bluuebunny/crossref_metadata_2025 huggingface dataset:
Service models for providing sex education to individuals with intellectual disabilities in the United States
Authors: Curtiss Sarah L. , Stoffers Melissa
Published: March 2023

Individuals with intellectual and developmental disabilities face barriers to accessing sex education, including a lack of professional ownership over providing sex education. Limited information exists regarding educator training background, funding structure, and who they serve. We interviewed 58 sex educators of individuals with intellectual and developmental disabilities. We integrated thematic analysis and composite narratives to identify service models and the benefits and challenges associated with them. We identified seven service delivery models: clinic-based board-certified behavior analysis; mental health therapists; small businesses; public health not-for-profits; disability programs; high school-based educators; and university-based educators; and three themes that addressed the strengths and challenges of these service models: Instructional Implications of the Short-term, Drop-in Approach; Getting on the Same Page; and Questioning Who Should Teach Sex Education. Understanding these typologies and their strengths and challenges provide insights into how we can build capacity for sex education services.
The orthographic/phonological neighbourhood size effect and set size
Authors: Guitard Dominic , Miller Leonie M , Neath Ian , Roodenrys Steven
Published: March 2023

A growing number of studies have shown that on serial recall tests, words with more orthographic/phonological neighbours are better recalled than otherwise comparable words with fewer neighbours, the so-called neighbourhood size effect. Greeno et al. replicated this result when using a large stimulus pool but found a reverse neighbourhood size effect—better recall of words with fewer rather than more neighbours—when using a small stimulus pool. We report three registered experiments that further examine the role of set size in the neighbourhood size effect. Experiment 1 used the large pool from Greeno et al. and replicated their finding of a large-neighbourhood advantage. Experiment 2 used the small pool from Greeno et al. but found no difference in recall between the large and small neighbourhood conditions. Experiment 3 also used a small pool but the small pool was randomly generated for each subject from the large pool used in Experiment 1. This resulted in a typical large neighbourhood advantage. We suggest that set size is not critical to the direction of the neighbourhood size effect, with a large neighbourhood advantage appearing with both small and large pools.
A systematic review of therapeutic strategies in gastroenteropancreatic grade 3 neuroendocrine tumors
Authors: Donadio Mauro D. , Brito Ângelo B. , Riechelmann Rachel P.
Published: March 2023

Background:

Gastroenteropancreatic (GEP) neuroendocrine neoplasms with Ki-67 > 20% were subdivided in the most recent 2019 World Health Organization histopathological classification into grade 3 (G3) neuroendocrine tumors (NETs), described as well-differentiated tumors, and neuroendocrine carcinomas, which are described as poorly differentiated tumors. This classification met the demand noted for different prognoses between these subgroups, prompting the need for treatment recommendations for well-differentiated G3 tumors.

Methods:

We systematically searched medical literature databases and oncology conferences for studies on G3 GEP NET to describe epidemiology, diagnosis, molecular features, and treatments used. We excluded studies that did not discriminate G3 NET data. Data were tabulated and described, and a quality analysis of the reports was performed.

Results:

We found 23 published studies and six abstracts; 89.7% of studies were retrospective, six were composed exclusively of G3 NETs. Among 761 patients, the median number of patients per study was 15, most were male and older than 60 years, and functional imaging tests were positive in more than 80% of cases. Overall, the scientific evidence supporting the treatment of G3 GEP NETs is limited. For localized disease, resection remains the standard treatment but there is no evidence to support neoadjuvant or adjuvant therapy. For advanced disease, capecitabine and temozolomide seems to be the most effective option, with a response rate, median progression-free survival, and median overall survival up to 37.9%, 20.6 months, and 41.2 months, respectively.

Conclusion:

The latest available data on the epidemiology, diagnosis, molecular changes, and treatment of G3 GEP NET are described. Yet, the level of evidence for treatment recommendations is low, as most studies are retrospective. A treatment algorithm for G3 GEP NET is proposed.
The Palmer ice core as a candidate Global boundary Stratotype Section and Point for the Anthropocene series
Authors: Thomas Elizabeth R , Vladimirova Diana O , Tetzner Dieter R , Emanuelsson Daniel B , Humby Jack , Turner Simon D , Rose Neil L , Roberts Sarah L , Gaca Pawel , Cundy Andrew B
Published: March 2023

The remote Antarctic continent, distant from human industrial activity, should be one of the last places on Earth to capture Anthropogenic change. Hence, stratigraphic evidence of pollution and nuclear activity in the Antarctic provides proof of the global nature of the Anthropocene epoch. We propose an Antarctic Peninsula ice core candidate for the Global boundary Stratotype Section and Point (GSSP) to the onset of the Anthropocene. The Palmer ice core captures the first evidence of spheroidal carbonaceous fly ash particles (SCPs), resulting from high temperature combustion deposited in Antarctic ice. SCPs first appear in 1936 CE, preceding the rise in plutonium (239+240Pu) concentrations from 1945 CE onwards. GSSP 1952 CE occurs at a depth of 34.9 m, coincident with the peak in 239+240Pu the primary marker for this site.
Hedging Effectiveness and Influential Direction Between Spot and Futures Market of Aluminium: An Evidence from India
Authors: Samal Laxmidhar , Das Sudhansu Kumar
Published: March 2023

