bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of the Efficacy Between Intradiscal Gelified Ethanol (Discogel) Injection and Intradiscal Combination of Pulsed Radiofrequency and Gelified Ethanol (Discogel) Injection for Chronic Discogenic Low Back Pain Treatment. A Randomized Double-Blind Clinical Study
Authors: Papadopoulos Dimitrios , Batistaki Chrysanthi , Kostopanagiotou Georgia 
Published: January 2020

AbstractObjectiveThe aim of the present study was to compare two new techniques, intradiscal gelified ethanol injection (Discogel) and the combination of intradiscal pulsed radiofrequency and gelified ethanol injection (PRF+Discogel), regarding their efficacy in discogenic low back pain treatment.DesignRandomized, double-blind, clinical study.MethodsThe final sample was randomized into group A (N = 18, D) and group B (N = 18, PRF+D). During the procedure, four patients from group B were excluded from the study. Groups A and B were assessed regarding the pain score (VAS 0–10), before the interventional procedures, and one, three, six, and 12 months after. Secondary objectives of the study were to compare the two groups regarding the results of the Roland Morris Disability Questionnaire, Lanss score, and quality of life score (EQ-5D).ResultsThere was no significant evidence for an overall difference in pain score between the two groups (analysis of variance, F = 3.24, df = 1, P = 0.084), except for the sixth and 12th months, when group B presented a statistically important difference compared with group A (Wilcoxon test). Group B appeared to be more effective, with a statistically significant difference, compared with group A regarding the secondary objectives of the study.ConclusionsAfter rigorous and comprehensive assessment by an independent observer, both Discogel alone and Discogel in combination with pulsed radiofrequency produced tangible improvements in pain, function, quality of life, and consumption of analgesics, which were sustained at 12 months.
Outcomes in Long-term Opioid Tapering and Buprenorphine Transition: A Retrospective Clinical Data Analysis
Authors: Sturgeon John A , Sullivan Mark D , Parker-Shames Simon , Tauben David , Coelho Paul 
Published: January 2020

AbstractBackgroundThere are significant medical risks of long-term opioid therapy (LTOT) for chronic pain. Consequently, there is a need to identify effective interventions for the reduction of high-dose full-agonist opioid medication use.MethodsThe current study details a retrospective review of 240 patients with chronic pain and LTOT presenting for treatment at a specialty opioid refill clinic. Patients first were initiated on an outpatient taper or, if taper was not tolerated, transitioned to buprenorphine. This study analyzes potential predictors of successful tapering, successful buprenorphine transition, or failure to complete either intervention and the effects of this clinical approach on pain intensity scores.ResultsOne hundred seven patients (44.6%) successfully tapered their opioid medications under the Centers for Disease Control and Prevention guideline target dose (90 mg morphine-equianalgesic dosage), 45 patients (18.8%) were successfully transitioned to buprenorphine, and 88 patients (36.6%) dropped out of treatment: 11 patients during taper, eight during buprenorphine transition, and 69 before initiating either treatment. Conclusions. Higher initial doses of opioids predicted a higher likelihood of requiring buprenorphine transition, and a co-occurring benzodiazepine or z-drug prescription predicted a greater likelihood of dropout from both interventions. Patterns of change in pain intensity according to treatment were mixed: among successfully tapered patients, 52.8% reported greater pain and 23.6% reported reduced pain, whereas 41.8% reported increased pain intensity and 48.8% reported decreased pain after buprenorphine transition. Further research is needed on predictors of treatment retention and dropout, as well as factors that may mitigate elevated pain scores after reduction of opioid dosing.
Application of biomaterials for the repair and treatment of osteonecrosis of the femoral head
Authors: Zhao Dewei , Ma Zhijie 
Published: January 2020

