bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic tunneling junctions based on 2D CrI3 and CrBr3: spin-filtering effects and high tunnel magnetoresistance via energy band difference
Authors: Liu Li , Ye Shizhuo , He Jin , Huang Qijun , Wang Hao , Chang Sheng
Published: November 2021

Recently, the study of two-dimensional materials has expanded to the field of spintronics. Intrinsically ferromagnetic van der Waals materials such as CrI3 and CrBr3 have received much attention due to their nearly

100

%

spin polarization and good stability, resulting in excellent performance in magnetic tunnel junctions. In this work, we design magnetic tunnel junctions (MTJs) of Cu/CrI3/Cu and Cu/CrBr3/Cu with electrodes of Cu(111) and a tunneling barrier of four-monolayer CrI3 or CrBr3. Our first-principle calculations combined with non-equilibrium Green’s function method indicate that the CrBr3-based MTJ has a larger maximum tunneling magnetoresistance ratio than the CrI3-based MTJ. In a wide bias voltage range, the CrI3-based MTJ can maintain high spin-filtering performance, while that of the CrBr3-based MTJ degrades sharply as the bias voltage increases. It is noted that a negative differential resistance effect is observed in the CrBr3-based MTJ. The differences in spin transport properties between the CrI3-based MTJ and the CrBr3-based MTJ are clarified in terms of the physics inside the device, including the spin-dependent density of states, band structures, Bloch states, and the electron density difference. This work provides some physical insights for the design of 2D van der Waals MTJs.
Reconfigurable nonvolatile Boolean logic with one-transistor-two-memristor for in-memory computing
Authors: Wang Ziling , Luo Li , Li Jie , Wang Lidan , Duan Shukai
Published: November 2021

In-memory computing is highly expected to break the von Neumann bottleneck and memory wall. Memristor with inherent nonvolatile property is considered to be a strong candidate to execute this new computing paradigm. In this work, we have presented a reconfigurable nonvolatile logic method based on one-transistor-two-memristor device structure, inhibiting the sneak path in the large-scale crossbar array. By merely adjusting the applied voltage signals, all 16 binary Boolean logic functions can be achieved in a single cell. More complex computing tasks including one-bit parallel full adder and set–reset latch have also been realized with optimization, showing simple operation process, high flexibility, and low computational complexity. The circuit verification based on cadence PSpice simulation is also provided, proving the feasibility of the proposed design. The work in this paper is intended to make progress in constructing architectures for in-memory computing paradigm.
FEQ: a new flux coordinates based equilibrium solver including both magnetic axis and separatrix
Authors: JIANG Xinhao , SUN Youwen
Published: November 2021

Accurate tokamak plasma equilibrium solution in flux coordinates is crucial for many stability and transport studies. Different approaches for dealing with singularities in solving the nonlinear Grad–Shafranov (GS) equation in flux coordinates or also known as straight field line coordinates are proposed in this paper. The GS equation is solved by iterating the position of grids directly in flux coordinates, and hence, no additional errors are introduced due to mapping process for a convergent solution. The singularity at magnetic axis in flux coordinates is removed by using a novel coordinate transform technique. Different from other techniques previously developed, no assumption in boundary condition at magnetic axis is used. This is consistent with the fact that there is no physical boundary at the magnetic axis. A flux coordinate system with poloidal coordinate chosen as the geometric poloidal angle is proposed. It conquers the difficulty in no definition of poloidal coordinate in flux coordinates at separatrix because of the singularity at x-point(s) in a divertor configuration. It also simplifies the process for computing poloidal flux coordinate during the iteration for solving the nonlinear GS equation. Non-uniform grids can be applied in both radial and poloidal coordinates, which allows it to increase the spacial resolution near x-point(s) in a divertor configuration. Based on the model proposed in this paper, a new Flux coordinates based EQuilibrium solver (FEQ) in tokamaks is developed. The numerical solutions from this code agree well with both the analytic Solov’ev solution and the numerical one from the EFIT code for a divertor configuration in the EAST tokamak. This code can be applied for simulating different equilibria with prescribed shape, pressure and current profiles, i.e. including both limiter and divertor configurations, positive triangularity and negative triangularity, different β, arbitrary magnetic shear profile etc. It provides a powerful and convenient fixed-boundary inverse equilibrium solver including both magnetic axis and separatrix in the solution for tokamak researches.
Power characteristics of multiple inductively coupled RF discharges inside a metallic chamber
Authors: LOJEN Dane , ZAPLOTNIK Rok , MOZETIČ Miran , VESEL Alenka , PRIMC Gregor
Published: November 2021

