bluuebunny/crossref_metadata_2025 huggingface dataset:
Modelling risk factors for high/low Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) in the Australian adults
Authors: Wahab Adam , Ju Xiangqun , Jamieson Lisa , Dreyer Craig
Published: October 2020

Objective

Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) is an instrument to assess the subjective perception needed for orthodontic treatment (OT). The study aimed to (1) evaluate the psychosocial impact of dental aesthetics and the potential role of OT and (2) determine associations between PIDAQ with self-rated general and oral health, oral health-related quality of life (OHRQOL), and receipt of OT among Australian adults.

Methods

Data were obtained from the 2013 Australian National Dental Telephone Interview Survey (NDTIS). The PIDAQ was utilized as main outcome, comprising items from four conceptual domains: self-confidence, social impact, psychological impact, and aesthetic concern. Participants reported their socio-demographic, behavioural, self-rated general and oral health as well as the poor OHRQOL using the Oral Impact on Daily Performance (OIDP) instrument and OT. The mean of PIDAQ and four subscales score and their 95% confidence intervals (CI) were estimated. Generalized liner regression was used to estimate association between PIDAQ and covariates by calculating the mean ratio (MR) and their 95% CI.

Results

There were 2936 Australian adults who completed the PIDAQ items. The mean PIDAQ score was 28.8 (95% CI: 28.0–29.6). Higher PIDAQ scores were identified among those who reported non-Australian birth, lower incomes, infrequent dental visits, less than 21 teeth and brushing teeth less than twice a day, fair/poor self-rated general and oral health, and poor OHRQOL. In multivariable modelling, the mean PIDAQ score was 1.91 (95% CI: 1.82–2.00) times higher among those with OIDP score >3 and 1.06 (95% CI:1.01–1.10) times higher in those who had OT, comparing with their counterparts. Also, higher PIDAQ scores were identified among females, last visiting a dentist more than 2 years ago, fair or poor self-rated oral and general health.

Conclusions

Higher PIDAQ scores that have a greater impact on OHRQOL were associated with poorer self-rated general and oral health. This may be explained by unfavourable dental attendance and oral health habits. The positive correlation with OIDP scores verifies the validity of the PIDAQ. Those who had received OT had lower PIDAQ and OIDP scores.
A single-cell RNA-sequencing training and analysis suite using the Galaxy framework
Authors: Tekman Mehmet , Batut Bérénice , Ostrovsky Alexander , Antoniewski Christophe , Clements Dave , Ramirez Fidel , Etherington Graham J , Hotz Hans-Rudolf , Scholtalbers Jelle , Manning Jonathan R , Bellenger Lea , Doyle Maria A , Heydarian Mohammad , Huang Ni , Soranzo Nicola , Moreno Pablo , Mautner Stefan , Papatheodorou Irene , Nekrutenko Anton , Taylor James , Blankenberg Daniel , Backofen Rolf , Grüning Björn
Published: October 2020

Background

The vast ecosystem of single-cell RNA-sequencing tools has until recently been plagued by an excess of diverging analysis strategies, inconsistent file formats, and compatibility issues between different software suites. The uptake of 10x Genomics datasets has begun to calm this diversity, and the bioinformatics community leans once more towards the large computing requirements and the statistically driven methods needed to process and understand these ever-growing datasets.

Results

Here we outline several Galaxy workflows and learning resources for single-cell RNA-sequencing, with the aim of providing a comprehensive analysis environment paired with a thorough user learning experience that bridges the knowledge gap between the computational methods and the underlying cell biology. The Galaxy reproducible bioinformatics framework provides tools, workflows, and trainings that not only enable users to perform 1-click 10x preprocessing but also empower them to demultiplex raw sequencing from custom tagged and full-length sequencing protocols. The downstream analysis supports a range of high-quality interoperable suites separated into common stages of analysis: inspection, filtering, normalization, confounder removal, and clustering. The teaching resources cover concepts from computer science to cell biology. Access to all resources is provided at the singlecell.usegalaxy.eu portal.

Conclusions

The reproducible and training-oriented Galaxy framework provides a sustainable high-performance computing environment for users to run flexible analyses on both 10x and alternative platforms. The tutorials from the Galaxy Training Network along with the frequent training workshops hosted by the Galaxy community provide a means for users to learn, publish, and teach single-cell RNA-sequencing analysis.
Milk Components by In-Line Fiber Optic Probe-Based FT-NIR: Commercial Scale Evaluation of a Potential Alternative Measurement Approach for Milk Payment
Authors: Tang Shuaikun , Johnson J Chris , Jarto Iswandi , Smith Bridgette , Morris Scott
Published: October 2020

Background

Mid-infrared (MIR) spectroscopy has traditionally been used to determine the macronutrients in bovine milk, as the basis of milk payment. Recent studies have demonstrated that NIR/FT-NIR spectroscopic systems can not only achieve MIR measurement performance, but are also generally simpler, more robust, and thus much more amenable to actual industrial process applications.

Objective

The goal of this unique study was to investigate the feasibility of in-line FT-NIR spectroscopy for milk fat, protein, and total solids (TS) determination in a large industrial dairy processing facility, as an alternative basis for milk payment.

Method

Multivariant chemometric models using partial least squares (PLS) regression were built to predict the milk components. Over 1000 composite FT-NIR results gathered from the milk unloading process were compared directly to independent third-party FT-IR results.