The article is an attempt to evaluate the price discovery functions and hedging effectiveness of the aluminum futures market in India. The article identifies the influential direction of price discovery and hedging effectiveness of the aluminum futures market of India. It has especially focused on the aluminum futures market of India for a period ranging from 2013 to 2020. Augmented Dicky-fuller test, PP test, Cointegration test, exogeneity Wald test, Wald co-efficient test, Granger causality test, variance decomposition and minimum variance hedge ratio are employed to achieve the objective of the study. The study finds a bi-directional causality effect between aluminum’s cash and the futures market. Therefore, the Spot and futures markets of aluminum influence each other in the price discovery. The findings of variance decomposition suggest that the futures market of aluminum implies weak exogenoity on spot. Similarly, futures prices reflect strong endogeneity. The hedge ratio of sub-sample and full sample period indicates that there is a lack of hedging effectiveness of aluminum futures. The study will help the hedgers to decide the number of futures positions they need to take to manage their spot exposure. It will help the futures market regulators to examine the stability of the market and other participants to design hedging and arbitrage strategies.
Development of a Cystic Fibrosis Primary Palliative Care Intervention: Qualitative Analysis of Patient and Family Caregiver Preferences
Authors: Basile Melissa J , Dhingra Lara , DiFiglia Stephanie , Polo Jennifer , Portenoy Russell , Wang Janice , Walker Patricia , Middour-Oxler Brandi , Linnemann Rachel W , Kier Catherine , Friedman Deborah , Berdella Maria , Abdullah Robert , Yonker Lael M , Markovitz Martha , Hadjiliadis Denis , Shiffman Melissa , Fischer Francine , Pollinger Sophie , Hardcastle Margot , Chaudhary Nivedita , Georgiopoulos Anna M
Published: March 2023

To prevent or mitigate chronic illness burden, people with cystic fibrosis (pwCF) and their family caregivers need primary (generalist-level) palliative care from the time of diagnosis forward. We used qualitative methods to explore their preferences about a screening-and-triage model (“ Improving Life with CF”) developed to standardize this care. We purposively sampled and interviewed 14 pwCF and caregivers from 5 Improving Life with CF study sites. Thematic analysis was guided by a priori codes using the National Consensus Project's Guidelines for Quality Palliative Care. Participants included 7 adults and 2 adolescents with CF (3 with advanced disease), 4 parents, 1 partner (7 women; 5 people of color). Few were familiar with palliative care. Illness burden was described in multiple domains, including physical (e.g., dyspnea, pain), psychological (e.g., anxiety), and social (e.g., family well-being; impact on work/school). Most preferred survey-based screening with care coordination by the CF team. Preferences for screening approaches varied. PwCF and caregivers experience illness burden and are receptive to a CF-team delivered primary palliative care screening-and-triage model with flexible processes.
Rheumatology Image of the Month: A Low Resource Innovation With Measurable Results
Authors: Semaka Amy , Katz Steven J
Published: March 2023

OBJECTIVES

Strategies to increase confidence in rheumatology knowledge are valuable for medical trainees and residents. A web-based teaching innovation was implemented in an attempt to increase rheumatology exposure for internal medicine residents.

METHODS

An Image of the Month webpage was established, where a practicing rheumatologist would post a new image that could be answered online by internal medicine residents. Cumulative data was analyzed to determine the extent and change in rheumatology exposure.

RESULTS

The Image of the Month webpage posted images for a total of 76 months between July 2010 to May 2017, with a total of 1326 submitted responses. The proportion of residents who only participated in Image of the Month and only did a rheumatology rotation averaged 36.1% and 16.5%, respectively. The proportion of residents who only participated in Image of the Month was higher than the proportion who only did a rheumatology rotation for all of the 7 time periods assessed. A total of 491 residents participated in Image of the Month, with an average of 54.9% of residents participating each year. Overall, on average, 52 residents had 1 or more submissions, 3.6 entries were submitted per resident, and 17.4 entries were submitted per month. Junior residents (PGY1) participated more often than senior residents (PGY3).

CONCLUSIONS

The Image of the Month webpage successfully improves internal medicine resident exposure to rheumatology with minimal resources and manpower required. Further study is necessary to determine the impact this exposure may have on the abilities and confidence levels of internal medicine residents.
Nanofluid containing motile gyrotactic microorganisms squeezed between parallel disks
Authors: Kumar Jada Prathap , Umavathi Jawali Channabasappa , Dhone Appasaheb Sharanappa
Published: March 2023

