bluuebunny/crossref_metadata_2025 huggingface dataset:
Meso-Level Racism in Medicine
Authors: Rondini Ashley C.
Published: August 2021

This article highlights that the standardization of medical care in the U.S. relies on clinical practice guidelines (CPGs), which indicate institutionalized norms about when and under what circumstances it is appropriate to administer specific medical tests and courses of treatment. However, when CPGs in medicine derive from medical research that was informed by since-debunked ideas about race, they may also facilitate structural racism.
Race, Trust in Police, and Mental Health Crisis Support
Authors: Frankham Emma , Jacobi Christopher , Vaidyanathan Brandon
Published: August 2021

This abstract is incorrect. Please see the corrected abstract here: https://journals.sagepub.com/doi/10.1177/15365042221083001 .

This report examines police-public encounters that resulted in the fatal shooting of civilians during 2015 and 2016. How police contact was initiated varies by race/ethnicity, age, sex, mental health status, and whether (or how) the individual killed by police was armed with a weapon. This crucial information sheds further light on fatal police shootings.
Undead Self and Society
Authors: Katz Nathan
Published: August 2021

This book review explores Psychobilly: Subcultural Survival by Kimberly Kattari, which describes psychobilly as a subculture based around the music genre of the same name.
Parent Advocacy for Lives That Matter
Authors: Harry Beth , Ocasio-Stoutenburg Lydia
Published: August 2021

This article draws parallels between the concept of “Black lives matter” and the efforts of caregivers to advocate for the value of the lives of their children who have disabilities. The authors identify three key concepts that undergird their argument: first, the concept of systemic bias as built in to the hierarchical valuing of different disabilities and the role of this bias in the valuing of parents’ voices; second, the ways in which stigmatized identity markers intersect to intensify bias; and third, the authors propose a broad interpretation of the meaning of parent advocacy in which service providers seek to work as co-advocates rather than as professional advisors. The authors review relevant literature on these themes and also draw on their own experiences as women of color who are parents of children with disabilities. They present their exploration of these topics against the backdrop of the convergence of the COVID-19 pandemic and the Black Lives Matter movement, and call on epistemological assumptions and intersectionality to address the question of whether participants’ perspectives on racism should be considered as “truth.”
Kenaf fibers reinforced unsaturated polyester composites: A review
Authors: Arjmandi Reza , Yıldırım Ilknur , Hatton Fiona , Hassan Azman , Jefferies Christopher , Mohamad Zurina , Othman Norhayani
Published: August 2021

Recently development of high-performance polymer composites made from natural resources in the various sectors is increasing tremendously due to the environmental issues and health hazard possessed by the synthetic fibers during disposal and manufacturing. Among the many different types of natural resources, kenaf fibers have been extensively investigated as an alternative reinforcement for polymer composites over the past few years due to their low cost, good mechanical properties, high specific strength, nonabrasive, eco-friendly, and biodegradability characteristics. Kenaf is regarded as an industrial crop in Malaysia and grown commercially in other parts of the world for different applications. It is certainly one of the important plants cultivated for natural fibers globally which has great potential to use as automotive and construction materials. In many research studies, kenaf fibers have been used as reinforcement in unsaturated polyester (UPE) which perfectly improved the features of the polyester resin. The tensile properties of kenaf fiber reinforced UPE are mainly influenced by the interfacial adhesion between the fibers and the polyester resin. Several chemical modifications are employed to improve the interfacial bonding between kenaf fibers and polyester, resulting in the enhancement of mechanical properties of the composites. Therefore, this paper explores and highlights of the previous studies around kenaf fiber reinforced UPE composites, in terms of processing methods, mechanical, water absorption, and morphological properties to provide a perfect source of literature for doing further research in this topic.
Correlation between computed tomography angiography and histology of carotid artery atherosclerosis: Can semi-automated imaging software predict a plaque's composition?
Authors: Benson John C , Nardi Valentina , Bois Melanie C , Saba Luca , Brinjikji Waleed , Savastano Luis , Lanzino Giuseppe , Lerman Amir
Published: August 2021

Background

Using computed tomography angiography to differentiate between components of carotid atherosclerotic lesions remains largely elusive. This study sought to validate a semi-automated software for computed tomography angiography plaque analysis using histologic comparisons.

Materials and Methods

A retrospective review was performed of consecutive patients that underwent a carotid endarterectomy, with pre-procedural computed tomography angiography imaging of the cervical arterial vasculature available for review. Images were evaluated using a commercially-available software package, which produced segmented analyses of intraplaque components (e.g. intraplaque hemorrhage, lipid-rich necrotic core, and calcifications). On imaging, each component was assessed in terms of its (1) presence or absence, and (2) both volume and proportion of the total plaque volume (if present). On histological evaluation of carotid endarterectomy specimens, each component was evaluated as an estimated proportion of total plaque volume.

