bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Carbon Pricing on Firm Emissions: Evidence from the Swedish CO2 Tax
Authors: Martinsson Gustav , Sajtos László , Strömberg Per , Thomann Christian
Published: January 2024

Sweden was one of the first countries to introduce a carbon tax back in 1991. We assemble a unique data set tracking CO2 emissions from Swedish manufacturing firms over 26 years to estimate the impact of carbon pricing on firm-level emission intensities. We estimate an emission-to-pricing elasticity of around two, with substantial heterogeneity across subsectors and firms, where higher abatement costs and tighter financial constraints are associated with lower elasticities. A simple calibration suggests that 2015 CO2 emissions from Swedish manufacturing would have been roughly 30% higher without carbon pricing.
Sleep disturbance and suicidal ideation mediated by psychotic-like experiences in adolescents: a two-wave longitudinal study
Authors: Bu Luowei , Wang Dongfang , Fan Yunge , Ye Haoxian , Liu Wenxu , Fan Fang
Published: January 2024

Study Objectives

Sleep disturbance may cause suicidal ideation (SI). This study aimed to examine their co-occurrence rate among adolescents and investigate whether psychotic-like experiences (PLEs) mediate this association.

Methods

A total of 17 722 Chinese adolescents were included in this two-wave longitudinal study. The baseline survey (time 1, T1) was conducted between April 21 and May 12, 2021, and the follow-up survey (time 2, T2) was implemented between December 17 and 26, 2021. At T1, participants completed questionnaires to assess their sleep disturbance, sleep duration, PLEs, SI, depressive symptoms, and sociodemographic characteristics. At T2, participants reported their PLEs, SI, and negative life events.

Results

The SI prevalence decreased from 20.2% (T1) to 18.4% (T2). Participants with SI showed significantly higher prevalence of sleep disturbance and short sleep duration compared to those without SI. Baseline sleep disturbance and short sleep duration were both associated with the increased risk of SI 6 months later. These longitudinal links were mediated by PLEs, independent of baseline covariates and negative life events.

Conclusions

These findings provide a novel insight into the mechanism linking sleep problems and suicidality, and stress the significance of assessing and addressing sleep problems and PLEs for adolescent suicide prevention and intervention.
Bupropion and varenicline administration reversed depressive behavior induced by acetamiprid exposure in mice: the role of nAChRs in depression
Authors: Mesripour Azadeh , Soltani Leila , Aliomrani Mehdi
Published: January 2024

Acetamiprid (ACE), is a popular neonicotinoid pesticide, that has a high affinity for mammalian nicotinic acetylcholine receptors (nAChRs). Therefore, ACE might induce depressive effects by perturbing the cholinergic system in mammalian. The aim of this study was to evaluate the effects of ACE exposure on depressive-like behaviors and grip strength (GS) in mice. Also the possible role of nAChR activation in depression was assessed by varenicline, and bupropion. Male Swiss mice (27 ± 2 g) were daily exposed to ACE by gavage (0.1, 1, 5 mg/kg), behavioral tests took place after 3 h, 7 days and 15 days, the subacute ACE (0.1 mg/kg) exposure was assessed after 30 days. Varenicline (0.5 mg/kg) or bupropion (4 mg/kg) were injected intraperitoneally 30 min prior exposure to (1 mg/kg) ACE. The locomotor activity, forced swimming test (FST), and sucrose preference (SP) test were assessed. After a week ACE dose dependently increased the immobility time during FST, and after 15 days’ depressive behavior was observed equally for ACE (0.1–5 mg/kg). The subacute exposure (0.1 mg/kg) significantly increased the immobility time, SP also declined that revealed anhedonia. These behavioral changes showed that ACE can initiate depressive effects. The changes in locomotor activity were not significant. GS significantly reduced following a week of exposure to ACE (1–5 mg/kg) that indicated neurotoxicity. These effects were antagonized by bupropion or varenicline, thus ACE effect on nAChRs was essential in initiating the depressive behavior.

Highlights ACE induced depressive behavior in mice dose dependently ACE exposure reduced mice grip strength ACE neurotoxicity was reversed by bupropion or varenicline nAChRs over activity is involved in ACE neurotoxicity in mice
Exploring workplace barriers faced by breastfeeding mothers who are PAs
Authors: Nourse Lindsay
Published: January 2024

Objectives:

To explore physician associate/assistant (PA) mothers' breastfeeding intention, duration, as well as workplace barriers for breastfeeding among working PA mothers and to determine if specialty has an effect on breastfeeding duration.

Methods:

A cross-sectional online survey was administered to PA mothers who had at least one biological child while a PA student or practicing as a PA. Study participants were recruited through the American Academy of Physician Associates' special interest group, PA Moms.

Results:

The 545 participants reported a breastfeeding goal of 12 months in 76.8% of births. Breastfeeding rates among participants were 96.3% at birth, 83.8% at age 3 months, 78.1% at age 6 months, and 54.8% at age 12 months. Exclusive breastfeeding rates were 77.9% at birth, 75% at age 3 months, and 42.6% at age 6 months. Workplace support from colleagues and support staff was associated with longer exclusive breastfeeding duration and any breastfeeding duration. Adequate time and place for expression of breastmilk and support from supervising or collaborating physicians were associated with longer duration of breastfeeding. Specialty had a statistically significant effect on exclusive breastfeeding duration.

