bluuebunny/crossref_metadata_2025 huggingface dataset:
From crisis to reform? Exploring three post-COVID pathways
Authors: Boin Arjen , ‘t Hart Paul
Published: January 2022

Crises are often viewed as catalysts for change. The coronavirus disease crisis is no exception. In many policy sectors, proponents of reform see this global crisis both as a justification and an enabler of necessary change. Policy scholars have paid ample attention to this crisis-reform thesis. Empirical research suggests that these proponents of crisis-induced change should not be too optimistic. The question remains why some crises give rise to reform whereas so many others do not. This paper focuses on one particular factor that crisis researchers have identified as important. Crisis research suggests that the outcome of the meaning-making process—the efforts to impose a dominant frame on a population—shapes the prospects of postcrisis change. The paper offers three ideal-typical framing scripts, which researchers can use to study postcrisis trajectories.
What has happened and what has not happened due to the coronavirus disease pandemic: a systemic perspective on policy change
Authors: Knill Christoph , Steinebach Yves
Published: January 2022

The societal and policy transformations associated with the coronavirus disease pandemic are currently subject of intense academic debate. In this paper, we contribute to this debate by adopting a systemic perspective on policy change, shedding light on the hidden and indirect crisis effects. Based on a comprehensive analysis of policy agenda developments in Germany, we find that the pandemic led to profound shifts in political attention across policy areas. We demonstrate that these agenda gains and losses per policy area vary by the extent to which the respective areas can be presented as relevant in managing the coronavirus disease crisis and its repercussions. Moreover, relying on the analysis of past four economic crises, we also find that there is limited potential for catching up dynamics after the crisis is over. Policy areas that lost agenda share during crisis are unlikely to make up for these losses by strong attention gains once the crisis is over. Crises have hence substantial, long-term and so far, neglected effects on policymaking in modern democracies.
Re-thinking the coronavirus pandemic as a policy punctuation: COVID-19 as a path-clearing policy accelerator
Authors: Hogan John , Howlett Michael , Murphy Mary
Published: January 2022

This article joins with others in this special issue to examine the evolution of our understanding of how the coronavirus disease (COVID)-19 pandemic impacted policy ideas and routines across a wide variety of sectors of government activity. Did policy ideas and routines transform as a result of the pandemic or were they merely a continuation of the status quo ante? If they did transform, are the transformations temporary in nature or likely to lead to significant, deep and permanent reform to existing policy paths and trajectories? As this article sets out, the literature on policy punctuations has evolved and helps us understand the impact of COVID-19 on policy-making but tends to conflate several distinct aspects of path trajectories and deviations under the general concept of “critical junctures” which muddy reflections and findings. Once the different possible types of punctuations have been clarified, however, the result is a set of concepts related to path creation and disruption—especially that of “path clearing”—which are better able to provide an explanation of the kinds of policy change to be expected to result from the impact of events such as the 2019 coronavirus pandemic.
Policy integration, problem-solving, and the coronavirus disease crisis: lessons for policy design
Authors: Maggetti Martino , Trein Philipp
Published: January 2022

The coronavirus disease pandemic has exposed differences in the capacity of governments around the world to integrate and coordinate different policy instruments into a coherent response. In this article, we conceptualize and empirically examine policy integration in responses to the coronavirus disease crisis in 35 countries. We then discuss how the interplay between restrictions, health protection, and economic policy has been articulated between, on the one hand, a policy design based on the complementarity of pro-public health and pro-economy measures, implying an integrated response, and, on the other, a policy design based on the perception of an inherent trade-off between the two. Finally, we discuss three implications from our analysis of policy integration against the coronavirus disease crisis for the post-COVID state: (a) the normalization and adaptation of integrated crisis responses; (b) the possible acceleration and “catching up” of problem-solving capacity as governments may use the crisis as an instance to put into place new social policies; and (c) policy integration as an accelerator of policy complexity and resistance against technocracy in the post-COVID state.
Managing stroke risk in patients with atrial fibrillation: a cross-sectional analysis of socio-demographic inequalities in a London borough
Authors: Wou Constance , Crompton James , Ashworth Mark , Williams Helen , Dodhia Hiten
Published: January 2022

Background

Stroke prevention is essential for patients with atrial fibrillation (AF), but some receive sub-optimal management. We reviewed those with a recorded AF diagnosis assessed with CHA2DS2-VASc stroke risk score (SRS) and socio-demographic determinants of anticoagulation prescribing. The objective was to compare with national guidance recommendations, which recommend anticoagulant therapy for SRS ≥ 2, to determine if there were inequalities in management.

Methods

A cross-sectional design was used to analyze records from all (n = 41) general practices in one London borough. Patients were excluded if they were <18 years, had AF resolved or diagnosed < 3 months. Logistic regression identified socio-demographic factors associated with high SRS and anticoagulant prescribing.

Results

Of 2913 patients, 2885 (99.0%) had an SRS, and 2411 (83.6%) a score ≥ 2 and 82.9% (1999 of 2411) were prescribed anticoagulation. Women (compared with men), Black and Mixed/Multiple ethnic groups (compared with White), and those living in most deprived areas (compared with least) were more likely to have a score ≥ 2. Patients with a high SRS from Black and Mixed/Multiple ethnic groups and aged 18–74 years were less likely to be prescribed anticoagulation.

