bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of illuminance and contrast on the reading of Chinese text by myopes
Authors: Bao J , Tan R , Huo J , Drobe B , Chen H
Published: January 2020

Twenty-four young adults with myopia in both eyes and no anisometropia participated in this study. Observers were instructed to read one A4-sized page of Chinese text at different levels of illuminance and text contrast, while their reading distance, head tilt angle and reading speed were recorded using an electromagnetic motion tracking system. Four illuminances (3, 30, 300 and 600 lx) and two text contrast levels (90% and 45%) were tested in randomised order. Observers tended to shorten their reading distance and increase their head tilt angle when reading at low illuminance. In addition, their reading speed was markedly slower at low illuminance and low contrast. These effects were found for both text contrast conditions but were greater at low contrast. Illuminance and text contrast play a critical role in myope’s reading behaviour. An illuminance of 300 lx or more with high-contrast text allows for good reading posture and rapid reading of Chinese text.
Politico-ideological violence: Zooming in on grievances
Authors: Ajil Ahmed
Published: January 2020

Most studies on politico-ideological violence (PIV) recognize the importance of socio-political and economic grievances, but they rarely analyse them in depth. I argue that this is symptomatic of a tendency of depoliticization in radicalization research in the post 9/11 context and suggest that the study of PIV may benefit from putting greater emphasis on the element of grievance. A grievance-based analysis allows for critical and reflexive consideration of structural and systemic factors pertinent for engagement in PIV and may thereby contribute to demystifying and re-politicizing the current debate on PIV. I propose three ‘ideal types’ of grievances (racial, ethnic and religious; socio-economic; political), which may be locally or globally oriented or inspired, and suggest that a combination of those is likely to be present in most forms of PIV. I conclude with a few methodological reflections and potential implications for policymaking.
Developing a Systems Mindset in Community-Based Prevention
Authors: Bensberg Monica
Published: January 2020

Background. A systems mindset is the ability to see problems in their wider context and in terms of their underlying structure. This research describes how a systems mindset was understood and applied by prevention practitioners in a large-scale community-based initiative that employed a systems thinking approach. Method. This qualitative research included 31 primary semistructured interviews. Deductive thematic analysis was based on Braun and Clarke’s analysis framework and was guided by Senge and Scharmer’s knowledge-creating system. Results. The practitioners had been introduced to systems theory and were aware of complex problems and the need for equally sophisticated solutions. Their knowledge was not in-depth, although this may be adequate, as a theoretical overview seemed to be sufficient to support practice. A range of tools was available to practitioners to guide their systems mindset; however, none were preferred. Practitioners’ awareness of the tools varied, as did their feelings toward them as some found them helpful and others did not. A narrower focus on tools could have benefited those who had not yet grasped systems theory. The use of projects within a systems approach confused some practitioners, yet others saw them as platforms to leverage change from. Implications for practice. With a systems mindset practitioners are able to develop systemic solutions to difficult problems. To do this, they require an overview of complex adaptive systems theory, an applied understanding of systems tools, and an experiential learning opportunity to shift their knowledge into practical know-how.
The Role of Robotic Path Assistance and Weight Support in Facilitating 3D Movements in Individuals With Poststroke Hemiparesis
Authors: Raghavan Preeti , Bilaloglu Seda , Ali Syed Zain , Jin Xin , Aluru Viswanath , Buckley Megan C. , Tang Alvin , Yousefi Arash , Stone Jennifer , Agrawal Sunil K. , Lu Ying
Published: January 2020

Background. High-intensity repetitive training is challenging to provide poststroke. Robotic approaches can facilitate such training by unweighting the limb and/or by improving trajectory control, but the extent to which these types of assistance are necessary is not known. Objective. The purpose of this study was to examine the extent to which robotic path assistance and/or weight support facilitate repetitive 3D movements in high functioning and low functioning subjects with poststroke arm motor impairment relative to healthy controls. Methods. Seven healthy controls and 18 subjects with chronic poststroke right-sided hemiparesis performed 300 repetitions of a 3D circle-drawing task using a 3D Cable-driven Arm Exoskeleton (CAREX) robot. Subjects performed 100 repetitions each with path assistance alone, weight support alone, and path assistance plus weight support in a random order over a single session. Kinematic data from the task were used to compute the normalized error and speed as well as the speed-error relationship. Results. Low functioning stroke subjects (Fugl-Meyer Scale score = 16.6 ± 6.5) showed the lowest error with path assistance plus weight support, whereas high functioning stroke subjects (Fugl-Meyer Scale score = 59.6 ± 6.8) moved faster with path assistance alone. When both speed and error were considered together, low functioning subjects significantly reduced their error and increased their speed but showed no difference across the robotic conditions. Conclusions. Robotic assistance can facilitate repetitive task performance in individuals with severe arm motor impairment, but path assistance provides little advantage over weight support alone. Future studies focusing on antigravity arm movement control are warranted poststroke.
4-AP-3-MeOH Promotes Structural and Functional Spontaneous Recovery in the Acute Sciatic Nerve Stretch Injury
Authors: Chen Yan , Wang Weidong , Zhao Zhimin , Ren Dong , Xin Danmou
Published: January 2020

Background:

4-AP-3-MeOH, a derivative of 4-aminopyridine, was developed and demonstrated to prevent nerve pulse diffusion due to myelin damage and significantly enhance axonal conduction following nerve injury. Currently, repurposing the existing drug such as 4-AP-3-MeOH to restore motor function is a promising and potential therapy of peripheral nerve injury. However, to evaluate drug effect on sciatic nerve injury is full of challenge.

