bluuebunny/crossref_metadata_2025_split huggingface dataset:
Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Perioperative Spine: Preoperative Osteoporosis Assessment
Authors: Dimar John , Bisson Erica F , Dhall Sanjay , Harrop James S , Hoh Daniel J , Mohamed Basma , Wang Marjorie C , Mummaneni Praveen V 
Published: July 2021

Abstract

BACKGROUND
Osteoporosis is a metabolic bone disease that commonly affects the elderly. Degenerative spinal disease that may require surgical intervention is also prevalent in this susceptible population. If undiagnosed or untreated before spine surgery, osteoporosis may result in an increased risk of postoperative adverse events. Nontreatment of osteoporosis preoperatively may be related to a poor understanding of bone physiology, a lack of standardized treatment algorithms, limited cost-effective interventions, and reluctance by spine surgeons to be the primary provider of osteoporosis management.

OBJECTIVE
The objective of this evidence-based review is to develop guidelines for the preoperative assessment and treatment of osteoporosis in patients undergoing spine surgery.

METHODS
A systematic review of the literature was performed using the National Library of Medicine/PubMed database and Embase for studies relevant to preoperative diagnostic studies that predict increased risk of osteoporosis-related postoperative adverse events and whether the preoperative treatment of low bone mineral density (BMD) in patients with osteoporosis improves outcome.

RESULTS
Out of 281 studies, 17 met the inclusion criteria and were included for systematic review. The task force affirmed a Grade B recommendation that preoperative osteoporosis testing with a dual-energy X-ray absorptiometry scan (T-score < −2.5), a computed tomography scan (Hounsfield units <97.9), and serum vitamin D3 level (<20 ng/mL) predict an increased risk of osteoporosis-related adverse events after spine surgery. The task force determined a Grade B recommendation that preoperative osteoporosis treatment with teriparatide increases BMD, induces earlier and more robust fusion, and may improve select patient outcomes. There is insufficient evidence regarding preoperative treatment with bisphosphonates alone and postoperative outcome.

CONCLUSION
This evidence-based clinical guideline provides a recommendation that patients with suspected osteoporosis undergo preoperative assessment and be appropriately counseled about the risk of postoperative adverse events if osteoporosis is confirmed. In addition, preoperative optimization of BMD with select treatments improves certain patient outcomes.
The full guidelines can be accessed at https://www.cns.org/guidelines/browse-guidelines-detail/3-preoperative-osteoporosis-assessment
H7N9 virus infection triggers lethal cytokine storm by activating gasdermin E-mediated pyroptosis of lung alveolar epithelial cells
Authors: Wan Xiaopeng , Li Jiqing , Wang Yupeng , Yu Xiaofei , He Xijun , Shi Jianzhong , Deng Guohua , Zeng Xianying , Tian Guobin , Li Yanbing , Jiang Yongping , Guan Yuntao , Li Chengjun , Shao Feng , Chen Hualan 
Published: July 2021

Abstract
The H7N9 influenza virus emerged in China in 2013, causing more than 1560 human infections, 39% of which were fatal. A ‘cytokine storm’ in the lungs of H7N9 patients has been linked to a poor prognosis and death; however, the underlying mechanism that triggers the cytokine storm is unknown. Here, we found that efficient replication of the H7N9 virus in mouse lungs activates gasdermin E (GSDME)-mediated pyroptosis in alveolar epithelial cells, and that the released cytosolic contents then trigger a cytokine storm. Knockout of Gsdme switched the manner of death of A549 and human primary alveolar epithelial cells from pyroptosis to apoptosis upon H7N9 virus infection, and Gsdme knockout mice survived H7N9 virus lethal infection. Our findings reveal that GSDME activation is a key and unique mechanism for the pulmonary cytokine storm and lethal outcome of H7N9 virus infection and thus opens a new door for the development of antivirals against the H7N9 virus.
Doctors’ reporting of mental health stigma and barriers to help-seeking
Authors: Wijeratne C , Johnco C , Draper B , Earl J 
Published: July 2021

Abstract

Background
Medical practitioners experience high levels of mental disorders but may be reluctant to seek care.

