bluuebunny/crossref_metadata_2025 huggingface dataset:
Orthodontic Force–Induced BMAL1 in PDLCs Is a Vital Osteoclastic Activator
Authors: Xie Y. , Tang Q. , Yu S. , Zheng W. , Chen G. , Huang X. , Chen L.
Published: June 2021

Orthodontic tooth movement (OTM) depends on periodontal ligament cells (PDLCs) sensing biomechanical stimuli and subsequently releasing signals to initiate alveolar bone remodeling. However, the mechanisms by which PDLCs sense biomechanical stimuli and affect osteoclastic activities are still unclear. This study demonstrates that the core circadian protein aryl hydrocarbon receptor nuclear translocator–like protein 1 (BMAL1) in PDLCs is highly involved in sensing and delivering biomechanical signals. Orthodontic force upregulates BMAL1 expression in periodontal tissues and cultured PDLCs in manners dependent on ERK (extracellular signal–regulated kinase) and AP1 (activator protein 1). Increased BMAL1 expression can enhance secretion of CCL2 (C-C motif chemokine 2) and RANKL (receptor activator of nuclear factor–κB ligand) in PDLCs, which subsequently promotes the recruitment of monocytes that differentiate into osteoclasts. The mechanistic delineation clarifies that AP1 induced by orthodontic force can directly interact with the BMAL1 promoter and activate gene transcription in PDLCs. Localized administration of the ERK phosphorylation inhibitor U0126 or the BMAL1 inhibitor GSK4112 suppressed ERK/AP1/BMAL1 signaling. These treatments dramatically reduced osteoclastic activity in the compression side of a rat orthodontic model, and the OTM rate was almost nonexistent. In summary, our results suggest that force-induced expression of BMAL1 in PDLCs is closely involved in controlling osteoclastic activities during OTM and plays a vital role in alveolar bone remodeling. It could be a useful therapeutic target for accelerating the OTM rate and controlling pathologic bone-remodeling activities.
FOXO3 Mediates Tooth Movement by Regulating Force-Induced Osteogenesis
Authors: Jin A. , Hong Y. , Yang Y. , Xu H. , Huang X. , Gao X. , Gong X. , Dai Q. , Jiang L.
Published: June 2021

The high prevalence of malocclusion and dentofacial malformations means that the demand for orthodontic treatments has been increasing rapidly. As the biological basis of orthodontic treatment, the mechanism of mechanical force–induced alveolar bone remodeling during orthodontic tooth movement (OTM) has become the key scientific issue of orthodontics. It has been demonstrated that bone mesenchymal stem cells (BMSCs) are crucial for bone remodeling and exhibit mechanical sensing properties. Mechanical force can promote osteoblastic differentiation of BMSCs and osteogenesis, but the key factor that mediates mechanical force–induced osteogenesis during OTM remains unclear. In this study, by performing reverse-phase protein arrays on BMSCs exposed to mechanical force, we found that the expression level of forkhead box O3 (FOXO3) was significantly upregulated during the mechanical force–induced osteoblastic differentiation of BMSCs. The number of FOXO3-positive cells was consistently higher on the OTM side as compared with the control side and accompanied by the enhancement of osteogenesis. Remarkably, inhibiting FOXO3 with repaglinide delayed OTM by severely impairing mechanical force–induced bone formation in vivo. Moreover, knockdown of FOXO3 effectively inhibited the mechanical force–induced osteoblastic differentiation of BMSCs, whereas the overexpression of FOXO3 enhanced this effect. Mechanistically, we revealed a novel regulatory model in which FOXO3 promoted osteocalcin transcription by activating its promoter in cooperation with runt-related transcription factor 2 (RUNX2). We collectively obtained the first evidence that FOXO3 is critical for OTM, where it responds to mechanical force and directly regulates downstream osteoblastic differentiation in an efficient manner.
Psychedelics as a Training Experience for Psychedelic Therapists: Drawing on History to Inform Current Practice
Authors: Nielson Elizabeth M.
Published: June 2021

The therapeutic use of psilocybin in psychedelic-assisted therapy models is currently being tested for a variety of indications, necessitating the training of hundreds of therapists. At present, training programs do not include the provision of a psilocybin experience for therapists, and the last time such an experience was offered with a similar compound was through the Spring Grove LSD Training Study between 1969 and 1974. This article explores archival Spring Grove data to inform training programs and efforts to establish or provide training experiences with psilocybin or otherwise include experiences with nonordinary states of consciousness in the training of psychedelic therapists.
How Association with Physical Waste Attenuates Consumer Preferences for Rescue-Based Food
Authors: de Visser-Amundson Anna , Peloza John , Kleijnen Mirella
Published: June 2021

