bluuebunny/crossref_metadata_2025 huggingface dataset:
Economic Value of Reducing Exposure to Environmental Health Risks
Authors: Viscusi W. Kip , Dalafave Rachel
Published: December 2020

Valuing the benefit of reduced exposures to environmental health risks requires assessment of the willingness to pay for the risk reduction. Usual measures typically estimate individual local rates of substitution between money and the reduced probability of the adverse health impact. Benefit-cost analyses then aggregate individuals’ willingness to pay to calculate society’s willingness to pay for the health risk reduction benefit. The theoretical basis for this approach is well established and is similar for mortality risks and health outcomes involving morbidity effects. Researchers have used both stated preference methods and revealed preference data that draw on values implicit in economic decisions. Continuing controversies with respect to valuation of environmental health impacts include the treatment of behavioral anomalies, such as the gap between willingness-to-pay and willingness-to-accept values, and the degree to which heterogeneity in values because of personal characteristics such as income and age should influence benefit values. A considerable literature exists on the value of a statistical life (VSL), the local tradeoff between fatality risk and money, which is used to value mortality risk reductions. Many VSL estimates use data from the United States for regulatory analyses of environmental policies, but several other countries have distinct valuation practices. There are empirical estimates of the benefits associated with reducing the risks of many environmental health effects, including cancer, respiratory diseases, gastrointestinal illnesses, and other health consequences that have morbidity effects.
The Spoken Language Checklist: A User-Friendly Normed Language Acquisition Checklist
Authors: Clark M Diane , Greene-Woods Ashley , Alofi Abdullah , Sides Misty , Buchanan Beverly , Hauschildt Sean , Alford Andrea , Courson Frances , Venable Tabitha
Published: December 2020

There are many variables having an impact on the spoken language acquisition of deaf and hard of hearing (DHH) children; therefore, it is critical for parents and professionals to have appropriate tools to monitor language acquisition. The Spoken Language Checklist (SLC) was developed to monitor and identify developmental milestones in a user-friendly checklist format that includes norms. The availability of the SLC will help parents and professionals to monitor the spoken language development of DHH children and provide interventions that should any delays be observed. Recognizing these delays early could prevent any insurmountable effects for cognitive development and further language development.
Rethinking Couples’ Fertility in Spain: Do Partners’ Relative Education, Employment, and Job Stability Matter?
Authors: Bueno Xiana , García-Román Joan
Published: December 2020

Fertility decisions among Spanish couples have been strongly driven by economic uncertainty in a context in which dual-earner couples have become the norm and in which the gender gap in education has reversed. However, the partners’ respective jobs do not carry the same weight in such decisions. We explore how homogamous or heterogamous education, employment, and job stability between partners can provide insights into couples’ fertility decisions using data from 2002 to 2018 Spanish Labor Force Survey. The results reveal that among heterogamic couples, the woman’s job stability more than the man’s is key for childbearing decisions, while no differences are found in fertility levels for educationally heterogamous partners. In homogamous couples, the results suggest a reversal of the negative education-fertility gradient and show that highly educated couples have a higher likelihood of having a child than less-educated couples. Dual-earner couples are more likely to be parents than couples affected by unemployment and as likely as those meeting the declining male breadwinner, female caregiver model. We conclude that the role played by female employment in fertility trumps the role played by gender essentialism, highlighting the nonexclusive importance of gender egalitarianism, female employment, and economic uncertainty to fertility.
Attachment to Home and Community in Older Rural African Americans in Mississippi
Authors: Adams-Price Carolyn , Riaz Muhammed , Ralston Margaret , Gardner Antonio
Published: December 2020

The purpose of this study was to examine qualitatively attachment to home and community in older rural African Americans in the Deep South. Sixty adults aged 52-79 (mean age 64.7, 24 males and 36 females) were interviewed using semi-structured interviews. Participants lived in two micropolitan counties in Mississippi, with most living in one of two mostly African American communities with fewer than 1000 residents. Interviewees were asked about their attachment to their house, the land the house is on, and the community in which they live. Interviews were recorded and transcribed, and transcriptions were analyzed for themes by two qualitative researchers using phenomenological analysis. The two researchers uncovered similar themes; discrepancies were discussed and integrated, and checked for consistency with the original text. The most prominent themes for attachment to home were sense of ownership/having built or made home their own, legacy/generational/historical attachment, sense of peace and safety, solitude and privacy, and attachment to specific features. Interviewees felt that their homes were a part of who they are and a part of their personal and family history; they also reported that their homes were safe and comfortable havens. When participants were asked about their attachment to their community, four themes emerged: socialization/friendly visiting, family and close ties, religious/spiritual, and solitude/quiet community. These results will be discussed in the context of Wahl’s 2012 model, which asserts that older adults’ attachment to place is a function of agency and belonging; belonging was a more prominent theme in this group.
Family Availability and Its Influence on Informal and Formal Care Used by Adults With Dementia in the United States
Authors: Choi HwaJung , Heisler Michele , Cho Tsai-Chin , Connell Cathleen
Published: December 2020

