bluuebunny/crossref_metadata_2025 huggingface dataset:
Session 3: Problem-Solving Plans
Authors: Weersing V. Robin , Gonzalez Araceli , Rozenman Michelle
Published: February 2022

The goal of Chapter 3 (Session 3) is to teach Problem-Solving PLANS as a way of tackling personal problems and ultimately reducing stress. In a step-by-step approach, youth learn how to Pinpoint the problem, List out different options (brainstorm), Analyze different solution options (pros and cons), Narrow it down to one solution and make a plan, and Solve the problem by carrying out A Plan for Action and seeing how it went. This chapter includes worksheets to take youth through each step of the Problem-Solving PLANS for a personal problem as well as to make a specific plan of action to try before the next session. Chapter 3 also includes worksheets to continue mood monitoring and to develop a specific plan for between-session practice.
Session 1: Understanding Stress and Mood
Authors: Weersing V. Robin , Gonzalez Araceli , Rozenman Michelle
Published: February 2022

This chapter details the content for the first session of BBT and involves three primary goals: (1) to orient and provide an overview of treatment to youth and parent(s), (2) provide psychoeducation about stress and natural responses to stress, and (3) introduce and assign mood monitoring. First, the therapist describes the structure and goals of BBT and how this intervention might be helpful in the context of the youth’s symptoms. Next, therapists engage families in discussion to normalize stress and negative emotions, and describe how stress can be a call to action, but that stress can also lead to behaviors such as avoidance and withdrawal that may become problematic over time. The chapter ends by introducing and practicing mood monitoring as a tool to understand links between certain situations and emotions in order to identify the youth’s behavioral patterns, which will set the foundation for a plan of action throughout BBT.
Session 2: Relax Your Self and Your World
Authors: Weersing V. Robin , Gonzalez Araceli , Rozenman Michelle
Published: February 2022

Chapter 2 (Session 2) focuses on understanding and managing physical responses to stress. Youth and their families will learn about how the body responds to stress to keep us safe, and how sometimes our bodies and minds may react strongly in situations that are not actually unsafe. Youth learn a variety of skills to manage the body’s response to stress, including ways to Relax Your Self (i.e., relax your body using deep breathing and progressive muscle relaxation, and relax your mind using guided imagery) and Relax Your World (i.e., pleasant activity scheduling). This chapter provides the therapist with guidance on how to prioritize which techniques to emphasize based on each youth’s symptom presentation. At the end of the session, the therapist will work with the youth and their parent to develop a relaxation plan for the week and to continue mood monitoring.
Session 3: Problem-Solving Plans
Authors: Weersing V. Robin , Gonzalez Araceli , Rozenman Michelle
Published: February 2022

The goal of Chapter 3 (Session 3) is to teach problem-solving using the PLANS acronym and apply this skill to a problem identified by the youth. The session begins by reinforcing completion of between-session practice of relaxation and pleasant activities and then introduces the stepwise skill of problem-solving. Youth learn how to Pinpoint the problem, List out different options, Analyze different solution options, Narrow it down to one solution and make a plan, and Solve the problem by enacting the plan and evaluating how it worked. The therapist and youth work together to apply Problem-Solving PLANS to a personal problem selected by the youth and develop a specific plan of action for youth to implement before the following session. Youths may vary with regard to how many components of the PLANS they are able to complete in session; this chapter provides guidance to aid the therapist in tailoring the content to each youth.
Session 4: Developing a Master Plan
Authors: Weersing V. Robin , Gonzalez Araceli , Rozenman Michelle
Published: February 2022

Chapter 4 (Session 4) sets the foundation for the remainder of the sessions in BBT. In addition to reviewing and consolidating skills from previous sessions, this session highlights avoidance as an unhelpful habit and emphasizes graded approach behaviors as a helpful response that will ultimately decrease stress and negative emotions. The therapist, youth, and parent will work together to identify major treatment goals related to the youth’s current internalizing difficulties and begin developing the Master Plan, which lays out a plan for graded engagement toward stress-inducing situations. Importantly, this session involves a demonstration activity that youth and therapist complete together in session. The demonstration activity involves practicing a small step on the youth’s Master Plan before translating the Master Plan items into between-session practice activities for this session and each session moving forward.
Introduction
Authors: White Susan W.
Published: February 2022

ASD/Autism spectrum disorder is fairly prevalent across countries, and the number of adults affected by ASD/Autism is growing at perhaps the fastest clip ever in our history. Unfortunately, clinical research has not kept pace with the swelling population. As such, providers are left with insufficient guidance on how to provide evidence-based support and treatment. This book was developed to facilitate dissemination of the extant research on a range of therapeutic approaches for mental healthcare providers who work with adults who have ASD/Autism. The history of identification, diagnosis, and treatment of ASD/Autism in adults is covered, followed by suggestions for use of empirical research in clinical practice when addressed psychiatric co-occurring conditions.
Ensuring Accessible and Acceptable Service Delivery for Adults With Autism
Authors: Spain Debbie , White Susan W. , Musich Francisco M.
Published: February 2022

