bluuebunny/crossref_metadata_2025 huggingface dataset:
Terahertz refractive index sensor based on dual plasmon-induced transparency in a graphene metasurface
Authors: Yang Xiaojie , Xu Hui , Xu Haiye , Li Ming , Yu Hongfei , Cheng Yuxuan , Chen Zhiquan
Published: March 2024

A novel graphene metasurface is proposed in this article, which is simulated by the finite difference time domain (FDTD) and found to exhibit a significant dual Plasmon-induced transparency (PIT) phenomenon in the terahertz frequency band. For further research, new transmission spectra are simulated using the coupled mode theory (CMT), and after comparison, it is found that the images were basically consistent and had a high degree of agreement. In addition, through observation and analysis of the PIT window, it is found that the PIT phenomenon can be effectively tuned by adjusting the Fermi level. Finally, the metasurface is proposed in this article, which has excellent sensing properties. After calculation and comparison of different refractive indices of surrounding media, it is found that the maximum sensitivity can reach 1.567 THz RIU−1 at a frequency of f = 4.8716 THz, with a figure of merit (FOM) of 23.855. Compared with other sensors of the same type, the sensor in this paper has great advantages. In summary, the graphene metasurface proposed in this article provides more theoretical support for manufacturing dynamically adjustable graphene sensors.
Formalizing screw theory with 3D geometric algebra
Authors: Delafosse Loris
Published: March 2024

This paper is intended for students and researchers looking for more insight into Screw Theory. It shows how algebraic considerations lead to both physical and geometrical understanding of screws, and how they can connect affine geometry (what the world is) to linear algebra (what we can easily compute). Various formulations of the theory are first reviewed, as each of them highlights a particular aspect of screws. Their respective qualities and defects are also discussed. Subsequently, the powerful framework of Geometric Algebra (GA) is introduced to elucidate the nature of various physical objects commonly associated with screws, and eventually a new formalism based on GA is proposed, in which traditional screws clearly appear as a special case of more general affine objects. This approach generalizes the concept of a screw in a coordinate-free and origin-independent form. A simultaneous proof of Euler’s First and Second Laws is provided to illustrate the use of this formalism.
Machine-Learned Potential Energy Surfaces for Free Sodium Clusters with Density Functional Accuracy: Applications to Melting
Authors: Nagare Balasaheb J , Chacko Sajeev , Kanhere Dilip G
Published: March 2024

Gaussian Process Regression based Gaussian Approximation Potential has been used to develop machine learned interatomic potentials having density functional accuracy, for free sodium clusters. The training data was generated from a large sample of over 100,000 data points computed for clusters in the size range of N = 40–200, where N denotes the number of atoms in the cluster, using the density functional method as implemented in the VASP code. Two models have been developed, model M1 using data for N = 55 only, and model M2 using additional data from larger clusters. The models are intended for computing thermodynamic properties using molecular dynamics. Hence, particular attention has been paid to improve the fitting of the forces. Although it was possible to obtain a good fit using the data of Na55 only, additional data points from larger clusters were needed to get better accuracies in energies and forces for larger sizes. Surprisingly, the model M1 could be significantly improved by adding about 50 data points per cluster from the larger sizes. Thus, it turns out that the best fit can be obtained by carefully selecting a small number of data points viz. 1,900 and 1,300 configurations for the two models M1 and M2, respectively. These two models have been deployed to compute the heat capacities of Na55. The heat capacities of Na147 and about 40 isomers for larger clusters of sizes N = 147, 200, 201, and 252, have been obtained using the final model M2. There is an excellent agreement between the computed and experimentally measured melting temperatures. The geometries of these isomers have been further optimized by density functional theory. The mean absolute error with respect to DFT energies is found to be about 7 meV/atom or less. The errors in the lowest interatomic bond lengths are below 2% in almost all the cases.
Robot-assisted support combined with electrical stimulation for the lower extremity in stroke patients: a systematic review
Authors: Rikhof C J H , Feenstra Y , Fleuren J F M , Buurke J H , Prinsen E C , Rietman J S , Prange-Lasonder G B
Published: March 2024

Objective. The incidence of stroke rising, leading to an increased demand for rehabilitation services. Literature has consistently shown that early and intensive rehabilitation is beneficial for stroke patients. Robot-assisted devices have been extensively studied in this context, as they have the potential to increase the frequency of therapy sessions and thereby the intensity. Robot-assisted systems can be combined with electrical stimulation (ES) to further enhance muscle activation and patient compliance. The objective of this study was to review the effectiveness of ES combined with all types of robot-assisted technology for lower extremity rehabilitation in stroke patients. Approach. A thorough search of peer-reviewed articles was conducted. The quality of the included studies was assessed using a modified version of the Downs and Black checklist. Relevant information regarding the interventions, devices, study populations, and more was extracted from the selected articles. Main results. A total of 26 articles were included in the review, with 23 of them scoring at least fair on the methodological quality. The analyzed devices could be categorized into two main groups: cycling combined with ES and robots combined with ES. Overall, all the studies demonstrated improvements in body function and structure, as well as activity level, as per the International Classification of Functioning, Disability, and Health model. Half of the studies in this review showed superiority of training with the combination of robot and ES over robot training alone or over conventional treatment. Significance. The combination of robot-assisted technology with ES is gaining increasing interest in stroke rehabilitation. However, the studies identified in this review present challenges in terms of comparability due to variations in outcome measures and intervention protocols. Future research should focus on actively involving and engaging patients in executing movements and strive for standardization in outcome values and intervention protocols.
Genomic islands of speciation harbor genes underlying coloration differences in a pair of Neotropical seedeaters
Authors: Nguyen Tram N , Repenning Márcio , Suertegaray Fontana Carla , Campagna Leonardo
Published: March 2024

