bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of rhomboid intercostal and subserratus plane block under direct vision for postoperative analgesia in thoracic surgeries: a prospective, randomized controlled trial
Authors: Kozanhan Betul , Semerkant Tolga , Esme Hıdır , Canitez Ahmet , İyisoy Mehmet Sinan
Published: October 2022

OBJECTIVES

This study is designed to evaluate the efficacy of rhomboid intercostal and subserratus plane (RISS) block under the surgeon’s direct vision for providing postoperative pain relief after thoracic surgeries.

METHODS

Forty patients who underwent thoracotomy were prospectively recruited and randomly assigned to group R (intravenous patient-controlled analgesia + continued RISS block; n = 20) and group C (intravenous patient-controlled analgesia; n = 20). Numeric rating scale at rest and cough, at post-anaesthetic care unit, 1, 2, 6, 9, 12, 24 and 48 h, was used as the primary outcome measure. Secondary outcome measures were the amount of tramadol consumption, the number of patients required rescue analgesia, the occurrence of postoperative adverse effects, pulmonary functions and the overall satisfaction with pain management.

RESULTS

Numeric rating scale scores both at rest and during coughing were significantly lower in group R than in group C at all time intervals (P < 0.001 in each). Tramadol consumption at 24 and 48 h was significantly lower in the group R block than in group C (P < 0.001 for each). None of the patients in group R requires rescue analgesia. The incidence of nausea and vomiting was similar among the groups. Compared with group C, change in lung function from baseline levels was significantly less in group R (P = 0.047 and P = 0.04 for FEV1 and FVC, respectively). The satisfaction scores in group R were significantly higher than that in group C (P < 0.001).

CONCLUSIONS

Continuous RISS block improved postoperative outcomes of thoracic surgery in terms of reduced postoperative pain scores, sparing opioid consumption, pulmonary function and patient satisfaction.
Estimating individual lifetime risk of incident cardiovascular events in adults with Type 2 diabetes: an update and geographical calibration of the DIAbetes Lifetime perspective model (DIAL2)
Authors: Østergaard Helena Bleken , Hageman Steven H J , Read Stephanie H , Taylor Owen , Pennells Lisa , Kaptoge Stephen , Petitjean Carmen , Xu Zhe , Shi Fanchao , McEvoy John William , Herrington William , Visseren Frank L J , Wood Angela , Eliasson Björn , Sattar Naveed , Wild Sarah , Di Angelantonio Emanuele , Dorresteijn Jannick A N
Published: October 2022

Aims

The 2021 European Society of Cardiology cardiovascular disease (CVD) prevention guidelines recommend the use of (lifetime) risk prediction models to aid decisions regarding intensified preventive treatment options in adults with Type 2 diabetes, e.g. the DIAbetes Lifetime perspective model (DIAL model). The aim of this study was to update the DIAL model using contemporary and representative registry data (DIAL2) and to systematically calibrate the model for use in other European countries.

Methods and results

The DIAL2 model was derived in 467 856 people with Type 2 diabetes without a history of CVD from the Swedish National Diabetes Register, with a median follow-up of 7.3 years (interquartile range: 4.0–10.6 years) and comprising 63 824 CVD (including fatal CVD, non-fatal stroke and non-fatal myocardial infarction) events and 66 048 non-CVD mortality events. The model was systematically recalibrated to Europe’s low- and moderate-risk regions using contemporary incidence data and mean risk factor distributions. The recalibrated DIAL2 model was externally validated in 218 267 individuals with Type 2 diabetes from the Scottish Care Information—Diabetes (SCID) and Clinical Practice Research Datalink (CPRD). In these individuals, 43 074 CVD events and 27 115 non-CVD fatal events were observed. The DIAL2 model discriminated well, with C-indices of 0.732 [95% confidence interval (CI) 0.726–0.739] in CPRD and 0.700 (95% CI 0.691–0.709) in SCID.

Conclusion

The recalibrated DIAL2 model provides a useful tool for the prediction of CVD-free life expectancy and lifetime CVD risk for people with Type 2 diabetes without previous CVD in the European low- and moderate-risk regions. These long-term individualized measures of CVD risk are well suited for shared decision-making in clinical practice as recommended by the 2021 CVD ESC prevention guidelines.
Co-occurrences enhance our understanding of aquatic fungal metacommunity assembly and reveal potential host–parasite interactions
Authors: Vass Máté , Eriksson Karolina , Carlsson-Graner Ulla , Wikner Johan , Andersson Agneta
Published: October 2022

