bluuebunny/crossref_metadata_2025 huggingface dataset:
Citizen Reactions to Bureaucratic Encounters: Different Ways of Coping With Public Authorities
Authors: Nielsen Vibeke Lehmann , Nielsen Helle Ørsted , Bisgaard Mette
Published: October 2020

Common to most studies on street-level bureaucrats is a fundamental acknowledgment that behaviors of citizens with whom the street-level bureaucrats interact play an important role for their decision-making. However, within literature, there is a lack of generic and systematic attention to the agency of the citizens. This article aims to respond to this criticism and answer the questions: How do citizens cope with public encounters? Do citizen behaviors towards public authorities divide into distinct, meaningful, multidimensional behavior types? Through an explorative theory-based approach, the article opens those questions. Based on self-reported survey-data on behavior, from a representative sample of Danish citizens, we use latent class analysis (LCA) to identify systematic patterns in citizens’ behavior towards public authorities (exemplified by Tax and Home Care Referral authorities). We identify five types of citizen coping behavior in public encounters: “Resisters,” “Activists,” “Accommodators,” “Flighters,” and “Cooperators.” The five types of coping behaviors can be placed in a three-dimensional space measuring degree of activity, degree of preparation, and degree of opposition. We suggest that this insight and conceptual framework of citizen coping behavior can create a starting point for researchers to embark a research agenda on citizens’ coping behavior in citizen-state encounters.
Variations of electric potential in the xylem of tree trunks associated with water content rhythms
Authors: Hao Zhibin , Li Wenbin , Hao Xiaomie
Published: October 2020

Instantaneous electrical responses in plants have been widely studied, but the mechanism of spontaneous, periodic electric potential alternations in the xylem of tree trunks remains controversial. The generation of the electric potential can be explained by the electrode potential, which depends on ion concentrations near electrodes. However, several different hypotheses about its periodic variations have been proposed, including streaming potential, ion diffusion, charge transport, and oxygen turnover. Here, we performed long-term measurements on the electric potential and water content in the xylem of trees, and observed changes in the electric potential and transpiration rate in response to varied numbers of leaves, light radiation, temperature, and relative air humidity. The electric potential showed a distinct seasonal trend, combined with daily rhythms, and could be affected by environmental changes. Rapid changes in the electric potential routinely lagged behind those of the transpiration rate, but their ranges of change were proportional. Both annual and diurnal patterns of the electric potential were synchronous with the trees’ water content. Moreover, we found potential function relationships between the electric potential and water content. Accordingly, we propose a new perspective, that the variations of the electric potential in tree xylem could be associated with water content rhythms.
Extrapolating the weight of a homogeneous retail drug seizure using packing weight
Authors: Kadane Joseph B , Wilkinson Emily , Yohannan Joshua C
Published: October 2020

We propose a method that yields a probability distribution for the net weight of drug powder resulting from a seizure of stamp bags. The technique involves the posterior predictive distribution of a beta distribution under a conjugate prior. The convolution of two distributions is computed for two visually distinct groups of stamp bags from the same seizure.
Exploring the robustness of Keplerian signals to the removal of active and telluric features
Authors: Lisogorskyi M , Jones H R A , Feng F , Butler R P , Vogt S
Published: October 2020

We examine the influence of activity- and telluric-induced radial velocity (RV) signals on high-resolution spectra taken with an iodine absorption cell. We exclude 2-$\mathring{\rm A}$ spectral chunks containing active and telluric lines based on the well-characterized K1V star α Centauri B and illustrate the method on Epsilon Eridani – an active K2V star with a long-period, low-amplitude planetary signal. After removal of the activity- and telluric-sensitive parts of the spectrum from the RV calculation, the significance of the planetary signal is increased and the stellar rotation signal disappears. In order to assess the robustness of the procedure, we perform Monte Carlo simulations based on removing random chunks of the spectrum. Simulations confirm that the removal of lines impacted by activity and tellurics provides a method for checking the robustness of a given Keplerian signal. We also test the approach on HD 40979, which is an active F8V star with a large-amplitude planetary signal. Our Monte Carlo simulations reveal that the significance of the Keplerian signal in the F star is much more sensitive to wavelength. Unlike the K star, the removal of active lines from the F star greatly reduces the RV precision. In this case, our removal of a K star active line from an F star does not a provide a simple useful diagnostic because it has far less RV information and heavily relies on the strong active lines.
Robust asteroseismic properties of the bright planet host HD 38529
Authors: Ball Warrick H , Chaplin William J , Nielsen Martin B , González-Cuesta Lucia , Mathur Savita , Santos Ângela R G , García Rafael , Buzasi Derek , Mosser Benoît , Deal Morgan , Stokholm Amalie , Mosumgaard Jakob Rørsted , Silva Aguirre Victor , Nsamba Benard , Campante Tiago , Cunha Margarida S , Ong Joel , Basu Sarbani , Örtel Sibel , Çelik Orhan Z , Yıldız Mutlu , Stassun Keivan , Kane Stephen R , Huber Daniel
Published: October 2020

