bluuebunny/crossref_metadata_2025 huggingface dataset:
Office-Based Buprenorphine Treatment
Authors: Noe Shelly R. , Keller Teresa
Published: March 2020

Opiate addiction is a serious global health issue that profoundly impacts the welfare of populations around the world. Opioid addiction affects an estimated 1.9 million individuals in the United States alone, stimulating a rise in treatment options such as medication-assisted treatment with buprenorphine. When combined with counseling and relapse prevention groups, medication-assisted treatment has proven to be an effective office-based opioid treatment for opiate dependence. Office-based opioid treatment has broadened access to treatment of opioid dependence, has decreased the risk for overdose, and is effective for reducing cravings and opioid use at proper dosing levels. However, treatment retention and relapse remain significant challenges. The purpose of this study was to identify characteristics predictive of retention in treatment time of opioid-dependent individuals receiving office-based buprenorphine treatment. The records of individuals enrolled in a public health office buprenorphine clinic (n = 350) were analyzed to determine retention time in treatment and whether retention time varied by selected individual variables. Participants in the study had a cumulative predicted retention time on buprenorphine of 65% at 30 days, 35% at 6 months, 25% at 12 months, and 18% at 18 months.
Reducing Student Nurse Stigmatization of the Patient Who Misuses Opioids
Authors: Maynard Kristi
Published: March 2020

The United States is in the midst of an opioid epidemic. The numbers of opioid-related deaths have been steadily climbing, magnifying the need for innovative intervention. Stigma is a set of preconceived, negative assumptions about a patient population or group. Stigma is a known deterrent to communication and the delivery of healthcare. Nurses serve as a primary contact for many marginalized patients within the healthcare system. The purpose of this scoping review is to gather known data on the use of educational interventions with nursing students to reduce stigmatizing tendencies. Inclusion criteria constituted an educational intervention involving student nurses and an effort to reduce stigmatizing attitudes toward patients who misuse opioids. The intervention must have taken place in an institute of higher learning between the years of 2003 and 2018. Exclusion criteria included community-wide studies. A single study was identified addressing nursing student reduction of stigmatization of the individual who uses opioids, and so, the search was expanded to include any student nursing intervention developed to reduce stigma toward any marginalized population. The following electronic databases were utilized in the search process: Cumulative Index of Nursing and Allied Health Literature, Google Scholar, Journal Storage, Microsoft Academic, and ScienceDirect. Reference pages of selected or related articles were reviewed in an attempt to identify additional pertinent literature through citation mapping. Fifteen studies were identified, each of which utilized a variable methodology for stigma reduction with varying levels of success.
Fluoro-deoxy-glucose uptake in the mylohyoid muscle: a common misconception
Authors: Pizzuto Daniele A. , Husmann Lars , Stolzmann Paul , Meerwein Christian , Orita Erika , von Schulthess Gustav K. , Huellner Martin W.
Published: March 2020

Aim

The mylohyoid muscle is often believed to exhibit high physiologic fluoro-deoxy-glucose (FDG) uptake. Aim of this study was to use PET/MR for adequately assessing the normal FDG distribution in floor of the mouth (FOM) muscles and neighboring major salivary glands.

Materials and methods

Patients scanned with a simultaneous PET/MRI system for initial staging or follow-up of head and neck tumors, with no malignant lesions in salivary glands or in FOM, were included. Volumes-of-interest (VOIs) were positioned separately for bilateral mylohyoid, digastric, genioglossus, and geniohyoid muscles, based on T2-weighted and T1-weighted images, and for bilateral parotid, submandibular, and sublingual glands in the same way. SUVmax was measured for each VOI.

Results

Six hundred and ninety-two VOIs were positioned. FDG uptake in mylohyoid (SUVmax = 1.94 ± 0.37) and digastric muscles (SUVmax = 2.01 ± 0.37) were significantly higher compared to that in geniohyoid (SUVmax = 1.67 ± 0.53) and genioglossus muscles (SUVmax = 1.75 ± 0.54) (Friedman’s test; P < 0.001). FDG uptake in the sublingual glands (SUVmax = 3.77 ± 1.63) was significantly higher compared to the parotid glands (SUVmax = 2.34 ± 0.60) and submandibular glands (SUVmax = 2.51 ± 0.59) (Wilcoxon signed-ranks test; P < 0.001). FDG uptake in sublingual glands was significantly higher than FDG uptake in the mylohyoid muscles (P < 0.001). FDG uptake in the parotid, submandibular, and sublingual glands was inversely correlated to the age of subjects (Spearman’ rho coefficient: –0.397/P = 0.004; –0.329/P = 0.021; –0.535/P < 0.001, respectively).

Conclusion

The sublingual glands yield the highest physiologic FDG uptake in the FOM. High FDG uptake in the mylohyoid muscle is a common misconception.
The Safety and Feasibility of a New Through‐the‐scope Balloon‐assisted Enteroscopy in Children
Authors: Broide Efrat , Shalem Tzippora , Richter Vered , Matalon Shay , Shirin Haim
Published: March 2020

Objectives:

Small bowel involvement in Crohn disease (CD) is clinically important for diagnosis and treatment. Single and double‐balloon enteroscopy have already become important diagnostic tools in such cases. The on‐demand NaviAid AB device enables deep advancement into the small bowel, using an anterograde or retrograde approach. In adults, this procedure is feasible, safe, and rapid. This work aimed to assess the safety and feasibility of NaviAid AB enteroscopy in pediatric patients.

