bluuebunny/crossref_metadata_2025 huggingface dataset:
A robust method for dynamic image stitching on a fully mechanized mining face
Authors: Li Ben , Mao Shanjun , Li Mei
Published: July 2021

Video surveillance systems can be applied in coal mines for remote monitoring and for production control. Stitching video images into a panorama enhances the usability of video systems, since a panorama offers a wider view than single images do. But there are big challenges when conventional image stitching methods are applied to the domain of coal mine, especially in the mining faces. These challenges consist of non-uniform illumination, missed scenes and oblique panoramas. In this paper, a robust method was proposed to solve these three problems: (i) to overcome the non-uniform illumination on a mining face, the wide dynamic range technology and the histogram matching algorithm were used to enhance single images and reduce differences among images, respectively; (ii) to eliminate the missed scenes, overlapped images were quickly taken, then the feature matching method and template recognition method were adaptively used to achieve robust stitching and (iii) to mitigate the obliqueness of panoramas, vertical correction technology was used, which exploited the posture information of the camera. Next, the adjacent panoramas were concatenated and experiments were conducted on a fully mechanized mining face. The results show that the proposed method solves these three problems well and a dynamic panorama of the partial long-wall mining face is outputted. The research provides a new approach for displaying extended scenes of stope faces in intelligent collieries.
Cumulative Social Risk and Child Screen Use: The Role of Child Temperament
Authors: McArthur Brae Anne , Hentges Rochelle , Christakis Dimitri A , McDonald Sheila , Tough Suzanne , Madigan Sheri
Published: July 2021

Objectives

It is critical to understand what children, and in which context, are at risk for high levels of screen use. This study examines whether child temperament interacts with cumulative social risk to predict young children’s screen use and if the results are consistent with differential susceptibility or diathesis-stress models.

Methods

Data from 1,992 families in Calgary, Alberta (81% White; 47% female; 94% >$40,000 income) from the All Our Families cohort were included. Mothers reported on cumulative social risk (e.g., low income and education, maternal depression) at <25 weeks of gestation, child’s temperament at 36 months of age (surgency/extraversion, negative affectivity, effortful control), and child’s screen use (hours/day) at 60 months of age. Along with socio-demographic factors, baseline levels of screen use were included as covariates.

Results

Children high in surgency (i.e., high-intensity pleasure, impulsivity) had greater screen use than children low in surgency as social risk exposure increased. In line with differential susceptibility, children high in surgency also had less screen use than children low in surgency in contexts of low social risk. Children with heightened negative affectivity (i.e., frequent expressions of fear/frustration) had greater screen use as social risk increased, supporting a diathesis-stress model.

Conclusions

Young children predisposed to high-intensity pleasure seeking and negative affectivity in environments characterized as high in social risk may be prone to greater durations of screen use. Findings suggest that an understanding of social risks and individual characteristics of the child should be considered when promoting healthy digital health habits.
Superresolving Herschel imaging: a proof of concept using Deep Neural Networks
Authors: Lauritsen Lynge , Dickinson Hugh , Bromley Jane , Serjeant Stephen , Lim Chen-Fatt , Gao Zhen-Kai , Wang Wei-Hao
Published: July 2021

Wide-field submillimetre surveys have driven many major advances in galaxy evolution in the past decade, but without extensive follow-up observations the coarse angular resolution of these surveys limits the science exploitation. This has driven the development of various analytical deconvolution methods. In the last half a decade Generative Adversarial Networks have been used to attempt deconvolutions on optical data. Here, we present an auto-encoder with a novel loss function to overcome this problem in the submillimeter wavelength range. This approach is successfully demonstrated on Herschel SPIRE 500 $\mu\mathrm{m}$ COSMOS data, with the superresolving target being the JCMT SCUBA-2 450 $\mu\mathrm{m}$ observations of the same field. We reproduce the JCMT SCUBA-2 images with high fidelity using this auto-encoder. This is quantified through the point source fluxes and positions, the completeness, and the purity.
Ribosome-binding and anti-microbial studies of the mycinamicins, 16-membered macrolide antibiotics from Micromonospora griseorubida
Authors: Breiner-Goldstein Elinor , Eyal Zohar , Matzov Donna , Halfon Yehuda , Cimicata Giuseppe , Baum Moti , Rokney Assaf , Ezernitchi Analia V , Lowell Andrew N , Schmidt Jennifer J , Rozenberg Haim , Zimmerman Ella , Bashan Anat , Valinsky Lea , Anzai Yojiro , Sherman David H , Yonath Ada
Published: July 2021

Macrolides have been effective clinical antibiotics for over 70 years. They inhibit protein biosynthesis in bacterial pathogens by narrowing the nascent protein exit tunnel in the ribosome. The macrolide class of natural products consist of a macrolactone ring linked to one or more sugar molecules. Most of the macrolides used currently are semi-synthetic erythromycin derivatives, composed of a 14- or 15-membered macrolactone ring. Rapidly emerging resistance in bacterial pathogens is among the most urgent global health challenges, which render many antibiotics ineffective, including next-generation macrolides. To address this threat and advance a longer-term plan for developing new antibiotics, we demonstrate how 16-membered macrolides overcome erythromycin resistance in clinically isolated Staphylococcus aureus strains. By determining the structures of complexes of the large ribosomal subunit of Deinococcus radiodurans (D50S) with these 16-membered selected macrolides, and performing anti-microbial studies, we identified resistance mechanisms they may overcome. This new information provides important insights toward the rational design of therapeutics that are effective against drug resistant human pathogens.
Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Perioperative Spine: Preoperative Osteoporosis Assessment
Authors: Dimar John , Bisson Erica F , Dhall Sanjay , Harrop James S , Hoh Daniel J , Mohamed Basma , Wang Marjorie C , Mummaneni Praveen V
Published: July 2021

