bluuebunny/crossref_metadata_2025 huggingface dataset:
Acupuncture for whiplash-associated disorder following road traffic collision: a physiotherapy service evaluation
Authors: Stuart Samuel , Armstrong Michael , Sewell Jennifer , Dixon Cheryl , Morris Rosie
Published: February 2020

Background:

Whiplash-associated disorder (WAD) is a common musculoskeletal condition that frequently occurs following a road traffic collision. Physiotherapy is often prescribed to help with the symptoms and injuries. Research evidence has demonstrated that acupuncture may be beneficial, but no studies have examined the routine clinical use of acupuncture by physiotherapists for treatment of WAD. Therefore, a physiotherapy service evaluation was conducted to examine the effects of acupuncture on WAD following a road traffic collision.

Methods:

This study involved 87 patients who attended a private physiotherapy practice following a road traffic collision after referral by their solicitor as part of a personal injury claim. Patients were included if they had been diagnosed with WAD (grades I–III) and received acupuncture as part of their treatment. An average of three sessions of acupuncture were received, which primarily involved needling of traditional acupuncture points and/or myofascial trigger points of the neck and upper/lower back.

Results:

Pain significantly reduced ( p < 0.001). Musculoskeletal outcome measures including neck disability index, Oswestry low back pain scale and Quick disabilities of the arm, shoulder and hand (Quick-DASH) scale also significantly improved (all p < 0.001). Adverse events were minor. The majority of the patients (n = 66) were able to return to full-work duties following treatment.

Conclusion:

Acupuncture appears to be an effective clinical treatment for WAD following a road traffic collision and should be considered by physiotherapists working with such patient groups.
Aging behavior of nano-CaCO3-modified polypropylene nonwoven fabric composites
Authors: Wang Zongqian , Li Yu , Fang Yinchun , Feng Ganyu , Xu Jingjing
Published: February 2020

Nano-CaCO3-modified polypropylene (PP) nonwoven fabric composite is widely used as the filter material which could overcome the poor lightfastness and low weight of the pure one, while its aging performances would be influenced. In this article, the aging behavior of the nano-CaCO3-modified PP nonwoven fabric composite was investigated. At first, the difference between untreated and CaCO3-modified PP nonwoven fabric was analyzed by scanning electron microscopy, thermogravimetric/differential thermal analysis, and X-ray diffraction. Then the aging behaviors of these two PP nonwoven fabrics were studied in detail. The results showed that the PP nonwoven fabric exhibited good acid corrosion resistance. On the contrary, acid corrosion resistance of the modified PP nonwoven fabric was poor; although its weight and strength didn’t change under weak acid condition, its weight and strength loss both increased obviously under medium and strong acid condition with the prolongation of corrosion time. Due to the ultraviolet (UV) energy dissipation of nano-CaCO3 particles, the UV aging resistance of the modified PP nonwoven fabric was improved, and the compound UV aging under weak acid condition was also superior to that of the untreated PP fabric. This article will provide experimental and theoretical base for the structural regulation of CaCO3-modified PP fibers.
Examining Caregivers’ Independence in Early Intervention Home Visit Sessions
Authors: Ciupe Antonela , Salisbury Christine
Published: February 2020

The purpose of this study was to examine how a delineated coaching process affected the ability of caregivers to take the lead in promoting their children’s learning in the context of daily activities. In addition, the correspondence between caregivers’ initiations during the intervention and their rate of improvement after the intervention was investigated. One provider coached three culturally diverse caregivers to use development-enhancing strategies with their children who evidenced moderate–severe disabilities. The coaching process designated by the acronym SOOPR, include targeted information sharing (S), observation and provision of opportunities for the caregiver to practice new skills with provider feedback (OO), problem solving and reflection (P), and review of the session (R). Results reveal that all three caregivers increased their initiations of three of four development-promoting behaviors: teaching, responsiveness, and encouragement. The descriptive data across sessions for each triad suggest that as the intervention progressed, the frequency of specific coaching strategies decreased which may have fostered the caregivers’ opportunities to take the lead in the sessions. In addition, a consistent pattern of direct proportionality between caregiver rate of improvement after the intervention and caregiver initiations during the intervention was identified. Study limitations and implications for research and practice are discussed.
Regulating Crime and the International Crime Drop
Authors: Clarke Ronald
Published: February 2020

Michael Quinn’s article reveals that Jeremy Bentham strongly endorsed the suggestions of Patrick Colquhoun, a London magistrate, for reducing the myriad of tempting opportunities for crime in large cities like London. However, it was Colquhoun’s other, positivist ideas about training the poor to resist these temptations that helped determine crime policy for the next 150 years. This positivist agenda has recently been criticized by environmental criminologists and crime scientists, who have revived Colquhoun’s ideas about reducing opportunities for crime and who have advanced the security hypothesis as the explanation for the international drop in crime.
Comparison of 2g vs 1 g of Prophylactic Cefazolin in Surgical Site Infections in Trauma Surgery Below the Knee
Authors: Sanders Fay R. K. , Kistemaker Rosanne M.G. , van ’t Hul Mirjam , Schepers Tim
Published: February 2020

Background:

The rate of surgical site infections (SSIs) after foot or ankle surgery remains high, despite the implementation of antibiotic prophylaxis. Recently, guidelines suggest a single dose of 2 g instead of 1 g of cefazolin for implant surgery; this decision is largely based on pharmacokinetic studies. However, the clinical effect of this higher dose has never been investigated in foot and ankle surgery. This retrospective cohort study investigated the effect of 2 g compared with 1 g of prophylactic cefazolin on the incidence of SSIs in foot and ankle surgery.

