bluuebunny/crossref_metadata_2025 huggingface dataset:
The Veil of Philanthropy
Authors: Stohr Karen
Published: September 2019

This chapter defends the practice that Kant described as “throwing the veil” of philanthropy or charity over the moral flaws and failings of other people. This practice requires not just avoiding making defamatory remarks and spreading unpleasant gossip but also actively working to generate charitable narratives about other people and their actions. The veil of philanthropy serves as a buffer against natural human tendencies toward self-conceit and misanthropy. The practice is essential to good moral neighborhoods because it enhances and reinforces individual and collective commitments to moral improvement, and it expresses faith in the eventual success in the project. Good moral neighborhoods depend on participants being able to maintain hope in moral progress. In other words, in order for moral improvement to be successful, it is necessary to act as though it could be.
Reproduction
Authors: Boris Eileen
Published: September 2019

This chapter analyzes the ILO’s Programme on Rural Women, which offered an alternative vision of development around the worth of subsistence and reproductive labor. Beginning in the late 1970s, its feminist staff moved beyond the findings of Ester Boserup on the gendered impact of development. They considered relations in the household, the centrality of women’s domestic and non-monetized work, and the significance of both for capitalist accumulation. Eschewing reliance on statistical data, program staff sought to decolonize knowledge by commissioning fieldwork and surveys by women researchers from the very places under investigation. The staff encouraged participatory action research that regarded rural women themselves as experts and empowered poor women collectively. The resulting studies, including ones by Lourdes Benería and Maria Mies, would define the field of women and development. But the program came into conflict with FEMMES, the ILO’s coordinating unit on women’s issues, over institutional domains, issue priorities, and the very meaning of equality. By the mid-1980s whether the conditions of the rural woman in the Global South would foreshadow wider precarity was unclear, but a general belief emerged that family labor created a barrier to full labor force participation.
Peace, the Constitution, and Rebellion, 1781–1800
Authors: Larson Carlton F.W.
Published: September 2019

The years following Cornwallis’s surrender in 1781 saw a few more treason cases, and a large number of cases of persons accused of aiding British prisoners to escape. Summary data on treason prosecutions are presented. Returning Loyalists were largely well treated. The state’s last treason indictment, dealing with the Connecticut land dispute, was issued in the late 1780s. The Constitutional Convention adopted a Treason Clause, the meaning of which was tested in trials resulting from the Whiskey Rebellion and Fries’s Rebellion. The prosecution and defense disagreed over whether these rebellions amounted to levying war against the United States. This debate contained many echoes of the earlier debate over resistance to British measures, and would not be conclusively resolved until the nineteenth century, if then.
Reading Revolution
Authors: Jones Polly
Published: September 2019

This chapter analyses the large and hitherto unexplored archives of readers’ letters to Politizdat and to individual authors about the series (Iurii Trifonov, Natan Eidel′man), in order to challenge understandings of how late Soviet literature was read, and to diversify the ‘uses’ of Soviet biography. Reader responses to the series reveal a vibrant multiplicity of late Soviet ‘interpretive communities’ and hermeneutic practices: the traditionally Soviet model of remoulding the self in the image of the hero; both factographic and more sophisticated historical reflection; and critique of the late Soviet public sphere and its constraints on self-expression. The ‘Fiery Revolutionaries’ series thus exemplifies the ways in which late Soviet ‘official’ culture could also contribute to pluralization and ‘diverse thinking’ (raznomyslie), which is often identified only with the underground. The historical collaboration and solidarity facilitated by the correspondence between the series’ authors and their readers also suggest the survival of intelligentsia networks and ideas of literary professionalism from the Khrushchev-era thaw.
Physiological and morphological effects of climate change
Authors: McKechnie Andrew E.
Published: September 2019

The direct impacts of higher temperatures on birds are manifested over timescales ranging from minutes and hours to years and decades. Over short timescales, acute exposure to high temperatures can lead to hyperthermia or dehydration, which among arid-zone species occasionally causes catastrophic mortality events. Over intermediate timescales of days to weeks, high temperatures can have chronic sub-lethal effects via body mass loss or reduced nestling growth rates, negatively affecting sev eral fitness components. Long-term effects of warming manifested over years to decades involve declining body mass or changes in appendage size. Key directions for future research include elucidating the role of phenotypic plasticity and epigenetic processes in avian adaptation to climate change, examining the role of stress pathways in mediating responses to heat events, and understanding the consequences of higher temperatures for species that traverse hot regions while migrating.
Predator–prey interactions and climate change
Authors: Bretagnolle Vincent , Terraube Julien
Published: September 2019