Results

Accuracy, precision, and linearity of the method were shown by Standard Error of Prediction (SEP) and Range/SEP of individual components. The SEP for fat, protein, and TS models were 0.09, 0.11, and 0.52, respectively. Range/SEP were 25.10, 12.60, and 6.40 for fat, protein, and TS, respectively. Accuracy and precision for the three components were further evaluated by the mean differences (0.01, 0.05, and 0.51) from dairy FT-IR results and the standard deviations of the mean difference (0.09, 0.09, and 0.13). Robustness was demonstrated by evaluating milk with natural variation over 6 months and using multiple instrumentation setups. The repeatability was also evaluated.

Conclusions

Overall, the in-line FT-NIR technology was found to have accurate, reliable, consistent performance similar to dairy FT-IR technology.
Not Too Far to Help: Residential Mobility, Global Identity, and Donations to Distant Beneficiaries
Authors: Wang Yajin , Kirmani Amna , Li Xiaolin
Published: October 2020

Extant research shows that consumers are more likely to donate to close than distant others, making donations to geographically distant beneficiaries a challenge. This article introduces residential mobility as a novel variable that can lead to increased donations toward distant beneficiaries. This article proposes that residential mobility (vs. stability) leads consumers to have a stronger global identity, whereby they see themselves as world citizens. This global identity results in higher donations to distant beneficiaries. A multi-method approach provides evidence for this prediction. An analysis of a national panel dataset demonstrates that high residential mobility is correlated with donations to distant beneficiaries. Lab experiments, including one with real monetary donations, replicate these effects using both actual moving experience and a residential mobility mindset.
Manipulation and Machine Induction
Authors: Liu Xiaofei
Published: October 2020

One type of soft-line reply to manipulation arguments, which I call ‘the another-agent reply’, focuses on the existence of some controlling agent(s) and how this can undermine the actor's moral responsibility. A well-known challenge to this type of reply is the so-called ‘machine induction’ case. This paper provides an argument for why ‘machine induction’ presents no real challenge to the another-agent reply. It further argues that any soft-liner who does not leave room for the existence of some controlling agent(s) in their explanation of why manipulation undermines responsibility will face a dilemma. Thus, instead of presenting a challenge to the another-agent reply, ‘machine induction’ actually presents a reason in support of it.
STAMP: a multiplex sequencing method for simultaneous evaluation of mitochondrial DNA heteroplasmies and content
Authors: Guo Xiaoxian , Wang Yiqin , Zhang Ruoyu , Gu Zhenglong
Published: October 2020

Human mitochondrial genome (mtDNA) variations, such as mtDNA heteroplasmies (the co-existence of mutated and wild-type mtDNA), have received increasing attention in recent years for their clinical relevance to numerous diseases. But large-scale population studies of mtDNA heteroplasmies have been lagging due to the lack of a labor- and cost-effective method. Here, we present a novel human mtDNA sequencing method called STAMP (sequencing by targeted amplification of multiplex probes) for measuring mtDNA heteroplasmies and content in a streamlined workflow. We show that STAMP has high-mapping rates to mtDNA, deep coverage of unique reads and high tolerance to sequencing and polymerase chain reaction errors when applied to human samples. STAMP also has high sensitivity and low false positive rates in identifying artificial mtDNA variants at fractions as low as 0.5% in genomic DNA samples. We further extend STAMP, by including nuclear DNA-targeting probes, to enable assessment of relative mtDNA content in the same assay. The high cost-effectiveness of STAMP, along with the flexibility of using it for measuring various aspects of mtDNA variations, will accelerate the research of mtDNA heteroplasmies and content in large population cohorts, and in the context of human diseases and aging.
Microbial Translocation in the Context of Hepatitis B Infection and Hepatitis D Infection
Authors: Townsend Elizabeth C , Zhang Grace Y , Ali Rabab , Surana Pallavi , Firke Marian , Moon Mi Sun , Han Ma Ai Thanda , Gewirtz Meital , Haddad James A , Kleiner David E , Koh Christopher , Heller Theo
Published: October 2020

Background

Increased microbial translocation (MT) into the systemic circulation is associated with liver disease progression. MT has yet to be completely defined in chronic hepatitis B (HBV) and chronic hepatitis D (HDV).

Aim

To characterize MT and associated immune response in chronic HBV and HDV at various stages of disease.

Methods

Serum from 53 HBV, 43 HDV, and 36 healthy control (HC) subjects was obtained. Subjects were categorized by aspartate aminotransferase to platelet ratio index into mild (<0.5), moderate, and severe (>1.0) disease. Cytokines, microbial products, and microbial DNA levels were assessed in a single treatment-naïve time point for each patient. Next-generation sequencing identified bacterial species present within patient sera.

Results

HBV and HDV subjects display higher serum concentrations of gram-negative (G-) bacterial lipopolysaccharide and fungal beta-glucan compared to HC (all p<0.01). Gram-positive (G+) bacterial peptidoglycan is higher in HBV compared to HDV and HC (both p<0.0001). Within both disease cohorts, peptidoglycan correlates with IL-1b, IL-8, IL-12p70, and IL-13 (all spearman-r>0.45, p<0.05). Next-generation sequencing from seven subjects with detectable serum bacterial DNA revealed changes in abundance of bacterial taxa and a higher proportion of gram-positive genera in severe disease. Greater G+/G- taxa ratio is associated with higher cytokine levels and disease markers.

