bluuebunny/crossref_metadata_2025_split huggingface dataset:
Uncovering the Late Pleistocene LSA of Mpumalanga Province, South Africa: Early Results from Iron Pig Rock Shelter
Authors: Bader Gregor D. , Linstädter Jörg , Schoeman Maria H. 
Published: April 2020

Abstract
South Africa is one of the best-studied regions in terms of Stone Age research in the last few decades. Considerable progress has been made, especially for the Middle Stone Age (MSA). Recently the late Pleistocene Later Stone Age (LSA) has come back into focus. However, there are still large understudied areas such as northeastern South Africa. Here we present the first data from an archaeological site containing late Pleistocene occupations associated with the Robberg techno-complex in this region. Iron Pig rock shelter provides a well-dated sequence spanning from >16000 cal BP to <9000 cal BP. A lithic analysis of the Robberg occupations of the lowermost layers 5 and 6 provided here implies gradual temporal shifts in technology indicating short-term changing traditions. A comparative review of other LSA sites in the wider region suggests considerable research gaps and the necessity of intensified work in this area.
Gift-Exchange in Diplomatic Practices during the Early Mongol Period
Authors: Yihao Qiu 
Published: April 2020

Abstract
Gift-exchange is the main element of a long-established tradition in Inner Asian diplomatic practice, representing a kind of political discourse. The Mongol Empire, after its rise in the early 13th century, changed the tradition of diplomatic ideology and practice, and established new principles subsequently. This article, according to multi-lingual sources, summarizes the formal and political aspects of gift-exchange during the pre-Mongol period and, furthermore, discusses the innovation and continuity of gift-exchange in the diplomatic practice of the earlier Mongol Empire.
Contacts between the Mongols and the Latin West from the Point of View of the Italian Chronicles in the Second Half of the Thirteenth Century
Authors: Ciocchetti Marco 
Published: April 2020

Abstract
When the news of the Mongol invasions in eastern Europe and western Asia reached the European courts in the first half of the thirteenth century, the papal court was the first to send embassies to the Mongols. The reports of missionaries and papal envoys, alongside the famous account of Marco Polo, provided Europeans with the first accounts on these terrible warriors. Italian chroniclers of the period included the information provided by these accounts in their works, including in their local chronicles the achievements and habits of these mysterious warriors from the east. Other chroniclers were eyewitnesses to the first diplomatic contacts between European and Mongolian sovereigns. Their testimonies offer interesting elements to observe the first rudimentary diplomatic approaches between two worlds so far apart. Comparing various medieval chronicles, this paper investigates a fundamental psychological difference in the way how Italian and Central European authors of the time perceived the Mongols. If on the one hand Central European sources describe the Mongol warriors with terror and fear, the Italian ones are more optimistic, as they consider them as a possible resource to definitively drive out the Muslim infidels from the Holy Land.
Intra-Mongol Diplomacy and Witch-Hunt during the Dissolution of the Empire: the Witchcraft Trial at the Court of Hülegü
Authors: Golev Konstantin 
Published: April 2020

Abstract
The present paper examines the events that led to the establishment of the Ilkhanate under Hülegü as well as the beginning of the war between the Hülegüids and the Jöchids of the Golden Horde. The article discusses the struggle between the two branches of Chinggis Khan’s Golden Lineage during the march of Hülegü through South West Asia. This process reached its apex when Hülegü decided to get rid of the Jöchid contingents in his army together with the princes that headed them. This happened because they were a serious obstacle on the way towards establishing his empire in Iran and the adjacent areas. Hülegü used an accusation in witchcraft as an official pretext to remove fellow Chinggisid prince (or princes).
Recent Changes in United States Extreme 3-Day Precipitation Using the R-CAT Scale
Authors: Lamjiri Maryam A. , Ralph F. Martin , Dettinger Michael D. 
Published: April 2020

