bluuebunny/crossref_metadata_2025 huggingface dataset:
Identifying actionable strategies: using Consolidated Framework for Implementation Research (CFIR)-informed interviews to evaluate the implementation of a multilevel intervention to improve colorectal cancer screening
Authors: Lam Helen , Quinn Michael , Cipriano-Steffens Toni , Jayaprakash Manasi , Koebnick Emily , Randal Fornessa , Liebovitz David , Polite Blasé , Kim Karen
Published: May 2021

Background

Many evidence-based interventions (EBIs) found to be effective in research studies often fail to translate into meaningful patient outcomes in practice. The purpose of this study was to identify facilitators and barriers that affect the implementation of three EBIs to improve colorectal cancer (CRC) screening in an urban federally qualified health center (FQHC) and offer actionable recommendations to improve future implementation efforts.

Methods

We conducted 16 semi-structured interviews guided by the Consolidation Framework for Implementation Research (CFIR) to describe diverse stakeholders’ implementation experience. The interviews were conducted in the participant’s clinic, audio-taped, and professionally transcribed for analysis.

Results

We used the five CFIR domains and 39 constructs and subconstructs as a coding template to conduct a template analysis. Based on experiences with the implementation of three EBIs, stakeholders described barriers and facilitators related to the intervention characteristics, outer setting, and inner setting. Implementation barriers included (1) perceived burden and provider fatigue with EHR (Electronic Health Record) provider reminders, (2) unreliable and ineffectual EHR provider reminders, (3) challenges to providing health care services to diverse patient populations, (4) lack of awareness about CRC screening among patients, (5) absence of CRC screening goals, (6) poor communication on goals and performance, and (7) absence of printed materials for frontline implementers to educate patients. Implementation facilitators included (1) quarterly provider assessment and feedback reports provided real-time data to motivate change, (2) integration with workflow processes, (3) pressure from funding requirement to report quality measures, (4) peer pressure to achieve high performance, and (5) a culture of teamwork and patient-centered mentality.

Conclusions

The CFIR can be used to conduct a post-implementation formative evaluation to identify barriers and facilitators that influenced the implementation. Furthermore, the CFIR can provide a template to organize research data and synthesize findings. With its clear terminology and meta-theoretical framework, the CFIR has the potential to promote knowledge-building for implementation. By identifying the contextual determinants, we can then determine implementation strategies to facilitate adoption and move EBIs to daily practice.
Screening for chronic hepatitis C and chronic hepatitis B infections among pregnant females: a cross-sectional study
Authors: Eletreby Rasha , Elraouf Maged Abd , Fouad Ahmed , Nasser Mona , Al Bassiouni Mostafa , Zayed Naglaa , Yosry Ayman , Abdellatif Zeinab
Published: May 2021

Background

In Egypt, an endemic country for both viral hepatitis C and B infections, infection could be more prevalent in pregnant females. This study aimed to assess the prevalence of chronic HCV and HBV in a cohort of pregnant Egyptian females, highlighting the disease burden for better preventive measures and better disease outcome. In this cross-sectional prospective study, 399 pregnant women attending antenatal clinic in a tertiary care center in Egypt were screened for HCV and HBV infection using ELISA testing. Clinical and biochemical characteristics were compared between positive and negative cases.

Results

Mean age was 26.78 years. Prevalence rates of HCV-Ab and HBsAg positivity were 7.02% and 7.52%. Isolated HBcAb positivity was found in only 2 patients (0.5%). All cases were negative for HBsAb. No combined HBV/HCV infection was detected. All positive cases for either HBV or HCV infections did not show any signs of hepatic decompensation. ALT was significantly higher among HBV positive versus negative patients (mean ± SD of 14.2 ± 5.77 IU/L versus 11.95 ± 5.21 IU/L, p = 0.02, reference range: 7-56 IU/L), while no significant difference was found between HCV positive and negative cases as regards liver enzymes.

Conclusion

In Egypt, HBV prevalence in pregnant females seems to be higher than general population. This was not evident for HCV infection; however, it is still higher than pooled prevalence rates worldwide. This higher prevalence for both viral infections warrants strict screening programs to prevent vertical transmission and to provide better maternal and fetal outcome.
A tale of the new and the old: renovation of Yong’an Warehouse at Yangpu waterfront, Shanghai
Authors: Yuan Philip F. , Wei Xiaoyu , Yu Wei
Published: May 2021

The urban riverside space of Shanghai is transforming. How to renovate industrial heritage buildings to renew their vitality while retaining their historical memories and integrate them into the contemporary cityscape and today’s urban lifestyle is a common challenge encountered by contemporary architects. This article takes the renovation of Yong’an Warehouse as an example to showcase a typical heritage conservation project’s design process. The architects took different approaches to accommodate the different statuses of the twin buildings of the Yong’an Warehouse, seeking to create a symbiotic twin relationship between the past and the present. This project adopted a conservation and utilisation approach that involves multilateral participation, emphasising value-oriented mythology, and providing an alternative thread for the renovation of historical architecture.
Poor Endometrial Proliferation After Clomiphene is Associated With Altered Estrogen Action
Authors: Hawkins Bressler Leah , Fritz Marc A , Wu San-Pin , Yuan Lingwen , Kafer Suzanna , Wang Tianyuan , DeMayo Francesco J , Young Steven L
Published: May 2021

Context

Suboptimal endometrial thickening is associated with lower pregnancy rates and occurs in some infertile women treated with clomiphene.

