bluuebunny/crossref_metadata_2025 huggingface dataset:
Creating supportive eating places: a systematic review of food service initiatives
Authors: Carins Julia , Pang Bo , Willmott Taylor , Knox Kathy , Storr Ryan , Robertson Dianne , Rundle-Thiele Sharyn , Pettigrew Simone
Published: December 2020

Obesity and diet-related health problems are complex, multi-factorial issues. Individual food choices are shaped by the wider context, and food environment level change is needed to support individual behaviour change. The food service sector can play an integral role, changing aspects of the food environment and contributing to improved consumer health. This systematic review aimed to analyse food service schemes that aimed to improve consumer health. Ten electronic databases were systematically searched to identify articles, supplemented with checking of reference lists from similar reviews and forward and backward searches to identify articles describing food service sector schemes. Sixteen schemes were identified, documented in 36 articles/reports. The schemes aimed to improve consumer health through one of three approaches—informing, enabling or engineering. In this order, these approaches involved increasing levels of effort from food services, corresponding with decreasing levels of effort for consumers. Half the schemes were informing, relying on an informed consumer to make a healthy choice. Most informing schemes had been evaluated to determine their impact on consumer choice and/or health, the evidence showed these schemes were generally ineffective. The effect of the enabling or engineering schemes on consumer choice and health had not been measured. Instead, evaluations focussed on process or business engagement rather than behavioural change assessments. This review indicates the food sector has the potential to contribute to consumer health through enabling and engineering; however, detailed outcome assessments are needed to draw definitive conclusions.
A Liouville-Type Theorem for the Lane–Emden Equation in a Half-space
Authors: Dupaigne Louis , Sirakov Boyan , Souplet Philippe
Published: December 2020

We prove that the Dirichlet problem for the Lane–Emden equation in a half-space has no positive solution that is monotone in the normal direction. As a consequence, this problem does not admit any positive classical solution that is bounded on finite strips. This question has a long history and our result solves a long-standing open problem. Such a nonexistence result was previously available only for bounded solutions or under a restriction on the power in the nonlinearity. The result extends to general convex nonlinearities.
Enzymatic Debridement for Burn Wound Care: Interrater Reliability and Impact of Experience in Post-intervention Therapy Decision
Authors: Siegwart Laura C , Böcker Arne H , Diehm Yannick F , Kotsougiani-Fischer Dimitra , Erdmann Stella , Ziegler Benjamin , Kneser Ulrich , Hirche Christoph , Fischer Sebastian
Published: December 2020

Enzymatic debridement (ED) has become a reliable tool for eschar removal. Although ED application is simple, wound bed evaluation and therapy decision post-intervention are prone to subjectivity and failure. Experience in ED might be the key, but this has not been proven yet. The aim of this study was to assess interrater reliability (IR) in post-intervention wound bed evaluation and therapy decision as well as the impact of experience. In addition, the authors introduce video assessment as a valuable tool for post-ED decision-making and education. A video-based survey was conducted among physicians with various experiences in ED. The survey involved multiple-choice and 5-point Likert scale questions about professional status, experience in ED, confidence in post-ED wound bed evaluation, and therapy decision. Subsequently, videos of 15 mixed pattern to full-thickness burns immediately after removal of the enzyme complex were demonstrated. Participants were asked for evaluation of each burn wound, including bleeding pattern and consequent therapy decision. IR ≥ 80% was considered as a consensus. Responses were stratified according to participants’ experience in applying ED (<10, 10–19, 20–49, and ≥50 applications). IR was assessed by chi-square test (raw agreement [RA]; ≥80% was considered as a consensus) and by calculation of Krippendorff’s alpha. In addition, expert consensus for therapy decision was compared with the actual clinical course of each shown patient. Last, participants were asked for their opinion on video as an assessment tool for post-ED wound bed evaluation, decision-making, and training. Thirty-one physicians from 11 burn centers participated in the survey. The overall consensus (raw agreement [RA] ≥ 80%) in post-ED wound bed evaluation and therapy decision was achieved in 20 and 40%, respectively. Krippendorff’s alpha is given by 0.32 (95% confidence interval: 0.15, 0.49) and 0.31 (95% confidence interval: 0.16, 0.47), respectively. Subgroup analysis revealed that physicians with high experience in ED achieved significantly more consensus in post-intervention wound bed evaluation and therapy decision compared with physicians with moderate experience (60 vs 13.3%; P = .02 and 86.7 vs 33.3%; P = .04, respectively). Video analysis was considered a feasible (90.3%) and beneficial (93.5%) tool for post-intervention wound bed evaluation and therapy decision as well as useful for training purposes (100%). Reliability of wound bed evaluation and therapy decision after ED depends on the experience of the rating physician. Video analysis is deemed to be a valuable tool for ED evaluation, decision-making, and user training.
Pain management practice patterns after hip arthroscopy: an international survey
Authors: Garcia Flávio L , Williams Brady T , Maheshwer Bhargavi , Bedi Asheesh , Wong Ivan H , Martin Hal D , Nho Shane J , Chahla Jorge
Published: December 2020

