bluuebunny/crossref_metadata_2025_split huggingface dataset:
Placing Caste: Spatialization, Urban Segregation, and Musical Boundary-Making
Authors: Diwakar Pranathi 
Published: September 2022

AbstractIn the face of India’s enduring caste inequalities, their entrenchment or resistance is central to social and urban navigation. In this article, I locate music as an important site to investigate how caste comes to be spatialized, where place identity comes to symbolize group difference, with the effect of exacerbating social and spatial segregation. I use ethnographic field notes from attending musical events and 103 interviews with members of two live musical worlds situated in the southern city of Chennai: Carnatic music, which is seen as the preserve of Brahmin, or “upper” caste residents of the city; and Gaana music, which is associated with Dalit, or previously “untouchable” caste urban residents. I argue that for caste elites, symbolic power is constructed and maintained through norms and boundary work, thus producing hegemonic place identity and cultural power. For the caste oppressed, caste discrimination is experienced as stigmatized place identity, which is variously managed, reappropriated, or rejected through a range of strategies. The persistence of place-based stigma to devalue caste identity shapes the experience of caste-based urban inequalities that obstruct marginalized communities’ right to the city. In recent years, Gaana musicians are using their music to protest caste-based urban segregation, indexing the rise of a cultural articulation of an anti-caste assertion that challenges the marginalization of urban Dalits. This article advances sociological understandings of the forms that urban segregation can take when layered with caste as an axis of social difference and conceptualizes spatialization of caste as a driver of urban segregation.
A Hospital-based Managed Alcohol Program in a Canadian Setting
Authors: Nolan Seonaid , Fairgrieve Christopher , Dong Huiru , Garrod Emma , van Heukelom Holly , Parappilly Beena P. , McLean Mark , Tsui Judith I. , Samet Jeffrey H. 
Published: September 2022

Objectives
A managed alcohol program (MAP) is a harm reduction strategy that provides regularly, witnessed alcohol to individuals with a severe alcohol use disorder. Although community MAPs have positive outcomes, applicability to hospital settings is unknown. This study describes a hospital-based MAP, characterizes its participants, and evaluates outcomes.

Methods
A retrospective chart review of MAP participants was conducted at an academic hospital in Vancouver, Canada, between July 2016 and October 2017. Data included demographics, alcohol/substance use, alcohol withdrawal risk, and MAP indication. Outcomes after MAP initiation included the change in mean daily alcohol consumption and liver enzymes.

Results
Seventeen patients participated in 26 hospital admissions: 76% male, mean age of 54 years, daily consumption prehospitalization of a mean 14 alcohol standard drinks, 59% reported previous nonbeverage alcohol consumption, and 41% participated in a community MAP. Most participants were high risk for severe, complicated alcohol withdrawal and presented in moderate withdrawal. Continuation of community MAP was the most common indication for hospital-based MAP initiation (38%), followed by a history of leaving hospital against medical advice (35%) and hospital illicit alcohol use (15%). Hospital-based MAP resulted in a mean of 5 fewer alcohol standard drinks daily compared with preadmission (P = 0.002; 95% confidence interval, 2–8) and improvement in liver enzymes, with few adverse events.

Conclusions
Participation in a hospital-based MAP may be an effective safe approach to reduce harms for some individuals with severe alcohol use disorder. Further study is needed to understand who benefits most from hospital-MAP and potential benefits/harms following hospital discharge.
Complications Are Infrequent After Humeral Shaft Fractures Due to Low-Energy Gunshot Injuries
Authors: Cho Elizabeth , Taylor Aaron , Olson Jeffrey J. , Entezari Vahid , Vallier Heather A. 
Published: September 2022

Objective:
To describe humerus shaft fractures after low-energy gunshot wound (GSW) and compare with blunt injuries. We hypothesized that nerve injury, infection, and fracture union would be similar.

Design:
Retrospective.

Setting:
Urban Level 1 trauma center.

Patients/Participants:
Four hundred three patients were treated for a humeral shaft fracture over 18 years. Sixty-two patients sustained injury due to GSW.

Intervention:
Primary open reduction and internal fixation was pursued in 59%, including 32% after GSW.

Main Outcome Measurements:
Rates of nerve injury, infection, and fracture union.

