bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of referral systems on costs and outcomes after hip fracture surgery in Taiwan
Authors: Chiou Bo-Lin , Chen Yu-Fu , Chen Hong-Yaw , Chen Cheng-Yen , Yeh Shu-Chuan Jennifer , Shi Hon-Yi
Published: September 2020

Objective

To explore the economic burdens of hip fracture surgery in patients referred to lower-level medical institutions and to evaluate how referral systems affect costs and outcomes of hip fracture surgery.

Design

A nationwide population-based retrospective cohort study.

Setting

All hospitals in Taiwan.

Participants

A total of 7500 patients who had received hip fracture surgery (International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic codes 820.0 ∼ 820.9 and procedure codes 79.15, 79.35, 81.52, 81.53) performed in 1997 to 2013.

Main outcome measures

Total costs including outpatient costs, inpatient costs and total medical costs and medical outcomes including 30-day readmission, 90-day readmission, infection, dislocation, revision and mortality.

Results

The patients were referred to a lower medical institution after hip fracture surgery (downward referral group) and 3034 patients continued treatment at the same medical institution (non-referral group). Demographic characteristics, clinical characteristics and institutional characteristics were significantly associated with postoperative costs and outcomes (P < 0.05). On average, the annual healthcare cost was New Taiwan Dollars (NT$)2262 per patient lower in the downward referral group compared with the non-referral group. The annual economic burdens of the downward referral group approximated NT$241 million (2019 exchange rate, NT$30.5 = US$1).

Conclusions

Postoperative costs and outcomes of hip fracture surgery are related not only to demographic and clinical characteristics, but also to institutional characteristics. The advantages of downward referral after hip fracture surgery can save huge medical costs and provide a useful reference for healthcare authorities when drafting policies for the referral system.
Status Matters in World Politics
Authors: Götz Elias
Published: September 2020

This article explores the burgeoning literature on status in world politics. Toward that end, it reviews three recently published books. The three books are representative of the different theoretical perspectives that have come to dominate status research in international relations. Renshon's Fighting for Status offers a rationalist–instrumental approach; Larson and Shevchenko's Quest for Status draws on insights from social identity theory; and Murray's The Struggle for Recognition is informed by constructivist theory. The article contrasts and compares the three works. Moreover, it identifies shortcomings and limitations in each book and, based on this discussion, suggests areas for further research. In particular, it is argued that scholars should devote more attention to competitive theory testing through process tracing; incorporate domestic politics more systematically into approaches of status seeking; develop case-specific explanations that fuse insights from the various perspectives; and examine how the interplay of material and ideational factors shapes states’ status aspirations.
Performance of Genetically Modified Soybean Expressing the Cry1A.105, Cry2Ab2, and Cry1Ac Proteins Against Key Lepidopteran Pests in Brazil
Authors: Bacalhau Fabiana B , Dourado Patrick M , Horikoshi Renato J , Carvalho Renato A , Semeão Altair , Martinelli Samuel , Berger Geraldo U , Head Graham P , Salvadori José R , Bernardi Oderlei
Published: September 2020

The pyramided genetically modified (GM) soybean [Glycine max L. (Merr.)] MON87751 × MON87708 × MON87701 × MON89788, expressing Cry1A.105, Cry2Ab2, and Cry1Ac from Bacillus thuringiensis Berliner, was approved for commercial use in Brazil. We conducted laboratory, greenhouse, and field studies to assess the efficacy of this Bt soybean against key soybean lepidopteran pests. Neonates of Anticarsia gemmatalis (Hübner) (Lepidoptera: Erebidae), Chrysodeixis includens (Walker), and Helicoverpa armigera (Hübner) (Lepidoptera: Noctuidae) were exposed to Bt proteins in diet-overlay bioassays. MON87751 × MON87708 × MON87701 × MON89788 soybean and individual components were evaluated in laboratory (leaf disc), greenhouse (high artificial infestations), and in field conditions (natural infestations). Neonates of A. gemmatalis, C. includens, and H. armigera were highly susceptible to Cry1A.105 (LC50 from 0.79 to 48.22 ng/cm2), Cry2Ab2 (LC50 from 1.24 to 8.36 ng/cm2), and Cry1Ac (LC50 from 0.15 to 5.07 ng/cm2) in diet-overlay bioassays. In laboratory leaf disc bioassays and greenhouse trials, MON87751 × MON87708 × MON87701 × MON89788 soybean as well as the individual components were highly effective in controlling A. gemmatalis, C. includens, and H. armigera. Similarly, under field conditions, the pyramided genotypes expressing Cry1A.105, Cry2Ab2, and Cry1Ac were highly effective at protecting soybean against C. includens. We concluded that the individual Bt proteins expressed by GM soybean MON87751 × MON87708 × MON87701 × MON89788 killed all or nearly all the susceptible A. gemmatalis, C. includens, and H. armigera, fulfilling one important criterion for successfully delaying resistance to pyramided Bt crops.
Early Chronic Intermittent Maternal Hyperoxygenation Impairs Cortical Development by Inhibition of Pax6-Positive Apical Progenitor Cell Proliferation
Authors: Markert Franz , Müller Luisa , Badstübner-Meeske Kathrin , Storch Alexander
Published: September 2020

