bluuebunny/crossref_metadata_2025 huggingface dataset:
Multi-load cases topological optimization by weighted sum method based on load case severity degree and ideality
Authors: Li Yongxin , Yang Quanwei , Chang Tao , Qin Tao , Wu Fenghe
Published: August 2020

Mechanical structures always bear multiple loads under working conditions. Topology optimization in multi-load cases is always treated as a multi-objective optimization problem, which is solved by the weighted sum method. However, different weight factor allocation strategies have led to discrepant optimization results, and when ill loading case problems appear, some unreasonable results are obtained by those alternatives. Moreover, many multi-objective optimization problems have certain optimization objective, and an evaluation formula to measure Pareto solution in the multi-objective optimization problem area is lacking. Regarding these two problems, a new method for calculating the weight factor is proposed based on the definition of load case severity degree. Additionally, an amplified load increment is derived and suggested in the minimum compliance with a volume constraint problem. Ideality is formulized from Pareto front to the ideal solution to evaluate the different optimization results. Benchmark topology optimization examples are solved and discussed. The results show that the load case severity degree is less affected by the different weighted sum functions and can avoid ill loading case phenomena, and the ideality of optimization result obtained by the load case severity degree is the best.
Prevalence of leisure participation in older adults with and without pain: A secondary data analysis of the 2014 Health and Retirement Study
Authors: Feller Haley , Baker Nancy
Published: August 2020

Objectives

The purpose of this study is to describe the prevalence of leisure activities in adults ages 50 and over and to examine if pain changes that prevalence.

Methods

We completed a secondary analysis using data from the 2014 Health and Retirement Study Leave-Behind Questionnaire (n = 7,541) to analyze frequency and 95% confidence intervals of leisure participation and its relationship to pain.

Results

The majority of respondents reported regular participation in half of the 10 leisure activities analyzed. Watching television (98.0%) and using the computer (64.5%) had the highest reported regular participation, while volunteering and attending a club or meeting warranted less than 10% regular participation. Of the 7,541 respondents, 39.1% reported pain. For those with pain, regular participation was significantly lower than those without pain in five leisure activities, with exercise having the greatest difference.

Discussion

The results of our secondary data analysis indicate that older adults may not be regularly participating in different types of leisure activities and that they more regularly participate in passive activities, such as watching television. Older adults with pain have significantly lower reported rates of participation in leisure activities than those without pain, especially in relation to exercise.
Women’s stories of non-fatal strangulation: Informing the criminal justice response
Authors: Douglas Heather , Fitzgerald Robin
Published: August 2020

Non-fatal strangulation is commonly reported by women who have experienced intimate partner violence and it has been identified as both an immediate risk to health and life but also a risk for future serious harm and even death. While some Australian states and Canada have followed the lead of American states in introducing criminal offences of non-fatal strangulation the United Kingdom is yet to do so. Non-fatal strangulation offences have come with challenges of definition and identification. The success of criminal justice responses requires an understanding of the ways in which women understand and describe their non-fatal strangulation victimisation. We analyse 24 women’s experiences of non-fatal strangulation as a basis for considering how to ensure that jurisdictions considering introduction of a new non-fatal strangulation offence or reform of an existing offence do not reproduce obstacles to prosecution and legal recognition and suggest a model definition of non-fatal strangulation for an offence.
Examining determinants of adherence to peace journalism: Empathy, reporting efficacy, and perceived journalistic roles
Authors: Adegbola Oluseyi , Zhang Weiwu
Published: August 2020

This study examines the practice of peace journalism by Nigerian journalists and how factors including empathy, reporting efficacy, perceived journalistic roles, and training may promote adherence to peace-oriented reporting. Data were collected using surveys ( n = 324) and semi-structured interviews ( n = 10). Results suggest that Nigerian journalists subscribe more to the tenets of peace journalism than to war journalism. Findings also demonstrate that, while empathic concern and conflict reporting efficacy can enhance adherence to peace journalism, inadequate training may undermine efforts to promote peace through reporting. Further, perceived journalistic roles appear to exert limited influence on reporting of conflict. Taken together, results shed light on how individual characteristics as well as attributes of the context in which journalists operate can shape their conflict reporting practices. Challenges of conflict reporting in Nigeria and implications for journalists’ enactment of peace journalism best practices are discussed.
Prior mood disorder diagnoses do not relate to current mood disorder symptoms or patient-reported disease severity in rotator cuff patients
Authors: Gibson Eric , LeBlanc Justin , Sabo Marlis T
Published: August 2020

Background

Surgery for rotator cuff syndrome does not always produce symptom improvement. Biological factors may explain some symptoms, but mood disorder symptoms may also contribute. The purpose of this study is to examine the interaction between disease severity, prevalence of mood disorder diagnoses, and current mood disorder symptoms in preoperative rotator cuff patients.

Methods

A prospective cohort of patients aged 35–75 years with unilateral rotator cuff disease awaiting surgery participated. Demographics, psychiatric history, the Hospital Anxiety & Depression Scale, and the Western Ontario Rotator Cuff index were collected. Descriptive and univariate statistical testing was performed.

