bluuebunny/crossref_metadata_2025 huggingface dataset:
Three-Dimensional Late Gadolinium Enhancement Cardiovascular Magnetic Resonance Predicts Inducibility of Ventricular Tachycardia in Adults With Repaired Tetralogy of Fallot
Authors: Ghonim Sarah , Ernst Sabine , Keegan Jenny , Giannakidis Archontis , Spadotto Veronica , Voges Inga , Smith Gillian C. , Boutsikou Maria , Montanaro Claudia , Wong Tom , Ho Siew Yen , McCarthy Karen P. , Shore Darryl F. , Dimopoulos Konstantinos , Uebing Anselm , Swan Lorna , Li Wei , Pennell Dudley J. , Gatzoulis Michael A. , Babu-Narayan Sonya V.
Published: October 2020

Background:

Adults with repaired tetralogy of Fallot die prematurely from ventricular tachycardia (VT) and sudden cardiac death. Inducible VT predicts mortality. Ventricular scar, the key substrate for VT, can be noninvasively defined with late gadolinium enhancement (LGE) cardiovascular magnetic resonance but whether this relates to inducible VT is unknown.

Methods:

Sixty-nine consecutive repaired tetralogy of Fallot patients (43 male, mean 40±15 years) clinically scheduled for invasive programmed VT-stimulation were prospectively recruited for prior 3-dimensional LGE cardiovascular magnetic resonance. Ventricular LGE was segmented and merged with reconstructed cardiac chambers and LGE volume measured.

Results:

VT was induced in 22 (31%) patients. Univariable predictors of inducible VT included increased RV LGE (odds ratio [OR], 1.15;
P
=0.001 per cm
3
), increased nonapical vent LV LGE (OR, 1.09;
P
=0.008 per cm
3
), older age (OR, 1.6;
P
=0.01 per decile), QRS duration ≥180 ms (OR, 3.5;
P
=0.02), history of nonsustained VT (OR, 3.5;
P
=0.02), and previous clinical sustained VT (OR, 12.8;
P
=0.003); only prior sustained VT (OR, 8.02;
P
=0.02) remained independent in bivariable analyses after controlling for RV LGE volume (OR, 1.14;
P
=0.003). An RV LGE volume of 25 cm
3
had 72% sensitivity and 81% specificity for predicting inducible VT (area under the curve, 0.81;
P
<0.001). At the extreme cutoffs for ruling-out and ruling-in inducible VT, RV LGE >10 cm
3
was 100% sensitive and >36 cm
3
was 100% specific for predicting inducible VT.

Conclusions:

Three-dimensional LGE cardiovascular magnetic resonance-defined scar burden is independently associated with inducible VT and may help refine patient selection for programmed VT-stimulation when applied to an at least intermediate clinical risk cohort.
Diabetic Retinopathy and Risk of Stroke
Authors: Wong Ka-Ho , Hu Katherine , Peterson Cecilia , Sheibani Nazanin , Tsivgoulis Georgios , Majersik Jennifer J. , de Havenon Adam H.
Published: October 2020

Background and Purpose:

Diabetic retinopathy (DR) is a common microvascular complication of diabetes, which causes damage to the retina and may lead to rapid vision loss. Previous research has shown that the macrovascular complications of diabetes, including stroke, are often comorbid with DR. We sought to explore the association between DR and subsequent stroke events.

Methods:

This is a secondary analysis of patients enrolled in the ACCORD Eye study (Action to Control Cardiovascular Risk in Diabetes). The primary outcome was stroke during follow-up. The exposure was presence of DR at study baseline. We fit adjusted Cox proportional hazards models to provide hazard ratios for stroke and included interaction terms with the ACCORD randomization arms.

Results:

We included 2828 patients, in whom the primary outcome of stroke was met by 117 (4.1%) patients during a mean (SD) of 5.4 (1.8) years of follow-up. DR was present in 874 of 2828 (30.9%) patients at baseline and was more common in patients with than without incident stroke (41.0% versus 30.5%;
P
=0.016). In an adjusted Cox regression model, DR was independently associated with incident stroke (hazard ratio, 1.52 [95% CI, 1.05–2.20];
P
=0.026). This association was not affected by randomization arm in the ACCORD glucose (
P
=0.300), lipid (
P
=0.660), or blood pressure interventions (
P
=0.469).

Conclusions:

DR is associated with an increased risk of stroke, which suggests that the microvascular pathology inherent to DR has larger cerebrovascular implications. This association appears not to be mediated by serum glucose, lipid, and blood pressure interventions.
Cerebral Small Vessel Disease, Risk Factors, and Cognition in Tenants of Precarious Housing
Authors: Zhou Lily W. , Panenka William J. , Al-Momen Ghadeer , Gicas Kristina M. , Thornton Allen E. , Jones Andrea A. , Woodward Melissa , Heran Manraj K.S. , Vertinsky A. Talia , Su Wayne , Barr Alasdair M. , MacEwan G. William , Lang Donna J. , Rauscher Alexander , Honer William G. , Field Thalia S.
Published: October 2020

Background and Purpose:

We aim to describe the burden, characteristics, and cognitive associations of cerebral small vessel disease in a Canadian sample living with multimorbidity in precarious housing.

Methods:

Participants received T1, T2-fluid-attenuated inversion recovery, and susceptibility-weighted imaging 3T magnetic resonance imaging sequences and comprehensive clinical, laboratory, and cognitive assessments. Cerebral small vessel disease burden was characterized using a modified Small Vessel Disease (mSVD) score. One point each was given for moderate-severe white matter hyperintensities, ≥1 cerebral microbleeds, and ≥1 lacune. Multivariable regression explored associations between mSVD score, risk factors, and cognitive performance.

