bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparative study on the effect of nano seashell, multiwall carbon nanotubes and nano alumina on mechanical and impact properties of bidirectional Kevlar/epoxy composite
Authors: Dodkey Soumitra M , Karandikar Rishi S , Srinidhi S , Gaur Piyush , Managuli Vishwanath , Muthukumar Chandrasekar , Singh Dalbir , Kumar Ravi Ranjan , Suresh C
Published: August 2022

The use of composite materials is becoming more widespread by the day. Composite materials are used in a variety of vital applications including aerospace, defense and marine. As a result, it is critical to investigate the mechanical and impact properties of these material-based components. Testing of these materials can provide information such as Ultimate Tensile Strength, Impact Strength, and modulus of elastic allowing their application to be better understood. It has been observed that symmetric laminates produce better results. Because of the presence of stiff filler material, the infusion of nanofillers changed the material failure behavior from ductile to brittle. In this comparative study, an attempt has been made in investigating the improvements in the material behavior of neat Kevlar along with the infusion of nano additives like alumina, seashell and MWCNT in varying proportions. Based on the obtained experimental values, graphs were plotted to demonstrate the variation of properties when these infusions were made. There is a significant improvement in the modulus values of the material, Ultimate tensile strength and Impact strength after the incorporation of the nano additives. The Ultimate Tensile Strength was improved by 0.32% in Alumina 1% + 0.25% wt. MWCNT, 21% improvement was found in Alumina 3% + 0.25% wt. MWCNT and 28.86% improvement in alumina 6 % + 0.25% wt. MWCNT compared to neat aramid fiber composite specimen. For the combination of seashell + MWCNT, it is also found that Ultimate Tensile Strength is considerably improved. It was observed that, that there is a 15.96% improvement in Seashell 1% + 0.25% wt. MWCN, 21% improvement in Seashell 3% + 0.25% wt. MWCNT and 29.78% improvement in Seashell 7% + 0.25% wt. MWCNT compared to neat aramid fiber composite specimen. The impact strength was evaluated by performing Charpy Impact Test (ASTMD 256). It was found that there is a 12% improvement in Seashell 1% + 0.25% wt. MWCNT, for Seashell 2% + 0.25% wt. MWCNT, there is a 50% increment in the Impact Strength value. It is also seen that impact properties have significantly improved when the combination of Alumina + MWCNT was infused. There is a 23.072% rise in Alumina 1% + 0.25% wt. MWCNT and 56.83% improvement in Alumina 3% + 0.25% wt. MWCNT compared to its neat aramid fiber composite specimen.
Obesity Indexes Are Positively Correlated With Blood Pressure Variability in Patients With Essential Hypertension
Authors: Liu Jin-ping , Dang Wei , Zhang Jing
Published: August 2022

Background

To analyze the relationship between obesity indexes, types of obesity, and blood pressure (BP) variability (BPV) in patients with hypertension.

Methods

A total of 284 patients (147 males, 137 females) with essential hypertension (EH) aged 70.7 ± 14.2 years were enrolled. Patients were grouped by body mass index (BMI), waist circumference, and obesity types. According to BMI, patients were divided control (BMI 18.5 to <24.0), overweight (BMI 24.0 to <28.0), and obesity (BMI ≥28.0 kg/m2) groups. According to waist circumference, patients were divided into control (<90 for male and <85 cm for female) and the obesity (≥90 for male and ≥85 cm for female) groups. According to obesity type, patients were divided into control (normal BMI and waist circumference), simple abdominal obesity (normal BMI and increased waist circumference), simple overweight (BMI ≥24.0 and normal waist circumference), and combined obesity (BMI ≥24.0 kg/m2 and increased waist circumference) groups. Twenty-four-hour ambulatory BP was recorded.

Results

When divided by BMI, daytime systolic BP standard deviation (dSBPSD), nighttime diastolic BP standard deviation (nDBPSD), daytime systolic BP variation coefficient (dSBPCV), and nighttime systolic BP standard deviation (nSBPSD) were higher in obesity group compared with control and overweight groups (P < 0.05). When divided by waist circumference, dSBPSD, daytime diastolic BP standard deviation (dDBPSD), and dSBPCV in the abdominal obesity group were higher than the control group (all P < 0.05). When divided by obesity type, simple abdominal obesity, simple overweight obesity, and combined obesity groups had higher 24-hour diastolic BP (24hDBP) and nighttime diastolic BP (nDBP) than the control group (P < 0.05), and the combined obesity group had higher daytime systolic BP (dSBP) and dSBPSD (P < 0.05). BMI was positively correlated with dSBPSD, nSBPSD, and nDBPSD (r = 0.160, 0.136, 0.163). Body fat percentage (BF%) was positively correlated with nSBPSD, nDBPSD, and nighttime systolic BP coefficient of variation (nSBPCV) (r = 0.175, 0.128, 0.153). Waist circumference was positively correlated with dSBPSD (r = 0.138, P < 0.05). Multiple linear regression analysis showed that dSBPSD was positively correlated with BMI, waist circumference, and waist-to-hip ratio, while nSBPSD, nDBPSD were positively correlated with BMI and BF% (P < 0.05), and nSBPCV was positively correlated with BF% (P < 0.05).