Adults with autism commonly experience mental health symptoms and co-occurring conditions. Chapters in this book highlight the wide range of evidence-based psychological therapies that can be effective for treating these and describe adaptations to enhance intervention accessibility. Alongside this, is a need to consider the context within which therapies are offered; that is, irrespective of therapeutic modality, service provision and provider input must also be tailored to the preferences and needs of adults with autism in order to maximize acceptability. This chapter outlines key overarching considerations for service providers and providers working with adults with autism.
Introduction and Rationale of Structured Clinical Management
Authors: Bateman Anthony
Published: February 2022

This chapter outlines structured clinical management (SCM) as the foundation for an effective treatment pathway for people diagnosed with personality disorder. SCM is not a specialist psychosocial treatment for a specific category of personality disorder but a psychological approach targeting the acute symptoms that make up personality disorder. Psychotherapeutic interventions that are able to create change in personality disorders share ‘three Cs’: consistency, coherence, and continuity. The approach is configured not only to deliver effective interventions but also to avoid harmful interactions between services, practitioners, and the person diagnosed with personality disorder. The majority of people diagnosed with personality disorder are treated within general mental health services rather than by specialist units.
Diagnosis, Formulation, and Assessment in SCM
Authors: Lester Rachael , Sampson Mark
Published: February 2022

This chapter reviews the history and epidemiology of the diagnosis of borderline personality disorder (BPD), including service users’ experiences of receiving the diagnosis. It then reviews how psychological formulation is used and applied to structured clinical management (SCM). Finally, the chapter reviews how the assessment process is structured, organized and delivered in the early sessions with the service user within the SCM framework.
The Clinical Stance and Individual SCM Sessions
Authors: Sampson Mark , Kayes Sharron
Published: February 2022

This chapter provides guidance on communication and ‘how to be’ when working with somebody who diagnosed with borderline personality disorder (BPD). These core qualities can be applied to all interactions including assessment, socialization, care coordination, in-patient work, and crisis management. Although ‘how to interact’ or what is often referred as the clinical stance in structured clinical management (SCM) focuses in this chapter on working with people diagnosed with BPD, these core competencies for effective communication will be invaluable for all service users. Finally, the chapter will describe how SCM problem-solving clinical sessions can be structured and delivered.
Working with Families and Carers
Authors: Chiocchi John , Slevin Paula , Evans Lisa , Gray Catriona , Armstrong Nicola , Anderson Kerry
Published: February 2022

This chapter describes a personal journey from a carer perspective that led to the development of a co-produced Peer-Led Training Programme (a carer education approach). It then provides an overview of three different models of carer programmes and family intervention sessions for people diagnosed with borderline personality disorder (BPD), as part of a structured clinical management (SCM) pathway. All three programmes were co-created by service users and their supporters and it is likely that drawing on the knowledge of both experts by experience and experts by occupation will blend helpful interventions whatever the dominant therapeutic model. Attending to both the needs of the service user’s wider support system and the resources they offer is integral to any SCM programme.
Practitioners’ Experiences of SCM
Authors: Hanmer Sarah , Potts Donna , Watts Robert , Maher Amy , McCann Isaac , Ellis Darren , Ludden John , Finch Karen , Jones Melanie , Weaving Lisa , Allam Kristine
Published: February 2022

This chapter describes a qualitative study of the experiences of structured clinical management (SCM) practitioners in UK National Health Service (NHS) services. To date, there have been no published qualitative studies of the experiences of mental health professionals providing SCM to service users with a diagnosis of borderline personality disorder (BPD). When considering the implementation and future development of an intervention, the qualitative experiences of both practitioners and service users helpfully inform high-quality improvement initiatives. It aims to help inform and shape the implementation of SCM in any type of mental health service. Analysis of the data highlights themes which demonstrates that SCM not only benefits the service user (clinical evidence) but also the practitioner and the wider system.
Lycaon pictus (Carnivora: Canidae)
Authors: Bucci Melanie E , Nicholson Kerry L , Krausman Paul R
Published: February 2022

Lycaon pictus (Temminck, 1820), the African wild dog, is a moderately sized carnivore with dog-like appearance and irregularly mottled black, yellow-brown, and white pelage. It has a head–body length of 76–112 cm, tail length of 30–41 cm, shoulder height of 61–78 cm, and body weight of 17–36 kg. Lycaon pictus has four toes on each foot, differentiating it from other canids; is the only extant species within the genus with no subspecies; and is unlikely to be confused with any other canid. Lycaon pictus was once widespread throughout sub-Saharan Africa inhabiting nearly all environments and now inhabits grasslands, montane savanna, and open woodlands. Lycaon pictus is recognized as “Endangered” (EN) by the U.S. Fish and Wildlife Service and the International Union for Conservation of Nature.
Extended sister-chromosome catenation leads to massive reorganization of the E. coli genome
Authors: Conin Brenna , Billault-Chaumartin Ingrid , El Sayyed Hafez , Quenech’Du Nicole , Cockram Charlotte , Koszul Romain , Espéli Olivier
Published: February 2022

