bluuebunny/crossref_metadata_2025 huggingface dataset:
In Response to COVID-19: Current Trends in Orthopaedic Surgery Sports Medicine Fellowships
Authors: Liles Jordan L. , Danilkowicz Richard , Dugas Jeffrey R. , Safran Marc , Taylor Dean , Amendola Annunziato “Ned” , Herzog Meredith , Provencher Matthew T. , Lau Brian C.
Published: February 2021

Background:

The COVID-19 (SARS-COV-2) pandemic has brought unprecedented challenges to the health care system and education models. The reduction in case volume, transition to remote learning, lack of sports coverage opportunities, and decreased clinical interactions have had an immediate effect on orthopaedic sports medicine fellowship programs.

Purpose/Hypothesis:

Our purpose was to gauge the response to the pandemic from a sports medicine fellowship education perspective. We hypothesized that (1) the COVID-19 pandemic has caused a significant change in training programs, (2) in-person surgical skills training and didactic learning would be substituted with virtual learning, and (3) hands-on surgical training and case numbers would decrease and the percentage of fellows graduating with skill levels commensurate with graduation would decrease.

Study Design:

Cross-sectional study.

Methods:

In May 2020, a survey was sent to the fellowship directors of all 90 orthopaedic sports medicine fellowships accredited by the Accreditation Council for Graduate Medical Education; it included questions on program characteristics, educational lectures, and surgical skills. A total of 37 completed surveys (41%) were returned, all of which were deidentified. Responses were compiled and saved on a closed, protected institutional server.

Results:

In a majority of responding programs (89%), fellows continued to participate in the operating room. Fellows continued with in-person clinical visits in 65% of programs, while 51% had their fellows participate in telehealth visits. Fellows were “redeployed” to help triage and assist with off-service needs in 21% of programs compared with 65% of resident programs having residents rotate off service. Regarding virtual education, 78% of programs have used or are planning to use platforms offered by medical societies, and 49% have used or are planning to use third-party independent education platforms. Of the 37 programs, 30 reported no in-person lectures or meetings, and there was a sharp decline in the number of programs participating in cadaver laboratories (n = 10; 27%) and industry courses (n = 6; 16%).

Conclusion:

Virtual didactic and surgical education and training as well as telehealth will play a larger role in the coming year than in the past. There are effects to fellows’ exposure to sports coverage and employment opportunities. The biggest challenge will be how to maintain the element of human interaction and connect with patients and trainees at a time when social distancing is needed to curb the spread of COVID-19.
Characteristics of the First 102 Severe COVID-19 Cases Treated With Convalescent Plasma or Tocilizumab or Both in Al-Nahdha Hospital, Oman
Authors: Al Harthi Saud , Osali Magdi Al , Kindi Nasser Al , Kharusi Zahir Al , Qasabi Salim Al , Hinai Mohamed Al , Ghafri Thamra Al
Published: February 2021

Background:

In the absence of an effective vaccine, the coronavirus disease (COVID-19) continues to cause more deaths. Evidence on the effectiveness of various COVID-19 management plans is inconclusive. This paper describes the characteristics of the first 102 severe COVID-19 in-patients treated with Convalescent Plasma (CP) therapy or Tocilizumab or both at Al-Nahdha hospital in Muscat, Oman. Additionally, differences in requiring critical care were explored across the treatment groups.

Methods:

Data of all the positive cases in Al-Nahdha hospital were retrieved from the electronic health information system retrospectively from April 1st to July 31st 2020. The required information was recorded in a bespoke sheet and exported to SPSS for further analysis. The primary outcome was defined as improved (discharged home) vs worsening (requiring critical care).

Results:

Out of the 102 severe cases of COVID-19 admissions, 20.6%, 59.8% and 20.6% received CP, Tocilizumab and both respectively. In average, CP was introduced at day 3.7(4.8) whereas Tocilizumab at day 7.8(5.1) from admission. The between-group differences in the proportion of patient who improved vs worsened were not significant ( P = 0.7). However, the within-group difference in the proportion of patient who improved vs worsened was significant in the Tocilizumab treatment group ( P = 0.03). All socio-demographics were not significantly different across the treatment groups. Most improvements in the studies parameters [CBC (total WBC, Lymph and neutrophil counts), oxygen and immune response “cytokine storm” parameters] post-treatment was attributed to the use of Tocilizumab. There was a statistically significant difference in the mean hospital stay between the improved and worsened cases across all treatment categories [at the population level: 8.2(5.0) improved vs 4.7(3.7) worsened- P < 0.001].

