bluuebunny/crossref_metadata_2025 huggingface dataset:
On the importance of scale in evolutionary quantitative genetics
Authors: Hansen Thomas F , Holstad Agnes , Houle David , Pélabon Christophe
Published: June 2024

The informed use of scales and units in evolutionary quantitative genetics is often neglected, and naïve standardizations can cause misinterpretations of empirical results. A potentially influential example of such neglect can be found in the recent book by Arnold (2023. Evolutionary quantitative genetics. Oxford University Press). There, Arnold championed the use of heritability over mean-scaled genetic variance as a measure of evolutionary potential arguing that mean-scaled genetic variances are correlated with trait means while heritabilities are not. Here, we show that Arnold’s empirical result is an artifact of ignoring the units in which traits are measured. More importantly, Arnold’s argument mistakenly assumes that the goal of mean scaling is to remove the relationship between mean and variance. In our view, the purpose of mean scaling is to put traits with different units on a common scale that makes evolutionary changes, or their potential, readily interpretable and comparable in terms of proportions of the mean.
Climate sensitive tree growth modelling of Myrocarpus frondosus in Southern Brazil using tree-ring time series and distributed generalized additive lag models
Authors: Schons Cristine Tagliapietra , Nothdurft Arne , Ritter Tim , Fleig Frederico Dimas
Published: June 2024

Climate change is expected to strongly affect the functioning of tropical and subtropical forest ecosystems around the globe, and tree-ring analysis is proving increasingly useful for understanding the changing dynamics in these environments. However, traditional dendroecological methods were not originally designed to jointly consider inter-annual and inter-tree variations, often assuming linear growth-climate relationships, and limiting the potential to address in-deep questions regarding the tree growth sensitivity to environmental drivers. In the present study, we applied a flexible generalized additive model to assess the climate-sensitivity of the species Myrocarpus frondosus Allemão growing in a subtropical Atlantic Forest (AF) site in southern Brazil. Tree-ring width time series from 117 stem cores together with monthly climate data of temperature and precipitation covering the period from 1968 to 2021 were used for model construction. The model was designed to simultaneously encompass detrending, to capture nonlinear effects of climate variables and their interactions and to predict mean tree-ring widths for the species. Based on a distributed lag model approach, we also tested the influence of different lengths of lagged climate series over the model accuracy. Both precipitation and temperature proved to be strong drivers of M. frondosus radial growth in the subtropical AF. An interaction effect between these regressor variables revealed a likely water stress scenario arising from warm and dry summer conditions, with strongly negative impacts for the species. Detrimental impacts on tree dormancy period can also be expected due to milder winters, with legacy effects on the radial increments across two subsequent years. In addition to monitoring, the approach applied here meets the needs for more robust predictions of the impacts of future climate conditions on species and communities, contributing to efforts aimed at the management and conservation in tropical and subtropical ecosystems, particularly in the AF.
Medicare Fee-For-Service Spending for Fall Injury and Nonfall Events: The Health, Aging, and Body Composition Study
Authors: Xue Lingshu , Napoleone Jenna M , Winger Mary E , Boudreau Robert M , Cauley Jane A , Donohue Julie M , Newman Anne B , Waters Teresa M , Strotmeyer Elsa S
Published: June 2024

Background and Objectives

Fall injuries are prevalent in older adults, yet whether higher spending occurs after nonfracture (NFFI) and fracture is unknown. We examined whether incident fall injuries, including NFFI and fractures, were associated with higher Medicare spending in 12 months after incident events in older adults.

Research Design and Methods

The Health, Aging, and Body Composition Study included 1 595 community-dwelling adults (53% women, 37% Black; 76.7 ± 2.9 years) with linked Medicare Fee-For-Service (FFS) claims at 2000/01 exam. Incident outpatient and inpatient fall injuries (N = 448) from 2000/01 exam to December 31, 2008 were identified using the first claim with a nonfracture injury diagnosis code with a fall E-code, or a fracture diagnosis code with/without an E-code. Up to 3 participants without fall injuries (N = 1 147) were matched on nonfall events to 448 participants in the fall injury month. We calculated the change in monthly FFS spending in 12 months before versus after index events in both groups. Generalized linear regression with centered outcomes and gamma distributions examined the association of prepost expenditure changes with fall injuries (including NFFI and fractures) adjusting for related covariates.

Results

Monthly spending increased after versus before fall injuries (USD$2 261 vs $981), nonfracture (N = 105; USD$2 083 vs $1 277), and fracture (N = 343; USD$2 315 vs $890) injuries (all p < .0001). However, after adjusting for covariates in final models, fall injuries were not significantly associated with larger increases in spending/month versus nonfall events (differential increase: USD$399.58 [95% CI: −USD$44.95 to $844.11]). Fracture prepost change in monthly spending was similar versus NFFI (differential increase: USD$471.93 [95% CI: −USD$21.17 to $965.02]).