Results

Of 80 included patients, 30 (37.5%) were female. The average age was 69.7 years (SD = 9.1). Based on imaging, intraplaque hemorrhage was the smallest contributor to plaque composition (1.2% of volumes on average). Statistically significant linear associations were noted between the proportion of intraplaque hemorrhage, lipid-rich necrotic core, and calcifications on histology and the volume of each component on imaging ( p values ranged from 0.0008 to 0.01). Area under curve were poor for intraplaque hemorrhage and lipid-rich necrotic core (0.59 and 0.61, respectively) and acceptable for calcifications (0.73).

Conclusion

Semi-automated analyses of computed tomography angiography have limited diagnostic accuracy in the detection of intraplaque hemorrhage and lipid-rich necrotic core in carotid artery plaques. However, volumetric imaging measurements of different components corresponded with histologic analysis.
Imaging of benign cervicofacial vascular anomalies and associated syndromes
Authors: Larson Anthony S , Brinjikji Waleed , Anderson Katelyn R , Tollefson Megha , Michelle Silvera V. , Guerin Julie B.
Published: August 2021

Cervicofacial vascular anomalies can result in morbidity, pain, and cosmetic concerns in affected individuals. Each anomaly has its own unique natural history, treatment, and associations with underlying genetic syndromes. For optimal patient care, it is important for the neuroradiologist to accurately recognize and characterize these entities to ensure appropriate treatment and management. In this review, we discuss the general characteristics, classifications, and imaging features associated with the most common vascular anomalies such as hemangiomas, arteriovenous malformations and fistulas, capillary malformations, venous malformations, and lymphatic malformations in the context of associated syndromes. Additionally, we discuss novel imaging techniques that aid in identifying these vascular anomalies.
Multidisciplinary Research as a Complex System
Authors: Dalton Amaris , Wolff Karin , Bekker Bernard
Published: August 2021

Collaborative research has become increasingly prominent since the mid-20th century. This article aspires to offer a fundamental ontology of a multidisciplinary research system. As a point of departure, we consider disciplinarity as a restricted language code as noted by Bernstein. The impetus for collaboration is found in a research problem’s transcendence of disciplinary bounds. This article makes several propositions that diverge from the consensus position regarding the formation and dynamics of a multidisciplinary system. Most notably that such a system adheres to the constituent elements of what could be regarded as a complex system, including an ensemble of elements, interactions between these elements, local disorder followed by the emergence of robust order and system memory. We propose that the internal communications and subsequent self-organization of such a system may be conceptualized as orientation signals, or ‘stigmergy’, analogous to those observed in swarms. System robustness, we argue, is a function of the individual researcher’s local autonomy and is, paradoxically, augmented by the weakness of communications across disciplinary bounds, along with the lack of central organization and the emphasis on research novelty. System memory, we argue, manifests itself in the ability of a researcher to change her/his route of inquiry, based on environmental feedback, whereby new information becomes incorporated into the adjusted research methodology. We propose that an emergent intelligence, at the level of the system, expresses itself in the unconcealment of the ‘form’ of the metaproblem. The theoretical model is empirically illustrated using, as an example, the contemporary field of renewable energy research, which is an area primed for collaborative research. It is anticipated that an improved understanding of multidisciplinary research systems provides insights into certain strengths particular to less integrated and self-organized forms of collaborative research along with a framework with which to improve the design and fostering of such systems.
Evaluation of the vibration characteristics and handle vibration damping of diesel-fueled 15-HP single-axle tractor
Authors: Busse Siraj K , Sinclair Anthony N , Redda Daniel T , Wondimu Diresibachew H
Published: August 2021

Attenuation of vibration transmitted from a single-axle tractor to a human hand results in a better operating environment, enhanced production performance, and decreased user pain. The purpose of this work was to attenuate the hand-transmitted vibration of a single axle tractor using a vibration damper made from a rubber compound. After the damper was installed, the vibration measurements were done for the second and third gears and compared to the undamped vibration. When the vibration measured with the second gear after the rubber dampers were mounted was compared to the vibration measured before application of damping, the upright, forward, and lateral directions of vibration showed 42%, 39%, and 46% reductions, respectively. In the third gear, the decrement was 46%, 29%, and 50% in the upright, forward, and lateral directions, respectively. The latency periods after application of the vibration damping show an increment of 2.55–4.76 years with second gear, and from 2.2 to 4.17 years with third gear. This reflects an increase of 89% and 90% with second and third gears respectively.
Visual content of Twitter during the 2018 protests in Iran: Analysis of its role and function
Authors: Esfandiari Maryam , Fridrich Bohdan , Yao Junxi
Published: August 2021

This study examines the visual content of Twitter posts, including photos and videos, published during the 2018 protests in Iran. Our main objective is to understand how these protests were visually represented on Twitter. The theoretical framework of this study is drawn from the ‘dynamic dual path way model of approach coping’ that categorizes responses of collective action in emotion-focused and problem-focused coping. Our findings reveal that visual content with efficacy-eliciting characteristics was posted more often than emotion-arousing content. Furthermore, visual content with more protest activity is more likely to be retweeted.
Insights into Bruneian students’ transformative mobility experiences from their community outreach activities in Vietnam
Authors: Kumpoh Asiyah az-Zahra Ahmad , Sulaiman Exzayrani Awang , Le Ha Phan
Published: August 2021

