bluuebunny/crossref_metadata_2025 huggingface dataset:
Authentic Assessment
Authors: Koh Kim H.
Published: November 2016

Authentic tasks replicate real-world challenges and standards of performance that experts or professionals typically face in the field. The term “authentic assessment” was first coined by Grant Wiggins in K‒12 educational contexts. Authentic assessment is an effective measure of intellectual achievement or ability because it requires students to demonstrate their deep understanding, higher-order thinking, and complex problem solving through the performance of exemplary tasks. Hence authentic assessment can serve as a powerful tool for assessing students’ 21st-century competencies in the context of global educational reforms. The review begins with a detailed explanation of the concept of authentic assessment. There is a substantial body of literature focusing on the definitions of authentic assessment. However, only those that are original and relevant to educational contexts are included.. Some of the criteria for authentic assessment defined by the authors overlap with each other, but their definitions are consistent. A comparison of authentic assessment and conventional assessment reveals that different purposes are served, as evidenced by the nature of the assessment and item response format. Examples of both types of assessments are included. Three major themes are examined within authentic assessment research in educational contexts: authentic assessment in educational or school reforms, teacher professional learning and development in authentic assessment, and authentic assessment as tools or methods used in a variety of subjects or disciplines in K‒12 schooling and in higher education institutions. Among these three themes, most studies were focused on the role of authentic assessment in educational or school reforms. Future research should focus on building teachers’ capacity in authentic assessment and assessment for learning through a critical inquiry approach in school-based professional learning communities or in teacher education programs. To enable the power of authentic assessment to unfold in the classrooms of the 21st century, it is essential that teachers are not only assessment literate but also competent in designing and using authentic assessments to support student learning and mastery of the 21st-century competencies.
International Cooperation for Education in Developing Countries
Authors: Williams James H.
Published: November 2016

This article looks broadly at the intersection of education, development, and international cooperation. It discusses trends in international cooperation in education for developing countries as well as ongoing challenges. Education has expanded rapidly throughout the world. Even so, the industrialized nations are decades if not generations ahead of parts of the developing world in terms of enrollment and learning attainment. For reasons of equity and economic development alone, it is imperative that all efforts be put to the task of achieving universal school enrollment and learning. To achieve such a goal in the context of what some researchers have termed a 100-year gap requires efforts on the part of national governments and international cooperation on the part of all nations of the world. International cooperation in education includes: (1) the institutions and architecture of international organizations; (2) development assistance, which is closely related; and (3) international agreements to promote education and other development goals. In a broad sense, these initiatives can be seen as moving toward increasingly cooperative relationships between wealthier nations and developing countries. International institutions involved in education include various agencies of the United Nations (UNESCO, UNICEF, ILO, UNHCR) as well as multilateral development banks (the World Bank, IMF, IDA, etc.); regional development banks (Asian Development Bank, Inter-American Development Bank, etc.); and bilateral development agencies. Development assistance is provided in the form of technical and financial assistance to national governments by bilateral development agencies, the multilateral development agencies, UN agencies, as well as an increasing number of non-governmental agencies (NGOs). The UN Declaration on Human Rights and the Convention on the Rights of the Child are foundational documents laying out the rights of all children to education and the obligation of governments to ensure children have access to quality education. Several global initiatives have led the way toward increasing educational participation in developing countries, including Education for All, the Millennium Development Goals, the UN Global Education First Initiative, and the Sustainable Development Goals. The article concludes with a listing of trends in educational development.
Asian Perspectives and Approaches for Developing Assistance in Promoting Human Capital
Authors: Cheng I-Hsuan , Chan Sheng-Ju
Published: November 2016

The human capital theory emphasizes the importance of education and training to improve worker skills and productivity in the dynamic global knowledge economy and 21st-century capitalism. In Asia, development assistance modalities and contents required for human capital development, such as higher education projects and skill development projects, are implemented by emerging Asian donors alone and through their collaboration with international counterparts. According to the Asian experience, there are four key points. First, the various Chinese, Indian, and other Asian development experiences affirm that different developing countries require different combinations of basic and high skills in the 21st century. Accordingly, the distribution and mobilization of official development assistance (ODA) in human capital development must depend on culturally and contextually specific assistance projects designed for different developing countries. Second, all stakeholders in the skill ecosystem, which includes donors, recipient governments, education institutions, firms, and individuals, must assume responsibilities for not only balancing the skill demand and supply but also sustaining positional competition in the local and global job markets. Third, the system underpinned by innovative financing from the private sector, emerging donors, as well as traditional Organisation for Economic Co-operation and Development (OECD) donors must focus on inclusive and sustainable economic development rather than economic accumulation and gross domestic product (GDP) growth only. Finally, higher education institutions should play a more critical and active role in providing international development assistance to empower skilled and competent individuals as change agents to work for/in, guide, and lead the skill ecosystem, which eventually will not only respond to economic demands in the short term but also promote economic transformation in the long run.
Approaches to Handling Common Response Styles and Issues in Educational Surveys
Authors: Kam Chester Chun Seng , Fan Xitao
Published: November 2016