Advanced nano and microtechnologies for nano/micro-electronic devices have made substantial advances in the past few years. These technologies are rapidly incorporating advanced fluid media such as nanofluids and biological microorganisms. Inspired by bio-nanofluid applications in medicine, biological systems and biotechnology in the present study, mathematical model is evolved for unsteady bio convective conducting nanofluid along with gyrotactic micro-organisms squeezed between parallel disks. The lower disk and upper disks are solids. The temperature field is improved by the methods of haphazard motion of nanoparticles and thermophoresis parameters. The nano-bio transfer model is written as a series of non-linear partial differential equations that are reduced into a set of ordinary differential equations using suitable transforms. The dimensionless problem is then numerically solved by RK-4th order scheme utilizing MATLAB bvp4c solver’s package to investigate the impact of the squeezing parameter, Hartman number, Brownian motion and thermophoresis parameter on motile microorganism velocity, temperature, nanoparticle concentration, and density. The friction factor, Nusselt number, Sherwood number and microorganism number distributions on Hartman number, thermophoresis and Brownian motion factors are also computed. The Brownian motion and the thermophoresis factors of nanoparticles cause an increment in temperature profiles for both suction and injection. The concentration and motile microorganism are both amplified for the Brownian parameter in the case of injection, whereas they are declined for suction and the opposite trend is observed for the thermophoresis parameter. The motile microorganism is deflated for both suction and injection with thermophoresis parameter. Suction and injection adversely affect the transfer properties at the disks. The resistive magnetic body force prevails in the core zone, resulting in a decrease in velocity. The heat generation in squeeze films with motile microorganisms can be successfully removed with magnetic nanoparticles which require a longer serviceability of the lubrication system, bio-medical systems and need for less maintenance and a longer lifespan approach. The finding is pertinent to novel bio-microsystems that combine nanofluid and the bioconvection phenomenon. The percentage increase in heat, mass, and microorganism transport rates is calculated.
The social sciences as future forming
Authors: Gergen Kenneth J.
Published: March 2023

The conception and practices of the social sciences are largely the product of a century past. We must now ask the question of whether these traditions adequately equip the sciences for dealing with the daunting global problems of today. Placed in particular question is the traditional focus of research on contemporaneous patterns, events, and conditions. In a world of rapid, globally rippling, and unpredictable change, the significance of such research is debatable. Given the perilous conditions of the world, a shift in the practices of social science is proposed, one that places in the vanguard of our pursuit, the active building of viable futures. Such a shift would favor practices of action research, generative theorizing, creating new forms of cultural life, and process-based education.
Long-term survival with sickle cell disease: a nationwide cohort study of Medicare and Medicaid beneficiaries
Authors: Jiao Boshen , Johnson Kate M. , Ramsey Scott D. , Bender M. A. , Devine Beth , Basu Anirban
Published: March 2023

To our knowledge, we report the first population-based period life table, the expected lifetime survival for Medicare and Medicaid beneficiaries with sickle cell disease (SCD), and the disparities in survival by insurance types in the United States. We constructed a retrospective cohort of individuals with diagnosed SCD receiving common care (any real-world patterns of care except transplant) based on nationwide Medicare and Medicaid claim data (2008-2016), covering beneficiaries in all 50 states. We analyzed lifetime survival probabilities using Kaplan-Meier curves and projected life expectancies at various ages for all, stratified by sex and insurance types. Our analysis included 94 616 individuals with SCD that have not undergone any transplant. Life expectancy at birth was 52.6 years (95% confidence interval: 51.9-53.4). Compared with the adults covered by Medicaid only, those covered by Medicare for disabilities or end-stage renal disease and those dually insured by Medicare and Medicaid had significantly worse life expectancy. Similarly, for beneficiaries aged ≥65 years, these 2 insurance types were associated with significantly shorter life expectancy than those enrolled in Medicare old age and survivor’s insurance. Our study underscores the persistent life expectancy shortfall for patients with SCD, the burden of premature mortality during adulthood, and survival disparities by insurance status.
Reference equations for breathlessness during incremental cycle exercise testing
Authors: Elmberg Viktor , Schiöler Linus , Lindow Thomas , Hedman Kristofer , Malinovschi Andrei , Lewthwaite Hayley , Jensen Dennis , Brudin Lars , Ekström Magnus
Published: March 2023

Background

Exertional breathlessness is commonly assessed using incremental exercise testing (IET), but reference equations for breathlessness responses are lacking. We aimed to develop reference equations for breathlessness intensity during IET.

Methods

A retrospective, consecutive cohort study of adults undergoing IET was carried out in Sweden. Exclusion criteria included cardiac or respiratory disease, death or any of the aforementioned diagnoses within 1 year of the IET, morbid obesity, abnormally low exercise capacity, submaximal exertion or an abnormal exercise test. Probabilities for breathlessness intensity ratings (Borg CR10) during IET in relation to power output (%predWmax), age, sex, height and body mass were analysed using marginal ordinal logistic regression. Reference equations for males and females were derived to predict the upper limit of normal (ULN) and the probability of different Borg CR10 intensity ratings.

Results

2581 participants (43% female) aged 18–90 years were included. Mean breathlessness intensity was similar between sexes at peak exertion (6.7±1.5versus6.4±1.5 Borg CR10 units) and throughout exercise in relation to %predWmax. Final reference equations included age, height and %predWmaxfor males, whereas height was not included for females. The models showed a close fit to observed breathlessness intensity ratings across %predWmaxvalues. Models using absolute W did not show superior fit. Scripts are provided for calculating the probability for different breathlessness intensity ratings and the ULN by %predWmaxthroughout IET.

Conclusion

We present the first reference equations for interpreting breathlessness intensity during incremental cycle exercise testing in males and females aged 18–90 years.
Sonographic follow-up of diaphragm function in COVID-19: an exploratory study
Authors: Veldman Carlijn , de Boer Wytze S. , Kerstjens Huib A.M. , Edens Mireille A. , van den Berg Jan Willem K.
Published: March 2023

Introduction

Survivors of COVID-19 frequently endure chronic disabilities. We hypothesise that diaphragm function has a long recovery time after COVID-19 hospitalisation and may play a role in post-COVID-19 syndrome. The aim of this study was to assess diaphragm function during COVID-19 hospitalisation and during recovery.

