bluuebunny/crossref_metadata_2025 huggingface dataset:
A-11 Social Determinants of Health in the Diagnosis and Management of Pediatric Concussion: A Content Analysis
Authors: Cook N E , Kissinger-Knox A , Iverson I A , Liu B C , Iverson G L
Published: July 2022

Purpose: This content analysis examined the literature underlying the Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children (i.e., the “Guideline”) to determine the extent to which social determinants of health (SDH) were examined or addressed. Methods: A published systematic review, that formed the basis for the Guideline, included 37 studies addressing diagnosis, prognosis, and treatment/rehabilitation. We examined those studies to identify SDH domains and associated subcategories derived from the Healthy People 2020 and 2030 websites. Pairs of raters coded each article with disagreements resolved by consensus. Results: At least one SDH domain was represented in 60% of the articles, usually mentioned descriptively, as a covariate, or as a design consideration. Very few were addressed as a primary focus of the study. The most frequently represented SDH domain was Education Access (43.2% of studies), receiving credit most often for reporting on participants with learning disabilities. Social and Community Context, broadly defined, was represented in nearly 1 of 3 studies (29.7%). Economic Stability and Health Care Access domains were included in 6 studies (16.2%). Some studies (k = 6, 16.2%) referenced SDH as important to consider for future research. The Guideline includes some commentary on health literacy and socioeconomic status. Conclusions: Social determinants of health are largely unrepresented as important or meaningful variables influencing the Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children, or in the studies included in the systematic review that informed the guideline.
A-14 Clinical Outcome Following Concussion Among College Athletes with a Prior Concussion History: A Systematic Review
Authors: Gaudet C E , Iverson G L , Kissinger-Knox A , Van Patten R , Cook N E
Published: July 2022

Purpose: This systematic review examined the association between prior concussion history and clinical outcomes following concussion among collegiate athletes. Methods: This review was registered with PROSPERO database for systematic reviews (protocol ID: CRD42016041479 & CRD42019128300) and adhered to PRISMA guidelines. Three searches of nine online databases were conducted: (1) database inception to June of 2016; (2) January 1, 2016 to February 1, 2019; and (3) February 1, 2019 to May 15, 2021. We screened 5118 abstracts and 619 full-text articles were reviewed. We utilized a likelihood heuristic to assess evidence for an association between concussion history and clinical outcomes. Results: Sixteen studies met inclusion criteria, and 13 studies reported the number of participants with a history of prior concussions (≥1)—which totaled 1690 of 4573 total participants (37.0%). Newcastle-Ottawa risk of bias ratings ranged from 3 to 9 (mean = 5.4, SD = 1.4). Across all studies, 43.8% (k = 7/16) reported a statistically significant result among primary analyses showing an association between concussion history and worse clinical outcome. A minority of studies reporting on symptom duration (4/13, 30.8%) and time to return to play (2/7, 28.6%) found an association between concussion history and worse outcome. Conclusions: The question of whether college athletes with a history of concussion have, on average, worse clinical outcome from their next concussion remains unresolved. Many studies to date are small, and only three focused specifically on this topic. Important clinical outcomes, such as time to return to academics, have not been adequately studied. Larger hypothesis-driven studies are needed.
A-15 Gender Differences in Self-Reported Symptomatology at Baseline Testing
Authors: Gilmore M , Golden C
Published: July 2022

Purpose: To examine whether there are gender differences in symptomatology reported at baseline testing in individuals who did not report a prior concussion history or a diagnosis of ADHD, dyslexia, autism, headaches, psychiatric conditions, substance abuse, and epilepsy at baseline using ImPACT. Methods: Participants were selected from an archival de-identified sports medicine ImPACT database. The sample (n = 1898) consisted of high school athletes who were primarily male (60.8%) adolescents in South Florida with an overall mean age of 15.35 years (SD = 1.09). A series of independent samples t-test was conducted to determine the relationship between gender and composite score performance at baseline. All analyses were conducted at p < 0.05. Results: The independent samples t-test found significant differences between gender and self-reported symptomatology concerning headaches [t(1,895) = 5.17, p < 0.001], irritability [t(1,895) = 5.23, p < 0.001], nervousness [t(1895) = 6.06, p < 0.001], sadness [t(1,895) = 3.86, p < 0.001], and feeling more emotional [t(1,895) = 7.83, p < 0.001]. No differences were seen in sleep, vestibular somatic, or cognitive symptoms. Conclusions: Results indicate high school age females are more likely to endorse symptoms related to disturbances in emotions and headaches when compared to their male counterparts at baseline testing. Differences were not seen between groups in regard to sleep, cognitive, and vestibular somatic symptoms. These results suggest that may be a specific gender profile of symptoms that can expected upon completion of baseline testing in high school athletes. Furthermore, these results signify certain symptoms that may need to be of more concern post-concussion in females when determining return to play and education.
A-25 Transcranial Photobiomodulation Treatment Effects In Former Athletes With Repetitive Head Hits
Authors: Liebel S W , Johnson P K , Lindsey H M , Russell H A , Hovenden E S , Velez C , Carr L S , Wilde E A , Tate D F
Published: July 2022

