bluuebunny/crossref_metadata_2025 huggingface dataset:
Charity Density and Social Need: A Longitudinal Perspective
Authors: McDonnell Diarmuid , Mohan John , Norman Paul
Published: March 2020

The distribution of charitable organizations in an equitable and socially just manner is a long-standing policy concern in the United Kingdom and many other jurisdictions. Geographic variations are important as they are linked to potentially inequitable service provision and opportunities for participation in voluntary activities. This study links large-scale administrative data on charities registered in England and Wales with local authority-level measures of material deprivation for 5 U.K. census years (1971–2011). Count and spatial regression models show evidence of nonlinear associations between charity density and social need, and changes in the shape of this distribution over time. In general, charity density is highest in the least deprived local authorities but this varies across different types of organizations and census years. These results provide important new insights into the evolving relationship between charity density and social need, and demonstrate the value of adopting more advanced, longitudinal statistical approaches for studying this phenomenon.
Can people on low incomes access affordable housing loans in urban Africa and Asia? Examples of innovative housing finance models from Reall’s global network
Authors: Jones Andrew , Stead Lisa
Published: March 2020

While delivering decent, affordable housing at scale is essential to global sustainable development, one formidable blockage is a lack of accessible housing finance for end users. People on low incomes have been perceived by lenders as high risk. They are excluded from financial systems and are forced to self-build using informal credit at exorbitant rates. This article engages with this problem, discussing practical examples and potential ways forward. It does so through case studies of models from Reall (a UK-based international development organization and social enterprise that promotes affordable homes) and its partner organizations in India, the Philippines, Nepal, Mozambique and Pakistan. The article evaluates the strengths and limitations of these models, and their potential for scaling up. Reall’s partners demonstrate that decent houses can be delivered at a cost that is accessible for potential low-income homeowners, while proving the viability of lending to borrowers in the bottom of the income pyramid. This is essential for demonstrating the commercial viability and impactful investment opportunity represented by affordable housing in urban Africa and Asia.
Urban water security: a comparative study of cities in the arid Americas
Authors: Díaz-Caravantes Rolando E , Zuniga-Teran Adriana , Martín Facundo , Bernabeu Marta , Stoker Philip , Scott Christopher
Published: March 2020

In this study we analyse how three cities in the arid Americas have addressed urban growth while facing water scarcity: Hermosillo, Mexico; Mendoza, Argentina; and Tucson, USA. We use the urban water security framework to examine five domains of water management: sociodemographic, economic, technological, ecological and governance (SETEG). Our analysis indicates that, in spite of water scarcity, urban growth has been promoted in the three cities. We argue that this expansion, although encouraged for economic development, is not sustainable in the long term. In the three cities, groundwater plays a major role in water supply, but growth has negatively affected riparian ecosystems, the health of the aquifers and access to domestic water. In order to pursue water security, several options are essential to enhance social–ecological system resilience. These include limits or reduction of urban expansion, reuse of treated effluent for riparian conservation, and community conservation efforts such as rainwater harvesting and other green infrastructure practices.
Holocene organic geochemical record from the Western Indus continental shelf (northern Arabian Sea)
Authors: Kahkashan Sanober , Chen Jianfang , Wang Xinhong , Clift Peter D , Jalali Bassem , Inam Asif , Saleem Monawwar , Aftab Javed , Ji Zhongqiang , Bai Youcheng , Li Zhongqiao , Haiyan Jin , Li Hongliang , Ran Lihua
Published: March 2020

Primary production on the Western Indus continental shelf has been linked to the large quantities of nutrients delivered to the shelf by the Indus River. Multiple geochemical tracers and biomarker records, including stable isotopes (δ13C and δ15N), total organic carbon (TOC), total nitrogen (TN), molar carbon/nitrogen (C/N) ratio, the branched and isoprenoid tetraether (BIT) index, and glycerol dialkyl glycerol tetraether (GDGT), have been analyzed from the Indus-23AP sediment core recovered from the northern Arabian Sea. Our records show evidence of a mixture of marine and terrestrially derived organic matter (OM) during the last 14,000 years, as indicated by the C/N ratio, δ13C, δ15N, and the BIT index. The three sterol biomarkers (brassicasterol, dinosterol, and cholesterol) show concurrent enrichments during the last 3 millennia reflecting increased phytoplankton abundance because of increased Indus river discharge of nutrients during the summer monsoon. GDGT crenarchaeol enrichment is related to the BIT index. The TEX86-derived sea surface temperature (SST) record is shifted toward the summer season because Crenarchaeota are more abundant and active during periods of high primary production. SSTs indicate a long-term warming trend during the Holocene related to increasing winter insolation in the low latitudes northern Hemisphere.
Neutrophil–lymphocyte ratio – a simple, accessible measure of inflammation, morbidity and prognosis in psychiatric disorders?
Authors: Zulfic Zlatan , Weickert Cynthia Shannon , Weickert Thomas W , Liu Dennis , Myles Nicholas , Galletly Cherrie
Published: March 2020

Objective:

A narrative review to describe the utility of the neutrophil-lymphocyte ratio (NLR) as an inflammatory marker in psychiatric and non-psychiatric disorders and to discuss the potential role of NLR in psychiatric research.

