bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring Knowledge, Beliefs, and Attitudes of Older Adults About Prescription Opioids
Authors: Rowan Noell , Arms Tamatha , Glose Susan
Published: December 2021

Over the past two decades, opioids have been considered important and acceptable in the treatment of pain for older adults, especially for chronic health conditions. Despite the fact that older adults are prescribed opioid medications at high rates, there is little research examining older adults’ knowledge, beliefs, and attitudes about opioid medications. The purpose of this study was to explore the knowledge, beliefs, and attitudes surrounding prescription opioid medications of community living older adults in a southeast area of the United States. A cross-sectional, descriptive, anonymous survey design of participants aged 55 or over was used. Study participants (N=119) reported bias in their attitudes and beliefs about the use and misuse of prescription opioid medications. Multiple regression analyses revealed that gender, age, work, marital status, and education level all had significant results in explaining variance in the statistical models. Even though study participants demonstrated high levels of education and understanding of the potential of addiction to opiates, there were a number of misconceptions revealed about prescription pain medications. This urges the necessity of increased awareness via further research, presentations, and creative discourse to assist in the understanding of precursors of addiction and ways to deal with pain that do not automatically rely on prescription opioid medicines. Implications include outreach to a larger and more diverse sample to address knowledge, beliefs, and attitudes surrounding prescription opioid medications of community living older adults.
Systems Barriers to Medication Management During Hospital to Home Transitions of Older Adults With Dementia
Authors: Keita-Fakeye Maningbe , Sharma Rhea , Greyson Sylvan , Samus Quincy , Gurses Ayse , Keller Sara , Arbaje Alicia
Published: December 2021

The hospital-to-home transition is a high-risk period for medication errors and adverse events for older adults living with dementia. Researchers conducted a qualitative study using semi-structured interviews and participant solicited diaries. Caregivers of adults ages 55 and older were recruited to understand barriers to medication management during hospital to skilled home health care transitions. We used a human factors engineering approach to guide our understanding of systems level barriers. At least two researchers independently coded each transcript using content analysis and the ATLAS.ti software. We interviewed 23 caregivers and identified five barrier types stemming from systems breakdowns related to: (1) knowledge and information, (2) access to and use of resources and tools, (3) caregiver burden, (4) pandemic concerns, and (5) health limitations. Caregivers grappled with receiving overwhelming, insufficient, incorrect, or conflicting information, and had difficulty managing information from different sources. Latinx caregivers encountered language barriers that impeded role and task clarity. Caregivers expressed mistrust in health systems elements and inability to access resources. Caregivers were in need of additional caregiving assistance, financial aid, and tools to manage medications. Balancing multiple medications and responsibilities left caregivers burdened. The health limitations of the older adult and COVID-19 concerns related to reduced access to resources and ability to deliver and receive in person care complicated task management. Altogether these barriers reflect systems level breakdowns impeding task understanding, execution, and overall management. These findings will inform the development of interdisciplinary strategies to ensure safer care transitions.
Building and Using Data Resources for Research on Job Characteristics, Health, and Retirement
Authors: Sonnega Amanda , Fisher Gwen
Published: December 2021

A growing literature seeks to understand the relationship between the experience of work and important later-life outcomes. Rich longitudinal measurement of both sides of this equation in datasets such as the Health and Retirement Study (HRS) have made this research possible. These data take the form of self-reported experiences of work (such as physical demands, job flexibility, job satisfaction etc.). Increasingly, researchers are looking to add potentially complementary information on the work environment available in the Occupational Information Network (O*NET) database through a linkage using occupation and industry codes in the survey data. The session talks will describe research conducted using O*NET linked with HRS data as well as ongoing work to create a new data resource that will allow other researchers to undertake research with O*NET-HRS linked data. Each presentation will include some discussion of both the value and limits of using the linkage to O*NET. Carpenter will provide a detailed description a new project linking the 2019 O*NET data to the HRS for public use.This presentation explains the types of variables that will be made available in the O*NET-HRS occupation project and will provide examples for how the measures can be used in longitudinal HRS studies. Using O*NET-HRS linked data, Carr will present on work examining the role of preretirement job complexity in alternative retirement paths and cognitive performance. Helppie-McFall will used the linked data to discuss the role of mismatch between demands of work and workers’ ability to meet those demands in retirement decisions.
The Longitudinal Association Between Social Isolation and Cognitive Decline Among Canadian Older Adults
Authors: Mehrabi Fereshteh , Béland François
Published: December 2021

Social isolation is an emerging public health concern with an emphasis on its potential preventive impact on cognitive impairment. We hypothesize that change in social isolation is associated with cognitive decline over two years. Latent growth models were used to test the hypothesis using data from the FRéLE longitudinal study among 1643 Canadian community-dwelling older adults aged 65 years and over. We assessed social isolation using social participation, social networks, and support from various social ties. We found that less contact with friends and children, less social support from friends, children, and partner, and the absence of partner were significantly associated with cognitive decline. Higher baseline social participation was related to the lower rate of cognitive decline over time. Fewer contacts with grandchildren were associated with cognitive decline over time. Our study suggests that public health policies in age-friendly cities and intergenerational contacts may promote cognitive health in older adults.
How Marital Status Shapes Grandparenting Children With Disabilities
Authors: Meyer Madonna Harrington
Published: December 2021