This research is to provide national estimates of spouse and adult child availability to care for adults 55+ with dementia and to examine associations between availability and formal and informal care utilization. Only 23% of adults with dementia had a non-disabled spouse; 66% had an adult child living less than 10 miles away. Substantial variations in family availability were discovered across demographic and socioeconomic groups. For example, 29% of non-Hispanic blacks vs. about 40% of other racial/ethnic groups (OR=0.63; p<0.001) had a spouse. Only 16% of the bottom wealth quartile had a spouse compared to 61% of the top quartile (OR=0.13; p<0.001). In contrast, the greater share of non-Hispanic blacks than non-Hispanic whites had a coresident adult child (OR=2.07; p<0.001) and a non-employed adult child (OR=1.45; p<0.001). Hispanics had the most family availability from both spouse and child. Having a spouse was significantly associated with a lower probability of receiving formal care; AOR=0.54 (95% CI 0.46-0.64) for any formal care; AOR=0.50 (95% CI 0.39-0.64) for institutional care. Having a coresident adult child in year T-2 also substantially reduced the probability of receiving formal care in year T (AOR=0.37; 95% CI 0.29-0.48). The presence of a spouse and co-resident adult child significantly reduce the use of formal care by adults with dementia in the US. Policies and interventions that rely on family members to provide dementia should reflect the substantial heterogeneity in potential family availability across racial/ethnic and socioeconomic groups.
Developing an Intervention to Reduce Sedentary Behavior: Assisted Living Resident Feedback
Authors: Webster Katelyn , Larson Janet
Published: December 2020

Older adults in assisted living (AL) tend to be highly sedentary, which increases their risk of functional decline and frailty. Reducing sedentary behavior (SB) and replacing it with light physical activity (LPA) could have important implications for maintenance of functional abilities. The purpose of this qualitative study was to gather feedback from AL residents on a proposed exercise-specific self-efficacy enhancing intervention designed to promote LPA and reduce SB. We conducted one-on-one semi-structured interviews at four AL facilities with 20 residents ages 65-99 (mean age 83.1; 60% women). They were presented with the proposed intervention and were asked questions to inform the development and modification of the intervention. Data were analyzed with a thematic analysis approach. Specific recommendations included short intervention sessions of one hour and scheduled in the morning. Many residents thought a 16 week intervention was too long. We identified broader themes, including concerns about how the intervention would work for residents with a wide range of abilities and concerns about safety. They suggested that exercises will need to be highly modifiable. Most residents recommended framing the intervention message as increasing LPA rather than decreasing SB, because it would be more positive. All except one said they would want to participate in the intervention, but they were unsure how many other residents would want to be more active. The resident feedback and suggestions will guide development of the intervention and are important for increasing the probability that a future feasibility and acceptability trial of the intervention will be successful.
Age-Friendly Initiatives and Primary Care in Rural Arkansas
Authors: McAtee Robin , Tobey Leah
Published: December 2020

The Arkansas Geriatric Education Collaborative (AGEC)’s Geriatric Workforce Enhancement Program is partnering with a plethora of community based organizations (CBO) and with ARcare, an Arkansas federally qualified healthcare clinic network, to implement the 4Ms of age-friendly care in rural clinics. Baseline clinical data related to the Age-Friendly 4M Framework has been gathered and quality improvement projects initiated to improve the outcomes. Initiatives to improve depression and cognitive screenings are addressing Mentation; fall prevention screens and the offering of fall prevention programs have been added for Mobility; high risk medication screens and chronic pain educational programs are being implemented to address Medications; and finally, Medicare Annual Wellness Visits is the cornerstone to improve what Matters to older adults. A campaign that involves partnered CBOs to address health literacy and increase involvement in evidence-based programs is also helping to drive improvements in age-friendly care in rural Arkansas.
Effect of Nutritional Stress on the Expression of Sirtuin Gene Family
Authors: Zhang Xiaomin , Ameer Fathima , Crane Jasmine , Azhar Gohar , Wei Jeanne
Published: December 2020

The sirtuin (SIRT) proteins are a highly conserved family of NAD+-dependent deacetylases that regulate histones as well as non-histone proteins. Seven sirtuin genes have been identified (SIRT1 to SIRT7) in mammals. SIRT1, SIRT6, and SIRT7 are primarily localized in the nucleus. SIRT2 is localized mainly in the cytoplasm. SIRT3, SIRT4, and SIRT5 are often located in the mitochondria. Therefore, the sirtuin family proteins exert their diverse functions at various cellular locations and regulate metabolism, stress responses, growth and aging processes. The sirtuin proteins are often considered as nutrient sensors. This study assessed the expression of sirtuin genes in C2C12 muscle cells under glucose stress conditions at different time points. Expression of all seven sirtuins was confirmed by Real-Time PCR analysis. SIRT1 (24 h) and SIRT3 (6 h and 15 h) are highly expressed under low glucose (2.7 mM) and high glucose (25 mM) conditions, whereas SIRT2 and SIRT4, SIRT5, SIRT6 and SIRT7 expressions were either relatively lower or there was no significant change under glucose stress conditions. Our results indicate that SIRT1 and SIRT3 demonstrated the greatest fluctuation in response to glucose stress, whether high or low glucose. These findings will help elucidate the role of sirtuins in the regulation of cellular processes, including metabolism. It will also help to enhance our understanding of the roles of sirtuin genes in regulation of blood sugar fluctuation in normal persons and diabetic patients, as well as in elderly individuals, many of whom are insulin resistant and “prediabetic” or diabetic.
Effects of Ambient Bright Light on Neurobehavioral Symptoms in Dementia: A Systematic Review
Authors: Jao Ying-Ling , Wang Julian , Liao Yo-Jen , Berish Diane , Van Haitsma Kimberly , Boltz Marie
Published: December 2020

