bluuebunny/crossref_metadata_2025_split huggingface dataset:
Response of size and trophic structure of zooplankton community to marine environmental conditions in the northern South China Sea in winter
Authors: Chen Yixiang , Lin Shiquan , Wang Chunsheng , Yang Juan , Sun Dong 
Published: April 2020

Abstract
The South China Sea (SCS) is a semi-enclosed marginal sea. And in the northern SCS (NSCS), the Pearl River plume, mesoscale eddies and Kuroshio intrusion may influence the structure of pelagic ecosystems. Here, based on mesozooplankton samples collected in the NSCS from December 2014 to January 2015, spatial variations of mesozooplankton biomass, abundance, normalized biomass size spectra (NBSS), size structure and trophic structure were analyzed to study the response of mesozooplankton community to the influence of highly variable oceanographic environment. High biomass, abundance and intercept of NBSS for the mesozooplankton community were observed in highly productive regions (net primary production &gt; 400 mg C m−2 day−1), such as river plume and cold eddy. No consistent spatial variation was observed for the slope of NBSS, probably because of highly dynamic marine environment in the NSCS. For the trophic structure of mesozooplankton community, the ratio of total chaetognaths biovolume to herbivores/omnivores biovolume (RTCH) was significantly high in river plume and Kuroshio intrusion. The high RTCH indicated unstable trophic structures, which may be due to extreme high proportion of smaller size individuals supported by discharge of river and transport of warm water species from the tropical western Pacific by Kuroshio intrusion, respectively.
Criteria for Identifying Technically Difficult Cases when Performing Sacroiliac Intraarticular Injections Based on the Grade of Sacroiliac Arthrogram
Authors: Kurosawa Daisuke , Murakami Eiichi , Aizawa Toshimi , Watanabe Takashi , Yabe Yutaka 
Published: April 2020

AbstractObjectiveAn intraarticular sacroiliac joint (SIJ) injection cannot always be performed successfully. Based on the patterns of the sacroiliac arthrogram, we explored possible indicators of technically difficult and technically easy injections into the SIJ including demographic features and anatomical features evident on preprocedural imaging.DesignObservational study.MethodsWe evaluated 76 patients with painful SIJ (total 108 joints) diagnosed by SIJ injections. The sacroiliac arthrogram was graded as follows: Grade (G) 0 = the margin of the joint was partially outlined; G1 = the margin was completely outlined; G2 = intraarticular space was substantially outlined; and G3 = intraarticular space was fully outlined. Two multivariable ordered logistic regression analyses were performed to test the relationships between gender, age, and Grade, as well as between computed tomography (CT) findings and grade.ResultsIn men, the totals by Grade were G0 = 8 (joints); G1 = 33; G2 = 3; and G3 = 0. In women, these were G0 = 4; G1 = 28; G2 = 22; and G3 = 10. The Grade was significantly higher in women and was also higher with age (P &lt; 0.05). Regarding morphological features in CT, minor osteophytes increased the odds in favor of better Grades of arthrogram (odds ratio = 3.50). Substantial vacuum phenomena strongly increased the odds of better arthrograms (20.52).ConclusionsOutlining the SIJ cavity fully is significantly more difficult in male patients of any age than in aged female patients. The presence of minor osteophytes and substantial vacuum phenomena on preprocedure CT scans can be reasonably reassuring to the practitioner that they are unlikely to encounter difficulties during injection.
“Hostages to Compliance”: Towards a Reasonableness Test for Administrative Burdens
Authors: Doughty Meghan , Baehler Karen J 
Published: April 2020

Abstract
Administrative burden on its most basic level refers to “an individual’s experience of policy implementation as onerous”. The concept of administrative burdens raises complex questions of both theory and practice for public administrators and scholars. Ambitious agendas have been laid out for investigating the origins, mechanisms, and impacts of administrative burdens, and for building practical knowledge about how to minimize administrative burdens without sacrificing program effectiveness and efficiency. Those same authors, and others, have advanced the concept theoretically as well. This article builds on those efforts to address a normative question at the concept’s core—namely, the question of what makes an administrative burden acceptable or excessive, reasonable or unreasonable. Our inquiry begins with the recognition that administrative burdens sometimes perform important functions and principles and methods are needed for determining when a specific type or degree of burden crosses the threshold from reasonableness to unreasonableness. Toward that end, we propose a five-part test, similar to those employed by the Supreme Court, for bureaucrats to use when assessing the justifications for bureaucratic procedures and requirements that involve administrative burden.
Interrater and Test-Retest Reliability of Performance-Based Clinical Tests Administered to Established Users of Lower Limb Prostheses
Authors: Sawers Andrew , Kim Janis , Balkman Geoff , Hafner Brian J 
Published: April 2020

Abstract

Objective
A major barrier to reducing falls among users of lower limb prostheses (LLP) has been an absence of statistical indices required for clinicians to select and interpret scores from performance-based clinical tests. The study aimed to derive estimates of reliability, measurement error, and minimal detectable change values in performance-based clinical tests administered to unilateral LLP users.

