bluuebunny/crossref_metadata_2025_split huggingface dataset:
Detection of nearly periodic spin period reversals in Vela X-1 on long time-scales: inkling of solar-like cycle in the donor star?
Authors: Chandra Amar Deo , Roy Jayashree , Agrawal P C , Choudhury Manojendu 
Published: August 2021

ABSTRACT
We explore the long-term evolution of the spin period of the high-mass X-ray binary pulsar Vela X-1 over a period of 46 yr. Our analysis indicates nearly periodic variations in the spin period of the pulsar on time-scales of about 5.9 yr. There is suggestion of an overall spin-down behaviour of the pulsar though it is noticed that the source appears to stay near its equilibrium period 283.4 s since MJD 51000, with rather erratic spin-up/spin-down episodes around this value. Our study suggests nearly cyclic turnover in the spin behaviour of the pulsar from spin-up to spin-down regimes on time-scales of about 17–19 yr. To our knowledge, this is the first report of periodic variation in the spin behaviour of a wind-fed accreting pulsar. We also observe erratic episodes of spin-up and spin-down behaviour on relatively shorter time-scales that is a well-known archetype of this wind-fed X-ray pulsar. We investigate whether nearly periodic long-term spin period changes in the pulsar can be explained by using known mechanisms of torque reversals in the accretion powered neutron stars. It appears that changes in the accretion environment of the pulsar using current ideas can probably lead to long-term spin period changes in this X-ray pulsar.
Interim Federal Health Program: Survey of access and utilization by paediatric health care providers
Authors: Leps Caroline , Monteiro Jessica , Barozzino Tony , Bowry Ashna , Rashid Meb , Sgro Michael , Suleman Shazeen 
Published: August 2021

Abstract

Background
The Interim Federal Health Program (IFHP) provides health care coverage to refugees and refugee claimants, yet remains underused by providers. The objective of this study was to assess Canadian paediatricians’ current understanding and utilization of the IFHP, and perceived barriers to utilization.

Methods
A one-time survey was administered via the Canadian Paediatric Surveillance Program in February 2020. In addition to descriptive statistics, multinomial logistic regressions were built to examine paediatrician use of the IFHP, and characteristics associated with registration and use.

Results
Of the 2,753 physicians surveyed, there were 1,006 respondents (general paediatricians and subspecialists). 52.2% of respondents had provided care to IFHP-eligible patients in the previous 6 months. Of those participants, only 26.4% were registered IFHP providers, and just 16% could identify 80% or more of IFHP-covered services. Knowledge of 80% or more of IFHP-covered services was associated with registration status (adjusted odds ratio [aOR] 1.92; 95%CI 1.09 to 3.37). Among those who knew they were not registered, 70.2% indicated they did not know they had to register. aOR demonstrated that those with fewer years of practice had higher odds of not knowing that they had to register (aOR 1.22; 95%CI 1.01 to 1.49).

Conclusions
We demonstrate that IFHP is poorly utilized by paediatric providers, with low registration rates and poor understanding of IFHP-covered supplemental services, even among those who have recently provided care to IFHP-eligible patients. Efforts to improve registration and knowledge of IFHP are essential to improving access to health care for refugee children and youth.
Cerebrospinal Fluid Pathologies in Schizophrenia-Spectrum Disorder—A Retrospective Chart Review
Authors: Campana Mattia , Strauß Johanna , Münz Susanne , Oviedo-Salcedo Tatiana , Fernando Piyumi , Eichhorn Peter , Falkai Peter , Hasan Alkomiet , Wagner Elias 
Published: August 2021

Abstract

Background
The role of inflammatory processes in the etiology of schizophrenia is increasingly being investigated. A link between psychosis and inflammation measured with different biomarkers has been reported in the literature and needs to be further explored. To investigate the presence of inflammatory biomarkers in first-episode psychosis (FEP) we analyzed the largest available FEP cohort to date regarding routine CSF and blood diagnostics.

Methods
We report a retrospective analysis of clinical data from all inpatients that were admitted to our tertiary care hospital with a ICD-10 diagnosis of F2x (schizophrenia-spectrum) between January 1, 2008 and August 1, 2018 and underwent a lumbar puncture.

Results
A total of n = 314 FEP patients were included in our sample. 42.7% patients (134/314) showed cerebrospinal fluid (CSF) alterations. Oligoclonal bands in the CSF were present in 21.8% of patients (67/307) with 12.4% (27/217) of patients presenting OCBs type 2 or 3. 15.8% (49/310) of our cohort revealed signs of blood-brain-barrier (BBB) dysfunction with increased albumin ratios. Mean serum CRP levels were 2.4 mg/l (SD = 9.5). CRP elevation was present in 116/280 cases (41.4%).

