bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Determining the Revisit Intentions of the Tourists: A Case Study of Bhutan
Authors: Lhendup Karma , Panda Bhagirathi
Published: October 2021

Bhutan is an important tourist destination in South Asia, and its tourism industry has emerged as the second highest revenue generator next to hydropower. Retaining and enticing first-time tourists to revisit their country is an important policy adopted by many countries of the world. However, the growth trajectory of tourists’ flow to Bhutan changed with a sharp decline in the repeat tourists over the past straight 8 years (2011–2018) with an annual negative growth of 19.1%. Against this backdrop and the non-availability of any meaningful study on tourists’ revisit dynamics, this study investigates the factors associated with the Bhutan revisit intentions of regional and international tourists by using both quantitative and qualitative data. The quantitative data are analysed using multinomial logistic regression and are triangulated with qualitative findings. Factors such as perceived value of money, safety and control variables, viz. gender, age, category of tourists and employment are found significantly affecting tourists’ Bhutan revisit intentions. Eventually, this study also discusses policy implications at the level of the state and tour operators.
Research to Consider While Effectively Re-Designing Child Welfare Services
Authors: Barth Richard P. , Berrick Jill Duerr , Garcia Antonio R. , Drake Brett , Jonson-Reid Melissa , Gyourko John R. , Greeson Johanna K. P.
Published: October 2021

An intense appetite for reforming and transforming child welfare services in the United States is yielding many new initiatives. Vulnerable children and families who become involved with child welfare clearly deserve higher quality and more effective services. New policies, programs, and practices should be built on sound evidence. Reforms based on misunderstandings about what the current data show may ultimately harm families. This review highlights 10 commonly held misconceptions which we assert are inconsistent with the best available contemporary evidence. Implications for better alignment of evidence and reform are discussed.
Race-Based Differences in the Utilization and Timing of Secondary Cleft Procedures in the United States
Authors: Peck Connor J. , Pourtaheri Navid , Parsaei Yassmin , Gowda Arvind U. , Yang Jenny , Lopez Joseph , Steinbacher Derek M.
Published: October 2021

Objective: Secondary procedures optimize outcomes following cleft lip and palate (CL/P) repair. We analyzed the association between race and the utilization and timing of revisionary/secondary cleft surgeries in the United States.

Primary CL/P repair, revisions, and secondary procedures—cleft rhinoplasty, speech surgery, and alveolar bone grafting (ABG)—performed from 2014–2018 were identified from the Pediatric National Surgical Quality Improvement Program (NSQIP) database. Utilization estimates were derived via univariable and multivariable logistic regression. A Kruskal-Wallis rank-sum test and multivariable linear regression were used to assess differences in timing for each procedure cohort.

The primary outcome measures were the odds of a patient being a certain race/ethnicity, and the age at which patients of different race/ethnicity receive surgery.

There were 23 780 procedures analyzed. After controlling for sex, diagnosis, and functional status, there were significant differences in utilization estimates across procedure groups. Primarily, utilization was lowest in patient who were Black for cleft rhinoplasty (OR = 0.70, P = .023), ABG (OR = 0.44, P < .001) and speech surgery (OR = 0.57, P = .012), and highest in patients who were Asian patients in all surgery cohorts (OR 2.05-4.43). Timing of surgery also varied by race, although differences were minimal.

Conclusions

Estimates of utilization and timing of secondary cleft procedures varied by race, particularly among patients who were Black (poor utilization) or Asian (high utilization). Further studies should identify the causes and implications of underutilized and/or delayed cleft care.
Imatinib plasma levels in patients with chronic myeloid leukaemia under routine clinical practice conditions
Authors: Del Rosario García Betel , González García Iris , Viña Romero María Micaela , González García Jonathan , Ramos Díaz Ruth , Mourani Padrón Ivette , Lakhwani Lakhwani Sunil , Nazco Casariego Gloria Julia , Gutiérrez Nicolás Fernando
Published: October 2021

Introduction

The addition of imatinib to the therapeutic arsenal for chronic myeloid leukaemia (CML) has changed the natural course of the disease, in such a way that it is now considered a chronic pathology. However, to achieve therapeutic success, it is necessary to reach adequate plasma concentrations to ensure efficacy and safety. In this study, we aimed to evaluate the plasma concentration of imatinib, analysing its influence on effectiveness and safety in patients with CML.

Methods

We performed a descriptive, multicentre study in which imatinib plasma levels from patients diagnosed with CML between 2019–2020 were analysed. An optimal therapeutic range of 750–1500 ng/mL was established for the stratification of patients, according to their minimum plasma concentrations measured at steady state (Cssmin).

Results

A total of 28 patients were included, of whom only 39.3% (n = 11) showed Cssmin within the therapeutic range. 100% of patients with Cssmin >750 ng/mL achieved an optimal molecular response, while only 50% of patients with Cssmin <750 ng/mL achieved an optimal molecular response ( p = 0.0004). The toxicity rate was 36.4% for patients with Cssmin >1500 ng/mL and 5.9% for those with Cssmin <1500 ng/mL ( p = 0.039).