Conclusions:

NLR is inexpensive and readily available using division of two measures obtained on routine blood testing. NLR is elevated in a number of psychiatric disorders. It can predict morbidity and mortality in a wide range of non-psychiatric conditions, but this has not been confirmed in psychiatric conditions. It can be calculated in large, pre-existing datasets to investigate clinical correlates of inflammatory processes. NLR may have a future role in identifying patients with an inflammatory phenotype who could benefit from adjunctive anti-inflammatory medications.
Social hierarchies in democracies and authoritarianism: The balance between power asymmetries and principal-agent chains
Authors: Toelstede Björn
Published: March 2020

Social hierarchies exist in democracies as well as in authoritarian societies. However, their nature is different. Democratic hierarchies are built bottom-up through election while autocratic hierarchies are built top-down through domination. Both, however, have power asymmetries between the weaker citizens and the stronger politicians, which are amplified the stronger the hierarchies are. This manuscript introduces a model that combines pro-/anti-social behavior with different degrees of hierarchies. It is argued that this model has the power to categorize countries according to these criteria and indicate when and how societies move between democracy and authoritarianism. Importantly, I illustrate that the balance between power asymmetries and principal-agent chains is key for understanding when and why democracies sometimes transcend into authoritarianism.
Linking Calling With Workaholism: Examining Obsessive and Harmonious Passion as Mediators and Moderators
Authors: Dalla Rosa Anna , Vianello Michelangelo
Published: March 2020

Career calling is a positive construct that describes how much individuals see their work as a meaningful and consuming passion, experienced as a transcendent summons, that defines their identity, their life’s purpose, and contributes to the common good. Somewhat surprisingly, recent research suggested that calling fosters workaholism. In a cross-sectional study ( N = 235), we investigated obsessive and harmonious passion as mediators and moderators of the relation between calling and workaholism. Results suggested that the relation between calling and workaholism is completely mediated by obsessive passion and partially mediated by harmonious passion. In addition, we observed that obsessive passion moderates the relation between calling and workaholism, such that when obsessive passion is high, calling protects individuals from workaholism. These results put into question the so-called dark side of calling.
High-frequency disturbance force suppression mechanism of a flywheel equipped with a flexible dynamic vibration absorber
Authors: Huang Xiuchang , Su Zhiwei , Wang Sen , Wei Xinsheng , Wang Yong , Hua Hongxing
Published: March 2020

Flywheels generate speed-related disturbances and induce micro-vibrations that influence the performance of high-sensitivity instruments on board. This study addresses dynamic modeling and disturbance force suppression of the flywheels due to its inherent characteristic structural modes. The disturbance force transmission of a rotating flywheel due to a unit radial force applied at the rim of the wheel body is reported using the three-dimensional finite element method and frequency response function–based substructuring method. The characteristic structural modes for the radial and axial disturbance forces are identified. The axial deformation–dominated flapping mode and the radial deformation–dominated transverse mode will contribute most to the axial and radial disturbance forces, respectively. A flexible ring structure, which is rested on the arms of the wheel body through independent viscoelastic pads and simultaneously in contact with the inner rim of the wheel body by independent resilient cushion members, is proposed to function as a damped dynamic vibration absorber. The modes of the dynamic vibration absorber and the modes of the flywheel equipped with the dynamic vibration absorber are analyzed. It is shown that the dynamic vibration absorber is effective to suppress both the radial and axial disturbance forces at the characteristic structural modes under different rotational speeds, provided that the loss factor of the complex elastic modulus for the viscoelastic pads is larger than 0.2 and the proportional damping constant for the stiffness matrix is larger than 6 Ns/m. Experimental analyses are conducted on a flywheel with a well-designed dynamic vibration absorber to validate the theoretical findings. Modal tests and disturbance force measurements are carried out for the flywheel with/without the dynamic vibration absorber. It is shown that the identified characteristic structural modes will contribute remarkable peaks for the radial and axial disturbance forces. The proposed dynamic vibration absorber is capable to suppress the high-frequency disturbance forces efficiently under different rotational speeds.
Single pedicle advancement flap for treatment of feline stenotic nares: technique and results in five cases
Authors: Berns Chanel N , Schmiedt Chad W , Dickerson Vanna M , Murphy Sean M
Published: March 2020

Objectives

Brachycephalic obstructive airway syndrome (BOAS) is a common cause of upper airway obstruction in dogs, but is appreciated less commonly in cats. Of the components of BOAS, stenotic nares appear to play a major role in cats. However, the axial deviation of the alar wing, a common cause of nasal obstruction in dogs, is typically not present. We report a series of brachycephalic cats with a ventral nasal obstruction resulting from redundant skin along the floor of the nares. In these cats, surgical techniques developed for dogs were felt to be suboptimal. Our aim is to describe a novel surgical procedure designed specifically to surgically correct stenotic nares in cats with an obstructive fold of skin ventral to the nostril.

Methods

Five brachycephalic cats presenting for clinical signs of stenotic nares underwent surgical repair. In each case, a resection of the skin fold followed by a bilateral single pedicle advancement flap technique was performed. Postoperative outcomes were obtained by contacting owners by telephone.

Results

All cats had positive outcomes, resulting in immediate reduction of the nasal fold and opening of the nares. Owners noted resolution of stertor and no episodes of respiratory distress. No surgical complications were reported.

