bluuebunny/crossref_metadata_2025 huggingface dataset:
Safety of Early Mobilization in Patients With Intraoperative Cerebrospinal Fluid Leak in Minimally Invasive Spine Surgery: A Case Series
Authors: Aljoghaiman Majid , Ellenbogen Yosef , Takroni Radwan , Yang Kaiyun , Farrokhyar Forough , Reddy Kesava
Published: February 2021

BACKGROUND

Cerebrospinal fluid (CSF) leak is a common complication in spine surgery. Repairing durotomy is more difficult in the setting of minimally invasive spine surgery (MISS). Efficacy of postoperative bed rest in case of dural tear in MISS is not clear.

OBJECTIVE

To assess the safety and efficacy of our protocol of dura closure without changing access, early mobilization, and discharge in cases of intraoperative CSF leak in MISS.

METHODS

A retrospective review from 2006 to 2018 of patients who underwent MISS for degenerative and neoplastic diseases with documented accidental or intentional durotomy was conducted. The primary outcome of interest was readmission rate for repair of persistent CSF leak. Secondary outcomes captured included development of pseudomeningocele, positional headache, and subdural hematoma.

RESULTS

A total of 80 patients were identified out of 527 patients. Of these, intentional durotomy was performed in 28 patients and unintentional durotomy occurred in 52 patients. Mean follow-up period was 80.6 mo. Most of the patients were discharged on postoperative day 0 (within 4 h of surgery) without activity restrictions. A total of 2 (2.5%) patients required readmission and dural repair for continuous CSF leak and 3 patients (3.75%) developed pseudomeningocele. No lumbar drain insertion, meningitis, or subdural hematoma was reported.

CONCLUSION

Early mobilization and discharge in cases of intraoperative CSF leak in MISS appear to be safe and not associated with higher rate of complications than that of reported literature.
Remarks On Ornstein’s Non-Inequality In ℝ2×2
Authors: Faraco Daniel , Guerra André
Published: February 2021

We give a very concise proof of Ornstein’s L1 non-inequality for first- and second-order operators in two dimensions. The proof just needs a two-dimensional laminate supported on three points.
Whose Disagreement Matters? Household Belief Dispersion and Stock Trading Volume
Authors: Li Dan , Li Geng
Published: February 2021

Theoretical models have long recognized the role of investor disagreements in the marketplace, but little evidence is documented regarding how belief dispersion affects trading activities in the broad equity market. Using over three decades of data from a survey of US households, we introduced a novel measure of household macroeconomic belief dispersion and document its positive relationship with market-wide stock trading volume, even after controlling for an array of professional analysts’ belief dispersion. Results are more pronounced for the belief dispersion among households who are more likely to own stocks. Furthermore, we show that the household belief dispersion is priced in the cross-section of stock returns, whereas that among professional analysts is not.
ASSESSMENT OF INTEGRITY AND LEAD-EQUIVALENCE OF SHIELDED GARMENTS USING TWO-DIMENSIONAL X-RAY IMAGES FROM A COMPUTED TOMOGRAPHY SCANNER
Authors: Kairn T , Maxwell S K , Trapp J V , Crowe S B
Published: February 2021

Shielded garments are widely recommended for occupational radiation protection in diagnostic and interventional radiology. This study investigated a novel method for efficiently verifying shielded garment integrity while simultaneously acquiring data for lead-equivalence measurements, using two-dimensional topogram images from computed tomography (CT) scanners. This method was tested against more-conventional measurements with superficial and orthovoltage radiotherapy treatment beams, for 12 shielded garments containing 3 different lead-free shielding materials. Despite some energy-dependent results, all shielded garments approximately achieved their specified lead-equivalence for the energy range expected during clinical use for fluoroscopy procedures, except for three shielded skirts that required two layers of material to be overlapped at the front. All lead-equivalence measurements from CT topograms agreed with or conservatively underestimated the kV narrow-beam results. This method is potentially useful for independently assessing the shielding properties of new shielded garments and performing annual checks for damage or degradation of existing shielded garments.
Mycobiome Transplant Increases Resistance toAustropuccinia psidiiin an Endangered Hawaiian Plant
Authors: Chock M. K. , Hoyt B. K. , Amend A. S.
Published: February 2021

The accelerated global movement of plant pathogens has become a substantial threat to rare and endangered plants. Although application of synthetic pesticides on endangered plants is often necessary to control disease in greenhouse settings, these chemical treatments degrade the leaf microbiome. This reduction in diversity can eliminate foliar microbes that are essential for pathogen resistance, making plant hosts more susceptible to disease once outplanted in the wild. Beneficial microbes that naturally occur in plant tissue are a resource that is quickly gaining traction as a viable means to increase plant fitness and pathogen resistance in both agricultural and wild habitats. This is of particular interest for threatened and endangered wild plant populations with limited genetic variation where breeding for resistance is not possible. In this experiment, we tested the effectiveness of microbial inoculations to inhibit the fungal pathogen Austropuccinia psidii, which is currently threatening the critically endangered Hawaiian Eugenia koolauensis with extinction. Using molecular and culture-based methods, we characterize foliar fungal communities of Myrtaceous hosts resistant to A. psidii and introduced these diverse fungi into the microbiome of E. koolauensis leaves. Our results indicate that transplanting an intact mycobiome community is more effective at reducing foliar disease resistance when compared with single-fungal-species inocula. These findings demonstrate the potential of whole-microbiome transplants as a powerful tool to inducing disease resistance and enhancing plant health within a conservation context.
Epidemiology of anaphylaxis
Authors: Tanno Luciana Kase , Demoly Pascal
Published: February 2021

Purpose of review

To understand the current global epidemiological data of anaphylaxis and identify potential strategies to improve patients’ care and prevention.

