bluuebunny/crossref_metadata_2025 huggingface dataset:
Successful colonoscopic removal of a foreign body that caused sigmoid colon perforation: a case report
Authors: Ma Zhenhua , Chen Wujie , Yang Ye , Xu Zhenjie , Jiang Haitao , Zhang Yang , Lu Dongdong
Published: February 2021

Large bowel perforation is an acute abdominal emergency requiring rapid diagnosis for proper treatment. The high mortality rate associated with large bowel perforation underlines the importance of an accurate and timely diagnosis. Computed tomography is useful for diagnosis of ingested foreign bodies, and endoscopic repair using clips can be an effective treatment of colon perforations. We herein describe a 78-year-old man with sigmoid colon perforation caused by accidental swallowing of a jujube pit. The jujube pit had become stuck in the wall of the sigmoid colon and was successfully removed by colonoscopy, avoiding an aggressive surgery. As a result of developments in endoscopic techniques, endoscopic closure has become a feasible option for the management of intestinal perforation.
Feasibility of oral health evaluation by intraoral digital photography: a pilot study
Authors: Guo ShuLing , Chen Yong , Mallineni Sreekanth Kumar , Huang ShuYing , Liu BaiWang , Zhang ShuYi , Lu Chang
Published: February 2021

Objectives

This study investigated the accuracy and duration of intraoral digital photograph examination (IDPE) for evaluating oral health status and explored the feasibility of remote oral health assessment.

Methods

Thirty-one healthy college students underwent evaluations of oral health status via clinical examination (CE) combined with panoramic X-ray assessment at baseline, followed by IDPE 1 month later using photos taken at baseline. Methods for evaluation of gingival health included the Modified Gingival Index (MGI) and Plaque Index (PI). Examinations of caries status included the decayed, missing, and filled teeth and surfaces indexes (DMFT and DMFS indexes, respectively). The duration of each evaluation was also recorded.

Results

There were significant differences in MGI and PI between CE and IDPE. There were no significant differences in DMFT and DMFS indexes between CE and IDPE, and there were positive correlations between CE and IDPE for each of the two indexes (DMFT index: r=0.56; DMFS index: r=0.69). The IDPE duration was shorter than the CE duration.

Conclusions

The feasibility of caries status assessment via IDPE is promising. Digital oral health evaluation merits further clinical consideration.

Trial registration

Xiamen University Training Program of Innovation and Entrepreneurship for Undergraduates, project number: 2018X0583. Registered 1 April 2018; http://cxw.xmu.edu.cn/admin/Innovation/NewInnovationDetail?id=6ce0a415-6131-496b-891a-6a1ae44e556d
A Novel Machine Learning Algorithm Predicts Dementia With Lewy Bodies Versus Parkinson’s Disease Dementia Based on Clinical and Neuropsychological Scores
Authors: Bougea Anastasia , Efthymiopoulou Efthymia , Spanou Ioanna , Zikos Panagiotis
Published: February 2021

Objective:

Our aim was to develop a machine learning algorithm based only on non-invasively clinic collectable predictors, for the accurate diagnosis of these disorders.

Methods:

This is an ongoing prospective cohort study ( ClinicalTrials.gov identifier NCT number NCT04448340) of 78 PDD and 62 DLB subjects whose diagnostic follow-up is available for at least 3 years after the baseline assessment. We used predictors such as clinico-demographic characteristics, 6 neuropsychological tests (mini mental, PD Cognitive Rating Scale, Brief Visuospatial Memory test, Symbol digit written, Wechsler adult intelligence scale, trail making A and B). We investigated logistic regression, K-Nearest Neighbors (K-NNs) Support Vector Machine (SVM), Naïve Bayes classifier, and Ensemble Model for their ability to predict successfully PDD or DLB diagnosis.

Results:

The K-NN classification model had an accuracy 91.2% of overall cases based on 15 best clinical and cognitive scores achieving 96.42% sensitivity and 81% specificity on discriminating between DLB and PDD. The binomial logistic regression classification model achieved an accuracy of 87.5% based on 15 best features, showing 93.93% sensitivity and 87% specificity. The SVM classification model had an accuracy 84.6% of overall cases based on 15 best features achieving 90.62% sensitivity and 78.58% specificity. A model created on Naïve Bayes classification had 82.05% accuracy, 93.10% sensitivity and 74.41% specificity. Finally, an Ensemble model, synthesized by the individual ones, achieved 89.74% accuracy, 93.75% sensitivity and 85.73% specificity.

Conclusion:

Machine learning method predicted with high accuracy, sensitivity and specificity PDD or DLB diagnosis based on non-invasively and easily in-the-clinic and neuropsychological tests.
Job Satisfaction and Sexual Orientation in Britain
Authors: Bayrakdar Sait , King Andrew
Published: February 2021

Studies looking at patterns of labour market outcomes among lesbian, gay and bisexual (LGB) individuals focus mostly on earnings, while non-pecuniary outcomes of LGB individuals have remained a relatively under-researched area. Using the latest wave of the Workplace Employment Relations Study (WERS), this article investigates the job satisfaction levels of LGB individuals compared to their heterosexual peers for the first time in Britain. The results show significantly lower job satisfaction levels only for bisexual men, compared to their heterosexual counterparts. Moreover, the findings do not show a direct impact of LGB(T)-related workplace policies on job satisfaction levels.
‘He may not be qualified in it, but I think he’s still got the knowledge’: Team-doctoring in combat sports
Authors: AlHashmi Reem , Matthews Christopher R
Published: February 2021