Purpose: Psychiatric symptoms, sleep disruption, reaction time, and fine motor coordination are associated with repetitive head hits. Transcranial photobiomodulation (tPBM) has been proposed as a non-invasive treatment for post-head injury symptoms. This proof-of-concept study begins to address tPBM’s potential utility in the neurorehabilitation of athletes with repetitive head hits. Methods: Study participants included 49 former male and female athletes (Mage = 45.90 years; SD = 14.45) with a history of repetitive head hits. Inclusion criteria were: aged 18–65 years and a self-reported history of concussive and/or repetitive sub-concussive events. We conducted a non-randomized study design wherein participants received active tPBM treatment for 8 weeks. At pre- and post-treatment timepoints, self-report questionnaires for depression (CES-D), posttraumatic stress (PCL-5), adjustment (MPAI-4), and sleep quality (PSQI) were obtained, as were assessments of simple reaction time, grip strength, and hand dexterity (Grooved Pegboard). Paired t-tests analyzed pre- and post-treatment effects. Results: Following tPBM treatment, study participants demonstrated statistically significant reductions in self-reported depression (t = 4.54, p < 0.001, d = 0.75), posttraumatic stress (t = 3.43, p < 0.001, d = 0.54), and adjustment (t = 5.23, p < 0.001, d = 0.83) symptoms compared to pre-treatment levels. Sleep quality (t = 3.72, p < 0.001, d = 0.57), simple reaction time (t = 4.57, p < 0.001, d = 0.73), dominant hand grip strength (t = 2.59, p = 0.013, d = 0.41), and nondominant hand grip strength (t = 4.18, p < 0.001, d = 67) improved following tPBM treatment. Bilateral hand dexterity did not significantly change following treatment. Conclusions: Results suggest that tPBM may reduce psychiatric symptoms and improve sleep quality, simple reaction time, and grip strength among former athletes with repetitive head hits. These data support future research on the potential neurorehabilitative effects of tPBM.
A-45 Clinical Considerations of Neuropsychologists for Treating Concussions
Authors: Stephenson K , O’Hara M , Holland C , Womble M , Jennings S , Weber Rawlins M , Elbin R J
Published: July 2022

Purpose: The purpose of this study was to explore sex specific clinical considerations by neuropsychologists’ and general clinical considerations for the treatment of concussion. Methods: Fourteen clinical neuropsychologists who see concussion patients regularly (>1 case per week) were interviewed using a semi-structured guide that included a generic patient vignette. Participants were asked about clinical considerations that they faced while assessing, managing, and treating concussion. Two investigators independently coded the transcriptions and met to compare coding processes, definitions, and categories. A final codebook was developed in an iterative fashion and reapplied to all transcripts. Independent coding and member checks contributed to the trustworthiness of the data. Results: Participants’ clinical experience in treating concussion ranged from 1 to 40 years, and the sample was 64% female (9/14). Four major themes were identified, including patients’ sex considerations, sleep and napping, patient education and reassurance, and mental health considerations. Several participants (4/14; 29%) noted the lack of action-oriented clinical recommendations for previously documented sex differences (i.e., menstruation). There was a lack of uniformity in sleep and napping recommendations across the participants (e.g., permitting napping vs recommended nap-length). Participants noted that a large portion of their clinical time was spent educating and reassuring patients that concussion is treatable. Comorbid mental health considerations such as anxiety were a prevailing clinical concern across participants. Conclusions: The study revealed the need for better action-oriented clinical recommendations in consensus statements that address the four main themes of sex considerations, sleep and napping considerations, patient education and reassurance, and mental health considerations.
Immunosuppressive therapy in virus-negative inflammatory cardiomyopathy: 20-year follow-up of the TIMIC trial
Authors: Chimenti Cristina , Russo Matteo Antonio , Frustaci Andrea
Published: July 2022

Aims

Long-term results of the Tailored IMmunosuppression in virus-negative Inflammatory Cardiomyopathy (TIMIC) trial protocol have been evaluated.

Methods and results

Eighty-five patients with endomyocardial biopsy-proven virus-negative chronic inflammatory cardiomyopathy were enrolled in the randomized, double-blind, placebo-controlled TIMIC trial and received prednisone and azathioprine (n = 43) vs. placebo (n = 42) for 6 months. Immunosuppressive treatment promoted an improvement in cardiac function in 88% of the cases compared with none of the patients in the placebo group, which were switched to a 6-month immunosuppressive therapy at the end of the 6-month study period. Long-term (up to 20 years) clinical outcomes of the whole cohort of 85 patients originally enrolled in the TIMIC trial (Group A) were compared with those of a 1:2 propensity score-matched control cohort of patients untreated with the TIMIC protocol (Group B) and followed for a comparable period of time. The primary outcome was a composite of cardiovascular death and heart transplantation. At long-term follow-up, the risk of cardiovascular death [hazard ratio (HR) 6.77; 95% confidence interval (CI) 2.36–19.45] and heart transplantation (HR 7.92; 95% CI 1.80–34.88) was significantly higher in Group B patients. Group A showed a persistent improvement in the left ventricular ejection fraction compared with Group B (HR 7.24; 95% CI 3.05–17.18). A higher number of Group B patients underwent implantable cardioverter defibrillator implantation. The incidence of recurrent myocarditis was similar between groups, and patients with evidence of a recurrent cardiac inflammatory process promptly responded to a TIMIC protocol application.