Most persons living with dementia (PLwD) experience behavioral and psychological symptoms of distress in dementia (BPSDs). Despite increased utilization of bright light to improve BPSDs, the evidence of effectiveness and dosage using ambient light has not been comprehensively examined. This review synthesized research evidence on the effect of ambient light on BPSD in PLwD. A literature search conducted in Scopus, PubMed, CINAHL, and Web of Science included keywords: dementia, bright light, ambient light, indirect light, behavior symptoms, agitation, wandering, depression, aggression, and apathy. Original studies that examined the effect of ambient light on BPSDs were included. Six studies were identified. Sample size ranged from 6 to 189. Lighting delivery methods included a lighting table and ceiling-mounted fixtures in public areas and/or participant’s bedroom. Lighting intensity ranged from 1,000-3,000 lux, color temperature ranged from bluish white to warm white, and exposure duration ranged from 4 to 24 hours a day. PLwD with higher light exposure showed more pleasure and alertness. Ambient bright lighting showed mixed results in reducing agitation with one study reporting increased agitation. Three out of four studies showed positive effects upon depressive symptoms. Ambient bright light positively impacted pleasure and alertness. Mixed results on agitation and depressive symptoms may be explained by differences in illuminance, color, duration, and targeted lighting positions. Further studies are needed to confirm the positive effects of ambient light on BPSD. Accurate lighting exposure measurements related to spectral compositions and dosage for individual PLwD would help explain the underlying relationships between lighting and BPSD.
Assessing Functional Need of Minority Older Adults Across Two Long-Term Services and Supports Settings
Authors: Travers Jasmine , Cohen Andrew , Coe Norma , Naylor Mary
Published: December 2020

Research has suggested that growth in Black and Hispanic older adults’ nursing home (NH) use may be the result of disparities in options for long-term services and supports (LTSS). To investigate this issue, we aimed to determine whether there were no differences in the functional needs of racial and ethnic groups who received care in NHs versus the community. We identified respondents aged ≥65 years in the 2016 Health and Retirement Study who reported requiring caregiving help. We compared the site of care for Black and Hispanic older adults (minority group) to White older adults (comparison group). We performed unadjusted analyses to assess the association of functional need with community vs. NH care. Functional need was operationalized using a functional-limitations score and six individual activities of daily living (ADL). There were 186 minority older adults (community=78%, NH=22%) and 357 White older adults (community=50%, NH=50%). Across settings, minority older adults did not differ in age, marital status, and income, but a greater percentage of men were in NHs (48% versus 28%; p=0.01). The functional-limitations score was higher in NHs than in the community for both groups. Functional needs for the minority group were similar across the two settings in 2/6 ADLs (dressing p=0.11, toileting p=0.09), while White older adults in NHs were more impaired in all ADLs. Functional need for minority older adults primarily differed by setting while demographics did not. These are important factors to consider when implementing programs to keep older adults out of NHs and in the community.
Can Robots Encourage Social Engagement Among Older Adults?
Authors: Lin Yichun , Fan Jing , Dietrich Mary , Beuscher Linda , Newhouse Paul , Sarkar Nilanjan , Mion Lorraine
Published: December 2020

Apathy in older adults in long term care (LTC) settings is common, associated with morbidity and mortality, and requires extensive personnel time. Most LTC sites are limited in their ability to provide activities. We conducted a 3-month pilot study at two LTCs to determine whether a robot, with/without virtual reality (VR), was successful in encouraging social engagement between older LTC adults. Three robot activities were offered twice weekly for three weeks (6 sessions). Two activities with VR consisted of two book sorting games. One activity was “Simon Says” where older adults took turns as leaders. Demographics and cognitive data were collected. Videos were coded and analyzed using Noldus Observer: activity engagement as visual and verbal attention to the robot activity and social engagement as visual and verbal attention towards their partner. Participants were 2 men and 14 women, mean age 83. One dropped out because of hearing problems; one dropped out because of cognitive impairment. Fourteen, ie 7 pairs, attended all 6 sessions; ten had MCI and one had AD. Social and activity engagement varied by activity and by participant. Participants’ perceptions (7-point Likert scale) remained positive over time (6.33 (SD 0.94) to 6.52 (SD 0.61)) but decreased slightly for the repeat activities (6.19 (SD 1.01) to 5.96 (SD 1.13)). Robots hold promise in LTC as ways to engage older adults who suffer from apathy. Further work is necessary to elucidate participant- and activity-level characteristics most conducive for success and mechanisms to increase the number and variety of activities.
Perceptions of a Transitional Care Model for Older Adults With Multimorbidity and Depressive Symptoms
Authors: Markle-Reid Maureen , McAiney Carrie , Ganann Rebecca , Whitmore Carly
Published: December 2020