Discussion and Implications

Although substantial increases occurred after injuries, with fracture and NFFI increasing similarly, changes in monthly spending after fall injury were not different compared to nonfall events. Our results contribute to the understanding of subsequent spending after fall injury that may inform further research on fall injury-related health care spending.
The Perspective of Residents Living With Dementia Toward Their Built Environment: A Walking Interview Study in German Nursing Homes
Authors: Fahsold Anne , Schmüdderich Kathrin , Roes Martina , Verbeek Hilde , Palm Rebecca , Holle Bernhard
Published: June 2024

Background and Objectives

In long-term care, the built environment can help residents maintain activities of daily living and thus positively influence their quality of life. The adequacy of the built environment can be systematically assessed using assessment tools. The German Environmental Audit Tool (G-EAT) was translated and psychometrically tested for the German setting. Previous research has shown that the perspective of people living with dementia has not been fully considered in this adaptation. To explore the residents’ perspective, the question of how residents living with dementia experience the built environment of nursing homes was investigated.

Research Design and Methods

Walking interviews were conducted with residents. Inclusion criteria for participation were the presence of dementia (medically diagnosed or indicated by symptoms) and the ability to express themselves verbally in German. For data analysis, the audio material was transcribed and supplemented by the researchers’ field notes and photographs. Data analysis followed an interpretative phenomenological approach.

Results

Fourteen residents from 2 nursing homes participated in the walking interviews. A total of 3 themes were identified: (1) being able to maintain the feeling “to refurnish” or having to let it go, (2) experiencing the limits and potentials of being independent because of the built environment, and (3) living in a community of residents.

Discussion and Implications

The perspective of the living environment of people living with dementia in nursing homes adds to the knowledge of assessment-based data. Boundaries between physical and social environments are experienced as fluid by residents. They do not see their living space as limited to their living unit but describe the nursing home as a living environment. This broadens the perspective of existing structural definitions in the setting.
The Association Between Grandchild Care and Biological Aging Among Middle-Aged and Older Adults in China
Authors: Xie Donghong , Wang Jiwen
Published: June 2024

Background and Objectives

Substantial evidence documents grandchild care is associated with self-reported health, life satisfaction, and depressive symptoms among middle-aged and older adults. However, little is known about the relationship between grandchild care and biological aging, especially in China, which emphasizes the unique cultural value of family. The current study sheds light on the biological consequence of grandchild care by examining the link between grandchild care and biological aging among middle-aged and older adults in China, and how gender and spousal involvement in caregiving affect this link.

Research Design and Methods

In a representative sample of Chinese adults aged 45–80 from the third wave of China Health and Retirement Longitudinal Study in 2015 (n = 3,384), we calculate biological age using Klemera–Doubal Method, and Ordinary Least Square models are used to examine the correlation between grandchild care and biological aging.

Results

High intensity of involvement in grandchild care is related to biological aging, and caring for grandchildren alone predicts greater biological aging. Compared with grandfathers, grandmothers lose more from grandchild care regardless of whether their husbands are involved in the care.

Discussion and Implications

Providing grandchild care should be a way to cope with age-related role discontinuity or loss, rather result in extra stress or burden for grandparents. Reducing the intensity of caregiving or increasing family support may attenuate the extent of biological aging.
Control or Compensation: Distorted Narrative and Aftermath of Article 17 CDSM
Authors: Woznica Ondřej
Published: June 2024

This article analyses the value gap argument and the legislative outcome of Art. 17 of the Directive on copyright in the Digital Single Market (CDSM). The analysis is based on a qualitative content analysis of key documents related to the value gap problem and entitlement analysis of the property and liability rules character of Art. 17.

The central theme of this article is the conflict between control and compensation. This ties into Peukert’s communication culture concept, which emphasizes exclusivity or access. Control and compensation are vital elements in the property and liability rules framework.

The first part explores the roots of the value gap argument and its connection to the proprietary paradigm of copyright. The content analysis of the value gap argument shows that it is built upon the property narrative of copyright.

The second part examines Art. 17 through the lens of property and liability rules, drawing on the framework developed by Calabresi and Melamed. The results show that Art. 17 has a mixed character, with a dominant property rule. However, when the real market dynamics are considered, the analysis reveals different results in different creative industries. Industries with strong collective management presence operate under liability rule schemes. As a result, authors in these industries benefit from ‘compensation without control’.

The article concludes that integrating liability rule mechanisms is crucial for promoting access and fair compensation. This is exemplified by Art. 17 and markets that function under liability rule organizations, where minor authors particularly stand to benefit.
A comparison between different models of delivering maternal cash transfers in Myanmar
Authors: Maffioli Elisa M , Tint Zaw Nicholus , Field Erica
Published: June 2024

As part of a randomized controlled trial conducted in Myanmar between 2016 and 2019, we explore the performance of a maternal cash transfer program across villages assigned to different models of delivery (by government health workers vs loan agents of a non-governmental organization) and identify key factors of success. Measures include enrolment inclusion and exclusion errors, failures in payment delivery to enrolled beneficiaries (whether beneficiaries received any transfer, fraction of benefits received and whether there were delays and underpayment of benefit amounts) and whether beneficiaries remained in the program beyond eligibility. We find that women in villages where government health workers delivered cash transfers received on average two additional monthly transfers, were 19.7% more likely to receive payments on time and in-full and were 14.6% less likely to stay in the program beyond eligibility. With respect to the primary health objective of the program—child nutrition—we find that children whose mother received cash by government health workers were less likely to be chronically malnourished compared to those whose mother received cash by loan agents. Overall, the delivery of cash transfers to mothers of young children by government health workers outperforms the delivery by loan agents in rural Myanmar. Qualitative evidence suggests two key factors of success: (1) trusted presence and past interactions with targeted beneficiaries and complementarities between government health workers’ expertise and the program; and (2) performance incentives based on specific health objectives along with top-down monitoring. We cannot exclude that other incentives or intrinsic motivation also played a role.
The geopolitics of technology standards: historical context for US, EU and Chinese approaches
Authors: Zúñiga Nicholas , Burton Saheli Datta , Blancato Filippo , Carr Madeline
Published: June 2024