Methods:

Single‐center, prospective study using the through‐the‐scope balloon‐assisted‐enteroscopy (TTS‐BAE) NaviAid AB device for the evaluation of the small bowel in children with suspected or known inflammatory bowel disease (IBD). The system consists of a single‐use balloon catheter inserted through the instrument channel of a standard colonoscope. It consists of an inflation/deflation system (NaviAid SPARK), which is inflated to anchoring pressure. The repetitive push‐pull technique enables the advancement of the colonoscope along the small intestine.

Results:

Fifty analyzed endoscopic procedures (30 retrograde, 20 anterograde) were performed in 34 children (52.9% boys, mean age 13.7 years). Average maximal depth of insertion (MDI), advancement depth using the NaviAid AB and average total procedure time were 138 cm (range 100–190 cm), 81 cm (range 40–120 cm), and 12.8 minutes (range 7.3–19.0 minutes), respectively, for the anterograde approach and 143 cm (range 100–170 cm), 64 cm (range 20–95 cm), and 21.9 minutes (range 13.9–32.0 minutes), respectively, for the retrograde approach. No serious or device‐related adverse events were reported.

Conclusions:

NaviAid AB enteroscopy in children is safe, feasible, and enables assessment of the small intestine in a short period of time.
The Asian Immigrant Cancer Survivor Experience in the United States: A Scoping Review of the Literature
Authors: Lockhart Joan Such , Oberleitner Melinda G. , Nolfi David A.
Published: March 2020

Background

Cancer is the leading cause of death for Asian Americans, a growing population in the United States. While cancer survivors often experience complex issues after diagnosis, being an immigrant and having cancer pose additional challenges.

Objective

This scoping review analyzed research about immigrant cancer survivors of Asian ethnicity in the United States and provided a structured method to understand an area of research and evidence. Aims focused on immigrants’ experiences and how findings could tailor evidence-based interventions, programs, and resources.

Methods

The PubMed, CINAHL, and Scopus databases were searched to identify studies in English (2009-2018) targeting Asian immigrant cancer survivors in the United States. While 385 records were initially identified, 32 studies met the inclusion criteria.

Results

Thematic analysis of charted study elements revealed 4 themes with subthemes: (1) survival patterns, (2) barriers, (3) culturally informed care, and (4) quality of life (QOL). While qualitative studies provided insight about the cancer experience from immigrants’ perspectives, quantitative designs posed descriptions and associations among QOL concepts.

Conclusions

Study results illustrate the need for survival research that explores outcomes by Asian ethnic subgroups and tracks the influence of acculturation. Future research should test culturally informed interventions that minimize barriers and foster QOL across the cancer continuum. Culturally tailored instruments can expedite larger-scaled studies that allow generalization.

Implications for Practice

Asian immigrants comprise an underserved, vulnerable, and growing group with various cancers. Nurses who care for immigrants and their families should be cognizant of cultural beliefs, values, practices, and issues related to communication, care access, and socioeconomics.
The Effects of Cognitive-Behavioral Stress Management for Breast Cancer Patients
Authors: Tang Maoting , Liu Xianliang , Wu Qian , Shi Yan
Published: March 2020

Background

Treatment for breast cancer can be stressful for patients. Cognitive-behavioral stress management (CBSM) interventions aim to improve patients’ skills in coping with stress and buffer against the negative effects of cancer.

Objectives

This meta-analysis aimed to demonstrate the impact of CBSM on breast cancer patients.

Methods

We searched PubMed, EMBASE, the Cochrane Database, ScienceDirect, MEDLINE, CENTRAL, CINAHL, and PsycNET for randomized controlled trials (RCTs) published up to November 21, 2017. We then performed a meta-analysis of RCTs that compared CBSM for patients with breast cancer with a 1-day psychoeducation seminar, wait-list controls, or standard care.

Results

Eighteen RCTs with 2564 participants were ultimately included. The results showed that CBSM can increase Measure of Current Status relaxation scores, benefit finding, and positive affect and decrease serum cortisol, anxiety, depression, thought avoidance and intrusion, and negative mood. However, it appears to have no effect on stress or mood disturbance.

Conclusions

Cognitive-behavioral stress management appears to be beneficial for breast cancer patients. Further high-quality RCTs are needed to clarify if any other factors are influenced by CBSM intervention.

Implications for Practice

Cognitive-behavioral stress management can help breast cancer patients develop skills to increase relaxation, benefit finding, and positive affect; CBSM may provide a buffer against the negative effects of cancer. Further, CBSM may help breast cancer patients replace negative thoughts, improve their thought processes and behaviors, and maintain social support using cognitive and interpersonal coping skills. Nurses should be aware of the benefits of CBSM in their day-to-day care of breast cancer patients.
Impact of a Standardized Patient Simulation on Behavioral Health Nurse Resident Confidence and Satisfaction in Learning
Authors: Haskell Brittany , Thul Susan
Published: March 2020