Conclusion

Virus-negative inflammatory cardiomyopathy benefits from immunosuppressive therapy even after long-term follow-up. Recurrence appears to respond to a new TIMIC protocol application.
Behaviourally informed, patient-led interventions to reduce missed appointments in general practice: a 12-month implementation study
Authors: Bull Shirley L , Frost Nicki , Bull Eleanor R
Published: July 2022

Background

Scalable, positive, behaviourally informed interventions may help people remember to attend their primary care appointment or cancel in good time, but have not yet been implemented long term.

Aim

To examine effects of social norms and making active commitments on missed and cancelled appointments in primary care over 12 months and explore implementation factors.

Design and setting

A mixed-methods design evaluation and implementation study led by a Patient Participation Group (PPG) member in a large GP practice in the West Midlands.

Methods

Following a 6-month baseline, waiting room notices were redesigned to emphasise positive social norms for desired behaviours. When booking appointments, receptionists were trained to invite patients to (i) verbally actively commit to cancelling if needed; (ii) write down their own appointment details. Monthly missed appointments (MAs) and cancellations were statistically compared with baseline averages and seasonally equivalent months. To explore implementation, reception staff completed a knowledge, attitude, and behaviour questionnaire at 9 months, analysed descriptively. Study team field notes were thematically analysed.

Results

Across 12 intervention months there was a mean of 37.67 fewer MAs per month (20% reduction) and 102.66 more cancellations (21.07% increase) compared with 6-month baseline means [MAs t(11) = −6.15, P < 0.001; cancellations t(11) = 3.637, P = 0.004] with statistically significant differences in seasonally equivalent months [MAs t(5) = −4.65, P = 0.006; cancellations t(5) = 3.263, P = 0.022]. Receptionists (n = 12) reported implementing the strategies except when facing pressures; knowledge and attitudes varied.

Conclusions

Behaviourally informed interventions reduced primary care MAs longer term; PPGs and practice teams can work together on quality improvement projects with support from leaders to prioritise and embed new practices.
Preconception vitamin D and miscarriage in a prospective cohort study
Authors: Subramanian A , Steiner A Z , Weinberg C R , Doss G L , Jukic A M Z
Published: July 2022

STUDY QUESTION

Is preconception vitamin D level associated with the risk of miscarriage?

SUMMARY ANSWER

Preconception vitamin D levels are not associated with the risk of miscarriage in a population of women conceiving naturally.

WHAT IS KNOWN ALREADY

In humans, low vitamin D has been associated with prolonged menstrual cycles, delayed ovulation and a lower probability of conception. Animal and in vitro data indicate that vitamin D may affect implantation.

STUDY DESIGN, SIZE, DURATION

This prospective time-to-pregnancy study included 362 women who were trying to conceive naturally between 2008 and 2015.

PARTICIPANTS/MATERIALS, SETTING, METHODS

This study included participants who had been trying to conceive naturally for 3 months or less at enrollment and aged 30–44 years. A preconception blood sample was collected and 25-hydroxyvitamin D [25(OH)D] was measured. Women who conceived (N = 362) were at risk of a miscarriage from the day of a reported positive pregnancy test until either a participant-reported pregnancy loss or 20 weeks post day of last menstrual period, whichever came first. Gestational age was defined by ovulation. Time to miscarriage (days) or censoring was modeled using a multivariate Cox proportional hazards model. Multiple imputation was performed for missing covariates and missing day of ovulation.

MAIN RESULTS AND THE ROLE OF CHANCE

The mean age was 33 years (SD: 3.0 years). Mean 25(OH)D was lower among those who reported their race as African-American and those with a higher BMI. After adjustment for age, race, BMI, education, exercise, alcohol and caffeine intake, compared to the referent group (30–<40 ng/ml), the hazard ratio (HR) and 95% CI for those with a low 25(OH)D level (<30 ng/ml) was 1.10 (CI: 0.62, 1.91). Among participants with a higher 25(OH)D level (≥40 ng/ml), the HR was 1.07 (CI: 0.62, 1.84).

LIMITATIONS, REASONS FOR CAUTION

This study was limited by a 25(OH)D measurement at only a single time point. A large percentage of women in this study had sufficient vitamin D levels, which may have limited our power to detect an effect of deficiency. Women in this study were older (30–44 years), and predominantly reported their race as White which may limit generalizability.

WIDER IMPLICATIONS OF THE FINDINGS

The findings of this study do not suggest an association between preconception vitamin D and miscarriage. Future research should focus on women at greater risk for miscarriage or in populations at risk for vitamin D deficiency or on supplementation.

STUDY FUNDING/COMPETING INTEREST(S)

This research was supported in part by the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences (Z01ES103333). This research was also supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (NIH) under award numbers R00HD079659 and R01HD067683. The authors have no conflicts of interest.