Objective

To examine cellular and molecular differences in the endometrium of women with suboptimal vs optimal endometrial thickening following clomiphene.

Methods

Translational prospective cohort study from 2018 to 2020 at a university-affiliated clinic. Reproductive age women with unexplained infertility treated with 100 mg of clomiphene on cycle days 3 to 7 who developed optimal (≥8mm; n = 6, controls) or suboptimal (<6mm; n = 7, subjects) endometrial thickness

underwent preovulatory blood and endometrial sampling.

The main outcome measures were endometrial tissue architecture, abundance and location of specific proteins, RNA expression, and estrogen receptor (ER) α binding.

Results

The endometrium of suboptimal subjects compared with optimal controls was characterized by a reduced volume of glandular epithelium (16% vs 24%, P = .01), decreased immunostaining of markers of proliferation (PCNA, ki67) and angiogenesis (PECAM-1), increased immunostaining of pan-leukocyte marker CD45 and ERβ, but decreased ERα immunostaining (all P < .05). RNA-seq identified 398 differentially expressed genes between groups. Pathway analysis of differentially expressed genes indicated reduced proliferation (Z-score = –2.2, P < .01), decreased angiogenesis (Z-score = –2.87, P < .001), increased inflammation (Z-score = +2.2, P < .01), and ERβ activation (Z-score = +1.6, P < .001) in suboptimal subjects. ChIP-seq identified 6 genes bound by ERα that were differentially expressed between groups (P < .01), some of which may play a role in implantation.

Conclusion

Women with suboptimal endometrial thickness after clomiphene exhibit aberrant ER expression patterns, architectural changes, and altered gene and protein expression suggesting reduced proliferation and angiogenesis in the setting of increased inflammation.
Palladium-Catalyzed Intramolecular Aromatic C–H Acylation of 2-Arylbenzoyl Fluorides
Authors: Sakurai Yuka , Ikai Kana , Hayakawa Kazuki , Ogiwara Yohei , Sakai Norio
Published: May 2021

The catalytic intramolecular cyclization of acyl fluorides using a Pd(OAc)2/PCy3 system is described. A wide range of 2-arylbenzoyl fluoride derivatives can be used as fluorenone precursors and the reaction proceeds via an intramolecular coupling between aromatic C–H bonds with acyl C–F bonds. The reaction can be applied to the synthesis of indenofluorenedione derivatives and to the construction of other molecules with five-membered rings.
Το αρχαίο ελληνικό παρελθόν ως εργαλείο πολιτικής και διπλωματίας στον δυτικό κόσμο του 20ου και 21ου αιώνα
Authors: Χαμουζάς Αναστάσιος
Published: May 2021

Το Αρχαίο Ελληνικό Παρελθόν εργαλειοποιείται συχνά στη δυτική πολιτική και διπλωματία, ιδίως ως μέσο πειθούς, όπως συνήθως αποτελεί παιδευτική υποδομή και στοιχείο διανοητικού εξοπλισμού για τον πολίτη του δυτικού κόσμου. Πώς όμως και γιατί ειδικά το Αρχαίο Ελληνικό Παρελθόν επιλέγεται στο πολιτικό και διπλωματικό πεδίο να γίνεται στοιχείο ρητορικής «ορθοπραξίας» που συγκροτεί δικαιοπολιτική συνείδηση και σκέψη ακόμη και στον 21ο αιώνα; Η έρευνα αυτή πρωτοτυπεί, γιατί δεν έχει αφετηρία την κλασική ελληνική γραμματεία και διανόηση, αλλά τμήματα από λόγους δυτικών πολιτικών ή διπλωματών όπου το Αρχαίο Ελληνικό Παρελθόν αποδεικνύεται ότι συσσωματώνει μια διαρκώς σύγχρονη έκφραση με πανανθρώπινη αποδοχή: ο λόγος της κλασικής Ελλάδας δηλαδή, αφ’ ενός προσφέρει και αφ’ ετέρου διερμηνεύει διεποχικά την πολιτική θεωρητική συνέχεια και υπαγορεύει την πρακτική αμεσότητα της καθολικής ελευθερίας, της δημοκρατίας, του μέτρου, της ειρήνης, του Κράτους Δικαίου. Έτσι, η δυτική πολιτική και η διπλωματία τείνει να προσκτάται με το Αρχαίο Ελληνικό Παρελθόν μια οικουμενικά αποδεκτή διαλεκτική κύρους, ορθότητας και συγκρότησης πλαισίου αλληλοκατανόησης μεταξύ των ανθρώπων για τη σύλληψη του πρακτέου.
Generalized graphs and grammars
Authors: Mikov Aleksandr
Published: May 2021

The textbook deals with ordinary graphs and their generalizations-hypergraphs, hierarchical structures, geometric graphs, random and dynamic graphs. Graph grammars are considered in detail.
Meets the requirements of the federal state educational standards of higher education of the latest generation.
For master's students studying in the areas of the 02.00.00 group "Computer and Information Sciences", and can also be used in senior bachelor's courses and other areas in the field of computer science and computer engineering.
Oil and Gas Chemistry
Authors: Ryabov Vladimir
Published: May 2021