This article provides a review of the historical trends that are shaping global competition for standard setting in emerging technologies. Specifically, it explores how the traditional rule-makers of international standardization, namely the United States and Europe, are responding to the rise of China in standard-setting. The article argues that three polities are adapting their standard-setting strategies to shifting power dynamics in the international technology order. To preserve its competitive advantage, the US is becoming more interventionist and proactive in setting technology standards. China has developed a long-term standardization strategy to bolster its domestic industrial development, increase its influence and reap greater profits from the process of rule-making. Finally, the EU is seeking a third way that strikes a balance between competition and cooperation to preserve values like interoperability, which have historically benefited its single market and the global economy at large. Our historical review shows that, while the three polities have different priorities and face distinct challenges, they all seem to converge towards a greater role for governments in standard-setting.
Protection of non-original objects generated by artificial intelligence: the Ukrainian copyright law approach
Authors: Bulat Nataliia
Published: June 2024

The Law of Ukraine ‘On Copyright and Related Rights’ of 1 December 2022 is the first attempt in the Ukrainian legislation to regulate relations concerning non-original objects generated by a computer programme (including artificial intelligence (AI)). The aim of the article is to analyse the approach to dealing with non-original objects generated by AI proposed by the Ukrainian copyright legislation. The paper provides a general overview of the Ukrainian copyright law approach to non-original objects generated by a computer programme. After that, special attention is paid to the meaning and scope of non-original objects generated by AI. Finally, the article discusses a question of who should be a holder of sui generis rights to non-original objects. Positively estimating the legislative novelty and the accuracy of terms ‘a non-original object generated by a computer programme’ and ‘works created by natural persons with using computer technologies’, the article provides some recommendations concerning art 33 of the Law of Ukraine ‘On Copyright and Related Rights’ interpretation and further legislation improvement.
DORAVIR: a French national survey of people with HIV-1 treated with an antiretroviral regimen including doravirine
Authors: Soulie Cathia , Balde Aliou , Fofana Djeneba , Charpentier Charlotte , Bonnafous Pascale , Sourice Justine , De Monte Anne , Avettand-Fenoel Véronique , Le Guillou-Guillemette Hélène , Bocket Laurence , Raymond Stéphanie , Marque Juillet Stéphanie , Trabaud Mary-Anne , Montes Brigitte , Maillard Anne , Hartard Cédric , Alessandri-Gradt Elodie , Brochot Etienne , Signori-Schmuck Anne , Assoumou Lambert , Marcelin Anne-Geneviève
Published: June 2024

Background

Doravirine is the latest NNRTI to be approved for the treatment of HIV-1 and has a different resistance profile from first-generation NNRTIs. Our aim was to investigate the virological efficacy of antiretroviral treatment including doravirine in people living with HIV-1 (PLWHIV), the factors associated with virological failure (VF) and those associated with the emergence of reverse transcriptase (RT) mutations in the case of VF.

Methods

A retrospective national survey of PLWHIV who were either naive or experienced on antiretroviral treatment including doravirine was conducted. VF was defined as two consecutive plasma viral loads (VLs) of ≥50 copies/mL or one VL of ≥200 copies/mL. Genotypic resistance tests were interpreted using the Stanford (v9.4.1) and ANRS (v33) algorithms.

Results

Of the 589 PLWHIV treated with a doravirine-containing regimen, 8.5% were naive and 91.5% had prior antiretroviral experience; 56.9% were infected with HIV-1 B subtype. Overall, 88.3% and 85.1% of participants were virologically controlled at Month (M)3 and M6 of doravirine treatment, respectively. In multivariable analysis, CRF02_AG subtype, higher zenith plasma HIV-1 RNA VL, doravirine initiation in the context of failure and baseline V179D mutation presence were associated with VF. Among 88 PLWHIV who experienced virological failure at M6, 15.9% had a median of 2 (IQR 1–3) HIV RT mutations. In multivariable analysis, the only factor associated with the occurrence of mutations was a genotypic sensitivity score that was not fully sensitive.

Conclusions

This study is one of the largest to characterize the virological efficacy of doravirine-containing regimens in clinical practice and to identify factors associated with VF or emergence of resistance mutations that should be considered in clinical management.
Analysis of PIK3CA mutations in the primary and recurrent tumors of hormone receptor positive/human epidermal growth factor receptor 2 negative breast cancer
Authors: Wang Yue , Li Xin , Zhang Shuang , Liang Li , Xu Ling , Liu Yinhua , Li Ting
Published: June 2024

Objective

Our aim was to compare the PIK3CA mutation status in matched primary and recurrent tumors of hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2−) breast cancer (BC) to gain insight into the optimization of patient selection and detection time for PIK3CA-targeted therapy.

Methods

The data were from 3035 patients with BC diagnosed at the Breast Disease Center, Peking University First Hospital, between January 2008 and December 2017. Matched primary and recurrent samples were profiled using amplification-refractory mutation system-polymerase chain reaction covering 11 mutational hotspots in PIK3CA.