Climate change is likely to impact all trophic levels, although the response of communities and ecosystems to it has only recently received considerable attention. Further, it is expected to affect the magnitude of species interactions themselves. In this chapter, we summarize why and how climate change could affect predator–prey interactions, then review the literature about its impact on predator–prey relationships in birds, and provide prospects for future studies. Expected effects on prey or predators may include changes in the following: distribution, phenology, population density, behaviour, morphology, or physiology. We review the currently available information concerning particular key topics: top-down versus bottom-up control, specialist versus generalist predators, functional versus numerical responses, trophic cascades and regime shifts, and lastly adaptation and selection. Finally, we focus our review on two well-studied bird examples: seabirds and raptors. Key future topics include long-term studies, modelling and experimental studies, evolutionary questions, and conservation issues.
Social Claims in the Shadow of the Fallen
Authors: Hassett Dónal
Published: September 2019

This chapter examines the left’s attempts to mobilize the wartime ‘moral economy of sacrifice’ in support of its vision of a just post-war order in the colony. Focusing on the immediate post-war moment, it examines how the campaigns of strike action and political protests led by socialists and trade unionists in the colony relied heavily on egalitarian notions grounded in the wartime experience. It also considers the response this provoked from conservative forces, which sought to counter the left’s rhetoric by stressing the ‘fraternity of arms’. Finally, it assesses the place of indigenous workers in these debates, asking how the left reconciled its use of an egalitarian language, drawn in part from the experience of the war, with its ambiguous attitude toward any erosion of European hegemony in the colony.
Working Conditions, Workers’ Rights, and Candidate Preference in the 2016 Democratic Primary
Authors: Lyon Gregory
Published: September 2019

Working conditions and workers’ rights have long been indicators of broader societal power, yet it is unclear whether candidates who take explicit stands on such issues can expect to find electoral support among voters. This study draws on cross-sectional and panel data to examine the relationship between attitudes toward such issues and candidate preference in the 2016 Democratic primary. Although research on vote choice suggests issue attitudes are typically remote considerations, the findings indicate that Democrats who were more concerned about workers’ working conditions and the exploitation of workers were significantly more likely to prefer Bernie Sanders in the 2016 Democratic primary. Moreover, findings from panel data suggest such attitudes were latent, rather than adopted, as Democrats who expressed support for stronger regulation of business in 2011 were significantly more likely to prefer Bernie Sanders five years later in 2016. The findings suggest that issue attitudes can be meaningful considerations when there are distinct options for voters, and that the unanticipated Democratic support enjoyed by Bernie Sanders in the 2016 Democratic primary is at least partially attributable to his strong and explicit stands on working conditions and workers’ rights.
Assessing Toxicokinetic Uncertainty and Variability in Risk Prioritization
Authors: Wambaugh John F , Wetmore Barbara A , Ring Caroline L , Nicolas Chantel I , Pearce Robert G , Honda Gregory S , Dinallo Roger , Angus Derek , Gilbert Jon , Sierra Teresa , Badrinarayanan Akshay , Snodgrass Bradley , Brockman Adam , Strock Chris , Setzer R Woodrow , Thomas Russell S
Published: September 2019

High(er) throughput toxicokinetics (HTTK) encompasses in vitro measures of key determinants of chemical toxicokinetics and reverse dosimetry approaches for in vitro-in vivo extrapolation (IVIVE). With HTTK, the bioactivity identified by any in vitro assay can be converted to human equivalent doses and compared with chemical intake estimates. Biological variability in HTTK has been previously considered, but the relative impact of measurement uncertainty has not. Bayesian methods were developed to provide chemical-specific uncertainty estimates for 2 in vitro toxicokinetic parameters: unbound fraction in plasma (fup) and intrinsic hepatic clearance (Clint). New experimental measurements of fup and Clint are reported for 418 and 467 chemicals, respectively. These data raise the HTTK chemical coverage of the ToxCast Phase I and II libraries to 57%. Although the standard protocol for Clint was followed, a revised protocol for fup measured unbound chemical at 10%, 30%, and 100% of physiologic plasma protein concentrations, allowing estimation of protein binding affinity. This protocol reduced the occurrence of chemicals with fup too low to measure from 44% to 9.1%. Uncertainty in fup was also reduced, with the median coefficient of variation dropping from 0.4 to 0.1. Monte Carlo simulation was used to propagate both measurement uncertainty and biological variability into IVIVE. The uncertainty propagation techniques used here also allow incorporation of other sources of uncertainty such as in silico predictors of HTTK parameters. These methods have the potential to inform risk-based prioritization based on the relationship between in vitro bioactivities and exposures.
Climatic and physiological regulation of the bimodal xylem formation pattern in Pinus pinaster saplings
Authors: Garcia-Forner Núria , Vieira Joana , Nabais Cristina , Carvalho Ana , Martínez-Vilalta Jordi , Campelo Filipe
Published: September 2019