Conclusions

Obesity indexes are positively correlated with BPV in EH patients.
Repeatable Battery for the Assessment of Neuropsychological Status: Italian Normative Data for Older Adults
Authors: Chipi Elena , Fruttini Daniela , Salvadori Nicola , Montanucci Chiara , Siena Elisa , Menculini Giulia , Mazzeschi Claudia , Parnetti Lucilla
Published: August 2022

Objective

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), widely used for detecting cognitive impairment in different neuropsychiatric conditions, is increasingly applied for measuring cognitive functioning in older individuals. Available normative data for RBANS Italian version suffer from under-representation of the older ages (>60 years) and are not corrected for education. Moreover, normative data are provided only for Indexes and Total scores. We thus administered RBANS Italian version in a larger sample of older adults, taking into account the effect of age, education and gender on all scores.

Method

We used a regression-based model to assess the effect of age, education, and gender on RBANS Subtests, Indexes and Total scores in a consecutive series of healthy cognitively normal volunteers aged 60–79 years (N = 158). The obtained norms were compared with the Italian original normative data by means of Wilcoxon rank-sum test.

Results

Multiple linear regression analyses showed that age and educational level significantly influence performances on most RBANS scores. A free-to-use Excel to calculate subject’s percentiles for any single score was developed. When compared with original normative values, our percentiles distribution of Indexes and Total scores did not reveal significant differences (p > .05).

Conclusion

The obtained normative data show good concordance with previous norms. The instrument seems not significantly affected by educational level. The possibility to correct for any single score could make RBANS a more precise measure for capturing subtle cognitive deficits in prevention studies.
Effectiveness and Safety of Ustekinumab in Elderly Patients with Crohn’s Disease: Real World Evidence From the ENEIDA Registry
Authors: Casas-Deza Diego , Lamuela-Calvo Luis Javier , Gomollón Fernando , Arbonés-Mainar José Miguel , Caballol Berta , Gisbert Javier P , Rivero Montserrat , Sánchez-Rodríguez Eugenia , Arias García Lara , Gutiérrez Casbas Ana , Merino Olga , Márquez Lucía , Laredo Viviana , Martín-Arranz María Dolores , López Serrano Pilar , Riestra Menéndez Sabino , González-Muñoza Carlos , de Castro Parga Luisa , Calvo Moya Marta , Fuentes-Valenzuela Esteban , Esteve Maria , Iborra Marisa , Dura Gil Miguel , Barreiro-De Acosta Manuel , Lorente-Poyatos Rufo Humberto , Manceñido Noemí , Calafat Margalida , Rodríguez-Lago Iago , Guardiola Capo Jordi , Payeras Maria Antonia , Morales Alvarado Víctor Jair , Tardillo Carlos , Bujanda Luis , Muñoz-Nuñez José Fernando , Ber Nieto Yolanda , Bermejo Fernando , Almela Pedro , Navarro-Llavat Mercè , Martínez Montiel Pilar , Rodríguez Gutiérrez Cristina , Van Domselaar Manuel , Sesé Eva , Martínez Pérez Teresa , Ricart Elena , Chaparro María , García María José , López-Sanromán Antonio , Sicilia Beatriz , Orts Beatriz , López-García Alicia , Martín-Arranz Eduardo , Pérez-Calle José Lázaro , de Francisco Ruth , García-Planella Esther , Domènech Eugeni , García-López y Santiago
Published: August 2022

Background and Aims

Clinical trials and real-life studies with ustekinumab in Crohn’s disease [CD] have revealed a good efficacy and safety profile. However, these data are scarcely available in elderly patients. Therefore, we aim to assess the effectiveness and safety of ustekinumab in elderly patients with CD.

Methods

Elderly patients [>60 years old] from the prospectively maintained ENEIDA registry treated with ustekinumab due to CD were included. Every patient was matched with two controls under 60 years of age, according to anti-tumour necrosis factor use and smoking habit. Values for the Harvey–Bradshaw Index [HBI], endoscopic activity, C-reactive protein [CRP] and faecal calprotectin [FC] were recorded at baseline and at weeks 16, 32 and 54.

Results

In total, 648 patients were included, 212 of whom were elderly. Effectiveness was similar between young and elderly patients during the follow-up. Steroid-free remission was similar at week 16 [54.6 vs 51.4%, p = 0.20], 32 [53.0% vs 54.5%, p = 0.26] and 54 [57.8% vs 51.1%, p = 0.21]. Persistence of ustekinumab as maintenance therapy was similar in both age groups [log-rank test; p = 0.91]. There was no difference in the rate of adverse effects [14.2% vs 11.2%, p = 0.350], including severe infections [7.1% vs 7.3%, p = 1.00], except for the occurrence of de novo neoplasms, which was higher in older patients [0.7% vs 4.3%, p = 0.003].

Conclusions

Ustekinumab is as effective in elderly patients with CD as it is in non-elderly patients. The safety profile also seems to be similar except for a higher rate of de novo neoplasms, probably related to the age of the elderly patients.
Mitral valve disease in ankylosing spondylitis: an autoimmune disease manifestation? A case report
Authors: El Mathari Sulayman , van der Wal Allard , Raterman Hennie , Kluin Jolanda
Published: August 2022

Background

Ankylosing spondylitis (AS) is a chronic inflammatory disease of primarily the joints of the spine. In the literature, AS is known to have cardiac manifestations. Most frequently, this is aortic regurgitation. However, in rare cases also mitral valve (MV) disease is observed in AS patients. The extent and mechanism of this involvement are still unclear. We aim to describe a histologically validated case report to add understanding on this topic.

Case summary

We show the case of a 51-year-old male who suffered since his youth from back pain and uveitis, which was later diagnosed as AS. After a first presentation with combined heart valve disease, the patient recovered on cardiac medical therapy and biologic treatment for AS. Four years later, cardiac complaints worsened mainly due to severe MV stenosis. Surgical treatment was performed with histopathologic analysis of the excised MV validating involvement of AS.

