bluuebunny/crossref_metadata_2025_split huggingface dataset:
A-43 Post-Traumatic Stress Symptoms in Sport-Related Concussion and Orthopedic Injury: An Initial Comparison
Authors: Tarkenton T , Presley C , Hynan L S , Miller S , Silver C H , Didehbani N , Cullum C M 
Published: June 2020

Abstract

Objective
Few studies have compared psychological responses to injury following sport-related concussion versus injury in general. The aim of this pilot investigation was to explore whether trauma-related stress symptoms differ between adolescents with sport-related concussion (SRC) vs. orthopedic injury (OI).

Method
Participants age 12-18 with SRC (n=48) or OI (n=12) presented to specialty clinics in the North Texas Concussion Registry (ConTex) within 21 days of injury (M= 6.7). Total scores from the PTSD Checklist for DSM-5 (PCL-5) were calculated (range=0-80). Independent t-test compared PCL-5 symptom scores between SRC and OI, and post-hoc analyses examined frequency of symptoms reported within each group.

Results
There was no significant difference between mean PCL-5 scores in SRC and OI groups, and both obtained scores above the typical cutoff for PTSD, defined as scores &gt;30 (range= 0-46; SRC=10%, OI=16%). Most commonly reported symptoms for both SRC and OI were sleep problems, feeling jumpy, and being “super alert.” SRC subjects were more likely to report difficulty concentrating (SRC=42%; OI=16%), while OI subjects were more likely to report feeling distant from other people (OI=50%; SRC=20%).

Conclusions
While total post-traumatic stress symptoms may not differ between SRC and OI groups, there may be differences in individual trauma-related symptoms based upon the nature of injury. Both injury groups may be susceptible to sleep difficulties and hypervigilance, yet SRC individuals may experience more cognitive complaints, while OI may report more feelings of isolation. Furture studies will need to use the PCL-5 with larger sample sizes and recovery indices to provide a more detailed comparison of the injury groups.
A-44 ImPACT of Amnesia Related Concussions Across Developmental Stages
Authors: Unjia K , Bennett R , Lashley L 
Published: June 2020

Abstract

Objective
This study aimed to examine the relationship between developmental stages and concussions that resulted in amnesia as measured by ImPACT.

Method
Participants were selected from an archival de-identified sports medicine ImPACT database. The sample (N = 4,200) was primarily male (62.2%) student athletes with ages ranging from 10 to 25 years. Participants were divided into three groups: Young athletes (n = 1,400), Adolescent (n = 1,400), and Adult (n = 1,400). A One-Way ANOVA was conducted to determine the relationship between age group and prevalence of concussions resulting in anterograde or retrograde amnesia.

Results
The One-Way ANOVA revealed significant differences between age group and anterograde F(2,4197) = 107.449, p &lt; .001 and retrograde amnesia F(2,4197) = 82.949, p &lt; .001. Bonferroni pairwise comparison revealed the adolescent athlete group experienced more concussions that result in both anterograde and retrograde amnesia compared to young and adult athletes. There was no significant difference between young and adult athletes. Additionally, there is a significant difference regarding total games missed following concussion F(2,4197) = 117.723, p &lt; .001, with adolescent athletes missing more games compared to young and adult athletes.

Conclusions
The findings of this study suggest adolescent athletes tend to experience more amnesia-related concussions compared to young and adult athletes. Additionally, adolescent athletes miss more games following these types of concussions. This study highlights the impact that certain types of concussions have on athletes across the developmental stages. Future research should analyze the cognitive effects of various types of concussions across the developmental stages.
A-47 Resting-State Functional Connectivity Associated with Contact Level in Female Varsity Athletes
Authors: Wilson A , Stevens W D , Wojtowicz M 
Published: June 2020

Abstract

Objective
The effects of participation in contact sports on brain functioning is a growing area of concern in the athlete population. This pilot study examined differences in resting-state functional connectivity (rsFC) associated with level of contact in female varsity student athletes.

Method
Resting-state functional magnetic resonance imaging (fMRI) scans were collected from 29 female university athletes. Level of contact was characterized by active participation in collision sports (n = 13) and contact sports (n = 16). Athletes completed baseline testing including self-reported psychological measures. RsFC was compared between groups using Independent Component Analysis (ICA) within the default mode (DMN), frontoparietal (FPN), dorsal attention (DAN), salience (SN), and sensorimotor (SMN) networks.

