bluuebunny/crossref_metadata_2025 huggingface dataset:
Simulation-based environmental-impact assessment of glycerol-to-hydrogen conversion technologies
Authors: Khalil Yehia F
Published: July 2021

This simulation-based comparative assessment aims to quantify the environmental and human-health impacts of greener hydrogen (H2) production via three glycerol-based technologies, including: supercritical water reforming (SCWR), aqueous-phase reforming (APR) and autothermal reforming (ATR). The GaBi (2018 edition) life-cycle assessment (LCA) platform is used to develop cradle-to-gate product system models for these technologies and the TRACI 2.1 methodology is used to quantify their midpoint impact categories. Aspen HYSYS (v11) process-simulation software is used to generate the life-cycle inventory (LCI) primary data required to produce 1 kg of H2 via each of the indicated glycerol-reforming technologies. Per ISO 14040:2006 reporting requirements for the LCA results interpretation step, three base case (BC) scenarios and four sensitivity scenarios (SS) are developed and quantified to compare the effects of different process electricity sources (US grid mix versus wind power) and thermal energy sources (natural gas versus biogas) on the LCA results. The high operating pressure (viz. 240 bar) of SCWR enabled assessment of the impact of in situ electricity generation to offset some of electricity required for this technology. The major insights from this research are as follows: (i) per 1 kg of produced H2, APR reduces CO2 emissions by ≈95% compared to ATR and by ≈92% compared to SCWR, (ii) for BC scenarios, the primary energy consumption (in MJ/kg of produced H2) is in the following order from highest to lowest: ATR > SCWR > APR and (iii) H2 production via glycerol APR is more environmentally sustainable than SCWR and ATR, and thus offers a promising path for greener H2 production. Future environmental sustainability studies should focus on expanding the scope of this study to include H2 production via water electrolysis using renewable electricity sources and via solar and nuclear-driven thermochemical water splitting.
A software-based approach in designing a rooftop bifacial PV system for the North Hall of Residence, IUT
Authors: Mehadi Abdullah Al , Chowdhury Misbahul Alam , Nishat Mirza Muntasir , Faisal Fahim , Islam Md Minhajul
Published: July 2021

Bifacial rooftop photovoltaic panels appear to be an excellent means of power generation in this era of urbanization, especially for land-limited countries like Bangladesh. This paper presents a software-based approach to design and simulate a bifacial solar-panel-based energy model on the rooftop of the North Hall of Residence of the Islamic University of Technology, Gazipur. This vertically mounted model investigates the feasibility and applicability of such an energy model in a university residence, situated in a load-shedding-prone area. Hence, three prominent software platforms, namely PVSOL, PVsyst and System Advisor Model (SAM), are brought into action and rigorous simulations are performed for three different orientations; promising outcomes are observed in terms of annual energy yield, bifacial gain (BG) and consumption coverage of the grid and PV model. The annual energy demand of the North Hall is ~444 733.5 kWh. The three orientations can generate annually 92 508.62, 94 643.48 and 86 758.94 kWh, respectively. Hence, it is evident that the proposed orientations can supply almost 19–21% of the site’s annual demand. Monthly BG analysis shows an overall increase in energy gain of 13%, 15.6% and 6% for Orientation-1, Orientation-2 and Orientation-3, respectively. A rigorous comparative analysis and deviation analysis among the software results has been accomplished to gain more insight into the feasibility of the proposed system. Thus, we have focused on a detailed software-based estimation of energy production for different orientations of the PV panels, considering several factors, which will provide prior knowledge and assessment before going for hardware implementation in the future.
Novel Approaches Identifying Relevant Patient-Reported Outcomes in Patients With Inflammatory Bowel Diseases—LISTEN 1
Authors: Teich Niels , Schulze Hermann , Knop Jana , Obermeier Michael , Stallmach Andreas
Published: July 2021

Background

Several patient-reported outcomes (PROs) have been established and are widely used in the assessment of patients with inflammatory bowel disease (IBD). However, it has never been investigated which PRO items are experienced by and are considered most relevant for IBD patients.

Methods

A review of IBD-related disease scores by a steering committee led to the identification of relevant PRO questions and assignment to 16 different PRO categories (9 symptoms and 7 impacts) that characterize patient’s disease burden. In a cross-sectional study, a digital patient survey was carried out to determine the self-reported experience by multiple response, the relevance of these PRO categories by pairwise comparison and the suitability of the respective questions and answer possibilities by yes-or-no-question.

Results

Sixty patients with Crohn’s disease (CD) (56.7% women; mean age 40.6 years; mean disease duration 12.4 years) and 60 patients with ulcerative colitis (UC) (51.7% women; mean age 37.3 years; mean disease duration 9.0 years) participated in the patient survey. All predefined symptoms and impacts, with the exception of nausea, were experienced by at least 50% of patients. Stool urgency and pain were rated the 2 most important symptoms in CD patients with similar ratings for relevance. Stool urgency was also the most important symptom in patients with UC, followed by stool frequency. Differences in self-reported experience between CD and UC patients were seen for the symptoms of rectal bleeding, pain, and nausea. Most important impact of symptoms in both patient groups were general wellbeing followed by social activities, while sexual activity was the least relevant impact category.

