bluuebunny/crossref_metadata_2025 huggingface dataset:
Individuals’ privacy concerns and adoption of contact tracing mobile applications in a pandemic: A situational privacy calculus perspective
Authors: Hassandoust Farkhondeh , Akhlaghpour Saeed , Johnston Allen C
Published: September 2020

Objective

The study sought to develop and empirically validate an integrative situational privacy calculus model for explaining potential users’ privacy concerns and intention to install a contact tracing mobile application (CTMA).

Materials and Methods

A survey instrument was developed based on the extant literature in 2 research streams of technology adoption and privacy calculus. Survey participants (N = 853) were recruited from all 50 U.S. states. Partial least squares structural equation modeling was used to validate and test the model.

Results

Individuals’ intention to install a CTMA is influenced by their risk beliefs, perceived individual and societal benefits to public health, privacy concerns, privacy protection initiatives (legal and technical protection), and technology features (anonymity and use of less sensitive data). We found only indirect relationships between trust in public health authorities and intention to install CTMA. Sex, education, media exposure, and past invasion of privacy did not have a significant relationship either, but interestingly, older people were slightly more inclined than younger people to install a CTMA.

Discussion

Our survey results confirm the initial concerns about the potentially low adoption rates of CTMA. Our model provides public health agencies with a validated list of factors influencing individuals’ privacy concerns and beliefs, enabling them to systematically take actions to address these identified issues, and increase CTMA adoption.

Conclusions

Developing CTMAs and increasing their adoption is an ongoing challenge for public health systems and policymakers. This research provides an evidence-based and situation-specific model for a better understanding of this theoretically and pragmatically important phenomenon.
Rapid Cognitive Decline Secondary to CSF Venous Fistula With Postoperative Rebound Intracranial Hypertension and a Hyperintense Paraspinal Vein Sign Seen Retrospectively
Authors: Tatum Peter S , Anderson Emily , Kravtsova Alina , Alnasser Osamah , Hedges Thomas , Green-Laroche Deborah M , Madan Neel
Published: September 2020

A 56-year-old female with 2 prior Chiari decompressions presented with rapidly progressive cognitive decline. Brain magnetic resonance imaging, computed tomography myelogram, and prone digital subtraction myelography revealed signs of brain sag and left T9 perineural cysts but no cerebrospinal fluid leaks. Symptoms improved after multilevel blood patches but recurred. Lateral decubitus digital subtraction myelography revealed a spinal cerebrospinal fluid venous fistula (SCVF), which resolved after neurosurgeons ligated the nerve root. Rebound headaches with papilledema occurred on postoperative day 9 and then resolved 2 months after acetazolamide was started. A hyperintense paraspinal vein was seen retrospectively on T2-weighted magnetic resonance imaging with Dixon fat suppression sequencing. This case is unique in the acuity of cognitive decline secondary to SCVF. Acetazolamide at the time of treatment may potentially be used as prophylaxis for rebound intracranial hypertension. The hyperintense paraspinal vein may have utility in future diagnosis of SCVF.
The baryon content of groups and clusters of galaxies in the FABLE simulations
Authors: Henden Nicholas A , Puchwein Ewald , Sijacki Debora
Published: September 2020

We study the gas and stellar mass content of galaxy groups and clusters in the fable suite of cosmological hydrodynamical simulations, including the evolution of their central brightest cluster galaxies (BCGs), satellite galaxies, and intracluster light (ICL). The total gas and stellar mass of fable clusters are in good agreement with observations and show negligible redshift evolution at fixed halo mass for $M_{500} \gtrsim 3 \times 10^{14} \, \mathrm{M}_{\odot }$ at z ≲ 1, in line with recent findings from Sunyaev–Zel’dovich (SZ)-selected cluster samples. Importantly, the simulations predict significant redshift evolution in these quantities in the low-mass ($M_{500} \sim 10^{14} \, \mathrm{M}_{\odot }$) regime, which will be testable with upcoming SZ surveys such as SPT-3G. Whilst the stellar masses of fable BCGs are in reasonable agreement with observations, the total stellar mass in satellite galaxies is lower than observed and the total mass in ICL is somewhat higher. This may be caused by enhanced tidal stripping of satellite galaxies due to their large sizes. BCGs are characterized by moderate stellar mass growth at z < 1 coincident with a late-time development of the ICL. The level of BCG mass growth is in good agreement with recent observations; however, we caution that the inferred growth depends sensitively on the mass definition. We further show that in situ star formation contributes more than half the mass of a BCG over its lifetime, the bulk of which is gained at z > 1 where star formation rates are highest. The stellar mass profiles of the BCG+ICL component are similar to observed profiles out to ∼100 kpc at z ≈ 0 and follow a close to power law shape out to several hundred kpc. We further demonstrate that the inferred size growth of BCGs can be severely biased by the choice of parametric model and the outer radius of the fit.
Source of circular polarization in radio pulsars
Authors: Jones P B
Published: September 2020

