bluuebunny/crossref_metadata_2025 huggingface dataset:
Lithium-plasmon-based low-powered dynamic color display
Authors: Liang Jie , Jin Yan , Yu Huiling , Chen Xinjie , Zhou Lin , Huo Pengcheng , Zhang Ye , Ma Haiyang , Jiang Yi , Zhu Bin , Xu Ting , Liu Hui , Zhu Shining , Zhu Jia
Published: June 2022

Display and power supply have been two essential and independent cornerstones of modern electronics. Here, we report a lithium-plasmon-based low-powered dynamic color display with intrinsic dual functionality (plasmonic display and energy recycling unit) which is a result of the electric-field-driven transformation of nanostructured lithium metals. Dynamic color displays are enabled by plasmonic transformation through electrodeposition (electrostripping) of lithium metals during the charging (discharging) process, while the consumed energy for coloring can be retrieved in the inverse process respectively. Energy recycling of lithium metals brings energy consumption down to 0.390 mW cm−2 (0.105 mW cm−2) for the active (static) coloration state of a proof-of-concept display/battery device, which approaches nearly-zero-energy-consumption in the near-100%-energy-efficiency limit of commercial lithium batteries. Combining the subwavelength feature of plasmonics with effective energy recycling, the lithium-plasmon-based dynamic display offers a promising route towards next-generation integrated photonic devices, with the intriguing advantages of low energy consumption, a small footprint and high resolution.
Impact of the Tips From Former Smokers Anti-Smoking Media Campaign on Youth Smoking Behaviors and Anti-Tobacco Attitudes
Authors: Slocum Elizabeth , Xie Yanmei , Colston David C , Emery Sherry , Patrick Megan E , Thrasher James F , Elliott Michael R , Fleischer Nancy L
Published: June 2022

Introduction

Anti-tobacco media campaigns can prevent youth smoking, but there is little research on how adult-targeted campaigns affect youth. We investigated the association between the Tips From Former Smokers (Tips) campaign and youth smoking behaviors and anti-tobacco attitudes, and variation by sex, race and/or ethnicity, or socioeconomic status.

Aims and Methods

We used data from the monitoring of the future study, a nationally representative survey on 8th, 10th, and 12th graders, from 2013–2015. Quartiles of Tips gross rating points (GRPs) were used to estimate exposure. Youth smoking behavior outcomes included smoking prevalence, initiation, and susceptibility. The anti-tobacco attitude outcomes included the extent that anti-tobacco ads made participants (1) less favorable towards smoking or (2) less likely to smoke cigarettes. Modified Poisson regression models estimated average marginal effects; separate additive interactions between Tips GRP exposure and sex, race and/or ethnicity, parents’ highest education, and college plans (12th graders only) were used to test for effect modification.

Results

Tips GRPs were not associated with smoking behaviors within any grade. However, 12th graders in the highest quartile of Tips had a 7.0 percentage point higher probability (95% CI = 0.023–0.116) of responding that anti-tobacco ads made them less likely to smoke. Tips GRPs were associated with a lower probability of past 30-day smoking prevalence among 10th grade females, but not males (joint P-value = .002). No additional statistically significant interactions were found for any other outcomes for any grade.

Conclusions

This study revealed the potential for adult-targeted campaigns to increase youth’s anti-smoking attitudes, but campaign exposure was not associated with smoking behaviors.

Implications

Few studies have examined the potential for anti-smoking media campaigns to influence audiences outside their targeted audience. In this study, we show the potential for adult-targeted campaigns to impact youth and suggest that Tips exposure may promote anti-smoking attitudes among youth.
Effect of Social Determinants of Health on Uncontrolled Human Immunodeficiency Virus (HIV) Infection Among Persons With HIV in San Francisco, California
Authors: Melo Jason S , Hessol Nancy A , Pipkin Sharon , Buchbinder Susan P , Hsu Ling C
Published: June 2022

Background

In 2010–2014, the San Francisco Department of Public Health (SFDPH) established programs to rapidly link people with human immunodeficiency virus (PWH) to care and offer antiretroviral therapy (ART) at human immunodeficiency virus (HIV) diagnosis. Such programs reduced the number of PWH out of care or with detectable HIV viral load (ie, uncontrolled HIV infection). We investigated the role of social determinants of health (SDH) on uncontrolled HIV.

Methods

Cross-sectional data from adult PWH diagnosed and reported to the SFDPH as of December 31, 2019, prescribed ART, and with confirmed San Francisco residency during 2017–2019 were analyzed in conjunction with SDH metrics derived from the American Community Survey 2015–2019. We focused on 5 census tract-level SDH metrics: percentage of residents below the federal poverty level, with less than a high school diploma, or uninsured; median household income; and Gini index. We compared uncontrolled HIV prevalence odds ratios (PORs) across quartiles of each metric independently using logistic regression models.

