bluuebunny/crossref_metadata_2025 huggingface dataset:
Initial 6-month quality review of a percutaneous endovascular arteriovenous fistula program
Authors: Sultan Sulaiman , Langsfeld Mark , Chavez LeAnn , Fabre Anna , Osofsky Robin , Argyropoulos Christos , Owen Jonathan G
Published: August 2020

Background:

Percutaneous arteriovenous fistulas have recently proven successful alternatives to surgical arteriovenous fistulas with encouraging initial results. The Ellipsys Endovascular Arteriovenous Fistula System utilizing ultrasound and thermal energy has recently received approval for use in the United States. At the University of New Mexico, we developed an integrated service between Vascular Surgery, Interventional Radiology, and Interventional Nephrology for percutaneous arteriovenous fistulas utilizing Ellipsys.

Methods:

We performed a retrospective chart review of the initial 6 months (January 1st 2019 to July 1st 2019) of 18 percutaneous arteriovenous fistula placements to evaluate our initial technical success rate, the number of arteriovenous fistulas meeting maturation characteristics or use in dialysis, and to identify areas for quality improvement.

Results:

Initial technical success was achieved in 17 out of 18 arteriovenous fistulas (94.4%). Three patients did not report for any follow-up at the end of the initial 6 months. Of the remaining patients, 7 out of 15 were using their arteriovenous fistulas or meeting maturation characteristics at the end of the study (46.7%). Patient loss to follow-up/no-show (16.7%), patient not yet requiring hemodialysis (27.8%), and poor post-surgical maturation and/or need for additional maturation procedures (55.6%) were the predominate reasons for non-use. We identified improved coordination of care, early intervention, and outpatient dialysis center education as the primary areas of focus for quality improvement.

Conclusion:

Initial technical success rate of percutaneous arteriovenous fistulas placement was comparable to published studies. Early and aggressive secondary angiographic interventions of arteriovenous fistulas failing to meet cannulation requirements, improved coordination of post-operative care, and outpatient dialysis center education appear to be the primary targets for quality improvement.
Community Meetings on the Rural Opioid Crisis: Setting a Path Forward by Learning from Others
Authors: Meadowcroft Devon , Whitacre Brian
Published: August 2020

Objectives:

This study implemented a series of meetings in one rural community struggling with the opioid crisis. Set in the town of Ardmore, Oklahoma, these meetings presented local residents who dealt with the crisis as part of their jobs with four categories of programs aimed at preventing and treating opioid-related issues. The ultimate goal was for the participants to develop a consensus about where resources should be appropriated in the future, based off the needs of the area.

Methods:

Three community meetings were held over a six-week period, with an average of 40 attendees. Data was collected through surveys, study circles, and a participant voting exercise. Surveys were distributed at the beginning and end of the meetings to determine if participant views changed over the course of the study. Study circles broke participants into small groups and prompted them with questions regarding the crisis to encourage group discussion. The participant voting exercise allowed participants to note where they would like future resources to be directed.

Findings:

Listening to experts and holding group discussions led to changes in opinions for some participants. Most felt that the most pressing need was to provide accessible opioid treatment options in their community. Youth-based prevention efforts were also noted as being a program that the community should focus on.

Conclusions:

Local perceptions of the most appropriate strategies for combatting the rural opioid crisis can change with group discussions alongside others who are actively involved with this issue. Future research should actively involve affected communities in order to develop relevant and accepted action plans.
Historical and generational forces in the Iridescent Life Course of bisexual women, men, and gender diverse older adults
Authors: Fredriksen Goldsen Karen , Jen Sarah , Clark Theresa , Kim Hyun-Jun , Jung Hyunzee , Goldsen Jayn
Published: August 2020

Purpose

Little is known about the life course of bisexual older adults. This study examines life events and experiences of bisexuals by generation: Pride Generation, born 1950–1964; Silenced Generation, born 1935–1949; and Invisible Generation, born 1934 or earlier, as well as by gender among women, men, and gender diverse older adults.

Methods

Aging with Pride: National Health, Aging, and Sexuality/Gender Study is the first national longitudinal study of LGBTQ older adults in the US. We utilize the Iridescent Life Course to examine the life events and life course experiences of bisexual older adults ( N = 216) using 2014 survey data. The Iridescent Life Course frames this study for comparing generational and gender differences in five key areas: identity development; work; kin and social relationships; bias-related experiences; and physical and mental health.

Findings

The Invisible Generation, the oldest generation, compared to the two younger generations, reports significant risks related to social relationships, the lowest levels of openly disclosing, and fewer bias-related experiences. They also demonstrate important signs of resilience and better mental health. Bisexual men and gender diverse older adults report higher rates of bias-related experiences and fewer social resources than bisexual women.