Results:
Patients with GSW were younger with a mean age of 30 years, more likely male (90%), with isolated injuries (84%), and less likely to have simple fractures (84%). Both groups experienced high rates of union (98% of GSW fractures vs. 99% of closed high-energy fractures). Deep infection occurred in 1 patient (1.6%) after GSW. Rates of deep infection in the closed and open blunt trauma fracture groups were similarly low at 1% and 4.5%, respectively. Nerve injury on presentation after GSW was more common than after low-energy and high-energy closed fractures (47% vs. 13% and 27%), but similar to blunt open fracture (52%). Despite higher rates of nerve injury, nerve recovery occurred at similarly high rates after both GSW and blunt injuries (78% vs. 86%).

Conclusions:
Nerve injuries are more common after GSW, but most recover without intervention. Infection is uncommon after GSW, and secondary unplanned operations are rare. Initial nonoperative care of most GSW humerus fractures, even with radial nerve injury at the time of presentation, seems appropriate.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Comparison of Deep Learning and Classical Machine Learning Algorithms to Predict Post-operative Outcomes for Anterior Cervical Discectomy and Fusion Procedures with State-of-the-art Performance
Authors: Rodrigues Adrian J. , Schonfeld Ethan , Varshneya Kunal , Stienen Martin N. , Staartjes Victor E. , Jin Michael C. , Veeravagu Anand 
Published: September 2022

Study Design.
Retrospective cohort.

Objective.
Due to Anterior cervical discectomy and fusion (ACDF) popularity, it is important to predict post-operative complications, unfavorable 90-day readmissions, and 2-year re-operations to improve surgical decision making, prognostication and planning.

Summary of Background Data.
Machine learning has been applied to predict post–operative complications for ACDF; however, studies were limited by sample size and model type. These studies achieved

0.70 AUC. Further approaches, not limited to ACDF, focused on specific complication types, and resulted in AUC between 0.70–0.76.

Methods.
The IBM MarketScan Commercial Claims and Encounters Database and Medicare Supplement were queried from 2007-2016 to identify adult patients who underwent an ACDF procedure (N=176,816). Traditional machine learning algorithms, logistic regression, support vector machines, were compared with deep neural networks to predict: 90-day post-operative complications, 90-day readmission, and 2-year reoperation. We further generated random deep learning model architectures and trained them on the 90-day complication task to approximate an upper bound. Lastly, using deep learning, we investigated the importance of each input variable for the prediction of 90-day post-operative complications in ACDF.

Results.
For the prediction of 90-day complication, 90-day readmission, and 2-year reoperation, the deep neural network-based models achieved area under the curve (AUC) of 0.832, 0.713, and 0.671. Logistic regression achieved AUCs of 0.820, 0.712, and 0.671. SVM approaches were significantly lower. The upper bound of deep learning performance was approximated as 0.832. Myelopathy, age, HIV, previous myocardial infarctions, obesity, and documentary weakness were found to be the strongest variable to predict 90-day post-operative complications.

Conclusions.
The deep neural network may be used to predict complications for clinical applications after multi-center validation. The results suggest limited added knowledge exists in interactions between the input variables used for this task. Future work should identify novel variables to increase predictive power.
Effect of Irisin on Human Nucleus Pulposus Cells: New Insights into the Biological Cross-talk Between Muscle and Intervertebral Disk
Authors: Vadalà Gianluca , Di Giacomo Giuseppina , Ambrosio Luca , Cicione Claudia , Tilotta Veronica , Russo Fabrizio , Papalia Rocco , Denaro Vincenzo 
Published: September 2022

Study Design.
In vitro study.

Objective.
To investigate the effect of irisin on human nucleus pulposus cells (hNPCs) in vitro.

Summary of Background Data.
Physical exercise (PE) favours weight loss and ameliorates function in patients with low back pain. Although there is no biological evidence that the intervertebral disk (IVD) can respond to PE, recent studies have shown that running is associated with increased IVD hydration and hypertrophy. Irisin, a myokine released upon muscle contraction, has demonstrated anabolic effects on different cell types, including chondrocytes.

