bluuebunny/crossref_metadata_2025 huggingface dataset:
Taking stock of the field of populism research: Are ideational approaches ‘moralistic’ and post-foundational discursive approaches ‘normative’?
Authors: Kim Seongcheol
Published: April 2021

This article sets out to examine two claims that have increasingly come to define the dividing lines between the ideational and the post-foundational discursive approaches to populism: namely, that the former is moralistic and the latter is normative in orientation. The article considers the conceptual merits of both critiques while using them to further examine some of the implicit assumptions and pitfalls within Cas Mudde’s and Ernesto Laclau’s paradigmatic conceptualizations of populism. It is argued that ideational scholars’ attribution of a moralistic particularity to populism runs the risk of pathologizing the latter for characteristics that are arguably constitutive of all politics, while the danger of a certain crypto-normativity can be seen in Laclau’s tendency to equate populism with the political and simultaneously emphasize its emancipatory effects. The key difference between the two approaches ultimately consists in the location that they assign to populism within the wider topography of politics itself.
Examining online health community users’ sharing behaviour: A social influence perspective
Authors: Zhou Tao
Published: April 2021

Online health communities (OHC) provide a platform for users to exchange health-related information and seek emotional support. However, users often lack the intention to share their knowledge, which may lead to the failure of OHC. Drawing on the social influence theory, this research examined OHC users’ sharing behaviour. The results indicated that users’ sharing intention is influenced by three social influence factors, which include subjective norm, social identity and group norm. In addition, social support and privacy concern have effects on these three social influence factors. The results imply that OHC need to leverage social influence in order to facilitate users’ sharing behaviour.
Three Continents, Two Fathers, One Donor: A Non-Puerperal Relactation Case Study
Authors: Lopez-Bassols Indira , Duke Lara Olchanetzky , Subramaniam Gayle
Published: April 2021

Introduction

A woman was able to relactate 7 years after breastfeeding her children. She donated her expressed milk to her friends, a same-sex male couple, who had a child through surrogacy in the United States. She lived in London and shipped her milk to Hong Kong, where they lived. The infant thrived on the donated expressed milk received during the first 3 months of his life.

Main issue

This case is unusual because the woman was not breastfeeding at the time, which would have made expressing easier, and she was not adopting. She consulted a National Childbirth Trust Breastfeeding Counsellor and an International Board Certified Lactation Consultant® who helped her explore non-puerperal relactation protocols.

Management

Her plan started 6 months before the birth and included the use of domperidone, frequent expressing by hand and with a hospital-grade pump. A breastfeeding specialist physician made suggestions on the dosage of domperidone. She donated a total of 35.06 L. She had the full support of her partner and family.

Conclusion

Non-puerperal induced lactation and relactation offer ways to make human milk accessible to all infants, particularly those from LGBTQ+ families in which no parent is lactating, as was the case with the same-sex male couple participating in this study. It is essential to disseminate the knowledge and skills needed to support non-puerperal induced lactation and relactation among all healthcare professionals involved.
Time–frequency analysis of the interaction mechanism between European carbon and crude oil markets
Authors: Wu Yaqi , Zhang Chen , Yun Po , Zhu Dandan , Cao Wei , Wagan Zulfiqar Ali
Published: April 2021

The joint behavior of internal and external system brings out a high complexity of the carbon and oil price interactions, such as non-linearity and multi-frequency. This paper innovatively proposed a time-frequency mechanism between carbon and oil markets from the two aspects of internal system and external factors, and introduced a novelty partial wavelet analytics to explore their dynamic multi-scale interactions. We selected the European carbon and Brent oil futures prices data from March 2009 to December 2020, with the consideration of several necessary control variables from the external surroundings. Our findings point to a stable and strong in-phase relationship between the two markets, with oil leading at medium and lower frequencies. However, the mutual leading relationships are especially sensitive during abnormal political events and periods of financial recession and global emergency, which are observed at different periods for intermediate horizons. What is more, the interactions are more diversified and feebler at short-timescale. Under the vision of carbon neutrality, these evidences provide invaluable guidance for regulators to structure a more flexible adjusting mechanism for the risk control of carbon markets, and also help investors to hedge risk aimed at different time horizons.
Moral distress among nurses: A mixed-methods study
Authors: Prompahakul Chuleeporn , Keim-Malpass Jessica , LeBaron Virginia , Yan Guofen , Epstein Elizabeth G
Published: April 2021

Background:

Moral distress is recognized as a problem affecting healthcare professionals globally. Unaddressed moral distress may lead to withdrawal from the moral dimensions of patient care, burnout, or leaving the profession. Despite the importance, studies related to moral distress are scant in Thailand.

Objective:

This study aims to describe the experience of moral distress and related factors among Thai nurses.

Design:

A convergent parallel mixed-methods design was used. The quantitative and qualitative data were collected in parallel using the Measure of Moral Distress for Healthcare Professionals and interview guide. The analysis was conducted separately and then integrated.

Participants:

Participants were Thai nurses from two large tertiary care institutions in a Southern province of Thailand.

