bluuebunny/crossref_metadata_2025 huggingface dataset:
Reproductive Characteristics and Pregnancy Outcomes in Hidden Celiac Disease Autoimmunity
Authors: Celdir Melis G. , Choung Rok Seon , Rostamkolaei Shahryar K. , Jansson-Knodell Claire L. , King Katherine S. , Larson Joseph J. , Absah Imad , Murray Joseph A.
Published: February 2021

INTRODUCTION:

Untreated symptomatic celiac disease (CD) adversely affects female reproduction; however, the effect of hidden CD autoimmunity is uncertain.

METHODS:

We identified women who were not previously diagnosed with CD and tested positive for tissue transglutaminase and endomysial antibodies between 2006 and 2011 in a community-based retrospective cohort study. We evaluated (i) the rate of adverse pregnancy outcomes and medical complications of pregnancy in successful singleton deliveries and (ii) reproductive characteristics in seropositive women without a clinical diagnosis of CD and age-matched seronegative women.

RESULTS:

Among 17,888 women whose serum samples were tested for CD autoimmunity, 215 seropositive and 415 seronegative women were included. We reviewed 231 and 509 live singleton deliveries of 117 seropositive and 250 seronegative mothers, respectively. Menarche and menopausal age, gravidity, parity, and age at first child were similar in seropositive and seronegative women. CD seropositivity was not associated with an increased risk of maternal pregnancy complications. Maternal seropositivity was associated with small for gestational age in boys (OR 3.77, 95% CI: 1.47–9.71; P = 0.006), but not in girls (OR 0.57, 95% CI: 0.15–2.17; P = 0.41). CD serum positivity was not associated with prematurity, small for gestational age (birth weight <10th percentile), or 5-minute Apgar score of less than 7.

DISCUSSION:

Although underpowered, the present study did not show any difference in reproductive characteristics or rates of adverse pregnancy outcomes in women with and without CD autoimmunity, except for birth weight in male offspring. Larger studies are needed to determine the effects of CD autoimmunity on female reproduction.
Exploratory Comparative Effectiveness Trial of Green Kiwifruit, Psyllium, or Prunes in US Patients With Chronic Constipation
Authors: Chey Samuel W. , Chey William D. , Jackson Kenya , Eswaran Shanti
Published: February 2021

INTRODUCTION:

Psyllium and prunes are proven treatments for chronic constipation (CC). Asian studies suggest that kiwifruit may also benefit CC symptoms. We report a partially randomized, comparative effectiveness trial evaluating kiwifruit, psyllium, and prunes in US patients with CC.

METHODS:

Adults with CC at a US medical center were randomized to 3 natural treatments. Eligible patients had ≤3 complete spontaneous bowel movements (CSBMs) per week and were partially randomized to green kiwifruit (2/d), prunes (100 g/d), or psyllium (12 g/d) for 4 weeks. The primary endpoint was the proportion of patients in each group reporting an increase of ≥1 CSBM per week compared with baseline for at least 2 of 4 treatment weeks. Key secondary outcomes included stool frequency, stool consistency, and straining assessed daily. Treatment satisfaction and adverse events (AEs) were also measured. Standard statistical methods were used, and a P < 0.05 was considered significant.

RESULTS:

Seventy-nine patients with CC (mean age = 42.7 years, 87% female, and 77% white) were partially randomized. Complete data were available for 75 patients (kiwifruit 29, prunes 24, and psyllium 22). For the primary endpoint, proportions of CSBM responders were similar for the treatments. For secondary outcomes comparing treatment weeks 3 and 4 to baseline, there was a significant increase in weekly CSBM rate with all 3 treatments (P ≤ 0.003); stool consistency significantly improved with kiwifruit (P = 0.01) and prunes (P = 0.049); and straining significantly improved with kiwifruit (P = 0.003), prunes (P < 0.001), and psyllium (P = 0.04). Patients randomized to the kiwifruit group reported significant improvement in bloating scores (P = 0.02). AEs were most common with psyllium and least common with kiwifruit. At the end of treatment, a smaller proportion of patients were dissatisfied with kiwifruit compared with prunes or psyllium (P = 0.02).

DISCUSSION:

Kiwifruit, prunes, and psyllium improve constipation symptoms in patients with CC. Kiwifruit was associated with the lowest rate of AEs and dissatisfaction with therapy.
Impact of Recreational Cannabis Legalization on Hospitalizations for Hyperemesis
Authors: Nemer Laura , Lara Luis F. , Hinton Alice , Conwell Darwin L. , Krishna Somashekar G. , Balasubramanian Gokulakrishnan
Published: February 2021

INTRODUCTION:

Chronic cannabis use had been associated with hyperemesis. We sought to determine whether cannabis liberalization contributed to increased hospitalizations for hyperemesis.

METHODS:

Cannabis use and admissions for hyperemesis in legalized states were compared with those of nonlegalized states, before and after cannabis legalization, using state inpatient databases.

RESULTS:

From 2011 to 2015, cannabis use increased 2.2 times in legalized states and 1.8 times in nonlegalized states. The odds of presentation with hyperemesis were higher in 2015 compared with those of 2011 in all states.

