bluuebunny/crossref_metadata_2025 huggingface dataset:
A Simple and High-Throughput LC–MS-MS Method for Simultaneous Measurement of Nicotine, Cotinine, 3-OH Cotinine, Nornicotine and Anabasine in Urine and Its Application in the General Korean Population
Authors: Oh Jongwon , Park Min-Seung , Chun Mi-Ryung , Hwang Jung Hye , Lee Jin-Young , Jee Jae Hwan , Lee Soo-Youn
Published: November 2020

Measuring nicotine metabolites is the most objective method for identifying smoke exposure. Liquid chromatography--tandem mass spectrometry (LC–MS-MS) can measure multiple metabolites and is sensitive enough to detect low concentrations of metabolites. Therefore, we developed a simple and high-throughput method for measuring nicotine, cotinine, trans-3ʹ-hydroxycotinine (3-OH cotinine), nornicotine and anabasine for population-based studies using LC–MS-MS. Each 30 µL of urine sample was diluted with 90 µL of acetonitrile containing five deuterated internal standards. Chromatographic separation used a C18 column, and LC–MS-MS analysis was performed with a multiple reaction monitoring mode. The chromatographic run time for each sample was 6.5 min. The method was validated by evaluating selectivity, interference, limit of detection, lower limit of quantification, precision, accuracy, linearity, extraction recovery, matrix effect and carryover according to guidelines. Our methods required a short preparation time (∼20 min) while simultaneously measuring five markers for smoking status. No endogenous or exogenous interference was found. Our method showed excellent precision and accuracy: within-run coefficient of variation (CV) 2.9–9.4%, between-run CV 4.8–8.7% and bias −10.1 to 5.3%. Linear dynamic ranges were 1–10,000 ng/mL for nicotine, nornicotine and anabasine; 2–5,000 ng/mL for cotinine and 5–15,000 ng/mL for 3-OH cotinine. Extraction recovery was consistent (87–109%) across concentrations. No significant matrix effect or carryover was observed. The validated method was applied to 849 urine samples. In samples from the 125 current smokers, nicotine, cotinine, 3-OH cotinine, nornicotine and anabasine were detected in 97.6, 99.2, 98.4, 96.8 and 87.2%, respectively. No markers were detected in 93.9% of 609 nonsmokers. The overlapping detection of multiple markers made it possible to identify the smoking status even in current smokers with a low concentration of cotinine. Our LC–MS-MS method using a simple sample preparation technique is sensitive and effective for screening of smoking status in the general population.
COVID-19’s impact on travel medicine surpasses that of all other emerging viral diseases
Authors: Leong Wei-Yee
Published: November 2020

COVID-19 has devastated economies, led to widespread lockdowns and an extent of travel restrictions that the world has not seen for decades.
Terrorism and Poverty
Authors: Gardeazabal Javier
Published: November 2020

Terrorism and poverty have multiple definitions. Terrorism is the premeditated use or threat to use violence by individuals or subnational groups to obtain a political or social goal through the intimidation of a large audience. Poverty is lacking sufficient material possessions or income to satisfy a person’s needs. Terrorism and poverty are multifaceted magnitudes. Terrorism can be domestic or transnational and rooted in ethnic, religious, economic, or political factors. Extreme poverty corresponds to a situation where the individual’s basic needs of food, clothing, and shelter are not met. More generally, poverty refers to failure to achieve these living standards along with education, health, and other necessities. Poverty is strongly and negatively associated with income. Both terrorism and poverty are related through social, economic, and political elements, making their association complex. Despite the intrinsic difficulty in appraising the relationship between terrorism and poverty, their connection is intriguing. This article compiles bibliographic references to empirical research related to two questions: Does terrorism cause poverty? Does poverty cause terrorism? There is a consensus on the answer to the first question: Terrorism has a negative impact on the economy, thus making individuals poorer. Hence, the research focuses on how to measure such negative impact and to assess its magnitude in various dimensions. However, the causal link from poverty to terrorism is not as easy to establish as intuition might suggest. Economic conditions do play a role in explaining terrorism outcomes, but their effect is mediated through other determinants making the causal relation from poverty to terrorism, if existing, much more complex. This article is organized as follows: After a section summarizing the general overviews of the field of terrorism studies in general and the Political Economy of Terrorism in particular, two sections organize the annotated bibliography regarding first the causal connection from terrorism to poverty and then from poverty to terrorism. The multiple economic consequences of terrorism are referred to in various subsections devoted to the aggregate economic cost of terrorism and its impact on investment, market valuation of firms, and the tourism sector. The role of poverty in causing terrorism is then analyzed including Aggregate Studies, some Explanations, and an analysis of the Policy Response to terrorism.
Higher Education Finance
Authors: Jongbloed Ben
Published: November 2020

