bluuebunny/crossref_metadata_2025 huggingface dataset:
Preventing Falls Among Older Adults in Primary Care: A Mixed Methods Process Evaluation Using the RE-AIM Framework
Authors: Johnston Yvonne A , Reome-Nedlik Chelsea , Parker Erin M , Bergen Gwen , Wentworth Leah , Bauer Michael
Published: August 2022

Background and Objectives

Falls are a leading cause of injuries and injury deaths for older adults. The Centers for Disease Control and Prevention’s Stopping Elderly Accidents Deaths and Injuries (STEADI) initiative, a multifactorial approach to fall prevention, was adapted for implementation within the primary care setting of a health system in upstate New York. The purpose of this article is to: (a) report process evaluation results for this implementation using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and (b) examine the utility of RE-AIM for assessing barriers and facilitators.

Research Design and Methods

This evaluation used mixed methods. Qualitative evaluation involved semistructured interviews with key stakeholders and intercept interviews with health care providers and clinic staff. Quantitative methods utilized surveys with clinic staff. Process evaluation tools were developed based on the AIM dimensions of the RE-AIM framework. The study was conducted over a 2-month period, approximately 18 months postimplementation, and complements previously published results of the program’s reach and effectiveness.

Results

Primary barriers by RE-AIM construct included competing organizational priorities (Adoption), competing patient care demands (Implementation), and staff turnover (Maintenance). Primary facilitators included having a physician champion (Adoption), preparing and training staff (Implementation), and communicating about STEADI and recognizing accomplishments (Maintenance).

Discussion and Implications

Results revealed a high degree of concordance between qualitative and quantitative analyses. The framework supported assessments of various stakeholders, multiple organizational levels, and the sequence of practice change activities. Mixed methods yielded rich data to inform future implementations of STEADI-based fall prevention.
SurvBenchmark: comprehensive benchmarking study of survival analysis methods using both omics data and clinical data
Authors: Zhang Yunwei , Wong Germaine , Mann Graham , Muller Samuel , Yang Jean Y H
Published: July 2022

Survival analysis is a branch of statistics that deals with both the tracking of time and the survival status simultaneously as the dependent response. Current comparisons of survival model performance mostly center on clinical data with classic statistical survival models, with prediction accuracy often serving as the sole metric of model performance. Moreover, survival analysis approaches for censored omics data have not been thoroughly investigated. The common approach is to binarize the survival time and perform a classification analysis.

Here, we develop a benchmarking design, SurvBenchmark, that evaluates a diverse collection of survival models for both clinical and omics data sets. SurvBenchmark not only focuses on classical approaches such as the Cox model but also evaluates state-of-the-art machine learning survival models. All approaches were assessed using multiple performance metrics; these include model predictability, stability, flexibility, and computational issues. Our systematic comparison design with 320 comparisons (20 methods over 16 data sets) shows that the performances of survival models vary in practice over real-world data sets and over the choice of the evaluation metric. In particular, we highlight that using multiple performance metrics is critical in providing a balanced assessment of various models. The results in our study will provide practical guidelines for translational scientists and clinicians, as well as define possible areas of investigation in both survival technique and benchmarking strategies.
The knowledge spillover of innovation
Authors: Audretsch David B , Belitski Maksim
Published: August 2022

This study advances our understanding of knowledge spillover of innovation, putting a firm’s own R&D investment and knowledge spillovers to a competitive test. We use three matched databases of 15,430 firms in the United Kingdom (UK) during the period 2002–2014 in order to demonstrate that knowledge spillovers emanating from R&D investment within and between industries have different effects on innovation compared to imitation and that the ability to access spillover is conditional on the firm’s own investment in R&D. This study furthers our understanding in two different ways. Firstly, it supports the two faces of the R&D story. Second, it demonstrates that the relationship between knowledge spillover and firm innovation depends on the firm’s own investment in R&D and reveals the positive effects of knowledge transfer as well as factors limiting the use of spillovers such as industry competition, transaction costs, and eventually innovation type.
Hardwiring antimicrobial resistance mitigation into global policy
Authors: Thornber Kelly , Kirchhelle Claas
Published: August 2022

In the wake of COVID-19, antimicrobial resistance (AMR) has become termed the ‘silent pandemic’, with a growing number of editorials warning that international momentum for AMR mitigation is being lost amidst the global turmoil of COVID-19, economic crises and the climate emergency. Yet, is it sufficient to now simply turn the volume of the pre-existing AMR policy discourse back up? Although existing AMR initiatives have previously achieved high levels of international attention, their impact remains limited. We believe it is time to critically reflect on the achievements of the past 7 years and adapt our AMR policies based on the substantial literature and evidence base that exists on the socioecological drivers of AMR. We argue that developing a more sustainable and impactful response requires a shift away from framing AMR as a unique threat in competition with other global challenges. Instead, we need to move towards an approach that emphasizes AMR as inherently interlinked and consciously hardwires upstream interventions into broader global developmental agendas.
Emergency Cranial Surgeries Without the Support of a Neurosurgeon: Experience of the French Military Surgeons
Authors: Sellier Aurore , Beucler Nathan , Joubert Christophe , Julien Clément , Tannyeres Paul , Anger Florent , Bernard Cédric , Desse Nicolas , Dagain Arnaud
Published: July 2022

Introduction

Unlike orthopedic or visceral surgeons, French military neurosurgeons are not permanently deployed on the conflict zone. Thus, craniocerebral war casualties are often managed by general surgeons in the mobile field surgical team. The objective of the study was to provide the feedback of French military surgeons who operated on craniocerebral injuries during their deployment in a role 2 surgical hospital without a neurosurgeon.

