bluuebunny/crossref_metadata_2025 huggingface dataset:
Business-Government Relations in the EU
Authors: Coen David , Katsaitis Alexander , Vannoni Matia
Published: March 2021

This monograph charts and assesses business lobbying in Brussels, taking into consideration its nuances. Indeed, a number of disciplines, theories, and methodological approaches grapple with this subject. The EU is one of the largest trading blocs and lobbying environments in the world. It is also a unique socio-political arena, in constant flux over the last fifty years. Business has not been idle; expanding its reach outside of the national domain, since the 1970s it has developed a spectacular advocacy toolbox, particularly in Europe and the US. Government affairs offices in Brussels today hardly resemble those forty years ago in quality or quantity. The relationship, is multi-layered, multi-level, multi-actor, and cuts across a series of institutional, thematic, legal, social, and governmental networks. With this in mind, this monograph draws on two different disciplines that act as a theoretical prism: political science, and business and management studies. The former helps make sense of the demand side of the equation, the role of government in shaping business activity. The latter provides the supply side, the company’s inner workings and its strategic choice to mobilize and lobby the EU. We employ three analytic perspectives: (i) macro; (ii) meso; (iii) micro. Bringing together different perspectives to business-government affairs in the EU, we aim to provide a rounded theoretical understanding of the relationship, a rich set of conceptual tools for its examination, and a detailed empirical mapping.
The Nature of the Policy Field and Business-Government Relations
Authors: Coen David , Katsaitis Alexander , Vannoni Matia
Published: March 2021

This chapter studies the nature of the policy field and its impact on business-lobbying in the EU. Drawing from theories on institutional legitimacy and information-access it observes the variation in density and diversity across regulatory and (re)distributive policy fields, and committee hearings. Empirically, the chapter employs business group surveys, conducts meticulous analysis of a population of 12,000 interest groups lobbying preferences across multiple policy fields assessing their density and diversity as well as their clustering. It includes a case study on business diverse coalition building focusing on net neutrality. Finally, the chapter observes the distribution of business interests across the European Parliament’s committee hearings. In doing so, this chapter contributes to discussions on legitimacy and public policy, chameleon pluralism, business mobilization, and the nature of the policy good.
Introduction—the Plan for this Book and the Lay of the Land
Authors: Jauernig Anja
Published: March 2021

The plan for the book is sketched, and a classification scheme for extant interpretations of Kant’s transcendental distinction between appearances and things in themselves is provided. The interpretation of Kant’s critical idealism that will be developed in the book, which is a version of the so-called classic two-world view, is presented in outline, and a brief overview of the history of the classic two-world view is given.
Things in Themselves and their Relation to Appearances
Authors: Jauernig Anja
Published: March 2021

The theses that things in themselves exist and ground appearances by affecting sensibility are discussed, a discussion that includes an examination of the difference between the empirical and transcendental distinction between things in themselves and appearances and of the role of the analogy between secondary qualities and spatiotemporal determinations in Kant’s explanation of critical idealism. The relation between the transcendental and the empirical self is revisited, and the two-world reading of this relation is confirmed and integrated with an account of Kant’s conception of human beings as composed of various distinct parts, including a body, an empirical self, and a transcendental self. The account, begun in chapter 3, of how critical idealism differs from ordinary idealism is further refined, and Kant’s arguments for the existence and grounding theses are reconstructed and shown to ultimately rely on the assumption that the human mind is essentially finite. Finally, two versions of critical idealism are distinguished—bold critical idealism and timid critical idealism—and it is argued that Kant is a bold critical idealist.
Kantian Things in Themselves, Leibniz-Wolffian Things in Themselves, and Fictionalism
Authors: Jauernig Anja
Published: March 2021

An account is provided of how Kant’s apparent endorsement of fictionalism about things in themselves, as well as his apparent endorsement of the Leibniz-Wolffian conception of things in themselves, can be reconciled with the reading that he is a realist about things in themselves as characterized in critical idealism. In this context, the difference between Kantian things in themselves and noumena, that is, objects of the pure understanding, is explained as well. Furthermore, two additional arguments for transcendental idealism that are suggested by Kant are subject to scrutiny, both of which seem odd at first glance since they rely on premises about things in themselves to which he does not appear to be entitled within the framework of the critical philosophy.
Plant-specific histone deacetylases are essential for early and late stages of Medicago nodule development
Authors: Li Huchen , Schilderink Stefan , Cao Qingqin , Kulikova Olga , Bisseling Ton
Published: March 2021

Legume and rhizobium species can establish a nitrogen-fixing nodule symbiosis. Previous studies have shown that several transcription factors that play a role in (lateral) root development are also involved in nodule development. Chromatin remodeling factors, like transcription factors, are key players in regulating gene expression. However, studies have not investigated whether chromatin remodeling genes that are essential for root development are also involved in nodule development. Here, we studied the role of Medicago (Medicago truncatula) histone deacetylases (MtHDTs) in nodule development. Arabidopsis (Arabidopsis thaliana) orthologs of HDTs have been shown to play a role in root development. MtHDT expression is induced in nodule primordia and is maintained in the nodule meristem and infection zone. Conditional, nodule-specific knockdown of MtHDT expression by RNAi blocks nodule primordium development. A few nodules may still form, but their nodule meristems are smaller, and rhizobial colonization of the cells derived from the meristem is markedly reduced. Although the HDTs are expressed during nodule and root development, transcriptome analyses indicate that HDTs control the development of each organ in a different manner. During nodule development, the MtHDTs positively regulate 3-hydroxy-3-methylglutaryl coenzyme a reductase 1 (MtHMGR1). Decreased expression of MtHMGR1 is sufficient to explain the inhibition of primordium formation.
A positive feedback loop mediated by CsERF31 initiates female cucumber flower development
Authors: Pan Jian , Wen Haifan , Chen Guanqun , Lin Wen-Hui , Du Hui , Chen Yue , Zhang Leyu , Lian Hongli , Wang Gang , Cai Run , Pan Junsong
Published: March 2021

