bluuebunny/crossref_metadata_2025 huggingface dataset:
Design and analysis of a two-degrees-of-freedom monolithic compliant piezoelectric microgripper
Authors: Song Shuaiguan , Yang Yiling , Fu Lei , Li Guoping , Wei Yanding
Published: February 2022

This paper presents the design, modeling, and testing of a compliant two-degrees-of-freedom microgripper using a single piezoelectric actuator. It can move along the x- and y-directions by combining double-leaf bridge and parallelogram mechanisms. An analytical model is established using the finite-element method. The displacement amplification ratio, natural frequency, and output coupling ratio are analyzed using ANSYS software. An experimental test system is built to verify the open-loop performances. Experimental results show that the displacement amplification ratios in the x- and y-directions are 30.8 and 8.6. The first resonant frequencies in the x- and y-directions are 123.3 and 546.9 Hz. If an input displacement of 10 μm is applied, the operating ranges in the x- and y-directions are 0–616.6 μm and 0–51.0 μm, and the gripping force range is 0–25.8 mN. Experimental results validate the feasibility of the theoretical model and simulation analysis. Also, closed-loop trajectory control is conducted to reduce the hysteresis nonlinearity and achieve a high control accuracy for the new microgripper.
Determinants of Vancomycin Trough Concentration in Patients Receiving Continuous Veno-Venous Hemodialysis
Authors: Quinn Nicholas J. , Sacha Gretchen L. , Wanek Matthew R. , Yerke Jason , Srinivas Pavithra , Hohlfelder Benjamin
Published: February 2022

Background:

Vancomycin pharmacokinetics are altered in the critically ill and are further distorted by renal replacement therapy. Limited literature is available evaluating vancomycin dosing in continuous veno-venous hemodialysis (CVVHD).

Objective:

The goal of this analysis was to identify factors that affect vancomycin trough concentration in patients on CVVHD and to determine an appropriate dosing strategy.

Methods:

This was a single-center, retrospective cohort study of adult inpatients admitted to the Cleveland Clinic from May 2016-December 2017. Patients in the intensive care unit who received ≥ 2 doses of vancomycin during CVVHD were included. Patients with interruptions of CVVHD inappropriately timed troughs, a change in dialysate rate, and those who received different vancomycin dosages were excluded. Multivariable linear regression including age, sex, weight, Sequential Organ Failure Assessment score, albumin, 24-hour urine output (UOP), dialysate rate, filter type, and vancomycin dose was run to determine predictors of vancomycin concentration.

Results:

A total of 160 patients were included. The median vancomycin dose was 12.6 mg/kg with a trough of 24.6 mcg/mL. Weight, 24-hour UOP, vancomycin dose (mg/kg), and dialysate rate (mL/kg/h) were all determined to be independent predictors of vancomycin trough level. Patients who received <10 mg/kg doses of vancomycin (N=18) achieved a median trough of 21.5 mcg/mL, with 83% being therapuetic. In patients who received >10 mg/kg (N=142), the median trough was 25.5 mcg/mL, with 47% being therapeutic.

Conclusion and Relevance:

Vancomycin dose, dialysate rate, UOP, and weight are independently associated with vancomycin trough concentration. In CVVHD patients, vancomycin dosed at 10 mg/kg every 24 hours may be an appropriate recommendation.
Impact of metformin on tyrosine kinase inhibitor response in chronic myeloid leukemia
Authors: Pokorny Rebecca , Stenehjem David D. , Gilreath Jeffrey A.
Published: February 2022

Objective

Oral tyrosine kinase inhibitors (TKIs) are first line therapy for chronic myeloid leukemia (CML). A complete cytogenetic response (CCyR) correlates with increased overall survival, however only 66%–88% of patients achieve CCyR after one year of TKI treatment. Because TKI therapy alone cannot eliminate CML stem cells, strategies aimed at achieving faster and deeper responses are needed to improve long-term survival. Metformin is a widely prescribed glucose-lowering agent for patients with diabetes and in preclinical studies, has been shown to suppress cell viability, induce apoptosis, and downregulate the mTORC1 signaling pathway in imatinib resistant CML cell lines (K562R). This study aims to investigate the utility of metformin added to TKI therapy in patients with CML.

Data Sources

An observational study at an academic medical center (Salt Lake City, UT) was performed for adults with newly diagnosed, chronic-phase CML to evaluate attainment of CCyR from TKI therapy with or without concomitant metformin use. Descriptive analyses were used to describe baseline characteristics and attainment of response to TKI therapy.

Data Summary

Fifty-nine patients were evaluated. One hundred percent (5 of 5) in the metformin group and 73.6% (39 of 54) in the non-metformin group achieved CCyR. Approximately 20% of patients in both groups relapsed (defined by a loss of CCyR during study) after a median 34.5 months of follow-up.

