bluuebunny/crossref_metadata_2025 huggingface dataset:
Performing aesthetic confidence: how contemporary art collectors maintain status
Authors: Wohl Hannah
Published: July 2019

In cultural markets, where value is highly uncertain, intermediaries and consumers select products by using status signals, including public metrics and informal recommendations. However, certain intermediaries and consumers risk their statuses and access to informal recommendations if they appear to rely on these status signals. Drawing upon the case of contemporary art collectors in New York City, I reveal that collectors work to maintain their statuses while utilizing status signals through performances of ‘aesthetic confidence’. In these performances, they claim a willingness to choose artworks based on their independent and good taste. Collectors flexibly cite multiple and sometimes opposing qualities of their purchases and interactions as evidence of aesthetic confidence. Higher status collectors reinforce status hierarchies through their privileged access to resources for displaying aesthetic confidence and their policing of lower status collectors’ claims. Performances of aesthetic confidence are both influenced by status and necessary for displaying status.
Special Cluster Learning Practice from Texts: Jews and Medicine in the Later Middle Ages
Authors: Cohen-Hanegbi Naama
Published: July 2019

The study of the medical practices of medieval European Jews has tended to centre on the dynamics of inclusion and exclusion of Jews in European societies, with medical practices and non-learned practitioners within Jewish communities receiving less attention. Information is particularly lacking on the more rudimentary aspects of medical training and practice, daily medical care and household medicine. This essay highlights features of the historiography of Jewish activity in medicine that beckon new or renewed scholarly attention. The essay introduces a cluster of articles, which begin to fill this lacuna while charting methodological keys for future work in the field.
To Promote or Hire? How Racial Processes and Organizational Characteristics Affect Internal Promotions in NCAA Division I College Basketball Coaching
Authors: Seebruck Ryan , Savage Scott V
Published: July 2019

We use data from 2008–2013 on the universe of internal promotion opportunities in the labor market of NCAA Division I men's college basketball coaching to examine how race and racial homophily affect the likelihood of internal promotion. We run probit regression analyses from the individual and organizational perspective, offering a robust test of six hypotheses. In line with the relational inequality perspective, we find that the racial match of assistants and head coaches explains discrepancies in internal promotion, with homogeneous white pairings seeing significantly increased odds compared to other racial combinations. In addition, our findings reveal that colleges and universities are more likely to promote internally as the racial composition of the staff more closely matches the race of the outgoing head coach, thereby underscoring how racial processes inform the micro-level interactions that shape organizational behavior.
In Utero and Lactational Exposure to Diisopentyl Phthalate Induces Fetal Toxicity and Antiandrogenic Effects in Rats
Authors: Curi Tatiana Zauer , Neubert da Silva Gabriela , Passoni Marcella Tapias , Lima Tolouei Sara Emilia , Meldola Heloísa , Romano Renata Marino , Grechi Nicole , Dalsenter Paulo Roberto , Martino-Andrade Anderson Joel
Published: July 2019

A previous study has demonstrated exposure of Brazilian pregnant women to diisopentyl phthalate (DiPeP), which reduces fetal rat testosterone production in a dose-responsive manner. In this study, we examined gene expression of steroidogenic proteins in rat fetal testes and investigated the effects of in utero and lactational DiPeP exposure on male rat reproductive development and function. For the prenatal experiment, we orally exposed pregnant Wistar rats to DiPeP or di-n-butyl phthalate (reference phthalate) at 0, 125, 250, and 500 mg/kg/day from gestation day 14–18 and the fetal testis was evaluated for transcript expression of Star, Cyp11a1, Cyp17a1, Cyp19a1, Insl3, Ar, Esr1, Esr2, and Gper1 by real-time quantitative PCR (RT-qPCR). Diisopentyl phthalate lowered mRNA levels of key steroidogenic proteins, lending support to the previously reported reductions in fetal testosterone production. Diisopentyl phthalate also lowered fetal testis transcript levels of Insl3 and changed gene expression of some steroid hormones receptors. For the postnatal experiment, pregnant rats were exposed orally to vehicle (canola oil) and 4 DiPeP doses (1, 10, 100, and 300 mg/kg/day) between gestation day 10 and postnatal day 21. Diisopentyl phthalate induced a range of reproductive and antiandrogenic effects that are typical of the rat phthalate syndrome, including reduced anogenital distance at the highest dose, reduced weight of seminal vesicles at 10 mg/kg/day and above, and testicular morphological and functional changes. Signs of fetal toxicity were observed at the highest dose. Together, our results indicate that DiPeP, a compound relevant to the human exposure scenario, is one of the most active antiandrogenic phthalates.
Prenatal Dexamethasone Exposure Induced Alterations in Neurobehavior and Hippocampal Glutamatergic System Balance in Female Rat Offspring
Authors: Huang Songqiang , Dong Wanting , Jiao Zhexiao , Liu Jie , Li Ke , Wang Hui , Xu Dan
Published: July 2019

