bluuebunny/crossref_metadata_2025_split huggingface dataset:
Examination of the Economic Burden of Frailty in Patients With Adult Spinal Deformity Undergoing Surgical Intervention
Authors: Passias Peter G. , Ahmad Waleed , Kummer Nicholas , Lafage Renaud , Lafage Virginie , Kebaish Khaled , Daniels Alan , Klineberg Eric , Soroceanu Alex , Gum Jeffrey , Line Breton , Hart Robert , Burton Douglas , Eastlack Robert , Jain Amit , Smith Justin S. , Ames Christopher P. , Shaffrey Christopher , Schwab Frank , Hostin Richard , Bess Shay 
Published: December 2021

BACKGROUND:
With increasing interest in cost optimization, costs of adult spinal deformity (ASD) surgery intersections with frailty merit investigation.

OBJECTIVE:
To investigate costs associated with ASD and frailty.

METHODS:
Patients with ASD (scoliosis ≥20°, sagittal vertical axis [SVA] ≥5 cm, pelvic tilt ≥ 25°, or thoracic kyphosis ≥ 60°) with baseline and 2-yr radiographic data were included. Patients were severely frail (SF), frail (F), or not frail (NF). Utility data were converted from Oswestry Disability Index to Short-Form Six-Dimension. Quality-adjusted life years (QALYs) used 3% rate for decline to life expectancy. Costs were calculated using PearlDiver. Loss of work costs were based on SRS-22rQ9 and US Bureau of Labor Statistics. Accounting for complications, length of stay, revisions, and death, cost per QALY at 2 yr and life expectancy were calculated.

RESULTS:
Five hundred ninety-two patients with ASD were included (59.8 ± 14.0 yr, 80% F, body mass index: 27.7 ± 6.0 kg/m2, Adult Spinal Deformity-Frailty Index: 3.3 ± 1.6, and Charlson Comorbidity Index: 1.8 ± 1.7). The average blood loss was 1569.3 mL, and the operative time was 376.6 min, with 63% undergoing osteotomy and 54% decompression. 69.3% had a posterior-only approach, 30% combined, and 0.7% anterior-only. 4.7% were SF, 22.3% F, and 73.0% NF. At baseline, 104 were unemployed losing $971.38 weekly. After 1 yr, 62 remained unemployed losing $50 508.64 yearly. With propensity score matching for baseline SVA, cost of ASD surgery at 2 yr for F/SF was greater than that for NF ($81 347 vs $69 722). Cost per QALY was higher for F/SF at 2 yr than that for NF ($436 473 vs $430 437). At life expectancy, cost per QALY differences became comparable ($58 965 vs $58 149).

CONCLUSION:
Despite greater initial cost, F and SF patients show greater improvement. Cost per QALY for NF and F patients becomes similar at life expectancy.
Syringomyelia From Extramedullary Compression: Resolution After Microsurgical Resection of a High-Cervical Spine Schwannoma: 2-Dimensional Operative Video
Authors: Mooney Michael A. , Al-Mefty Ossama 
Published: December 2021

Syringomyelia with compression at the foramen magnum is a well-studied subject with a pathophysiological hypothesis explaining syrinx development and treatment.
1,2
However, compression of the cervical cord, as in cervical spondylosis, can also lead to cavitation in the spinal cord.
3,4
Although the association of intramedullary spinal cord tumors with syringomyelia is well known,
5
the association of extramedullary tumors with syringomyelia is scarcely reported, and it is of unknown mechanism and uncertain outcomes regarding syrinx resolution.
Syringomyelia is reported to be associated with intramedullary spinal schwannoma.
6
However, spinal schwannomas are by and large extramedullary tumors that produce deficits through compressive radiculopathy or myelopathy. The association of extramedullary schwannomas with syringomyelia is extremely rare. In this article, we present a patient with an extramedullary high-cervical schwannoma causing significant syringomyelia who underwent microsurgical resection of the schwannoma, with subsequent total resolution of the syringomyelia. The patient consented for surgery.
Images from Lancet 1969 at 6:36 in video Reprinted from The Lancet, Vol. 294, Bernard Williams, The Distending Force in the Production of “Communicating Syringomyelia,” Pages 189-193, Copyright 1969, with permission from Elsevier.
The Utilization of the Cranio-Orbital Zygomatic Approach for the Resection of Juvenile Nasopharyngeal Angiofibroma: 2-Dimensional Operative Video
Authors: Aversa Antonio , Al-Mefty Ossama 
Published: December 2021