Ethical considerations:

This study was approved by our organization's Institutional Review Board for Health Sciences Research, and by the Institutional Review Boards of the two local institutions in Thailand. Permission from the publisher was received to translate and utilize the Measure of Moral Distress (MMD-HP) under the license number: 4676990097151.

Results:

A total of 462 participants completed the survey questions. The top 7 causes of moral distress were related to system-level root causes and end-of-life care situations. Hierarchical multiple regression showed that work units, considering leaving position, and number of moral distress episodes in the past year were significant predictors of moral distress. Twenty interviews demonstrated three main themes of distressing causes: (1) powerlessness (at patients/family-, team-, and organizational-levels), (2) end-of-life issues, and (3) poor team function (poor communication and collaboration, incompetent healthcare providers, and inappropriate behavior of colleagues). The integration of data from both components indicated that the qualitative interviews enrich the quantitative findings, especially as related to the top 7 causes of moral distress.

Discussion:

Although the experience of moral distress among Thai nurses is similar to studies conducted elsewhere, the patient’s and family’s religious perspective that ties into the concept of moral distress needs to be explored.

Conclusions:

Although the root causes of moral distress are similar among different cultures, the experience of Thai nurses may vary according to culture and context.
Barriers and Solutions to Passing State Legislation to Protect the Rights of Parents With Disabilities: Lessons From Interviews With Advocates, Attorneys, and Legislators
Authors: Albert Sasha M. , Powell Robyn M. , Rubinstein Jack
Published: April 2021

Parents with disabilities experience discrimination within the child welfare, family law, and adoption and foster care systems. In response, there have been increasing calls for states to pass legislation prohibiting discrimination against parents with disabilities, and as of 2020, 28 states have passed or are considering such legislation. This qualitative study explored the perspectives of 19 advocates, attorneys, and legislators on barriers and solutions for passing legislation to protect the rights of parents with disabilities. Participants identified three barriers: (a) legislators’ pejorative attitudes toward parents with disabilities, (b) external opposition, and (c) legislative barriers. Participants also identified eight solutions: (a) cross-disability advocacy, (b) education, (c) relationship-building, (d) bipartisanship, (e) support from state and national organizations, (f) strong sponsors, (g) incrementalism, and (h) model legislation. Study findings should help to inform ongoing legislative advocacy to protect the rights of parents with disabilities.
The Reliability and Validity of the Lifespan Sibling Relationship Scale (LSRS) With an English-Speaking Young Adult Sample
Authors: Gungordu Nahide , Hernandez-Reif Maria , Choi Youn-Jeng , Walker David-Ian
Published: April 2021

The Lifespan Sibling Relationship Scale (LSRS) is the most comprehensive self-report questionnaire available to evaluate the quality of sibling relationships based on feelings, behaviors, and opinions across child and adult periods of development. To the best of our knowledge, the psychometric properties of the LSRS have not been assessed or reported in an English-speaking population since this assessment tool was introduced 20 years ago. The current study examined the internal reliability and construct validity of the LSRS with a sample of 370 young adults living in the United States. Results indicated that the original six-factor model of the LSRS is plausible with minor modifications to measure the sibling relationship quality and with its close correlation between factors and scales.
A Novel Participant-Empowered Pedagogical Approach to Engage and Retain Control Group Participants in Arts-Based Randomized Controlled Trials
Authors: Matto Holly C. , Ihara Emily S. , Tompkins Catherine , McNeil Kathryn , Lopez-Piper Adriana , Eber Maxine , Dhokai Niyati , Davis Rick , Cortes Nelson , Caswell Shane V. , Coogan Sarah M. , Fauntroy Victoria , Glass Elizabeth , Baraniecki-Zwil Gwen , Ambegaonkar Jatin P.
Published: April 2021

The overall purpose of this randomized controlled trial (RCT) was to examine the effect of arts classes (ballroom dance and ukulele) on older adults’ well-being compared with a social conversation control group. This article describes a novel participant-empowered pedagogical approach to enhance control group retention and engagement. Sixty-four participants ( M = 71 years) participated twice weekly in a 10-week intervention that included ballroom dancing ( n = 23), ukulele playing ( n = 17), and social conversation ( n = 24). Focus group themes revealed participants felt challenged as they crossed their comfort zones, increased confidence, and enhanced social connections. Community-engaged arts programs for older adults should further examine mechanisms that foster positive social connections during sessions, paying special attention to the design of the control group condition in RCTs where competing arts-based intervention groups may be more desirable to participants.
Starting Small: A Descriptive Case Study of Principal Competencies That Support the PreK-K-3 Continuum
Authors: Garrity Sarah M. , Bridi Julia , Kotas Jaqueline , Gianzero Gina
Published: April 2021