Conclusions

Stool urgency was the most relevant and most self-reported symptom for both CD and UC. Relevance and self-reported experience of pain and rectal bleeding differed between the 2 diseases. Therefore, the future collection of PROs should take these disease specificities into consideration.
An evaluation of the predictive performance and mapping power of the BayesR model for genomic prediction
Authors: Mollandin Fanny , Rau Andrea , Croiseau Pascal
Published: July 2021

Technological advances and decreasing costs have led to the rise of increasingly dense genotyping data, making feasible the identification of potential causal markers. Custom genotyping chips, which combine medium-density genotypes with a custom genotype panel, can capitalize on these candidates to potentially yield improved accuracy and interpretability in genomic prediction. A particularly promising model to this end is BayesR, which divides markers into four effect size classes. BayesR has been shown to yield accurate predictions and promise for quantitative trait loci (QTL) mapping in real data applications, but an extensive benchmarking in simulated data is currently lacking. Based on a set of real genotypes, we generated simulated data under a variety of genetic architectures and phenotype heritabilities, and we evaluated the impact of excluding or including causal markers among the genotypes. We define several statistical criteria for QTL mapping, including several based on sliding windows to account for linkage disequilibrium (LD). We compare and contrast these statistics and their ability to accurately prioritize known causal markers. Overall, we confirm the strong predictive performance for BayesR in moderately to highly heritable traits, particularly for 50k custom data. In cases of low heritability or weak LD with the causal marker in 50k genotypes, QTL mapping is a challenge, regardless of the criterion used. BayesR is a promising approach to simultaneously obtain accurate predictions and interpretable classifications of SNPs into effect size classes. We illustrated the performance of BayesR in a variety of simulation scenarios, and compared the advantages and limitations of each.
Decision G 1/19 and the Messy Misconception of the COMVIK Approach
Authors: Baldus Oliver
Published: July 2021

Decision G 1/19 of the Enlarged Board of Appeal (EBA) of the European Patent Office (EPO) answers the question whether computer simulations can be protected under the EPC. It was decided that these simulations in principle could solve a technical problem by producing a technical effect going beyond the simulation’s implementation on a computer. The result of the decision is rather non-spectacular and obvious, since it simply states that simulations can be protected under EPC law when they solve a technical problem. Nevertheless, the decision casts an extensive light on the general and established criteria to be used for assessing technicality. In this context a misconception of the COMVIK approach becomes apparent. The COMVIK approach is based on distinguishing technical from non-technical features. All technical features must be considered when assessing inventive step of an invention over prior art, while non-technical features have no significance for this purpose. In this view it is assumed that all information provided by a claim can be either classified as a technical or a non-technical feature. Further it is assumed that features exist that are inherently technical, i.e. technical per se. However, this concept of an inherent technical character is misleading. Basically, all information should first be distinguished as to whether it has a substantial effect on the design of the claimed subject-matter. Information that does not influence its ‘appearance’ must be seen a ‘non-feature’, whereas all other information describing a characteristic of the claimed subject-matter forms a ‘feature’. Secondly the so determined features are to be divided into technical or non-technical features, solely depending on whether they contribute to the solution of the concrete technical problem of the invention. In this way, the non-feature concept avoids many classification problems associated with the former COMVIK approach and constitutes the only admissible way to assess technicality correctly, consistently and non-sophistically.
Comparative Evaluation of the SMARTCHEK Salmonella Species Detection Kit for GENECHECKER UF-300 Real-Time PCR System with Rapi:chipTM and Rapi:DirectTM Lysis Buffer for Select Foods: AOAC Performance Tested MethodSM 032101
Authors: Lee Dobu , Choi Okran , Park Jinhee
Published: July 2021

Background

The candidate method, SMARTCHEK Salmonella spp. Detection Kit assay is designed for rapid detection of Salmonella spp. in select food matrixes, for use in conjunction with the Genesystems Rapi:chipTM and GENECHECKER UF-300 real-time PCR system.

Objective

The independent laboratory evaluation consisted of an inclusivity and exclusivity study, product consistency study, robustness study, stability study, and a matrix study. The paired matrix study tested romaine lettuce, peanut butter, liquid whole egg, chicken carcass rinsate, and raw chicken. The robustness study evaluated the method by changing three method parameters. The accelerated stability and product consistency study was conducted at 8, 16, 24, 32, and 40 days.

Methods

The candidate method was compared to the U.S. Department of Agriculture Food Safety and Inspection Service Microbiology Laboratory Guidebook 4.10 Isolation and Identification of Salmonella from Meat, Poultry, Pasteurized Egg, and Siluriformes (Fish) Products and Carcass and Environmental Sponges and to the U.S. Food and Drug Administration Bacteriological Analytical Manual, Chapter 5: Salmonella following a paired study design.

Results

All 108 Salmonella isolates were detected in all three broths tested for inclusivity, while all 35 non-Salmonella isolates were correctly excluded. In the matrix study, the candidate method showed no significant differences between confirmed candidate method results and reference method results for all food matrixes evaluated.

Conclusion

The candidate method is an effective method for the qualitative detection of Salmonella spp. in select food matrixes.

