bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhanced angiogenesis by the hyaluronic acid hydrogels immobilized with a VEGF mimetic peptide in a traumatic brain injury model in rats
Authors: Lu Jiaju , Guan Fengyi , Cui Fuzhai , Sun Xiaodan , Zhao Lingyun , Wang Ying , Wang Xiumei 
Published: August 2019

AbstractAngiogenesis plays an important role in brain injury repair, which contributes to the reconstruction of regenerative neurovascular niche for promoting axonal regeneration in the lesion area. As a major component of developing brain extracellular matrix, hyaluronic acid (HA) has attracted more attention as a supporting matrix for brain repair. In the present study, HA-KLT hydrogel was developed via modifying HA with a VEGF mimetic peptide of KLT (KLTWQELYQLKYKGI). The characterization of the hydrogel shows that it could provide a porous, three-dimensional scaffold structure, which has a large specific surface area available for cell adhesion and interaction. Compared with the unmodified HA hydrogel, the HA-KLT hydrogel could effectively promote the attachment, spreading and proliferation of endothelial cells in vitro. Furthermore, the pro-angiogenic ability of hydrogels in vivo was evaluated by implanting them into the lesion cavities in the injured rat brain. Our results showed that the hydrogels could form a permissive interface with the host tissues at 4 weeks after implantation. Moreover, they could efficiently inhibit the formation of glial scars at the injured sites. The HA-KLT hydrogel could significantly increase the expression of endoglin/CD105 and promote the formation of blood vessels, suggesting that HA-KLT hydrogel promoted angiogenesis in vivo. Collectively, the HA-KLT hydrogel has the potential to repair brain defects by promoting angiogenesis and inhibiting the formation of glial-derived scar tissue.
Teen Moms: Violence, Consent, and Embodied Subjectivity in Middle English Pregnancy Laments
Authors: Harris Carissa M 
Published: August 2019

Abstract
This article examines power and coercion in five Middle English and Middle Scots lyrics voiced by pregnant, abandoned singlewomen. It focuses on the language of consent and embodiment in these pregnancy laments, arguing that they both protest and normalize masculine violence in heterosexual erotic relations, highlight the various factors that undermine young singlewomen’s consent, articulate acute dissatisfaction with gendered power inequalities, and demonstrate the devastating consequences of sexual ignorance. It explores the different ways that we can read these lyrics when considering issues of voice, audience, performance, and manuscript context. The essay closes by linking the popularity of medieval unplanned pregnancy narratives to modern-day reality television programming, arguing that the trans-historical popularity of these stories merits further exploration.
Decline of “the American Dream”? Outlook toward the Future across Three Generations of Midwest Families
Authors: Mortimer Jeylan T , Mont’Alvao Arnaldo , Aronson Pamela 
Published: August 2019

AbstractExpansion of higher education and long-term economic growth have fostered high aspirations among adolescents. Recently, however, deteriorating labor force opportunities, particularly since the “Great Recession,” and rising inequality have challenged the “American Dream.” To assess how parental and adolescent outlooks have evolved over time, we examine shifts in future orientations across three generations of Midwest American families. Our unique data archive from the Youth Development Study includes 266 Generation 1 and Generation 2 parent-child dyads and 422 Generation 3 children. We assess change over two decades in parental expectations for their children’s educational attainments (comparing G1 and G2) and in adolescents’ socioeconomic aspirations, life course optimism, and anticipated work-family conflict (comparing G2 and G3). An initial between-families analysis examines aggregate change across generations; a second fixed-effects analysis assesses attitudinal differences between parents and children in the same families and the extent to which generational shifts in family circumstances and adolescents’ educational performance account for change in adolescents’ future orientations. We find that “millennial” adolescents had more positive outlooks than “Gen X” parents did at the same age. Generational increase in adolescent socioeconomic aspirations held even when socioeconomic origin, parent-child relationship quality, adolescent school performance, and other predictors were controlled. We find evidence that growing adolescent optimism across generations is attributable to rising parental educational expectations, increasing adolescent grades in school, and higher-quality parent-child relationships. We conclude that the “American Dream” is still alive for many contemporary parents and their adolescent children.
Do Energy Burdens Contribute to Economic Poverty in the United States? A Panel Analysis
Authors: Bohr Jeremiah , McCreery Anna C 
Published: August 2019

