bluuebunny/crossref_metadata_2025 huggingface dataset:
Category II Intrapartum Fetal Heart Rate Patterns Unassociated With Recognized Sentinel Events
Authors: Clark Steven L.
Published: June 2022

The evolution of continuous electronic fetal heart rate (FHR) monitoring has presented the obstetrician with a critical clinical conundrum: basic science observations suggest that such monitoring might be associated with improved long-term neurologic outcomes, yet, after a half century of use and millions of cesarean deliveries based on FHR monitoring, evidence for such improvement remains absent. This dichotomy appears to be related to widespread misconceptions regarding the physiology underlying various FHR patterns and the developmental origins of cerebral palsy. These misconceptions are strengthened by a reliance on anecdotal experience and tradition in lieu of evidence-based medicine, the confusing “category II” FHR designation, medical-legal considerations, and our tendency to view fetal monitoring, as originally conceptualized, as a single, indivisible entity whose concepts must be accepted or rejected en bloc. Ill-defined and largely imaginary conditions such as “depletion of fetal reserve” are particularly harmful and their use in clinical medicine uniquely not evidence based. A solution to this self-inflicted injury to our specialty will require a concerted effort involving teachers, authors, and researchers.
Human Milk–Expression Technologies
Authors: Liberty Abigail , Rubin Elizabeth S. , Bullard Kimberley A. , Au Katherine
Published: June 2022

Lactation is a powerful tool for improving health trajectories and promoting reproductive justice. Multiple new human milk–expression technologies are available. Although direct feeding is optimal and feasible in many circumstances, understanding human milk–expression technology and counseling patients appropriately represents one of the ways physicians can support patients in meeting their feeding goals. Breast pumps and breast pump accessories may help patients establish and maintain breastfeeding, but these technologies continue to evolve and are not always intuitive. The core components of a pump are the attachment at the breast, valves, tubing, motor, device programming, and reservoir. Whereas closed systems can be used by multiple patients, open systems are single-user and they are not able to be sterilized. Mobile pumps may help support breastfeeding individuals who are unable to remain stationary for the time necessary to express milk. Nonelectric pumps represent an important adjuvant technology. There are a wide variety of pump accessories that may help patients overcome specific breastfeeding challenges. Obstetricians remain uniquely positioned to support patients in achieving their lactation goals, which is enhanced by familiarity with the supportive technologies available.
Pilot Study of Maternal Autoantibody–Related Autism
Authors: Angkustsiri Kathleen , Fussell Jill J. , Bennett Amanda , Schauer Joseph , Ramirez-Celis Alexandra , Hansen Robin L. , Van de Water Judy
Published: June 2022

Objective:

The objective of this study was to investigate the presence of maternal autoantibody–related autism spectrum disorder (MAR-ASD) in 2 geographically distinct DBPNet clinical sites (Pennsylvania and Arkansas). MAR-ASD is a biologically defined subtype of ASD that is defined by the presence of autoantibodies specific to proteins in the fetal brain and present in approximately 20% of a Northern California sample but has not been studied in other states.

Methods:

Sixty-eight mothers of children with ASD were recruited from 2 DBPNet clinics and provided blood samples. Mothers also completed behavioral questionnaires about their children, and data from the child's clinical diagnostic assessment were abstracted.

Results:

The mean age of mothers was 38.5 ± 6.1 years, and the mean age of children was 8.3 ± 2.7 years. MAR-ASD was present in 24% of the sample and similar across sites. Children of +MAR mothers had more severe autism symptoms as measured by Autism Diagnostic Observation Schedule comparison scores (W = 3604; p < 0.001) and the Social Communication Questionnaire (W = 4556; p < 0.001). There were no differences in IQ, adaptive function, or aberrant behavior.

Conclusion:

MAR-ASD is a subtype of autism that is present in similar frequencies across 3 states and related to autism severity.
Impact of Patient and Operative Factors on Nipple-Areola Complex Sensation after Bilateral Reduction Mammaplasty
Authors: Payton Jesse I. , Abraham Jasson T. , Novak Matthew D. , Hammonds Kendall P. , Altman Andrew
Published: June 2022

Background:

Alteration of nipple-areola complex (NAC) sensation following reduction mammoplasty is commonly reported and may impact patient satisfaction. The goal of this study was to evaluate the patient and procedural factors that influence the rates of subjective NAC sensation change.

Methods:

A retrospective review of all patients who underwent primary bilateral reduction mammoplasty between January 2014 and August 2018 at the senior author’s institution was performed. The primary outcome measured was subjective NAC sensation via digital stimulation of the NAC with the patient reporting sensation as decreased, unchanged, or increased.

Results:

In total, 274 patients met inclusion criteria. NAC sensation was decreased in 19% of breasts, unchanged in 74%, and increased in 7.3%. Patients who underwent vertical pattern, superomedial pedicle reductions were more likely to report a decrease in sensation than those who underwent Wise pattern, inferior pedicle reductions (26% versus 13%; P = 0.0025). Patients with minor complications were more likely to report decreased NAC sensation than those who did not (23% versus 15%; P = 0.0264). The only factor found to be associated with increased sensation was operative time.