Recent findings

Anaphylaxis mortality and morbidity statistics (MMS) may gain new perspectives with the implementation of the International Classification of Diseases (ICD)-11 in the forthcoming years. Improving the quality of epidemiological data related to anaphylaxis should clarify some areas of uncertainty about risk factors, leading to better targeting of strategies to protect those patients at risk, and support decision-making to facilitate healthcare planning and implementation of public health measures to prevent anaphylaxis.

Anaphylaxis is a complex noncommunicable diseases with adverse impact on health-related quality of life of patients and their carriers and a significant proportion of deaths may be preventable. It requires an integrated holistic plan to improve quality of healthcare and gathering accurate and comparable epidemiological data is key. Morbidity related to anaphylaxis seems to be increasing worldwide whereas mortality of anaphylaxis appears to be low and stable, but this still has great challenges in capturing quality anaphylaxis MMS. Improving the quality of epidemiological data related to anaphylaxis should clarify some areas of uncertainty about risk factors, leading to better targeting of strategies to protect those patients at risk. As knowledge derived from populations is key information for more realistic decision-making, the construction of the new section addressed to anaphylaxis in the ICD-11 will allow the collection of more accurate epidemiological data to support quality management of patients, and better facilitate healthcare planning to implement public health measures to prevent and reduce the morbidity and mortality attributable to these conditions.
A Telemedicine Buprenorphine Clinic to Serve New York City: Initial Evaluation of the NYC Public Hospital System's Initiative to Expand Treatment Access During the COVID-19 Pandemic
Authors: Tofighi Babak , McNeely Jennifer , Walzer Dalia , Fansiwala Kush , Demner Adam , Chaudhury Chloe S. , Subudhi Ipsita , Schatz Daniel , Reed Timothy , Krawczyk Noa
Published: February 2021

Objectives:

The purpose of this study was to assess the feasibility and clinical impact of telemedicine-based opioid treatment with buprenorphine-naloxone following the Coronavirus disease 2019 pandemic.

Methods:

Participants included in this retrospective analysis consisted of adult New York City residents with opioid use disorder eligible for enrollment in the NYC Health+Hospitals Virtual Buprenorphine Clinic between March and May 2020 (n = 78). Follow-up data were comprised of rates of retention in treatment at 2 months, referrals to community treatment, and induction-related events.

Results:

During the initial 9 weeks of clinic operations, the clinic inducted 78 patients on to buprenorphine-naloxone and completed 252 visits. Patient referrals included non-NYC Health + Hospitals (n = 22, 28.2%) and NYC Health + Hospitals healthcare providers (n = 17, 21.8%), homeless shelter staff (n = 13, 16.7%), and the NYC Health + Hospitals jail reentry program in Rikers Island (n = 11, 14.1%). At 8 weeks, 42 patients remained in care (53.8%), 21 were referred to a community treatment program (26.9%), and 15 were lost to follow-up (19.2%). No patients were terminated from care due to disruptive behavior or suspicions of diversion or misuse of Buprenorphine. Adverse clinical outcomes were uncommon and included persistent withdrawal symptoms (n = 8, 4.3%) and one nonfatal opioid overdose (0.5%).

Conclusions:

Telemedicine-based opioid treatment and unobserved home induction on buprenorphine-naloxone offers a safe and feasible approach to expand the reach of opioid use disorder treatment, primary care, and behavioral health for a highly vulnerable urban population during an unprecedented natural disaster.
Reduction in Oregon's Medication Dosing Visits After the SARS-CoV-2 Relaxation of Restrictions on Take-home Medication
Authors: McIlveen John W. , Hoffman Kim , Priest Kelsey C. , Choi Dongseok , Korthuis Phillip Todd , McCarty Dennis
Published: February 2021

To slow the spread of SARS-CoV-2 in opioid treatment programs (OTPs), SAMHSA notified State Opioid Treatment Authorities that stable patients could receive up to 27 days of take-homes, less stable patients could receive up to 13 days with fewer take-homes for other patients. An analysis assessed how the relaxed standards affected the number of patient dosing visits and the amount of take-home medications dispensed in Oregon's 20 public, nonprofit, and for-profit OTPs.

OTPs reported the number of patients receiving take homes pre and post federal policy change at 3 time points: pre SARS-CoV-2 (February or first half of March), post 1 SARS-CoV-2 (March, April, or May), and post 2 SARS-CoV-2 (April, May, or June). The patients receiving each quantity of take-homes were counted and means calculated for visits and take-homes per patient per month. A negative binomial mixed-effects regression model assessed change in mean dosing visits per patient.