In bacteria, chromosome segregation occurs progressively from the origin to terminus within minutes of replication of each locus. Between replication and segregation, sister loci are held in an apparent cohesive state by topological links. The decatenation activity of topoisomerase IV (Topo IV) is required for segregation of replicated loci, yet little is known about the structuring of the chromosome maintained in a cohesive state. In this work, we investigated chromosome folding in cells with altered decatenation activities. Within minutes after Topo IV inactivation, massive chromosome reorganization occurs, associated with increased in contacts between nearby loci, likely trans-contacts between sister chromatids, and in long-range contacts between the terminus and distant loci. We deciphered the respective roles of Topo III, MatP and MukB when TopoIV activity becomes limiting. Topo III reduces short-range inter-sister contacts suggesting its activity near replication forks. MatP, the terminus macrodomain organizing system, and MukB, the Escherichia coli SMC, promote long-range contacts with the terminus. We propose that the large-scale conformational changes observed under these conditions reveal defective decatenation attempts involving the terminus area. Our results support a model of spatial and temporal partitioning of the tasks required for sister chromosome segregation.
The Thirty Millimeter Telescope
Authors: Ita Yoshifusa , Ichikawa Takashi , Tsutsui Hironori , Hanaue Takumi , Komiyama Takahiro , Onozato Hiroki , Iwamatsu Atsushi , Morita Ryosuke , Habasaki Yuta , Amemiya Ryuto , Hanawa Miho , Yanagisawa Kenshi , Izumiura Hideyuki , Nakada Yoshikazu
Published: February 2022

A near-infrared telescope with an effective aperture diameter of 30 mm has been developed. The primary objective of the development is to observe northern bright stars in the J, H, and Ks bands and provide accurate photometric data on those stars. The second objective is to observe a belt-like region along the northern Galactic plane (|b| ≤ 5° and δ ≥ −30°) repeatedly, to monitor bright variable stars there. The telescope has been in use since 2016 December. The purpose of this paper is to describe the design and operational performances of the telescope, the photometric calibration methods, and our scientific goals. We show that the telescope has the ability to provide photometry with an uncertainty of less than $5\%$ for stars brighter than 7, 6.5, and 6 mag in the J, H, and Ks bands, respectively. The repeatability of the photometric measurements for the same star is better than $1\%$ for bright stars. Our observations will provide accurate photometry on bright stars that are lacking in the Two Micron Sky Survey and the Two Micron All-Sky Survey. Repeated observations at a good cadence will also reveal their nature in terms of variability in the near-infrared.
The ‘Criminalization’ of the Cop: How Incremental, Systematic Flaws Lead to Misunderstanding Police Calls for Service Involving Persons with Mental Illness
Authors: Mitchell Renèe J , Wire Sean , Balog Alan
Published: February 2022

Recently, there has been an increased push for the adoption of alternative responses to policing. With mental health calls, these efforts take the form of co-responder models, in which mental health professionals respond to calls alongside police, or more recently behavioural health teams that respond alone. For any alternative, it is important to understand the prevalence of the problem, here measured as the volume of calls. However, measuring calls involving persons with mental illness (PwMI) has been historically problematic due to data ambiguity and missing context. We partner with the Burlington Police Department in North Carolina to better identify the full universe of calls involving PwMI. Using supplementary data sources and mental health keyword identification, we find that less than half of all calls involving PwMI are identified as such in the original call. Understanding the full universe of calls has implications for resource allocation, decisions to adopt alternate responses, and providing context for the current state of interaction between police and the population of PwMI.
The Role of Patient Recovery Expectations in the Outcomes of Physical Therapist Intervention: A Systematic Review
Authors: Wassinger Craig A , Edwards D Chase , Bourassa Michael , Reagan Don , Weyant Emily C , Walden Rachel R
Published: February 2022

Objective

The purpose of this study was to determine the association between baseline patient recovery expectations and outcomes following physical therapy care.

Methods

PubMed, CINAHL Complete, PEDro, SPORTDiscus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and PsycINFO were searched from inception to February 2021. Concepts represented in the search included physical therapy, patient expectations, patient outcomes, and their relevant synonyms. Two reviewers independently screened studies of article abstracts and full texts. Eligibility criteria included English language studies that evaluated adults seeking physical therapist intervention for any health condition where both patient outcome (recovery) expectations and functional or other outcome measures were reported. Methodologic standards were assessed using the Critical Appraisal Skills Program criteria. Data were extracted using a custom template for this review with planned descriptive reporting of results. Vote counting was used to measure reported outcomes.

Results

Twenty-one studies were included in this review, representing 4879 individuals. Studies were most commonly prospective cohort studies or secondary analyses of controlled trials. Varied expectation, outcome, and statistical measures that generally link patient recovery expectations with self-reported outcomes in musculoskeletal practice were used.

Conclusion

Patient recovery expectations are commonly associated with patient outcomes in musculoskeletal physical therapy.

