bluuebunny/crossref_metadata_2025 huggingface dataset:
Farming, The Environment, Climate Change, and Water
Authors: Paarlberg Robert
Published: November 2020

Does agriculture always damage the environment?

From the perspective of deep ecology, all forms of agriculture damage the natural environment. When our early ancestors went from hunting and gathering to planting crops and grazing animals, they cut forests and redirected waterways. Wild plants and animals...
The Future of Food Politics
Authors: Paarlberg Robert
Published: November 2020

In the future, will obesity continue to replace hunger as the world’s most serious food problem?

In terms of the numbers affected, yes. In 2008, according to the World Health Organization, 500 million adults globally over the age of 20 were technically obese. If we...
Introduction
Authors: Esposito John L. , Delong-Bas Natana J.
Published: November 2020

Shariah: What Everyone Needs to Know provides informed answers to many questions and charges that surround the debate over Shariah and Islamic Law. As its title indicates, we have written for a broad nonspecialist audience as well as for policymakers, political commentators, religious leaders,...
Shariah Courts
Authors: Esposito John L. , Delong-Bas Natana J.
Published: November 2020

Rooted in the local community, Shariah courts played a pivotal role in Muslim societies through the ages. In this chapter, we look at the responsibilities of qadis (judges) and muftis (legal scholars and experts) not only in the courtroom but also in the broader Muslim...
The Five Pillars of Islam and Community Life
Authors: Esposito John L. , Delong-Bas Natana J.
Published: November 2020

An important prophetic tradition maintains that “Islam was built upon five ‘foundations.’ ” The Five Pillars (the profession of faith [shahadah], daily prayers [salat], almsgiving [zakat], the fast of Ramadan [sawm], and the pilgrimage to Mecca [Hajj])...
War, Peace, and the Common Good
Authors: Esposito John L. , Delong-Bas Natana J.
Published: November 2020

In the twentieth and twenty-first centuries, visions of Islamic societies and claims to Islamic authenticity and legitimacy have expanded in many directions. At times, these calls for construction of societies are based on Islam and Shariah; at others, they call for defending the Muslim community...
The Ethics of Defense and Private Security Contracting
Authors: Lucas George
Published: November 2020

What is “defense and security contracting”?

This simple phrase refers to an enormous diversity of private commercial enterprises that support military operations. They can be either combat-related or not. Typically, national defense departments have hired private firms to do work in three broad areas:...
Military Ethics and Unmanned Systems
Authors: Lucas George
Published: November 2020

What are “unmanned systems”?

This is the generic term coined by engineers for remotely piloted or remotely operated devices such as robots or drones. Unmanned systems include those that are programmed to operate by themselves (automatic and autonomous systems), as well as those that...
Introduction
Authors: Lucas George
Published: November 2020

Why Military Ethics?

In 2003, during the first year of the American-led military intervention in Iraq, a contingent of reserve army personnel in charge of the Abu Ghraib prison was discovered to have engaged in numerous acts of torture and abuse of prisoners. Torture...
The Parallax Shift
Authors: Prados John
Published: November 2020

Special Forces materialized during a period when US military doctrine was actually least favorable to their creation. Under President Dwight D. Eisenhower, who entered office near the end of the Korean War, the military’s emphasis shifted from preparing its forces for near-term potential conflict...
After September 11
Authors: Prados John
Published: November 2020

Brigadier General Stanley McChrystal stood near the door of a C-130J transport, ready for a practice parachute jump near Fort Bragg, when the air force jumpmaster leaned over to say something to the lead man, McChrystal’s boss. It was September 11, 2001. McChrystal overheard...
Who’s who in Special Forces
Authors: Prados John
Published: November 2020

Harry C. Aderholt (1920–2010). In effect the father of air force special operations, “Heinie” Aderholt was a pilot in an air transport unit in North Africa and Italy in World War II. Planes like his had been involved in so-called Carpetbagger flights, inserting...
The Carbon Footprint Controversy
Authors: Norwood F. Bailey , Oltenacu Pascal A. , Calvo-Lorenzo Michelle S. , Lancaster Sarah
Published: November 2020

What Is the Carbon Footprint Controversy?

Nearly all humans consume meat, dairy, and egg products in some form. In recent years the environmental movement has touted the necessity of reducing one’s “carbon footprint.” Can we reduce our footprint without changing our diet? Much controversy surrounds...
The GMO Controversy
Authors: Norwood F. Bailey , Oltenacu Pascal A. , Calvo-Lorenzo Michelle S. , Lancaster Sarah
Published: November 2020

What Is the GMO Controversy?

Suppose you are a citizen of France, China, or Germany—three among ten nations that consume horse meat. You enter a store to purchase a few pounds of the meat, but for some reason are worried that the owner is actually...
Introduction
Authors: Blumenstyk Goldie
Published: November 2020

Is higher education in America in crisis?

Over the past thirty years, the price of college has gone up faster than prices of almost all other goods and services. Student debt is at an all-time high of $1.2 trillion. Doubts about the value of college...
The Key Issues
Authors: Ker-Lindsay James
Published: November 2020

This is the chapter-level abstract
Current and Future Settlement Efforts
Authors: Ker-Lindsay James
Published: November 2020

This is the chapter-level abstract
The Place and Significance of Sudan
Authors: Natsios Andrew S.
Published: November 2020

Why should anyone care about Sudan?