Epidemiological investigations have suggested that periodic use of dexamethasone during pregnancy is a risk factor for abnormal behavior in offspring, but the potential mechanism remains unclear. In this study, we investigated the changes in the glutamatergic system and neurobehavior in female offspring with prenatal dexamethasone exposure (PDE) to explore intrauterine programing mechanisms. Compared with the control group, rat offspring with PDE exhibited spatial memory deficits and anxiety-like behavior. The expression of hippocampal glucocorticoid receptors (GR) and histone deacetylase 2 (HDAC2) increased, whereas histone H3 lysine 14 acetylation (H3K14ac) of brain-derived neurotrophic factor (BDNF) exon IV (BDNF IV) and expression of BDNF decreased. The glutamatergic system also changed. We further observed that changes in the fetal hippocampus were consistent with those in adult offspring. In vitro, the administration of 0.5 μM dexamethasone to the H19-7 fetal hippocampal neuron cells directly led to a cascade of changes in the GR/HDAC2/BDNF pathway, whereas the GR antagonist RU486 and the HDAC2 inhibitor romidepsin (Rom) reversed changes caused by dexamethasone to the H3K14ac level of BDNF IV and to the expression of BDNF. The increase in HDAC2 can be reversed by RU486, and the changes in the glutamatergic system can be partially reversed after supplementation with BDNF. It is suggested that PDE increases the expression of HDAC2 by activating GR, reducing the H3K14ac level of BDNF IV, inducing alterations in neurobehavior and hippocampal glutamatergic system balance. The findings suggest that BDNF supplementation and glutamatergic system improvement are potential therapeutic targets for the fetal origins of abnormal neurobehavior.
The long-term changing dynamics of dengue infectivity in Guangdong, China, from 2008–2018: a modelling analysis
Authors: Zhao Shi , Musa Salihu S , Meng Jiayi , Qin Jing , He Daihai
Published: July 2019

Background

Dengue remains a severe threat to public health in tropical and subtropical regions. In China, over 85% of domestic dengue cases are in the Guangdong province and there were 53 139 reported cases during 2008–2018. In Guangdong, the 2014 dengue outbreak was the largest in the last 20 y and it was probably triggered by a new strain imported from other regions.

Methods

We studied the long-term patterns of dengue infectivity in Guangdong from 2008–2018 and compared the infectivity estimates across different periods.

Results

We found that the annual epidemics approximately followed exponential growth during 2011–2014. The transmission rates were at a low level during 2008–2012, significantly increased 1.43-fold [1.22, 1.69] during 2013–2014 and then decreased back to a low level after 2015. By using the mosquito index and the likelihood-inference approach, we found that the new strain most likely invaded Guangdong in April 2014.

Conclusions

The long-term changing dynamics of dengue infectivity are associated with the new dengue virus strain invasion and public health control programmes. The increase in infectiousness indicates the potential for dengue to go from being imported to becoming an endemic in Guangdong, China.
Preventing More “Missing Girls”: A Review of Policies to Tackle Son Preference
Authors: Kumar Sneha , Sinha Nistha
Published: July 2019

In parts of Asia, the South Caucasus, and the Balkans, son preference is strong enough to trigger significant levels of sex selection, resulting in the excess mortality of girls and skewing child sex ratios in favor of boys. Every year, an estimated 1.8 million girls go “missing” because of the widespread use of sex selective practices in these regions. The pervasive use of such practices is reflective of the striking inequities girls face immediately, and it also has possible negative implications for efforts to improve women's status in the long term. Recognizing this as a public policy concern, governments have employed direct measures such as banning the use of prenatal sex selection technology, and providing financial incentives to families that have girls. This study reviews cross-country experiences to take stock of the direct interventions used and finds no conclusive evidence that they are effective in reducing the higher mortality risk for girls. In fact, bans on the use of sex selection technology may inadvertently worsen the status of the very individuals they intend to protect, and financial incentives to families with girls offer only short-term benefits at most. Instead, what seems to work are policies that indirectly raise the value of daughters. The study also underscores the paucity of causal studies in this literature.
16Performance, Theater, Drama
Authors: Kastleman Rebecca
Published: July 2019

The year 2018 was an especially fruitful and wide-ranging one for theater and performance studies. Several major monographs deepened discussion in established subject areas within the field, while new methodological approaches emerged, opening fresh directions in scholarship. This review focuses on four major areas of conversation that shaped the field in 2018: 1. Expanding Performance Aesthetics; 2. Economic and Material Contexts of Performance; 3. Enacting Public Justice; and 4. Performance on the Move.
Infection of the Native California Grass, Bromus carinatus, by Fusarium circinatum, the Cause of Pitch Canker in Pines
Authors: Carter Jason W. , Gordon Thomas R.
Published: July 2019

At Point Reyes National Seashore in California, Fusarium circinatum, the causal agent of pitch canker in pines, was isolated from Pinus muricata, the California native grass, Bromus carinatus, and the introduced grass, Holcus lanatus. All grass plants from which F. circinatum was isolated were symptomless. Pathogenicity of grass isolates was confirmed by inoculation of P. radiata trees, which developed symptoms similar to trees inoculated with a pine isolate of F. circinatum. Isolates from grasses were somatically compatible with isolates recovered from symptomatic pines. B. carinatus grown in a growth chamber was inoculated with a green fluorescent protein-expressing strain of F. circinatum. Segments of inoculated leaves were incubated in moist chambers; after 1 to 2 days, sporulating hyphae were observed growing from leaf tissue. Spores of F. circinatum removed from B. carinatus leaves were confirmed to be fluorescent when illuminated with ultraviolet light. These results raise the possibility that B. carinatus cryptically infected by F. circinatum may be a source of propagules capable of infecting pines.
Operative Versus Nonoperative Management of Displaced Midshaft Clavicle Fractures in Pediatric and Adolescent Patients: A Systematic Review and Meta-Analysis
Authors: Gao Burke , Dwivedi Shashank , Patel Shyam A. , Nwizu Chibuikem , Cruz Aristides I.
Published: July 2019

Objectives:

The purpose of this study was to systematically review and quantitatively analyze outcomes in operative versus nonoperative management of displaced midshaft clavicle fractures in pediatric and adolescent patients.