Conclusions
This large retrospective analysis on FEP cohort greatly enriches the clinical data available on this population and contributes to the discussion around inflammation in psychosis. Of note, even though several inflammatory alterations were found both in CSF and in blood tests, we found no evidence for a significant relationship between peripheral inflammation and inflammatory CSF. Furthermore, no significant relationship between CSF alterations and peripheral inflammation measured with CRP could be established.
Unemployment and Opioid-Related Mortality Rates in U.S. Counties: Investigating Social Capital and Social Isolation-Smoking Pathways
Authors: Yang Tse-Chuan , Kim Seulki , Matthews Stephen A 
Published: August 2021

Abstract
We examine two mechanisms–social capital and socio-behavior–potentially linking unemployment rates to opioid-related mortality and investigate whether the mechanisms differ geographically by the pace of the opioid crisis. Applying path analysis techniques to 2015–2017 opioid-related mortality in U.S. counties (N=2,648), we find that (1) high unemployment rates are not directly associated with opioid-related mortality rates; (2) high unemployment rates are negatively associated with social capital, and low social capital contributes to high opioid-related mortality; (3) high unemployment rates increase social isolation and the prevalence of smoking, which is positively related to opioid-related mortality; and (4) the pathways are stronger among counties in the states experiencing a rapid growth in opioid-related mortality rates than among those states that are not. Our findings offer insight into how unemployment rates shape the opioid crisis and suggest that the relationship between unemployment and opioid-related mortality is complex.
US-situs foundations
Authors: Mayo Todd D , Staehr Amy M , Sanborn Von 
Published: August 2021

Abstract
In the United States, two states that have been at the vanguard of developing and enacting modern trust laws—New Hampshire and Wyoming—have recently enacted laws allowing foundations. For families seeking a US-situs foundation, both states provide similar, well-developed statutory regimes for foundations. The statutes have many common elements. One such element is the flexibility that families have when designing foundations. While that flexibility should enable most families to achieve their objectives in either state, some families may find that one state’s statutory regime is better suited to their particular situation and objectives. The present article presents the reader with a detailed comparative outline of the New Hampshire and Wyoming foundation laws.
Establishing a province-wide referral network to improve access to gender-affirming primary healthcare services
Authors: Lane Jennifer , McCarthy Christopher , Dart Garry , Furlotte Kirk 
Published: August 2021

Abstract:
It is possible and necessary to provide trans and gender nonconforming (TGNC) individuals with gender-affirming care (GAC) in primary care settings. A known risk of increased suicidality among TGNC individuals and a lack of provider training on prescribing gender-affirming hormones (GAH) in the Canadian province of Nova Scotia highlighted a need for building capacity around GAC delivery. A referral network was established across the province, which reduced wait times to access GAH by several months.
The Association of Asymmetric Skinfolds and the Diagnosis of Developmental Dysplasia of the Hip in Infants
Authors: Liu Bing , Hu Xiaoyun , Li Lianyong , Gao Shuxi 
Published: August 2021

Background:
The clinical finding of asymmetric skinfolds (ASF) in infants is used to indicate the possibility of developmental dysplasia of the hip (DDH). The association of ASF and a diagnosis of DDH remains unknown.

Purpose:
To determine the association of ASF in the gluteal and femoral regions with a diagnosis of DDH.

Methods:
The correlation of ASF and other physical examination findings with DDH was compared retrospectively. The medical records of infants who underwent DDH screening in the clinic were analyzed. The physical examination findings were reviewed and categorized as ASF, clunk of the hip, limb-length discrepancy, hip abduction limitation, combined conditions of musculoskeletal disorders, and regular screening for DDH. The hip conditions were classified by Graf's ultrasound method. Type IIb and higher classifications were defined as DDH. The diagnosed rate and severity of DDH based on physical examination findings were calculated and compared.

Results:
Clinical data of 3266 infants aged up to 6 months were reviewed, and 194 infants were diagnosed with DDH by ultrasound examination. ASF was the most common indication for DDH screening (64.5%; 2107/3266). However, this was poorly correlated with a diagnosis of DDH (4.79%; P < .0001). No difference was found between the Graf classification severity and various indications (P = .079).

Implications for Practice:
Clinicians should recognize that, although ASF is the most common reason for DDH screening in infants, ASF does not correlate with a diagnosis of DDH.

