bluuebunny/crossref_metadata_2025 huggingface dataset:
Mother care for procedural pain in infants
Authors: Campbell-Yeo Marsha , Benoit Britney , Richardson Brianna , Johnston Celeste
Published: June 2021

A major role of mothers is to protect their infant from harm, including pain. The aim of this chapter is to review the evidence on the effectiveness of maternal strategies that are efficacious in managing procedural pain. These strategies are naturally occurring and have been used for millenia by mothers, but only recently have been systematically studied. Breastfeeding, holding the baby on the bare chest, known as kangaroo mother care, are such strategies. Whilst providing care in this close manner, other components of the mother’s presence may play a role, such as her voice and her odor. Facsimiles of maternal presence such as a recording of mother’s voice and materials containing her odour have been examined as potential strategies to relieve pain in the infant. The question of the potency of pain relieving strategies provided by caregivers, other than the mother, has been addressed to some extent and will be included in this chapter. The mechanisms underlying the pain relieving effects of maternal care, as they are currently understood, will be presented. Finally, pragmatic issues in implementing maternal strategies for decreasing pain will be discussed
Complementary drugs
Authors: Weydert Joy A.
Published: June 2021

Research into the use of botanical agents, nutritional supplements, and diet to manage pain has increased owing to the interest and demand of patients and physicians. Pharmacological agents are typically used as first-line therapy for pain and symptom management; however, for some patients these agents may not work well in the long term or have side effects that are not tolerated. Other patients may prefer nonpharmacological therapies. Most clinicians are not trained or may not be comfortable recommending these complementary agents. It is the goal of this chapter to introduce to practitioners the evidence-based data that support the safety and efficacy of these complementary drugs.
Knowledge translation strategies for mobilizing individuals to implement pain evidence to practice
Authors: Tutelman Perri R. , Chambers Christine T. , Barwick Melanie
Published: June 2021

Pediatric pain research will only benefit children if the results of this research are used in practice. Knowledge translation (KT) involves the sharing of research evidence to different knowledge users in a manner that is accessible and understandable. This chapter provides an overview of KT and its applications to pediatric pain, with a focus on the effectiveness of KT directed to individual knowledge users (e.g., patients and caregivers, and clinicians) versus organizations or systems. KT goals, strategies, and initiatives are described. The importance of evaluating KT is highlighted. Examples of effective KT strategies, activities, and initiatives directed towards individual patients and caregivers are presented. The importance of effective KT to ensure that children with pain benefit from pediatric pain research evidence is emphasized.
Digital health technologies for pediatric pain
Authors: Jibb Lindsay A. , Stinson Jennifer N.
Published: June 2021

The rapid growth in digital health technologies in the last two decades means that several new tools have become available to monitor and manage chronic, recurrent, and acute pain in children and adolescents. These tools include the internet (and associated social support networks), mobile phones, and telemedicine, as well as virtual reality and other high-technology distraction interventions. The benefits of digital health technology-based pain therapies include improved treatment accessibility and satisfaction, and potential decreases in therapy cost. Digital health therapies for children and adolescents with pain represent exciting treatment possibilities. Future, rigorous research into the design and effectiveness testing of these therapies will shed more light on how digital health technologies might decrease pain intensity and improve the quality of life for children and adolescents with chronic, recurrent, and acute pain.
The exomoon corridor for multiple moon systems
Authors: Teachey Alex
Published: June 2021

The so-called ‘exomoon corridor’ is a potentially powerful new tool for identifying possible exomoon hosts, enabled by the observation that fully half of all planets hosting an exomoon will exhibit transit timing variation (TTV) periodicities of 2–4 epochs. One key outstanding problem in the search for exomoons, however, is the question of how well the methods we have developed under the single moon assumption extend to systems with multiple moons. In this work, we use N-body simulations to examine the exomoon corridor effect in the more general case of N ≥ 1 moons, generating realistic TTVs produced by satellite systems more akin to those seen in the outer Solar System. We find that indeed the relationship does hold for systems with up to 5 moons in both resonant and non-resonant chain configurations. Our results suggest an observational bias against finding systems with large numbers of massive moons; as the number of moons increases, total satellite mass ratios are generally required to be significantly lower in order to maintain stability, or architectures must be more finely tuned to survive. Moons produced in impact or capture scenarios may therefore dominate early detections. Finally, we examine the distribution of TTV periods measured for a large number of Kepler objects of interest (KOIs) and find the same characteristic exomoon corridor distribution in several cases. This could be dynamical evidence for an abundance of moons in the field, though we caution against strong inferences based on this result.
The dependence of subhalo abundance matching on galaxy photometry and selection criteria
Authors: Stiskalek Richard , Desmond Harry , Holvey Thomas , Jones Michael G
Published: June 2021