BACKGROUND

Osteoporosis is a metabolic bone disease that commonly affects the elderly. Degenerative spinal disease that may require surgical intervention is also prevalent in this susceptible population. If undiagnosed or untreated before spine surgery, osteoporosis may result in an increased risk of postoperative adverse events. Nontreatment of osteoporosis preoperatively may be related to a poor understanding of bone physiology, a lack of standardized treatment algorithms, limited cost-effective interventions, and reluctance by spine surgeons to be the primary provider of osteoporosis management.

OBJECTIVE

The objective of this evidence-based review is to develop guidelines for the preoperative assessment and treatment of osteoporosis in patients undergoing spine surgery.

METHODS

A systematic review of the literature was performed using the National Library of Medicine/PubMed database and Embase for studies relevant to preoperative diagnostic studies that predict increased risk of osteoporosis-related postoperative adverse events and whether the preoperative treatment of low bone mineral density (BMD) in patients with osteoporosis improves outcome.

RESULTS

Out of 281 studies, 17 met the inclusion criteria and were included for systematic review. The task force affirmed a Grade B recommendation that preoperative osteoporosis testing with a dual-energy X-ray absorptiometry scan (T-score < −2.5), a computed tomography scan (Hounsfield units <97.9), and serum vitamin D3 level (<20 ng/mL) predict an increased risk of osteoporosis-related adverse events after spine surgery. The task force determined a Grade B recommendation that preoperative osteoporosis treatment with teriparatide increases BMD, induces earlier and more robust fusion, and may improve select patient outcomes. There is insufficient evidence regarding preoperative treatment with bisphosphonates alone and postoperative outcome.

CONCLUSION

This evidence-based clinical guideline provides a recommendation that patients with suspected osteoporosis undergo preoperative assessment and be appropriately counseled about the risk of postoperative adverse events if osteoporosis is confirmed. In addition, preoperative optimization of BMD with select treatments improves certain patient outcomes.

The full guidelines can be accessed at https://www.cns.org/guidelines/browse-guidelines-detail/3-preoperative-osteoporosis-assessment
H7N9 virus infection triggers lethal cytokine storm by activating gasdermin E-mediated pyroptosis of lung alveolar epithelial cells
Authors: Wan Xiaopeng , Li Jiqing , Wang Yupeng , Yu Xiaofei , He Xijun , Shi Jianzhong , Deng Guohua , Zeng Xianying , Tian Guobin , Li Yanbing , Jiang Yongping , Guan Yuntao , Li Chengjun , Shao Feng , Chen Hualan
Published: July 2021

The H7N9 influenza virus emerged in China in 2013, causing more than 1560 human infections, 39% of which were fatal. A ‘cytokine storm’ in the lungs of H7N9 patients has been linked to a poor prognosis and death; however, the underlying mechanism that triggers the cytokine storm is unknown. Here, we found that efficient replication of the H7N9 virus in mouse lungs activates gasdermin E (GSDME)-mediated pyroptosis in alveolar epithelial cells, and that the released cytosolic contents then trigger a cytokine storm. Knockout of Gsdme switched the manner of death of A549 and human primary alveolar epithelial cells from pyroptosis to apoptosis upon H7N9 virus infection, and Gsdme knockout mice survived H7N9 virus lethal infection. Our findings reveal that GSDME activation is a key and unique mechanism for the pulmonary cytokine storm and lethal outcome of H7N9 virus infection and thus opens a new door for the development of antivirals against the H7N9 virus.
Doctors’ reporting of mental health stigma and barriers to help-seeking
Authors: Wijeratne C , Johnco C , Draper B , Earl J
Published: July 2021

Background

Medical practitioners experience high levels of mental disorders but may be reluctant to seek care.

Aims

To determine medical practitioner attitudes towards other doctors with anxiety/depression, barriers to seeking mental healthcare, treatments received for depression and the effects of age.

Methods

Data from the National Mental Health Survey of Doctors and Medical Students, conducted in Australia, were analysed (N = 10 038 medical practitioners). Attitudes to anxiety/depression were assessed with 12 statements (total stigma score, range 12–60). Barriers to seeking professional help, and coping strategies used, for anxiety/depression were measured. Practitioners with a history of depression were asked what personal supports and treatments were received. Practitioners were compared by age—younger (40 years and younger), middle-aged (41–60) and older (61+).

Results

Attitudes and help-seeking behaviours varied with age. Older doctors had a more positive outlook and less total stigma, with the exception that they believed a doctor with anxiety/depression was less reliable. Younger practitioners were most likely to report barriers, such as confidentiality, impact on career progression and registration, to seeking help. For practitioners with depression, counselling and counselling plus medication were most likely to be received by the younger and middle-aged groups, whereas medication alone was most likely to be received by the middle-aged and older groups.