Conclusions

Future research is warranted to validate these findings and determine the utility of metformin added to TKI therapy.
Pericardial effusion with pembrolizumab
Authors: Fernández Madrigal Laura , Montero Pérez Olalla , Rodriguez Garcés Maria Yeray , Inoriza Rueda Ángel , Martínez Marcos Francisco Javier
Published: February 2022

Introduction

The treatment of non-small cell lung cancer (NSCLC) has profoundly changed on account of the arrival of new therapies, like immunotherapy. Within this group of drugs, those aimed at the programmed cell death-1 or programmed cell death ligand-1(PD1/PDL-1) are very relevant, for example, Pembrolizumab. Although its adverse reactions are generally mild and well tolerated, it has been associated with certain immune-related adverse events (IrAEs) than can be serious and affect any organ.

Case report

A 62-year-old woman diagnosed with stage IV NSCLC with a single bone metastasis and PD-L1 expression of 60% started treatment with cisplatin-pemetrexed-pembrolizumab, and maintenance with pembrolizumab.

Management and outcome

The patient attended the ER with pericardial effusion that was assumed to be a Pembrolizumab IrAE and was managed with corticosteroids. The patient fully recovered but immunotherapy was not reintroduced due to the severity of the AE.

Discussion

The cardiovascular system is among the least affected organs by immunotoxicity, with an incidence between 0.09–0.6%. However, some authors suspect the incidence is underestimated. Median time to onset is highly variable, ranging from 6 weeks since the first dose to 2 years after discontinuation of the treatment. There are not guidelines on the most effective management of the IrAEs, but according to the pharmaceutical reference, corticosteroids should be initiated followed by a progressive reduction. If no response is obtained, another immunosuppressive agent should be added. The determination to restart immunotherapy depends on the severity of the adverse reaction, the availability of other alternative treatments, and the cancer response.
Health care seeking behaviors and perspective on indigenous palliative care among cancer patients in Kenya
Authors: Cheboi Solomon , Kariuki Peris , Mutai Joseph , Kibet Staline , Nyamanga Philemon
Published: February 2022

Introduction

Holistic integrated community palliative care services remain a mirage to cancer patients. Nonetheless, a number of cancer patients are jamming traditional medicinal places seeking therapy. The results of these visits are undocumented. This study explored healthcare seeking behaviors and perspectives on cancer indigenous palliative care among patients visiting traditional health practitioners in Kenya.

Methods

A cross-sectional study was undertaken through client exit survey. Face to face interviews were conducted using semi-structured questionnaires with all consenting cancer patients exiting mapped outlets. Data was analyzed using Statistical Package for Social Science Version 22.0.

Results

A total of 433 respondents were interviewed and the majority were female 59.6%, Christians 97.2%, married 89.8% and educated 85.7%. Their mean age was 48.25 ± 15. 58. Education, sex and religion were significantly associated with perceived improvement. The predominant cancer types were breast cancer (22.4%); throat (14.8%), prostate (12.9%), bone (12.5%), cervical (9.9%), stomach (6.0%) and skin cancer (5.1%). The most frequently used traditional medicine was herbal medicine that was driven by unresponsive conditions (42.2%), inaccessible biomedical services (18.8%) and yearning for second opinion (18%) over a condition. Seventy six percent of the respondents reported improved and prolonged quality of life. 78.2% reported improved eating, drinking, standing, walking and doing light duties alone. Patients felt healthier, hopeful, happier, confident and bonded to their families.

Conclusions

Use of indigenous palliative care is predominant to all major cancer conditions and driven by the quest for cure, successful stories, trustworthiness and beliefs, previous experience and avoiding medical procedures such as surgery.
Fecal shedding of extended-spectrum beta-lactamase-producing Enterobacterales in cats admitted to an animal shelter
Authors: Weese J Scott , O’Brien Tyler , Bateman Shane
Published: February 2022

Objectives

The objective of this study was to evaluate shedding of extended-spectrum beta-lactamase (ESBL)-producing bacteria in cats admitted to an animal shelter.

Methods

Fecal samples were collected from cats admitted to an animal shelter between 12 June and 23 August 2018. Selective enrichment culture for ESBL-producing bacteria was performed and isolates were speciated and tested for selected ESBL genes using PCR.

Results

ESBL-producing Enterobacterales were identified in fecal samples from 2/87 (2.3%; 95% confidence interval 0.6–8.0) cats. One isolate was an Escherichia coli that possessed blaCTX-M-1, blaCMY-2 and blaTEM genes. The other was Enterobacter cloacae possessing blaCTX-M-1 and blaCMY-2.

Conclusions and relevance

While the study sample size and prevalence rate for ESBL-producing bacteria were low, these data document that cats admitted to similar shelters could harbor these agents. The risk posed by ESBL-producing bacterium shedding in cats, both to cats and other species, is currently unclear. However, these findings support the need for more investigation of interspecies transmission of ESBL-producing bacteria and ESBL genes, as well as the importance of antimicrobial stewardship and routine infection control measures.
Surgical management after Oxaliplatin extravasation: A case report and literature review
Authors: Van Praet Laura , Boecxstaens Veerle , Douchy Thomas
Published: February 2022

This case report describes a unique case of chronic reaction after extravasation of oxaliplatin. The pain and extensive subcutaneous induration did not resolve after 9 months of conservative treatment. Surgical debridement with removal of the totally implantable venous access device (TIVAD) resulted in immediate resolution of the symptoms. Oxaliplatin has both irritant and vesicant properties that are difficult to distinguish at initial clinical presentation. In most literature cases complaints resolve within 3 months with conservative treatment yet surgical debridement should be considered if complaints persist beyond this period.
Results of a Hepatitis C Micro-Elimination Program in Two Addiction Centers Among Subjects With Substance Use Disorder
Authors: Vega-Astudillo Pablo , Basurte-Villamor Ignacio , De Ema López Inés , Olmos Espinos Ruth , Mesías-Pérez Beatriz , Szerman Nestor
Published: February 2022

Objectives:

We aimed to evaluate a hepatitis C (HCV) micro-elimination program in 2 addiction centers among subjects with substance use disorders (SUD).