This article is concerned with the internationalisation of higher education and student mobility for society and community engagement purposes. Drawing on the specific case study of Universiti Brunei Darussalam’s Community Outreach Programme overseas, it examines the programme’s operation in Vietnam as well as investigates Bruneian students’ experiences during their programme activities in this Asian country. The article also explores the impacts of such experiences on the students’ growth and transformations. The reported growth and transformations, on the one hand, demonstrate the importance of social engagement beyond campus and correspond to the internationalisation in higher education for society agenda recently advocated by international education scholars and practitioners. They also offer rich insights into (inter-Asian) student mobility for non-academic purposes, which remain largely under-researched. On the other hand, underlying the students’ transformative experiences are many issues associated with student safety and wellbeing that require ethical responses and appropriate adaptive pedagogies.
Contemplative reflections on international education: Transformative possibilities
Authors: Leve Annabelle
Published: August 2021

A commentary in response to this special issue theme and published articles.
Maternal knowledge-seeking behavior among pregnant women in Tanzania
Authors: Kaaya Elsie Somi , Ko Jesuk , Luhanga Edith
Published: August 2021

Background:

Maternal mortality continues to be a global challenge with about 830 women dying of childbirth and pregnancy complications every day. Tanzania has a maternal mortality rate of 524 deaths per 100,000 live births.

Objective:

Knowing symptoms associated with antenatal risks among pregnant women may result in seeking care earlier or self-advocating for more immediate treatment in health facilities. This article sought to identify knowledge-seeking behaviors of pregnant women in Northern Tanzania, to determine the challenges met and how these should be addressed to enhance knowledge on pregnancy risks and when to seek care.

Methods:

Interview questions and questionnaires were the main data collection tools. Six gynecologists and four midwives were interviewed, while 168 pregnant women and 14 recent mothers participated in the questionnaires.

Results:

With the rise in mobile technology and Internet penetration in Tanzania, more women are seeking information through online sources. However, for women to trust these sources, medical experts have to be involved in developing the systems.

Conclusion:

Through expert systems diagnosis of pregnancy complications and recommendations from experts can be made available to pregnant women in Tanzania. In addition, self-care education during pregnancy will save women money and reduce hospital loads in Tanzania.
Accuracy and reproducibility of visual estimation of the acetabular cup positioning in total hip arthroplasty on plain radiographs by orthopaedic surgeons
Authors: Somerville Charlotte MB , Geddes James Arthur , Tofighi Mehdi , Boddu Krishna
Published: August 2021

Objectives

To examine whether trauma and orthopaedic surgeons could visually assess the anteversion and inclination of a total hip replacement acetabular component from standard anteroposterior radiograph and anteversion on a standard lateral radiograph with accuracy or reproducibility. Main outcome measurement: The main outcome was accuracy of visual estimations of angles. The secondary outcome was whether these estimations were reproducible though intra-observer variability.

Results

Mean angles of anteversion on the anteroposterior, inclination on the anteroposterior and anteversion on the lateral on formal measurements were 15.2°, 45.4° and 19.9°; and the visual estimates were 17.5°, 45.9° and 18.2°, respectively. When comparing the visual estimates of surgeons and formal measurements, the results ranged from very poor to very good. Intra-observer reproducibility was moderate for all angles. The difference between the consultants and speciality registrars was not significant.

Conclusion

This study illustrated that not all orthopaedic surgeons were able to visually estimate angles well. Although some of our participants were very accurate, there were some who statistically were very poor. This level of inaccuracy can lead to inconsistency and we strongly suggested specialist software is used to assess acetabular cup position on postoperative plane radiographs rather than relying on ‘visual estimations’.
Rehabilitation after flexor tendon repair and others: a safe and efficient protocol
Authors: Tang Jin Bo
Published: August 2021

In this review I detail the protocol that I use after flexor tendon repair and outline my experience regarding how its framework might be used for other disorders. The early passive–active flexion protocol has a sufficient number of cycles of active flexion in each exercise session, which is at least 40, and ideally 60 to 80. The frequency of exercise sessions may range from 4 to 6 a day, distributed in the morning, afternoon and evening. Increasing the number of daily sessions without a sufficient number of runs in each session is ineffective. In the first 2–3 weeks after surgery, active digital flexion should go through only a partial range. In weeks 4–6, the patient gradually moves through the full range. With modifications, I suggest generalization of the partial-range finger motion to therapy after treating other hand injuries. I consider partial-range active flexion a generalizable working principle for different hand disorders.
Acute and Chronic Glucose Control in Critically Ill Patients With Diabetes: The Impact of Prior Insulin Treatment
Authors: Krinsley James S. , Rule Peter , Brownlee Michael , Roberts Gregory , Preiser Jean-Charles , Chaudry Sherose , Dionne Krista , Heluey-Rodrigues Camilla , Umpierrez Guillermo E. , Hirsch Irl B.
Published: August 2021

Background:

Emerging data highlight the interactions of preadmission glycemia, reflected by admission HbA1c levels, glycemic control during critical illness, and mortality. The association of preadmission insulin treatment with outcomes is unknown.