The characteristics of an innovative configuration of multiple radiofrequency (RF) coils immersed in a large metallic chamber are presented. Water-cooled copper coils were mounted within the slits of double-walled glass tubes, which were immersed into a stainless-steel chamber. The coils were connected in parallel to a gamma-type matching network, powered by an RF generator operating at industrial frequency. Adjustable leads enabled optimisation of the line impedances and thus uniformly distributed RF power across the four coils. Transitions from E- to H-mode and vice versa were measured for all coils at various oxygen pressures between 5 and 25 Pa. A uniform plasma was sustained in H-mode at the absorbed power threshold, which increased monotonously with increasing pressure in the metallic chamber. All coils exhibit the same E- to H-mode transition hysteresis and need the same amount of power for transitioning from E- to H-mode. The setup enables maintaining uniform plasma in virtually any number of coils at high power without the risk of arcing and without the dead volume typical for a classical configuration with coils mounted outside the metallic chamber.
Microwave preionization and electron cyclotron resonance plasma current startup in the EXL-50 spherical tokamak
Authors: CHEN Bin , ZHU Yubao , ZHOU Qing , DING Jiangbo , SONG Xianming , SONG Shaodong , YANG Yuanming , ZHAO Xin , YANG Enwu , LIU Minsheng
Published: November 2021

Preionization has been widely employed to create initial plasma and help the toroidal plasma current formation. This research focuses on implementing a simple, economical and practical electron cyclotron resonance (ECR) preionization technique on the newly constructed EXL-50 spherical tokamak, and evaluating the effectiveness on improving the plasma current startup. Two types ECR microwave preionization experiments for the plasma initialization without the central solenoid are reported: (1) 2.45 GHz microwave preionization and current startup with 2.45 GHz ECR source; (2) 2.45 GHz microwave preionization and current startup with 28 GHz ECR source. Application of the 2.45 GHz ECR microwave preionization to the experiments has contributed to (1) getting rid of the plasma breakdown delay; (2) the significant improvement of the discharge quality: the discharge is much longer and more stable while the driven plasma current is larger, compared to the discharge without preionization.
Strichartz Estimates for Wave Equations with Charge Transfer Hamiltonians
Authors: Chen Gong
Published: November 2021

We prove Strichartz estimates (both regular and reversed) for a scattering state to the wave equation with a charge transfer Hamiltonian in

R

3

\mathbb {R}^{3}

:
\[
<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" alttext="partial-differential Subscript t t Baseline u minus normal upper Delta u plus sigma-summation Underscript j equals 1 Overscript m Endscripts upper V Subscript j Baseline left-parenthesis x minus ModifyingAbove v With right-arrow Subscript j Baseline t right-parenthesis u equals 0 period">

∂

t
t

u
−
Δ
u
+

∑

j
=
1

m

V

j

(
x
−

v
→

j

t
)

u
=
0.

\partial _{tt}u-\Delta u+\sum _{j=1}^{m}V_{j}\left (x-\vec {v}_{j}t\right )u=0.

\]
The energy estimate and the local energy decay of a scattering state are also established. In order to study nonlinear multisoltion systems, we will present the inhomogeneous generalizations of Strichartz estimates and local decay estimates. As an application of our results, we show that scattering states indeed scatter to solutions to the free wave equation. These estimates for this linear models are also of crucial importance for problems related to interactions of potentials and solitons, for example, in [Comm. Math. Phys. 364 (2018), no. 1, pp. 45–82].
Literary Theory on Acid
Authors: Fawaz Ramzi
Published: November 2021

This essay argues for the value of psychedelic experience as a framework for amplifying the social and political impacts of literature on the affective lives of readers and viewers. Psychedelics are chemical compounds that induce a hypersaturated experience of life that represents facets of the world to us in unfamiliar, intensified form. Neurochemical studies of the psychedelically “tripping” brain suggest that the experience can have wide-reaching, long-term positive outcomes including the expansion of one’s sensory apprehension of the world, a stronger ability to grapple with life’s contingency and human mortality, and the mitigation of depression, anxiety, and addiction. The author identifies several crucial ways in which literary criticism and pedagogy’s enhancement of cultural meaning making dovetails with the best aspects of psychedelic states, including the activation of readers’ and students’ aesthetic sensibilities. A psychedelically inflected criticism aims to achieve the psychedelic experience’s “blossoming of mental states” by revitalizing the literary text as a site for exploring, refining, and retuning the sensorium, thereby enriching one’s perceptual and imaginative capacities. The author unpacks how the insights of psychedelic experiences can shape distinct pedagogical and interpretative practices that respond to our current global political crises. This can potentially revivify the therapeutic value of the humanities as an institution invested in honing the creative and ethical faculties of generations of youth while attending to their long-term affective well-being.
3DFI: a pipeline to infer protein function using structural homology
Authors: Julian Alexander Thomas , Mascarenhas dos Santos Anne Caroline , Pombert Jean-François
Published: November 2021

Inferring protein function is an integral part of genome annotation and analysis. This process is usually performed in silico, and most in silico inferences are based on sequence homology approaches, which can fail when in presence of divergent sequences. However, because protein structures and their biological roles are intertwined, protein function can also be inferred by searching for structural homology. Many excellent tools have been released in recent years with regards to protein structure prediction, structural homology searches and protein visualization. Unfortunately, these tools are disconnected from each other and often use a web server-based approach that is ill-suited to high-throughput genome-wide analyses. To help assist genome annotation, we built a structural homology-based pipeline called 3DFI (for tridimensional functional inference) leveraging some of the best structural homology tools. This pipeline was built with simplicity of use in mind and enables genome-wide structural homology inferences.