Maternal hyperoxygenation is a feasible, noninvasive method to treat fetal diseases, such as heart hypoplasia, but effects of maternal hyperoxygenation on the developing brain remain poorly understood. Previous studies showed that short-term maternal hyperoxygenation during midneurogenic phase (E14–E16) but not in earlier development (E10–E12) increases oxygen tension and enhances neurogenesis in the developing mouse cortex. We investigated effects of early chronic maternal hyperoxygenation (CMH) as a potential clinical treatment. Pregnant C57BL/6J mice were housed in a chamber at 75% atmospheric oxygen and the brains of E16 fetuses were analyzed using immunohistochemistry. The mitosis marker phH3 showed a significant reduction of proliferation in the dorsolateral cortices of CMH-treated E16 fetuses. Numbers of Tbr2-positive intermediate progenitor cells were unaffected whereas numbers of Pax6-positive apical progenitor cells were significantly reduced in CMH-treated mice. This resulted in altered cortical plate development with fewer Satb2-positive upper layer neurons but more Tbr1-positive neurons corresponding to the deeper layer 6. Thus, maternal hyperoxygenation affects the developing cortex depending on timing and length of applied oxygen. Early CMH causes a severe reduction of neuroprogenitor proliferation likely affecting cortical development. Further studies are needed to investigate the mechanisms underlying these findings and to assess the clinical and neurodevelopmental outcomes of the pups.
Celebrating YourCircle of Life: Eudaimonic Responses to Nostalgic Entertainment Experiences
Authors: Watts Judy , Bonus James , Wing Hannah
Published: September 2020

Studies of eudaimonic entertainment experiences have primarily examined the effects of exposure to serious content (e.g., tragic movies) rather than lighthearted content that nonetheless harbors personal significance (e.g., beloved movies from childhood). Two experiments investigated the characteristics of these so-called nostalgic entertainment experiences among U.S. adults, using Star Wars movies in Study 1 (N = 1,127) and animated Disney movies in Study 2 (N = 945). Results indicate that exposure to nostalgic content elicits more appreciation than comparable content released recently (i.e., sequels and remakes), and the same level of appreciation as exposure to scenes of self-sacrifice. However, exposure to nostalgic content produces self-affirmation, whereas exposure to scenes of self-sacrifice produces self-transcendence. These findings underscore the limitations of existing two-factor models of entertainment, and modifications are proposed.
Water use strategy of Ammopiptanthus mongolicus community in a drought year on the Mongolian Plateau
Authors: Zhu Ya-Juan , Wang Guo-Jie , Xin Zhi-Ming
Published: September 2020

Aims

In desert ecosystems, water is a restricting factor for plant growth and vegetation dynamics. The relatively stable water source from deep soil profile or groundwater is important for plant survival during drought. Understanding water use strategy of endangered species, in desert ecosystem is essential for their conservation and restoration such as Ammopiptanthus mongolicus on the Mongolian Plateau.

Methods

The stable isotope method of δD and δ 18O was used to examine the main water sources of A. mongolicus and two companion shrubs, e.g. Artemisia ordosica and Artemisia xerophytica. The contribution of different water sources to each species was calculated by IsoSource model. Leaf δ 13C was used to compare long-term water use efficiency of three shrubs. Soil moisture and root distribution of three shrubs was measured to explain plant water use strategy.

Important Findings

The results showed that A. mongolicus relied on groundwater and 150–200 cm deep soil water, with the former contributing to almost half of its total water source. Artemisia ordosica mainly used 150–200 cm deep soil water, but also used shallow soil water within 100 cm in summer and autumn. Artemisia xerophytica mainly used 150–200 cm deep soil water and groundwater, with the latter contributing to about 30%–60% of its total water source. The three shrubs had dimorphic or deep root systems, which are in accord with their water sources. The WUE in the evergreen shrub A. mongolicus was higher than in two deciduous Artemisia shrubs, which may be an adaptive advantage in desert ecosystem. Therefore, groundwater is an important water source for the endangered shrub A. mongolicus in a drought year on Mongolian Plateau. Ammopiptanthus mongolicus and two Artemisia shrubs competed for deep soil water and groundwater.
Cerebral histoplasmosis caused by Histoplasma capsulatum var. duboisii in a patient with no known immunodeficiency
Authors: Paccoud Olivier , Nervo Marine , Alanio Alexandre , Garcia-Hermoso Dea , Bougnoux Marie-Elisabeth , Mateo Joaquim , Mandonnet Emmanuel , Lortholary Olivier , Lanternier Fanny , Adle-Biassette Homa
Published: September 2020

We report the first case of central nervous system histoplasmosis caused by Histoplasma capsulatum var. duboisii in a patient with no underlying immunodeficiency. African histoplasmosis is an underdiagnosed endemic fungal infection which should be included in the differential diagnosis of cerebral lesions in patients originating from Western and Central Africa.
The Alcock Paczynski test with voids in 21 cm intensity field
Authors: Endo Takao , Tashiro Hiroyuki , Nishizawa Atsushi J
Published: September 2020

Feasibility of the Alcock Paczynski (AP) test by stacking voids in the 21 cm line intensity field is presented. We analyse the IllustrisTNG simulation to obtain the 21 cm signal map. We then randomly distribute particles depending on the 21 cm intensity field to find voids by using publicly available code, VIDE. As in the galaxy clustering, the shape of the stacked void in the 21 cm field is squashed along the line of sight due to the peculiar velocities in redshift space, although it becomes spherical in real space. The redshift-space distortion for the stacked void weakly depends on redshift and we show that the dependency can be well described by the linear prediction, with the amplitude of the offset being free parameters. We find that the AP test using the stacked voids in a 21 cm intensity map is feasible and the parameter estimation on Ωm and w is unbiased.
Historical Introgression from Wild Relatives Enhanced Climatic Adaptation and Resistance to Pneumonia in Sheep
Authors: Cao Yin-Hong , Xu Song-Song , Shen Min , Chen Ze-Hui , Gao Lei , Lv Feng-Hua , Xie Xing-Long , Wang Xin-Hua , Yang Hua , Liu Chang-Bin , Zhou Ping , Wan Peng-Cheng , Zhang Yun-Sheng , Yang Jing-Quan , Pi Wen-Hui , Hehua EEr , Berry Donagh P , Barbato Mario , Esmailizadeh Ali , Nosrati Maryam , Salehian-Dehkordi Hosein , Dehghani-Qanatqestani Mostafa , Dotsev Arsen V , Deniskova Tatiana E , Zinovieva Natalia A , Brem Gottfried , Štěpánek Ondřej , Ciani Elena , Weimann Christina , Erhardt Georg , Mwacharo Joram M , Ahbara Abulgasim , Han Jian-Lin , Hanotte Olivier , Miller Joshua M , Sim Zijian , Coltman David , Kantanen Juha , Bruford Michael W , Lenstra Johannes A , Kijas James , Li Meng-Hua
Published: September 2020

