bluuebunny/crossref_metadata_2025 huggingface dataset:
ESTIMATION OF THE ORGAN AND EFFECTIVE DOSE TO PATIENTS UNDERGOING MEDICAL DIAGNOSTIC X-RAY EXAMINATIONS IN SAUDI ARABIA
Authors: Ababneh Zaid Q , Almusallam Moayed , Alfajri Ibrahim , Ababneh Anas M , Aljarrah Khaled M , Tries Mark A , Al Anazi Nawaf
Published: April 2021

Quantifying the radiological risk from diagnostic radiography is essential for patients’ safety. Effective dose is considered the best quantity to determine the stochastic risk associated with the radiological examinations. Therefore, the present work investigated organ and effective dose for adult patients in the most common type of X-ray examinations, such as the chest (PA/LAT), abdomen (AP) and lumbar spine (AP/LAT) projections. The PCXMC version 2 Monte Carlo program was used to estimate the organ and effective dose for 547 patients who underwent a radiographic examination at the King Abdulaziz Hospital, Saudi Arabia. The results showed wide variation in organ doses. The largest organ dose in each X-ray examination were 2.72 mGy for the spleen in the lumbar spine (LAT), 1.98 mGy for the urinary bladder in the lumbar spine (AP), 0.40 mGy for the spleen in the chest (PA), 0.11 mGy for the kidney in the chest (LAT) and 1.78 mGy for the testicles in the abdomen (AP) examinations. Values for the effective dose were estimated for each investigated X-ray examination, and the results were compared with the published values available in the literature. The obtained values for effective dose were relatively lower than those reported by the European Commission and the United Nations Scientific Committee on the Effects of Atomic Radiation for the same examinations. The results presented here will help establish a database that will be useful for future comparisons and monitoring in radiographic procedures.
Duration of Untreated Psychosis in First-Episode Psychosis is not Associated With Common Genetic Variants for Major Psychiatric Conditions: Results From the Multi-Center EU-GEI Study
Authors: Ajnakina Olesya , Rodriguez Victoria , Quattrone Diego , di Forti Marta , Vassos Evangelos , Arango Celso , Berardi Domenico , Bernardo Miguel , Bobes Julio , de Haan Lieuwe , Del-Ben Cristina Marta , Gayer-Anderson Charlotte , Jongsma Hannah E , Lasalvia Antonio , Tosato Sarah , Llorca Pierre-Michel , Menezes Paulo Rossi , Rutten Bart P , Santos Jose Luis , Sanjuán Julio , Selten Jean-Paul , Szöke Andrei , Tarricone Ilaria , D’Andrea Giuseppe , Richards Alexander , Tortelli Andrea , Velthorst Eva , Jones Peter B , Arrojo Romero Manuel , La Cascia Caterina , Kirkbride James B , van Os Jim , O’Donovan Mick , Murray Robin M ,   EU-GEI WP2 Group
Published: April 2021

Duration of untreated psychosis (DUP) is associated with clinical outcomes in people with a diagnosis of first-episode psychosis (FEP), but factors associated with length of DUP are still poorly understood. Aiming to obtain insights into the possible biological impact on DUP, we report genetic analyses of a large multi-center phenotypically well-defined sample encompassing individuals with a diagnosis of FEP recruited from 6 countries spanning 17 research sites, as part of the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study. Genetic propensity was measured using polygenic scores for schizophrenia (SZ-PGS), bipolar disorder (BD-PGS), major depressive disorder (MDD-PGS), and intelligence (IQ-PGS), which were calculated based on the results from the most recent genome-wide association meta-analyses. Following imputation for missing data and log transformation of DUP to handle skewedness, the association between DUP and polygenic scores (PGS), adjusting for important confounders, was investigated with multivariable linear regression models. The sample comprised 619 individuals with a diagnosis of FEP disorders with a median age at first contact of 29.0 years (interquartile range [IQR] = 22.0–38.0). The median length of DUP in the sample was 10.1 weeks (IQR = 3.8–30.8). One SD increases in SZ-PGS, BD-PGS, MDD-PGS or IQ-PGS were not significantly associated with the length of DUP. Our results suggest that genetic variation does not contribute to the DUP in patients with a diagnosis of FEP disorders.
The “New Father” Between Ideals and Practices: New Masculinity Ideology, Gender Role Attitudes, and Fathers’ Involvement in Childcare
Authors: Offer Shira , Kaplan Danny
Published: April 2021

Current research demonstrates a gap between widely shared ideals of new fatherhood and men’s limited participation in childcare. Previous studies treat gender attitudes primarily in terms of work and family roles. In contrast, this study centers on perceptions of masculinity as a broader cultural-ideological construct. Specifically, it focuses on “new masculinity ideology,” a previously unexplored masculinity perspective associated with values such as authenticity, emotional expressivity, and holistic self-awareness. Using a sample of around 1,400 employed fathers in the United States drawn from the AmeriSpeak Panel conducted by the National Opinion Research Center, we examined how identification with new masculinity relates to gender role attitudes and three childcare involvement outcomes. Results from moderation analyses based on the computation of simple slopes show that new masculinity played an important role in emotional engagement and parental responsibility but not in routine care. New masculinity moderated the association between father involvement attitudes and childcare outcomes, suggesting that fathers who endorse this ideology are more likely to act in ways that are congruent with their inner beliefs. The breadwinning role appeared to remain important. This study highlights the ways in which the often confounded images of the “new man” and “new father” are conceptually distinct.
Genetic diversity of avian leukosis virus subgroup J (ALV-J): toward a unified phylogenetic classification and nomenclature system
Authors: Deng Qiaomu , Li Min , He Chengwei , Lu Qiaoe , Gao Yanli , Li Qiuhong , Shi Mengya , Wang Peikun , Wei Ping
Published: April 2021