Several studies have examined the provision of medical care in a variety of competitive sport settings. These are important contributions, but the majority of this work has focused on elite sports that tend to have a group of medical health professionals as part of the team, with little attention given to sports that lack access to such services. This lack of dedicated medical support may result in athletes being more likely to engage in ‘team-doctoring’ – a term used to describe athletes seeking medical advice from teammates and coaches. This concept is yet to be theorised and empirically described. In this paper, we begin to define, explore and contextualise the process of team-doctoring in relation to sociocultural interactions, beliefs embedded within the combat sport subculture and the critical role it plays in shaping fighters’ perceptions of health and injury. In so doing, we demonstrate that team-doctoring is the process whereby apparent medical knowledge is (mis)understood, recommended, transferred, interpreted and developed within a somewhat coherent team.
Multicultural Virtual Team Performance: The Impact of Media Choice and Language Diversity
Authors: Eisenberg Julia , Glikson Ella , Lisak Alon
Published: February 2021

Globally distributed multinational virtual teams (MNVTs) are increasingly prevalent. To better understand communication in MNVTs, we explored the effects of using verbal and written synchronous communication media under different levels of English Language Proficiency (ELP) diversity. The results of data collected from 45 MNVTs, composed of MBA students who worked on a joint project, revealed that while verbal communication leads to higher perceived proximity within low ELP diversity teams, written communication contributes to perceived proximity when ELP diversity is high. Perceived proximity in turn, positively influences MNVT performance. We discuss the theoretical and practical implications of these findings for MNVTs.
The Parental Struggle With the Israeli Genital Socialization Process
Authors: Meoded Danon Limor
Published: February 2021

The focus of this article is on how parents of children with “nonnormative” genitalia cope with the conflict between the genital socialization process and their children’s genital autonomy in the Israeli medical–sociocultural context. Based on a qualitative narrative study that included 18 parents of children born with atypical genitalia and 23 parents who had chosen not to circumcise their sons, I compare parents’ experiences and perceptions of genital autonomy and examine the challenges posed by the Israeli genital socialization process from their perspective. In this study, I aim to shed light on the stressful and powerful Israeli genital socialization process, in which the medical, familial, and religious forces reproduce gendered normative genital appearances. The parents’ physical and emotional experiences include feelings of doubt and a critical stance toward genital socialization, changes in perceptions regarding genital appearance, and parental practices that challenge the meaning and outcomes of genital surgeries.
Influence of feedstock type and particle size on efficiency of biochar in improving tensile crack resistance and shear strength in lean clayey soil
Authors: Kumar Himanshu , Huang Shan , Mei Guoxiong , Garg Ankit
Published: February 2021

The development of tensile stress can cause desiccation cracks, further increasing infiltration and inducing instability in green infrastructure (slopes and landfill liners). Recent research has promoted the use of biochar (i.e., stable carbon with a life period of more than 500 years) as an eco-friendly material that can provide simultaneous benefits in reducing tensile stresses and crack development, aiming to enhance landfill cover longevity. However, there is a lack of guidelines and criteria for selecting biochar (feedstock type and particle size) as landfill cover material. This study aims to investigate the effects of biochar particle size and feedstock type on cracking of soil. Two contrasting feedstock types (i.e., pig manure-based and wood-based) have been selected for amendment on lean clay soil. Laboratory experiments were conducted to monitor the cracks. The results show that wood biochar (WB) is more efficient in crack reduction than pig manure biochar (PMB). Moreover, it has been observed that fine-grained biochar is more suspectable to cracks formation regardless of biochar type. The cohesion and internal friction angle of biochar are dependent on the surface morphology of biochar. WB has more angularity and sharp edges, which can increase interlocking in soil, thereby enhancing shear resistance and, hence, soil stability. The comprehensive study can help narrow down the selectivity of biochar and its specifications to mitigate cracks and enhance the strength of landfill cover.
School Nurse Perspectives on COVID-19
Authors: Hoke Alicia M. , Keller Chelsea M. , Calo William A. , Sekhar Deepa L. , Lehman Erik B. , Kraschnewski Jennifer L.
Published: February 2021

Pennsylvania responded to the COVID-19 pandemic by closing schools and moving to online instruction in March 2020. We surveyed Pennsylvania school nurses ( N = 350) in May 2020 to assess the impact of COVID-19 on nurses’ concerns about returning to school and impact on practice. Data were analyzed using χ2 tests and regression analyses. Urban school nurses were more concerned about returning to the school building without a COVID-19 vaccine than rural nurses ( OR = 1.58, 95% CI [1.05, 2.38]). Nurses in urban locales were more likely to report being asked for guidance on COVID-19 ( OR = 1.69, 95% CI [1.06, 2.68]), modify communication practices ( OR = 2.33, 95% CI [1.42, 3.82]), and be “very/extremely concerned” about their safety ( OR = 2.16, 95% CI [1.35, 3.44]). Locale and student density are important factors to consider when resuming in-person instruction; however, schools should recognize school nurses for their vital role in health communication to assist in pandemic preparedness and response.
Peer-to-Peer Dining: A Motivation Study
Authors: Lin Pearl, M. C. , Ok Chihyung Michael , Ching Au Wai
Published: February 2021