Methods:

The program was based on simplifying the diagnosis of HCV infections by avoiding referral to primary care for the diagnosis and performing the necessary tests at the point of care (ie, the addition center) and simplifying the patient pathway by directly referring patients to the specialized care for treatment. Descriptive and multivariate analyses are presented.

Results:

Of the 1497 subjects included in the program, 327 reported that they were anti-HCV-positive. Among the 1170 patients who were offered the HCV rapid antibody test, 180 (15.4%) did not perform the test. Performing the HCV rapid antibody test only contributed ten patients (3%) to the 337 who were anti-HCV-positive. A high proportion (147 out of 327 [45%]) of subjects who reported being anti-HCV-positive also reported that they had not been treated for HCV. Among the 67 subjects who were HCV-RNA-positive and were referred for treatment, 53 (79%) ultimately received and completed antiviral treatment. Unfortunately, we did not find any factors associated with not performing dry blood testing, and the factors associated with not performing the HCV rapid antibody test were difficult to interpret, and the model showed low goodness of fit.

Conclusions:

Our results suggest that a micro-elimination program focused on patients with SUD attending an addiction center is not effective for screening the presence of hepatitis C but is successful for linking patients with hepatitis C to antiviral treatment.
A randomized controlled trial of a web-based mindfulness programme for people with MS with and without a history of recurrent depression
Authors: Sesel Amy-Lee , Sharpe Louise , Beadnall Heidi N , Barnett Michael H , Szabo Marianna , Naismith Sharon L
Published: February 2022

Background:

Evidence shows small positive effects associated with psychological treatments for people with multiple sclerosis (PwMS). In a recent meta-analysis, the treatment with the largest effect size was a mindfulness-based intervention (MBI).

Objectives:

We aimed to determine whether an Internet-delivered MBI was beneficial for PwMS. Furthermore, we aimed to investigate history of recurrent depression as a moderator of treatment outcome.

Methods:

Participants ( N = 132) were assessed based on whether they had a history of recurrent depression, then stratified and randomized to MBI or waitlist. Outcomes were assessed at baseline, post-intervention, and 3 and 6 months.

Results:

The MBI group reported significantly improved depressive symptoms (primary outcome) compared with the waitlist ( p = 0.046, Cohen’s d = 0.39). Those with a history of recurrent depression benefitted significantly more than those without ( p = 0.034, d = 0.66). There were benefits for health-related quality of life (HRQoL) in the MBI, irrespective of depression history ( p = 0.009, d = 0.5). Pain interference was less overall in the MBI group ( p < 0.001, d = 0.2), but change over time did not differ from waitlist. There were no treatment effects for anxiety, pain severity or fatigue.

Conclusion:

The Internet-delivered MBI significantly improved depressive symptoms and HRQoL in PwMS. For depression, the benefits were greater for those with a history of recurrent depression.

Trial Registration:

ACTRN12618001260213, available at: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375598
Measuring hidden demand and price behavior from US outbound health tourism spending
Authors: Ridderstaat Jorge
Published: February 2022

The health tourism literature has covered several topics, but studies on the workings of health tourism demand and prices are still under-highlighted. This study investigates US outbound health tourism demand and price developments (real exchange rates) for 50 destinations, using outbound health tourism spending as a reference variable. The study applies the dynamic time warping approach, a sophisticated technique to assess similarities between time series, specifically, the outbound health spending with demand and prices. The results show that demand developments have similarities with US outbound health tourism spending in the short-run, with about 1.2% of all US outbound travelers being health tourists. Price developments have both long- and short-term similarities with outbound health tourism spending. The findings could help policy-makers in better managing the health tourism industry.
The Preston Model: Economic Democracy, Cooperation, and Paradoxes in Organisational and Social Identification
Authors: Prinos Ioannis , Manley Julian
Published: February 2022

The ‘Preston Model’ (PM) has substantially improved the socio-economic outlook of Preston (UK). It is a community wealth-building approach, harnessing local economic power for a more resilient, environmentally sustainable, democratic economy and socially cohesive community, prioritising social value, through private and public sector partnerships. This qualitative research article investigates how people in local ‘anchor institutions’ (major wealth creators and employers ‘anchored’ in Preston) perceive the PM. Focusing on economic democracy and solidarity, and building on organisational and social identity theory, its relation with democratic participation, organisational identification and pride processes enabling social change is examined. Most interviewees doubt its organisational and local impact; nevertheless, they exhibit a sense of pride as its ‘drivers’, attributing to it ‘higher’ ethical values. While the PM exerts a subtle emotional, aspirational, and socio-cultural influence, it still represents a shifting, alternative socio-economic paradigm, emerging through both individual and collective assent, rather than specific policy directives.
The usefulness of open events: Navigating professional spaces of urban Meetups
Authors: Alarcon Andrea
Published: February 2022

