bluuebunny/crossref_metadata_2025_split huggingface dataset:
Autonomic dysregulation and sleep homeostasis in insomnia
Authors: Grimaldi Daniela , Reid Kathryn J , Papalambros Nelly A , Braun Rosemary I , Malkani Roneil G , Abbott Sabra M , Ong Jason C , Zee Phyllis C 
Published: December 2020

Abstract

Study Objectives
Insomnia is common in older adults, and is associated with poor health, including cognitive impairment and cardio-metabolic disease. Although the mechanisms linking insomnia with these comorbidities remain unclear, age-related changes in sleep and autonomic nervous system (ANS) regulation might represent a shared mechanistic pathway. In this study, we assessed the relationship between ANS activity with indices of objective and subjective sleep quality in older adults with insomnia.

Methods
Forty-three adults with chronic insomnia and 16 age-matched healthy sleeper controls were studied. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), objective sleep quality by electroencephalogram spectral components derived from polysomnography, and ANS activity by measuring 24-h plasma cortisol and norepinephrine (NE).

Results
Sleep cycle analysis displayed lower slow oscillatory (SO: 0.5–1.25 Hz) activity in the first cycle in insomnia compared to controls. In insomnia, 24-h cortisol levels were higher and 24-h NE levels were lower than controls. In controls, but not in insomnia, there was a significant interaction between NE level during wake and SO activity levels across the sleep cycles, such that in controls but not in insomnia, NE level during wake was positively associated with the amount of SO activity in the first cycle. In insomnia, lower 24-h NE level and SO activity in the first sleep cycle were associated with poorer subjective sleep quality.

Conclusion
Dysregulation of autonomic activity may be an underlying mechanism that links objective and subjective measures of sleep quality in older adults with insomnia, and potentially contribute to adverse health outcomes.
The Nordic Model of Father Quotas in Leave Policies: A Case of Policy Transfer?
Authors: Windwehr Jana , Duvander Ann-Zofie , Ellingsæter Anne Lise , Eydal Guðný Björk , Humer Živa , Nakazato Hideki 
Published: December 2020

Abstract
This contribution asks whether the most recent innovation of Nordic family policies, the so-called father quota, has been an object of policy learning in countries that followed the Nordic example of leave policies earlier, such as Germany, Slovenia, and Japan. Our case studies show that analyses of policy learning, especially in the social field, need to take into account the specific contexts and actor constellations in “export” and “import” countries. Rather than representing a blueprint, the Nordic father quotas have served as an inspiration within messy and fragmented processes of policy learning leading to hybrid arrangements in import countries.
The impact of international sanctions on Jersey trust structures
Authors: Wickham Henry 
Published: December 2020

Abstract
Sanctions issued by the United Nations, USA and European Union are at the top of the risk agenda, particularly for financial institutions. This trend is set to be continued by the post-Brexit UK following its passing of the Sanctions and Anti-Money Laundering Act 2018 which, among other things, enables the UK to enact its own autonomous sanctions. Consistent with its commitment to meeting international standards, Jersey has a legal framework which supports the implementation of such sanctions.
The Medial Elevation Osteotomy for Late-presenting and Recurrent Infantile Blount Disease
Authors: Maré Pieter Herman , Thompson David Mungo , Marais Leonard Charles 
Published: December 2020

Background:
Late-presenting or recurrent infantile Blount disease (IBD) is characterized by knee instability because of medial tibial plateau depression, multiplanar proximal tibial deformity, and potential distal femoral deformity. The surgical treatment strategy includes medial elevation osteotomy to stabilize the knee, together with proximal tibial osteotomy to correct alignment, and lateral epiphysiodesis to prevent a recurrence. This study’s primary aim was to describe the clinical outcomes of medial elevation osteotomy for the management of late-presenting and recurrent IBD.

Methods:
The authors reviewed the records of 48 children (64 limbs) who had medial elevation osteotomies and lateral epiphysiodesis, combined with proximal tibial realignment in 78% (50/64) of cases in the same setting. IBD was bilateral in 33% (16/48), 77% (37/48) were female individuals, and 42% (20/48) were obese.