Conclusion

We found evidence of age and ethnic inequity in anticoagulation prescribing for stroke prevention in patients with AF.
Collective health behavior and face mask utilization during the COVID-19 pandemic in Oklahoma, USA
Authors: Bray Laura A , Porter Olivia , Kim Andrew , Jervis Lori L
Published: January 2022

Background

Face mask use offers an important public health tool for reducing the spread of coronavirus disease 2019 (COVID-19), yet the politicization of COVID-19 has resulted in uneven adherence. This study assesses the effects of setting characteristics and the sociodemographic composition of crowds on group-level masking rates.

Methods

We conducted 123 site observations of masking behavior at public locations across Oklahoma (USA) between June and September 2020. We used analyses of variance and t-tests to examine variation in masking and ordinary least squares regression to model the effect of setting and sociodemographic characteristics on site-level masking rates.

Results

The masking rate across all sites averaged 34% but varied widely. Site-level masking rates were higher at metropolitan sites and sites with a store or municipal masking mandate. The masking rate at sites where women or older adults (60+) were the predominant group did not differ significantly from other sites. Ethnically diverse sites exhibited significantly higher masking rates compared with predominantly white sites. Findings indicate that setting characteristics explained a greater amount of variation in collective masking rates than sociodemographic differences.

Conclusions

This study underscores the importance of place and policy for mask adherence. In the absence of state-level mandates, masking policies at a more local level may be effective.
Asset Pricing Tests of Infrequently Traded Securities: The Case of Municipal Bonds
Authors: Chen Yao-Tsung , Wu Chunchi , Yeh Chung-Ying
Published: January 2022

Using a dynamic selection model, we obtain consistent and unbiased estimates of risk and returns for infrequently traded bonds and conduct the first comprehensive asset pricing test of municipal bonds using the multifactor approach. Correction for sample selection and infrequent trading problems results in substantially higher beta estimates. Besides conventional risk factors, illiquidity and taxes are important for the pricing of municipal bonds. Importantly, bond returns contain a significant liquidity risk premium. Failing to account for sample selection bias leads to erroneous inference on the magnitude of systematic risk and substantial underestimation of risk premiums. (JEL G12, G14)
Comparing Partitioned Models to Mixture Models: Do Information Criteria Apply?
Authors: Crotty Stephen M , Holland Barbara R
Published: January 2022

The use of information criteria to distinguish between phylogenetic models has become ubiquitous within the field. However, the variety and complexity of available models are much greater now than when these practices were established. The literature shows an increasing trajectory of healthy skepticism with regard to the use of information theory-based model selection within phylogenetics. We add to this by analyzing the specific case of comparison between partition and mixture models. We argue from a theoretical basis that information criteria are inherently more likely to favor partition models over mixture models, and we then demonstrate this through simulation. Based on our findings, we suggest that partition and mixture models are not suitable for information-theory based model comparison. [AIC, BIC; information criteria; maximum likelihood; mixture models; partitioned model; phylogenetics.]
Evaluation of a social marketing approach to healthy, home-cooked family meals for low-income mothers of young children
Authors: Tietyen Mullins Janet , Walters Jackie , Najor Jean , Mikuška Jakub , Courtney Anita , Norman-Burgdolf Heather
Published: January 2022

Cooking is a complex behavior associated with more frequent and nutrient-dense family meals. The Cook Together, Eat Together (CTET) social marketing program used formative, process, and outcome evaluations over a 3-year period to design a program to increase fruit and vegetable intake and frequency of family meals. We used a quasi-experimental, mixed-methods design with a nonequivalent comparison group to evaluate fruit and vegetable intake and family meals. Eight focus groups of mothers in low-income families with young children revealed two predominant behavioral mediators: (i) importance of family time and (ii) desire for children to learn to cook and become self-sufficient adults. Program design was grounded in formative evaluation and organized by the four Ps of social marketing: (i) product—learning to prepare healthy meals while teaching children to cook; (ii) price—lowered by reducing barriers of food cost, kitchen clean-up, meal planning, grocery shopping; (iii) placement—in neighborhood gathering places with a “cooking social”; and (iv) promotion—flyers, newsletters, and social media. Outcome indicators were assessed pre/post intervention with questions from instruments validated for the audience. Significant changes (n = 68, p ≥ .002, Bonferroni adjustment for p = .05, Cohen’s d = .50 medium effect size) were found in consumption of fruits and vegetables with an average increase of half cup each per day. CTET participation significantly increased fruits and vegetables served and eaten at family meals. A social marketing approach can help families with young children increase fruit and vegetable consumption.
The Bureaucratization of Death: The First World War, Families, and the State
Authors: Foster Ann-Marie
Published: January 2022