The transition from student nurse to nurse graduate can be overwhelming. Although nurse residency programs ease this transition, standardized patient (SP) simulations supplementing these programs are underutilized. An SP simulation series was created and imbedded into a behavioral health nurse residency program. Nurse residents were satisfied with the learning experience and gained self-confidence, which was sustained over 30 days. Staff development educators should consider supplementing a nurse residency program with an SP simulation to hone behavioral health clinical skill application.
An Innovative Action-Learning Plan Designed for the Struggling Orientee
Authors: Mathen Gracy C. , Hoke Linda M.
Published: March 2020

When an orientee is struggling, early identification and intervention is key. Implementing an action-learning plan refocuses the orientee, placing the accountability on them, targeting specific areas that will develop them as a competent nurse. The action-learning plan factors in holistic measures that help the orientee in processing their experience. The action-learning plan can be individualized to any unit and organization.
Pubic Hair Grooming and Sexually Transmitted Infections: A Clinic-Based Cross-Sectional Survey
Authors: Gaither Thomas W. , Fergus Kirkpatrick , Sutcliffe Siobhan , Cedars Benjamin , Enriquez Anthony , Lee Austin , Mmonu Nnenaya , Cohen Stephanie , Breyer Benjamin
Published: March 2020

Background

Pubic hair grooming has been correlated with a self-reported history of sexually transmitted infections (STIs). We examined this relationship further in a cross-sectional survey of patients attending an urban STI clinic in San Francisco in 2018.

Methods

Pubic hair grooming practices and detailed sexual histories were obtained. Sexually transmitted infections were confirmed via laboratory diagnosis or physical examination by a licensed provider.

Results

A total of 314 individuals completed the survey. The median age of participants was 31 years. In total, there were 247 (80%) men, 58 (19%) women, and 5 (2%) transgender participants. Of the 247 men, 177 (72%) identified as gay or bisexual. Twenty-five (82%) of 314 patients reported pubic hair grooming within the past 3 months. Seventy-eight (25%) patients were diagnosed with a new STI during their visit. There were no significant associations between reporting any anal or genital grooming and being diagnosed with an STI. However, anal groomers were 3 times as likely to be diagnosed with a rectal STI after adjustment (adjusted odds ratio, 3.0; 95% confidence interval, 1.2–7.5) compared with genital only groomers and nongroomers. Participants who report removing all of their pubic hair more than 6 times within the past year had higher prevalence of genital STIs (33.3%, 6–10 times; 28.6%, >10 times) compared with participants who never groom all of their pubic hair (15.3%, P = 0.01).

Conclusions

We found no association between recent grooming and genital STIs. Anal grooming was associated with rectal STIs in gay and bisexual men.
The Utility of Perilipin in Liposarcomas: PLIN1 Differentiates Round Cell Liposarcoma From Other Round Cell Sarcomas
Authors: Compton Margaret L. , Al-Rohil Rami N.
Published: March 2020

Liposarcoma is the most common soft tissue sarcoma in adults; however, accurate diagnosis often depends on the use of ancillary molecular testing which can be time consuming and expensive. Myxoid/round cell liposarcoma may be a diagnostic challenge due to the morphologic similarities with other nonadipocytic sarcomas with round cell morphology. Immunohistochemistry may be a helpful adjunct to appropriately triage cases for molecular testing. Perilipin 1 (PLIN1) and perilipin 2 (adipophilin) (PLIN2) are intracellular proteins involved in lipid droplet formation, which we hypothesized may be useful as immunohistochemical markers for liposarcoma. Using archival tumor tissue, we assessed pattern of PLIN1 and PLIN2 expression in 46 adipocytic tumors and 36 nonadipocytic sarcomas. PLIN1 was expressed in 88% of liposarcomas, including 100% of myxoid/round cell liposarcomas, and did not have any expression in nonadipocytic sarcomas. PLIN1 was not expressed in dedifferentiated liposarcoma. Although PLIN2 demonstrates increased sensitivity for liposarcoma, including expression in dedifferentiated liposarcoma, it is not specific for adipocytic differentiation and is expressed in other nonadipocytic sarcomas. Furthermore, PLIN2 is not expressed in lipoma-like well-differentiated liposarcoma, and as such has limited diagnostic utility.
Spectrum of Hepatic Manifestations of Common Variable Immunodeficiency
Authors: Crotty Rory , Taylor Martin S. , Farmer Jocelyn R. , Kakar Sanjay , Yilmaz Funda , Ardeniz Ömür , Patil Deepa T. , Deshpande Vikram
Published: March 2020