Seasonality in tree cambial activity and xylem formation encompass large variation in environmental conditions. Abiotic stressors such as warming or drought also modulate plant behavior at species and individual level. Despite xylem formation susceptibility to carbon (C) and water availability, it is still unknown which are the key physiological variables that regulate xylogenesis, and to what extent plant performance contributes to further explain the number of cells in the different phases of xylem development. Xylogenesis and physiological behavior was monitored in saplings of Pinus pinaster Aiton, a bimodal growth pattern species, distributed in different irrigation regimes. Xylogenesis and plant physiological behavior were compared between treatments and the relationship between climate, physiology and the number of cells in the cambium, enlargement and cell-wall thickening phases was evaluated. Xylogenesis regulation shifted from physiological to climatic control as cell differentiation advanced to mature tracheids. The number of cells in the cambium increased with assimilation rates and decreased with the water potential gradient through the plant. Enlargement was the most susceptible phase to plant relative water content, whereas no physiological variable contributed to explain the number of cells in the wall thickening phase, which declined as temperatures increased. All treatments showed a bimodal growth pattern with a second growth period starting when primary growth was completed and after plants had experienced the highest summer hydraulic losses. Our study demonstrates the importance of including physiological responses and not only climate to fully understand xylogenesis, with special attention to the enlargement phase. This is critical when studying species with a bimodal growth pattern because the second growth peak responds to internal shifts of C allocation and may strongly depend on plant hydraulic responses and not on a fine tuning of cambial activity with soil water availability.
Effect of a Cognitive Aid on Reducing Sugammadex Use and Associated Costs
Authors: Drzymalski Dan M. , Schumann Roman , Massaro Frank J. , Trzcinka Agnieszka , Azocar Ruben J.
Published: September 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

The authors observed increased pharmaceutical costs after the introduction of sugammadex in our institution. After a request to decrease sugammadex use, the authors implemented a cognitive aid to help choose between reversal agents. The purpose of this study was to determine if sugammadex use changed after cognitive aid implementation. The authors’ hypothesis was that sugammadex use and associated costs would decrease.

Methods

A cognitive aid suggesting reversal agent doses based on train-of-four count was developed. It was included with each dispensed reversal agent set and in medication dispensing cabinet bins containing reversal agents. An interrupted time series analysis was performed using pharmaceutical invoices and anesthesia records. The primary outcome was the number of sugammadex administrations. Secondary outcomes included total pharmaceutical acquisition costs of neuromuscular blocking drugs and reversal agents, adverse respiratory events, emergence duration, and number of neuromuscular blocking drug administrations.

Results

Before cognitive aid implementation, the number of sugammadex administrations was increasing at a monthly rate of 20 per 1,000 general anesthetics (P < 0.001). Afterward, the monthly rate was 4 per 1,000 general anesthetics (P = 0.361). One month after cognitive aid implementation, the number of sugammadex administrations decreased by 281 per 1,000 general anesthetics (95% CI, 228 to 333, P < 0.001). In the final study month, there were 509 fewer sugammadex administrations than predicted per 1,000 general anesthetics (95% CI, 366 to 653; P < 0.0001), and total pharmaceutical acquisition costs per 1,000 general anesthetics were $11,947 less than predicted (95% CI, $4,043 to $19,851; P = 0.003). There was no significant change in adverse respiratory events, emergence duration, or administrations of rocuronium, vecuronium, or atracurium. In the final month, there were 75 more suxamethonium administrations than predicted per 1,000 general anesthetics (95% CI, 32 to 119; P = 0.0008).

Conclusions

Cognitive aid implementation to choose between reversal agents was associated with a decrease in sugammadex use and acquisition costs.
A Population-based Comparative Effectiveness Study of Peripheral Nerve Blocks for Hip Fracture Surgery
Authors: Hamilton Gavin M. , Lalu Manoj M. , Ramlogan Reva , Bryson Gregory L. , Abdallah Faraj W. , McCartney Colin J. L. , McIsaac Daniel I.
Published: September 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Adverse outcomes and resource use rates are high after hip fracture surgery. Peripheral nerve blocks could improve outcomes through enhanced analgesia and decreased opioid related adverse events. We hypothesized that these benefits would translate into decreased resource use (length of stay [primary outcome] and costs), and better clinical outcomes (pneumonia and mortality).

Methods

The authors conducted a retrospective cohort study of hip fracture surgery patients in Ontario, Canada (2011 to 2015) using linked health administrative data. Multilevel regression, instrumental variable, and propensity scores were used to determine the association of nerve blocks with resource use and outcomes.

Results

The authors identified 65,271 hip fracture surgery patients; 10,030 (15.4%) received a block. With a block, the median hospital stay was 7 (interquartile range, 4 to 13) days versus 8 (interquartile range, 5 to 14) days without. Following adjustment, nerve blocks were associated with a 0.6-day decrease in length of stay (95% CI, 0.5 to 0.8). This small difference was consistent with instrumental variable (1.1 days; 95% CI, 0.9 to 1.2) and propensity score (0.2 days; 95% CI, 0.2 to 0.3) analyses. Costs were lower with a nerve block (adjusted difference, −$1,421; 95% CI, −$1,579 to −$1,289 [Canadian dollars]), but no difference in mortality (adjusted odds ratio, 0.99; 95% CI, 0.89 to 1.11) or pneumonia (adjusted odds ratio, 1.01; 95% CI, 0.88 to 1.16) was observed.