Results

The analysis included 7486 PWH (6889 controlled HIV; 597 uncontrolled HIV). Unadjusted PORs of uncontrolled HIV rose with increasingly marginalized quartiles, compared to the least marginalized quartile for each metric. Adjusting for demographics and transmission category, the POR for uncontrolled HIV for PWH in the most marginalized quartile remained significant across metrics for poverty (POR = 2.0; confidence interval [CI] = 1.5–2.6), education (POR = 2.4; CI = 1.8–3.2), insurance (POR = 1.8; CI = 1.3–2.5), income (POR = 1.8; CI = 1.4–2.3), and income inequality (POR = 1.5; CI = 1.1–2.0).

Conclusions

Beyond demographics, SDH differentially affected the ability of PWH to control HIV. Despite established care programs, PWH experiencing socioeconomic marginalization require additional support to achieve health outcome goals.
Gyrohydrodynamics: Relativistic spinful fluid with strong vorticity
Authors: Cao Zheng , Hattori Koichi , Hongo Masaru , Huang Xu-Guang , Taya Hidetoshi
Published: June 2022

We develop a relativistic (quasi-)hydrodynamic framework, dubbed gyrohydrodynamics, to describe the fluid dynamics of many-body systems with spin under strong vorticity based on entropy-current analysis. This framework generalizes the recently developed spin hydrodynamics to the regime where the spin density is at the leading order in derivatives but suppressed by another small parameter, the Planck constant ℏ, due to its quantum nature. Our analysis shows that the complete first-order constitutive relations of gyrohydrodynamics involve 17 transport coefficients and are highly anisotropic.
The Sleep Well Baby project: an automated real-time sleep–wake state prediction algorithm in preterm infants
Authors: Sentner Thom , Wang Xiaowan , de Groot Eline R , van Schaijk Lieke , Tataranno Maria Luisa , Vijlbrief Daniel C , Benders Manon J N L , Bartels Richard , Dudink Jeroen
Published: June 2022

Study Objectives

Sleep is an important driver of early brain development. However, sleep is often disturbed in preterm infants admitted to the neonatal intensive care unit (NICU). We aimed to develop an automated algorithm based on routinely measured vital parameters to classify sleep–wake states of preterm infants in real-time at the bedside.

Methods

In this study, sleep–wake state observations were obtained in 1-minute epochs using a behavioral scale developed in-house while vital signs were recorded simultaneously. Three types of vital parameter data, namely, heart rate, respiratory rate, and oxygen saturation, were collected at a low-frequency sampling rate of 0.4 Hz. A supervised machine learning workflow was used to train a classifier to predict sleep–wake states. Independent training (n = 37) and validation datasets were validation n = 9) datasets were used. Finally, a setup was designed for real-time implementation at the bedside.

Results

The macro-averaged area-under-the-receiver-operator-characteristic (AUROC) of the automated sleep staging algorithm ranged between 0.69 and 0.82 for the training data, and 0.61 and 0.78 for the validation data. The algorithm provided the most accurate prediction for wake states (AUROC = 0.80). These findings were well validated on an independent sample (AUROC = 0.77).

Conclusions

With this study, to the best of our knowledge, a reliable, nonobtrusive, and real-time sleep staging algorithm was developed for the first time for preterm infants. Deploying this algorithm in the NICU environment may assist and adapt bedside clinical work based on infants’ sleep–wake states, potentially promoting the early brain development and well-being of preterm infants.
Association of sleep quality, media use and book reading with behavioral problems in early childhood. The Ulm SPATZ Health Study
Authors: Ricci C , Poulain T , Keil J , Rothenbacher D , Genuneit J
Published: June 2022

Study Objectives

The objective of the study was to investigate the association of sleep quality, media use and book reading on internalizing, externalizing and prosocial behavior in early childhood.

Methods

In this cross-sectional study, we investigated a data set consisting of three consecutive yearly waves of the prospective Ulm SPATZ Health Study, conducted in southern Germany with 565, 496, and 421 children of 4–6 years of age, respectively.

Standardized effects of the overall score and subscales of the Children’s Sleep Habits Questionnaire, parent-reported child media use and book reading as well as their interaction term on the total score of the Strengths and Difficulties Questionnaire along with its externalizing, internalizing and prosocial subscales were estimated by multivariate adjusted random intercept mixed models.

Results

Overall sleep quality was associated more with internalizing than externalizing behavior; parasomnias associated with both behaviors. Night waking and sleep anxiety associated only with internalizing behavior. High levels of media use were associated with less internalizing behavior. More book reading resulted in less externalizing and internalizing behavior but more prosocial behavior. Finally, book reading and media use do not interact to determine child’s behavior.

Conclusions

The current work supports a strategy of monitoring sleep quality, reducing media use and promoting book reading in order to avoid behavioral problems in early childhood.
A montane species treeline is defined by both temperature and drought effects on growth season length
Authors: Bar-On Peleg , Yaakobi Assaf , Moran Uri , Rozenstein Offer , Kopler Idan , Klein Tamir
Published: June 2022

Montane treelines are defined by a threshold low temperature. However, what are the dynamics when the snow-free summer growth season coincides with a 6-month seasonal drought? We tested this fundamental question by measuring tree growth and leaf activity across elevations in Mt Hermon (2814 m; in Israel and Syria), where oak trees (Quercus look and Quercus boissieri) form an observed treeline at 1900 m.