Conclusions:

PA mothers failed to meet their breastfeeding goals, despite high initiation rates. Dedicated time and space to express breastmilk and workplace support may significantly improve PA mothers' breastfeeding duration.
Diversity of PA cohorts during the evolution to an entry-level master's degree
Authors: Young Peter A. , Griffith Cynthia F. , Ticknor Iesha L. , McElroy-Brooklyn Jameka , DiRuggiero Douglas , Bae Gordon H. , Froman Richard , Kayingo Gerald
Published: January 2024

Objective:

This study evaluated the racial and ethnic diversity of physician associate/assistant (PA) graduating cohorts during the profession's transition from a standard undergraduate degree to an entry-level master's degree.

Methods:

Using all existing program reports from the Physician Assistant Education Association (1985-2019), we explored potential associations between changes in tuition, degree types offered, and racial/ethnic makeup of graduating cohorts.

Results:

We observed a strong negative association between Black students and graduates versus increasing tuition and the rise of master's level programs.

Conclusions:

More equitable opportunities for joining the PA profession may be needed.
Reporting of Facet Joint Inflammation in Lumbar Spine MRI Studies in Patients With low Back Pain
Authors: Acosta Julbe José I. , Gottreich Julia R. , Ermann Joerg , Isaac Zacharia , DeFilipp Miriam , Andrew Michael N. , Chang Yuchiao , Zampini Jay M. , Katz Jeffrey N. , Mandell Jacob C.
Published: January 2024

Study design:

Retrospective.

Objective:

We aimed to assess the frequency of facet joint inflammatory features noted in routine radiology reports of lumbar spine Magnetic Resonance Imaging (MRI) studies among patients with chronic low back pain.

Summary of Background Data:

Facet joint arthropathy is one of the most common causes of chronic low back pain. It may encompass various inflammatory imaging characteristics, such as facet joint effusion, bone marrow edema, and soft tissue edema. The extent to which radiology reports mention inflammatory features of the lumbar facet joints and the accuracy of these reports has not been investigated.

Methods:

We performed a chart review on 49 subjects with previous facet-related interventions (i.e., medial branch blocks or intra-articular facet joint injection) and MRI available in the medical record. One senior musculoskeletal radiologist and a musculoskeletal radiology fellow graded the inflammatory features using a published facet joint inflammation grading system (gold standard). We identified the inflammatory markers mentioned in the radiology reports and calculated the sensitivity and positive predictive value of the radiology reports compared with gold standard readings.

Results:

Compared with the gold standard, the sensitivity of radiology reports for facet joint effusion, bone marrow, and soft tissue edema ranged from 6% to 22%, and the positive predictive value ranged from 25% to 100%. L4/5 had the highest number of cases with inflammatory features noted on the reports.

Conclusion:

Inflammatory findings, such as facet joint effusion, bone marrow edema, and soft tissue edema, are not commonly identified in radiology reports. Further investigations are needed to determine the clinical importance of MRI-detected lumbar facet joint inflammatory features as a potential mechanism of nociception and as a predictor of outcomes following injections or other therapies.
Evaluating Prognostic Bias of Critical Illness Severity Scores Based on Age, Sex, and Primary Language in the United States: A Retrospective Multicenter Study
Authors: Liu Xiaoli , Shen Max , Lie Margaret , Zhang Zhongheng , Liu Chao , Li Deyu , Mark Roger G. , Zhang Zhengbo , Celi Leo Anthony
Published: January 2024

OBJECTIVES:

Although illness severity scoring systems are widely used to support clinical decision-making and assess ICU performance, their potential bias across different age, sex, and primary language groups has not been well-studied.

DESIGN, SETTING, AND PATIENTS:

We aimed to identify potential bias of Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) IVa scores via large ICU databases.

SETTING/PATIENTS:

This multicenter, retrospective study was conducted using data from the Medical Information Mart for Intensive Care (MIMIC) and eICU Collaborative Research Database. SOFA and APACHE IVa scores were obtained from ICU admission. Hospital mortality was the primary outcome. Discrimination (area under receiver operating characteristic [AUROC] curve) and calibration (standardized mortality ratio [SMR]) were assessed for all subgroups.

INTERVENTIONS:

Not applicable.

MEASUREMENTS AND MAIN RESULTS:

A total of 196,310 patient encounters were studied. Discrimination for both scores was worse in older patients compared with younger patients and female patients rather than male patients. In MIMIC, discrimination of SOFA in non-English primary language speakers patients was worse than that of English speakers (AUROC 0.726 vs. 0.783, p < 0.0001). Evaluating calibration via SMR showed statistically significant underestimations of mortality when compared with overall cohort in the oldest patients for both SOFA and APACHE IVa, female patients (1.09) for SOFA, and non-English primary language patients (1.38) for SOFA in MIMIC.

CONCLUSIONS:

Differences in discrimination and calibration of two scores across varying age, sex, and primary language groups suggest illness severity scores are prone to bias in mortality predictions. Caution must be taken when using them for quality benchmarking and decision-making among diverse real-world populations.
Antibiotic resistance in Helicobacter pylori among children and adolescents in East Asia: A systematic review and meta-analysis
Authors: Zhou Yuhang , Zhang Yanli , Du Shiyu
Published: January 2024

Background:

In East Asia, Helicobacter pylori (H. pylori) infection and related diseases are common, primarily during childhood and adolescence. The rates of primary antibiotic resistance in H. pylori among East Asian children and adolescents have not been extensively explored; few relevant systematic reviews or meta-analyses have been conducted. We evaluated the rates of antibiotic resistance in H. pylori among East Asian children and adolescents, with the goal of facilitating individualized treatment recommendations.