Conclusions

Receipt of nerve blocks for hip fracture surgery is associated with decreased length of stay and health system costs, although small effect sizes may not reflect clinical significance for length of stay.
Acoustic Shadowing Facilitates Ultrasound-guided Radial Artery Cannulation in Young Children
Authors: Quan ZheFeng , Zhang Liang , Zhou Chen , Chi Ping , He HaiLi , Li Ying
Published: September 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Arterial cannulation in young children can be challenging. Ultrasound guidance using focused acoustic shadowing may be suitable for guiding radial artery puncture in young children. The present research tested the hypothesis that ultrasound guidance using focused acoustic shadowing helps increase the success rate of radial artery cannulation in this population.

Methods

In a double-blinded, parallel-group trial, 79 young children undergoing surgery under general anesthesia were randomly assigned to two groups (1:1 ratio): the traditional ultrasound group and the novel ultrasound group. Young children in the traditional group underwent conventional ultrasound-guided radial artery puncture, whereas those in the novel ultrasound group underwent radial artery puncture guided by acoustic shadowing ultrasound with double developing lines. All radial artery punctures were performed using the short-axis out-of-plane approach. The primary endpoint was the success rate of cannulation at the first attempt. The secondary endpoints included cannulation failure rate, ultrasound location time, and puncture time.

Results

The success rate of cannulation at the first attempt in the novel ultrasound group (35 of 39 [90%]) was significantly higher than that in the traditional ultrasound group (24 of 40 [60%]; difference: 30% [95% CI, 12 to 48%], P =0.002). None of the patients in the ultrasound with acoustic shadowing group experienced failure of radial artery puncture and cannulation. The ultrasound location time and puncture time in the ultrasound acoustic shadowing group were significantly lower than that in the traditional ultrasound group (location time: median [interquartile range]: 6 [5, 8] vs. 18 [15, 21] s; puncture time: 24 [15, 41] vs. 40 [23, 56] s).

Conclusions

Acoustic shadowing via the use of double developing lines significantly improved the success rate of radial artery puncture in young children, compared with that achieved with the use of traditional ultrasound guidance.
Perioperative Neurocognitive Disorder
Authors: Eckenhoff Roderic G. , Maze Mervyn , Xie Zhongcong , Culley Deborah J. , Goodlin Sarah J. , Zuo Zhiyi , Wei Huafeng , Whittington Robert A. , Terrando Niccolò , Orser Beverley A. , Eckenhoff Maryellen F.
Published: September 2019

The purpose of this article is to provide a succinct summary of the different experimental approaches that have been used in preclinical postoperative cognitive dysfunction research, and an overview of the knowledge that has accrued. This is not intended to be a comprehensive review, but rather is intended to highlight how the many different approaches have contributed to our understanding of postoperative cognitive dysfunction, and to identify knowledge gaps to be filled by further research. The authors have organized this report by the level of experimental and systems complexity, starting with molecular and cellular approaches, then moving to intact invertebrates and vertebrate animal models. In addition, the authors’ goal is to improve the quality and consistency of postoperative cognitive dysfunction and perioperative neurocognitive disorder research by promoting optimal study design, enhanced transparency, and “best practices” in experimental design and reporting to increase the likelihood of corroborating results. Thus, the authors conclude with general guidelines for designing, conducting and reporting perioperative neurocognitive disorder rodent research.
An Automated Software Application Reduces Controlled Substance Discrepancies in Perioperative Areas
Authors: Shah Nirav , Sinha Anik , Thompson Aleda , Tremper Kevin , Meka Arjun , Kheterpal Sachin
Published: September 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Perioperative controlled substance diversion and tracking have received increased regulatory focus throughout the United States. The authors’ institution developed and implemented an automated web-based software application for perioperative controlled substance management. The authors hypothesized that implementation of such a system reduces errors as measured by missing controlled substance medications, missing controlled substance kits (a package of multiple controlled substance medications), and missing witness signatures during kit return.

Methods

From December 1, 2014 to March 31, 2017, the authors obtained missing controlled substance medication, controlled substance kit, and witness return signature data during the preimplementation, implementation, and study period of the controlled substance management application at a single university hospital. This before and after study was based on a QI project at the authors’ institution. The authors included all cases requiring anesthesia services. The primary outcome of this study was the rate of missing controlled substance medications. Secondary outcomes included rates for kits not returned to pharmacy and missing kit return witness signatures.

Results

There were 54,302 cases during the preimplementation period, 57,670 cases during the implementation period, and 65,911 cases during the study period. The number of missing controlled substance medication (difference 0.7 per 1,000 cases; 95% CI, 0.38–1.02; P < 0.001) and kit return errors (difference 0.45 per 1,000 cases; 95% CI, 0.24–0.66, P < 0.001) declined after implementation of the application. There was no difference in the number of missing witness return signatures (difference 0.09 per 1,000 cases; 95% CI, −0.08 to 0.26, P = 0.350). A user survey with 206 of 485 (42%) response rate demonstrated that providers believed the new application managed controlled substances better than the previous system.