Availability and implementation

3DFI is available on GitHub https://github.com/PombertLab/3DFI under the permissive MIT license. The pipeline is written in Perl and Python.

Supplementary information

Supplementary data are available at Bioinformatics Advances online.
pdCSM-GPCR: predicting potent GPCR ligands with graph-based signatures
Authors: Velloso João Paulo L , Ascher David B , Pires Douglas E V
Published: November 2021

Motivation

G protein-coupled receptors (GPCRs) can selectively bind to many types of ligands, ranging from light-sensitive compounds, ions, hormones, pheromones and neurotransmitters, modulating cell physiology. Considering their role in many essential cellular processes, they are one of the most targeted protein families, with over a third of all approved drugs modulating GPCR signalling. Despite this, the large diversity of receptors and their multipass transmembrane architectures make the identification and development of novel specific, and safe GPCR ligands a challenge. While computational approaches have the potential to assist GPCR drug development, they have presented limited performance and generalization capabilities. Here, we explored the use of graph-based signatures to develop pdCSM-GPCR, a method capable of rapidly and accurately screening potential GPCR ligands.

Results

Bioactivity data (IC50, EC50, Ki and Kd) for individual GPCRs were curated. After curation, we used the data for developing predictive models for 36 major GPCR targets, across 4 classes (A, B, C and F). Our models compose the most comprehensive computational resource for GPCR bioactivity prediction to date. Across stratified 10-fold cross-validation and blind tests, our approach achieved Pearson’s correlations of up to 0.89, significantly outperforming previous methods. Interpreting our results, we identified common important features of potent GPCRs ligands, which tend to have bicyclic rings, leading to higher levels of aromaticity. We believe pdCSM-GPCR will be an invaluable tool to assist screening efforts, enriching compound libraries and ranking candidates for further experimental validation.

Availability and implementation

pdCSM-GPCR predictive models and datasets used have been made available via a freely accessible and easy-to-use web server at http://biosig.unimelb.edu.au/pdcsm_gpcr/.

Supplementary information

Supplementary data are available at Bioinformatics Advances online.
Current State of Laboratory Automation in Clinical Microbiology Laboratory
Authors: Antonios Kritikos , Croxatto Antony , Culbreath Karissa
Published: November 2021

Background

Although it has been 30 years since the first automation systems were introduced in the microbiology laboratory, total laboratory automation (TLA) has only recently been recognized as a valuable component of the laboratory. A growing number of publications illustrate the potential impact of automation. TLA can improve standardization, increase laboratory efficiency, increase workplace safety, and reduce long-term costs.

Content

This review provides a preview of the current state of automation in clinical microbiology and covers the main developments during the last years. We describe the available hardware systems (that range from single function devices to multifunction workstations) and the challenging alterations on workflow and organization of the laboratory that have to be implemented to optimize automation.

Despite the many advantages in efficiency, productivity, and timeliness that automation offers, it is not without new and unique challenges. For every advantage that laboratory automation provides, there are similar challenges that a laboratory must face. Change management strategies should be used to lead to a successful implementation. TLA represents, moreover, a substantial initial investment. Nevertheless, if properly approached, there are a number of important benefits that can be achieved through implementation of automation in the clinical microbiology laboratory. Future developments in the field of automation will likely focus on image analysis and artificial intelligence improvements. Patient care, however, should remain the epicenter of all future directions and there will always be a need for clinical microbiology expertise to interpret the complex clinical and laboratory information.
Evidence
Authors: Munday Roderick
Published: November 2021

Titles in the Core Text series take the reader straight to the heart of the subject, providing focused, concise, and reliable guides for students at all levels. Written by leading academics and renowned for their clarity, these concise texts explain the intellectual challenges of each area of the law. Evidence provides students with a succinct yet thought-provoking introduction to all of the key areas covered on undergraduate law of evidence courses. Vibrant and engaging, the book sets out to demystify a traditionally intimidating area of law. Probing analysis of the issues, both historical and current, ensures that the text contains a thorough exploration of the ‘core’ of the subject. The book covers: the relevance and admissibility of evidence; presumptions and the burden of proof; witnesses: competence, compellability and various privileges; the course of the trial; witnesses’ previous consistent statements and the remnants of the rule against narrative; character and credibility; evidence of the defendant’s bad character; the opinion rule and the presentation of expert evidence; the rule against hearsay; confessions; drawing adverse inferences from a defendant’s omissions, lies or false alibis; and identification evidence. A clearly structured introduction, this is the ideal text for any student who may find evidence a somewhat forbidding subject.
Courtesy Stigma Management: Social Identity Work among China’s “Leftover Women”
Authors: Liu Chihling , Kozinets Robert V
Published: November 2021