During the pre SARS-CoV-2 period, OTPs served 7792 patients monthly with 120,513 medication visits and dispensed 44,883 take-home doses. Mean patient visits per month were 15.5 with 5.8 take-homes per patient per month. Following the policy change, medication visits declined 33% and take-home medication increased 97% with 10.4 mean visits per patient and 11.3 mean take-homes per patient. The negative binomial mixed-effects regression model estimated a 54% reduction in mean visits per patient. The policy change had the intended effect. More research is needed to assess unintended consequences associated with increased access to take-home medication.
Upper Limb Lengthening in Achondroplasia Using Unilateral External Fixation
Authors: Arenas-Miquelez Antonio , Arbeloa-Gutierrez Lucas , Amaya Martín , Vázquez Blanca , De Pablos Fernández Julio
Published: February 2021

Purpose:

The purpose of this study was to analyze the long-term results of humeral lengthening in achondroplastic patients and make suggestions on the most appropriate surgical technique to improve patient outcomes.

Methods:

Fifty-four humeral lengthening procedures performed in 27 achondroplastic patients were reviewed. Elongations were performed by means of callotasis with unilateral external fixation. Inclusion criteria were: achondroplastic patients under 17 years without prior arm operations and minimum follow-up of 36 months.

Results:

Fifty humeri in 25 patients (13 men and 12 women), aged between 9 and 17 years, met the inclusion criteria. Mean humeral lengthening was 8.82 cm (range: 5 to 10.5 cm), which represented an elongation of 54.80% (range: 46% to 63%) of the original length. The healing index was 0.91 months (range: 0.72 to 1.4 mo) per centimeter gained. Shoulder and elbow range of motion and stability were preserved in 47 limbs. Noncomplicated cases consistently experienced a significant functional improvement in the performance of activities of daily living such as putting on footwear and personal hygiene. Short-term complications included 11 pin-tract infections, 1 radial nerve neuropraxia, and 1 failure of the regenerated bone formation. None of these complications prevented from completion of treatment. Long-term complications included 2 cases of nonunion, 3 elbow flexion contractures, and 2 cases of psychological dissatisfaction, all of them in 4 patients. Factors associated with long-term complications were intraoperative fragment displacement and distal humeral osteotomy. No fractures of the regenerated bone were identified in the long term.

Conclusions:

Callotasis with unilateral external fixation is a reliable and well-tolerated procedure for humeral lengthening in achondroplastic patients, with an acceptable complication rate. Guided fixator placement and a proximal humeral osteotomy are strongly recommended technical tips as they may help prevent complications and improve outcomes.

Level of Evidence:

Level IV—case series.
The Pediatric Open Supracondylar Fracture: Associated Injuries and Surgical Management
Authors: Armstrong Douglas G. , Monahan Kevin , Lehman Erik B. , Hennrikus William L.
Published: February 2021

Background:

While supracondylar (SC) fractures are relatively common in children, the incidence of open injuries is believed to be only 1%. Two prior studies on open SC fractures in children reported an increased incidence of vascular injuries. The purposes of our study were to clarify the incidence, associated conditions, and current treatment for open SC fractures.

Methods:

The Pennsylvania Trauma Outcome Study database was queried. Subjects age 25 to 156 months old admitted to trauma centers between January 2000 and December 2015 with a SC fracture were included. Controls were those with closed fractures and the study group, those with open injuries. Study variables were age, sex, weight, injury severity score, length of stay (LOS), nerve injury, ipsilateral forearm fracture, compartment syndrome/fasciotomy, requirement for a vascular procedure. Other variables were mode of treatment, provisional reduction, repeat reduction, time interval between referring facility admission and operation, and time from emergency department admission to operation.

Results:

A total of 4308 subjects were included, 104 (2.4%) of whom had an open SC fracture. LOS was 2 days for the study group versus 1 day for controls (P<0.001). Open SC fractures were more likely than closed to be associated with a nerve injury (13.5% vs. 3.7%), ipsilateral forearm fracture (18.3% vs. 6.4%) and/or a vascular procedure (6.7% vs. 0.3%) (P<0.001). 5.9% of those in the study group required repeat surgery compared with 0.4% for controls (P<0.001). Time from emergency department admission to operation was 3.2 versus 10.3 hours (P<0.001).

Conclusions:

We report the largest series to date of open SC fractures in children. Surgeons caring for such patients should be aware of their increased risks for both associated injuries and potential requirement for vascular reconstruction. The majority of children with an open SC fracture are managed with 1 operation and in the absence of vascular injury, seldom require an extended LOS.

Level of Evidence:

Level III—retrospective cohort study.
Controversies in Surgical Treatment of Recalcitrant Plantar Fasciitis
Authors: Cheney Nicholas , Sharpe Barry Dale , Lauf Jason , Long Joseph
Published: February 2021

Plantar fasciitis is a common cause of heel pain that is seen by both orthopedic surgeons and primary care providers. It is a condition that was previously thought to be because of inflammation of the plantar fascia but has more recently been linked an equinus contracture of the gastrocnemius muscle. The condition can be handled both conservatively and surgically, with the primary management being nonoperative. For operative interventions, the treatment of choice was classically a plantar fasciotomy. Over the past several years, the gastrocnemius recession has become an operative treatment of choice. The gastrocnemius recession has shown better symptom relief with less morbidity. The technique to perform a gastrocnemius recession is described within the chapter, as well as the postoperative management. In the future, the duration of nonoperative management for recalcitrant disease may be reduced. However, more randomized control trials showing positive results of the gastrocnemius recession may allow for shorter nonoperative management period creating a new standard treatment algorithm.