Methods:

Sciatic functional index was used to determine and measure the walking track in the stretch injury model. Nerve conductivity was performed by electrical stimulation of a nerve and recording the compound muscle action potential. Myelin thickness and regeneration was imaged and measured with transmission electron microscopy (TEM).

Results:

In this study, we developed a sciatic nerve injury model to minimize the spontaneous recovery mechanism and found that 4-AP-3-MeOH not only improved walking ability of the animals but also reduced the sensitivity to thermal stimulus. More interesting, 4-AP-3-MeOH enhanced and recovered electric conductivity of injured nerve; our TEM results indicated that the axon sheath thickness was increased and myelin was regenerated, which was an important evidence to support the recovery of injured nerve conductivity with 4-AP-3-MeOH treatment.

Conclusions:

In summary, our studies suggest that 4-AP-3-MeOH is a viable and promising approach to the therapy of peripheral nerve injury and in support of repurposing the existing drug to restore motor function.
miR-21 may Act as a Potential Mediator Between Inflammation and Abnormal Bone Formation in Ankylosing Spondylitis Based on TNF-α Concentration-Dependent Manner Through the JAK2/STAT3 Pathway
Authors: Zou Yu-Cong , Yan Li-Man , Gao Yan-Ping , Wang Zhi- Yun , Liu Gang
Published: January 2020

Objective:

To explore the role of microRNA (miR-21) in new bone formation in ankylosing spondylitis (AS) as mediated by different concentration of tumor necrosis factor-α (TNF-α).

Methods:

Fibroblasts isolated from the hips of patients with AS were induced to osteogenesis. These cells were then stimulated with varying concentrations of TNF-α. MicroRNA-21 expressions were evaluated using reverse transcription–polymerase chain reaction (RT-PCR) and osteogenesis was detected via Alizarin Red S (ARS) staining and measurement of alkaline phosphatase (ALP) activity. Relative expressions of p-STAT3, Nuclear STAT3, cytoplasm STAT3, Runx2, BMP2, osteopontin, osteocalcin, and LC3B in AS fibroblasts were measured after exposure to different concentrations of TNF-α. The STAT3-inhibiting small interfering RNA allowed further exploration on its impact on miR-21 and primary miR-21 expressions. A proteoglycan-induced arthritis (PGIA) Balb/c mouse model was established in order to monitor sacroiliac joint (SIJ) inflammation and subsequent damage through magnetic resonance image. Serum miR-21 and TNF-α expressions were evaluated using RT-PCR and enzyme-linked immunosorbent assay. At week 16, mice models were transfected intravenously with miR-21 overexpressing agomir and miR-21 inhibiting antagomir for 7 successive days. The rate of abnormal bone formation at SIJ was evaluated using microcomputed tomography and hematoxylin and eosin staining at week 24. Western blot analysis enabled quantification of STAT-3, JAK-2, and interleukin (IL)-17A expressions present in the SIJ.

Results:

The in vitro miR-21 expression and osteogenesis activity were noted to be augmented in the setting of low TNF-α concentrations (0.01-0.1 ng/mL) while they were depressed in settings with higher TNF-α concentrations (1-10 ng/mL). Samples with the most distinct ARS manifestation and ALP activity as well as the highest miR-21 expressions were those who received 0.1 ng/mL of TNF-α. Primary miR-21 was found to be notable raised by Si-STAT3, while the converse effect was seen in mature miR-21 expressions. Intravenous injection of exogenous miR-21 contributed to new bone formation and significantly elevated expressions of STAT3, JAK2, and IL-17 in PGIA mice.

Conclusions:

The results revealed that miR-21 may act as a potential mediator between new bone formation and inflammation in AS.
Personal Health Practices and Perceptions of Lifestyle Counseling and Preventive Services Among Residents
Authors: Lee Jenny Sunghyun , Wilson April , Okunowo Oluwatimilehin , Trinh Jennifer , Sivoravong Jon
Published: January 2020

Background. Primary care residents are expected to provide lifestyle counseling and preventive services for patients with chronic diseases; also, physicians’ personal lifestyle practice impacts patient care. The purpose of this article is to assess healthy lifestyle behaviors and attitudes to engage in lifestyle counseling and preventive services among residents and fellows in different training levels and specialty. Methods. A cross-sectional pilot study was conducted on medical residents and fellows (n = 57). Surveys collected information on lifestyle behaviors and perceptions of lifestyle counseling and preventive services. Comparisons of study measures were made across residents’ specialty and training levels. Fisher’s exact and analysis of variance tests were used for statistical analysis. Results. There were several significant differences in perceptions of counseling and screening by specialty and training level. There were no significant differences in personal lifestyle behaviors between all resident specialties and training levels. Conclusion. Our findings suggest that there are opportunities to improve healthy lifestyle behaviors and perceptions of lifestyle counseling and preventive services among residents in different specialties and training levels. This knowledge can inform development of training programs in lifestyle and preventive medicine practice during residency and fellowship.
Witnessing, Remembering, and Testifying: Why the Past Is Special for Human Beings
Authors: Mahr Johannes B. , Csibra Gergely
Published: January 2020