Prior consumer research has tended to focus on identity-related stigma management of individuals toward their own stigma. However, little is known about the consumption-related identity work that stigmatized individuals undertake to discharge the courtesy stigma attached to close associates such as family members. Courtesy stigma refers to the discredit directed toward people who are closely associated with a stigmatized individual or group. Drawing on interview, ethnographic, and netnographic data on China’s ‘Leftover Women,’ our research analyzes the personal and, more centrally, the social identity work related consumption counternarratives that these women construct—through combinations of specific kinds of consumption and gift-giving practices—to counteract family and courtesy stigma. Counternarratives are the resistance stories that people tell and live to either implicitly or explicitly challenge the dominant cultural narrative. The findings of our investigation help to build an enhanced understanding of how stigmatized individuals act as consumers in the market and via digital channels to tackle the family identity challenges of courtesy stigma that have not been explored in extant studies of consumer stigma identity work.
Fatty acid secretion by the white-rot fungus,Trametes versicolor
Authors: Hao Guyu , Barker Guy C
Published: November 2021

Fungi can acquire and store nutrients through decomposing and converting organic matter into fatty acids. This research demonstrates for the first time that the white-rot fungus Trametes versicolor has the ability to secrete extracellular droplets which can contain a high concentration of long-chain fatty acids and unsaturated fatty acids as well as monosaccharides and polysaccharides. The concentration and composition of the fatty acids varied according to the age of the droplet and the feedstock used for growth of the fungi. The results raise the possibility that these droplets could be harvested offering a new approach for the microbial generation of oil from waste.
The HrpX Protein Activates Synthesis of the RaxX Sulfopeptide, Required for Activation of XA21-Mediated Immunity to Xanthomonas oryzae pv. oryzae
Authors: Joe Anna , Stewart Valley , Ronald Pamela C.
Published: November 2021

Upon encountering a susceptible plant host, a bacterial pathogen expresses specific virulence factors. For example, in planta, the Xanthomonas HrpX protein activates transcription of roughly 150 genes encoding components of the type III secretion system or its translocated effectors, as well as other secreted proteins implicated in pathogenesis. Here, we show that X. oryzae pv. oryzae growth in planta or in HrpX-inducing XOM2 media resulted in HrpX-dependent transcription of the raxX and raxST genes that control production of the RaxX sulfopeptide, exported through a type I secretion system. The RaxX protein is required for activation of XA21-mediated immunity in Xa21+ rice lines. We identified potential plant-inducible promoter elements upstream of the likely 5′ ends of the raxX and raxST transcripts. Deletions and nucleotide substitutions confirmed that these elements are required for HrpX-dependent expression of raxX and raxST. We conclude that raxX-raxST gene expression is induced by HrpX during growth in planta and, therefore, is coordinately expressed with other genes required for pathogenesis.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Postoperative Pain and Age: A Retrospective Cohort Association Study
Authors: van Dijk Jacqueline F. M. , Zaslansky Ruth , van Boekel Regina L. M. , Cheuk-Alam Juanita M. , Baart Sara J. , Huygen Frank J. P. M. , Rijsdijk Mienke
Published: November 2021

Background

As the population ages, the number of elderly people undergoing surgery increases. Literature on the incidence and intensity of postoperative pain in the elderly is conflicting. This study examines associations between age and pain-related patient reported outcomes and perioperative pain management in a dataset of surgical patients undergoing four common surgeries: spinal surgery, hip or knee replacement, or laparoscopic cholecystectomy. Based on the authors’ clinical experience, they hypothesize that pain scores are lower in older patients.

Methods

In this retrospective cohort, study data were collected between 2010 and 2018 as part of the international PAIN OUT program. Patients filled out the International Pain Outcomes Questionnaire on postoperative day 1.

Results

A total of 11,510 patients from 26 countries, 59% female, with a mean age of 62 yr, underwent one of the aforementioned types of surgery. Large variation was detected within each age group for worst pain, yet for each surgical procedure, mean scores decreased significantly with age (mean Numeric Rating Scale range, 6.3 to 7.3; β = –0.2 per decade; P ≤ 0.001), representing a decrease of 1.3 Numeric Rating Scale points across a lifespan. The interference of pain with activities in bed, sleep, breathing deeply or coughing, nausea, drowsiness, anxiety, helplessness, opioid administration on the ward, and wish for more pain treatment also decreases with age for two or more of the procedures. Across the procedures, patients reported being in severe pain on postoperative day one 26 to 38% of the time, and pain interfered moderately to severely with movement.

Conclusions

The authors’ findings indicate that postoperative pain decreases with increasing age. The change is, however, small and of questionable clinical significance. Additionally, there are still too many patients, at any age, undergoing common surgeries who suffer from moderate to severe pain, which interferes with function, supporting the need for tailoring care to the individual patient.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Effect of Global Ventilation to Perfusion Ratio, for Normal Lungs, on Desflurane and Sevoflurane Elimination Kinetics
Authors: Baumgardner James E. , Kretzschmar Moritz , Kozian Alf , Hachenberg Thomas , Schilling Thomas , Larsson Anders , Hedenstierna Göran
Published: November 2021

Background

Kinetics of the uptake of inhaled anesthetics have been well studied, but the kinetics of elimination might be of more practical importance. The objective of the authors’ study was to assess the effect of the overall ventilation/perfusion ratio (VA/Q), for normal lungs, on elimination kinetics of desflurane and sevoflurane.

Methods

The authors developed a mathematical model of inhaled anesthetic elimination that explicitly relates the terminal washout time constant to the global lung VA/Q ratio. Assumptions and results of the model were tested with experimental data from a recent study, where desflurane and sevoflurane elimination were observed for three different VA/Q conditions: normal, low, and high.