Based on ethnographic research, this paper examines the burden of search that individuals bear in navigating the plethora of open events surrounding the tech industry. It focuses on one learn-to-code Meetup, finding that attendees are pulled in by the hope embedded in the popular imaginary of coding, particularly the programming language Python, as a way to change their careers. While the gathering’s call labels it as a learning space,the study finds teaching happens rarely, instead drawing individuals who seek peers based on a Python affinity, in part to break the side-by-side-but-not together norms of urban mobile work. This paper argues that the hope of individual professional change spills over into the hope of sharing space with programmers and to find “local Python community”. However, given the porosity of events facilitated by online convening, the gathering falls short of attracting those already pertaining to that community itself.
Determination of local constitutive behavior of AA6061–T6 friction stir welds using digital image correlation
Authors: Ono Yuichi , Yokoyama Takashi
Published: February 2022

The local constitutive behavior of aluminum alloy 6061–T6 friction stir welds was characterized by uniaxial tensile tests using digital image correlation. The global tensile stress–strain relations for friction stir weld specimens were determined using a conventional testing machine equipped with an extensometer. The digital image correlation method was simultaneously applied to measure the full-field strain distributions over a 30 mm gauge length of the friction stir weld specimens during loading. The global specimen strains over the gauge length were determined by superimposing local strains measured by digital image correlation using the “inverse rule of mixtures” for composites. The Hollomon and Ludwik constitutive models were used to describe the local flow curves for the weld zones. The global true stress–true strain curves obtained from uniaxial tensile tests were compared with those constructed by superimposing local strains measured using digital image correlation. Both the global mechanical responses were in good agreement with each other. It is shown that the global true stress–true strain curves can be constructed using the inverse rule of mixtures method from the local constitutive equations for the different weld zones determined by the uniaxial tensile tests using digital image correlation.
Stressors and coping strategies in Chinese family caregivers of people with dementia in long-term care facilities: A qualitative descriptive study
Authors: Hui Zhaozhao , Yang Chen , Fan Lee Diana Tze
Published: February 2022

Objectives

This study aimed to explore the stressors along with coping strategies in Chinese family caregivers whose relative with dementia had been placed into a long-term care facility.

Methods

A qualitative descriptive study was conducted with 17 Chinese family caregivers of institutionalised older adults with dementia, recruited via purposeful sampling. Information regarding stressors along with coping strategies was collected through face-to-face semi-structured individual interviews. The interviews were audio-recorded, transcribed, anonymised and imported into MAXQDA 2018.2. Data were analysed with qualitative content analysis.

Findings

Three categories of stressors emerged: socioeconomic pressure, hassles arising from continuing caregiving and suboptimal care provided by the facility. In particular, the family caregivers’ experienced tremendous pressure of negative comments from people around since long-term care placement was traditionally viewed as unfilial in Chinese societies. Various coping strategies were adopted by Chinese family caregivers to deal with the stressors; however, they were not always adaptive.

Implications

Health care authorities and professionals should recognise family caregivers’ stressors after long-term care placement of a relative with dementia with the consideration of the unique socio-cultural needs. Appropriate and effective interventions should be developed and implemented to facilitate family caregivers to cope with stressful situations after long-term care placement and further to safeguard their psychosocial well-being.
Is there a right to a fully vaccinated care team?
Authors: Schwartzberg Jordan L , Levenson Jeremy , Appel Jacob M
Published: February 2022

Although COVID-19 vaccines are free and readily available in the United States, many healthcare workers remain unvaccinated, potentially exposing their patients to a life-threatening pathogen. This paper reviews the ethical and legal factors surrounding patient requests to limit their care teams exclusively to vaccinated providers. Key factors that shape policy in this area include patient autonomy, the rights of healthcare workers, and the duties of healthcare institutions. Hospitals must also balance the rights of interested parties in the context of logistical constraints, equity, and public health considerations.
How we talk(ed) about it: Ways of speaking about computational architecture
Authors: Horvath Anca-Simona
Published: February 2022

If we understand architecture as a three-part system formed by the building, its image, or drawings and images describing buildings, and the critical discourse around architecture, then the texts or ways of speaking about architecture play a key role in understanding the field and its development. By analysing a corpus of around 4.6 million words from texts written between 2005 and 2020 that form a part of critical discourse in computational architecture (understood as the result of the intense digitalization of the field), this paper aims to map ways of speaking about computational architecture. This contributes to architectural theory and might help gain a better understanding of the evolution of the digitalization of construction in general. Findings show that computational architecture is surrounded by a specific way of speaking, hybridized with words from fields such as biology, neuroscience, arts and humanities, and engineering. While some topics such as ‘sustainability’ or ‘biology’ come up consistently in the discourse, others, such as ‘people’ or ‘human’, have periods when they are more and less popular. After highlighting open research questions, the paper concludes by presenting a map of periodic and recurring topics in ways of speaking about computational architecture over the last 15 years, thus tracking and documenting long-term trends, and illuminating patterns in the broader field of digital construction.
Torsional behavior of non-crimp orthogonal woven composite using experimental and numerical methods
Authors: Aghaei Hamid Reza , Varsei Mehdi , Ajeli Saeed , Dolatabadi Mehdi Kamali , Yazdanshenas Mohammad Esmail
Published: February 2022