Several post-operative pain control methods have been described for hip arthroscopy including systemic medications, intra-articular or peri-portal injection of local anesthetics and peripheral nerve blocks. The diversity of modalities used may reflect a lack of consensus regarding an optimal approach. The purpose of this investigation was to conduct an international survey to assess pain management patterns after hip arthroscopy. It was hypothesized that a lack of agreement would be present in the majority of the surgeons’ responses. A 25-question multiple-choice survey was designed and distributed to members of multiple orthopedic professional organizations related to sports medicine and hip arthroscopy. Clinical agreement was defined as > 80% of respondents selecting a single answer choice, while general agreement was defined as >60% of a given answer choice. Two hundred and fifteen surgeons completed the survey. Clinical agreement was only evident in the use of oral non-steroidal anti-inflammatory drugs (NSAIDs) for pain management after hip arthroscopy. A significant number of respondents (15.8%) had to readmit a patient to the hospital for pain control in the first 30 days after hip arthroscopy in the past year. There is significant variability in pain management practice after hip arthroscopy. The use of oral NSAIDs in the post-operative period was the only practice that reached a clinical agreement. As the field of hip preservation surgery continues to evolve and expand rapidly, further research on pain management after hip arthroscopy is clearly needed to establish evidence-based guidelines and improve clinical practice.
Less than you’d think—a prospective study on MRSA-colonization in healthy travellers
Authors: Tran Dai T , Winter Doris , Christner Martin , Ramharter Michael , Addo Marylyn M , Rolling Thierry , Vinnemeier Christof , Koch Till
Published: December 2020

International travel has been identified as a major contributing factor to the global spread of MRSA. We examined the incidence of MRSA-colonization in a cohort of 196 travellers. We observed a low rate of only one case of MRSA, indicating a low risk of acquisition of MRSA-colonization in travel.
Broad-band ‘spectro-temporal’ features of extragalactic black hole binaries LMC X-1 and LMC X-3: an AstroSat perspective
Authors: G R Bhuvana , D Radhika , Agrawal V K , Mandal S , Nandi A
Published: December 2020

We present the first results of extragalactic black hole (BH) X-ray binaries LMC X-1 and LMC X-3 using all the archival and legacy observations by AstroSat during the period of 2016–2020. Broad-band energy spectra (0.5–20 keV) of both sources obtained from the Soft X-ray Telescope and Large Area X-ray Proportional Counter on-board AstroSat are characterized by strong thermal disc blackbody component (kTin ∼ 1keV, $f_{\mathrm{ disc}}\gt 79{{\ \rm per\ cent}}$) along with a steep power-law (Γ ∼ 2.4–3.2). Bolometric luminosity of LMC X-1 varies from $7{\,\mathrm{ to}\,}10{{\ \rm per\ cent}}$ of Eddington luminosity (LEdd) and for LMC X-3 is in the range $7{-}13{{\ \rm per\ cent}}$ of LEdd. We study the long-term variation of light curve using MAXI data and find the fractional variance to be ${\sim}25{{\ \rm per\ cent}}$ for LMC X-1 and ${\sim}53{{\ \rm per\ cent}}$ for LMC X-3. We examine the temporal properties of both sources and obtain fractional rms variability of power density spectrum in the frequency range 0.002–10 Hz to be ${\sim}9{}-17{{\ \rm per\ cent}}$ for LMC X-1, and ${\sim}7{}-11{{\ \rm per\ cent}}$ for LMC X-3. The ‘spectro-temporal’ properties indicate both sources are in thermally dominated soft state. By modelling the spectra with relativistic accretion disc model, we determine the mass of LMC X-1 and LMC X-3 in the range $7.64{-}10.00$ and $5.35{-}6.22\, \mathrm{ M}_{\odot }$, respectively. We also constrain the spin of LMC X-1 to be in the range 0.82–0.92 and that of LMC X-3 in 0.22–0.41 with 90 per cent confidence. We discuss the implications of our results in the context of accretion dynamics around the BH binaries and compare it with the previous findings of both sources.
Resolved spectral variations of the centimetre-wavelength continuum from the ρ Oph W photodissociation region
Authors: Casassus Simon , Vidal Matías , Arce-Tord Carla , Dickinson Clive , White Glenn J , Burton Michael , Indermuehle Balthasar , Hensley Brandon
Published: December 2020

Centimetre-wavelength radio continuum emission in excess of free–free, synchrotron, and Rayleigh–Jeans dust emission (excess microwave emission, EME), and often called ‘anomalous microwave emission’, is bright in molecular cloud regions exposed to UV radiation, i.e. in photodissociation regions (PDRs). The EME correlates with infrared (IR) dust emission on degree angular scales. Resolved observations of well-studied PDRs are needed to compare the spectral variations of the cm-continuum with tracers of physical conditions and of the dust grain population. The EME is particularly bright in the regions of the ρ Ophiuchi molecular cloud (ρ Oph) that surround the earliest type star in the complex, HD 147889, where the peak signal stems from the filament known as the ρ Oph W PDR. Here, we report on Australia Telescope Compact Array observations of ρ Oph W that resolve the width of the filament. We recover extended emission using a variant of non-parametric image synthesis performed in the sky plane. The multifrequency 17–39 GHz mosaics reveal spectral variations in the centimetre-wavelength continuum. At ∼30 arcsec resolutions, the 17–20 GHz intensities tightly follow the mid-IR, $I_\mathrm{cm} \propto I(8\, \mu$m), despite the breakdown of this correlation on larger scales. However, while the 33–39 GHz filament is parallel to Infrared Array Camera 8 μm, it is offset by 15–20 arcsec towards the UV source. Such morphological differences in frequency reflect spectral variations, which we quantify spectroscopically as a sharp and steepening high-frequency cutoff, interpreted in terms of the spinning dust emission mechanism as a minimum grain size $a_\mathrm{cutoff} \sim 6 \pm 1\,$Å that increases deeper into the PDR.
Correcting sky-quality-meter measurements for ageing effects using twilight as calibrator
Authors: Puschnig Johannes , Näslund Magnus , Schwope Axel , Wallner Stefan
Published: December 2020