The Transiting Exoplanet Survey Satellite (TESS) is recording short-cadence, high duty-cycle timeseries across most of the sky, which presents the opportunity to detect and study oscillations in interesting stars, in particular planet hosts. We have detected and analysed solar-like oscillations in the bright G4 subgiant HD 38529, which hosts an inner, roughly Jupiter-mass planet on a $14.3\, \mathrm{d}$ orbit and an outer, low-mass brown dwarf on a $2136\, \mathrm{d}$ orbit. We combine results from multiple stellar modelling teams to produce robust asteroseismic estimates of the star’s properties, including its mass $M=1.48\pm 0.04\, \mathrm{M}_\odot {}$, radius $R=2.68\pm 0.03\, \mathrm{R}_\odot {}$, and age $t=3.07\pm 0.39\, \mathrm{Gyr}{}$. Our results confirm that HD 38529 has a mass near the higher end of the range that can be found in the literature and also demonstrate that precise stellar properties can be measured given shorter timeseries than produced by CoRoT, Kepler, or K2.
Reducing the variance of redshift space distortion measurements from mock galaxy catalogues with different lines of sight
Authors: Smith Alex , de Mattia Arnaud , Burtin Etienne , Chuang Chia-Hsun , Zhao Cheng
Published: October 2020

Accurate mock catalogues are essential for assessing systematics in the cosmological analysis of large galaxy surveys. Anisotropic two-point clustering measurements from the same simulation show some scatter for different lines of sight (LOS), but are on average equal, due to cosmic variance. This results in scatter in the measured cosmological parameters. We use the OuterRim N-body simulation halo catalogue to investigate this, considering the three simulation axes as LOS. The quadrupole of the two-point statistics is particularly sensitive to changes in the LOS, with subper cent level differences in the velocity distributions resulting in ∼1.5 σ shifts on large scales. Averaging over multiple LOS can reduce the impact of cosmic variance. We derive an expression for the Gaussian cross-correlation between the power spectrum multipole measurements, for any two LOS, including shot noise, and the corresponding reduction in variance in the average measurement. Quadrupole measurements are anticorrelated, and for three orthogonal LOS, the variance on the average measurement is reduced by more than 1/3. We perform a Fisher analysis to predict the corresponding gain in precision on the cosmological parameter measurements, which we compare against a set of 300 extended Baryon Oscillation Spectroscopic Survey emission-line galaxy EZmocks. The gain in fσ8, which measures the growth of structure, is also better than 1/3. Averaging over multiple LOS in future mock challenges will allow the redshift space distortion models to be constrained with the same systematic error, with less than three times the CPU time.
The S2 Stream: the shreds of a primitive dwarf galaxy.*
Authors: Aguado David S , Myeong G C , Belokurov Vasily , Evans N Wyn , Koposov Sergey E , Prieto Carlos Allende , Lanfranchi Gustavo A , Matteucci Francesca , Shetrone Matthew , Sbordone Luca , Navarrete Camila , Hernández Jonay I González , Chanamé Julio , de Arriba Luis Peralta , Yuan Zhen
Published: October 2020

The S2 stream is a kinematically cold stream that is plunging downwards through the Galactic disc. It may be part of a hotter and more diffuse structure called the Helmi stream. We present a multi-instrument chemical analysis of the stars in the metal-poor S2 stream using both high- and low-resolution spectroscopy, complemented with a re-analysis of the archival data to give a total sample of 62 S2 members. Our high-resolution program provides α-elements (C, Mg, Si, Ca and Ti), iron-peak elements (V, Cr, Mn, Fe, Ni), n-capture process elements (Sr, Ba) and other elements such as Li, Na, Al, and Sc for a subsample of S2 objects. We report coherent abundance patterns over a large metallicity spread (∼1 dex) confirming that the S2 stream was produced by a disrupted dwarf galaxy. The combination of S2’s α-elements displays a mildly decreasing trend with increasing metallicity which can be tentatively interpreted as a “knee” at [Fe/H]<−2. At the low metallicity end, the n-capture elements in S2 may be dominated by r-process production however several stars are Ba-enhanced, but unusually poor in Sr. Moreover, some of the low-[Fe/H] stars appear to be carbon-enhanced. We interpret the observed abundance patterns with the help of chemical evolution models that demonstrate the need for modest star-formation efficiency and low wind efficiency confirming that the progenitor of S2 was a primitive dwarf galaxy.
A combination of growth factors and cytokines alter preimplantation mouse embryo development, foetal development and gene expression profiles
Authors: Gurner Kathryn H , Truong Thi T , Harvey Alexandra J , Gardner David K
Published: October 2020

Within the maternal tract, the preimplantation embryo is exposed to an array of growth factors (GFs) and cytokines, most of which are absent from culture media used in clinical IVF. Whilst the addition of individual GFs and cytokines to embryo culture media can improve preimplantation mouse embryo development, there is a lack of evidence on the combined synergistic effects of GFs and cytokines on embryo development and further foetal growth. Therefore, in this study, the effect of a combined group of GFs and cytokines on mouse preimplantation embryo development and subsequent foetal development and gene expression profiles was investigated. Supplementation of embryo culture media with an optimised combination of GFs and cytokines (0.05 ng/ml vascular endothelial GF, 1 ng/ml platelet-derived GF, 0.13 ng/ml insulin-like GF 1, 0.026 ng/ml insulin-like GF 2 and 1 ng/ml granulocyte colony-stimulating factor) had no effect on embryo morphokinetics but significantly increased trophectoderm cell number (P = 0.0002) and total cell number (P = 0.024). Treatment with this combination of GFs and cytokines also significantly increased blastocyst outgrowth area (P < 0.05) and, following embryo transfer, increased foetal weight (P = 0.027), crown-rump length (P = 0.017) and overall morphological development (P = 0.027). RNA-seq analysis of in vitro derived foetuses identified concurrent alterations to the transcriptional profiles of liver and placental tissues compared with those developed in vivo, with greater changes observed in the GF and cytokine treated group. Together these data highlight the importance of balancing the actions of such factors for the regulation of normal development and emphasise the need for further studies investigating this prior to clinical implementation.
HMPDACC: a Human Microbiome Project Multi-omic data resource
Authors: Creasy Heather Huot , Felix Victor , Aluvathingal Jain , Crabtree Jonathan , Ifeonu Olukemi , Matsumura James , McCracken Carrie , Nickel Lance , Orvis Joshua , Schor Mike , Giglio Michelle , Mahurkar Anup , White Owen
Published: October 2020