Conclusions

This study aimed to describe the correlation between the toxicity and effectiveness of imatinib according to its Cssmin in routine clinical practice conditions. Based on our findings, it would be certainly justified to monitor patient plasma concentrations of imatinib on a daily routine basis in our hospitals.
General Psychology Otherwise: A Decolonial Articulation
Authors:   Decolonial Psychology Editorial Collective
Published: October 2021

Critics have faulted the project of general psychology for conceptions of general truth that (1) emphasize basic processes abstracted from context and (2) rest on a narrow foundation of research among people in enclaves of Eurocentric modernity. Informed by these critiques, we propose decolonial perspectives as a new scholarly imaginary for general psychology Otherwise. Whereas hegemonic articulations of general psychology tend to ignore life in majority-world communities as something peripheral to its knowledge project, decolonial perspectives regard these communities as a privileged site for general understanding. Indeed, the epistemic standpoint of such communities is especially useful for understanding the coloniality inherent in modern individualist lifeways and the fundamental relationality of human existence. Similarly, whereas hegemonic articulations of general psychology tend to impose particular Eurocentric forms masquerading as general laws, the decolonial vision for general psychology Otherwise exchanges the universalized particular for a more pluralistic (or pluriversal) general.
Vision loss in a pregnant woman with nephrotic syndrome
Authors: Tsani Zoi , Ntafos Antonios , Toumanidou Victoria , Dastiridou Anna , Ploumi Ioanna , Androudi Sofia
Published: October 2021

Purpose

To report acute visual acuity loss in a pregnant woman with nephrotic syndrome.

Case Report

A 34-year-old pregnant woman was referred to our service for acute, bilateral visual impairment, associated with bilateral below knee edema (BKE). Best-corrected visual acuity (BCVA) was hand motion in the right eye and 20/200 in the left eye. Dilated fundus exam disclosed multiple pigment epithelium detachments involving the macula in both eyes. After consultation with a nephrologist a diagnosis of nephrotic syndrome was made. Unfortunately, a week later she lost the fetus. At follow-up evaluation, 20 days after the miscarriage, BCVA improved to 20/25 in both eyes with near normal restoration of the retinal anatomy.

Conclusion

In nephrotic syndrome, sequestration of interstitial fluids, which leads to classic generalized edema, could be the origin of interstitial accumulation of fluids in the retinal and subretinal layers. Increased awareness by the gynaecologists and prompt treatment may prevent fetus miscarriage.
Mobilization against Sexual Harassment in the European Parliament: The MeTooEP campaign
Authors: Berthet Valentine
Published: October 2021

The international #MeToo campaign against sexual harassment constitutes the most prominent contemporary campaign against sexual harassment worldwide. It exposed the issue by undermining the ‘culture of silence’ prevailing in several contexts, including political institutions. This article analyses one specific variant of #MeToo, the campaign MeTooEP that emerged in the European Parliament (EP). MeTooEP is unique in many ways: it was the first collective action against sexual harassment in parliaments emerging in the #MeToo aftermath and it was the first collective action within the EP led by members of the staff, which eventually drove some internal policy changes. Using a unique, large interview dataset, the analysis shows how the actors behind MeTooEP were crucial in shaping the campaign. Their knowledge of institutional rules, practices and daily presence in the EP facilitated their advocacy and transformed the Parliament into an enabling platform for their actions. With the help of Feminist Institutionalism, the analysis demonstrates how the formal and informal institutional EP bodies with their rules and regulations shaped MeTooEP in ways that constrained and empowered it.
In praise of holistic scholarship: A collective essay in memory of Mark Easterby-Smith
Authors: Robinson Sarah , Contu Alessia , Elliott Carole , Gagnon Suzanne , Antonacopoulou Elena , Bogolyubov Pavel , Crossan Mary , Cunliffe Ann , Elkjaer Bente , Graça Manuel , Kars Selen , Li Shenxue , Lyles Marjorie , Snell Robin , St Amour Wayne , Stead Valerie , Thorpe Richard , Vera Dusya
Published: October 2021

This collective essay was born out of a desire to honor and remember Professor Mark Easterby-Smith, a founder of the Management Learning community. To do this, we invited community members to share their experiences of working with Mark. The resulting narratives remember Mark as a co-author, co-researcher, project manager, conference organizer, research leader, PhD supervisor, and much more. The memories cover many different aspects of Mark’s academic spectrum: from evaluation to research methods to cross-cultural management, to dynamic capabilities, naming but a few. This space for remembrance however developed into a space of reflection and conceptualization. Inspired by the range and extent of Mark’s interests, skills, experiences, and personal qualities, this essay became conceptual as well as personal as we turned the spotlight on academic careers and consider alternative paths for Management Learning scholarship today. Using the collective representations of Mark’s career as a starting point, we develop, the concept of holistic scholarship, which embraces certain attitudes and orientations in navigating the dialectical spaces and transcending tensions in academic life. We reflect on how such holistic scholarship can be practised in our contemporary and challenging times and what inspiration and lessons we can draw from Mark’s legacy.
Examining the quality of mobile-assisted, video-making task outcomes: The role of proficiency, narrative ability, digital literacy, and motivation
Authors: Kang Sanghee , Kim YouJin
Published: October 2021