Methods:

All patients undergoing trauma-related surgery of the foot, ankle, or lower leg between September 2015 and March 2019 were included. The primary outcome was the incidence of an SSI. SSIs were compared between patients receiving 1 g and 2 g of cefazolin as surgical prophylaxis, using a propensity score to correct for possible confounders.

Results:

A total of 293 patients received 1 g and 126 patients received 2 g of cefazolin. The overall number of SSIs was 19 (6.5%) in the 1-g group and 6 (4.8%) in the 2-g group. Corrected for possible confounders, this was not statistically significant (OR, 0.770; P = .608).

Conclusion:

Even though the decrease in SSI rate from 6.5% to 4.8% was found not to be statistically significant, it might be clinically relevant considering the reduction in morbidity, mortality, and healthcare costs. Research linking pharmacokinetic and clinical results of prophylactic cefazolin is needed to establish whether or not the current recommendations and guidelines are sufficient for preventing SSIs in foot and ankle surgery.

Level of Evidence:

Level III, retrospective comparative series.
Risk Factors for Failure in Hammertoe Surgery
Authors: Albright Rachel H. , Hassan Moiz , Randich Jacob , O’Keefe Robert , Klein Erin E. , Weil Lowell , Weil Lowell , Fleischer Adam E.
Published: February 2020

Background:

Hammertoe correction is perhaps the most common elective surgery performed in the foot, yet rates of symptomatic recurrence and revision surgery can be high. In this study, we aimed to identify patient and provider risk factors associated with failure after hammertoe surgery.

Methods:

Consecutive patients with a minimum of 6 months’ follow-up undergoing hammertoe surgery within a single, urban foot and ankle practice between January 1, 2011, and December 31, 2013, served as the basis of this retrospective cohort study. Cox regression analysis was used to identify important predictor variables obtained through chart and radiographic review. One hundred fifty-two patients (311 toes) with a mean age of 60.8 ± 11.2 years and mean follow-up of 29.5 ± 21.2 months were included.

Results:

Statistically significant predictors of failure were having a larger preoperative transverse plane deviation of the digit (hazard ratio [HR], 1.03 for each degree; P < .001; 95% CI, 1.02, 1.04), operating on the second toe (vs third or fourth) (HR, 2.23; P = .003; 95% CI, 1.31, 3.81), use of a phalangeal osteotomy to reduce the proximal interphalangeal (PIP) joint (HR, 2.77; P = .005; 95% CI, 1.36, 5.64), and using less common/conventional operative techniques to reduce the PIP joint (HR, 2.62; P = .03; 95% CI, 1.09, 6.26). Concomitant performance of first ray surgery reduced hammertoe recurrence by 50% (HR, 0.51; P = .01; 95% CI, 0.30, 0.87).

Conclusion:

We identified risk factors that may provide guidance for surgeons during preoperative hammertoe surgery consultations. This information may better equip patients with appropriate postoperative expectations when contemplating surgery.

Level of Evidence:

Level III, retrospective case series.
Institutional and Economic Determinants of Regional Public Debt in Spain
Authors: Delgado-Téllez Mar , Pérez Javier J.
Published: February 2020

We analyze from an empirical point of view the evolution and determinants of Spanish regional public debt. Spain offers an interesting case study because of its high level of fiscal decentralization, implemented gradually during the past four decades, the parallel entry into force of a number of national fiscal rules in that period, and the heterogeneity of its regions, both in terms of economic fundamentals and some institutional features. Our main findings are the following: (i) on average, over the sample of study, regional governments’ fiscal policies reacted to public debt increase; (ii) fiscal rules played a limited role in controlling debt surges; (iii) a higher degree of regional fiscal coresponsibility tends to be linked to more subdued debt dynamics; (iv) market disciple has encouraged some fiscal restraint at the regional level; and (v) increases in public commercial debt have affected the standard debt.
Patency and functionality of radiocephalic arteriovenous fistulas with an external support device (VasQ™): Real-world single-center experience
Authors: Shahverdyan Robert , Meyer Tobias , Matoussevitch Vladimir
Published: February 2020

Background:

The VasQTM device was designed to improve the outcome of arteriovenous fistulae by optimizing the hemodynamics of the flow in the juxta-anastomotic region of the arteriovenous fistulae through tailored external support. The aim of the study was to evaluate the impact of the VasQ on outcome of radiocephalic arteriovenous fistulae in a real-world setting.

