bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of rainfall, forage biomass, and population density, on survival and growth of juvenile kangaroos
Authors: Plaisir Charles-Alexandre , King Wendy J , Forsyth David M , Festa-Bianchet Marco
Published: November 2021

A central goal of ecology is to understand how environmental variation affects populations. Long-term studies of marked individuals can quantify the effects of environmental variation on key life-history traits. We monitored the survival and growth of 336 individually marked juvenile eastern grey kangaroos (Macropus giganteus), a large herbivore living in a seasonal but unpredictable environment. During our 12-year study, the population experienced substantial variation in rainfall, forage biomass, and density. We used structural equation modeling to determine how variation in temperature and rainfall affected juvenile survival and growth through its effect on forage biomass and population density. Independently of population density, forage biomass had strong positive effects on survival from 10 to 21 months. At low population density, forage biomass also had a positive effect on skeletal growth to 26 months. Increasing maternal body condition improved rearing success for daughters but not for sons. High population density reduced skeletal growth to 26 months for both sexes. Rainfall had an increasingly positive effect on forage biomass at high temperatures, indicating a seasonal effect on food availability. Our study reveals interacting effects of environmental variation on juvenile survival and growth for a large mammal with a conservative reproductive strategy that experiences substantial stochasticity in food availability.
Effects of capture on stress-axis measures in endangered little brown bats (Myotis lucifugus)
Authors: Edwards Phoebe D , Boonstra Rudy , Bosson Curtis O , Jane Harms N , Kukka Piia M , Willis Craig K R , Jung Thomas S
Published: November 2021

Little brown bats (Myotis lucifugus) are a widely distributed species in North America that have been decimated by the fungal disease white-nose syndrome. As such, little brown bats are the focus of monitoring and research initiatives that often include capturing and handling free-ranging individuals. We examined the stress response of 198 adult female little brown bats after being captured from three bat houses, during the summer. Our objective was to inform best practices to researchers capturing and handling bats in the wild. We compared the stress response among bats held for <3 min (baseline), 15–30 min, or >30 min, and then among bats held alone or in a group with conspecifics. We measured the levels of plasma total and free cortisol, maximum corticosteroid binding capacity (MCBC), and blood glucose. Relative to baseline, total and free cortisol levels were significantly higher in bats held for 15–30 min and higher still in those held for > 30 min. Blood glucose levels were elevated after >30 min of holding. MCBC levels showed no differences among holding times. We detected a weak effect of social holding condition, with solitary-held bats having lower total cortisol levels than group-held bats, but MCBC, free cortisol, and blood glucose levels showed no effect of social holding condition. Our findings demonstrate that capture time should be minimized and suggest that little brown bats should be handled and released within 30 min of capture as means of reducing stress. Further, solitary holding did not appear to increase stress measures, which supports holding bats individually after capture, instead of in groups, to reduce risk of pathogen and parasite transmission.
March 23, 2005—Getting Finished
Authors: McQuellon Richard P.
Published: November 2021

Nell has taken a major step toward her goal of leaving this world peacefully by initiating increased contact with home hospice care. She has changed physically even more since our last visit three weeks ago. Her tumor is growing and making it more difficult for her to travel by car. However, she is able to move around her apartment with little difficulty. She has had many interactions with healthcare providers, some disturbing but most helpful. She reiterates her disappointment at her doctor’s revelation that death is not yet on the horizon. She has spiritual musings as well as questions about her own life force, which may be keeping her on earth even though she is ready to leave. She has noticed an increasing irritability, related to the discomfort she feels with the size of her tumor. She is learning to adjust her medications and habits in order to reduce pain. Telling her story to a listener is a form of medicine that gives her comfort.
May 30, 2005—Far from Home
Authors: McQuellon Richard P.
Published: November 2021

Nell requested a transfusion to boost her energy due to her low hemoglobin. During the 10-hour odyssey, she met helpful healthcare providers and saw many opportunities to express her gratitude. Al and Anna accompanied her and helped ease the distress of travel. Nevertheless, anxiety spiked badly when she discovered that her do-not-resuscitate (DNR) form was still at home, hanging prominently on the wall above her bed. Nell knew that resuscitation success rates were low for people over 65 and that her tumor would continue to grow, eventually closing off life; in any case, she does not want to be kept alive artificially. Fortunately, Anna later brought the DNR to the hospital. It acts as a security object for Nell, like the rosary she frequently holds.
June 14, 2005—Facing, Accepting and Yielding
Authors: McQuellon Richard P.
Published: November 2021

Nell greets me at the door tonight. She is thin, fading. Therese Schroeder-Sheker has described cancer patients as “disappearing slowly.” Nell’s humor is reserved tonight and her movements are slow and deliberate. She walks cautiously from the front door to the living room, nasal cannula in place, oxygen tube trailing. She offers me a Coke. I follow her to her room holding the oxygen tube and our drinks. We discuss the works of Thich Nhat Hanh and the concept of mindfulness. Nell refers to After the Ecstasy, the Laundry by Jack Kornfield. She notes that for her, after facing death, there are the tasks of daily living such as “getting this damn TV working!” Nell is a brave woman and grateful for the kind people in her life. She believes that kindness will come to her aid as she moves through to the end. She has expressed gratitude since our very first meeting.
The Ethics of Uncertainty
Authors: Johnson L. Syd M
Published: November 2021