For more than two centuries, Sudan has attracted an unusual level of attention beyond its own borders. This international interest converged in the last decade of the twentieth century and the first decade of the twenty-first century as four...
The Birth of Modern Sudan
Authors: Natsios Andrew S.
Published: November 2020

How has Sudan’s early history affected its current problems?

To answer this question, we need to follow Sudan’s history, principally that of the last two centuries. European fascination with Sudan dates from attempts in the eighteenth century to find the source of the Nile, one...
The Rule of the Anglo-Egyptian Condominium
Authors: Natsios Andrew S.
Published: November 2020

How did the British and Egyptian colonial period set the stage for later Sudanese conflicts after independence?

The British and Egyptian rule continued and accelerated the discontinuities of nineteenth-century development in Sudan. The disparity between the development of the Nile River Valley and the neglect...
Fourth Period of Modern Sudan (1956–2005)
Authors: Natsios Andrew S.
Published: November 2020

How did the first North–South civil war begin?

Between October 18 and 21, 1954, southern leaders organized a second Juba Conference, this time with no northern sanction or delegates present to guide the results. The conference voted for independence from Egypt (which affirmed the National...
When It Comes To Drugs, Why Can’t We Think Calmly and Play Nice?
Authors: Kleiman Mark A. R. , Caulkins Jonathan P. , Hawken Angela
Published: November 2020

Why do arguments about drug policy get so irrational and so mean-spirited?

Patterns of drug taking are intertwined with personal and social identity. The drugs people use, or don’t use, define them as much as their clothing, the music they listen to, the sports they...
Conclusion: What Is To Be Done?
Authors: Kleiman Mark A. R. , Caulkins Jonathan P. , Hawken Angela
Published: November 2020

The answer to that crucial question depends on judgments about right and wrong, and about the relative importance of different good and bad things, as well as on predictions about the outcomes of alternative policies. It also depends on one’s willingness—or reluctance—to make big changes....
Climate and Fisheries
Authors: Hilborn Ray , Hilborn Ulrike
Published: November 2020

How does climate affect fish populations?

Herring are among the most abundant fishes in the world and have been the basis for regional and national economies for centuries. In 1855, over 95,000 people were employed in the herring industry in Scotland. In an 1864...
High Seas Fisheries
Authors: Hilborn Ray , Hilborn Ulrike
Published: November 2020

What is the status of bluefin tuna that were proposed for CITES listing?

Throughout the western Mediterranean Sea, an annual ritual known in Sicily as matanza has taken place for perhaps 400 years. Nets are set in shallow water near the shore...
Illegal Fishing
Authors: Hilborn Ray , Hilborn Ulrike
Published: November 2020

Is illegal fishing an important problem in overfishing?

On August 7, 2003, the Australian patrol vessel Southern Supporter spotted a vessel thought to be illegally fishing within the Australian 200-mile economic zone around Heard Island, 2,400 miles southwest of Perth in the...
Public Policy and Reproductive Politics
Authors: Solinger Rickie
Published: November 2020

How do policies such as day-care funding and family leave shape women’s reproductive decisions?

Only about one in five US households has a male wage earner and a full-time female “homemaker.” In fact, women are the primary earners in 40 percent of American...
The Environment and Reproductive Politics
Authors: Solinger Rickie
Published: November 2020

How are environmental contaminants affecting reproductive health in the United States?

No one knows for sure the relationship between contaminants and reproduction, but there are some indications that the effects are felt nationwide. Today, chemical production in the United States is a $450 billion...
Tuberculosis and Influenza
Authors: Doherty Peter C.
Published: November 2020

Why should TB and influenza be considered together?

Apart from being respiratory pathogens, what links tuberculosis (TB) and flu is that they are old, very dangerous infections that simply will not go away. While SARS was an arriviste virus that flamed brightly and then...
Protecting Humanity from and During Pandemics
Authors: Doherty Peter C.
Published: November 2020

Is there anything that I can do personally to limit the possibility of a dangerous pandemic?

While pandemics are by their nature unpredictable, there are some things worth considering when it comes to the issue of personal safety and responsibility. The first point is...
What Can We Do?
Authors: Singer P. W. , Friedman Allan
Published: November 2020

Don’t Get Fooled: Why Can’t We Just Build a New, More Secure Internet?

The proposal started out as an April Fool’s joke, but many people still took it seriously.

Steve Bellovin, a computer network and security researcher, can claim to have literally written the...
Ecological Effects of Introduced Species—Straightforward Impacts
Authors: Simberloff Daniel
Published: November 2020

Invasive nonnative species have a huge number of ecological impacts. Some are apparent to the most casual observer; others are less obvious, and some, while important, are so subtle that they cannot be detected without intensive research. However, just because they are subtle need...
Evolution of Introduced and Native Species
Authors: Simberloff Daniel
Published: November 2020

What is the paradox of invasion genetics?

A paradox of invasions is the fact that many widespread invasions began with very few individuals. For instance, the entire North American population of an introduced European solitary bee species probably originated from one female. Additionally, several...
How and Why Do Invasions Occur?
Authors: Simberloff Daniel
Published: November 2020

Why do people deliberately introduce animals?