TRIAL REGISTRATION NUMBER

N/A.
Reptilian Innate Immunology and Ecoimmunology: What Do We Know and Where Are We Going?
Authors: Field Emily K , Hartzheim Alyssa , Terry Jennifer , Dawson Grant , Haydt Natalie , Neuman-Lee Lorin A
Published: July 2022

Reptiles, the only ectothermic amniotes, employ a wide variety of physiological adaptations to adjust to their environments but remain vastly understudied in the field of immunology and ecoimmunology in comparison to other vertebrate taxa. To address this knowledge gap, we assessed the current state of research on reptilian innate immunology by conducting an extensive literature search of peer-reviewed articles published across the four orders of Reptilia (Crocodilia, Testudines, Squamata, and Rhynchocephalia). Using our compiled dataset, we investigated common techniques, characterization of immune components, differences in findings and type of research among the four orders, and immune responses to ecological and life-history variables. We found that there are differences in the types of questions asked and approaches used for each of these reptilian orders. The different conceptual frameworks applied to each group has led to a lack of unified understanding of reptilian immunological strategies, which, in turn, have resulted in large conceptual gaps in the field of ecoimmunology as a whole. To apply ecoimmunological concepts and techniques most effectively to reptiles, we must combine traditional immunological studies with ecoimmunological studies to continue to identify, characterize, and describe the reptilian immune components and responses. This review highlights the advances and gaps that remain to help identify targeted and cohesive approaches for future research in reptilian ecoimmunological studies.
Interrogating the Debates Around Lawfare and Legal Mobilization: A Literature Review
Authors: Matthews Thandiwe
Published: July 2022

Liberal democracies throughout the world have been confronted with the instrumentalization of the rule of law by private and public actors to achieve undemocratic aims, thereby challenging the widely held idea that the law is concrete, normative and objective in a manner that political ideologies are not. At the same time, law-based advocacy remains an effective mechanism to counter the rise of state and non-state actors who seek to impede the advancement of progressive structural transformation toward the realization of human rights. In attempting to explain these contradictions, the terms ‘lawfare’ and ‘legal mobilization’ have gained prominence in scholarly discussions, largely in reference to the social and political ramifications of a particular application of the rule of law and whose interests it seeks to advance. This paper explores the implications of the rule of law as an institution of power that has the potential to both positively and negatively impact progressive social change in the pursuit of expanding human rights. The literature broadly unpacks the functional use of legal mechanisms, strategies associated therewith and the conditions under which these combined factors achieve or undermine the intended objectives of various state and non-state actors. The paper presents three specific strands in the literature that explore: (1) how social movements use law-based advocacy to counter (il)legitimate forms of legal instrumentalism that sustain hegemony and subsequent marginalization; (2) the judicialization of politics at the domestic and international levels; and (3) the legal culture and practices that govern litigation strategies. The paper addresses the debate across a number of themes, including economic and social rights protection, international criminal justice and environmental protection.
Climatic comparison of the gray wolf (Canis lupus) subspecies in North America using niche-based distribution models and its implications for conservation programs
Authors: González-Bernal Alejandro , Rojas-Soto Octavio , Martínez-Meyer Enrique
Published: July 2022

The gray wolf, Canis lupus, once inhabited much of the northern hemisphere worldwide; however, persecution drove its populations almost to extinction. In North America, diverse conservation programs have been implemented in the last decades to recover its populations in the wild, many of them guided by the historical distribution of the gray wolf subspecies. Over time, several authors have proposed different subspecies classifications. Nevertheless, most of them are mutually inconsistent regarding the number and distribution of subspecies, creating controversy when implementing conservation programs. This study used niche-based distribution models and cluster analysis to explore the bioclimatic profiles of C. lupus across North America and compare them with different subspecies classifications to identify environmental correlatives that support the proposed designations. Our cluster analysis results indicate that the optimal number of climatic groups was five, designated as Northern, Eastern, Western, Coastal, and Southern groups, with transitional overlap boundaries located at their peripheries, indicating climatic gradients between them and supporting the idea of intergrading zones. The geographic ranges of these groups mismatched to a different extent with all subspecies delimitations. In general, the boundaries of putative subspecies did not match the climatic patterns of North America. Our results may contribute to the recovery programs underway for this carnivore by identifying suitable areas for the release of individuals from specific lineages. New approaches to characterizing the intraspecific variation of the gray wolf should include all evidence available, including genetic, morphological, and ecological information.
Characterization of acetonitrile ice irradiated by X-rays employing the procoda code – I. Effective rate constants and abundances at chemical equilibrium
Authors: Carvalho Geanderson A , Pilling Sérgio , Galvão Breno R L
Published: July 2022

In this work, the chemical evolution of pure acetonitrile ice at 13 K irradiated with broad-band soft X-rays (from 6 eV to 2 keV) is determined by using a computational methodology (procoda code) to best fit the experimental data. To simulate the chemical evolution of the acetonitrile ice under an astrophysical analogous situation, the code employs 273 reaction rates involving 33 molecular species (5 species observed in the experiment and 28 non-observed or unknown). The considered reaction network describes 240 chemical reactions (including dissociation, bimolecular, and termolecular rates) and 33 individual desorption rates. The summed desorption yield was determined to be 0.23 molecules per photon, in agreement with previous estimates. Average values for dissociation, bimolecular, and termolecular effective rate constants were determined as 2.3 × 10−3 s−1, 9.7 × 10−26 cm3 molecule−1 s−1, and 3.2 × 10−47 cm6 molecule−2 s−1, respectively. Some branching ratios within reaction groups were also determined. Molecular abundances at chemical equilibrium were obtained, such as CH3CN (67.5 per cent), H (10.6 per cent), CN (6.7 per cent), CH2 (6.4 per cent), CH (2.5 per cent), CH3 (1.2 per cent), CH4 (1.1 per cent), C2N2 (0.8 per cent), HCN (0.8 per cent), and CH3NC (0.6 per cent). The results of this work can be employed in future astrochemical models to map chemical evolution embedded species in astrophysical regions in the presence of an ionizing radiation field.
Statistical capacity development and the production of epistemic infrastructures
Authors: Tichenor Marlee
Published: July 2022