Avian leukosis virus subgroup J (ALV-J) has infected a variety of birds, causing major economic losses in China. Understanding the comprehensive criteria of classification and nomenclature of ALV-J would be useful for the investigation of the viral evolution and also for the prevention and control of this infection. An in-depth analysis of the genetic diversity of ALV-J was performed in the present study. Four hundred and seventy-five sequences of the gp85 gene, including thirteen of avian endogenous retrovirus designated ev/J and 462 of ALV-J, were used in the phylogenetic and the evolutionary distance analysis for this classification. The study identified that the current ALV-J strains were divided into two first-order clades (Clades 1 and 2) and three second-order clades (Clades 1.1, 1.2 and 1.3). The current Chinese ALV-J strains are predominantly in Clade 1.3, and the Chinese and Egyptian chicken flocks have been facing the emerging Clade 2 viruses. This system pioneers the classification efforts for ALV-J, which uses Pilot tree for rapid classification of the new isolates and also the addition of possible new clades. The proposed unified classification system will facilitate future studies of ALV-J epidemiology and genetic evolution and of the comparison of sequences obtained across the world.
Nurse Faculty Experiences Teaching Chronic Illness Self-Management Concepts: An Exploratory Study
Authors: Lam Christina K. , Copel Linda C. , Deveneau Lilianna
Published: April 2021

AIM

The aim of the study was to explore how nurse faculty prepare students to teach chronic disease self-management.

BACKGROUND

Self-management addresses patient activities in response to a change in baseline health. Evidence suggests nurses may not be educated on how to engage patients in chronic disease self-management.

METHOD

This qualitative study used semistructured interviews to explore experiences of 13 nurse faculty across three universities in preparing nursing students to address self-management concepts for adults living with chronic disease.

RESULTS

Three themes emerged from 104 identified significant statements: conceptualizing and valuing chronic disease self-management in nursing education, making chronic disease self-management fit, and sharing the impact of health care reform on chronic disease care.

CONCLUSION

Self-management is regarded as highly complex and evolving. As such, nursing education curricula must also evolve to emphasize successful approaches to preventing chronic disease and incorporating chronic disease self-management and behavior modification in the curriculum.
Varenicline for the Treatment of Cocaine Dependence
Authors: Lynch Kevin G. , Plebani Jennifer , Spratt Kelly , Morales Mark , Tamminga Mila , Feibush Philip , Kampman Kyle M.
Published: April 2021

Objectives:

Varenicline is a partial agonist at the α2β4 and α6β2 nAChR receptors and a full agonist at α7 receptors. Both α7 and α6β2 receptors are implicated in the neural reward circuitry activated by cocaine use. A preliminary clinical trial suggested that varenicline treatment reduced cocaine use. This trial was intended to replicate and extend the findings of the previous trial.

Methods:

This was a 12-week, double-blind, placebo-controlled clinical trial involving 156 subjects with DSM IV cocaine dependence. Subjects received up to 2 mg of varenicline or identical placebo daily along with weekly relapse prevention psychotherapy. The primary outcome measure was cocaine use measured by thrice-weekly urine drug screens. Additional outcome measures included end of study cocaine abstinence, cocaine craving, cocaine withdrawal symptom severity, cigarette use, and global improvement measure by the Clinical Global Improvement Scale.

Results:

End of study cocaine abstinence, measured by urine drug screens during the last 3 weeks of the trial, was not different between groups (8% in the varenicline treated subjects and versus 9% in placebo-treated subjects). Generalized estimating equations analysis of urine drug screen results showed no significant difference between groups in cocaine abstinence over the 12 weeks of the trial. There were no significant differences between the 2 groups in cocaine craving or cocaine withdrawal symptom severity. Varenicline was well-tolerated. There were no medication-associated serious adverse events.

Conclusions:

Varenicline plus cognitive-behavioral therapy does not seem to be an efficacious treatment for cocaine dependence.
Spinal Anesthesia is Superior to General Anesthesia for Percutaneous Achilles Tenotomy in Infants
Authors: Acquaviva Michael A. , Caltoum Christine B. , Bielski Robert J. , Loder Randall T. , Boyer Tanna J. , Cossu Anne E. , Castelluccio Peter F.
Published: April 2021

Background:

Concern about the effects of inhaled, halogenated anesthetics on neurodevelopment of infants has renewed interest in regional anesthesia as an alternative to general anesthesia (GA). Infants undergoing percutaneous Achilles tenotomy (PAT) are well suited for spinal anesthesia (SP).

Methods:

Thirty infants (mean age: 2.3 mo) undergoing PAT with SP were compared with 15 infants (mean age: 2.0 mo) undergoing PAT with GA. Data collected included perioperative times, heart rate and blood pressure, and the administration of opioids.

Results:

Ten of 15 GA (67%) patients received perioperative opioids as opposed to 1 of 30 SP patients (3.3%) (P<0.0001). The time from the start of anesthesia to the start of surgery was shorter in the SP group (8.5 vs. 14 min, P<0.0009). The time from the start of anesthesia to first oral intake was shorter in the SP group (12 vs. 31 min, P<0.0033). The time of first phase recovery (phase 1 post anesthesia care unit) was shorter in the SP group (15.5 vs. 34 min, P<0.0026). Surgery time was not significantly different between the groups (SP: 15.5 min, GA: 15 min, P=0.81).