Subhalo abundance matching (SHAM) is a popular technique for assigning galaxy mass or luminosity to haloes produced in N-body simulations. The method works by matching the cumulative number functions of the galaxy and halo properties, and is therefore sensitive both to the precise definitions of those properties and to the selection criteria used to define the samples. Further dependence follows when SHAM parameters are calibrated with galaxy clustering, which is known to depend strongly on the manner in which galaxies are selected. In this paper we introduce a new parametrization for SHAM and derive the best-fitting SHAM parameters as a function of various properties of the selection of the galaxy sample and of the photometric definition, including Sérsic versus Petrosian magnitudes, stellar masses versus r-band magnitudes, and optical (Sloan Digital Sky Survey) versus $\mathrm{H}\, \small {\rm I}$ (ALFALFA) selection. In each case we calculate the models’ goodness-of-fit to measurements of the projected two-point galaxy correlation function. In the optically selected samples we find strong evidence that the scatter in the galaxy–halo connection increases towards the faint end, and that AM performs better with luminosity than stellar mass. The SHAM parameters of optically and $\mathrm{H}\, \small {\rm I}$-selected galaxies are mutually exclusive, with the latter suggesting the importance of properties beyond halo mass. We provide best-fitting parameters for the SHAM galaxy–halo connection as a function of each of our input choices, extending the domain of validity of the model while reducing potential systematic error in its use.
Constraints on the presence of platinum and gold in the spectra of the kilonova AT2017gfo
Authors: Gillanders J H , McCann M , Sim S A , Smartt S J , Ballance C P
Published: June 2021

Binary neutron star mergers are thought to be one of the dominant sites of production for rapid neutron capture elements, including platinum and gold. Since the discovery of the binary neutron star merger GW170817, and its associated kilonova AT2017gfo, numerous works have attempted to determine the composition of its outflowing material, but they have been hampered by the lack of complete atomic data. Here, we demonstrate how inclusion of new atomic data in synthetic spectra calculations can provide insights and constraints on the production of the heaviest elements. We employ theoretical atomic data (obtained using $\small {\rm GRASP}^{0}$) for neutral, singly and doubly ionized platinum and gold, to generate photospheric and simple nebular phase model spectra for kilonova-like ejecta properties. We make predictions for the locations of strong transitions, which could feasibly appear in the spectra of kilonovae that are rich in these species. We identify low-lying electric quadrupole and magnetic dipole transitions that may give rise to forbidden lines when the ejecta becomes optically thin. The strongest lines lie beyond 8000 Å, motivating high quality near-infrared spectroscopic follow-up of kilonova candidates. We compare our model spectra to the observed spectra of AT2017gfo, and conclude that no platinum or gold signatures are prominent in the ejecta. From our nebular phase modelling, we place tentative upper limits on the platinum and gold mass of ≲ a few 10−3 M⊙, and ≲ 10−2 M⊙, respectively. This work demonstrates how new atomic data of heavy elements can be included in radiative transfer calculations, and motivates future searches for elemental signatures.
The probabilistic random forest applied to the selection of quasar candidates in the QUBRICS survey
Authors: Guarneri Francesco , Calderone Giorgio , Cristiani Stefano , Fontanot Fabio , Boutsia Konstantina , Cupani Guido , Grazian Andrea , D’Odorico Valentina
Published: June 2021

The number of known, bright (i < 18), high-redshift (z > 2.5) QSOs in the Southern hemisphere is considerably lower than the corresponding number in the Northern hemisphere due to the lack of multiwavelength surveys at δ < 0. Recent works, such as the QUBRICS survey, successfully identified new, high-redshift QSOs in the South by means of a machine-learning approach applied on a large photometric data-set. Building on the success of QUBRICS, we present a new QSO selection method based on the Probabilistic Random Forest (PRF), an improvement of the classic Random Forest algorithm. The PRF takes into account measurement errors, treating input data as probability distribution functions: this allows us to obtain better accuracy and a robust predictive model. We applied the PRF to the same photometric data-set used in QUBRICS, based on the SkyMapper DR1, Gaia DR2, 2MASS, WISE, and GALEX databases. The resulting candidate list includes 626 sources with i < 18. We estimate for our proposed algorithm a completeness of ∼84 per cent and a purity of ${\sim}78{{\ \rm per\ cent}}$ on the test data-sets. Preliminary spectroscopic campaigns allowed us to observe 41 candidates, of which 29 turned out to be z > 2.5 QSOs. The performances of the PRF, currently comparable to those of the CCA, are expected to improve as the number of high-z QSOs available for the training sample grows: results are however already promising, despite this being one of the first applications of this method to an astrophysical context.
Axisymmetric magneto-plastic evolution of neutron-star crusts
Authors: Gourgouliatos Konstantinos N , Lander Samuel K
Published: June 2021

Magnetic field evolution in neutron-star crusts is driven by the Hall effect and Ohmic dissipation, for as long as the crust is sufficiently strong to absorb Maxwell stresses exerted by the field and thus makes the momentum equation redundant. For the strongest neutron-star fields, however, stresses build to the point of crustal failure, at which point the standard evolution equations are no longer valid. Here, we study the evolution of the magnetic field of the crust up to and beyond crustal failure, whence the crust begins to flow plastically. We perform global axisymmetric evolutions, exploring different types of failures affecting a limited region of the crust. We find that a plastic flow does not simply suppress the Hall effect even in the regime of a low plastic viscosity, but it rather leads to non-trivial evolution – in some cases even overreacting and enhancing the impact of the Hall effect. Its impact is more pronounced in the toroidal field, with the differences on the poloidal field being less substantial. We argue that both the nature of magnetar bursts and their spin-down evolution will be affected by plastic flow, so that observations of these phenomena may help us to constrain the way the crust fails.
Interhemispheric Contralateral Transfalcine Approach for Subparacentral Arteriovenous Malformation: 3-Dimensional Operative Video
Authors: Baldoncini Matías , Campero Alvaro , Luzzi Sabino , Villalonga Juan F
Published: June 2021