Conclusions:

Results from this study provided baseline information about the characteristics of confirmed COVID-19 cases in Al-Nahdha hospital who received CP, Tocilizumab or both. Results obtained seems to be promising in preventing critical care, especially for Tocilizumab. However, further randomized studies are needed.
Social Literacy: Nurses’ Contribution Toward the Co-Production of Self-Management
Authors: Dubbin Leslie , Burke Nancy , Fleming Mark , Thompson-Lastad Ariana , Napoles Tessa M. , Yen Irene , Shim Janet K.
Published: February 2021

We share findings from a larger ethnographic study of two urban complex care management programs in the Western United States. The data presented stem from in-depth interviews conducted with 17 complex care management RNs and participant observations of home visits. We advance the concept of social literacy as a nursing attribute that comprises an RN’s recognition and responses to the varied types of hinderances to self-management with which patients must contend in their lived environment. It is through social literacy that complex care management RNs reconceptualize and understand health literacy to be a product born out of the social circumstances in which patients live and the stratified nature of the health care systems that provide them care. Social literacy provides a broader framework for health literacy—one that is situated within the patient’s social context through which complex care management RNs must navigate for self-management goals to be achieved.
Risk of Secondary Distress for Graduate Students Conducting Qualitative Research on Sensitive Subjects: A Scoping Review of Canadian Dissertations and Theses
Authors: Orr Elizabeth , Durepos Pamela , Jones Vikki , Jack Susan M.
Published: February 2021

Qualitative research, in the methods employed and topics explored, is emotionally demanding. While it is common for ethics protocols to protect research participants from emotional distress, the personal impact of emotional work on the researcher can often go unaddressed. Qualitative researchers, in particular graduate student researchers studying sensitive topics, are at risk of psychological effects. It is unclear, however, how this impact on the researcher is discussed in graduate student work and/or the steps taken to address this risk. To provide an overview of how impact on the researcher is considered in Canadian graduate student research, a comprehensive scoping review of dissertations was conducted. Less than 5% ( n = 11) of dissertations reviewed included a plan to mitigate psychological risk to the researcher—suggesting a need for further guidance on minimizing risk of emotional distress. The application of trauma and violence-informed principles to graduate supervision policy and practice is discussed as a promising harm mitigation strategy.
Boosting the Sustainable Representation of Women in STEM With Evidence-Based Policy Initiatives
Authors: Moss-Racusin Corinne A. , Pietri Evava S. , van der Toorn Jojanneke , Ashburn-Nardo Leslie
Published: February 2021

Women are missing from Science, Technology, Education, and Mathematics (STEM) fields, undermining intellectual inclusivity, meritocracy goals, national competitiveness, and high-quality advances. Solutions require not only hiring more women, but boosting their sustainable representation (i.e., their lasting, substantial presence and valued engagement). Evidence-based policies can shift organizational culture, enabling women’s full and durable participation. The present review presents (1) numerous causes of women’s underrepresentation in STEM and (2) evidence-based interventions to tackling these causes. Specific policy initiatives (derived from the scientific evidence) would promote the sustainable representation of women in STEM.
People Downplay Health Risks to Fulfill Their Goals: A Motivational Framework for Guiding Behavioral Policy
Authors: Kopetz Catalina , Woerner Jacqueline I.
Published: February 2021

Risky behaviors represent serious threats to health and the main causes of morbidity and mortality in the developed world. Despite known negative consequences, people continue to abuse alcohol and drugs, to smoke, overeat, engage in risky sexual behavior, and drive under the influence of alcohol and drugs. This might happen because they perceive these behaviors as the best and sometimes the only means to fulfill important goals. To understand and to prevent health-risk behavior, scientists and policy-makers should consider the function that these behaviors serve. A theoretical framework based on the principles of goal pursuit helps explain (a) why health-risk behaviors become a means to people’s goals and (b) the psychological processes that facilitate initiation and maintenance of health-risk behaviors despite known negative consequences. Principles of goal pursuit could inform policy to reduce health-risk behaviors and their negative consequences.
Changing Students’ Beliefs About Learning Can Unveil Their Potential
Authors: O’Keefe Paul A. , Lee Hae Yeon , Chen Patricia
Published: February 2021

Too often, students fall short of their potential. Although structural and cognitive factors can contribute to this underperformance, how students subjectively construe themselves and their educational contexts can also play significant roles. Social-psychological interventions can increase student motivation, resilience, and achievement by altering these construals. To provide general recommendations for their implementation, we focus on interventions that address common student concerns, which stem from maladaptive beliefs that (a) intelligence cannot be improved; (b) some academic topics are uninteresting and personally irrelevant; (c) learning is an unplanned, passive activity; and (d) others think that “people like me” do not have the potential for success. These interventions tend to be relatively brief, easily implemented, highly scalable, and low in cost, time, and labor. Through a partnership of psychological scientists and practitioners, these carefully contextualized, theory-driven interventions can help students achieve their potential.
How Risky Is That Risk Sharing Agreement? Mean-Variance Tradeoffs and Unintended Consequences of Six Common Risk Sharing Agreements
Authors: Zaric Gregory S.
Published: February 2021