How does marital status shape grandparent care work when grandchildren have disabilities? Based on 50 in-depth interviews with grandparents who provide various types of care for grandchildren with disabilities, we find that marital status shapes care work in three distinct ways: (1) Many who are married describe both grandparents working as a team to provide vital care; (2) Some who are married describe spouses, primarily grandfathers, who are either unable or unwilling to provide care; and (3) Many who are not married, primarily grandmothers, describe providing relatively high levels of care and support despite relatively low resources. While nearly all report a great deal of joy and satisfaction with their care work, those who are single, have greater care responsibilities, and fewer resources are more likely to report adverse social, emotional, physical, and financial impacts. More robust social policies could alleviate the impact of marital status on grandparent care work.
Nursing Home Post-Acute Care Specialization Groups and Financial Outcomes
Authors: Wang Xiao (Joyce) , Burr Jeffrey , Weech-Maldonado Robert , Hefele Jennifer , Boerner Kathrin
Published: December 2021

Nursing homes (NHs) have increasingly specialized in post-acute care (PAC). However, it remains unclear as to why some NHs engage in more specialization than the others. Furthermore, the relationship between financial outcomes and PAC specialization has not been examined using more accurate financial indicators. This study developed a NH PAC specialization typology and examined financial outcomes (i.e. total revenue per inpatient day, operating margin) of different specialization groups. We employed NH-level panel data from 2011 through 2017 and focused on over 9,000 urban NHs per year. Multiple data sources were utilized like the Certification and Survey Provider Enhanced Reporting data; Medicare Cost Reports; and Brown University’s LTCfocUS. We employed Latent Profile Analysis to develop distinct NH care specialization groups based on PAC staffing levels. This analysis revealed heterogeneous and clustered patterns of PAC staffing utilization and identified a four-group typology: “low specialization,” “mixed specialization,” “moderate PAC specialization,” and “intensive PAC specialization.” Using fixed-effects modeling, we then examined financial outcomes of the four PAC specialization groups. Although being in a group with higher level of commitment to PAC specialization was associated with higher revenues, it was not necessarily associated with higher operating margins. Further, in stratified analyses, for-profit and not-for-profit NHs showed different patterns in these associations. This suggested that although NHs compete for patients paid at higher reimbursement policies, increased costs may offset higher revenues as a result of specialization. Future studies should track financial outcome trajectories of NHs by care specialization groups in light of various payment innovations.
Social Isolation and Suicidal Ideation of Older People: The Buffering Effects of Neighborhood Social Cohesion
Authors: Bomi Choi , Jun Hey Jung , Joo Susanna
Published: December 2021

This study aimed to examine the buffering effect of neighborhood social cohesion on the association of social isolation and suicidal ideation among Korean older people. The sample was older adults who were 65 years old or older and participated in the Korea Health Survey 2017 collected by the Center for Disease and Prevention (N=67,835). Social isolation was measured with three indicators: living-alone, contact isolation (less than weekly contact with family, friends, or neighbors), and participation isolation (less than monthly social organization attendance). Neighborhood social cohesion was measured with two indicators: trust in neighbors and the welfare budget ratio to represent social capital and social inclusion capabilities, respectively. Multilevel logistic regression analyses were performed to estimate the dynamic relationships between social isolation, neighborhood social cohesion, and suicidal ideation. Results of the main effect indicated that social isolation is a significant risk factor for suicidal ideation and neighborhood social cohesion works as a protective factor against suicidal ideation. Results of cross-level interactions showed that the welfare budget ratio moderated the association between participation isolation and suicidal ideation (OR=0.960, p<.001). The negative effect of participation isolation was reduced as the welfare budget ratio of the neighborhood increased. Neighborhood social cohesion indicators did not moderate the association between the remaining types of social isolation and suicidal ideation. The evidence from this study highlights the importance of social welfare expenditures when building suicide prevention interventions and age-friendly communities.
Promoting Health Equity Through Partnerships
Authors: Phillips Karon
Published: December 2021

Funded by The John A. Hartford Foundation, Trust for America’s Health’s (TFAH) Healthy Aging initiative has supported states as they develop Age-Friendly Public Health Systems (AFPHS). The goal of this national initiative is to make healthy aging a core function of state and local public health departments. Through this initiative, TFAH is working directly with states as they work to improve the health of older adults, with a particular focus on health equity. Given the increased prevalence of health disparities, prioritizing health equity has become important for many organizations. Through new partnerships and collaboration with aging services providers and health care systems, public health departments have developed innovative ways to improve the health and well-being of older adults from racial/ethnically diverse backgrounds. Areas of collaboration between the public health and aging sectors include sharing data on older adult health and working together to address social isolation.
Exploitation history of Atlantic bluefin tuna in the eastern Atlantic and Mediterranean—insights from ancient bones
Authors: Andrews Adam J , Di Natale Antonio , Bernal-Casasola Darío , Aniceti Veronica , Onar Vedat , Oueslati Tarek , Theodropoulou Tatiana , Morales-Muñiz Arturo , Cilli Elisabetta , Tinti Fausto
Published: December 2021

