Does Social Support Influence Bulimic Behaviors through its Impact on Cognitive Appraisal

Social support is one of many interpersonal functions that is impaired among individuals with bulimia nervosa. The buffering hypothesis of social support posits that social support shields the deleterious impact of stress on bulimic behaviors. However, the specific mechanism by which social support protects against the negative impact of stress on bulimic symptoms remains to be clarified. To investigate this mechanism, two studies examined the potential role of cognitive appraisal as a mediator in the relationship between social support and bulimic behaviors among undergraduate students. Study 1 was a longitudinal, naturalistic study in which participants completed online surveys at two assessment points that were four weeks apart. Bootstrap analyses revealed that cognitive appraisal did not mediate the relationship between perceived social support and bulimic behaviors. Exploratory analyses demonstrated that perceived stress, a construct parallel to cognitive appraisal with the emotional experiences taken into consideration, acted as a mediator in this relationship. Perceived social support appeared to be associated with decrease future bulimic behaviors through lowered stress perception. Study 2 was an experimental study that examined the role of cognitive appraisal in the relationship between social support and food consumption, which was used as a laboratory analogue of binge eating. Female participants were randomly assigned into one of two groups: with or without social support available. Stress was induced with a speech task, followed by a bogus taste task. Results demonstrated that perceived stress, instead of cognitive appraisal mediated the relationship between subjective ratings of the experimenter?s supportiveness and calories consumed. Unexpectedly, perceived supportiveness was associated with more caloric consumption through lower stress perception among individuals with high restraint. These studies extended the existing literature by examining perceived social support, perceived stress, and bulimic behaviors in a mediation model. Findings have theoretical and clinical implications for the role of social support in bulimic behaviors and the stress-disordered eating relationship. For example, stress does not always predict binge eating. Moreover, findings suggest the importance of social support in stress management and eating disorder treatments as well as the potential for emotional interventions for eating disorders.Graduate School and Interdisciplinary Studies. North Dakota State UniversityDepartment of Psychology. North Dakota State Universit

Multinationals offshore sourcing of finance and accounting in Malaysia: exploring the drivers from the perspectives of transaction costs, resource-based view and location advantages

The purpose of this research is to analyse the effects of drivers from the perspectives of Transactions costs economics (TCE), Resource-based view and Location Advantages on multinationals (MNCs) Finance and Accounting (FA) offshore sourcing strategy. A survey was developed to evaluate the significance of these drivers based on Malaysia-based MNCs with FA offshore establishments. Hypotheses are developed to advance the understanding of the effects of these drivers. Evidence from the study shows that uncertainty due to technology positively and significantly affects offshore insourcing of FA activities. Human asset specificity, which is always presented as inversely related to offshore outsourcing, demonstrated inconsistent effects. Apart from the economic factors, strategic value FA activities and the development of skills that are customised to the requirement of the firm affect offshore insourcing of FA. However, unique skills do not play any significant role. The study proposed the existence of a synergistic relationship between TCE and RBV. The interaction effects between uncertainty due to technology and strategic value FA activities on offshore insourcing strategy is evidenced, proving that this collaborated effort will not only empower the MNCs to create competitive advantage through innovating their FA processes, it also indicates using TCE and RBV in tandem elevates the benefits of offshore sourcing decision. Results show that the relationship between the integrated TCE and RBV drivers and offshore insourcing strategy is affected positively by the presence of location advantages. Results also revealed MNCs’ aspirations in offshoring FA activities deviate from solely seeking costs effectiveness or in acquiring FA professionals. The findings suggest the effectiveness of offshore insourcing of FA activities depends on the technological development of digital solutions along with the reengineering of specific capabilities and the access to location advantages such as innovations and technical competence. Analyses indicate this portfolio of factors expand MNCs’ FA sourcing footprint to the next level which is the offshore insourcing of highly strategic and complex FA processes