Background. Pharmaceutical risk sharing agreements (RSAs) are commonly used to manage uncertainties in costs and/or clinical benefits when new drugs are added to a formulary. However, existing mathematical models of RSAs ignore the impact of RSAs on clinical and financial risk. Methods. We develop a model in which the number of patients, total drug consumption per patient, and incremental health benefits per patient are uncertain at the time of the introduction of a new drug. We use the model to evaluate the impact of six common RSAs on total drug costs and total net monetary benefit (NMB). Results. We show that, relative to not having an RSA in place, each RSA reduces expected total drug costs and increases expected total NMB. Each RSA also improves two measures of risk by reducing the probability that total drug costs exceed any threshold and reducing the probability of obtaining negative NMB. However, the effects on variance in both NMB and total drug costs are mixed. In some cases, relative to not having an RSA in place, implementing an RSA can increase variability in total drug costs or total NMB. We also show that, for some RSAs, when their parameters are adjusted so that they have the same impact on expected total drug cost, they can be rank-ordered in terms of their impact on variance in drug costs. Conclusions. Although all RSAs reduce expected total drug costs and increase expected total NMB, some RSAs may actually have the undesirable effect of increasing risk. Payers and formulary managers should be aware of these mean-variance tradeoffs and the potentially unintended results of RSAs when designing and negotiating RSAs.
Work-related extended availability, psychological detachment, and interindividual differences: A cross-lagged panel study
Authors: Thörel Eberhard , Pauls Nina , Göritz Anja S
Published: February 2021

Work-related extended availability (WREA) refers to employees being available for work-related matters during leisure time. Although studies have suggested negative effects of WREA on employee health, there is a scarcity of longitudinal research especially studies trying to disentangle how WREA may impact health. Moreover, there are only few studies dealing with interindividual differences in the effects of WREA on health. These aspects are crucial as they can help laying a foundation for interventions that help coming to terms with negative effects of WREA. The current study implemented a cross-lagged panel design with three waves to clarify how effects of WREA unfold and whether there are interindividual differences. Based on the stressor-detachment-model and person-environmental-fit theory, we proposed that (1) the relationship between WREA and sleep as well as between WREA and exhaustion is mediated by psychological detachment, and (2) that the relationship between WREA and the outcomes is moderated by segmentation preferences. In total, 528 employees (320 women, mean age = 48 years) participated in the study. Although there was a cross-lagged negative association between WREA and detachment, we did not find an indirect relationship between WREA and either sleep or exhaustion via detachment. Moreover, we did not find evidence for interindividual differences in the effects of WREA on any of the outcomes. On the basis of the negative cross-lagged relationship between WREA and detachment from work, we recommend organizations to discourage employees from WREA, because failure to regularly recover from work may lead to health issues in the long run.
Use of geodesign tools for visualisation of scenarios for an ecologically sensitive area at a local scale
Authors: Srivastava Sanjeev Kumar , Scott Gary , Rosier Johanna
Published: February 2021

This study presents methods to create past, recent and alternate scenarios for an ecologically sensitive and development prone area in a sub-tropical coastal spit. A variety of geodesign tools were used for creating interactive 3d representations of the digital earth at a local scale. The geodesign tools included existing and archived high-resolution active and passive remote sensing datasets, existing, derived and digitised spatial layers together with products of procedural modelling. The 3d representations in virtual environments of different scenarios were further converted to a diverse variety of digital formats to enable their visualisation across diverse media that included interactive 3d scenes in geographical information systems (GIS), interactive web scenes on web browsers (desktops and smart devices), fly-through in generic movie formats and real 3d visualisation in the CAVE2 environment. This study discusses the utility of all the resources for planning curriculum and the potential of these resources to facilitate an understanding of alternate scenarios for citizens, stakeholders and new learners. Finally, this study evaluates sources while critically discussing openly shared resources in the context of collaborative planning with citizens, educators, students and planners.
Book review: Into an Unborn Age: A Review of Shyamal Kumar Pramanik, The Untouchable & Other Poems
Authors: Roy Basudhara
Published: February 2021

Into an Unborn Age: A Review of Shyamal Kumar Pramanik, The Untouchable & Other Poems. Trans. by Jaydeep Sarangi and Anurima Chanda. New Delhi: Authorspress, 2020, pp. 91, ₹295 (paperback). ISBN: 978-93-90155-96-5.
Genesis, Historicity and Persistence of Dalit Protest Literature and Movements in Odisha
Authors: Malik Suratha Kumar
Published: February 2021

Even after seven decades of India’s independence, the status of the Dalits remain unchanged where caste system, along with the practice of untouchability, remains a universal phenomenon of rural India, and the state of Odisha is not an exception. Among various issues that the Dalits in the state are facing, the greatest problem is that they are not allowed to worship inside some of the temples even today, by the upper caste Hindus. Against this flagitious practice, voices from the marginalized concerned have been raised time and again. However, like other states, the state of Odisha has not witnessed a strong all-Odisha Dalit movement either in colonial or in postcolonial period. But this does not mean that Dalits in the state are silently tolerating all caste oppressions and are not conscious; rather, they have protested against the dominant castes from time to time. There are different phases of Dalit protest literature and movements in the state from precolonial period to the present day. The state has witnessed some small, sporadic and scattered Dalit movements, and protest literature against the caste system and untouchability in the past, but these remained limited within the form of literature and religion due to various reasons. In this juncture, an endeavour has been made in this article to articulate and unify these small sporadic Dalit movements and protest literatures into a theoretical account by building coherency and continuity in its nature and spirit.
Book review: Govardhan Wankhede, My Life: The Journey of a Dalit Sociologist
Authors: Nandgaye Vicky
Published: February 2021

