bluuebunny/crossref_metadata_2025 huggingface dataset:
Afatinib as first-line treatment in patients with EGFR-mutated non-small cell lung cancer in routine clinical practice
Authors: Brückl Wolfgang M. , Reck Martin , Griesinger Frank , Schäfer Harald , Kortsik Cornelius , Gaska Tobias , Rawluk Justyna , Krüger Stefan , Kokowski Konrad , Budweiser Stephan , Ficker Joachim H. , Hoffmann Christopher , Schüler Andrea , Laack Eckart
Published: May 2021

Background:

Lung cancer is a leading cause of cancer-related death in Germany and worldwide. Non-small cell lung cancer (NSCLC) comprises ~80% of lung cancer diagnoses; in White patients, around 10% of NSCLC cases are epidermal growth factor receptor mutation-positive ( EGFRm+). Head-to-head clinical trials have demonstrated superior efficacy with second-/third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) versus first-generation EGFR TKIs in EGFRm+ NSCLC. Data from routine clinical practice are necessary to confirm that clinical trial findings are transferable to real-world populations.

Methods:

In NCT02047903, a prospective non-interventional study in Germany, patients with EGFRm+ NSCLC received first-line afatinib until disease progression or intolerable adverse events. Key objectives were progression-free survival (PFS) rate at 12 months, objective response rate (ORR) and overall survival (OS). Safety/tolerability was also assessed.

Results:

Of 152 patients, 106 (69.7%) were female, 20 (13.1%) patients had an uncommon EGFR mutation and 51 patients (33.6%) had brain metastases. A starting dose of <40 mg was received by 39 (25.7%) patients. Overall, the 12-month PFS rate was 50.2% while the median PFS was 12.2 months. The ORR was 74.6% and the median OS was 30.4 months. In patients with brain metastases and uncommon mutations, the median PFS was 10.5 and 10.7 months, and the ORR was 77.3% and 83.3%, respectively. Treatment effectiveness was similar in patients with a starting dose of <40 mg (median PFS: 16.4 months; ORR, 81.3%) and a starting dose of 40 mg (median PFS: 10.8 months; ORR, 72.1%). Adverse drug reactions were manageable and consistent with the known afatinib safety profile.

Conclusion:

The results support clinical trial data for afatinib in routine clinical practice, including in patients generally excluded from clinical trials. Outcomes were positive in patients with uncommon EGFR mutations and in those with brain metastases. Treatment benefit was also seen in patients receiving a <40 mg afatinib starting dose, supporting patient-tailored dosing.
The Illusion of Electoral Stability: From Party System Erosion to Right-Wing Populism in Brazil
Authors: Borges André
Published: May 2021

Although comparative research has relied heavily on electoral volatility as a proxy for party system institutionalisation (PSI), this measure cannot account for the patterns of interparty interactions that are key to determine the degree of party system stability. I develop a new measure – the party bloc volatility (PBV) index – to account for consistency in the ideological positions and in the partisan composition of the government and opposition blocs. I demonstrate the limitations of the index of electoral volatility by analysing the case of Brazil. Although electoral volatility substantially decreased between 1994 and 2010, the patterns of interparty alliances became less and less predictable from 2002 onwards, as party fragmentation increased while interparty ideological differences decreased. In combination with a major economic and political crisis, these trends led to the discrediting of the established parties and thus favoured the rise of the extreme right in the 2018 elections.
The Endocrine Hospitalist: Enhancing the Quality of Diabetes Care
Authors: Zilbermint Mihail
Published: May 2021

The endocrine hospitalist and inpatient diabetes management team increases access to endocrinology consultations and improves glycemic control and quality metrics such as length of stay and hospital readmission. Enhanced glycemic care is needed in both academic and community hospital settings. Endocrine fellowship programs should implement endocrine hospitalist rotations with emphasis on training endocrine fellows to deliver fast-paced inpatient endocrine care. Entrepreneurship, innovation, and a “start-up” culture within the field of Endocrinology should be encouraged and supported by healthcare systems.
Impact of Carbohydrate Counting Error on Glycemic Control in Open-Loop Management of Type 1 Diabetes: Quantitative Assessment Through an In Silico Trial
Authors: Roversi Chiara , Vettoretti Martina , Del Favero Simone , Facchinetti Andrea , Choudhary Pratik , Sparacino Giovanni
Published: May 2021

Background:

In the management of type 1 diabetes (T1D), systematic and random errors in carb-counting can have an adverse effect on glycemic control. In this study, we performed an in silico trial aiming at quantifying the impact of different levels of carb-counting error on glycemic control.

Methods:

The T1D patient decision simulator was used to simulate 7-day glycemic profiles of 100 adults using open-loop therapy. The simulation was repeated for different values of systematic and random carb-counting errors, generated with Gaussian distribution varying the error mean from -10% to +10% and standard deviation (SD) from 0% to 50%. The effect of the error was evaluated by computing the difference of time inside (∆TIR), above (∆TAR) and below (∆TBR) the target glycemic range (70-180mg/dl) compared to the reference case, that is, absence of error. Finally, 3 linear regression models were developed to mathematically describe how error mean and SD variations result in ∆TIR, ∆TAR, and ∆TBR changes.