DISCUSSION:

Recreational legalization may be contributing to rising cannabis use. Hospitalizations for hyperemesis have also increased but did not seem to be solely due to cannabis legalization.
Equal Opportunity: Women Representation on Editorial Boards and Authorship of Editorials in Gastroenterology and Hepatology Journals
Authors: Subramaniam Mythri , Azad Nabila , Wasan Sharmeel K. , Long Michelle T.
Published: February 2021

INTRODUCTION:

The proportion of women editorial board members and authors of editorials in major gastroenterology journals is not known.

METHODS:

We determined the sex of editorial board members (n = 2,282) and authors of editorials (n = 1,705) across 6 journals from 1985 to 2020 at 5-year intervals.

RESULTS:

The proportion of women editorial board members increased from 2.9% in 1985 to 19.8% in 2020 (P < 0.0001) and women authors of editorials increased from 0% in 1985 to 22.2% in 2020 (P < 0.0001).

DISCUSSION:

The proportion of women represented over time has improved, but opportunities likely exist to improve further.
Tendências discursivas sobre aprendizagem no campo pedagógico contemporâneo brasileiro
Authors: Lopes Maura Corcini , Enzweiler Deise Andreia
Published: February 2021

Neste artigo, o objetivo é refletir sobre os processos contemporâneos de naturalização dos discursos sobre a aprendizagem e seus efeitos no campo pedagógico brasileiro na atualidade, problematizando-os. Esta reflexão é resultado da convergência de distintas pesquisas direcionadas à docência na educação escolar contemporânea e à produção teórica no campo educacional desde o movimento renovador escolanovista brasileiro. As referidas pesquisas tiveram como materialidade empírica 57 narrativas de docentes brasileiros realizadas entre os anos de 2012 e 2016, e 90 edições da Revista Brasileira de Estudos Pedagógicos publicadas entre as décadas de 1940 e 1960. Esses diferentes exercícios investigativos possibilitaram uma leitura reflexiva do presente, bem como um exercício de análise histórica. Conclui-se que, apesar de o movimento escolanovista propor uma renovação educacional a partir da primeira metade do século XX, havia tendências apontando para um tipo de proposição educacional que não descartava a função pedagógica da condução, diferentemente das tendências pedagógicas predominantes no presente. Conclui-se, ainda, que as práticas de ensino revisitadas podem ser capazes de operar na contramão de práticas de decomposição subjetiva endógena, pois se dão no interior da escola.
The Legal Background of Sovereign Wealth Funds and Their Role in National Economies
Authors: András Kecskés
Published: February 2021

Sovereign wealth funds (SWF) are a type of fund which are established and operated by the state. They came into the limelight after the financial crises of 2007–08, when they saved the most emblematic listed companies in the USA and Europe. The aim of the article is to explore certain key issues related to sovereign wealth funds. The paper discusses the origins of the term and certain related economic concepts, including factors which resulted in the creation of sovereign wealth funds. The legal background is also elaborated on both international and national levels, giving an insight to the regulatory framework. The article closes with propounding a sovereign wealth fund in Hungary based on the National Investment Agency model proposed by Hockett and Omarova. This section gives an overview of state property management and its legal background. The increasing activity in the management of international reserves by the National Bank of Hungary and the expansion of the regulatory background for trust-like institutions are all pointing towards the possibility of a Hungarian sovereign wealth fund.
Self-placement of Complex Financial Instruments by Banks to Retail Clients and Civil Liability Issues – An Overview of Greek Case-Law
Authors: O. Mitsou Anna
Published: February 2021

This study focuses on self-placement of complex financial instruments to retail clients which is often associated with mis-selling practices. Recent case law in Greece concerning distribution Of “Coco” bonds by a Cypriot bank to its clients reveals, on the one hand, the stand Of Greek Courts concerning the interpretation of certain ambiguous MiFID I Conduct of Business (COB) rules and, on the other, their interplay with civil law duties and the intricacies that arise in order to substantiate a civil liability claim for breach of the COB rules, such as the difficulty to prove causation in securities litigation. The study further evaluates the new MiFID II/MiFIR provisions that relate to the practice of self-placement and supports the adoption of a civil liability regime at the EU level, as well as other alternatives to further enhance retail investor protection.
Analysis of Customer-Oriented Information for Tourism Enterprises Under the Social Media Environment
Authors: Yang Ziwei
Published: February 2021

Social media is a virtual community or network platform that the public uses to achieve self-creation and it’s sharing with others; under the social media environment, self-media channels become more abundant, and the autonomy and originality of content dissemination are also continuously enhanced. When tourism enterprises face increasing market competition, personalized and targeted promotional programs will, to a certain extent, have a certain appeal to competitors’ potential customer groups, thereby providing tourism enterprise customers with relevant benefits for oriental information, and also serving as an important way for companies to develop new customers. Based on the summary and analysis of previous literature works, this paper expounded the research status and significance of social media environment, elaborated the development background, current status and future challenges of customer-oriented information analysis for tourism enterprises, introduced the methods and principles of customer’s transfer value and life cycle and social media environment’s cognitive composition, proposed a sentiment model of tourist-oriented information analysis under the social media environment, and analysed the management strategy and scheduling platform of customer-oriented information, constructed an analysis system of customer-oriented information in social media environment, performed the reliability, validity, transfer and perception value analysis of customer-oriented information and finally conducted case simulation and its result analysis. The study results of this paper provide a reference for further researches on the customer-oriented information analysis for tourism enterprises under the social media environment.
A compact single element dielectric resonator MIMO antenna with low mutual coupling
Authors: Biswas Ashim Kumar , Chakraborty Ujjal
Published: February 2021