How animals, particularly livestock, adapt to various climates and environments over short evolutionary time is of fundamental biological interest. Further, understanding the genetic mechanisms of adaptation in indigenous livestock populations is important for designing appropriate breeding programs to cope with the impacts of changing climate. Here, we conducted a comprehensive genomic analysis of diversity, interspecies introgression, and climate-mediated selective signatures in a global sample of sheep and their wild relatives. By examining 600K and 50K genome-wide single nucleotide polymorphism data from 3,447 samples representing 111 domestic sheep populations and 403 samples from all their seven wild relatives (argali, Asiatic mouflon, European mouflon, urial, snow sheep, bighorn, and thinhorn sheep), coupled with 88 whole-genome sequences, we detected clear signals of common introgression from wild relatives into sympatric domestic populations, thereby increasing their genomic diversities. The introgressions provided beneficial genetic variants in native populations, which were significantly associated with local climatic adaptation. We observed common introgression signals of alleles in olfactory-related genes (e.g., ADCY3 and TRPV1) and the PADI gene family including in particular PADI2, which is associated with antibacterial innate immunity. Further analyses of whole-genome sequences showed that the introgressed alleles in a specific region of PADI2 (chr2: 248,302,667–248,306,614) correlate with resistance to pneumonia. We conclude that wild introgression enhanced climatic adaptation and resistance to pneumonia in sheep. This has enabled them to adapt to varying climatic and environmental conditions after domestication.
Risk factors associated with tinnitus in 2948 Dutch survivors of childhood cancer: a Dutch LATER questionnaire study
Authors: Meijer Annelot J M , Fiocco Marta F , Janssens Geert O , Clemens Eva , Tissing Wim J E , Loonen Jacqueline J , van Dulmen-den Broeder Eline , de Vries Andrica C H , Bresters Dorine , Versluys Birgitta , Ronckers Cécile M , Kremer Leontien C M , van der Pal Helena J , Neggers Sebastian J C M M , van der Heiden-van der Loo Margriet , Stokroos Robert J , Hoetink Alex E , van Grotel Martine , van den Heuvel-Eibrink Marry M
Published: September 2020

Background

Tinnitus is a serious late effect of childhood cancer treatment. The aim of this study was to determine the occurrence and risk factors for tinnitus in a national cohort of childhood cancer survivors (CCS).

Methods

Data were collected within the national Dutch Childhood Oncology Group - Long-Term Effects after Childhood Cancer (DCOG-LATER) cohort by a self-reported health questionnaire among 5327 Dutch CCS treated between 1963 and 2002. Siblings (N = 1663) were invited to complete the same questionnaire. Relevant patient characteristics and treatment factors were obtained from the Dutch LATER database. The occurrence of tinnitus in survivors was compared to siblings. To study the effect of risk factors, multivariate logistic regression models were estimated.

Results

In total, 2948 CCS and 1055 siblings completed the tinnitus item. Tinnitus was reported in 9.5% of survivors and in 3.7% of siblings (odds ratio [OR] 3.0, 95% confidence interval [CI] 2.9–3.1). Risk factors associated with tinnitus in CCS were total cumulative dose cisplatin ≥400 mg/m2 (OR 2.4, 95% CI 1.4–4.0), age at diagnosis (≥10 years: OR 2.1, 95% CI 1.6–2.8), cranial irradiation/total body irradiation (TBI; OR 1.9, 95% CI 1.5–2.5), and neuro/ear, nose, throat (ENT) surgery (OR 1.8, 95% CI 1.1–2.9). Fifty-one percent of CCS with tinnitus had received treatment with either cisplatin, cranial irradiation/TBI, and/or neuro/ENT surgery.

Conclusions

Tinnitus in CCS was present nearly 3 times more often than in siblings. Awareness in CCS previously treated with cisplatin, cranial irradiation/TBI, and/or neuro/ENT surgery is warranted. As only half of affected CCS had a history of these treatments, it seems that other factors might be associated with tinnitus occurrence in this population.
Real-World Utilization and Outcomes of the Veterans Health Administration’s Smoking Cessation Text Message Program
Authors: Christofferson Dana E , Dennis Paul A , Hertzberg Jeffrey S , Beckham Jean C , Knoeppel Jennifer , Hamlett-Berry Kim
Published: September 2020

Introduction

Smoking cessation mobile health (mHealth) programs are effective and have been recommended for integration into health care services but have not been evaluated in real-world health care settings. The Veterans Health Administration, a safety net health care provider, provides health care for 9 million US military veterans. Veterans Health Administration implemented the SmokefreeVET text message program in 2013.

Methods

A retrospective evaluation of 6153 SmokefreeVET subscribers was conducted. The primary outcome was 30-day self-reported abstinence at 6 months. Secondary outcomes included percentage of opt outs, program completers, and 30-day self-reported abstinence at 3 months.