Survey has been a widely used data collection method for a variety of purposes in educational research. Although response styles have the potential to contaminate survey results, educational researchers often do little to control for such negative effects. Under discussion are five common response issues, their impact on survey data, and the methods that may be used to minimize the negative impact of these response issues on survey data. The five response issues in question are acquiescence (including disacquiescence), careless responding, extreme response, social desirability, and item-keying effect. Acquiescence (disacquiescence) refers to a respondent’s general tendency to agree (or disagree) with an item regardless of its content. This response style can distort item and construct correlations, compromising the results of factor analytic and correlational findings. Careless responding refers to a respondent’s tendency to pay insufficient attention to item content before responding, which can also lead to a biased estimation of relationships. Extreme response refers to the tendency of selecting extreme response options (e.g., strongly agree or strongly disagree) over middle options (e.g., neutral). Social desirability refers to a respondent’s tendency to rate him- or herself in an overly positive light. Finally, item-keying effect refers to a respondent’s differential responses to regular-keyed and reverse-keyed items. This effect often creates the illusion that items with opposite keying directions measure distinct constructs even when they may not.

A growing amount of research has been done on how to control for the negative impact of these response styles, although the research may be limited and uneven for different response issues. A variety of approaches and methods exist for handling these response issues in research practice. Different response issues may require considerations at different stages of research. For example, effective handling of acquiescence response may require steps in both survey construction (e.g., including a hidden measure of acquiescence) and survey data analytic treatment (partial correlation technique), while controlling for item-keying effect may require more sophisticated modeling techniques (e.g., multitrait-multimethod confirmatory factor analysis).
The Ilkhanate: Mongol Rule in Medieval Western Asia, 1256–1335
Authors: Lane George
Published: November 2016

Despite enduring years of adverse and highly critical propaganda and entrenched negative attitudes from both the scholarly world and the general public, the Mongols and successors of Chinggis Khan have continued to hold the world’s rapt attention and interest. However, the Chinggisids have in recent years and especially since 2001 and the publication of Thomas Allsen’s Culture and Conquest, benefited from a spreading positive re-evaluation by the academic community and revisionist researchers, which amounts to a fresh assessment of the Chinggisid domination of western Asia. It is now acknowledged that they enjoyed a constructive, generally positive relationship with much of the Muslim world. Relations with Iran were particularly strong, so much so that it was Iranians who invited Hulegu and the Chinggisid army to come to the west in 1254 and who actively cooperated in the establishment of the Ilkhanate. The state of Iran had ceased to exist after the Arab invasion of the region in the 7th century, and in its place, Greater Iran became a collection of often warring statelets: Azerbaijan, Khorasan, Fars, Iraq al-Arab, Iraq al-‘Ajam, Sistan, and Jabal, to name a few. After Hulegu crossed the Oxus, c. 1254, he revived the idea of Iran, and the Ilkhanate essentially became the basis for what eventually became the modern state of Iran.

From 1220 to 1254 Iran had existed in a state of anarchy, loosely under the control of Chinggisid military governors. Iran’s city-states were peripheral to an empire to which they paid taxes but from which they derived few advantages nor enjoyed any of the benefits to which their taxes should have entitled them. The delegation sent from Qazvin to Mongke’s coronation requested the Great Khan to send a prince of the blood to rule Iran and to replace the inept military governor. The delegation wanted Iran to be absorbed by the empire so that the country could benefit from joining a global community and a global market. Chinggis Khan had initiated the world’s first experience of globalization, and Iran wanted to be part of that experience. The Ilkhanate (1258–1335) was a Persian renaissance and established Iranians once again as key regional players. Although the ruling family remained ethnically Mongol, the government was multiethnic, and the country was multicultural. In 1295, when the seventh Ilkhan, Ghazan, ascended the throne and announced his submission to Islam, his act signified the union of Turk and Tajik, of “steppe and sown,” of Iran and Turan, of Persian, Chinese and Turkish cultures, and the coronation of a king of and for all Iranians. It was immaterial whether his conversion was sincere or just politically astute. What was important was his proclamation of becoming a legitimate Iranian king duty bound to serve all his people, whether Turk or Tajik, and that his reign was hailed as the start of a golden age, as well as being a high point of relations with the Yuan regime in the east. The Mongols never left Iran, but simply assimilated.
American Indian Activism after 1945
Authors: Shreve Bradley
Published: November 2016

