bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effectiveness of Parenting Programs in Preventing Abusive Head Trauma: A Systematic Review and Meta-Analysis
Authors: Chang Hsin-Yi , Chang Yu-Chun , Chang Yi-Ting , Chen Yi-Wen , Wu Pei-Yu , Feng Jui-Ying
Published: February 2023

Parenting programs are the most common intervention for preventing the lethal form of child maltreatment, abusive head trauma (AHT). However, certain results of the effects of these programs have not yet been compared across studies. A systematic review with meta-analysis is warranted to quantitively synthesize the available evidence to identify effective elements and strategies of the programs for preventing AHT. This review aims to estimate AHT preventive parenting programs’ pooled effect on the reduction of AHT incidence, the improvement of parental knowledge, and the increased use of safe strategies in response to infants’ inconsolable crying. Studies published in English and Mandarin were searched and retained if they were randomized control trials (RCTs) or with a quasi-experimental design, included an AHT preventive parenting program, and provided data that quantified targeted outcomes. Eighteen studies were included in this review. AHT preventive parenting programs had a pooled effect on improving parents’ knowledge and increasing the use of safe coping strategies in response to inconsolable crying but not on the incidence of AHT and parents’ emotional self-regulation. Subgroup analyses showed that the intervention effects were mostly present across study designs or measurements and emerged in the reduction of AHT incidence compared with historical controls. The findings suggest that AHT preventive parenting programs enhance parenting knowledge and skills to provide safe care for infants. Further efforts to evaluate AHT parenting programs on the reduction of AHT incidence are necessary for decision-making on allocating and disseminating interventions.
Impact of Radiotherapy Combined With Chemotherapy on Long-Term Outcomes of Patients With Recurrent Nasopharyngeal Carcinoma
Authors: Li Ying , Liu Wei , Xu Yun , Guo Lan-Yan , Weng You-Liang , Huang Zong-Wei , Chen Xiao-Chuan , Lin Ting , Lu Jun , Qiu Su-Fang
Published: February 2023

Background: It remains controversial whether the application of chemotherapy has an impact on recurrent nasopharyngeal carcinoma (rNPC) patients with salvage radiotherapy. Here, we aimed to evaluate treatment outcomes of rNPC patients and derive a prognostic model to assess the benefit of chemotherapy in patients with re-radiotherapy. Methods: This study was conducted as a retrospective study. In total, 340 rNPC patients treated with salvage intensity-modulated radiotherapy (IMRT) or radiochemotherapy (RCT) from October 2006 to September 2019 were included in this study. Overall survival (OS) was the primary outcome. Kaplan-Meier method was employed to detect the prognostic difference with Log-rank tests. The Cox regression analysis was performed to explore the potential prognostic factors while the multivariate Cox analysis was used to identify candidate variables for the prognostic model of OS. Results: The 5-year actuarial rates of OS, progression-free survival, loco-regional progression-free survival, and distant metastases-free survival did not show significant difference between the IMRT and RCT groups ( P > .05). Age at recurrence and rT category were found to be the independent prognostic factors for OS. We found that rNPC patients suffered poor OS in the high-risk group (patients with higher age at recurrence and advanced rT category) (high-risk vs low-risk, HR = 1.87, 95% CI: 1.36-2.57, P < .001). Salvage RT alone may be superior to RCT for patients in the low-risk group (RCT group vs RT group, HR = 1.89, 95% CI: 1.11-3.20, P = .038). Conclusion: Salvage RT combined with chemotherapy cannot improve survival outcomes for rNPC. More novel clinical trials should be explored to develop individualized strategies to improve survival and minimize toxicities.
Angel Anxiety: Alice Angel as the Uncanny Presence in Bendy and the Ink Machine
Authors: Jones Ashley P.
Published: February 2023

Exploring the roles of gender performance through the experience of digital gaming provides an arena for discussing the power of fear and anxiety as cultural tools for counterhegemonic forces. The power and function of gender performativity in its varied and multiplicitous forms is a newer branch of game studies research. In this article, fear and anxiety are explored as a game procedure and cultural tool used by the character Alice Angel in Kindly Beast's Bendy and the Ink Machine. By enacting Barbara Creed's uncanny gaze and the monstrous-feminine, Alice Angel calls attention and visibility to the function of the abject as a form of visibility for the oppressed. The monstrous-feminine as a theoretical concept for horror media texts provides a framework to explore the posing, behaviors, and actions of game characters and their relationships to the player and culture at large.
Physical Activity Associated with Older Adult Pickleball Participation: A Pilot Study
Authors: Casper Jonathan M. , Bocarro Jason. N. , Drake Nicholas R.
Published: February 2023