Materials and Methods

A cross-sectional survey was conducted by phone in March 2020, involving every military surgeon currently working in the French Military Training Hospitals, with an experience of cranial surgery without the support of a neurosurgeon during deployment. We strived to obtain contextual, clinical, radiological, and surgical data.

Results

A total of 33 cranial procedures involving 64 surgeons were reported from 1993 to 2018. A preoperative CT scan was not available in 18 patients (55%). Half of the procedures consisted in debridement of craniocerebral wounds (52%, n = 17), followed by decompressive craniectomies (30%, n = 10), craniotomy with hematoma evacuation (15%, n = 5), and finally one (3%) surgery with exploratory burr holes were performed. The 30-day survival rate was 52% (n = 17) and 50% (n = 10/20) among the patients who sustained severe traumatic brain injury.

Conclusions

This survey demonstrates the feasibility and the plus-value of a neurosurgical damage control procedure performed on the field by a surgeon nonspecialized in cranial surgery. The stereotyped neurosurgical techniques used by the in-theater surgeon were learned during a specific predeployment training course. However, the use of a live telemedicine neurosurgical support seems indispensable and could benefit the general surgeon in strained resources setting.
Triazole resistance in Aspergillus fumigatus isolates in Africa: a systematic review
Authors: Amona Fructueux Modeste , Oladele Rita Okeoghene , Resendiz-Sharpe Agustin , Denning David W , Kosmidis Chris , Lagrou Katrien , Zhong Hanying , Han Li
Published: July 2022

Emergence of triazole resistance has been observed in Aspergillus fumigatus over the past decade including Africa. This review summarizes the current published data on the epidemiology and reported mechanisms of triazole-resistant Aspergillus fumigatus (TRAF) in both environmental and clinical isolates from Africa. Searches on databases Medline, PubMed, HINARI, Science Direct, Scopus and Google Scholar on triazole resistance published between 2000 and 2021 from Africa were performed. Isolate source, antifungal susceptibility using internationally recognized methods, cyp51A mechanism of resistance and genotype were collected. Eleven published African studies were found that fitted the search criteria; these were subsequently analyzed. In total this constituted of 1686 environmental and 46 clinical samples. A TRAF prevalence of 17.1% (66/387) and 1.3% (5/387) was found in respectively environmental and clinical settings in African studies. Resistant to itraconazole, voriconazole, and posaconazole was documented. Most of the triazole-resistant isolates (30/71, 42.25%) were found to possess the TR34/L98H mutation in the cyp51A-gene; fewer with TR46/Y121F/T289A (n = 8), F46Y/M172V/E427K (n = 1), G54E (n = 13), and M172V (n = 1) mutations. African isolates with the TR34/L98H, TR46/Y121F/T289A and the G54E mutations were closely related and could be grouped in one of two clusters (cluster-B), whereas the cyp51A-M172V mutation clustered with most cyp51A-WT strains (cluster-A). A single case from Kenya shows that TR34/L98H from environmental and clinical isolates are closely related. Our findings highlight that triazole resistance in environmental and clinical A. fumigatus is a cause for concern in a number of African countries. There is need for epidemiological surveillance to determine the true burden of the problem in Africa.

Lay Summary

Emergence of triazole resistance has been observed in Aspergillus fumigatus. TRAF was found from environmental (17.1%) and clinical (1.3%) settings in Africa. We highlighted that triazole resistance in environmental and clinical A. fumigatus is a cause for concern in a number of African countries.
Revisiting the continuum reverberation lags in the AGN PKS 0558−504
Authors: González-Buitrago D H , Santisteban J V Hernández , Barth A J , Jimenez-Bailón E , Li Yan-Rong , García-Díaz Ma T , Vargas A Lopez , Herrera-Endoqui M
Published: July 2022

We present a revised analysis of the photometric reverberation mapping campaign of the narrow-line Seyfert 1 galaxy PKS 0558 − 504 carried out with the Swift Observatory during 2008–2010. Previously, Gliozzi et al. (2013) found using the Discrete Correlation Function (DCF) method that the short-wavelength continuum variations lagged behind variations at longer wavelengths, the opposite of the trend expected for thermal reprocessing of X-rays by the accretion disc, and they interpreted their results as evidence against the reprocessing model. We carried out new DCF measurements that demonstrate that the inverted lag-wavelength relationship found by Gliozzi et al. resulted from their having interchanged the order of the driving and responding light curves when measuring the lags. To determine the inter-band lags and uncertainties more accurately, we carried out new measurements with four independent methods. These give consistent results showing time delays increasing as a function of wavelength, as expected for the disc reprocessing scenario. The slope of the re-analysed delay spectrum appears to be roughly compatible with the predicted τ ∝ λ4/3 relationship for reprocessing by an optically thick and geometrically thin accretion disc, although the data points exhibit a large scatter about the fitted power-law trend.
Searching for giant planets in the outer Solar system with far-infrared all-sky surveys
Authors: Sedgwick Chris , Serjeant Stephen
Published: July 2022