Designating statistical capacity development as a target for measurement in the Sustainable Development Goals (SDGs) created a dilemma for statistical decision-makers in the United Nations system, as some saw the inclusion of statistical capacity in SDG17 as a “conflict of interest,” making their work both a goal of the SDGs and a means to achieve them. In 2022, there are five indicators for measuring both the statistical capacity of individual countries and the support provided to strengthen it, including one indicator for measuring a country’s ability to monitor the SDGs themselves. In this article, I argue that the epistemic infrastructuring of statistical capacity into the SDG framework is a privileged case. By parsing the interconnections between the data, actors, networks, and processes that constitute statistical capacity on national and global levels, we can understand how central these materialities and processes are in constituting the larger policy agenda of the SDGs as well as debates over the problems that statistical capacity is meant to solve. Like all indicators in the SDG framework, statistical capacity indicators are performative – defined and delineated by the global statistics community that also helps define and delineate the SDG framework’s development problems. Unlike other indicators, however, statistical capacity indicators have the added weight of also producing the conditions of possibility for the “SDG framework itself.” In this way, debates over what constitutes statistical capacity and its strengthening are also debates about ownership of policy agendas and where tensions between the local and global erupt.
ED-based COVID-19 vaccination campaign finds higher vaccination rates for individuals from racial and ethnic minority groups compared with clinic setting
Authors: Wendel Sarah K , Jackson Conner L , Resnick-Ault Daniel , Jacknin Gabrielle , Zane Richard D , Michael Sean S , Bookman Kelly J , Ginde Adit A
Published: July 2022

Background

Emergency department visits associated with Coronavirus Disease 2019 (COVID-19) continue to indicate racial and ethnic inequities. We describe the sociodemographic characteristics of individuals receiving COVID-19 vaccination in the emergency department and compare with an outpatient clinic population and emergency department (ED) patients who were eligible but not vaccinated.

Methods

We conducted a retrospective analysis of electronic health record data at an urban academic ED from May to July 2021. The primary aim was to characterize the ED-vaccinated population, compared with ED patients who were eligible but unvaccinated and the physically adjacent outpatient vaccination clinic population.

Results

A total of 627 COVID-19 vaccinations were administered in the ED. Overall, 49% of ED patients during that time had already received at least one vaccine dose prior to ED arrival. Hispanic, non-Hispanic Black patients, and patients on non-commercial insurance had higher odds of being vaccinated in the ED as compared with outpatient clinic setting. Among eligible ED patients, men and patients who were uninsured/self-pay were more likely to accept ED vaccination.

Conclusions

This ED COVID-19 vaccination campaign demonstrated a higher likelihood to vaccinate individuals from racial/ethnic minority groups, those with high social vulnerability, and non-commercial insurance, when compared with a co-located outpatient vaccination clinic.
Talk the talk and walk the walk? European insurance capital regulation and the financial vocabulary of motive
Authors: van der Heide Arjen W
Published: July 2022

‘Financialization’ refers to a variety of processes characterized by the increased prevalence of financial actors and logics in contemporary capitalist societies. Borrowing from Mills, I suggest that financialization may fruitfully be understood as the institutionalization of a financial vocabulary of motive. Mills argues that the type of reasons we give and the type of reasons we accept as legitimate varies, dependent on the social setting. The financial vocabulary of motive requires actors to motivate their actions by analogical extension of key concepts, ideas and paradigmatic problem solutions from modern finance theory. Analysing documents and 44 oral history interviews, I study the implementation of Solvency II—a European regulatory framework for insurance capital that transforms how insurers evaluate their assets and liabilities. To prevent the immediate failure of insurers’ traditional business models, insurers had to re-articulate past practices in the language of financial risk management.
An Alternative Fixation Option for Subtrochanteric Femur Fractures in Children: Adult Proximal Humerus Plate
Authors: Danişman Murat , Özdemir Erdi , Dursun Gökay , Ayvaz Mehmet , Yilmaz Güney
Published: July 2022

Background:

Subtrochanteric femur fractures are unstable injuries due to strong muscle forces on the proximal femur. The ideal fixation device is controversial in the treatment of subtrochanteric femur fractures in children. The aim of this study is to evaluate the clinical and radiological outcomes of subtrochanteric femur fractures in children treated with an adult proximal humerus plate.

Methods:

A total of 9 patients [mean age at surgery, 8.3 years (range: 7 to 12); mean follow-up period, 28.1 months (range: 12 to 56)] who underwent surgery due to a subtrochanteric femur fracture and treated with an adult proximal humerus between January 2017 and December 2021 were retrospectively evaluated. Four of the patients had a pathological fracture associated with a benign bone tumor while 5 patients had a nonpathological fracture. The clinical and radiological outcomes were assessed using the Flynn scoring system at the latest follow-up. Time to union and complications were recorded.