The Human Microbiome Project (HMP) explored microbial communities of the human body in both healthy and disease states. Two phases of the HMP (HMP and iHMP) together generated >48TB of data (public and controlled access) from multiple, varied omics studies of both the microbiome and associated hosts. The Human Microbiome Project Data Coordination Center (HMPDACC) was established to provide a portal to access data and resources produced by the HMP. The HMPDACC provides a unified data repository, multi-faceted search functionality, analysis pipelines and standardized protocols to facilitate community use of HMP data. Recent efforts have been put toward making HMP data more findable, accessible, interoperable and reusable. HMPDACC resources are freely available at www.hmpdacc.org.
PpCas9 from Pasteurella pneumotropica — a compact Type II-C Cas9 ortholog active in human cells
Authors: Fedorova Iana , Vasileva Aleksandra , Selkova Polina , Abramova Marina , Arseniev Anatolii , Pobegalov Georgii , Kazalov Maksim , Musharova Olga , Goryanin Ignatiy , Artamonova Daria , Zyubko Tatyana , Shmakov Sergey , Artamonova Tatyana , Khodorkovskii Mikhail , Severinov Konstantin
Published: October 2020

CRISPR-Cas defense systems opened up the field of genome editing due to the ease with which effector Cas nucleases can be programmed with guide RNAs to access desirable genomic sites. Type II-A SpCas9 from Streptococcus pyogenes was the first Cas9 nuclease used for genome editing and it remains the most popular enzyme of its class. Nevertheless, SpCas9 has some drawbacks including a relatively large size and restriction to targets flanked by an ‘NGG’ PAM sequence. The more compact Type II-C Cas9 orthologs can help to overcome the size limitation of SpCas9. Yet, only a few Type II-C nucleases were fully characterized to date. Here, we characterized two Cas9 II-C orthologs, DfCas9 from Defluviimonas sp.20V17 and PpCas9 from Pasteurella pneumotropica. Both DfCas9 and PpCas9 cleave DNA in vitro and have novel PAM requirements. Unlike DfCas9, the PpCas9 nuclease is active in human cells. This small nuclease requires an ‘NNNNRTT’ PAM orthogonal to that of SpCas9 and thus potentially can broaden the range of Cas9 applications in biomedicine and biotechnology.
The central sphere of an ALE space
Authors: Hitchin Nigel
Published: October 2020

We consider the induced metric on the spherical fixed point set of a circle action on an ALE space and describe it by using the algebraic geometry of rational curves on algebraic surfaces, in particular the lines on a cubic.
Venous thromboembolism in anti-neutrophil cytoplasmic antibody-associated vasculitis: an underlying prothrombotic condition?
Authors: Antovic Aleksandra , Svensson Einar , Lövström Björn , Illescas Vera Bäckström , Nordin Annica , Börjesson Ola , Arnaud Laurent , Bruchfeld Annette , Gunnarsson Iva
Published: October 2020

Objectives

We investigated the incidence and potential underlying risk factors of venous thromboembolism (VTE) in patients with AAV. We assessed haemostatic disturbances and factors that might contribute to the risk of development of VTE.

Methods

ANCA-positive AAV patients (n = 187) were included. Previously identified risk factors for VTE and current medication were retrieved from the medical records. We assessed haemostasis using different methods [endogenous thrombin potential (ETP), overall haemostatic potential (OHP), overall coagulation potential (OCP) and overall fibrinolysis potential (OFP)] in patients with active AAV (n = 19), inactive AAV (n = 15) and healthy controls (n = 15).

Results

Twenty-eight VTEs occurred in 24 patients over a total follow-up time of 1020 person-years. A majority of VTEs occurred within the first year after diagnosis. Old age (P < 0.01), ongoing prednisolone treatment and recent rituximab administration were more common in the VTE group (P < 0.05 for all). ETP and OHP were significantly increased and OFP significantly decreased in plasma from active compared with inactive AAV patients (P < 0.05, P < 0.01 and P < 0.05, respectively) and healthy controls (P < 0.001). We could not confirm previously reported risk factors for VTE development.