Methods:

This observational cohort study includes 5245 patients admitted to the medical-surgical intensive care unit of a university-affiliated teaching hospital. Three groups were analyzed: patients with diabetes with prior insulin treatment (DM-INS, n = 538); patients with diabetes with no prior insulin treatment (DM-No-INS, n = 986); no history of diabetes (NO-DM, n = 3721). Groups were stratified by HbA1c level: <6.5%; 6.5%-7.9% and >8.0%.

Results:

Among the three strata of HbA1c, mean blood glucose (BG), coefficient of variation (CV), and hypoglycemia increased with increasing HbA1c, and were higher for DM-INS than for DM-No-INS. Among patients with HbA1c < 6.5%, mean BG ≥ 180 mg/dL and CV > 30% were associated with lower severity-adjusted mortality in DM-INS compared to patients with mean BG 80-140 mg/dL and CV < 15%, ( P = .0058 and < .0001, respectively), but higher severity-adjusted mortality among DM-No-INS ( P = .0001 and < .0001, respectively) and NON-DM ( P < .0001 and < .0001, respectively). Among patients with HbA1c ≥ 8.0%, mean BG ≥ 180 mg/dL was associated with lower severity-adjusted mortality for both DM-INS and DM-No-INS than was mean BG 80-140 mg/dL ( p < 0.0001 for both comparisons).

Conclusions:

Significant differences in mortality were found among patients with diabetes based on insulin treatment and HbA1c at home and post-admission glycemic control. Prospective studies need to confirm an individualized approach to glycemic control in the critically ill.
An Interventionist and Psychometrician Considers Assessing Changes in Spiritual Formation
Authors: Worthington Everett L.
Published: August 2021

There are two parts to this present article. First, I consider the applied problem of assessing changes in a congregation—how often to assess, why assess, what changes are looked for, what interventions are assessed, why look to the components of interventions, and how to avoid problems interpreting your data. Brief assessments are mandatory. Pastors and lay leaders can make simple but sound assessments of their spiritual formation programs using item response theory, goal attainment scales, single items, parceling single items, or narrative responses as five alternatives. I describe dangers in interpreting the findings such as not knowing the base rate of change and mistaking the assessment for the mission. In the second part of the article, I briefly describe a program labeled a deep dive into humility. I summarize the assessments that were done, which gives a practical example of the technical recommendations I made earlier in the article.
Typical is Trustworthy - Evidence for a Generalized Heuristic
Authors: Alves Hans , Uğurlar Pinar , Unkelbach Christian
Published: August 2021

When judging whether someone is trustworthy, people rely on the perceptual typicality of a person’s face. We tested whether a more general typical-is-trustworthy heuristic exists based on the descriptive typicality of a person. In four experiments, we provided participants with descriptive information about the typicality of target persons’ attributes (i.e., population prevalence) and measured perceived trustworthiness. Participants consistently expected descriptively typical targets to be more trustworthy than descriptively atypical targets. These findings show that typicality-based trustworthiness inferences are not only confided to perceptual typicality but also apply to descriptive typicality, suggesting a general typical-is-trustworthiness heuristic. This implies a human tendency to trust typical individuals more and, conversely, a disadvantage for atypical individuals such as minorities.
A Tale of Peaks and Valleys: Sinusoid Relationship Patterns Between Mountainousness and Basic Human Values
Authors: Stieger Stefan , Götz Friedrich M. , Wilson Chris , Volsa Selina , Rentfrow Peter J.
Published: August 2021

Mountains—mythic and majestic—have fueled widespread speculation about their effects on character. Emerging empirical evidence has begun to show that physical topography is indeed associated with personality traits, especially heightened openness. Here, we extend this work to the domain of personal values, linking novel large-scale individual values data ( n = 32,666) to objective indicators of altitude and mountainousness derived from satellite radar data. Partial correlations and conditional random forest machine-learning algorithms demonstrate that altitude and mountainousness are related to increased conservation values and decreased hedonism. Effect sizes are generally small (| r| < .031) but comparable to other socio-ecological predictors, such as population density and latitude. The findings align with the dual-pressure model of ecological stress, suggesting that it might be most adaptive in the mountains to have an open personality to effectively deal with threats and endorse conservative values that promote a social order that minimizes threats.
Ballistic impact resistance of additive manufactured high-strength maraging steel: An experimental study
Authors: Costas Miguel , Edwards-Mowforth Maisie , Kristoffersen Martin , Teixeira-Dias Filipe , Brøtan Vegard , Paulsen Christian O. , Børvik Tore
Published: August 2021