Neurovascular procedures along the interhemispheric fissure harbor unique features differentiating them from those arteriovenous malformations (AVMs) located at the lateral surface of the brain.
1-4

 The aim of this 3-dimensional operative video is to present a microsurgical resection of an AVM in a subparacentral location, operated through an interhemispheric contralateral transfalcine approach.
1,3,5

 This is a case of a 29-yr-old female, with headaches and history of seizures. The patient presented an interhemispheric bleeding 6 mo before the surgery. The magnetic resonance imaging (MRI) showed a vascular lesion located on the medial surface of the right hemisphere at the confluence between the cingulate sulcus and its ascending sulcus. In the cerebral angiography, a right medial AVM was observed, receiving afference from the right anterior cerebral artery and draining to the superior longitudinal sinus. The patient signed an informed consent for the procedure and agreed with the use of her images and surgical video for research and academic purposes.

 The patient was in a supine position, and a left interhemispheric contralateral transfalcine approach was performed,
1-3
a circumferential dissection of the nidus, and, finally, the AVM was resected in one piece.

 The patient evolved without neurological deficits after the surgery. The postoperative MRI and angiography showed a complete resection of the AVM.

 In the case presented, to avoid exposing the drainage vein first and to use the gravity of the exposure, the contralateral transfalcine interhemispheric approach was used,
1,2
which finally accomplished the proposed objectives.
Accumulation by Attachment: Colonial Benevolence and the Rule of Capital in Nineteenth-Century Panjab
Authors: Gill Navyug
Published: June 2021

A persistent theme in the emergence of capitalism is the displacement of peasants from the countryside into industrializing cities, with regions not undergoing such a transition usually deemed semi-feudal, proto-capitalist or pre-modern. Instead of separations, however, Panjab was the site of an altogether different dynamic of accumulation based on forging a series of novel attachments. This article begins by tracing the East India Company’s conquest in 1849, and the development of an ostensibly benevolent land revenue settlement based on surveying, measuring and calculating agrarian potential. Next, it examines how this process generated a set of natural and human contingencies so that certain castes were fixed to parcels of land, and expected to pay increasing rates while cultivating global commodities and conducting exchanges in cash. To make sense of this difference, it then contrasts the archive of settlement work with Karl Marx’s narrative of primitive accumulation, to explicate the conditions and limitations of its universality. Together this demonstrates how caste-based peasant agriculture in Panjab was a new phenomenon implicated in a modern yet distinctive rule of capital. In a broader sense, this offers possibilities to rethink the politics of comparative analysis as well as the alterity of capitalist transitions across the colonial world.
Assessing Variation in State Opioid Tapering Laws: Comparing State Laws with the CDC Guideline
Authors: Danielson Elizabeth C , Harle Christopher A , Silverman Ross , Blackburn Justin , Menachemi Nir
Published: June 2021

Objective

In 2016, the Center for Disease Control and Prevention released an opioid prescribing guideline for primary care in response to opioid overdose deaths. Despite efforts to encourage safer prescribing practices, experts and federal agencies suspect prescribing guidelines may be misapplied in clinical practice, resulting in abrupt tapering from opioid therapy. Although state laws likely influence prescriber behavior, little is known about state tapering laws. Thus, we examined the scope and variation of state tapering laws compared with federal opioid guidelines.

Methods

We conducted a comprehensive review of state laws through December 31, 2019, using keyword searches in LexisNexus. Identified laws were coded based on the inclusion of attributes derived from federal opioid guidelines and an expert consensus panel report. We examined whether law attributes were associated with state characteristics, including region, population, governor’s political affiliation, opioid prescribing rates, and opioid overdose rates.

Results

We found 27 states and one federal district had law(s) mentioning tapering. Most laws were authored by medical boards or workers’ compensation groups (65.6%) while some laws included a penalty (32.8%). Approximately half of guideline attributes (54.2%) were included in state laws; however, only two state’s laws cautioned against abrupt tapering. States with higher overdose death rates were more likely to enact a tapering law (P < 0.001) and have a penalty (P = 0.007).

Conclusions

State tapering laws incorporate some federal guideline attributes but most lack attributes deemed critical by experts. Without clear instruction, patients risk inappropriate tapering and discontinuation of opioid therapy. Given these findings, policymakers should consider addressing this gap.
Library Patrons’ Psychosocial Needs: Perceptions of Need and Reasons for Accessing Social Work Services
Authors: Wahler Elizabeth A , Provence Mary A , Johnson Sarah C , Helling John , Williams Michael
Published: June 2021

Public libraries in the United States have begun to partner with social work to address the psychosocial needs observed in patrons that are beyond the training and education of most library staff. This is a new area of inquiry with limited research available. Of the few published studies, the majority focus on staff perceptions of patrons’ needs and surveys of patrons experiencing homelessness about their use of public libraries. The present study is the first to examine and compare staff perception of patrons’ needs, patrons’ self-expressed needs, and the actual use of social work services by patrons within one library system. Comparisons are explored between actual service usage alongside the perception of patrons’ needs as originally reported by both staff and patron groups. Implications for library-based social work practice are discussed.
Validity Evidence for Assessing Entrustable Professional Activities During Undergraduate Medical Education
Authors: Violato Claudio , Cullen Michael J. , Englander Robert , Murray Katherine E. , Hobday Patricia M. , Borman-Shoap Emily , Ersan Ozge
Published: June 2021

Purpose

To explore validity evidence for the use of entrustable professional activities (EPAs) as an assessment framework in medical education.