In the last decade, numerous sky quality meters (SQMs) have been installed around the world, aiming to assess the temporal change of the night sky brightness, and thus the change in light pollution. However, it has become clear that SQM readings may be affected by ageing effects such as degradation of the sensor sensitivity and/or loss of transmissivity of optical components (filter, housing window). To date, the magnitude of the darkening has not been assessed in a systematic way. We report for the first time on the quantification of the SQM ageing effect and describe the applied method. We combine long-term SQM measurements obtained between 2011 and 2019 in Potsdam-Babelsberg (23 km to the south-west of the centre of Berlin), Vienna and Stockholm with a readily available empirical twilight model, which serves as a calibrator. Twilight SQM observations, calibrated for changing Sun altitudes, reveal a linear degradation of the measurement systems (SQM + housing window) with the following slopes: 34 ± 4, 46 ± 2 and 53 ± 2 mmagSQM arcsec−2 yr−1 for Stockholm, Potsdam-Babelsberg and Vienna, respectively. With the highest slope found in Vienna (latitude ∼48°) and the lowest one found in Stockholm (latitude ∼59°), we find an indication for the dependence of the trend on solar irradiance (which is a function of geographic latitude).
Population Dynamics and Structural Effects at Short and Long Range Support the Hypothesis of the Selective Advantage of the G614 SARS-CoV-2 Spike Variant
Authors: Trucchi Emiliano , Gratton Paolo , Mafessoni Fabrizio , Motta Stefano , Cicconardi Francesco , Mancia Filippo , Bertorelle Giorgio , D’Annessa Ilda , Di Marino Daniele
Published: December 2020

SARS-CoV-2 epidemics quickly propagated worldwide, sorting virus genomic variants in newly established propagules of infections. Stochasticity in transmission within and between countries or an actual selective advantage could explain the global high frequency reached by some genomic variants. Using statistical analyses, demographic reconstructions, and molecular dynamics simulations, we show that the globally invasive G614 spike variant 1) underwent a significant demographic expansion in most countries explained neither by stochastic effects nor by overrepresentation in clinical samples, 2) increases the spike S1/S2 furin-like site conformational plasticity (short-range effect), and 3) modifies the internal motion of the receptor-binding domain affecting its cross-connection with other functional domains (long-range effect). Our results support the hypothesis of a selective advantage at the basis of the spread of the G614 variant, which we suggest may be due to structural modification of the spike protein at the S1/S2 proteolytic site, and provide structural information to guide the design of variant-specific drugs.
Levels and distribution of tetrodotoxin in the blue-lined octopusHapalochlaena fasciatain Japan, with special reference to within-body allocation
Authors: Yamate Yuta , Takatani Tomohiro , Takegaki Takeshi
Published: December 2020

The toxins present in poisonous and venomous animals have both offensive and defensive functions. The blue-lined octopus Hapalochlaena fasciata has tetrodotoxin (TTX) in various organs, including the salivary glands, muscles and skin, and TTX is assumed to be used in both offence and defence. In this study, we explore the evolution of toxicity in H. fasciata by measuring the levels and distribution of TTX in H. fasciata specimens collected in Japan and by investigating the TTX allocation within the body. TTX was detected in all 13 adults and 3 paralarvae studied. The concentration of TTX was highest in the anterior and posterior salivary glands, and the total amount of TTX was highest in the muscles and skin. Larger individuals had significantly higher amounts of TTX, but the TTX concentrations in the muscles and skin were not correlated with body weight. There were large individual differences in TTX concentration and some individuals showed extremely low TTX levels. These individual differences may be related to regional, seasonal and sexual differences, although the origin of TTX in this species is still unclear. Furthermore, we found a strong positive correlation between TTX concentrations in the posterior salivary gland and TTX concentrations in muscles and skin, with the former being c. 20 times greater than the latter. This suggests that the allocation ratio may not result from a plastic allocation, reflecting the TTX needs of each organ or the amount of available TTX, but rather may, at least partly, be evolutionarily fixed.
#FlavorsSaveLives: An Analysis of Twitter Posts Opposing Flavored E-cigarette Bans
Authors: Kirkpatrick Matthew G , Dormanesh Allison , Rivera Vanessa , Majmundar Anuja , Soto Daniel W , Chen-Sankey Julia Cen , Cruz Tess Boley , Unger Jennifer B , Allem Jon-Patrick
Published: December 2020

Background

Starting in 2019 policies restricting the availability of flavored e-cigarette products were proposed or implemented in the United States to curb vaping by youth. People took to Twitter to voice their opposition, referencing the phrase “Flavors Save Lives.” This study documented the emerging themes pertaining to “Flavors Saves Lives” over a 12-month period.

