bluuebunny/crossref_metadata_2025 huggingface dataset:
Vaping in Pregnancy: A Systematic Review
Authors: Calder Robert , Gant Eleanor , Bauld Linda , McNeill Ann , Robson Debbie , Brose Leonie S
Published: January 2021

Introduction

Smoking in pregnancy increases the risk of negative health outcomes. Vaping can be effective for smoking cessation in nonpregnant populations. We conducted a systematic review of vaping in pregnancy, covering prevalence, patterns of use, reasons for use, smoking cessation, and health effects.

Methods

Five academic databases were searched on 17 February 2020. Studies reporting prevalence, patterns, reasons, cessation, or health effects of vaping in pregnancy were included; animal and in vitro studies were excluded. A narrative review was used, with risk of bias assessed using Hoy and colleague’s tool, the Newcastle–Ottawa scale, and the Consolidated Criteria for reporting Qualitative Research.

Results

Twenty-three studies were identified: 11 survey, 7 qualitative, 3 cohort, and 2 secondary analyses of randomized clinical trials. Prevalence of vaping in pregnancy (four studies) was between 1.2% and 7.0% overall, and <1% among nonsmokers. Twelve studies reported patterns of use, but findings were inconsistent. Twelve of 14 studies asking why pregnant women vaped reported that most vaped to reduce or quit smoking. Mixed findings were reported from six studies on smoking cessation. Of three studies with health-related outcomes, two were underpowered and one reported similar birthweights for babies born to nonsmokers and women who vaped, with both higher (p < .0001) than the birthweight of babies born to smokers.

Conclusions

There were insufficient data to draw conclusions about prevalence, patterns, and effects of vaping in pregnancy on smoking cessation. The limited literature suggests that vaping in pregnancy has little or no effect on birthweight.

Implications

Smoking causes many negative health outcomes for pregnant women and to babies born to people who smoke. There remains a paucity of research on the effects of vaping in pregnancy. There is, however, the potential for vaping products to reduce the negative health outcomes associated with smoking. More research is needed to develop an evidence base in this area.
Mucosal immune responses in COVID19 - a living review
Authors: Pearson Claire F , Jeffery Rebecca ,   The Oxford-Cardiff COVID-19 Literature Consortium, Ahern David J , Almuttaqi Hannah , Alonzi Dominic S , Alrubayyi Aljawharah , Alsaleh Ghada , Bart Valentina M T , Batchelor Vicky , Bayliss Rebecca , Berthold Dorothée L , Bezbradica Jelena S , Bharuchq Tehmina , Borrmann Helene , Borsa Mariana , Borst Rowie , Brun Juliane , Burnell Stephanie , Capitani Lorenzo , Cavounidis Athena , Chapman Lucy , Chauveau Anne , Cifuentes Liliana , Codd Amy Susan , Compeer Ewoud Bernardus , Coveney Clarissa , Cross Amy , Danielli Sara , Davies Luke C , Dendrou Calliope A , Dimonte Sandra , Peter Durairaj Ruban Rex , Dustin Lynn B , Dyer Arthur , Fielding Ceri , Fischer Fabian , Gallimore Awen , Galloway Sarah , Gammage Anís , Gea-Mallorquí Ester , Godkin Andrew , Hanna Stephanie Jean , Heuberger Cornelia , Hulin-Curtis Sarah , Issa Fadi , Jones Emma , Jones Ruth , Ladell Kristin , Lauder Sarah N , Liddiard Kate , Ligoxygakis Petros , Lu Fangfang , MacLachlan Bruce , Maleki-Toyserkani Shayda , Mann Elizabeth H , Marzeda Anna M , Matthews Reginald James , Mazet Julie M , Milicic Anita , Mitchell Emma , Moon Owen , Nguyen Van Dien , O'Hanlon Miriam , Pavillet Clara Eléonore , Peppa Dimitra , Pires Ana , Pring Eleanor , Quastel Max , Reed Sophie , Rehwinkel Jan , Richmond Niamh , Richter Felix Clemens , Robinson Alice J B , Rodrigues Patrícia R S , Sabberwal Pragati , Sami Arvind , Peres Raphael Sanches , Sattentau Quentin , Schonfeldova Barbora , Scourfield David Oliver , Selvakumar Tharini A , Shepherd Freya R , Shorten Cariad , Simon Anna Katharina , Smith Adrian L , Crespo Alicia Teijeira , Tellier Michael , Thornton Emily , Uhl Lion F K , van Grinsven Erinke , Wann Angus K T , Williams Richard , Wilson Joseph D , Zhou Dingxi , Zhu Zihan , Thornton Emily E
Published: January 2021

COVID-19 was initially characterized as a disease primarily of the lungs, but it is becoming increasingly clear that the SARS-CoV2 virus is able to infect many organs and cause a broad pathological response. The primary infection site is likely to be a mucosal surface, mainly the lungs or the intestine, where epithelial cells can be infected with virus. Although it is clear that virus within the lungs can cause severe pathology, driven by an exaggerated immune response, infection within the intestine generally seems to cause minor or no symptoms. In this review, we compare the disease processes between the lungs and gastrointestinal tract, and what might drive these different responses. As the microbiome is a key part of mucosal barrier sites, we also consider the effect that microbial species may play on infection and the subsequent immune responses. Because of difficulties obtaining tissue samples, there are currently few studies focused on the local mucosal response rather than the systemic response, but understanding the local immune response will become increasingly important for understanding the mechanisms of disease in order to develop better treatments.
Scale Shortening and Decrease in Measurement Precision: Analysis of the Pain Self-Efficacy Questionnaire and Its Short Forms in an Italian-Speaking Population With Neck Pain Disorders
Authors: Monticone Marco , Giordano Andrea , Franchignoni Franco
Published: January 2021

Objective

Short (2- and 4-item) forms of the Pain Self-Efficacy Questionnaire (PSEQ) have been proposed, but their measurement precision at the individual level is unclear.