Discussion

Histopathologic analysis showed chronic fibro inflammatory thickening of the MV leaflets and subvalvular apparatus. These pathological features could fit with the inflammatory nature of AS. Since this is a rare case, the recognition of fibro inflammatory thickening leading to commissural fusion and stenosis may contribute to better understanding of heart valve disease in AS to create a base for better cardiac management in this specific patient group.
Tandem mass tag labeling to assess proteome differences between intermediate and very tender beef steaks
Authors: Dang David S , Zhai Chaoyu , Nair Mahesh N , Thornton Kara J , Sawalhah Mohammed N , Matarneh Sulaiman K
Published: August 2022

Tenderness is considered as one of the most important quality attributes dictating consumers’ overall satisfaction and future purchasing decisions of fresh beef. However, the ability to predict and manage tenderness has proven very challenging due to the numerous factors that contribute to variation in end-product tenderness. Proteomic profiling allows for global examination of differentially abundant proteins in the meat and can provide new insight into biological mechanisms related to meat tenderness. Hence, the objective of this study was to examine proteomic profiles of beef longissimus lumborum (LL) steaks varying in tenderness, with the intention to identify potential biomarkers related to tenderness. For this purpose, beef LL muscle samples were collected from 99 carcasses at 0 and 384 h postmortem. Based on Warner–Bratzler shear force values at 384 h, 16 samples with the highest (intermediate tender, IT) and lowest (very tender, VT) values were selected to be used for proteomic analysis in this study (n = 8 per category). Using tandem mass tag-based proteomics, a total of 876 proteins were identified, of which 51 proteins were differentially abundant (P < 0.05) between the tenderness categories and aging periods. The differentially identified proteins encompassed a wide array of biological processes related to muscle contraction, calcium signaling, metabolism, extracellular matrix organization, chaperone, and apoptosis. A greater (P < 0.05) relative abundance of proteins associated with carbohydrate metabolism and apoptosis, and a lower (P < 0.05) relative abundance of proteins involved in muscle contraction was observed in the VT steaks after aging compared with the IT steaks, suggesting that more proteolysis occurred in the VT steaks. This may be explained by the greater (P < 0.05) abundance of chaperonin and calcium-binding proteins in the IT steaks, which could have limited the extent of postmortem proteolysis in these steaks. In addition, a greater (P < 0.05) abundance of connective tissue proteins was also observed in the IT steaks, which likely contributed to the difference in tenderness due to added background toughness. The established proteomic database obtained in this study may provide a reference for future research regarding potential protein biomarkers that are associated with meat tenderness.
Poor maternal diet during gestation alters offspring muscle proteome in sheep
Authors: Reed Sarah A , Balsbaugh Jeremy , Li Xiaomeng , Moore Timothy E , Jones Amanda K , Pillai Sambhu M , Hoffman Maria L , Govoni Kristen E , Zinn Steven A
Published: August 2022

Poor maternal nutrition during gestation can result in reduced offspring muscle growth and altered muscle metabolism. We hypothesized that over- or restricted-nutrition during gestation would alter the longissimus dorsi muscle (LM) proteome of offspring. Pregnant ewes were fed 60% (restricted), 100% (control), or 140% (over) of National Research Council requirements for total digestible nutrients from day 30 of gestation until parturition. Fetal (RES, CON, OVER) LM were collected at days 90 and 135 of gestation, or from offspring within 24 h of birth. Sarcoplasmic proteins were isolated, trypsin digested, and subjected to multiplexed, label-based quantitative mass spectrometry analysis integrating tandem mass tag technology. Differential expression of proteins was identified by ANOVA followed by Tukey’s HSD post hoc tests, and regularized regression via the elastic net. Significance was set at P < 0.05. Over-represented pathways containing differentially expressed proteins were identified by Reactome and included metabolism of proteins, immune system, cellular response to stress/external stimuli, developmental biology, and infectious disease. As a result of maternal diet, a total of 312 proteins were differentially expressed (day 90 = 89 proteins; day 135 = 115 proteins; birth = 131 proteins). Expression of eukaryotic initiation factor (EIF) 2S3, EIF3L, and EIF4G2 was lower in OVER fetuses at day 90 of gestation (P < 0.05). Calcineurin A and mitogen-activated protein kinase 1 were greater in RES fetuses at day 90 (P < 0.04). At day 135 of gestation, pyruvate kinase and lactate dehydrogenase A expression were greater in OVER fetuses than CON (P < 0.04). Thioredoxin expression was greater in RES fetuses relative to CON at day 135 (P = 0.05). At birth, proteins of the COP9 signalosome complex were greater in RES offspring relative to OVER (P < 0.05). Together, these data indicate that protein degradation and synthesis, metabolism, and oxidative stress are altered in a time and diet-specific manner, which may contribute to the phenotypic and metabolic changes observed during fetal development and postnatal growth.
Elevated dietary selenium rescues mitochondrial capacity impairment induced by decreased vitamin E intake in young exercising horses
Authors: Owen Randi N , Semanchik Pier L , Latham Christine M , Brennan Kristen M , White-Springer Sarah H
Published: August 2022