Methods

We conducted a prospective single-centre cohort study in 49 enrolled patients, of which 28 completed 1-year follow-up. Participants were evaluated for diaphragm function. Diaphragm function was assessed using ultrasound measuring of diaphragm thickening fraction (TF) within 24 h after admission, after 7 days of admission or at discharge, whichever came first, and 3 and 12 months after hospital admission.

Results

Estimated mean TF increased from 0.56 (95% CI 0.46–0.66) on admission to 0.78 (95% CI 0.65–0.89) at discharge or 7 days after admission, to 1.05 (95% CI 0.83–1.26) 3 months after admission and to 1.54 (95% CI 1.31–1.76) 12 months after admission. The improvements from admission to discharge, 3 months and 12 months were all significant (linear mixed modelling; p=0.020, p<0.001 and p<0.001, respectively), and the improvement from discharge to 3-month follow-up was borderline significant (p<0.1).

Conclusion

Diaphragm function was impaired during hospitalisation for COVID-19. During recovery in hospital and up to 1-year follow-up, diaphragm TF improved, suggesting a long recovery time of the diaphragm. Diaphragm ultrasound may be a valuable modality in the screening and follow-up of (post-)COVID-19 patients for diaphragm dysfunction.
Patient perspectives on noninvasive prenatal testing among black women in the United States: a scoping review
Authors: Thomas Shameka P. , Keller Madison A. , Ranson Tiara , Willard Rachele E.
Published: March 2023

Advances in reproductive health technologies such as noninvasive prenatal testing (NIPT) are changing the landscape of prenatal care and maternal health. NIPT, made clinically available in the United States (US) in 2011, is a screening test that utilizes cell-free DNA (cfDNA) to detect for aneuploidies and genetic characteristics in fetal DNA. In September 2020, the American College of Obstetricians and Gynecologists (ACOG) recommended NIPT for all pregnant patients regardless of age or risk factors. We examined peer-reviewed, empirical studies published from January 2011 to February 2022, assessing NIPT studies with patient perspectives in the US and what is known about how empirical studies include Black women. Our scoping review draws from PubMed (with advanced MeSH search options) and Scopus databases for advanced scoping review, with 33 articles meeting our criteria. Empirical studies on NIPT show patient perceptions range across five themes: 1) accuracy / safety, 2) return of results, 3) patient knowledge, 4) informed consent, and 5) perceptions among minoritized groups (with perceptions of race and gender as a social demographic intersection). Additionally, among the 15 studies that included that Black woman in their study sample, none measured the perceptions of Black women with genetic conditions. Bridging this knowledge gap is critical because NIPT is becoming increasingly accessible across the nation and is being developed to screen for additional genetic conditions, such as sickle cell disease. Ultimately, NIPT researchers need to go to greater lengths to examine the patient perspectives of Black women with and without genetic conditions.
Paternal preconception modifiable risk factors for adverse pregnancy and offspring outcomes: a review of contemporary evidence from observational studies
Authors: Carter Tristan , Schoenaker Danielle , Adams Jon , Steel Amie
Published: March 2023

Background

The preconception period represents transgenerational opportunities to optimize modifiable risk factors associated with both short and long-term adverse health outcomes for women, men, and children. As such, preconception care is recommended to couples during this time to enable them to optimise their health in preparation for pregnancy. Historically, preconception research predominately focuses on maternal modifiable risks and health behaviours associated with pregnancy and offspring outcomes; limited attention has been given to inform paternal preconception health risks and outcomes. This systematic review aims to advance paternal preconception research by synthesising the current evidence on modifiable paternal preconception health behaviours and risk factors to identify associations with pregnancy and/or offspring outcomes.

Methods

Medline, Embase, Maternity and Infant care, CINAHL, PsycINFO, Scopus, and ISI Proceedings were searched on the 5th of January 2023, a date limit was set [2012–2023] in each database. A Google Scholar search was also conducted identifying all other relevant papers. Studies were included if they were observational, reporting associations of modifiable risk factors in the preconception period among males (e.g., identified as reproductive partners of pregnant women and/or fathers of offspring for which outcomes were reported) with adverse pregnancy and offspring outcomes. Study quality was assessed using the Newcastle–Ottawa Scale. Exposure and outcome heterogeneity precluded meta-analysis, and results were summarised in tables.

Results

This review identified 56 cohort and nine case control studies. Studies reported on a range of risk factors and/or health behaviours including paternal body composition (n = 25), alcohol intake (n = 6), cannabis use (n = 5), physical activity (n = 2), smoking (n = 20), stress (n = 3) and nutrition (n = 13). Outcomes included fecundability, IVF/ISCI live birth, offspring weight, body composition/BMI, asthma, lung function, leukemia, preterm birth, and behavioural issues. Despite the limited number of studies and substantial heterogeneity in reporting, results of studies assessed as good quality showed that paternal smoking may increase the risk of birth defects and higher paternal BMI was associated with higher offspring birthweight.