Govardhan Wankhede, My Life: The Journey of a Dalit Sociologist. Aakar Books India Publication, 2020, 191 pp., ₹595 (Hardcover), ISBN: 978-9350026854.
Anatomical and Functional Outcomes of Relaxing Parafoveal Nasal Retinotomy for Refractory Macular Hole Repair
Authors: Tsipursky Michael S. , Byun Matthew , Jager Rama D. , Sheth Veeral S.
Published: February 2021

Purpose:

This work aimed to assess postoperative outcomes associated with relaxing parafoveal nasal retinotomy for refractory macular hole repair.

Methods:

This was a retrospective interventional study of patients with persistent or recurrent macular holes following 1 or more standard repair procedures with pars plana vitrectomy and internal limiting membrane peeling. Patients received an additional pars plana vitrectomy and relaxing parafoveal nasal retinotomy, followed by fluid-air and air-gas exchange. Key postoperative outcomes included the achievement of macular hole closure and changes in visual acuity from baseline.

Results:

Thirteen patients with refractory macular holes were included, with a median age of 65 years (range, 49-90 years). The aperture diameter of the 13 macular holes ranged from 180 to 799 µm (median, 538 µm). Vitrectomy and relaxing parafoveal nasal retinotomy were performed in all 13 eyes, and after a median follow-up of 12 months (range, 3-34 months), anatomical closure was achieved in 12 of 13 eyes (92.3%). Overall, visual acuity (mean ± SE) improved significantly from 1.20 ± 0.15 logMAR (approximate Snellen equivalent, 20/320) at baseline to 0.84 ± 0.11 logMAR (Snellen, ∼ 20/125) during postoperative follow-up ( P < .05). Central and paracentral scotomas were observed in 8 of 11 eyes with postoperative Humphrey visual field 10-2 and/or 24-2 data available.

Conclusions:

Relaxing parafoveal nasal retinotomy may be an effective method to promote anatomical closure and improve vision outcomes in patients with recalcitrant macular holes.
Procurement, finance and the energy transition: Between global processes and territorial realities
Authors: Baker Lucy
Published: February 2021

Utility-scale renewable electricity generation is essential to decarbonisation as well as to ensuring affordable and secure electricity supplies around the world. Yet thus far there has been limited critical thinking dedicated to the complexities behind the finance and ownership of this new infrastructure and how national and local stakeholders should participate in and benefit from its development, particularly in contexts of high inequality in low- and middle-income countries. As the global renewable energy industry becomes increasingly consolidated and financialised, evidence from a number of countries suggests that despite the pro-environmental outcomes of utility-scale renewable electricity generation, the processes and institutions that procure and finance it have often failed to include or benefit individuals and communities living in the national and local vicinity. This paper therefore sets two key competing objectives of renewable electricity generation in context: as a predictable, long-term revenue stream for investors, and as a mechanism for socio-economic development and community empowerment. Building on scholarship from human geography, development studies and sustainability transitions, my analysis takes forward understandings of the role of finance in utility-scale renewable electricity generation as a key aspect of the political economy of the energy transition. In exploring the evolution of renewable electricity as a new and rapidly emerging asset class I consider how its development is increasingly determined by the frameworks and logics of finance and investment. Drawing on examples from South Africa and Mexico, I address the following questions: What are the evolving configurations and processes of finance and investment in utility-scale renewable electricity generation? How have they been facilitated? And what tensions have arisen from their implementation at the national and local level?
Entrepreneurial Action and Intention: The Role of Entrepreneurial Mindset, Emotional Intelligence, and Grit
Authors: Kwapisz Agnieszka , Schell William J. , Aytes Kregg , Bryant Scott
Published: February 2021

Increasing students’ entrepreneurial mindset (EM) is one of the main goals of entrepreneurship education, which is increasingly taught across multiple disciplines. One challenge in EM education is finding an effective measure. In this work, we investigate the Engineering Student Entrepreneurial Mindset Assessment (ESEMA), which intends to measure a broad definition of EM. This paper compares the constructs of the ESEMA to those found in related measures of traits and attitudes using a sample that includes engineering students, business students, and practicing entrepreneurs. In addition to validating the instrument constructs, we explore the relationship between the ESEMA factors and measures of Emotional Intelligence (EI) and Grit. Our study confirms that the ESEMA survey loads into the six expected factors. We discover that ESEMA-Empathy and EI-Others’ Emotion Appraisal as well as EI-Use of Emotion and Grit-Perseverance are similar constructs. Additionally, our results show EM-Ideation, EM-Interest, and EI-Use of Emotion to consistently and positively relate to entrepreneurial action and intention while EM-Open Mindedness relates negatively. Overall, our study provides a better understanding of how we can measure students’ entrepreneurial mindset, differences in mindsets across disciplines and between students and practicing entrepreneurs, and the relationship of the constructs measured and entrepreneurial actions and intentions.
Strategies for active and passive pediatric RSV immunization
Authors: Eichinger Katherine M. , Kosanovich Jessica L. , Lipp Madeline , Empey Kerry M. , Petrovsky Nikolai
Published: February 2021

Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections in children worldwide, with the most severe disease occurring in very young infants. Despite half a century of research there still are no licensed RSV vaccines. Difficulties in RSV vaccine development stem from a number of factors, including: (a) a very short time frame between birth and first RSV exposure; (b) interfering effects of maternal antibodies; and (c) differentially regulated immune responses in infants causing a marked T helper 2 (Th2) immune bias. This review seeks to provide an age-specific understanding of RSV immunity critical to the development of a successful pediatric RSV vaccine. Historical and future approaches to the prevention of infant RSV are reviewed, including passive protection using monoclonal antibodies or maternal immunization strategies versus active infant immunization using pre-fusion forms of RSV F protein antigens formulated with novel adjuvants such as Advax that avoid excess Th2 immune polarization.
Effect of Structured Yoga Program on Stress and Professional Quality of Life Among Nursing Staff in a Tertiary Care Hospital of Delhi—A Small Scale Phase-II Trial
Authors: Mandal Suprakash , Misra Puneet , Sharma Gautam , Sagar Rajesh , Kant Shashi , Dwivedi SN , Lakshmy R. , Goswami Kiran
Published: February 2021

Background.

Nursing staff suffer from various level of stress and burnout. We aimed to assess the effect of 12 weeks of structured yoga on stress and the professional quality of life among nursing staff.

Design and method.

An open-label, phase-II randomized clinical trial was undertaken considering a sample size of convenience was done. In service nursing staff were randomized (1:1) to intervention group and wait-list control group. Primary outcome was perceived stress which was measured by Perceived Stress Scale (PSS). Secondary measures were professional quality measured by Professional Quality of Life (ProQOL) scale, blood pressure, serum cortisol, and high-sensitive C-reactive protein. Both the per-protocol and intention to treat analysis was done.

Results.

Total 113 participants were allocated to intervention group (n = 58, mean = 35 years, SD = 7.9 years) and wait-list control group (n = 55, mean = 32.5 years, SD = 6.8 years). After 12 weeks, 19 participants of intervention group and 32 participants of wait-list control group were included in the per-protocol analysis. Follow-up mean PSS score was 15.4 (95% CI 12.6-18.2, SD 5.8) in intervention group, 20.7 (95% CI 19.7-21.7, SD 2.8) in wait-list control group (p-value < 0.0001). The other parameters didn’t differ between the groups and from baseline to end line too.

Conclusions and relevance.

The finding showed supervised structured yoga may be efficacious to reduce stress. Studies with larger sample size are needed to confirm the findings.

Trial registration.

It was approved by the Institute Ethics Committee (Reference no: IECPG-543/20.12.2017, RT-57/31.01.2018) and was registered prospectively in the Clinical Trial Registry of India prospectively (No. CTRI/2018/02/012206).
Life story work for children and young people with care experience: A scoping review
Authors: Hammond Simon P. , Young Julie , Duddy Claire
Published: February 2021

This scoping review was undertaken to provide an overview of peer-reviewed empirical evidence concerning the undertaking of Life Story Work (LSW) with children and young people with care experience (CYPCE). Our search identified 1,336 potentially relevant publications. Of these, 24 empirical studies met our inclusion criteria and examined a wide range of practices in different countries. Using a thematic approach, key findings and characteristics related to current conceptualizations of LSW are explored and knowledge gaps identified. Our review shows that predominantly small-scale qualitative studies have been undertaken. These studies typically reported participants’ experiences and perspectives on pre-existing LSW practices (17 articles), or evaluations of innovative practices (7 articles). However, both lacked efficacy data. We identified numerous LSW practices that were consistently identified as providing “high-quality” experiences: young person-led approaches; consistent support to access and process personal information, including chronological facts, reasons for care entry and beyond; the use of artifacts; and assistance/training for carers supporting LSW. The included studies also identified practices that undermined LSW: rushed, incomplete accounts, using insensitive language that failed to include different voices from a young person’s past. The discussion appraises the findings through a critical lens and concludes that LSW is a clear priority for all and represents an intervention that has potential to help the unaddressed mental health needs of CYPCE. Unfortunately, without better evidence on how this intervention works best, for whom, over what period, and at what cost, practice cannot move forward. This paper challenges all stakeholders to realize this potential.
Air quality in the clinical embryology laboratory: a mini-review
Authors: Sciorio Romualdo , Rapalini Erika , Esteves Sandro C.
Published: February 2021