Materials and Methods.
hNPCs were exposed to 5, 10, and 25 ng/mL irisin. Cell proliferation, glycosaminoglycan (GAG) content, metabolic activity, gene expression of collagen type II (COL2), matrix metalloproteinase (MMP)-13, tissue inhibitor of matrix metalloproteinase (TIMP)-1 and TIMP-3, aggrecan (ACAN), interleukin (IL)-1β, a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)-5 were assessed. In addition, MTT assay and ADAMTS-5, COL2, TIMP-1, and IL-1β gene expression were evaluated following incubation with irisin for 24 hours and subsequent culture with 10 ng/mL IL-1β and vice versa (incubation for 24 hours with IL-1β and subsequent culture with irisin).

Results.
Irisin increased hNPC proliferation, metabolic activity, and GAG content, as well as COL2, ACAN, TIMP-1 and TIMP-3 gene expression, while decreasing MMP-13 and IL-1β mRNA levels. Irisin pretreatment of hNPCs cultured in proinflammatory conditions resulted in a rescue of metabolic activity and a decrease of IL-1β levels. Similarly, incubation of hNPCs with IL-1β and subsequent exposure to irisin led to an increment of metabolic activity, COL2 gene expression, and a reduction of IL-1β and ADAMTS-5 levels.

Conclusions.
Irisin increases hNPC proliferation, GAG content, metabolic activity, and promotes anabolic gene expression while reducing catabolic markers. Irisin may be one of the mediators by which PE and muscle tissues modulate IVD metabolism, suggesting the existence of a biological cross-talk between the muscle and IVD.
Effort-based decision making in response to high-dose androgens: role of dopamine receptors
Authors: Donovan Alexandra , Wood Ruth I. 
Published: September 2022

Introduction
Anabolic-androgenic steroids (AAS) are performance-enhancing drugs used by both world-class and rank-and-file athletes. AAS abuse has been linked with risky decision-making, ranging from drunk driving to abusing multiple drugs. Our lab uses operant behavior in rats to test the effects of AAS (testosterone) on decision making. In our previous study, testosterone caused rats to work harder for food reward during an effort discounting (ED) task. ED is sensitive to dopamine in the nucleus accumbens, and AAS alter accumbens dopamine receptor expression. Accordingly, we determined if testosterone increases response to dopamine receptor antagonists during ED.

Methods
Rats were treated chronically with high-dose testosterone (7.5 mg/kg; n = 9) or vehicle (n = 9). We measured baseline preference for the large reward in an ED task, where rats choose between a small easy reward (one lever press for one sugar pellet) and a large difficult reward (2, 5, 10, or 15 presses for three pellets). Preference for the large reward was measured after administration of D1-like (SCH23390, 0.01 mg/kg) or D2-like (eticlopride, 0.06 mg/kg) receptor antagonists.

Results
At baseline, testosterone- and vehicle-treated rats showed similar preference for the large reward lever (FR5, testosterone: 68.6 ± 9.7% and vehicle: 85.7 ± 2.5%). SCH23390 reduced large reward preference significantly in both groups (FR5, testosterone: 41.3 ± 9.2%; vehicle: 49.1 ± 8.2%; F
(1,16) = 17.7; P < 0.05). Eticlopride decreased large reward preference in both groups, but more strongly in testosterone-treated rats (FR5: testosterone: 37.0 ± 9.7%; vehicle: 56.3 ± 7.8%; F
(1,16) = 35.3; P < 0.05).

Conclusion
Testosterone increases response to dopamine D2-like receptor blockade, and this contributes to previously observed changes in decision-making behaviors.
Influence of Specialty Contact Lens Wear on Posterior Corneal Tomography in Keratoconus Subjects
Authors: Deboutte Isabel , Kreps Elke O. , Rozema Jos J. , van Hoey Maarten , Anthonissen Lieselotte , Koppen Carina 
Published: September 2022

Objective:
To evaluate the effect of specialty contact lens (CL) wear on posterior corneal tomography in keratoconus subjects.

Methods:
Patients with keratoconus who were wearing specialty CL were included in this retrospective cohort study. Tomographic parameters were evaluated with Scheimpflug imaging (Pentacam HR) before lens fitting and immediately after removal of CLs worn habitually for a period of several months. Subjects were divided into groups, according to type of lens (corneal, scleral, and hybrid) and keratoconus severity based on Belin/Ambrosio D (BAD-D) score, for further analysis.

