bluuebunny/crossref_metadata_2025 huggingface dataset:
Cannabis Use in Persons With Inflammatory Bowel Disease and Vulnerability to Substance Misuse
Authors: Hansen Tawnya M , Sabourin Brigitte C , Oketola Banke , Bernstein Charles N , Singh Harminder , Targownik Laura E
Published: November 2019

Background

It is unknown whether cannabis users self-medicating their inflammatory bowel disease (IBD) symptoms are more likely to have comorbid mental health or personality risk factors associated with an increased potential for substance misuse compared with recreational cannabis users.

Methods

We surveyed individuals with IBD about their cannabis use, their mental health symptoms, and personality risk factors associated with substance misuse. We compared risk factors for substance misuse between individuals using cannabis to manage IBD symptoms and those using cannabis recreationally.

Results

Of 201 persons with IBD who completed the questionnaire, 108 reported lifetime cannabis use. Of those, a larger proportion of Crohn’s disease patients used cannabis to manage IBD symptoms (53% [34/64] vs 28% [12/43]; P = 0.010). Individuals self-medicating with cannabis were more likely to use cannabis for coping reasons (P = 0.016) and demonstrated higher levels of impulsivity (P = 0.004) and depressive symptoms (P = 0.012) when compared with individuals using cannabis recreationally. Logistic regression revealed that cannabis was 4.1 times (P = 0.05) and 3.7 times (P = 0.05) more likely to be used for IBD symptoms by smokers and individuals with moderate–severe depressive symptoms, respectively. Individuals high in impulsivity were 4.1 times more likely to use cannabis for their IBD symptoms than those low in impulsivity (P = 0.005).

Conclusions

Persons with IBD self-medicating with cannabis have characteristics associated with increased vulnerability to substance misuse when compared with those using cannabis recreationally. Screening for mental health comorbidities and vulnerability to substance misuse should be undertaken if cannabis is to be used to treat IBD symptoms.
March and the pursuit of organizational intelligence: the interplay between procedural rationality and sensible foolishness
Authors: Ocasio William , Rhee Luke , Boynton Dylan
Published: November 2019

March’s long and varied career in organization theory encompasses a number of seemingly disparate themes from rationality, to ambiguity and the garbage can model, to exploration and exploitation in organizations. We examine March’s diverse research trajectory and conclude that his different insights can be brought together under one common theme for his career: that both procedural rationality and sensible foolishness are necessary for the pursuit of organizational intelligence. Traditional models of rationality, even bounded rationality, are insufficient because goals are unstable and inconsistent, and causal ambiguity leads to myopic learning or worse. To explain the interplay between procedural rationality and sensible foolishness in organizations, we explore their role in the inter-related processes of programing, monitoring, sensemaking, search, and decision making.
Pericardial hernias in adults: a systematic review of the literature
Authors: Schizas Dimitrios , Katsaros Ioannis , Karatza Elli , Theochari Nikoletta A , Kykalos Stylianos , Nastos Constantinos , Michalopoulos Nikolaos , Avgerinos Dimitrios V , Chatzimavroudis Grigoris , Arkadopoulos Nikolaos
Published: November 2019

OBJECTIVES

A pericardial hernia is defined as the protrusion of abdominal viscera through the central tendon of the diaphragm into the pericardial sac. It is a rare clinical entity whose symptoms vary considerably. The objective of this study was to evaluate the clinical manifestations of and the optimal surgical treatments for pericardial hernias.

METHODS

PubMed and the Cochrane bibliographical databases were searched (last search: 20 April 2019) for studies on pericardial diaphragmatic hernias in the adult population.

RESULTS

Eighty studies met our inclusion criteria and reported on 85 patients (62 men and 23 women) with a mean age of 55.86 ± 15.79 years (mean ± standard deviation) presenting with a pericardial hernia at health care facilities. The leading aetiology was trauma (56.5%) followed by iatrogenic interventions (30.6%). The most common herniated organs were the transverse colon (49.4%) and the greater omentum (48.2%). Seventy-one patients (83.5%) underwent an open surgical repair, whereas 14 (16.5%) had a laparoscopic approach. Mesh or a patch was applied in 41.9% of cases. A postoperative morbidity rate of 16.9% was recorded, whereas the mortality rate reached 2.4%.

CONCLUSIONS

Pericardial hernia is a rare disease characterized by abdominal organs herniating into the pericardium. It requires a high degree of suspicion for early diagnosis, and all medical professionals should be encouraged to report such cases to clarify the best available therapeutic approach.
Control of Nipah Virus Infection in Mice by the Host Adaptors Mitochondrial Antiviral Signaling Protein (MAVS) and Myeloid Differentiation Primary Response 88 (MyD88)
Authors: Iampietro Mathieu , Aurine Noemie , Dhondt Kevin P , Dumont Claire , Pelissier Rodolphe , Spanier Julia , Vallve Audrey , Raoul Herve , Kalinke Ulrich , Horvat Branka
Published: November 2019