American Indian activism after 1945 was as much a part of the larger, global decolonization movement rooted in centuries of imperialism as it was a direct response to the ethos of civic nationalism and integration that had gained momentum in the United States following World War II. This ethos manifested itself in the disastrous federal policies of termination and relocation, which sought to end federal services to recognized Indian tribes and encourage Native people to leave reservations for cities. In response, tribal leaders from throughout Indian Country formed the National Congress of American Indians (NCAI) in 1944 to litigate and lobby for the collective well-being of Native peoples. The NCAI was the first intertribal organization to embrace the concepts of sovereignty, treaty rights, and cultural preservation—principles that continue to guide Native activists today. As American Indian activism grew increasingly militant in the late 1960s and 1970s, civil disobedience, demonstrations, and takeovers became the preferred tactics of “Red Power” organizations such as the National Indian Youth Council (NIYC), the Indians of All Tribes, and the American Indian Movement (AIM). At the same time, others established more focused efforts that employed less confrontational methods. For example, the Native American Rights Fund (NARF) served as a legal apparatus that represented Native nations, using the courts to protect treaty rights and expand sovereignty; the Council of Energy Resource Tribes (CERT) sought to secure greater returns on the mineral wealth found on tribal lands; and the American Indian Higher Education Consortium (AIHEC) brought Native educators together to work for greater self-determination and culturally rooted curricula in Indian schools. While the more militant of these organizations and efforts have withered, those that have exploited established channels have grown and flourished. Such efforts will no doubt continue into the unforeseeable future so long as the state of Native nations remains uncertain.
Martin Luther’s Influence on the Rise of the Natural Sciences
Authors: Larson Duane H.
Published: November 2016

Were Luther to have lived another two decades, he might have been surprised even so early on to be informed that he positively influenced the rise of natural science. One can readily cite many Luther quotes that would cast him as anti-science; decontextualized quoting readily constructs such caricatures. But the truth of the matter is quite otherwise.

Consideration of Luther and Luther’s protégés and their philosophical-historical contexts reveals their positive regard for science. This is explicit in Luther’s immediate heirs like Melanchthon and Andreas Osiander. Though they differed in their opinions about the work of Copernicus, both respected him and the discipline he practiced. Luther’s influence carried beyond his immediate disciples through Johannes Kepler into the 17th century. The Irish-Anglican chemist and theologian Robert Boyle, for example, was significantly influenced by the Reformation principle of God’s sovereignty. In turn, Boyle strongly influenced Isaac Newton. But Lutheran support for the natural sciences had one major qualification. When “freed science” appeared to speculate more on God’s action than describe the visible character of natural phenomena, Luther saw overreaching ambition.

Such are the outlines of a historical approach of Luther’s influence on the beginning of the scientific revolution. Other Lutheran theological themes contributed to natural science’s robustness. In addition to a focus on God’s sovereignty—and so the doctrine of justification by grace through faith—these themes include (1) the nature of biblical authority, (2) the “realistic” epistemology of the theology of the cross, and (3) sacramentology.
Martin Luther and the Rise of World Christianities
Authors: Erling Maria
Published: November 2016

Scholars use the concept of World Christianity both to account for the growth of Christianity beyond Western Christendom and to recognize the changing map of vitality and leadership within Christian churches beyond the European and North American context. Scholars who use this concept have also committed to documenting the history of all of the churches around the world, making special efforts thereby not only to note the contributions of founders and missionary agencies, but also to investigate the important input of local teachers, evangelists, and pastors, so that a more inclusive history may be made available to these faith communities for their own self-understanding and direction. The spread of Christianity beyond the borders of Europe, a subject once envisioned by Kenneth Latourette as the result of the great century of missionary advance, cannot be understood solely as the accomplishment of the Protestant and Roman Catholic missionaries sent from western Europe and North America. Through all the centuries of Christian expansion and migration, scholars need to document and explain not only the theological foundations of various faith traditions, but also how multiple Christianities have adapted and thrived and become rooted in multiple cultural contexts, and exhibit a special vibrancy today in the postcolonial, post-missionary churches in Africa and Asia. Luther’s influence on the rise of World Christianities is an important element in the vitality of contemporary churches in Africa and Asia, but his theological contribution to Christianity beyond the West awaits a fuller articulation and application to the questions and concerns of these emerging centers of Christianity.
The Environmental History of Russia
Authors: Brain Stephen
Published: November 2016

