bluuebunny/crossref_metadata_2025 huggingface dataset:
United States Of America (‘.us’)
Authors: Towns William R
Published: March 2021

The standard for trademark infringement in the United States is ‘likelihood of confusion’. Under this standard trademark infringement occurs when, dependent on the attendant circumstances, two parties’ use of the same or similar mark with related goods and services would be likely to cause the public mistakenly to believe: (1) that the goods and services emanate from the same source; or (2) that the parties are in some manner affiliated or that the goods and services of one party have the sponsorship, endorsement, or approval of the other party. In either case, trademark law aims to protect the public from deceit, and to prevent the diversion of reputation and goodwill from the one who has created it to another who has not.
Introduction and Outline of Process
Authors: O’Dea Geoff , Long Julian , Smyth Alexandra
Published: March 2021

A scheme of arrangement, or simply a ‘scheme’, is a statutory procedure which allows a company to reach an arrangement or compromise with its members or creditors (or any class of them).
Creditor Schemes in Practice
Authors: O’Dea Geoff , Long Julian , Smyth Alexandra
Published: March 2021

In order for the court to have jurisdiction to sanction a scheme the ‘company’ or debtor must have agreed—by the necessary resolutions being approved by the requisite majorities at the scheme meeting(s)—a ‘compromise’ or ‘arrangement’ with its ‘creditors’. Every person who has a quantifiable pecuniary claim against the company, whether actual, contingent, unliquidated or prospective, is a creditor within the meaning of the Companies Act 2006—Re Midland Coal, Coke and Iron Co.
The Requirement Of A Defect: Introductory Issues
Authors: Fairgrieve Duncan , Goldberg Richard
Published: March 2021

The removal of a requirement of proving negligence, which is usually regarded as the distinguishing feature of the system of strict liability introduced by Pt I of the Consumer Protection Act 1987, will in all probability shift the focus of attention to the question of whether the claimant has established that the product is defective. As will be seen, the question gives rise to many difficult issues. Indeed, one writer has observed that ‘the problem of defining defectiveness has exercised the minds of legal scholars perhaps more than any other aspect of product liability law’.
Rights Conferred
Authors: Annette Kur , Senftleben Martin
Published: March 2021

EU trade mark law confers exclusive rights on the proprietor of a registered trade mark. It provides for three general types of protection. Article 9(2) EUTMR and Article 10(2) TMD offer protection against confusion under sub (b) (see paragraph 5.105 et seq.) and protection against dilution under sub (c) (see paragraph 5.182 et seq.). In double identity cases (identical signs used for identical goods or services), sub (a) (see paragraph 5.64 et seq.) provides for ‘absolute’ protection (recital 16 TMD) combining elements of both forms of infringement on the basis of the function theory developed by the Court.
Trade Marks as Objects of Property
Authors: Annette Kur , Senftleben Martin
Published: March 2021

Harmonized EU trade mark law contains rules on trade marks as objects of property in Articles 16 to 24a of the European Union Trade Mark Regulation (EUTMR) and Articles 22 to 26 of the Trade Mark Directive (TMD). These rules cover transfer and assignment, the possibility of giving trade marks as security and granting rights in rem, the levy of execution, the involvement of EUTMs in insolvency proceedings, and issues of trade mark licensing. The substantive provisions are accompanied by procedural rules concerning the recordal of corresponding legal transactions in the register. While the TMD only guarantees the possibility of registration, the EUTMR contains more detailed registration requirements.
Enforcing Patent Rights
Authors: Grubb Philip W , Thomsen Peter R , Hoxie Tom , Wright Gordon
Published: March 2021

This chapter discusses patent law enforcement in the UK, US, Continental Europe, and Asia, first considering the rules on infringement. In the UK, for instance, patent infringement is not a crime, but a tort. Essentially, the right given by a patent is the right to sue for infringement. While this is true for all countries having an Anglo-Saxon legal system and also for many others, there are some countries in which patent infringement is a criminal offence. With regard to procedure, matters of patent law are under the sole jurisdiction of federal courts in the US. In the UK, nearly all infringement actions are heard by the courts and regulated by the Civil Procedure Rules 1998. In Continental Europe, most of the evidence is written, rather than oral, and the role of the judge is seen more as that of an investigator than that of a referee.
The Negligence Liability of Public Authorities, Second Edition
Authors: Fairgrieve Duncan , Squires QC Dan
Published: March 2021

Whether, and in what circumstances, public authorities should be held liable for negligence in the performance of their public functions is a highly complex area of the law. Written by Cherie Blair and Dan Squires QC, the first edition of The Negligence Liability of Public Authorities provided a much needed guide to these complexities and offered a detailed account of the law for practitioners and academics. This second edition builds on the reputation of the first, including full coverage of the many important cases which have been decided since 2006. Divided into two parts, Part I focuses on the extent to which the public nature of a defendant affects civil liability and the principles that govern and limit that liability. Part II considers the law as it impacts upon specific areas of public authorities' activities. It examines cases in a range of key areas, including the police, social services, highways, education, and the emergency services and aims to set out in a comprehensive way the different legal issues that have arisen in each area. By examining cases in a variety of jurisdictions, including Australia, Canada, South Africa, New Zealand and the USA, the authors further broaden the scope of this authoritative text. The book also identifies the underlying principles and policy arguments which have shaped the law more generally, making it an extremely useful resource for a wide variety of practitioners.
MEASUREMENTS OF SEASONAL VARIATIONS OF RADIOACTIVITY DISTRIBUTIONS IN RIVERINE SOIL SEDIMENT OF ADO-ODO OTA, SOUTH-WEST NIGERIA: PROBABILISTIC APPROACH USING MONTE CARLO
Authors: Maxwell Omeje , Adewoyin Olusegun O , Joel Emmanuel S , Ikechukwu B Ijeh , Timothy-Terhile Mary A , Okoro Emeka E , Uchechukwu Omeje Anne , Adeleye Bosede Ngozi , Michael Orosun Muyiwa , Ifeanyi Oha A , Ogunrinola Iyanuoluwa E , Ahuekwe Eze F , Saeed M A
Published: March 2021