Conclusion:

Infants undergoing PAT with SP received less opioid, did not require an airway device, did not receive potent inhaled, halogenated hydrocarbon anesthetics, and exhibited faster and qualitatively better postoperative recovery.

Level of Evidence:

Level III—case control study.
Effects of HDAC4 on IL-1β-induced matrix metalloproteinase expression regulated partially through the WNT3A/β-catenin pathway
Authors: Ning Qi , Gan Ye-Hua , Shi Rui-Rui , Meng Juan-Hong
Published: April 2021

Background:

Histone deacetylase 4 (HDAC4) regulates chondrocyte hypertrophy and bone formation. The aim of the present study was to explore the effects of HDAC4 on Interleukin 1 beta (IL-1β)-induced chondrocyte extracellular matrix degradation and whether it is regulated through the WNT family member 3A (WNT3A)/β-catenin signaling pathway.

Methods:

Primary chondrocytes (CC) and human chondrosarcoma cells (SW1353 cells) were treated with IL-1β and the level of HDAC4 was assayed using Western blotting. Then, HDAC4 expression in the SW1353 cells was silenced using small interfering RNA to detect the effect of HDAC4 knockdown on the levels of matrix metalloproteinase 3 (MMP3) and MMP13 induced by IL-1β. After transfection with HDAC4 plasmids, the overexpression efficiency was examined using Real-time quantitative polymerase chain reaction (qRT-PCR) and the levels of MMP3 and MMP13 were assayed using Western blotting. After incubation with IL-1β, the translocation of β-catenin into the nucleus was observed using immunofluorescence staining in SW1353 cells to investigate the activation of the WNT3A/β-catenin signaling pathway. Finally, treatment with WNT3A and transfection with glycogen synthase kinase 3 beta (GSK3β) plasmids were assessed for their effects on HDAC4 levels using Western blotting.

Results:

IL-1β downregulated HDAC4 levels in chondrocytes and SW1353 cells. Furthermore, HDAC4 knockdown increased the levels of MMP3 and MMP13, which contributed to the degradation of the extracellular matrix. Overexpression of HDAC4 inhibited IL-1β-induced increases in MMP3 and MMP13. IL-1β upregulated the levels of WNT3A, and WNT3A reduced HDAC4 levels in SW1353 cells. GSK-3β rescued IL-1β-induced downregulation of HDAC4 in SW1353 cells.

Conclusion:

HDAC4 exerted an inhibitory effect on IL-1β-induced extracellular matrix degradation and was regulated partially by the WNT3A/β-catenin signaling pathway.
Role of Small-Gauge Proportionate Reflux-Assisted Hydrodissection In Elevated Symptomatic Vitreofoveal Traction
Authors: Boral Subhendu K. , Agarwal Deepak
Published: April 2021

Background/Purpose:

To describe a new technique to release the elevated symptomatic vitreofoveal traction.

Methods:

This was a retrospective, interventional case series where a new technique of hydrodissection by proportionate reflux property of small-gauge vitrectomy cutter was used in cases of elevated symptomatic vitreofoveal traction as evident on optical coherence tomography. After vitrectomy, an opening was made in the taut posterior hyaloid face around the foveal elevation. Then, the cutter tip was insinuated inside the hyaloid opening, and the port opening was directed toward the tip of the fovea at its hyaloid attachment. The proportionate reflux property of the cutter was then used to cause reflux of cassette fluid. The hydrostatic force thus generated separates the vitreofoveal attachment. End point was separation of vitreofoveal traction.

Results:

Seven eyes of seven patients were operated by 27-gauge (n = 3) or 25-gauge (n = 4) vitrectomy system. Mean preoperative and postoperative BCVA were LogMAR 0.44 (20/55) ± 0.14 and LogMAR 0.27 (20/37) ± 0.11, respectively (P = 0.23). Mean preoperative foveal elevation was 560.86 ± 196.57 μm, which significantly decreased postoperatively to 251 ± 79.13 μm (P < 0.01). VMTs were successfully released in all cases. Mean follow-up was 184.00 ± 80.32 days.

Conclusion:

Small-gauge proportionate reflux-assisted hydrodissection is an innovative technique for management of elevated symptomatic cases of vitreofoveal traction.
CATASTROPHIC ANTIPHOSPHOLIPID SYNDROME AND POSTERIOR OCULAR INVOLVEMENT
Authors: Morel Nathalie , Bonnet Clémence , Mehawej Hanane , Le Guern Véronique , Pérard Laurent , Roumier Mathilde , Brezin Antoine , Godeau Bertrand , Haroche Julien , Benhamou Ygal , Lambert Marc , Yelnik Cécile M. , Maillard Nicolas , Bodaghi Bahram , Piette Jean-Charles , Costedoat-Chalumeau Nathalie
Published: April 2021

Purpose:

To describe the posterior ophthalmic manifestations of catastrophic antiphospholipid syndrome.

Methods:

Retrospective case series of patients presenting with catastrophic antiphospholipid syndrome and posterior segment ocular manifestations. The main outcomes were the type of posterior segment manifestations at catastrophic antiphospholipid syndrome diagnosis, specifically retinal vascular occlusion, vasculitis, or choroidopathy, and the final best-corrected visual acuity.