Although increasing evidence has demonstrated the benefits of mobile technology in diverse aspects of language learning, research on the use of mobiles in task-based instruction has been scarce. Particularly, there has been little research directly investigating predictors of the quality of mobile-assisted, video-making tasks. To fill the gap and contribute to the area of emerging technology-mediated, task-based language teaching, the current study examined predicting factors of the quality of digital-video-making task outcomes. Forty-eight Korean high school students completed a digital-video-making task using a mobile application called KineMaster. Students created a self-introduction storytelling video focusing on their experiences of success or failure in their life. To examine predicting factors (English writing proficiency, first language narrative ability, digital literacy, intrinsic and extrinsic motivation), multiple data sources were gathered: timed argumentative English essays and Korean writing samples on the same narrative topic, a digital literacy questionnaire, and a motivation survey. For data analyses, the quality of the digital-video-making task outcome was scored using an analytic rubric assessing the use of multi-modes, language use, and task fulfillment. Students’ English and Korean narrative essays were rated for English writing proficiency and first language narrative ability, respectively. Digital literacy and motivation questionnaires were analysed quantitatively, and the composite scores were included in statistical models. Multiple regression models were created to investigate which factors predicted the quality of the digital-video-making task outcome. The results showed that English writing proficiency and first language narrative ability significantly predicted the quality of language use and task fulfillment. The findings shed light on mobile-assisted task performance in foreign language classrooms.
‘The English language enables me to visit my pain’. Exploring experiences of using a later-learned language in the healing journey of survivors of sexuality persecution
Authors: Cook Sally Rachel , Dewaele Jean-Marc
Published: October 2021

Aims and objectives:

This qualitative study explores the experience of using a later-learned language, English (ELX), in the therapeutic journey of refugee survivors of sexuality persecution to enhance understanding of the role of language in their rehabilitation.

Design/methodology/approach:

This is a multiple case study of three refugees, persecuted in their home country because of their sexual orientation, who are regular attendees of a therapeutic community, Room to Heal, based in London. A qualitatively driven mixed-method research design using Interpretative Phenomenological Analysis (IPA) and ethnography was employed.

Data and analysis:

Data were gathered through semi-structured interviews with the first author. They consisted of questions about the relationship between the participants’ languages, emotions and sense of self.

Findings/conclusions:

Participants shared common positive experiences characterised by feelings of the ELX being a liberating tool that empowered them and enabled them to bear witness to their trauma, express their same-sex love more easily and be more self-accepting, and contributed to the (re)invention and performance of a ‘new’ self.

Originality:

The originality resides first in the unique profile of the participants – victims of persecution because of their sexual orientation; second in the unique context – a therapeutic community supporting refugees; and third in the methodology – a qualitatively driven mixed-method design combining IPA and ethnography.

Significance/implications:

The findings support an embodied perspective of languages and highlight the need for therapists to be aware of multilingualism and its effects. The reduced emotional resonance of a later-learned language may offer its users a way to access trauma and build a new self within the therapeutic process.
Axial compressive behavior of circular concrete-filled double steel tubular short columns
Authors: Ci Junchang , Ahmed Mizan , Tran Viet-Linh , Jia Hong , Chen Shicai
Published: October 2021

This article investigates the axial compressive performance of concrete-filled double steel tubular (CFDST) short columns composed of circular section loaded concentrically. An experimental program comprised of compression tests on short columns is carried out to examine their structural performance. Axial compression tests on conventional concrete-filled steel tubular (CFST) columns and double-skin concrete-filled steel tubular (DCFST) columns are also performed for comparison purposes. The test parameters include the diameter-to-thickness of the outer and inner steel tubes, concrete strength, and diameter ratio. The test results exhibit that CFDST short columns composed of the circular section have improved structural performance compared to its CFST and DCFST counterparts. A theoretical model is also presented to simulate the test ultimate strengths and load-axial strain relationships of CFDST columns. The existing design models proposed including the codified design specifications are evaluated against the collected test data for predicting the axial compressive strengths of circular CFDST columns. It is seen that the existing codified design models cannot yield their ultimate axial compressive strengths accurately. A practical artificial neural network (ANN) model is proposed to estimate the ultimate load of such columns loaded concentrically.
Developing adaptive neuro-fuzzy inference system-based models to predict the bending strength of polyurethane foam-cored sandwich panels
Authors: Nazerian Morteza , Naderi Fateme , Partovinia Ali , Papadopoulos Antonios N , Younesi-Kordkheili Hamed
Published: October 2021