Conclusions and relevance

In brachycephalic cats, the ventral skin fold may be a significant contributor to stenotic nares, unlike dogs. Resection of the skin fold, followed by bilateral single pedicle advancement flaps is a novel technique and appeared to be successful for treating stenotic nares in this series of brachycephalic cats.
The velvet glove: Benevolent sexism in President Trump’s tweets
Authors: Scotto di Carlo Giuseppina
Published: March 2020

The present article is part of a preliminary study concerning the discursive manifestations of US President Trump’s sexist beliefs. While many studies have focused on Trump’s usage of hostile sexism, this work examines the linguistic strategies utilised by Trump to convey benevolent sexism, a form of discrimination based on the idea that women are weak and need to be protected, that they should respect traditional male-centric gender roles, and that they should be idolised by men. Drawing upon Fiske and Glick’s Ambivalent Sexism Theory, the study will analyse a corpus of all the positive tweets addressing women tweeted by Trump since the beginning of his 2016 campaign (July 2015). The study sheds a light on how President Trump’s usage of hostile and benevolent sexism are actually two sides of the same coin: they both confirm the idea of women as an inferior sex.
Writing bugchasing ethnoperformance: Creative representations of online interactions
Authors: García-Iglesias Jaime
Published: March 2020

In this piece, I discuss the creation of ethnoperformance as a method of exploring and representing online spaces. I highlight the need for writing that acknowledges the influence of technology in online communication and argue for the suitability of ethnodrama as a writing method. In particular, I focus on bugchasers – men who fetishize HIV – and their online discussions. Bugchasers’ comments to a forum, articulated as a five act ethnoperformance, serve as a case study to showcase how this form of writing allows users to discuss their negotiations of fantasy/reality while also acknowledging the uncertainty of online spaces and the mediation by technology. I finally defend the view that the visceral reactions ethnodrama produces generate interesting reflexive standpoints from which to research stigmatized practices and ideas.
Development of an individualized asynchronous sensor-based telerehabilitation program for patients undergoing total knee replacement: Participatory design
Authors: Naeemabadi MReza , Søndergaard Jesper Hessellund , Klastrup Anita , Schlünsen Anne Philbert , Lauritsen Rikke Emilie Kildahl , Hansen John , Madsen Niels Kragh , Simonsen Ole , Andersen Ole Kæseler , Kim Katherine K , Dinesen Birthe
Published: March 2020

Telerehabilitation programs can be employed to establish communication between patients and healthcare professionals and empower patients performing their training remotely. This study aimed to identify patients’ requirements after a total knee replacement following a self-training rehabilitation program, leading to the design and development of a telerehabilitation program that can meet the stakeholders’ actual needs. System design, development, and testing were conducted in five iterations based on a participatory design approach. Data collection was performed using interviews, observations, prototyping, and questionnaires. It was found that the main barriers facing the existing rehabilitation program were a lack of clear communication, lack of relevant information, and healthcare professional’s feedback. The participants emphasized the main themes of communication, information, training, and motivation in the process of design and development. In using the telerehabilitation program, the patients reported a high level of user-friendliness, flexibility, and a sense of security. This study has identified obstacles in the current rehabilitation program and revealed the potential effectiveness of using asynchronous communication and sensor-based technologies by employing participatory design and development. A higher level of portability and flexibility were observed. However, future studies and development are required to investigate the overall usability and reliability of the telerehabilitation program.
A smartphone application to improve the precision of biopsy site identification: A proof-of-concept study
Authors: DaCunha Matthew , Habashi-Daniel Arlette , Hanson Cody , Nichols Evan , Fraga Garth R
Published: March 2020

Dermatologists rely on skin biopsies to diagnose cutaneous tumors and rashes. Skin biopsy sites should be accurately identified with conventional anatomical site descriptors in the pathology request form. Reliance upon free-text entries to describe these biopsy sites is prone to user error and can cause medical misadventures such as wrong-site follow-up surgery. We sought to determine whether a smartphone application (RightSite) could improve the precision of biopsy site labeling. We conducted a prospective proof-of-concept study of 100 smartphone-assisted skin biopsy site identifiers with matched comparison to 100 historical controls. Student’s t-test was used to identify significant differences in the precision of anatomic descriptors before and after adoption of the application. We found a 69% improvement in precision of anatomic site labeling with the RightSite smartphone application (P < 0.0001). These data show smartphone-assisted biopsy site labeling improves the precision of anatomic site descriptors. Integrating graphical user interfaces into the electronic health records system could improve health care by standardizing anatomic site nomenclature and site-specific descriptors.
Research Note: Describing average illuminance for P-class roads
Authors: Fotios S , Robbins C
Published: March 2020

Design criteria for lighting in subsidiary roads usually include a minimum average horizontal illuminance, widely assumed to be the arithmetic mean illuminance. Analyses of the illuminance distributions over thirty road sections shows that the distributions are not normal and hence the median is more appropriate than the arithmetic mean as a measure of central tendency: the medians are significantly lower than the arithmetic means but the two are highly correlated. Design recommendations should state whether it is the arithmetic mean or median and not just the ‘average’ that is required.
miR-331-3p Suppresses Cell Proliferation in TNBC Cells by Downregulating NRP2
Authors: Zhao Mingchuan , Zhang Mengmeng , Tao Zhonghua , Cao Jun , Wang Leiping , Hu Xichun
Published: March 2020

Purpose:

Triple-negative breast cancer is characterized by fast progression with high possible for metastasis and poor survival. Dysfunction of microRNAs plays an important role in the initiation and progression of cancer. Our previous microRNA-seq data indicated the downregulation of miR-331-3p in triple-negative breast cancer tissues compared with that of the noncancer tissues. However, the function of miR-331-3p in triple-negative breast cancer remains largely unknown. Herein, the involvement of miR-331-3p in triple-negative breast cancer was investigated and the therapeutic potential of miR-331-3p was also explored.