This study examined tourist motivations to determine whether peer-to-peer dining is a new, pursuable tourism product. A two-stage analysis of semistructured interview data from 28 individuals yielded three push dimensions (i.e., seeking variety, gaining authentic experience, and enhancing social circle) and six pull dimensions (i.e., food items, atmosphere, relationship with the host, value, service quality, and type of food), which were linked by word-of-mouth and publicity for peer-to-peer dining. Several motivational differences identified between participation in the sharing economy and in conventional dining have suggested that peer-to-peer dining reflects a novel product in food tourism. Interestingly, findings also suggested that tourists perceive local and overseas peer-to-peer dining services differently. This research contributes to the existing literature on the sharing economy and bears practical implications for food destination development and branding.
Correlation between retrobulbar blood flow parameters and retinal nerve fiber, ganglion cell and inner plexus layer thickness in myopia
Authors: Grudzińska Ewa M , Zaborski Daniel , Modrzejewska Monika
Published: February 2021

Purpose:

To assess the thickness of the retinal nerve fiber layer (RNFL), ganglion cell and inner plexus layer (GCIPL) and blood flow parameters in retrobulbar vessels, and to analyze correlations between these parameters in myopes.

Methods:

The study included forty myopic and 20 healthy eyes. Standard eye examination was supplemented with OCT of the optic nerve and macula (GCIPL, RNFL, RNFL in each quadrant and rim area of the optic nerve) and color Doppler imaging of retrobulbar arteries [peak systolic and end-diastolic velocities, pulsatile index and resistance index (RI) in the ophthalmic (OA), central retinal (CRA), nasal posterior ciliary and temporal posterior ciliary arteries].

Results:

Significant correlations were found between blood flow parameters in the CRA, RNFL and GCIPL thickness, and axial length (AL) and spherical equivalent (SE). There were significant positive correlations between RNFL with PSV and EDV in the CRA and negative correlations between RNFL and RI in the CRA. GCIPL was positively correlated with PSV and EDV in the CRA. The decrease in RA was associated with reduced blood flow velocities in the CRA, TPCA and NPCA.

Conclusion:

The reduced retrobulbar blood flow in healthy young myopes is correlated with increasing AL and refractive value, and thinning of the RNFL and GCIPL. Reduction of the rim-area of the optic disc is associated with vascular and retinal circulatory disorders. These phenomena indicate the vascular basis of the described changes. To the best of our knowledge, this is the first study which correlates ocular circulation with retinal structure.
Application of PCA with georeferenced data in the tourism industry: A case study in the province of Córdoba, Argentina
Authors: Luna Laura I
Published: February 2021

The spatial analysis of tourism industries provides information about their structure, which is necessary for decision-making. In this work, tourism industries in the departments of Córdoba province, Argentina, for the 2001–2014 period were mapped. Multivariate methods with and without spatial restrictions (spatial principal components (sPCs) analysis, MULTISPATI-PCA, and principal components analysis (PCA), respectively) were applied and their performance was compared. MULTISPATI-PCA yielded a higher degree of spatial structuring of the components that summarize tourism activities than PCA. The methodological innovation lies in the generation of statistics for multidimensional spatial data. The departments were classified according to the participation of tourism activities in the value added of tourism using the sPCs obtained as input of the cluster fuzzy k-means analysis. This information provides elements necessary for appropriately defining local development strategies and, therefore, is useful to improve decision-making.
From questionnaire to practical application: A quality of life profile for populations with diverse disabilities
Authors: Jespersen Louise N , Andersen Anette , Due Pernille , Ersbøll Annette K , Damsgaard Mogens T , Michelsen Susan I
Published: February 2021

Aims:

Existing quality of life questionnaires are either disease specific or generic in their assessment of themes which are perceived important to the quality of life in populations with disabilities. To be able to improve quality of life in a population with diverse disabilities there was a need for a cross-disability instrument. The Electronic Quality of Life (EQOL)-questionnaire was developed to meet this need. It is crucial that such an instrument is validated, easy to use, and interpret by, for example, clinicians and policy planners. This study aims to test the content validity of the EQOL questionnaire and to construct a user-friendly, cross-disability quality of life profile.

Methods:

To further test the content validity of the EQOL-questionnaire, we conducted field test analyses on 318 individuals (aged 16–64) with self-reported disabilities. Comments on the questionnaire were scrutinised and sorted. A profile with six domains of quality of life was developed. Model fit was evaluated by confirmatory factor analysis and content validity was evaluated based on distributions.

Results:

The EQOL-questionnaire was found to have an acceptable content validity and respondents from the field test found that it features important themes of quality of life. The confirmatory factor analysis estimated a satisfying model fit by the root-mean-squared error of approximation (0.06), whereas the comparative fit index and goodness of fit index indicated poorer model fit. Graphical charts, with colour categories for user-friendly interpretation, were constructed.