Results:

Random errors globally deteriorate the glycemic control; systematic underestimations lead to, on average, up to 5.2% more TAR than the reference case, while systematic overestimation results in up to 0.8% more TBR. The different time in range metrics were linearly related with error mean and SD ( R2>0.95), with slopes of [Formula: see text], [Formula: see text] for ∆TIR, [Formula: see text], [Formula: see text] for ∆TAR, and [Formula: see text], [Formula: see text] for ∆TBR.

Conclusions:

The quantification of carb-counting error impact performed in this work may be useful understanding causes of glycemic variability and the impact of possible therapy adjustments or behavior changes in different glucose metrics.
Epidemiology of Acute Extensor Mechanism Injuries in Collegiate-Level Athletes in the United States
Authors: Chen Kevin K. , Chan Jimmy J. , Ranson William , Debellis Nicholas , Huang Hsin-Hui , Vulcano Ettore , Colvin Alexis
Published: May 2021

Background:

Extensor mechanism injuries involving the quadriceps tendon, patella, or patellar tendon can be a devastating setback for athletes. Despite the potential severity and relative frequency with which these injuries occur, large-scale epidemiological data on collegiate-level athletes are lacking.

Study Design:

Descriptive epidemiology study.

Level of Evidence:

Level 4.

Methods:

Knee extensor mechanism injuries across 16 sports among National Collegiate Athletic Association (NCAA) men and women during the 2004-2005 to 2013-2014 academic years were analyzed using the NCAA Injury Surveillance Program (NCAA-ISP). Extensor mechanism injuries per 100,000 athlete-exposures (AEs), operative rate, annual injury and reinjury rates, in-season status (pre-/regular/postseason), and time lost were compiled and calculated.

Results:

A total of 11,778,265 AEs were identified and included in the study. Overall, 1,748 extensor mechanism injuries were identified, with an injury rate (IR) of 14.84 (per 100,000 AEs). N = 114 (6.5%) injuries were classified as severe injuries with a relatively higher median time loss (44 days) and operative risk (18.42%). Male athletes had higher risk of season-ending injuries in both all (3.20% vs 0.89%, P < 0.01) and severe (41.54% vs 16.33%, P < 0.01) extensor mechanism injuries. Similarly, contact injuries were more frequently season-ending injuries (4.44% vs 1.69%, P = 0.01). Women’s soccer (IR = 2.59), women’s field hockey (IR = 2.15), and women’s cross country (IR = 2.14) were the sports with the highest rate of severe extensor mechanism injuries.

Conclusion:

Extensor mechanism injuries in collegiate athletes represent a significant set of injuries both in terms of volume and potentially to their athletic careers. Male athletes and contact injuries appear to have a greater risk of severe injuries. Injuries defined as severe had a higher risk of operative intervention and greater amount of missed playing time.

Clinical Relevance:

Knowledge of the epidemiology of extensor mechanism injuries may help clinicians guide their athlete patients in sports-related injury prevention and management.
Acute Subdural Hemorrhage as the Initial Presentation of Intracranial Hypotension Following Cervical Chiropractic Manipulation: A Case Report and Systematic Review
Authors: Fernando Emmaline Z. , Jamora Roland Dominic G. , Torio Erickson F. , Mariano Manuel M. , Cuanang Joven R. , de Guzman Vincent E.
Published: May 2021

Spontaneous intracranial hypotension (SIH) still remains an underdiagnosed etiology of new-onset headache. Important risk factors include chiropractic manipulation (CM). We present a case of a 36-year-old Filipino woman who presented with severe bifrontal and postural headache associated with dizziness, vomiting, and doubling of vision. A cranial computed tomography scan was done which showed an acute subdural hematoma (SDH) at the interhemispheric area. Pain medications were given which afforded minimal relief. On history, the headaches occurred 2 weeks after cervical CM. Cranial and cervical magnetic resonance imaging revealed findings supportive of intracranial hypotension and neck trauma, respectively. The patient improved with conservative management. We found 12 articles on SIH and CM after a systematic review of literature. Eleven patients (90.9%) initially presented with orthostatic headache. Eight patients (66.7%) were initially treated conservatively but only 5 (62.5%) had complete recovery. Recovery was achieved within 14 days from start of supportive therapy. Among the 3 patients who failed conservative treatment, 2 underwent non-directed epidural blood patch and one required neurosurgical intervention. This report highlights that a thorough history is warranted in patients with new onset headache. A history of CM must be actively sought. The limited evidence from the case reports showed that patients with SIH and SDH but with normal neurologic examination and minor spinal pathology can be managed conservatively for less than 2 weeks. This review showed that conservative treatment in a closely monitored environment may be an appropriate first line treatment.
Case Report: Opsoclonus-Myoclonus Syndrome Associated With Contactin-Associated Protein-Like 2 and Acetylcholine Receptor Autoantibodies in the Setting of Non-Small Cell Lung Carcinoma
Authors: Rosenow Christian S. , Dawit Sara , Farrugia Luca P. , Henry, MA Katharine A. , Sharma Akanksha , McKeon Andrew , Porter Alyx B. , Grill Marie F.
Published: May 2021