Data Sources:

Using the Preferred Reporting items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, systematic searches of PubMed and EMBASE were conducted to identify English-language studies reporting outcomes in displaced pediatric midshaft clavicle fractures from 1997 to 2018.

Study Selection:

Studies that reported on outcomes of operative and/or nonoperative treatment of displaced midshaft clavicle fractures in patients younger than 19 years were included.

Data Extraction:

Patient and treatment characteristics, union rates, time to union, time to return to activity, patient-reported outcome measures, and complications were extracted.

Data Synthesis:

All extracted data were recorded and qualitatively compared. QuickDASH (Quick Disabilities of the Arm, Shoulder, and Hand) scores and Constant scores were pooled using random-effects modeling and compared among studies, which adequately reported data for hypothesis testing.

Conclusions:

Three thousand eight hundred ten articles were identified, and 12 met inclusion criteria. These studies encompassed 497 patients with an average age of 14.1 years (8–18 years, range). Both operative and nonoperative management of displaced midshaft clavicle fractures in this population provide excellent rates of union and patient-reported outcome measures. Compared with nonoperative management, operative management yielded faster return to activity, superior Constant scores, and equal QuickDASH scores. Operative management had higher complication rates and complications that required secondary operative treatment (mostly related to implant prominence).

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Conventional Versus Stereotactic Image-guided Pedicle Screw Placement During Posterior Lumbar Fusions
Authors: Pendharkar Arjun V. , Rezaii Paymon G. , Ho Allen L. , Sussman Eric S. , Veeravagu Anand , Ratliff John K. , Desai Atman M.
Published: July 2019

Study Design.

Retrospective 1:1 propensity score-matched analysis on a national longitudinal database between 2007 and 2016.

Objective.

The aim of this study was to compare complication rates, revision rates, and payment differences between navigated and conventional posterior lumbar fusion (PLF) procedures with instrumentation.

Summary of Background Data.

Stereotactic navigation techniques for spinal instrumentation have been widely demonstrated to improve screw placement accuracies and decrease perforation rates when compared to conventional fluoroscopic and free-hand techniques. However, the clinical utility of navigation for instrumented PLF remains controversial.

Methods.

Patients who underwent elective laminectomy and instrumented PLF were stratified into “single level” and “3- to 6-level” cohorts. Navigation and conventional groups within each cohort were balanced using 1:1 propensity score matching, resulting in 1786 navigated and conventional patients in the single-level cohort and 2060 in the 3 to 6 level cohort. Outcomes were compared using bivariate analysis.

Results.

For the single-level cohort, there were no significant differences in rates of complications, readmissions, revisions, and length of stay between the navigation and conventional groups. For the 3- to 6-level cohort, length of stay was significantly longer in the navigation group (P < 0.0001). Rates of readmissions were, however, greater for the conventional group (30-day: P = 0.0239; 90-day: P = 0.0449). Overall complications were also greater for the conventional group (P = 0.0338), whereas revision rate was not significantly different between the 2 groups. Total payments were significantly greater for the navigation group in both the single level and 3- to 6-level cohorts (P < 0.0001).

Conclusion.

Although use of navigation for 3- to 6-level instrumented PLF was associated with increased length of stay and payments, the concurrent decreased overall complication and readmission rates alluded to its potential clinical utility. However, for single-level instrumented PLF, no differences in outcomes were found between groups, suggesting that the value in navigation may lie in more complex procedures.

Level of Evidence: 3
The Use of Patient-Reported Outcome Measurement Information System Physical Function to Predict Outcomes Based on Body Mass Index Following Minimally Invasive Transforaminal Lumbar Interbody Fusion
Authors: Yoo Joon S. , Hrynewycz Nadia M. , Brundage Thomas S. , Singh Kern
Published: July 2019

Study Design.

Retrospective.

Objective.

To determine clinical outcomes in obese patients compared with non-obese patients utilizing Patient-Reported Outcome Measurement Information System Physical Function (PROMIS PF) following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

Summary of Background Data.

Although obesity is a risk factor for poor outcomes after spinal fusion, there has not been a study to evaluate clinical outcomes of obese patients utilizing the PROMIS PF survey.

Methods.

Patients undergoing MIS TLIF were stratified into three cohorts: non-obese (body mass index [BMI] ≤ 29.9 kg/m2), obese I (BMI = 30.0–34.9 kg/m2), and obese II–III (BMI ≥ 35.0 kg/m2). Demographic and perioperative characteristics were compared using chi-squared analysis and linear regression. Change in PROMIS PF scores was calculated using paired t tests. Differences in PROMIS PF scores at each postoperative timepoint and changes in PROMIS PF from baseline were compared using linear regression.

Results.

One hundred eighty-six patients were included: 101 were non-obese, 41 were classified as obese I, and 44 were classified as obese II–III. Obese patients were more likely to be diabetic. Otherwise, no significant differences in demographic and perioperative characteristics were identified. Patients with higher BMIs reported significantly lower PROMIS PF scores at preoperative and all postoperative timepoints. However, patients experienced similar improvements through 6-month follow-up in PROMIS PF scores regardless of BMI. For the non-obese cohort, the change in the postoperative PROMIS PF score from baseline was significant at every postoperative timepoint. However, for the obese I and obese II–III cohorts, the change in the PROMIS PF score from baseline was significant at the 3-month and 6-month timepoints, but not at the 6-week timepoint.

