bluuebunny/crossref_metadata_2025 huggingface dataset:
A Prospective Observational Study of Emergency Department–Initiated Physical Therapy for Acute Low Back Pain
Authors: Kim Howard S , Ciolino Jody D , Lancki Nicola , Strickland Kyle J , Pinto Daniel , Stankiewicz Christine , Courtney D Mark , Lambert Bruce L , McCarthy Danielle M
Published: December 2020

Objective

Low back pain accounts for nearly 4 million emergency department (ED) visits annually and is a significant source of disability. Physical therapy has been suggested as a potentially effective nonopioid treatment for low back pain; however, no studies to our knowledge have yet evaluated the emerging resource of ED-initiated physical therapy. The study objective was to compare patient-reported outcomes in patients receiving ED-initiated physical therapy and patients receiving usual care for acute low back pain.

Methods

This was a prospective observational study of ED patients receiving either physical therapy or usual care for acute low back pain from May 1, 2018, to May 24, 2019, at a single academic ED (>91,000 annual visits). The primary outcome was pain-related functioning, assessed with Oswestry Disability Index (ODI) and Patient-Reported Outcomes Measurement Information System pain interference (PROMIS-PI) scores. The secondary outcome was use of high-risk medications (opioids, benzodiazepines, and skeletal muscle relaxants). Outcomes were compared over 3 months using adjusted linear mixed and generalized estimating equation models.

Results

For 101 participants (43 receiving ED-initiated physical therapy and 58 receiving usual care), the median age was 40.5 years and 59% were women. Baseline outcome scores in the ED-initiated physical therapy group were higher than those in the usual care group (ODI = 51.1 vs 36.0; PROMIS-PI = 67.6 vs 62.7). Patients receiving ED-initiated physical therapy had greater improvements in both ODI and PROMIS-PI scores at the 3-month follow-up (ODI = −14.4 [95% CI = −23.0 to −5.7]; PROMIS-PI = −5.1 [95% CI = −9.9 to −0.4]) and lower use of high-risk medications (odds ratio = 0.05 [95% CI = 0.01 to 0.58]).

Conclusion

In this single-center observational study, ED-initiated physical therapy for acute low back pain was associated with improvements in functioning and lower use of high-risk medications compared with usual care; the causality of these relationships remains to be explored.

Impact

ED-initiated physical therapy is a promising therapy for acute low back pain that may reduce reliance on high-risk medications while improving patient-reported outcomes.

Lay Summary

Emergency department–initiated physical therapy for low back pain was associated with greater improvement in functioning and lower use of high-risk medications over 3 months.
Effectiveness and safety of treat-to-target strategy in elderly-onset rheumatoid arthritis: a 3-year prospective observational study
Authors: Sugihara Takahiko , Ishizaki Tatsuro , Onoguchi Wataru , Baba Hiroyuki , Matsumoto Takumi , Iga Shoko , Kubo Kanae , Kamiya Mari , Hirano Fumio , Hosoya Tadashi , Miyasaka Nobuyuki , Harigai Masayoshi
Published: December 2020

Objectives

To evaluate 3-year outcomes of following a treat-to-target (T2T) strategy targeting low disease activity for patients with elderly-onset RA (EORA) and to confirm safety profile of T2T.

Methods

Treatment was adjusted to target low disease activity with conventional synthetic DMARDs, followed by biologic DMARDs (bDMARDs) in 197 MTX-naïve EORA patients (mean age 74.9 years) with moderate-to-high disease activity. Non-implementation of T2T was evaluated at week 12, 24, 36, 52, 76, 104 and 128. To evaluate risks of using MTX, bDMARDs and glucocorticoids, 2122 periods of 3 months each were analysed using Bayesian hierarchical logistic regression models.

Results

Of the patients, 84.7% received methotrexate, 34.0% glucocorticoids with DMARDs and 41.6% bDMARDs during the observation period. Sixty-nine of the 197 patients failed to adhere to T2T because of comorbidities or the patient’s own decision: 33 failed once, 19 twice, 10 three times and 6 four times or more. Simplified disease activity index (SDAI) remission and HAQ Disability Index (HAQ-DI) ≤0.5 at 3 years were achieved in 57.8% and 70.3% of the 128 patients adhering to T2T, and 34.8% and 43.5% of the 69 patients who did not adhere to T2T, respectively, and these were significantly different. Eighty-nine serious adverse events (SAEs) of any type were reported in 61 patients. MTX, bDMARDs and glucocorticoid were not associated with SAEs when adjusted for mean SDAI during the observation period and comorbidities at baseline.