After the First World War the British state tried to show the families of the dead their thanks, and memorialize the dead, through the two-minute silence and the creation of the Tomb of the Unknown Warrior. However, before families of deceased servicepeople encountered the state through national commemorations they encountered it through the administrative paperwork of death. Other than brief mentions in wider works, the bureaucracy of death is remarkably absent from discussions of death, yet the paperwork associated with death was a significant part of family experiences of bereavement, particularly in wartime. This article argues that state bureaucracy played a key role in defining people’s experience of wartime bereavement, both practically, through the paperwork sent, but also temporally, by controlling when and how families could carry out grave-related elements of mourning, such as choosing an epitaph. Over the course of the early inter-war period, the bureaucracy of death encountered by the families of the war dead could profoundly shape their experience of loss.
Women of the Left, Patriotism, and National Identity, 1914–28
Authors: Swift David
Published: January 2022

The literature on the role of women in the First World War, and the war’s effect on gender roles, considers conservative and socialist feminism, the expansion of the franchise in 1918 and 1928, and state welfare policies. However, there has been less work on the women of the Left who participated in the war effort, and who used nationalism to push for socialist and feminist objectives. These women have been understudied for various reasons: as women, they were often disregarded by military and political historians, and as enablers a conflict they have usually been overlooked by historians of gender and of the Left. This article is concerned with these women, and examines the extent, nature and significance of their participation within the war effort and their use of nationalism to advance socialist and feminist objectives. It analyses how their actions during the conflict affected the gender, class and political frameworks of the time, both in the lead-up to the Representation of the People Act 1918, and in the first years of female enfranchisement. Based on extensive use of the files of the War, Emergency: Workers’ National Committee and on the publications of the labour and co-operative movements, it argues that a substantial section of the female labour movement articulated a sense of British nationalism in the years during and after the First World War, utilized this to advance their political, economic, and feminist objectives, and in doing so challenged political orthodoxy and prevailing gender roles.
Construction of the final results of infinite iterative processes in individuals’ mind in a geometrical context
Authors: Barahmand Ali
Published: January 2022

This study provides a framework for explaining the way individuals might construct the final result of infinite iterative processes in a geometrical context. To this end, 30 undergraduate students were interviewed. The analysis of the data collected yielded two different views: first, there were those who believed that the presented infinite iterative processes will have to end because nothing else could be imagined; second, there were those who claimed that the processes will not end because assuming that a final result will fall out of processes would be paradoxical. In this regard, this study demonstrates how some related paradoxes in a geometrical context can be interpreted, by analyzing their potential sources, within the proposed framework.
Situation of insecticide resistance in malaria vectors in the World Health Organization of Eastern Mediterranean region 1990–2020
Authors: Vatandoost Hassan , Hanafi-Bojd Ahmad Ali , Nikpoor Fatemeh , Raeisi Ahmad , Abai Mohammad Reza , Zaim Morteza
Published: January 2022

Malaria is the most important mosquito-borne disease, which is transmitted by Anopheles species. According to the recent report of World Health Organization, there were an estimated 229 million malaria cases in 2019 in 87 malaria endemic countries. There are several vector control method specially using pesticides. The aim of this study was to collect all the data about insecticide resistant of malaria vectors in the Eastern Mediterranean region countries. In this study, all the published papers related to insecticide resistance of malaria vectors in the region were collected and resistant status of vectors in the countries was mapped. Resistance to different insecticide classes such as pyrethroids, organophosphate, organochlorine and carbamates were evaluated using World Health Organization guidelines. Results showed a wide variety of susceptibility/resistance status to these chemicals according to the location, historical context of pesticide used, genetic background of vectors, age and abdominal conditions of adults may play a role in the susceptibility status of these species to different insecticides. The results of this study is providing a guideline for countries to manage their vector control activities against insecticide resistance of malaria vectors and provide novel approaches such as male sterility, using Wolbachia, using new insecticide with new mode of action.
Discomfort, Doubt, and the Edge of Learning
Authors: Kumagai Arno K.
Published: January 2022

Discomfort is a constant presence in the practice of medicine and an oft-ignored feature of medical education. Nonetheless, if approached with thoughtfulness, patience, and understanding, discomfort may play a critical role in the education of physicians who practice with excellence, compassion, and justice. Taking Plato’s notion of aporia—a moment of discomfort, perplexity, or impasse—as a starting point, the author follows the meandering path of aporia through Western philosophy and educational theory to argue for the importance of discomfort in opening up and orienting perspectives toward just and humanistic practice. Practical applications of this approach include problem-posing questions (from the work of Brazilian education theorist Paulo Freire), exercises to “make strange” beliefs and assumptions that are taken for granted, and the use of stories—especially stories without endings—all of which may prompt reflection and dialogical exchange. Framing this type of teaching and learning in Russian psychologist L.S. Vygotsky’s theories of development, the author proposes that mentorship and dialogical interactions may help learners to navigate through moments of discomfort and uncertainty and extend the edge of learning. This approach may give birth to a zone of proximal development that is enriched with explorations of self, others, and the world.
Defining Student-as-Teacher Curricula in the Absence of National Guidelines: An Innovative Model
Authors: Fuchs Michael A. , Schwartz Andrea W. , Caton Julia B. , Gooding Holly , Richards Jeremy B.
Published: January 2022