Conclusions

HBV and HDV patients display increased translocation of bacterial and fungal products into serum. Increased proportion of gram-positive genera is associated with disease progression. Correlations of peptidoglycan with anti-microbial cytokines suggests particular microbial classes may contribute to systemic inflammation and possibly disease progression.
Opportunities to Offer Harm Reduction to People who Inject Drugs During Infectious Disease Encounters: Narrative Review
Authors: Peckham Alyssa M , Young Erika H
Published: October 2020

Increased rates of overdose (OD) and blood-borne infections have been associated with injection drug use (IDU). This increasing overlap between IDU-related infectious diseases (ID) is a byproduct of the opioid OD crisis, especially with the transition to synthetic opioids with faster onset and shorter duration leading to potentially more frequent injections. ID specialists are uniquely positioned to positively impact the opioid OD crisis by capitalizing on opportunistic moments of engagement during clinical encounters with people who inject drugs (PWID). Harm reduction services should therefore be expanded and offered to PWID in ID settings to reduce rates of OD, infection, and hospitalization. Major target areas include (1) teaching and distribution of materials related to safer injection practice such as sterile injection supplies, fentanyl test strips, and naloxone; (2) increased screening and access to pre-exposure prophylaxis and postexposure prophylaxis; and (3) initiation of medications for opioid use disorder. Incorporating these strategies in various treatment settings can expand treatment access, improve patient outcomes, and reduce stigma associated with IDU.
Dynamics of the Antibody Response After a Third Dose of Measles-Mumps-Rubella Vaccine Indicate a Slower Decline Compared With a Second Dose
Authors: Kaaijk Patricia , Nicolaie M Alina , van Rooijen Debbie , van Houten Marianne A , van der Klis Fiona R , Buisman Anne-Marie , van Binnendijk Rob S
Published: October 2020

Background

Breakthrough infections of measles and mumps have raised concerns about the duration of vaccine-induced immunity, which might be improved by a third dose of measles-mumps-rubella vaccine (MMR3).

Methods

Here we compared (IgG) antibody levels against measles, mumps, and rubella in blood samples of 9-year-old children and young adults (18–25 years) following MMR2 and MMR3, respectively.

Results

We found that, in addition to antibody boosting for all 3 vaccine components, MMR3 resulted in lower antibody decay rates than MMR2; the declines were most prominent for mumps and rubella.

Conclusions

This study suggests that MMR3 provides long-lasting seroprotection against measles, mumps, and rubella.
Bringing the Law Back In: The Law-Government Nexus in an Era of Network Governance
Authors: Zouridis Stavros , Leijtens Vera
Published: October 2020

Recently, scholars have claimed that public management theory has too much ignored law. Consequently, the under-legalized conception of public management has produced a flawed understanding of public management theory as well as public management practices, threatening public institutions’ legitimacy. In this article, we argue that law never left public management theory. Rather, the link between government and law has been redefined twice. We refer to the assumptions that constitute this link as the law-government nexus. This nexus changed from lawfulness in a public administration paradigm, to legal instrumentalism in a (new) public management paradigm, and to a networked concept in the public governance (PG) paradigm. In order to prevent a faulty over-legalized conception of public management, bringing the law back in should be built on lessons from the past. This article elaborates on three strategies to reconnect law and public management. We map the strengths and weaknesses of each law-government nexus and illustrate these with the case of the Dutch tax agency. In our strategies that aim to reconceptualize the current law-government nexus, we incorporate the benefits of each paradigm for public management theory. The revised law-governance nexus enables the PG paradigm to correspond to contemporary issues without encountering old pathologies.
ASSESSING THE COMPLIANCE OF ELECTROMAGNETIC FIELDS RADIATED BY BASE STATIONS AND WIFI ACCESS POINTS WITH INTERNATIONAL GUIDELINES ON UNIVERSITY CAMPUS
Authors: Keshmiri Sajedeh , Gholampour Neda , Mohtashami Vahid
Published: October 2020

This paper presents a series of electromagnetic field measurements performed on the campus of Ferdowsi University of Mashhad in order to assess the compliance of radiation levels of cellular base stations and WiFi access points with international guidelines. A calibrated, broadband and isotropic probe is used and recommendations of International Telecommunication Union (ITU) are followed up throughout measurements. More than 300 outdoor and indoor locations have been systematically chosen for measurements. The recorded data are post-processed and compared with the guideline of International Commission on Non-Ionizing Radiation Protection (ICNIRP). Measured power densities of WiFi access points are low and do not exceed 1% of the level allowed by ICNIRP. For cellular base stations, measured power density is usually low outdoors, but reaches up to 16% of the allowed radiation level in publicly accessible indoor locations. Comprehensive exposure assessment, as recommended by ITU, has been performed to estimate the maximum possible radiation of one indoor base station. It is concluded that precautionary actions have to be taken by university authorities to limit the presence of students in close proximity to specific indoor antennas. Moreover, comprehensive exposure assessment is more likely necessary for indoor base stations whereas such assessment is not usually required outdoors.
Spatial analysis of malaria in Kotabaru, South Kalimantan, Indonesia: an evaluation to guide elimination strategies
Authors: Juhairiyah Juhairiyah , Andiarsa Dicky , Indriyati Liestiana , Ridha Muhammad Rasyid , Prasodjo Rachmalina Soerachman , Dhewantara Pandji Wibawa
Published: October 2020

Background

Malaria remains a significant public health concern in Indonesia. Knowledge about spatial patterns of the residual malaria hotspots is critical to help design elimination strategies in Kotabaru district, South Kalimantan, Indonesia.