Results

Of 140 participants (75M:65W) aged 55 ± 8 years, 34 reported a prior diagnosis of a mood disorder. There was a moderate positive relationship between disease severity and current depression and anxiety scores. Women were more likely to carry a diagnosis of a mood disorder, but there were no differences in current symptom levels between genders. No differences were found in patient-reported outcome measure scores between patients with and without a mood disorder diagnosis.

Discussion

Current mood disorder symptoms were associated with greater disease severity, whereas the presence of a past mood disorder diagnosis was not. Awareness of this relationship may reduce bias about past mood disorder diagnoses during decision-making.
List Experiments, Political Sophistication, and Vote Buying: Experimental Evidence from Mexico
Authors: Castro Cornejo Rodrigo , Beltrán Ulises
Published: August 2020

This research conducted list experiments to estimate the percentage of respondents who received electoral gifts during the 2015 legislative and the 2015 and 2017 subnational campaigns in Mexico. Consistent with recent studies on sensitive survey techniques, our research finds that list experiments seem to methodologically work better among more sophisticated voters (e.g. those with higher levels of education). Such findings suggest that previous studies that rely on list experiments tend to underestimate the percentage of voters who receive electoral gifts since this technique tends to work better among respondents who are, in fact, least likely to be targeted by clientelistic strategies. Given levels of education in the region, we suggest that research solely relying on list experiments approach its empirical findings with caution.
Effects of Static and Dynamic Stretching With Strengthening Exercises in Patients With Patellofemoral Pain Who Have Inflexible Hamstrings: A Randomized Controlled Trial
Authors: Lee Jin Hyuck , Jang Ki-Mo , Kim Eunseon , Rhim Hye Chang , Kim Hyeong-Dong
Published: August 2020

Background:

Patellofemoral pain (PFP) syndrome is closely associated with muscle tightness. However, studies regarding the effects of stretching exercises on PFP patients with inflexible hamstrings are scarce. The aim of the study was to compare the effects between static and dynamic hamstring stretching in patients with PFP who have inflexible hamstrings.

Hypothesis:

Compared with static hamstring stretching, dynamic hamstring stretching will improve the parameters of hamstring flexibility, knee muscle strength, muscle activation time, and clinical outcomes in this patient population.

Study Design:

Prospective randomized controlled trial.

Level of Evidence:

Level 2.

Methods:

A total of 46 patients (25, static stretching; 21, dynamic stretching) participated. Hamstring flexibility was assessed according to the popliteal angle during active knee extension. Muscle strength and muscle activation time were measured using an isokinetic device. Clinical outcomes were evaluated using the visual analog scale (VAS) for pain and the anterior knee pain scale (AKPS).

Results:

There were no differences in hamstring flexibility and knee muscle strength of the affected knees between the groups ( P > 0.05). Significantly improved muscle activation time and clinical outcomes of the affected knees were observed in the dynamic stretching group compared with the static stretching group (all Ps < 0.01 for hamstring, quadriceps, VAS, and AKPS).

Conclusion:

In patients with PFP who have inflexible hamstrings, dynamic hamstring stretching with strengthening exercises was superior for improving muscle activation time and clinical outcomes compared with static hamstring stretching with strengthening exercises.

Clinical Relevance:

Clinicians and therapists could implement dynamic hamstring stretching to improve function and reduce pain in patients with PFP who have inflexible hamstrings.
Retained second twin secondary to an undiagnosed bicornuate uterus in a poorly supervised labour: A case report
Authors: Enebe Joseph Tochukwu , Omeke Chidimma Akudo , Chukwubuike Emeka Kevin
Published: August 2020

Congenital anomalies of the uterus may result from maldevelopment, abnormal fusion or failure of recanalisation of the paramesonephric (Müllerian) ducts. They are uncommon and are associated with various fertility and pregnancy outcomes. Uterine anomalies have been associated with infertility and pregnancy-related complications. Some cases of successful pregnancies among women with a bicornuate uterus have been reported. However, successful twin pregnancy in a bicornuate uterus is very rare. We report the case of a 24-year-old primigravida who presented with a retained second twin secondary to an undiagnosed bicornuate uterus. An abdominal examination revealed an enlarged abdomen with the uterus tilted to the right and also a palpable firm mass on the left iliac fossa. The retained foetus was presenting cephalic, and the foetal heart rate was 118 bpm. A diagnosis of a retained second twin secondary to a suspected uterine anomaly and suspected foetal distress was made. An emergency caesarean section revealed two horns of the uterus, each having a fallopian tube, an ovary and a cervix. Both cervices opened into one vagina. A 3.0 kg live male baby was successfully delivered through a transverse incision on the lower segment of the right horn of the uterus. The client had an uneventful recovery and was discharged home together with her babies after 4 days. In conclusion, congenital anomalies of the uterus should be considered in cases of a retained second twin. A prompt and accurate diagnosis followed by appropriate management will go a long way in ensuring a good outcome, as was had in this case.
Dismissal Legislation and the Transition Payment in the Netherlands: Towards employment security?
Authors: Borghouts - van de Pas Irmgard , van Drongelen Harry
Published: August 2020