Conclusions

Stigmatizing attitudes towards mental disorder and barriers to help-seeking remain prevalent within the medical profession. Our results suggest doctors’ health programs should address mental health stigma in younger practitioners and facilitate education about psychological treatments in older practitioners.
A study of the accretion mechanisms of the high-mass X-ray binary IGR J00370+6122
Authors: Uchida Nagomi , Takahashi Hiromitsu , Fukazawa Yasushi , Makishima Kazuo
Published: July 2021

IGR J00370+6122 is a high-mass X-ray binary with a B1 Ib primary star and a companion suggested to be a neutron star because of the detection of a 346 s pulsation in a one-off 4 ks observation. To better understand the nature of the compact companion, the present work performs timing and spectral studies of the X-ray data of this object, taken with XMM-Newton, Swift, Suzaku, RXTE, and INTEGRAL. In the XMM-Newton data, a sign of coherent 674 s pulsation was detected, for which the previous 346 s period may be the second harmonic. The spectra exhibited the “harder when brighter” trend in the 1–10 keV range, and a flat continuum without clear cutoff in the 10–80 keV range. These properties are both similar to those observed from several low-luminosity accreting pulsars, including X Persei in particular. Thus, the compact object in IGR J00370+6122 is considered to be a magnetized neutron star with a rather low luminosity. The orbital period was refined to 15.6649 ± 0.0014 d. Along the orbit, the luminosity changes by three orders of magnitude, involving a sudden drop from ∼4 × 1033 to ∼1 × 1032 erg s−1 at an orbital phase of 0.3 (and probably vice verse at 0.95). Although these phenomena cannot be explained by simple Hoyle–Lyttleton accretion from the primary’s stellar winds, they can be explained when incorporating the propeller effect with a strong dipole magnetic field of ∼5 × 1013 G. Therefore, the neutron star in IGR J00370+6122 may have a stronger magnetic field compared to ordinary X-ray pulsars.
Skill-Biased Structural Change
Authors: Buera Francisco J , Kaboski Joseph P , Rogerson Richard , Vizcaino Juan I
Published: July 2021

Using a broad panel of advanced economies, we document that increases in GDP per capita are associated with a systematic shift in the composition of value added to sectors that are intensive in high-skill labour, a process we label as skill-biased structural change. It follows that further development in these economies leads to an increase in the relative demand for skilled labour. We develop a quantitative two-sector model of this process as a laboratory to assess the sources of the rise of the skill premium in the U.S. and a set of ten other advanced economies, over the period 1977 to 2005. For the U.S., we find that the sector-specific skill neutral component of technical change accounts for 18–24% of the overall increase of the skill premium due to technical change, and that the mechanism through which this component of technical change affects the skill premium is via skill-biased structural change.
COVID-19 and Its Impact on Financial Markets and the Real Economy
Authors: Goldstein Itay , Koijen Ralph S J , Mueller Holger M
Published: July 2021

The COVID-19 pandemic severely disrupted financial markets and the real economy worldwide. These extraordinary events prompted large monetary and fiscal policy interventions. Recognizing the unusual nature of the shock, the academic community has produced an impressive amount of research during the last year. Macro-finance models have been extended to analyze the impact of epidemics. Empirical papers study the origins and consequences of the disruptions and the impact of policy interventions. New research evaluates the ongoing financial fragility and its relation to previous episodes and regulations. This special issue contains early contributions to this important and rapidly developing literature.1
Revisiting the Source of Wilt Symptoms: X-Ray Microcomputed Tomography Provides Direct Evidence That Ralstonia Biomass Clogs Xylem Vessels
Authors: Ingel Brian , Caldwell Denise , Duong Fiona , Parkinson Dilworth Y. , McCulloh Katherine A. , Iyer-Pascuzzi Anjali S. , McElrone Andrew J. , Lowe-Power Tiffany M.
Published: July 2021

Ralstonia causes wilt diseases by colonizing xylem vessels and disrupting water transport. The dogma is that bacterial biomass clogs vessels and reduces the flow of xylem sap due to Ralstonia abundance. However, the physiological mechanism of xylem disruption during bacterial wilt is untested. Using a tomato and Ralstonia pseudosolanacearum GMI1000 model, we visualized and quantified spatiotemporal dynamics of xylem disruption during bacterial wilt. First, we measured stomatal conductance of leaflets on mock-inoculated and wilt-symptomatic plants. Wilted leaflets had reduced stomatal conductance, as did turgid leaflets on the same petiole as wilted leaflets. Next, we used X-ray microcomputed tomography (X-ray microCT) and light microscopy to differentiate between mechanisms of xylem disruption: blockage by bacterial biomass, blockage by vascular tyloses, or sap displacement by gas embolisms. We imaged intact plant stems to quantify embolized vessels. Embolized vessels were rare, but infected plants with low bacterial populations had a nonsignificant trend of more vessel embolisms. To test whether vessels are clogged during bacterial wilt, we imaged excised stems after brief dehydration. Most vessels in mock-infected plants emptied their contents after excision, but nonconductive clogged vessels were abundant in infected plants by 2 days post infection. At wilt onset, when bacterial populations exceeded 5 × 108 CFU/g stem tissue, approximately half of the vessels were clogged with electron-dense bacterial biomass. We found no evidence of tyloses in X-ray microCT reconstructions or from light microscopy of preserved stems. Therefore, bacterial blockage of vessels appears to be the principal cause of xylem disruption during Ralstonia wilt.

