bluuebunny/crossref_metadata_2025_split huggingface dataset:
The shell phenotypic variability of the keyhole limpetFissurella latimarginata: insights from an experimental approach using a water flow flume
Authors: Vasconcelos Joana , Caamaño Diego , Tuset Víctor M , Sousa Ricardo , Riera Rodrigo 
Published: November 2021

ABSTRACTHydrodynamics are a major environmental factor on intertidal rocky shores. Morphological responses to this factor are expected to strongly influence spatial distribution of species across environmental gradients. We here analysed the shell phenotypic variability of the limpet Fissurella latimarginata using geometric morphometric analysis. The limpets were obtained from a sheltered intertidal coastal area and a wave-exposed environment. To determine whether the shell shape variation of the intertidal molluscs is linked to their resistance to differential intertidal wave exposure, mesocosm studies were developed in a hydraulic flume to explore the effects of hydrodynamic forces on this limpet species. A unidirectional current was used to test the impacts of step-by-step increased current flow velocities for each limpet. The phenotypic variability observed in the populations of F. latimarginata was associated with habitats characterized by contrasting wave exposure. Limpets from exposed environments showed a flattened, round to laterally wider and posteriorly narrower shell shape, larger foot and higher full limpet height, and were dislodged at higher velocities. A more laterally compressed and peaked shape was found in limpets from sheltered areas and these showed a lower resistance to wave action by dislodging at lower velocities.
Advocacy in European Civil Societies: Organizational Trade-offs Between Selective and Collective Incentive Provision
Authors: Bolleyer Nicole , Correa Patricia 
Published: November 2021

AbstractCivil society organizations (CSOs) are a cornerstone of democracy in Europe. Nonetheless, “civil society” and “political society” should not be equated as membership-based organizations are not necessarily politically engaged. This paper theorizes and empirically examines which membership-based CSOs engage in interest representation through sustained advocacy activity. We propose an incentive-theoretical framework on CSO investments in advocacy activities—a collective, non-exclusive incentive from which also non-members can profit—by organizations fundamentally dependent on member support. Theorizing how CSOs' own structural characteristics, resource dependencies, and government demand for CSO input affect how CSOs reconcile selective and collective incentive provision, we test our hypotheses using new data from four recent surveys conducted in four European democracies. In line with our framework, CSOs organizing individual citizens rather than corporate actors and those pursuing member interests are less likely to engage in advocacy, while CSO professionalization and state funding access enhance CSOs’ propensities to do so. Furthermore, the analysis shows that the former structural CSO characteristics are similarly relevant for CSO advocacy across distinct country settings, while the role of resource variables is mediated by institutional context revealing an important source of inequality in democratic interest representation.
Sex-Specific Risk Factors and Health Disparity Among Hepatitis C Positive Patients Receiving Pharmacotherapy for Opioid Use Disorder: Findings From a Propensity Matched Analysis
Authors: Dennis Brittany B. , Martin Leslie J. , Naji Leen , Akhtar Daud , Cholankeril George , Kim Donghee , Sanger Nitika , Hillmer Alannah , Chawar Caroul , D’Elia Alessia , Panesar Balpreet , Worster Andrew , Marsh David C. , O’Shea Tim , Bawor Monica , Thabane Lehana , Samaan Zainab , Ahmed Aijaz 
Published: November 2021

Background
The incidence of opioid-related fatality has reached unparalleled levels across North America. Patients with comorbid hepatitis C virus (HCV) remain the most vulnerable and difficult to treat. Considering the unique challenges associated with this population, we aimed to re-examine the impact of HCV on response to medication assistant treatment for opioid use disorder and establish sex-specific risk factors affecting care.

Methods
This study employs a multi-center prospective cohort design, with 1-year follow-up. Patients aged ≥18, receiving methadone for opioid use disorder were recruited from a network of outpatient opioid addiction treatment centers across Southern Ontario, Canada. Patients with ≥50% positive opioid urine screens over 1 year of follow-up were classified as poor responders. The prognostic impact of HCV on response was established using a propensity score matched analysis. Sex-specific regression models were constructed to evaluate risk factors for treatment response.