The past is undeniably special for human beings. To a large extent, both individuals and collectives define themselves through history. Moreover, humans seem to have a special way of cognitively representing the past: episodic memory. As opposed to other ways of representing knowledge, remembering the past in episodic memory brings with it the ability to become a witness. Episodic memory allows us to determine what of our knowledge about the past comes from our own experience and thereby what parts of the past we can give testimony about. In this article, we aim to give an account of the special status of the past by asking why humans have developed the ability to give testimony about it. We argue that the past is special for human beings because it is regularly, and often principally, the only thing that can determine present social realities such as commitments, entitlements, and obligations. Because the social effects of the past often do not leave physical traces behind, remembering the past and the ability to bear testimony it brings is necessary for coordinating social realities with other individuals.
What do patients value as incentives for participation in clinical trials? A pilot discrete choice experiment
Authors: Vellinga Akke , Devine Colum , Ho Min Yun , Clarke Colin , Leahy Patrick , Bourke Jane , Devane Declan , Duane Sinead , Kearney Patricia
Published: January 2020

Incentivising has shown to improve participation in clinical trials. However, ethical concerns suggest that incentives may be coercive, obscure trial risks and encourage individuals to enrol in clinical trials for the wrong reasons. The aim of our study was to develop and pilot a discrete choice experiment (DCE) to explore and identify preferences for incentives. A DCE was designed by including following attributes (and levels) of incentives: value, method, and time involvement. To account for trial benefit and risk, each was included as an attribute with levels low, medium and high. For testing purposes, the DCE was administrated using SurveyMonkey in a population of third level students. A total of 245 students, representative of the general student population, participated in the online DCE. The results provide a template to assess and explore the use of different incentive methods in clinical trials. The template can be used in its current format or adapted to particular scenarios. This pilot study provides a feasible methodology to explore the use of incentives for participation in clinical trials and can be adapted to specific trial requirements to provide information for ethical applications or identify the most favourable incentive for participation in clinical trials.
Accelerated Muscle Recovery After In Vivo Curcumin Supplementation
Authors: Tsai Sen-Wei , Huang Chi-Chang , Hsu Yi-Ju , Chen Chun-Jung , Lee Po-Ying , Huang Yu-Hui , Lee Mon-Chien , Chiu Yen-Shuo , Tung Yu-Tang
Published: January 2020

The currently available treatment options for muscle injuries are suboptimal and often delay muscle recovery. In this study, the effects of curcumin on inflammation and skeletal muscle regeneration after contusion-induced injury in mice were investigated. The mice were randomly assigned to 4 groups, namely normal control (NC), with induced injury (mass-drop injury, MDI) and without treatment (MDI [M]), with induced injury and diclofenac (DCF) treatment (MDI + DCF [M + D]), and with induced injury and curcumin treatment (MDI + curcumin [M + C]). Contusion-induced injury was inflicted on the left gastrocnemius muscle, and DCF or curcumin was orally administered after injury once per day for 7 days. The M group exhibited significantly higher lipid peroxidation, myeloperoxidase (MPO), and desmin than the NC group. The M + D and M + C groups have lower lipid peroxidation and neutrophils (decrease in MPO protein) and higher muscle satellite cell regeneration (increase in desmin protein) than the M group. Additionally, for the contusion-induced muscle injury, curcumin could affect the specific proteins of inflammation, neutrophils, and differentiation of satellite cells, including Ikk-α/ß, MPO, and myogenin. In conclusion, curcumin potentially accelerates muscle recovery; therefore, it may be a potential candidate for further research as an effective treatment to enhance muscle repair.
Responsiveness of a Balance Assessment Using a Mobile Application
Authors: Krause David A. , Anderson Sarah E. , Campbell Graeme R. , Davis Samson J. , Tindall Samuel W. , Hollman John H.
Published: January 2020

Background:

Balance assessment is used by clinicians as part of athlete concussion screening. The King-Devick (K-D) Balance app is designed to provide an objective balance assessment value. The purpose of this study was to investigate the responsiveness of a balance assessment using the K-D Balance app.

Hypothesis:

The K-D Balance app will demonstrate acceptable responsiveness for balance assessment.

Study Design:

Repeated-measures study.

Level of Evidence:

Level 5.

Methods:

A convenience sample of 25 participants between the ages of 20 and 25 years completed testing procedures. A battery of balance tests using the K-D Balance app on an iPhone were conducted 1 week apart. After a 5-minute warm-up, 3 stances were assessed: double leg, tandem right, and tandem left. The K-D Balance app guided the test positions and test times. A value representing movement was generated by the app algorithm. Analysis included descriptive statistics along with intraclass correlation coefficient and minimal detectable change (MDC).