[Formula: see text] The author(s) have dedicated the work to the public domain under the Creative Commons CC0 “No Rights Reserved” license by waiving all of his or her rights to the work worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law, 2022.
Complications of a congenital iris cyst in a newborn
Authors: Nelson Catherine , Pierce Bradley
Published: July 2021

Congenital iris cysts are a rare condition in infants that can lead to multiple complications. This report describes an infant born with an iris cyst who developed complications including secondary glaucoma, cataracts, and visual impairment, requiring management with multiple surgical interventions and medications.
A physician associate-led clinic for people with severe mental illness in the United Kingdom
Authors: Shah Chetan , Singh Pratima , Matin Samina , Farrow Joanne , Magon Rakesh , Zia Asif , Tatt-Smith Paris , Watson Charles , Smith Andrew
Published: July 2021

Objective:

To evaluate an enhanced physical health clinic led by physician associates (PAs) for patients with severe mental illness.

Methods:

A guidance and data collection tool was developed to support and document the outcomes of the PA-led enhanced physical health clinic.

Results:

The clinic led to diagnoses of diabetes, hyperlipidemia, and hematologic abnormalities. One patient was started on metformin, two patients started a prediabetes program with their general practitioner, one patient started simvastatin, one patient switched from cigarettes to e-cigarettes, and one patient switched from olanzapine to aripiprazole because of metabolic adverse reactions. Three patients intended to contact the National Health Service for cancer screening for which they were eligible but they had not taken up.

Conclusions:

PAs can be integrated into a community mental health multidisciplinary team and support the physical health of people with severe mental illness. Mental health trusts should consider roles for PAs in their workforce planning.
Feasibility and Effectiveness of a Quality Improvement Curriculum for Combined Medicine Subspecialty Fellows
Authors: Hommel Erin , Sonstein Lindsay , Raji Mukaila
Published: July 2021

Background:

The Accreditation Council for Graduate Medical Education (ACGME) requires training in quality improvement (QI) yet many programs struggle to incorporate appropriate content. Small fellowship programs may find it particularly difficult, limited by a lack of well-trained faculty. We report on the feasibility and effectiveness of a consolidated curriculum for subspecialty fellowship programs.

Methods:

Two QI experts were identified to design a curriculum. Interactive didactic sessions were created to guide development and implementation of fellow QI projects. All projects culminated in abstract/poster presentation.

Results:

Seven of 10 eligible fellowships participated. Twenty-four projects were completed with 70% reaching improvement in process measures. Trainees improved confidence in 11 of 12 QI domains. Program directors stated enhancement in QI education with 100% recommending program continuation.

Conclusions:

Consolidating teaching efforts with existing QI experts can lead to an effective QI curriculum for fellowship programs. This model can be expanded to other graduate medical education trainees as a means to increase QI proficiency.
Biologics as treatment options for anaphylaxis
Authors: Cafarotti Arianna , Fiocchi Alessandro , Arasi Stefania
Published: July 2021

Purpose of review

To provide the most recent insights in the use of biologicals in the treatment of patients with anaphylaxis.

Recent findings

There is evidence that biologics such as omalizumab may be safe and effective in preventing anaphylactic reactions in patients at high risk mainly because of severe food allergy or desensitization procedures to food, airborne allergen, drugs, or hymenoptera venom.

Further knowledge will guide the adoption and implementation of any new therapy including biologics for anaphylaxis according to the stratification of risk/benefits.
A Novel Artificial Intelligence–assisted Risk Assessment Model for Preventing Complications in Esthetic Surgery
Authors: Bukret Williams E.
Published: July 2021

Background

Prevention of complications to reduce morbidity and mortality, and improve patient satisfaction is of paramount importance to plastic surgeons. This study aimed to evaluate the predictive risk factors for complications and to validate a novel risk assessment model, using artificial intelligence.

METHODS

A retrospective review of esthetic surgery procedures performed by the author between 2015 and 2020 was conducted. The Pearson correlation test was used to analyze the risk factors and complications. Differences in the mean risk scores among the three risk groups were tested using one-way analysis of variance. Risk scoring was validated using a machine learning process with a support vector machine in a Google Colaboratory environment.

RESULTS

Of the 372 patients, 28 (7.5%) experienced complications. The Pearson correlation coefficients between the risk score and body mass index (BMI: 0.99), age (0.97), and Caprini score of 5 or more (0.98) were statistically significant (P < 0.01). The correlations between the risk scores and sex (−0.16, P = 0.58), smoking habit (−0.16, P = 0.58), or combined procedures (−0.16, P = 0.58) were not significant. Necrosis was significantly correlated with dehiscence (0.92, P = 0.003) and seroma (0.77, P = 0.041). The accuracy of the predictive model was 100% for the training sample and 97.3% for the test sample.

CONCLUSIONS

Body mass index, age, and the Caprini score were risk factors for complications following esthetic surgery. The proposed risk assessment system is a valid tool for improving eligibility and preventing complications.
Destination Design msTRAM: For Greater Reconstructive Certainty
Authors: Pripotnev Stahs , Williamson J. Scott
Published: July 2021

Background:

Performing delayed reconstruction to a unilateral breast while simultaneously performing a balancing procedure on the contralateral side can be the most difficult situation to achieve symmetry. We present here a novel approach to free TRAM-based breast reconstruction using reverse planning and subunit principles with simultaneous balancing reduction mastopexy and immediate nipple reconstruction.