Conclusion.

Patients with higher BMI had lower preoperative PROMIS PF scores and experienced similar improvement in PROMIS PF scores in the postoperative period. This study established that PROMIS PF may be utilized to evaluate the recovery of obese patients following MIS TLIF.

Level of Evidence: 3
Ten-year Longitudinal Follow-up MRI Study of Age-related Changes in Thoracic Intervertebral Discs in Asymptomatic Subjects
Authors: Okada Eijiro , Daimon Kenshi , Fujiwara Hirokazu , Nishiwaki Yuji , Nojiri Kenya , Watanabe Masahiko , Katoh Hiroyuki , Ishihama Hiroko , Fujita Nobuyuki , Tsuji Takashi , Nakamura Masaya , Matsumoto Morio , Watanabe Kota
Published: July 2019

Study Design.

Prospective longitudinal study.

Objective.

The aim of this study was to evaluate long-term degenerative changes in intervertebral discs in the thoracic spine in healthy asymptomatic subjects.

Summary of Background Data.

Longitudinal magnetic resonance imaging (MRI) studies of intervertebral disc degeneration have been reported for the cervical and lumbar but not the thoracic spine.

Methods.

In this longitudinal study (average follow-up 10.0 ± 0.6 years), we assessed degenerative changes in the thoracic spine of 103 volunteers (58 men) of 223 healthy volunteers in the initial MRI study of the thoracic spine (follow-up rate 46.2%). The mean age at the initial study was 45.0 ± 11.5 years (24–77 years). Initial and follow-up thoracic-spine MRIs were graded for the following 4 factors of degenerative changes: decrease in signal intensity of intervertebral disc (DSI), posterior disc protrusion (PDP), anterior compression of dura and spinal cord (AC), and disc-space narrowing (DSN) from T1–2 to T12–L1. We assessed associations between changes in MRI grade and demographical factors such as age, sex, body mass index, smoking habits, sports activities, and disc degeneration in the cervical spine.

Results.

MRIs revealed that 63.1% of the subjects had degenerative changes in the thoracic intervertebral discs that had progressed at least one grade during the follow-up period. DSI progressed in 44.7% of subjects, PDP in 21.4%, and AC in 18.4% during the 10-year period. No DSN progression was seen. DSI was frequently observed in the upper thoracic spine (T1–2 to T4–5). Disc degeneration was relatively scarce in the lower thoracic spine (T9–10 to T12–L1). PDP was frequently observed in the middle thoracic spine (T5–6 toT8–9). We found significant associations between DSI and cervical-spine degeneration (P = .004) and between AC and smoking (P = .04).

Conclusion.

Progressive thoracic disc degeneration, observed in 63.1% of subjects; was significantly associated with smoking and with cervical-spine degeneration.

Level of Evidence: 2
Preoperative Dehydration does not Increase the Risk of Complications Following Elective Lumbar Surgery
Authors: Renfree Sean P. , Chung Andrew S. , Waldrop Robert A. , Crandall Dennis , Chang Michael S.
Published: July 2019

Study Design.

A retrospective cohort study.

Objective.

The aim of this study was to evaluate the effect of preoperative dehydration on hospital length of stay (LOS), rates of 30-day postoperative complications, related reoperations, and readmissions.

Summary of Background Data.

Preoperative dehydration has long been associated with postoperative infection, deep vein thrombosis (DVT), acute renal failure, and an increased hospital LOS. To our knowledge, the effect of preoperative dehydration on complication rates for patients undergoing elective lumbar spine surgery has not been well described.

Methods.

An analysis of American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data from 2006 to 2013 was performed. Patients undergoing elective lumbar procedures were identified and exclusion criteria eliminated patients who underwent any emergency procedures, infections, tumor cases, or revision surgeries. Patient dehydration was defined as preoperative blood urea nitrogen/creatinine (BUN/Cr) ratio greater than 20.

Results.

Patients (4698; 34.5%) with preoperative dehydration based on BUN/Cr ratio were identified. Univariate analysis was suggestive of an association between preoperative dehydration and an increased risk of DVT (1.1% compared with 0.6%; P = 0.002), urinary tract infection (2.5% compared with 1.6%; P < 0.001), and need for transfusion postoperatively (17.6% compared with 14.4%; P < 0.001). However, on the basis of multivariate regression, no significant association between dehydration and increased odds of aforementioned outcomes was identified.

Conclusion.

Preoperative dehydration does not appear to negatively affect perioperative outcomes or readmission in patients undergoing elective lumbar spine surgery.

Level of Evidence: 3
Cervical Spine Fractures
Authors: Fourman Mitchell S. , Shaw Jeremy D. , Vaudreuil Nicholas J. , Dombrowski Malcolm E. , Wawrose Rick A. , Boakye Lorraine A.T. , Alarcon Louis H. , Lee Joon Y. , Donaldson William F.
Published: July 2019

Study Design.

Retrospective cohort study.

Objective.

Compare a novel two-step algorithm for indicating a computed tomography angiography (CTA) in the setting of a cervical spine fracture with established gold standard criteria.

Summary of Background Data.

As CTA permits the rapid detection of blunt cerebrovascular injuries (BCVI), screening criteria for its use have broadened. However, more recent work warns of the potential for the overdiagnosis of BCVI, which must be considered with the adoption of broad criteria.

Methods.

