bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prediction tool for high risk of surgical site infection in spinal surgery
Authors: Namba Takanori , Ueno Masaki , Inoue Gen , Imura Takayuki , Saito Wataru , Nakazawa Toshiyuki , Miyagi Masayuki , Shirasawa Eiki , Takahashi Osamu , Takaso Masashi 
Published: April 2020

AbstractObjective:The incidence of surgical site infection (SSI) is higher in spinal surgeries than in general orthopedic operations. In this study, we aimed to develop a scoring system with reduced health care costs for detecting spinal surgery patients at high risk for SSI.Design:Retrospective cohort study.Patients:In total, 824 patients who underwent spinal surgery at 2 university hospitals from September 2005 to May 2011.Methods:We reviewed the medical records of 824 patients, and we examined 19 risk factors to identify high-risk patients. After narrowing down the variables by univariate analysis, multiple logistic analysis was performed for factors withPvalues <.2, using SSI as a dependent variable. Only factors that showedPvalues <.05 were included in the final models, and each factor was scored based on the β coefficient values obtained. The clinical prediction rules were thereby prepared.Results:“Emergency operation,” “blood loss >400 mL,” “presence of diabetes,” “presence of skin disease,” and “total serum albumin value <3.2 g/dL” were detected by multivariable modeling and were incorporated into the risk scores. Applying these 5 independent predictive factors, we were able to predict the infection incidence after spinal surgery.Conclusions:Our present study could aid physicians in making decisions regarding prevention strategies in patients undergoing spinal surgery. Stratification of risks employing this scoring system will facilitate the identification of patients most likely to benefit from complex, time-consuming and expensive infection prevention strategies, thereby possibly reducing healthcare costs.
Exploring Firm-Level Antecedents that Drive Motives of Internationalization: A Study of Knowledge Intensive Indian Firms
Authors: Ahsan Faisal M. , Sinha Ashutosh , Srinivasan R 
Published: April 2020

ABSTRACTWe study firm level antecedents that drive different motives of internationalization of emerging economy firms. Based on firm's resource based considerations of asset exploitation versus asset augmentation and locational advantages of host countries, we provide a framework to classify the motives of internationalization of emerging economy firms belonging to knowledge intensive industries. Motives of internationalization have been classified into three broad categories – market-seeking, opportunity-seeking, and strategic asset-seeking. We determine motives behind different modes of internationalization – alliances, acquisitions, and greenfield ventures. Drawing upon the adaptability, amalgamation, and ambidexterity (AAA) advantages from the springboard perspective, we find that firm characteristics like R&D investments, availability of financial slack, firm's ownership structure, and family control shape up its motive of internationalization.
Explaining Population Displacement Strategies in Civil Wars: A Cross-National Analysis
Authors: Lichtenheld Adam G. 
Published: April 2020

AbstractWhy do combatants uproot civilians in wartime? In this paper I identify cross-national variation in three population-displacement strategies—cleansing, depopulation, and forced relocation—and test different explanations for their use by state actors. I advance a new “assortative” theory to explain forced relocation, the most common type. I argue that combatants displace not only to expel undesirable populations, but also to identify the undesirables in the first place by forcing people to send signals of loyalty and affiliation based on whether, and to where, they flee. This makes communities more “legible” and facilitates the extraction of rents and recruits. I test these arguments using a novel Strategic Displacement in Civil Conflict data set (1945–2008). Consistent with my expectations, different displacement strategies occur in different contexts and appear to follow different logics. Cleansing is more likely in conventional wars, where territorial conquest takes primacy, while forced relocation is more likely in irregular wars, where identification problems are most acute. The evidence indicates that cleansing follows a logic of punishment. The results for relocation, however, are consistent with the implications of my assortative logic: it is more likely to be employed by resource-constrained incumbents fighting insurgencies in “illegible” areas—rural, peripheral territories. A case study from Uganda based on in-depth fieldwork provides evidence for the assortative mechanism. As the most comprehensive analysis of wartime displacement strategies to date, this paper challenges some core assumptions about a devastating form of contemporary political violence.
Improving use of maternal care services among married adolescent girls: an intervention study in rural India
Authors: Dyalchand Ashok , Pande Rohini Prabha , Kulkarni Gopal , Khale Manisha 
Published: April 2020