Interferon (IFN) type I plays a critical role in the protection of mice from lethal Nipah virus (NiV) infection, but mechanisms responsible for IFN-I induction remain unknown. In the current study, we demonstrated the critical role of the mitochondrial antiviral signaling protein signaling pathway in IFN-I production and NiV replication in murine embryonic fibroblasts in vitro, and the redundant but essential roles of both mitochondrial antiviral signaling protein and myeloid differentiation primary response 88 adaptors, but not toll/interleukin-1 receptor/resistance [TIR] domain–containing adaptor–inducing IFN-β (TRIF), in the control of NiV infection in mice. These results reveal potential novel targets for antiviral intervention and help in understanding NiV immunopathogenesis.
Pediatric patient portal use in one health system
Authors: Szilagyi Peter G , Valderrama Rebecca , Vangala Sitaram , Albertin Christina , Okikawa David , Sloyan Michael , Lopez Nathalie , Lerner Carlos F
Published: November 2019

Objective

The study sought to assess, for children in one large health system, (1) characteristics of active users of the patient portal (≥1 use in prior 12 months), (2) portal use by adolescents, and (3) variations in pediatric patient portal use.

Materials and Methods

We analyzed data from the electronic health record regarding pediatric portal use during 2017-2018 across a health system (39 871 pediatric patients).

Results

Altogether, 63.5% of pediatric patients were active portal users. Children (proxies) who were boys, privately insured, white, and spoke English were more likely to be active users. Common uses involved messaging with physicians, medications, allergies, letters, and laboratory results. By 15 years of age, >50% of adolescents used the portal by themselves (without a proxy). Pediatric portal use varied widely across practices.

Discussion

Pediatric or adolescent portal use is quite high, but large variations exist.

Conclusion

Use of the portal for pediatric care may reflect varying pediatric patient engagement.
Bemisia tabaci (Hemiptera: Aleyrodidae) Insecticide Resistance in Shandong Province, China
Authors: Wang Fan , Liu Jin , Chen Peng , Li Hong-Yang , Ma Jing-Jing , Liu Yong-Jie , Wang Kai
Published: November 2019

The Bemisia tabaci (Gennadius) (Hemiptera: Aleyrodidae) complex comprises important pests and virus vectors in agricultural crops worldwide. In China, B. tabaci has spread to more than 20 provinces and caused severe losses of vegetables, fruits, and ornamental plants. However, B. tabaci has developed resistance to many insecticidal classes in Shandong Province, eastern China. In this study, we investigated the cryptic species, insecticide resistance and detoxifying enzymes of B. tabaci from six representative locations exhibiting severe damage in Shandong. At four of the six locations, B. tabaci Mediterranean (MED) comprised 100% of the samples collected. In a further two locations, species composition was predominantly (>94%) MED with B. tabaci Middle East–Asia Minor 1 (MEAM1), comprising a low proportion (<6%) of the samples collected. For all field populations, avermectin was the most effective insecticide against adult B. tabaci, pyriproxyfen had a significant effect on B. tabaci eggs and field populations were susceptible to pymetrozine. Six field populations of B. tabaci have developed low-to-moderate resistance to neonicotinoids. The detoxifying enzyme activity of carboxylesterase, glutathione S-transferase, and multifunctional oxidase were quantified. Multifunctional oxidase and glutathione S-transferase activity were positively correlated with insecticide resistance in several B. tabaci populations.
Patterns of Genomic Divergence and Signals of Selection in Sympatric and Allopatric Northeastern Pacific and Sea of Cortez Populations of the Sargo (Anisotremus davidsonii) and Longjaw Mudsucker (Gillichthys mirabilis)
Authors: Garcia Eric , Simison W Brian , Bernardi Giacomo
Published: November 2019

Studying how isolation can impact population divergence and adaptation in co-distributed species can bring us closer to understanding how landscapes affect biodiversity. The Sargo, Anisotremus davidsonii (Haemulidae), and the Longjaw mudsucker, Gillichthys mirabilis (Gobiidae), offer a notable framework to study such mechanisms as their Pacific populations cross phylogeographic breaks at Point Conception, California, United States, and Punta Eugenia, Mexico, and are separated to those in the Sea of Cortez by the Baja California peninsula. Here, thousands of loci are genotyped from 48 Sargos and 73 mudsuckers using RADseq to characterize overall genomic divergence, and search for common patterns of putatively neutral and non-neutral structure based on outlier loci among populations with hypothesized different levels of isolation. We further search for parallels between population divergence and the total proportion of outliers, outlier FST distribution, and the proportion of outliers matching coding regions in GenBank. Statistically significant differentiation is seen across Point Conception in mudsucker (FST = 0.15), Punta Eugenia in Sargo (FST = 0.02), and on either side of the Baja California peninsula in both species (FST = 0.11 and 0.23, in Sargo and mudsucker, respectively). Each species shows structure using neutral and non-neutral loci. Finally, higher population divergence yields a more even distribution of outliers along their differentiation range but does not always translate into higher outlier proportions or higher rates in which outliers are matched to coding regions. If repeated in similar systems, observed genomic patterns might reveal speciation signatures in diverse networks of population isolation.
Transitional Ecology: embedding ecological experiments into temporary urban public art
Authors: Kay Adam D , Scherber Elizabeth , Gaitan Hunter , Lovelee Amanda
Published: November 2019