In an effort to combat food waste, many firms have introduced rescue-based foods (RBFs), which are made from ingredients that are safe to eat but would otherwise be wasted, often due to aesthetic issues or oversupply. Although the benefits of RBF are varied, some firms adopt strategies that highlight RBF’s waste-reduction benefits, such as reduced landfill use or lower environmental impact. This research posits that when firms adopt strategies that highlight associations between physical waste and RBF, those associations can generate negative mental imagery, which can trigger disgust and mitigate positive consumer attitudes toward RBF. When such associations are not present, demand is consistent with demand for conventional foods. The authors find support for the role of mental imagery in this demand mitigation process, with some promotional appeals stimulating thoughts of physical waste. Counterintuitively, this research reveals that when marketers adopt the common practice of using environmental benefit appeals that can trigger physical waste associations, such as the color green, consumer demand for RBF diminishes. Conversely, focusing on the societal benefits or limiting the number of cues available to create physical waste associations generates consumer demand for these foods on a level equivalent to that of conventional food.
Increases in SARS-CoV-2 Test Positivity Rates Among Hispanic People in a Northern California Health System
Authors: Rodriguez Fatima , Coquet Jean , Harrington Robert , Hernandez-Boussard Tina
Published: June 2021

Racial/ethnic minority groups are disproportionately affected by the COVID-19 pandemic. We examined ethnic differences in SARS-CoV-2 testing patterns and positivity rates in a large health care system in Northern California. The study population included patients tested for SARS-CoV-2 from March 4, 2020, through January 12, 2021, at Stanford Health Care. We used adjusted hierarchical logistic regression models to identify factors associated with receiving a positive test result. During the study period, 282 916 SARS-CoV-2 tests were administered to 179 032 unique patients, 32 766 (18.3%) of whom were Hispanic. Hispanic patients were 3 times more likely to receive a positive test result than patients in other racial/ethnic groups (odds ratio = 3.16; 95% CI, 3.00-3.32). The rate of receiving a positive test result for SARS-CoV-2 among Hispanic patients increased from 5.4% in mid-March to 15.7% in mid-July, decreased to 3.9% in mid-October, and increased to 21.2% toward the end of December. Hispanic patients were more likely than non-Hispanic patients to receive a positive test result for SARS-CoV-2, with increasing trends during regional surges. The disproportionate and growing overrepresentation of Hispanic people receiving a positive test result for SARS-CoV-2 demonstrates the need to focus public health prevention efforts on these communities.
Coverage and Timing of Influenza Vaccination Among Privately Insured Pregnant Women in the United States, 2010-2018
Authors: Hong Kai , Lindley Megan C. , Zhou Fangjun
Published: June 2021

Objective

Pregnant women are at increased risk of serious complications from influenza and are recommended to receive an influenza vaccination during pregnancy. The objective of this study was to assess trends, timing patterns, and associated factors of influenza vaccination among pregnant women.

Methods

We used 2010-2018 MarketScan data on 1 286 749 pregnant women aged 15-49 who were privately insured to examine trends and timing patterns of influenza vaccination coverage. We examined descriptive statistics and identified factors associated with vaccination uptake by using multivariate log-binomial and Cox proportional hazard models.

Results

In-plan influenza vaccination coverage before delivery increased from 22.0% during the 2010-2011 influenza season to 33.2% during the 2017-2018 influenza season. About two-thirds of vaccinated women received the vaccine in September or October during each influenza season. For women who delivered in September through May, influenza vaccination coverage increased rapidly at the beginning of influenza season and flattened after October. For women who delivered in June through August, influenza vaccination coverage increased gradually until February and flattened thereafter. Most vaccinated women who delivered before January received the vaccine in the third trimester. Increased likelihood of being vaccinated was associated with age 31-40, living in a metropolitan statistical area, living outside the South, enrollment in a consumer-driven or high-deductible health plan, being spouses or dependents of policy holders, and delivery in November through January.

Conclusions

Despite increases during the past several years, vaccination uptake is still suboptimal, particularly after October. Health care provider education on timing of vaccination and recommendations throughout influenza seasons are needed to improve influenza vaccination coverage among pregnant women.
A novel thread connection structure of slimehole drilling tool in ultra-deep natural gas well
Authors: Ying Zhang , Zhanghua Lian , Anqi Gao , Kun Yang
Published: June 2021

The thread connection’s root fillet radius of 0.038″ size is the greatest weakness of the API NC type joints and thread. During the slimehole drilling, especially in the deep and ultra-deep gas well, its stress concentration factor and notch sensitivity factor are very high A novel thread connection design (TM) of a drilling tool is proposed to decrease the fatigue failure of the slimehole drilling tool in the deep and the ultra-deep gas well in the Tarim oilfield China. The novelty in the TM thread structure is, reducing the threads per inch, extending the distance from the last engaged thread to the external shoulder of the pin and adding three threads to the conventional connection. The novel thread connection will improve the slimehole drilling tool’s anti-fatigue life due to its improved elasticity and rigidity. Furthermore, the TM can transfer the maximum stress at the connection root to the loaded surface, which can effectively lower the fatigue notch’s sensitivity coefficient. In this paper, the finite element method (FEM) is applied to carry out the detailed comparative analysis of the TM with existing thread connection NC38, TX60 and TH90. The TM has the lowest stress concentration factor and fatigue notch sensitivity coefficient, so its anti-fatigue life is the highest. In addition, TM is manufactured and is tested at Tarim oilfield in China.
Modern Taboos and Moral Regulations: Mother’s Milk in the Symbolic Order
Authors: Andrews Therese
Published: June 2021