Results:
The mean age at surgery was 8.6 years (SD, 1.6; range, 5.8 to 12.8). The mean preoperative tibiofemoral angle (TFA) was 28±11 degrees (8 to 55 degrees), and the mean angle of depression of the medial plateau (ADMP) was 49±8 degrees (26 to 65 degrees). Distal femoral valgus was present in 27% (17/62) and varus in 10% (6/62) children. At a median follow-up of 3.2 years (range, 1 to 6.2 y), the median TFA was 1-degree valgus (interquartile range, 7-degree varus to 5-degree valgus), whereas the ADMP was corrected to 25±8 degrees (8 to 45 degrees). Obesity was associated with more severe deformity as measured by TFA (P<0.001) but did not affect the extent of medial plateau depression (P=0.113). The good or excellent alignment was achieved in 75% (47/63) limbs. Obesity was associated with an increased risk of recurrence [odds ratio (OR), 5.21; 95% CI, 1.26-21.63; P=0.023]. Age at the surgery or previous surgery was not associated with recurrence (OR, 1.29; 95% CI, 0.88-1.88; P=0.195 and OR, 1.22; 95% CI, 0.36-4.17; P=0.746). Obesity and residual instability were associated with an increased risk of poor alignment at the latest follow-up (OR, 3.24; 95% CI, 1.02-10.31; P=0.047 and OR, 1.21; 95% CI, 1.05-1.40; P=0.008).

Conclusion:
Late-presenting or recurrent IBD is a surgical challenge. Obesity is associated with more severe deformity. Medial elevation osteotomy combined with lateral proximal tibial epiphysiodesis and metaphyseal tibial realignment osteotomy will result in restoration of lower limb alignment in a high proportion of cases. The recurrent deformity may be the result of failed epiphysiodesis. Obesity and residual instability are associated with an increased risk of poor alignment. Although complications are rare, surgical measures to decrease risk should be followed.

Level of Evidence:
Level IV.
Are Postcast Removal X-rays and a Second Follow-up Necessary in the Treatment of Nondisplaced Supracondylar Humerus Fractures?
Authors: Zakrzewski Allyson M. , Ferrick Michael R. 
Published: December 2020

Background:
The utility of routine follow-up radiographs for the treatment of nondisplaced pediatric supracondylar humerus fractures has not been established. The purpose of this study is to (1) determine the frequency that postcast removal x-rays change patient management and (2) determine the role of routine follow-up for range of motion evaluation after cast removal in the treatment of nondisplaced supracondylar humerus fractures.

Methods:
We conducted a single center retrospective chart review of patients under the age of 18 years old that sustained nondisplaced supracondylar humerus fractures between January 1, 2010 and July 1, 2018. Demographic information, fracture characteristics, time to follow-up and each appointment outcome were recorded. A change in patient management after postcast removal x-ray was defined as a need for an additional period of immobilization, a delay in initiation of range of motion exercises, or need for operative intervention. In addition, the appointment for range of motion evaluation was considered to alter management if further activity restriction was required, a formal physical therapy program was recommended or an additional office visit required. Unscheduled appointments were also noted.

Results:
A total of 489 patients met inclusion criteria. The average age was 4.90±2.68 years and 51.8% were female. A total of 487 patients had routine follow-up x-rays after cast removal. No patient had a change of management based on postcast removal radiographs. In all, 290 patients returned for range of motion follow-up with 94.8% of patients being discharged from care. There were 14 patients whose management changed based on this evaluation (4.8%). The most common reason was an additional appointment for range of motion evaluation (12/14 patients, 86%). There were 13 patients with unscheduled evaluation after discharge from care, 77% were secondary to repeat injury.

Conclusion:
This study suggests that postcast removal x-rays and routine follow-up after cast removal rarely change patient management and may not be necessary in the treatment of nondisplaced pediatric supracondylar humerus fractures.

Level of Evidence:
Level IV—case series.
Efficacy of Supraclavicular Scalenotomy Followed by External Neurolysis without Rib Resection for Post-traumatic Neurogenic Thoracic Outlet Syndrome
Authors: Yoshizumi Tetsuya , Murata Hidetoshi , Kanno Hiroshi , Shinonaga Masamichi 
Published: December 2020

Mini
Most patients with neurogenic thoracic outlet syndrome (NTOS) have a history of trauma. Scar tissue formation within the scalene muscle and around the nerves after injury cause arm and hand symptoms. We report that supraclavicular scalenotomy followed by external neurolysis without rib resection is very effective as the surgical treatment.

