bluuebunny/crossref_metadata_2025_split huggingface dataset:
Applying principles of injury and infectious disease control to the opioid mortality epidemic in North America: critical intervention gaps
Authors: Fischer Benedikt , Pang Michelle , Tyndall Mark 
Published: November 2019

ABSTRACT
North America has been experiencing an acute and unprecedented public health crisis involving excessive and increasing levels of opioid-related overdose mortality. In the present commentary, we examine current interventions (as existent mainly in Canada) to date and compare them against established intervention frameworks and practices in other areas of public health, specifically injury and infectious disease control. We observe that current interventions focusing on opioid drug safety or exposure—specifically those that focus on distinctly potent and toxic opioid products driving major increases in overdose mortality—may be considered the equivalent of ‘agent-’ or ‘vector’-based interventions. Such interventions have been largely neglected in favor of ‘host’ (e.g., drug user-oriented) or ‘environmental’ measures among strategies to reduce opioid-related overdose, likely contributing to the limited efficacy of current measures. We explore potential reasons, implications and remedies for these gaps in the overall public health strategy employed towards improved interventions to reduce opioid-related health harms.
The effects of soybean hulls level, distillers dried grains with solubles, and net energy formulation on nursery pig performance1
Authors: Goehring Devin L , Wu Fangzhou , DeRouchey Joel M , Goodband Robert D , Tokach Mike D , Woodworth Jason C , Paulk Chad B , Dritz Steve S 
Published: November 2019

Abstract
Four experiments were conducted to investigate the effects of increasing dietary soybean hulls without or with distillers dried grains with solubles (DDGS) and net energy (NE) formulation on nursery pig performance. In experiment 1, a total of 210 nursery pigs (initially 6.6 ± 0.1 kg) were used in a 34-d study. Pigs were fed one of five diets that contained increasing soybean hulls (0%, 5%, 10%, 15%, and 20%). Diets were not balanced for NE. Increasing soybean hulls decreased (linear, P &lt; 0.01) average daily gain (ADG) and gain:feed ratio(G:F), and tended to decrease average daily feed intake (ADFI; quadratic, P &lt; 0.10). In experiment 2, 210 nursery pigs (initially 13.6 ± 0.1 kg) were used in a 20-d study to determine the effect of equal NE formulation in diets with soybean hulls. Pigs were fed one of five diets containing 0% (control), 10%, or 20% soybean hulls either balanced to contain equal NE to the control diet or not balanced for energy. Diets containing 10% and 20% soybean hulls with balanced NE contained 3.60% and 7.15% added soybean oil, respectively. Increasing soybean hulls decreased (linear, P &lt; 0.01) ADG regardless of formulation method. Pigs fed increasing soybean hulls without added fat had decreased (linear, P &lt; 0.01) G:F. Increasing soybean hulls in diets with balanced NE decreased (linear, P &lt; 0.02) ADFI, but did not affect G:F. In experiment 3, 600 pigs (initially 6.8 ± 0.1 kg) were used in a 42-d study. Pigs were fed 1 of 10 diets containing 0%, 3%, 6%, 9%, or 12% soybean hulls without or with DDGS (15% from d 0 to 14, 30% from d 15 to 42). Feeding DDGS reduced (P &lt; 0.04) ADG and ADFI, and tended to increase (P &lt; 0.06) G:F. Increasing soybean hulls decreased G:F quadratically (P &lt; 0.03) in diets without DDGS, but decreased G:F linearly (P &lt; 0.01) in diets with DDGS (soybean hulls × DDGS interaction, P &lt; 0.05). In experiment 4, 304 barrows (initially 11.7 ± 0.2 kg) were used in a 21-d study. Pigs were fed one of eight diets containing 0%, 5%, 10%, or 15% soybean hulls with or without 20% DDGS. No soybean hull × DDGS interactions were observed. Increasing soybean hulls tended to decrease (linear, P &lt; 0.08) G:F. In conclusion, feeding low levels of soybean hulls did not affect nursery pig performance but more than 5% soybean hulls, with or without DDGS, decreased G:F. Formulating diets containing soybean hulls on an equal NE basis eliminated the negative effects on G:F, but the NE (1,003 kcal/kg) of soybean hulls used in this study was underestimated.
The Politics of Community Drama in Interwar England
Authors: Neima Anna 
Published: November 2019