The scope of the clinical embryology laboratory has expanded over recent years. It now includes conventional in vitro fertilization (IVF) techniques and complex and time-demanding procedures like blastocyst culture, processing of surgically retrieved sperm, and trophectoderm biopsy for preimplantation genetic testing. These procedures require a stable culture environment in which ambient air quality might play a critical role. The existing data indicate that both particulate matter and chemical pollution adversely affect IVF results, with low levels for better outcomes. As a result, IVF clinics have invested in air cleaning technologies with variable efficiency to remove particulates and volatile organic compounds. However, specific regulatory frameworks mandating air quality control are limited, as are evidence-based guidelines for the best air quality control practices in the embryology laboratory. In this review, we describe the principles and existing solutions for improving air quality and summarize the clinical evidence concerning air quality control in the embryology laboratory. In addition, we discuss the gaps in knowledge that could guide future research to improve clinical outcomes.
Occurrence of a Clonal T-Cell Population in a Case of Chronic Myelomonocytic Leukemia
Authors: Patil Anupama , Wanve Balasaheb , Kar Pradeep , Velusamy Shanthi
Published: February 2021

Chronic myelo-monocytic leukemia (CMML) is an aggressive myeloid neoplasm with some features of a myelodysplastic syndrome (MDS) and others of a myeloproliferative neoplasm (MPN). Rarely, patients with CMML have a co-existing lympho-proliferative disorder (LPD). In most cases, the lymphoid neoplasm is diagnosed first, and the CMML is considered to be a secondary therapy-induced form of leukemia. We report herein a unique case of de-novo CMML, with an underlying clonal T-cell population and describe its clinical presentation and laboratory findings. A 70-year old male presented with a 3-month history of cough, dsypnea, abdominal distension, and low-grade fever. Physical and radiological examination revealed hepatosplenomegaly but no lymphadenopathy. Peripheral blood had absolute monocytosis with marrow showing CMML with 10% blasts along with dysplasia in myeloid and erythroid lineages. Flow cytometry indicated possibility of chronic myelo-monocytic leukemia with 13% monocytic cells along with an additional clonal population of gamma/delta T cells (15%) with aberrant immunophenotype. Polymerase chain reaction (PCR) analysis was positive for clonal T-cell rearrangement. A diagnosis of CMML with an underlying clonal T-CLPD was made. The synchronous occurrence of CMML and T-cell neoplasm may be attributed to a genetic mutation common to both. Currently, there are no treatment guidelines for group of patients; hence individualized therapeutic strategies should be implemented to enable symptomatic improvement and provide optimum care.
Polysomnography in the Early Consolidation Phase of Mandibular Distraction as a Tool to Identify Residual Tongue-Based Airway Obstruction and Need for Further Distraction: A Follow-Up Study
Authors: Prescher Hannes , Mokhlesi Babak , Mhlaba Julie M. , Talmage Garrick D. , Baroody Fuad M. , Bandla Hari P.R. , Reid Russel R.
Published: February 2021

Background: The objective of this study was to analyze and report our experience with using polysomnography (PSG) during the early consolidation phase of mandibular distraction osteogenesis (MDO) in patients with Pierre Robin Sequence and associated tongue-based airway obstruction with management decisions informed by the results. The secondary objective was to determine whether pre-operative PSG can predict which patients will have persistent obstructive sleep apnea (OSA) and require additional distraction. Methods: A single-surgeon, retrospective review was performed of all patients who underwent MDO for treatment of tongue-based airway obstruction over an 11-year period. Pre-operative and post-distraction 16-channel overnight bedside PSG was performed on all patients and scored according to the AASM Scoring Manual. Patients who demonstrated persistent OSA underwent further distraction and were reevaluated by PSG after final distraction length was achieved. Results: Pre-operative and post-distraction PSG was obtained and available for analysis in 37 patients. Apnea-Hypopnea Index (AHI) improved from 45.85 ± 34.41 to 9.73 ± 10.85 ( P < .001). There was evidence for persistent, severe OSA in 14 patients (38%) and persistent, moderate OSA in 6 patients (16%) in the early consolidation phase of MDO. Nine of these patients underwent additional distraction and demonstrated symptomatic resolution and quantitative improvement in all PSG measures. The group of patients that underwent additional distraction had significantly more severe baseline OSA as defined by preoperative AHI, oxygen desaturation index (ODI), and percentage of time spent below 90% SpO2. There was no significant difference in patient characteristics or pre-operative symptoms between the 2 groups. Conclusions: PSG can be performed at the bedside at the end of the distraction phase of MDO to assess for residual airway obstruction and inform the need for further distraction. Pre-operative PSG measures can help predict the need for further distraction and aid in operative planning and distractor placement.
A ground motion based procedure to identify the earthquakes that are the most relevant for probabilistic seismic hazard analysis
Authors: Anderson John G , Cotton Fabrice , Bindi Dino
Published: February 2021