A two-port multiple input multiple output (MIMO) dielectric resonator antenna is proposed where two orthogonally connected feed lines are combined to unite two orthogonally produced modes. The feed lines build a hybrid network. The backplane is defected by a circular defected ground structure (CDGS), which is extended by two rectangular slits placed orthogonally with the input ports. The antenna uses a single ‘H/I’-shaped dielectric resonator (DR) element. It covers frequency spectrum from 7.29 to 10.65 GHz and fulfils the international telecommunication union (ITU) (8–8.5 GHz) and Maritime Radio Navigational (8.85–9 and 9.2–9.5 GHz) application bands. The antenna offers very high port isolation (>18 dB) and diversity properties throughout the whole application band. The antenna also provides circular polarization (AR ≤ 3 dB) in the operating ranges from 8 to 8.25 GHz and 8.85 to 8.9 GHz. Simulated and measured results make clear to the antenna most suitable for MIMO operation.
Preparation of Zn-MOFs by microwave-assisted ball milling for removal of tetracycline hydrochloride and Congo red from wastewater
Authors: Ren Qinhui , Wei Fuhua , Chen Hongliang , Chen Ding , Ding Bo
Published: February 2021

In this study, we prepared Zn-MOFs as an ordinary, low-cost, and efficiency method taking advantage of zinc(ii) acetate monohydrate and 1,3,5-benzenetricarboxylic acid in microwave-assisted ball milling. The Zn-MOFs were measured via scanning electron microscopy, infrared spectrometry, X-ray diffraction, and thermogravimetry. We explored its use as a photocatalyst for the degradation of tetracycline hydrochloride and Congo red from aqueous solutions. The results demonstrate that the kinetic model was appropriate for the removal of organic pollutants. In general, it is feasible, inexpensive, and effective to use metal organic framework (MOF) to treat waste liquid. Therefore, our findings indicate that Zn-MOFs have broad application vista in wastewater purification.
Rates of anastomotic leak and fistula following surgical management of bowel endometriosis: a comparison of shaving, discoid excision, and segmental resection
Authors: Klebanoff Jordan S. , Barnes Whitney A. , Denny Katherine , Mangini Marissa G. , Kazma Jamil , Laganà Antonio Simone , Habib Nassir , Ayoubi Jean Marc , Moawad Gaby N.
Published: February 2021

Endometriosis is a complex chronic inflammatory condition that can create a multitude of bothersome painful symptoms for women. Bowel endometriosis is often misdiagnosed or overlooked leading to years of suffering for many women. The surgical management of bowel endometriosis varies based on extent of disease as well as surgeon experience. Surgical treatment for bowel endometriosis is complex and a variety of intraoperative and postoperative complications must be considered. Two significant postoperative complications for bowel endometriosis include anastomotic leak and fistula formation. There is continued debate regarding the appropriate surgical treatment for bowel endometriosis. Aggressive surgery with segmental bowel resection is being utilized more cautiously, with an increase in less aggressive shaving or disc excision techniques. Historic beliefs regarding the limitations of shaving and disc excision are being challenged, and with a reduction in morbidity these less aggressive techniques are winning favor among gynecologic surgeons. Shaving, discoid excision, and segmental bowel resection are all feasible surgical management options for bowel endometriosis. Segmental resection is associated with the highest rates of both anastomotic leak and fistula formation, while shaving is associated with the lowest.
Annealing effect of scratch characteristics of ZnMgO epilayers on R-plane sapphire
Authors: Wen Hua-Chiang , Hsieh Ming-Chu , Lan Yu-Pin , Chou Wu-Ching
Published: February 2021

The nanotribological properties of Zn0.75Mg0.25O grown on R-plane sapphire using metal-organic vapor-phase epitaxy at different substrate temperatures (RT, 600, 700 and 800 °C) were investigated. A slight sliding track was observed at ramped loads of 250 μN, and an obvious bulge edge surrounding the groove was observed at ramped loads of 1 000 μN. Because of the annealing treatment, all the Zn0.75Mg0.25O coatings showed a reconstruction phenomenon of crystallites. The volumes of the bulge edges were as high as 30% in the annealed specimens and were larger than the volumes of the RT-treated specimens when ramped loads of 1 000 μN were applied. Under frictional loading, atomic force microscopy examination of scratch-tested films indicated lower bonding forces on R-plane sapphire than M-plane sapphire.
Impact of Mo content on the microstructure– toughness relationship in the coarse-grained heat-affected zone of high-strength low-alloy steels
Authors: Cao Yuxin , Wan Xiangliang , Zhou Feng , Shen Yu , Liu Yu , Li Guangqiang , Wu Kaiming
Published: February 2021