Abstract
There was a wave of reform-oriented drama across England in the 1920s and 1930s, which extended from urban, socialist theatre to the ‘late modernist’ enthusiasm for rural pageantry and from adult education to Church revival. Most scholarship looks at drama in these various milieus separately, but this study of three plays that were put on in a corner of South West England—a nativity play, an innovative ‘dance-mime’, and a Workers’ Educational Association narrative piece—brings them together. These plays shared a connection to Dartington Hall, a social and cultural experiment set on a large estate in Devon in 1925 by an American heiress, Dorothy Elmhirst, and her Yorkshire-born husband, Leonard, which became a nexus for the various strands of community-seeking theatre evident in interwar England—as well as for social reform more generally. This article shows how dramatic performances formed part of the quest for communal unity that was a dominant strand in social thinking between the wars: driven by fears about class strife, the effects of democratization, the recurrence of war, and the fragmenting effects of secular modernity, elites, artists, and activists of diverse hues tried to reform the very idea of Englishness by putting on plays—fostering values of community and communality, while often taking inspiration from an idealized vision of the rural community of England’s pre-industrial past.
Escape the Sim! An Escape Room Innovation to Orient Learners to the Simulation Environment
Authors: Robertiello Gina , Genee Jordan , Marrera Amnerys 
Published: November 2019

Abstract
Orientation to the environment and equipment promotes psychological safety in simulation. Providing orientation activities also increases learner perceptions of simulation effectiveness, confidence, and learning overall. Escape rooms, used by educators from primary levels through graduate programs, promote skills in teamwork, creative problem-solving, and critical thinking ability. Creating an escape room-themed simulation experience with the objective of orienting learners to the simulation environment and equipment is an interactive way to prepare learners for simulation, while encouraging teamwork and group dynamics.
Indications and Clinical Results of Radial Head Replacement: Has Anything Changed?
Authors: Eyberg Blake A. , McKee Michael D. 
Published: November 2019

Summary:
Radial head fractures are common injuries comprising 1/3 of the fractures about the elbow. As a secondary valgus stabilizer of the elbow, radial head fractures can compromise elbow stability leading to long-term pain, dysfunction, and degenerative change. Furthermore, radial head fractures can be accompanied by associated injuries including ligamentous lesions that can further exacerbate elbow instability, leading to long-term sequelae. As fixation principles and technology have evolved, so has the ability to render surgical treatment for these fractures. In general, minimally displaced and some displaced fractures may be treated nonoperatively with early motion. Fractures with a block to rotation and displaced fragments with 3 or fewer fragments may be treated with open reduction and internal fixation. Comminuted fractures or those with greater than 3 fragments may be successfully treated with radial head replacement. Associated elbow instability will also influence treatment decisions.
Prevalence of depression and anxiety in women newly diagnosed with vulvovaginal atrophy and dyspareunia
Authors: Moyneur Erick , Dea Katherine , Derogatis Leonard R. , Vekeman Francis , Dury Alain Y. , Labrie Fernand 
Published: November 2019

Abstract

Objective:
To quantify the association between vulvovaginal atrophy and depression, major depressive disorder, and anxiety.

Methods:
Women with vulvovaginal atrophy from the Truven Health MarketScan Commercial and Medicare Supplemental Databases (01/2010-09/2016) with ≥365 days of continuous insurance coverage before and after the first vulvovaginal atrophy/dyspareunia diagnosis (index date) were selected. Women with vulvovaginal atrophy were matched 1:3 to women without (controls) according to age, calendar year, health plan, and region. The study period spanned from 12 months before to 12 months after index date. The ratios of diagnosed depression, major depressive disorder, and anxiety among women with vulvovaginal atrophy and the controls were calculated. Logistic regressions adjusting for proxies of menopause were used to compare prevalence.

Results:
In all, 125,889 women with vulvovaginal atrophy and 376,057 controls were included (mean age 60.7 [45-101]). The prevalence of depression, major depressive disorder, and anxiety was higher among women with vulvovaginal atrophy compared with controls (23.9% vs 18.9%, 6.3% vs 4.7%, 16.6% vs 11.3%), with prevalence ratios of 1.26, 1.33, and 1.47, respectively (all P
< 0.0001). Highest prevalences and differences were observed in younger women. Findings were consistent when analyzing newly diagnosed conditions. When adjusting for proxies of menopause (insomnia, vasomotor symptoms, dysuria, and estrogen therapy), vulvovaginal atrophy remained significant (prevalence odds ratios; depression 1.23, major depressive disorder 1.22, anxiety 1.39; all P < 0.0001).