It is known that the concept of limiting polarization introduced 70 yr ago by K. G. Budden has the capacity to explain the magnitude of circular polarization seen in normal pulsars with light-cylinder radii of the order of 109–10 cm under the assumption of a high-multiplicity electron–positron plasma. However, a review of limiting polarization under the same assumption in millisecond pulsars indicates that it is inapplicable there because the region of limiting polarization lies far outside the light cylinder. This paper, using the ion–proton model, evaluates circular polarization both generally and specifically for J2144−3933, and gives a fairly detailed understanding of the observations in normal pulsars including the change of sign as a function of frequency seen in J0908−4913. But it also fails to explain circular polarization in millisecond pulsars owing to the smaller particle number densities and birefringence of the magnetosphere in these objects. However, the review of limiting polarization finds that, within the ion–proton model, this distinct process can describe their circular polarization. It is argued that certain features of millisecond pulsar Stokes profiles are clearly consistent with limiting polarization.
Intellectual changes after radiation for children with brain tumors: which brain structures are most important?
Authors: Tsang Derek S , Kim Laurence , Liu Zhihui Amy , Janzen Laura , Khandwala Mohammad , Bouffet Eric , Laperriere Normand , Dama Hitesh , Keilty Dana , Craig Tim , Ramaswamy Vijay , Hodgson David C , Mabbott Donald
Published: September 2020

Background

The objective of this study was to evaluate the contribution of radiation dose to different intracranial structures on changes in intellectual function for children with brain tumors.

Methods

We evaluated children with brain tumors treated in 2005–2017 who had longitudinal neuropsychological assessments and available photon dosimetric data (if radiation therapy [RT] given). Full Scale Intelligence Quotient (FSIQ) and index scores were evaluated (perceptual reasoning index [PRI], processing speed index [PSI], verbal comprehension index [VCI], and working memory index [WMI]). Multivariable linear mixed effects models were used to model endpoints, with age at RT and dose to different brain regions as fixed effects and patient-specific random intercepts. P-values (P*) were adjusted for multiple comparisons.

Results

Sixty-nine patients were included, 56 of whom received RT. Median neuropsychological follow-up was 3.2 years. Right temporal lobe mean dose was strongly associated with decline in FSIQ (P* = 0.005); with each gray increase in mean dose, there was a decrease of 0.052 FSIQ points per year. Dose to 50% (D50) of the supratentorial brain was associated with decline in PSI (P* = 0.006) and WMI (P* = 0.001). Right and left hippocampus D50 were individually strongly associated with declines in VCI (P* = 0.009 for each). Presence of a ventriculoperitoneal shunt decreased FSIQ by 10 points.

Conclusions

We reported associations between dosimetry to specific brain regions and intellectual outcomes, with suggested avoidance structures during RT planning. These models can help clinicians anticipate changes in neurocognition post-RT and guide selection of an optimal RT plan.
Patterns of E-cigarette Use and Subsequent Cigarette Smoking Cessation Over 2 Years (2013/2014–2015/2016) in the Population Assessment of Tobacco and Health Study
Authors: Glasser Allison M , Vojjala Mahathi , Cantrell Jennifer , Levy David T , Giovenco Daniel P , Abrams David , Niaura Raymond
Published: September 2020

Introduction

Understanding the population impact of e-cigarettes requires determining their effect on cigarette smoking cessation.

Methods

Using the US Population Assessment of Tobacco and Health cohort, we examined smoking cessation among adult current cigarette smokers at Wave 1 with follow-up data at Waves 2 and 3 (n = 9724).

Results

By Wave 3 (2015/2016), 17.3% of smokers had quit smoking. Smokers using e-cigarettes daily or who increased to daily use over the three waves were two to four times more likely to have quit in the short term (<1 year) and long term (1+ years) compared with never e-cigarette users (p < .001). E-cigarette use in the last quit attempt was associated with a higher likelihood of short-term (<1 year) quitting at Wave 3 (adjusted relative risk ratio: 1.33; 95% confidence interval: 1.04, 1.71) compared with smokers who did not use an e-cigarette in their last quit attempt. Noncurrent (no use in any wave) e-cigarette users and users who were unstable in use frequency were 33% and 47% less likely to quit in the short-term, respectively (p < .001). Flavored (vs nonflavored) and using a rechargeable (vs disposable) e-cigarette device was associated with an increased likelihood of both short- and long-term quitting.

Conclusion

Smoking cessation was more likely among frequent e-cigarette users, users of e-cigarettes in last quit attempt, and users of flavored and rechargeable devices. Less frequent, unstable, past, or never e-cigarette users were less likely to quit smoking. Monitoring the relationship between patterns of e-cigarette and cigarette use is complex but critical for gauging the potential of e-cigarettes as a harm reduction tool.

Implications

This study suggests that consistent and frequent e-cigarette use over time is associated with cigarette smoking cessation among adults in the United States. In addition, findings suggest that flavored e-cigarette use and use of rechargeable e-cigarette devices can facilitate smoking cessation. These results underscore the importance of carefully defining and characterizing e-cigarette exposure patterns, potential confounders, and use of e-cigarettes to quit smoking, as well as variations in length of the smoking cessation.
The role of cultural beliefs on eating patterns and food practices among pregnant women: a systematic review
Authors: de Diego-Cordero Rocío , Rivilla-Garcia Estefanía , Diaz-Jimenez Desireé , Lucchetti Giancarlo , Badanta Bárbara
Published: September 2020

Context

Despite the importance of cultural beliefs in clinical practice, few systematic reviews have investigated how these beliefs influence food practices in pregnant women.

Objective

To explore the role of cultural beliefs in eating patterns and food practices among pregnant women, highlighting food recommendations, food taboos and restrictions, and their association with health.

Data Sources

A systematic review was conducted using the following electronic databases: PubMed, Scopus, CINAHL, PsycINFO, and Web of Science from May 2014 to May 2019.

