bluuebunny/crossref_metadata_2025 huggingface dataset:
Achieving Successful Outcomes in High-Level Athletes With Borderline Hip Dysplasia Undergoing Hip Arthroscopy With Capsular Plication and Labral Preservation: A Propensity-Matched Controlled Study
Authors: Jimenez Andrew E. , Monahan Peter F. , Miecznikowski Kara B. , Saks Benjamin R. , Ankem Hari K. , Sabetian Payam W. , Lall Ajay C. , Domb Benjamin G.
Published: June 2021

Background:

Return to sports (RTS) rates and patient-reported outcomes (PROs) after hip arthroscopy in athletes with borderline dysplasia (BD) have not been established.

Purpose:

(1) To report minimum 2-year PROs and RTS rates in high-level athletes with BD who underwent hip arthroscopy for labral pathology in the setting of microinstability and (2) to compare clinical results with those of a matched control group of athletes with normal acetabular coverage.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Data were reviewed for surgery performed between January 2012 and July 2018. Patients were considered eligible if they received a primary hip arthroscopy in the setting of BD (lateral center-edge angle, 18°-25°) and competed in professional, collegiate, or high school sports. Inclusion criteria included preoperative and minimum 2-year follow-up scores for the modified Harris Hip Score, Non-arthritic Hip Score, Hip Outcome Score–Sport Specific Subscale, and visual analog scale for pain. Athletes with BD were matched to a control group of athletes with normal acetabular coverage (lateral center-edge angle, 25°-40°).

Results:

A total of 65 patients with BD were included in the study with a mean ± standard deviation follow-up of 47.5 ± 20.4 months. Athletes with BD showed significant improvement in all outcome measures recorded, demonstrated high RTS rates (80.7%), and achieved the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) for the Hip Outcome Score–Sport Specific Subscale at high rates (MCID, 90.8%; PASS, 75.4%). When compared with a propensity-matched control group with normal acetabular coverage, capsular plication was performed more commonly in the BD group (93.8% vs 82.7%; P = .037). PROs and RTS, PASS, and MCID rates were similar between the BD and control groups ( P > .05).

Conclusion:

High-level athletes with BD who undergo primary hip arthroscopy for labral pathology in the setting of microinstability may expect favorable PROs and RTS rates at minimum 2-year follow-up. These results were comparable with those of a control group of athletes with normal coverage.
Predictors of Lower Depression Levels in Older Adults During COVID-19 Lockdown
Authors: Bohn Lucimere , Gomes Sérgio , Neto Elzier Sampaio de Queiroz , Lage Ana Carolina Silveira de Souza , de Freitas Maria das Dores Bezerra , Magalhães Fabíola de Paula , Mota Jorge , Soares Miranda Luisa
Published: June 2021

Background

Social distancing during the COVID-19 pandemic may lead to adverse mental health consequences, such as depression, among older adults. This study aimed to investigate the predictors of lower depression scores in older adults living under lockdown.

Methods

1,123 older Brazilian adults were cross-sectionally assessed for depression, physical activity (PA), pet ownership (dogs, cats, and birds), ability to make video calls, leaving home during lockdown, and not living alone. The statistical procedures included linear regression and analysis of covariance (ANCOVA).

Results

After adjusting for age, sex, and race, moderate to vigorous PA (β = −0.014, p < .001), it was found that PA (β = −0.905, p < .001) and dog ownership (β = −0.545, p = .004) were associated with lower depression. No association was observed between depression and other conditions.

Conclusions

With the likelihood of subsequent COVID-19 waves, remotely delivered PA programs might be a strategy to counteract the negative psychological effects of lockdown on older adults.
“When I Least Expected It”: an Autoethnography of Reporting Workplace Sexual Harassment and Compassionate Bystanders”
Authors: Armitage Janet S.
Published: June 2021

I present an evocative autoethnographic account of reporting workplace sexual harassment that illustrates the decision-making and satisfaction (or lack thereof) with reporting and interactions with and perceptions of compassionate bystanders not only during but also after the actual incident. While reporting is lauded as the key to deterrence and as a successful approach to dealing with the stresses of harassment, it alone does not fully address emotional harms associated with workplace sexual harassment in organizational environments often more compliant than compassionate. In contrast, this article aligns with emerging evidence that views bystanders as underused resources who can deter sexual harassment and bring needed respite to victim’s suffering through compassionate noticing, feeling, and responding. While my account is personal and cannot be generalized to others, it does offer both a familiar and theoretically informed narrative that describes the prolonged presence and engagement of compassionate bystanders in my experience of workplace sexual harassment and reveals bystander compassion as the key to offset the gap where reporting as remediation neither sufficiently heals the victim nor redresses persist sexual harassment in the workplace.
Envisioning Entrepreneurship’s Future: Introducing Me-Search and Research Agendas
Authors: Shepherd Dean A. , Wiklund Johan , Dimov Dimo
Published: June 2021

