bluuebunny/crossref_metadata_2025 huggingface dataset:
Immigration and European Politics
Authors: Goodman Sara Wallace
Published: November 2019

Immigration is among the most transformative experiences of postwar Europe. It has reoriented political parties, restructured the European party system, and given birth to new political parties, namely far-right exclusionary populist parties. Alongside these political changes, immigration presents innumerable social and economic challenges that have forced political elites to face hard questions about national belonging, economic growth, and demographic realities in aging nation-states. Reflecting the scale of this challenge, there are several branches of scholarship that strive to understanding and contextualize immigration in the European political landscape. There are three, general areas of immigration-related fields: immigration policy, immigration politics, and migrant politics. Immigration policy studies examine the rules and procedures that facilitate the entry, settlement, integration, and citizenship of a migrant. This is an admittedly maximalist definition—one can reserve the term “immigration policy” merely to the process and dynamics of admission. Yet, the reality of immigrant-related policy design and implementation shows policies as joined-up, aligned, and mutually reinforcing. As such, “immigration policy” incorporates all policies that address the condition of and consequences of migration. This body of work traditionally examines political, economic, and social determinants of policy and the effects of immigration policy on a variety of attitudinal and behavior outcomes, among both immigrant and native populations. The second group of scholarship looks at immigration politics. This body of work considers how political parties and elections structure and mobilize around immigration issues and saliency. Work within this strand may range from studying public opinion and electoral data to interviews that capture elite or other stakeholder (e.g., firm) preferences. This strand stretches across multiple levels of analysis, from the very local—like neighborhoods and city blocks, to regions, to national politics, to the supranational European Union. A final strand of literature looks at migrant politics. These are studies that look specifically at the formation of political identity, migrant political behavior, and migrant representation. Of course, these three strands of immigration studies are not mutually exclusive and often overlap, e.g., studies on how policies affect immigrant political behavior. Immigration politics is a critical factor shaping domestic politics and foreign policy alike. As immigration continues to fundamentally transform the European political space—immigration from both within Europe and without—we identify a number of critical pieces that help shape our understanding of this transition here to which scholars that seek to understand European politics today ignore at their own peril.
Organizing for Continuous Improvement in Education
Authors: Cohen-Vogel Lora , Harrison Christopher , Rauch Griffard Megan
Published: November 2019

In education, the organization of continuous improvement refers to the structure of social relations between subgroups and institutions working to integrate quality improvement into the daily lives of individuals within the PreK-16 education system. On its own, the term social organization generally refers to patterns of relationships both among and between individuals and groups that persist over time, are interrelated, and affect the operations of the entity as well as the actions of its individual members. In a broad sense, organizations engaged in continuous improvement draw from two theories of organizational learning: Englebart’s stratified model of organizational improvement and Argyris’s single- and double-loop learning. These organizations engage in improvement work with regularity, infusing it into the day-to-day activities of members, and situating problems of practice as the naturally occurring outputs of a system as its currently designed. This article provides an overview of the research on the social organization of continuous improvement in education, highlighting selections that inform how the structures through which people interact enhance or inhibit organizational learning. Organized into nine sections, the article begins with a general overview with key selections from organizational studies and closely related fields that inform today’s understanding of improvement-focused organizations. The second section covers early, seminal texts that apply ideas about organizational learning to educational systems. Next are sections related to the organizational forms in which improvement work in education is occurring: research-practice partnerships; research alliances; networked improvement communities; designed-based research collaboratives; interagency restructuring; and individual schools as improvement organizations. The final section focuses on what’s known about how to lead organizations engaged in continuous improvement. The citations, though not exhaustive, provide a comprehensive overview of the topic and provide an entry point for those looking build or study improvement-focused organizations in education. Citations have been included because of their significance in the field and the lessons they hold for their readers.
Carl Maria von Weber
Authors: Morgan Joseph E.
Published: November 2019

With a career that began at the end of the Napoleonic Wars, just as a concept of a unified German identity was emerging, Carl Maria von Weber (b. 1786–d. 1826) earned a great deal of fame writing songs for soldiers and students. Since then, Weber’s three late operas, and specifically his Der Freischütz (1821), have long been recognized as central to a narrative surrounding the emergence of a German operatic style. Indeed, Richard Wagner recognized Weber’s influence in his own writings, and later, the hyper-nationalistic elements of Germany laid great credence to that influence in their conception of a culturally superior German art and culture. However, in the late 20th century, critics started to isolate and study the aspects of Weber’s style that he had borrowed from foreign cultures. One particularly striking example is Weber’s adoption of the traditional formal conventions of the Italian Scena (Basevi’s la solita forma) in the 19th century. Despite Weber’s own overt statements against the Italian style, scholars have noted the clear influence of Italian opera on his works. Similarly, many of the very elements that would be cited as prototypically German in Weber’s works—the systems of thematic reference and motivic organization, the greater role of the orchestra in the texture, and the greater demands placed on the singer in terms of volume—are all increasingly cited as French in origin. Thus, the historical understanding of who Weber was and the character of his nationalist identity remains in flux, and Der Freischütz, Euryanthe, and Oberon retain a place in the operatic repertoire. On the other hand, Weber’s prominence as a musician and composer of symphonies, chamber music, and German Art songs has undergone a different path of study. As an early Romantic composer of piano sonatas, linking the delicate ornamentation of Frédéric Chopin (b. 1810–d. 1849) with the Viennese classicism of Wolfgang Amadeus Mozart (b. 1756–d. 1791), Weber has maintained his position on the edge of the mainstream repertoire in this genre, too. His compositions for clarinet as well as his bassoon and horn concertos also remain important parts of those instruments’ repertoires. Yet perhaps his biggest exposure results from the performance of his operatic overtures on the concert stage. In all, looking at individual genres, Weber’s impact is easy to underestimate, but taken as a whole, as an accomplished composer, pianist, conductor, and writer, his works and career made a tremendous impact on classical music in the 19th century.
19th Century and Modernismo Poetry in Spanish America
Authors: Ruisánchez Serra José Ramón
Published: November 2019