Disorders of consciousness (DoCs) raise difficult and complex questions about the value of life for persons with impaired consciousness, the rights of persons unable to make medical decisions, and our social, medical, and ethical obligations to patients whose personhood has frequently been challenged and neglected. Recent neuroscientific discoveries have led to enhanced understanding of the heterogeneity of these disorders and patients, and focused renewed attention on the disturbingly high rate of misdiagnosis. This book examines the entanglement of epistemic and ethical uncertainty in DoCs and other medical contexts, and how they interact to create both epistemic and ethical risks. Philosopher and bioethicist L. Syd M Johnson pulls together multiple threads—the ontological mysteries of consciousness, medical uncertainty about unconsciousness, ableist bias, withdrawal of treatment in neurointensive care, and the rarely questioned view that consciousness is essential to personhood and moral status. Johnson challenges longstanding bioethical dogmas about DoC patients, and argues for an ethics of uncertainty for contexts where there is a need for decisive action in the presence of unavoidable uncertainty. The ethics of uncertainty refocuses ethical inquiry concerning persons with DoCs, placing less emphasis on their contested personhood, and more on inductive risk and uncertainty, on respect for autonomy, and especially on epistemic justice, and the duties of privileged epistemic agents. It is an approach with applications beyond brain injury, encouraging an expansive and humane approach that enables surrogate decision makers facing fraught, complex, risky choices to fulfill their obligations as moral and epistemic agents.
Uncertainty
Authors: Johnson L. Syd M
Published: November 2021

The relatively brief history of disorders of consciousness has seen two epistemic eras—the first was marked by certainty, both ethical and epistemic, about the vegetative state. The second era has been notable for its epistemic and ethical uncertainty. This chapter looks at the 21st century neuroscientific revolution in disorders of consciousness and its ongoing reverberations. Uncertainty about these disorders continues to increase. There are ontological and epistemic doubts about behavioral diagnosis, which looks for the contents of consciousness, or local states of consciousness, while trying to capture the global states of consciousness that are of most diagnostic and ethical interest. The scientific and medical uncertainty, and the high rate of misdiagnosis, complicate ethical decision-making for patients with these disorders.
Upstream/Downstream
Authors: Johnson L. Syd M
Published: November 2021

Withdrawal of life-sustaining treatment is the leading factor in deaths after brain injuries: 64 to 92 percent of neurointensive care deaths occur after treatment withdrawal, most within the first 72 hours after injury. There is risk inversion in the way the upstream and downstream ethical risks are weighed for comatose patients. The inversion occurs when more certain risks are undertaken upstream (in neurointensive care) to avoid less certain, more speculative risks downstream. These are ethical risks—the upstream risk is that withdrawing life-sustaining treatment soon after a brain injury will result in death, and a lost opportunity to survive and live a good and flourishing life. The downstream risk is that the patient will survive, but in a condition that is unacceptable to them. The upstream/downstream problem is a wicked problem, where each solution can create new problems. Whether the risks can, and should, be reinverted is the question.
Moral Status and the Consciousness Criterion
Authors: Johnson L. Syd M
Published: November 2021

The Consciousness Criterion is the claim that moral status requires consciousness, or that being conscious is a necessary condition for being a person. The idea that consciousness imbues an entity with special value, or moral status, is widely accepted in Western cultures. So much so that it is hardly questioned. It should be questioned. This chapter shows that the Consciousness Criterion fails for two reasons: 1) consciousness is not a moral property, and consciousness alone is not sufficient to ground moral properties (like being autonomous, or being a moral agent), and 2) conscious creatures cannot be identified with certainty, so consciousness is not epistemically robust enough to undergird personhood or moral status. Thus consciousness cannot be a necessary condition for being a person. The moral status project of deciding who is and is not a person is rejected as uninformative concerning what is ethically permissible.
Epidemiological Health Information
Authors: Vaughan J Patrick , Victora Cesar , R Chowdhury A Mushtaque
Published: November 2021

Epidemiological health information is vital for planning and managing health services. This chapter examines importance of different diseases, local health surveillance systems and availability of data and how to use it. Information is reviewed for typical patterns of morbidity, mortality, and burden of disease. Local epidemiological data are useful to estimate expected numbers of cases, geographical access to health facilities, quality of services, and the coverage achieved for different programmes. Importance of understanding seasonality on health data and indicators of inequalities is explained. A local health information checklist is given.
Data Processing and Analysis
Authors: Vaughan J Patrick , Victora Cesar , R Chowdhury A Mushtaque
Published: November 2021

