bluuebunny/crossref_metadata_2025_split huggingface dataset:
Benevolent Transgressive Play in Dungeons & Dragons [D&D]
Authors: Sidhu Premeet , Carter Marcus 
Published: August 2023

Background Research into transgressive play experiences in games has grown in recent years. In this article, we explore the potential for transgressive play to be constructive in multiplayer settings—something we conceptualize as “benevolent transgression.” Aim This article describes the presence and appeal of benevolent transgressive play experiences in the tabletop role-playing game Dungeons & Dragons [D&D]. Research Methods In 2021, amid the COVID-19 pandemic, we conducted focus group discussions (3 groups, 14 participants, aged 24–55) and an online survey (354 participants, aged 18–63) with current D&D players to better understand what play experiences were meaningful and appealing for them—in consideration of the game’s contemporary resurgence. Key Finding and Discussion Our qualitative analysis focuses on participant responses that described the presence and appeal of transgressive play that knowingly challenges player boundaries or game boundaries, what we term benevolent transgression. We propose two key factors that we believe enable it—1) player agency and 2) collaborative negotiation—and briefly discuss benevolent transgression in consideration of game-based learning [GBL].
Outcomes of Tenosynovial Giant Cell Tumor of the Foot and Ankle
Authors: Barnett James Robert , Rudran Branavan , Khan Amir , O’Reilly-Harbidge Sarah , Patel Shelain , Malhotra Karan , Cullen Nicholas , Welck Matthew , Aston William 
Published: August 2023

Background: Tenosynovial giant cell tumor (TGCT) is a benign proliferative disease affecting synovial membranes. There are 2 forms, localized (L-TGCT) and diffuse (D-TGCT), which although histologically similar behave differently. It is locally invasive and is treated in most cases by operative excision. The aim of this study was to assess current practice, how the patients’ presentation affected their outcome, as well as review the recurrence rates and complications. Methods: A retrospective analysis of 123 cases was performed in patients treated between 2003 and 2019 with TGCT of the foot and/or ankle. Data were collected on age at presentation, radiologic pattern of disease, location of disease, treatment provided, and recurrence rates. The minimum follow-up was 2 years with a mean of 7.7 years. Results: There were 61.7% female patients with a mean age of 39 (range, 11-76) years. L-TGCT accounted for 85 (69.1%) cases and D-TGCT for 38 (30.9%). The most prevalent preoperative symptoms were a palpable mass (78/123) and pain (65/123). Radiologically confirmed recurrence in the operative group was noted in 14.5% (16/110) cases. This comprised 4% (3/75) of operatively treated L-TGCT and 37% (13/35) of operatively treated D-TGCT. Patients with pain on presentation and those with erosive changes on presenting magnetic resonance imaging (MRI) were more likely to have persistent postoperative pain ( P < .001 for both). Where patients had both preoperative pain and erosive changes, 57.1% had postoperative pain. Thirteen cases were managed nonoperatively where symptoms were minimal, with 1 case requiring surgery at a later date. Conclusion: Outcomes of TGCT management are dependent on the disease type, extent of preoperative erosive changes, and presence of preoperative pain. These data are useful for counseling patients regarding the outcomes of surgical intervention and help guide the timing of intervention. Level of Evidence: Level III, retrospective cohort study.
Role of Lateral Ankle Ligaments in Vertical Stability of the Fibula: A Cadaveric Model
Authors: Filippi Jorge , Gutiérrez Paulina , Quezada José , Massri-Pugin Jafet , Bastías Gonzalo F. , Melo Rodrigo , Vidal Catalina , Silvestre Rony 
Published: August 2023