Conclusions

A software application that tracks perioperative controlled substance kits with deep integration into the electronic health record and pharmacy systems is associated with a decrease in management errors.
Deficit Accumulation and Phenotype Assessments of Frailty Both Poorly Predict Duration of Hospitalization and Serious Complications after Noncardiac Surgery
Authors: Sonny Abraham , Kurz Andrea , Skolaris Linda A. , Boehm Laura , Reynolds Angela , Cummings Kenneth C. , Makarova Natalya , Yang Dongsheng , Sessler Daniel I.
Published: September 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Frailty is associated with adverse postoperative outcomes, but it remains unclear which measure of frailty is best. This study compared two approaches: the Modified Frailty Index, which is a deficit accumulation model (number of accumulated deficits), and the Hopkins Frailty Score, which is a phenotype model (consisting of shrinking, weakness, exhaustion, slowness, and low physical activity). The primary aim was to compare the ability of each frailty score to predict prolonged hospitalization. Secondarily, the ability of each score to predict 30-day readmission and/or postoperative complications was compared.

Methods

This study prospectively enrolled adults presenting for preanesthesia evaluation before elective noncardiac surgery. The Hopkins Frailty Score and Modified Frailty Index were both determined. The ability of each frailty score to predict the primary outcome (prolonged hospitalization) was compared using a ratio of root-mean-square prediction errors from linear regression models. The ability of each score to predict the secondary outcome (readmission and complications) was compared using ratio of root-mean-square prediction errors from logistic regression models.

Results

The study included 1,042 patients. The frailty rates were 23% (Modified Frailty Index of 4 or higher) and 18% (Hopkins Frailty Score of 3 or higher). In total, 12.9% patients were readmitted or had postoperative complications. The error of the Modified Frailty Index and Hopkins Frailty Score in predicting the primary outcome was 2.5 (95% CI, 2.2, 2.9) and 2.6 (95% CI, 2.2, 3.0) days, respectively, and their ratio was 1.0 (95% CI, 1.0, 1.0), indicating similarly poor prediction. Similarly, the error of respective frailty scores in predicting the probability of secondary outcome was high, specifically 0.3 (95% CI, 0.3, 0.4) and 0.3 (95% CI, 0.3, 0.4), and their ratio was 1.00 (95% CI, 1.0, 1.0).

Conclusions

The Modified Frailty Index and Hopkins Frailty Score were similarly poor predictors of perioperative risk. Further studies, with different frailty screening tools, are needed to identify the best method to measure perioperative frailty.
Artificial Intelligence in Anesthesiology
Authors: Hashimoto Daniel A. , Witkowski Elan , Gao Lei , Meireles Ozanan , Rosman Guy
Published: September 2019

Artificial intelligence has been advancing in fields including anesthesiology. This scoping review of the intersection of artificial intelligence and anesthesia research identified and summarized six themes of applications of artificial intelligence in anesthesiology: (1) depth of anesthesia monitoring, (2) control of anesthesia, (3) event and risk prediction, (4) ultrasound guidance, (5) pain management, and (6) operating room logistics. Based on papers identified in the review, several topics within artificial intelligence were described and summarized: (1) machine learning (including supervised, unsupervised, and reinforcement learning), (2) techniques in artificial intelligence (e.g., classical machine learning, neural networks and deep learning, Bayesian methods), and (3) major applied fields in artificial intelligence.

The implications of artificial intelligence for the practicing anesthesiologist are discussed as are its limitations and the role of clinicians in further developing artificial intelligence for use in clinical care. Artificial intelligence has the potential to impact the practice of anesthesiology in aspects ranging from perioperative support to critical care delivery to outpatient pain management.
NICU Nurses' Stress and Work Environment in an Open Ward Compared to a Combined Pod and Single-Family Room Design
Authors: Feeley Nancy , Robins Stephanie , Charbonneau Lyne , Genest Christine , Lavigne Geneviève , Lavoie-Tremblay Mélanie
Published: September 2019

Background:

The architectural design of a neonatal intensive care unit may affect the quality of the work environment for nurses, yet few studies have been conducted using reliable and valid measures. Recent studies have suggested some drawbacks of single-family rooms (SFRs) for both infants and parents. Research is needed to explore nurses' work environment in units combining pods and SFRs.

Purpose:

To compare neonatal intensive care unit nurses' work stress, satisfaction, obstacles, support, team effectiveness, ability to provide family-centered care, and satisfaction with noise, light, and sightlines in an open ward with a new unit of pods and SFRs.

Methods:

A pre-post occupancy study was conducted in a level 3 unit before and after transitioning to a new unit of 6-bed pods and SFRs.