Results

SmokefreeVET subscribers were on average 47.5 years old and 71.4% male. Smoking cessation medication use was reported by 11.5% of subscribers at the start of their quit attempt and subscribers enrolled in the program for an average of 29 days. Subscribers who were younger, female, and heavier smokers were more likely to opt out of the six-week program early. The abstinence rate for the primary outcome, self-reported 30-day abstinence at 6 months among all subscribers was 3.7%.

Conclusions

SmokefreeVET enrolled a younger and more female population of subscribers than other studies of veterans interested in tobacco treatment. The mHealth program was generally acceptable to veterans, yet strategies to increase retention may improve completion rates and outcomes. In this real-world setting, nearly half of the mHealth program subscribers combined use of the text program with smoking cessation medication. Further study of the optimal combination of mHealth with smoking cessation treatments is needed.

Implications

mHealth smoking cessation programs can be effectively implemented within real-world health care settings, even in those serving disadvantaged populations. Further research to improve mHealth program efficacy and integration into clinical settings will increase the population-level impact of these effective smoking cessation programs.
A Sequential Multiple-Assignment Randomized Trial (SMART) for Stepped Care Management of Low Back Pain in the Military Health System: A Trial Protocol
Authors: Fritz Julie M , Rhon Daniel I , Teyhen Deydre S , Kean Jacob , Vanneman Megan E , Garland Eric L , Lee Ian E , Thorp Richard E , Greene Tom H
Published: September 2020

Background

The Defense Health Agency has prioritized system-level pain management initiatives within the Military Health System (MHS), with low back pain as one of the key focus areas. A stepped care model focused on nonpharmacologic treatment to promote self-management is recommended. Implementation of stepped care is complicated by lack of information on the most effective nonpharmacologic strategies and how to sequence and tailor the various available options. The Sequential Multiple-Assignment Randomization Trial for Low Back Pain (SMART LBP) is a multisite pragmatic trial using a SMART design to assess the effectiveness of nonpharmacologic treatments for chronic low back pain.

Design

This SMART trial has two treatment phases. Participants from three military treatment facilities are randomized to 6 weeks of phase I treatment, receiving either physical therapy (PT) or Army Medicine’s holistic Move2Health (M2H) program in a package specific to low back pain. Nonresponders to treatment in phase I are again randomized to phase II treatment of combined M2H + PT or mindfulness-based treatment using the Mindfulness-Oriented Recovery Enhancement (MORE) program. The primary outcome is the Patient-Reported Outcomes Measurement Information System pain interference computer-adapted test score.

This trial is part of an initiative funded by the National Institutes of Health, Veterans Affairs, and the Department of Defense to establish a national infrastructure for effective system-level management of chronic pain with a focus on nonpharmacologic treatments. The results of this study will provide important information on nonpharmacologic care for chronic LBP in the MHS embedded within a stepped care framework.
Looking up Answers to Political Knowledge Questions in Web Surveys
Authors: Höhne Jan Karem , Cornesse Carina , Schlosser Stephan , Couper Mick P , Blom Annelies G
Published: September 2020

Political knowledge can affect measures obtained in public opinion research and political science. When asked political knowledge questions, some respondents look up the answers online, inflating political knowledge scores. This response behavior is detectable in web surveys using paradata. This study investigates whether and to what extent respondents switch away from the survey to search for answers online using JavaScript OnBlur functions. Respondents were randomly assigned to device types (PC or smartphone) and response formats (open or closed) and answered a self-report question. The results reveal that about 30 percent of the respondents look up answers, depending on the device type and response format. They also reveal that switching away and correct answers are significantly associated with the response format. These findings provide new insights on looking up answers online and show that paradata are a promising new method to detect response behavior that may lead to incorrect inferences about respondents’ political knowledge. The findings also show that paradata and self-reports complement each other and that both measures should be combined in future web surveys measuring political knowledge.
Is seronegative rheumatoid arthritis true rheumatoid arthritis? A nationwide cohort study
Authors: Paalanen Kirsi , Puolakka Kari , Nikiphorou Elena , Hannonen Pekka , Sokka Tuulikki
Published: September 2020

Objectives

The classification of seronegative arthritides can be challenging. Our aim was to examine the incidence of SpA diagnosis among patients initially diagnosed as seronegative RA.

Methods

Using nationwide Finnish registers from social insurance institutions, we identified all adult patients who were diagnosed with incident seronegative RA [International Classification of Diseases (ICD)-10 code M06] from 1 January 2000 to 31 December 2014. The patients whose diagnoses subsequently changed to the ICD-10 codes of SpA (M07, M45, M46, K50 and K51) were identified in the national care register, until 31 December 2016.

Results

A total of 9784 adult seronegative RA patients were identified. Of these, 564 patients had their diagnosis subsequently changed to SpA: 275 (48.7%) patients with PsA, 245 (43.4%) patients with axial SpA and 44 (7.8%) patients with diagnoses related to IBD. The cumulative incidence of SpA diagnoses in 15 years was 10.4% (95% CI 8.9, 12.1) and 8.1% (95% CI 7.1, 9.3) in men and women, respectively.

Conclusion

This study calls for vigilance in seronegative RA patients, especially those with more atypical presentations, since the diagnosis could change. The possibility of SpA diagnosis should be considered and specifically looked for, as this could impact on management and response to treatment.
Vitamin D receptor gene polymorphisms and osteoarthritis: a meta-analysis
Authors: Li Hui-Min , Liu Yi , Zhang Ren-Jie , Ding Jing-Yu , Shen Cai-Liang
Published: September 2020

Objective

To investigate the association of vitamin D receptor (VDR) gene polymorphisms with OA susceptibility.