The radioactivity levels were measured using a hand-held gamma-ray survey meter and NaI (Tl) based gamma spectroscopy to evaluate the seasonal variation of radioactivity levels in the riverine area of Ado-Odo Ota. The measured iso-dose map reported higher gamma dose rate of 79 nGy/h, approximately 34% higher than the world average of 59 nGy/h. The values for U-238, Th-232 and K-40 activity levels ranged between 29.9 and 21.6; 103.2 and 31.2; 802.2 and 233.5 with mean values of 26.1, 55.6 and 499.3 Bq/kg, respectively. According to the mean, 5th and 95th percentiles of the probabilities using the Monte Carlo simulation, the Radium equivalent activities and the absorbed dose rates are within their respective recommended limits of 370 Bq/kg and 84 nGy/h. This study could be used to monitor dose rates and radiological risks for the areas covering the small area (Ado-Odo Ota) to the larger area (West African Region) as baseline data.
Does It Pay to Do Novel Science? The Selectivity Patterns in Science Funding
Authors: Ayoubi Charles , Pezzoni Michele , Visentin Fabiana
Published: March 2021

Public funding agencies aim to fund novel breakthrough research to promote the radical scientific discoveries of tomorrow. Identifying the profiles of scientists being financed to pursue their research is therefore crucial. This paper shows that the funding process is not always awarding the most novel scientists. Exploiting rich data on all applications to a leading Swiss research funding program, we find that novel scientists have a higher probability of applying for funds than non-novel scientists, but they get on average lower ratings by grant evaluators and have fewer chances of being funded. We discuss the implications for the allocation of scientific research spending.
Bidirectional relationship between sleep and sedentary behavior in adults with overweight or obesity: A secondary analysis
Authors: Imes Christopher C , Bizhanova Zhadyra , Kline Christopher E , Rockette-Wagner Bonny , Chasens Eileen R , Sereika Susan M , Burke Lora E
Published: March 2021

Study Objectives

The relationships between daytime sedentary behavior and that night’s sleep and sleep and next day’s sedentary behavior are unknown. The purpose of this analysis was to examine these potentially bidirectional associations.

Methods

This study was a secondary analysis of baseline data from an ecological momentary assessment study to determine the triggers for dietary lapses during a weight loss intervention. Sedentary behavior, physical activity, and sleep were objectively measured using accelerometers. Linear mixed modeling was used to examine the bidirectional multivariate associations between activity and sleep characteristics for each outcome examined separately. The models included sex, age, body mass index (BMI), education, and day of the week (weekday vs. weekend).

Results

Participants were predominantly white (81.5%) and female (88.9%) with a mean age of 51.2 ± 10.6 years. Longer previous night’s total sleep time (TST) (b = −0.320, standard error [SE] = 0.060; p < .001) and being a weekend (b = −63.845, SE = 9.406; p < .001) were associated with less sedentary time the next day. More daytime sedentary time was associated with less wake after sleep onset (b = −0.018, SE = 0.008; p = .016), fewer awakenings (b = −0.010, SE = 0.004; p = .016), and less TST (b = −0.060, SE = 0.028; p = .029) that night.

Conclusions

The bidirectional relationships between sedentary time and sleep characteristics are complex and may vary depending on participant characteristics and duration of sedentary and sleep time. Interventions to decrease sedentary behavior may benefit by targeting sleep duration and weekday activity.
Fusarium verticillioides FvPex8 Is a Key Component of the Peroxisomal Docking/Translocation Module That Serves Important Roles in Fumonisin Biosynthesis but Not in Virulence
Authors: Yu Wenying , Lin Mei , Peng Minghui , Yan Huijuan , Wang Jiajia , Zhou Jie , Lu Guodong , Wang Zonghua , Shim Won Bo
Published: March 2021

Peroxisomes are ubiquitous organelles in eukaryotes that fulfill various important metabolic functions. In this study, we investigated the role of docking/translocation module (DTM) peroxins, mainly FvPex8, FvPex13, FvPex14, and FvPex33, in Fusarium verticillioides development, virulence, and fumonisin B1 (FB1) biosynthesis. Protein interaction experiments suggested that FvPex13 serves as the central DTM subunit in F. verticillioides. Notably, FvPex8 and FvPex14 did not show direct interaction in our experiments. We generated gene-deletion mutants (ΔFvpex8, ΔFvpex13, ΔFvpex14, ΔFvpex33, ΔFvpex33/14) and further examined the functional role of these peroxins. Deletion mutants exhibited disparity in carbon nutrient utilization and defect in cell-wall integrity when stress agents were applied. Under nutrient starvation, mutants also showed higher levels of lipid droplet accumulation. Particularly, ΔFvpex8 mutant showed significant FB1 reduction and altered expression of key FB1 biosynthesis genes. However, FvPex13 was primarily responsible for asexual conidia reproduction and virulence, while the ΔFvpex33/14 double mutant also showed a virulence defect. In summary, our study suggests that FvPex13 is the central component of DTM, with direct physical interaction with other DTM peroxins, and regulates peroxisome membrane biogenesis as well as PTS1- and PTS2-mediated transmembrane cargo transportation. Importantly, we also characterized FvPex8 as a key component in F. verticillioides DTM that affects peroxisome function and FB1 biosynthesis.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Aggressiveness of Spanish Isolates of Xylella fastidiosa to Almond Plants of Different Cultivars Under Greenhouse Conditions
Authors: Baró Aina , Montesinos Laura , Badosa Esther , Montesinos Emilio
Published: March 2021