Impact

Evidence supports measuring baseline patient expectations as part of a holistic examination process.
A field of alternative food organizations: a study of discourses, actions and goals toward food system change in Geneva, Switzerland
Authors: Huber Johanna , Lorenzini Jasmine
Published: February 2022

While there is an abundant literature on alternative food organizations (AFOs), this research mostly consists of studies focusing on single types of food organizations. Hence, we lack a more encompassing understanding of how different types of AFOs are connected and what their collective transformative potential is within the food regime. In this article, we analyze how AFOs build a field, bring about social change collectively, and examine toward what type of change they work. Building on original survey data, network analyses and frames analyses, we propose an innovative quantitative operationalization of strategic action fields. We show that AFOs engaged in an information exchange network are more likely to hold systemic goals such as anticapitalism and food democracy than isolated AFOs. They also use more contentious action repertoires. We argue that a field of AFOs has more transformative potential than isolated organizations because they collectively challenge the status quo.
Ethyl Phloretate and Ethyl p-Coumarate: Two Phytotoxins from Valsa mali and Their Pathogenic Activities
Authors: Zhang Zhichao , Tian Runze , Zhu Liangliang , Tang Lin , Tian Xiangrong , Huang Lili
Published: February 2022

Valsa mali, the causal agent of apple Valsa canker, produces several phytotoxic metabolites to promote infection. Bioassay and 1H nuclear magnetic resonance (NMR)-guided isolation from the culture filtrate of V. mali strain 03-8 led to the identification of seven compounds including three unreported ones, ethyl phloretate (1), ethyl p-coumarate (2), and 1-p-hydroxybenzoyl glycerol (3). Compounds 1 and 2 produced significant phytotoxicity, with average lesion areas of 6.22 and 3.74 mm2, along with 2.96 and 3.47 mm2 at 1 mg/ml on mature and tissue-cultured apple leaves, respectively, whereas compound 3 did not cause any symptoms on host plants. The necrotic lesion area of compounds 1 and 2 on tobacco leaves was 52.65 and 48.28 mm2, respectively, compared with the negative control (0.46 mm2) at 1 mg/ml. At the same concentration, compounds 1 and 2 showed no significant influence on the germination rate of lettuce seeds while significantly decreasing the root length of lettuce seedlings to 6.74 and 4.67 mm, respectively, compared with that treated with sterile distilled water (22.01 mm). The discovery indicated that compounds 1 and 2 could be considered as non-host-specific toxins. Furthermore, compounds 1 and 2 could cause cell shrinkage, organelle damage, plasmolysis, and eventually ruptured protoplasmic membranes with cell death for their phytotoxicity in the host plants under optical microscopy and transmission electron microscopy. The results shed light on the mechanism for toxins 1 and 2 in V. mali-infected plants at the macroscopic and cellular levels.
Development, Validation, and Utility of Species-Specific Diagnostic Markers for Detection of Peronospora belbahrii
Authors: Standish J. R. , Góngora-Castillo E. , Bowman M. J. , Childs K. L. , Tian M. , Quesada-Ocampo L. M.
Published: February 2022

Peronospora belbahrii is an oomycete and the cause of basil downy mildew, one of the most destructive diseases affecting basil production worldwide. Disease management is challenging due to wind-dispersed sporangia and contaminated seed; therefore, identifying P. belbahrii in seed lots before sale or planting or in the field before symptoms develop could allow for timely deployment of disease management strategies. In this study, a draft genome assembly and next-generation sequencing reads for P. belbahrii, as well as publicly available DNA-seq and RNA-seq reads of several other downy mildew pathogens, were incorporated into a bioinformatics pipeline to predict P. belbahrii-specific diagnostic markers. The specificity of each candidate marker was validated against a diverse DNA collection of P. belbahrii, host tissue, and related oomycetes using PCR. Two species-specific markers were identified and used as templates to develop a highly sensitive probe-based real-time quantitative PCR (qPCR) assay that could detect P. belbahrii in leaf tissue and seed samples. Both markers were capable of reliably detecting as low as 500 fg/µl of P. belbahrii genomic DNA and as few as 10 sporangia. The qPCR assay was then validated with seed samples collected from a basil cultivar experiment. In total, 48 seed samples were collected and tested; P. belbahrii was detected in samples of all cultivars at estimated concentrations of 600 fg/µl up to 250 pg/µl and at as few as 10 sporangia up to >1,000 sporangia. The markers and assays are valuable for diagnostics and identifying P. belbahrii-contaminated seed lots to mitigate the effects of future basil downy mildew epidemics.
The Copper-Binding Protein CutC Is Involved in Copper Homeostasis and Affects Virulence in the Xylem-Limited Pathogen Xylella fastidiosa
Authors: Ge Qing , Zhu Xinyu , Cobine Paul A. , De La Fuente Leonardo
Published: February 2022

Copper (Cu) is an essential element that can be toxic if homeostasis is disrupted. Xylella fastidiosa, a xylem-limited plant pathogenic bacterium that causes disease in many economically important crops worldwide, has been exposed to Cu stress caused by wide application of Cu-containing antimicrobials used to control other diseases. However, X. fastidiosa Cu homeostasis mechanisms are still poorly understood. The potentially Cu-related protein CutC, which is involved in Cu tolerance in Escherichia coli and humans, has not been analyzed functionally in plant pathogenic bacteria. We demonstrate that recombinantly expressed X. fastidiosa CutC binds Cu and deletion of cutC gene (PD0586) in X. fastidiosa showed increased sensitivity to Cu-shock compared with wild type (WT) strain TemeculaL. When infecting plants in the greenhouse, cutC mutant showed decreased disease incidence and severity compared with WT but adding Cu exaggerated severity. Interestingly, the inoculation of cutC mutant caused reduced symptoms in the acropetal regions of plants. We hypothesize that X. fastidiosa cutC is involved in Cu homeostasis by binding Cu in cells, leading to Cu detoxification, which is crucial to withstand Cu-shock stress. Unveiling the role of cutC gene in X. fastidiosa facilitates further understanding of Cu homeostasis in bacterial pathogens.
Malnutrition and Pressure Injury Risk in Vulnerable Populations: Application of the 2019 International Clinical Practice Guideline
Authors: Munoz Nancy , Litchford Mary , Cox Jill , Nelson Jeffrey L. , Nie Ann Marie , Delmore Barbara
Published: February 2022

