bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Victim Blaming and Locus of Control on Mental Health Outcomes Among Female Sexual Assault Survivors
Authors: Wilson Laura C. , Farley Abigail , Horton Sierra F.
Published: June 2022

To elucidate individual differences in sexual assault survivor outcomes, we examined locus of control as a moderator of the relationship between victim blaming and both posttraumatic stress disorder (PTSD) symptoms and unhealthy alcohol use. The sample consisted of 82 female sexual assault survivors who had disclosed their victimization to at least one person. The results of this survey demonstrated that locus of control did not moderate the relationship between victim blaming and PTSD, or the relationship between victim blaming and unhealthy alcohol use. The findings further supported the direct relationship between victim blaming and a range of negative mental health outcomes among survivors.
Curriculum Interventions and Pedagogical Approaches for Virtual Care Delivery: A Scoping Review
Authors: Palesy Debra , Forrest Gail , Crowley Margaret E.
Published: June 2022

The onset of the COVID-19 pandemic has accelerated the adoption of virtual care as a modality for home-based care delivery to individuals and cohorts who might not otherwise have access. While a number of positive outcomes have been reported, rapid growth has occurred without critical consideration of clinician education and training. Little is known about the curricular and pedagogical requirements for educating current and future clinicians in virtual care provision. This review was informed by Arksey and O’Malley’s five-stage methodological framework for scoping reviews, first published in 2005. Using a clearly articulated search strategy and reporting process, over 4000 pieces of literature were analysed to inform this review. A final 17 papers were included. Common themes emerging in relation to curricula content include the basics of virtual care, cultural awareness, interprofessional collaboration/training, telepresence, encompassing non-verbal, verbal and environmental considerations, and virtual care clinical skills. Standalone modules are recommended for delivering ‘the basics’ of virtual care, while the interactive/participative approach is endorsed as an appropriate method of instruction. The reviewed literature reviewed offers a set of core inclusions and pedagogical approaches for a virtual care education program, although these are often mentioned in general terms and are not always well described. Moving beyond the COVID-19 pandemic, virtual care education for current and future clinicians requires a consistent and cohesive approach to curricula and pedagogies. These approaches should be rigorously evaluated as part of a continuous quality improvement process.
Comparative study of laser flare photometry versus slit-lamp cell measurement in pediatric chronic non-infectious anterior uveitis
Authors: Yalçındağ F. Nilüfer , Köse Helin Ceren , Temel Emine
Published: June 2022

Purpose

To evaluate the role of laser flare photometry (LFP) for monitoring the course of intraocular inflammation in children with chronic anterior uveitis.

Methods

Seventy-six eyes of 43 children with non-infectious chronic anterior uveitis were reviewed retrospectively.

Results

The median follow-up was 48.6 ± 23.1 months. Patients on immunosuppressive treatment at last follow-up, showed significantly higher flare values than patients who discontinued treatment (20.47 ± 15.49 vs. 6.33 ± 4.87 p < 0.001). The higher LFP values were correlated with the duration of immunosuppressive treatment, total duration of topical corticosteroid use and the risk for development of ocular complications at all follow-ups (all p < 0.001). No significant correlation was found between the AC cell grades and the duration of immunosuppressive treatment, topical corticosteroid use and the prevalence of complications.

Conclusion

LFP measurements have a predictive value of monitoring the course of uveitis and the occurrence of ocular complications, and it should be considered as a primary modality to monitor intraocular inflammation in children with chronic anterior uveitis.
A comparison of mortality rates following revision hip arthroplasty for periprosthetic fracture, infection or aseptic loosening
Authors: Barrow Jonathan A , Divecha Hiren M , Hastie Graham R , Wynn Jones Henry , Board Tim N
Published: June 2022

Background:

Mortality following revision hip surgery for periprosthetic fracture (PPF) is comparable to neck of femur fractures. Our institution provides a regional “PPF Service”. The aim of this study was to determine the time to surgery and mortality rate for PPF, compared to revision for infection or aseptic loosening.

Methods:

Revision arthroplasty procedures performed for PPF, infection or aseptic loosening between January 2014 and December 2015 were identified. Comparisons were made between the 3 groups for baseline demographics, admission to higher-level care, length of stay, complications and mortality.

Results:

There were 37 PPF, 71 infected and 221 aseptic revisions. PPF had a higher proportion of females (65% vs. 39% in infection and 53% in aseptic; p = 0.031) and grade 3 and 4 ASA patients ( p = 0.006). Median time to surgery for PPF was 8 days (95% CI, 6–16). Single-stage procedures were performed in 84% of PPF, 42% of infections and 99% of aseptic revisions ( p < 0.001). 19% of PPF revisions required HDU admission, 1% in the aseptic group and none in the infection group. Median length of stay was significantly different (PPF 10; infection 14; aseptic 8 days ( p < 0.001). The 1-year mortality rate for PPF was 0%, 2.8% for infection and 0.9% in the aseptic group ( p = 0.342).