Sex determination is a crucially important developmental event that is pervasive throughout nature and enhances the adaptation of species. Among plants, cucumber (Cucumis sativus L.) can generate both unisexual and bisexual flowers, and the sex type is mainly controlled by several 1-aminocyclopropane-1-carboxylic acid synthases (CsACSs). However, the regulatory mechanism of these synthases remains elusive. Here, we used gene expression analysis, protein–DNA interaction assays, and transgenic plants to study the function of a gynoecium-specific gene, ETHYLENE RESPONSE FACTOR31 (CsERF31), in female flower differentiation. We found that in a predetermined female flower, ethylene signaling activates CsERF31 by CsEIN3, and then CsERF31 stimulates CsACS2, which triggers a positive feedback loop to ensure female rather than bisexual flower development. A similar interplay is functionally conserved in melon (Cucumis melo L.). Knockdown of CsERF31 by RNAi causes defective bisexual flowers to replace female flowers. Ectopic expression of CsERF31 suppresses stamen development and promotes pistil development in male flowers, demonstrating that CsERF31 functions as a sex switch. Taken together, our data confirm that CsERF31 represents the molecular link between female–male determination and female–bisexual determination, and provide mechanistic insight into how ethylene promotes female flowers, rather than bisexual flowers, in cucumber sex determination.
A Mixed-Methods Investigation into Patients’ Decisions to Attend an Emergency Department for Chronic Pain
Authors: Brady Bernadette , Andary Toni , Pang Sheng Min , Dennis Sarah , Liamputtong Pranee , Boland Robert , Tcharkhedian Elise , Jennings Matthew , Pavlovic Natalie , Zind Marguerite , Middleton Paul , Chipchase Lucy
Published: March 2021

Objective

This study explored factors that underpin decisions to seek emergency department (ED) care for chronic noncancer pain in patients identifying as culturally and linguistically diverse (CALD) or Australian born.

Design and Methods

This mixed-methods study was underpinned by the Behavioral Model of Health Services Use conceptual framework. Consenting consecutive patients attending the ED for a chronic pain condition were recruited to a CALD (n = 45) or Australian-born (n = 45) cohort. Statistical comparisons compared the demographic, pain, health literacy, and episode of care profiles of both cohorts. Twenty-three CALD and 16 Australian-born participants consented to an audio-recorded semi-structured interview (n = 24) or focus group (n = 5 focus groups) conducted in their preferred language. Interviews were translated and transcribed into English for analysis using applied thematic analysis, guided by the conceptual framework. Data were triangulated to investigate the patterns of ED utilization and contributing factors for both cohorts.

Results

ED attendance was a product of escalating distress, influenced by the degree to which participants’ perceived needs outweighed their capacity to manage their pain. This interaction was amplified by the presence of predisposing factors, including constrained social positions, trauma exposure, and biomedical health beliefs. Importantly, experiences varied between the two cohorts with higher degrees of pain catastrophizing, lower health literacy, and greater social challenges present for the CALD cohort.

Conclusion

This study highlights the role contextual factors play in amplifying pain-related distress for CALD and Australian-born patients with chronic pain. The findings support a need for health care providers to recognize features of higher vulnerability and consider streamlining access to available support services.
Asking About Attitude Change
Authors: Graham Matthew H , Coppock Alexander
Published: March 2021

Surveys often ask respondents how information or events changed their attitudes. Does [information X] make you more or less supportive of [policy Y]? Does [scandal X] make you more or less likely to vote for [politician Y]? We show that this type of question (the change format) exhibits poor measurement properties, in large part because subjects engage in response substitution. When asked how their attitudes changed, people often report the level of their attitudes rather than the change in them. As an alternative, we propose the counterfactual format, which asks subjects what their attitude would have been in the counterfactual world in which they did not know the treatment information. Using a series of experiments embedded in four studies, we show that the counterfactual format greatly reduces bias relative to the change format.
Onset of comorbidities and flare patterns within pre-existing morbidity clusters in people with gout: 5-year primary care cohort study
Authors: Bajpai Ram , Muller Sara , Mallen Christian , Watson Lorraine , Richette Pascal , Hider Samantha L , Roddy Edward
Published: March 2021

Objective

To investigate the onset of comorbidities and pattern of flares over 5 years according to baseline comorbidity clusters in people with gout.

Methods

In a prospective primary care-based cohort study, adults aged ≥18 years with gout were identified from primary care medical records in 20 general practices across the West Midlands, UK and followed up over 5 years. Four clusters of participants have been defined previously according to baseline comorbidity status. The associations of (i) incident comorbidities and (ii) gout flares with baseline cluster membership were estimated using age and sex-adjusted Poisson regression and mixed effects ordinal logistic regression, respectively.