Background: In unstable ankle fractures, the role of the deltoid and syndesmosis ligaments has been widely studied. However, it is uncertain what the importance of the lateral ankle ligament complex (LALC) is in the vertical stability of the fibula. Given its anatomical position, it should prevent the proximal translation of the fibula. This study aims to evaluate the role of the LALC in stabilizing the fibula in the vertical plane. Methods: Eleven below-knee cadaveric specimens were used in this study. Proximal traction of the fibula was performed by applying 50 N in the intact state and after sequential transection of the syndesmotic ligaments, anterior talofibular ligament (ATFL), and the calcaneofibular ligament (CFL). At each stage, the proximal displacement of the fibula was measured. One-way repeated measures analysis of variance with post hoc Bonferroni correction was carried out to determine any significant differences between the groups. A P value <.05 was considered statistically significant. Results: The vertical displacement of the fibula in the intact state, and after sequential transection of syndesmotic ligaments, ATFL, and CFL was 1.96 ± 1.19 mm, 3.96 ± 1.33 mm, 5.9 ± 1.73 mm, and 10.22 ± 2.76 mm, respectively. There was no significant difference in the proximal displacement of the fibula between the intact and the syndesmotic ligaments groups ( P < .05). However, when the syndesmotic ligaments were transected in conjunction with ATFL ± CFL, a significant difference was observed compared to the intact state ( P < .001). Conclusion: The complete disruption of syndesmotic ligaments did not significantly increase the proximal displacement of the fibula. However, when the ATFL ± CFL were additionally disrupted, there was a significant increase in the vertical translation of the fibula. Clinical Relevance: To our knowledge, this is the first study describing that LALC plays a paramount role in the vertical stability of the fibula. Concomitant syndesmosis and LALC should be suspected in an axially unstable fibular fracture with a significant proximal displacement.
Sequential Targeted Therapy for Advanced, Metastatic, and Recurrent Cervical Cancer: A Cost-Effectiveness Analysis of the Patient Journey
Authors: Richardson Michael T. , Attwood Kristopher , Smith Gabriella , Liang Su-Ying , LaVigne Mager Katherine , Tewari Krishnansu S. , Coleman Robert L. , Kapp Daniel S. , Chan John K. , Monk Bradley J. 
Published: August 2023

Objectives To evaluate outcomes and cost-effectiveness of targeted therapy sequencing for metastatic and recurrent cervical cancer. Method Models were simulated based on phase II and III trials on bevacizumab (bev) from GOG-240, cemiplimab (cemi) from GOG 3016, pembrolizumab (pembro) from KEYNOTE-826, and tisotumab vedotin (tiso) from GOG 3023. Costs were based on IBM Micromedex RED BOOK™ and company listed costs. Results For [chemo + bev → chemo], total cost was $125,918.04, with median overall survival (mOS) of 21.8 months, and cost-effectiveness ratio (CER) of $119,835.79. For [chemo + bev → cemi], total cost was $187,562.99 with mOS of 28.5 months and CER of $162,039.16. For [chemo + bev + pembro → chemo], total cost was $319,963.78 with mOS 32.9 months and CER of $249,930.10. For [chemo + bev + pembro → tiso], total cost was $455,204.45, with mOS 36.5 months and CER of $320,072.99. Conclusion The combination of immunotherapies and biologics have significantly increased overall survival, but with associated higher costs, primarily related to drug costs.
Epiretinal membrane formation and optic disc vascularisation in type 2A macular telangiectasia (MacTel)
Authors: Venkatesh Ramesh , Mangla Rubble , Handa Ashit , Parmar Yash , Sangoram Rohini , Chhablani Jay 
Published: August 2023

Purpose To describe a rare clinical finding of epiretinal membrane (ERM) and abnormal optic disc vascularisation in type 2A macular telangiectasia (MacTel). Case description A 52-year-old asymptomatic healthy male was examined in the retina clinic. In both eyes, corrected visual acuity was 20/20, N6. Anterior segment examination and intraocular pressure were both normal in both eyes. Results The right eye's dilated fundus examination revealed loss of retinal transparency and superficial intraretinal crystals. A thick ERM extending from the optic disc to the macula obscured the details of the underlying perifoveal region in the left eye fundus. The diagnosis of bilateral type 2 MacTel was confirmed by confocal blue reflectance imaging, fluorescein angiography (FA), and macular optical coherence tomography (OCT). The left eye macular OCT scan also revealed a thick ERM without causing significant retinal traction. Furthermore, FA of the left eye revealed early hyperfluorescence with intense late leakage at the inferior aspect of the optic disc, giving the impression of abnormal optic disc vascularisation. No other cause for the disc vascularisation could be identified. OCT scan through the area with the optic disc leakage revealed a tuft of irregular hyperreflective tissue lying over the ERM. OCT angiography imaging confirmed the vascularity within the tuft of hyperreflective tissue over the ERM. Over a two-year period, no changes in clinical or imaging features were observed. Conclusion In type 2A MacTel eyes, ERM formation and abnormal disc vascularisation are uncommon findings. More histopathologic research is needed to characterise these membranes.
Dupilumab induced ocular surface disease: A prospective case series
Authors: Pradhan Sayali Prakash , Sadiq Salman Naveed , Cartes Cristian , Babakinejad Parastoo , Ball Stephanie , Reynolds Nick J , Meggitt Simon , Figueiredo Francisco C 
Published: August 2023