Methods

The study period was from May 1, 2019, to May 1, 2020. A stratified sampling procedure supplied 2500 tweets for analysis. Posts were classified by one or more of the following themes: (1) Political Referendum; (2) Institutional Distrust; (3) Individual Rights; (4) Misinformation; (5) THC Vaping is the Real Problem; (6) Smoking Cessation; (7) Adult Use; and (8) Not a Bot. The temporal pattern of tweets over the year was examined.

Results

Political Referendum (76.5%) and Institutional Distrust (31.3%) were the most prominent themes, followed by Not a Bot (11.0%), Individual Rights (10.4%), Adult Use (8.0%), Smoking Cessation (6.6%), Misinformation (5.9%), and THC Vaping is the Real Problem (3.5%). Total tweet frequencies increased in September 2019 and peaked in November 2019 before returning to relatively low numbers. Political Referendum and Institutional Distrust were consistently the most prevalent themes over time.

Conclusion

Twitter posts with the phrase “Flavors Save Lives” commonly discussed voting against political incumbents and mentioned distrust of government representatives. Findings demonstrated the possibility of near real-time Twitter monitoring of public opposition to flavor bans. These data may be valuable for designing tobacco control information campaigns in the future.

Implications

(a) Starting in 2019 policies restricting the availability of flavored e-cigarette products were proposed or implemented in the United States to curb vaping by youth. (b) This study content analyzed Twitter posts with the phrase “Flavors Save Lives” from a 12-month period to understand opposition to flavor restrictions. (c) Twitter posts commonly discussed voting against political incumbents and mentioned distrust of government representatives. (d) Findings demonstrated the possibility of near real-time Twitter monitoring of public opposition to flavor bans, and contribute to a more comprehensive assessment of different sub-population's responses to current and proposed tobacco control information policies.
Operational Evaluation of the Effectiveness of Long-lasting Insecticidal Nets on Human-Vector Contact in an African Urban Malaria Context
Authors: Traoré Dipomin F , Sagna André B , Assi Serge B , Tchiekoi Bertin N’Cho , Adja Akré M , Dagnogo Mamadou , Koffi Alphonsine A , Rogier Christophe , Remoue Franck
Published: December 2020

Background

Malaria is still a major public health concern in Côte d’Ivoire despite mass distribution of long-lasting insecticidal nets (LLINs) as a key preventive strategy. This study intended to evaluate the operational effectiveness of LLINs on the level of human-vector contact using 1 antibody-based biomarker of exposure to Anopheles in urban areas.

Methods

This cross-sectional study collected socio-demographic data and use of LLINs from 9 neighborhoods in the city of Bouaké (Côte d’Ivoire). Dry blood spots performed in children aged >6 months and adults were used to evaluate immunoglobulin G (IgG) responses to the Anopheles gSG6-P1 salivary peptide.

Results

IgG response levels to the salivary peptide were significantly lower in individuals who declared having “always” (n = 270) slept under an LLIN compared with those who had “often” (n = 2087) and “never” (n = 88) slept under an LLIN (P < .0001). IgG response levels to gSG6-P1 between those who declared having “always” and “not always” slept under an LLIN varied according to neighborhood, socio-professional category, and age group.

Conclusions

The human IgG level to this gSG6-P1 salivary peptide could be a useful tool to evaluate the actual effectiveness of LLINs and help design behavioral change interventions that are crucial for sustaining universal coverage.
Screening for Sexually Transmitted Infections During Hepatitis C Treatment to Predict Reinfection Among People With HIV
Authors: Hill Lucas A , Martin Natasha K , Torriani Francesca J , Jain Sonia , Qin Huifang , Mathews Wm Christopher , Cachay Edward R
Published: December 2020

Background

Little is known about the risk of hepatitis C virus (HCV) reinfection among people with HIV (PWH) in the direct-acting antiviral (DAA) era. We evaluate HCV reinfection rates in the DAA era and characterize presustained virologic response (SVR) behavioral risk factors associated with reinfection among PWH at the University of California, San Diego (UCSD).

Methods

Observational longitudinal cohort of PWH treated with DAAs between 2014 and July 2019 who achieved SVR and had at least 1 subsequent HCV viral load measurement. HCV reinfection was defined as new HCV viremia after SVR. We examined whether screening for sexually transmitted infections (STIs) and substance use during the pre-SVR period could identify patients at greater risk for reinfection using exact Poisson regression to compare reinfection incidence rates between those with and without pre-SVR STIs and positive urine drug screens.

Results

Eight out of 200 PWH were reinfected with HCV a median ~26 weeks after SVR over 328.1 person-years of follow-up (PYFU), for an incidence rate of 2.44/100 PYFU. The observed HCV reinfection rate was highest among men who have sex with men who inject drugs (MSM IDU; 4.63/100 PFYU) and those aged 30–39 years (6.80/100 PYFU). Having a positive gonorrhea/chlamydia test during the pre-SVR period was a predictor of HCV reinfection.