Results

The comorbidity with the highest incidence was coronary artery disease (39.2%), followed by hypertension (36.7%), chronic kidney disease stage ≥3 (18.1%), obesity (16.0%), hyperlipidaemia (11.7%), diabetes (8.8%) and cancer (8.4%). There were statistically significant associations observed between cluster membership and incidence of coronary artery disease, hyperlipidaemia, heart failure and hypertension. In each cluster, nearly one-third of participants reported two or more gout flares at each time-point. History of oligo/polyarticular flares (odds ratio [OR]= 2.16, 95% confidence interval [CI]: 1.73, 2.70) and obesity (1.66, 95% CI: 1.21, 2.25) were associated with increasing flares whereas current use of allopurinol was associated with lower risk (0.42, 95% CI: 0.34–0.53). Cluster membership was not associated with flares.

Conclusion

Substantial numbers of people in each cluster developed new comorbidities that varies by cluster membership. People also experienced multiple flares over time, but these did not differ between clusters. Clinicians should be vigilant for the development of new comorbidities in people with gout.
Mobilizing P2P Diffusion for New Agricultural Practices: Experimental Evidence from Bangladesh
Authors: Fafchamps Marcel , Islam Asad , Malek Abdul , Pakrashi Debayan
Published: March 2021

This paper uses a randomized controlled experiment in which farmers trained on a new rice cultivation method teach two other farmers. The results show that the intervention increases yields and farm profits among treated farmers. Teacher-trainees are effective at spreading knowledge and inducing adoption relative to just training. Incentivizing teacher-trainees improves knowledge transmission but not adoption. Matching teacher-trainees with farmers who list them as role models does not improve knowledge transmission and may hurt adoption. Using mediation analysis, the study finds that the knowledge of the teacher-trainee is correlated with that of their students, consistent with knowledge transmission. The paper also finds that systems of rice intensification (SRI) knowledge predicts adoption of some SRI practices, and that adoption by teacher-trainees predicts adoption by their students, suggesting that students follow the example of their teacher. With cost-benefit estimates of social returns in excess of 100 percent, explicitly mobilizing peer-to-peer (P2P) transmission of knowledge seems a cost-effective way of inducing the adoption of new profitable agricultural practices.
How the Global Tea Industry Copes With Fungal Diseases – Challenges and Opportunities
Authors: Pandey Abhay K. , Sinniah Ganga D. , Babu Azariah , Tanti Amarjyoti
Published: March 2021

Tea (Camellia sinensis [L.] O. Kuntze) is a plantation crop, grown commercially in Asia, Africa, and South America. Among biotic threats to tea production, diseases caused by fungal pathogens are most significant. Worldwide, tea plants are challenged by several root, stem, and foliar diseases. Foliar diseases, blister blight, gray blight, and brown blight are particularly important as they adversely affect the bud and the two youngest leaves, causing loss of harvestable shoots. Over the past several decades, climate change and field management practices have influenced the risk of crop damage by several fungal pathogens, as well as the development and spread of diseases. Management interventions, such as the adoption of good cultural/agronomic practices, use of fungicides and microbial biocontrol agents, plant defense elicitors, and deployment of resistant cultivars, have mitigated damage to tea plants caused by fungal diseases. A clearer understanding of knowledge gaps and the benefits of plant disease management strategies available is needed. The present article reviews the prevailing knowledge of major fungal pathogens of the tea crop, their genetic variability, the damage they cause and its economic impact, and the need for new disease management strategies as climate change intensifies. We will also emphasize important knowledge gaps that are priority targets for future research.
Mixed conjugated linoleic acid sex‐dependently reverses high‐fat diet‐induced insulin resistance via the gut‐adipose axis
Authors: Li Haoyu , Zhuang Pan , Zhang Yu , Shou Qiyang , Lu Yanhua , Wang Guangfa , Qiu Jieni , Wang Jun , He Lilin , Chen Jingnan , Jiao Jingjing
Published: March 2021

Conjugated linoleic acid (CLA) may prevent the development of obesity and metabolic disorders. However, the effects of CLA on inflammation and glucose metabolism are controversial. The underlying mechanisms governing the gut microbiota and sexual dimorphisms have also not been elucidated. The present study assessed the effect of CLA on glucose and lipid metabolism in established obesity and examined the mechanism of action based on gut microbiota. Four‐week‐old C57BL/6J mice were fed a high‐fat diet (HFD) for 10 weeks to induce obesity. The diet‐induced obese (DIO) mice were fed an HFD supplemented with mixed CLA (50% cis‐9, trans‐11 isomer and 50% trans‐10, cis‐12 isomers, 0.2% wt/wt) for 15 weeks. CLA supplementation remarkably reversed body weight in both sexes. CLA favored anti‐inflammatory microbiota in male mice, mediating increased short‐chain fatty acids and decreased lipopolysaccharide (LPS) production, which alleviated global inflammation and improved insulin sensitivity via inhibition of the TLR4‐NF‐κB pathway in adipose tissue. CLA promoted the growth of hydrogen sulfide‐producing Desulfovibrio and the release of LPS in female mice, which aggravated adipose inflammation and insulin resistance. Although CLA impaired glucose metabolism in females, brown adipose tissue was significantly activated with browning of white adipose tissue in both sexes, which led to enhanced energy expenditure. Fecal transplantation from CLA‐treated mice to DIO mice mimicked the sex‐dependent phenotype. In conclusion, CLA decreased body weight and increased energy expenditure but sex‐dependently modulated insulin resistance via the gut‐adipose axis.
Optimizing the management of inpatient cardiac arrest
Authors: Carter Michael
Published: March 2021