Results

The mathematical model predicts that the global VA/Q ratio, for normal lungs, modifies the time constant for tissue anesthetic washout throughout the entire elimination. For all three VA/Q conditions, the ratio of arterial to mixed venous anesthetic partial pressure Part/Pmv reached a constant value after 5 min of elimination, as predicted by the retention equation. The time constant corrected for incomplete lung clearance was a better predictor of late-stage kinetics than the intrinsic tissue time constant.

Conclusions

In addition to the well-known role of the lungs in the early phases of inhaled anesthetic washout, the lungs play a long-overlooked role in modulating the kinetics of tissue washout during the later stages of inhaled anesthetic elimination. The VA/Q ratio influences the kinetics of desflurane and sevoflurane elimination throughout the entire elimination, with more pronounced slowing of tissue washout at lower VA/Q ratios.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Systemic Immunosuppression for Prevention of Recurrent Tendon Adhesions
Authors: Mailey Brian , O’Shea Grace , Romanelli Michael , West Bradley
Published: November 2021

Background:

The recovery for patients after tendon repair is frequently limited by development of tendon adhesions. This scar tissue formation is dependent on immune system activation. Tacrolimus has unique properties that may contribute to the prevention of overactive scarring by inhibition of inflammatory cytokines.

Methods:

Herein, we present a case using systemic immunosuppression to prevent recurrent adhesion accumulation in a patient with a prior spaghetti wrist injury. Tacrolimus began 1 week before repeat-secondary tenolysis surgery, and it continued for 3 months postoperative. Dosing was tapered to a serum level between 5 and 8 µg/L.

Results:

The 27-year-old male patient suffered a volar wrist laceration transecting all flexor tendons and volar wrist nerves. He underwent immediate repair but had a poor outcome despite early range of motion therapy. A primary tenolysis only improved his average arc of finger motion from 72 to 95 degrees. Secondary tenolysis augmented with systemic tacrolimus improved his arc of finger motion from 95 to 202 degrees. Mechanistically, tacrolimus prevents proper function of activated T and B cells. This results in decreased proliferation, angiogenesis, and cytoskeletal organization of fibroblasts on inflammation and integrin adhesions, and it potentially explains the reduced tendon molecule adhesions seen in this patient.

Conclusions:

Tacrolimus may be effective in reducing motion, limiting tendon adhesions. The novel use of this medication resulted in the return of near-normal hand function in a patient placed on low-dose tacrolimus after primary tenolysis had failed.
Subtotal Nasal Reconstruction in a 91-year-old Patient: Expanded Double Forehead Flaps and Costal Cartilage
Authors: Nakajima Yuta , Iwasawa Motonao , Mishima Yoshito
Published: November 2021

Nasal reconstruction in very elderly patients is challenging. We attempted subtotal nasal reconstruction with an expanded double forehead flap and autologous costal cartilage support in a 91-year-old woman presenting with subtotal nasal defects after sebaceous carcinoma resection. Only small parts of the bilateral alae and the columella base remained after resection, and the frontal area of the septum was also resected. We planned to use an expanded double forehead flap to reconstruct the whole external skin cover and lining of the nose. We chose a 200-mL tissue expander and injected 152 mL of saline over 15 weeks. The expansion course in this patient was slower than that in younger patients because of the limited expansibility of her forehead skin. However, the skin tolerated the repeated expansions well, and the double forehead flap was expanded to the planned size preoperatively. The nasal support grafts were composed of the L-strut and alar battens from the eighth and ninth costal cartilages, and were fixed using nonabsorbable sutures. Histological examination revealed cartilage matrix degeneration and a reduced number of living chondrocytes, yet no calcification or fragility. After 18 months of follow-up, the framework maintained its shape, and the dorsum was straight without warping. The autologous costal cartilage provided a natural nasal shape and nostrils. Thus, an expanded double forehead flap with careful tissue expansion and a rib cartilage graft can allow natural nose reconstruction without a microvascular technique in very elderly patients.
Minimally Invasive Micro Sclerostomy (MIMS) Procedure: A Novel Glaucoma Filtration Procedure
Authors: Geffen Noa , Kumar Dhivya A. , Barayev Edward , Gershoni Assaf , Rotenberg Michael , Zahavi Alon , Glovinsky Yoseph , Agarwal Amar
Published: November 2021

Précis:

Intermediate-term results suggest that ab interno Minimally Invasive Micro Sclerostomy (MIMS) stent-less subconjunctival filtration procedure is a promising treatment option for patients with open-angle glaucoma (OAG).

Purpose:

MIMS is a novel ab interno, stent-less, subconjunctival filtration procedure. This study set to investigate the safety, performance, and efficacy of MIMS in OAG patients.

Methods:

Prospective, open-label, single arm clinical trial with intrasubject comparisons. Study participants were adults with OAG who were candidates for a filtration procedure. Patients were operated by a single surgeon (A.A.) in Chennai, India. Following mitomycin-C pretreatment, ab interno MIMS procedure was performed alone or combined with phacoemulsification surgery. Procedure-related complications and adverse events were assessed. Primary outcomes: patients (%) achieving an intraocular pressure (IOP) ≥5 mm Hg and ≤18 mm Hg, and an IOP reduction of >20% as compared with baseline, with or without hypotensive medications, with no need for recurrent surgery.