Overexploitation has directly, negatively affected marine fish populations in the past half-century, modifying not only their abundance but their behaviour and life-history traits. The recovery and resilience of such populations is dependent upon their exploitation history, which often extends back millennia. Hence, data on when exploitation intensified and how populations were composed in historical periods, have the potential to reveal long-term population dynamics and provide context on the baselines currently used in fisheries management and conservation. Here, we setup a framework for investigations on the exploitation history of Atlantic bluefin tuna (Thunnus thynnus; BFT) in the eastern Atlantic and Mediterranean by collating records of their zooarchaeological remains and critically reviewing these alongside the literature. Then, we outline how novel multidisciplinary applications on BFT remains may be used to document long-term population dynamics. Our review of literature provides clear evidence of BFT overexploitation during the mid-20th century ce. Furthermore, a strong case could be made that the intensification of BFT exploitation extends back further to at least the 19th century ce, if not the 13th–16th century ce, in the eastern Atlantic and Mediterranean. However, a host of archaeological evidence would suggest that BFT exploitation may have been intensive since antiquity. Altogether, this indicates that by the currently used management baselines of the 1970s,  population abundance and complexity was already likely to have declined from historical levels, and we identify how biomolecular and morphometric analyses of BFT remains have the potential to further investigate this.
False-Positive Human Immunodeficiency Virus Test Results in Patients Receiving Lentivirus-Based Chimeric Antigen Receptor T-Cell Therapy: Case Report, Review of the Literature, and Proposed Recommendations
Authors: Villalba Julian A , Maus Marcela V , Frigault Matthew J , Zaffini Rebecca , Gandhi Rajesh T , Rosenberg Eric S , Siedner Mark J
Published: December 2021

There are emerging reports of false-positive HIV nucleic acid testing (NAT) in patients who have received chimeric antigen receptor (CAR) T-cell therapies. We present a case of a 66-year-old-woman with primary-refractory stage IIIA double-hit high-grade B-cell lymphoma, in whom we detected false-positive HIV-1 NAT results after receipt of a third-generation self-inactivating investigational lentivirus-based CAR T-cell therapy. We reviewed the current state of the science on HIV-1 NAT and found that all reported false-positive cases have occurred in the setting of lentivirus-based CAR T-cell therapy and testing with FDA-approved platforms targeting the 5’LTR genomic region. Herein, we offer recommendations for HIV diagnostic testing in patients undergoing this mode of therapy. Clinicians managing this patient population should be aware of cross-reactivity between these therapeutic agents and commonly used HIV-1 NAT assays.
A scoping review of knowledge authoring tools used for developing computerized clinical decision support systems
Authors: Nair Sujith Surendran , Li Chenyu , Doijad Ritu , Nagy Paul , Lehmann Harold , Kharrazi Hadi
Published: December 2021

Objective

Clinical Knowledge Authoring Tools (CKATs) are integral to the computerized Clinical Decision Support (CDS) development life cycle. CKATs enable authors to generate accurate, complete, and reliable digital knowledge artifacts in a relatively efficient and affordable manner. This scoping review aims to compare knowledge authoring tools and derive the common features of CKATs.

Materials and Methods

We performed a keyword-based literature search, followed by a snowball search, to identify peer-reviewed publications describing the development or use of CKATs. We used PubMed and Embase search engines to perform the initial search (n = 1579). After removing duplicate articles, nonrelevant manuscripts, and not peer-reviewed publication, we identified 47 eligible studies describing 33 unique CKATs. The reviewed CKATs were further assessed, and salient characteristics were extracted and grouped as common CKAT features.

Results

Among the identified CKATs, 55% use an open source platform, 70% provide an application programming interface for CDS system integration, and 79% provide features to validate/test the knowledge. The majority of the reviewed CKATs describe the flow of information, offer a graphical user interface for knowledge authors, and provide intellisense coding features (94%, 97%, and 97%, respectively). The composed list of criteria for CKAT included topics such as simulating the clinical setting, validating the knowledge, standardized clinical models and vocabulary, and domain independence. None of the reviewed CKATs met all common criteria.