This article offers a sociological analysis of taboos surrounding breast milk and breastfeeding and how these are expressed within a breastfeeding friendly society such as Norway. Two taboos are identified: (1) Giving up breastfeeding ‘too early’ and (2) not giving up breastfeeding ‘in time’. These taboos are explored through the lenses of Mary Douglas and her conceptualization of purity and danger. Attention is particularly drawn to the ways in which the very same substance, a bodily fluid, and a practice changes symbolic character – from pure to impure – when the child reaches a certain age. Both the substance and the practice become ‘matter out of place’ depending on context. The analysis is based on data stemming from ethnographic interviews with mothers; newspaper and magazine articles and photos; internet accounts and blog comments.
Zombie infrastructure: A legal geography of railroad monstrosity in the California desert
Authors: Sizek Julia
Published: June 2021

This paper proposes the concept of zombie infrastructure to understand the entangled histories of railroad colonialism, Indigenous dispossession, and corporate power in the California desert. I examine debates over the Cadiz project, a contemporary water project that proposes to take water from a California desert aquifer and transport it to the California coast. I argue that the life of the Cadiz project depends on Cadiz Inc.’s ability to revive the legal rights and body of a little-used railroad shortline, thus bringing back a legal infrastructure and corporate power from the late nineteenth century in the service of a new corporation. In so doing, the Cadiz project enlivens the racialized dispossession of land and labor that the railroad initially required. Routing the politics of a contemporary infrastructure project through the railroad and its octopus past, I argue, places the politics of infrastructure at the intersection of laws, monstrosity, and dispossession. Drawing on economic and legal geography, this paper proposes the concept of zombie infrastructure, a concept that builds on what activists call zombie projects in order to show the life and death of infrastructure, and reveals how contemporary capitalists enliven old infrastructures for new purposes.
Decolonizing regional planning from the Global South: Active geographies and social struggles in Northeastern Brazil
Authors: Ferretti Federico
Published: June 2021

This paper addresses the engagement of critical geographers from Northeastern Brazil with regional planning, aiming at transforming society by acting on their region’s spaces. Extending and putting in relation literature on planning theory in the Global South and geographical scholarship on decoloniality, I explore new archives showing how the planning work that these geographers performed from 1957 to 1964 was an example of the ‘South’ re-elaborating and putting into practice notions arising from ‘international’ literature, such as that of ‘active geography’, and pioneering critical uses of instruments, such as mappings and statistics, that have often been associated with technocracy and political conservatism. Connected with peasants’ struggles and with a theoretical framework that is cognisant of the colonial histories and insurgent Black and indigenous traditions in the Northeast, these geographers’ works show that there is no ‘Southern Theory’ without a concrete engagement of scholars with social and political problems, one which is not limited to ‘participation’, but aims at challenging the political powers in place. Although not devoid of contradictions that are analysed here, the experiences of these Southern geographers acting in and for the South can provide precious insights into current (Northern or Southern) scholarly programmes aimed at resisting oppression.
Family communication patterns and relationship quality between emerging adults and their parents
Authors: Szkody Erica , McKinney Cliff
Published: June 2021

Few researchers have examined how family communication patterns influence child help-seeking behaviors and child help-providing behaviors in relation to the parent-child relationship during the period of emerging adulthood. In the current study we utilized a latent profile analysis to determine family communication pattern types from two standard communication orientations (i.e., conversation orientation and conformity orientation). We also examined how pattern types were associated with parent-emerging adult relationship quality and help/support seeking/providing behavior within the family during the period of emerging adulthood as reported by emerging adults ( n = 129) and one of their parental figures ( n = 129). The data supported two family communication types (i.e., protective and pluralistic) created from conversation and conformity orientation scores and we utilized them to differentiate between relationship qualities and help/support seeking/providing behavior when those behaviors were reported by emerging adults but not their parental figures.
Increased number of deaths within 24 h of admission during a period of social restriction related to the COVID-19 pandemic: A retrospective service evaluation in a metropolitan palliative care unit
Authors: Everitt Rachel , Robinson Neil , Marco David , Weil Jennifer , Bryan Tamsin
Published: June 2021

Background:

COVID-19 has led to implementation of wide-ranging social restriction measures with consequent impact on health care utilisation in many domains. There is little published data on the experience of palliative care services catering to a population with low case numbers of COVID-19.

Aim:

This study aimed to consider the impact of COVID-19 on utilisation of inpatient palliative care in the context of low community transmission, and low numbers of cases in hospital.

Design:

A retrospective service evaluation examining differences in number of admissions, diagnoses, number of deaths and time from admission to death, across three discrete 8-week time periods spanning the early COVID-19 pandemic.

Setting/participants:

All admissions ( n = 194) to a metropolitan tertiary hospital inpatient palliative care unit in Melbourne during the study period.

Results:

An initial 16.9% fall in admissions was followed by a return to baseline admission numbers, with a 46.7% increase in number of deaths compared to baseline. The number of deaths within 24 h rose from 10.8% to 37.3% ( p < 0.01). The number of patients with non-malignant diagnoses increased from 32.4% to 52%, and those with non-malignant diagnoses were more likely to die rapidly ( p < 0.01). There were no patients with COVID-19 infection.