Aims
To determine medical practitioner attitudes towards other doctors with anxiety/depression, barriers to seeking mental healthcare, treatments received for depression and the effects of age.

Methods
Data from the National Mental Health Survey of Doctors and Medical Students, conducted in Australia, were analysed (N = 10 038 medical practitioners). Attitudes to anxiety/depression were assessed with 12 statements (total stigma score, range 12–60). Barriers to seeking professional help, and coping strategies used, for anxiety/depression were measured. Practitioners with a history of depression were asked what personal supports and treatments were received. Practitioners were compared by age—younger (40 years and younger), middle-aged (41–60) and older (61+).

Results
Attitudes and help-seeking behaviours varied with age. Older doctors had a more positive outlook and less total stigma, with the exception that they believed a doctor with anxiety/depression was less reliable. Younger practitioners were most likely to report barriers, such as confidentiality, impact on career progression and registration, to seeking help. For practitioners with depression, counselling and counselling plus medication were most likely to be received by the younger and middle-aged groups, whereas medication alone was most likely to be received by the middle-aged and older groups.

Conclusions
Stigmatizing attitudes towards mental disorder and barriers to help-seeking remain prevalent within the medical profession. Our results suggest doctors’ health programs should address mental health stigma in younger practitioners and facilitate education about psychological treatments in older practitioners.
A study of the accretion mechanisms of the high-mass X-ray binary IGR J00370+6122
Authors: Uchida Nagomi , Takahashi Hiromitsu , Fukazawa Yasushi , Makishima Kazuo 
Published: July 2021

Abstract
IGR J00370+6122 is a high-mass X-ray binary with a B1 Ib primary star and a companion suggested to be a neutron star because of the detection of a 346 s pulsation in a one-off 4 ks observation. To better understand the nature of the compact companion, the present work performs timing and spectral studies of the X-ray data of this object, taken with XMM-Newton, Swift, Suzaku, RXTE, and INTEGRAL. In the XMM-Newton data, a sign of coherent 674 s pulsation was detected, for which the previous 346 s period may be the second harmonic. The spectra exhibited the “harder when brighter” trend in the 1–10 keV range, and a flat continuum without clear cutoff in the 10–80 keV range. These properties are both similar to those observed from several low-luminosity accreting pulsars, including X Persei in particular. Thus, the compact object in IGR J00370+6122 is considered to be a magnetized neutron star with a rather low luminosity. The orbital period was refined to 15.6649 ± 0.0014 d. Along the orbit, the luminosity changes by three orders of magnitude, involving a sudden drop from ∼4 × 1033 to ∼1 × 1032 erg s−1 at an orbital phase of 0.3 (and probably vice verse at 0.95). Although these phenomena cannot be explained by simple Hoyle–Lyttleton accretion from the primary’s stellar winds, they can be explained when incorporating the propeller effect with a strong dipole magnetic field of ∼5 × 1013 G. Therefore, the neutron star in IGR J00370+6122 may have a stronger magnetic field compared to ordinary X-ray pulsars.
Skill-Biased Structural Change
Authors: Buera Francisco J , Kaboski Joseph P , Rogerson Richard , Vizcaino Juan I 
Published: July 2021

AbstractUsing a broad panel of advanced economies, we document that increases in GDP per capita are associated with a systematic shift in the composition of value added to sectors that are intensive in high-skill labour, a process we label as skill-biased structural change. It follows that further development in these economies leads to an increase in the relative demand for skilled labour. We develop a quantitative two-sector model of this process as a laboratory to assess the sources of the rise of the skill premium in the U.S. and a set of ten other advanced economies, over the period 1977 to 2005. For the U.S., we find that the sector-specific skill neutral component of technical change accounts for 18–24% of the overall increase of the skill premium due to technical change, and that the mechanism through which this component of technical change affects the skill premium is via skill-biased structural change.
COVID-19 and Its Impact on Financial Markets and the Real Economy
Authors: Goldstein Itay , Koijen Ralph S J , Mueller Holger M 
Published: July 2021