Results:

The median score of the K-D test was 0.5 for session 1 and 0.4 for session 2. The ICC was 0.42 (95% CI, 0.04-0.70), and the MDC was 1.58.

Conclusion:

The MDC value of 1.58 represents the threshold of meaningful change in balance, as measured with the K-D Balance app.

Clinical Relevance:

Clinicians can use the results of this study to objectively assess changes in balance over time using the K-D Balance app.
Qualitative employment relationships for Ph.D. students in the EU?
Authors: Foubert Petra , Maes Alexander , Wilms Michelle
Published: January 2020

This contribution intends to shed light on the working conditions of Belgian and Italian Ph.D. students, from the angle of EU law. In Belgium these (mostly young) researchers can be recruited either as ‘Ph.D. fellows’ or ‘teaching assistants’. Ph.D. fellows have a student-like status: they touch a fellowship exempt from personal income tax. However, social contributions are being withheld, for them to enjoy social security benefits and build up pension rights. Teaching assistants have an employee-like position: they receive a salary which is subject to personal income tax as well as to social security contributions. In Italy, Ph.D. students have a standard student-like status, comparable to Belgian Ph.D. fellows. The working hypothesis is that the pressure that (Belgian) universities experience to speed up research efforts (and outcomes) does not necessarily lead to qualitative (employment) relationships but may, instead, create some sort of precarious work. In light of the recent work-life balance Directive, this contribution will illustrate the differences in status with regard to paternity and parental leave.
Insights into the role of intestinal microbiota in hematopoietic stem-cell transplantation
Authors: Zama Daniele , Bossù Gianluca , Leardini Davide , Muratore Edoardo , Biagi Elena , Prete Arcangelo , Pession Andrea , Masetti Riccardo
Published: January 2020

The gut microbiota (GM) is able to modulate the human immune system. The development of novel investigation methods has provided better characterization of the GM, increasing our knowledge of the role of GM in the context of hematopoietic stem-cell transplantation (HSCT). In particular, the GM influences the development of the major complications seen after HSCT, having an impact on overall survival.

In fact, this evidence highlights the possible therapeutic implications of modulation of the GM during HSCT. Insights into the complex mechanisms and functions of the GM are essential for the rational design of these therapeutics. To date, preemptive and curative approaches have been tested. The current state of understanding of the impact of the GM on HSCT, and therapies targeting the GM balance is reviewed herein.
Challenges to children’s rights: Experiences from Ethiopia
Authors: Ayele Daniel Gebretsadik
Published: January 2020

In Ethiopia, there have been significant legislative frameworks in order to protect the rights of children and reduce their vulnerability. However, many of the relevant child right instruments have not yet been implemented to a satisfying degree. The aim of this article is to understand the challenges that impede the effectiveness of child rights system from children’s perspective. The empirical data upon which the author draws was gathered through repeated periods of qualitative fieldwork carried out in 2014/2015 with 24 children in the town of Dilla in Gedeo, southern Ethiopia. Parents, legal experts, police officers, and social workers also participated in the study. The author used informal dialogue, in-depth interviews, and focus group discussions to obtain the empirical data. This study has also benefited from various secondary sources. As the study shows, negative social construct of children, culturally embedded decisions and practices, poverty and deprivation, gaps in legislative frameworks, lack of resources, coordination, and commitment among responsible actors are identified as major challenges that impede the enforcement of child rights system. Thus, it is necessary to adopt holistic approach and deal with the broader structural and social barriers that denied children what they deserve in so many ways.
Abdominal obesity and the risk of recurrent atherosclerotic cardiovascular disease after myocardial infarction
Authors: Mohammadi Hanieh , Ohm Joel , Discacciati Andrea , Sundstrom Johan , Hambraeus Kristina , Jernberg Tomas , Svensson Per
Published: January 2020

Background

The association between abdominal obesity and recurrent atherosclerotic cardiovascular disease after myocardial infarction remains unknown.

Objective

The purpose of this study was to investigate the prevalence of abdominal obesity and its association with recurrent atherosclerotic cardiovascular disease in patients after a first myocardial infarction.

Design and methods

In this register-based observational cohort, 22,882 patients were identified from the national Swedish Web-system for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) registry at a clinical revisit 4–10 weeks after their first myocardial infarction 2005–2014. Patients were followed for recurrent atherosclerotic cardiovascular disease defined as non-fatal myocardial infarction, coronary heart disease death, non-fatal or fatal ischaemic stroke. Univariate and multivariable-adjusted Cox regression models were used to calculate hazard ratios and 95% confidence intervals in quintiles of waist circumference as well as three categories of body mass index including normal weight, overweight and obesity.

Results

The majority of patients had abdominal obesity. During a median follow-up time of 3.8 years, 1232 men (7.3%) and 469 women (7.9%) experienced a recurrent atherosclerotic cardiovascular disease event. In the univariate analysis, risk was elevated in the fifth quintile (hazard ratio 1.22, 95% confidence interval 1.07–1.39) compared with the first. In the multivariable-adjusted analysis, risk was elevated in the fourth and fifth quintiles (hazard ratio 1.21, confidence interval 1.03–1.43 and hazard ratio 1.25, confidence interval 1.04–1.50), respectively. Gender-stratified analyses showed similar associations in men, while U-shaped associations were observed in women and the body mass index analyses.

