bluuebunny/crossref_metadata_2025 huggingface dataset:
What Is the Long-Term Impact of an Implant Stewardship Program on Orthopaedic Trauma Implant Pricing?
Authors: Morellato John , O'Hara Nathan N. , Baker Mitchell , O'Toole Robert V. , Pollak Andrew N.
Published: September 2020

Objectives:

To analyze the effectiveness of an implant stewardship program on implant cost containment and to estimate surgeons' responsiveness to implant price changes.

Design:

Interrupted time series.

Setting:

Level I trauma center.

Patients/Participants:

Monitored usage of 5 trauma constructs by 10 surgeons over a 5-year period.

Intervention:

Red-Yellow-Green (RYG) implant pricing comparison chart.

Main Outcome Measurements:

Primary outcomes were changes in the mean price, minimum price, and the number of price changes. The secondary outcome was surgeons' responsiveness to RYG/cost changes.

Results:

The study consisted of 2468 procedures. A mean construct price decrease of $66 per year [95% confidence interval (CI), $−170 to $−151], with distal femoral plates demonstrating the largest mean annual price decline ($486; 95% CI, $−540 to $−432). The minimum construct price decreased by $131 per year (95% CI, $−155 to $−111), with the largest reductions observed for distal femoral plates (−$436 per year; 95% CI, $−516 to $−354) and external fixators (−$122 per year; 95% CI, $−258 to $−136). The median price decrease was $407 (range: $6 to $2491) or 12.5% of the previous price. Positive changes in RYG levels increased surgeons' usage of tibial nails by 115%, femoral nails by 106%, and external fixators by 104%. Surgeons' implant selection was insensitive to RYG changes for distal femoral plates [RYG elasticity (E

RYG
): −0.74] and proximal tibia plates (E

RYG
: −0.21).

Conclusions:

The implant stewardship program was associated with substantial implant price reductions. Surgeons' implant selection was especially sensitive to price changes for intramedullary nails and external fixators.
Effects of Restoration of Sagittal Alignment on Adjacent Segment Degeneration in Instrumented Lumbar Fusions
Authors: Kim Sang-Il , Min Hyung-Ki , Ha Kee-Yong , Park Hyung-Youl , Cho Chang-Hee , Cho Ryu-Kyoung , Kim Young-Hoon
Published: September 2020

Study Design.

Retrospective case-control study.

Objective.

To investigate the effects of postoperative sagittal alignment on radiographic adjacent segment degeneration (ASD) after lumbar fusion surgery.

Summary of Background Data.

ASD is one of inherent problems with fusion surgery. Many confounding factors are related to the development of ASD. Recently, sagittal alignment has been emphasized for its significance on ASD.

Methods.

Seventy-three patients who underwent four-level lumbar fusion surgery (L2–S1) were divided into two groups according to postoperative sagittal alignment (pelvic incidence–lumbar lordosis [PI–LL] ≥ or <9°): 44 patients (matched group, including 10 patients who underwent pedicle subtraction osteotomy [PSO] at L4) and 29 patients (mismatched group). The general demographics, radiographic parameters, and clinical outcomes were recorded. Preoperative disc degeneration at L1–2 was evaluated by Pfirrmann grade and Kellgren-Lawrence (K-L) grade. Disc degeneration at L1–2 was evaluated by the K-L grade on 2-year postoperative X-rays.

Results.

The incidence of radiographic ASD (11 [25%] vs. 16 patients [55%], P = 0.02) and Oswestry Disability Index (ODI) scores (36.9 ± 19.9 vs. 49.4 ± 20.7, P = 0.015) at postoperative 2 years were significantly higher in the mismatched group. There were no significant differences in other demographic and radiographic parameters between the two groups. On subgroup analysis between 10 PSO patients and the mismatched group, the mismatched group showed a higher incidence of radiographic ASD (16 [55%] vs. 1 patient [10%], P = 0.041) and worse ODI scores (49.7 ± 20.5 vs. 39.0 ± 20.7, P = 0.040). Preoperative Pfirrmann grade at L1–2 (odds ratio [OR] = 4.191, 95% confidence interval [CI]: 1.754–10.013, P = 0.001) and postoperative PI–LL mismatch (OR = 4.890, 95% CI: 1.550–15.427, P = 0.007) showed significant relationships with the development of radiographic ASD at postoperative 2 years.

Conclusion.

The restoration of optimal sagittal alignment, even with PSO, may provide a protective effect on the development of radiographic ASD, although the preoperative disc degeneration grade was a risk factor for radiographic ASD.

Level of Evidence: 3
Knowledge, beliefs, and practices related to cancer screening and prevention in Lebanon: community and social media users’ perspectives
Authors: Telvizian Talar , Al Ghadban Yasmina , Alawa Jude , Mukherji Deborah , Zgheib Nathalie K. , Sawaf Bisher , Nasr Rihab , Bardus Marco
Published: September 2020

Objective

Common to many countries in the Middle East, Lebanon has an increasing cancer burden; however, national screening programs are limited to breast cancer. The literature on cancer screening practices and beliefs is scarce. This cross-sectional study investigates the knowledge, beliefs, and practices related to the prevention and screening for breast, cervical, colon, lung, and skin cancers among Lebanese residents, recruited through social media advertisements and community outreach activities.

Methods

Participants filled an anonymous questionnaire either via a web-based interface or using tablets distributed at primary health clinics. The characteristics of the two cohorts were compared with chi-square and t-tests. We performed descriptive analysis, followed by multivariate logistic regression for predictors of cancer screening.