Research and theory suggests that children and families are best served by a preschool to third grade approach (PreK−3) to early childhood education that is aligned, integrated, and based on developmentally appropriate practice. Because of the recent expansion of publicly funded preschool programs, principals are becoming increasingly responsible for overseeing these programs, and, as instructional leaders, play a critical role in establishing working conditions and creating organizational capacity to support teachers’ professional growth. Unfortunately, however, early childhood education is rarely addressed in principal preparation programs and principals are often unfamiliar with the science of child development. Using a qualitative case study design, the current study describes how one school principal began to lead a PreK−3 community at her school by examining data collected across a two-year period as the principal led a professional learning community with preschool, transitional kindergarten, and kindergarten teachers. The PreK−3 Learning Communities Competencies for Effective Principals developed by the National Association of Elementary School Principals were used to identify the thoughts, behaviors, and actions of one principal as she engaged in this work. Results from this study further discourse in the field as to what this approach looks like in practice and call attention to the need for structural changes in preschool and elementary settings.
Normative Distribution of First Metatarsal Axial Rotation
Authors: Steadman Jesse , Bakshi Neil , Arena Christopher , Leake Richard , Barg Alexej , Saltzman Charles L.
Published: April 2021

Background:

First metatarsal (M1) axial rotation is recognized as a clinically relevant component of hallux valgus deformity. Methods to realign the M1 in 3 dimensions have been developed. One goal of these operations is to restore normal rotation of the first ray. The aim of this study is to provide estimates for the normal distribution of M1 rotation in patients without relevant anatomic pathology.

Methods:

Using stringent clinical and radiographic criteria, we evaluated a set of plain radiograph and weightbearing computed tomography (WBCT) images of 62 feet from a consecutive patient database. Subjects included had normal foot alignment without bunion symptoms. M1 rotation of each foot was measured using 2 unique methods (Saltzman et al and Kim et al methods). Measurement of rotation was performed by 2 observers from coronal WBCT images. Mean values and confidence intervals (CIs) of M1 rotation were calculated for each method. Inter- and intraobserver reliability values were also reported.

Results:

Mean M1 rotation values of 2.1 degrees (95% CI: 0.9-3.4) and 6.1 degrees (95% CI: 4.4-7.8) were identified using the Saltzman et al and Kim et al methods, respectively. Inter- and intraobserver reliability values were interpreted as excellent for both methods.

Conclusion:

In this study, we describe the natural distribution of the M1 axial rotation in subjects without bunion or other identifiable bony foot deformities. This information should provide a normative reference for surgeons correcting rotational issues of the first metatarsal.

Level of Evidence:

Level III, retrospective cohort study.
The Prevalence and Associated Factors of Cancer Screening Uptake Among a National Population-Based Sample of Adults in Marshall Islands
Authors: Pengpid Supa , Zhang Chao , Peltzer Karl
Published: April 2021

Background:

The study aimed to estimate the prevalence and associated factors of cancer screening among men and women in the general population in Marshall Islands.

Methods:

The national cross-sectional sub-study population consisted of 2,813 persons aged 21-75 years (Median = 37.4 years) from the “2017/2018 Marshall Islands STEPS survey”. Information about cancer screening uptake included Pap smear or Vaginal Inspection with Acetic Acid (=VIA), clinical breast examination, mammography, faecal occult blood test (FOBT), and colonoscopy.

Results:

The prevalence of past 2 years mammography screening was 21.7% among women aged 50-74 years, past year CBE 15.9% among women aged 40 years and older, past 3 years Pap smear or VIA 32.6% among women 21-65 years, past year FOBT 21.8% among women and 22.3% among men aged 50-75 years, and past 10 years colonoscopy 9.1% among women and 7.3% among men aged 50-75 years. In adjusted logistic regression, cholesterol screening (AOR: 1.91, 95% CI: 1.07-3.41) was associated with past 2 years mammography screening among women aged 50-74 years. Blood pressure screening (AOR: 2.39, 95% CI: 1.71-3.35), glucose screening (AOR: 1.59, 95% CI: 1.13-2.23), dental visit in the past year (AOR: 1.51, 95% CI: 1.17, 1.96), binge drinking (AOR: 1.88, 95% CI: 1.07-3.30), and 2-3 servings of fruit and vegetable consumption a day (AOR: 1.42, 95% CI: 1.03-1.95) were positively and high physical activity (30 days a month) (AOR: 0.56, 95% CI: 0.41-0.76) was negatively associated with Pap smear or VIA screening among women aged 21-65 years. Higher education (AOR: 2.58, 95% CI: 1.02-6.58), and cholesterol screening (AOR: 2.87, 95% CI: 1.48-5.59), were positively and current smoking (AOR: 0.09, 95% CI: 0.01-0.65) was negatively associated with past 10 years colonoscopy uptake among 50-75 year-olds.

Conclusion:

The study showed a low cancer screening uptake, and several factors were identified that can assist in promoting cancer screening in Marshall Islands.
Foregrounding Backgrounds: How Scientists Conceive Art to Express the Invisible
Authors: Parks Perry , White Linda
Published: April 2021

Scientist-artist collaborations have become a high-profile form of science communication as scientists seek creative ways to connect with publics. This qualitative case study examines one such collaboration from the perspective of scientist and artist participants’ experiences with the purpose and meaning of art. To do so, we draw on John Dewey’s concept of art as experience and Nigel Thrift and other nonrepresentational theorists’ emphasis on overlooked backgrounds that suffuse daily life. We find that sci-art creators see inherent beauty in research, seek to foreground their underappreciated objects of study, and harbor mostly instrumental goals for educating publics through their artwork.
Splanchnic Vein Thrombosis in Acute Pancreatitis and Its Consequences
Authors: Nawacki Łukasz , Matykiewicz Jarosław , Stochmal Ewa , Głuszek Stanisław
Published: April 2021