Conclusions

Abdominal obesity was common in post-myocardial infarction patients and larger waist circumference was independently associated with recurrent atherosclerotic cardiovascular disease, particularly in men. We recommend utilising waist circumference to identify patients at increased risk of recurrent atherosclerotic cardiovascular disease after myocardial infarction.
Immodest proposals: Learned liberal consensus as a cannibalistic theological system
Authors: Ricker Aaron
Published: January 2020

This article considers imperial Roman and German forms of liberal elite consensus on “proper religious diversity” to set the stage for an examination of the contemporary form of liberal consensus discernible in a recent public talk given by Charles Taylor and Rowan Williams. In each case, attention is drawn to the ways in which “proper religious diversity” is defined to serve ideological and theological agendas. Romanitas, Germanentum, and the Taylor–Williams consensus are cannibalistic theological systems: each uses a public stance of reasonable openmindedness regarding “proper religious diversity” to build and police a theological position that arrogates the perceived value of selected “religious” traditions by re-making them in its own image. Imperial Romanitas and Germanentum served in this way to absorb a diversity of traditions deemed palatable and digestible into overarching theological visions which were convenient to those in power. When Taylor and Williams use the platform of Religious Studies to promote the modern liberal view of “diversity in (true) religion” as a source of pro-social order, their efforts serve a similar crypto-theological and imperialist project.
Low-dose subcutaneous immunoglobulin is an effective treatment for autoimmune bullous skin disorders: A case report
Authors: Streu Erin , Wiseman Marni C , Johnston James B
Published: January 2020

Intravenous immunoglobulin is a recognized treatment in recalcitrant autoimmune bullous diseases. Infusions are administered monthly over 1–5 days in the hospital setting and associated with mild to severe infusion-related systemic effects, in part due to the high doses necessary to induce and achieve remission. We present a case series of four patients with bullous diseases treated successfully with low-dose subcutaneous IgG who achieved remission with maintenance therapy. Patient-administered smaller, more frequent doses of IgG into subcutaneous tissue more closely mimics the body’s own antibody production and produces a more stable serum trough level. Subcutaneous IgG is a novel treatment approach in bullous diseases which can induce a state remission.
Deliberation about the 2014 Umbrella Movement in a Hong Kong elite newspaper: A quantitative study of the Hong Kong Economic Journal
Authors: Tam Waikeung
Published: January 2020

Deliberative democratic theorists have argued that effective deliberation is central to democracy. Does Hong Kong possess a viable public sphere for deliberating important public issues, as the city has been striving for a full democracy since the 1980s? This article addresses this significant question by examining the quality of deliberation on the 2014 Umbrella Movement by the editorials and commentaries in an elite print Chinese newspaper – the Hong Kong Economic Journal – based on the “Discourse Quality Index” and other criteria used by major works on mediated deliberation. This article argues that the Journal has served as a viable public sphere for deliberating important public concerns in Hong Kong. The Journal’s editorials and commentaries performed well in terms of offering reasoned arguments and engaging in dialogue with opposing viewpoints. Regarding respect for the actors which were involved in the Umbrella Movement, the Journal as a whole had maintained a civilized tone. However, there was an indication that commentary authors had less tolerance toward actors from the opposite camps.
How the Chinese public makes decisions about controversial technologies: A case study on GMOs
Authors: You Chunhui
Published: January 2020

A number of events in China in recent years have been characterized by tensions or controversies between scientists and the public, such as the p-Xylene chemical project in Xiamen, nuclear energy projects, and genetic engineering. Scientists tend to attribute such conflict to inadequate public knowledge of science, leading to misunderstandings about it. However, that view ignores the influence on public perceptions of news reports and online discussions about controversial technologies in new media. Social media reporting affects the audience's perception of the risks posed by controversial technologies and can cause people to lose confidence in the scientific community and damage their trust in government. Thus, the public opposes these technologies. In this context, this study explores the relationship between the public's trust in the scientific community and the government on the one hand and its attitude towards controversial technologies on the other. I surveyed 1,235 people using a national online probability sampling strategy. I found that people's use of new media was significantly related to the extent of their knowledge of specific controversial technologies and was associated with other people's opinions about those technologies. The more attention people paid to WeChat coverage of genetically modified organisms (GMOs), the more supportive they were of them. Thus, the public's use of new media is a key factor in predicting its positive attitude to GMOs. Scientific literacy also significantly affects public attitudes to GMOs, directly as well as indirectly.
Biomechanical Comparison of Anterograde and Retrograde Lesser Trochanter Avulsion Repair
Authors: Otto Alexander , Baldino Joshua B. , DiCosmo Alyssa M. , Coyner Katherine , Johnson Jeremiah D. , Obopilwe Elifho , Cote Mark P. , Muench Lukas N. , Beitzel Knut , Scheiderer Bastian , Imhoff Andreas B. , Mazzocca Augustus D. , Mehl Julian
Published: January 2020

Background:

Lesser trochanter avulsions are rare injuries in adolescents. Severe cases with relevant fragment displacement can be treated surgically. However, no standard approach is available in the literature. Operative techniques are presently limited to anterograde fixations. A new retrograde approach to reduce operative difficulty and postoperative morbidity has been proposed. So far, no biomechanical comparison of these techniques is available.