Results:

Median age of the 228 participants (77% male) was 44.7 years (range, 23.3–63.2). In n=188 participants with consistent good quality magnetic resonance imaging sequences, mSVD scores were 0 (n=127, 68%), 1 (n=50, 27%), and 2 (n=11, 6%). Overall, one-third had an mSVD ≥1 n=61 (32%); this proportion was unchanged when adding participants with missing sequences n=72/228 (32%). The most prevalent feature was white matter hyperintensities 53/218 (24%) then cerebral microbleed 16/191 (8%) and lacunes 16/228 (7%). Older age (odds ratio, 1.10 [95% CI, 1.05–1.15],
P
<0.001), higher diastolic blood pressure (odds ratio, 1.05 [95% CI, 1.01–1.09],
P
=0.008), and a history of injection drug use (odds ratio, 3.13 [95% CI, 1.07–9.16],
P
=0.037) had significant independent associations with a mSVD score of ≥1 in multivariable analysis. mSVD ≥1 was associated with lower performance on tests of verbal memory, sustained attention, and decision-making, contributing 4% to 5% of the variance in each cognitive domain.

Conclusions:

The 32% prevalence of cerebral small vessel disease in this young, socially marginalized cohort was higher than expected for age and was associated with poorer cognitive performance.
An updated species inventory of Callithamnion sensu lato Rhodophyta, Callithamniaceae in South Africa with the description of Callithamnion africanum sp. nov.

Authors: REDDY MAGGIE M. , STEGENGA HERRE , ANDERSON ROBERT J. , BOLTON JOHN J.
Published: October 2020

The species diversity of Callithamnion sensu lato in South Africa is re-visited using existing literature, morphology and DNA. The identity of a putative new species is confirmed as distinct using DNA and is described here as Callithamnion africanum sp. nov. Callithamnion africanum differs molecularly and morphologically from a similar species, C. cordatum with which it shares a similar habitat and distribution range in South Africa. Callithamnion africanum is resolved in the Callithamnion sensu stricto clade and is sister to the type species of the genus, Callithamnion corymbosum. Additionally, Callithamnion stuposum, a species described from South Africa and a common component of the seaweed flora, was recovered in the larger, unresolved Callithamnion sensu lato clade. An updated species inventory of Callithamnion sensu lato in South Africa is provided, and indicates a lack of sequence data for the large majority of species. Furthermore, a global rbcL phylogeny highlights a number of taxonomic concerns regarding the classification of taxa circumscribed to Callithamnion sensu lato and calls for a global revision using DNA, type specimens or material collected from near type localities.
Typification of the name Eryngium siculum (Apiaceae)

Authors: SCAFIDI FILIPPO , FERRARO VALERIA , DI GRISTINA EMILIO
Published: October 2020

As part of an ongoing study on the names of vascular plants described from Sicily (e.g., Di Gristina et al. 2012, Domina et al. 2014, 2016, Di Gristina et al. 2017, Domina et al. 2017a, 2017b, Scafidi & Domina 2019, Di Gristina et al. 2020), a nomenclature study of the name Eryngium siculum Lojacono-Pojero (1906: 294) (Apiaceae Lindl.), which appears to be yet untypified (see Domina et al. 2014, Peruzzi et al. 2015), is here presented. The present study, which deals with the untypified name Eryngium siculum Lojacono-Pojero (1906: 294), falls within the researches promoted by the Italian Botanical Society aimed to recognize and typify all the taxa described from Italy, in order to increase their systematic knowledge and promote further studies (Peruzzi et al. 2015, Brundu et al. 2017, Peruzzi et al. 2019).
Diaporthe taiwanensis: A new taxon causing leaf spots and necrosis on Ixora chinensis in Taiwan

Authors: ARIYAWANSA HIRAN A. , TSAI ICHEN , WITHEE PATCHAREEYA , TANJIRA MEDSAII , YEN CHIA-YUN , AL-RASHED SARAH , ELGORBAN ABDALLAH M. , CHEEWANGKOON RATCHADAWAN
Published: October 2020

Diaporthe taiwanensis sp. nov. (Diaporthales, Sordariomycetes, Ascomycota) isolated on living leaves of Ixora chinensis from Taiwan, is characterized using both phenotypic and genetic characters. Phylogenetic reconstructions based on concatenated DNA sequence data of four nuclear genetic markers (ITS, tef1-α, β-tubulin and cal) show that the new taxon is separated from other representative species of Diaporthe with high statistical support. The new taxon differs from its phylogenetically related congeners mainly by having larger alpha conidia and producing beta conidia in culture and further by host and geographical distribution. Artificial inoculation on leaves confirmed the pathogenicity of the novel fungus to Ixora. The present study is the first report of Diaporthe species causing leaf spots and necrosis on Ixora chinensis in Taiwan.
Description of a new species of Cosmocerca Diesing, 1861 (Nematoda: Cosmocercidae) in Hoplobatrachus crassus (Jerdon, 1853) (Anura: Dicroglossidae) from Asansol coal-field area, West Bengal, India
Authors: BANERJEE SIDDHARTHASANKAR , SOU SUJAN KUMAR
Published: October 2020