The financing of higher (or tertiary) education deals with issues of resourcing (i.e., funding) higher education institutions, their students, and their (academic and nonacademic) staff. The study of higher education finance covers the sources of funding for higher education (including the balance between public and private funds) as well as the uses of those funds (for education, research, student support, infrastructure, staffing, campus development, etc.). The management of funds is essentially a study of choice—about using scarce resources to achieve often-conflicting goals—which implies that it also extends to issues of priority setting, effectiveness, and efficiency. In many ways, these are questions of a political-economic nature. With higher education being such a large part of the public sector, the study of higher education finance, on the one hand, may be seen as part of public finance, while on the other hand, as a subfield of the economics of education. In times of shrinking public budgets, there is increasing scrutiny on how public resources for higher education are allocated and used. At the national (country, state) level, reforms in educational financing are frequently debated in policy circles, with the goal of identifying the funding mechanism that produces the best outcomes in terms of guaranteeing access for students, high-quality education, and high-quality research, as well as connecting this education and research to the needs of society. At the level of the higher education institution (i.e., university, college, or specialized institution), debates will often focus on the internal budgeting system and how the institution can make sure it runs its operations in a financially sound way in the short term, with sufficient incentives for efficiency and revenue generation, as well as incentives for innovation on the mid- to long term. All of this illustrates the many trade-offs and dilemmas that appear in the study of higher education finance. It also shows that the topic of higher education finance touches on many other research fields in higher education, including, for example, governance, privatization, and student financial aid. And given the political-economic nature of these issues, many conceptual approaches used for the study of higher education finance are imported from economics, political science, public administration, public policy, or organizational studies. Because the field of higher education finance is constantly evolving, the topics that are at the forefront of scholarly research are to be found primarily in academic journals. The themes covered in the study of higher education finance deal with some of the above-mentioned major trade-offs and dilemmas. After first presenting some of the general-overview works in higher education finance, this article will cover some of these themes touching on the most-important policy debates in higher education finance.
Dynamic Capabilities
Authors: Tuschke Anja , Buellet Emma
Published: November 2020

As a relatively young, yet flagship discipline of strategic management, dynamic capabilities research has emerged as one of the central perspectives exploring the foundations of the achievement of sustainable competitive advantage, especially in the context of dynamic environments. Dynamic capabilities are deeply rooted in, and sometimes seen as an extension of, the resource-based view of the firm. The notion that competitive advantage both stems from the exploitation of current capabilities and the development of new ones was already vaguely conceptualized by prominent contributors of the resource-based view such as Edith Penrose and Birger Wernerfelt. However, the idea that there are special capabilities—dynamic capabilities—enabling organizations to build, integrate, or reconfigure their internal and external resource and competence base, was formerly conceptualized in the late 1990s as a separate yet connected stream of research (see Teece, et al. 1997—cited under Seminal Papers—which is titled “Dynamic Capabilities and Strategic Management”). The dynamic capabilities perspective is also strongly connected to evolutionary economics. This is why the field has focused for some time on the exploration of semi-automatic and path-dependent routines as the foundation of dynamic capabilities. However, proponents of the behavioral theory of the firm have criticized this approach and integrated the deliberate human element in the dynamic capabilities perspective (for an overview of the theoretical assumptions underpinning the dynamic capabilities perspective, see the article “Dynamic Capabilities and the Role of Managers in Business Strategy and Economic Performance”—Augier and Teece 2009, cited under Conceptual Refinements). As a result, various important debates emerged in the community and the field has been generally criticized for its ambiguity, inconsistency, and conflicting assumptions. This is exemplified by the important number of diverging conceptual contributions to the field, still up to this day, and by the relatively late materialization of empirical work. Nevertheless, the vast number of contributions illustrates the necessity to consider dynamism, which underlies the concept of dynamic capabilities, as a key component of competitive advantage and organizational adaption (see the separate Oxford Bibliographies in Management article “Organizational Adaptation”). The key contributors of the dynamic capabilities perspective in management research are, among others, Kathleen Eisenhardt, Constance Helfat, Margaret Peteraf, David Teece, and Sidney Winter. To support scholars to move toward a theory of dynamic capabilities, this bibliography provides an overview of the field, its origin and developments, while highlighting the conceptual and empirical problems that remain to be solved.
Effect of Drug Disposal Kits and Fact Sheets on Elimination of Leftover Prescription Opioids: The DISPOSE Multi-Arm Randomized Controlled Trial
Authors: Bicket Mark C , Fu Denise , Swarthout Meghan D , White Elizabeth , Nesbit Suzanne A , Monitto Constance L
Published: November 2020

Objective

To determine how passively providing informational handouts and/or drug disposal kits affects rates of leftover prescription opioid disposal.

Design

A multi-arm parallel-group randomized controlled trial with masked outcome assessment and computer-guided randomization.

Setting

Johns Hopkins Health System outpatient pharmacies.

Subjects

Individuals who filled ≥1 short-term prescription for an immediate-release opioid for themselves or a family member.

Methods

In June 2019, 499 individuals were randomized to receive an informational handout detailing U.S. Food and Drug Administration–recommended ways to properly dispose of leftover opioids (n = 188), the informational handout and a drug disposal kit with instructions on its use (n = 170), or no intervention (n = 141) at prescription pickup. Subjects were subsequently contacted by telephone, and outcomes were assessed by a standardized survey. The primary outcome was the use of a safe opioid disposal method.