We have explored a method for finding giant planets in the outer Solar system by detecting their thermal emission and proper motion between two far-infrared all-sky surveys separated by 23.4 yr, taken with the InfraRed Astronomical Satellite (IRAS) and the AKARI Space Telescope. An upper distance limit of about 8000 AU is given by both the sensitivities of these surveys and the distance at which proper motion becomes too small to be detected. This paper covers the region from 8000 AU to 700 AU. We have used a series of filtering and SED-fitting algorithms to find candidate pairs, whose IRAS and AKARI flux measurements could together plausibly be fitted by a Planck thermal distribution for a likely planetary temperature. Theoretical studies have placed various constraints on the likely existence of unknown planets in the outer Solar system. The main observational constraint to date comes from a WISE study: an upper limit on an unknown planet’s mass out into the Oort cloud. Our work confirms this result for our distance range, and provides additional observational constraints for lower distances and planetary masses, subject to the proviso that the planet is not confused with Galactic cirrus. We found 535 potential candidates with reasonable spectral energy distribution (SED) fits. Most would have masses close to or below that of Neptune (∼0.05 Jupiter mass), and be located below 1000 AU. However, examination of the infrared images of these candidates suggests that none is sufficiently compelling to warrant follow-up, since all are located inside or close to cirrus clouds, which are most likely the source of the far-infrared flux.
Photometric redshifts from SDSS images with an interpretable deep capsule network
Authors: Dey Biprateep , Andrews Brett H , Newman Jeffrey A , Mao Yao-Yuan , Rau Markus Michael , Zhou Rongpu
Published: July 2022

Studies of cosmology, galaxy evolution, and astronomical transients with current and next-generation wide-field imaging surveys like the Rubin Observatory Legacy Survey of Space and Time are all critically dependent on estimates of photometric redshifts. Capsule networks are a new type of neural network architecture that is better suited for identifying morphological features of the input images than traditional convolutional neural networks. We use a deep capsule network trained on ugriz images, spectroscopic redshifts, and Galaxy Zoo spiral/elliptical classifications of ∼400 000 Sloan Digital Sky Survey galaxies to do photometric redshift estimation. We achieve a photometric redshift prediction accuracy and a fraction of catastrophic outliers that are comparable to or better than current methods for SDSS main galaxy sample-like data sets (r ≤ 17.8 and zspec ≤ 0.4) while requiring less data and fewer trainable parameters. Furthermore, the decision-making of our capsule network is much more easily interpretable as capsules act as a low-dimensional encoding of the image. When the capsules are projected on a two-dimensional manifold, they form a single redshift sequence with the fraction of spirals in a region exhibiting a gradient roughly perpendicular to the redshift sequence. We perturb encodings of real galaxy images in this low-dimensional space to create synthetic galaxy images that demonstrate the image properties (e.g. size, orientation, and surface brightness) encoded by each dimension. We also measure correlations between galaxy properties (e.g. magnitudes, colours, and stellar mass) and each capsule dimension. We publicly release our code, estimated redshifts, and additional catalogues at https://biprateep.github.io/encapZulate-1.
Fingerprints of modified gravity on galaxies in voids
Authors: Cataldi Pedro , Pedrosa Susana , Padilla Nelson , Landau Susana , Arnold Christian , Li Baojiu
Published: July 2022

We search for detectable signatures of f(R) gravity and its chameleon screening mechanism in the baryonic and dark matter (DM) properties of simulated void galaxies. The enhancement of the gravitational acceleration can have a meaningful impact on the scaling relations as well as on the halo morphology. The galaxy rotational velocity field (calculated with the velocity of the gas disc and the acceleration fields) deviates from the typical values of the Tully–Fisher Relation in General Relativity (GR). For a given stellar mass, f(R) gravity tends to produce greater maximum velocities. On the other hand, the mass in haloes in f(R) gravity is more concentrated than their counterparts in GR. This trend changes when the concentration is calculated with the dynamical density profile, which takes into account the unscreened outer regions of the halo. Stellar discs interact with the overall potential well in the central regions, modifying the morphology of the screening regions and reshaping them. We find a trend for galaxies with a more dominant stellar disc to deviate further from round screening regions. We find that small haloes are less triaxial and more round in f(R) than their GR counterparts. The difference between halo morphology becomes smaller in f(R) haloes whose inner regions are screened. These results suggest possible observables that could unveil modified gravity effects on galaxies in voids in future cosmological tests of gravity.
Tracing the environmental history of observed galaxies via extended fast action minimization method
Authors: Sarpa E , Longobardi A , Kraljic K , Veropalumbo A , Schimd C
Published: July 2022