The aim of this paper was to improve the performance of the adaptive neuro-fuzzy inference system (ANFIS) and to predict the flexural strength of the sandwich panels made with thin medium density fiberboard as surface layers, and polyurethane foam as a core layer, by applying metaheuristic optimization methods. For this purpose, various models, namely ant colony optimization for the continuous domain (ACOR), differential evolution (DE), genetic algorithm (GA), and particle swarm optimization (PSO) were applied and compared, as different efficient bio-inspired paradigms, to assess their suitability for training the adaptive neuro-fuzzy inference system model. The predicted values of the flexural strength resulting from applying adaptive neuro-fuzzy inference system trained by ACOR, DE, GA, and PSO, were compared with the values derived from adaptive neuro-fuzzy inference system classical model. The molar ratio of formaldehyde to melamine and urea, sandwich panel thickness, and the weight ratio of the modified starch to MUF resin (OS/MUF weight ratio) were used as an input variables and the modulus of rupture was used as an output one. The developed hybrid models were used to predict the values of the modulus of rupture obtained from experimental tests. In order to evaluate and compare the performance of the models, three performance criteria were employed namely, determination coefficient (R2), root mean square error, and mean absolute percentage error. It was found that ANFIS–ACOR, ANFIS–DE, ANFIS–GA, and ANFIS–PSO showed different performance ratios compared to the predicting model. In addition, the ANFIS–GA model is found to be by far more accurate than the other hybrid models.
Predicting organizational citizenship behavior in a multicultural environment: The role of cultural intelligence and cultural distance
Authors: Kadam Raavee , Balasubramanian Sreejith , Kareem Abdul Waheed , Jabeen Shazi S
Published: October 2021

Cross-cultural research in organizational citizenship behavior (OCB) has primarily focused on testing the generalizability of various OCB dimensions in different cultures, while attempting to unearth any culture-specific OCB notions that may arise from the values of a particular culture. But with the contemporary workplace becoming increasingly multicultural, this research attempts to move beyond the study of OCB in culturally homogenous environments and investigates its manifestation in a multicultural context. This study proposes cultural intelligence (CQ) as one of the antecedents of OCB, which enables individuals in foreign cultures to understand the perceptions of OCB in that particular culture, and posits that individuals with high levels of CQ exhibit OCB in multicultural environments. Furthermore, this study investigates the moderating effect of cultural distance (CD) on the relationship between CQ and OCB to test whether culturally similar or different environments strengthen or weaken this relationship. The study draws upon the trait activation theory to test the hypotheses under investigation. Data for this study were collected from 513 expatriates of 31 different nationalities working in a multicultural environment and analyzed using structural equation modeling. The results indicated that CQ had a positive impact on OCB, but CD did not have any impact on the CQ-OCB relationship. The findings of this study have important implications for human resource managers managing a culturally diverse workforce.
Clamped Carotid Dissection Can Reduce Postoperative Stroke After Carotid Endarterectomy
Authors: Pini Rodolfo , Faggioli Gianluca , Palermo Sergio , Fronterrè Sara , Alaidroos Moad , Vacirca Andrea , Gallitto Enrico , Gargiulo Mauro
Published: October 2021

Background: The outcomes of carotid endarterectomy (CEA) are constantly reported in a multitude of studies; however, the specific causes of perioperative stroke have been scarcely investigated. The aim of the present study was to analyze and categorize the causes of perioperative strokes after CEA. Methods: All CEAs performed from 2006 to 2019 in a single center were collected. CEA was routinely performed under general anesthesia, with routine shunting and patching, using cerebral near-infrared spectroscopy monitoring. Carotid exposure technique was classified as either clamped-dissection (CD) or preclamping-dissection (PCD) if the carotid bifurcation was dissected after or prior to carotid clamping. Perioperative and 30-day strokes and their possible mechanisms were evaluated according to preoperative symptoms and surgical technique adopted. Results: Among 1760 CEAs performed, 30 (1.7%) perioperative strokes occurred. 14 (47%) were identified upon emergence from general anesthesia, and 16 (53%) were noted in the first 30 days following intervention. Stroke etiology was categorized as follows: technical (acute thrombosis or intimal flap or due to intraoperative complications), embolic (no recognized technical defect), hemorrhagic, or contralateral. Symptomatic patients had a significantly higher rate of any type of stroke than asymptomatic patients (3.8% vs 0.9%, P = .0001). CD was protective for postoperative stroke (0.9% vs 3.1%, P = .001) in both symptomatic and asymptomatic patients (2.5% vs 5.9%, P = .05; 0.4% vs 1.9%, P = .005), particularly for the cohort in which symptomatic patients (0.7% vs 3.2%, P = .04) suffered postoperative embolic stroke. Conclusion: Perioperative stroke in CEA may be multifactorial in etiology, including a result of technical errors. A CD technique may help reduce the incidence of perioperative stroke.
Race Deficits in Pain Detection: Medical Providers and Laypeople Fail to Accurately Perceive Pain Authenticity Among Black People
Authors: Lloyd E. Paige , Lloyd Audrey R. , McConnell Allen R. , Hugenberg Kurt
Published: October 2021

Across six studies ( N = 904), we suggest a novel mechanism for race disparities in pain treatment: Perceiver deficits in discriminating real from fake pain for Black (relative to White) individuals. Across Studies 1–4, White participants (Studies 1–4) and Black participants (Study 2) were better at discerning authentic from inauthentic pain expressions for White targets than for Black targets. This effect emerged for both subtle (Studies 1 and 2) and intense (Studies 3 and 4) pain stimuli. Studies 5 and 6 examined consequences for medical care decisions by examining pain treatment recommendations by laypeople (Study 5) and pain authenticity judgments by medical providers (Study 6). This work advances theory in pain perception, emotion judgment, and intergroup relations. It also has practical significance for identifying unexplored mechanisms causing racial disparities in medical care.
Systemic Racism in Police Killings: New Evidence From the Mapping Police Violence Database, 2013–2021
Authors: DeAngelis Reed T.
Published: October 2021