Methods:

Real-time quantitative polymerase chain reaction was performed to detect the expression of miR-331-3p in triple-negative breast cancer tissues and cell lines. The cell proliferation was determined by the cell counting kit-8 assay. Apoptosis of triple-negative breast cancer cells was examined by annexin V/propidium iodide staining. miRDB database was used to predict the potential targets of miR-331-3p. Western blot was performed to examine the expression of the target protein.

Results:

miR-331-3p was significantly downregulated in triple-negative breast cancer tissues and cell line. Lower miR-331-3p expression was significantly correlated with the tumor size, TNM stage, and lymph node metastasis of patients with triple-negative breast cancer. Functional experiments showed that the overexpression of miR-331-3p inhibited the proliferation and increased apoptosis of triple-negative breast cancer cells. Neuropilin-2 was identified as a target of miR-331-3p, which harbored binding site of miR-331-3p in its 3′-untranslated region. Overexpression of miR-331-3p decreased the messenger RNA and protein levels of neuropilin-2 in triple-negative breast cancer cells. Restoration of neuropilin-2 partially reversed the inhibitory effects of miR-331-3p on the proliferation of triple-negative breast cancer cells.

Conclusions:

Our results demonstrated the novel function of miR-331-3p/neuropilin-2 signaling in regulating the malignant behaviors of triple-negative breast cancer cells, which suggested miR-331-3p as a potential target for the treatment of triple-negative breast cancer.
The Effect of Instructional Leadership and Distributed Leadership on Teacher Self-efficacy and Job Satisfaction: Mediating Roles of Supportive School Culture and Teacher Collaboration
Authors: Liu Yan , Bellibaş Mehmet Şükrü , Gümüş Sedat
Published: March 2020

Research evidence regarding the relative effects of instructional leadership and distributed leadership on teacher job satisfaction and self-efficacy is limited; it is even less evidential when the indirect effects of mediation variables between school leadership and teacher outcomes, including supportive school culture and teacher collaboration, are added to the total effects. In this study, the six aforementioned variables are added to one model focusing on both the direct effects instructional and distributed leadership have on teacher job satisfaction and self-efficacy, and the indirect effects through the mediation variables of supportive school culture and teacher collaboration. Using the 2013 Teaching and Learning International Survey data, this research applied a rigorous structural equation model (SEM)with the design-based approach using the balanced repeated replication (BRR) weights. The results suggest that distributed leadership and instructional leadership are both positively and directly associated with teacher job satisfaction and teacher self-efficacy, respectively. Meanwhile, distributed leadership is positively and indirectly associated with both teacher job satisfaction and self-efficacy, while instructional leadership is indirectly associated with teacher job satisfaction through the mediation effects of supportive school culture and teacher collaboration.
The Janus face of imprisonment: Contrasting judicial conceptions of imprisonment purposes in the European Court of Human Rights and the Supreme Court of the United States
Authors: Dagan Netanel
Published: March 2020

This article considers how the Supreme Court of the United States and the European Court of Human Rights apply, interpret and frame abstract imprisonment purposes, and how they view their relevance to prison conditions, while discussing the constitutionality of prison conditions. The article argues that the Supreme Court and the European Court of Human Rights view, conceptualise and interpret the purposes of imprisonment differently. Regarding the purposes of retribution and rehabilitation specifically, the analysis presented in the article exposes a ‘Janus face’, meaning that each purpose can, and is, interpreted in two different, and almost contrasting ways. The article offers three themes regarding the conceptualisation of imprisonment purposes by the Supreme Court and the European Court of Human Rights: First, the relationship between the purposes of sentencing and imprisonment along the penal continuum, and the role of rehabilitation in a prison regime: should sentencing purposes be relatively static during their implementation in prison, meaning that retributive-oriented sentencing purposes should be pursued (Supreme Court), or should they conversely progress with the passage of time, from retribution to resocialisation as the primary purpose of imprisonment (European Court of Human Rights). Second, the meaning of retributivism in regard to prison conditions: should prisoners pay a debt to society by suffering in restrictive prison conditions (Supreme Court), or is retributivism achieved by atonement and by finding ways to compensate or repair harms caused by crime (European Court of Human Rights). Third, the way in which prison rehabilitation is framed and understood: should prison rehabilitation be seen as a risk management tool aimed purely at lowering recidivism (Supreme Court), or as a moral concept grounded in a prisoner’s ability to change his life and belief in personal responsibility for one’s actions (European Court of Human Rights). Possible theoretical implications and general policy implications are considered in the article.
Endpoint selection for noninferiority percutaneous coronary intervention trials: a methodological description
Authors: Waliszewski Matthias , Rosenberg Mark , Rittger Harald , Breul Viktor , Krackhardt Florian
Published: March 2020

Background:

The objective of this review is to provide a practical update on endpoint selection for noninferiority (NI) studies in percutaneous coronary intervention studies.