Methods:

We searched PubMed, Embase, and the Cochrane Library for studies in any language published up to February 2023 that explored antibiotic resistance in H. pylori among East Asian children and adolescents. We used MeSH and non-MeSH terms related to the topic, including terms related to children, adolescents, antibiotic resistance, H. pylori, and nations or regions. Additionally, we reviewed the reference lists of relevant articles. Studies that matched our strict predefined eligibility criteria were included in the screening process. Using established assessment methods, we evaluated the quality of the included studies.

Results:

We identified 15 observational studies involving 4831 H. pylori isolates, all published between 2001 and 2022. There was substantial primary antibiotic resistance in H. pylori isolates from East Asian children and adolescents. The rates of primary resistance were 51% (95% confidence interval [CI]: 40–62%) for metronidazole; 37% (95% CI: 20–53%) for clarithromycin; 19% (95% CI: 11–28%) for levofloxacin; and less than 3% each for amoxicillin, tetracycline, and furazolidone. Subgroup analysis revealed a prominent increase in metronidazole resistance over time. Clarithromycin and levofloxacin resistance rates fluctuated between 2005 and 2015, then remained stable; other antibiotic resistance rates were generally stable. Metronidazole, clarithromycin, and levofloxacin resistance rates were significantly higher in the Chinese mainland than in other East Asian regions. The rates of dual and multiple antibiotic resistance were 28% (95% CI: 21–36%) and 10% (95% CI: 7–14%), highlighting the potential for diverse resistance patterns.

Conclusions:

H. pylori isolates from East Asian children and adolescents exhibit high levels of metronidazole and clarithromycin resistance, particularly in the Chinese mainland. The non-negligible rates of dual and multiple resistance highlight the complexity of this problem.

Registration:

PROSPERO, No. CRD42023402510.
Exploring the Intricate Interplay Between Obesity and Atrial Fibrillation: Mechanisms, Management, and Clinical Implications
Authors: Chand Swati , Patel Jay , Tripathi Ashish , Thapa Sangharsha , Frishman William H. , Aronow Wilbert S.
Published: January 2024

Atrial fibrillation (AF) stands as a prevalent and escalating cardiac arrhythmia in the United States, with obesity emerging as a prominent modifiable risk factor. This article explores the intricate relationship between obesity and AF, delving into the multifaceted pathophysiological mechanisms linking the 2 conditions. Various factors, such as autonomic dysfunction, left atrial stretch, inflammation, and hormonal imbalances, contribute to the initiation and perpetuation of AF in obese individuals. The Atrial Fibrillation Better Care pathway, emphasizing lifestyle modifications and weight loss strategies, emerges as a practical guideline for managing AF in obesity. This comprehensive review underscores the critical role of obesity as a significant modifiable risk factor for AF, urging a proactive approach to its management. Implementing the Atrial Fibrillation Better Care approach, focusing on encouraging physical activity, promoting healthy dietary habits, and raising awareness about the risks associated with obesity prove essential in preventing and mitigating the burden of AF in the obese population.
Tofacitinib Is Associated With Increased Risk of Postoperative Venous Thromboembolism in Patients With Ulcerative Colitis
Authors: Russell Tara A. , Banerjee Sudeep , Lipman Jeremy , Holubar Stefan D. , Hull Tracy , Steele Scott R. , Lightner Amy L.
Published: January 2024

BACKGROUND:

In 2019, the Food and Drug Administration issued a black box warning for increased risk of venous thromboembolism in rheumatoid arthritis patients exposed to tofacitinib. There is limited data regarding the postoperative venous thromboembolism risk in ulcerative colitis patients exposed to tofacitinib.

OBJECTIVE:

To assess if preoperative exposure to tofacitinib is associated with increased odds of postoperative venous thromboembolism.

DESIGN:

Retrospective review.

SETTINGS:

Tertiary academic medical center.

PATIENTS:

Consecutive patients exposed to tofacitinib within 4 weeks prior to total abdominal colectomy or total proctocolectomy, with or without ileostomy, from 2014 to 2021, matched 1:2 for tofacitinib exposure or no exposure.

INTERVENTION:

Tofacitinib exposure versus no exposure.

MAIN OUTCOME MEASURES:

Ninety-day postoperative venous thromboembolism rate.

RESULTS:

Forty-two patients with tofacitinib exposure and 84 case-matched patients without tofacitinib exposure underwent surgery for medically-refractory ulcerative colitis. Nine (22.0%) tofacitinib exposed patients, and 7 (8.5%) unexposed patients, were diagnosed with a venous thromboembolism within 90-days of surgery. In univariate logistic regression, patients exposed to tofacitinib had 3.01 times increased odds of developing a venous thromboembolism within 90-days following surgery compared to unexposed (p = 0.04, 95% CI 1.03-8.79). Other venous thromboembolism risk factors were not significantly associated with venous thromboembolisms. Venous thromboembolisms in both groups were most commonly portomesenteric vein thromboses (66.7% in tofacitinib exposed and 42.9% in unexposed) and were diagnosed at a mean of 23.2 days (range, 3-90 days) postoperatively in the tofacitinib exposed and 7.9 days (1 to 19 days) in the unexposed groups, respectively. There were no statistically significant differences in location or timing between the 2 groups.

LIMITATIONS:

Retrospective nature of the study and associated biases. Reliance on clinically diagnosed venous thromboembolisms may underreport true incidence rate.