Motives for introducing nonnative species are many. The underlying incentive behind all of these introductions, however, boils down to one simple truth: people are never happy with the species they have. This one phrase could serve as the...
How Are Species Introductions Regulated?
Authors: Simberloff Daniel
Published: November 2020

What international agreements address biological invasions?

Most biological invasions arise from the deliberate or accidental transport of species from one nation to another, so it is no surprise that, as the enormous impacts of invasions came to be recognized in the late 1980s (Chapter...
Controversies Surrounding Biological Invasions
Authors: Simberloff Daniel
Published: November 2020

Which introduced species are harmful and which are useful?

Several critics suggest that rather few introduced species are harmful and some are even useful, so the angst experienced over invasions and the publicity generated about them are overblown. It is true that most introduced...
Libertarianism
Authors: Brennan Jason
Published: November 2020

Historically, Americans have seen libertarians as far outside the mainstream, but with the rise of the Tea Party movement, libertarian principles have risen to the forefront of Republican politics. But libertarianism is more than the philosophy of individual freedom and unfettered markets that Republicans have embraced. Indeed, as Jason Brennan points out, libertarianism is a quite different--and far richer--system of thought than most of us suspect. In this timely new entry in Oxford's acclaimed series What Everyone Needs to Know, Brennan offers a nuanced portrait of libertarianism, proceeding through a series of questions to illuminate the essential elements of libertarianism and the problems the philosophy addresses, including such topics as the Value of Liberty, Human Nature and Ethics, Economic Liberty, Civil Rights, Social Justice and the Poor, Government and Democracy, and Contemporary Politics. Brennan asks the most fundamental and challenging questions: What do Libertarians think liberty is? Do libertarians think everyone should be selfish? Are libertarians just out to protect the interests of big business? What do libertarians think we should do about racial injustice? What would libertarians do about pollution? Are Tea Party activists true libertarians? As he sheds light on libertarian beliefs, Brennan overturns numerous misconceptions. Libertarianism is not about simple-minded paranoia about government, he writes. Rather, it celebrates the ideal of peaceful cooperation among free and equal people. Libertarians believe that the rich always capture political power; they want to minimize the power available to them in order to protect the weak. Brennan argues that libertarians are, in fact, animated by benevolence and a deep concern for the poor. Clear, concise, and incisively written, this volume explains a vitally important philosophy in American history--and a potent force in contemporary politics.
Building
Authors: Kalyvas Stathis N.
Published: November 2020

How was the new state built?

Becoming independent was the easy part. The leaders of the new state faced a daunting task. They sought to create a modern European state in a rather primitive region of the world, inhabited by an illiterate population of subsistence...
Takeoff
Authors: Kalyvas Stathis N.
Published: November 2020

What was the state of Greece in the aftermath of the Civil War?

Greece entered the 1950s in a state of total disarray. It had undergone uninterrupted conflict for nine years and experienced multiple calamities since 1920. In fact, the incidence of war, occupation, civil...
Future
Authors: Kalyvas Stathis N.
Published: November 2020

What are the seven boom-bust-bailout cycles of Greek history?

Looking back at the historical trajectory of modern Greece, it is possible to discern a succession of seven major boom, bust, and bailout cycles. All began with highly ambitious projects that often struck contemporary observers...
India in the 21st Century
Authors: Kamdar Mira
Published: November 2020

India is fast overtaking China to become the most populous country on Earth. By mid-century, its 1.7 billion people will live in what is projected to become the world’s second-largest economy after China. While a democracy and an open society compared to China, assertive Hindu nationalism is posing new challenges to India’s democratic freedoms and institutions at a time when illiberal democracies and autocratic leaders are on the rise worldwide. How India’s destiny plays out in the coming decades will matter deeply to a world where the West’s influence in shaping the 21st century will decline as that of these two Asian giants and other emerging economies in Africa and Latin America rise. In India in the 21st Century, Mira Kamdar, a former member of the New York Times Editorial Board and an award-winning author, offers readers an introduction to India today in all its complexity. In a concise question-and-answer format, Kamdar addresses India’s history, including its ancient civilization and kingdoms; its religious plurality; its colonial legacy and independence movement; the political and social structures in place today; its rapidly growing economy and financial system; India’s place in the geopolitical landscape of the 21st century; the challenge to India posed by climate change and dwindling global resources; wealth concentration and stark social inequalities; the rise of big data and robotics; the role of social media and more. She explores India’s contradictions and complications, while celebrating the merging of India’s multicultural landscape and deep artistic and intellectual heritage with the Information Age and the expansion of mass media. With clarity and balance, Kamdar brings her in-depth knowledge of India and eloquent writing style to bear in this focused and incisive addition to Oxford’s highly successful What Everyone Needs to Know® series.
Introduction
Authors: Kamdar Mira
Published: November 2020

India enchants the world with its culture, excites with its potential, and intrigues with its traditions. It perplexes with its complexity, and it shocks with its violence, poverty, and corruption, yet it comforts much of the world—Western democracies in particular—with its large English-speaking population and...
The British Raj and the Road to Independence
Authors: Kamdar Mira
Published: November 2020

What was the East India Company?

On December 31, 1600, Queen Elizabeth I granted a royal charter giving a group of English adventurers a fifteen-year monopoly over England’s trade with Asia. The first incarnation of the British East India Company was born. The British were...
Politics
Authors: Kamdar Mira
Published: November 2020

What is India’s political system?