A new cosmocercid nematode species, Cosmocerca asansolensis sp. nov. (Ascaridida, Cosmocercidae) is described from an Indian bullfrog, Hoplobatrachus crassus (Jerdon, 1853), from Asansol town, Paschim Bardhaman district, West Bengal, India. This species is characterized by the presence of five pairs of plectanes supporting preanal papillae, absence of somatic papillae in females, and having one pair large postanal papillae, a single papilla on the upper lip of cloaca, a single papilla on the lower lip of cloaca and one pair adanal papillae in males and one pair postanal papillae in females. Spicules of the present species are equal, moderately sclerotized, knobbed and wide proximal end gradually tapering to a fine point distally. The gubernaculum is well sclerotized and Y-shaped. Cosmocerca asansolensis sp. nov. represents the 33rd species assigned to the genus, 8th from Oriental region and 6th species from India.
Cisplatin Nanoparticles for Folate Targeted Delivery in Ovarian Cancer: Study in SKOV-3 Cancer Cells
Authors: Wang Ruijing , Shen Guohong , Lv Qingfeng , Pan Min
Published: October 2020

Tumor targeting of drug to specific site via use of folate is one the choicest method for enhancing specificity of Cisplatin. Chitosan was conjugated with folate via amino acylation method and Folate-chitosan-Cisplatin-nanoparticles (FA-CS-Cis-NP's) were prepared using ionotropic gelation
method. Thus prepared nanoparticles were evaluated for various parameters such as particles size, % encapsulation efficiency, % drug release, cytotoxic assay, cellular uptake. The average particle size of nanoparticles was found to be 265 nm with encapsulation efficiency of 89.43%. The cumulative
release of drug from dosage form was found to be 82.31% for 240 min. The higher level of intra-cellular accumulation of Cisplatin was found to be in case of FA-CS-Cis-NP's than conventional drug delivery when cultured with folate. The results indicate that targeting of FA-CSCis-NP's is possible
with folate targeting and are proved as potential folate receptor positive tumor cell targeting drug delivery system.
Compound Kushen Injection Promoted the Killing Effect of Cytokine-Induced Killer Cells Which Was Activated by Dendritic-Colon Cancer Stem Cell Fusion Cells on Colon Cancer Stem Cells
Authors: Yang Yang , Ma Yanxia , Wang Zhanzheng , Wang Li , Zhao Yubo , Hui Yang , Zhang Chi , Feng Feixue
Published: October 2020

Colon cancer stem cells (cCSCs) are highly tumorigenic and resistant to traditional chemotherapeutic drugs. Therefore, they are an essential factor in colorectal cancer (CRC) metastasis and recurrence. Dendritic cells (DCs) could bind to the tumor cells and form the fusion cells (FCs).
And these FCs could inhibit the development of malignant tumors. Furthermore, the cytokine induced killer (CIK) cells (CD3+ /CD56+ T lymphocytes) could also apply for the immunotherapy of cancer. And compound Kushen injection (CKI) is a traditional Chinese medicine (TCM) which has been used
for the treatment of various tumors. However, whether the dendritic-colon cancer stem cell fusion cells (DC-cCSC FCs) could activate the CIK cells and kill the colon cancer stem cells is unknown. And whether the CKI could enhance the lethal effect is still unclear. In this study, we collected
peripheral blood samples from healthy participants to acquire mononuclear cells and induced DC and CIK cells. Meanwhile, the CD44+ cells (cCSCs) were screened from SW480 cells. Next, the DC-cCSC FCs were established for the next experiments. At last, CCK-8 assays were performed to determine
the effect of DC-cCSC FCs and CKI on the viability of cCSCs. We found that DC-cCSC FCs enhanced the proliferation of CIK cells and induce the CIK cells to secrete more IL-12. The DC-cCSC FCs enhanced the inhibitory effect of CIK cells on cCSCs. Furthermore, application of CKI enhanced the
killing rates of DC-cCSC FCs and CIK cells on cCSCs. CIK cells activated by the DC-cCSC FCs had the lethal effect on the cCSCs. Furthermore, CKI enhanced this lethal effect of DC-cCSC FCs and CIK cells.
Significance of Expression of miR-365, Cartilage Oligomeric Matrix Protein and Inflammatory Factors in Knee Osteoarthritis
Authors: Lin Ren , Xue Jinglai , Qiu Junqin
Published: October 2020

This study is to investigate the high expression of miR-365, cartilage oligomeric matrix protein (COMP) and inflammatory factors in knee osteoarthritis and their correlation with disease activity. The 94 patients with knee osteoarthritis were selected as the observation group. Controls
were 94 healthy people matched according to the age and gender of the observation group. The expression levels of blood miR-365, cartilage oligomeric matrix protein, and the inflammatory IL-6 and TNF-α were compared between two groups and correlations between these indicators and Lysholm
knee scores were determined. The serum levels of miR-365, cartilage oligomeric matrix protein and the inflammatory factors IL-6 and TNF-α in osteoarthritis patients exceeded those in the normal control group (P < 0 05), and miR-365 was positively correlated with cartilage oligomeric
matrix protein and IL-6 and TNF-α (P < 0 05). In addition, the positive correlation was found between the Lysholm osteoarthritis score and the above factors (P < 0 05). Finally, logistic analysis of elevated peripheral blood miR-365 and COMP is an independent risk factor for osteoarthritis.
MiR-365, COMP and inflammatory factors IL-6 and TNF-α are highly expressed in knee osteoarthritis.
Interpreting and Stabilizing Machine-Learning Parametrizations of Convection
Authors: Brenowitz Noah D. , Beucler Tom , Pritchard Michael , Bretherton Christopher S.
Published: October 2020

