bluuebunny/crossref_metadata_2025_split huggingface dataset:
Percutaneous Fixation of a Fifth Metatarsal Base Fracture
Authors: Lindsey Benjamin B. , Bakshi Neil K. , Holmes James R. , Talusan Paul G. , Walton David M. , Hearty Thomas M. 
Published: July 2021

Summary:
Owing to a vascular watershed, zone II and III fifth metatarsal base fractures commonly progress to nonunion without operative intervention. This article and the accompanying video demonstrate the use of intramedullary screw fixation for a fifth metatarsal base fracture and review treatment decisions involved with management of these injuries.
Pediatric Posterior Sternoclavicular Dislocation Closed Reduction and Management
Authors: Honeycutt Michael Wesley , Cox Kyle , Michaeli David , Hulon Brian , Brewer Jeffrey 
Published: July 2021

Summary:
Posterior sternoclavicular joint (SCJ) dislocations are rare shoulder girdle injuries. Despite the paucity of cases, posterior SCJ dislocations pose an important threat to patient safety because of the proximity of the medial clavicle to the mediastinum, resulting in possible compression and/or injury to these structures. Current guidelines recommend attempting closed reduction in the acute setting followed by open reduction if closed reduction is unsuccessful. This video highlights a case of posterior SCJ dislocation in a pediatric patient who presented with dyspnea after a football injury.
Proximal Humerus Fracture—Open Reduction Internal Fixation With an Expandable Intramedullary Nitinol Scaffold
Authors: Rogers Davis , Raad Micheal , Srikumaran Uma , Shafiq Babar 
Published: July 2021

Summary:
For the treatment of proximal humerus fractures, the intramedullary nitinol scaffold is a novel implant that has gained popularity and demonstrated promising 1-year outcomes as an alternative to bone grafting for providing intramedullary structural support to the humeral head. The aim of this video is to demonstrate the insertion of this device safely, while highlighting potential pitfalls, in a 67-year-old patient with a displaced, varus angulated 2-part proximal humerus fracture.
Impact of Fasting on Cardiovascular Outcomes in Patients With Hypertension
Authors: Hammoud Sabah , Kurdi Mazen , van den Bemt Bart J. F. 
Published: July 2021

Abstract:
Fasting has been frequently practiced for religious or medical purposes worldwide. However, limited literature assesses the impact of different fasting patterns on the physiologic and cardiac-related parameters in patients with hypertension. This review aims to examine the effect of fasting on cardiovascular outcomes in hypertensive patients. Medline, Embase, and Cochrane library were systematically screened until March 2021 for observational prospective cohorts investigating the effect of fasting on cardiovascular outcomes. Articles were assessed by searching for hypertension and fasting, both as Medical Subject Headings (MeSH) terms and text words. The review included studies assessing Ramadan, intermittent, and water-only fasting. Water-only fasting reduces body weight, blood pressure, and lipolytic activity of fasting hypertensive patients without affecting average heart rate. Ramadan fasting enhances lipid profile, although it shows conflicting results for body weight, blood pressure, and heart rate variability. Considering the limited studies in this field, further research should be conducted to support the clinical impact of fasting on the cardiovascular health of patients with hypertension.
How Do Care Transitions Work?
Authors: Zwart Dorien L.M. , Schnipper Jeffrey L. , Vermond Debbie , Bates David W. 
Published: July 2021

Background:
Failure of safe care transitions after hospital discharge results in unnecessary worsening of symptoms, extended period of illness or readmission to the hospital.

Objective:
The objective of this study was to add to the understanding of the working of care transition interventions between hospital and home through unraveling the contextual elements and mechanisms that may have played a role in the success of these interventions, and by developing a conceptual model of how these components relate to each other.

Research Design:
This was a qualitative study using in-person, semi-structured interviews, based on realist evaluation methods.

Subjects:
A total of 26 researchers, designers, administrators, and/or practitioners of both current “leading” care transitions interventions and of less successful care transition intervention studies or practices.

Measures:
The contextual elements and working mechanisms of the different care transition intervention studies or practices.

Results:
Three main contextual factors (internal environment, external environment, and patient population) and 7 working mechanisms (simplifiying, verifiying, connecting, translating, coaching, monitoring, and anticipating) were found to be relevant to the outcome of care transition interventions. Context, Intervention, Mechanism, and Outcome (CIMO) configurations revealed that, in response to these contextual factors, care transition interventions triggered one or several of the mechanisms, in turn generating outcomes, including a safer care transition.