Conclusion:

By identifying themes reported as problematic, the EQOL-profile can be used to inform and target interventions aiming to improve quality of life in populations with diverse disabilities.
Walking Rome without leaving home: practicing cultural geography during the COVID-19 pandemic
Authors: Kowalewski Maciej
Published: February 2021

The time of COVID-19 lockdown has given us an opportunity to practice experimental methodologies of cultural geography. I use early-20th-century Polish guides to Rome, Italy, to provide exercises in auto-geography. The aim of these exercises is to enrich the practice of cultural geography by opening up to self-exploration and combining lectures and imagination with distanced spaces. These exercises relate to finding the hidden narrator, understanding locational formulations, and assessing the role of our own assumptions and memories in studying urban narratives. Although travel guides are typically read as sources of historical and cultural knowledge, I propose also reading them to better understand the relationship between reading practice and the researcher’s prior knowledge.
Radicalizing Rights: Basic Liberties and Direct Action
Authors: Raekstad Paul , Rossi Enzo
Published: February 2021

Strikes often lack a reasonable chance of success unless they violate some basic liberties (of contract, movement, etc.). This creates a dilemma for liberal democracies that recognize a right to strike: either the right is toothless, or the basic liberties do not have priority and so are not basic. Alex Gourevitch argues that grounding the radical right to strike in an interest in freedom resolves the dilemma. We point out an ambiguity in this solution: it either does not solve the dilemma, or it tacitly presupposes that there is no dilemma. However, we go on to show that a modified, dynamic conception of the radical right to strike can ground its priority, albeit at the expense of the basicness of certain static basic liberties. What is more, we argue that this generalizes to other forms of direct action, such as the recent Black Lives Matter blockades and those at Standing Rock.
Ag/VO2/Ag sandwich nylon film for smart thermal management and thermo-responsive electrical conductivity
Authors: Peng Linghui , Shen Lingling , Fan Weiren , Liu Zichuan , Qiu Hongbo , Yu Aibing , Jiang Xuchuan
Published: February 2021

Due to the effects of climate changing, the importance of outdoor thermal comfort has been recognized, and has gained more and more research attentions. Unlike indoor space where air conditioning can be easily implemented, outdoor thermal comfort can only be achieved by localized thermal management. Using textile is a simple but energy-saving way to realize outdoor thermal comfort. Herein, we report the design of a smart thermal management film with the silver/vanadium dioxide/silver (Ag/VO2/Ag) sandwich structure prepared by one-dimensional (1 D) nanowires. It was found that the Ag/VO2/Ag sandwich film was able to lower the temperature by around 10 °C under intense infrared (IR) radiation. In addition, the Ag/VO2/Ag sandwich structure film showed a thermo-responsive electrical conductivity and an outstanding bending stability, due to network structure formed by nanowires. It was experimentally proved that this sandwich structure was superior to other layer structures in IR shielding performance and thermo-responsive electrical conductivity. The as-prepared Ag/VO2/Ag sandwich structure film has great potential for various applications such as wearable devices, flexible electronics, medical monitors and smart IR radiation management.
Collecting Pandemic Phenomena: Reflections on Rapid Response Collecting and the Art Museum
Authors: Debono Sandro
Published: February 2021

Rapid Response Collecting has been a most apt methodology with which to document the COVID-19 pandemic for an increasing number of museums. As the phenomenon unfolded across the globe, museums searched for and head-hunted the truth-revealing objects that could tell the stories and histories of the present to current and future generations. Indeed, the COVID-19 pandemic took Rapid Response Collecting to a higher level. A methodology originally conceived for a sporadic phenomenon happening within a specific context during the early years of the 21st century gained much more traction almost overnight. This paper shall make a case for a better understanding of the potential use and application of Rapid Response Collecting by art museums. It shall look into the defining values of this collections development methodology and how these can be applied and adopted when acquiring works of art. In doing so, it shall seek to understand to what extent the mainstream version of Rapid Response Collecting can be adapted for the needs, purposes and requirements of the art museum.
Predictors of Secondary Ulnar Shortening and Reoperation After Arthroscopic TFCC Debridement
Authors: Verhiel Svenna H. W. L. , Ritt Marco J. P. F. , Chen Neal C.
Published: February 2021

Background:

Predicting which patients will do well with arthroscopic triangular fibrocartilage complex (TFCC) debridement alone or which patients may benefit from arthroscopic debridement and ulnar shortening at the same time can be challenging. In this retrospective cohort study, we aimed to assess the rate and type of complications and reoperations after arthroscopic TFCC debridement. Furthermore, we aimed to identify factors associated with reoperation and specifically ulnar shortening osteotomy (USO) after this procedure.

Methods:

We included 163 patients who underwent arthroscopic TFCC debridement as a first surgery for treatment of their ulnar-sided wrist pain. Patient charts were manually reviewed, and ulnar variance was measured on preoperative posteroanterior radiographs of the wrist. Bivariate analysis and multivariable logistic regression analysis were performed to identify factors associated with reoperation. Additional subgroup analyses looking at USO after TFCC debridement were performed with Kaplan-Meier analysis and Cox regression survival analysis.

Results:

We found a complication rate of 14% and a reoperation rate of 19% (most common USO with 10%). Chondromalacia was independently associated with reoperation. Forty percent of patients with a positive ulnar variance later proceeded to USO. A hazard ratio of 1.8 per millimeter of ulnar variance was found.

Conclusions:

Our data suggest that patients with a positive ulnar variance with frank chondral loss at the time of arthroscopic TFCC debridement may benefit from simultaneous USO.
Is Opioid-Limiting Legislation Effective for Hand Surgery Patients?
Authors: Shah Kalpit N. , Reid Daniel B. C. , Ruddell Jack H. , Shapiro Benjamin H. , James Peter , Gil Joseph A. , Daniels Alan H. , Akelman Edward
Published: February 2021

Background:

The Rhode Island State Legislature passed the Uniform Controlled Substances Act in 2016 to limit opioid prescriptions. We aimed to objectively evaluate its effect on opioid prescribing for hand surgery patients and also identify risk factors for prolonged opioid use.