Results

A total of 407 participants completed the survey online, and 262 filled the study in tablets available at primary care clinics. The two samples were significantly different in terms of age, education, and perceived socioeconomic status. Online participants demonstrated higher knowledge and higher participation in screening practices than their counterparts recruited through community outreach. Mammography (44.7% online and 39.9% in-person), and cervical cancer screening (44.5% online and 36.7% community) had the highest participation rates. In both samples, participants who were older and more educated were more likely to report engagement with cancer screening practices.

Conclusions

Our study revealed significant knowledge gaps in cancer prevention and screening. Different sampling techniques accessed diverse populations, highlighting the need for educational messages and targeted screening programs to be inclusive of socio-economically disadvantaged communities with low education and health literacy.
Quantitative CT angiography predicts large artery occlusion types and successful thrombectomy in acute ischemic stroke
Authors: Chien Chun , Lin Chun-Jen , Chang Feng-Chi , Chung Chih-Ping , Lin Chung-Jung , Liu Hung-Yu , Chi Nai-Fang , Hsu Li-Chi , Tang Chih-Wei , Guo Wan-Yuo , Luo Chao-Bao , Lai Yen-Jun , Lee I-Hui
Published: September 2020

Background:

Clinical and radiological outcomes of endovascular thrombectomy (EVT) are related to etiologies of large vessel occlusion (LVO) in acute stroke. However, preprocedural computed tomography angiography (CTA) or CT perfusion imaging can hardly distinguish embolic occlusion from atherosclerotic occlusion. We hypothesized that quantitative multiphase CTA (mCTA) of LVO may predict occlusion types and thrombectomy outcome.

Methods:

We retrospectively evaluated the consecutive stroke patients who had undergone mCTA and EVT <6 hours of onset at two independent medical centers. The intra-arterial radiodensities of Hounsfield unit (HU) were measured to examine the HUdistal/proximal ratio using receiver operating characteristic curve analysis. The derived cut-off value was re-examined in an independent cohort.

Results:

In the derivation cohort (n = 102), 81 patients (79.4%) were embolic occlusion without severe residual intracranial atherosclerotic stenosis (ICAS[−]) and 21 patients were atherosclerosis-related occlusion (ICAS[+]) based on digital subtraction angiography (DSA). The optimal cut-off to predict embolic occlusion was HU ratio <0.6 measured at 2 mm from the occlusion site (maximum area under the curve = 0.87; sensitivity 96%; specificity 81%). This cut-off also independently predicted successful recanalization using stent-retrievers and/or contact aspiration (modified Treatment in Cerebral Ischemia score ≥2b; p = 0.002) after adjusting for age, atrial fibrillation, and collateral circulation score, but not predicted favorable outcome at 3 months post stroke. Importantly, in the validation cohort (n = 95, 80% embolic occlusion), this HU ratio cut-off similarly predicted occlusion types and recanalization outcome, respectively.

Conclusion:

The mCTA-based quantitative radiodensities of acute LVO provides preprocedural predictive values of DSA-determined occlusion types and thrombectomy outcomes.
COVID-19 Exposure Among First Responders in Arizona
Authors: Shukla Vershalee , Lau Christine S.M. , Towns Mikayla , Mayer Jennifer , Kalkbrenner Kara , Beuerlein Steve , Prichard Pablo
Published: September 2020

Objective:

The number of COVID-19 cases in Arizona is rapidly increasing, leading the country in the rate of new daily cases. Exposure among first responders remains unknown.

Methods:

Rates of SARS-CoV-2 IgG among first responders in Arizona were determined, and attitudes/views about the impact of COVID-19 on their work life was analyzed.

Results:

Of 3326 first responders, 50 (1.50%) tested positive for SARS-CoV-2 IgG. Most first responders thought antibody testing would help ease their anxieties (62.5%) and be beneficial to their work-life (60.6%).

Conclusion:

The rate of COVID-19 exposure among first responders in Arizona is low—1.50%. COVID-19 is a concern among many of the first responders, and antibody testing was beneficial in easing their anxieties about going to work and performing work-related duties.
Cosmetic Glove-Like Finger Prosthesis—A Novel Technique: A Case Report
Authors: Kurian Byju Paul , Mathew Cinil , Joseph Angel Mary , George Merlyn
Published: September 2020

Introduction

Complete or partial finger loss is the most frequently encountered form of partial hand loss, which can result in physical, psychosocial, and economic damage to an individual. Thus, fabrication of a prosthesis that can offer a psychological, functional, and rehabilitative advantage can be a big morale booster to such individuals.

Materials and Methods

This clinical report presents a novel technique of prosthetic rehabilitation of a left thumb with thermoplastic resin and silicone material. Methods include making impressions of the donor and recipient finger, duplication of wax patterns of the donor finger, fabrication of a master cast for the fabrication of the finger using thermoplastic resin and silicone material, and external characterization.

Results

The thermoplastic resin silicone elastomeric prosthesis clearly fulfilled the patient's objective of restoring his defect with an aesthetically superior, lightweight prosthesis without the need to undergo any surgical procedures. The patient was comfortable using the prosthesis and was satisfied with the retention of the prosthesis. However, application of external characterization was required every 6 months.