Splanchnic vein thrombosis (SVT) is a serious vascular complication that can occur in patients with acute pancreatitis. We assessed the incidence of SVT and its relationship with acute pancreatitis (AP) and associated complications. We carried out a retrospective analysis of medical histories from patients hospitalized with AP in a single surgical center. Histories were acquired from patients with abdominal and pelvic computed tomography scans performed between the 2nd and 3rd day of hospitalization. We assessed the impact and extent of thrombosis over the disease course. We found a strong positive correlation (Cramer’s V coefficient = 0.34) between SVT and disease severity. Mortality in the study group was 7.2% (8 patients) of which 5 patients (62.5%) were diagnosed with SVT. We observed an increased incidence of death among patients with thrombosis, with results approaching significance ( P = 0.056). In our study, we found that SVT has a negative effect on the course of AP and is associated with more severe disease and increased mortality.
Cooperative-game-theoretic optimal robust path tracking control for autonomous vehicles
Authors: Hu Zhanyi , Huang Jin , Yang Zeyu , Zhong Zhihua
Published: April 2021

Modeling uncertainties are a major concern in vehicle path tracking control. As a practical engineering system, the uncertainties in vehicle lateral dynamics can be time-varying while bounded and have certain distributions wherein. The fuzzy set theory can effectively describe system uncertainties in terms of boundary and distribution. Contrary to fuzzy logic-based approaches, this article puts forward an explicit multiparameter optimal robust control law to ensure the uniform boundedness and ultimate uniform boundedness of the closed-loop path tracking dynamical system. Then, the tracking performance as well as the control cost is quantified as cost functions using fuzzy set theories. Finally, an optimization problem is established in the content of cooperative game to seek the optimal values for the tunable parameters. Simulations are conducted using CarSim and Simulink under double lane change and serpentine driving conditions. The results show that the proposed robust optimal control exhibits superior tracking performance.
Curating the urban music festival: Festivalisation, the ‘shuffle’ logic, and digitally-shaped music consumption
Authors: Nunes Paulo , Birdsall Carolyn
Published: April 2021

In recent years, music festivals have grown in significance within local cultural policy, city branding and tourism agendas. Taking the Mexefest festival in Lisbon as a case in point, this article asks how, in the digital streaming era, music festivals in urban environments are framed, curated and experienced. Drawing on ethnographic fieldwork, our analysis examines how music festival programmers curate the urban festival experience, for both locals and tourists alike. First, we identify the emergence of urban music festivals in recent decades, and how modern festival programmes have adopted the cultural technique of the ‘shuffle mode’ as an influential principle. Second, we investigate the work of festival programmers through the lens of ‘cultural intermediaries’, and ask how their programming strategies, particularly through digital mobile media (such as music playlists), contribute to an aestheticised experience of the city during the festival. Third, we focus on how the Mexefest festival events are staged in tandem with brand activation by sponsors like mobile phone company Vodafone and their radio station Vodafone FM. In doing so, we highlight the participation of festival-goers through their embodied engagements with digital media, music listening and urban space, and evaluate the heuristic value of ‘shuffle curation’ as a tool for the understanding of music festivals as a distinctly global and networked form of leisure consumption in urban culture.
Shear response of steel fiber reinforced recycled concrete-filled steel tube columns
Authors: Liu Zhenzhen , Lu Yiyan , Li Shan , Liao Jiancong
Published: April 2021

A comprehensive study of the shear characteristics of steel fiber reinforced recycled concrete-filled steel tube (SRCFST) columns is conducted. 50 CFST stub columns are tested with the variables of steel tube diameter-thickness ratio ( D/t), shear span-to-depth ratio (λ), axial compression ratio ( n), and concrete mix. Two types of cements, three recycled aggregate percentages, three water-cement ratios, and three steel fiber contents are considered in design of concrete mixes. The experimental results show that SRCFST columns present the coincident shear behavior of the ordinary CFST columns. As λ is increased, shear resistance shows a downtrend, while the flexural strength presents an increasing trend. Imposing axial compression or thickening steel tube contributes to an adequate safety margin in plastic period. Based on the contributions superposition method, a predicted model of the shear capacity of SRCFST columns is proposed in consideration of shear-span ratio, axial compression, and self-stress.
Optimal three-dimensional design of functionally graded parts for additive manufacturing using Tamura–Tomota–Ozawa model
Authors: Nayak Priyambada , Armani Amir
Published: April 2021