The timeline of the long 19th century in Spanish America can be defined by different chronological benchmarks. While some historians mark its beginning with the expulsion of the Jesuits (1767) and the creation of the Viceroyalty of Río de la Plata (1776), others set its beginnings with the wars of independence (1791–1822). Historians also disagree on its ending. Some choose the end of the Mexican Revolution (1917), while others push further to the foundation of the Partido Nacional Revolucionario in Mexico, in 1929. For this entry, it is preferable to signal the beginning and end of 19th century in Latin America with milestones more closely related to poetry: 1805–1916. The former marks the publication of the first issue of El Diario de México, where the creations of the local Arcadia appeared while the latter marks the death of Rubén Darío and the first edition of Ramón López Velarde’s La sangre devota. Even within these strict chronological limits, offering a panoramic view of the poetry written throughout the continent is difficult. Before the advanced printing technologies that allowed the first truly massive newspapers to circulate in Buenos Aires and Mexico City that would spawn the advent of literary Modernismo, it is nearly impossible to speak of poets of true Pan American stature. Andrés Bello (b. 1781–d. 1865) and José María Heredia (b. 1842–d. 1905) are the exception. These two poets exerted considerable influence as is evident in the importance that was granted to them in the first published anthology of Latin American Poetry, América poética 1846–1847, and even much later by Spanish philologist Marcelino Menéndez y Pelayo (b. 1856–d. 1912) in his four-volume anthology, Antología de poetas hispano-americanos publicada por la Real Academia Española 1893–1895. Generally, authors had considerable national and at times regional influence but rarely achieved continental recognition. Consequently, this disjointed geography leads to a very large number of critical studies dedicated to local spheres with very few satisfactorily going beyond the realm of the national. This absence reflects a period when the most pressing need was to create national differences.
Television Authorship
Authors: Hadas Leora
Published: November 2019

Unlike the well-established tradition of auteurism in its sibling art cinema, in the case of television, the question of authorship continues to be fraught: subject to contestations not only over who can be called the television author but over whether that author exists at all. The heavily collaborative and standardized nature of most television production has been a long-standing issue for discussions of authorship, which have often argued that the concept is not useful for analyzing television—putting emphasis instead on the polysemic television text—or else focused on the struggle for control and agency between creative practitioners and television networks. Two main strands that coalesced early on in scholarship locate the television author either in the producer or the writer, with additional early work on directors mostly reaching a dead end. Over time, the focus has shifted to invest authorship in a hyphenate writer-producer figure, and in the late 2010s, both academic and popular criticism is often concerned with the figure of the showrunner. While not an official title credit, it is this figure of the individual seen as exercising full creative control of a show that is now often celebrated or indeed critiqued as television’s auteur. In the United States, the study of television authorship can be broadly mapped onto ideas of periodization in television and is bound up with issues of quality, cult, and artistic legitimation. Moments and figures of frequent interest to scholars are the anthology writers of the “golden age”; the late 1970s emergence of MTM and Norman Lear’s work with Tandem Productions as early birds of “quality” television, as well as ideas of studio authorship and company style; the appearance of the showrunner concept in the mid-1990s with Dick Wolf and cult showrunners such as Joss Whedon; and the auteurist branding of HBO from 1999 (The Sopranos) onward, leading into ideas of a “second golden age” led by the showrunner as auteur. Today’s “Peak TV” period is characterized by interest in the position of the author in transmedia television, in questions of representation and diversity in television production, and in the complex relationships between producers and audiences in a digital participatory culture. In the United Kingdom, in the meantime, much scholarship has centered on particular historical “playwrights” in the mold of Dennis Potter, and the question of television authorship is bound up with questions of literary adaptation and high and low culture. Changes in modes of production of television globally are now opening up the field to broader interest in television writers and producers as authors, but research is still scarce.
Environmental Writing
Authors: Long Mark
Published: November 2019