Conclusion

The current evidence demonstrates a role of paternal preconception health in influencing outcomes related to pregnancy success and offspring health. The evidence is however limited and heterogenous, and further high-quality research is needed to inform clinical preconception care guidelines to support men and couples to prepare for a health pregnancy and child.
Determination of penetration and protection of fatty acids in bleached hair according to the fatty acid chain length and the application to understanding the protective effects of MCT oil and coconut oil
Authors: Kim Suhwan , Ahn Cheunsoon
Published: March 2023

Hair treatments containing vegetable oils protect the damaged hair by surface coating and by penetrating in hair thereby filling the gaps caused by oxidative damage. Vegetable oil is composed mostly of medium-chain or long-chain fatty acids which exist as triglycerides. Although there are literatures which deal with the penetration of specific natural oils into hair there is a lack of research which provide the empirical data that can be used to explain the penetration of larger population of vegetable oils. This research was aimed to examine whether the chain length of fatty acid affect the penetration of fatty acid and protection in hair and also to apply the results on explaining the protective effect of Medium-Chain Triglyceride oil (MCT oil) and Coconut oil. Nine different hair treatments were formulated with three medium-chain fatty acids (C8:0, C10:0, C12:0), three long-chain fatty acids (C14:0, C16:0, C18:0), MCT oil, Coconut oil, and a blank. Composition of fatty acids of hair was examined by the Gas chromatography mass spectrometry. Penetration of fatty acid in hair was examined by the UV–VIS spectrophotometry. Protection of damaged hair was examined by the differences in color, tensile strength, thickness, and the concentration of protein leak of 21-day vs. 0-day measurements. Results of t-test indicated that the penetration and the protection of the medium-chain fatty acid was significantly better than those of the long-chain fatty acid, and that MCT oil and coconut oil were not significantly different.
Perceived COVID-19 pandemic impact and protective factors predicting patient-reported depression and anxiety in individuals living with cancer
Authors: Fortune Erica E. , Zaleta Alexandra K. , Morris Victoria G.
Published: March 2023

Background

The COVID-19 pandemic presents a unique, amplified threat to those living with a cancer diagnosis, but personal factors may play a role in how this affects well-being. This cross-sectional study (1) describes the impacts of COVID-19 on cancer patients’ lives, and (2) explores the extent to which specific impacts of COVID-19 and noted protective factors, hope and resilience, predict two crucial patient-reported outcomes, depression and anxiety, after controlling for relevant sociodemographic and clinical factors.

Methods

520 cancer patients and survivors in the U.S. completed an online survey during the first year of the pandemic and answered questions about COVID-19 areas of impact, psychological well-being, hope, and resilience. Hierarchical regression analyses were used to analyze the unique impact of each group of variables on patient-reported levels of depression and anxiety during the pandemic.

Results

Participants strongly endorsed COVID-19 impact across several areas of life, especially social activity, well-being, and ability to acquire basic essentials. Regression models explained a substantial amount of variance in patient-reported depression (R2 = .50, p < .001) and anxiety (R2 = .44, p < .001), revealing COVID-19 financial impact as a significant predictor of depression (β = 0.07), and COVID-19 family impact as a significant predictor of anxiety (β = 0.14), even after controlling for the effects of relevant sociodemographic and clinical variables. Additionally, resilience and hope were the largest predictors of both depression (β = − 0.19 and − 0.37, respectively) and anxiety (β = − 0.18 and − 0.29), suggesting that they account for unique variance in patient-reported mental health during the COVID-19 pandemic and might serve as important protective factors.

Conclusions

The current results add to existing literature documenting the significant effect of COVID-19 on those living with cancer. COVID-19 impact, including financial and family well-being, as well as positive psychological constructs, hope and resilience, play a crucial role in levels of patient-reported depression and anxiety during the pandemic. As COVID-19 continues to evolve, health care providers should routinely assess psychological well-being and needs related to COVID-19 financial and family impact in an effort to appropriately align individuals with resources and support, and consider how hope and resilience can be fostered to serve as psychological buffers during this time.
Utilization of Wearable Pedometer Devices in the Perioperative Period: A Qualitative Systematic Review
Authors: Jin Zhaosheng , Lee Christopher , Zhang Kalissa , Jeong Rosen , Gan Tong J. , Richman Deborah C.
Published: March 2023

Functional capacity assessment is important for perioperative risk stratification; however, there are currently limited options for objective and economical functional capacity evaluation. Pedometer functions are now widely available in mobile devices and offer a nonintrusive and objective approach to measuring patient activity level over time. Therefore, we conducted this systematic review to assess the value of pedometer readings in predicting perioperative outcomes. We systematically searched PubMed, EMBASE (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science Citation Index for studies, which assessed the correlation between perioperative (30 days before to 30 days after surgery) pedometer data and perioperative outcomes. We identified a total of 18 studies for inclusion. Seven of the studies recorded preoperative pedometer data, and 13 studies recorded postoperative pedometer data. Notably, 10 of the studies covered oncologic surgery patients. The included studies consistently reported that preoperative pedometer readings correlated with postoperative complication rates. In addition, in-hospital postoperative pedometer readings correlated with postdischarge complications and readmissions. Perioperative pedometer data demonstrated consistent and biologically plausible association with perioperative outcomes. Further studies are needed to validate the use of pedometer in the perioperative period and to identify the optimal approach for its use to potentially improve patient outcomes.
Fantasies of Valentina
Authors: Gonsalez Marcos
Published: March 2023