Results:

This study included 23 patients (11 cases treated by the authors and 12 published case reports); 21 (91%) of them female. Their median age at diagnosis was 28 years (range, 16–79 years). Ophthalmologic manifestations were usually bilateral (n = 19, 83%) and involved vascular occlusive retinopathy (n = 17, 74%), choroidopathy (n = 11, 48%), or retinal vasculitis (n = 1, 4%). Final best-corrected visual acuity was not significantly worse than the best-corrected visual acuity at diagnosis (P = 0.16). Retinal vascular occlusions were associated with poorer final visual acuity than choroidopathy (P = 0.002). After a median follow-up of 14 months (range, 2–132 months), nearly half the patients (n = 11, 48%) had permanent vision loss including best-corrected visual acuity of <20/400 for 4 patients.

Conclusion:

Posterior ophthalmic manifestations of catastrophic antiphospholipid syndrome were mainly bilateral retinal vascular occlusion, which had the worst visual prognosis, followed by choroidopathy and retinal vasculitis. Permanent visual loss was common.
Lysozyme Deposition on Contact Lenses in an In Vitro Blink-Simulation Eye Model Versus a Static Vial Deposition Model
Authors: Chan Vivian W. Y. , Phan Chau-Minh , Ngo William , Jones Lyndon
Published: April 2021

Purpose:

To evaluate active lysozyme deposition on daily disposable (DD) contact lenses (CL) using a novel in vitro blink model.

Methods:

Three conventional hydrogel DD CL materials (etafilcon A, omafilcon A, nelfilcon A) and three silicone hydrogel DD CL materials (delefilcon A, senofilcon A, somofilcon A) were tested. The device blink rate was set to 6 blinks/min with a tear flow rate of 1 μL/min using an artificial tear solution (ATS) containing lysozyme and other typical tear film components. After incubation at 2, 4, or 8 hr, lenses were removed, and lysozyme activity was measured. A separate experiment was conducted with lenses incubated in a static vial containing 480 μL of ATS.

Results:

Etafilcon A deposited significantly higher amounts of active lysozyme (402±102 μg/lens) than other lens materials after 8 hr (P<0.0001). Etafilcon A had a higher amount of active lysozyme using the blink model compared with the static vial (P=0.0435), whereas somofilcon A (P=0.0076) and senofilcon A (P=0.0019) had a higher amount of lysozyme activity in the vial compared with the blink model.

Conclusion:

The blink model can be tuned to provide quantitative data that closely mimics ex vivo studies and can be used to model deposition of lysozyme on CL materials.
The Effects of Video Instruction on Neuroscience Intensive Care Unit Nursing Skills in Case Presentations and Neurological Examinations
Authors: Lau K. H. Vincent , Hamlyn Emily , Williams Thomas James , Qureshi M. Mustafa , Mak Kimberly , Mian Asim , Cervantes-Arslanian Anna , Zhu Shuhan , Takahashi Courtney
Published: April 2021

BACKGROUND: The emergence of neuroscience intensive care units (NSICUs) for the past decades has led to growing interest in targeted training for NSICU nurses. We sought to evaluate the use of video instruction on NSICU nurses' skills in case presentations and neurological examinations, which has timely advantages as an asynchronous and distanced learning modality. METHODS: We enrolled NSICU and surgical intensive care unit nurses who took shifts in the NSICU at our institution. Participants were observed by a neurocritical care attending physician presenting the clinical details of an admitted patient and conducting a neurological examination, with both parties completing a 10-item evaluation on NSICU nursing presentation and examination skills. Participants randomized to an intervention group were given access to an instructional video on NSICU nursing skills. A median of 21 days later, participants were observed by a physician blinded to study randomization, with both parties recompleting the evaluation. Differences between day 1 and day 21 scores were analyzed using paired sample t tests. RESULTS: Fifteen NSICU and 55 surgical intensive care unit nurses were enrolled. Surgical intensive care unit nurses in both the intervention and control groups had statistically significant improvement between day 1 and day 21 physician-rated scores, with a greater increase in the intervention group; self-rated scores did not change. For NSICU nurses, there were no differences in physician-rated or self-rated scores for either group. CONCLUSIONS: Surgical intensive care unit nurses who underwent direct observation and self-evaluation had improvement in physician-rated NSICU nursing skills, likely as these activities allowed for reflective observation in Kolb's experiential learning cycle. Greater improvement in participants who viewed an instructional video highlights its value as a teaching modality for nurses.
Components of Empowerment Among Family Caregivers of Community-Dwelling People With Dementia in Japan: A Qualitative Research Study
Authors: SAKANASHI Sayori , FUJITA Kimie , KONNO Rie
Published: April 2021

Background

Family caregivers of people with dementia (PWDs) experience significant physical, psychological, and social burdens. Empowerment, which refers to the process of gaining power in society through behavioral change, is important to coping successfully with care-related burdens. The high burden of care faced by family caregivers in Japan often makes accepting social support difficult for caregivers of PWDs, resulting in feelings of isolation. Clarifying what components constitute empowering experiences for family caregivers of PWDs is necessary to gain a better understanding of their empowerment experiences and to develop relevant support schemes.

Purpose

This study was developed to describe the components of empowerment experienced by family caregivers of community-dwelling PWDs in Japan.