Opsoclonus myoclonus syndrome (OMS) is a rare immune-mediated paraneoplastic or para/-post-infectious syndrome characterized by “dancing” eye movements, myoclonus, and ataxia. Neuropsychiatric symptoms have also been reported. Without treatment, OMS may progress to further neurological impairment and even death. Autoimmune attack of CNS structures in OMS is most commonly mediated by anti-Ri (also known as ANNA2) IgG antibodies, with additional findings implicating antibodies targeting various neurotransmitter receptors. Prompt immunotherapy and neoplasm treatment may result in improvement. We report a novel association of Contactin-Associated Protein-Like 2 (Caspr2) antibodies occurring in association with paraneoplastic OMS. While breast cancer and small cell lung cancer (SCLC) are more commonly associated with OMS among adults, we characterize a novel association between Caspr2 antibody in a patient with mixed non-small cell and small cell lung carcinoma.
Mentorship for Doctor of Education Candidates: Exploring Sustainability, Networking, and Expected Outcomes within a Mentoring Program
Authors: Geesa Rachel Louise , McConnell Kat R. , Brown Rebecca D.
Published: May 2021

Candidates who pursue a Doctor of Education (EdD) often have a unique set of challenges as these candidates typically hold professional leadership roles in schools, districts, or organizations while taking courses and completing a dissertation. EdD candidates may benefit from participating in a mentoring relationship to gain social, emotional, academic, and career readiness support. In this paper, we explore perceptions of an EdD mentoring program related to sustainability, networking, and expected outcomes of their current mentoring opportunities. Perceptions of mentors’ and mentees’ self-efficacy, readiness, and progress are also studied in order to better support candidates in completing the doctoral program.
“Recovery warriors”: The National Eating Disorders Association’s online community and rhetorical vision
Authors: Aghazadeh Sarah A.
Published: May 2021

Mental health advocacy organizations play an important role in mitigating stigma and questioning the social norms that can create negative health outcomes. This essay explores how a U.S. advocacy organization attempted to facilitate shared meaning about a stigmatized health issue with its online community via rhetorical vision, or narrative that connects people in shared reality. Through the lens of symbolic convergence theory (SCT), a fantasy theme analysis of the National Eating Disorders Association’s (NEDA) social media messages and comments uncovered a recovery warrior metaphor that framed eating disorder recovery as a heroic journey. The analysis describes potential reasons why NEDA would attempt to foster a rhetorical vision informed by a warrior narrative, how it used warriors as a cue to facilitate vision, and the tensions within the community that expose the evolution and limitations of recovery warriors to constitute a rhetorical vision and community. Theoretical implications are offered at the intersections of public relations and SCT. These implications provide a roadmap for advocacy organizations attempting to build symbolic community and shared narratives online in the context of stigmatized health conditions while also interrogating organizational power to shape rhetorical visions.
When public relations can heal: An embodied theory of silence for public communication
Authors: Archetti Cristina
Published: May 2021

This article extends the conceptualization of silence in public relations beyond strategic communication. It develops a new theoretical framework to explain the mechanisms through which suffering and pain felt inside the body translate into silence, exclusion from public debate, and communication gaps in health communication. This happens through intermediate steps that involve, among others, the role of the media in the narrative construction of the body and the self. This framework advances an understanding of public relations oriented towards civil society and is based on the empirical case study of involuntary childlessness (i.e. not having children not by choice): even in the age of ubiquitous communication, despite affecting about 25% of the adult population of virtually all developed countries, this issue is shrouded in taboo and seldom heard of. The analysis makes the case for a more material, indeed embodied, approach to conceptualizing silence in public relations.
Cryptococcosis complicating diabetes mellitus: a scoping review
Authors: Nsenga Lauryn , Kajjimu Jonathan , Olum Ronald , Ninsiima Sandra , Kyazze Andrew Peter , Ssekamatte Phillip , Kibirige Davis , Baluku Joseph Baruch , Andia-Biraro Irene , Bongomin Felix
Published: May 2021

Background:

A better understanding of the epidemiology of cryptococcal infection in HIV-negative individuals is an international research interest. Immune dysfunction in diabetes mellitus (DM) significantly increases the risk of acquiring and reactivation of infection due to Cryptococcus neoformans. Risk factors and outcomes of cryptococcosis in DM are not well documented.

Objective:

The objective of this study was to determine the clinical characteristics and outcomes of cryptococcal infections in persons living with DM.

Methods:

MEDLINE (via PubMed), EMBASE, and the Cochrane Library databases were searched in November 2020. The searches covered the period between 1980 and 2020.We included studies that reported confirmed cryptococcosis in patients with DM. Reference lists of included articles were also searched, and additional studies were included if appropriate. No language restriction was applied. Single case reports, case series and original articles were included whereas review articles were excluded.