Understanding the environmental consequences of urbanization is a pressing objective, and more experimental ecology in urban areas would be useful in meeting this goal. Here we introduce the concept of Transitional Ecology, which involves incorporating ecological field research into temporary public art on vacant urban land. Ecological experiments can yield useful results about urban systems over short time periods. Incorporating such experiments into temporary public art allows the space to provide diverse community benefits. Although this fusion introduces challenges for both ecologists and artists, it can also create formal and informal science training activities while raising public awareness of environmental science. We illustrate these challenges and opportunities with the Urban Flower Field, a phytoremediation project in a temporary urban park.
Spontaneous reactivation of a site-specifically placed transgene independent of copy number or DNA methylation
Authors: Wei Junjie , Dong Zhicheng , Ow David W
Published: November 2019

As millions of seeds are produced from a breeding line, the long-term stability of transgene expression is vital for commercial-scale production of seeds with transgenic traits. Transgenes can be silenced by epigenetic mechanisms, but reactivation of expression can occur as a result of treatment with chromatin modification inhibitors such as 5-azacytidine, from stress such as heat or UV-B, or in mutants that have acquired a defect in gene silencing. Previously, we targeted a gfp reporter gene into the tobacco (Nicotiana tabacum) genome by site-specific recombination but still found some silenced lines among independent integration events. One such line also had a second random copy and both copies showed DNA hypermethylation. To test whether removing the second copy would reactivate gfp expression, two T1 plants were backcrossed to the wild type. Whereas the silenced status was maintained in the progenies from one backcross, spontaneous partial reactivation of gfp expression was found among progenies from a second backcross. However, this reactivation did not correlate with loss of the second random copy or with a significant change in the pattern or amount of DNA hypermethylation. This finding supports the suggestion that gene reactivation does not necessarily involve loss of DNA homology or methylation.
Establishment of Reference Intervals for Alkaline Phosphatase in Pakistani Children Using a Data Mining Approach
Authors: Ahmed Sibtain , Zierk Jakob , Khan Aysha Habib
Published: November 2019

Objective

To establish reference intervals (RIs) for alkaline phosphatase (ALP) levels in Pakistani children using an indirect data mining approach.

Methods

ALP levels analyzed on a Siemens Advia 1800 analyzer using the International Federation of Clinical Chemistry’s photometric method for both inpatients and outpatients aged 1 to 17 years between January 2013 and December 2017, including patients from intensive care units and specialty units, were retrieved. RIs were calculated using a previously validated indirect algorithm developed by the German Society of Clinical Chemistry and Laboratory Medicine’s Working Group on Guide Limits.

Results

From a total of 108,845 results, after the exclusion of patients with multiple specimens, RIs were calculated for 24,628 males and 18,083 females with stratification into fine-grained age groups. These RIs demonstrate the complex age- and sex-related ALP dynamics occurring during physiological development.

Conclusion

The population-specific RIs serve to allow an accurate understanding of the fluctuations in analyte activity with increasing age and to support clinical decision making.
Super-Earth ingestion can explain the anomalously high metal abundances of M67 Y2235
Authors: Church Ross P , Mustill Alexander J , Liu Fan
Published: November 2019

We investigate the hypothesis that ingestion of a terrestrial or super-Earth planet could cause the anomalously high metal abundances seen in a turn-off star in the open cluster M67, when compared to other turn-off stars in the same cluster. We show that the mass of the convective envelope of the star is likely only 3.45 × 10−3 M⊙, and hence 5.2 M⊕ of rock is required to obtain the observed 0.128 dex metal enhancement. Rocky planets dissolve entirely in the convective envelope if they enter it with sufficiently tangential orbits: we find that the critical condition for dissolution is that the planet’s radial velocity must be less than 40% of its total velocity at the stellar surface; or, equivalently, the impact parameter must be greater than about 0.9. We model the delivery of rocky planets to the stellar surface both by planet-planet scattering in a realistic multi-planet system, and by Lidov–Kozai cycles driven by a more massive planetary or stellar companion. In both cases almost all planets that are ingested arrive at the star on grazing orbits and hence will dissolve in the surface convection zone. We conclude that super-Earth ingestion is a good explanation for the metal enhancement in M67 Y2235, and that a high-resolution spectroscopic survey of stellar abundances around the turn-off and main sequence of M67 has the potential to constrain the frequency of late-time dynamical instability in planetary systems.
nIFTy galaxy cluster simulations VI: the dynamical imprint of substructure on gaseous cluster outskirts.
Authors: Power C , Elahi P J , Welker C , Knebe A , Pearce F R , Yepes G , Davé R , Kay S T , McCarthy I G , Puchwein E , Borgani S , Cunnama D , Cui W , Schaye J
Published: November 2019

Galaxy cluster outskirts mark the transition region from the mildly non-linear cosmic web to the highly non-linear, virialised, cluster interior. It is in this transition region that the intra-cluster medium (ICM) begins to influence the properties of accreting galaxies and groups, as ram pressure impacts a galaxy’s cold gas content and subsequent star formation rate. Conversely, the thermodynamical properties of the ICM in this transition region should also feel the influence of accreting substructure (i.e. galaxies and groups), whose passage can drive shocks. In this paper, we use a suite of cosmological hydrodynamical zoom simulations of a single galaxy cluster, drawn from the nIFTy comparison project, to study how the dynamics of substructure accreted from the cosmic web influences the thermodynamical properties of the ICM in the cluster’s outskirts. We demonstrate how features evident in radial profiles of the ICM (e.g. gas density and temperature) can be linked to strong shocks, transient and short-lived in nature, driven by the passage of substructure. The range of astrophysical codes and galaxy formation models in our comparison are broadly consistent in their predictions (e.g. agreeing when and where shocks occur, but differing in how strong shocks will be); this is as we would expect of a process driven by large-scale gravitational dynamics and strong, inefficently radiating, shocks. This suggests that mapping such shock structures in the ICM in a cluster’s outskirts (via e.g. radio synchrotron emission) could provide a complementary measure of its recent merger and accretion history.
The Effects of a Systemwide Diagnostic Stewardship Change on West Nile Virus Disease Ordering Practices
Authors: Karaba Andrew H , Blair Paul W , Martin Kevin , Saheed Mustapha O , Carroll Karen C , Borowitz Michael J
Published: November 2019