AbstractFor many households, energy consumption represents a non-discretionary portion of their budget and directly relates to quality of life. As researchers continue to study the environmental impacts of energy behavior, it is important to explore how energy consumption relates to socio-economic wellbeing. This paper examines the economic impacts of being energy-burdened in the United States, defined as spending at least 10% of household income on heating and electricity services; energy burdens are partially, but not entirely, driven by income, since energy needs and costs can vary substantially due to housing characteristics, utility rates, and other factors. Using panel data of US household income and energy expenditures during 1999–2017, this analysis demonstrates that energy-burdened households were at about 150%–200% greater risk of transitioning into or extending the duration of economic poverty over a two-year timeframe relative to non-burdened households. This analysis indicates that dedicating inordinate amounts of income to energy services can threaten a household’s economic well-being over time, possibly by preventing a household from engaging in other economic activities or compounding existing economic hardship. These results emphasize the importance of energy assistance and energy efficiency for low-income households, drawing attention to how structures of energy consumption, the welfare state, and social stratification intertwine.
A new genus of Pycnodontidae (Actinopterygii) from the Upper Jurassic of France and Germany, included in a phylogeny of Pycnodontiformes
Authors: Ebert Martin 
Published: August 2019

AbstractThe new genus Thiollierepycnodus is erected here to accommodate ‘Gyrodus’ wagneri or ‘Proscinetes’ wagneri, a taxon known since the 19th century from the marine Kimmeridgian Plattenkalk of Cerin (France) and since 2014 at the excavation site of the Naturkunde-Museum Bamberg in Wattendorf (Germany). Thiollierepycnodus is placed in Pycnodontidae (Upper Jurassic to Eocene), which is the most advanced family of Pycnodontiformes. With 154–152 Myr (Upper Jurassic), Thiollierepycnodus belongs to the stratigraphically oldest Pycnodontidae, still possessing some primitive features such as four incisiform teeth in the dentary, a crown of bifurcated anterior dentary teeth, reduced scale bars posterior to the dorsal fin origin, but the area of pterygiophores without scales and nine to 10 postanal ventral keel scales and approximately 10 complete scale rows posterior to the cloaca. A phylogenetic analysis leads to the placement of this taxon in Proscinetinae. This and the introduction of two additional taxa from the Cretaceous of Lebanon in the phylogeny are further steps to enlighten the broader evolutionary patterns of Pycnodontidae.
Selection of Lowest Instrumented Vertebra Using Fulcrum Bending Radiographs Achieved Shorter Fusion Safely Compared With the Last “Substantially” Touching Vertebra in Lenke Type 1A and 2A Curves
Authors: Kwan Kenny Yat Hong , Wong Cheuk Pang , Koh Hui Yu , Cheung Kenneth Man Chee 
Published: August 2019

Study Design.
Retrospective study with prospective radiographic data collection.

Objective.
To compare fusion level determination criteria using the fulcrum bending radiograph (FBR) and the last substantially touched vertebra (STV) as the lowest instrumented vertebra (LIV) in the radiographic outcomes of correction surgery for Lenke 1A and 2A scoliosis patients with a minimum of 2-year follow-up.

Summary of Background Data.
The STV has been proposed as the LIV in Lenke 1A and 2A curves to avoid postoperative distal adding-on. However, the influence of the inherent flexibility of the curves on selecting the LIV in relation to the STV is not known.

Methods.
A total of 65 consecutive Lenke 1A and 2A patients who underwent posterior selective thoracic fusion were included in this study with a minimum of 2-year follow-up. LIV determination was compared with the FBR and STV methods. The curve correction, trunk shift, radiographic shoulder height, list, and the incidence of distal adding-on were documented.