Transitioning from hospital to home is an important healthcare system priority. This paper reports on the qualitative findings from a larger mixed methods study designed to examine the implementation and effectiveness of a new transitional care intervention (Community Assets Supporting Transitions [CAST]). The goal of the CAST intervention is to improve the quality and experience of hospital-to-home transitions for older adults (≥ 65 years) with depressive symptoms and multimorbidity. Semi-structured interviews were completed with a sub-set of intervention group trial participants including 11 older adult participants and 1 caregiver, as well as 4 intervention nurses. A qualitative descriptive design was used to explore the perceived impacts of the CAST intervention on participants and their caregivers. Audio-recorded interviews were transcribed verbatim, with descriptive codes and themes generated using conventional content analysis. Patient participants indicated that the intervention resulted in improved access to information (e.g., medication review) and services (e.g., care coordination) that enhanced their self-management. Participants felt that the home visits and phone visits were valuable and helped to improve their mental health. Intervention nurses described advocating for patients to help achieve their needs. For example, nurses advocated for physiotherapy services to provide additional education to support patient mobility. Understanding patient, caregiver, and provider perceptions of the impact of the CAST intervention will help to identify how to improve the delivery of this transitional care intervention, to bridge the gap between hospital and community care, and to positively impact patient health outcomes.
Marital Religious Homogamy and Dimensions of Well-Being in Later Life: Evidence From the United States
Authors: Upenieks Laura , Schafer Markus , Uecker Jeremy
Published: December 2020

Past research points to the importance of couple-level religious similarity for multiple dimensions of older adults’ partnership quality and stability, but we have a limited understanding of whether religious homogamy matters for the well-being of seniors. This study uses dyadic data from the National Social Life, Health, and Aging Project (NSHAP), a representative sample of 953 individuals ages 62–91 plus their marital or cohabiting partners. Using actor-partner interdependence models in the general structural equation model framework (GSEM), we find that religious attendance homogamy is beneficial for the physical health of men and the mental health and self-reported happiness of women. There were no associations between religious homogamy for religious importance detected. Taken together, our results attest to the ongoing importance of religious similarity—service attendance, in particular—for mental and physical well-being in later life. Future research is needed to more fully examine which mechanisms account for these patterns.
Tofacitinib Treatment Safety in Moderate to Severe Ulcerative Colitis: Comparison of Observational Population Cohort Data From the IBM MarketScan® Administrative Claims Database With Tofacitinib Trial Data
Authors: Curtis Jeffrey R , Regueiro Miguel , Yun Huifeng , Su Chinyu , DiBonaventura Marco , Lawendy Nervin , Nduaka Chudy I , Koram Nana , Cappelleri Joseph C , Chan Gary , Modesto Irene , Lichtenstein Gary R
Published: December 2020

Background

Tofacitinib is an oral, small molecule Janus kinase inhibitor for the treatment of ulcerative colitis (UC). We aimed to estimate the overall incidence of safety events in patients with UC in a real-life population cohort for comparison with the tofacitinib UC clinical trial program.

Methods

Clinical trial-like criteria were applied to an IBM MarketScan® claims database population-based cohort (n = 22,967) of patients with UC (October 2010 to September 2015) to identify a UC trial-like cohort treated with tumor necrosis factor inhibitors (TNFi; n = 6366) to compare with the tofacitinib UC clinical trial cohort (n = 1157).

Results

Incidence rates (events per 100 patient-years; [95% confidence interval]) in the UC trial-like cohort were as follows: serious infections, 3.33 (2.73–4.02); opportunistic infections (OIs; excluding herpes zoster [HZ]), 1.45 (1.06–1.93); HZ, 1.77 (1.34–2.29); malignancies (excluding nonmelanoma skin cancer [NMSC]), 0.63 (0.43–0.90); NMSC, 1.69 (1.35–2.10); major adverse cardiovascular events (MACE), 0.51 (0.31–0.79); pulmonary embolism (PE), 0.54 (0.30–0.89); deep vein thrombosis (DVT), 1.41 (1.00–1.93); and gastrointestinal perforations, 0.31 (0.16–0.54). Compared with the UC trial-like cohort, tofacitinib-treated patients had numerically lower incidence rates for serious infections (1.75 [1.27–2.36]), OIs (excluding HZ; 0.16 [0.04–0.42]), NMSC (0.78 [0.47–1.22]), PE (0.16 [0.04–0.41]), and DVT (0.04 [0.00–0.23]), and a higher rate for HZ (3.57 [2.84–4.43]); rates for malignancies (excluding NMSC), MACE, and gastrointestinal perforations were similar.

Conclusions

When acknowledging limitations of comparing claims data with controlled clinical trial data, incidence rates for HZ among TNFi-treated patients in the UC trial-like cohort were lower than in the tofacitinib UC clinical trial cohort; rates for serious infections, OIs, NMSC, PE, and DVT were numerically higher.