Methods:

A retrospective chart review and a BREAST-Q questionnaire of a single surgeon’s practice was performed to compare revision rates and patient satisfaction following Destination Design msTRAM reconstruction compared with a historical cohort of patients who received traditional free TRAM reconstruction.

Results:

The chart review identified 39 patients treated with the traditional unilateral technique from 1997 to 2004 and 88 patients treated with the novel unilateral technique from 2004 to 2017. Traditional technique patients had a breast revision rate of 64.1% and a nipple revision rate of 42.3% after secondary nipple reconstruction. Destination Design patients had a breast revision rate of 44.3% (P = 0.0394) and a nipple revision rate of 37.9% (P = 0.689) after primary nipple reconstruction. The BREAST-Q questionnaire was sent to nine traditional technique patients with 8 responses (89%), and 35 Destination Design patients with 25 responses (71%). Survey results showed that traditional technique and Destination Design patients had an overall breast satisfaction rate of 67.5% and 63.9%, respectively.

Conclusions:

The Destination Design msTRAM breast reconstruction technique leads to a statistically significant reduction in breast flap revisions, and allows for equally accurate immediate nipple reconstruction compared with traditional methods with no additional complications. Overall patient satisfaction is comparable with both techniques.
Factors associated with difficulty in adapting and intent to leave among new graduate nurses in South Korea
Authors: Park Sun-young , Kim Heejung , Ma Chenjuan
Published: July 2021

Background

New graduate nurses experience difficulty in adapting to a new environment, which affects intent to leave. However, data on the factors contributing to difficulty in adapting and intent to leave among new graduate nurses are insufficient.

Purpose

The aim of the study was to explore and compare factors associated with difficulty in adapting and the intent to leave among new graduate nurses in South Korea.

Methodology

This cross-sectional study used secondary data analysis. Primary data were obtained from the 2015–2016 Korean National Graduates Occupational Mobility Survey. Descriptive statistics, independent t tests, and chi-square statistics with weighted samples besides multivariate logistic regression analyses were conducted (N = 467).

Results

Roughly 46% of nurses reported difficulty adapting, and 16% expressed their intent to leave. The factors linked to difficulty in adapting were working at large hospitals with rotating shifts, low person–job fit, and low satisfaction with personal competency; intent to leave was associated with high monthly salary and low satisfaction with the workplace (all ps < .05). Difficulty in adapting did not equate to their intent to leave.

Conclusions

There were high rates of difficulty in adapting and intent to leave among new graduate nurses. Although different factors were associated with difficulty adapting and intent to leave, workplace condition is a common factor.

Practice Implications

Different strategies are needed to improve adaptation and intention of leaving among new graduate nurses. For better adaptation, developing training programs enhancing professional competency with a sufficient training period is required. In addition, providing staff and resources to reduce the intent to leave is crucial.
Gender Differences in Personal and Situational Risk Factors for Traumatic Brain Injury Among Older Adults
Authors: Yu Wen-Yu , Hwang Hei-Fen , Lin Mau-Roung
Published: July 2021

Objective:

To investigate differences between older men and women in Taiwan in personal and situational risk factors for sustaining a traumatic brain injury (TBI) versus soft-tissue injury (STI) due to a fall.

Design:

Matched case-control study.

Participants and Settings:

Cases were defined as patients with a primary diagnosis of TBI due to a fall and were identified from those 60 years or older who visited the emergency department (ED) of 3 university-affiliated hospitals in 2015. Matched by the same hospital ED, gender, and time of falling, 3 controls who had no TBI and who had sustained only soft-tissue injury (STI) due to falling were selected for comparison with each case. Personal factors and situational exposures were compared between the control and case groups. In total, 96 cases and 288 controls in men and 72 cases and 216 controls in women participated in this study.

Main Measures:

Personal factors (sociodemographic and lifestyle factors, medical characteristics, and functional abilities) and situational exposures (location, activities before the fall, center-of-mass change, type of fall, falling direction, protective response, and impact during the fall).

Results:

In men, after adjusting for other variables, older age (odds ratio [OR] = 1.04), regular alcohol use (OR = 2.03), an indoor fall (OR = 1.92), activity of getting in/out of bed (OR = 2.56), a fall due to dizziness (OR = 4.09), and falling backward (OR = 2.95) were independently associated with a higher odds of TBI. In women, an older age (OR = 1.03), the presence of Parkinson disease (OR = 10.4), activities of toileting (OR = 2.50), getting in/out of bed (OR = 4.90), and negotiating stairs (OR = 7.13), a fall due to dizziness (OR = 5.05), and falling backward (OR = 2.61) were independently associated with a higher odds of TBI.