Conclusions:

Patients were more likely to report decreased sensation if a vertical skin resection, superomedial pedicle was chosen, or if patients experienced a minor complication. The only factor found to correlate with increased NAC sensation was longer operative times.
The Canadian version of the National Institutes of Health minimum dataset for chronic low back pain research: reference values from the Quebec Low Back Pain Study
Authors: Angarita-Fonseca Adriana , Pagé M. Gabrielle , Meloto Carolina B. , Gentile Erika Lauren , Léonard Guillaume , Massé-Alarie Hugo , Tufa Iulia , Roy Jean-Sébastien , Stone Laura S. , Choinière Manon , Fortin Maryse , Roy Mathieu , Sean Monica , Tétreault Pascal , Rainville Pierre , Deslauriers Simon , Lacasse Anaïs
Published: June 2022

The National Institutes of Health (NIH) minimum dataset for chronic low back pain (CLBP) was developed in response to the challenge of standardizing measurements across studies. Although reference values are critical in research on CLBP to identify individuals and communities at risk of poor outcomes such as disability, no reference values have been published for the Quebec (Canada) context. This study was aimed to (1) provide reference values for the Canadian version of the NIH minimum dataset among individuals with CLBP in Quebec, both overall and stratified by gender, age, and pain impact stratification (PIS) subgroups, and (2) assess the internal consistency of the minimum data set domains (pain interference, physical function, emotional distress or depression, sleep disturbance, and PIS score). We included 2847 individuals living with CLBP who completed the baseline web survey of the Quebec Low Back Pain Study (age: 44.0 ± 11.2 years, 48.1% women) and were recruited through social media and healthcare settings. The mean score was 6.1 ± 1.8 for pain intensity. Pain interference, physical function, emotional distress or depression, sleep disturbance, and PIS scores were 12.9 ± 4.1, 14.4 ± 3.9, 9.8 ± 4.4, 13.0 ± 3.6, and 26.4 ± 6.6, respectively. Emotional distress or depression showed floor effects. Good-to-excellent internal consistency was found overall and by language, gender, and age subgroups for all domains (alpha: 0.81-0.93) and poor-to-excellent internal consistency for PIS subgroups (alpha: 0.59-0.91). This study presents reference values and recommendations for using the Canadian version of the NIH minimum dataset for CLBP that can be useful for researchers and clinicians.
Plasma Clozapine and Norclozapine After Use of Either Crushed Tablets or Suspension Compared With Tablets
Authors: Flanagan Robert James , Hunter Samora , Obee Stephen John , Reeves Suzanne
Published: June 2022

Background

With clozapine, either crushed tablets suspended in an aqueous medium or proprietary suspension is sometimes prescribed as an alternative to tablets, but bioequivalence data are scant.

Methods

We compared clozapine dose, and plasma clozapine and N-desmethylclozapine (norclozapine) concentrations after use of either tablets or crushed tablets/suspension in samples submitted for clozapine therapeutic drug monitoring, 1993 to 2017.

Results

There were 846 patients (1646 samples) given crushed tablets/suspension and 6065 patients (10,779 samples) given tablets. The median dose (mg d−1) was significantly higher in men (500 vs 450) and women (500 vs 400) given crushed tablets/suspension, but the median plasma clozapine and norclozapine concentrations (mg L−1) were significantly lower (men: 0.29 and 0.22 vs 0.39 and 0.28; women: 0.35 and 0.26 vs 0.50 and 0.32, respectively). A subgroup of 480 patients was prescribed either crushed tablets/suspension (1016 samples) or tablets (1259 samples) at different times. The median dose was again significantly higher in men (500 vs 500) and women (500 vs 450), but the median plasma clozapine and norclozapine concentrations were significantly lower (men: 0.29 and 0.22 vs 0.32 and 0.24; women: 0.30 and 0.24 vs 0.38 and 0.29, respectively).

Implications

Poor adherence, sedimentation of suspension before use, and incomplete dosage are potential contributors to the lower median plasma clozapine and norclozapine concentrations observed after use of either crushed clozapine tablets or suspension as compared with tablets. Those administering crushed tablets/suspension should be aware of these factors.
Resuscitation guideline highlights
Authors: Olasveengen Theresa M. , Ristagno Giuseppe , Smyth Michael A.
Published: June 2022

Purpose of review

The purpose of this review was to give an overview of the most significant updates in resuscitation guidelines and provide some insights into the new topics being considered in upcoming reviews.

Recent findings

Recent updates to resuscitation guidelines have highlighted the importance of the earlier links in the chain-of-survival aimed to improve early recognition, early cardiopulmonary resuscitation (CPR) and defibrillation. Empowering lay rescuers with the support of emergency medical dispatchers or telecommunicators and engaging the community through dispatching volunteers and Automated External Defibrillators, are considered key in improving cardiac arrest outcomes. Novel CPR strategies such as passive insufflation and head-up CPR are being explored, but lack high-certainty evidence. Increased focus on survivorship also highlights the need for more evidence based guidance on how to facilitate the necessary follow-up and rehabilitation after cardiac arrest. Many of the systematic and scoping reviews performed within cardiac arrest resuscitation domains identifies significant knowledge gaps on key elements of our resuscitation practices. There is an urgent need to address these gaps to further improve survival from cardiac arrest in all settings.