ClinicalTrials.gov

NCT00787202, NCT01465763, NCT01458951, NCT01458574, NCT01470612.
First Case Report of Mange in Molossus molossus (Chiroptera: Molossidae) Caused by Notoedres (Notoedres) yunkeri (Sarcoptiformes: Sarcoptidae) in Minas Gerais State, Brazil
Authors: Bassini-Silva Ricardo , Huang-Bastos Matheus , de Mello Érica Munhoz , Oconnor Barry M , Barros-Battesti Darci Moraes , de Castro Jacinavicius Fernando
Published: December 2020

There are many records of the family Sarcoptidae in bats. The species Notoedres (Notoedres) yunkeri has been reported only once, parasitizing a molossid bat in Panama. In the present study, we expand the occurrence of the species to Brazil.
L’évaluation complète de la santé sexuelle à l’ adolescence
Authors: Johnson Natasha
Published: December 2020

L’activité et l’expérimentation sexuelles sont des aspects normaux du développement des adolescents, mais peuvent toutefois avoir des effets défavorables sur la santé, y compris sous forme d’infections transmises sexuellement, de grossesse non planifiée et de violence dans les fréquentations. Les conseils préventifs aux adolescents sur la santé sexuelle et reproductive doivent inclure les questions relatives au développement sexuel normal, telles que l’identité et l’attirance, les relations sécuritaires, les activités sexuelles mieux protégées et la contraception. Les professionnels de la santé peuvent améliorer l’éducation sexuelle des jeunes qu’ils rencontrent en cabinet et contribuer à atténuer les effets négatifs de leur sexualité sur la santé. Le présent point de pratique propose l’approche des 7 P pour aider les professionnels de la santé à obtenir une évaluation complète de la santé sexuelle des adolescents. Des enjeux liés à l’adolescence sont abordés, comme l’identité, la confidentialité, le consentement et la violence dans les fréquentations, et des ressources de la Société canadienne de pédiatrie sont proposées pour fournir des cheminements cliniques plus détaillés sur des enjeux connexes : la contraception, la grossesse et les infections transmises sexuellement.
Canadian medical schools’ preclerkship paediatric clinical skills curricula: How can we improve?
Authors: Hudson Alexandra , Mclaughlin Robyn , Miller Stephen , Holland Joanna , Blake Kim
Published: December 2020

Background

Little is known about how Canadian medical schools teach paediatric clinical skills (history and physical exam) to preclerkship students, or its cost to the institutions.

Methods

Clinical skills program directors from all 17 Canadian medical schools were contacted to complete a questionnaire focused on teaching methods, and barriers/strengths of their Preclerkship Paediatric Clinical Skills program.

Results

Seventeen schools (100% response rate) participated. Seven schools (41%) do not introduce paediatric clinical skills until the second year of medicine. Half of the schools (53%) dedicate <10 total hours to preclerkship paediatric clinical skills. Fifty-nine per cent have ≤6 total hours of hands-on paediatric patient interaction (real or simulated). Medical students were least likely to be exposed to the infant age group (age 1 to 24 months). Twelve schools (71%) used simulated parent/child dyads. The most significant barriers identified by programs were limited time for sessions and patient availability. We describe one sample medical school’s simulated parent/paediatric patient program where every student has hands-on learning with paediatric patients of all ages (program cost $938/student).

Discussion

This study is the first to summarize Canadian preclerkship paediatric clinical skills programs, among which there is great variability and commonly experienced barriers. Many students are not being exposed to all age groups of paediatric patients before their clerkship years. Medical schools can use this information to strengthen this important and challenging aspect of the curriculum, while being mindful of its fiscal implications.
Neurobiobehavioral responses to virtual social rejection in females—exploring the influence of oxytocin
Authors: Radke Sina , Jankowiak Kathrin , Tops Sanne , Abel Ted , Habel Ute , Derntl Birgit
Published: December 2020

In recent years, especially adolescents and young adults interact frequently via social media and digital communication. Mimicking an online communication platform where participants could initiate short conversations with two computerized interlocutors, the Verbal Interaction Social Threat Task (VISTTA) was used to induce feelings of social rejection. Motivational and physiological reactions were investigated in 43 healthy young women undergoing functional magnetic resonance imaging (fMRI), of which 22 received 24 international units (IU) intranasal oxytocin and 21 received placebo. Replicating previous findings, social rejection entailed a lower willingness to cooperate with the two peers. Increased activation in the anterior cingulate cortex and bilateral insula/inferior frontal gyrus was observed when receiving negative feedback from others, and in the precuneus when subsequently rating one’s willingness to cooperate with them in the future. Oxytocin did not seem to alter responses to social rejection. The current findings provide validation of the VISTTA for examining consequences of rejection in a virtual social interaction that bears a strong resemblance to online communication platforms.
The Impact of Physical Therapy Following Cervical Spine Surgery for Degenerative Spine Disorders
Authors: Lantz Justin M. , Abedi Aidin , Tran Frances , Cahill Rafael , Kulig Kornelia , Michener Lori A. , Hah Raymond J. , Wang Jeffrey C. , Buser Zorica
Published: December 2020

Study Design:

Systematic review.

Objective:

To characterize the effects of postoperative physical therapy (PT) after surgery for cervical spondylosis on patient-reported outcomes and impairments. Secondarily, to identify associated complications, adverse effects, and health care costs with postoperative PT, and to describe the content, timing, and duration of the PT.

Summary of Background Data:

Cervical spine surgery is common; however, it is unclear if the addition of postoperative PT leads to improved patient outcomes and decreased health care costs.

Materials and Methods:

PubMed, Embase, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Web of Science were searched until July 2019. All peer-reviewed articles involving cervical spine surgery with postoperative PT for cervical spondylosis were considered for inclusion. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials. Findings were described narratively, and GRADE approach was used to define the quality of evidence.