Method

Formative assessments on the 13 Core EPAs for entering residency were collected for 4 cohorts of students over a 9- to 12-month longitudinal integrated clerkship as part of the Education in Pediatrics Across the Continuum pilot at the University of Minnesota Medical School. The students requested assessments from clinical supervisors based on direct observation while engaging in patient care together. Based on each observation, the faculty member rated the student on a 9-point scale corresponding to levels of supervision required. Six EPAs were included in the present analyses. Student ratings were depicted as curves describing their performance over time; regression models were employed to fit the curves. The unit of analyses for the learning curves was observations rather than individual students.

Results

(1) Frequent assessments on EPAs provided a developmental picture of competence consistent with the negative exponential learning curve theory; (2) This finding was true across a variety of EPAs and across students; and (3) The time to attain the threshold level of performance on the EPA for entrustment varied by student and EPA.

Conclusions

The results provide validity evidence for an EPA-based program of assessment. Students assessed using multiple observations performing the Core EPAs for entering residency demonstrate classic developmental progression toward the desired level of competence resulting in entrustment decisions. Future work with larger data samples will allow further psychometric analyses of assessment of EPAs.
The Minnesota Method: A Learner-Driven, Entrustable Professional Activity-Based Comprehensive Program of Assessment for Medical Students
Authors: Hobday Patricia M. , Borman-Shoap Emily , Cullen Michael J. , Englander Robert , Murray Katherine E.
Published: June 2021

Problem

Assessment has been the Achilles heel of competency-based medical education. It requires a program of assessment in which outcomes are clearly defined, students know where they are in the development of the competencies, and what the next steps are to attaining them. Achieving this goal in a feasible manner has been elusive with traditional assessment methods alone. The Education in Pediatrics Across the Continuum (EPAC) program at the University of Minnesota developed a robust program of assessment that has utility and recognizes when students are ready for the undergraduate to graduate medical education transition.

Approach

The authors developed a learner-driven program of assessment in the foundational clinical training of medical students in the EPAC program based on the Core Entrustable Professional Activities for Entering Residency (Core EPAs). Frequent workplace-based assessments, coupled with summative assessments, informed a quarterly clinical competency committee and individualized learning plans. The data were displayed on real time dashboards for the students to review.

Outcomes

Over 4 cohorts from 2015 to 2019, students (n = 13) averaged approximately 200 discrete Core EPA workplace-based assessments during their foundational clinical training year. Assessments were completed by an average of 9 different preceptors each month across 8 different specialties. The data were displayed in a way students and faculty could monitor development and inform a clinical competency committee’s ability to determine readiness to transition to advanced clinical rotations and residency.

Next Steps

The next steps include continuing to scale the program of assessment to a larger cohort of students.
Preoperative optimization of patients undergoing interventional procedures: infrastructure, logistics, and evidence-based medicine
Authors: Beg Tazeen , Daoud Bahaa E. , Richman Deborah C.
Published: June 2021

Purpose of review

Patients presenting for non-operating room procedures are often ‘too sick’ for surgery and require specific anesthesia care in remote areas with logistical and scheduling challenges.

Recent findings

Increased complexity and scope of minimally invasive procedures have expanded this practice. In addition, the concept of therapeutic options other than conventional surgery is gaining traction.

Our review of recent literature confirms the complexity and supports the safety of providing care in non-operating room anesthesia locations. Standard preanesthesia assessments and principles apply to these areas.
Nondrug Treatment Approaches Used in Alcohol and Substance Addictions and Related Factors
Authors: Turan Caglar , Yazici Esra , Yazici Ahmet B. , Erol Atila
Published: June 2021

Objectives:

Current treatment methods in alcohol and substance use disorders (ASUDs) cannot meet the demands of patients for many reasons. This situation may result in individuals with addiction seeking different approaches. This study aims to investigate nondrug methods used by individuals with ASUD to cope with their disorder and the factors that may be associated with it.

Materials and Methods:

The study was carried out on 103 volunteer patients who presented to a Training and Research Hospital alcohol substance treatment center. In the study, the God Attachment Inventory, the Addiction Profile Index-Practitioner Form, and the Non-Drug Treatment Questionnaire were used, and Structured Clinical Interview for DSM-IV (SCID-1) and Structured Clinical Interview for DSM-IV (SCID-2) psychiatric interviews were conducted.