The future of the field of entrepreneurship is bright primarily because of the many research opportunities to make a difference. However, as scholars how can we find these opportunities and choose the ones most likely to contribute to the literature? This essay introduces me-search and a special issue of research-agenda papers from leading scholars as tools for blazing new trails in entrepreneurship research. Me-search and the agenda papers point to the importance of solving a practical problem; problematizing, contextualizing, and abstracting entrepreneurship research; and using empirical theorizing to explore entrepreneurial phenomena.
Commercial Fishing as an Occupational Determinant of Opioid Overdoses and Deaths of Despair in Two Massachusetts Fishing Ports, 2000–2014
Authors: Fulmer Scott , Jain Shruti , Kriebel David
Published: June 2021

The opioid epidemic has had disproportionate effects across various sectors of the population, differentially impacting various occupations. Commercial fishing has among the highest rates of occupational fatalities in the United States. This study used death certificate data from two Massachusetts fishing ports to calculate proportionate mortality ratios of fatal opioid overdose as a cause of death in commercial fishing. Statistically significant proportionate mortality ratios revealed that commercial fishermen were greater than four times more likely to die from opioid poisoning than nonfishermen living in the same fishing ports. These important quantitative findings suggest opioid overdoses, and deaths to diseases of despair in general, deserve further study in prevention, particularly among those employed in commercial fishing.
Efficacy of Low-Intensity Cognitive Behavior Intervention for Chinese Delinquent Youth
Authors: Zhuang Xiaoyu , Lau Yin Yim , Huang Yu-Te , Tam Cherry Hau Lin , Chan Wilson Man Ho , Yeung Kenneth Kin Wa , Ng Ting Kin , Wong Daniel Fu Keung
Published: June 2021

Purpose:

Recent literature has pointed out the seriously unmet treatment needs of delinquent youth with mental health problems in Hong Kong. This study pioneers to systematically develop and evaluate the effectiveness of a structured low-intensity cognitive behavioral intervention (LICBI) to concurrently address mental health issues and delinquent behaviors among Hong Kong Chinese youth.

Method:

A quasi-experimental controlled design was adopted with three assessments at baseline, postintervention, and 6-week follow-up. One hundred and eighty participants were recruited to the LICBI and 123 to the control group.

Results:

Multilevel modeling analyses showed that the LICBI might be effective in improving mental health–related factors (impulsivity, self-esteem, negative emotions, and loneliness) and delinquent behaviors. A mediation analysis suggested that LICBI might reduce participants’ delinquent behaviors through reducing their impulsivity and enhancing their self-esteem.

Discussion:

The results provide preliminary evidence for the effectiveness of LICBI for Chinese delinquent youth in a community social service setting.
School Nurses’ Experiences With Health Dialogues: A Swedish Case
Authors: Kostenius Catrine
Published: June 2021

The aim of this study was to describe school nurses’ experiences with health dialogues and elicit their thoughts about how schools can reach the full potential in promoting students’ health literacy and learning. The phenomenological analysis resulted in four themes: (i) A golden opportunity…or not, (ii) Like a double-edged sword, (iii) Able or unable organizations, and (iv) Visions of good conditions for health and learning. School nurses’ experiences revealed that health dialogues are beneficial and can be valuable tools in promoting health and learning when (1) the health dialogues are an important part of the educational assignment, (2) school nurses are valued for fulfilling the educational assignment, and their work conditions are reasonable, (3) the results from the health dialogues and health questionnaires are used systematically to promote health and learning, (4) a “whole-school approach” is used to build enabling relationships among all school staff and students.
A Retrospective Study of 52 Patients With Primary Small Cell Carcinoma of the Esophagus Treated With Radical Surgery
Authors: Fan Ningbo , Wang Zhen , Huang Yuanheng , Tan Zihui , Yang Han , Lin Peng
Published: June 2021

Background:

Primary small cell carcinoma of the esophagus (SCCE) is a rare and extremely fatal disease. We aim to evaluate the efficacy of radical surgery for resectable SCCE and to explore potential prognostic factors.

Methods:

We retrospectively reviewed 52 consecutive SCCE patients who underwent radical surgery from February 1993 to November 2014 at a single institution. The Kaplan-Meier estimator with log-rank test was used to assess overall survival (OS), disease-free survival (DFS) and median survival time. Univariate and multivariable analyses were used to evaluate prognostic factors through Cox proportional hazard regression model.

Results:

Twenty-five (48.1%) patients were treated with surgery alone, whereas 27 (51.9%) patients underwent adjuvant therapy after surgery. The median OS time was 17.4 months (95% CI: 13.5-21.3). The median DFS time was 13.4 months (95% CI: 7.7-19.0). Patients whose tumors were located in the lower part of thoracic esophagus and the esophagogastric junction showed significantly better OS (27.0 vs. 13.2 months, P = 0.016) and DFS (27.0 vs. 11.3 months, P = 0.017) than those located in the upper and middle parts. Patients with N0 status experienced significantly better OS (21.4 vs. 11.6 months, P = 0.012) and DFS (21.4 vs. 8.6 months, P = 0.012) than those with N+ status. Patients whose tumor lengths were shorter than 5 cm had a better OS (17.4 vs. 5.7 months, P = 0.035) than those longer than 5 cm. Patients who underwent chemotherapy experienced a significantly improved OS (21.0 vs. 14.1 months, P = 0.032) compared to surgery alone. Multivariable analysis showed that lower tumor location, shorter tumor length, pN0 status and chemotherapy independently predicted better OS; lower tumor location and pN0 status independently predicted better DFS.