Conclusion

A high prevalence of VTE in AAV patients was seen within the first year after diagnosis, suggesting that disease activity contributes to development of VTE. Old age and concurrent treatment should also be taken into account when estimating VTE risk. The results also indicate disturbances in the haemostatic balance towards pro-thrombotic conditions in AAV patients, where ETP and OHP might be useful markers for identifying patients at high risk.
Homer and the Discovery of the Pacific: Gunn, Keats, Pope
Authors: Power Henry
Published: October 2020

Thom Gunn’s ‘The Discovery of the Pacific’ (1970) describes a young couple who have driven across America and reached the Californian coast. Their exhilaration as they stare at the ocean recalls another moment of epiphany; when John Keats read George Chapman’s translation of Homer, he felt like a conquistador setting eyes on the Pacific for the first time. In this essay, I argue that Gunn’s poem engages closely with Keats’s ‘On First Looking into Chapman’s Homer’, and that Keats’s sonnet in turn draws on ancient ideas of Homer as being like the ocean. These are ideas Keats seems to have drawn from Alexander Pope’s translation of (and commentary on) the Homeric poems. Pope, Keats, and Gunn all regard the Homer poems as being in some way oceanic—both because of their vastness and capaciousness, and because they have been previously discovered by so many earlier readers.
The Cutoff Structure of Top Trading Cycles in School Choice
Authors: Leshno Jacob D , Lo Irene
Published: October 2020

This article develops a tractable theoretical framework for the Top Trading Cycles (TTC) mechanism for school choice that allows quantifying welfare and optimizing policy decisions. We compute welfare for TTC and Deferred Acceptance (DA) under different priority structures and find that the choice of priorities can have larger welfare implications than the choice of mechanism. We solve for the welfare-maximizing distributions of school quality for parametrized economies and find that optimal investment decisions can be very different under TTC and DA. Our framework relies on a novel characterization of the TTC assignment in terms of a cutoff for each pair of schools. These cutoffs parallel prices in competitive equilibrium, with students’ priorities serving the role of endowments. We show that these cutoffs can be computed directly from the distribution of preferences and priorities in a continuum model and derive closed-form solutions and comparative statics for parameterized settings. The TTC cutoffs not only clarify the role of priorities in determining the TTC assignment but also demonstrate that TTC is more complicated than DA.
Corticosteroid Responsive Encephalopathy: Prolonged Coma in Patients Late in the Course of Dreadful Severe Acute Respiratory Syndrome Coronavirus 2 Infection
Authors: Montaut Victor , Madigan Simone , Pugin Deborah , Clerc Olivier , Haesler Laurence
Published: October 2020

Background:

Responsible for the coronavirus disease 2019 pandemic that began in December 2019, severe acute respiratory syndrome coronavirus 2 mainly causes respiratory insult. Few cases were reported of extrapulmonary involvement, many of which were neurologic.

Case Summary:

In this case report, we present two cases of prolonged coma after weaning off sedation in severe acute respiratory syndrome coronavirus 2 patients with rapid neurologic improvement shortly after high-dose corticosteroid regimen.

Conclusions:

We thus hypothesize an inflammatory process being responsible for the prolonged coma. Inflammatory neurologic insult has been described with other coronaviruses. Further studies are needed to determinate the extent and underlying mechanism of neurologic involvement in severe acute respiratory syndrome coronavirus 2 infections.
Cardiopulmonary Exercise Testing Using the Modified Balke Protocol in Fully Ambulatory People With Multiple Sclerosis
Authors: Feasel Corey D. , Sandroff Brian M. , Motl Robert W.
Published: October 2020

Purpose:

This study examined the application, outcomes, and validity of cardiopulmonary exercise test (CPET) outcomes using a modified Balke protocol on a motor-driven treadmill in fully ambulatory people with multiple sclerosis (MS).

Methods:

Fully ambulatory people with MS (N = 20) underwent assessments of disability (Expanded Disability Status Scale, EDSS), walking endurance (6-minute walk distance, 6MWD), and cognition (Symbol Digit Modalities Test, SDMT), and completed a maximal CPET (modified Balke protocol) on a motor-driven treadmill while expired gases were collected with indirect calorimetry. Serious adverse events (AEs) and AEs, defined by National Institutes of Health guidelines, and provision of a “maximal” effort test using standard criteria for a maximal effort were documented. The physiological outcomes derived from the CPET included oxygen uptake (V̇o
2), carbon dioxide production, ventilation (VE), respiratory exchange ratio, and heart rate (HR). Other outcomes were calculated using standard guidelines, including V̇o
2/HR slope and oxygen uptake efficiency slope (V̇o
2/log10VE). Descriptive statistics were summarized with mean ± SD and descriptively compared with normative data from apparently healthy individuals using a similar CPET protocol. Spearman's rho rank-order correlations (ρ) were performed among peak V̇o
2 and SDMT, 6MWD, and EDSS scores.

Results:

There were no AEs, and 17 of 20 tests were characterized as yielding a maximal effort and therefore interpretable. V̇o
2 peak derived from the modified Balke protocol was predictably different in MS (25.8 ± 6.3) than normative values for healthy samples men (43.4 ± 9.3) and women (35.0 ± 7.2). V̇o
2 peak positively correlated with SDMT (ρ = 0.53, P = .01) and 6MWD (ρ = 0.73, P = .0003), and negatively correlated with disability (ρ = −0.51, P = .02).