Results

By 6 weeks after prescription pickup, 227 eligible individuals reported they had stopped taking prescription opioids to treat pain and had leftover medication. No difference in safe disposal was observed between the non-intervention group (10% [6/63]) and the group that received disposal kits (14% [10/73]) (risk ratio = 1.44; 95% confidence interval: 0.55 to 3.74) or the group that received a fact sheet (11% [10/91]) (risk ratio = 1.15; 95% confidence interval: 0.44 to 3.01).

Conclusions

These findings suggest that passive provision of a drug disposal kit at prescription pickup did not increase rates of leftover opioid disposal when compared with provision of a fact sheet alone or no intervention. Active interventions may deserve further investigation.
Diaporthe Seed Decay of Soybean [Glycine max (L.) Merr.] Is Endemic in the United States, But New Fungi Are Involved
Authors: Petrović Kristina , Skaltsas Demetra , Castlebury Lisa A. , Kontz Brian , Allen Tom W. , Chilvers Martin I. , Gregory Nancy , Kelly Heather M. , Koehler Alyssa M. , Kleczewski Nathan M. , Mueller Daren S. , Price Paul P. , Smith Damon L. , Mathew Febina M.
Published: November 2020

Diaporthe seed decay can compromise seed quality in soybean [Glycine max (L.) Merr.] in the warm and humid production areas of the United States during crop maturation. In the current study, 45 isolates of Diaporthe were recovered from seed sampled from soybean fields affected by Diaporthe-associated diseases in eight U.S. states in 2017. The isolates obtained belonged to 10 species of Diaporthe based on morphology and phylogenetic analyses of the internal transcribed spacer, partial translation elongation factor 1-α, and β-tubulin gene sequences. The associated species included D. aspalathi, D. caulivora, D. kongii, D. longicolla, D. sojae, D. ueckerae, D. unshiuensis, and three novel fungi, D. bacilloides, D. flavescens, and D. insulistroma. One isolate each of the 10 species was examined for pathogenicity on seed of cultivar Sava under controlled conditions. Seven days postinoculation, significant differences in the percentages of decayed seeds and seedling necrosis were observed among the isolates and the noninoculated control (P < 0.0001). While the isolates of D. bacilloides, D. longicolla, and D. ueckerae caused a significantly greater percentage of decayed seeds (P < 0.0001), the isolate of D. aspalathi caused the greatest seedling necrosis (P < 0.0001). The observation of new fungi causing Diaporthe seed decay suggests the need for a more comprehensive survey in U.S. soybean producing areas since members of the genus Diaporthe appear to form a complex that causes seed decay.
Identification of Soybean (Glycine max) Check Lines for Evaluating Genetic Resistance to Sclerotinia Stem Rot
Authors: Webster Richard W. , Roth Mitchell G. , Reed Hannah , Mueller Brian , Groves Carol L. , McCaghey Megan , Chilvers Martin I. , Mueller Daren S. , Kabbage Mehdi , Smith Damon L.
Published: November 2020

Soybean production in the upper midwestern United States is affected by Sclerotinia stem rot (SSR) caused by the fungal pathogen Sclerotinia sclerotiorum. Genetic resistance is an important management strategy for this disease; however, assessing genetic resistance to S. sclerotiorum is challenging because a standardized method of examining resistance across genotypes is lacking. Using a panel of nine diverse S. sclerotiorum isolates, four soybean lines were assessed for reproducible responses to S. sclerotiorum infection. Significant differences in SSR severity were found across isolates (P < 0.01) and soybean lines (P < 0.01), including one susceptible, two moderately resistant, and one highly resistant line. These four validated lines were used to screen 11 other soybean genotypes to evaluate their resistance levels, and significant differences were found across genotypes (P < 0.01). Among these 11 genotypes, five commercial and public cultivars displayed high resistance and were assessed during field studies across the upper midwestern United States growing region to determine their response to SSR and yield. These five cultivars resulted in low disease levels (P < 0.01) in the field that were consistent with greenhouse experiment results. The yields were significantly different in fields with disease present (P < 0.01) and disease absent (P < 0.01), and the order of cultivar performance was consistent between environments where disease was present or absent, suggesting that resistance prevented yield loss to disease. This study suggests that the use of a soybean check panel can accurately assess SSR resistance in soybean germplasm and aid in breeding and commercial soybean development.
In Vitro Characterization of Pressure Redistribution Among Commercially Available Wound Dressings
Authors: Niezgoda Jeffrey A , Niezgoda Jonathan A , Gopalakrishnan Sandeep
Published: November 2020

OBJECTIVE

Recent clinical evidence has suggested that certain wound dressings may play a significant role in protocols to prevent or reduce pressure injury (PI) in patients at risk by modifying the pressure, friction, and shear forces that can contribute to PI. The aim of this study was to investigate the pressure reduction properties of commercially available wound dressings in vitro.

METHODS

Using a standardized protocol (1.7 kg, 7.5-cm sphere), testing was performed in a controlled environment by the same clinician using a pressure mapping device (XSENSOR LX205; XSENSOR Technology Corporation, Calgary, Alberta, Canada) to measure and compare the pressure mitigation properties in a variety of wound dressings.