Data only becomes useful information when it has been analysed and the information has been processed, analysed, and interpreted. Small datasets of 100 or less subjects can be analysed quickly by hand. Data analysis starts with one-, two-, and three-way tables with the analysed data then summarized as percentages, proportions, range, averages, median, and standard deviation. Correlation measures associations between two variables and multiple variables may need to be analysed using regression techniques. Age and sex standardization is usually needed when comparing survey or reported data from two or more different populations. Analysis using computer programmes, such as EpiInfo, is useful for surveys.
Sacroiliac Joint Pain
Authors: Abd-Elsayed Alaa , Sayed Dawood
Published: November 2021

Lower back pain attributed to the sacroiliac joint (SIJ) is prevalent but historically has been frequently underdiagnosed. Even when the SIJ is properly identified as a source of lower back pain, individuals suffering from SIJ dysfunction are often not treated effectively. Improved educational resources for clinicians based on effective evidence-based treatments for SIJ dysfunction are critical in improving the current gap in diagnosis and treatment. Several established and emerging treatments exist for patients with SIJ dysfunction, but prior to this text, no comprehensive resource has existed that addressed management of SIJ dysfunction. This text presents a full and up-to-date review of all the available treatments for SIJ dysfunction, with the aim of providing clinicians with a single comprehensive resource for treatment of their patients.
Complications of peripheral nerve stimulation for sacroiliac pain
Authors: Hughes Meghan Cantlon , Abd-Elsayed Alaa
Published: November 2021

This chapter will look at complications of peripheral nerve stimulation (PNS) by stratifying them into three distinct categories: hardware-related complications (lead migration or fracture, connection issues, and premature battery depletion), biologic complications (infection), and programming or therapy-related complications. Today, the complications related to current PNS procedures are rare and minor. Hospital admission is exceedingly unlikely. Every new device on the market is working not only to improve performance but also to mitigate risks such as lead migration and infection. Also included in this chapter is background information about how the procedure and the hardware have evolved over the years, leading to improved performance and fewer complications.
Postoperative care
Authors: Latif Usman , Concannon Tyler , Frazier Andrew
Published: November 2021

This chapter discusses postoperative recommendations, including ambulation, wound care, antibiotic guidelines, and follow-up interval, for patients who have undergone open surgical SIJ fusion versus minimally invasive (MIS) SIJ fusion. Postoperative care varies widely based on the surgical approach. In particular, patients undergoing MIS are less likely to be admitted, ambulate sooner, have a shorter period of less stringent restrictions, and have faster wound healing with fewer complications. These benefits are due to a variety of factors including shorter incision length, less tissue disruption, decreased operating time, and less blood loss. This benefit is most pronounced with approaches that do not involve the use of hardware. Patients undergoing open surgery typically progress through a 4- to 5-month phased plan of progressive physical therapy. In contrast, patients undergoing MIS, particularly percutaneous SIJ fusion with bone allograft, are able to ambulate immediately and have a short period of mild restrictions followed by return to normal activity. The advent of new surgical techniques and less invasive solutions for SIJ fusion is leading the way to an easier postoperative recovery period for patients.
What if fusion fails?
Authors: Kalia Hemant
Published: November 2021

Minimally invasive sacroiliac joint fusion and fixation are effective treatment options for chronic low back pain that is mediated by sacroiliac joint pathology. Numerous factors related to either the patient or the device/fusion approach can predispose to fusion failure. It is imperative to identify these modifiable risk factors and address them appropriately. Currently, there is a dearth of literature regarding optimal treatment options in cases of sacroiliac joint fusion failure. Treatment options for sacroiliac joint fusion failure such as neuroablation, neuromodulation, and surgical revision, either open or using minimally invasive technique, can be considered in patients with sacroiliac joint fusion failure.
Waisted: The Biology of Body Fat
Authors: Denton Nathan
Published: November 2021

Waisted outlines the fascinating and misunderstood biology of fat (i.e., adipose tissue). This controversial, much-maligned organ plays a crucial yet curiously overlooked role in the global obesity crisis currently wreaking havoc on the world’s healthcare systems and economies. Attaining a better appreciation of the biology of fat, its social meanings, and how these intersect is essential for improving the world’s physical and mental health. Far from being a passive layer of blubber under the skin, fat plays a highly dynamic role in energy metabolism, reproductive health, and immunity, with these links having ancient origins in the evolution of modern humanity. Waisted provides a comprehensive, evidence-based perspective on the biology of fat and its crucial role in human evolution, health, disease, and society. Waisted draws upon biomedical, epidemiological, and evolutionary research to understand adipose tissue biology and the striking relationship between body fat distribution and health outcomes. Waisted demonstrates the practical implications of key conceptual points through relatable real-world cases and highlights how seemingly disparate common and rare diseases may be underpinned by adipose tissue dysfunction. Overall, Waisted covers a wide breadth of material that challenges and reframes the generally negative perspective of fat to highlight the underappreciated importance of adipose tissue biology in humans.
Defining Your Shape
Authors: Denton Nathan
Published: November 2021