Result:

In individuals with addiction, the rate of seeking any nondrug method was found to be 33%. To get rid of addiction, turning to religion was mostly preferred (24.3%). In terms of subheadings, self-help methods such as praying (17.4%) and engaging in sports (6.7%) were the most preferred. No relationship was found between the patients’ attachment style to God and personality disorder diagnoses and the frequency of seeking nondrug methods and the type of nondrug method. It has been found that there is a relationship between the severity of addiction and the use of nondrug methods.

Conclusions:

In addition to the medical approaches of patients with ASUD problems, it is observed that they attempt to cope using traditional and complementary methods and prefer the self-help methods among these methods. However, further studies are needed to investigate the contribution of these methods to current treatment methods.
Evaluation and management of low-energy pelvic ring fractures in elderly patients: a narrative review
Authors: VanDe Merkt Kelly , Radabaugh Colin , Riehl John T.
Published: June 2021

The incidence of pelvic ring fractures has shown a steady increase in elderly patients that has been caused by a rapidly aging population and increased life expectancy. Many of these injuries result from a low-energy mechanism such as a fall from standing height. Classification systems such as the Young and Burgess and Tile classifications commonly are used to describe these fractures. One of the major distinctions to be made is whether the fracture pattern is stable or unstable in order to determine treatment. The goal of treatment is to restore patients back to their preinjury level of function. Mortality rate has previously been shown to be high in these injuries (20% at 30 days).
Quality and Accuracy of Cervical Radiculopathy-specific Information on the Internet
Authors: Truumees David , Duncan Ashley , Kunj Amin , Rajagopalan Dayal , Geck Matthew , Singh Devender , Stokes John , Truumees Eeric
Published: June 2021

Study Design.

Cross-sectional analysis.

Objective.

This study aimed to evaluate the quality and accuracy of the content surrounding cervical radiculopathy available on the internet.

Summary of Background Data.

Those experiencing cervical radiculopathy and their families are increasingly browsing the worldwide web for medical information. As the information offered is likely to influence their health care choices, spine care providers must understand the quality and accuracy of that information.

Methods.

Independent searches were conducted on the three most commonly accessed search engines (Google, Yahoo, and Bing) using the keyword “cervical radiculopathy.” The searches were performed on June 28th, 2019. The top 50 sites from each search engines were reviewed. The websites were evaluated using quality, accuracy and usability markers.

Results.

Seventy-seven unique websites were analyzed; 54.5% were physician or medical group professional sites, 20.8% as non-physician, 10.4% as unidentified, 7.8% as academics, and 6.5% were commercial. Accuracy ranged from <25% to >75% were recorded with a mean accuracy of 3.5 signifying 50% to 75% agreement. Overall, website categories had a significant effect on Journal of American Medical Association (JAMA) score, content quality, accuracy, total summary scores, distraction index, reading ease, and grade level (P 
< 0.05). Academic sites had the highest mean quality content, accuracy and total summary scores. Four of the top five websites with the highest total summary scores were physician driven. On average, Health on the Net code (HONcode) certified websites had lower grade level readability with greater reading ease and higher DISCERN and JAMA scores than uncertified sites (P < 0.05).

Conclusion.

Despite the wide number of sources available, the quality, accuracy, pertinence, and intelligibility of the information remains highly variable. Clinicians treating patients with cervical radiculopathy should direct them to verifiable sites with regulated information and, where possible, contribute high- quality information to those sites.

Level of Evidence: 4
Surgical Elbow Dislocation: Technique and Comparative Outcomes
Authors: Hoyt Benjamin W. , Clark DesRaj M. , Walsh Sarah A. , Pensy Raymond A.
Published: June 2021

Introduction:

Surgical access to lateral column fractures of the distal humerus is difficult via traditional approaches due to limited anterior articular exposure for direct reduction and fixation. We have refined a surgical elbow dislocation approach to the articular surface of the distal humerus for fixation of lateral column injuries, which may permit improved access for operative fixation.

Materials and Methods:

We performed a retrospective review of lateral column fractures treated with open reduction internal fixation at our institution between 2009 and 2019. We divided patients into 3 cohorts based on surgical approach: surgical dislocation (n=10), lateral (n=17), and posterior (n=9). Surgical reports, radiographs, and patient records were reviewed for hardware positioning, tourniquet time, estimated blood loss, postoperative reduction quality, and patient outcomes including range of motion, neurovascular injury, development of heterotopic ossification, and pain on a visual analog scale.

Results:

With the numbers available, we were unable to detect a significant difference in outcomes including pain, range of motion, or blood loss. No patients treated with this approach experienced neurovascular injury, instability, or nonunion at follow-up.

Conclusions:

The surgical elbow dislocation is a powerful tool to aid reduction and osteosynthesis of intra-articular fractures of the lateral distal humerus. It may enable greater articular access for complex distal humerus patterns without deleterious effects on surgical or patient reported outcomes.
Proof of Concept Example for Use of Simulation to Allow Data Pooling Despite Privacy Restrictions
Authors: Filshtein Teresa J. , Li Xiang , Zimmerman Scott C. , Ackley Sarah F. , Glymour M. Maria , Power Melinda C.
Published: June 2021

Background:

Integrating results from multiple samples is often desirable, but privacy restrictions may preclude full data pooling, and most datasets do not include fully harmonized variable sets. We propose a simulation-based method leveraging partial information across datasets to guide creation of synthetic data based on explicit assumptions about the underlying causal structure that permits pooled analyses that adjust for all desired confounders in the context of privacy restrictions.