Level of Evidence: Diagnostic level I, systematic review of studies.
Nail Plate Fixation Technique to Optimize Indirect Reduction and Fixation of Proximal Tibia Fractures
Authors: Obey Mitchel R. , Berkes Marschall B.
Published: February 2021

Purpose:

Treatment of proximal quarter and fifth tibia fractures can be very difficult. Intramedullary nailing is associated with predictable apex anterior angular and translational deformities as well as coronal plane displacement. This can be combated with blocking screws, but they can be difficult to place precisely and perhaps not feasible in cases of metaphyseal comminution. Achieving and maintaining a reduction is relatively easy with plate fixation, particularly with precontoured anatomic plates; however, plate fixation may be suboptimal particularly in unreliable patients. The goal was to describe our technique involving minimally invasive plating of proximal tibia fractures to achieve an indirection reduction followed by intramedullary nailing.

Materials and Methods:

Describe the step-by-step surgical technique for fixation of proximal tibia fractures with a nail plate construct. All patients who underwent this technique for fixation of a proximal tibia fracture at our institution between July 1, 2017, and October 1, 2019 were reviewed to evaluate clinical and radiographic outcomes.

Results:

Six patients (7 tibias) with a mean age of 51.6 years were identified. The mean follow-up was 148 days. At the time of the final follow-up, we observed a union of all fractures without loss of reduction or alignment, and there were no instances of implant failure or complications.

Conclusion:

This technique for fixation of proximal tibia fractures can reliably achieve and maintain alignment and provide optimal fixation in these challenging fractures with good outcomes.
Impact of Baseline Corticosteroids on Immunotherapy Efficacy in Patients With Advanced Melanoma
Authors: Kartolo Adi , Deluce Jasna , Holstead Ryan , Hopman Wilma , Lenehan John , Baetz Tara
Published: February 2021

This is a 2-center, retrospective study which aimed to evaluate the effect of baseline corticosteroid use on immunotherapy efficacy in patients with advanced melanoma. We included all patients with advanced unresectable and metastatic melanoma on single-agent programmed cell death protein 1 (PD-1) inhibitors at the Cancer Centre of Southeastern Ontario and London Regional Cancer Program. We defined baseline corticosteroid use as prednisone-equivalent of ≥10 mg within 30 days of immunotherapy initiation. Our study had 166 patients in total, and 25 were taking corticosteroids at the initiation of the PD-1 inhibitor. Baseline prednisone-equivalent ≥10 mg did not have effect on median overall survival (hazard ratio=1.590, 95% confidence interval: 0.773–3.270, P=0.208). However, a higher dose of baseline prednisone-equivalent ≥50 mg was independently associated with poor median overall survival (hazard ratio=2.313, 95% confidence interval: 1.103–4.830, P=0.026) when compared with baseline prednisone-equivalent 0–49 mg, even when controlled for confounders including baseline Eastern Cooperative Oncology Group ≥2 and baseline brain metastasis. Consideration should be made to decrease the use of unnecessary steroids as much as possible before initiation of PD-1 inhibitor treatment.
The Role of Metformin in Treating Preeclampsia
Authors: Cheng Decui , Zhou Xuexin , Xu Xianming
Published: February 2021

Preeclampsia (PE) is a principal cause of maternal and newborn mortality that poses financial and physical burdens to tens of thousands of families each year. Unfortunately, there is no effective management to arrest the progression of this disease unless delivery. Therefore, standardized management or preventive treatments are needed urgently. PE is closely associated with placental hypoxia, which increases the secretion of soluble fms-like tyrosine kinase 1 (sFlt-1) as well as soluble endoglin (sEng) into the maternal circulation. Metformin has been found to inhibit those anti-angiogenic factors so it might be a candidate to prevent or treat PE. Women who are diagnosed with gestational diabetes mellitus (GDM) are more likely to have complications of hypertension or PE, so this review aims to demonstrate that the application of metformin in GDM might prevent the onset or progression of PE complicated with GDM.
Syncytiotrophoblast Derived Extracellular Vesicles in Relation to Preeclampsia
Authors: Cooke William R. , Jones Gabriel D. , Redman Christopher W.G. , Vatish Manu
Published: February 2021

The syncytiotrophoblast, a fused single-cell layer between mother and fetus, constitutively releases extracellular vesicles (STBEV) directly into the maternal circulation. STBEV contain a variety of proteins and RNA which can be targeted to specific cells. In preeclampsia, asymptomatic placental oxidative stress is a precursor to later multi-organ dysfunction in the mother. Increased STBEV release in preeclampsia is considered a manifestation of syncytiotrophoblast stress, which may play a key role in signaling between fetus and mother. STBEV release in preeclampsia changes, both in terms of volume and content. In this review, we outline the latest advances in STBEV isolation and detection. We consider evidence for differential STBEV release, protein cargo and RNA content in preeclampsia, highlighting common pitfalls in study design. We summarise studies to date demonstrating STBEV actions on target cells. Ultimately, we consider how STBEV fit into the pathophysiology of the heterogeneous syndrome of preeclampsia. The key unifying concept in early- and late-onset preeclampsia is syncytiotrophoblast stress. We submit that STBEV are the key stress signal in preeclampsia. We believe that further investigation of STBEV release, content, and actions may offer valuable insights into preeclampsia pathophysiology and potential new clinical diagnostics and therapeutic targets.
Untimed Efavirenz Drug Levels After Switching From Brand to Generic Formulations: A Short Communication
Authors: Watson Birgit E. , Atkinson Kieran , Auyeung Kathleen , Baynes Katherine A. , Lepik Katherine J. , Toy Junine , Sereda Paul , Barrios Rolando , Brumme Chanson J.
Published: February 2021

Background:

In British Columbia, antiretrovirals are distributed at no cost to patients via a publicly funded program, using generic formulations if available. A generic efavirenz-emtricitabine-tenofovir DF (EFV-FTC-TDF) combination pill became available in April 2018. The authors compared EFV untimed drug levels in subjects switching from brand to generic EFV-FTC-TDF.