Conclusion:
We developed a conceptual model which explains the working of care transition interventions within different contexts, and believe it can help support future successful implementation of care transition interventions.
Domino Free Flap Transfer Using a Superficial Circumflex Iliac Artery Perforator Flap for the Toe Flap Donor Site
Authors: Fuse Yuma , Yamamoto Takumi , Kageyama Takashi , Sakai Hayahito , Tsukuura Reiko , Yoshimatsu Hidehiko , Yamamoto Nana 
Published: July 2021

Background
Toe-to-hand transfer is a favorable option for finger reconstruction, but donor site healing can be challenging. The superficial circumflex iliac artery perforator (SCIP) flap has yet to be used widely for toe reconstruction. The purpose of this report was to validate the efficacy of the sequential simultaneous free SCIP flap transfer for the toe flap donor site in a consecutive case series.

Methods
The medical records of 18 consecutive patients who underwent a simultaneous SCIP flap transfer and a toe-to-hand transplant were reviewed. Free SCIP flap reconstruction was performed in a simultaneous 2-team approach. The SCIP flaps were transferred to various toe flap donor sites: a great toe wraparound flap in 9 cases, a second toe distal phalangeal flap in 4 cases, a great toe osteo-onycho-cutaneous flap in 3 cases, a twisted wraparound flap in 1 case, and a great toe hemipulp flap in 1 case.

Results
The size of the SCIP flap ranged from 5 × 3 to 16 × 8 cm. A mean of the total operative time was 229.2 minutes (range, 118–441 minutes; SD, 75.8 minutes). All the SCIP and toe flaps survived completely. Minor wound dehiscence was seen in 2 cases, and the wound healed by conservative treatment. The mean follow-up period was 23.7 months (range, 7–44 months; SD, 9.7 months). No patient had gait dysfunction postoperatively.

Conclusions
A sequential SCIP flap transfer was performed simultaneously without additional time, allowing secure soft tissue coverage of the toe flap donor even with avascular tissue such as bone or tendon exposed. The sequential SCIP flap transfer can be a useful option for reconstruction of toe flap donor site, when multiple microsurgeons and microscopes are available.
Microvascular Flap Reconstruction for Head and Neck Cancers in Previously Operated and/or Radiated Neck
Authors: Shankhdhar Vinay K. , Mantri Mayur R. , Wagh Snehjeet , Thiagarajan Shivakumar , Chaukar Devendra , Jaiswal Dushyant , Mathews Saumya 
Published: July 2021

Background
Microvascular reconstruction after oncologic resection with curative intent in recurrent or second primary cancer cases is challenging not only because of the complexity of the defect but also due to difficulty in finding suitable donor vessels in the neck that has already been subjected to surgery and subsequent adjuvant treatment. In our present study, we evaluated the success of free flaps, reexplorations, and factors associated with reexploration and with flap failures in previously operated and/or radiated neck.

Methods
In this retrospective study, we analyzed patients who underwent microvascular reconstruction from January 2016 to December 2018 in patients with previous surgery and/or radiation, considered as “already treated neck” (ATN). These cases were reviewed to analyze variables that included age, sex, indication for surgery (recurrence, second primary, osteoradionecrosis, and secondary reconstruction), duration since previous surgery or radiation, free flap done, donor vessels used, the need to go to the contralateral neck or outside the neck, need for vein grafts, flap reexploration rate, flap survival rate, and hospital stay of the patients. We also tried to identify factors that predisposed for a reexploration after performing reconstruction with a free flap in ATN.

Results
Of 1522 free flaps done, 371 patients were included in the study. Flap success rate was 90.8% in ATN, which was comparable to naive neck (94%; P = 0.108). The reexploration rate in ATN (16.2%) was significantly higher (P = 0.0003) than in naive neck (9.8%). The previous treatment (neck dissection) received [P = 0.001; odds ratio, 13.7 (1.87–101.6)] was the most significant predisposing factor, and patients undergoing osteocutaneous flaps were more prone to undergo reexplorations (P = 0.05). Side of anastomosis, vessel used for anastomosis, comorbidities, and time since previous treatment did not affect the reexploration rate significantly.

Conclusions
Microvascular reconstruction can be safely performed in ATN with good success rates, and it should not be a deterrent in whom free flap is required to achieve best functional outcome. However, it may be associated with increase in reexploration rates in the postoperative period. Patients having undergone a previous neck dissection are at more risk of undergoing this reexploration in comparison with radiotherapy (RT)/chemotherapy and radiotherapy (CTRT) alone.
Children’s emotional wellbeing during spring 2020 COVID-19 restrictions: a qualitative study with parents of young children in England
Authors: Chambers Stephanie , Clarke Joanne , Kipping Ruth , Langford Rebecca , Brophy Rachel , Hannam Kim , Taylor Hilary , Willis Kate , Simpson Sharon A 
Published: July 2021