Conclusion

Based on the Iridescent Life Course, we document important differences in the heterogeneity and intersectionality in bisexual lives, particularly for those in late life and those gender diverse. It is essential to document the distinct nature of bisexuals’ life course, as it provides both historical and contemporary insights into aging and the reframing of future research.
Multilevel governance: Identity, political contestation, and policy
Authors: Kleider Hanna
Published: August 2020

This commentary takes stock of how Multi-level Governance and European Integration has helped scholars frame empirical research agendas. It focuses on three specific research programmes emanating from the book: (1) the role of identity in multi-level governance, (2) political contestation in multi-level systems, and (3) the effect of multi-level governance on policy outcomes. It aims to highlight existing knowledge in these lines of research whilst offering several critical reflections and directions for future research.

The commentary argues that the book’s observation that governance structures are ultimately shaped by identities rather than by efficiency considerations has proved almost prophetic given recent backlash against the EU. The book expertly shows that there is an inherent tension in sharing authority across multiple levels of government, and that multi-level systems require constant recalibration and renegotiation of how authority is shared.
From ‘de jure’ to ‘de facto’ decentralised public policies: The multi-level governance approach
Authors: Charbit Claire
Published: August 2020

This contribution recalls the existing interdependencies across levels of government and elaborates on the multi-level governance gaps framework to identify coordination and capacity reinforcement tools to improve public policy outcomes in decentralised contexts. It details how the Organisation for Economic Co-operation and Development has adopted this approach. This paper then focuses on one of the tools used by countries and regions – Contracts. Contracts across levels of government, though not exempt of drawbacks, can favour information-sharing and mutual understanding as to how to address common policy priorities, while reducing the transaction costs of policy implementation; and generate trust between public actors for their future endeavours. The last section underlines some more general observations and questions like the use of multi-level governance approach to preserve the ‘biodiversity’ of regions. The note concludes with the need to re-insert relationships with people and not only among public authorities in a ‘new generation’ multi-level governance framework.
Multi-level governance in a ‘Europe with the regions’
Authors: Schakel Arjan H
Published: August 2020

The concept of multilevel governance was introduced to reveal the impact of regions on European Union (EU) policy making in Brussels. In this contribution, I show that multilevel governance also exposes regional involvement in EU affairs within the member states. In contrast to perspectives that focus on formal decision-making by central governments, multilevel governance uncovers significant sharing of authority between governmental actors within and beyond national states even in cases where the formal right to make a decision lies with national governments or the EU legislator. I argue that the concept of multilevel governance is key for understanding developments within a three-tiered EU polity because it directs scholarly attention to the incentives for regions to be involved in EU affairs and for national governments and EU institutions to share their authority with regions.
Conceptualising backlash movements: A (patch-worked) perspective from social movement studies
Authors: della Porta Donatella
Published: August 2020

This article discusses the potential contribution to the concept of backlash in social movement studies. If we consider backlash politics as characterised by the convergence of an intensified organisational networking, increased capacity for collective actions and aggressive framing by retrograde actors (including movements), social movement studies might provide (a) theoretical suggestions to embed the analysis in an established sets of concepts and hypotheses on the development of contentious politics, of which backlash politics is a type and (b) empirical knowledge on a specific form of retrograde movements, those related to the radical right. Building upon some established concepts in social movement studies, I will address the identity framing, organisational resources and contextual opportunities for backlash politics.
An analysis of the effectiveness and use by the New Zealand Police of the TASER from 2009 to 2017
Authors: den Heyer Garth
Published: August 2020

A number of police agencies around the world have introduced conductive energy devices such as the TASER as a less-than-lethal weapon to restrain physically violent subjects. Despite the increase in TASER use, there is a limited amount of literature available that examines its use and effectiveness. The New Zealand Police introduced the TASER in 2009 following a successful trial of the device. This research examines the use and effectiveness of the TASER by the New Zealand Police for the period 2010 to 2017 and shows that the use of the device has increased year-on-year. The analysis also found that while use of the device has increased at violent events, the form of that use has changed. Over the period of analysis, use of the discharge mode has increased compared with the show mode and as the use of the TASER increased, injuries sustained by subjects and officers also increased. The research also highlights the limitations of the methodology adopted to measure the effectiveness of TASER use and discusses options that could assist future research in examining use of the TASER by police agencies.
Does differentiated integration strengthen the democratic legitimacy of the EU? Evidence from the 2015 Danish opt-out referendum
Authors: Schraff Dominik , Schimmelfennig Frank
Published: August 2020