Methods:

A 6-month period (January-June 2016) prior to passage of the law was compared with a period following its implementation (July-December 2017). Thumb carpometacarpal arthroplasty and distal radius fracture fixation were classified as “major surgery” and carpal tunnel and trigger finger release as “minor surgery.” Prescription Drug Monitoring Database was used to review controlled substances filled during the study periods.

Results:

A total of 1380 patients met our inclusion criteria, with 644 prelaw and 736 postlaw patients. Patients undergoing “major surgery” saw a significant decrease in the number of pills issued in the first postoperative prescription (41.1 vs 21.0) and a corresponding decrease in morphine milligram equivalents (MMEs) (318.6 vs 159.2 MMEs) after implementation. A 30% decrease in MMEs was also seen in those undergoing “major surgery” in the first 30 days postoperatively (544.7 vs 381.7 MMEs). Risk factors for prolonged opioid use included male sex and preoperative opioid use.

Conclusions:

In Rhode Island, opioid-limiting legislation resulted in a significant decrease in the number of pills and MMEs of the initial prescription and a 30% decrease in total MMEs in the 30-day postoperative period after “major hand surgery.” Additional research is needed to explore the association between legislation and clinical outcomes.
Hyperventilation syndrome
Authors: Bennett Alexander
Published: February 2021

The image of a patient breathing into a brown paper bag is a quite familiar one in popular culture. Although this is not recommended, it has been used by some patients to relieve the symptoms of hyperventilation. Hyperventilation syndrome (sometimes known as ‘dysfunctional breathing’) is defined as chronic or intermittent episodes of hyperventilation with associated somatic symptoms. There are many possible symptoms, but they generally include anxiety, paraesthesia and a further sensation of breathlessness. It should be a diagnosis of exclusion, as other conditions causing similar symptoms can be life-threatening.
Evaluation of Trueness and Precision of a Bench-Top Laboratory Glucose Analyzer Using Reference Materials
Authors: Baumstark Annette , Pleus Stefan , Hartwig Matthias , Freckmann Guido
Published: February 2021

SUPER GL compact is a bench-top analyzer for glucose, lactate, and hemoglobin concentrations. Glucose measurements in the biosensor are based on an enzymatic-amperometric reaction of glucose with glucose oxidase.

In this study, trueness and precision were assessed with Standard Reference Material 965b (National Institute of Standards and Technology, Gaithersburg, MD) for 2 SUPER GL compact (S1 and S2) and 1 YSI 2300 STAT Plus (Y) device, using a protocol based on CLSI EP05-A3.

Precision was similar among S1, S2, and Y. S1 and S2 exhibited negative bias at low concentrations and positive bias at high concentrations, whereas Y showed negative bias that increased with higher concentrations. Overall, SUPER GL compact’s performance was comparable to that of YSI 2300 STAT Plus.
Prevalence and Consequences of Sport Specialization Among Little League Baseball Players
Authors: Post Eric G. , Rosenthal Michael D. , Pennock Andrew T. , Rauh Mitchell J.
Published: February 2021

Background:

Baseball is one of the most popular boy’s youth sports, and there has been a rise in the rates of certain overuse injuries among players. Specialization has been identified as a risk factor for overuse injury in high school athlete populations, but there is little understanding of the prevalence or consequences of sport specialization in Little League baseball players.

Hypothesis:

Sport specialization will be highly prevalent among Little League baseball players and specialization will be associated with worse throwing arm health.

Study Design:

Cross-sectional study.

Level of Evidence:

Level 3.

Methods:

A total of 246 Little League baseball players (male; N = 241; age, 9.5 ± 1.6 years) between 7 and 12 years old completed an anonymous, online questionnaire with their parent’s assistance. The questionnaire consisted of participant demographics and baseball participation information, including sport specialization status and the Youth Throwing Score (YTS), a valid and reliable patient-reported outcome measure for youth baseball players.

Results:

Only 29 (11.8%) players met the criteria for high specialization. Approximately one-third of all players (n = 77; 31.3%) reported participating in baseball year-round or receiving private coaching outside of their league (n = 81; 32.9%). Highly specialized athletes demonstrated worse scores on the YTS on average compared with low-specialization athletes (mean [SE]: 56.9 [1.6] vs 61.1 [1.2]; P = 0.01). Similarly, pitching in the previous year ( P < 0.01) or traveling overnight regularly for showcases ( P = 0.01) were associated with a worse score on the YTS.

Conclusion:

While the prevalence of high sport specialization was low among Little League baseball players, other behaviors associated with specialization such as year-round play and the receiving of private coaching were more common. Highly specialized Little League players demonstrated worse throwing arm health compared with low-specialization players.

Clinical Relevance:

Little League players and their parents may represent a potential target audience for dissemination campaigns regarding sport specialization.
Confidence to Return to Play After Anterior Cruciate Ligament Reconstruction Is Influenced by Quadriceps Strength Symmetry and Injury Mechanism
Authors: Della Villa Francesco , Straub Rachel K. , Mandelbaum Bert , Powers Christopher M.
Published: February 2021

Background:

Although the restoration of quadriceps strength symmetry is a primary rehabilitation goal after anterior cruciate ligament reconstruction (ACLR), little is known about the potential relationship between quadriceps strength symmetry and psychological readiness to return to play (RTP).

Hypothesis:

Quadriceps strength symmetry will be associated with psychological readiness to RTP after ACLR. Secondarily, injury mechanism will influence the association between quadriceps strength and psychological readiness to RTP.