Most environmental writing in the United States through the 20th century is entangled with the concept of nature—the commonplace idea of a space apart from the human world. In American environmental writing this idea of nature is reproduced in narratives of exploration and pastoral visions of the landscape during the colonial and early national periods; in 19th-century mythographies of the American frontier; and in 20th-century social movements dedicated to preservation and conservation. By the middle of the 19th century, environmental writers were working in forms, such as the nature essay, to record individual experiences of nature and investigate the local knowledge of place-based communities. However, by the middle of the 20th century, environmental writers began considering human life as a part of the nonhuman world. Through this conceptual lens, environmental writing becomes radically inclusive as writers explore natural habitats such as the human body, material exchanges and unfolding biological processes, and the social and economic ecologies of built and urban environments. At the same time, environmental writing has chronicled the global environmental crisis in the Anthropocene—an epoch in which the slow violence of environmental change, accelerated by expanding human populations and inexorable economic growth, becomes visible in deforestation, the loss of soils, species extinction, bioaccumulation, ocean acidification, toxic emissions, and climate change.
Internal Carotid Artery to Posterior Cerebral Artery Bypass for Fusiform Basilar Artery Aneurysm: 2-Dimensional Operative Video
Authors: Hendricks Benjamin K , Spetzler Robert F
Published: November 2019

Fusiform dolichoectatic basilar trunk aneurysms pose an immense surgical challenge because of the extremely eloquent tissue at risk during the procedure and the complex management strategies required to relieve mass effect on the brainstem. The patient presented in this case experienced progressive brainstem deterioration with quadraparesis and multiple cranial neuropathies. The patient underwent a modified orbitozygomatic craniotomy for visualization, and an end-to-side anastomosis between a radial artery interposition graft and the posterior cerebral artery was performed, followed by an end-to-side anastomosis of the interposition graft to the intracranial internal carotid artery. A permanent clip was applied to the top of the basilar trunk to obliterate distal flow. Postoperative imaging demonstrated progressive thrombosis of the fusiform aneurysm. Basilar aneurysms represent challenging lesions for both microsurgical and endovascular treatments. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.
MODELLING AND SIMULATION FOR RADIOLOGICAL DOSE ASSESSMENT OF PSAMMOTHERAPY AND CLIMATOTHERPY
Authors: Allam Kh A
Published: November 2019

Patient and occupational dose rates due to psammotherapy (sand therapy) and climatotherapy treatments in high natural background areas in Egypt have been evaluated. Monte Carlo mathematical simulations using adult human phantoms were applied to consider the effect of elevated 238U, 232Th and 40K concentrations and the nonhomogeneous distribution of natural radionuclides in beach sand. Three situations: phantom covered by sand or lying on the beach and points in air at several heights above sand level, were considered. The gamma-ray doses per treatment were calculated at a reference point located on the phantom surface centrally above the genital area. The thus calculated patient-absorbed-dose ranges at this reference point were 0.006–0.018 mGy and 0.004–0.023 mGy per climatotherapy and psammotherapy treatments, respectively.
PERIPHERAL SURFACE DOSE FROM A LINEAR ACCELERATOR: RADIOCHROMIC FILM EXPERIMENTAL MEASUREMENTS OF FLATTENING FILTER FREE VERSUS FLATTENED BEAMS
Authors: García-Hernández Trinitat , Vicedo-González Aurora , Sánchez-Nieto Beatriz , Romero-Expósito Maite , Roselló-Ferrando Joan
Published: November 2019

There is a growing interest in the use of flattening filter free (FFF) beams due to the shorter treatment times. The reduction of head scatter suggests a better radiation protection to radiotherapy patients, considering the expected decrease in peripheral surface dose (PSD). In this work, PSD of flattened (FF) and FFF-photon beams was compared. A radiochromic film calibration method to reduce energy dependence was used. PSD was measured at distances from 2 to 50 cm to the field border for different square field sizes, modifying relevant clinical parameters. Also, clinical breast and prostate stereotactic body radiotherapy (SBRT) plans were studied. For square beams, FFF PSD is lower compared with FF PSD (differences ranging from 3 to 64%) and 10 MV FFF yields to the lowest value, for distances greater than 5 cm. For SBRT plans, near and far away from the field border, there is a reduction of PSD for FFF-beams, but the behavior at intermediate distances should be checked depending on the case.
Insolvent trusts—the Z Trusts litigation
Authors: Passmore Oliver
Published: November 2019

The Z Trusts litigation in Jersey represents the first occasion on which a Court has considered what is to happen when a trust becomes “insolvent”. The Royal Court has given a series of judgments which deal with various aspects of such a situation, from the duties of trustees, to the procedure for creditor claims, to the question of priority between creditors. As such, it represents a case study in how a Court might approach such a situation and provides useful guidance to trustees and those who transact with them as to what might happen in such circumstances.
Mitochondrial fusion mediated by fusion promotion and fission inhibition directs adult mouse heart function toward a different direction
Authors: Qin Yuan , Li Anqi , Liu Bilin , Jiang Wenting , Gao Meng , Tian Xiangang , Gong Guohua
Published: November 2019