Results
Collision sport athletes reported younger age at first sport (M = 4.7, SD = 1.2) and fewer past concussions (Md = 0, Range = 0–3) compared to contact sport athletes (M = 7.5, SD = 3.4; Md = 7.5, Range = 0–6; ps &lt; .05). Collision sport athletes also reported fewer symptoms of depression on the Patient Health Questionnaire-9 (p = 0.03). Collision sport athletes had decreased rsFC between the SMN and the left inferior frontal gyrus (T = −5.6, pFDR = 0.008) compared to the contact sport athletes. This difference in rsFC was not associated with age at first sport or prior concussion history.

Conclusions
Consistent with prior studies of varsity athletes, altered patterns of rsFC were observed in areas supporting somatomotor function in female athletes with suspected greater contact exposure. Further research is necessary to examine whether these neural changes are attributable to greater exposure to sub-concussive hits or other factors, such as differences in visuomotor abilities.
Division of labour among culms in the clonal reedArundo donax(Poaceae) is underlain by their pre-determined hydraulic structure
Authors: Shtein Ilana , Baruchim Paz , Lev-Yadun Simcha 
Published: June 2020

AbstractClonal plants present an interesting example of division of labour among their ramets. Here we elaborated on hydraulic structure in respect to the division of labour among ramets in Arundo donax, a perennial clonal reed. Mature clones have three shoot types: (1) large mostly flowering; (2) medium mostly vegetative and (3) small vegetative. The shoots grow from buds initiating in the upper side of underground rhizomes, and the shoot growth is primary with vasculature produced from the procambium. We tested whether the number of vascular strands in a shoot has a fixed developmental programme or follows a flexible developmental pattern, and we found that the number of vascular strands strongly differs between shoot types. Large shoots on average have 560 vascular strands with both the widest vessels and significantly highest hydraulic conductivity. Medium ones and small shoots have 409 and 102 on average, respectively, with narrower vessels and with low conductivity. Thus, the shoot apices have three alternative developmental programmes. Apparently, a clone is built of functionally different modular units that enable Arundo donax to maximize its potential in a heterogeneous environment. Although the smaller culms do not contribute directly to the sexual reproduction of the clone, under stress their safer hydraulic system offers them a better chance of survival.
Drug-induced Liver Injury in a Patient With Coronavirus Disease 2019: Potential Interaction of Remdesivir With P-Glycoprotein Inhibitors
Authors: Leegwater Emiel , Strik Anne , Wilms Erik B , Bosma Liesbeth B E , Burger David M , Ottens Thomas H , van Nieuwkoop Cees 
Published: June 2020

Abstract
We report a case of a man with COVID-19 who developed acute hepatotoxicity related to remdesivir with probable interaction of P-glycoprotein (P-gp) inhibitors. Until further details on this interaction become available, we recommend physicians to be cautious with the prescription of P-gp inhibitors in patients receiving remdesivir therapy.
Slowly progressive anti-neutrophil cytoplasmic antibody-associated renal vasculitis: clinico-pathological characterization and outcome
Authors: Trivioli Giorgio , Gopaluni Seerapani , Urban Maria L. , Gianfreda Davide , Cassia Matthias A. , Vercelloni Paolo G. , Calatroni Marta , Bettiol Alessandra , Esposito Pasquale , Murtas Corrado , Alberici Federico , Maritati Federica , Manenti Lucio , Palmisano Alessandra , Emmi Giacomo , Romagnani Paola , Moroni Gabriella , Gregorini Gina , Sinico Renato A. , Jayne David R.W. , Vaglio Augusto 
Published: June 2020

Abstract

Background
Although rapidly progressive glomerulonephritis is the main renal phenotype of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), slow renal disease progression is sometimes observed. These forms have been rarely discussed; we analysed their prevalence, clinico-pathological characteristics and outcome.

Methods
We screened patients with microscopic polyangiitis (MPA) and granulomatosis with polyangiitis followed at seven referral centres and selected those with estimated glomerular filtration rate (eGFR) reduction &lt;50% over a 6-month period preceding diagnosis. Data regarding patient features and response to treatment were retrieved.