Methods:

This proof-of-concept project uses data from the Health and Retirement Study (HRS) and Atherosclerosis Risk in Communities (ARIC) study. We specified an estimand of interest and a directed acyclic graph (DAG) summarizing the presumed causal structure for the effect of glycated hemoglobin (HbA1c) on cognitive change. We derived publicly reportable statistics to describe the joint distribution of each variable in our DAG. These summary estimates were used as data-generating rules to create synthetic datasets. After pooling, we imputed missing covariates in the synthetic datasets and used the synthetic data to estimate the pooled effect of HbA1c on cognitive change, adjusting for all desired covariates.

Results:

Distributions of covariates and model coefficients and associated standard errors for our model estimating the effect of HbA1c on cognitive change were similar across cohort-specific original and preimputation synthetic data. The estimate from the pooled synthetic incorporates control for confounders measured in either original dataset.

Discussion:

Our approach has advantages over meta-analysis or individual-level pooling/data harmonization when privacy concerns preclude data sharing and key confounders are not uniformly measured across datasets.
Menopause preparedness: perspectives for patient, provider, and policymaker consideration
Authors: Aninye Irene O. , Laitner Melissa H. , Chinnappan Shivani
Published: June 2021

Objective:

The aim of the study was to identify priorities to address unmet needs in clinical care, education, and access to treatment to improve quality of life for individuals during the menopause transition.

Methods:

The Society for Women's Health Research convened a working group of 13 experts to discuss updates in research, clinical practice, and policy on menopause. Participants included patient advocates, policy leaders, and clinical specialists and researchers from gynecology, reproductive endocrinology, psychiatry, and epidemiology. Overarching themes and recommendations for improving menopause care were identified and determined by consensus agreement of the participants at the conclusion of the meeting.

Results:

The Society for Women's Health Research Menopause Working Group identified gaps in clinical care, policy, and patient and provider education. Limited understanding of menopause by patients and clinicians contributes to delays in recognizing the menopause transition and engaging in symptom management. Recent studies on hormone therapy and alternative treatment options provide evidence to inform updates on existing policy recommendations and coverage.

Conclusions:

To improve care and quality of life for individuals during the menopause transition and after menopause, the working group recommends developing a more standardized approach to menopause preparedness that includes education for both patients and providers, as well as considering policy solutions to address regulatory barriers to care. Providers also need to factor in the diverse needs of individuals experiencing menopause in the development of their personalized care.
Treatment patterns and survival in patients with small cell lung cancer in Taiwan
Authors: Chiang Chi-Lu , Hsieh Wen-Ting , Tang Chao-Hsiun , Sheu Mei-Ling , Chen Yuh-Min
Published: June 2021

Background:

Small cell lung cancer (SCLC) is the most aggressive form of lung cancer. The chemotherapy regimens and their efficacy in practice are seldom reported. We aimed to investigate treatment patterns and survival outcomes of patients with SCLC in Taiwan.

Methods:

Patients newly diagnosed with SCLC from 2011 to 2015 were identified from the Cancer Registry database. Their clinical characteristics, treatment regimens, and survival status were obtained from National Health Insurance Research database. The Kaplan–Meier method and Cox-proportional hazard model were used to analyze the survival outcomes.

Results:

Among a total of 2707 patients enrolled, 439 were in the limited stage (LS, 16.22%) and 2268 were in the extensive stage of the disease (ES, 83.78%). The median age was 66 and the majority were male (90.36%). The first-line regimen used for the patients was etoposide/cisplatin-based treatment, followed by etoposide/carboplatin-based regimen, and etoposide only. The median overall survival (OS) was 16.92 months (95% confidence interval [CI] 15.31–18.92) and 8.71 months (95% CI 8.38–9.07) in LS and ES patients, respectively. Chemotherapy regimen, Eastern Cooperative Oncology Group performance status, and history of radiotherapy were significant factors associated with OS. On the other hand, the major second-line treatment was a topotecan-based regimen (68.3%). However, this showed inferior survival outcome compared to etoposide-based regimen (5.09 months [95% CI 4.76–5.62] versus 8.77 months [95% CI 6.31–11.89], p < 0.001).

Conclusion:

Etoposide is the preferred and superior first-line chemotherapy regimen in combination with platinum, and an alternative choice of second-line regimen for Taiwanese patients with SCLC.
Clinical Decision Path for Identifying Recurrent Falls in Late Middle-Aged and Older Patients With Chronic Schizophrenia
Authors: WANG Mei-Yeh , LIU I-Chao , CHIU Chen-Huan
Published: June 2021

Background

Falls are a major hazard for elderly patients with schizophrenia. As patients with schizophrenia may experience a more-accelerated rate of physical aging than the overall elderly population, the risk of falls may emerge during the late middle-age period in this population. Furthermore, the risk of falls is affected by multiple, interrelated risk factors.

Purpose

This study was undertaken to capture the complexity of the risk of falls in patients with schizophrenia. A cross-sectional approach was used to apply classification and regression tree (CART) analysis to generate a clinical decision path to identify the risk factors of recurrent falls in late middle-aged and older patients with schizophrenia.