The textbook provides up-to-date data on the composition and properties of hydrocarbons and other oil and gas compounds, on the physical and chemical methods and methods for separating and identifying oil components (molecular spectroscopy, mass spectrometry, NMR spectroscopy, electron paramagnetic resonance, atomic adsorption spectroscopy, neutron activation analysis). The chemistry and mechanism of thermal and catalytic transformations of oil components in the main processes of oil raw materials processing, as well as the problems of the origin of oil and the transformation of oil in the environment are considered.
Meets the requirements of the federal state educational standards of higher education of the latest generation.
It is intended for training in the course "Chemistry of oil and gas", for the preparation of bachelors, masters and certified specialists in the field of training "Oil and Gas business". It can be used for training in other areas in oil and gas universities and be of interest to specialists working in the field of chemistry and technology of oil refining and in other areas of the oil and gas industry.
Environmental impact assessment
Authors: Strel'nikov Viktor , Chernysheva Natal'ya
Published: May 2021

The training manual covers various aspects of environmental impact assessment. It is intended to formulate students studying in the field of "Ecology and Nature Management", an idea of the main types of impact on the components of the environment, the standards of environmental quality and criteria for assessing the state of its components. The basic concepts of environmental impact assessment on environmental components, environmental forecasting and modeling are analyzed.
For undergraduate students of higher educational institutions in the field of "Ecology and nature Management". It may be of particular interest to managers and employees of organizations whose activities are related to the focus "Ecology and nature management".
Fundamentals of accounting (fundamentals of theory, business situations, tests)
Authors: Kizilov Aleksandr
Published: May 2021

The textbook contains the basics of accounting theory, tasks for conducting practical classes on the course "Fundamentals of Accounting". In order to monitor the current study of the material on all topics, tests are provided to help students consolidate their knowledge, and teachers — to find out the degree of assimilation of the subject. The proposed material is presented not only in text, but also in drawings and diagrams that contribute to the effective perception of the course being studied.
Meets the requirements of the federal state educational standards of higher education of the latest generation.
For undergraduate students of all forms of education in the field of training 38.03.01 "Economics".
Social dialectics of prehistory
Authors: Nekrasov Stanislav
Published: May 2021

The author of the monograph, written on the original material, restores the classical scientific social philosophy, which allows the means of dialectical methodology and materialism in sociology to predict the end of the prehistory of antagonistic epochs and the beginning of the true history of a single humanity.
The new industrialization at the moment of transition from prehistory to history creates civilizational neo-industrialism as a dialectical synthesis of traditional civilization and progressive formation in the form of new socialism. The global project of neo-industrialism civilizes humanity — saves it from barbarism, wars, social inequality, and the destruction of nature. In historical Russia, civilizing development is realized at the expense of new industrialization and the solution of general democratic tasks with the transition to post-capitalist tasks.
Conceptually, civilizational neo-industrialism acts as the fifth world theory, which makes it possible to understand the future of the dialectic of new social forces in the transition from prehistory to history.
It is of interest to postgraduates, researchers and a wide range of readers in order to determine the worldview position, clarify the philosophical base of science and search for scientists, understand the dialectics of social existence and social consciousness.
Philosophy of Physics: towards new Principles of Scientific Knowledge
Authors: Karpenko Ivan
Published: May 2021

The author analyzes a number of key problems of modern physics and cosmology, offers original interpretations and solutions, and also discusses the prospects for the development of science in the context of attempts to create a "theory of everything". The monograph pays special attention to the physical theories of the multiverse, the new principles of scientific knowledge resulting from these theories, and the connection between consciousness and concrete physical reality.
It is intended both for those who are just discovering the world of philosophy of science in the most fundamental field — physics, and for specialists who are professionally engaged in the topic and are interested in the most relevant research.
Management accounting of expenses of an industrial enterprise
Authors: Osipov Vladimir
Published: May 2021

The monograph comprehensively examines the problems of management accounting of expenses of an industrial enterprise in order to find ways to improve the efficiency of its functioning in the current economic conditions.
A detailed description of the process of resource consumption is given, the role of management accounting in ensuring its successful implementation is determined. The composition of the information used in the management of the company's expenses is disclosed. Domestic and foreign management accounting systems are considered, and proposals for their further improvement are put forward. The procedure for monitoring management decisions that determine the costs of an enterprise at certain stages of their existence is studied. Close attention is paid to the economic analysis aimed at finding reserves for improving the efficiency of resource consumption and identifying ways to implement them.
For students, postgraduates, teachers and anyone interested in management accounting.
The Press becomes Power: Political Discussions on the Pages of the US Periodical Press in the Late 18th Century
Authors: Filimonova Mariya
Published: May 2021

The monograph examines the evolution of American public opinion in the key period of the history of the creation of the United States as an independent state, the ratification of the Constitution and the formation of federal power. It is shown what methods were used by the mass media of the XVIII century. to mobilize the masses, how the work with information took place, how the news agenda was formed. The growing influence of the press in American society is presented as a natural part of the political and cultural transformations associated with the War of Independence and the difficult international situation of the 1790s.
It is intended for American historians, researchers, teachers of higher and secondary schools, students, bachelors, masters and postgraduates, as well as anyone interested in the problems of US history.
Modern automation in process control systems
Authors: Ivshin Valeriy , Peruhin Marat
Published: May 2021