Conclusions

The HCV reinfection rate in the DAA era is similar to the rate observed in the interferon era in San Diego in PWH. STI screening during HCV treatment may help determine those at higher risk for HCV reinfection.
Magnitude, Specificity, and Avidity of Sporozoite-Specific Antibodies Associate With Protection Status and Distinguish Among RTS,S/AS01 Dose Regimens
Authors: Dennison S Moses , Reichartz Matthew , Abraha Milite , Spreng Rachel L , Wille-Reece Ulrike , Dutta Sheetij , Jongert Erik , Alam S Munir , Tomaras Georgia D
Published: December 2020

Background

The malaria vaccine, RTS,S/AS01, demonstrated an enhanced efficacy (86.7%) in a delayed third fractional dose (0.1.7Fx) regimen in controlled human malaria infection trials compared with a standard full-dose (0.1.2) regimen (62.5%). To understand the humoral component of the RTS,S/AS01 vaccine-induced protection against sporozoite infection in these 2 regimens, we investigated the serum antibody dynamics of 0.1.2 and 0.1.7Fx groups vaccinees.

Methods

The specific binding responses (magnitude) and dissociation rates (avidity) of serum antibodies interaction with a recombinant Plasmodium falciparum circumsporozoite protein (CSP) and peptides corresponding to the central repeat region (NANP6), the C-terminal region (PF16), and the N-terminal junction (N-interface) of CSP, respectively, were measured using a Biolayer Interferometry assay.

Results

On the day of challenge, higher NANP6-specific antibody responses were associated with protection in the 0.1.2 group. In contrast, slower antibody dissociation rates for CSP and PF16 binding were observed in the protected 0.1.7Fx group. Protected vaccinees of both groups exhibited 2- to 3-fold higher N-interface peptide binding antibody responses.

Conclusions

Unlike the standard dose, the delayed-fractional third dose of RTS,S/AS01 induced higher avidity CSP and PF16 binding antibodies that were associated with protection against sporozoite infection.
Self-Collected Oral Fluid Saliva Is Insensitive Compared With Nasal-Oropharyngeal Swabs in the Detection of Severe Acute Respiratory Syndrome Coronavirus 2 in Outpatients
Authors: Manabe Yukari C , Reuland Carolyn , Yu Tong , Azamfirei Razvan , Hardick Justin P , Church Taylor , Brown Diane M , Sewell Thelio T , Antar Annuka , Blair Paul W , Heaney Chris D , Pekosz Andrew , Thomas David L ,   Ambulatory COVID Team, Cox Andrea , Keller Sara , Keruly Jeanne , Klein Sabra , Mehta Shruti , Mostafa Heba , Pisanic Nora , Sauer Lauren , Tornheim Jeffrey , Townsend Jennifer , Armstrong Derek , Bachu Vismaya , Barnaba Brittany , Charles Curtisha , Dai Weiwei , Ganesan Abhinaya , Holden Jeffrey , Jang Minyoung , Johnstone J R , Kruczynski Kate , Kusemiju Oyinkansola , Lambrou Anastasia , Li Lucy , Littlefield Kirsten , Park Han-Sol , Tuchler Amanda , Montana Manuela Plazas , Prizzi Michelle , Ursin Rebecca
Published: December 2020

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic control will require widespread access to accurate diagnostics. Salivary sampling circumvents swab supply chain bottlenecks, is amenable to self-collection, and is less likely to create an aerosol during collection compared with the nasopharyngeal swab.

Methods

We compared real-time reverse-transcription polymerase chain reaction Abbott m2000 results from matched salivary oral fluid (gingival crevicular fluid collected in an Oracol device) and nasal-oropharyngeal (OP) self-collected specimens in viral transport media from a nonhospitalized, ambulatory cohort of coronavirus disease 2019 (COVID-19) patients at multiple time points. These 2 sentences should be at the beginning of the results.

Results

There were 171 matched specimen pairs. Compared with nasal-OP swabs, 41.6% of the oral fluid samples were positive. Adding spit to the oral fluid percent collection device increased the percent positive agreement from 37.2% (16 of 43) to 44.6% (29 of 65). The positive percent agreement was highest in the first 5 days after symptoms and decreased thereafter. All of the infectious nasal-OP samples (culture positive on VeroE6 TMPRSS2 cells) had a matched SARS-CoV-2 positive oral fluid sample.

Conclusions

In this study of nonhospitalized SARS-CoV-2-infected persons, we demonstrate lower diagnostic sensitivity of self-collected oral fluid compared with nasal-OP specimens, a difference that was especially prominent more than 5 days from symptom onset. These data do not justify the routine use of oral fluid collection for diagnosis of SARS-CoV-2 despite the greater ease of collection. It also underscores the importance of considering the method of saliva specimen collection and the time from symptom onset especially in outpatient populations.
Navigation-Guided Subaxial Cervical Pedicle Screws in Revision Spine Surgery: 2-Dimensional Operative Video
Authors: Mao Jennifer Z , Agyei Justice O , Ghannam Moleca M , Khan Asham , Christensen Marc , Meyers Joshua E , Pollina John , Mullin Jeffrey P
Published: December 2020