The aggressiveness of Spanish isolates of Xylella fastidiosa, representing different sequence types, were studied in almond plants of several cultivars by means of the dynamics of the population levels and symptoms, colonization and spread, and dose–effect relationships. Pathogen dynamics in almond plants under greenhouse conditions showed doubling times of 2.1 to 2.5 days during the exponential growth phase, with a maximum population size of about 35 days postinoculation (dpi). Differences in patterns in population dynamics were observed between sap and xylem tissue after the exponential growth, as population levels in the xylem tissue remained stable while viable cells in sap decreased. Population levels were higher in two upward zones than in the downward zone with respect to the inoculation area. The first symptoms were observed between 20 and 60 dpi, and disease severity increased over time at doubling times of 30 days, with a maximum observed at 120 dpi. Strains tested showed differences in population levels in the cultivars studied and were able to spread with different intensity from contaminated plant parts to new growing shoots after pruning. Two almond isolates showed different performance in dose–effect relationships when inoculated in cultivar Avijor. Whereas IVIA 5387.2 reached high population levels but showed high median effective dose (ED50) and minimal infective dose (MID) values, IVIA 5901.2 showed low population levels and low ED50 and MID values. This study has implications for the epidemiology of X. fastidiosa in almond crops, estimating doubling times of the pathogen in planta and of symptom development and showing differences in aggressiveness between strains.
Does Navigation Make Spinal Fusion for Adolescent Idiopathic Scoliosis Safer? Insights From a National Database
Authors: Kaur Japsimran , Koltsov Jayme C.B. , Kwong Jeffrey W. , Cheng Ivan , Vorhies John S.
Published: March 2021

Study Design.

Retrospective Cohort.

Objective.

To evaluate the effect of computer-assisted navigation (NAV) on rates of complications and reoperations after spinal fusion (SF) for adolescent idiopathic scoliosis (AIS) using a nationally representative claims database.

Summary of Background Data.

Significant controversy surrounds the reported benefits of NAV in SF for AIS. Previous studies have demonstrated decreased rates of pedicle screw breaches with NAV compared to free-hand methods but no impact on complication rates. Thus, the clinical utility of NAV remains uncertain.

Methods.

Analyses were performed using the IBM MarketScan databases. Patients aged 10 to 18 undergoing SF for AIS were grouped by use of NAV. Patients with nonidiopathic scoliosis were excluded. Univariate and risk-adjusted multivariate analyses were performed. Primary outcomes were neurological complications, any medical complications, and reoperations. Secondary outcomes included adjusted total reimbursements and length of stay.

Results.

A total of 12,046 patients undergoing SF for AIS were identified, and 8640 had 90-day follow-up. NAV was used in 467 patients (5.4%), increasing from 2007 to 2015. After risk adjustment, the odds for any complication within 90 days were lower with NAV (OR = 0.61, P = 0.025), but neurological complications were unrelated to NAV (P = 0.742). NAV was not associated with reoperation within 90 days (P = 0.757) or 2 years (P = 0.095). We observed a $25,038 increase in adjusted total reimbursements (P < 0.001) and a 0.32-day decrease in length of stay (P = 0.022) with use of NAV.

Conclusion.

In this national sample, NAV was associated with a lower rate of total complications but no change in rates of neurological complications or reoperations. In addition, NAV was associated with a large increase in total payments, despite a modest decrease in hospital stay. Considering the increasing popularity of NAV, this study provides important context regarding the utility of NAV for AIS.

Level of Evidence: 3
Morphological Evaluation of the Subaxial Cervical Spine in Patients with Basilar Invagination
Authors: Lin Shaoyi , Bao Minggui , Wang Zihan , Zou Xiaobao , Ge Su , Ma Xiangyang , Chen Jianting , Ji Wei , Yang Jincheng
Published: March 2021

Study Design.

Retrospective study.

Objective.

To evaluate the morphologic features of the subaixal cervical spine in patients with basilar invagination (BI) and provide information for the accurate screw placement in this region.

Summary of Background Data.

BI is a congenital anomaly, comprising a wide range of abnormal structures. The screw fixation can be required in situation that BI is combined with subaxial cervical spine pathologies. However, there are no literatures specifically addressed the subaxial cervical morphology of BI.

Method.

A total of 42 BI patients were included in this retrospective study. Forty-two patients without head or cervical disease were matched for sexes and ages. Information on radiographic features of the subaxial cervical spine was collected and compared systematically.

Results.

There were no differences in the age and sex between the BI and control group. The BI group manifested a wider pedicle and laminar than the control group at all cervical levels, except for the pedicle of C6 and C7, and the laminar of C3 and C6. In addition, the BI group had a wider lateral mass from C3 to C5 than the control group. There were no differences in most measurements of the length of pedicle, laminar, and lateral mass.