Methods:

Archived plasma HIV viral load samples were identified for consenting participants who switched from brand to generic EFV-FTC-TDF; 3 preswitch and 2–3 postswitch samples, collected ≥1 month apart were assessed for each subject. “Untimed” EFV concentrations with unknown dosing and collection time were assessed using a validated liquid chromatography–tandem mass spectrometry method. Participants' mean, minimum, and maximum EFV levels were compared using the Wilcoxon signed rank test. Participants with EFV levels in the range associated with lower risks of virologic failure and central nervous system toxicity (1000–4000 ng/mL), preswitch and postswitch, were enumerated.

Results:

EFV levels were assessed in 297 preswitch and 249 postswitch samples from 99 participants, having exposure to brand and generic EFV for a median of 103 (Q1-Q3: 87–116) and 10.3 (Q1-Q3: 8.9–11.7) months, respectively. The final brand sample was collected at a median of 98 days preswitch; the first generic sample was collected at a median of 133 days postswitch. No significant differences were observed in participant mean EFV levels before (median 1968 ng/mL; Q1-Q3: 1534–2878 ng/mL) and after (median 1987 ng/mL; Q1-Q3: 1521–2834 ng/mL) switch (P = 0.85). Eighty participants had mean EFV levels within the 1000–4000 ng/mL range on the brand drug, of which 74 remained within this range postswitch.

Conclusions:

There were no statistically significant differences between untimed EFV levels in patients switching from the brand to generic EFV combination pill. Given the long elimination half-life of EFV, untimed drug levels may be a convenient way to estimate product bioequivalence.
Is it time for prenatal chromosomal-microarray analysis to all women? A review of the diagnostic yield in structurally normal fetuses
Authors: Daum Hagit , Stern Shira , Shkedi-Rafid Shiri
Published: February 2021

Purpose of review

Chromosomal-microarray analysis (CMA) is the first-tier test in pregnancies with structural malformations. Accumulating data show that pathogenic copy number variants (CNVs) can also be identified in structurally normal fetuses. We set out to summarize the published data on the diagnostic yield of CMA in structurally normal fetuses.

Recent findings

Six studies summarize a total of 29,612 prenatal CMAs performed in structurally normal fetuses. The incidence of highly penetrant pathogenic/likely pathogenic CNVs is 0.4–2.5%. Variability was demonstrated in the timing of CMA testing and type of CNVs classified as pathogenic. The incidence of variants of uncertain significance is 0.4–5.4%. The prevalence of susceptibility loci is 0.3–0.7% when specified, and the incidence of CNVs associated with late onset disease is 0.1%.

With a frequency of abnormal CNVs of 1:40 to 1:250 in structurally normal fetuses, it is recommended that all pregnant women be informed of the possibility to have CMA performed, even in the absence of malformations. Information should also be provided about uncertain and secondary findings.
A Clinician’s Guide to Polycultural Psychiatry
Authors: Yager Joel
Published: February 2021

Patients and families each present unique microcultures, mixing and blending numerous broadly conceptualized cultural identity groups. Within individuals and families, cultural identities are experienced and enacted as complex matrices of intersecting identities that, to varying degrees, complement, assimilate, accommodate, or clash. In these patterns, individuals’ relationships to cultures are not necessarily categorically distinct (“multicultural”). Instead, they are often “polycultural,” defined as partial and plural; rather than interpreting different cultural traditions as separate and independent, they are, within the lives of individuals and families, better understood as systems that interact with and influence one another.

Cultural identity groups extend beyond those traditionally considered by transcultural psychiatry—that is, beyond ethnic, racial, and language groups. They encompass (in alphabetical order) educational, ethnic, extended family, gender-oriented, generational, geographic, language and dialect, organizational, physical or psychiatric disability, political, professional, racial, religious, sect, social class, and vocational identity groups, among others. Simplistic assumptions and generalities about identity groups risk cultural stereotyping that may negatively bias clinical assessments. Therefore, practitioners striving for cultural sensitivity need to adopt nuanced strategies for approaching broad polycultural identity questions in clinical practice. Accordingly, this article suggests frameworks and strategies for (1) assessing and confronting one’s own cultural preconceptions and prejudices, and (2) developing etic (objective quantitative data) and emic (insiders’ experiential worldviews) perspectives pertinent to clinical anthropathology. Both etic and emic perspectives are necessary for polyculturally nuanced, respectful, comprehensive inquiries pertinent to patients’ and family’s health beliefs, psychiatric difficulties, and health practices. Supplementary material from the DSM-5 section on cultural formulation is adapted and discussed, along with the implications of polycultural psychiatry for education and training in psychiatry.
A Close Look at the Clinical Efficacy of Rho-Associated Protein Kinase Inhibitor Eye Drops for Fuchs Endothelial Corneal Dystrophy
Authors: Kinoshita Shigeru , Colby Kathryn A. , Kruse Friedrich E.
Published: February 2021