Results:

A total of 10,743 studies were screened. Six studies met inclusion criteria; 2 randomized controlled trials and 4 subsequent follow-up studies containing study arms that included postoperative PT after cervical spine surgery. Meta-analysis was not performed due to study heterogeneity and no study compared PT+surgery to surgery alone. PT treatment included exercise therapy, cognitive behavioral therapy, and optional vestibular rehabilitation. Included studies indicated PT appeared to have positive effects on patient outcomes, however, there were no treatment control groups and the quality of evidence was very low to low. Timing, duration, and content of PT programs varied. No studies reported complications, adverse effects, or cost-effectiveness relating to PT after surgery.

Conclusions:

Current literature prevents a definitive conclusion regarding the impact of postoperative PT, given the lack of treatment control groups. PT treatment was limited to exercise therapy, cognitive behavioral therapy, and optional vestibular rehabilitation in the included studies. PT treatment varied, limiting consistent recommendations for content, timing, and treatment duration. Controlled trials are needed to determine the effectiveness of the addition of postoperative PT following cervical spine surgery for cervical spondylosis.

Level of Evidence:

Level II.
Comparison of Posterior Unilateral Vertebral Column Resection Versus Posterior Vertebral Column Resection for Severe Thoracolumbar Angular Kyphosis as a Revision Surgical Modality
Authors: Xue Rui , Liu Dai , Shen Yong
Published: December 2020

Objective:

The objective of this study was to determine the safety and efficacy of posterior unilateral vertebral column resection (PUVCR) as revision surgery for severe thoracolumbar angular kyphosis.

Patients and Methods:

This is a retrospective cohort study. Adult patients undergoing revision surgery for severe thoracolumbar angular kyphosis in 2010–2016 with ≥2-year follow-up at our institution were assessed. Perioperative complications and clinical outcomes, including blood loss, operation time, Visual Analog Scale score, Oswestry Disability Index, and preoperative and postoperative kyphotic angles, were analyzed.

Results:

This study included 58 patients who were divided into the PUVCR group and the posterior vertebral column resection (PVCR) group. Age (P=0.810), sex distribution (P=0.500), and vertebrae that underwent surgery (P=0.638) were similar in the 2 groups. Shorter mean operation time was observed in the PUVCR group as compared with the PVCR group (P<0.001). In addition, less blood loss was recorded in the PUVCR group as compared with the PVCR group (P=0.001). There were no significant differences between the 2 groups in a change of Visual Analog Scale scores postoperation versus preoperation (P=0.961), and at postoperative 3 months (P=0.906), 12 months (P=0.752), and 24 months (P=0.811) versus postoperation, respectively. There were no significant differences between the 2 groups in Oswestry Disability Index changes postoperation versus preoperation (P=0.157), and at postoperative 3 months (P=0.899), 12 months (P=0.947), and 24 months (P=0.811) versus postoperation, respectively. PUVCR and PVCR were comparable in deformity correction (P=0.434) and final angle correction (P=0.790). Complication rates in the PUVCR and PVCR groups were 7.1% and 36.7%, respectively.

Conclusion:

PUVCR has comparable safety and efficacy to PVCR in treating severe thoracolumbar angular kyphosis, with the advantages of the shorter operation time, less blood loss, and fewer complications.
A Quality Improvement Evaluation of a Primary As-Needed Light Sedation Protocol in Mechanically Ventilated Adults
Authors: Groetzinger Lara M. , Rivosecchi Ryan M. , McVerry Bryan J. , Smithburger Pamela L. , Lamberty Phillip E. , Donahoe Michael P. , Barbash Ian J.
Published: December 2020

Objectives:

First, to implement successfully a light-sedation protocol, favoring initial as-needed (prioritizing as-needed) boluses over continuous infusion sedation, and second, to evaluate if this protocol was associated with differences in patient-level sedative requirements, clinical outcomes, and unit-level longitudinal changes in pharmacy charges for sedative medications.

Design:

Retrospective review comparing patients who received the prioritizing as-needed sedation protocol to similar patients eligible for the prioritizing as-needed protocol but treated initially with continuous infusion sedation.

Setting:

Thirty-two bed medical ICUs in a large academic medical center.

Patients:

A total of 254 mechanical ventilated patients with a target Riker Sedation-Agitation Scale goal of 3 or 4 were evaluated over a 2-year period. Of the evaluable patients, 114 received the prioritizing as-needed sedation protocol and 140 received a primary continuous infusion approach.

Interventions:

A multidisciplinary leadership team created and implemented a light-sedation protocol, focusing on avoiding initiation of continuous sedative infusions and prioritizing prioritizing as-needed sedation.

Measurements and Main Results: :

Overall, 42% of patients in the prioritizing as-needed group never received continuous infusion sedation. Compared with the continuous infusion sedation group, patients treated with the prioritizing as-needed protocol received significantly less opioid, propofol, and benzodiazepine. Patients in the prioritizing as-needed group experienced less delirium, shorter duration of mechanical ventilation, and shorter ICU length of stay. Adverse events were similar between the two groups. At the unit level, protocol implementation was associated with reductions in the use of continuous infusion sedative medications.