Hypothesis:

Retrograde repair of the lesser trochanter with a titanium cortical button will produce superior stability under load to failure and similar displacement under cyclic loading compared with anterograde fixation with titanium suture anchors.

Study Design:

Controlled laboratory study.

Methods:

Sixteen paired hemipelvic cadaveric specimens (mean age, 62.5 ± 10.7 years) were dissected to isolate the lesser trochanter and iliopsoas muscle. After repair of a simulated lesser trochanter avulsion, specimens were tested under cyclic loading between 10 and 125 N at 1 Hz for 1500 cycles before finally being loaded to failure at a rate of 120 mm/min in a material testing machine. Motion tracking was used to assess displacement at the superior and inferior aspects of the iliopsoas tendon under cyclic loading.

Results:

Load to failure was significantly greater for the retrograde repair compared with the anterograde repair (1075.24 ± 179.39 vs 321.85 ± 62.45 N; P = .012). Mean displacement at the superior repair aspect (retrograde vs anterograde: 3.29 ± 1.84 vs 4.39 ± 4.50 mm; P = .779) and mean displacement at the inferior aspect (3.54 ± 2.13 vs 4.22 ± 4.48 mm; P = .779) of the iliopsoas tendon did not significantly differ by the type of repair. Mode of failure was tendon tearing by the sutures for each retrograde repair and anchor pullout for each anterograde repair.

Conclusion:

Surgical repair of lesser trochanter avulsion fractures with retrograde fixation using a titanium cortical button demonstrated superior load to failure and similar displacement under cyclic loading compared with anterograde fixation using suture anchors.

Clinical Relevance:

The retrograde approach provides a biomechanically validated alternative to other surgical techniques for this injury.
Nurse-Family Partnership and Geography: An Intersectional Perspective
Authors: Campbell Karen A. , MacKinnon Karen , Dobbins Maureen , Jack Susan M. ,   for the British Columbia Healthy Connections Project
Published: January 2020

Nurse-Family Partnership is a targeted public health intervention program designed to improve child and maternal health through nurse home visiting. In the context of a process evaluation, we posed the question: “In what ways do Canadian public health nurses explain their experiences with delivering this program across different geographical environments?” The qualitative methodology of interpretive description guided study decisions and data were collected through 10 focus groups with 50 nurses conducted over 2 years. We applied an intersectionality lens to explore the influence of all types of geography on the delivery of Nurse-Family Partnership. The findings from our analysis suggest that the nature of clients’ place and their associated social and physical geography emphasizes inadequacies of organizational and support structures that create health inequities for clients. Geography had a significant impact on program delivery for clients who were living with multiple forms of oppression and it worked to reinforce disadvantage.
Adolescents’ Experiences of Staying Overnight at Family-Centered Pediatric Wards
Authors: Lundgren Johan , Norell-Clarke Annika , Hellström Ingrid , Angelhoff Charlotte
Published: January 2020

Background

Sleep is essential for health and recovery. Hospital stays may affect adolescents’ sleep quality negatively as routines in the ward are not adapted for adolescents’ developmental status or sleep habits. The aims with this study were to (a) explore and describe how adolescents experience sleep in the family-centered pediatric ward, (b) explore and describe how adolescents experience the presence or absence of a parent during the hospital stay, and (c) identify circumstances that the adolescents describe as influential of their sleep in the pediatric wards.

Methods

This is a qualitative interview study employing thematic analysis with an inductive and exploratory approach. Sixteen adolescents aged between 13 and 17 years participated in the study.

Results

Three themes were found: the importance of good sleep, safety as a prerequisite for sleep in hospital, and circumstances influencing adolescents’ sleep in hospital.

Conclusion

The adolescents described their sleep at the pediatric ward positively, but mentioned disturbing factors associated with pain, nightly check-ups, noises, and inactivity. Parental presence was perceived as very positive both during the night and the day.
Turning the Table: Developing Students’ Skills in Receiving Feedback
Authors: Dwyer Laura Paglis
Published: January 2020

Developing skills in soliciting, receiving, and responding effectively to critical or negative performance feedback is at least as important as delivering feedback well. Organizational Behavior courses, however, focus almost exclusively on teaching students how to deliver feedback. The purpose of this scenario-based classroom exercise is to “turn the table,” that is, focus on the recipient in a feedback conversation and his or her processing of information about performance. Its target audience is instructors teaching undergraduate students in Organizational Behavior, Leadership, or Management Principles courses. The learning objectives emphasize understanding the barriers that get in the way of effectively responding to performance feedback, and learning techniques for overcoming them.
The Efficiency of Online “Inked” Videos Versus Recorded PowerPoint Lectures on Teaching Pathophysiology to Medical Students in Pre-Clerkship Years: A Pilot Study
Authors: Liu Regina , Relan Anju , Napolitano Jason
Published: January 2020

Background:

As online learning develops an increasingly important role in medical education, new online teaching modalities are arising all the time. One such teaching modality that is gaining popularity among medical students is the “inked” video, a type of animated video that utilizes a virtual blackboard. Student reviews suggest that the dynamic style of the inked video allows it to teach more efficiently than traditional teaching modalities, but currently there is no quantitative evidence to support or guide the use of this teaching modality.