Conclusion

Our scoping review highlights the key specifications for a CKAT. The CKAT specification proposed in this review can guide CDS authors in developing more targeted CKATs.
Single-Center Experience With Paraquat Exposure in Nine Patients
Authors: McKinzie Brian P , Powell Brandon D , Sljivic Sanja , Hollowell Jamie , Maxwell Eli , Nizamani Rabia , King Booker , Williams Felicia N
Published: December 2021

Paraquat dichloride is a widely used, highly toxic chemical herbicide and a significant cause of fatal poisonings. Toxicity is thought to be secondary to generation of reactive oxygen species. Hours after exposure, patients may experience signs and symptoms ranging from nausea to multisystem organ failure. To mitigate complications and death, immunosuppression with cyclophosphamide and corticosteroid-based therapies has shown to be an effective option in limited studies. Our objective is to report our center’s experience treating patients that had been exposed to paraquat over a 2-day period. Patients were identified using our Institutional Burn Center registry and linked to the clinical and administrative data. Demographics, length of stay (LOS), costs, and mortality were evaluated. There were nine patients admitted from the exposure. All were male. All survived. Eight were undocumented migrant farmers. The average age was 36 years (25–59 years). The average LOS was 3.3 days (2–5 days). Seventy-eight percent had cutaneous injury, but only one required debridement and placement of a skin substitute. Thirty-three percent complained of continued shortness of breath after discharge. Average total hospital cost was $28,131 ($9,500–$51,000). Paraquat is a highly toxic herbicide and exposure can be fatal if not treated promptly. Immediate decontamination and repeated pulse therapy with cyclophosphamide and methylprednisolone may be life-saving.
Associations of Inflammatory Bowel Disease and Subsequent Cancers in a Population-Based Study of Older Adults in the United States
Authors: Wang Jeanny H , D’Arcy Monica , Barnes Edward L , Freedman Neal D , Engels Eric A , Song Minkyo
Published: December 2021

Background

Cancer risk is elevated in patients with inflammatory bowel disease (IBD). A comprehensive investigation of cancer risk in older patients (≥66 years of age) is needed, because this understudied population is at high risk.

Methods

We performed a case-control study using Surveillance Epidemiology and End Results–Medicare data including 1 986 735 incident cancer cases (aged 66-99 years; diagnosed 1992-2015) and 200 000 controls matched by sex, age, race and ethnicity, and selection year. IBD was identified by ulcerative colitis (UC) or Crohn’s disease (CD) diagnosis codes. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated with logistic regression, adjusting for potential confounders. For colorectal cancers, we further adjusted for screening rates. We assessed confounding by medication exposure among patients with prescription drug coverage.

Results

IBD, CD, and UC were present in 0.8%, 0.3%, and 0.5% in both cancer cases and non-cancer controls. Of 51 cancers examined, IBD was statistically significantly associated with cancers of the small intestine (OR = 2.55, 95% CI = 2.15 to 3.01), intrahepatic (OR = 1.92, 95% CI = 1.47 to 2.51) and extrahepatic bile ducts (OR = 1.75, 95% CI = 1.38 to 2.22), rectum (OR = 1.61, 95% CI = 1.36 to 1.90), and colon (OR = 1.21, 95% CI = 1.10 to 1.33). CD was associated with cancers of the small intestine (OR = 4.55, 95% CI = 3.65 to 5.67), and UC was associated with cancers of the intrahepatic bile ducts (OR = 1.87, 95% CI = 1.34 to 2.61), rectum (OR = 1.80, 95% CI = 1.47 to 2.20), and colon (OR = 1.28, 95% CI = 1.14 to 1.43). After adjusting for medication exposure, IBD was not statistically significantly associated with lung cancer, melanoma, diffuse large B-cell lymphoma, and myelodysplastic syndrome.

Conclusions

In this large study among older adults (≥66 years of age), IBD was positively associated with gastrointestinal cancers. Associations with extraintestinal cancers may reflect the effect of immunosuppressive medications.
Bank Consolidation, Interest Rates, and Risk: A Post-Merger Analysis Based on Loan-Level Data from the Corporate Sector*
Authors: Juranek Steffen , Nilsen Øivind A , Ulsaker Simen A
Published: December 2021

In this paper, we analyze the bank merger between DnB and Gjensidige Bank in 2003, ranked by market share as number one and number three in the Norwegian bank market. Focusing on loans to firms, our difference-in-differences analysis shows no increase of concentration of new loans. The concentration in affected markets (markets where both merging parties were present) developed similar to unaffected markets. Moreover, the interest rate tended to be lower in the affected markets relative to unaffected markets, but this relationship is weak and not statistically significant. The merger also affected the riskiness of loans only marginally. These weak effects could be the result of efficiency gains in the form of lower costs being pass-through to customers, and the increased market power (and consequently higher interest rates) canceled each other out. The remedial measures imposed by the Norwegian Competition Authority on the two merging parties are also likely to explain some of the modest effects of the merger. The weak effects are largely coincident with international literature showing the effects of mergers and acquisitions in the banking sector to be modest.
The Great Lakes Silviculture Library: Insights into a Case Study Platform
Authors: Moser Robert Lane , Sagor Eli S , Russell Matthew B , Windmuller-Campione Marcella A
Published: December 2021