Study Design.
Consecutive case series.

Objective.
Our aim was to evaluate the outcomes of patients who underwent supraclavicular scalenotomy followed by external neurolysis without rib resection for post-traumatic NTOS.

Summary of Background Data.
Neurogenic thoracic outlet syndrome (NTOS) comprises over 95% of all TOS patients, and most patients with NTOS have a history of trauma before the onset of their symptoms.

Methods.
Patients treated with supraclavicular scalenotomy and neurolysis without rib resection from September 2014 to December 2019 were retrospectively reviewed by using the medical records and operative notes. Patient's characteristics, clinical symptoms before treatment, operative findings, and short- and long-term outcomes were assessed. To assess clinical outcomes at 2 months after surgery (short-term outcomes) and 12 months later (long-term outcomes), we used a 4-grade categorization (Excellent, Good, Fair, and Poor) of patients’ subjective evaluations after surgery on the basis of modified Odom's criteria. Excellent and Good were defined as a successful outcome.

Results.
Ninety-six supraclavicular scalenotomies without rib resection were performed on patients with post-traumatic NTOS. The most common intraoperative observation was the fibrous bands within the anterior scalene muscle in 86 cases (89.6%). The short-term outcome with patients’ subjective evaluation in 96 operations at 2 months after surgery showed a 96.9% success rate (Excellent + Good). In 85 cases followed for more than 12 months after surgery, the success rate based on patients’ subjective evaluation at the last clinic follow-up appointment as a long-term outcome was 74.1%.

Conclusion.
In post-traumatic NTOS, it has been reported the arm and hand symptoms are due to pressure on the brachial plexus, which can stem from the swollen muscle following injuries and later from tightness of the scarred muscle. Considering this mechanism and our results, we concluded that supraclavicular scalenotomy and external neurolysis without rib resection made sense, as they were very effective and adequate to improve symptoms of NTOS.

Level of Evidence: 5
Reducing Wrong-level Spinal Surgeries Through Root Cause Analyses
Authors: Srivatsa Shaarada , Vira Shaleen , Schils Jean , Shook Steven , Gill Amanjit , Krishnaney Ajit A. 
Published: December 2020

Mini
This study is a comprehensive narrative of all wrong-level spine surgeries and prevention strategies employed at our institution between 2008 and 2019, and aims to provide a roadmap for developing a rigorous prevention protocol. We systematically track root cause analyses and policy changes to determine which prevention strategies are most effective.

Study Design.
Retrospective review.

Objective.
We aim to create a comprehensive narrative of all wrong-level spinal surgeries (WLSS) and subsequent prevention strategies employed at our institution and provide a roadmap for developing a rigorous prevention protocol.

Summary of Background Data.
There is currently no published evidence-based protocol to prevent WLSS. Previous studies are limited to multi-institution surgeon surveys and opinion pieces; the impact of serial interventions to eliminate WLSS is lacking. No studies have longitudinally analyzed a single institution's serial root cause analyses (RCA) of individual WLSS cases and the stepwise impact of targeted interventions to reduce WLSS occurrence.

Methods.
We reviewed all wrong-site spine surgeries and prevention strategies employed at our institution between 2008 and 2019, and corresponding WLSS-related RCAs were collected from institutional records. We conducted a longitudinal analysis of these reports and tracked policy implementations that resulted along with the incidence of WLSS following each policy.

Results.
Fifteen WLSS were identified with 13 corresponding RCAs of 21,179 spine surgeries between 2008 and 2019. Three policy categories emerged: imaging, operating room (OR) culture, and vertebral body marking. The salient changes from each category were: requiring two immovable vertebral markers (2013); requiring intraoperative radiographs with markers and retractors positioned (2014); open-ended questioning during spinal level verification by residents and fellows (2015); and requiring an impartial radiologist to have verbal contact with the operating surgeon intraoperatively to collaboratively discuss localization (2018). Each change resulted in WLSS incidence decline (five in 2014, three in 2015, 0 in 2019).