Conclusion.

BI patients have a wider pedicle and laminar than the general population in the subaxial cervical spine, but the same size in length of pedicle, laminar, and lateral mass.

Level of Evidence: 4
Marked Increase in Spinal Deformity Surgery Throughout the United States
Authors: Beschloss Alexander , Dicindio Christina , Lombardi Joseph , Varthi Arya , Ozturk Ali , Lehman Ronald , Lenke Lawrence , Saifi Comron
Published: March 2021

Study Design.

Retrospective cohort database study.

Objective.

The aim of this study was to investigate trends in utilization and demographics in Spinal Deformity Surgery.

Summary of Background Data.

The aging population in the United States will likely result in increased incidence of adult degenerative scoliosis. With a national focus on resource utilization and value-based care, it is essential for surgeons, researchers, and health care policy makers to know utilization and demographic trends of spinal surgery with long fusion construct.

Methods.

The National Inpatient Sample (NIS) database was queried for patients who underwent fusion or refusion of nine or more vertebrae (ICD-9-CM 81.64) between 2004 and 2015 across 44 states. Demographic and economic data include annual number of surgeries, incidence, patient age, sex, region, insurance type, charge, routine discharge, length of stay, and data. The NIS database represents a 20% sample of discharges from US hospitals, excluding rehabilitation and long-term acute care hospitals, which is weighted to provide national estimates.

Result.

In 2014, there were 14,615 fusions involving nine or more vertebrae across the United States. The number of fusions involving nine or more levels has increased 141% from 6072 in 2004. Long fusion constructs increased 460% from 2004 to 2014 among patients 65 to 84 years’ old. The mean hospital cost associated with long fusion spine surgery was $69,546 per case in 2015. Between 2004 and 2014, the payer breakdown for individuals receiving spinal deformity surgery is as follows: 54.2% private insurance, 18% Medicare, and 21.2% Medicaid.

Conclusion.

The massive increase (141%) in utilization of long construct spine fusion was primarily driven by 460% rise in incidence of the surgery among those aged 65 to 84. Although the cause is unknown, it is possible that this rise was, at least in part, driven by the implementation of the affordable care act, improved surgical safety, and better knowledge of spinopelvic parameters.

Level of Evidence: 3
Time-demand, Radiation Exposure and Outcomes of Minimally Invasive Spine Surgery With the Use of Skin-Anchored Intraoperative Navigation
Authors: Vaishnav Avani S. , Gang Catherine H. , Qureshi Sheeraz A.
Published: March 2021

Study Design:

Retrospective review.

Objective:

The aim was to evaluate the learning curve of skin-anchored intraoperative navigation (ION) for minimally invasive lumbar surgery.

Summary of Background Data:

ION is increasingly being utilized to provide better visualization, improve accuracy, and enable less invasive procedures. The use of noninvasive skin-anchored trackers for navigation is a novel technique, with the few reports on this technique demonstrating safety, feasibility, and significant reductions in radiation exposure compared with conventional fluoroscopy. However, a commonly cited deterrent to wider adoption is the learning curve.

Methods:

Retrospective review of patients undergoing 1-level minimally invasive lumbar surgery was performed. Outcomes were: (1) time for ION set-up and image-acquisition; (2) operative time; (3) fluoroscopy time; (4) radiation dose; (5) operative complications; (6) need for repeat spin; (7) incorrect localization.

Chronologic case number was plotted against each outcome. Derivative of the nonlinear curve fit to the dataset for each outcome was solved to find plateau in learning.

Results:

A total of 270 patients [114 microdiscectomy; 79 laminectomy; 77 minimally invasive transforaminal lumbar interbody fusion (MI-TLIF)] were included. (1) ION set-up and image-acquisition: no learning curve for microdiscectomy. Proficiency at 23 and 31 cases for laminectomy and MI-TLIF, respectively. (2) Operative time: no learning curve for microdiscectomy. Proficiency at 36 and 31 cases for laminectomy and MI-TLIF, respectively. (3) Fluoroscopy time: no learning curve. (4) Radiation dose: proficiency at 42 and 33 cases for microdiscectomy and laminectomy, respectively. No learning curve for MI-TLIF. (5) Operative complications: unable to evaluate for microdiscectomy and MI-TLIF. Proficiency at 29 cases for laminectomy. (6) Repeat spin: unable to evaluate for microdiscectomy and laminectomy. For MI-TLIF, chronology was not associated with repeat spins. (7) Incorrect localization: none.

Conclusions:

Skin-anchored ION did not result in any wrong level surgeries. Learning curve for other parameters varied by surgery type, but was achieved at 25–35 cases for a majority of outcomes.