Conclusions:

Our results demonstrated similarities and differences in personal and situational risk factors for fall-related TBIs versus STIs between older men and women, and gender differences should be considered when developing intervention strategies.
The Emerging Role of Telehealth for Concussion Clinical Care During the Coronavirus (COVID-19) Pandemic
Authors: Womble Melissa N. , Reynolds Erin , Kissinger-Knox Alicia , Collins Michael W. , Kontos Anthony P. , West Robin V. , Eagle Shawn , Elbin R. J.
Published: July 2021

The coronavirus disease 2019 (COVID-19) pandemic has substantially altered the delivery of healthcare for providers and their patients. Patients have been reticent to seek care for many diseases and injuries including concussion due to fears of potential exposure to COVID-19. Moreover, because of social distancing recommendations and stay-at-home orders, patient screening, evaluation, and delivery of care have become less efficient or impossible to perform via in-person clinic visits. Consequently, there was a sudden need to shift healthcare delivery from primarily in-person visits to telehealth. This sudden shift in healthcare delivery brings with it both challenges and opportunities for clinical concussion care. This article is designed to discuss these challenges and opportunities and provide an experiential-based framework for providing concussion care via telehealth. We first provide an overview of a clinical concussion model utilized at concussion specialty clinics from 3 geographically disparate healthcare systems for in-person service delivery prior to COVID-19. We then discuss the creation of new clinical workflows to facilitate the continued provision of concussion specialty care using telehealth. Finally, we examine lessons learned during this healthcare delivery shift including limitations and potential barriers for telehealth for concussion care, as well as opportunities for expansion of concussion care in rural and underserved areas. We also discuss the need to empirically evaluate the comparative efficacy of telehealth and in-person concussion care moving forward.
Disruptive Dizziness Among Post-9/11 Veterans With Deployment-Related Traumatic Brain Injury
Authors: Swan Alicia A. , Akin Faith W. , Amuan Megan E. , Riska Kristal M. , Hall Courtney D. , Kalvesmaki Andrea , Padilla Silvia , Crowsey Eden , Pugh Mary Jo
Published: July 2021

Objective:

To identify disruption due to dizziness symptoms following deployment-related traumatic brain injury (TBI) and factors associated with receiving diagnoses for these symptoms.

Setting:

Administrative medical record data from the Department of Veterans Affairs (VA).

Participants:

Post-9/11 veterans with at least 3 years of VA care who reported at least occasional disruption due to dizziness symptoms on the comprehensive TBI evaluation.

Design:

A cross-sectional, retrospective, observational study.

Main Measures:

International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes of dizziness, vestibular dysfunction, and other postconcussive conditions; neurobehavioral Symptom Inventory.

Results:

Increased access to or utilization of specialty care at the VA was significant predictors of dizziness and/or vestibular dysfunction diagnoses in the fully adjusted model. Veterans who identified as Black non-Hispanic and those with substance use disorder diagnoses or care were substantially less likely to receive dizziness and vestibular dysfunction diagnoses.

Conclusions:

Access to specialty care was the single best predictor of dizziness and vestibular dysfunction diagnoses, underscoring the importance of facilitating referrals to and utilization of specialized, comprehensive clinical facilities or experts for veterans who report disruptive dizziness following deployment-related TBI. There is a clear need for an evidence-based pathway to address disruptive symptoms of dizziness, given the substantial variation in audiovestibular tests utilized by US providers by region and clinical specialty. Further, the dearth of diagnoses among Black veterans and those in more rural areas underscores the potential for enhanced cultural competency among providers, telemedicine, and patient education to bridge existing gaps in the care of dizziness.
Family Burden in Adolescents With Refractory Postconcussion Symptoms
Authors: Brooks Brian L. , Kumari Jeshna , Virani Shane
Published: July 2021

Objective:

A significant minority of adolescents will have persistent postconcussion symptoms after an injury, potentially having a negative impact on family functioning. However, the reasons for a family's negative impact are not clearly understood. The objective of this study was to determine whether preinjury/demographic factors, injury characteristics, and/or worse postinjury symptoms are associated with higher levels of family stress in youth with refractory postconcussion symptoms.

Setting:

Pediatric refractory concussion clinic in a tertiary care center.

Participants:

A total of 121 adolescents (13-18 years old) who were 1 to 12 months postconcussion.

Measures:

Primary outcome was the mean stress rating on the Family Burden of Injury Interview (FBII), a 27-item questionnaire rating the impact on a family as a result of an injury. Preinjury/demographic and injury details were collected. Youth and their parents also completed measures of postconcussion symptoms, depression, anxiety, and behavioral problems.

Results:

Participants had a mean age of 16.0 years (SD = 1.3), of which, 65% identified as female, and were on an average 5.2 months (SD = 2.4) postconcussion. FBII ratings were not significantly correlated with demographics, preinjury functioning, injury severity, duration of persistent postconcussion problems (ie, time since injury), or self-reported postconcussion symptoms. Greater family burden (higher FBII ratings) significantly correlated with worse parent-reported postconcussion symptoms, worse psychological functioning (self-reported depression, parent-reported anxiety, and depression), and worse behavioral functioning (parent-reported conduct problems and peer problems). A multiple linear regression model revealed that parent-perceived postconcussion cognitive symptoms (β = .292, t = 2.56, P = .012) and parent-perceived peer problems (β = .263, t = 2.59, P = .011) were significantly associated with family burden (F
8,105 = 6.53; P < .001; R
2 = 0.35).