Methods:

This was a single-center, retrospective analysis of patients with either fistula creation before or after dialysis initiation with implantation of the VasQ device during creation of end-to-side radiocephalic arteriovenous fistulae between June 2018 and May 2019. The flow rate and vein diameter were evaluated intraoperatively, at discharge within 48 h postprocedure and at a follow-up of 1, 3, 6, 9, and 12 months.

Results:

Thirty-three VasQ devices were implanted during 33 radiocephalic arteriovenous fistula procedures. The study population comprised mostly of men, with an average age of 66 years. Mean intraoperative flow was 428 mL/min (range: 130–945). All patients were discharged with patent arteriovenous fistulae and mean fistula flow of 740 mL/min (range: 230–1300 mL/min). The primary patency was 100% and 79% at 3 and 6 months, respectively. Cumulative/secondary patency was 100% and 90% at 3 and 6 months, respectively.

Conclusion:

Data presented here suggest that the VasQ device has the potential to provide benefit to the functionality of radiocephalic arteriovenous fistulae.
Emigration Chests in Ankara, Turkey: Tracing Spatial Trajectories of Tatar Community
Authors: Akiş Tonguç
Published: February 2020

During migration, whether due to war, political conflict, or poverty, immigrants of turmoil carry their limited personal belongings, family items, and supportive objects in their luggage, bags, and, in some cases, chests to their new homes. Throughout this displacement, chests of migration are necessary and valuable witnesses via their materiality and they wait in their specific corners of houses dare to be contemplated. After the demanding journey, some immigrants continue to use both the chest itself and its contents at their new house in the target locations. In addition, used chests and their contents link immigrants to the journey and to the former location. The immigrants often choose to organize, decorate, and arrange their homes and rooms according to these chests and the items within. This rich mutual relationship between chest, immigrant, and house allows for multidimensional readings considering the spatial trajectories and narratives of migration. Moreover, the trialectic relationships of chest, immigrant, and their space within generate the arguments on the production of space in particular. In this paper, decoding of recent in-depth interviews, documentation of chest locations on each space, and revealing archival material of immigrant families in Ankara, Turkey, are systematized to illustrate the journey of emigration together with the particularities of chest keepers’ attitudes and feelings. Additionally, inscriptions, contents, types, and paths of chest are unlocked on private and communal spaces of the Tatar community. This paper aims to uncover those implanted, profound, and engrained interactions on space of immigrant during expedition of chest.
(Im)Mobile imagination. On trailing, feeling stuck and imagining work on-the-move
Authors: Cangià Flavia
Published: February 2020

Emerging research focuses on the role of time in the context of mobility and explores the conditions of ‘wait’ and ‘stuckness’ as conceptual tools for understanding the tempos and socio-cultural implications of mobile experiences. This paper contributes to this research by exploring these conditions in the context of work and geographical mobility, with a special focus on people who migrate and follow their working partners in international professional migration and temporarily live in Switzerland. The increasingly mobile and changing conditions of some professional sectors have made transnational career trajectories imaginable also for many partners. Yet, at times, their working life is not easily reconstituted on the occasion of the move, and the timing for job-search and unemployment can extend indefinitely. I will discuss how mobile professionals’ partners, by transiting from a working situation to another one that is not yet in place, experience a condition of stuckness between identities, phases of life and destinations of migration. I will ask how the subjective experience of stuckness can trigger and at times block a person’s capacity to imagine work under conditions of geographical mobility.
A framework of evidence-based practice for digital support, co-developed with and for the autism community
Authors: Zervogianni Vanessa , Fletcher-Watson Sue , Herrera Gerardo , Goodwin Matthew , Pérez-Fuster Patricia , Brosnan Mark , Grynszpan Ouriel
Published: February 2020

A wide array of digital supports (such as apps) have been developed for the autism community, many of which have little or no evidence to support their effectiveness. A Delphi study methodology was used to develop a consensus on what constitutes good evidence for digital supports among the broader autism community, including autistic people and their families, as well as autism-related professionals and researchers. A four-phase Delphi study consultation with 27 panel members resulted in agreement on three categories for which evidence is required: reliability, engagement and effectiveness of the technology. Consensus was also reached on four key sources of evidence for these three categories: hands-on experience, academic sources, expert views and online reviews. These were differentially weighted as sources of evidence within these three categories.

Lay abstract

Digital supports are any type of technologies that have been intentionally developed to improve daily living in some way. A wide array of digital supports (such as apps) have been developed for the autism community specifically, but there is little or no evidence of whether they work or not. This study sought to identify what types of evidence the autistic community valued and wanted to see provided to enable an informed choice to be made regarding digital supports. A consensus was developed between autistic people and their families, practitioners (such as therapists and teachers) as well as researchers, to identify the core aspects of evidence that everyone agreed were useful. In all, 27 people reached agreement on three categories for which evidence is required: reliability, engagement and the effectiveness of the technology. Consensus was also reached on four key sources of evidence for these three categories: hands-on experience, academic sources, expert views and online reviews. The resulting framework allows for any technology to be evaluated for the level of evidence identifying how effective it is. The framework can be used by autistic people, their families, practitioners and researchers to ensure that decisions concerning the provision of support for autistic people is informed by evidence, that is, ‘evidence-based practice’.
Mobile phones in Africa: The politics of cultural and material integration into local economies
Authors: Ogone James Odhiambo
Published: February 2020