Conclusion

T2T strategy for EORA by using MTX and bDMARDs was effective with an acceptable safety profile. Adhering to T2T led to better outcomes.
Comparative Analysis of Chemotherapy-Induced Peripheral Neuropathy in Bioengineered Sensory Nerve Tissue Distinguishes Mechanistic Differences in Early-Stage Vincristine-, Cisplatin-, and Paclitaxel-Induced Nerve Damage
Authors: Pollard Kevin J , Bolon Brad , Moore Michael J
Published: December 2020

Chemotherapy-induced peripheral neuropathy (CIPN) is a well-known, potentially permanent side effect of widely used antineoplastic agents. The mechanisms of neuropathic progression are poorly understood, and the need to test efficacy of novel interventions to treat CIPN continues to grow. Bioengineered microphysiological nerve tissue (“nerve on a chip”) has been suggested as an in vitro platform for modeling the structure and physiology of in situ peripheral nerve tissue. Here, we find that length-dependent nerve conduction and histopathologic changes induced by cisplatin, paclitaxel, or vincristine in rat dorsal root ganglion-derived microphysiological sensory nerve tissue recapitulate published descriptions of clinical electrophysiological changes and neuropathologic biopsy findings in test animals and human patients with CIPN. We additionally confirm the postulated link between vincristine-induced axoplasmic transport failure and functional impairment of nerve conduction, the postulated paclitaxel-induced somal toxicity, and identify a potential central role of gliotoxicity in cisplatin-induced sensory neuropathy. Microphysiological CIPN combines the tight experimental control afforded by in vitro experimentation with clinically relevant functional and structural outputs that conventionally require in vivo models. Microphysiological nerve tissue provides a low-cost, high-throughput alternative to conventional nonclinical models for efficiently and effectively investigating lesions, mechanisms, and treatments of CIPN. Neural microphysiological systems are capable of modeling complex neurological disease at the tissue level offering unique advantages over conventional methodology for both testing and generating hypotheses in neurological disease modeling.

Impact Statement Recapitulation of distinct hallmarks of clinical CIPN in microphysiological sensory nerve validates a novel peripheral neurotoxicity model with unique advantages over conventional model systems.
Outcomes of Neonates Requiring Neonatal Intensive Care Admission for Necrotizing Enterocolitis in a Resource-Restricted Hospital in Cape Town, South Africa
Authors: Satardien M , Van Wyk L , Sidler D , Van Zyl J I
Published: December 2020

Lay Summary

Necrotizing enterocolitis remains one of the most common gastrointestinal emergencies in neonates. Neonates admitted to a resource-restricted neonatal intensive care unit with a presumptive diagnosis of advanced NEC were reviewed. We were able to identify risk factors associated with a higher chance of death or poor neurodevelopmental outcomes. Our outcomes are comparable with international literature.
The Politics of Chronic Hunger And Famine
Authors: Paarlberg Robert
Published: December 2020

How do we measure hunger?

In our personal lives, hunger is a sensation we feel regularly at mealtime. In the world of politics and public policy, “hunger” is often used as a substitute word for chronic undernutrition, a long-term dietary condition that includes either a...
Interpretive Strategies
Authors: Coogan Michael
Published: December 2020

What are interpretive strategies?

Interpretive strategies are methodologies of various types used in studying the Bible. Some of these, such as textual criticism and archaeology, we have discussed earlier, and some, such as reception history, we will discuss in subsequent chapters. Many of them overlap,...
Effect of Biological and Chemical Treatments During Flowering on Stem-End Rot Disease, and Mango Yield
Authors: Feygenberg Oleg , Diskin Sonia , Maurer Dalia , Alkan Noam
Published: December 2020

Pathogenic fungi, as the Botryosphaeriaceae family, can penetrate during flowering and endophytically colonize the stem of mango fruit (Mangifera indica) without causing any visible symptoms. Those fungi become active during abiotic stress or fruit ripening and cause stem and inflorescence dieback or fruit stem-end rot (SER) fungal disease. We hypothesized that anti-fungal treatments during the main event of Botryosphaeriaceae penetration would reduce the disease. Initially, we showed that treatments with the fungicide “Switch” (fludioxonil and cyprodinil) during orchard flowering (cv. Keitt and Shelly) reduced the occurrence of pathogenic fungi in the fruit stem-end and significantly reduced fruit’s incidence of SER disease. As mango orchards are sprayed weekly against powdery mildew (PM) disease during flowering, we combined two treatments against PM disease with two treatments against both PM- and SER-causing pathogens. Application of biological treatments of the fungicide “Serenade” (Bacillus subtilis) or chemical treatments of the fungicides “Luna Tranquility” (fluopyram and pyrimethanil) or “Switch” during flowering in ‘Shelly’ and ‘Keitt’ mango orchards significantly reduced inflorescence/stem dieback (up to 50%) and fruit drop and significantly increased the number of fruit per tree, which led to a significant increase in yield, up to 41%, in heavily infected orchards. In addition, this application during flowering (March to April) affected post-harvest fruit quality (August to September) by a significant (P < 0.005) reduction of the incidence and the severity of stem-end rot disease and even fruit side-rot disease, without affecting fruit ripening and other quality parameters. While all fungicides were effective, the chemical fungicides were more effective than the biological fungicide. Thus, changing the PM fungicide regime to control Botryosphaeriaceae penetration during mango orchard flowering led to reduced inflorescence/stem dieback, reduced fruit drop, increase in yield, and minimized post-harvest decay.
Population Genomics of Filamentous Plant Pathogens—A Brief Overview of Research Questions, Approaches, and Pitfalls
Authors: Everhart Sydney , Gambhir Nikita , Stam Remco
Published: December 2020