Methods:

A PubMed search was conducted for predefined terms to explore the use of NI designs and intrapatient comparisons to determine their current importance. Sample size calculations for the most frequently used endpoints with NI hypotheses were done to increase statistical awareness.

Results:

Reported NI trials, with the most frequently chosen clinical endpoint of major adverse cardiac events (MACE), had NI margins ranging from 1.66% to 5.00%, resulting in patient populations of 400–1500 per treatment group. Clinical study endpoints comprising of MACE complemented with rates of bleeding complications and stent thrombosis (ST) are suggested to conduct a statistically and clinically meaningful NI trial. Study designs with surrogate endpoints amenable to intrapatient randomizations, are a very attractive option to reduce the number of necessary patients by about half. Comparative clinical endpoint studies with MACE and ST/bleeding rates to study a shortened dual antiplatelet therapy (DAPT) in coronary stent trials are feasible, whereas ST as the sole primary endpoint is not useful.

Conclusions:

Expanded composite clinical endpoints (MACE complemented by ST and bleeding rates and intrapatient randomization for selected surrogate endpoints) may be suitable tools to meet future needs in device approval, recertification and reimbursement.
A Pair of Novel Sulfonyl-Containing N-Acetyldopamine Dimeric Enantiomers From Aspongopus chinensis
Authors: Liao Li , Yan Yong-Ming , Xu Te , Xia Hou-Lin , Cheng Yong-Xian
Published: March 2020

A pair of novel sulfonyl-containing N-acetyldopamine dimer enanitomers, (±)-aspongamide E (1), a new ester 2-aminoethyl ( E)-hex-2-enoate (2), along with 3 known compounds (3-5) were isolated from Aspongopus chinensis. Their structures were determined by spectroscopic methods. Compound 1 is a racemic mixture, chiral high-performance liquid chromatography separation followed by electronic circular dichroism calculations assigned the absolute configurations of 2 enantiomers of 1. Compounds 3-5 were isolated from A. chinensis for the first time. The biological activity of the selected new compounds against renal fibrosis was evaluated.
Epigallocatechin-3-Gallate Protects Neuro-2a Cells From Sodium Fluoride-Induced Oxidative Damage In Vitro
Authors: Li Na , Xin Dongdong , Li Hongbo , Zhao Yanyan , Zhou Wei , Zhang Hao , Hu Liangbin , Ge Yaming , Mo Haizhen
Published: March 2020

Fluoride is an essential trace element, but its beneficial range is narrow, and excess fluoride may have negative health effects. The objective of this study was to investigate the potential cytoprotective effects of epigallocatechin-3-gallate (EGCG) in cultured neuro-2a neuroblastoma cells exposed to sodium fluoride (NaF)-induced oxidative stress. Isolated Neuro-2a cells were exposed to increasing concentrations of NaF (0, 1, 2, 4, 6, and 8 mM) for 24 hours to induce oxidative stress. Moreover, to determine the concentration of EGCG necessary for protective effects, we exposed isolated Neuro-2a cells to increasing concentrations of EGCG (0, 0.5, 1, 5, 10, 20, 40, 60, 80, and 100 μg/mL) for 24 and 48 hours. Pretreatment with EGCG at various doses (0, 0.5, 1, 5, 10, 20, and 40 μg/mL) was evaluated in Neuro-2a cells for 24 hours, followed by an NaF (4 mM per culture well) challenge for 24 hours. As shown in this study, EGCG can protect Neuro-2a cells from NaF-induced apoptosis. This effect may be due to the reactive oxygen species scavenging activity of EGCC.
Long-Term Follow-up of Functional and Radiographic Outcome After Revision Surgery for Fibula Malunion
Authors: Birnie Merel F. N. , Sanders Fay R. K. , Halm Jens A. , Schepers Tim
Published: March 2020

Background. Ankle fractures are some of the most common injuries seen in the emergency department. Malunited ankle fractures are uncommon. Patients with malunion frequently present with multiple complaints. Radiographs often show abnormalities in anatomical alignment. Aim. To evaluate the anatomical alignment on radiographic imaging in patients with malunited ankle fractures. Secondary aims were to evaluate patient satisfaction after reconstruction and to investigate the relationships between radiological alignment and functional outcome. Methods. All consecutive patients (n = 25) treated for a fibula malunion between January 1, 2002, and September 1, 2017, were included. The primary outcome was anatomical alignment of the ankle mortise. The talocrural angle (TCA), talar tilt (TT), and medial clear space (MCS) were used to investigate to what extent revision surgery had improved alignment. The patient-related outcome measure consisted of the Olerud and Molander Ankle Score (OMAS). To assess quality of life (QoL) the EQ-5D-5L was used. Results. The median TCA was 78.4° before revision and 79.25° after revision; P = .297. The median TT was 2.95° before revision and 0.70° after; P < .001. The MCS before revision was 5.2 mm and 3.17 mm after; P < .000). The OMAS had a median of 67.5 points. Analysis of the QoL questionnaires yielded a score of 0.84 points. Conclusion. Anatomical alignment improves significantly after revision surgery of malunited ankles. Measurements of the TCA appeared less useful in determining the anatomical alignment. In our series, 60% of patients reported good to excellent results. The QoL scores of our patient were comparable to those in the healthy population in the Netherlands.