Russian environmental history is a new field of inquiry, with the first archivally based monographs appearing only in the last years of the 20th century. Despite the field’s youth, scholars studying the topic have developed two distinct and contrasting approaches to its central question: How should the relationship between Russian culture and the natural world be characterized? Implicit in this question are two others: Is the Russian attitude toward the non-human world more sensitive than that which prevails in the West; and if so, is the Russian environment healthier or more stable than that of the United States and Western Europe? In other words, does Russia, because of its traditional suspicion of individualism and consumerism, have something to teach the West? Or, on the contrary, has the Russian historical tendency toward authoritarianism and collectivism facilitated predatory policies that have degraded the environment? Because environmentalism as a political movement and environmental history as an academic subject both emerged during the Cold War, at a time when the Western social, political, and economic system vied with the Soviet approach for support around the world, the comparative (and competitive) aspect of Russian environmental history has always been an important factor, although sometimes an implicit one. Accordingly, the existing scholarly works about Russian environmental history generally fall into one of two camps: one very critical of the Russian environmental record and the seeming disregard of the Russian government for environmental damage, and a somewhat newer group of works that draw attention to the fundamentally different concerns that motivate Russian environmental policies. The first group emphasizes Russian environmental catastrophes such as the desiccated Aral Sea, the eroded Virgin Lands, and the public health epidemics related to the severely polluted air of Soviet industrial cities. The environmental crises that the first group cites are, most often, problems once prevalent in the West, but successfully ameliorated by the environmental legislation of the late 1960s and early 1970s. The second group, in contrast, highlights Russian environmental policies that do not have strict Western analogues, suggesting that a thorough comparison of the Russian and Western environmental records requires, first of all, a careful examination of what constitutes environmental responsibility.
Benefit Transfer for Ecosystem Services
Authors: Boyle Kevin J. , Parmeter Christopher F.
Published: November 2016

Benefit transfer is the projection of benefits from one place and time to another time at the same place or to a new place. Thus, benefit transfer includes the adaptation of an original study to a new policy application at the same location or the adaptation to a different location. The appeal of a benefit transfer is that it can be cost effective, both monetarily and in time. Using previous studies, analysts can select existing results to construct a transferred value for the desired amenity influenced by the policy change. Benefit transfer practices are not unique to valuing ecosystem service and are generally applicable to a variety of changes in ecosystem services. An ideal benefit transfer will scale value estimates to both the ecosystem services and the preferences of those who hold values. The article outlines the steps in a benefit transfer, types of transfers, accuracy of transferred values, and challenges when conducting ecosystem transfers and ends with recommendations for the implementation of benefit transfers to support decision-making.
Cities, Green Space, and Mental Well-Being
Authors: Roe Jenny
Published: November 2016

Mental and behavioral disorders account for approximately 7.4% of the global burden of disease, with depression now the world’s leading cause of disability. One in four people in the world will suffer from a mental health problem at some point in their life. City planning and design holds much promise for reducing this burden of disease, and for offering solutions that are affordable, accessible and equitable. Increasingly urban green space is recognized as an important social determinant of health, with the potential to protect mental health – for example, by buffering against life stressors - as well as relieving the symptom severity of specific psychiatric disorders. Pathways linking urban green space with mental wellbeing include the ability of natural stimuli – trees, water, light patterns – to promote ‘involuntary attention’ allowing the brain to disengage and recover from cognitive fatigue. This article brings together evidence of the positive effects of urban green space on common mental health problems (i.e. stress, anxiety, depression) together with evidence of its role in the symptom relief of specific psychiatric disorders, including schizophrenia and psychosis, post-traumatic stress disorder (PTSD), dementia, attention deficit/hyperactivity Disorder (ADHD) and autism. Urban green space is a potential force for building mental health: city planners, urban designers, policy makers and public health professionals need to maximize the opportunities in applying green space strategies for both health prevention and in supporting treatment of mental ill health.
Managing the Commons: How Extension Facilitates Local Participation to Manage Natural Resources
Authors: Mandal Bidisha , Lawrence Timothy
Published: November 2016

Extension promotes volunteerism and facilitates community involvement in the informed decision‐making process required for managing natural resources; Extension also enhances local social capital. This important role does not receive as much attention in the literature on Extension and its scope as does its traditional role of information provision. We conducted a study to examine the need and demand for Extension programs in a rural community comprised entirely of islands and tangibly dependent on natural resources. We found that affiliation with Extension has a strong impact on the willingness to pay for Extension programs. Thus, we provide evidence that supports the argument that Extension is an important service and an appropriate use of public funds for economic development. This finding is in line with Elinor Ostrom’s theory in new institutional economics that well‐designed, robust local entities that stimulate local participation can assist in managing natural resources.
Automated neuron tracing using probability hypothesis density filtering
Authors: Radojević Miroslav , Meijering Erik
Published: November 2016

Motivation

The functionality of neurons and their role in neuronal networks is tightly connected to the cell morphology. A fundamental problem in many neurobiological studies aiming to unravel this connection is the digital reconstruction of neuronal cell morphology from microscopic image data. Many methods have been developed for this, but they are far from perfect, and better methods are needed.

Results

Here we present a new method for tracing neuron centerlines needed for full reconstruction. The method uses a fundamentally different approach than previous methods by considering neuron tracing as a Bayesian multi-object tracking problem. The problem is solved using probability hypothesis density filtering. Results of experiments on 2D and 3D fluorescence microscopy image datasets of real neurons indicate the proposed method performs comparably or even better than the state of the art.

Availability and Implementation

Software implementing the proposed neuron tracing method was written in the Java programming language as a plugin for the ImageJ platform. Source code is freely available for non-commercial use at https://bitbucket.org/miroslavradojevic/phd.