With ever-decreasing sequencing costs, research on the population biology of plant pathogens is transitioning from population genetics—using dozens of genetic markers or polymorphism data of several genes—to population genomics—using several hundred to tens of thousands of markers or whole-genome sequence data. The field of population genomics is characterized by rapid theoretical and methodological advances and by numerous steps and pitfalls in its technical and analytical workflow. In this article, we aim to provide a brief overview of topics relevant to the study of population genomics of filamentous plant pathogens and direct readers to more extensive reviews for in-depth understanding. We briefly discuss different types of population genomics-inspired research questions and give insights into the sampling strategies that can be used to answer such questions. We then consider different sequencing strategies, the various options available for data processing, and some of the currently available tools for population genomic data analysis. We conclude by highlighting some of the hurdles along the population genomic workflow, providing cautionary warnings relative to assumptions and technical challenges, and presenting our own future perspectives of the field of population genomics for filamentous plant pathogens.
Intraoperative Oxygen Concentration and Neurocognition after Cardiac Surgery
Authors: Shaefi Shahzad , Shankar Puja , Mueller Ariel L. , O’Gara Brian P. , Spear Kyle , Khabbaz Kamal R. , Bagchi Aranya , Chu Louis M. , Banner-Goodspeed Valerie , Leaf David E. , Talmor Daniel S. , Marcantonio Edward R. , Subramaniam Balachundhar
Published: December 2020

Background

Despite evidence suggesting detrimental effects of perioperative hyperoxia, hyperoxygenation remains commonplace in cardiac surgery. Hyperoxygenation may increase oxidative damage and neuronal injury leading to potential differences in postoperative neurocognition. Therefore, this study tested the primary hypothesis that intraoperative normoxia, as compared to hyperoxia, reduces postoperative cognitive dysfunction in older patients having cardiac surgery.

Methods

A randomized double-blind trial was conducted in patients aged 65 yr or older having coronary artery bypass graft surgery with cardiopulmonary bypass. A total of 100 patients were randomized to one of two intraoperative oxygen delivery strategies. Normoxic patients (n = 50) received a minimum fraction of inspired oxygen of 0.35 to maintain a Pao
2 above 70 mmHg before and after cardiopulmonary bypass and between 100 and 150 mmHg during cardiopulmonary bypass. Hyperoxic patients (n = 50) received a fraction of inspired oxygen of 1.0 throughout surgery, irrespective of Pao
2 levels. The primary outcome was neurocognitive function measured on postoperative day 2 using the Telephonic Montreal Cognitive Assessment. Secondary outcomes included neurocognitive function at 1, 3, and 6 months, as well as postoperative delirium, mortality, and durations of mechanical ventilation, intensive care unit stay, and hospital stay.

Results

The median age was 71 yr (interquartile range, 68 to 75), and the median baseline neurocognitive score was 17 (16 to 19). The median intraoperative Pao
2 was 309 (285 to 352) mmHg in the hyperoxia group and 153 (133 to 168) mmHg in the normoxia group (P < 0.001). The median Telephonic Montreal Cognitive Assessment score on postoperative day 2 was 18 (16 to 20) in the hyperoxia group and 18 (14 to 20) in the normoxia group (P = 0.42). Neurocognitive function at 1, 3, and 6 months, as well as secondary outcomes, were not statistically different between groups.

Conclusions

In this randomized controlled trial, intraoperative normoxia did not reduce postoperative cognitive dysfunction when compared to intraoperative hyperoxia in older patients having cardiac surgery. Although the optimal intraoperative oxygenation strategy remains uncertain, the results indicate that intraoperative hyperoxia does not worsen postoperative cognition after cardiac surgery.

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An old disease on the rise: new approaches to syphilis in pregnancy
Authors: Liew Zi-Qi , Ly Victoria , Olson-Chen Courtney
Published: December 2020

Purpose of review

Maternal and congenital syphilis infection is on the rise in the United States and worldwide. Without adequate testing or provider recognition of infection, treatment can be neglected resulting in significant perinatal morbidity and mortality. This review article discusses the epidemiology ofT. pallidum, describes novel diagnostic tests, and considers the need to expand therapeutic options.

Recent findings

A new chemiluminescence immunoassay for use in the reverse-sequence algorithm is more sensitive and specific in pregnant women than previously noted and is helpful for identifying pregnant women at highest risk for neonatal congenital syphilis. Point-of-care testing may be used to detect early syphilitic disease and provide same-day testing and treatment. Randomized control trials of oral cefixime for treatment of syphilis are paving the way for potential use in pregnant women. Penicillin skin testing, challenge, and desensitization in pregnancy can be done safely.

Congenital syphilis is a preventable disease and treatable infection in the modern world, but we are still met with challenges in its eradication. We should proceed with advancing efficient laboratory testing, expanding medical therapy, and implementing public health measures to curb the rise of the disease.
Four-Year Survival Comparison of Endothelial Keratoplasty Techniques in Patients With Previous Glaucoma Surgery
Authors: Alshaker Sara , Mimouni Michael , Batawi Hatim , Cohen Eyal , Trinh Tanya , Santaella Gisella , Chan Clara C. , Slomovic Allan R. , Rootman David S. , Sorkin Nir
Published: December 2020

Purpose:

To compare 4-year survival outcomes of Descemet membrane endothelial keratoplasty (DMEK) and Descemet-stripping automated endothelial keratoplasty (DSAEK) in eyes with previous glaucoma surgery.