The 1949 constitution established India as a “sovereign democratic republic.” In 1976, under a state of emergency imposed by then Prime Minister Indira Gandhi that suspended many citizen rights and freedoms, a forty-second amendment to the original constitution added the...
Independence and the Civilian Government (1948–1962): Mixed Heritages
Authors: Steinberg David I.
Published: November 2020

The civilian government, which lasted from independence in 1948 until the military coup of 1962 (with a military interregnum in 1958–1960), has variously been resurrected as a positive or negative guide to the political future of Myanmar. Many observers believe that the representative parliamentary democratic...
The Nature of Burmese Politics
Authors: Steinberg David I.
Published: November 2020

The generalizations that follow—as difficult to form as they are necessary if we are to gauge and anticipate the country’s prospects—should not be interpreted as either rigid or deterministic. They lie along a spectrum, one in the eyes of this writer, and are tendencies that...
Climate Change and Ocean Acidification
Authors: Weis Judith S.
Published: November 2020

What causes global warming or climate change?

The burning of fossil fuels emits carbon dioxide into the atmosphere, which results in the greenhouse effect—less heat can be re-radiated away from the earth, thus raising the temperature of the atmosphere and ocean. In the past...
Population Genomics of Bacterial Plant Pathogens
Authors: Straub Christina , Colombi Elena , McCann Honour C.
Published: November 2020

Population genomics is transforming our understanding of pathogen biology and evolution, and contributing to the prevention and management of disease in diverse crops. We provide an overview of key methods in bacterial population genomics and describe recent work focusing on three topics of critical importance to plant pathology: (i) resolving pathogen origins and transmission pathways during outbreak events, (ii) identifying the genetic basis of host specificity and virulence, and (iii) understanding how pathogens evolve in response to changing agricultural practices.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Early Occupational Intervention for People with Low Back Pain in Physically Demanding Jobs: 1-year Follow-up Results of the Randomized Controlled GOBACK Trial
Authors: Rosenberg Naomi Rebecca , Petersen Sesilje Bondo , Begtrup Luise Moelenberg , Flachs Esben Meulengracht , Petersen Jonathan Aavang , Hansen Bjarke Brandt , Kirkeskov Lilli , Bliddal Henning , Christensen Robin , Kristensen Lars Erik , Fournier Gilles Ludger , Kryger Ann Isabel
Published: November 2020

Study Design.

Randomized controlled trial with 1-year follow up.

Objective.

The aim of this study was to assess whether people with low back pain (LBP) and self-reported physically demanding jobs, benefit from an occupational medicine intervention, in addition to a single hospital consultation and a magnetic resonance imaging, at 1 year of follow-up. Secondly, to examine whether the positive health effects, found in both groups at 6 months, persist at 1-year follow-up.

Summary of Background Data.

The prevalence of LBP is high in the working population, resulting in a substantial social and economic burden. Although there are many guidelines available on the management of LBP, including multidisciplinary biopsychosocial rehabilitation, they provide limited guidance on the occupational medicine aspects.

Methods.

As reported previously, 305 participants with LBP and self-reported physically demanding jobs were enrolled in the randomized controlled study and randomly allocated to clinical care with additional occupational medicine intervention or clinical care alone. Data were collected at baseline, 6 months, and 1 year. Outcomes included in the present 1-year follow-up study are changes in neuropathic pain (painDETECT questionnaire), severity of pain (0–10 numerical rating scale), disability (Roland Morris Disability Questionnaire), fear-avoidance beliefs (FABQ), physical, and mental quality of life (short-form 36).

Results.

The study showed no effect of an occupational intervention on neuropathic pain, fear-avoidance beliefs, physical and mental quality of life nor disability measured after 1 year. The positive effects found at 6 months in both groups, remained at 1-year follow-up.

Conclusion.

The results suggest that a thorough clinical consultation, with focus on explaining the cause of pain and instructions to stay active, can promote long-lasting physical and mental health in individuals with LBP. Therefore, additional occupational interventions could focus on altering occupational obstacles on a structural level.

Level of Evidence: 2
Factor XI Deficiency in a Patient with Cervical Spondylotic Myelopathy
Authors: Serikyaku Hisashi , Higa Shoichiro , Yara Tetsuya , Miyata Yuji
Published: November 2020

Study Design.

Case report.

Objective.

To summarize the clinical manifestations and treatment of Factor XI deficiency in a patient with cervical spondylotic myelopathy.

Summary of Background Data.

Factor XI deficiency is a rare genetic bleeding disorder caused by reduced levels and insufficient activity of a coagulation factor XI. It is claimed to be associated with prominent bleeding in case of trauma and surgery irrelevant to the FXI level. This is the first ever case of a patient with factor XI deficiency with cervical spondylotic myelopathy.

Methods.

A case was investigated retrospectively and the relevant literature was reviewed.

Results.