Data Extraction

Articles were included if the studies included pregnant women, analyzed how cultural beliefs may influence eating patterns, were peer-reviewed articles with original data, published in the last 5 years, and in English or Spanish language. Quality assessment was also performed.

Data Analysis

A total of 544 articles were identified in the search and 24 were included in the final analysis (17 using qualitative design, 6 using quantitative design, and 1 with a mixed-design). These studies were predominantly from the African continent (n = 15). Our findings showed that culture is a key factor related to “taboos” and food restrictions, which are transmitted by the family or members of community, having a strong religious or spiritual influence. All these restrictions are related to the fear of unfavorable pregnancy outcomes such as the risk of abortion, dystocia, and congenital macrosomia, or are used to avoid child problems such as cutaneous and respiratory disorders.

Conclusions

Findings from this study indicate cultural beliefs are strongly associated with food patterns and eating habits in pregnant women. Administrators and health professionals should be aware of these beliefs to minimize problems in the perinatal period.
Public Management’s Problems are Legal Problems: How Law Contributes to Inequity in Contemporary Governance
Authors: Merriman Ben
Published: September 2020

Over the latter half of the twentieth century, legal changes obliged public organizations in the United States to alter and standardize their procedures to provide due process and promote equal protection. Integration of administration into the constitutional order produced two remarkable changes. First, the everyday work of administration uses forms and vocabularies resembling those of law and the court system. Second, adoption of legally mandated due process protections catalyzed a broader values reorientation, yielding practices that promote social equity and public participation. However, as administrative practice became more law-like, partisans and organized interests made new use of legal tactics to bend administrative decision-making toward their own ends. Common patterns of unequal outcomes in the American legal system thus arise, in similar forms, in administrative settings. Law’s problems have thereby become governance problems. This article elucidates these past and current patterns by reading law and society literature alongside that of public administration and public management. In doing so, it shows that these two fields have long developed in parallel and have much to contribute to each other. This article underscores the importance of mutual learning and understanding between the fields of law and society and public administration and management.
COVID-19-related mobility reduction: heterogenous effects on sleep and physical activity rhythms
Authors: Ong Ju Lynn , Lau TeYang , Massar Stijn A A , Chong Zhi Ting , Ng Ben K L , Koek Daphne , Zhao Wanting , Yeo B T Thomas , Cheong Karen , Chee Michael W L
Published: September 2020

Study Objectives

Mobility restrictions imposed to suppress transmission of COVID-19 can alter physical activity (PA) and sleep patterns that are important for health and well-being. Characterization of response heterogeneity and their underlying associations may assist in stratifying the health impact of the pandemic.

Methods

We obtained wearable data covering baseline, incremental mobility restriction, and lockdown periods from 1,824 city-dwelling, working adults aged 21–40 years, incorporating 206,381 nights of sleep and 334,038 days of PA. Distinct rest-activity rhythm (RAR) profiles were identified using k-means clustering, indicating participants’ temporal distribution of step counts over the day. Hierarchical clustering of the proportion of days spent in each of these RAR profiles revealed four groups who expressed different mixtures of RAR profiles before and during the lockdown.

Results

Time in bed increased by 20 min during the lockdown without loss of sleep efficiency, while social jetlag measures decreased by 15 min. Resting heart rate declined by ~2 bpm. PA dropped an average of 42%. Four groups with different compositions of RAR profiles were found. Three were better able to maintain PA and weekday/weekend differentiation during lockdown. The least active group comprising ~51% of the sample, were younger and predominantly singles. Habitually less active already, this group showed the greatest reduction in PA during lockdown with little weekday/weekend differences.

Conclusion

In the early aftermath of COVID-19 mobility restriction, PA appears to be more severely affected than sleep. RAR evaluation uncovered heterogeneity of responses to lockdown that could associate with different outcomes should the resolution of COVID-19 be protracted.
Multidimensional sleep health domains in older men and women: an actigraphy factor analysis
Authors: Wallace Meredith L , Yu Lan , Buysse Daniel J , Stone Katie L , Redline Susan , Smagula Stephen F , Stefanick Marcia L , Kritz-Silverstein Donna , Hall Martica H
Published: September 2020

The multidimensional sleep health framework emphasizes that sleep can be characterized across several domains, with implications for developing novel sleep treatments and improved prediction and health screening. However, empirical evidence regarding the domains and representative measures that exist in actigraphy-assessed sleep is lacking. We aimed to establish these domains and representative measures in older adults by examining the factor structure of 28 actigraphy-derived sleep measures from 2,841 older men from the Osteoporotic Fractures in Men Sleep Study and, separately, from 2,719 older women from the Study of Osteoporotic Fractures. Measures included means and standard deviations of actigraphy summary measures and estimates from extended cosine models of the raw actigraphy data. Exploratory factor analyses revealed the same five factors in both sexes: Timing (e.g. mean midpoint from sleep onset to wake-up), Efficiency (e.g. mean sleep efficiency), Duration (e.g. mean minutes from sleep onset to wake-up), Sleepiness/Wakefulness (e.g. mean minutes napping and amplitude of rhythm), and Regularity (e.g. standard deviation of the midpoint). Within each sex, confirmatory factor analyses confirmed the one-factor structure of each factor and the entire five-factor structure (Comparative Fit Index and Tucker–Lewis Index ≥ 0.95; Root Mean Square Error of Approximation 0.08–0.38). Correlation magnitudes among factors ranged from 0.01 to 0.34. These findings demonstrate the validity of conceptualizing actigraphy sleep as multidimensional, provide a framework for selecting sleep health domains and representative measures, and suggest targets for behavioral interventions. Similar analyses should be performed with additional measures of rhythmicity, other age ranges, and more racially/ethnically diverse samples.
Associations between sleep and cognitive performance in a racially/ethnically diverse cohort: the Study of Women’s Health Across the Nation
Authors: Swanson Leslie M , Hood Michelle M , Hall Martica H , Kravitz Howard M , Matthews Karen A , Joffe Hadine , Thurston Rebecca C , Butters Meryl A , Ruppert Kristine , Harlow Siobán D
Published: September 2020

Study Objectives

To determine whether actigraphy-assessed indices of sleep are associated with cognitive performance in women, and explore whether these associations vary by race/ethnicity.