Methods:

This is a retrospective, comparative case series, including patients with previous trabeculectomy or glaucoma drainage device implantation, who later underwent either DMEK (n = 48) or DSAEK (n = 41). Follow-up was limited to 12 to 60 months to prevent bias. Primary outcomes were graft survival and rejection. Secondary outcomes were best spectacle-corrected visual acuity (BSCVA), detachment/rebubble, endothelial cell loss, and intraocular pressure elevations.

Results:

Baseline characteristics, follow-up duration, and preexisting glaucoma parameters did not differ significantly between the groups. Graft survival probability after DMEK and DSAEK was 75% and 75% at 1 year, 63% and 50% at 2 years, 49% and 44% at 3 years, 28% and 33% at 4 years, and 28% and 29% at 5 years, respectively (P = 0.899 between the groups). Graft rejection rates were 20.8% and 19.5%, respectively (P = 1.000). Primary failure, rebubbling, endothelial cell loss, and intraocular pressure elevation did not differ significantly between the groups. Preoperative BSCVA did not differ between the groups (P = 0.821). Postoperative BSCVA was significantly better in the DMEK group at 6, 12, and 24 months (P < 0.001, P = 0.022, and P = 0.047, respectively). In a multivariable model (R
2 = 0.576), the type of surgery was the only significant factor affecting postoperative BSCVA, in favor of DMEK (coefficient value −0.518, P = 0.002).

Conclusions:

In eyes with previous glaucoma surgery, DMEK and DSAEK had comparably low survival and comparably high rejection rates. Postoperative visual acuity might be better after DMEK in this setting.
Endothelial Biopsy for the Diagnosis and Management of Culture-Negative Retrocorneal Fungal Keratitis With the Assistance of Optical Coherence Tomography Imaging
Authors: Palioura Sotiria , Tsiampali Chara , Dubovy Sander R. , Yoo Sonia H.
Published: December 2020

Purpose:

To report a case of a culture-negative deep fungal corneal infection that was diagnosed after histopathology of an anterior segment optical coherence tomography–guided endothelial biopsy.

Methods:

A 22-year-old woman with history of contact lens wear and concomitant topical steroid use presented with a mid-stromal corneal infiltrate that failed to respond to oral acyclovir and topical fortified antibiotics. Although cornea stains, cultures, and confocal microscopy showed negative results, there was high clinical suspicion for fungal keratitis. After 2 months on topical natamycin, oral voriconazole, and serial intrastromal and intracameral voriconazole injections, the infiltrate enlarged and deepened. Imaging with anterior segment optical coherence tomography revealed that the infection had progressed to an endothelial plaque.

Results:

Diagnostic endothelial biopsy was performed in the operating room. Cultures showed again negative results, whereas histopathology of the removed specimen revealed fungal elements. The postoperative edema at the site of the biopsy resolved over the course of 4 weeks, and a posterior stromal scar formed. Serial intrastromal and intracameral voriconazole injections were continued for the first postoperative month. At the 1-year and the 3-year follow-up examinations, the patient's vision was 20/20 without recurrence.

Conclusions:

Intraoperative scraping of the endothelial plaque and histopathologic evaluation of the specimen proved to be of utmost importance for definitive diagnosis and resolution of the culture-negative deep fungal infection in this case. This young patient's cornea was retained and vision remains excellent.
Revisiting patient-related barriers to cancer pain management in the context of the US opioid crisis
Authors: Kwekkeboom Kristine , Serlin Ronald C. , Ward Sandra E. , LeBlanc Thomas W. , Ogunseitan Adeboye , Cleary James
Published: December 2020

Patient fear of addiction is a well-documented barrier to the use of analgesic medications for cancer pain control. Over the past 2 decades in the United States, an “opioid crisis” has arisen, accompanied by risk messages delivered through news outlets, public health education, and patient–provider communication. The purpose of this study was to determine if patient-related barriers to cancer pain management–specifically, fears of addiction–and related pain outcomes (pain severity, pain interference with daily life, and adequacy of pain management) have worsened over the last 20 years. A sample of 157 outpatients with active recurrent or active metastatic cancer completed the Barriers Questionnaire-II (BQ-II) and measures of pain and analgesic use. We identified 7 comparison studies published between 2002 and 2020 that reported patient-related barriers using the BQ-II. Significant linear relationships were found between later year of publication and greater fear of addiction (harmful effect subscale score, B = 0.0350, R
2 = 0.0347, F1,637 = 23.19, P < 0.0001) and between year of publication and more pain management barriers overall (total BQ-II score, B = 0.039, R
2 = 0.065, F1,923 = 73.79, P < 0.0001). Relationships between BQ-II scores (harmful effect and total) and pain outcomes did not change over time. Despite worsening in patient-related barriers, the proportion of patients with adequate vs inadequate analgesic use did not differ over time. Notably, 40% of participants reported inadequate analgesic use, a statistic that has not improved in 20 years. Additional research is necessary to clarify factors contributing to changing beliefs. Findings indicate a continuing need for clinical and possibly system/policy-level interventions to support adequate cancer pain management.
Auditory Brainstem Implant in Adult Patient With Cochlear Ossification From Otosclerosis
Authors: Christopher Laura H. , Noonan Kathryn , Barnard Zachary , Mehta Gautum , Rock Jordan , Slattery William H. , Lekovic Gregory P.
Published: December 2020

Objective:

The objective is to describe auditory brainstem implantation in a case of extensive cochlear otosclerosis.