Maintenance of mitochondrial health, which is supported in part by dietary antioxidants such as selenium (Se) and vitamin E (vitE), is pertinent to optimizing athletic performance. Deficiencies in Se and vitE negatively impact muscle health but mitochondrial adaptations to various levels of dietary Se and vitE are poorly understood. Young Quarter Horses (mean ± SD: 17.6 ± 0.9 mo) undergoing submaximal exercise training were used to test the hypothesis that a proprietary antioxidant blend containing elevated Se yeast (EconomasE, Alltech, Inc., Nicholasville, KY) would improve mitochondrial characteristics compared to Se at current requirements, even with reduced vitE intake. Horses were balanced by age, sex, body weight (BW), and farm of origin and randomly assigned to one of three custom-formulated concentrates fed at 1% BW (dry matter, DM basis) for 12 wk: 1) 100 IU vitE/kg DM and 0.1 mg Se/kg DM (CON, n = 6); 2) no added vitE plus EconomasE to provide 0.1 mg Se/kg DM (ESe1, n = 6); or 3) no added vitE plus EconomasE to provide 0.3 mg Se/kg DM (ESe3, n = 6). Samples collected at week 0 and 12 were analyzed for serum Se and middle gluteal glutathione peroxidase (GPx) and mitochondrial enzyme activities by kinetic colorimetry and mitochondrial capacities by high-resolution respirometry. Data were analyzed using mixed linear models in SAS v9.4 with repeated measures (time) and fixed effects of time, diet, and time × diet; horse(diet) served as a random effect. Serum Se tended to increase in all horses by week 12 (P = 0.08) but was unaffected by diet. Muscle GPx activity remained similar among all horses throughout the duration of the study. Mitochondrial volume density (citrate synthase [CS] activity), integrative function (cytochrome c oxidase [CCO] activity per mg protein), and integrative (per mg tissue) oxidative (P) and electron transfer (E) capacities increased from week 0 to 12 in all horses (P ≤ 0.01). Intrinsic (relative to CS) CCO activity decreased in all horses (P = 0.001), while intrinsic P and E capacities decreased only in ESe1 horses from week 0 to 12 (P ≤ 0.002). These results suggest that feeding EconomasE to provide 0.3 mg Se/kg DM may prevent adverse effects of removing 100 IU dietary vitE/kg DM on mitochondria in young horses. More research is needed to determine optimal dietary Se and vitE levels in performance horses to maximize mitochondrial energy production.
The impact of Zearalenone on heat-stressed skeletal muscle in pigs
Authors: Rudolph Tori E , Roach Crystal M , Baumgard Lance H , Ross Jason W , Keating Aileen F , Selsby Josh T
Published: August 2022

Heat stress (HS) and Zearalenone (ZEN) exposure affect growth, production efficiency, and animal welfare; and, under extreme situations, both can be lethal. Given that both HS and ZEN independently cause oxidative stress, we hypothesized that simultaneous exposure to HS and ZEN would cause greater oxidative stress in porcine skeletal muscle than either condition, alone. To address this hypothesis, crossbred, prepubertal gilts were treated with either vehicle control (cookie dough) or ZEN (40 μg/kg) and exposed to either thermoneutral (TN; 21.0 °C) or 12-h diurnal HS conditions (night: 32.2 °C; day: 35.0 °C) for 7 d. Pigs were euthanized immediately following the environmental challenge and the glycolytic (STW) and oxidative (STR) portions of the semitendinosus muscle were collected for analysis. In STR, malondialdehyde (MDA) concentration, a marker of oxidative stress, tended to increase following ZEN exposure (P = 0.08). HS increased CAT (P = 0.019) and SOD1 (P = 0.049) protein abundance, while ZEN decreased GPX1 protein abundance (P = 0.064) and activity (P = 0.036). In STR, HS did not alter protein expression of HSP27, HSP70, or HSP90. Conversely, in STW, MDA-modified proteins remained similar between all groups. Consistent with STR, ZEN decreased GPX1 (P = 0.046) protein abundance in STW. In STW, ZEN decreased protein abundance of HSP27 (P = 0.032) and pHSP27 (P = 0.0068), while HS increased protein expression of HSP70 (P = 0.04) and HSP90 (P = 0.041). These data suggest a muscle fiber type-specific response to HS or ZEN exposure, potentially rendering STR more susceptible to HS- and/or ZEN-induced oxidative stress, however, the combination of HS and ZEN did not augment oxidative stress.
The socioecological correlates of meal skipping in community-dwelling older adults: a systematic review
Authors: Wild Holly , Baek Yeji , Shah Shivangi , Gasevic Danijela , Owen Alice
Published: August 2022

Context

Meal skipping may contribute to nutrient deficiency across the lifespan. Multiple socioecological factors have been identified as correlates of meal skipping in adolescents and adults, but evidence in older adults is limited.

Objective

To determine the socioecological correlates of meal skipping in community-dwelling older adults.

Data source

Embase, PsycINFO, CINAHL, and MEDLINE electronic databases were systematically searched from inception to March 2021.

Data extraction

A total of 473 original research studies on socioecological factors and meal skipping among community-dwelling adults aged ≥65 years were identified. Title, abstract, and full-text review was performed by 2 reviewers independently, and a third reviewer resolved disagreements. A total of 23 studies met our inclusion criteria. Data were extracted by 1 reviewer from these studies and independently verified by another. The Newcastle-Ottawa Scale was used to assess methodological quality.

Data analysis

The frequency of meal skipping in included studies ranged between 2.1% and 61%. This review identified 5 domains of socioecological correlates associated with meal skipping in older adults: sociodemographic, behavioral, biomedical, psychological, and social.

Conclusion

Understanding the factors associated with meal skipping in older adults can inform the development of targeted interventions to improve nutrition and health.