Level of Evidence:

Level III.
Bowman-stromal inlay using an intraocular lens injector for management of keratoconus
Authors: Mittal Vikas , Rathod Darshana , Sehdev Nancy
Published: March 2021

A simple approach for transplanting Bowman layer and anterior stroma Bowman-stromal inlay (BSI) in keratoconic patients as an intervention to cease progression of ectasia and increase the overall thickness is described. A femtosecond laser was used to create BSI from human eye bank donor corneas and form an intrastromal pocket in the host cornea. The inlay was placed in the intrastromal space using an intraocular lens injector. This technique was performed successfully in 10 eyes of patients with progressive corneal ectasia. Postoperatively, the increased host pachymetry was as per BSI thickness. The tomography parameters remained stable, suggesting stabilization of keratoconus over a mean 15.9 months of follow-up. The BSI may offer a technically easy and safe technique of stromal augmentation to arrest keratoconus progression. It also opens up the possibility of surface ablation in the future for visual rehabilitation.
Protective role of natural killer cells in neuropathic pain conditions
Authors: Lassen Josephine , Stürner Klarissa Hanja , Gierthmühlen Janne , Dargvainiene Justina , Kixmüller Dorthe , Leypoldt Frank , Baron Ralf , Hüllemann Philipp
Published: March 2021

During the past few years, the research of chronic neuropathic pain has focused on neuroinflammation within the central nervous system and its impact on pain chronicity. As part of the ERA-Net NEURON consortium, we aimed to identify immune cell patterns in the cerebrospinal fluid (CSF) of patients with herpes zoster neuralgia and patients with polyneuropathy (PNP), which may contribute to pain chronicity in these neuropathic pain conditions. Cerebrospinal fluid of 41 patients (10 herpes zoster and 31 PNP) was analyzed by flow cytometry identifying lymphocyte subsets: CD4+ (T-helper cells), CD8+ (cytotoxic T cells), CD19+ (B cells), and CD56+ (natural killer [NK]) cells. At baseline and at follow-up, the somatosensory phenotype was assessed with quantitative sensory testing. In addition, the patients answered epidemiological questionnaires and the PainDETECT questionnaire. Immune cell profiles and somatosensory profiles, as well as painDETECT questionnaire scores, were analyzed and correlated to determine specific immune cell patterns, which contribute to chronic pain. We found a negative correlation (P = 0.004, r = −0.596) between the frequency of NK cells and mechanical pain sensitivity (MPS), one of the most relevant quantitative sensory testing markers for central sensitization; a high frequency of NK cells correlated with low MPS. The analysis of the individual follow-up showed a worsening of the pain condition if NK-cell frequency was low. Low NK-cell frequency is associated with signs of central sensitization (MPS), whereas high NK-cell frequency might prevent central sensitization. Therefore, NK cells seem to play a protective role within the neuroinflammatory cascade and may be used as a marker for pain chronicity.
Classism in pain assessment and management: the mediating role of female patient dehumanization and perceived life hardship
Authors: Bernardes Sónia F. , Tomé-Pires Catarina , Brandão Tânia , Campos Lúcia , Teixeira Filipa , Goubert Liesbet
Published: March 2021

Compared with racism and sexism, classism in pain assessment and management practices (PAMPs) has been less investigated, and its mediating mechanisms are still unknown. Drawing on a social psychological model of dehumanization, this research aimed to test (1) the effect of patient socioeconomic status (SES; a proxy of social class) on PAMPs and (2) whether patient dehumanization and perceived life hardship mediated these effects. Two online experimental studies were conducted, in which patient SES was manipulated (low vs high) within-subjects. One-hundred sixty-two female medical students (study 1) and 105 female nurses (study 2) were presented with vignettes/images depicting 2 cases of women with chronic low-back pain, followed by videos of them performing a pain-inducing movement. Participants reported on patient dehumanization, perceived life hardship, and PAMPs. The low SES patient was perceived as less pain sensitive (medical students alone) but more disabled, credible, and her pain more attributed to psychological causes (by nurses alone). Medical students recommended less nonpharmacological treatments but prescribed slightly stronger medication. Medical students were less willing to provide individualized care to the low SES patient, whereas nurses showed the opposite pattern. Patient mechanistic dehumanization mediated SES effects on pain disability (medical students alone). Perceived life hardship mediated SES effects on pain disability, credibility (nurses alone), and intentions of providing individualized care (nurses alone). These finding bear novel contributions to the fields of pain, health service research, and social psychology and have important implications to the development of more effective future interventions to reduce classism in PAMPs.
Male Youth Ice Hockey Concussion Incidence in a USA Hockey Membership–Adjusted Population: A Peak in 2011 and the Impact of Major Rule Changes
Authors: Morrissey Patrick J. , Shah Neil V. , Hayden Andrew J. , Zhou Jack J. , Bloom Lee R. , Aylyarov Alexandr , Chatterjee Dipal , Newman Jared M. , Hariri Omar K. , McCarthy Matthew T. , Hesham Khalid , Urban William P.
Published: March 2021

Objective:

To investigate the incidence of youth ice hockey–related concussions preceding and following the implementation of new body-checking and head contact rules by USA hockey in 2011. We hypothesized a decrease in concussions after the rule change.

Design:

Retrospective analysis.

Setting:

United States emergency department (ED) data queried in the National Electronic InjurySurveillance System (NEISS).

Patients:

National Electronic Injury Surveillance System reported male youth (≤18 years) ice hockey concussion cases from January 1, 2002, to December 31, 2016. In total, 848 players were diagnosed with concussion, representing a national estimate of 17 374 cases.

Independent Variables:

Time, specifically years.

Main Outcome Measures:

Incidences and incidence rates (measured per 10 000 person-years) of male youth ice hockey concussions. Annual trends were analyzed using descriptive and linear or polynomial regression analysis.