Neural networks are a promising technique for parameterizing subgrid-scale physics (e.g., moist atmospheric convection) in coarse-resolution climate models, but their lack of interpretability and reliability prevents widespread adoption. For instance, it is not fully understood why neural network parameterizations often cause dramatic instability when coupled to atmospheric fluid dynamics. This paper introduces tools for interpreting their behavior that are customized to the parameterization task. First, we assess the nonlinear sensitivity of a neural network to lower-tropospheric stability and the midtropospheric moisture, two widely studied controls of moist convection. Second, we couple the linearized response functions of these neural networks to simplified gravity wave dynamics, and analytically diagnose the corresponding phase speeds, growth rates, wavelengths, and spatial structures. To demonstrate their versatility, these techniques are tested on two sets of neural networks, one trained with a superparameterized version of the Community Atmosphere Model (SPCAM) and the second with a near-global cloud-resolving model (GCRM). Even though the SPCAM simulation has a warmer climate than the cloud-resolving model, both neural networks predict stronger heating/drying in moist and unstable environments, which is consistent with observations. Moreover, the spectral analysis can predict that instability occurs when GCMs are coupled to networks that support gravity waves that are unstable and have phase speeds larger than 5 m s−1. In contrast, standing unstable modes do not cause catastrophic instability. Using these tools, differences between the SPCAM-trained versus GCRM-trained neural networks are analyzed, and strategies to incrementally improve both of their coupled online performance unveiled.
The Complementary Value of XBT and Argo Observations to Monitor Ocean Boundary Currents and Meridional Heat and Volume Transports: A Case Study in the Atlantic Ocean
Authors: Goes Marlos , Goni Gustavo , Dong Shenfu , Boyer Timothy , Baringer Molly
Published: October 2020

This work assesses the value of expendable bathythermograph (XBT) and Argo profiling float observations to monitor the Atlantic Ocean boundary current systems (BCS), meridional overturning circulation (MOC), and meridional heat transport (MHT). Data from six XBT transects and available Argo floats in the Atlantic Ocean for the period from 2000 to 2018 are used to estimate the structure and variability of the BCS, MOC, and MHT, taking into account different temporal and spatial mapping strategies. The comparison of Argo data density along these six XBT transects shows that Argo observations outnumber XBT observations only above mapping scales of 30 days and 3° boxes. The comparison of Argo and XBT data for the Brazil Current and Gulf Stream shows that Argo cannot reproduce the structure and variability of these currents, as it lacks sufficient resolution to resolve the gradients across these narrow jets. For the MHT and MOC, Argo estimates are similar to those produced by XBTs at a coarse mapping resolution of 5° and 30 days. However, at such a coarse resolution the root-mean-square errors calculated for both XBT and Argo estimates relative to a high-resolution baseline are higher than 3 Sv (1 Sv ≡ 106 m3 s−1) and 0.25 PW for the MOC and MHT, respectively, accounting for about 25%–30% of their mean values due to the smoothing of eddy variability along the transects. A key result of this study is that using Argo and XBT data jointly, rather than separately, improves the estimates of MHT, MOC, and BCS.
The coronavirus crisis reveals blind spots in Nordic labour market data – A sociological perspective
Authors: Ilsøe Anna , Larsen Trine P
Published: October 2020

The Nordic countries are renowned for their unique administrative register data that include various aspects of an individual’s labour market activities. However, studies of government-led help packages and their effects during the coronavirus crisis in Denmark reveal that the labour market statistics used by government and academics have several blind spots when it comes to some of the most vulnerable groups in the labour market. There are strong signs that we underestimate the scope and depth of atypical work and even lack reliable data. We argue in this piece that the coronavirus crisis is an important lesson for labour market sociology that calls for methodological development.
Accountable Government Spending: A Cross-National Analysis of Child Mortality in Developing Nations
Authors: Sommer Jamie M.
Published: October 2020

What can national governments do to improve their capacity for well-being? While increasing public medical care expenditures can facilitate increased well-being in developing nations, cross-national research often finds that public medical care expenditures have no effect on indicators of well-being, such as child mortality. This ineffective public spending could be due to a lack of governance; however, this relationship is understudied in the cross-national literature. Using 2-way fixed and generalized least squares random effects models for a sample of 74 low- and middle-income nations from 1996 to 2012, I examine how the interaction among 5 measures of national governance and public medical care expenditures impact child mortality. The findings reveal the importance of governance in determining the effectiveness of public medical care expenditures. Both public medical care expenditures and governance improvements are essential to reduce child mortality.
Dyeing mechanism and photodegradation kinetics of gardenia yellow natural colorant
Authors: Jiang Huiyu , Hu Xiaodong , Khan Asfandyar , Yao Jinbo , Tahir Hussain Muhammad
Published: October 2020

In this study, gardenia yellow solution is used to dye 100% cotton fabric. The dyeing rate curve and adsorption isotherms were recorded to explore the thermodynamic model and to calculate the corresponding parameters. A definite concentration of gardenia yellow solution was placed under the xenon arc lamp for irradiation to test its photodegradability. Absorbance of the solution was measured at different degradation times and the corresponding varying curve of the absorbance was drawn to explore the photodegradation reaction order of the natural colorant and consistent parameters were calculated. The experimental results proved that the dyeing of cotton fabric with gardenia yellow colorant followed the pseudo second order kinetic model whereas adsorption isotherm followed the Langmuir model and the photodegradation process followed the second order kinetic model. Values of different parameters were calculated: reaction rate constant k = 2.26 × 10–3 (mg · L−1)1−m h−1, the correlation coefficient R2 = 0.994, and half decay time t1/2 = 5.82 h.
The Impact of Laws on Norms Perceptions
Authors: Eisner Léïla , Turner-Zwinkels Felicity , Spini Dario
Published: October 2020