Systematic review registration

PROSPERO registration no. CRD42021249338.
Low levels of hybridization between domestic and wild Mallards wintering in the lower Mississippi Flyway
Authors: Davis J Brian , Outlaw Diana C , Ringelman Kevin M , Kaminski Richard M , Lavretsky Philip
Published: August 2022

The Mallard (Anas platyrhynchos) duck is a ubiquitous and socio-economically important game bird in North America. Despite their generally abundant midcontinent population, Mallards in eastern North America are declining, which may be partially explained by extensive hybridization with human-released domestically derived game-farm Mallards. We investigated the genetic composition of Mallards in the middle and lower Mississippi flyway, key wintering regions for the species. We found that nearly 30% of wild Mallards carried mitochondrial (mtDNA) haplotypes derived from domestic Mallards present in North America, indicating that the individuals had female game-farm Mallard lineage in their past; however, nuclear results identified only 4% of the same sample set as putative hybrids. Recovering 30% of samples with Old World (OW) A mtDNA haplotypes is concordant with general trends across the Mississippi flyway and this percentage was stable across Mallards we sampled a decade apart. The capture and perpetuation of OW A mtDNA haplotypes are likely due to female breeding structure, whereas reversal of the nuclear signal back to wild ancestry is due to sequential backcrossing and lower and/or declining admixture with game-farm Mallards. Future studies of wild ancestry of Mississippi flyway Mallards will benefit from coupling molecular and spatial technology across flyways, seasons, and years to search for potential transitions of Mallard populations with different genetic ancestry, and whether the genetic ancestry is somehow linked to an individual’s natal and subsequent breeding location.
Dangerous Proximities: Anglo-American Humanitarian Paternalists in the Era of Indigenous Removal
Authors: Martini Elspeth
Published: August 2022

This article explores Indigenous removal as a trans-imperial phenomenon through the writings of U.S. superintendent of Indian affairs, Thomas McKenney, and three of his British imperial counterparts—George Arthur, Charles La Trobe, and Francis Bond Head—all of whom declared themselves committed to ameliorating the condition of Indigenous people and concluded that this project necessitated Indigenous removal from proximity to British or U.S. settler populations. All four men employed stereotyped paternalistic imaginings to justify removal as the humanitarian duty of the self-proclaimed “civilized” toward Indigenous people. Yet their writing about their own proximity to actual Indigenous people—in spaces that in the 1820s and 1830s comprised the “Wests” of Anglophone expansion in North America and Australia—also reveal Indigenous bodily realities and political imperatives that instead posed dangers to these “civilized” men and their paternal schemas. Although these four Anglo-American men’s rendering of such dangerous proximities do not, of course, fully explain the causes and horrors of removal policies, they suggest the need to look at the intimate spaces of Anglo-American imperial reach to reveal otherwise unacknowledged reasons why those proclaiming genuine concern for Indigenous wellbeing would support the stark subjugation and segregation of Indigenous removal.
Effects of Early Life Trauma on Risks for Adult Opioid Use Disorder Are Mediated by Stress and Occur Independent of Depression and Anxiety
Authors: Dunn Kelly E. , Turner Gavin M. , Oswald Lynn M.
Published: August 2022

Objectives

Adverse childhood experiences, or early life trauma (ELT), may be a potential risk factor for opioid use disorders (OUDs) that could be further influenced by depression, anxiety, and stress. The prevalence and strength of these associations are largely unknown.

Methods

This study examined the association between current OUD severity and lifetime history of ELT, and the degree to which current depression, anxiety, and stress influenced this association, in persons (n = 310) with at least 1 lifetime exposure to opioids using an online survey.

Results

Ninety-three percent of respondents experienced at least 1 trauma in their lifetime, and 65% met the criteria for OUD. Early life trauma was largely unassociated with demographics but demonstrated an almost “dose-dependent” association among all forms of ELT (total, general, physical, emotional, sexual), whereby more ELT was associated with more severe current OUD. A multivariate mediation model found perceived stress to be a robust mediator of this association. Current psychiatric functioning did not significantly moderate the relationship between ELT and OUD, suggesting that ELT may impact OUD severity at varying levels of psychiatric functioning.

Conclusions

These data support existing evidence that greater ELT may influence adult OUD severity and identify perceived stress as a potential mechanistic contributor to this association. Results are preliminary in nature but support continued research into mechanisms underlying the association between ELT and OUD, particularly conformational changes in the stress system resultant from ELT, and interventions to mitigate the impact of ELT on OUD development and/or develop trauma-informed OUD treatment approaches.
The Naloxone Component of Buprenorphine/Naloxone: Discouraging Misuse, but at What Cost?
Authors: Gregg Jessica , Hartley Jennifer , Lawrence David , Risser Amanda , Blazes Christopher
Published: August 2022

Because opioid overdose deaths in the United States continue to rise, it is critical to increase patient access to buprenorphine, which treats opioid use disorder and reduces mortality. An underrecognized barrier to buprenorphine treatment (both for maintenance and treatment of acute withdrawal) is limited access to buprenorphine monoproduct. In the United States, buprenorphine is primarily prescribed as a combination product also containing naloxone, added to reduce the potential for misuse. Because naloxone has relatively low sublingual bioavailability compared with buprenorphine, adverse effects are generally considered mild and rare. The authors' clinical experience, however, suggests that adverse effects may be less benign than generally accepted and can have negative effects for the patient, the provider-patient relationship, and the health care system as a whole. The insistence on prescribing combination product can foster stigma and mistrust, creating barriers to care and increased risk of overdose and death.
Methadone Dose, Cannabis Use, and Treatment Retention: Findings From a Community-based Sample of People Who Use Unregulated Drugs
Authors: Lake Stephanie , Buxton Jane , Walsh Zach , Cooper Ziva D. , Socías M. Eugenia , Fairbairn Nadia , Hayashi Kanna , Milloy M-J
Published: August 2022

Objectives

Lower daily methadone dose is negatively associated with retention in methadone maintenance treatment (MMT). Cannabis use during MMT is common, with many patients reporting its use for opioid withdrawal mitigation. We sought to test whether the association between lower MMT dose and treatment retention differs by concurrent high-frequency cannabis use in a community sample of people on MMT.