Supplementary information

Supplementary data are available at Bioinformatics online.
The structural bioinformatics library: modeling in biomolecular science and beyond
Authors: Cazals Frédéric , Dreyfus Tom
Published: November 2016

Motivation

Software in structural bioinformatics has mainly been application driven. To favor practitioners seeking off-the-shelf applications, but also developers seeking advanced building blocks to develop novel applications, we undertook the design of the Structural Bioinformatics Library (SBL, http://sbl.inria.fr), a generic C ++/python cross-platform software library targeting complex problems in structural bioinformatics. Its tenet is based on a modular design offering a rich and versatile framework allowing the development of novel applications requiring well specified complex operations, without compromising robustness and performances.

Results

The SBL involves four software components (1–4 thereafter). For end-users, the SBL provides ready to use, state-of-the-art (1) applications to handle molecular models defined by unions of balls, to deal with molecular flexibility, to model macro-molecular assemblies. These applications can also be combined to tackle integrated analysis problems. For developers, the SBL provides a broad C ++ toolbox with modular design, involving core (2) algorithms, (3) biophysical models and (4) modules, the latter being especially suited to develop novel applications. The SBL comes with a thorough documentation consisting of user and reference manuals, and a bugzilla platform to handle community feedback.

Availability and Implementation

The SBL is available from http://sbl.inria.fr

Supplementary information

Supplementary data are available at Bioinformatics online.
The early life stages of an estuarine fish, the red drum (Sciaenops ocellatus), are tolerant to high pCO2
Authors: Lonthair Joshua , Ern Rasmus , Esbaugh Andrew J.
Published: November 2016

Ocean acidification (OA) and other climate change induced environmental alterations are resulting in unprecedented rates of environmental deterioration. This environmental change is generally thought to be too fast for adaptation using typical evolutionary processes, and thus sensitivity may be dependent on the presence of existing tolerant genotypes and species. Estuaries undergo natural pCO2 fluctuations over a variety of time scales, and levels regularly exceed the predicted end of the century values. Interestingly, estuarine fish species have been overlooked in reference to the impacts of OA. Here, we use the estuarine red drum (Sciaenops ocellatus) as a model to explore the hypothesis that early life stages of estuarine species have intrinsic tolerance to elevated pCO2. Our sensitivity endpoints included: survival, growth, yolk consumption, heart rate, and scototaxis. Survival was significantly decreased when exposed to 1300 μatm and 3000 μatm, and coincided with a significant increase in heart rate at the 3000 μatm exposure. However, these effects were less pronounced than the findings of previous studies on other marine fish species. Yolk depletion rate and standard length were not significantly affected by pCO2. Scototaxis behaviour was also not significantly affected by exposure to elevated levels of pCO2 under both acute and acclimated exposure scenarios. Overall, these results support the hypothesis that estuarine life history and habitat usage may play a critical role in determining sensitivity of fish species to OA. Furthermore, estuarine species may provide present-day insight into the physiological and ecological foundation of OA tolerance.
Workplace Temporalities: A Time-Based Critique of the Flexible Working Provisions
Authors: Rose Emily
Published: November 2016

The right to request for flexible working legislation (sections 80F–80I, Employment Rights Act 1996) attempts to reconcile the demands of employees’ jobs with those in their personal lives. It does this by detailing a procedure whereby employees can request an adjustment to the amount of time spent working and the timing of those hours. The duration of work time and the timing of work time are indeed critical factors in employees’ ability to manage their work and personal lives. But it is questionable whether these purely quantitative features of work time capture the temporal issues that feed into the work–personal life problem. This article reviews the temporal assumptions implicit in the flexible working legislation and critically evaluates them in light of broader theoretical perspectives on time. In particular, it highlights the role of temporal subjectivities, which employees develop at work, and the relationship of these to new emerging patterns of work. A case study focusing on software engineers and managers is presented to demonstrate these theoretical viewpoints in practice. The article concludes that the legislation’s failure to address the social and collective nature of time is problematic, and that this hinders real progress in achieving flexible working.
Impact of Hospital-Employed Physician Assistants on a Level II Community-Based Orthopaedic Trauma System
Authors: Althausen Peter L. , Shannon Steven , Owens Brianne , Coll Daniel , Cvitash Michael , Lu Minggen , O’Mara Timothy J. , Bray Timothy J.
Published: November 2016

Objectives:

The American Academy of Orthopedic Surgeons and the Orthopedic Trauma Association have released guidelines for the provision of orthopedic trauma services such as adequate stipends, designated operating rooms, ancillary staff, and guaranteed reimbursement for indigent care. One recommendation included a provision for hospital-based physician assistants (PAs). Given current reimbursement arrangements, PA collections for billable services may not meet their salary and benefit expenses. However, their actions may indirectly affect emergency room, operating room, and hospital reimbursement and patient care itself. The purpose of our study is to define the true impact of hospitalbased PAs on orthopaedic trauma care at a level II community hospital.