Our knowledge of aquatic fungal communities, their assembly, distributions and ecological roles in marine ecosystems is scarce. Hence, we aimed to investigate fungal metacommunities of coastal habitats in a subarctic zone (northern Baltic Sea, Sweden). Using a novel joint species distribution model and network approach, we quantified the importance of biotic associations contributing to the assembly of mycoplankton, further, detected potential biotic interactions between fungi–algae pairs, respectively. Our long-read metabarcoding approach identified 493 fungal taxa, of which a dominant fraction (44.4%) was assigned as early-diverging fungi (i.e. Cryptomycota and Chytridiomycota). Alpha diversity of mycoplankton declined and community compositions changed along inlet–bay–offshore transects. The distributions of most fungi were rather influenced by environmental factors than by spatial drivers, and the influence of biotic associations was pronounced when environmental filtering was weak. We found great number of co-occurrences (120) among the dominant fungal groups, and the 25 associations between fungal and algal OTUs suggested potential host–parasite and/or saprotroph links, supporting a Cryptomycota-based mycoloop pathway. We emphasize that the contribution of biotic associations to mycoplankton assembly are important to consider in future studies as it helps to improve predictions of species distributions in aquatic ecosystems.
Investigating Biological Pathways Underpinning the Longitudinal Association Between Loneliness and Cognitive Impairment
Authors: Yu Kexin , Siang Ng Ted Kheng
Published: October 2022

Background

Loneliness precedes the onset of cognitive impairment (CI) in older adults. Although the mechanisms through which loneliness “gets under the skin” to influence the risk of developing CI have been conceptually proposed, they are rarely empirically examined. The Evolutionary Theory of Loneliness posits that loneliness as a stressor could cause dysregulations in multiple physiological systems. The current study investigated whether inflammatory, cardiovascular, and kidney biomarkers mediate the longitudinal association between loneliness and CI.

Methods

Cross-lagged panel models were used to examine the hypothesized relationships, using 2006, 2010, and 2014 waves of data from the Health and Retirement Study (N = 7,037). Loneliness was measured with the 3-item UCLA loneliness scale. CI was assessed with the modified telephone interview for cognitive status. Biomarkers included HbA1C, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, C-reactive protein, and Cystatin C. Using a stepwise model-building approach, first, the model included only loneliness, CI, and biomarker variables; then, sociodemographic covariates were added; lastly, health status were controlled for.

Results

In unadjusted and partially adjusted models, loneliness was associated with higher odds of worse cognitive status in an 8-year follow-up. Only HbA1C mediated the longitudinal association between loneliness and CI. However, after further controlling for health status, all associations became nonsignificant.

Conclusions

Examining a large number of participants and linking a limited number of biological markers with cognition and loneliness longitudinally, our empirical data did not support theoretical propositions, highlighting the critical importance of controlling for confounders in future studies examining longitudinal mediational relationships underlying loneliness and CI.
Observed versus expected morbidity and mortality in patients undergoing mitral valve repair
Authors: Newell Paige , Tartarini Richard , Hirji Sameer , Harloff Morgan , McGurk Siobhan , Cherkasky Olena , Kaneko Tsuyoshi
Published: October 2022

OBJECTIVES

Mitral valve repair (MVP) is the gold standard treatment for degenerative mitral regurgitation. With the expansion of transcatheter technologies, this study compares the outcome of MVP in low-risk and non-low-risk patients to serve as a benchmark.

METHODS

This retrospective, single-institution study examined all patients who underwent MVP for primary mitral regurgitation from 2005 to 2018. Patients were stratified into 2 risk categories: low-risk [Society of Thoracic Surgeons (STS) Predicted Risk of Mortality (STS-PROM) ≤2%] and non-low risk (STS-PROM > 2% or age > 75), with a subgroup of very low risk (STS-PROM ≤1%, age <75).

RESULTS

A total of 1207 patients were included, and 1053 patients were classified as low risk and 154 as non-low risk. The non-low-risk group was significantly older, more likely to be female, and had a higher comorbidity burden than the low-risk group (all P < 0.01). For the low-risk group, the observed-to-expected (O:E) STS mortality ratio was 0.4 and the composite morbidity and mortality ratio was 0.6, whereas for the non-low risk, the O:E mortality was 1.5 and the composite morbidity and mortality was 0.9. When the subgroup of very low-risk group was assessed, the mortality O:E ratio was 0.

CONCLUSIONS

The observed composite morbidity and mortality of patients undergoing MVP were persistently lower in low-risk patients, mainly driven by the very low-risk group. The excellent outcome of MVP in low-risk patients should be validated on a national level to determine how transcatheter technologies can be utilized in these patients.
Recognition as Transitional Justice ‘From Below’: Analysing Victims’ Grassroots Activism in Postconflict Colombia
Authors: Tamayo Gomez Camilo
Published: October 2022

The framework of transitional justice ‘from below’ is often used to explore perspectives where victims are addressed as subjects with their own agency and organizational capability in temporal and normative aspects. Using qualitative research techniques to analyse victims’ organizations in Colombia, this article establishes the notion of recognition as crucial to comprehending ‘from below’ perspectives of transitional justice. It explores the cases of the Never Again Museum and the Trails for Life and Reconciliation in Eastern Antioquia. It examines victims’ efforts to create processes of ‘democratization of pain’ (the transformation of personal experiences of loss into common public knowledge) as expressions of recognition. The article’s main contribution rests in the idea that by scrutinizing victims’ initiatives as expressions of recognition, the normative idea of transitional justice ‘from below’ can be reinvigorated. It demonstrates that the concept of transitional justice ‘from below’ constitutes an abstract ideal that needs to be redefined by bringing into consideration the function and particularities of victims’ grassroots activism.
Deposition path-dependent lightweight support design and its implication to self-support topology optimization
Authors: Wang Yifan , Wu Tao , Liu Jikai , Yu Huangchao
Published: October 2022