Patient, Intervention, and Results:

A case is presented of a 65-year-old male with bilateral cochlear otosclerosis and profound sensorineural hearing loss. Imaging studies showed distorted cochlear anatomy bilaterally and ossification of cochlear ducts. He underwent successful placement of an auditory brainstem implant using a retrosigmoid craniotomy approach.

Conclusions:

Extensive cochlear otosclerosis may distort cochlear anatomy such that cochlear implantation is expected to have a poor outcome. Auditory brainstem implantation may be an additional treatment option in these patients.
Precise Evaluation of the Cochlear Duct Length by Flat-panel Volume Computed Tomography (fpVCT)—Implication of Secondary Reconstructions
Authors: Schendzielorz Philipp , Ilgen Lukas , Mueller-Graff Tassilo , Noyalet Laurent , Völker Johannes , Taeger Johannes , Hagen Rudolf , Neun Tilmann , Zabler Simon , Althoff Daniel , Rak Kristen
Published: December 2020

Hypothesis:

Flat-panel volume computed tomography (fpVCT) and secondary reconstruction allow for more accurate measurements of two-turn length (2TL), cochlear duct length (CDL), and angular length (AL).

Background:

Cochlear geometry is a controversially debated topic. In the meantime, there are many different studies partly reporting highly divergent values. Our aim is to discuss the differences and to propose a radiological possibility to improve cochlear measurements using 3D-curved multiplanar reconstruction and fpVCT.

Methods:

Performing different image modalities and settings, we tried to find a clinically usable option that allows for a high degree of accuracy. Therefore, we tested them against reference values of high-definition micro-computed tomography.

Results:

Comparison of 99 μm slice thickness secondary reconstruction of fpVCT and reference showed no significant differences for 2TL and CDL (p ≥ 0.05). Accordingly, ICC (intraclass correlation) values were excellent (ICC ≥ 0.75; lower limit of confidence interval [CI] ≥ 0.75; Cronbach's alpha [α] ≥ 0.9). Evaluating AL, there was a significant difference (difference: −17.27°; p = 0.002). The lower limit of the CI of the ICC was unacceptable (ICC = 0.944; lower limit of CI = 0.248; α = 0.990). Regarding the Bland-Altman plots, there were no clinically unacceptable errors, but a systematic underestimation of AL.

Conclusion:

Secondary reconstruction is a suitable tool for producing reliable data that allow the accurate measurement of 2TL and CDL. The option of generating these reconstructions from raw data limits the need for higher radiation doses. Nevertheless, there is an underestimation of AL using secondary reconstructions.
Cochlear Implantation in Adults With Single-sided Deafness: Outcomes and Device Use
Authors: Deep Nicholas L. , Spitzer Emily R. , Shapiro William H. , Waltzman Susan B. , Roland J. Thomas , Friedmann David R.
Published: December 2020

Objective:

To describe our experience with adults undergoing cochlear implantation (CI) for treatment of single-sided deafness (SSD).

Study Design:

Retrospective case review.

Setting:

Tertiary referral center.

Patients:

Fifty-three adults with SSD.

Intervention(s):

Unilateral CI.

Main Outcome Measure(s):

Speech perception testing in quiet and noise, tinnitus suppression, and device usage from datalogs.

Results:

The mean age at CI was 53.2 years (SD 11.9). The mean duration of deafness was 4.0 years (SD 7.8). The most common etiology was idiopathic sudden SNHL (50%). Word recognition improved from 8.7% (SD 15) preoperatively to 61.8% (SD 20) at a mean follow-up of 3.3 years (SD 1.8) (p < 0.0001). Adaptive speech recognition testing in the “binaural with CI” condition (speech directed toward the front and noise toward the normal hearing ear) revealed a significant improvement by 2.6-dB SNR compared to the preoperative unaided condition (p = 0.0002) and by 3.6-dB SNR compared to when a device to route sound to the contralateral side was used (p < 0.0001). Tinnitus suppression was reported to be complete in 23 patients (43%) and improved in 20 patients (38%) while the device was on. The addition of the CI did not lead to a decrement in hearing performance in any spatial configuration. Device usage averaged 8.7 (SD 3.7) hours/day.

Conclusions:

Cochlear implantation in adult SSD patients can suppress tinnitus and achieve speech perception outcomes comparable with CI in conventional candidates. Modest improvements in spatial hearing were also observed and primarily attributable to the head shadow effect. Careful patient selection and counseling regarding potential benefits are important to optimize outcomes.
Are opioids necessary in post sinus surgery care?
Authors: Karkos Petros D. , Constantinidis Jannis
Published: December 2020

Purpose of review

The aim of the review is to review the recent literature on the use of opioids in post sinus surgery care.

Recent findings

Research regarding the use of opioids in post sinus surgery over the past two years support previous thinking that there is an overprescription of opioids for an operation which is not particularly painful, resulting in the potential for narcotic abuse and misuse.