Innovation and knowledge exchange are critical to foster adaptive management and continual learning. Across the spectrum of knowledge exchange, ranging from peer-reviewed research to anecdotes, there is a largely untapped middle ground: real-world silvicultural case studies implemented and documented by foresters. The University of Minnesota Great Lakes Silviculture Library is a novel, freely available platform designed to enable foresters to exchange these case studies. Five years after its launch, we conducted focus groups with foresters from Minnesota and Wisconsin, USA, and Ontario, Canada, to explore the platform’s usage and value. Participants valued having access to examples of silvicultural treatments and their outcomes that they could easily digest, apply, and share. They gained new knowledge from management across administrative boundaries. They also appreciated the consistent, relatable case study format. However, participants noted that limited time was the primary barrier to wider authorship and readership. The Library enables information exchange across agencies and disciplines within natural resources, giving greater voice to practicing foresters and supplementing other sources of forestry knowledge.
A conditional, a fuzzy and a probabilistic interpretation of self-organizing maps
Authors: Giordano Laura , Gliozzi Valentina , Theseider DuprÉ Daniele
Published: December 2021

In this paper we establish a link between fuzzy and preferential semantics for description logics and self-organizing maps (SOMs), which have been proposed as possible candidates to explain the psychological mechanisms underlying category generalization. In particular, we show that the input/output behavior of a SOM after training can be described by a fuzzy description logic interpretation as well as by a preferential interpretation, based on a concept-wise multipreference semantics, which takes into account preferences with respect to different concepts and has been recently proposed for ranked and for weighted defeasible description logics. Properties of the network can be proven by model checking on the fuzzy or on the preferential interpretation. Starting from the fuzzy interpretation, we also provide a probabilistic account for this neural network model.
Detecting Soldiers’ Fatigue Using Eye-Tracking Glasses: Practical Field Applications and Research Opportunities
Authors: Schweizer Theresa , Wyss Thomas , Gilgen-Ammann Rahel
Published: December 2021

Introduction

Objectively determining soldiers’ fatigue levels could help prevent injuries or accidents resulting from inattention or decreased alertness. Eye-tracking technologies, such as optical eye tracking (OET) and electrooculography (EOG), are often used to monitor fatigue. Eyeblinks—especially blink frequency and blink duration—are known as easily observable and valid biomarkers of fatigue. Currently, various eye trackers (i.e., eye-tracking glasses) are available on the market using either OET or EOG technologies. These wearable eye trackers offer several advantages, including unobtrusive functionality, practicality, and low costs. However, several challenges and limitations must be considered when implementing these technologies in the field to monitor fatigue levels. This review investigates the feasibility of eye tracking in the field focusing on the practical applications in military operational environments.

Materials and Method

This paper summarizes the existing literature about eyeblink dynamics and available wearable eye-tracking technologies, exposing challenges and limitations, as well as discussing practical recommendations on how to improve the feasibility of eye tracking in the field.

Results

So far, no eye-tracking glasses can be recommended for use in a demanding work environment. First, eyeblink dynamics are influenced by multiple factors; therefore, environments, situations, and individual behavior must be taken into account. Second, the glasses’ placement, sunlight, facial or body movements, vibrations, and sweat can drastically decrease measurement accuracy. The placement of the eye cameras for the OET and the placement of the electrodes for the EOG must be chosen consciously, the sampling rate must be minimal 200 Hz, and software and hardware must be robust to resist any factors influencing eye tracking.

Conclusion

Monitoring physiological and psychological readiness of soldiers, as well as other civil professionals that face higher risks when their attention is impaired or reduced, is necessary. However, improvements to eye-tracking devices’ hardware, calibration method, sampling rate, and algorithm are needed in order to accurately monitor fatigue levels in the field.
Predictors of persistent inflammation in children with familial Mediterranean fever
Authors: Gezgin Yıldırım Deniz , Esmeray Senol Pelin , Söylemezoğlu Oğuz
Published: December 2021

Objectives

Persistent inflammation is an insidious feature of familial Mediterranean fever (FMF) that may cause chronic complications. This study aimed to investigate the predictors of persistent inflammation in children with FMF.

Methods

The medical charts of 1077 paediatric FMF patients were retrospectively collected. The patients were divided into two groups: with and without subclinical inflammation.

Results

A total of 133 (12%) patients had persistent inflammation. M694V homozygosity, colchicine resistance, positive family history for FMF, erysipelas-like erythema, leg pain, arthritis, chest pain, inflammatory comorbidities, early disease onset, high PRAS score, and long attack duration were established as independent predictors of persistent inflammation (P < .001, P < .001, P < .001, P < .001, P = 0.006, P < .001, P < .001, P = .014, P < .001, P < .001, and P < .001, respectively). However, gender, abdominal pain, fever, and attack frequency were not found to be independent risk factors for predicting persistent inflammation (P = .412, P = .531, P = .451, and P = .693, respectively).