Conclusions:

Radical surgery in combination with chemotherapy has better outcomes than surgery alone for resectable SCCE. Higher tumor location, longer tumor length, lymph node metastasis and not undergoing chemotherapy independently predict worse prognoses.
Vibration analysis of rotating porous functionally graded material beams using exact formulation
Authors: Amoozgar Mohammadreza , Gelman Len
Published: June 2021

In this article, the exact free vibration of porous functionally graded rotating blades is investigated. The nonlinear 3D dynamics of the blade is simulated using the geometrically exact fully intrinsic beam equations, and the corresponding cross-sectional properties of the FG beam are developed. The material properties of the functionally graded material blade are graded through the thickness using a power law distribution. Furthermore, it is assumed that due to the manufacturing process, a level of porosity exists in the material which in turn can affect the material properties of the blade. Two porosity models resembling the even and uneven distributions of porosity are considered. First, the obtained results for a functionally graded material rotating blade are compared with those reported in the literature, and a very good agreement is observed. Furthermore, the effect of various parameters on the vibration of the functionally graded material beam is investigated. It is obtained that the dynamics of the rotating blade is sensitive to the type of the porosity due to manufacturing flaws. Moreover, the numerical results show that the blade length to height ratio, power law index, rotating speed and porosity distribution model affect the dynamics of the beam significantly.
Caregiver-Reported Burden in RE-KINECT: Data From a Prospective Real-World Tardive Dyskinesia Screening Study
Authors: Cutler Andrew J. , Caroff Stanley N. , Tanner Caroline M. , Shalhoub Huda , Lenderking William R. , Pagé Véronique , Franey Ericha , Yonan Chuck
Published: June 2021

Background:

RE-KINECT (NCT03062033), a real-world study of possible tardive dyskinesia (TD) in antipsychotic-treated patients, included a questionnaire to assess the effects of patients’ abnormal involuntary movements on caregivers.

Aims:

To capture the experiences of caregivers who assisted individuals with abnormal involuntary movements that were confirmed by clinicians as being consistent with TD.

Methods:

Qualified (nonpaid) caregivers were invited to complete a questionnaire that included the following: caregivers’ sociodemographic characteristics, their perceptions about the impact of abnormal involuntary movements on patients, and the impact of these movements on themselves (caregivers).

Results:

Of the 41 participating caregivers, 25 (61.0%) were women, 20 (48.8%) were employed full time or part time, and 35 (85.4%) were family members or friends. Based on responses from caregivers who noticed patients’ abnormal involuntary movements and were caring for individuals who also noticed those movements, 48.0% of patients had “a lot” of severity in ≥1 body region and 76.0% had abnormal involuntary movements in ≥2 regions. Caregiver ratings were significantly correlated with patient ratings (but not with clinician ratings) for maximum severity of abnormal involuntary movements and the number of affected regions (both p <.05). Based on their own judgments and perceptions, caregivers reported that the patient’s movements had “some” or “a lot” of impact on their (caregiver’s) ability to continue usual activities (50.0%), be productive (58.3%), socialize (55.6%), or take care of self (50.0%).

Conclusions:

Caregivers as well as patients are negatively affected by TD, and the impact of TD on caregivers’ lives should be considered when determining treatment options.
Structure and Function of Major SARS-CoV-2 and SARS-CoV Proteins
Authors: Gorkhali Ritesh , Koirala Prashanna , Rijal Sadikshya , Mainali Ashmita , Baral Adesh , Bhattarai Hitesh Kumar
Published: June 2021