Methods

We obtained data from participants initiating MMT in 2 community-recruited prospective cohorts of people who use drugs in Vancouver, Canada. We built multivariable Cox frailty models to estimate the relationships between MMT dose (<90 mg/d vs ≥90 mg/d) and time to treatment discontinuation. We included an interaction term to test whether high-frequency (≥daily) cannabis use modified the measured effect of lower treatment dose on treatment retention.

Results

Between December 2005 and December 2018, 829 participants (54.1%) initiated at least 1 MMT episode and were included in the analysis. Lower MMT dose was strongly positively associated with treatment discontinuation regardless of concurrent high-frequency cannabis use (interaction P > 0.05). Structural factors including homelessness and incarceration were significantly and positively associated with treatment discontinuation.

Conclusions

Although we previously found the magnitude and strength of the relationship between lower MMT dose and high-frequency unregulated opioid use to be tempered during high-frequency cannabis use periods, this effect measure modification does not appear to translate to time retained in treatment. Cannabis-based interventions to promote retention in MMT are unlikely to produce long-term benefit without addressing external factors that place MMT patients at increased risk of treatment discontinuation.
In-hospital Substance Use Policies: An Opportunity to Advance Equity, Reduce Stigma, and Offer Evidence-based Addiction Care
Authors: Martin Marlene , Snyder Hannah R. , Otway Gillian , Holpit Leslie , Day Lukejohn W. , Seidman Dominika
Published: August 2022

In-hospital substance use is common among patients with addiction because of undertreated withdrawal, undertreated pain, negative feelings, and stigma. Health care system responses to in-hospital substance use often perpetuate stigma and criminalization of people with addiction, long etched into our culture by the racist War on Drugs. In this commentary, we describe how our hospital convened an interprofessional workgroup to revise our in-hospital substance use policy. Our updated policy recommends health care workers respond to substance use concerns by offering patients adequate pain control, evidence-based addiction treatment, and supportive services instead of punitive responses. We provide best-practice recommendations for in-hospital substance use policies.
Short-term Outcomes and Difficulty of Repeat Laparoscopic Liver Resection
Authors: Mori Shozo , Mishima Kohei , Ozaki Takahiro , Fujiyama Yoshiki , Wakabayashi Go
Published: August 2022

Objectives:

To investigate the feasibility of repeat laparoscopic liver resection (Rep-LLR), including repeat anatomical resection (Rep-AR), as compared to initial-LLR (Ini-LLR).

Background:

The indications of LLR have expanded to treatment of recurrent liver tumors. However, the feasibility of Rep-LLR, including Rep-AR, has not yet been adequately assessed.

Methods:

Data of 297 patients who had undergone LLR were reviewed. Among the 297 patients, 235 (AR: 168) had undergone Ini-LLR and 62 (AR: 27) had undergone Rep-LLR, and the surgical outcomes were compared between the groups. In addition, multivariate analysis was performed to identify predictors of the difficulty of Rep-LLR based on the operation time and volume of blood loss.

Results:

Of the 62 patients who had undergone Rep-LLR, 44, 14, and 4 had undergone second, third, and fourth repeat LRs, respectively. No significant intergroup differences were observed in regard to the operation time, blood loss, conversion rate to open surgery, postoperative morbidity, or postoperative hospital stay. However, the proportion of patients in whom the Pringle maneuver was used was significantly lower in the Rep-LLR group than in the Ini-LLR group. Multivariate analysis identified surgical procedure ≥sectionectomy at the initial/previous LR and an IWATE difficulty score of ≥6 as being independent predictors of the difficulty of Rep-LLR. Use of adhesion barriers at the initial/previous LR was associated with a decreased risk of failure to perform the Pringle maneuver during Rep-LLR.

Conclusions:

Rep-LLR can offer outcomes comparable to those of Ini-LLR over the short term.
A Newer Way of Determining LIV in AIS Patients: Rotation of the Touched Vertebrae
Authors: Sarwahi Vishal , Hasan Sayyida , Wendolowski Stephen , Visahan Keshin , Atlas Aaron , Galina Jesse , Lo Yungtai , Amaral Terry , Rao Himanshu , Thornhill Beverly
Published: August 2022

Study Design.

A retrospective review.

Objective.

The objective of this study was to determine whether fusing to touched vertebra (TV) on prone x-rays (XRs) with minimal rotation (Gd 0/1) allow for shorter fusion with optimal correction.

Summary of Background.

Previous studies have shown risk of “adding on” when TV is not selected as lowest instrumented vertebra (LIV). Fusion proximal to TV leads to suboptimal results but fusing to TV on standing XRs can result in longer fusions. On lying down XRs, TV moves proximally, and its rotation decreases by a grade.

Methods.

TV patients with minimal rotation were selected on prone (TVP) or standing XRs (TVS). Patients fused to rotated (Gd 2+) TV on standing or prone XRs were considered touched vertebra rotated (TVR). In the non-TV (NTV) group, LIV was fused proximal to TV. Disk wedging ≥5° determined risk of “adding-on.” To compare patients fused to minimally rotated TV, to those that were not, patients in group A (TVP + TVS) were compared with group B (TVR + NTV).

