bluuebunny/crossref_metadata_2025 huggingface dataset:
Concentrate Questions and Answers Human Rights and Civil Liberties
Authors: Foster Steve
Published: September 2018

The Concentrate Questions and Answers series offer the best preparation for tackling exam questions. Each book includes typical questions, diagram answer plans, caution advice, suggested answers, illustrative diagrams and flowcharts, and advice on gaining extra marks. Concentrate Q&A Human Rights & Civil Liberties offers expert advice on what to expect from your human rights and civil liberties exam, how best to prepare, and guidance on what examiners are really looking for. Written by experienced examiners, it provides: clear commentary with each question and answer; bullet point and diagram answer plans; tips to make your answer really stand out from the crowd; and further reading suggestions at the end of every chapter. The book should help you to: identify typical law exam questions; structure a first-class answer; avoid common mistakes; show the examiner what you know; make your answer stand out from the crowd. After an introduction, it covers: the nature and enforcement of human rights and civil liberties; the European Convention on Human Rights; the Human Rights Act 1998; the right to life; freedom from torture and inhuman and degrading treatment; due process, liberty and security of the person, and the right to a fair trial; prisoners’ rights; the right to private life; freedom of expression; and freedom of religion, association, and peaceful assembly.
Current closure in the pulsar magnetosphere
Authors: Contopoulos I
Published: September 2018

Current closure in the pulsar magnetosphere holds the key to its structure. We must determine not only the global electric circuit, but also the source of its electric charge carriers. We address this issue with the minimum number of assumptions: (1) The magnetosphere is everywhere ideal and force free, except above the polar cap and in some finite part of the current sheet; and (2) pairs are produced above the polar cap with multiplicity κ. We show that a thin region of width δ ≈ rpc/2κ ≪ rpc along the rim of the polar cap provides all the charges that are needed in the equatorial and separatrix electric current sheet. These charges are transferred to the current sheet in a narrow dissipation zone just outside the magnetospheric Y-point. The maximum accelerating potential in this region is equal to the potential drop in the thin polar cap rim, which is approximately equal to 1/κ times the potential drop from the centre to the edge of the polar cap. The dissipated electromagnetic energy is approximately equal to 1.5/κ times the total pulsar spin-down energy loss. Our framework allows to calculate the high-energy emission in terms of the pair multiplicity.
Attributes, Attitudes, and Practices of Clinicians Concerned with Opioid Prescribing
Authors: Razouki Zayd , Khokhar Bushra A , Philpot Lindsey M , Ebbert Jon O
Published: September 2018

Background

Many clinicians who prescribe opioids for chronic noncancer pain (CNCP) express concerns about opioid misuse, addiction, and physiological dependence. We evaluated the association between the degree of clinician concerns (highly vs less concerned), clinician attributes, other attitudes and beliefs, and opioid prescribing practices.

Methods

A web-based survey of clinicians at a multispecialty medical practice.

Results

Compared with less concerned clinicians, clinicians highly concerned with opioid misuse, addiction, and physiological dependence were more confident prescribing opioids (risk ratio [RR] = 1.34, 95% confidence interval [CI] = 1.08–1.67) but were more reluctant to do so (RR = 1.13, 95% CI = 1.03–1.25). They were more likely to report screening patients for substance use disorder (RR = 1.18, 95% CI = 1.01–1.37) and to discontinue prescribing opioids to a patient due to aberrant opioid use behaviors (RR = 1.30, 95% CI = 1.13–1.50). They were also less likely to prescribe benzodiazepines and opioids concurrently (RR = 0.40, 95% CI = 0.25–0.65). Highly concerned clinicians were more likely to work in clinics which engage in “best practices” for opioid prescribing requiring urine drug screening (RR = 4.65, 95% CI = 2.51–8.61), prescription monitoring program review (RR = 2.90, 95% CI = 1.84–4.56), controlled substance agreements (RR = 4.88, 95% CI = 2.64–9.03), and other practices. Controlling for clinician concern, prescribing practices were also associated with clinician confidence, reluctance, and satisfaction.

Conclusions

Highly concerned clinicians are more confident but more reluctant to prescribe opioids. Controlling for clinician concern, confidence in care and reluctance to prescribe opioids were associated with more conservative prescribing practices.
CE: Acute Pain Management for People with Opioid Use Disorder
Authors: Broglio Kathleen , Matzo Marianne
Published: September 2018

Medication-assisted treatment for opioid use disorder (OUD), which incorporates methadone, buprenorphine, or naltrexone, has been shown to reduce all-cause mortality rates in patients with this disease—and the numbers of patients receiving such treatment is substantial. In 2016, among U.S. patients with OUD, nearly 350,000 were treated with methadone, more than 60,000 were treated with buprenorphine, and more than 10,000 were treated with naltrexone. Managing acute pain in patients receiving this treatment can be a significant nursing challenge. The authors discuss the attributes of the three medications used to treat OUD and, through a composite patient case, review how to manage acute pain effectively in patients receiving this type of treatment.

This article is one in a series on palliative care developed in collaboration with the Hospice and Palliative Nurses Association (https://advancingexpertcare.org), which offers education, certification, advocacy, leadership, and research on palliative care.
Practice Variation Among Surgeons Treating Lumbar Spinal Stenosis in a Single Institution
Authors: Ogink Paul T. , van Wulfften Palthe Olivier , Teunis Teun , Bono Christopher M. , Harris Mitchell B. , Schwab Joseph H. , Cha Thomas D.
Published: September 2018

Study Design.

A retrospective study.

Objective.