Incomplete speciation can be leveraged to associate phenotypes with genotypes, thus providing insights into the traits relevant to the reproductive isolation of diverging taxa. We investigate the genetic underpinnings of the phenotypic differences between Sporophila plumbea and Sporophila beltoni. Sporophila beltoni has only recently been described based, most notably, based on differences in bill coloration (yellow vs. black in S. plumbea). Both species are indistinguishable through mtDNA or reduced-representation genomic data, and even whole-genome sequencing revealed low genetic differentiation. Demographic reconstructions attribute this genetic homogeneity to gene flow, despite divergence in the order of millions of generations. We found a narrow hybrid zone in southern Brazil where genetically, yet not phenotypically, admixed individuals appear to be prevalent. Despite the overall low genetic differentiation, we identified 3 narrow peaks along the genome with highly differentiated SNPs. These regions harbor 6 genes, one of which is involved in pigmentation (EDN3) and is a candidate for controlling bill color. Within the outlier peaks, we found signatures of resistance to gene flow, as expected for islands of speciation. Our study shows how genes related to coloration traits are likely involved in generating prezygotic isolation and establishing species boundaries early in speciation.
Influence of reforestation tree species on decomposition of larch stumps and coarse roots: role of wood microbial communities and soil properties
Authors: Yue Yang , Men Xiuli , Chen Xiangwei
Published: March 2024

Stumps and coarse roots are the most important coarse woody debris component in managed forests. However, their decomposition is still poorly understood, especially the influence of the characteristics of the microbial communities on wood decomposition. In this study, we investigated decaying larch (Larix olgensis Henry) stumps and coarse roots in reforestations of birch (Betula pendula Roth.), ash (Fraxinus mandshurica Rupr.), pine (Pinus sylvestris var. Mongolica), and larch in the northeast of China. We measured wood density loss, cellulose, and lignin concentrations, analyzed microbial community composition, and assessed the physical and chemical properties of woodland soils. Our findings reveal that larch stumps and coarse roots experienced the most rapid decomposition within birch reforestation areas, exhibiting significant density loss in stumps (33.84%) and coarse roots (43.68%). Bacterial diversity on larch stumps and coarse roots was highest in birch reforestation, with dominant phyla including Proteobacteria, Actinobacteriota, and Bacteroidota. Fungal diversity was also highest in birch reforestation, with Ascomycota as the dominant phylum in larch stumps and coarse roots. Furthermore, a mantel test analysis indicated that soil pH and temperature were significant factors in wood decomposition which affected microbial communities. This suggests that the choice of the reforestation tree species affects the decomposition of stumps and coarse roots by affecting soil properties and wood microbial communities. Understanding this process is vital for refining carbon balance evaluations, and enhancing ecosystem-level carbon modeling.
Impacts of ground ultra-low volume adulticide applications on Culex pipiens and Culex restuans (Diptera: Culicidae) abundance, age structure, and West Nile virus infection in Cook County, Illinois
Authors: Lopez Kristina , Susong Katie , Irwin Patrick , Paskewitz Susan , Bartholomay Lyric
Published: March 2024

Since the introduction of West Nile virus (WNV) to the United States over 20 years ago, thousands of cases of human disease and death have been reported. Yearly seasonal outbreaks continue to persist, and the city and suburbs of Chicago, Illinois, is considered a “hot spot” for WNV activity. To interrupt WNV transmission, ground ultra-low volume (ULV) adulticide applications are regularly used to reduce Culex pipiens L. and Culex restuans Theobold (Diptera: Culicidae) abundance and infection. The real-world effectiveness of adulticide applications has not been comprehensively assessed, and prior studies, including our own investigation, have yielded inconclusive or conflicting results. Therefore, we expanded our prior work and evaluated the effects of 5 sequential weekly truck-mounted ULV adulticide applications in large residential areas in the northern suburbs of Chicago, Illinois, in 2019 and 2020. Each day, Cx. pipiens and Cx. restuans host-seeking and gravid mosquitoes were collected to assess abundance, age structure, and WNV infection rates. Adulticide applications resulted in significant reductions of both host-seeking and gravid abundance on the night of treatment. The reduction in host-seeking mosquitoes was followed by a reduction in gravid mosquitoes trapped 3 and 4 days after adulticide application and an increase in the proportion of nulliparous mosquitoes. WNV infection rates were significantly reduced in treatment sites as compared to untreated sites when infection rates were higher in 2020. This large-scale study provides comprehensive evidence that ground ULV adulticide applications are an effective tool in an integrated mosquito management program for combating WNV vectors and infection risk.
Evaluation of the Root Rupture Method for Controlling Belowground Spread of the Oak Wilt Pathogen (Bretziella fagacearum) in Northeast Wisconsin, USA
Authors: Yang Anna , Haugen Linda M , Mausel David L , Lampereur John , Stueck Tommy , Montgomery Rebecca A , Juzwik Jennifer
Published: March 2024