Nowadays, using three dimensional fabric as a reinforcement part in the composite has been increased. Non-crimp three dimensional orthogonal woven fabric is a subgroup of 3D woven fabrics that in this study was used to fabricate composite preforms. The fabrics were produced by glass yarn in two different fiber volume fractions. All fabric preforms were utilized to produce composites with polyester and epoxy resins. To compare the torsional behavior of the composites, a torsion test was applied to all samples and torque-revolution curves from the experimental results were compared together. Results showed that composites that were fabricated by epoxy resin have more torsional strength in comparison with composites in that their matrix is polyester resin. Moreover, preforms with high fiber volume fractions showed high torsional strength in each type of matrix. The torsion strength of high volume fraction for polyester matrix was 47.34 KPa, however for the sample with epoxy matrix the torsion strength was determined 81.26 KPa. Furthermore, a multiscale finite element model was applied to calculate elastic constants and predict the torsional behavior of the composites. The numerical results were compared with experimental results that a good agreement between numerical and experimental results was observed. Therefore, the proposed model can predict the torsional behavior of the composite with different fiber volume fractions.
ISGylation is increased in the peripheral blood mononuclear cells derived from symptomatic COVID-19 patients
Authors: Schwartzenburg Joshua , Reed Ryan , Koul Hari , Zea Arnold H , Shellito Judd , Miele Lucio , Crabtree Judy S , Desai Shyamal
Published: February 2022

Cytokine-driven hyper inflammation has been identified as a critical factor behind poor outcomes in patients severely infected with SARS-CoV-2 virus. Notably, protein ISGylation, a protein conjugated form of Type 1 IFN-inducible ubiquitin-like protein ISG15 (Interferon-Stimulated Gene 15), induces cytokine storm (CS) and augments colonic inflammation in colitis-associated colon cancers in mouse models. However, whether ISGylation is increased and causally responsible for CS and hyper inflammation in symptomatic COVID-19 patients is unknown. Here, we measured ISGylation levels in peripheral blood mononuclear cells (PBMCs) from 10 symptomatic (SARS-CoV-2-positive with symptoms) and asymptomatic (SARS-CoV-2-positive with no symptoms) COVID-19 patients, and 4 uninfected individuals (SARS-CoV-2-negative), using WesTm assay. Strikingly, we note significant increases in protein ISGylation and MX-1 (myxovirus-resistance protein-1) protein levels, both induced by type-I IFN, in symptomatic but not in asymptomatic patients and uninfected individuals. Knowing that ISGylation augments CS and intestinal inflammation in colon cancers, we propose that increased ISGylation may be an underlying cause of CS and inflammation in symptomatic patients.
Pursuing Paid Employment for Youth with Severe Disabilities: Multiple Perspectives on Pressing Challenges
Authors: Awsumb Jessica , Schutz Michele , Carter Erik , Schwartzman Ben , Burgess Leah , Lounds Taylor Julie
Published: February 2022

The road to employment begins in high school. However, few youth with severe disabilities currently participate in paid employment before graduation. The purpose of this study was to map the breadth of barriers that can hinder youth from accessing this influential transition experience. We held individual ( n = 8) and focus group ( n = 16) interviews with 74 transition stakeholders, including parents, educators, adult agency staff, school district leaders, and local employers. Collectively, they identified 47 barriers falling within eight broad categories of challenges: school, student, family, workplace, service system, partnership, transportation, and community. Although there were areas of clear consensus, noticeable differences were evident in the concerns raised by each of these five stakeholder groups. We present recommendations for research and practice aimed at connecting more youth with severe disabilities to early work experiences that can change their post-school employment trajectories.
Current Practices and Challenges in Language Proficiency Assessment for English Learners with Complex Support Needs
Authors: de Valenzuela J. S. , Pacheco Rosalía , Shenoy Sunaina
Published: February 2022

The use of alternate English language proficiency (Alt-ELP) assessments is an emerging phenomenon with real-life consequences for students with complex support needs from language minority homes. Our examination of U.S. state practices during the 2017–2018 academic year for the identification of English learners (ELs) with complex support needs revealed that only 36 states and the District of Columbia used an Alt-ELP assessment. In addition, some states provided criteria for students to exit EL services, but others did not report or have established redesignation criteria. We found that a wide range of redesignation criteria were adopted by states, revealing a lack of consensus about what constitutes ELP for students with complex support needs. These data suggested substantial challenges remain in developing and implementing Alt-ELP assessments.
Radiographic and Clinical Outcomes of Radioscapholunate Arthrodesis in Patients With Inflammatory and Posttraumatic Arthritis
Authors: Zelenski Nicole A. , Trentadue Taylor P. , Moran Steven L. , Rizzo Marco
Published: February 2022

Background:

Radioscapholunate (RSL) fusion is performed for painful radiocarpal arthritis that is typically posttraumatic or inflammatory in nature. The purpose of this study was to determine whether patients with inflammatory conditions undergoing RSL fusion had comparable outcomes as those with posttraumatic arthritis and to determine factors impacting union.