We present a novel application of the extended Fast Action Minimization method (eFAM) aimed at assessing the role of the environment in shaping galaxy evolution and validate our approach against the Magneticum hydrodynamical simulation. We consider the z ≃ 0 snapshot as our observed catalogue and use the reconstructed trajectories of galaxies to model the evolution of cosmic structures. At the statistical level, the fraction of volume occupied by voids, sheets, filaments, and clusters in the reconstructed and simulated high-redshift snapshots agree within 1σ. Locally, we estimate the accuracy of eFAM structures by computing their purity with respect to simulated structures, P, at the cells of a regular grid. Up to z = 1.2, clusters have 0.58 < P < 0.93, filaments vary in 0.90 < P < 0.99, sheets show 0.78 < P < 0.92, and voids have 0.90 < P < 0.92. As redshift increases, comparing reconstructed and simulated tracers becomes more difficult and the purity decreases to P ∼ 0.6. We retrieve the environmental history of individual galaxies by tracing their trajectories through the cosmic web and relate their observed gas fraction, fgas, with the time spent within different structures. For galaxies in clusters and filaments, eFAM reproduces the dependence of fgas on the redshift of accretion/infall as traced by the simulations with a 1.5σ statistical agreement (which decreases to 2.5σ for low-mass galaxies in filaments). These results support the application of eFAM to observational data to study the environmental dependence of galaxy properties, offering a complementary approach to that based on light-cone observations.
Resolved imaging of exoplanets with the solar gravitational lens
Authors: Turyshev Slava G , Toth Viktor T
Published: July 2022

We discuss the feasibility of direct multipixel imaging of exoplanets with the solar gravitational lens (SGL) in the context of a realistic deep space mission. For this, we consider an optical telescope, placed in the image plane that forms in the strong interference region of the SGL. We consider an Earth-like exoplanet located in our immediate stellar neighbourhood and model its characteristics using our own Earth. We estimate photon fluxes from such a compact, extended, resolved exoplanet. This light appears in the form of an Einstein ring around the Sun, seen through the solar corona. The solar corona background contributes a significant amount of stochastic noise and represents the main noise source for observations utilizing the SGL. We estimate the magnitude of this noise. We compute the resulting signal-to-noise ratios (SNRs) and related integration times that are needed to perform imaging measurements under realistic conditions. It is known that deconvolution, removing the blur due to the SGL’s spherical aberration substantially decreases the SNR. Our key finding is that this ‘penalty’ is significantly mitigated when sampling locations in the image plane (image pixels) remain widely spaced. Consequently, we conclude that an imaging mission is challenging but feasible, using technologies that are either already available or in active development. Under realistic conditions, high-resolution imaging of Earth-like exoplanets in our galactic neighbourhood requires only weeks or months of integration time, not years as previously thought: a high quality 1000 × 1000 pixel image of an Earth-like planet at Proxima Centauri could be obtained with SNR > 10 using approximately 14 months of integration time.
4Ecocriticism
Authors: Macklin Rebecca
Published: August 2022

Much ecocriticism scholarship published in 2021 sought to tackle the question of environmental emergency. The work considered in this essay covers a considerable range of topics, temporalities, and spaces, ranging from British histories of industrial extraction to Canada’s polluted waterways in the present, and draws upon an array of disciplinary contexts, including work from literary theory, media studies, the environmental humanities, waste and discard studies, Black studies, feminist theory, and Indigenous studies. I examine works that suggest new ways of understanding our current ‘crisis’ through a reframing of timescales and an emphasis on infrastructures; works that think explicitly about extraction and extractivism by considering what critical and cultural theory can offer to help better conceptualize both the climate crisis and the structures of racial capitalism on which it is grounded; and works that employ and develop experimental, hybrid forms of creative-theoretical research methods, operating outside the bounds of what we might traditionally understand as ecocriticism. I conclude by suggesting that these experimental modes of theory exemplify how ecocriticism and the environmental humanities are increasingly turning to new forms to imagine possible routes out of contemporary intersecting crises. The essay is divided into four key sections: 1. Introduction: Code Red for Humanity; 2. The Colonial Logics and Infrastructures of Environmental Crisis; 3. Theorizing Extraction and Extractivism; 4. Finding New Forms.
The Effect ofSeptoria glycinesand Fungicide Application on the Soybean Phyllosphere Mycobiome
Authors: Lin Heng-An , Mideros Santiago X.
Published: July 2022

Septoria brown spot, caused by Septoria glycines, is Illinois’ most prevalent soybean disease. It is common to use foliar fungicides to control Septoria brown spot and other late-season diseases of soybean. The effects of fungicide on nontarget organisms in the phyllosphere are unknown. To study the effect of S. glycines and fungicide application on the soybean phyllosphere mycobiome, we conducted a replicated field trial and collected samples at three soybean developmental stages. Then, we sequenced full-length internal transcribed spacer and a partial large subunit region using Oxford Nanopore technologies. Sequencing and data analysis produced 3,342 operational taxonomic units. The richness of the fungal community increased with the host development. There were differences in mycobiome diversity between soybean lines at the early developmental stage but not at the reproductive stages. Inoculation with S. glycines did not affect the α diversity but some significant changes were observed for the β diversity. At the beginning seed stage (R5), fungicide application changed the composition of the fungal community. The fungicide treatment decreased the proportion of several fungal taxa but it increased the proportion of Septoria. The core mycobiome in the phyllosphere was composed of genera Gibberella, Alternaria, Didymella, Cladosporium, Plectosphaerella, Colletotrichum, and Bipolaris. Network analysis identified significant interactions between Septoria and Diaporthe, Bipolaris, and two other taxonomic units. In this study, we set Septoria as the target organism and demonstrated that metabarcoding could be a tool to quantify the effect of multiple treatments on the mycobiome community. Better understanding of the dynamics of the phyllosphere microbiome is necessary to untangle the late-season diseases of soybean.
Identification and Fine Mapping of Gummy Stem Blight Resistance Gene Gsb-7(t) in Melon
Authors: Ma Jian , Li Congcong , Tian Jiaxing , Qiu Yanhong , Geng Lihua , Wang Jianshe
Published: July 2022