Results:

Twenty-one phacoemulsification-MIMS and 10 standalone MIMS procedures were performed. Mean age was 63.94±6.33 years. Mean duration of MIMS was 1:58±0:25 (min:s). Scleral tunnels were achieved in all cases. No device malfunctions, intraoperative complications, or serious adverse events were reported. Five (16.12%) patients presented with iris clogging 1 to 24 weeks following procedure. Two were treated with laser and 3 required trabeculectomy. Mean IOP change from baseline at 24 weeks was 47.4% (31.2 to 16.4 mm Hg, P<0.0001, n=23). The mean difference was −14.8 mm Hg (95% confidence interval: −17.6, −11.9) with no statistically significant differences between groups. Qualified success was achieved in 21 (84%), 17 (74%), and 13 (93%) after 12, 24, and 52 weeks, respectively. Complete success was achieved in 17 (68%), 13 (57%), and 8 (57%) after 12, 24, and 52 weeks, respectively.

Conclusions:

The interim results suggest that MIMS procedure may be a simple and effective surgical option for early OAG patients requiring target IOP in high teens although iris clogging of incision site is the major concern with this procedure.
Outcomes of Resident Performed Hydrus, iStent, and Kahook Glaucoma Procedures in a Predominantly African American Population
Authors: Meer Elana , Liu Tianyu , Hua Peiying , Ying Gui-shuang , Miller Eydie , Lehman Amanda
Published: November 2021

Précis:

This retrospective study characterized the efficacy and safety of 3 different microinvasive glaucoma surgery (MIGS) procedures in a predominantly African American population at the Philadelphia Veterans Affairs Hospital (Hydrus, Kahook, iStent), demonstrating no significant difference in intraocular pressure (IOP) and medication reduction between the 3 at long-term follow-up.

Purpose:

To compare the efficacy and safety of 3 different MIGS procedures in a predominantly African American population.

Methods:

Retrospective cohort study of patients undergoing cataract extraction combined with 1 of 3 MIGS procedures (Hydrus, iStent, Kahook) at the Philadelphia Veterans Affairs Medical Center between January 1, 2015 and November 1, 2020. Analysis of variance and regression models were used to compare reduction in IOP and medication use among 3 MIGS types.

Results:

A total of 123 eyes of 112 patients were included, including 56 (45.5%) eyes for Hydrus, 40 (32.5%) eyes for iStent, and 27 (22.0%) eyes for Kahook. Adjusted mean IOP reduction was greater for Hydrus at postoperative day 1 (−4.49 vs. −1.76 for iStent and −1.69 for Kahook, P=0.05 and greater for Kahook at postoperative week 1 (−2.53 vs. +0.70 for iStent vs. −1.41 for Hydrus, P=0.02), but did not differ significantly between MIGS types at subsequent postoperative visits (all P>0.05). In multivariable analysis, MIGS type was not significantly associated with reduction in IOP or medication use at 9 to 12 months postoperatively. There were no significant differences in complication rates across MIGS types.

Conclusion:

In this study, the difference in IOP lowering and medication reduction postoperatively between the Hydrus, iStent, and Kahook was not statistically significant after postoperative day 1. More studies are needed to evaluate outcomes of MIGS surgeries in glaucoma populations of different disease severity.
Multiple Systemic Vascular Risk Factors Are Associated With Low-Tension Glaucoma
Authors: Funk Robert O. , Hodge David O. , Kohli Darrell , Roddy Gavin W.
Published: November 2021

Précis:

Multiple systemic vascular-associated conditions including systemic hypertension and hypotension, diabetes mellitus, migraine headache, peripheral vascular disease, Raynaud syndrome, and anemia were associated with low-tension glaucoma.

Purpose:

The purpose of this study was to identify systemic risk factors associated with low-tension glaucoma.

Patients and Methods:

A retrospective case-control study design was employed to identify patients seen at the Mayo Clinic Department of Ophthalmology between 2005 and 2015 with low-tension glaucoma and an age-matched and sex-matched control group, each containing 277 patients.

Results:

The low-tension glaucoma group had more myopic refractive errors (−1.6 vs. −1.0 D, P<0.001), lower intraocular pressure (14.2 vs. 15.2 mm Hg, P<0.001), and a higher cup-to-disc ratio (0.7 vs. 0.3, P<0.001). The low-tension glaucoma group was significantly less likely to be obese (body mass index >30, P=0.03). This group had a significantly higher prevalence of systemic hypertension [odds ratio (OR): 1.64, P=0.004], diabetes mellitus (OR: 3.01, P<0.001), peripheral vascular disease (OR: 2.61, P=0.009), migraine headache (OR: 2.12, P=0.02), anemia (OR: 2.18, P=0.003), systemic hypotension (OR: 4.43, P<0.001), Raynaud syndrome (OR: 3.09, P=0.05), and angiotensin-converting enzyme inhibitor (OR: 1.64, P=0.01) or calcium channel blocker use (OR: 1.98, P=0.004). After adjusting for systemic hypertension, calcium channel blocker use remained significant (OR: 1.70, P=0.03). No significant difference was found between groups with respect to hyperlipidemia, obstructive sleep apnea, coronary artery disease, carotid stenosis, stroke, or statin, angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, beta-blocker, or metformin use.