The current understanding on the clinical efficacy of Rho-associated protein kinase (ROCK) inhibitor for treating Fuchs endothelial corneal dystrophy is summarized to clarify whether the “off-label” ROCK-inhibitor eye-drop application are appropriate. ROCK-inhibitor eye drops may eventually be deemed a cutting-edge therapy for Fuchs endothelial corneal dystrophy patients with acute corneal endothelial defect.
Penetrating Keratoplasty in Infants With Peters Anomaly: Visual and Graft Outcomes
Authors: Lin Qi , Li Li , Sun Yajie , Miao Sen , Li Xu , Shi Wei , Pan Zhiqiang
Published: February 2021

Purpose:

To determine the prevalence of survival of corneal grafts and visual outcomes of primary penetrating keratoplasty (PK) in infants with Peters anomaly (PA) in Beijing, China.

Methods:

Twenty-nine patients (37 eyes) with PA who underwent PK before the age of 1 year were included. Optical correction for all eyes and occlusion therapy of amblyopia for a unilateral opacity were performed 2 weeks after suture removal. All infants underwent assessment of visual acuity after surgery using Teller Acuity Cards. Survival probabilities were estimated using the Kaplan–Meier method and log-rank test. Visual outcomes and prognosis factors were analyzed using the χ2 test.

Results:

The mean age of 29 infants undergoing primary PK was 5.7 ± 2.3 months. The mean follow-up duration was 18.0 ± 3.0 months. Twenty-seven (73.0%) of 37 grafts retained full clarity at final follow-up. Visual acuity above ambulatory was achieved in 67.6% (25/37) and >20/260 was achieved in 48.6% (18/37) of cases. Of all surgical indications, vascularized PA I (50.0%, 6/12) and PA II (18.2%, 2/11) showed a lower proportion achieving visual acuity >20/260 than nonvascularized PA I (71.4%, 10/14) (P = 0.030 < 0.05). There was no significant difference in the prevalence of graft survival and vision outcome between infants younger than 6 months and older than >6 months.

Conclusions:

For infants with PA who underwent PK, the prevalence of graft survival and visual acuity were related mainly to the indication. The main risk factors were corneal vascularization and an abnormal lens.
Ocular Pain Symptoms in Individuals With and Without a History of Refractive Surgery: Results From a Cross-Sectional Survey
Authors: Baksh Brandon S. , Morkin Melina , Felix Elizabeth , Karp Carol L. , Galor Anat
Published: February 2021

Purpose:

This study characterized ocular pain symptoms in individuals with and without a history of refractive surgery (RS) using a cross-sectional survey of individuals with ocular pain.

Methods:

A link to an anonymous survey was posted on a corneal neuralgia Facebook group that included individuals with ocular pain from any etiology and sent to individuals seen in our clinic with ocular pain. The survey asked about medical history, ocular pain symptoms (using standardized questionnaires), and treatment responses. Respondents were split into 2 groups based on a history of RS.

Results:

One hundred one individuals responded to the survey. The mean age for all respondents was 41.6 ± 15.6 years, and 50% reported a history of RS. A total of 46% of individuals with a history of RS reported that their ocular pain started within 1 month of surgery, with median pain duration of 36 (interquartile range 22–84) months. The median Dry Eye Questionnaire-5 (range 0–22) scores were 16 and 15 for the RS and no-RS groups, respectively. Most individuals in both groups characterized their pain as burning (score ≥1: RS, 86%; no-RS, 80%) and reported evoked pain to wind, light, or temperature (score ≥1: RS, 97%; no-RS, 85%). Fifty-nine of 101 individuals responded to treatment questions. Individuals in both groups reported >30% improvement in pain symptoms with some topical and systemic approaches.

Conclusions:

Individuals with a history of RS developed ocular pain soon after surgery, which persisted for years. Symptom profiles were similar between those with and without RS. Topical and systemic approaches can treat pain in both groups.
Cutaneous Radiation-Associated Angiosarcoma After Cervical Cancer Treatment: A Case Report
Authors: Xu Cong-Cong , Zhang Wei , Chen Hao
Published: February 2021

Introduction:

Cutaneous radiation-associated (cRAA) angiosarcoma is a rare malignant neoplasm derived from vascular endothelial cells, but a relatively commonly recognized complication of radiation therapy.

Here, we present a patient with cRAA, who undergone radiochemotherapy for cervical cancer 11 years ago.

Case presentation:

A 48-year-old woman presented with a 6-month history of painless purple skin plaques and nodules on her lower abdomen and right thigh. The patient had undergone radiochemotherapy for cervical cancer 11 years ago. A skin biopsy showed a diffuse proliferation of irregular anastomosing dilated vascular structures with atypical endothelial cells. She was diagnosed as cRAA according to clinical and histological manifestations.

Discussion:

cRAA is a rare malignant neoplasm but it is a complication of radiation therapy. The incidence of cRAA has increased in recent years. Clinical and pathological manifestations are highly varied. Radical resection is the preferred treatment.