Differentiation has become a durable feature of European integration but we know little about its effects on citizens. Does differentiated integration improve the democratic quality of the European Union and strengthen citizens’ support – or does it promote political divides and foster citizens’ alienation from European integration? This article develops a theoretical argument on the positive attitudinal effects of differentiated integration, contending that differentiation accommodates heterogeneous preferences in a diverse EU and strengthens citizens’ ownership of European integration. A quasi-experimental analysis of public opinion of the 2015 Danish Justice and Home Affairs opt-out referendum demonstrates that the public vote increased citizens’ EU efficacy, indeed. Eurosceptic voters in particular strengthen their belief that their individual voice counts in EU politics, suggesting that differentiation can have a positive effect on the perceived democratic quality of the EU.
Seeds of authoritarian opposition: Far-right education politics in post-war Europe
Authors: Giudici Anja
Published: August 2020

Since the 1980s, right-wing extremism, radicalism, and populism have emerged as transformative forces in European politics. This unexpected resurgence has triggered an interdisciplinary scholarly effort to refine our understanding of the far right. Educationalists, however, have largely been absent from this endeavour, leaving us unable to theorise and address the potential effects of the far right’s political and cultural growth on European education. This article aims to provide an empirically based conceptional groundwork for educational research on the far right. Drawing on archival research and content analysis of programmatic material produced by diverse and influential far-right organisations in France, (West) Germany, and Italy, I show that the post-war European far right disposes of the two essential features of a social movement: an action-oriented frame that reduces educational reforms to a common contentious theme, and a dense organisational network. The latter engages in institutional and contentious politics, as well as education. Theoretically, these findings suggest that, in the realm of education, the far right ought to be conceptualised as a social movement that seeks to influence education policy, and represents itself an educational actor. Addressing the far right’s multifaceted educational engagement thus requires a combined effort across European education research.
Beyond Recidivism and Desistance
Authors: Sered Susan Starr
Published: August 2020

Reflecting on research following formerly incarcerated Massachusetts women for more than a decade, this paper questions whether conventional understandings of recidivism and desistance are meaningful frames for understanding women’s life trajectories. Drawing on our ongoing ethnographic work we argue that conventional measures of recidivism and desistance tend to (1) overstate the significance of distinctions between licit and illicit behavior—especially for women, (2) undervalue macro/structural and institutionalized barriers to stable housing and employment, (3) overly focus on individual choices and narratives in contexts where freedoms are constrained by structural and institutional policies and practices, (4) overlook the risks and erratic nature of daily and family life for women and other vulnerable, marginalized and poorly-resourced populations.
Pediatric pharmacists’ perspectives on essential skills and activities for community pharmacists caring for pediatric patients: A mixed-methods study
Authors: Kelly Jordan , Bengry Tanner , Romanick Marcel , Jupp Jennifer , Dersch-Mills Deonne
Published: August 2020

Background:

Provision of care to pediatric patients represents a set of unique challenges for pharmacists. Pharmacists practising in pediatric-specialty areas (acute care or ambulatory) have unique perspectives on approaches to pediatric care that can be shared to support pharmacists less familiar with this group of patients in providing effective, patient-centred care.

Methods:

This was a mixed-methods study using data from pharmacist interviews to quantify and qualitatively describe the approaches to care most commonly reported by pediatric-specialty pharmacists when asked to provide advice to pharmacists on providing pharmaceutical care to infants and children. Data were coded in duplicate using an inductive approach, and discrepancies were resolved by consensus. The number of times a theme (or subtheme) was mentioned and the number of pharmacists who mentioned it were used as markers of the relative importance of the content.

Results:

The themes (and subthemes) that emerged as most important were clinical activities (dose checks, considering indication, using up-to-date height/weight), caregiver counselling (demonstrating measurement, discussing administration), medication safety (using consistent concentrations of liquids), compounded medications (risks of, use of caution), adherence (formulation considerations, palatability), avoiding use of over-the counter products (except analgesics/antipyretics) and use of external supports (colleagues, caregivers, resources).

Conclusions:

We present a collated and prioritized list of practical approaches for pharmacists to use when caring for pediatric patients across the spectrum of practice. Can Pharm J (Ott) 2020;153:xx-xx.
Peripheral bone density measurement: An interdisciplinary initiative for improving health outcomes for people with learning disabilities
Authors: Walsh Niamh , Barr Owen , Lang Deirdre , Currid Melissa , Hoey Carmel
Published: August 2020

Challenges exist in respect of people with intellectual disabilities who, with the increasing life expectancy, have a growing risk of age-related degenerative conditions. Changes in bone health are associated with increasing age and the bone health of people who have intellectual disabilities is well documented in the literature as being poor in comparison to the general population. A heel scan clinic was set up in an intellectual disability service as a service improvement initiative. There were 12 females and 17 males scanned using a heel scanner. Only 3 (10.3%) people with intellectual disabilities were in the normal bone mineral density (BMD) range. Peripheral BMD screening for people has been shown to provide important information about the bone health of people with intellectual disabilities which has prompted further treatment by general practitioners and has the potential to provide an accessible way to obtain information on the bone health of people with intellectual disabilities.
The importance of supportive relationships with general practitioners, hospitals and pharmacists for mothers who ‘give medicines’ to children with severe and profound intellectual disabilities
Authors: Doyle Carmel
Published: August 2020