The purpose of this study was to analyze the Rasch psychometric characteristics of PSEQ and its 3 short forms (one 4-item and two 2-item versions) in an Italian-speaking population with neck pain (NP) disorders and compare their measurement precision at the individual level through calculation of the test information function (TIF).

Methods

Secondary analysis of data from a prospective single-group observational study was conducted. In 161 consecutive participants (mean age = 45 years [SD = 14]; 104 women) with NP disorders, a Rasch analysis was performed on each version of the PSEQ (full scale plus 3 short forms), and the TIF was calculated to examine the degree of measurement precision in estimating person ability over the whole measured construct (pain self-efficacy).

Results

In all versions of the PSEQ, the rating scale fulfilled the category functioning criteria, and all items showed an adequate fit to the Rasch model. The TIF showed a bell-shaped distribution of information, with an acceptable measurement precision (standard error <0.5) for persons with a wide range of ability; conversely, measurement precision was unacceptably low in each short form (particularly the two 2-item versions).

Conclusions

The results confirm and expand reports on the sound psychometric characteristics of PSEQ, showing for the first time, to our knowledge, its conditional precision in estimating pain self-efficacy measures in Italian individuals with NP disorders. The study cautions against use of the 3 PSEQ short forms for individual-level clinical decision-making.

Impact

Short scales are popular in rehabilitation settings largely because they can save assessment time and related costs. The psychometric characteristics of the 10-item PSEQ were confirmed and deepened, including its precision in estimating individual pain self-efficacy at different levels of this latent variable. On the other hand, low measurement precision of the 3 PSEQ short forms cautions against their use for individual judgments.
Characterizing Pelvic Floor Muscle Function and Morphometry in Survivors of Gynecological Cancer Who Have Dyspareunia: A Comparative Cross-Sectional Study
Authors: Cyr Marie-Pierre , Dumoulin Chantale , Bessette Paul , Pina Annick , Gotlieb Walter H , Lapointe-Milot Korine , Morin Mélanie
Published: January 2021

Objective

More than one-half of gynecological cancer survivors are affected by pain during sexual intercourse, also known as dyspareunia. Oncological treatments may result in pelvic floor muscle (PFM) alterations, which are suspected to play a key role in dyspareunia. However, to our knowledge, no study has investigated PFM function and morphometry in this population. The aim of the study was to characterize and compare PFM function and morphometry between gynecological cancer survivors with dyspareunia and asymptomatic women.

Methods

Twenty-four gynecological cancer survivors with dyspareunia and 32 women with a history of total hysterectomy but without pelvic pain (asymptomatic women) participated in this comparative cross-sectional study. PFM passive forces (tone), flexibility, stiffness, maximal strength, coordination, and endurance were assessed with an intra-vaginal dynamometric speculum. Bladder neck position, levator plate angle, anorectal angle, and levator hiatal dimensions were measured at rest and on maximal contraction with 3D/4D transperineal ultrasound imaging.

Results

Compared with asymptomatic women, gynecological cancer survivors showed heightened PFM tone, lower flexibility, higher stiffness, and lower coordination and endurance. At rest, they had a smaller anorectal angle and smaller levator hiatal dimensions, indicating heightened PFM tone. They also presented fewer changes from rest to maximal contraction for anorectal angle and levator hiatal dimensions, suggesting an elevated tone or altered contractile properties.

Conclusions

Gynecological cancer survivors with dyspareunia present with altered PFM function and morphometry. This research therefore provides a better understanding of the underlying mechanisms of dyspareunia in cancer survivors.

Impact

Our study confirms alterations in PFM function and morphometry in gynecological cancer survivors with dyspareunia. These findings support the rationale for developing and assessing the efficacy of physical therapy targeting PFM alterations in this population.
Folklore
Authors: Michalopoulos Stelios , Xue Melanie Meng
Published: January 2021

Folklore is the collection of traditional beliefs, customs, and stories of a community passed through the generations by word of mouth. We introduce to economics a unique catalog of oral traditions spanning approximately 1,000 societies. After validating the catalog’s content by showing that the groups’ motifs reflect known geographic and social attributes, we present two sets of applications. First, we illustrate how to fill in the gaps and expand upon a group’s ethnographic record, focusing on political complexity, high gods, and trade. Second, we discuss how machine learning and human classification methods can help shed light on cultural traits, using gender roles, attitudes toward risk, and trust as examples. Societies with tales portraying men as dominant and women as submissive tend to relegate their women to subordinate positions in their communities, both historically and today. More risk-averse and less entrepreneurial people grew up listening to stories wherein competitions and challenges are more likely to be harmful than beneficial. Communities with low tolerance toward antisocial behavior, captured by the prevalence of tricksters being punished, are more trusting and prosperous today. These patterns hold across groups, countries, and second-generation immigrants. Overall, the results highlight the significance of folklore in cultural economics, calling for additional applications.
Health outcomes of continuous positive airway pressure versus mandibular advancement device for the treatment of severe obstructive sleep apnea: an individual participant data meta-analysis
Authors: Trzepizur Wojciech , Cistulli Peter A , Glos Martin , Vielle Bruno , Sutherland Kate , Wijkstra Peter J , Hoekema Aarnoud , Gagnadoux Frédéric
Published: January 2021