Results

PIK3CA mutations were detected in 54.3% primary tumors and 48.6% corresponding recurrences. PIK3CA mutation was detected in 37.5% cases in the locoregional recurrent group and 40.0% of distant metastasis, without a statistical difference. Besides, PIK3CA mutations were concordant in 88.6% of the matched pairs. For patients treated with neoadjuvant chemotherapy, 100% concordance was observed. However, PIK3CA mutation was neither correlated with clinicopathological features nor associated with clinical outcomes.

Conclusions

Mutations in PIK3CA in HR+/HER2− BC generally progressed to recurrent tumors. The high concordance rate of PIK3CA mutation status between primary tumors and corresponding recurrences suggests that the detection of primary tumors could be a substitute approach when recurrent samples are not easily obtainable.
Laboratory testing consolidation and total laboratory automation improves service efficiency and effectiveness: a study of a medical center in Taiwan
Authors: Tseng Chih-Wei , Li Ying-Chun , Lee Herng-Sheng , Tseng Yang-Ming
Published: June 2024

Background

Test consolidation and total laboratory automation (TLA) were implemented in a core laboratory with a high volume of specimens in a medical center in Taiwan to reduce the costs of laboratory services and improve laboratory workflow and performance.

Methods

Using a retrospective research approach, 5 stat and 7 routine tests were used to analyze the in-laboratory to report turnaround time (IR-TAT). Mean, SD, medium, 90th percentile, outlier percentage of IR-TAT, full-time equivalents, productivity, tube touch moment (TTM), and financial impact were determined and compared pre- and post-TLA.

Results

The mean IR-TAT of overall stat chemical tests for inpatient and outpatient were 32.8% and 11.9% reductions, respectively. The productivity of each medical technologist increased by 32.4% per month, and there was a reduction of 5 medical technologists compared with the number required to complete the same tests before consolidation. The TTM of staff per year post-TLA decreased by 74.1% tube touches.

Conclusion

The efficiency of laboratory services was improved by consolidation to the core laboratory along with TLA implementation coupled with logic rules such as delta-check and autoverification. Effectiveness was improved as measured by an increase in productivity, labor reduction, staff safety, and cost reduction.
Sloshing and spiral structures breeding a putative radio mini-halo in the environment of a cool-core cluster, Abell 795
Authors: Kadam S K , Salunkhe Sameer , Vagshette N D , Paul Surajit , Sonkamble S S , Pawar P K , Patil M K
Published: June 2024

Spiral structures and cold fronts in X-rays are frequently observed in cool-core galaxy clusters. However, studies on radio mini-haloes associated with such spirals and their physical connections are rare. Here, we present the detection of an extended diffuse radio emission entrained in the X-ray spiral structure in a known cool-core cluster, Abell 795. Though the cool core is a sign of the relaxed nature, our re-analysed 30-ks Chandra X-ray data of Abell 795 confirm the presence of an interesting log spiral structure of an X-ray deficit region complemented by an X-ray excess counter spiral in the residual map, exposing its dynamical activity. Our new analysis of 150- and 325-MHz Giant Metrewave Radio Telescope archival data confirms the detection of a ∼180-kpc ultra-steep (α ∼ −2.7) diffuse radio structure, previously reported as a candidate radio mini-halo from low-sensitive survey maps. This emission spans the entire spiral structure, enclosed by two previously reported cold fronts. Furthermore, optical spectra from the Sloan Digital Sky Survey Data Release 13 and far-ultraviolet data from the Galaxy Evolution Explorer show a considerably low total star formation rate of 2.52 M⊙ yr−1 with no significant variation in metallicity distribution. We argue that the two-phase (hot and cold) plasma at the core with differential velocity has plausibly caused the spiral formation and has redistributed the secondary electrons from the brightest cluster galaxy or the pre-accelerated electrons, which have been (re-)accelerated by the sloshing turbulence to form the observed candidate radio mini-halo structure. This is supported by a few previous studies indicating that spiral formation and sloshing turbulence quenches star formation and facilitates smooth metallicity distribution by mixing the gas in the core.
Community-based HIV Self-testing for Persons Who Use Drugs Can Contribute to Reaching Ending the HIV Epidemic in the US (EHE) Goals
Authors: Assoumou Sabrina A , Bonilla Haley V , Ruiz-Mercado Glorimar , Von Lossnitzer Meg , Baker Richard , Crawford Natalie D , Bernstein Judith A
Published: June 2024

In a pilot study providing HIV self-testing to persons who use drugs (N = 40), we identified 3 new HIV cases when partnering with a community-based organization. Most (82%) participants were interested in preexposure prophylaxis. HIV self-testing could contribute to efforts to Ending the HIV Epidemic in the United States.