Results:

The national estimate of youth ice hockey–related concussions seen in US emergency departments (EDs) increased significantly from 656 in 2007 to 2042 in 2011 (P < 0.01). During the same period, their respective incidence increased significantly from 21.8 to 66.8 per 10 000, before dropping through 2016 (P < 0.05). After 2011, concussions decreased from 1965 in 2012 to 1292 in 2016 (P = 0.055). The gap in concussion incidence between the 11 to 12 and 13 to 14 divisions widened after 2011 (before 2011: 41 vs 49 per 10 000 person-years [P = 0.80]; after 2011: 45 and 89, respectively [P < 0.01]).

Conclusions:

US EDs experienced a significant increase in youth ice hockey concussion visits from 2007 to 2011. After the 2011 rule changes, concussion visits decreased significantly from 2012 to 2016.
Optimizing hemodynamic function during cardiopulmonary resuscitation
Authors: Vammen Lauge , Fjølner Jesper , Hansen Kasper , Granfeldt Asger
Published: March 2021

Purpose of review

The purpose of this narrative review is to provide an update on hemodynamics during cardiopulmonary resuscitation (CPR) and to describe emerging therapies to optimize perfusion.

Recent findings

Cadaver studies have shown large inter-individual variations in blood distribution and anatomical placement of the heart during chest compressions. Using advanced CT techniques the studies have demonstrated atrial and slight right ventricular compression, but no direct compression of the left ventricle. A hemodynamic-directed CPR strategy may overcome this by allowing individualized hand-placement, drug dosing, and compression rate and depth. Through animal studies and one clinical before-and-after study head-up CPR has shown promising results as a potential strategy to improve cerebral perfusion. Two studies have demonstrated that placement of an endovascular balloon occlusion in the aorta (REBOA) can be performed during ongoing CPR.

Modern imaging techniques may help increase our understanding on the mechanism of forward flow during CPR. This could provide new information on how to optimize perfusion. Head-up CPR and the use of REBOA during CPR are novel methods that might improve cerebral perfusion during CPR; both techniques do, however, still await clinical testing.
Practice and Quality Improvement Leaders Survey of Expectations of DNP Graduates' Quality Improvement Expertise
Authors: Hammersla Margaret , Belcher Anne , Ruccio Lucy Rose , Martin Jeff , Bingham Debra
Published: March 2021

Background

Input from practice leaders will improve how doctor of nursing practice (DNP) education is meeting the needs of the employer and improving patient outcomes.

Purpose

This article describes the expectations practice leaders have of new DNP graduates' ability to contribute to quality improvement (QI) efforts within health care organizations.

Methods

A survey of practice leaders and QI experts investigated the importance and use of QI knowledge and skills. Practice leaders were also asked about the expectations of DNP graduates at the time of hire.

Results

The results of this study support the need for nurses pursuing a DNP in advanced nursing practice to have education and training beyond their area of specialization, specifically in QI methods and tools.

Conclusions

Faculty need to provide DNP students education that includes concepts in QI and leadership to meet the expectations of future employers and the needs of a complex and changing health care system.
Describing the Delivery of Evidence-Based Physical Therapy Intervention to Individuals With Cerebral Palsy
Authors: Bailes Amy F. , Greve Kelly , Long Jason , Kurowski Brad G. , Vargus-Adams Jilda , Aronow Bruce , Mitelpunkt Alexis
Published: March 2021

Purpose:

To characterize by evidence grades and examine variation in type of physical therapy intervention delivered in routine clinical care in individuals with cerebral palsy (CP).

Methods:

Retrospective data collection from the electronic record over 1 year at a tertiary care pediatric outpatient therapy division.

Results:

Four hundred sixty-five individuals with CP received 28 344 interventions during 4335 treatment visits. Sixty-six percent of interventions were evidence-based interventions (EBIs). Significant variation was demonstrated across Gross Motor Function Classification System levels, with children classified as level V receiving the least and level III the most. The most frequent EBIs delivered were caregiver education, motor control, functional strengthening, ankle-foot orthoses, treadmill training, and fit of adaptive equipment.

Conclusions:

Further work is needed to determine whether amount of EBI is related to better outcomes. Combining this information with other aspects of dose (intensity, time, and frequency) may elucidate the contribution of each with outcomes.
Arboviral central nervous system infections
Authors: Schultz Jonathan S. , Sparks Hadrian , Beckham J. David
Published: March 2021

Purpose of review

This review provides an overview of arthropod-borne virus (arbovirus) infections that are important causes of human neurological infections world-wide. As many of the individual viruses in a specific genus or family cause overlapping clinical syndromes, this review discusses important viruses in groups to highlight some of the similarities and differences in groups of neuroinvasive arbovirus infections.

Recent Findings

Arboviruses that cause neurological infections in humans continue to emerge and distribute to new regions. The geographic range of the vectors, the hosts and subsequent arbovirus infections in humans continues to expand and evolve. As emerging arboviruses move into new geographic regions, it is important to examine the associated epidemiological and clinical impacts of these infections as they enter new populations.

Arboviruses from the Flaviviridae, Togaviridae and Bunyaviridae families continue to emerge and spread into new regions. The arboviruses within these virus families cause characteristic neuroinvasive diseases in human populations. A complete understanding of the epidemiological and clinical features of the neuroinvasive arboviruses is important such that these pathogens can be recognized and diagnosed in humans as they emerge. Ongoing research to develop rapid, accurate diagnostics, therapeutic options and vaccines for these pathogens is needed to address future outbreaks of disease in human populations.
The Effects of Lipoaspirate-Derived Fibrous Tissue on Survival Quality and Mechanical Property of Fat Grafts
Authors: Huang Ben , Zhang Xinyu , Yang Mingxia , Yin Bo , Cai Lei , Li Facheng , Han Xuefeng
Published: March 2021

Background:

Fibrous connective tissue (referred to as fiber) in lipoaspirates would be discarded before lipotransfer in case of cannula blockage. However, the fiber contains extracellular matrix which provide structure support and is rich in stromal vascular fractions (SVFs). Removal of the fiber might theoretically affect the survival quality and mechanical properties of fat grafts. But there is few evidence in vivo and vitro about how the fiber affects the fat grafts.