Conclusion.
Stepwise process improvement based on WLSS case review is necessary, as no one change in standard operating procedure effectively eliminated WLSS. Improvements in communication between OR staff, surgeon, and radiologist, as well as intraoperative imaging and marking optimization all contributed to improvements in WLSS rates. By focusing on lessons learned from RCAs using this methodology, institutions can iteratively improve rates of WLSS.

Level of Evidence: 4
Effects of CYP2D6 Genotypes on Venlafaxine Metabolism in Japanese Psychiatric Patients With Depression
Authors: Komahashi-Sasaki Hazuki , Yasui-Furukori Norio , Sasaki Taro , Shinozaki Masataka , Hayashi Yuki , Kato Kazuko , Inoue Yoshimasa , Tsuchimine Shoko , Watanabe Takashi , Sugawara Norio , Shimoda Kazutaka 
Published: December 2020

Background:
Venlafaxine (VEN) is primarily metabolized by CYP2D6. Although several studies have reported the significant effects of CYP2D6 on VEN and O-desmethylvenlafaxine (ODV) pharmacokinetics in Whites, limited data are available regarding the effects of the Asian-specific CYP2D6 genotype on VEN metabolism. This study evaluated the effects of the CYP2D6*10 and CYP2D6*5 genotypes on the steady-state plasma concentrations of VEN and ODV in Japanese patients.

Methods:
This study included 75 Japanese patients with depression who were treated with VEN. Steady-state plasma concentrations of VEN and ODV were measured using liquid chromatography. Polymerase chain reaction was used to determine CYP2D6 genotypes. A stepwise multiple regression analysis was performed to analyze the relationship between independent variables (sex, age, smoking habit, and number of mutated alleles, CYP2D6*10 and CYP2D6*5), subject-dependent variables (plasma concentrations of VEN and ODV [all corrected for dose and body weight]), and the ODV/VEN ratio.

Results:
Significant correlations were observed between the daily dose of VEN (corrected for body weight) and plasma concentrations of VEN (r = 0.498, P < 0.001) and ODV (r = 0.380, P = 0.001); ODV plasma concentrations were approximately 3.2 times higher than VEN plasma concentrations (VEN versus ODV = 18.60 ng/mL versus 59.10 ng/mL). VEN plasma concentrations (corrected for dose and body weight) did not differ with differing numbers of CYP2D6-mutated alleles. However, the ODV/VEN ratio decreased as the number of mutated CYP2D6 alleles increased (P = 0.001).

Conclusions:
This is the first study to examine the effects of CYP2D6*10 in a clinical setting. Although no effects on the plasma concentrations of VEN or ODV were observed, CYP2D6 polymorphism affects the ODV/VEN ratio. Further studies are needed to confirm the clinical relevance of these findings.
Strategic use of health information exchange and market share, payer mix, and operating margins
Authors: Vest Joshua R. , Freedman Seth , Unruh Mark Aaron , Bako Abdulaziz T. , Simon Kosali 
Published: December 2020

Background
Health information exchange (HIE) capabilities are tied to health care organizations’ strategic and business goals. As a technology that connects information from different organizations, HIE may be a source of competitive advantage and a path to improvements in performance.

Purpose
The aim of the study was to identify the impact of hospitals’ use of HIE capabilities on outcomes that may be sensitive to changes in various contracting arrangements and referral patterns arising from improved connectivity.

Methodology
Using a panel of community hospitals in nine states, we examined the association between the number of different data types the hospital could exchange via HIE and changes in market share, payer mix, and operating margin (2010–2014). Regression models that controlled for the number of different data types shared intraorganizationally and other time-varying factors and included both hospital and time fixed effects were used for adjusted estimates of the relationships between changes in HIE capabilities and outcomes.

Results
Increasing HIE capability was associated with a 13 percentage point increase in a hospital’s discharges that were covered by commercial insurers or Medicare (i.e., payer mix). Conversely, increasing intraorganizational information sharing was associated with a 9.6 percentage point decrease in the percentage of discharges covered by commercial insurers or Medicare. Increasing HIE capability or intraorganizational information sharing was not associated with increased market share nor with operating margin.

Conclusions
Improving information sharing with external organizations may be an approach to support strategic business goals.