Design:

Retrospective case series.

Setting:

Level II trauma center.

Patients/Participants:

One thousand one hundred four trauma patients with orthopaedic injuries.

Intervention:

PA involvement.

Main Outcome Measurements:

Emergency room data such as triage time, time until seen by the orthopedic service, and total emergency room time was recorded. Operating room data such as time to surgery, set-up time, total operating time, and out of room time was entered as well. Charts were reviewed to determine if patients were given postoperative antibiotics and Deep Venous Thrombosis (DVT) prophylaxis. Intraoperative and postoperative complications were noted, and lengths of stay were calculated for all patients.

Results:

At our institution, PA collections from patient care cover only 50% of their costs for salary and benefits. However, with PA involvement, trauma patients with orthopedic injuries were seen 205 minutes faster (P = 0.006), total Emergency Room (ER) time decreased 175 minutes (P = 0.0001), and time to surgery improved 360 minutes (P . 0.03). Operating room parameters were minimally improved, but postoperative DVT prophylaxis increased by a mean of 6.73% (P = 0.0084), postoperative antibiotic administration increased by 2.88% (P = 0.0302), and there was a 4.67% decrease in postoperative complications (P = 0.0034). Average length of stay decreased by 0.61 days (P = 0.27).

Conclusions:

Although the PA’s collections do not cover their costs, the indirect economic and patient care impacts are clear. By increasing emergency room pull through and decreasing times to Operating Room (OR), operative times, lengths of stay, and complications, their existence is clearly beneficial to hospitals, physicians, and patients as well.

Level of Evidence:

Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Cervical fracture patterns associated with vertebral artery injuries
Authors: Sud Sunjay , Ali Moiz , Stammen Kari , Yu Elizabeth , Jain Nikhil , Khan Safdar N.
Published: November 2016

Background:

Injury to the vertebral artery commonly occurs in the presence of traumatic cervical spine fractures. Data correlating incidence rates with specific fracture patterns remain unclear.

Methods:

We reviewed records of adult patients diagnosed with traumatic cervical spine fractures over a 10-year span. Subjects met at least one of the criteria: cervical vertebral subluxations (Pattern 1), fractures involving the transverse foramina (Pattern 2), fractures of C1-C3 (Pattern 3), and comminuted fractures in any segment of the cervical vertebra (Pattern 4).

Results:

Of the 119 patients included, 30 were diagnosed with vertebral artery injury (25.2%). The highest incidence was demonstrated in patients with the pattern combination of 1 and 2 only (n=3, 66.7%) and, 2 and 4 only (n=3, 66.7%). The next highest incidence was shown in patients with any combination including both pattern 2 and 4 (n=17, 41.1%). Patients with combination 1, 3, and 4 only (n=5, 40.0%), and with any combination including pattern 1 and 2 (n=10, 40.0%) had the third highest incidence.

Conclusions:

Our analysis demonstrated a high incidence of vertebral artery injury when the transverse foramina was involved and when any combination of three of the four high-risk patterns were involved in traumatic cervical fractures. These findings may be used to suspect vertebral artery injury in high likelihood injuries, reduce costly diagnostic testing, and guide providers to start treatment sooner.
Triple prophylaxis for the prevention of surgical site infections in total joint arthroplasty
Authors: Hofmann Kurt J. , Hayden Brett L. , Kong Qingwu , Pevear Mary E. , Cassidy Charles , Smith Eric L.
Published: November 2016

Background:

Surgical site infection is a devastating complication and the most common mode of failure in total joint arthroplasty (TJA). The purpose of this study was to evaluate a unique triple prophylaxis protocol (preoperative nasal application of mupirocin, preoperative intravenous administration of vancomycin, and intraoperative betadine irrigation) in reducing surgical site infection rates in TJA.

Methods:

Our sample included 1034 consecutive patients who underwent primary hip or knee TJA for degenerative joint disease in the 2 yr prior to (control group) and 2 yr after institution of this protocol (treatment group). After follow-up of a minimum of 1 yr, we identified all patients who developed surgical site infection. We then calculated and compared the overall, superficial, deep, and methacillin-resistant Staphylococcus aureus (MRSA) surgical site infection rates between the control and treatment groups.

Results:

The overall surgical site infection rate decreased from 2.0% in our control cohort to 0.7% (P=0.08) in our treatment cohort. Rates of deep surgical site infection significantly decreased from 1.4% to 0.2% (P=0.02), but no change was observed in rates of superficial surgical site infection (0.6% to 0.6%, P=0.92). The rate of MRSA infection decreased from 0.6% to 0.2%, but this was not significant (P=0.28).