Study Objectives

The impact of therapy with continuous positive airway pressure (CPAP) and mandibular advancement device (MAD) has not been directly compared in patients with severe obstructive sleep apnea (OSA). The purpose of this individual participant data meta-analysis was to compare the treatment effects of CPAP and titratable MAD on sleepiness, quality of life, sleep-disordered breathing severity, and sleep structure in patients with severe OSA.

Methods

Randomized controlled trials (RCTs) that included severe OSA patients were identified in order to compare the impact of the two treatments. Individual data from severe OSA patients were extracted from the databases and pooled for analysis.

Results

Of the seven studies identified, three crossover RCT and one parallel-group RCT corresponding to 151 patients and 249 observations (125 in the CPAP treatment arm and 124 in the MAD treatment arm) were included in the analysis. Titratable MAD had a similar impact to CPAP on major patient-centered outcomes (sleepiness and quality of life). CPAP was more effective in reducing AHI and ODI. However, the two treatments had a similar impact on sleep structure with an increase of N3 and REM sleep. Finally, treatment adherence and preference were largely in favor of MAD.

Conclusion

This meta-analysis suggests that MAD represents an effective alternative treatment in severe OSA patients intolerant to CPAP or who prefer alternate therapy.
Molecular resolution of a behavioral paradox: sleep and arousal are regulated by distinct acetylcholine receptors in different neuronal types in Drosophila
Authors: Dai Xihuimin , Zhou Enxing , Yang Wei , Mao Renbo , Zhang Wenxia , Rao Yi
Published: January 2021

Sleep and arousal are both important for animals. The neurotransmitter acetylcholine (ACh) has long been found to promote both sleep and arousal in mammals, an apparent paradox which has also been found to exist in flies, causing much confusion in understanding sleep and arousal. Here, we have systematically studied all 13 ACh receptors (AChRs) in Drosophila to understand mechanisms underlying ACh function in sleep and arousal. We found that exogenous stimuli-induced arousal was decreased in nAChRα3 mutants, whereas sleep was decreased in nAChRα2 and nAChRβ2 mutants. nAChRα3 functions in dopaminergic neurons to promote exogenous stimuli-induced arousal, whereas nAChRα2 and β2 function in octopaminergic neurons to promote sleep. Our studies have revealed that a single transmitter can promote endogenous sleep and exogenous stimuli-induced arousal through distinct receptors in different types of downstream neurons.
Comparison of two live-animal ultrasound systems for genetic evaluation of carcass traits in Angus cattle
Authors: Duff C J , van der Werf J H J , Parnell P F , Clark S A
Published: January 2021

The improvement of carcass traits is an important breeding objective in beef cattle breeding programs. The most common way of selecting for improvement in carcass traits is via indirect selection using ultrasound scanning of selection candidates which are submitted to genetic evaluation programs. Two systems used to analyze ultrasound images to predict carcass traits are the Pie Medical Esaote Aquila (PIE) and Central Ultrasound Processing (CUP). This study compared the ability of the two systems to predict carcass traits for genetic evaluation in Australian Angus cattle. Genetic and phenotypic parameters were estimated using data from 1,648 Angus steers which were ultrasound scanned twice with both systems, first at feedlot entry and then following 100 d in the feedlot. The traits interpreted from ultrasound scanning included eye muscle area (EMA), rib fat (RIB) rump fat (RUMP), and intramuscular fat (IMF). Abattoir carcass data were collected on all steers following the full feedlot feeding period of 285 d. For all ultrasound scan traits, CUP resulted in higher phenotypic and genetic variances compared to the PIE. For IMF, CUP had higher heritability at feedlot intake (0.51 for CUP compared to 0.37 for PIE) and after 100 d feeding (0.54 for CUP compared to 0.45 PIE). CUP predicted IMF also tended to have stronger correlations with the breeding objective traits of carcass IMF and marbling traits, both genetically (ranging from 0.59 to 0.75 for CUP compared to 0.45–0.63 for PIE) and phenotypically (ranging from 0.27 to 0.43 for CUP compared to 0.19–0.28 for PIE). Ultrasound scan EMA was the only group of traits in which the heritabilities were higher for PIE (0.52 for PIE compared to 0.40 for CUP at feedlot intake and 0.46 for PIE compared to 0.43 for CUP at 100 d of feeding), however with similar relationships to the breeding objective carcass EMA observed. For subcutaneous fat traits of ultrasound RIB and RUMP, the heritabilites and genetic correlations to the related carcass traits were similar, with the exception being the higher heritability observed for CUP predicted RUMP at feedlot intake at 0.52 compared to 0.38 for PIE. The results from this study indicates that the CUP system, compared to PIE, provides an advantage for genetic evaluation of carcass traits in Angus cattle, particularly for the IMF and associated marbling traits.
Spring phenology is affected by fall non-structural carbohydrate concentration and winter sugar redistribution in three Mediterranean nut tree species
Authors: Amico Roxas Adele , Orozco Jessica , Guzmán-Delgado Paula , Zwieniecki Maciej A
Published: January 2021