We report that removing the clinically insensitive West Nile virus CSF nucleic acid amplification test (NAAT) from the electronic health record (EHR) test menu decreased costs and may have improved diagnostic yield. Removing high-cost, low yield tests from the EHR can be an effective diagnostic stewardship intervention.
Vascular Transposition of the Superior Cerebellar Artery Using a Fenestrated Clip and Fibrin Glue in Trigeminal Neuralgia: 2-Dimensional Operative Video
Authors: Abi-Aad Karl R , Turcotte Evelyn , Patra Devi P , Welz Matthew E , Maiti Tanmoy , Hess Ryan , Kalen Brian , Krishna Chandan , Zimmerman Richard S , Bendok Bernard R
Published: November 2019

This is the case of an 86-yr-old gentleman who presented with left facial pain exacerbated by eating, drinking, chewing, and shaving (distribution: V2, V3). The patient was diagnosed with trigeminal neuralgia and was refractory to medications. Imaging showed a superior cerebellar artery (SCA) loop adjacent to the trigeminal nerve root entry zone and a decision to perform a microvascular decompression of the fifth nerve was presented to the patient. After patient informed consent was obtained, a standard 3 cm × 3 cm retrosigmoid craniotomy was performed with the patient in a supine head turned position and in reverse Trendelenburg. The arachnoid bands tethering the SCA to the trigeminal nerve were sharply divided. A slit was then made in the tentorium and a 3 mm fenestrated clip was then used to secure the transposed SCA away from the trigeminal nerve. The SCA proximal to this was slightly patulous in its course so a small amount of a fibrin glue was also used to secure the more proximal SCA to the tentorium. The patient was symptom-free postoperatively and no longer required medical therapy. Additionally, imaging was consistent with adequate separation of the nerve from adjacent vessels.
1-5
Clinically Integrated Physical Therapist Practice in Cancer Care: A New Comprehensive Approach
Authors: Barnes Christopher A , Stout Nicole L , Varghese, Jr Thomas K , Ulrich Cornelia M , Couriel Daniel R , Lee Catherine J , Noren Christopher S , LaStayo Paul C
Published: November 2019

Best practice recommendations in cancer care increasingly call for integrated rehabilitation services to address physical impairments and disability. These recommendations have languished primarily due to a lack of pragmatic, generalizable intervention models. This perspective paper proposes a clinically integrated physical therapist (CI-PT) model that enables flexible and scalable services for screening, triage, and intervention addressing functional mobility. The model is based on (1) a CI-PT embedded in cancer care provider clinics, and (2) rehabilitation across the care continuum determined by the patient’s level of functional mobility. The CI-PT model includes regular screening of functional mobility in provider clinics via a patient-reported mobility measure—the Activity Measure for Post-Acute Care, a brief physical therapy evaluation tailored to the specific functional needs of the individual—and a tailored, skilled physical therapist intervention based on functional level. The CI-PT model provides a pragmatic, barrier-free, patient-centric, data-driven approach to integrating rehabilitation as part of standard care for survivors of cancer. The model standardizes CI-PT practice and may be sufficiently agile to provide targeted interventions in widely varying cancer settings and populations. Therefore, it may be ideal for wide implementation among outpatient oncological settings. Implementation of this model requires a shared approach to care that includes physical therapists, rehabilitation administrators, cancer care providers, and cancer center administrators.
A high-resolution fMRI investigation of BNST and centromedial amygdala activity as a function of affective stimulus predictability, anticipation, and duration
Authors: Pedersen Walker S , Muftuler L Tugan , Larson Christine L
Published: November 2019

Relative to the centromedial amygdala (CM), the bed nucleus of the stria terminalis (BNST) may exhibit more sustained activation toward threat, sensitivity to unpredictability and activation during anxious anticipation. These factors are often intertwined. For example, greater BNST (vs CM) activation during a block of aversive stimuli may reflect either more sustained activation to the stimuli or greater activation due to the anticipation of upcoming stimuli. To further investigate these questions, we had participants (19 females, 9 males) complete a task adapted from a study conducted by Somerville, Whalen and Kelly in 2013, during high-resolution 7-Tesla fMRI BOLD acquisition. We found a larger response to negative vs neutral blocks (sustained threat) than to images (transient) in the BNST, but not the CM. However, in an additional analysis, we also found BNST, but not CM, activation to the onset of the anticipation period on negative vs neutral trials, possibly contributing to BNST activation across negative blocks. Predictability did not affect CM or BNST activation. These results suggest a BNST role in anxious anticipation and highlight the need for further research clarifying the temporal response characteristics of these regions.
Suppression of Parvalbumin Interneuron Activity in the Prefrontal Cortex Recapitulates Features of Impaired Excitatory/Inhibitory Balance and Sensory Processing in Schizophrenia
Authors: Toader Oana , von Heimendahl Moritz , Schuelert Niklas , Nissen Wiebke , Rosenbrock Holger
Published: November 2019