Results.
Mean preoperative, postoperative, and final follow-up standing coronal Cobb angles of primary curves were 59.37°, 15.58°, and 16.62° respectively. Using the FBR to determine the LIV, STV was selected in 16 patients (25%), STV-1 in 34 (52%), STV-2 in 11 (17%), and STV-3 in three (5%). Fusion level difference between using FBR and STV method was statistically significantly larger (P = 0.019) in patients with more than 70% fulcrum flexibility (mean: 1.18 levels, range: 0–3 levels) than those with less than or equal to 70% flexibility (mean: 0.70 level, range: –1 to 3 levels). Mean fulcrum flexibility was 73.9% in patients who achieved a shorter fusion by FBR method and 66.3% in patients who did not achieve a shorter fusion. Adding-on was observed in three patients (4.6%).

Conclusion.
By considering the curve flexibility, LIV determination using FBR method achieved a shorter fusion than STV method in over 70% of Lenke 1A and 2A patients, while being safe and effective at 2-year follow-up.

Level of Evidence: 3.
Intraoperative Ischemic Stroke in Elective Spine Surgery
Authors: Ishak Basem , Abdul-Jabbar Amir , Singla Amit , Yilmaz Emre , von Glinski Alexander , Ramey Wyatt L. , Blecher Ronen , Tymchak Zane , Oskouian Rod , Chapman Jens R. 
Published: August 2019

Study Design.
. Retrospective study.

Objective.
. To determine incidence, risk factors, complications, and early postoperative outcome in patients with intraoperative ischemic stroke during elective spine surgery.

Summary of Background Data.
. Overall, stroke is the fifth leading cause of death in the United States and the second leading cause of death worldwide. It can be a catastrophic event and the main cause of neurological disability in adults.

Methods.
. A retrospective review of the electronic medical records of patients who underwent elective spine surgery between January 2016 and November 2018 at a larger tertiary referral center was conducted. Patients with infection and neoplastic disease were excluded. Patient demographics, pre- and postoperative neurological status, surgical treatment, surgical time, blood loss, intraoperative abnormalities, risk factors, history of stroke, medical treatment, diagnostics, hospital stay, complications, and mortality were collected.

Results.
. Out of 5029 surgically treated patients receiving elective spine surgery, a total of seven patients (0.15%) were identified who developed an ischemic stroke during the surgical procedure. Patients were predominantly females (n = 6). Ischemic pontine stroke occurred in two patients. Further distributions of ischemic stroke were: left caudate nucleus, left posterior inferior cerebellar artery, left external capsule, left middle cerebral artery, and acute ischemic supratentorial spots. The main risk factors identified for intraoperative ischemic stroke include hypertension, diabetes, smoking, dyslipidemia, and possibly major intraoperative CSF leak. Three patients (43%) had neurological deficits which did not improve during hospital stay. Two patients recovered fully and two patients died. Therefore, in-hospital mortality rate of this subset of patients was 29%.

Conclusion.
. With the increase of spinal procedures, it is important to identify patients at risk for having an ischemic stroke and to optimize their comorbidities preoperatively. Patients with intraoperative ischemic stroke carry a higher risk for morbidity and mortality during the index hospitalization.

Level of Evidence: 4
Effect of Perioperative Mental Status on Health-related Quality of Life in Patients With Adult Spinal Deformities
Authors: Watanabe Yuh , Yoshida Go , Hasegawa Tomohiko , Yamato Yu , Togawa Daisuke , Banno Tomohiro , Oe Shin , Arima Hideyuki , Ushirozako Hiroki , Yamada Tomohiro , Murata Hideyuki , Matsuyama Yukihiro 
Published: August 2019

Study Design.
A retrospective study.

Objective.
We aimed to evaluate the impact of mental status on the clinical outcomes of patients with adult spinal deformity (ASD).

Summary of Background Data.
Limited information is currently available on how preoperative mental status affects postoperative health-related quality of life (HRQOL) in patients with ASD.

Methods.
We enrolled 165 patients with ASD who underwent corrective surgery at a single university hospital between March 2010 and September 2015. We compared Scoliosis Research Society-22r (SRS-22r) and Oswestry Disability Index (ODI) scores using various x-ray parameters at these time points: preoperative period and postoperative 2 years. Additionally, to determine the associations between perioperative complications and mental health disorders, we examined these x-ray parameters: lumbar lordosis, thoracic kyphosis, sacral slope, pelvic incidence, pelvic tilt, sagittal vertical axis (SVA), and T1 pelvic angle (TPA).