This research note provides new evidence consistent with systemic anti-Black racism in police killings across the United States. Data come from the Mapping Police Violence Database (2013–2021). I calculate race-specific odds and probabilities that victims of police killings exhibited mental illness, were armed with a weapon, or attempted to flee the scene at the time of their killing. Multilevel, multivariable logistic regression techniques are applied to further account for the victim's age, gender, year of killing, and geographical clustering. I find that White victims are underrepresented, and Black victims overrepresented in the database. Relative to White victims, Black victims also have 60% lower odds of exhibiting signs of mental illness, 23% lower odds of being armed, and 28% higher odds of fleeing. Hispanic victims exhibit 45% lower odds of being armed relative to their White peers but are otherwise comparable. These patterns persist regardless of the victim's age, gender, year of killing, or geographical location (state, zip code, and neighborhood type). Thus, the threshold for being perceived as dangerous, and thereby falling victim to lethal police force, appears to be higher for White civilians relative to their Black or Hispanic peers. Current findings provide empirical support for political initiatives to curb lethal police force, as such efforts could help to reduce racial disparities in deaths by police nationwide.
Examining Customer Motivation and Its Impact on Customer Engagement Behavior in Social Media: The Mediating Effect of Brand Experience
Authors: Chen Xi , Jiao Chunlan , Ji Ran , Li Yu
Published: October 2021

This study investigates the mediating effect of brand experience on the relationship between customer motivation and engagement behavior and conceptualizes customer motivation from the multiple dimensions of information seeking, entertainment, and social interaction. Based on 565 valid questionnaires, it analyzes the impact of customer motivation on brand experience and customer engagement behavior using SPSS and AMOS. First, customer motivation with information seeking, entertainment, and social interaction significantly impacts customer brand experience. Second, customer brand experience significantly impacts customer engagement behavior of reuse, feedback, and WOM intentions. Finally, this study explores the mediating role of customer brand experience between customer motivation and customer engagement behavior and its impact on social media. It provides a reference for social media literature research. These findings will provide insights on motivating customers to participate in social media.
The Hip Center Rule Can be Used to Decide if Measured Pelvic Incidence is Accurate
Authors: Fisk Felicity , Oitment Colby , Taliaferro Kevin , Pahuta Markian A.
Published: October 2021

Study Design

Simulation study.

Objective

Pelvic incidence (PI) should be considered during surgical planning. The ideal patient position with both hip centers perfectly aligned for a lateral radiograph is rarely obtained. It has been suggested that a radiograph with axial and coronal rotation up to 20° is acceptable to obtain a measured PI within 6 degrees of the actual PI. We seek to: (1) evaluate the effect of variations in PI and patient malpositioning on measured vs true PI, and (2) determine whether the presence of one hip center within the bony acetabular rim of the contralateral hip can serve as a simple clinical decision rule on the accuracy of measured PI.

Methods

Published anthropometric three-dimensional pelvic landmark coordinates were used in this study. Radiographic projections were generated using linear algebra for combinations of axial and coronal rotation from −20° to +20°. True and measured PIs were compared.

Results

Rotation to 20° cannot be uniformly accepted as decision rule. Pelvises with higher PIs are more sensitive to malpositioning with greater PI deviation with smaller amounts of rotation. Diagnostic performance of the hip center rule demonstrated a sensitivity of 25.58% and a specificity of 100.00%.

Conclusions

Rather than assessing the quality of radiographs for PI measurement by magnitude of malpositioning, we recommend clinicians use the “hip center rule.” As long as at least one hip center is contained within the bony acetabular rim of the contralateral hip, there is high confidence that measured PI will be within 6° of true PI.
Factors Affecting the Outsourcing Activities in Public and Private Sector Banks in India
Authors: Rautela Poonam , Sarkar Madhulika P. , Goel Rekha
Published: October 2021

This article aims to identify the major factors which prove as motivation and influence for a bank while deciding what, when, how and whom to outsource. A survey questionnaire was developed and responses were collected from 434 bank employees from two major groups of public sector banks and private sector banks in India. Exploratory factor analysis has been used to find out the latent factors for outsourcing decisions. Results of the study find Strategic competitive advantage, better customer service, better use of resources, capitalization on technological advancements, and cost-effectiveness as the major motivating factors for outsourcing the IT/IS, HR, marketing services, financial and other services. The present research article will be of great help for banks to measure the impact of outsourcing on the profitability, productivity, liquidity, and market share of the banks.
Functional Consequences of Poor Binaural Hearing in Development: Evidence From Children With Unilateral Hearing Loss and Children Receiving Bilateral Cochlear Implants
Authors: McSweeny Claire , Cushing Sharon L. , Campos Jennifer L. , Papsin Blake C. , Gordon Karen A.
Published: October 2021