Results:

A total of 28 studies (24 single case reports, 4 retrospectives) were included involving 47 unique patients from Asia (17 cases), North America (six cases), South America (three cases) and Africa (two cases). Men constituted 75% ( n = 18) of the cases. Median age was 60.5 (range: 27–79) years. The majority of the patients had cryptococcal meningitis (68.1%, n = 32) followed by disseminated cryptococcosis (6.4%, n = 7), and others (isolated cutaneous disease one, peritonitis one, pleural one, thyroid one, adrenal one). Diagnosis was achieved through either culture and microscopy (38/47), cryptococcal antigen tests (9/47) or histopathology (9/47) singly or in a combination. All-cause mortality was 38.3% ( n = 18). Among those with meningitis mortality was 36.2%.

Conclusion:

A wide spectrum of cryptococcal infections with varying severity occurs in DM. Mortality remains unacceptably high. There is a need for more studies to characterize better cryptococcal disease in DM.
Butler, Chakrabarty and the possibilities of radical postsecular politics
Authors: Ort Jakub
Published: May 2021

This article interprets critiques of secularity and the related concept of history as progress in the work of Dipesh Chakrabarty and Judith Butler. At the same time, it defends their approach against the criticism voiced by Gregor McLennan. It shows that the postsecular conception of the politics of both authors is not just an attempt to open public space to a wider range of religious and cultural voices. Rather, it is a critique of the way in which political secularism and the ideology of progress are used by the modern state to legitimize the exercise of its own power. Butler and Chakrabarty's postsecular policy is thus based primarily on coalition building against these legitimization frameworks, which opens up the possibility of forming new postsecular political subjects. It illustrates the theoretical approach of both authors with an example of the church sanctuary movement in Germany.
Cerebral Perfusion in Hemodialysis Patients: A Feasibility Study
Authors: Vanderlinden Jessica Anne , Holden Rachel Mary , Scott Stephen Harold , Boyd John Gordon
Published: May 2021

Background:

Patients on hemodialysis (HD) are known to exhibit low values of regional cerebral oxygenation (rSO2) and impaired cognitive functioning. The etiology of both is currently unknown.

Objective:

To determine the feasibility of serially monitoring rSO2 in patients initiating HD. In addition, we sought to investigate how rSO2 is related to hemodynamic and dialysis parameters.

Design:

Prospective observational study.

Setting:

Single-center tertiary academic teaching hospital in Ontario, Canada.

Participants:

Six patients initiating HD were enrolled in the study.

Methods:

Feasibility was defined as successful study enrollment (>1 patient/month), successful consent rate (>70%), high data capture rates (>90%), and assessment tolerability. Regional cerebral oxygenation monitoring was performed 1 time/wk for the first year of dialysis. A neuropsychological battery was performed 3 times during the study: before dialysis initiation, 3 months, and 1 year after dialysis initiation. The neuropsychological battery included a traditional screening tool: the Repeatable Battery for the Assessment of Neuropsychological Status, and a robot-based assessment: Kinarm.

Results:

Our overall consent rate was 33%, and our enrollment rate was 0.4 patients/mo. In total 243 rSO2 sessions were recorded, with a data capture rate of 91.4% (222/243) across the 6 patients. Throughout the study, no adverse interactions were reported. Correlations between rSO2 with hemodynamic and dialysis parameters showed individual patient variability. However, at the individual level, all patients demonstrated positive correlations between mean arterial pressure and rSO2. Patients who had more than 3 liters of fluid showed significant negative correlations with rSO2. Less cognitive impairment was detected after initiating dialysis.

Limitation:

This small cohort limits conclusions that can be made between rSO2 and hemodynamic and dialysis parameters.

Conclusions:

Prospectively monitoring rSO2 in patients was unfeasible in a single dialysis unit, due to low consent and enrollment rates. However, rSO2 monitoring may provide unique insights into the effects of HD on cerebral oxygenation that should be further investigated.

Trial Registration:

Due to the feasibility nature of this study, no trial registration was performed.
Mobile health apps: An exploration of user-generated reviews in Google Play Store on a physical activity application
Authors: Al-Abbadey Miznah , Fong Megan M-W , Wilde Laura J , Ingham Roger , Ghio Daniela
Published: May 2021

Objective

This study aimed to evaluate reviews that have been posted publicly on the app ‘MapMyRun’ to investigate which features were associated with usage of the app. A secondary aim was to determine whether MapMyRun consisted of specific behaviour change techniques that would have increased the likelihood of users being engaged with the app.

Methods

Reviews posted on MapMyRun by users between 1st May 2017- 30th April 2018 were extracted, coded and analysed using content analysis.

Results

Eleven behaviour change techniques were identified among the features of MapMyRun. A total of 3,253 reviews met the inclusion/exclusion criteria, and 12 codes were developed. The codes were grouped into 8 subthemes within 2 main themes: ‘Effort’ and ‘Self-monitoring’. Consistent with previous literature, ‘Goal-Setting’ and ‘Self-Monitoring of Behaviour’ were two techniques included in MapMyRun. Social features of MapMyRun facilitated competition among users, their family, and friends.