Abstract
Osteonecrosis of the femoral head (ONFH) is one of the most common causes of hip disability in young adults. However, its cause and pathogenesis remain unclear, and might be caused by a variety of factors. ONFH mainly occurs in young adults. If not treated, 70–80% of patients would progress into femoral head collapse in 3 years, and eventually require hip arthroplasty. Since these patients are younger and more physically active, multiple revision hip arthroplasty might be needed in their life. Repeated revision hip arthroplasty is difficult and risky, and has many complications, which inevitably affects the physical and mental health of patients. To delay the time of total hip arthroplasty for young adult patients with ONFH, biomaterials are used for its repair, which has a high clinical and social value for the retention of the patient’s own hip function. At present, there are many types of biomaterials used in repairing the femoral head, there is no uniform standard of use and the clinical effects are different. In this review, the main biomaterials used in the repair of ONFH are summarized and analyzed, and the prospects are also described.
Information Revealed through the Regulatory Process: Interactions between the SEC and Companies ahead of Their IPO
Authors: Lowry Michelle , Michaely Roni , Volkova Ekaterina 
Published: January 2020

AbstractWe analyze communications between the SEC and firms prior to IPOs using LDA analysis and KL divergence. The SEC’s concerns closely map onto the regulator’s stated mandate: companies increase prospectus disclosures on precise topics of SEC concern. Revenue recognition is the dominant topic of SEC concern, and it is not independently discovered by investors. Increased SEC concern about it is associated with greater secondary sales, lower post-IPO liquidity, lower post-IPO returns, and a higher probability of withdrawal. The regulator’s role during the capital raising process results in increased transparency but contributes to delays in the going public process.
Ultrasound verified enthesophytes are associated with radiographic progression at entheses in psoriatic arthritis
Authors: Lackner Angelika , Heber Daniel , Bosch Philipp , Adelsmayr Gabriel , Duftner Christina , Ficjan Anja , Gretler Judith , Hermann Josef , Husic Rusmir , Graninger Winfried B , Dejaco Christian 
Published: January 2020

Abstract

Objectives
The aim of this prospective study was to examine whether ultrasound or clinical abnormalities at enthesal sites predict radiographic progression at entheses in psoriatic arthritis (PsA).

Methods
Consecutive PsA patients were included and subjected to clinical and ultrasound assessments at 14 entheses at baseline, 6 and 12 months. Radiographs were performed at 0 and 12 months. By US, we investigated structural (erosions, osteophytes) and inflammatory changes [grey scale (0–32) and power Doppler (0–14, range global ultrasound score 0–140)], and radiographs were evaluated for enthesophytes and erosions (score range 0–56). Multivariate regression models were conducted to identify the possible association of clinical and ultrasound findings with radiographic progression.

Results
We examined 83 patients at baseline, of whom 43 (51.8%) had complete clinical, ultrasound and X-ray data. Twenty-four of 43 patients (55.8%) developed radiographic progression of entheses. These patients were younger (49.6 vs 59.3, P =0.005), had shorter disease duration (9.7 vs 17.9 years, P=0.015) and lower clinical disease activity at 6-months [disease activity in psoriatic arthritis (DAPSA) 6.7 vs 17.0, P=0.018] as compared with patients without progression. Non-progressors had higher ultrasound enthesophyte scores at baseline than progressors (20 vs 15, P&lt;0.05). The multivariate regression analysis revealed that 48.6% of the variance of the X-ray score at 12-months follow-up (RegcoeffB = 0.827, P=0.000) could be explained by the baseline US enthesophyte score.

Conclusion
Our data indicate that radiographic progression at entheses is linked with age, disease duration and ultrasound verified enthesophytes at baseline. No other ultrasound parameter predicted radiographic progression at entheses.
Dynamic surface tension of xylem sap lipids
Authors: Yang Jinlong , M Michaud Joseph , Jansen Steven , Schenk H Jochen , Zuo Yi Y 
Published: January 2020