In part II: TVP, TVS, TVR, and NTV patients were compared. Subanalysis compared levels saved as the difference between predicted and real LIV in TVP and TVS patients. Another subanalysis was carried out for Lenke 1+2 and Lenke 3, 4, 5.

In part III: XRs of nonoperative adolescents idiopathic scoliosis patients with Cobb <30 and Risser 4/5 were analyzed to determine “acceptable” end vertebra tilt and disc wedging and served as controls.

Results.

There were a significantly greater number of patients in group B patients(TVR + NTV) with final disk wedging ≥5°, final LIV translation ≥1 and ≥2 cm (P<0.001).

Utilizing prone XRs in TVP saved average 1 level, and 1.2 levels in TVS patients. TVP patients also had similar LIV tilt, disk wedging and coronal balance(P>0.05) to controls.

Conclusion.

Choosing minimally rotated (Gd 0/1) TV on prone XR saves levels without sacrificing radiographic outcomes.
Filing a Workers' Compensation Claim for Low Back Pain and Associated Factors
Authors: Kyung Minjung , Lee Soo-Jeong , Collman Nicole , Domeracki Sandra , Hong OiSaeng
Published: August 2022

Objective

The aim of this study was to examine the degree of reporting work-related low back pain (LBP) by workers' compensation (WC) claim filing and associated factors among US workers.

Methods

We conducted multivariable logistic regression using the 2015 National Health Interview Survey data.

Results

Among 1203 US workers with self-reported work-related LBP diagnosis, only 19.6% filed for WC. Compared with non-Hispanic White workers, Black, Asian, and Hispanic workers were less likely to file for WC. Workers' compensation filing was less frequent among workers in independent work arrangement and who stopped working, changed jobs, or made a change in work and more frequent among workers 45 to 64 years of age and having high LBP frequency.

Conclusions

Our study findings suggest underreporting of work-related LBP to the WC system is common. Barriers to WC filing should be addressed especially for racial/ethnic minorities and independent workers.
Case Report: Improved Choroidal Circulation in a Patient with Unilateral Acute Idiopathic Maculopathy
Authors: Sotozono Akiko , Mizobuchi Kei , Hayashi Takaaki , Shikauchi Mamiko , Nakano Tadashi
Published: August 2022

SIGNIFICANCE

Unilateral acute idiopathic maculopathy is a rare retinochoroidal disorder, the cause of which is unknown. Multimodal retinal imaging obtained in this case suggests that the cause of unilateral acute idiopathic maculopathy is impaired choroidal circulation.

PURPOSE

This study aimed to report a patient with unilateral acute idiopathic maculopathy who showed improvement of choroidal circulation over time in optical coherence tomography angiography images.

CASE REPORT

A 33-year-old woman with a prodromal flu-like illness noticed a sudden central visual field abnormality in the right eye. Five days after the onset, best-corrected visual acuity was 0.15 in the right eye. Fundus photography showed a yellowish lesion at the macula in the right eye. Optical coherence tomography showed a blurred ellipsoid zone and a thickened retinal pigment epithelium at the fovea and a disrupted/blurred ellipsoid zone and retinal pigment epithelium at the parafovea. Optical coherence tomography angiography segmentation of the choriocapillaris revealed a hypointense region at the fovea with a hyperintense region surrounding it. One week after the onset, best-corrected visual acuity was improved from 0.15 to 2.0 in the right eye. Furthermore, the yellowish macula lesion shrank, and the outer retinal layers showed improvement in optical coherence tomography. Optical coherence tomography angiography showed reduction of the hypointense region and enlargement of the hyperintense region. Approximately 1 year after the onset, the yellowish lesion was faded. Optical coherence tomography revealed an almost normal ellipsoid zone but a thickened interdigitation zone. Optical coherence tomography angiography also revealed an apparent hyperintense instead of the hypointense region and increased choroidal blood flow.

CONCLUSIONS

The current patient showed a gradual recovery of choroidal circulation and outer retinal layer morphology 1 year after the onset of unilateral acute idiopathic maculopathy. Optical coherence tomography angiography findings indicated that the primary cause of unilateral acute idiopathic maculopathy was impaired choroidal circulation, and choroidal vessels improved morphologically over the disease course.
Comparison of Factors Associated with Myopia among Middle School Students in Urban and Rural Regions of Anhui, China
Authors: Peng Wei , Sun Shao Ming , Wang Fei , Sun Yi Ning
Published: August 2022

SIGNIFICANCE

The prevention and control of myopia have become a major public health task throughout the world. The analysis of the modifiable factors associated with myopia will help in planning concrete strategies that can be widely implemented by schools and families.

PURPOSE

This study assessed the modifiable factors associated with myopia and compared them between rural and urban regions.

METHODS

Data were collected from December 2020 to March 2021. A multistage stratified cluster sampling method was used to select 6154 middle school students. All children underwent an eye examination, including visual acuity and cycloplegic refraction. Data on near work, sleep, and outdoor activities were collected in questionnaires.

RESULTS

The myopia prevalence values in urban and rural regions were 68.1 and 63.7%, respectively (χ
2 = 15.57, P < .001). More than 3 hours of homework per day (odds ratio [OR] in urban and rural regions, 1.36 [95% confidence interval {CI}, 1.07 to 1.75] vs. 1.72 [95% CI, 1.43 to 2.07]), 36 to 40 core subjects per week (OR, 1.30 [95% CI, 1.04 to 1.57] vs. 1.42 [95% CI, 1.24 to 1.64]), and going to sleep before 10 o'clock (OR, 0.56 [95% CI, 0.32 to 0.93] vs. 0.50 [95% CI, 0.28 to 0.90]) were significantly associated with myopia in both regions. In contrast, taking breaks during near work was a significant factor in the rural region (<1 hour: OR, 0.57 [95% CI, 0.42 to 0.76]; 1 to 2 hours: OR, 0.63 [95% CI, 0.46 to 0.86]) but not in the urban region. More time outdoors per day was associated with a reduced prevalence of myopia only for urban children (2 to 3 hours: OR, 0.55 [95% CI, 0.31 to 0.97]; >3 hours: OR, 0.38 [95% CI, 0.19 to 0.75]).