Common variable immunodeficiency (CVID) has a heterogenous clinical presentation and can be challenging to diagnose. Distinct histologic changes have been linked with CVID in several organ systems, which can help identify the correct diagnosis. In this study we review a cohort of hepatic CVID biopsies, to better define the spectrum of histologic and biochemical alterations. We reviewed 26 liver biopsies from 24 patients with CVID, obtained at 4 institutions between 2010 and 2019. Histologic slides were examined, and pathologic, biochemical, and clinical features were recorded. A control cohort of 21 patients with nodular regenerative hyperplasia (NRH) but lacking CVID was also examined. Liver function tests were frequently abnormal, especially alkaline phosphatase (median: 193 IU/L) and aspartate transaminase (median: 56 U/L), elevated in 23 and 17 of 25 biopsies, respectively. Fifteen patients had CVID involvement of other organs. Histologic features of primary biliary cholangitis were present in 2 patients, with florid duct lesions and prominent bile duct injury, in association with positive antimitochondrial antibodies. Among the other 24 biopsies, mild to moderate portal and lobular inflammation were present in 18 and 17 of 24 biopsies, respectively. Overall, 22 of 24 biopsies showed NRH-like changes. Plasma cell were absent. A distinct pattern of pericellular fibrosis was present in 23 of 26 biopsies overall. Involvement ranged from focal centrizonal fibrosis to bridging fibrosis and was accompanied by increased intrasinusoidal lymphocytes in 13 of 24 biopsies. Pericellular fibrosis was identified in 1 of 21 biopsies in the control cohort. Additional findings included granulomatous inflammation or nonhepatocellular foreign body-type multinucleate giant cells, identified in 4 biopsies. Three of 6 examined biopsies also demonstrated focal hepatocellular copper deposition. Hepatic disease in CVID is often associated with elevated alkaline phosphatase and aspartate transaminase and is characterized histologically by the mild nonspecific portal and lobular hepatitis, absence of plasma cells, NRH-like changes, and less commonly, typical histologic features of primary biliary cholangitis. We have also identified a distinctive pattern of delicate pericellular fibrosis that is a helpful clue to the diagnosis of hepatic disease in CVID, especially when accompanied by NRH-like changes.
SRF-FOXO1 and SRF-NCOA1 Fusion Genes Delineate a Distinctive Subset of Well-differentiated Rhabdomyosarcoma
Authors: Karanian Marie , Pissaloux Daniel , Gomez-Brouchet Anne , Chevenet Carole , Le Loarer François , Fernandez Carla , Minard Veronique , Corradini Nadege , Castex Marie-Pierre , Duc-Gallet Adeline , Blay Jean-Yves , Tirode Franck
Published: March 2020

Rhabdomyosarcoma (RMS) encompasses a heterogenous collection of tumors in which new groups have recently been identified that improved the World Health Organization (WHO) classification. While performing RNA-sequencing in our routine practice, we identified 3 cases of well-differentiated RMS harboring new fusion genes. We also analyzed these tumors through array-comparative genomic hybridization. Clinically, these tumors were deep paraspinal tumors, occurring in neo-nat and young children. The patients underwent resection and adjuvant therapy. At the time of last follow-up (ranging from 12 to 108 mo), they were alive without disease. Histologically, these tumors consisted of well-differentiated rhabdomyoblastic proliferations with nuclear atypia, infiltrative borders, and a specific growth pattern. These tumors harbored new fusion genes involvingSRFand eitherFOXO1orNCOA1. We compared the expression profiles of these 3 tumors to the expression data of a series of 33 skeletal muscle tumors including embryonal RMSs, alveolar rhandomyosarcomas, RMSs withVGLL2fusions, RMSs with themyoD1mutation,EWSR1/FUS-TFCP2epithelioid and spindle cell RMSs of the bone, and rhabdomyomas withPTCH1loss. According to clustering analyses, the 3SRF-fused tumors formed a distinct group with a specific expression profile different from that of the other types of skeletal muscle tumors. Array-comparative genomic hybridization showed a recurrent gain of chromosome 11. These 3 tumors define a new group of RMS associated with a fusion of theSRFgene.FOXO1rearrangements, usually used to confirm the diagnosis of alveolar RMS and identify poor-outcome RMSs, were identified in a nonalveolar RMS for the first time.
Day-of-Injury Computed Tomography and Longitudinal Rehabilitation Outcomes
Authors: Frodsham Kayla M. , Fair Joseph E. , Frost R. Brock , Hopkins Ramona O. , Bigler Erin D. , Majercik Sarah , Bledsoe Joseph , Ryser David , MacDonald Joel , Barrett Ryan , Horn Susan D. , Pisani David , Stevens Mark , Larson Michael J.
Published: March 2020

Objective

The aim of the study was to compare the relative predictive value of Marshall Classification System and Rotterdam scores on long-term rehabilitation outcomes. This study hypothesized that Rotterdam would outperform Marshall Classification System.

Design

The study used an observational cohort design with a consecutive sample of 88 participants (25 females, mean age = 42.0 [SD = 21.3]) with moderate to severe traumatic brain injury who were admitted to trauma service with subsequent transfer to the rehabilitation unit between February 2009 and July 2011 and who had clearly readable computed tomography scans. Twenty-three participants did not return for the 9-mo postdischarge follow-up. Day-of-injury computed tomography images were scored using both Marshall Classification System and Rotterdam criteria by two independent raters, blind to outcomes. Functional outcomes were measured by length of stay in rehabilitation and the cognitive and motor subscales of the Functional Independence Measure at rehabilitation discharge and 9-mo postdischarge follow-up.

Results

Neither Marshall Classification System nor Rotterdam scales as a whole significantly predicted Functional Independence Measure motor or cognitive outcomes at discharge or 9-mo follow-up. Both scales, however, predicted length of stay in rehabilitation. Specific Marshall scores (3 and 6) and Rotterdam scores (5 and 6) significantly predicted subacute outcomes such as Functional Independence Measure cognitive at discharge from rehabilitation and length of stay.