Oak wilt, caused by the pathogen Bretziella fagacearum, is a destructive disease on oak (Quercus) species in the United States. Established methods to control the belowground spread of oak wilt are not appropriate in all circumstances; thus, forest health managers have a strong need for alternative methods for disease control. We evaluated the effectiveness of operational stump excavation treatments (i.e., “root rupture” method) applied between 2004 and 2014 to control belowground spread of oak wilt on two forests in northeast Wisconsin, USA. The root rupture method achieved a high level of disease control (≥85% of evaluated disease infection centers) for 5 years by harvesting red oak trees within infection centers and uprooting the stumps and associated root mass. The likelihood of disease control success depended on the initial size of the infection center that was treated, with larger infection centers being less likely to be contained with a single treatment than small infection centers. This study highlights the importance of early detection and prompt management in oak wilt suppression programs.

Study Implications: Forest management agencies and organizations in the North Central United States continue to face oak wilt epidemics. No single tool or treatment method ensures complete containment of oak wilt; thus, most managers carefully consider all the tools and techniques available to them and determine what best suits their budget and land use priorities. Stump excavation (i.e., “root rupture” method) is a cost-effective treatment for halting belowground spread of the oak wilt fungus, Bretziella fagacearum, that can achieve a high level of disease control. In northern red oak (Quercus rubra) stands with high economic value, this treatment can be applied as a group selection, with the value of the timber potentially offsetting the cost of treatment. The opportunity for complete disease control decreases as oak wilt infection centers increase in size; thus, monitoring and early control actions are critical.
False-positive HIV screening test in a healthcare student
Authors: Quigley J , Hussain T , Arthur C
Published: March 2024

This case report describes a 22-year-old female Ambulance Technician student who displayed human immunodeficiency virus (HIV) false positivity following a recent hepatitis B vaccination. Occupational health clinicians who work in a healthcare setting (with healthcare staff and/or students) should be aware of the possibility of false-positive HIV screening test results, and where a false positive is suspected, they should consider what the underlying cause could be and should consider whether further medical investigation is required.
The Enterics for Global Health (EFGH) Shigella Surveillance Study in The Gambia
Authors: Conteh Bakary , Badji Henry , Jallow Abdoulie F , Karim Mehrab , Manneh Alhagie , Keita Belali , Sarwar Golam , Ceesay Bubacarr E , Jarju Sheikh , Jabang Abdoulie M J , Baldeh Ebrima , Ikumapayi Usman N , Secka Ousman , Antonio Martin , Roca Anna , D’Alessandro Umberto , Kotloff Karen L , Hossain M Jahangir
Published: March 2024

Background

The Gambia, located in West Africa, is one of 7 country sites conducting the Enterics for Global Health (EFGH) Shigella Surveillance Study to establish incidence and consequence of Shigella-associated medically attended diarrhea among children 6–35 months old.

Methods

Here we describe the study site and research experience, sociodemographic characteristics of the study catchment area, facilities of recruitment for diarrhea case surveillance, and known care-seeking behavior for diarrheal illness. We also describe The Gambia's healthcare system and financing, current vaccine schedule and Shigella vaccine adaptation, local diarrhea management guidelines and challenges, and antibiotic resistance patterns in the region.

Conclusions

The EFGH study in The Gambia will contribute to the multisite network of Shigella surveillance study and prepare the site for future vaccine trials. In addition, the data produced will inform policy makers about prevention strategies and upcoming Shigella vaccine studies among children in this setting.
Controlling Images of Neighborhoods in Gentrification Coverage
Authors: Rucks-Ahidiana Zawadi
Published: March 2024

Prior literature has largely used the concept of “controlling images” to explain how the news media and other institutions use racialized and gendered stereotypes to control marginalized groups. This article extends the concept of controlling images to neighborhoods using 583 newspaper articles about gentrification in San Francisco. Using qualitative and spatial analysis, I demonstrate how controlling images exist in media through representations, underrepresentations, and omissions in the form of three controlling images of neighborhoods: “The apolitical Asiantown” appears through the omission of Asian neighborhoods and Asian residents of other gentrifying neighborhoods, “the immigrant barrio” through the underrepresentation of Latinx residents and centering of White residents in Latinx neighborhoods, and “the violent ’hood” through the focus on issues of blight, crime, and violence in Black neighborhoods. The findings contribute to our understanding of how institutional racism operates not only through racist representations, but also through racist exclusions.
Unwitting Accomplices: Equal Treatment and the Perpetuation of Racialized Information Inequality in School Choice
Authors: Faude Sarah
Published: March 2024