Conclusion:

Increased numbers of deaths within 24 h of admission occurred on the palliative care unit despite low COVID-19 case numbers in the wider community, and in the setting of widespread social restriction measures. More research is needed examining the health-related consequences of such restrictions for individuals not infected with COVID-19.
The impact of digital health interventions on the psychological outcomes of patients and families receiving paediatric palliative care: A systematic review and narrative synthesis
Authors: Archer Stephanie , Cheung Natalie H.Y. , Williams Ivor , Darzi Ara
Published: June 2021

Background:

Digital health interventions are becoming increasingly important and may be particularly relevant for paediatric palliative care. In line with the aims of palliative care, digital health interventions should aim to maintain, if not improve, psychological wellbeing. However, the extent to which the psychological outcomes of digital health interventions are assessed is currently unknown.

Aim:

To identify and synthesise the literature exploring the impact of all digital health interventions on the psychological outcomes of patients and families receiving paediatric palliative care.

Design:

Systematic review and narrative synthesis.

Data sources:

MEDLINE, EMBASE, Health Management Information Consortium, PsycINFO, Cumulative Index to Nursing and Allied Health Literature and the Midwives Information & Resource Service were searched on the 27th July 2020, in addition to the first five pages of Google Scholar. To be included in the review, papers must have contained: quantitative or qualitative data on psychosocial outcomes, data from patients aged 0–18 receiving palliative care or their families, a digital health intervention, and been written in English.

Results:

Three studies were included in the review. All looked at the psychological impact of telehealth interventions. Papers demonstrated fair or good quality reporting but had small sample sizes and varied designs.

Conclusions:

Despite the design and development of digital health interventions that span the technological landscape, little research has assessed their psychosocial impact in the paediatric palliative care community. Whilst the evidence base around the role of these interventions continues to grow, their impact on children and their families must not be overlooked.
Tissue outcome prediction in hyperacute ischemic stroke: Comparison of machine learning models
Authors: Benzakoun Joseph , Charron Sylvain , Turc Guillaume , Hassen Wagih Ben , Legrand Laurence , Boulouis Grégoire , Naggara Olivier , Baron Jean-Claude , Thirion Bertrand , Oppenheim Catherine
Published: June 2021

Machine Learning (ML) has been proposed for tissue fate prediction after acute ischemic stroke (AIS), with the aim to help treatment decision and patient management. We compared three different ML models to the clinical method based on diffusion-perfusion thresholding for the voxel-based prediction of final infarct, using a large MRI dataset obtained in a cohort of AIS patients prior to recanalization treatment. Baseline MRI (MRI0), including diffusion-weighted sequence (DWI) and Tmax maps from perfusion-weighted sequence, and 24-hr follow-up MRI (MRI24h) were retrospectively collected in consecutive 394 patients AIS patients (median age = 70 years; final infarct volume = 28mL). Manually segmented DWI24h lesion was considered the final infarct. Gradient Boosting, Random Forests and U-Net were trained using DWI, apparent diffusion coefficient (ADC) and Tmax maps on MRI0 as inputs to predict final infarct. Tissue outcome predictions were compared to final infarct using Dice score. Gradient Boosting had significantly better predictive performance (median [IQR] Dice Score as for median age, maybe you can replace the comma with an equal sign for consistency 0.53 [0.29–0.68]) than U-Net (0.48 [0.18–0.68]), Random Forests (0.51 [0.27–0.66]), and clinical thresholding method (0.45 [0.25–0.62]) ( P < 0.001). In this benchmark of ML models for tissue outcome prediction in AIS, Gradient Boosting outperformed other ML models and clinical thresholding method and is thus promising for future decision-making.
Selective intra-carotid blood cooling in acute ischemic stroke: A safety and feasibility study in an ovine stroke model
Authors: Cattaneo Giorgio FM , Herrmann Andrea M , Eiden Sebastian A , Wieser Manuela , Kellner Elias , Doostkam Soroush , Süß Patrick , Kiefer Selina , Fauth Lisa , Maurer Christoph J , Wolfertz Julia , Nitzsche Björn , Büchert Michael , Jost Tobias , Ihorst Gabriele , Haberstroh Jörg , Mülling Christoph , Strecker Christoph , Niesen Wolf-Dirk , Shah Mukesch J , Urbach Horst , Boltze Johannes , Meckel Stephan
Published: June 2021

Selective therapeutic hypothermia (TH) showed promising preclinical results as a neuroprotective strategy in acute ischemic stroke. We aimed to assess safety and feasibility of an intracarotid cooling catheter conceived for fast and selective brain cooling during endovascular thrombectomy in an ovine stroke model.

Transient middle cerebral artery occlusion (MCAO, 3 h) was performed in 20 sheep. In the hypothermia group (n = 10), selective TH was initiated 20 minutes before recanalization, and was maintained for another 3 h. In the normothermia control group (n = 10), a standard 8 French catheter was used instead. Primary endpoints were intranasal cooling performance (feasibility) plus vessel patency assessed by digital subtraction angiography and carotid artery wall integrity (histopathology, both safety). Secondary endpoints were neurological outcome and infarct volumes.

Computed tomography perfusion demonstrated MCA territory hypoperfusion during MCAO in both groups. Intranasal temperature decreased by 1.1 °C/3.1 °C after 10/60 minutes in the TH group and 0.3 °C/0.4 °C in the normothermia group (p < 0.001). Carotid artery and branching vessel patency as well as carotid wall integrity was indifferent between groups. Infarct volumes (p = 0.74) and neurological outcome (p = 0.82) were similar in both groups.