Results.
We found correlations between the preoperative SRS-22r total score and preoperative ODI (r = −0.692, P < 0.01) and postoperative ODI (r = –0.443, P < 0.01). Preoperative SRS-22r mental domain correlated with preoperative ODI (r = −0.561, P ≤ 0.01) and postoperative ODI (r = −0.315, P ≤ 0.01). Perioperative (preoperative and postoperative) SRS-22r mental domain did not correlate with the postoperative x-ray parameters except for SVA and TPA. Postoperative mental health correlated with early infection (P < 0.05), hematoma (P < 0.05), deep vein thrombosis (P < 0.05), and delirium (P < 0.05). Regression analysis revealed that preoperative SRS-22r mental health score correlated with preoperative ODI (P < 0.001) and postoperative ODI (P < 0.001). The regression coefficient number between preoperative SRS-22r mental health score and perioperative (preoperative and postoperative) ODI improved from −17.3 to −10.2 from preoperative to postoperative periods.

Conclusion.
Diminished preoperative mental health worsened postoperative HRQOL. Perioperative complications influence postoperative mental status and HRQOL; hence, screening preoperative mental health is important.

Level of Evidence: 3
A Machine Learning Algorithm to Predict Severe Sepsis and Septic Shock: Development, Implementation, and Impact on Clinical Practice*
Authors: Giannini Heather M. , Ginestra Jennifer C. , Chivers Corey , Draugelis Michael , Hanish Asaf , Schweickert William D. , Fuchs Barry D. , Meadows Laurie , Lynch Michael , Donnelly Patrick J. , Pavan Kimberly , Fishman Neil O. , Hanson C. William , Umscheid Craig A. 
Published: August 2019

Objectives:
Develop and implement a machine learning algorithm to predict severe sepsis and septic shock and evaluate the impact on clinical practice and patient outcomes.

Design:
Retrospective cohort for algorithm derivation and validation, pre-post impact evaluation.

Setting:
Tertiary teaching hospital system in Philadelphia, PA.

Patients:
All non-ICU admissions; algorithm derivation July 2011 to June 2014 (n = 162,212); algorithm validation October to December 2015 (n = 10,448); silent versus alert comparison January 2016 to February 2017 (silent n = 22,280; alert n = 32,184).

Interventions:
A random-forest classifier, derived and validated using electronic health record data, was deployed both silently and later with an alert to notify clinical teams of sepsis prediction.

Measurement and Main Result:
Patients identified for training the algorithm were required to have International Classification of Diseases, 9th Edition codes for severe sepsis or septic shock and a positive blood culture during their hospital encounter with either a lactate greater than 2.2 mmol/L or a systolic blood pressure less than 90 mm Hg. The algorithm demonstrated a sensitivity of 26% and specificity of 98%, with a positive predictive value of 29% and positive likelihood ratio of 13. The alert resulted in a small statistically significant increase in lactate testing and IV fluid administration. There was no significant difference in mortality, discharge disposition, or transfer to ICU, although there was a reduction in time-to-ICU transfer.

Conclusions:
Our machine learning algorithm can predict, with low sensitivity but high specificity, the impending occurrence of severe sepsis and septic shock. Algorithm-generated predictive alerts modestly impacted clinical measures. Next steps include describing clinical perception of this tool and optimizing algorithm design and delivery.
Acute Adverse Events After Spinal Cord Injury and Their Relationship to Long-term Neurologic and Functional Outcomes: Analysis From the North American Clinical Trials Network for Spinal Cord Injury
Authors: Jiang Fan , Jaja Blessing N. R. , Kurpad Shekar N. , Badhiwala Jetan H. , Aarabi Bizhan , Grossman Robert G. , Harrop James S. , Guest Jim D. , Schär Ralph T. , Shaffrey Chris I. , Boakye Max , Toups Elizabeth G. , Wilson Jefferson R. , Fehlings Michael G. 
Published: August 2019

Objectives:
There are few contemporary, prospective multicenter series on the spectrum of acute adverse events and their relationship to long-term outcomes after traumatic spinal cord injury. The goal of this study is to assess the prevalence of adverse events after traumatic spinal cord injury and to evaluate the effects on long-term clinical outcome.