Methods

Meta-analyses were performed using allelic contrast, contrast of homozygotes, and recessive and dominant models to clarify the association between OA and VDR ApaI, BsmI, TaqI and FokI polymorphisms. Odds ratio (OR) and the corresponding 95% CI were obtained, and subgroup analyses were performed based on the ethnicity and OA sites.

Results

A total of 18 studies with 2983 OA patients and 4177 controls were included in this meta-analysis. There were statistically significant associations in the spine between OA susceptibility and the VDR BsmI (B vs b: OR = 1.25, 95% CI: 1.03, 1.53, P = 0.026; BB vs bb: OR = 1.56, 95% CI: 1.02, 2.37, P = 0.038) and TaqI (T vs t: OR = 0.73, 95% CI: 0.54, 0.99, P = 0.044; TT vs Tt + tt: OR = 0.63, 95% CI: 0.42, 0.95, P = 0.028) polymorphisms, but not for the other polymorphisms. A statistically significant association was found between the VDR FokI polymorphism and OA susceptibility in the knee in the recessive model contrast (FF vs Ff + ff: OR = 0.63, 95% CI: 0.42, 0.95, P = 0.028), but this result was only pooled from one study. However, no significant associations were found between the VDR ApaI polymorphism and OA. Besides, ethnic stratification also indicated that there was no significant association between VDR gene polymorphism and OA in Caucasians or Asians.

Conclusion

Our meta-analysis suggests that the VDR BsmI and TaqI polymorphisms are associated with OA susceptibility in the spine. However, the VDR ApaI polymorphism is not a significant genetic risk factor for OA.
Scrutinising the role of members in charitable companies: Lehtimäki and others v Cooper [2020] UKSC 33
Authors: Leung Samuel Yee Ching
Published: September 2020

The law of charities is generally recognised as a branch of the law of trust but, nonetheless, has received special judicial treatment as distinguished from ordinary trust doctrines. In Lehtimäki and others v Cooper [2020] UKSC 33, interesting but difficult questions arose as to how the court should treat the members of charitable companies, and the decision made by the court has significant implications in charity law and trust law. First, the court has recognised the members as fiduciaries to charitable companies, but the boundary of the fiduciary duty needs further judicial clarification. Secondly, the court created an exception to the well-settled “non-intervention principle” in trust law but it calls for scrutiny. Lastly, Lehtimäki has an impact on the corporate governance of charitable companies, since it held that fiduciaries of charitable companies must obey an order made by the court which exercises a discretion of the trustees upon their surrender of discretion.
Reading Three Landscapes in the Nineteenth-Century U.S. West
Authors: O’Donnell Ronan
Published: September 2020

Previous work examining the interactions between people and their physical environment in the U.S. West has tended to neglect the spatial scale between individual sites, such as settlements and regions. This study seeks a solution to this problem by testing the methods of landscape history in three case studies in the State of Colorado. The use of historical maps alongside other manuscript sources reveals that western landscapes provide a fruitful arena for such work. For instance, it is possible to show that there is great variation in human settlement and land use within individual landscapes and between the case study areas. At the same time, is has been possible to chart patterns of change and continuity in the human use and alteration of the landscapes through the construction of settlements, roads, and field systems and to suggest reasons why these features took certain forms. Consequently, there is great potential for similar studies elsewhere in the U.S. West, and such studies are likely to have a significant impact upon on our understanding of the region’s history.
An integrated approach to re-evaluate the validity of the family Leptobathynellidae (Crustacea: Bathynellacea)
Authors: Camacho Ana I , Mas-Peinado Paloma , Reddy Yenumula Ranga , Bandari Elia , Shaik Shabbudin , Perina Giulia , Dorda Beatriz A , Casado Adrian , Rey Isabel
Published: September 2020

The systematic status of the controversial crustacean family Leptobathynellidae is investigated using molecular and morphological methods in this study. Partial sequences of the nuclear 18S gene are studied from 28 genera of Bathynellacea from several continents. The analysis includes some of the most plesiomorphic genera of the family Parabathynellidae, such as Billibathynella and Brevisomabathynella from Australia; Habrobathynella and Parvulobathynella from India; the diverse Iberobathynella; the cosmopolitan genus Hexabathynella; and representative genera of two subfamilies of Bathynellidae (Gallobathynellinae and Bathynellinae). We used a molecular approach to analyse the systematic relationships amongst 64 species from Europe, North America, Australia and Asia, and review the morphological characters relevant at the family level. The molecular phylogeny clearly shows the presence of three highly divergent clades that could represent the three families. This is the first molecular phylogenetic reconstruction of Bathynellacea that can be used to: (1) verify the validity of Leptobathynellidae, (2) explore the diversity of the families and (3) explore the phylogenetic relationships among families. We propose a plausible evolutionary scenario for the order Bathynellacea.
Use of AM-PAC “6 Click” Scores to Predict Discharge Location Post-hospitalization in Adults With Cardiovascular Disease: A Retrospective Cohort Study
Authors: Fernandez Natalia , Gore Shweta , Benson Samantha , Blackwood Jennifer
Published: September 2020

Purpose:

Scores on the Activity Measure for Post-Acute Care (AMPAC) 6-Clicks are used in the hospital setting as functional measures to guide care and discharge recommendations. However, limited evidence exists regarding the accuracy of AMPAC 6-Clicks in predicting discharge location for those with cardiovascular disease (CVD). The purpose of this study was to determine the accuracy of AM-PAC 6-Clicks scores to predict discharge to home/self-care from an acute care hospital in adults with CVD.