Results
Of 856 patients, 41 (5%) had slowly progressive renal AAV. All had MPA and all but one was P-ANCA/myeloperoxidase (MPO) ANCA-positive. At diagnosis, the median age was 70 years [interquartile range (IQR) 64–78] and extra-renal manifestations were absent or subclinical (interstitial lung lesions in 10, 24%). The median (IQR) eGFR was 23 mL/min/1.73 m2 (15–35); six patients (15%) had started renal replacement therapy (RRT). All had proteinuria (median 1180 mg/24 h, IQR 670–2600) and micro-haematuria. Main histologic findings were extracapillary proliferation at chronic stages and glomerulosclerosis; following Berden’s classification, 6/28 biopsies (21%) were ‘focal’, 1/28 (4%) ‘crescentic’, 9/28 (32%) ‘mixed’ and 12/28 (43%) ‘sclerotic’. At last follow-up (median 32 months, IQR 12–52), 20/34 patients (59%) treated with immunosuppression had eGFR improvement &gt;25% as compared with diagnosis, while 4/34 (12%) had started RRT.

Conclusions
AAV may present with slow renal disease progression; this subset is hallmarked by advanced age at diagnosis, positive MPO-ANCA, subclinical interstitial lung lesions and chronic damage at kidney biopsy. Partial renal recovery may occur following immunosuppression.
Metformin directly suppresses atherosclerosis in normoglycaemic mice via haematopoietic adenosine monophosphate-activated protein kinase
Authors: Seneviratne Anusha , Cave Luke , Hyde Gareth , Moestrup Soren Kragh , Carling David , Mason Justin C , Haskard Dorian O , Boyle Joseph James 
Published: June 2020

Abstract

Aims
Atherosclerotic vascular disease has an inflammatory pathogenesis. Heme from intraplaque haemorrhage may drive a protective and pro-resolving macrophage M2-like phenotype, Mhem, via AMPK and activating transcription factor 1 (ATF1). The antidiabetic drug metformin may also activate AMPK-dependent signalling. Hypothesis: Metformin systematically induces atheroprotective genes in macrophages via AMPK and ATF1, thereby suppresses atherogenesis.

Methods and results
Normoglycaemic Ldlr−/− hyperlipidaemic mice were treated with oral metformin, which profoundly suppressed atherosclerotic lesion development (P &lt; 5 × 10−11). Bone marrow transplantation from AMPK-deficient mice demonstrated that metformin-related atheroprotection required haematopoietic AMPK [analysis of variance (ANOVA), P &lt; 0.03]. Metformin at a clinically relevant concentration (10 μM) evoked AMPK-dependent and ATF1-dependent increases in Hmox1, Nr1h2 (Lxrb), Abca1, Apoe, Igf1, and Pdgf, increases in several M2-markers and decreases in Nos2, in murine bone marrow macrophages. Similar effects were seen in human blood-derived macrophages, in which metformin-induced protective genes and M2-like genes, suppressible by si-ATF1-mediated knockdown. Microarray analysis comparing metformin with heme in human macrophages indicated that the transcriptomic effects of metformin were related to those of heme, but not identical. Metformin-induced lesional macrophage expression of p-AMPK, p-ATF1, and downstream M2-like protective effects.

Conclusion
Metformin activates a conserved AMPK-ATF1-M2-like pathway in mouse and human macrophages, and results in highly suppressed atherogenesis in hyperlipidaemic mice via haematopoietic AMPK.
Surgical revascularization for acute coronary syndromes: a report from the North Rhine-Westphalia surgical myocardial infarction registry
Authors: Liakopoulos Oliver J , Slottosch Ingo , Wendt Daniel , Welp Hendryk , Schiller Wolfgang , Martens Sven , Choi Yeong-Hoon , Welz Armin , Pisarenko Julia , Neuhäuser Markus , Jakob Heinz , Ruhparwar Arjang , Wahlers Thorsten , Thielmann Matthias 
Published: June 2020

Abstract

OBJECTIVES

The aim of this was to analyse current outcomes in patients referred to coronary artery bypass grafting (CABG) for acute coronary syndromes (ACSs), including ST-elevation or non-ST-elevation ACS (non-ST-segment elevation myocardial infarction) or unstable angina.

METHODS
Patients (n = 2432) undergoing CABG for ACS between January 2010 and December 2017 were prospectively entered into a surgical myocardial infarction registry in North Rhine-Westphalia, Germany. Key end points were in-hospital all-cause mortality (IHM) and major adverse cardio-cerebral events (MACCE). Predictors for IHM and MACCE were analysed by multivariable logistic regression.