Accumulating evidence supports parvalbumin expressing inhibitory interneuron (PV IN) dysfunction in the prefrontal cortex as a cause for cognitive impairment associated with schizophrenia (CIAS). PV IN decreased activity is suggested to be the culprit for many of the EEG deficits measured in patients, which correlate with deficits in working memory (WM), cognitive flexibility and attention. In the last few decades, CIAS has been recognized as a heavy burden on the quality of life of patients with schizophrenia, but little progress has been made in finding new treatment options. An important limiting factor in this process is the lack of adequate preclinical models and an incomplete understanding of the circuits engaged in cognition. In this study, we back-translated an auditory stimulation protocol regularly used in human EEG studies into mice and combined it with optogenetics to investigate the role of prefrontal cortex PV INs in excitatory/inhibitory balance and cortical processing. We also assessed spatial WM and reversal learning (RL) during inhibition of prefrontal cortex PV INs. We found significant impairments in trial-to-trial reliability, increased basal network activity and increased oscillation power at 20–60 Hz, and a decreased signal-to-noise ratio, but no significant impairments in behavior. These changes reflect some but not all neurophysiological deficits seen in patients with schizophrenia, suggesting that other neuronal populations and possibly brain regions are involved as well. Our work supports and expands previous findings and highlights the versatility of an approach that combines innovative technologies with back-translated tools used in humans.
Characterizing Colonization Patterns ofClavibacter michiganensisDuring Infection of Tolerant WildSolanumSpecies
Authors: Peritore-Galve F. Christopher , Miller Christine , Smart Christine D.
Published: November 2019

Clavibacter michiganensis is the Gram-positive causal agent of bacterial canker of tomato, an economically devastating disease with a worldwide distribution. C. michiganensis colonizes the xylem, leading to unilateral wilt, stem canker, and plant death. C. michiganensis can also infect developing tomato fruit through splash dispersal, forming exterior bird’s eye lesions. There are no documented sources of qualitative resistance in Solanum spp.; however, quantitative trait loci conferring tolerance in Solanum arcanum and Solanum habrochaites have been identified. Mechanisms of tolerance and C. michiganensis colonization patterns in wild tomato species remain poorly understood. This study describes differences in symptom development and colonization patterns of the wild type (WT) and a hypervirulent bacterial expansin knockout (ΔCmEXLX2) in wild and cultivated tomato genotypes. Overall, WT and ΔCmEXLX2 cause less severe symptoms in wild tomato species and are impeded in spread and colonization of the vascular system. Laser scanning confocal microscopy and scanning electron microscopy were used to observe preferential colonization of protoxylem vessels and reduced intravascular spread in wild tomatoes. Differences in C. michiganensis in vitro growth and aggregation were determined in xylem sap, which may suggest that responses to pathogen colonization are occurring, leading to reduced colonization density in wild tomato species. Finally, wild tomato fruit was determined to be susceptible to C. michiganensis through in vivo inoculations and assessing lesion numbers and size. Fruit symptom severity was in some cases unrelated to severity of symptoms during vascular infection, suggesting different mechanisms for colonization of different tissues.
The Effect of Foregrounding Intended Use on Observers’ Ratings and Comments in the Assessment of Clinical Competence
Authors: Tavares Walter , Young Meredith , Gauthier Geneviève , St-Onge Christina
Published: November 2019

Purpose

Some educational programs have adopted the premise that the same assessment can serve both formative and summative goals; however, how observers understand and integrate the intended uses of assessment may affect the way they execute the assessment task. The objective of this study was to explore the effect of foregrounding a different intended use (formative vs summative learner assessment) on observer contributions (ratings and comments).

Method

In this randomized, experimental, between-groups, mixed-methods study (May–September 2017), participants observed 3 prerecorded clinical performances under formative or summative assessment conditions. Participants rated performances using a global rating tool and provided comments. Participants were then asked to reconsider their ratings from the alternative perspective (from which they were originally blinded). They received the opportunity to alter their ratings and comments and to provide rationales for their decision to change or preserve their original ratings and comments. Outcomes included participant–observers’ comments, ratings, changes to each, and stated rationales for changing or preserving their contributions.

Results

Foregrounding different intended uses of assessment data for participant–observers did not result in differences in ratings, number or type of comments (both emphasized evaluative over constructive statements), or the ability to differentiate among performances. After adopting the alternative perspective, participant–observers made only small changes in ratings or comments. Participant–observers reported that they engage in the process in an evaluative manner despite different intended uses.

Conclusions

Foregrounding different intended uses for assessments did not result in significant systematic differences in the assessment data generated. Observers provided more evaluative than constructive statements overall, regardless of the intended use of the assessment. Future research is needed to explore whether these results hold in social/workplace-based contexts and how they might affect learners.
Seeking Inclusion Excellence: Understanding Racial Microaggressions as Experienced by Underrepresented Medical and Nursing Students
Authors: Ackerman-Barger Kupiri , Boatright Dowin , Gonzalez-Colaso Rosana , Orozco Regina , Latimore Darin
Published: November 2019

Purpose

To describe how racial microaggressions may affect optimal learning for under-represented health professions students.