Poor binaural hearing in children was hypothesized to contribute to related cognitive and academic deficits. Children with unilateral hearing have normal hearing in one ear but no access to binaural cues. Their cognitive and academic deficits could be unique from children receiving bilateral cochlear implants (CIs) at young ages who have poor access to spectral cues and impaired binaural sensitivity. Both groups are at risk for vestibular/balance deficits which could further contribute to memory and learning challenges. Eighty-eight children (43 male:45 female, aged 9.89  ±  3.40 years), grouped by unilateral hearing loss ( n = 20), bilateral CI ( n = 32), and typically developing ( n = 36), completed a battery of sensory, cognitive, and academic tests. Analyses revealed that children in both hearing loss groups had significantly poorer skills (accounting for age) on most tests than their normal hearing peers. Children with unilateral hearing loss had more asymmetric speech perception than children with bilateral CIs ( p < .0001) but balance and language deficits ( p = .0004, p < .0001, respectively) were similar in the two hearing loss groups ( p > .05). Visuospatial memory deficits occurred in both hearing loss groups ( p = .02) but more consistently across tests in children with unilateral hearing loss. Verbal memory was not significantly different than normal ( p > .05). Principal component analyses revealed deficits in a main cluster of visuospatial memory, oral language, mathematics, and reading measures (explaining 46.8% data variability). The remaining components revealed clusters of self-reported hearing, balance and vestibular function, and speech perception deficits. The findings indicate significant developmental impacts of poor binaural hearing in children.
Standard Error of the Mean and Minimal Detectable Change of Gait Speed in Older Adults Using Japanese Long-Term Care Insurance System
Authors: Takada Yui , Tanaka Shigeharu
Published: October 2021

Evaluation of motor function, such as gait ability, can accurately predict the subsequent occurrence of disability in older adults. There are no reports of standard error of the mean (SEM) or minimal detectable change (MDC) with respect to gait in Japanese long-term care insurance-certified individuals. The purpose of this study was to investigate the values of preferred gait, fast gait, and the timed up and go (TUG) test. This study included 46 participants using the Japanese long-term care insurance system. (age 86.5 ± 6.6 years, 12 men, 34 women). The duration of three gait were measured twice using a stopwatch. The SEM was 0.07 for preferred gait, 0.09 for fast gait and 2.59 for TUG. The MDC was 0.19 for preferred gait, 0.26 for fast gait, and 7.17 for TUG. The SEM and MDC values of preferred gait, fast gait, and TUG in this study corroborated with those of previous studies, whereas others were different. Considering that gait speed differs with the country, it may be difficult to compare it among different population groups. We obtained the results of gait speed of Japanese long-term care insurance-certified individuals, which is a new finding
Biomechanical Analysis of Single Interference Screw vs Interference Screw With Cortical Button for Flexor Hallucis Longus Transfer
Authors: Neary Kaitlin C. , McClish Sarah J. , Khoury Anthony N. , Denove Nicholas , Konicek John , Wijdicks Coen A.
Published: October 2021

Background:

Flexor hallucis longus tendon transfer (FHL) with a cortical button tension slide is an innovative addition that has not been measured against traditional methods.

Methods:

12 pairs (n=24) of fresh-frozen cadaveric tibia-to-toe samples were used and randomized to receive one of the operative FHL techniques. Specimens underwent bone density analysis. Biomechanical loading was applied between 20 and 60 N at 1 Hz for 100 cycles. Post–cyclic load to failure occurred at 1.25 mm/s. Cyclic displacement, structural stiffness, and ultimate load were derived from load-displacement curves. Student t tests evaluated significant effects between both FHL techniques. Linear regression analysis assessed interactions between bone density and strength of FHL technique.

Results:

Average tendon diameter was 5.44±0.46 mm. Average bone density was 1.06±0.08 g/cm2. Addition of a cortical button to FHL transfer did not significantly affect cyclic displacement (0.78±0.52 mm vs 0.87±0.80 mm) or structural stiffness (162.11±43.34 N/mm vs 167.57±49.19 N/mm). Cortical button addition to FHL transfer resulted in significantly increased ultimate load (343.72±68.93 N) compared with interference screw alone (255.62±77.17 N) ( P = .0002). Linear regression analyses did not reveal any significant interactions between bone density and FHL tendon transfer technique.

Conclusion:

Enhanced strength can be achieved with FHL tendon transfer to calcaneus using an interference screw and cortical button tension slide technique as compared to an interference screw alone. Cortical buttons in the setting of FHL tendon transfer to the calcaneus offers an additional level of support.

Clinical Relevance:

Operative cases presenting with poor bone quality due to osteoporosis or osteopenia could benefit from cortical button fixation during FHL transfer. Clinical studies are needed to determine if the increased construct stability conferred from the additional use of a flip button results in fewer FHL transfer failures or better clinical outcomes.

Level of Evidence:

Level V, Controlled Laboratory Study.
The Cyber Avatar of Sexual Harassment at the Workplace: Media Analysis of Reports During COVID-19
Authors: Ahuja Kanika K. , Padhy Priyanka
Published: October 2021

Background:

Whether working at physical workplaces or from the seeming safety of home, women employees continue to be hounded by sexual harassment. During COVID-19, sexual harassment has taken on a cyber avatar and continues to enjoy the protections afforded by ambiguity and inept implementation.