A novel two-step metric for indicating CTA screening was compared with the American College of Surgeons guidelines and the expanded Denver Criteria using patients who presented with cervical spine fractures to a tertiary-level 1 trauma center from January 1, 2012 to January 1, 2016. The ability for each metric to identify BCVI and posterior circulation strokes that occurred during this period was assessed.

Results.

A total of 721 patients with cervical fractures were included, of whom 417 underwent CTAs (57.8%). Sixty-eight BCVIs and seven strokes were diagnosed in this cohort. All algorithms detected an equivalent number of BCVIs (52 with the novel metric, 54 with the ACS and Denver Criteria, P = 0.84) and strokes (7/7, 100% with the novel metric, 6/7, 85.7% with the ACS and Denver Criteria, P = 1.0). However, 63% fewer scans would have been needed with the proposed screening algorithm compared with the ACS or Denver Criteria (261/721, 36.2% of all patients with our criteria vs. 413/721, 57.3% with the ACS standard and 417/721, 57.8%) with the Denver Criteria, P < 0.0002 for each).

Conclusion.

A two-step criterion based on mechanism of injury and patient factors is a potentially useful guide for identifying patients at risk of BCVI and stroke after cervical spine fractures. Further prospective analyses are required prior to widespread clinical adoption.

Level of Evidence: 4.
Long-Term Outcomes After Extensor Carpi Ulnaris Subsheath Reconstruction With Extensor Retinaculum
Authors: Verhiel Svenna H.W.L. , Özkan Sezai , Chen Neal C. , Jupiter Jesse B.
Published: July 2019

This study assessed the long-term outcomes and complications of patients that underwent operative treatment for extensor carpi ulnaris subluxation. Fifteen patients underwent extensor carpi ulnaris subsheath reconstruction at a median of 5.9 weeks nonoperative treatment interval (interquartile range: 2.4 to 13). Reconstruction consisted of using the extensor retinaculum as a sling reconstruction. We found that about 1 in 3 patients had a complication or reoperation. At a median of 8 years follow-up, many patients had some residual symptoms, but in general, most patients were satisfied.
The Inverted Free Functioning Gracilis Muscle Transfer For Restoration of Elbow Flexion Following Delayed Presentation or Failed Primary Nerve Reconstruction of Upper Trunk Injuries
Authors: Wade Sean M. , Nesti Leon J. , Wind Gary G. , Howard Robert T. , Souza Jason M.
Published: July 2019

Free functional gracilis transfer is a well-established technique for restoring active elbow flexion in brachial plexus injuries following delayed presentation or failed nerve reconstruction procedures. In cases of delayed presentation or failed nerve reconstruction following upper trunk injuries, the lower trunk intraplexal median and ulnar nerves are spared, thereby making them available to reinnervate the transferred gracilis. Therefore, we have inverted the conventional free functional gracilis orientation so as to orient the flap’s recipient nerve in closer proximity to donor median or ulnar nerve fascicles to enable a short, tension-free coaptation in the middle to distal arm. Herein is our descriptive surgical technique for performing an inverted free functional gracilis muscle transfer in order to restore elbow flexion in the setting of an upper trunk injury.
Incorporating Laboratory Values Into a Machine Learning Model Improves In-Hospital Mortality Predictions After Rapid Response Team Call
Authors: Reardon Peter M. , Parimbelli Enea , Wilk Szymon , Michalowski Wojtek , Murphy Kyle , Shen Jennifer , Herritt Brent , Gershkovich Benjamin , Tanuseputro Peter , Kyeremanteng Kwadwo
Published: July 2019

Objectives:

Machine learning models have been used to predict mortality among patients requiring rapid response team activation. The goal of our study was to assess the impact of adding laboratory values into the model.

Design:

A gradient boosted decision tree model was derived and internally validated to predict a primary outcome of in-hospital mortality. The base model was then augmented with laboratory values.

Setting:

Two tertiary care hospitals within The Ottawa Hospital network.

Patients:

Inpatients over the age of 18 years who experienced a rapid response team activation between January 1, 2015, and May 31, 2016.

Interventions:

None.

Measurements and Main Results:

A total of 2,061 rapid response team activations occurred during the study period. The in-hospital mortality rate was 29.4%. Patients who died were older (median age, 72 vs 68 yr; p < 0.001), had a longer length of stay (length of stay) prior to rapid response team activation (4 vs 2 d; p < 0.001), and more often had respiratory distress (31% vs 22%; p < 0.001). Our base model without laboratory values performed with an area under the receiver operating curve of 0.71 (95% CI, 0.71–0.72). When the base model was augmented with laboratory values, the area under the receiver operating curve improved to 0.77 (95% CI, 0.77–0.78). Important mortality predictors in the base model were age, estimated ratio of Pao
2 to Fio
2 (calculated using oxygen saturation and estimated Fio
2), length of stay prior to rapid response team activation, and systolic blood pressure.

Conclusions:

Machine learning models can identify rapid response team patients at a high risk of mortality and potentially supplement clinical decision making. Incorporating laboratory values into model development significantly improved predictive performance in this study.
Ultrasonographic Detection of Micro-Bubbles in the Right Atrium to Confirm Peripheral Venous Catheter Position in Children
Authors: Takeshita Jun , Nakajima Yasufumi , Kawamura Atsushi , Taniguchi Masashi , Shimizu Yoshiyuki , Takeuchi Muneyuki , Shime Nobuaki
Published: July 2019

Objectives:

In pediatric patients, indwelling peripheral venous catheters are sometimes displaced to extravascular positions, causing infiltration or extravasation. No reliable techniques are available to confirm accurate IV catheterization. However, ultrasonographic detection of micro-bubble turbulence in the right atrium after saline injection has been reported to be useful in confirming central venous catheter positions in both adults and children. This study evaluated whether this micro-bubble detection test can offer better confirmation of peripheral venous catheter positions compared with the smooth saline injection technique in pediatric patients.