Results:
Thirty-four eyes of 34 subjects diagnosed with keratoconus were included. Mean duration of habitual CL wear was 7.0±0.3 months. For the entire cohort, a small increase in flat keratometric reading at the anterior corneal surface (K1F; P=0.032) and at the posterior surface (K1B; P=0.041) was found. In the corneal CL group (10 eyes; 29.4%), flattening of the anterior corneal curvature was detected (Kmax; P=0.015). An increase in K1B value was seen in the scleral CL group (15 eyes; 44.1%) (P=0.03). Combined topometric indices showed a small but significant difference in the entire cohort (P<0.05) and in the subgroups of corneal CL wear and of moderate keratoconus (BAD-D score≥7).

Conclusion:
Various types of specialty CLs exert a differential influence on corneal parameters. A small steepening of keratometry at the posterior surface (K1B) was observed in the scleral lens group. Although corneal lens wear flattens the anterior cornea (Kmax), it does not significantly alter the posterior corneal surface.
Ocular Surface in Patients With Obstructive Sleep Apnea Syndrome: Evaluation of Clinical Parameters and Impression Cytology
Authors: Gunes Irem , Oltulu Refik , Oltulu Pembe , Turk Nazlı , Yosunkaya Sebnem 
Published: September 2022

Purpose:
To evaluate the effect of obstructive sleep apnea syndrome (OSAS) on the ocular surface and conjunctival cytology and the relationship between the findings and disease severity.

Methods:
One hundred six eyes of 106 patients (77 patients with OSAS and 29 control subjects) were included in the study. Twenty-three patients with an apnea–hypopnea index (AHI) of 5 to 15 were classified as mild OSAS (group 1), 27 patients with an AHI of 15 to 30 were classified as moderate OSAS (group 2), and 27 patients with an AHI≥30 were classified as severe OSAS (group 3). The following tests were used to evaluate the ocular surface: tear break-up time (TBUT), Schirmer I test, ocular surface disease index (OSDI), and conjunctival impression cytology (CIC). The results obtained from the tests were analyzed and compared between the groups.

Results:
The mean value of the Schirmer I test was 15.03±10.16 (1–35) mm in the control group, whereas it was found as 13.39±8.80 (3–35) mm, 9.85±7.81 (1–30) mm, and 9.41±7.53 (2–35) mm in the mild, moderate, and severe OSAS groups, respectively, and the difference between the groups was significant (P=0.002). Although the mean TBUT score was 9.83±5.03 (3–23) seconds in the control group, it was 11.04±6.22 (3–20), 6.26±3.48 (1–16), and 5.44±3.09 (1–10) in the mild, moderate, and severe OSAS groups, respectively, and the difference between the groups was significant (P<0.001). Although the mean OSDI score was 12.76±14.84 (range, 0–41.65) in the control group, it was 11.52±12.95 (range, 0–44.40), 25.06±19.45 (range, 0–75), and 20.31±19.87 (range, 0–77.70) in the mild, moderate, and severe OSAS groups, respectively, and the difference between the groups was significant (P=0.015). Although the mean CIC stage was 0.47±0.60 (0–2) in the control group, it was 0.89±0.74 (0–2), 1.52±0.75 (0–3), and 1.83±0.69 (1–3) in the mild, moderate, and severe OSAS groups, respectively, and the difference between groups was significant (P<0.001).

Conclusion:
In addition to decreased tear production and TBUT, cytological changes including squamous metaplasia were detected between patients with OSAS and the control group.
Patient preferences in the treatment of chronic musculoskeletal pain: a systematic review of discrete choice experiments
Authors: Zhu Mengting , Dong Dong , Lo Hermione Hin-Man , Wong Samuel Yeung-Shan , Mo Phoenix Kit-Han , Sit Regina Wing-Shan 
Published: September 2022