Results:

There were no significant differences in nurse stress, satisfaction, support from colleagues, perceptions of team effectiveness, and ability to provide family-centered care between the open ward and the pod/SFR unit. Organizational obstacles, such as difficulties obtaining information from colleagues, were significantly lower in the pod/SFR. In contrast, environmental and technology obstacles were greater in the new pod/SFR unit.

Implications for Practice:

Some specific aspects of the pod/SFR unit are optimal for neonatal intensive care unit nurses, while other aspects of the open ward are perceived more favorably.

Implications for Research:

Studies are needed to examine the isolation the nurses may experience in SFR units, as well as strategies to reduce isolation.
Considerations for Preterm Human Milk Feedings When Caring for Mothers Who Are Overweight or Obese
Authors: Robinson Daniel T. , Josefson Jami , Van Horn Linda
Published: September 2019

Background:

Mother's milk is the recommended source of nutrition for all newborns. Preterm infants may be further compromised by maternal factors that impede successful lactation and alter milk composition.

Purpose:

To review and summarize the state of the science regarding implications of maternal overweight and obesity on successful lactation and associated alterations in preterm mother's milk composition.

Methods/Search Strategy:

PubMed, EMBASE, and Web of Science searches were performed using relevant key words to identify references addressing maternal overweight or obesity, prematurity, human milk, and lactation.

Findings/Results:

In the United States, more than half of women enter pregnancy with an overweight or obese body mass index. These women have increased risk of adverse pregnancy outcomes and obstetric complications that can undermine successful initiation and continuation of lactation, including preterm birth. Maternal overweight and obesity are also associated with alterations in mother's milk composition.

Implications for Practice:

Mother-preterm infant dyads affected by maternal overweight and obesity are at risk for barriers to initiation and continuation of lactation. Support for early initiation of milk expression is needed. Continued support, especially during the first weeks of lactation, can facilitate sustained milk production.

Implications for Research:

Considerable knowledge gaps remain in this area of human milk science. Future research is needed to facilitate more comprehensive understanding of differences in milk composition associated with maternal overweight and obesity and their impact on clinical outcomes in the preterm infant.
To Consent, or Not to Consent, That Is the Question
Authors: McGlothen-Bell Kelly , Cleveland Lisa , Pados Britt Frisk
Published: September 2019

Background:

Evidence supports the superiority of mother's own milk (MOM) in reducing the comorbidities common to prematurity and very low birth weight. In situations where an insufficient amount of MOM is available or maternal contraindications prevent its use, pasteurized donor human milk (DHM) is a viable substitution. When DHM is deemed best, a common practice in many neonatal intensive care units (NICUs) is for parents to provide their consent. However, no universal mandate for informed consent exists. Often, healthcare providers present and obtain the consent for DHM use prior to delivery or shortly after birth and this consent may be “bundled” along with other standardized NICU treatment consents. This approach is likely less than ideal since it provides insufficient time for decision making and often precedes the mother's ability to initiate the expression of her own milk.

Purpose:

To review the history of DHM use and the ethics surrounding the consenting process including the ethical principles involved in infant feeding decision making. We argue for the standardization and consistent use of informed consent for DHM in the NICU and offer clinical practice implications.

Findings/Results/Implications for Practice and Research:

Providers face several challenges in the consenting process for the use of DHM in the NICU setting. These include limited time to support parents and educate them appropriately during the decision-making process. Standardized and consistent use of informed consent is essential to address the ethical concerns surrounding the use of DHM in the NICU setting.
Barriers to Providing Mother's Own Milk to Extremely Preterm Infants in the NICU
Authors: Fernández Medina Isabel María , Fernández-Sola Cayetano , López-Rodríguez María Mar , Hernández-Padilla José Manuel , Jiménez Lasserrotte María del Mar , Granero-Molina José
Published: September 2019

Background:

Mothers' own milk (MOM) has more than nutritional benefits for extremely preterm infants (<28 weeks). However, mothers encounter barriers that make it difficult to provide their own milk to their extremely preterm infants.

Purpose:

The aim of this study was to describe and understand the experiences of mothers of extremely preterm infants regarding barriers to providing their own milk during infant hospital stay in the neonatal intensive care unit (NICU).

Methods:

This study followed a qualitative, interpretative design using Gadamer's hermeneutic approach and included 15 in-depth semistructured interviews. The data were analyzed using a modified form of the steps described by Fleming.

Results:

Fifteen mothers of extremely preterm infants participated in the study. The following themes were extracted from the data analysis: (1) “unexpected and unusual lactation,” including the subthemes “the extremely preterm birth and the decision to provide MOM,” “the battle to produce milk,” and “my job was to make milk”; and (2) “providing MOM to a tiny infant in an unknown technological environment,” with the subthemes “the limitations of providing MOM in the NICU” and “the difficulties of having an extremely preterm infant.”