Design:

Randomized controlled study.

Setting:

Single tertiary PICU.

Patients:

Pediatric patients (weighing < 15 kg) who already had or required a peripheral venous catheter.

Interventions:

Patients were randomly allocated to either of the two groups (150 patients per group): undergoing either the micro-bubble detection test (M group) or the smooth saline injection test (S group).

Measurements and Main Results:

The peripheral venous catheters were confirmed to be IV located in the final position in 137 and 139 patients in the M and S groups, respectively. In properly located catheters, the tests were positive in 100% (n = 137/137; sensitivity, 100%; 95% CI, 97.8–100), and in 89% (n = 124/139; 95% CI, 82.8–93.8) of the M and S groups, respectively (p = 0.0001). Among the catheters located in extravascular positions, the tests were negative in 100% (n = 13/13; specificity, 100%; 95% CI, 79.4–100), and in 64% (n = 7/11; 95% CI, 30.8–89.1) of the M and S groups, respectively (p = 0.017).

Conclusions:

The micro-bubble detection test is a useful technique for detecting extravasation and confirming proper positioning of peripheral IV catheters in pediatric patients.
A Motivational Telephone Intervention to Reduce Early Dropouts in Cardiac Rehabilitation
Authors: LaValley Grace , Storer Andrew , Szalai Heidi , Farah Michel , Pack Quinn R.
Published: July 2019

Purpose:

Cardiac rehabilitation (CR) improves outcomes, yet early dropout is common. The purpose of the study was to determine whether a motivational telephone intervention among patients at risk for nonadherence would reduce early dropouts.

Methods:

We performed a randomized double-blind pilot study with the intervention group receiving the telephone intervention 1 to 3 d after outpatient CR orientation. The control group received the standard of care, which did not routinely monitor attendance until 2 wk after orientation. The primary outcome was the percentage of patients who attended their second exercise session as scheduled. Secondary outcomes included attendance at the second CR session at any point and total number of sessions attended. Because not everyone randomized to the intervention was able to be contacted, we also conducted a per-protocol analysis.

Results:

One hundred patients were randomized to 2 groups (age 62 ± 15 yr, 46% male, 40% with myocardial infarction) with 49 in the intervention group. Patients who received the intervention were more likely to attend their second session as scheduled compared with the standard of care (80% vs 49%; relative risk = 1.62; 95% CI, 1.18-2.22). Although there was no difference in total number of sessions between groups, there was a statistically significant improvement in overall return rate among the per-protocol group (87% vs 66%; relative risk = 1.31; 95% CI, 1.05-1.63).

Conclusions:

A nursing-based telephone intervention targeted to patients at risk for early dropout shortly after their CR orientation improved both on-time and eventual return rates. This straightforward strategy represents an attractive adjunct to improve adherence to outpatient CR.
Functional and Cardiovascular Measurements in Patients With Peripheral Artery Disease
Authors: Correia Marilia A. , de Sousa Adilson Santos Andrade , Andrade-Lima Aluísio , Germano-Soares Antônio H. , Zerati Antônio Eduardo , Puech-Leao Pedro , Wolosker Nelson , Gardner Andrew W. , Ritti-Dias Raphael M. , Cucato Gabriel G.
Published: July 2019

Purpose:

To compare functional and cardiovascular variables of men and women with peripheral artery disease (PAD).

Methods:

This observational, cross-sectional study included 67 women and 144 men (age 66 ± 9 and 67 ± 10 yr, respectively) with PAD. Patients were submitted to a clinical evaluation, 6-min walk test (6MWT) and cardiovascular evaluation, including blood pressure, arterial stiffness variables, and heart rate variability.

Results:

Women had lower claudication onset distance (P = .033) and 6MWT distance (P < .001), and similar percentage of the predicted 6MWT distance (P > .05). Women had higher pulse pressure (P = .002), augmentation index (P < .001), augmentation index corrected by 75 bpm (P < .001), and brachial and central systolic blood pressure (P = .041 and P = .029). Diastolic blood pressure, pulse wave velocity, and heart rate variability were similar between sexes (P > .05).

Conclusion:

Although predicted 6MWT performance was similar between sexes, women had higher blood pressure and wave reflection variables compared with men. Interventions to reduce blood pressure and wave reflection should be emphasized in women with PAD.
The Process of Implementing a Mobility Technician in the General Medicine and Surgical Population to Increase Patient Mobility and Improve Hospital Quality Measures: A Pilot Study
Authors: Exum Emelia , Hull Brian L.
Published: July 2019

Background:

Hospital-associated disability (HAD) has been linked to prolonged and inappropriate immobility. HAD and increased postacute care (PAC) rehabilitation spending are also associated.

Purpose:

This pilot aims to describe the implementation processes of a designated mobility technician (MT), providing daily mobility on a medical and surgical acute care unit. During the MT implementation, we explore the resulting effects on patient length of stay (LOS), PAC utilization, patient satisfaction, falls, and hospital cost.