Study Design:

Retrospective cohort.

Level of Evidence:

Level 3 (cohort study).

Methods:

A total of 78 female patients completed strength testing and the Injury–Psychological Readiness to Return to Sport (I-PRRS) scale at an outpatient clinical facility as part of return to sport testing after ACLR. Linear regression analysis was used to assess the relationship between the I-PRRS and the independent variables of interest (quadriceps strength symmetry and injury mechanism).

Results:

For all patients combined, a significant symmetry × mechanism interaction was found. When split by injury mechanism, a significant linear relationship was found between quadriceps strength symmetry and the I-PRRS score in patients who experienced a noncontact injury (n = 55; P = 0.01; R2 = 0.24). No such relationship was found for those who experienced a contact injury (n = 23; P = 0.97; R2 = 0.01).

Conclusion:

Greater quadriceps strength symmetry was associated with greater psychological readiness to RTP in female athletes after ACLR. This relationship, however, was present only in those who experienced a noncontact injury.

Clinical Relevance:

Clinicians should consider both the physical and the psychological factors in assessing a patient’s readiness to RTP. This may be particularly important for those who have experienced an ACL tear through a noncontact mechanism.
A Rare Case of Steroid-Resistant Neurosarcoidosis of the Cavernous Sinus With Optic Neuropathy: A Case Report
Authors: Barforoshi Shiva , Patel Nikhil A. , Singh Alvin P. , Li Terrence , Mba Benjamin
Published: February 2021

Sarcoidosis is an inflammatory disease that presents with nervous system involvement in 5-10% of cases, commonly known as neurosarcoidosis.1 While there are no randomized controlled trials for the treatment of neurosarcoidosis, expert opinion supports initial treatment with corticosteroids and the use of steroid-sparing or anti-TNF agents in refractory or severe cases. We report a case of a 48-year-old African American male with a past medical history of biopsy-proven hepatic and renal sarcoidosis and progressive headache, dizziness, and blurry vision for 5 months, presenting with an acute exacerbation of right-sided vision loss over one day. MRI of the brain revealed a dural-based mass extending into the right cavernous sinus and compressing the right optic nerve. Given the pathological confirmation of systemic granulomatous disease consistent with sarcoidosis, clinical manifestations, bilateral hilar and mediastinal lymphadenopathy, MRI findings typical of central nervous system inflammation, and exclusion of other possible etiologies, the patient was diagnosed with probable neurosarcoidosis. Corticosteroids initially resolved his symptoms; however, he suffered an acute relapse. Combination therapy with corticosteroids plus mycophenolate mofetil (MMF) led to the eventual resolution of his symptoms. Only 8 cases of neurosarcoidosis involving the cavernous sinus have been reported. Our patient represents the only reported case of probable neurosarcoidosis of the cavernous sinus with optic neuropathy successfully treated with corticosteroid plus MMF combination therapy. We highlight the need to consider early, aggressive treatment in cases of neurosarcoidosis with optic neuropathy and to develop criteria to guide treatment strategy based on neurolocalization and the degree of neurological disability.
Flexible cystoscopy and laser stone fragmentation via Mitrofanoff stoma: A case series
Authors: Conway Joanne M , Christodoulidou Michelle , Reid Sheilagh , Patterson Jake M
Published: February 2021

Objective:

This case series aimed to demonstrate that flexible cystoscopy and laser stone fragmentation via a Mitrofanoff stoma is possible and an effective treatment for symptomatic bladder stones in complex patients with inaccessible urethras and challenging anatomy.

Patients and methods:

We present three cases which were managed in a tertiary centre. The procedure involved using a flexible cystoscope via the Mitrofanoff stoma and laser stone fragmentation without the need for an access sheath.

Results:

This technique was performed safely and demonstrated successful bladder stone clearance on follow-up, with no postoperative complications.

Conclusion:

Our case series illustrates a technique that can be performed in this select group of patients in specialist centres with the relevant surgical exposure and expertise.

Level of evidence

Level 4.
Considerations on Conducting Research on Wellness in the Context of the Learning Environment
Authors: Gruppen Larry D , Fogarasi Miklos C
Published: February 2021

The learning environment (LE) provides a context for many educational phenomena, of which wellness and burnout are particularly important. The LE can be thought of as consisting of a psychosocial dimension of personal, social, and organizational factors and a sociomaterial dimension that consists of spatial and technical factors. The interplay between elements of the LE and wellness of the participants is complex and only partially understood, requiring further research. Using this multidimensional model to describe and to plan to deliberately modify the learning environment can foster more rigorous and meaningful research evidence about the interaction of wellness and the LE. This article highlights four key considerations that scholars of wellness should consider when exploring the impact of the LE or designing interventions to modify the environment. These include 1) a thoughtful definition and theoretical conceptualization of the LE, 2) clarity about the study variables that are essential to the study question(s), 3) thoughtful and appropriate measurement of those variables, and 4) a study design that balances quality with feasibility. We provide a practical illustration of how these considerations can be applied in studies exploring the intersection of wellness and the LE.
Successful Closed Reduction of Atlantoaxial Rotatory Fixation in Children—A Retrospective Study of 30 Patients
Authors: Xu Ping , Zhang Zhiqiang , Zheng Yiming , Meng Junrong , Qian Chuang , Fu Dong , Wang Dahui
Published: February 2021

Study Design:

Retrospective cohort study.

Objectives:

To review our treatment experience and to investigate the process of this disease.