CONCLUSIONS

Homework loads and the time of going to sleep were associated with myopia for children in both urban and rural regions. However, time outdoors was only associated with myopia in urban regions, and taking breaks during near work was only associated with myopia in rural regions.
Decreasing Intubation for Ineffective Ventilation after Birth for Very Low Birth Weight Neonates
Authors: Herrick Heidi M. , Weinberg Danielle D. , James Jennifer , Murray Ashley , Brown-Jackson Loretta , Chaudhary Aasma , Posencheg Michael A. , Foglia Elizabeth E.
Published: August 2022

Introduction:

Despite recommendations promoting noninvasive delivery room (DR) ventilation, local historical preterm DR noninvasive ventilation rates were low (50%−64%). Project aims were to improve DR noninvasive ventilation rate in very low birth weight (VLBW) neonates (<1500 g) with a focus on decreasing DR intubations for ineffective positive pressure ventilation (PPV).

Methods:

We addressed drivers for improving noninvasive ventilation and decreasing intubations for ineffective PPV through plan-do-study-act cycles. Outcome measures were intubation for ineffective PPV (defined as intubation for heart rate <100 despite ongoing PPV) and final respiratory support in the DR. Our process measure was adherence to division-wide DR-intubation guidelines. Balancing measures were maximum FiO2 and hypothermia. We analyzed data using statistical process control charts and special cause variation rules.

Results:

There were 139 DR intubations among 521 VLBW neonates between January 2015 and February 2020. The noninvasive ventilation rate upon intensive care nursery admission was higher than historically reported at 73% and sustained throughout the project. The intubation rate for ineffective PPV was 10% and did not change. The number of VLBW neonates between intubations for ineffective PPV increased from 6.1 to 8.0. Ten intubations did not comply with guidelines. Balancing measures were unaffected.

Conclusions:

Noninvasive ventilation rates were higher than historically reported and remained high. After plan-do-study-act cycles, the number of VLBW neonates between intubations for ineffective PPV increased without impacting balancing measures. Our data demonstrate that effective ventilation (heart rate > 100) using noninvasive support is possible in up to 90% of VLBW infants but requires ongoing PPV training.
Improving the Evidence-based Care of Febrile Neonates: A Quality Improvement Initiative
Authors: Yu Lily , Bensman Rachel S. , Hariharan Selena L. , McAneney Constance M. , Ovalle Victoria Wurster , Kurowski Eileen Murtagh
Published: August 2022

Introduction:

Our emergency department updated our care algorithm to provide evidence-based, standardized care to 0- to 60-day-old febrile neonates. Specifically, we wanted to increase the proportion of visits for which algorithm-adherent care was provided from 90% to 95% for infants 0–28 days, and from 67% to 95% for infants 29–60 days, by June 30, 2020.

Methods:

Our emergency medicine team outlined our theory for improvement and used multiple plan-do-study-act cycles to test interventions aimed at key drivers. Interventions included constructing an updated care algorithm, clinician, and nurse education, integrating an updated opt-out order set, and streamlined discharge instructions. Our primary outcome was the proportion of patient encounters in which clinicians ordered algorithm-adherent care. In addition, our quality improvement team manually reviewed all failures to determine the reasons for failure and inform further interventions.

Results:

We evaluated 2,248 visits between January 2018 and October 2021. Algorithm-adherent care for 29- to 60-day-old infants improved from 67% to 92%. Algorithm-adherent care for 0- to 28-day infants improved from 90% to 96%. We sustained these improvements for 22 months. Failure to adhere to the algorithm in the 29- to 60-day-old infant group was primarily due to clinicians not ordering procalcitonin.

Conclusions:

Using quality improvement methods, we successfully increased algorithm-adherent evaluation of febrile neonates 0–60 days old in our pediatric emergency departments. Education and opt-out order sets were keys to implementing our new algorithm.
Sustained Reduction in Intravenous Pump Turnaround Time Using Lean Methodology
Authors: Neogi Smriti , Schneider Glenn , Schaffzin Joshua K.
Published: August 2022

Introduction:

Intravenous pumps provide essential, life-sustaining medications to patients. Pumps must be in working order and available on short notice to be effective. We identified inefficiencies in our pump management process that inflated the cost and time to complete repairs.

Methods:

Our multidisciplinary team completed a 60-day before-after trial that followed the Toyota Production System Lean methodology and evaluated the sustainability of our improvements for the following 48 months. We used value stream mapping and manual time studies to identify areas for improvement. Device turnaround time (TAT) was the number of days from receiving a device for repair to its return to service. Interventions included: establishing a reliable system to receive and track repair requests, creating a better organized, more efficient workroom, streamlining the inventory of repair parts, and tracking delivery systems reliably.

Results:

We reduced mean intravenous pump TAT by 89% and sustained TAT at 74%–97% below baseline for 4 years, including during the COVID pandemic.

Conclusions:

We used Lean methodology to create a system to receive, track, and provide safe, functional equipment to providers promptly. Both clinical and nonclinical healthcare professionals can use Lean to produce a sustainable improved system.