In public education, racially segregated schools are now often understood as a natural result of a messy mix of failed policies and parent decisions. However, parent decisions and school choice are both constrained by districts. In the case of Boston Public Schools (BPS), the staff hired to support “well-informed choices” do not provide information to families—including those who need it most—even when it could mitigate known inequities. Using data from semi-structured interviews with 37 staff, participant observation in registration sites, a supplemental survey of 1,887 registering families, and district administrative data on all registering families, I find that BPS constrains the actions of frontline staff, making them unwitting proponents of the fallacy of choice. The equal treatment of families who come with unequal access to the registration and choice systems protects racial privilege in relation to schools and harms both families of color and the staff of color who work with them. This racism of omission enacted within the choice apparatus causes staff and families to focus on the selection process rather than the limited and racialized access to the public good of schools.
Organoid-based personalized medicine: from tumor outcome prediction to autologous transplantation
Authors: Soto-Gamez Abel , Gunawan Jeremy P , Barazzuol Lara , Pringle Sarah , Coppes Rob P
Published: March 2024

Inter-individual variation largely influences disease susceptibility, as well as response to therapy. In a clinical context, the optimal treatment of a disease should consider inter-individual variation and formulate tailored decisions at an individual level. In recent years, emerging organoid technologies promise to capture part of an individual’s phenotypic variability and prove helpful in providing clinically relevant molecular insights. Organoids are stem cell-derived 3-dimensional models that contain multiple cell types that can self-organize and give rise to complex structures mimicking the organization and functionality of the tissue of origin. Organoids therefore represent a more faithful recapitulation of the dynamics of the tissues of interest, compared to conventional monolayer cultures, thus supporting their use in evaluating disease prognosis, or as a tool to predict treatment outcomes. Additionally, the individualized nature of patient-derived organoids enables the use of autologous organoids as a source of transplantable material not limited by histocompatibility. An increasing amount of preclinical evidence has paved the way for clinical trials exploring the applications of organoid-based technologies, some of which are in phase I/II. This review focuses on the recent progress concerning the use of patient-derived organoids in personalized medicine, including (1) diagnostics and disease prognosis, (2) treatment outcome prediction to guide therapeutic advice, and (3) organoid transplantation or cell-based therapies. We discuss examples of these potential applications and the challenges associated with their future implementation.
Improving Calculations of Electron Eye-lens Operational Dose Coefficients Using the Monte Carlo Codes PENELOPE and MCNP6.2
Authors: Dubeau Jacques , Sun Jiansheng , Djeffal Salah , Ali Fawaz
Published: March 2024

After considering epidemiological studies on the induction of cataracts in individuals exposed to radiation, the International Commission on Radiological Protection recommended, in 2012, a reduction in the annual eye-dose limit of occupationally exposed workers. This imposed higher performance demands on existing dosimetry systems and the development of new dosimetry technologies. The operational quantity to be measured is H
p(3), the personal dose equivalent at a depth of 3 mm in an ICRU 4-element tissue cylinder 20 cm in height and 20 cm in diameter. The conversion coefficients per unit incident fluence, H
p(3)/Φ, were calculated using Monte Carlo simulation codes. In the case of incident electrons, the literature shows that the resulting coefficients depend on the electron transport options selected for the Monte Carlo simulations as well as the tally zone thickness. In this study, electron operational eye-lens dose coefficients were calculated using MCNP6.2 in its default settings and by invoking the single-event feature. The results were compared to those from PENELOPE, a well-known code for its enhanced accuracy in handling low-energy electron transport. The results are in agreement for the entire energy range for these two series of simulations, but differences are found with previously published dose coefficients in the literature. This impacts the calibration of dosimeters for electrons and may require a change in the commonly accepted dose coefficients.
Circumferential resection margin rates in esophageal cancer resection: oncological equivalency and comparable clinical outcomes between open versus minimally invasive techniques – a retrospective cohort study
Authors: Patel Pranav H. , Patel Nikhil M. , Doyle Joseph P. , Patel Hina K. , Alhasan Yousef , Luangsomboon Alfa , Petrou Nikoletta , Bhogal Ricky H. , Kumar Sacheen , Chaudry Mohammed A. , Allum William H.
Published: March 2024

Background:

Radical surgery for esophageal cancer requires macroscopic and microscopic clearance of all malignant tissue. A critical element of the procedure is achieving a negative circumferential margin (CRM) to minimize local recurrence. The utility of minimally invasive surgery poses challenges in replicating techniques developed in open surgery, particularly for hiatal dissection in esophago-gastrectomy. In this study, the technical approach and clinical and oncological outcomes for open and laparoscopic esophago-gastrectomy are described with particular reference to CRM involvement.

Materials and methods:

This cohort study included all patients undergoing either open or laparoscopic esophago-gastrectomy between January 2004 and June 2022 in a single tertiary center. A standard surgical technique for hiatal dissection of the esophago-gastric junction developed in open surgery was adapted for a laparoscopic approach. Clinical parameters, length of stay (LOS), postoperative complications, and mortality data were collected and analyzed by a Mann–Whitney U or Fisher’s exact method.