Teaching is a critical skill in the medical profession, yet has only recently gained recognition as a core skill for medical students and trainees. Student-as-teacher (SAT) programs provide medical students formal teaching instruction with opportunities for practice. While efforts to determine how SAT courses should be taught are ongoing, the authors’ review of SAT programs in medical schools’ curricula shows they are diverse and often developed by faculty and trainees who advocate for formal teacher training at their institutions, rather than by medical school leadership. Consequently, there is significant heterogeneity among known SAT programs with regard to content, format, and evaluation methods. As efforts are underway to create guidelines and competency frameworks for SAT programs, medical educators must engage in open and critical discussion about the optimal content and organization for SAT educational experiences, emphasizing outcomes-based value and curricular and experiential consistency across programs. The authors describe an innovative SAT elective at Harvard Medical School (HMS), discuss research supporting curricular content and decisions, and emphasize potential implications for the conception and implementation of SAT programs at other institutions. The HMS SAT course is a year-long, elective, longitudinal curriculum built on a community of practice model and comprising 5 key components: Fundamentals of Medical Education seminar series, teaching field experiences, teaching observations, final educational product, and self-reflection. This 5-component theoretically justified model covers essential topics of SAT programming, providing students a comprehensive educational skills training curriculum. Medical educators developing SAT courses must identify common core competencies and curricular activities to implement SAT programs informed by the perspective of local stakeholders and institutional needs. Further growth of SAT programs in medical education offers opportunities for collaboration and coordination among medical educators, institutions, and licensing and accreditation bodies, to further develop consistent guidelines for teaching medical education skills to future medical educators.
The Great Health Paradox: A Call for Increasing Investment in Public Health
Authors: Blazer Dan G. , Colenda Christopher C. , Applegate William B. , Reifler Burton V.
Published: January 2022

The great health paradox is that the least expensive and most effective public health measures available for addressing the COVID-19 pandemic—and other society-wide health challenges—have long been ignored and rejected in the United States in favor of more expensive and personalized care. The U.S. medical system is being overwhelmed in part because of this paradox. The authors argue that the country has invested excessively in acute care medical technology while investing insufficiently in its public health infrastructure.

In this Invited Commentary, the authors recommend 5 steps that academic medicine should take to increase emphasis on and understanding of public health interventions to address society’s health problems: (1) incorporate problem-based learning experiences in the medical school curriculum and community-based clinical rotations in public health departments, (2) better integrate schools of public health and schools of medicine, (3) encourage physicians to pursue public health careers, (4) educate the public about strategies for decreasing chronic illnesses, and (5) increase collaboration with colleagues around the world to identify and track outbreaks.
Alcohol-related Opioid Overdose Deaths in Minnesota Between 2011 and 2020: Trends by Sex
Authors: Friedman Jessica K. , Wright Nate , Gloppen Kari M.
Published: January 2022

Objectives

To characterize the overall trend and differences by sex in opioid overdose death (OOD) and alcohol-related opioid overdose deaths (AOOD) in Minnesota between 2011 and 2020 in relation to drug overdose deaths.

Methods

Using Minnesota death certificate data from 2011 to 2020, we identified OOD and AOOD among Minnesota residents aged 15 and older who died of a drug overdose death. We calculated significant differences in the annual proportion of OOD and AOOD and sex differences using Pearson x

2
tests.

Results

Approximately 59% of all drug overdose deaths are attributed to opioids, and 18% of those deaths are alcohol-related. Significant increases in the proportion of OOD were found between 2019 and 2020 and a significant decrease between 2017 and 2018 for women only. No significant changes were found in the overall proportion of AOOD. Men had higher on average proportions of OOD and alcohol-related OOD.

Conclusions

Proportions of OOD in relation to overdose deaths increased between 2011 and 2020, with a precipitous increase between 2019 and 2020 while the proportion of AOOD remained relatively stable over the period. Alcohol remains a contributing factor in approximately 1 in 5 OODs in Minnesota. These results support the need for accessible, evidence-based prevention and treatment programs to prevent drug overdose.
A Plea From People Who Use Drugs to Clinicians: New Ways to Initiate Buprenorphine Are Urgently Needed in the Fentanyl Era
Authors: Sue Kimberly L. , Cohen Shawn , Tilley Jess , Yocheved Avi
Published: January 2022

With the worst opioid overdose death crisis in the United States history, urgent new approaches to assist people who use drugs onto medication for opioid use disorder are necessary. In this commentary, addiction medicine clinicians and drug user union representatives align to argue that conventional ways of buprenorphine initiation that require periods of withdrawal must be augmented with additional novel approaches to initiation. In the fentanyl era, members of the New England Users Union and Portland Users Union report encountering precipitated withdrawal, being unable to stop using full agonist opioids for a required period of time, and difficulty initiating this medication that could offer them some stability and life-saving treatment. People who use drugs should be involved at all levels with ongoing research, clinical and policy efforts to improve buprenorphine initiation as their lives and their suffering are at stake.
The Social Context of Unhealthy Alcohol Use Among Emergency Department Patients: A Cross Sectional Study
Authors: Anderson Erik S. , Fraimow-Wong Leah , Blake Rachel , Batiste Kierra , Liang Amy , DeFries Triveni , Herring Andrew A. , Alter Harrison
Published: January 2022

Background

Housing status and additional social determinants of health are important data for clinicians and policy makers to design and implement effective interventions for emergency department (ED) patients with unhealthy alcohol use (UAU).