Nutrition plays a vital role in promoting skin integrity and supporting tissue repair in the presence of chronic wounds such as pressure injuries (PIs). Individuals who are malnourished are at greater risk of polymorbid conditions, adverse clinical outcomes, longer hospital lengths of stay, PI development, and mortality, and incur increased healthcare costs compared with patients who are adequately nourished. In addition, some patient populations tend to be more vulnerable to PI formation, such as neonates, patients with obesity, older adults, and individuals who are critically ill. Accordingly, this article aims to review the latest nutrition care recommendations for the prevention and treatment of PIs, including those recommendations tailored to special populations. A secondary objective is to translate nutrition recommendations into actionable steps for the healthcare professional to implement as part of a patient plan of care.

Implementing an evidence-based plan of care built around individualized nutrition interventions is an essential step supporting skin integrity for these populations. The 2019 Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline (CPG) affirms that meeting nutrient requirements is essential for growth, development, maintenance, and repair of body tissues. Many macronutrients and micronutrients work synergistically to heal PIs. Registered dietitian nutritionists play an important role in helping patients identify the most nutrient dense foods, protein supplements, and oral nutrition supplements to meet their unique requirements.
Tools to enhance nursing students' confidence and skills in medication administration
Authors: Robichaux Colette C. , Lewis Travis “Pete” , Gros Rhonda C.
Published: February 2022

Nursing students experience high levels of stress and anxiety, which can be evident in tasks like administering medications in the clinical setting. This article shares tools to help decrease student stress during medication administration and foster a culture of safety.
Issues in patient identification during COVID-19
Authors: Jones-Darnell Tracy
Published: February 2022

This article presents cases of patient misidentification during the onset of the COVID-19 pandemic to illustrate the critical importance of positive patient identification.
Clinical Outcomes of Corrective Fusion Surgery From the Thoracic Spine to the Pelvis for Adult Spinal Deformity at 1, 2, and 5 years Postoperatively
Authors: Arima Hideyuki , Hasegawa Tomohiko , Yamato Yu , Yoshida Go , Banno Tomohiro , Oe Shin , Mihara Yuki , Ide Koichiro , Watanabe Yuh , Nakai Keiichi , Kurosu Kenta , Matsuyama Yukihiro
Published: February 2022

Study Design.

Retrospective cohort study.

Objective.

To investigate whether patient-reported outcomes (PROs) were consistent at 2 and 5 years after corrective fusion surgery from the thoracic spine to the pelvis in patients with adult spinal deformity (ASD) and to analyze whether revision surgery affected long-term outcomes.

Summary of Background Data.

PROs up to 2 years after corrective surgeries for ASD have been well-studied, but there are few reports of mid- to long-term results.

Methods.

We retrospectively analyzed patients with ASD who underwent corrective fusion surgery from the thoracic spine to the pelvis between 2010 and 2015. We investigated radiographic parameters and PROs (Scoliosis Research Society 22r [SRS-22r], Oswestry Disability Index [ODI]) preoperatively and at 1, 2, and 5 years postoperatively, and the correlations between PROs at these time points. We also compared changes in PROs at 5 years in patients who underwent revision surgery and those who did not.

Results.

A total of 131 patients who underwent corrective fusion surgery from the thoracic spine to the pelvis were analyzed. The PROs at 1 and 5 years after surgery showed significant correlations in all SRS-22r domains (function [
r 
= 0.620], pain [
r 
= 0.577], self-image [
r 
= 0.563], mental health [
r 
= 0.589], subtotal [
r 
= 0.663], and ODI [
r 
= 0.654]). The PROs at 2 and 5 years after surgery showed significantly strong correlations in all domains (function [
r 
= 0.715], pain [
r 
= 0.678], self-image [
r 
= 0.653], mental health [
r 
= 0.675], subtotal [
r 
= 0.741], and ODI [
r 
= 0.746]). There were no significant differences in the change in PROs at 5 years in any domain in patients who underwent revision surgery (all P 
> 0.05).

Conclusion.

One-year postoperative PROs improved significantly. Two-year PROs correlated strongly with 5-year postoperative PROs, indicating that 2-year PROs can predict longer term outcomes. The need for revision surgery did not influence the mid- to long-term clinical outcomes of corrective fusion surgery for ASD.

Level of Evidence: 3
Association of Prenatal Antibiotics and Mode of Birth With Otolaryngology Surgery in Offspring
Authors: Lovern Claire , Todd Isobel M. F. , Håberg Siri E. , Magnus Maria C. , Burgner David P. , Miller Jessica E.
Published: February 2022

Background:

Pediatric otolaryngology surgery is commonly performed after recurrent infections and allergy/atopy. Prenatal antibiotic exposure and cesarean section deliveries increase the risk of severe infection and allergy/atopy in the offspring, but the relationship with common, related surgical outcomes is unknown. This study measures the associations between prenatal antibiotic use and mode of birth with common pediatric otolaryngology surgery.