Methods

This qualitative descriptive study used semistructured in-depth interviews to explore components of empowerment experienced by family caregivers of adults/older adults with dementia. Purposive sampling was used to recruit 20 family caregivers (age range: 50–87 years) from four self-help groups. A qualitative content analysis method was used to analyze the data. The components derived from the interviews were reviewed by three nursing researchers not directly involved in this study who are specialists in qualitative research and geriatric nursing.

Results

Four categories and 12 subcategories were derived to illuminate the components of empowerment among family caregivers of PWDs. Specifically, these categories were as follows: (a) proactive aspects of dementia care that were acquired through the caregiving experience, (b) creating a relationship that respects PWDs, (c) Building relationships based on mutual understanding of one's surroundings, and (d) understanding the social aspects of dementia care.

Conclusions/Implications for Practice

The findings of this study provide additional understanding of the components of the empowerment experiences of family caregivers of PWDs in Japan and in other East Asian countries experiencing increasing dementia diagnoses and population aging. In addition, the structural components of empowerment offer a useful perspective for health professionals on assessment and intervention that is framed on the cultural characteristics of East Asia. Ultimately, the results suggest that healthcare professionals should develop intervention programs that are tailored to the needs of caregivers at different levels of empowerment.
Clinical Scholar Preparation
Authors: Horner Marianne Druva
Published: April 2021

The Colorado Center for Nursing Excellence established a formal didactic course in 2005 to deliberately prepare clinical faculty using expert clinical nurses. Independently, the National League for Nursing, in 2018, established criteria for certification for clinical nurse educators. The content of this course content closely mirrors those competencies and provides preparation for the exam. As a result, Clinical Scholars have established themselves as important players in nursing education in Colorado.
Presentation, Management and Outcomes of Pediatric Pulmonary Embolus
Authors: Lucas Alexandra , Rosovsky Rachel , Clark Maureen , Grabowski Eric , Yager Phoebe
Published: April 2021

Objectives

To review the presentation, management, and outcomes of pediatric pulmonary embolism (PE) patients treated at a single institution over 10 years to determine whether laboratory findings and clinical presentation predict disease severity.

Methods

We performed a retrospective chart review of patients treated for PE in a 14-bed pediatric intensive care unit from January 1, 2008, to December 31, 2018. Associations between clot burden and disease severity, clinical risk factors (body mass index, recent hospitalization, estrogen use), clinical presentation (heart rate, oxygen saturation), and laboratory values (white blood cell count, D-Dimer, troponin, proBNP) were performed using Student t test, χ2 tests, and 1-way analysis of variance. Patients were risk stratified by American Heart Association guidelines.

Results

Eighteen (72%) patients (girls) were treated for PE. Common risk factors included recent hospitalization (67%) and oral contraceptives (62%). Risk factors, clinical presentation (including hypoxemia and tachypnea), and laboratory studies did not correlate with disease severity or clot burden. Electrocardiogram and radiographic findings were non-specific. Computer tomography pulmonary angiography (CTPA) was required to diagnose 94%. Sixteen received unfractionated heparin, and 5 required additional intervention. Risk factors, clinical features, and laboratory studies did not predict who required intervention.

Conclusions

Of 18 pediatric patients treated for PE at a single institution over 10 years, vital signs and laboratory data did not predict disease severity or clot burden, and CTPA was required for diagnosis in all but 1. Emergency room providers must have a high index of suspicion for diagnosis and cannot be reassured by normal electrocardiogram or plain film findings. At a time when pediatric providers are under pressure to minimize unnecessary radiation exposure, this lack of correlation of clinical presentation and laboratory findings highlights the importance of considering CTPA when PE is suspected.
Examination of Caregiver Social Factors and Its Influence on Low-Acuity Pediatric Emergency Department Utilization
Authors: Murray Ashlee , Fein Joel , Beulah Brianna , Mollen Cynthia
Published: April 2021

Objectives

Social factors, such as adverse childhood experiences (ACEs), often influence health care utilization. Our study explores the association between caregiver social factors and low-acuity pediatric emergency department (ED) utilization, with the hypothesis that caregivers with high ACE exposure may use ED services more frequently for low-acuity complaints.

Methods

In this case-control study, we performed surveys of caregivers with children aged 1 to 12 years registered for care in our pediatric ED. We defined high utilizers (cases) as those children with ≥3 low-acuity visits in the previous year and low utilizers (controls) as having no prior low-acuity visits, exclusive of the current visit. We compared the proportion of high ACE exposure (≥4 ACEs) between both groups.

Results

We enrolled 114 cases and 134 controls. We found no association between number of ACEs and odds of being a case or control (ED utilization). Demographics were significantly different between the 2 groups (ie, caregiver age, race, education, and household income); caregiver ACE exposure was high in both groups (20.2% cases vs 29.1% controls with [≥4 ACEs]).

Conclusions

Although we did not find an association between caregiver ACEs and frequent low-acuity pediatric ED utilization, our data shed light on the overall prevalence of caregiver ACEs in families that seek care in our pediatric ED, even for the first time. Our findings emphasize the risk of conscious bias that can lead to inaccuracy: assuming that it is only high utilizers who experience social stressors. Future work should explore the contribution of structural inequities that influence caretakers' decisions to seek care for their children for low-acuity complaints, and consider types of interventions that could address and mitigate these inequities.
Clinical Spectrum of Pediatric Heat Illness and Heatstroke in a North American Desert Climate
Authors: Fisher Jay D. , Shah Ami P. , Norozian Farnaz
Published: April 2021