Mitochondrial fusion and fission are essential for heart function. Abrogating mitochondrial dynamism leads to cardiomyopathy. Excessive mitochondrial fragmentation is involved in most heart diseases, thus enhancing mitochondrial fusion will be a potential therapeutic strategy. To understand the effects of promoting mitochondrial fusion in adult cardiac, we investigated mice hearts, and cultured murine embryonic fibroblasts (MEFs), in which mitofusin 2 (Mfn2) overexpressed or dynamin‐related protein 1 (Drp1) was abrogated concomitantly forcing mitochondrial fusion. Parallel studies revealed that fission‐defective Drp1 knockout hearts and MEFs evoked stronger mitochondrial enlargement, enhanced mitophagy with mitochondrial volume decrease and increased mitochondrial calcium uptake, superoxide production, and permeability transition pore opening, contributed to cardiomyocyte apoptosis and dilated cardiomyopathy. Mfn2 overexpression in the adult heart is comparable with the control except for slight mitochondrial enlargement and mitochondrial volume increase, but without mitophagy induction. Moreover, Mfn2 overexpression increases mitochondrial biogenesis and fusion could protect against mitochondrial fragmentation and Drp1 deletion evoking mitophagy in MEFs. Our findings indicate that mitochondrial fusion provoked by fusion promotion and fission inhibition direct the different fate of heart, Mfn2 upregulation other than Drp1 downregulation well maintains heart mitochondrial function is a more safe strategy for correcting excessive mitochondrial fragmentation in hearts.
An adipose tissue galectin controls endothelial cell function via preferential recognition of 3‐fucosylated glycans
Authors: Maller Sebastián M. , Cagnoni Alejandro J. , Bannoud Nadia , Sigaut Lorena , Pérez Sáez Juan M. , Pietrasanta Lía I. , Yang Ri‐Yao , Liu Fu‐Tong , Croci Diego O. , Di Lella Santiago , Sundblad Victoria , Rabinovich Gabriel A. , Mariño Karina V.
Published: November 2019

Upon overnutrition, adipocytes activate a homeostatic program to adjust anabolic pressure. An inflammatory response enables adipose tissue (AT) expansion with concomitant enlargement of its capillary network, and reduces energy storage by increasing insulin resistance. Galectin‐12 (Gal‐12), an endogenous lectin preferentially expressed in AT, plays a key role in adipocyte differentiation, lipolysis, and glucose homeostasis. Here, we reveal biochemical and biophysical determinants of Gal‐12 structure, including its preferential recognition of 3‐fucosylated structures, a unique feature among members of the galectin family. Furthermore, we identify a previously unanticipated role for this lectin in the regulation of angiogenesis within AT. Gal‐12 showed preferential localization within the inner side of lipid droplets, and its expression was upregulated under hypoxic conditions. Through glycosylation‐dependent binding to endothelial cells, Gal‐12 promoted in vitro angiogenesis. Moreover, analysis of in vivo AT vasculature showed reduced vascular networks in Gal‐12‐deficient (Lgals12‐/‐) compared to wild‐type mice, supporting a role for this lectin in AT angiogenesis. In conclusion, this study unveils biochemical, topological, and functional features of a hypoxia‐regulated galectin in AT, which modulates endothelial cell function through recognition of 3‐fucosylated glycans. Thus, glycosylation‐dependent programs may control AT homeostasis by modulating endothelial cell biology with critical implications in metabolic disorders and inflammation.
Down syndrome, severe psoriasis, and increased risk for cardiovascular events
Authors: Sismour Brittany , D'Acunto Kristin
Published: November 2019

Down syndrome is a genetic disorder known to cause many complications with lifelong effects. Patients with Down syndrome are known to produce excess interferon gamma, a major culprit of psoriasis formation and severity. Both conditions increase patient risk for major cardiovascular events; however, a potential association between Down syndrome and severe psoriasis has not been well studied. This article discusses a patient with Down syndrome and worsening plaque psoriasis who died of an acute myocardial infarction.
What is the role of dehydroepiandrosterone in gynecologic practice?
Authors: Gajarawala Shilpa N. , Wood Tiffany A. , Stanton Amanda P.
Published: November 2019

In small clinical trials, dehydroepiandrosterone (DHEA) has been found to relieve symptoms associated with postmenopausal conditions and infertility in women. DHEA may provide a cost-effective alternative to typical hormone therapies. Because of a lack of long-term and large-scale studies, only intravaginal DHEA supplementation is approved and recommended for treatment. Further investigation of DHEA supplementation is needed and encouraged to determine its safety and effectiveness.
An alternative fixation method for femoral varus derotational osteotomy in spastic cerebral palsy: the Rush rod
Authors: Deignan Brian J. , Washburn Stephanie , Pilc Emily , Tuten Hans Robert
Published: November 2019