Conclusions:

Despite the PPF group having higher ASA grades and more HDU admissions, our 1-year mortality rate was 0% and not significantly different to infection or aseptic loosening. Our low complication and 1-year mortality rate is encouraging and supports the safety of a regional “Periprosthetic Fracture Service”.
Comparison between transposed arteriovenous fistulas and arteriovenous graft for the hemodialysis patients: A meta-analysis and systematic review
Authors: Tang Qian-hui , Yang Han , Chen Jing , Lin Qiu-ning , Qin Zhong , Hu Ming , Qin Xiao
Published: June 2022

It is challenging for a surgeon to determine the appropriate vascular access for hemodialysis patients whose cephalic vein is usually inaccessible. The purpose of the study is to compare the complications and patency rates between transposed arteriovenous fistulas (tAVF) and arteriovenous graft (AVG) for the hemodialysis patients. Studies were recruited from PubMed, Cochrane library, EMBASE, the web of science databases, and reviewing reference lists of related studies from the inception dates to September 2, 2021. Statistical analyses were conducted using the statistical tool Review Manager version5.3 (Cochrane Collaboration, London, UK). I2 > 50% was defined as a high degree of heterogeneity, and then a random-effects model was used. Otherwise, the fixed-effects model was used. Odds ratio with its 95% confidence interval (95% CI) was used. Thirty-three trials (26 retrospective studies, four randomized controlled trials, two prospective trials, and one controlled-comparative study) with 6430 enrolled participants were identified in our analysis. The results showed that tAVF was accompanied with lower thrombosis rate (103/1184 (8.69%) vs 257/1367 (18.80%); I2 = 45%; 95% CI, 0.34 (0.26, 0.45)) and infection rate (43/2031 (2.12%) vs 180/2147 (8.38%); I2 = 0%; 95% CI, 0.20 (0.14, 0.30)) than arteriovenous graft. The significantly better primary patency rates, secondary patency rates, and primary assisted patency rates during follow-up were found in tAVF. However, the failure rate and the prevalence of hematoma were significantly lower in AVG group. No evidence showed the rate of overall mortality, steal syndrome, and aneurysm reduced in tAVF. Our results showed that tAVF is a promising vascular access technique for hemodialysis patients whose cephalic vein is inaccessible. Our data showed that tAVF has less thrombosis, infection risk, and better patency rates when compared with AVG. However, more attentions need to be paid to transposed arteriovenous fistulas maturation and hematoma.
Clinically relevant profiles of myelin content changes in patients with multiple sclerosis: A multimodal and multicompartment imaging study
Authors: Lazzarotto Andrea , Tonietto Matteo , Poirion Emilie , Battaglini Marco , Palladino Raffaele , Benoit Charline , Ricigliano Vito AG , Maillart Elisabeth , De Stefano Nicola , Stankoff Bruno , Bodini Benedetta
Published: June 2022

Objective:

To investigate the clinical relevance of individual profiles of cortical and white matter lesion myelin content changes combining magnetisation transfer imaging (MTI) and 11C-PiB-positron emission tomography (PET) in patients with multiple sclerosis (MS).

Methods:

MTI and [11C]PiB-PET acquired in 19 patients with MS followed up over 2–4 months and in seven healthy controls (HCs), were employed to generate individual maps of cortical and white matter (WM) lesion myelin content changes, respectively. These maps were used to calculate individual indices of demyelination and remyelination, and to investigate their association with clinical scores.

Results:

Cortical remyelination ranged between 1% and 5% of the total cortical volume (17%–45% of the cortical volume demyelinated at baseline). WM lesion remyelination ranged between 8% and 22% of the lesional volume. An extensive cortical remyelination was associated with a shorter disease duration (rho = −0.63, p = 0.01) and, in combination with WM lesion remyelination, explained 68%–70% of the variance of clinical scores ( p < 0.01).

Conclusion:

Our multimodal and multicompartment approach allows us to explore single-patient cortical and WM lesion demyelination and remyelination, and to generate clinically relevant indices of myelin repair. These indices may be used as outcome measures in clinical trials, thus increasing the chance to identify successful promyelinating treatments in patients with MS.
Roses and thorns: Political talk in reality TV subreddits
Authors: Chen Amanda , McCabe Katherine T
Published: June 2022

Most online media consumption is not driven by a desire to seek out news and politics. However, the public may still encounter politics because it arises organically in communities devoted to non-political subjects. This study examines the potential of popular reality television online discussion forums to serve as online third spaces and stimulate political discussion due to the natural connections that audiences make between the cast members and “real life” in reality-based programming. Based on a quantitative analysis of political comments made to reality television subreddits and a survey of visitors to a popular subreddit focused on The Bachelor television show, the findings not only demonstrate the ability of entertainment-focused online communities to expose a broad segment of the public to political talk, but also point to the obstacles in promoting political discussion that is simultaneously enjoyable, informative, and tolerant of diverse viewpoints.
Optimization of thermal barrier coating performance and durability over a drive cycle
Authors: Koutsakis Georgios , Ghandhi Jaal B
Published: June 2022