AbstractThe COVID-19 pandemic severely disrupted financial markets and the real economy worldwide. These extraordinary events prompted large monetary and fiscal policy interventions. Recognizing the unusual nature of the shock, the academic community has produced an impressive amount of research during the last year. Macro-finance models have been extended to analyze the impact of epidemics. Empirical papers study the origins and consequences of the disruptions and the impact of policy interventions. New research evaluates the ongoing financial fragility and its relation to previous episodes and regulations. This special issue contains early contributions to this important and rapidly developing literature.1
Revisiting the Source of Wilt Symptoms: X-Ray Microcomputed Tomography Provides Direct Evidence That Ralstonia Biomass Clogs Xylem Vessels
Authors: Ingel Brian , Caldwell Denise , Duong Fiona , Parkinson Dilworth Y. , McCulloh Katherine A. , Iyer-Pascuzzi Anjali S. , McElrone Andrew J. , Lowe-Power Tiffany M. 
Published: July 2021

Ralstonia causes wilt diseases by colonizing xylem vessels and disrupting water transport. The dogma is that bacterial biomass clogs vessels and reduces the flow of xylem sap due to Ralstonia abundance. However, the physiological mechanism of xylem disruption during bacterial wilt is untested. Using a tomato and Ralstonia pseudosolanacearum GMI1000 model, we visualized and quantified spatiotemporal dynamics of xylem disruption during bacterial wilt. First, we measured stomatal conductance of leaflets on mock-inoculated and wilt-symptomatic plants. Wilted leaflets had reduced stomatal conductance, as did turgid leaflets on the same petiole as wilted leaflets. Next, we used X-ray microcomputed tomography (X-ray microCT) and light microscopy to differentiate between mechanisms of xylem disruption: blockage by bacterial biomass, blockage by vascular tyloses, or sap displacement by gas embolisms. We imaged intact plant stems to quantify embolized vessels. Embolized vessels were rare, but infected plants with low bacterial populations had a nonsignificant trend of more vessel embolisms. To test whether vessels are clogged during bacterial wilt, we imaged excised stems after brief dehydration. Most vessels in mock-infected plants emptied their contents after excision, but nonconductive clogged vessels were abundant in infected plants by 2 days post infection. At wilt onset, when bacterial populations exceeded 5 × 108 CFU/g stem tissue, approximately half of the vessels were clogged with electron-dense bacterial biomass. We found no evidence of tyloses in X-ray microCT reconstructions or from light microscopy of preserved stems. Therefore, bacterial blockage of vessels appears to be the principal cause of xylem disruption during Ralstonia wilt. [Formula: see text] The author(s) have dedicated the work to the public domain under the Creative Commons CC0 “No Rights Reserved” license by waiving all of his or her rights to the work worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law, 2022.
A physician associate-led clinic for people with severe mental illness in the United Kingdom
Authors: Shah Chetan , Singh Pratima , Matin Samina , Farrow Joanne , Magon Rakesh , Zia Asif , Tatt-Smith Paris , Watson Charles , Smith Andrew 
Published: July 2021

ABSTRACT

Objective:
To evaluate an enhanced physical health clinic led by physician associates (PAs) for patients with severe mental illness.

Methods:
A guidance and data collection tool was developed to support and document the outcomes of the PA-led enhanced physical health clinic.

Results:
The clinic led to diagnoses of diabetes, hyperlipidemia, and hematologic abnormalities. One patient was started on metformin, two patients started a prediabetes program with their general practitioner, one patient started simvastatin, one patient switched from cigarettes to e-cigarettes, and one patient switched from olanzapine to aripiprazole because of metabolic adverse reactions. Three patients intended to contact the National Health Service for cancer screening for which they were eligible but they had not taken up.

Conclusions:
PAs can be integrated into a community mental health multidisciplinary team and support the physical health of people with severe mental illness. Mental health trusts should consider roles for PAs in their workforce planning.
Feasibility and Effectiveness of a Quality Improvement Curriculum for Combined Medicine Subspecialty Fellows
Authors: Hommel Erin , Sonstein Lindsay , Raji Mukaila 
Published: July 2021

Background:
The Accreditation Council for Graduate Medical Education (ACGME) requires training in quality improvement (QI) yet many programs struggle to incorporate appropriate content. Small fellowship programs may find it particularly difficult, limited by a lack of well-trained faculty. We report on the feasibility and effectiveness of a consolidated curriculum for subspecialty fellowship programs.