Results:

All patients demonstrated a solid fusion of the fracture site and were able to bear full weight at the latest follow-up. The mean time to union was 8.2 weeks (range: 6 to 10). Based on the Flynn scoring system at the latest follow-up, seven patients had excellent clinical outcomes and two patients had satisfactory outcomes. Two patients had limb length discrepancy, and one patient had coxa valga and a limb length discrepancy of 16 mm. There were no patients with nonunion, infection, implant failure, osteonecrosis of the femoral head, and heterotopic bone formation.

Conclusion:

This study suggests that the adult proximal humerus plate may be an effective alternative fixation option in the treatment of subtrochanteric femur fractures in children, including pathological fractures.

Level of Evidence:

Level IV, Case series
Risk Factors for Upper Extremity Refractures in Children
Authors: Gottschalk Hilton P. , Hughes Garza Holly , Barczyk Amanda N. , Duzinski Sarah V. , Lawson Karla A.
Published: July 2022

Background:

Multiple descriptive studies have been published on refracture patterns, particularly for forearm fractures. However, few large cohorts have been analyzed quantitatively including the odds of refracture, and with a comprehensive assessment of the possible predictive factors associated with refracture. This study aimed to assess the frequency and timing of upper extremity refracture in a large pediatric orthopaedics practice, and to evaluate the strength of association of various patient-level and fracture-related factors with refracture.

Methods:

Medical records were reviewed retrospectively for patients 1 to 18 years of age with at least 1 upper extremity fracture (ICD-9 codes 810 to 819) between June 1, 2010 and May 31, 2011. Characteristics of patients and fractures were assessed for the association with refracture using bivariate analysis and multivariable logistic regression.

Results:

Among 2793 patients with a total of 2902 upper extremity fractures, 2% were treated for refracture within 2 years, at a median of 6 months (188 d) after the initial injury. Midshaft location, and characterization of the fracture as angulated or buckle, were associated with being more likely to refracture. Eighty percent of refractures were the result of a fall, with almost 25% involving a high-energy mechanism and about 15% from monkey bars or other playground equipment. The adjusted odds of refracture were 4 times higher if noncompliance with treatment recommendations was documented, when controlling for insurance type and number of days before orthopaedic evaluation. Forearm fractures were almost 4 times more likely to refracture compared with other bones, controlling for midshaft location, days immobilized, and buckle or torus characterization of the fracture.

Conclusions:

Our practice saw a refracture occurrence in 2% of patients, with median time to refracture of ~6 months. The factors most strongly associated with refracture were midshaft fracture location, forearm fracture as opposed to clavicle or humerus, and noncompliance as defined in the study. Falls and high energy activities, such as use of wheeled devices, skis, or trampolines, were important mechanisms of refracture.

Level of Evidence:

This study is a Level II prognostic study. It is a retrospective study that evaluates the effect of patient and fracture characteristics on the outcome of upper extremity refracture.
Elastic Lumbar Support Versus Rigid Thoracolumbar Orthosis for Acute Pediatric Spondylolysis: A Prospective Controlled Study
Authors: Virkki Ella , Holstila Milja , Kolari Terhi , Lastikka Markus , Mattila Kimmo , Malmi Sari , Pajulo Olli , Helenius Ilkka
Published: July 2022

Study Design.

A prospective study on clinical, radiographic, and health-related quality of life (HRQoL) outcomes in children with acute spondylolysis treated with a rigid thoracolumbar orthosis or with an elastic lumbar support.

Objective.

To compare outcomes of pediatric spondylosysis treated with a hard brace or an elastic lumbar support.

Summary of Background Data.

The benefits of the use of a rigid orthosis in treatment of spondylolysis are not clear.

Materials and Methods.

Fifty-seven consecutive children with acute spondylolysis (mean age: 14.1 yr, range: 9–17 yr) were prospectively enrolled. Patients were treated with a rigid thoracolumbar orthosis (Boston brace) or with a low-profile, elastic lumbar support. First 14 patients were randomized the remaining 43 chose brace type themselves. Treatment period was four months. Treatment outcomes included bony union of the spondylolysis assessed with a computed tomography at four months and HRQoL using the Scoliosis Research Society-24 outcome questionnaire filled out before and after the treatment.

Results.

Of the 57 patients, 54 completed the treatment protocol. Twenty-nine patients were treated using the Boston brace and 25 patients the elastic lumbar support. Bony union was obtained in 69.0% (20/29) of the Boston brace and in 60.0% (15/25) of the elastic lumbar support group patients. Difference in union rates was not significant (relative risk=1.14, 95% confidence interval: 0.44–2.98, P=0.785). There was no difference in the Scoliosis Research Society-24 total or domain scores at the end of follow-up between the treatment groups (P>0.159 for all comparisons). In the whole cohort, the bony union did not predict better HRQoL in the end of the treatment (P=0.869), although the pain domain improved significantly in the whole cohort (P<0.001).

Conclusions.

A rigid thoracolumbar orthosis did not provide any benefits over an elastic lumbar support in terms of bony union or HRQoL outcomes in children with acute spondylolysis.