The quantity and quality of physical activity accrued from recreational pickleball participation have not been published. The purpose of this study was to determine the amount and intensity of physical activity older adults (65 years and older) get from pickleball participation. Thirty-three pickleball participants wore FitbitHR monitors for 2 weeks and logged days/times of pickleball participation. On average, participants spent over 68 min of moderate to vigorous intensity physical activity (MVPA) per playing session. Playing pickleball had beneficial cardiovascular benefits, as participants averaged over 86 min at increased heart rate zones. On average, participants gained significantly more steps on pickleball play days versus non-pickleball play days. Pickleball play days were found to have significantly more MVPA minutes, and participants were significantly less sedentary. The results inform sport and leisure providers evidence that pickleball participation helps older adults meet the Centers for Disease Control and Prevention (CDC)/U.S. Department of Health and Human Services (USHHS) recommended guidelines for MVPA per week if played three or more times. Knowing the health benefits of pickleball may assist sport and leisure managers as they accommodate this popular sport activity.
Publicly Disclosed Pricing for Common Upper-Extremity Procedures: An Analysis of Hospital Chargemasters
Authors: Ozdag Yagiz , Hayes Daniel S. , Boualam Benchaa , Foster Brian K. , Klena Joel C. , Grandizio Louis C.
Published: February 2023

Background:

American hospitals are required to provide price transparency data (known as a chargemaster) for medical services, which is intended to allow consumers to accurately estimate the cost of medical services. Our purpose was to identify hospital compliance in publishing chargemaster documents and to assess the price information published for common upper-extremity services and procedures.

Methods:

We performed a cross-sectional analysis of publicly available chargemaster data from 122 hospitals, which included the top-20-ranked Honor Roll hospitals from US News and World Report and 2 top-ranked hospitals from each state. Chargemaster files were accessed for each hospital, and price information was recorded for 10 common upper-extremity procedures including radiographs, injections, and surgeries. Mean procedural prices were compared between academic and nonacademic hospitals.

Results:

Chargemaster files were able to be accessed for 107 (88%) of 122 institutions. Price estimates for imaging studies were more frequently reported (73%) than those of procedures (23%-41%). With 50 hospitals reporting a price estimate, carpal tunnel injection was the most frequently reported procedure, whereas trigger finger release was the least frequently reported (41% and 23%, respectively). Wide price ranges were noted, with mean charges for a total shoulder arthroplasty listed as US $51 723 (range, US $247-US $364 024). Mean prices between academic and nonacademic hospital systems were similar.

Conclusions:

While most (88%) of the included hospitals have been compliant with publishing their price transparency files, price estimates for common upper-extremity procedures and imaging studies are inconsistently reported and, when present, demonstrate high levels of price variability between and within hospital systems.
Study on the frictional properties of the top ring-liner conjunction for different-viscosity lubricant
Authors: Hei Di , Zheng Meiru , Liu Cheng , Jiang Liutao , Zhang Yongfang , Zhao Xiaowei
Published: February 2023

In modern internal combustion engines, the lubricant viscosity affects greatly the friction power loss. To obtain maximum fuel economy of the engines, the lubricants with different viscosities are considered to evaluate the friction properties of the compression ring-cylinder liner conjunction in the engines in this study. To conduct the evaluation, an improved mixed lubrication model is developed with considerations of the cylinder liner deformation, the lubricant thermal effect & transportation, and the change of lubrication condition from full flooded to starve. On this basis, the influence of different viscosity lubricants on the minimum oil film thickness, friction, power loss, FMEP, and wear load are investigated. The numerical result indicates that the low viscosity lubricant is more beneficial to facilitate the change of lubrication condition from starve to fully flooded. Furthermore, the low viscosity lubricant will result in large wear load on the compression ring surface while reducing the friction power loss.
Exploring the perceptions of leadership in Hong Kong rugby
Authors: Groves Jevon , Clements Dan
Published: February 2023

The concept of leadership within sports coaching continues to fascinate and intrigue a multitude of stakeholders. There is still a need for a greater understanding of its role within a complex, dynamic field of inquiry that seemingly relies heavily on the ‘coach as leader’ for a multitude of outcomes (e.g. performance success, athlete development, social outcomes). Given the call for more contextually specific and action orientated research, the aim of this study was to explore the perceptions of coach leadership within the Hong Kong rugby union environment. The study adopted an interpretive paradigm to gain deep insight into coaches’ and players perceptions of leadership in rugby. Data was collected from 16 participants via three separate online focus groups. Qualitative thematic analysis was used to analyse and interpret the data. The findings suggest that for leadership to be effective, coaches must possess a socio-cultural understanding of their context, have a clear vision for their team and have a principle of transformational and value-based leadership to assist with decision making. Additionally, coaches must become role models and demonstrate authentic leadership characteristics to be able to build and maintain relationships with the people in their organisation through effective communication. Sharing leadership appeared to be an effective method adopted by coaches to enhance leadership throughout a rugby organisation. We suggest that the results provide a grounding for coach learning within a unique coaching context.
The effectiveness of two comprehensive recovery protocols on performance and physiological measures in elite soccer players: A parallel group-randomized trial
Authors: Altarriba-Bartes Albert , Vicens-Bordas Jordi , Peña Javier , Alarcón-Palacios Fernando , Sixtos-Meliton Luis A , Matabosch-Pijuan Martí , Giménez-Martínez Enric , Beato Marco , Calleja-González Julio
Published: February 2023