Levels of Evidence: Level IV: Case series
Indications and Outcomes for Patients With Limited Symptoms Undergoing Endoscopic Sinus Surgery
Authors: Rahman Arifeen S. , Hwang Peter H. , Alapati Rahul , Lin Yan , Nayak Jayakar V. , Patel Zara M. , Yan Carol H.
Published: March 2020

Background

Previous research have suggested that chronic rhinosinusitis (CRS) patients with lower symptomatic scores, demonstrated by a 22-item Sinonasal Outcome Test (SNOT-22) score <20, may not achieve meaningful quality of life improvement following endoscopic sinus surgery (ESS). However, indications for ESS are continuing to be defined and many low SNOT-22 scoring patients still undergo elective surgery for CRS and other benign sinonasal pathologies. The outcomes for these patients have not been previously studied.

Objectives

We sought to evaluate surgical indications and outcomes for those patients with limited symptoms undergoing ESS.

Methods

We screened 2829 ESS procedures from 2010–2018 to identify patients with a preoperative SNOT-22 score <20. We reviewed disease characteristics, preoperative Lund–Mackay (LM) scores, and pre- and postoperative SNOT-22 scores in patients with at least 3 months’ follow-up.

Results

Of all surgical ESS patients screened, 114 had low preoperative SNOT-22 scores (4.0%). Indications for these surgeries included CRS (50.0%), odontogenic sinus disease (11.4%), mucocele (10.5%), recurrent acute sinusitis (7.0%), fungal ball (5.3%), and silent sinus syndrome (4.4%). Specifically, among CRS patients, 45.6% had pulmonary comorbidities and/or systemic immunodeficiencies. Moreover, 100% of CRS patients with nasal polyps and 73.1% of CRS without polyps had LM scores >5. Patients with preoperative SNOT-22 scores between 15 and 19 achieved an average 6.5 point reduction ( P < .001) postoperatively, whereas those with scores between 10 and 14 had a 5.4 point reduction ( P < .001), and preoperative scores <9 resulted in no significant decrease in postoperative symptom scores ( P = .98). Overall, there was a 3.3 point SNOT-22 reduction among all patients at 3 months postoperatively ( P < .001).

Conclusion

Patients with limited sinonasal symptoms may benefit from surgical treatment despite asymptomatic clinical presentations. A case-by-case analysis of comorbidities or unique clinical features should inform surgical decision-making for patients with lower SNOT-22 scores.
Resolving the Puzzle of Conspiracy Worldview and Political Activism: Belief in Secret Plots Decreases Normative but Increases Nonnormative Political Engagement
Authors: Imhoff Roland , Dieterle Lea , Lamberty Pia
Published: March 2020

It is a hitherto open and debated question whether the belief in conspiracies increases or attenuates the willingness to engage in political action. In the present article, we tested the notion, whether (a) the relation between belief in conspiracies and general political engagement is curvilinear (inverted U-shaped) and (b) there may be opposing relations to normative versus nonnormative forms of political engagement. Two preregistered experiments ( N = 194, N = 402) support both propositions and show that the hypothetical adoption of a worldview that sees the world as governed by secret plots attenuates reported intentions to participate in normative, legal forms of political participation but increases reported intentions to employ nonnormative, illegal means of political articulation. These results provide first evidence for the notion that political extremism and violence might seem an almost logical conclusion when seeing the world as governed by conspiracies.
Recurrent acute ischaemic strokes as the primary presentation of Sjögren’s syndrome
Authors: Raja Shariff Raja Ezman Faridz , Kasim Sazzli
Published: March 2020

Sjögren’s syndrome (SS) is a multi-systemic autoimmune disease. Central nervous system (CNS) involvement is rare. We report a case of large-vessel vasculitis and cerebral infarction as an initial presentation of SS. Neurological complications in SS is often due to peripheral neuropathy through small-vessel vasculitis. In rare cases, CNS involvement can occur, including acute ischaemic strokes (AIS), linked to both accelerated artherosclerosis and large-vessel vasculitis. Management of SS-related AIS remains complex due to the scarcity of evidence, although a role for immunomodulation and biologics remains promising. Clinicians should remain vigilant in identifying SS as a cause for stroke, especially in the young.
Endometriosis in a case with Fraser Syndrome
Authors: Ooi Rucira Xiu Xian , Griffiths Anthony
Published: March 2020

Introduction:

Fraser Syndrome is a rare genetic disorder characterized by urogenital defects, cutaneous syndactyly and cryptophthalmos commonly diagnosed during foetal autopsy. Vaginal atresia is one of the major diagnostic criteria of Fraser Syndrome and could be a contributing factor of endometriosis following the development of hematocolpos. Imperforate hymen, often misdiagnosed as vaginal atresia, is a rare diagnosis in patients with Müllerian anomalies. Here, we report a case of Fraser Syndrome with chronic pelvic pain as a result of delayed hymenotomy and the extensive management of endometriosis.