Methods:

This was a retrospective review of all RSL fusions over a 25-year period. Demographic information, wrist range of motion, postoperative complications, and surgical technique, including presence or absence of resection of distal scaphoid pole, data were collected. Radiographs were examined for evidence of healing of the RSL fusion site as well as development of midcarpal arthritis.

Results:

Fifty-six patients underwent RSL fusion. Eight patients required revision of radiocarpal arthrodesis for painful nonunion. The fusion rate was 85.7%, and median 25th to 75th percentile (time to healing was 4.0 3.2-5.2) months. There were no differences in time to or rate of union by inflammatory arthropathy status. Grip strength increased significantly and pain decreased significantly with surgery. Union rate was 90% with the use of K-wires, screws, or staples, which was significantly greater than plates, fusion cups, or multiple implant types. The use of autologous bone graft significantly decreased the rate of nonunion and significantly decreased time to union by 3 months compared to allograft alone. Extension was significantly improved with scaphoid distal pole resection versus without distal scaphoid pole resection.

Conclusions:

Radioscapholunate (RSL) fusion is an effective treatment for radiocarpal arthritis but has high nonunion rates. Fixation with K-wires, screws, or staples and use of autograft confers improved union rate.
The Current State of Fat Grafting in the Hand: A Systematic Review for Hand Diseases
Authors: Khouri Alexander N. , Adidharma Widya , MacEachern Mark , Haase Steven C. , Waljee Jennifer F. , Cederna Paul S. , Strong Amy L.
Published: February 2022

Autologous fat grafting (AFG) has traditionally been used for facial rejuvenation and soft tissue augmentation, but in recent years, its use has expanded to treat diseases of the hand. Autologous fat grafting is ideal for use in the hand because it is minimally invasive, can restore volume, and has regenerative capabilities. This review summarizes the emerging evidence regarding the safety and efficacy of AFG to the hand in several conditions, including systemic sclerosis, Dupuytren disease, osteoarthritis, burns, and traumatic fingertip injuries. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant literature search on the use of AFG in hand pathologies was performed on October 8, 2020, in Ovid MEDLINE, Elsevier Embase, Clarivate Web of Science, and Wiley Cochrane Central Register of Controlled Trials. The retrieved hits were screened and reviewed by 2 independent reviewers and a third reviewer adjudicated when required. Reviewers identified 919 unique hits. Screening of the abstracts identified 22 manuscripts which described the use of AFG to treat an identified hand condition. Studies suggest AFG in the hands is a safe, noninvasive option for the management of systemic sclerosis, Dupuytren contracture, osteoarthritis, burns, and traumatic fingertip injuries. While AFG is a promising therapeutic option for autoimmune, inflammatory, and fibrotic disease manifestations in the hand, further studies are warranted to understand its efficacy and to establish more robust clinical guidelines. Studies to date show the regenerative, immunomodulatory, and volume-filling properties of AFG that facilitate wound healing and restoration of hand function with limited complications.
Creating counter-publics through deliberation in the classroom: The case of philosophy for children
Authors: Nishiyama Kei
Published: February 2022

In recent years, the ‘deliberative turn’ of political theory has travelled to the classroom. The predominant approach focuses on the ‘educative’ aspect of deliberation by simulating a fictional public debate in which students discuss controversial political questions given by adults. However, such practice tends to pay scant attention to the critical aspect of deliberation that enables students to challenge and examine unjust socio-political structures and dominant discourses in their lives. This article cautions that classroom deliberation without its critical edge makes deliberation more tokenistic and students less agentic. To show the democratic dynamics of critical classroom deliberation, this article draws insights from the author’s fieldwork on Philosophy for Children (P4C) implemented in two Japanese schools. The case study shows that students’ engagement in critical deliberation facilitated their creation of two types of counter-publics, namely, pedagogical and political, that helped them formulate counter-strategies and counter-voices differently.
The DNA damage repair landscape in Black women with breast cancer
Authors: Mazumder Aloran , Jimenez Athena , Ellsworth Rachel E. , Freedland Stephen J. , George Sophia , Bainbridge Matthew N. , Haricharan Svasti
Published: February 2022

Background:

Estrogen receptor positive (ER+) breast cancer is one of the most commonly diagnosed malignancies in women irrespective of their race or ethnicity. While Black women with ER+ breast cancer are 42% more likely to die of their disease than White women, molecular mechanisms underlying this disparate outcome are understudied. Recent studies identify DNA damage repair (DDR) genes as a new class of endocrine therapy resistance driver that contributes to poor survival among ER+ breast cancer patients. Here, we systematically analyze DDR regulation in the tumors and normal breast of Black women and its impact on survival outcome.