Selective TH was feasible and safe. However, a larger number of subjects might be required to demonstrate efficacy.
Correlation between matrix metalloproteinase-2 polymorphisms and first and recurrent atherosclerotic ischemic stroke events: a case–control study
Authors: Li Ying , Ouyang Qing-rong , Li Juan , Chen Xiao-rong , Li Lin-lin , Xu Lei , Yu Ming
Published: June 2021

Objective

To determine the associations between matrix metalloproteinase-2 (MMP-2, encoded by the MMP2 gene) 1306C/T and 735C/T polymorphisms and first and recurrent ischemic stroke in a Chinese population.

Methods

Patients with first and recurrent ischemic stroke were included. Serum MMP-2 was measured, and MMP2 1306C/T and 735C/T polymorphisms were detected. The associations between MMP2 1306C/T and 735C/T polymorphisms and first and recurrent ischemic stroke were analyzed.

Results

Serum MMP-2 in patients with first and recurrent ischemic stroke was significantly higher compared with controls, and patients with recurrent ischemic stroke had higher MMP-2 than those with first ischemic stroke. The frequency of the CC genotype and C allele of MMP2 735C/T was highest in patients with recurrent ischemic stroke, followed by patients with first ischemic stroke, and controls. Conversely, the genotype and allele of MMP2 1306C/T did not significantly differ between groups. The CC genotype of MMP2 735C/T was independently associated with first and recurrent ischemic stroke (odds ratios = 1.45 and 1.64, respectively), as was the C allele of MMP2 735C/T (odds ratios = 1.68 and 1.77, respectively).

Conclusions

The CC genotype and C allele of MMP2 735C/T were associated with first and recurrent ischemic stroke in a Chinese population.
What Is the Failure Rate After Arthroscopic Repair of Bucket-Handle Meniscal Tears? A Systematic Review and Meta-analysis
Authors: Costa Giuseppe Gianluca , Grassi Alberto , Zocco Gianluca , Graceffa Angelo , Lauria Michele , Fanzone Giuseppe , Zaffagnini Stefano , Russo Arcangelo
Published: June 2021

Background:

Meniscal repair has become the treatment of choice for meniscal tears, especially in the subset of bucket-handle meniscal tears (BHMTs). However, a comprehensive estimate of the corresponding failure rate is not available, thus maintaining doubts about the healing potential of these tears. Furthermore, a wide range of factors to predict high failure rates have been reported but with conflicting evidence.

Purpose:

To determine the failure rate after arthroscopic repair of BHMTs as reported in the literature, compare this with the failure rate of simple meniscal tears extracted from the same studies, and analyze the influence of factors previously reported to be predictive of meniscal repair failure.

Study Design:

Systematic review and meta-analysis; Level of evidence, 4.

Methods:

A systematic search was conducted by 2 independent reviewers using principal bibliographic databases (PubMed, Scopus, Cochrane Library, and EMBASE). After a stepwise exclusion process, 38 articles met the inclusion criteria. Failure rate data were analyzed with a random-effects proportional meta-analysis (weighted for individual study size), and forest plots were constructed to determine any statistically significant differences between BHMTs versus simple tears (longitudinal, radial, or horizontal), medial versus lateral BHMTs, isolated procedures versus repairs with concomitant anterior cruciate ligament reconstruction, and tears in red-red versus red-white zones. Moreover, a meta-regression analysis was conducted to evaluate the effect of patient age and sex, suture technique (in-out or all-inside), time from injury to surgery, mean number of stitches, and length of follow-up on failure rates.

Results:

The pooled failure rate was 14.8% (95% CI, 11.3%-18.3%; I2 = 77.2%). A total of 17 studies provided failure rates of both BHMT repairs (46/311 repairs) and simple tear repairs (54/546 repairs), demonstrating a significantly higher failure rate for BHMT repairs (risk ratio [RR] = 1.50; 95% CI, 1.05-2.15; I2 = 0%; P = .03). Medial BHMT repairs (RR = 1.94; 95% CI, 1.25-3.01; I2 = 0%; P = .003) and isolated repairs (RR = 1.77; 95% CI, 1.15-2.72; I2 = 0%; P = .009) had statistically higher risk of failure, but no statistically significant difference was found between tears in red-red versus red-white zones. Among the other factors evaluated with meta-regression, only the mean number of stitches showed a statistically significant effect on failure rates.

Conclusion:

Based on the currently available literature, this systematic review provides a reasonably comprehensive analysis of failure rate after arthroscopic BHMT repair; failure is estimated to occur in 14.8% of cases. Medial tears and isolated repairs were the 2 major predictors of failure.
Increased Posterior Tibial Slope Is Associated With Greater Risk of Graft Roof Impingement After Anatomic Anterior Cruciate Ligament Reconstruction
Authors: Song Guan-yang , Ni Qian-kun , Zheng Tong , Feng Hua , Zhang Zhi-jun , Zhang Hui
Published: June 2021

Background:

Increased posterior tibial slope (PTS) has been reported to be associated with irreducible anterior tibial subluxation in extension after anatomic anterior cruciate ligament (ACL) reconstruction (ACLR), which raises concerns about the greater risk of graft roof impingement (GRI) although the tibial tunnel is positioned anatomically.