The rapid expansion of mobile telephony in Africa has been the subject of many debates both in the academia and industry. However, such discourse has tended to focus more on the technology itself rather than its users. This article seeks to frame mobile phones as modern technologies whose contextual uses are heavily entangled in the unique socio-economic dynamics of the African continent. Here the focus is on the African informal economy and the culture it enables, the fractious nature of infrastructure and practices of repair, African notions of conviviality and their political role, and African traditions in the context of globalization. Through these various lenses the study considers the different ways in which the mobile phone becomes Africanized.
‘Vulnerable’ Kids Going Country: Children and Young People’s Involvement in County Lines Drug Dealing
Authors: Windle James , Moyle Leah , Coomber Ross
Published: February 2020

This article employs a range of sources to critically explore the role of children and young people in county lines drug dealing, the potential harms they are exposed to and the difficulties of protecting them. As county lines centre upon the movement and exploitation of vulnerable peoples, we utilise the human trafficking literature for further insights into the dynamics of county lines and current policy responses. The article concludes by discussing the challenges of safeguarding young people, particularly that over-worked and under-resourced frontline practitioners can experience difficulties identifying the vulnerability of young people caught up in county lines, particularly beneath their tough exteriors.
Effect of long-wavelength light on electroencephalogram and subjective alertness
Authors: Lin J , Westland S
Published: February 2020

This study extends previous findings on the effect of different levels of short-wavelength light on human alertness. This study explores the alerting ability of long-wavelength light at two levels (40 lx and 160 lx). Eight subjects took part in the 60-minute experiment for each of two nights, during which their objective alertness and subjective alertness were evaluated using electroencephalogram and questionnaire. Results show that both levels increased electroencephalogram beta power, which shows a different pattern compared with the previous findings on short-wavelength light. These results strongly suggest that although short-wavelength light may impact alertness through circadian system, long-wavelength light will have to achieve that through other pathways. The further comparison between current and previous results also suggests that long-wavelength light is just as strong on acute alerting ability, as shown by electroencephalogram measures and self-rating questionnaire, as short-wavelength light.
Children HIV disclosure: Should the children know their HIV status prior treatment and what are the information have to be told?
Authors: Yetti Krisna , Lindayani Linlin , Huang Mei-Chih
Published: February 2020

Informing children about their HIV status is a complex challenge and the most difficult part for parents and health care providers. As more children with HIV reaching adolescence and adulthood, they begin to take part in the management of their health care and potentially initiate HIV-risk behaviours. Thus, it is increasing attention to address the concrete disclosure process. There is no clear direction regarding the disclosure process, particularly when the children starting to take HIV medication and what is the information has to be told, children. This paper was presented as an example case scenario, according to the real experiences. This case reflects an ethical dilemma faced by parents and health care providers to deal with issues related children HIV disclosure especially when the appropriate time to disclose regarding initiation of HIV treatment and the content of information have to be told to children. Parent and health care providers often lay informing the children about the medication required to take every day. In reality, they inform the children that this medicine is for fever or malaria, etc. it will have a significant impact on adherence to medication and further success of HIV treatment. The reason for making such lied information due to fear that disclosure may distress the child. Therefore, policymakers need to have consensus regardless of whether or not to disclose HIV status to children before the treatment and develop a local guideline that can accommodate specific cultural issues. There is potential to state law that more uniform for public health prevention and successful HIV treatment. Future studies can explore the most effective approach for children HIV disclosure to minimalize potential harm to children.
Pedal Flow Hemodynamics in Patients With Chronic Limb-Threatening Ischemia
Authors: Sommerset Jill , Teso Desarom , Karmy-Jones Riyad , Vea Yolanda , Feliciano Beejay
Published: February 2020

Ankle-brachial index (ABI) and duplex ultrasound (DUS) are accepted standardized tests performed on patients with suspected peripheral arterial disease. In the nondiabetic patient, ABIs can be a reliable test for disease above the level of the ankle. Toe brachial index (TBI) is also an accepted modality to test for small vessel disease. However, ABIs and TBIs fall short in providing a complete evaluation of arterial flow especially in pedal arteries in the setting of noncompressible arteries. Direct duplex ultrasonography can provide a comprehensive evaluation of arterial flow hemodynamics in the lower extremity. However, we wanted to understand the role of arterial collateral flow to the foot in the setting of tibial vessel occlusion. Using DUS, we sought to define the changes that occur in the arterial flow hemodynamics in the foot in relation to occlusions of specific tibial inflow vessels.
Plate Pack Structural Integrity Analysis for Plate and Shell Heat Exchangers at High Temperatures and Pressures
Authors: Hyun-Seok Noh , Jong-Rae Cho , Seung-Hun Song
Published: February 2020