Highlights

The SMARTCHEK Salmonella spp. Detection Kit assay allows for fast, reliable detection of Salmonella spp. with results obtained after 24 h of incubation and a PCR run time of only 35 min.
Consequences of the Lack of Criminalization of Enforced Disappearance at the Domestic Level
Authors: Citroni Gabriella
Published: July 2021

The obligation to codify enforced disappearance as an autonomous offence under domestic criminal legislation is well established in international law and jurisprudence, and it responds to the need to adequately comprehend and address the extraordinarily complex nature of this crime. Yet very few states abide by such an obligation. When called upon to explain this failure, those lacking a separate offence in their domestic legislation — including Italy — argue that other offences (e.g. kidnapping, abduction, torture, or illegal deprivation of liberty) are adequate. The article analyses the Italian experience with investigations and proceedings conducted in the absence of an autonomous offence of enforced disappearance. They concern enforced disappearances perpetrated in the context of the Operación Cóndor in Latin America where the victims were Italian nationals, requests for extradition concerning cases that amount to enforced disappearance, and enforced disappearances committed in the realm of operations of ‘extraordinary renditions’. The consequences of the lack of criminalization of enforced disappearance include the undue fragmentation of responsibility when pressing charges; challenges concerning the evidentiary criteria, especially with regard to the mental element; the application of tight statutes of limitation; and the failure to adequately implement the aut dedere aut judicare principle, ultimately resulting in an increased rate of impunity.
Are the well-fed less thirsty? Effects of drought and salinity on New Zealand mangroves
Authors: Ravi Sridevi , Bader Martin K-F , Young Tim , Duxbury Mark , Clearwater Michael , Macinnis-Ng Cate , Leuzinger Sebastian
Published: July 2021

Despite a large number of studies examining the effects of abiotic stress factors on plants, the mechanistic explanations of drought-induced tree mortality remain inconclusive and even less is known about how multiple stressors interact. The role of non-structural carbohydrates (NSCs) in preventing or postponing drought mortality is gaining attention. Here, we tested the role of NSCs in mitigating the effects of drought and salinity in New Zealand mangroves, Avicennia marina subsp. australasica. We experimentally manipulated plant NSC levels, prior to subjecting them to combinations of drought and salinity. Plant growth and survival rates were 2- and 3-fold higher in the high-NSC (H-NSC) group than in the low-NSC (L-NSC) group under high salinity and drought conditions, respectively. After 12 weeks under high salinity–high drought conditions, the H-NSC group showed higher stem hydraulic conductivity (281 ± 50 mmol cm−1 s−1 MPa−1) compared with the L-NSC group (134 ± 40 mmol cm−1 s−1 MPa−1). Although starch levels remained relatively constant, we found a 20% increase in soluble sugars in the stems of H-NSC group under high drought and high salinity in week 8 compared with week 12. Our results suggest (i) an important role of NSCs in mitigating the effects of low soil water potential caused by drought and salinity, and (ii) sink-limited growth under conditions of combined salinity and drought.
Antegrade revascularization of the three mesenteric vessels to treat chronic mesenteric ischemia
Authors: Chaouch Nazih , Zagzoog Mohammad M
Published: July 2021

Chronic mesenteric ischemia is a serious vascular disease that progresses with acute mesenteric ischemia, along with high mortality. Elective intervention has been shown to prevent this progression and improve symptoms. Controversy remains about whether antegrade or retrograde mesenteric bypass has better outcomes and whether restoration of flow to a single vessel versus multiple mesenteric vessels should be performed. This study reports on our experience using an antegrade prosthetic bypass graft to treat chronic occlusions of the celiac trunk, superior mesenteric artery, and inferior mesenteric artery at their origins, all of which result in visceral ischemia.
Reduced Susceptibility to Metronidazole Is Associated With Initial Clinical Failure in Clostridioides difficile Infection
Authors: Gonzales-Luna Anne J , Olaitan Abiola O , Shen Wan-Jou , Deshpande Aditi , Carlson Travis J , Dotson Kierra M , Lancaster Chris , Begum Khurshida , Alam M Jahangir , Hurdle Julian G , Garey Kevin W
Published: July 2021

Background

Clinical studies have demonstrated inferior cure rates when metronidazole (MTZ) is used to treat Clostridioides difficile infection (CDI). We hypothesized that a newly identified, heme-inducible form of reduced MTZ susceptibility in C. difficile leads to higher odds of initial clinical failure in patients with CDI treated with MTZ.

Methods

This multicenter cohort study included adults diagnosed with CDI between 2017 and 2018. C. difficile isolated from stool samples underwent agar dilution MTZ susceptibility testing with incorporation of fresh heme. Blinded investigators reviewed medical records for initial clinical failure and other relevant clinical variables. Classification and regression tree (CART) analysis was used to identify the MTZ minimum inhibitory concentration (MIC) breakpoint that was predictive of initial clinical failure. Results were confirmed using univariate and multivariable logistic regression analyses to account for potential confounders.

Results

Of the 356 patients included, 72% received MTZ-based therapy and 27% experienced initial clinical failure. CART analysis identified an MTZ MIC ≥1 µg/mL above which patients had a higher rate of initial clinical failure. MTZ MICs ranged from 0.25 to 8 µg/mL (MIC50/90 = 0.25/2 µg/mL), and approximately 18% of isolates had MTZ MICs ≥1 µg/mL. In multivariable analysis, an MTZ MIC ≥1 µg/mL was an independent predictor of initial clinical failure in patients receiving an MTZ-based treatment regimen (odds ratio, 2.27 [95% confidence interval, 1.18–4.34]).