Hypothesis:

Increased PTS would be associated with greater risk of GRI after anatomic ACLR.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

Between January 2016 and December 2017, a total of 418 consecutive patients were diagnosed as having noncontact ACL injuries and underwent primary anatomic ACLR. Among them, 26 patients had ≥1 of the following features during the second-look arthroscopy: fractured/guillotined bundles at the tibial insertion or cyclops lesion. These patients were confirmed to have GRI and were allocated to the study group. They were also matched 1:2 to 52 control participants without GRI. PTS was measured on true lateral whole-leg radiographs. Intra-articular ACL graft signal intensity was evaluated on postoperative magnetic resonance imaging scans (mean, 32.8 months; range, 26-38 months) and divided into 3 grades (I, good; II, moderate; III, poor) based on degree of GRI. Moreover, anterior subluxation of the lateral compartment (ASLC) and medial compartment (ASMC) in extension relative to the femoral condyles were measured on postoperative magnetic resonance imaging scans and compared between the groups. In addition, predictors of GRI were evaluated using multivariate logistic regression analysis and included body mass index, PTS, pivot-shift test, KT-1000 side-to-side difference, and concomitant meniscal tears.

Results:

PTS in the study group was significantly higher than that in control group (mean ± SD, 13.8°± 1.5° vs 9.5°± 1.8°; P < .05). In the study group (n = 26), patients with grade III (poor) graft signal intensity (n = 9) showed significantly higher PTS than those with grade II (moderate; n = 17) (16.4°± 1.7° vs 12.4°± 1.3°; P < .05). Moreover, the mean postoperative ASLC and ASMC in extension were significantly larger in the study group than the control group (ASLC, 4.1 ± 1.3 vs 0.8 ± 0.4 mm; ASMC, 4.3 ± 1.5 vs 0.9 ± 0.3 mm; P < .05). Furthermore, the abnormal degree of PTS (≥12°) was determined to be an independent risk factor associated with GRI after anatomic ACLR (odds ratio, 9.0 [95% CI, 3.7-30.2]; P < .001), whereas body mass index, grade of pivot-shift test, KT-1000 side-to-side difference, and concomitant meniscal tears were not.

Conclusion:

Increased PTS (≥12°) was associated with greater risk of GRI after anatomic ACLR. This may provide additional information for counseling patients with greater risk of GRI.
The Application of Computerized Adaptive Testing to the International Knee Documentation Committee Subjective Knee Evaluation Form
Authors: Lee Donghoon , Rao Somnath , Campbell Richard E. , Plummer Otho R. , Tjoumakaris Fotios P. , Cohen Steven B. , Freedman Kevin B.
Published: June 2021

Background:

Patient-reported outcome measures (PROMs) are commonly used to monitor functional outcomes for clinical and research purposes; unfortunately, many PROMs include redundant, burdensome questions for patients. The use of predictive models to implement computerized adaptive testing (CAT) offer a potential solution to reduce question burden in outcomes research.

Purpose:

To validate the usage of an appropriate CAT system to improve the efficiency of the International Knee Documentation Committee (IKDC) Subjective Knee Form.

Study Design:

Cohort study (Diagnosis); Level of evidence, 2.

Methods:

Validation was based on electronically collected patient responses from 2 separate orthopaedic sports medicine clinics. Diagnoses included, but were not limited to, meniscal lesions, ligamentous injuries, and chondral defects. The CAT system was previously developed through analysis of an electronic knee PROM database that did not contain any of these cases.

Results:

A total of 2173 patient responses (1229 patients) were collected. The CAT model was able to reduce the question burden by a mean of 9.33 questions (45.1%). Higher CAT-predicted scores correlated strongly with higher actual scores ( r = 0.99; intraclass correlation coefficient = 0.99). The mean difference between the CAT-predicted score and the actual PROM score was 0.48 of a point on a scale of 0 to 100.

Conclusion:

The use of CAT systems, in conjunction with electronic PROMs, can accurately predict outcome scores for IKDC PROMs, while dramatically decreasing the number of questionnaire items needed for any given patient. By decreasing questionnaire burden, clinicians and researchers can potentially increase patient participation and follow-up in both clinical assessments and research trials.
The contamination of trauma. Traumatized minds, broken families and dysfunctional work groups: Organizational and interpersonal dynamics in complex child welfare court proceedings
Authors: Stevenson Stuart
Published: June 2021

Professional work groups engaging with traumatized and dysfunctional families are presented with a disproportionate challenge to an already inevitably painful process that can be an obstacle to balanced decision-making in the children’s best interests. Trauma, abuse and neglect can influence the professional culture that condenses around these families. This occurs more often with the most challenging families with a possible history of professional failure resulting in professional conflict, impulsive and poor decision-making due to the occasions that these destructive dynamics have become unmanageable. Serious case reviews into the deaths of children regularly outline professional failures relating to a breakdown in communication within the professional system and essential and potential lifesaving information having been lost or failing to have been acted upon. The ability to understand complex group and organizational dynamics and the ability to manage relationships with traumatized adults and children, as well as within traumatized work groups is, therefore, an essential skill set for professionals working with the most vulnerable children and families. This article explores trauma and its impact on a work group and why this process was disturbed by uncontained anxiety resulting in professional conflict.
First do no harm?
Authors: Maratos Anna , Bledin Kenneth
Published: June 2021