A method is proposed to identify within seismic catalogs those earthquakes that are most relevant to the seismic hazard. The approach contrasts with the classical approach to decluster the seismic catalog with the expectation that the remaining main shocks will be the relevant events for the seismic hazard analysis. We apply a time window like in the window declustering approach of Gardner and Knopoff, but the time window is motivated by relevance to engineering. A ground motion criterion replaces the spatial window. An event in the time window is included in the “Maximum Shaking Earthquake Catalog (MSEQ catalog)” if the median ground motion at its epicenter exceeds the predicted median ground motion there from the main shock, using a locally appropriate ground motion prediction equation. Ground motion can be measured by any parameter that is estimated by a ground motion prediction equation. We consider peak acceleration and spectral amplitude (SA) at periods of 0.2, 1.0, and 3.0 s. The longer period parameters systematically remove more small events. The purpose is not to produce a declustered catalog, in which each group of physically related earthquakes is represented by its largest event. Statistical properties of the MSEQ catalog somewhat resemble the corresponding declustered catalog in three tested regions, but the MSEQ catalogs all retain more large-magnitude earthquakes. The MSEQ catalog may better represent the potential hazard in a region, and thus might be considered as an alternative to a declustered catalog in developing the seismicity model for probabilistic seismic hazard analysis.
Horseshoe Kidney in Conjunction With Autosomal Dominant Polycystic Kidney Disease: A Case Report
Authors: Philo Dakota
Published: February 2021

Horseshoe kidney in the presence of autosomal dominant polycystic kidney disease is a rare occurrence of two relatively common and unrelated renal findings. Visualization of multiple, bilateral cysts along with fusion of the kidneys by a midline isthmus can usually isolate these diagnoses. Accurate sonographic evaluation is essential in determining the degree of disease progression and possible complications associated with these diseases. Sonography is also useful in identifying extrarenal involvement and eliminating differential diagnoses.
Effectiveness of Bedside Sonography by Residents for Fluid Management by Inferior Vena Cava Assessment
Authors: Bhatt Manasvini , Kumar Arvind , Gupta Kartik , Halkur Shankar Sujay , Vyas Surabhi , Khan M. A. , Soneja Manish , Baitha Upendra , Jadon Ranveer S. , Wig Naveet
Published: February 2021

Objective:

To study the utility of point of care ultrasound (POCUS) in the diagnosis and management of shock when performed by medicine residents.

Methods:

A retrospective, case-control study was carried out in the medical intensive care unit at a tertiary care hospital. Consecutive patients who had received bolus fluid for hypotension during the hospital stay were screened from the case sheets and recorded.

Results:

A total of 57 patients were recruited into the study. Baseline parameters were comparable in both groups. The median amount of fluid given by the physician was 1000 milliliters (500, 1500) in the inferior vena cava (IVC) group as compared with 1000 milliliters (500, 1000) in the clinical group which was similar between the groups ( P = .51). The median quantity of fluid received in the first hour in the IVC group (500 milliliters; 75, 750) was significantly higher than in the clinical group (100 milliliters; 100, 125) ( z = 2.98; P = .003). More improvement in heart rate ( P = .0004), mean arterial pressure (MAP; P = .04), and Acute Physiology and Chronic Health Evaluation (APACHE; P = .0004) score was seen in the IVC group which was statistically significant.

Conclusion:

In this cohort, there was a significant increase in MAP, reduction in the APACHE II score, and heart rate in the IVC group when compared with the clinical group.
Cleaning the palate and tongue without nausea: a mixed methods study exploring the appropriate depth and direction of oral care
Authors: Cheng Yang , Zhou Yu-feng , Ding Ya-ping , Xing Ying , Shan Enfang , Sun Hang
Published: February 2021

Background

It is advisable to clean the palate and tongue thoroughly during oral care to protect against nosocomial infections. However, improper cleaning may cause nausea. To date, no robust data are available regarding how to implement this procedure properly. Furthermore, traditional cotton balls, forceps and normal saline are still used in clinical in China. This mixed methods study aimed to explore the appropriate depth and direction of cleaning methods for palates and tongues without causing nausea and the factors influencing cleaning depth and discomfort in traditional oral care.

Methods

Our study recruited students (n = 276) from a medical university. The first phase was a quantitative study, in which forceps were slowly inserted into their throats until the gag reflex was triggered, and then, the insertion depth was measured. After that, participants were randomly divided into two groups. In group A, palates and tongues were cleaned coronally and then sagittally, with the converse order used for group B. The extent of nausea was measured. Additionally, the qualitative data were types of discomfort other than nausea reported by the participants.

Results

The tolerable depths (without causing nausea) for cleaning the palate and tongue were 6.75 ± 1.07 cm and 6.92 ± 1.11 cm, respectively. Participants of male sex and with high BMI (overweight/obese) were associated with greater tolerable cleaning depth. The extent of nausea caused by cleaning both the palate and the tongue sagittally was higher than that elicited by coronal cleaning (p = 0.025 and p = 0.003, respectively). Other discomforts included itching, saltiness and coldness.