Conclusions:
Vulvovaginal atrophy is associated with a significantly higher prevalence/incidence of depression, major depressive disorder, and anxiety. The higher prevalence/incidence and greater differences in younger women highlight the need for a multidisciplinary approach and early diagnosis/management of vulvovaginal atrophy.
Pediatric Concussion: Managing Persistent Symptoms With an Interdisciplinary Approach
Authors: Scratch Shannon E. , Rumney Peter , Agnihotri Sabrina , Reed Nick 
Published: November 2019

Objective:We outline the development of a clinic that works directly with youth clients, their caregivers, and family members to help address symptoms that are persisting long after the youth sustained a concussion. Client referral characteristics are described, as well as general clinic flow and procedures. Particular emphasis is placed on a novel interdisciplinary team assessment pathway designed with input from clients and families to help provide consistent treatment plans, education, direction, and conclusions for those clients with complex psychosocial, cognitive, and physical presentations.Setting and Participants:The Persistent Concussion Clinic at Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.Conclusions:Youth with persistent concussion symptoms have limited access to interdisciplinary clinics and supports. This article outlines the practices of a large, hospital-based interdisciplinary clinic whose model can inform clinical care pathways and practices for this underserved population. Facilitators and barriers to access are discussed and future directions for the clinic and persistent concussion care in Ontario and internationally are reviewed.
Baseline Central Visual Field Defect as a Risk Factor For NTG Progression: A 5-Year Prospective Study
Authors: Raman Puspha , Suliman Nurull B. , Zahari Mimiwati , Mohamad Nor Fadhilah , Kook Michael S. , Ramli Norlina 
Published: November 2019

Precis:
This 5-year follow-up study on normal-tension glaucoma (NTG) patients demonstrated that those with baseline central visual field (VF) defect progress at a more increased rate compared with those with peripheral field defect.

Purpose:
The purpose of this study was to investigate the clinical characteristics, including 24-hour ocular perfusion pressure and risk of progression in patients with baseline central VF defect, as compared with those with peripheral VF defect in NTG.

Design:
This was a prospective, longitudinal study.

Methods:
A total of 65 NTG patients who completed 5 years of follow-up were included in this study. All the enrolled patients underwent baseline 24-hour intraocular pressure and blood pressure monitoring via 2-hourly measurements in their habitual position and had ≥5 reliable VF tests during the 5-year follow-up. Patients were assigned to two groups on the basis of VF defect locations at baseline, the central 10 degrees, and the peripheral 10- to 24-degree area. Modified Anderson criteria were used to assess global VF progression over 5 years. Kaplan-Meier analyses were used to compare the elapsed time of confirmed VF progression in the two groups. Hazard ratios for the association between clinical risk factors and VF progression were obtained by using Cox proportional hazards models.

Results:
There were no significant differences between the patients with baseline central and peripheral VF defects in terms of demography, clinical, ocular and systemic hemodynamic factors. Eyes with baseline defects involving the central fields progressed faster (difference: βcentral=−0.78 dB/y, 95% confidence interval=−0.22 to −1.33, P=0.007) and have 3.56 times higher hazard of progressing (95% confidence interval=1.17-10.82, P=0.025) than those with only peripheral defects.

Conclusion:
NTG patients with baseline central VF involvement are at increased risk of progression compared with those with peripheral VF defect.
Prevalence and Outcomes of Balloon Atrial Septostomy in Neonates With Transposition of Great Arteries
Authors: Hamzah Mohammed , Othman Hasan F. , Peluso Allison M. , Sammour Ibrahim , Aly Hany 
Published: November 2019

Objectives:
Transposition of the great arteries is the most common cyanotic congenital heart defect. Surgical correction usually occurs in the first week of life; presence of restrictive interatrial communication and severe hypoxemia warrants urgent intervention with balloon atrial septostomy and medical stabilization prior to surgery. The main objective of this study is to compare the characteristics, outcomes, and mortality risks in patients with transposition of the great arteries who underwent balloon atrial septostomy during their hospitalization versus transposition of the great arteries patients who have not undergone this procedure.

Design:
Retrospective analysis of administrative data.

Setting:
Data from Kids’ Inpatient Database complemented with the National Inpatient Sample dataset for the years 1998–2014, this includes data from participating hospitals in 47 U.S. States and the District of Columbia.

Patients:
Neonates admitted with transposition of the great arteries.

Interventions:
None.