Heat exchangers capable of withstanding high temperature and pressure are required to achieve increased thermal efficiency and compactness. A welded plate and shell heat exchanger, developed for applications involving pressures up to 150 bar and temperatures up to 600 °C, has exhibited advantages that allow a more wide use of heat exchangers. However, few studies have tested the structural integrity of the plate pack of this design. In this paper, the structural integrity of the heat transfer pack was tested using finite element analysis. Elastic and elastic-plastic models were applied for one set of heat transfer plates, while layers of two and four plates were used to verify the effect of the boundary conditions. The plate results were evaluated according to the ASME Boiler and Pressure Vessel Code, Section VIII Division 2. Finally, the function of the end plate in the plate packs was numerically studied.
Intensive care management of arterial carbon dioxide in acute intracerebral haemorrhage: Case report of influences on cerebral haemodynamics
Authors: Caldas Juliana R , Passos Rogério da H , Robinson Thompson G , Panerai Ronney B , Minhas Jatinder S
Published: February 2020

Intracerebral haemorrhage is relatively common and has devastating consequences. Furthermore, non-invasive and invasive strategies to manage raised intracranial pressure remain limited and associated with high morbidity and mortality. We report a case of a 72-year-old male with intracerebral haemorrhage with ventricular extension, hydrocephalus and intracranial hypertension, who was evaluated by transcranial Doppler ultrasound and optic nerve sheath diameter. This case demonstrates that beyond pharmacological and surgical interventions, simple manipulation of arterial carbon dioxide has the propensity to improve cerebral haemodynamic parameters. Our results demonstrate the negative effects of hypercapnia on cerebral autoregulation and the benefits of having transcranial Doppler ultrasound available in the intensive care unit point of care.
Cumulative Disadvantage: A Psychological Framework for Understanding How Innocence Can Lead to Confession, Wrongful Conviction, and Beyond
Authors: Scherr Kyle C. , Redlich Allison D. , Kassin Saul M.
Published: February 2020

False confessions are a contributing factor in almost 30% of DNA exonerations in the United States. Similar problems have been documented all over the world. We present a novel framework to highlight the processes through which innocent people, once misidentified as suspects, experience cumulative disadvantages that culminate in pernicious consequences. The cumulative-disadvantage framework details how the innocent suspect’s naivete and the interrogator’s presumption of guilt trigger a process that can lead to false confession, the aftereffects of which spread to corrupt evidence gathering, bias forensic analysis, and virtually ensure wrongful convictions at trial or through pressured false guilty pleas. The framework integrates nascent research underscoring the enduring effects of the accumulated disadvantages postconviction and even after exoneration. We synthesize findings from psychological science, corroborating naturalistic evidence, and relevant legal precedents to explain how an innocent suspect’s disadvantages can accumulate through the actions of law enforcement, forensic examiners, prosecutors, defense attorneys, judges, juries, and appeals courts. We conclude with prescribed research directions that can lead to empirically driven reforms to address the gestalt of the multistage process.
Effective and safe diet therapies for Lennox-Gastaut syndrome with mitochondrial dysfunction
Authors: Na Ji-Hoon , Kim Heung-Dong , Lee Young-Mock
Published: February 2020

Background:

Lennox-Gastaut syndrome (LGS) is a typical intractable form of epilepsy that most often occurs between the second and sixth year of life. This study aimed to evaluate the clinical efficacy and safety of ketogenic diet therapies (DTs) for LGS with mitochondrial dysfunction.

Methods:

This was a retrospective study involving 20 LGS patients with mitochondrial dysfunction who received several DTs from 2004 to 2014 at a single tertiary care center. Seizure reduction rate, cognitive function, retention rate, electroencephalography (EEG) changes, and adverse effects were examined before and after DTs.

Results:

The retention rates at 1 and 2 years after initiation of DTs were 45% and 40%, respectively. After 1-year follow up, we observed seizure freedom in two patients, 75% seizure reduction in two patients, 50% reduction in three patients, and 25% reduction in one patient. After 2-year follow up, the outcomes were seizure freedom in two patients, 90% seizure reduction in one patient, 75% reduction in two patients, and 50% reduction in two patients. EEG findings improved in nine patients. Nine patients were treated with DTs for 1 year; all patients demonstrated improved cognitive status. Eight patients were treated with DTs for 2 years, of whom seven had improved cognitive status. Poor tolerability of DTs was due to poor oral intake and gastrointestinal problems.

Conclusions:

We demonstrate that, in LGS with mitochondrial dysfunction, improvement of seizures and cognitive function are not inferior to those in other patients treated with DTs. This study showed that DTs are efficacious and feasible for LGS patients with mitochondrial dysfunction and can significantly improve their prognosis.
Impact of Mind–Body Medicine Professional Skills Training on Healthcare Professional Burnout
Authors: Weinlander Eva Elisabeth , Daza Eric Jay , Winget Marcy
Published: February 2020

Background

Healthcare professional burnout has reached epidemic proportions, with downstream effects on personal and patient health and on our institutions. Solutions lie in the domains of work culture, operational efforts, and personal strategies.