Methods

Participants were 1,126 postmenopausal community-dwelling females (mean age 65 years) from the observational Study of Women’s Health Across the Nation (SWAN); 25% were black, 46% white, 13% Chinese, 11% Japanese, and 5% Hispanic. Actigraphy-assessed sleep measures included total sleep time, wake after sleep onset (WASO), and fragmentation. Cognitive measures included immediate and delayed verbal memory, working memory, and information processing speed. All measures were assessed in conjunction with SWAN annual visit 15.

Results

Across the sample, after covariate adjustment, greater WASO and fragmentation were concurrently associated with slower information processing speed. Black participants had significantly worse sleep relative to other race/ethnic groups. Significant race/sleep interactions were observed; in black, but not white, participants, greater fragmentation was concurrently associated with worse verbal memory and slower information processing speed, and greater WASO was concurrently associated with slower information processing speed. Sleep-cognitive performance associations were not different in Chinese and Japanese participants relative to white participants.

Conclusions

Greater wakefulness and fragmentation during sleep are concurrently associated with slower information processing. Sleep continuity impacted concurrent cognitive performance in black, but not white, women. This effect may not have been detected in white women because their sleep was largely within the normal range. Future longitudinal studies in diverse samples are critical to further understand whether race/ethnicity moderates the influence of sleep on cognitive performance.
Baseline and 1-year longitudinal data from the National Restless Legs Syndrome Opioid Registry
Authors: Winkelman John W , Purks Julia , Wipper Benjamin
Published: September 2020

Study Objectives

Restless legs syndrome (RLS) is a sensory-motor neurological disorder. Low dose opioid medications are prescribed for treatment-refractory RLS. We describe baseline and 1-year longitudinal dosing and symptom outcomes for the National RLS Opioid Registry.

Methods

Individuals currently taking a prescribed opioid for diagnosed RLS are included in the registry. Information on initial and current opioid dosages, side effects, past and current concomitant RLS treatments, RLS severity, psychiatric history, and opioid abuse risk factors were collected at baseline. Follow-up online surveys were performed at 6 months and 1-year.

Results

Participants (n = 500) are primarily white, elderly, educated, and retired. Half of all subjects are on opioid monotherapy. Nearly 50% of all subjects are taking methadone, and one-quarter are taking oxycodone formulations. The median total daily opioid dose is 30.0 morphine milligram equivalents (MME). At baseline, three-quarters of registry participants had been taking a prescribed opioid for RLS for more than 1 year and one-third for more than 5 years, and had mild-moderate RLS symptoms. At 1-year follow-up, 31.2% increased dose (median = 10 MME) and 16.0% decreased dose of their opioid. An MME increase ≥25 was associated with: opioid use for non-RLS pain, <1 year of opioid use, opioid switch to methadone, and discontinuation of non-opioid RLS medications which, combined, accounted for 91.7% of those with 1-year follow-up increases ≥25 MME.

Conclusions

In refractory RLS, prescribed opioids are generally used at low doses with good efficacy. Longitudinally over 1 year, roughly one-third of participants increased their prescribed opioid dose, though generally by small amounts, with larger dose increases accounted for by predictable features.
Growth performance and gut health of Escherichia coli-challenged weaned pigs fed diets supplemented with a Bacillus subtilis direct-fed microbial
Authors: Park Sangwoo , Lee Jung Wook , Jerez Bogota Kevin , Francis David , González-Vega Jolie Caroline , Htoo John K , Woyengo Tofuko Awori
Published: September 2020