Methods

Laboratory-confirmed malaria cases from 2012 to 2016 were analysed to examine the trend in malaria cases. Decomposition analysis was performed to assess seasonality. Annual spatial clustering of the incidence and hotspots were identified by Moran's I and the local indicator for spatial association, respectively.

Results

The annual parasite incidence of malaria was significantly reduced by 87% from 2012 to 2016. Plasmodium vivax infections were significantly much more prevalent over time, followed by Plasmodium falciparum infections (p<0.001). The monthly seasonality of P. vivax and P. falciparum was distinct. High incidence was spatially clustered identified in the north, west and parts of south Kotabaru. Two persistent and four re-emerging high-risk clusters were identified during the period. Despite the significant reduction in the incidence of malaria, the residual high-risk villages remained clustered in the northern part of Kotabaru.

Conclusions

A spatially explicit decision support system is needed to support surveillance and control programs in the identified high-risk areas to succeed in the elimination goal of 2030.
Methods for Screening Wheat Genotypes for Resistance to Sharp Eyespot in the Field and Greenhouse
Authors: Liu Jiang , Anderson Nicole P. , Mundt Christopher C.
Published: October 2020

Screening methodology of wheat genotypes for resistance to sharp eyespot (caused by Rhizoctonia cerealis) was developed. Disease severity differed among cultivars and between field and greenhouse trials. However, the cultivars Bobtail and Rosalyn had consistently lower severity in field experiments with high sharp eyespot disease pressure. Artificial inoculation was crucial to achieving adequate disease levels for effective screening but planting date had very little effect. Greenhouse inoculation of adult wheat plants was much less successful in categorizing resistance to sharp eyespot. Seedling inoculations in the greenhouse were highly inadequate as a screening method. Selection for resistance to sharp eyespot by artificial inoculation in field trials is feasible in wheat breeding programs.
Functional Outcomes of Patella Fractures Treated With Anterior Plate Osteosynthesis at One Year
Authors: Shymon Stephen J. , Jansson Hayley , Schneiderman Brian A. , Nazareth Alexander , Hoshino Christopher Max , Zinar Daniel M. , Gold Stuart M.
Published: October 2020

Objectives:

To evaluate the functional outcomes of patients with displaced patellar fractures treated with anterior plate constructs.

Design:

Prospective cohort and retrospective clinical and radiographic assessment.

Setting:

Level I Trauma Center.

Patients/Participants:

Between 2014 and 2018, 18 patients who underwent operative intervention for an isolated, displaced patella fracture (OTA/AO 34C1-3) with a minimum of 1-year follow-up agreed to participate in the study. The mean follow-up was 19.5 ± 6.0 months.

Intervention:

Patients were treated with 2.4 or 2.7-mm plates and supplemental screws or cerclage wires.

Main Outcome Measurements:

Patients were evaluated with the Short Form-36 Survey and the Knee Injury and Osteoarthritis Outcome Scores and asked about symptomatic implants. The range of motion was assessed by goniometer.

Results:

The cohort had no wound complications, infections, nonunion, loss of reduction, or implant failure. Active knee flexion was 131 ± 7 degrees. Five patients (28%) endorsed implant irritation. Only one patient (5.5%) underwent implant removal, which consisted of transverse screw removal alone. Twelve of the 14 patients (86%), who were previously employed, returned to work at 10 ± 7 weeks. All Knee Injury and Osteoarthritis Outcome Scores subscale scores and the Short Form-36 Survey scores for physical functioning, limitations due to physical health, limitations due to mental health, and social functioning were significantly lower than reference population norms (P < 0.05).

Conclusions:

Anterior plating provides reliable fixation for displaced patellar fractures and results in a low incidence of implant irritation. However, patients who had anterior fixation for displaced patella fractures continue to exhibit functional deficits at 1-year postoperatively.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Radiographic Quantification of Safe Zones for Screw Placement in the Femoral Neck: A Computed Tomography–Based Analysis
Authors: Kumar Arvind , Kumar Mukesh , Arora Rajesh , Passey Jigyasa , Das Saubhik , Chauhan Shishir
Published: October 2020

Objectives:

The purpose of this study is to design a radiographic map of the femoral neck showing proportion-based locations of the safe zones for screw placement with widest bony extents in anteroposterior and lateral radiographs using normal computed tomography–based data.

Methods:

We analyzed computed tomography–based studies of 50 intact normal proximal femora equally from male and female subjects. Using software-developed radiographs, the proportionate locations of the maximal anteroposterior and cephalocaudal extents in both constricted zones were measured. The width of the femoral neck in the measurement zone was taken as the reference for calculation of proportions.

Results:

For anteroposterior radiographs, the anteroposterior safe zones in the femoral neck are located at the gradients of 34.21% and 34.33% from the superior border in midcervical and basicervical regions, respectively. In lateral radiographs, they correlate with the visible anterior extent of femoral neck and lie at a gradient of 7.16% and 11.79% from the visible posterior border in midcervical and basicervical regions, respectively. In lateral radiographs, the calcar-based cephalocaudal safe zone was located at the gradients of 43.49% and 39.53% from the visible posterior border in midcervical and basicervical regions, respectively. In anteroposterior radiographs, cephalic limit of the calcar-based safe zone is located at the gradients of 9.63% and 17.82% from the superior border in midcervical and basicervical regions, respectively.