Gummy stem blight (GSB), caused by Didymella bryoniae, is a devastating fungal disease of melon worldwide. Breeding GSB-resistant cultivars with host resistance genes is considered the most economic and effective strategy to control this disease. In this study, 260 melon germplasm resources were screened for resistance to GSB, and an inbred line, H55R, that exhibited immunity to GSB was identified. To further understand the resistance mechanism of H55R against GSB, an F2 population was obtained from a cross between the GSB-susceptible line A15 and H55R, and genetic analysis indicated that the GSB resistance in H55R was controlled by a single dominant gene, tentatively named Gsb-7(t). The Gsb-7(t) gene was finally delimited to a 140-kb interval on chromosome 7 using bulked segregant analysis and chromosome walking strategies. Ten putative genes were annotated in this region that contains a wall-associated receptor kinase (WAK) gene MELO3C010403. The MELO3C010403 gene contains two alternative transcripts, MELO3C010403-T1 and MELO3C010403-T2, with five and seven nonsynonymous mutation sites, respectively. Gene expression analysis showed that expression of MELO3C010403-T2 but not MELO3C010403-T1 was significantly induced by D. bryoniae at 24 h postinoculation, indicating that the MELO3C010403-T2 transcript of MELO3C010403 was the most likely candidate gene of Gsb-7(t). Our results offer new genetic resources and will be helpful for the development of GSB-resistant melon cultivars in the future.
Anticipated Barriers to Sustained Engagement in Treatment With Medications for Opioid Use Disorder After Release From Incarceration
Authors: Kaplowitz Eliana , Truong Ashley , Macmadu Alexandria , Berk Justin , Martin Harrison , Burke Caroline , Rich Josiah D. , Brinkley-Rubinstein Lauren
Published: August 2022

Background

Although the burden of opioid use disorder is disproportionately high among persons who are incarcerated, medications for opioid use disorder are often unavailable in correctional settings. The Rhode Island Department of Corrections provides all 3 classes of medications for opioid use disorder to clinically eligible persons who are incarcerated. Despite a decrease in fatal overdoses among persons with recent criminal legal system involvement since the program's implementation, barriers to continued engagement in treatment after release from incarceration still exist.

Methods

We conducted 40 semistructured, qualitative interviews with people who were incarcerated and enrolled in the comprehensive medications for opioid use disorder program at the Rhode Island Department of Corrections. Analysis applied a general, inductive approach using NVivo 12.

Results

Participants discussed barriers to treatment engagement before incarceration, as well as anticipated barriers to medications to treat opioid use disorder continuation after release from incarceration. Structural factors including housing, health insurance, transportation, and the treatment program structure, as well as social factors such as social support networks were perceived to influence retention in medications to treat opioid use disorder post-release.

Conclusion

Our findings suggest that people with opioid use disorder who are incarcerated encounter unique challenges upon community reentry. Addressing structural factors that pose barriers to post-release engagement is essential to sustaining retention. We recommend utilization of peer recovery specialists to alleviate some of the stress of navigating the structural barriers identified by participants.
“It Just Depends on their Stability”: A Qualitative Examination of Patient Factors Influencing Providers’ Contraceptive Counseling Approaches for Persons With Substance Use Disorders
Authors: Balto Rwina , Brooks Jennifer H. , Mayo Rachel M. , Eichelberger Kacey Y. , Charron Elizabeth
Published: August 2022

Objectives

This qualitative study examined how patient-related factors influence providers’ contraceptive counseling for persons with substance use disorders (SUDs). Specifically, we explored individual behavior and social factors that contribute to providers modifying their contraceptive counseling approaches and described how providers alter their counseling recommendations and communication strategies in the presence of such factors.

Methods

In 2019, we purposively recruited a national sample of contraceptive providers (N = 24) and conducted semistructured phone interviews to inquire about their contraceptive counseling practices for women with SUDs. Interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis with inductive codes.

Results

Participants included 10 medical doctors, 8 nurse practitioners, and 6 certified nurse-midwives. We found that providers modify their contraceptive counseling provision when their patients are actively using substances or have unstable living conditions, such as intimate partner violence or homelessness. With patients experiencing these instabilities, providers reported postponing contraceptive discussions until patients are stabilized in treatment, recommending long-active reversible contraceptive methods, and varying communication styles according to their own perceptions of patients’ communication needs. Providers perceived that individuals in long-term recovery have increased stability and fewer barriers to contraceptive access and adherence and therefore reported increased willingness to provide greater autonomy during contraceptive decision making and shift the counseling focus to short-acting contraceptive methods.