Conclusions

Using a reproducible method to determine C. difficile MICs to MTZ, a breakpoint of ≥1 µg/mL identified patients at higher risk of initial clinical failure.
Addressing digital diversity: Care matters in vulnerable digital relations in a Swedish library context
Authors: Sefyrin Johanna , Gustafsson Mariana , Wihlborg Elin
Published: July 2021

As societies become increasingly digitalized, the requirements for inclusion continuously increase. In a Swedish public, municipal, library context, it is common that individuals who face difficulties related to digital technologies come and ask for help. In this paper, we explore care in relations constituted by individuals and digital technologies and analyze how care matters for digital inclusion. It builds on field studies in a Swedish library context and includes qualitative interviews, focus groups, and observations of employees working to support individuals with digital needs. In order to analyze the material, we apply the concept of care. In the concluding discussion, we argue first for viewing individuals as sociomaterial entanglements of relations constituted by humans and non-humans, second that these sociomaterial entangled relations are vulnerable, shifting, and fluid, rather than stable, and third that these relations are in constant need of care.
The activation of nuclear factor-E2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1) signaling blunts cholestasis-induced liver and kidney injury
Authors: Mousavi Khadijeh , Niknahad Hossein , Li Huifeng , Jia Zhipeng , Manthari Ram Kumar , Zhao Yangfei , Shi Xiong , Chen Yuanyu , Ahmadi Asrin , Azarpira Negar , Khalvati Bahman , Ommati Mohammad Mehdi , Heidari Reza
Published: July 2021

Cholestasis is a severe clinical complication that severely damages the liver. Kidneys are also the most affected extrahepatic organs in cholestasis. The pivotal role of oxidative stress has been mentioned in the pathogenesis of cholestasis-induced organ injury. The activation of the nuclear factor-E2-related factor 2 (Nrf2) pathway is involved in response to oxidative stress. The current study was designed to evaluate the potential role of Nrf2 signaling activation in preventing bile acids-induced toxicity in the liver and kidney. Dimethyl fumarate was used as a robust activator of Nrf2 signaling. Rats underwent bile duct ligation surgery and were treated with dimethyl fumarate (10 and 40 mg/kg). Severe oxidative stress was evident in the liver and kidney of cholestatic animals (P < 0.05). On the other hand, the expression and activity of Nrf2 and downstream genes were time-dependently decreased (P < 0.05). Moreover, significant mitochondrial depolarization, decreased ATP levels, and mitochondrial permeabilization were detected in bile duct-ligated rats (P < 0.05). Histopathological alterations included liver necrosis, fibrosis, inflammation and kidney interstitial inflammation, and cast formation. It was found that dimethyl fumarate significantly decreased hepatic and renal injury in cholestatic animals (P < 0.05). Based on these data, the activation of the cellular antioxidant response could serve as an efficient therapeutic option for managing cholestasis-induced organ injury.
Pharmacotherapy for the Prevention of Chronic Pain after Surgery in Adults: An Updated Systematic Review and Meta-analysis
Authors: Carley Meg E. , Chaparro Luis E. , Choinière Manon , Kehlet Henrik , Moore R. Andrew , Van Den Kerkhof Elizabeth , Gilron Ian
Published: July 2021

Background

Chronic postsurgical pain can severely impair patient health and quality of life. This systematic review update evaluated the effectiveness of systemic drugs to prevent chronic postsurgical pain.

Methods

The authors included double-blind, placebo-controlled, randomized controlled trials including adults that evaluated perioperative systemic drugs. Studies that evaluated same drug(s) administered similarly were pooled. The primary outcome was the proportion reporting any pain at 3 or more months postsurgery.

Results

The authors identified 70 new studies and 40 from 2013. Most evaluated ketamine, pregabalin, gabapentin, IV lidocaine, nonsteroidal anti-inflammatory drugs, and corticosteroids. Some meta-analyses showed statistically significant—but of unclear clinical relevance—reductions in chronic postsurgical pain prevalence after treatment with pregabalin, IV lidocaine, and nonsteroidal anti-inflammatory drugs. Meta-analyses with more than three studies and more than 500 participants showed no effect of ketamine on prevalence of any pain at 6 months when administered for 24 h or less (risk ratio, 0.62 [95% CI, 0.36 to 1.07]; prevalence, 0 to 88% ketamine; 0 to 94% placebo) or more than 24 h (risk ratio, 0.91 [95% CI, 0.74 to 1.12]; 6 to 71% ketamine; 5 to 78% placebo), no effect of pregabalin on prevalence of any pain at 3 months (risk ratio, 0.88 [95% CI, 0.70 to 1.10]; 4 to 88% pregabalin; 3 to 80% placebo) or 6 months (risk ratio, 0.78 [95% CI, 0.47 to 1.28]; 6 to 68% pregabalin; 4 to 69% placebo) when administered more than 24 h, and an effect of pregabalin on prevalence of moderate/severe pain at 3 months when administered more than 24 h (risk ratio, 0.47 [95% CI, 0.33 to 0.68]; 0 to 20% pregabalin; 4 to 34% placebo). However, the results should be interpreted with caution given small study sizes, variable surgical types, dosages, timing and method of outcome measurements in relation to the acute pain trajectory in question, and preoperative pain status.