Implications for Research:
Additional research should examine the relationship between DDH and ASF in other populations.
Resectability of Pancreatic Cancer Is in the Eye of the Observer
Authors: Giannone Fabio , Capretti Giovanni , Abu Hilal Mohammed , Boggi Ugo , Campra Donata , Cappelli Carla , Casadei Riccardo , De Luca Raffaele , Falconi Massimo , Giannotti Gabriele , Gianotti Luca , Girelli Roberto , Gollini Paola , Ippolito Davide , Limerutti Giorgio , Maganuco Lorenzo , Malagnino Valeria , Malleo Giuseppe , Morone Mario , Mosconi Cristina , Mrakic Federica , Palumbo Diego , Salvia Roberto , Sgroi Salvatore , Zerbi Alessandro , Balzano Gianpaolo 
Published: August 2021

Objectives:
To determine the reproducibility of the National Comprehensive Cancer Network (NCCN) resectability status classification for pancreatic cancer.

Background:
The NCCN classification defines 3 resectability classes (resectable, borderline resectable, locally advanced), according to vascular invasion. It is used to recommend different approaches and stratify patients during clinical trials.

Methods:
Prospective, multicenter, observational study (trial ID: NCT03673423). Main outcome measure was the interobserver agreement of tumor assignment to different resectability classes and quantification of vascular invasion degrees. Agreement was measured by Fleiss’ k (k = 1 perfect agreement; k = 0 agreement by chance). Sixty-nine computed tomography (CT) scans of pathologically confirmed pancreatic adenocarcinoma were independently reviewed in a blinded fashion by 22 observers from 11 hospitals (11 surgeons and 11 radiologists). Rating differences between surgeons or radiologists and between hospitals with different volumes (≥60 or <60 resections/year) were assessed.

Results:
Complete agreement among 22 observers was recorded in 5 CT scans (7.2%), whereas 25 CT scans (36.2%) were variously assigned to all 3 resectability classes. Interobserver agreement varied from fair to moderate (Fleiss’ k range: 0.282–0.555), with the lowest agreement for borderline resectable tumors. Assessing vascular contact ≤180° had the lowest agreement for all vessels (k range: 0.196–0.362). The highest concordance was recorded for venous invasion >180° (k range: 0.619–0.756). Neither reviewers’ specialty nor hospital volume influenced the agreement.

Conclusions:
There is high variability in the assignment to resectability categories, which may compromise the reliability of treatments recommendations and the evidence of trials stratifying patients in resectability classes. Criteria should be revised to allow a reproducible classification.
Congenital Posteromedial Bowing of Tibia: Comparison of Early and Late Lengthening
Authors: Sagade Bhushan , Jagani Naeem , Chaudhary Ishani , Chaudhary Milind 
Published: August 2021

Background:
Congenital posteromedial bowing of tibia (CPMBT), a rare anomaly, is characterized by a decreasing deformity and a gradually increasing limb shortening. Lengthening in CPMBT has not been studied extensively. Our series compares the duration and complications of lengthening in younger versus older children to determine early lengthening safety and benefits.

Methods:
We studied 28 tibial lengthenings performed by a single surgeon in 23 patients, divided into 2 equal groups of 14 segments: group A 5 years or younger (preschool) and group B above 5 years. All were lengthened with circular external fixators, of which 3 were lengthened over a nail. We measured preoperative (bo) and postoperative (po) sagittal, coronal, and oblique plane deformities, initial limb length discrepancy (LLD), percentage LLD (% LLD), amount of lengthening (AmtL), percentage lengthening (%L), external fixator duration (EFD), and external fixator index (EFI). We graded complications by Lascombes’ criteria, results by Association for the Study and Application of the Methods of Ilizarov bone score.

Results:
The mean age was 8.8±7.1 years; the mean follow-up was 7.9 years. Group A had significantly greater bo-sagittal, coronal, and oblique plane deformities. Mean LLD (3.4 cm in group A vs. 4.1 cm in group B) was similar in both. Expected LLD at maturity (LLDM) using the multiplier method was greater than previously reported (mean, range in group A: 7.2 cm, 4.4 to 9.5 cm; group B: 5 cm, 2.5 to 9.7 cm). Though AmtL (3.5 and 4.1 cm) was similar in both, %L was 24% in group A and 15.7% in group B (P=0.002). EFD (116.6 days) and EFI (33.7 days/cm) were lesser in group A compared with group B (200.3 days, P=0.001; 50.2 days/cm, P=0.01). Lascombes’ triple contract was fulfilled in 11/14 lengthenings in group A versus 3/14 in group B. Association for the Study and Application of the Methods of Ilizarov bone score was good and excellent in both groups (P=0.44).