Large randomized controlled trials with detailed pain recording scoring systems are needed to assess the opioid requirements – if any – after sinus surgery.
TikTok, Tide Pods and Tiger King: health implications of trends taking over pediatric populations
Authors: Kriegel Elana R. , Lazarevic Bojan , Athanasian Christian E. , Milanaik Ruth L.
Published: December 2020

Purpose of review

With children and adolescents constantly connected to their devices in an ever-changing technological landscape, new and emerging trends in entertainment media have created potential health implications for pediatric patients. The purpose of this review is to provide pediatricians with explanations of specific trends on streaming services, the popular new mobile application TikTok, recent widespread ‘Internet Challenges’ that include pediatric participants, and new technologies. These emerging trends can pose potential harms to the health and wellbeing of children and adolescents.

Recent findings

Recent reports and news articles have discussed popular technological trends and the adverse effects that can occur. Although technology provides access to information and social connection for youth, it also creates platforms where children can be exposed to disturbing content, peer pressure, cyberbullying, and encouragement to participate in activities that could cause potential physical harm or even death.

Pediatricians need to be aware of trends to best understand the implications of these technologies, especially in clinical practice. Pediatricians play an important role in educating parents and patients about the risks of these trends, in facilitating conversations about related topics including self-esteem, cyberbullying and peer pressure to promote healthy internet use, and providing necessary resources.
Molecular Subtyping of Triple Negative Breast Cancer by Surrogate Immunohistochemistry Markers
Authors: Kumar Sandeep , Bal Amanjit , Das Ashim , Bhattacharyya Shalmoli , Laroiya Ishita , Khare Siddhant , Singh Gurpreet
Published: December 2020

Triple negative breast cancer (TNBC) is a heterogeneous disease and an attempt was made to classify TNBCs into surrogate molecular subtypes using immunohistochemical markers. Tissue microarrays were constructed for 245 cases of TNBCs. For classification of TNBCs immunohistochemistry was done on tissue microarrays for cytokeratin 5/6, 4/14 (CK5/6, CK4/14), epidermal growth factor receptor (EGFR), vimentin, E-cadherin, claudin 3 and 7, androgen receptor (AR) and aldehyde dehydrogenase1A. The TNBCs were classified into basal-like 1 (BL1) type (CK5/6+, CK4/14+, EGFR− n=32; 13.1%), basal-like 2 (BL2) type (EGFR+, n=4; 1.6%), mesenchymal type (Vimentin+, E-cadherin ̅, claudin 3−and 7−, n=70; 28.6%), luminal androgen type (AR+, n=41; 16.7%), mixed type (n=37; 15.1%), and unclassified type (n=61; 24.9%). Luminal androgen receptor subtype showed apocrine features, and was associated with older age group, lower proliferation index and high frequency of lymph node metastasis. Basal subtype was cellular with rich stromal lymphocytic infiltrate. Mesenchymal stem like subtype was associated with younger age group with metaplastic and mesenchymal features. Mesenchymal stem like and unclassified subtype had shorter overall survival with median of 68.2 and 69.2 months, respectively, and the BL2 had median disease-free survival of 35.4 months. On immunohistochemistry TNBC is a heterogeneous entity composed of 6 major subtypes. Immunohistochemical subtyping of TNBC can provide information on prognostication and selection of appropriate targeted therapy for these patients.
Pediatric Abdominal Tuberculosis With Calcified Intra-abdominal Lymph Nodes Identified by Point-of-Care Ultrasound
Authors: James Vigil , Samuel John , Ong Gene Yong-Kwang
Published: December 2020

Background

Tuberculosis of the abdomen is one of the most common extrapulmonary manifestations of tuberculosis. Even in areas where tuberculosis is endemic, intra-abdominal tuberculous can pose a diagnostic and management challenge because of the lack of presence of overt clinical signs and availability of expertise for point of care diagnostics. Point-of-care ultrasound (POCUS) of the abdomen performed by emergency physicians is increasingly being used for a variety of clinical presentations to facilitate accurate diagnoses in the emergency department.

Case Report

We describe the case of a patient presenting to the pediatric emergency department with acute abdominal pain, in whom POCUS helped expedite the diagnosis of abdominal tuberculosis.

Conclusions

In the right clinical setting, the concurrent presence of intra-abdominal lymphadenopathy, ascites, mesenteric thickening, ileocecal thickening, and splenic microabscesses on ultrasound imaging should lead to consideration of the diagnosis of intra-abdominal tuberculosis. Although typically diagnosed on computed tomography or magnetic resonance imaging, in our case, POCUS helped facilitate the bedside diagnosis of abdominal tuberculosis in the emergency department.
Safe Ground Transport of Pediatric COVID-19 Patients—A Single-Center First-Surge Experience
Authors: McPherson Mona L. , Krennerich Emily C. , Arrington Amy S. , Sitler S. Garry , Graf Jeanine M.
Published: December 2020

Objectives

The COVID-19 pandemic has brought new challenges to pediatric transport programs. The aims of this study were to describe the transport of pediatric patients with confirmed COVID-19 and to review the operational challenges that our transport system encountered.

Methods

A retrospective descriptive study was performed to review all COVID-19 pediatric transport performed over a 6-month period during the initial pandemic surge in 2020. Pediatric patients with a known positive SARS-CoV-2 polymerase chain reaction test at the time of transport were included. Patients' hospital records, including their transport record, were reviewed for demographics, diagnoses, transport interventions and complications, and admission disposition. Descriptive statistics were used to describe the patient cohort.