When opinions in a society change toward more or less tolerance of a group, people do not necessarily see it. Drawing on a quasi-representative survey (Study 1, N = 830) and a natural experiment (Study 2, N = 437), we investigated people’s perceptions of the societal norms toward sexual minorities and the influence of laws on these (mis-)perceptions. Study 1 indicated pluralistic ignorance as participants overestimated the societal disapproval toward same-sex issues. Complementing this finding, Study 2 found that informing participants about a new law legalizing stepchild adoption decreased perceived societal disapproval of same-sex parenting compared with participants not informed about the law. Pluralistic ignorance, however, was not affected by the new law. While results indicate that pluralistic ignorance may be more resilient to change, they also highlight that laws can have a dual impact on societies, changing not only the legal situation but also shifting perceptions of societal norms.
Sleep Architecture in Children With Down Syndrome With and Without Obstructive Sleep Apnea
Authors: Heubi Christine H. , Knollman Philip , Wiley Susan , Shott Sally R. , Smith David F. , Ishman Stacey L. , Meinzen‐Derr Jareen
Published: October 2020

Objective

To characterize polysomnographic sleep architecture in children with Down syndrome and compare findings in those with and without obstructive sleep apnea.

Study Design

Case series with retrospective review.

Setting

Single tertiary pediatric hospital (2005‐2018).

Methods

We reviewed the electronic health records of patients undergoing polysomnography who were referred from a specialized center for children with Down syndrome (age, ≥12 months). Continuous positive airway pressure titration, oxygen titration, and split‐night studies were excluded.

Results

A total of 397 children were included (52.4% male, 81.6% Caucasian). Mean age at the time of polysomnography was 4.7 years (range, 1.4‐14.7); 79.4% had obstructive sleep apnea. Sleep variables were reported as mean (SD) values: sleep efficiency, 85% (11%); sleep latency, 29.8 minutes (35.6); total sleep time, 426 minutes (74.6); rapid eye movement (REM) latency, 126.8 minutes (66.3); time spent in REM sleep, 22% (7%); arousal index, 13.3 (5); and time spent supine, 44% (28%). There were no significant differences between those with obstructive sleep apnea and those without. Sleep efficiency <80% was seen in 32.5%; 34.3% had a sleep latency >30 minutes; 15.9% had total sleep time <360 minutes; and 75.6% had an arousal index >10/h. Overall, 69.2% had ≥2 metrics of poor sleep architecture. REM sleep time <20% was seen in 35.3%. REM sleep time decreased with age.

Conclusion

In children with Down syndrome, 32.5% had sleep efficiency <80%; 75.6% had an elevated arousal index; and 15.9% had total sleep time <360 minutes. More than a third of the patients had ≥3 markers of poor sleep architecture. There was no difference in children with or without obstructive sleep apnea.
Multi‐institutional Comparison of Temporal Bone Models: A Collaboration of the AAO‐HNSF 3D‐Printed Temporal Bone Working Group
Authors: Mowry Sarah E. , Jabbour Noel , Rose Austin S. , Wiet Gregory J. , Svrakic Maja , Zopf David A. , Vankoevering Kyle , Powell Allison , Freiser Monika E. , Hochman Jordan , Smith Richard
Published: October 2020

Objective

The American Academy of Otolaryngology–Head and Neck Surgery Foundation’s (AAO‐HNSF’s) 3D‐Printed Temporal Bone Working Group was formed with the goal of sharing information and experience relating to the development of 3D‐printed temporal bone models. The group conducted a multi‐institutional study to directly compare several recently developed models.

Study Design

Expert opinion survey.

Setting

Temporal bone laboratory.

Methods

The working group convened in 2018. The various methods in which 3D virtual models had been created and printed in physical form were then shared and recorded. This allowed for comparison of the advantages, disadvantages, and costs of each method. In addition, a drilling event was held during the October 2018 AAO‐HNSF Annual Meeting. Each model was drilled and evaluated by attending‐level working group members using an 15‐question Likert scale questionnaire. The models were graded on anatomic accuracy as well as their suitability as a simulation of both cadaveric and operative temporal bone drilling.

Results

The models produced for this study demonstrate significant anatomic detail and a likeness to human cadaver specimens for drilling and dissection. Models printed in standard resin material with a stereolithography printer scored highest in the evaluation, though the margin of difference was negligible in several categories.