The aim of this study was to examine practice variation in the treatment of lumbar spinal stenosis and identify targets for reducing variation.

Summary of Background Data.

Lumbar spinal stenosis is a degenerative condition susceptible to practice variation. Reducing variation aims to improve quality, increase safety, and lower costs. Establishing differences in surgeons’ practices from a single institution can help identify personalized variation.

Methods.

We identified adult patients first diagnosed with lumbar spinal stenosis between 2003 and 2015 in three hospitals of the same institution with ICD-9 codes.

We extracted number of office visits, imaging procedures, injections, electromyographies (EMGs), and surgery within the first year after diagnosis; physical therapy within the first 3 months after diagnosis. Multivariable logistic regression was used to identify factors associated with surgery. The coefficient of variation (CV) was calculated to compare the variation in practice.

Results.

The 10,858 patients we included had an average of 2.5 visits (±1.9), 1.5 imaging procedures (±2.0), 0.03 EMGs (±0.22), and 0.16 injections (±0.53); 36% had at least one surgical procedure and 32% had physical therapy as part of their care. The CV was smallest for number of visits (19%) and largest for EMG (140%).

Male sex [odds ratio (OR): 1.23, P < 0.001], seeing an additional surgeon (OR: 2.82, P < 0.001), and having an additional spine diagnosis (OR: 3.71, P < 0.001) were independently associated with surgery. Visiting an orthopedic clinic (OR: 0.46, P < 0.001) was independently associated with less surgical interventions than visiting a neurosurgical clinic.

Conclusion.

There is widespread variation in the entire spectrum of diagnosis and therapy for lumbar spinal stenosis among surgeons in the same institution. Male gender, seeing an additional surgeon, having an additional spine diagnosis, and visiting a neurosurgery clinic were independently associated with increased surgical intervention. The main target we identified for decreasing variability was the use of diagnostic EMG.

Level of Evidence: 3
Comparing the Diagnostic Accuracies of F-18 Fluorodeoxyglucose Positron Emission Tomography and Magnetic Resonance Imaging for the Detection of Spondylodiscitis
Authors: Kim Seong-Jang , Pak Kyoungjune , Kim Keunyoung , Lee Jung Sub
Published: September 2018

Study Design.

A meta-analysis.

Objective.

The aim of this study was to compare the diagnostic accuracies of F-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography (PET) and magnetic resonance imaging (MRI) for the detection of spondylodiscitis through a meta-analysis.

Summary of Background Data.

There is no meta-analysis study that compares the diagnostic accuracies of F-18 FDG PET and MRI for the detection of spondylodiscitis.

Methods.

The MEDLINE and EMBASE databases were searched from the earliest available date of indexing to January 10, 2018 for studies comparing the diagnostic performance F-18 FDG PET with that of MRI for the detection of spondylodiscitis. We determined the sensitivities and specificities across studies, calculated the positive and negative likelihood ratios (LR+ and LR−), and constructed the summary receiver operating characteristic curves.

Results.

In the seven studies (212 patients) selected, the pooled sensitivity and specificity of F-18 FDG PET were 0.95 (95% confidence interval [CI]: 0.87–0.98) and 0.88 (95% CI: 0.73–0.95), respectively. The LR syntheses showed an overall LR+ of 7.6 (95% CI: 3.4–17.2) and LR− of 0.05 (95% CI: 0.02–0.14). The pooled diagnostic odds ratio was 141 (95% CI: 44–444). The pooled sensitivity and specificity of MRI were 0.85 (95% CI: 0.65–0.95) and 0.66 (95% CI: 0.48–0.80), respectively. The LR syntheses showed an overall LR+ of 2.5 (95% CI: 1.5–4.2) and LR− of 0.22 (95% CI: 0.08–0.60). The pooled diagnostic odds ratio was 11 (95% CI: 3–42). In the meta-regression analysis, no variable was identified as the source of the study heterogeneity.

Conclusion.

The current meta-analysis shows that F-18 FDG PET has better diagnostic accuracy than MRI for the detection of spondylodiscitis. Further large multicenter studies would be necessary to substantiate the diagnostic accuracies of F-18 FDG PET and MRI for spondylodiscitis.

Level of Evidence: 2
Psychometric Properties Study of the Oswestry Disability Index in a Spanish Population With Previous Lumbar Disc Surgery
Authors: Selva-Sevilla Carmen , Ferrara Paula , Gerónimo-Pardo Manuel
Published: September 2018

Study Design.

Evaluation of the psychometric properties of a questionnaire.

Objective.

To assess the psychometric properties of the Spanish version of the Oswestry Disability Index (ODI) in a Spanish population with previous lumbar disc surgery.

Summary of Background Data.

ODI is frequently used for measuring disability in spinal disorders. In 1995, ODI was translated and transculturally adapted into the Spanish context; its content and apparent validity, internal consistency and test–retest reliability were demonstrated for a Spanish population with lumbar pain. However, this score has not been tested in terms of discriminative capacity (floor and ceiling effects) and construct validity.

Methods.

Two hundred seventy-five patients who had previously undergone surgical treatment for disc lumbar herniation completed the ODI, Short-Form 36 (SF36), EuroQol-5D (EQ5D), and Numerical Rating Scale for Back Pain. Internal consistency, floor and ceiling effects and construct validity (convergent, divergent, and “known-groups” validities) were assessed.

Results.