Conclusions:

We discovered that using this three-pronged prophylaxis approach for primary total knee and hip arthroplasties significantly decreased the rates of deep SSI compared to patients who did not receive these interventions. This protocol has the potential for changing the current protocol for preventing surgical site infection in future TJA.
Cost Savings Opportunities in Perioperative Management of the Patients With Orthopaedic Trauma
Authors: Moody Alastair E. , Moody Catriona E. , Althausen Peter L.
Published: November 2016

Considerable opportunities for cost savings exist surrounding the perioperative management of patients with orthopaedic fracture and trauma. Scientific evidence is available to support each potential cost savings measure. Much of these data had been documented for years but has never been adhered to, resulting in millions of dollars in unnecessary testing and treatment. Careful attention to preoperative laboratory testing can save huge amounts of money and expedite medical clearance for injured patients. The use of a dedicated orthopaedic trauma operating room has been shown to improve resource utilization, decrease costs, and surgical complications. A variety of anesthetic techniques and agents can reduce operative time, recovery room time, and hospital lengths of stay. Strict adherence to blood utilization protocols, appropriate deep venous thrombosis prophylaxis, and multimodal postoperative pain control with oversight from dedicated hip fracture hospitalists is critical to cost containment. Careful attention to postoperative disposition to acute care and management of postoperative testing and radiographs can also be another area of cost containment. Institutional protocols must be created and followed by a team of orthopaedic surgeons, hospitalists, and anesthesiologists to significantly impact the costs associated with care of patient with orthopaedic trauma and fracture.
The Clinical and Economic Impact of Generic Locking Plate Utilization at a Level II Trauma Center
Authors: Mcphillamy Austin , Gurnea Taylor P. , Moody Alastair E. , Kurnik Christopher G. , Lu Minggen
Published: November 2016

Objectives:

In today's climate of cost containment and fiscal responsibility, generic implant alternatives represent an interesting area of untapped resources. As patents have expired on many commonly used trauma implants, generic alternatives have recently become available from a variety of sources. The purpose of this study was to examine the clinical and economic impact of a cost containment program using high quality, generic orthopaedic locking plates. The implants available for study were anatomically precontoured plates for the clavicle, proximal humerus, distal radius, proximal tibia, distal tibia, and distal fibula.

Design:

Retrospective review.

Setting:

Level II Trauma center.

Patients:

828 adult patients with operatively managed clavicle, proximal humerus, distal radius, proximal tibia, tibial pilon, and ankle fractures.

Intervention:

Operative treatment with conventional or generic implants.

Results:

The 414 patients treated with generic implants were compared with 414 patients treated with conventional implants. There were no significant differences in age, sex, presence of diabetes, smoking history or fracture type between the generic and conventional groups. No difference in operative time, estimated blood loss or intraoperative complication rate was observed. No increase in postoperative infection rate, hardware failure, hardware loosening, malunion, nonunion or need for hardware removal was noted. Overall, our hospital realized a 56% reduction in implant costs, an average savings of $1197 per case, and a total savings of $458,080 for the study period.

Conclusions:

Use of generic orthopaedic implants has been successful at our institution, providing equivalent clinical outcomes while significantly reducing implant expenditures. Based on our data, the use of generic implants has the potential to markedly reduce operative costs as long as quality products are used.

Level of Evidence:

Therapeutic Level III.
Effect of an Acid-sensing Ion Channels Inhibitor on Pain-related Behavior by Nucleus Pulposus Applied on the Nerve Root in Rats
Authors: Kobayashi Yoshihiro , Sekiguchi Miho , Konno Shin-ichi
Published: November 2016

Study Design.

Controlled, interventional animal study.

Objective.

To examine the effect of an inhibitor of acid-sensing ion channel 3 (ASIC3) on pain-related behavior induced by application of the nucleus pulposus (NP) onto the dorsal root ganglion (DRG) in rats.

Summary of Background Data.

ASIC3 is associated with acidosis pain in inflamed or ischemic tissues and is expressed in sensory neurons and NP cells. The ASIC3 inhibitor, APETx2, increases the mechanical threshold of pain in models of knee osteoarthritis or postoperative pain. However, the efficacy of APETx2 for pain relief in the NP application model remains unknown.

Methods.

Autologous NP was applied to the left L5 nerve root of 183 adult female Sprague-Dawley rats. The DRGs were treated with NP plus one of the following four treatments: saline solution (SM), low (0.01 μg: LD), medium (0.1 μg: MD), or high dose (1.0 μg: HD) of APETx2. Behavioral testing was performed to investigate the mechanical withdrawal threshold using von Frey hairs. Expression of nerve growth factor, hypoxia-inducible factor-1α (HIF1α), activating transcription factor-3, and ionized calcium-binding adaptor molecule-1 was evaluated using immunohistochemistry. Statistical differences among multiple groups were assessed using the Steel test, the Tukey-Kramer test, and the Dunnett test. P < 0.05 were considered significant.

Results.

The thresholds in the HD group were higher than those in the SM group at Days 14 and 21 (P < 0.05). In the MD group, the threshold was higher than in the SM group at Day 14 (P < 0.05). High doses of APETx2 reduced the expression of HIF1α after Day 14 compared with the SM group (P < 0.05).