The purpose of protection against dismissal is to protect the employee against unjustified dismissal, which is expected to lead to stable employment relationships and job security. In recent years, the concept of employment security has entered the world of policy and science. This article aims to contribute to the field of labour law by investigating the objectives and effects of the Dutch transition payment process in relation to the relatively new notion of employment security. To do so, the ins and outs of the Dutch transition payment process are discussed. We compare and analyse the Dutch dismissal law before and after the introduction of the Work and Security Act ( Wet werk en zekerheid (WWZ)) on 1 July 2015. We discuss the (unintended) employer and employee effects of dismissal law reform in the Netherlands and we analyse the objectives of the transition payment in relation to employment security. Based on a large-scale survey of redundant employees we shed light on the question of whether the transition payment is used for the purpose intended by the legislature. This article concludes by discussing the changes to the transition payment and dismissal compensation with the introduction of the new Balanced Labour Market Act ( Wet arbeidsmarkt in balans (WAB)) on 1 January 2020. Although the legislature has attributed a clear formal transition function to the transition payment, the transition function is lacking from a substantive law perspective and we conclude that employment security is still in its infancy in Dutch dismissal legislation.
Facial recognition in police hands: Assessing the ‘Clearview case’ from a European perspective
Authors: Rezende Isadora Neroni
Published: August 2020

Since 2019, over 600 law enforcement agencies across the United States have started using a groundbreaking facial recognition app designed by Clearview AI, a tech start-up which now plans to market its technology also in Europe. While the Clearview app is an expression of the wider phenomenon of the repurposing of privately held data in the law enforcement context, its use in criminal proceedings is likely to encroach on individuals’ rights in unprecedented ways. Indeed, the Clearview app goes far beyond traditional facial recognition tools. If these have been historically limited to matching government-stored images, Clearview now combines its technology with a database of over three billion images published on the Internet. Against this background, this article will review the use of this new investigative tool in light of the European Union (EU) legal framework on privacy and data protection. The proposed assessment will proceed as follows. Firstly, it will briefly assess the lawfulness of Clearview AI’s data scraping practices under the General Data Protection Regulation. Secondly, it will discuss the transfer of scraped data from the company to EU law enforcement agencies under the regime of the Directive 2016/680/EU (the Directive). Finally, it will analyse the compliance of the Clearview app with art 10 of the Police Directive, which lays down the criteria for lawful processing of biometric data. More specifically, this last analysis will focus on the strict necessity test, as defined in the Charter of Fundamental Rights of the European Union and the European Convention on Human Rights. Following this assessment, it will be argued that the Clearview app’s use in criminal proceedings is highly problematic in light of the EU legislation on privacy and data protection.
ICT officials' opinion on deploying Open Source Learning Management System for teaching and learning in universities in a developing society
Authors: Asamoah Moses Kumi
Published: August 2020

Information and Communication Technology specialists, working within universities play important roles in the deployment of educational technologies for teaching and learning. Given the centrality of these specialists and the woeful dearth of empirics on this subject-matter in Sub-Saharan Africa, this paper interrogates the perspectives of ICT specialists working within universities in Ghana, on the deployment of Moodle®/Sakai® Learning Management System (LMS) by universities in the country for teaching and learning and the challenges involved. Data collection entailed semi-structured interviews with twenty informants. Thematic analysis was used for data analysis. It emerged that there has been impressive formulation of e-learning policy, construction of computer laboratories, Staff Resource Centre, Electronic Support Unit in the Balm Library, installation of Internet facility, Learning Management System, Enterprise Solution Software, Library Solution Software to promote ICT-mediated teaching and learning in the face of barriers. The paper adds knowledge to the extant literature in the field, impacts practice and policy along the pathway for ensuring sustainable deployment of LMS in universities in Sub-Saharan Africa.
Online student perceptions of their communication preparedness
Authors: Kaufmann Renee , Vallade Jessalyn I
Published: August 2020

Though scholars have identified a myriad of student characteristics and skills necessary to prepare individuals for online education, one notable gap in the literature is a focus on preparedness for online communication and interaction. To address this gap, the purpose of the present study was to explore what elements of interaction students identified being most and least prepared for when communicating with their instructor and peers in an online class. Participants responded to four open-ended questions on their perceptions of communication preparedness in the online classroom. Responses were open-coded and findings reveal that there is a lot of potential uncertainty surrounding communication and interaction within this context, as well as challenges for creating authentic connections within this space. Based on participant responses, practical implications for both online instructors and online students are offered.
Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker of renal injury in patients with ureteric stones: a pilot study
Authors: Bolgeri Marco , Whiting Danielle , Reche Antonio , Manghat Padmini , Sriprasad Seshadri
Published: August 2020

Objective:

The role of neutrophil gelatinase-associated lipocalin in renal obstruction remains unclear. The aim of this study is to assess neutrophil gelatinase-associated lipocalin kinetics and its potential role as a biomarker of renal damage in acute ureteric colic.

Methods:

Thirty-six patients with acute ureteric colic were prospectively recruited and compared with two control groups. Blood and urine samples for plasma neutrophil gelatinase-associated lipocalin and urinary neutrophil gelatinase-associated lipocalin levels were obtained at various time points.