Discussion

This article presents a new application of thermoplastic resin in maxillofacial prosthesis. This technique eliminates lengthy laboratory and clinical procedures and reduces the chair side time for practitioner and patient. It also is a cost-effective technique.

Conclusion

A convenient and affordable method of prosthetic rehabilitation of amputated fingers has been presented. The morale of the patient was also boosted to a great extent.
A Theoretical Model of Physical Function and Mobility Apprehension in Persons with Amputation of a Lower Limb
Authors: Mathis Shannon L. , Welch Maggi R.
Published: September 2020

Introduction

An avoidance behavior is an inhibitive response to normal activities of daily life based on actions taken to escape movement in tasks that one considers challenging. In persons with lower-limb amputation, pain catastrophizing, the tendency to ruminate and magnify painful sensations, is a risk factor for mobility apprehension, an avoidance behavior. Avoidance behavior leads to physical deconditioning of the muscles. The purpose of this study was to link the psychological trait of avoidance to physiological traits of strength for the purpose of understanding balance. It was hypothesized that in persons with lower-limb amputation, poor balance will correlate directly with mobility apprehension and indirectly with muscular strength.

Materials and Methods

Adult participants who had a well-fitting prosthesis and had the ability to ambulate at least 10 ft were asked to participate in the study. Participants completed questionnaires regarding demographic information and self-report instruments measuring mobility apprehension. Mobility apprehension was measured using the Tampa Scale for Kinesiophobia (TSK). Balance was measured using the Berg Balance Scale. A handheld dynamometer was used to assess isometric strength of the left and right hip extension, trunk flexors, and trunk extensors. Hip strength was defined as the mean value of the strength of the left and right hip extensors. Core strength was defined as the mean strength value between the trunk flexors and extensor muscles.

Results

Of the participants, 80% reported comorbidities (e.g., diabetes, high blood pressure, and heart disease). The mean (SD) TSK score was 38.65 (6.68), where a score of 39 or higher indicates a high level of mobility apprehension. The mean (SD) hip and core strengths were 15.78 (9.29) lb and 5.60 (3.17) lb, respectively. The mean (SD) Berg Balance score was 46.25 (6.74). There was a moderate direct correlation between balance and hip strength (r = 0.45, p = 0.046). Core strength approached a significant direct correlation with balance (r = 0.39, p = 0.085). However, mobility apprehension was not related to balance.

Conclusion

Results may assist clinicians in aiming exercise programs toward increasing hip and potentially core strength, thus improving balance to promote better mobility for individuals with a lower-limb amputation.
Canadians Reporting Sport-Related Concussions: Increasing and Now Stabilizing
Authors: Gordon Kevin E. , Kuhle Stefan
Published: September 2020

Background:

Canada is currently engaged in a national harmonization of strategies to prevent and manage sport-related concussions.

Objective:

To examine the annual incidence rates of reported sport-related concussions or other brain injuries by participants in the Canadian Community Health Survey, a national public health survey which provides nearly 2 decades of serial data using consistent methodology.

Design:

Serial cross-sectional survey.

Setting:

Population-based Canadian survey from 2000 to 2018 that collects data on “concussions or other brain injuries.”

Participants:

Respondents 12 years and older.

Independent Variables:

Sex and age categorized 12 to 14 years, 15 to 19 years, 20 to 29 years, and 30+ years.

Outcome measures:

National incidence rates of participants reporting concussions or other brain injuries occurring within the previous year while engaged in “organized sports/leisure sports or physical exercise.”

Results:

Data were available for 2000/01, 2003, 2005/6, 2009/10, 2013/4, and 2017/8 (N = 757 383). A previously stable annual incidence of reported sport-related concussions or other brain injuries increased nearly 2 and a half-fold from 2005/06 through 2013/14 (P < 0.0001) but seems to have stabilized recently (2013/14 vs 2017/8, P = 0.35). This trend is similar for both men and women but is manifest primarily within youth (12-19 years) as opposed to adults (>19 years). Approximately 1 in 450 Canadians 12 years and older report sport-related concussions or other brain injuries as their most significant injury associated with disability in the previous year (2017-2018: 221 per 100 000 population, 95% confidence interval: 179-264).

Conclusions:

In Canada, the annual incidence rates of reported sport-related concussions or other brain injuries is changing and may reflect improved reporting and recognition.
From the Other Side of the Bed
Authors: Jones Jamie L. , Barone Claudia , Brown Lana M. , Wright Patricia , Mitchell Anita , Ray Trenda
Published: September 2020

Background:

To provide patient- and family-centered care, health care providers must understand the caregiver experience. Evidence suggests that registered nurses functioning as family caregivers (RNFCs) may have unique experiences and challenges.

Purpose:

The purpose of this study was to explore the lived experiences of RNFCs during an adult family member's episode of care in the southern United States.

Methods:

A descriptive phenomenological approach was used to describe the essence of the RNFC experience throughout an episode of care. Twenty-five participants were recruited for semistructured, audio-recorded interviews. Data were analyzed using descriptive data analysis and constant comparison techniques.

Results:

Participants were predominantly female (88%). The essence of the phenomenon was dual roles. Five themes emerged: (1) blurring the boundaries, (2) revealing my identity, (3) having insider knowledge, (4) managing expectations, and (5) learning from my experience.