The objective of this study is to present the clinical and radiographic data collected from patients who were treated with a varus derotational osteotomy using Rush rod fixation and compare this to published norms of outcomes using blade plate fixation. A retrospective chart and radiograph review was conducted after identifying 44 patients with 61 hips who underwent varus derotational osteotomy with Rush rod fixation at our institution between 2006 and 2016. We identified 44 patients with 61 hips who underwent the procedure. Information from follow-up clinic visits was gathered and any complications were noted. The patients’ radiographs were analyzed to measure neck-shaft angle, center-edge angle, and acetabular index. At the time of surgery, 44 patients (61 hips) also had soft tissue releases performed, 44 (61 hips) had an open reduction of the hip, and 39 (55 hips) had Dega acetabular osteotomies performed as well. The average pre-operative neck-shaft angle was measured at 163.0° (range 128–180) with average post-operative neck-shaft angles measuring 111.3° (range 85–167). The acetabular index improved from an average of 33.3° (range 16–60) to 16.4 (range 4–35). Post-operative Center-Edge Angle measured 29.7° (range 5–45). There were no infections or cases of avascular necrosis of the femoral head. We present an alternative fixation method for performing varus derotational osteotomy of the proximal femur in children with cerebral palsy using the Rush rod. In our retrospective analysis of 61 hips undergoing this procedure, we present comparable radiographic outcomes with decreased complication rates. Level of evidence: Retrospective comparative study to previously published results, Level III.
Expert Consensus for Early Onset Scoliosis Surgery
Authors: Hughes Michael S. , Swarup Ishaan , Makarewich Christopher A. , Williams Brendan A. , Talwar Divya , Cahill Patrick J. , Flynn John M. , Anari Jason B.
Published: November 2019

Background:

Despite a validated classification system, high-quality multicenter research databases (CSSG/GSSG), and a recent proliferation in publications, early-onset scoliosis (EOS) surgeons have no consensus on standards for surgical treatment. The 21st-century revolution in EOS care has only accelerated, with the arrival of a classification system, magnetically controlled growing rod, nusinersen, and improved nonoperative care (Mehta or Risser casting and compliance-monitored braces). This dizzying pace of change may have outstripped our ability to develop best-practice standards for EOS surgical indications. To learn where consensus is best (and worst) at this moment, we surveyed EOS world thought-leaders on a collection of representative cases.

Methods:

A 6-case survey was constructed and sent to 20 EOS world thought-leaders. The cases were selected to be representative of the major treatment categories: idiopathic, neuromuscular, syndromic, congenital, thoracic dysplasia, and spinal muscular atrophy (specifically to assess the impact of nusinersen and parasol deformity on surgical planning). Respondents were queried regarding treatment with specific attention to instrumentation and construct when surgery was selected. Responses regarding surgical timing and technique were analyzed for consensus (defined as >80%). χ2 analysis was performed to evaluate for differences in treatment preferences based on years of experience.

Results:

The survey response was 100%. Clinical experience ranged from 8 to 40 years (average 23.9 y). There was no consensus on any case. The greatest variability was on the congenital case; the closest to consensus was on the spinal muscular atrophy case. Three or more approaches were selected for all 6 cases; >4 approaches were selected for 5 cases. There is a trend towards screw fixation for proximal anchors. The management of thoracic dysplasia and parasol deformity is far from consensus.

Conclusion:

The lack of consensus for surgical treatment of 6 representative EOS cases demands a renewed effort and commitment to develop best-practice guidelines based on multicenter outcome data.

Level of Evidence:

Level V—Expert Opinion.
How Does Body Mass Index Influence Outcomes in Patients After Lumbar Fusion?
Authors: Divi Srikanth N. , Goyal Dhruv K.C. , Galetta Matthew S. , Fang Taolin , Padua Fortunado G. , Reyes Ariana A. , Kaye Ian David , Kurd Mark F. , Woods Barrett I. , Radcliff Kris E. , Rihn Jeffery A. , Anderson David Greg , Hilibrand Alan S. , Kepler Christopher K. , Vaccaro Alexander R. , Schroeder Gregory D.
Published: November 2019

Study Design.

Retrospective study.

Objective.

The purpose of the present study is to determine how body mass index (BMI) affects patient-reported outcome measurements (PROMs) after lumbar fusions.

Summary of Background Data.

Although greater preoperative BMI is known to increase the rates of adverse events after surgery, there is a paucity of literature assessing the influence of BMI on PROMs after lumbar fusion.

Methods.

Patients undergoing lumbar fusion surgery between 1 and 3 levels were retrospectively identified. PROMs analyzed were the Short Form-12 Physical Component Score, Mental Component Score, Oswestry Disability Index (ODI), and Visual Analog Scale Back and Leg pain scores. Patients were divided into groups based on preoperative BMI: class 1, BMI <25.0; class 2, BMI 25.0 to 29.9; class 3, BMI 30.0 to 34.9; and class 4, BMI ≥35.0. Absolute PROM scores, the recovery ratio, and the percentage of patients achieving minimum clinically important difference between groups were compared.

Results.

A total of 54 (14.8%) patients in class 1, 140 (38.2%) in class 2, 109 (29.8%) in class 3, and 63 (17.2%) in class 4 were included. All patients improved after surgery across all outcome measures (P < 0.001) except for class 4 patients, who did not improve in terms of Short Form-12 Mental Component Score scores after surgery (P = 0.276). Preoperative Short Form-12 Physical Component Score (P = 0.002) and Oswestry Disability Index (P < 0.0001) scores were significantly different between BMI groups—with class 4 having worse disability than class 1 and 2. BMI was not a significant predictor for any outcome domain. Overall 30- and 90-day readmission rates were similar between groups, with a higher revision rate in the class 4 group (P = 0.036), due to a higher incidence of postoperative surgical site infections (P = 0.014).

Conclusion.

All patients undergoing short-segment lumbar fusion for degenerative disease improved to a similar degree with respect to PROMs. Those in the highest class of obesity (BMI ≥35.0) were, however, at a greater risk for postoperative surgical site infection.