Results:

There were significantly higher levels of urinary neutrophil gelatinase-associated lipocalin and the urinary neutrophil gelatinase-associated lipocalin/creatinine ratio at presentation when comparing patients with acute ureteric colic to healthy controls ( P=0.002 and P=0.004, respectively). In patients with acute ureteric colic managed with surgical intervention ( n=27) there was a significant reduction in plasma neutrophil gelatinase-associated lipocalin ( P=0.001) and an increase in the urinary neutrophil gelatinase-associated lipocalin/creatinine ratio 6 hours postoperatively ( P=0.03). Eight of nine patients managed conservatively for acute ureteric obstruction had spontaneous stone passage at follow-up (median 26 days) with a significant reduction in the urinary neutrophil gelatinase-associated lipocalin/creatinine ratio ( P=0.03).

Conclusion:

The observation of a reduction in plasma neutrophil gelatinase-associated lipocalin and urinary neutrophil gelatinase-associated lipocalin levels following relief of renal obstruction due to ureteric stones suggests the potential role of neutrophil gelatinase-associated lipocalin as a biomarker in this scenario and in the follow-up setting as a potential marker of relief of obstruction.

Level of evidence:

3b
Adult attachment styles, self-esteem, and quality of life in women with fibromyalgia
Authors: Sechi Cristina , Vismara Laura , Brennstuhl Marie Jo , Tarquinio Cyril , Lucarelli Loredana
Published: August 2020

Recently, the research on pain-related disability has increasingly paid attention to the psychological and social factors that may influence the biological condition. In the current study, we aimed to explore attachment styles, self-esteem, and quality of life in individuals with a diagnosis of fibromyalgia. Participants were 371 diagnosed women, with a mean age of 42.7 years (standard deviation = 10.6). The average number of years since diagnosis was 7.4 years (standard deviation = 2.4) years. To assess attachment, quality of life, and self-esteem, women responded, respectively, to the Relationship Questionnaire, the World Health Organization Quality of Life Questionnaire, and the Rosenberg Self-Esteem Inventory. Our results showed that secure attachment relationships and high self-esteem represent protective factors for quality of life of women with fibromyalgia, while the contrary emerged for insecure attachments and low self-esteem. The understanding of the psychological components that contribute to fibromyalgia may improve the effectiveness of interventions.
Older Adults, Social Technologies, and the Coronavirus Pandemic: Challenges, Strengths, and Strategies for Support
Authors: Moore Ryan C. , Hancock Jeffrey T.
Published: August 2020

COVID-19 is a threat to everyone’s health but can be especially devastating to older individuals. To prevent spread of the virus, social distancing has become the norm worldwide. However, with social distancing comes significantly less face-to-face interaction, which may be particularly harmful to older adults given their existing levels of loneliness. While social technologies can be used to provide critical social interaction during this time of necessary physical distancing, older adults tend to either lack access to these technologies or the skills and experience necessary to use them effectively. Once online, older adults face the additional challenge of being outsized targets of misinformation and scams, both of which abound in the context of COVID-19. In this essay, we discuss the challenges faced by older adults in their use of digital media for social connection in the present pandemic, as well as highlight some of the population’s untapped strengths which can be leveraged to help them live prosperous online lives. Finally, we provide recommendations for actions which key stakeholders can take to support older adults in this pursuit.
Rhythmic Recursion? Human Sensitivity to a Lindenmayer Grammar with Self-similar Structure in a Musical Task
Authors: Geambaşu Andreea , Toron Laura , Ravignani Andrea , Levelt Clara C.
Published: August 2020

Processing of recursion has been proposed as the foundation of human linguistic ability. Yet this ability may be shared with other domains, such as the musical or rhythmic domain. Lindenmayer grammars (L-systems) have been proposed as a recursive grammar for use in artificial grammar experiments to test recursive processing abilities, and previous work had shown that participants are able to learn such a grammar using linguistic stimuli (syllables). In the present work, we used two experimental paradigms (a yes/no task and a two-alternative forced choice) to test whether adult participants are able to learn a recursive Lindenmayer grammar composed of drum sounds. After a brief exposure phase, we found that participants at the group level were sensitive to the exposure grammar and capable of distinguishing the grammatical and ungrammatical test strings above chance level in both tasks. While we found evidence of participants’ sensitivity to a very complex L-system grammar in a non-linguistic, potentially musical domain, the results were not robust. We discuss the discrepancy within our results and with the previous literature using L-systems in the linguistic domain. Furthermore, we propose directions for future music cognition research using L-system grammars.
On Justice in Pedagogical Contexts
Authors: Benner Dietrich
Published: August 2020

Purpose:

This article explores the question of what is meant by justice in pedagogical contexts and whether there is a proven pedagogical concept of justice at all, from which the public and scientific controversies about justice in pedagogical contexts can be judged.

Design/Approach/Methods:

Instead of developing a positive pedagogical concept of justice, this article analyzes pedagogical injustices and assigns them to different levels of the educational system.

Findings:

The result is a differentiated pedagogical phenomenology of injustices in pedagogical contexts, which at the same time shows starting points for possible changes.