RESULTS
Patients (78% males) were referred for CABG for unstable angina (25%), non-ST-segment elevation myocardial infarction (50%), and ST-segment elevation myocardial infarction (25%). The mean patient age was 68 ± 11 years, logistic EuroSCORE was 19 ± 18% and three-vessel and left main stem diseases were diagnosed in 81% and 45% of patients, respectively. On-pump CABG with cardiac arrest or beating heart was performed in 92% and 2%, respectively, with only 6% off-pump surgery and 6% multiple arterial revascularization (3.1 ± 1.0 grafts, 93% left internal thoracic artery). Emergency CABG was performed in 23% of patients (42% in ST-segment elevation myocardial infarction; P &lt; 0.001). The total IHM and MACCE rates were 8.1% and 17.5% and were highest in ST-segment elevation myocardial infarction patients with 12.6% and 28.5%, respectively (P &lt; 0.001). Key predictors for IHM and MACCE were female gender, elevated troponin, left ventricular ejection fraction, inotropic support, logistic EuroSCORE, cardiopulmonary bypass and aortic clamp time and the need for emergency CABG.

CONCLUSIONS
Surgical myocardial revascularization in patients with ACS is still linked to substantial in-hospital mortality. Emergency CABG for patients with ACS was associated with poorer outcomes.
Letting the masses pay for the welfare state: tax regressivity in postwar Sweden
Authors: Lantz Gunnar 
Published: June 2020

Abstract
The mixed economy of the twentieth century shows conflicting developments in tax collection. Progressive taxes to limit top incomes are not the whole story. An examination of Sweden 1958–2012 shows that the progressivity of direct taxes was offset by consumption taxes and social security contributions. Previous studies conclude that tax progressivity peaked in the 1980s. This study shows instead how Swedish taxation became regressive in that period. The literature on welfare regimes and redistributive universalism relies empirically on conditions in the 1980s. Sweden did exhibit universalism in social spending but also a corresponding universalism in revenue collection.
Symmetric pressure stabilization for equal-order finite element approximations to the time-dependent Navier–Stokes equations
Authors: García-Archilla Bosco , John Volker , Novo Julia 
Published: June 2020

Abstract
Non-inf-sup-stable finite element approximations to the incompressible Navier–Stokes equations based on equal-order spaces for velocity and pressure are studied in this paper. To account for the violation of the discrete inf-sup condition, different types of symmetric pressure stabilization terms are considered. It is shown in the numerical analysis that these terms also improve stabilization of dominating convection in the following sense: error bounds with constants independent of inverse powers of the viscosity are derived. For proving the bound for the $L^2$ error of the pressure the choice of a suitable initial approximation for the velocity is essential.
Enhancing leniency programme in public markets
Authors: Alexia Giosa Penelope 
Published: June 2020

Abstract
The article focuses on the leniency programme, the key mechanism to strengthen the public enforcement of competition law, and its compatibility with the debarment mechanism and self-cleaning measures, which are both procurement remedies. As the article will show, procurement remedies interfere with cartel enforcement and the debarment mechanism undermines leniency in public procurement. The fact that firms may be banned from bidding, where there are plausible indications for their participation in agreements aiming at distorting competition, discourages infringing companies from coming forward and self-reporting. Even the self-cleaning measures under the current procurement Directive 2014/24/EU, which aim to help debarred firms to avoid exclusion or minimize its risk, undermine leniency in public procurement. This is particularly true after the recent judgment of the European Court of Justice in c-124/17 Vossloh Laeis GmbH v Stadtwerke München GmbH case. In this case, it was held that a contracting authority must be able to ask a leniency applicant to provide the decision of the competition authority concerning it. This must apply even if there is a pending private action for damages for breach of competition law by the contracting authority against that leniency applicant. In view of the above conflicting policy objectives, a number of proposals are discussed in order to better align leniency programmes with the mechanism of debarment and self-cleaning policy in public procurement. In this way, the article contributes to the optimal design of enforcement policies.
Quadruple advanced synchronous colorectal cancers successfully treated by laparoscopic surgery: a case report
Authors: Ma Jianwei , Akagi Tomonori , Etoh Tsuyoshi , Kono Yohei , Hiratsuka Takahiro , Suzuki Kosuke , Ninomiya Shigeo , Shibata Tomotaka , Ueda Yoshitake , Toujigamori Manabu , Shiroshita Hidefumi , Shiraishi Norio , Inomata Masafumi 
Published: June 2020