Objectives:

The study explores how media reported cyber sexual harassment (CSH) during a 1-year period after COVID-19 in India. It explores the dominant discourses evident in such media reports, such as the ways in which CSH is manifested, psychosocial factors behind the same, action taken (if any), and organizational practices.

Method:

The present study involved content analysis of electronic print media content (newspapers and magazines) published in India, in the English language, between the period March 2020 and February 2021. A final pool of 24 articles was purposively arrived at through an Internet-based search, which was classified as news story, editorial, opinion piece, interview, column, and other. Content analysis of the articles was carried out to uncover the main themes. Within these themes, the researchers carried out open coding to identify subthemes.

Results:

Six broad themes emerged from the articles: manifestations of CSH, causes of CSH, outcomes of CSH, action taken by the victim, organizational practices, and barriers in seeking redressal. Manifestations included inappropriate behavior by boss/colleagues during meeting (30.6%), social media harassment (22.6%), video calls/meeting/work at odd hours (17.7%), inappropriate attire (14.5%), sexist behavior and comments (8.1%), and inappropriate jokes (6.2%). Some of the causes reported for CSH were blurring of personal and professional boundaries, lack of guidelines regarding virtual workplaces, job uncertainty, and notions of patriarchy. Only 29.2% articles highlighted any action(s) taken by the victim. Some of the barriers in seeking redressal were reported to be lack of awareness and/or clear guidelines, fear about the repercussions, difficulty in proving CSH, daunting appellate process, lack of privacy with family members around, and patriarchal culture.

Conclusion:

The study reiterates the need for clear and consistent communication on CSH, both in organizations and through the media. It is imperative not only to revive and modify the existing policies on CSH but also to implement them effectively. In the “new normal,” organizations need to formulate responses that are multilevel, swift, and coordinated across stakeholders, policymakers, technology specialists, and social scientists.
Arthroscopic Reverse Bankart Surgical Repair
Authors: Dean Robert S. , Gowd Anirudh K. , Bunker Carson D. , Beck Edward C. , Dennis Eric J. , Waterman Brian R.
Published: October 2021

Background:

Posterior glenoid labrum lesions occur in only 2% to 10% of all cases of shoulder instability, yet these injuries may cause significant shoulder dysfunction in an athletic population. Moreover, these injuries frequently require surgical intervention and present a unique surgical challenge.

Indications:

Indications for arthroscopic posterior labral repair include symptomatic posterior labral tears identified on magnetic resonance imaging with or without contrast, that failed nonsurgical management (ie, lifestyle modification, nonsteroidal anti-inflammatory drug, and physical therapy). Patients may present with a positive posterior load and shift or positive posterior apprehension test.

Technique Description:

With the patient in the lateral decubitus position, use a standard posterior superior portal, an ancillary anterior superior portal, a posterior-inferior, and the portal of Wilmington. After portal placement and diagnostic arthroscopy, the torn labrum is debrided. The torn portion of the posterior labrum is then mobilized from approximately the 6 o’clock to 10 o’clock positions, and a curette and shaver are used to produce a bleeding margin for fixation. Two double-loaded 2.4-mm suture anchors are placed, passed, and tied; one at the 6:30 o’clock position and the other at the 8 o’clock position. A cinch stich configuration using a 2.9-mm pushlock anchor can be used at the 10 o’clock position. A polydioxanone suture is used to assist with capsular plication and to close the posterior portal.

Results:

The literature suggests that 90% to 94% of patients are able to return to their desired sport with 5% to 10% reporting recurrent instability by 2 years after operation. Two out of 3 patients report no limitations at 2 years.

Discussion/Conclusion:

Arthroscopic repair of posterior labral tears with suture anchors can be an effective surgical option for patients with reverse Bankart lesions. Using advanced imaging to identify concomitant pathologies, meticulous surgical technique, direct visualization of the anatomy and anchor placement, and a dedicated rehabilitation program, greater than 90% of patients can expect to return to sport.
Impaired formation of neutrophil extracellular traps in patients with MDS
Authors: Brings Carolin , Fröbel Julia , Cadeddu Patrick , Germing Ulrich , Haas Rainer , Gattermann Norbert
Published: October 2021