Methods

We surveyed patients in an urban, safety-net ED from June to August 2018. UAU was assessed by a validated single-item screening question endorsed by the National Institute on Alcohol Abuse and Alcoholism. Housing status was assessed using items validated for housing stability.

Results

Seven hundred fifty-eight patients completed the survey (60% response rate), and 296 (39%; 95% confidence interval: 36%–43%) reported UAU. Patients with and without UAU had the same rates of ED visits (median 2, interquartile range: 1–4; P = 0.69) and hospitalizations (median 0, interquartile range: 0–0; P = 0.31) in the 12 months before index visit. Patients with UAU were more likely to lack stable housing compared to patients without UAU (69% vs 59%; P = 0.006). Illicit drug use and prescription drug misuse was more common in patients with UAU compared to those without UAU (29% vs 14%, P < 0.001; and 18% vs 10%; P < 0.001, respectively). Only 60 (20.3%) of the 296 patients with UAU had a documented diagnosis of UAU in the medical record.

Conclusions

UAU is common in the general ED patient population and usually not clinically recognized. Patients with UAU have high rates of homelessness and co-occurring substance use. Future studies should consider strategies to incorporate social determinants of health and harm reduction treatments into ED-based interventions for UAU.
Management of Xylazine Withdrawal in a Hospitalized Patient: A Case Report
Authors: Ehrman-Dupre Rachel , Kaigh Caroline , Salzman Matt , Haroz Rachel , Peterson Lars-Kristofer , Schmidt Ryan
Published: January 2022

Background

Xylazine is an alpha-2 adrenergic agonist commonly used as a large animal anesthetic. It is used as an adulterant in illicit opioids, and it is now well established that its synergistic effect with opioids increases lethality. The amount of xylazine adulterating illicit opioids is growing at an alarming rate, present in almost one-third of opioid overdose deaths reported in Philadelphia in 2019. Despite this, there are no reports considering the management of patients using xylazine chronically. In particular, there are no reported cases detailing the management of xylazine withdrawal or exploring the potential for ongoing treatment for those in recovery from xylazine use.

Case Summary

We present the case of a 29 year old female with opioid use disorder and chronic xylazine use, admitted to the intensive care unit for treatment of chronic lower extremity wounds thought to be due to xylazine injection. Her xylazine withdrawal was managed with a combination of dexmedetomidine infusion, phenobarbital and tizanidine, later transitioned to clonidine. By hospital day 4 she was no longer experiencing withdrawal symptoms. She was transitioned from full-agonist opioids for pain to buprenorphine via a buprenorphine “micro-induction” and was ultimately discharged on buprenorphine, clonidine, and gabapentin on day 19 of admission.

Clinical Significance

This case illustrates a potential treatment pathway that allows for safe and comfortable xylazine withdrawal in hospitalized patients. It also provides an introduction into several medical concerns affecting this patient population specifically, including xylazine-mediated soft tissue wounds.
Pembrolizumab Achieves a Complete Response in an NF-1 Mutated, PD-L1 Positive Malignant Peripheral Nerve Sheath Tumor: A Case Report and Review of the Benchmarks
Authors: Larson Kristian , Russ Atlantis , Arif-Tiwari Hina , Mahadevan Daruka , Elliott Alex , Bhattacharyya Achyut , Babiker Hani
Published: January 2022

Malignant peripheral nerve sheath tumors (MPNSTs) represent a rare subtype of neural crest cell-derived soft tissue sarcomas (STS). Standard of care therapy comprises surgical resection followed by adjuvant radiation, and most clinical studies have demonstrated finite survival benefit of radiation and chemotherapy. In metastatic disease, palliative chemotherapy provides very limited efficacy. We report a 60-year-old male patient with a primary para vertebral tumor at T7–T8 with lung metastases who recurred after surgical resection and later progressed on epirubicin plus ifosfamide. He was an international patient and referred to the phase 1 clinic. Molecular profiling and immunohistochemistry of the tumor revealed a PD-L1 expression of 70% (2+) and pathogenic genetic alterations by next-generation sequencing in ARID1A, CDKN2A, KMT2A, NF1, and TP53. Immune checkpoint therapy (ICT) with pembrolizumab was commenced, and interval computed tomography revealed a complete remission by cycle 6. Randomized clinical trials illustrate that ICTs such as anti-PD-1 and anti-CTLA4 monoclonal antibodies in STS cohorts display low or modest response rates by variable PD-L1 expression. This and 3 other case reports of disparate PD-L1 expression demonstrate complete responses in PD-L1 positive MPNSTs treated with ICT. These case reports necessitate further study of ICT in neural crest cell subtype of STS.
Temporal Trends and Predictors of Opioid Use Among Older Patients With Cancer
Authors: Salans Mia , Riviere Paul , Vitzthum Lucas K. , Nalawade Vinit , Murphy James D.
Published: January 2022

Objectives:

While opioids represent a cornerstone of cancer pain management, the timing and patterns of opioid use in the cancer population have not been well studied. This study sought to explore longitudinal trends in opioid use among Medicare beneficiaries with nonmetastatic cancer.