Conclusions

Despite agreement that chronic postsurgical pain is an important topic, extremely little progress has been made since 2013, likely due to study designs being insufficient to address the complexities of this multifactorial problem.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Peripheral Nerve Blocks and Potentially Attributable Adverse Events in Older People with Hip Fracture: A Retrospective Population-based Cohort Study
Authors: Melton Natalie , Talarico Robert , Abdallah Faraj , Beaulé Paul E. , Boet Sylvain , Forster Alan J. , Fernando Shannon M. , Huang Allen , McCartney Colin J. L. , Meulenkamp Bradley , Perry Jeff , Power Barbara , Ramlogan Reva , Taljaard Monica , Tanuseputro Peter , van Walraven Carl , Wijeysundera Duminda N. , McIsaac Daniel I.
Published: July 2021

Background

Peripheral nerve blocks are being used with increasing frequency for management of hip fracture–related pain. Despite converging evidence that nerve blocks may be beneficial, safety data are lacking. This study hypothesized that peripheral nerve block receipt would not be associated with adverse events potentially attributable to nerve blocks, as well as overall patient safety incidents while in hospital.

Methods

This was a preregistered, retrospective population-based cohort study using linked administrative data. This study identified all hip fracture admissions in people 50 yr of age or older and identified all nerve blocks (although we were unable to ascertain the specific anatomic location or type of block), potentially attributable adverse events (composite of seizures, fall-related injuries, cardiac arrest, nerve injury), and any patient safety events using validated codes. The study also estimated the unadjusted and adjusted association of nerve blocks with adverse events; adjusted absolute risk differences were also calculated.

Results

In total, 91,563 hip fracture patients from 2009 to 2017 were identified; 15,631 (17.1%) received a nerve block, and 5,321 (5.8%; 95% CI, 5.7 to 6.0%) patients experienced a potentially nerve block–attributable adverse event: 866 (5.5%) in patients with a block and 4,455 (5.9%) without a block. Before and after adjustment, nerve blocks were not associated with potentially attributable adverse events (adjusted odds ratio, 1.05; 95% CI, 0.97 to 1.15; and adjusted risk difference, 0.3%, 95% CI, –0.1 to 0.8).

Conclusions

The data suggest that nerve blocks in hip fracture patients are not associated with higher rates of potentially nerve block–attributable adverse events, although these findings may be influenced by limitations in routinely collected administrative data.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Utility of the Merchant View Radiograph for Assessment of Tibial Tubercle-Trochlear Groove Distance: A Comparison to MRI in Pediatric and Adolescent Patients
Authors: Bernholt David L. , Lamplot Joseph D. , Block Andrew M. , Nepple Jeffrey J.
Published: July 2021

Background:

Plain radiographic evaluation remains the standard initial assessment of patellar instability, while 3-dimensional imaging is obtained in some patients. Merchant radiographs can demonstrate the tibial tubercle relative to the trochlear groove (TT-TG), but the determination of the TT-TG from these radiographs has been abandoned since its original description. The purpose of this study is to evaluate the utility of the TT-TG measured on Merchant radiographs for the assessment of patellar instability.

Methods:

A prospective cohort study was performed of pediatric and adolescent patients aged 10 to 18 who underwent standardized Merchant radiographs, including a total of 98 knees (in 57 patients). Merchant TT-TG was measured as the distance between the center of the trochlear groove and the tibial tubercle, with both lines perpendicular to the anterior femoral condylar axis. In Part 1, the Merchant TT-TG measured by the tibial tubercle radiographic appearance was compared with the measurement utilizing a radiographic marker. In Part 2, the Merchant TT-TG was compared with the magnetic resonance imaging (MRI) TT-TG distance using bivariate linear regression analysis. TT-TG measurements were compared in patients with and without patellar instability with receiver operating characteristic curve analysis.

Results:

The tibial tubercle was identified on Merchant radiograph in 81.7% (67/82) of knees, and there was an excellent correlation (Pearson correlation coefficient=0.85) between the Merchant TT-TG and the measurement based on marker placement. Merchant TT-TG was on average 4.5 mm less than MRI TT-TG (12.8±4.4 vs. 8.4±7.7 mm, P<0.001) and was moderately correlated (Pearson correlation coefficient=0.58, P<0.01). TT-TG distance was increased in patients with patellar instability compared with those without patellar instability on the Merchant view (10.5±6.9 vs. 2.0±5.5 mm, P<0.001) and MRI (13.9±4.4 vs. 10.5±2.9 mm, P=0.012). Merchant TT-TG also demonstrated a higher area under the curve than MRI TT-TG (0.872 vs. 0.775) in differentiating patients with and without patellar instability.

Conclusions:

Standardized Merchant radiographs allow for reliable assessment of the Merchant TT-TG distance when the tibial tubercle is visualized and moderately correlate with MRI TT-TG (with Merchant TT-TG on average 4.5 mm less than MRI).