Hypothesis:

When compared to the traditional recorded PowerPoint lecture, online inked videos teach the same pathophysiology concepts to pre-clerkship medical students in a shorter amount of time.

Method:

A randomized, crossover-design study was conducted with second-year medical students at the David Geffen School of Medicine at University of California, Los Angeles (n = 22). Students were randomized to 2 groups. Each group received 2 lessons on 2 different pathophysiology topics: one via a shorter inked video and the other via a longer recorded PowerPoint lecture. Two sets of dependent variables were used to test modality effects: immediate post-tests scores and delayed retention post-test scores. A perceptions survey was also administered to assess student preferences between the 2 teaching modalities.

Results:

Students performed similarly on immediate and delayed post-tests for the shorter inked videos and the longer recorded PowerPoint lectures ( P > .05). Students reported greater engagement ( P < .05) and greater satisfaction with learning ( P < .05) with the inked videos than the recorded PowerPoint lectures.

Conclusions:

This study, although limited by its small-scale and single-institution design, provides preliminary evidence that online inked videos may be a more efficient and non-inferior alternative to recorded PowerPoint lectures.
Enhancing and accelerating stroke treatment in Eastern European region: Methods and achievement of the ESO EAST program
Authors: Mikulík Robert , Caso Valeria , Bornstein Natan M , Svobodová Veronika , Pezzella Francesca Romana , Grecu Andreea , Simsic Steven , Gdovinova Zuzana , Członkowska Anna , Mishchenko Tamara S , Flomin Yuriy , Milanov Ivan G , Andonova Silva , Tiu Cristina , Arsovska Anita , Budinčević Hrvoje , Groppa Stanislav A , Bereczki Daniel , Kõrv Janika , Kharitonova Tatiana , Vosko Milan R
Published: January 2020

Introduction

Despite the availability of prevention and therapies of stroke, their implementation in clinical practice, even of low-cost ones, remains poor. In 2015, the European Stroke Organisation (ESO) initiated the ESO Enhancing and Accelerating Stroke Treatment (EAST) program, which aims to improve stroke care quality, primarily in Eastern Europe. Here, we describe its methods and milestones.

Patients and methods

The ESO EAST program is using an implementation strategy based on a ‘detecting-understanding-reducing disparities’ conceptual framework: stroke care quality is first measured (after developing a platform for data collection), gaps are identified in the current service delivery, and ultimately feedback is provided to participating hospitals, followed by the application of interventions to reduce disparities. The ESO EAST program is carried out by establishing a stroke quality registry, stroke management infrastructure, and creating education and training opportunities for healthcare professionals.

Results

Program management and leadership infrastructure has been established in 19 countries (Country Representatives in 22 countries, National Steering Committee in 19 countries). A software platform for data collection and analysis: Registry of Stroke Care Quality was developed, and launched in 2016, and has been used to collect data from over 90,000 patients from >750 hospitals and 56 countries between September 2016 and May 2019. Training in thrombolysis, nursing and research skills has been initiated.

Discussion

ESO EAST is the first pan-Eastern European (and beyond) multifaceted quality improvement intervention putting evidence-informed policies into practice. Continuous monitoring of stroke care quality allows hospital-to-hospital and country-to-country benchmarking and identification of the gaps and needs in health care.
The association between disease activity and patient-reported outcomes in patients with moderate-to-severe ulcerative colitis in the United States and Europe
Authors: Armuzzi Alessandro , Tarallo Miriam , Lucas James , Bluff Daniel , Hoskin Benjamin , Bargo Danielle , Cappelleri Joseph C. , Salese Leonardo , daCosta DiBonaventura Marco
Published: January 2020

Background

Patients with ulcerative colitis (UC) experience periods of recurring and episodic clinical signs and symptoms. This study sought to establish the association between disease activity and health-related quality of life (HRQoL) and other patient-reported outcomes.

Methods

United States (US) and European Union 5 ([EU5]; i.e., France, Germany, Italy, Spain, and the United Kingdom) data from the 2015 and 2017 Adelphi Inflammatory Bowel Disease-Specific Programme (IBD-DSP) were used. The IBD-DSP is a database of retrospective patient chart information integrated with patient survey data (EuroQoL-5 Dimensions [EQ-5D], Short Quality of Life in Inflammatory Bowel Disease Questionnaire [SIBDQ], and Work Productivity and Activity Impairment-Ulcerative Colitis [WPAI-UC] questionnaire).

Using available chart information, physicians classified their moderate-to-severe patients into one of the following categories: remission with a Mayo endoscopic score = 0 (“deep remission”), remission without a Mayo endoscopic score = 0 (“remission”), or active disease. Differences among disease activity categories with respect to patient-reported outcomes were analyzed using generalized linear models, controlling for confounding variables.