A 66-year-old man with a 2-months history of lack of finger dexterity and gait disturbance was referred to our department. He did not have a history of bleeding or coagulation disorder nor did his family. Magnetic resonance imaging (MRI) of the cervical spine revealed spinal canal stenosis at C3/4 to C5/6 and intramedullary hyperintensity at C3/4 on the :T2 weighted image (T2WI). Preoperative examination revealed no abnormal findings but a severe prolonged activated partial-thromboplastin time (APTT) of 139.8 seconds. Coagulation factor activity assay revealed severe deficiency of factor XI (<0.1%). In accordance with hematologist's recommendation, four units of fresh frozen plasma (FFP) were transfused on the day before surgery and APTT assayed early morning on the day of surgery was 70.5 seconds. An additional four units of FFP were transfused during the surgery and APTT was 60 seconds. The postoperative course was uneventful and the patient was discharged on the postoperative day 14.

Conclusion.

Factor XI deficiency patients may develop excessive bleeding after trauma or surgery. Preoperative examination with prolonged APTT should be pursued until a diagnosis of is made. Under diagnosis of Factor XI deficiency, meticulous attentions are required for perioperative bleeding management including postoperative hematoma in spinal surgery.

Level of Evidence: 5
Validation of the Nepali versions of the Neck Disability Index and the Numerical Rating Scale for Neck Pain
Authors: Shrestha Dipak , Shrestha Rohit , Grotle Margreth , Nygaard Øystein P. , Solberg Tore K.
Published: November 2020

Study Design.

A cross-sectional study with a test–retest design.

Objective.

To translate and culturally adapt the numerical rating scale (NRS) for neck pain intensity and the Neck Disability Index (NDI), and asses their measurement properties in a Nepalese neck pain population.

Summary of Background Data.

Neck pain is one of the most common musculoskeletal disorders in Nepal. Research on neck pain disorders has been hampered by lack of standardized patient-reported outcome measures (PROMs) in Nepali language. Therefore, we aimed at validating a Nepali version of the NDI and NRS neck pain.

Methods.

At Dhulikhel hospital in Nepal, 150 patients with neck pain and/or cervical radiculopathy completed the translated self-administered questionnaires. We had made one cultural adaption of the NDI driving item in the final Nepali version. Relative reliability was analyzed with intraclass correlation coefficient (ICC 2.1) and absolute reliability with the smallest detectable change (SDC). Internal consistency was assessed by Cronbach alpha. Construct and discriminative validity was assessed by Spearman correlation for a priori hypotheses, receiver-operating characteristics curves, and analysis of variance. Time spent and assistance needed to complete the questionnaires were used to assess feasibility.

Results.

Test–restest reliability was excellent with ICC (95% confidence intervals) of 0.87 (0.66, 0.94) for NDI and 0.97 (0.94, 0.99) for NRS neck pain. The absolute reliability was acceptable (a SDC of 1.6 for NRS and 9.3 for NDI) and a Cronbach alpha (internal consistency) of 0.70 for NDI, as well as acceptable construct validity, discriminative validity, and feasibility.

Conclusion.

The Nepali versions of the NRS neck pain and NDI can be recommended for assessing pain and disability among patients with neck pain and cervical radiculopathy, but their responsiveness to change remains to be tested.

Level of Evidence: 2
The Impact of Obesity on Risk Factors for Adverse Outcomes in Patients Undergoing Elective Posterior Lumbar Spine Fusion
Authors: Jain Deeptee , Durand Wesley , Shaw Jeremy D. , Burch Shane , Deviren Vedat , Berven Sigurd
Published: November 2020

Study Design.

Retrospective case–control study.

Objective.

The aim of this study was to determine the influence of obesity on risk factors for adverse outcome after lumbar spine fusion (LSF).

Summary of Background Data.

Obesity is risk factor for complications after LSF and poses unique challenges regarding optimization of care. Nonetheless, this patient population is not well-studied.

Methods.

Adult patients undergoing LSF were identified the State Inpatient Database. Patients were identified as obese or nonobese using ICD-9 codes. Outcome variables were 90-day readmission, major medical complication, infection, and revision rates. Data were queried for demographics, comorbidities, surgery characteristics, and outcome variables. Logistic multivariate regression was utilized, serially testing interactions between obesity and other independent variables in separate models for each outcome. The Benjamini-Hochberg procedure was used to adjust statistical significance for multiple comparisons.

Results.

A total of 262,153 patients were included: 31,062 obese and 231, 091 nonobese. For major complications, obese patients had lower odds ratios (ORs) versus nonobese patients for cerebrovascular accident, diabetes with chronic complications, age ≥65, congestive heart failure, history of myocardial infarction, renal disease, chronic pulmonary disease, Medicare/Medicaid payor, more than two levels fused, transforaminal/posterior lumbar interbody fusion, and female sex, and higher OR for non-White race. For readmission, obese patients had lower OR for age ≥65, history of MI, renal disease, and mental health disease, and higher OR for female sex. For revision, obese patients had higher OR for female sex and TLIF/PLIF. For infection, obese patients had lower OR for diabetes with and without chronic complications, and higher OR for female sex.

Conclusion.

Many medical comorbidities have less impact in obese patients than nonobese patients in predicting adverse outcomes despite increased rates of adverse outcomes in obese patients. These findings reflect the impact of obesity as an independent risk factor and have important implications for preoperative optimization.