Methods:

Data linkage analysis of all live-born, singleton children, born between 2008 and 2018 was done using Norwegian national health registry data. Exposures of interest were prenatal antibiotics and mode of birth. The primary outcome was common otolaryngology surgery before 10 years of age. Exposure–outcome associations were estimated through multivariable Cox proportional hazards models adjusting for predefined covariates. Interaction between exposures was explored.

Results:

Of 539,390 children, 146,832 (27.2%) had mothers who were prescribed antibiotics during pregnancy, 83,473 (15.5%) were delivered via cesarean section, and 48,565 (9.0%) underwent an otolaryngology surgery during the study period. Prenatal antibiotic exposure [adjusted hazard ratio (aHR), 1.22; 95% CI: 1.20–1.24] and cesarean section (aHR, 1.14; 95% CI: 1.11–1.16) were each associated with otolaryngology surgery after mutual adjustment. There was some evidence of an interaction between the 2 exposures (P= 0.03).

Conclusions:

Antibiotic exposure in pregnancy and cesarean section may adversely affect early immune development and increase the risk of recurrent upper airway infections and allergy/atopy that may require otolaryngology surgery. Mechanistic studies are warranted to explore genetic and/or molecular pathways that explain these findings. This may identify potential therapeutic targets to reduce the burden of otolaryngology surgery.
Pharmacodynamic Evaluation of Ampicillin-sulbactam in Pediatric Patients Using Plasma and Urine Data
Authors: Onita Tetsushu , Ikawa Kazuro , Ishihara Noriyuki , Tamaki Hiroki , Yano Takahisa , Naora Kohji , Morikawa Norifumi
Published: February 2022

Background:

We aimed to develop population pharmacokinetic (PK) models of ampicillin and sulbactam using pooled data analysis and to optimize dosing regimens of ampicillin-sulbactam (combination ratio of 2:1) in pediatric patients.

Methods:

Population PK models of ampicillin and sulbactam were separately developed by simultaneously fitting plasma and urine data from pediatric patients in 14 published studies. Based on these models, we estimated the probability of attaining a pharmacodynamic (PD) target [50% of time that free drug concentrations above the minimum inhibitory concentration, 50% fT > minimum inhibitory concentration (MIC)] against MIC90 [MIC that blocked the growth of 90% of the strains] of common bacteria in community-acquired pneumonia.

Results:

The analysis included 54 pediatric patients (0.083–16.42 years of age, 4.0–77.0 kg of body weight). A total of 284 plasma concentrations and 90 urinary excretions from 0 to 6 hours after administration were used for population PK modeling. The data were adequately described by 2-compartment models for ampicillin and sulbactam. Age was not a statistically significant covariate in the PK of either drug. The PK/PD breakpoint MICs for 45 mg/kg 3 times daily and 75 mg/kg 4 times daily (q.i.d.) were 0.25 and 1 μg/mL, respectively. For empiric therapy of community-acquired pneumonia, because MIC90 values for the main target pathogens is high (MIC90 = 2 μg/mL for Streptococcus pneumoniae and MIC90 = 4 μg/mL for Haemophilus influenzae), 75 mg/kg q.i.d. (Food and Drug Administration–approved maximum dosage in United States) might be better than 45 mg/kg 3 times daily (within approved dosage in Japan) to cover many pathogens.

Conclusions:

From the results of this PK/PD approach, 75 mg/kg q.i.d. (Food and Drug Administration–approved maximum dosage) should be recommended in the empiric therapy of community-acquired pneumonia.
Utility of Esophageal Ultrasound-guided Biopsy of Mediastinal Lymph Nodes in Diagnosis of Childhood Tuberculosis
Authors: Cohen Jonathan Marc , Banks Matthew , Kon Onn Min , Eisen Sarah
Published: February 2022

A 6-year-old boy with autistic spectrum disorder was diagnosed with tuberculosis infection following contact tracing of his mother who had isoniazid-resistant pulmonary tuberculosis. He progressed to develop mediastinal lymphadenopathy causing a persistent cough. He was too small to undergo endobronchial ultrasound-guided biopsy. As an alternative, he underwent esophageal endoscopic ultrasound-guided biopsy, leading to confirmation of the diagnosis. We believe this approach to diagnostic biopsy is underrecognized in pediatric practice, and highlight its utility with this case and a brief literature review.
Myopic outcome after intraocular lens implantation in a patient who previously had small-incision lenticule extraction
Authors: Li Xinxin , Li Shaowei , Li Luyao , Liu Chang , Li Qiumei
Published: February 2022

Introduction:

This is a report of cataract surgery in a post–small-incision lenticule extraction (SMILE) patient with low myopia.

Patient and clinical findings:

A 49-year-old man underwent bilateral SMILE 18 months previously, and the visual acuity of both eyes recovered to 20/20. The patient noticed a gradual reduction in visual acuity in his left eye and blurring for 3 months. The corrected distance visual acuity (CDVA) was 20/67 in his left eye.