The present study elucidates the influence of Mo content on the microstructure – toughness relationship in the coarsegrained heat-affected zone of high-strength low-alloy steels. The low-Mo and high-Mo steels were subjected to 100 kJ cm–1 heat input welding thermal cycling. The results indicated that (Ti,Mo)-carbonitrides were formed in high-Mo steel, whereas (Ti,Nb)-carbonitrides were formed in low-Mo steel. The finer and dispersed precipitates in high-Mo steel refined the prior austenite grain in the coarse-grained heat-affected zone based on the grain boundary pinning effect. However, the smaller prior austenite grain and excessive Mo content induced the formation of an entirely bainitic microstructure in high-Mo steel. Furthermore, a higher fraction of martensite –austenite constituents was observed in high-Mo steel. These results could be responsible for the deterioration of the toughness in the coarse-grained heat-affected zone of high-Mo steel.
The influence of Cr, Al, Co, Fe and C on negative creep of Waspaloy
Authors: Firlus Konstantin , Völkl Rainer , Gabel Johannes , Glatzel Uwe
Published: February 2021

Negative creep using precision dilatation experiments is investigated on a broad variety of single, dual and multiphase nickel-based superalloys. Pure nickel and dilute binary nickel-based alloys show no signs of negative creep. However, with higher contents of Cr and Al and in highly alloyed ternary and multicomponent nickel-based alloys negative creep is observed. Short range ordering of Cr and/ or Al are identified to cause negative creep at 550 °C. Carbon additions leading to retarded carbide precipitation or transformation can enhance negative creep.
Effect of Ag additions on the microstructure and phase transformations of Zn-22Al-2Cu (wt.%) alloy
Authors: Ferreira-Palma Carlos , Dorantes-Rosales Héctor J. , López-Hirata Víctor M. , Torres-Castillo Alberto A.
Published: February 2021

The relationship between microstructure and mechanical properties is studied for eutectoid Zn-22Al (wt.%) alloys modified with Cu and Ag. Three alloys with a Cu content of 2 wt.% and varying amounts of Ag were cast and hot-extruded. Different microstructural characteristics were induced by heat treatments: natural aging, artificial aging and furnace cooling. Structural and microstructural characterizations were carried out with X-ray diffraction and scanning electron microscopy. Mechanical properties were determined by tensile testing. Dilatometry was used for determining the effects of composition on the transformation points. The addition of Ag increased the ε phase fraction and provided solid solution strengthening, improving the mechanical strength and reducing ductility. Ag additions also displaced the eutectoid reaction to higher temperatures. The microstructure of the matrix has proven to have a strong impact on mechanical properties. The naturally aged specimens presented the highest ductility and tensile strength; however, these properties are severely affected by aging. Lamellar microstructures present the lowest ductility and values of tensile strength between those of the natural and artificially-aged specimens.
Development of high-insulating materials with aerogel for protective clothing applications – an overview
Authors: Greszta Agnieszka , Krzemińska Sylwia , Bartkowiak Grażyna , Dąbrowska Anna
Published: February 2021

Aerogels are ultra-light solids with extremely low thermal conductivity (even lower than air), thanks to which they have a huge potential in a wide range of applications. The purpose of this publication is to present the state-of-the art knowledge of the possibility of using aerogels to increase the thermal insulation properties of clothing materials intended for use in both cold and hot environments. Various methods of aerogels application to textile materials (non-woven, woven and knitted fabrics) are discussed, indicating their advantages and limitations. Numerous research studies confirm that aerogels significantly improve the thermal insulation properties of materials, but due to their delicate and brittle structure and their tendency to dusting, their application still poses considerable problems.
Characterizing the use of osteopathic manipulative medicine in the obstetric population by trimester and indications for use
Authors: Faloon Jordan , Bishop Karly , Craig Wendy , Brock Julia
Published: February 2021

Context

Osteopathic manipulative medicine (OMM) has been shown to successfully alleviate some pregnancy-related pain. However, most of the published data focuses on the third trimester and postpartum period or musculoskeletal indications.

Objective

To explore OMM use among obstetrical providers and determine the frequency of use by trimester and by clinical indications across multiple types of women’s healthcare practices in Southern and Central Maine.

Methods

An anonymous, 43-item survey, presented in English, was emailed to 172 eligible providers (physicians, nurse practitioners, and certified nurse midwives with obstetrics privileges at one of two main delivery centers in southern and central Maine) via an encrypted database system in January 2018. Follow-up email reminders were sent weekly for three weeks. Questions addressed use of OMM for specific indications, knowledge of OMM, and perceived barriers use of OMM.

Results

The survey response rate was 73 of 172 (42%); 95% of respondents were physicians (n=69). Due to the low response rate of non-physicians, only data from physicians was included in the study. Data were summarized descriptively as frequencies (n [%]). The highest rates of OMM utilization were during the third trimester (35 [51.5%]) and postpartum (41 [60.3%]) periods, while the lowest rates of utilization were in the intrapartum (eight [11.9%]) and first trimester periods (26 [38.3%]). Osteopathic physicians (n=19) used OMM more frequently in the first, second, and third trimesters, as well as the intrapartum period (10 [52.6%]; 11 [57.9%]; 14 [73.7%]; and six [31.6%], respectively) compared with their allopathic physician (n=50) counterparts (nine [8%]; 15 [30%]; 21 [42%]; and two [4%], respectively). While osteopathic physicians reported higher frequencies of OMM use and referral for non-musculoskeletal indications such as constipation, edema, and nasal congestion (13 [68.4%]; 11 [57.9%]; 10 [52.6%], respectively), musculoskeletal complaints were the most frequently cited indication for OMM use among both osteopathic and allopathic physicians (low back, 67 [97.1%]; pelvis, 65 [94.2%]; coccyx, 50 [72.5%]; and head, 49 [71%]).