Conclusions

This study highlights that substance use and social “stability” of patients contributes to how providers approach their contraceptive counseling and make methods recommendations for their patients with SUDs. More research is needed to understand strategies that individuals with SUDs use to overcome barriers to contraceptive access and adherence in the context of active substance use and social instability.
Early Adherence to Prescribed Brace Wear for Adolescent Idiopathic Scoliosis Is Associated With Future Brace Wear
Authors: Linden Gabriel S. , Emans John B. , Karlin Lawrence I. , O’Neill Nora P. , Williams Kathryn A. , Hresko Michael T.
Published: August 2022

Study Design.

Retrospective cohort study.

Objective.

To assess if initial adherence to prescribed brace wear for adolescent idiopathic scoliosis (AIS) predicts future adherence and curve improvement.

Summary of Background Data.

AIS bracing can be effective if patients adhere to prescribed brace wear. Previous research has associated age, sex, and brace prescription length with future adherence. We hypothesize that a patient’s initial adherence to brace wear may be associated with future adherence and outcomes.

Materials and Methods.

Consecutive AIS patients who met the Scoliosis Research Society (SRS) criteria for bracing from 2015 to 2019 at a single center were reviewed. Patients were stratified into groups based on their adherence during the initial one-month brace wean-in period—adherent patients were defined as wearing the brace >80% of the daily prescribed amount. Brace wear was recorded by a thermosensor and assessed during the wean-in period, six-, 12-, and 24-month postbracing appointments. Statistical testing was conducted to analyze if initial adherence was associated with future adherence, curve change, and bracing success—defined as reaching Risser stage 4 with a Cobb angle <40°.

Results.

Sixty patients (mean age=12.5 yr) were included, of which the majority were females (83%) with thoracic curves (70%). Thirty-two patients were considered adherent, and this cohort demonstrated improved adherence relative to the nonadherent group at the six-, 12-, and 24-month appointments (P<0.001). Adherent patients also showed a significant reduction in their scoliosis at the 12-month appointment, unlike nonadherent patients (P<0.001). Ninety-seven percent of adherent patients achieved bracing success compared with 71% of nonadherent (P=0.016). Females were more likely to be adherent than males.

Conclusions.

Initial adherence to prescribed AIS brace wear was associated with future adherence, bracing success, and curve improvement. Early recognition of nonadherence may offer an opportunity for supportive intervention to improve brace wear behavior.
Validation of Age-adjusted Ideal Sagittal Alignment in Terms of Proximal Junctional Failure and Clinical Outcomes in Adult Spinal Deformity
Authors: Park Se-Jun , Lee Chong-Suh , Kang Byeong-Jik , Shin Tae Soo , Kim Il Su , Park Jin-Sung , Lee Keun-Ho , Shin Dae Hun
Published: August 2022

Study Design.

Retrospective study.

Objective.

To validate the age-adjusted ideal sagittal alignment in terms of proximal junctional failure (PJF) and clinical outcomes.

Summary of Background.

It is reported that optimal sagittal correction with regard to the age-adjusted ideal sagittal alignment reduces the risk of PJF development. However, few studies have validated this concept. The age-considered optimal correction is likely to be undercorrection in terms of conventional surgical target, such as pelvic incidence (PI) – lumbar lordosis (LL) within ±9°. Therefore, the clinical impact of age-adjusted sagittal alignment should be evaluated along with radiographic effect.

Methods.

Adult spinal deformity (ASD) patients, aged ≥50 years, who underwent ≥4-level fusion to sacrum with a minimum of four-years of follow-up data were included in this study. Radiographic risk factors for PJF (including age-adjusted ideal PI-LL) were evaluated with multivariate analyses. Three groups were created based on PI-LL offset between age-adjusted ideal PI-LL and actual PI-LL: undercorrection, ideal correction, and overcorrection. Clinical outcomes were compared among the three groups.

Results.

This study included 194 ASD patients. The mean age was 68.5 years and there were 172 females (88.7%). PJF developed in 99 patients (51.0%) at a mean postoperative period of 14.9 months. Multivariate analysis for PJF revealed that only PI-LL offset group had statistical significance. The proportion of patients with PJF was greatest in the overcorrection group followed by the ideal correction and undercorrection groups. Overcorrected patients regard to the age-adjusted ideal alignment showed poorer clinical outcomes than the other patient groups.

Conclusion.

Overcorrection relative to age-adjusted sagittal alignment increases the risk of PJF development and is associated with poor clinical outcomes. Older patients and those with small PI are likely to be overcorrected in terms of the age-adjusted PI-LL target. Therefore, the age-adjusted alignment should be considered more strictly in these patients.
Prehospital Bundle of Care Based on Antibiotic Therapy and Hemodynamic Optimization Is Associated With a 30-Day Mortality Decrease in Patients With Septic Shock*
Authors: Jouffroy Romain , Gilbert Basile , Tourtier Jean Pierre , Bloch-Laine Emmanuel , Ecollan Patrick , Boularan Josiane , Bounes Vincent , Vivien Benoit , Pressat-Laffouilhère Thibaut , Gueye Papa
Published: July 2022

OBJECTIVES:

This study aims to investigate the association between the 30-day mortality in patients with septic shock (SS) and a prehospital bundle of care completion, antibiotic therapy administration, and hemodynamic optimization defined as a fluid expansion of at least 10 mL.kg−1.hr−1.