Spanish ODI showed a very good internal consistency: Cronbach-α coefficient for ODI score was 0.928; Cronbach-α coefficient, if the item was deleted, did not increase by more than 0.1 for each item; and Item-total correlations ranged from strong to very strong. There was floor effect for both ODI score and for all individual items. There was no ceiling effect. Spanish ODI showed very good construct validity because 88% (7/8) of the hypotheses about convergent, divergent and “known-groups” validities were supported. Concerning convergent validity, ODI was strongly correlated with the Numerical Rating Scale for Back Pain (0.717; P < 0.001), SF36-Utility (rho = −0.786; P < 0.001), Physical Component Summary score SF36 (rho = −0.787; P < 0.001), Mental Component Summary score SF36 (rho = −0.605; P < 0.001), EQ5D-Utility (rho = −0.833; P < 0.001) and some EQ5D physical components.

Conclusion.

Spanish ODI showed good psychometric properties (internal consistency and construct validity), similar to others validation studies. Spanish ODI is a valid instrument for the measurement of disability in Spanish patients with previous lumbar disc surgery, specifically in patients with moderate/intense disability.

Level of Evidence: 4
Preoperative Age and Prognostic Nutritional Index Are Useful Factors for Evaluating Postoperative Delirium Among Patients With Adult Spinal Deformity
Authors: Oe Shin , Togawa Daisuke , Yamato Yu , Hasegawa Tomohiko , Yoshida Go , Kobayashi Sho , Yasuda Tatsuya , Banno Tomohiro , Arima Hideyuki , Mihara Yuki , Ushirozako Hiroki , Yamada Tomohiro , Matsuyama Yukihiro
Published: September 2018

Study Design.

A retrospective study of postoperative delirium after adult spinal deformity (ASD) surgery.

Objective.

To identify the risk factors of post-ASD surgery delirium, including nutritional state before surgery.

Summary of Background Data.

Recently, malnutrition was reported as one of the risk factors of delirium. The prognostic nutritional index (PNI) and controlling nutritional status index (CONUT) scores are simple methods of nutritional evaluation. However, there are no reports that verify that delirium is related to the PNI and CONUT score in patients who have undergone ASD surgery.

Methods.

A consecutive 319 patients who underwent ASD surgery were divided into a delirium group (group D) or nondelirium group (group ND). Preoperative risk factors, including PNI, were assessed.

Results.

Group D consisted of 30 patients and group ND consisted of 289 patients. There was significant difference in age (group D:group ND = 73:62, P = 0.000), serum albumin (4.2:4.3, P = 0.028), operative time (422:395 min, P = 0.029), PNI score (49:52, P = 0.011), and CONUT score (1.7:1.1, P = 0.046). Using multiple logistic regression analysis, we found significant risk factors for delirium to be age (P = 0.006, odds ratio = 1.11, 95% confidence interval = 1.03–1.19) and PNI (P = 0.003, odds ratio = 0.87, 95% confidence interval = 0.79–0.96). A receiver operating characteristic curve showed that the cut-off value of PNI and age for delirium were 49.7 and 68.5 years, respectively.

Conclusion.

The risk factors of postoperative delirium after ASD surgery were PNI less than 49.7 and age more than 68.5 years. Patients who undergo ASD surgery beyond these preoperative cut-off values should be cautioned about delirium and be required to provide adequate informed consent.

Level of Evidence: 3
Changes in the Sagittal Cranio-Cervical Posture Following a 12-Week Intervention Using a Simple Spinal Traction Device
Authors: Shahar David , Sayers Mark G.L.
Published: September 2018

Study Design.

Non-controlled clinical trial.

Objective.

To assess the efficacy of a simple home spinal traction device on sagittal cranio-cervical posture and related symptoms.

Summary of Background Data.

Forward head protraction (FHP) and cranio-cervical malalignment were shown to be consequential in the development adverse musculoskeletal radiographic findings and symptoms in that region.

Methods.

Participants (n = 13, 18–36-year-old) were drawn from a mildly symptomatic population, all presented with cranio-cervical malalignment and considerable FHP. Participants used a simple home spinal traction device for 12 weeks, 10 min/d. Sagittal cervical radiographs and the SF36 health survey were obtained pre/post intervention and guideline compliance was recorded. Radiographic evaluation included typical measurements of sagittal cranio-cervical alignment and FHP (e.g., atlas plane line, vertical axis line, sagittal cranial angle, absolute rotation angle). Standard paired samples t tests, chi-squared, and effect size analyses were used to assess pre- and post-intervention changes.

Results.

Each of the key radiographic variables recorded significant moderate to very large positive changes as a result of the intervention. Similarly, Chi-squared analyses indicated that saggital cervical spine configuration tended to become more lordotic (P = 0.007), with four participants shifting from a kyphotic to a lordotic presentation. SF36 health survey data demonstrated mostly significant positive changes throughout all tested domains, and moderate positive changes were recorded across all radiographic cranio-cervical mesured paramenters (e.g., decreased FHP, increased cervical lordosis, and cranial extention). Participants indicated high level of protocol compliance.

Conclusion.

This study has demonstrated that the unsupervised daily use of a simple home spinal traction device (Thoracic Pillow®) proved effective in bringing positive plastic changes to the sagittal cranio-cervical alignment and reduction in symptoms in the tested population during a short intervention period.

Level of Evidence: 3
Predictive Model for Medical and Surgical Readmissions Following Elective Lumbar Spine Surgery
Authors: Sivaganesan Ahilan , Zuckerman Scott , Khan Inamullah , Nian Hui , Harrell Frank E. , Pennings Jacquelyn S. , Harbaugh Robert , Foley Kevin T. , Bydon Mohamad , Asher Anthony L. , Devin Clinton J. , Archer Kristin R.
Published: September 2018

Study Design.