A continuous evidence evaluation process for resuscitation after cardiac arrest is triggered by new evidence or request by the resuscitation community, and provides more current and relevant guidance for clinicians.
Health inequities in out-of-hospital cardiac arrest
Authors: Boulton Adam J. , Del Rios Marina , Perkins Gavin D.
Published: June 2022

Purpose of review

Out-of-hospital cardiac arrest (OHCA) is a time-critical emergency in which a rapid response following the chain of survival is crucial to save life. Disparities in care can occur at each link in this pathway and hence produce health inequities. This review summarises the health inequities that exist for OHCA patients and suggests how they may be addressed.

Recent findings

There is international evidence that the incidence of OHCA is increased with increasing deprivation and in ethnic minorities. These groups have lower rates of bystander CPR and bystander-initiated defibrillation, which may be due to barriers in accessing cardiopulmonary resuscitation training, provision of public access defibrillators, and language barriers with emergency call handlers. There are also disparities in the ambulance response and in-hospital care following resuscitation. These disadvantaged communities have poorer survival following OHCA.

OHCA disproportionately affects deprived communities and ethnic minorities. These groups experience disparities in care throughout the chain of survival and this appears to translate into poorer outcomes. Addressing these inequities will require coordinated action that engages with disadvantaged communities.
Remote monitoring in the use of extracorporeal membrane oxygenation and acute mechanical circulatory support
Authors: Aguirre Aaron D. , Shelton Kenneth T.
Published: June 2022

Purpose of review

To provide an overview of the role of remote monitoring tools in management of critically-ill patients requiring acute mechanical circulatory support (MCS).

Recent findings

Tele-critical care systems have received new interest during the COVID-19 pandemic, which has stretched the capacity of health systems everywhere. At the same time, utilization of MCS and extracorporeal membrane oxygenation (ECMO) technologies has increased during the pandemic. The opportunity for remote monitoring and clinical decision support for ECMO and acute MCS devices has been recognized by industry partners, with several major platforms implementing technology infrastructure for it in available products. Healthcare systems face challenges interfacing multiple devices from multiple manufacturers with each other and with their designated electronic health records. Furthermore, the availability of data must be combined with algorithms for alerting on clinical events and with implementation systems to act upon these alerts. Studies are not yet published validating remote monitoring platforms for ECMO and MCS in clinical care.

Remote monitoring for MCS devices represents a major opportunity for further investigation to improve the utilization of these devices and better serve patients.
Gastrointestinal Symptoms Profile in Pediatric Patients With Gastroparesis Compared to Healthy Controls
Authors: Febo-Rodriguez Liz , Chumpitazi Bruno P. , Musaad Salma , Sher Andrew C. , Varni James W. , Shulman Robert J.
Published: June 2022

Objectives:

The primary objective was to compare the patient-reported gastrointestinal symptoms profiles of pediatric patients with gastroparesis to matched healthy controls using the Pediatric Quality of Life Inventory™ (PedsQL™) Gastrointestinal Symptoms Scales. The secondary objectives were to compare pediatric patients with gastroparesis to pediatric patients with gastroparesis-like symptoms and normal gastric emptying and to compare pediatric patients with gastroparesis-like symptoms and normal gastric emptying to matched healthy controls.

Methods:

The PedsQL™ Gastrointestinal Symptoms Scales were completed by 64 pediatric patients with gastroparesis, 59 pediatric patients with gastroparesis-like symptoms and normal gastric emptying, and 200 age, gender, and race/ethnicity matched healthy controls. The PedsQL™ Gastrointestinal Symptoms Scales encompass 10 individual multi-item scales which measure stomach pain, stomach discomfort when eating, food and drink limits, trouble swallowing, heartburn and reflux, nausea and vomiting, gas and bloating, constipation, blood in poop, and diarrhea/fecal incontinence. Based on gastric emptying scintigraphy testing, those with abnormal gastric retention were classified as having gastroparesis.

Results:

The gastrointestinal symptoms profile analysis identified large differences between those with gastroparesis compared to healthy controls (most P<0.001), with the largest effect sizes for upper gastrointestinal symptoms including stomach pain, stomach discomfort when eating, food and drink limits, nausea, and vomiting. Those with gastroparesis self-reported similar gastrointestinal symptoms to those with normal gastric emptying, except for increased constipation.

Conclusions:

Pediatric patients with gastroparesis self-reported broad multidimensional gastrointestinal symptoms profiles in comparison to healthy controls with large differences, indicating the critical need for more highly efficacious interventions to bring patient functioning within the normal range of healthy functioning.
The Outcome of Patients With Cystic Biliary Atresia With Intact Proximal Hepatic Ducts Following Hepatic-Cyst-Jejunostomy
Authors: Asai Akihiro , Wu Jia-Feng , Wang Kasper S. , Yamataka Atsuyuki , Nio Masaki , Su Da-Jyun , Short Celia , Tsuboi Koichi , Ochi Takanori , Sasaki Hideyuki , Okubo Ryuji , Yodoshi Toshifumi , Konishi Kenichiro , Rogers Michael E. , Tiao Gregory M. ,   on Behalf of Pacific Biliary Atresia Study Group (PaBAS)
Published: June 2022

Objectives:

To determine the outcomes of patients with cystic biliary atresia by correlating the anatomy of the hepatic ducts with the choice of biliary reconstruction surgery.

Background:

The Kasai hepatoportoenterostomy (Kasai) is the initial surgical procedure offered to most patients with biliary atresia. In contrast, a hepatic-cyst-jejunostomy has been reported to be effective in patients with the cystic form of biliary atresia.