Diagnosis, intervention, and outcomes:

The slitlamp examination revealed an anterior subcapsular cataract. The intraocular lens (IOL) power was calculated by using a multiformula averaging method. A standard femtosecond laser–assisted phacoemulsification cataract surgery was performed and a trifocal IOL implanted. 2 months after IOL implantation, the uncorrected distance visual acuity of the left eye was 20/33, the autorefraction values were −1.37 −0.25 × 146, and the CDVA was 20/20.

Conclusions:

This case report showed that current postrefractive IOL power calculation formulas or methods may lead to myopic outcomes in patients who previously received SMILE. A standard IOL calculation may be more suitable for such patients. Additional case studies are needed to accurately calculate IOL power after SMILE similar to laser in situ keratomileusis.
Nursing Home Staff Perceptions of End-of-Life Care for Residents With Advanced Dementia
Authors: Akunor Harriet S. , McCarthy Ellen P. , Hendricksen Meghan , Roach Ashley , Hendrix Rogers Anita , Mitchell Susan L. , Lopez Ruth Palan
Published: February 2022

Nursing homes (NHs) are an important site of death for residents with advanced dementia. Few studies have explored the experiences of NH staff about providing end-of-life care for residents with advanced dementia. This study aimed to describe NH staff perceptions on where end-of-life care should be delivered, the role of Medicare hospice care, and their experiences providing end-of-life care to residents with advanced dementia. Data from the Assessment of Disparities and Variation for Alzheimer's disease Nursing home Care at End of life study were used to explore the study objectives. Semistructured interviews with 158 NH staff working in 13 NHs across the United States were analyzed. Most NH staff endorsed the NH as a better site of death for residents with advanced dementia compared with a hospital. They expressed mixed perceptions about hospice care. However, regardless of their role, the staff expressed experiencing difficult emotions while providing end-of-life care to residents with dementia because of the close attachments they had formed with them and bearing witness to their decline. The findings show that most NH staff have strong emotional attachments to their dying residents with dementia and prefer to care for them at the NH rather than transfer them to the hospital.
Seasonality of Pediatric Mental Health Emergency Department Visits, School, and COVID-19
Authors: Copeland John Nathan , Babyak Michael , Inscoe Adrienne Banny , Maslow Gary R.
Published: February 2022

Objectives

The aim of this study was to explore how the academic calendar, and by extension school-year stressors, contributes to the seasonality of pediatric mental health emergency department (ED) visits.

Methods

The authors reviewed all pediatric mental health ED visits at a large urban medical center from 2014 to 2019. Patients who were younger than 18 years at time of presentation, were Durham residents, and had a primary payer of Medicaid were included in the sample population, and the dates of ED visits of the sample population were compared against dates of academic semesters and summer/winter breaks of a relevant school calendar. Of patients with multiple ED visits, only the first ED presentation was included, and descriptive statistics and a rate ratio were used to describe the study group and identify the rate of ED visits during semesters compared with breaks.

Results

Among the sample population from 2014 to 2019, there were 1004 first pediatric mental health ED visits. Of these ED visits, the average number of visits per week during summer/winter breaks was 2.2, and the average number of visits per week during academic semester dates was 3.4. The rate of ED visits was significantly greater during academic semesters compared with breaks (Rate Ratio, 1.6; 95% confidence interval, 1.4–2.0; P < 0.001).

Conclusions

Children may be at greater risk of behavioral health crises or having increased mental needs when school is in session. As many children's mental health has worsened during the COVID-19 (coronavirus disease 2019) pandemic, these findings highlight the need for increased mental health services in the school setting as children return to in-person learning. In addition, it may benefit health systems to plan behavioral health staffing around academic calendars.
Methodologic and Reporting Quality of Economic Evaluations in Hand and Wrist Surgery: A Systematic Review
Authors: Uhlman Kathryn , Miroshnychenko Anna , Duku Eric , Xie Feng , Thoma Achilles
Published: February 2022

Background:

Economic evaluations can inform decision-making; however, previous publications have identified poor quality of economic evaluations in surgical specialties.

Methods:

Study periods were from January 1, 2006, to April 20, 2020 (methodologic quality) and January 1, 2014, to April 20, 2020 (reporting quality). Primary outcomes were methodologic quality [Guidelines for Authors and Peer Reviewers of Economic Submissions to The BMJ (Drummond’s checklist), 33 points; Quality of Health Economic Studies (QHES), 100 points; Consensus on Health Economic Criteria (CHEC), 19 points] and reporting quality (Consolidated Health Economic Evaluation Standards (CHEERS) statement, 24 points).

Results:

Forty-seven hand economic evaluations were included. Partial economic analyses (i.e., cost analysis) were the most common (n = 34; 72 percent). Average scores of full economic evaluations (i.e., cost-utility analysis and cost-effectiveness analysis) were: Drummond’s checklist, 27.08 of 33 (82.05 percent); QHES, 79.76 of 100 (79.76 percent); CHEC, 15.54 of 19 (81.78 percent); and CHEERS, 20.25 of 24 (84.38 percent). Cost utility analyses had the highest methodologic and reporting quality scores: Drummond’s checklist, 28.89 of 35 (82.54 percent); QHES, 86.56 of 100 (86.56 percent); CHEC, 16.78 of 19 (88.30 percent); and CHEERS, 20.8 of 24 (86.67 percent). The association (multiple R) between CHEC and CHEERS was strongest: CHEC, 0.953; Drummond’s checklist, 0.907; and QHES, 0.909.