Level of Evidence: 3
Factors Associated With Progression to Surgical Intervention for Lumbar Disc Herniation in the Military Health System
Authors: Anderson Ashley B. , Braswell Matthew J. , Pisano Alfred J. , Watson Nora I. , Dickens Jonathan F. , Helgeson Melvin D. , Brooks Daniel I. , Wagner Scott C.
Published: November 2020

Study Design.

Retrospective cohort.

Objective.

To determine surgery-free survival of patients receiving conservative management of lumbar disc herniation (LDH) in the military healthcare system (MHS) and risk factors for surgical intervention.

Summary of Background Data.

Radiculopathy from LDH is a major cause of morbidity and cost.

Methods.

The Military Data Repository was queried for all patients diagnosed with LDH from FY2011–2018; the earliest such diagnosis in a military treatment facility (MTF) was kept for each patient as the initial diagnosis. Follow-up time to surgical intervention was defined as the time from diagnosis to first encounter for lumbar microdiscectomy or lumbar decompression in either a MTF or in the civilian sector. The Military Data Repository was also queried for history of tobacco use at any time during MHS care, age at the time of diagnosis, sex, MHS beneficiary category, and diagnosing facility characteristics. Multivariable Cox proportional hazards models were used to evaluate the associations of patient and diagnosing facility characteristics with time to surgical intervention.

Results.

A total of 84,985 MHS beneficiaries including 62,771 active duty service members were diagnosed with LDH in a MTF during the 8-year study period. A total of 10,532 (12.4%) MHS beneficiaries, including 7650 (10.9%) active duty, failed conservative management onto surgical intervention with lumbar microdiscectomy or lumbar decompression. Median follow-up time of the cohort was 5.2 (interquartile range 2.6, 7.5) years. Among all healthcare beneficiaries, several patient-level (younger age, male sex, and history of tobacco use) and facility-level characteristics (hospital vs. clinic and surgical care vs. primary care clinic) were independently associated with higher risk of surgical intervention.

Conclusion.

LDH compromises military readiness and negatively impacts healthcare costs. MHS beneficiaries with LDH have a good prognosis with approximately 88% of patients successfully completing conservative management. However, strategies to improve outcomes of conservative management in LDH should address risks associated with both patient and facility characteristics.

Level of Evidence: 4
Practices to support relational coordination in care transitions: Observations from the VA rural Transitions Nurse Program
Authors: Gilmartin Heather M. , Battaglia Catherine , Warsavage Theodore , Connelly Brigid , Burke Robert E.
Published: November 2020

Background

Ensuring safe transitions of care around hospital discharge requires effective relationships and communication between health care teams. Relational coordination (RC) is a process of communicating and relating for the purpose of task integration that predicts desirable outcomes for patients and providers. RC can be measured using a validated survey.

Purpose

The aim of the study was to demonstrate the application of RC practices within the rural Transitions Nurse Program (TNP), a nationwide transitions of care intervention for Veterans, and assess relationships and mechanisms for developing RC in teams.

Methodology/Approach

TNP implemented practices expected to support RC. These included creation of a transition nurse role, preimplementation site visits, process mapping to understand workflow, creation of standardized communication templates and protocols, and inclusion of teamwork and shared accountability in job descriptions and annual reviews. We used the RC Survey to measure RC for TNP health care teams. Associations between the months each site participated in TNP, number of Veterans enrolled, and adherence to the TNP intervention were assessed as possible mechanisms for developing high RC using Spearman (rs
) correlations.

Results

The RC Survey was completed by 44 providers from 11 Veterans Health Administration medical centers. RC scores were high across sites (mean = 4.19; 1–5 Likert scale) and were positively correlated with months participating in TNP (rs
= .66) and number of enrollees (rs
= .63), but not with adherence to the TNP intervention (rs
= .12).

Practice Implications

The impact of practices to support RC can be assessed using the RC Survey. Our findings suggest scale-up time is a likely mechanism to the development of high-quality relationships and communication within teams.
Use of a Procalcitonin-guided Antibiotic Treatment Algorithm in the Pediatric Intensive Care Unit
Authors: Katz Sophie E. , Crook Jennifer , Gillon Jessica , Stanford J. Eric , Wang Li , Colby Jennifer M. , Banerjee Ritu
Published: November 2020

Background:

The utility of procalcitonin testing in the pediatric intensive care unit (PICU) is not known. We sought to determine the impact of a procalcitonin-guided antibiotic treatment algorithm implemented with antibiotic stewardship (AS) guidance vs. usual care on antibiotic use in critically ill children.

Methods:

Single center, pragmatic, randomized prospective clinical trial of critically ill children admitted to an ICU setting and started on intravenous antibiotics from February 15, 2018, to April 11, 2019. Patients were assigned on a monthly basis to either the procalcitonin or usual care arm. The procalcitonin arm had procalcitonin testing on hospital days 0, 1, 2, and 4 and stewardship assistance with algorithm result interpretation. Both arms had routine AS audit and feedback. The primary outcome was median antibiotic days of therapy per patient in the first 14-days after enrollment.

Results:

Among 270 patients, 137 were in the procalcitonin arm and 133 in the usual care arm. Antibiotic days of therapy (DOT) were not significantly different between the procalcitonin arm (6.6, IQR: 3.1–10.9) and the usual care arm (7.6, IQR: 3–11.8; P = 0.37). More AS recommendations were made in the procalcitonin vs. control arm (54 vs. 37; P = 0.03). Adherence with algorithm-based antibiotic recommendations was high in the procalcitonin arm (70%).