Results
Among participants eligible for inclusion (n = 1234), HCV was prevalent in 25% (n = 307). HCV patients exhibited significantly higher rates of high-risk opioid consumption patterns 35.29% (standard deviation 0.478). Sex-specific examination revealed females with HCV incur a 2 times increased risk for high-risk opioid consumption behaviors (female odds ratio: 1.95, 95% confidence interval 1.23, 3.10; P = 0.01).

Conclusions
Findings from this study establish the link between HCV and poor treatment response, with differentially higher risk among female patients. In light of the high potential for overdose among this population, concerted efforts are required for distinguishing the source for sex-based disparities, in addition to establishing trauma and gender informed treatment protocols.
What Are the Long-Term Changes to Bowel Function Patient-reported Outcomes After Elective Sigmoidectomy for Diverticular Disease?
Authors: Gray Phillip J. , Goldwag Jenaya L. , Eid Mark A. , Trooboff Spencer W. , Wilson Matthew Z. , Ivatury Srinivas J. 
Published: November 2021

Objective:
To evaluate long-term changes to bowel function after elective sigmoidectomy for diverticular disease.

Background:
For patients with diverticular disease, choosing surgery is often based on the presumption of improvement in preoperative symptoms. Our group previously reported bowel function does not change in the early perioperative period; however, studies of long-term outcomes are limited.

Methods:
This is an observational study of patients that underwent elective sigmoidectomy for diverticular disease and completed the Colorectal Functional Outcome (COREFO) questionnaire before surgery. Patients were stratified into two groups based on presence or absence of a preoperative symptomatic score (i.e., total COREFO ≥ 15). Long-term bowel function (>1 year from surgery) was assessed using the COREFO questionnaire via telephone or subsequent clinic visit. Paired t-tests compared mean preoperative scores to mean long-term scores.

Results:
Fifty-one patients met inclusion criteria (21 symptomatic, 30 asymptomatic). All symptomatic patients had uncomplicated disease, whereas 90% of asymptomatic patients had complicated disease. Median time from operation to questionnaire completion was 23 months (IQR = 13–34). Asymptomatic patients demonstrated impaired bowel function, predominantly driven by changes in the social impact domain. Symptomatic patients demonstrated improved bowel function, driven by changes in the incontinence, social impact, stool-related aspects, and need for medication domains.

Conclusions:
In the long-term after elective sigmoidectomy for diverticular disease, patients with symptomatic bowel function preoperatively improve substantially, while those with asymptomatic preoperative scores demonstrate statistically significant impairment. Patients determined to be symptomatic with patient-reported outcomes likely benefit long-term from sigmoid resection.
Mini-Abstract: In this manuscript, long-term changes to patient-reported bowel function were assessed using a validated questionnaire after sigmoidectomy for diverticular disease. We found that in patients with symptomatic preoperative bowel function, long-term bowel function improved after elective resection. Alternatively, patients with asymptomatic preoperative bowel function demonstrated long-term impairment in bowel function.
Reverberation Degrades Pitch Perception but Not Mandarin Tone and Vowel Recognition of Cochlear Implant Users
Authors: Xu Lei , Luo Jianfen , Xie Dianzhao , Chao Xiuhua , Wang Ruijie , Zahorik Pavel , Luo Xin 
Published: November 2021

Objectives:
The primary goal of this study was to investigate the effects of reverberation on Mandarin tone and vowel recognition of cochlear implant (CI) users and normal-hearing (NH) listeners. To understand the performance of Mandarin tone recognition, this study also measured participants’ pitch perception and the availability of temporal envelope cues in reverberation.

Design:
Fifteen CI users and nine NH listeners, all Mandarin speakers, were asked to recognize Mandarin single-vowels produced in four lexical tones and rank harmonic complex tones in pitch with different reverberation times (RTs) from 0 to 1 second. Virtual acoustic techniques were used to simulate rooms with different degrees of reverberation. Vowel duration and correlation between amplitude envelope and fundamental frequency (F0) contour were analyzed for different tones as a function of the RT.