Group analysts seldom write about the risk of harming their patients. Yet it is now widely recognized that all psychotherapies come with a small risk of harm and this risk has remained since it was first identified in the 1970s. In the wider group psychotherapy literature, risk of harm has been linked to the poor management of conflict and scapegoating, the misuse of interpretation, narcissistic leadership and unsuitability or lack of preparation of patients. Group analytic writers have examined each of these areas to varying degrees but not from the perspective of harm to the patient. This article highlights this ‘blind spot’ within the profession and signals the need for action.
Face-to-face versus Video Teleconference Group Cognitive Behavioural Therapy for Anxiety and Related Disorders: A Preliminary Comparison
Authors: Milosevic Irena , Cameron Duncan H. , Milanovic Melissa , McCabe Randi E. , Rowa Karen
Published: June 2021

Objective:

Telehealth is being increasingly incorporated into the delivery of mental health care and has received widespread attention during the COVID-19 pandemic for its ability to facilitate care during physical distancing restrictions. Videoconferencing is a common telehealth modality for delivering psychotherapy and has demonstrated similar outcomes to those of face-to-face therapy. Cognitive behavioural therapy (CBT) is the most common psychotherapy evaluated across various telehealth modalities; however, studies on CBT delivered via videoconference, particularly in a group therapy format, are lacking. Further, little research exists on videoconference group CBT for anxiety disorders. Accordingly, the present study compared the outcomes of group CBT for anxiety and related disorders delivered via videoconference versus face-to-face.

Method:

Using a non-randomized design, data on attendance, dropout, clinical outcomes, and functional impairment were collected from 413 adult outpatients of a tertiary care anxiety disorders clinic who attended a CBT group for panic disorder/agoraphobia, social anxiety disorder, generalized anxiety disorder (GAD), or obsessive-compulsive disorder delivered either face-to-face (pre-COVID-19 pandemic) or via videoconference (since the onset of COVID-19 pandemic). Outcomes were assessed using well-validated self-report measures. Data were collected pre-treatment, across 12 weekly sessions, and post-treatment. Intent-to-treat analyses were applied to symptom outcome measures.

Results:

Face-to-face CBT conferred only a slight benefit over videoconference CBT for symptom outcomes across all groups, but when assessed individually, only the GAD group showed greater symptom improvement in the face-to-face format. Effect sizes for significant differences between the delivery formats were small. Participants in videoconference groups tended to have slightly higher attendance rates in some instances, whereas functional improvement and treatment dropout were comparable across the delivery formats.

Conclusions:

Results provide preliminary evidence that videoconference group CBT for anxiety and related disorders may be a promising and effective alternative to face-to-face CBT. Additional research is needed to establish equivalence between these delivery formats.
Experiences of Volunteers and Patient Satisfaction in Home Based Palliative Care, Puducherry, South India—A Descriptive Qualitative Study
Authors: Subramanian Sadhana , Sarkar Sonali , Vijayageetha Mathavaswami , Adhinarayanan S
Published: June 2021

Background: Increasing burden of non-communicable diseases and ageing population has parallely increased the need for Palliative care. Unavailable, inaccessible, and inadequate palliative care services in our setting increased the need for volunteers. In Puducherry, palliative care programme was implemented through trained volunteers in 2015. Objectives: To explore the experiences of volunteers who provide palliative care and also to get feedback on volunteering from the patients who received care. Settings and Design: A descriptive qualitative study was carried out at two Non-Governmental Organizations (NGO) working for palliative care in and around Puducherry. Methods and Material: Participants were selected purposively to include seven volunteers and eight patients to attain information saturation. The time period of this study was between September and October 2018. Analysis Used: Manual thematic analysis was done to identify codes, which were grouped to form categories and themes. Results: Factors that facilitated participants to take up the role of volunteers were witnessing the death of family members with unmet palliative care when required and experiences in organizations working for elderly and disabled children. Improvement in patients’ condition and patient satisfaction motivated them to continue, despite lack of resources and social support. Their perception was of having become bolder and empathetic by working as palliative care volunteers. Patients reported satisfaction with the provision of drugs and other materialistic support like clothes and sweets during festivals; however, their basic and financial needs remained unmet. Conclusion: The palliative care programme or the National programme for elderly should focus on components that would improve the quality of palliative care by reducing patients’ dissatisfaction. Support in terms of provision of drugs, financial help and nutrition is necessary to improve both the patients’ and volunteers’ satisfaction in palliative care services.
Moving Toward Critical Consciousness and Anti-Oppressive Practice Approaches With People at Risk of Sex Trafficking: Perspectives From Social Service Providers
Authors: Gerassi Lara B. , Klein L. B. , Rosales Maria del Carmen
Published: June 2021