Methods:

A retrospective review of medical record data comprised of AM-PAC 6-Clicks basic mobility or daily activity scores at physical or occupational therapy evaluation and discharge was completed. Logistic regression analyses were performed to determine if 6-Clicks scores could predict discharge to home/self-care while controlling for age, insurance type, and length of stay. Receiver operating characteristic curves were created to determine the 6-Clicks scores with the best sensitivity/specificity to determine discharge to home/self-care.

Results:

Logistic regression models indicated that the basic mobility score at discharge from physical therapy services accounted for 71% of the variance in predicting discharge to home/self-care after controlling for covariates. The best 6-Clicks non-converted cutoff value for accuracy of discharge to home/self-care was 20.50 for daily activity and 18.5 for basic mobility completed at discharge.

Conclusions:

Basic mobility scores at discharge are significant predictors of discharge to home/self-care in older adults with CVD. Further inpatient rehabilitation services should be considered for patients who score less than 18.5 (converted = 44.5) on the basic mobility or 20.50 (converted = 43.15) on the daily activity measures.
Shave Excision Versus Elliptical Excision of Nonpigmented Intradermal Melanocytic Nevi: Comparative Assessment of Recurrence and Cosmetic Outcomes
Authors: Camini Leandra , Manzoni Ana Paula Dornelles , Weber Magda Blessmann , Luzzato Laura , Soares Andréa Santos , Bonamigo Renan Rangel
Published: September 2020

BACKGROUND

Nonpigmented intradermal melanocytic nevi (IMN) are benign lesions often removed for cosmetic reasons. There is no consensus as to the best technique for IMN excision.

OBJECTIVE

To compare cosmetic outcomes and risk of recurrence after shave excision versus elliptical excision of IMN.

MATERIALS AND METHODS

In this randomized clinical trial, patients underwent shave excision or elliptical excision with sutured closure of IMN of the face or back. Recurrence, patient satisfaction, cosmetic outcome, postoperative discomfort, scar size, discoloration, and presence of hypertrophic or keloid scars were evaluated at 3, 6, and 9 months.

RESULTS

Overall, 145 nevi were removed from 45 patients (86.7% women, mean age 52.1 ± 12.5 years). The recurrence rate was 11.7%, occurring only after shave excision; 94.1% of recurrences were observed at 3-month follow-up. Shave excision was associated with less discomfort 48 hours after intervention but a greater likelihood of involved lateral and deep margins (p < .001). Scars were larger after elliptical excision and suture than after shave excision (p < .01). The mean patient satisfaction was higher in the shave excision group (p < .004).

CONCLUSION

Shave excision of IMN is associated with higher rates of involved surgical margins and recurrence than elliptical excision but provides superior cosmesis and patient satisfaction.
Topical Scar Treatment Products for Wounds: A Systematic Review
Authors: Tran Benjamin , Wu Jashin J. , Ratner Desiree , Han George
Published: September 2020

BACKGROUND

There is an increasing number of over-the-counter topical products that are said to prevent pathologic scar formation and improve scar cosmesis. However, robust clinical data are lacking to substantiate these claims and to guide selection of topical products.

OBJECTIVE

To determine the effectiveness of topical scar management products, including silicone gel, Allium cepa onion extract, vitamin E, trolamine, and microporous tape.

METHODS AND MATERIALS

A PubMed search (2005–2019) was performed to identify studies of topical scar management products. Randomized controlled trials (RCTs), quasi-RCTs, meta-analyses, and controlled clinical trials were included for analysis.

RESULTS

A total of 34 trials were included in this study. Of the 16 trials investigating silicone gel sheets, numerous high-quality RCTs found that silicone gel sheets and silicone gels significantly improved scar outcomes. Only a limited number of studies supported the effectiveness of onion extract, vitamin E, trolamine, and microporous tape products.

CONCLUSION

Silicone gel products are an effective noninvasive treatment to prevent formation of pathologic scars and improve mature scars. Further high-quality studies are needed to elucidate the long-term effectiveness of these therapies.
Development of a Model of the Acute and Delayed Effects of High Dose Radiation Exposure in Jackson Diversity Outbred Mice; Comparison to Inbred C57BL/6 Mice
Authors: Patterson Andrea M. , Plett P. Artur , Chua Hui Lin , Sampson Carol H. , Fisher Alexa , Feng Hailin , Unthank Joseph L. , Miller Steven J. , Katz Barry P. , MacVittie Thomas J. , Orschell Christie M.
Published: September 2020

Development of medical countermeasures against radiation relies on robust animal models for efficacy testing. Mouse models have advantages over larger species due to economics, ease of conducting aging studies, existence of historical databases, and research tools allowing for sophisticated mechanistic studies. However, the radiation dose-response relationship of inbred strains is inherently steep and sensitive to experimental variables, and inbred models have been criticized for lacking genetic diversity. Jackson Diversity Outbred (JDO) mice are the most genetically diverse strain available, developed by the Collaborative Cross Consortium using eight founder strains, and may represent a more accurate model of humans than inbred strains. Herein, models of the Hematopoietic-Acute Radiation Syndrome and the Delayed Effects of Acute Radiation Exposure were developed in JDO mice and compared to inbred C57BL/6. The dose response relationship curve in JDO mice mirrored the more shallow curves of primates and humans, characteristic of genetic diversity. JDO mice were more radioresistant than C57BL/6 and differed in sensitivity to antibiotic countermeasures. The model was validated with pegylated-G-CSF, which provided significantly enhanced 30-d survival and accelerated blood recovery. Long-term JDO survivors exhibited increased recovery of blood cells and functional bone marrow hematopoietic progenitors compared to C57BL/6. While JDO hematopoietic stem cells declined more in number, they maintained a greater degree of quiescence compared to C57BL/6, which is essential for maintaining function. These JDO radiation models offer many of the advantages of small animals with the genetic diversity of large animals, providing an attractive alternative to currently available radiation animal models.
Simultaneous Orbital and Intracranial Abscesses in 17 Cases
Authors: Park Michael M. , Ahmed Osama M. , Ng John D. , Vloka Caroline N. , Dansdill Daniel , Shinder Roman , Sniegowski Matthew , Richani Karina , Lucarelli Mark J. , van Landingham Suzanne W. , Pointdujour-Lim Renelle
Published: September 2020

Purpose:

To describe the demographics, clinical presentation, treatment, and outcomes of a rare cohort with simultaneous orbital and intracranial abscesses.