Conclusion

These results suggest that more education is needed about OMM use in the obstetric population, particularly during early trimesters and the intrapartum period, as well as for visceral and lymphatic complaints of pregnancy.
Pilot study assessing the effect of osteopathic manipulative treatment (OMT) on length of stay in neonates after therapeutic hypothermia
Authors: Bendixen Kira , Beinlich Alexis , Beck Bryan , Hashmi Nabeel , Craig Alexa
Published: February 2021

Context

Term neonates treated with therapeutic hypothermia (TH) may experience delays in acquiring skills for oral feeding, thus prolonging hospital admission.

Objective

To determine whether osteopathic manipulative treatment (OMT) can decrease the overall length of stay (LOS) for term neonates by accelerating the transition to full oral feeds.

Methods

A pilot study was conducted to compare LOS in term neonates treated with OMT to matched historical controls. Eligibility criteria were gestational age greater than or equal to 37 weeks, mild to moderate encephalopathy, absent seizure activity, and no brain injury on magnetic resonance imaging. Treated neonates had OMT twice between day of life four and seven, then twice per week on nonconsecutive days until hospital discharge. Secondary outcomes were to compare the number of days with nasogastric tube in both OMT and historically matched control groups and to characterize somatic dysfunction patterns in the primary affected areas of the craniosacral mechanism.

Results

Twelve of 28 neonates treated with TH between October 2017 and August 2018 met eligibility criteria for the study and were matched 3:1 to 36 historical controls. On average, mothers of neonates who received OMT were older than the historical control mothers (31.3 years [SD, ±6.0] vs. 27.4 [SD, ±4.5]; p=0.02) Nineteen of the 36 historical control neonates, but no neonates in the OMT group, were intubated for a median of two days (interquartile range 1, 4). The mean LOS in the OMT group was 9.1 vs. 11.6 days for historical controls (p=0.048); however, in a sensitivity analysis excluding intubated neonates from the historical controls, the difference was 9.1 vs. 10.1 days (p=0.21). All neonates were orally feeding at discharge. Neonates given OMT had between two and four treatments lasting 8–20 minutes. By the final treatment, the craniosacral mechanism’s intraosseous and cranial base compressions and physiologic motion were improved. There were no adverse effects noted during OMT sessions.

Conclusion

Our findings suggest that OMT performed on term neonates treated with TH may decrease the amount of time needed to acquire the necessary skills for oral feeding. Although this result was not statistically significant, it may be clinically significant. A larger prospective clinical trial may have the power needed to detect a statistically significant reduction in LOS and number of days to full oral feeds in this patient population.
Osteopathic manipulative treatment (OMT) use among osteopathic physicians in the United States
Authors: Healy Colson J. , Brockway Matthew D. , Wilde Benjamin B.
Published: February 2021

Context

Updated data on the use of Osteopathic Manipulative Treatments (OMT) by osteopathic physicians in the United States is overdue. This data would provide an up-to-date point of reference for evaluating the current use of OMT as a distinguishing feature of the osteopathic profession.

Objective

To determine the prevalence of OMT use, barriers to its use, and factors that correlate with increased use.

Methods

The American Osteopathic Association (AOA) distributed its triannual survey on professional practices and preferences of osteopathic physicians, including questions on OMT, to a random sample of 10,000 osteopathic physicians in August 2018 through Survey Monkey (San Mateo, CA). Follow-up efforts included a paper survey mailed to nonrespondents one month after initial distribution and three subsequent email reminders. The survey was available from August 15, 2018 to November 5, 2018. The OMT questions focused on frequency of OMT use, perceived barriers, and basic demographic information of osteopathic physician respondents. Statistical analysis (including a one sample test of proportion, chi-square, and Spearman’s rho) was performed to identify significant factors influencing OMT use.

Results

Of 10,000 surveyed osteopathic physicians, 1,683 (16.83%) responded. Of those respondents, 1,308 (77.74%) reported using OMT on less than 5% of their patients, while 958 (56.95%) did not use OMT on any of their patients. Impactful barriers to OMT use included lack of time, lack of reimbursement, lack of institutional/practice support, and lack of confidence/proficiency. Factors positively correlated with OMT use included female gender, being full owner of a practice, and practicing in an office-based setting.

Conclusion

Our data suggest that OMT use among osteopathic physicians in the US continues to decline. Barriers to its use appear to be related to the difficulty that most physicians have with successfully integrating OMT into the country’s insurance-based system of healthcare delivery. Follow-up investigations on this subject in subsequent years will be imperative in the ongoing effort to monitor and preserve the distinctiveness of the osteopathic profession.
Red blood cell distribution width and outcome in trauma patients
Authors: Brown McKenzie , Nassoiy Sean , Plackett Timothy , Luchette Fred , Posluszny Joseph
Published: February 2021

Context

Red blood cell distribution width (RDW) has been used to predict mortality during infection and inflammatory diseases. It also been purported to be predictive of mortality following traumatic injury.

Objective

To identify the role of RDW in predicting mortality in trauma patients. We also sought to identify the role of RDW in predicting the development of sepsis in trauma patients.