Objectives

To evaluate the impact of a 5-day mind–body medicine professional training program on burnout and quality of life.

Methods

We conducted pre- and postevaluation of a mind–body medicine skills training for healthcare professionals on 6 wellness domains using 2 validated instruments: the Maslach Burnout Inventory and the Professional Quality of Life Survey.

Results

There was a statistically significant improvement in changes in emotional exhaustion, depersonalization, personal accomplishment, compassion satisfaction, burnout, and secondary traumatic stress which was sustained at 12 months. Largest relative improvements occurred in emotional exhaustion and depersonalization, 22% and 21%, respectively.

Conclusion

In addition to providing an important patient care skill set, mind–body medicine training may be an effective way to mitigate burnout and improve healthcare professional well-being.
An Analysis of Current Treatment Trends in Platelet-Rich Plasma Therapy in the Medicare Database
Authors: Werner Brian C. , Cancienne Jourdan M. , Browning Robert , Verma Nikhil N. , Cole Brian J.
Published: February 2020

Background:

The use of platelet-rich plasma (PRP) in the Medicare population is not well described.

Purpose:

To investigate the national use of PRP among Medicare beneficiaries, including the incidence and conditions for which it was used in both operative and nonoperative settings, and determine charges to Medicare.

Study Design:

Descriptive epidemiology study.

Methods:

The Medicare Standard Analytical Files within the PearlDiver database were queried for PRP injections by use of Current Procedural Terminology (CPT) code 0232T from 2010 to 2014. A search of every associated International Classification of Diseases, 9th Revision, code and CPT code on the day of the injection was performed, and codes were broadly categorized as shoulder, knee, elbow, hip, and foot/ankle. These categories were then subdivided into 2 groups based on whether the injection was performed at the time of surgery or for a nonoperative condition. The patient data were analyzed by demographics and geographic region. In further analysis, the charges sent to Medicare for PRP injections were stratified by year and musculoskeletal site.

Results:

A total of 3654 PRP injections were coded for and administered during the study period; 57% of recipients were men and 33% were 65 to 69 years of age. We found that 42% of all PRP injections were administered in the southern geographic region. PRP injections were most commonly associated with shoulder diagnoses, followed closely by the foot and ankle and by the knee. The majority of injections given for shoulder conditions were performed at the time of surgery, whereas the majority of knee conditions treated with PRP were associated with nonoperative treatments. Annual charges to Medicare for PRP injections increased 400%, from $500,000 in 2010 to more than $2 million in 2014.

Conclusion:

The use and breadth of PRP therapy have increased substantially in Medicare beneficiaries. Further research is required to obtain a consensus on treatment recommendations for PRP use in this population in addition to strategies to obtain insurance reimbursement.
Treatment of Pectoralis Major Tendon Tears: A Systematic Review and Meta-analysis of Operative and Nonoperative Treatment
Authors: Bodendorfer Blake M. , McCormick Brian P. , Wang David X. , Looney Austin M. , Conroy Christine M. , Fryar Caroline M. , Kotler Joshua A. , Ferris William J. , Postma William F. , Chang Edward S.
Published: February 2020

Background:

The incidence of pectoralis major tendon tears is increasing, and repair is generally considered; however, a paucity of comparative data are available to demonstrate the superiority of operative treatment.

Purpose/Hypothesis:

The purpose of this study is to compare the outcomes of operative and nonoperative treatment of pectoralis major tendon tears. We hypothesized that repair would result in superior outcomes compared with nonoperative treatment.

Methods:

In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic review of the literature was completed by use of MEDLINE, SPORTDiscus, CINAHL, Cochrane, EMBASE, and Web of Science databases. We included English-language studies that had a minimum of 6 months of average follow-up and 5 cases per study. The MINORS (Methodological Index for Non-Randomized Studies) was used to assess the quality of the existing literature. Meta-analysis of pooled mechanisms of injury and outcomes was completed. Pooled effect sizes were calculated from random-effects models. Continuous variables were assessed by use of mixed-model analysis, with the individual study designated as a random effect and the desired treatment for comparison as a fixed effect. Bivariate frequency data were transformed via the Freeman-Tukey log-linear transformation for variance stabilization and then assessed through use of a mixed model with a study level random effect and subsequently back-transformed. Significance was set at P < .05.

Results:

A total of 23 articles with 664 injuries met the inclusion criteria for comparison. All patients were male, with an average age of 31.48 years; 63.2% of injuries occurred during weight training, and the average follow-up was 37.02 months. Included studies had moderately high methodological quality. Operative treatment was significantly superior to nonoperative treatment, with relative improvements of functional outcome by 23.33% (0.70 improvement by Bak criteria which is scored 1-4; P = .027), full isometric strength 77.07% ( P < .001), isokinetic strength 28.86% ( P < .001) compared with the uninjured arm, cosmesis satisfaction 13.79% ( P = .037), and resting deformity 98.85% ( P < .001). The overall complication rate for operative treatment was 14.21%, including a 3.08% rate of rerupture.