Results

N = 289 and N = 1037 patient charts with linked surveys were included from the US and EU5, respectively. The disease activity distribution was as follows: active disease = 40.1% (US) and 33.6% (EU5); remission = 48.0 and 53.0%; deep remission = 11.9 and 13.3%. Patients with active disease reported significantly lower levels of EQ-5D health state utilities (adjusted mean [AdjM] = 0.87 [US] and 0.78 [EU5]) compared with remission (AdjM = 0.92 and 0.91) and deep remission (AdjM = 0.93 and 0.91) (all P < 0.05 compared with active disease within each region). Similar findings were observed with the scores from the SIBDQ and the WPAI-UC. No significant differences were observed between remission categories.

Conclusions

Among patients with moderate-to-severe UC in the US and EU5, active disease was associated with significant impairments in HRQoL, work and leisure activities. These results reinforce the importance, to both the patient and society, of achieving some level of remission to restore generic and disease-related HRQoL and one’s ability to work productively.
Study protocol: HipSTHeR - a register-based randomised controlled trial – hip screws or (total) hip replacement for undisplaced femoral neck fractures in older patients
Authors: Wolf Olof , Sjöholm Pontus , Hailer Nils P. , Möller Michael , Mukka Sebastian
Published: January 2020

Background

Femoral neck fractures (FNFs), which are common in the older population, are associated with high mortality and morbidity. Some 20% of FNFs are undisplaced (uFNFs). The routine surgical procedure for uFNFs is internal fixation (IF) with 2–3 screws/pins with a reported reoperation rate in older patients (age ≥ 75 years) of up to 21%. The reoperation rate for hemiarthroplasties for displaced fractures is lower than for undisplaced fractures operated with IF. This study will aim to determine whether the outcome for older patients with an uFNF can be improved by replacing the hip instead of preserving it.

Methods

A national multicentre, register-based, randomised controlled trial (rRCT) will be conducted. For this trial, 1440 patients, ≥75 years with an acute uFNF, will be allocated. Eligible patients will be identified by the Swedish Fracture Register (SFR) platform, which will notify the admitting orthopaedic surgeon of eligibility. After informed consent has been given and documented, patients will be randomised to either IF (control group) or arthroplasty (intervention group) within the SFR platform. Injury mechanism, fracture classification, date of injury, and type of treatment are registered in the SFR. Type and brand of arthroplasty, surgical approach, and fixation are obtained from the Swedish Hip Arthroplasty Register (SHAR). The study cohort from the SFR will be cross-checked with the National Patient Register and the SHAR for outcome variables at 2, 5, and 10 years.

The primary outcome will be a composite variable comprising reoperation rate and mortality at 2 years postoperatively. Secondary endpoints will include reoperation rate and mortality as stand-alone variables. In addition, secondary endpoints will be patient-reported outcomes as measured by the Short Musculoskeletal Functional Assessment questionnaire at 1 year postoperatively as routinely collected within the SFR. Further secondary endpoints will include the occurrence of adverse events such as pneumonia, stroke or myocardial infarction and evaluation of the external validity of the study.

Discussion

This large, multicentre, register-based randomised controlled trial could potentially shift the treatment of uFNFs in older patients towards primary hip arthroplasty in order to improve the outcome.

Trial registration

The trial is registered at www.clinicaltrials.gov (NCT03966716); May 29, 2019.
Research on the health of and interventions for family caregivers of people with dementia: a bibliometric analysis of research output during 1988–2018
Authors: Shi Hui , Mao Chen , Tang Jinling , Liang Huiying
Published: January 2020

Background

Dementia is a serious and growing health problem, and since most people with dementia live at home, caring responsibilities generally fall on family members. Caregivers are often inadequately supported by formal health services and have poorer psychological and physical health. Our study aimed to compare the contributions of publications from different countries, institutions and authors and present a bibliometric analysis to determine the hotspots and trends in research concerning the health of and interventions for family dementia caregivers.

Methods

Studies published during 1988–2018 were extracted from the Science Citation Index Expanded of the Web of Science. Each abstract of publications was evaluated to obtain the basic information. A bibliometric analysis was used to evaluate the number or cooperation networks of publications, countries, institutions, journals, citations, authors, references, and keywords. The resulting articles were analyzed descriptively, and the publication keywords were visualized using VOSviewer.

Results

Five hundred forty-two articles were identified. The annual number of relevant publications has steadily increased since approximately 2006. The USA has the highest number of publications (36.2%), followed by the UK (12.9%). China entered the field late, but research conducted in China has rapidly developed. The most productive institution, journal, and author in this field are University College London, the Journal of the American Geriatrics Society, and Orrell M from the UK, respectively. A co-occurrence analysis of the keywords reveals a mainstream research focus on burden, depression, quality of life, and corresponding interventions for people with dementia caregivers. The keywords “psychosocial intervention”, “long-term”, “e-learning/online”, “communication”, and “qualitative research” reflect the latest hotspots, appearing in approximately 2017–2018.

Conclusion

Our study details the performance statistics, main topics and trends research on the health of and interventions for dementia caregivers from 1988 to 2018 and provides a comprehensive analysis.