Conclusions

M694V homozygosity, colchicine resistance, positive family history, erysipelas-like erythema, leg pain, arthritis, chest pain, inflammatory comorbidities, early disease onset, high activity score, and long attack duration may be predictors of persistent inflammation in FMF. These predictors may help clinicians suspect the occurrence of subclinical inflammation and should aid in better disease management in FMF.
Fairness, Individuality, and Free Riding
Authors: Morgan-Knapp Christopher
Published: December 2021

According to most contemporary theorists, free riding on the cooperative contributions of others is unfair. At the same time, obligations to contribute to cooperative schemes can compel conformity with conventional practices, and can do so to a degree that poses a real threat to individuality. This paper exposes this tension between fairness and individuality, and proposes a way to resolve it. The resolution depends on an alternative approach to understanding fairness—one that appeals to the relational goods fairness is meant to maintain. In particular, norms of fairness protect against the interactions within a relationship becoming disrespectful. Many instances of free riding are indeed disrespectful and hence unfair. But this is not always so: one can choose to live a lifestyle that fails to return the benefits their community provides without disrespecting one's fellows. It is thus possible to free ride without being unfair, and so duties of fairness need not add to those already formidable forces that threaten to extinguish valuable individuality.
An Exploration of the Experiences of Physical Therapists Who Identify as LGBTQIA+: Navigating Sexual Orientation and Gender Identity in Clinical, Academic, and Professional Roles
Authors: Ross Megan H , Hammond John , Bezner Janet , Brown Darren , Wright Andrea , Chipchase Lucy , Miciak Maxi , Whittaker Jackie L , Setchell Jenny
Published: December 2021

Objective

The purpose of this study was to explore physical therapy through the stories of physical therapists who identify as lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other related identities (LGBTQIA+) to consider how the profession enacts and constructs gender and sexual orientation.

Methods

Physical therapists with clinical, academic, and professional roles who identify as LGBTQIA+ were recruited from Australia, the United Kingdom, Canada, and the United States. In-depth data were collected via narrative interviews. An iterative group discourse analysis was used to examine key discourses underpinning interview narratives and how these relate to the physical therapy profession.

Results

Twenty-two physical therapists were interviewed. Participants had between 1.5 and 40 years of experience across various clinical areas and settings. Participants identified with varying sexual orientations and gender identities. Analysis identified discourses discussed under the following headings: (1) normativity, which related to hetero-normative assumptions about sexual orientation and cisnormative assumptions about gender identity and the intersectionality among sexual orientation, gender identity, and other forms of marginalization; (2) stress and labor, which explored the stress experienced by physical therapists who are LGBTQIA+ (due to fear of discrimination or actual discrimination) and additional emotional and other types of labor or work done in the workplace to hide aspects of their lives to feel safe, educate colleagues, and be a role model; and (3) professionalism, which related to the heterosexual/cisnormative (and other) “norms” that comprised participants’ ideas of presenting as “professional” and positioning physical therapists who are LGBTQIA+ as “unprofessional.”

Conclusion

Findings suggest that cultural norms may need to be reconceptualized in physical therapy to promote inclusion and belonging of individuals who identify as LGBTQIA+. Approaches to upskill new and existing physical therapists may include elements such as individual and institutional reflexivity, learning and implementing appropriate terminology, displaying indicators of inclusivity, and cultural safety training. These elements may provide the first steps to promote inclusive and culturally safe environments for individuals who identify as LGBTQIA+ within the profession.

Impact

This is the first known study to explore the lived experiences of those who identify as LGBTQIA+ in the physical therapy profession. The findings highlight how prevailing normative discourses in Western society are also present in physical therapy and impact those who identify as LGBTQIA+.
Therapeutic efficacy of denosumab for rheumatoid arthritis: a systematic review and meta-analysis
Authors: Yagita Mayu , Morita Takayoshi , Kumanogoh Atsushi
Published: December 2021

Objectives

Denosumab is used for osteoporosis because it inhibits osteoclast maturation and suppresses bone resorption. Although denosumab is expected to inhibit the bone erosion in RA, its therapeutic efficacy is not well established. The aim of this study was to estimate the effects of denosumab on RA through a meta-analysis.

Methods

A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. PubMed, Web of Science and Scopus were searched for original studies providing information on BMD, joint destruction and disease activity in denosumab-treated RA. A random-effects model was used in the meta-analysis.

Results

Of the 367 studies identified, 18 met the selection criteria. The BMDs of the lumbar spine, total hip and femoral neck at 12 months after denosumab treatment increased by 5.27% (95% CI: 4.37, 6.18), 2.82% (2.46, 3.18) and 3.07% (2.66, 3.48), respectively. In the sensitivity analysis, age and sex tended to influence the effect of denosumab therapy on the rate of variation of BMD, but not glucocorticoid use. The changes in the modified total sharp, erosion and joint space narrowing scores at 12 months after denosumab treatment were significantly smaller with denosumab than with placebo, although the DAS did not change after denosumab treatment.