Originality/Value:

The originality of this article is that an instrumentalization of education in the service of extra-pedagogical norms of justice is avoided and a pragmatic approach is developed, which shows how pedagogical injustices can be reduced. Although the arguments for this are developed on the basis of discourses held in Germany, they are of general and international importance.
Prevalence of Cardiac Risk Factors and Attitude toward Self-Risk Assessment among Cardiac Care Givers
Authors: Furnaz Shumaila , Karim Musa , Ali Sajjad , Haque Muhammad Tanzeel ul , Usman Muhammad Abdullah , Kumar Dileep , Siddiqi Tariq Jamal , Kazmi Khawar Abbas
Published: August 2020

Objective:

Aim of this survey was to assess the prevalence of cardiovascular diseases (CVD) risk factors and attitude toward self-risk assessment among cardiac care physicians (who did not have CVD history), at a tertiary care cardiac center in Pakistan.

Design:

In this survey we included cardiac care givers who had a minimum of 1 year of working experience in a cardiac care center.

Participants:

Participants with self-reported history of established diagnosis of CVD were excluded. Face-to-face interviews were conducted with the help of a structured questionnaire which consisted of demographic information, data regarding established CVD risk factors, self-awareness, and attitude toward CVD risk assessment.

Results:

A total of 126 participants were interviewed, out of which 20.6% (26) were females and mean age was 36.1±7.6 years. The most prevalent CVD risk factor was family history of CVD (33.3%) followed by smoking (14.3%) and 23.8% had body mass index of ≥27.5 kg/m2. Around 23% of the participants did not know their cholesterol levels, similarly more than 74% were not aware of their high-density lipoproteins levels. More than 76% had never assessed their CVD risk and more than 37% don’t know or don’t have any opinion about their own CVD risk.

Conclusions:

The present study reveals low prevalence of conventional cardiac risk factors and marginally higher tendency of modifiable risk factors, such as smoking and obesity, among the cardiac physicians. A large proportion of these cardiac physicians have not yet assessed their CVD risk.
The Effects of Environmental Management and Debt Financing on Sustainable Financial Growth in the Tourism Industry
Authors: Xu Xin Long , Sun Chao , Li Yi , Zhou Nidi
Published: August 2020

Environmental management and sustainable financial growth are currently hot topics in academic research. This article examines the relationships among environmental management, debt financing, and sustainable financial growth in the Chinese tourism industry. The results show that environmental management and debt financing have promoted sustainable financial growth, and the overall effect of debt financing on sustainable financial growth has been affected by environmental management. After employing different methods of controlling the endogeneity, these conclusions are still robust. We also examine the mediating effect and threshold effect on environmental management, debt financing, and sustainable financial growth, and the results reveal that debt financing can mediate the effect of environmental management on sustainable financial growth and that there is nonlinear impact of debt financing on sustainable financial growth in different thresholds of environmental management. The analysis results show that the presented policy proposals promote the development of tourism companies from the aspects of debt financing and environmental management.
Complete Versus Incomplete Surgical Resection in Intramedullary Ependymomas: A Systematic Review and Meta-analysis
Authors: Salari Farhad , Golpayegani Mehdi , Sadeghi-Naini Mohsen , Hanaei Sara , Shokraneh Farhad , Ahmadi Ayat , Khayat-kashani Hamid Reza , Vacarro Alexander R. , Rahimi-Movaghar Vafa
Published: August 2020

Study Design:

Systematic review.

Objective:

To compare outcomes of complete versus incomplete resection in primary intramedullary spinal cord ependymoma.

Methods:

A comprehensive search of the MEDLINE, CENTRAL, and Embase databases was conducted by 2 independent investigators. Random-effect meta-analysis and meta-regression with seven covariates were performed to evaluate the reason for the heterogeneity among studies. We also used individual patient data in the integrative analysis to compare complete and incomplete resection based on 4 outcomes: progression-free survival (PFS), overall survival (OS), postoperative neurological improvement (PNI), and follow-up neurological improvement (FNI).

Results:

A total of 23 studies were identified, including 407 cases. Significant heterogeneity among included studies was observed in risk estimates (I2 for PFS, FNI, and PNI were 49.5%, 78.3%, and 87.2%, respectively). The mean follow-up time across cases was 48.6 ± 2.35 months. Cox proportional multivariable analysis revealed that the complete resection can prolong PFS (model, hazard ratio = 0.18, CI 0.05-0.54, P = .004,) and improve the FNI (binary logistic regression, adjusted odds ratio = 16.5, CI 1.6-171, P = .019). However, PNI and OS were similar in patients with incomplete resected spinal cord ependymoma compared with complete resection (binary logistic regression respectively and Cox multivariable analysis, P > .5).

Conclusion:

The data presented in this study showed that OS was not significantly affected by the degree of surgery. However, complete resection of intramedullary ependymomas provides the optimal outcomes with longer PFS and better long-term neurological outcomes than incomplete resection.
Higher Body Mass Index Is Associated With Biochemical Changes in Knee Articular Cartilage After Marathon Running: A Quantitative T2-Relaxation MRI Study
Authors: Wang Zhongzheng , Ai Songtao , Tian Fei , Liow Ming Han Lincoln , Wang Shaobai , Zhao Jinzhong , Tsai Tsung-Yuan
Published: August 2020

Background:

More than 30 million individuals participate in marathon running every year worldwide. As the popularity of marathon running continues to increase, it is essential for the purposes of injury prevention to understand the effects of marathon running on the knee cartilage.