Method

The authors conducted focus groups and individual interviews from November 2017 to June 2018 with 37 students at University of California, Davis and Yale University who self-identified as underrepresented in medicine or nursing. Questions explored incidence, response to, and effects of racial microaggressions, as well as students’ suggestions for change. Data were organized and coded, then thematic analysis was used to identify themes and subthemes.

Results

The data showed consistent examples of microaggressions across both health professions and schools, with peers, faculty, preceptors, and structural elements of the curricula all contributing to microaggressive behavior. The 3 major themes were: students felt devalued by microaggressions; students identified how microaggressions affected their learning, academic performance, and personal wellness; and students had suggestions for promoting inclusion.

Conclusions

The data indicated that students perceived that their daily experiences were affected by racial microaggressions. Participants reported strong emotions while experiencing racial microaggressions including feeling stressed, frustrated, and angered by these interactions. Further, students believed microaggressions negatively affected their learning, academic performance, and overall well-being. This study shows the need for leadership and faculty of health professions schools to implement policies, practices, and instructional strategies that support and leverage diversity so that innovative problem-solving can emerge to better serve underserved communities and reduce health disparities.
Approaches to Measuring Trends in Interdisciplinary Research Publications at One Academic Medical Center
Authors: Weston Christine M. , Terkowitz Mia S. , Thompson Carol B. , Ford Daniel E.
Published: November 2019

Purpose

To determine if interdisciplinary research has increased between 2005 and 2015, based on an analysis of journal articles containing at least 1 author from Johns Hopkins University, and to compare different methods for determining the disciplinarity of research articles.

Method

In 2017–2018, 100 peer-reviewed biomedical science articles were randomly selected from years 2005, 2010, and 2015 and classified as unidisciplinary or interdisciplinary based on Scopus author affiliation data (method 1). The corresponding authors of the 2010 and 2015 articles were sent a survey asking them to describe the disciplines involved in their research (method 2) and to define their research as unidisciplinary or interdisciplinary based on provided definitions (method 3).

Results

There was a statistically significant increase in the proportion of interdisciplinary articles in 2015 compared with both 2005 and 2010 (P = .02). Comparison of the 3 methods indicated that 45% of the articles were classified as interdisciplinary based on author affiliation data (method 1), 40% based on the corresponding author’s description of the disciplines involved in their research (method 2), and 71% based on the corresponding author’s definition of their article’s disciplinarity (method 3). There was a statistically significant difference in the proportion of articles classified as interdisciplinary between methods 1 and 3 (P < .001) and between methods 2 and 3 (P < .001).

Conclusions

This study found that interdisciplinary research increased at Johns Hopkins University over the past decade and highlights the difference between corresponding authors’ views of their own research and other methods for determining interdisciplinarity.
Opioid and Amphetamine Treatment Trends Among American Indians in the Great Plains
Authors: Mitton Julian A. , Jackson Sean , Ho J. Janet , Tobey Matthew
Published: November 2019

Objectives:

Traditionally underserved populations in the United States, particularly rural and American Indian/Alaska Native (AI/AN) communities, are disproportionately impacted by the opioid and amphetamine epidemics and have a higher risk for substance use disorders. AI/AN communities in the American Great Plains face exceptional health risks. We aim to describe recent trends in opioid and amphetamine treatment admissions for AI/ANs living in the Great Plains relative to that of the general population.

Methods:

We used data from the 2014 to 2016 Substance Abuse and Mental Health Services Administration (SAMHSA) Drug and Alcohol Services Information System (DASIS) Treatment Episode Data Set (TEDS) for Admissions. We extracted opioid and amphetamine treatment admissions for self-identified AI/AN and non-AI/AN patients living in the Great Plains: North Dakota, South Dakota, Nebraska, and Iowa. Average annual admission rates were calculated and compared from 2014 to 2016 for AI/AN versus non-AI/AN populations.

Results:

While opioid and amphetamine treatment admissions from 2014 to 2016 increased in both AI/AN (49 vs 80 per 10,000) and non-AI/AN (20 vs 26 per 10,000) populations, the rate of increase was significantly greater among AI/ANs (64% vs 32%; P < 0. 01). These trends are largely reflective of increased amphetamine use treatment admissions observed in both AI/AN and non-AI/AN populations.

Conclusions:

Treatment admissions for opioid and amphetamine use have increased from 2014 to 2016 for both AI/AN and non-AI/AN individuals in the Great Plains, driven largely by amphetamine use. AI/AN individuals were observed to seek care at a much higher rate. This increase in treatment admissions suggests increasing demand for services, which, in turn, necessitates greater investment of resources into AI/AN health facilities to address opioid and amphetamine use disorder in this underserved population.
Light syringe barrel (external fixator) for phalangeal and metacarpal fractures: A case series
Authors: Abdallah Mahmoud M. , Nageeb Mahmoud Ahmed , Moharram Ashraf Nehad , Amin Sherif Nabil , Mansour Ayman
Published: November 2019

Background:

External fixation is a well-established technique for management of displaced metacarpal and phalangeal fractures. External fixation can achieve adequate fixation with relatively low complications.