Elite soccer players consistently report using several recovery methods after practices and games. However, it is unclear how their subsequent performance could be enhanced using broad protocols. The aim of this study was to compare the effectiveness of two different comprehensive recovery protocols in physiological, neuromuscular, and perceptual outcomes. Eighteen Mexican National Team players (19.56 ± 0.62 years) were recruited. Using a randomized parallel group design, players followed one of two recovery protocols: (a) carbohydrate and protein shake, foam roller, cold-water immersion, and tart cherry juice concentrate ( n = 9) or (b) carbohydrate and protein shake, stretching, and intermittent cold-water immersion ( n = 9) following the completion of an unofficial game and the day after. Muscular creatine kinase, countermovement jump, hamstring maximal voluntary contraction, perceived recovery, and muscle soreness were assessed before, immediately after, and 20-44-68 h post-game. Significant effects (set at ρ≤0.05) of time were present in both interventions. Muscular creatine kinase was normalized entirely at 68 h post-game, while neuromuscular and perceptual outcomes were homogenized at 44 h. No statistically significant effects between protocols were found. Still, the interaction effects showed changes only in the group using protocol (a) at post-game and 20 h after in neuromuscular and muscle soreness. There were large correlations between muscular creatine kinase and accelerations, decelerations, sprints, and high-speed running distances. In conclusion, the interventions are equally effective for improving physiological, neuromuscular, and perceptual outcomes. Thus, elite soccer players may benefit from different combinations of methods after practices or games to obtain positive effects on recovery after them.
Rehabilitation following shoulder arthroscopic stabilisation surgery: A survey of UK practice
Authors: Maher Natasha , Willmore Elaine , Bateman Marcus , Blacknall James , Chester Rachel , Horsley Ian , Gibson Jo , O’ Sullivan Joel , Jaggi Anju
Published: February 2023

Background

Optimal rehabilitation following arthroscopic shoulder stabilisation for traumatic anterior instability is unknown. The purpose of this study was to establish current UK practice for this patient group.

Methods

A self-administered online questionnaire was developed and distributed to UK surgeons and physiotherapists.

Results

138 responses were received. Routine immobilisation was reported in 79.7% of responses with a cross-body sling being the preferred position (63.4%). Duration of immobilisation and timescales to initiate movement were highly variable. Return to light work was advised when patients felt able (25.4%) or after 6 weeks (26.1%). 58.7% recommended waiting for 12 weeks to return to manual work. 56% recommended non-contact sport could be resumed after 12 weeks. For contact sport, recommendations varied from 6 weeks (3.8%) to 6 months (5.8%). Psychological readiness was the most frequently cited criteria for return to play (58.6%). Factors such as hyperlaxity (40.6%), age (32.6%) and kinesiophobia (28.3%) were not considered as relevant as reported quality of surgical fixation (50%).

Conclusion

There is no clear consensus regarding optimal post-operative rehabilitation following arthroscopic shoulder stabilisation. Further work is required to establish high value, personalised pathways for this patient group.
An examination into pre-Service English-as-a-Foreign-Language teachers’ Self-Perceived technological-Pedagogical-Content-knowledge
Authors: Koşar Gülten
Published: February 2023

A literature review indicates that no research has been conducted to date to examine pre-service English as a foreign language (EFL) teachers’ self-perceived technological pedagogical content knowledge (TPACK). Therefore, this study explores pre-service EFL teachers’ (PSEFLTs) self-perceived TPACK, to understand whether it changes in line with their year of study and their views on the probable contribution of the pre-service English teacher education program to their TPACK. The findings obtained from the analysis of the data collected from a 36-item EFL TPACK questionnaire, conducted by performing descriptive statistics, one-way ANOVA and a post hoc analysis, revealed that the level of PSEFLTs’ technological knowledge was the highest, while their content knowledge was the lowest. In addition, there was a statistically significant difference in 28 items between the PSEFLTs’ TPACK, resulting from the responses of the second-year students. The content analysis of the qualitative data gathered from telephone interviews demonstrated that even though the interviewees overwhelmingly regarded their TPACK level as high, they suggested that the curriculum for this program could be enriched by adding a course to it on the use of technology in EFL teaching.
Online teaching practicum procedures during the COVID-19 pandemic in Turkish EFL context
Authors: Atmaca Çağla
Published: February 2023

This case study aimed to reveal the reflections of pre-service English teachers on online teaching practicum procedures during the COVID-19 pandemic in Turkish EFL context. There were 20 participants, and the data were gathered through an online interview form. The interview items focused on course requirements, observation tasks, mentor-supervisor feedback, and benefits and challenges of online teaching procedures. The gathered data were subjected to summative content analysis and the results indicated that although the participants mentioned various professional gains, the challenges of online teaching practicum experiences outweighed its benefits. In light of the findings, it can be claimed that relevant stakeholders can be offered training about online teaching practices, and the existing infrastructure can be improved in the form of hybrid settings in order to facilitate transition to online educational platforms and to improve university-school collaboration in the future.
Mark Fisher and reimagining postcapitalist geographies
Authors: Sutherland Callum
Published: February 2023