Methods and Results:

We performed an international multicenter retrospective review. Two hundred eighty-seven patients were included, and 33 cases of cystic biliary atresia were identified. Outcomes were the serum total bilirubin level 3 months post-surgery and native liver survival at 2 years of age and were compared between cases who received the Kasai versus hepatic-cyst-jejunostomy in correlation to the anatomy of proximal hepatic ducts. The patients were categorized into 3 anatomical groups: patent intact hepatic ducts (n = 10), patent hypoplastic hepatic ducts (n = 13), and obliterated hepatic ducts (n = 10). All 10 patients with patent intact hepatic duct group underwent hepatic-cyst-jejunostomy, and 9 experienced bile drainage and native liver survival. Among the 13 patients with hypoplastic hepatic ducts, 11 underwent the Kasai procedure, and 9 had bile drainage, whereas 2 underwent hepatic-cyst-jejunostomy, and one survived with the native liver. All of the patients with obliterated hepatic ducts underwent the Kasai procedure; 5 established biliary drainage and survived with the native liver. Of 5 who did not drain, 3 underwent liver transplantation.

Conclusions:

In patients with cystic biliary atresia, the subset with a connection between cyst and intrahepatic bile ducts via intact proximal hepatic ducts had favorable clinical outcomes following hepatic-cyst-jejunostomy.
Feeding in Preterm Neonates With Antenatal Doppler Abnormalities: A Systematic Review and Meta-Analysis
Authors: Anne Rajendra Prasad , Aradhya Abhishek S. , Murki Srinivas
Published: June 2022

Objectives:

In this systematic review and meta-analysis, we attempted to determine the most appropriate feed initiation and advancement practices in preterm neonates with antenatal Doppler abnormalities.

Methods:

We included randomized controlled trials comparing different feed initiation and advancement practices in neonates with antenatal Doppler abnormalities. The databases of PubMed, Embase, Cochrane, CINAHL, Scopus, and Google Scholar were searched on February 25, 2022. The risk of bias was assessed using the Risk of Bias tool, version 2. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. RevMan 5.4 was used for data analysis.

Results:

Of the 1499 unique records identified, 7 studies were eligible for inclusion (6 on feed initiation, 1 on feed advancement). Early enteral feeding did not increase NEC stage 2 or more [risk ratio (RR) 1.12, 95% confidence interval (CI) 0.71–1.78; 6 studies, 775 participants] and mortality (RR 0.83, 95% CI 0.47–1.48; 5 studies, 642 participants). A trend was noted towards an increase in feeding intolerance (RR 1.23, 95% CI 0.98–1.56; 5 studies, 715 participants). There was a significant reduction in age at full enteral feeds, duration of total parental nutrition, and rates of hospital-acquired infections. Rapid feed advancement decreased the age at full enteral feeds without affecting other outcomes. The overall certainty of the evidence was rated low. Heterogeneity was not significant.

Conclusion:

There is low-certainty evidence that early feed initiation in preterm neonates with antenatal Doppler abnormalities does not increase rates of NEC and mortality. There is insufficient data on the speed of feed advancement.
Object Permanence and the Relationship to Sitting Development in Infants With Motor Delays
Authors: An Mihee , Marcinowski Emily C. , Hsu Lin-Ya , Stankus Jaclynn , Jancart Karl L. , Lobo Michele A. , Dusing Stacey C. , McCoy Sarah W. , Bovaird James A. , Willett Sandra , Harbourne Regina T.
Published: June 2022

Purpose:

This study examines object permanence development in infants with motor delays (MD) compared with infants with typical development (TD) and in relation to sitting skill.

Methods:

Fifty-six infants with MD (mean age = 10 months) and 36 with TD (mean age = 5.7 months) were assessed at baseline and then at 1.5, 3, and 6 months postbaseline. A scale was developed to measure object permanence (Object Permanence Scale [OPS]), and the Gross Motor Function Measure sitting subsection (GMFM-SS), and the Bayley Scales of Infant and Toddler Development, 3rd Edition (Bayley-III) were administered.

Results:

Interrater reliability of the OPS was excellent and correlation between the OPS and Bayley-III cognitive scores was moderately positive. Compared with TD, infants with MD were delayed in development of object permanence but demonstrated increased understanding over time and as sitting skills improved.

Conclusion:

In children with MD, object permanence, as quantified by the OPS, emerges in conjunction with sitting skill.
Research Summit V: Optimizing Transitions From Infancy to Early Adulthood in Children With Neuromotor Conditions
Authors: Sargent Barbara , Harbourne Regina , Moreau Noelle G. , Sukal-Moulton Theresa , Tovin Melissa , Cameron Judy L. , Stevenson Richard D. , Novak Iona , Heathcock Jill
Published: June 2022

Purpose:

The purpose of this executive summary is to review the process and outcomes of the Academy of Pediatric Physical Therapy Research Summit V, “Optimizing transitions from infancy to young adulthood in children with neuromotor disabilities: biological and environmental factors to support functional independence.”