A purposeful sample of 15 mothers of children with severe and profound intellectual disabilities participated in this hermeneutic phenomenological study through interviews and completion of a diary. The aim of the study was to explore mothers’ lived experience of ‘giving medicines’ to children with severe and profound intellectual disabilities. Findings yielded multiple themes, one of which gave insight into the importance of supportive relationships with health professionals. The general practitioner (GP), hospital and pharmacist are key in providing supportive elements to mothers’ daily role. Having the support of a helpful GP was key in helping mothers cope on a daily basis for child related queries on illness, getting prescriptions or seeking advice. Accessibility to the hospital and avoiding the emergency department with their child was recommended. The pharmacist was central to the daily activities relating to ‘giving medicines’ and a good relationship resulted in a happier mother.
Christian sports coaches and servant leadership
Authors: Vinson Don , Parker Andrew
Published: August 2020

The world of competitive sport can present a challenging environment for Christian athletes and coaches. The culture of competitive sport, and particularly the attitude to winning, can cause athletes and coaches to question how their Christian faith should shape participation and/or whether they should participate at all. Few empirical studies have explored how Christian coaches frame their practice to align with their faith and reconcile the potential contradictions and challenges of coaching within competitive sporting environments. That said, there has been a recent increase in the number of studies exploring the potential relationship between sports coaching and the concept of servant leadership – a framework which is commensurate with a Christian world view. The aim of this paper is to contribute to these debates by presenting empirical evidence to explore the philosophies, intended practices and sociocultural factors influencing how Christian coaches sought to lead in competitive sporting environments. One hundred and ten coaches (female = 24, male = 86) completed an online qualitative questionnaire which explored their beliefs about leadership and coaching practice. This paper considers the ways in which Christian coaches’ might seek to frame their leadership behaviours within the context of competitive sport and how their approaches might align, or otherwise, with the theoretical tenets of servant leadership.
Should I Have Said “No”? Critical Reflections on Tensions in Forum Theater
Authors: Olesen Birgitte Ravn
Published: August 2020

Tensions play a productive role in the dynamics of inclusion and exclusion, a process in which certain voices are privileged and others are marginalized. In this article, I invite the reader to join me on a self-reflexive journey through my facilitation of a Forum Theater event with young refugees, which took place in a context of harsh xenophobic sentiment in the public debate in Denmark. I wish to share my challenging experiences with facilitation of Forum Theater in this group, as well as critically reflect on why I engaged in dialogue with the group the way I did and how the effects of my own privileges were invisible to me at the time of framing the facilitation, even if my aim was to contribute to awareness and activism. Through my writing, I have become aware of how my blindness to the differences regarding race and social status became crucial for the knowledge we could produce in the group. I conclude the article by discussing how a facilitator can use the perceived tensions as stepping stones in activist inquiry.
Blast resistant behaviour of tunnels in sedimentary rocks
Authors: Zaid Mohammad , Sadique Md Rehan
Published: August 2020

The tunnels are being constructed for the faster movement of goods and services from different locations. Therefore, Underground Urban Space (UUS) has evolved as an integral part of metro cities. Critical structures like tunnels have to be designed resistant to the blast due to possible threats and attacks. In the present paper, the efforts are made to analyse and understand the response of rock tunnel for an internal blast loading. The numerical analysis based on the finite element method has been carried out for a 35 m long rock tunnel in a rock mass of longitudinal cross-section 30 m × 30 m. The elastoplastic behaviour of the sedimentary rocks, that is, Sandstone, Mudstone and Silty Sandstone has been incorporated by using a Mohr-Coulomb constitutive material model. The plastic behaviour of the concrete tunnel lining has been incorporated by using concrete damage plasticity model. Moreover, for the Trinitrotoluene (TNT) Jones-Wilkens-Lee (JWL) material model has been considered. Analysis has been performed through the Coupled-Eulerian-Lagrangian (CEL) approach, which incorporates the advantages of both Eulerian and Lagrangian modelling. The present study focuses on the analysis of the tunnels constructed in three different sedimentary rocks, that is, Sandstone, Silty Sandstone and Mudstone. It has been concluded that Mudstone rock is more susceptible to failure due to internal blast load. However, Sandstone rocks were found to be relatively higher blast resistant, hence, may be considered as safer rocks for the construction when compared to other rocks of the present study.
Proprioceptive impairment in unilateral neglect after stroke: A systematic review
Authors: Fisher Georgia , Quel de Oliveira Camila , Verhagen Arianne , Gandevia Simon , Kennedy David
Published: August 2020

Introduction:

Unilateral neglect is a debilitating condition that can occur after stroke and can affect a variety of domains and modalities, including proprioception. Proprioception is a sensorimotor process essential to motor function and is thus important to consider in unilateral neglect. To date, there has not been a comprehensive review of studies examining the various aspects of proprioceptive impairment in unilateral neglect after stroke. This review aimed to determine if people with unilateral neglect have more severe proprioceptive impairments than those without unilateral neglect after stroke.