Traditionally, lateral mass screws (LMSs) have been the mainstay of posterior fixation in the subaxial spine. Although LMSs provide adequate fixation, cervical pedicle screws (CPSs) facilitate high fusion rates (90.5%) and provide for greater bone purchase, better reduction, lower rates of screw loosening or pull out, 2 times greater biomechanical advantage, superior stabilization, decreased development of pseudarthrosis, and decreased revision surgeries compared to LMSs.
1-4
In addition, CPSs can be a powerful bail-out option after lateral mass construct failure. Navigation-guided CPS placement has been reported to have an accuracy of 90.3%.
5
Navigation has the added advantage of mitigating screw malposition for the placement of CPS because of the smaller pedicle sizes and variability in cervical anatomy.
1,3,6
The potential risks of subaxial CPS placement include the risks of vertebral artery injury, spinal cord injury, and injury to adjacent neurovasculature.
2
The overall radiographic breach rate with intraoperative imaging is reported to range from 2.9% of 22.9%, with the majority of breaches occurring in the lateral direction.
7,8
Despite radiographic breaches, the occurrence of nerve root injury (0.31% per screw), vertebral artery injury (0.15% per screw), and spinal cord injury (0% per screw) is rare.
3,7
Here, we demonstrate navigation-assisted C1-C2 posterior fusion, with combined C1 LMSs and C2 pedicle screws with subaxial pedicle screw revision of prior failed instrumentation.
3

 The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary.
Minimally Invasive Tubular Separation Surgery for Metastatic Spinal Cord Compression: 2-Dimensional Operative Video
Authors: De la Garza Ramos Rafael , Echt Murray , Gelfand Yaroslav , Yanamadala Vijay , Yassari Reza
Published: December 2020

Symptomatic cord compression affects approximately 20% of patients with spinal metastatic disease. Direct decompressive surgery followed by conventional radiation was shown to be superior to radiation alone in a landmark trial published in 2005.
1
For radioresistant tumors causing high-grade compression, however, “separation surgery” followed by stereotactic body radiation therapy was developed. The main goal of this newer technique is to decompress and create a distance between the spinal cord and tumor to allow for safe delivery of radiation.
2
This technique has shown to provide durable local tumor control, pain relief, and preservation of neurological function.
3,4
In this study, we describe a minimally invasive tubular separation surgery technique used to treat symptomatic cord compression in a 59-yr-old man with metastatic prostate adenocarcinoma to T9. The patient presented with acute motor weakness and sensory level. A tubular retraction system was used to dock over the pedicle at T9 bilaterally and a posterior decompression with ligamentectomy was first performed. This was followed by transpedicular decompression and ventral removal of the posterior longitudinal ligament. Space was created between the ventral tumor and spinal cord to allow for postoperative stereotactic body radiation. The patient had a significant improvement in his strength and gait postoperatively.

Patient consent was obtained for videotaping prior to surgical intervention.
A Two-Scale Analysis for a Spherical Pendulum with a Vertically Vibrating Pivot
Authors: Grundy R E
Published: December 2020

In this article, we consider the behaviour of a simple undamped spherical pendulum subject to high-frequency small amplitude vertical oscillations of its pivot. We use the method of multiple scales to derive an autonomous ordinary differential equation describing the slow time behaviour of the polar angle which generalises the Kapitza equation for the plane problem. We analyse the phase plane structure of this equation and show that for a range of parameter values there are conical orbits which lie entirely above the horizontal. Going further, we identify a family of quasi-conical orbits some of which may lie entirely above the pivot and establish that initial conditions can be chosen so that precession is eliminated for these orbits. For the general initial value problem, we show that the leading order solutions for the polar and azimuthal angles diverge significantly from their exact counterparts. However, by consolidating the slow scale error term into the leading order structure we may construct extremely accurate solutions for the slow scale evolution of the system. These solutions, confirmed by exact numerical simulations, show that by suitable choice of initial data orbital precession can be eliminated.
Materiality, Quarantine and Contagion in the Early Modern Mediterranean
Authors: Inì Marina
Published: December 2020

To fight the spread of the plague, early modern Mediterranean states commonly quarantined goods and people on the move inside complexes called lazzaretti. These institutions, managed by the health magistracies of different Mediterranean cities, formed a transnational plague-preventative system. Based on an exploration of both the early modern theory of contagion and the eighteenth-century quarantine procedures shared between Health Offices across the Mediterranean, this article demonstrates that goods were categorised into different levels of contagion depending on their materials. Different disinfection practices were followed according to the level of danger posed by different types of goods. Anxieties caused by the interaction between surfaces and the human body shaped the procedures, the architecture and the everyday routine inside lazzaretti. While analysing the materiality of quarantined goods, the regulations and the architecture of the lazzaretti, this article highlights the relevance of material culture to early modern medical preventative practices.
Knowledge, Observation and Practices Related to Neonatal Jaundice in a Rural Community in Kano, Nigeria
Authors: Farouk Zubaida L , Slusher Tina M , Danzomo Abba Ahmed , Slusher Ida L
Published: December 2020

Background

Neonatal jaundice (NNJ) is a common condition and when not adequately treated leads to acute bilirubin encephalopathy/kernicterus. This largely preventable condition is an important cause of death and disability in low- and middle-income countries. Education, early detection and effective management are key for prevention and require an understanding of community knowledge and practices to foster appropriate behavior to prevent severe NNJ. Therefore, the aim of this study was to identify knowledge, observation for jaundice (both active and passive) and practices related to NNJ in northern Nigeria.