The textbook describes the basics of the theory, schemes, designs and technical characteristics of intelligent measuring instruments. The principles of operation of control and measuring devices, automatic regulators and control devices are considered. Numerous examples of automation schemes are given.
Meets the requirements of the federal state educational standards of higher education of the latest generation.
For students of technological universities.
Wastewater treatment: new flotation models and flotation combines of the KBS type and special purpose
Authors: Ksenofontov Boris
Published: May 2021

In this monograph, for the first time in the world literature, the multi-stage and generalized flotation models proposed by the author more than thirty years ago are considered in a broad aspect. The possibilities of their use in various areas of flotation water purification, precipitation thickening and mineral processing are shown. Issues related to new flotation equipment in the form of flotation combines of the KBS type and special purpose, developed on the basis of multi-stage and generalized models of the flotation process, are widely covered. The prospects and ways of intensification of flotation processes of water purification are indicated.
For a wide range of readers, including researchers, university teachers, postgraduates, masters, bachelors and undergraduates.
Sampling methods and metereological factors on pests and beneficial organisms in strawberries
Authors: Benatto Alessandra , De Souza Mireli Trombin , Souza Michele Trombin de , Mógor Atila Francisco , Pimentel Ida Chapaval , Zawadneak Maria Aparecida Cassilha
Published: May 2021

We characterize the population dynamics of pests and beneficial organisms in strawberries to assess the impact of two meteorological factors (temperature and precipitation) and define the most appropriate method for monitoring insects in strawberries crop. Population dynamics were monitored weekly using the plant beat method and Möericke traps in Albion strawberries. Measurements were taken in organic strawberry farms over two growing seasons, from March 26, 2010 to August 23, 2010 (first season - 2009/2010) and from October 4, 2010 to March 21, 2011 (second season - 2009/2010) in the municipality of Pinhais, Paraná state, southern Brazil (25º25'S; 49º08'W). We collected a total of 7,971 pests and 1,987 beneficial organisms. The most abundant pests were Chaetosiphon fragaefolii (Cockerell) (Hemiptera: Aphididae) in the first growing season and Tetranychus urticae (Koch) (Acari: Tetranychidae) in the second. Beneficial organisms from Acari, Araneae, and Hymenoptera parasitoids predominated in both seasons. Temperature and precipitation were the the primary climatic factor associated with the population variation of aphids. Populations of C. fragaefolii grew when the temperature was between 16°C and 25ºC. We found that plant beat was the fastest and most suitable method for strawberry pests monitoring since it captured insects that were effectively colonizing the plants. This study contributes to a better understanding of the entomofauna associated with cultivation of organic strawberry.
The Interplay of Having an Abortion, Relationship Satisfaction, and Union Dissolution
Authors: Hajek Kristin
Published: May 2021

This study researches the associations between having an abortion, relationship satisfaction, and union dissolution. Empirical evidence on this topic is scarce, and there is a pronounced lack of studies analysing longitudinal data: Most previous studies have used data from women recruited from abortion clinics who are about to undergo an abortion, and therefore do not incorporate a prospective measure of relationship satisfaction pre-pregnancy. Panel studies, on the other hand, collect prospective data on various topics and allow for the estimation of more advanced models that can help identify causal mechanisms. Using data from the German Family Panel pairfam in combination with pooled logistic regressions, discrete-time event history models, as well as fixed effects regression models, this study compares relationships up to nine years before having had an abortion and eight years afterwards. The findings of the analyses can neither confirm that relationship satisfaction acts as a confounding factor that influences both the likelihood of terminating a pregnancy and union dissolution, nor as a mediating factor between having an abortion and union dissolution. A negative effect of having an abortion on relationship satisfaction appears to be only temporary. In the year of an abortion, relationship satisfaction decreases slightly. In the following years, a significant difference in relationship satisfaction to pre-abortion years is no longer visible. By using panel data, the temporal order of events can be retraced, resulting in the discovery that relationship satisfaction and union dissolution do not change drastically from pre-abortion values after having an abortion.

* This article belongs to a special issue on "Identification of causal mechanisms in demographic research: The contribution of panel data".
Does Marriage Increase Couples’ Life Satisfaction?
Authors: Gattig Alexander , Minkus Lara
Published: May 2021

Many contemporary studies find that married couples are more satisfied with life than unmarried people. However, whether marriage makes people more satisfied with life or whether more satisfied couples are more likely to marry remains a debated question. We reassess this relationship with panel data from the German Family Panel (pairfam) and extend previous analyses by adding individual trajectories (slopes) to standard fixed-effects regressions (FEIS). We are thereby able to distinguish – controlling for time-constant unobserved heterogeneity – whether there is in fact an effect of marriage on life satisfaction, whether people who are simply happier in their relationship are more likely to get married, or whether people whose development in life satisfaction is more positive are more likely to get married. We translate these different social mechanisms into different analytical strategies and find that OLS regression – due to its confounding effects between and within persons – overestimates the effect of marriage on life satisfaction. A fixed-effects estimator reveals a much lower effect of marriage on life satisfaction for couples who marry compared to those who continue to live apart together or cohabitate. Additionally, using a FEIS estimator and adjusting for – non-linear – development of individual life satisfaction over time, suggests that this effect is in fact causal.