Fat defines our body shape and our body shape often reflects our biological destiny. The regional distribution of fat emerges from the complex interplay between many players, particularly hormones, genetics, and epigenetics. Several external factors can shift this dynamic balance though, such as exercise or drugs (by design or as an unintended side effect), whereas surgical interventions that modify regional fat mass can have good, bad, or ugly consequences. This chapter draws upon the concepts introduced in previous chapters to understand how a number of different factors and interventions influence body fat distribution and considers the associated health consequences.
Oxford Handbook of Medical Ethics and Law
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

The Oxford Handbook of Medical Ethics and law provides a practical and accessible guide to the legal and ethical issues which a medical professional might face. It explains the major ethical theories - consequentialism, deontology, virtue ethics and principlism -and presents a method for moral decision-making, based on the application of theory and critical reasoning. The books sets out the key legal principles governing medical practice including the obtaining of consent; the law of negligence; the principles of confidentiality; the law on organ donation; and the legal regulation of end of life. The book goes on to present a number of ‘real life’ situations in which the ethical and legal principles are applied in a concrete and clear way. The book also contains extracts from the key legislation governing the practice of medicine.
Critical reasoning
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter explores the process of moral reasoning. It explains that often moral judgements are complex. There is no single rule that can be used to identify the correct answer. The chapter explains what makes a good or bad moral argument. It explores how different approaches can be combined to resolve an ethical dilemma.
Key articles of law
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter introduces the concept of human rights and some of the key rights recognised in English law. This includes rights such as the right to life, liberty, freedom from torture and inhuman treatment, privacy and respect for private and family life. It also explores the importance concept of discrimination and the commitment the law to ensure that people are not discriminated against in respect of their rights.
Ethico-legal issues by medical specialism A–M
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter covers Ethico-legal issues by medical specialism and includes topics on the following subjects (A-M): Anaesthetics: Child refusing treatment, Cardiac Surgery: Candour, Dentistry: Gillick Competence, Dermatology; a right to treatment?, Diabetology: Maintaining clinical records, Elderly Care: Refusal of Treatment, Emergency Department: Knife Crime, Emergency Department: Restraint/Self-Defence, Endocrinology: Wishes/Feelings, ENT: Consent/Necessity, Family Planning: Gillick Competence, Gastroenterology: Mental Health Act, General Practice: Cultural Circumcision, General Surgery: Need for clinicians to keep up to date, Genetics: Confidentiality, Gynaecology: abortion, HIV: Confidentiality, Intensive Care: DNACPR, Interventional Radiology: Relative Risks, and Maxillofacial: Candour.
Abortion Act 1967
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter covers the Abortion Act 1967 and includes topics on The Regulation of Abortion and Conscientious objection to abortion.
Gender Recognition Act 2004
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter covers the Gender Recognition Act 2014 and the subject of Gender recognition.
Surrogacy Arrangements Act 1985
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter covers the Surrogacy Arrangements Act 1985 and includes topics on Surrogacy and Prohibition of Commercial Surrogacy.
MODELLING THE EXPOSURE OF RESIDENTS OF A RADIUM-CONTAMINATED LIVING PLACE
Authors: Murith Christophe , Di Tommaso Gennaro , Estier Sybille , Flury Thomas , Palacios-Gruson Martha , Stalder Claudio , Baechler Sébastien
Published: November 2021

Within the framework of the Swiss Radium Action Plan 2015–22, which aims to investigate and remediate sites contaminated by the radium used in the Swiss watch industry, a reference level of 1 mSv per y has been defined for the exposure of residents. An additional protection objective has been set for soil contamination, which should not exceed the value of 1000 Bq per kg 226Ra. Based on measurements on the study sites, the doses received by residents were calculated accordingly to the methodology, in both indoor and outdoor areas, taking into account external exposure and ingestion. The site diagnosis approach consists of a screening procedure based on a rapid measurement, followed, if necessary, by additional analysis to estimate doses. Sites where modelling indicates that the reference level or the complementary protection objective for soil contamination have been exceeded are subject to remediation. The application of the methodology based on these radiological criteria to 752 sites diagnosed until December 2020 indicates a rate of sites (buildings and outdoor areas) requiring remediation of ~16%. The annual doses to residents calculated by modelling are between 1 and 20 mSv per y for these sites.
Environmental exposures: evolving evidence for their roles in adult allergic disorders
Authors: Harada Kaoru , Miller Rachel L.
Published: November 2021

Purpose of review

Allergic disorders are the result of complex interactions between genetic predisposition and environmental exposures. Elucidating how specific environmental exposures contribute to allergic diseases in adults is crucial, especially as the world population ages in a rapidly changing environment.

Recent findings

The effects of environmental exposures on allergic diseases remain understudied in adults. Although epidemiological studies suggest various environmental exposures are associated with the development and exacerbation of allergic diseases, further longitudinal studies are needed across various age groups in adults to pinpoint the exposures of concerns and the time windows of susceptibility. Mechanistic studies in adults are few. A multicomponent strategy targeting several allergens has been conditionally recommended for asthma, but recent findings on mitigation strategies remain limited.