Level of Eviden:

2
Failure in Adult Spinal Deformity Surgery
Authors: Burke John F. , Scheer Justin K. , Lau Darryl , Safaee Michael M. , Lui Austin , Jha Sonya , Jedwood Chloe , Thapar Isabelle , Belfield Bethany , Nobahar Nami , Wang Albert J. , Wang Elaina J. , Catalan Tony , Chang Diana , Fury Marissa , Maloney Patrick , Aryan Henry E. , Smith Justin S. , Clark Aaron J. , Ames Christopher P.
Published: July 2022

Study Design.

Literature review.

Objective.

The aim of this review is to summarize recent literature on adult spinal deformity (ASD) treatment failure as well as prevention strategies for these failure modes.

Summary of Background Data.

There is substantial evidence that ASD surgery can provide significant clinical benefits to patients. The volume of ASD surgery is increasing, and significantly more complex procedures are being performed, especially in the aging population with multiple comorbidities. Although there is potential for significant improvements in pain and disability with ASD surgery, these procedures continue to be associated with major complications and even outright failure.

Methods.

A systematic search of the PubMed database was performed for articles relevant to failure after ASD surgery. Institutional review board approval was not needed.

Results.

Failure and the potential need for revision surgery generally fall into 1 of 4 well-defined phenotypes: clinical failure, radiographic failure, the need for reoperation, and lack of cost-effectiveness. Revision surgery rates remain relatively high, challenging the overall cost-effectiveness of these procedures.

Conclusion.

By consolidating the key evidence regarding failure, further research and innovation may be stimulated with the goal of significantly improving the safety and cost-effectiveness of ASD surgery.
Comparison of Disease-Specific, Generic, and Hearing-Specific Instruments Assessing Health-Related Quality of Life in Patients Undergoing Middle Ear Surgery for Chronic Otitis Media: A Prospective Correlational Study
Authors: Tailor Bhavesh V. , Phillips John S. , Nunney Ian , Yung Matthew W.
Published: July 2022

Objective

This study aimed to determine the responsiveness of three instruments (disease-specific, generic, and hearing-specific) assessing health-related quality of life (HRQoL) in adult patients undergoing surgery for chronic otitis media (COM).

Study Design

Prospective correlational study.

Setting

Two otology referral centers in England, United Kingdom.

Patients

Consecutive adult patients undergoing middle ear surgery for COM.

Main Outcome Measure(s)

HRQoL assessment and audiometry were performed preoperatively and 12 months after surgery. HRQoL was assessed using disease-specific (Chronic Otitis Media Questionnaire-12 [COMQ-12]), generic (Euro-Qol-5D-5L), and hearing-specific (Hearing Handicap Inventory for Adults [HHIA]) instruments.

Results

A total of 52 patients (mean [standard deviation {SD}] age, 47.3 [18.3] yr) were included, with 42 patients completing both preoperative and postoperative COMQ-12 forms. COMQ-12 and HHIA total scores significantly improved after surgery (COMQ-12: mean [SD], 28.3 [11.6] versus 14.8 [10.6]; p < 0.001; HHIA: 42.9 (28.4) versus 32.6 (27.5); p = 0.012). General HRQoL measured with the Euro-Qol-5D-5L was unaffected by surgery (p > 0.05). The standardized response means for the COMQ-12 and HHIA total scores were 1.21 and 0.44, respectively. Postoperative air conduction thresholds were moderately correlated with the postoperative COMQ-12 (r = 0.46, p = 0.005) and HHIA (r = 0.41, p = 0.012) total scores.

Conclusions

Middle ear surgery significantly improved both disease-specific and hearing-specific HRQoL, whereas general HRQoL did not change. Only the COMQ-12 is highly responsive to surgical intervention. This study supports the use of the COMQ-12 to monitor patient-reported outcomes in both research and routine clinical settings.
Adoption of Patient Engagement Strategies by Physician Practices in the United States
Authors: Miller-Rosales Chris , Lewis Valerie A. , Shortell Stephen M. , Rodriguez Hector P.
Published: July 2022

Background:

Patient engagement strategies can equip patients with tools to navigate treatment decisions and improve patient-centered outcomes. Despite increased recognition about the importance of patient engagement, little is known about the extent of physician practice adoption of patient engagement strategies nationally.

Methods:

We analyzed data collected from the National Survey of Healthcare Organizations and Systems (NSHOS) on physician practice adoption of patient engagement strategies. Stratified-cluster sampling was used to select physician practices operating under different organizational structures. Multivariable linear regression models estimated the association of practice ownership, health information technology functionality, use of screening activities, patient responsiveness, chronic care management processes, and the adoption of patient engagement strategies, including shared decision-making, motivational interviewing, and shared medical appointments. All regression models controlled for participation in payment reforms, practice size, Medicaid revenue percentage, and geographic region.

Results:

We found modest and varied adoption of patient engagement strategies by practices of different ownership types, with health system-owned practices having the lowest adoption of ownership types. Practice capabilities, including chronic care management processes, routine screening of medical and social risks, and patient care dissemination strategies were associated with greater practice-level adoption of patient engagement strategies.