ClinicalTrials.gov registration: NCT05528562
A Survey of Judicial Effectiveness: The Last Quarter Century of Empirical Evidence
Authors: Bosio Erica
Published: June 2024

Courts around the world are often perceived to be ineffective in the delivery of justice. The resolution of cases takes too long, costs too much, and is biased in favor of the rich and politically connected. These stylized facts motivate judicial reform. With the benefit of a quarter century of empirical research, this paper finds that judicial reform is successful in improving court effectiveness when it coincides with or is motivated by periods of extraordinary politics. We study the four most discussed ingredients of judicial effectiveness—independence, access, efficiency, and quality—and find that transformative judicial reform is most likely to succeed in countries emerging from conflict and violence or those that are pursuing accession to regional or international groups. Absent such conditions, reformers are better off focusing on the adoption of procedural rules that increase the effectiveness of the existing judicial system. The survey highlights procedural reforms that deliver better outcomes.
Uses of Linguistic Context in Speech Listening: Does Acquired Hearing Loss Lead to Reduced Engagement of Prediction?
Authors: Fernandez Leigh B. , Pickering Martin J. , Naylor Graham , Hadley Lauren V.
Published: June 2024

Research investigating the complex interplay of cognitive mechanisms involved in speech listening for people with hearing loss has been gaining prominence. In particular, linguistic context allows the use of several cognitive mechanisms that are not well distinguished in hearing science, namely those relating to “postdiction”, “integration”, and “prediction”. We offer the perspective that an unacknowledged impact of hearing loss is the differential use of predictive mechanisms relative to age-matched individuals with normal hearing. As evidence, we first review how degraded auditory input leads to reduced prediction in people with normal hearing, then consider the literature exploring context use in people with acquired postlingual hearing loss. We argue that no research on hearing loss has directly assessed prediction. Because current interventions for hearing do not fully alleviate difficulty in conversation, and avoidance of spoken social interaction may be a mediator between hearing loss and cognitive decline, this perspective could lead to greater understanding of cognitive effects of hearing loss and provide insight regarding new targets for intervention.
Assessing Correlations and Demographic Interactions Between PROMIS25 and SRS30 in Pediatric Patients With Spinal Deformity
Authors: Niknam Kian , Less Justin T. , Swarup Ishaan
Published: June 2024

Introduction:

Historically, patient-reported outcome measures (PROMs) have been measured using anatomy-specific instruments. However, these instruments may be influenced by the presence of concomitant illnesses not associated with the orthopaedic condition. As such, standardized PROM tool, such as PROMIS25, have been developed to assess patient outcomes. In this study, we aim to compare the correlation and association between 2 common PROMs used for pediatric patients with spinal deformity.

Methods:

This study included patients younger than 21 years who were indicated for spinal deformity surgery at our institution. All patients were invited to complete SRS-30 and PROMIS-25 instruments through an automated, electronic patient-reported outcome platform before surgery. Patient demographics were recorded and Spearman correlations were calculated between the various PROMIS and SRS domains. Correlations were compared between different baseline characteristics and demographics using a rho-to-z transformation method. Ceiling and floor effects were also investigated.

Results:

A total of 207 patients were enrolled in this study. The majority of PROMIS and SRS domains had moderate to strong correlations, with higher correlations observed when each instrument tried to capture the same construct. For example, there was strong correlation between PROMIS raw pain and SRS pain (ρ=−0.86, P<0.01), and PROMIS Depression and SRS Mental Health (ρ=−0.76, P<0.01). Ceiling effects ranged from 1.0 to 16.9% in SRS and 0.5 to 28.5% is PROMIS. Floor effects ranged from 0.5 to 1.5% in SRS and 0.5 to 29.0% in PROMIS. There were significant differences in the correlation between SRS Mental Health and PROMIS Depression when comparing between different sexes (male: ρ=−0.74, female: ρ=−0.59, P=0.04). In addition, there were significant differences in the correlation between SRS Mental Health and PROMIS Anxiety when comparing between different insurance payors (commercial: ρ=−0.86, female: ρ=−0.75, P=0.03).

Conclusions:

There is strong correlation between SRS and PROMIS domains in pediatric patients with spinal deformity. These correlations can differ by baseline characteristics and demographics. Providers should consider these differences when interpreting PROMs in diverse patient populations.

Level of Evidence:

Level III; Retrospective comparative study
Assessment of Surgical Complications Strengthen the Relationship Between Spine Surgery Procedure Intensity and Chronic Opioid Use After Surgery
Authors: Rhon Daniel I. , Greenlee Tina A. , Lawson Bryan K. , McCafferty Randall R. , Gill Norman W.
Published: June 2024

Study Design.

Prospective cohort using routinely collected health data.

Objective.

To compare opioid use based on surgery intensity (low or high).

Summary of Background Data.

Many factors influence an individual’s experience of pain. The extent to which postsurgical opioid use is influenced by the severity of spine surgery is unknown.

Methods.

The participants were individuals undergoing spine surgery in a large military hospital. Procedures were categorized as low intensity (eg, microdiscectomy and laminectomy) and high intensity (eg, fusion and arthroplasty). The Surgical Scheduling System and Military Health System Data Repository were queried for healthcare utilization the 1 year before and after surgery. We compared opioid use after surgery between groups, adjusting for prior opioid use and surgical complications.

Results.

A total of 342 individuals met the inclusion criteria, with mean age 45.4 years (SD 10.9), and 33.0% were women. Of these, 221 (64.6%) underwent a low-intensity procedure and 121 (35.4%) underwent a high-intensity procedure. Mean postoperative opioid prescription fills were greater in the high- versus low-intensity group (9.0 vs. 5.7; P<0.001), as were the mean total days’ supply (158.9 vs. 81.8; P<0.001). Median morphine milligram equivalents (MMEs) were not significantly different (40.2 vs. 42.7; P=0.287). Of the cohort, 26.3% were chronic opioid users after surgery. Adjusted rates of long-term opioid use were not different between groups when only accounting for prior opioid use but significantly higher for the high-intensity group when adjusting for surgical complications (OR=2.08; 95% CI 1.09–3.97). Of the entire cohort, 52.5% was still filling opioid prescriptions after 6 months.