In this paper, I outline the spatial imaginaries of the late radical thinker Mark Fisher (1968–2017). I begin by explaining Fisher's focus on culture and desire as forces that must be addressed if an effective postcapitalist politics is to be formed and underscoring that so far in postcapitalist geographies, the roles of culture and desire have been relatively overlooked. I then delineate three spatial imaginaries threaded through Fisher's work, which I call 3D hauntology, grotesque stratigraphy, and acid topology, demonstrating how they offer fresh ideas at the nexus of postcapitalist geography and political strategy. To conclude, I argue that postcapitalist geographers must urgently foster cultural and political experiments that wager on latent popular desire for a future characterised by a reimagined communism.
Panarchies of transformation and resilience: Delineating systemic change in the society, economy, and ecology of Malakand
Authors: Jan Muhammad Ayub , Zubair Muhammad , Aman Shahida
Published: February 2023

Malakand district of Khyber Pakhtunkhwa province in Pakistan has been going through phenomenal transformations in the socioeconomic, political, and ecological spheres since 1969. To understand these transformations, this article employs the theories of ‘panarchy’, ‘resilience’, and ‘adaptive cycles’, borrowed from the literature on socio-ecological systems and sustainability transformation. These studies see disruptive transformation as a systemic change in the economy and society in relation to ecology. The evidence for the article is derived from fieldwork conducted by the first author during his doctoral study in 2007–2008 and later visits in September to October 2012. The scales chosen for the analysis are local (Batkhela, Malakand) and regional (North West of Pakistan). The article argues that theoretical constructs such as panarchy, and adaptive cycles have explanatory value to delineate the socioeconomic, political, and ecological transformation, in the Malakand region, over a period. The article finds out that in Malakand, smaller actors at smaller scales enacted change at bigger scales of adaptive cycles. The change at a smaller scale due to the emergence of Batkhela Bazaar brought changes at bigger scales in the region. However, due to the interaction between multiple cycles at different scales, the system demonstrated some resilience to change, consequently forging a sustainable change in the region. Despite these explicit findings, we understand that interpreting theoretical constructs such as panarchies and adaptive cycles requires more rigorous research, particularly to develop a more precise connection between ecological change and socio-economic transformation in Malakand.
CPEC: Pakistan and China’s joint step towards a shared destiny
Authors: Majeed Tabassum , Anwar Zahid , Bashir Faiza
Published: February 2023

China has been considered to be a sleeping giant but is now actively playing its role in regional and world politics. There are many reasons behind the shift in China’s foreign policy from ignoring multi-lateral diplomacy to owning it, one of which is the economic rise of China due to its increasing energy demands. The “good neighbor policy” was introduced by Chinese President Hu Jintao in 2003, making China endorse interdependence regionally and internationally, instead of competition. This policy of China’s turned its surrounding regions into a trading hub. Pakistan has always had a very friendly foreign policy with its neighboring country China. The China Pakistan Economic Corridor (CPEC) is proof of the Pak–China friendship in the 21st century. This corridor is not only advantageous for China and Pakistan but will bring stability to the South Asian region as well. This descriptive-analytical study dichotomizes the concept of “win-win cooperation” by applying it to CPEC as a win-win outcome for both China and Pakistan. The study describes that CPEC is a chance for Pakistan to become stronger as a country in the international community and will work as a booster for China in becoming the topmost economy of the world. The study highlights the key objective of CPEC by substantiating that better logistics, developed infrastructure, and improved transportation among countries are vital for economic stability and progress. Further, CPEC can revitalize the economy of Pakistan by enhancing infrastructural and social progress while giving a secure and short route to China as a replacement for the Strait of Malacca, increasing and speeding up the trading and investment activities of China throughout the world.
Translating an Economic Analysis into a Tool for Public Health Resource Allocation in Cancer Survivorship
Authors: Rivers Zachary , Roth Joshua A. , Wright Winona , Rim Sun Hee , Richardson Lisa C. , Thomas Cheryll C. , Townsend Julie S. , Ramsey Scott D.
Published: February 2023

Background. The complexity of decision science models may prevent their use to assist in decision making. User-centered design (UCD) principles provide an opportunity to engage end users in model development and refinement, potentially reducing complexity and increasing model utilization in a practical setting. We report our experiences with UCD to develop a modeling tool for cancer control planners evaluating cancer survivorship interventions. Design. Using UCD principles (described in the article), we developed a dynamic cohort model of cancer survivorship for individuals with female breast, colorectal, lung, and prostate cancer over 10 y. Parameters were obtained from the National Program of Cancer Registries and peer-reviewed literature, with model outcomes captured in quality-adjusted life-years and net monetary benefit. Prototyping and iteration were conducted with structured focus groups involving state cancer control planners and staff from the Centers for Disease Control and Prevention and the American Public Health Association. Results. Initial feedback highlighted model complexity and unclear purpose as barriers to end user uptake. Revisions addressed complexity by simplifying model input requirements, providing clear examples of input types, and reducing complex language. Wording was added to the results page to explain the interpretation of results. After these updates, feedback demonstrated that end users more clearly understood how to use and apply the model for cancer survivorship resource allocation tasks. Conclusions. A UCD approach identified challenges faced by end users in integrating a decision aid into their workflow. This approach created collaboration between modelers and end users, tailoring revisions to meet the needs of the users. Future models developed for individuals without a decision science background could leverage UCD to ensure the model meets the needs of the intended audience.