Conclusions

This was the first qualitative review to assess a single mobile health physical activity app and analyse it from the perspectives of the users. Creators of future mobile health apps should focus on user friendliness and the use of social features, as both may increase the chances of users’ continued use with the app.
Returning life to society: Biography as a narrative of the whole
Authors: Zhao Bingxiang
Published: May 2021

Biography is a unique form of narration in ethnography and historiography. This article attempts to position Lin Yueh-Hwa’s works within the context of sociological and anthropological debate since the 1920s. In doing so it explores the potential uses of the biographical method in the study of Chinese history and society. Although Lin was a bearer of the biographical tradition of Chinese literature and history, his works were also profoundly influenced by both the narrative method of life history in the United States and social-life studies in France. In addition to these two influential biographical traditions, anthropologists in Britain developed the genealogical approach to investigating sacred kingship. This study regards these three traditions of individual-life biography, social-life studies and genealogy as a “biographic triad”. Relevant works in contemporary Chinese sociology and anthropology are reviewed within this framework. It is conceivable that phenomenological description alone is insufficient when applying the biographical method. One must take into consideration Chinese centralized power and the overall social structure of China. Only by placing “life biography” against society’s ever-changing processes can one turn individual stories into powerful narratives depicting the whole structure of Chinese social life.
Compiling Life-Oriented Moral Education Textbooks for Elementary Schools in China: The Mimetic Approach in Morality and Law
Authors: Tang (唐燕) Yan
Published: May 2021

Purpose:

This study explores a novel approach to compiling life-oriented moral textbooks for elementary schools in China, specifically focusing on Morality and Law.

Design/Approach/Methods:

Adopting Aristotle’s Poetics as its theoretical perspective, this study illustrates and analyzes the mimetic approach used in compiling the life-oriented moral education textbook, Morality and Law.

Findings:

The mimetic approach involves imitating children's real activities, thoughts, and feelings in textbooks. The mimetic approach to compiling life-oriented moral textbooks comprises three strategies: constructing children's life events as building blocks for textbook compilation, designing an intricate textual device exposing the wholeness of children's life actions, and designing inward learning activities leading to children's inner worlds.

Originality/Value:

From the perspective of Aristotle's Poetics, the approach to compilation in Morality and Law can be defined as mimetic. And the compilation activity in the life-oriented moral education textbook also can be described as a process of mimesis. So this article presents a new approach to compile moral education textbooks and  an innovative way to understand the nature of one compiling activity.
Obesity Management Education Needs Among General Internists: A Survey
Authors: Nanda Sanjeev , Adusumalli Jayanth , Hurt Ryan T. , Ghosh Karthik , Fischer Karen M. , Hagenbrock Martha C. , Ganesh Ravindra , Ratrout Basem M. , Raslau David , Schroeder Darrell R. , Wight Elizabeth C. , Kuhle Carol L. , Thicke Lori A. , Lazik Natalia , Croghan Ivana T.
Published: May 2021

Objective

The purpose of this study was to determine self-reported knowledge, attitudes, prior experience, and perceived needs for the management of overweight and obese patients within a General Internal Medicine Practice.

Patients and Methods

An emailed cross-sectional survey was sent between June 20, 2019 and September 12, 2019 to 194 healthcare workers (93 primary care providers (PCPs) and 101 nurses) which focused on management of patients with weight issues.

Results

In total, 80 of the eligible 194 participants completed the survey (nurses = 42, PCPs = 38). Up to 87% were white, 74.7% female (74.7%). Most of the responders were either in the age group of 30’s (30%) or 50’s (30%). Among the responders, 48.8% reported some type of specialty training in weight management since their medical training with lectures being the most common form of training (36%). When asked about their interest in either weight management training or strategies to initiate weight conversations, 79% of the respondents reported an interest in education on weight management or strategies to initiate weight conversations, while 65.8% indicated they would be interested in both topics.

Conclusion

Our study suggests that healthcare workers have a self-reported need for further training in management of overweight and obese patients, irrespective of previous training in this area.
Aspergillus Endocarditis of Pulmonary Homograft in a Congenital Heart Disease Patient
Authors: Karangelis Dimos , Tzifa Aphrodite , Mylonas Konstantinos S. , Gatzoulis Michael A. , Kavvouras Charalampos , Mitropoulos Fotis
Published: May 2021

Aspergillus endocarditis (AE) is a life-threatening condition with mortality rates approximating 80%. Herein, we describe the case of a 19-year-old patient with congenitally corrected transposition of great arteries, ventricular septal defect, and pulmonary atresia, who underwent seven cardiac surgical procedures in the past. The patient was operated for AE of a previously implanted pulmonary valve homograft associated with septic pulmonary embolism and right heart failure but succumbed to multi-organ failure three months later. To our knowledge, this is one of two reported cases of Aspergillus infection of a pulmonary homograft, indicating the rarity of the disease.
School Counselors and Unified Educator–Counselor Identity: A Data-Informed Approach to Suicide Prevention
Authors: Morris Carrie A. Wachter , Wester Kelly L. , Jones Connie T. , Fantahun Saron
Published: May 2021

School counselors are vital in crisis prevention and intervention. In this article, we discuss the unified educator–counselor identity as it informs the suicide prevention work of school counselors, illustrated with a data-based case example from a quantitative study based in one high school. This case example includes a decision tree to show how school counselors can use data to understand the suicide prevention and intervention needs of a diverse student body in their own schools.
Embracing School Counselors’ Situatedness: Data-Based Decision Making as Fulfillment of a Complex Identity
Authors: Zyromski Brett , Griffith Catherine , Choi Jihyeon
Published: May 2021