Conclusion:

Families of youth with refractory postconcussion symptoms can experience a negative impact. The severity of reported family burden in those with slow recovery from concussion was significantly associated with parents' perception of their child's cognitive symptoms and peer problems. These results could provide support for family-based interventions in this population.
Repetitive Traumatic Brain Injury Among Older Adults
Authors: Chauhan Aparna Vadlamani , Guralnik Jack , dosReis Susan , Sorkin John D. , Badjatia Neeraj , Albrecht Jennifer S.
Published: July 2021

Objective:

To determine the incidence of and assess risk factors for repetitive traumatic brain injury (TBI) among older adults in the United States.

Design:

Retrospective cohort study.

Setting:

Administrative claims data obtained from the Centers for Medicare & Medicaid Services' Chronic Conditions Data Warehouse.

Participants:

Individuals 65 years or older and diagnosed with TBI between July 2008 and September 2012 drawn from a 5% random sample of US Medicare beneficiaries.

Main Measures:

Repetitive TBI was identified as a second TBI occurring at least 90 days after the first occurrence of TBI following an 18-month TBI-free period. We identified factors associated with repetitive TBI using a log-binomial model.

Results:

A total of 38 064 older Medicare beneficiaries experienced a TBI. Of these, 4562 (12%) beneficiaries sustained at least one subsequent TBI over up to 5 years of follow-up. The unadjusted incidence rate of repetitive TBI was 3022 (95% CI, 2935-3111) per 100 000 person-years. Epilepsy was the strongest predictor of repetitive TBI (relative risk [RR] = 1.44; 95% CI, 1.25-1.56), followed by Alzheimer disease and related dementias (RR = 1.32; 95% CI 1.20-1.45), and depression (RR = 1.30; 95% CI, 1.21-1.38).

Conclusions:

Injury prevention and fall-reduction interventions could be targeted to identify groups of older adults at an increased risk of repetitive head injury. Future work should focus on injury-reduction initiatives to reduce the risk of repetitive TBI as well as assessment of outcomes related to repetitive TBI.
Blast Wound Dehiscence During Descemet Membrane Endothelial Keratoplasty Rebubbling in a Previous Penetrating Keratoplasty: A Case Report
Authors: Coco Giulia , Borgia Alfredo , Romano Davide , Kaye Stephen B. , Romano Vito
Published: July 2021

Purpose:

The purpose of this study was to describe a rare complication of Descemet membrane endothelial keratoplasty (DMEK) rebubbling.

Methods:

An 86-year-old woman with bilateral penetrating keratoplasty (PK) performed 20 years previously for Fuchs endothelial dystrophy underwent DMEK surgery for endothelial corneal decompensation in the left eye. Surgery was complicated in the postoperative period by repeated DMEK graft detachments requiring rebubbling.

Results:

The third rebubbling procedure caused a traumatic PK wound dehiscence at the graft–host junction with full-thickness opening of approximately 180 degrees. PK wound dehiscence was resutured in the theater, DMEK lenticule was removed from the eye, and the full-thickness graft was repeated.

Conclusions:

DMEK graft rebubbling in patients with previous PK may lead to traumatic wound dehiscence. Avoidance of excessive increases in intraocular pressure during the rebubbling procedure should be encouraged to decrease the risk of this rare complication.
Systems Analysis of a Dedicated Ambulatory Respiratory Unit for Seeing and Ensuring Follow-up of Patients With COVID-19 Symptoms
Authors: Benneyan James C. , White Tiantian , Nehls Nicole , Yap Tze Sheng , Aronson Mark , Sternberg Scot , Anderson Tim , Goyal Kashika , Lindenberg Julia , Kim Hans , Cohen Marc , Phillips Russell S. , Schiff Gordon D.
Published: July 2021

COVID-19 necessitated significant care redesign, including new ambulatory workflows to handle surge volumes, protect patients and staff, and ensure timely reliable care. Opportunities also exist to harvest lessons from workflow innovations to benefit routine care. We describe a dedicated COVID-19 ambulatory unit for closing testing and follow-up loops characterized by standardized workflows and electronic communication, documentation, and order placement. More than 85% of follow-ups were completed within 24 hours, with no observed staff, nor patient infections associated with unit operations. Identified issues include role confusion, staffing and gatekeeping bottlenecks, and patient reluctance to visit in person or discuss concerns with phone screeners.
Fabrication of hyaluronic acid-gold nanoparticles with chitosan to modulate neural differentiation of mesenchymal stem cells
Authors: Shen Chiung-Chyi , Yang Meng-Yin , Chang Kai-Bo , Tseng Chia-Hsuan , Yang Yi-Ping , Yang Yi-Chin , Kung Mei-Lang , Lai Wei-Yi , Lin Tzu-Wei , Hsieh Hsien-Hsu , Hung Huey-Shan
Published: July 2021

Background:

Chitosan (Chi) is a natural material which has been widely used in neural applications due to possessing better biocompatibility. In this research study, a novel of nanocomposites film based on Chi with hyaluronic acid (HA), combined with varying amounts of gold nanoparticles (AuNPs), was created resulting in pure Chi, Chi-HA, Chi-HA-AuNPs (25 ppm), and Chi-HA-AuNPs (50 ppm).

Methods:

This study focused on evaluating their effects on mesenchymal stem cell (MSC) viability, colony formation, and biocompatibility. The surface morphology and chemical position were characterized through UV-visible spectroscopy (UV-Vis), Fourier-transform infrared spectroscopy (FTIR), SEM, and contact-angle assessment.