Abstract
Chronic musculoskeletal pain (CMP) is a preference-sensitive condition for which numerous treatment options are available, each with benefits and risks. Thus, patient preferences play a critical role in decision making. This study summarized evidence from discrete choice experiments (DCEs) to quantify patient preferences for CMP treatment and identified important treatment attributes. A systematic review of DCEs on patient preferences for CMP treatment was conducted. Studies were included if they used DCE to determine patient preferences for CMP. A previously described methodological assessment tool was used to assess the risk of bias. The treatment attributes were summarized and sorted according to the frequency of citation and relative weight. Subgroup analyses were conducted to explore the intervention-specific attributes. A total of 15 eligible studies with 4065 participants were included. We identified “capacity to realize daily life activities,” “risk of adverse events,” “effectiveness in pain reduction,” and “out-of-pocket cost” as important attributes. Although “treatment frequency” and “onset of treatment efficacy” were less frequently mentioned, they were also important attributes. The attribute of “risk of adverse events” was especially important for drug treatment. The “out-of-pocket cost” and “treatment location and mode” were important attributes of exercise therapy. The attributes identified in this review will inform the design of future DCE studies, facilitate the translation of measurement-based care to value-based care, and provide the rationale to promote shared decision making and patient-centered care.
Medical school grades may predict future clinical competence
Authors: Wu Jr-Wei , Cheng Hao-Min , Huang Shiau-Shian , Liang Jen-Feng , Huang Chia-Chang , Shulruf Boaz , Yang Ying-Ying , Chen Chen-Huan , Hou Ming-Chih , Huey-Herng Sheu Wayne 
Published: September 2022

Background:
In real-world medical education, there is a lack of reliable predictors of future clinical competencies. Hence, we aim to identify the factors associated with clinical competencies and construct a prediction model to identify “improvement required” trainees.

Methods:
We analyzed data from medical students who graduated from National Yang-Ming University with clerkship training and participated in the postgraduate year (PGY) interview at Taipei Veterans General Hospital. Clinical competencies were evaluated using grades of national objective structured clinical examination (OSCEs). This study used data from medical students who graduated in July 2018 as the derivation cohort (N = 50) and those who graduated in July 2020 (n = 56) for validation.

Results:
Medical school grades were associated with the performance of national OSCEs (Pearson r = 0.34, p = 0.017), but the grades of the structured PGY interviews were marginally associated with the national OSCE (Pearson r = 0.268, p = 0.06). A prediction model was constructed to identify “improvement required” trainees, defined: trainees with the lowest 25% of scores in the national OSCEs. According to this model, trainees with the lowest 25% medical school grades predicted a higher risk of the “improvement required” clinical performance (Q1–Q3 vs Q4 = 15% vs 60%, odds ratio = 8.5 [95% confidence interval = 1.8-39.4], p = 0.029). In the validation cohort, our prediction model could accurately classify 76.7% “improvement required” and “nonimprovement required” students.

Conclusion:
Our study suggests that interventions for students with unsatisfactory medical school grades are warranted to improve their clinical competencies.
Regional block anesthesia for adult patients with inguinal hernia repair: A systematic review
Authors: Lv Jie , Zhang Qi , Zeng Ting , Li Xue-Feng , Cui Yang 
Published: September 2022

Background:
Inguinal hernia repair (IHR) is a common surgical technique performed under regional block anesthesia (RBA). Although previous clinical trials have explored the effectiveness and safety of RBA for IHR, no systematic review has investigated its effectiveness and safety in adult patients with IHR.

Methods:
This systematic review searched electronic databases (PubMed, Embase, Cochrane Library, CNKI, Wangfang, and VIP) from their inception to July 1, 2022. We included all potential randomized controlled trials that focused on the effects and safety of RBA in adult patients with IHR. Outcomes included operative time, total rescue analgesics, numerical rating scale at 24 hours, occurrence rate of nausea and vomiting, and occurrence rate of urinary retention (ORUCR).

Results:
Five randomized controlled trials, involving 347 patients with IHR, were included in this study. Meta-analysis results showed that no significant differences were identified on operative time (MD = −0.20; fixed 95% confidence interval [CI], −3.87, 3.47; P = .92; I² = 0%), total rescue analgesics (MD = −8.90; fixed 95% CI, −20.36, 2.56; P = .13; I² = 28%), and occurrence rate of nausea and vomiting (MD = 0.39; fixed 95% CI, 0.13, 1.16; P = .09; I² = 0%) between 2 types of anesthesias. However, significant differences were detected in the numerical rating scale at 24 hours (MD = −1.53; random 95% CI, −2.35, −0.71; P < .001; I² = 75%) and ORUCR (MD = 0.20; fixed 95% CI, 0.05, 0.80; P = .02; I² = 0%) between the 2 management groups.

Conclusion:
The results of this study demonstrated that IHR patients with RBA benefit more from post-surgery pain relief at 24h and a decrease in the ORUCR than those with CSA.