Conclusions

Marshall Classification System and Rotterdam scales may have limited utility in predicting long-term functional outcome, but specific Marshall and Rotterdam scores, primarily linked to increased severity and intracranial pressure, may predict subacute outcomes.
Identifying and Monitoring Deficiencies in Physical Examination of the Foot and Ankle With Diagnostic Ultrasound
Authors: Bitterman Jason , Oh-Park Mooyeon , Lew Henry L. , Ma Rex T.
Published: March 2020

Despite the high incidence of foot and ankle injuries and their biomechanical importance to more proximal joints, the foot and ankle are some of the most daunting and underemphasized musculoskeletal structures in medical training. This study used musculoskeletal ultrasound to identify a knowledge gap in physical medicine and rehabilitation residents in foot and ankle surface anatomy palpation and to determine whether senior residents had higher examination performance compared with more junior residents. Physical medicine and rehabilitation residents at different levels of training were tested cross-sectionally, and palpation accuracy was compared by class year. There was a trend of improvement across class years, with significant class differences in accuracy for the talonavicular joint, calcaneocuboidal joint, and posterior tibialis and peroneal tendons (P < 0.05). Despite this trend, the accuracy was not consistently higher among the senior residents considering the training they received. For all 30 residents assessed, accuracy within 1 cm was highest for the tibiotalar joint (93.3%), peroneal tendons (83.3%), posterior tibialis tendon (63.3%), and talonavicular joint (50%). It was lower for the calcaneocuboidal joint (26.7%) and the second (13.3%) and fourth for the tarsometatarsal joints (20%). Anatomical knowledge and palpation skills of the foot and ankle, particularly at the midfoot and forefoot, may be an area of improvement for physical medicine and rehabilitation resident training.
An Evaluation of the Utility of the Breast Reconstruction Risk Assessment Score Risk Model in Prepectoral Tissue Expander Breast Reconstruction
Authors: Martin Shanique , Turner Elizabeth , Nguyen Alan , Thornton Brian , Nazerali Rahim S.
Published: March 2020

Introduction

Individualized postsurgical risk assessment models provide surgeons and patients with information that is vital to the surgical decision-making process. One such tool, the Breast Reconstruction Risk Assessment (BRA) score, uses a limited selection of patient-specific factors to predict 30-day postsurgical risk of surgical site infection, seroma, dehiscence, reoperation and explantation associated with immediate submuscular tissue expander breast reconstruction. This model's performance in prepectoral tissue expander reconstruction has not been previously reported. Here, we evaluate the performance of the BRA score model in a population of patients who underwent immediate prepectoral tissue expander breast reconstruction.

Materials and Methods

A retrospective chart review was conducted of prepectoral breast reconstructions performed in 2 institutions between January 2017 and December 2018. Complications occurring within 30 days postoperatively were documented and compared with the BRA score predicted risk for each patient.

Results

Overall 247 patients (average age, 49.2 years) were included in the study. The mean BRA score predicted 30-day risk of a complication was 13.0% (7.5–41.5%). The observed rate of 30-day postoperative complications was 31.2% (77 patients), though only 36 (14.6%) patients had complications included in the model. The remaining patients experienced skin necrosis or hematoma as their only early complication. The 30-day BRA score model demonstrated good fit for the overall occurrence of any of the BRA score predicted complications (Hosmer-Lemeshow 0.7167), though the model discrimination was poor (C statistic <0.60). Notably, half of the 30-day postsurgical complications observed in this study were due to skin necrosis, a complication not currently included in the 30-day BRA score model.

Conclusions

Our results indicate that the current 30-day BRA score model may have poor predictive value in prepectoral breast reconstruction. The most common early complication observed, skin necrosis, is not currently included in the model, suggesting that caution should be applied when using this risk predictive calculator as an adjunct to patient evaluation and counseling.
Soft Tissue Contouring at the Time of Osseointegrated Implant Reconstruction for Lower Extremity Amputation
Authors: Marano Andrew A. , Modiri Omeed , Rozbruch S Robert , Otterburn David M.
Published: March 2020

Introduction

Patients with lower extremity amputations using a classic socket prosthesis face many challenges related to the socket-limb interface. The adaptation of osseointegration has allowed for the attachment of a prosthesis directly to bone, eliminating this interface and providing mechanical benefits. Contrary to the socket prosthesis, the osseointegrated prosthesis requires reducing and minimizing the soft tissue envelope. Studies have shown that patients who have undergone placement of these implants have high rates of reoperation for soft tissue redundancy. The purpose of our study was to evaluate complication rates and need for revisional surgery using our technique of soft tissue closure around the prosthesis at the time of implant placement.

Methods

An institutional review board–approved, retrospective chart review was performed on all patients who underwent implantation of an osseointegrated prosthesis for lower extremity amputation with concomitant plastic surgery closure at our institution during a 2-year period from June 2017 to June 2019. Patient demographics, health status descriptors, operative data, length of admission, and rates of postoperative complications were gathered from the electronic medical record and coded into a HIPAA-compliant database. Specific outcomes tracked included minor and major infection, osteomyelitis, implant failure, hematoma, seroma, delayed wound healing, and rates of reoperation and readmission.

Results

There were a total of 14 patients who underwent osseointegrated implant placement with concomitant plastic surgical coverage of the prosthesis during the study period. The average patient age was 50 years (range, 26–70 years), and average body mass index was 32.2 kg/m2 (range, 19.7–44.8 kg/m2). Average follow-up time was 28 weeks (range, 10–73 weeks). There were 2 cases of local infection resolved with a course of oral antibiotics. There were no instances of infection requiring procedural intervention or hospital admission, nor any cases of osteomyelitis. Two patients required outpatient surgery for exchange of implant abutment, one required revision of a prosthesis for hardware loosening, and one required targeted muscle reinnervation of a sciatic nerve neuroma. There were no patients who required revisional surgery for soft tissue redundancy and no cases of delayed wound healing.