RESULTS

A total of 13 different commercially available dressings were tested in triplicate for changes in pressure redistribution as compared with the control. One dressing demonstrated the greatest reduction of pressure forces (OxyBand PR; 50.33 ± 1.45 mm Hg) compared with the control (302.7 ± 0.33 mm Hg) and the greatest surface area of all the study dressings tested. There was a negative correlation (R
2 = 0.73) between the average pressure distribution of a wound dressing and its contact area. Further, the peak pressure for OxyBand PR (P ≤ .05) was significantly different from all other tested dressings.

CONCLUSIONS

One dressing (OxyBand PR) provided superior pressure redistribution and significantly reduced peak pressure in this study when compared with currently available standard foam and silicone dressings that are marketed for the purpose of PI prevention.
Joint Initiative Between Infectious Diseases and Podiatry in Outpatient Settings Improves Outcomes and Adherence to Treatment
Authors: Fukuta Yuriko , Fijalkowski Danny R. , Fujii Tomoko
Published: November 2020

BACKGROUND

A joint infectious disease-podiatry clinic (JIDPC) in which an infectious diseases physician and a podiatrist see patients with diabetic foot infections together once a week was initiated in January 2017. This study was designed to investigate if the JIDPC can improve patient adherence and reduce recurrent infections.

METHODS

A retrospective analysis of patients with diabetic foot infection admitted to Wheeling Hospital from March 2013 to December 2018 was performed. Initially, the patients were followed by infectious diseases and podiatry in their clinics separately (preintervention group). Beginning January 2017, they were followed together at the JIDPC (postintervention group). Recurrent infection, mortality, and loss to follow-up were compared using logistic regression models.

RESULTS

Surgeries were performed in 52.5% of preintervention group participants (n = 99) and 81.9% of postintervention group participants (n = 55; P < .001). The preintervention group was more likely to be lost to follow-up (30.3% vs 9.1%; odds ratio [OR], 4.35 [confidence interval (CI), 1.58–11.99]), but the association was attenuated with further adjustment for surgery (OR 3.35 [CI, 1.17–9.62]). The risk of infection recurrence in 6 months was significantly higher in the preintervention group (36.1% vs 20.8%; OR, 2.16 [CI, 0.99–4.71]), but with further adjustment for surgery, this was not significant (P = .067; OR, 2.17 [CI, 0.95–4.94]). Mortality and 90-day readmission were not significantly different.

CONCLUSIONS

Implementation of JIDPCs may decrease the incidence of recurrent infections among patients with diabetic foot infections.
From Outside to Inside: A Systematic Approach to the Head CT From the Emergency Department
Authors: Povlow Michael R. , Cloran Francis J. , Bui-Mansfield Liem T.
Published: November 2020

The use of CT for the evaluation of head injuries and mental status changes is common. Radiologists must have a reliable system for evaluating a head CT scan, which will improve diagnostic accuracy and speed of interpretation. This article discusses a systematic approach to head CT interpretation and review some of the common pathologies seen in clinical practice.
Does Faculty Experience Count? A Quantitative Analysis of Evidence-Based Testing Practices in Baccalaureate Nursing Education
Authors: Moore Wendy L.
Published: November 2020

AIM

This study explored evidence-based testing practices of nurse faculty teaching in baccalaureate programs.

BACKGROUND

Faculty-developed examinations are important for determining progression in nursing programs. Little is known about faculty who implement such practices most often.

METHOD

A causal comparative study with a convenience sample of 177 was used to answer the research question. Participants were grouped according to level of teaching experience based on Benner’s novice to expert theory. Individual/group means were calculated for the best practices in test development survey; one-way analysis of variance was used to identify significant differences between groups.

RESULTS

Expert faculty had higher overall mean scores than the other four groups, with significantly higher scores than both the advanced beginner (p = .007) and proficient (p = .020) groups.

CONCLUSION

Faculty with more experience seem to implement evidence-based testing practices most often. This information can be used to guide faculty development and peer-mentoring initiatives within nursing programs.
Understanding the peer, manager, and system influence on patient safety
Authors: Forbes Thompson H. , Wynn Joan , Anderson Teresa , Swanson Melvin
Published: November 2020

A unique view of the Hospital Survey on Patient Safety Culture
Emerging Characteristics of Isotonitazene-Involved Overdose Deaths: A Case-Control Study
Authors: Shover Chelsea L. , Falasinnu Titilola O. , Freedman Rohan B. , Humphreys Keith
Published: November 2020

Objectives:

Case reports of fatal overdoses involving the novel synthetic opioid isotonitazene have prompted the U.S. Drug Enforcement Administration to consider an emergency scheduling of the drug in June 2020. We aimed to epidemiologically characterize deaths involving isotonitazene.

Methods:

We conducted a case control study using publicly available mortality records from January 1, 2020 to July 31, 2020 in Cook County, IL and Milwaukee County, WI. Cases (all deaths involving isotonitazene) and controls (all deaths involving other synthetic opioids) were compared on demographic characteristics, number of substances involved in fatal overdose, and co-involvement of other substances.

Results:

We identified 40 fatal overdoses involving isotonitazene and 981 fatal overdoses involving other synthetic opioids. Isotonitazene deaths involved a significantly greater number of substances, and were significantly more likely to involve the designer benzodiazepine flualprazolam.