A methodology to thermo-mechanically optimize a piston thermal barrier coating over a full drive cycle was established. The optimization objective was to minimize the heat transfer to the engine wall while maintaining structural integrity of the coating. Over 800 candidate materials were investigated and the optimization required more than one million non-road transient drive cycle calculations; real materials were investigated to ensure a realizable result and the existence of thermal and mechanical properties. High computational efficiency was achieved using a recently developed analytical heat transfer technique for multilayer engine walls. An uncoupled approach was utilized for the optimization, wherein the gas temperature and heat transfer coefficient profiles from a fully coupled and calibrated baseline model over the 20-min drive cycle were employed. The coating/piston interface temperature was constrained to be below the maximum piston service temperature limit. The durability was assessed using a recently developed analytical coating delamination framework for engine in-cylinder coatings based on the energy release rate when a crack forms. Results are presented for a mechanically unconstrained optimization and for cases constrained to three fixed levels of drive-cycle maximum energy release rate, and also constrained by the individual material’s toughness. The best-performing coating materials identified were verified using the fully coupled system-level model, which compared well to the uncoupled predictions. A study on the effect of adding a sealing layer to some high-performing, but porous, coatings showed a reduction in fuel consumption benefit and an increased exhaust temperature over the cycle, but the system still outperformed the uncoated case. The results of the study elucidate the importance of including engine performance and mechanical failure considerations in thermal barrier coating design.
Intertextuality and New Testament Studies
Authors: Kim Doosuk
Published: June 2022

Intertextuality is a hermeneutical strand of poststructuralism. In biblical scholarship, since Hays’s influential work Echoes of Scripture in the Letters of Paul (1989), the term has also been employed to refer to a later text’s interpretation of an earlier text. Regrettably, however, for the past three decades, scholars have failed to come to a consensus on how to understand and apply intertextuality in New Testament studies. Though both literary and biblical studies employ the same term intertextuality, their conception and application of intertextuality differs substantially. Accordingly, this essay will sketch how literary and biblical studies have perceived and utilized the concept of intertextuality. Following this, the study will evaluate these approaches. Finally, the present essay will conclude with a proposal for how to relate intertextuality and New Testament studies that is a cogent middle ground between poststructuralism and biblical studies, thereby compensating for both sides’ deficiencies.
Chylous Ascites Revisited - old Disease, new Management
Authors: Campbell S. , Ghosh S. , Williams N.
Published: June 2022

Extravasation of chyle from the intestinal lymphatics into the peritoneal cavity results in chylous ascites, identified by its characteristic milky appearance. Chylous ascites is rare, but it has been suggested that its incidence may be increasing in the adult population. Successful management depends on identifying the underlying cause of the lymphatic disruption. The spectrum of causative pathologies seen in adult and paediatric practices are vastly different: congenital lymphatic problems predominate in the latter, while occult malignancy often causes adult chylous ascites. This review looks at the various aetiologies, diagnosis and the recent advances in the management of this condition. gynaecological malignancies, while in the paediatric population, both sexes are affected equally. It has been suggested that the incidence of chylous ascites may be increasing in line with higher incidence of malignant disease and complications of HIV infection. The reason for this may simply reflect increased reporting of the disorder, or it may be due to increasing diagnostic capability.

The majority of early reports of chylous ascites describe anecdotal cases, and there are very few series describing the causes and management of the condition. This again reflects the rarity of chylous ascites.

There is a need for a review of this rare cause of ascites to highlight changing aetiology and new therapeutic options.
Hyperammonaemic encephalopathy following bariatric surgery: A case of a potentially life-threatening delayed complication
Authors: Ward Emily , Gifford Hugh , Botros Shady , Hughes Cara
Published: June 2022

Hyperammonaemia is a life-threatening condition with numerous aetiologies and a variable presentation. It is increasingly associated with bariatric weight-loss procedures and significant mortality despite treatment. Symptoms often occur long after surgery and at times in association with other trigger illnesses. Patients can present to general medicine, general practice and intensive care as well as surgical and anaesthetic teams. We present the case of a male patient who underwent a sleeve gastrectomy with subsequent weight loss and suffered from hyperammonaemic encephalopathy on multiple occasions. His delayed postoperative complication was likely to be multifactorial in nature, and this is outlined in the case. We discuss presentation, investigation, management and patient outcomes.
Prediction of Wound Recurrence in Patients With Chronic Limb-Threatening Ischemia Undergoing Endovascular Treatment
Authors: Fukagawa Tomoya , Mori Shinsuke , Yamawaki Masahiro , Kobayashi Norihiro , Tsutsumi Masakazu , Honda Yohsuke , Makino Kenji , Ito Yoshiaki
Published: June 2022

Purpose:

Chronic limb-threatening ischemia due to isolated below-the-knee lesions is a factor associated with wound recurrence. However, there is a lack of data regarding wound recurrence in such cases. This study aimed to determine the predictors of wound recurrence in patients with chronic limb-threatening ischemia undergoing endovascular treatment.

Patients and Methods:

This was a single-center, retrospective, observational study. We enrolled 152 consecutive patients with chronic limb-threatening ischemia (172 limbs) who achieved complete wound healing after undergoing endovascular treatment for isolated below-the-knee lesions between February 2008 and December 2017. Of these, the wound had recurred in 56 limbs (33%), and we divided the patients into 2 groups based on wound recurrence. We evaluated the recurrence rate of chronic limb-threatening ischemia and predictors of wound recurrence. Wound recurrence was defined as recurrence of the wound within 2 years of complete wound healing.