Conclusions:

Partial economic evaluations in hand surgery are prevalent but not very useful. The Consensus on Health Economic Criteria and Consolidated Health Economic Evaluation Standards should be used in tandem when undertaking and evaluating economic evaluation in hand surgery.
Transfer of a C7 Fascicle for the Pectoralis Major to the Suprascapular Nerve: A 3-Year Follow-Up Patient Series
Authors: Cambon-Binder Adeline , Belkheyar Zoubir
Published: February 2022

Background:

In patients with C5-C6 brachial plexus injury, spinal accessory nerve transfer to the suprascapular nerve is usually performed for the restoration of shoulder abduction. In order to minimize donor deficits, we transferred one fascicle of the ipsilateral C7 root, dedicated to the pectoralis major muscle, to the suprascapular nerve.

Methods:

Ten patients with a mean age of 33 years (range, 19 to 51 years) were operated on at a mean delay of 4 months after their trauma (range, 2 to 7 months). Patients had C5-C6 brachial plexus palsy with avulsed roots on spinal magnetic resonance imaging scan. In addition to the partial C7 transfer, patients sustained nerve transfers to the posterior branch of the axillary nerve and to the motor branches of the musculocutaneous nerve for the biceps and brachialis muscles.

Results:

At a mean follow-up of 36 months (range, 29 to 42 months), mean shoulder abduction and external rotation ranges of motion were, respectively, 99 degrees (range, 60 to 120 degrees; p = 0.001) and 58 degrees (range, 0 to 80 degrees; p = 0.001). In nine patients, shoulder abduction strength was graded M4, according the British Medical Research Council grading scale, against 1.6 kg (range, 1 to 2 kg), and was graded M3 in one patient. External rotation strength was graded M4 in nine patients and M3 in one patient. Residual strength of the pectoralis major muscle was graded M4+ in every patient.

Conclusions:

C7 partial transfer to the suprascapular nerve showed satisfactory results at long-term follow-up for active shoulder abduction and external rotation recovery in C5-C6 brachial plexus palsies. This technique replaced spinal accessory nerve transfer in the authors’ practice.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
The Best of Chest Wall Reconstruction: Principles and Clinical Application for Complex Oncologic and Sternal Defects
Authors: Isaac Kathryn V. , Elzinga Kate , Buchel Edward W.
Published: February 2022

Learning Objectives:

After studying this article, the participant should be able to: 1. Appraise and evaluate risk factors for respiratory compromise following oncologic resection. 2. Outline and apply an algorithmic approach to reconstruction of the chest wall based on defect composition, size, and characteristics of surrounding tissue. 3. Recognize and evaluate indications for and types of skeletal stabilization of the chest wall. 4. Critically consider, compare, and select pedicled and free flaps for chest wall reconstruction that do not impair residual respiratory function or skeletal stability.

Chest wall reconstruction restores respiratory function, provides protection for underlying viscera, and supports the shoulder girdle. Common indications for chest wall reconstruction include neoplasms, trauma, infectious processes, and congenital defects. Loss of chest wall integrity can result in respiratory and cardiac compromise and upper extremity instability. Advances in reconstructive techniques have expanded the resectability of large complex oncologic tumors by safely and reliably restoring chest wall integrity in an immediate fashion with minimal or no secondary deficits. The purpose of this article is to provide the reader with current evidenced-based knowledge to optimize care of patients requiring chest wall reconstruction. This article discusses the evaluation and management of oncologic chest wall defects, reviews controversial considerations in chest wall reconstruction, and provides an algorithm for the reconstruction of complex chest wall defects. Respiratory preservation, semirigid stabilization, and longevity are key when reconstructing chest wall defects.
Who’s Auditioning Who? Applicant-Reported Elements of the Best and Worst Plastic Surgery Subinternships
Authors: Wickenheisser Victoria A. , Langdell Hannah C. , Brown David A. , Phillips Brett T.
Published: February 2022

Background:

Many integrated plastic surgery applicants choose to complete one or more visiting subinternships or “away rotations” at programs outside of their home institution. As these rotations are so critical on both sides of the application process, the authors sought to identify the factors that influence subinternship experiences for plastic surgery applicants.

Methods:

A survey was used to collect information about demographics, the subinternship experience, and interview preferences. The survey was distributed to current plastic surgery interns and applicants who applied to Duke Plastic Surgery in the 2019/2020 application cycle.

Results:

One hundred forty-two responses were received (response rate, 35.2 percent). The mean number of subinternships completed was 4.47. The defining feature of respondents’ best subinternship most often included engagement from faculty and residents, autonomy, and integration with the team. The worst feature of respondents’ worst subinternship experience most often included a sense of disinterested or “malignant” residents and faculty, lacking operative/educational opportunities, and disorganization of the rotation. The majority of applicants (60.3 percent) would prefer to return for a standard interview day over interviewing while on rotation.

Conclusions:

The subinternship experience remains a critical part of the applicant experience when applying to integrated plastic surgery residency programs. The experience on these rotations leaves a lasting impression that is highly variable and influences future recommendations to peers. Rotating students value inclusivity and case volume, and they take note of negative interactions they witness among residents and faculty. These results can help as programs design their subinternship experience for visiting students in the future.