Conclusions:

Multiple vascular-associated conditions were associated with low-tension glaucoma including systemic hypertension, diabetes mellitus, peripheral vascular disease, migraine headache, Raynaud syndrome, anemia, systemic hypotension, and calcium channel blocker use. This study strengthens the evidence for the vascular hypothesis of low-tension glaucoma.
A Double-Blind, Placebo-Controlled Trial of Bupropion Add-on to Olanzapine or Risperidone in Overweight Individuals With Schizophrenia
Authors: Weizman Shira , Shelef Assaf , Bloemhof Bris Esther , Stryjer Rafael
Published: November 2021

Background

Weight gain due to antipsychotics is a challenging clinical problem because, to date, no effective pharmacological strategies have been found. Bupropion is often used in people with schizophrenia for smoking cessation and is well tolerated. However, studies on its use as weight loss treatment are scarce. The aim of the study was to examine the effectiveness of bupropion as a single weight loss treatment in overweight individuals maintained on long-term olanzapine or risperidone.

Methods

This randomized, double-blind, placebo-controlled, 8-week study included 26 overweight (body mass index ≥27 kg/m2) individuals with schizophrenia maintained on olanzapine (10–20 mg/d) or risperidone (2–4 mg/d). Participants were randomly allocated to a study group that received bupropion (150–300 mg/d) or to a placebo group. The positive and Negative Syndrome Scale and the Clinical Global Impression–Severity Scale were used to assess severity of psychosis at baseline and end of study (8 weeks).

Results

Bupropion addition, but not placebo, was associated with a significant reduction in body weight. Severity of psychotic symptoms was not altered in either group.

Conclusions

The results demonstrate the efficacy of bupropion, compared with placebo, in patients maintained on chronic treatment with olanzapine or risperidone, both known to be major contributors to significant weight gain.
Overview of Sport-Specific Injuries
Authors: Scanaliato John P. , Wells Matthew E. , Dunn John C. , Garcia E’Stephan J.
Published: November 2021

Athletes are at risk for a variety of injuries not typically sustained in everyday life. The team physician must be capable of not only identifying and treating injuries as they occur, but he or she must be armed with the knowledge to minimize the risk of injuries before they occur. This review serves to provide an overview of the various sport-specific injuries typically encountered by team physicians. Injuries are grouped by body part and/or organ system, when possible. We do not aim to cover in detail the various treatments for these injuries; rather, we hope that this article provides a comprehensive overview of sport-specific injury, and demonstrate the well-roundedness in skills that must be possessed by team physicians.
Rates and timing of short-term complications following operative treatment of tibial shaft fractures
Authors: Upfill-Brown Alex , Hwang Richard , Clarkson Sam , Brodke Dane , Devana Sai , Mayer Erik , Kelley Benjamin , Arshi Armin , Lee Christopher
Published: November 2021

Introduction:

Tibial shaft fractures are a relatively common injury in orthopaedic surgery, with management options including intramedullary nail (IMN) fixation or open reduction internal fixation (ORIF) with plate osteosynthesis. Using a large national database, we sought to compare the prevalence and timing of short-term complications following either IMN or ORIF for tibial shaft fractures.

Methods:

The American College of Surgeons National Surgical Quality Improvement Program was used to identify patients undergoing IMN or ORIF for the treatment of tibial shaft fracture between 2012 and 2018. Multivariate Poisson hurdle regression models were utilized to determine predictors of postoperative complications as well as the timing of postoperative complications.

Results:

A total of 4963 tibial shaft fracture were identified, with 3601 patients undergoing IMN (72.6%) and 1362 undergoing ORIF (27.4%). Patients undergoing IMN had a lower mean age of 48.8 compared with 53.9 for plate osteosynthesis (P < .001). IMN patients were also more likely to be male (53.5%) compared with ORIF patients (44.2%, P < .001). In multivariate analysis, ORIF patients were significantly more likely to experience surgical site complications, including dehiscence, superficial, and deep infections (OR 2.04, P = .003). There was no difference in probability of VTE between constructs; however, patients who underwent ORIF were diagnosed with VTE earlier than those who underwent IMN (relative rate 0.50, P < .001). There was no difference between ORIF and IMN with regard to probability or timing of subsequent blood transfusion, major complications, or return to the operating room. Many patient factors, such as higher American Society of Anesthesiologists score, congestive heart failure, and hypertension, were independently associated with an increased risk of postoperative complications.