Results:

Patients’ backgrounds were similar in both groups, including mean age (72±9 vs 72±11; p=0.76) and hemodialysis (43% vs 40%; p=0.66). Pre-pedal arch type 2 (52% vs 8%; p<0.01), infrapopliteal grade 4 of the Global Limb Anatomic Staging System (77% vs 59%; p=0.02), and Wound, Ischemia, and foot Infection criteria stage 4 (43% vs 28%; p=0.04) were more common in the wound recurrence group. Multivariate Cox proportional hazard analysis identified pre-pedal arch type 2 (hazard ratio, 5.28; 95% confidence interval, 3.08–9.10; p<0.01) and Wound, Ischemia, and foot Infection criteria stage 4 (hazard ratio, 1.98; 95% confidence interval, 1.15–3.36; p=0.01) as predictors of wound recurrence after complete wound healing.

Conclusion:

Pre-pedal arch type 2 and Wound, Ischemia, and foot Infection classification system stage 4 were associated with wound recurrence in patients with chronic limb-threatening ischemia who achieved complete wound healing after undergoing endovascular treatment for isolated below-the-knee lesions.
Indigenous Nigeria medicinal herbal remedies: A potential source for therapeutic against rheumatoid arthritis
Authors: Arunsi Uche O , Chioma Ogbuka E , Etusim Paschal E , Owumi Solomon E
Published: June 2022

Rheumatoid arthritis (RA) is a debilitating disease associated with locomotion impairment, and conventional therapeutic drugs are not optimal for managing RA. There is an avalanche of medications used for the management of RA. Still, studies have shown that they are associated with severe side effects, including hepatotoxicity, retinopathy, and cardiotoxicity disorders of the central nervous system (CNS), skin, blood, and infections. Complementary and alternative medicine (CAM) is currently gaining attention as a novel panacea for managing debilitating diseases, such as RA. Nigerian folk herbal remedies are replete with a plethora of curative medicine, albeit unvalidated scientifically but with seemingly miraculous provenance. Studies of the identification of bioactive compounds present in these botanicals using advanced spectral analytical techniques have enhanced our understanding of the role of Nigerian herbal remedies in the treatment and management of RA. Interestingly, experimental studies abound that the bioactive compounds present in the extracts of plant botanicals protected animals from the development of RA in different experimental models and reduced the toxicity associated with conventional therapeutics. Validated mechanisms of RA amelioration in human and animal models include suppression of the expression of NF-κB, IL-1β, TNF-α, IL-6, IL-8, IL-17, IL-23, chemokines, TGF-β, RANKL, RANK, iNOS, arginase, COX-2, VEGFA, VEGFR, NFATC1, and TRAP in the synoviocytes. Decreased ROS, NO, MDA, carbonyl groups, and PGE2in the synovial fluid increased the expression of PPARα/γ; antioxidant and anti-inflammatory molecules also improve RA etiology. In this mini-review, we discuss the global burden of RA, the novel role of plant-based botanicals as potential therapeutics against signaling pathways in RA. Also addressed is the possible repurposing/reprofiling of plant botanicals to increase their therapeutic index among RA patients that patronize traditional healers in Nigeria with a global projection.
Effect of Levetiracetam Use Duration on Overall Survival of Isocitrate Dehydrogenase Wild-Type Glioblastoma in Adults
Authors: King-Stephens David
Published: June 2022

[Box: see text]
Use of information criteria for selecting a correlation structure for longitudinal cluster randomised trials
Authors: Rezaei-Darzi Ehsan , Kasza Jessica , Forbes Andrew , Bowden Rhys
Published: June 2022

Background:

When designing and analysing longitudinal cluster randomised trials, such as the stepped wedge, the similarity of outcomes from the same cluster must be accounted for through the choice of a form for the within-cluster correlation structure. Several choices for this structure are commonly considered for application within the linear mixed model paradigm. The first assumes a constant intra-cluster correlation for all pairs of outcomes from the same cluster (the exchangeable/Hussey and Hughes model); the second assumes that correlations of outcomes measured in the same period are higher than outcomes measured in different periods (the block exchangeable model) and the third is the discrete-time decay model, which allows the correlation between pairs of outcomes to decay over time. Currently, there is limited guidance on how to select the most appropriate within-cluster correlation structure.

Methods:

We simulated continuous outcomes under each of the three considered within-cluster correlation structures for a range of design and parameter choices, and, using the ASReml-R package, fit each linear mixed model to each simulated dataset. We evaluated the performance of the Akaike and Bayesian information criteria for selecting the correct within-cluster correlation structure for each dataset.

Results:

For smaller total sample sizes, neither criteria performs particularly well in selecting the correct within-cluster correlation structure, with the simpler exchangeable model being favoured. Furthermore, in general, the Bayesian information criterion favours the exchangeable model. When the cluster auto-correlation (which defines the degree of dependence between observations in adjacent time periods) is large and number of periods is small, neither criteria is able to distinguish between the block exchangeable and discrete time decay models. However, for increasing numbers of clusters, periods, and subjects per cluster period, both the Akaike and Bayesian information criteria perform increasingly well in the detection of the correct within-cluster correlation structure.