Methods

A retrospective observational study was performed of the medical records for all adult trauma patients admitted to Loyola University Medical Center from 2007 to 2014. Patients admitted for fewer than four days were excluded. Admission, peak, and change from admission to peak (Δ) RDW were recorded to determine the relationship with in-hospital mortality. Patient age, development of sepsis during the hospitalization, admission to the intensive care unit (ICU), and discharge disposition were also examined.

Results

A total of 9,845 patients were admitted to the trauma service between 2007 and 2014, and a total of 2,512 (25.5%) patients fit the inclusion criteria and had both admission and peak values available. One-hundred twenty (4.6%) died while in the hospital. RDW values for all patients were (mean [standard deviation, SD]): admission 14.09 (1.88), peak 15.09 (2.34), and Δ RDW 1.00 (1.44). Admission, peak, and Δ RDW were not significant predictors of mortality (all p>0.50; hazard ratio [HR], 1.01–1.03). However, trauma patients who eventually developed sepsis had significantly higher RDW values (admission RDW: 14.27 (2.02) sepsis vs. 13.98 (1.73) no sepsis, p<0.001; peak RDW: 15.95 (2.55) vs. 14.51 (1.97), p<0.001; Δ RDW: 1.68 (1.77) vs. 0.53 (0.91), p<0.001).

Conclusion

Admission, peak, and Δ RDW were not associated with in-hospital mortality in adult trauma patients with a length of stay (LOS) ≥four days. However, the development of sepsis in trauma patients is closely linked to increased RDW values and in-hospital mortality.
First-time sports-related concussion recovery revisited: management changes and impact on recovery
Authors: Neidecker John M. , Gealt David B. , Lambert Kathryn , Luksch John R. , Weaver Martin D.
Published: February 2021

Context

Concussion is among the most common injuries in athletes. Over the past 10 years, concussion knowledge has expanded, and guidelines for management have changed. Recent changes include recommendations against strict mental and physical rest after sustaining a concussion, a better recognition of preexisting conditions predisposing protracted concussion recovery, and the addition of preliminary patient counseling and education about the expected course of concussion recovery.

Objective

To assess the impact of changes in concussion management on the duration of symptoms in middle school and high school athletes after sustaining a first-time, sports-related concussion.

Methods

A retrospective review was performed of medical records of athletes who sustained a concussion between 2016 and 2018 and were treated by the same primary care physician (J.M.N) using the revised approach to concussion management described. Patients were included if they were 11 to 18 years old and had a diagnosis of first-time concussion sustained while playing organized sports. Athletes who sustained a concomitant injury or sustained a concussion outside of organized sports were excluded from the study; athletes lost to follow-up or with incomplete forms were also excluded. Each athlete’s length of symptomatic time from his or her concussion was calculated. This data was then compared with a previously-published data set of athletes who sustained a concussion between 2011 and 2013, with the same inclusion criteria but a different approach to concussion management.

Results

A total of 110 male and 72 female athletes (N=182) met the study’s eligibility criteria. Collectively, athletes of both sexes from the 2016–2018 data set reported a higher incidence of preexisting conditions associated with prolonged concussion recovery compared with the data set of 2011–2013 athletes. However, both sexes from the 2016–2018 data set also reported a shorter median duration of concussion symptoms compared with the 2011–2013 athletes (median duration 5 vs. 11 days for male athletes and 7 vs. 28 days for female athletes, respectively; p<0.001).

Conclusion

Recent changes in concussion management have led to decreased duration of symptoms among 11- to 18-year-old athletes with first-time, sports-related concussions. These management changes include advocating for early activity, recognizing preexisting conditions, and educating athletes about the realities of concussion recovery.
Evaluating disease outbreaks with syndromic surveillance using medical student clinical rotation patient encounter logs
Authors: Bruzda Gabrielle , Rawlins Fred , Sumpter Cameron , Garner Harold R.
Published: February 2021

Context

While the data generated by medical students at schools that require electronic patient encounter logs is primarily used to monitor their training progress, it can also be a great source of public health data. Specifically, it can be used for syndromic surveillance, a method used to analyze instantaneous health data for early detection of disease outbreaks.

Objective

To analyze how the International Classification of Diseases, 10th Revision (ICD-10) codes input by medical students at the Edward Via College of Osteopathic Medicine into the Clinical Rotation Evaluation and Documentation Organizer (CREDO) patient encounter logging system could act as a new syndromic surveillance tool.

Methods

A CREDO database query was conducted for ICD-10 codes entered between November 1, 2019 and March 13, 2020 using the World Health Organization’s 2011 revised case definitions for Influenza Like Illness (ILI). During that period, medical students had an approximated mean of 3,000 patient encounters per day from over 1,500 clinical sites. A cumulative sum technique was applied to the data to generate alert thresholds. Breast cancer, a disease with a stable incidence during the specified timeframe, was used as a control.

Results

Total ILI daily ICD-10 counts that exceeded alert thresholds represented unusual levels of disease occurred 11 times from November 20, 2020 through February 28, 2020. This analysis is consistent with the COVID-19 pandemic timeline. The first statistically significant ILI increase occurred nine days prior to the first laboratory confirmed case in the country.