Discussion:

Isotonitazene was involved in a substantial minority of synthetic opioid overdose deaths in the first 7 months of 2020. Future studies characterizing its prevalence in other markets are warranted. Emergence of highly potent novel synthetic opioids underscore the need for comprehensive health services for people with opioid use disorder.
The Effect of Perioperative Lidocaine Infusion on Postoperative Pain and Postsurgical Recovery Parameters in Gynecologic Cancer Surgery
Authors: Kutay Yazici Kübra , Kaya Menşure , Aksu Büşra , Ünver Süheyla
Published: November 2020

Objectives:

The primary objective of this prospective nonblinded randomized study was to investigate the effect of perioperative systemic lidocaine infusion on pain control after major gynecologic oncology surgery. Patient-reported outcomes, postoperative recovery parameters, and complications were secondary endpoints of the study.

Materials and Methods:

Seventy-five patients with American Society of Anesthesiologists I-III were divided into 3 groups based on perioperative analgesia methods—(1) opioid group: patient-controlled analgesia (PCA) with morphine; (2) lidocaine group: perioperative intravenous lidocaine infusion, plus PCA with morphine; and (3) the epidural group: PCA with bupivacaine. The Visual Analog Scale (VAS) was recorded postoperatively. In addition, nausea-vomiting, time to first oral intake, time to first ambulation, time to first flatus, and length of hospital stay were recorded.

Results:

VAS scores (rest) at 24 hours and VAS scores (cough) at 12 and 24 hours were significantly lower in the epidural group than in the opioid group (P<0.05). VAS scores were found to be similar between the lidocaine and epidural group. The nausea-vomiting incidence was lower in the lidocaine group than in the opioid group (P˂0.05). Compared with the other 2 groups, the first flatus time was shorter in the lidocaine group (P<0.05).

Discussion:

Perioperative lidocaine infusion is effective as epidural analgesia, which is often advocated as the gold-standard analgesic technique for abdominal surgery and is superior to the others in terms of time to first flatus and the incidence of nausea-vomiting.
Management of Endovascular Treatment for Acute Ischemic Stroke During the COVID-19 Pandemic at a Single Institution in Beijing, China: A Brief Report
Authors: Li Shu , Zeng Min , Dong Jia , Li Muhan , Yan Xiang , Li Ruowen , Zhang Yuewei , Huo Xiaochuan , Miao Zhongrong , Wang Shuo , Peng Yuming , Han Ruquan
Published: November 2020

Background:

The coronavirus disease (COVID-19) pandemic is currently a major challenge for health care systems around the world. For a time-sensitive emergency such as acute ischemic stroke (AIS), streamlined workflow times are essential to ensure good clinical outcomes.

Methods:

The aim of this single-center, retrospective, observational study was to describe changes in stroke workflow patterns and clinical care during the COVID-19 pandemic. Data from AIS patients undergoing emergent endovascular treatment (EVT) between 23 January and 8 April 2020 were retrospectively collected and compared with data from patients admitted during a similar period in 2019. The primary outcome was difference in time from symptom onset to recanalization. Secondary outcomes included workflow times, clinical management, discharge outcomes, and health-economic data.

Results:

In all, 21 AIS patients were admitted for emergent EVT during the 77-day study period, compared with 42 cases in 2019. Median time from symptom onset to recanalization was 132 minutes longer during the pandemic compared with the previous year (672 vs. 540 min, P=0.049). Patients admitted during the pandemic had a higher likelihood of endotracheal intubation (84.6% vs. 42.4%, P<0.05) and a higher incidence of delayed extubation after EVT (69.2% vs. 45.5%, P<0.05). National Institutes of Health Stroke Scale at hospital discharge was similar in the 2 cohorts, whereas neurointensive care unit stay was longer in patients admitted during the pandemic (10 vs. 7 days, P=0.013) and hospitalization costs were higher (123.9 vs. 95.2 thousand Chinese Yuan, P=0.052).

Conclusion:

Disruptions to medical services during the COVID-19 pandemic has particularly impacted AIS patients undergoing emergent EVT, resulting in increased workflow times. A structured and multidisciplinary protocol should be implemented to minimize treatment delays and maximize patient outcomes.
Do the clinical scores (Pirani and Dimeglio scores) correlate with the radiological parameters in idiopathic club foot in infants? A cross-sectional study
Authors: Sriharsha Yatham , Balaji Gopisankar , Bharathi Deepak , Patro Dilip Kumar
Published: November 2020

This study was done to identify how well clinical scores and their sub-scores correlate with the radiographic parameters in idiopathic clubfoot. We studied 76 patients of idiopathic clubfoot who are from 5 months to 12 months of age. Deformity was assessed clinically with Pirani and Dimeglio scores and radiologically using eight parameters. Correlation between clinical and radiological scores was studied. All the eight radiological parameters were showing statistically significant correlation with clinical scores – both Pirani and Dimeglio scores. The mean total Pirani score at the time of X-ray was 2.31 with a SD of 1.58 (N = 118 minimum score = 0 and maximum score = 5.5), whereas the mean radiographic score was 3.67 with a SD of 2.1 (N = 118, minimum score = 0, maximum score = 8). The mean total Dimeglio score at the time of X-ray was 9.03 with a SD of 3.54 (N = 118, minimum score = 4 and maximum score = 15), whereas the mean total radiographic score was 3.67 with a SD of 2.1 (N = 118, minimum score = 0, maximum score = 8). Clinical scores correlate well with radiological parameters in infants with idiopathic clubfoot and hence the routine use of radiographs can be avoided in evaluation and follow-up thereby avoiding exposure to radiation.
The outcome of loose bone fragments in pediatric supracondylar humerus fractures: a retrospective study
Authors: Yang Lei , Yang Panyi , Li Lang , Tang Xueyang
Published: November 2020