Results:

Overall 447 patients underwent an esophago-gastrectomy in the study with 219 open and 228 laparoscopic procedures. The CRM involvement was 18.8% in open surgery and 13.6% in laparoscopic surgery. The 90-day-mortality for open surgery was 4.1 compared with 2.2% for laparoscopic procedures. Median Intensive care unit (ITU), inpatient LOS and 30-day readmission rates were shorter for laparoscopic compared with open esophago-gastrectomy (ITU: 5 versus 8 days, P=0.0004; LOS: 14 versus 20 days, P=0.022; 30-day re-admission 7.46 versus 10.50%). Postoperative complication rates were comparable across both cohorts. The rates of starting adjuvant chemotherapy were 51.8 after open and 74.4% in laparoscopic esophago-gastrectomy.

Conclusion:

This study presents a standardized surgical approach to hiatal dissection for esophageal cancer. The authors present equivalence between open and laparoscopic esophago-gastrectomy in clinical, oncological, and survival outcomes with similar rates of CRM involvement. The authors also observe a significantly shorter hospital length of stay with the minimally invasive approach.
Informal Family Care Partner Well-Being Is Diminished in End-Stage Liver Disease
Authors: Hansen Lissi , Chang Michael F. , Hiatt Shirin , Dieckmann Nathan F. , Lee Christopher S.
Published: March 2024

Background

Chronic liver disease is a significant global neglected public health problem. End-stage liver disease is associated with substantial symptom complexity, disability, and care needs that require assistance from informal family care partners. Research on these care partners' caregiver burden or strain, symptoms, and quality of life is sparse and has not focused on these variables as co-occurring or in the context of the quality of the relationship care partners have with the patients.

Objectives

The purpose of this study was to provide a collective presentation of patterns and determinants of well-being as measured by caregiver strain, depression, sleep, and quality of life in a cohort of informal family care partners for adult outpatients with end-stage liver disease.

Methods

Care partners (aged >18 years) were recruited from two liver clinics within two tertiary healthcare systems and invited to complete a cross-sectional survey. They completed the Multidimensional Caregiver Strain Index, Patient Health Questionnaire, Pittsburgh Sleep Quality Index, Short Form Health Survey, and Mutuality Scale. Descriptive statistics and latent class mixture modeling were used to analyze these data.

Results

The sample was predominantly female and White. The well-being of care partners was diminished. Three distinct classes of well-being were identified: mildly diminished (53.2%), moderately diminished (39.0%), and severely diminished (7.8%). Those at a greater risk of worse well-being were younger and spouses and had poorer relationship quality with the patients.

Discussion

To improve the well-being of care partners in moderately and severely diminished classes, assessing and addressing caregiver strain and co-occurring symptoms is essential. Addressing the strain and symptoms has the potential to maintain or optimize care partners' ability to provide care to patients. Future researchers should include longitudinal and dyadic studies to examine how patients' disease progression and symptoms may affect family care partners' well-being and vice versa.
An Analysis of Incident Reports Related to Electronic Medication Management: How They Change Over Time
Authors: Kinlay Madaline , Zheng Wu Yi , Burke Rosemary , Juraskova Ilona , Ho Lai Mun (Rebecca) , Turton Hannah , Trinh Jason , Baysari Melissa T.
Published: March 2024

Objective

Electronic medication management (EMM) systems have been shown to introduce new patient safety risks that were not possible, or unlikely to occur, with the use of paper charts. Our aim was to examine the factors that contribute to EMM-related incidents and how these incidents change over time with ongoing EMM use.

Methods

Incidents reported at 3 hospitals between January 1, 2010, and December 31, 2019, were extracted using a keyword search and then screened to identify EMM-related reports. Data contained in EMM-related incident reports were then classified as unsafe acts made by users and the latent conditions contributing to each incident.

Results

In our sample, 444 incident reports were determined to be EMM related. Commission errors were the most frequent unsafe act reported by users (n = 298), whereas workarounds were reported in only 13 reports. User latent conditions (n = 207) were described in the highest number of incident reports, followed by conditions related to the organization (n = 200) and EMM design (n = 184). Over time, user unfamiliarity with the system remained a key contributor to reported incidents. Although fewer articles to electronic transfer errors were reported over time, incident reports related to the transfer of information between different computerized systems increased as hospitals adopted more clinical information systems.

Conclusions

Electronic medication management–related incidents continue to occur years after EMM implementation and are driven by design, user, and organizational conditions. Although factors contribute to reported incidents in varying degrees over time, some factors are persistent and highlight the importance of continuously improving the EMM system and its use.
Speech Outcomes After Palatal Lengthening Via Double Opposing Buccinator Myomucosal Flaps
Authors: Monte Thais Miguel , Raposo-Amaral Cesar A. , Sabbag Anelise , Gil André , Menezes Priscila T. , Raposo-Amaral Cassio E.
Published: March 2024

Background

Palatal lengthening is becoming a first-line treatment choice for cleft patients with velopharyngeal insufficiency (VPI). As cleft palate–related surgical outcomes are age dependent, speech outcomes may be similarly affected by patient age at the time of treatment. The primary goal of this study is to determine whether there are age-related speech outcome differences when double opposing buccinator myomucosal flaps are used as part of a palatal lengthening protocol and whether these outcome differences preclude utilization of this technique for specific patient age groups.