While in theory, individuals can be established at higher elevations (minimum daily temperature >6.5 °C for >4 months even at the summit), soil drying and vapor pressure deficit in summer enforces growth cessation in August, leaving only 2–3 months for tree growth. At lower elevations, Q. look Kotschy is replaced by Quercus cerris L. (1300 m) and Quercus calliprinos Webb (1000 m) in accompanying Q. boissieri Reut., and growth season length (GSL) is longer due to an earlier start in April. Leaf gas exchange continues during autumn, but assimilates are no longer utilized in growth. Interestingly, the growth and activity of Q. boissieri were equivalent to that of each of the other three species across the ~1 km elevation gradient. A planting experiment at 2100 m showed that seedlings of the four oak species survived the cold winter and showed budding of leaves in summer, but wilted in August. Our unique mountain site in the Eastern Mediterranean introduces a new factor to the formation of treelines, involving a drought limitation on GSL. This site presents the elevation edge for each species and the southern distribution edge for both the endemic Q. look and the broad-range Q. cerris. With ongoing warming, Q. look and Q. boissieri are slowly expanding to higher elevations, while Q. cerris is at risk of future extirpation.
Reflections From Rhode Island’s Safe Consumption Sites Regulations Committee: A Lesson in Racial Equity
Authors: Vanjani Rahul , Soske Jon , Pitts Andrea , Bailer Dennis
Published: June 2022

In July 2021, a statewide measure to create Harm Reduction Centers (also known as safe consumption sites [SCS]) was signed into law in Rhode Island. Convincing evidence shows that SCS can reduce premature death in the surrounding neighborhood. Although SCS have had success around the globe for approaching 40 years, implementing a harm reduction center of this kind in the United States requires consideration of this country’s unique racial and geographic politics. In this manuscript, we describe a series of discussions at the Regulations Committee meetings in Rhode Island around the question of whether or not to mandate the presence of inhalation rooms. Through this vignette, we aim to convey how, at the highest level of government, citizens of Rhode Island were able to promote and prioritize racial equity.
Changes in Alcohol Consumption by Beverage Type Attributable to the COVID-19 Pandemic for 10 States, March 2020 to November 2020: An Ecological Simulation-based Analysis
Authors: Pytell Jarratt D. , Thakrar Ashish P. , Chander Geetanjali , Colantuoni Elizabeth
Published: June 2022

Objectives

Consumption of high potency alcohol is associated with greater healthcare burden, yet little attention has been placed on the change in types of alcohol consumed during the COVID-19 pandemic. We estimate the change in alcohol consumption by beverage type attributable to the COVID-19 pandemic.

Methods

The National Institute on Alcohol Abuse and Alcoholism provided apparent alcohol consumption (“consumption”) by beverage type for 10 states for January 2017 through November 2020 based on sales and tax data. The 38-month period to February 2020 was used to train quasi-Poisson regression models. The models then predicted the monthly consumption based on the historical trends in the absence of the COVID-19 pandemic from March through November 2020. The difference between the observed and predicted is the change in consumption attributable to the COVID-19 pandemic.

Results

Beyond what was expected based on historical trends, spirits consumption increased significantly for 6 states (Colorado, Massachusetts, Missouri, North Dakota, Minnesota, and Tennessee) ranging from 4% (95% confidence interval [CI] 1%–6%) to 17% (95% CI 6%–28%) which is equivalent to 7 (95% CI 2–18) to 32 95% CI 12–48) excess standard spirits drinks per-capita; Alaska, Florida, Illinois, and Kentucky had no significant change. Wine consumption increased 10% (95% CI 3%–18%) in Colorado and 8% (95% CI 3%–12%) in Tennessee. Wine consumption in Alaska decreased 6% (95% CI, 3%–10%) and beer consumption decreased 8% (95% CI 4%–11%).

Conclusions

During the COVID-19 pandemic, spirits consumption increased relative to wine and beer. Increased consumption of higher potency alcohol beverages could lead to higher alcohol-related healthcare and societal burden.
An Exploration of Young Adults With Opioid Use Disorder and How Their Perceptions of Family Members’ Beliefs Affects Medication Treatment
Authors: Bagley Sarah M. , Schoenberger Samantha F. , dellaBitta Vanessa , Lunze Karsten , Barron Kendyl , Hadland Scott E. , Park Tae Woo
Published: June 2022

Background

Young adults with opioid use disorder (OUD) have low engagement and retention in medication treatment. Families are uniquely situated to play an important role in treatment decisions. This qualitative study explored how young adults with OUD perceive their families’ beliefs about OUD and medication treatment, and how those beliefs impacted young adults’ beliefs about their own treatment decisions.

Methods

We conducted a qualitative study of a convenience sample of 20 English-speaking young adults with OUD receiving care from an urban safety net hospital in Massachusetts. We explored young adults’ perceptions of how families viewed medication treatment. We conducted semi-structured interviews that were recorded and transcribed. We analyzed interviews using hybrid inductive and deductive categorization to support thematic analysis.