AbstractThis study examined the effect of the Safe Adolescent Transition and Health Initiative (SATHI) programme on the use of maternal care services among rural, pregnant adolescents in India. This was an intensive community-based, multi-site intervention project conducted in Maharashtra state between 2008 and 2011. Its aims were to improve the reproductive health of married adolescent girls and avert the adverse consequences of early motherhood. It had a quasi-experimental, case-control, pre-post design to enable rigorous evaluation. This study used cross-sectional data from 644 married girls aged under 19 years at baseline and 802 at endline to assess the maternal care outcomes of antenatal care, delivery and postnatal services and nutrition during pregnancy. Difference-in-differences analysis showed that all outcomes improved significantly in the study sites between baseline and endline, and the improvement in study sites was significantly larger than in the control sites. Multivariate analysis showed a statistically significant dose–response effect of intervention participation for antenatal care, pregnancy nutrition and postnatal care. Study participation was not statistically significantly associated with higher rates of safe or institutional delivery. The analysis suggests that training and supporting community health workers to work with married adolescent girls using interpersonal communication and interacting frequently with them and their families and communities can significantly improve the use of maternal care services among this population. With almost a million community health workers and 200,000 auxiliary nurse midwives at the community level providing primary level care in India, this intervention offers a proven strategy to replicate and scale-up to reach large numbers of married adolescent girls who do not currently use maternal care services.
Fronto-thalamic structural and effective connectivity and delusions in schizophrenia: a combined DTI/DCM study
Authors: Csukly Gábor , Szabó Ádám , Polgár Patrícia , Farkas Kinga , Gyebnár Gyula , Kozák Lajos R. , Stefanics Gábor 
Published: April 2020

AbstractBackgroundSchizophrenia (SZ) is a complex disorder characterized by a range of behavioral and cognitive symptoms as well as structural and functional alterations in multiple cortical and subcortical structures. SZ is associated with reduced functional network connectivity involving core regions such as the anterior cingulate cortex (ACC) and the thalamus. However, little is known whether effective coupling, the directed influence of one structure over the other, is altered during rest in the ACC–thalamus network.MethodsWe collected resting-state fMRI and diffusion-weighted MRI data from 18 patients and 20 healthy controls. We analyzed fronto-thalamic effective connectivity using dynamic causal modeling for cross-spectral densities in a network consisting of the ACC and the left and right medio-dorsal thalamic regions. We studied structural connectivity using fractional anisotropy (FA).ResultsWe found decreased coupling strength from the right thalamus to the ACC and from the right thalamus to the left thalamus, as well as increased inhibitory intrinsic connectivity in the right thalamus in patients relative to controls. ACC-to-left thalamus coupling strength correlated with the Positive and Negative Syndrome Scale (PANSS) total positive syndrome score and with delusion score. Whole-brain structural analysis revealed several tracts with reduced FA in patients, with a maximum decrease in white matter tracts containing fronto-thalamic and cingulo-thalamic fibers.ConclusionsWe found altered effective and structural connectivity within the ACC–thalamus network in SZ. Our results indicate that ACC–thalamus network activity at rest is characterized by reduced thalamus-to-ACC coupling. We suggest that positive symptoms may arise as a consequence of compensatory measures to imbalanced fronto-thalamic coupling.
Causal relationships between blood lipids and depression phenotypes: a Mendelian randomisation analysis
Authors: So Hon-Cheong , Chau Carlos Kwan-long , Cheng Yu-ying , Sham Pak C. 
Published: April 2020

AbstractBackgroundThe etiology of depression remains poorly understood. Changes in blood lipid levels were reported to be associated with depression and suicide, however study findings were mixed.MethodsWe performed a two-sample Mendelian randomisation (MR) analysis to investigate the causal relationship between blood lipids and depression phenotypes, based on large-scale GWAS summary statistics (N= 188 577/480 359 for lipid/depression traits respectively). Five depression-related phenotypes were included, namely major depression (MD; from PGC), depressive symptoms (DS; from SSGAC), longest duration and number of episodes of low mood, and history of deliberate self-harm (DSH)/suicide (from UK Biobank). MR was conducted with inverse-variance weighted (MR-IVW), Egger and Generalised Summary-data-based MR (GSMR) methods.ResultsThere was consistent evidence that triglyceride (TG) is causally associated with DS (MR-IVWβfor one-s.d.increase in TG = 0.0346, 95% CI 0.0114–0.0578), supported by MR-IVW and GSMR and multipler2clumping thresholds. We also observed relatively consistent associations of TG with DSH/suicide (MR-Egger OR = 2.514, CI 1.579–4.003). There was moderate evidence for positive associations of TG with MD and the number of episodes of low mood. For HDL-c, we observed moderate evidence for causal associations with DS and MD. LDL-c and TC did not show robust causal relationships with depression phenotypes, except for weak evidence that LDL-c is inversely related to DSH/suicide. We did not detect significant associations when depression phenotypes were treated as exposures.ConclusionsThis study provides evidence to a causal relationship between TG, and to a lesser extent, altered cholesterol levels with depression phenotypes. Further studies on its mechanistic basis and the effects of lipid-lowering therapies are warranted.
100 Olanzapine/Samidorphan for Schizophrenia: Weight Gain and Metabolic Outcomes in Phase 3 ENLIGHTEN-2 and Subsequent Long-Term, Open-Label Safety Study
Authors: Correll Christoph U. , Newcomer John W. , Silverman Bernard , DiPetrillo Lauren , Graham Christine , Jiang Ying , Du Yangchun , Simmons Adam , Hopkinson Craig , McDonnell David , Kahn Rene 
Published: April 2020