Safety of Pedicle Screws in Adolescent Idiopathic Scoliosis Surgery

To review existing publications on the safety of pedicle screw insertions in adolescent idiopathic scoliosis (AIS). Despite having increased risk for neurological and visceral injuries, the use of pedicle screws have led to increased correction rates in scoliosis surgery. A review was performed on topics pertinent to pedicle screw insertion in AIS, which included pedicle morphometry in AIS, structures at risk during pedicle screw insertion, and accuracy and safety of various pedicle screw insertion techniques. The importance of computer navigation and future research regarding pedicle screw placement in AIS were also briefly reviewed. Many authors have reported abnormal pedicle anatomy in AIS. Injury to the neural structures was highest over the apical region, whereas aortic injury was the highest at T5 and T10. In the proximal thoracic spine, the esophagus could be injured even with screws as short as 25 mm. Overall pedicle perforation rates for perforations >0 and >2 mm (assessed by computed tomography) ranged from 6.4% to 65.0% and 3.7% to 29.9%, respectively. The critical pedicle perforation (>2 mm excluding lateral thoracic) and anterior perforation (>0 mm) rates was reported to range from 1.5% to 14.5% and 0.0% to 16.1%, respectively. Pedicle perforation rates were lower with the use of computer navigation. The incidence of neurological adverse events after scoliosis surgery was 0.06%–1.9%. Aortic injury has only been observed in case reports. According to the available literature, pedicle screw insertion in AIS is considered safe with low rates of clinical adverse events. Moreover, the use of navigation technology has been shown to reduce pedicle perforation rates

Scarf-related hangman's fracture: A case report

Background: Injury to the cervical spine due to a scarf-associated accident has not been reported in the literature. We present a case of a hangman's fracture in a 43-year-old woman that resulted from a scarf-related injury as a consequence of a motor vehicle accident. Purpose: To identify the mechanism of a scarf-related injury causing Hangman's fracture. Case Report: A 43-year-old woman was involved in a motor vehicle accident. She was wearing a scarf, which is a common clothing accessory for women in Malaysia. The scarf was violently torn off her head during the injury, causing a type I hangman's fracture. A halo vest for a total period of 3 months was applied. Conclusion: A scarf-related injury can cause an injury that resembles judicial hanging, leading to a traumatic spondylolisthesis of the axis. Careful evaluation of the cervical spine radiographs is crucial as occult fracture of the axis can be missed

Minimally Invasive Spinal Stabilization Using Fluoroscopic-Guided Percutaneous Screws as a Form of Palliative Surgery in Patients with Spinal Metastasis

Study DesignProspective cohort study.PurposeTo report the outcome of 50 patients with spinal metastases treated with minimally invasive stabilization (MISt) using fluoroscopic guided percutaneous pedicle screws with/without minimally invasive decompression.Overview of LiteratureThe advent of minimally invasive percutaneous pedicle screw stabilization system has revolutionized the treatment of spinal metastasis.MethodsBetween 2008 and 2013, 50 cases of spinal metastasis with pathological fracture(s) with/without neurology deficit were treated by MISt at our institution. The patients were assessed by Tomita score, pain score, operation time, blood loss, neurological recovery, time to ambulation and survival.ResultsThe mean Tomita score was 6.3±2.4. Thirty seven patients (74.0%) required minimally invasive decompression in addition to MISt. The mean operating time was 2.3±0.5 hours for MISt alone and 3.4±1.2 hours for MISt with decompression. Mean blood loss for MISt alone and MISt with decompression was 0.4±0.2 L and 1.7±0.9 L, respectively. MISt provided a statistically significant reduction in visual analog scale pain score with mean preoperative score of 7.9±1.4 that was significantly decreased to 2.5±1.2 postoperatively (p=0.000). For patients with neurological deficit, 70% displayed improvement of one Frankel grade and 5% had an improvement of 2 Frankel grades. No patient was bed-ridden postoperatively, with the average time to ambulation of 3.4±1.8 days. The mean overall survival time was 11.3 months (range, 2–51 months). Those with a Tomita score <8 survived significantly longer than those a Tomita score ≥8 with a mean survival of 14.1±12.5 months and 6.8±4.9 months, respectively (p=0.019). There were no surgical complications, except one case of implant failure.ConclusionsMISt is an acceptable treatment option for spinal metastatic patients, providing good relief of instability back pain with no major complications

Neurological Recovery in Two Patients with Cauda Equina Syndrome Secondary to L5 Lumbar Spine Giant Cell Tumour after Treatment with Denosumab without Surgery