Results

We identified 3 themes. First, family history of substance use disorder and treatment negatively impacted how young adults perceive their OUD and medication treatment. Second, young adults shared that many families held negative or stigmatizing views of medication treatment. Finally, acceptance by family was important but young adults acknowledged that keeping treatment decisions from family was sometimes necessary.

Conclusions

In this qualitative exploration of young adults with OUD, we found that young adults felt that their families held important beliefs about the kind of treatment family members found most appropriate, and these perceived family beliefs impacted their treatment choices. Future research to improve engagement and retention of youth adults with OUD could target the beliefs of family members.
When Effects Cannot be Estimated: Redefining Estimands to Understand the Effects of Naloxone Access Laws
Authors: Rudolph Kara E. , Gimbrone Catherine , Matthay Ellicott C. , Díaz Iván , Davis Corey S. , Keyes Katherine , Cerdá Magdalena
Published: June 2022

Violations of the positivity assumption (also called the common support condition) challenge health policy research and can result in significant bias, large variance, and invalid inference. We define positivity in the single- and multiple-timepoint (i.e., longitudinal) health policy evaluation setting, and discuss real-world threats to positivity. We show empirical evidence of the practical positivity violations that can result when attempting to estimate the effects of health policies (in this case, Naloxone Access Laws). In such scenarios, an alternative is to estimate the effect of a shift in law enactment (e.g., the effect if enactment had been delayed by some number of years). Such an effect corresponds to what is called a modified treatment policy, and dramatically weakens the required positivity assumption, thereby offering a means to estimate policy effects even in scenarios with serious positivity problems. We apply the approach to define and estimate the longitudinal effects of Naloxone Access Laws on opioid overdose rates.
On the Conventional Definition of Path-specific Effects: Fully Mediated Interaction With Multiple Ordered Mediators
Authors: Tai An-Shun , Liao Le-Hsuan , Lin Sheng-Hsuan
Published: June 2022

Path-specific effects are a critical measure for assessing mediation in the presence of multiple mediators. However, the conventional definition of path-specific effects has generated controversy because it often causes misinterpretation of the results of multiple mediator analysis. For in-depth analysis of this issue, we propose the concept of decomposing fully mediated interaction from the average causal effect. We show that misclassification of fully mediated interaction is the main cause of misinterpretation of path-specific effects. We propose two strategies for specifying fully mediated interaction: isolating and reclassifying fully mediated interaction. The choice of strategy depends on the objective. Isolating fully mediated interaction is the superior strategy when the main objective is elucidating the mediation mechanism, whereas reclassifying it is superior when the main objective is precisely interpreting the mediation analysis results. To compare performance, this study used the two proposed strategies and the conventional decomposition strategy to analyze the mediating roles of dyspnea and anxiety in the effect of impaired lung function on poor health status in a population of patients with chronic obstructive pulmonary disease. The estimation result showed that the conventional decomposition strategy underestimates the importance of dyspnea as a mechanism of this disease. Specifically, the strategy of reclassifying fully mediated interaction revealed that 50% of the average causal effect is attributable to mediating effects, particularly the mediating effect of dyspnea.
Therapeutic bronchoscopy for malignant central airway obstruction: impact on quality of life and risk-benefit analysis
Authors: Bashour Sami I. , Lazarus Donald R.
Published: June 2022

Purpose of review

Malignant central airway obstruction (CAO) is a common complication in cancer and confers significant symptom burden and reduction in quality of life. Multiple bronchoscopic interventions exist for malignant CAO. In this review, we discuss the role of therapeutic bronchoscopy in the management of malignant CAO, emphasizing its impact on symptom control and quality of life while balancing the risks and benefits of intervention.

Recent findings

Significant practice variations exist among practitioners of therapeutic bronchoscopy, and limited data exist to guide real-time clinical decision-making. Recent analyses demonstrate that therapeutic bronchoscopy is effective for symptoms associated with malignant CAO with infrequent complications. These studies also show that many of the improvements in symptoms and quality of life are sustained after intervention and are associated with improved overall survival in patients with malignant CAO. Recent data have also shown that the improvement in symptoms associated with therapeutic bronchoscopy may enable more definitive cancer treatment, further improving patient outcomes.

Therapeutic bronchoscopy is safe and effective at improving patient-centered outcomes in malignant CAO. Research is ongoing to better understand its optimal role in this setting, refine decision-making regarding advanced bronchoscopic interventions, and further improve patient outcomes.
Effects of diabetes on osteocytes
Authors: Kaur Japneet , Khosla Sundeep , Farr Joshua N.
Published: June 2022

Purpose of review

Better understanding of the mechanisms underlying skeletal dysfunction in the context of diabetes is needed to guide the development of therapeutic interventions to reduce the burden of diabetic fractures. Osteocytes, the ‘master regulators’ of bone remodeling, have emerged as key culprits in the pathogenesis of diabetes-related skeletal fragility.