Maraging steel is a low carbon steel known for its ultra high-strength after heat treatment. In combination with Additive Manufacturing (AM), the properties of maraging steel indicate potential to enable complex geometries and improved performance-to-weight ratios for ballistic protection. This study investigates the ballistic performance of AM maraging steel monolithic plates and profile panels fabricated by powder bed fusion. The mechanical properties of the maraging steel, both in the as-built state and after heat treatment, were revealed through quasi-static and dynamic tests in three different directions with respect to the build direction. Metallurgical studies were also conducted to investigate the microstructure of the material both before and after testing. The ballistic perforation resistance of the maraging steel samples was disclosed in a ballistic range by firing 7.62 mm APM2 bullets towards the different target configurations. Ballistic limit curves and velocities were obtained, demonstrating that the thickest heat-treated AM maraging steel plate has a particularly good potential for ballistic protection. The hard core of the armour piercing bullet broke in all tests and occasionally shattered during tests with heat-treated targets. However, due to the severe brittleness of the material, the targets showed significant fragmentation in some cases and most significantly for the profile panels.
Opioid use after outpatient elective general surgery: quantifying the burden of persistent use
Authors: Clarke Collin , McClure Andrew , Allen Laura , Hartford Luke , Van Koughnett Julie Ann , Gray Daryl , Murphy Patrick B , Vinden Chris , Leslie Ken , Vogt Kelly N
Published: August 2021

Purpose:

Surgery is a major risk factor for chronic opioid use among patients who had not recently been prescribed opioids. This study identifies the rate of, and risk factors for, persistent opioid use following laparoscopic cholecystectomy and open inguinal hernia repair in patients not recently prescribed opioids.

Methods:

This retrospective population-based cohort study included all patients who had not been prescribed opioids in the 6 months prior to undergoing open inguinal hernia repair or laparoscopic cholecystectomy from January 2013 to July 2016 in Ontario. Opioid prescription was identified from the provincial Narcotics Monitoring System and data were obtained from the Institute for Clinical Evaluative Sciences. The primary outcome was persistent opioid use after surgery (3, 6, 9 and 12 months). Associated risk factors and prescribing patterns were also examined.

Results:

Among the 90,326 patients in the study cohort, 80% filled an opioid prescription after surgery, with 11%, 9%, 5% and 1% filling a prescription at 3, 6, 9 and 12 months, respectively. Significant variability was identified in the type of opioid prescribed (41% codeine, 31% oxycodone, 18% tramadol) and in regional prescribing patterns (mean prescription/region range, 135–225 oral morphine equivalents). Predictors of continued opioid use included age, female gender, lower income quintile and being operated on by less experienced surgeons.

Conclusion:

Most patients who undergo elective cholecystectomy and hernia repair will fill a prescription for an opioid after surgery, and many will continue to fill opioid prescriptions for considerably longer than clinically anticipated. There is important variability in opioid type, regional prescribing patterns and risk factors that identify strategic targets to reduce the opioid burden in this patient population.
Radical nephrectomy and vena caval thrombectomy with the use of cardiopulmonary bypass and hypothermic circulatory arrest: Experience at a large tertiary institution
Authors: Storey Benjamin , Grant Alexander , Tiu Albert
Published: August 2021

Objective:

This study aimed to review the experience at a large regional tertiary centre of open radical nephrectomy (RN) with vena caval thrombectomy with cardiopulmonary bypass (CPB) and hypothermic circulatory arrest (HCA) for the management of renal masses.

Method:

Data on patients with renal masses who had undergone RN and vena caval thrombectomy with CPB and HCA had been prospectively collected at two centres over a 19-year period (2000–2019). Twenty-three consecutive patients were identified and retrospectively analysed for operative and tumour characteristics and for postoperative outcome. Kaplan–Meier survival analysis was performed to compare patient outcomes based on tumour characteristics.

Results:

Median operating time was 358 minutes (interquartile range (IQR)=94 minutes), median bypass time was 117 minutes (IQR=28.5 minutes) and median circulation arrest time was 25 minutes (IQR=18.5 minutes). The median hospital length of stay was 11 days (IQR=5.3 days). Total complication rate was 52% ( n=12), consisting of four minor and eight major complications (Clavien–Dindo score >IIIa), including one intraoperative death. The overall five-year survival rate was 73% (11/15), with a median follow-up time of 53.1 months. Eleven (48%) patients were surgically cured, with a median follow-up time of 60.1 months (IQR=71.8 months). Disease recurrence was seen in eight (35%) patients, of whom four died. Patients who died survived for a median of 46.5 months. Median survival after the diagnosis of metastatic disease was seven months.

Conclusions:

We report the largest Australian cohort of RN with vena caval thrombectomy with CPB and HCA. We demonstrate outcomes comparable to major overseas centres, with an overall five-year survival rate of 73%. This suggests that even patients with extensive venal caval thrombus from renal masses can experience long-term survival benefit from RN and venal caval thrombectomy.