Implications for Practice:

To provide MOM to an extremely preterm infant, there is a need for informational and practical counseling by neonatal nurses educated in breastfeeding according to mothers' requirements and emotional needs.

Implications for Research:

Future research may analyze the parents' and neonatal nurses' experience about facilitators to improve MOM provision and the influence of women's sociodemographic characteristics in providing MOM to the extremely preterm infants.
Human Milk and Breastfeeding Outcomes in Infants With Myelomeningocele
Authors: Spatz Diane L. , Froh Elizabeth B.
Published: September 2019

Background:

In 2015, the study setting instituted an enteral feeding pathway, “PO Ad Lib Feeding to Support Breastfeeding.” Many infants admitted to the study setting's newborn/infant intensive care unit with a primary diagnosis of myelomeningocele fall within the setting's enteral feeding pathway's inclusion criteria.

Purpose:

The primary objective of this study is to describe the enteral feeding exposure and trends, by type and method, among infants with myelomeningocele.

Methods:

Retrospective descriptive cohort design. Participants were infants with a primary diagnosis of myelomeningocele between 2013 and 2016. The electronic health record was used to collect descriptive data (demographics and daily enteral feeding exposure). Data were analyzed using descriptive statistics.

Findings/Results:

More than 80% (n = 148, 81.3%) of the participants' mothers had a personalized prenatal nutrition consultation and the majority of those mothers (n = 102/118, 86.4%) had a goal to breastfeed for more than 6 months. The majority (n = 144/182, 79.1%) of the study cohort was exposed to mothers' own human milk as their first feed. It is also notable that 80.8% (n = 147) fed at least once directly at the breast; however, infants were also fed by bottle or by feeding tube.

Implications for Practice:

It demonstrates that with appropriate evidence-based breastfeeding interventions, mothers having infants with myelomeningocele can expect to feed their infants human milk as well as direct breastfeed.

Implications for Research:

Future research should focus on human milk/breastfeeding outcomes of infants with myelomeningocele post–hospital discharge. Long-term breastfeeding may have an important role in the development of infants with myelomeningocele.
The 100 Top-Cited Articles on Spinal Deformity
Authors: Zhang Yanbin , Wumaier Muhetaer , He Da , Xiao Bin , Zhang Jianguo
Published: September 2019

Study Design.

A bibliometric analysis.

Objective.

To identify and analyze the 100 top-cited articles on spinal deformity.

Summary of Background Data.

The nature of spinal deformity leads to the complexity of its treatment. There is a scarcity of guidelines for the treatment of spinal deformity despite of the growing literature. So it is crucial to discern researches with higher impact and quality.

Methods.

A keyword search using the Thomson Reuters Web of Science was conducted to select articles relevant to spinal deformity. The 100 top-cited articles were identified based on titles and abstracts, and then analyzed.

Results.

The citation count for the final 100 articles ranged from 154 to 775, with an average of 243.0 citations. Most studies were published in the journal Spine (49/100). The most productive publication time was from 2000 to 2009. The natural history of scoliosis was the most frequent topic (10 articles), followed by pedicle screw instrumentation (8), outcome of nonoperative treatment for adolescent idiopathic scoliosis (AIS) (8), health-related quality of life (7), relationship between sagittal parameters and clinical symptoms (7), and complications of surgical treatment (7). Despite AIS was the most common deformity, the top two most frequently cited articles were all about adult spinal deformity, both describing the correlation between sagittal parameters and symptoms.

Conclusion.

The current study attempted to develop a resource with detailed information on 100 top-cited articles on spinal deformity. It demonstrated the essential advances in spinal deformity. Although the most common spinal deformity is AIS, the adult spinal deformity is of greater impact. These insights into priorities and trends of the researches could help future academic pursuits.

Level of Evidence: 5
High, As Well As Low, Preoperative Platelet Counts Correlate With Adverse Outcomes After Elective Posterior Lumbar Surgery
Authors: Malpani Rohil , Gala Raj J. , Adrados Murillo , Galivanche Anoop R. , Clark Michael G. , Mercier Michael R. , Pathak Neil , Mets Elbert J. , Grauer Jonathan N.
Published: September 2019

Study Design.

Retrospective cohort study of prospectively collected data.

Objective.

Assess correlation between preoperative platelet counts and postoperative adverse events after elective posterior lumbar surgery procedures.

Summary of Background Data.

Preoperative low platelet counts have been correlated with adverse outcomes after posterior lumbar surgery. Nonetheless, the effect of varying platelet counts has not been studied in detail for a large patient population, especially on the high end of the platelet spectrum.

Methods.

Patients who underwent elective posterior lumbar surgery were identified in the 2011 to 2016 National Surgical Quality Improvement Program database. Preoperative platelet counts were considered relative to 30-day perioperative adverse outcomes. Patients were classified into platelet categories based on determining upper and lower bounds on when the adverse outcomes crossed a relative risk of 1.5. Univariate and multivariate analyses compared 30-day postoperative complications, readmissions, operative time, and hospital length of stay between those with low, normal, and high platelet counts.