Conclusion

Although denosumab has an inhibitory effect on the bone resorption in RA, its effects might be influenced by the age and sex of RA patients, but not by glucocorticoid use.
Hydroxyapatite composited PEEK with 3D porous surface enhances osteoblast differentiation through mediating NO by macrophage
Authors: Liu Xingdan , Ouyang Liping , Chen Lan , Qiao Yuqin , Ma Xiaohan , Xu Guohua , Liu Xuanyong
Published: December 2021

The adverse immune response mediated by macrophages is one of the main factors that are prone to lead poor osseointegration of polyetheretherketone (PEEK) implants in clinic. Hence, endowing PEEK with immunomodulatory ability to avoid the adverse immune response becomes a promising strategy to promote bone repair. In this work, sulfonation and hydrothermal treatment were used to fabricate a 3D porous surface on PEEK and hydroxyapatite (HA) composited PEEK. The HA composited PEEK with 3D porous surface inhibited macrophages polarizing to M1 phenotype and downregulated inducible nitric oxide synthase protein expression, which led to a nitric oxide concentration reduction in culture medium of mouse bone marrow mesenchymal stem cells (mBMSCs) under co-culture condition. The decrease of nitric oxide concentration could help to increase bone formation-related OSX and ALP genes expressions and decrease bone resorption-related MMP-9 and MMP-13 genes expressions via cAMP–PKA–RUNX2 pathway in mBMSCs. In summary, the HA composited PEEK with 3D porous surface has the potential to promote osteogenesis of PEEK through immunomodulation, which provides a promising strategy to improve the bone repair ability of PEEK.
Automated Segmentation of Spinal Muscles From Upright Open MRI Using a Multiscale Pyramid 2D Convolutional Neural Network
Authors: Dourthe Benjamin , Shaikh Noor , Pai S. Anoosha , Fels Sidney , Brown Stephen H.M. , Wilson David R. , Street John , Oxland Thomas R.
Published: December 2021

Study Design.

Randomized trial.

Objective.

To implement an algorithm enabling the automated segmentation of spinal muscles from open magnetic resonance images in healthy volunteers and patients with adult spinal deformity (ASD).

Summary of Background Data.

Understanding spinal muscle anatomy is critical to diagnosing and treating spinal deformity.

Muscle boundaries can be extrapolated from medical images using segmentation, which is usually done manually by clinical experts and remains complicated and time-consuming.

Methods.

Three groups were examined: two healthy volunteer groups (N = 6 for each group) and one ASD group (N = 8 patients) were imaged at the lumbar and thoracic regions of the spine in an upright open magnetic resonance imaging scanner while maintaining different postures (various seated, standing, and supine). For each group and region, a selection of regions of interest (ROIs) was manually segmented. A multiscale pyramid two-dimensional convolutional neural network was implemented to automatically segment all defined ROIs. A five-fold crossvalidation method was applied and distinct models were trained for each resulting set and group and evaluated using Dice coefficients calculated between the model output and the manually segmented target.

Results.

Good to excellent results were found across all ROIs for the ASD (Dice coefficient >0.76) and healthy (dice coefficient > 0.86) groups.

Conclusion.

This study represents a fundamental step toward the development of an automated spinal muscle properties extraction pipeline, which will ultimately allow clinicians to have easier access to patient-specific simulations, diagnosis, and treatment.
Safety and Vascular Impact of Perforator Propeller Flaps during Distal Lower Limb Reconstruction
Authors: Eldahshoury Tarek , Cacciola Roberto , El-Gazzar Khaled
Published: December 2021

Background:

In distal lower limb defects, the paucity of local tissues dictates a free-flap (FF)-based reconstruction frequently. The propeller perforator flap (PPF) offers a good alternative when the patient or the limb or both are not fit for FF-based reconstruction. Also, in contexts of restricted healthcare resources, armed conflict scenarios, or during pandemics like the ongoing COVID-19 pandemic, PPF is considered a valuable alternative to free-flap-based reconstruction. Additionally, PPFs are less sacrificing in terms of major limb vessels and distal limb vascularity. Yet, the distal lower limb vascular impact for PPF-based reconstruction has not been studied before.

Methods:

In total, 23 patients with distal lower limb defects were reconstructed with PPFs. By using U/S arterial duplex, the peak arterial velocity (PA velocity) was measured pre and postoperatively in 15 (65.2%) out of the 23 patients. This measurement was done to the vessel segment distal to the used perforator.

Results:

An estimated 21 out of 23 flaps succeeded to reconstruct the patients’ defects safely and to give all patients stable coverage without further surgeries. Only two patients had flap failure, which was managed successfully through additional reconstruction sessions. The difference between pre- and postoperative PA velocity was not statistically significant.

Conclusions:

PPFs are a safe cost-effective reconstruction modality for distal lower limb defects. This advantage is very valuable in cases of restricted healthcare resources, wars, and during pandemics. In terms of distal limb vascularity, PPFs have no significant impact and can be used safely.
Right-sided Electrocardiogram in Patients With Acute Pulmonary Embolism
Authors: Jahanian Sekineh , Ayati Aryan , Hosseini Kaveh , Heidari Firouzeh , Yadangi Somayeh , Ahmadian Tahereh , Hosseinsabet Ali , Jenab Yaser
Published: December 2021

Background:

Acute pulmonary embolism (APE) is an emergent condition. The diagnostic tools are CT angiography and echocardiography. However, all of these modalities can be used under stable and nonemergent conditions. As electrocardiographic (ECG) studies are more feasible under emergent situations, Objective: we aimed to study right-sided ECG (RS-ECG) in patients with APE with further analysis regarding echocardiographic findings and pulmonary embolism severity index (PESI).