This study retrospectively analyzes prospectively collected data.

Objective.

Here we aim to develop predictive models for 3-month medical and surgical readmission after elective lumbar surgery, based on a multi-institutional, national spine registry.

Summary of Background Data.

Unplanned readmissions place considerable stress on payers, hospitals, and patients. Medicare data reveals a 30-day readmission rate of 7.8% for lumbar-decompressions and 13.0% for lumbar-fusions, and hospitals are now being penalized for excessive 30-day readmission rates by virtue of the Hospital Readmissions Reduction Program.

Methods.

The Quality and Outcomes Database (QOD) was queried for patients undergoing elective lumbar surgery for degenerative diseases. The QOD prospectively captures 3-month readmissions through electronic medical record (EMR) review and self-reported outcome questionnaires. Distinct multivariable logistic regression models were fitted for surgery-related and medical readmissions adjusting for patient and surgery-specific variables.

Results.

Of the total 33,674 patients included in this study 2079 (6.15%) reported at least one readmission during the 90-day postoperative period. The odds of medical readmission were significantly higher for older patients, males versus females, African Americans versus Caucasion, those with higher American Society of Anesthesiologists (ASA) grade, diabetes, coronary artery disease, higher numbers of involved levels, anterior only or anterior–posterior versus posterior approach; also, for patients who were unemployed compared with employed patients and those with high baseline Oswestry Disability Index (ODI). The odds of surgery-related readmission were significantly greater for patients with a higher body mass index (BMI), a higher ASA grade, female versus male, and African Americans versus Caucasians; also, for patients with severe depression, more involved spinal levels, anterior-only surgical approaches and higher baseline ODI scores.

Conclusion.

In this study we present internally validated predictive models for medical and surgical readmission after elective lumbar spine surgery. These findings set the stage for targeted interventions with a potential to reduce unnecessary readmissions, and also suggest that medical and surgical readmissions be treated as distinct clinical events.

Level of Evidence: 3
Smoking and Helicobacter pylori infection: an individual participant pooled analysis (Stomach Cancer Pooling- StoP Project)
Authors: Ferro Ana , Morais Samantha , Pelucchi Claudio , Aragonés Nuria , Kogevinas Manolis , López-Carrillo Lizbeth , Malekzadeh Reza , Tsugane Shoichiro , Hamada Gerson S. , Hidaka Akihisa , Hernández-Ramírez Raúl U. , López-Cervantes Malaquias , Zaridze David , Maximovitch Dmitry , Pourfarzi Farhad , Zhang Zuo-Feng , Yu Guo-Pei , Pakseresht Mohammadreza , Ye Weimin , Plymoth Amelie , Leja Marcis , Gasenko Evita , Derakhshan Mohammad H. , Negri Eva , La Vecchia Carlo , Peleteiro Bárbara , Lunet Nuno
Published: September 2018

Smoking has been associated with acquisition and increased persistence of Helicobacter pylori infection, as well as with lower effectiveness of its eradication. A greater prevalence of infection among smokers could contribute to the increased risk for gastric cancer. We aimed to estimate the association between smoking and seropositivity to H. pylori through an individual participant data pooled analysis using controls from 14 case–control studies participating in the Stomach Cancer Pooling Project. Summary odds ratios and prevalence ratios (PRs), adjusted for age, sex and social class, and the corresponding 95% confidence intervals (CIs) were estimated through random-effects meta-analysis. Heterogeneity was quantified using the I
2 statistic and publication bias with Egger’s test. There was no significant association between smoking (ever vs. never) and H. pylori seropositivity (adjusted odds ratio = 1.08; 95% CI: 0.89–1.32; adjusted PR = 1.01; 95% CI: 0.98–1.05). The strength of the association did not increase with the intensity or duration of smoking; stratified analyses according to sex, age, region or type of sample did not yield a consistent pattern of variation or statistically significant results, except for participants younger than 55 years and who had been smoking for more than 30 years (adjusted PR = 1.08; 95% CI: 1.02–1.15). This is the first collaborative analysis providing pooled estimates for the association between smoking and H. pylori seropositivity, based on detailed and uniform information and adjusting for major covariates. The results do not support an association between smoking and H. pylori infection.
Factors Influencing Information and Communication Technology Knowledge and Use Among Nurse Managers in Selected Hospitals in the Volta Region of Ghana
Authors: Adatara Peter , Baku Elizabeth Aku , Atakro Confidence Alorse , Adedia David Mensah , Jonathan Justice Wiston Amstrong
Published: September 2018

This study adopted a cross-sectional design to examine the factors that influence the use of information and communication technology among 108 nurse managers in selected hospitals in the Volta Region of Ghana. A self-administered questionnaire was used to gather data. A χ
2 test of association identified sex (P < .0001), age (P < .0001), years of work experience (P < .0001), rank of the respondents (P < .0001), computer training (P < .0001), computer ownership (P < .0001), and previous use of computers before appointment as a unit manager (P < .0001) as the factors that significantly influenced the use of information and communication technology among nurse managers.
Validation of chronic mild stress in the Wistar-Kyoto rat as an animal model of treatment-resistant depression
Authors: Willner Paul , Gruca Piotr , Lason Magdalena , Tota-Glowczyk Katarzyna , Litwa Ewa , Niemczyk Monika , Papp Mariusz
Published: September 2018