Although some conventional manufacturing technologies are capable of producing functionally graded materials, only a few additive manufacturing processes are able to build functionally graded materials with complex distribution of material composition. To exploit this unique advantage, we have developed a new methodology capable of optimization of material distribution for three-dimensional parts for any given conditions. Representation of material distribution was done through a new technique by extending the nonuniform rational basis spline surfaces to four-dimensional space. Mori–Tanaka, Levin, and Tamura–Tomota–Ozawa models were employed for the estimation of effective material properties of functionally graded structures. Subroutines were developed in a commercial finite element software to enable the analysis of parts made from functionally graded material. A constrained particle swarm optimization method was selected and implemented to optimize the material composition distribution taking into account the additive manufacturing limitations. As a case study, the material distribution optimization of a functionally graded femur bone plate under thermomechanical loading was considered. The objective was to maximize the safety factor; i.e. the ratio of local yield strength of the functionally graded plate over the von Mises stress. The results showed significant improvement compared to nonoptimal part and demonstrated the efficacy of the proposed methodology.
What asylum and refugee policies do Europeans want? Evidence from a cross-national conjoint experiment
Authors: Jeannet Anne-Marie , Heidland Tobias , Ruhs Martin
Published: April 2021

The protection of asylum seekers and refugees has become one of the most politically divisive issues in the European Union, yet there has been a lack of research on public preferences for asylum and refugee policies. This article analyzes which policies Europeans prefer and why. We advance a theoretical framework that explains how asylum and refugee policies that use limits and conditions enable individuals to resolve conflicting humanitarian and perceived national interest logics. Using an original conjoint experiment in eight countries, we demonstrate that Europeans prefer policies that provide refugee protection but also impose control through limits or conditions. In contrast to the divisive political debates between European Union member states, we find consistent public preferences across European countries.
A novel data-driven method for structural health monitoring under ambient vibration and high-dimensional features by robust multidimensional scaling
Authors: Entezami Alireza , Sarmadi Hassan , Salar Masoud , De Michele Carlo , Arslan Ali Nadir
Published: April 2021

Dealing with the problem of large volumes of high-dimensional features and detecting damage under ambient vibration are critical to structural health monitoring. To address these challenges, this article proposes a novel data-driven method for early damage detection of civil engineering structures by robust multidimensional scaling. The proposed method consists of some simple but effective computational parts including a segmentation process, a pairwise distance calculation, an iterative algorithm regarding robust multidimensional scaling, a matrix vectorization procedure, and a Euclidean norm computation. AutoRegressive Moving Average models are fitted to vibration time-domain responses caused by ambient excitations to extract the model residuals as high-dimensional features. In order to increase the reliability of damage detection and avoid any false alarm, the extreme value theory is considered to determine a reliable threshold limit. However, the selection of an appropriate extreme value distribution is crucial and troublesome. To cope with this limitation, this article introduces the generalized extreme value distribution and its shape parameter for choosing the best extreme value model among Gumbel, Fréchet, and Weibull distributions. The main contributions of this article include developing a novel data-driven strategy for early damage detection and addressing the limitation of using high-dimensional features. Experimental data sets of two well-known civil structures are utilized to validate the proposed method along with some comparative studies. Results demonstrate that the proposed data-driven method in conjunction with the extreme value theory is highly able to detect damage under ambient vibration and high-dimensional features.
Developing Community-Based Mentorship: Supporting Health Science Training in Historically Marginalized Communities
Authors: Elias Thistle I. , Thompson Jessica R. , Boak Brandi , Cannon Joy
Published: April 2021

Community mentors can play a unique and critical role in developing and supporting graduate and health professional student learning in underresourced community-based settings. These mentors can benefit from extra preparation for a potentially unfamiliar role as teachers about complex social and structural challenges faced by the populations with which they work. Encouraging mentors to recognize and share their valuable expertise while developing their teaching skills can (1) improve mentors’ abilities to work effectively with graduate-level and health science students from multiple disciplines, (2) bolster student learning about important historical social and structural determinants of participants’ health, and (3) help students understand the broader context within which organizations serving vulnerable populations operate. As such, in one full-time, community-engaged, interdisciplinary practicum program, Bridging the Gaps-Pittsburgh, part of the multiinstitutional Bridging the Gaps Network, a half-day mentor workshop has been required for two decades for new community mentors to develop their capacity to be community-based teachers of largely graduate-level health science students. Additionally, program staff aim to support mentors and connect them to faculty and community resources in a variety of ways. Our model supports the argument that applied learning by health professional students in community settings can be significantly enhanced through building and supporting the capacity of community mentors to act as recognized teachers in areas of community expertise.
Conservative Surgery for Diabetic Foot Osteomyelitis is not Associated With Longer Survival Time Without Recurrence of Foot Ulcer When Compared With Amputation
Authors: Aragón-Sánchez Javier , Víquez-Molina Gerardo , López-Valverde María E. , Rojas-Bonilla José M. , Murillo-Vargas Christian
Published: April 2021