Conclusions:

Radiographic margins cannot be reliably trusted for screw fixation of femoral neck fractures. The proportionate locations of the anteroposterior and calcar-based cephalocaudal safe zones with widest bone stock in anteroposterior and lateral fluoroscopic projections can help in the safe placement of screws for fixation of femoral neck fractures.
Unnecessary Preoperative Cardiology Evaluation and Transthoracic Echocardiogram Delays Time to Surgery for Geriatric Hip Fractures
Authors: Hoehmann Christopher L. , Thompson Jeffrey , Long Mitchell , DiVella Michael , Munnangi Swapna , Ruotolo Charles , Galos David K.
Published: October 2020

Objective:

Delays to surgery for patients with geriatric hip fracture are associated with increased morbidity and mortality. The American Heart Association (AHA) and American College of Cardiology (ACC) Clinical Practice Guidelines (CPG) were created to standardize preoperative cardiology consultation and transthoracic echocardiogram (TTE). This study's purpose is to determine if these practices are over used and delay time to surgery at a safety net hospital.

Design:

Retrospective review.

Setting:

Level 1 trauma center and safety net hospital.

Patients:

Charts were reviewed for indications of preoperative cardiology consultation or TTE per AHA and ACC CPG in 412 patients admitted with geriatric hip fracture.

Intervention:

Criteria meeting the AHA/ACC guidelines for preoperative TTE and cardiac consultations.

Main Outcome Measurements:

Time to surgical intervention.

Results:

Despite 17.7% of patients meeting criteria, 44.4% of patients received cardiology consultation. Of those patients, 33.8% met criteria for receiving preoperative TTE but 89.4% received one. Time to surgery was greater for patients receiving cardiology consultation (25.42 ± 14.54 hours, P-value <0.001) versus those who did not (19.27 ± 13.76, P-value <0.001) and for those receiving preoperative TTE (26.00 ± 15.33 hours, P-value <0.001) versus those who did not (18.94 ± 12.92, P-value <0.001).

Conclusions:

Cardiology consultation and TTE are frequently used against AHA/ACC CPG. These measures are expensive and delay surgery, which can increase morbidity and mortality. These findings persisted despite limited resources available in a safety net hospital. Hospitals should improve adherence to CPG, or modify protocols.

Level of Evidence:

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Novel Simultaneous Decompression Through Single-stage Mini-thoracotomy for Concurrent Ossification of the Posterior Longitudinal Ligament and Ossification of the Ligamentum Flavum at the Same Thoracic Level
Authors: Yoon Jongwon , Bae Junseok , Shin Sang-Ha , Bae Youngsik , Lee Sang-Ho
Published: October 2020

Study Design.

Technical case report.

Objective.

To describe a novel technique of decompression through single-stage mini-thoracotomy for removing concurrent ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF) at the same thoracic level simultaneously.

Summary of Background Data.

Concurrent OPLL and OLF at the same thoracic level is not common. Because these conditions lead to severe thoracic myelopathy, however, they require surgical decompression.

To date, several cases with concurrent OPLL and OLF at the same thoracic level and surgical methods to treat these conditions have been described. However, no consensus on the surgical methods for the treatment these conditions has been established and these surgical methods have been also reported to be linked with the incidence of complication like neurological deterioration and the requirement of bone grafting and instrumentation.

Methods.

Three consecutive patients who presented with thoracic myelopathy caused by concurrent OPLL and OLF at the same thoracic level were treated by our novel surgical technique of decompression through single-stage mini-thoracotomy.

Results.

Simultaneous complete removal of OPLL and OLF through single-stage mini-thoracotomy was performed successfully in the three patients. All patients’ preoperative symptoms gradually improved during the follow-up period, and no additional complications were associated with removal of OLF through thoracotomy. And there was no kyphotic change or instability in the thoracic spine after more than a year of follow-up although both bone grafting and instrumentation were not performed.

Conclusion.

This novel surgical technique is considered to be able to be a safe and effective alternative to the conventional treatment of selective cases of thoracic myelopathy caused by concurrent OPLL and OLF at the same thoracic level.

Level of Evidence: 4
Use of Higher-strength Opioids has a Dose-Dependent Association With Reoperations After Lumbar Decompression and Interbody Fusion Surgery
Authors: Samuel Andre M. , Lovecchio Francis C. , Premkumar Ajay , Louie Philip K. , Vaishnav Avani S. , Iyer Sravisht , McAnany Steven J. , Albert Todd J. , Gang Catherine Himo , Qureshi Sheeraz A.
Published: October 2020

Study Design.

A retrospective cohort study.

Objective.

The aim of this study was to identify an association between preoperative opioid use and reoperations rates.

Summary of Background Data.

Chronic opioid use is a public health crisis in the United States and has been linked to worse outcomes after lumbar spine surgery. However, no studies have identified an association between preoperative opioid use and reoperations rates.

Methods.

A retrospective cohort study was conducted using patients from one private insurance database who underwent primary lumbar decompression/discectomy (LDD) or posterior/transforaminal lumbar interbody fusion (PLIF/TLIF). Preoperative use of five specific opioid medications (tramadol, hydromorphone, oxycodone, hydromorphone, and extended-release oxycodone) was categorized as acute (within 3 months), subacute (acute use and use between 3 and 6 months), or chronic (subacute use and use before 6 months). Multivariate regression, controlling for multilevel surgery, age, sex, and Charlson Comorbidity Index, was used to determine the association of each medication on reoperations within 5 years.