* This article belongs to a special issue on "Identification of causal mechanisms in demographic research: The contribution of panel data".
Crystal Palace – Liminal ‘Self’ and Its Projection in Anne Rice’s Interview with the Vampire and The Vampire Lestat
Authors: Koroniak Anna
Published: May 2021

Crystal Palace – Liminal ‘Self’ and Its Projectionin Anne Rice’s Interview with the Vampire and The Vampire Lestat

This paper offers an analysis of the liminality of the ‘Self’ and its subsequent projection onto the material world in Anne Rice’s early novels, Interview with The Vampire and The Vampire Lestat. The study is focused on two characters of the said works – Lestat de Lioncourtand his long-time companion Claudia – and aims at examining their respective‘Selves’ as preternatural beings as well as unique individuals. The research draws on Judith Butler’s and Rosi Braidotti’s theories in order to examine the physical, emotional, and mental changes the characters under go. It subsequently shows that the preternatural ‘Self’exists in a constant state of non-telic transformation, as well as that the perennial metamorphosisis continuously reflected in the characters’ material homes.
Early outcomes of a modern cemented total knee arthroplasty
Authors: Yang JaeWon , Heckmann Nathanael D. , Nahhas Cindy R. , Salzano Michael B. , Ruzich Gregory P. , Jacobs Joshua J. , Paprosky Wayne G. , Rosenberg Aaron G. , Nam Denis
Published: May 2021

Aims

Recent total knee arthroplasty (TKA) designs have featured more anatomical morphologies and shorter tibial keels. However, several reports have raised concerns about the impact of these modifications on implant longevity. The aim of this study was to report the early performance of a modern, cemented TKA design.

Methods

All patients who received a primary, cemented TKA between 2012 and 2017 with a minimum two-year follow-up were included. The implant investigated features an asymmetrical tibial baseplate and shortened keel. Patient demographic details, Knee Society Scores (KSS), component alignment, and the presence of radiolucent lines at final follow-up were recorded. Kaplan-Meier analyses were performed to estimate survivorship.

Results

A total of 720 of 754 primary TKAs (95.5%) were included with a mean follow-up of 3.9 years (SD 1.3); 562 (78.1%) were cruciate-retaining and 158 (21.9%) were posterior-stabilized. A total of 11 (1.5%) required reoperation for periprosthetic joint infection and seven (1.0%) for aseptic tibial loosening (five cruciate-retaining, two posterior-stabilized). Loosening occurred at a mean of 3.3 years (0.9 to 6.5). There were no cases of loosening in the 33 patients who received a 14 mm × 30 mm tibial stem extension. All-cause survivorship was 96.6% at three years (95% confidence interval (CI) 95.3% to 98.0%) and 96.2% at five years (95% CI 94.8% to 97.7%). Survivorship with revision for aseptic loosening was 99.6% at three years (95% CI 99.1% to 100.0%) and 99.1% at five years (95% CI 98.4% to 99.9%). Tibial components were in significantly more varus in those with aseptic loosening (mean 3.4° (SD 3.7°) vs 1.3° (SD 2.0°); p = 0.015). There were no other differences in demographic, radiological, or surgical characteristics between revised and non-revised TKAs for aseptic loosening (p = 0.293 to 1.00). Mean KSS improved significantly from 57.3 (SD 9.5) preoperatively to 92.6 (SD 8.9) at the final follow-up (p < 0.001).

Conclusion

This is the largest series to date of this design of implant. At short-term follow-up, the rate of aseptic tibial loosening is not overly concerning. Further observation is required to determine if there will be an abnormal rate of loosening at mid- to long-term follow-up. Cite this article: Bone Joint J 2021;103-B(6 Supple A):51–58.
Editorial
Authors: Sadao Iizuka Edson
Published: May 2021

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Establishing minimally invasive cardiac surgery in a low-volume mitral surgery centre
Authors: Kirmani BH , Knowles A , Saravanan P , Zacharias J
Published: May 2021

Introduction

Despite early enthusiasm, minimally invasive cardiac surgery has had a low uptake compared with novel techniques in interventional cardiology. Steep learning curves from high-volume centres have deterred smaller units from engaging, even though low-volume centres undertake a large proportion of surgical interventions worldwide. We sought to identify the safety and experience of learning minimally invasive cardiac surgery after undertaking a structured fellowship at Blackpool Victoria Hospital, a low-volume centre.

Materials and methods

A retrospective analysis of outcomes for all consecutive minimally invasive cardiac surgery procedures performed via a right mini-thoracotomy at our institution between 2007 and 2017 was undertaken. Clinical outcomes included death, conversion to sternotomy, stroke, renal failure and other organ support. Cardiopulmonary bypass, aortic cross-clamp times and learning cumulative sum sequential probability method curves were also assessed to determine how safely the procedure was adopted.

Results

A total of 316 patients were operated on for mitral, tricuspid, atrial fibrillation, septal defects or other conditions. The mean logistic European System for Cardiac Operative Risk Evaluation score was 7.0 (± 8.5). Conversion to sternotomy occurred in 12 patients (3.8%) and in-hospital mortality was 7 (2.2%). None of the converted patients died. The learning curves showed an accelerated process of adoption, similar to reference figures from a high-volume German centre.