We evaluated the clinical and imaging outcomes of loose bone fragments in children with supracondylar humerus fractures after closed reduction with percutaneous pin (CRPP) fixation. A retrospective review was conducted on 12 children with fragments on imaging after closed reduction of displaced humeral supracondylar fractures (Gartland III). Primary radiographic assessment included fragment outcome, postoperative Baumann angle, carrying angle and loss of reduction. Clinical outcome included the elbow range of motion (ROM), Flynn grade and other complications. Between January 2015 and January 2018, 460 children (2–14 years old) with supracondylar humerus fractures were treated at our center, including 12 (2.6%) with loose bone fragments on postoperative X-ray. Union or absorption of fragments was noted in all 12 patients at 1 year postoperatively, with good radiographic and clinical outcomes. The mean Baumann angle was 15.5° ± 4.3° and the mean carrying angle was 11.2° ± 2.8°. All patients had a normal elbow ROM. Ten patients achieved an excellent and two a good result according to the Flynn criteria. Good results were achieved after CRPP fixation in 12 children with supracondylar humerus fractures and loose bone fragments. The fragments were mainly absorbed or achieved union to the humerus within 1 year.
Ankle Morphology and Juvenile Osteochondritis Dissecans (JOCD) of the Talus: Is There an Association? An MRI Study
Authors: Masquijo J. Javier , Allende Felicitas , Carabajal Miguel
Published: November 2020

Purpose:

Factors that contribute to the development of juvenile osteochondritis dissecans (JOCD) of the talus are poorly understood. Some authors suggest that a higher loading of the affected zone may be a cofactor in osteochondral lesions. Therefore, the purpose of the study is to evaluate any association between ankle morphology and talus JOCD using morphologic parameters from magnetic resonance images. Our hypothesis is that ankles with JOCD lesions would have differences in the anatomy compared with age and sex-matched unaffected ankles.

Methods:

We evaluated a total of 75 extremities. There were 22 patients (25 ankles) with talus JOCD lesions, and 50 patients (50 ankles) sex and age-matched individuals with healthy ankles served as controls. Two examiners conducted independent measurements of 8 magnetic resonance images parameters: tibial anterior surface angle, tibial shaft both malleoli angle (TBM), tibial axis-medial malleolus angle, anterior opening angle of the talus, malleolar width, tibial lateral surface angle, Maximal tibial thickness, length of trochlea tali arc, and height of trochlea tali arc. Measurement reliability was assessed using intraclass correlation coefficients. Differences in parameters between JOCD patients and controls were evaluated using independent t test. The level of significance was taken to be P<0.05.

Results:

Intraclass correlation coefficients demonstrated good to excellent consistency for all measurements. Sagittal parameters demonstrated a significant length of trochlea tali arc increase in ankles with JOCD lesions compared with normal ankles (P=0.015). There was no statistical difference in any of the axial or coronal parameters.

Conclusions:

Ankle morphology may have a relationship with JOCD lesions. Future larger studies will be useful for further clarifying our findings, and detecting other potential predisposing factors with clinical relevance and how they can be modified.

Study Design:

Cross-sectional study (Level of evidence III).
Chronic Exertional Compartment Syndrome of the Forearm: Mini-invasive Technique Using an Endoscopic Soft Tissue Release System
Authors: Tamborini Federico , Minini Andrea , Garutti Leonardo , Smeraglia Francesco , Valdatta Luigi , Cherubino Mario
Published: November 2020

Chronic exertional compartment syndrome of the forearm is a rare disease characterized by the recurrent onset of forearm pain and progressive weakness during exertion. Over the years many surgical techniques have been reported in literature: wide-open fasciotomy, mini-open fasciotomy, fasciotomy associated with fasciectomy, and mini-invasive endoscopic fasciotomy. Compared with traditional open techniques, mini-invasive techniques are characterized by minimal tissue trauma, less postoperative pain, faster recovery to normal activity and better esthetical result. We describe a mini-invasive endoscopic technique for the treatment of forearm chronic exertional compartment syndrome using the SmartRelease endoscopic tissue release system (MicroAire).
Neoadjuvant immunotherapy in nonsmall cell lung cancer
Authors: Pall Georg
Published: November 2020

Purpose of review

Immune-checkpoint inhibitors have improved treatment outcomes for metastatic nonsmall cell lung cancer (NSCLC). Whether this therapeutic potential might also translate into survival gains in earlier stages is an area of active research. Based on preclinical rationale the neoadjuvant administration of immunotherapeutic agents is of special interest. This review is intended to summarize the existing background, published early clinical evidence, and provide perspective on future developments regarding neoadjuvant immunotherapy in NSCLC.