Materials and Methods:

Within a cohort of 16,072 Medicare beneficiaries ≥66 years old diagnosed with nonmetastatic cancer between 2007 and 2013, we determined the likelihood of receiving a short-term (0 to 6 mo postdiagnosis), intermediate-term (6 to 12 mo postdiagnosis), long-term (1 to 2 y postdiagnosis), and high-risk (morphine equivalent dose ≥90 mg/day) opioid prescription after cancer diagnosis. Multivariable logistic regression models were used to identify patient and cancer risk factors associated with these opioid use endpoints.

Results:

During the study period, 74.6% of patients received an opioid prescription, while only 2.66% of patients received a high-risk prescription. Factors associated with use varied somewhat between short-term, intermediate-term, and long-term use, though in general, patients at higher risk of receiving an opioid prescription after their cancer diagnosis were younger, had higher stage disease, lived in regions of higher poverty, and had a history of prior opioid use. Prescriptions for high-risk opioids were associated with individuals living in regions with lower poverty.

Conclusions:

Temporal trends in opioid use in cancer patients depend on patient, demographic, and tumor characteristics. Overall, understanding these correlations may help physicians better identify patient-specific risks of opioid use and could help better inform future evidence-based, cancer-specific opioid prescription guidelines.
Relationship between serum vitamin D concentration and parameters of gonadal function in infertile male patients
Authors: Holzer Mariela , Massa Estefanía , Ghersevich Sergio
Published: January 2022

Background

Vitamin D (vitD) deficiency could affect male reproductive function. Our objective was to investigate the relationship between serum vitD concentrations and hormonal and seminal parameters in infertile patients and to compare the results with those in healthy controls.

Materials and methods

Infertile patients (n = 29) and normozoospermic healthy donors (n = 27) were recruited for the study. Serum concentrations of vitD, total testosterone, estradiol, and sex hormone-binding globulin were determined using chemiluminescence assays, and free testosterone concentration was determined by radioimmunoassay. Semen analysis was performed as suggested by the World Health Organization. Statistical analysis was conducted using Student’s t test, contingency tables, and linear regression studies.

Results

VitD concentrations were lower in patients than in controls (p < 0.001). A significant association (p < 0.001) was observed between vitD concentrations <20ng/mL and infertility. In the control group, significant correlations were reported between vitD concentrations >30 ng/mL and the concentrations of testosterone (p < 0.05), free testosterone (p < 0.01), and estradiol (p < 0.05). A direct correlation was found between vitD concentration and percentage of sperm vitality (p = 0.01). VitD also positively correlated with the percentage of progressive sperm motility (p <0.05) and sex hormone-binding globulin concentrations (p < 0.01).

Conclusions

VitD may affect male reproductive parameters, and its deficiency could be associated with infertility.
Analysis of Variation of Orbital Soft Tissue by a Novel Method in Magnetic Resonance Imaging
Authors: Takekawa Chikara , Fukumoto Takeshi , Haraoka Goichi , Terashi Hiroto
Published: January 2022

Accurate evaluation of the orbital soft tissue is essential when conducting surgery to remove excess lower eyelid fat. However, the eyelid puffiness decreases in the supine-position intraoperatively and when magnetic resonance imaging is performed preoperatively, compared with the standing/sitting-position in which patients are commonly examined. We investigated the orbital soft tissue difference between standing/sitting and supine positions. The study was conducted on six patients with an average age of 58.5 years. Anterior soft tissue and adipose tissue of eyeball axis, anterior adipose tissue in front of the infraorbital margin, total adipose tissue, and horizontal and vertical orbital positions were determined. Statistical examination by t test showed that soft tissue and adipose tissue, except for total adipose tissue, were significantly reduced in the supine-position compared with the standing/sitting-position. There was a significant difference in eye position only in the vertical direction. Anterior adipose tissue in front of the infraorbital margin, which is important during lower eyelid surgery, appeared 17.5% lower in the supine-position than in the standing/sitting-position. It is necessary to consider this postural discrepancy during the surgical management of lower eyelid fat.
ACQUIRED VITELLIFORM LESIONS
Authors: Barequet Dana , Iglicki Matias , Meshi Amit , Loewenstein Anat , Goldstein Michaella , Zur Dinah
Published: January 2022

Purpose:

To describe a novel finding of acquired vitelliform lesions in eyes with peripapillary pachychoroid syndrome.

Methods:

A retrospective, multicenter, observational case series including seven patients with peripapillary pachychoroid syndrome and concomitant acquired vitelliform lesions. Medical records and multimodal imaging findings were comprehensively reviewed.

Results:

Six of seven patients were men, with a mean age of 72.6 years. Mean baseline best-corrected visual acuity was 0.11 ± 0.07 (Snellen equivalent 20/25), and all patients presented with baseline best-corrected visual acuity of 20/30 or better. Mean follow-up time was 24.4 months (range 1–54 months). At last follow-up, best-corrected visual acuity was stable in 13/14 eyes, and deteriorated in one eye because of subfoveal atrophy.