Methods:

Clinical data of AARF patients, who received closed reduction, was retrospectively reviewed. Patients were divided into 2 groups according to the length of delay (Group I: 1 month ≤ delayed time < 3 months), Group II (delayed time < 1 months). The correlation between the length of delayed time and clinical recovery (CR), radiological recovery (RR), and total recovery time were measured. The atlantodental interval (ADI), lateral mass-dens interval (LDI) and lateral joint space (LJS) were compared at admission and final follow-up.

Results:

30 children (12 girls and 18 boys) with AARF had received conservative treatment. The mean age at initial treatment was 8.13-year-old, ranging from 5 to 14. The mean follow-up time was 26.93 months (range, 6-87 months). The average length of delayed time was 28.53 days (range, 2-80 days). When the LDI, LJS, and ADI differences are compared at admission and the final visit, the differences are reduced significantly on LDI and LJS. A positive correlation is observed between the length of the delay and CR time and total recovery time (r = 0.63, p = 0.00 and r = 0.47, p = 0.01) respectively.

Conclusions:

Pediatric AARF patients who have a delay time < 3 months can be treated with closed reduction successfully. The longer the delayed time, the longer the traction time, but the cervical collar time is almost the same. The LDI and LJS on the anteroposterior of X-rays are convenient to estimate the progress of this condition during the treatment.
The Effects of Homestead Exemptions for Seniors and Disabled People on School Districts
Authors: Combs Alex E. , Foster John M.
Published: February 2021

Homestead exemptions for senior and disabled homeowners disproportionally erode rural tax bases but may still stimulate local educational spending. This article examines one such exemption in Kentucky. Two-stage generalized method of moments is used to estimate the demand for local education spending, then spending in the absence of the exemption is simulated to estimate effects on school district expenditure and academic performance. We combine Census and National Center of Education Statistics data with detailed exemption and academic performance data from Kentucky’s Departments of Revenue and Education into a panel spanning 1999–2013. Results suggest the exemption provides relatively generous tax relief without increasing resource and academic achievement gaps between rural and nonrural districts. This is largely attributable to Kentucky’s strong school finance equalization effort. Our findings can help states with a similarly targeted exemption consider such impacts in relation to their own demography and funding systems.
The Colony-Stimulating Factor 3 Receptor M696T Mutated in a Patient with Ph+ Acute Lymphoblastic Leukemia
Authors: Chen Xin , Wang Bichen , Pang Aiming , Jiang Erlie , Chu Yajing , Yuan Weiping , Feng Sizhou , Han Ming-Zhe
Published: February 2021

Purpose: Colony-stimulating factor 3 receptor (CSF3R) mutations have been identified in a variety of myeloid disorders, such as severe congenital neutropenia (SCN), chronic neutrophilic leukemia (CNL), myelodysplastic syndrome (MDS), acute myeloid leukemia (AML), and atypical chronic myelogenous leukemia (aCML). Although CSF3R point mutations (e.g., T618I) are emerging as key players in CNL/aCML, the significance of rarer CSF3R mutations is unknown. We report a case of philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL) with the M696T mutation in CSF3R gene and assess the pathogenicity of the CSF3R M696T mutation in Ph+ ALL.

Experimental Design: Here we report on a 32-year-old female who presented with asthenia. The initial hematological workup revealed white blood cell (WBC) count of 97 x 109/L (normal range 4-10 x 109/L). There was 84% prolymphocyte in the bone marrow. The immunophenotype of the blasts as judged from flow cytometry was in accordance with a B-ALL. The fusion gene for BCR-ABL P210 was positive. Hot mutation closely related to diseases was: CSF3R (nucleotide change c.2087 T>C, amino acid change p.M696T, mutation frequency 50.4%). Cytogenetic analysis showed 46, XX, t (9;22) (q34;q11). The patient was diagnosed as Ph+ ALL with the CSF3R M696T mutation and achieved Long-term survival after unrelated donor hematopoietic stem cell transplantation. Meanwhile we performed a series of experiments using murine interleukin 3 (IL-3)-dependent Ba/F3 cell line to evaluate the transforming capacity of the CSF3R M696T mutation. The phosphorylation of STAT3 was analyzed by G-CSF dependence assays and immunoblot analysis to evaluate the CSF3R M696T mutation contribution to the tumor transformation ability of Ba/F3 cells.

Results: This patient achieved complete remission with chemotherapy in combination with tyrosine kinase inhibitor (TKI) and long-term survival by unrelated donor transplantation. We confirmed the presence of a CSF3R M696T germline mutation in this patient, and the mutation was inherited from her mother. The experiments in vitro result showed the CSF3R M696T mutation harbors marginal contribution to the tumor transformation ability of Ba/F3 cells. CSF3R M696T mutation was neutral in tumor transformation ability.

Conclusions: We believe that TKI is still effective in patients with the CSF3R M696T mutation in Ph+ ALL. Donor with CSF3R M696T mutation might still be selected.