Highlights

Model complexity and unclear purpose are 2 barriers that prevent lay users from integrating decision science tools into their workflow. Modelers could integrate the user-centered design framework when developing a model for lay users to reduce complexity and ensure the model meets the needs of the users.
Renal cyst formation complicating ALK inhibitors
Authors: Niu Xiaomin , Wakelee Heather A , Anand Shuchi
Published: February 2023

With rapid discovery of oncogenic deriver genes over the past decade, several tyrosine kinase inhibitors (TKIs) were developed to target the anaplastic lymphoma kinase (ALK) aberration in non-small cell lung cancers (NSCLCs), including first, second and third-generation ALK inhibitors for ALK-rearranged NSCLC treatment. However with recent data published from several clinical trials and retrospective studies investigating the efficacy of these TKIs in ALK-rearranged NSCLC patients, development of renal cysts is a side effect associated with first generation TKI crizotinib; the mechanism for cyst formation, and whether it is a class effect, is unclear. In this review we will summarize published data on development of kidney injury and renal cysts associated with ALK inhibitors with focus on crizotinib-related renal cysts.
Nicotine Use and Metabotropic Glutamate Receptor 5 in Individuals With Major Depressive and Posttraumatic Stress Disorders
Authors: Baldassarri Stephen R. , Asch Ruth H. , Hillmer Ansel T. , Pietrzak Robert H. , DellaGioia Nicole , Esterlis Irina , Davis Margaret T.
Published: February 2023

Metabotropic glutamate receptor 5 (mGluR5) dysregulation has been implicated in the pathophysiology of many psychiatric disorders, as well as nicotine use and dependence. We used positron emission tomography with [18F]FPEB to measure mGluR5 availability in vivo in 6 groups: (1) nicotine users (NUs) without other psychiatric comorbidities ( n =  23); (2) comparison controls (CCs) without nicotine use or psychiatric comorbidities ( n =  38); (3) major depressive disorder subjects with concurrent nicotine use (MDD-NU; n =  19); (4) MDD subjects without concurrent nicotine use (MDD-CC; n =  20); (5) posttraumatic stress disorder subjects with concurrent nicotine use (PTSD-NU; n =  17); and (6) PTSD subjects without concurrent nicotine use (PTSD-CC; n =  16). The goal of the study was to test the hypothesis that mGluR5 availability in key corticolimbic regions of interest (ROIs) is different in NU with versus without comorbid psychiatric disorders (ROI: dorsolateral prefrontal cortex [dlPFC], orbitofrontal cortex [OFC], ventromedial prefrontal cortex [vmPFC], anterior cingulate cortex [ACC], amygdala, hippocampus). We found that NU had 11%–13% lower mGluR5 availability in OFC, vmPFC, dlPFC, and ACC as compared with CC, while PTSD-NU had 9%–11% higher mGluR5 availability in OFC, dlPFC, and ACC compared with PTSD. Furthermore, relationships between mGluR5 availability and psychiatric symptoms varied as a function of psychiatric diagnosis among NUs. NU showed a negative correlation between mGluR5 and smoking cravings and urges ( r's = –0.58 to –0.70, p's = 0.011 – 0.047), while PTSD-NU had the reverse relationship ( r's = 0.60–0.71, p's = 0.013–0.035 in ACC, vmPFC, and dlPFC). These findings have substantial implications for our understanding of glutamate homeostasis in psychiatric subgroups and for identifying key neural phenotypes among NU. mGluR5 is a potential treatment target for precision medicine in individuals with nicotine use.
StylishGAN: Toward Fashion Illustration Generation
Authors: Zou Xingxing , Wong Waikeung
Published: February 2023

In this article, we propose StylishGAN, a generative adversarial network that generates a fashion illustration sketch given an actual photo of a human model. The generated stylish sketches not only capture the image style from real photos to hand drawings with a cleaner background, but also adjust model’s body into a perfectly proportioned shape. StylishGAN learns proportional transformation and texture information through a proposed body-shaping attentional module. Furthermore, we introduce a contextual fashionable loss that augments the design details, especially the fabric texture, of the clothing. To implement our method, we prepare a new fashion dataset, namely, StylishU, that consists of 3578 paired photo–sketch images. In each pair, we have one real photo collected from the fashion show and one corresponding illustration sketch created by professional fashion illustrators. Extensive experiments show the performance of our method qualitatively and quantitatively.
Influence of energy input parameters on wire feed rate and surface characteristics during WECM of Nitinol SMA
Authors: Besekar Naresh , Bhattacharyya B.
Published: February 2023