Methods

A retrospective study was performed on consecutive nonsyndromic patients with VPI who underwent treatment using double opposing buccinator myomucosal flaps at our hospital between 2014 and 2021. Patients who completed the 15-month follow-up were stratified by age. Group A aged between 2 and 7 years (n = 14), group B aged 8 and 18 years (n = 23), and group C aged older than 18 years (n = 25) were included. Standardized perceptual speech evaluations and nasopharyngoscopy were performed. Hypernasality, soft palate mobility, and lateral palatal wall mobility were assessed both preoperatively and at a 15-month postoperative interval. Complications were also recorded. The χ2 test was used for statistical comparison.

Results

All of the age-stratified patient groups in this study showed significant improvement in hypernasality, soft palate mobility, and lateral wall mobility (P < 0.01), with no statistically significant differences between the different patient age groups. Overall speech success was achieved in 69.4% of patients. Patients in group A achieved 78.6% speech success, patients in group B achieved 78.3% speech success, and patients in group C achieved 56% speech success, with no statistically significant differences being shown regarding speech success between the different patient age groups (P > 0.05).

Conclusions

Regardless of age, palatal lengthening via double opposing buccinator myomucosal flaps similarly improves speech outcomes.
The Role of the Fascia-Only Anterolateral Thigh Flap in Extremity Reconstruction
Authors: Hassan Bashar , Fairchild Berry , Grant Michael P. , Lamaris Gregory A.
Published: March 2024

Background

Free flap selection in extremity reconstruction can be challenging. The ideal flap has to be thin and pliable to achieve optimal contour and function. We explore the role of the fascia-only anterolateral thigh (fALT) flap in extremity reconstruction.

Methods

We conducted a retrospective review of our experience using fALT-free flap for extremity reconstruction over a 2-year period. Patient demographics, mechanism of injury, flap characteristics, complications- and follow-up were recorded. Descriptive statistics were calculated.

Results

Twelve patients were included. The median (interquartile range [IQR]) age was 34 (28–52) years. One fALT flap was used for upper extremity reconstruction, while 11 flaps were used for lower extremity reconstruction (4 for lower third of the leg, 4 for dorsum of foot, and 3 for heel). The median (IQR) flap surface area was 90 (63–120) cm2 and time from injury to reconstruction was 10 (6–16) days. The postoperative course was uneventful for all flaps except for 1 flap failure and 1 delayed healing. The median (IQR) follow-up was 2 (1–4) months. In all cases, durable soft tissue reconstruction was achieved with no need for revisions.

Conclusions

The fALT-free flap can be successfully used in extremity reconstruction. The ALT fascia has robust perfusion that allows for the harvest of a large flap that can be surfaced with a split thickness skin graft. Its thin pliable tissue provides excellent contour for the hand, distal leg, and foot that does not require future thinning, optimizing the cosmetic and functional result.
Diagnostic approach to penetrating neck trauma: What you need to know
Authors: Siletz Anaar , Inaba Kenji
Published: March 2024

Diagnostic evaluation of penetrating neck trauma has evolved considerably over the last several decades. The contemporary approach to these injuries is based primarily on clinical signs of injury and multidetector computed tomographic angiography. The neck is evaluated as a unit, rather than relying on the surface anatomy zones in which external injuries are seen to guide the workup of internal injuries. This “no-zone” approach safely spares many patients from negative explorations and unnecessary invasive tests. The purpose of this review is to describe an evidence-based approach to the diagnostic evaluation of penetrating neck trauma, including indications for adjunctive testing beyond physical examination and multidetector computed tomographic angiography.

LEVEL OF EVIDENCE

Literature Synthesis and Expert Opinion; Level V.
American Association for the Surgery of Trauma/American College of Surgeons Committee on trauma clinical protocol for post-discharge venous thromboembolism prophylaxis after trauma
Authors: Berndtson Allison E. , Cross Alisa , Yorkgitis Brian K. , Kennedy Ryan , Kochuba Matthew P. , Tignanelli Christopher , Tominaga Gail T. , Jacobs David G. , Ashley Dennis W. , Ley Eric J. , Napolitano Lena , Costantini Todd W.
Published: March 2024

Trauma patients are at an elevated risk for developing venous thromboembolism (VTE), which includes pulmonary embolism and deep vein thrombosis. In the inpatient setting, prompt pharmacologic prophylaxis is utilized to prevent VTE. For patients with lower extremity fractures or limited mobility, VTE risk does not return to baseline levels post-discharge. Currently, there are limited data to guide post-discharge VTE prophylaxis in trauma patients. The goal of these post-discharge VTE prophylaxis guidelines are to identify patients at the highest risk of developing VTE after discharge and to offer pharmacologic prophylaxis strategies to limit this risk.
Prehospital tranexamic acid is associated with a survival benefit without an increase in complications: Results of two harmonized randomized clinical trials
Authors: Mazzei Michael , Donohue Jack K. , Schreiber Martin , Rowell Susan , Guyette Francis X. , Cotton Bryan , Eastridge Brian J. , Nirula Raminder , Vercruysse Gary A. , O'Keeffe Terence , Joseph Bellal , Brown Joshua B. , Neal Matthew D. , Sperry Jason L.
Published: March 2024

INTRODUCTION

Recent randomized clinical trials have demonstrated that prehospital tranexamic acid (TXA) administration following injury is safe and improves survival. However, the effect of prehospital TXA on adverse events, transfusion requirements, and any dose-response relationships require further elucidation.