This paper presents a lightweight support design method for material extrusion-type three-dimensional printed panel structures that innovatively involves the deposition path curvature information for support point determination. Specifically, this support design method provides a robust segmentation algorithm to divide the filament deposition paths into segments based on the curvature sign alternating condition, and then searches for the fewest support points for the filaments counting on the experimentally calibrated relationship between the maximum allowable self-support distance and the local mean curvature. The proposed method features in generating thin-walled skeleton-ray styled support structures that are lightweight while providing firm support for the panels. More importantly, the support design method provides a new type of self-support criterion for structural topology optimization involving non-designable planar panels, i.e., only a sparse point set would be sufficient to support the panel. Consequently, more materials could be spent on enhancing the load-bearing capacity instead of being wasted on oversupporting. The achievable structural performances from self-support topology optimization with this new self-support criterion can improve significantly. Support design and printing tests were conducted on a few panel structures that validated the improved support effect compared with equal-volume supports generated by commercial software. Equidistant and gap-free deposited filaments, no filament collapse due to insufficient support, and no isolated voids reflect the improved support effect. The improved self-support topological design was also validated through a comparative numerical case study, and a compliance reduction of 7.76% was achieved.
It’s not arthritis! Resolution of the illusion of joint space narrowing with acetabuloplasty and labral reconstruction for the calcified labrum
Authors: Owens Jade S , Saks Benjamin R , Miecznikowski Kara B , Maldonado David R , Jimenez Andrew E , Lall Ajay C , Domb Benjamin G
Published: October 2022

Labral calcification may be part of the natural history of untreated femoroacetabular impingement syndrome (FAIS) in certain patients, making it a potential target for intervention with the goal of preserving the hip joint. The purpose of this study was to investigate if calcified labra create the appearance of lateral joint space narrowing and report minimum 2-year patient-reported outcome measures (PROMs) after treating patients with arthroscopic acetabuloplasty and labral reconstruction. Prospectively collected data on patients who underwent primary hip arthroscopy for FAIS and labral tearing from February 2015 to April 2021 were reviewed. Patients treated with primary labral reconstruction for an intraoperatively confirmed diagnosis of labral calcification were included. A sub-analysis was performed for patients with a minimum of 2-year follow-up. Preoperative and postoperative PROMs for the modified Harris hip score, nonarthritic hip score, the International Hip Outcome Tool-12 and visual analog scale for pain were recorded. Forty-six hips (46 patients) were included, with 19 hips in the sub-analysis. There was a significant increase in apparent lateral joint space width (JSW) measured on supine anteroposterior (AP) pelvis radiographs with no significant changes in medial and central JSW and significant decreases in the lateral and anterior center-edge angles and alpha angle. Patients experienced significant increases in PROMs and high rates of achieving psychometric thresholds. Patients presenting with FAIS and calcified labra may have apparent lateral joint space narrowing on pre-operative supine AP pelvis radiographs. These patients have low rates of full-thickness femoral head and acetabular cartilage pathology, this apparent narrowing can be corrected and excellent outcomes and survivorship can be achieved, with primary labral reconstruction.
The Desirability of Difference: Georges Canguilhem and Body Integrity Identity Disorder
Authors: Gibson Richard B
Published: October 2022

Opponents of the provision of therapeutic, healthy limb amputation in Body Integrity Identity Disorder cases argue that such surgeries stand in contrast to the goal of medical practice – that of health restoration and maintenance. This paper refutes such a conclusion via an appeal to the nuanced and reflective model of health proposed by Georges Canguilhem. The paper examines the conceptual entanglement of the statistically common with the normatively desirable, arguing that a healthy body can take multiple forms, including that of an amputee, provided that such a form enables the continuing ability to initiate new norms of existence. It concludes that the practice of healthy limb amputation in cases of Body Integrity Identity Disorder is not only compatible with the goal of medicine but is potentially the only method of achieving this goal in the face of a complex and often mischaracterized disorder.
Imaging zinc trafficking in vivo by positron emission tomography with zinc-62
Authors: Firth George , Yu Zilin , Bartnicka Joanna J , Parker David , Kim Jana , Sunassee Kavitha , Greenwood Hannah E , Al-Salamee Fahad , Jauregui-Osoro Maite , Di Pietro Alberto , Guzman Joanna , Blower Philip J
Published: October 2022