Method:

Mutation and up/downregulation of 104 DDR genes in breast tumor and normal samples from Black patients relative to White counterparts was assessed. For DDR genes that were differently regulated in the tumor samples from Black women in multiple datasets associations with survival outcome were tested.

Results:

Overall, Black patient tumors upregulate or downregulate RNA levels of a wide array of single strand break repair (SSBR) genes relative to their white counterparts and uniformly upregulate double strand break repair (DSBR) genes. This DSBR upregulation was also detectable in samples of normal breast tissue from Black women. Eight candidate DDR genes were reproducibly differently regulated in tumors from Black women and associated with poor survival. A unique DDR signature comprised of simultaneous upregulation of homologous recombination gene expression and downregulation of SSBR genes was enriched in Black patients. This signature associated with cell cycle dysregulation ( p < 0.001), a hallmark of endocrine therapy resistance, and concordantly, with significantly worse survival outcomes in all datasets analyzed (hazard ratio of 9.5, p < 0.001).

Conclusion:

These results constitute the first systematic analysis of DDR regulation in Black women and provide strong rationale for refining biomarker profiles to ensure precision medicine for underserved populations.
eHealth Services and SDG3: Increasing the Capacity of Care
Authors: Wyllie Jessica , Carlson Jamie , Heinsch Milena , Kay-Lambkin Frances , McCoy Alicia
Published: February 2022

The paper’s research objective pertains to explicating the concept of value co-creation of health and social outcomes in an eHealth digital ecosystem context that is critical in addressing sustainable development goal (SDG) 3 – good health and well-being. It conceptualises a theoretical framework using the dynamics inherent to the value cocreation process involving a user of eHealth services and considers the influences of all involved actors from an activity theory and dialogic engagement perspectives. A Mental Health, Alcohol and other drug use eHealth service (eCLiPSE) assists as a case to illustrate the proposed theoretical framework where three overarching propositions are advanced to provide managerial guidance and critical research enquiry. This framework clarifies the importance of improving dialogic engagement processes during both synchronous and asynchronous interactions over time as value creation pathways. Managerially, the paper points to the importance of optimising service design processes and role readiness of actors (users and healthcare professionals) to better enable consumers to engage in effective dialogue in eHealth interactions for harnessing value co-creation. Through the introduction of this framework, eHealth services can be better delivered and scaled to increase the capacity of care and achieve health outcomes pivotal to the success of SDG3.
Averting Repulsion? Body-Directed Self-Disgust and Autobiographical Memory Retrieval
Authors: von Spreckelsen Paula , Wessel Ineke , Glashouwer Klaske A. , de Jong Peter J.
Published: February 2022

A negative body image and appraisals of disgust with one’s (physical) self reflect schematic representations of one’s body, which we classified under the term repulsive body image (RBI). We propose that an RBI biases autobiographical memory processing towards schema (=RBI)-congruent and over-general memories. Women with high (HRBI; n = 61) and low (LRBI; n = 64) levels of habitual body-directed self-disgust were asked to retrieve memories in response to abstract body words in a minimal instruction Autobiographical Memory Test. Compared to the LRBI group, the HRBI group recalled a higher number of autobiographical memories that involved appraisals of the own body as disgusting, and reported elevated habitual tendencies to prevent experiencing disgust towards the own body. Neither RBI scores nor tendencies to prevent experiencing body-related disgust were found to be statistically significant predictors of memory specificity. The overall low memory specificity could be indicative of a need for more sensitive measures of autobiographical memory specificity to examine disgust-driven avoidance at the memory level. Nevertheless, the current results may indicate that disgust-related memories and the prevention of experiencing disgust towards the own body could play a role in body image concerns.
Doing Adulthood While Returning to School: When Emerging Adults Struggle With Institutional Frameworks
Authors: Bühler-Niederberger Doris , Schuchart Claudia , Türkyilmaz Aytüre
Published: February 2022

This article focuses on young people between 18 and around 30 in Germany returning to school after dropping out or finishing their education at a lower level than they are now striving for. The facilities they attend provide what is called a “second-chance education”; the possibility of upgrading their school-leaving certificate at a later stage. However, the curricula and school regulations of the secondary schools apply in these institutions. Therefore, despite their age, students must meet the expectations placed on secondary school students. Six focus group discussions show how students cope with what they consider a contradiction: institutional requirements and their own perception of age. The students' interpretations and strategies are analyzed in light of Erving Goffman’s concepts of role conflict and role distance. The findings indicate that such education programs need to be better adapted to emerging adults and offer clues as to how they might do so.
An Artificial Intelligence Approach to Predicting Unplanned Intubation Following Anterior Cervical Discectomy and Fusion
Authors: Veeramani Ashwin , Zhang Andrew S , Blackburn Amy Z. , Etzel Christine M. , DiSilvestro Kevin J. , McDonald Christopher L. , Daniels Alan H.
Published: February 2022

Study Design

Level III retrospective database study.

Objectives

The purpose of this study is to determine if machine learning algorithms are effective in predicting unplanned intubation following anterior cervical discectomy and fusion (ACDF).