Fundus examination revealed peripapillary retinal pigment epithelium alterations and pigment migration in all eyes. Fundus autofluorescence showed mottled hyperautofluorescence and hypoautofluorescence in the peripapillary region, and hypoautofluorescent lesions corresponding to the pigmentary changes. Optical coherence tomography showed nasal choroidal thickening and pachyvessels with overlying retinal pigment epithelium irregularity. All eyes presented with peripapillary intraretinal fluid. Subretinal fluid was present in five eyes of three patients. Acquired vitelliform lesions were present in 11 eyes.

Conclusion:

The novel association between peripapillary pachychoroid syndrome and acquired vitelliform lesions is characterized by the classic findings of both entities, and visual prognosis is accordingly good.
Evaluating Visual Field Progression in Advanced Glaucoma Using Trend Analysis of Targeted Mean Total Deviation
Authors: Miki Atsuya , Okazaki Tomoyuki , Weinreb Robert N. , Morota Misa , Tanimura Aki , Kawashima Rumi , Usui Shinichi , Matsushita Kenji , Nishida Kohji
Published: January 2022

Purpose:

Trend analysis of visual field (VF) global indices may underestimate the rate of progression in severe glaucoma because of the influence of test points without detectable sensitivity. To test this hypothesis, we compared the rates of change of VF global indices with and without exclusion of undetectable points at various disease stages.

Materials and Methods:

Six hundred and forty-eight eyes of 366 glaucoma patients with 8 or more reliable 30-2 standard automated perimetry over more than 2 years were enrolled. We calculated targeted mean total deviation (TMTD) by averaging total deviation except points which were consistently undetectable in 3 baseline tests. Eyes were classified as early (≥−6 dB), moderate (−6 dB to −12 dB), advanced (−12 dB to −20 dB), and severe (<−20 dB) based on baseline mean deviation (MD). The rates of change of MD and TMTD in each stage were statistically compared.

Results:

Mean age±SD at baseline was 56.9±11.9 years. The MD slope (−0.34 dB/y) in severe glaucoma was significantly slower than TMTD slope (−0.42 dB/y, P=0.028) and was slower than MD slopes in the other stages. Difference between MD slopes and TMTD slopes was most prominent in eyes with MD values less than −25 dB (P=0.002).

Conclusions:

Undetectable locations in eyes with severe glaucoma may underestimate the rates of VF progression. Trend analysis of TMTD rather than global indices offers a practical and simple approach for alleviating underestimation of VF progression in severe glaucoma.
Factors associated with postoperative respiratory conditions and critical outcomes on pediatric liver transplantation: A single-center experience
Authors: Wu Jeng-Hung , Liu Chin-Su , Tsai Hsin-Lin , Su Chih-Ting , Tang Yi-Hsuan , Lee Yu-Sheng , Tsao Pei-Chen , Yeh Yi-Ting , Chen Wei-Yu , Jeng Mei-Jy
Published: January 2022

Background:

Orthotopic liver transplantation (OLT) is an established therapeutic option for pediatric end-stage liver disease (PELD). The postoperative respiratory conditions of OLT recipients may be associated with subsequent clinical outcomes including length of stay (LOS) in the pediatric intensive care unit (PICU). This study aimed to characterize the postoperative respiratory conditions, associated factors, and outcomes after pediatric OLT.

Methods:

Clinical data of children receiving OLT from July 2014 to July 2020 were retrospectively collected. Postoperative respiratory conditions were defined as time to extubation, significant pleural effusion, and initial postoperative PaO2/FiO2 ratio. Logistic and multiple regressions were applied to analyze the associations among clinical factors, postoperative respiratory conditions, and clinical outcomes.

Results:

Twenty-two patients with median age of 1.4-year-old (range: 25 days to 12 years old) were analyzed. Mortality within 28 days was 4.5% and median LOS in the PICU was 18 days. Of 22 patients, 11 patients (50.0%) were extubated over 24 hours after surgery, and 8 patients (36.4%) required drainage for pleural effusions. Longer LOS in the PICU were noted in patients extubated over 24 hours (p = 0.008), complicated with significant pleural effusions (p = 0.02) after surgery, and having low initial postoperative PaO2/FiO2 (<300 mmHg) (p = 0.001). Among clinical factors, massive intraoperative blood transfusion (>40 mL/kg) was significantly associated with prolonged intubations, significant pleural effusions, low initial postoperative PaO2/FiO2, and prolonged LOS in the PICU (>14 days). The initial postoperative PaO2/FiO2 significantly depended on age, disease severity (PELD score), and whether the patient received massive intraoperative blood transfusion.