Design:
Multicenter prospective registry.

Setting:
Consortium of 11 university-affiliated medical centers in the North American Clinical Trials Network.

Patients:
Eight-hundred one spinal cord injury patients enrolled by participating centers.

Interventions:
Appropriate spinal cord injury treatment at individual centers.

Measurements and Main Results:
A total of 2,303 adverse events were recorded for 502 patients (63%). Penalized maximum logistic regression models were fitted to estimate the likelihood of neurologic recovery (ASIA Impairment Scale improvement ≥ 1 grade point) and functional outcomes in subjects who developed adverse events at 6 months postinjury. After accounting for potential confounders, the group that developed adverse events showed less neurologic recovery (odds ratio, 0.55; 95% CI, 0.32–0.96) and was more likely to require assisted breathing (odds ratio, 6.55; 95% CI, 1.17–36.67); dependent ambulation (odds ratio, 7.38; 95% CI, 4.35–13.06) and have impaired bladder (odds ratio, 9.63; 95% CI, 5.19–17.87) or bowel function (odds ratio, 7.86; 95% CI, 4.31–14.32) measured using the Spinal Cord Independence Measure subscores.

Conclusions:
Results from this contemporary series demonstrate that acute adverse events are common and are associated with worsened long-term outcomes after traumatic spinal cord injury.
Is Spinal Anesthesia Safer than General Anesthesia for Patients Undergoing Revision THA? Analysis of the ACS-NSQIP Database
Authors: Wilson Jacob M. , Farley Kevin X. , Bradbury Thomas L. , Guild George N. 
Published: August 2019

Abstract

Background
The incidence of revision THA continues to increase and there is a need to identify risk factors contributing to postoperative complications. Anesthesia type has been shown to be associated with complication rates in patients who undergo primary THA, but it is not clear whether the same is true among patients undergoing revision THA.

Questions/purposes
(1) After controlling for confounding variables, in the setting of a large-database analysis, is spinal anesthesia associated with a lower risk of death, readmission, reoperation, postoperative transfusion, thromboembolic events, surgical site infection (SSI), and re-intubation among patients undergoing revision THA?

Methods
The American College of Surgeons-National Surgical Quality Improvement (ACS-NSQIP) database was queried for patients undergoing aseptic, revision THA with either spinal or general anesthesia. Coarsened exact matching was used to match patients based on several baseline characteristics, including age, sex, body mass index, surgery type (Current Procedural Terminology code), and the modified Frailty Index score. Coarsened exact matching is a statistical method of exact matching that matches on chosen characteristics, in which continuous variables may be temporarily coarsened (such as, into discrete categorical variables) to facilitate matching. This method is an alternate to and requires less estimation than traditional propensity score matching. Then, using a model controlling for baseline patient characteristics and operative time, we performed multivariate logistic and linear regression analyses of matched cohorts to examine differences in mortality, readmission, reoperation, thromboembolic events, transfusion, SSI, and re-intubation.

Results
After statistical matching and controlling for baseline demographic variables, surgery type (one- or two-component revision), surgical time and modified Frailty Index we found that patients receiving general anesthesia had higher odds of mortality (OR 3.72 [95% CI 1.31 to 10.50]; p = 0.013), readmission (OR 1.49 [95% CI 1.24 to 1.80]; p < 0.001), reoperation (OR 1.40 [95% CI 1.13 to 1.73]; p = 0.002), thromboembolic events (OR 2.57 [95% CI 1.37 to 4.84]; p = 0.003), SSI (OR 1.32 [95% CI 1.01 to 1.72]; p = 0.046), postoperative transfusion (OR 1.57 [95%CI 1.39 to 1.78]; p < 0.001) and unplanned intubation or failure to wean off intubation (OR 5.95 [95% CI 1.43 to 24.72]; p = 0.014).

Conclusions
In patients undergoing revision THA, spinal anesthesia is associated with a decreased risk of several complications. The current investigation suggests that, when practical (such as when long surgical times or changes to the surgical plan are not anticipated), spinal anesthesia should be considered for use during revision THA.

Level of Evidence
Level III, therapeutic study.