Purpose:

To investigate the immediate effects of marathon running on knee articular cartilage and to determine the relationship between body mass index and cartilage biochemical composition.

Study Design:

Descriptive laboratory study.

Methods:

T2-relaxation magnetic resonance imaging (MRI) of knees in 18 nonprofessional marathoners (mean age, 35.6 ± 6.4 years) was performed before and after a full-length marathon. Three-dimensional models of the knee articular cartilage were reconstructed and divided into different regions of interest. The 3-dimensional models were then applied to corresponding T2-relaxation MRI maps to calculate T2 values in each region of interest. The mean values of the T2-relaxation times in each region of interest before and after the marathon were compared by use of the paired Student t test. The Pearson correlation coefficient between T2 change and runner body mass index (BMI) was calculated.

Results:

Postmarathon T2-relaxation times were significantly higher than premarathon values for patellofemoral cartilage (32.6 ± 12.1 vs 34.1 ± 10.9 ms; P < .01) and medial tibial cartilage (35.6 ± 11.7 vs 34.6 ± 12.0 ms; P = .01). The greatest increase was observed in the anterior part of the medial tibial cartilage. No statistically significant changes were seen in the T2-relaxation times of the lateral tibial and femoral cartilage. Postmarathon T2-relaxation elevation in the anteromedial knee tibiofemoral joint cartilage strongly correlated with body weight ( R = 0.6746; P = .03) and BMI ( R = 0.6989; P = .001). Changes in T2-relaxation times did not correlate with marathon time, height, age, or sex in any regions of interest.

Conclusion:

Marathon running leads to immediate postmarathon elevated T2-relaxation values within knee articular cartilage, suggesting biochemical content alteration. Additionally, runners with higher BMI may have greater changes in cartilage biochemical composition after a marathon. Further studies should investigate whether these changes are sustained over time to determine the relationship between immediate biochemical changes in cartilage composition and cartilage degeneration.

Clinical Relevance:

Runners with a higher BMI may carry a higher risk of anteromedial tibiofemoral cartilage degeneration compared with runners with lower BMI.
Physical Performance Improves With Time and a Functional Knee Brace in Athletes After ACL Reconstruction
Authors: Dickerson Laura C. , Peebles Alexander T. , Moskal Joseph T. , Miller Thomas K. , Queen Robin M.
Published: August 2020

Background:

Athletes who return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR) often have reduced physical performance and a high reinjury rate. Additionally, it is currently unclear how physical performance measures can change during the RTS transition and with the use of a functional knee brace.

Purpose/Hypothesis:

The purpose of this study was to examine the effects of time since surgery (at RTS and 3 months after RTS) and of wearing a brace on physical performance in patients who have undergone ACLR. We hypothesized that physical performance measures would improve with time and would not be affected by brace condition.

Study Design:

Controlled laboratory study.

Methods:

A total of 28 patients who underwent ACLR (9 males, 19 females) completed physical performance testing both after being released for RTS and 3 months later. Physical performance tests included the modified agility t test (MAT) and vertical jump height, which were completed with and without a knee brace. A repeated-measures analysis of variance determined the effect of time and bracing on performance measures.

Results:

The impact of the knee brace was different at the 2 time points for the MAT side shuffle ( P = .047). Wearing a functional knee brace did not affect any other physical performance measure. MAT times improved for total time ( P < .001) and backpedal ( P < .001), and vertical jump height increased ( P = .002) in the 3 months after RTS.

Conclusion:

The present study showed that physical performance measures of agility and vertical jump height improved in the first 3 months after RTS. This study also showed that wearing a knee brace did not hinder physical performance.

Clinical Relevance:

Wearing a functional knee brace does not affect physical performance, and therefore a brace could be worn during the RTS transition without concern. Additionally, physical performance measures may still improve 3 months past traditional RTS, therefore justifying delayed RTS.
Using Patient Voice to Personalize the Opioid Epidemic: An Evaluation of 2 Educational Interventions
Authors: Schlaudecker Jeffrey , Zamudio Olivia , Goodnow Keesha , Pallerla Harini , Regan Saundra
Published: August 2020

Despite rising opioid fatalities, attitudes remain indifferent toward those with opioid use disorder (OUD). Utilizing patient voice may be one way to move providers to action. We included persons with OUD in 2 educational sessions as an important tool of attitude change. Post-session surveys demonstrate increased compassion, deeper understanding of challenges, and positive change in attitude. Inclusion of patient voice was identified as the most useful feature of both educational sessions. Four themes emerged: value of patient voice; change in attitude; barriers to change; and enhanced provider role. Future educational sessions should include the voice of persons living with OUD.
Factors Associated With Patient Satisfaction Measured Using a Guttman-Type Scale
Authors: Versluijs Yvonne , Brown Laura E , Rao Mauna , Gonzalez Amanda I , Driscoll Matthew D , Ring David
Published: August 2020