Conclusions:

We found no difference in antibiotic DOT between study arms. This trial was underpowered but demonstrates feasibility of using a procalcitonin-guided antibiotic treatment algorithm with AS audit and feedback in the PICU.
Ovarian Torsion in Pediatric and Adolescent Patients
Authors: Zander Wendy , Frederick Katherine
Published: November 2020

Introduction

Although rare, ovarian torsion is a surgical emergency. The purpose of this article is to raise awareness of the occurrence, review anatomy and pathophysiology, and share diagnosis and management options with other healthcare providers.

Methods

This article was composed by two professional nurses who, in seeking to understand more about this dangerous condition, worked together in searching the literature for the latest information on etiology and management options for the patient.

Conclusions

The sudden onset of lower abdominal pain in female children and adolescents requires immediate evaluation by a qualified medical professional. In the case of ovarian torsion, speed is of the essence if normal function can possibly be restored or if surgical intervention for removal is required.
A comparative study of classic and HIV-viremic and aviremic AIDS Kaposi sarcoma
Authors: Séverin David , Bessaoud Faiza , Meftah Nadia , Du Thanh Aurelie , Tretarre Brigitte , Guillot Bernard , Makinson Alain
Published: November 2020

Background:

Kaposi sarcoma in people living with HIV (PLHIV) is the most common AIDS-associated malignancy. There is increased interest in Kaposi sarcoma in PLHIV with controlled HIV viremia.

Objectives:

To describe Kaposi sarcoma occurring in PLHIV despite virological control and to compare their clinical presentations with viremic AIDS-Kaposi sarcoma (AIDS-KS) and classic Kaposi sarcoma (CKS).

Methods:

This was a monocentric retrospective study, including all Kaposi sarcoma patients registered between the 1 January of 2000 and 31 December 2017 in a comprehensive data bank for all cancers in the Hérault region, South of France. AIDS-KS were also described using chart reviews from the Infectious diseases Department, which followed more than 90% of PLHIV from the same region. We defined aviremic AIDS-KS as Kaposi sarcoma occurring in persons taking HAART with a HIV viral load less than 50 copies for more than 12 months. We compared clinical characteristics of persons with aviremic AIDS-KS, viremic AIDS-KS and CKS, using the Kriegel score and number and topography of skin lesions, and presence of lymphedema.

Results:

We retrieved 187 Kaposi sarcoma cases, of which 12 occurred in PLHIV with aviremic AIDS-KS. Kriegel score stage I was found in 10 (83%) of the aviremic AIDS-KS, 34 (68%) of CKS and 38 (58.4%) of viremic AIDS-KS cases, with similar clinical presentations between aviremic AIDS-KS and CKS groups, and viremic AIDS-KS persons having more aggressive presentations. One person with aviremic AIDS-KS had visceral involvement.

Conclusion:

We showed that Kaposi sarcoma in PLHIV with controlled viremia were generally indolent, similarly to CKS. Visceral involvement is, however, possible.
Cerebral Infarction With Increased Uptake on 123I-FP-CIT SPECT
Authors: Nakajima Satoshi , Fushimi Yasutaka , Kawashima Hirotsugu , Murai Toshiya , Nakamoto Yuji
Published: November 2020

A 76-year-old woman underwent 123I-FP-CIT brain SPECT due to postural reflex impairment. The transverse slices demonstrated increased uptake in the right middle cerebral artery territory. MR images obtained 2 weeks earlier showed cerebral infarction in the corresponding area. 123I-FP-CIT has high binding affinity for dopamine transporters, especially in the nerve endings of nigrostriatal dopaminergic neurons.
Will Baseline Total Lesion Glycolysis Play a Role in Improving the Prognostic Value of the NCCN-IPI in Primary Gastric Diffuse Large B-Cell Lymphoma Patients Treated With the R-CHOP Regimen?
Authors: Jiang Chong , Ding Chongyang , Xu Jingyan , Teng Yue , Chen Jieyu , Wang Zhen , Zhou Zhengyang
Published: November 2020

Purpose

The aim was to explore whether baseline total lesion glycolysis (TLG) can improve the prognostic value of the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) in primary gastric diffuse large B-cell lymphoma (PG-DLBCL) patients treated with an R-CHOP–like regimen.

Materials and Methods

Ninety-four PG-DLBCL patients who underwent baseline PET/CT between July 2010 and May 2019 were included in this retrospective study. FDG-avid lesions in each patient were segmented to calculate the SUVmax, total metabolic tumor volume (TMTV), and TLG. Progression-free survival (PFS) and overall survival (OS) were used as end points to evaluate prognosis.

Results

During the follow-up period of 5 to 108 months (35.3 ± 23.5 months), high TLG and a high NCCN-IPI were significantly associated with poor PFS and OS. Total lesion glycolysis and the NCCN-IPI were independent predictors of PFS and OS. Patients were stratified into 3 groups according to the combination of TLG and the NCCN-IPI for PFS (P < 0.001) and OS (P < 0.001): high-risk group (TLG > 1159.1 and NCCN-IPI 4–8) (PFS and OS, 57.7% and 61.5%, respectively, n = 42), intermediate-risk group (TLG > 1159.1 or NCCN-IPI 4–8) (PFS and OS, both 76.9%, n = 26), and low-risk group (TLG ≤ 1159.1 and NCCN-IPI 0–3) (PFS and OS, 97.6% and 100.0%, respectively, n = 26).