Non-invasive imaging techniques to dynamically map whole-body trafficking of essential metals in vivo in health and diseases are needed. Despite 62Zn having appropriate physical properties for positron emission tomography (PET) imaging (half-life, 9.3 h; positron emission, 8.2%), its complex decay via 62Cu (half-life, 10 min; positron emission, 97%) has limited its use. We aimed to develop a method to extract 62Zn from a 62Zn/62Cu generator, and to investigate its use for in vivo imaging of zinc trafficking despite its complex decay. 62Zn prepared by proton irradiation of natural copper foil was used to construct a conventional 62Zn/62Cu generator. 62Zn was eluted using trisodium citrate and used for biological experiments, compared with 64Cu in similar buffer. PET/CT imaging and ex vivo tissue radioactivity measurements were performed following intravenous injection in healthy mice. [62Zn]Zn-citrate was readily eluted from the generator with citrate buffer. PET imaging with the eluate demonstrated biodistribution similar to previous observations with the shorter-lived 63Zn (half-life 38.5 min), with significant differences compared to [64Cu]Cu-citrate, notably in pancreas (>10-fold higher at 1 h post-injection). Between 4 and 24 h, 62Zn retention in liver, pancreas, and kidney declined over time, while brain uptake increased. Like 64Cu, 62Zn showed hepatobiliary excretion from liver to intestines, unaffected by fasting. Although it offers limited reliability of scanning before 1 h post-injection, 62Zn-PET allows investigation of zinc trafficking in vivo for >24 h and hence provides a useful new tool to investigate diseases where zinc homeostasis is disrupted in preclinical models and humans.
Early Outpatient Treatment With Remdesivir in Patients at High Risk for Severe COVID-19: A Prospective Cohort Study
Authors: Rajme-López Sandra , Martinez-Guerra Bernardo A , Zalapa-Soto Jessica , Román-Montes Carla M , Tamez-Torres Karla M , González-Lara María F , Hernandez-Gilosul Thierry , Kershenobich-Stalnikowitz David , Sifuentes-Osornio José , Ponce-de-León Alfredo , Ruíz-Palacios Guillermo M
Published: October 2022

Background

Early treatment of coronavirus disease 2019 (COVID-19) with remdesivir in high-risk patients, including those with immunosuppression of different causes, has not been evaluated. The objective of this study was to assess the clinical effectiveness of early remdesivir treatment among patients with mild to moderate COVID-19 at high risk of progression.

Methods

This prospective cohort comparative study was conducted in a tertiary referral center in Mexico City. Patients with mild to moderate COVID-19 at high risk for progression were treated with an ambulatory 3-day course of remdesivir. The primary efficacy composite outcome was hospitalization or death at 28 days after symptom onset. A Cox proportional hazards regression model was used to identify associations with the primary outcome.

Results

From December 1, 2021, to April 30, 2022, a total of 196 high-risk patients were diagnosed with COVID-19, of whom 126 were included in this study (43%, 54/126, received remdesivir; 57%, 72/126, did not receive remdesivir). Baseline clinical characteristics were similar between groups; autoimmune diseases (39/126), solid organ transplant (31/126), and malignant neoplasms (24/126) were the most common immunocompromising conditions. Diabetes mellitus was strongly associated with the primary outcome in both groups. Prior severe acute respiratory syndrome coronavirus 2 infection or vaccination was not independently associated with COVID-19 progression. Treatment with remdesivir significantly reduced the odds of hospitalization or death (adjusted hazard ratio, 0.16; 95% CI, 0.06–0.44; P < .01).

Conclusions

Early outpatient treatment with remdesivir significantly reduces hospitalization or death by 84% in high-risk, majority immunosuppressed patients with Omicron variant COVID-19.
Comparative Effectiveness of Front-Line Ipilimumab and Nivolumab or Axitinib and Pembrolizumab in Metastatic Clear Cell Renal Cell Carcinoma
Authors: Zarrabi Kevin K , Handorf Elizabeth , Miron Benjamin , Zibelman Matthew R , Anari Fern , Ghatalia Pooja , Plimack Elizabeth R , Geynisman Daniel M
Published: October 2022

Background

Treatment of metastatic renal cell carcinoma (mRCC) is rapidly evolving with new combination therapies demonstrating improved response rates and survival. There are no head-to-head prospective trials comparing an immunotherapy doublet with an immunotherapy/tyrosine-kinase inhibitor-based combination. We compare real-world outcomes in patients treated with axitinib/pembrolizumab (axi/pembro) or ipilimumab/nivolumab (ipi/nivo). The primary endpoints were overall-survival (OS) and real-world progression-free survival (rwPFS).

Patients and Methods

We used a de-identified database to select patients diagnosed with clear cell mRCC and treated with front-line axi/pembro or ipi/nivo from 2018 to 2022. Analyses are adjusted using propensity score-based inverse probability of treatment weighting, balancing age, gender, insurance, race, IMDC risk, and nephrectomy status. We compared survival by treatment groups using weighted and unweighted Kaplan–Meier curves with log-rank tests and weighted Cox proportional hazards regressions.

Results

We included a total of 1506 patients with mRCC who received frontline axi/pembro (n = 547) or ipi/nivo (n = 959). Median follow-up time was 20.0 months (range: 0.2-47.6). Baseline demographics were similar between the 2 cohorts. Adjusted median OS for the full population was 28.9 months for axi/pembro and was 24.3 months for ipi/nivo (P = .09). Twenty-four-month survival was 53.8% for axi/pembro treated patients and 50.2% for ipi/nivo treated patients. rwPFS was 10.6 months for axi/pembro treated patients and 6.9 months for ipi/nivo treated patients. Treatment with axi/pembro conferred improved survival in the IMDC favorable risk strata, with no significant difference in survival observed within the full cohort.