Conclusions:

Implementation and use of a prioritizing as-needed protocol targeting light sedation appear to be safe and effective. These single-ICU retrospective findings require wider, prospective validation.
Arrhythmia Mechanisms in Human Induced Pluripotent Stem Cell–Derived Cardiomyocytes
Authors: Paci Michelangelo , Penttinen Kirsi , Pekkanen-Mattila Mari , Koivumäki Jussi T.
Published: December 2020

Despite major efforts by clinicians and researchers, cardiac arrhythmia remains a leading cause of morbidity and mortality in the world. Experimental work has relied on combining high-throughput strategies with standard molecular and electrophysiological studies, which are, to a great extent, based on the use of animal models. Because this poses major challenges for translation, the progress in the development of novel antiarrhythmic agents and clinical care has been mostly disappointing. Recently, the advent of human induced pluripotent stem cell–derived cardiomyocytes has opened new avenues for both basic cardiac research and drug discovery; now, there is an unlimited source of cardiomyocytes of human origin, both from healthy individuals and patients with cardiac diseases. Understanding arrhythmic mechanisms is one of the main use cases of human induced pluripotent stem cell–derived cardiomyocytes, in addition to pharmacological cardiotoxicity and efficacy testing, in vitro disease modeling, developing patient-specific models and personalized drugs, and regenerative medicine. Here, we review the advances that the human induced pluripotent stem cell–derived-based modeling systems have brought so far regarding the understanding of both arrhythmogenic triggers and substrates, while also briefly speculating about the possibilities in the future.
Fear-avoidance beliefs are associated with reduced lumbar spine flexion during object lifting in pain-free adults
Authors: Knechtle Deborah , Schmid Stefan , Suter Magdalena , Riner Fabienne , Moschini Greta , Senteler Marco , Schweinhardt Petra , Meier Michael L.
Published: December 2020

There is a long-held belief that physical activities such as lifting with a flexed spine is generally harmful for the back and can cause low back pain (LBP), potentially reinforcing fear-avoidance beliefs underlying pain-related fear. In patients with chronic LBP, pain-related fear has been shown to be associated with reduced lumbar range of motion during lifting, suggesting a protective response to pain. However, despite short-term beneficial effects for tissue health, recent evidence suggests that maintaining a protective trunk movement strategy may also pose a risk for (persistent) LBP due to possible pronociceptive consequences of altered spinal motion, potentially leading to increased loading on lumbar tissues. Yet, it is unknown if similar protective movement strategies already exist in pain-free individuals, which would yield potential insights into the role of fear-avoidance beliefs in motor behavior in the absence of pain. Therefore, the aim of this study is to test whether fear-avoidance beliefs influence spinal motion during lifting in a healthy cohort of pain-free adults without a history of chronic pain. The study subjects (N = 57) filled out several pain-related fear questionnaires and were asked to perform a lifting task (5kg-box). High-resolution spinal kinematics were assessed using an optical motion capturing system. Time-sensitive analyses were performed based on statistical parametric mapping. The results demonstrated time-specific and negative relationships between self-report measures of pain-related fear and lumbar spine flexion angles during lifting, indicating potential unfavorable interactions between psychological factors and spinal motion during lifting in pain-free subjects.
Remote management of musculoskeletal pain: a pragmatic approach to the implementation of video and phone consultations in musculoskeletal practice
Authors: Hohenschurz-Schmidt David , Scott Whitney , Park Charlie , Christopoulos Georgios , Vogel Steven , Draper-Rodi Jerry
Published: December 2020

Introduction:

Remote consultations through phone or video are gaining in importance for the treatment of musculoskeletal pain across a range of health care providers. However, there is a plethora of technical options for practitioners to choose from, and there are various challenges in the adaptation of clinical processes as well as several special considerations regarding regulatory context and patient management. Practitioners are faced with a lack of high-quality peer-reviewed resources to guide the planning and practical implementation of remote consultations.

Objectives:

This Clinical Update seeks to provide practical guidance for the planning and implementation of remote consultations for the management and treatment of people with musculoskeletal pain.

Methods:

Recommendations are based on a brief overview of the relevant research regarding phone and video consultations for musculoskeletal practice and derived from the literature, relevant guidelines, and practical experience.

Results:

The technical feasibility of remote consultations for musculoskeletal complaints is good, patient satisfaction is high, and a growing body of evidence supports its comparative effectiveness to in-person consultations in some circumstances for improving pain and functioning. We consider in detail practical aspects such as the choosing of hardware and software, we touch on the legal and regulatory context, and we focus on the adaptation of clinical processes and communication.

Conclusion:

This Clinical Update draws together best-practice evidence in a practically applicable format, enabling therapists who are working with people with pain to directly apply this knowledge to their individual clinical settings and the requirements of their patients.
Characteristics of Sexual Partnerships Among Men With Diagnosed HIV Who Have Sex With Men, United States and Puerto Rico—2015–2019
Authors: Dasgupta Sharoda , Tie Yunfeng , Bradley Heather , Beer Linda , Rosenberg Eli S. , Holtgrave David , Fagan Jennifer , Green Shana , Shouse Roy L.
Published: December 2020

Background:

Understanding sexual partnerships of HIV-positive persons, particularly at the dyad level, can help in quantifying HIV transmission risk. We described sexual partnerships among HIV-positive men who have sex with men (MSM), including partnerships with a high risk for sexual HIV transmission.

Setting:

The Medical Monitoring Project is an annual, cross-sectional study that reports representative estimates on U.S. HIV-positive adults.