Juvenile angiofibroma is a rare benign expansive lesion typically affecting young men. Surgery is the current mainstay of treatment. Because it is a very vascular lesion, preoperative transarterial embolization can decrease intraoperative bleeding.
1,2
Transmaxillary or transpalatal approaches were used for totally extracranial lesions. Endonasal endoscopic resection became wildly used for radical excision with limited morbidity.
2
In large lesions with intracranial extension and cavernous sinus involvement (Fisch type 4), purely anterior approaches (endoscopic or transmaxillary) can be associated with significant carotid artery and cranial nerves injuries and excessive hemorrhage from internal carotid artery supply that cannot be eliminated by preoperative embolization.
3
Subtotal resection has been preconized in such cases, but tumor progression, cranial nerves and vision compromise, and major nasal postoperative bleeding could ensue. Radiotherapy of residual tumor has been associated with long-term complications, particularly given the young age of these patients.
2
The cranio-orbital zygomatic approach provides an excellent exposure to the extensions into the middle fossa, anterior fossa, cavernous sinus, paranasal sinus, and infratemporal fossa components of large angiofibromas.
4–6
It is particularly advantageous in the early interruption of the cavernous carotid feeders that are not amenable to safe embolization, rendering the tumor devascularized and bloodlessly resected. This article demonstrates the details and the advantages of this approach in a 13-year-old adolescent boy operated in 1997 for giant juvenile angiofibroma with extension in the middle fossa and the parasellar space with major vascularization from the cavernous carotid artery. The guardian consented to the procedure and publication of images.
Image at 3:05 reprinted with permission from Al-Mefty O, Operative Atlas of Meningiomas. Vol 1, © LWW, 1998. Image at 3:25 from Arnautović KI, Al-Mefty O, Angtuaco E. A combined microsurgical skull-base and endovascular approach to giant and large paraclinoid aneurysms. Surg Neurol. 1998;50(6):504-520; © Elsevier, 1998. Used with permission. Image at 9:21 reprinted from Kempe LG and Krekorian EA,
6
with permission from John Wiley and Sons, © 1969 The Triological Society.
The growth and expansion of meningeal lymphatic networks are affected in craniosynostosis
Authors: Ang Phillip S. , Matrongolo Matt J. , Tischfield Max A. 
Published: December 2021

ABSTRACT
Skull malformations are associated with vascular anomalies that can impair fluid balance in the central nervous system. We previously reported that humans with craniosynostosis and mutations in TWIST1 have dural venous sinus malformations. It is still unknown whether meningeal lymphatic networks, which are patterned alongside the venous sinuses, are also affected. We now show that the growth and expansion of meningeal lymphatics are perturbed in Twist1 craniosynostosis models. Changes to the local meningeal environment, including hypoplastic dura and venous malformations, affect the ability of lymphatic networks to sprout and remodel. Dorsal networks along the transverse sinus are hypoplastic with reduced branching. By contrast, basal networks closer to the skull base are more variably affected, showing exuberant growth in some animals, suggesting they are compensating for vessel loss in dorsal networks. Injecting a molecular tracer into cerebrospinal fluid reveals significantly less drainage to the deep cervical lymph nodes, which is indicative of impaired lymphatic function. Collectively, our results show that meningeal lymphatic networks are affected in craniosynostosis, suggesting that the clearance of β-amyloid and waste from the central nervous system may be impeded.
Comparison of temporal fine structure sensitivity and concurrent vowel perception between children with and without reading disability
Authors: Pitchaimuthu Arivudainambi , Ananth Eshwari , Bhat Jayashree S , Haralakatta Shivananjappa Somashekara 
Published: December 2021