Deciduous trees mostly rely on non-structural carbohydrates (NSC—soluble carbohydrates and starch) stored prior to dormancy to sustain both spring bloom and the initial phase of spring growth prior to the transition of leaves from sink to source. Winter management of NSC, their loss due to respiration, reallocation patterns and remobilization during spring, seems to be key to a timely and synchronous bloom. To assess tree dependence on NSC during dormancy, we tested whether the interruption of local branch NSC accumulation prior to dormancy by defoliation and the interruption of NSC translocation by phloem girdling influence spring phenology in three major deciduous Mediterranean nut crop species: Prunus dulcis (Mill.) D.A Webb, a hybrid between Pistacia integerrima (J. L. Stewart ex Brandis) and P. atlantica Desf. (referred to as P. integerrima), and Juglans regia L. Defoliation treatments had different effects on NSC concentration in different species depending on the time of application. However, despite the significant initial impact (increase or decrease of NSC concentration), with time this impact diminished resulting in overall similar concentrations between control and defoliated branches suggesting the presence of NSC reallocation during dormancy. Phloem girdling in P. dulcis and P. integerrima resulted in reduced export activity and greater NSC concentrations, while in J. regia girdling resulted in lower NSC concentrations, indicating that this species requires a net import of NSC during dormancy. Bud break was distinctly delayed by both defoliation and phloem girdling in all the three species, providing evidence of the significant roles that fall NSC accumulation and winter NSC management play in priming trees for spring growth resumption.
L’acquisition du statut d’entreprenant-commerçant en droit OHADA
Authors: Tamkam Silatchom Guy Armel
Published: January 2021

Les conditions d’acquisition de la qualité d’entreprenant-commerçant présentent des particularités au moment de l’entrée dans le cadre de l’entreprenant. Ainsi, contrairement au statut du commerçant qui est ouvert tant aux personnes physiques, qu’aux personnes morales, le statut d’entreprenant est exclusivement réservé aux personnes physiques et la déclaration au RRCM est simplifiée. Mais, au moment de l’exercice de l’activité commerciale, les conditions se rapprochent de celles du commerçant. Cet état de chose fait que les frontières des deux statuts sont poreuses et l’on pourra s’interroger sur l’opportunité de leur distinction.
Building Trust
Authors: Kennedy Maureen Shawn
Published: January 2021

Nurses can help change the course of the COVID-19 pandemic.
Desire to Share in Decision-Making Linked to Dissatisfaction with Hospital Care
Authors: Rosenberg Karen
Published: January 2021

According to this study:

Patients who prefer to participate in medical decision-making are more likely to be dissatisfied with hospital care.
Mindfulness-Based Interventions to Reduce Burnout and Stress in Physicians: A Systematic Review and Meta-Analysis
Authors: Fendel Johannes C. , Bürkle Johannes J. , Göritz Anja S.
Published: January 2021

Purpose

To perform a systematic review and meta-analysis of studies evaluating the effectiveness of mindfulness-based interventions (MBIs) in reducing burnout and stress among physicians.

Method

The authors searched records in MEDLINE, Embase, PsycINFO, PSYNDEX, Web of Science, CINAHL, and CENTRAL from database inception to August 8, 2019, using combinations of terms for mindfulness, interventions, and physicians. Eligible studies were randomized controlled trials (RCTs) and nonrandomized trials (NRTs), including controlled and noncontrolled before-after studies, all assessing burnout and stress among physicians preintervention and postintervention via validated instruments. Two reviewers independently screened records, extracted data, assessed risk of bias, and rated overall quality of evidence. The authors used random-effects modeling to calculate pooled effect sizes and conducted prespecified subgroup and sensitivity analyses to explore potential moderators.

Results

Of 6,831 identified records, 25 studies (with 925 physicians) were ultimately included. MBIs were associated with significant small reductions in burnout in between-group analyses (5 comparisons: standardized mean difference [SMD] = −0.26; 95% confidence interval [CI] = −0.50, −0.03) and pre–post analyses (21 comparisons: SMD = −0.26; 95% CI = −0.37, −0.15), and with a significant medium reduction in stress in between-group analyses (4 comparisons: SMD = −0.55; 95% CI = −0.95, −0.14) and a significant small reduction in stress in pre–post analyses (17 comparisons: SMD = −0.41; 95% CI = −0.61, −0.20). Versions of established MBIs showed higher effectiveness in reducing stress than other forms of MBIs or a mindfulness app. Reductions were maintained over an average follow-up of 5.3 months. The risk of bias was moderate with RCTs and high with NRTs. The overall quality of evidence was low to very low.

Conclusions

MBIs can be effective in reducing physicians’ burnout and stress. Shortcomings in the quality of evidence highlight the need for high-quality controlled trials providing long-term follow-up data.
Clinical Risk Factors and Perioperative Hematological Characteristics of Early Postoperative Symptomatic Deep Vein Thrombosis in Posterior Lumbar Spinal Surgery
Authors: Zhang Hengyan , Weng Huiling , Yu Keyi , Qiu Guixing
Published: January 2021

Study Design.