Methods
A total of 60 unilateral LLP users were administered the Narrowing Beam Walking Test, Timed ``Up and Go'' (TUG), Four Square Step Test (FSST), and 10-Meter Walk Test on 2 occasions, 3 to 9 days apart. Intraclass correlation coefficients (ICCs) were calculated to assess interrater and test-retest reliability, while standard error of measurement (SEM) and minimal detectable change (MDC90) were derived to establish estimates of measurement error in individual scores or changes in score for each test.

Results
Interrater reliability ICCs (1,1) were high for all tests (ie, ≥0.98). Test-retest ICCs (2,1) varied by test, ranging from .88 for the TUG to .97 for the FSST. SEM and MDC90 varied between .39 and .96 and between .91 seconds and 2.2 seconds for the time-based tests (FSST, TUG, 10-Meter Walk Test). SEM and MDC90 for the Narrowing Beam Walking Test were .07 and .16, respectively.

Conclusion
With the exception of the TUG, studied tests had test-retest ICCs (2,1) that exceeded the minimum required threshold to be considered suitable for group- and individual-level applications (ie, ICC ≥ 0.70 and ≥ 0.90, respectively). Future research on individuals with dysvascular and transfemoral amputations or in specific age categories is required.

Impact
Along with published validity indices, these reliability, error, and change indices can help clinicians select balance tests suitable for LLP users. They can also help clinicians interpret test scores to make informed, evidence-based clinical decisions.
Transforming Unitary States into Federations: Path-Dependent Construction of Political Identities in Belgium and Lebanon
Authors: Farhat Nadim , Vloeberghs Ward , Bourbeau Philippe , Poirier Philippe 
Published: April 2020

AbstractThe theory of congruence in comparative federalism holds that institutional design will, eventually, reflect societal divisions by transferring central powers to new, autonomous entities. While this model helps to understand why many divided societies adopt federalism, it cannot explain why only certain unitary states transform into federal ones while others do not. We use a historical institutionalism approach to identify the critical junctures in the trajectory of two prominent plural polities, Belgium and Lebanon. We suggest that the politicization of identities during initial stages of state-building plays a major role in the transformation of a unitary state into a federation—which occurs in the former but not in the latter of our cases. The current contrast in both consociational democracies is explained here as a legacy of the late nineteenth century, which set in motion decisive logics of public governance that direct institutional dynamics until today.
TLR1/2 and 5 induce elevated cytokine levels from rheumatoid arthritis monocytes independent of ACPA or RF autoantibody status
Authors: Thwaites Ryan S , Unterberger Sarah , Chamberlain Giselle , Walker-Bone Karen , Davies Kevin A , Sacre Sandra 
Published: April 2020

Abstract

Objective
RA is an autoimmune inflammatory joint disease. Both RF and ACPA are associated with more progressive disease and higher levels of systemic inflammation. Monocyte activation of toll-like receptors (TLRs) by endogenous ligands is a potential source of increased production of systemic cytokines. RA monocytes have elevated TLRs, some of which are associated with the disease activity score using 28 joints (DAS28). The aim of this study was to measure TLR-induced cytokine production from monocytes, stratified by autoantibody status, to assess if their capacity to induce cytokines is related to autoantibody status or DAS28.

Methods
Peripheral blood monocytes isolated from RA patients and healthy controls were stimulated with TLR1/2, TLR2/6, TLR4, TLR5, TLR7, TLR8 and TLR9 ligands for 18 h before measuring IL-6, TNFα and IL-10. Serum was used to confirm the autoantibody status. Cytokine levels were compared with RF, ACPA and DAS28.

Results
RA monocytes demonstrated significantly increased IL-6 and TNFα upon TLR1/2 stimulation and IL-6 and IL-10 upon TLR5 activation. TLR7 and TLR9 activation did not induce cytokines and no significant differences were observed between RA and healthy control monocytes upon TLR2/6, TLR4 or TLR8 activation. When stratified by ACPA or RF status there were no correlations between autoantibody status and elevated cytokine levels. However, TLR1/2-induced IL-6 did correlate with DAS28.