Abstract:Background:Opioid antagonists may mitigate medication-associated weight gain and/or metabolic dysregulation. ENLIGHTEN-2 evaluated a combination of olanzapine and the opioid antagonist samidorphan (OLZ/SAM) vs olanzapine for effects on weight gain and metabolic parameters over 24 weeks in adults with stable schizophrenia.METHODS:This phase 3, double-blind study (ClinicalTrials.gov: NCT02694328) enrolled adults 18–55 yo with stable schizophrenia, randomized 1:1 to once-daily OLZ/SAM or olanzapine. Co-primary endpoints were percent change from baseline in body weight and proportion of patients with ≥10% weight gain at week 24. Waist circumference and fasting metabolic parameters were also measured. Completers could enter a 52-week open-label safety extension.RESULTS:561 patients were randomized: 550 were dosed, 538 had ≥1 post-baseline weight assessment, and 352 (64%) completed; 10.9% discontinued due to AEs. At week 24, least squares mean (SE) percent weight change from baseline was 4.21 (0.68)% with OLZ/SAM and 6.59 (0.67)% with olanzapine (difference, −2.38 [0.76]%; P=0.003). Fewer patients treated with OLZ/SAM (17.8%) had ≥10% weight gain vs olanzapine (29.8%; odds ratio=0.50; P=0.003). The change from baseline in waist circumference was significantly smaller with OLZ/SAM (P<0.001). Common AEs (≥10%) with OLZ/SAM and olanzapine were weight increased (24.8%, 36.2%), somnolence (21.2%, 18.1%), dry mouth (12.8%, 8.0%), and increased appetite (10.9%, 12.3%), respectively. Metabolic parameter changes were generally small and remained stable with long-term OLZ/SAM treatment.DISCUSSION:OLZ/SAM treatment limited weight gain associated with olanzapine. Metabolic parameter changes were generally small, similar between groups over 24 weeks, and remained stable over an additional 52 weeks of open-label OLZ/SAM treatment.Funding Acknowledgements:This study was funded by Alkermes, Inc.
108 Warning: Generic Suboxone Not Equal to Name Brand
Authors: Datt Arvind , Hirsch Alan R. 
Published: April 2020

Abstract:Introduction:On June 14, 2018, the FDA approved generic buprenorphine/naloxone, as an alternative to the brand Suboxone (FDA,2018). A patient who developed acute withdrawal symptoms when switched from Suboxone to generic buprenorphine/naloxone at the same dosage, with resolution with replacement with brand name Suboxone, is presented. Induction of withdrawal with generic buprenorphine/naloxone has not heretofore been described.Methods:Case Study: A 39-year-old right handed single male presented with a past medical history of intravenous heroin dependence. He was relapse free for 5 years and without change on Suboxone film 8mg/2mg twice daily, and was provided with prescriptions for the same, which was substituted to generic brand Dr. Reddy’s Lab SA buprenorphine HCl/naloxone HCl 8mg/2mg film. After two days on this, one hour after taking generic buprenorphine/naloxone film, symptoms of withdrawal began as manifest by hot flashes, diaphoresis, cold chills, leg cramping, and nausea without vomiting. These were the same symptoms he experienced during his past inpatient withdrawal from opioids. These symptoms recurred every day for an entire week until switching back to brand name Suboxone, whereupon his withdrawal symptoms resolved.Discussion:The mechanism whereby the generic buprenorphine/naloxone combination induced withdrawal symptoms is unclear. It appears that this generic version was either not effectively blocking the mu receptors or the naloxone was inducing a withdrawal state. Possibly the porous nature of the film was such that less of the buprenorphine was absorbed through the mucosa. As a result, less was transferred into the bloodstream, across the blood brain barrier, to the nucleus accumbens, and ultimately on kappa opioid/mu receptor (Centerwatch, 2002). Alternatively, a greater amount of naloxone may have been absorbed transmucosally, thus inducing withdrawal. The absorption may have been normal, but the exact milligram dosage may not be accurate with either too little buprenorphine or too much naloxone. On the other hand, this buprenorphine compound may have been pH sensitive, such that it became inactivated upon exposure to the mildly acidic salivary pH. He could have been malingering this response. Again this is unlikely since he was not given a higher dose of buprenorphine/naloxone, rather the same dose of Suboxone as previously prescribed. It is important that physicians be aware of the possibility for acute withdrawal and increased cravings, which can lead to relapse while using this agent. Further investigation of the efficacy of the generic variant and Suboxone as replacement therapy is warranted.
116 An Experimental Study to Assess the Professional and Social Consequences of Tardive Dyskinesia
Authors: Ayyagari Rajeev , Goldschmidt Debbie , Mu Fan , Caroff Stanley N. , Carroll Benjamin 
Published: April 2020