Since at least the 1930s, school counselors have used data to inform school counseling programming. However, the evolving complexity of school counselors’ identity calls for an updated understanding of the use of data. We offer an expanded definition of data-based decision making that reflects the purpose of using data in educational settings and an appreciation of the complexity of the school counselor identity. We discuss implications for applying the data-based decision-making process using a multifaceted school counselor identity lens to support students’ success.
Marital Satisfaction as a Moderator of Molecular Genetic Influences on Mental Health
Authors: South Susan C. , Mann Frank D. , Krueger Robert F.
Published: May 2021

The quality of one’s romantic relationship is associated with mental health. Low levels of relationship quality may be a stressor that triggers a predisposition or diathesis to mental illness. Analyses were conducted to examine whether relationship quality moderated the association between polygenic risk scores (PRSs) for several mental health syndromes on phenotypic measures of those syndromes. Data were drawn from the Midlife in the United States (MIDUS) study of health and well-being. A subsample was genotyped, and PRSs were calculated. The PRS for anxiety was more strongly related to the anxiety phenotype when satisfaction was low than when satisfaction was high, providing evidence of a genetic susceptibility process between marital distress and anxiety. The expression of genetic influences on a phenotype in the presence of certain environmental stressors is complex and may depend on the specific phenotype and the methodology by which genetic influences are estimated.
The Futures We Want: How Goal-Directed Imagination Relates to Mental Health
Authors: Gamble Beau , Tippett Lynette J. , Moreau David , Addis Donna Rose
Published: May 2021

Imagination is an adaptive ability that can be directed toward the pursuit of personal goals. Although there is a wealth of research on goals and on imagination, few studies lie at the intersection—little is known about individual differences in goal-directed imagination. In 153 adults, we examined how 28 aspects of goal setting, pursuit, and goal-directed imagination relate to mental health. Higher well-being and lower depressive symptoms were strongly linked (a) to having goals that were more attainable, under control, and expected to bring more joy and (b) to goal-directed imagination that was clearer, more detailed, more positive, and less negative. Importantly, the emotional valence of goal-directed imagination strongly predicted well-being at a 2-month follow-up even after controlling for mental health at baseline. These findings underscore the relevance of goal-directed imagination to well-being and depressive symptoms and highlight potential targets for goal- and imagery-based interventions to improve mental health.
Polygenic Score for Smoking Is Associated With Externalizing Psychopathology and Disinhibited Personality Traits but Not Internalizing Psychopathology in Adolescence
Authors: Hicks Brian M. , Clark D. Angus , Deak Joseph D. , Liu Mengzhen , Durbin C. Emily , Schaefer Jonathan D. , Wilson Sylia , Iacono William G. , McGue Matt , Vrieze Scott I.
Published: May 2021

We examined whether a polygenic score (PGS) for smoking measured genetic risk for general behavioral disinhibition by estimating its associations with externalizing and internalizing psychopathology and related personality traits at multiple time points in adolescence (ages 11, 14, and 17 years; N = 3,225). The smoking PGS had strong associations with the stable variance across time for all the externalizing measures (mean standardized β = 0.27), agreeableness (β = −0.22, 95% confidence interval [CI] = [−0.28, −0.16]), and conscientiousness (β = −0.19, 95% CI = [−0.24, −0.13]) but was not significantly associated with internalizing measures (mean β = 0.06) or extraversion (β = 0.01, 95% CI = [−0.05, 0.07]). After controlling for smoking at age 17 years, the associations with externalizing, low agreeableness, and low conscientiousness remained statistically significant. The smoking PGS measures genetic influences that contribute to a spectrum of phenotypes related to behavioral disinhibition, including externalizing psychopathology and normal-range personality traits related to behavioral control but not internalizing psychopathology.
Selectively Interfering With Intrusive but Not Voluntary Memories of a Trauma Film: Accounting for the Role of Associative Memory
Authors: Lau-Zhu Alex , Henson Richard N. , Holmes Emily A.
Published: May 2021

Intrusive memories of a traumatic event can be reduced by a subsequent interference procedure, seemingly sparing voluntary memory for that event. This selective-interference effect has potential therapeutic benefits (e.g., for emotional disorders) and legal importance (e.g., for witness testimony). However, the measurements of intrusive memory and voluntary memory typically differ in the role of associations between a cue and the emotional memory “hotspots.” To test this, we asked participants to watch a traumatic film followed by either an interference procedure (reminder plus Tetris) or control procedure (reminder only). Measurement of intrusions (using a laboratory task) and voluntary memory (recognition for film stills) were crossed with the presence or absence of associative cues. The reminder-plus-Tetris group exhibited fewer intrusions despite comparable recognition memory, replicating the results of prior studies. Note that this selective interference did not appear to depend on associative cues. This involuntary versus voluntary memory dissociation for emotional material further supports separate-trace memory theories and has applied advantages.
Subaxial Cervical Pedicular Screw Insertion via the Nonanatomic Axis: Technical Notes and Preliminary Clinical Report
Authors: Wang Yingbo , Hu Bo , Wu Jian , Chen Wei , Wang Zhong , Liu Mingyong , Zhao Jianhua , Liu Peng
Published: May 2021

Study Design:

Retrospective study.