Methods:
Two QI experts were identified to design a curriculum. Interactive didactic sessions were created to guide development and implementation of fellow QI projects. All projects culminated in abstract/poster presentation.

Results:
Seven of 10 eligible fellowships participated. Twenty-four projects were completed with 70% reaching improvement in process measures. Trainees improved confidence in 11 of 12 QI domains. Program directors stated enhancement in QI education with 100% recommending program continuation.

Conclusions:
Consolidating teaching efforts with existing QI experts can lead to an effective QI curriculum for fellowship programs. This model can be expanded to other graduate medical education trainees as a means to increase QI proficiency.
Biologics as treatment options for anaphylaxis
Authors: Cafarotti Arianna , Fiocchi Alessandro , Arasi Stefania 
Published: July 2021

Purpose of review
To provide the most recent insights in the use of biologicals in the treatment of patients with anaphylaxis.

Recent findings
There is evidence that biologics such as omalizumab may be safe and effective in preventing anaphylactic reactions in patients at high risk mainly because of severe food allergy or desensitization procedures to food, airborne allergen, drugs, or hymenoptera venom.

Summary
Further knowledge will guide the adoption and implementation of any new therapy including biologics for anaphylaxis according to the stratification of risk/benefits.
A Novel Artificial Intelligence–assisted Risk Assessment Model for Preventing Complications in Esthetic Surgery
Authors: Bukret Williams E. 
Published: July 2021

Background
Prevention of complications to reduce morbidity and mortality, and improve patient satisfaction is of paramount importance to plastic surgeons. This study aimed to evaluate the predictive risk factors for complications and to validate a novel risk assessment model, using artificial intelligence.

METHODS
A retrospective review of esthetic surgery procedures performed by the author between 2015 and 2020 was conducted. The Pearson correlation test was used to analyze the risk factors and complications. Differences in the mean risk scores among the three risk groups were tested using one-way analysis of variance. Risk scoring was validated using a machine learning process with a support vector machine in a Google Colaboratory environment.

RESULTS
Of the 372 patients, 28 (7.5%) experienced complications. The Pearson correlation coefficients between the risk score and body mass index (BMI: 0.99), age (0.97), and Caprini score of 5 or more (0.98) were statistically significant (P < 0.01). The correlations between the risk scores and sex (−0.16, P = 0.58), smoking habit (−0.16, P = 0.58), or combined procedures (−0.16, P = 0.58) were not significant. Necrosis was significantly correlated with dehiscence (0.92, P = 0.003) and seroma (0.77, P = 0.041). The accuracy of the predictive model was 100% for the training sample and 97.3% for the test sample.

CONCLUSIONS
Body mass index, age, and the Caprini score were risk factors for complications following esthetic surgery. The proposed risk assessment system is a valid tool for improving eligibility and preventing complications.
Destination Design msTRAM: For Greater Reconstructive Certainty
Authors: Pripotnev Stahs , Williamson J. Scott 
Published: July 2021

Background:
Performing delayed reconstruction to a unilateral breast while simultaneously performing a balancing procedure on the contralateral side can be the most difficult situation to achieve symmetry. We present here a novel approach to free TRAM-based breast reconstruction using reverse planning and subunit principles with simultaneous balancing reduction mastopexy and immediate nipple reconstruction.

Methods:
A retrospective chart review and a BREAST-Q questionnaire of a single surgeon’s practice was performed to compare revision rates and patient satisfaction following Destination Design msTRAM reconstruction compared with a historical cohort of patients who received traditional free TRAM reconstruction.

Results:
The chart review identified 39 patients treated with the traditional unilateral technique from 1997 to 2004 and 88 patients treated with the novel unilateral technique from 2004 to 2017. Traditional technique patients had a breast revision rate of 64.1% and a nipple revision rate of 42.3% after secondary nipple reconstruction. Destination Design patients had a breast revision rate of 44.3% (P = 0.0394) and a nipple revision rate of 37.9% (P = 0.689) after primary nipple reconstruction. The BREAST-Q questionnaire was sent to nine traditional technique patients with 8 responses (89%), and 35 Destination Design patients with 25 responses (71%). Survey results showed that traditional technique and Destination Design patients had an overall breast satisfaction rate of 67.5% and 63.9%, respectively.