Results.

A total of 11,551 patients undergoing LDD and 3291 patients undergoing PLIF/TLIF without previous lumbar spine surgery were identified. In the LDD group, opioid-naïve patients had a 5-year reoperation rate of 2.8%, compared with 25.0% and 8.0 with chronic preoperative use of hydromorphone and oxycodone, respectively. In multivariate analysis, any preoperative use of oxycodone was associated with increased reoperations (odds ratios [OR] = 1.4, 2.0, and 2.3, for acute, subacute, and chronic use; P < 0.01). Chronic use of hydromorphone was also associated with increased reoperations (OR = 7.5, P < 0.01).

In the PLIF/TLIF group, opioid-naïve patients had a 5-year reoperation rate of 11.3%, compared with 66.7% and 16.8% with chronic preoperative use of hydromorphone and oxycodone, respectively. In multivariate analysis, any preoperative use of hydromorphone was associated with increased reoperations (OR = 2.9, 4.0, and 14.0, for acute, subacute, and chronic use; P < 0.05).

Conclusion.

Preoperative use of the higher-potency opioid medications is associated with increased reoperations after LDD and PLIF/TLIF in a dose-dependent manner. Surgeons should use this data for preoperative opioid cessation counseling and individualized risk stratification.

Level of Evidence: 3
Does Duration of Pain at Baseline Influence Longer-term Clinical Outcomes of Low Back Pain Patients Managed on an Evidence-Based Pathway?
Authors: Jess Mary-Anne , Ryan Cormac , Hamilton Sharon , Wellburn Shaun , Atkinson Greg , Greenough Charles , Peat Glynis , Coxon Andrew , Fatoye Francis , Ferguson Diarmaid , Dickson Alastair , Ridley Helen , Martin Denis
Published: October 2020

Study Design.

Nonrandomized longitudinal observational study.

Objective.

The aim of this study was to evaluate the association between baseline pain duration and medium-to-long term clinical outcomes, in low back pain (LBP) patients enrolled on the North East of England Regional Back Pain and Radicular Pain Pathway (NERBPP).

Summary of Background Data.

The NERBPP is based upon National Institute for Health and Care Excellence (NICE) guidelines. These guidelines no longer differentiate management of LBP patients based on pain duration. Medium-to-long term data from the NERBPP is lacking.

Methods.

Between May 2015 and December 2019, 786 and 552 LBP patients from the NERBPP returned 6-month and 12-month follow-up outcome measures, respectively. Outcomes included pain (Numerical rating scale), function (Oswestry Disability Index) and quality-of-life (EuroQol five-dimension, five-level questionnaire), analyzed using a series of covariate-adjusted models. Patients were categorized into four groups based upon baseline pain duration: <3 months, ≥3 to <6 months, ≥6 months to <12 months, ≥12 months.

Results.

Patients with <3 months duration demonstrated clinically important improvements on all outcomes, at both follow-ups. The improvements in outcomes from this group were larger than those in the ≥12 month's duration group (P < 0.05), these group differences in change, in some cases surpassed our threshold for clinical relevance. Functional improvements in those with ≥12 month's duration were not clinically relevant at either follow-up. All patients, regardless of baseline pain duration, reported similar levels of readiness to self-manage at the 12-month follow-up.

Conclusion.

Baseline pain duration would appear to be of clinical importance. Patients with shorter baseline pain duration demonstrated better outcomes. Those with ≥12 month's duration of pain may need additional support during their management to achieve clinically relevant functional improvements in the medium-to-long term. These findings raise questions about the decision by NICE to move away from duration of pain to differentiate management of LBP patients.

Level of Evidence: 3
Targeting the Vascular Endothelium in the Treatment of COVID-19
Authors: Suvorava Tatsiana , Kaesemeyer Wayne
Published: October 2020

The involvement of the vascular endothelium in the complications of coronavirus disease 2019 is now recognized. Chief among these are pulmonary endotheliitis, cytokine storm, endotoxic shock, and cardiovascular collapse. This Perspectives article is focused on therapeutical strategies to reduce the risk of these complications by targeting the vascular endothelium as a part of the overall treatment of coronavirus disease 2019.
Comparison of Visual and Tomographic Outcomes of Epithelium-On and Epithelium-Off Accelerated Corneal Crosslinking: A Longitudinal Study
Authors: Niyazmand Hamed , McKelvie James , Li Ye , McLintock Cameron
Published: October 2020

Purpose:

To compare the visual and tomographic outcomes of epithelium-on and epithelium-off corneal collagen crosslinking (CXL) in an accelerated protocol in eyes with progressive keratoconus.

Methods:

Sixty-one patients with progressive keratoconus (female patients, n = 30; male patients, n = 31) aged 17 and 48 years (mean age: 25.8 ± 6.2 yrs) were included in this study. Patients underwent either epithelium-off (n = 27) or epithelium-on (n = 34) CXL using an accelerated protocol. Patients with at least 12 months of follow-up were included in the study. Visual and tomographic data from 3, 6, and 12 months after surgery were analyzed.