Methods:

Right-sided and standard electrocardiogram were obtained from 143 patients with confirmed APE. T-wave inversion, ST segment elevation (STE), and QS pattern in RS-ECG have been considered as abnormal changes.

Results:

T-wave inversion, STE, and QS pattern were found in 78.3%, 42%, and 39.9% of patients, respectively. 88.1% of patients showed at least one of these abnormalities in their RS-ECGs. Sensitivity of RS-ECG for APE was 0.88, which was higher than sensitivity of standard ECG (0.79). Patients with STE in right precordial leads, had increased right to left ventricular (RV/LV) diameter ratio (P = 0.021) and had higher PESI score (P = 0.000). Moreover, STE in RS-ECG was an independent predictor for PESI score in patients with moderate (odds ratio 4.05; 95% confidence interval [CI], 1.37-11.96; P < 0.05) and high 30-day mortality risk (odds ratio 8.42; 95% CI, 2.08-33.93; P < 0.05).

Conclusions:

Abnormal changes in RS-ECG were associated with an increase in RV/LV diameter ratio and higher PESI score, which may be indicated poor prognosis in patients with APE. The most clinically useful ECG finding was STE which was associated with increased RV/LV diameter ratio and PESI score.
CHOROIDAL NEOVASCULARIZATION IN TORPEDO MACULOPATHY TREATED BY AFLIBERCEPT: LONG-TERM FOLLOW-UP USING OPTICAL COHERENCE TOMOGRAPHY AND OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Ghezzaz Amina , Idlefqih Wafa , Chahed Sadri , Mahdjoubi Amir
Published: December 2021

Purpose:

To report a case of torpedo maculopathy (TM) in an elderly patient complicated by choroidal neovascularization (CNV) and that was treated by intravitreal aflibercept injections and monitored during 30 months using optical coherence tomography (OCT) and OCT angiography.

Methods:

A 74-year-old woman complained of a metamorphopsia in the left eye. Visual acuity was 20/25 while fundus examination showed a hypopigmented torpedo-shaped chorioretinal lesion in the temporal macula associated with a retinal exudation.

Results:

Multimodal imaging showed a severe chorioretinal excavation confirming the diagnosis of TM associated with an exudative Type 1 CNV. Intravitreal aflibercept injections allowed an initial good anatomical and functional improvement, but multiple recurrences occurred. At the last visit, 30 months after the start of 14 intravitreal aflibercept injections, a persistent subretinal fluid was present with a decreased visual acuity to 20/32 while the CNV surface grew in OCT angiography.

Conclusion:

This first case of long-term follow-up of CNV secondary to TM showed an anti-VEGF dependency or even a resistance with extension of CNV. Thus, a deep retinochoroidal atrophy could be the late evolution of TM that may result on severe CNV in advanced stages. A regular TM monitoring including OCT and OCT angiography would be necessary to detect any potential CNV for an early and aggressive treatment.
EXTENSIVE ORBITAL AND PARAPHARYNGEAL EMPHYSEMA REQUIRING URGENT CANTHOTOMY AND CANTHOLYSIS AFTER PARS PLANA VITRECTOMY
Authors: Nithianandan Harrish , Nassrallah Georges , Al-Kaabi Abdullah , Politis Michael , Campagnoli Thalmon , Khan Zainab , Kapusta Michael A.
Published: December 2021

Purpose:

The authors report the emergent management of a case of orbital and parapharyngeal emphysema causing orbital compartment syndrome and signs of peripheral neuropathy days after pars plana vitrectomy.

Methods:

Case report.

Results:

A 20-year-old woman underwent 3-port 23-gauge pars plana vitrectomy in the right eye for total retinal detachment under general anesthesia. All sclerotomies were secured with 7-0 polyglactin 910 (Vicryl; Ethicon) sutures before instillation of 15% C3F8 gas. On the third postoperative day, the patient presented with a 3-mm proptosis, near-total ophthalmoplegia, jaw protrusion, head deviation, tongue protrusion, and facial twitching. Computed tomography showed extensive subcutaneous gas in the right orbit and bilateral parapharyngeal spaces, and a tethered right optic nerve with globe tenting. A decision was made to perform urgent lateral canthotomy and cantholysis. Three hours after canthotomy and cantholysis, her neurologic signs had resolved except for intermittent tongue protrusion, which resolved thereafter. At postoperative Week 7, the patient's vision was 20/70 and her intraocular pressure was 13 mmHg.

Conclusion:

To the authors' knowledge, this is the only report of a modern small-gauge vitrectomy procedure being complicated by orbital compartment syndrome and extensive emphysema causing peripheral neuropathy, and successfully treated with urgent canthotomy and cantholysis.