This study was conducted to investigate the effects of a direct-fed microbial (DFM) product (Bacillus subtilis strain DSM 32540) in weaned pigs challenged with K88 strain of Escherichia coli on growth performance and indicators of gut health. A total of 21 weaned pigs [initial body weight (BW) = 8.19 kg] were housed individually in pens and fed three diets (seven replicates per diet) for 21 d in a completely randomized design. The three diets were a corn-soybean meal-based basal diet without feed additives, a basal diet with 0.25% antibiotics (neo-Oxy 10-10; neomycin + oxytetracycline), or a basal diet with 0.05% DFM. All pigs were orally challenged with a subclinical dose (6.7 × 108 CFU/mL) of K88 strain of E. coli on day 3 of the study (3 d after weaning). Feed intake and BW data were collected on days 0, 3, 7, 14, and 21. Fecal scores were recorded daily. On day 21, pigs were sacrificed to determine various indicators of gut health. Supplementation of the basal diet with antibiotics or DFM did not affect the overall (days 0–21) growth performance of pigs. However, antibiotics or DFM supplementation increased (P = 0.010) gain:feed (G:F) of pigs during the post-E. coli challenge period (days 3–21) by 23% and 24%, respectively. The G:F for the DFM-supplemented diet did not differ from that for the antibiotics-supplemented diet. The frequency of diarrhea for pigs fed a diet with antibiotics or DFM tended to be lower (P = 0.071) than that of pigs fed the basal diet. The jejunal villous height (VH) and the VH to crypt depth ratio (VH:CD) were increased (P < 0.001) by 33% and 35%, respectively, due to the inclusion of antibiotics in the basal diet and by 43% and 41%, respectively due to the inclusion of DFM in the basal diet. The VH and VH:CD for the DFM-supplemented diet were greater (P < 0.05) than those for the antibiotics-supplemented diet. Ileal VH was increased (P < 0.05) by 46% due to the inclusion of DFM in the basal diet. The empty weight of small intestine, cecum, or colon relative to live BW was unaffected by dietary antibiotics or DFM supplementation. In conclusion, the addition of DFM to the basal diet improved the feed efficiency of E. coli-challenged weaned pigs to a value similar to that of the antibiotics-supplemented diet and increased jejunal VH and VH:CD ratio to values greater than those for the antibiotics-supplemented diet. Thus, under E. coli challenge, the test DFM product may replace the use of antibiotics as a growth promoter in diets for weaned pigs to improve feed efficiency and gut integrity.
Changing the landscape of South Asian migrant health research by advancing second-generation immigrant health needs
Authors: Ali Shahmir H , DiClemente Ralph J , Parekh Niyati
Published: September 2020

South Asian immigrants confront a growing non-communicable disease burden, a significant issue in countries such as the USA. While efforts have slowly begun to address South Asian migrant health, second-generation communities remain underserved and understudied despite facing many of the same non-communicable disease concerns. The aim of this commentary is to highlight unique health disparities contributing to the current South Asian migrant health status and identify pathways for further formative research needed to inform subsequent development, implementation, and evaluation of health interventions targeting this community. Extant peer-reviewed literature addressing second-generation South Asian health issues was used to identify key research pathways needed to address existing gaps. Specifically, we call for (a) enhancing targeted surveillance and recruitment in research and (b) collecting data to help characterize behavioral and cultural patterns that may contribute to disease onset and progression. Expanding research on second-generation South Asian migrant health may help to develop tailored and targeted interventions.
Effective Masking Levels for Bone Conduction Auditory Brainstem Response Stimuli in Infants and Adults with Normal Hearing
Authors: Lau Ricky , Small Susan A.
Published: September 2020

Objective:

The purpose of the present study was to investigate effective masking levels (EMLs) for bone conduction (BC) auditory brainstem response (ABR) testing in infants and adults. Early hearing detection and intervention programs aim to limit delays in identifying ear-specific type/degree of hearing loss in infants using the ABR. Ear-specific assessment poses challenges as sound delivered to one ear can travel across the skull and activate the contralateral cochlea. Wave V amplitude and latency measures ipsilateral and contralateral to the bone oscillator can be compared to isolate the test cochlea in some cases; however, when these findings are equivocal, clinical masking is required. This study aims to determine EMLs for ABRs elicited to 500- and 2000-Hz BC stimuli for normal-hearing infants (0 to 18 months) and adults.

Design:

Participants were 21 adults (18 to 54 years) and 24 infants (5 to 47 weeks) with normal hearing. BC 500- and 2000-Hz brief tonal stimuli at intensities approximating normal levels were presented via a B-71 oscillator (infants: 20 dB nHL at 500 Hz and 30 dB nHL at 2000 Hz; adults: 500 and 2000 Hz at 20 and 30 dB nHL, respectively). White noise masking was presented binaurally via ER-3A earphones (22 to 82 dB SPL; 10-dB steps). The lowest level of masking to eliminate a BC response was deemed the EML.

Results:

For stimuli presented at 20 dB nHL, adult mean (1 SD) EMLs for 500 and 2000 Hz were 65 (9) and 53 (6) dB SPL, respectively. Mean EMLs for infants were 80 (6) dB SPL for 500 Hz at 20 dB nHL and 64 (9) dB SPL for 2000 Hz at 30 dB nHL. Compared to adults, infants required approximately 13 dB more masking at 500 Hz but a similar amount of masking at 2000 Hz. Infants required 26 dB more masking at 500 versus 2000 Hz, whereas, adults required only 12 dB more masking.

Conclusions:

Maximum binaural EMLs for infant BC responses elicited to 500 Hz at 20 dB nHL are 82 dB SPL, and for 2000 Hz at 30 and 40 dB nHL, respectively, are 72 and 82 dB SPL. Monaural masking levels for the nontest ear (assuming 10 dB of interaural attenuation) recommended clinically are as follows: (1) 500 Hz: 72 and 82 dB SPL at 20 and 30 dB nHL, respectively; and (2) 2000 Hz: 62, 72, and 82 dB SPL at 30, 40, and 50 dB nHL, respectively. Unsafe levels of white noise would be needed to effectively mask at greater stimulus levels.
Health-Related Quality of Life Outcomes of Instrumented Circumferential Spinal Fusion for Pediatric Spondylolisthesis
Authors: Virkki Ella N. , Oksanen Hanna , Diarbakerli Elias , Helenius Linda , Pape Bernd , Pajulo Olli , Gerdhem Paul , Helenius Ilkka
Published: September 2020

Study Design.