Methods:

This is a study of 45 patients (48 digits) with phalangeal and metacarpal fractures that were managed using a simple light external fixator system. Eighteen patients had a comminuted fracture pattern, sixteen had a transverse, ten had an oblique, and two had a spiral fracture pattern. Radiographic outcomes were reviewed on a regular basis after surgery. Functional outcomes were assessed using total active motion of the digit and plotted using the American Society for Surgery of the Hand (ASSH) score.

Results:

All the patients achieved radiographic fracture union at a mean duration of 6 wk (average 4-8 wk). As for functional outcomes according to the ASSH score, excellent results were achieved in 34, good results in three, fair results in nine, and poor in two. One patient had redisplacement that required revision internal fixation. Fair and poor results were found mainly in elderly and uncooperative patients due to noncompliance with postoperative hand mobility exercises.

Conclusions:

The light external fixator system provided a simple, easy, cheap, and adequate technique for management of displaced metacarpal and phalangeal fractures, with good radiographic and clinical outcomes. Strict adherence to hand motion exercises is mandatory to achieve favorable outcomes.

Level of Evidence:

Level IV.
YouTube as an information source for clubfoot: a quality analysis of video content
Authors: Ranade Ashish S. , Belthur Mohan V. , Oka Gauri A. , Malone Jason D.
Published: November 2019

Idiopathic clubfoot is the most common congenital anomaly of the lower extremity. YouTube has emerged as an important source of health-related information for patients and families. Parents seek information about clubfoot on YouTube. However, the quality of these videos remains unknown. Therefore, we decided to evaluate the quality of YouTube videos about clubfoot. We searched YouTube for clubfoot videos using appropriate keywords. English language videos with more than 10 000 views were included. Three fellowship trained pediatric orthopedic surgeons independently assessed the videos and classified them into corporate, hospital, education and private. The quality of information was assessed using the Modified DISCERN and JAMA benchmark scores. The search yielded 12 060 videos of which 42 were analyzed. There were 9 (21%) videos from corporate organizations, 12 (29%) from hospitals, 3 (7%) from educational organizations and 18 (43%) by private individuals. The mean Modified DISCERN score was 2.1 ± 1.07 (range 0.3–4) and mean JAMA benchmark score was 0.9 ± 0.65 (range 0–2). Educational videos had highest mean Modified DISCERN score (3.1 ± 0.85) and private videos, the least (1.43 ± 1). This difference was statistically significant (P = 0.004). Hospital videos had highest mean JAMA benchmark score of 1.3 ± 0.6 as compared with private videos which had the least mean score of 0.5 ± 0.6. This difference was also statistically significant (P = 0.001). The results of our study indicate that the quality of information on idiopathic clubfoot on YouTube needs improvement. Videos from educational and hospital sources should be preferred over private sources.
Outcomes at Skeletal Maturity of 34 Children With Scoliosis Treated With a Traditional Single Growing Rod
Authors: Bouthors Charlie , Gaume Mathilde , Glorion Chistophe , Miladi Lotfi
Published: November 2019

Study Design.

Retrospective case series.

Objectives.

To analyze the outcomes at skeletal maturity of patients treated with a single traditional growing rod (GR). To compare results of patients according to whether posterior spinal fusion (PSF) was performed at treatment completion.

Summary of Background Data.

Few studies examined the end results of GRs at skeletal maturity. There is no agreement on requirement of PSF at GR treatment completion.

Methods.

Clinical and radiological analysis of consecutive patients with severe and/or progressive scoliosis treated initially with traditional single GR. Group comparisons of patients with PSF and without fusion surgery at treatment completion.

Results.

Thirty-four patients underwent traditional single GR implantation at a median age of 11.7 years. Median follow-up was 6.5 years. At last follow-up, T1-S1 distance was increased by a median 116 mm (P < 0.001) and median major curve Cobb angle was changed from 55° preoperatively to 30° (P < 0.001). Complications included 26 rod fractures, 1 implant prominence, 4 proximal junctional kyphosis, 2 proximal hook dislodgments, and 2 wound infections. At the beginning our experience, PSF was performed systematically in 17 patients. Relying on spinal ankylosis, 17 patients were subsequently not fused at GR treatment completion (single GR removed N = 2, single GR retained N = 7, dual GR surgery N = 8). There were no statistical differences between groups in improvements of radiological parameters from preoperative GR insertion to last follow-up. No GR fracture occurred after dual GR surgery.

Conclusion.

Single GR allows curve control and promotes spinal growth. Dual GR is, however, recommended for rod fracture prevention and better correction maintenance. In patients with satisfactory deformity correction at skeletal maturity, one may consider retaining dual GR instead of performing PSF.

Level of Evidence: 4
Lower SRS Mental Health Scores are Associated With Greater Preoperative Pain in Patients With Adolescent Idiopathic Scoliosis
Authors: Hwang Steven W. , Pahys Joshua M. , Bastrom Tracey P. , Lonner Baron S. , Newton Peter O. , Samdani Amer F.
Published: November 2019

Study Design.

Retrospective review of a prospectively collected multicenter database.

Objective.

The aim of this study was to investigate factors associated with low preoperative SRS pain scores.

Summary of Background Data.

The prevalence of preoperative pain in patients with adolescent idiopathic scoliosis (AIS) has become increasingly evident and is a primary concern for patients and families. Greater preoperative pain is associated with more postoperative pain; however, less is understood about what contributes to preoperative pain.