Conclusions:

Cardiopulmonary exercise test using a modified Balke protocol on a motorized treadmill is safe, feasible, and valid for the measurement of aerobic power in fully ambulatory people with MS.
Rehabilitation of Patients Presenting With Coronavirus Disease-19 and Hemiparesis: A Case Series
Authors: Jordan Jennifer L. , Rice Jeremy , Bassett Shane , Lazore Jessica , Weeks Douglas L.
Published: October 2020

Introduction:

The novel coronavirus disease-19 (COVID-19) has many unique features in its presentation. One increasingly noted symptom is the incidence of hypercoagulability which may lead to ischemic stroke. Physical therapists (PTs) are an integral component of the medical team and contribute to the early identification of stroke-like symptoms in patients with COVID-19.

Case Presentation:

This case series will describe the rehabilitation process of 3 patients who survived critical illness due to COVID-19 and had secondary complications including right hemiparesis while in critical care. Patients received rehabilitation by PTs and occupational therapists on average 6 times per week with interventions focused on recovery of strength, functional mobility, neurological re-education, and cognition. The mobility status was assessed with the Perme Intensive Care Unit Mobility Score.

Conclusion:

Patients who present with COVID-19 need careful screening for neurological impairment. Conventional means to diagnose stroke, such as radiological imaging, can be difficult to obtain in these unique circumstances because of infection control measures. Physical therapists can assist in early identification of neurological impairment in the absence of traditional diagnostic methods through identification of deficits in abilities such as mobility and balance.
Barriers and facilitators of laparoscopic surgical training in rural north-east India: a qualitative study
Authors: Wilkinson Ellen , Aruparayil Noel , Gnanaraj Jesudian , Mishra Anurag , Bains Lovenish , Bolton William , Brown Julia , Jayne David
Published: October 2020

Introduction:

Laparoscopic surgery has advantages for treating many abdominal surgical conditions, but its use in low and middle-income countries (LMICs) is limited by many factors, including a lack of training opportunities. The aim of this study was to explore the training experiences of surgeons in rural north-east India to highlight the barriers and facilitators to laparoscopic surgery.

Methods:

Eleven surgeons with experience in laparoscopy in rural north-east India were recruited using purposive and convenience sampling. Ethical approval was obtained from the Institutional Ethics Committee, Maulana Azad Medical College, New Delhi, India and the Leeds Institute of Health Sciences Research Ethics Sub-Committee, West Yorkshire, England. Consenting participants took part in semi-structured interviews, either between May 20 and 25, 2019 in rural north-east India or via Skype or at the University of Leeds in June 2019. Interviews were audio-recorded and transcribed and thematic content analysis performed.

Results:

Exposure to laparoscopy during postgraduate training was common, but training experiences were inconsistent and informal. Alternative training opportunities are limited by availability and cost. There is high demand for a structured curriculum, incorporating formal assessment and credentialing, to include observation and assistance in live surgery and laparoscopic simulation.

Conclusions:

Laparoscopic training experiences are highly variable, with limited training resources and lack of a curriculum. Poor accessibility is consistent with that recorded in literature. Current recommendations include government support and funding to guide development of a standardized curriculum and widen access to training programs for surgeons in rural settings.
Scheimpflug Densitometry in Keratoconus: A New Method of Visualizing the Cone
Authors: Jiménez-García Marta , Ní Dhubhghaill Sorcha , Consejo Alejandra , Hershko Sarah , Koppen Carina , Rozema Jos J.
Published: October 2020

Purpose:

To report an observation made while performing Scheimpflug densitometry analysis on the corneal region affected in keratoconus (KC) that seems to delineate the base of the cone.

Methods:

Scheimpflug densitometries of 20 healthy subjects and 90 patients with KC were examined. Corneal densitometry was analyzed using both “1-layer” and “2-layer” approaches. The first considers the corneal transparency layer by layer at different depths, whereas the second averages densitometry between 2 corneal layers selected by the examiner. Fixed layers, 120 μm depth, and endothelium were selected. Repeated same-day scans and longitudinal series of scans were also evaluated to see whether the findings evolved over time.

Results:

Eighty-eight of 90 KC cases displayed a bright area on the densitometry map that corresponded to the cone location. The area's characteristics, such as its brightness, contrast, and the presence of a delimiting arc correlated with KC severity and was more noticeable in advanced cases. No similar marks were found in any of the normal subjects. The shape, location, and extent of the mark were consistent over consecutive measures taken on the same day. Changes over time were also seen in eyes with known clinical progression but was also seen in eyes considered clinically stable.

Conclusions:

The densitometry mark seems to correspond with the zone most affected by KC and could be a supplementary tool for documenting KC stage, alongside conventional parameters. Further studies are required to ascertain whether it could prove useful in KC detection, to determine progression, and to relate it to corneal biomechanical behavior.
Long-term Follow-up of 14 Eyes With Bilateral and Multiple Ciliary Body Cysts: Prognosis of this Rare Entity
Authors: Hugo Juliette , Feumi Charles , Morin Adèle , Nguyen Michelle , Lachkar Yves
Published: October 2020

Purpose:

To describe the long-term outcomes of eyes with bilateral and multiple ciliary body cysts (CBC).

Methods:

This retrospective study included patients with multiple and bilateral CBC diagnosed by high-resolution ultrasound biomicroscopy and followed by a single glaucoma specialist from 2000 to 2020. All patients underwent complete ophthalmic examination including dynamic indentation gonioscopy, retinal nerve fiber layer (RNFL) measurement by optic coherence tomography and automated perimetry.