A recent review proposed four criteria for an animal model of treatment-resistant depression (TRD): a phenotypic resemblance to a risk factor for depression; enhanced response to stress; nonresponse to antidepressant drugs and response to treatments effective in TRD, such as deep brain stimulation (DBS) of the prefrontal cortex or ketamine. Chronic mild stress (CMS) provides a valid model of depression; the Wistar-Kyoto (WKY) rat is considered to be nonresponsive to antidepressant drugs. Here, we applied CMS to WKY rats. WKY and Wistar rats were exposed to CMS, then treated with saline, imipramine, citalopram or venlafaxine. After 5 weeks of CMS and 3 weeks of drug treatment, all WKY groups were implanted unilaterally with DBS electrodes in the prefrontal cortex, and examined in sucrose intake, elevated plus maze (EPM; decreased entries and time in the open arms) and novel object recognition (decreased exploration) tests, following 2×2 h of DBS. CMS decreased sucrose intake, open arm entries on the EPM, and object recognition. Relative to Wistars, WKY rats showed evidence of increased emotionality in the EPM and novel object recognition tests, and a greater impact of CMS on body weight gain and open arm entries. Wistars responded to drug treatment with an increase in sucrose intake but WKY were nonresponsive to drug treatment on all three behavioural tests. With one exception, DBS reversed the anhedonic, anxiogenic and dyscognitive effects of CMS in all groups of WKY rats. In a further experiment, subacute ketamine (10 mg/kg) also normalized behaviour on all three tests. We conclude that WKY rats subjected to CMS meet all four criteria for a valid model of TRD, and provide a basis for studying the mechanism of action of DBS.
Sex differences in the effectiveness of buprenorphine to decrease rates of responding in rhesus monkeys
Authors: Schwienteck Kathryn L. , Negus S. Stevens , Banks Matthew L.
Published: September 2018

Sex differences in μ-opioid receptor (MOR) agonist-induced antinociception have been reported in nonhuman primates. The degree to which μ-opioid receptor agonist sex differences in nonhuman primates extend to other behavioral endpoints remains unknown. The present study compared the behavioral effects of three MOR ligands (fentanyl, buprenorphine, and naltrexone) that varied in efficacy to stimulate [35S]-GTPγS binding (from highest to lowest: fentanyl, buprenorphine, and naltrexone) in male and female rhesus monkeys. Male (n=3) and female (n=3) monkeys were trained to respond under a fixed-ratio 10 schedule of food presentation during daily sessions consisting of multiple components. Once rates of responding were stable, cumulative dose–effect functions were determined for intramuscular fentanyl (0.00032–0.032 mg/kg), buprenorphine (0.001–1 mg/kg), and naltrexone (0.01–0.1 mg/kg). Fentanyl dose-dependently decreased rates of responding in both sexes and the corresponding ED50 values were not significantly different. Buprenorphine dose-dependently decreased rates of responding in females, but not males. Naltrexone did not significantly alter behavior in either females or males. Overall, these results suggest that the expression of sex differences in MOR pharmacology depends upon both the efficacy of the MOR ligand and the behavioral endpoint.
FIVE-YEAR FUNCTIONAL OUTCOMES AFTER EPIRETINAL MEMBRANE SURGERY
Authors: Jonna Gowtham , Thompson Ian A. , Mendel Thomas A. , Kim Stephen J.
Published: September 2018

Purpose:

To evaluate 5-year functional outcomes involving the inner retina after epiretinal membrane (ERM) surgery.

Methods:

The study eye (SE) and fellow eye (FE) of 20 patients undergoing ERM surgery were examined preoperatively and at 3, 12, 24, 36, 48, and 60 months postoperatively. Retinal nerve fiber layer and ganglion cell–inner plexiform layer (GC-IPL) thicknesses were analyzed using spectral domain optical coherence tomography. Humphrey visual field mean deviation, pattern SD, and qualitative changes were assessed and compared over time.

Results:

Mean GC-IPL thickness in SEs was less than that of FEs at all time points with progressive thinning in SEs after ERM surgery. There was significant thinning of the superotemporal GC-IPL in SEs as compared to FEs at 3 months and 60 months (P < 0.05). Humphrey visual field mean deviation was greater in SEs as compared to FEs but statistically significant only at 0, 12, and 24 months (P < 0.05). Pattern SD increased from baseline in SEs but remained near baseline in FEs.

Conclusion:

Surgical eyes after ERM surgery demonstrated progressive thinning of the GC-IPL and transient worsening trends in Humphrey visual field mean deviation and pattern SD as compared to controls after ERM surgery.
PERIPAPILLARY NEUROVASCULAR COUPLING IN THE EARLY STAGES OF DIABETIC RETINOPATHY
Authors: Rodrigues Tiago M. , Marques João P. , Soares Mário , Dolan Michael-John , Melo Pedro , Simão Sílvia , Teles João , Figueira João , Murta Joaquim N. , Silva Rufino
Published: September 2018

Purpose:

To study radial peripapillary capillary (RPC) density in the early stages of diabetic retinopathy (DR), using optical coherence tomography angiography.

Methods:

A cross-sectional evaluation of RPCs was performed using optical coherence tomography angiography (Avanti RTVue-XR 100, Optovue Inc, Fremont, CA). Annular RPC density was the primary outcome. Global density and retinal nerve fiber layer thickness were secondary outcomes. Diabetic eyes were divided into three groups: no DR, mild nonproliferative DR (mild NPDR), and moderate NPDR. Multilevel mixed-effects univariate and multivariate linear regression models were used.