Conclusions:
In a large series of lengthenings in CPMBT, we found younger children presenting with large deformities and large projected length discrepancies could be safely lengthened with significantly lesser EFD and complications than in older children.

Level of Evidence:
Level IV—therapeutic study.
Fluid Balance and Ventilator-Associated Events Among Patients Admitted to ICUs in China: A Nested Case-Control Study*
Authors: Wang Wen , Zhu Shichao , He Qiao , Wang Mingqi , Kang Yan , Zhang Rui , Ji Peng , Zou Kang , Klompas Michael , Zong Zhiyong , Sun Xin 
Published: August 2021

OBJECTIVES:
Fluid therapy is an important component of intensive care management, however, optimal fluid management is unknown. The relationship between fluid balance and ventilator-associated events has not been well established. This study investigated the dose-response relationship between fluid balance and ventilator-associated events.

DESIGN:
Nested case-control study.

SETTING:
The study was based on a well-established, research-oriented registry of healthcare-associated infections at ICUs of West China Hospital system (Chengdu, China).

PATIENTS:
A total of 1,528 ventilator-associated event cases with 3,038 matched controls, who consistently underwent mechanical ventilation for at least 4 days from April 1, 2015, to December 31, 2018, were included.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
We calculated cumulative fluid balance within 4 days prior to ventilator-associated event occurrence. A weighted Cox proportional hazards model with restricted cubic splines was used to evaluate the dose-response relationship. A nonlinear relationship between fluid balance and all three tiers of ventilator-associated events, patients with fluid balance between –1 and 0 L had the lowest risk (p < 0.05 for nonlinear test). The risk of ventilator-associated event was significantly higher in patients with positive fluid balance (4 d cumulative fluid balance: 1 L: 1.19; 3 L: 1.92; 5 L: 2.58; 7 L: 3.24), but not in those with negative fluid balance (–5 L: 1.34; –3 L: 1.14; –1 L: 0.98).

CONCLUSIONS:
There was nonlinear relationship between fluid balance and all three tiers of ventilator-associated event, with an fluid balance between –1 and 0 L corresponding to the lowest risk. Positive but not negative fluid balance increased the risk of ventilator-associated events, with higher positive fluid balance more likely to lead to ventilator-associated events.
Safety Profile of Thread Lifts on the Face and Neck: An Evidence-Based Systematic Review
Authors: Pham Christine T. , Chu Sherman , Foulad Delila P. , Mesinkovska Natasha A. 
Published: August 2021

BACKGROUND
“Thread lifting” has quickly gained popularity as a minimally invasive treatment for facial rejuvenation. However, the effectiveness is questionable, and the safety and adverse effects are often not discussed.

OBJECTIVE
To identify and discuss the adverse effects associated with various types of threads.

MATERIALS AND METHODS
Studies describing the use of thread lifts were identified using a PubMed search. Inclusion criteria included studies in which barbed and nonbarbed threads were used for the face and neck.

RESULTS
Fifty-nine articles consisting of 14,222 patients (14,134 barbed, 81 nonbarbed, and 7 combined cases) were included. The most common side effects overall were facial asymmetry (n = 6,143), edema/tumefaction (n = 453), and ecchymosis (n = 407). Serious adverse effects were rare and consisted of paresthesias, alopecia, and injuries to vessels/glands. Most adverse effects were transient and self-resolving, with the exception of contour irregularities, injuries to vessels/glands, infections, and inflammatory reactions.

CONCLUSION
Most side effects associated with threads were self-resolving, whereas more serious cases subsided with treatment. Future studies are critical to further determine whether thread lifting provides long-lasting, safe, and satisfying results.
Anatomical Landmarks of the Beard Region
Authors: Durgun Ufuk , Ergün Selma Sönmez , Gayretli Özcan , Kelahmetoğlu Osman , Çamli Mehmet F. 
Published: August 2021

BACKGROUND
With recent advancements in hair restoration techniques, hair can be transplanted into nonscalp areas, such as the beard region, and the result looks natural. Although scalp zones and landmarks have been available for planning and designing the hairline, landmarks that will determine the beard lines are yet to be presented and made known for clinical practice.

OBJECTIVE
This study aimed to determine and analyze the beard lines and anatomical boundaries of the beard area to provide a more natural restoration/reconstruction appearance.

MATERIALS AND METHODS
The soft-tissue landmarks of the face that will enable physicians to create natural-looking beard lines were determined. Based on these important points, beard lines were analyzed with anthropometric methods by using the photographs of 32 male volunteers.