Conclusions.

Higher-intensity procedures were associated with greater postoperative opioid use than lower-intensity procedures. Chronic opioid use was not significantly different between surgical intensity groups when considering only prior opioid use. Chronic opioid use was significantly higher among higher intensity procedures when accounting for surgical complications. The presence of surgical complications is a stronger predictor of postsurgical long-term opioid use in high-intensity surgeries than history of opioid use alone.

Level of Evidence.

Level III.
Efficacy of Biphasic Calcium Phosphate Ceramic With a Needle-Shaped Surface Topography Versus Autograft in Instrumented Posterolateral Spinal Fusion
Authors: Stempels Hilde W. , Lehr A. Mechteld , Delawi Diyar , Hoebink Eric A. , Wiljouw Inge A.A.A. , Kempen Diederik H.R. , van Susante Job L.C. , Kruyt Moyo C. ,   on behalf of the Dutch Clinical Spine Research Group
Published: June 2024

Study Design.

A multicenter randomized controlled noninferiority trial with intrapatient comparisons.

Objective.

The aim of this study was to determine noninferiority of a slowly resorbable biphasic calcium phosphate with submicron microporosity (BCP<μm, MagnetOs Granules) as an alternative for autograft in instrumented posterolateral fusion (PLF).

Summary of Background Data.

Successful spinal fusion with a solid bone bridge between the vertebrae is traditionally achieved by grafting with autologous iliac bone. However, the disadvantages of autografts and unsatisfactory fusion rates have prompted the exploration of alternatives, including ceramics. Nevertheless, clinical evidence for the standalone use of these materials is limited.

Methods.

Adults indicated for instrumented PLF (1 to 6 levels) were enrolled at 5 participating centers. After bilateral instrumentation and fusion-bed preparation, the randomized allocation side (left or right) was disclosed. Per segment 10 cc of BCP<μm granules (1 to 2 mm) were placed in the posterolateral gutter on one side and 10 cc autograft on the contralateral side. Fusion was systematically scored on 1-year follow-up CT scans. The study was powered to detect >15% inferiority with binomial paired comparisons of the fusion performance score per treatment side.

Results.

Of the 100 patients (57 ± 12.9 y, 62% female), 91 subjects and 128 segments were analyzed. The overall posterolateral fusion rate per segment (left and/or right) was 83%. For the BCP<μm side only the fusion rate was 79% versus 47% for the autograft side (difference of 32 percentage points, 95% CI, 23-41). Analysis of the primary outcome confirmed the noninferiority of BCP<μm with an absolute difference in paired proportions of 39.6% (95% CI, 26.8-51.2; p < 0.001).

Conclusion.

This clinical trial demonstrates noninferiority and indicates superiority of MagnetOs Granules as a standalone ceramic when compared to autograft for posterolateral spinal fusion. These results challange the belief that autologous bone is the most optimal graft material.
Deciphering HIV-associated inflammation: microbiome's influence and experimental insights
Authors: Lippincott Ricky A. , O’Connor John , Neff Charles P. , Lozupone Catherine , Palmer Brent E.
Published: June 2024

Purpose of review

To review novel experimental approaches for studying host:microbe interactions and their role in intestinal and systemic inflammation in people living with HIV (PLWH).

Recent findings

Inflammation in PLWH is impacted by interactions between the microbiome, the intestinal epithelium, and immune cells. This complex interplay is not fully understood and requires a variety of analytical techniques to study. Using a multiomic systems biology approach provides hypothesis generating data on host:microbe interactions that can be used to guide further investigation. The direct interactions between host cells and microbes can be elucidated using peripheral blood mononuclear cells (PBMCs), lamina propria mononuclear cells (LPMC's) or human intestinal organoids (HIO). Additionally, the broader relationship between the host and the microbiome can be explored using animal models such as nonhuman primates and germ-free and double humanized mice.

To explore complex host:microbe relationships, hypotheses are generated and investigations are guided by multiomic data, while causal components are identified using in-vitro and in-vivo assays.
Incidence of Orbital Mucocele following Orbital Floor Fracture Repair
Authors: Nachabe Adeem M. , Messa Genevieve E. , Boraski Jonathan C.
Published: June 2024

Mucoceles can often present as a complication after prior sinus surgery or maxillofacial trauma when mucosal drainage is obstructed. Their presence in the orbit following orbital wall fracture and subsequent repair represent an exceedingly rare complication whose occurrence is limited to a few reported cases in the literature. In these patients, continuous cyst expansion and subsequent mass effect may lead to ophthalmic symptoms, including orbital pain, proptosis, diplopia, and globe dystopia. We report the discovery of an orbital mucocele after orbital floor fracture repair and its possible association with the nonporous reconstruction plate utilized for fixation. When a patient with history of orbital wall reconstruction presents with new-onset ocular symptoms, an orbital mucocele should be considered as a potential diagnosis.
Nontopical Nitrates in Flap Perfusion and Delay Phenomenon
Authors: Izadpanah Amin , Jansen David A. , Chaffin Abigail E. , Alt Eckhard U. , Izadpanah Reza
Published: June 2024

Background:

Topical nitrates have demonstrated efficacy in improving flap perfusion. However, evidence for nontopical nitrates in modulation of flap perfusion dynamics has yet to be consolidated. Here, we review evidence regarding the use of intravascular, sublingual, and oral nitrates in modulating flap perfusion.