Abstract
Among synchronous colorectal cancers (SCRCs) reported previously, the incidence of quadruple advanced SCRCs is very rare. We present the case who underwent laparoscopic two-segment resection of the colon requiring two anastomoses that was performed for quadruple advanced cancers, and four tumors were curatively removed. There were no signs of recurrence at 64 months after surgery. Laparoscopic surgery provided less invasiveness even for quadruple advanced SCRCs in terms of early recovery with an acceptable long-term outcome.
Impact of Succinct Training on Open Cricothyrotomy Performance: A Randomized, Prospective, Observational Study of U.S. Army First Responders
Authors: Muller Kurtis L , Facciolla Cynthia A , Monti Jonathan , Cronin Aaron 
Published: June 2020

AbstractIntroductionPrimary airway failure has become the second most common cause of potentially survivable battlefield fatality. Cricothyrotomy is taught to all U.S. military providers as a means of securing an airway in extremis. However, retrospective studies show that cricothyrotomy failure rates for U.S. military first responders performing the procedure in combat is 33%. Our hypothesis was that these rates could be improved.Materials and MethodsWe conducted a randomized, prospective, observational study to evaluate the effects of inexpensive, succinct training on open cricothyrotomy performance by studying two unique U.S. Army First Responder participant groups. One participant group consisted of regular U.S. Army Medics (68 Ws). The second group was Special Operations Combat Medics. We evaluated both groups’ baseline ability to correctly perform a cricothyrotomy and then randomly assigned individuals within each group to either a training or practice group.ResultsThe training group had a higher proportion of success and performed the cricothyrotomy faster than the practice group with 68 Ws group appearing to benefit most from training: their procedural success rates increased by an average of 23%, and their average time-to-correct-placement decreased by 21 seconds—a 33% improvement over baseline.ConclusionWith one manikin, a qualified trainer, and $35 worth of expendable supplies, 10 medics could be trained in the procedure in just 2–3 hours. Our study suggests that this simple intervention has the potential to significantly improve U.S. Army First Responders’ ability to correctly perform an open cricothyrotomy and drastically decrease the time needed to perform this lifesaving procedure correctly, possibly saving one in four potentially survivable combat casualties suffering from airway compromise.
Improving the Efficiency of a Military Treatment Facility Transfer Center Process
Authors: Emry Marvin E , Settelmeyer Deanna R , McMann Leah P , Hopkinson Susan G 
Published: June 2020

Abstract

Introduction
A performance improvement project was initiated at Tripler Army Medical Center (TAMC) to decrease the amount of inpatient stays by military beneficiaries at civilian hospitals. Before the start of the project, the transfer process from external emergency rooms was completed by patient administration personnel and residents. This process had a median time to disposition decision of 40 minutes and led to missed opportunities for TAMC to care for military beneficiaries. The goals for the project were to have the median transfer process at less than 30 minutes from first call to time of disposition, to minimize unnecessary transfer denials, and to improve the perception of TAMC transfer process.

Materials and Methods
The team implemented multiple countermeasures as a performance improvement project to improve the transfer process. These included enhancing technological capabilities, providing clinically trained personnel to answer initial telephone calls, establishing rapid attending physician contact for acceptance, and standardizing data collection. Descriptive data were used to describe the progress toward project goals to include median time to disposition, number of monthly calls, and reasons for denials of patient transfers.

Results
The project met all proposed goals. The median time to disposition decision was reduced to 22 minutes. The primary reasons for denials included that the transfer was considered medically unnecessary (40.6%), no beds were available (18.9%), and the patient was unstable for transport (14.9%). As a reflection of improved customer service, there was an overall increase in transfer requests and positive feedback from the referring physicians at the local civilian hospitals.

Conclusion
The improved transfer process at TAMC resulted in a decreased median time of transfer request process, increased total transfer requests, and improved relationships with local civilian hospitals. While we acknowledge that each MTF has facility and regional characteristics (such as capability, capacity, military staffing, and degree of availability of civilian healthcare resources) that may contribute to variation from TAMC, the concepts and changes made in the transfer process may be considered a best practice to be adopted by other military facilities to promote the recapture of beneficiaries into the Defense Health Agency system.