Conclusions:

With increasing amounts of data, be they number of clusters, periods or subjects per cluster period, both the Akaike and Bayesian information criteria are increasingly likely to select the correct correlation structure. We recommend that if there are sufficient data available when planning a trial, that the Akaike or Bayesian information criterion is used to guide the choice of within-cluster correlation structure in the absence of other compelling justifications for a specific correlation structure. We also suggest that researchers conduct supplementary analyses under alternate correlation structures to gauge sensitivity to the initial choice.
Civic action and student voice
Authors: McGinnis Eric , Mitra Dana
Published: June 2022

This study explores the ways that youth make sense of the United Nations Sustainable Development Goals and how context informs the scope and nature of youth-led local civic action. Using an embedded case study approach, this study focuses on the Cultivating Pathways to Sustainability project, which engages scores of young people in the state of Vermont, U.S.A. Data for this study was drawn from observations and interviews of middle and high school students and teachers from 18 participating schools. The study’s findings show the value of intermediaries as catalysts for civic action, demonstrate ways of linking global policy with local civic action, and show how a youth-adult partnership model can deepen the meaning and implementation of civic action.
Prisoners regulating prisons: Voice, action, participation and riot
Authors: Buck Gillian , Tomczak Philippa
Published: June 2022

Prisoners are a critical source of prison regulation around the world, but regulation by (rather than of) prisoners remains little analysed. In this article, we utilise the 1990 riots at HMP Strangeways (England), as a case study of prisoners (re)shaping imprisonment. We examine prisoners’ roles in these riots and subsequent cross-sectoral regulatory activities. We innovatively use the four-phase process of translation from actor-network theory to guide document analysis of (1) Lord Woolf’s official inquiry into the riots and (2) the voluntary organisation Prison Reform Trust’s follow-up report. We explore how participatory approaches could inform prison regulation through (former) prisoners partnering with external regulators throughout the processes of identifying problems and solutions to establish broader alliances seeking social change.
Media portrayal of hackers inChina DailyandThe New York Times: A corpus-based critical discourse analysis
Authors: Pei Jiamin , Li Dandi , Cheng Le
Published: June 2022

This study draws on a synergy of Corpus Linguistics and Critical Discourse Studies to scrutinize the portrayal of hackers in China Daily and The New York Times in the 21st century (2001–2020), primarily revolving around the main social actors and targets in hacking. This study demonstrates that both media share a positive transformation of the image-building of hackers in the 21st century. Besides, countries are salient social actors in hacker media discourse and the two media differ in their ways of constructing them. The New York Times tends to have a negative other-representation and categorical otherness of specific countries through such discursive strategies as negative other-representation and group categorization, whereas China Daily is prone to insist on opposing the US hacking allegations in a defensive manner. Regarding major targets, China Daily highlights government websites whereas The New York Times emphasizes government websites, officials’ emails, large technology companies, and election infrastructure. The analysis shows that the two media’s different ways of framing hackers are underpinned by the ideologies behind them and the Chinese and US socio-political landscapes. This study can provide insights into how hacker discourse in media is represented in the 21st century and how national identities are constructed in the media representations of hackers.
Outcomes of reverse shoulder arthroplasty in patients under 55 years old: Results from the New Zealand joint registry
Authors: Gao Ryan , van der Merwe Michael , Coleman Brendan , Boyle Matthew J , Frampton Christopher MA , Hirner Marc
Published: June 2022

Background

The appropriate age at which to perform reverse shoulder arthroplasty is controversial. The aim of this study was to compare the outcomes of reverse shoulder arthroplasty between younger and older patients.

Methods

Patients who underwent primary reverse shoulder arthroplasty between January 2000 and December 2019 were identified from New Zealand Joint Registry records. Patients were stratified into two cohorts according to age at the time of surgery: < 55 years and ≥ 55 years. These two groups were then compared with regard to baseline characteristics, indications for surgery, revision rates, and patient-reported outcomes using the Oxford Shoulder Score and American Shoulder and Elbow Score (ASES).

Results

A total of 5518 primary reverse shoulder arthroplasty cases were identified, with 75 patients < 55 years at the time of surgery (range: 34–54 years). The mean duration of follow-up was 2.36 years (range: 0.11–13.37 years) in the younger cohort and 3.10 years (range: 0.01–16.22 years) in the older patient cohort. Indications for surgery differed significantly between the two groups, with younger patients having higher rates of inflammatory arthritis ( p < 0.001), posttraumatic arthritis ( p < 0.001), and avascular necrosis ( p = 0.049). The younger cohort had an inferior 6-month postoperative Oxford Shoulder Score compared to the older cohort (mean: 28.5 [younger cohort] vs. 35.7 [older cohort]; p < 0.001). There was no significant difference in revision rate between the younger and older patient cohorts during the study period (1.56 [<55 years] vs. 0.74 [≥55 years] revisions per 100 component-years; p = 0.332).

Conclusion

Our early results suggest that younger patients undergoing reverse shoulder arthroplasty demonstrate high implant retention rates, comparable to older patients. Longer-term patient-reported outcomes in younger patients are required to guide appropriate patient selection for reverse shoulder arthroplasty.