Conclusions:

While caregiver experiences may be similar, RNFCs struggle with dual roles of registered nurse and caregiver, occasionally blurring boundaries of care.
Building a Reliable Health Care System
Authors: Alexander Catherine , Rovinski-Wagner Christine , Wagner Sandra , Oliver Brant J.
Published: September 2020

Background:

There is limited evidence available identifying best practices to promote and sustain optimal outpatient-to-inpatient handoff processes to ensure safe and reliable continuity of care.

Local Problem:

A sentinel event occurred during the transition of care from the outpatient-to-inpatient setting. A root cause analysis revealed that the facility's standard operating procedure for patient handoffs was not consistently followed.

Methods:

A Lean Six Sigma approach was used to improve patient transfer with the implementation of a Situation-Background-Assessment-Recommendation handoff policy. Inferential and statistical process control methods were used to assess performance outcomes pre- and postdissemination.

Results:

Over 36 months there was a slow, steady decrease in patient transfer time including reduced variability. The most significant improvement effect occurred in the third year with a 50% reduction in transfer time.

Conclusions:

Longitudinal monitoring provides the opportunity to accurately identify beneficial outcomes, which develop downstream from initial quality improvement efforts.
Dysmenorrhea Symptom-Based Phenotypes
Authors: Chen Chen X. , Carpenter Janet S. , Ofner Susan , LaPradd Michelle , Fortenberry J. Dennis
Published: September 2020

Background

Dysmenorrhea is a prevalent pain condition among women and a risk factor for other chronic pain conditions. Individuals vary in dysmenorrhea pain severity, the number of painful sites, and co-occurring gastrointestinal symptoms. Three dysmenorrhea symptom-based phenotypes were previously identified using latent class analysis; however, there is a need to validate these in an independent sample, so they can be used in mechanistic and interventional research. There is also a need to further characterize dysmenorrhea symptom-based phenotypes in terms of demographic, clinical, and psychobehavioral characteristics so they can be used to inform precision dysmenorrhea treatment.

Objectives

The study objectives were to (a) determine whether the same dysmenorrhea symptom-based phenotypes would be found in a new sample; (b) determine whether including demographic, clinical, and psychobehavioral covariates in latent class analyses would change individuals’ phenotype memberships; and (c) investigate relationships between dysmenorrhea symptom-based phenotypes and demographic, clinical, and psychobehavioral characteristics.

Methods

This cross-sectional survey study included 678 women (aged 14–42 years) with dysmenorrhea. Participants reported dysmenorrhea symptom severity, demographic, clinical (comorbid chronic pain and gynecological conditions), and psychobehavioral characteristics (perceived stress, anxiety, depression, sleep disturbance, and pain catastrophizing). We used latent class analysis to identify symptom-based phenotypes. We compared analyses with and without covariates (i.e., demographic, clinical, and psychobehavioral characteristics) to determine if individuals’ phenotype memberships changed. We then examined associations between phenotypes and demographic, clinical, and psychobehavioral characteristics.

Results

We reproduced three dysmenorrhea symptom-based phenotypes: the “mild localized pain” phenotype (characterized by mild abdominal cramps), the “severe localized pain” phenotype (characterized by severe abdominal cramps), and the “multiple severe symptoms” phenotype (characterized by severe pain at multiple locations and gastrointestinal symptoms). Analyses with and without covariates had little effect on individuals’ phenotype membership. Race, comorbid chronic pain condition, endometriosis, and pain catastrophizing were significantly associated with the dysmenorrhea phenotypes.

Discussion

Findings provide a foundation to further study mechanisms of dysmenorrhea symptom heterogeneity and develop dysmenorrhea precision treatments. The three dysmenorrhea symptom-based phenotypes were validated in a second sample. Demographic, clinical, and psychobehavioral factors were associated with dysmenorrhea symptom-based phenotypes.
Declining Chlamydia and Gonorrhea Diagnoses Among Pregnant Women in South Carolina, 2008 to 2018
Authors: Lazenby Gweneth B. , Savage Ashlyn H. , Horner Gwynneth , Richmond Joshua , Peterman Thomas A.
Published: September 2020

Background

Reported US cases of chlamydia and gonorrhea have increased since 2000, whereas studies in select populations suggest that the prevalence of these diseases has decreased. We sought to determine if these diagnoses are increasing among pregnant women delivering at our center.

Methods

This is a retrospective study of women delivering at least 1 infant >18 weeks of gestation at the Medical University of South Carolina for 11 years (2008–2018). Using the perinatal information system, we collected maternal race, age, insurer, and chlamydia and gonorrhea screening results during the pregnancy of record. Cochran-Armitage trend analyses were performed to evaluate trends in these diagnoses by delivery year for all women and for age/race subgroups.

Results

During the study period, there were 24,807 deliveries. The median age of women was 28 years (interquartile range, 23–32 years). Five percent (5.0%) of women were diagnosed with chlamydia and 1.2% with gonorrhea. The percent of women diagnosed decreased for both chlamydia (9.6%–3.4%) and gonorrhea (2.5%–1.1%; P < 0.001, trend analyses for both). A higher percentage of Black women had chlamydia and gonorrhea, and both diagnoses declined over time: 17.4% to 6.9% (P < 0.0001) for chlamydia and 5.8% to 2.1% (P < 0.0001) for gonorrhea. In a subanalysis of race and age, Black women younger than 25 years experienced the most significant decline in chlamydia diagnoses (P < 0.0001).