Conclusions

Adequate planning of incisions and soft tissue contouring is important in the care of osseointegrated patients. Plastic surgery involvement can decrease soft tissue complications and lead to improved patient outcomes.
Weight Outcomes of Sleeve Gastrectomy and Gastric Bypass Compared to Nonsurgical Treatment
Authors: Arterburn David E. , Johnson Eric , Coleman Karen J. , Herrinton Lisa J. , Courcoulas Anita P. , Fisher David , Li Robert A. , Theis Mary Kay , Liu Liyan , Fraser James R. , Haneuse Sebastien
Published: March 2020

Objective:

To investigate weight trajectories among patients with severe obesity undergoing sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and nonsurgical treatment.

Background:

Although bariatric procedures are associated with substantial weight loss, few studies have compared surgical outcomes to nonsurgical treatment, particularly for SG.

Methods:

In this retrospective, matched cohort study, adult patients with body mass index ≥35 kg/m2 who underwent RYGB or SG procedures from January 2005 through September 2015 were matched to 87,965 nonsurgical patients. Hierarchical linear models were used to investigate percent total weight loss (%TWL) and regain at 5 years among RYGB, SG, and nonsurgical patients, and at 10 years for RYGB and nonsurgical patients.

Results:

Among 13,900 SG, 17,258 RYGB, and 87,965 nonsurgical patients, the 5-year follow-up rate was 70.9%, 72.0%, and 64.5%, respectively. At 1 year, RYGB patients had 28.4%TWL (95% confidence interval: 28.2, 28.5), SG 23.0%TWL (22.8, 23.2), and nonsurgical patients 0.2%TWL (0.1, 0.4). At 5 years, RYGB had 21.7%TWL (21.5, 22.0), SG 16.0%TWL (15.4, 16.6), and nonsurgical patients 2.2%TWL (2.0, 2.5). After 5 years, 3.7% of RYGB and 10.1% of SG patients had regained weight to within 5% of baseline. At 10 years, RYGB patients had 20.2%TWL (19.3, 21.0) and nonsurgical patients 4.8%TWL (4.0, 5.5).

Conclusions:

In this study, patients with severe obesity who underwent SG and RYGB lost significantly more weight at 5 years than nonsurgical patients. Weight regain was common after surgery but regain to within 5% of baseline was rare.
Long-term Comparison of Robotic and Laparoscopic Gastrectomy for Gastric Cancer
Authors: Shin Ho-Jung , Son Sang-Yong , Wang Bo , Roh Chul Kyu , Hur Hoon , Han Sang-Uk
Published: March 2020

Objective:

To compare long-term outcomes between robotic and LG approaches using propensity score weighting based on a generalized boosted method to control for selection bias.

Summary of Background Data:

Minimally invasive surgical approaches for GC are increasing, yet limited evidence exists for long-term outcomes of robotic gastrectomy (RG).

Methods:

Patients (n = 2084) with GC stages I-III who underwent LG or RG between 2009 and 2017 were analyzed. Generalized boosted method was used to estimate a propensity score derived from all available preoperative characteristics. Long-term outcomes were compared using the adjusted Kaplan-Meier method and the weighted Cox proportional hazards regression model.

Results:

After propensity score weighting, the population was balanced. Patients who underwent RG showed reduced blood loss (16 mL less, P = 0.025), sufficient lymph node harvest from the initial period, and no changes in surgical outcomes over time. With 52-month median follow-up, no difference was noted in 5-year overall survival in unweighted [91.5% in LG vs 94% in RG; hazard ratio (HR), 0.71; 95% confidence interval (CI), 0.46–1.1; P = 0.126] and weighted populations (94.2% in LG vs 93.2% in RG; HR, 0.88; 95% CI, 0.52–1.48; P = 0.636). There were no differences in 5-year recurrence-free survival (RFS), with unweighted 5-year RFS of 95.4% for LG and 95.2% for RG (HR, 0.95; 95% CI, 0.55–1.64; P = 0.845) and weighted 5-year RFS of 96.3% for LG and 95.3% for RG (HR, 1.24; 95% CI, 0.66–2.33; P = 0.498).

Conclusions:

After balancing covariates, RG demonstrated reliable surgical outcomes from the beginning. Long-term survival after RG and LG for GC was similar.
Mediators of Socioeconomic Inequity in Living-donor Kidney Transplantation: Results From a UK Multicenter Case-Control Study
Authors: Bailey Pippa K. , Caskey Fergus J. , MacNeill Stephanie , Tomson Charles R.V. , Dor Frank J.M.F. , Ben-Shlomo Yoav
Published: March 2020

Background.

There is evidence of socioeconomic inequity in access to living-donor kidney transplantation, but limited evidence as to why. We investigated possible mediators of the inequity.

Methods.