Results:

We included 155 eyes (n = 42 control; n = 27 no DR; n = 28 mild NPDR; and n = 58 moderate NPDR) from 86 subjects (mean [SD] age 63.39 [10.70] years; 46.45% male). When compared with controls, a significant decrease in annular RPC density was found in all groups of diabetic eyes on multivariate analysis (no DR: β = −2.95, P < 0.001; mild NPDR: β = −1.76, P = 0.017; and moderate NPDR: β = −2.82, P < 0.001). We also detected a significant decrease in retinal nerve fiber layer thickness in diabetic eyes (even in the no DR group). Furthermore, in diabetic eyes, annular RPC density and retinal nerve fiber layer thickness correlated significantly (R = 0.4874, P < 0.001).

Conclusion:

Peripapillary neurovascular changes occur early in the course of DR. Their significance in the progression of DR warrants further research.
The prevalence and years lived with disability caused by low back pain in China, 1990 to 2016: findings from the global burden of disease study 2016
Authors: Wu Aimin , Dong Wenlan , Liu Shiwei , Cheung Jason Pui Yin , Kwan Kenny Yat Hong , Zeng Xinying , Zhang Kai , Sun Zhenyu , Wang Xiangyang , Cheung Kenneth Man Chee , Zhou Maigeng , Zhao Jie
Published: September 2018

The aim of this work was to quantify the prevalence and years lived with disability (YLDs) caused by low back pain (LBP) in China from 1990 to 2016. Data from the GBD 2016 (Global Burden of Diseases, Injuries, and Risk Factors Study 2016) were used. We analyzed the age-sex-province-specific prevalence and YLDs for LBP of 33 provinces/regions in China. Comparisons were made with the data retrieved from the 1990 GBD study. We estimated that 5.45 × 107 individuals had LBP in 1990, which rose to 6.73 × 107 in 2016. The age-standardized prevalence of LBP decreased from 5.6% (95% uncertainty interval [95% UI]: 4.9%-6.3%) in 1990 to 4.2% (95% UI: 3.8%-4.8%) in 2016. The YLDs for LBP increased from 6.2 million (95% UI: 4.3-8.3 million) in 1990 to 7.7 million (95% UI: 5.4-10.2) in 2016. Age-standardized YLD rate (per 100,000 person) decreased from 637.5 (95% UI: 449.9-848.8) in 1990 to 481.9 (95% UI: 338.6-637.0) in 2016. A female preponderance was observed for prevalence and YLDs. The prevalence and YLDs rate for LBP slightly decreased from 1990 to 2016 in China; however, the total individuals and YLDs increased. Low back pain still ranks as the second leading cause of YLD burden disease in China. Considerable attention should be paid for LBP, especially in the female population.
Associations of catechol-O-methyltransferase (rs4680) single nucleotide polymorphisms with opioid use and dose among adults with chronic pain
Authors: Hooten W. Michael , Biernacka Joanna M. , O'Brien Travis G. , Cunningham Julie M. , Black John L.
Published: September 2018

Catechol-O-methyltransferase (COMT) regulates extracellular catecholamines. A widely studied COMT single nucleotide polymorphism (rs4680) changes the translated amino acid from valine to methionine (Val158Met); the polymorphism has been shown to influence opioid use. The aims of this study were to investigate the influence of COMT Val158Met on the likelihood and dose of opioid use in adults with chronic pain. Adults with chronic pain consecutively admitted to an outpatient pain rehabilitation program were recruited for study participation (N = 298). Individuals were genotyped for COMT Val158Met (rs4680). The polymorphism was analyzed using an additive and codominant genotype model. The distribution of genotypes was 23% (N = 70) for Val/Val, 49% (N = 146) for Val/Met, and 27% (N = 82) for Met/Met (Hardy–Weinberg, P > 0.90). No significant association was observed between opioid use and genotype under the additive model; however, a significant association was observed under the codominant model (P = 0.027). A post hoc comparison demonstrated that the Met/Met genotype was more likely to use opioids compared with the Val/Met genotype (P = 0.0089). No significant association was observed between morphine equivalent dose and genotype under the additive model; however, a significant association was observed under the codominant model (P = 0.0496). A post hoc comparison demonstrated that the Val/Met (P = 0.019) and Met/Met (P = 0.043) genotypes used greater morphine equivalent dose compared with the Val/Val genotype. This study extends key knowledge about the influence of the Met/Met genotype and Met allele on opioid use in adults with chronic pain.
PRISM: a brief screening tool to identify risk in parents of youth with chronic pain
Authors: Simons Laura E. , Lewandowski Holley Amy , Phelps Emily , Wilson Anna C.
Published: September 2018

Having a child with chronic pain impacts a parent's life. Reciprocally, parent cognitive, affective, and behavioral responses to the child's chronic pain can influence the child's pain experience. The purpose of this study is to develop a brief self-report screening tool (Parent Risk and Impact Screening Measure [PRISM]) of parent psychosocial functioning and behavioral responses to child pain. This measure assesses parents' reports of their own stress, health, psychosocial functioning, and disruption in activities due to their child's pain and related disability. In an effort to preliminarily validate this screening tool, we examined the PRISM in relation to existing measures of parent distress, parent behavior, and child functioning. An initial 30-item PRISM was administered to 229 parents of children with persistent pain. Parents also reported on distress, protectiveness, pain catastrophizing and family impact, and youth completed measures of pain, pain-related disability, and quality of life. Item refinement resulted in a final 12-item PRISM tool. The PRISM demonstrates strong internal consistency, and initial support for construct validity was shown by associations with parent distress, protectiveness, and catastrophizing. Results also revealed higher PRISM scores are associated with higher child pain intensity, greater functional disability, and poorer quality of life. Cutoff scores were determined to identify parents at differing levels of risk. The PRISM is a brief and clinically important means of screening parent distress and behaviors associated with child pain-related dysfunction. Further validation will use PRISM in longitudinal studies, particularly testing PRISM scores as a predictor of parent and child outcomes over time.
The Relationship Between the Quality of Work and Organizational Commitment of Prison Nurses
Authors: KARAASLAN Ayfer , ASLAN Manar
Published: September 2018

Background:

Nurses working in prisons are exposed to security problems while serving those who may be uninterested in their own healthcare, face high risks of drug and alcohol addiction, and may have aggressive personalities. For this reason, nurses working in prisons may have more problems with work-related quality of life than their non-prison-nurse peers.