Methods:

The MEDLINE, Embase, Scopus, CINAHL and Web of Science databases were searched from inception to September 2019 using an a priori search strategy. Two independent reviewers screened abstracts and full texts, and extracted data from the included full texts. A third reviewer resolved disagreements at each step. Risk of bias was assessed using the AXIS Quality Assessment tool.

Results:

A total of 191 abstracts were identified, with 56 eligible for full-text screening. A total of 18 studies were included in the review and provided evidence that people with unilateral neglect have more severe proprioceptive impairment than people without unilateral neglect. This impairment is present in multiple subtypes of unilateral neglect and aspects of proprioception. Most studies had a moderate risk of bias.

Conclusion:

People with unilateral neglect after stroke are more likely to have impaired processing of multiple types of proprioceptive information than those without unilateral neglect. However, the available evidence is limited by the large heterogeneity of assessment tools used to identify unilateral neglect and proprioception. Unilateral neglect and proprioception were rarely assessed comprehensively. PROSPERO Registration: CRD42018086070.
A tale of three pumps and a mechanical heart
Authors: Omran Tarek , Carr Cornelia S , Wani Lateef , Mahmoud Imad , Taha Rula , Shoman Bassam , Omar Amr Salah , Alkhulaifi Abdulaziz M
Published: August 2020

Temporary mechanical circulatory support device (tMCS) failure could qualify patients with advanced heart failure to receive a long-term solution. We report on a patient who presented with cardiorespiratory arrest that required a tMCS and developed acute type A aortic dissection. Data Sources: our case adds further evidence regarding the support of a patient with a second (or more) incidence of tMCS. This patient subsequently underwent left ventricular assist device insertion and type A aortic dissection repair, as a combined procedure, with a satisfactory outcome.
The dripping candle wax sign of melorheostosis
Authors: Hoang Van Trung , Van Hoang Anh Thi , Chansomphou Vichit , Trinh Cong Thao
Published: August 2020

Melorheostosis is a rare benign bone disease including dysostosis and sclerosis. Dripping candle wax presence is a common and typical sign of melorheostosis. This sign appears as irregular hyperostosis of the cortical bone which is likened to melted wax flowing down one side of a candle. It can sometimes cause pain, stiffness joint, or limitation of motion in the affected areas implicitly but mostly has no symptoms. It is usually observed on plain radiography; its appearance is generally hyperplasia on one side of the bone. We report a 33-year-old male who has an incidental diagnosis of melorheostosis post-trauma.
A Case Report of Baclofen Toxicity in a Pediatric Patient With Normal Kidney Function Successfully Treated With Hemodialysis
Authors: Shah Siddharth A. , Kwon Stephanie J. , Potter Katherine E.
Published: August 2020

Rationale:

Baclofen is a commonly prescribed medication used to decrease spasticity in children with cerebral palsy. Despite its widespread use, this medication has not demonstrated to be consistently effective in clinical studies. Baclofen is also associated with systemic adverse effects due to potent neuronal depression. The management of baclofen toxicity is mainly supportive; however, some studies have shown that hemodialysis may alleviate the symptoms of an overdose and shorten the recovery time.

Presenting concerns:

In this case report, a 6-year-old boy with mild cerebral palsy, neuromyelitis optica, and normal kidney function was found unresponsive at home, with altered mental status, after ingesting 1300 mg of baclofen unobserved. The patient was intubated and mechanically ventilated because of significant neurologic depression with subsequent respiratory failure.

Diagnosis:

The patient was diagnosed with baclofen-induced encephalopathy. An elevated serum baclofen level of 4.00 µg/mL (therapeutic range of 0.08-0.40 µg/mL) was observed 10 hours after he was found unresponsive. The patient’s respiratory status deteriorated; he had high ventilatory requirements and remained comatose.

Intervention:

With the worsening of his clinical condition in the intensive care unit, hemodialysis, administered via a high-efficiency high-flux dialyzer, was initiated approximately 18 hours after he was found unresponsive. The patient underwent 2 hemodialysis runs spaced 9 hours apart, with blood flow rates approaching 250 mL/min.

Outcomes:

Within 3 hours of the first hemodialysis treatment, the patient started to regain consciousness. He was extubated to room air 6 hours after the second hemodialysis treatment.