Nitinol shape memory alloy (SMA) has outstanding chemical and mechanical properties which make the machining of Nitinol SMA more difficult than other materials due to super-elasticity and multiphase transformation. Wire electrochemical machining (WECM) is a nontraditional process, which removes conductive material through anodic dissolution despite of material’s properties. In this paper, the mathematical model is presented for slit width calculation for the influence of different parameters using vibration-assisted nozzle jet flushing. In this experimental investigation, the effect of prominent energy input parameters on wire feed rate to achieve better homogeneity, machining accuracy, and surface quality with a 300 µm thick sheet of Nitinol SMA micro-slits has been presented using an in-house developed WECM set-up. Experimental results revealed that the wire feed rate and surface roughness drastically increases with an increase in the most influencing energy input parameter, that is, pulse voltage with minimum average surface roughness (Ra) of 0.1076 µm and 123.60 µm average slit width at 7 V pulse voltage. Finally, the curved complex micro-feature of a 120 µm thick sheet of Nitinol SMA was fabricated successfully with a 137.795 µm average slit width under the controlled process parameter combination using WECM.
Medial Patellofemoral Ligament Reconstruction With a Single-Limb Allograft: A Reproducible and Effective Technique
Authors: Forsythe Brian , Berlinberg Elyse J. , Sivasundaram Lakshmanan , Poirier Jon-Luc R. , Patel Harsh H. , Khan Zeeshan A. , Chahla Jorge , Hevesi Mario
Published: February 2023

Background:

Medial patellofemoral ligament (MPFL) injury occurs in up 96% of lateral patellar dislocations, commonly affecting those less than 20 years old. The MPFL can be reconstructed using either a double-limb or single-limb technique. While both techniques achieve similar patient outcomes, a single-limb technique may require less operative time.

Indications:

The MPFL reconstruction is indicated in patients with recurrent patellar subluxations, dislocations, or unresolved apprehension. Care should be exercised in identifying whether patients require additional procedures in addition to MPFL reconstruction such as tibial tubercle osteotomy or trochleoplasty. These considerations include TT-TG >17 to 20 mm and Dejour B/D trochlear dysplasia.

Technique Description:

Following diagnostic arthroscopy, a medial peripatellar incision is made. Layers 1 and 2 are sharply dissected over the patellar periosteum, and tissue planes are subsequently developed using Metzenbaum scissors. A plane between layers 2 and 3 extending from the medial patella to the medial femoral epicondyle is developed. Using fluoroscopy, Schöttle point is identified, and a femoral tunnel is drilled. Two PEEK anchors are placed at the junction of the proximal one-third and distal two-thirds of the patella. In parallel, a tibialis anterior graft is sized, whipstitched, and tensioned on the back table. One end of the prepared graft is secured in the femoral tunnel with a PEEK tenodesis screw. The graft is then shuttled between layers 2 and 3, followed by fixation on the patellar side using the previously placed suture anchors. Isometry of the graft is confirmed under direct and arthroscopic visualization.

Results:

In multiple systematic reviews of single-limb versus double-limb MPFL reconstruction, no differences were observed in terms of patient-reported outcome scores, repeat dislocation, and reoperation. Furthermore, a recent meta-analysis suggests a trend toward less postoperative stiffness (1.2% vs 3.5%, P = .09) for single-bundle techniques.

Discussion/Conclusion:

Single-limb MPFL reconstruction is reproducible and effective, with clinically satisfactory outcomes and low failure rates. Single-limb MPFL reconstruction demonstrates similar outcomes as double-limb reconstruction, with a potential decrease in surgical time and postoperative stiffness.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Arthroscopic Double-Row Rotator Cuff Repair With Box Configuration
Authors: Sabzevari Soheil , Murray Ryan , Charles Shaquille , Reddy Rajiv P. , Lin Albert
Published: February 2023

Background:

Arthroscopic transosseous-equivalent (TOE) techniques may offer additional advantages, including a more efficient surgery with a self-reinforcing construct with equivalent clinical results to medial knotted TOE repair for rotator cuff tears (RCTs).

Indications:

An arthroscopic knotless double-row (DR) rotator cuff repair (RCR) using FiberTak RC anchors for medial row fixation with box configuration may be an appropriate construct for operatively indicated small-to-moderate full-thickness RCTs.

Technique:

Our modified technique uses TOE repair principles to address RCTs too small for traditional 4.75-mm anchors using medial row fixation and too large to apply a single medial to lateral anchor repair. The patient is placed in a beach chair position. In addition to standard anterior and posterior portals, a lower lateral working portal and a higher posterolateral viewing portal are made. Subsequent to supraspinatus footprint visualization/preparation, two 2.6-mm FiberTak RC anchors each loaded with 1 LabralTape and 1 FiberWire are placed medially. The 4 sets of sutures for one anchor are placed through the rotator cuff tendon together in 1 spot and the process is repeated for the second anchor. One FiberWire from each anchor is then tied extracorporeally and then a double pulley technique is used to compress the medial aspect of the repair at the footprint in a box configuration. Finally, 1 limb of LabralTape from each of the medial anchors along with the corresponding FiberWire is secured through 2 lateral-row 4.75-mm anchors anteriorly and posteriorly to restore the lateral footprint and secure the rotator cuff in TOE box configuration. This modified technique can provide anatomical compression of the rotator cuff tendon at the footprint with additional medial compression achieved by the box configuration while taking advantage of knotless fixation.