Conclusions:

This national study is the first to characterize the adoption of patient engagement strategies by US physician practices. We found modest adoption of shared decision-making and motivational interviewing, and low adoption of shared medical appointments. Risk-based payment reform has the potential to motivate greater practice-level patient engagement, but the extent to which it occurs may depend on internal practice capabilities.
Indeterminate skeletal and lymph node lesion on 18F PSMA 1007 PET/CT scanning: lessons from a review at 12 months with PSMA-RADS
Authors: Bhoil Amit , Seshadri Nagabhushan , Vinjamuri Sobhan
Published: July 2022

Aims of the study

The study utilizes the prostate-specific membrane antigen-reporting and data system (PSMA-RADS) version 1.0 in a real-world patient scenario in the evaluation of equivocal lesions using the PSMA-RADS categorization for patient management and communication in multidisciplinary team (MDT) meetings.

Methods

A retrospective analysis of 203 patients who had 18F PSMA PET/CT for either restaging or staging over 12 months was undertaken. The scans were evaluated for local disease, lymph node involvement and distant metastases. The scan findings were classified as suspicious for metastases, and equivocal and benign lesions. Experience with PSMA ligand imaging was considered while classifying the lesions, equivocal lesions were assessed with PSMA-RADS and followed up with complementary imaging and/or clinical follow-up assessment or MDT for further patient management.

Results

A total of 91 of 203 patients had equivocal lesions. Follow-up assessment was performed in 47 of 91 patients with imaging (n = 36) or MDT discussion (n = 11).

On follow-up imaging (n = 36), equivocal lesion was seen in skeletal lesions (n = 24), pelvic lymph nodes (n = 6), both skeletal and pelvic nodes (n = 4), hilar and mediastinal lymph nodes (n = 1) and spleen (n = 1). The patients were reclassified as benign, metastatic with few lesion remained equivocal. Overall follow-up assessment impacted clinical management in 47% patients.

Conclusion

18F PSMA PET/CT may show equivocal lesions; many of them in the skeleton, a small proportion of which are ultimately proven metastatic. In contrast, a higher proportion of the equivocal nodes in the pelvis end up being metastatic on follow-up. A structured reporting with PSMA-RADS grading helps in the proper classification of lesions and standardization of reports.
Molecular biomarkers to help select neoadjuvant systemic therapy for urothelial carcinoma of the bladder
Authors: Laukhtina Ekaterina , Pradere Benjamin , Lemberger Ursula , Karakiewicz Pierre I. , Fajkovic Harun , Shariat Shahrokh F.
Published: July 2022

Purpose of review

In this review, we aimed to summarize the available evidence on pretreatment molecular biomarkers that may help to predict oncologic and pathologic outcomes in patients treated with neoadjuvant systemic therapy (NAST) for urothelial carcinoma of the bladder (UCB).

Recent findings

Several readily available and easily measurable blood-based biomarkers (e.g., neutrophil to lymphocyte or platelet–lymphocyte ratios) seems to help improve the selection of UCB patients who are most likely to benefit from NAST. Recent evidence suggests liquid biopsy including circulating tumor DNA (ctDNA) to be a promising tool to guide the administration of NAST in UCB patients. Pretreatment molecular and genetic characterization of transurethral resection of the bladder tumor samples may also help understand the tumor biology as luminal and basal tumor subtypes seems to be more responsive to NAST, while claudin-low and luminal-infiltrated tumor subtypes are less. In the context of neoadjuvant immunotherapy, programmed death-ligand 1 (PD-L1) status and ctDNA remain the only biomarker with possible value as the clinical utility of tumor mutational burden remains controversial/poor.

Biomarker approach is a necessary step to usher the age of precision/personalized medicine for muscle-invasive UCB with the overarching good to prevent both over- and under-therapy. The present review may offer a robust framework to compare and assess current and future molecular biomarkers for the selection of NAST in muscle-invasive UCB.
Hospital Trends of Acute Pancreatitis During the Coronavirus Disease 2019 Pandemic
Authors: Ramsey Mitchell L. , Patel Arsheya , Sobotka Lindsay A. , Lim Woobeen , Kirkpatrick Robert B. , Han Samuel , Hart Phil A. , Krishna Somashekar G. , Lara Luis F. , Lee Peter J. , Conwell Darwin L. , Papachristou Georgios I.
Published: July 2022

Objective

The coronavirus disease 2019 pandemic led to changes in individuals' behaviors and healthcare delivery. We examined the impact of these changes on the rates and clinical course of acute pancreatitis (AP).

Methods

Hospitalizations for AP from March 1 through August 31 in 2019 (baseline group) and the same period in 2020 (pandemic group) were retrospectively reviewed. Univariate and multivariate analyses were used for demographics and outcomes.

Results

Two hundred eighty subjects (315 admissions) were identified in 2019 and 237 subjects (264 admissions) in 2020. Subjects in the pandemic group were more likely to have systemic inflammatory response syndrome (40% vs 25%, P < 0.01), pancreatic necrosis (14% vs 10%, P = 0.03), and persistent organ failure (17% vs 9%, P = 0.01) compared with prepandemic. There was no difference in etiology of AP. A multivariable model indicates that increased comorbidities, prior pancreatitis, pancreatic necrosis, and prescription of opiates at discharge were associated with 30-day readmissions during the pandemic.

Conclusions

Fewer patients were admitted for AP during the pandemic, suggesting that patients with milder symptoms avoided hospital interaction. Practices followed during the pandemic, especially avoidance of hospitalization and improved efficiency of hospital management, may reduce the burden of pancreatitis care in the future.