AbstractExtraordinary precipitation events have impacted the United States recently, including Hurricanes Harvey (2017) and Florence (2018), with 3-day precipitation totals larger than any others reported in the United States during the past 70 years. The rainfall category (R-CAT) scaling method is used here to document extreme precipitation events and test for trends nationally. The R-CAT scale uses thresholds of 3-day precipitation total in 100-mm increments (starting with 200 mm) that do not vary temporally or geographically, allowing for simple, intuitive comparisons of extremes over space and time. The paper that introduced the scale only required levels 1–4 to represent historical extremes, finding that R-CATs 3–4 strike the conterminous United States about as frequently as EF 4–5 tornadoes or category 3–5 hurricanes. Remarkably, Florence and Harvey require extending the scale to R-CAT 7 and 9, respectively. Trend analyses of annual maximum 3-day totals (1950–2019) here identify significant increases in the eastern United States, along with declines in Northern California and Oregon. Consistent with these results, R-CAT storms have been more frequent in the eastern, and less frequent in western, United States during the past decade compared to 1950–2008. Tropical storms dominate R-CAT events along the southeastern coast and East Coast with surprising contributions from atmospheric rivers, while atmospheric rivers completely dominate along the West Coast.
Severe obstructive sleep apnea is associated with coronary microvascular dysfunction and obstruction in patients with ST-elevation myocardial infarction
Authors: Ichikawa Yoshitaka , Izumiya Yasuhiro , Tamita Koichi , Hayashi Hiroya , Ishikawa Hirotoshi , Shibata Atsushi , Yamamuro Atsushi , Yoshiyama Minoru 
Published: April 2020

Abstract

Background
Coronary microvascular dysfunction and obstruction (CMVO) is a strong predictor of a poor prognosis in patients with ST-segment elevation myocardial infarction (STEMI). Although research has suggested that obstructive sleep apnea (OSA) exacerbates CMVO after primary percutaneous coronary intervention, data supporting a correlation between OSA and CMVO are limited. This study was performed to investigate whether OSA is associated with CMVO, detected as microvascular obstruction on cardiovascular magnetic resonance images, in patients with STEMI.

Methods
Patients (N = 249) with a first STEMI underwent primary percutaneous coronary intervention. CMVO was evaluated on cardiovascular magnetic resonance images based on the presence of microvascular obstruction. OSA was classified into four levels of severity based on the respiratory event index (REI): absent (REI of &lt;5), mild (REI of ≥5 to &lt;15), moderate (REI of ≥15 to &lt;30) and severe (REI of ≥30).

Results
The REI was significantly higher in the presence of microvascular obstruction (n = 139) than in its absence (n = 110) (REI of 12.8 vs. 10.7, respectively; p = 0.023). Microvascular obstruction was observed in 42%, 58%, 57% and 70% of patients in the absent, mild, moderate and severe OSA groups, respectively. Multiple logistic regression analysis showed that severe OSA was associated with increased odds of microvascular obstruction (odds ratio (OR), 5.10; 95% confidence interval (CI),1.61–16.2; p = 0.006). Mild and moderate OSA were also associated with increased odds of microvascular obstruction (mild OSA: OR, 2.88; 95% CI, 1.19–7.00; p = 0.019 and moderate OSA: OR, 3.79; 95% CI, 1.43–10.1; p = 0.008).

Conclusion
Severe OSA was associated with CMVO after primary percutaneous coronary intervention in patients with STEMI.
PEDIATRIC AND ADOLESCENT SHOULDER INSTABILITY: DOES INSURANCE STATUS PREDICT THE DEVELOPMENT OF BONY BANKART AND ENGAGING HILL-SACHS LESIONS?
Authors: Hung NJ , Darvesky DM , Pandya NK 
Published: April 2020

Background: Pediatric and adolescent patients who undergo shoulder stabilization surgery have higher rates of failure than their adult counterparts. The impact of insurance status on intra-operative findings and outcomes is largely unknown. Hypothesis/Purpose: We hypothesized that patients with public insurance who undergo shoulder stabilization surgery would have greater degrees of bony pathology; leading to poor outcomes after stabilization. Methods: This was a retrospective cohort study of pediatric and adolescent patients with public and private insurance who were treated for recurrent shoulder instability from 2011-2017. Patients were treated at a tertiary care children’s hospital by a single orthopaedic surgeon. Patients 10 to 18 years of age were included in the study if they presented with recurrent shoulder instability and underwent surgical intervention for their injury. Time from injury to clinical consultation, imaging, and surgical intervention; incidences of labral pathology and secondary bony injury; and rates of repeat dislocation and repeat surgery were compared between the public and private insurance cohorts Results: Thirty-seven patients had public insurance while 18 patients had private insurance. Privately insured patients were evaluated by clinicians nearly five times faster than were publicly insured patients (p < 0.001), and they obtained MRIs over four times faster than did public insurance patients (p < 0.001). Publicly insured patients were twice as likely to have secondary bony injuries (p=0.043). Postoperatively, a significantly greater number (24.3%) of publicly insured patients experienced re-dislocation versus the complete absence of re-dislocation in the privately insured patients (p=0.022). Conclusion: Public insurance status impacts access to care and correlates with both the development of secondary bony injury and an increased rate of clinical failure manifested as repeat post-operative dislocations. [Table: see text] Table 1 shows the summary of results for public and private insurance cohorts for days from injury to clinic, injury to MRI, injury to surgery, clinic to MRI, MRI to surgery as well as number of prior dislocations, incidence of anterior only vs. complex labral pathology, incidence of bony involvement, incidence of repeat dislocations, and incidence of repeat surgery. * denotes that the difference between the two insurance cohorts was not statistically significant.
ADJUVANT TREATMENT OF OCD LESIONS OF THE KNEE WITH BONE STIMULATORS
Authors: Mathew Stephen T. , Coene Ryan P. , Williams Kathryn A. , Micheli Lyle J. , Milewski Matthew D. 
Published: April 2020