Methods:

We performed a review of the literature for evidence linking nontopical nitrates and flap perfusion, and included clinical studies, animal studies, and in vitro studies.

Results:

Evidence suggests that intravascular, sublingual, and oral nitrates exert vasodilatory properties, which may be harnessed for identification of perforators and improved flap perfusion. We also found evidence suggesting nitrates may facilitate ischemic preconditioning while reducing ischemia–reperfusion injury.

Conclusions:

Nitrates delivered intravascularly, sublingually, or orally may increase flap perfusion and serve as a method for ischemic preconditioning, particularly in the intraoperative setting.
ORAL CURCUMIN TO REDUCE RISK OF PROLIFERATIVE VITREORETINOPATHY FOLLOWING RHEGMATOGENOUS RETINAL DETACHMENT REPAIR
Authors: Zheng Yuxi , Valikodath Nita , Woodward Richmond , Allen Ariana , Grewal Dilraj S. , Fekrat Sharon
Published: June 2024

Purpose:

To evaluate outcomes of patients who underwent rhegmatogenous retinal detachment repair and were started on oral curcumin for proliferative vitreoretinopathy (PVR) prevention.

Methods:

Retrospective, observational case series of eyes of patients undergoing high-risk rhegmatogenous retinal detachment repair that was started on curcumin postoperatively. Recommended dosage was 500 mg twice daily for 30 days followed by 500 mg daily for 60 days. The primary outcome was recurrent PVR-related rhegmatogenous retinal detachment within 6 months and a single-surgery retinal reattachment rate. Secondary outcomes included epiretinal membrane formation, visual acuity, and curcumin safety profile.

Results:

Thirty-two eyes of 31 patients met the study inclusion criteria. Postoperatively, 2 eyes developed a PVR-related detachment (6.3%), and 2 eyes redetached due to new breaks without PVR (6.3%). Overall, single-surgery retinal reattachment rate was 87.5%. Single-surgery retinal reattachment rate without silicone oil was 92.6% (25/27). Of the 12 cases with Grade C PVR-related retinal detachment, the single-surgery retinal reattachment rate was 91.7%. Postoperatively, 7 eyes developed an epiretinal membrane (21.9%), of which 3 underwent epiretinal membrane removal (9.4%). No patient had gastrointestinal upset or anemia.

Conclusion:

This proof-of-concept clinical study suggests that oral curcumin is well tolerated and warrants further investigation for its potential to reduce the risk of PVR after rhegmatogenous retinal detachment repair in eyes at higher risk of PVR.
Comparing a Head-Mounted Smartphone Visual Field Analyzer to Standard Automated Perimetry in Glaucoma: A Prospective Study
Authors: Wang Sean K. , Tran Elaine M. , Yan William , Kosaraju Reshma , Sun Yang , Chang Robert T.
Published: June 2024

Précis:

Wang et al compare an FDA-registered head-mounted smartphone device (PalmScan VF2000) with standard automated perimetry (SAP) in glaucoma patients and find that the head-mounted device may not fully recapitulate SAP testing.

Purpose:

This study prospectively compared visual field testing using the PalmScan VF2000 Visual Field Analyzer, a head-mounted smartphone device, with standard automated perimetry (SAP).

Methods:

Patients with glaucoma undergoing Humphrey Field Analyzer SAP testing were asked to complete in-office PalmScan testing using a Samsung S5 smartphone in a virtual reality-style headset. Glaucoma severity was defined as SAP mean deviation (MD) >−6 dB for mild, between −6 and −12 dB for moderate, and <−12 dB for severe. Global parameters MD and pattern SD from PalmScan and SAP were compared using t-tests and Bland-Altman analyses. Bland-Altmann analyses of PalmScan and SAP MD were conducted for the superonasal, superotemporal, inferonasal, and inferotemporal visual field quadrants. The repeatability of PalmScan was assessed using Spearman’s correlations and intraclass correlation coefficients (ICCs).

Results:

Fifty-one patients (51 eyes) completed both SAP and PalmScan testing and met the criteria for analysis. Compared with SAP, global MD and pattern SD measurements from PalmScan differed by an average of +0.62±0.26 dB (range: −3.25 to +4.60 dB) and −1.00±0.24 dB (range: −6.03 to +2.77 dB), respectively, while MD scores from individual visual field quadrants differed by as much as −6.58 to +11.43 dB. The agreement between PalmScan and SAP in classifying glaucoma severity was 86.3% across all eyes. PalmScan and SAP identified the same quadrant as having the worst visual field defect in 66.7% of eyes.

Conclusions:

Despite advantages in cost and accessibility, the PalmScan head-mounted perimetry device may not be able to fully recapitulate SAP testing.
Challenging diagnosis and repair of an extensive cyclodialysis cleft
Authors: Braudo Sharon , Neuman Gil , Shitrit Noa , Goldberg Mordechai
Published: June 2024

Introduction:

This report describes a challenging case involving the diagnosis and surgical repair of an extensive cyclodialysis cleft (CDC) in a young, phakic patient.