Level of Evidence:

Level III.
A Preference-Sensitive Online Instrument to Support Shared Decision Making for Patients With Pelvic Organ Prolapse
Authors: Hulbaek Mette , Primdahl Jette , Birkelund Regner , Al-kozai Selwan Adnan Hussein , Barawi Sabat , Ebbesen Niels Teglhus , Nielsen Jesper Bo
Published: July 2021

A preference-sensitive instrument for women with pelvic organ prolapse was developed to increase shared decision-making. This study aimed to assess the feasibility of a randomized controlled trial to measure the effectiveness of the instrument. A pilot randomized controlled trial was conducted at three Danish gynecological clinics to assess feasibility through recruitment rates, per-protocol use and women's perception of (1) support for decision-making, (2) shared decision-making (Shared Decision-Making Questionnaire), and (3) satisfaction with their decisions. In addition, a focus group interview with participating gynecologists (five gynecologists) was conducted. We invited 226 women and recruited 46 (20%). The most common reason (45%) for nonparticipation was overlooking the invitation in their online public mailbox. Shared Decision-Making Questionnaire showed high data completeness (96%) but indicated a ceiling effect. Women felt the developed instrument supported their decision-making and more so if it was used interactively during consultations. Despite finding the instrument generally useful, gynecologists tended to apply the instrument inconsistently and not per protocol (41%), and some used it as a template for all consultations.

This pilot study indicates that recruitment methods, for a future randomized controlled trial, for example, nurse-led preconsultations, need reconsideration due to low recruitment rates and inefficient per-protocol use. In a future randomized controlled trial, cluster randomization should avoid the carryover effect bias.
Understanding and Accommodating Patient and Staff Choice When Implementing Video Consultations in Mental Health Services
Authors: Painter Jon , Turner James , Procter Paula M.
Published: July 2021

During the COVID-19 pandemic, some mental healthcare in the United Kingdom has moved online, with more likely to follow. The current evidence base for video consultations is modest; hence, this study seeks to aid decision-makers by reporting on one large National Health Service mental health trust's video-consultation pilot project. Patients' choices/preferences were gathered via online forms; and staff's views, through a focus group. The typical patient was female, 26 years old, living in a deprived locality. Consultations typically lasted 37 minutes, saving patients 0–30 minutes of travel and £0–£3.00. Satisfaction was high, and the software was intuitive. Audio quality varied, but patients felt able to disclose “as if in person,” were willing to use video consultation again, and found them more preferable than home visits and clinic attendance. Staff could foresee benefits but were concerned for their therapeutic relationships and were avoidant without familiarization, training, clinical coaching, and managerial reassurances especially regarding high-risk patients/situations. They argued video consultation would not suit all patients and should be used according to individual need. We found COVID-19 is necessitating staff to adopt video consultation and that patients are satisfied. However, unless staff's concerns are resolved, enabling them to use their full repertoire of interpersonal skills, therapeutic relationships will trump efficiency and video consultations may not remain their treatment modality of choice.
Testicular torsion in adults: Demographics and 30-day outcomes after orchiopexy or orchiectomy
Authors: Brungardt Joseph G. , McLeay Matthew T. , Schropp Kurt P.
Published: July 2021

Background:

Most often studied in the pediatric population, testicular torsion also affects the adult male population. Little data exists on demographics, patient risk factors, and associated outcomes for the surgical management of testicular torsion. This study sought to describe differences in demographics and outcomes for those patients requiring orchiopexy or orchiectomy.

Materials and methods:

An analysis of the American College of Surgeons National Surgical Quality Improvement Program database (2015–2018) was performed, capturing patients with a postoperative diagnosis of testicular torsion. Patients were stratified into 2 groups if they received orchiopexy or orchiectomy. Demographics, perioperative variables, surgeon specialty, and outcomes were analyzed.

Results:

A total of 769 patients undergoing surgical treatment of testicular torsion were captured. Most of these patients were White (46.81%) and young adults (28.33 ± 12.04 years) and 28.8% required orchiectomy. Those undergoing orchiectomy were more likely to be older, have more comorbidities, and have a systemic inflammatory response syndrome. Mean operative time was longer in the orchiectomy group (48 ± 23 vs. 44 ± 20 minutes, p < 0.0124). There were no deaths at 30 days. Length of stay and rate of superficial wound infection were higher in the orchiectomy group and discharge to home was more likely in the orchiopexy group.

Conclusions:

Adult testicular torsion should be considered in an acute scrotum differential. Adult patients requiring orchiectomy for testicular torsion are more likely to have confounding medical conditions compared to those undergoing orchiopexy. Clinically, rates of complications between the 2 procedures are small, making the decision to perform orchiopexy or orchiectomy based on the scenario.
Malignant Syphilis as an Initial Presentation of HIV Infection: A Case Report
Authors: Djawad Khairuddin
Published: July 2021

Introduction

: Malignant syphilis (MS) is a rare and severe variant of secondary syphilis that is frequently associated with HIV infection. The clinical impact of HIV and syphilis co-infection is bidirectional, and the presence of MS is associated with acute HIV infection. Clinically, MS is characterized by nodular and ulcerative lesions affecting the trunk and extremities, which are covered with thick crusts. The treatment of choice for MS remains benzathine penicillin G.

Herein, we report a case in which MS was the initial presentation of HIV infection.

Case presentation

: A 35-year-old male patient came with the chief complaint of extensive erythematous nodular rash for the past one month, with notable ulceration on some lesions with annular configuration along with fever and malaise. Based on the abovementioned clinical, laboratory, and histopathologic findings, the patient was diagnosed with MS and HIV. The diagnosis was established based on histopathological examination and syphilis serological testing.

Discussion

: Cutaneous disorders are a frequent presenting feature of HIV infection. The clinical manifestations of syphilis in immunosuppressed patients are often severe and/or atypical. The patient was then treated with weekly intramuscular administration of 2.4 million units of benzathine penicillin G for 3 weeks and achieved rapid and significant clinical improvement, with no Jarisch-Herxheimer reaction.