CONCLUSIONS:

Tofacitinib exposure prior to surgery for medically-refractory ulcerative colitis is associated with 3 times increased odds of venous thromboembolism as compared to patients without tofacitinib exposure. See Video Abstract.
Accurate detection of Korotkoff sounds reveals large discrepancy between intra-arterial systolic pressure and simultaneous noninvasive measurement of blood pressure with brachial cuff sphygmomanometry
Authors: Celler Branko G. , Yong Andy , Rubenis Imants , Butlin Mark , Argha Ahmadreza , Rehan Rajan , Avolio Alberto
Published: January 2024

Cardiovascular disease is the number 1 cause of death globally, with elevated blood pressure (BP) being the single largest risk factor. Hence, BP is an important physiological parameter used as an indicator of cardiovascular health. Noninvasive cuff-based automated monitoring is now the dominant method for BP measurement and irrespective of whether the oscillometric or the auscultatory method is used, all are calibrated according to the Universal Standard (ISO 81060-2:2019), which requires two trained operators to listen to Korotkoff K1 sounds for SBP and K4/K5 sounds for DBP. Hence, Korotkoff sounds are fundamental to the calibration of all NIBP devices. In this study of 40 lightly sedated patients, aged 64.1 ± 9.6 years, we compare SBP and DBP recorded directly by intra-arterial fluid filled catheters to values recorded from the onset (SBP-K) and cessation (DBP-K) of Korotkoff sounds. We demonstrate that whilst DBP-K measurements are in good agreement, with a mean difference of −0.3 ± 5.2 mmHg, SBP-K underestimates true intra-arterial SBP (IA-SBP) by an average of 14 ± 9.6 mmHg. The underestimation arises from delays in the re-opening of the brachial artery following deflation of the brachial cuff to below SBP. The reasons for this delay are not known but appear related to the difference between SBP and the pressure under the cuff as blood first begins to flow, as the cuff deflates. Linear models are presented that can correct the underestimation in SBP resulting in estimates with a mean difference of 0.2 ± 7.1 mmHg with respect to intra-arterial SBP.
Association between anxiety and elevated blood pressure in adolescent patients: a single-center cross-sectional study
Authors: Astudillo Yaritzy , Kibrom Sara , Pereira Tanya , Solomon Sonia , Krishnan Sankaran , Samsonov Dmitry
Published: January 2024

Objective:

Although anxiety is known to be associated with elevated blood pressure and hypertension in adults, this has not been studied in children. The aim of this study was to determine the association between anxiety and elevated blood pressures in adolescents.

Methods:

Adolescents, aged 12–18 years old, referred to the nephrology clinic were eligible to participate. Elevated blood pressure was defined as either SBP or DBP measurement above the 95th percentile for age, height, and sex. Participants were evaluated for anxiety using the validated Screen for Child Anxiety Related Disorders questionnaire filled independently by the child (SCARED-C) and parent (SCARED-P) evaluating the child.

Results:

Two hundred adolescents participated in this study. Thirty-one (53%) of SCARED-P-positive participants were found to have elevated blood pressure compared with 27 (19%) of SCARED-P negative, P 0.03. Twenty-five (43%) of SCARED-P positive had elevated DBP compared with 31 (28%) of SCARED-P negative (P 0.003). In SCARED-P positive, mean DBP (78.4 ± 9.9) was higher compared with SCARED-P negative (74.9 ± 9.2) (P 0.03). In a subgroup of adolescents (№ 130) not treated with blood pressure medications mean DBP was higher in both SCARED-P (79.0 ± 10.1) and SCARED-C (77.1 ± 10.4) positive groups compared with SCARED-P (73.6 ± 9.3) and SCARED-C (73 ± 8.9) negative, respectively.

Conclusion:

Our study demonstrates an association between anxiety and elevated DBP in adolescent children. Screening adolescents for anxiety should be a part of the routine evaluation of adolescent children.
Salt sensitivity risk derived from nocturnal dipping and 24-h heart rate predicts long-term blood pressure reduction following renal denervation
Authors: Sesa-Ashton Gianni , Carnagarin Revathy , Nolde Janis M. , Muente Ida , Lee Rebecca , Macefield Vaughan G. , Dawood Tye , Sata Yusuke , Lambert Elisabeth A. , Lambert Gavin W. , Walton Antony , Kiuchi Marcio G. , Esler Murray D. , Schlaich Markus P.
Published: January 2024

Background:

Renal denervation (RDN) has been consistently shown in recent sham-controlled clinical trials to reduce blood pressure (BP). Salt sensitivity is a critical factor in hypertension pathogenesis, but cumbersome to assess by gold-standard methodology. Twenty-four-hour average heart rate (HR) and mean arterial pressure (MAP) dipping, taken by ambulatory blood pressure monitoring (ABPM), stratifies patients into high, moderate, and low salt sensitivity index (SSI) risk categories.

Objectives:

We aimed to assess whether ABPM-derived SSI risk could predict the systolic blood pressure reduction at long-term follow-up in a real-world RDN patient cohort.

Methods:

Sixty participants had repeat ABPM as part of a renal denervation long-term follow-up. Average time since RDN was 8.9 ± 1.2 years. Based on baseline ABPM, participants were stratified into low (HR < 70 bpm and MAP dipping > 10%), moderate (HR ≥70 bpm or MAP dipping ≤ 10%), and high (HR ≥ 70 bpm and MAP dipping ≤ 10%) SSI risk groups, respectively.