DESIGN:

To assess the association between prehospital BUndle of Care (BUC) completion and 30-day mortality, the inverse probability treatment weighting (IPTW) propensity method was performed.

SETTING:

International guidelines recommend early treatment implementation in order to reduce SS mortality. More than one single treatment, a bundle of care, including antibiotic therapy and hemodynamic optimization, is more efficient.

PATIENTS:

From May 2016 to March 2021, patients with SS requiring prehospital mobile ICU (mICU) intervention were retrospectively analyzed.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Among the 529 patients with SS requiring action by the mICU enrolled in this study, 354 (67%) were analyzed. Presumed pulmonary, digestive, and urinary infections were the cause of the SS in 49%, 25%, and 13% of the cases, respectively. The overall 30-day mortality was 32%. Seventy-one patients (20%) received prehospital antibiotic therapy and fluid expansion. Log binomial regression weighted with IPTW resulted in a significant association between 30-day mortality and prehospital BUC completion (respiratory rate [RR] of 0.56 [0.33–0.89]; p = 0.02 and adjusted RR 0.52 [0.27–0.93]; p = 0.03).

CONCLUSIONS:

A prehospital bundle of care, based on antibiotic therapy and hemodynamic optimization, is associated with a 30-day mortality decrease among patients suffering from SS cared for by an mICU.
Diagnostic diversity and heterogeneity of tumors: a real-world study of metastasis re-biopsy in advanced breast cancer
Authors: Lv Huimin , Niu Limin , Zhang Mengwei , Zeng Huiai , Zhao Shengnan , Yan Min
Published: August 2022

Background:

Re-biopsy of metastasis in advanced breast cancer (ABC) has become an international convention to assist the diagnosis and evaluation of tumor heterogeneity. This study aimed to detect diagnostic diversity and inconsistencies among estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) expression levels between primary and metastatic lesions.

Methods:

We conducted a retrospective analysis of 1670 cases of ABC patients who had undergone at least one lesion re-biopsy from January 2010 to December 2018. The pathological diagnosis of biopsies, distribution of biopsy sites, and severe puncture complications at each site were collected. In addition, the inconsistency rates and related factors of ER, PR, and HER2 expression between primary and metastatic lesions were analyzed fully considering patients’ demographic profiles and disease characteristics.

Results:

In total, 1670 cases of breast cancer (BC) patients diagnosed by pathology underwent one to four biopsies of recurrences or metastases in different sites or at different stages during the rescue treatment, producing 2019 histopathological specimens which were analyzed in the study. Pathological diagnosis showed that eight patients had benign pathological diagnoses, 11 patients had second primary malignant tumors but without recurrences of breast cancer, and 17 patients had pathologically confirmed breast cancer recurrences combined with second primary cancer. In 1173 patients who presented ER, PR, and HER2 expressions in primary and metastatic lesions, the inconsistency rates of ER, PR, and HER2 were 17.5% (205/1173), 31.3% (367/1173), and 13.9% (163/1173), respectively. The multivariate analysis showed that the age at the onset of breast cancer or adjuvant endocrine therapy was an independent factor affecting changes in PR expression level. Except one liver puncture with local hemorrhage and two lung punctures with hemopneumothorax, no other severe puncture complications occurred in 1950 non-surgical rebiopsies.

Conclusions:

The pathological diagnosis of metastasis re-biopsy of ABC was diverse, and the ER, PR, and HER2 expression levels were inconsistent between primary and metastatic lesions. Therefore, more attention should be paid to perform biopsies of relapsed and metastatic breast cancers routinely in clinical practice.
Differences in incidence, staging, and survival of urologic cancers in patients under 65 living in the US-Mexico border region
Authors: Taylor Zachariah D. , Chew Lauren , Tumey Tyler , Gard Charlotte C. , Woods Michael E.
Published: July 2022

Objectives

To describe and compare the incidence, stage at diagnosis, and survival for genitourinary cancers in the border regions and in Hispanic-Americans.

Materials and methods

A population-based search was performed using the Surveillance, Epidemiology, and End Results Program 18 database and the Texas Cancer Registry from 2000 to 2017. Cox regression models were performed with adjusted for age, gender, race, cancer type, cancer stage, insurance status, and cause of death were used to compare cancer-specific survival.

Results

A total of 63,236 kidney and renal pelvis, 38,398 bladder, 170,640 prostate, 24,313 testicular cancer cases were identified. Cancer-specific survival was found to be improved in Hispanic-Americans in kidney and renal pelvis (hazard ratio [HR], 0.903, 95% confidence interval [CI], 0.856–0.952, p = 0.0001), and bladder cancers (HR, 0.817, 95% CI, 0.743–0.898, p < 0.001), despite a more advanced stage at diagnosis in Hispanics with bladder cancer (p < 0.0074). Testicular cancer has a survival disadvantage for individuals living in the border region (HR, 1.315, 95% CI, 1.124–1.539, p = 0.0006).