Level of Evidence: 3
The Effects of Marijuana Use on Lumbar Spinal Fusion
Authors: Jakoi Andre M. , Kirchner Gregory J. , Kerbel Yehuda E. , Iorio Justin A. , Khalsa Amrit S.
Published: November 2019

Mini

This study compared clinical and patient-reported outcomes following transforaminal lumbar interbody fusion between patients who use or do not use marijuana. We found that patients who use marijuana are younger, but do not demonstrate any differences in preoperative or postoperative Oswestry disability index scores or rates of fusion.

Study Design.

A retrospective cohort study.

Objective.

The purpose of this study was to evaluate marijuana usage and its effect on outcomes following transforaminal lumbar interbody fusion (TLIF).

Summary of Background Data.

As marijuana becomes legalized throughout the United States, its medicinal and recreational usage is becoming more mainstream. Clinicians currently have little guidance regarding both short-term and long-term effects of marijuana usage on surgical interventions. While the rate of lumbar spinal fusion in the United States continues to grow, the effect of marijuana usage on fusion remains uncertain.

Methods.

One hundred two patients who underwent TLIF performed by the same surgeon were followed for 12 months. Patients were self-reported for marijuana usage (n = 36). Patient reported outcome measures included preoperative Oswestry disability index (ODI), 6-month ODI, and 12-month ODI, as well as length of stay (LOS), complications, return to operating room (OR), revision surgery, and confirmed fusion. Continuous variables were compared using the independent two-sample t test or analysis of variance (ANOVA), whereas categorical variables were analyzed using the chi-square or Fischer exact tests. Adjusted analysis was performed using a multivariate logistic regression model.

Results.

Marijuana usage was associated with a younger population (P < 0.001), but showed no difference regarding sex or body mass index compared with the non-usage group. There was no statistically significant difference in complications, return to OR, or revision surgery between groups. When controlling for factors such as age and preoperative ODI, multivariate analysis demonstrated that marijuana usage did not limit postoperative ODI reduction. The marijuana usage group demonstrated shorter LOS (2.42 vs. 3.00 d, P = 0.020). Fusion rates at 12 months were similar between groups (96% vs. 92.3%, P = 0.678). ODI was similar between groups at all time points.

Conclusion.

Perioperative outcomes were similar in patients who underwent TLIF regardless of marijuana usage.

Level of Evidence: 3
Cross-cultural Adaptation, Reliability, Validity, and Responsiveness of the Simplified-Chinese Version of Neck Disability Index
Authors: Lim Hanniel Han Rong , Tang Zhi Yin , Hashim Masayu Afiqah Binte Masagoes , Yang Mingxing , Koh Eileen Yi Ling , Koh Kim Hwee
Published: November 2019

Study Design.

Cross-cultural adaptation and psychometric evaluation.

Objective.

The aim of this study was to translate the Neck Disability Index (NDI) into the simplified-Chinese language and to evaluate the reliability, validity, and responsiveness of the new questionnaire.

Summary of Background Data.

Neck pain is a major health problem resulting in major disability. NDI is the most frequently used scale for self-rating of disability due to neck pain. At present, there is no simplified-Chinese version of the NDI. The aims of this study were to culturally adapt and translate the NDI into the simplified-Chinese language (NDI-SC) and to evaluate its psychometric properties in patients with neck pain.

Methods.

The NDI was translated into simplified-Chinese version based on established guidelines. A total of 70 patients participated in this study. Patients were asked to complete a set of questionnaires comprising of their demographic information, the NDI-SC, and a visual analog scale (VAS) of pain. Fifty-six patients returned after 1 to 2 weeks to complete the same set of questionnaires and the global rating of change (GROC) scale. Then, the NDI-SC was evaluated for content validity, construct validity, internal consistency, test-retest reliability, and responsiveness.

Results.

The NDI-SC demonstrated excellent internal consistency (Cronbach α = 0.92) and good test-retest reliability (ICC2,1 = 0.85). Content validity was confirmed as no floor or ceiling effects were detected for the NDI-SC total score. Construct validity was established with factor analysis revealing two-factor subscales explaining 66% of the variance. The NDI-SC showed a strong correlation with VAS (Rp = 0.61, P < 0.001) and a moderate correlation with GROC (Rs = 0.46, P < 0.001). The correlation between NDI-SC change scores and VAS change scores was also moderate (Rp = 0.59, P < 0.001).

Conclusion.

The results showed that the NDI-SC is a reliable, valid, and responsive instrument to measure functional limitations in patients with neck pain.

Level of Evidence: 3
Evaluation of Serotonin Release Assay and Enzyme-Linked Immunosorbent Assay Optical Density Thresholds for Heparin-Induced Thrombocytopenia in Patients on Extracorporeal Membrane Oxygenation
Authors: Kataria Vivek , Moore Leanne , Harrison Sarah , Hernandez Omar , Vaughan Nathan , Schwartz Gary
Published: November 2019

Objectives:

Heparin-induced thrombocytopenia is a recognized concern in patients on extracorporeal life support. The purpose of this study was to evaluate the applicability of an enzyme-linked immunosorbent assay optical density threshold less than 1 to rule out heparin-induced thrombocytopenia in patients on extracorporeal membrane oxygenation.