Conclusion

Simulated 3D temporal bones created through a number of printing methods have potential benefit in surgical training, preoperative simulation for challenging otologic cases, and the standardized testing of temporal bone surgical skills.
Local supplier firms in Madagascar’s apparel export industry: Upgrading paths, transnational social relations and regional production networks
Authors: Whitfield Lindsay , Staritz Cornelia
Published: October 2020

This article asks whether and how local firms in low-income countries can participate, upgrade and capture value in apparel global value chains in the context of increased entry barriers and asymmetric power relations. It focuses on Madagascar, which is the top apparel exporter in Sub-Saharan Africa and one where there is a significant number of local firms. The article examines the capability-building processes of local firms, which are the basis for upgrading paths and broader sector development. We do this by combining conceptual insights from the Technological Capabilities literature with the conjunctural approach to Global Value Chains and Global Production Networks. Based on extensive fieldwork in Madagascar’s apparel export sector, the article explains how the relational, local and regional assets that local firms can leverage in building technological capabilities influence their choices with regards to export strategies and their upgrading paths. In turn, these assets are linked to different types of local ownership, and they emerge through historical legacies and the national socio-economic context, which give rise to specific transnational social relations, as well as through regional economic formations and global value chain dynamics.
Current Concepts Regarding Patellofemoral Trochlear Dysplasia
Authors: Levy Benjamin J. , Tanaka Miho J. , Fulkerson John P.
Published: October 2020

Optimal treatment of patients with patellofemoral trochlear dysplasia and recurrent patellar instability requires in-depth understanding of this complex structural anomaly. An extensive review of the literature suggests that dysplasia occurs as a result of aberrant forces applied to the patellofemoral joint in the majority of cases. Evidence supports surgical stabilization that reconstructs the medial patellofemoral and/or medial quadriceps tendon–femoral ligament without added trochleoplasty in the majority of patients with trochlear dysplasia and recurrent patellar instability. Adding tibial tubercle transfer distally, medially, or anteromedially in those who need it to treat specific deficits in alignment or articular cartilage can be beneficial in selected patients with trochlear dysplasia and recurrent patellar instability. Trochleoplasty may be appropriate in those few cases in which permanent stable patellofemoral tracking cannot be restored otherwise, but the indications are not yet clear, particularly as trochleoplasty adds risk to the articular cartilage. Improved understanding of imaging techniques and 3-dimensional reproductions of dysplastic patellofemoral joints are useful in surgical planning for patients with recurrent patellar instability and trochlear dysplasia.
Suture Tape Augmented Broström Procedure and Early Accelerated Rehabilitation
Authors: Martin Kevin D. , Andres Nolan N. , Robinson William H.
Published: October 2020

Background:

Immediately following a lateral ligament reconstruction of the ankle, the strength of the repair is far less than that of the native anterior talofibular ligament (ATFL). Additionally, early functional rehabilitation has been shown to increase laxity of the repair. We hypothesized that a Broström procedure augmented with a suture-tape construct would allow early functional rehabilitation while maintaining patient reported outcomes within a military population.

Methods:

This study is a retrospective study of 93 consecutive patients with chronic lateral ankle instability that were treated with a Broström procedure augmented with a suture-tape construct. Subjects were evaluated at 2, 6, and 12 weeks postoperatively, with yearly satisfaction reviews. Demographics and functional outcomes including Foot and Ankle Disability Index (FADI), visual analog scale (VAS), satisfaction score, and clinical measures including single-leg hop and single-leg heel raise were recorded. Our patients included 75 males and 18 females with a mean age of 30 ± 7 (range, 19-51) years; our mean follow-up was 19 (range, 3-48) months.

Results:

The mean FADI score improved from 67 preoperatively to 87 and 90 at 6 and 12 weeks ( P < .001), with 60 patients (65%) obtaining a score greater than 90. The mean VAS scores improved from 4.8 preoperatively to 1.4 and 1.3 at 6 and 12 weeks ( P < .001). Eighty-two (96%) of the patients asked were able to complete a single-leg hop and single-leg heel raise at 6 weeks. The 12-, 24-, 36-, and 48-month satisfaction scores were 8.5, 9.8, 9.2, and 8.9, respectively. Demographics collected did not impact results.

Conclusion:

This study suggests that a Broström procedure augmented with suture tape enabled early safe functional rehabilitation without subsequent failure. Our data also demonstrated a sustained high level of patient satisfaction while preventing reoccurrence within a high-demand military population.

Level of Evidence:

Level IV, retrospective case series.
Health Policy by Litigation
Authors: Keith Katie , McElvain Joel
Published: October 2020

Since its enactment, the Affordable Care Act (ACA) has faced numerous legal challenges. Many of these lawsuits have focused on implementation of the law and the limits of executive power. Opponents challenged the ACA under the Obama Administration while supporters have turned to the courts to prevent the Trump Administration from undermining the law. In the meantime, Congress remains gridlocked over the ACA and many other critical health policy issues, leaving the executive branch to adopt its preferred policy approach and ultimately leading to lawsuits. This article briefly discusses the history of litigation over the ACA and some reasons why this litigation has been so enduring. The article then identifies other areas of health policy that are or could be future targets for litigation. Finally, the article comments on the potential impact of the courts on future health reform efforts.
Parity is Not Enough!
Authors: Lawrence Matthew B.
Published: October 2020

This commentary describes limitations of mental health parity requirements in ensuring access to insurance coverage for mental health treatment and surveys regulatory options employed by states in Medicaid managed care programs as supplements to parity that can further reduce the risk of inappropriate denials of coverage.
Introduction of biosimilar pegfilgrastim in France: Economic analysis of switching from originator
Authors: Tilleul Patrick R , Rodgers-Gray Barry S , Edwards James O
Published: October 2020

Objectives

To assess the economic impact of introducing biosimilar pegfilgrastim compared to the current standard granulocyte colony-stimulating factor (G-CSF) practice in France.

Methods

A budget impact model was developed to investigate the impact of introducing pegfilgrastim biosimilar over 5 years. The model analysed drug acquisition costs, ambulatory costs, as well as costs associated with poor outcomes, and compared the current standard practice of long-acting and short-acting G-CSF to a revised practice including pegfilgrastim biosimilar in addition to standard practice treatments. The cost of switching to pegfilgrastim biosimilar, within a pharmacy setting, was analysed within the model using data from a survey of French pharmacists.