Objective:

To report the technical details of subaxial cervical pedicular screw insertion via the nonanatomic axis (nAA-CPS) and evaluate its clinical safety and accuracy.

Methods:

The nAA-CPS technique was performed in 21 patients. Preoperative and intraoperative management-related details are described, and a manipulation protocol is presented. Clinical outcomes were used to assess the safety and accuracy of screws was evaluated using postoperative computed tomography (CT) according to the pedicle perforation grading system, and the nonanatomic pedicle transverse angle (nPTA) and nonanatomic pedicle axis length (nPAL) were assessed based on pre- and postoperative CT images.

Results:

According to “one constant entry point (EP) and two perpendicular trajectory angles” protocol, nAA-CPS was performed without much interference from the muscles. No intraoperative or postoperative neurovascular complications related to the technique were observed. Of the 112 inserted screws, 78 (69.64%) were assessed as grade 0, 24 (21.43%) as grade 1, 4 (3.57%) as grade 2 and 6 (5.36%) as grade 3. The overall rate of correct position (grades 0 and 1) was 91.07% (102/112), and the rate of malposition was 8.93% (10/112), including five screws implanted medially and the other five laterally. The nPTA was highly consistent on pre- and postoperative CT ( P < .05), while postoperative nPAL was significantly shorter than preoperative nPAL ( P > .05).

Conclusions:

Clinically, the accuracy and safety of nAA-CPS was similar to the traditional CPS technique. The protocol, derived from previous radiological studies and workshops, greatly helped standardize clinical manipulation; thus, nAA-CPS is a promising alternative to the traditional CPS.
Performance and Upskilling: Indian IT Sector Temporary Workers’ Job Insecurity Coping Strategies Identified Through Grounded Theory
Authors: Rajthilak R. , Singh Swati , Alok Swati
Published: May 2021

Globally, the demand for temporary workers is rising across organizations and sectors, driven by benefits of lower cost and workforce flexibility. Flexibility for organizations, however, means job insecurity for the temporary worker. This study focuses on understanding how the Indian IT sector’s temporary agency workers (TAWs), that is, temporary workers recruited by staffing agencies to work with client organizations, cope with their job insecurity. Grounded theory-based analysis of 36 interviews revealed that TAWs rely on enhancing their employability as the primary strategy to combat job insecurity. In addition, to enhance employability, TAWs make proactive efforts to perform consistently and upskill continuously. TAWs also expect support, largely in the form of learning and development opportunities, from the staffing agency and client to augment employability. The findings and recommendations in this article to help TAWs improve employability hold significance for TAWs, staffing agencies as well as clients. With enhanced employability, TAWs overcome job insecurity—an impediment to job performance, which is of direct relevance to the worker and the client—and also affects the staffing agency’s long-term relationship with the client.
Accordion: A Useful and Workable Classification of Complications After Breast Reconstructive Surgery
Authors: Jończyk Justyna , Jankau Jerzy
Published: May 2021

Background: The aim of this study was to evaluate whether Accordion Severity Grading System can serve as a tool for classification, and severity assessment in reporting postoperative complications after breast reconstructive surgery. Methods: A retrospective analysis covered 88 breast reconstruction surgeries following mastectomy and prophylactic breast amputation with simultaneous reconstruction conducted from January 2015 to December 2017. All registered postoperative complications were evaluated using the Accordion Severity Grading System. The time horizon selected was 6 weeks after surgery. Results: Eighty-two adverse events which met the criteria for complications according to the Accordion classification were observed in 53.4% (n = 47) of the patients. The highest percentage of complications was observed in the group where reconstruction involved using autologous tissues (pedicled transverse rectus abdominis myocutaneous), which were associated with 77.4% risk of complications. In patients with combined methods (latissimus dorsi + prosthesis), complications occurred in half of the cases (51.4%). In patients who underwent reconstructive procedures with artificial materials (expander/prosthesis), complications occurred in 20% of cases. A high γ correlation coefficient of 0.7 ( P < .001) was observed between the Accordion degree assigned to the patient and the length of hospital stay. A moderately strong correlation was found between the degree of Accordion system and rehospitalization rate (r = 0.54; P < .0001) and cost of hospital care (r = 0.65; P < .001). Discussion: Based upon the presented study, Accordion Severity Grading System is a workable, intuitive and universal scale for classifying and assessing the severity of postoperative complications and may be recommended for documenting complications in breast reconstructive procedures.
Posterior Interosseous Nerve Graft: Utilizing External Landmarks and Anthropometric Ratios to Predict Available Length for Digital Nerve Reconstruction in a Cadaveric Study
Authors: Vivace Bradley J. , Kachare Swapnil D. , Meredith Luke T. , Kachare Milind D. , Kapsalis Christina N. , Muresan Claude , Choo Joshua H. , Kasdan Morton L. , Wilhelmi Bradon J.
Published: May 2021

Objective:

In digital nerve defects that require grafting, autografts remain the efficacious option. The sensory posterior interosseous nerve (PIN) is an ideal choice as it is of similar caliber to digital nerves and leaves no donor morbidity upon resection. However, a finite length of harvestable PIN exists, and considerable variations of this length have been reported in the literature. There exists no predictive model to estimate this length. We sought to determine a method to accurately predict the available length of PIN based on individual patient anthropometry.