SARS-CoV-2 virus, the causative agent of COVID-19 pandemic, has a genomic organization consisting of 16 nonstructural proteins (nsps), 4 structural proteins, and 9 accessory proteins. Relative of SARS-CoV-2, SARS-CoV, has genomic organization, which is very similar. In this article, the function and structure of the proteins of SARS-CoV-2 and SARS-CoV are described in great detail. The nsps are expressed as a single or two polyproteins, which are then cleaved into individual proteins using two proteases of the virus, a chymotrypsin-like protease and a papain-like protease. The released proteins serve as centers of virus replication and transcription. Some of these nsps modulate the host’s translation and immune systems, while others help the virus evade the host immune system. Some of the nsps help form replication-transcription complex at double-membrane vesicles. Others, including one RNA-dependent RNA polymerase and one exonuclease, help in the polymerization of newly synthesized RNA of the virus and help minimize the mutation rate by proofreading. After synthesis of the viral RNA, it gets capped. The capping consists of adding GMP and a methylation mark, called cap 0 and additionally adding a methyl group to the terminal ribose called cap1. Capping is accomplished with the help of a helicase, which also helps remove a phosphate, two methyltransferases, and a scaffolding factor. Among the structural proteins, S protein forms the receptor of the virus, which latches on the angiotensin-converting enzyme 2 receptor of the host and N protein binds and protects the genomic RNA of the virus. The accessory proteins found in these viruses are small proteins with immune modulatory roles. Besides functions of these proteins, solved X-ray and cryogenic electron microscopy structures related to the function of the proteins along with comparisons to other coronavirus homologs have been described in the article. Finally, the rate of mutation of SARS-CoV-2 residues of the proteome during the 2020 pandemic has been described. Some proteins are mutated more often than other proteins, but the significance of these mutation rates is not fully understood.
Challenges of Applying Conservation Agriculture in Iran: An Overview on Experts and Farmers’ Perspectives
Authors: Ataei Pouria , Sadighi Hassan , Aenis Thomas , Chizari Mohammad , Abbasi Enayat
Published: June 2021

Different countries face diverse challenges for Conservation Agriculture (CA) development. The main purpose of this study was to examine the challenges of applying CA in Iran from the perspective of experts and farmers. A focus group method was used to investigate the challenges. The research sample consisting of farmers and experts of CA in different provinces includes those 19 experts and 15 farmers. Inductive content analysis and coding (open, axial, and selective coding) were employed to analyze the farmers’ and experts’ discussions. The findings showed that the challenges of applying CA in the studied provinces could be divided into 6 general categories: institutional-infrastructure (7 concepts), economic (5 concepts), training-research (2 concepts), environmental (4 concepts), mechanization (2 concepts), and cognitive (2 concepts) challenges. The economic and institutional-infrastructure challenges were the most frequent related to applying CA. It can be concluded that to solve the challenges of applying CA, it is necessary to link various sectors of government (the Ministry of Agriculture), education and research (Agricultural Research, Education and Extension Organization), and industry together. But farmers themselves are also a major contributor to meet the challenges of CA development through participation in planning CA project and training-extension programs. Therefore, farmers’ communities should also pave the way for a transition from conventional agriculture to CA with their participation.
Modeling behavioral intention toward traveling in times of a health-related crisis
Authors: Su Diep Ngoc , Tran Kim Phuong Thi , Nguyen Ly Ngoc Thi , Thai Tram Huyen Thi , Doan Thanh Hoai Thi , Tran Vinh Trung
Published: June 2021

This study proposes an integrated model based on the Risk Perception Attitude (RPA) framework and the Theory of Planned Behavior (TPB) model to investigate behavioral intention toward traveling in times of a health-related crisis. A survey was conducted via online networks of travelers, yielding 338 valid cases. The findings indicate that health risk perception is affected by information search about the Covid-19 disease. The relationship between health risk perception and behavioral intention toward traveling during a health-related crisis is not direct, but indirect via health self-efficacy and attitude about their future trip. The study contributes to understand a cognitive process of tourists’ behavior intention toward traveling in a health-related crisis. Practically, this study’s findings provide tourists, government agencies, tourism marketers, and policy-makers and other tourism stakeholders with important suggestions for tourism recovery during and after the pandemic.
L1 congruency, word frequency, collocational frequency, L2 proficiency, and their combined effects on Chinese–English bilinguals’ L2 collocational processing
Authors: Fang Nan , Zhang Ping
Published: June 2021

Aims:

The current study investigated the effects of first language (L1) congruency, word frequency, collocational frequency, second language (L2) proficiency, and their combined effects on L2 collocational processing.

Methodology:

Twenty English native speakers and 60 adult Chinese–English bilinguals (intermediate and advanced) completed an online phrasal decision task. They made a judgment about whether target word pairs (congruent collocations, incongruent collocations, and non-collocational baseline items) were commonly used in English.

Data and analysis:

Response time and accuracy data were analyzed with mixed-effects models, with focus on the interactions of the variables of interest.

Findings:

Results demonstrated differential effects for the response time and accuracy data: (1) both L2 groups were significantly more accurate but not significantly faster in judging the congruent collocations than the incongruent collocations, and unexpectedly similar patterns were observed with the L1 group; (2) all participants were sensitive to word frequency and collocational frequency, but they differed in the manner and degree of such sensitivity; and (3) the processing of incongruent collocations showed greater combined effects of word frequency and collocational frequency than did the processing of congruent collocations.

Originality:

We specifically investigated the effects of multiple influencing factors and their combined effects. In addition, we addressed a methodological limitation regarding stimuli control by using congruent and incongruent collocational pairs that differed in only one constituent word.