Methods

Two hundred ninety-one patients aged 55 years or older were recruited from psychiatric halfway houses for assessment. Frailty, physical functional performance, depressive severity, cognitive function, and level of fatigue were measured, respectively, using the Study of Osteoporotic Fractures Frailty Index, Short Physical Performance Battery (SPPB), Center for Epidemiological Studies Depression Scale, Short Portable Mental Status Questionnaire (SPMSQ), and Chinese version of the Fatigue Severity Scale. The variables revealed by descriptive statistics to be statistically significant were further analyzed using CART analysis.

Results

The overall proportion of recurrent fallers in this study was 19.2%. CART analysis revealed eight end groups and identified four predictors: frailty, physical functional performance, cognitive function, and sex. The most prominent condition for recurrent fallers was frailty, present in 57.1% of the frail participants. In the nonfrail group (both prefrail and robust), participants with an SPPB score of less than 10 had a 29.7% chance of being a recurrent faller versus 13.6% for those with an SPPB score of 10 or more. Furthermore, an SPMSQ score of 7 was the next-best split among participants without frailty, with an SPPB score of 10 or more. Finally, among participants without frailty and with an SPPB score of 10 or more and an SPMSQ score of more than 7, the proportion of recurrent fallers was higher in women than men.

Conclusions

The results of this study indicate that assessing frailty status may be an effective, first-step approach to identifying schizophrenic patients at an increased risk of recurrent falls. Among patients with prefrailty or robust status, an SPPB score cutoff of 10, an SPMSQ score cutoff of 7, and being female may be used sequentially to identify individuals at a heightened risk of recurrent falls.
ACOEM OEM Core Competencies: 2021
Authors: Hartenbaum Natalie P. , Baker Beth A. , Levin Jeffrey L. , Saito Kenji , Sayeed Yusef , Green-McKenzie Judith
Published: June 2021

Competency is defined as possession of sufficient physical, intellectual, and behavioral qualifications to perform a task or serve in a role which adequately accomplishes a desired outcome. Recognizing the need for defining competencies essential to occupational and environmental medicine (OEM) physicians, the American College of Occupational and Environmental Medicine developed its first set of OEM Competencies in 1998. Later updated in 2008, and again in 2014, the increasing globalization and modernization of the workplace, along with published research on OEM practice, required an update to ensure OEM physicians stay current with the field and practice of OEM. Delineation of core competencies for the profession provides employers, government agencies, health care organizations, and other health practitioners a solid context of the role and expertise of OEM physicians.
Per Oral Endoscopic Myotomy for Zenker’s Diverticulum
Authors: Kahaleh Michel , Mahpour Noah Y. , Tyberg Amy , Bareket Romy , Shahid Haroon M. , Sarkar Avik , Abdelqader Abdelhai , Gjeorgjievski Mihajlo , Marino Daniel , Kats Daniel , Gaidhane Monica , Greenberg Ian , Lee David P. , Bushe Bryce , Eke Chiemeziem , Sun Hojin , Kedia Prashant , Méndez Ana L.M. , Lambroza Arnon , Barret Maximilien , Hallit Rachel , Eleftheriadis Nikolas P. , Nieto Jose , Oleas Roberto , Robles-Medranda Carlos , Bapaye Amol
Published: June 2021

Introduction:

Endoscopic management of Zenker diverticuli (ZD) has traditionally been via septotomy technique. The recent development of tunneling technique has shown to be both efficacious and safe. The aim of this study is to evaluate the tunneling technique using per oral endoscopic myotomy (Z-POEM) versus septotomy.

Methods:

Patients who underwent endoscopic management of ZD either by Z-POEM or septotomy from March 2017 until November 2020 from 9 international academic centers were included. Demographics, clinical data preprocedure and postprocedure, procedure time, adverse events, and hospital length of stay were analyzed.

Results:

A total of 101 patients (mean age 74.9 y old, 55.4% male) were included: septotomy (n=49), Z-POEM (n=52). Preprocedure Functional Oral Intake Scale score and Eckardt score was 5.3 and 5.4 for the septotomy group and 5.9 and 5.15 for the Z-POEM group. Technical success was achieved in 98% of the Z-POEM group and 100% of the septotomy group. Clinical success was achieved in 84% and 92% in the septotomy versus Z-POEM groups. Adverse events occurred in 30.6% (n=15) in septotomy group versus 9.6% (n=5) in the Z-POEM group (P=0.017). Reintervention for ongoing symptoms occurred in 7 patients in the septotomy group and 3 patients in the Z-POEM group. Mean hospital length of stay was shorter for the Z-POEM group, at 1.5 versus 1.9 days.

Conclusions:

A tunneling technique via the Z-POEM procedure is an efficacious and safe endoscopic treatment for ZD. Z-POEM is a safer procedure with a statistically significant reduction in adverse events compared with traditional septotomy technique.
Changes in Type 2 Diabetes Medication Utilization and Costs in the United States, 2014–2019
Authors: Neilson Lynn M. , Munshi Kiraat D. , Peasah Samuel K. , Huang Yan , Swart Elizabeth C.S. , Henderson Rochelle , Manolis Chronis , Good Chester B.
Published: June 2021

Objective:

The objective of this study was to describe national changes in utilization and associated costs of antidiabetic medications in the United States from 2014 to 2019, across different drug classes and insurance plans.