Methods:

A cadaveric dissection study was performed in a fresh tissue laboratory. The length of the sensory branch of the PIN and various anthropometric measurements were made in respect to surface anatomy of the ulna to develop a predictable ratio for available PIN donor graft.

Results:

A total of 16 specimens were obtained. On average the length of the PIN was 5.7 cm (range: 3.3-9. cm) and the length of the ulna was 25.7 cm (range: 23.5-30.6 cm). The ratio of PIN to ulnar length was 0.222 ( r = 0.4651). Using one-fifth the length of the ulna, the mean predicted length of the PIN was 5.14 cm (range: 4.7-6.1 cm). On univariate analysis, there was no significant difference between the measured and predicted PIN length ( P = .249).

Conclusion:

An anthropometric ratio predicated on reproducible surface anatomy of the ulna is a useful tool in predicting the sensory PIN length. Such a prediction may be a useful in guiding patient discussions concerning surgical options for digital nerve reconstruction.
Availability and Spatial Inequality of Rural Infrastructure in Jungle Mahal Blocks of Purulia District, India
Authors: Patra Uttam Kumar , Paul Suman
Published: May 2021

Rural infrastructure is fundamental and central to the concept of quality of life as well as human development. The major characteristic of regional development is the constant widening of regional disparity in India after different plan period. Various Finance Commissions and Planning Commissions laid emphasis on the objective of achieving balanced regional development. The article identifies a gap in terms of education, health, communication and financial infrastructure in the study of panchayats of Jungle Mahal blocks. Mapping of regional disparities can aid in effective policymaking at the preliminary stage of planning. Panchayat level inequality has been analysing using dimension index and principal component analysis (PCA). Wide disparities in the availability of rural infrastructure have been pointed out and proper recommendation has also been made to minimise the gap in spatial inequality.
Severe Sinus Bradycardia: An Unusual Cardiac Manifestation of COVID-19
Authors: Ali Mohammed , Awadelkarim Abdalaziz , Bishop Patrick , Alhusain Rashid , Adam Omeralfaroug , Subahi Ahmed , Elmoghrabi Adel , Afonso Luis
Published: May 2021

There has been an accumulating evidence of association between COVID-19 (coronavirus disease 2019) infection and cardiovascular complications. We describe a case of a 58-year-old lady with a history of systolic heart failure and COVID-19 infection, who developed persistent symptomatic bradycardia, requiring pacemaker placement as unusual conductive tissue involvement of this novel coronavirus.
Concussion in National Football League Athletes Is Not Associated With Increased Risk of Acute, Noncontact Lower Extremity Musculoskeletal Injury
Authors: Jildeh Toufic R. , Meta Fabien , Young Jacob , Page Brendan , Okoroha Kelechi R.
Published: May 2021

Background:

Impaired neuromuscular function after concussion has recently been linked to increased risk of lower extremity injuries in athletes.

Purpose:

To determine if National Football League (NFL) athletes have an increased risk of sustaining an acute, noncontact lower extremity injury in the 90-day period after return to play (RTP) and whether on-field performance differs pre- and postconcussion.

Study Design:

Cohort study, Level of evidence, 3.

Methods:

NFL concussions in offensive players from the 2012-2013 to the 2016-2017 seasons were studied. Age, position, injury location/type, RTP, and athlete factors were noted. A 90-day RTP postconcussive period was analyzed for lower extremity injuries. Concussion and injury data were obtained from publicly available sources. Nonconcussed, offensive skill position NFL athletes from the same period were used as a control cohort, with the 2014 season as the reference season. Power rating performance metrics were calculated for ±1, ±2, and ±3 seasons pre- and postconcussion. Conditional logistic regression was used to determine associations between concussion and lower extremity injury as well as the relationship of concussions to on-field performance.

Results:

In total, 116 concussions were recorded in 108 NFL athletes during the study period. There was no statistically significant difference in the incidence of an acute, noncontact lower extremity injury between concussed and control athletes (8.5% vs 12.8%; P = .143), which correlates with an odds ratio of 0.573 (95% CI, 0.270-1.217). Days (66.4 ± 81.9 days vs 45.1 ± 69.2 days; P = .423) and games missed (3.67 ± 3.0 vs 2.9 ± 2.7 games; P = .470) were similar in concussed athletes and control athletes after a lower extremity injury. No significant changes in power ratings were noted in concussed athletes in the acute period (±1 season to injury) when comparing pre- and postconcussion.

Conclusion:

Concussed, NFL offensive athletes did not demonstrate increased odds of acute, noncontact, lower extremity injury in a 90-day RTP period when compared with nonconcussed controls. Immediate on-field performance of skill position players did not appear to be affected by concussion.