Results:

One-way ANOVA indicated a significant treatment effect (P = 0.03) between low (n = 15), moderate (n = 35), and high (n = 10) SSI risk with systolic BP reduction of 9.6 ± 3.7 mmHg, 8.4 ± 3.5 mmHg, and 28.2 ± 9.6 mmHg, respectively. Baseline BP was not significantly different between SSI Risk groups (P = 0.18). High SSI risk independently correlated with systolic BP reduction (P = 0.02).

Conclusions:

Our investigation indicates that SSI risk may be a simple and accessible measure for predicting the BP response to RDN. However, the influence of pharmacological therapy on these participants is an important extraneous variable requiring testing in prospective or drug naive RDN cohorts.
Inverse association between obesity and aortic pressure augmentation is attenuated in women: the Wakuya study
Authors: Tagawa Kaname , Tsuru Yusuke , Yokoi Katsumi , Aonuma Takanori , Hashimoto Junichiro
Published: January 2024

Objective:

Pressure wave reflection predicts cardiovascular events in the general population. Obesity is negatively associated with pressure wave reflection. Muscular arterial diameter (responsible for pressure wave reflection) increases with obesity, and obesity-dependent dilation of muscular arteries is attenuated in women compared with men. We investigated the sex differences in the cross-sectional relationship between obesity and pressure wave reflection in a general population cohort.

Methods:

Tonometric pressure waveforms were recorded in 928 adults (mean age, 56 ± 10 years) to estimate the aortic augmentation index. The BMI was calculated using height and body weight, and waist circumference was recorded at the umbilical level.

Results:

Aortic augmentation index was significantly higher in women than in men. Indices of obesity (BMI and waist circumference) were negatively correlated with the aortic augmentation index in both men and women, even after adjusting for mean arterial pressure (both P < 0.001). Sex and BMI had no synergistic effect on the aortic augmentation index. However, when waist circumference was substituted for BMI, sex and waist circumference had a reciprocal influence on decreasing the aortic augmentation index independent of age, mean arterial pressure, diabetes, and hyperlipidemia (interaction, P = 0.045).

Conclusion:

The negative correlation between overweight/obesity and aortic pressure augmentation from peripheral wave reflection is inhibited in women more than in men. Sex differences in aortic pressure augmentation are greater in individuals with central (abdominal) obesity than in those with general obesity.
Comparison of cuff inflation and cuff deflation brachial sphygmomanometry with intra-arterial blood pressure as reference
Authors: Celler Branko G. , Yong Andy , Rubenis Imants , Butlin Mark , Argha Ahmadreza , Rehan Rajan , Avolio Alberto
Published: January 2024

Conventional sphygmomanometry with cuff deflation is used to calibrate all noninvasive BP (NIBP) instruments and the International Standard makes no mention of calibrating methods specifically for NIBP instruments, which estimate systolic and diastolic pressure during cuff inflation rather than cuff deflation. There is however increasing interest in inflation-based NIBP (iNIBP) instruments on the basis of shorter measurement time, reduction in maximal inflation pressure and improvement in patient comfort and outcomes.

However, we have previously demonstrated that SBP estimates based on the occurrence of the first K1 Korotkoff sounds during cuff deflation can underestimate intra-arterial SBP (IA-SBP) by an average of 14 ± 10 mmHg.

In this study, we compare the dynamics of intra-arterial blood pressure (IABP) measurements with sequential measurement of Korotkoff sounds during both cuff inflation and cuff deflation in the same individual. In 40 individuals aged 64.1 ± 9.6 years (range 36–86 years), the overall dynamic responses below the cuff were similar, but the underestimation error was significantly larger during inflation than deflation, increasing from 14 ± 10 to 19 ± 12 mmHg (P < 0.0001).

No statistical models were found which could compensate for this error as were found for cuff deflation. The statistically significant BP differences between inflation and deflation protocols reported in this study suggest different behaviour of the arterial and venous vasculature between arterial opening and closing which warrant further investigation, particularly for iNIBP devices reporting estimates during cuff inflation. In addition, measuring Korotkoff sounds during cuff inflation represents significant technical difficulties because of increasing pump motor noise.
Enhancing inverted internal limiting membrane flap stability in macular hole retinal detachment by the “viscoelastic agent pool” technique
Authors: Fan Yuanyuan , Chen Lifeng , Wu Mengai , Lin Li , Li Haidong , Zheng Bin Bin
Published: January 2024

Purpose:

To evaluate the surgical anatomical and functional results of “viscoelastic agent pool” technique-assisted stability of inverted internal limiting membrane (ILM) flap in macular hole retinal detachment (MHRD).

Methods:

The innovative surgical technique was carried out on 10 patients with MHRD. The primary outcomes included best corrected visual acuity (BCVA) after surgery, rate of closure of MH, retinal reattachment, and occurrence of complications.

Results:

The mean age of the individuals was 67.70±8.75 (range, 55–84) years; mean axial length, 29.34±1.53 (range, 27.10–30.93) mm; mean corrected MH diameter, 685.30± 345.65 (range, 172–1325) μm; and average follow-up period, 6.01±1.71 (range, 3.10–8.4) months. In six eyes (60%), the postoperative BCVA showed improvement. All patients had MH closure, and the retinal reattachment rate was 100%. No postoperative complications were noted.