Further research on how environmental exposures cause and exacerbate allergic disorders is needed in adults, particularly across disease phenotypes. The effects of mitigation strategies against environmentally induced adult allergic diseases remain large research gaps. A better understanding of how and which environmental exposures contribute to allergic disorders is necessary to identify patients who are at higher risk and would benefit from specific interventions.
Temporal Transitions in Fibrinolysis after Trauma: Adverse Outcome Is Principally Related to Late Hypofibrinolysis
Authors: Rossetto Andrea , Vulliamy Paul , Lee Kim May , Brohi Karim , Davenport Ross
Published: November 2021

Background

The relationship between late clinical outcomes after injury and early dynamic changes between fibrinolytic states is not fully understood. The authors hypothesized that temporal transitions in fibrinolysis states using rotational thromboelastometry (ROTEM) would aid stratification of adverse late clinical outcomes and improve understanding of how tranexamic acid modulates the fibrinolytic response and impacts mortality.

Methods

The authors conducted a secondary analysis of previously collected data from trauma patients enrolled into an ongoing prospective cohort study (International Standard Randomised Controlled Trial Number [ISRCTN] 12962642) at a major trauma center in the United Kingdom. ROTEM was performed on admission and at 24 h with patients retrospectively grouped into three fibrinolysis categories: tissue factor–activated ROTEM maximum lysis of less than 5% (low); tissue factor–activated ROTEM maximum lysis of 5 to 15% (normal); or tissue factor–activated ROTEM maximum lysis of more than 15% (high). Primary outcomes were multiorgan dysfunction syndrome and 28-day mortality.

Results

Seven-hundred thirty-one patients were included: 299 (41%) were treated with tranexamic acid and 432 (59%) were untreated. Two different cohorts with low-maximum lysis at 24 h were identified: (1) severe brain injury and (2) admission shock and hemorrhage. Multiple organ dysfunction syndrome was greatest in those with low-maximum lysis on admission and at 24 h, and late mortality was four times higher than in patients who remained normal during the first 24 h (7 of 42 [17%] vs. 9 of 223 [4%]; P = 0.029). Patients that transitioned to or remained in low-maximum lysis had increased odds of organ dysfunction (5.43 [95% CI, 1.43 to 20.61] and 4.85 [95% CI, 1.83 to 12.83], respectively). Tranexamic acid abolished ROTEM hyperfibrinolysis (high) on admission, increased the frequency of persistent low-maximum lysis (67 of 195 [34%]) vs. 8 of 79 [10%]; P = 0.002), and was associated with reduced early mortality (28 of 195 [14%] vs. 23 of 79 [29%]; P = 0.015). No increase in late deaths, regardless of fibrinolysis transition patterns, was observed.

Conclusions

Adverse late outcomes are more closely related to 24-h maximum lysis, irrespective of admission levels. Tranexamic acid alters early fibrinolysis transition patterns, but late mortality in patients with low-maximum lysis at 24 h is not increased.

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Clinical characteristics and distribution of paediatric hand fractures at a tertiary hospital in South China: a retrospective analysis
Authors: Zhi Xinwang , Xie Dongming , Yang Haiyi , Hong Kai , Chen Weidong , Xu Hongwen , Canavese Federico , Zhou Qinghe
Published: November 2021

The aim of this study was to evaluate the characteristics of paediatric hand fractures (PHF) at a tertiary hospital in South China based on sex, age, mechanism of injury and anatomical region. A retrospective observational study was performed on children aged 15 years and younger who were referred for actual or suspected hand fractures between January 2016 and December 2020. Medical records and radiographs were reviewed for age at the time of injury, sex, site and fracture pattern and mechanism of injury. A total of 436 consecutive children with 478 hand fractures were reviewed. Hand fractures was more common in boys (281/436; 64.4%) than in girls (155/436; 35.6%), although most fractures occurred in children aged 0–3 years (198/436; 45.4%). Distal phalanges were the most commonly injured bones (184/478; 38.5%), and the base fractures were most common (151/476; 31.7%); the fifth digit was most commonly injured (150/478; 31.3%). Crush injuries were the leading cause of fracture in children younger than 6 years of age (207/325; 63.7%), whereas punch injuries were the major cause of injury in older age groups (55/153; 35.9%); 60.1% of the fractures were managed nonsurgically. This study showed patterns of PHF in a tertiary hospital in South China. It illustrates the local variability across sex, age group, injury type and injury mechanism. Such demographic data will be valuable for optimally resourcing healthcare systems locally and help guide prevention policies.
Approaches to the problem of nonidentifiability in the age-period-cohort models in the analysis of cancer mortality: a scoping review
Authors: Perea Lillia Magali Estrada , Antunes José Leopoldo Ferreira , Peres Marco A
Published: November 2021