This questionnaire-based case-control study included 14 UK hospitals. Participants were adults transplanted between April 1, 2013 and March 31, 2017. Living-donor kidney transplant (LDKT) recipients (cases) were compared with deceased-donor kidney transplant recipients (controls). We collected data on mediators identified in earlier qualitative work: perceived social support (Interpersonal Support Evaluation List shortened version-12), patient activation (Patient Activation Measure 13), and LDKT knowledge (Rotterdam Renal Replacement Knowledge Test). We performed mediation analyses to investigate what proportion of the effect of socioeconomic position (education and income) on case-control status was mediated by these variables.

Results.

One thousand two-hundred and forty questionnaires were returned (40% response). Receipt of an LDKT over a deceased-donor kidney transplant was associated with higher socioeconomic position [adjusted odds ratio (aOR) university degree versus no degree aOR = 1.48 (95% confidence interval [CI], 1.18-1.84), P = 0.001 and aOR per +£1000 increase in monthly household income after tax 1.14 (95% CI, 1.11-1.17), P < 0.001] higher perceived social support (aOR per +1-point Interpersonal Support Evaluation List shortened version-12 score = 1.05 (95% CI, 1.03-1.08), P < 0.001), higher levels of patient activation (aOR per +1 patient activation measure level = 1.35 (95% CI, 1.24-1.48), P < 0.001), and greater LDKT knowledge (aOR per + 1-point Rotterdam Renal Replacement Knowledge Test score = 1.59 (95% CI, 1.49-1.69), P < 0.001). Mediation analyses revealed that perceived social support, patient activation, and LDKT knowledge together mediate 48.5% (95% CI, 12.7-84.3, P = 0.008) of the association between university education and LDKT status, and 46.0% (95% CI, 28.7-63.4, P < 0.001) of the association between income and LDKT status.

Conclusions.

LDKT knowledge, perceived social support, and patient activation are associated with the socioeconomic position of people with kidney disease, and mediate approximately 50% of the association between the socioeconomic position and receipt of an LDKT. Interventions that target these factors may redress observed socioeconomic inequity.
The longer the better: evidence that narwhal tusks are sexually selected
Authors: Graham Zackary A. , Garde Eva , Heide-Jørgensen Mads Peter , Palaoro Alexandre V.
Published: March 2020

Once thought to be the magical horn of a unicorn, narwhal tusks are one of the most charismatic structures in biology. Despite years of speculation, little is known about the tusk's function, because narwhals spend most of their lives hidden underneath the Arctic ice. Some hypotheses propose that the tusk has sexual functions as a weapon or as a signal. By contrast, other hypotheses propose that the tusk functions as an environmental sensor. Since assessing the tusks function in nature is difficult, we can use the morphological relationships of tusk size with body size to understand this mysterious trait. To do so, we collected morphology data on 245 adult male narwhals over the course of 35 years. Based on the disproportional growth and large variation in tusk length we found, we provide the best evidence to date that narwhal tusks are indeed sexually selected. By combining our results on tusk scaling with known material properties of the tusk, we suggest that the narwhal tusk is a sexually selected signal that is used during male–male contests.
The role of mural mechanics on cephalopod palaeoecology
Authors: Lemanis Robert , Stier Deborah , Zlotnikov Igor , Zaslansky Paul , Fuchs Dirk
Published: March 2020

Cephalopods transformed the molluscan shell into a buoyancy device that must be strong enough to resist external water pressure. Historically, unique features of the shell have been interpreted on the basis that the strength of the shell presents a hard limit on maximum habitat depth. One such feature is the mural flap, which is a semi-prismatic layer deposited on the inner surface of some coleoid septa that has been suggested to strengthen the shell and permit colonization of deeper waters. We test this hypothesis by constructing finite-element models that show how mural modifications affect the response of the shell to hydrostatic pressure. The mural flaps are found to have no notable structural function. Another mural modification discovered here is the adapical ridge flap that initially seemed to have a potential function in shifting peak stress away from the attachment site of the septum; however, the irregular distribution of this feature casts any functional interpretation in doubt. Ecological separation of belemnites and decabrachians is likely not mediated by the presence/absence of mural flaps. This work illustrates a potential caveat that not all unique septal features formed in response to increasing hydrostatic pressure and deeper habitats.
Slip-spring simulations of different constraint release environments for linear polymer chains
Authors: Ma Teng , Lin Guochang , Tan Huifeng
Published: March 2020

The constraint release (CR) mechanism has important effects on polymer relaxation and the chains will show different relaxation behaviour in conditions of monodisperse, bidisperse and other topological environments. By comparing relaxation data of linear polyisoprene (PI) chains dissolved in very long matrix and monodisperse melts, Matsumiya
et al.
showed that CR mechanism accelerates both dielectric and viscoelastic relaxation (Matsumiya
et al.
2013
Macromolecules
46
, 6067. (
doi:10.1021/ma400606n
)). In this work, the experimental data reported by Matsumiya
et al.
are reproduced using the single slip-spring (SSp) model and the CR accelerating effects on both dielectric and viscoelastic relaxation are validated by simulations. This effect on viscoelastic relaxation is more pronounced. The coincidence for end-to-end relaxation and the viscoelastic relaxation has also been checked using probe version SSp model. A variant of SSp with each entanglement assigning a characteristic lifetime is also proposed to simulate various CR environment flexibly. Using this lifetime version SSp model, the correct relaxation function can be obtained with equal numbers of entanglement destructions by CR and reptation/contour length fluctuation (CLF) for monodisperse melts. Good agreement with published experiment data is also obtained for bidisperse melts, which validates the ability to correctly describe the CR environment of the lifetime version model.
Critical slowing down associated with critical transition and risk of collapse in crypto-currency
Authors: Tu Chengyi , D'Odorico Paolo , Suweis Samir
Published: March 2020