Conclusions
Elevated TLR-induced cytokines in RA monocytes were not related to ACPA or RF status. However, TLR1/2-induced IL-6 was associated with disease activity.
OPTIMAL COLLIMATION SIGNIFICANTLY IMPROVES LUMBAR SPINE RADIOGRAPHY
Authors: Pazanin Anamaria , Skrk Damijan , O'Driscoll Jessica C , McEntee Mark F , Mekis Nejc 
Published: April 2020

Abstract

Purpose
To determine the influence of optimal collimation during lumbar spine radiography on radiation dose and image quality.

Material and methods
110 lumbar spine patients were split into two groups—the first imaged with standard collimation and the second with optimal collimation. Body mass index, image field size, exposure conditions and dose area product were measured. Effective and absorbed organ doses were calculated. Image quality was assessed.

Results
Optimal collimation reduced the primary field by up to 40%. The effective dose was reduced by 48% for the AP projection, while no differences were found for the LAT projection due to incorrect positioning of the central beam with standard collimation. The absorbed dose to selected radiosensitive organs decreased by 41 and 10% in the AP and LAT projections, respectively. Image quality for the LAT projection improved by 24% and maintained for the AP projection.

Conclusion
Optimal collimation in lumbar spine imaging significantly influences patient exposure to radiation.
A new species group from the Daphnia curvirostris species complex (Cladocera: Anomopoda) from the eastern Palaearctic: taxonomy, phylogeny and phylogeography
Authors: Kotov Alexey A , Garibian Petr G , Bekker Eugeniya I , Taylor Derek J , Karabanov Dmitry P 
Published: April 2020

Abstract
The eastern Palaearctic is a centre of diversity for freshwater cladocerans (Crustacea), but little is known about the evolution and taxonomy of this diversity. Daphnia curvirostris is a Holarctic species complex that has most of its diversity in the eastern Palaearctic. We examined the phylogeography, rates of evolution and taxonomic status for each clade of the D. curvirostris complex using morphological and genetic evidence from four genes. The cybertaxonomical and morphological evidence supported an eastern Palaearctic clade, with at least four species (described here as the Daphnia korovchinskyi sp. nov. group) having diagnostic morphological characters. We also detected convergent morphological characters in the D. curvirostris complex that provided information about species boundaries. Two of the new species (Daphnia koreana sp. nov. and Daphnia ishidai sp. nov.) are known from single ponds and are threatened by human activity. Divergence time estimates suggested an ancient origin (12–28 Mya) for the D. korovchinskyi group, but these estimates are complicated by the small number of calibration points.
Long-term Outcomes of Living-Related Conjunctival Limbal Allograft Compared With Keratolimbal Allograft in Patients With Limbal Stem Cell Deficiency
Authors: Cheung Albert Y. , Eslani Medi , Kurji Khaliq H. , Wright Elizabeth , Sarnicola Enrica , Govil Amit , Holland Edward J. 
Published: April 2020

Purpose:
To compare the long-term outcomes of living-related conjunctival limbal allograft (lr-CLAL) with keratolimbal allograft (KLAL) in patients with limbal stem cell deficiency.

Methods:
A retrospective, comparative, interventional cohort of patients with bilateral total limbal stem cell deficiency who underwent surgical treatment with a KLAL or lr-CLAL procedure alone (not combined with any other ocular surface stem cell transplantation procedures) with a minimum follow-up of 1 year and who received systemic immunosuppression. Ocular surface stability, best-corrected visual acuity (BCVA), and postoperative complications at the last follow-up were the main outcome measures.

Results:
There were 224 eyes that underwent KLAL alone and 63 eyes that underwent lr-CLAL alone, with a mean follow-up time for all eyes of 7.2 years (range 1.0–16.0 years). For lr-CLAL eyes, 82.5% maintained a stable ocular surface compared with 64.7% of KLAL eyes at the last follow-up. Only 6.3% of lr-CLAL eyes demonstrated a failed ocular surface compared with 15.6% of KLAL eyes. The mean BCVA was 20/158 for KLAL eyes compared with 20/100 for lr-CLAL eyes at the last follow-up. A smaller proportion of lr-CLAL eyes (30.2% compared with 43.3%) developed an episode of acute rejection, and a higher proportion of these episodes resolved with treatment in the lr-CLAL group (79.0% compared with 53.6%).