Conclusion

It is appropriate to increase the cleaning depth of the palate and tongue for adult males and overweight/obese individuals. Moreover, coronal cleaning causes lower levels of nausea, and traditional oral care appliances should be improved.
Functional phenotyping of the CYP2D6 probe drug codeine in the horse
Authors: Gretler S. R. , Finno C. J. , Kass P. H. , Knych H. K.
Published: February 2021

Background

In humans, the drug metabolizing enzyme CYP2D6 is highly polymorphic resulting in substantial differences in the metabolism of drugs including anti-arrhythmics, neuroleptics, and opioids. The objective of this study was to phenotype a population of 100 horses from five different breeds and assess differences in the metabolic activity of the equine CYP2D6 homolog using codeine as a probe drug. Administration of a probe drug is a common method used for patient phenotyping in human medicine, whereby the ratio of parent drug to metabolite (metabolic ratio, MR) can be used to compare relative enzyme function between individuals. A single oral dose of codeine (0.6 mg/kg) was administered and plasma concentrations of codeine and its metabolites were determined using liquid chromatography mass spectrometry. The MR of codeine O-demethylation [(codeine)/(morphine + morphine-3-glucuronide + morphine-6-glucuronide)] was determined using the area under the plasma concentration-time curve extrapolated from time zero to infinity (AUC0-∞) for each analyte and used to group horses into predicted phenotypes (high-, moderate-, and low-MR).

Results

The MR of codeine O-demethylation ranged from 0.002 to 0.147 (median 0.018) among all horses. No significant difference in MR was observed between breeds, age, or sex. Of the 100 horses, 11 were classified as high-MR, 72 moderate-MR, and 17 low-MR. Codeine AUC0-∞ and O-demethylation MR were significantly different (p < 0.05) between all three groups. The mean ± SD MR was 0.089 ± 0.027, 0.022 ± 0.011, and 0.0095 ± 0.001 for high-, moderate-, and low-MR groups, respectively. The AUC for the morphine metabolites morphine-3-glucuronide and morphine-6-glucuronide were significantly different between high-and low-MR groups (p < 0.004 and p < 0.006).

Conclusions

The MR calculated from plasma following codeine administration allowed for classification of horses into metabolic phenotypes within a large population. The range of codeine metabolism observed among horses suggests the presence of genetic polymorphisms in CYP2D82 of which codeine is a known substrate. Additional studies including CYP2D82 genotyping of high- and low-MR individuals are necessary to determine the presence of CYP2D polymorphisms and their functional implications with respect to the metabolism of therapeutics.
Plasmodium falciparum outbreak in native communities of Condorcanqui, Amazonas, Perú
Authors: Montenegro Carla C. , Bustamante-Chauca T. Pershing , Pajuelo Reyes Cecilia , Bernal Miguel , Gonzales Lizandro , Tapia-Limonchi Rafael , Tejedo Juan R. , Chenet Stella M.
Published: February 2021

Background

Malaria remains a serious health threat in the Amazonas Region of Peru and approximately 95% of the cases, mainly Plasmodium vivax, are found in native communities of The Rio Santiago District, Condorcanqui Province. In 2019, more than one thousand malaria cases were reported, with an unusual number of Plasmodium falciparum autochthonous cases. The present study aims to report this P. falciparum outbreak while describing the epidemiology of malaria and the risk factors associated in the native communities of Amazonas, Peru.

Methods

The DIRESA-Amazonas in collaboration with the Condorcanqui Health Network and the Institute of Tropical Diseases of the UNTRM carried out a malaria Active Case Detection (ACD III) between January 31st and February 10th of 2020. A total of 2718 (47.4%) individuals from 21 native communities grouped in eight sanitary districts, were screened for malaria infections. Each participant was screened for malaria using microscopy. Follow-up surveys were conducted for all malaria positive individuals to collect socio-demographic data. Spatial clustering of infection risk was calculated using a generalized linear model (GLM). Analysis of risk considered factors such as gender, age, type of infection, symptomatology, and parasitaemia.

Results

The study suggests that the P. falciparum index case was imported from Loreto and later spread to other communities of Rio Santiago during 2019. The ACD III reported 220 (8.1%) malaria cases, 46 P. falciparum, 168 P. vivax and 6 mixed infections. SaTScan analysis detected a cluster of high infection risk in Middle Rio Santiago and a particular high P. falciparum infection risk cluster in Upper Rio Santiago. Interestingly, the evaluation of different risk factors showed significant associations between low parasitaemia and P. falciparum asymptomatic cases.

Conclusion

This is the first report of a P. falciparum outbreak in native communities of Condorcanqui, Amazonas. Timely identification and treatment of symptomatic and asymptomatic cases are critical to achieve malaria control and possible elimination in this area. However, the current malaria situation in Condorcanqui is uncertain, given that malaria ACD activities have been postponed due to COVID-19.