Results:
Vowel durations of different tones significantly increased with longer RTs. Amplitude-F0 correlation remained similar for the falling Tone 4 but greatly decreased for the other tones in reverberation. NH listeners had robust pitch-ranking, tone recognition, and vowel recognition performance as the RT increased. Reverberation significantly degraded CI users’ pitch-ranking thresholds but did not significantly affect the overall scores of tone and vowel recognition with CIs. Detailed analyses of tone confusion matrices showed that CI users reduced the flat Tone-1 responses but increased the falling Tone-4 responses in reverberation, possibly due to the falling amplitude envelope of late reflections after the original vowel segment. CI users’ tone recognition scores were not correlated with their pitch-ranking thresholds.

Conclusions:
NH listeners can reliably recognize Mandarin tones in reverberation using salient pitch cues from spectral and temporal fine structures. However, CI users have poorer pitch perception using F0-related amplitude modulations that are reduced in reverberation. Reverberation distorts speech amplitude envelopes, which affect the distribution of tone responses but not the accuracy of tone recognition with CIs. Recognition of vowels with stationary formant trajectories is not affected by reverberation for both NH listeners and CI users, regardless of the available spectral resolution. Future studies should test how the relatively stable vowel and tone recognition may contribute to sentence recognition in reverberation of Mandarin-speaking CI users.
Comparison of Patient-Reported Outcomes After Suprapatellar Versus Infrapatellar Nailing Techniques for Tibial Shaft Fractures: A Systematic Review and Meta-analysis
Authors: Sepehri Aresh , You Daniel , Lobo Akshay A. , Schneider Prism , Lefaivre Kelly A. , Guy Pierre 
Published: November 2021

Objectives:
To compare patient-reported outcome measures (PROMs) between patients who underwent intramedullary nail (IMN) fixation for tibial shaft fractures using an infrapatellar (IP) or the newer suprapatellar (SP) approach. Secondary outcomes included fluoroscopic radiation exposure, operative time, and radiographic outcomes.

Data Sources:
A systematic literature search of the databases Ovid MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials Study Selection.

Study Selection:
Level I to III studies in which patients over the age of 18 years with acute tibial shaft fractures who underwent tibial IMN fixation using an IP or SP approach for fracture fixation were assessed for inclusion. Studies with a minimum of 10 patients in each cohort that reported on postoperative patient-reported outcomes with at least 6 months of follow-up were included for analysis.

Data Extraction and Synthesis:
Twelve studies that reported PROMs and compared IP and SP intramedullary nailing of tibial shaft fractures were analyzed. This included 654 patients who underwent IP IMN fixation and 542 patients who underwent SP IMN fixation. A random-effects model for unadjusted/crude study estimates were pooled using inverse variance (IV) weighting for continuous variable analysis.

Conclusions:
This review found a significant improvement in PROM for patients with tibial shaft fractures when the SP IMN technique was used. In addition, there was a significant decrease in intraoperative fluoroscopy time consistent with other radiographic findings demonstrating improved start point accuracy and reduction with SP IMN fixation of tibial shaft fractures.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Age-related Outcomes and Complications of Osteodistraction in the Pediatric Upper Extremity: A Large Retrospective Single-center Study of 61 Cases
Authors: Scheider Philipp , Ganger Rudolf , Farr Sebastian 
Published: November 2021

Background:
The study purpose was to assess: (1) the complication rate of osteodistraction in the pediatric upper extremity, its severity and relation to patient-specific and treatment-specific parameters, and (2) dedicated patient-reported outcome scores after these procedures.

Methods:
This retrospective study analyzed a chart of patients undergoing osteodistraction of the upper limb between 2003 and 2020. Demographics, distraction-specific parameters, healing index, and any complications graded according to the Sink grading scale (grades 1 to 5) were extracted. An additional phone interview was performed to assess patient satisfaction and functionality of the elongated limb using the Quick-DASH (Disabilities of Arm, Shoulder, and Hand) score.