A retrospective analysis (2015–2019) of data collected from patients who underwent posterior lumbar spinal surgery.

Objective.

This study aims to identify the incidence, perioperative hematological characteristics, potential prognostic indicators, and risk factors of deep venous thrombosis (DVT) in the lower limbs after posterior lumbar spinal surgery. Eliminating risk factors or taking measures against patients at risk may reduce the incidence of DVT.

Summary of Background Data.

Deep venous thromboses have been extensively studied in other reconstructive surgeries. Present literatures provide limited evidence for determining the prognostic and risk factors for this complication after spinal surgery.

Methods.

Patients who underwent posterior lumbar spinal surgery with internal fixation in the Spine Surgery Center of Peking Union Medical College Hospital (PUMCH) were evaluated. The patient demographics, the number of operative segments, the hematological and biochemical parameters on baseline and postoperative day 1, and the presence of DVTs were obtained from all patients. The diagnosis of DVT was established by venous ultrasound when symptomatic. A multivariate logistic regression test was subsequently performed to determine the prognostic indicators and risk factors for DVT.

Results.

A total of 2053 patients who received lumbar spine procedures were qualified and included. Patients were followed up for 12 weeks. Early symptomatic DVT occurred in 58 individuals (2.39%; 95% confidence interval [CI], 0.4–0.7%). Advanced age, higher preoperative serum D-dimer level, and lower serum potassium level were recognized as independent risk factors for symptomatic DVT.

Conclusion.

Multiple independent risk factors were identified for early symptomatic DVT after posterior lumbar spine surgery. Postoperative prophylactic anti-coagulation treatment might be warranted for patients with high D-dimer or low potassium levels before the procedure.

Level of Evidence: 4
Does Selective Posterior Correction and Fusion Surgery Influence Cervical Sagittal Alignment in Patient with Lenke Type 5 Adolescent Idiopathic Scoliosis?—A 5-year Follow-up Retrospective Cohort Study
Authors: Okubo Toshiki , Yagi Mitsuru , Suzuki Satoshi , Nori Satoshi , Tsuji Osahiko , Nagoshi Narihito , Okada Eijiro , Fujita Nobuyuki , Nakamura Masaya , Matsumoto Morio , Watanabe Kota
Published: January 2021

Study Design.

A retrospective comparative study.

Objective.

The aim of this study was to examine the changes in cervical sagittal alignment (CSA) following surgical correction in a patient with Lenke type 5 adolescent idiopathic scoliosis (AIS) and evaluate any possible factors influencing postoperative CSA.

Summary of Background Data.

Few studies have assessed the association between CSA and thoracic or lumbar sagittal alignment in AIS patients with major thoracolumbar/lumbar curve who underwent posterior correction and fusion surgery.

Methods.

Sixty-six patients with Lenke type 5 AIS (two males and 64 females, the mean age at surgery of 16.2 years) were included in this study. They were followed up for minimum 5 years after surgery. Multiple linear regression analysis was used to evaluate possible factors influencing the postoperative CSA. To determine the influence of upper end vertebra (UEV) level on postoperative CSA, the subjects were divided into two groups according to UEV level of ≥T9 or ≤T10. The outcome variables were compared between the two groups and analyzed for changes in various spinal sagittal profiles using radiographic outcomes.

Results.

Multiple linear regression analysis revealed that preoperative T10-L2 kyphosis and LL were significantly correlated with postoperative C2–7 lordosis. However, CSA did not significantly change at 5 years after surgery. Sub-analysis of the cohort revealed that in the UEV ≥T9 group, the mean thoracic kyphosis significantly increased from 20.3° ± 10.6° to 24.0° ± 8.9° and the mean C2–7 lordosis also significantly increased from −12.5° ± 8.3° to −4.3° ± 10.3° at 5-year postoperatively. SRS-22 outcomes were comparable between the groups.

Conclusion.

We indicated that the CSA was not influenced by surgical correction in most Lenke type 5 AIS patients. However, in a patient whose UEV was located at T9 or higher levels, CSA was influenced through the changes in thoracic kyphosis following posterior correction surgery.

Level of Evidence: 4
Association of Medicare and Medicaid Insurance Status with Increased Spine Surgery Utilization Rates
Authors: Benton Joshua A. , Weiss Brandon T. , Mowrey Wenzhu B. , Yassari Neeky , Wang Benjamin , Ramos Rafael De La Garza , Gelfand Yaroslav , Castro-Rivas Erida , Puthenpura Vidya , Yassari Reza , Yanamadala Vijay
Published: January 2021

Study Design.

Retrospective single-institution study.

Objective.

The aim of this study was to determine the relationship between patients’ insurance status and the likelihood for them to be recommended various spine interventions upon evaluation in our neurosurgical clinics.

Summary of Background Data.

Socioeconomically disadvantaged populations have worse outcomes after spine surgery. No studies have looked at the differential rates of recommendation for surgery for patients presenting to spine surgeons based on socioeconomic status.

Methods.

We studied patients initially seeking spine care from spine-fellowship trained neurosurgeons at our institution from July 1, 2018 to June 30, 2019. Multivariable logistic regression was used to assess the association between insurance status and the recommended patient treatment.

Results.