Abstract:Study Objective:Evaluate the impact of orofacial tardive dyskinesia (TD) symptoms on the professional and social lives of patients with TD.Background:TD, a movement disorder affecting the face and extremities, may arise in patients taking antipsychotics. The impact of social stigma on the professional and social lives of patients with orofacial manifestations of TD has not been thoroughly examined.Methods:This study is an experimental, randomized digital survey of a general population sample. Three component surveys were developed, corresponding to employment, dating, and friendship domains. For each domain, participants were randomized 1:1 into either a test group (who viewed a video of a scripted interview with a standardized patient actor depicting TD movements) or a control group (who viewed the same actors but without TD movements), and asked about their impressions of the video subject. Actor simulations were validated by physicians familiar with TD and rehearsed to simulate a total Abnormal Involuntary Movement Scale score between 6 and 10. Statistical comparison was made using Wilcoxon sign-rank or chi-squared tests for continuous and categorical variables, respectively.Results:A total of 800 respondents completed each survey. In all domains, respondents had more-negative perceptions of actors portraying TD movements than of the same actors without movements. Regarding employment, 34.8% fewer respondents in the test group versus the control group agreed that the actor would be suitable for client-facing jobs (P<0.001). Regarding dating, the proportions of respondents who agreed that they would like to continue talking to the actor and who would be interested in meeting them for coffee/drink were 25.0% and 27.2% lower, respectively, in the test group than in the control group (P<0.001). Regarding friendship, the proportions of respondents who rated the actor as interesting and who would be interested in friendship with them were 18.8% and 16.5% lower, respectively, in the test group than in the control group (P<0.001).Conclusions:Actors simulating orofacial TD movements were perceived to be statistically significantly less likely to move forward in a job interview, be considered as a potential romantic partner, or be a new friend. This is the first study to quantify the stigma faced by people with TD in a variety of professional and social situations.Funding Acknowledgements:This study was funded by Teva Pharmaceuticals, Petach Tikva, Israel.
163 Appreciating Historical Racial and Ethnic Nuance in Developing Novel Approaches to Effective Communication of Mental Illness in the Black Community
Authors: Higgins Napoleon B. 
Published: April 2020

Abstract:There are many barriers to mental health care in the Black Community. These barriers lead to racial disparities in access to treatment and quality of life, along with inappropriate treatment and misdiagnosis in mental and physical health. These disparities directly lead to increased morbidity, mortality and poor mental health in the our communities. Many would question if Black people are not interested in mental health and don’t see it as a needed concern. This talk will address that all cultures are not the same and that there is a fundamental need to address communities on their terms and not make them conform into a "majority culture" approach and perception of mental health care, but rather focus on the individual patient and community needs for mental health care. Often psychiatrists and other mental health professionals are trained in a very academic scientific approach to identification and treatment of mental illness. Too often this model does not fit the needs of all patients due to it not taking into account ethnic differences in communication of mental health and desired outcomes of the patient. This often leads to a lack of understanding on with both sides, the mental health professional and the patient. Too often a patient may see the physician, be given a diagnosis, starts taking a prescription, but then not be able to explain what is their diagnosis, the name of the medication, what it is for, nor what is the medication supposed to do for them. This could lead to unexpected poor outcomes due to the lack of effective communication. This talk will attempt to explain the barriers of communication to the Black community while appreciating and supporting cultural nuance and effective communication. This is needed to help bring mental health to the community in a digestible way and to meet the communities needs on their level. To do this, psychiatry needs to shift it’s focus to understanding cultural characteristics, such as how Black patients may have different cultural needs and may benefit from a unique, customized approach to their mental health. There is a need for psychiatry to take into consideration the spiritual aspects of patients and how many focus not only on needing to improve themselves, but also on how their mental health and behavior are impacting their family and the community as a whole. The traditional model of interview, diagnosis with medication, and follow up for medication adjustment is not fitting all communities leading to the detriment of their mental health.