Conclusion:

Patients with suspicious violaceous lesions should undergo biopsy. Clinical suspicion and pathological examination are of the utmost importance for cRAA.
Agriculture Exposure and Time to Pregnancy Among Women Enrolled in the French Prospective Cohort AGRICAN
Authors: Pons Romain , Boulanger Mathilde , Tual Séverine , Busson Amandine , Renier Marine , Perrier Stéphanie , Levêque-Morlais Noémie , Marcotullio Elisabeth , Baldi Isabelle , Lebailly Pierre
Published: February 2021

Objectives:

In few retrospective studies, prolonged time-to-pregnancy (TTP) was observed for women exposed to pesticides especially in flower production. The present study investigated time-to-pregnancy in the AGRICAN cohort.

Methods:

Analyses were performed on 616 women reporting a pregnancy (2005 to 2017), and data on agricultural activities performed before the last pregnancy was retrospectively collected. Fecundability odds ratios (fOR) were estimated using a discrete time analogue of Cox proportional hazard model adjusted on maternal and paternal age, body mass index (BMI), and alcohol consumption.

Results:

A decrease in fecundability was non-significantly associated with farm work (adjusted fOR = 0.86; 95% confidence interval [CI]: 0.71 to 1.05). Decreases were also observed for nightwork (afOR = 0.75; 95% CI: 0.49 to 1.15) and exposure to vibrations (afOR = 0.68; 95% CI: 0.43 to 1.09).

Conclusion:

Women working on a farm before conception appeared to experience a longer TTP. Negative associations were suggested for some agricultural activities and working conditions.
Use of Vinegar and Water to Identify COVID-19 Cases During a Workplace Entrance Screening Protocol
Authors: Kalia Nimisha , Moraga Jessica Aguilar , Manzanares Max , Friede Vanessa , Kusti Mohannad , Bernacki Edward J. , Tao Xuguang (Grant)
Published: February 2021

Objective:

To evaluate an empirical olfactory test to identify COVID-19 cases during a workplace entrance screening.

Method:

An active screening for olfactory dysfunction using water and vinegar was conducted in April to June 2020 among 4120 meat packing workers in Latin America.

Results:

The sensitivity and specificity of the active olfactory screening examination were 41.2% and 85.3%, respectively, using reverse transcription polymerase chain reaction (RT-PCR) tests as a gold standard. 10.6% of employees who tested positive for COVID-19 had an olfactory dysfunction as their only symptom. These individuals would not have been identified with standard workplace screening measures including temperature screening.

Conclusion:

Active screening for olfactory dysfunction may serve as a valuable tool to both identify potential COVID-19 infections and exclude those who do not have infection and should be a part of parallel algorithm combined with standard workplace entrance screening procedures.
Time Restricted Feeding Reduces Inflammation and Cortisol Response to a Firegrounds Test in Professional Firefighters
Authors: McAllister Matthew J. , Gonzalez Andrew E. , Waldman Hunter S.
Published: February 2021

Objective:

Firefighters are at a heightened risk for developing cardiovascular disease. The purpose of this study was to determine if time restricted feeding (TRF) can improve the stress/inflammatory response to a simulated firegrounds test (FGT) in professional firefighters.

Methods:

Thirteen firefighters participated in an 8-week TRF intervention (14:10 [fasting:feeding]) protocol and completed a FGT before and after the intervention. Blood lactate, heart rate, salivary C-reactive protein (CRP), interleukin-6 (IL-6), interleukin 1-β (IL-1β), and cortisol were measured pre and post FGT.

Results:

Following TRF, the salivary cortisol response to the FGT was significantly (P < 0.05) reduced. Salivary IL-6 and IL-1β were also significantly lower, and CRP was higher following the intervention.

Conclusions:

These findings demonstrate lower inflammation and reduced stress response to FGT following TRF and may suggest implications in terms of cardiometabolic benefits for firefighters.
Longitudinal Integration of Oral Health Training Into Physician Assistant Education
Authors: Sadowski Catherine K. , Aycock Mallory M.
Published: February 2021

Purpose

The purpose of this study was to evaluate physician assistant (PA) student knowledge after integrating an oral health curriculum longitudinally into a PA program and to assess student perceptions of the oral health curriculum.

Methods

This study was a 2-group longitudinal study comparing differences between the groups at 2 points in time. Cohort I (n = 60) took an oral health pretest and then, after completing oral health training, took a posttest. Cohort II (n = 49), which had not received oral health training, took identical testing on the same time interval. The students in Cohort I assessed the value of the oral health curriculum by answering a standardized perception survey.

Results

Cohort I had a statistically significant increase (p ≤ .0001) in posttest assessment scores compared to Cohort II (control group). The students who were exposed to the oral health curriculum reported a deeper understanding and appreciation of oral health disease and increased confidence in oral health clinical application.

Conclusions

A greater awareness of the importance of oral health and chronic disease has evolved within PA education over the past 2 decades. Despite this progress, there is still a need to expand this curriculum and improve PA students' depth of knowledge in oral health. This study presents a novel and effective approach to incorporating an oral health curriculum into a PA program.
Did I learn enough to practice? Reflections of new nurse practitioner graduates in providing sexual and reproductive health care
Authors: Cappiello Joyce D. , Boardman Maureen B.
Published: February 2021

Background:

The Centers for Disease Control and Prevention and the US Office of Population Health have published guidelines for providing family planning services.

Purpose:

The study explores how nurse practitioners (NPs) perceived their preparation and competency in providing a range of sexual and reproductive health care in their first two years of community-based practice.