Results:

There were no differences between the visual and tomographic characteristics of the epithelium-on and epithelium-off groups at baseline (P > 0.05). No significant changes in uncorrected and best spectacles-corrected visual acuity were found at any stage during the first 12 months within either group or between the groups (all P > 0.05). There were no changes in thickness and keratometric parameters at any stage during the first 12 months within either group, or between groups (P > 0.05) except for a transient significant thinning of the central cornea in all groups in the first 3 months which recovered by 6 months. There was no significant difference between groups regarding the number of eyes with progression in the 12 months after treatment (P > 0.05).

Conclusions:

Epithelium-on and epithelium-off CXL in an accelerated protocol provide comparable visual and tomographic outcomes after 1 year in eyes with progressive keratoconus.
Variability in the management and imaging use in paediatric minor head trauma in European emergency departments. A Research in European Pediatric Emergency Medicine study
Authors: Velasco Roberto , Moore Carmel M. , Deiratany Samir , D’Elia Federica , Tourteau Laetitia Bertrand , Zuiani Chiara , Bognar Zsolt , Erdelyi Katalin , Fadgyas Balazs , Fejes Marianna , Teksam Ozlem , Mirzeyev Yalçin , Esmeray Pelin , Fernández Santiago M. , Ricondo Amaia , Da Dalt Liviana , Bressan Silvia , Priante Elena , Snoeck Eveline , Broers Merel , Castman-Berrevoets Coriene E. , Fernandes Ricardo M. , Borges Joana , Obieta Anaida , Alcalde Maider , Piñol Sergio , González Javier , Azzali Annachiara , Gioè Daniela , La Spina Luisa , Bianconi Martina , Arribas Marta , Parri Niccolò
Published: October 2020

Objective

The objective of the study was to assess the variability in the management of paediatric MHT in European emergency departments (EDs).

Methods

This was a multicentre retrospective study of children ≤18 years old with minor head trauma (MHT) (Glasgow Coma Scale ≥14) who presented to 15 European EDs between 1 January 2013 and 31 December 31. Data on clinical characteristics, imaging tests, and disposition of included patients were collected at each hospital over a 3-year period.

Results

We included 11 212 patients. Skull radiography was performed in 3416 (30.5%) patients, range 0.4–92.3%. A computed tomography (CT) was obtained in 696 (6.2%) patients, range 1.6–42.8%. The rate of admission varied from 0 to 48.2%.

Conclusion

We found great variability in terms of the type of imaging and rate of CT scan obtained. Our study suggests opportunity for improvement in the area of paediatric head injury and the need for targeted individualised ED interventions to improve management of MHT.
Investigation of the Status of Nurses Returning to Work After Recovering From COVID-19 and Influencing Factors
Authors: Zheng Na , Zhang Teng , Liu Yu , Zhu Xiu-qin
Published: October 2020

Background:

More than 3000 medical personnel in China had been infected with coronavirus disease-2019 (COVID-19). We report on 75 previously infected nurses who returned to work.

Purpose:

The aim was to understand the adaptation status of nurses after recovering from COVID-19 and returning to work.

Methods:

Data were collected online via the Work Adaptation Scale and the Psychological Capital Scale, and the related influencing factors were analyzed.

Results:

The social integration and task mastery scores were highest, and the clear roles and cultural adaptation scores were low. The self-efficacy and hope scores were highest, but the resilience and optimism scores were not high. Psychological capital was positively correlated with work adaptation (P < .01).

Conclusions:

To ensure the quality and safety of nursing care, nurse managers should adopt effective intervention measures to address the physical and mental health of returning nurses and improve their levels of psychological capital and adaptability.
A Mixed-Methods Study of the Experiences and Beliefs of Older People With Complex Health Care Needs About Medication Adherence
Authors: Purvis Sacha , Manias Elizabeth , Redley Bernice
Published: October 2020

Background:

Medication adherence is seldom examined in older people from diverse ethnic, cultural, and language backgrounds.

Purpose:

The purpose of this study was to explore medication adherence among culturally diverse older people with complex health care needs.

Methods:

Using a mixed-methods design, a consecutive sample of 40 older people living in a culturally diverse, low socioeconomic area completed the Brief Medication Questionnaire; 12 reporting high medication nonadherence were interviewed. Analyses used descriptive statistics and thematic analyses.

Results:

Participants experienced high medication nonadherence (n = 34, 85%), language barriers (n = 15, 37.5%), financial difficulties (n = 24, 60%), and poor understanding of their medications (n = 34, 85%). Medication nonadherence was attributed to finger dexterity (57.5%), poor vision (85%), and memory problems (87.5%). Interviews revealed 5 themes to explain nonadherence: (1) illness beliefs; (2) experiences of the aging process; (3) challenges for non-English-speaking participants; (4) adherence impediments; and (5) therapeutic relationships.

Conclusions:

Vulnerable, older people had high medication nonadherence. Targeted interventions may enhance medication adherence in this group.
COVID-19 and Nurse-Sensitive Indicators
Authors: Stifter Janet , Sermersheim Emily , Ellsworth Mary , Dowding Erin , Day Elizabeth , Silvestri Karen , Margwarth Jessica , Korkmaz Kerem , Walkowiak Nicole , Boudreau Lisa , Hernandez Laura , Harbert Bryce , Ambutas Shirley , Abraham Aney , Shaw Phil
Published: October 2020

Background:

Nurse-sensitive quality indicators have historically been used as a metric of nursing care quality in health care organizations.