Conclusion:

Pectoralis major tendon repair resulted in significantly superior outcomes compared with nonoperative treatment, with an associated 14.21% complication rate. Statistically significant improvements were noted in functional outcome, isokinetic strength, isometric strength, cosmesis, and resting deformity.
Gaps in Treatment and Surveillance: Head and Neck Cancer Care in a Safety‐Net Hospital
Authors: Yu Karina , Westbrook Marisa , Brodie Shauna , Lisker Sarah , Vittinghoff Eric , Hua Vivian , Russell Marika , Sarkar Urmimala
Published: February 2020

Objective

Treatment delays and suboptimal adherence to posttreatment surveillance may adversely affect head and neck cancer (HNC) outcomes. Such challenges can be exacerbated in safety‐net settings that struggle with limited resources and serve a disproportionate number of patients vulnerable to gaps in care. This study aims to characterize treatment delays and adherence with posttreatment surveillance in HNC care at an urban tertiary care public hospital in San Francisco.

Study Design

Retrospective chart review.

Setting

Urban tertiary care public hospital in San Francisco.

Subjects and Methods

We identified all cases of HNC diagnosed from 2008 to 2010 through the electronic medical record. We abstracted data, including patient characteristics, disease characteristics, pathology and radiology findings, treatment details, posttreatment follow‐up, and clinical outcomes.

Results

We included 64 patients. Median time from diagnosis to treatment initiation (DTI) was 57 days for all patients, 54 days for patients undergoing surgery only, 49 days for patients undergoing surgery followed by adjuvant radiation ± chemotherapy, 65 days for patients undergoing definitive radiation ± chemotherapy, and 29 days for patients undergoing neoadjuvant chemotherapy followed by radiation or chemoradiation. Overall, 69% of patients completed recommended treatment. Forty‐two of 61 (69%) patients demonstrated adherence to posttreatment visits in year 1; this fell to 14 out of 30 patients (47%) by year 5.

Conclusion

DTI was persistently prolonged in this study compared with prior studies in other public hospital settings. Adherence to posttreatment surveillance was suboptimal and continued to decline as the surveillance period progressed.
Plasma cell-directed therapies in monoclonal gammopathy-associated scleromyxedema
Authors: Mahévas Thibault , Arnulf Bertrand , Bouaziz Jean-David , Bulai Livideanu Cristina , Osio Amélie , Servy Amandine , Cribier Bernard , Sassolas Bruno , Jachiet Marie , Michel Laurence , Aucouturier Pierre , Lipsker Dan , Frances Camille , Sbidian Emilie , Rybojad Michel , Descamps Vincent , D'Incan Michel , Humbert Philippe , Beylot-Barry Marie , Passeron Thierry , de Moreuil Claire , Taha Ruba Y , Hermine Olivier , Dupuy Alain , Barbarot Sébastien , Debarbieux Sebastien , Carpentier Olivier , Brault Fanny , Schmutz Jean-Luc , Thomas-Beaulieu Domitille , Modiano Philippe , Zarnitsky Charles , Lifermann Francois , Baubion Emilie , Limal Nicolas , Le Bras Fabien , Le Moigne Marie , Tauber Marie , Talbot Alexis , Prud'homme Romain , Peltier Sandy , de Masson Adele , Battistella Maxime , Bagot Martine , Mékinian Arsène , Fain Olivier
Published: February 2020

Scleromyxedema is a rare skin and systemic mucinosis that is usually associated with monoclonal gammopathy (MG). In this French, multicenter, retrospective study of 33 patients, we investigated the clinical and therapeutic features of MG-associated scleromyxedema. Skin molecular signatures were analyzed using a transcriptomic approach. Skin symptoms included papular eruptions (100%), sclerodermoid features (91%), and leonine facies (39%). MG involved an IgG isotype in all patients, with a predominant λ light chain (73%). Associated hematologic malignancies were diagnosed in 4/33 patients (12%) (smoldering myeloma, n=2; chronic lymphoid leukemia, n=1; and refractory cytopenia with multilineage dysplasia n=1). Carpal tunnel syndrome (33%), arthralgia (25%) and dermato-neuro syndrome (DNS) (18%) were the most common systemic complications. One patient with mucinous cardiopathy died of acute heart failure. Intravenous immunoglobulin (HDIVig) treatment alone or in combination with steroids appeared to be quite effective in nonsevere cases (clinical complete response achieved in 13/31 patients). Plasma cell-directed therapies using lenalidomide and/or bortezomib with dexamethasone and HDIVig led to a significant improvement in severe cases (HDIVig-refractory or cases with central nervous system or cardiac involvement). The emergency treatment of DNS with combined plasmapheresis, HDIVig, and high-dose corticosteroids induced the complete remission of neurological symptoms in 4/5 patients. Quantitative reverse transcriptase-PCR (RT-PCR) analysis of 6 scleromyxedema skin samples showed significantly higher profibrotic pathway levels (transforming growth factor β (TGFβ) and collagen-1) than in healthy skin. Prospective studies targeting plasma cell clones and/or fibrotic pathways are warranted for long-term scleromyxedema management.
Cellular sources of interleukin-6 and associations with clinical phenotypes and outcomes in pulmonary arterial hypertension
Authors: Simpson Catherine E. , Chen Jenny Y. , Damico Rachel L. , Hassoun Paul M. , Martin Lisa J. , Yang Jun , Nies Melanie , Griffiths Megan , Vaidya Dhananjay , Brandal Stephanie , Pauciulo Michael W. , Lutz Katie A. , Coleman Anna W. , Austin Eric D. , Ivy Dunbar D. , Nichols William C. , Everett Allen D.
Published: February 2020