This article analyzes a RuPaul's Drag Race contestant, Valentina, and the ways her trans/queer of color and Latinx performance strategies obfuscate neoliberal, colonial-capitalist logics. Drawing on trans of color theory, television studies, and Latinx studies, this article argues that Valentina's queer nonbinary racialized televisual persona—which includes, for instance, her iconic lip-synch, mask-wearing faux pas, or campy telenovela moments—enacts aesthetic and performative tactics that defy demands for capitalist productivity, minoritized respectability and professionalism, and racial uplift. The article examines how a trans/queer Mexican American drag queen like Valentina, herself a televisual spectacle, defies discourses structured around debating good versus bad representation, a binary that hamstrings much of the scholarship on Latinx people on television by remixing Latinx stereotypes such as the Latina spitfire with trans/queer possibilities. This torquing of stereotypes centers trans/queer racialized Latinx joy, pleasure, and humor, activating worlds hospitable to trans/queer of color living and thriving.
115 State-to-State Variation in Medicaid and Medicare Reimbursement: Implications for Healthcare Access Among Vulnerable Populations
Authors: Rallo Michael Stephen , Berke Chandler , Menger Richard P.
Published: March 2023

INTRODUCTION:

Medicaid and Medicare are social insurance programs providing coverage for specific populations, namely low-income and aged individuals. While Medicare is a federally indexed health insurance program, Medicaid is largely administered by individual states resulting in varying policies and practices.

METHODS:

Maximum allowed physician reimbursement fees for twenty common neurosurgical codes were obtained from the 2022 Medicare Physician Fee Schedule and individual state Medicaid Fee-for-Service Schedules. The Medicaid-Medicare Index (MMI), which measures Medicaid reimbursement as a fraction of Medicare allowed amounts, was calculated for each procedure across 49 states and the District of Columbia. MMI <1 or >1 indicates that Medicaid reimburses less than or greater than Medicare, respectively. The proportion of providers accepting new Medicaid patients and total Medicaid enrollment were compared across states as a function of MMI.

RESULTS:

Maximum allowed amounts for Medicare reimbursement (CV = 0.09) were less variable than Medicaid (CV = 0.26, p < 0.01). The average national MMI was 0.79 with a range of 0.37 in NY/NJ to 1.43 in NE. The largest absolute disparity was observed for intracranial aneurysm clipping in NY, where the maximum Medicaid reimbursement is $3,496.52 less than that of Medicare. Higher MMI was associated with a significantly larger proportion of providers accepting new Medicaid patients (R2 = 0.43, p < 0.01). Moreover, MMI varied inversely with the number of Medicaid beneficiaries (R2 = 0.12, p = 0.01).

CONCLUSIONS:

Medicaid reimbursement varies drastically between states reflecting the disparate methods of fee calculation. Lower reimbursement is associated with more limited provider enrollment, especially in states with a greater number of beneficiaries. While more limited access to Medicaid-accepting neurosurgeons may contribute to poorer outcomes, this is an issue that warrants further exploration.
128 NMDA-Receptor Antagonism for the Prevention of Neurological Dysfunction in Traumatic Brain Injury: Results of a Randomized Pre-Clinical Trial
Authors: Maclean Mark , Muradov Jamil , Greene Ryan , Friedman Alon
Published: March 2023

INTRODUCTION:

Cortical spreading depolarization (CSD) represents a pathomechanistic target for neuroprotective therapy given the association with lesion development and poor outcomes following traumatic brain injury (TBI).

METHODS:

Experiments were conducted using 9-week-old Sprague Dawley rats. Daily neurobehavioral scores were recorded by trained, blinded observers. Using an established weight-drop model, animals received either single moderate (modTBI; n = 23) or four daily mild (rmTBI; n = 30) head impacts. Sham animals received brief anesthetic without TBI (n = 40). Animals underwent cranial window surgery and CSDs were electrically triggered by cortical stimulation; electrophysiological, imaging and blood-flow were monitored using intravital microscopy. Ketamine (100uM topical and 25 mg/kg IP, respectively) and memantine (10 mg/kg IP) were tested in vivo. Subsequently, a RCT was conducted (N=31) using memantine (10 mg/kg) or saline (2.5 cc/kg). Primary outcome: proportion of animals resilient to rmTBI (neurobehavioral scores ≥ 6 out of 12).

RESULTS:

In modTBI, and rmTBI animal models, intraperitoneal ketamine and memantine reduced the proportion of electrically triggered CSDs by 79-88%, and 42-73%, respectively. The average relative amplitude of change in ECoG were reduced by 70-75%, and 51-60%, respectively. Memantine significantly reduced spreading depression and cortical hypoperfusion following CSD. RCT animals in the memantine group were more likely resilient to injury (93% vs. 56%; p = 0.023) and had higher mean neurological scores (9.27 (SD 3.08) vs. 5.56 (SD 3.05)), p < 0.001) compared to saline.