Implications:

Our findings highlight the non-colinear relationship of L2 proficiency and (explicit and implicit) collocational knowledge as well as the semantic aspects of cross-language differences, and they also support the usage-based models.
Current trends and therapies in orchialgia management
Authors: Campbell Kevin , Lipshultz Larry
Published: June 2021

The management of pain is a complex condition that will be encountered by most practicing clinicians. In the genitourinary community, testicular pain may be classified as acute or chronic. Initial evaluation of chronic groin and scrotal content pain (CGSCP) begins with a detailed history and physical examination to elucidate the presenting pathology. Multiple therapy algorithms have been proposed with no definitive consensus; however, most begin with conservative intervention and medical management prior to advancing to more invasive procedures. Surgical approaches may range from reconstruction, as in vasovasostomy for post-vasectomy pain syndrome, to excision of the offending agent, as in epididymectomy. This review seeks to focus on chronic pain in the genitourinary community and review techniques of pain management in the current intervention for orchialgia, as well as identify future methods of treatment.
Registration of catheter-related complications in adverse events reporting systems: a major underestimation of the real complication practice
Authors: Laan Bart J , Godfried Mieke H , Geerlings Suzanne E
Published: June 2021

Reporting and learning from preventable adverse events is crucial to improve patient safety. Although physicians should file and analyse adverse events by law in The Netherlands, it is unknown if these reporting systems are sufficiently used in clinical practice. This study is a substudy of the multicenter RICAT trial, a successful quality improvement project to reduce inappropriate use of intravenous and urinary catheters in medical wards in seven hospitals, in which we screened 5696 patients and documented 803 catheter-related complications. We also checked the adverse events reporting systems of these patients and found that only 13 (1.6%) of 803 catheter-related complications were registered. Of the infectious complications only five (10.9%) of 46 catheter-associated bloodstream infections and urinary tract infections were registered. We conclude that the reported complications were a major underestimation of the real complication practice in medical wards in The Netherlands.

The RICAT trial is registered at Netherlands Trial Register, trial NL5438.
Rush immunotherapy in two cats with atopic skin syndrome
Authors: Jones Selene , Bloom Paul
Published: June 2021

Case series summary

Two cats with feline atopic skin syndrome (FASS) were included in this case series. They were diagnosed with FASS by a combination of history, physical examination and exclusion of other pruritic diseases. They underwent rush immunotherapy (RIT) after determination of offending environmental allergens by either serum IgE or intradermal testing. Cats were premedicated with an antihistamine and hospitalized for the day to undergo the procedure and to ensure adequate observation. Allergen extracts were administered subcutaneously at increasing concentrations every 30 mins until the maintenance dose of 20,000 protein nitrogen units/ml was reached. Both cats successfully completed RIT without any adverse reactions and their clinical signs improved afterwards. RIT appears to be an alternative treatment option for cats with FASS. Larger studies are needed to more accurately assess the safety and long-term efficacy of RIT in the feline patient, as well as the incidence of adverse reactions and optimal premedication protocol. Further evaluation of the route of injections for RIT is also warranted.

Relevance and novel information

RIT has been reported to be a safe treatment option in canine atopic dermatitis. Its use in FASS is limited to a pilot study of four cats. The purpose of this series was to describe two additional cats that underwent RIT using a different premedication protocol.
Preventing Fragility Fractures: A 3-Month Critical Window of Opportunity
Authors: Howenstein Abby , Wally Meghan , Pierrie Sarah , Bailey Gisele , Roomian Tamar , Seymour Rachel B. , Karunakar Madhav
Published: June 2021

Introduction:

Low-energy falls are the leading cause of injury-related morbidity and mortality in the elderly. In the past, physicians focused on treating fractures resulting from falls rather than preventing them. The purpose of this study is to identify patients with a hospital encounter for fall prior to a fracture as an opportunity for pre-injury intervention when patients might be motivated to engage in falls prevention.

Materials & Methods:

A retrospective analysis of all emergency room and inpatient encounters in 2016 with an ICD10 diagnosis code including “fall” across a tri-state health system was performed. Subsequent encounters with diagnosis of fracture within 2 years were then identified. Data was collected for time to subsequent fracture, fracture type and location, and length of stay of initial encounter.

Results:

There were 12,382 encounters for falls among 10,589 patients. Of those patients, 1,040 (9.8%) sustained a subsequent fracture. Fractures were most commonly lower extremity fractures (661 fractures; 63.5%), including hip fractures (447 fractures; 45.87%). Median time from fall to fracture was 105 days (IQR 16-359 days).

Discussion:

Falls are an important, modifiable risk factor for fragility fracture. This study demonstrates that patients are presenting to the hospital with one of the main modifiable risk factors for fracture within a time window that allows for intervention.

Conclusions:

Presentation to the hospital for a fall is a vital opportunity to intervene and prevent subsequent fracture in a high-risk population.
The Effect of Modifiable Risk Factors on Postoperative Complications in Lumbar Spine Fusions
Authors: Ton Andy , Shahrestani Shane , Chen Xiao T , Ballatori Alexander M , Wang Jeffrey C. , Buser Zorica
Published: June 2021

Study Design:

Retrospective cohort study.

Objectives:

The impact of modifiable risk factors (MRFs) on complications, costs, and readmission rates at 30, 90, and 180-days following lumbar spine fusion.