Results

The budget impact model calculated a cost saving of €51,007,531 over 5 years switching from the current standard practice to pegfilgrastim biosimilar. A sensitivity analysis accounting for variation in pegfilgrastim biosimilar uptake of 1) 15% in year 1 and 1% in years 2–5 and 2) 15% in years 1–5, estimated savings ranging between €29,377,784 and €79,847,194, respectively. A further analysis predicted cost savings of €287,344,835 over 5 years with the extension of pegfilgrastim biosimilar, at an uptake of 15% in year 1 and 7% in years 2–4, to both long-acting and short-acting G-CSF groups compared to unchanged current practice.

Conclusions

The introduction of pegfilgrastim biosimilar will help to reduce cost and alleviate some of the financial pressure on the French healthcare system.
Trends and perioperative outcomes of patients with human immunodeficiency virus (HIV) undergoing lower extremity revascularization
Authors: Kim Tanner I , Brahmandam Anand , Sarac Timur P , Orion Kristine C
Published: October 2020

The development of highly active antiretroviral therapy (HAART) has significantly improved the life expectancy of patients with human immunodeficiency virus (HIV), but has led to the rise of chronic conditions including peripheral artery disease (PAD). However, trends and outcomes among patients with HIV undergoing lower extremity revascularization are poorly characterized. The aim of this study was to investigate the trends and perioperative outcomes of lower extremity revascularization among patients with HIV and PAD in a national database. The National Inpatient Sample (NIS) was reviewed between 2003 and 2014. All hospital admissions with a diagnosis of PAD undergoing lower extremity revascularization were stratified based on HIV status. Outcomes were assessed using propensity score matching and multivariable regression. Among all patients undergoing lower extremity revascularization for PAD, there was a significant increase in the proportion of patients with HIV from 0.21% in 2003 to 0.52% in 2014 ( p < 0.01). Patients with HIV were more likely to be younger, male, and have fewer comorbidities, including coronary artery disease and diabetes, at the time of intervention compared to patients without HIV. With propensity score matching and multivariable regression, HIV status was associated with increased total hospital costs, but not length of stay, major amputation, or mortality. Patients with HIV with PAD who undergo revascularization are younger with fewer comorbidities, but have increased hospital costs compared to those without HIV. Lower extremity revascularization for PAD is safe for patients with HIV without increased risk of in-hospital major amputation or mortality, and continues to increase each year.
Role of vitamin D supplements in prevention of hungry bone syndrome after successful parathyroidectomy for primary hyperparathyroidism: A prospective study
Authors: Salman Mohamed AbdAlla , Rabiee Ahmed , Salman Ahmed Abdallah , Youssef Ahmed , Shaaban Hossam El-Din , Ftohy Tarek , Maurice Karim Kamal , Balamoun Hany
Published: October 2020

Background:

We postulated that the preoperative correction of vitamin D levels can significantly reduce the incidence of hunger bone syndrome among patients undergoing parathyroidectomy for primary hyperparathyroidism.

Methods:

We performed a prospective, randomized, open-label study on 102 patients with primary hyperparathyroidism and coexisting vitamin D deficiency who were scheduled to undergo parathyroidectomy. Patients were divided into the following two groups: group I which included 52 patients who did not receive preoperative vitamin D supplementation; and group II which included 50 patients who received cholecalciferol 1000–2000 IU daily or 50000 IU weekly until they achieve vitamin D levels >20 ng/mL (group IIa = 25 patients) or vitamin D levels >30 ng/mL (group IIb = 25 patients).

Results:

The incidence of hunger bone syndrome in group IIb was lower than group I and group IIa (8% versus 16% versus 23%, respectively); however, this difference did not reach the level of statistical significance (p = 0.22). Patients with hunger bone syndrome were significantly younger and had higher serum phosphorus, alkaline phosphatase, magnesium, and bone mineral density at baseline than patients without hunger bone syndrome. On the other hand, patients with hunger bone syndrome had significantly lower 25-hydroxyvitamin D at baseline than patients without hunger bone syndrome (p = 0.001). The ROC curve showed that the baseline level of serum 25-hydroxyvitamin D was not an independent discriminator of hunger bone syndrome (area under curve = 0.21 (95% CI: 0.06–0.34); p = 0.011).

Conclusions:

Preoperative course of vitamin D supplements has no preventive role on the postoperative incidence of hunger bone syndrome among patients with primary hyperparathyroidism and coexisting vitamin D deficiency undergoing parathyroidectomy.
ITSMEI: An intelligent transport system for monitoring traffic and event information
Authors: Quessada Matheus S , Pereira Rickson S , Revejes William , Sartori Bruno , Gottsfritz Euclydes N , Lieira Douglas D , da Silva Marco AC , Rocha Filho Geraldo P , Meneguette Rodolfo I
Published: October 2020