Conclusions

In this retrospective, real-world study of patients treated with front-line combination therapy, patients with IMDC favorable risk disease had better survival when treated with axi/pembro compared to ipi/nivo. However, survival for the entire population and the 24-month median overall survival were not statistically different between treatment groups. Longer follow-up is necessary to discern any emerging significant differences.
On Being a Stranger in a Foreign Land: Providing Integrative Oncology Therapies to COVID-19 Medical Professionals
Authors: Ben-Arye Eran , Samuels Noah , Kassem Sameer
Published: October 2022

This narrative describes an innovative program using integrative medicine therapies to improve the well-being of patients and providers in a hospital’s COVID-19 departments.
The Advent, Development, and Impact of Christianity in Africa
Authors: Ayegboyin Isaac Deji , Ogunewu Michael Adeleke
Published: October 2022

Christianity is a prominent religion and a force to be reckoned with in the lives of the people of Africa. Curiously, and unknown to many, Christianity was already present on the continent (in North Africa) in the first century. However, given the devastation it experienced around the turn of the 8th century, one would expect it to have died a natural death. But this was not to be. Christianity made an astonishing reappearance between the 15th and 19th centuries. This chapter adopts a descriptive approach backed with the qualitative use of existing literature to investigate the beginning, development, and contributions of the Christian Church in Africa and shows that it has had a remarkable impact on the religious, social, and even economic life of the people. It makes recommendations concerning how the faith can be solidified to produce a working model for the 21st-century church.
Early defoliation induces auxin redistribution, promoting paradormancy release in pear buds
Authors: Wei Jia , Yang Qinsong , Ni Junbei , Gao Yuhao , Tang Yinxin , Bai Songling , Teng Yuanwen
Published: October 2022

Paradormancy of fruit trees occurs in summer and autumn when signals from adjacent organs stimulate buds to develop slowly. This stage has received less attention that the other stages of dormancy, and the underlying mechanism remains uncharacterized. Early defoliation in late summer and early autumn is usually followed by out-of-season blooming in pear (Pyrus spp.), which substantially decreases the number of buds the following spring and negatively affects fruit production. This early bud flush is an example of paradormancy release. Here, we determined that flower bud auxin content is stable after defoliation; however, polar distribution of the pear (Pyrus pyrifolia) PIN-FORMED auxin efflux carrier 1b (PpyPIN1b) implied that auxin tends to be exported from buds. Transcriptome analysis of floral buds after artificial defoliation revealed changes in auxin metabolism, transport, and signal transduction pathways. Exogenous application of a high concentration of the auxin analog 1-naphthaleneacetic acid (300 mg/L) suppressed PpyPIN1b expression and its protein accumulation in the cell membrane, likely leading to decreased auxin efflux from buds, which hindered flower bud sprouting. Furthermore, carbohydrates and additional hormones also influenced out-of-season flowering. Our results indicate that defoliation-induced auxin efflux from buds accelerates bud paradormancy release. This differs from release of apical-dominance-related lateral bud paradormancy after the apex is removed. Our findings and proposed model further elucidate the mechanism underlying paradormancy and will help researchers to develop methods for inhibiting early defoliation-induced out-of-season bud sprouting.
Toward a data infrastructure for the Plant Cell Atlas
Authors: Fahlgren Noah , Kapoor Muskan , Yordanova Galabina , Papatheodorou Irene , Waese Jamie , Cole Benjamin , Harrison Peter , Ware Doreen , Tickle Timothy , Paten Benedict , Burdett Tony , Elsik Christine G , Tuggle Christopher K , Provart Nicholas J
Published: October 2022

We review how a data infrastructure for the Plant Cell Atlas might be built using existing infrastructure and platforms. The Human Cell Atlas has developed an extensive infrastructure for human and mouse single cell data, while the European Bioinformatics Institute has developed a Single Cell Expression Atlas, that currently houses several plant data sets. We discuss issues related to appropriate ontologies for describing a plant single cell experiment. We imagine how such an infrastructure will enable biologists and data scientists to glean new insights into plant biology in the coming decades, as long as such data are made accessible to the community in an open manner.
Risk assessment for long- and short-range airborne transmission of SARS-CoV-2, indoors and outdoors
Authors: Poydenot Florian , Abdourahamane Ismael , Caplain Elsa , Der Samuel , Haiech Jacques , Jallon Antoine , Khoutami Inés , Loucif Amir , Marinov Emil , Andreotti Bruno
Published: October 2022