Conclusions:

The "Viscoelastic agent pool" technique, an innovative surgical approach designed to enhance the stability of the ILM flap, serves as an effective adjunctive procedure for the inverted ILM flap technique. It presents a viable option for patients with MHRD.
DISAPPEARING CHOROIDAL MASS: OPHTHALMIC MANIFESTATIONS OF A PRESUMED KIKUCHI–FUJIMOTO DISEASE
Authors: Rodríguez-Castro Selene , Fromow-Guerra Jans , Garza-González Salvador , Pinilla-Monroy Angela , Soberon Vidal
Published: January 2024

Purpose:

To report our findings in a patient with presumed Kikuchi–Fujimoto disease.

Methods:

Report of clinical findings, fundus images, optical coherence tomography, and ultrasonography.

Results:

A 19-year-old female patient who presented with an unusual form of symptoms that fit a disease called Kikuchi–Fujimoto disease. A large choroidal mass was observed in the posterior pole; a month later, the mass was completely gone.

Conclusion:

Large choroidal masses can occur in patients with Kikuchi–Fujimoto disease, and these do not warrant treatment as they are self-limiting.
Kytococcus schroeteri
Authors: Pandey Ishwari , Pai Sumita , Purmessur Rushmi , Kappeler Ruth , Ali Jason M.
Published: January 2024

Kytococcus schroeteriis a gram-positive coccus naturally found as part of the normal skin flora. Infection caused by this organism is not common but seems to be limited to patients with implanted prostheses. To date, there have been only 22 reported cases ofK. schroetericausing disease, of which 9 are cases of prosthetic valve endocarditis. In this review, we report on 3 further cases ofK. schroeteriprosthetic valve endocarditis and review the previously reported cases. The common theme is one of delayed diagnosis, with the organism not initially identified, often after initially being misdiagnosed as aMicrococcusspecies. Prosthetic valve endocarditis caused byK. schroeteriis commonly associated with large vegetations leading to patients often requiring surgical intervention after embolic events or to prevent them. There is currently no guidance in relation to the antimicrobial treatment, but a combination of vancomycin with rifampicin and gentamicin for 6 weeks has been noted to be efficacious.
Are Nurse-Led Eczema Clinics Effective in Reducing the Severity of Atopic Dermatitis and Its Impact on Children and Families?
Authors: Gartland Tim , Kennedy Robyn , Leins Liz , Paea Danielle , King Emma
Published: January 2024

BACKGROUND

Initiation and expansion of nurse-led eczema clinics at a large tertiary hospital in Melbourne has improved timely access to treatment and education for many children with eczema and their families.

OBJECTIVE

The aim of this study was to determine the effectiveness of nurse-led eczema clinics in treating eczema and reducing its impact on quality of life and also the level of parent or guardian satisfaction with the clinical experience.

METHODS

All families attending two weekly community-based nurse-led eczema clinics and two weekly hospital-based nurse-led eczema clinics were invited to take part in a survey-based evaluation. A parent or guardian completed surveys at initial and follow-up clinic visits, and eczema severity was assessed at both visits using SCORAD.

RESULTS

There were 342 participants. Eczema severity was reduced by 62% (18 points), and the quality-of-life impact scores fell by at least 50% for individuals and families. More than 90% of parents rated the clinician and overall clinic experience as “excellent” or “very good.”

CONCLUSION

The nurse-led eczema clinics were effective in reducing the severity of eczema and the negative impact of eczema on the individual and the family unit. The magnitude of this reduction was clinically and statistically significant. Participants' clinic experience was highly positive.
Dermoscopy for Nurse Practitioners
Authors: Bourne Kaylyn
Published: January 2024

Dermoscopy refers to the examination of skin by use of a dermatoscope. These devices provide a practical, noninvasive, painless, and incredibly detailed view of the skin. When used in the hands of a trained clinician, dermoscopy significantly increases diagnostic accuracy. Although most known for its role in pigmented lesion assessment, dermoscopy use has expanded to include the evaluation of nonpigmented lesions, conditions of the hair (trichoscopy), infestations (entomodermatoscopy), nail disease (onychoscopy), and cutaneous inflammatory disease (inflammatoscopy). Studies suggest that dermoscopy is valuable as it increases sensitivity for skin cancer detection. This is especially important in the setting of melanoma as it accounts for most skin-cancer-related deaths. Overall, utilization enhances diagnosis, prompts treatment, reduces morbidity and mortality, and increases healthcare cost-effectiveness. This article is written with the intent to inform dermatology nurse practitioners about this innovation. It may additionally serve as a useful resource for other advanced care providers who perform cutaneous assessment. Examples of such clinicians may include, but are not limited to, urgent care providers, pediatricians, dentists, podiatrists, and primary care providers.
Evaluation of the efficacy of using dental pulp graft in the healing of the alveolar bone after impacted canine extraction: a prospective cohort study
Authors: Aljarmakani Omar , Assad Mounzer
Published: January 2024

The purpose of this study was to evaluate the radiographic density of the alveolar bone of the maxilla after extraction of the impacted canines and using the pulp tissue as an autogenous graft.

Materials and methods:

This prospective cohort study recruited 14 patients (8 females and 6 males) between 2021 and 2023, with an average age of 35 years. All participants had palatally impacted maxillary canines. The impacted teeth were extracted surgically. The extracted teeth were then used for autogenous grafting. The pulp tissue was removed, cut into small pieces, and placed on an absorbable gelatin sponge before being inserted into the extraction socket. The wound was subsequently closed meticulously. After 4 months, the bone density was assessed radiographically using the Hounsfield Scale on cone beam computed tomography scans.