AbstractThe surface tension of xylem sap has been traditionally assumed to be close to that of the pure water because decreasing surface tension is thought to increase vulnerability to air seeding and embolism. However, xylem sap contains insoluble lipid-based surfactants, which also coat vessel and pit membrane surfaces, where gas bubbles can enter xylem under negative pressure in the process known as air seeding. Because of the insolubility of amphiphilic lipids, the surface tension influencing air seeding in pit pores is not the equilibrium surface tension of extracted bulk sap but the local surface tension at gas–liquid interfaces, which depends dynamically on the local concentration of lipids per surface area. To estimate the dynamic surface tension in lipid layers that line surfaces in the xylem apoplast, we studied the time-dependent and surface area-regulated surface tensions of apoplastic lipids extracted from xylem sap of four woody angiosperm plants using constrained drop surfactometry. Xylem lipids were found to demonstrate potent surface activity, with surface tensions reaching an equilibrium at ~25 mN m-1 and varying between a minimum of 19 mN m-1 and a maximum of 68 mN m-1 when changing the surface area between 50 and 160% around the equilibrium surface area. It is concluded that xylem lipid films in natural conditions most likely range from nonequilibrium metastable conditions of a supersaturated compression state to an undersaturated expansion state, depending on the local surface areas of gas–liquid interfaces. Together with findings that maximum pore constrictions in angiosperm pit membranes are much smaller than previously assumed, low dynamic surface tension in xylem turns out to be entirely compatible with the cohesion–tension and air-seeding theories, as well as with the existence of lipid-coated nanobubbles in xylem sap, and with the range of vulnerabilities to embolism observed in plants.
Think Twice: Effects on Diagnostic Accuracy of Returning to the Case to Reflect Upon the Initial Diagnosis
Authors: Mamede Sílvia , Hautz Wolf E. , Berendonk Christoph , Hautz Stefanie C. , Sauter Thomas C. , Rotgans Jerome , Zwaan Laura , Schmidt Henk G. 
Published: January 2020

Purpose
Diagnostic errors have been attributed to failure to sufficiently reflect on initial diagnoses. However, evidence of the benefits of reflection is conflicting. This study examined whether reflection upon initial diagnoses on difficult cases improved diagnostic accuracy and whether reflection triggered by confrontation with case evidence was more beneficial than simply revising initial diagnoses.

Method
Participants were physicians in Bern, Switzerland, registered for the 2018 Swiss internal medicine certification exam. They diagnosed written clinical cases, providing an initial diagnosis by following the same instructions and returning to the case to provide a final diagnosis. The latter required different types of reflection depending on the physician’s experimental condition: return without instructions, identify confirmatory evidence, identify contradictory evidence, or identify both confirmatory and contradictory evidence. The authors examined diagnostic accuracy scores (range 0–1) as a function of diagnostic phase and reflection type.

Results
One hundred and sixty-seven physicians participated. Diagnostic accuracy scores did not significantly differ between the 4 groups of physicians in the initial (I) or the final (F) diagnostic phase (mean [95% CI]: return without instructions, I: 0.21 [0.17, 0.26], F: 0.23 [0.18, 0.28]; confirmatory evidence, I: 0.24 [0.19, 0.29], F: 0.31 [0.25, 0.37]; contradictory evidence, I: 0.22 [0.17, 0.26], F: 0.26 [0.22, 0.30]; confirmatory and contradictory evidence, I: 0.19 [0.15, 0.23], F: 0.25 [0.20, 0.31]). Regardless of type of reflection employed while revising the case, accuracy increased significantly between initial and final diagnosis, I: 0.22 (0.19, 0.24) vs F: 0.26 (0.24, 0.29); P < .001.

Conclusions
Physicians’ diagnostic accuracy improved after reflecting upon initial diagnoses provided for difficult cases, independently of the evidence searched for while reflecting. The findings support the importance attributed to reflection in clinical teaching. Future research should investigate whether revising the case can become more beneficial by triggering additional reflection.
Association Between E-cigarette Use and Depression in US Adults
Authors: Saeed Omar B. , Chavan Bhakti , Haile Zelalem T. 
Published: January 2020

Objectives:
Electronic cigarette (e-cigarette) use has recently increased among adults in the United States. Previous studies have identified physical health outcomes associated with e-cigarettes. Few studies have examined the relationship between e-cigarette use and mental health outcomes. This study aimed to investigate the relationship between e-cigarette use and depression.

Methods:
The present cross-sectional study analyzed data from the 2017 Behavioral Risk Factor Surveillance System (BRFSS) in the United States (n = 11918).