Overall, 663 consecutive outpatients met inclusion criteria. Univariate analysis revealed a statistically significant association between insurance status and treatment recommendations for surgery (P < 0.001). Multivariate logistic regression demonstrated that compared with private insurance, Medicare (odds ratio [OR] 3.54, 95% confidence interval [CI] 1.21–7.53, P = 0.001) and Medicaid patients (OR 2.46, 95% CI 1.21–5.17, P = 0.014) were more likely to be recommended for surgery. Uninsured patients did not receive recommendations for surgery at significantly different rates than patients with private insurance.

Conclusion.

Medicare and Medicaid patients are more likely to be recommended for spine surgery when initially seeking spine care from a neurosurgeon. These findings may stem from a number of factors, including differential severity of the patient's condition at presentation, disparities in access to care, and differences in shared decision making between surgeons and patients.

Level of Evidence: 3
An 8-Year-Old Boy With Treatment-Resistant Encopresis
Authors: Stein Martin T. , Benninga Marc A. , Felt Barbara T.
Published: January 2021

CASE:

Paul is an 8-year-old boy with a long-standing history of encopresis and enuresis. Potty training was initiated when he was 21/2 years old. At this time, his mother was absent from the home for 6 weeks when she cared for her ill father in a different city. The process of teaching Paul to use the bathroom was described as “inconsistent” due to multiple caretakers.

Paul never successfully mastered bowel and bladder control. He continues to wet and soil his clothes on a daily basis at home and school. According to his parents, he does not accept responsibility and comments about his soiling such as, “I didn't do it; someone else must have put it there.” One of Paul's teachers commented that she could tell at the beginning of the school day whether he would maintain bowel and bladder control. If he was “agitated and talkative” in the early morning, he would often soil that day.

He had a pediatric gastroenterological evaluation at the age of 5 years when he was having daily episodes of stool soiling. Physical examination revealed normal anal tone, normal placement of the anus, and moderate stool in the rectal vault. An abdominal radiograph revealed moderate stool throughout the colon. He was treated with Miralax and instructed to sit on the toilet twice daily. Paul did not respond to these interventions and was diagnosed with “overflow incontinence secondary to stool withholding.” When he was taking Miralax, he had a normal barium enema radiograph. He was admitted to the hospital for a cleanout with a polyethylene glycol/electrolyte solution.

Although abdominal radiographs demonstrated absence of colonic stool for the following 5 months, he continued to soil his clothing. Play therapy and biofeedback did not change the chronic soiling and wetting pattern. An evaluation at the Continence Clinic resulted in a rigorous program including stooling after each meal, wearing a vibrating watch reminding him to void every 2 hours, drinking 60 ounces of water per day, tracking elimination patterns on a calendar, and a daily laxative (polyethylene glycol). A neuropsychological evaluation revealed a superior aptitude associated with unresolved early childhood issues of self-control, self-care, and frustration tolerance. Family therapy was initiated. However, daily fecal soiling and wetting persisted.

Paul was born full-term without prenatal or perinatal complications. He was breast fed for 1 year and described as an easy baby. He achieved motor, social, and language milestone on time. Paul had difficulty with separation and aggression in preschool (e.g., biting). In school, teachers report inattention, fidgetiness, and difficulty following directions. He has been obese since age 3 years; his current body mass index is 29.
Growth–and Documentation–Deficits: Where To Start in Helping Families
Authors: Hernandez Wilhelmina , Frank Deborah A. , Morton Samantha , Palacios Carmen , Augustyn Marilyn
Published: January 2021

CASE:

Pedro is a 2-year 7-month-old boy who was presented for the first time after a visit to a local emergency room (ER) for diarrhea. At the time of his birth, his undocumented mother, Clara, was 20 years old, uninsured, and with limited English proficiency living approximately 400 miles south of our practice in a different state. Although she had been brought to the United States as a child, she had never finished high school. Pedro was born what mother thought was full-term at his parent's home, where a lay midwife assisted during the delivery. Pedro was not brought to a medical facility at birth; therefore, neither medical nor legal documentation of his birth in the United States, or elsewhere, existed.

After enduring 4 years of ongoing verbal and physical abuse, Clara fled to her maternal aunt in our community. The child's initial exposure to medical care was during the emergency visit, which ended up in referral to us. The ED physician suggested that the child visit a primary care physician, but establishment of pediatric care was not made until months later. The child received his first vaccines and immediately was referred to the Growth and Nutrition clinic due to mild wasting and stunting based on Waterlow criteria.
1
Pedro speaks both English and Spanish and has no 2-word combinations and a 50-word combined vocabulary in English and Spanish. In addition, a complete blood count was consistent with iron deficiency anemia, but both sickle cell and G6PD screening are negative.

The nutritionist from the specialty clinic obtained a detailed history including overall appetite, feeding skills, meal plans, and eating environment noting that the child was a competent finger feeder. The family's meals were distributed throughout the day as a meal at home and a shared fast food meal while accompanying mother, as she worked as a hair stylist 6 days per week. In addition, the diet is supplemented by ricewater mixed with sugar and ground carrots throughout the day.

Where would you head next?