The pro-inflammatory cytokine interleukin (IL)-6 has been associated with outcomes in small pulmonary arterial hypertension (PAH) cohorts composed largely of patients with severe idiopathic PAH (IPAH). It is unclear whether IL-6 is a marker of critical illness or a mechanistic biomarker of pulmonary vascular remodelling. We hypothesised that IL-6 is produced by pulmonary vascular cells and sought to explore IL-6 associations with phenotypes and outcomes across diverse subtypes in a large PAH cohort.

IL-6 protein and gene expression levels were measured in cultured pulmonary artery smooth muscle cells (PASMCs) and endothelial cells (PAECs) from PAH patients and healthy controls. Serum IL-6 was measured in 2017 well-characterised PAH subjects representing each PAH subgroup. Relationships between IL-6 levels, clinical variables, and mortality were analysed using regression models.

Significantly higher IL-6 protein and gene expression levels were produced by PASMCs than by PAECs in PAH (p<0.001), while there was no difference in IL-6 between cell types in controls. Serum IL-6 was highest in PAH related to portal hypertension and connective tissue diseases (CTD-PAH). In multivariable modelling, serum IL-6 was associated with survival in the overall cohort (hazard ratio 1.22, 95% CI 1.08–1.38; p<0.01) and in IPAH, but not in CTD-PAH. IL-6 remained associated with survival in low-risk subgroups of subjects with mild disease.

IL-6 is released from PASMCs, and circulating IL-6 is associated with specific clinical phenotypes and outcomes in various PAH subgroups, including subjects with less severe disease. IL-6 is a mechanistic biomarker, and thus a potential therapeutic target, in certain PAH subgroups.
Biomedical event extraction with a novel combination strategy based on hybrid deep neural networks
Authors: Zhu Lvxing , Zheng Haoran
Published: February 2020

Background

Biomedical event extraction is a fundamental and in-demand technology that has attracted substantial interest from many researchers. Previous works have heavily relied on manual designed features and external NLP packages in which the feature engineering is large and complex. Additionally, most of the existing works use the pipeline process that breaks down a task into simple sub-tasks but ignores the interaction between them. To overcome these limitations, we propose a novel event combination strategy based on hybrid deep neural networks to settle the task in a joint end-to-end manner.

Results

We adapted our method to several annotated corpora of biomedical event extraction tasks. Our method achieved state-of-the-art performance with noticeable overall F1 score improvement compared to that of existing methods for all of these corpora.

Conclusions

The experimental results demonstrated that our method is effective for biomedical event extraction. The combination strategy can reconstruct complex events from the output of deep neural networks, while the deep neural networks effectively capture the feature representation from the raw text. The biomedical event extraction implementation is available online athttp://www.predictor.xin/event_extraction.
A transcriptomic and proteomic atlas of expression in the Nezara viridula (Heteroptera: Pentatomidae) midgut suggests the compartmentalization of xenobiotic metabolism and nutrient digestion
Authors: Denecke Shane , Ioannidis Panagiotis , Buer Benjamin , Ilias Aris , Douris Vassilis , Topalis Pantelis , Nauen Ralf , Geibel Sven , Vontas John
Published: February 2020

Background

Stink bugs are an emerging threat to crop security in many parts of the globe, but there are few genetic resources available to study their physiology at a molecular level. This is especially true for tissues such as the midgut, which forms the barrier between ingested material and the inside of the body.

Results

Here, we focus on the midgut of the southern green stink bug Nezara viridula and use both transcriptomic and proteomic approaches to create an atlas of expression along the four compartments of the anterior-posterior axis. Estimates of the transcriptome completeness were high, which led us to compare our predicted gene set to other related stink bugs and Hemiptera, finding a high number of species-specific genes in N. viridula. To understand midgut function, gene ontology and gene family enrichment analyses were performed for the most highly expressed and specific genes in each midgut compartment. These data suggested a role for the anterior midgut (regions M1-M3) in digestion and xenobiotic metabolism, while the most posterior compartment (M4) was enriched in transmembrane proteins. A more detailed characterization of these findings was undertaken by identifying individual members of the cytochrome P450 superfamily and nutrient transporters thought to absorb amino acids or sugars.

Conclusions

These findings represent an initial step to understand the compartmentalization and physiology of the N. viridula midgut at a genetic level. Future studies will be able to build on this work and explore the molecular physiology of the stink bug midgut.