Conclusions:
lr-CLAL demonstrates lower rejection rates, improved graft survival, and better BCVA compared with KLAL. Both careful preoperative donor selection and triple-agent systemic immunosuppression (including tapered systemic corticosteroids) are critical to optimizing the ocular surface stem cell transplantation outcomes.
A Modified Hughes Flap for Correction of Refractory Cicatricial Lower Lid Retraction With Concomitant Ectropion
Authors: Chen Ying , Al-Sadah Zakeya , Kikkawa Don O , Lee Bradford W 
Published: April 2020

Introduction:
Correction of lower eyelid retraction commonly involves one or more techniques, including recession of the eyelid retractors, spacer grafts, horizontal lid tightening, and midface lifting. However, patients presenting with cicatricial lower lid retraction following prior eyelid surgery often have scarring and concomitant ectropion or entropion that cause unpredictable wound healing, recicatrization, and suboptimal outcomes. The modified Hughes tarsoconjunctival flap is typically used to repair full-thickness eyelid defects. Prior reports describe treating refractory lower lid retraction with a modified Hughes flap placed beneath the tarsus after full-thickness blepharotomy. We present our experience with a novel surgical technique for treating refractory cicatricial lower lid retraction using a modified Hughes flap above the tarsus after excision of the scarred lid margin.

Methods:
Three patients were treated using this technique. The upper edge of the lower eyelid and associated scar tissue are excised. A modified Hughes flap is mobilized and secured above the posterior lamellar remnant. A full-thickness skin graft is placed over the flap. The flap is divided 4–5 weeks later.

Results:
This surgical technique was employed in all 3 cases. All cases were revisional, with 2 having extensive multioperative histories with multiple unsuccessful reconstructions and lid retraction repairs. All patients had improvement in cicatricial eyelid retraction, lagophthalmos, exposure keratopathy, and resolution of concomitant cicatricial ectropion.

Conclusions:
The technique of using a modified Hughes flap to reconstruct above the tarsus with excision of the scarred lid margin was effective in correcting refractory cicatricial lower lid retraction. This procedure can be considered in multioperative cases in which traditional techniques for lower lid retraction repair have failed. Reconstructing a new lid margin reduces the risk of recicatrization and suboptimal results.
Multidisciplinary Frontotemporal Orbitozygomatic Craniotomy for Spheno-orbital Meningiomas: Ophthalmic and Orbital Outcomes
Authors: Idowu Oluwatobi O. , Ashraf Davin C. , Magill Stephen T. , Kersten Robert C. , McDermott Michael W. , Vagefi M. Reza 
Published: April 2020

Purpose:
Advances in surgical approaches have improved access for total or near-total resection of spheno-orbital meningiomas (SOM). Herein, the outcomes of multidisciplinary resection and reconstruction of SOM via frontotemporal orbitozygomatic craniotomy at a single institution are evaluated.

Methods:
A retrospective chart review was performed of all patients with SOM who underwent joint neurosurgical and oculofacial plastic resection via frontotemporal orbitozygomatic craniotomy between January 1999 and December 2018. Demographic data, clinical presentation, risk factors for meningioma, radiographic imaging, pathology results, postoperative outcomes, and surgical complications were reviewed. The outcome measures assessed included visual acuity, pupillary function, color vision, ocular motility, visual fields, and proptosis.

Results:
A total of 48 patients were identified having had multidisciplinary frontotemporal orbitozygomatic craniotomy for SOM of which 43 met inclusion criteria. A mean follow-up period of 23.9 ± 20.4 months (range 1–60) was observed. There were 35 patients who underwent primary resection and 8 patients who had prior surgical resection. The main presenting complaints were proptosis (88%), headache (44%), and reduced vision (12%). Gross total resection was achieved in 15 patients (35%) while near-total or subtotal resection was achieved in the remainder. Histologic analysis revealed World Health Organization grade I meningioma in 72% of tumors, grade II in 23%, and grade III in 5%. Mean visual acuity (Logarithm of the Minimum Angle of Resolution) improved from 0.24 ± 0.46 preoperatively to 0.09 ± 0.13 postoperatively (p = 0.03). Surgery improved proptosis, with a reduction in mean Hertel exophthalmometry from 22.37 ± 3.78 mm to 17.91 ± 3.84 mm (p < 0.001), of which 80% had no residual proptosis or developed subsequent recurrence. Exophthalmic index calculated by radiologic evaluation also improved from a mean preoperative value of 1.32 ± 0.19 to 1.12 ± 0.13 at the 6-month interval after surgery (p < 0.001). Before surgery, 19 (45%) patients had a relative afferent pupillary reaction with improvement in 9 (24%) after surgery. Of the 14 (33%) patients with preoperative ocular motility deficit, 7 (16%) had resolution of ocular motility deficit postoperatively. The most common surgical complications were temporalis muscle atrophy with temporal hollowing (14%), wound infection (7%), neurogenic strabismus secondary to trochlear nerve palsy (5%), restrictive strabismus (5%), and aponeurotic blepharoptosis (5%).