Purpose To identify the incidence, risk factors, demographics, and clinical profile of dupilumab-induced ocular surface disease (DIOSD) in patients with atopic dermatitis (AD), propose a standardised treatment protocol (STP) and evaluate the response. Methods Prospective case series of AD patients treated in the Dermatology Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK developing ocular symptoms after commencing Dupilumab between September 2018 and February 2020. A standard history and examination protocol were used including subjective symptom severity grading and Ocular Surface Disease Index (OSDI) questionnaire on each visit. Standard treatment was prescribed, and response evaluated. Results 32 of 113 included patients (28.31%) developed DIOSD, of which 20 (62.5%) were referred to the Cornea Service. Median age was 38.0 years (IQR 26.8; range 19–74). Male to female ratio was 1:1. Average time to onset of ocular symptoms from starting dupilumab was 9.2 weeks (IQR 8.8; range 0.1-40). 90% patients had bilateral conjunctival inflammation and blepharitis at presentation. Significant improvement in the subjective severity scale and the median OSDI score (from 34.0 to 10.2) was noted in response to topical eye treatment. Dupilumab was discontinued in none. Conclusions DIOSD is not uncommon although, with timely referral and appropriate topical treatment better clinical outcome and patient satisfaction can be achieved without the need to discontinue Dupilumab. Prior allergic conjunctivitis did not affect the incidence or severity of DIOSD. Further prospective studies with longer follow-up and more focus on possible disease mechanism such as goblet cell related changes and immune response are needed.
Maternal control and eating styles in children: The mediating role of emotion differentiation
Authors: Scotto Rosato Marco , Cipriano Annarosa , Napolano Rosanna , Cella Stefania 
Published: August 2023

Introduction: Theoretical accounts and empirical research suggest that mother-child interactions significantly influence the child’s eating styles (emotional, external, and restrained eating). However, little or no research has explored the association between maternal psychological control and eating styles and whether other mechanisms may be involved in such association. To address this shortcoming, the present study aimed to investigate the mediating role of difficulties in differentiating emotions between maternal control and eating styles. Methods: Participants were 324 elementary school children (Girls = 172, 53.1%) aged between 8 and 11 years (Mage = 9.13, SD = .89) assessed through self-report measures. Parents provided information about weight and height. Results: Path analysis model showed an acceptable fit to the data (χ2 (3) = 3.966, p = .256; RMSEA = .032; CFI = .990; TLI = .911; SRMR = .018). Difficulties in differentiating emotions significantly mediated the relationship between maternal control and emotional eating (β = −.071, 95%CI [−.094, −.052]; p < .001). The model was invariant across genders. Conclusions: Our findings support the importance of dyadic interaction in enhancing the risk for dysfunctional eating style during infancy, showing that emotion differentiation deficits may be particularly salient in such relationship. Clinical and practical implications of these findings are discussed.
Between information campaign and controversy: a quantitative newspaper content analysis about COVID-19 vaccination in Switzerland and Austria
Authors: Zimmermann Bettina M. , Paul Katharina T. , Janny Anna , Butt Zarah 
Published: August 2023

Aims: Because media portrayal reflects and shapes public opinion and health policy, investigating news coverage of public health issues is highly relevant for public health research and practice. Addressing a topical issue, this study investigated how newspaper coverage framed COVID-19 vaccines in Austria and German-speaking Switzerland and how it developed over time. Methods: A quantitative newspaper content analysis of six newspapers from Austria and German-speaking Switzerland published between January 1 and 31, 2022 was conducted. Frames were identified for each country separately through hierarchical cluster analysis (Ward’s method) based on frame elements. Results: Four frames were identified in both countries: (1) Evaluating new vaccines, (2) Discussing mandates, (3) Promoting vaccination, (4) Mentioning vaccines. In Frames 1 (Switzerland 86.4%, Austria 93.3%) and 3 (Switzerland 92.7%, Austria 98.9%), most articles included vaccine-endorsing statements, with Swiss coverage including additional negative statements more often than Austrian coverage (43.2%/44.6% vs 4.0%/3.3%). Frame 2 was closely linked to vaccine skepticism only in Austria and contained more evaluative statements in Austrian newspapers (25.4% endorsing, 35.4% rejecting; in Switzerland 14.5%/18.1%). The Austrian tabloid Kronen Zeitung published most articles (497/1091, 45.6%). Conclusions: The commercialized and comparatively high share of tabloid news coverage in Austria may have contributed to oversimplified and polarizing COVID-19 vaccine debates in this context. Insufficiently balanced and adequate information may contribute to a loss of public trust in vaccination and may therefore affect vaccination uptake. Authorities and public health professionals should consider this effect when designing information campaigns.
Comparative evaluation of the dentoalveolar effects of three Class II correctors: A finite element analysis study
Authors: Plaza-Ruiz Sonia Patricia , Rojas-Plaza Paula Alejandra , Basto-Tacuma Jessica , Velandia-Palacio Luz Andrea , Jara-López Liliana 
Published: August 2023