Conclusion

Syndromic surveillance can be timelier than traditional surveillance methods, which require laboratory testing to confirm disease. As a result of this study, we are installing a real-time alert for ILI into CREDO, so rates can be monitored continuously as an indicator of possible future new infectious disease outbreaks.
Osteopathic students and graduates matching into pathology residency, 2011–2020
Authors: Jajosky Ryan Philip , Coulson Hannah C. , Rosengrant Abric J. , Jajosky Audrey N. , Jajosky Philip G.
Published: February 2021

Context

In the past decade, two changes have affected the pathology residency match. First, the American Osteopathic Association (AOA) Match, which did not offer pathology residency, became accredited under a single graduate medical education (GME) system with the Main Residency Match (MRM), which offers pathology residency. Second, substantially fewer United States senior-year allopathic medical students (US MD seniors) matched into pathology residency.

Objective

To determine whether there were major changes in the number and percentage of osteopathic students and physicians (DOs) matching into pathology residency programs over the past decade.

Methods

Pathology match outcomes for DOs from 2011 to 2020 were obtained by reviewing AOA Match data from the National Matching Services and MRM data from the National Resident Matching Program (NRMP). The number of DOs that filled pathology positions in the MRM was divided by the total number of pathology positions filled in the MRM to calculate the percentage of pathology positions taken by DOs.

Results

Over the past decade, there was a 109% increase in the total number of DOs matching into pathology residency (34 in 2011 vs. 71 in 2020). During this time, there was a 23.3% increase in the total number of pathology positions filled in the MRM (476 in 2011 vs. 587 in 2020). Thus, the percentage of pathology residency positions filled by DOs increased from 7.1% in 2011 to 12.1% in 2020. The substantial increase of DOs in pathology occurred simultaneously with a 94.2% increase in the total number of DOs filling AOA/MRM “postgraduate year 1” (PGY-1) positions (3201 in 2011 vs. 6215 in 2020). Thus, the percentage of DOs choosing pathology residency has remained steady (1.06% in 2011 and 1.14% in 2020). In 2020, pathology had the third lowest percentage of filled PGY-1 residency positions taken by DOs, out of 15 major medical specialties.

Conclusion

The proportion of DOs choosing pathology residency was stable from 2011 to 2020 despite the move to a single GME accreditation system and the stark decline in US MD seniors choosing pathology. In 2020, a slightly higher percentage of DOs (1.14%) chose pathology residency than US MD seniors (1.13%). Overall, DOs more often choose other medical specialties, including primary care. Additional studies are needed to determine why fewer US MD seniors, but not fewer DOs, are choosing pathology residency.
SGLT2 inhibitors: a narrative review of efficacy and safety
Authors: Nelinson Donald S. , Sosa Jose M. , Chilton Robert J.
Published: February 2021

Type 2 diabetes mellitus (T2DM) is a cardio-renal-metabolic condition that is frequently associated with multiple comorbidities, including atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and chronic kidney disease (CKD). The sodium-glucose co-transporter-2 (SGLT2) inhibitors, which lower glycated hemoglobin, fasting and postprandial plasma glucose levels, body weight, and blood pressure, as well as reduce the risk of a range of cardiovascular and renal outcomes without increasing hypoglycaemic risk, have heralded a paradigm shift in the management of T2DM. These drugs are compatible with most other glucose-lowering agents and can be used in patients with a wide range of comorbid conditions, including ASCVD, HF, and CKD, and in those with estimated glomerular filtration rates as low as 30 mL/min/1.73 m2. However, there are misunderstandings surrounding the clinical implications of SGLT2 inhibitors’ mechanism of action and concerns about the key adverse events with which this class of drugs has been associated. This narrative review summarizes the data that support the efficacy of SGLT2 inhibitors in reducing the risks of cardiovascular and renal outcomes in patients with T2DM and comorbid conditions and clarifies information relating to SGLT2 inhibitor-related adverse events.
The history of medical education: a commentary on race
Authors: Daher Yasmeen , Austin Evan T. , Munter Bryce T. , Murphy Lauren , Gray Kendra
Published: February 2021

The institution of medicine was built on a foundation of racism and segregation, the consequences of which still permeate the experiences of Black physicians and patients. To predict the future direction of medical inclusivity, we must first understand the history of medicine as it pertains to race, diversity, and equity. In this Commentary, we review material from publicly available books, articles, and media outlets in a variety of areas, including undergraduate medical education and professional medical societies, where we found an abundance of policies and practices that created a foundation of systemic racism in medical training that carried through the career paths of Black physicians. The objective of this Commentary is to present the history of race in the medical education system and medical society membership, acknowledge the present state of both, and offer concrete solutions to increase diversity in our medical community.
Toward the use of medical scent detection dogs for COVID-19 screening
Authors: Dickey Tommy , Junqueira Heather
Published: February 2021