Patient experience measures such as satisfaction are increasingly tracked and incentivized. Satisfaction questionnaires have notable ceiling effects that may limit learning and improvement. This study tested a Guttman-type (iterative) Satisfaction Scale (GSS) after a musculoskeletal specialty care visit in the hope that it might reduce the ceiling effect. We measured floor effects, ceiling effects, skewness, and kurtosis of GSS. We also assessed factors independently associated with GSS and the top 2 possible scores. In this cross-sectional study, 164 patients seeing an orthopedic surgeon completed questionnaires measuring (1) a demographics, (2) symptoms of depression, (3) catastrophic thinking in response to nociception, (4) heightened illness concerns, and (5) satisfaction with the visit (GSS). Bivariate and multivariable analyses sought associations of the explanatory variable with total GSS and top 2 scores of GSS. Accounting for potential confounding using multivariable analysis, lower satisfaction was independently associated with greater symptoms of depression (β: −0.03; 95% CI: −0.05 to −0.00; P = .047). The top 2 scores of the GSS were independently associated with women (compared to men: odds ratio [OR]: 2.12, 99% CI: 1.01-4.45, P = .046) and lower level of education (masters’ degree compared to high school; OR: 0.16, 95% CI: 004-0.61, P = .007). The GSS had no floor effect, a ceiling effect of 38%, a skewness of −0.08, and a kurtosis of 1.3.

The 38% ceiling effect of the iterative (Guttman-style) satisfaction measure is lower than ordinal satisfaction scales, but still undesirably high. Alternative approaches for reducing the ceiling effect of patient experience measures are needed.
Effect on Foot Width With Triplanar Tarsometatarsal Arthrodesis for Hallux Valgus
Authors: Vaida Justin , Ray Justin J. , Shackleford Taylor L. , DeCarbo William T. , Hatch Daniel J. , Dayton Paul , McAleer Jody P. , Smith W. Bret , Santrock Robert D.
Published: August 2020

Background:

Foot width reduction is a desirable cosmetic and functional outcome for patients with hallux valgus. Triplanar first tarsometatarsal (TMT) arthrodesis could achieve this goal by 3-dimensional correction of the deformity. The aim of this study was to evaluate changes in bony and soft tissue width in patients undergoing triplanar first TMT arthrodesis.

Methods:

After receiving Institutional Review Board approval, charts were retrospectively reviewed for patients undergoing triplanar first TMT arthrodesis for hallux valgus at 4 institutions between 2016 and 2019. Patients who underwent concomitant first metatarsal head osteotomies (eg, Silver or Chevron) or fifth metatarsal osteotomies were excluded. Preoperative and postoperative anteroposterior weightbearing radiographs were compared to evaluate for changes in bony and soft tissue width. One hundred forty-eight feet from 144 patients (48.1 ± 15.7 years, 92.5% female) met inclusion criteria.

Results:

Preoperative osseous foot width was 96.2 mm, compared to 85.8 mm postoperatively ( P < .001). Preoperative soft tissue width was 106.6 mm, compared to 99.3 mm postoperatively ( P < .001). Postoperatively, patients had an average 10.4 ± 4.0 mm reduction (10.8% reduction) in osseous width and average 7.3 ± 4.0 mm reduction (6.8% reduction) in soft tissue width.

Conclusions:

Triplanar first TMT arthrodesis reduced both osseous and soft tissue foot width, providing a desirable cosmetic and functional outcome for patients with hallux valgus. Future studies are needed to determine if patient satisfaction and outcome measures correlate with reductions in foot width. Level of evidence: Level III, retrospective comparative study
Chinese character variants in Vietnam:A case study of characters inThe Complete Secrets for Buddhist Monks in Practice of Precious Rites
Authors: Mạnh Trịnh Khắc
Published: August 2020

Based on the approaches of graphology and positivism, the paper enumerates and analyses the Chinese character variants in the book titled The Complete Secrets for Buddhist Monks in Practice of Precious Rites 釋氏寶鼎行持秘旨全章, compiled by Zen Master Huyền Quang (1254–1334). Thus, the paper focuses on analysing 56 Chinese character variants found in the book and comes to the conclusion that the number of Chinese character variants created in Vietnam is double the number of those imported from China.
COVID-19: interim guidance on rehabilitation in the hospital and post-hospital phase from a European Respiratory Society- and American Thoracic Society-coordinated international task force
Authors: Spruit Martijn A. , Holland Anne E. , Singh Sally J. , Tonia Thomy , Wilson Kevin C. , Troosters Thierry
Published: August 2020

Background

Patients with coronavirus disease 2019 (COVID-19) or post-COVID-19 will probably have a need for rehabilitation during and directly after the hospitalisation. Data on safety and efficacy are lacking. Healthcare professionals cannot wait for published randomised controlled trials before they can start these rehabilitative interventions in daily clinical practice, as the number of post-COVID-19 patients increases rapidly. The Convergence of Opinion on Recommendations and Evidence process was used to make interim recommendations for rehabilitation in the hospital and post-hospital phases in COVID-19 and post-COVID-19 patients, respectively.

Methods

93 experts were asked to fill out 13 multiple-choice questions. Agreement of directionality was tabulated for each question. ≥70% agreement on directionality was necessary to make consensus suggestions.