Aiming to detect age, period and cohort effects in cancer mortality, age-period-cohort models (APC) can be applied to distinguish these effects. The main difficulty with adjusting an APC model involving age, period and cohort factors is the linear relationship between them, leading to a condition known as the ‘nonidentifiability problem’. Many methods have been developed by statisticians to solve it, but there is not a consensus. All these existing methods, with their advantages and disadvantages, create confusion when choosing which one of them should be implemented. In this context, the present scoping review intends not to show all methods developed to avoid the nonidentifiability problem on APC models but to show which of them are, in fact, applied in the literature, especially in the cancer mortality studies. A search strategy was made to identify evidence on MEDLINE (PubMed), Scopus, EMBASE, Science Direct and Web of Science. A total of 46 papers were analyzed. The main methods found were: Holford’s method (n = 14; 30%), ntrinsic estimator (n = 10; 22%), Osmond & Gardner method n = 8; 17%), Carstensen (n = 6;13%), Bayesian approach (n = 6;13%) and others (n = 2; 5%). Even with their limitations, all methods have beneficial applications. However, the decision to use one or another method seemed to be more related to an observed geographic pattern.
Functional Surgery for Subungual Melanoma: Surgical Tips Based on Histological Analysis of 21 Cadavers
Authors: Kim Byung Jun , Kim Jinhyun , Hu Julong , Kwak Yoonjin , Kwon Sung Tack
Published: November 2021

BACKGROUND

Amputation has been the standard treatment for subungual melanoma. Although there is growing attention toward a more conservative functional surgery, specific operative techniques are not yet available.

OBJECTIVE

We aimed to provide objective measurements for use in functional surgery by analyzing the anatomy of the nail apparatus obtained from 21 cadavers.

MATERIALS AND METHODS

Nailbed thickness was histologically measured in each subunit, and skin surface anatomy was evaluated to determine the proximal resection margin. Immunohistochemical staining was performed to analyze microvessel distribution according to the nail subunit.

RESULTS

The nailbed thickness was the thinnest at the most proximal point of the nail matrix (thumbs, 1.10 ± 0.42 mm; big toes, 1.15 ± 0.37 mm) and the thickest at the hyponychium (thumbs, 2.86 ± 0.82 mm; big toes, 2.72 ± 0.84 mm). The distance from the eponychium to the skin surface closest to the bony cortex of extensor tendon insertion was 6.92 ± 5.13 mm in thumbs and 5.14 ± 1.59 mm in big toes. The median microvessel density was the highest at the hyponychium (25.74 vessels/mm2) and lowest at the germinal matrix (16.26 vessels/mm2) (p < .05).

CONCLUSION

This histological study offers practical tips, including those to help decide the proximal and deep resection margins, in functional surgery.
Evaluation of Device-Based Cutaneous Channels Using Optical Coherence Tomography: Impact for Topical Drug Delivery
Authors: Wang Jordan V. , Mehrabi Joseph N. , Zachary Christopher B. , Geronemus Roy G.
Published: November 2021

BACKGROUND

Topical medications play a large role in the management of cutaneous diseases, but penetration is limited. Device-assisted drug delivery using mechanical destruction, lasers, and other energy-based modalities can increase penetration and absorption through creation of transcutaneous channels.

OBJECTIVE

To examine real-time, in vivo cutaneous changes in response to various devices used to improve topical drug delivery through optical coherence tomography (OCT) imaging.

METHODS AND MATERIALS

Treatment was performed with 8 medical devices, including mechanical destruction, lasers, and other energy-based modalities. Optical coherence tomography was used for real-time, noninvasive, in vivo imaging.

RESULTS

Using OCT, microneedling and radiofrequency microneedling demonstrated no cutaneous channels. Both low-energy, low-density, fractional nonablative lasers produced transient channels, which closed within hours. The fractional nonablative 1,927-nm thulium fiber and 1,550-nm erbium fiber lasers created channels with epidermal debris within, which were still closing at 24 hours. The fractional thermomechanical ablative device and the fractional ablative CO2 laser produced channels that were still open at 24 hours. CO2 laser channels had thick rims of coagulated tissue and remained open for longer.

CONCLUSION

Demonstrable differences among the devices were seen, and only some can produce observable channels, the characteristics of which vary with each technology.
Case Report of Conjunctival Melanoacanthoma
Authors: Rao Nitya , Reed Donovan , Epstein Aliza , Wang Min , Silberman Mark , Durairaj Vikram
Published: November 2021

Purpose:

The purpose of this study was to describe a case of conjunctival melanoacanthoma, an exceedingly rare condition that has yet to be fully described in the literature.

Methods:

Melanoacanthomas are most commonly seen on the skin or oral mucosa and are believed to result from local irritation or trauma. A 34-year-old Hispanic man presented with a painless, solitary, pigmented conjunctival lesion, in addition to bilateral pterygia suggesting chronic solar damage. The lesion was excised and sent for analysis.