We report two patients with cauda equina syndrome (CES) secondary to L5 giant cell tumour (GCT) who achieved good neurological recovery after treatment with denosumab without surgery. The first patient was a 26-year-old man with L5 GCT causing CES who regained bowel and urinary control, muscle power improvement from grade 2 to grade 4 and Oswestry disability index (ODI) improvement from 48 to 23 after denosumab treatment. The second patient was a 25-year-old woman with L5 GCT causing CES who regained bowel and urinary control, muscle power improvement from grade 0 to grade 4 and ODI improvement from 42 to 20 after denosumab treatment. The usage of denosumab in the treatment of patients with CES due to GCT allows potential neurological recovery without any surgical intervention. If surgery is not contraindicated, more time is obtained to prepare the patient preoperatively to attain safer surgery and to achieve complete tumour clearance

Surgical Morphometry of C1 and C2 Vertebrae: A Three-Dimensional Computed Tomography Analysis of 180 Chinese, Indian, and Malay Patients

Study DesignClinical imaging study.PurposeTo study the surgical morphometry of C1 and C2 vertebrae in Chinese, Indian, and Malay patients.Overview of LiteratureC1 lateral mass and C2 pedicle screw fixation is gaining popularity. However, there is a lack of C1–C2 morphometric data for the Asian population.MethodsComputed tomography analysis of 180 subjects (60 subjects each belonging to Chinese, Indian, and Malay populations) using simulation software was performed. Length and angulations of C1 lateral mass (C1LM) and C2 pedicle (C2P) screws were assessed.ResultsThe predicted C1LM screw length was between 23.2 and 30.2 mm. The safe zone of trajectories was within 11.0°±7.7° laterally to 29.1°±6.2° medially in the axial plane and 37.0°±10.2° caudally to 20.9°±7.8° cephalically in the sagittal plane. The shortest and longest predicted C2P screw lengths were 22.1±2.8 mm and 28.5±3.2 mm, respectively. The safe trajectories were from 25.1° to 39.3° medially in the axial plane and 32.3° to 45.9° cephalically in the sagittal plane.ConclusionsC1LM screw length was 23–30 mm with the axial safe zone from 11° laterally to 29° medially and sagittal safe zone at 21° cephalically. C2P screw length was 22–28 mm with axial safe zone from 26° to 40° medially and sagittal safe zone from 32° to 46° cephalically. These data serve as an important reference for Chinese, Indian, and Malay populations during C1–C2 instrumentation

Cervical Supine Side-Bending versus Cervical Supine Traction Radiographs: Which Is Better in Predicting Proximal Thoracic Flexibility for Lenke 1 and 2 Adolescent Idiopathic Scoliosis?

Study Design Prospective cohort study. Purpose This study compared cervical supine side-bending (CSSB) and cervical supine traction (CST) radiographs to assess the flexibility and predict the correctability of the proximal thoracic (PT) curve for patients with adolescent idiopathic scoliosis (AIS) classified as Lenke 1 and 2. Overview of Literature Knowledge of the flexibility of the PT curve is crucial in the management of patients with AIS. There are no reports comparing CSSB and CST radiographs to assess this parameter. Methods Thirty patients with Lenke 1 and 2 AIS scheduled for posterior spinal fusion surgery were recruited. A standing whole spine radiography and physician-supervised CSSB and CST radiographies were performed. Patient demographic and radiological parameters were recorded, including age, gender, weight, height, body mass index, PT angle, main thoracic angle, CSSB PT angle, CST PT angle, and postoperative PT angle. From the data collected, the curve flexibility and curve correction index were calculated and compared. Results CSSB had a significantly (p <0.05) smaller PT angle (16.6°±10.4°) in comparison to CST (23.7°±10.7°). CSSB had significantly (p <0.05) greater flexibility (44.2%±19.7%) in comparison to CST (19.5%±18.1%). The CSSB correction index (1.2±0.9) was significantly closer to 1 in comparison to the CST correction index (4.4±5.3). There was no difference (p =0.72) between the CSSB PT angle (16.6°±10.4°) and the postoperative PT angle (16.1°±7.5°). However, the CST PT angle (23.7°±10.7°) was significantly (p <0.05) larger than the postoperative PT angle (16.1°±7.5°). Conclusions CSSB radiographs were better for demonstrating PT flexibility and more accurately predicted correctability in comparison to the CST radiographs