Results

76 (82%) experts reached consensus on all questions based upon indirect evidence and clinical experience on the need for early rehabilitation during the hospital admission, the screening for treatable traits with rehabilitation in all patients at discharge and 6–8 weeks after discharge, and around the content of rehabilitation for these patients. It advocates for assessment of oxygen needs at discharge and more comprehensive assessment of rehabilitation needs, including physical as well as mental aspects 6–8 weeks after discharge. Based on the deficits identified, multidisciplinary rehabilitation should be offered with attention on skeletal muscle and functional as well as mental restoration.

Conclusions

This multinational task force recommends early, bedside rehabilitation for patients affected by severe COVID-19. The model of pulmonary rehabilitation may suit as a framework, particularly in a subset of patients with long-term respiratory consequences.
Targeting transforming growth factor-β receptors in pulmonary hypertension
Authors: Guignabert Christophe , Humbert Marc
Published: August 2020

The transforming growth factor-β (TGF-β) superfamily includes several groups of multifunctional proteins that form two major branches, namely the TGF-β–activin–nodal branch and the bone morphogenetic protein (BMP)–growth differentiation factor (GDF) branch. The response to the activation of these two branches, acting through canonical (small mothers against decapentaplegic (Smad) 2/3 and Smad 1/5/8, respectively) and noncanonical signalling pathways, are diverse and vary for different environmental conditions and cell types. An extensive body of data gathered in recent years has demonstrated a central role for the cross-talk between these two branches in a number of cellular processes, which include the regulation of cell proliferation and differentiation, as well as the transduction of signalling cascades for the development and maintenance of different tissues and organs. Importantly, alterations in these pathways, which include heterozygous germline mutations and/or alterations in the expression of several constitutive members, have been identified in patients with familial/heritable pulmonary arterial hypertension (PAH) or idiopathic PAH (IPAH). Consequently, loss or dysfunction in the delicate, finely-tuned balance between the TGF-β–activin–nodal branch and the BMP–GDF branch are currently viewed as the major molecular defect playing a critical role in PAH predisposition and disease progression. Here we review the role of the TGF-β–activin–nodal branch in PAH and illustrate how this knowledge has not only provided insight into understanding its pathogenesis, but has also paved the way for possible novel therapeutic approaches.
Properties of beta oscillations in Dup15q syndrome
Authors: Saravanapandian Vidya , Frohlich Joel , Hipp Joerg F. , Hyde Carly , Scheffler Aaron W. , Golshani Peyman , Cook Edwin H. , Reiter Lawrence T. , Senturk Damla , Jeste Shafali S.
Published: August 2020

Background

Duplications of 15q11.2-q13.1 (Dup15q syndrome) are highly penetrant for autism, intellectual disability, hypotonia, and epilepsy. The 15q region harbors genes critical for brain development, particularlyUBE3Aand a cluster of gamma-aminobutyric acid type A receptor (GABAAR) genes. We recently described an electrophysiological biomarker of the syndrome, characterized by excessive beta oscillations (12–30 Hz), resembling electroencephalogram (EEG) changes induced by allosteric modulation of GABAARs. In this follow-up study, we tested a larger cohort of children with Dup15q syndrome to comprehensively examine properties of this EEG biomarker that would inform its use in future clinical trials, specifically, its (1) relation to basic clinical features, such as age, duplication type, and epilepsy; (2) relation to behavioral characteristics, such as cognition and adaptive function; (3) stability over time; and (4) reproducibility of the signal in clinical EEG recordings.

Methods

We computed EEG power and beta peak frequency (BPF) in a cohort of children with Dup15q syndrome (N= 41, age range 9–189 months). To relate EEG parameters to clinical (study 1) and behavioral features (study 2), we examined age, duplication type, epilepsy, cognition, and daily living skills (DLS) as predictors of beta power and BPF. To evaluate stability over time (study 3), we derived the intraclass correlation coefficients (ICC) from beta power and BPF computed from children with multiple EEG recordings (N= 10, age range 18–161 months). To evaluate reproducibility in a clinical setting (study 4), we derived ICCs from beta power computed from children (N= 8, age range 19–96 months), who had undergone both research EEG and clinical EEG.

Results

The most promising relationships between EEG and clinical traits were found using BPF. BPF was predicted both by epilepsy status (R2= 0.11,p= 0.038) and the DLS component of the Vineland Adaptive Behavior Scale (R2= 0.17,p= 0.01). Beta power and peak frequency showed high stability across repeated visits (beta power ICC = 0.93, BPF ICC = 0.92). A reproducibility analysis revealed that beta power estimates are comparable between research and clinical EEG (ICC = 0.94).

Conclusions

In this era of precision health, with pharmacological and neuromodulatory therapies being developed and tested for specific genetic etiologies of neurodevelopmental disorders, quantification and examination of mechanistic biomarkers can greatly improve clinical trials. To this end, the robust beta oscillations evident in Dup15q syndrome are clinically reproducible and stable over time. With future preclinical and computational studies that will help disentangle the underlying mechanism, it is possible that this biomarker could serve as a robust measure of drug target engagement or a proximal outcome measure in future disease modifying intervention trials.