Recent findings

Preclinical data and early clinical trials suggest promising efficacy of immune-checkpoint inhibitors in early-stage NSCLC when administered in a neoadjuvant manner. Compared to historical controls, the rates of pathologic and radiographic regression seem to be improved, in particular when immunotherapy is combined with standard platinum-based chemotherapy. These favorable treatment effects are accompanied by a moderate toxicity profile without impairing surgical outcomes. Several phase III trials are underway to provide definitive evidence.

Neoadjuvant immunotherapy has the potential to substantially improve outcomes in early-stage NSCLC and therefore to change daily clinical practice in the near future.
Safety and efficacy of combination nivolumab plus ipilimumab in patients with advanced melanoma: results from a North American expanded access program (CheckMate 218)
Authors: Hodi F. Stephen , Chapman Paul B. , Sznol Mario , Lao Christopher D. , Gonzalez Rene , Smylie Michael , Daniels Gregory A. , Thompson John A. , Kudchadkar Ragini , Sharfman William , Atkins Michael , Spigel David R. , Pavlick Anna , Monzon Jose , Kim Kevin B. , Ernst Scott , Khushalani Nikhil I. , van Dijck Wim , Lobo Maurice , Hogg David
Published: November 2020

CheckMate 218, a North American expanded access program (EAP), investigated nivolumab plus ipilimumab in patients with advanced melanoma. Safety and efficacy, including 2-year survival in clinically relevant patient subgroups, are reported. Eligible patients were aged ≥18 years with unresectable stage III/IV melanoma, an Eastern Cooperative Oncology Group performance status of 0/1, and no prior checkpoint inhibitors. Patients received nivolumab 1 mg/kg plus ipilimumab 3 mg/kg every 3 weeks for 4 cycles (induction) followed by nivolumab 3 mg/kg every 2 weeks (maintenance) until progression or unacceptable toxicity or a maximum of 48 weeks. Safety and overall survival (OS) data were collected. This EAP included 754 treated patients from the USA (n = 580) and Canada (n = 174). Median follow-up time was 17.8 months. All-grade and grade 3–4 treatment-related adverse events were reported in 96% and 53% of patients and led to treatment discontinuation in 36% and 26% of patients, respectively. OS rates at 12 and 24 months were 82% [95% confidence interval (CI) 79–84] and 70% (95% CI 66–74), respectively. Twenty-four-month OS rates were 63% in patients aged ≥75 years, 56% in patients with elevated lactate dehydrogenase levels, 73% in patients with BRAF wild-type tumors, 70% in patients with BRAF mutant tumors, and 56% in patients with mucosal melanoma. In this EAP, nivolumab plus ipilimumab demonstrated high survival rates and safety outcomes consistent with those from randomized clinical trials, further supporting the use of this combination for advanced melanoma across multiple subgroups.
Beyond Initial Screening: One-Year Follow-up of Adolescents with Internalizing Problems on the Pediatric Symptom Checklist
Authors: Holcomb Juliana M. , Arauz Boudreau Alexy , Riobueno-Naylor Alexa , Haile Haregnesh , Lucke Cara M. , Bergmann Paul , Joseph Bernard , Jellinek Michael , Murphy J. Michael
Published: November 2020

Objective:

Screening for adolescent depression is a quality indicator for pediatric care, and the parent-completed, 17-item Pediatric Symptom Checklist's internalizing (PSC-17P-INT) subscale has been validated for this purpose. The current study assessed the feasibility of PSC-17P-INT screening, the prevalence of risk on 2 consecutive PSC-17P-INTs, and rates of behavioral health (BH) service use before and after screening.

Methods:

The parent-report PSC-17 was completed on tablet devices before well-child visits (WCVs) with results instantaneously available to clinicians in the electronic health record. Billing data were used to identify adolescents with 2 consecutive WCVs and possible BH service utilization 6 months before and after their first screen.

Results:

In 2017, 1,068 adolescents (12–17 years old) were seen for a WCV, and 637 (59.6%) of them had one in 2018. Most (93.9%; N = 604) completed a PSC at both visits. Patients who scored positively on their first PSC-17P-INT were about 9 times more likely to receive subsequent BH services than patients who screened negative (24.3% vs 2.6%, χ2 = 59.65, p < 0.001). However, risk prevalence increased from the first (11.6%) to the second (14.9%) screen, and only 37.1% of at-risk patients remitted.

Conclusion:

The current study demonstrated that screening adolescents for depression using the PSC-17P-INT was feasible and associated with a significant increase in BH treatment rates. The study also demonstrated that the PSC could be used to track adolescents at risk for depression, found that most youth who screened positive remained at risk 1 year later, and supported recent quality guidelines calling for annual depression screening and follow-up for adolescents with depression.
The role of opioidergic system in modulating cost/benefit decision-making in alcohol-preferring AA rats and Wistar rats
Authors: Oinio Ville , Sundström Mikko , Bäckström Pia , Uhari-Väänänen Johanna , Kiianmaa Kalervo , Raasmaja Atso , Piepponen Petteri
Published: November 2020