Novel findings:

Supportive management is the primary treatment of baclofen toxicity in a pediatric patient with normal kidney function. Hemodialysis may be considered in severe cases of baclofen toxicity and worsening clinical status, but further studies are needed to confirm this finding.
Case Report: Segmental Arterial Mediolysis, a Rare Cause of Hypertension
Authors: Xu Jieqing Jessica , Rasuli Pasteur , Burns Kevin D.
Published: August 2020

Rationale:

The differential diagnosis for hypertension with elevated plasma renin is broad. This case illustrates one of the rarer, and therefore underrecognized, causes of high renin hypertension.

Presenting concerns of the patient:

A 41-year-old man with a medical history significant for multiple ischemic strokes and dyslipidemia presented for assessment of decreased renal function and resistant hypertension. His initial workup for secondary causes of hypertension was remarkable for an elevated plasma renin and normal aldosterone. Further investigation with computed tomography (CT) angiography was performed, which demonstrated multiple bilateral renal aneurysms and infarcts.

Diagnoses:

After ruling out other potential causes of bilateral renal aneurysms and infarcts, a diagnosis of segmental arterial mediolysis (SAM) was made.

Interventions:

Optimization of antihypertensive regimen, counseling regarding regular home blood pressure monitoring, and smoking cessation.

Outcomes:

The patient achieved excellent blood pressure control, stable renal function, and had no further strokes or other vascular events.

Teaching points:

Our case demonstrates the importance of considering SAM in the diagnosis of hypertension with elevated plasma renin and as a vasculitis mimic. It also highlights the importance of considering renal vascular imaging in the workup of resistant hypertension.
Real-life effects of benralizumab on allergic chronic rhinosinusitis and nasal polyposis associated with severe asthma
Authors: Lombardo Nicola , Pelaia Corrado , Ciriolo Marco , Della Corte Marcello , Piazzetta Giovanna , Lobello Nadia , Viola Pasquale , Pelaia Girolamo
Published: August 2020

The aim of this study has been to evaluate the efficacy of the IL-5 receptor blocker benralizumab on chronic rhinosinusitis with nasal polyposis (CRSwNP), associated with severe eosinophilic allergic asthma. Ten patients with severe eosinophilic allergic asthma and CRSwNP were enrolled. Sino-nasal outcome test (SNOT-22), numerical rating scale (NRS), endoscopic nasal polyp score, Lund Mackey CT (computed tomography) score, and blood eosinophil count were measured at baseline and after 24 weeks of treatment with benralizumab. All the above clinical, endoscopic, imaging, and hematological parameters significantly improved after 24 weeks of treatment with benralizumab. In particular, SNOT-22 decreased from 61.10 ± 17.20 to 26.30 ± 19.74 ( P < 0.001), NRS decreased from 7.20 ± 1.55 to 3.40 ± 2.22 ( P < 0.001), the endoscopic polyp nasal score decreased from 4.20 ± 1.32 to 2.50 ± 1.78 ( P < 0.001), the Lund-Mackay CT score decreased from 16.60 ± 5.50 to 6.90 ± 5.99 ( P < 0.001), and blood eosinophil count decreased from 807.3 ± 271.1 cells/μL to 0 cells/μL ( P < 0.0001). These results strongly suggest that benralizumab exerted a very effective therapeutic action on CRSwNP associated with severe asthma, thus improving nasal symptoms and decreasing polyp size.
Use of Work Systems to Increase the Independence of Adolescents With Autism Spectrum Disorder
Authors: Sreckovic Melissa A. , Hume Kara A. , Regan Tara E.
Published: August 2020

Developing skills for functional independence is important to gain employment, engage in postsecondary education, and live independently. Unfortunately, individuals with autism spectrum disorder (ASD) experience difficulties with functional independence skills needed to complete common, everyday tasks. This study examined the effects of work systems to increase independent task initiation and completion of tasks in home settings completed by three adolescents with ASD. The work systems were implemented by parents. Results indicated parent-implemented work systems are effective at increasing the task initiation and completion of everyday tasks, completed by adolescents with ASD.
Development of Religious Identity and Commitment During Emerging Adulthood: A Mixed-Methods Longitudinal Study
Authors: Jia Fanli , Alisat Susan , Algrim Kaylise , Pratt Michael W.
Published: August 2020

Past research has found that religious commitment declines during emerging adulthood unless individuals make significant life commitments. A growing body of research has suggested that a resolution of religious commitment is related to personal identity development. In the present study, we examined religious belief and identity in relation to religious commitment during emerging and young adulthood longitudinally and using a mixed-methods approach. The study included 55 participants (72% females, 87% Christians, and 90% European Canadians) who were followed 3 times at the ages of 23, 26, and 32. We found that early religious belief at age 23 positively predicted religious commitment 9 years later at age 32. However, this relationship was mediated by religious identity maturity at age 26. In addition, we explored religious identity themes in a set of interviews. We found that people who were able to connect with significant markers of religious identity would maintain high religious commitments at age 32. The study thus suggested that religious identity in emerging adulthood might prevent a decline in religious commitment later in life.
Differential Role of Psychosocial, Health Care System and Neighborhood Factors on the Retention in HIV Care of Women and Men in the Ryan White Program
Authors: Trepka Mary Jo , Sheehan Diana M. , Dawit Rahel , Li Tan , Fennie Kristopher P. , Gebrezgi Merhawi T. , Brock Petra , Beach Mary Catherine , Ladner Robert A.
Published: August 2020