Results:

Seven patients (14 eyes) with bilateral and multiple CBC were included with a mean follow-up of 98±39 months. Four eyes of 2 patients had complete angle closure at first examination and 3 of them underwent trabeculectomy with good visual outcomes. Four eyes of 2 patients had a reversible angle-closure at first examination and underwent a ultrasound biomicroscopy–guided laser peripheral iridotomy (LPI) which reopened the irido-corneal angles. Two of these eyes needed intensification of hypotensive drops during the follow-up. Among the 6 eyes (3 patients) with open angle at first examination, all had had LPI at last follow-up visit, 5 had normal RNFL and visual field and 1 received an additional hypotensive drop because of RNFL progression.

Conclusion:

Our long-term cohort of bilateral and multiple CBC demonstrates that this rare entity may have a good prognosis if LPI is performed before extension of peripheral anterior synechiae. Irreversible angle closure required trabeculectomy in 75% of cases in our cohort with however good visual outcomes.
Sensitivity to Central Crowding for Faces in Patients With Glaucoma
Authors: Stievenard Aymeric , Rouland Jean F. , Peyrin Carole , Warniez Aude , Boucart Muriel
Published: October 2020

Precis:

Some patients with glaucoma report difficulties to recognize faces when they are far away. We show that this deficit could result from a higher sensitivity to crowding in central vision.

Purpose:

The aim of the study is to investigate whether face recognition difficulties reported by some patients with glaucoma result from a greater sensitivity to inner crowding in central vision.

Methods:

Seventeen patients with glaucoma and 17 age-matched normally sighted controls participated in the study. An isolated mouth (uncrowded condition) or a mouth within a face (crowded condition) was randomly displayed centrally for 200 ms. For each condition, participants were asked to decide whether the mouth was closed or open. The stimuli were presented at 3 angular sizes (0.6×0.4, 1×0.72, and 1.5×1.08 degrees). Accuracy was measured.

Results:

Crowding affected performance differentially for patients and controls. Consistent with previous studies controls exhibited a “face superiority effect,” with a better accuracy when the mouth was located within the face than when it was isolated. Sensitivity to crowding, reflected in a better accuracy with the isolated mouth, was observed in 10 of 17 patients only for small images. Crowding disappeared for larger faces, as the facial features were spaced out. Five patients were not sensitive to crowding. Importantly, no difference was found between the 2 subgroups of patients (sensitive vs. nonsensitive) in terms of mean deviation, contrast sensitivity, acuity, thickness of the retinal nerve fiber layer, or macular ganglion cell-inner plexiform layer.

Conclusions:

An excessive sensitivity to central crowding might explain the difficulties in face perception and reading reported by some patients with glaucoma. The sensory or cognitive processes underlying this excessive sensitivity must be elucidated to improve central perception in glaucoma.
Assessment of Ocular Surface Disease in Glaucoma Patients in Ghana
Authors: Kobia-Acquah Emmanuel , Gyekye Gloria Atta-Penkra , Antwi-Adjei Ellen K. , Koomson Nana Y. , Cobbina Francis , Donkor Richard , Akowuah Prince K.
Published: October 2020

Precis:

Dry eye disease (DED) observed in this study is associated with ocular surface abnormalities as shown by specific dry eye tests. Changes in tear quality may be responsible for dry eye symptoms among the participants.

Purpose:

This study sought to evaluate DED in glaucoma patients in Ghana.

Materials and Methods:

This was a hospital-based descriptive cross-sectional study involving glaucoma patients on topical glaucoma treatment for at least 6 months. The medical records of participants were thoroughly reviewed for information on demographics, ocular history, medical history, number of topical antiglaucoma medications used within the last 6 months, and any other ophthalmic medications used by the participants. An Ocular Surface Disease Index (OSDI) questionnaire was administered to each participant, after which Schirmer test and tear break-up time (TBUT) were performed on each participant in a controlled environment.

Results:

A total of 100 individuals participated in the study. The mean±SD age of participants was 60.44±14.05 years. The majority (60.0%) of the participants were females and 55.0% of participants used 2 or more topical antiglaucoma medication. Of the participants, 81.0% reported subjective dry eye symptoms. Schirmer test and TBUT showed that 55.0% and 87.0% of the participants had decreased tear production and abnormal tear quality, respectively. Multiple logistic regression showed a significant association between age and abnormal OSDI (P=0.037), Schirmer test (P=0.003), and TBUT (P=0.042); the number of topical glaucoma medications and OSDI (P=0.016) and Schirmer test (P=0.009). The prevalence of DED was 23.0%. Increasing age was associated with an ∼7 times higher odds of having DED (P=0.0019), using >2 glaucoma medications with ∼4.5 times higher odds of having DED (P=0.001), 5 or more years of glaucoma medication use with ∼4 times higher odds of DED (P=0.009), and both benzalkonium chloride and sodium chlorite as preservative was associated with ∼3.5 times higher odds of DED (P=0.047).

Conclusion:

DED is prevalent among glaucoma patients in Ghana and is associated with age, duration of glaucoma medication, type of preservatives, and number of topical glaucoma medications.
Hemorrhagic Descemet’s Membrane Detachment in Nonpenetrating Glaucoma Surgery
Authors: Djavanmardi Shirin , Arciniegas-Perasso Carlos A. , Duch Susana , Avila-Marrón Elena , Milla Elena
Published: October 2020

Purpose:

To describe 5 representative cases of hemorrhagic Descemet’s membrane (DM) detachment in glaucoma surgery that had different origins, mechanisms and treatments.