A prospective study on the clinical, radiographic, and the health-related quality of life (HRQOL) outcomes in adolescents with spondylolisthesis undergoing instrumented circumferential spinal fusion compared with age and sex matched controls.

Objective.

To determine the outcomes of pediatric spondylolisthesis patients minimum 2 years after surgery and to compare their HRQOL with age and sex matched controls.

Summary of Background Data.

There is limited evidence of the HRQOL of adolescent spondylolisthesis patients after surgery and no studies comparing it with healthy controls.

Methods.

Twenty-six consecutive adolescents (mean age 14.7 yr, range 10–18 yr) undergoing instrumented reduction with intercorporeal spinal fusion for spondylolisthesis (11 low-grade, 15 high-grade) by a single orthopedic surgeon were included to this study cohort and matched by age and sex with two controls. The HRQOL was measured with Scoliosis Research Society-24 (SRS-24) questionnaire before surgery, 6 months and 2 years after the surgery.

Results.

The mean (SD) vertebral slip in the low-grade patients was 25% (13%) and 67% (15%) in the high-grade patients and 6% (7%) and 21% (25%) postoperatively, respectively (P ≤ 0.041 for both comparisons). Three (12%) patients developed a non-union during follow-up. None of the patients developed a persistent neurologic deficit, but two (8%) patients presented with chronic postsurgical pain persisting 24 months. Seven (27%) of the patients had reoperations for any reason during the follow-up. Pain and activity domains of the SRS-24 improved significantly from preoperative to 2-year follow-up (P ≤ 0.007 for both). SRS pain, self-image, function domains, and total score were significantly worse as compared with the 52 controls (P ≤ 0.020 for all comparisons).

Conclusion.

Risk of non-union is relatively low after instrumented spinal reduction in adolescents with spondylolisthesis. HRQOL improves significantly after instrumented reduction and circumferential spinal fusion in adolescents with spondylolisthesis, but remains at statistically lower level than in the controls.

Level of Evidence: 2
Radiation Exposure in Minimally Invasive Lumbar Fusion Surgery
Authors: Klingler Jan-Helge , Scholz Christoph , Krüger Marie T. , Naseri Yashar , Volz Florian , Hohenhaus Marc , Brönner Johannes , Hoedlmoser Herbert , Sircar Ronen , Hubbe Ulrich
Published: September 2020

Study Design.

Randomized controlled trial.

Objective.

The aim of this study was to compare the dosemetrically determined radiation exposure of surgeon and patient during minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) using conventional 2D fluoroscopy (FLUORO) or 3D fluoroscopy-based navigation (NAV).

Summary of Background Data.

MIS TLIF was shown to exhibit higher radiation exposures compared to open techniques. In particular, the routinely exposed surgeon encounters the risks of increased radiation doses. With the additional use of intraoperative 3D navigation, major steps of the operation can be performed without exposing the operating room staff to ionizing radiation.

Methods.

Forty-four patients undergoing monosegmental MIS TLIF were randomized into the two intraoperative imaging technique groups (FLUORO or NAV). The primary endpoint was the radiation exposure of the surgeon; the secondary endpoints were the radiation exposure of the patient and C-arm readings.

Results.

After exclusion of three patients, 41 patients were analyzed. In general, the average radiation exposure of the surgeon was lower in the NAV group without being statistically significant. The radiation exposure of the patient was significantly higher in the NAV group at all dosemeter sites. The average fluoroscopy time was 63 ± 36 versus 109 ± 31 sec (FLUORO versus NAV group, P < 0.001).

Conclusion.

The additional use of intraoperative 3D fluoroscopy-based navigation compared to conventional 2D fluoroscopy alone showed a nonsignificant reduction of the radiation exposure of the surgeon in monosegmental MIS TLIF, while increasing the radiation exposure of the patient.

Level of Evidence: 1
Cost and Complications of Single-Level Lumbar Decompression in Those Over and Under 75
Authors: Rosas Samuel , Knio Ziyad O. , Gowd Anirudh K. , Luo T. David , Emory Cynthia L. , O’Gara Tadhg J.
Published: September 2020

Study Design.

Retrospective database analysis.

Objective.

This study aimed to compare costs and complication rates following single-level lumbar decompression in patients under age 75 versus patients aged 75 and older.

Summary of Background Data.

Lumbar decompression is a common surgical treatment for lumbar pathology; however, its effectiveness can be debated in elderly patients because complication rates and costs by age group are not well-defined.

Methods.

The Medicare database was queried through the PearlDiver server for patients who underwent single-level lumbar decompression without fusion as an index procedure. The 90-day complication and reoperation rates were compared between age groups after matching for sex and comorbidity burden. Same day and 90-day costs are compared.

Results.

The matched cohort included 89,388 total patients (n = 44,694 for each study arm). Compared to the under 75 age group, the 75 and older age group had greater rates of deep venous thrombosis (odds ratio [OR] 1.443, P = 0.042) and dural tear (OR 1.560, P = 0.043), and a lower rate of seroma complicating the procedure (OR 0.419, P = 0.009). There was no difference in overall 90-day reoperation rate in patients under age 75 versus patients aged 75 and older (9.66% vs. 9.28%, P = 0.051), although the 75 and older age group had a greater rate of laminectomy without discectomy (CPT-63047; OR 1.175, P < 0.001), while having a lower rate of laminotomy with discectomy (CPT-63042 and CPT-63030; OR 0.727 and 0.867, respectively, P = 0.013 and <0.001, respectively). The 75 and older age group had greater same day ($3329.24 vs. $3138.05, P < 0.001) and 90-day ($5014.82 vs. $4749.44, P < 0.001) mean reimbursement.