We investigated potential differential impact of barriers to HIV care retention among women relative to men. Client intake, health assessment, service, and laboratory information among clients receiving medical case management during 2017 in the Miami-Dade County Ryan White Program (RWP) were obtained and linked to American Community Survey data by ZIP code. Cross-classified multilevel logistic regression analysis was conducted. Among 1609 women and 5330 men, 84.6% and 83.7% were retained in care. While simultaneously controlling for all demographic characteristics, vulnerable/enabling factors, and neighborhood indices in the model, younger age, being US born, not working, and having a medical provider with low volume (<10) of clients remained associated with non-retention in care among women and men; while having ≥3 minors in the household and being perinatally infected were additionally associated with retention only for women. Both gender-specific and gender-non-specific barriers should be considered in efforts to achieve higher retention rates.
Nontraumatic Exertional Fatalities in Football Players, Part 2: Excess in Conditioning Kills
Authors: Boden Barry P. , Fine Ken M. , Spencer Tiahna A. , Breit Ilan , Anderson Scott A.
Published: August 2020

Background:

The incidence of nontraumatic fatalities in high school (HS) and National Collegiate Athletic Association (NCAA) football players has continued at a constant rate since the 1960s.

Purpose:

To describe the causes of nontraumatic fatalities in HS and NCAA football players and provide prevention strategies.

Study Design:

Descriptive epidemiology study.

Methods:

We reviewed 187 fatalities in HS and NCAA nontraumatic football players catalogued by the National Registry of Catastrophic Sports Injuries during a 20-year period between July 1998 and June 2018.

Results:

The majority (n = 162; 86.6%) of fatalities occurred during a practice or conditioning session. Most fatalities, when timing was known, (n = 126; 70.6%) occurred outside of the regular playing season, with the highest incidence in the August preseason (n = 64; 34.2%). All documented conditioning sessions were supervised by a coach (n = 92) or strength and conditioning coach (n = 40). The exercise regimen at the time of the fatality involved high-intensity aerobic training in 94.7%. Punishment was identified as the intent in 36 fatalities. The average body mass index of the athletes was 32.6 kg/m2. For athletes who died due to exertional heat stroke, the average body mass index was 36.4 kg/m2, and 97.1% were linemen.

Conclusion:

Most nontraumatic fatalities in HS and NCAA football players occurred during coach-supervised conditioning sessions. The primary cause of exertion-related fatalities was high-intensity aerobic workouts that might have been intended as punishment and/or excess repetitions. Exertion-related fatalities are potentially preventable by applying standards in workout design, holding coaches accountable, and ensuring compliance with the athlete’s health and current welfare policies.
A Metaregression Analysis of the Effects of School Racial and Ethnic Composition on K–12 Reading, Language Arts, and English Outcomes
Authors: Mickelson Roslyn Arlin , Bottia Martha Cecilia , Larimore Savannah
Published: August 2020

Racial and ethnic differences in educational outcomes significantly narrowed during the 1970s and 1980s when K–12 public schools were desegregated. However, when schools resegregated starting roughly in the late 1980s, racial gaps in outcomes widened again. Because of literacy’s pivotal role in learning, the authors investigate if segregation contributes to racial gaps in K–12 reading performance. Drawing upon structural vulnerability and cumulative advantage/disadvantage theories to frame this study, the authors conduct multilevel metaregression analyses of 131 effect sizes from 30 primary studies to investigate if school composition effects contribute to racial gaps in K–12 reading outcomes and if any effects vary in magnitude or direction for students from different racial/ethnic backgrounds or grade levels. The metaregression analyses control for the primary studies’ regression model characteristics and research designs. The results indicate a small, negative, statistically significant relationship between the percentage of a school’s disadvantaged minority enrollment and the mean reading achievement of the students who attend it. The negative association is stronger when segregation is measured by percentage Black and is stronger for high school students. These two findings suggest that the disadvantages of segregated education cumulate as more structurally vulnerable students transition from elementary to secondary school. Additional results suggest that a school’s racial composition effect is not the same as its socioeconomic status composition effect. The two organizational characteristics have distinct, albeit interrelated, influences on reading scores. Together the findings suggest that racially and ethnically segregated schooling both reflects and helps reproduce racial/ethnic inequality in literacy outcomes.
Dementia Is Associated With Earlier Mortality for Men and Women in the United States
Authors: White Lindsay , Fishman Paul , Basu Anirban , Crane Paul K. , Larson Eric B. , Coe Norma B.
Published: August 2020