Methods:

Clinical records of patients that had undergone a nonpenetrating glaucoma surgery, with a diagnosis of hemorrhagic DM detachment were reviewed for demographic data, clinical findings and treatment applied.

Results:

Five patients with hemorrhagic DM detachment were included in this case series. They all had different causes, namely a massive hemorrhage at the end of a canaloplasty procedure, a needling maneuver, autologous blood injection, Swan syndrome, and frequent eye rubbing. Hematoma evacuation was performed in 4 eyes, 1 of them from under the scleral flap of the deep sclerectomy and 3 of them through a surgical or laser perforation in DM. Air tamponade was done in most of these cases. One of these cases required transcorneal suture fixation. One case was observed expectantly. All cases successfully recovered but peripheral corneal stain was persistent in 2 cases.

Conclusion:

Hemorrhagic DM detachment is a rare but potential vision-threatening complication in glaucoma surgery. Different mechanisms may cause the bleeding and there are several techniques available to approach this complication. Pre-Descemet hematoma should be drained to avoid permanent corneal stain and air/gas tamponade may help to prevent recurrences.
Exposure to Air Pollution and Risk of Hip Fracture
Authors: Oh Tak Kyu , Song In-Ae
Published: October 2020

Objectives:

We aimed to investigate whether exposure to air pollutants was associated with the risk of hip fracture.

Methods:

We extracted data on a 2010 cohort of the adult population (more than or equal to 30 years old) from a South Korean database.

Results:

A total of 178,147 individuals were included in the analysis, and hip fracture had occurred in 919 individuals (0.5%). In a multivariable logistic regression model, a 1 mcg/m3 increase in concentrations of particulate matter measuring of less than or equal to 10 μm was associated with 2% increase in hip fracture risk (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.01 to 1.03; P = 0.039); there were no significant associations between hip fracture risk and exposure to SO2 (P = 0.076), ozone (P = 0.220), carbon monoxide (P = 0.698), or sulfur dioxide (P = 0.114).

Conclusions:

Particular matter air concentration may be a modifiable risk factor for hip fracture.
The Effects of an Infant Calming Intervention on Mothers' Parenting Self-Efficacy and Satisfaction During the Postpartum Period
Authors: Botha Elina , Helminen Mika , Kaunonen Marja , Lubbe Welma , Joronen Katja
Published: October 2020

The aim of this study was to evaluate the effects of a behavioral infant calming technique to support mothers' parenting self-efficacy and parenting satisfaction. The methods of this randomized controlled trial are based on the CONSORT guidelines. Data were collected during March 1 to May 20, 2019, from 3 postpartum units in 1 university-level hospital in Finland. A total of 250 mothers agreed to participate, of which 120 were randomly allocated to the intervention group and 130 to the control group. All mothers completed a baseline questionnaire before randomization. Mothers in the intervention group were taught the 5 S's infant calming technique. The control group received standard care. Follow-up data were collected 6 to 8 weeks postpartum. The primary outcome measure was the change in parenting self-efficacy and parenting satisfaction scores over the follow-up period. The intervention group showed significantly larger improvements in parenting self-efficacy scores. There were no statistically significant differences in median improvements in parenting satisfaction. The 5 S's infant calming technique is feasible. These study findings may assist midwifery and neonatal nursing staff to support mothers and families during the postpartum period, whether the infants are fussy or not.
Creating a “Culture of Triage”: A Dual-Perspective Study of Interruptions During ICU Rounds
Authors: Rosenblatt Samuel A. , Balmer Dorene F. , Boyer Donald L.
Published: October 2020

Objectives:

To explore interrupters’ and interruptees’ experiences of interruptions occurring during morning rounds in a PICU in an attempt to understand better how to limit interruptions that threaten patient safety.

Design:

Qualitative ethnographic study including observations, field interviews, and in-depth interviews.

Setting:

A 55-bed PICU in a free-standing, quaternary-care children’s hospital.

Subjects (Participants):

Attending physicians, fellow physicians, frontline clinicians (resident physicians and nurse practitioners), and nurses working in the PICU.

Interventions:

Data collection occurred in two parts: 1) field observations during morning rounds with brief field interviews conducted with participants involved in an observed interruption and 2) in-depth interviews conducted with selected participants from prior field observations.

Measurements and Main Results:

Data were coded using a constant comparative method with thematic analysis, clustering codes into groups, and subsequently into themes. We observed 11 rounding encounters (17 hr of observation and 48 patient encounters), conducting 25 field interviews and eight in-depth interviews. Themes included culture of interruption triage, interruption triage criteria, and barriers to interruption triage. Interruptees desired forming a culture of triage, whereby less-urgent interruptions were deferred until later or addressed through an asynchronous method; this desire was misaligned with interrupters who described ongoing interruption triage based on clinical changes, time-sensitivity, and interrupter comfort, despite not having a formal triage algorithm. Barriers to interruption triage included a lack of situational awareness and experience among interrupters and interruptees.