Cardiac arrest is a common event in the inpatient setting, and although attempts have been made to simplify the approach to its management via systemwide training in CPR and Advanced Cardiac Life Support, significant challenges remain in implementing these guidelines in the management of cardiac arrest.
ACLS interventional skills: Are we as good as we should be?
Authors: Good Jason J. , Rabener Michael J.
Published: March 2021

Objective:

This study evaluated the competence of Advanced Cardiac Life Support certified personnel at hands-on ACLS skills.

Methods:

The observational, cross-sectional study assessed participants' subjective confidence and objective skills using the ACLS mega code examination. Testing was performed with a Laerdal manikin and standardized code carts.

Results:

Participants had a 12% (6% to 22%, 95% CI) pass rate for the stable tachyarrhythmia scenario and a 57% (44% to 69%, 95% CI) pass rate for the unstable tachyarrhythmia scenario. The most significant skills missed were appropriate medications and postconversion maintenance in the stable scenario and appropriate energy selection and successful shock delivery for the unstable scenario.

Conclusions:

ACLS providers feel confident in their ACLS skills; however, actual performance demonstrated poor performance in the management of patients with stable and unstable tachyarrhythmias. The recommendation is to observe initial and recertification ACLS classes to investigate the standard to which these core skills are being taught and evaluated.
Treating breast implant-associated anaplastic large cell lymphoma
Authors: McKernan Cayla
Published: March 2021

Each year, hundreds of thousands of women undergo aesthetic or reconstructive breast implant surgery. Clinicians and patients must be aware of the benefits and risks of this surgery. Recently, the FDA suggested a recall of certain textured breast implants because of a link between these implants and a rare form of lymphoma, now referred to as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). This malignancy has an indolent course and an excellent prognosis when detected and treated early. This article reviews BIA-ALCL, addresses public safety advisories, and emphasizes protocol that all clinicians should follow when encountering a patient with textured breast implants.
Which SSRI is safest for patients with CVD and major depressive disorder?
Authors: Dunham Sabrina , Wilkening G. Lucy , Schwier Nicholas C.
Published: March 2021

Major depressive disorder is a common mood disorder and presents increased morbidity and mortality risks for patients with comorbid cardiovascular disease (CVD). Selective serotonin reuptake inhibitors (SSRIs) are a cornerstone of treatment for major depressive disorder, given their relative safety and affordability compared with other antidepressant classes, and SSRIs frequently are used in patients with CVD. However, clinicians should carefully weigh safety considerations before prescribing SSRIs in these patients. This article reviews the safety of SSRIs in patients with CVD and discusses SSRI selection.
Doing More With Written Feedback: Improving Learner Satisfaction and Reflection With the LEAF (Learner-Engaged Analysis of Feedback) Method
Authors: Saddawi-Konefka Daniel , Sullivan Amy , Beltran Christine , Baker Keith
Published: March 2021

Problem

Written feedback is often overly positive, nonspecific, and difficult to interpret. Learner satisfaction with written feedback is low and obtaining written feedback that encourages self-reflection is challenging. Improving feedback quality is laborious and only modestly effective.

Approach

The authors developed the LEAF (Learner-Engaged Analysis of Feedback) method to improve learner satisfaction with, and reflection on, existing written feedback. The method pairs a learner and coach to methodically identify themes in the learner’s written feedback. Themes occurring more frequently or less frequently than typical offer areas for reflection, as they may identify learners’ relative strengths or weaknesses. The method was introduced at the Massachusetts General Hospital in 2017 during program director (PD) meetings with anesthesiology residents. In 2018, resident satisfaction was measured (1 to 5 Likert-type questions, 1 = “not at all satisfied,” 5 = “extremely satisfied”) for 4 feedback sources, 2 related to the LEAF method (PD meetings, written feedback) and 2 unrelated (verbal feedback, mentor feedback). Residents’ comments were qualitatively assessed to explore the impact on self-reflection.

Outcomes

Residents who had participated in a LEAF session (n = 54), compared with those who had not (n = 11), reported higher satisfaction with written feedback (mean 3.1 versus 2.5, d = 0.53, P = .03) and PD meeting feedback (mean 3.8 versus 2.8, d = 0.80, P = .03). There were no significant differences between groups for satisfaction with feedback unrelated to the LEAF method. Qualitative analysis of comments suggested that residents found the method useful for providing holistic self-assessment, facilitating goal setting, uncovering blind spots, and improving feedback interpretation.

Next Steps

Next steps should include studies determining if the association between increased learner satisfaction with written feedback and the LEAF method is causal, and whether this feedback process changes learners’ subsequent behaviors.
Age Effects of Bone Conduction Vibration Vestibular-evoked Myogenic Potentials (VEMPs) Using B81 and Impulse Hammer Stimuli
Authors: Patterson Jessie N. , Rodriguez Amanda I. , Gordon Katherine R. , Honaker Julie A. , Janky Kristen L.
Published: March 2021

Objective:

Recently developed, the Radioear B81 bone oscillator allows for higher bone conduction vibration output; however, normative data are lacking regarding its use in vestibular-evoked myogenic potential (VEMP) testing. The purpose of this study was to examine the effect of age on cervical and ocular VEMP (c- and oVEMP) responses using the B81 and to compare with air conduction stimuli (ACS) and impulse hammer (IH) VEMP response characteristics.