Case Report:

A 15-year-old girl with Fraser Syndrome presented with pelvic pain. Examination revealed a large hematocolpos caused by an imperforate hymen. Due to the lack of paediatric intensive care locally, she had a delayed hymenotomy. She continued to suffer from chronic pelvic non-cyclical pain post-hymenotomy. Preliminary laparoscopy and biopsy showed endometriosis. Despite excision and clearance of endometriosis, she experienced persistent pain while taking morphine and was trialled with several hormonal therapies such as leuprorelin acetate, progestogen and combined hormonal therapy. She received medical therapy for 10 years until she re-presented with erratic bleeding and pain. Laparoscopy again identified endometriosis.

Conclusion:

Early recognition and treatment minimize risk of endometriosis especially in premenarcheal adolescent girls with obstructive Müllerian anomalies presenting with pelvic pain. Adequate pain control and medical management permit a delay in surgical intervention facilitating further investigations and thorough counselling with the patient and family about the implications of endometriosis on fertility and quality of life.
Was Paul Klee’s scleroderma an occupational disease? A series of historical and clinical vignettes, part III
Authors: Silver Richard M
Published: March 2020

Paul Klee (1879–1940), one of the most influential artists of the 20th century, died at 60 years of age from complications of systemic sclerosis (scleroderma). The precipitating event(s) of Klee’s scleroderma, as in most cases, will never be known. Among various potential factors, exposure to heavy metals, crystalline silica, and organic solvents—acting alone or in combination—can now be considered potential factors in the onset of Klee’s disease. By altering and modulating epigenetic determinants in a genetically susceptible host, these and other environmental factors may have led to perturbations of self-tolerance and inflammation culminating in Klee’s scleroderma.
Towards a Learning Philosophy Based on Experience in Entrepreneurship Education
Authors: Hägg Gustav , Kurczewska Agnieszka
Published: March 2020

If experience is the guiding light in entrepreneurship education, then where is the philosophy of experience? This article illuminates the philosophical foundations of entrepreneurship education by discussing learning through experience. We introduce a diagram that addresses primary and secondary experiences and their interplay as well as a model that further reveals how educative entrepreneurial experience can be researched through empirical phenomenology. We suggest that although entrepreneurship is currently positioned as an experiential subject in academia, the theoretical and philosophical roots of experience in learning have not been fully addressed, leading to a deficit in our understanding of how knowledge is derived from experience, and how experience may differ depending on its philosophical underpinnings.
Checkpoint inhibitor blockade and epigenetic reprogrammability in CD8+ T-cell activation and exhaustion
Authors: Belizário José , Destro Rodrigues Maria Fernanda
Published: March 2020

CD8+ T-cell exhaustion is a dysfunctional state that is regulated through the expression of inhibitory checkpoint receptor genes including the cytotoxic T-lymphocyte–associated antigen 4, programmed death 1, and DNA methylation of effector genes interferon-γ, perforin, and granzyme B. Different strategies have been used to reverse T-cell exhaustion, which is an adverse event of checkpoint inhibitor blockade. Here, we present the mechanisms by which DNA methyltransferase inhibitors and Simian virus 40 large T antigen through viral mimicry can promote the reversion of exhausted CD8+ T cells. We examine how these pharmacological strategies can work together to improve the clinical efficacy of immunotherapies.
Predictors of loss to follow-up of tuberculosis cases under the DOTS programme in Namibia
Authors: Kibuule Dan , Aiases Philomein , Ruswa Nunurai , Rennie Timothy William , Verbeeck Roger K. , Godman Brian , Mubita Mwangana
Published: March 2020

Background

In Namibia, one out of every 25 cases of tuberculosis (TB) is “lost to follow-up” (LTFU). This has impacted negatively on national efforts to end the disease by 2035. The aim of this study was to determine the trends and predictors of LTFU under the directly observed treatment short-course (DOTS) programme in Namibia.

Methods

The study involved a retrospective longitudinal analysis of a nationwide cohort of TB cases registered under the DOTS programme in Namibia from 2006 to 2015. The trends and predictors of LTFU among cases in the National Electronic TB Register of the National TB and Leprosy Program were respectively determined by interrupted time series and multivariate logistic regression analyses using R-Studio software.

Results

Out of 104 203 TB cases, 3775 (3.6%) were LTFU. A quarter (26%) of cases with poor outcomes were due to LTFU. The annual decline in cases of LTFU was significant between the first (2005–2010) and second (2010–2015) medium-term plan period for TB programme implementation (p=0.002). The independent predictors of LTFU were male sex (p=0.004), 15–24 years age group (p=0.03), provider of treatment (p<0.001), intensive phase (p=0.047) and living in border/transit regions (p<0.001). HIV co-infection and TB regimen were not significant predictors of LTFU.

Conclusions

There were declining trends in LTFU in Namibia. DOTS programmes should integrate socioeconomic interventions for young and middle-aged adult male TB cases to reduce LTFU.
The impact of perceived risk, screening eligibility and worry on preference for lung cancer screening: a cross-sectional survey
Authors: See Katharine , Manser Renee , Park Elyse R. , Steinfort Daniel , King Bridget , Piccolo Francesco , Manners David
Published: March 2020

Lung cancer screening is effective at reducing lung cancer deaths when individuals at greatest risk are screened. Recruitment initiatives target all current and former smokers, of whom only some are eligible for screening, potentially leading to discordance between screening preference and eligibility in ineligible individuals. The objective of the present study was to identify factors associated with preference for screening among ever-smokers.