Conclusions

We observed declining diagnoses of chlamydia and gonorrhea among pregnant women in our center. Although Black women delivering were more likely to have either diagnoses, they experienced a significant decline in both chlamydia and gonorrhea over time.
Syphilitic Reinfections During the Same Pregnancy—Florida, 2018
Authors: Matthias James , Sanon Ruth , Bowen Virginia B. , Spencer Emma C. , Peterman Thomas A.
Published: September 2020

We reviewed all cases of syphilis reported among pregnant women in Florida in 2018 for syphilitic reinfection. Nineteen (7.3%) of 261 pregnant women with syphilis were reported as reinfected during the same pregnancy. Timely rescreening and treatment prevented 6 (31.6%) of 19 reinfected women from delivering infants with congenital syphilis.
Detection of Recurrent Hepatitis C Viremia Using Surveillance Data, New York City
Authors: Guerra Kevin , Bocour Angelica , Moore Miranda S. , Winters Ann
Published: September 2020

The introduction of direct-acting antivirals for treating hepatitis C virus (HCV) infection has greatly improved cure rates. However, persons with past HCV infection who engage in high-risk behaviors can be reinfected. Surveillance data from the New York City (NYC) Health Department were used to detect and investigate individuals cured during January 2014 to December 2016 who had a subsequent positive RNA test (recurrence) by April 2018. Clinical interpretation of recurrence was obtained using provider interviews and review of medical records available through Regional Health Information Organizations. Among 6938 cured individuals, 209 recurrence events were detected (2.7 per 100 person-years). Investigations were completed for 62 (30%) events. Of 38 investigated events occurring less than 12 months postcure, 17 (45%) were relapses; of 24 events occurring 12 or more months postcure, only one (4%) was a relapse. Understanding the timing, frequency, and clinical interpretation of HCV recurrence will guide HCV prevention and elimination efforts for NYC.
Receipt and Timeliness of Newborn Hearing Screening and Diagnostic Services Among Babies Born in 2017 in 9 States
Authors: Deng Xidong , Ema Suhana , Mason Craig , Nash Ashley , Carbone Eric , Gaffney Marcus
Published: September 2020

Context:

By providing timely services at all steps along the continuum of the early hearing detection and intervention (EHDI) process, providers may be able to lessen potential adverse effects of late identification of hearing loss on children's language development.

Objective:

To examine the timeliness of key events in the EHDI process from birth through diagnosis of hearing loss among different populations.

Design:

Retrospective, cross-sectional.

Setting:

Data pooled from 9 states' EHDI information systems were used to determine the extent to which timely screening and diagnosis were achieved by 754 613 infants born in calendar year 2017. Enrollment into early intervention for children diagnosed is not examined here due to incomplete data.

Participants:

Nine state EHDI programs were selected to participate in this study for their successful experience in using EHDI-IS to collect detailed child-level data.

Main Outcome Measures:

Age of service, rate of service receipt.

Results:

Median age of newborn hearing screening was 1 day, and median age of hearing loss diagnosis was 68 days. Early completion of newborn hearing screening was associated with maternal education, maternal race/ethnicity, and admission into a neonatal intensive care unit (NICU). Receiving and completing follow-up diagnostic services were associated with maternal education, maternal race/ethnicity, age of screening, and enrollment into the Women, Infants, and Children program.

Conclusions:

Timely completion of the newborn hearing screening is achieved by most of the population among the participating states. Increased efforts may be considered by state EHDI programs to provide additional follow-up and education to underrepresented racial/ethnic groups, mothers with less education, and NICU infants and their families as these groups appear to be at an increased risk for delayed diagnostic testing for hearing loss.
Perceptions of Syringe Service Programs and Supervised Use Sites Among a Sample of Registered Voters in a US State
Authors: Brooks-Russell Ashley , Brandspigel Sara , Franco Carol Y. , Alishahi Musheng L. , Lee-Winn Angela E.
Published: September 2020

Context:

The decision to initiate a syringe service program or expand to a supervised use site is often influenced by local public support or opposition.

Objective:

The purpose of this study was to better understand public attitudes to local syringe service programs to inform the possibility of expanding services.

Design, Setting, and Participants:

We surveyed a sample of registered voters (n = 690) in the 8 counties in the state of Colorado with existing syringe service programs.

Main Outcome Measures:

Respondents were asked about their awareness of and attitudes toward syringe service programs and supervised use sites.

Results:

More than three-fourths of respondents reported they were familiar with syringe service programs, but only a quarter knew they were legal, despite all survey respondents living near an operating program. Nearly one in 3 respondents thought a syringe service program or a supervised use site makes a community better, and a majority (57%) thought supervised use sites should be legal in their state. There were significant differences in attitudes toward the benefits and risks of syringe service programs by political party affiliation.

Conclusion:

Understanding the level of community knowledge and support for syringe service programs, as well as the reasons for opposition, can be helpful in addressing community concerns when seeking to initiate or expand services.
Mechanical Vibration–Extracted Stromal Vascular Fraction Improves Volume Retention after Autologous Fat Grafting
Authors: Zhang Kai , Liu Fuwei , Zhang Yanyuan , Huang Xin , Tang Mingyue , Hou Yan , Lv Qianxin , Jin Dan , Li Yunpeng , Kong Liang
Published: September 2020

Background:

The stromal vascular fraction can improve volume retention after fat grafting, but the optimal stromal vascular fraction extraction method remains controversial. This study investigated the effect of mechanical vibration on stromal vascular fraction activity and explored the efficacy of vibration as a new extraction method compared to centrifugation, enzyme digestion, and nanoemulsion methods.