Results:

Histopathologic analysis of tissue samples demonstrated melanocyte proliferation and epithelial dysplasia, yielding a final pathologic diagnosis of conjunctival melanoacanthoma with dysplastic and acantholytic-type features. The patient is being closely followed and has not had recurrence of the lesion.

Conclusions:

Only 1 prior case of conjunctival melanoacanthoma has been documented. As such, there is no standard of care regarding appropriate management.
Interactions between cannabinoid and opioid receptors in a mouse model of diabetic neuropathy
Authors: Toniolo Elaine F. , Gupta Achla , Franciosi Adriano C. , Gomes Ivone , Devi Lakshmi A. , Dale Camila S.
Published: November 2021

Diabetic neuropathy, often associated with diabetes mellitus, is a painful condition with no known effective treatment except glycemic control. Studies with neuropathic pain models report alterations in cannabinoid and opioid receptor expression levels; receptors whose activation induces analgesia. We examined whether interactions between CB1R and opioid receptors could be targeted for the treatment of diabetic neuropathy. For this, we generated antibodies that selectively recognize native CB1R-MOR and CB1R-DOR heteromers using a subtractive immunization strategy. We assessed the levels of CB1R, MOR, DOR, and interacting complexes using a model of streptozotocin-induced diabetic neuropathy and detected increased levels of CB1R, MOR, DOR, and CB1R-MOR complexes compared with those in controls. An examination of G-protein signaling revealed that activity induced by the MOR, but not the DOR agonist, was potentiated by low nanomolar doses of CB1R ligands, including antagonists, suggesting an allosteric modulation of MOR signaling by CB1R ligands within CB1R-MOR complexes. Because the peptide endocannabinoid, hemopressin, caused a significant potentiation of MOR activity, we examined its effect on mechanical allodynia and found that it blocked allodynia in wild-type mice and mice with diabetic neuropathy lacking DOR (but have CB1R-MOR complexes). However, hemopressin does not alter the levels of CB1R-MOR complexes in diabetic mice lacking DOR but increases the levels of CB1R-DOR complexes in diabetic mice lacking MOR. Together, these results suggest the involvement of CB1R-MOR and CB1R-DOR complexes in diabetic neuropathy and that hemopressin could be developed as a potential therapeutic for the treatment of this painful condition.
Health-Related Quality of Life in Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention: A Cross-Sectional Study
Authors: KIM Yujeong
Published: November 2021

Background

The percutaneous coronary intervention (PCI) is the most common treatment for coronary artery disease. Health-related quality of life (HRQoL), alongside mortality and recurrence rates, is a key outcome indicator for PCI.

Purpose

The aim of this study was to investigate the factors influencing HRQoL in patients with coronary artery disease who had received PCI.

Methods

A convenience sample from the cardiovascular center of a tertiary hospital in South Korea was recruited for this descriptive, cross-sectional study. This study was conducted using a structured questionnaire and patients' medical records on a sample of 210 patients with coronary artery disease who were ≥ 18 years old and > 1 month post-PCI. The questionnaire collected information on general, clinical, and psychosocial characteristics. Data were analyzed using descriptive statistics, independent t test, one-way analysis of variance, the Scheffé test, and the Pearson correlation test. A multiple linear regression, together with the significant variables in univariate analysis, was used to determine the variables that significantly influenced HRQoL.

Results

HRQoL was found to vary significantly with age, marital status, subjective economic status, primary caregiver, duration since first PCI, New York Heart Association class, anxiety, depression, and social support. The significant general characteristics shown to affect HRQoL in patients who had undergone PCI included age, marital status, and primary caregiver. The significant clinical characteristics shown to affect HRQoL included duration from first PCI and New York Heart Association class. The significant psychosocial characteristics shown to affect HRQoL included anxiety and depression. Primary caregiver and New York Heart Association class were identified as having the greatest impact on HRQoL in the PCI patients in this study.

Conclusions

To enhance HRQoL in patients who had received PCI, their post-PCI physical and psychological symptoms should be regularly assessed. Furthermore, intervention strategies aimed to improve quality of life in patients with severe functional limitations and those receiving family care are necessary.
Long Working Hours and Risk of Depression by Household Income Level
Authors: Park Min Young , Lee Jongin , Kim Hyoung-Ryoul , Lee Yu Min , Ahn Joonho , Lee Dong-Wook , Kang Mo-Yeol
Published: November 2021

Objectives:

To investigate the relationship between working hours and the risk of depression according to household income level.

Methods:

We used the data from the Korea National Health and Nutrition Examination Survey. The information on working hours was obtained from the questionnaire, and depression was assessed by The Patient Health Questionnaire-9. After stratifying by household income level, the risk of depression for long working hour group (more than or equal to 52 hours a week), compared with the 30 to 51 working hour group as a reference, were calculated using multiple logistic regression.

Results:

It was found that long working hours associated with high risk for depression in the group with the highest income, but not in the group with the lowest income.