Methods:

Patients with lumbar spine fusions within the 2016-2017 Nationwide Readmissions Database (NRD). Patients were stratified by the following MRFs: Alcohol use, tobacco/nicotine use, nutritional malnourishment, dyslipidemia, and primary hypertension. Differences in complications, non-elective readmission rates, costs, and length of stay were compared between MRFs and the non-MRF group. Statistical analysis was conducted using Tukey multiple comparisons of means, 1-way ANOVA, Wald testing, unpaired Welch 2-sample t-tests, multivariate analysis, and predictive modeling.

Results:

The final analysis included 297,579 lumbar fusion patients. At 30 and 90 days, patients with nutritional malnutrition, dyslipidemia, and primary hypertension had significantly greater readmission rates than patients without MRFs (all P<0.01). At 180-days, all MRFs had significantly greater readmission rates than the non-MRF group (all P<0.001). Dyslipidemia demonstrated significantly greater rates of myocardial infarction at 90 days compared to all groups (all P<0.02). Nutritional malnutrition was associated with a significantly greater mortality rate than primary hypertension, non-MRF, and tobacco/nicotine use at 90 days ( P<0.001) and only tobacco/nicotine use at 180 days ( P=0.007). Predictive modeling showed increases of 0.77%, 1.70%, and 2.44% risk of readmission at 30, 90, and 180-days respectively per additional MRF (all P<0.001).

Conclusions:

These findings highlight the negative impact each MRF has on patients following lumbar spinal fusion. Further longitudinal research is necessary to comprehensively characterize the effects of various MRFs on spine surgery outcomes.
Delayed Pediatric Diagnosis of Cysticercosis and Uveitis Presenting as Chronic Multifocal Subretinal Fluid Blebs
Authors: Li Katie , Geddie Brooke , Sutherland Liliya , Sharma Sumit , Srivastava Sunil , Boss Joseph
Published: June 2021

Purpose:

To report an unusual case of intraocular cysticercosis in a 11-year-old boy that presented with chronic posterior uveitis and associated recalcitrant subfoveal and multifocal subretinal fluid blebs. The patient was later found to have a subsequent free-floating vitreous cyst that had been concealed from examination for years.

Methods:

Case report.

Results:

A diagnostic and therapeutic vitrectomy and cyst extraction revealed eosinophilic material suggestive of cysticercosis. Brain magnetic resonance imaging revealed suggestive neurocysticercosis and serological titers for cysticercosis immunoglobulin G were positive. After antihelminthic therapy and surgical removal of the cyst, the patient did well with complete resolution of multifocal subretinal fluid blebs and visual acuity improvement to 20/25.

Conclusion:

Ocular cysticercosis is a sight-threatening parasitic disease that can cause visually threatening manifestations if not identified and treated in a timely manner. Awareness of atypical presentations such as seen in this case in a pediatric patient is paramount.
Delivery of melittin-loaded niosomes for breast cancer treatment: an in vitro and in vivo evaluation of anti-cancer effect
Authors: Dabbagh Moghaddam Farnaz , Akbarzadeh Iman , Marzbankia Ehsan , Farid Mahsa , khaledi Leila , Reihani Amir Hossein , Javidfar Mehrnoosh , Mortazavi Pejman
Published: June 2021

Background

Melittin, a peptide component of honey bee venom, is an appealing candidate for cancer therapy. In the current study, melittin, melittin-loaded niosome, and empty niosome had been optimized and the anticancer effect assessed in vitro on 4T1 and SKBR3 breast cell lines and in vivo on BALB/C inbred mice. "Thin-layer hydration method" was used for preparing the niosomes; different niosomal formulations of melittin were prepared and characterized in terms of morphology, size, polydispersity index, encapsulation efficiency, release kinetics, and stability. A niosome was formulated and loaded with melittin as a promising drug carrier system for chemotherapy of the breast cancer cells. Hemolysis, apoptosis, cell cytotoxicity, invasion and migration of selected concentrations of melittin, and melittin-loaded niosome were evaluated on 4T1 and SKBR3 cells using hemolytic activity assay, flow cytometry, MTT assay, soft agar colony assay, and wound healing assay. Real-time PCR was used to determine the gene expression. 40 BALB/c inbred mice were used; then, the histopathology, P53 immunohistochemical assay and estimate of renal and liver enzyme activity for all groups had been done.

Results

This study showed melittin-loaded niosome is an excellent substitute in breast cancer treatment due to enhanced targeting, encapsulation efficiency, PDI, and release rate and shows a high anticancer effect on cell lines. The melittin-loaded niosome affects the genes expression by studied cells were higher than other samples; down-regulates the expression of Bcl2, MMP2, and MMP9 genes while they up-regulate the expression of Bax, Caspase3 and Caspase9 genes. They have also enhanced the apoptosis rate and inhibited cell migration, invasion in both cell lines compared to the melittin samples. Results of histopathology showed reduce mitosis index, invasion and pleomorphism in melittin-loaded niosome. Renal and hepatic biomarker activity did not significantly differ in melittin-loaded niosome and melittin compared to healthy control. In immunohistochemistry, P53 expression did not show a significant change in all groups.