Background: Recently, bone stimulators have been increasingly used for fracture care, particularly in the context of delayed healing and nonunions. Bone stimulation provides upregulation of osteogenic factors and stimulation of osteoblasts to create new bone. Hypothesis/Purpose: The purpose of this study was to determine if adjuvant use of bone stimulation would improve the rate of healing in the operative management of stable osteochondritis dissecans (OCD) of the knee. Methods: Forty patients who presented with a stable OCD lesion of the knee were included in the present retrospective study. All patients were managed with operative intervention with anterograde drilling by a single senior surgeon. The patients in the two groups, those with or without the use of bone stimulators post-operatively, were matched for skeletal maturity, lesion location, gender and age at surgery. The primary outcome measure of the rate of healing was determined from 3 month post-operative MRIs and clinical results were also analyzed. Results: At two years, 36 patients (90%) in both groups went on to clinical healing without further interventions. Two patients in each group required re-operations. The bone stimulator group had a mean decrease of 0.9 (± 1.8) mm in lesion coronal width and had 12 patients (63%) who had overall improved healing as compared to the non-bone stimulator group which had a 0.8 (± 3.6) mm decrease in coronal width and 14 patients (78%) with improved healing (p=0.272). No statistical differences in imaging or clinical healing were found between the two groups. Male patients were seen to have a clinically important decreased time from surgery to sports clearance (4 versus 5.5 months, p=0.063), discharge (7.8 versus 13.4 months, p=0.057), and increased overall healing (81% versus 55%, p=0.187) as compared to females. Skeletally immature patients had a decreased time from surgery to discharge (7.0 versus 18.3 months, p=0.005), improved overall healing (79% versus 50%, p=0.158), and decreased reoperation rate (3% versus 30%, p=0.042) when compared to the skeletally mature patients. Conclusion: In the surgical treatment of stable knee OCD lesions, bone stimulator use did not appear to improve radiographic or clinical healing. However, this study was not powered to examine the clinically important differences between the patients with and without the use of bone stimulators. Further multi-institutional studies will be needed to further elucidate differences. This study did find that skeletally immature patients had improved outcomes both clinically and on imaging as compared to skeletally mature patients.
LIMB SYMMETRY IS NOT ENOUGH: ESTABLISHMENT OF HEIGHT NORMALIZED HOP DISTANCES WITHIN HEALTHY YOUTH ATHLETES
Authors: Greenberg Elliot M. , Karl Michael , Leung Anne , Lawrence J. Todd , Ganley Theodore 
Published: April 2020