Design:

c- and oVEMP were completed with ACS, B81, and IH stimuli in healthy participants (age range = 10 to 87 years, n = 85).

Results:

Regardless of stimulus type, c- and oVEMP amplitudes and response rates decreased with age. For cVEMP response rates, ACS performed better or equal to B81, which was superior to the IH. For cVEMP corrected amplitude, ACS had significantly higher amplitudes compared with B81 and IH. There was no difference in cVEMP corrected amplitude between B81 and IH. For oVEMP, response rates were comparable between stimuli with the largest disparity in response rates occurring in the oldest groups where IH outperformed both ACS and B81. For oVEMP amplitude, IH had significantly higher amplitudes compared with B81 and ACS. There was no difference in oVEMP amplitude between B81 and ACS.

Conclusions:

Age significantly affected c- and oVEMP amplitudes regardless of stimulus type (ACS, B81, IH). All stimuli are appropriate for eliciting c- and oVEMP in the young individuals. While ACS resulted in higher cVEMP corrected amplitudes, either ACS or B81 are appropriate for older individuals. However, for oVEMPs, higher response rates and larger amplitudes were noted for IH followed by B81 and ACS. Overall, the B81 performed well across the lifespan for c- and oVEMPs and may be a reasonable bone conduction vibration option for patients with absent ACS VEMPs, but at this time is not recommended as a replacement to ACS.
Optimizing Ocular Vestibular Evoked Myogenic Potentials With Narrow Band CE-Chirps
Authors: Mat Quentin , Duterme Jean-Pierre , Tainmont Sophie , Lelubre Christophe , Manto Mario
Published: March 2021

Objectives:

To evaluate the effects of narrow band CE-Chirp (NB CE-Chirp) on the amplitudes and latencies in ocular vestibular evoked myogenic potentials (oVEMPs) at 500 and 1000 Hz in comparison with tone burst (TB).

Design:

Twenty-one healthy volunteers were included in the study and tested in air conduction with a “belly-tendon” montage. Recording conditions were randomized for each participant and each modality was tested twice to check the reproducibility of the procedure.

Results:

NB CE-Chirps at 500 Hz revealed larger n1-p1 amplitudes than 500 Hz TBs (p = .001), which were also larger than NB CE-Chirps and TBs at 1000 Hz (p = .022, p < .001, respectively). Besides, n1 and p1 latencies were shorter in NB CE-Chirp than in TB at 500 Hz (p < .001) and 1000 Hz (p < .001). The older the participants, the lower the amplitudes (p = .021, p = .031) and the longer the n1 (p = .030, p = .025) and p1 latencies (p < .001, p < .001) in 500 Hz NB CE-Chirps and 500 Hz TBs. Interaural asymmetry ratios were slightly higher in 500 Hz NB CE-Chirps as compared to 500 Hz TBs (p = .013).

Conclusions:

NB CE-Chirps at 500 Hz improved the amplitudes of waveforms in oVEMPs. As for TBs with clicks before, enhancing oVEMPs amplitudes is an essential step to distinguish a healthy person from a patient with either utricular or its related pathways disorder and potentially minimize the risk of cochlear damages. Additional studies including a higher number of healthy participants and patients with vestibular disorders are required to confirm this hypothesis. The large interindividual variability of interaural asymmetry ratios in NB CE-Chirp and in TB at 500 Hz could be explained by the selected montage.
Comparisons of initial outcomes and cost-effectiveness after total ankle arthroplasty versus bipolar osteochondral allograft transplantation in the ankle: a retrospective cohort study
Authors: Smith Caitlyn J. , Crist Brett D. , Rucinski Kylee , Cook James L. , Leary Emily V.
Published: March 2021

Background:

Total ankle arthroplasty (TAA) has been a standard-of-care surgical treatment option for patients who are suffering from ankle disorders since the 1960s. It is costly with a limited lifespan; younger, active patients will likely need additional surgeries. Evidence-based advancements in osteochondral allograft (OCA) preservation and transplantation techniques have resulted in improved outcomes, making it a potentially more appropriate treatment option for specific patients. This study compares 90-day clinical and self-reported outcomes for patients who received TAA or bipolar OCA ankle transplantation.

Methods:

Differences in costs and quality-adjusted life years (QALY) for patients were determined using postoperative 1-year follow-up. An institutional review board-approved review of electronic medical records and billing data was conducted for patients who underwent TAA or bipolar OCA ankle transplantation (n=35) at a single institution between 2014 and 2018. Postoperative patient-reported outcome scores and cost comparisons were completed using a two-sample t-test, or nonparametric alternative, or chi-square test.

Results:

Three months after surgery, no statistically significant differences in patient-reported outcomes, postsurgical complications, or value-based care metrics were observed between older TAA (n=18) or younger OCA groups (n=17). Based on data, OCA and TAA were both considered cost-effective treatment options; differences in the incremental cost-effectiveness between OCA and TAA were not statistically significant (P=0.99), and 1-year outcomes were good to excellent.