The spectrum of historical features and clinical presentations of heat illness and heatstroke in the pediatric population has received limited focus in the emergency medicine literature. The majority of published cases involve children trapped in closed spaces and adolescent athletes undergoing high-intensity training regimens in geographical regions with moderately high ambient temperatures and high humidity. There has been less research on the potential impact of extreme temperatures and radiant heat that are the hallmarks of the US southwest region. We performed a retrospective review of pediatric heat illness at our facility located in a North American desert climate.
Three-Dimensional Printed Nasal Prostheses After Oncologic Rhinectomies: Workflow and Patients’ Satisfaction
Authors: Salati Victoria , Reinhard Antoine , Broome Martin
Published: April 2021

Reconstructions after oncologic full-thickness rhinectomies are often deferred from the ablative surgery. Definitive silicone prostheses are usually not used for transitional rehabilitation, and therefore, patients may deal with major facial defects for a long time before reconstruction. The aim was to develop a time- and cost-effective digital workflow to three-dimensional print temporary nasal prostheses and to assess patients’ satisfaction. This prospective study enrolled all consecutive patients after full thickness ablative surgery and deferred reconstruction, from May 2018 to October 2019, at a tertiary care academic institution. With a dedicated software, the pre- and postoperative scans were three-dimensional processed to create the prosthesis and they were directly printed in elastic transparent resin. A cross-sectional survey was conducted 4 months after the rehabilitation to assess patients’ satisfaction regarding comfort, aesthetics, and security of the retaining system. Seven patients were enrolled and they were all rehabilitated using this workflow. Mean time of design was 2h48 (SD 40 minutes), and mean printing time was 5h18 (SD 1 hour). Mean cost of production was 753 U.S. Dollars (SD 144 U.S. Dollars). Median scores of the visual analog scales were 8 out of 10 for each topic with interquartile range of 4 to 7 for aesthetics, 7 to 9 for comfort, and 7 to 10 for security of the retaining system. It has shown its feasibility in terms of costs and time of production. Patients were satisfied and it can be considered as a mean to help patients to deal with treatment sequelaes before definitive reconstruction.
Endoscopic Hernia Repair: A Novel Technique for the Repair of Inguinal Hernia in a Cadaver Model
Authors: Gülaydin Nihat , Ersöz Feyzullah , Kalayci Mustafa , Kara Erdoğan
Published: April 2021

Background:

The techniques of total extraperitoneal and transabdominal preperitoneal hernia repair have been conducted for laparoscopic repair of inguinal hernia since long. However, they offer significant disadvantages of requiring general anesthesia, producing negative cosmetic outcomes, and other serious complications. We examined the feasibility of applying an endoscopic method alternative to total extraperitoneal and transabdominal preperitoneal for laparoscopic repair of inguinal hernia in a cadaver model so as to overcome the disadvantages of the presently available techniques.

Methods:

A total of 4 male and 2 female cadavers [aged 18 y and above, body mass index (BMI) <40 kg/m2], who were planned for a routine autopsy between January 24 and 26, 2020 were selected for the present study conducted at the Forensic Medicine Institute. Twelve laparoscopic repair surgeries of inguinal hernia were performed in 6 of these cadavers using both the inguinal areas.

Results:

We conducted a total of 12 surgeries on 4 male (mean age: 43.25 y; BMI: 29.05 kg/m2) and 2 female cadavers (mean age: 76.50 y; BMI: 26.60 kg/m2). A 7×5-cm-shaped mesh was used for both the sexes. For the fixation of the mesh, a titanium tacker was used in pubic tubercle and tendon conjoint, whereas for the fixation of ligamentum inguinale, 2/0 PDS was used in 3 surgeries, 2/0 15-cm V-Loc was used in another 3 surgeries, and titanium tacker was used in 6 surgeries.

Conclusions:

We demonstrated that the technique of endoscopic surgery that offers the advantages of open inguinal surgery in a cadaver model can be combined with the presently used laparoscopic intervention so as to combine all the advantages, especially for patients who are not suitable for general anesthesia, who are experiencing a recurrence after laparoscopic intervention, and who do not want any visible scares resultant from the surgery. For future studies, we suggest that the proposed technique be applied to inguinal hernia patients to ascertain clearer results.
Predictive Risk Factors for Postoperative Complications and Its Impact on Survival in Laparoscopic Resection for Colon Cancer
Authors: Granero Lucia , Cienfuegos Javier A. , Baixauli Jorge , Pastor Carlos , Sánchez Justicia Carlos , Valentí Víctor , Rotellar Fernando , Hernández Lizoáin José Luis
Published: April 2021

Background:

Laparoscopic resection is the ideal treatment of colon cancer. The aim of the study was to analyze the predictive factors for postoperative complications and their impact on oncologic outcomes in laparoscopic resections in colon cancer.

Materials and Methods:

In all patients undergoing elective laparoscopic surgery the number and degree of severity of postoperative complications were recorded and classified according to Clavien-Dindo. A univariate analysis was made of the demographic, surgical, and oncologic variables of patients with and without complications. The statistically significant variables were then entered into a multivariate model. In both groups overall and disease-free survival were analyzed using Kaplan-Meier estimates.

Results:

Of 524 patients, 138 (26.3%) experienced some type of complication, 110 less severe (79.7%) and 28 (20.4%) severe. Twenty-nine conversions to open surgery occurred (5.5%) and hospital mortality was 0.2%.

In the multivariate analysis, use of corticosteroids [odds ratio (OR): 3.619], oral anticoagulants (OR: 3.49), blood transfusions (OR: 4.30), and conversion to open surgery (OR: 3.93) were significantly associated with the development of complications. However, sigmoid resections were associated with fewer complications (OR: 0.45).