Methods

This descriptive, correlational and cross-sectional study enrolled 298 household members with an average age of 29.8 years in Kano, Nigeria. A structured questionnaire regarding knowledge of, potential sequelae and causes and local practices related to NNJ was administered and data were analyzed using descriptive and Chi-square statistics.

Results

Participants reported: 85% NNJ to be a sign of illness; 3% understood that NNJ could cause brain damage; 94% did not actively observe for jaundice in their newborns; 56% did not know what causes NNJ; 88% would seek care if their newborn developed jaundice. Significant relationships between educational levels and what study participants would do if a newborn develops jaundice and between occupation, educational level and knowledge about causes of NNJ were noted, consistent with a difference in active jaundice observation between ethnic groups.

Conclusion

A public health approach to NNJ with a strong community education program is a crucial next step in the fight to eliminate severe NNJ.
Extensive Antibiotic and Antimalarial Prescription Rate among Children with Acute Febrile Diseases in the Lake Victoria Region, Tanzania
Authors: Huth Philipp Florian Brixius , Addo Marylyn , Daniel Tim , Groendahl Britta , Hokororo Adolfine , Koliopoulos Philip , Mshana Stephen , Pretsch Leah , Schmidt Christian , Zuechner Antke , Gehring Stephan , Kayange Neema
Published: December 2020

Objectives

Acute mosquito-borne febrile diseases pose a threat to children in the Sub-Saharan-Africa with ∼272 000 children dying worldwide from malaria in 2018. Although the awareness for malaria in this area has increased due to improved health education, the apparent decline of actual malaria cases has not affected clinical practice significantly. This study collected clinical and epidemiologic data of children presenting with acute febrile diseases in order delineate their diagnostic and therapeutic management.

Methods

A hospital-based cross-sectional clinical study was conducted at the Sekou Toure Regional Referral Hospital in Tanzania. Children between 1 month and 12 years of age with an axillary temperature ≥ 37.5°C were recruited from August 2016 to December 2016. Children received full clinical examination. In addition, file data about diagnostics and treatment were collected and malaria rapid diagnostic tests (mRDTs) were performed. Confirmatory malaria polymerase chain reaction was performed from dry blood spots.

Results

From 1381 children presented in the pediatric outpatient department, 133 met the inclusion criteria. Out of 133 febrile children, 10.5% were malaria positive. Treatment data indicate the prescription of antimalarials in 35.3% and antibiotics in 63.9% of the children with an overlap of 24.1% receiving both. Despite a negative mRDT, 36 patients received antimalarials.

Conclusions

The findings of this study confirm a significant decline of malaria cases in the Lake Victoria region. The discrepancy between the valuable results provided by mRDTs and the high prescription rates of antibiotics and antimalarials call for an enforced diagnostic and therapeutic algorithm.

LAY SUMMARY

The aim of the study was to take a closer look at reported cases of febrile diseases in the Lake Victoria region and assess the relationship between clinical as well as diagnostic findings and the resulting therapeutic concept. Based on these findings the prescription rate of antimalarial and antibiotic drugs was analyzed. The results showed an overall high prescription rate of antimalarials and antibiotics in both diagnosed malaria cases and cases with diagnosed bacterial infections.

Not only with regards to the possible side effects of these medications but also keeping in mind the apparent misuse of resources this practice poses a serious burden to the health care system in this low resource country.
Prevention of food allergy: can we stop the rise of IgE mediated food allergies?
Authors: Santos Alexandra F.
Published: December 2020

Purpose of review

Food allergy has become more prevalent in recent decades. Without a curative treatment for food allergy, prevention is key. Can we intervene and halt the food allergy epidemic?

Recent findings

There are three main hypotheses to explain the rise in food allergy: the dual-allergen exposure hypothesis, the hygiene hypothesis and the vitamin D hypothesis. In a recent systematic review of randomized controlled trials, only introduction of allergenic foods, namely egg and peanut, in the diet at the time of weaning and avoidance of temporary supplementation with cow's milk formula in the first few days of life showed low to moderate evidence of a preventive effect.

For primary prevention, introduction of allergenic foods at the time of weaning and avoidance of temporary supplementation with cow's milk formula in the first few days of life has been recommended. Introduction of foods once allergy has been excluded may be beneficial for sensitized subjects (secondary prevention). Once food allergy has been established, it is important to minimise complications (tertiary prevention) through allergen avoidance, timely treatment of allergic reactions, control of atopic co-morbidities and dietetic and psychological support, as appropriate. Immunomodulatory treatments can potentially be disease-modifying and require further research.
Wellness-Centered Leadership: Equipping Health Care Leaders to Cultivate Physician Well-Being and Professional Fulfillment
Authors: Shanafelt Tait , Trockel Mickey , Rodriguez Ashleigh , Logan Dave
Published: December 2020