Measurements and Main Results:
A total of 17,392 neonates with diagnosis of transposition of the great arteries were captured in the databases we used. Male-to-female ratio was 2:1. The rate of balloon atrial septostomy in patients with transposition of the great arteries was 27.7% without significant change over the years. There was no significant difference in mortality between balloon atrial septostomy and no balloon atrial septostomy (6.3% vs 6.7%; p = 0.29). Neonates with balloon atrial septostomy had a two-fold increase in their length of stay compared with no balloon atrial septostomy (16 d vs 7 d; p < 0.0001). Stroke was present in 1.1% of balloon atrial septostomy group versus 0.6% in those who did not have balloon atrial septostomy (odds ratio, 1.85; 95% CI, 1.29–2.65; p < 0.0001). Extracorporeal membrane oxygenation was used more in balloon atrial septostomy group (5.1% vs 3.1%; p < 0.0001).

Conclusions:
There was no difference in mortality rate between balloon atrial septostomy and no balloon atrial septostomy patients. The prevalence of the diagnosis of stroke in this study was higher in patients who underwent balloon atrial septostomy. Furthermore, comparison of in-hospital mortality in balloon atrial septostomy and no balloon atrial septostomy revealed increased mortality risk in no balloon atrial septostomy patients transferred from other institution, no balloon atrial septostomy patients supported with extracorporeal membrane oxygenation, and balloon atrial septostomy patients diagnosed with stroke. Finally, length of stay and charges were higher in balloon atrial septostomy patients.
Effectiveness of a 5-Week Inpatient Dialectical Behavior Therapy for Borderline Personality Disorder
Authors: PROBST THOMAS , O’ROURKE TERESA , DECKER VERENA , KIEßLING EVA , MEYER SASCHA , BOFINGER CHRISTINE , NIKLEWSKI GÜNTER , MÜHLBERGER ANDREAS , PIEH CHRISTOPH 
Published: November 2019

Objective:
The goal of this study was to evaluate whether symptoms are reduced and emotion regulation improves when patients with borderline personality disorder (BPD) receive a 5-week course of inpatient dialectical behavioral therapy (DBT) and if changes in emotion regulation are associated with changes in symptoms.

Methods:
Forty-four patients with BPD receiving a 5-week course of DBT in a German psychiatry clinic participated. The short version of the “Borderline Symptom List” (BSL-23) was the patient-reported outcome. To measure emotion regulation, the “Self-Report Measure for the Assessment of Emotion Regulation Skills” (SEK-27) was administered. Wilcoxon tests were performed to evaluate whether pre-post changes in the BSL-23 and SEK-27 reached statistical significance. Effect sizes (d) were calculated and correlations between the pre-post differences for both measures were computed to test associations between changes in emotion regulation and changes in symptoms. Completer (n=33) and intention-to-treat (n=43) analyses were performed.

Results:
Symptoms (BSL-23) were reduced and emotion regulation (SEK-27) improved during the 5-week inpatient DBT treatment (completer and intention-to-treat analysis: P<0.001). Effect sizes reached d=0.47 for the BSL-23 and d=0.84 for the SEK-27 in the completer analysis, and d=0.38 for the BSL-23 and d=0.68 for the SEK-27 in the intention-to-treat analysis. Improvements in emotion regulation (SEK-27) were correlated with reductions in symptoms (BSL-23) in both the completer (r=0.54; P=0.001) and the intention-to-treat (r=0.59; P<0.001) analyses.

Conclusions:
These findings indicate that a 5-week course of inpatient DBT can effectively reduce symptoms in patients with BPD and that the more patients’ emotion regulation improves, the more the patients benefit from the therapy.
Antipsychotics Do Not Influence Neurological Soft Signs in Children and Adolescents at Ultra-High Risk for Psychosis: A Pilot Study
Authors: PITZIANTI MARIABERNARDA , CASARELLI LIVIA , PONTILLO MARIA , VICARI STEFANO , ARMANDO MARCO , PASINI AUGUSTO 
Published: November 2019

Objective:
Ultra-high risk for psychosis (UHR) is considered as the condition that temporally precedes the onset of psychotic symptoms. In addition to the core symptoms, patients with schizophrenia show motor abnormalities, also known as neurological soft signs (NSS), that are considered an endophenotype for psychotic disorders and particularly for schizophrenia. Antipsychotic medications do not appear to influence NSS in individuals with schizophrenia. However, NSS in UHR subjects have been poorly studied and, to date, we do not know what effects antipsychotics have in early treated UHR subjects. Therefore, we evaluated NSS in treated UHR subjects in comparison with drug-naive UHR subjects and a group of healthy control subjects and the effect of pharmacological treatment on early treated UHR children and adolescents.