Overall 5-year and 10-year survival in both groups, was 83.3%, 74.1%, 76.0%, and 67.1%, respectively (P=0.18). Disease-free survival at 5 and 10 years, excluding stage IV tumors, was 88.6% and 90.4%, respectively (P=0.881).

Conclusions:

The use of corticosteroids, oral anticoagulants, blood transfusions, and conversion to open surgery are all independent predictive factors of postoperative complications. Sigmoid resections are associated with fewer complications. In laparoscopic resections of the colon, complications do not negatively affect long-term oncologic outcomes.
Clinical Outcomes of a Multidisciplinary Female Chronic Pelvic Pain Program
Authors: Westbay Lauren C. , Adams William , Kistner Margaret , Brincat Cynthia , Bresler Larissa , Yang Linda C. , Fitzgerald Colleen M.
Published: April 2021

Objective

The aim of this study was to describe patient-reported longitudinal outcomes in a multidisciplinary female chronic pelvic pain (CPP) program.

Methods

We conducted a retrospective cohort study for women cared for in a tertiary, multidisciplinary, female (CPP) program between 2012 and 2017. Patient demographics were collected from electronic medical records. Patients completed the numerical rating scale for pain, Pain Disability Index (PDI), and Patient Global Impression of Improvement scale at each visit. Mixed-effects models were used to assess change in patient responses over time.

Results

Patients (N = 317) with a mean age of 44.3 years (SD, 14.6) and median duration of symptoms of 3 years (interquartile range, 1.0–7.0) were assessed in this analysis. The primary diagnosis was pelvic floor myofascial pain (67%). On multivariable analysis, numerical rating scale scores decreased by −0.11 point [95% confidence interval (CI), −0.20 to −0.01] every 3 months (P = 0.03). On multivariable analysis, total PDI score decreased by −0.88 point (95% CI, −1.43 to −0.33) (P = 0.003), and PDI sexual subscores decreased by −0.29 point (95% CI, −0.44 to −0.14) (P < 0.001) every 3 months. A higher (worse) Patient Global Impression of Improvement score was associated with a higher (worse) PDI score at follow-up (odds ratio, 1.04; 95% CI, 1.01–1.07; P = 0.01).

Conclusions

Patients in a multidisciplinary CPP program demonstrated improvement over time in pain disability that was associated with an overall global impression of improvement.
The Patient Acceptable Symptom State in Female Urinary Incontinence
Authors: Sanderson Derrick J. , Zavez Alexis , Meekins A. Rebecca , Eddib Abeer , Lee Toy G. , Barber Matthew D. , Duecy Erin
Published: April 2021

Objective

The objective of this study is to characterize an acceptable health state, using the patient acceptable symptom state (PASS) question, in adult women with urinary incontinence.

Methods

This is a prospective multicenter cohort study determining PASS thresholds from condition-specific measures using an electronic research platform in English-speaking women seeking nonsurgical treatment of urinary incontinence between March 2019 and May 2020. Exclusions included pregnancy, isolated overactive bladder, and pelvic organ prolapse greater than stage II. The cohort was described and then grouped based on achievement of PASS. The PASS thresholds were determined using the 75th percentile and univariate regression methods. Multivariable regression modeling was used to understand the influence of covariates on PASS achievement.

Results

The study was completed by 100 (80%) of the 125 enrolled subjects. Of these, 45% (n = 45) achieved PASS after a median of 7 weeks of treatment (range, 6–13 weeks). The corresponding questionnaire score for PASS was estimated to be 6 for the Incontinence Severity Index, 3 for the Patient Global Impression of Severity and Improvement, 37.5 using the Urinary Distress Inventory 6, and 33.3 using the Incontinence Impact Questionnaire 7. Increasing age was independently associated with achieving PASS after adjusting for treatment adherence and outcomes scores (adjusted odds ratio, 1.05 [95% confidence interval, 1.01–1.10]; P = 0.02).

Conclusions

PASS was achieved in 45% of women after conservative treatment of urinary incontinence. PASS offers a new perspective for analysis and interpretation of outcome measures used in pelvic floor disorders and can serve as a reference for future research and clinical care pathways.
Toxin-associated infectious diseases: tetanus, botulism and diphtheria
Authors: Pfausler Bettina , Rass Verena , Helbok Raimund , Beer Ronny
Published: April 2021

Purpose of review

The incidence rates of the toxin-related infectious diseases, tetanus, diphtheria and botulism declined dramatically over the past decades mainly because of the implementation of immunization programs also in low-and-middle-income countries (LAMICs) and by improving hygiene conditions. But still, single cases occur, and they need fastest possible recognition and management.

Recent findings

Over the past 20 years, the incidence of neonatal tetanus has declined by more than 90%. This success was achieved by immunizing women in reproductive age in areas of high risk as sub-Saharan Africa and parts of Asia. Larger regional outbreaks of diphtheria have been reported from the former Soviet Union in the 1990s and from India in 2017. Botulism is still rare, mainly seen in infants and, in recent years, in intravenous drug abusers.