Objective: To compare the stress distribution and total strain applied to the dentition, periodontal ligament (PDL) and cortical and trabecular bones by three Class II correctors using finite element analysis. Design: Three-dimensional analysis of stresses and total strain of the dentition with three Class II correctors. Setting: Computational study. Methods: Three-dimensional finite element models of Class II elastics, the Forsus Fatigue Resistant Device (FRD) and the Carriere Motion Appliance (CMA) were constructed from a cone-beam computed tomography (CBTC) image of an orthodontic Class II patient. The distribution of stress (von Mises and principal stress) and the total strain (mm) in maxillo-mandibular dentition, PDL, cortical and trabecular bone were analysed. Results: The highest von Mises yield and the maximum principal stress in the three models were found at the teeth, followed by the cortical bone, trabecular bone and PDL. The maximum stress and total deformation were located at the upper canines and lower molars in the Class II elastics and CMA models, in the upper first molars in the Forsus FRD and CMA, and in the lower first premolars in the Forsus FRD. In addition, stress was distributed in the anterior and posterior regions of the teeth, and the total deformation was found in the distal direction in the upper arch and in the mesial direction in the lower arch. Conclusion: The stress concentrations in the three models were located close to the active components of each appliance, producing specific patterns of stress distribution and displacement that should be taken into account when planning the type of appliance to be used for the correction of the Class II malocclusion.
Lived experiences of maintaining self-identity among persons living with young-onset dementia: A qualitative meta-synthesis
Authors: Tang Xueting , Wang Junqiao , Wu Bei , Navarra Ann-Margaret , Cui Xiaoyan , Wang Jing 
Published: August 2023

Background The self-identity of persons with young-onset dementia (YOD) is affected by the disease progression. However, the lived experience of maintaining self-identity along the disease trajectory is understudied. This meta-synthesis integrated qualitative data on the challenges, coping strategies, and needs of persons living with YOD and how their experiences affected their self-identity over time. Methods Four English (PubMed, Scopus, CINAHL, PsycINFO) and two Chinese (CNKI and Wanfang) electronic databases were searched for published literature peer-reviewed from the time of database inception to 2022. We used thematic analysis to extract and synthesize data from the literature concerning the long-term lived experiences of persons living with YOD. Results A total of five peer-reviewed publications were eligible for inclusion in this meta-synthesis study. We identified four themes: (1) declining cognitive function and a prolonged diagnostic process threaten the self-identity of persons living with YOD, (2) struggling to accept the diagnosis of YOD and maintain self-identity, (3) maintaining self-identity and the normalcy of life through social support and person-centered care, and (4) living with YOD through self-development and self-identity reshaping at a later stage of the disease. Conclusions Persons living with YOD experience challenges maintaining their self-identity throughout the disease trajectory. These challenges are affected by their cognitive function, experiences of personal and social stigma associated with the disease, perceived social support, and person-centered care. Study findings have implications for developing tailored supportive programs for persons living with YOD at various stages of the disease trajectory.
Consistency between two subjective assessments of activities of daily living: Patient- and occupational therapist-reported judgments
Authors: Lien Hung-Pin , Wang Yi-Ching , Chen Yi-Miau , Fan Shih-Chen , Chen Mei-Hsiang , Chiang Hsin-yu , Hsieh Ching-Lin 
Published: August 2023