Level of evidence

Level III, retrospective case-control study.
Reversal of Advanced Directives in Neurologic Emergencies
Authors: McHugh Daryl C. , George Benjamin P. , Bender Matthew T. , Horowitz Robert K. , Kaufman David C. , Holloway Robert G. , Roberts Debra E.
Published: June 2022

Objective

Patients with advanced directives or Medical Orders for Life-Sustaining Treatment (MOLST), including “Do Not Resuscitate” (DNR) and/or “Do Not Intubate” (DNI), may be candidates for procedural interventions when presenting with acute neurologic emergencies. Such interventions may limit morbidity and mortality, but typically they require MOLST reversal. We investigated outcomes of patients with MOLST reversal for treatment of neurologic emergencies.

Methods

We conducted a retrospective chart review from July 1, 2019 to April 30, 2021 of patients with MOLST reversal treated in our NeuroMedicine Intensive Care Unit. Variables collected include neurologic disease, MOLST reversal decision maker, procedural interventions, and outcomes.

Results

Twenty-seven patients (18 female, median age 78 years (IQR 73-85 years), median baseline modified Rankin score 1 [IQR 0-2.5] were identified with MOLST reversal. The most common pre-procedural MOLST was DNR/DNI (n=22, 81%), and 93% (n=25) pre-procedural MOLSTs were completed by the patient. MOLSTs were reversed by surrogates in n=23 cases (85%). The median time from MOLST completion to MOLST reversal was 603 days (IQR 45 days to 4 years). The most common neurologic emergency was ischemic stroke (n=14, 52%). Most patients died (n=14, 52%), 26% (n=7) were discharged to skilled nursing, and 22% (n=6) returned to home or assisted living.

Conclusions

In neurologic emergencies, urgent shared decision making is needed to ensure goal-concordant care, which may result in reversal of existing advanced directives. Outcomes of patients with MOLST reversal were heterogeneous, emphasizing the importance of deliberate patient-centered care weighing the risks and benefits of each intervention.
Where is Liberland? Ideology and power beyond territory
Authors: Cattaruzza Amaël
Published: June 2022

In response to James Riding and Carl Dahlman's thought-provoking article, I wish to question the link between the self-proclaimed micronation Liberland and the territory of Gornja Siga. Indeed, if we consider that the real location of Liberland is in cyberspace, and not on the small terra nullius stuck on the banks of the Danube, at the Croatian-Serbian border, the reflection refers to other ‘geographical imaginaries’, putting forward the libertarian ideology of the protagonists, and the articulation between militant networks and technologies, which make possible the emergence of this ‘private state’ without a proper territory. Would the claim of Gornja Siga be then only the territorial camouflage of a political movement ‘off-ground’?
Appraising The Evidence for Conservative versus Surgical Management of Motor Deficits in Degenerative Cervical Radiculopathy
Authors: Gebreyohanes Axumawi , Erotocritou Marios , Choi David
Published: June 2022

Study Design

Systematic review.

Objectives

Understanding the prevalence and outcome of motor deficits in degenerative cervical radiculopathy is important to guide management. We compared motor radiculopathy outcomes after conservative and surgical management, a particular focus being painful vs painless radiculopathy.

Methods

MEDLINE and EMBASE databases were searched. We stratified each study cohort into 1 of 6 groups, I–VI, based on whether radiculopathy was painful, painless or unspecified, and whether interventions were surgical or non-surgical.

Results

Of 10 514 initial studies, 44 matched the selection criteria. Whilst 42 (95.5%) provided baseline motor radiculopathy data, only 22 (50.0%) provided follow-up motor outcomes. Mean baseline prevalence of motor deficits was 39.1% (9.2%–73.3%) in conservative cohorts and 60.5% (18.5%–94.1%) in surgical cohorts. Group VI, ‘surgically-managed motor radiculopathy with unclear pain status’ had the largest number of cohorts. Conversely, no cohorts were found in Group III, ‘conservatively-managed painless motor radiculopathy’. Large disparities in data quality made direct comparison of conservative vs operative management difficult.

Conclusions

Overall pre-intervention prevalence of motor deficits in degenerative cervical radiculopathy is 56.4%. Many studies fail to report motor outcomes after intervention, meaning statistical evidence to guide optimal management of motor radiculopathy is currently lacking. Our study highlights the need for more evidence, preferably from a prospective long-term study, to allow direct comparisons of motor outcomes after conservative and surgical management.
Managing Severe Postburn Wrist Flexion Contracture by Proximal Row Carpectomy and Abdominal Interpolation Flap
Authors: Karatan Berrak , Yamak Kamil
Published: June 2022