Level of evidence:

Level 3.
A Systemic Functional Study of the System of Modality in Chinese
Authors: Yang Shu
Published: August 2021

In previous systemic functional studies of modality in Chinese, the systems of types and degrees of modality have been discussed; however, the system that characterizes the realization of types and degrees of modality has been largely neglected, and realizations of modality have not been systematically explored. This paper explores the system of MODALITY in Chinese and realizations derived from the system from the perspective of Systemic Functional Linguistics. In this study, the systems of types and values of modality in Chinese are re-examined. The system of types of modality excludes usuality, since it distinguishes itself from modalization and modulation essentially. The system of values of modality is treated as a cline. More importantly, the study gives a systematic and comprehensive description of the system of MANIFESTATIONS that describes the realization of modality, which distinguishes among explicitly subjective, explicitly objective, and implicitly subjective realizations of modality. The present study is the first attempt to systematically and critically examine the systems of types, values, and realizations of modality in Chinese. It may contribute to a better understanding of modality in the particular language of Chinese, and may lend support to system-based typology, supplementing structure-based typology.
Stem cell therapy for fracture non-union: The current evidence from human studies
Authors: Thurairajah Kabilan , Briggs Gabrielle D , Balogh Zsolt J
Published: August 2021

Non-union is a taxing complication of fracture management for both the patient and their surgeon. Modern fracture fixation techniques have been developed to optimise the biomechanical environment for fracture healing but do not guarantee union. Patient biology has a critical role in achieving union and stem cell therapy has potential for improving fracture healing at a cellular level to treat or avoid non-union. This article reviews the current understanding of non-union, concepts in bone healing and the current literature on the application of stem cells in non-union.
Normative PROMIS Scores in Healthy Collegiate Athletes: Establishing a Target for Return to Function in the Young Adult Athlete
Authors: Minaie Arya , Bernholt David L. , Block Andrew M. , Patel Ronak M. , Wright Rick W. , Matava Matthew J. , Nepple Jeffrey J.
Published: August 2021

Background:

The Patient-Reported Outcomes Measurement Information System (PROMIS) computer-adaptive testing (CAT) has been shown to be a valid and reliable means of assessing patient-reported outcomes. However, normal scores and distributions for a subset of a healthy young athletic population have not been established.

Purpose:

To establish normative PROMIS scores for the domains of Physical Function (PF-CAT), Mobility (M-CAT), Upper Extremity Function (UE-CAT), and Pain Interference (PI-CAT) and determine the frequency of floor and ceiling effects in a population of healthy collegiate athletes.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Healthy collegiate athletes (18-23 years of age) were prospectively enrolled to complete the 4 PROMIS CAT domains. Additionally, the athletes provided information regarding their age, sex, and sport(s). Mean scores (±SD) and identification of ceiling or floor effects were calculated. Ceiling and floor effects were considered significant if >15% of the participants obtained the highest or lowest possible score on a domain.

Results:

A total of 194 healthy athletes (mean age, 19.1 years) were included in the study: 118 (60.8%) men and 76 (39.2%) women. Mean scores were 62.9 ± 6.7 for PF-CAT, 58.2 ± 4.1 for M-CAT, 57.4 ± 5.8 for UE-CAT, and 43.2 ± 6.2 for PI-CAT. Distributions of scores for M-CAT and UE-CAT indicated strong ceiling effects by 77.3% and 66.0% of the participants, respectively. In healthy athletes, the PF-CAT differed most from the expected population-based mean score (50), with the mean being >1 SD above (62.9), without a ceiling effect observed. There were no significant sex- or age-based differences on any of the PROMIS domain scores.

Conclusion:

Healthy collegiate athletes scored nearly 1 SD from population-based means for all of the domains tested. M-CAT and UE-CAT demonstrated ceiling effects in more than two-thirds of healthy athletes, which may limit their utility in this population. The PF-CAT did not demonstrate floor or ceiling effects and demonstrated differences in a young adult athletic population from the population mean. The mean PF-CAT score of 62.9 can represent a target for return of function in injured athletes.
Suture Slippage After Arthroscopic Cuff Repair: Medial Displacement of Suture Knots on Follow-up Ultrasonography
Authors: Kim Hyungsuk , Han Sung Bin , Song Hyun Seok
Published: August 2021

Background:

Compared with the single-row technique, the double-row rotator cuff repair technique is known to have a higher load to failure and a lower frequency of gap formation, leading to a lower retear rate. There are some patients with poor clinical outcomes or poor muscle strength without radiologic retear.

Purpose/Hypothesis:

To assess the postoperative position of suture knots via serial ultrasonography in patients who had undergone arthroscopic rotator cuff repair with the suture-bridge technique. Our hypothesis was that the suture would pull out of the lateral anchor (suture slippage), changing the positions of the medial suture knots during healing.

Study Design:

Case series; Level of evidence, 4.

Methods:

This study included 53 patients (55 shoulders) who underwent arthroscopic suture-bridge repair and were evaluated for a minimum of 24 months. On serial ultrasonography, a straight line was drawn between the top of the greater tuberosity and the medial cortex of the anchor hole. The distances between the knots of the medial rows and the perpendicular line through the center of the anchor hole were measured in longitudinal plane images of the supraspinatus. Follow-up ultrasonography was performed at 2, 3, and 6 months postoperatively as well as at the final visit. The visual analog scale, the American Shoulder and Elbow Surgeons score, the Constant score, and the University of California, Los Angeles shoulder score were recorded preoperatively and on the final follow-up.

Results:

Of the 55 shoulders, 6 developed retears at repaired sites. The mean follow-up duration was 37.5 months (range, 24-65 months). Slippage distance increased significantly over time ( P < .001). The slippage at the final visit did not differ between patients with retear and no retear (13.4 mm for retear group; 10.6 mm for no retear group [ P = .096]).