These are challenging times for physicians. Extensive changes in the practice environment have altered the nature of physicians’ interactions with patients and their role in the health care delivery system. Many physicians feel as if they are “cogs in the wheel” of austere corporations that care more about productivity and finances than compassion or quality. They often do not see how the strategy and plan of their organization align with the values of the profession. Despite their expertise, they frequently do not feel they have a voice or input in the operational plan of their work unit, department, or organization. At their core, the authors believe all of these factors represent leadership issues. Many models of leadership have been proposed, and there are a number of effective philosophies and approaches. Here, the authors propose a new integrative model of Wellness-Centered Leadership (WCL). WCL includes core skills and qualities from the foremost leadership philosophies along with evidence on the relationship between leadership and physician well-being and distills them into a single framework designed to cultivate leadership behaviors that promote engagement and professional fulfillment. The 3 elements of WCL are: care about people always, cultivate individual and team relationships, and inspire change. A summary of the mindset, behaviors, and outcomes of the elements of the WCL model is presented, and the application of the elements for physician leaders is discussed. The authors believe that learning and developing the skills that advance these elements should be the aspiration of all health care leaders and a foundational focus of leadership development programs. If cultivated, the authors believe that WCL will empower individual and team performance to address the current problems faced by health care organizations as well as the iterative innovation needed to address challenges that may arise in the decades to come.
Strategies From 11 U.S. Medical Schools for Integrating Basic Science Into Core Clerkships
Authors: Daniel Michelle , Morrison Gail , Hauer Karen E. , Pock Arnyce , Seibert Christine , Amiel Jonathan , Poag Molly , Ismail Nadia , Dalrymple John L. , Esposito Karin , Pettepher Cathleen , Santen Sally A.
Published: December 2020

Calls for curricular reform in medical schools and enhanced integration of basic and clinical science have resulted in a shift toward preclerkship curricula that enhance the clinical relevance of foundational science instruction and provide students with earlier immersion in the clinical environment. These reforms have resulted in shortened preclerkship curricula, yet the promise of integrated basic science education into clerkships has not been sufficiently realized because of barriers such as the nature of clinical practice, time constraints, and limited faculty knowledge. As personalized medicine requires that physicians have a more nuanced understanding of basic science, this is cause for alarm. To address this problem, several schools have developed instructional and assessment strategies to better integrate basic science into the clinical curriculum.

In this article, faculty and deans from 11 U.S. medical schools discuss the strategies they implemented and the lessons they learned to provide guidance to other schools seeking to enhance basic science education during clerkships. The strategies include program-level interventions (e.g., longitudinal sessions dedicated to basic science during clerkships, weeks of lessons dedicated to basic science interspersed in clerkships), clerkship-level interventions (e.g., case-based learning with online modules, multidisciplinary clerkship dedicated to applied science), bedside-level interventions (e.g., basic science teaching scripts, self-directed learning), and changes to formative and summative assessments (e.g., spaced repetition/leveraging test-enhanced learning, developing customized examinations). The authors discovered that: interventions were more successful when buy-in from faculty and students was considered, central oversight by curricular committees collaborating with faculty was key, and some integration efforts may require schools to provide significant resources. All schools administered the United States Medical Licensing Examination Step 1 exam to students after clerkship, with positive outcomes. The authors have demonstrated that it is feasible to incorporate basic science into clinical clerkships, but certain challenges remain.
Learning in the Time of COVID-19: Key Lessons From the Pandemic for Medical Trainees
Authors: Jain Snigdha , Carlos W. Graham
Published: December 2020

The COVID-19 pandemic has changed the face of education for undergraduate and graduate medical trainees. Lectures, clinical clerkships, and testing have all been impacted significantly because of patient care needs and concern for the health and safety of trainees. While traditional teaching strategies have been upended, the challenges posed by the pandemic have also created unique opportunities for trainees. In this article, the authors summarize lessons trainees can learn from the ongoing pandemic in the following areas: public health, disaster preparedness, and resource allocation; reinventing professional and personal roles to meet the needs of the health care system; flexibility in navigating testing, licensure, and certification; appraising scientific evidence quickly and accurately; balancing a physician’s call to duty with fear for personal safety; combating moral injury; interprofessional collaboration; and advocating for oneself and one’s colleagues. Focusing on these lessons can help educators steer their efforts to better prepare future physicians for unforeseen challenges that may come up in their personal and professional lives as well as in society as a whole.
Meaningful Causal Decompositions in Health Equity Research
Authors: Jackson John W.
Published: December 2020

Causal decomposition analyses can help build the evidence base for interventions that address health disparities (inequities). They ask how disparities in outcomes may change under hypothetical intervention. Through study design and assumptions, they can rule out alternate explanations such as confounding, selection bias, and measurement error, thereby identifying potential targets for intervention. Unfortunately, the literature on causal decomposition analysis and related methods have largely ignored equity concerns that actual interventionists would respect, limiting their relevance and practical value. This article addresses these concerns by explicitly considering what covariates the outcome disparity and hypothetical intervention adjust for (so-called allowable covariates) and the equity value judgments these choices convey, drawing from the bioethics, biostatistics, epidemiology, and health services research literatures. From this discussion, we generalize decomposition estimands and formulae to incorporate allowable covariate sets (and thereby reflect equity choices) while still allowing for adjustment of non-allowable covariates needed to satisfy causal assumptions. For these general formulae, we provide weighting-based estimators based on adaptations of ratio-of-mediator-probability and inverse-odds-ratio weighting. We discuss when these estimators reduce to already used estimators under certain equity value judgments, and a novel adaptation under other judgments.