Objective:

To assess the effect of fibers on the survival quality and mechanical property of fat grafts.

Methods:

The SVFs in both fat and fiber were obtained by collagenase digestion for cells counting and comparison. Three groups were designed according to the different proportions of fat and fiber: the fat group (100% fat), the mixed group (50% fat, 50% fiber in volume ratio), and the fiber group (100% fiber). Three groups of grafts were transplanted in vivo to evaluate the differences in volume retention rate, histological characteristics and mechanical properties.

Results:

The amount of SVF cells in fibers (3.47 ± 1.49 × 104 cells/mL) was significantly lower than that in fat (12.3 ± 4.95 × 104 cells/mL) (P < 0.05). Grafts in the mixed group and the fiber group showed an increase of volume retention at week 4, but the fiber content showed no significant effects on the volume retention of grafts in three groups at week 12. Elasticity modulus of grafts in the fat group was higher than that in the fiber group and the mixed group at week 4 and 8, the fiber content showed no significant effects on the elasticity modulus of grafts in three groups at week 12. The addition of the fiber reduced the inflammation, cysts, fibrosis, and capillaries density of the grafts.

Conclusions:

There were few SVF cells in the fiber. When it was mixed with fat in different proportions and transplanted in vivo, the content of fiber showed no significantly different effects on the long-term volume retention and mechanical property of fat grafts. Due to the risk of blockage, it is recommended to discard the fiber in lipoaspirates.
The Role of TEG and ROTEM in Damage Control Resuscitation
Authors: Brill Jason B. , Brenner Megan , Duchesne Juan , Roberts Derek , Ferrada Paula , Horer Tal , Kauvar David , Khan Mansoor , Kirkpatrick Andrew , Ordonez Carlos , Perreira Bruno , Priouzram Artai , Cotton Bryan A.
Published: March 2021

Trauma-induced coagulopathy is associated with very high mortality, and hemorrhage remains the leading preventable cause of death after injury. Directed methods to combat coagulopathy and attain hemostasis are needed. The available literature regarding viscoelastic testing, including thrombelastography (TEG) and rotational thromboelastometry (ROTEM), was reviewed to provide clinically relevant guidance for emergency resuscitation. These tests predict massive transfusion and developing coagulopathy earlier than conventional coagulation testing, within 15 min using rapid testing. They can guide resuscitation after trauma, as well. TEG and ROTEM direct early transfusion of fresh frozen plasma when clinical gestalt has not activated a massive transfusion protocol. Reaction time and clotting time via these tests can also detect clinically significant levels of direct oral anticoagulants. Slowed clot kinetics suggest the need for transfusion of fibrinogen via concentrates or cryoprecipitate. Lowered clot strength can be corrected with platelets and fibrinogen. Finally, viscoelastic tests identify fibrinolysis, a finding associated with significantly increased mortality yet one that no conventional coagulation test can reliably detect. Using these parameters, guided resuscitation begins within minutes of a patient's arrival. A growing body of evidence suggests this approach may improve survival while reducing volumes of blood products transfused.
Monitoring the propagation of SARS CoV2 variants by tracking identified mutation in wastewater using specific RT-qPCR
Authors: Wurtzer S , Waldman P , Levert M , Mouchel JM , Gorgé O , Boni M , Maday Y ,   OBEPINE consortium, Marechal V , Moulin L
Published: March 2021

Since the end of 2020, the COVID-19 pandemic has experienced a major turning point with the appearance and rapid spread of new variants, causing a significant increase in the number of new cases requiring hospitalization. These so-called UK, South African or Brazilian variants are characterized by combinations of mutations which allow them to be distinguished from the variants which have circulated since the start of the epidemic. The impact of these variants on the functioning of healthcare systems requires monitoring the spread of these variants, which are more contagious, more lethal and may reinfect people who are already immune to a natural infection or to a vaccination. Monitoring the viral genome in wastewater has shown great value in early detection of the dynamics of virus spreading in populations.

The sequencing of viral genomes is used in humans, but its application and interpretation on wastewater matrices are much more complex due to the diversity of circulating strains. Also this study demonstrates the possibility of following certain mutations found in these new variants by targeted RT-qPCR. This study is the first carried out in France demonstrating the spreading dynamics of the 69-70 deletion in the Spike protein of SARS-CoV-2.
Effect of vaccination on transmission of COVID-19: an observational study in healthcare workers and their households
Authors: V Shah Anoop S , Gribben Ciara , Bishop Jennifer , Hanlon Peter , Caldwell David , Wood Rachael , Reid Martin , McMenamin Jim , Goldberg David , Stockton Diane , Hutchinson Sharon , Robertson Chris , McKeigue Paul M , Colhoun Helen M , McAllister David A
Published: March 2021

Background

The effect of vaccination for COVID-19 on onward transmission is unknown.

Methods

A national record linkage study determined documented COVID-19 cases and hospitalisations in unvaccinated household members of vaccinated and unvaccinated healthcare workers from 8th December 2020 to 3rd March 2021. The primary endpoint was COVID-19 14 days following the first dose.