Conclusions

Our study successfully declares that melittin-loaded niosome had more anti-cancer effects than free melittin. This project has demonstrated that niosomes are suitable vesicle carriers for melittin, compare to the free form.
Flipped learning enhances non-technical skill performance in simulation-based education: a randomised controlled trial
Authors: Moll-Khosrawi Parisa , Zöllner Christian , Cencin Nadine , Schulte-Uentrop Leonie
Published: June 2021

Background

Many efforts of the past years aimed to build a safer health care system and hereby, non-technical skills (NTS) have been recognised to be responsible for over 70 % of preventable medical mishaps. In order to counteract those mishaps, several simulation-based trainings have been implemented in health care education to convey NTS. Still, the best and effective way to foster NTS in simulation-based training is not known. Due to the importance of NTS, this gap in knowledge needs to be filled. A possible approach to convey NTS effectively during simulation-based medical education (SBME), might be the use of the flipped learning approach. The benefits of flipped learning regarding the improvement of human factors (NTS), have not been investigated yet. Therefore, the authors introduced flipped learning as an experimental intervention into their SBME emergency trainings and aimed to analyse, whether flipped learning improved students´ NTS performance compared to lecture-based learning (LBL).

Methods

In a randomized controlled trial, 3rd year medical students participated in a SBME training and then received either a further SBME training with integrated flipped learning on NTS (intervention), or a further SBME training and an accompanying lecture on NTS (control). NTS performance was assessed on three skill dimensions with a validated behavioural marker system.

Results

The authors analysed NTS performance of 102 students, prior and after their allocation to each teaching method. The baseline NTS performance of both groups did not differ, whereas the intervention group enhanced significantly on all three skill dimensions (t (44) = 5.63, p < .001; t (44) = 4.47, p < .001; t (44) = 4.94, p < .001).

Conclusion

The integration of flipped learning into SBME yields a significant improvement of NTS performance and therefore medical educators should consider the application of flipped learning to convey complex human factors and skills.
Fast-track flipping: flipped classroom framework development with open-source H5P interactive tools
Authors: Wehling Judith , Volkenstein Stefan , Dazert Stefan , Wrobel Christian , van Ackeren Konstantin , Johannsen Katharina , Dombrowski Tobias
Published: June 2021

Background

The availability and popularity of laptops, tablet PCs and smartphones in private and work environments offers considerable potential for reasonably integrating blended learning formats into structured medical learning environments. The promising educational principle of the flipped classroom (FC) provides the opportunity to effectively combine e-learning and face-to-face teaching within a single framework. However, similar to most blended learning formats, the FC requires a solid groundwork of structured digitized learning content. As rearranging a whole curriculum is intense and time consuming, physicians occupied simultaneously in clinical practice and teaching may be confronted with a lack of time during this process.

Methods

We developed two straightforward approaches to transforming a pre-existing, lecture-based otolaryngology curriculum into interactive videos within a Moodle learning management system. Special attention was given to reducing individual working time for medical professionals. Thus, while one approach was mainly guided by a medical professional to control the content-related quality of video processing, we investigated an alternative approach outsourcing work to a technician. Afterwards, the working time was analysed and compared. The resulting videos were revised with the H5P plugin for moodle to adjust the content where necessary.

Results

We identified a fast-track approach for creating structured e-learning content suitable for flipped-classroom-based lectures, other blended learning formats, or even providing a whole curriculum online. The alternative approach significantly reduced working time for medical professionals but did not impair the content-related quality significantly.

Conclusions

The use of H5P interactive tools via Moodle LMS provides a major procedural benefit by allowing the easy adjustment of pre-existing video material into suitable online content. Reasonably outsourcing work to technicians can significantly reduce the working time of medical professionals without decreasing the quality of learning content. The presented workflow can be used as a flexible approach for flipped classroom frameworks or other blended learning strategies where interactive videos are applicable.
Who should be tested in a pandemic? Ethical considerations
Authors: Hansson Sven Ove , Helgesson Gert , Juth Niklas
Published: June 2021

Background

In the initial phase of the Covid-19 pandemic, difficult decisions had to be made on the allocation of testing resources. Similar situations can arise in future pandemics. Therefore, careful consideration of who should be tested is an important part of pandemic preparedness. We focus on four ethical aspects of that problem: how to prioritize scarce testing resources, the regulation of commercial direct-to-consumer test services, testing of unauthorized immigrants, and obligatory testing.

Main text

The distribution of scarce resources for testing: We emphasize the use of needs-based criteria, but also acknowledge the importance of choosing a testing strategy that contributes efficiently to stopping the overall spread of the disease. Commercial direct-to-consumer test services: Except in cases of acute scarcity, such services will in practice have to be allowed. We propose that they should be subject to regulation that ensures test quality and adequate information to users. Testing of unauthorized immigrants, their children and other people with unclear legal status: Like everyone else, these individuals may be in need of testing, and it is in society’s interest to reach them with testing in order to stop the spread of the disease. A society that offers comprehensive medical services to unauthorized immigrants is in a much better position to reach them in a pandemic than a society that previously excluded them from healthcare. Obligatory testing: While there are often strong reasons for universal testing in residential areas or on workplaces, there are in most cases better ways to achieve testing coverage than to make testing mandatory.