Background: Most experts recommend utilizing single leg hop tests to help determine an athlete’s readiness to return to sports after anterior cruciate ligament reconstruction (ACLR). A limb symmetry index (LSI =involved limb/uninvolved limb) of ≥90% is typically required by most contemporary protocols. However, limb symmetry may underestimate continued post-operative deficits due to performance declines within the uninvolved limb after ACLR. Additionally, LSI may not accurately identify those at risk of repeat injury, and doesn’t assist in ensuring maximal patient effort. Comparing height normalized hop distances to uninjured controls has been suggested as an additional criteria to better recognize performance deficits after ACLR. Purpose: To characterize single leg hop test performance in a large group of healthy youth athletes and determine the relationships of sex or age on hop performance. Methods: This was a cross-sectional study of healthy youth athletes aged 8-14 years-old, who were currently participating in organized sports. Using their dominant leg, each subject performed a triple hop (TrH) in which they quickly hopped on one leg three times, achieving maximal linear distance, while holding their balance after the last hop. Distance from starting line to the heel was recorded in centimeters. Each subject’s hop distance was normalized to body height and served as the dependent variable. A two-way ANOVA analyzed any effects of age and sex. A-priori alpha was set at p≤0.05. Results: A total of 340 subjects (Male [n=184], mean age 10.9±1.5 years) were included. Across the entire sample, mean TrH distance was 2.2 times body height. ANOVA demonstrated no differences for main effect of sex (mean TrH/height, Males=2.2, Females=2.1, p=0.212). (Figure 1) Main effect of age was significant (p<0.001) with Bonferroni post-hoc analysis indicating 13 year-olds normalized TrH distance (2.6 times body height) was greater than all other age groups (8 yrs=1.9, 9yrs=2.0, 10yrs=2.1, 11yrs=2.2, 12yrs=2.3). (Figure 2) The 12 year-old performance was significantly greater than 8-9 year-olds only (2.3 vs 1.9-2.0). Conclusions: When normalized to body height, TrH performance increases around the ages of 12-13 years. Regardless of sex, athletes aged 8-11 can be expected to TrH approximately 2 times body height, while athletes near age 13 should have TrH values of 2.6 times body height. Due to post-operative deconditioning within the healthy limb, the use of age-matched hopping norms in addition to LSI may offer better determination of functional recovery or effort. As performance changes with age, future research should focus on establishing normative performance in older subjects. Figures/Tables: [Figure: see text][Figure: see text]
EVALUATING THE EFFECT OF SPINAL DEFORMITY ON PEDIATRIC PATIENT ACTIVITY LEVELS
Authors: Yau Annie , Heath Madison R. , Fabricant Peter D. 
Published: April 2020

Background: Idiopathic scoliosis has historically been considered a benign condition without significant functional limitations for the patient. However, as curves progress, patients may experience worsening pain, deformity, and quality of life. Patient reported outcome measures (PROMs) help assess functional limitations that may indicate treatment. Purpose: The objective of this study was to compare physical activity related PROM scores in three groups of patients with different severities of spinal curvature. Methods: Pediatric patients diagnosed with adolescent and juvenile idiopathic scoliosis, kyphoscoliosis, or spinal asymmetry completed the SRS-22R, HSS Pedi-FABS activity scale, and Patient-Reported Outcomes Management Information System (PROMIS) Pediatric Computer Adaptive Tests for Mobility and Physical Activity (PA) at a single institution from July 2018 to February 2019. Radiographic images were reviewed, and patients were grouped as Spinal Asymmetry (SA), Mild Deformity (MD), and Severe Deformity (SD) by major Cobb angle measuring less than 10°, between 10° and 40°, and greater than 40° respectively. One-way ANOVA with a Tukey post-hoc correction was used to determine differences between groups. Results: 206 pediatric patients (65% female) with a mean age 13.5 ± 2.2 years were included. The mean Cobb angles by group were 7.1° ± 2.1° in SA (n=51), 19.4° ± 7.8° in MD (n=130), and 50.2° ± 9.1° in SD (n=25). Compared to both SA and MD patients, SD patients scored lower on PROMIS Mobility (p<0.005). Compared to SA patients only, SD patients had lower scores on the HSS Pedi-FABS (p<0.01) and SRS-22R Function (p<0.05). PROMIS PA scores decreased with increasing spinal deformity, but these differences were not statistically significant. There was no significant difference between SA and MD for all PROMs administered. Conclusion: These findings suggest that mobility, function, and physical activity are affected by increasing severity of spinal curvature. Patients with severe spinal deformity reported lower PROMs compared to patients without clinical spinal deformity. Finally, patients with spinal asymmetry and mild deformity do not report significantly different PROMs. Tables: [Table: see text]
A QUALITY IMPROVEMENT PROJECT TO REDUCE THE USE OF COMBINATION OPIOID/ACETAMINOPHEN MEDICATIONS WITHIN A LARGE HEALTH SYSTEM
Authors: Trivedi Sunny , Shea Kevin , Chadwick Whitney , Gaskari Shabnam , Wang Ellen , Caruso Thomas 
Published: April 2020