Methods:

Twenty-four rabbits were divided into three groups, and adipose tissue was harvested from the scapular region of each rabbit. In the first group, stromal vascular fraction was extracted from adipose tissue by vibration with different frequencies and durations. Cell counts and colony formation were assessed to determine the optimal vibration parameters. In the second group, stromal vascular fraction was extracted by the four methods, and the cell counts, proliferation, and adipogenic capabilities were observed in vitro. In the third group, adipose tissue mixed with stromal vascular fraction extracted by means of the four methods was grafted into rabbit ears. Volume retention and histologic changes were evaluated over 24 weeks.

Results:

Stromal vascular fraction activity was not influenced by low-frequency (≤45 Hz) and short-duration (≤20 minutes) vibrations. Vibration at 30 Hz for 15 minutes was most efficient for stromal vascular fraction extraction. In vitro, stromal vascular fraction extracted by vibration showed advantages for cell viability. In vivo, the vibration group showed a more normal tissue morphology and a higher retention rate (60.68 ± 7.07 percent) than the enzyme digestion (31.88 ± 4.99 percent), centrifugation (43.76 ± 4.32 percent), and nanoemulsion groups (21.79 ± 3.57 percent) (p < 0.05).

Conclusion:

Vibration at 30 Hz for 15 minutes is recommended as a novel nonenzymatic method to extract stromal vascular fraction with high activity.
Progressive Bone Destruction in Rapidly Destructive Coxopathy Is Characterized by Elevated Serum Levels of Matrix Metalloprotease-3 and C-Reactive Protein
Authors: Ando Wataru , Hashimoto Yoshichika , Yasui Hirohiko , Ogawa Takeshi , Koyama Tsuyoshi , Tsuda Takayuki , Ohzono Kenji
Published: September 2020

Objective

Rapidly destructive coxopathy (RDC) is a rare condition characterized by rapid joint space narrowing; however, its pathology remains unclear. This study aimed to clarify the association of laboratory biomarkers with the radiological progression of RDC.

Methods

We examined 34 female and 4 male patients with RDC between October 2010 and April 2018. Patients were divided into 3 groups according to the progressive radiographic staging of RDC. Group 1 patients had progressive obliteration of the joint space without subchondral destruction (n = 11), group 2 had progressed subchondral destruction (n = 18), and group 3 had cessation of bone destruction observed for more than 6 months (n = 9). Clinical evaluation results were assessed using the Japanese Orthopedic Association hip score. Blood test results, including serum matrix metalloproteinase-3 (MMP-3), and C-reactive protein (CRP), were also evaluated.

Results

There were no significant differences in patient background or Japanese Orthopedic Association hip scores among the groups. However, there were significant differences in MMP-3 levels among groups, with MMP-3 levels in group 2 being significantly higher than those in group 3 (group 2, 118.4 ± 81.2 ng/mL; group 3, 42.5 ± 15.1 ng/mL, p < 0.001). The CRP levels in group 2 were also significantly higher than those in group 3 (group 2, 0.77 ± 0.92 mg/dL; group 3, 0.13 ± 0.07 mg/dL, p = 0.019), but elevated CRP levels in group 2 decreased back to the reference range.

Conclusions

Matrix metalloproteinase-3 and CRP are the biomarkers of RDC progression but not of its occurrence. Severe inflammatory response may be associated with bone destruction in RDC.
Endoscopic Repair of Nasal Septal Perforations With Fascia Lata
Authors: Ozdilek Alper , Kilavuz Ahmet Erdem , Serin Gediz Murat
Published: September 2020

Purpose:

Nasal septal perforation (NSP) consists of defects of mucosa, cartilage, and bone. Nasal septal surgery is by far the most common cause of NSP. Many surgical approaches have been described for NSP repair. In this study, the authors describe a novel technique for repairing all sizes of NSP using an only fascia lata graft.

Methods:

The authors implemented a retrospective study design. Seventeen patients who underwent NSP repair between January 2016 and January 2019 were included to the study. Entire nasal surgical steps were performed under endoscopic view, harvested fascia lata graft is placed in tympanoplasty fashion after all edges of perforation is elevated and implantation bed is prepared.

Results:

The mean size of the septal peforations were 18.52 ± 4.17 mm horizontally, 11.52 ± 3.42 mm vertically. The mean follow up period was 14.47 ± 9.5 months (range: 2–36). In 15 of the 17 patients, total NSP closure was achieved (88,23%).

Conclusions:

Endoscopic close technique using fascia lata for nasal septal perforation closure is a safe and reliable technique with high success rate and it should be considered in patients with nasal septal perforation.
Columellar Wound Immediately After Open Rhinoseptoplasty Treated With Application of DuoDERM Extra Thin
Authors: In Seung Min , An Hong Geun , Kim Jong-Yeup , Lee Ki-Il
Published: September 2020

Most patients who undergo open rhinoseptoplasty do not develop any wound at the transcolumellar incision site. However, some patients require wound care immediately post-operation. Dressing is difficult to perform in the columellar region because of the location. Here, we report 2 cases of columellar wound as a complication of open rhinoseptoplasty. A patient developed mild wound dehiscence immediately after primary rhinoseptoplasty, whereas another developed partial columellar skin necrosis after the revision operation. We applied DuoDERM Extra Thin dressing (ConvaTec Group, Deeside, UK) for columellar wound and achieved healing. DuoDERM Extra Thin can be a simple and easy dressing material for immediate care of transcolumellar wounds.
Transseptal Suturing With Turbinate Coblation in Nasal Septoturbinoplasty
Authors: Lee Yi-Chan , Hsin Li-Jen , Chang Chih-Chen , Tsai Yao-Te , Fang Tuan-Jen
Published: September 2020

Objective:

Transseptal suture-assisted septoplasty and coblation are two techniques that can effectively treat septal deviation and inferior turbinate hypertrophy without the need for post-operative packing. In the existing literature, however, the early post-operative symptoms and surgical outcomes of the combination of these 2 procedures have not been addressed.