METHODS

A secondary analysis was performed using harmonized data from two large, double-blinded, randomized prehospital TXA trials. Outcomes, including 28-day mortality, pertinent adverse events, and 24-hour red cell transfusion requirements, were compared between TXA and placebo groups. Regression analyses were used to determine the independent associations of TXA after adjusting for study enrollment, injury characteristics, and shock severity across a broad spectrum of injured patients. Dose-response relationships were similarly characterized based upon grams of prehospital TXA administered.

RESULTS

A total of 1,744 patients had data available for secondary analysis and were included in the current harmonized secondary analysis. The study cohort had an overall mortality of 11.2% and a median Injury Severity Score of 16 (interquartile range, 5–26). Tranexamic acid was independently associated with a lower risk of 28-day mortality (hazard ratio, 0.72; 95% confidence interval [CI], 0.54–0.96; p = 0.03). Prehospital TXA also demonstrated an independent 22% lower risk of mortality for every gram of prehospital TXA administered (hazard ratio, 0.78; 95% CI, 0.63–0.96; p = 0.02). Multivariable linear regression verified that patients who received TXA were independently associated with lower 24-hour red cell transfusion requirements (β
= −0.31; 95% CI, −0.61 to −0.01; p = 0.04) with a dose-response relationship (β
= −0.24; 95% CI, −0.45 to −0.02; p = 0.03). There was no independent association of prehospital TXA administration on thromboembolism, seizure, or stroke.

CONCLUSION

In this secondary analysis of harmonized data from two large randomized interventional trials, prehospital TXA administration across a broad spectrum of injured patients is safe. Prehospital TXA is associated with a significant 28-day survival benefit and lower red cell transfusion requirements at 24 hours and demonstrates a dose-response relationship.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level III.
Identifying factors predicting outcomes after major trauma in older patients: Prognostic systematic review and meta-analysis
Authors: Iddagoda Mayura Thilanka , Trevenen Michelle , Meaton Claire , Etherton-Beer Christopher , Flicker Leon
Published: March 2024

INTRODUCTION

Trauma is the most common cause of morbidity and mortality in older people, and it is important to determine the predictors of outcomes after major trauma in older people.

METHODS

MEDLINE, Embase, and Web of Science were searched, and manual search of relevant papers since 1987 to February 2023 was performed. Random-effects meta-analyses were performed. The primary outcome of interest was mortality, and secondary outcomes were medical complications, length of stay, discharge destination, readmission, and intensive care requirement.

RESULTS

Among 6,064 studies in the search strategy, 136 studies qualified the inclusion criteria. Forty-three factors, ranging from demographics to patient factors, admission measurements, and injury factors, were identified as potential predictors. Mortality was the commonest outcome investigated, and increasing age was associated with increased risk of in-hospital mortality (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.03–1.07) along with male sex (OR, 1.40; 95% CI, 1.24–1.59). Comorbidities of heart disease (OR, 2.59; 95% CI, 1.41–4.77), renal disease (OR, 2.52; 95% CI, 1.79–3.56), respiratory disease (OR, 1.40; 95% CI, 1.09–1.81), diabetes (OR, 1.35; 95% CI, 1.03–1.77), and neurological disease (OR, 1.42; 95% CI, 0.93–2.18) were also associated with increased in-hospital mortality risk. Each point increase in the Glasgow Coma Scale lowered the risk of in-hospital mortality (OR, 0.85; 95% CI, 0.76–0.95), while each point increase in Injury Severity Score increased the risk of in-hospital mortality (OR, 1.07; 95% CI, 1.04–1.09). There were limited studies and substantial variability in secondary outcome predictors; however, medical comorbidities, frailty, and premorbid living condition appeared predictive for those outcomes.

CONCLUSION

This review was able to identify potential predictors for older trauma patients. The identification of these factors allows for future development of risk stratification tools for clinicians.