Conclusion

: Co-infection with syphilis and HIV alters the course of both diseases, and most HIV-infected patients with syphilis have typical disease manifestations associated with decreased CD4+ T-cell counts.
Clostridioides difficile
Authors: Pasarón Raquel , Calisto Juan L.
Published: July 2021

The purpose of this article is to present an exemplar related to diagnostic testing whereby reasoned decisions can assist the pediatric surgical clinician in the expeditious screening, diagnosis, and management of Clostridioides difficile infection (CDI). In 2017, the Emerging Infections Program for CDI reported that the incidence of healthcare-associated CDI was 9.03 in 100,000 and 26.70 for community-associated CDI in the 1- to 17-year age group. Multistate prevalence data looking at healthcare-associated infections (HCAIs) in acute care hospitals showed that C. difficile was the most common pathogen, causing 12.1% of HCAIs. Given the current trends, defining the pediatric epidemiological characteristics of CDI, which is less common than in adults, is vital. Consequently, clinicians need to know when to suspect CDI; however, classic risks associated with this HCAI are considered to be a moving target leading to challenges in the diagnosis, management, and ability to control the disease. Because the diagnosis of CDI is based on clinical and laboratory findings and precludes management, a sensitive and specific diagnostic test with rapid turnaround time is imperative. The use of probabilities is discussed in the context of the threshold approach in clinical decision making.
Institutional Variation in Gastrostomy Tube Placement After Duodenal Atresia Repair in Children With Trisomy 21
Authors: Maassel Nathan L. , Guerra Mary Elizabeth , Solomon Daniel G. , Stitelman David H.
Published: July 2021

Objectives:

To compare institutional practice patterns for gastrostomy tube placement in neonates with duodenal atresia (DA) and trisomy 21.

Methods:

A retrospective review of the Pediatric Health Information System (PHIS) from 2015 to 2018 identified infants <10 days old with ICD-10 diagnostic codes for DA and trisomy 21, in addition to procedure codes for an intestinal bypass or duodenoduodenostomy. This cohort was then queried for gastrostomy tube procedure codes and diagnostic codes for associated co-morbidities.

Results:

Two hundred and nine infants were identified with DA, trisomy 21, and an intestinal bypass. Fifty-seven (27%) underwent gastrostomy placement. Baseline characteristics of those with and without gastrostomy tubes were similar. Patients from 16 hospitals that placed no gastrostomy tubes (No-G-tube-Hospitals) were compared to children from 30 hospitals that placed at least one gastrostomy tube (G-tube-Hospitals). Open atresia repairs occurred more frequently at G-tube-Hospitals, but patients were otherwise similar. There was no difference in readmission at 12 months for gastrostomy placement between children from No-G-tube-Hospitals and those from G-tube-Hospitals that did not undergo gastrostomy during their index admission.

Conclusions:

One-third of institutions in this study did not place gastrostomy tubes during index admissions for neonates with trisomy 21 and DA, yet this did not negatively impact the length of stay or incidence of subsequent gastrostomy placement as a result. Future research is needed to determine factors that predispose patients to failure without gastrostomy, as well as best practices for post-operative management in these patients to reduce unnecessary tube placement.
Career Adaptability
Authors: Walden Christine M. , Forbes Thompson H. , Swanson Melvin , Lake Donna , Oehlert Julie Kennedy , Scott Elaine S.
Published: July 2021

This cross-sectional quantitative study explored career adaptability and career intentions in newly licensed nurses working in acute care hospitals throughout North Carolina. Data were analyzed from 277 registered nurses completing an online study instrument. Findings demonstrate a relationship between levels of career adaptability and career intentions, offering career adaptability as a new measurement to explore newly licensed nurses’ desire to pursue career and educational change and expand transition programs to include developing career trajectories within organizations.
Hepatic Cavernous Hemangioma Mimicking Metastasis of Midgut Neuroendocrine Neoplasia on 18F-Fluorodihydroxyphenylalanine PET/CT
Authors: Noskovicova Lucia , Kovacova Martina , Janik Jan , Marcinek Juraj , Balogova Sona
Published: July 2021

A 61-year-old man after resection of well-differentiated midgut neuroendocrine neoplasia (NEN) was referred to 18F-fluorodihydroxyphenylalanine PET/CT for localization of recurrent midgut NEN in the context of clinical symptoms and mild elevation of serum CgA (chromogranin A) levels. Isolated hepatic focus of increased 18F-Fluorodihydroxyphenylalanine uptake was detected. The biopsy of this focus, followed by radiofrequency ablation, revealed a hepatic cavernous hemangioma. Complete remission of midgut NEN was confirmed during 4-year clinical and imaging follow-up. The persistent mild elevation of serum CgA was retrospectively attributed to treatment with proton-pump inhibitors.
No Evidence to Favor 99mTc-HMPAO or 99mTc-ECD for Ictal Brain Perfusion SPECT for Identification of the Seizure Onset Zone
Authors: Jaber Mariam , Taherpour Jila , Voges Berthold , Apostolova Ivayla , Sauvigny Thomas , House Patrick M. , Lanz Michael , Lindenau Matthias , Klutmann Susanne , Martens Tobias , Stodieck Stefan , Buchert Ralph
Published: July 2021

Purpose

Ictal brain perfusion SPECT with the tracer 99mTc-HMPAO or 99mTc-ECD is widely used for identification of the epileptic seizure onset zone (SOZ) in presurgical evaluation if standard pointers are uncertain or inconsistent. For both tracers, there are theoretical arguments to favor it over the other for this task. The aim of this study was to compare the performance of ictal brain perfusion SPECT between 99mTc-HMPAO and 99mTc-ECD in a rather large patient sample.