Methods:

A quality improvement pilot study was created comparing the percentage of PAC discharge locations before and during the mobility pilot (MP) on 1 general medical (GM) unit (37 beds) and 1 general surgical (GS) unit (27 beds). Following the nursing assessment of medical stability and mobility with a progressive mobility algorithm, patients were assigned a Johns Hopkins Highest Level of Mobility (JH-HLM) score and placed on the MT schedule. The MT mobilized each selected patient to the next appropriate level of mobility, with a goal of at least 1 JH-HLM level of increase and recorded the score. Patient discharge location was recorded at the end of the inpatient stay. Patient satisfaction scores, LOS, and incidence of falls were also monitored throughout the pilot.

Outcomes:

Eighty-nine percent of GM compared with 83% of the baseline data group patients and 83% of the GS compared with 90% for the baseline data group patients discharged to home with an average increase in JH-HLM score of 1.22 per mobility session. In addition, during the MP both units decreased the LOS by 5.84% to 9.03%, the GS unit experienced increased patient satisfaction scores by 9.19%, and both units improved Press Ganey ratings of Responsiveness of Staff by 16.47% to 37.00%. No falls were associated with the MT or MP and the GM unit decreased overall falls by 53.3%.

Discussion:

The MP is a promising tool for increasing patient mobility in the nonintensive care GM and GS setting, while potentially decreasing the need for PAC rehabilitation for many patients with minimal mobility deficits. Although not all of the results were statistically significant, positive effects on hospital ratings show promise toward helping to improve the overall patient experience during admission, decreasing LOS, decreasing overall fall rate, and an associated decrease in GM patient PAC spending in those most likely to be affected by HAD related to immobility. These positive effects can potentially improve hospital profit margins through the Centers for Medicare & Medicaid Services' value-based purchasing reimbursement program.
Heart Rate Variability and Cardiorespiratory Fitness in Non-Hispanic Black Versus Non-Hispanic White Adolescents With Type 1 Diabetes
Authors: Faulkner Melissa Spezia , Quinn Laurie , Fritschi Cynthia , Tripp Natalie , Hayat Matthew J.
Published: July 2019

Background

Evidence indicates that fewer non-Hispanic black versus non-Hispanic white youths with type 1 diabetes are meeting treatment goals for optimal glycemic outcomes, predisposing them to risks for cardiovascular (CV) morbidity and mortality in adulthood.

Purpose

We sought to assess the association of sex and race with heart rate variability (HRV) and cardiorespiratory fitness in adolescents with type 1 diabetes. The association between the HRV and cardiorespiratory outcomes with glucose control was also examined.

Methods

A secondary data analysis of 95 adolescents with type 1 diabetes (n = 66 non-Hispanic white n = 29 non-Hispanic black) was used. Using 24-hour Holter recordings, spectral and time domain measures of HRV were obtained. Cardiorespiratory fitness using a graded exercise test was completed. Descriptive statistics and Pearson correlation coefficients were used to assess associations between glucose control and study outcomes, and general linear models were applied to explore and quantify associations of sex and race with HRV and cardiorespiratory fitness.

Results

Body mass index (mean [standard deviation]) was similar between non-Hispanic black (23.5 [3.9]) and non-Hispanic white (22.7 [3.8]) adolescents. Females and non-Hispanic black adolescents had significantly lower HRV and cardiorespiratory fitness levels. Moderate associations were found between lower HRV and poorer glycemic control (HbA1c). Recent HbA1c was significantly higher in non-Hispanic black (9.7 [1.8]) than non-Hispanic white (8.2 [1.2]).

Conclusion

Findings support the importance of early identification of CV health risks in adolescents with type 1 diabetes, particularly for non-Hispanic black adolescents. Interventions focused on overall improvement in glycemic control for adolescents with type 1 diabetes are a priority for minimizing future CV complications.
Monthly Extended-Release Risperidone (RBP-7000) in the Treatment of Schizophrenia
Authors: Andorn Anne , Graham Jay , Csernansky John , Newcomer John W. , Shinde Sunita , Muma Gilbert , Heidbreder Christian , Fava Maurizio
Published: July 2019

Purpose/Background

The Phase 3 program for RBP-7000, a once-monthly subcutaneous (SC) extended-release risperidone formulation approved for treatment of schizophrenia, consisted of a double-blind placebo-controlled trial (previously reported) and a 52-week open-label study of monthly RBP-7000 120 mg. The primary objective of the open-label study was to evaluate the long-term safety and tolerability of RBP-7000 in adults with schizophrenia. A secondary objective was to assess long-term maintenance of effectiveness.

Methods/Procedures

The 52-week Phase 3 open-label study (NCT02203838) enrolled 92 rollover participants from the double-blind trial (NCT02109562) and 408 stable (Positive and Negative Syndrome Scale [PANSS] total score, ≤70) de novo participants. Participants received up to 13 monthly SC injections of RBP-7000 120 mg. Safety assessments included treatment-emergent adverse events, injection-site assessments, vital signs, laboratory and ECG parameters, extrapyramidal symptoms, and suicidality. Clinical outcomes included the PANSS and Clinical Global Impression—Severity.

Findings/Results

Overall, 367 participants (73.4%) reported 1 or more treatment-emergent adverse event; the most common were injection-site pain (13.0%) and weight increase (12.8%). Most participants (>80%) experienced no injection-site reactions. No clinically meaningful changes were observed in laboratory or electrocardiogram values, vital signs, extrapyramidal symptoms, or suicidality. Over 12 months of exposure, mean PANSS scores continued to improve in rollover participants and remained stable among de novo participants. Mean Clinical Global Impression—Severity scores remained stable among all participants.