Summary of Key Points:

An interdisciplinary group of researchers, representatives from funding agencies, and individuals with neuromotor disabilities and their parents participated in an intensive 2.5-day summit to determine research priorities to optimize life transitions for children with neuromotor disabilities. Recommended priorities for research included (1) promoting self-determination and self-efficacy of individuals with neuromotor disabilities and their families, (2) best care at the right time: evidence-based best practice care, led and navigated by families seamlessly across the lifespan, (3) strengthening connections between developmental domains to enhance function and participation, and (4) optimal dosing and timing to support adaptive bone, muscle, and brain plasticity across the lifespan.
Seated Outcome Measures in Children With Duchenne Muscular Dystrophy
Authors: Kern Rebecca , Carvell Kimberly , Gupta Apeksha , Verma Sumit
Published: June 2022

Purpose:

Quantifiable motor strength measures to assess disease severity throughout the continuum of Duchenne muscular dystrophy (DMD) are needed. To study the feasibility of seated trunk strength using hand-held dynamometry (HHD) and caregiver-reported subjective functional independence measures in boys with DMD.

Methods:

Prospective, cross-sectional, observational study of 18 participants with DMD enrolled from pediatric muscular dystrophy clinic during routine clinical assessment. Hand-held dynamometry, seated reach distance test and Pediatric Evaluation of Disability Inventory (PEDI) were administered.

Results:

All study participants regardless of the walking status were able to complete the seated function tests demonstrating feasibility. The age of the participants correlated negatively with PEDI mobility and positively with HHD extension scores. The seated measures did not statistically correlate with PEDI mobility scores.

Conclusions:

Seated motor strength measures and PEDI mobility scores are feasible. The PEDI mobility and HHD extension scores correlate with age. Study limitations included single-center experience and cross-sectional data.

Video abstract link:

https://www.dropbox.com/s/s4r0k7o6s0tfbkb/PT-Seated-Measures-And-DMD-2022.mp4?dl=0
Intraoperative Optical and Fluorescence Imaging of Blood Flow Distributions in Mastectomy Skin Flaps for Identifying Ischemic Tissues
Authors: Mazdeyasna Siavash , Huang Chong , Paranzino Alisha B. , Mohtasebi Mehrana , Cheng Qiang , Wong Lesley , Yu Guoqiang
Published: June 2022

Insufficient blood flow causes mastectomy skin flap necrosis in 5 to 30 percent of cases. Fluorescence angiography with the injection of indocyanine green dye has shown high sensitivities (90 to 100 percent) but moderate specificities (72 to 50 percent) in predicting mastectomy skin flap necrosis. However, a number of challenging issues limit its wide acceptance in clinical settings, including allergic reaction, short time-window for observation, and high cost for equipment and supplies. An emerging inexpensive speckle contrast diffuse correlation tomography technology enables noninvasive, noncontact, and continuous three-dimensional imaging of blood flow distributions in deep tissues. This preliminary study tested the hypothesis that speckle contrast diffuse correlation tomography and indocyanine green–fluorescence angiography measurements of blood flow distributions in mastectomy skin flaps are consistent. Eleven female patients undergoing skin-sparing or nipple-sparing mastectomies were imaged sequentially by the dye-free speckle contrast diffuse correlation tomography and dye-based commercial fluorescence angiography (SPY-PHI). Resulting images from these two imaging modalities were co-registered based on the ischemic areas with the lowest blood flow values. Because the ischemic areas have irregular shapes, a novel contour-based algorithm was used to compare three-dimensional images of blood flow distribution and two-dimensional maps of indocyanine green perfusion. Significant correlations were observed between the two measurements in all contours from a selected area of 10 × 10 mm2 with the lowest blood flow (r ≥ 0.78; p < 0.004), suggesting that speckle contrast diffuse correlation tomography provides the information for identifying ischemic tissues in mastectomy skin flaps. With further optimization and validation in large populations, speckle contrast diffuse correlation tomography may ultimately be used as a noninvasive and inexpensive imaging tool for intraoperative assessment of skin flap viability to predict mastectomy skin flap necrosis.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Diagnostic, II.
Transverse Upper Gracilis Flap Breast Reconstruction: A 5-Year Consecutive Case Series of Patient-Reported Outcomes
Authors: Jessica Anne Savage , Zhao Jade , Mackey Simon , Blackburn Adam Victor
Published: June 2022

Background:

The transverse upper gracilis flap is an important reconstructive option for patients who desire autologous reconstruction after mastectomy but in whom a deep inferior epigastric perforator flap is unavailable or undesirable. The authors present an analysis of outcomes and patient satisfaction results, from a consecutive series in a single institution.

Methods:

Using a prospectively populated free flap database, all patients undergoing transverse upper gracilis flap breast reconstruction for a mastectomy defect between January of 2013 and December of 2017 were identified. Retrospective review of clinical notes, admissions, and discharge information was conducted to identify outcomes, secondary operations, and complications. All patients were contacted by letter and invited to take part in a patient satisfaction survey a minimum of 12 months after free-flap surgery.

Results:

Seventy-eight patients underwent transverse upper gracilis flap breast reconstruction using a total of 103 transverse upper gracilis flaps to reconstruct 99 breast mounds in the 5-year period studied. Patient satisfaction is evidenced by BREAST-Q scores showing 81 ± 19 percent Satisfaction with Breasts, 80 ± 20 percent Psychosocial Well-Being, and 84 ± 19 percent Physical Well-Being of the chest. Forty-six of 53 (87 percent) report satisfaction with the postoperative appearance of their thigh unclothed and 51 of 53 (96 percent) report satisfaction clothed.