Background: Children with reading disabilities (RD) exhibit difficulty in perceiving speech in background noise due to poor auditory stream segregation. There is a dearth of literature on measures of temporal fine structure sensitivity (TFS) and concurrent vowel perception abilities to assess auditory stream segregation in children with reading disabilities. Hence the present study compared temporal fine structure sensitivity (TFS) and concurrent vowel perception abilities between children with and without reading deficits. Method: The present research consisted of a total number of 30 participants, 15 children with reading disabilities (RD) and fifteen typically developing (TD) children within the age range of 7-14 years and were designated as Group 1 and Group 2 respectively. Both groups were matched for age, grade, and classroom curricular instructions. The groups were evaluated for TFS and concurrent vowel perception abilities and the performance was compared using independent ‘t’ test and repeated measure ANOVA respectively. Results: Results revealed that the children with RD performed significantly (p < 0.001) poorer than TD children on both TFS and concurrent vowel identification task. On concurrent vowel identification tasks, there was no significant interaction found between reading ability and F0 difference suggesting that the trend was similar in both the groups. Conclusion: The study concludes that the children with RD show poor temporal fine structure sensitivity and concurrent vowel identification scores compared to age and grade matched TD children owing to poor auditory stream segregation in children with RD.
The impact of ear growth on identification rates using an ear biometric system in young infants
Authors: Simukanga Alinani , Kobayashi Misaki , Etter Lauren , Qin Wenda , Pieciak Rachel , Albuquerque Duarte , Chen Yu-Jen , Betke Margrit , MacLeod William , Phiri Jackson , Mwananyanda Lawrence , Gill Christopher J. 
Published: December 2021

Background Accurate patient identification is essential for delivering longitudinal care. Our team developed an ear biometric system (SEARCH) to improve patient identification. To address how ear growth affects matching rates longitudinally, we constructed an infant cohort, obtaining ear image sets monthly to map a 9-month span of observations. This analysis had three main objectives: 1) map trajectory of ear growth during the first 9 months of life; 2) determine the impact of ear growth on matching accuracy; and 3) explore computer vision techniques to counter a loss of accuracy. Methodology Infants were enrolled from an urban clinic in Lusaka, Zambia. Roughly half were enrolled at their first vaccination visit and ~half at their last vaccination. Follow-up visits for each patient occurred monthly for 6 months. At each visit, we collected four images of the infant’s ears, and the child’s weight. We analyze ear area versus age and change in ear area versus age. We conduct pair-wise comparisons for all age intervals. Results From 227 enrolled infants we acquired age-specific datasets for 6 days through 9 months. Maximal ear growth occurred between 6 days and 14 weeks. Growth was significant until 6 months of age, after which further growth appeared minimal. Examining look-back performance to the 6-month visit, baseline pair-wise comparisons yielded identification rates that ranged 46.9–75%. Concatenating left and right ears per participant improved identification rates to 61.5–100%. Concatenating images captured on adjacent visits further improved identification rates to 90.3–100%. Lastly, combining these two approaches improved identification to 100%. All matching strategies showed the weakest matching rates during periods of maximal growth (i.e., <6 months). Conclusion By quantifying the effect that ear growth has on performance of the SEARCH platform, we show that ear identification is a feasible solution for patient identification in an infant population 6 months and above.
A Model of Product Line Marketing
Authors: He Chuan , Ke Shaowei , Zhang Xingtan 
Published: December 2021

Firms offer a variety of products to meet different customer needs. In many horizontally differentiated markets, prices are stable, and firms make infrequent adjustments to their product lines. Although prior research focused on product line design, we investigate how firms should allocate their marketing effort when their product lines are fixed. We propose a simple model to analyze product line marketing. Our model exhibits a flagship product effect in which the firm’s optimal marketing effort is concentrated, provided that the ratio between consumer tastes dispersion and the convexity of the cost of marketing effort is below a threshold. The flagship product is selected according to a marketing effort allocation index that measures the trade-off between a product’s markup and its potential market share. This result is robust with or without competition and whether prices are exogenous or endogenous. Firms often experience shocks to their marketing cost because of technological improvement or externalities. If a monopolist’s cost of marketing effort declines, she should place more emphasis on a low-utility, high-markup product. Conversely, if the cost increases, the monopolist may find it beneficial to focus her marketing effort on a high-utility, low-markup product. When multiproduct firms compete against each other, we show that if the opponent’s cost of marketing effort decreases, there can be a spillover effect, in which the firm benefits from the opponent’s cost reduction, thereby leading to a win-win situation. This paper was accepted by Dmitri Kuksov, marketing.
The Demand for, and Avoidance of, Information
Authors: Golman Russell , Loewenstein George , Molnar Andras , Saccardo Silvia 
Published: December 2021