Patients and Methods:
Fifteen UHR subjects receiving pharmacological treatment, 15 drug-naive UHR subjects, and 25 healthy control subjects were evaluated for NSS to analyze any differences between clinical subjects and healthy controls and to evaluate the effect of antipsychotic medications in early treated UHR subjects.

Results:
Both clinical groups showed a greater number of NSS compared with the healthy control subjects. However, no significant differences in NSS were found between treated and drug-naive UHR subjects.

Conclusions:
Consistent with what has been observed in the population of patients with a first psychotic episode and/or with schizophrenia, our results support the conclusion that antipsychotic medications do not influence NSS in children and adolescents who are at high risk for psychosis.
Chinese Therapists’ Beliefs About Exposure Therapy for Anxiety and Obsessive-Compulsive Disorders
Authors: FANG FANG , ZHANG YINGYING , ZHANG LI , JIANG MEIMEI , SONG RUI , WANG YU , WANG ZUOWEI , LI BIN , FARRELL NICHOLAS , CEPEDA SANDRA L. , SCHNEIDER SOPHIE C. , MCINGVALE ELIZABETH , SHRESTHA SRIJANA , GOODMAN WAYNE K. , ZHANG CHENCHENG , STORCH ERIC A. 
Published: November 2019

Objectives:
The goal of this study was to assess Chinese therapists’ beliefs about exposure therapy and to examine the psychometric properties of the Chinese version of the Therapist Beliefs about Exposure Scale (TBES). Modification of therapists’ beliefs about exposure therapy was also assessed following attendance at an exposure and response prevention therapy (ERP) training workshop.

Methods:
A total of 203 therapists participated in the study. The TBES and a measure of anxiety sensitivity were administered in Chinese. After a half-day ERP training workshop, the Chinese version of the TBES was administered to the participants again.

Results:
The Chinese version of the TBES demonstrated adequate internal consistency, moderate item-level psychometric properties, and a normal distribution in the sample in this study. The TBES scores of the participants decreased significantly after they attended an ERP training course. The reduction in TBES scores was significantly correlated with therapists’ caseload of clients with obsessive-compulsive disorder.

Conclusions:
The results of this study support the reliability of the Chinese version of the TBES. Chinese therapists had more negative beliefs about exposure than did American therapists who were evaluated in a different study; however, therapists’ negative beliefs were significantly reduced after they attended an ERP training workshop. Future studies are encouraged to explore effective strategies to improve the disseminiation and delivery of exposure therapy in China.
Plain Computed Tomography With Spectral Imaging Findings of Early Cerebral Ischemia
Authors: Yongjun Luo , Hao Zhu , Wenjuan Zhang , Dan Wang , Qiaoying Zhang , Junlin Zhou 
Published: November 2019

Purpose:
To investigate the findings of plain spectral computed tomography (CT) with multiparameter of early cerebral ischemia.

Patients and Methods:
Thirty-three patients with suspected early cerebral ischemia who received a one-stop CT examination (plain scan with spectral CT imaging mode, CTP and CTA) of the brain were enrolled in this study. No clear lesion was observed in any patient on the plain CT. However, the CTA displayed evidence of vascular stenosis and the CTP displayed a corresponding low perfusion area consistent with early cerebral ischemia. Regions of interest were placed in the abnormal perfusion regions and the contralateral symmetric regions on plain CT. Then, the CT value of the monochromatic images (70 kV), the slope of the spectral HU curve, blood (iodine), iodine (water), and water (iodine) concentrations were measured. A paired t-test was performed for data comparison. The receiver operating characteristic curve was used to evaluate diagnostic performance.

Results:
The CT values of the ischemic regions at 70 keV, the spectral HU curve, water, and blood values of the ischemic measurements were slightly lower than those of the contralateral symmetric regions (P < .05). Monochromatic images at 70 keV had the highest area under the curve value, and the sensitivity and specificity were 90.0% and 63.0%, respectively.

Conclusion:
The difference of monochromatic CT values, spectral HU curve, and basic material concentrations between the early cerebral ischemia region and the contralateral symmetric region on spectral CT imaging may provide a reference with the diagnosis of early cerebral ischemia.