Methods:

A historical cohort study of 17 patients with simultaneous orbital and intracranial abscesses between 2010 and 2018 was performed. The demographics, location of abscesses, treatment, and outcomes of these patients were analyzed.

Results:

The mean age was 26.9 years (range 5–83 years). Fourteen patients (82%) were male. In this cohort, the most common orbital abscess location was the superior orbit, involved in 14 patients (82%). The most common site of intracranial abscess was the frontal lobe, involved in 16 patients (94%). Concurrent sinus disease was present in 16 patients (94%). Surgical evacuation was the standard of treatment, with 94% of patients undergoing at least one surgical procedure. Streptococcus species were the most common, isolated from 6 sinus cultures (43%), 3 orbitotomy cultures (21%), and 4 craniectomy cultures (36%). Staphylococcus species were also common. Most patients (94%) had stable or improved mental status and visual function at the conclusion of their treatment.

Conclusions:

Simultaneous orbital and intracranial abscesses are rare. Local invasion from the orbit into the intracranial space may occur from direct spread, thus superior orbital abscesses pose the greatest risk for intracranial spread. Additional factors such as infection with Streptococcus and Staphylococcus species as well as male sex appear to be risk factors for intracranial spread. For those who develop intracranial abscesses, young age and absence of seizures or altered mental status at presentation may be associated with favorable outcomes.
Clinical evaluation of a new monofocal IOL with enhanced intermediate function in patients with cataract
Authors: Auffarth Gerd U. , Gerl Matthias , Tsai Linda , Janakiraman D. Priya , Jackson Beth , Alarcon Aixa , Dick H. Burkhard ,   Quantum Study Group
Published: September 2020

Purpose:

To evaluate the effectiveness and safety of 2 enhanced monofocal intraocular lenses (IOLs). The TECNIS Eyhance IOL (Model ICB00) was compared with a standard monofocal IOL (TECNIS Monofocal, Model ZCB00).

Setting:

European multicenter study.

Design:

Prospective, bilateral, randomized, comparative/evaluator-masked, controlled study.

Methods:

Adult subjects scheduled to undergo bilateral, primary phacoemulsification cataract extraction and posterior IOL implantation were randomized to receive the enhanced monofocal ICB00 IOL or the monofocal ZCB00 IOL in both eyes. Monocular endpoints at 6 months included distance-corrected intermediate visual acuity (DCIVA), photopic corrected distance visual acuity, and uncorrected intermediate visual acuity (UIVA). Binocular visual acuities, monocular corrected distance contrast sensitivity (first eyes), patient-reported outcomes, and safety were assessed at 6 months.

Results:

Overall, 139 patients were bilaterally implanted with the enhanced monofocal IOL (n = 67) or standard monofocal IOL (n = 72) and available for the 6-month visit. The enhanced monofocal IOL significantly improved mean monocular and binocular DCIVA and UIVA by at least 1-line logarithm of the minimum angle of resolution vs the standard monofocal IOL (all P ≤ .0001). Distance vision for the enhanced monofocal IOL was 20/20 or better and comparable with that of the standard monofocal lens at 6 months. Contrast sensitivity, photic phenomena outcomes, and rates of adverse events were similar between the 2 groups.

Conclusions:

In patients undergoing cataract surgery, TECNIS Eyhance IOL Model ICB00 provided enhanced intermediate vision and similar distance performance and photic phenomena compared with a standard monofocal IOL, along with improved functional performance in daily life.
Accelerated contact lens–assisted corneal crosslinking and piggyback modification in a pediatric case with advanced keratoconus and thin cornea
Authors: Toprak Ibrahim
Published: September 2020

A 14-year-old girl presented with bilateral keratoconus (KC). Maximum keratometry was 63.9 diopters (D) in the right eye and 63.7 D in the left eye. Minimum corneal thickness was 371 μm in the right eye and 370 μm in the left eye. The right eye underwent epithelium-off accelerated corneal crosslinking (CXL) using hypotonic dextran-free 0.1% riboflavin solution and a riboflavin-soaked ultraviolet–barrier-free soft contact lens to increase thickness to more than 400 μm. The same procedure was followed for the left eye 4 months later, when 2 riboflavin-soaked soft contact lenses were applied in piggyback fashion. At 19 months postopertively, in the right eye, visual acuity, maximum keratometry, mean keratometry, and topographical indices were improved. In the left eye, visual acuity, mean keratometry, and central KC index were improved. Accelerated CXL and piggyback modification was a safe and an effective treatment in this pediatric case with KC with thin cornea.
Pedunculated Outgrowths in the Flexural Creases
Authors: Ferguson Heather R. , Jacob Sharon E.
Published: September 2020

Teledermatology is the term used to describe the provision of dermatologic medical services through telecommunication technology. The following is a teledermatology case of numerous pedunculated outgrowths in the flexural creases.
Trichloroacetic Acid Peel Technique for the Treatment of Actinic Keratosis
Authors: Smith Jordan A. , Macknet K. Dale , Anderson Nancy J. , Wong Samantha , Jacob Sharon E.
Published: September 2020