Practice Implications
Organizations may be served by identifying ways to leverage HIE instead of focusing on intraorganizational exchange capabilities.
LONGITUDINAL FLUORESCENCE LIFETIME IMAGING OPHTHALMOSCOPY ANALYSIS IN PATIENTS WITH MACULAR TELANGIECTASIA TYPE 2 (MacTel)
Authors: Sauer Lydia , Vitale Alexandra S. , Modersitzki Natalie K. , Bernstein Paul S. 
Published: December 2020

Purpose:
Fluorescence lifetime imaging ophthalmoscopy (FLIO) shows characteristic patterns in macular telangiectasia Type 2 (MacTel). This study investigates FLIO changes over time to better understand disease progression.

Methods:
Thirty-three patients with MacTel (age 60 ± 15 years) were followed at the Moran Eye Center with a prototype Heidelberg Engineering FLIO. The mean follow-up time was 19 ± 8 months (range 6–34 months). Fundus autofluorescence was excited at 473 nm, and FLIO lifetimes were recorded in in short (498–560 nm) and long (560–720 nm) spectral wavelengths channels

Results:
Autofluorescence lifetimes imaging ophthalmoscopy lifetimes from the MacTel area prolonged significantly over time (subfield T1, baseline: short spectral channel 210 ± 54 ps, long spectral channel 269 ± 58 ps; follow-up: short spectral channel 225 ± 59 ps, P < 0.001, long spectral channel 282 ± 64 ps, P < 0.01). The average 12-months prolongation of FLIO lifetimes was 9 ps (short spectral channel) and 8 ps (long spectral channel). Autofluorescence lifetimes changes correlated positively with ellipsoid zone loss and negatively with changes in retinal thickness.

Conclusion:
Autofluorescence lifetimes in MacTel slowly prolong over time, and temporal patterns progress to full rings. Detailed knowledge about FLIO changes will aid in understanding disease development and progression.
Use of Provider Scorecards to Improve Early Postoperative Recovery—Initial Implementation Study
Authors: Khadge Shradha D. , Tanella Anthony , Mtuke Francis , Deiner Stacie , Hyman Jaime B. 
Published: December 2020

ABSTRACT
Intraoperative anesthetic technique directly impacts immediate postoperative recovery, yet there are few opportunities for anesthesiologists to receive feedback and no easily available benchmarks, making it difficult to reflect on one's own practice. This initial implementation study used retrospective data from 5,712 ambulatory surgery cases with healthy adult patients undergoing general anesthesia in 2018 at a large tertiary care academic center. It examines variation in practice among anesthesiologists for eight surgical specialties. Scorecards assessing intraoperative and postoperative opioids, antiemetics, nonopioid analgesics, regional blocks, recovery time, and severe postoperative pain compared with peers were given to anesthesiologists with prefeedback and postfeedback surveys assessing their attitudes toward feedback. Before receiving their scorecard, 71% of providers predicted their performance was average, and 29% predicted their performance was above average. After receiving their scorecards, 42% rated their quality of recovery as worse than expected, 42% rated it as expected, and 16% rated it as better than expected. Thirteen percent disagreed, 44% were neutral, and 44% agreed that this feedback will change their practice. Implementing a scorecard of patient-centered measures that shows where an anesthesiologist stands in the distribution of their peers was well-received, provides a benchmark, and has the potential to change practice.
Integrated Pharmacy and PrEP Navigation Services to Support PrEP Uptake: A Quality Improvement Project
Authors: Coleman Megan , Hodges Ashley , Henn Sarah , Lambert Crystal Chapman 
Published: December 2020

Abstract
Preexposure prophylaxis (PrEP) is highly effective in preventing HIV among both men and women, with the reduction in risk directly linked to medication adherence. Navigation services and other adherence interventions have demonstrated efficacy in medication uptake; however, their use may not be fully integrated into clinic operations or their roles clearly defined. This quality improvement (QI) project developed an evidenced-based PrEP Navigation (PN) tool to identify patient-reported barriers to uptake and to support process improvement at a large community health center in Washington, DC. Outcomes related to patient-reported barriers, patient demographics, and time to medication pickup from the pharmacy were measured before and after implementation. A total of 198 patients were included in this analysis. Mean days from initial prescription to medication pickup was reduced by 1.42 days (p = .030) following PN tool implementation. The evidenced-based PN tool is modifiable to the needs of the individual clinic and the patients they care for to support wide-scale PrEP uptake and continuous system process improvements.