Recent findings

Both type 1 diabetes and type 2 diabetes cause chronic hyperglycemia that, over time, reduces bone quality and bone formation. In addition to acting as mechanosensors, osteocytes are important regulators of osteoblast and osteoclast activities; however, diabetes leads to osteocyte dysfunction. Indeed, diabetes causes the accumulation of advanced glycation end-products and senescent cells that can affect osteocyte viability and functions via increased receptor for advanced glycation endproducts (RAGE) signaling or the production of a pro-inflammatory senescence-associated secretory phenotype. These changes may increase osteocyte-derived sclerostin production and decrease the ability of osteocytes to sense mechanical stimuli thereby contributing to poor bone quality in humans with diabetes.

Osteocyte dysfunction exists at the nexus of diabetic skeletal disease. Therefore, interventions targeting the RAGE signaling pathway, senescent cells, and those that inhibit sclerostin or mechanically stimulate osteocytes may alleviate the deleterious effects of diabetes on osteocytes and bone quality.
Trends in outpatient versus inpatient urologic surgery at a university academic medical center
Authors: Madhusoodanan Vinayak , Carto Chase , Parmar Madhumita , Ritch Chad , Parekh Dipen J. , Ramasamy Ranjith
Published: June 2022

Purpose of review

To analyze trends in outpatient and inpatient urologic surgeries at a large university academic medical center and test the hypothesis that the proportion of outpatient surgeries has been increasing as compared to inpatient surgeries in urology.

Recent findings

We analyzed a total of 33,054 claims for urologic surgeries at a large university academic medical center from 2010 to 2020, of which 23.2% met inpatient criteria (n = 7695), whereas 76.7% were outpatient (n = 25,359). Although outpatient claims increased yearly by an average of 24%, inpatient claims increased yearly by an average of only 1%. Over the same period, Medicare-specific outpatient claims mirrored these trends, and Medicare-specific inpatient claims decreased.

Outcomes of inpatient surgeries are used as a metric for quality by the Centers for Medicare and Medicaid Services (CMS) as well as US News and World Report (USNWR) rankings. However, with increasing numbers of minimally invasive operations, a large proportion of urologic surgeries are performed on an outpatient basis. As this trend continues, it will be important for organizations like CMS and USNWR to incorporate methods of measuring quality that better reflect outpatient surgical outcomes for the urologic subspecialty.
Nonmuscle-invasive bladder cancer, old problems, new insights
Authors: Compérat Eva , Wasinger Gabriel , Oszwald André , Pradere Benjamin , Shariat Shahrokh
Published: June 2022

Purpose of review

Nonmuscle-invasive bladder cancer (NMIBC) is the most frequent bladder cancer and represents around 75% of bladder cancers. This review will discuss known challenges and recent advances in staging, grading and treatment stratification based on pathology.

Recent findings

Pathological staging and grading in NMIBC remains challenging and different techniques exist. Substaging has been shown to be of prognostic relevance and to help predict treatment response in patients receiving Bacillus Calmette-Guérin (BCG) therapy, which is the treatment of choice for high-grade NMIBC. Recent advances in molecular classification and artificial intelligence were also able to show promising results in the stratification of patients.

Many challenges in the diagnosis of NMIBC are still unresolved and ask for more prospective research. New technologies, molecular insights and AI will help in the upcoming years to better stratify and manage these patients.
Surviving a Cyberattack in Anatomic Pathology: Disaster Response and Creation of an Incident Command System
Authors: Stowman Anne M. , Kalof Alexandra N.
Published: June 2022

Laboratories are increasingly reliant on networked electronic health information systems and therefore especially vulnerable to prolonged downtimes for a variety of reasons, which can be planned or unanticipated events. Our hospital was the victim of a cyberattack causing a complete shutdown of all computer systems, a downtime that lasted 25 days. The effects were devastating for patients, hospital employees, financials, public opinion, and hospital operations. After a week of downtime in the anatomic pathology laboratory, it became evident that our laboratory needed to rethink our organizational structure in order to regain operational status. It was then that we developed an Incident Command System, which allowed for 2-way communication and provided the adaptability and support needed to respond to the rapid process changes needed during the crisis.
The Value and Challenges of Internal Error Tracking in Anatomic Pathology Quality Management
Authors: Jacobs Jonathan , Staats Paul N.
Published: June 2022

A case of a sudden increase in reports of a specific error in the anatomic pathology laboratory is evaluated, yielding insights into the value, challenges, and limitations of using error reports as a quality management tool. The discussion considers the utility of a robust error-reporting system for anatomic pathology laboratories and identifies key factors at each step to improve success. Initial reporting must be easy and rewarding to reporters, and they must have confidence that reporting will not result in adverse impacts on coworkers. Categorization of common errors simplifies reporting, investigation, tracking, and data presentation. Response to errors should focus on addressing system design failures, while also providing nonjudgmental, nonpunitive feedback to individuals. Error categories can be chosen for systematic quality improvement projects based on severity and frequency of the error. When monitoring trends in error data, it is important to remember that the data are very sensitive to changes in reporting rates as well as changes in error rates, so they must be interpreted with great caution.
A Framework for Utilization of Turnaround Time as a Quality Metric in Surgical Pathology
Authors: DeSimone Mia S. , Heher Yael K.
Published: June 2022