REFERENCE

1. Waterlow JC. Classification and definition of protein-calorie malnutrition. Br Med J. 1972;3:566-569.
“Media Addiction” in a 10-Year-Old Boy
Authors: Brown Scott , Scharf Michael A. , Bustos Cristina , Chavira Denise , Stein Martin T.
Published: January 2021

CASE:

Bryan is a 10-year-old boy who is brought to his pediatrician by his parents with concerns about oppositional behaviors. Bryan's parents report that he has always been hyperactive and oppositional since a very young age. He has been previously diagnosed with attention-deficit hyperactivity disorder and has been treated with appropriate stimulant medications for several years; however, despite this, his parents feel increasingly unable to manage his difficult behaviors. He refuses to do chores or follow through with household routines. He refuses to go to bed at night. His family feels unable to take him to public places because he “climbs all over everything.” At school, he acts up in class, is often disruptive, and requires close supervision by teachers. He was recently kicked off of the school bus. He has very few friends, and his parents state that other children do not enjoy to be around him.

Bryan's parents also report that he is “obsessed” with electronics. He spends most his free time watching TV and movies and playing computer games. He has a television in his bedroom because otherwise he “monopolizes” the family television. The family also owns several portable electronic devices that he frequently uses. Bryan insists on watching TV during meals and even that the TV stays on in an adjacent room while showering. He gets up early each morning and turns on the television. He refuses to leave the house unless he can take a portable screen device with him. His parents admit to difficulty placing limits on this behavior because they feel it is the only way to keep his other behaviors under control. His mother explains “it is our only pacifier” and that attempts to place restrictions are met with explosive tantrums and have thus been short lived. These efforts have also been impeded due to the habits of his parents and older sibling, who also enjoy spending a significant amount of time watching television.
Maternal proximity to Central Appalachia surface mining and birth outcomes
Authors: Buttling Lauren G. , McKnight Molly X. , Kolivras Korine N. , Ranganathan Shyam , Gohlke Julia M.
Published: January 2021

Background:

Maternal residency in Central Appalachia counties with coal production has been previously associated with increased rates of low birth weight (LBW). To refine the relationship between surface mining and birth outcomes, this study employs finer spatiotemporal estimates of exposure.

Methods:

We developed characterizations of annual surface mining boundaries in Central Appalachia between 1986 and 2015 using Landsat data. Maternal address on birth records was geocoded and assigned amount of surface mining within a 5 km radius of residence (street-level). Births were also assigned the amount of surface mining within residential ZIP code tabulation area (ZCTA). Associations between exposure to active mining during gestation year and birth weight, LBW, preterm birth (PTB), and term low birth weight (tLBW) were determined, adjusting for outcome rates before active mining and available covariates.

Results:

The percent of land actively mined within a 5 km buffer of residence (or ZCTA) was negatively associated with birth weight (5 km: β = –14.07 g; 95% confidence interval [CI] = –19.35, –8.79, P = 1.79 × 10–7; ZCTA: β = –9.93 g; 95% CI = –12.54, –7.33, P = 7.94 × 10–14). We also found positive associations between PTB and active mining within 5 km (odds ratio [OR] = 1.06; 95% CI = 1.03, 1.09, P = 1.43 × 10–4) and within ZCTA (OR = 1.04; 95% CI = 1.03, 1.06, P = 9.21 × 10–8). Positive relationships were also found between amount of active mining within 5 km or ZIP code of residence and LBW and tLBW outcomes.

Conclusions:

Maternal residency near active surface mining during gestation may increase risk of PTB and LBW.
Centralizing environmental datasets to support (inter)national chronic disease research
Authors: Brook Jeffrey R. , Doiron Dany , Setton Eleanor , Lakerveld Jeroen
Published: January 2021

Background:

Whereas environmental data are increasingly available, it is often not clear how or if datasets are available for health research. Exposure metrics are typically developed for specific research initiatives using disparate exposure assessment methods and no mechanisms are put in place for centralizing, archiving, or distributing environmental datasets. In parallel, potentially vast amounts of environmental data are emerging due to new technologies such as high resolution imagery and machine learning.

Objectives:

The Canadian Urban Environmental Health Research Consortium (CANUE) and the Geoscience and Health Cohort Consortium (GECCO) provide a proof of concept that centralizing and disseminating environmental data for health research is valuable and can accelerate discovery. In this essay, we argue that more efficient use of exposure data for environmental epidemiological research over the next decade requires progress in four key areas: metadata and data access portals, linkage with health databases, harmonization of exposure measures and models over large areas, and leveraging “big data” streams for exposure characterization and evaluation of temporal changes.

Discussion:

Optimizing the use of existing environmental data and exploiting emerging data streams can provide unprecedented research opportunities in environmental epidemiology through a better characterization of individuals’ exposures and the ability to study the intersecting impacts of multiple environmental features or urban attributes across different populations around the world. Proper documentation, linkage, and dissemination of new and emerging exposure data leads to a better awareness of data availability, a reduction of duplication of effort and increases research output.
Intra-abdominal Deep Inferior Epigastric Vessel Course Does Not Preclude Successful DIEP Flap Breast Reconstruction
Authors: Helm Douglas L. , Steigner Michael L. , Serebrakian Arman T. , Erdmann-Sager Jessica
Published: January 2021