Patients and Methods

The study retrospectively included 196 patients from clinical routine in whom ictal perfusion SPECT had been performed with stabilized 99mTc-HMPAO (n = 110) or 99mTc-ECD (n = 86). Lateralization and localization of the SOZ were obtained by the consensus of 2 independent readers based on visual inspection of the SPECT images.

Results

The 99mTc-HMPAO group and the 99mTc-ECD group were well matched with respect to age, sex, age at first seizure, duration of disease, seizure frequency, history of previous brain surgery, and findings of presurgical MRI. The proportion of lateralizing ictal SPECT did not differ significantly between 99mTc-HMPAO and 99mTc-ECD (65.5% vs 72.1%, P = 0.36). Sensitivity of ictal perfusion SPECT (independent of the tracer) for correct localization of the SOZ in 62 patients with temporal lobe epilepsy and at least worthwhile improvement (Engel scale ≤ III) 12 months after temporal epilepsy surgery was 63%.

Conclusions

This study does not provide evidence to favor 99mTc-HMPAO or 99mTc-ECD for identification of the SOZ by ictal perfusion SPECT.
Vascularized Pericranial Flap as a Method to Prevent Persistent Skull Defects After Craniectomy for Sagittal Synostosis
Authors: Flores Chiara A. , French Brooke M. , Alexander Allyson L. , Graber Sarah , Wittenberg Blake , Poppleton Kim , Wilkinson C. Corbett
Published: July 2021

Some cranial defects resulting from sagittal craniectomy for craniosynostosis never completely close and require cranioplasty. This study evaluates the results of 2 methods to minimize such defects: (1) trapezoidal craniectomy that is narrower posteriorly (2) vascularized pericranial flap that is sewn to the dura under a rectangular craniectomy.

Children who underwent primary open sagittal craniectomy with biparietal morcellation (with/without frontal cranioplasty) for single-suture nonsyndromic sagittal synostosis from 2013 through 2018 were included. Children were excluded if there was a dural tear, if they had no 1-year follow-up, or if they had unmeasured and/or uncounted skull defects. Surgeries were divided into (1) standard craniectomy, (2) trapezoidal craniectomy, or (3) craniectomy with pericranial flap. Differences in percentage of children with defects and mean total defect area 1 year postsurgery were compared between the 3 groups.

We reviewed 148 cases. After exclusions, 34 of 53 children (64%) who underwent standard craniectomy, 6 of 17 children (35%) who had pericranial flaps, and 5 of 11 children (46%) who underwent trapezoidal craniectomy had defects 1 year postsurgery. The percentage of children with defects (P = 0.0364) but not the defect area was significantly higher in the standard craniectomy than in the pericranial flap group. The percentage of subjects with defects was not significantly different between the standard and the trapezoidal craniectomy groups.

Sewing a vascularized pericranial flap to the dura at the craniectomy site may protect against persistent bony defects after sagittal craniectomy for craniosynostosis. Longer follow-up is needed to determine if this technique leads to lower rates of cranioplasty.
An Observational Study to Evaluate Association Between Velopharyngeal Anatomy and Speech Outcomes in Adult Patients With Severe Velopharyngeal Insufficiency
Authors: Lou Qun , Liu Ting , Wang Xudong , Wu Dandan , Wang Guomin , Chen Yang , Wan Teng
Published: July 2021

Objective:

By measuring velopharyngeal structure and evaluating speech intelligibility, to explore and observe the association between velopharyngeal anatomy and speech outcomes in these patients.

Methods:

Thirty-one adult patients with velopharyngeal insufficiency after the primary palatoplasty aged 18 to 35 years (mean 22.03 years) were enrolled as the study group. The patients had significant hypernasality and audible nasal emission. The degree of velopharyngeal closure assessed by electronic nasopharyngeal fiberoptic endoscopy was grade III. Cephalometric analysis was performed on lateral cephalograms to measure velopharyngeal structure, including hard palate length (ANS-PNS), velar length (PNS-U), pharyngeal depth (PNS-PPW), and oropharyngeal airway space (U-MPW). Their speech intelligibility was evaluated through the Mandarin Chinese speech intelligibility test, and each speech sample was examined by 2 speech and language pathologists. The results were assessed with the SPSS 23.0 software package, and regression analysis was used to examine the relationship between velopharyngeal structure and speech outcomes.

Results:

A significant negative correlation was confirmed between speech intelligibility and pharyngeal depth. Pharyngeal depth also showed a linear relationship with speech intelligibility, and there was no significant correlation between speech intelligibility and other measures (hard palate length, velar length, oropharyngeal airway space).

Conclusions:

In the velopharyngeal anatomy, only pharyngeal depth was associated with speech intelligibility in adult patients with severe velopharyngeal insufficiency, this is consistent with our clinical observation. It suggests that appropriate reduction of pharyngeal depth during palatopharyngoplasty may have a good effect on the speech recovery in patients with cleft palate and patients with velopharyngeal insufficiency after palatorrhaphy.