Introduction: Postburn upper extremity contractures can greatly diminish the quality of life. To successfully manage these contractures and achieve successful functional outcomes, an optimal surgical method should be planned to address all affected tissues on the extremities. Conventional soft tissue transfers after releasing the contracture, such as skin grafts or flaps, may be insufficient. In addition to capsulotomy, tendon release, and lengthening procedures, more aggressive modalities may be indicated. Methods: In this retrospective study, patients who developed wrist flexion deformities due to burn injuries and underwent proximal row carpectomy and abdominal interpolation flaps were included. Results: Between January 2019 and June 2020, 5 patients underwent surgery using this technique. All patients were male, 2 had thermal burns, 2 had electrical burns, and 1 had chemical burns. Preoperatively, all patients had severe flexion deformities ranging from 70° to 85°. There were no postoperative complications, and stable wrists with a good and functional alignment were achieved, although the preoperative and postoperative range of motion differences were limited, where a postoperative range of motions were ranging from 5 to 15 in terms of extension, 15 to 20 in terms of flexion. Preoperative QuickDash scores were between 79.5 and 95.5, postoperative scores ranged from 25 to 36.4. Conclusion Proximal row carpectomy shortens the length of the wrist, resurfaces the wrist joint, and provides a release in tendons and other soft tissues. Together with soft tissue transfer, this technique can be used for severe wrist flexion contractures.
Using Discrete Choice Methodology to Explore the Impact of Patient Room Window Design on Hospital Choice
Authors: Woo May , Jafarifiroozabadi Roxana , MacNaughton Piers , Mihandoust Sahar , Kennedy Sara , Joseph Anjali
Published: June 2022

Evidence-based design has been fundamental to designing healthcare environments for patient outcomes and experience, yet few studies have studied how design factors drive patient choice. 652 patients who recently received care at hospitals across the United States were administered an online discrete choice survey to investigate the factors playing into their choice between hypothetical hospitals. Discrete choice models are widely used to model patient preferences among treatment alternatives, but few studies have utilized this approach to investigate healthcare design alternatives. In the current study, respondents were asked to choose between hypothetical hospitals that differed in patient room design, window features of the room, appointment availability, distance from home, insurance coverage, and HCAHPS ratings. The results demonstrate that patient room design that allowed unobscured access to daylight and views through windows, in-network insurance coverage, closer distance from home, and one-star higher patient experience rating increased the likelihood of a patient's hospital choice. The study broadly explores discrete choice model's applicability to healthcare design and its ability to quantify patient perceptions with a metric meaningful for hospital administrators.
Impact of Hydrocodone Rescheduling on Dental Prescribing of Opioids
Authors: Yan C.H. , Hubbard C.C. , Lee T.A. , Sharp L.K. , Evans C.T. , Calip G.S. , Rowan S.A. , McGregor J.C. , Gellad W.F. , Suda K.J.
Published: June 2022

Introduction:

In the United States, dentists frequently prescribe hydrocodone. In October 2014, the US Drug Enforcement Administration rescheduled hydrocodone from controlled substance schedule III to II, introducing more restricted prescribing and dispensing regulations, which may have changed dental prescribing of opioids.

Objective:

The study aim was to evaluate the impact of the hydrocodone rescheduling on dental prescribing of opioids in the United States.

Methods:

This was a cross-sectional study of opioids prescribed by dentists between October 2012 and October 2016, using the IQVIA Longitudinal Prescription Dataset. Monthly dentist-based opioid prescribing rate (opioid prescription [Rx]/1,000 dentists) and monthly average opioid dosages per prescription (mean morphine milligram equivalent per day [MME/d]) were measured in the 24 mo before and after hydrocodone rescheduling in October 2014 (index or interruption). An interrupted time-series analysis was conducted using segmented ordinary least square regression models, with Newey–West standard errors to handle autocorrelation.

Results:

Dentists prescribed 50,412,942 opioid prescriptions across the 49 mo. Hydrocodone was the most commonly prescribed opioid pre- and postindex (74.9% and 63.8%, respectively), followed by codeine (13.8% and 21.6%), oxycodone (8.1% and 9.5%), and tramadol (2.9% and 4.8%). At index, hydrocodone prescribing immediately decreased by −834.8 Rx/1,000 dentists (95% confidence interval [CI], −1,040.2 to −629.4), with increased prescribing of codeine (421.9; 95% CI, 369.7–474.0), oxycodone (85.3; 95% CI, 45.4–125.2), and tramadol (111.8; 95% CI, 101.4–122.3). The mean MME increased at index for all opioids except for hydrocodone, and dosages subsequently decreased during the postindex period.

Conclusion:

Following the rescheduling, dentist prescribing of hydrocodone declined while prescribing of nonhydrocodone opioids increased. Understanding the impact of this regulation informs strategies to ensure appropriate prescribing of opioids for dental pain.

Knowledge Transfer Statement:

The study findings can be used by policy makers to make informed decisions in developing future risk mitigation strategies aimed to regulate opioid prescribing behaviors. Furthermore, dentist-specific resources and guidelines are needed subsequent to these policies in order to meet the dental population needs.
Corrosive flows, faulty materialities: Building the brine collector in the Llobregat River Basin, Catalonia
Authors: Gorostiza Santiago , March Hug , Conde Marta , Sauri David
Published: June 2022