We present 2 patients in whom the course of the deep inferior epigastric vessels was intra-abdominal during deep inferior epigastric perforator (DIEP) flap breast reconstruction. Preoperative computed tomography angiography gave no indication of an unusual pedicle location. In both cases, pedicle dissection was completed safely without bowel injury, and reconstruction was completed successfully. Reconstructive surgeons need not abandon DIEP flap reconstruction upon discovering that the deep inferior epigastric vessels are intra-abdominal. Unfortunately, computed tomography angiography imaging does not identify this variant preoperatively. The risk of postoperative ileus after intra-abdominal pedicle dissection may be higher than the risk after dissection of retrorectus deep inferior epigastric pedicles, and thus it is reasonable to consider the use of prophylactic mesh in these cases.
A Competency Assessment Tool for Unilateral Cleft Lip Repair
Authors: Rogers-Vizena Carolyn R. , Sideridis Georgios D. , Patel Krishna G. , Garland Catharine B. , Mount Delora L. , Yao Caroline A.
Published: January 2021

Background:

Objective evaluation of operative performance is increasingly important in surgical training. Evaluation tools include global rating scales of performance and procedure-specific skills checklists. For unilateral cleft lip repair, the numerous techniques make universal evaluation challenging. Thus, we sought to create a unilateral cleft lip evaluation tool agnostic to specific repair technique.

Methods:

Four surgeons with expertise in 3 common cleft lip repair techniques participated in a 3-round Delphi process to generate consensus evaluation points spanning all techniques. Items were categorized as marking the repair, performing the repair, and final result. Two blinded raters then scored videos of simulated cleft lip repairs using both the 21-item novel checklist and the modified Objective Structured Assessment of Technical Skills. Kappa and T values were calculated for both scales to determine level of agreement.

Results:

Ten videos of repairs performed by novice residents through experienced craniofacial fellows were scored. Moderate (κ = 0.41–0.60) to substantial (κ = 0.61–0.80) interrater reliability was seen for the majority of questions in both the novel tool and the Objective Structured Assessment of Technical Skills. A single question in the novel tool had almost perfect agreement (κ = 0.81–1.00), 8 had moderate agreement, and 6 had substantial agreement. Poorly scoring questions were discarded from the final 18-item tool.

Conclusions:

Despite variations in unilateral cleft lip repair technique, common themes exist that can be used to assess performance and outcome. A universal evaluation tool has potential implications for trainee assessment, surgeon credentialing, and screening for surgical missions.
Mastectomy and Prepectoral Reconstruction in an Ambulatory Surgery Center Reduces Major Infectious Complication Rates
Authors: Schwartz Jean-Claude
Published: January 2021

Background:

Mastectomy and implant-based reconstruction is typically performed in a hospital setting (HS) with overnight admission. The aim of this study was to evaluate postoperative complications and outcomes with same-day discharge from an ambulatory surgery center (ASC) compared with the same surgery performed in the HS.

Methods:

Patients who underwent mastectomy and immediate prepectoral tissue expander reconstruction were included in this retrospective study. Surgery was performed in an ASC with same-day discharge or the HS with overnight observation or same-day discharge. Patient demographics, operative details, outcomes, complications, and patient satisfaction were compared.

Results:

One hundred six women (183 breasts) underwent surgery in the HS, and 103 women (177 breasts) had their surgery in an ASC between August 2014 and September 2019. Demographics, comorbidities, and operative details were similar. Although there was no difference in the rates of most major complications, infectious complications requiring operative intervention were less frequent in the ASC [2.3% (n = 4) versus 11.5% (n = 21); P = 0.001]. Patient satisfaction, evaluated with a 5-point Likert scale, was higher in the ASC.

Conclusions:

Mastectomy and prepectoral reconstruction in an ASC is a safe alternative to the standard approach of performing this procedure in the HS. Although the rates of most surgical complications are similar between the HS and ASC, we have found a significantly reduced rate of major infectious complications requiring surgical intervention in the ASC which reduces overall cost and patient morbidity. Finally, patient satisfaction was higher in the ASC compared with the HS.
Should We Consider Preparing Patients for Future Face Transplant when Managing Complex Facial Trauma?
Authors: Zeiderman Matthew R. , Firriolo Joseph M. , Dave Dattesh R. , Pu Lee L.Q.
Published: January 2021

With advancements in microsurgical technique and experience, face transplantation is becoming a clinical reality and acceptable procedure. Preparation of the maxillofacial skeleton and initial soft-tissue coverage for face transplant candidates is essential for optimizing the ultimate outcome by providing immediate coverage of vital structures, functionality, and a stable skeletal framework. We present our experience of preparing such a patient who underwent a successful face transplant, with an excellent outcome. A 24-year-old man sustained a self-inflicted ballistic injury to his face. Composite tissue deficits included significant soft-tissue loss in the central lower and midface, comminuted fractures of midface, and large bone gaps of the maxilla and mandible. He underwent open reduction internal fixation of bilateral LeFort III, zygomaticomaxillary complex, and complex maxillary and mandibular fractures with titanium plates and a free anterolateral thigh perforator flap to the midface with concomitant pedicled left supraclavicular artery fasciocutaneous flap to the lower face. He subsequently underwent a second free anterolateral thigh perforator for the exposed mandibular hardware due to partial necrosis of the supraclavicular artery fasciocutaneous flap. The patient achieved stable bone reconstruction and soft-tissue coverage and was discharged home. He was placed on the waiting list for a face transplant by another center in the country and eventually underwent a successful face transplant. We believe that the preparation of the patient with complex craniomaxillofacial trauma for face transplant should be considered when the extent of injury exceeds conventional reconstructive limits. Our approach provides the best opportunity for an optimal face transplant outcome while minimizing flap donor site morbidity.