Conclusions:

This is the first consecutive series of transverse upper gracilis flap breast reconstruction outcomes that presents BREAST-Q scores for multiple, postoperative reconstruction modules and details complications stratified by Clavien-Dindo score. The methodology can be easily replicated and benchmarked against. Our donor-site complication rates are lower than previous publications and patient satisfaction data reveal that this is a well-accepted option for patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Preventing Medication Errors in Pediatric Anesthesia: A Systematic Scoping Review
Authors: Shawahna Ramzi , Jaber Mohammad , Jumaa Eman , Antari Bisan
Published: June 2022

Objective

Preventing medication errors and improving patient safety in pediatric anesthesia are top priorities. This systematic scoping review was conducted to identify and summarize reports on medication errors in pediatric anesthesia. The study also aimed to qualitatively synthesize medication error situations in pediatric anesthesia and recommendations to eliminate/minimize them.

Methods

The databases: Cochrane, MEDLINE through PubMed, Embase, CINAHL through EBSCO, and PsycINFO were extensively searched from their inception to March 3, 2020. Error situations in pediatric anesthesia and recommendations to minimize/reduce these errors were synthesized qualitatively. Recommendations were graded by level of evidence using the methodology of the Joanna Briggs Institute.

Results

Data were extracted from 39 publications. Dosing errors were the most commonly reported. Scenarios representing medication (n = 33) error situations in pediatric anesthesia and recommendations to eliminate/minimize medication errors (n = 36) were qualitatively synthesized. Of the recommendations, 2 (5.6%) were related to manufacture, 4 (11.1%) were related to policy, 1 (2.8%) was related to presentation to user, 1 (2.8%) was related to process tools, 17 (47.2%) were related to administration, 3 (8.3%) were related to recording/documentation, and 8 (22.2%) recommendations were classified as others. Of those, 29 (80.6%), 3 (8.3%), 3 (8.3%), and 1 (2.8%) were graded as evidence level 1, 2, 3, and 5, respectively.

Discussion

Medication error situations that might occur in pediatric anesthesia and recommendations on how to eliminate/minimize medication errors were also qualitatively synthesized. Adherence to recommendations might reduce the incidence of medication errors in pediatric anesthesia.
Distinct forms of migration and mobility are differentially associated with HIV treatment adherence
Authors: Murnane Pamela M. , Gandhi Monica , Bacchetti Peter , Getahun Monica , Gutin Sarah A. , Okochi Hideaki , Maeri Irene , Eyul Patrick , Omoding Daniel , Okiring Jaffer , Tallerico Regina , Louie Alexander , Akullian Adam , Kamya Moses R. , Bukusi Elizabeth A. , Charlebois Edwin D. , Camlin Carol S.
Published: June 2022

Objective:

We examined whether human mobility was associated with antiretroviral treatment adherence, measured via antiretroviral hair concentrations.

Design:

This is a cross-sectional analysis of adults on antiretroviral treatment in East Africa at baseline in an observational cohort study.

Methods:

Participants reported recent mobility (overnight travel) and histories of migration (changes of residence), including reasons, frequency/duration, and locations. Hair antiretroviral concentrations were analyzed using validated methods. We estimated associations between mobility and antiretroviral concentrations via linear regression adjusted for age, sex, region, years on treatment.

Results:

Among 383 participants, half were women and the median age was 40. Among men, 25% reported recent work-related mobility, 30% nonwork mobility, and 11% migrated in the past year (mostly across district boundaries); among women, 6 and 57% reported work-related and nonwork mobility, respectively, and 8% recently migrated (mostly within district). Those reporting work-related trips 2 nights or less had 72% higher hair antiretroviral levels (P = 0.02) than those who did not travel for work; in contrast, nonwork mobility (any duration, vs. none) was associated with 24% lower levels (P = 0.06). Intra-district migrations were associated with 59% lower antiretroviral levels than nonmigrants (P = 0.003) while inter-district migrations were not (27% higher, P = 0.40).

Conclusion:

We found that localized/intra-district migration and nonwork travel—more common among women—were associated with lower adherence, potentially reflecting care interruptions or staying with family/friends unaware of the participants’ status. In contrast, short work-related trips—more common among men—were associated with higher adherence, perhaps reflecting higher income. Adherence interventions may require tailoring by sex and forms of mobility.
Investigating the optimum sample type and target genes for SARS-CoV-2 detection
Authors: Zhan Junjie , xie Ying , Wang Junxue , Hang Xiaofeng
Published: June 2022

Aims

The cycle threshold (Ct) value for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid detection is important because of the criteria for quarantine management, including release from it, which are defined in Guidelines on the Novel Coronavirus-Infected Pneumonia Diagnosis and Treatment (Provisional 9th Edition, China). As this is also currently relevant because of the recent SARS-CoV-2 epidemic in Shanghai, we discuss the SARS-CoV-2 nucleic acid detection and its problems. We focus on the gene fragments and sample types involved in nucleic acid detection and their effect on the latest criteria for release from quarantine.

Methods

A total of 215 patients with SARS-CoV-2 infection were included. Pharyngeal swabs (nasopharyngeal swabs plus oropharyngeal swabs) were collected in the early stage of the disease, and pharyngeal swabs, sputum samples, and anal swabs were collected both in the middle and advanced stages of the disease. The Open reading frame 1ab (ORF lab) gene, Nucleocapsid (N) gene and Envelop (E) gene of each sample were quantitatively analyzed using fluorescence qPCR technique.