Whether and how social service providers use practice strategies that address racism is critically understudied, particularly with people who are at risk of sex trafficking. The purpose of this article is to understand (1) the perceptions of racial disparities in sex trafficking (as learned from sex trafficking education), and (2) the strategies used to address racism in practice (color-evasiveness, anti-oppressive practice [AOP]). We used a directed content analysis approach to analyze 24 semistructured, in-depth interviews of providers who knowingly encounter sex-trafficked young people in a majority white region of a Midwestern state (census indicates that minority populations include African American, Native American, and Hispanic/Latino people). Findings suggest that providers perceived sex trafficking education (e.g., trainings they attended) as predominantly focused on economic standing and family risks, rather than racial disparities and roles of structural racial oppression. They also experienced challenges in naming the racial identities of clients and addressing racism in practice. Implications for implementing critical consciousness and AOP strategies as well as future research directions are discussed.
An Experimental Study of a Peer-Facilitated Violence Prevention Program for Women in Prison
Authors: Messina Nena P. , Calhoun Stacy
Published: June 2021

The literature has shown a strong correlation between victimization and violence. As the majority of treatment programs for violence and the associated research have been focused on men, it is vital that services are also oriented to the needs of women who perpetrate violence. Beyond Violence ( BV) was developed to fill the gap in violence prevention programming for justice-involved women with histories of violence victimization and perpetration. This randomized controlled trial reports the results of a peer-facilitated model of the BV program implemented in a women’s prison. Women volunteered for the intervention and the study. Participants were randomized to either the 20-session BV condition or to a waitlist control (WC) condition. All 145 participants were asked to complete a preintervention (Time 1) and postintervention (Time 2) survey that included validated measures to assess for depression, anxiety, PTSD, anger/aggression, and emotional dysregulation. Preliminary analyses of the background characteristics and preintervention outcome scores showed no significant differences between the groups at Time 1, indicating that randomization was successful. Separate ANCOVAs were run for 13 outcomes measured using the pretest scores from study participants as the covariate and group assignment as the independent variable. Hypotheses were predominantly supported, and findings showed that the BV participants had significant reductions in the majority of the outcome measures at the postintervention assessment when compared to the WC participants. Future research should continue to explore the advantages of peer-facilitated program models and should incorporate postrelease outcomes to assess change over time.
Development Starts With Historical Endowments: Industrial Policy and Leadership Are Catalysts
Authors: Hill Edward (Ned)
Published: June 2021

Ben Armstrong compares the implementation of regional economic development programs in the Pittsburgh and Cleveland metropolitan statistical areas during the 1980s. He argues that their regional economies and research institutions were then similar. He contends that the transformational policy difference occurred when Pennsylvania’s governor mandated that the presidents of Pittsburgh’s research universities be programmatic leaders while Ohio’s governor did not do the same. Armstrong concludes that Pittsburgh’s Metropolitan Statistical Area became a center of high-tech innovation as a result, while Cleveland’s did not. This author contends that disparities in regional technology resources, as well as institutional self-interest and leadership, were the critical differences. Cleveland’s institutions had to give priority to fixing their business problems. Armstrong and the author agree that economic endowments and industrial policy played roles in both regions’ economic outcomes; where they disagree is on the weights given to each.
Medicines Related Problems (MRPs) Originating in Primary Care Settings in Older Adults - A Systematic Review
Authors: Ude-Okeleke Rosetta Chinyere , Aslanpour Zoe , Dhillon Soraya , Umaru Nkiruka
Published: June 2021

Background:

As people age, they become increasingly vulnerable to the untoward effects of medicines due to changes in body systems. These may result in medicines related problems (MRPs) and consequent decline or deterioration in health.

Aim:

To identify MRPs, indicators of deterioration associated with these MRPs, and preventative interventions from the literature.

Design and Setting:

Systematic review of primary studies on MRPs originating in Primary Care in older people.

Methods:

Relevant studies published between 2001 and April 2018 were obtained from Medline (via PubMed), CINAHL, Embase, Psych Info, PASCAL, Scopus, Cochrane Library, Science Direct, and Zetoc. Falls, delirium, pressure ulcer, hospitalization, use of health services and death were agreed indicators of deterioration. The methodological quality of included studies was assessed using the Down and Black tool.

Results:

There were 1858 articles retrieved from the data bases. Out of these, 21 full text articles met inclusion criteria for the review. MRPs identified were medication error, potentially inappropriate medicines, adverse drug reaction and non-adherence. These were associated with indicators of deterioration. Interventions that involved doctors, pharmacists and patients in planning and implementation yielded benefits in halting MRPs.

Conclusion:

This Systematic review summarizes MRPs and associated indicators of deterioration. Appropriate interventions appeared to be effective against certain MRPs and their consequences. Further studies to explore deterioration presented in this systematic review is imperative.
Doing More With Less: Pragmatic Implementation of Vancomycin Area-Under-the-Curve (AUC) Monitoring
Authors: Huang Joanne , Chan Jeannie D. , Nguyen Thu , Jain Rupali , Escobar Zahra Kassamali
Published: June 2021

Universal area-under-the-curve (AUC) guided vancomycin therapeutic drug monitoring (TDM) is resource-intensive, cost-prohibitive, and presents a paradigm shift that leaves institutions with the quandary of defining the preferred and most practical method for TDM. We report a step-by-step quality improvement process using 4 plan-do-study-act (PDSA) cycles to provide a framework for development of a hybrid model of trough and AUC-based vancomycin monitoring. We found trough-based monitoring a pragmatic strategy as a first-tier approach when anticipated use is short-term. AUC-guided monitoring was most impactful and cost-effective when reserved for patients with high-risk for nephrotoxicity. We encourage others to consider quality improvement tools to locally adopt AUC-based monitoring.