Methodological orientation:

Qualitative. Thematic analysis used to analyze data from structured and open-ended interview questions.

Sample:

Through snowballing recruitment, 35 NPs participated in interviews.

Conclusions:

Participants were most confident and likely to provide contraceptive and sexually transmitted infection services. Participants felt less prepared to provide male sexual health and care to the lesbian, gay, bisexual, transgender, queer, and intersex+ population. Nurse practitioners expressed interest in building skills with discussing healthy sexuality across the life span, specifically postmenopausal sexual concerns, teen sexuality, trauma-informed care related to sexual violence, and early pregnancy decision making. Some participants had little preparation in early pregnancy decision making/options counseling. Faculty need to examine barriers to teaching these skills because the curriculum should address all legal pregnancy options, including discussing the NP's professional obligations. More preparation was needed in the clinical management of erectile dysfunction, polycystic ovary syndrome, herpes, syphilis, abnormal uterine bleeding, dyspareunia, pelvic pain, miscarriage management, and how to discuss prostate cancer screening.

Implications for practice:

The recommendations of the quality family planning, with additions, form a sound basis for sexual and reproductive health care standards, education, and clinical practice, should be part of NP education.
C19TM: A nurse practitioner and physician assistant–led telemonitoring initiative ensures timely transfer of critically ill coronavirus disease 2019 patients
Authors: Santos Christan D. , Grek Ami A. , Ojard Michelle M. , Propst Joshua A. , Hastings Jacquelyn J. , Krider Tina L. , Villar Dolores C. , Sanghavi Devang K. , Freeman William D. , Siegel Jason L.
Published: February 2021

The coronavirus disease 2019 (COVID-19) pandemic has required swift implementation of innovative practices in health care across the globe. We describe a nurse practitioner (NP) and physician assistant (PA)–led initiative to implement telemonitoring (TM) of noncritical patients with COVID-19 by critical care NPs and PAs (C19TM) for early detection of decompensation and early transfer to the intensive care unit (ICU). Every hospitalized patient with suspected or confirmed COVID-19 received an initial telemedicine consult with a critical care NP or PA. Patients were subsequently monitored via electronic health record once every 12-hour shift for the following indicators: oxygen modality and flow, increase in oxygen requirements, sustained tachypnea, and hemodynamic instability. If signs of decompensation were noted, the NP/PA would remotely reassess the patient, provide recommendations to the hospital internal medicine team, and transfer the patient to the ICU. The primary goal was to avoid cardiopulmonary deterioration requiring aerosol-generating procedures outside of the ICU. Over 65 days, 113 patients (86 suspected and 27 confirmed) were enrolled in C19TM. As a result, there were 13 transfers to the ICU, none of which required an aerosol-generating procedure outside of the ICU.
Clinical delineation of an adult female patient with a rare interstitial 10q24.32q25.1 microdeletion
Authors: Jehee Fernanda S. , Bouma Tia , Bouman Arjan
Published: February 2021

Interstitial deletions encompassing the 10q24.32q25.1 region are rare. Only three patients have been reported in literature to date. We describe a 44-year-old female with a 2.8 Mb microdeletion in 10q24.32q25.1. Clinical findings in this patient are delineated and compared to previously reported patients with (partly) overlapping microdeletions. Based on the few descriptions available in the literature, the major phenotypic features of microdeletion 10q24.32q25.1 seem to be profound developmental delay, severe intellectual disability, short stature, cleft lip and palate, multiple congenital malformations (brain, kidney and cardiac), ophthalmic problems and an increased risk to develop basal cell carcinoma. As far as we are aware, this is the first report of an adult patient with a 10q24.32q25.1 microdeletion in literature. Suggestions are made regarding the medical work-up for newly identified patients with a 10q24.32q25.1 microdeletion as well as for a possible interaction of the compound deletion of SUFU and FGF8 in midline craniofacial abnormalities.
Reminiscence therapy-based care program for reducing anxiety and depression in glioma survivors
Authors: Zhao Xu
Published: February 2021

This study aimed to evaluate the effect of reminiscence therapy-based care (RTBC) program on anxiety, depression, patients satisfaction, and survival benefit in glioma patients after tumor resection.

A total of 150 eligible glioma patients were randomized into the RTBC group (N = 75, receiving RTBC) and the control care (CC) group (N = 75, receiving CC). Interventions were performed twice a month for 12 months. Anxiety was evaluated by Hospital Anxiety and Depression Scale (HADS) for anxiety score and Zung self-rating anxiety scale (SAS) score; meanwhile, depression was evaluated by HADS for depression score and Zung self-rating depression scale (SDS) score; additionally, patients satisfaction was scored. A 36-month follow-up was performed, and accumulating overall survival (OS) were calculated.

Both anxiety level and depression level were reduced in the RTBC group compared with the CC group at month 9 and month 12 (all P < .05); meanwhile, the proportion of anxious patients and depressed patients were decreased in the RTBC group compared with the CC group at month 12 (all P < .05). Moreover, patients satisfaction scores were increased in the RTBC group compared to the CC group at month 6, month 9, and month 12 (all P < .05). Additionally, accumulating OS showed an increasing tendency in the RTBC group compared to the CC group, but no statistical significance was observed (P = .186).

RTBC program ameliorates anxiety, depression, and promotes patients satisfaction in glioma patients after tumor resection.