Results

Exclusion of the E gene detection results had no significant effect on the interpretation of the nucleic acid Ct value of 35, with a positive concordance rate of 98.7% (95% CI 86.0%–100%) and an overall concordance rate of 99.7% (95% CI 92.9%–100%). The kappa coefficient was 0.99 (95% CI 0.92–1.00). Compared with nucleic acid detection using both pharyngeal swab and sputum sample, the positive concordance rate of the detection using pharyngeal swab alone was 47.6% (95% CI 27.8%–99.3%). The kappa coefficient was 0.63 (95% CI 0.53–0.75), and the consistency was not ideal.

Conclusions

Nucleic acid detection using the ORF 1ab gene and the N gene can achieve the purpose of SARS-CoV-2 detection. Nucleic acid detection using sputum samples is significant in the determination of Ct values and its significance in the development of the criteria for release from quarantine needs to be taken into account. It is suggested that to increase the accuracy of nucleic acid detection, instead of unilaterally pursuing increasing the number of target genes for amplification and improving PCR techniques, more attention should be paid to sampling and sample reliability, as well as strict quality control of the detection process.
Homologous and heterologous boosting of the ChAdOx1-S1-S COVID-19 vaccine with the SCB-2019 vaccine candidate: a randomized, observer-blinded, controlled, phase 2 study
Authors: Costa Clemens Sue Ann , Milan Eveline Pipolo , Sprinz Eduardo , Neto José Cerbino , Pacciarini Filippo , Li Ping , Chen Hui-Ling , Smolenov Igor , Pollard Andrew , Clemens Ralf
Published: June 2022

Background

Ongoing outbreaks of COVID-19 are driven by waning immunity following primary immunizations and emergence of new SARS-CoV-2 variants which escape vaccine-induced neutralizing antibodies. It has been suggested that heterologous boosters could enhance and potentially maintain population immunity.

Methods

We assessed immunogenicity and reactogenicity of booster doses of different formulations of alum-adjuvanted SCB-2019 vaccine (9 μg SCB-2019 with or without CpG-1018 adjuvant, or 30 μg SCB-2019 with CpG-1018) in Brazilian adults primed with ChAdOx1-S vector vaccine. S-protein antibodies and ACE2-binding inhibition were measured by ELISA on Days 1, 15 and 29. Participants self-reported solicited adverse events and reactions.

Results

All SCB-2019 formulations increased S-protein ELISA antibodies and ACE2 binding inhibition to a greater extent than ChAdOx1-S. After 30 μg SCB-2019+CpG+alum titers against wild-type S-protein were significantly higher than after ChAdOx1-S on Days 15 and 29, as were titers of neutralizing antibodies against wild-type strain and Beta, Gamma, Delta, and Omicron variants. Boosting with SCB-2019 or ChAdOx1-S was well tolerated with no vaccine-related serious or severe adverse events.

Conclusions

Boosting ChAdOx1-S-primed adults with SCB-2019 induced higher levels of antibodies against a wild-type strain and SARS-CoV-2 variants than a homologous ChAdOx1-S booster, highest responses being with the 30 μg SCB-2019+CpG+alum formulation.
Within-patient evolution of plasmid-mediated antimicrobial resistance
Authors: DelaFuente Javier , Toribio-Celestino Laura , Santos-Lopez Alfonso , Leon-Sampedro Ricardo , Valle Aida Alonso-del , Costas Coloma , Hernandez-Garcia Marta , Cui Lun , Rodriguez-Beltran Jeronimo , Bikard David , Canton Rafael , Millan Alvaro San
Published: June 2022

Antibiotic resistance (AMR) in bacteria is a major threat to public health, and one of the key elements in the spread and evolution of AMR in clinical pathogens is the transfer of conjugative plasmids. The drivers of AMR evolution have been extensively studied in vitro, but the evolution of plasmid-mediated AMR in vivo remains poorly explored. Here, we tracked the evolution of the clinically-relevant plasmid pOXA-48, which confers resistance to the last-resort antibiotics carbapenems, in a large collection of enterobacterial clones isolated from the gut of hospitalised patients. Combining genomic and experimental approaches, we first characterized plasmid diversity and the genotypic and phenotypic effects of multiple plasmid mutations on a common genetic background. Second, using cutting-edge genomic editing in wild-type multidrug resistant enterobacteria, we dissected three cases of within-patient plasmid-mediated AMR evolution. Our results revealed, for the first time, compensatory evolution of plasmid-associated fitness cost, as well as the evolution of enhanced plasmid-mediated AMR, in bacteria evolving within the gut of hospitalised patients. Crucially, we observed that the evolution of plasmid-mediated AMR in vivo involves a pivotal trade-off between resistance levels and bacterial fitness. This study highlights the need to develop new evolution-informed approaches to tackle plasmid-mediated AMR dissemination.
Leveraging place field repetition to understand positional versus nonpositional inputs to hippocampal field CA1
Authors: Hockeimer William , Lai Ruo-Yah , Natrajan Maanasa , Snider William , Knierim James J.
Published: June 2022