RESULTS
The ideal upper and lower beard lines and the anatomical boundaries of the beard area were determined using these landmarks.

CONCLUSION
These lines ensure that beard restoration/reconstruction provides a more natural appearance.
Weight Change and the Onset of Cardiovascular Diseases: Emulating Trials Using Electronic Health Records
Authors: Katsoulis Michail , Stavola Bianca D. , Diaz-Ordaz Karla , Gomes Manuel , Lai Alvina , Lagiou Pagona , Wannamethee Goya , Tsilidis Konstantinos , Lumbers R. Thomas , Denaxas Spiros , Banerjee Amitava , Parisinos Constantinos A. , Batterham Rachel , Patel Riyaz , Langenberg Claudia , Hemingway Harry 
Published: August 2021

Background:
Cross-sectional measures of body mass index (BMI) are associated with cardiovascular disease (CVD) incidence, but less is known about whether weight change affects the risk of CVD.

Methods:
We estimated the effect of 2-y weight change interventions on 7-y risk of CVD (CVD death, myocardial infarction, stroke, hospitalization from coronary heart disease, and heart failure) by emulating hypothetical interventions using electronic health records. We identified 138,567 individuals with 45–69 years of age without chronic disease in England from 1998 to 2016. We performed pooled logistic regression, using inverse-probability weighting to adjust for baseline and time-varying confounders. We categorized each individual into a weight loss, maintenance, or gain group.

Results:
Among those of normal weight, both weight loss [risk difference (RD) vs. weight maintenance = 1.5% (0.3% to 3.0%)] and gain [RD = 1.3% (0.5% to 2.2%)] were associated with increased risk for CVD compared with weight maintenance. Among overweight individuals, we observed moderately higher risk of CVD in both the weight loss [RD = 0.7% (−0.2% to 1.7%)] and the weight gain group [RD = 0.7% (−0.1% to 1.7%)], compared with maintenance. In the obese, those losing weight showed lower risk of coronary heart disease [RD = −1.4% (−2.4% to −0.6%)] but not of stroke. When we assumed that chronic disease occurred 1–3 years before the recorded date, estimates for weight loss and gain were attenuated among overweight individuals; estimates for loss were lower among obese individuals.

Conclusion:
Among individuals with obesity, the weight-loss group had a lower risk of coronary heart disease but not of stroke. Weight gain was associated with increased risk of CVD across BMI groups. See video abstract at, http://links.lww.com/EDE/B838.
CLINICAL FEATURES AND SURGICAL OUTCOMES OF ENCIRCLING SCLERAL BUCKLING WITH CRYOTHERAPY IN FAMILIAL EXUDATIVE VITREORETINOPATHY-ASSOCIATED RHEGMATOGENOUS RETINAL DETACHMENT
Authors: Huang Liuhui , Liang Tingyi , Lyu Jiao , Jin Haiying , Zhao Peiquan 
Published: August 2021

Purpose:
To report the clinical features and surgical outcomes of encircling scleral buckling surgery with cryotherapy in familial exudative vitreoretinopathy (FEVR) patients with rhegmatogenous RD.

Methods:
This study was a consecutive, retrospective interventional case series. Clinical features, including the FEVR stage, proliferative vitreoretinopathy grade, range of RD and degeneration, and presence of retinal breaks, and surgical outcomes, including the success rate, best-corrected visual acuity, and myopic shift, were analyzed.

Results:
There were 16 eyes with Stage 3A FEVR and eight eyes with Stage 4A FEVR. 13 eyes had Grade A proliferative vitreoretinopathy, and 11 eyes had Grade B proliferative vitreoretinopathy. Retinal reattachment was achieved in 22 of 24 eyes (91.67%) with FEVR-rhegmatogenous RD after initial encircling scleral buckling surgery. The best-corrected visual acuity improved from a mean of 1.08 ± 0.86 logarithm of the minimum angle of resolution preoperatively to 0.45 ± 0.41 logarithm of the minimum angle of resolution postoperatively (P < 0.01). A myopic shift of −2.39 ± 1.38 (range, −1 to −6) diopter (P < 0.01) was observed. The mean follow-up period was 34.5 ± 27.7 (range, 7–104) months.

Conclusion:
Our study clarified the efficacy of encircling scleral buckling surgery with cryotherapy in FEVR-rhegmatogenous RD with Stage 3A or 4A FEVR and Grade A or B proliferative vitreoretinopathy, especially in patients with multiple retinal holes.