Conclusion.

APETx2 significantly improved pain-related behavior in a dose-dependent manner. APETx2 may inhibit ASIC3 and partly inhibit Nav1.8 channels. This ASIC3 channel inhibitor may be a potential therapeutic agent in early-stage lumbar disc herniation.

Level of Evidence: N/A
Analysis of Sagittal Parameters in Patients Undergoing One- or Two-Level Closing Wedge Osteotomy for Correcting Thoracolumbar Kyphosis Secondary to Ankylosing Spondylitis
Authors: Hua Wen-bin , Zhang Yu-kun , Gao Yong , Liu Xian-zhe , Yang Shu-hua , Wu Xing-huo , Wang Jing , Yang Cao
Published: November 2016

Study Design.

Retrospective analysis of clinical records.

Objective.

To assess and compare the improvement in sagittal balance after one- or two-level closing wedge osteotomy for correcting thoracolumbar kyphosis secondary to ankylosing spondylitis (AS).

Summary of Background Data.

Closing wedge osteotomy represents a common approach to correct kyphosis in AS. Although several reports have described the outcomes of one- or two-level closing wedge osteotomy in terms of sagittal parameters, data comparing the outcomes of these procedures are scarce.

Methods.

Between January 2010 and December 2014, 22 patients with AS underwent closing wedge osteotomy (one-level, 12 patients; two-level, 10 patients) for correcting thoracolumbar kyphosis (mean follow-up, 24.8 months; range, 12–60 months). Preoperative and postoperative chin-brow vertical angle, and the sagittal parameters of the vertebral osteotomy segment were documented and compared. Perioperative and postoperative complications were also recorded.

Results.

The chin-brow vertical angle improved significantly, from 55.0° ± 27.3° to 4.7° ± 4.9° and from 38.2° ± 14.9° to 3.2° ± 5.4° in the one-level and two-level groups, respectively. The total correction (thoracic kyphosis and lumbar lordosis) was 32.8° ± 18.2° and 53.7° ± 9.4° in the one-level and two-level groups, respectively. No death, complete paralysis, or vascular complications occurred during the procedure, but cerebrospinal fluid leak was noted in one and two patients from the one-level and two-level groups, respectively. A distal pedicle screw adjacent to the osteotomy segment became loose during surgery in one patient (one-level group). Postoperatively, no transient neurological deficit, infection, delay union, or loosening or breaking of the internal fixation devices was observed. Osteotomy site fusion was achieved in all patients, and the Oswestry Disability Index scores improved significantly.

Conclusion.

Closing wedge osteotomy is effective and safe for correcting thoracolumbar kyphosis in patients with AS. Significant correction and improvement in all sagittal parameters were noted in both groups, but two-level closing wedge osteotomy provided better correction.

Level of Evidence: 3
The Azygos Vein Is at Potential Risk of Injury From Malpositioning of Left Thoracic Pedicle Screw in Thoracic Adolescent Idiopathic Scoliosis Patients
Authors: Jiang Jun , Qian Bang-ping , Qiu Yong , Wang Bin , Yu Yang , Zhu Ze-zhang
Published: November 2016

Study Design.

A computed tomography study.

Objective.

To evaluate the changed position of azygos vein in patients with thoracic adolescent idiopathic scoliosis (AIS) and to analyze the potential risk of injury of azygos vein from thoracic pedicle screw placement in these patients.

Summary of Background Data.

It has been widely recognized that the anatomic positions of structures adjacent to the vertebrae may change in patients with AIS. To date, no study had evaluated such change of azygos vein in patients with AIS.

Methods.

Twenty-five patients with thoracic AIS and 17 age-matched normal teenagers were included in the present study. Axial computed tomography images from T7 to T10 level were obtained to evaluate azygos vein-vertebral angle (defined as 0° when the azygos vein was located directly laterally to the left and 180° when directly laterally to the right). The percentage of azygos vein located in the direction of left screw passage was calculated to analyze the potential risk of injury from left pedicle screw placement.

Results.

The azygos vein-vertebral angles were significantly smaller in patients with AIS when compared with normal teenagers from T7 to T10 level (P < 0.001). The percentage of azygos vein at high risk of injury from left pedicle screw placement was 80% (20/25) at T7 level, 84% (21/25) at T8 level, 76% (19/25) at T9 level, and 72% (18/25) at T10 level in patients with AIS. No azygos vein was found to be at risk of injury from right pedicle screw placement in patients with AIS. The azygos vein was safe from pedicle screw placement on both sides in normal teenagers.

Conclusion.

The changed relative anatomic position of azygos vein in patients with thoracic AIS places the azygos vein at high potential risk of injury from excessively long left pedicle screw placement. Spine surgeons should choose appropriate screw length to avoid anterior cortex perforation.

Level of Evidence: 3