AbstractBackgroundDuring COVID-19 restrictions in England in spring 2020, early years settings for young children were closed to all but a small percentage of families, social contact was limited and play areas in parks were closed. Concerns were raised about the impact of these restrictions on young children’s emotional wellbeing. The aim of this study was to explore parents’ perceptions of young children’s emotional wellbeing during these COVID-19 restrictions.MethodsWe interviewed 20 parents of children 3-4 years due to begin school in England in September 2020. Interviews were conducted via telephone (n=18) and video call (n=2), audio-recorded and transcribed verbatim. Interviews focused on childcare arrangements, children’s behaviour and transition to school. A sample of transcripts were coded line-by-line to create a coding framework, which was subsequently applied to the remaining transcripts. Coded data were then analysed using a nurture lens to develop themes and further understanding.ResultsParticipants were predominantly mothers (n=16), White British (n=10), and educated to degree level (n=13), with half the sample living in the highest deprivation quintile in England (n=10). Five were single parents. Three themes developed from nurturing concepts were identified: creating age-appropriate explanations; understanding children’s behaviour; concerns about school transition. Parents recognised their children’s emotional wellbeing was impacted but attempted to support their young children whilst looking ahead to their transition to primary school.ConclusionsThis study is one of the first to examine in-depth the impact of COVID-19 restrictions on young children’s emotional wellbeing. The longer-term impacts are not yet understood. Although young children may be unable to understand in detail what the virus is, they undoubtedly experience the disruption it brings to their lives. The wellbeing of families and children needs to be nurtured as they recover from the effects of the pandemic to allow them to thrive.Key messagesCOVID-19 restrictions are predicted to have a negative impact on young children.We interviewed parents of children in England due to begin primary school to understand their experiences of COVID-19 restrictions.Nurture concepts helped us understand the challenges families faced.Key themes identified were: creating age-appropriate explanations; understanding children’s behaviour; and concerns about school transition.We suggest a nurturing approach to recovery to best support children and their families.
Dominance of Alpha and Iota variants in SARS-CoV-2 vaccine breakthrough infections in New York City
Authors: Duerr Ralf , Dimartino Dacia , Marier Christian , Zappile Paul , Wang Guiqing , Lighter Jennifer , Elbel Brian , Troxel Andrea , Heguy Adriana 
Published: July 2021

AbstractThe efficacy of COVID-19 mRNA vaccines is high, but breakthrough infections still occur. We compared the SARS-CoV-2 genomes of 76 breakthrough cases after full vaccination with BNT162b2 (Pfizer/BioNTech), mRNA-1273 (Moderna), or JNJ-78436735 (Janssen) to unvaccinated controls (February-April 2021) in metropolitan New York, including their phylogenetic relationship, distribution of variants, and full spike mutation profiles. Their median age was 48 years; seven required hospitalization and one died. Most breakthrough infections (57/76) occurred with B.1.1.7 (Alpha) or B.1.526 (Iota). Among the 7 hospitalized cases, 4 were infected with B.1.1.7, including 1 death. Both unmatched and matched statistical analyses considering age, sex, vaccine type, and study month as covariates supported the null hypothesis of equal variant distributions between vaccinated and unvaccinated in chi-squared and McNemar tests (p>0.1) highlighting a high vaccine efficacy against B.1.1.7 and B.1.526. There was no clear association among breakthroughs between type of vaccine received and variant. In the vaccinated group, spike mutations in the N-terminal domain and receptor-binding domain that have been associated with immune evasion were overrepresented. The evolving dynamic of SARS-CoV-2 variants requires broad genomic analyses of breakthrough infections to provide real-life information on immune escape mediated by circulating variants and their spike mutations.
Do pesticide residues have enduring negative effect on macroinvertebrates and vertebrates in fallow rice paddies?
Authors: Song Jheng-Sin , Kuo Chi-Chien 
Published: July 2021

AbstractRice is one of the most important staple food in the world, with irrigated rice paddies largely converted from natural wetlands. The effectiveness of rice fields in help preserve species depends partially on management practices, including the usage of pesticides. However, related studies have focused predominately on the cultivation period, leaving the effects of soil pesticide residues on aquatic invertebrates during the fallow periods little explored; other animals, such as waterbirds, also rely on aquatic invertebrates in flooded fallow fields for their survival. We therefore investigated vertebrates and macroinvertebrates (terrestrial and aquatic) on rice stands and in flooded water during cultivation and fallow periods in organic and conventional rice fields in Taiwan. Association of environmental factors with terrestrial and aquatic organisms was also analyzed. In total, 32,880 individuals of 144 invertebrate families and 381 individuals of 15 vertebrate families were recorded after nine samplings each for six organic and six conventional rice fields. Family richness and abundance of all invertebrates (terrestrial and aquatic) were higher in organic than in conventional fields during the cultivation period, but were similar between the two agricultural practices during the fallow period. Richness and abundance of terrestrial invertebrates in both organic and conventional fields increased with the progression of rice cultivation, so did the differences between the two practices. Richness of aquatic invertebrates was mostly constant across the sampling period, while abundance increased but differences decreased during the fallow period. Richness and abundance of terrestrial invertebrates were positively associated with ambient temperature and height of rice stand. Abundance of aquatic invertebrates were positively associated with pH value and amount of dissolved oxygen but negatively associated with water temperature. Richness and abundance of all vertebrates and each of the constituting groups (fish, amphibian, reptile, bird, and migratory waterbird) were statistically similar between the two practices although abundance of migratory waterbirds in organic fields were two times those in conventional fields during the fallow period. Our study suggested accumulated effects of pesticides on suppressing terrestrial invertebrates during the cultivation period, but diminishing effects of pesticide residues on repressing aquatic invertebrates during the fallow period. This comprehensive study provided a holistic picture on macroinvertebrate and vertebrate fauna, as well as ramifications of pesticide usage, in a representative Southeast Asia rice paddy ecosystem. Further study should compare rice fields with natural wetlands to better assess how to capitalize on agroecosystems for biodiversity conservation.
MWEB: Growth strategy options for an internet service provider
Authors: Hoosain Rihana , Bick Geoff , Samuelsson Mikael 
Published: July 2021