CONCLUSIONS:

The NMDA-receptor antagonist memantine supresses CSDs and reduces pathological cerebral hypoperfusion in vivo following CSDs. In a rmTBI RCT, memantine prevented neurological decline.
141 Polyvinylpyrrolidone-Coated Catheters Show Fewer Astrocytes and Choroid Plexus Epithelium Adhesion and Better Flow/Pressure Performance Than Other Commercial Catheters in a New Catheter Assay System
Authors: Chan Alvin , Ruiz Leandro , Lee Seunghyun , Shah Vaibhavi , Muhonen Michael
Published: March 2023

INTRODUCTION:

The major cause of failure of cerebral spinal fluid (CSF) shunting devices in pediatric patients is proximal catheter occlusion. There are a number of shunt catheters commercially available, but their occlusion properties are unclear.

METHODS:

There were four catheters tested: 1) antibiotic-impregnated, 2) polyvinylpyrrolidone, 3) barium stripe, and 4) barium impregnated. Catheters were inoculated with cultured astrocytes or choroid cells and incubated in growth media for 7 days prior to testing. Sample catheters were placed into a 3D-printed ventricular replicating system to test occlusion properties. Artificial CSF was pumped through the system to mimic physiologic flow and pressure resistance sensors measured obstruction. Afterward testing, catheters were stained with anti-GFAP or anti-transthyretin to visualize cellular adhesion using a fluorescence microscope.

RESULTS:

Five catheters of each type were used. Polyvinylpyrrolidone catheters had the highest flow (e.g., least obstruction) in the ventricular replication system (0.12 mL/min) compared to the antibiotic coated (0.10 mL/min), barium stripe (0.02 mL/min) or barium impregnated (0.08 mL/min; p < 0.01). Polyvinylpyrrolidone catheters showed the lowest median cell attachment after cell marker staining (<1 cells per 0.07 mm2) compared to antibiotic coated (4.0 cells per 0.07 mm2), barium stripe (3.5 per 0.07 mm2) or barium impregnated (2.0 per 0.07 mm2).

CONCLUSIONS:

Polyvinylpyrrolidone catheters were least likely to be occluded by astrocytes or choroid cells during testing in a novel ventricular replicating system due to lower cellular adhesion. Our findings may have clinical significance when choosing proximal ventricular catheters that are least likely to occlude and prevent proximal shunt failure.
143 Elucidating the Function of the Wnt Signaling Pathway in Hydrocephalus
Authors: Bramall Alexa Natalie , Anton Eva , Lee Amelia , Fecci Peter Edward , Lascola Christopher , Venkatraman Talaignair
Published: March 2023

INTRODUCTION:

Although acquired hydrocephalus is commonly encountered by neurosurgeons, our understanding of the mechanisms underlying its pathogenesis remain poor. Furthermore, normal CSF physiology is dependent on the proper function of ventricular ependymal cells and choroid plexus epithelium (CPE), although few neurosurgical studies have addressed the functions of these cells.

METHODS:

Alteration of the Wnt pathway is achieved by generating FoxJ1-Cre;Apclox/lox and FoxJ1-Cre;Ctnnb1lox/lox mice, which express Cre upon induction with tamoxifen, as well as via intraventricular delivery of an AAV1-eGFP-Cre in Apclox/lox and Ctnnb1lox/lox mice. T2 weighted MRI with 3D volumetrics is applied to assess ventricular anatomy, in addition to standard molecular biology techniques to examine downstream signaling mechanisms. Kaolin and whole blood injection are used as models of obstructive and communicating hydrocephalus, respectively.

RESULTS:

B-catenin is strongly expressed in adult mouse ependyma and CPE, suggesting that the canonical Wnt pathway continues to be active after these cells have developed. Moreover, up-regulation of this pathway in adult FoxJ1-Cre;Apclox/lox mice results in significant ventricular enlargement (n = 3; p = 0.03). Both FoxJ1-Cre transgenic mice and intraventricular AAV1-eGFP-Cre drive selective expression within ependyma and CPE, suggesting that these may be useful models for investigating important molecular pathways within these cells.

CONCLUSIONS:

Our data suggests that the canonical Wnt signaling pathway plays a role in the maintenance of normal adult CSF dynamics. Moreover, we show selective targeting of ependyma and CPE using an adeno-associated virus, which may represent a novel strategy for modifying genes and/or proteins involved in CSF regulation.
148 Peroneal Nerve Repair With Crossbridge Ladder Technique: Parallel End-to-Side Neurorrhaphies
Authors: Ammanuel Simon , Kim Jason Jungmin , Burkett Daniel , Bond Evalina , Hanna Amgad S.
Published: March 2023

INTRODUCTION:

Multiple nerve transfer techniques are used to treat patients with nerve injuries when a primary repair is not possible. These techniques are categorized to end-to-end, end-to-side, and side-to-side neurorrhaphy.

METHODS:

Four patients with significant loss of ankle dorsiflexion were seen in the clinic and underwent evaluation, including electrodiagnostic studies. A cross-bridge ladder repair technique was used between the tibial nerve as the donor and the common peroneal nerve as the recipient via one or two nerve grafts coapted in parallel with end-to-side neurorrhaphies. Dorsiflexion strength was measured preoperatively using the Medical Research Council (MRC) grading system and at each postoperative follow-up appointment.