Results:
Overall, 3.7% and 11.2% of the participants were current and former e-cigarette users, respectively. A significantly higher proportion of current e-cigarette users reported having depression (32.4%) than former users (27.3%) and non-users (16.0%). In the multivariable model, we found significant interactions between marital status, employment status, marijuana use and e-cigarette use on depression. Compared to people who do not use e-cigarettes, the odds of self-reported depression were higher among unemployed current e-cigarette users (OR = 2.85, 95% CI = 1.63, 4.97) and unemployed former e-cigarette users (OR = 1.89, 95% CI = 1.26, 2.84). Compared to people who do not use marijuana, the odds of self-reported depression were higher among marijuana users who were also current e-cigarette users (OR = 1.68, 95% CI = 1.08, 2.61) and former e-cigarette users (OR = 1.35, 95% CI = 1.07, 1.71). Compared to people who do not use e-cigarettes, the odds of self-reported depression were higher among widowed/divorced/separated participants who were current e-cigarette users (OR = 3.42, 95% CI = 1.60, 7.29) and former e-cigarette users (OR = 1.55, 95% CI = 1.03, 2.34).

Conclusion:
In a representative sample of adults in the United States e-cigarette use is associated with depression, predominantly in widowed/divorced/separated, unemployed and people who use marijuana. This association was independent of potential cofounders.
Avoiding NICU Transfers for Newborns With Neonatal Opioid Withdrawal Syndrome (NOWS): A Quality Improvement Initiative to Manage NOWS on the Mother-baby Unit
Authors: Spence Kimberly , Boedeker Rebecca , Harhausen Mary , Kaushal Gauri , Buchanan Paula , Josephsen Justin 
Published: January 2020

Objectives:
To reduce transfers to the neonatal intensive care unit (NICU) for neonates with opioid withdrawal while also reducing length of stay and pharmacologic intervention, and maintaining standards of safety.

Patients and methods:
This was a single-center quality-improvement (QI) initiative in a free-standing maternity hospital comparing outcomes for neonatal opioid withdrawal syndrome (NOWS) before and after a series of QI bundles in infants >36 weeks’ gestation age (GA). We compared outcomes to our preintervention period (January, 2013 to December, 2013; n = 42) with outcomes postintervention cycle 1 (October, 2016 to September, 2017; n = 126), and postintervention cycle 2 (November, 2017 to October, 2018; n = 160). Cycle 1 included organizing a multidisciplinary task force who focused on emphasis on nonpharmacologic and dyad-centered care, and also standardized pharmacologic management. Cycle 2 reflects the transition to a functional assessment tool and as-needed morphine administration on the postpartum floor.

Results:
Transfer to the NICU for management of NOWS dropped from 71.4% before the quality improvement project down to 5.6% (P < 0.001), with the remainder managed on the mother-baby unit. Length of stay decreased from 17.8 days to 7.2 days, and opioid replacement dropped from 60% down to 16% (P < 0.001 for both). There were no adverse events from morphine administration for any of the infants in this series.

Conclusions:
Our study demonstrates how care can be safely provided to most infants with neonatal opioid withdrawal on a postpartum unit without needing transfer to another unit or a higher level of care facility.
Acceptability and Feasibility of a Mobile Health Application for Video Directly Observed Therapy of Buprenorphine for Opioid Use Disorders in an Office-based Setting
Authors: Godersky Margo E. , Klein Jared W. , Merrill Joseph O. , Blalock Kendra L. , Saxon Andrew J. , Samet Jeffrey H. , Tsui Judith I. 
Published: January 2020

Introduction/Background:
Video directly observed therapy (video-DOT) through a mobile health platform may improve buprenorphine adherence and decrease diversion. This pilot study tested the acceptability and feasibility of using this technology among patients receiving buprenorphine in an office-based setting.

Methods:
Participants were instructed to record videos of themselves taking buprenorphine. Data were collected from weekly in-person visits over a 4-week period; assessments included self-report of medication adherence, substance use, satisfaction with treatment and use of the application, and also urine drug testing. Open-ended questions at the final visit solicited feedback on patients’ experiences using the mobile health application.

