painting researchers out of their research through a naïve search for ‘objectivity’, reflexivity that is scaffolded by theory, offers a way through which researchers’ biases and subjectivities can be made explicit and their data analysis transparent. In making this argument, we encourage medical researchers to engage with, and be attuned to, theoretical perspectives outwith their own discipline.
Management of GERD in Patients With Obesity
Authors: Greer Katarina B.
Published: January 2022

Gastroesophageal reflux disease (GERD) affects an estimated 20% of the population in the Unites States. Lifestyle modifications and proton pump inhibitor therapy are effective for majority of patients, however, some patients cannot tolerate this treatment or find it ineffective requiring endoscopic or surgical management. Obese patients with GERD who pursue surgical management are at increased risk of developing recurrence of symptoms after laparoscopic anti-reflux surgery. Roux en Y gastric bypass remains the surgical procedure of choice for obese patients with GERD. Endoluminal weight loss interventions seek to offer minimally invasive options for obesity management, however, their efficacy for GERD management in patients with obesity remains to be determined.
Foregut Issues After Bariatric Surgery
Authors: Cheema Fareed , Pryor Aurora D.
Published: January 2022

Weight loss surgery has overall been shown to be very safe and effective. However, long-term outcomes data has allowed codification of post-operative complications specific to the type of weight loss surgery performed. This review focuses specifically on foregut-related postoperative complications after weight loss surgery, most of which are not discussed on a broad scale in the literature yet whose prevalence continues to rise. Clinicians should maintain a broad differential when treating patients with complications after bariatric surgery in order to perform a thorough and precise workup to identify the diagnosis and guide management.