Methods:

During 2015–2019, we assessed sexual behaviors by interview, and viral load results from medical records. Among sexually active HIV-positive MSM (n = 4923), we described prevalence of high-risk sex, defined as: (1) not having sustained viral suppression, and (2) having condomless sex with an HIV-negative partner not known to be taking pre-exposure prophylaxis or an HIV-unknown partner. We described sexual partnerships among HIV-positive MSM (n = 13,024 partnerships among 4923 MSM). For HIV-discordant partnerships (n = 7768), we reported the proportion involved in high-risk sex, and associations with high-risk sex using prevalence ratios with predicted marginal means, controlling for age of the HIV-positive partner (P < 0.05).

Results:

More than half (66%) of sexually active HIV-positive MSM had condomless sex; 11% had high-risk sex. Blacks were more likely to have detectable viral loads, but less likely to have condomless sex, making prevalence of high-risk sex comparable between racial/ethnic groups. Dyad-level analyses among HIV-discordant partnerships indicated that prevalence of high-risk sex was higher among partnerships with HIV-positive white MSM, which was not observed using person-level data alone.

Conclusions:

In the context of ending the HIV epidemic, behavioral and clinical surveillance data can help monitor HIV transmission risk and target prevention efforts to reduce transmission among populations at disproportionate risk.
Rituximab for Inflammatory Myopathies in a Colombian Cohort
Authors: Santos Víctor A. , Aragón Cristian C. , Posso-Osorio Iván , Naranjo-Escobar Juan , Milisenda J.C. , Obando María Alejandra , Barrera Tatiana , Zamorano Laura , Hormaza-Jaramillo Andrés
Published: December 2020

Introduction/Objectives

Rituximab (RTX) is a treatment for refractory inflammatory myopathies, such as dermatomyositis (DM) and polymyositis (PM). This study describes the characteristics of patients receiving RTX for myositis in our institution to evaluate its efficacy.

Method

We collected demographic data from all patients diagnosed with DM or PM who received RTX between 2011 and 2018. Clinical and serological variables (including creatine phosphokinase [CPK] levels) were analyzed. Remission of disease was defined as no evidence of disease activity (active myositis) for longer than a 6-month continuous period while undergoing myositis therapy or no medication.

Results

Eighteen patients who had received first-line immunosuppressants were included. Fifteen (83%) had DM, 2 (11%) had PM, 1 had juvenile dermatomyositis, and 14 (77%) were women. All patients received glucocorticoids. Three patients (16.6%) were treated with RTX as monotherapy, and 15 (83.3%) were treated with RTX combined with other immunosuppressants. On average, there were 2 RTX treatment cycles. Improved muscular weakness was found in 13 cases (72%), and improved serum CPK levels were found in 15 cases (83%). Twelve patients (66%) achieved remission.

Conclusions

Most patients experienced an objective improvement, as reflected in their serum CPK values and degree of muscular weakness. This suggests that RTX could be helpful in treating refractory myositis.
Systolic and Diastolic Cardiac Functions in Juvenile Spondyloarthropathies
Authors: Yildiz Mehmet , Dedeoglu Reyhan , Akdeniz Beste , Adrovic Amra , Haslak Fatih , Karagozlu Fatih , Koker Oya , Ulug Nujin , Sahin Sezgin , Barut Kenan , Oztunc Funda , Kasapcopur Ozgur
Published: December 2020

Background/Objective

Juvenile spondyloarthropathies (JSpAs) are a group of inflammatory diseases characterized by asymmetric peripheral arthritis (especially in lower extremities), axial skeleton involvement, and enthesitis. Although cardiovascular findings of inflammatory diseases such as juvenile systemic lupus erythematosus (SLE) and juvenile scleroderma (SD) are well documented, there are only a few studies assessing the cardiovascular consequences of JSpA in the literature.

Methods

Forty patients with JSpA and 20 healthy controls were included into this cross-sectional study. Cardiac functions of the participants were evaluated by conventional echocardiography and pulse-wave (PW) tissue Doppler.

Results

The patients with JSpA had higher mitral lateral S (p = 0.005) and E’ wave (p < 0.001), tricuspid A’ wave (p = 0.03), ejection fraction (p = 0.03) and shortening fraction (p = 0.01) than the control patients. In contrast, the patients with JSpA had lower left ventricle MPI (p = 0.01) and the ratio of tricuspid E’/A’ waves (p = 0.05). Patients with enthesitis detected on magnetic resonance imaging had lower ejection fraction (p = 0.05), the ratio of E/A waves (p = 0.03) and had higher Mitral lateral A’ wave (p = 0.01) than those without. There was a significant inverse correlation between the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and PW transmitral A velocity (r = −0.256, p = 0.03), the BASDAI score and tricuspid annular plane systolic excursion (r = −0.301, p = 0.04), the BASDAI score and the ratio of E/E' waves (r = −0.276, p = 0.02), and the Juvenile Spondyloarthritis Disease Activity Index and PW transmitral A velocity (r = −0.246, p = 0.04).

Conclusions

In this study, we report the possible early signs of RV diastolic dysfunction and possible association between magnetic resonance imaging–confirmed enthesitis and lower LV systolic functions. Early identification of cardiac dysfunctions can help with prevention of long-term cardiovascular complications.