Method:

This retrospective study included 65 patients who underwent concomitant nasal septoturbinoplasty. The patients were divided into two groups: the transseptal suture-assisted septoplasty and inferior turbinate coblation group (no-packing group: 33 patients) and the conventional septoturbinoplasty group with merocel packing (packing group: 32 patients). The post-operative symptoms within 14 days, complications and surgical outcomes at 3 months after surgery were recorded and analyzed.

Results:

The patients in the no-packing group experienced less nasal obstruction on the first, second and third days post-operatively than those in the packing group (P < 0.000, P < 0.000, and P = 0.043, respectively). The patients in the no-packing group also had less nasal bleeding (P = 0.000 and P = 0.001), dry mouth sensation (P = 0.016 and P = 0.034) and swallowing disturbance (P = 0.013 and P = 0.012) on the first and second days post-operatively, respectively. In terms of orbital symptoms, the patients in the packing group had more severe epiphora (P = 0.031) and swelling sensations (P = 0.040) on the first day post-operatively.

Conclusions:

Transseptal suturing and coblation-assisted septoturbinoplasty can be considered to prevent packing-related comorbidities and reduce post-operative discomfort.
Complete Visual Recovery From Severe Outer Retinitis After Tonsillitis
Authors: Kawashima Rumi , Matsushita Kenji , Hashida Noriyasu , Kuniyoshi Kazuki , Fujikado Takashi , Nishida Kohji
Published: September 2020

Background:

To report a case of severe acute bilateral outer retinitis after tonsillitis and rapid morphologic and functional recovery after steroid treatment.

Methods:

Observational case report.

Results:

A 26-year-old woman with acute bilateral blurred vision that developed after tonsillitis underwent spectral-domain optical coherence tomography (SD-OCT) that showed photoreceptor outer segment damage. Full-field electroretinography (ERG) and multifocal ERG were nonrecordable. The patient had a remarkable anatomic and functional recovery in response to steroid treatment; however, partial damage remained around the macula on SD-OCT, and an adaptive optics imaging system showed damaged cone photoreceptors.

Conclusions:

Prednisolone is an effective treatment for a disease that is believed to be due to suspicious involvement of the autoimmune system. Even severe outer retinitis can recover completely with rapid diagnosis and treatment.
Utility of Spectral-Domain Optical Coherence Tomography in Differentiating Papilledema From Pseudopapilledema: A Prospective Longitudinal Study
Authors: Jivraj Imran , Cruz Cesar A. , Pistilli Maxwell , Kohli Anita A. , Liu Grant T. , Shindler Kenneth S. , Avery Robert A. , Garvin Mona K. , Wang Jui-Kai , Ross Ahmara , Tamhankar Madhura A.
Published: September 2020

Background:

Prospective and longitudinal studies assessing the utility of spectral-domain optical coherence tomography (SD-OCT) to differentiate papilledema from pseudopapilledema are lacking. We studied the sensitivity and specificity of baseline and longitudinal changes in SD-OCT parameters with 3D segmentation software to distinguish between papilledema and pseudopapilledema in a cohort of patients referred for evaluation of undiagnosed optic disc elevation.

Methods:

Fifty-two adult patients with optic disc elevation were enrolled in a prospective longitudinal study. A diagnosis of papilledema was made when there was a change in the appearance of the optic disc elevation on fundus photographs as noted by an independent observer at or before 6 months. The degree of optic disc elevation was graded using the Frisen scale and patients with mild optic disc elevation (Frisen grades 1 and 2) were separately analyzed. SD-OCT parameters including peripapillary retinal nerve fiber layer (pRNFL), total retinal thickness (TRT), paracentral ganglion cell layer–inner plexiform layer (GCL-IPL) thickness, and optic nerve head volume (ONHV) at baseline and within 6 months of follow-up were measured.

Results:

Twenty-seven (52%) patients were diagnosed with papilledema and 25 (48%) with pseudopapilledema. Among patients with mild optic disc elevation (Frisen grades 1 and 2), baseline pRNFL (110.1 µm vs 151.3 µm) and change in pRNFL (ΔpRNFL) (7.3 µm vs 52.3 µm) were greater among those with papilledema. Baseline and absolute changes in TRT and ONHV were also significantly higher among patients with papilledema. The mean GCL-IPL thickness was similar at baseline, but there was a small reduction in GCL-IPL thickness among patients with papilledema. Receiver operator curves (ROCs) were generated; ΔpRNFL (0.93), ΔTRT (0.94), and ΔONHV (0.95) had the highest area under the curve (AUC).