Discussion

It is possible for low-volume cardiac surgical centres to undertake minimally invasive surgical programmes with good outcomes and short learning curves. Despite technical complexities, with a team approach, the learning curve can be navigated safely.
A Rare Case of Aneurysmal Bone Cyst – Navicular Bone Treated by Intralesional Sclerotherapy Agent Polidocanol
Authors: Bansal Kapil , Baskaran Swarnesh , Dahuja Anshul , Gupta Nikhil
Published: May 2021

Introduction: Aneurysmal bone cyst (ABC) is an intraosseous arteriovenous malformation, usually treated by surgical excision but with higher recurrence rates. The occurrence of this lesion in navicular bone is a rare entity. Repetitive sclerotherapy using 3% polidocanol is a minimally invasive, safer method of treatment for ABCs.
Methods: A patient of ABC of the navicular bone precisely diagnosed through X-ray, MRI, and biopsy was given periodic injections of 4 ml of 3% polidocanol under aseptic precautions from April 2018 to July 2018. A total of four injections given at an interval of 1 month.
Results: Regular follow-up done for 1 year. At the end of all the four injections, the lesion healed completely with a relief in presenting symptoms. No complications were reported. At 3 months post-therapy, the patient was able to walk without pain. After 1 year of follow-up, the patient was symptom-free with no signs of recurrence.
Conclusion: Surgical resection/curettage has higher chances of recurrence; therefore, usage of intralesional sclerotherapy agent polidocanol should be considered the treatment of choice in the lesions smaller than 5 cm.
Keywords: Aneurysmal bone cyst, sclerotherapy, polidocanol.
Acute Kidney Injury Secondary to Rhabdomyolysis: A Rare Complication of Low-Energy Trauma
Authors: Banerjee Sumit , Gupta Akshat , N Jeshwanth
Published: May 2021

Introduction: Crush syndrome refers to the systemic manifestation of muscle cell injury following release of myocyte contents into the blood circulation. It is seen most commonly in patients sustaining high-energy trauma. Acute kidney injury is one of the most serious complications of crush syndrome and is an important cause of mortality in these patients. In contrast, the occurrence of rhabdomyolysis in patients sustaining low-energy trauma is sparsely reported in the literature. The authors report one such rare case.
Case Report: The patient was a 77-year-old hypertensive male who presented to the emergency following an episode of slip and fall at home. After prompt resuscitation, he was sent for radiological evaluation which revealed fractures of the left inter-trochanteric femur and left proximal humerus. Meanwhile, laboratory investigations showed grossly deranged renal parameters, along with elevated serum creatinine phosphokinase levels (more than 5 times the baseline). A diagnosis of acute kidney injury secondary to traumatic rhabdomyolysis was made. Medical management included adequate intravenous fluid administration combined with strict input-output monitoring. Subsequently, the patient underwent closed reduction and internal fixation of the inter-trochanteric femur fracture with a proximal femoral nail. However, fracture of the proximal humerus was managed non-operatively with sling immobilization as patient refused to give consent for a second surgery.
Conclusion: Although rare, acute kidney injury secondary to rhabdomyolysis can occur in patients with low-energy trauma. It is important not to confuse it with chronic renal insufficiency, especially in geriatrics many of whom are long-standing hypertensives.
Keywords: Acute kidney injury, crush syndrome, low-energy trauma, rhabdomyolysis.
Two-level Osteotomy for Genu Valgum with Tibia Valga: Surgical Planning and Execution
Authors: Naik Aarjav B. , Shah Dhruv S.
Published: May 2021

Introduction: Proximal tibial injury leading to tibia valga which, in turn, leading to genu valgum is well described deformity. Management options vary between growth modulation and corrective osteotomy. Osteotomy which is used for skeletally mature patients can either be done in single stage or in multiple stages or in gradual manner.
Case Report: We describe here a method to obtain single-stage correction with two-level osteotomy in a 20-year-old patient. It includes medial closing wedge osteotomy at distal femur and translational osteotomy at tibial shaft.
Conclusion: This method of two-level osteotomy recognizes and treats two deformities (i.e., genu valgum and tibia valga) separately and achieves correction in one stage with perfect restoration of mechanical axis of lower limb and joint line obliquity of knee.
Keywords: Genu valgum, tibia valga, double-level osteotomy, closing wedge osteotomy, translational osteotomy.
Breach Rate Analysis of Pedicle Screw Instrumentation using Free-Hand Technique in the Surgical Correction of Adolescent Idiopathic Scoliosis
Authors: Librianto Didik , Saleh Ifran , Saleh Fachrisal , Utami Widyastuti Srie , Hutami Witantra Dhamar
Published: May 2021