Conservative surgery of diabetic foot osteomyelitis (DFO) in which bone infection is removed without amputation could minimize the biomechanical changes associated with foot surgery. We hypothesize that patients who undergo conservative surgery will have a longer survival time without recurrence of foot ulcers and further amputations than those who undergo any type of amputation to treat DFO. We assessed a retrospective cohort of 108 patients who underwent surgery for DFO from January 2011 to December 2012. Patients were followed-up until May 2020. Reulceration and reamputation-free survival times were plotted using the Kaplan–Meier method and were calculated from the date of first surgery to recurrence, new amputation, or end of the study. A stratified log rank was used to study differences among groups. Cumulative survival without recurrences at 1, 5, and 8 years was 95%, 36%, and 29%, respectively, in patients who underwent conservative surgery and 95%, 43%, and 30%, respectively, in those undergoing amputation. Cumulative survival without a new amputation at 1, 5, and 8 years was 100%, 80%, and 80%, respectively, in patients who underwent conservative surgery and 98%, 82%, and 69%, respectively, in those undergoing amputation. No differences were found regarding either recurrence (log rank, P = .98) or new amputations (log rank, P = .64). In conclusion, conservative surgery is as safe as amputation to arrest bone infection in the feet of patients with diabetes. Conservative surgery was not associated with a lower rate of recurrence and new amputations than those patients who underwent amputations.
Humoral immune response to COVID-19 mRNA vaccine in patients with multiple sclerosis treated with high-efficacy disease-modifying therapies
Authors: Achiron Anat , Mandel Mathilda , Dreyer-Alster Sapir , Harari Gil , Magalashvili David , Sonis Polina , Dolev Mark , Menascu Shay , Flechter Shlomo , Falb Rina , Gurevich Michael
Published: April 2021

Background and Aims:

The National Multiple Sclerosis Society and other expert organizations recommended that all patients with multiple sclerosis (MS) should be vaccinated against COVID-19. However, the effect of disease-modifying therapies (DMTs) on the efficacy to mount an appropriate immune response is unknown. We aimed to characterize humoral immunity in mRNA-COVID-19 MS vaccinees treated with high-efficacy DMTs.

Methods:

We measured SARS-CoV-2 IgG response using anti-spike protein-based serology (EUROIMMUN) in 125 MS patients vaccinated with BNT162b2-COVID-19 vaccine 1 month after the second dose. Patients were either untreated or under treatment with fingolimod, cladribine, or ocrelizumab. A group of healthy subjects similarly vaccinated served as control. The percent of subjects that developed protective antibodies, the titer, and the time from the last dosing were evaluated.

Results:

Protective humoral immunity of 97.9%, 100%, 100%, 22.7%, and 3.8%, was observed in COVID-19 vaccinated healthy subjects ( N = 47), untreated MS patients ( N = 32), and MS patients treated with cladribine ( N = 23), ocrelizumab ( N = 44), and fingolimod ( N = 26), respectively. SARS-CoV-2 IgG antibody titer was high in healthy subjects, untreated MS patients, and MS patients under cladribine treatment, within 29.5–55 days after the second vaccine dose. Only 22.7% of patients treated with ocrelizumab developed humoral IgG response irrespective to normal absolute lymphocyte count. Most fingolimod-treated MS patients had very low lymphocyte count and failed to develop SARS-COV-2 antibodies. Age, disease duration, and time from the last dosing did not affect humoral response to COVID-19 vaccination.

Conclusions:

Cladribine treatment does not impair humoral response to COVID-19 vaccination. We recommend postponing ocrelizumab treatment in MS patients willing to be vaccinated as a protective humoral response can be expected only in some. We do not recommend vaccinating MS patients treated with fingolimod as a protective humoral response is not expected.
Psychological Capital, Positive Affect, and Organizational Outcomes
Authors: Da Shu , Zhu Ze , Cen Hongyu , Gong Xianmin , Siu Oi Ling , Zhang Xichao
Published: April 2021

Psychological capital (PsyCap) is a higher-order construct comprising hope, efficacy, optimism, and resiliency, which has attracted more and more attention from both academics and practitioners. Despite promising progress made in the PsyCap literature, the underlying mechanisms linking PsyCap to organizational outcomes still need more investigation utilizing longitudinal research design. Moreover, the reciprocal relationships between PsyCap and positive affect require more attention. Therefore, we aim to test the central role of positive affect in the relationships between PsyCap and affective organizational commitment (AOC) on one hand and organizational citizenship behaviour toward organization (OCBO) on the other hand as well as the reciprocal relationships between PsyCap and positive affect in this study. A three-wave longitudinal survey was conducted using a cross-lagged panel design with a one-month time lag between two consecutive waves. Panel data was collected from 208 workers in Beijing, China. The results support the hypothesis that positive affect serves as a mediator in the relationships between PsyCap and OCBO. Moreover, we also find some support for a reciprocal relationship between PsyCap and positive affect. The theoretical and practical implications of the findings are also discussed.
Applications of Machine Learning to Imaging of Spinal Disorders: Current Status and Future Directions
Authors: Merali Zamir A. , Colak Errol , Wilson Jefferson R.
Published: April 2021

Study Design:

Narrative review.

Objectives:

We aim to describe current progress in the application of artificial intelligence and machine learning technology to provide automated analysis of imaging in patients with spinal disorders.

Methods:

A literature search utilizing the PubMed database was performed. Relevant studies from all the evidence levels have been included.

Results:

Within spine surgery, artificial intelligence and machine learning technologies have achieved near-human performance in narrow image classification tasks on specific datasets in spinal degenerative disease, spinal deformity, spine trauma, and spine oncology.