Conclusions:

The mean baseline and absolute changes in SD-OCT measurements (pRFNL, TRT, and ONHV) were significantly greater among patients with papilledema, and remained significantly greater when patients with mild optic disc elevation were separately analyzed. ROCs demonstrated that ΔpRNFL, ΔTRT, and ΔONHV have the highest AUC and are best able to differentiate between papilledema and pseudopapilledema.
Handheld Optical Coherence Tomography in a Young Infant With Albinism and Fovea Plana
Authors: Rufai Sohaib R. , Lee Helena , Gottlob Irene
Published: September 2020

We present handheld optical coherence tomography (OCT) diagnosis of Grade 4 foveal hypoplasia (fovea plana) in a 28-day-old infant with albinism. Grade 4 foveal hypoplasia is characterized by the absence of the foveal pit, absence of outer segment lengthening, and absence of outer nuclear layer widening. Binocular visual acuity at 58 months follow-up was 1.2 logarithm of the minimal angle of resolution (logMAR). We describe our handheld OCT acquisition protocol and compare the morphological features with a healthy, age-matched control subject.
Healthy cardiovascular biomarkers across the lifespan in wild-born chimpanzees (Pan troglodytes)
Authors: Cole Megan F. , Cantwell Averill , Rukundo Joshua , Ajarova Lilly , Fernandez-Navarro Sofia , Atencia Rebeca , Rosati Alexandra G.
Published: September 2020

Chimpanzees (Pan troglodytes) are a crucial model for understanding the evolution of human health and longevity. Cardiovascular disease is a major source of mortality during ageing in humans and therefore a key issue for comparative research. Current data indicate that compared to humans, chimpanzees have proatherogenic blood lipid profiles, an important risk factor for cardiovascular disease in humans. However, most work to date on chimpanzee lipids come from laboratory-living populations where lifestyles diverge from a wild context. Here, we examined cardiovascular profiles in chimpanzees living in African sanctuaries, who range semi-free in large forested enclosures, consume a naturalistic diet, and generally experience conditions more similar to a wild chimpanzee lifestyle. We measured blood lipids, body weight and body fat in 75 sanctuary chimpanzees and compared them to publicly available data from laboratory-living chimpanzees from the Primate Aging Database. We found that semi-free-ranging chimpanzees exhibited lower body weight and lower levels of lipids that are risk factors for human cardiovascular disease, and that some of these disparities increased with age. Our findings support the hypothesis that lifestyle can shape health indices in chimpanzees, similar to effects observed across human populations, and contribute to an emerging understanding of human cardiovascular health in an evolutionary context.

This article is part of the theme issue ‘Evolution of the primate ageing process’.
Optogenetic evaluation of the ability of different cutaneous C-fiber afferents to evoke aversive behaviors
Authors: Warwick Charles A. , Cassidy Colleen , Hachisuka Junichi , Wright Margaret C. , Baumbauer Kyle M. , Adelman Peter C. , Lee Kuan H. , Smith Kelly M. , Ross Sarah E. , Koerber H. Richard
Published: September 2020

Most cutaneous C-fibers, including both peptidergic and non-peptidergic subtypes are presumed to be nociceptors and respond to noxious input in a graded manner. However, mechanically sensitive, non-peptidergic C-fibers also respond to mechanical input in the innocuous range, and so the degree to which they contribute to nociception remains unclear. To address this gap, we investigated the function of non-peptidergic afferents using theMrgprdCreallele. In real time place aversion studies, we found that low frequency optogenetic activation ofMrgrpdCrelineage neurons was not aversive in naïve mice, but became aversive after spared nerve injury (SNI). To address the underlying mechanisms of this allodynia, we recorded from lamina I spinoparabrachial (SPB) neurons using the semi-intactex vivopreparation. Following SNI, innocuous brushing of the skin gave rise to abnormal activity in lamina I SPB neurons, consisting of an increase in the proportion of recorded neurons that responded with excitatory post synaptic potentials or action potentials. This increase was likely due, at least in part, to an increase in the proportion of lamina I (LI) SPB neurons that received input upon optogenetic activation ofMrgprdCrelineage neurons. Intriguingly, in SPB neurons there was a significant increase in the EPSC latency fromMrgprdCrelineage input following SNI, consistent with the possibility that the greater activation post SNI could be due to the recruitment of a new polysynaptic circuit. Together, our findings suggestMrgprdCrelineage neurons can provide mechanical input to the dorsal horn that is non-noxious before injury but becomes noxious afterwards due the engagement of a previously silent polysynaptic circuit in the dorsal horn.
Quantifying dispersal variability among nearshore marine populations
Authors: Catalano Katrina A. , Dedrick Allison G. , Stuart Michelle R. , Puritz Jonathan B. , Montes Humberto R. , Pinsky Malin L.
Published: September 2020

Dispersal drives diverse processes from population persistence to community dynamics. However, the amount of temporal variation in dispersal and its consequences for metapopulation dynamics is largely unknown for organisms with environmentally driven dispersal (e.g., many marine larvae, arthropods, and plant seeds). Here, we quantify variation in the dispersal kernel across seven years and monsoon seasons for a common coral reef fish,Amphiprion clarkii, using genetic parentage assignments. Connectivity patterns varied strongly among years and seasons in the scale and shape but not in the direction of dispersal. This interannual variation in dispersal kernels introduced temporal covariance among dispersal routes with overall positive correlations in connections across the metapopulation that may reduce stochastic metapopulation growth rates. The extent of variation in mean dispersal distance observed here among years is comparable in magnitude to the differences across reef fish species. Considering dispersal variability will be an important avenue for further metapopulation and metacommunity research across diverse taxa.