Disclosures

No relevant conflicts of interest to declare.
Frequency of IKZF1 Deletions in a Peruvian Population with B-Cell Acute Lymphoblastic Leukemia
Authors: Enriquez Daniel J , Mitchell Rachel J. , Alapi Krisztina Zuborne , Cervantes Elizabeth , Cancino Karina , Casas Jhoysi , Valcarcel Bryan , Sandival Gustavo , Haro Juan C , Samanez-Figari Cesar , Zapata Arturo , Garcia-Leon Juan L , Fielding Adele K.
Published: February 2021

Frequency of IKZF1 Deletions in a Peruvian Population with B-cell Acute Lymphoblastic Leukemia

Background: B-cell Acute Lymphoblastic Leukemia (B-ALL) is an aggressive disease with worse outcomes in older patients, and latino ethnicity. Additionally, Latino populations are at higher risk of developing B-ALL.IKZF1is an essential lymphoid transcription factor with deletions (ΔIKZF1)implicated in treatment failure and relapses. We aimed to evaluate the frequency ofIKZF1deletions in a cohort of Peruvian patients with newly diagnosed B-ALL.

Methods: We collected diagnostic bone marrow samples from 41 consecutive patients with B-ALL diagnosed between 2015-2019 at Instituto Nacional de Enfermedades Neoplasicas (INEN; Lima, Peru). Bone marrow samples were cryopreserved prior to induction treatment. DNA was extracted using High Pure PCR Template Preparation Kit (Roche) at INEN. Samples with adequate DNA were screened forΔIKZF1by multiplex endpoint PCR covering four main deletions - dominant negative Δ4-7 or the loss of function Δ2-7, Δ4-8, and Δ2-8 IKZF1 deletions at UCL Cancer Insitute (London, UK) using the primers described by Caye et. al. We analyzed outcomes byIKZF1status.

Results: Forty-one cases were enrolled during the study period. Clinical characteristics are presented in Table 1. Median age was 20 years[1-63]. Fifteen∆IKZF1cases (37%) were detected (67%BCR-ABL1 negand 33%BCR-ABL1pos).Cases withΔIKZF1were older than those with wild-typeIKZF1(median age 31 vs 13 years, p=0.002). Median presenting white blood count (WBC) was 48 x109/L [R:2-218], with a higher WBC inΔIKZF1compared to wild-type (87 vs 24 x109/L, p=0.001). The most frequent deletion was ∆4-7 (sevenBCR-ABL1 negand threeBCR-ABL1 pos) additional deletions are described in table 2. All patients received intensive 'pediatric-based' treatment, 21 with BFM-2009 and 19 with the CALGB 10403 protocol. CR rates after induction were 67% and 92% for∆IKZF1and wild-type cases, respectively. Eleven (73%) of patients with∆IKZF1subjects (73%) were MRD positive by flow cytometry after induction compared to 11 (44%) among wild-type. At a median follow-up of 2 years EFS was 38% in the∆IKZF1group and 58% in the wild type group, correspond OS was 38% and 58%, respectively.

Conclusion: A high frequency of IKZF1 deletions was found in a Peruvian population with B-ALL and was associated with older age and higher presenting white blood counts. Prospective studies with larger Latino population are warranted to confirm this finding.

Disclosures

No relevant conflicts of interest to declare.
Association of Blood Type on Clinical Outcomes in Black/African Americans Hospitalized for COVID-19 Infection
Authors: Cheng Yan , Mohammed Sharif , Okoh Alexis , Lee Ki (Steve) , Raczek Corinne , Krushna Amin , Cohen Alice J. , Nagarakanti Sandhya
Published: February 2021

Introduction: Early studies from Wuhan, China have reported an association between blood type and outcomes in COVID-19 infected patients. Conflicting reports in literature have investigated the protective role of blood type O against worst outcomes associated with COVID-19 infections. Approximately 50% of Black/African Americans (AA) have blood group O. Our study is the only study to date looking at the association between Black/AA and blood type. We aimed to determine the association between blood type and Black/AA patients hospitalized for COVID-19.

Methods: We retrospectively reviewed data on patients with known blood type, who were admitted for COVID-19 at a single center between March and April 2020. We excluded other races in our study because only about 2% of the population was Caucasian and 8% representing other races, representing a small subset of patients under study whereas Black/AA represented about 90% of our hospitalized patients. Patients were stratified into 4 groups based on their ABO blood type. Baseline demographic, clinical characteristics and clinical course of the disease were compared. The primary end point was in-hospital mortality. Secondary endpoints included admission to the intensive care unit (ICU), acute kidney injury requiring hemodialysis and length of stay (LOS).

Results: During the study period, a total of 256 patients were reviewed. Distribution of ABO type was as follows; A: (N=65) 25%, B: (N=62) 24%, AB: (N=9) 4%, O: (N=120) 47%. Compared to blood types A, B and O, AB patients were younger (mean; yrs. 63 vs. 63 vs. 62 vs. 43 yrs. p=0.0242). Blood type B patients were more likely to present with nausea, than groups A, AB, and O. (27% vs. 10% vs. 0% vs. 5%; p=0.017). All other characteristics including baseline inflammatory markers were comparable. There was no difference among groups regarding in-hospital mortality (A: 39% B: 29% AB: 33% O: 31% p value: 0.676) or admission to the ICU (A:31% B: 28% AB: 33% O: 34% p value: 0.840). The incidence of acute kidney injury requiring hemodialysis was higher in blood type A patients compared to B, AB, and O. (31% vs. 0% vs. 23% vs. 19%; p=0.046). In hospital LOS was comparable among all groups.

Conclusions: In this single center analysis of black/AA patients admitted for COVID-19, there was no association between blood type and in-hospital mortality or admission to ICU. Blood type A patients had a higher propensity of kidney injury, but this did not translate into worse in-hospital survival.

Disclosures

Cohen: GBT: Speakers Bureau.