Conclusion:

Although substantial challenges remain to be overcome it is clear that artificial intelligence and machine learning technology will influence the practice of spine surgery in the future.
Recoup From Home? Comparison of Relative Cost Savings for ACDF, Lumbar Discectomy, and Short Segment Fusion Performed in the Inpatient Versus Outpatient Setting
Authors: Mikhail Christopher M. , Echt Murray , Selverian Stephen R. , Cho Samuel K.
Published: April 2021

Study Design:

Broad narrative review.

Objective:

To review and summarize the current literature on the cost efficacy of performing ACDF, lumbar discectomy and short segment fusions of the lumbar spine performed in the outpatient setting.

Methods:

A thorough review of peer- reviewed literature was performed on the relative cost-savings, as well as guidelines, outcomes, and indications for successfully implementing outpatient protocols for routine spine procedures.

Results:

Primary elective 1-2 level ACDF can be safely performed in most patient populations with a higher patient satisfaction rate and no significant difference in 90-day reoperations and readmission rates, and a savings of 4000 to 41 305 USD per case. Lumbar discectomy performed through minimally invasive techniques has decreased recovery times with similar patient outcomes to open procedures. Performing lumbar microdiscectomy in the outpatient setting is safe, cheaper by as much as 12 934 USD per case and has better or equivalent outcomes to their inpatient counterparts. Unlike ACDF and lumbar microdiscectomy, short segment fusions are rarely performed in ASCs. However, with the advent of minimally invasive techniques paired with improved pain control, same-day discharge after lumbar fusion has limited clinical data but appears to have potential cost-savings up to 65-70% by reducing admissions.

Conclusion:

Performing ACDF, lumbar discectomy and short segment fusions in the outpatient setting is a safe and effective way of reducing cost in select patient populations.
Spine Instrumented Surgery on a Budget—Tools for Lowering Cost Without Changing Outcome
Authors: Eli Ilyas , Whitmore Robert G. , Ghogawala Zoher
Published: April 2021

Study Design:

Review article.

Objectives:

There have been substantial increases in the utilization of complex spinal surgery in the last 20 years. Spinal instrumented surgery is associated with high costs as well as significant variation in approach and care. The objective of this manuscript is to identify and review drivers of instrumented spine surgery cost and explain how surgeons can reduce costs without compromising outcome.

Methods:

A literature search was conducted using PubMed. The literature review returned 217 citations. 27 publications were found to meet the inclusion criteria. The relevant literature on drivers of spine instrumented surgery cost is reviewed.

Results:

The drivers of cost in instrumented spine surgery are varied and include implant costs, complications, readmissions, facility-based costs, surgeon-driven preferences, and patient comorbidities. Each major cost driver represents an opportunity for potential reductions in cost. With high resource utilization and often uncertain outcomes, spinal surgery has been heavily scrutinized by payers and hospital systems, with efforts to reduce costs and standardize surgical approach and care pathways.

Conclusions:

Education about cost and commitment to standardization would be useful strategies to reduce cost without compromising patient-reported outcomes after instrumented spinal fusion.
Diagnosing Urothelial Carcinoma from Delirium: A Near Miss
Authors: Chen Pauline , Korah Tessy
Published: April 2021

Urinary tract infection (UTI) is a common cause of delirium in the elderly. Although diagnosis of delirium secondary to UTI is relatively straightforward, a lack of thorough investigation could result in missing underlying factors and medical conditions that may require immediate clinical/surgical intervention. Case of a 77-year-old male with delirium diagnosis and multiple psychiatric hospital admissions is reported here. This patient with multiple medical disorders and anxiety was admitted to psychiatric facilities on three different occasions with multiple psychiatric diagnoses including delirium. After a month of hospital stay and thorough medical and radiological examinations, the cause of refractory delirium was identified as multifactorial including urothelial carcinoma. Although UTI and urinary retention are common in the elderly, this case shows the importance of multifactorial diagnoses in cases of prolonged or refractory delirium to avoid delays in appropriate treatment.
Real-world use of thrombopoietin receptor agonists in older patients with primary immune thrombocytopenia
Authors: Palandri Francesca , Rossi Elena , Bartoletti Daniela , Ferretti Antonietta , Ruggeri Marco , Lucchini Elisa , Carrai Valentina , Barcellini Wilma , Patriarca Andrea , Rivolti Elena , Consoli Ugo , Cantoni Silvia , Oliva Esther Natalie , Chiurazzi Federico , Caocci Giovanni , Giuffrida Gaetano , Borchiellini Alessandra , Auteri Giuseppe , Baldacci Erminia , Carli Giuseppe , Nicolosi Daniela , Sutto Emanuele , Carpenedo Monica , Cavo Michele , Mazzucconi Maria Gabriella , Zaja Francesco , De Stefano Valerio , Rodeghiero Francesco , Vianelli Nicola
Published: April 2021