Conclusions:
Multidisciplinary frontotemporal orbitozygomatic for resection of SOM is a safe and effective means of tumor removal. It can provide improved visual acuity and proptosis metrics, as well as relief of optic neuropathy and ocular motility deficits.
Utilization and Costs by Primary Care Provider Type
Authors: Smith Valerie A. , Morgan Perri A. , Edelman David , Woolson Sandra L. , Berkowitz Theodore S.Z. , Van Houtven Courtney H. , Hendrix Cristina C. , Everett Christine M. , White Brandolyn S. , Jackson George L. 
Published: April 2020

Objective:
The objective of this study was to compare health care utilization and costs among diabetes patients with physician, nurse practitioner (NP), or physician assistant (PA) primary care providers (PCPs).

Research Design and Methods:
Cohort study using Veterans Affairs (VA) electronic health record data to examine the relationship between PCP type and utilization and costs over 1 year in 368,481 adult, diabetes patients. Relationship between PCP type and utilization and costs in 2013 was examined with extensive adjustment for patient and facility characteristics. Emergency department and outpatient analyses used negative binomial models; hospitalizations used logistic regression. Costs were analyzed using generalized linear models.

Results:
PCPs were physicians, NPs, and PAs for 74.9% (n=276,009), 18.2% (n=67,120), and 6.9% (n=25,352) of patients respectively. Patients of NPs and PAs have lower odds of inpatient admission [odds ratio for NP vs. physician 0.90, 95% confidence interval (CI)=0.87–0.93; PA vs. physician 0.92, 95% CI=0.87–0.97], and lower emergency department use (0.67 visits on average for physicians, 95% CI=0.65–0.68; 0.60 for NPs, 95% CI=0.58–0.63; 0.59 for PAs, 95% CI=0.56–0.63). This translates into NPs and PAs having ~$500–$700 less health care costs per patient per year (P<0.0001).

Conclusions:
Expanded use of NPs and PAs in the PCP role for some patients may be associated with notable cost savings. In our cohort, substituting care patterns and creating similar clinical situations in which they practice, NPs and PAs may have reduced costs of care by up to 150–190 million dollars in 2013.
Immunological Profiling of Paediatric Inflammatory Bowel Disease Using Unsupervised Machine Learning
Authors: Coelho Tracy , Mossotto Enrico , Gao Yifang , Haggarty Rachel , Ashton James J. , Batra Akshay , Stafford Imogen S. , Beattie Robert M. , Williams Anthony P. , Ennis Sarah 
Published: April 2020

ABSTRACTObjectives:The current classification of inflammatory bowel disease (IBD) is based on clinical phenotypes, which is blind to the molecular basis of the disease. The aim of this study was to stratify a treatment‐naïve paediatric IBD cohort through specific innate immunity pathway profiling and application of unsupervised machine learning (UML).Methods:In order to test the molecular integrity of biological pathways implicated in IBD, innate immune responses were assessed at diagnosis in 22 paediatric patients and 10 age‐matched controls. Peripheral blood mononuclear cells (PBMCs) were selectively stimulated for assessing the functionality of upstream activation receptors including NOD2, toll‐like receptor (TLR) 1‐2 and TLR4, and the downstream cytokine responses (IL‐10, IL‐1β, IL‐6, and TNF‐α) using multiplex assays. Cytokine data generated were subjected to hierarchical clustering to assess for patient stratification.Results:Combined immune responses in patients across 12 effector responses were significantly reduced compared with controls (P = 0.003) and driven primarily by “hypofunctional” TLR responses (P values 0.045, 0.010, and 0.018 for TLR4‐mediated IL‐10, IL‐1β, and TNF‐α, respectively; 0.018 and 0.015 for TLR1‐2 ‐mediated IL‐10 and IL‐1β). Hierarchical clustering generated 3 distinct clusters of patients and a fourth group of “unclustered” individuals. No relationship was observed between the observed immune clusters and the clinical disease phenotype.Conclusions:Although a clinically useful outcome was not observed through hierarchical clustering, our study provides a rationale for using an UML approach to stratify patients. The study also highlights the predominance of hypo‐inflammatory innate immune responses as a key mechanism in the pathogenesis of IBD.