Research has highlighted the association of a positive family history of alcoholism with a positive treatment response to opioid antagonists in those with a gambling disorder. However, the role of the opioidergic system in gambling behavior is not well understood, and preclinical studies are needed to clarify this. In this study, Alko Alcohol (AA) and Wistar rats went through operant lever pressing training where the task was to choose the more profitable of two options. Different sized sucrose rewards guided the lever choices, and the probability of gaining rewards changed slowly to a level where choosing the smaller reward was the most profitable option. After training, rats were administered subcutaneously with opioid agonist morphine or opioid antagonist naltrexone to study the impact of opioidergic mechanisms on cost/benefit decisions. No difference was found in the decision-making between AA rats or Wistar rats after the morphine administration, but control data revealed a minor decision enhancing effect in AA rats. Naltrexone had no impact on the decisions in AA rats but promoted unprofitable decisions in Wistar rats. Supporting behavioral data showed that in both rat strains morphine increased, and naltrexone decreased, sucrose consumption. Naltrexone also increased the time to accomplish the operant task. The results suggest that opioid agonists could improve decision-making in cost-benefit settings in rats that are naturally prone to high alcohol drinking. The naltrexone results are ambiguous but may partly explain why opioid antagonists lack a positive pharmacotherapeutic effect in some subgroups of gamblers.
Effects of olanzapine on anxiety-related behaviour in male and female rats assessed after 21–24 and 42–45 days of chronic treatment
Authors: Lockington Molly R. , Hughes Robert N.
Published: November 2020

Olanzapine can decrease anxiety and impair memory, but there is limited information about length of treatment or sex differences in its effectiveness. Therefore, effects of 21–24 and 41–45 days of treatment and sex differences on anxiety-related behaviour and spatial memory were assessed in PVG/c (PVG/c is the internationally recognised way of referring to this rat strain) male and female rats. From 70 days after birth (PND70), all rats received no drug or 6, 11 or 15 mg/kg/day olanzapine via drinking water. From PND91, they were given four daily tests in an open field, light–dark box, zero maze and Y maze, and then again 21 days later from PND112. At PND91-94, all olanzapine doses decreased open-field ambulation and walking, and 6 and 15 mg/kg/day decreased rearing, increased immobility while 15 mg/kg/day decreased shuttles in the light/dark box (all suggesting higher anxiety). At PND112–115, 11 mg/kg/day increased open-field ambulation, walking, rearing, centre occupancy and light/dark-box shuttles and light-side entries while decreasing open-field immobility and corner occupancy (all suggesting lower anxiety). There were also several results in the open field and light/dark box suggesting olanzapine decreased anxiety for males but increased it for females. A significant olanzapine-related preference for the novel Y-maze arm either improved spatial memory, or decreased anxiety. Olanzapine thus appeared anxiogenic after 21 days’ treatment, becoming anxiolytic after 42 days. This could depend on the sex of the rats (females more responsive to lower doses), and the dose (11 mg/kg/day being most effective). Therefore, while olanzapine was generally anxiolytic, it also had some treatment length- and sex-related anxiogenic effects.
Impact of the Opioid Epidemic on Drug Testing
Authors: McMillin Gwendolyn A. , Johnson-Davis Kamisha L. , Kelly Brian N. , Scott Bonnie , Yang Yifei K.
Published: November 2020

Background:

This review provides a description of how the opioid epidemic has impacted drug testing.

Methods:

Four major service areas of drug testing were considered, including emergency response, routine clinical care, routine forensics, and death investigations.

Results:

Several factors that the opioid epidemic has impacted in drug testing are discussed, including specimens, breadth of compounds recommended for testing, time to result required for specific applications, analytical approaches, interpretive support requirements, and examples of published practice guidelines.

Conclusions:

Both clinical and forensic laboratories have adapted practices and developed new testing approaches to respond to the opioid epidemic. Such changes are likely to continue evolving in parallel with changes in both prescription and nonprescription opioid availability and use patterns, as well as emerging populations that are affected by the “waves” of the opioid epidemic.
Radiation Exposure Dose Distribution of Workers Engaged in Decontamination and Related Work Following the Fukushima Nuclear Disaster
Authors: Fukunaga Hisanori , Ogawa Tsubasa , Asano Tomohiro , Ito Atsuo
Published: November 2020

Since the Fukushima nuclear disaster in March 2011, decontamination operations have been conducted across a wide area of Japan. The Japanese System of Registration and Management of Radiation Exposure Doses for Decontamination and Related Work, which was launched in November 2013, is administered by the Radiation Effects Association with the participation of prime contractors who perform decontamination and related work. This study aims to investigate the radiation exposure dose distribution of workers engaged in decontamination and related work, using data obtained from the above registration system. We analyzed the radiation exposure dose distributions among workers in 11 Fukushima prefectural municipalities (Futaba, Iitate, Katsurao, Kawamata, Kawauchi, Namie, Naraha, Minamisōma, Okuma, Tamura, and Tomioka) from 2013 to 2018. The mean radiation exposure doses of workers in each municipality were generally low, although a Kruskal–Wallis test showed a significant regional difference in the figures. The highest mean dose was 0.5 mSv in Okuma in 2018, and the second highest was that of Futaba. The workers engaged in the land development and construction of the interim facilities may have been exposed to more radiation than other workers across 11 Fukushima prefectural municipalities. Following large-scale nuclear accidents or radiation emergencies, radiation dose monitoring and health management for each worker need to be optimized according to their work assignments.