Ever-smokers aged 55–80 years attending outpatient clinics at three Australian hospitals were invited. The survey recorded: 1) demographics; 2) objective lung cancer risk and screening eligibility using the Prostate Lung Colon Ovarian 2012 risk model; and 3) perceived lung cancer risk, worry about and seriousness of lung cancer using a validated questionnaire. Multivariable ordinal logistic regression identified predictors of screening preference.

The survey was completed by 283 individuals (response rate 27%). Preference for screening was high (72%) with no significant difference between low-dose computed tomography screening-eligible and -ineligible individuals (77%versus68%, p=0.11). Worry about lung cancer (adjusted-proportional odds ratio (adj-OR) 1.31, 95% CI 1.08–1.58; p=0.007) and perceived seriousness of lung cancer (adj-OR 1.31, 95% CI 1.05–1.64; p=0.02) were associated with higher preference for lung cancer screening while screening eligibility was not. The concept of “early detection” was the most important driver to have screening while practical obstacles like difficulty travelling to the scan or taking time off work were the least important barriers to screening.

Most current or former smokers prefer to undergo screening. Worry about lung cancer and perceived seriousness of the diagnosis are more important drivers for screening preference than eligibility status.
Factors associated with delay in treatment initiation for pulmonary tuberculosis
Authors: Roberts David J. , Mannes Trish , Verlander Neville Q. , Anderson Charlotte
Published: March 2020

Background

Delays in treatment initiation for tuberculosis (TB) may lead to worse clinical outcomes and increased transmission. We aimed to determine factors associated with treatment delays, to guide public health action.

Methods

We extracted data on clinical characteristics and documented potential barriers to treatment from all pulmonary TB cases with clinical case review data from 2011 to 2015 and linked these to TB surveillance data. We described the distribution of delays from symptom onset to first presentation (“presentation delay”) and from presentation to treatment (“healthcare delay”). We calculated time ratios (TRs) to determine the association between sociodemographic and clinical factors and delay outcomes.

Results

Median presentation delay was 30 days (interquartile range (IQR) 11–72 days). Language barriers were associated with 40% longer presentation delay (TR 1.40, 1.01–1.94). Median healthcare delay was 40 days (IQR 13–89 days), and mostly consisted of the time taken before deciding to refer to TB specialists (median 26 days, IQR 4–73 days). Shorter healthcare delay was associated with positive sputum smear (TR 0.58, 0.47–0.70), UK residency <2 years (TR 0.47, 0.32–0.67), male sex (TR 0.74, 0.60–0.91) and secondary care referral (TR 0.63, 0.51–0.78).

Conclusions

Our findings support continued initiatives to enable access to care for migrant populations to minimise presentation delay. Multifaceted approaches to increase clinician awareness of TB clinical presentations, to implement systems enabling early case recognition, to maximise the yield from sputum smear investigations and to ensure rapid diagnosis of smear negative cases are required to achieve further TB control.
Virus, allergic sensitisation and cortisol in infant bronchiolitis and risk of early asthma
Authors: Hunderi Jon Olav Gjengstø , Rolfsjord Leif Bjarte , Carlsen Karin C. Lødrup , Holst René , Bakkeheim Egil , Berents Teresa Løvold , Carlsen Kai-Håkon , Skjerven Håvard Ove
Published: March 2020

Background

Acute bronchiolitis during infancy and human rhinovirus (HRV) lower respiratory tract infections increases the risk of asthma in atopic children. We aimed to explore whether specific viruses, allergic sensitisation or cortisol levels during acute bronchiolitis in infancy increase the risk of early asthma, using recurrent wheeze as a proxy.

Methods

In 294 children with a mean (range) age of 4.2 (0–12) months enrolled during hospitalisation for acute infant bronchiolitis, we analysed virus in nasopharyngeal aspirates, serum specific immunoglobulin E against food and inhalant allergens, and salivary morning cortisol. These factors were assessed by regression analyses, adjusted for age, sex and parental atopy, for risk of recurrent wheeze, defined as a minimum of three parentally reported episodes of wheeze at the 2-year follow-up investigation.

Results

At 2 years, children with, compared to without, recurrent wheeze had similar rates of respiratory syncytial virus (RSV) (82.9%versus81.8%) and HRV (34.9%versus35.0%) at the acute bronchiolitis, respectively. During infancy, 6.9% of children with and 9.2% of children without recurrent wheeze at 2 years were sensitised to at least one allergen (p=0.5). Neither recurrent wheeze nor incidence rate ratios for the number of wheeze episodes at 2 years were significantly associated with specific viruses, high viral load of RSV or HRV, allergic sensitisation, or morning salivary cortisol level during acute bronchiolitis in infancy.

Conclusion

In children hospitalised with acute infant bronchiolitis, specific viruses, viral load, allergic sensitisation and salivary morning cortisol did not increase the risk of early asthma by 2 years of age.