Purpose:

This descriptive research study was conducted to evaluate the work-related quality of life and organizational commitment of nurses who work at prisons and detention centers.

Methods:

According to 2015 data, approximately 513 nurses currently work in prisons in Turkey. The study group consisted of 224 nurses who currently work in prisons or detention centers. The data were collected by sending a created link address to the e-mail addresses of nurses who work in these facilities. A 13-item sociodemographic information form, including a demographics datasheet, a work-related quality of life scale, and an organizational commitment scale, was used to collect data.

Results:

The participants reported a moderate level of work-related quality of life and organizational commitment. Moreover, work-related quality of life was shown to affect organizational commitment, with 20% of the total variance in organizational commitment explained by work-related quality of life.

Conclusions/Implications for Practice:

This study supports that work-related quality of life affects organizational commitment positively. Therefore, regulating working conditions by taking into consideration employee security will positively affect job satisfaction in terms of both the institution and the employee. Moreover, as nurses do not only work in hospitals, taking this action should also work in different settings. Administrators should ensure the work-related quality of life of the prison nurses by understanding the difficulties of prison nursing.
Cervical Cancer Incidence Among Elderly Women in Massachusetts Compared With Younger Women
Authors: Feldman Sarah , Cook Erin , Davis Michelle , Gershman Susan T. , Hanchate Amresh , Haas Jennifer S. , Perkins Rebecca B.
Published: September 2018

Importance

Current cancer screening guidelines recommend cessation of cervical cancer screening at the age of 65 years for most women. To examine residual risk among elderly women, we compared cervical cancer incidence rates (IRs) in Massachusetts from 2004 to 2015 among women younger than 65 years versus 65 years and older.

Materials and Methods

The Massachusetts Cancer Registry was used to identify all women diagnosed with cervical cancer between January 01, 2004, to December 31, 2015. Cancer incidence was calculated based on age of diagnosis (<65 years vs ≥65 years).

Results

In Massachusetts, 2,418 incident cases of cervical cancer were diagnosed from 2004 to 2014, of which 571 (23.6%) were diagnosed among women 65 years and older. When compared with women diagnosed younger than 65 years, women diagnosed at the age of 65 years and older were more likely to be diagnosed with stage II or higher (71.8% vs 43.8%, p < .001). Cervical cancer IRs decreased annually for women younger than 65 years from 2004 to 2015. Among women 65 years and older, cancer IRs decreased by 3.9% annually from 2004 to 2013 (p = .0009), but 2013 to 2015 showed an increasing trend (annual percent change + 14.1%, p = .12).

Conclusions and Relevance

Women 65 years and older account for one quarter of cervical cancer diagnoses in Massachusetts and present with higher-stage disease than younger women. Upcoming planned revisions in screening and prevention guidelines should address the continued risk of cervical cancer for older women.
Human Papillomavirus Knowledge, Attitudes, Practices, and Prevalence Among Men Who Have Sex With Men in Monrovia, Liberia
Authors: Lieber Molly , Reynolds Christopher W. , Lieb Whitney , McGill Stephen , Beddoe Ann Marie
Published: September 2018

Objective

The aim of this study was to assess human papillomavirus (HPV) prevalence, knowledge, attitudes, and practices, among men who have sex with men (MSM) in Monrovia, Liberia.

Materials and Method

This cross-sectional study was conducted with 107 MSM, aged 18 to 58 years, completing questionnaires and anal HPV screenings. Using peer-educators and direct community involvement, demographics, risk factors, and HPV knowledge data were collected.

Results

Forty-eight participants (45%) were HPV positive and 21 participants (19.6%) self-identified as HIV positive. When examining HPV risk factors, 22 participants reported first sexual experience before the age of 15 years. Approximately half of participants (n = 58, 54.2%) have receptive anal sex and 40 (37.4%) reported more than 20 lifetime sexual partners. Eight participants (7.5%) had no formal education and 80 (74.8%) were not formally employed. Two-thirds of participants (64%) had never heard of HPV. Education was not significantly correlated with HPV knowledge. χ2 tests of independence were performed, and the relation between oral and anal sex and HPV knowledge was significant (χ2 (1) = 5.08, p < .05; χ2 (1) = 4.18, p < .05), respectively, such that those who engaged in oral and anal sex had lower levels of HPV knowledge.