Results:

Postoperatively, a sling is worn for 4 weeks, passive range of motion (ROM) is initiated at 2 weeks, active ROM is begun at 6 weeks, and strengthening at 3 months. Patients may return to full unrestricted activities around 5 to 6 months.

Discussion/Conclusion:

A modified arthroscopic DR RCR with box configuration is an excellent treatment option for patients with small-to-moderate full-thickness RCT who fail conservative treatment.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Transorbital Ultrasonography Used to Detect Papilledema, in a Patient With Intracranial Hypertension
Authors: Cheong Issac , Bermeo Milton , Tamagnone Francisco Marcelo
Published: February 2023

Intracranial hypertension (IH) is an important cause of secondary brain injury, and it is often associated with poor outcomes; due to that monitoring of intracranial pressure (ICP) is essential for the management of neurocritical patients. Although invasive methods have been the gold standard for ICP monitoring, recent non-invasive ultrasonography techniques have been used to estimate ICP. Among the most used methods are the measurement of the diameter of the optic nerve sheath and transorbital ultrasonography to evaluate papilledema. This presented case is of a patient with refractory IH due to subarachnoid hemorrhage, measured through an intraventricular catheter. A transorbital sonogram was performed and showed the presence of papilledema.
Phase 1/2 study of carfilzomib, pomalidomide, and dexamethasone with and without daratumumab in relapsed multiple myeloma
Authors: Derman Benjamin A. , Zonder Jeffrey , Reece Donna , Cole Craig , Berdeja Jesus , Stefka Andrew T. , Major Ajay , Kin Andrew , Griffith Kent , Jasielec Jagoda , Jakubowiak Andrzej J.
Published: February 2023

We conducted a phase 1/2 study of carfilzomib, pomalidomide, and dexamethasone (KPd) and KPd with daratumumab (Dara-KPd) in relapsed/refractory multiple myeloma. The primary end points were identification of a maximum tolerated dose (MTD) of KPd for phase 1, and rates of overall response (ORR) and near complete response (nCR) after 4 cycles of KPd and Dara-KPd, respectively, for phase 2. The MTD for KPd was carfilzomib 20/27 mg/m2 on days 1, 2, 8, 9, 15, and 16 (cycles 1-8) and days 1, 2, 15, and 16 for cycles 9 and beyond; oral pomalidomide 4 mg on days 1 to 21; and oral dexamethasone 40 mg weekly in 28-day cycles. Sixty-six patients received KPd, including 34 at the MTD. The ORR after 4 cycles of KPd at the MTD was 27/34 (79%; 95% confidence interval [CI], 62%-91%), meeting the statistical threshold for efficacy. At a median follow-up of 44 months, the median progression-free survival (PFS) was 13 months and overall survival (OS) 44 months. Twenty-eight patients received Dara-KPd. The rate of nCR or better after 4 cycles was 11/28 (39%; 95% CI, 22%-59%), meeting the statistical threshold for efficacy. As the best response to Dara-KPd, the ORR was 25/28 (89%) and the rate of measurable residual disease negativity by flow cytometry (10−5) was 17/26 (65%). At a median follow-up of 26 months, the median PFS and OS for Dara-KPd were not reached. Dara-KPd induced deeper and more durable responses than KPd without compromising safety in a predominantly high-risk, lenalidomide-refractory population, warranting further evaluation of this quadruplet. This trial is registered at www.clinicaltrials.gov as #NCT01665794.
Systematic analysis identifies XRCC4 as a potential immunological and prognostic biomarker associated with pan-cancer
Authors: Yu Yang , Sun Yanyan , Li Zhaoxian , Li Jiang , Tian Dazhi
Published: February 2023

Background

XRCC4 is a NHEJ factor identified recently that plays a vital role in repairing DNA double-stranded breaks. Studies have reported the associations between abnormal expression of XRCC4 and tumor susceptibility and radiosensitivity, but the potential biological mechanisms by which XRCC4 exerts effects on tumorigenesis are not fully understood. This study aimed to systematically investigate the role of XRCC4 across cancer types.

Methods

The TIMER, GTEX and Xiantao Academic database were used to interpret the expression of XRCC4. Genomic alterations and protein expression in human organic and tumor tissues were applied in cBioPortal and the Human Protein Atlas databases. Correlations between XRCC4 expression and immune and molecular subtypes were analyzed by using the TISIDB database. Protein–protein interactions, GO and KEGG enrichment were also applied for XRCC4-related genes. The TIMER and the Tumor Immune Single Cell Hub (TISCH) online databases were used to explore the relationship between XRCC4 and tumor immune microenvironment. Drug sensitivity information was acquired from the CellMiner database to analyze the effect of XRCC4 on sensitivity analysis.