Trichloroacetic acid (TCA) peels are a treatment used to improve the skin's appearance and exfoliate the skin surface by coagulating both living and dead keratinocytes. Peels can be performed with different strength concentrations of acid to achieve different depths of exfoliation. Superficial peels (for cosmetic indications) are often performed with a 10%–25% TCA solution. Because TCA is able to penetrate the stratum spinosum (the depth of dysplastic cells in actinic keratosis), medium-depth 35% TCA peels may be used as an adjuvant therapy for actinic keratoses.
Immunoglobulin A Vasculitis Case Report
Authors: Mannke Kristin , Maguire Madeleine
Published: September 2020

Immunoglobulin A (IgA) vasculitis, also known as Henoch–Schönlein purpura, is a type of cutaneous small-vessel vasculitis. IgA vasculitis typically presents with nonblanching, palpable purpura favoring dependent sites and areas of trauma (Bolognia et al., 2014). In some cases, IgA vasculitis is associated with systemic disease—most commonly, kidney injury. Nevertheless, most cases of IgA vasculitis are self-limiting, and the disease resolves over weeks to months (Bolognia et al., 2017).
Eligibility for HIV Preexposure Prophylaxis, Intention to Use Preexposure Prophylaxis, and Informal Use of Preexposure Prophylaxis Among Men Who Have Sex With Men in Amsterdam, the Netherlands
Authors: Hulstein Sebastiaan H. , Matser Amy , van der Loeff Maarten F. Schim , Hoornenborg Elske , Prins Maria , de Vries Henry J.C.
Published: September 2020

Background

Before 2019, availability of affordable HIV preexposure prophylaxis (PrEP) was limited in the Netherlands. Consequently, some men who have sex with men and transgender persons obtained PrEP informally, that is, without a prescription.

Methods

Between September 2017 and August 2018, we enrolled informal PrEP users in a cohort study (Informal PrEP [InPrEP]) at the Amsterdam Sexually Transmitted Infections (STI) Clinic. We compared PrEP use, PrEP eligibility and intention, chemsex, and STI positivity between 3 groups: (1) informal PrEP users enrolled in InPrEP, (2) nonenrolled informal PrEP users, and (3) non-PrEP users. Also, we assessed intention and associated characteristics among non-PrEP users who were eligible for PrEP.

Results

During the study period, we enrolled 118 informal PrEP users in InPrEP who were compared with 224 nonenrolled informal PrEP users and 4975 non-PrEP users. Preexposure prophylaxis eligibility rates were 83.1%, 93.4%, and 63.0%; chemsex were reported by 39.1%, 48.1%, and 11.7%; and STI positivity was reported by 28.0%, 42.5%, and 20.3%, respectively. Among PrEP-eligible non-PrEP users, PrEP intention was 16.6% and associated with increasing age, non-Dutch origin, higher educational level, receptive condomless anal sex, increasing number of sex partners, chemsex, and sex with men only.

Conclusions

Most informal PrEP users are eligible to use PrEP and have a clear sexual health care need. Especially in settings with limited PrEP access, providing the necessary care for informal PrEP users is important. The intention to use PrEP is low among PrEP-eligible STI clinic visitors. Further research should investigate modes to increase PrEP intention among PrEP-eligible persons.
Effect of Scleral Lens Oxygen Permeability on Corneal Physiology
Authors: Dhallu Sandeep K. , Huarte Sonia Trave , Bilkhu Paramdeep S. , Boychev Nikolay , Wolffsohn James S.
Published: September 2020

SIGNIFICANCE

This randomized, masked, crossover clinical study identifies that ≥125 Dk materials should be used for scleral lens daily wear if disruption to corneal oxygen is to be minimized.

PURPOSE

Modern scleral lens use has increased and has proven to be successful where other types and materials have previously failed. Although the required oxygen permeability has been modeled, this has not been established clinically.

METHODS

Fifteen masked participants aged 20.7 ± 2.3 years (10 female) were bilaterally fitted with five different scleral lenses (65, 100, 125, 163, and 180+ Dk) of the same shape profile and one soft silicone hydrogel lens compared with no lens wear on separate occasions in a randomized order. A masked researcher measured corneal thickness and fluid reservoir depth, corneal curvature, objective bulbar and limbal redness, corneal biomechanics, and ocular surface oxygen consumption before and after 8 hours of wear. In addition, comfort scores were obtained using a visual analog scale.

RESULTS

Scleral lenses with oxygen permeability of 65 Dk resulted in greater corneal thickness (1.37 ± 1.25%) after 8 hours of wear versus ≥100 Dk materials (0.58 ± 0.99%; F = 17.215, P < .001) because of stromal thickening; edema with ≥100 Dk materials was associated with fluid reservoir depth (r = 0.231, P = .05). Fluid reservoir depth decreased similarly with all oxygen-permeable lenses from 325.6 ± 99.1 μm to 174.2 ± 100.8 μm after 8 hours of wear (F = 0.961, P = .44). Oxygen consumption reduced with ≤125 Dk lenses (χ2 = 604.196, P < .001). Soft and scleral lens wear had no effect on corneal curvature, corneal biomechanics, or ocular hyperemia (P > .05). Soft lenses were more comfortable than all the scleral lenses (P < .05), and the 180+ Dk lenses had the best comfort among the sclerals (P < .05).

CONCLUSIONS

A ≥125 Dk is advised for safe scleral lens daily wear. Scleral lens wear leads to an increase in corneal thickness, regardless of lens-material oxygen permeability because of the fluid reservoir depth.