Management scientists recognize that decision making depends on the information people have but lack a unified behavioral theory of the demand for (and avoidance of) information. Drawing on an existing theoretical framework in which utility depends on beliefs and the attention paid to them, we develop and test a theory of the demand for information encompassing instrumental considerations, curiosity, and desire to direct attention to beliefs one feels good about. We decompose an individual’s demand for information into the desire to refine beliefs, holding attention constant, and the desire to focus attention on anticipated beliefs, holding these beliefs constant. Because the utility of resolving uncertainty (i.e., refining beliefs) depends on the attention paid to it and more important or salient questions capture more attention, demand for information depends on the importance and salience of the question(s) it addresses. In addition, because getting new information focuses attention on one’s beliefs and people want to savor good news and ignore bad news, the desire to obtain or avoid information depends on the valence (i.e., goodness or badness) of anticipated beliefs. Five experiments (n = 2,361) test and find support for these hypotheses, looking at neutrally valenced as well as ego-relevant information. People are indeed more inclined to acquire information (a) when it feels more important, even if it cannot aid decision making (Experiments 1A and 2A); (b) when a question is more salient, manipulated through time lag (Experiments 1B and 2B); and (c) when anticipated beliefs have higher valence (Experiment 2C). This paper was accepted by Yan Chen, behavioral economics and decision analysis.
What you need to know about: delirium in older adults in hospital
Authors: Jones Howell T , Davis Daniel HJ 
Published: December 2021

Delirium is a clinical syndrome characterised by a disturbance of perception, consciousness and/or cognitive function, with an acute onset, fluctuating course and a severe deterioration arising over hours or days. Delirium is usually triggered by a combination of influences including acute illness, surgery, drugs and environmental factors. It is commonly seen in older people presenting to hospital, but can also develop during hospitalisation. There are three types of delirium: hypoactive, hyperactive and mixed. All patients over 65 years old presenting to hospital should be screened for delirium using the ‘4AT’ tool. An alternate method for diagnosing hospital-acquired delirium is described. This article outlines a 10-stage method for diagnosing, managing and preventing delirium, with emphasis on which areas of the history and examination should be prioritised, what the salient investigations are and both non-pharmacological and pharmacological approaches to preventing and treating delirium. Finally, this article explores which patients require specialist referrals or investigations and how to best follow up patients with delirium.
Consumption of single products versus fixed-dose combination medicines for hypertension and hyperlipidemia during 2015–2019 in South Korea
Authors: Lee Yujin , Shin Jihye , Kim Yujeong , Kim Dong-Sook 
Published: December 2021

Background
Fixed-dose combinations can simplify prescribing, and numerous combination products exist for hypertension and dyslipidemia in South Korea. This study’s aim was to compare trends in the consumption of single products versus fixed-dose combinations for hypertension and hyperlipidemia.

Methods and findings
We analyzed the Korean national health insurance claims database from January 2015 through December 2019. Consumption of medicines was calculated using the defined daily dose per 1,000 inhabitants per day (DIDs) and expenditures over time. During 2015–2019, the use of antihypertensive drugs increased with an annual growth rate (AGR) of 0.9% for single products and with an AGR of 35.6% for fixed-dose combinations. A notable increase was observed for antihyperlipidemic combination drugs with an AGR of 268.1% compared to single products with 35.7%. For older adults (65+ years), the consumption of drugs for hypertension and hyperlipidemia was 3–4.5 and about 3 times higher, respectively, than in adults aged 20–64 years, and a sharp increase was found in antihyperlipidemic fixed-dose combinations among older adults. A large increase was seen for C09 (agents acting on the renin-angiotensin system) with an AGR of 36.5%, especially C09DB (angiotensin II receptor blockers + calcium channel blockers) was widely used and steeply increased with 114.2%. For antihyperlipidemic drugs, C10AA (HMG CoA reductase inhibitors) accounted for a large share and sharply increased, with 52.1 DIDs in 2019 and with an AGR of 78.4%, whereas C10BA (combinations of various lipid modifying agents) increased 9.6 times from 2.9 DIDs (96 million USD) in 2015 to 27.7 DIDs (912 million USD) in 2019.