Conclusions:

These results will guide more robust planning for 90-day postoperative reimbursement guidelines. Ongoing work is needed to assess mid-term and long-term outcomes for patients with respect to morbidity, complications, patient-reported outcomes, costs, and QALY.

Level of Clinical Evidence:

Level III.
Trunnionosis in total knee arthroplasty: an unusual case report in revision knee arthroplasty
Authors: Malhotra Rajesh , Gautam Deepak , Mahato Ajay , Gupta Saurabh , Panday Pushpender , Chawla Anoop
Published: March 2021

Background:

Trunnionosis has been described as an emerging cause of failure in total hip arthroplasty. However, its role in total knee arthroplasty failure is poorly described.

Case Report:

A case of catastrophic failure of revision total knee arthroplasty at 7 years due to trunnionosis at the femoral extension rod morse-taper junction is described. The possible mechanism of failure is discussed based on a comprehensive finite element analysis.

Conclusions:

The limitations of modularity and trunnionosis must be understood, as many patients have been receiving modular total knee arthroplasty at younger ages.
Calcaneal Sliding Osteotomy Versus Calcaneal Lengthening Osteotomy for Valgus Foot Deformity Correction in Children With Cerebral Palsy
Authors: Rethlefsen Susan A. , Hanson Alison M. , Wren Tishya A.L. , Kay Robert M.
Published: March 2021

Background:

Medial calcaneal sliding (CS) osteotomy and lateral column lengthening (LCL) are often performed to relieve pain and improve transverse plane alignment and gait stability for children with cerebral palsy (CP) and valgus foot deformities. The purpose of this study was to examine the effectiveness of these procedures in this population.

Methods:

Retrospective medical record review (including 3D gait analysis data) of patients with CP who underwent LCL (26 subjects, 46 limbs) or CS (46 subjects, 73 limbs). Data extraction included complications (modified Clavien-Dindo system), change in standing foot position (modified Yoo system), and change in gait kinematics and kinetics preoperatively to postoperatively. Groups were compared using paired t tests, Fisher exact test, and survivorship analysis using Cox proportional hazard models.

Results:

Subjects were 57% male, average age at surgery 11.1 (SD 2.5) years. Average length of follow-up was 3.2 (SD 2.8) years, and was longer in the LCL group (P=0.0004). Complications were minor with similar rates between groups (P=0.14). Prolonged pain and plantar hypersensitivity occurred only in the CS group. Successful maintenance of deformity correction was achieved in 52/73 limbs (71%) in the CS group and 16/44 limbs (36%) in the LCL group (P<0.001). Recurrent pes valgus and need for repeat foot surgery were more common after LCL (P=0.003 and 0.001, respectively). Recurrent pes valgus never occurred when talonavicular fusion was done concomitantly with CS. After accounting for the between group difference in length of follow-up, there was no difference in the rates of recurrent valgus or repeat foot surgery between LCL and CS. None of the variables predicted development of pes varus (P>0.20). Ankle kinematics and kinetics during gait were unchanged in both groups.

Conclusions:

CS and LCL have similar effectiveness in providing long-lasting correction of valgus foot deformities. Concomitant talonavicular fusion is key to success of CS for lower functioning patients with severe deformities, and obligate brace wearers.

Level of Evidence:

Level III, retrospective comparative study.
Mechanical Analysis of Explanted Telescopic Rods in the Management of Osteogenesis Imperfecta: A Multicenter Study
Authors: Nicolaou Nicolas , Luo Quanshun , Giles Stephen N. , Maruthainar Kunalan , Kitchen Matthew P. , Thomas Simon , Fernandes James A. , Roposch Andreas
Published: March 2021

Background:

Telescopic rods in the management of osteogenesis imperfecta fail frequently. This could be attributed to technical errors, rod design, and rod structure. We aimed to analyze the mechanical properties and tribology of explanted male and female components to identify effects of in vivo telescoping that may relate to observed patterns of successful telescoping or failure.

Methods:

Recruitment took place at 3 of the 4 English centers for osteogenesis imperfecta. Twenty-five rods explanted for growth or failure during revision to a new rod were analyzed in terms of clinical indication and prerevision imaging to identify if there was a technical mode of failure. Laboratory analysis was performed using optical and scanning electrical microscopy, radiograph diffraction analysis, hardness test, bending test, and energy-dispersive x-ray spectroscopy.

Results:

All implants tested were of high-grade stainless steel. Female components had inferior strength [mean Vickers hardness property (HV0.3) at 0.3 to 313 kg] in comparison to male components (HV0.3 406) due to different techniques of manufacture. Female rods also had a higher wear coefficient (7.89×10−12 m3/N/m3) than the male rods (6.46×10−12 m3/N/m3). Abrasive wear, shear deformation, scratches, and wear debris were identified in all rods. Male and female components displayed corrosion contributing to adhesive wear. Intraoperatively cut rods, particularly the female components, had irregular ends leading to more wear.

Conclusions:

Current manufacturing techniques result in inferior material strength in female components compared with males, which combined with wear patterns is likely to lead to implant failure. Intraoperative cutting of rods may increase risk of failure due to wear. Considering techniques to improve strength as well as design in new implants may lead to better outcomes.