The efficacy and safety of thrombopoietin receptor agonists (TRAs) in older patients with primary immune thrombocytopenia (ITP) are unknown. We investigated TRA response and switch, thrombotic/hemorrhagic risk, and sustained responses off-treatment (SROTs) in 384 patients with ITP aged ≥60 years. After 3 months, 82.5% and 74.3% of eltrombopag- and romiplostim-treated patients, respectively, achieved a response; 66.7% maintained the response (median follow-up, 2.7 years). Eighty-five (22.2%) patients switched to the alternative TRA; although no cross-toxicity was observed, 83.3% of resistant patients had a response after the switch. Thirty-four major thromboses (3 fatal) and 14 major hemorrhages (none fatal) occurred in 18 and 10 patients, respectively, while on TRAs and were associated with thrombosis history (subdistribution hazard ratio, 2.04, P = .05) and platelet count <20 × 109/L (subdistribution hazard ratio, 1.69; P = .04), respectively, at TRA start. A recurrent event occurred in 15.6% of patients surviving thrombosis, in all cases but 1 during persisting TRA treatment (incidence rate, 7.7 per 100 patient-years). All recurrences occurred in the absence of adequate antithrombotic secondary prophylaxis. Sixty-two (16.5%) responding patients discontinued TRAs; 53 (13.8%) patients maintained SROTs, which were associated with TRA discontinuation in complete response (P < .001). Very old age (≥75 years; 41.1%) was associated with the more frequent start of TRAs in the persistent/acute phase but not with response or thrombotic/hemorrhagic risk. TRAs are effective in older patients with ITP, with no fatal hemorrhages and with SROTs in a significant portion of patients. Caution is warranted in patients with a history of thrombosis, and a careful risk/benefit balance should be considered.
Transcriptome analysis reveals gene responses to herbicide, tribenuron methyl, in Brassica napus L. during seed germination
Authors: Wang Liuyan , Wang Ruili , Lei Wei , Wu Jiayi , Li Chenyang , Shi Hongsong , Meng Lijiao , Yuan Fang , Zhou Qingyuan , Cui Cui
Published: April 2021

Background

Tribenuron methyl (TBM) is an herbicide that inhibits sulfonylurea acetolactate synthase (ALS) and is one of the most widely used broad-leaved herbicides for crop production. However, soil residues or drifting of the herbicide spray might affect the germination and growth of rapeseed, Brassica napus, so it is imperative to understand the response mechanism of rape to TBM during germination. The aim of this study was to use transcriptome analysis to reveal the gene responses in herbicide-tolerant rapeseed to TBM stress during seed germination.

Results

2414, 2286, and 1068 differentially expressed genes (DEGs) were identified in TBM-treated resistant vs sensitive lines, treated vs. control sensitive lines, treated vs. control resistant lines, respectively. GO analysis showed that most DEGs were annotated to the oxidation-reduction pathways and catalytic activity. KEGG enrichment was mainly involved in plant-pathogen interactions, α-linolenic acid metabolism, glucosinolate biosynthesis, and phenylpropanoid biosynthesis. Based on GO and KEGG enrichment, a total of 137 target genes were identified, including genes involved in biotransferase activity, response to antioxidant stress and lipid metabolism. Biotransferase genes, CYP450, ABC and GST, detoxify herbicide molecules through physical or biochemical processes. Antioxidant genes, RBOH, WRKY, CDPK, MAPK, CAT, and POD regulate plant tolerance by transmitting ROS signals and triggering antioxidant enzyme expression. Lipid-related genes and hormone-related genes were also found, such as LOX3, ADH1, JAZ6, BIN2 and ERF, and they also played an important role in herbicide resistance.

Conclusions

This study provides insights for selecting TBM-tolerant rapeseed germplasm and exploring the molecular mechanism of TBM tolerance during germination.
BdERECTA controls vasculature patterning and phloem-xylem organization in Brachypodium distachyon
Authors: Sakai Kaori , Citerne Sylvie , Antelme Sébastien , Le Bris Philippe , Daniel Sylviane , Bouder Axelle , D’Orlando Angelina , Cartwright Amy , Tellier Frédérique , Pateyron Stéphanie , Delannoy Etienne , Laudencia-Chingcuanco Debbie , Mouille Gregory , Palauqui Jean Christophe , Vogel John , Sibout Richard
Published: April 2021

Background

The vascular system of plants consists of two main tissue types, xylem and phloem. These tissues are organized into vascular bundles that are arranged into a complex network running through the plant that is essential for the viability of land plants. Despite their obvious importance, the genes involved in the organization of vascular tissues remain poorly understood in grasses.

Results

We studied in detail the vascular network in stems from the model grass Brachypodium distachyon (Brachypodium) and identified a large set of genes differentially expressed in vascular bundles versus parenchyma tissues. To decipher the underlying molecular mechanisms of vascularization in grasses, we conducted a forward genetic screen for abnormal vasculature. We identified a mutation that severely affected the organization of vascular tissues. This mutant displayed defects in anastomosis of the vascular network and uncommon amphivasal vascular bundles. The causal mutation is a premature stop codon in ERECTA, a LRR receptor-like serine/threonine-protein kinase. Mutations in this gene are pleiotropic indicating that it serves multiple roles during plant development. This mutant also displayed changes in cell wall composition, gene expression and hormone homeostasis.

Conclusion

In summary, ERECTA has a pleiotropic role in Brachypodium. We propose a major role of ERECTA in vasculature anastomosis and vascular tissue organization in Brachypodium.