The disorderly growth of urban centers can lead to serious socioeconomic disadvantages, such as health problems, due to long-term exposure to toxic gases and also monetary losses due to time stopped in congestion. Thus, there is a need for systems that help in the management and control of the flow of vehicles on the roads, seeking to reduce the damage resulting from a faulty transportation system and also avoiding the use of an inefficient system of information dissemination of urban roads. In this scenario, innovative systems are being developed to analyze the conjunction of road conditions to supervise and provide routes as needed for drivers to provide greater comfort and safety to vehicle traffic on urban roads. Thus, in this work, we propose the development of a system to monitor vehicle traffic, informing about events that are taking place on the roads in real time. The system can recommend new routes to drivers or allow drivers to take action based on information received from a particular road. As well as, the system uses driver location information for traffic monitoring, which will later be available for any devices, either a mobile device (smartphone) or a desktop. For the evaluation of the proposed system, a user case was developed for the Catanduva city in which we performed a test with the proposed system and was possible to verify a reduction in vehicle stopping time by 42% and a shorter travel time of 50% with an average speed of 33 km/h.
Brazilian vascular surgeons experience during the coronavirus (COVID-19) pandemic
Authors: Malgor Rafael D , Sobreira Marcone Lima , Mouawad Nicolas J , Johnson Adam P , Wohlauer Max V , Coogan Sheila M , Cuff Robert F , Coleman Dawn M , Sheahan Malachi G , Woo Karen , Shalhub Sherene
Published: October 2020

Background

The COVID-19 pandemic has made a significant impact on all spheres of society. The objective of this study was to examine the impact of COVID-19 on the practices, finances, and social aspects of Brazilian vascular surgeons’ lives.

Methods

This is a descriptive analysis of the responses from Brazilian vascular surgeons to the cross-sectional anonymous Society for Vascular Surgery Wellness Task Force Pandemic Practice, Anxiety, Coping, and Support Survey for Vascular Surgeons disseminated 14–24 April 2020. Survey dissemination in Brazil occurred mainly via the Brazilian Society of Angiology and Vascular Surgery (SBACV) and social media. The survey evaluated the impact of the COVID-19 pandemic on vascular surgeons’ lives by assessing COVID-19-related stressors, anxiety using theGeneral Anxiety Disorder (GAD)-7 scale, and coping strategies using the Brief Coping Orientation to Problems Experienced (Brief-COPE) inventory.

Results

A total of 452 responses were recorded from Brazil, with 335 (74%) respondents completing the entire survey. The majority of respondents were males ( N = 301, 67%) and practiced in an urban hospitals. The majority of respondents considered themselves at high risk to be infected with COVID-19 ( N = 251, 55.8%), and just over half the respondents noted that they had adequate PPE at their primary hospital ( N = 171, 54%). One hundred and nine (35%) surgeons confirmed that their hospitals followed professional surgical society guidelines for prioritizing surgeries during the pandemic. At the time of the survey, only 33 (10%) surgeons stated they have pre-operative testing of patients for COVID-19 available at their hospital. Academic vascular surgeons reported being redeployed more often to help with other non-vascular duties compared to community-based or solo practitioners (43% vs. 30% vs. 21% respectively, P = .01). Severe anxiety due to pandemic-related financial concerns was similar in those surgeons practicing solo compared to those in community- or academic-based/group practice (46% vs. 38% vs. 22%; P = .54). The respondents reported their anxiety levels as mild based on the stressors investigated instead of moderate-severe (54% vs. 46%; P = .04). Social media was utilized heavily during the pandemic, with video gatherings being the most commonly used tool (76%). Self-distraction (60%) and situational acceptance (81%) were the most frequently reported coping mechanisms used among Brazilian vascular surgeons.

Conclusion

The COVID pandemic has greatly affected healthcare providers around the world. At the time of this survey, Brazilian vascular surgeons are reporting low anxiety levels during this time and are using mostly active coping mechanisms.
A randomized control trial of intensive aphasia therapy after acute stroke: The Very Early Rehabilitation for SpEech (VERSE) study
Authors: Godecke Erin , Armstrong Elizabeth , Rai Tapan , Ciccone Natalie , Rose Miranda L , Middleton Sandy , Whitworth Anne , Holland Audrey , Ellery Fiona , Hankey Graeme J , Cadilhac Dominique A , Bernhardt Julie ,   on behalf of the VERSE Collaborative Group
Published: October 2020

Background

Effectiveness of early intensive aphasia rehabilitation after stroke is unknown. The Very Early Rehabilitation for SpEech trial (VERSE) aimed to determine whether intensive aphasia therapy, beginning within 14 days after stroke, improved communication recovery compared to usual care.

Methods

Prospective, randomized, single-blinded trial conducted at 17 acute-care hospitals across Australia/New Zealand from 2014 to 2018. Participants with aphasia following acute stroke were randomized to receive usual care (direct usual care aphasia therapy), or one of two higher intensity regimens (20 sessions of either non-prescribed (usual care-plus or prescribed (VERSE) direct aphasia therapy). The primary outcome was improvement of communication on the Western Aphasia Battery-Revised Aphasia Quotient (AQ) at 12 weeks after stroke. Our pre-planned intention to treat analysis combined high intensity groups for the primary outcome.

Findings

Among 13,654 acute stroke patients screened, 25% (3477) had aphasia, of whom 25% (866) were eligible and 246 randomized to usual care ( n = 81; 33%), usual care-plus ( n = 82; 33%) or VERSE ( n = 83; 34%). At 12 weeks after stroke, the primary outcome was assessed in 217 participants (88%); 14 had died, 9 had withdrawn, and 6 were too unwell for assessment. Communication recovery was 50.3% (95% CI 45.7–54.8) in the high intensity group ( n = 147) and 52.1% (95% CI 46.1–58.1) in the usual care group ( n = 70; difference −1.8, 95% CI −8.7–5.0). There was no difference between groups in non-fatal or fatal adverse events ( p = 0.72).

Interpretation

Early, intensive aphasia therapy did not improve communication recovery within 12 weeks post stroke compared to usual care.