Design:

Retrospective, single-center study.

Setting:

Patients were recruited from a prospectively maintained database of all patients on extracorporeal membrane oxygenation from 2012 to 2018 at a tertiary referral center.

Patients:

Forty-seven patients on extracorporeal membrane oxygenation support.

Interventions:

The primary objective was to evaluate the application of enzyme-linked immunosorbent assay optical density thresholds and the serotonin release assay in patients on extracorporeal membrane oxygenation. Patients were divided into two cohorts, serotonin release assay negative and serotonin release assay positive. In order to perform a sensitivity and specificity analysis of enzyme-linked immunosorbent assay optical density thresholds, heparin-induced thrombocytopenia negative was defined as an optical density less than 1.0 and heparin-induced thrombocytopenia positive as an optical density greater than or equal to 1.0.

Measurements and Main Results:

Utilizing the prespecified optical density thresholds, a specificity and negative predictive value of 89% and 95% were achieved, respectively.

Conclusions:

This assessment has helped to identify optical density thresholds for patients undergoing extracorporeal membrane oxygenation. Our data suggest that an optical density threshold of 1.0 may aid clinicians in objectively ruling out heparin-induced thrombocytopenia without sending a confirmatory serotonin release assay. Increasing the optical density threshold to 1.0 resulted in a high specificity and negative predictive value.
Effect of Continuous Epinephrine Infusion on Survival in Critically Ill Patients: A Meta-Analysis of Randomized Trials*
Authors: Belletti Alessandro , Nagy Adam , Sartorelli Marianna , Mucchetti Marta , Putzu Alessandro , Sartini Chiara , Morselli Federica , De Domenico Pierfrancesco , Zangrillo Alberto , Landoni Giovanni , Lembo Rosalba
Published: November 2019

Objectives:

Epinephrine is frequently used as an inotropic and vasopressor agent in critically ill patients requiring hemodynamic support. Data from observational trials suggested that epinephrine use is associated with a worse outcome as compared with other adrenergic and nonadrenergic vasoactive drugs. We performed a systematic review and meta-analysis of randomized controlled trials to investigate the effect of epinephrine administration on outcome of critically ill patients.

Data Sources:

PubMed, EMBASE, and Cochrane central register were searched by two independent investigators up to March 2019.

Study Selection:

Inclusion criteria were: administration of epinephrine as IV continuous infusion, patients admitted to an ICU or undergoing major surgery, and randomized controlled trials. Studies on epinephrine administration as bolus (e.g., during cardiopulmonary resuscitation), were excluded. The primary outcome was mortality at the longest follow-up available.

Data Extraction:

Two independent investigators examined and extracted data from eligible trials.

Data Synthesis:

A total of 5,249 studies were assessed, with a total of 12 studies (1,227 patients) finally included in the meta-analysis. The majority of the trials were performed in the setting of septic shock, and the most frequent comparator was a combination of norepinephrine plus dobutamine. We found no difference in all-cause mortality at the longest follow-up available (197/579 [34.0%] in the epinephrine group vs 219/648 [33.8%] in the control group; risk ratio = 0.95; 95% CI, 0.82–1.10; p = 0.49; I
2 = 0%). No differences in the need for renal replacement therapy, occurrence rate of myocardial ischemia, occurrence rate of arrhythmias, and length of ICU stay were observed.

Conclusions:

Current randomized evidence showed that continuous IV administration of epinephrine as inotropic/vasopressor agent is not associated with a worse outcome in critically ill patients.
Epinephrine for Out-of-Hospital Cardiac Arrest: An Updated Systematic Review and Meta-Analysis*
Authors: Aves Theresa , Chopra Amit , Patel Matthew , Lin Steve
Published: November 2019

Objectives:

To perform an updated systematic review and meta-analysis of clinical trials evaluating epinephrine for adult out-of-hospital cardiac arrest resuscitation.

Data Sources:

The search included MEDLINE, EMBASE, and Ovid Evidence-Based Medicine, clinical trial registries, and bibliographies.

Study Selection:

Randomized and quasi-randomized controlled trials that compared the current standard dose of epinephrine to placebo, high or low dose epinephrine, any other vasopressor alone or in combination were screened by three independent reviewers.

Data Extraction:

Randomized and quasi-randomized controlled trials that compared the current standard dose of epinephrine to placebo, high or low dose epinephrine, any other vasopressor alone or in combination were screened by three independent reviewers.

Data Synthesis:

A total of 17 trials (21,510 patients) were included; seven were judged to be at high risk of bias. Compared to placebo, pooled results from two trials showed that standard dose of epinephrine increased return of spontaneous circulation (risk ratio, 3.09; 95% CI, 2.82–3.89), survival to hospital admission (risk ratio, 2.50; 95% CI, 1.68–3.72), and survival to discharge (risk ratio, 1.44; 95% CI, 1.11–1.86). The largest placebo-controlled trial showed that standard dose of epinephrine also improved survival at 30 days and 3 months but not neurologic outcomes, standard dose of epinephrine decreased return of spontaneous circulation (risk ratio, 0.87; 95% CI, 0.77–0.98) and survival to admission (risk ratio, 0.88; 95% CI, 0.78–0.99) when compared with high dose epinephrine. There were no differences in outcomes between standard dose of epinephrine and vasopressin alone or in combination with epinephrine.