Results:

When seeding MSCs on Chi-HA-AuNPs (50 ppm), the results showed high cell viability, biocompatibility, and the highest colony formation ability. Meanwhile, the evidence showed that Chi-HA-Au nanofilm was able to inhibit nestin and β-tubulin expression of MSCs, as well as inhibit the ability of neurogenic differentiation. Furthermore, the results of matrix metalloproteinase 2/9 (MMP2/9) expression in MSCs were also significantly higher in the Chi-HA-AuNP (50 ppm) group, guiding with angiogenesis and wound healing abilities. In addition, in our rat model, both capsule thickness and collagen deposition were the lowest in Chi-HA-AuNPs (50 ppm).

Conclusion:

Thus, in view of the in vitro and in vivo results, Chi-HA-AuNPs (50 ppm) could not only maintain the greatest stemness properties and regulate the neurogenic differentiation ability of MSCs, but was able to also induce the least immune response. Herein, Chi-HA-Au 50 ppm nanofilm holds promise as a suitable material for nerve regeneration engineering.
Image-enhanced endoscopy for detection of second primary esophageal neoplasms in patients with hypopharyngeal cancer: Prevalence, risk factors, and characteristics
Authors: Huang Yu-Wen , Wang Yen-Po , Lee Tsung-Lun , Chang Chia-Fan , Hou Ming-Chih , Tai Shyh-Kuan , Chu Pen-Yuan
Published: July 2021

Background:

Esophageal second primary neoplasms (ESPNs) are common in hypopharyngeal squamous cell carcinoma (HPSCC) patients and are associated with poor prognoses. The effectiveness of image-enhanced endoscopy (IEE) has not been well established.

Methods:

We reviewed the patients between April 2016 and April 2018 with HPSCC receiving ESPNs screening via white-light imaging, narrow-band imaging, and Lugol chromoendoscopy.

Results:

Of 99 eligible patients, ESPNs prevalence was 31%. Of the 69 patients assigned to the follow-up group, 23 with positive findings showed significantly increased previous histories of second primary malignancies in the upper aerodigestive tract. Among them, patients without symptoms at the time of IEE screening showed less advanced T stages and higher percentages of receiving minimal invasive therapy.

Conclusion:

The present study represented the clinical utility of routine IEE screening in HPSCC patients and proposed routine surveillance may help identify and properly manage early-stage ESPN.
Ischemic Stroke Risk Among Adult Brain Tumor Survivors: Evidence to Guide Practice
Authors: Figuracion Karl Cristie F. , Jung Wonkyung , Martha Sarah R.
Published: July 2021

INTRODUCTION: Primary brain tumors are the leading cause of cancer mortality in the United States affecting approximately 90,000 Americans each year. A major complication for brain tumor survivors is acute ischemic stroke (AIS). Currently, there are limited research to provide guidelines for AIS prevention and management in adult brain tumor survivors. The purpose of this review is to discuss the most common risk factors for AIS in adult brain tumor survivors along with best evidence for assessment, screening, and strategies to prevent AIS in this population. METHODS: Relevant literature was identified by searching CINAHL and PubMed databases using the following keywords: “brain tumor survivors,” “adults,” “stroke,” “risk factors,” “guidelines,” “prevention,” and “management”. Articles not pertaining to adult brain tumor survivors and AIS were excluded. RESULTS: The location of the tumor, dose, extent, and type of radiation contribute to the development of vascular injury and subsequent carotid stenosis among brain tumor survivors. Endothelial growth factor inhibitor and chemotherapy drugs induces vascular remodeling. Other symptoms such as neurological impairments and co-morbidities are also present among brain tumor survivors. Furthermore, AIS increases from the time of primary brain tumor diagnosis and incidence further increases among patients who were diagnosed with a brain tumor as a child. CONCLUSION: Nurses play a key role in the assessment, prevention, and identifying individuals who are at risk of AIS during brain tumor survivorship. Engaging patients and their caregivers on minimizing their risks of AIS is crucial in the outpatient setting. Annual surveillance visits that include intracranial artery imaging should be used to identify individuals considered most at risk for developing AIS symptoms.
Extracellular matrix: paving the way to the newest trends in atherosclerosis
Authors: Gialeli Chrysostomi , Shami Annelie , Gonçalves Isabel
Published: July 2021

Purpose of review

The extracellular matrix (ECM) is critical for all aspects of vascular pathobiology. In vascular disease the balance of its structural components is shifted. In atherosclerotic plaques there is in fact a dynamic battle between stabilizing and proinflammatory responses. This review explores the most recent strides that have been made to detail the active role of the ECM – and its main binding partners – in driving atherosclerotic plaque development and destabilization.

Recent findings

Proteoglycans-glycosaminoglycans (PGs-GAGs) synthesis and remodelling, as well as elastin synthesis, cross-linking, degradation and its elastokines potentially affect disease progression, providing multiple steps for potential therapeutic intervention and diagnostic targeted imaging. Of note, GAGs biosynthetic enzymes modulate the phenotype of vascular resident and infiltrating cells. In addition, while plaque collagen structure exerts very palpable effects on its immediate surroundings, a new role for collagen is also emerging on a more systemic level as a biomarker for cardiovascular disease as well as a target for selective drug-delivery.

The importance of studying the ECM in atherosclerosis is more and more acknowledged and various systems are being developed to visualize, target and mimic it.