Conclusions:

Interrupters and interruptees did not have a shared understanding of the culture of triage within the PICU. Although interrupters attempted to triage interruptions, no formal triage algorithm existed and interruptees did not perceive a triaging culture. Using data from this study, we created a triage algorithm that could inform future studies, potentially decrease unnecessary interruptions, and optimize information sharing for essential interruptions.
Lumbar Spinal Stenosis and Potential Management With Prostaglandin E1 Analogs
Authors: Marcolina Austin , Vu Kevin , Annaswamy Thiru M.
Published: October 2020

Lumbar spinal stenosis is one of the most commonly diagnosed spinal disorders worldwide and remains a major cause for surgery in older adults. Lumbar spinal stenosis is clinically defined as a progressive degenerative disorder with low back pain and associated neurogenic intermittent claudication. Conservative and surgical management of lumbar spinal stenosis has been shown to be minimally effective on its symptoms. A treatment option that has not been investigated in the United States is the utilization of prostaglandin E1 analogs, which have been used primarily in Japan for the treatment of lumbar spinal stenosis since the 1980s. The vasodilatory and antiplatelet aggregation effects of prostaglandin E1 presumably improve symptoms of lumbar spinal stenosis by increasing blood flow to the spinal nerve roots. This brief report examines the potential vascular pathology of lumbar spinal stenosis, reviews evidence on the use of prostaglandin E1 analog limaprost in Japan for lumbar spinal stenosis, and briefly discusses misoprostol as a possible alternative in the United States. The studies summarized in this report suggest that prostaglandin E1 analogs may provide benefit as a conservative treatment option for patients with lumbar spinal stenosis. However, higher-quality studies conducted in the United States and comparison with other currently used conservative treatments are required before it can be recommended for routine clinical use.
Carpal Tunnel Syndrome in Autoimmune Rheumatic Diseases and Inflammatory Bowel Diseases
Authors: Hsu Po-Cheng , Chiu Jan-Wei , Yang Yi-Chiang , Jeng Mei-Jy
Published: October 2020

Objective

The relationship between autoimmune rheumatic diseases, inflammatory bowel diseases, and carpal tunnel syndrome is unclear. We aimed to survey the occurrence and characteristics of carpal tunnel syndrome in autoimmune rheumatic diseases and inflammatory bowel diseases, compared with the general population.

Methods

We used the Longitudinal Health Insurance Database 2015 from Taiwan’s National Health Insurance Research Database. Patients diagnosed with autoimmune rheumatic diseases/inflammatory bowel diseases were identified. The incidence rates and surgical rates of carpal tunnel syndrome among individual diseases were calculated. The hazard ratios when compared with age and sex matched, and 1:1 ratio control groups were surveyed.

Results

A total of 2591 women and 701 men were identified. The incidence rate of carpal tunnel syndrome was highest in Crohn disease (1001 per 100,000 person-years, 95% confidence interval = 0–2747), followed by scleroderma and Sjögren syndrome. The incidence rate in the control group was 571 per 100,000 person-years (95% confidence interval = 314–829). Significantly increased adjusted hazard ratios were seen in Sjögren syndrome (1.44, 95% confidence interval = 1.09–1.90) and rheumatic arthritis (1.33, 95% confidence interval = 1.05–1.70). The overall surgical rate was 0.2% in patients with autoimmune rheumatic diseases/inflammatory bowel diseases and 0.3% in the control group, without a significant difference (P = 0.85).

Conclusions

Patients with Sjögren syndrome and rheumatic arthritis are susceptible to carpal tunnel syndrome. Patients with autoimmune rheumatic diseases/inflammatory bowel diseases have similar surgical rates as general population.
Perceptions of Equity and Inclusion in Acute Care Surgery
Authors: Tseng Esther S. , Zakrison Tanya L. , Williams Brian , Bernard Andrew C. , Martin Matthew J. , Zebib Laura , Soklaridis Sophie , Kaafarani Haytham M. , Zarzaur Ben L. , Crandall Marie , Seamon Mark J. , Winfield Robert D. , Bruns Brandon
Published: October 2020

Objectives and Background:

The aim of this study was to characterize equity and inclusion in acute care surgery (ACS) with a survey to examine the demographics of ACS surgeons, the exclusionary or biased behaviors they witnessed and experienced, and where those behaviors happen. A major initiative of the Equity, Quality, and Inclusion in Trauma Surgery Practice Ad Hoc Task Force of the Eastern Association for the Surgery of Trauma was to characterize equity and inclusion in ACS. To do so, a survey was created with the above objectives.

Methods:

A cross-sectional, mixed-methods anonymous online survey was sent to all EAST members. Closed-ended questions are reported as percentages with a cutoff of α = 0.05 for significance. Quantitative results were analyzed focusing on mistreatment and bias.

Results:

Most respondents identified as white, non-Hispanic and male. In the past 12 months, 57.5% of females witnessed or experienced sexual harassment, whereas 48.6% of surgeons of color witnessed or experienced racial/ethnic discrimination. Sexual harassment, racial/ethnic prejudice, or discrimination based on sexual orientation/sex identity was more frequent in the workplace than at academic conferences or in ACS. Females were more likely than males to report unfair treatment due to age, appearance or sex in the workplace and ACS (P ≤ 0.002). Surgeons of color were more likely than white, non-Hispanics to report unfair treatment in the workplace and ACS due to race/ethnicity (P < 0.001).

Conclusions:

This is the first survey of ACS surgeons on equity and inclusion. Perceptions of bias are prevalent. Minorities reported more inequity than their white male counterparts. Behavior in the workplace was worse than at academic conferences or ACS. Ensuring equity and inclusion may help ACS attract and retain the best and brightest without fear of unfair treatment.