Objectives: Sociodemographic trends in the United States may influence future dementia-associated mortality, yet there is little evidence about their potential impact. Our study objective was to estimate the effect of dementia on survival in adults stratified by sex, education, and marital status. Methods: Using survey data from the Health and Retirement Study (HRS) linked to Medicare claims from 1991 to 2012, we identified a retrospective cohort of adults with at least one International Classification of Diseases—ninth revision—Clinical Modification (ICD-9-CM) dementia diagnosis code ( n = 3,714). For each case, we randomly selected up to five comparators, matching on sex, birth year, education, and HRS entry year ( n = 9,531), and assigned comparators the diagnosis date of their matched case. Participants were followed for up to 60 months following diagnosis. We estimated a survival function for the entire study population and then within successive strata defined by sex, education, and marital status. Results: On average, dementia cases were 80.5 years old at diagnosis. Most were female, had less than college-level education, and approximately 40% were married at diagnosis. In multivariate analyses, dementia diagnosis was associated with earlier mortality for women (predicted median survival of 54.5 months vs. 62.5 months; dementia coefficient = −0.13; 95% confidence interval [CI] = [−0.22, −0.04]; p = .003), but even more so among men (predicted median survival of 35.5 months vs. 54.5 months; dementia coefficient = −0.42; 95% CI = [−0.52, −0.31]; p < .001). We found substantial heterogeneity in the relationship between dementia and survival, associated with both education and marital status. Conclusion: Both sex and level of education moderate the relationship between dementia diagnosis and length of survival.
Patient Experiences With Transfer for Community Hospital Inpatient Admission From an Academic Emergency Department
Authors: Sonis Jonathan D , Berlyand Yosef , Yun Brian J , Aaronson Emily L , Raja Ali S , Brown David F M , Pestka Steven B , White Benjamin A
Published: August 2020

Emergency department (ED) crowding continues to be a major challenge and has important ramifications for patient care quality. One strategy to decrease ED crowding has been to implement alternative pathways to traditional hospital admission. Through a survey-based retrospective cohort study, we aimed to assess the patient experience for those who agreed to transfer and admission to an affiliated community hospital from a large, academic center’s ED. In all, 85% of participants rated their overall experience as either great or good, 92% did not find it hard to make the decision to be transferred, and 95% found the transfer process itself to be easy.
Contribution of First-Tarsometatarsal Joint Fusion to Deformity Correction in the Treatment of Adult-Acquired Flatfoot Deformity
Authors: Day Jonathan , Conti Matthew S. , Williams Nicholas , Ellis Scott J. , Deland Jonathan T. , Cody Elizabeth A.
Published: August 2020

Background:

Severe adult-acquired flatfoot deformity (AAFD) is often associated with painful medial column collapse at the naviculocuneiform (NC) joint. However, many surgeons surgically correct the deformity without directly addressing this joint. The purpose of this study was to examine the role of first-tarsometatarsal (TMT) fusion combined with subtalar fusion in correcting deformity at the NC joint.

Methods:

We retrospectively analyzed 40 patients (41 feet) who underwent first-TMT and subtalar (ST) fusion as part of a flatfoot reconstructive procedure. We assessed 6 radiographic parameters both preoperatively and at a minimum of 6 months postoperatively, including talonavicular (TN) coverage angle, lateral talo–first metatarsal angle, lateral talocalcaneal angle, calcaneal pitch, hindfoot moment arm, and a newly defined navicular-cuneiform incongruency angle (NCIA). Patient-Reported Outcomes Measurement Information System (PROMIS) clinical outcomes were assessed preoperatively and at a minimum 1-year follow-up.

Results:

The NCIA demonstrated excellent interobserver reliability, with no significant change between pre- and postoperative measurements. All other radiographic parameters, except calcaneal pitch, demonstrated statistically significant improvement postoperatively ( P < .01). Overall, patients had statistically significant improvement in all PROMIS domains ( P < .01), except for depression. Worsening NC deformity was not associated with worse patient-reported outcomes.

Conclusions:

Our data suggest that when addressing painful collapse of the medial arch in patients with AAFD, fusion of the first-TMT joint in combination with other procedures leads to acceptable radiographic and clinical outcomes. There was no change in deformity at the NC joint in our patient cohort at short-term follow-up, and patients achieved significant improvement in multiple PROMIS domains. Although TMT fusion had no effect on NC deformity, residual or worsening NC deformity did not significantly affect clinical outcomes. In addition, the NCIA was found to be a reliable radiographic parameter to assess NC deformity in the presence of talonavicular and/or first-TMT fusion.

Level of Evidence:

Level III, retrospective comparative study.