The year 2017 saw the rise and fall of the crypto-currency market, followed by high variability in the price of all crypto-currencies. In this work, we study the abrupt transition in crypto-currency residuals, which is associated with the critical transition (the phenomenon of critical slowing down) or the stochastic transition phenomena. We find that, regardless of the specific crypto-currency or rolling window size, the autocorrelation always fluctuates around a high value, while the standard deviation increases monotonically. Therefore, while the autocorrelation does not display the signals of critical slowing down, the standard deviation can be used to anticipate critical or stochastic transitions. In particular, we have detected two sudden jumps in the standard deviation, in the second quarter of 2017 and at the beginning of 2018, which could have served as the early warning signals of two major price collapses that have happened in the following periods. We finally propose a mean-field phenomenological model for the price of crypto-currency to show how the use of the standard deviation of the residuals is a better leading indicator of the collapse in price than the time-series' autocorrelation. Our findings represent a first step towards a better diagnostic of the risk of critical transition in the price and/or volume of crypto-currencies.
Interaction mechanisms quantified from dynamical features of frog choruses
Authors: Ota Kaiichiro , Aihara Ikkyu , Aoyagi Toshio
Published: March 2020

We employ a mathematical model (a phase oscillator model) to describe the deterministic and stochastic features of frog choruses in which male frogs attempt to avoid call overlaps. The mathematical model with a general interaction term is identified using a Bayesian approach, and it qualitatively reproduces the stationary and dynamical features of the empirical data. In addition, we quantify the magnitude of attention paid among the male frogs from the identified model, and then analyse the relationship between attention and behavioural parameters using a statistical approach. Our analysis demonstrates a negative correlation between attention and inter-frog distance, and also suggests a behavioural strategy in which male frogs selectively attend to a less attractive male frog (i.e. a male producing calls at longer intervals) in order to more effectively advertise their superior relative attractiveness to females.
Genotype-environment interaction and the maintenance of genetic variation: an empirical study ofLobelia inflata(Campanulaceae)
Authors: Côté Kristen , Simons Andrew M.
Published: March 2020

High levels of genetic variation are often observed in natural populations, suggesting the action of processes such as frequency-dependent selection, heterozygote advantage and variable selection. However, the maintenance of genetic variation in fitness-related traits remains incompletely explained. The extent of genetic variation in obligately self-fertilizing populations ofLobelia inflata(Campanulaceae L.) strongly implies balancing selection.Lobelia inflatathus offers an exceptional opportunity for an empirical test of genotype-environment interaction (G × E) as a variance-maintaining mechanism under fluctuating selection:L. inflatais monocarpic and reproduces only by seed, facilitating assessment of lifetime fitness; genome-wide homozygosity precludes some mechanisms of balancing selection, and microsatellites are, in effect, genotypic lineage markers. Here, we find support for the temporal G × E hypothesis using a manipulated space-for-time approach across four environments: a field environment, an outdoor experimental plot and two differing growth-chamber environments. High genetic variance was confirmed: 83 field-collected individuals consisted of 45 distinct microsatellite lineages with, on average, 4.5 alleles per locus. Rank-order fitness, measured as lifetime fruit production in 16 replicated multilocus genotypes, changed significantly across environments. Phenotypic differences among microsatellite lineages were detected. Results thus support the G × E hypothesis in principle. However, the evaluation of the effect size of this mechanism and fitness effects of life-history traits will require a long-term study of fluctuating selection on labelled genotypes in the field.
Multi-level modelling of time-series cross-sectional data reveals the dynamic interaction between ecological threats and democratic development
Authors: Kusano Kodai , Kemmelmeier Markus
Published: March 2020

What is the relationship between environment and democracy? The framework of cultural evolution suggests that societal development is an adaptation to ecological threats. Pertinent theories assume that democracy emerges as societies adapt to ecological factors such as higher economic wealth, lower pathogen threats, less demanding climates and fewer natural disasters. However, previous research confused within-country processes with between-country processes and erroneously interpreted between-country findings as if they generalize to within-country mechanisms. We analyse a time-series cross-sectional dataset to study the dynamic relationship between environment and democracy (1949–2016), accounting for previous misconceptions in levels of analysis. By separating within-country processes from between-country processes, we find that the relationship between environment and democracy not only differs by country but also depends on the level of analysis. Economic wealth predicts increasing levels of democracy in between-country comparisons, but within-country comparisons show that democracy declines in years when countries become wealthier. This relationship is only prevalent among historically wealthy countries but not among historically poor countries, whose wealth also increased over time. By contrast, pathogen prevalence predicts lower levels of democracy in both between-country and within-country comparisons. Multi-level modelling also confirms that the within-country effect of pathogen prevalence remains robust even after considering a region-level analysis. Longitudinal analyses identifying temporal precedence reveal that not only reductions in pathogen prevalence drive future democracy, but also democracy reduces future pathogen prevalence and increases future wealth. These nuanced results contrast with previous analyses using narrow, cross-sectional data. Overall, our findings illuminate the dynamic process by which environment and democracy shape each other.