Research Design and Methods:

This retrospective, cross-sectional study examined administrative claims from a large national pharmacy benefits manager from January 1, 2014, to December 31, 2019. Patients aged 18 years and above enrolled in commercial, Medicare, or Medicaid health plans who filled ≥1 prescription claim for an antidiabetic medication(s) during the 6-year period were included. Utilization was examined as the total number of 30-day adjusted prescription fills per user per month (PUPM). Gross costs were calculated as the sum of plan costs (net of rebates) and member out-of-pocket costs. Differences in mean utilization and costs PUPM between 2014 and 2019 for each medication class were calculated.

Results:

The final analytic sample increased from 745,290 patients in 2014 to 1,596,006 in 2019. Antidiabetic medication utilization increased by 8.8% from 2014 to 2019, driven by increases in sodium-glucose cotransporter 2 inhibitor (48.7%; P<0.001), glucagon-like peptide 1 receptor agonist (11.8%; P<0.001), insulin (8.1%; P<0.001), and metformin (2.9%; P<0.05) utilization. Average costs PUPM rose 47.5% (P<0.001), from $126.52 in 2014 to $186.58 in 2019. Sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, and combination drugs contributed significantly to these increased costs, with 6-year cost differences of 57.3%, 46.9%, and 47.2%, respectively (all P<0.001).

Conclusion:

Our study demonstrates a shift in antidiabetic medication class utilization from 2014 to 2019, where associated costs net of rebates significantly increased to a disproportionately greater extent than the significant increase in utilization PUPM.
Clinical Predictors and Outcomes for Recurrent Pneumatosis Intestinalis in Children: A Case Control Study
Authors: Ta Allison De Groot , Farrell Michael , Dillman Jonathan R. , Trout Andrew T.
Published: June 2021

Introduction:

Pneumatosis intestinalis (PI) is air collections within the wall of the intestine that can be associated with life threatening conditions. Recurrent episodes of PI have been reported; however, little is known about risks for recurrent disease. This study aims to identify predictors of recurrent PI and evaluate long-term outcomes in patients with recurrent PI.

Methods:

This retrospective case-control study evaluated patients, ages 6 months to 18 years, with imaging evidence of PI over a 30-month period. Images were analyzed by consensus to confirm PI. Recurrent PI was defined as new findings of PI after resolution by imaging and/or at least 1-month interval between episodes of PI. Univariate and multivariable analyses were performed using logistic regression, with significance set to P < 0.05.

Results:

Forty-six children were included. Recurrent PI occurred in 17 (37%) patients, with a total of 39 episodes. Predictors of recurrent PI all related to the segment of bowel involved with small bowel PI predictive of recurrent PI (odds ratio [OR] 1.6; 95% confidence interval [CI] 1.01, 2.4) and colonic PI protective (OR 0.6; 95% CI 0.4, 0.87) after adjusting for age. Predictors for surgical intervention included cerebral palsy (OR 17; 95% CI 1.7, 167) and PI involving small bowel (OR 19; 95% 3.1, 114).

Conclusion:

Location of PI is predictive of recurrence. Clinical outcomes were similar between groups with single episode and recurrent PI.
Distinct Sleep Disturbance Profiles in Patients With Gastrointestinal Cancers Receiving Chemotherapy
Authors: Lin Yufen , Bailey Donald E. , Docherty Sharron L. , Porter Laura S. , Cooper Bruce A. , Paul Steven M. , Hammer Marilyn J. , Conley Yvette P. , Levine Jon D. , Miaskowski Christine
Published: June 2021

Background

Patients with gastrointestinal cancers experience moderate to high levels of sleep disturbance during chemotherapy that decreases their functional status and quality of life (QOL).

Objective

The objectives of this study were to identify subgroups of patients with gastrointestinal cancers with distinct sleep disturbance profiles and evaluate for differences among these subgroups in demographic, clinical, and sleep characteristics, as well as co-occurring symptoms and QOL outcomes.

Methods

Patients (n = 405) completed questionnaires 6 times over 2 cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct sleep disturbance profiles.

Results

Three distinct sleep disturbance profiles (ie, low, high, very high) were identified. Compared with the low class, patients in the other 2 classes were significantly younger and less likely to be married and to exercise on a regular basis and received a higher number of previous treatments. Compared with the low class, patients in the other 2 classes reported higher levels of anxiety, depressive symptoms, morning and evening fatigue, and pain and lower levels of attentional function and QOL scores at enrollment.

Conclusions

This study is the first to use latent profile analysis to identify subgroups of patients with gastrointestinal cancers with distinct sleep disturbance profiles. Findings provide new insights on the associations between sleep disturbance and multiple co-occurring symptoms in these patients.

Implications for Practice

Clinicians can identify patients who are at the highest risk for sleep disturbance and recommend a variety of sleep hygiene interventions (eg, establishment of a bedtime routine), as well as initiate interventions for other co-occurring symptoms.