Levels of Evidence:

Level IV—cross-sectional study.
Characteristics of Patients Undergoing Surgical Treatment for Spinal Metastases From Colorectal Cancer
Authors: Park Se-Jun , Park Jin-Sung , Nam Yunjin , Lee Chong-Suh
Published: March 2021

Study Design:

This was a retrospective study.

Objective:

This study aimed to investigate the prognosis and characteristics of patients undergoing surgical treatment for colorectal cancer (CRC) spinal metastasis. To better understand the characteristics of such patients, their results were compared with those with spinal metastasis from non–small cell lung cancer (NSCLC), as the prognosis of these patients is well-studied.

Summary of Background Data:

CRC commonly metastasizes to the liver or lung, while spinal metastases occur infrequently. The literature contains very few studies evaluating the prognosis of patients with spinal metastases from CRC.

Materials and Methods:

A consecutive 155 patients who underwent surgical treatment for spinal metastases from CRC (n=35) or NSCLC (n=120) between 2010 and 2018 were included in this study. Data were collected throughout the disease course, including those concerning all cancer-related treatments for both the primary cancer and spinal metastasis. Categorical variables were divided into patient, tumor, and treatment factors, and postoperative survival times were compared between the CRC and NSCLC groups.

Results:

The mean interval from cancer diagnosis to spinal metastasis was significantly greater in CRC group (32.5 mo) than in NSCLC group (12.9 mo). Concurrent spinal metastasis was more common in NSCLC group than CRC group (45.0% vs. 17.2%; P=0.003). Visceral metastasis was found more frequently in CRC group than NSCLC group (77.1% vs. 42.5%; P<0.001). The proportion of patients undergoing postoperative systemic treatment was significantly higher in NSCLC group than CRC group (59.2% vs. 20.0%; P<0.001). Median survival time after spine surgery was 4.2 months in CRC group and 5.8 months in NSCLC group (P=0.015).

Conclusions:

The prognosis after surgical treatment for CRC spinal metastasis was poor, and worse than that of NSCLC group. These results can be explained by the later development of spinal metastases and the limited chance of postoperative medical treatment in CRC spinal metastasis.
Treatment outcome in children with central nervous system-positive Burkitt lymphoma using only intrathecal and systemic chemotherapy combined with rituximab
Authors: Huang Shuang , Jin Lin , Yang Jing , Duan Yan-Long , Zhang Meng , Zhou Chun-Ju , Zhang Yong-Hong
Published: March 2021

Background:

With current chemotherapy treatment, >90% of survival has been obtained for Burkitt lymphoma (BL). In this study, the demographic characteristics and treatment outcomes are presented for 78 children in China with central nervous system-positive (CNS+) BL.

Methods:

This retrospective study consecutively enrolled 78 CNS+ BL patients in Beijing Children's Hospital (BCH) from 2007 to 2019 who received the BCH B-cell non-Hodgkin's lymphoma regimen (modified by French-American-British mature lymphoma B-cell 96 [FAB/LMB96] C1 arm ± rituximab). Clinical characteristics, methods of disease detection in the CNS, and outcomes were evaluated. Univariate and multivariate analyses were used to assess prognostic factors.

Results:

The median age of 65 boys and 13 girls at the time of diagnosis was 5.7 years (ranging from 1 to 14 years). Patients were followed up for a median time of 34 months (ranging from 1 to 72 months). Bone marrow invasion was found in 38 (48.7%) patients. There were 48 (61.5%), 44 (56.4%), and 25 (32%) patients with cranial nerve palsy, intracerebral mass (ICM), and para-meningeal extension, respectively. Abnormal cerebrospinal fluid (CSF) morphology and CSF immunophenotype appeared in 15 (19.2%) and 15 (19.2%) patients, respectively. There were 69 (88.5%) patients treated with chemotherapy combined with rituximab, and nine patients were treated solely with chemotherapy. Finally, five patients died of treatment-related infection, recurrence occurred for 13, and one developed a second tumor. The 3-year overall survival and event-free survival rates were 78.9% ± 4.7% and 71.4% ± 6.0%, respectively. Treatment with chemotherapy only, ICM positivity, and >4 organs involved at diagnosis were independent risk factors.

Conclusions:

Rituximab combined with a modified LMB96 regimen has greatly increased the efficacy of treatment for Chinese children with CNS+ BL, and with the continuous collection of outcome data, treatment-related complications are decreasing. For further verification, a large sample multicentre randomized controlled study should be performed to explore a treatment scheme for Chinese children with even greater efficacy.
Ambient air pollution exposure and radiographic pulmonary vascular volumes
Authors: Synn Andrew J. , Byanova Katerina L. , Li Wenyuan , Gold Diane R. , Di Qian , Kloog Itai , Schwartz Joel , San José Estépar Raúl , Washko George R. , O’Connor George T. , Mittleman Murray A. , Rice Mary B.
Published: March 2021

Background:

Exposure to higher levels of ambient air pollution is a known risk factor for cardiovascular disease but long-term effects of pollution exposure on the pulmonary vessels are unknown.