Neutrophil extracellular traps (NETs) are networks of extracellular fibers primarily composed of DNA and histone proteins, which bind pathogens. We investigated NET formation in 12 patients with myelodysplastic syndrome (MDS) and 15 age-adjusted normal controls after stimulation with phorbol-12-myristate-13-acetate (PMA). Histones and neutrophil elastase were visualized by immunostaining. Since NET formation is triggered by reactive oxygen species (ROS), mainly produced by reduced NADP-oxidase and myeloperoxidase (MPO), ROS were analyzed by flow cytometry using hydroethidine, 3’-(p-aminophenyl) fluorescein, and 3’-(hydroxyphenyl) fluorescein. On fluorescence microscopy, PMA-stimulated MDS neutrophils generated fewer NETs than controls (stimulated increase from 17% to 67% vs 17% to 85%) (P = .02) and showed less cellular swelling (P = .04). The decrease in mean fluorescence intensity (MFI) of 4’,6-diamidino-2-phenylindole, indicating chromatin decondensation, was significantly less in MDS neutrophils than controls (ΔMFI 3467 vs ΔMFI 4687, P = .03). In addition, the decrease in MFI for fluorescein isothiocyanate, indicating release of neutrophil elastase from cytoplasmic granules, was diminished in patients with MDS (P = .00002). On flow cytometry, less cell swelling after PMA (P = .02) and a smaller decrease in granularity after H2O2 stimulation (P = .002) were confirmed. PMA-stimulated ROS production and oxidative burst activity did not reveal significant differences between MDS and controls. However, inhibition of MPO activity was more easily achieved in patients with MDS (P = .01), corroborating the notion of a partial MPO defect. We conclude that NET formation is significantly impaired in MDS neutrophils. Although we found abnormalities of MPO-dependent generation of hypochloride, impaired ROS production may not be the only cause of deficient NETosis in MDS.
Effects of age on sugammadex reversal of neuromuscular blockade induced by rocuronium in Chinese children: a prospective pilot trial
Authors: Zhang Ruidong , Hu Jie , Li Shengde , Xue Bin , Wang Lu , Bai Jie , Zheng Jijian
Published: October 2021

Background

Sugammadex reverses neuromuscular blockade induced by steroidal relaxants. We compared the recovery for neuromuscular blockade reversal with sugammadex in children aged 1–12 years.

Methods

From August 2019 to August 2020, patients who received 2.0 mg·kg− 1 sugammadex for neuromuscular blockade reversal after surgery were recruited. The primary outcome was the time for the train-of-four ratio (TOFR) to recover to 0.9; secondary outcomes included the incidence of the TOFR < 0.9, extubation time, length of stay at the post-anesthesia care unit, and adverse events. Hemodynamic parameters before and 5 min after sugammadex administration and vital signs in the recovery room were also recorded.

Results

Eighty-six children were recruited (1 to < 3 years, n = 23; 3 to < 5 years, n = 33; 5 to ≤12 years, n = 30). Intergroup differences in the recovery of the TOFR to 0.9 were not statistically significant (F = 0.691, p = 0.504). Recurrence of the TOFR < 0.9 was not observed in any group. Five minutes after sugammadex administration, the heart rates of patients aged 3 to < 5 and 5 to ≤12 years were significantly lower than those at baseline (p < 0.05). Extubation time was similar in patients aged 1 to ≤12 years. Length of stay and end-tidal capnography at the post-anesthesia care unit as well as adverse events did not differ significantly.

Conclusion

A moderate (TOF count two) rocuronium-induced neuromuscular blockade can be effectively and similarly reversed with sugammadex 2 mg·kg− 1 in Chinese children aged 1–12 years.

Trial registration

Chinese Clinical Trial Registry: ChiCTR1900023715 (June 8, 2019).
Clinical outcomes of endoscopic removal of foreign bodies from the upper gastrointestinal tract
Authors: Yoo Dong Ryeol , Im Chang Bin , Jun Baek Gyu , Seo Hyun Il , Park Jong Kyu , Lee Sang Jin , Han Koon Hee , Kim Young Don , Jeong Woo Jin , Cheon Gab Jin , Na Hee Kyong , Lee Jeong Hoon , Choi Kee Don , Jung Kee Wook , Kim Do Hoon , Song Ho June , Lee Gin Hyug , Jung Hwoon-Yong , Gong Eun Jeong , Ahn Ji Yong
Published: October 2021

Background

Ingested foreign objects frequently require emergency removal. This study aimed to investigate the clinical outcomes of endoscopic removal of foreign bodies from the upper gastrointestinal tract and the risk factors for adverse events.

Methods

Adults (> 18 years) who underwent endoscopic management of ingested foreign bodies at two centers, one inland and one on the coast, between January 2008 and December 2017 were eligible. Clinical characteristics and procedure-related outcomes were retrospectively reviewed. Patients were divided into two groups, based on whether the foreign bodies were sharp or blunt in shape.

Results

A total of 853 patients aged 19–96 years were analyzed. Ingestion of fish bones was more common in the coastal area, whereas ingestion of food boluses was more common in the inland area. The duration of impaction ranged from 1 h to over 1 month and was significantly longer in patients who ingested blunt than sharp foreign bodies (15 vs. 5 h, p < 0.001). Most (98.9%) foreign bodies were successfully removed. Adverse events occurred in 31.2 % of patients, including ulcers (4.0%) and perforations (3.3 %). Multivariate analysis showed that age (odds ratio [OR] 1.015, p = 0.012), sharp foreign bodies (OR 5.133, p < 0.001), location in the esophagus (OR 2.723, p = 0.018), and duration of impaction (OR 1.431, p < 0.001) were factors associated with adverse events.

Conclusions

Early recognition and timely endoscopic removal of ingested foreign bodies, particularly in elderly patients and those with sharp foreign bodies, may improve clinical outcomes.