The history of hydraulic infrastructures is plagued with failures often with catastrophic consequences. Although the agency of water in disasters has been widely documented less well known are the substances in water such as salt that may cause infrastructural collapse and harm humans, flora and fauna. In the Llobregat River Basin (Barcelona), a 120-km long pipe transports salt-saturated wastewaters produced in the potash mines of central Catalonia to the Mediterranean Sea. Conceived as a technological fix to reduce river water salinization, the brine collector started operating in 1989 and succeeded to cut by half the concentration of salts in river waters. However, as the extraction of potash salts increased the brine collector soon reached its full capacity and became prone to leaks and ruptures that poured salt-saturated flows into the rivers and adjacent lands. Moreover, the reduction in salinity achieved was not enough to prevent the need of salt-removing technology for the drinking water plants supplying Barcelona. The brine collector understood as a sociotechnical system assembling material, discursive, organizational, and institutional components proved the fragility of rules and regulations addressed to manage salt pollution in the basin. More fundamentally, the assemblage constituted by the collector showed how the interplay between private (the mining company) and public (the regional water agency) organizations has resulted in the successful shifting of impacts created by salt from the private to the public sphere in economic, health, and environmental terms.
Relationships Between Remote Asynchronous Lectures and Summative Assessment Performance in four Pharmacotherapeutics Courses
Authors: Sedlacek Jordan , Boylan Paul M. , Perry Antonio
Published: June 2022

Background: Synchronous education describes when teaching, learning, and assessment occur concurrently and asynchronous education describes when teaching, learning, and assessment occur anytime. Remote learning is where teaching and learning occur via technological means. Objective: This report describes a remote, asynchronous learning method implemented in a 3-year, block curriculum, Doctor of Pharmacy degree program. Methods: Remote asynchronous lectures embedded with quizzes were delivered to pharmacy students at the end of their first professional year and beginning of their second professional year. Camtasia software and Screencast.com were utilized during portions of 4 pharmacotherapeutic-based courses. Students completed time-spaced quizzes embedded every 5 to 15 minutes throughout the videos and quiz scores were recorded. Discrete watches, number of total watches, and average number of video quiz questions correctly answered were examined for Spearman’s rank correlation coefficient (ρ) with end-of-course summative assessment scores. Results: There were no strong positive correlations between discrete watches, number of total watches, and average number of video quiz questions correctly answered and end-of-course assessment scores (ρ range: –0.47 to 0.25). There were weak to moderate correlations within the rheumatology and dermatology assessment scores based on the Screencast.com content questions and the number of unique video watches (ρ = 0.40), average number of total video watches (ρ = 0.28), and average percent of quiz questions correct (ρ = 0.40), all of which were statistically significant ( P < 0.05). Conclusions: Remote asynchronous lectures including time-spaced quizzes were not associated with improvements in summative assessment performance. Mild positive correlations between remote asynchronous lectures and time-spaced quizzes may correspond with discrete questions on a summative assessment but those relationships may be influenced by the content within the remote asynchronous lectures.
Aberrant EVI1 splicing contributes to EVI1-rearranged leukemia
Authors: Tanaka Atsushi , Nakano Taizo A. , Nomura Masaki , Yamazaki Hiromi , Bewersdorf Jan P. , Mulet-Lazaro Roger , Hogg Simon , Liu Bo , Penson Alex , Yokoyama Akihiko , Zang Weijia , Havermans Marije , Koizumi Miho , Hayashi Yasutaka , Cho Hana , Kanai Akinori , Lee Stanley C. , Xiao Muran , Koike Yui , Zhang Yifan , Fukumoto Miki , Aoyama Yumi , Konuma Tsuyoshi , Kunimoto Hiroyoshi , Inaba Toshiya , Nakajima Hideaki , Honda Hiroaki , Kawamoto Hiroshi , Delwel Ruud , Abdel-Wahab Omar , Inoue Daichi
Published: June 2022

Detailed genomic and epigenomic analyses of MECOM (the MDS1 and EVI1 complex locus) have revealed that inversion or translocation of chromosome 3 drives inv(3)/t(3;3) myeloid leukemias via structural rearrangement of an enhancer that upregulates transcription of EVI1. Here, we identify a novel, previously unannotated oncogenic RNA-splicing derived isoform of EVI1 that is frequently present in inv(3)/t(3;3) acute myeloid leukemia (AML) and directly contributes to leukemic transformation. This EVI1 isoform is generated by oncogenic mutations in the core RNA splicing factor SF3B1, which is mutated in >30% of inv(3)/t(3;3) myeloid neoplasm patients and thereby represents the single most commonly cooccurring genomic alteration in inv(3)/t(3;3) patients. SF3B1 mutations are statistically uniquely enriched in inv(3)/t(3;3) myeloid neoplasm patients and patient-derived cell lines compared with other forms of AML and promote mis-splicing of EVI1 generating an in-frame insertion of 6 amino acids at the 3′ end of the second zinc finger domain of EVI1. Expression of this EVI1 splice variant enhanced the self-renewal of hematopoietic stem cells, and introduction of mutant SF3B1 in mice bearing the humanized inv(3)(q21q26) allele resulted in generation of this novel EVI1 isoform in mice and hastened leukemogenesis in vivo. The mutant SF3B1 spliceosome depends upon an exonic splicing enhancer within EVI1 exon 13 to promote usage of a cryptic branch point and aberrant 3′ splice site within intron 12 resulting in the generation of this isoform. These data provide a mechanistic basis for the frequent cooccurrence of SF3B1 mutations as well as new insights into the pathogenesis of myeloid leukemias harboring inv(3)/t(3;3).