Results

Of the 883 transports performed between April and October 2020, 146 (16%) tested positive for COVID-19 during the initial surge in our geographical area. Patient acuity was diverse with 40% of children having a chronic complex medical condition. More than 25% of children required aerosol-generating procedures during transport. The most common medical diagnosis was respiratory compromise, and the most common surgical diagnosis was appendicitis. No adverse events occurred during transports, and no transport team members contracted COVID-19 because of workplace exposure. Transport program operational challenges ranged from rapidly changing system logistics/policies to educational and utilization of proper personal protective equipment.

Conclusions

Children with COVID-19 can be transported safely with adaption of transport program procedures. Change management and team stress should be anticipated and can be addressed with repeated education and messaging.
Posttraumatic Stress Disorder and Chronic Pain Conditions in Men: A Twin Study
Authors: Gasperi Marianna , Panizzon Matthew , Goldberg Jack , Buchwald Dedra , Afari Niloofar
Published: December 2020

Objective

Posttraumatic stress disorder (PTSD) is highly comorbid with chronic pain conditions that often co-occur such as migraine headaches, temporomandibular disorder, irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, chronic prostatitis/chronic pelvic pain syndrome, and tension headaches. Using a genetically informative sample, the current study evaluated the genetic and environmental factors contributing to the co-occurrence of PTSD and chronic pain conditions.

Methods

Data from 4680 male twins in the Vietnam Era Twin Registry were examined. Biometric modeling was used to estimate genetic and environmental variance components and genetic and environmental correlations between PTSD and multiple chronic pain conditions.

Results

Heritabilities were estimated at 43% (95% confidence interval [CI] = 15%–63%) for PTSD and 34% (95% CI = 27%–41%) for the combined history of any one or more pain condition. Specific pain condition heritabilities ranged from 15% (95% CI = 0%–48%) for tension headaches to 41% (95% CI = 27%–54%) for migraine headaches. Environmental influences accounted for the remaining variance in pain conditions. The genetic correlation between PTSD and combined history of any one or more pain condition was r
g
= 0.61 (95% CI = 0.46–0.89) and ranged for individual pain conditions from r
g
= 0.44 (95% CI = 0.24–0.77) for migraine headache to r
g
= 0.75 (95% CI = 0.52–1.00) for tension headaches.

Conclusions

PTSD and chronic pain conditions are highly comorbid, and this relationship can be explained by both genetic and environmental overlap. The precise mechanisms underlying these relationships are likely diverse and multifactorial.
Brain Contrast-Enhanced Ultrasound Evaluation of a Pediatric Swine Model
Authors: Hwang Misun , Khaw Kristina , Sridharan Anush , Poznick Laura , Hallowell Thomas , Delso Nile , Roberts Anna L. , Kilbaugh Todd J.
Published: December 2020

Brain injury remains a leading cause of morbidity and mortality in children. We evaluated the feasibility of using a pediatric swine model to develop contrast-enhanced ultrasound (CEUS)–based measures of brain perfusion for clinical application in various types of brain injury monitoring. Six-week-old, 10-kg swine (N = 10) were anesthetized, and an acoustic window was created in the right frontal cranium to provide visualization of an oblique coronal plane and bilateral thalami. Ultrasound contrast agent was administered via a femoral venous catheter as a weight-based (0.03 mL/kg) bolus. After localization of the imaging plane, CEUS cine clips were acquired for 90 seconds. Bolus injection of contrast agent provided global visualization of cerebral perfusion and highlighted microvasculature in the brain. Preliminary evaluation of bolus kinetics in piglets showed a central gray nuclei–to–cortex ratio similar to human infants with a steep wash-in that crossed and remained above the 1.0 threshold for most of the enhancement period. We demonstrated the similarity in brain perfusion between piglets and human infants, specifically central gray nuclei–to–cortex ratio, showing preliminary feasibility of its use as a pediatric model of brain perfusion. Contrast-enhanced ultrasound can be performed at the bedside as a minimally invasive procedure, and quantitative CEUS may provide critical information regarding changes in brain perfusion as a result of injury or as a response to therapy.
Can general and particularistic types of trust mix? Advancing the trust (dis-) continuity debate in a Chinese context
Authors: Horak Sven , Klein Andreas , Li Xiaomei
Published: December 2020

Purpose

We challenge the discontinuity (also called incompatibility) hypothesis of generalized and particularistic trust, suggesting that the two types of trust are incompatible. This view is problematic because if so, it remains unclear, for instance, how communities scoring high in particularistic trust can ever develop further when transferring trust to spheres outside the community is not an option. In this research, we explore the potential permeability of different types of trust in an emerging market context using the case of China.

Design/methodology/approach

Using a purposeful sampling technique, we gathered data among Chinese professionals (n = 290) in the Jingjinji Metropolitan Region in Tianjin. We analyzed the data by performing structural equation modeling.

Findings

As we identify interdependencies between generalized and particularistic types of trust, our results speak in favor of the continuity hypothesis. We find that the more people trust other people from an outside group (out-group trust), the less they trust quasi-familiar others (in-group trust). Further, in-group trust increases once the environment urges people to engage in informal network (guanxi)-based transactions.