Conclusions

Disparities exist between Hispanic-Americans and Non-Hispanic White and also between individuals living in the border counties when compared to other regions. This is most significant in individuals with testicular cancer residing in the border region who demonstrate worse overall survival.
Building trust in real-world data: lessons from INSIGHT, the UK's health data research hub for eye health and oculomics
Authors: Denniston Alastair K. , Kale Aditya U. , Lee Wen Hwa , Mollan Susan P. , Keane Pearse A.
Published: August 2022

Purpose of review

In this review, we consider the challenges of creating a trusted resource for real-world data in ophthalmology, based on our experience of establishing INSIGHT, the UK's Health Data Research Hub for Eye Health and Oculomics.

Recent findings

The INSIGHT Health Data Research Hub maximizes the benefits and impact of historical, patient-level UK National Health Service (NHS) electronic health record data, including images, through making it research-ready including curation and anonymisation. It is built around a shared ‘north star’ of enabling research for patient benefit. INSIGHT has worked to establish patient and public trust in the concept and delivery of INSIGHT, with efficient and robust governance processes that support safe and secure access to data for researchers. By linking to systemic data, there is an opportunity for discovery of novel ophthalmic biomarkers of systemic diseases (‘oculomics’). Datasets that provide a representation of the whole population are an important tool to address the increasingly recognized threat of health data poverty.

Enabling efficient, safe access to routinely collected clinical data is a substantial undertaking, especially when this includes imaging modalities, but provides an exceptional resource for research. Research and innovation built on inclusive real-world data is an important tool in ensuring that discoveries and technologies of the future may not only favour selected groups, but also work for all patients.
Comparison of accuracy of a toric calculator with predicted vs measured posterior corneal astigmatism
Authors: Wang Li , Koch Douglas D.
Published: August 2022

Purpose:

To compare the accuracy of postoperative residual astigmatism prediction using the Barrett toric calculator with predicted vs measured posterior corneal astigmatism (PCA).

Setting:

Cullen Eye Institute, Baylor College of Medicine, Houston, Texas.

Design:

Retrospective case series.

Methods:

We included 602 eyes with monofocal nontoric intraocular lens implantation. Biometry and PCA were obtained from the IOLMaster 700. Anticipated postoperative refractive astigmatism was calculated with the Barrett toric calculator for predicted and measured PCA, and the astigmatism prediction errors (PEs) for each were calculated using vector analysis. The vector PE magnitudes and percentage of eyes within certain amounts of vector PEs were compared between 2 methods.

Results:

Compared with the Barrett toric calculator with predicted PCA, the Barrett toric calculator with measured PCA produced significantly smaller mean vector PE (0.54 diopter [D] vs 0.57 D) and higher percentage of eyes with vector PE of ≤0.5 D (57.6% [347/602] vs 52.5% [316/602]) (both P < .05). In eyes with predicted residual astigmatism of ≥0.5 D, the Barrett toric calculator with measured PCA again yielded a significantly higher percentage of eyes with vector PE of ≤0.5 D (51.2% [226/441] vs 44.7% [197/441], P < .05).

Conclusions:

Accuracy of residual astigmatism prediction is improved using the Barrett toric calculator with measured PCA rather than predicted PCA.
Superior facet joint violation between open and minimally invasive techniques in lumbar fusion surgery: An updated systematic review and meta-analysis
Authors: Liu Po-Chun , Lu Yi , Lin Hsi-Hsien , Yao Yu-Cheng , Chang Ming-Chau , Wang Shih-Tien , Chou Po-Hsin
Published: July 2022

Background:

Superior facet joint violation (FJV) is a potential risk factor for adjacent segment disease following lumbar fusion surgery. We sought to conduct a systematic review and meta-analysis to compare screw-related superior FJV rates between the open and different minimally invasive (MI) techniques—fluoroscopy-based, 3D-image navigation, and navigation with robotic assistance—in adult lumbar fusion surgery.

Methods:

We searched original articles comparing the rates of screw-related FJV between the open and different MI techniques in adult lumbar fusion surgery for lumbar degenerative diseases in PubMed, EMBASE, and the Cochrane Library from inception to September 2021. We compared the numbers of top-level pedicle screws and associated superior FJVs in the main analyses and performed subgroup analysis based on different MI techniques to examine whether individual MI approaches differed in superior FJV rate. Risk ratio (RR) and 95% confidence interval (CI) were calculated in a random-effect meta-analysis.

Results:

Included in the meta-analysis were 16 articles with 2655 patients and 4638 top-level pedicle screws. The pooled analysis showed no significant difference in superior FJV rates between the MI and open groups (RR: 0.89, 95% CI: 0.62-1.28). The subgroup analysis demonstrated that the overall rates of superior FJV were 27.1% (411/1518) for fluoroscopy-based, 7.1% (43/603) for 3D-image navigation, and 3.2% (7/216) for navigation with robotic assistance. Compared with the open method, the overall RRs were 1.53 (95% CI: 1.19-1.96) for fluoroscopy-based, 0.41 (95% CI: 0.22-0.75) for 3D-image navigation, and 0.25 (95% CI: 0.08-0.72) for navigation with robotic assistance.

Conclusion:

Among the three common MI techniques, fluoroscopy-based can be associated with a higher risk of superior FJV, while both 3D-image navigation and navigation with robotic assistance may be associated with lower risks as compared with the open method. Considering the limitations of the study, more trials are needed to prove these clinical findings.