Conclusion:

Suture knots of the medial row migrated medially via a suture pullout from the lateral row anchor of suture-bridge technique. Suture slippage distance did not differ significantly between retear and no retear groups.
Suture Anchor Versus Transosseous Tunnel Repair for Inferior Pole Patellar Fractures Treated With Partial Patellectomy and Tendon Advancement: A Biomechanical Study
Authors: O’Donnell Ryan , Lemme Nicholas J. , Marcaccio Stephen , Walsh Devin F. , Shah Kalpit N. , Owens Brett D. , DeFroda Steven F.
Published: August 2021

Background:

Comminuted inferior pole patellar fractures can be treated in numerous ways. To date, there have been no studies comparing the biomechanical properties of transosseous tunnels versus suture anchor fixation for partial patellectomy and tendon advancement of inferior pole patellar fractures.

Hypothesis:

Suture anchor repair will result in less gapping at the repair site. We also hypothesize no difference in load to failure between the groups.

Study Design:

Controlled laboratory study.

Methods:

Ten cadaveric knee extensor mechanisms (5 matched pairs; patella and patellar tendon) were used to simulate a fracture of the extra-articular distal pole of the patella. The distal simulated fracture fragment was excised, and the patellar tendon was advanced and repaired with either transosseous bone tunnels through the patella or 2 single-loaded suture anchors preloaded with 1 suture per anchor. Load to failure and elongation from cycles 1 to 250 between 20 and 100 N of force were measured, and modes of failure were recorded. Statistical analysis was performed using a paired 2-tailed Student t test.

Results:

The suture anchor group had less gapping during cyclic loading as compared with the transosseous tunnel group (mean ± SD, 6.83 ± 2.23 vs 13.30 ± 5.74 mm; P = .047). There was no statistical difference in the load to failure between the groups. The most common mode of failure was at the suture-anchor interface in the suture anchor group (4 of 5) and at the knot proximally on the patella in the transosseous tunnel group (4 of 5).

Conclusion:

Suture anchors yielded similar strength profiles and less tendon gapping with cyclic loading when compared with transosseous tunnels in the treatment of comminuted distal pole of the patellar fractures managed with partial patellectomy and patellar tendon advancement.

Clinical Relevance:

Suture anchors may offer robust repair and earlier range of motion in the treatment of fractures of the distal pole of the patella. Clinical randomized controlled trials would help clinicians better understand the difference in repair techniques and confirm the translational efficacy in clinical practice.
Association Between Transtibial Meniscus Root Repair and Rate of Meniscal Healing and Extrusion on Postoperative Magnetic Resonance Imaging: A Prospective Multicenter Study
Authors: Krych Aaron J. , Nauert Richard F. , Song Bryant M. , Cook Corey S. , Johnson Adam C. , Smith Patrick A. , Stuart Michael J.
Published: August 2021

Background:

Prospective studies evaluating second-look imaging of meniscus root repair using a transtibial pull-out technique are limited; therefore, optimal surgical indications and the technique for meniscus root repair remain uncertain.

Hypothesis:

It was hypothesized that there would be a high rate of healing, improvement in meniscal extrusion, and prevention of articular cartilage degeneration and subchondral bone abnormalities after meniscus root repair.

Study Design:

Case series; Level of evidence, 4.

Methods:

Consecutive patients undergoing transtibial root repair were prospectively enrolled at 2 orthopaedic centers between March 2017 and January 2019. Pre- and postoperative magnetic resonance imaging (MRI) scans were reviewed by a musculoskeletal radiologist in a blinded fashion for meniscal healing, quantification of extrusion, articular cartilage grade, subchondral bone changes, and coronary/meniscotibial ligament abnormalities. Given persistent extrusion observed on postoperative MRI scans, an additional 10 patients gave consent and were enrolled for immediate (before weightbearing) postoperative MRI scans.

Results:

A total of 45 patients (16 male, 29 female; mean ± standard deviation age, 42.3 ± 12.9 years; body mass index, 31.6) were prospectively enrolled in the study; there were 47 meniscus root repairs: 29 medial and 18 lateral (2 with both). Postoperative MRI was obtained at an average of 6.3 months (range, 5.1-8 months); 98% of meniscal repairs had evidence of healing. Mean extrusion increased significantly, from 1.9 ± 1.5 mm preoperatively to 2.6 ± 1.4 mm postoperatively ( P = .03). There was no significant progression of chondromalacia grade, subchondral edema, insufficiency fracture, subchondral cysts, or subchondral collapse. In the additional 10-patient cohort, the mean preoperative extrusion (1.6 ± 1.2 mm) was not significantly different from that immediately postoperatively (2.0 ± 1.0 mm; P = .23).

Conclusion:

Prospective MRI analysis of transtibial meniscus root repair confirmed a high rate of meniscal healing and no observable progression of cartilage degeneration or subchondral bone abnormalities at the short-term follow-up. However, meniscal extrusion worsened in the first 6 months after surgery.