Conclusions

Among the MSM population, HPV prevalence is high, as are high-risk practices. Participants lack HPV knowledge, independent of educational achievement, and are eager to receive educational information. Future studies should focus on identifying additional risk factors and implementing public health educational interventions.
Potential Health Effects of Tea
Authors: Haufe Thomas C. , Ho Kacie K. H. Y. , Ferruzzi Mario G. , Neilson Andrew P.
Published: September 2018

Brewed tea (from the Camellia sinensis plant) is the second most commonly consumed beverage in the world, and its consumption has been associated with several human health benefits. Tea polyphenols are absorbed in the intestine following consumption and metabolized by both human and microbial systems to yield a mixture of complex metabolites that can be found in circulation and throughout the body. Identification of tea phenolic constituents and their metabolites has served to strengthen the association between tea consumption and specific health benefits, as well as to measure potential differences between tea product forms. The current state of research suggests that long-term consumption of tea and tea polyphenols may provide distinct health benefits, with the strongest associations being the promotion of cardiovascular health, as well as antidiabetic and antiobesity effects. However, much regarding tea and health remains to be discovered. This includes development of a better understanding of the role of abundant oxidized polyphenol forms in oolong and black tea, whose bioavailability and specific role in health benefits remain unknown. This technical summary focuses on tea polyphenol bioaccessibility/bioavailability, discusses potential bioactivity, and highlights studies that link tea consumption and health.
An Investigation of Pressure Profiles and Wearer Comfort During Walking With a Transtibial Hydrocast Socket
Authors: Laing Sheridan , Lythgo Noel , Lavranos Jim , Lee Peter Vee Sin
Published: September 2018

Objective

The aims of the study were to conduct an investigation of the transtibial hydrocast socket interface pressures during walking and to explore potential relationships between pressures experienced and resultant wearer comfort.

Design

In this cross-sectional study, pressure data at the limb and hydrocast socket interface during walking were collected from 16 users of hydrocast sockets. The pressures at this interface were described by location, magnitude, and duration for all participants and were compared between the most and least comfortable participants.

Results

High pressures were found about the bony prominences of the residual limb, especially the tibial crest of the anterior distal region. Factors identified as potentially causing discomfort (P < 0.1, d > 0.80) were high peak pressures at the anterior proximal region and longer durations of submaximal loading at the lateral proximal region and the anterior and medial distal regions. High pressure variability at the anterior proximal region may also contribute to discomfort (P = 0.106, d = 0.88).

Conclusions

The hydrocast socket interface pressures have been described for a cohort of users. A number of differences were found in the pressure profiles of the most and least comfortable participants. These differences suggest trends between the identified pressure parameters and resultant wearer comfort. Future studies should confirm these exploratory results.
Advancing HIV Biomedical Prevention Research for At-Risk Adolescents
Authors: Kapogiannis Bill G. , Nelson Robert M. , Siberry George K. , Lee Sonia , Hazra Rohan
Published: September 2018

Despite significant additions to the HIV prevention toolbox, infection rates across the United States continue to rise among vulnerable adolescents and young adults. Access to these interventions by youth at risk for HIV is limited by the lack of data about their safety and use, compounding the myriad contextual barriers to effectively preventing HIV in this group. The NIH-funded Adolescent Trials Network implemented an innovative approach to the inclusion of adolescents at risk for HIV infection who consented for their own participation in the first adolescent study of HIV pre-exposure prophylaxis (PrEP). This model of mature minor consent was supported by state-based adolescent treatment statutes that extend an adolescent's ability to consent to participation in research with a sufficient prospect of clinical benefit from the intervention to justify the potential risks, and a balance of benefits and risks that is at least as favorable as available evidence-based alternatives. Important data on the safety and patterns of PrEP use by at-risk adolescents prompted the FDA to revise the label. The expanded indication of PrEP for HIV prevention in adolescents is hoped to inform clinical guidelines and provides a powerful tool to reduce new infections in the United States among vulnerable at-risk adolescents. Lessons learned from this years-long iterative endeavor have implications for improving access to the rapidly evolving landscape of HIV prevention modalities, including recently implemented studies of long-acting PrEP formulations designed to reduce the burden of daily adherence required by oral PrEP, a major clinical pitfall for adolescent clinicians and their patients.
Impact of Patient–Provider Attachment on Hospital Readmissions Among People Living With HIV: A Population-Based Study
Authors: Parent Stephanie , Barrios Rolando , Nosyk Bohdan , Ye Monica , Bacani Nicanor , Panagiotoglou Dimitra , Montaner Julio , Ti Lianping ,   on behalf of the STOP HIV/AIDS in BC Study Group
Published: September 2018

Background:

Hospital readmission 30 days after discharge is associated with adverse health outcomes, and people living with HIV (PLWH) experience elevated rates of hospital readmission. Although continuity of care with a health care provider is associated with lower rates of 30-day readmission among the general population, little is known about this relationship among PLWH. The objective of this study is to examine whether engaging with the same provider, defined as patient–provider attachment, is associated with 30-day readmission for this population.

Setting:

Data were derived from the Seek and Treat for Optimal Prevention of HIV in British Columbia cohort.

Methods:

Using generalized estimating equation with a logit link function, we examined the association between patient–provider attachment and 30-day hospital readmission. We determined whether readmission was due to all cause or to a similar cause as the index admission.

Results:

Seven thousand thirteen PLWH were hospitalized during the study period. Nine hundred twenty-one (13.1%) were readmitted to hospital for all cause and 564 (8.0%) for the similar cause as the index admission. Patient–provider attachment was negatively associated with 30-day readmission for all causes (adjusted odds ratio = 0.85, confidence interval = 0.83 to 0.86). A second multivariable model indicated that patient–provider attachment was also negatively associated with 30-day readmission for a similar cause (adjusted odds ratio = 0.86, confidence interval = 0.84 to 0.88).

Conclusions:

Our results indicate that a higher proportion of patient–provider attachment was negatively associated with 30-day hospital readmission among PLWH. Our study findings support the adoption of interventions that seek to build patient–provider relationships to optimize outcomes for PLWH and enhance health care sustainability.