Purpose To examine the consistency between patient- and occupational therapist-reported judgments of patients’ ability and change in ADL abilities. Materials Patient- and therapist-reported ADL abilities were assessed using a Visual Analogue Scale, whilst the changes in patients’ ADL abilities were reported by patients and therapists using a 15-point Likert-type scale. Methods Repeated assessments at a 3-week interval were used. 88 inpatients with stroke and 16 occupational therapists were recruited from rehabilitation wards in a medical center. Results Moderate correlations ( rs = .53–.56) were found between the patient- and therapist-reported ADL abilities. The patient-reported scores were significantly lower ( ds = .45; ps < .001 at follow-up) than the therapist-reported scores. Only low correlation ( r = .33) was found for the change scores. Conclusions Our findings indicated that there was only a moderate to low correlation between the patients' reports and the therapists' judgments regarding the patients' ADL ability and its change. Because both patients’ reports and therapists’ judgments affect decisions on rehabilitation, frequent communication may be beneficial for reaching consensus and helpful in managing the interventions.
Incidental finding of an undifferentiated sarcoma during lower limb Doppler ultrasound: A case report
Authors: Ilounoh Christopher Ekene , Eteng Rajuno Ernest , Arlachov Yuriy 
Published: August 2023

Introduction: Undifferentiated sarcoma is considered a rare and aggressive type of soft tissue sarcoma with the lower extremity reported as the common site for soft tissue sarcomas. Case presentation: We present a rare incidental finding of undifferentiated sarcoma during lower limb Doppler ultrasound with a presenting symptom of right thrombotic-like calf pain in a 49-year-old female. Discussion: On ultrasound, the presented undifferentiated sarcoma appeared as a large heterogeneous, oval-shaped, soft tissue mass deeply seated in the right calf with involvement of the soleus muscle. The features on ultrasound mimicked those of a hematoma; however, the possibility of the lesion being a haematoma was promptly ruled out with the demonstration of internal vascularity on colour Doppler application. The case was then referred to a sarcoma triage multidisciplinary team for a review. Magnetic resonance imaging, computed tomography and biopsy were parts of the diagnostic workup for this case, histology confirmed the soft tissue lesion to be an undifferentiated sarcoma. Emergency above knee amputation of the right leg was performed as part of the patient’s treatment. Conclusion: This case report presents a rare incidental finding of undifferentiated sarcoma encountered during lower limb Doppler ultrasound causing thrombotic-like calf pain. Sonographers are encouraged to pay necessary attention and carefully examine any adjacent and incidental soft tissue lesion during lower limb Doppler ultrasound using compression, two-dimensional imaging and colour imaging, especially those that appear with characteristic features of malignancy; urgent referral should be made of such cases to a tertiary soft tissue sarcoma centre for further evaluation and management.
Association between intraoperative starch use and postoperative kidney dysfunction in patients undergoing major gastro-intestinal surgery: A propensity score–matched analysis
Authors: Iyer Karthik V , Giri Sanjeeb , Ray Bikash R , Muthiah Thilaka , Anand Rahul K , Kaur Manpreet , Kumar Rakesh , Punj Jyotsna , Rewari Vimi , Sahni Peush , Maitra Souvik 
Published: August 2023

Background: The impact of intraoperative starch-based fluid therapy on postoperative kidney dysfunction in patients undergoing major abdominal surgery is uncertain. Low molecular weight starch is expected to cause less postoperative kidney dysfunction. Methods: This retrospective study evaluated the impact of intraoperative 6% hydroxyethyl starch on postoperative renal dysfunction. The primary outcome of this study was postoperative acute kidney injury as per KDIGO definition within 72 hours of surgery. Results: This study analysed data from 461 patients with a median (interquartile range) age of 45 (33–58) years, and 48.2% of all patients were female. The proportion (95% confidence interval) of patients who developed acute kidney injury was 0.18 (0.14−0.21); 62.9% of patients had acute kidney injury stage I, 32% had acute kidney injury stage II, and the rest were acute kidney injury stage III. In the propensity score–matched sample, the average treatment effect of intraoperative colloid use on postoperative serum creatinine at day 3 (p = 0.32), duration of postoperative intensive care unit stay (p = 0.97), duration of hospital stay (p = 0.37), postoperative worst international normalised ratio (p = 0.92), and postoperative transfusion requirement (p = 0.40) were not statistically significant. Conclusion: Intraoperative use of low molecular weight hydroxyethyl starch use was not associated with postoperative kidney dysfunction and coagulopathy in adult patients undergoing major open abdominal surgery.