Registration:

NCT03037242 ( ClinicalTrials.gov identifier).
The Biopsychosocial Impact of COVID-19 on Older Adults
Authors: Laher Nazeefah , Bocchinfuso Sara , Chidiac Madeline , Doherty Claire , Persson Alexandra , Warren Emma
Published: August 2021

COVID-19 has spread rapidly around the world and taken over 2.6 million lives. Older adults experience disproportionate morbidity and mortality from the disease because increasing age and the presence of comorbidities are important predictors of negative outcomes. Lasting effects of COVID-19 have been described after recovery from the acute illness despite eradication of the virus from the body. The impact of COVID-19 on a person’s biological health post-infection is observed in multiple systems including respiratory, cardiac, renal, haematological, and neurological. Psychological dysfunction following recovery is also prevalent. Social factors such as distancing and stay at home measures leave older adults isolated and food insecure; they also face intertwined financial and health risks due to the resulting economic shutdown. This study examines the effects of COVID-19 on older adults using the biopsychosocial model framework.
Board Certification Is Associated With a Reduced Risk of Endophthalmitis After Intravitreal Injections
Authors: Emerson Geoffrey G. , Rahman Moshiur M. , Kim Diana H. , Stein Joshua D. , VanderBeek Brian L.
Published: August 2021

Purpose:

This work investigates associations between physician qualifications and the risk of postintravitreal injection endophthalmitis.

Methods:

This retrospective analysis of data from medical claims studied Medicare beneficiaries undergoing 1 or more intravitreal injections between January 1, 2013, and December 31, 2017. Logistic regression analysis was performed to assess whether board certification status or retina subspecialty training was associated with lower risk of postinjection endophthalmitis, controlling for patient's age, race, and sex, type of agent injected, diagnosis, and year of injection. The main outcome measure was odds ratio (OR) of receiving a diagnosis of endophthalmitis in the 14 days after intravitreal injection. Clinical outcome and quality of care were not evaluated in this study.

Results:

A total of 2 907 324 intravitreal injections were performed on 219 640 patients by 4315 ophthalmologists, 3196 (74%) of whom were retina specialists and 4021 (92%) of whom were certified by the American Board of Ophthalmology (ABO). Overall, there were 1088 (0.037%) cases of postinjection endophthalmitis, of which 1024 (0.037%) were injected by ABO-certified ophthalmologists and 64 (0.050%) by non–board-certified ophthalmologists. Injections by ABO-certified ophthalmologist had 28% reduced odds of endophthalmitis (OR = 0.72; 95% CI, 0.523-0.996, P = .05). Higher odds of endophthalmitis were observed for corticosteroid injections (OR = 3.91; 95% CI, 2.75-5.56, P < .001) and aflibercept injections (OR = 1.47; 95% CI, 1.19-1.80, P < .001). Patients' sex and race, the diagnosis associated with the injection, and providers' retina subspeciality training were not associated with the rate of endophthalmitis ( P < .20 for all comparisons).

Conclusions:

We found evidence that endophthalmitis may be reduced when ABO-certified physicians perform an intravitreal injection.
Roth-like Spot in an Adult With Vitamin B6 Deficiency and Nonepileptic Seizures
Authors: Driscoll Diana , Callanan David
Published: August 2021

Purpose:

This work reports retinal findings in an adult patient with vitamin B6 deficiency.

Methods:

A case review of a single patient is presented.

Results:

A patient with a Roth-type retinal lesion and a history of nonepileptic seizures was found to have lymphocytic colitis. She was treated with pyridoxine, which resolved her seizures and the white-centered hemorrhage.

Conclusions:

Vitamin B6 deficiency should be considered in the differential diagnosis of patients presenting with white-centered hemorrhages and a history of nonepileptic seizures.
Gujarat NRE Coke Ltd.: Revival of Companies in Distress
Authors: Mundhra Ravi Prakash , Agarwal Saurabh
Published: August 2021

The case study on Gujarat NRE Coke Limited is about a company that has been a pioneer in the metcoke industry. The company is the largest manufacturer of metcoke in India. This case study sets out the details of the company providing insight on its journey starting from its humble beginning to its glorious past to its present struggles. The case provides a picture of the economics of a company and how policy decisions of the government, changing global economic conditions and myopic legal and financial system prevailing in a country can change the fortunes of a high-flying viable company.
Women migrant workers and counter-trafficking responses in Association of Southeast Asian Nations: The enduring challenge of safety and security
Authors: Segrave Marie , Tan Shih Joo
Published: August 2021

Drawing on a study undertaken across eight Association of Southeast Asian Nations countries in 2019, this article focuses on the persistence of investment in criminal justice infrastructure and mechanisms 20 years after the Palermo Protocol came into effect. We examine the enduring challenges and limitations around counter trafficking responses that remain removed from the lived realities of women migrant workers. Building on qualitative interviews with stakeholders and women migrant workers, we argue that women's protection from migration and labor exploitation and gendered violence remains elusive. This study highlights how counter-trafficking systems undermine women's safety and argues for a move away from siloed trafficking efforts, toward a much broader commitment to upholding women migrant workers’ rights and protection.