Current testing for the presence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus), which causes the novel coronavirus 2019 (COVID-19) infection, is typically reliant upon collection of nasal swab samples from subjects. These tests (reverse transcription polymerase chain reaction [RT-PCR] and antigen) are intrusive, can take significant time to process, and can give deleterious false negative and false positive results. Alternative methods for COVID-19 testing and screening are being studied, including the use of trained scent detection dogs to detect volatile organic compounds (VOCs) associated with the COVID virus. In August 2020 and October 2020, the first author (T.D.) searched MEDLINE/PubMed, Cochrane Library, Google Scholar, and additional news articles using keyword phrases including “COVID scent dogs,” “COVID sniffer dogs,” and “COVID detection dog,” returning a total of 13 articles, nine of which were duplicates. Four remaining peer-reviewed studies dedicated to determining the feasibility and efficacy of detecting and screening individuals who may be infected by the COVID-19 virus with scent detection dogs were then examined. In this narrative review, the authors describe the methodologies and results of the remaining four studies, which demonstrated that the sensitivity, specificity, and overall success rates reported by the summarized scent detection studies are comparable to or better than the standard RT-PCR and antigen testing procedures, meaning that scent detection dogs can likely be effectively employed to nonintrusively screen and identify individuals infected with the COVID-19 virus in hospitals, senior care facilities, schools, universities, airports, and even large public gatherings for sporting events and concerts.
Writing Esther: How do Writing, Power and Gender Intersect in the Megillah and its Literary Afterlife?
Authors: Wood Sorrel
Published: February 2021

There are two instances in the entire Hebrew Bible in which women feature as the to write. “One is Esther (Esther 9:29) and the other is:” כתב subject of the verb Jezebel (1 Kgs 21:8). This paper takes this fact as a starting point from which to illuminate the narrative and thematic junctures of writing, power and gender in Esther and its literary afterlife. It utilizes the hermeneutical framework of feminist literary theory, as well as drawing upon narratology and linguistic theory related to gender and power, and textual theory related to metatextuality and intertextuality, in order to explore the ways in which the narrator, the canonization process and the reception history of the text have functioned to constrain and restrain Esther’s authorial identity and status, and conversely the places and spaces where it has been developed and emphasised. Key areas of exploration include the writing culture of the Late Persian and Early Hellenistic periods, creative rewritings of Esther in the Targums and in Rabbinic Haggadah, and a consideration of the implications of the fact that Esther and Jezebel are the only explicitly identified female writers in the Hebrew Bible (Esther. (9:29, 1 Kings 21:8–9)).
The Twin Crises of Covid-19 and Racism: Pragmatic Mastery, Theory, Religion, and Ethics
Authors: Barber Michael D.
Published: February 2021

In 2020, two crises emerged into prominence in the United States and other parts of the world: (1) the flourishing of the COVID-19 virus, in which the polarization and relativization of knowledge have hobbled efforts to prevent pandemic spread, and (2) the killing of George Floyd which has stirred worldwide protests against centuries of racial oppression and unbared an underlying racist ideology about the seemingly lesser value of Black people. It might seem that both these crises are unrelated, but this article argues that both crises are rooted in a common phenomenon, the surge of the pursuit of everyday pragmatic mastery beyond its legitimate boundary. This pursuit of mastery has instrumentalized structures of discourse, thereby undermining Alfred Schutz’s paradigm of the well-informed citizen seeking to understand dispassionately imposed relevances and the non-pragmatic provinces of meaning that might have restrained the pursuit of such mastery, such as the provinces of theoretical science and religious experience. As regards racism, the pursuance of such mastery results in transgressing and eliminating through violence the ethical boundaries the Levinasian other prescribes. These twin crises are not disparate happenings occurring now to remedy the tedium of the pandemic, but are bound together at the hip.
The 20-m Multistage Fitness Test and 2.4-km Run: Applications to Law Enforcement Fitness Assessment
Authors: Lockie Robert G. , Dulla Joseph M. , Orr Robin M. , Dawes J. Jay
Published: February 2021

Aerobic fitness tests are common in testing protocols for law enforcement candidates, recruits, and officers because of the importance of aerobic fitness for academy survivability and job task performance. Two popular tests are the 2.4-km run and 20-m multistage fitness test (20MSFT). The differences, strengths, and limitations for both tests are discussed in this article, with a focus on the pacing required in each test. The 2.4-km run typically uses an internal pacing strategy, while the 20MSFT features an external pacing strategy because of the audible beeps that increase the running speed in the test. For the 2.4-km run, self-motivation is required to complete the event, whereas for the 20MSFT, the external pacing requirement is more typical of a police foot pursuit where the offender dictates the pace. This may have greater application to job tasks, where pacing is often determined by external sources (e.g., pursuing and apprehending an offender). In addition, for the 20MSFT, the limited space required and ability to test indoors may make it more applicable for testing law enforcement personnel. Where possible, staff should explore the use of the most appropriate aerobic fitness test for use in their personnel, be it the 20MSFT or the 2.4-km run.
A Case for Conscious Normativity: Or How Ethics Literacy Can Benefit Sociology Students and Their Teachers
Authors: Flores Rubén , Burg Ryan
Published: February 2021

We argue that sociology students and their teachers could benefit from cultivating literacy in normative ethics, as well as from developing a thoughtful approach to ethical values and principles, an intellectual virtue that we label “conscious normativity.” The benefits of ethics literacy and conscious normativity include a deeper appreciation for the centrality of normative evaluations in social life, a renewed connection with many of the intellectual and ethical traditions that underpin sociology and society, and an enhanced ability to navigate the discipline’s inescapable plurality and to develop an informed position on the doctrine of value neutrality. We outline some ways in which students and their teachers could enhance their ethics literacy, focusing on the many points of contact between sociological practice and ethical reflection. The article concludes by considering the meaning of our argument for sociology’s relationship to ethics, highlighting the cycles of critique that become accessible to consciously normative sociologists.