Methods:

Among 2428 Framingham Heart Study participants who underwent chest computed tomography (CT) between 2008 and 2011, pulmonary vascular volumes were calculated by image analysis, including the total vascular volume and small vessel volume (cross-sectional area <5 mm2; BV5 defined as small vessel volume). Using spatiotemporal models and participant home address, we assigned 1-year (2008) and 5-year (2004–2008) average concentrations of fine particulate matter (PM2.5), elemental carbon (EC), and ground-level ozone (O3), and distance to major roadway. We examined associations of 1- and 5-year exposures, and distance to road, with CT vascular volumes using multivariable linear regression models.

Results:

There was a consistent negative association of higher O3 with lower small vessel volumes, which persisted after adjustment for distance to road. Per interquartile range (IQR) of 2008 O3, BV5 was 0.34 mL lower (95% confidence intervals [CI], −0.61 to −0.06; P = 0.02), with similar results for 5-year exposure. One-year EC exposure and closer proximity to road were weakly associated with small vessel volumes; BV5 was 0.18 mL higher per IQR of 2008 EC (95% CI, −0.05 to 0.42; P = 0.13) and 0.40 mL higher per IQR closer proximity to road (95% CI: −0.10 to 0.89; P = 0.12). PM2.5 was not associated with small vascular volumes; BV5 was 0.26 mL lower per IQR of 2008 PM2.5 (95% CI: −0.68 to 0.16; P = 0.22).

Conclusions:

Among community-dwelling adults living in the northeastern United States, higher exposure to O3 was associated with lower small pulmonary vessel volumes on CT.
The University of Pennsylvania Flap Course Enters Virtual Reality: The Global Impact
Authors: Klifto Kevin M. , Azoury Saïd C. , Muramoto Lorna M. , Zenn Michael R. , Levin L. Scott , Kovach Stephen J.
Published: March 2021

Background:

The purpose of this study was to evaluate participants from the in-person Penn Flap Course (PFC) and virtual PFC to determine if the virtual PFC increased diversity in culture, sex, education, and surgical specialties internationally and within the United States. Our hypothesis is that the virtual PFC increases diversity internationally and within the United States.

Methods:

A retrospective descriptive comparison was performed between participants from the in-person PFC from the years 2017 to 2019 and virtual PFC in 2020. Frequency maps were generated to determine differences in participation of cultures, sexes, education, and specialties internationally and within the United States. Net Promoter Scores (NPSs) were used to assess participant satisfaction with the virtual course.

Results:

The in-person PFC included 124 participants from the years 2017 to 2019, whereas the virtual PFC included 770 participants in the year 2020. Compared to the in-person course, the virtual course included more cultures (countries: 60 versus 11; states: 35 versus 22), women (countries: 38 versus 7; states: 23 versus 9), students/researchers (countries: 24 versus 0; states: 9 versus 0), residents (countries: 44 versus 5; states: 26 versus 15), fellows (countries: 21 versus 2; states: 21 versus 9), attendings (countries: 34 versus 8; states: 16 versus 11), plastic surgery (countries: 54 versus 9; states: 31 versus 18), orthopedic surgery (countries: 12 versus 5; states: 11 versus 9), and other specialties (countries: 19 versus 1; states: 8 versus 2). Our overall NPS for the virtual PFC totaled 75%, categorized as “world class” based on global NPS.

Conclusion:

A virtual interface for a flap course increased participation and diversity of culture, sex, education, and specialties internationally and within the United States with “world class” participant satisfaction.
Drug adherence and psychosocial characteristics of patients presenting with hypertensive urgency at the emergency department
Authors: Lauder Lucas , Ewen Sebastian , Glasmacher Julius , Lammert Frank , Reith Wolfgang , Schreiber Naemi , Kaddu-Mulindwa Dominic , Ukena Christian , Böhm Michael , Meyer Markus R. , Mahfoud Felix
Published: March 2021

Objective:

To identify potentially targetable psychosocial factors associated with nonadherence to prescribed antihypertensive medications in patients presenting with hypertensive urgencies at an emergency department.

Methods:

This prospective study included patients treated with antihypertensive drugs who presented with hypertensive urgencies (SBP ≥180 mmHg and/or DBP ≥110 mmHg) at the emergency department of a tertiary referral clinic between April 2018 and April 2019. Health literacy was assessed using the Newest Vital Sign test. The Hospital Anxiety and Depression Scale (HADS) was used to quantify symptoms of anxiety and depression. Patients were classified nonadherent if less than 80% of the prescribed antihypertensive drugs were detectable in urine or plasma using liquid chromatography-high-resolution mass spectrometry.

Results:

A total of 104 patients (62% women) presenting with hypertensive urgencies with a median SBP of 200 mmHg (IQR 190–212) and DBP of 97.5 mmHg (IQR 87–104) were included. Twenty-five patients (24%) were nonadherent to their antihypertensive medication. Nonadherent patients were more often men (66 versus 23%, P = 0.039), prescribed higher numbers of antihypertensive drugs (median 3, IQR 3–4 versus 2, IQR 1–3; P < 0.001), and more often treated with calcium channel blockers (76 versus 25%; P < 0.001) and/or diuretics (64 versus 40%; P = 0.030). There was no difference in health literacy (P = 0.904) or the scores on the HADS subscales for depression (P = 0.319) and anxiety (P = 0.529) between adherent and nonadherent patients.

Conclusion:

Male sex, higher numbers of antihypertensive drugs, and treatment with diuretics and/or calcium channel blockers were associated with nonadherence. We did not identify a specific psychosocial characteristic associated with nonadherence.