Results

The XRCC4 expression was significantly upregulated in 15 tumor types and downregulated in two tumor types compared with the normal tissues, most of which were validated by the results of Xiantao academic platform. XRCC4 was expressed at intermediate level in malignant cells. The XRCC4 expression was related to the molecular and immune subtypes of human cancers, and the survival outcome of 11 types of cancers, including KIRC, STAD and LIHC. The main type of frequent genetic alteration is amplification. Strong correlations were also found between XRCC4 and immune checkpoint genes in 33 human cancers. Furthermore, the abnormal expression of XRCC4 was related to immune cell infiltration and drug sensitivity. Enrichment analysis showed that XRCC4 was significantly correlated with DNA damage response.

Conclusions

This comprehensive pan-cancer analysis suggested that XRCC4 may play a vital role in the prognosis and immunotherapy response in cancer patients, and it is a promising therapy target in the future.
Operation of national coordinating service for interhospital transfer from emergency departments: experience and implications from Korea
Authors: Min Hye Sook , Sung Ho Kyung , Choi Goeun , Sung Hyehyun , Lee Minhee , Kim Seong Jung , Ko Eunsil
Published: February 2023

Background

Since 2014, Korea has been operating the National Emergency Medical Situation Room (NEMSR) to provide regional emergency departments (EDs) with coordination services for the interhospital transfer of critically ill patients. The present study aimed to describe the NEMSR’s experience and interhospital transfer pattern from EDs nationwide, and investigate the factors related to delayed transfers or transfers that could not be arranged by the NEMSR.

Methods

This study was a retrospective cross-sectional analysis of the NEMSR’s coordination registry from 2017 to 2019. The demographic and hospital characteristics related to emergency transfers were analyzed with hierarchical logistic models.

Results

The NEMSR received a total of 14,003 requests for the arrangement of the interhospital transfers of critically ill patients from 2017 to 2019. Of 10,222 requests included in the analysis, 8297 (81.17%) successful transfers were coordinated by the NEMSR. Transfers were requested mainly due to a shortage of medical staff (59.79%) and ICU beds (30.80%). Delayed transfers were significantly associated with insufficient hospital resources. The larger the bed capacity of the sending hospital, the more difficult it was to coordinate the transfer (odds ratio [OR] for transfer not arranged = 2.04; 95% confidence interval [CI]: 1.48–2.82, ≥ 1000 beds vs. < 300 beds) and the longer the transfer was delayed (OR for delays of more than 44 minutes = 2.08; 95% CI: 1.57–2.76, ≥ 1000 beds vs. < 300 beds).

Conclusions

The operation of the NEMSR has clinical importance in that it could efficiently coordinate interhospital transfers through a protocolized process and resource information system. The coordination role is significant as information technology in emergency care develops while regional gaps in the distribution of medical resources widen.
RETRACTED ARTICLE: Injuries and outcomes resulting due to falls in elderly patients presenting to the Emergency Department of a tertiary care hospital – a cohort study
Authors: Soomar Salman Muhammad , Dhalla Zeyanna
Published: February 2023

Background

Fall injuries and trauma-related hospitalizations are the most common causes of injury and in-hospital stay amongst the elderly population. After the age of 65, the severity and frequency of fall-related problems increases; the repercussions are challenging for senior citizens, caregivers, and healthcare professionals. This study aims to determine the injuries and outcomes resulting from falls in elderly patients presenting to Emergency Department of a tertiary care hospital.

Methods

A cohort study design was used. All elderly patients aged ≥ 60 years who visit the Emergency Department with a history of a fall as a primary complaint presenting to the ED of a tertiary care hospital in Karachi, Pakistan were included. A purposive sampling strategy was used to enroll 318 patients from August 2021 to February 2022. The outcome was risk of mortality. Each individual was followed for 90 days to study the outcome. A multivariable logistic regression was applied to check the association between the outcome and covariates. Crude and adjusted risk ratios were reported. A p-value ≤ 0.05 was considered significant.

Results

Of the 318 participants, 265 (83.3%) were fall injury patients with comorbidities. More than half of the patients in both groups were female [32 (60.4%) & 146 (55.1%)]. Eyeglasses were used by most of the fall patients both without and with comorbidities [21 (39.6%) & 152 (57.4%) p 0.018]. There were multiple reasons for a fall including imbalance/dizziness, which was reported by one third of participants in both groups [15 (28.3%) & 77 (29.1%)] followed by a fall from stairs/steps/escalator [15 (28.3%) & 44 (16.6%) p 0.005]. At the end of one month, of those who had a comorbidity 20 (7.5%) expired. The risk of mortality among fall related injuries in elderly patients who were more than 80 years was 1.48 times (95% CI: 1.20–2.10) more likely when compared to those patients who were younger than 80 years.

Conclusion

Efforts should be made to improve management of the underlying etiology of falls to prevent them in future. The factors that contribute to falls should be identified. Strategies and interventions should be planned to mitigate this risk of fall in elderly to improve their quality of life.