Methods

The National Surgical Quality Initiative Program (NSQIP) was queried to select patients who had undergone ACDF. Machine learning analysis was conducted in Python and multivariate regression analysis was conducted in R. C-Statistics area under the curve (AUC) and prediction accuracy were used to measure the classifier’s effectiveness in distinguishing cases.

Results

In total, 54 502 patients met the study criteria. Of these patients, .51% underwent an unplanned re-intubation. Machine learning algorithms accurately classified between 72%-100% of the test cases with AUC values of between .52-.77. Multivariable regression indicated that the number of levels fused, male sex, COPD, American Society of Anesthesiologists (ASA) > 2, increased operating time, Age > 65, pre-operative weight loss, dialysis, and disseminated cancer were associated with increased risk of unplanned intubation.

Conclusions

The models presented here achieved high accuracy in predicting risk factors for re-intubation following ACDF surgery. Machine learning analysis may be useful in identifying patients who are at a higher risk of unplanned post-operative re-intubation and their treatment plans can be modified to prophylactically prevent respiratory compromise and consequently unplanned re-intubation.
Role of Social Networking Sites in Financial Product Choice: An Investigation Through the Theory of Planned Behavior
Authors: Akhtar Mohammed Anam , Khan Khurram Ajaz , Hoang Hung Cuong
Published: February 2022

This study aims to find the role social networking sites (SNSs) have in the form of expert opinions and blogs available at digital platforms, on financial product choice (FPC). How do social blogs and online expert opinions influence people’s purchasing decisions when using a TPB-based model? The research is conducted in northern India on an individual-level survey basis. The effects of the chosen variable on purchase intentions through the theory of planned behavior were examined by partial least square-structural equation modeling (PLS-SEM) using SMART-PLS 3.2. The results revealed that social media platforms have a positive impact on individuals’ FPCs through blogs and opinions. This study adds to the literature by providing insights into the impact of social media on financial product selection in a developing country like India, an area that is not much explored. More so, there is no conclusive literature available in the Indian context using gender as a moderator over TPB while examining intention to invest in financial products. The study provides a better understanding of investment behavior using online social platforms, blogs, and online expert opinion to policymakers and regulators like SEBI and service providers for enhancing the reach of their services. However, constraints such as dealing with self-reporting and generalizing findings to various situations are expected to be overcome with additional research in the field.
Computed Tomography Imaging Analysis of the MPFL Femoral Footprint Morphology and the Saddle Sulcus: Evaluation of 1094 Knees
Authors: Chen Jiebo , Xiong Yijia , Han Kang , Xu Caiqi , Cai Jiangyu , Wu Chenliang , Ye Zipeng , Zhao Jinzhong , Xie Guoming
Published: February 2022

Background:

The medial patellofemoral ligament (MPFL) has been reported to be anatomically attached from an osseous saddle region (saddle sulcus) between neighboring landmarks on the femur, including the adductor tubercle (AT), medial epicondyle (ME), and medial gastrocnemius tubercle (MGT). However, the position and prevalence of the saddle sulcus remain unknown.

Purpose:

To study the femoral footprint of MPFL and the prevalence of the saddle sulcus with computed tomography (CT) imaging; quantify the position of the saddle sulcus; and determine the relevant factors of the identified position and measuring distances.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A total of 1094 knees in 753 patients were studied. Knees were organized into an anterior cruciate ligament reconstruction (ACLR) group (controls) and a recurrent patellar dislocation (RPD) group. Using 3-dimensionally reconstructed CT images, the authors determined the prevalence of the saddle sulcus and its position relative to the AT, the ME, the Schöttle point (1.3 mm anterior to the distal posterior cortex and 2.5 mm distal to the posterior origin of the medial femoral condyle), and the Fujino point (approximately 10 mm distal to the AT). Analysis of covariance was used to adjust for age, sex, side, and body mass index on the measurements.

Results:

There were 555 knees in the control group and 539 knees in the RPD group. The MPFL femoral footprint presented as an oblique, oblong, osseous region (saddle sulcus) in 75.7% of knees (75.0%, ACLR group vs 76.4%, RPD group; P < .001). The saddle sulcus was located a mean of 12.2 mm (95% CI, 12.0-12.4 mm) from a line connecting the apex of the AT to the ME (AT-ME) and a mean of 7.6 mm (95% CI, 7.5-7.8 mm) posteriorly perpendicular to that line. The location as a proportion of the AT-ME distance was 63.1% (95% CI, 62.6%-63.7%) in the X direction and 39.8% (95% CI, 39.1%-40.5%) in the Y direction. The Schöttle and Fujino points lay anterior and proximal to the saddle sulcus more than 5 mm away from the center of the saddle sulcus. Women had a higher prevalence of saddle sulcus (odds ratio [OR], 1.33 [95% CI, 1.00-1.75]; P = .046) compared with men.

Conclusion:

The saddle sulcus was identified in 75.7% of knees from the medial femoral aspect, with its center located consistently between the AT and ME.
Anything But Typical
Authors: Xiang Xinran Maria
Published: February 2022

A graduating child neurology resident reflects upon how her first neurology “patient” single-handedly taught her an entire textbook worth of knowledge and became the guiding force that led her to leave general pediatrics.