Conclusions:
The Destination Design msTRAM breast reconstruction technique leads to a statistically significant reduction in breast flap revisions, and allows for equally accurate immediate nipple reconstruction compared with traditional methods with no additional complications. Overall patient satisfaction is comparable with both techniques.
Factors associated with difficulty in adapting and intent to leave among new graduate nurses in South Korea
Authors: Park Sun-young , Kim Heejung , Ma Chenjuan 
Published: July 2021

Background
New graduate nurses experience difficulty in adapting to a new environment, which affects intent to leave. However, data on the factors contributing to difficulty in adapting and intent to leave among new graduate nurses are insufficient.

Purpose
The aim of the study was to explore and compare factors associated with difficulty in adapting and the intent to leave among new graduate nurses in South Korea.

Methodology
This cross-sectional study used secondary data analysis. Primary data were obtained from the 2015–2016 Korean National Graduates Occupational Mobility Survey. Descriptive statistics, independent t tests, and chi-square statistics with weighted samples besides multivariate logistic regression analyses were conducted (N = 467).

Results
Roughly 46% of nurses reported difficulty adapting, and 16% expressed their intent to leave. The factors linked to difficulty in adapting were working at large hospitals with rotating shifts, low person–job fit, and low satisfaction with personal competency; intent to leave was associated with high monthly salary and low satisfaction with the workplace (all ps < .05). Difficulty in adapting did not equate to their intent to leave.

Conclusions
There were high rates of difficulty in adapting and intent to leave among new graduate nurses. Although different factors were associated with difficulty adapting and intent to leave, workplace condition is a common factor.

Practice Implications
Different strategies are needed to improve adaptation and intention of leaving among new graduate nurses. For better adaptation, developing training programs enhancing professional competency with a sufficient training period is required. In addition, providing staff and resources to reduce the intent to leave is crucial.
Gender Differences in Personal and Situational Risk Factors for Traumatic Brain Injury Among Older Adults
Authors: Yu Wen-Yu , Hwang Hei-Fen , Lin Mau-Roung 
Published: July 2021

Objective:
To investigate differences between older men and women in Taiwan in personal and situational risk factors for sustaining a traumatic brain injury (TBI) versus soft-tissue injury (STI) due to a fall.

Design:
Matched case-control study.

Participants and Settings:
Cases were defined as patients with a primary diagnosis of TBI due to a fall and were identified from those 60 years or older who visited the emergency department (ED) of 3 university-affiliated hospitals in 2015. Matched by the same hospital ED, gender, and time of falling, 3 controls who had no TBI and who had sustained only soft-tissue injury (STI) due to falling were selected for comparison with each case. Personal factors and situational exposures were compared between the control and case groups. In total, 96 cases and 288 controls in men and 72 cases and 216 controls in women participated in this study.

Main Measures:
Personal factors (sociodemographic and lifestyle factors, medical characteristics, and functional abilities) and situational exposures (location, activities before the fall, center-of-mass change, type of fall, falling direction, protective response, and impact during the fall).

Results:
In men, after adjusting for other variables, older age (odds ratio [OR] = 1.04), regular alcohol use (OR = 2.03), an indoor fall (OR = 1.92), activity of getting in/out of bed (OR = 2.56), a fall due to dizziness (OR = 4.09), and falling backward (OR = 2.95) were independently associated with a higher odds of TBI. In women, an older age (OR = 1.03), the presence of Parkinson disease (OR = 10.4), activities of toileting (OR = 2.50), getting in/out of bed (OR = 4.90), and negotiating stairs (OR = 7.13), a fall due to dizziness (OR = 5.05), and falling backward (OR = 2.61) were independently associated with a higher odds of TBI.

Conclusions:
Our results demonstrated similarities and differences in personal and situational risk factors for fall-related TBIs versus STIs between older men and women, and gender differences should be considered when developing intervention strategies.