Timeliness of surgical pathology result reporting is a critical quality metric for patients and treating clinicians. Over the past several decades, studies have sought to define laboratory turnaround time (TAT) in the context of the surgical pathology workflow, investigate the various factors that influence TAT, and develop a framework to monitor, measure, and track TAT within and across laboratories. However, the complexity of health care delivery and health information technology creates barriers to tracking TAT that should be considered in the context of local environments. We seek to provide background and context as well as a framework for tracking TAT as a key quality metric in surgical pathology. We outline a roadmap to monitoring local TAT to maximize efficiency and customer satisfaction while reducing diagnostic error and near-miss safety events.
Pediatric Penile Bee Sting
Authors: Huseynov Mirzaman , Cebisli Ali , Ozturk Atiye , Sahin Mahmut , Akin Ozdemir Merve , Polat Mustafa
Published: June 2022

Objectives

The aims of this study, for the first time in the literature, are to evaluate the symptoms, clinical course, and treatment management of penile bee stings in children and to discuss whether bee stings can be evaluated within the scope of summer penile syndrome.

Methods

Records of all pediatric patients presented to the emergency department of our hospital from June 2020 to October 2021 due to bee sting of penis were reviewed. Only patients with isolated penile bee stings were included in the study. Patients were evaluated in terms of the age at presentation, time of occurrence, symptoms, and treatment modality.

Results

There were 10 patients treated for penile bee sting. Patients ranged in age from 3 to 7 years (mean, 4.2 years). The most common complaints of the patients at presentation were pain (100%), swelling (100%), and dysuria (70%). Three of the patients were unable to void. The gauze moistened with warm saline was applied to the penis of these patients who developed glob, and all of these patients urinated after the warm application. Three of the patients had progressive erythema on the penile skin. These patients were admitted to the pediatric surgery department to monitor whether skin necrosis would develop. In all patients, the erythema regressed significantly within 48 hours and regained its completely normal appearance at the end of 72 hours.

Conclusions

The probability of the development of serious local reactions and urological problems in penile bee stings is low. Oral nonsteroidal anti-inflammatory drug and warm, wet dressing are usually sufficient to treat local reactions. Penile bee stings may be evaluated within the scope of summer penile syndrome because their symptoms, clinical findings, and treatments are almost similar.
Low Relevancy of Outcome Measurements of Studies of Pediatric Pain in the Emergency Department
Authors: de Vries Tjalling W.
Published: June 2022

Many children visiting the emergency department (ED) experience pain. Several pharmacological and nonpharmacological interventions are used for pain control. Little is known about the outcome measurements in studies about pain in children in the ED.

Furthermore, it is not known if complete pain relief was reached.

Methods

PubMed, the Cochrane Database of Systematic Reviews, and EMBASE were searched for articles on clinical trials for pain relief in children in the ED. Inclusion criteria contained predictable and identifiable pain such as after trauma or during procedures.

Results

Of 620 articles found, 45 fulfilled the criteria. Twenty studies (44%) used pharmacological interventions, and 25 (56%) studied nonpharmacological interventions. In 24 studies (53%), a statistically significant pain reduction was described in the intervention group. In 21 studies (47%), a clinically relevant reduction in pain was found. In only 1 study, the reported aim was to reach absence of pain.

Conclusion

Half of the interventions decreased pain in children in the ED. However, most studies did not aim at complete pain relief. Even in intervention groups with statistically significant decrease in pain, children still had pain. Children in the ED deserve better.

Complete pain relief should be the goal of any intervention for these children in the ED.

Studies on pain treatment in the ED should have complete pain relief as primary end point.
Color-matching techniques for creating esthetic hand and finger prostheses
Authors: Leow Michael E. L. , Puhaindran Mark E. , Chong Alphonsus K. S.
Published: June 2022

Background:

Color matching is a critically important part of, and by far, also the most challenging aspect of producing esthetic silicone prosthesis. There is a knowledge gap in the literature and a lack of opportunities for training in the expertise, particularly regarding color-matching techniques.

Objective:

This article details a color-matching technique that is able to achieve life-like coloration in esthetic prosthesis.

Technique:

Each prosthesis is molded in an outer and inner layers of silicone tinted to different shades and opacities incorporating an intermediate touch-up layer to reproduce the detailed coloration of the hand (because of the presence of veins, finger joint/dermal pigmentations, a vascularized nail bed, and pinkish palm). This method of color-matching prosthesis combining intrinsic and extrinsic techniques simulates the layered anatomy and optical properties of the human skin to effectively replicate its esthetic and life-like coloration. Technical tips for achieving an accurate color match to the patient’s skin, including pigment formulation adjustments for a tanned vs. a fair skin, and for painting the touch-up details are discussed. Methods for modifying the color tones of completed prosthesis and for minimizing metameric color differences when the prosthesis is viewed under different light sources are also presented.