Conclusion:

Pediatric patients of OLT with poor postoperative respiratory conditions including low initial PaO2/FiO2 ratio, extubation over 24 hours or significant pleural effusions have longer LOS in the PICU, and the requirement of massive intraoperative transfusion was a risk factor for both poor postoperative respiratory conditions and prolonged LOS in the PICU.
Experience of adult cochlear implantation at a tertiary hospital
Authors: Chen Shih-Lung , Chan Kai-Chieh , Hu Chih-Yu , Fang Hsuan-Yeh , Wu Che-Ming
Published: January 2022

Background:

The prevalence of adult cochlear implant (CI) surgery is increasing. However, the relevant adult CI data in Taiwan are insufficient due to the relatively small number of adult implant patients. The two main factors hindering adult implantation are the high cost of the surgery itself and inadequate knowledge regarding the effectiveness of CI for hearing and suppression of tinnitus. Here, we present data regarding adult CI outcomes from a single tertiary hospital.

Methods:

A total of 116 consecutive adult CI recipients (≥18 years old) who completed at least 12 months of speech perception tests (words and sentences) between January 1999 and December 2020 were enrolled in this retrospective population-based cohort study. Thirty patients completed speech perception (words and sentences) testing as well as three questionnaires relating to quality of life, and 71 completed full tinnitus suppression studies. Subjects’ pre- and post-CI questionnaires were evaluated to assess overall CI outcome.

Results:

For auditory evaluation, the scores of easy sentences (ES), difficult sentences (DS), and phonetically balanced (PB) word recognition tests reached a plateau at 3 months post-CI (p = 0.005, 0.001, and 0.004, respectively) in most subjects. The post-CI scores of bodily pain, mental health, and social role functioning were significantly higher than corresponding pre-CI scores on the SF-36 Health Survey–Taiwan version (p = 0.036, 0.019, and 0.002, respectively). Furthermore, the post-CI scores of basic sound perception, speech production, and advanced sound perception were significantly higher than the corresponding pre-CI scores on the Nijmegen Cochlear Implant Questionnaire (p < 0.001, 0.013, and <0.001, respectively). Self-esteem was significantly correlated with the Categories of Auditory Performance scale and Speech Intelligibility Rating scale at 3, 6, and 9 months post-CI. CI improved tinnitus in approximately 65.1% of 71 adults. Based on the Tinnitus Handicap Inventory, 66.7% of patients were in grade 3–5 before surgery. However, after CI, only 34.4% of patients remained in THI grade 3–5.

Conclusion:

This study confirmed that CI can improve speech perception (words and sentences), physical health, mental health, social interaction, and self-esteem in adult patients with profound hearing loss. CI also significantly alleviated tinnitus. The outcomes of ES, DS, and PB tests at 3 months post-CI were non-inferior to other longer post-CI periods and could be utilized as references for recovery and evaluation of prognosis.
Effects of Familial Relationships on School Adjustment of Adolescents and Young Adults With Congenital Heart Disease
Authors: Moon Youngji , Jung Jo Won , Lee Sunhee
Published: January 2022

Background

As more than 85% of patients with congenital heart disease (CHD) have grown to adulthood through improvement in treatment and surgery, the difficulties they experience are expanding into areas related to daily life. Accordingly, adjustment to school in adolescents and young adults (AYAs) with CHD is of increasing interest and is influenced by familial factors.

Objective

This was a cross-sectional descriptive study to examine the effects of parental positive emotional expressiveness and sibling relationships on school adjustment of AYAs with CHD.

Methods

In this study, a self-reported questionnaire survey was used to collect the data. The participants were 104 AYAs with CHD aged 13 to 21 years who were attending school and had siblings.

Results

Maternal positive emotional expressiveness (r = 0.584, P < .01), paternal positive emotional expressiveness (r = 0.584, P < .01), and sibling warmth/closeness (r = 0.478, P < .01) were significantly correlated with school adjustment. However, the results of multiple regression analysis showed that only maternal positive emotional expressiveness (ß = 0.459, P < .05) and sibling warmth/closeness (ß = 0.236, P < .05) were significantly associated with school adjustment.

Conclusions

Adolescents and young adults with CHD who reported higher maternal positive emotional expressiveness and sibling warmth/closeness exhibited better school adjustment. Findings suggest that intervention programs to increase parental positive expressiveness and enhance warmth/closeness of sibling relationships may contribute to improving school adjustment.
Occupational Exposures and Lung Cancer Risk—An Analysis of the CARTaGENE Study
Authors: Moayedi-Nia Saeedeh , Pasquet Romain , Siemiatycki Jack , Koushik Anita , Ho Vikki
Published: January 2022

Objective:

To determine the associations between prevalent occupational agents and lung cancer risk.

Methods:

A case-cohort design (ncases= 147;nsub-cohort= 1,032) was nested within the CARTaGENE prospective cohort study. The Canadian Job Exposure Matrix was used to determine the probability of exposure to 27 agents in participants’ longest-held jobs. Multivariable logistic regression with robust variance estimators was used to determine the associations between each agent and lung cancer risk while adjusting for established lung cancer risk factors.

Results:

Increased lung cancer risk was observed among those exposed to ashes, calcium sulfate, formaldehyde, cooking fumes, alkanes, aliphatic aldehydes, and cleaning agents. Lower lung cancer risk was found among participants exposed to carbon monoxide and polycyclic aromatic hydrocarbons from petroleum.

Conclusion:

Our findings support the role of several occupational agents, for which we have limited knowledge, in contributing to lung cancer risk.