Conclusion.

Elderly patients experience greater rates of select perioperative complications, with mildly increased costs. There is no significant difference in overall 90-day reoperation rates.

Level of Evidence: 3
Is There a Relationship Between Bony Fusion After Anterior Cervical Discectomy and Fusion and Heterotopic Ossification After Cervical Disc Arthroplasty in Hybrid Surgery?
Authors: He Junbo , Ding Chen , Liu Hao , Wu Tingkui , Huang Kangkang , Wang Beiyu , Hong Ying , Liu Ying
Published: September 2020

Study Design.

Retrospective analysis.

Objective.

The aim of this study was to investigate the relationship between bony fusion after anterior cervical discectomy and fusion (ACDF) and heterotopic ossification (HO) after cervical disc arthroplasty (CDA) in hybrid surgery (HS).

Summary of Background Data.

The mechanism of postoperative bone formation still remains unknown. It is considered a risk factor in CDA but is essential for a solid union in ACDF. With HS, we could directly study the mechanism and relationship of different forms of postoperative bone formation.

Methods.

Clinical data of 91 patients who had undergone consecutive two-level HS between January 2011 and January 2018 and with a minimum of 2-year follow-up was analyzed. HO was assessed based on McAfee's classifications, whereas fusion success was evaluated according the Food and Drug Administration approved criteria. Clinical outcomes and radiographic parameters were collected and used for the relevant comparisons.

Results.

HO was identified in 48.4% of patients (44/91). The fusion rates of patients in the HO group and the non-HO group at 3, 6, and 12 months postoperatively, and the final follow-up were 81.8% and 19.1%, 95.4% and 74.5%, 95.4% and 85.1%, and 97.7% and 93.6%, respectively. The fusion rates were significantly higher at 3 and 6 months after operation in the HO group than in the non-HO group (P < 0.05). Patients in both groups had significant improvements across all clinical outcomes at final follow-up.

Conclusion.

There was a significant relationship between bony fusion and occurrence of HO after HS, suggesting that both bony fusion and HO are reflections of individual osteogenic capacity. However, a reliable predictor of postoperative bone formation is needed in the future to guarantee a solid bony fusion after ACDF and to further take full advantage of the motion-preserving from CDA.

Level of Evidence: 3
Differences in Bone Mineral Density and Bone Turnover Markers Between Subjects With and Without Diffuse Idiopathic Skeletal Hyperostosis
Authors: Uehara Masashi , Takahashi Jun , Ikegami Shota , Tokida Ryosuke , Nishimura Hikaru , Sakai Noriko , Nakamura Yukio , Kato Hiroyuki
Published: September 2020

Study Design.

Japanese resident cohort study based on a municipal registry.

Objective.

This study of a community-dwelling elderly Japanese population employed random sampling from the basic resident registry of a rural town for subject selection to investigate the differences in bone mineral density (BMD) and bone turnover markers between subjects with and without diffuse idiopathic skeletal hyperostosis (DISH).

Summary of Background Data.

DISH is a condition characterized by the calcification and ossification of soft tissues. Although some reports have addressed BMD in DISH, the precise status of BMD and bone metabolism in individuals with DISH remains unclear.

Methods.

Eight groups based on age (50s, 60s, 70s, and 80s) and sex after random sampling from the resident registry of Obuse town were established. A total of 411 participants (202 males and 209 females) were enrolled for the evaluation of BMD and bone turnover markers. All subjects underwent a single whole-spine lateral radiographic examination for the existence of DISH. The BMD and bone turnover markers of subjects with and without DISH were analyzed for associations with the disorder using multivariate analysis.

Results.

DISH was detected in 66 (16.1%) participants in our population cohort. According to multivariate analysis, increased lumbar and hip BMD were significantly related to DISH (odds ratio: 7.47 and 22.8, respectively).

Conclusion.

This study clarified the differences in BMD and bone turnover markers between subjects with and without DISH on a general population basis. Multivariate analysis revealed increased lumbar and hip BMD to be significantly associated with DISH, with no remarkable findings for bone turnover markers.

Level of Evidence: 4
Health Care Lobbying, Political Action Committees, and Spine Surgery
Authors: Menger Richard , Shaw Thomas , Bunch Jaclyn , Barry James , Marciano Gerard , Menger Austin , Martino Anthony , Lenke Lawrence , Vitale Michael G.
Published: September 2020

Study Design.

Retrospective review.

Objective.

The aim of this study was to analyze the political contributions and strategies of the Political Action Committee (PACs) lobbying for the political interests of spine surgeons.

Summary of Background Data.

In 2016, a presidential election year, $514,224,628 was spent on health care lobbying. Only 16% ($85,061,148) was on behalf of health professionals providing care. Below we chronicle the overlapping contributions between the three different physician-based Political Action Committee (PAC) lobbying entities as it relates specifically to spine surgery.

Methods.

Data were abstracted for the PACs of the American Association of Neurological Surgeons (AANS), American Association of Orthopedic Surgeons (AAOS), and the North American Spine Society (NASS). These data were obtained using OpenSecrets (opensecrets.org), and the Federal Election Commission (fec.gov) website. All data points were collected biannually from 2006 to 2018 and statistically analyzed as appropriate.

Results.