Discussion:

The technique is instrumental in achieving good outcomes for life-likeness and esthetic coloration in the prostheses fitted at our center. Studies previously published that investigated patients’ evaluation of important esthetic characteristics of their prosthesis after a period of adjustment to fitting have shown a generally high level of patient satisfaction.
Derivation and validation of an improved pediatric shock index for predicting need for early intervention and outcomes in pediatric trauma
Authors: Georgette Nathan , Keskey Robert , Hampton David , Alberto Emily , Chokshi Nikunj , Zakrison Tanya L. , Wilson Kenneth , McQueen Alisa , Burd Randall S. , Slidell Mark B.
Published: June 2022

BACKGROUND

Shock index, pediatric age adjusted (SIPA), has been widely applied in pediatric trauma but has limited precision because of the reference ranges used in its derivation. We hypothesized that a pediatric shock index (PSI) equation based on age-based vital signs would outperform SIPA.

METHODS

A retrospective cohort of trauma patients aged 1 to 18 years from Trauma Quality Programs — Participant Use File 2010 to 2018 was performed. A random 70% training subset was used to derive Youden index–optimizing shock index (SI) cutoffs by age for blood transfusion within 4 hours. We used linear regression to derive equations representing the PSI cutoff for children 12 years or younger and 13 years or older. For children 13 years or older, the well-established SI of 0.9 remained optimal, consistent with SIPA and other indices. For children 12 years or younger in the 30% validation subset, we compared our age-based PSI to SIPA as predictors of early transfusion, mortality, pediatric intensive care unit admission, and injury severity score of ≥25. For bedside use, a simplified “rapid” pediatric shock index (rPSI) equation was also derived and compared with SIPA.

RESULTS

A total of 439,699 patients aged 1 to 12 years met the inclusion criteria with 2,718 (1.3% of those with available outcome data) requiring transfusion within 4 hours of presentation. In the validation set, positive predictive values for early transfusion were higher for PSI (8.3%; 95% confidence interval [CI], 7.5–9.1%) and rPSI (6.3%; 95% CI, 5.7–6.9%) than SIPA (4.3%; 95% CI, 3.9–4.7%). For early transfusion, negative predictive values for both PSI (99.3%; 95% CI, 99.2–99.3%) and rPSI (99.3%; 95% CI, 99.2–99.4%) were similar to SIPA (99.4%; 95% CI, 99.3–99.4%).

CONCLUSION

We derived the PSI and rPSI for use in pediatric trauma using empiric, age-based SI cutoffs. The PSI and rPSI achieved higher positive predictive values and similar negative predictive values to SIPA in predicting the need for early blood transfusion and mortality.

LEVEL OF EVIDENCE

Prognostic/Epidemiological; level III.
High Altitude as a Risk Factor for the Development of Nonarteritic Anterior Ischemic Optic Neuropathy
Authors: Liu Yin A. , Mesentier-Louro Louise A. , Shariati Mohammad A. , Moss Heather E. , Beres Shannon J. , Liao Yaping Joyce
Published: June 2022

Background:

Episodic high-altitude exposure leads to optic disc edema and retinopathy. It is uncertain whether high-altitude exposure is a risk factor for nonarteritic anterior ischemic optic neuropathy (NAION).

Methods:

We performed a single-center, retrospective, cross-sectional case study of 5 patients with high-altitude–associated NAION (HA-NAION) from April 2014 to April 2019. Main study parameters included known vascular risk factors for NAION, evolution of visual acuity, visual field, optic disc, and macula measurements.

Results:

We studied 5 eyes of 5 patients with HA-NAION that occurred at 7,000–9,000 ft above sea level, 28 patients with classic NAION that developed at sea level (normal altitude NAION or NA-NAION), and 40 controls. All 5 patients with HA-NAION had clinically confirmed NAION by a neuro-ophthalmologist within 3–21 days of onset and comprehensive follow-up evaluations (average follow-up of 23 months). Other than high-altitude exposure, 4 of 5 patients had undiagnosed obstructive sleep apnea (OSA, apnea–hypopnea index 5.4–22.2) and 1 had systemic vascular risk factors. All patients had disc-at-risk in the contralateral eye. The best-corrected distance visual acuity was 20/20 to 20/70 (median logMAR 0) at presentation and 20/70 to counting finger (median logMAR 0) at ≥6 months. Automated static perimetry revealed average mean deviation of −18.6 dB at presentation and −22.1 dB at ≥6 months. The average retinal nerve fiber layer was 244 µm (80–348 µm) at onset and 59 µm (55–80 µm) at ≥6 months. The average ganglion cell complex thickness was 50 µm (43–54 µm) at onset and 52 µm (50–55 µm) at ≥6 months. The patients with OSA were started on home continuous positive airway pressure treatment. Visual outcomes were similar in patients with HA-NAION and NA-NAION. - After addressing all NAION risk factors, no new events occurred in the HA-NAION group within 2-8 years with or without repeat high-altitude exposure.