Conclusions:

Postoperative complications within 30 days are common after the surgical treatment of tibial shaft fractures. The risk of developing specific complications and the timing of these complications vary depending on numerous factors, including potentially modifiable risk factors such as the method of fixation or operative time, as well as nonmodifiable risk factors such as medical comorbidities.
Azithromycin and Major Adverse Kidney Events in Critically Ill Patients With Sepsis-Associated Acute Kidney Injury
Authors: Behal Michael L. , Nguyen Jonny L. , Li Xilong , Feola David J. , Neyra Javier A. , Flannery Alexander H.
Published: November 2021

Background:

Sepsis-associated acute kidney injury (SA-AKI) is associated with significant morbidity and mortality. Immune dysregulation is a hallmark of sepsis, with important contributions to organ dysfunction including injury and repair mechanisms in AKI. Macrolide antibiotics, such as azithromycin, have previously demonstrated in preclinical models a myriad of immunomodulatory effects that may benefit critically ill patients with SA-AKI. The aim of this study was to determine if early receipt of azithromycin in SA-AKI is associated with a reduction in major adverse kidney events (MAKE) at hospital discharge.

Methods:

This was a single center, retrospective cohort study of critically ill adult patients with SA-AKI. Early exposure to azithromycin was defined as receipt of one or more doses within 48 h of a hospital admission with SA-AKI. The primary outcome of MAKE assessed at hospital discharge was the composite of death, requirement for kidney replacement therapy, or a decline in estimated glomerular filtration rate of 25% or more. Multivariable logistic regression was used to account for potential confounders in the assessment.

Results:

Of 737 included patients with SA-AKI, 152 (20.6%) received azithromycin. Patients that received early azithromycin were less likely to experience MAKE at hospital discharge when compared to those patients not receiving azithromycin: 38.8% versus 48.4% (P = 0.035). In multivariable logistic regression, receipt of azithromycin was independently associated with a decreased odds of MAKE at hospital discharge (aOR 0.62, 95% CI 0.41–0.93).

Conclusions:

Early exposure to azithromycin in SA-AKI is independently associated with lower odds of MAKE at hospital discharge.
Screening and detection of delirium in an adult critical care setting: a best practice implementation project
Authors: de Souza-Talarico Juliana N. , da Silva Fernanda C. , de Motta Maia Flávia O. , Sichieri Karina , Cardoso Diley , Garcia Paulo , Matos Tatiane M. , Nascimento Tatiane S.
Published: November 2021

Aim:

To assess compliance with evidence-based practice regarding screening and detection of delirium in adult patients at the ICU from a university hospital.

Methods:

The compliance rates were evaluated using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tool. This strategy was designed in three phases: (1) establishing a team and conducting a baseline audit based on criteria informed by the evidence; (2) reflecting on the results of the baseline audit and designing and implementing strategies to address noncompliance found in the baseline audit informed by the JBI Getting Research into Practice framework; and (3) conducting a follow-up audit to assess the outcomes of the interventions implemented to improve practice and identify future practice issues to be addressed in subsequent audits. The implementation protocol was designed based on the primary barriers and facilitators identified in the baseline audit, allied to a training program and electronic medical records changes. Nursing documentation available in medical records from patients admitted in the ICU was used to assess the baseline and follow-up audit compliance rates.

Results:

None of the medical records evaluated before the implementation protocol showed compliance with the following audit criteria: a valid and reliable instrument is accessible in the ward environment (0%), the nursing care documentation supports that the Confusion Assessment Method for the Intensive Care Unit instrument is being used (0%) and population assessed for delirium includes all adults over the age of 65, cognitive impairment, dementia, or both, current hip fracture and severe illness (0%). After the evidence-based practice implementation, the follow-up audit revealed up to 100% compliance rates with those criteria, showing that all patients under risk were screened and assessed for delirium. The only exception was the Confusion Assessment Method for the Intensive Care Unit use, whose compliance was observed in 80.95% of the medical records.

Conclusion:

These findings support that baseline and follow-up audits allied to a delirium training program, and changes in the electronic nursing records increase the compliance rates related to the evidence-based practice for screening patients under risk and assessing delirium.
Improving care for thalassemia patients in line with best practice standards at a tertiary referral cancer care center
Authors: Bongay Leilani , Kynoch Kathryn
Published: November 2021

Background:

Beta-thalassemia major is a chronic hematological disorder that requires life-long management. This project aimed to improve thalassemia patients’ care through the implementation of best practice standards at a tertiary referral cancer care center.

Methods:

The current project utilized a clinical audit design. A pre and post-implementation audit was carried out following best practice standards for patients with thalassemia. Chart review of nine thalassemia patients was undertaken pre and post-implementation of staff education, local clinical guidelines, and an annual care plan to manage thalassemia to determine adherence to best practice standards. Data were collected between June 2019 and June 2020 at a specialist outpatient and day treatment unit located in inner Brisbane, Australia.

Results:

The pre-implementation audit results showed low compliance to the audit criteria, with the exception of nursing staff education. Following the implementation of strategies to align current care with evidence-based recommendations, the post-implementation audit showed improvement across all areas. Overall, implementation strategies were successful in improving patient care for thalassemia patients by 100%. Staff thalassemia education increased from 45 to 92%.

Conclusion:

Implementing an individualized treatment plan and thalassemia-specific nursing documentation as well as developing local clinical guidelines and providing targeted nurse education were effective strategies to improve care for thalassemia patients in line with best practice standards.