Implications/Conclusions

Except for anticipated injection-site reactions, RBP-7000 demonstrated a favorable safety and tolerability profile similar to oral risperidone. Notably, PANSS scores continued to improve for participants from the pivotal study and remained stable for de novo participants.
Mobility Disorders in Stroke, Parkinson Disease, and Multiple Sclerosis
Authors: Cattaneo Davide , Gervasoni Elisa , Pupillo Elisabetta , Bianchi Elisa , Aprile Irene , Imbimbo Isabella , Russo Rita , Cruciani Arianna , Jonsdottir Johanna , Agostini Michela , Beghi Ettore
Published: July 2019

Objective

The aims of the study were to compare mobility in multiple sclerosis, Parkinson disease, and stroke, and to quantify the relationship between mobility and participation restrictions.

Design

This is a multicenter cross-sectional study. Included were compliant subjects with Parkinson disease, multiple sclerosis, and stroke seen for rehabilitation, with no comorbidities interfering with mobility. Functional scales were applied to each subject to investigate gait speed (10-meter walking test), balance while maintaining body position (Berg Balance Scale), dynamic balance and mobility (Timed Up and Go and Dynamic Gait Index), and participation (Community Integration Questionnaire).

Results

Two hundred ninety-nine patients (111 multiple sclerosis, 94 Parkinson disease, and 94 stroke) were enrolled. Stroke had the slowest gait speed (mean gait speed = 0.9 m/sec) compared with Parkinson disease (1.1 m/sec), and multiple sclerosis (1.2 m/sec) (P< 0.001). Multiple sclerosis was more limited than Parkinson disease and stroke in dynamic balance both in the Timed Up and Go Test (multiple sclerosis = 16.7 secs, Parkinson disease = 11.4 secs, stroke = 14.0 secs;P< 0.001) and Dynamic Gait Index (multiple sclerosis = 11.6 points, Parkinson disease = 12.9 points, stroke = 13.6 points;P= 0.03); ability to maintain balance and body position (Berg Balance Scale) was more affected in stroke and Parkinson disease than multiple sclerosis (multiple sclerosis = 42.6 points, Parkinson disease = 39.4 points, stroke = 39.7 points;P= 0.03). Balance disorders were associated with participation restrictions but not gait speed.

Conclusions

Neurological conditions have differing impacts on gait and balance, leading to different levels of participation restriction.
Use of Bone Morphogenetic Protein in Pediatric Cranioplasty With Pre- and Postoperative Radiation Therapy
Authors: Sharma Jyoti , Tuncer Fatma Betul , Gociman Barbu , Siddiqi Faizi
Published: July 2019

Introduction:

Bone morphogenetic protein (BMP) is a signaling protein that has proven efficacy in the setting of bone repair. It has been widely used in orthopedic surgery and is being implemented more in the field of craniofacial surgery, although there is limited report on its use in pediatric patients.

Case:

A 6-year-old female with stage IV neuroblastoma with metastasis to the parietal parasagittal calvarium, which had failed to respond to multiple medical therapies, including radiation therapy. The tumor was excised and the defect was replaced with a combination of split calvarial bone graft and rhBMP-2. The patient received post-operative radiation therapy with no reports of complications of the defect site on immediate and long term follow up.

Conclusion:

The use of BMP has the potential to aid in bone generation for high-risk calvarial defects. It can be safe and efficacious to use in the pediatric population; however, future studies should be done to determine the safest and most effective dosing of BMP.
Donor Site Changes in Bone Thickness, Volume, and Density Following Split Cranial Bone Graft Harvest
Authors: B Sandeep , Sharma Ramesh K. , John Jerry R. , Khandelwal Niranjan
Published: July 2019

The calvarium can provide large amount of good quality corticocancellous autogenous bone graft. Although many studies have highlighted the advantages of the split cranial bone graft, there is no published work available in the literature about the fate of donor site of the split cranial bone graft. The present study was undertaken to assess the donor site as regards to the thickness, volume, and the density of the residual bone over a period of 12 months in the postoperative period. A total of 30 patients in the age group of 15 to 43 years were studied from January 2015 to January 2016. Postoperative computer tomography scans were taken at 2 weeks, 6 months, and 1 year postoperative to measure the bone thickness, volume, and density at the donor site of the split cranial bone graft harvest. The bone thickness at the donor site showed progressive increase in the thickness over the period of study and the average increase in thickness was about 12.4% at the end of 1 year. The average increase in volume at the donor site was of 2.65% after 12 months. Similarly, the average bone density increased by 3.7% at the end of 1 year. This prospective study conclusively proves that the residual bone at the donor site of the split cranial bone graft harvest site continues to grow in thickness and density over a period of 1 year.
Using the International Classification of Functioning, Disability, and Health to Guide Students' Clinical Approach to Aging With Pathology
Authors: Ramsey Crystal R. , Preston Ashton , Barredo Ronald , Lehman David
Published: July 2019

Despite the wide acceptance of the International Classification of Function, Disability, and Health (ICF) model, there remains a fundamental gap in the utilization of the ICF to foster clinical decision-making in physical therapy students. This article proposes a shift from initiating the patient examination with assessment of body structures and functions to a model that incorporates adult learning theory and clinical expertise theory to facilitate students' transition to expert clinicians. The authors offer the example of an older patient with a neurological condition to demonstrate the reasoning process that delineates typical aging from the disease process for optimal patient outcomes.