In 2016, the AAOS PAC contributed $2,648,218, the AANS PAC $348,091, and the NASS PAC $183,612. After accounting for respective group size, the AAOS spent >2.34 times that of the AANS. Orthopedists were 3.84 times (95% confidence interval 3.42–4.3) more likely to donate to their PAC than neurosurgeons (P < 0.001) during the 2016 election. The majority of contributions among the three different lobbyist organizations were to federal candidates, followed by fundraising committees, and finally to the national party. Eighty-eight percent of AANS donations went to Republican candidates, whereas AAOS and NASS were 63% and 67%, respectively. From 2008 to 2016, the AAOS PAC had a highest political contributions spend per active member of parent organization ($126.39) as compared to AANS ($80.52) and NASS ($17.81). The AAOS had five surgeons for every donor to the AAOS PAC, whereas the AANS had 14 surgeons and NASS 38 members per each donor. The AANS had a higher percentage of Republican donations with 78.9% of donations going to Republicans as compared to 61.8% of AAOS contributions and 67.9% of NASS contributions.

Conclusion.

Spine surgery is unique in that three different physician-based lobbyist organizations seek to influence legislative priorities with the AAOS having the most substantial fiscal impact and greatest participation. Choreography of donation strategies is essential to maximize physician voice at the policy level.

Level of Evidence: 5
Targeting HER2 heterogeneity in early-stage breast cancer
Authors: Pernas Sonia , Tolaney Sara M.
Published: September 2020

Purpose of review

HER2-positive (HER2+) breast cancer is clinically and biologically a heterogenous disease and not all patients benefit to the same extent from current anti-HER2 therapies.

Recent findings

Among HER2+ breast cancer, molecular intrinsic subtypes, PIK3CA mutation status, levels of HER2 gene/protein, immune infiltration, or intratumor heterogeneity modulate HER2-treatment sensitivity. HER2-enriched carcinomas, with high levels of HER2 and tumor-infiltrating lymphocytes (TILs) are highly sensitive to anti-HER2 therapies, regardless of chemotherapy. Luminal A/B tumors are more estrogen receptor-dependent than HER2-dependent, harbor higher rates of PIK3CA mutations, and are less responsive to anti-HER2 treatment. HER2 intratumoral heterogeneity that exists in approximately 10% of HER2+ disease may also cause treatment resistance. Early changes occur during neoadjuvant anti-HER2 therapy that can predict response. Importantly, HER2 expression is not a binary but rather a continuous variable. Overall, 34–63% of HER2-negative breast cancers express HER2, and HER2-low tumors have become a new entity, for which novel targeted therapies may be effective.

Although much of what is discussed currently remains investigational, it is clear that HER2+ breast cancer is a complex disease comprising different entities. Future strategies to escalate or de-escalate treatment in early-stage HER2+ disease should consider other biomarkers beyond HER2 and estrogen receptor status, including intrinsic subtype, HER2 levels, and TILs; and evaluate different treatment strategies among patients with estrogen receptor-positive/HER2+ and estrogen receptor-negative/HER2+ diseases.
Gene Therapy of the Hemoglobinopathies
Authors: Kunz Joachim B. , Kulozik Andreas E.
Published: September 2020

Sickle cell disease and the ß‐thalassemias are caused by mutations of the ß‐globin gene and represent the most frequent single gene disorders worldwide. Even in European countries with a previous low frequency of these conditions the prevalence has substantially increased following large scale migration from Africa and the Middle East to Europe. The hemoglobin diseases severely limit both, life expectancy and quality of life and require either life‐long supportive therapy if cure cannot be achieved by allogeneic stem cell transplantation. Strategies for ex vivo gene therapy aiming at either re‐establishing normal ß‐globin chain synthesis or at re‐activating fetal γ‐globin chain and HbF expression are currently in clinical development. The European Medicine Agency (EMA) conditionally licensed gene addition therapy based on lentiviral transduction of hematopoietic stem cells in 2019 for a selected group of patients with transfusion dependent non‐ß° thalassemia major without a suitable stem cell donor. Gene therapy thus offers a relevant chance to this group of patients for whom cure has previously not been on the horizon. In this review, we discuss the potential and the challenges of gene addition and gene editing strategies for the hemoglobin diseases.
ANGIOGRAPHIC SMOKESTACK LEAKAGE NOT ASSOCIATED WITH CENTRAL SEROUS CHORIORETINOPATHY
Authors: El Khatib Bahaeddin A. , Noble Carl W. , Chang Luke , Im Lily , Patronas Marena
Published: September 2020

Purpose:

To report a series of cases with smokestack leakage on fundus fluorescein angiography outside the clinical setting of central serous chorioretinopathy.

Methods:

A multicenter, observational retrospective case series evaluating fundus fluorescein angiography on Topcon and Optos systems.

Results:

Seven patients with neovascularization due to ischemic retinopathy demonstrated a unique smokestack pattern of angiographic leakage. The patients' ages ranged between 44 and 71 years and were seen at 3 academic teaching hospitals in the Washington–Baltimore metropolitan area. Five patients had been diagnosed with proliferative diabetic retinopathy, one with sickle cell ischemic retinopathy, and one with branch retinal artery occlusion; none of the patients had a known history or clinical signs of current or past central serous chorioretinopathy.

Conclusion:

This is the first published case series to the author's knowledge of ischemic retinopathy displaying a smokestack leakage pattern on fundus fluorescein angiography that is classically described with idiopathic central serous chorioretinopathy.