Conclusion
The findings of increased consumption and drug spending among older adults underscores the need for real-world evidence about health outcomes of fixed-dose combinations in this population.
Upper limb rehabilitation system based on virtual reality for breast cancer patients: Development and usability study
Authors: Zhou Zijun , Li Jiaxin , Wang He , Luan Ze , Li Yuan , Peng Xin 
Published: December 2021

Background
Functional exercise is crucial for breast cancer patients after surgery, and the use of virtual reality technology to assist patients with postoperative upper limb functional rehabilitation has gradually attracted the attention of researchers. However, the usability of the developed rehabilitation system is still unknown to a large extent. The purpose of this study was to develop a virtual reality upper limb rehabilitation system for patients after breast cancer surgery and to explore its usability.

Methods
We built a multidisciplinary team based on virtual reality and human-computer interaction technology and designed and developed an upper limb function rehabilitation system for breast cancer patients after surgery. Breast cancer patients were recruited from a grade III-a general hospital in Changchun city for the experiment. We used the System Usability Scale to evaluate the system availability, the Presence Questionnaire scale to measure the immersive virtual reality scene, and the Simulator Sickness Questionnaire subjective measurement scale for simulator sickness symptoms.

Results
This upper limb rehabilitation system hardware consisted of Head-mounted Display, a control handle and notebook computers. The software consisted of rehabilitation exercises and game modules. A total of 15 patients were tested on this system, all of whom were female. The mean age was 54.73±7.78 years, and no patients were excluded from the experiment because of adverse reactions such as dizziness and vomiting. The System Usability Scale score was 90.50±5.69, the Presence Questionnaire score was 113.40±9.58, the Simulator Sickness Questionnaire-nausea score was 0.93±1.16, the Simulator Sickness Questionnaire-oculomotor score was 0.80±1.27, the Simulator Sickness Questionnaire-disorientation score was 0.80±1.27, and the Simulator Sickness Questionnaire total score was 2.53±3.40.

Conclusions
This study fills in the blanks regarding the upper limb rehabilitation of breast cancer patients based on virtual reality technology system usability research. As the starting point of research in the future, we will improve the system’s function and design strictly randomized controlled trials, using larger samples in the promotion, to evaluate its application in breast cancer patients with upper limbs and other physiological functions and the feasibility and effects of rehabilitation.
Predicting life expectancy after geriatric hip fracture: A systematic review
Authors: Lee Alexander , Weintraub Sara , Xi Ianto Lin , Ahn Jaimo , Bernstein Joseph 
Published: December 2021

Background
Displaced femoral neck fractures in geriatric patients are typically treated with either hemiarthroplasty or total hip arthroplasty. The choice between hemiarthroplasty and total hip arthroplasty requires a good estimate of the patient’s life expectancy, as the recent HEALTH trial suggests that the benefits of the two operations do not diverge, if at all, until the second year post-operatively. A systematic review was this performed to determine if there sufficient information in the medical literature to estimate a patient’s life expectancy beyond two years and to identify those patient variables affecting survival of that duration.

Methods
Pubmed, Embase, and Cochrane databases were queried for articles reporting survival data for at least two years post-operatively for at least 100 patients, age 65 or greater, treated surgically for an isolated hip fracture. A final set of 43 papers was created. The methods section of all selected papers was then reviewed to determine which variables were collected in the studies and the results section was reviewed to note whether an effect was reported for all collected variables.

Results
There were 43 eligible studies with 25 unique variables identified. Only age, gender, comorbidities, the presence of dementia and fracture type were collected in a majority of studies, and within that, only age and gender were reported in a majority of the results. Most (15/ 25) variables were reported in 5 or fewer of the studies.

Discussion
There are important deficiencies in the literature precluding the evidence-based estimation of 2 year life expectancy. Because the ostensible advantages of total hip arthroplasty are reaped only by those who survive two years or more, there is a need for additional data collection, analysis and reporting regarding survival after geriatric hip fracture.