Results:
This study included 61 cases from 48 individual patients. The mean age at the start of distraction was 11.5±3.6 years. The ulna was the most frequently lengthened bone, with 21 (34.4%) cases. Ninety-four complications were observed, with an average complication rate of 77.0%. Based on the Sink grading scale (1 to 5), grade 3 complications were most common (n=29; 47.5%) followed by grade 1 (n=14; 23.0%), 2 (n=14; 23.0%), and 4 (n=4; 6.6%). A significantly lower and thus better bone healing index was observed for the age category less than 10 years compared with the 14 to 18 years group (P=0.006). The average satisfaction was 4.2±1.0 points of 5. The mean Quick-DASH score was 14.1±12.5, indicating very good clinical outcomes.

Conclusions:
Despite the occurrence of numerous complications, high patient satisfaction and good daily life functionality of the treated limb was observed. An age of more than 14 years at the beginning of therapy had a negative prognostic effect on bone healing during distraction. Thus, osteodistraction in the upper extremity may preferably be performed less than 10 years of age because of enhanced bone regeneration.

Level of Evidence:
Level IV—retrospective case series.
Limb Lengthening With Precice Intramedullary Lengthening Nails in Children and Adolescents
Authors: Radler Christof , Mindler Gabriel T. , Stauffer Alexandra , Weiß Carina , Ganger Rudolf 
Published: November 2021

Background:
The Precice intramedullary bone lengthening nail has been used in our department since 2013. We sought to determine the efficacy and safety of intramedullary limb lengthening with Precice nails in children and adolescents.

Methods:
We retrospectively investigated patients 18 years and younger who underwent lower-limb lengthening using the Precice nail. Radiologic and clinical outcome data were obtained from a prospective database. The minimum postimplantation follow-up was 12 months. Between March 2013 and March 2020, 161 patients underwent limb lengthening with a Precice nail; 76 patients met the inclusion criteria.

Results:
We used 84 nails in 76 patients (68 femurs and 16 tibias). Femoral nails were inserted using an antegrade approach in 57 patients and a retrograde approach in 11. The mean age at surgery was 16 years (range, 9 to 18 y). The mean lengthening was 33 mm (range, 14 to 80 mm) with additional acute axial or rotational malalignment correction in 16 segments. At the last follow-up (mean=2.1, years; range, 1 to 5 y), all regenerates had healed and all patients were mobile with full weight-bearing. Complications that necessitated surgical revision occurred in 6 patients (8%), and the desired lengthening was not achieved in 2 patients. Postlengthening malalignment occurred in 4 patients (5 tibial nails). The weight-bearing index, defined as days from surgery to full weight-bearing/cm of lengthening, was a mean of 45 days (range, 7 to 127 d/cm).

Conclusions:
The Precice nail facilitated reliable and safe bone lengthening and was associated with a low complication rate. Correction of additional malalignment was possible by applying intraoperative acute correction or guided growth.

Level of Evidence:
Level IV—therapeutic study investigating the results of treatment.
Faculty Development Offered by US Medical Schools: A National Survey of Pediatric Educators
Authors: Osman Cynthia , Bradshaw Chanda , Tewksbury Linda 
Published: November 2021

Introduction:
There are limited data on the status of faculty development (FD) in the United States. Through a national survey of pediatric educators, we explored the frequency and topics of FD on teaching skills offered at US medical schools, as well as the strategies' schools use to encourage and track participation.

Methods:
Five piloted questions were included in the 2017 Annual Council on Medical Student Education in Pediatrics Survey. We used descriptive statistics.

Results:
Ninety-seven (66%) of the 148 surveyed US medical schools responded to at least one FD question. Ninety-eight percent of respondents reported being offered FD on teaching, with 97% of those respondents reporting that FD occurred at least annually. A variety of FD topics were reported, with feedback and precepting being most common. Incentives included continuing medical education (CME credit) (39%) and being relieved of clinical duties (23%). However, 29% reported little support for FD. Only 20% of schools reported their department tracked FD participation outside the department.