RESULTS:

All four patients had suffered persistent and severe foot drop (MRC of 0) following trauma that had occurred between 6 and 15 months preoperatively. Three of the four patients improved to an MRC of 2 several months postoperatively. The last patient had an immediate improvement to an MRC of 2 by his first month and had a complete recovery of ankle dorsiflexion within four months from surgery.

CONCLUSIONS:

We demonstrate the utility and clinical outcomes of the cross-bridge ladder technique in patients with persistent and prolonged food drop following trauma. Both early and late recovery were seen while all patients regained motor function, with some patients continuing to improve up to the most recent follow-up.
155 Cost-Effectiveness Analysis of Deep Brain Stimulation Versus Treatment as Usual for Treatment-Resistant Obsessive-Compulsive Disorder
Authors: Najera Ricardo Andres , Shofty Ben , Anand Adrish , Gadot Ron , Storch Eric , Goodman Wayne , Sheth Sameer A.
Published: March 2023

INTRODUCTION:

Deep brain stimulation (DBS) is an effective neurosurgical option for patients with treatment-resistant obsessive-compulsive disorder (TROCD). Despite being more costly than neuroablative procedures of comparable efficacy, DBS has gained popularity for its reversibility. Though its cost-effectiveness has been investigated in movement disorders, few economic analyses of DBS for psychiatric disorders exist.

METHODS:

We developed decision analytic models to compare the cost-effectiveness of DBS to treatment as usual (TAU) for TROCD, varying device type (non-rechargeable or rechargeable) or time-horizon (three or five years). Effectiveness data were based on literature review. Published algorithms were used to convert Y-BOCS scores into utilities. Costs were approached from the healthcare sector perspective and drawn from Medicare reimbursement rates. Monte Carlo (MC) simulations and probabilistic sensitivity analyses were performed to estimate the incremental cost-effectiveness ratio (ICER) in USD ($) per quality-adjusted life-year (QALY).

RESULTS:

We included 238 and 265 TROCD patients across 28 studies who underwent DBS and had sufficient follow-up in our 3- and 5-year models, respectively. Non-rechargeable DBS was less cost-effective than TAU (3-year ICER = $153,221/QALY; 5-year ICER = $194,043/QALY). Rechargeable DBS was moderately more cost-effective at three years (ICER = $70,646/QALY) and definitively more cost-effective at five years (ICER = $37,652/QALY) compared to TAU. At three and five years, net QALYs gained were greater in DBS than TAU by 0.36 and 0.59, respectively. At willingness-to-pay thresholds of $50,000/QALY for definitive cost-effectiveness and $100,000/QALY for moderate cost-effectiveness, rechargeable DBS was moderately more cost-effective than TAU at 3 years in 100% and more cost-effective at 5 years in 96% of iterations.

CONCLUSIONS:

Compared to TAU, in the U.S., rechargeable DBS for TROCD is more cost-effective under a range of possible cost and effectiveness values. However, non-rechargeable DBS is not more cost-effective than TAU for TROCD due to high costs of battery replacement.
167 STA-MCA Bypass for Symptomatic Moyamoya Disease—Lessons Learnt From 89 Revascularisations
Authors: Raheja Amol , Sreenivasan Sanjeev Ariyandath , Suri Ashish , Singh Manmohan , Mishra Shashwat , Tandon Vivek , Phuyal Subash , Devarajan Leve J. , Kalaivani Mani , Chandra Sarat P. , Kale Shashank S.
Published: March 2023

INTRODUCTION:

Efficacy of surgical revascularisation procedures over conservative management in moyamoya disease (MMD) has been established in the past. However there is dearth of literature on comprehensive evaluation of impact of age and Suzuki staging on clinical and angiographic outcome in symptomatic MMD patients undergoing direct revascularisation (DR) via superficial temporal artery – middle cerebral artery (STA-MCA) bypass.

METHODS:

We analysed consecutive MMD patients who underwent direct-revascularisation (DR) via STA-MCA bypass. Primary outcome measures were mRS scale and stroke risk reduction. Secondary outcome measure was angiographic outcome score (AOS).

RESULTS:

70 patients (89 DR procedures), including 37.9% adults (>18 yr), were operated over a duration of 8 years and followed up for 2 years (mean). Long-term bypass-patency rates were deemed 83.3% and 88.8% in children and adults respectively. In pediatric age group, median mRS scores improved from 3 to 2 (p = 0.001), 97.3% were free of recurrent strokes and AOS scores improved significantly (p = 0.002). Amongst adult MMD patients, median mRS score marginally improved from 3 to 2 (p = 0.25), 100% were free of recurrent strokes and AOS improved significantly (p=0.02). On comparing pediatric and adult patients, improvement in mRS scores (p = 0.14) and AOS scores (p = 0.65) were similar across the two age groups. Overall late stage MMD patients (Suzuki stages IV-VI) showed better improvement in mRS scores when compared with early stage MMD patients (Suzuki stages I-III; p = 0.04). Recurrent stroke rates were similar in both groups (p = 0.26). AOS scores improved significantly in both early and late stage MMD (p < 0.001 in both), though the improvement amongst the two groups was similar (p = 0.88).

CONCLUSIONS:

Using meticulous surgical technique, excellent long-term bypass patency rates can be achieved to facilitate optimal clinical and angiographic outcome in symptomatic MMD patients, irrespective of the age group and stage of disease.