Conclusions

Both TLG and the NCCN-IPI are independent predictors of PG-DLBCL patient survival. Moreover, the combination of TLG and the NCCN-IPI improved patient risk stratification and might help personalize therapeutic regimens.
Detection of Unexpected Brown Tumors Due to Hyperparathyroidism Diagnosed by 18F-FDG PET/CT
Authors: Geysen Astrid , Van Laere Koen , Verscuren Raf
Published: November 2020

A 27-year-old man was called to receive a kidney transplant. The preoperative CT of the chest showed multiple osteolytic lesions, as well as a hypodense structure posterior in the right thyroid lobe. Blood analysis showed elevated parathyroid hormone, phosphorus, and alkaline phosphatase levels, with normal calcium and 25-OH-vitamin D. 18F-FDG PET/CT demonstrated generalized elevated FDG uptake in the bone (due to hyperparathyroidism), as well as multiple hypermetabolic focal lesions spread throughout the bone (fitting brown tumors). The nodule posterior of the right thyroid lobe showed an intense FDG uptake as well, suggestive of a parathyroid adenoma/hyperplasia. Histopathology confirmed the diagnosis.
Anomalous Origin and Course of Right Vertebral Artery With Aberrant Right Subclavian Artery
Authors: Taydas Onur , Sakci Zakir , Ogul Hayri
Published: November 2020

Origin and course anomalies of the vertebral arteries are rare. They are considered a congenital anomaly that occurs in the early stages of embryonic development. Thanks to magnetic resonance angiography, these anomalies can be diagnosed easily. Detecting these anomalies is especially important before endovascular interventional procedures. In this case report, we present magnetic resonance angiography findings of a patient with extraforaminal vertebral artery that originated from right common carotid artery and also with aberrant right subclavian artery.
Experiment of Mechanical Properties of a Customized Distractor Based on Three-Dimensional Printing Technology
Authors: Zhao Xinran , Li Guangwei , Shen Guofang , Wei Jianhe , Cai Ming
Published: November 2020

This study aimed to design and fabricate a customized distractor based on 3D printing technology and compare its mechanical properties with conventional distractor. The investigators designed and implemented a study composed of conventional and customized distractors. The design of customized distractor was based on the specification of conventional mandibular distractors and was fabricated using selective laser melting (SLM) technology. The same type of conventional distractors served as control group. Vickers-hardness test, three-point bending test and welding strength test were carried out for the conventional and customized distractor respectively and data was analyzed with t test using SPSS13.0 software package. The sample was composed of 18 distractors grouped as follows: customized distractor (n = 9) and conventional distractor (n = 9). The customized distractor showed better result than the conventional distractor in mechanical property tests, with statistically significant differences in Vickers-hardness and maximum load (P < 0.05), and no significant differences in yield strength and welding strength (P > 0.05). The results of this study suggest indicated that compared to the conventional distractor, the customized distractor had better mechanical properties and could be used in maxillofacial distraction osteogenesis.
Stereotactic EEG Practices: A Survey of United States Tertiary Referral Epilepsy Centers
Authors: Gavvala Jay , Zafar Muhammad , Sinha Saurabh R. , Kalamangalam Giridhar , Schuele Stephan ,   On behalf of the American SEEG Consortium, supported by The American Clinical Neurophysiology Society
Published: November 2020

Purpose:

Stereotactic EEG (SEEG) is being increasingly used in the intracranial evaluation of refractory epilepsy in the United States. In this study, the authors describe current practice of SEEG among National Association of Epilepsy Centers tertiary referral (level IV) centers.

Methods:

Using the Survey Monkey platform, a survey was sent to all National Association of Epilepsy Centers level IV center directors.

Results:

Of 192 centers polled, 104 directors completed the survey (54% response rate). Ninety-two percent currently perform SEEG. Of these, 55% of institutions reported that greater than 75% of their invasive electrode cases used SEEG. Stereotactic EEG was commonly used over subdural electrodes in cases of suspected mesial temporal lobe epilepsy (87%), nonlesional frontal lobe epilepsy (79%), insular epilepsy (100%), and individuals with prior epilepsy surgery (74%). Most centers (72%) used single-lead electrocardiogram monitoring concurrently with SEEG, but less than half used continuous pulse oximetry (47%) and only a few used respiratory belts (3%). Other significant intercenter technical variabilities included electrode nomenclature and choice of reference electrode. Patient care protocols varied among centers in patient-to-nurse ratio and allowed patient activity. Half of all centers had personnel who had prior experience in SEEG (50.5%); 20% of centers had adopted SEEG without any formal training.

Conclusions:

Stereotactic EEG has become the principal method for intracranial EEG monitoring in the majority of epilepsy surgery centers in the United States. Most report similar indications for use of SEEG, though significant variability exists in the utilization of concurrent cardiopulmonary monitoring as well as several technical and patient care practices. There is significant variability in level of background training in SEEG among practitioners. The study highlights the need for consensus statements and guidelines to benchmark SEEG practice and develop uniform standards in the United States.