Introduction: Free-hand technique is one of the techniques used by spine surgeon during pedicle screw instrumentation of surgical correction of spinal deformities, including scoliosis. The previous studies showed that this technique is safe. However, some inherent factors may influence its outcomes, including screw breaching which is potentially violates spinal cord and other intimate structures. To con?rm the safety and accuracy of this technique, additional study measuring the breach rate of pedicle screw placement in scoliosis is mandatory.
Materials and Methods: We performed a retrospective study of patients with adolescent idiopathic scoliosis (AIS) from Fatmawati General Hospital, Jakarta, treated for surgical correction during a period of 2017–2018 using free-hand technique for pedicle screw instrumentation. Post-operative computed tomography scan (CT scan) was analyzed to measure the medial and lateral breaches. P < 0.05 was deemed to be statistically significant.
Results: A total of 94 pedicle screws from six female patients with AIS were included in our study. Overall breach occurred in 33% instrumented screws, the majority of it was a low-grade breach. Of the breached screws, medial and lateral breach occurred in 20% and 12% of screws, respectively. There were no differences in the overall, medial, and lateral breaches between thoracic and lumbar vertebrae (P > 0.05). Medial breach was significantly higher in middle thoracic segment compared to other thoracic segments (P = 0.048). Risk of medial breach was 3 times higher in the convex side of deformity (P = 0.012), whereas risk of lateral breach was 4.6 times higher in the concave side of the deformity (P = 0.021).
Conclusion: The majority of breached screws were low-grade violation within the safe zone, with no neurological sequelae. Our study found that free-hand technique is safe and effective method of pedicle screw instrumentation for correction of AIS. Some inherent factors may influence the risk of
Cambridge Protocol for Management of Segmental Bone Loss
Authors: Tennyson Maria , Krzak Ada Maria , Krkovic Matija , Abdulkarim Ali
Published: May 2021

Abstract

Introduction: Segmental long bone defects are some of the most challenging to surgically reconstruct; however, there is no clear guidance on which of the myriad of techniques is superior in a given clinical context. We describe three cases of segmental bone loss presenting to a major trauma center and have use these to develop a treatment algorithm for the sub-acute management of such fractures.
Case Report: Case 1 – Acute shortening and delayed lengthening using lengthening intramedullary (IM) nail to treat diaphyseal non-union of the femur with associated 3 cm shortening. Case 2 – 15 cm traumatic bone loss of femur, failed Masquelet, treated with IM nail, monolateral external-fixation and cable with a mean lengthening rate of 46 days/cm. Case 3 – 12 cm tibial traumatic bone loss, failed Masquelet, treated with fine wire frame with a mean lengthening rate of 49 days/cm.
Conclusion: As our cases illustrate; attempting complicated, definitive management in the acute phase generates complications and necessitates re-intervention. As such, we have developed a treatment algorithm for traumatic segmental bone loss. We recommend waiting 6 weeks and reimaging to check for evidence of spontaneous bone formation before deciding on definitive treatment. First-line treatment for femoral defects <4 cm is acute limb shortening with delayed lengthening using lengthening IM nail. First-line treatment for femoral defects >4 cm is lengthening over nail with monolateral external fixator. First-line treatment of tibial segmental bone defects in our hands is fine wire circular frames which provide excellent scope for soft tissue coverage and deformity correction. Treatment times of over 2 years in a frame are not uncommon and patients must diligently comply with pin sites management and lengthening protocols. This is the first paper providing an algorithm to guide surgeons in choosing the best lower limb reconstruction options in the sub-acute setting; considering the skill s
A Challenging Case of Extraordinary – Long standing Forearm Non-union Treated with Extensive Debridement, Locking Plates, and Bone Grafting. Technical Considerations in Multiple-operated, Neglected Non-unions
Authors: Komnos George A , Papageorgiou Fotis , Malizos Konstantinos N
Published: May 2021

Introduction: Forearm non-unions pose a significant treatment challenge to orthopedic surgeons. Repetitive treatment failures can lead to a devastating situation for the patient. Forearm function influences both elbow and wrist proper function.
Case Report: A functionless hand is presented, describing a longstanding non-union, treated with multiple surgeries before. A thorough debridement with respect to blood supply and local biology are of major importance before applying the locking plates along with the use of bone-graft. The reconstruction of the forearm converted a functionless arm to a fully functioning arm and the patient returned eventually to her previous activities.
Conclusion: Fixation with locking plates combined with the use of autograft can lead to very satisfactory results even in extraordinary cases, especially when attention is paid to local anatomy and blood supply.
Keywords: Forearm nonunion, locking plates, multiple surgeries.
A Case Report of Chondromyxoid Fibroma of the Neck of Femur, Intracapsular Location
Authors: Jain Siddharth , Garg Sitender , Mittal Ravi
Published: May 2021

Introduction: Chondromyxoid fibroma (CMF) is an uncommon benign tumor accounts for <2% of all benign and <1% all bone tumors. It is a cartilage tumor with myxoid and fibrous elements. Because of rarity and resemblance with other benign and malignant tumor, diagnosis of this tumor always remains challenging. Often, this lesion affects metaphysis of long growing bones of children and young adults. Common locations of this tumor are around the growth plate of proximal tibia and fibula and distal femur.
Case Report: A 21-year-old male presented to orthopedic outpatient department with a history of the left hip pain for 1 year, following a trivial fall before 1 year. The patient was not able to do heavy strenuous activities such as running, jumping, and other sports activities. Terminal range of movements were painful. Magnetic resonance imaging suggested of cystic lesion involving synovial lining near head-and-neck junction of the left femur. Curettage of the lesion was done. The bone defect was not found to be large enough to be filled with bone graft. Histopathological examination showed lobular pattern with stellate to spindle-shaped cells on the myxoid background.
Conclusion: CMF of subcapital region of femoral neck is an extremely unusual presentation. When occurring in middle-aged persons and in uncommon locations, this can raise suspicion of chondrosarcoma. Although intralesional curettage has the risk of recurrence in post-operative period, sufficient and careful curettage and excision of lesion will be enough to treat these benign lesions with good prognosis.
Keywords: Chondromyxoid fibroma, intracapsular, benign tumor.
A Rare Case of Intra-articular Osteochondroma of the Femoral Neck: A Case Report
Authors: Hammad Yazan , Saleh Ahmad , Aburumman Ibrahim F , Balasim Marwan , Al-Hyari Mohammad Ibrahem , Al-Ajlouni Jihad
Published: May 2021