Originality/value

Advancing the common view of China being a typical low-trust society, in which distrust in strangers (outsiders) prevails, we find a recent trend of an increase in general trust, which might lead to increases of out-group and in-group trust alike. Contrary to the wide spread idea thatguanxiis declining in the present day, we findguanxito be persistent.
An emerging genre of contemporary fact-checking
Authors: Juneström Amalia
Published: December 2020

Purpose

By exploring the social features of contemporary fact-checking this study aims to increase our understanding of fact-checking as a genre and shed light on some of the aspects that underpin the communication that fact-checkers engage in.

Design/methodology/approach

By analyzing one snapshot of early COVID-19 coverage by three well-known fact-checkers and another one six months later, this study explores fact-checking as a genre. The material was examined for recurrent characteristics and the findings were categorized into corresponding themes that emerged through an open coding process.

Findings

Three aspects were found to underpin a contemporary fact-checking genre. Firstly, the fact-checkers strive to facilitate accessibility. Secondly, the notion of building trust underlies the way fact-checkers promote themselves. Thirdly, fact-checking is underpinned by a pedagogical aspect. While the values and beliefs that are known to characterize traditional news media discourses are predominant in the construction of a fact-checking genre, fact-checkers also draw on conceptions typically found within academia to enact professional practices.

Originality/value

Contemporary fact-checking is still a fairly unexplored topic of research. This is particularly the case outside the field of journalism and media studies. This study complements earlier research from the perspective of information studies by exploring how fact-checking practices impact the communication and production of news in society.
Acting hot or not? Testing the citing to show-off hypothesis
Authors: Nicolaisen Jeppe , Frandsen Tove Faber
Published: December 2020

Purpose

Citation analysis as a method for studying scientific communication is frequently criticized for being based on biased citation practices. Questionable motives for the reference selection have been suggested including the claim that authors tend to cite hot papers in order to show-off. In this study, the authors investigate the claim that authors tend to cite the recent literature in order to show-off.

Design/methodology/approach

Following Moed and Garfield (2004), the authors investigate the claim by analyzing the proportion of recent references as a function of the length of the reference lists of citing papers. The authors analyze reference lists of citing papers in the fields of biomedical engineering, economics, medicine, psychology and library and information science between 2010 and 2019. From each of these fields, a number of journals are included in the analysis to represent the field. In total, 42 journals are included in the analyses comprising a selection of almost 65,000 journal articles. The proportion of recent references is calculated using two citation windows. The proportion of recent references as a function of the length of the reference lists is calculated through simple linear regressions to predict the share of recent references based on the number of references.

Findings

The results of the linear regressions indicate that in most cases, there are a statistically significant relationship between the share of recent references and the number of references. This study’s results show that when authors display selective referencing behavior, references to the recent literature tend to be only marginally increased, and some results even display the opposite tendency (marginally overciting the older literature).

Originality/value

This study of the claim that authors tend to cite the recent literature in order to show-off does not confirm the hypothesis.
Senior housing in Scotland: a development and investment opportunity?
Authors: Fyfe Andrew , Hutchison Norman
Published: December 2020

Purpose

This article aims to understand the housing needs of older people and to ascertain the level of demand and supply of age-related housing in Scotland. It also explores interest in different types of retirement accommodation and tenure options.

Design/methodology/approach

A review of existing literature is undertaken on senior housing preferences and residential satisfaction. Primary data is collected from an online survey of people over 55 in Scotland to ascertain demand side requirements with secondary data on current supply obtained from the Elderly Accommodation Counsel and data on future pipeline collated from market reports.

Findings

The results from the survey confirm earlier research that seniors when looking for accommodation in their retirement years particularly focus on the local area, access to shops, social relations with neighbours and the design of the home interior. Current analysis of the level of supply at a county level reveals that there is significant undersupply with some particularly striking regional differences. Along with a desire for owner occupation there is interest, particularly among the 75 plus age group, to lease their accommodation, perhaps a consequence of volatile property markets, insufficient pension provision or a desire to pass wealth to their family prior to death. This shortfall in supply highlights development opportunities and raises the possibility of introducing a build-to-rent senior housing offering, which may be of interest to institutional investors.

Practical implications

The Scottish Government is currently reviewing its strategy for Scotland's older people. The results are of practical benefit as they expose the gaps in supply of age-related stock at county level. This may require the government to introduce policy measures to encourage a mix of housing types suited for the ageing demographics of the population. This research highlights opportunities for developers and investors to fill that gap and explains why advancements in technology should be incorporated in the design process.

Originality/value

This paper brings together supply side data of senior housing in Scotland and provides insights into the housing preferences of seniors. It will be of direct value and interest to developers and institutional investors.
Information management during a crisis – providing an open and reliable information infrastructure for a sustainable world
Authors: Saarti Jarmo
Published: December 2020

Purpose

The purpose of this paper is to analyze the impact of the corona situation on the academic library services, policies and activities.

Design/methodology/approach

The methodology of the paper is opinion piece based on experiences.

Findings

There is a need for global policymaking for both the open academic resources dissemination and crisis management.

Originality/value

The originality of the paper is based on recent experiences.