Background: Combination analgesics are among the most commonly prescribed pain medications in pediatric orthopedic patients. However, combined analgesics do not allow for individual medication titration, which can increase the risk of opioid misuse and hepatoxicity from acetaminophen. Increasingly, the risks of combined analgesics associated with opioid misuse and hepatotoxicity are recognized by the FDA and other organizations. Given these risks, consideration should be made for independent administration of acetaminophen and opioids. Hypothesis/Purpose: The primary aim was to alter the prescribing habits of pediatric orthopedic providers at our institution from postoperative combined opioid/acetaminophen medicines to independent opioids and acetaminophen. Methods: The study took place at a children’s hospital level one trauma center. A multidisciplinary team of health professionals utilized lean methodology to develop a project plan. Guided by a key driver diagram, (1) combination oxycodone/acetaminophen products were removed from hospital formulary, (2) a revised inpatient and outpatient electronic order set was implemented, and (3) multiple education efforts (emails, in person meetings) were conducted. Outcomes included inpatient and outpatient percent combined opioid/acetaminophen orders by surgical providers over twenty-seven months. Statistical process control charts were used to measure combination opioid prescribing practices for orthopedic and other surgical specialties. Results: Prior to intervention, inpatient combination opioid/acetaminophen products were prescribed for an average of 46% of all opioid prescriptions for orthopedic patients. After intervention and multiple educational efforts, the percent of combined opioid/acetaminophen products dropped to 31% and then to 3% by end of the investigational period. For outpatient prescriptions, the combined products accounted for 88% prior to intervention and dropped to 15% at project completion. Conclusion: By removing combined oxycodone/acetaminophen products from hospital formulary, educating the medical staff, and employing electronic order sets, the inpatient/outpatient prescribing practice of pediatric orthopedic surgeons changed from the common use of combined opioid/acetaminophen products to independent medications. This project demonstrates that changing medication prescription practice can be accomplished with 3 steps within a hospital system. Reducing the use of combination opioid/acetaminophen products may have further positive impacts on opioid misuse and hepatoxicity.
ANKLE BRACE USE AND RISK OF ACUTE LOWER EXTREMITY INJURY AMONG FEMALE HIGH SCHOOL VOLLEYBALL PLAYERS
Authors: Kliethermes Stephanie , McGuine Timothy , Biese Kevin , Bell David , Watson Andrew , Brooks M. Alison , Post Eric , Lang Pamela 
Published: April 2020

Background: Lower extremity injuries (LEIs), particularly ankle sprains, are the most common injury reported among female volleyball players. Many athletes wear ankle braces to help prevent injury; however, it is unknown whether ankle brace use reduces the rate and severity of ankle and LEI in these athletes. Hypothesis/Purpose: Determine if ankle brace use is associated with a reduced rate and severity of LEIs and ankle injuries among female high school volleyball players. Methods: 2073 female volleyball players from 78 high schools were prospectively followed for injury, including acute LEI, during their fall 2018 volleyball season. Baseline data was collected on each participant including ankle brace use and type worn. Brace type was classified as soft- (e.g. fabric) or hard-shell. Injury severity was measured as days lost from sport. Incidence rates are reported per 1000 athlete exposures. Results: 210 acute LEIs were observed during the season, of which 122 (58%) were ankle injuries. 76% of non-contact LEIs were due to jumping/landing or rotating around a planted foot. Similarly, 76% of contact LEIs were due to the floor or a teammate. The rate of LEI for athletes wearing soft-shell(SS) braces was 1.14 (95% CI: 0.76, 1.72), compared to 0.53 (95% CI: 0.25, 1.10) for those wearing hard-shells (HS) and 0.52 (95% CI: 0.37, 0.71) for those not wearing braces (NONE). The rate of a LEI for athletes wearing SS was 2.22 (95% CI: 1.31, 3.74) times as high as that for NONE (p=0.003). No association was found between LEI risk in athletes wearing HS versus NONE (IRR: 1.02, 95% CI: 0.45, 2.30). Similarly, the rates of ankle injury for HS, SS and NONE were 0.08 (95% CI: 0.01, 0.530), 0.40 (95% CI: 0.20, 0.79), and 0.16 (95% CI: 0.09, 0.28), respectively. The rate of ankle injury was 2.5 times as great in participants wearing SS compared to NONE (p=0.04). No association was detected for HS braces (p=0.48). No difference in median days lost for LEI (HS: 2[IQR 1,13], SS: 4[1, 10] None: 3[1,9]) or ankle injury (HS: 7[IQR 2,13], SS: 5[1, 11] None: 3[1,10]) was detected by brace use (p=0.99, p=0.79, respectively). Conclusion: The use of SS braces resulted in an increased risk of LEI and ankle injury among female high-school volleyball players; moreover, HS braces were not found to be associated with injury risk nor did ankle brace use affect severity of LEI and ankle injury in this population.