Results:

After 4 months, the mean radiographic bone density value in the extraction area was (652.77 ± 56.13 HU), while the average density of the original bone was (659.7 ± 39.6 HU).

Conclusions:

Within the limits of this study, dental pulp tissue can be used to restore bony defects of the alveolar bone in the maxilla. However, further research is needed to confirm these findings.
Research and Practice in Quality Improvement and Implementation Science
Authors: Dolansky Mary A. , Horvat Davey Christine , Moore Shirley M.
Published: January 2024

Background:

Nurses play an essential role in the achievement of quality depicted by the Quintuple Aim to improve clinical outcomes, patient experience, equity, provider well-being, and reduction of costs. When quality gaps occur, practice change is required and is facilitated by quality improvement (QI) and implementation science (IS) methods. QI and IS research are required to advance our understanding of the mechanisms that explain how evidence is implemented and improvements are made.

Problem:

Despite past efforts of the evidence-based practice and QI movements, challenges persist in sustaining practice improvements and translating research findings to direct patient care.

Approach:

The purpose of this article is to describe the Synergy for Change Model that proposes that both QI and IS research and practice be used to accelerate improvements in health care quality.

Conclusions:

Recognizing the synergy of QI and IS practice and research will accelerate nursing's contributions to high-quality and safe care.
The LIMB-Q: Reliability and Validity of a Novel Patient-Reported Outcome Measure for Patients with Lower Extremity Trauma
Authors: Mundy Lily R. , Klassen Anne F. , Pusic Andrea L. , deJong Tim , Hollenbeck Scott T. , Gage Mark J. ,   LIMB-Q Development Team
Published: January 2024

Background:

The LIMB-Q is a novel patient-reported outcome measure for patients with lower extremity trauma. The aim of this study was to perform a psychometric validation of the LIMB-Q based on the Rasch measurement theory.

Methods:

An international, multisite convenience sample of patients with lower extremity traumatic injuries distal to the midfemur was recruited from clinical sites in the United States and the Netherlands and online platforms (in English; Trauma Survivors Network patient support group and the Prolific academic research platform). A cross-sectional survey of the LIMB-Q was conducted with test–retest reliability analysis performed 1 to 2 weeks after initial completion in a subgroup of patients.

Results:

The LIMB-Q was field-tested in 713 patients. The mean age was 41 years (SD, 17 years; range, 18 to 85 years), the mean time from injury was 7 years (SD, 9 years; range, 0 to 58 years), and there were various injury and treatment characteristics (39% fracture surgery only, 38% flap or graft, 13% amputation, 10% amputation and flap or graft). Out of 382 items tested, 164 were retained across 16 scales. Reliability was demonstrated with person separation index values of 0.80 or greater in 14 scales (0.78 to 0.79 in the remaining 2 scales), Cronbach alpha values 0.83 or greater, and intraclass correlation coefficient values 0.70 or greater. Each scale was unidimensional, measurement invariance was confirmed across clinical and demographic factors, test–retest analysis showed adequate reliability, and construct validity was demonstrated.

Conclusion:

The LIMB-Q is a patient-reported outcome measure with 16 independently functioning scales (6 to 15 items per scale) developed and validated specifically for patients with lower extremity trauma with fractures, reconstruction, or amputation.
Risk Factors for Hardware Removal Following Bimaxillary Surgery: A National Database Analysis
Authors: Shah Jennifer K. , Silverstein Max , Cevallos Priscila , Johnstone Thomas , Wu Robin , Nazerali Rahim , Bruckman Karl
Published: January 2024

Orthognathic surgery typically relies on the rigid fixation of fracture fragments using metal hardware. Though hardware is usually intended to be implanted permanently, the removal of hardware (ROH) is sometimes indicated for a variety of reasons. The authors sought to identify risk factors for ROH following orthognathic surgery. The authors conducted a retrospective analysis of the Merative MarketScan Research Databases, 2007–2021 using Current Procedural Terminology (CPT) and International Classification of Disease (ICD-9 and ICD-10) codes to identify patients who underwent an index Le Fort 1 osteotomy and bilateral sagittal split osteotomy operation on the same day. Statistical analysis involved χ2, Shapiro-Wilk, Wilcoxon-Mann-Whitney, Poisson regression, and multivariable logistic regression tests. 4698 patients met the inclusion criteria. The mean age at surgery was 25 years, and 57% were female. ROH occurred in 5.9% of patients. The mean time to hardware removal was 190.5±172.4 days. In a multivariate logistic regression, increased odds of ROH were associated with older patient age [OR: 1.02 (1.01–1.03), P=0.046], sleep apnea [OR: 1.62 (1.13–2.32), P=0.018], and craniofacial syndrome and/or cleft diagnoses [OR: 1.88 (1.14-2.55), P<0.001]. In the same model, postoperative oral antibiotic prophylaxis was not associated with ROH (P=0.494). The incidence of all-cause complications [IRR: 1.03 (1.01–1.05), P<0.001] rose over the study period, while the incidence of ROH did not change significantly (P=0.281). Patients at elevated risk should be counseled on the increased possibility of a second operation for ROH before having orthognathic surgery to ensure expectations and health care utilization decisions align with the evidence.
Objective Assessment of the Repeated Botox Treatment to the Synkinesis of Facial Paralysis by the Integrated Electromyography
Authors: Homma Tsutomu , Uemura Noriko , Tanaka Kentaro , Mori Hiroki , Okazaki Mutsumi
Published: January 2024

Background:

The widely used botox type A (BTX-A) is effective against synkinesis in facial palsy sequelae. Repeated injections are necessary and permanent improvements have been reported. We objectively evaluated the changes in synkinesis at >6 months after BTX-A injection, including changes over time with the number of administrations.