Tetanus, diphtheria and botulism are rarities in high-income countries (HICs) with unlimited access to immunization programs and standard hygiene procedures. The diagnosis of all three diseases is still, even in the 21st century, based upon patient‘s history and clinical signs and symptoms. Neither biochemical bedside tests nor neuroradiological investigations help to confirm the diagnosis in an emergency situation.
Energy and frequency ripple in devices with inertial excitation of oscillations
Authors: Blekhman I. , Blekhman L. I. , Vaisberg L. A. , Vasilkov V. B.
Published: April 2021

We consider vibration devices that consist of softly vibration-isolated rigid bodies subjected to vibrations transmitted by means of inertial vibration exciters (unbalanced rotors) driven into rotation by electric motors. Typically, when designing such devices, it is assumed that the rotors rotate uniformly with a certain circular frequency and the body performs small harmonic oscillations with the same frequency. The present work, using a second-order approximation of their nonlinear coupled differential equations, shows that the rotor and the oscillating body keep exchanging energy. At the same time, the angular velocity of the rotor oscillates with the working frequency as well as with its multiple frequencies during each revolution. As a result, the acceleration of the oscillating body also acquires harmonics with multiple frequencies. This may cause both unwanted and beneficial resonance phenomena. We obtain formulae describing the magnitudes of these ripples. We show that the magnitude of oscillations of the angular frequency can also be estimated using energy considerations. Such estimates are provided for the three most common schemes of dynamic devices. Available experimental data confirm the main conclusions of the theory. We discuss both the harmful effects of these phenomena as well as their possible applications. The latter include design of bi-harmonic vibration exciters and exciters based on vibrational resonance.

This article is part of the theme issue ‘Vibrational and stochastic resonance in driven nonlinear systems (part 2)’.
Impacts of autapse on chaotic resonance in single neurons and small-world neuronal networks
Authors: Baysal Veli , Erkan Erdem , Yilmaz Ergin
Published: April 2021

Chaotic resonance (CR) is a new phenomenon induced by an intermediate level of chaotic signal intensity in neuronal systems. In the current study, we investigated the effects of autapse on the CR phenomenon in single neurons and small-world (SW) neuronal networks. In single neurons, we assume that the neuron has only one autapse modelled as electrical, excitatory chemical and inhibitory chemical synapse, respectively. Then, we analysed the effects of each one on the CR, separately. Obtained results revealed that, regardless of its type, autapse significantly increases the chaotic resonance of the appropriate autaptic parameter’s values. It is also observed that, at the optimal chaotic current intensity, the multiple CR emerges depending on autaptic time delay for all the autapse types when the autaptic delay time or its integer multiples match the half period or period of the weak signal. In SW networks, we investigated the effects of chaotic activity on the prorogation of pacemaker activity, where pacemaker neurons have different kinds of autapse as considered in single neuron cases. Obtained results revealed that excitatory and electrical autapses prominently increase the prorogation of pacemaker activity, whereas inhibitory autapse reduces or does not change it. Also, the best propagation was obtained when the autapse was excitatory.

This article is part of the theme issue ‘Vibrational and stochastic resonance in driven nonlinear systems (part 2)’.
On some applications of vibrational resonance on noisy image perception: the role of the perturbation parameters
Authors: Morfu S. , Usama B. I. , Marquié P.
Published: April 2021

In this paper, we first propose a brief overview of nonlinear resonance applications in the context of image processing. Next, we introduce a threshold detector based on these resonance properties to investigate the perception of subthreshold noisy images. By considering a random perturbation, we revisit the well-known stochastic resonance (SR) detector whose best performances are achieved when the noise intensity is tuned to an optimal value. We then introduce a vibrational resonance detector by replacing the noisy perturbation with a spatial high-frequency signal. To enhance the image perception through this detector, it is shown that the noise level of the input images must be lower than the optimal noise value of the SR-based detector. Under these conditions, considering the same noise level for both detectors, we establish that the vibrational resonance (VR)-based detector significantly outperforms the SR-based detector in terms of image perception. Moreover, we show that whatever the perturbation amplitude, the best perception through the VR detector is ensured when the perturbation frequency exceeds the image size.

This article is part of the theme issue ‘Vibrational and stochastic resonance in driven nonlinear systems (part 2)’.
Strategy for generation of replication–competent recombinant rotaviruses expressing multiple foreign genes
Authors: Hatazawa Riona , Fukuda Saori , Kumamoto Kanako , Matsushita Fumio , Nagao Shizuko , Murata Takayuki , Taniguchi Koki , Matsui Taei , Komoto Satoshi
Published: April 2021

With the recent establishment of robust reverse genetics systems for rotavirus, rotavirus is being developed as a vector to express foreign genes. However, insertion of larger sequences such as those encoding multiple foreign genes into the rotavirus genome has been challenging because the virus segments are small. In this paper, we attempted to insert multiple foreign genes into a single gene segment of rotavirus to determine whether it can efficiently express multiple exogenous genes from its genome. At first, we engineered a truncated NSP1 segment platform lacking most of the NSP1 open reading frame and including a self-cleaving 2A sequence (2A), which made it possible to generate a recombinant rotavirus stably expressing NanoLuc (Nluc) luciferase as a model foreign gene. Based on this approach, we then demonstrated the generation of a replication-competent recombinant rotavirus expressing three reporter genes (Nluc, EGFP, and mCherry) by separating them with self-cleaving 2As, indicating the capacity of rotaviruses as to the insertion of multiple foreign genes. Importantly, the inserted multiple foreign genes remained genetically stable during serial passages in cell culture, indicating the potential of rotaviruses as attractive expression vectors. The strategy described here will serve as a model for the generation of rotavirus-based vectors designed for the expression and/or delivery of multiple foreign genes.