Results.

In total, 137,709 posterior lumbar surgery patients were identified. Using the relative risk threshold of 1.5 for the occurrence of any adverse event, patients were divided into abnormally low (≤140,000/mL) and abnormally high (≥447,000/mL) platelet cohorts. The abnormally low and high platelet groups were associated with higher rates of any, major, minor adverse events, transfusion, and longer hospital length of stay. Furthermore, the abnormally low platelet counts were associated with a higher risk of readmissions.

Conclusion.

The data-based cut-offs for abnormally high and low platelet counts closely mirrored those found in literature. Based on these definitions, abnormally high and low preoperative platelet counts were associated with adverse outcomes after elective posterior lumbar surgery. These findings facilitate risk stratification and suggest targeted consideration for patients with high, as well as low, preoperative platelet counts.

Level of Evidence: 3
Decompression With or Without Fusion for Lumbar Stenosis
Authors: Ziino Chason , Mertz Kevin , Hu Serena , Kamal Robin
Published: September 2019

Study Design.

Retrospective database review.

Objective.

Compare 1-year episode of care costs between single-level decompression and decompression plus fusion for lumbar stenosis.

Summary of Background Data.

Lumbar stenosis is the most common indication for surgery in patients over 65. Medicare direct hospital costs for lumbar surgery reached $1.65 billion in 2007. Despite stenosis being a common indication for surgery, there is debate as to the preferred surgical treatment. Cost-minimization analysis is a framework that identifies potential cost savings between treatment options that have similar outcomes. We performed a cost-minimization analysis of decompression versus decompression with fusion for lumbar stenosis from the payer perspective.

Methods.

An administrative claims database of privately insured patients (Humana) identified patients who underwent decompression (n = 5349) or decompression with fusion (n = 8540) for lumbar stenosis with and without spondylolisthesis and compared overall costs. All patients were identified and costs identified for a 1-year period. Complication rates and costs were described using summary statistics.

Results.

Mean treatment costs at 1 year after surgery were higher for patients who underwent decompression and fusion compared to patients who underwent decompression alone ($20,892 for fusion vs. $6329 for decompression; P < 0.001). Facility costs (P < 0.001), surgeon costs (P < 0.001), and physical therapy costs (P < 0.001) were higher in the fusion group. Cost differences related to infection or durotomy reached significance (P < 0.04). No difference in cost was identified for supplies.

Conclusion.

Decompression had significantly lower costs for the treatment of lumbar stenosis, including treatment for postoperative complications. If cost minimization is the primary goal, decompression is favored for surgical treatment of lumbar stenosis. Other factors including shared decision-making directed toward patient's values, patient-reported outcomes, and preferences should also be recognized as drivers of healthcare decisions.

Level of Evidence: 3
Adult Spinal Deformity Surgery in Patients With Movement Disorders
Authors: Varshneya Kunal , Azad Tej D. , Pendharkar Arjun V. , Desai Atman , Cheng Ivan , Karikari Isaac , Ratliff John K. , Veeravagu Anand
Published: September 2019

Study Design.

This was a retrospective study using national administrative data from the MarketScan database.

Objective.

To investigate the complication rates, quality outcomes, and costs in a nationwide cohort of patients with movement disorders (MD) who undergo spinal deformity surgery.

Summary of Background Data.

Patients with MD often present with spinal deformities, but their tolerance for surgical intervention is unknown.

Methods.

The MarketScan administrative claims database was queried to identify adult patients with MD who underwent spinal deformity surgery. A propensity-score match was conducted to create two uniform cohorts and mitigate interpopulation confounders. Perioperative complication rates, 90-day postoperative outcomes, and total costs were compared between patients with MD and controls.

Results.

A total of 316 patients with MD (1.7%) were identified from the 18,970 undergoing spinal deformity surgery. The complication rate for MD patients was 44.6% and for the controls 35.6% (P = 0.009). The two most common perioperative complications were more likely to occur in MD patients, acute-posthemorrhagic anemia (26.9% vs. 20.8%, P < 0.05) and deficiency anemia (15.5% vs. 8.5%, P < 0.05). At 90 days, MD patients were more likely to be readmitted (17.4% vs. 13.2%, P < 0.05) and have a higher total cost ($94,672 vs. $85,190, P < 0.05). After propensity-score match, the overall complication rate remained higher in the MD group (44.6% vs. 37.6%, P < 0.05). 90-day readmissions and costs also remained significantly higher in the MD cohort. Multivariate modeling revealed MD was an independent predictor of postoperative complication and inpatient readmission. Subgroup analysis revealed that Parkinson disease was an independent predictor of inpatient readmission, reoperation, and increased length of stay.

Conclusion.

Patients with MD who undergo spinal deformity surgery may be at risk of higher rate of perioperative complications and 90-day readmissions compared with patients without these disorders.

Level of Evidence: 3