Abstract

Introduction: The osteochondroma (OC) is considered a benign tumor with long bone preference. It presents usually at the metaphyseal part of the bone, with rare cases of intra-articular origins especially in the hip joint. The presentation of such rare cases varies according to its site and mass effect, which may compress the adjacent nerves, tendon, or vascular structures. The femoral neck OC carries a higher risk of femoral head vascular injury and necrosis, as well as sciatic nerve injury, which requires careful preoperative planning and intraoperative cautions. We report a rare case of intra-articular OC in the hip.
Case Report: A 28-year-old male, presented to our hospital, with complaints of right-side gluteal pain, decrease hip joint extension, and feeling of a hard mass for 2 years. The radiographic evaluation showed an osseous mass related posterior and inferior to the right femur neck, with cortical and medullary continuation, and cartilaginous cap on the magnetic resonance image. The suspicious was OC, and planned for excision and histopathological evaluation. The excision was done through lateral hip approach, and it was intra-articular with marked stretching of the joint capsule. Complete excision was done, as close as possible to the femoral neck cortex using saw and osteotomes, followed by prophylactic fixation using two cannulated screws. The histopathology reports confirm the diagnoses, and the patient started on hip range of motion and abductor strengthening exercises. Over a 4-month follow-up period the patient showed significant improvement in his hip range of motion.
Conclusion: The intra articular OC of the hip is as rare presentation of the OC, which carries the risks of avascular necrosis as well as nerve compression. Clinical suspicion, proper planning, and histopathological evaluation are needed for better results.
Keywords: Hip joint, intra-articular tumor, osteochondroma.
Laser Doppler holography of the anterior segment for blood flow imaging, eye tracking, and transparency assessment
Authors: Puyo Léo , David Clémentine , Saad Rana , Saad Sami , Gautier Josselin , Sahel José Alain , Borderie Vincent , Paques Michel , Atlan Michael
Published: May 2021

Laser Doppler holography (LDH) is a full-field blood flow imaging technique able to reveal human retinal and choroidal blood flow with high temporal resolution. We here report on using LDH in the anterior segment of the eye without making changes to the instrument. Blood flow in the bulbar conjunctiva and episclera as well as in corneal neovascularization can be effectively imaged. We additionally demonstrate simultaneous holographic imaging of the anterior and posterior segments by simply adapting the numerical propagation distance to the plane of interest. We used this feature to track the movements of the retina and pupil with high temporal resolution. Finally, we show that the light backscattered by the retina can be used for retro-illumination of the anterior segment. Hence digital holography can reveal opacities caused by absorption or diffusion in the cornea and eye lens.
Salient role of the non-Hermitian coupling for optimizing conditions in multiple maximizations of inter-cavity light transfer
Authors: Yu Hyeon-Hye , Gwak Sunjae , Kim Hyundong , Ryu Jung-Wan , Kim Chil-Min , Yi Chang-Hwan
Published: May 2021

We reveal that non-Hermitian lossy couplings in an inter-cavity light transfer process are crucial for an optimum light transfer, unlike the prevailed belief. Our results turn out the fact that the light transfer can have multiple maxima following the increased inter-cavity distance. To validate this finding both in the weak and strong coupling regimes, we demonstrate our claim in the vicinity of the so-called exceptional point. We believe our results can contribute to realizing coupled-optical-cavity-based devices which is functional with an ultra-efficient light transfer, especially when the device scale is as small as the operation wavelength.
Leadershipstile im Kontext von Schulentwicklungsprozessen
Authors: Hofmann Franz , Carmignola Matteo
Published: May 2021

The focus on educational quality on the single school-level and the aim for ongoing school-improvement direct the attention to investigating the quality of leadership of school administrators. However, despite a large number of educational leadership models, some do not provide a sound theoretical framework, as they confound domains and tasks with the leadership style or identify leadership styles that are based on inconsistent assumptions of motivational psychology. In this paper, a leadership model for the specific context of leading school improvement processes is designed using a functional approach, which is based on the theory of personality systems interactions (PSI). We identified four styles of leadership enactment: the (1)visionary-enthusiastic, the (2) (latent)anxious-goal-fixated, the (3)passive-avoidant, and the (4)self-directed style. The newly developed instrument was validated for a sample ofn = 901 teachers andk = 75 principals. In the discussion section, particular attention is paid to the self-directed style, for which favorable effects can be postulated both in the change management of school improvement processes and in regard to the motivational experience of teachers.