Results

The cohort comprised of 194,362 household members (mean age 31·1 ± 20·9 years) and 144,525 healthcare workers (mean age 44·4 ± 11·4 years). 113,253 (78·3%) of healthcare workers received at least one dose of the BNT162b2 mRNA or ChAdOx1 nCoV-19 vaccine and 36,227 (25·1%) received a second dose. There were 3,123 and 4,343 documented COVID-19 cases and 175 and 177 COVID-19 hospitalisations in household members of healthcare workers and healthcare workers respectively. Household members of vaccinated healthcare workers had a lower risk of COVID-19 case compared to household members of unvaccinated healthcare worker (rate per 100 person-years 9·40 versus 5·93; HR 0·70, 95% confidence interval [CI] 0·63 to 0·78). The effect size for COVID-19 hospitalisation was similar, with the confidence interval crossing the null (HR 0·77 [95% CI 0·53 to 1·10]). The rate per 100 person years was lower in vaccinated compared to unvaccinated healthcare workers for documented (20·13 versus 8·51; HR 0·45 [95% CI 0·42 to 0·49]) and hospitalized COVID-19 (0·97 versus 0·14; HR 0·16 [95% CI 0·09 to 0·27]). Compared to the period before the first dose, the risk of documented COVID-19 case was lower at ≥ 14 days after the second dose for household members (HR 0·46 [95% CI 0·30to 0·70]) and healthcare workers (HR 0·08 [95% CI 0·04 to 0·17]).

Interpretation

Vaccination of health care workers was associated with a substantial reduction in COVID-19 cases in household contacts consistent with an effect of vaccination on transmission.
Household transmission of SARS-CoV-2 R.1 lineage with spike E484K mutation in Japan
Authors: Hirotsu Yosuke , Omata Masao
Published: March 2021

We aimed to investigate SARS-CoV-2 emerging lineage harboring variants in receptor binding domain (RBD) of spike protein in Japan. Total nucleic acids were subjected to whole genome sequencing on samples from 133 patients with coronavirus disease (COVID-19). We obtained the SARS-CoV-2 genome sequence from these patients and examined variants in RBD. As a result, three patients were infected with SARS-CoV-2 harboring E484K mutation in January 2021. These three patients were relatives; one was in the 40s, and two were younger than 10 years old. They had no history of staying abroad and were living in Japan. This strains were classified into GR clade (GISAID), 20B clade (Nextstrain) and R.1 lineage (PANGO). As of March 5, 2021, the R.1 lineage have been identified in 305 samples and dominantly observed in the USA (44%, 135 / 305) and Japan (28%, 84 / 305) from the GISAID database. During the period between October 26, 2020 and February 23, 2021, the frequency of the R.1 lineage was 0.97% (84 / 8,629) of the total confirmed data in Japan and 0.15% (135 / 90,450) in the USA. Although SARS-CoV-2 R.1 lineage was not globally predominant as of March 2021, further analysis is needed to determine whether R.1 variant will disappear or expand in the future.
Isolated fetal neural tube defects associate with increased risk of placental pathology: evidence from the Collaborative Perinatal Project
Authors: White Marina , Grynspan David , Van Mieghem Tim , Connor Kristin L
Published: March 2021

Objective

To compare placental pathology and fetal growth in pregnancies with an isolated fetal neural tube defect (NTD; cases) to those without congenital anomalies (controls). We hypothesised that cases would be at an increased risk of placental pathology and poorer anthropometric outcomes at birth compared to controls

Methods

We performed a matched case-cohort study using data from the Collaborative Perinatal Project. Cases (n=74) and controls (n=148) were matched (1:2 ratio) for maternal pre-pregnancy BMI, maternal race, infant sex, gestational age at birth and study site. Primary outcomes were placental characteristics (weight and size measurements, pathology). Secondary outcomes were infant birth outcomes. Subgroup analysis was done by type of NTD (spina bifida, anencephaly or encephalocele), infant sex, and preterm/term delivery. Data were analysed using adjusted generalized linear and nominal logistic regression models. Results are presented as adjusted β or adjusted odds ratio (aOR; 95% confidence interval).

Results

Cases had lower placental weight (β=-22.2 g [-37.8 – −6.6]), surface area (β=-9.6 cm2 [-18.3 – −1.0]) and birth length z-scores (β=-0.4 [-0.7 – −0.001]) compared to controls. Cases were more likely to have a single umbilical artery (vs. two; 6 [8.1%] vs. 1 [0.7%]; aOR=301 [52.6 – 1726]), overall placental hypermaturity (9 [12.2%] vs. 5 [3.4%]; aOR=6.8 [3.1 – 14.7]), and many (vs. few) Hofbauer cells (9 [12.2%] vs. 7 [4.7%]; aOR=3.02 [1.2 – 7.3]), stromal fibrosis (9 [12.2%] vs. 10 [6.8%]; aOR=3.0 [1.4 – 6.3]) and pathological edema (11 [14.9%] vs. 12 [8.1%]; aOR=3.04 [1.4 – 6.7]) in placental terminal villi compared to controls. Placental pathology varied across NTD subtypes, infant sex, and preterms vs. term pregnancies.

Conclusions

Fetuses with isolated NTDs may be at increased risk of placental pathology, which could be contributing to poor fetal growth in these pregnancies and subsequent postnatal morbidities.