Discussion:
Our data suggest that the majority of medical schools offer FD on teaching skills at least yearly, with a variety of topics. Institutions utilize a variety of incentives for participation. However, a significant minority of respondents reported little support for FD. Further, departments rarely track faculty FD participation.
Attention-Deficit/Hyperactivity Disorder Practice Patterns: A Survey of Kentucky Pediatric Providers
Authors: Trace Marie E. , Feygin Yana B. , Williams Patricia G. , Winders Davis Deborah , Brothers Kyle B. , Sullivan Janice E. , Calhoun Aaron W. 
Published: November 2021

ABSTRACT:

Objective:
Kentucky ranks among the highest in the nation for attention-deficit/hyperactivity disorder (ADHD) prevalence in children aged 4 to 17 years. In 2011, the American Academy of Pediatrics (AAP) released a clinical practice guideline based on the DSM-IV. A guideline revision based on the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) was released in October 2019. In this study, we assess and describe pediatric providers' ADHD practices using the 2011 guideline and DSM-5 diagnostic criteria.

Methods:
This was a cross-sectional, survey-based descriptive study. Kentucky Chapter of the AAP (KY AAP) members were anonymously surveyed. The results were examined for trends in routine practice.

Results:
Fifty-eight general pediatricians and pediatric residents responded to the survey, yielding a 38% (58/154) response rate. Among respondents performing routine diagnosis of ADHD (N = 51), 73% (37/51) used DSM-5 criteria. Most providers usually or always initially assessed for coexisting behavioral conditions (96%; 49/51), developmental conditions (78%; 39/51), and adverse childhood experiences (73%; 37/51). Among respondents performing routine management of ADHD (N = 55), only 11% (6/55) of respondents indicated that they titrated stimulant medications every 3 to 7 days. After initiation of medication, 78% of providers scheduled a follow-up visit within 2 to 4 weeks. During subsequent visits, only half indicated discussing behavioral interventions, screening for coexisting conditions, and reviewing follow-up teacher-rated ADHD scales.

Conclusion:
Pediatricians in the KY AAP adhere to the DSM-5 criteria for diagnosing ADHD. Pediatric providers' practices would benefit from education in improvements in pharmacotherapy titration, surveillance of coexisting conditions associated with ADHD, discussion of psychosocial interventions, and school support strategies.
The Impact of Keeping Indoor Dining Closed on COVID-19 Rates Among Large US Cities
Authors: Schnake-Mahl Alina S. , O’Leary Gabriella , Mullachery Pricila H. , Vaidya Vaishnavi , Connor Gabrielle , Rollins Heather , Kolker Jennifer , Diez Roux Ana V. , Bilal Usama 
Published: November 2021

Background:
Indoor dining is one of the potential drivers of COVID-19 transmission. We used the heterogeneity among state government preemption of city indoor dining closures to estimate the impact of keeping indoor dining closed on COVID-19 incidence.

Methods:
We obtained case rates and city or state reopening dates from March to October 2020 in 11 US cities. We categorized cities as treatment cities that were allowed by the state to reopen but kept indoor dining closed or comparison cities that would have kept indoor dining closed but that were preempted by their state and had to reopen indoor dining. We modeled associations using a difference-in-difference approach and an event study specification. We ran negative binomial regression models, with city-day as the unit of analysis, city population as an offset, and controlling for time-varying nonpharmaceutical interventions, as well as city and time fixed effects in sensitivity analysis and the event study specification.

Results:
Keeping indoor dining closed was associated with a 55% (IRR = 0.45; 95% confidence intervals = 0.21, 0.99) decline in the new COVID-19 case rate over 6 weeks compared with cities that reopened indoor dining, and these results were consistent after testing alternative modeling strategies.

Conclusions:
Keeping indoor dining closed may be directly or indirectly associated with reductions in COVID-19 spread. Evidence of the relationship between indoor dining and COVID-19 case rates can inform policies to restrict indoor dining as a tailored strategy to reduce COVID-19 incidence. See video abstract at, http://links.lww.com/EDE/B902.