Results:
The sample consisted of 14 patients; a majority were male (86%) and White (79%). All participants except 1 (93%) were able to use the application successfully to upload videos. Among those who successfully used the application, the percentage of daily videos uploaded per participant ranged from 18% to 96%; on average, daily videos were submitted by participants 72% of the time. Most participants (10/14; 71%) reported being “very satisfied” with the application; of the remaining 4 participants, 2 were “satisfied” and 2 were “neutral.” Participants reported liking the accountability and structure of the application provided and its ease of use. Negative feedback included minor discomfort at viewing one's self during recording and the time required.

Conclusions:
Based on these results, use of a mobile health application for video-DOT of buprenorphine appears feasible and acceptable for patients who are treated in an office-based setting. Further research is needed to test whether use of such an application can improve treatment delivery and health outcomes.
Targeting Occipital Headache Pain
Authors: Vanterpool Stephanie G. , Heidel Robert E. , Rejoub Lina R. 
Published: January 2020

Background and Objectives:
Occipital nerve block (ONB) is an effective procedure for treating occipital headache pain. However, traditional suboccipital approaches to ONB remain underutilized in acute and chronic settings. An alternative location for ONB is the superior nuchal line, where anatomic studies show a reliable relationship between the occipital artery (OA) and greater occipital nerve. This study evaluated the efficacy and validity of an alternative, single skin insertion, paresthesia-based approach to block both the greater and lesser occipital nerve.

Materials and Methods:
Patients with a clinical diagnosis of occipital headache were included in this study. External landmarks of the cervical spinous process and ipsilateral tragus were used to predict the location of the OA pulse at the superior nuchal line. Alternative ONB technique was used to block both the greater and lesser occipital nerves using single skin insertion and paresthesia confirmation. Demographic data, preprocedure, and postprocedure pain scores were collected, along with the incidence of procedural outcomes, including OA pulse palpation, paresthesia, and postprocedure numbness.

Results:
Data were obtained prospectively from 50 patients. Mean pain scores for the sample decreased by 54.64% postprocedure (P<0.001). Greater occipital nerve paresthesia was confirmed 90.0% on the left (95% confidence interval [CI]: 76.3-97.2) and 90.9% on the right side (95% CI: 78.3-97.5). Postprocedure numbness in greater occipital nerve distribution was reported 80.6% on left (95% CI: 64.0-91.8) and 90% on right (95% CI: 76.3-97.2).

Discussion:
The results suggest that this alternative approach to ONB effectively reduces occipital headache pain and reliably predicts OA pulse and related greater occipital nerve location as confirmed by paresthesia.
Loudness Perception and Dynamic Range Depending on Interphase Gaps of Biphasic Pulses in Cochlear Implants
Authors: Pieper Sabrina H. , Brill Stefan , Bahmer Andreas 
Published: January 2020

Objectives:
The human auditory nerve can be electrically stimulated by cochlear implants (CIs) with pulse trains consisting of biphasic pulses with small interphase gaps (IPGs). In animal experiments, lower electrically evoked compound action potential (ECAP) thresholds in implanted animals were found for increasing IPGs (2.1, 10, 20, 30 μs). ECAP thresholds may correlate with loudness thresholds. Therefore, in this study, the IPG effect on loudness and dynamic range was investigated in nine CI subjects.

Design:
A loudness-matching procedure was designed with three different IPGs (2.1, 10, 30 μs) at three different pulse rates (200, 600, 1000 pps). An adaptive loudness-balancing test was performed at the 50% stimulus amplitude level of the dynamic range and most comfortable loudness level (MCL).

Results:
Increasing the IPG or increasing the pulse rate led to a significant decrease in stimulus amplitude for 50% level and MCL in the adaptive test. Because the stimulus amplitudes for 50% level and MCL decreased in a different manner, the calculated upper dynamic range between MCL and 50% level significantly decreased for increasing IPG between 0.24 and 0.38 dB. This decrease in the upper dynamic range was observed for all pulse rates.

Conclusions:
It is possible to reduce the stimulus amplitude level for the same loudness impression using larger IPGs in CIs; however, larger IPGs decrease the dynamic range. These findings could help during the fitting process of CIs to find the balance between saving battery and a proper dynamic range.