Patient and Clinical Findings:

A 25-year-old man presented with ocular pain, visual impairment, eyelid hematoma, subconjunctival hemorrhage, and Berlin edema after blunt trauma to the right eye. Initial conservative treatment with medications was converted to surgery due to hypotony-induced maculopathy.

Diagnosis, Intervention, and Outcomes:

Ultrasound biomicroscopy (UBM) and gonioscopy revealed extensive supraciliary and suprachoroidal fluid and a CDC whose dimensions were inconclusive. However, consequent intraoperative UBM provided precise real-time anatomical evidence of an extensive CDC extending 8 clock hours and mandating closure with a direct cycloplexy approach. Layered scleral dissection and direct suturing of the ciliary body to the sclera were performed with 8-0 nylon sutures, resulting in CDC resolution, supraciliary and suprachoroidal fluid absorption, visual acuity improvement, and intraocular pressure stabilization.

Conclusions:

This case highlights the innovative use of intraoperative UBM as a critical tool, offering real-time guidance in managing an extensive CDC. The successful closure and improved visual outcomes in this case further validate the efficacy of direct cycloplexy for extensive CDCs.
CT-based AI model for predicting therapeutic outcomes in ureteral stones after single extracorporeal shock wave lithotripsy through a cohort study
Authors: Yang Huancheng , Wu Xiang , Liu Weihao , Yang Zhong , Wang Tianyu , You Weifan , Ye Baiwei , Wu Bingni , Wu Kai , Zeng Haoyang , Liu Hanlin
Published: June 2024

Objectives:

Exploring the efficacy of an artificial intelligence (AI) model derived from the analysis of computed tomography (CT) images to precisely forecast the therapeutic outcomes of singular-session extracorporeal shock wave lithotripsy (ESWL) in the management of ureteral stones.

Methods:

A total of 317 patients diagnosed clinically with ureteral stones were included in this investigation. Unenhanced CT was administered to the participants within the initial fortnight preceding the inaugural ESWL. The internal cohort consisted of 250 individuals from a local healthcare facility, whereas the external cohort comprised 67 participants from another local medical institution. The proposed framework comprises three main components: an automated semantic segmentation model developed using 3D U-Net, a feature extractor that integrates radiomics and autoencoder techniques, and an ESWL efficacy prediction model trained with various machine learning algorithms. All participants underwent thorough postoperative follow-up examinations 4 weeks hence. The efficacy of ESWL was defined by the absence of stones or residual fragments measuring ≤2 mm in KUB X-ray assessments. Model stability and generalizability were judiciously validated through a fivefold cross-validation approach and a multicenter external test strategy. Moreover, Shapley Additive Explanations (SHAP) values for individual features were computed to elucidate the nuanced contributions of each feature to the model’s decision-making process.

Results:

The semantic segmentation model the authors constructed exhibited an average Dice coefficient of 0.88±0.08 on the external testing set. ESWL classifiers built using Support Vector Machine (SVM), Random Forest (RF), XGBoost (XB), and CatBoost (CB) achieved AUROC values of 0.78, 0.84, 0.85, and 0.90, respectively, on the internal validation set. For the external testing set, SVM, RF, XB, and CB predicted ESWL with AUROC values of 0.68, 0.79, 0.80, and 0.83, respectively, with the last one being the optimal algorithm. The radiomics features and auto-encoder features made significant contributions to the decision-making process of the classification model.

Conclusions:

This investigation unmistakably underscores the remarkable predictive prowess exhibited by a scrupulously crafted AI model using CT images to precisely anticipate the therapeutic results of a singular session of ESWL for ureteral stones.
Opportunities for Improving Detection of Cancer Predisposition Syndromes in Pediatric Solid Tumor Patients
Authors: Hu Benjamin , Kirkey Danielle , Wakeling Adrienne , McGuinness Molly , Kreimer Sara , Crane Jacquelyn , Spunt Sheri L.
Published: June 2024

Background:

Detection of cancer predisposition syndromes (CPS) depends on identifying risk factors, including tumor type, family history, and physical findings, to prompt referral for genetic counseling/testing. Whether pediatric oncology providers (POPs) collect adequate family history information is unknown.

Methods:

A single-institution retrospective chart review of solid tumor patients <18 years of age referred for a CPS evaluation between January 1, 2017 and January 31, 2019 was performed. POP adherence to American Society of Clinical Oncology (ASCO) family history collection recommendations was measured and compared with genetic counselor performance. Whether sufficient family history was documented to satisfy the criteria of three genetic counseling referral guidelines [American College of Medical Genetics (ACMG), updated Jongmans (UJ), and McGill Interactive Pediatric OncoGenetic Guidelines (MIPOGG)] was evaluated.

Results:

POPs and genetic counselors achieved all 6 ASCO family history metrics in 3% and 99% of 129 eligible cases, respectively. POPs failed to document sufficient family history to satisfy genetic counseling referral criteria in most cases (74% ACMG, 73% UJ, 79% MIPOGG).

Conclusions:

POPs perform poorly in family history collection, raising concern that some patients at risk for a CPS based on their family history may not be referred for genetic counseling/testing. Interventions to improve family history collection are needed to enhance CPS detection.