Subject area of the teaching case:
The case is particularly relevant for students studying elements of business strategy with an interest in strategic decision-making, competitive strategy, and growth strategy. The case leverages several strategic frameworks taught throughout business courses and illustrates a real-world application of these frameworks to support sound strategic decision-making. Furthermore, the case examines the relevance of sustainable competitive advantage and the linkages to the appropriate growth strategy for a business. It is recommended that this case be taught once students have covered the applicable theory and frameworks in class.

Student level:
This case is designed for business administration students, in particular MBA, EMBA, speciality Masters, or executive education students.

Brief overview of the teaching case:
MWEB is a leading first-tier South African internet services provider, with an operating history spanning over 22 years. The MWEB brand is a household name across South Africa, seen as one of the pioneers of the internet industry and accredited with bringing the internet to ordinary consumers across the country. The state of competition in the market, however, has intensified and MWEB's traditional operating model has not evolved fast enough to meet the changing landscape. The market is in the midst of a price war, to which MWEB has responded by reducing market pricing and offering attractive deals, undercutting all its competitors. The results have been positive; sales have increased and churn has reduced, but competitors have already started to follow. The dilemma facing CEO Sean Nourse and his management team is how to accelerate growth in a highly commoditised market with intense competition while ensuring the long-term profitability of the business. The case encourages the consideration of the strategic decision-making process by analysing the competitive landscape, evaluating the options, and reaching a decision on the most viable growth strategy for the business.

Expected learning outcomes:

To analyse the competitive landscape and the forces at play
To conduct a competitor analysis, appraise long-term profitability in the industry, identify profitable strategic positions, and determine how MWEB may achieve and protect its competitive advantage
To identify and analyse the key parameters that, in combination, represent a company's business model
To critically analyse the contextual factors that are presented as business challenges, evaluating and understanding the impact and scale of these challenges
To critically assess relevant growth strategy alternatives for MWEB and analyse the viability of the alternatives presented
To conduct an informal valuation to determine a purchase price for an acquisition target for the business
Applicability of drywall technologies for disaster-induced housing reconstruction
Authors: Hulathdoowage Nimasha Dilukshi , Hadiwattage Chandanie 
Published: July 2021

Purpose
The sluggish progression of disaster-induced housing reconstruction (DHR) in Sri Lanka provoked the assessment of drywall technologies as a mode of improving efficiency. The purpose of this paper is to investigate the applicability of drywall technologies to adopt a technical solution to DHR.

Design/methodology/approach
The research contextualized a mixed research design via a case-study strategy integrating semi-structured interviews, documentary reviews and observations. Two cases based on the 2016 Samasarakanda landslide were investigated. Within-case-analysis and cross-case-analysis were performed to derive conclusions.

Findings
Enablers for drywall technologies application are time saving, cost-saving, less water consumption and logistical easiness. Less strength of drywall technologies will not be a critical obstruction owing to the expected disaster resilience from the concrete frame and the subsequent requirement of non-load bearing walls for landslide DHR. Labor source, community acceptance, durability are potential settings of barriers. Observing model houses, researching the resistance of drywall technologies to landslide-induced vibrations and impulsive waves are some further research areas discovered.

Research limitations/implications
Empirical findings are centered on the 2016 Samasarakanda DHR.

Practical implications
Because of many issues in updating guidelines, drawings and BOQs, a protocol should be gazetted in the parliament to improve its updating flexibility allowing provisions to apply novel technologies for DHR.

Originality/value
Being one of the very first of this kind of research, contextually, the research is original. This study provokes insightful investigation of drywall technologies for DHR beyond its overlooked properties. This study reveals many wall construction challenges of the 2016 Samasarakanda DHR which have not yet been explored in research.