Preventive measures to reduce infection are needed to combat the COVID-19 pandemic and prepare for a possible endemic phase. Current prophylactic vaccines are highly effective to prevent disease but lose their ability to reduce viral transmission as viral evolution leads to increasing immune escape. Long-term proactive public health policies must therefore complement vaccination with available nonpharmaceutical interventions aiming to reduce the viral transmission risk in public spaces. Here, we revisit the quantitative assessment of airborne transmission risk, considering asymptotic limits that considerably simplify its expression. We show that the aerosol transmission risk is the product of three factors: a biological factor that depends on the viral strain, a hydrodynamical factor defined as the ratio of concentration in viral particles between inhaled and exhaled air, and a face mask filtering factor. The short-range contribution to the risk, present both indoors and outdoors, is related to the turbulent dispersion of exhaled aerosols by air drafts and by convection (indoors), or by the wind (outdoors). We show experimentally that airborne droplets and CO2 molecules present the same dispersion. As a consequence, the dilution factor, and therefore the risk, can be measured quantitatively using the CO2 concentration, regardless of the room volume, the flow rate of fresh air, and the occupancy. We show that the dispersion cone leads to a concentration in viral particles, and therefore a short-range transmission risk, inversely proportional to the squared distance to an infected person and to the flow velocity. The aerosolization criterion derived as an intermediate result, which compares the Stokes relaxation time to the Lagrangian time-scale, may find application for a broad class of aerosol-borne pathogens and pollutants.
Simulation-Based Education in Physical Therapist Professional Education: A Scoping Review
Authors: Stockert Brad , Silberman Nicki , Rucker Jason , Bradford Jacque , Gorman Sharon L , Greenwood Kristin Curry , Macauley Kelly , Nordon-Craft Amy , Quiben Myla
Published: October 2022

Objectives

The purposes of this study were to (1) describe and summarize the use of simulation-based education (SBE) with student physical therapists in the international literature and (2) describe the application and integration of standards of best practice (SOBP) for SBE reported in published physical therapy education research.

Methods

Ovid MEDLINE, CINAHL, Web of Science, and ERIC databases were searched. The search included any published study that involved the use of SBE with student physical therapists. Because this was a scoping review, only descriptive statistics were compiled; no methodological quality assessment was performed.

Results

This scoping review revealed a significant increase in literature describing SBE with student physical therapists in the past 10 years. Simulation was used to address learning objectives across a variety of content areas and clinical settings. Communication skills were the most common objectives for simulation. Limited use of SOBP, published in 2016, was reported, and use of author-generated outcome measures without validation was common.

Conclusions

Although there has been an increase in literature reporting the use of SBE with student physical therapists across many practice areas and settings, many articles reported limited use and integration of published SOBP and frequently utilized outcome measures that had not been validated.

Impact

The findings show that limited use of validated outcome measures and SOBP constrain the capacity for reproducing studies, comparing findings among studies, and completing systematic reviews that could inform and optimize best practices for the use of SBE in physical therapist professional education. Further research on SBE in physical therapy would benefit from investigations that integrated and reported the use of SOBP for standardized patients, simulation design, and delivery and assessment of learning outcomes over time at multiple Kirkpatrick learning levels.
Simulation-Based Education in Physical Therapist Education: Perspectives From the Strategic Initiative Panel on Simulation in Physical Therapist Education
Authors: Quiben Myla , Greenwood Kristin Curry , Gorman Sharon L , Bradford Jacque , Macauley Kelly , Nordon-Craft Amy , Rucker Jason , Silberman Nicki , Stockert Brad
Published: October 2022

In the summer of 2018, The American Council of Academic Physical Therapy appointed 9 individuals versed in simulation education to form the Strategic Initiative Panel on Simulation to (1) investigate the use of simulation in physical therapist education, (2) explore the role of simulation in meeting accreditation standards and curriculum elements related to clinical education and interprofessional education, and (3) describe models and best practices for the use of simulation in physical therapist education. Over the 3 years of Strategic Initiative Panel on Simulation work, the panel identified several significant gaps in simulation education and research practice. This paper clarifies the essential elements required to optimize the delivery of simulation-based education in physical therapy following best practices, frames the existing challenges to move the profession forward, and recommends specific actions needed to address the many continued questions related to the effective use of simulation-based education in physical therapist education.
Comparing an Expanded Versus Brief Telehealth Physical Therapist Intervention for Knee Osteoarthritis: Study Protocol for the Delaware PEAK Randomized Controlled Trial
Authors: Jakiela Jason T , Voinier Dana , Hinman Rana S , Copson Jennifer , Schmitt Laura A , Leonard Tara R , Aily Jéssica B , Bodt Barry A , White Daniel K
Published: October 2022

Objective

The purpose of this study is to investigate whether a remotely delivered physical therapist intervention increases physical activity (PA) over 12 weeks, compared with existing web-based resources, in adults with knee osteoarthritis (OA).