Conclusions:

NAION can occur under high-altitude conditions. HA-NAION is associated with relatively younger age at onset, disc-at-risk, and OSA. These patients exhibit a relatively progressive course of vision loss after initial onset and severe thinning of optic nerves on optical coherence tomography. Treatment for OSA is recommended, especially with repeated high-altitude exposure.
A taste for numbers:Caenorhabditis elegansforaging follows a low-dimensional rule of thumb
Authors: Madirolas Gabriel , Al-Asmar Alid , Gaouar Lydia , Marie-Louise Leslie , Garza-Enriquez Andrea , Khona Mikail , Ratzke Christoph , Gore Jeff , Pérez-Escudero Alfonso
Published: June 2022

Rules of thumb are behavioral algorithms that approximate optimal behavior while lowering cognitive and sensory costs. One way to reduce these costs is by reducing dimensionality: While the theoretically optimal behavior may depend on many environmental variables, a rule of thumb may use a low-dimensional combination of variables that performs reasonably well. Experimental proof of a dimensionality reduction requires an exhaustive mapping of all relevant combinations of several environmental parameters, which we performed forCaenorhabditis elegansforaging by covering all combinations of food density (across 4 orders of magnitude) and food type (across 12 bacterial strains). We found a one-dimensional rule: Worms respond to food density measured as number of bacteria per unit surface, disregarding other factors such as biomass content or bacterial strain. We also measured fitness experimentally, determining that the rule is near-optimal and therefore constitutes a rule of thumb that leverages the most informative environmental variable.
Association of physical activity and the risk of COVID-19 hospitalization: a dose–response meta-analysis
Authors: Li Dan , Jin Shengzhen , Lu Songtao
Published: June 2022

Background

Many people have experienced a high burden due to the spread of the coronavirus disease (COVID-19) and its serious consequences for health and everyday life. Prior studies have reported that physical activity (PA) may lower the risk of COVID-19 hospitalization. The present meta-analysis (PROSPERO registration number: CRD42022339672) explored the dose– response relationship between PA and the risk of COVID-19 hospitalization.

Methods

Epidemiological observational studies on the relationship between PA and the risk of COVID-19 hospitalization were included. Categorical dose–response relationships between PA and the risk of COVID-19 hospitalization were assessed using random effect models. Robust error meta-regression models assessed the continuous relationship between PA (metabolic equivalent [MET]–h/week) and COVID-19 hospitalization risk across studies reporting quantitative PA estimates.

Results

Seventeen observational studies (cohort\case–control\cross-section) met the criteria for inclusion in the meta-analysis. Categorical dose-relationship analysis showed a 40% (risk ratio (RR) 0.60, 95% confidence intervals (CI): 0.48–0.71) reduction in the risk of COVID-19 hospitalization compared to the lowest dose of PA. The results of the continuous dose–response relationship showed a non-linear inverse relationship (Pnon-linearity < 0.05) between PA and the risk of COVID-19 hospitalization. When total PA was less than or greater than 10 Met-h/week, an increase of 4 Met-h/week was associated with a 14% (RR = 0.83, 95%CI: 0.85–0.87) and 11% (RR = 0.89, 95%CI: 0.87–0.90) reduction in the risk of COVID-19 hospitalization, respectively.

Conclusions

There was an inverse non-linear dose–response relationship between PA level and the risk of COVID-19 hospitalization. Doses of the guideline-recommended minimum PA levels by WTO may be required for more substantial reductions in the COVID-19 hospitalization risk.
Systematic review of candidate prognostic factors for falling in older adults identified from motion analysis of challenging walking tasks
Authors: Dubbeldam Rosemary , Lee Yu Yuan , Pennone Juliana , Mochizuki Luis , Mouel Charlotte Le
Published: June 2022

The objective of this systematic review is to identify motion analysis parameters measured during challenging walking tasks which can predict fall risk in the older population. Numerous studies have attempted to predict fall risk from the motion analysis of standing balance or steady walking. However, most falls do not occur during steady gait but occur due to challenging centre of mass displacements or environmental hazards resulting in slipping, tripping or falls on stairs. We conducted a systematic review of motion analysis parameters during stair climbing, perturbed walking and obstacle crossing, predictive of fall risk in healthy older adults. We searched the databases of Pubmed, Scopus and IEEEexplore.

A total of 78 articles were included, of which 62 simply compared a group of younger to a group of older adults. Importantly, the differences found between younger and older adults did not match those found between older adults at higher and lower risk of falls. Two prospective and six retrospective fall history studies were included. The other eight studies compared two groups of older adults with higher or lower risk based on mental or physical performance, functional decline, unsteadiness complaints or task performance. A wide range of parameters were reported, including outcomes related to success, timing, foot and step, centre of mass, force plates, dynamic stability, joints and segments. Due to the large variety in parameter assessment methods, a meta-analysis was not possible. Despite the range of parameters assessed, only a few candidate prognostic factors could be identified: older adults with a retrospective fall history demonstrated a significant largerstep length variability, largerstep time variability, andprolonged anticipatory postural adjustmentsin obstacle crossing compared to older adults without a fall history. Older adults who fell during a tripping perturbation had alarger angular momentumthan those who did not fall. Lastly, in an obstacle course,reduced gait flexibility(i.e., change in stepping pattern relative to unobstructed walking) was a prognostic factor for falling in daily life. We provided recommendations for future fall risk assessment in terms of study design.

In conclusion, studies comparing older to younger adults cannot be used to explore relationships between fall risk and motion analysis parameters. Even when comparing two older adult populations, it is necessary to measure fall history to identify fall risk prognostic factors.