The hippocampus is believed to encode episodic memory by binding information about the content of experience within a spatiotemporal framework encoding the location and temporal context of that experience. Previous work implies a distinction between positional inputs to the hippocampus that provide information about an animal’s location and nonpositional inputs which provide information about the content of experience, both sensory and navigational. Here we leverage the phenomenon of “place field repetition” to better understand the functional dissociation between positional and nonpositional inputs to CA1. Rats navigated freely on a novel maze consisting of linear segments arranged in a rectilinear, city-block configuration, which combined elements of open-field foraging and linear-track tasks. Unlike typical results in open-field foraging, place fields were directionally tuned on the maze, even though the animal’s behavior was not constrained to 1-D trajectories. Repeating fields from the same cell tended to have the same directional preference when the fields were aligned along a linear corridor of the maze, but they showed uncorrelated directional preferences when they were unaligned across different corridors. Lastly, individual fields displayed complex time dynamics which resulted in the population activity changing gradually over the course of minutes. These temporal dynamics were evident across repeating fields of the same cell. These results demonstrate that the positional inputs that drive a cell to fire in similar locations across the maze can be behaviorally and temporally dissociated from the nonpositional inputs that alter the firing rates of the cell within its place fields, thereby increasing the flexibility of the system to encode episodic variables within a spatiotemporal framework provided by place cells.
Celebrity endorsement in marketing from 1960 to 2021: a bibliometric review and future agenda
Authors: Wang Shaoshan , Liu Matthew Tingchi
Published: June 2022

Purpose

This study deployed a bibliometric analysis of 604 academic articles on celebrity endorsement collected from the Scopus database from January 1960 to August 2021 (the first published article dated back to 1976). This study integrated three bibliometric analyses: timeline visualization, co-citation cluster analysis, and historical direct citation analysis. This study conducted a qualitative review to further examine the obtained quantitative results.

Design/methodology/approach

This study reviewed the existing research on the celebrity endorsement domain. Based on a bibliometric review of existing literature, this study aimed to provide main theoretical roots and research trajectories and propose new research avenues concerning the theory, context, characteristics, and research methodologies adopted within the marketing discipline.

Findings

The findings revealed that the existing relevant research focused on celebrity endorsement in different periods. The main theoretical roots and research trajectories identified were developed under the influence of primary articles from co-citation analysis and historical direct citation.

Research limitations/implications

Based on the quantitative bibliometric analysis and a qualitative literature review, this study has provided a comprehensive overview of the current stage of this domain. The study also has underscored an abundance of celebrity endorsement literature and revealed the research topics that require further investigations to theoretically and empirically advance the understanding of celebrity endorsement.

Practical implications

Some topics were recommended for further research within the theory, context, characteristics, and methodology aspects. Some practical examples and suggestions are also given in the study.

Originality/value

This study proposed a bibliometric overview of celebrity endorsement in the marketing discipline, especially based on timeline visualization, co-citation cluster analysis, and historical direct citation analysis. Furthermore, this study offered a research agenda for further studies in the marketing discipline.
A constrained topology optimization methodology based on budget constrained min-cut
Authors: Xia Meng , Sykulski Jan
Published: June 2022

Purpose

The purpose of this paper is to propose a novel methodology based on budget constrained Min-Cut theorem to solve constrained topology optimization (TO).

Design/methodology/approach

This paper establishes a weighted network with budget, which is derived from the sensitivity with respect to the constraint function. The total budget carried by the topology evaluates the extent to which the constraint is satisfied. By finding the Min-Cut under budget constraint in each step, the proposed method is able to solve constrained TO problem.

Findings

The results obtained from a magnetic actuator including a yoke, a coil and an armature have demonstrated that the proposed method is effective to solve constrained TO problem.

Originality/value

A novel methodology based on budget constrained Min-Cut is proposed to solve constrained TO problem.
Emerging technology and auditing practice: analysis for future directions
Authors: Thottoli Mohammed Muneerali , Ahmed Essia Ries , Thomas K.V.
Published: June 2022

Purpose

The purpose of this paper is to explore the effects of emerging technology (technology adoption, perceived benefits, technological challenges and ease of use) and the auditing practice of accounting professionals.

Design/methodology/approach

The primary method of data collection was a questionnaire directed to newly practicing chartered accountants who are partners of sole proprietorship or partnership firms in India. The data were analyzed by using partial least squares structural equation modeling (PLS-SEM).

Findings

The findings revealed that there is a positive and significant relationship between characteristics of emerging technology (technology adoption, technological challenges and ease of use) and auditing practice, while factors of the perceived benefits had a negative relationship with auditing practice.

Research limitations/implications

The study model would aid technology enabled audit research by giving a platform for a new study to investigate further detailed solutions to emerging information technology determinants.

Practical implications

This study illustrates how tools technique perceived benefit motivates sole proprietorship practicing auditors to adopt emerging technology- enabled auditing software for auditing client's financial statements. Further, this study has added to the information technology auditing literature and might add benefits to the numerous other audit firms to adopt in emerging technology tools their audit firm.

Social implications

Audit firms, generally sole proprietorship and partnership firms, should be given enough awareness about the latest audit software tools to carry out their audit tasks efficiently.

Originality/value

The study findings highlight benefits of emerging technology-enabled auditing practice among owners/partners of the sole proprietorship or partnership firms, which is not extensively discussed in the prior studies. Furthermore, it broadens knowledge of perceived benefit, technological challenges and ease of use in technology-enabled audit software in the auditing and accounting literature.