Problem:

At our academic medical center, critically ill COVID-19 patients led to a dramatic change in the organizational standard of care resulting in an increase in nurse-sensitive health care–associated infections.

Approach:

Nursing performance improvement teams provided the structure for development of innovative strategies implemented in real time by our frontline clinicians to address the quality and safety issues found with these elevated health care–associated infections.

Outcomes:

A new COVID-19 CLABSI (central line–associated bloodstream infection) Tip Sheet and a Prone Positioning Kit for HAPI Prevention are strategies developed to address quality of care issues experienced with the COVID-19 patients.

Conclusions:

Deployment of these innovative practice strategies has led to a decline in health care–associated infections and instituted a new care standard for the COVID-19 patients.
Brief Report: Virologic and Immunologic Outcomes for HIV Patients With Coronavirus Disease 2019
Authors: Hu Rong , Yan Han , Liu Manqing , Tang Li , Kong Wenhua , Zhu Zerong , Liu Pan , Bai Wenjuan , Hu Xuejiao , Ding Jie , Wang Xia , Xie Nianhua
Published: October 2020

Background:

To describe the virologic and immunologic outcomes among people living with HIV (PLHIV) coinfected with SARS-CoV-2.

Setting:

Wuhan, China.

Methods:

Thirty-five coinfected patients were identified by matching the reported cases in National Notifiable Infectious Disease Report system for COVID-19 and HIV in Wuhan by time of April 19, 2020. Questionnaire-based survey and follow-up with blood sample collection were used to obtain characteristics before COVID-19 and after recovery. Nonparametric Mann–Whitney U test, χ2, or Fisher exact test, Mcnemar test, and Wilcoxon test were conducted.

Results:

Twenty of the 35 coinfected patients were identified as asymptomatic/mild/moderate COVID-19 (nonsevere group) and 15 were identified as severe/critical (severe group). The severe and nonsevere group had no differences in demographics, HIV baseline status, the intervals between last tests and follow-up tests for CD4+ cell count and HIV-1 viral load (all P > 0.05). Overall, there was a significantly increased number of coinfected patients with HIV-1 viral load ≥20 copies/mL after recovery (P = 0.008). The median viral load increased significantly after recovery in severe group (P = 0.034), whereas no significant change of HIV-1 viral load was observed in the nonsevere group. Limited change of CD4+ cell count was found (all P > 0.05).

Conclusion:

The coinfection of SARS-CoV-2 may put PLHIV at greater risk for HIV-1 viral rebound especially for severe/critical COVID-19, whereas it had limited impacts on CD4+ cell count. Whether continuous antiretroviral therapy against HIV infection would have significant impacts on CD4+ cell count among PLHIV coinfected with SARS-CoV-2 needs further research.
LRP8 (rs5177) and CEP85L (rs11756438) are contributed to schizophrenia susceptibility in Iranian population
Authors: Poursaei Elham , Daneshmandpour Yousef , Aghaei Moghadam Ehsan , Abolghasemi Mahsa , Jamshidi Javad , Baradaran Behzad , Asadi Milad , Kazeminasab Somayeh , Emamalizadeh Babak
Published: October 2020

Introduction Schizophrenia is recognized as one of the most important mental illnesses of the last century. Many genetic and environmental factors are involved in this condition. Recently, the genome-wide association study identified two significant genes LRP8 and CEP85L associated with psychiatric disorders. LRP8 (low-density lipoprotein receptor-related protein 8) acts as a cytoplasmic receptor for Reelin. Many studies have revealed that LRP8 was significantly related to schizophrenia and bipolar disorder in Chinese population. CEP85L standing for ‘centrosomal protein 85 kDa-like’ is another gene, which has been reportedly associated with BPD. Methods We performed a case-control study to analyze the association between rs5177 single-nucleotide polymorphism in the LRP8 gene plus the single-nucleotide polymorphism rs11756438 in the CEP85L gene and schizophrenia in the Iranian population. The genotype for rs5177 was determined by ARMS PCR method, while for rs11756438 genotype, it was determined by PCR-RFLP method after which statistical analysis was performed for each polymorphism. In rs5177, the CC genotype was susceptible to the disease while G allele was associated with disease protection. Results and Conclusion In rs11756438, the AA genotype was associated with disease susceptibility, while allele A did not have a significant association with the disease.
From war zone to biosphere reserve: the Korean DMZ as a scientific landscape
Authors: Brady Lisa M.
Published: October 2020

The Korean DMZ—at once a war zone, a historical landscape and a living laboratory—offers a compelling example of how scientific fieldwork can alter the definition of place. This article explores how scientists introduced new layers of meaning to the region, thereby contributing to shifts in perspective about the border area and to changes in land-use policies there. As early as the mid 1960s, scientists described the DMZ as a scientifically unique and valuable place and argued for setting it aside as a nature reserve; by the late 1990s, the vision of the DMZ as a scientific landscape gained currency both within Korea and internationally and has become central to discussions about the zone's future. This article draws from published and unpublished scientific reports whose authors directly argue for assigning official conservation status to all or part of the DMZ and its border regions; it aims to demonstrate the important role scientists have played in redefining the DMZ through highlighting its environmental and scientific value. The article places these developments within the larger environmental history of Korea, suggesting links between changing emphases in environmental activism and policy-making and evolving ideas about the value and purpose of the DMZ.