Methods.

A prospectively collected, multicenter database was queried for patients with AIS. Patients were divided into 2 cohorts based on preoperative SRS pain scores: ≤ 3 (Pain cohort), 4 to 5 (No Pain cohort). Univariate analysis was performed identifying which factors were associated with a low preoperative SRS score and used for a CART analysis.

Results.

Of 2585 patients total, 2141 (83%) patients had SRS pain scores of 4 to 5 (No Pain) and 444 (17%) had SRS pain scores ≤3 (Pain). Female sex, older age, greater % body mass index, larger lumbar curves, greater T5–12 kyphosis, and lower mental health scores were associated with greater preoperative pain. In multivariate CART analysis, lower mental health SRS scores (P = 0.04) and older age (P = 0.003) remained significant, with mental health scores having the greatest contribution. In subdividing the mental health component questions, anxiety-related questions appeared to have the greatest effect followed by mood/depression (SRS Question 13: OR 2.04; Q16: OR 1.35; Q7: OR 1.31; Q3: OR 1.20).

Conclusion.

Anxiety and mood are potentially modifiable risk factors that have the greatest impact on pre- and postoperative pain. These results can be used to identify higher-risk patients and develop preoperative therapeutic protocols to improve postoperative outcomes.

Level of Evidence: 3
Suppression of Superoxide-Hydrogen Peroxide Production at Site IQ of Mitochondrial Complex I Attenuates Myocardial Stunning and Improves Postcardiac Arrest Outcomes
Authors: Piao Lin , Fang Yong-Hu , Hamanaka Robert B. , Mutlu Gökhan M. , Dezfulian Cameron , Archer Stephen L. , Sharp Willard W.
Published: November 2019

Objectives:

Cardiogenic shock following cardiopulmonary resuscitation for sudden cardiac arrest is common, occurring even in the absence of acute coronary artery occlusion, and contributes to high rates of postcardiopulmonary resuscitation mortality. The pathophysiology of this shock is unclear, and effective therapies for improving clinical outcomes are lacking.

Design:

Laboratory investigation.

Setting:

University laboratory.

Subjects:

C57BL/6 adult female mice.

Interventions:

Anesthetized and ventilated adult female C57BL/6 wild-type mice underwent a 4, 8, 12, or 16-minute potassium chloride-induced cardiac arrest followed by 90 seconds of cardiopulmonary resuscitation. Mice were then blindly randomized to a single IV injection of vehicle (phosphate-buffered saline) or suppressor of site IQ electron leak, an inhibitor of superoxide production by complex I of the mitochondrial electron transport chain. Suppressor of site IQ electron leak and vehicle were administered during cardiopulmonary resuscitation.

Measurements and Main Results:

Using a murine model of asystolic cardiac arrest, we discovered that duration of cardiac arrest prior to cardiopulmonary resuscitation determined postresuscitation success rates, degree of neurologic injury, and severity of myocardial dysfunction. Post-cardiopulmonary resuscitation cardiac dysfunction was not associated with myocardial necrosis, apoptosis, inflammation, or mitochondrial permeability transition pore opening. Furthermore, left ventricular function recovered within 72 hours of cardiopulmonary resuscitation, indicative of myocardial stunning. Postcardiopulmonary resuscitation, the myocardium exhibited increased reactive oxygen species and evidence of mitochondrial injury, specifically reperfusion-induced reactive oxygen species generation at electron transport chain complex I. Suppressor of site IQ electron leak, which inhibits complex I-dependent reactive oxygen species generation by suppression of site IQ electron leak, decreased myocardial reactive oxygen species generation and improved postcardiopulmonary resuscitation myocardial function, neurologic outcomes, and survival.

Conclusions:

The severity of cardiogenic shock following asystolic cardiac arrest is dependent on the length of cardiac arrest prior to cardiopulmonary resuscitation and is mediated by myocardial stunning resulting from mitochondrial electron transport chain complex I dysfunction. A novel pharmacologic agent targeting this mechanism, suppressor of site IQ electron leak, represents a potential, practical therapy for improving sudden cardiac arrest resuscitation outcomes.
Fibroblastic Rheumatism Versus Variant Disease of Multinucleate Cell Angiohistiocytoma
Authors: Cai Sophie Carrie Shan , Tee Shang Ian , Lee Joyce Siong See , Tan Lucinda Siyun
Published: November 2019

We report an unusual case of a 49-year-old woman who presented with persistent papulonodules over bilateral fingers and inframammary region in conjunction with features of connective tissue disease including symmetrical polyarthritis and Raynaud phenomenon. Skin biopsy showed an upper-to-mid dermal proliferation of bland spindled cells with thickened collagen bundles and occasional multinucleated giant cells. Dermal blood vessels were only marginally increased. On immunohistochemistry, both the spindled cells and multinucleated giant cells stained negatively for smooth muscle actin. Some of the spindled cells stained positively with CD68 and CD163, whereas the multinucleated giant cells stained negatively for both stains. Elastic fibers were absent on elastic Van Gieson. The clinical and histopathologic features raise a diagnostic dilemma between fibroblastic rheumatism and multinucleate cell angiohistiocytoma. The patient responded well to cyclosporine and methotrexate therapy, with gradual improvement of the finger nodules.