Conclusion

In summary, we propose (1) decision-making primarily based on needs-based criteria, (2) strict regulation but not prohibition of direct-to-consumer test services, (3) test services offered to unauthorized immigrants, preferably as part of comprehensive medical services, and (4) broad outreach of testing services whenever possible, but in general not obligatory testing.
Building a laboratory at a Primarily Undergraduate Institution (PUI)
Authors: Dahlberg Caroline Lund , King-Smith Christina , Riggs Blake
Published: June 2021

Scientists who are interested in building research programs at primarily-undergraduate institutions (PUIs) have unique considerations compared to colleagues at research-intensive (R1) institutions. Maintaining a research program at a PUI holds unique challenges that should be considered before prospective faculty go on the job market, as they negotiate a job offer, and after they begin a new position. In this article we describe some of the considerations that aspiring and newly hired faculty should keep in mind as they plan out how they will set up a laboratory as a new Principle Investigator (PI) at a PUI.

Anyone hoping to start a research program at a PUI should understand both the timeframe of interviews, job offers, and negotiations and the challenges and rewards of working with undergraduate researchers. Once a job is offered, candidates should be aware of the range of negotiable terms that can be part of a start-up package. Space and equipment considerations are also important, and making the most of shared spaces, existing infrastructure, and deals can extend the purchasing power of start-up funds as a new PIs builds their lab. PUIs’ focus on undergraduate education and mentorship leads to important opportunities for collaboration, funding, and bringing research projects directly into undergraduate teaching laboratories.

A major focus of any new laboratory leader must be on building a productive, equitable, and supportive laboratory community. Equitable onboarding, mentorship plans, and formalized expectations, can all help build a productive and sustainable laboratory research program. However, important considerations about safety, inclusion, student schedules, and a PI’s own professional commitments are also extremely important concerns when working with undergraduates in research. A successful research program at a PUI will bring students into meaningful scientific inquiry and requires insights and skills that are often not the focus of scientific training. This article aims to describe the scope of setting up a new laboratory as a way to alleviate some of the burden that new and prospective faculty often feel.
Introduction to effective mentorship for early-career research scientists
Authors: Diggs-Andrews Kelly A. , Mayer D. C. Ghislaine , Riggs Blake
Published: June 2021

Diversifying the scientific workforce remains a national priority due to the continued lack of representation from underrepresented individuals in STEM fields. Quality mentoring has been identified as a stimulus to enhance not only research success, but also recruitment and retention of underrepresented groups pursuing STEM careers. Utilizing theEntering Mentoringtraining curriculum framework, this report provides a brief synopsis and key takeaways from the 2019 NIH-ASCB Accomplishing Career Transition (ACT) workshop, “Introduction to Effective Mentorship for Scientists” for 30 senior postdoctoral and early-career faculty researchers from historically underrepresented racial and ethnicity backgrounds. In addition, effective strategies and best practices to enhance STEM mentoring for early-career researchers are provided, which have practical applications for diverse mentoring relationships across disciplines, career stages, and mentee types.
A guide to setting up and managing a lab at a research-intensive institution
Authors: Goldstein Bob , Avasthi Prachee
Published: June 2021

Postdocs who land faculty jobs at research-intensive institutions need to juggle several new large-scale tasks: identifying space and equipment needs for their lab, negotiating the hiring package, outfitting the lab with supplies, building a team, and learning to manage time in ways that can promote productivity and happiness. Here we share tips to help new hires think clearly about each of these tasks.
Preparing for tenure and promotion at PUI institutions
Authors: Vega Leticia R. , Hengartner Christoph J.
Published: June 2021

In this paper, we discuss the importance for faculty to become familiar with the general guidelines for collecting, assembling and preparing a tenure and promotion (T&P) application or dossier at a Primarily Undergraduate Institution (PUI) and the critical role that mentoring plays throughout the T&P process. While key elements of the application process such as submission timelines and documentation guidelines are usually outlined in the faculty handbook of the specific institution, many aspects of assembling the dossier are not necessarily detailed in writing anywhere. Instead, there are important elements of the T&P process that typically rely on institutional knowledge and guidance that is often communicated informally. Junior faculty who have limited access to “informal communications” are at a significant disadvantage when they go through the T&P process even when they show accomplishments in teaching effectiveness, research, and service. The problem is especially important for women and underrepresented minority faculty in STEM disciplines that are less well represented among senior faculty in STEM. Senior faculty often serve as informal or formal mentors to their less seasoned colleagues. The goal of this article is to help demystify the T&P process by offering practical suggestions and describing some of the specific materials and steps that are an important part of documenting the development of a faculty member at a PUI.