Methods

This will be a single-center, randomized controlled trial with 2 parallel arms: (1) the Expanded Intervention (Delaware PEAK [Physical Exercise and Activity for Knee osteoarthritis]), which includes five 45- to 60-minute video conference-based sessions of supervised exercise (strengthening exercises, step goals) that are remotely delivered over 12 weeks by a physical therapist; or (2) the Brief Intervention (control group), a website that includes prerecorded videos directing participants to web-based resources for strengthening, PA, and pain management for knee OA that are freely available. The trial will enroll 100 participants who meet the National Institute for Health and Care Excellence OA clinical criteria (≥45 years old, have activity-related knee pain, and have no morning stiffness or it lasts ≤30 minutes), reside in the contiguous United States (excluding Alaska and Hawaii), and are seeking to be more physically active. Outcomes include PA (time in moderate-to-vigorous and light PA, steps per day), sedentary behaviors, treatment beliefs, and self-efficacy for exercise. Our primary outcome is moderate-to-vigorous PA. Outcomes will be measured at baseline, 12 weeks, and 24 weeks.

Impact

This protocol focuses on the remote delivery of physical therapy via telehealth to adults with knee OA and comes at a critical time, because the burden of inactivity is of particular concern in this population. If successful, the findings of this work will provide strong support for the broad implementation of Delaware PEAK, highlight the utility of telehealth in physical therapy, and address the critical need to utilize exercise to manage adults with knee OA through physical therapists.
When Should You Adjust Standard Errors for Clustering?
Authors: Abadie Alberto , Athey Susan , Imbens Guido W , Wooldridge Jeffrey M
Published: October 2022

Clustered standard errors, with clusters defined by factors such as geography, are widespread in empirical research in economics and many other disciplines. Formally, clustered standard errors adjust for the correlations induced by sampling the outcome variable from a data-generating process with unobserved cluster-level components. However, the standard econometric framework for clustering leaves important questions unanswered: (i) Why do we adjust standard errors for clustering in some ways but not others, for example, by state but not by gender, and in observational studies but not in completely randomized experiments? (ii) Is the clustered variance estimator valid if we observe a large fraction of the clusters in the population? (iii) In what settings does the choice of whether and how to cluster make a difference? We address these and other questions using a novel framework for clustered inference on average treatment effects. In addition to the common sampling component, the new framework incorporates a design component that accounts for the variability induced on the estimator by the treatment assignment mechanism. We show that, when the number of clusters in the sample is a nonnegligible fraction of the number of clusters in the population, conventional clustered standard errors can be severely inflated, and propose new variance estimators that correct for this bias.
Why do Borrowers Default on Mortgages?
Authors: Ganong Peter , Noel Pascal
Published: October 2022

There are three prevailing theories of mortgage default: strategic default (driven by negative equity), cash flow default (driven by negative life events), and double-trigger default (where both negative triggers are necessary). It has been difficult to compare these theories in part because negative life events are measured with error. We address this measurement error using a comparison group of borrowers with no strategic-default motive. Our central finding is that only 6% of underwater defaults are caused exclusively by negative equity, an order of magnitude lower than previously thought. We then analyze the remaining defaults. We find that 70% are driven solely by negative life events (i.e., cash flow defaults), while 24% are driven by the interaction between negative life events and negative equity (i.e., double-trigger defaults). Together, the results provide a full decomposition of the theories underlying borrower default and suggest that negative life events play a central role.
Economic assessment of foot-and-mouth disease outbreaks in Brazil
Authors: de Menezes Taís Cristina , Countryman Amanda M , Ferreira Filho Joaquim Bento de Souza , Ferreira Fernando
Published: October 2022

Foot-and-mouth disease (FMD) outbreaks in cloven-hoofed animals cause substantial economic impacts because of animal depopulation, increased government spending on control, eradication and surveillance measures, and bans on international trade. This study employs a computable general equilibrium (CGE) modeling framework in tandem with results from an epidemiological model to evaluate the economic consequences of a hypothetical FMD outbreak in Brazil. FMD-induced productivity losses and restrictions on international trade of livestock and meat products are applied as exogenous shocks in the economic model. Results show increased bilateral trade of beef and pork, mainly in South America, North Africa, and Russia. Simulated welfare losses in Brazil range from $132 million to $271 million depending on the severity of trade restrictions imposed. This study expands the rich literature on animal health economics. Results highlight the importance of maintaining the health of Brazilian herds, especially when considering Brazil's position as one of the main meat suppliers in the international market.
Brain responses to the vicarious facilitation of pain by facial expressions of pain and fear
Authors: Khatibi Ali , Roy Mathieu , Chen Jen-I , Gill Louis-Nascan , Piche Mathieu , Rainville Pierre
Published: October 2022

Observing pain in others facilitates self-pain in the observer. Vicarious pain facilitation mechanisms are poorly understood. We scanned 21 subjects while they observed pain, fear and neutral dynamic facial expressions. In 33% of the trials, a noxious electrical stimulus was delivered. The nociceptive flexion reflex (NFR) and pain ratings were recorded. Both pain and fear expressions increased self-pain ratings (fear > pain) and the NFR amplitude. Enhanced response to self-pain following pain and fear observation involves brain regions including the insula (INS) (pain > fear in anterior part), amygdala, mid-cingulate cortex (MCC), paracentral lobule, precuneus, supplementary motor area and pre-central gyrus. These results are consistent with the motivational priming account where vicarious pain facilitation involves a global enhancement of pain-related responses by negatively valenced stimuli. However, a psychophysiological interaction analysis centered on the left INS revealed increased functional connectivity with the aMCC in response to the painful stimulus following pain observation compared to fear. The opposite connectivity pattern (fear > pain) was observed in the fusiform gyrus, cerebellum (I–IV), lingual gyrus and thalamus, suggesting that pain and fear expressions influence pain-evoked brain responses differentially. Distinctive connectivity patterns demonstrate a stronger effect of pain observation in the cingulo-insular network, which may reflect partly overlapping networks underlying the representation of pain in self and others.
A survey of Mathematics Learning Support in the United States
Authors: Mac an Bhaird Ciarán , Thomas David A
Published: October 2022