Methods:

In 48 patients who received multiple BTX-A injections, evaluation by the Sunnybrook Facial Grading System (FGS) and integrated electromyography (iEMG) was performed before treatment and at least 6 months after the first, second, and third BTX-A injection. The iEMG ratio on the affected and healthy sides was calculated for each mimetic muscle and mimic motion.

Results:

There was no significant difference in the FGS synkinesis score before treatment and after the third injection, although an improvement was observed. The iEMG ratio was significantly improved in the orbicularis oculi with open-mouth smile and lip pucker after the third dose compared to before treatment. The orbicularis oris showed a significant improvement when the eyelids were closed, while the platysma showed a significant improvement when the eyelids were closed and when the lip was pursed. Multiple regression analysis revealed that the orbicularis oculi and platysma had a greater effect on the iEMG ratio for the number of treatments than other factors.

Conclusions:

Repeated BTX-A injections showed improvements in synkinesis for the orbicularis oculi, orbicularis oris, and platysma, even after >6 months, compared to before treatment.
Analysis of Sexual Dimorphic Features of the Jawline and Chin in White Celebrity Faces
Authors: Salinas Cristina A. , Liu Alice , Sharaf Basel A.
Published: January 2024

Background:

The jawline greatly influences facial shape and contributes to facial dimorphism. Analysis of lower facial shape and sexual dimorphic differences in contemporary attractive white faces can advance the goals of lower facial aesthetics and facial gender–affirming surgery (FGAS).

Methods:

Full-face, front-view photos of 47 white female and 21 white male celebrities were included from a list generated using GQ magazine’s Highest Paid Models issue, People Magazine’s Beautiful issue (1991–2022), and celebrities featured on lifestyle websites. Facial landmarks were detected through a facial analysis program using Vision framework and MATLAB. After converting pixel distances to absolute distances, lower face measurements were compared between males and females.

Results:

The mean lower facial height was 6.08 cm in females and 7.00 cm in males (P value<0.001). The mean bigonial width was 11.21 cm in females and 12.30 cm in males (P value<0.001). The ratio of facial height to lower facial height was 2.98 in females and 2.76 in males (P value<0.001), signifying that symmetry in facial thirds is more prevalent in attractive female faces, while a longer lower face is more common in attractive male faces. The greatest differences in female and male facial contours were at gonial angles and chin.

Conclusions:

Analysis of contemporary white celebrity faces demonstrated significantly wider and longer lower facial measurements in males. The overall contour of the female lower face was more tapered at the gonial angles and chin compared to males. These results are important when planning lower facial rejuvenation or FGAS, as lower face size and proportions influence perceived gender and attractiveness.
A Brief Clinical Study: Consecutive Occurences of Frontal Sinus Pneumocele
Authors: Menville Jesse E. , Persad-Paisley Elijah M. , Woo Albert S.
Published: January 2024

Sinus pneumocele is a rare condition marked by pathologic expansion of a paranasal sinus with concomitant bone loss. Here, we describe the case of a 24-year-old male who first presented with a 2×3 cm bony projection of his right medial forehead. Exam and history were notably absent for any skin tethering, prior trauma, inflammation, or neurological symptoms. A computed tomography scan confirmed the prominence was secondary to an enlarged right frontal sinus. The pneumocele was successfully corrected through surgery, but the patient notably developed a similar presentation on the left frontal sinus nearly 1 year later. Clinical findings support a hypothesis of air trapping through mucosal thickening. This second pneumocele was managed similarly.
Complete Extensive Heterotopic Ossification of the Entire Free Fibula Flap Vascular Pedicle in Maxillary Reconstruction
Authors: Abou Ghanem Odette , O’Sick Nicholas Robert , Kalmar Christopher L. , Golinko Michael
Published: January 2024

Introduction:

Heterotopic ossification is a pathologic extra-skeletal bone formation as a form of aberrant repair process with acquired or genetic etiologies. In plastic surgery, it has been well-described in the burn and trauma patients. Rarely, it can happen along the vascular pedicle of free tissue transfer, and when it happens, it is most commonly in head and neck reconstruction.

Case Presentation:

Here we present a case of complete extensive heterotopic ossification of the entire vascular pedicle from the anastomosis to the bone in an osteocutaneous free fibula flap (FFF). The fibula was used as a 2-segment reconstruction for a maxillary defect resulting from a self-inflicted gunshot wound. The skin paddle was used to reconstruct the anterior palatal defect.

Discussion:

Heterotopic ossification of the FFF vascular pedicle is most reported in the head and neck reconstruction cases. It is rare, but when it happens, it occurs earlier, more commonly, and more extensively in cases of maxillary reconstruction than in cases of mandibular reconstruction. Flap loss due to this sequela has not been reported, and surgical debridement is indicated only when symptomatic.

Conclusion:

Heterotopic ossification of an FFF vascular pedicle is a rare but well-described entity. The periosteal bone formation capacity preservation after revascularization of the flap is thought to be one of the major etiologies of this phenomenon. Hence, some have suggested a modification in the harvesting technique of the FFF that could mitigate return to the operating room, especially when it is for maxillary reconstruction in the trauma patient. Keywords: Keywords: free fibula flap, heterotopic ossification, maxillary reconstruction, mandibular reconstruction.