Conclusions:

Largely based on one randomized controlled trial, standard dose of epinephrine improved overall survival but not neurologic outcomes in out-of-hospital cardiac arrest patients compared with placebo. There is a paucity of trials with meaningful patient outcomes; future epinephrine trials should evaluate dose and method of delivery on long-term survival, neurologic function, and quality of life after cardiac arrest.
Organ Doses from Chest Radiographs in Tuberculosis Patients in Canada and Their Uncertainties in Periods from 1930 to 1969
Authors: Kocher David C. , Apostoaei A. Iulian , Thomas Brian A. , Borrego David , Lee Choonsik , Zablotska Lydia B.
Published: November 2019

This paper describes a study to estimate absorbed doses to various organs from film-based chest radiographs and their uncertainties in the periods 1930 to 1948, 1949 to 1955, and 1956 to 1969. Estimated organ doses will be used in new analyses of risks of cancer and other diseases in tuberculosis patients in Canada who had chest fluoroscopic and radiographic examinations in those periods. In this paper, doses to lungs, female breast, active bone marrow, and heart from a single chest radiograph in adults and children of ages 1, 5, 10, and 15 y in the Canadian cohort and their uncertainties are estimated using (1) data on the tube voltage (kV), total filtration (mm Al), tube-current exposure-time product (mA s), and tube output (mR [mA s]−1) in each period; (2) assumptions about patient orientation, distance from the source to the skin of a patient, and film size; and (3) new calculations of sex- and age-specific organ dose conversion coefficients (organ doses per dose in air at skin entrance). Variations in estimated doses to each organ across the three periods are less than 20% in adults and up to about 30% at younger ages. Uncertainties in estimated organ doses are about a factor of 2 to 3 in adults and up to a factor of 4 at younger ages and are due mainly to uncertainties in the tube voltage and tube-current exposure-time product.
A Review of Problem Solving and Reflection as Caregiver Coaching Strategies in Early Intervention
Authors: Lorio Ciera M. , Romano Mollie , Woods Juliann J. , Brown Jennifer
Published: November 2019

An increasing number of researchers are examining the benefits and outcomes of caregiver-implemented interventions for young children with delays or disabilities. Most report the incorporation of multiple coaching strategies within their approach; however, definitions and descriptions of coaching strategies and processes continue to be limited. This scoping review examined the use of various coaching strategies across models of caregiver coaching in early intervention, with a specific focus on problem solving and reflection coaching strategies occurring in the literature between 2011 and 2018. Problem solving and reflection are 2 coaching strategies incorporated into coaching approaches to build caregiver competency, confidence, and independence within intervention implementation. The results of this review may guide the field in further defining caregiver coaching as well as specific coaching strategies, such as problem solving and reflection.
Overimitation of Children With Cochlear Implants or Hearing Aids in Comparison With Children With Normal Hearing
Authors: Wang Zhidan , Zhu Xiaoyu , Fong Frankie T. K. , Meng Jing , Wang Haijing
Published: November 2019

Our proclivity toward high-fidelity transmission of knowledge is one of the key mechanisms that underpins our success as a species. This study evaluated overimitation within children with hearing impairments (who had either a cochlear implant or a hearing aid) in relation to those with normal hearing. A total of seventy-two 4-year-old children were shown how to operate novel objects using a series of causally irrelevant actions, followed by causally relevant action. We measured the degree to which children reproduced the irrelevant actions as an indicator of imitative fidelity. Children with either hearing impairments or normal hearing replicated the irrelevant actions at rates above the baseline. However, imitative fidelity of the former group was significantly lower. In addition, children with hearing impairments were also less likely to identify and achieve the outcome by performing the relevant act. This study advances our understanding of social learning in children with hearing impairments and proposes potential weakness of social-cognitive skills within this population.
Implementation of Developmental Screening by Childcare Providers
Authors: Shahidullah Jeffrey D. , Forman Susan G. , Norton Amy M. , Harris Jill F. , Palejwala Mohammed H. , Chaudhuri Anindita
Published: November 2019

Early identification of young children at developmental risk is important for linkage to needed services. Yet, despite guidelines for developmental screening, many pediatricians do not systematically use screening tools. Because many young children spend time in childcare settings, conducting screening in these settings may improve rates of early identification. Surveys were sent to 356 childcare providers who attended brief developmental screening training to determine practices and perceptions related to implementation of screening in the childcare setting. A 51.7% useable response rate was obtained. A majority of respondents strongly agreed that developmental screening should be conducted in childcare centers, that it is important for staff to discuss developmental concerns with parents and to link children with concerns to resources, and that their center director supported use of the screening tool. Several attitudes both about developmental screening and about organizational support had a positive and significant relationship with current use and intended future use of developmental screening tools. Findings suggest that even brief staff training may positively impact screening attitudes and practices, although follow-up technical assistance may result in fuller, more effective implementation.