Mathematics Learning Support (MLS) has been widely available in Higher Education Institutions in the United States (US) for decades. However, until recently, there has been little research that considered the extent of provision. In this paper, we present the results of a survey of MLS with responses from 268 institutions across the US, which indicate that such support is well established across responding institutions. To place these results in context, we compare them to other recent international surveys of provision. We discuss what these findings mean and the collaborative opportunities that are available for US and international practitioners and researchers in this area.
Racial and Ethnic Disparities in Primary Cesarean Birth and Adverse Outcomes Among Low-Risk Nulliparous People
Authors: Fishel Bartal Michal , Chen Han-Yang , Mendez-Figueroa Hector , Wagner Stephen M. , Chauhan Suneet S.P.
Published: October 2022

OBJECTIVE:

To compare trend of primary cesarean delivery rate and composite neonatal and maternal adverse outcomes in low-risk pregnancies among racial and ethnic groups: non-Hispanic White, non-Hispanic Black, and Hispanic.

METHODS:

This population-based cohort study used U.S. vital statistics data (2015–2019) to evaluate low-risk, nulliparous patients with nonanomalous singletons who labored and delivered at 37–41 weeks of gestation. The primary outcome was the primary cesarean delivery rate. Secondary outcomes included composite neonatal adverse outcome (Apgar score less than 5 at 5 minutes, assisted ventilation for more than 6 hours, seizure, or death), and composite maternal adverse outcome (intensive care unit admission, blood transfusion, uterine rupture, or unplanned hysterectomy), as well as infant death. Multivariable Poisson regression models were used to estimate adjusted relative risks (aRR) and 95% CIs.

RESULTS:

Among 4.3 million births, 60.6% identified as non-Hispanic White, 14.6% identified as non-Hispanic Black, and 24.8% identified as Hispanic. The rate of primary cesarean delivery was 18.5% (n=804,155). An increased risk for cesarean delivery was found in non-Hispanic Black (21.7%, aRR 1.24, 95% CI 1.23–1.25) and Hispanic (17.3%, aRR 1.09, 95% CI 1.09–1.10) individuals, compared with non-Hispanic White individuals (18.1%) after multivariable adjustment. There was an upward trend in the rate of primary cesarean delivery in all racial and ethnic groups (P for linear trend<0.001 for all groups). However, the racial and ethnic disparity in the rate of primary cesarean delivery remained stable during the study period. The composite neonatal adverse outcome was lower in Hispanic individuals in all newborns (10.7 vs 8.3 per 1,000 live births, aRR 0.74, 95% CI 0.72–0.75), and in newborns delivered by primary cesarean delivery (18.5 vs 15.0 per 1,000 live births, aRR 0.73, 95% CI 0.70–0.76), compared with non-Hispanic White individuals.

CONCLUSION:

Using a nationally representative sample in the United States, we found racial and ethnic disparities in the primary cesarean delivery rate in low-risk nulliparous patients, which persisted throughout the study period.
Periurethral and Anterior Vaginal Wall Masses
Authors: Jacox Natalie , Yao Henry Han-I , Baverstock Richard , Trpkov Kiril , Carlson Kevin
Published: October 2022

OBJECTIVE:

To describe the etiology and presenting symptoms of periurethral and anterior vaginal wall masses in a large series of patients in an academic institution.

METHODS:

A retrospective chart review of 126 patients presenting and undergoing treatment for periurethral and anterior vaginal wall masses between November 2001 and July 2021 was completed. Clinicopathologic data were extracted. Ethics approval was obtained. The primary objective of this study was to determine the etiology of these masses; secondary objectives included determining the rates of presenting symptoms, complications, resolution of stress urinary incontinence (SUI), and de novo SUI.

RESULTS:

The median age of patients was 42 years. The most common etiology was urethral diverticula (39.7%), followed by Skene gland cysts or abscesses (30.2%). The rate of malignancy was 1.6%, and the rate of infection was 21.4%. The most common presenting symptoms were sensation of mass (78.6%), dyspareunia (52.4%), and discharge (46.0%). The rate of surgical complications was 9.5%. Three patients had recurrence on follow-up, but there were no recurrent urethral diverticula after excision. The rate of de novo SUI was 5.6%. The rate of resolution of SUI was 67.6%, and all patients who had slings reported resolution of SUI.

CONCLUSION:

Urethral diverticula and Skene gland cysts or abscesses accounted for 70% of periurethral and anterior vaginal wall masses in this series. Treatment by complete excision is usually successful.