Conclusions:

The relationship between long working hours and the risk of depression varied by household income level.
Obesity and myosteatosis: the two characteristics of dynapenia in patients with cirrhosis
Authors: Sugiyama Yoshiaki , Ishizu Yoji , Ando Yusuke , Yokoyama Shinya , Yamamoto Kenta , Ito Takanori , Imai Norihiro , Nakamura Masanao , Honda Takashi , Kawashima Hiroki , Ishikawa Tetsuya , Ishigami Masatoshi
Published: November 2021

Objective

In patients with liver cirrhosis, the clinical characteristics of dynapenia, a condition in which skeletal muscle mass is maintained but muscle strength is reduced, are not yet known. This study aimed to clarify the characteristics of dynapenia and its impact on quality of life (QOL) in patients with liver cirrhosis.

Methods

We retrospectively analyzed 116 patients with cirrhosis. Based on grip strength and skeletal muscle mass measured by the bioelectrical impedance analysis method, patients were divided into four groups: normal muscle status, dynapenia, pre-sarcopenia (a condition involving only low muscle mass), and sarcopenia. The characteristics of dynapenia and its influence on QOL were examined.

Results

Fourteen patients had dynapenia. Liver function did not differ among the four groups. In patients with dynapenia, BMI was highest and computed tomography attenuation of skeletal muscle at the third lumbar spine vertebra was lowest among the four groups. The percentage of patients with both BMI ≥25 kg/m2 and myosteatosis was significantly higher in patients with dynapenia [9/14 (64.3%)] than in those with sarcopenia [2/23 (8.7%), P = 0.004] and pre-sarcopenia [0/18 (0%), P < 0.001] and tended to be higher than those with normal muscle status [16/61 (26.2%), P = 0.065]. The physical QOL in patients with dynapenia was as low as that in those with sarcopenia and significantly lower than that in those with normal muscle status.

Conclusion

Cirrhotic patients with dynapenia had high BMI and myosteatosis, and impaired physical QOL.
Histo‐Blood Group Antigens, Enteropathogen Carriage and Environmental Enteropathy in Stunted Zambian Children
Authors: Chandwe Kanta , Zyambo Kanekwa , Mulenga Chola , Haritunians Talin , Amadi Beatrice , Kosek Margaret , Heimburger Douglas C. , McGovern Dermot , Kelly Paul
Published: November 2021

Objectives:

Stunting, the most common form of childhood undernutrition, is associated with environmental enteropathy (EE). Enteric infections are believed to play a role in the pathophysiology of EE and stunting though the exact mechanism remains undetermined. The FUT2 (secretor) and FUT3 (Lewis) genes have been shown to be associated with some symptomatic enteric infections in both children and adults. These genes are responsible for the presence of histo‐blood group antigens (HBGAs) in various secretions and epithelial surfaces.

We evaluated whether the secretor and Lewis status influences asymptomatic enteric infections and thus EE severity on duodenal biopsies of stunted children.

Methods:

In this case‐control study, we used saliva samples to determine the secretor and Lewis status of stunted children (cases, n = 113) enrolled in a nutritional rehabilitation program and from their well‐nourished counterparts (controls, n = 42). Where available, saliva was also collected from the mothers. Baseline stool samples were used to detect asymptomatic enteropathogen carriage. Duodenal biopsies were collected from a subgroup of stunted children (n = 77) who had an upper gastrointestinal endoscopy done as part of the evaluation process for their non‐response to nutritional therapy.

Results:

The proportion of secretors was similar between the cases and the controls (82% vs 81%, P = 0.81). The stunted children had significantly higher rates of carrying multiple enteropathogens, but this was not associated with their secretor status nor that of their mothers. The secretor status was also not associated with mucosal morphometry of duodenal biopsies.

Conclusion:

This case‐control analysis in Zambian children does not support the hypothesis that fucosylation status determines asymptomatic enteropathogen carriage in stunting.
Depression and Anxiety in Adult Persons With Epilepsy and Their Caregivers
Authors: Tsamakis Konstantinos , Teagarden Diane L. , Villarreal Hannah K. , Morton Matthew L. , Janocko Nicholas J. , Groover Olivia , Loring David W. , Drane Daniel L. , Karakis Ioannis
Published: November 2021

This study evaluated the rates of depression and anxiety and their determinants in adult persons with epilepsy and their caregivers. Both completed surveys about demographic, disease-related, and psychosocial characteristics. One hundred patients and caregivers participated. A mood disorder was present in 89% of patients and 56% of caregivers. In the univariate analysis, the presence of mood disorder in the patient was associated with being unmarried, unemployed, frequent hospitalizations, side effects from polypharmacy, patient stigma, patient quality of life, caregiver anxiety, and caregiver burden. In the multivariate analysis, medication side effects sustained as an important determinant. In the univariate analysis, the presence of mood disorder in the caregiver was associated with seizure frequency, patient anxiety, patient quality of life, caregiver stigma, and caregiver burden. In the multivariate analysis, patient anxiety level and caregiver burden sustained as important determinants. Adult persons with epilepsy and their caregivers experience high rates of mood disorders, explained by certain clinical factors.