LEVEL OF EVIDENCE

Systematic Review and Meta-Analysis; Level III.
Microbacterium abyssi sp. nov. and Microbacterium limosum sp. nov., two new species of the genus Microbacterium, isolated from deep-sea sediment samples
Authors: Ding Yihan , Ding Xiaorui , Chen Yiting , Wei Shiping , Zhang Gaiyun
Published: March 2024

Two Gram-positive, non-motile, short rod-shaped actinomycete strains, designated as A18JL241T and Y20T, were isolated from deep-sea sediment samples collected from the Southwest Indian Ocean and Western Pacific Ocean, respectively. Both of the isolates were able to grow within the temperature range of 5–40 °C, NaCl concentration range of 0–7  % (w/v) and at pH 6.0–12.0. The two most abundant cellular fatty acids of both strains were anteiso-C15  :  0 and anteiso-C17  :  0. The major polar lipid contents of the two strains were phosphatidylglycerol, diphosphatidylglycerol, phosphatidylethanolamine and one unidentified glycolipid. These two strains shared common chemotaxonomic features comprising MK-10 and MK-12 as the respiratory quinones. The genomic DNA G+C contents of the two strains were 68.1 and 70.4  mol%, respectively. The 16S rRNA gene phylogeny showed that the novel strains formed two distinct sublines within the genus Microbacterium. Strain A18JL241T was most closely related to the type strain of Microbacterium tenebrionis KCTC 49593T (98.8 % sequence similarity), whereas strain Y20T formed a tight cluster with the type strain of Microbacterium schleiferi NBRC 15075T (99.0 %). The orthologous average nucleotide identity (ANI) and digital DNA–DNA hybridization (dDDH) values with the type strains of related Microbacterium species were in the range of 74.1–89.1  % and 19.4–36.9  %, respectively, which were below the recognized thresholds of 95–96 % ANI and 70 % dDDH for species definition. Based on the results obtained here, it can be concluded that strains A18JL241T and Y20T represent two novel species of the genus Microbacterium, for which the names Microbacterium abyssi sp. nov. (type strain A18JL241T=JCM 33956T=MCCC 1A16622T) and Microbacterium limosum sp. nov. (type strain Y20T=JCM 33960T=MCCC 1A16747T) are proposed.
Evaluating Accuracy and Reproducibility of Large Language Model Performance in Pharmacy Education
Authors: Most Amoreena , Hu Mengxuan , Yang Huibo , Liu Tianming , Chen Xianyan , Li Sheng , Xu Steven , Liu Zhengliang , Sikora Andrea
Published: March 2024

The purpose of this study was to compare performance of ChatGPT (GPT-3.5), ChatGPT (GPT-4), Claude2, Llama2-7b, and Llama2-13b on 219 multiple-choice questions focusing on critical care pharmacotherapy. To further assess the ability of engineering LLMs to improve reasoning abilities and performance, we examined responses with a zero-shot Chain-of-Thought (CoT) approach, CoT prompting, and a custom built GPT (PharmacyGPT). A 219 multiple-choice questions focused on critical care pharmacotherapy topics used in Doctor of Pharmacy curricula from two accredited colleges of pharmacy was compiled for this study. A total of five LLMs were evaluated: ChatGPT (GPT-3.5), ChatGPT (GPT-4), Claude2, Llama2-7b, and Llama2-13b. The primary outcome was response accuracy. Of the five LLMs tested, GPT-4 showed the highest average accuracy rate at 71.6%. A larger variance indicates lower consistency and reduced confidence in its answers. Llama2-13b had the lowest variance (0.070) of all the LLMs, but performed with an accuracy of 41.5%. Following analaysis of overall accuracy, performance on knowledge- vs. skill-based questions were assessed. All five LLMs demonstrated higher accuracy on knowledge-based questions compared to skill-based questions. GPT-4 had the highest accuracy for knowledge- and skill-based questions, with an accuracy of 87% and 67%, respectively. Response accuracy from LLMs in the domain of clinical pharmacy can be improved by using prompt engineering techniques.
Automated Detection of Sleep Apnea Using Machine Learning: A Novel Approach Using Smartphone and Microphone for Breathing Sound Analysis
Authors: Bhatt Om
Published: March 2024

In this study, we evaluate the accuracy of a novel setup in the detection of apneas and hypopneas and estimating the apnea-hypopnea index (AHI). The study device setup consists of a microphone placed underneath the nose and a smartphone to collect the data. We recruited patients who were referred to the St. Josephs Hamilton Sleep Clinic for a sleep study. Data from our study device is collected simultaneously with polysomnography (PSG) in the sleep lab. A total of 26 patients were recruited, of which 2 dropped out during the data collection. Data from the microphone was too noisy for interpretation in 3 patients. Across the remaining 21 patients, the AHI based on their PSG ranged from 2 to 125 events/h, with an average AHI of 34 events/h. We used regression models trained on microphone audio data to identify noise and we developed an algorithm based on root-mean-square of the audio data for automatic detection of apneas and hypopneas. With reference to the PSG, our study device had a sensitivity of 94% and specificity of 87% in detecting apneas/hypopneas across a cumulative 120.9 hours of sleep data and more than 3700 such events. Our study device was able to accurately predict the AHI to within 4.3 events/h (+/-3.1). As such, we can conclude that our study device is accurate in identifying apneas/hypopneas, estimating the AHI and at ruling out cases of severe sleep apnea and can potentially be used as a screening test for this purpose. Our study device has the practical advantages of being very low cost and potentially more accessible as a screening tool, though further validation studies are needed to study accuracy across a larger population and for use at-home.