bluuebunny/crossref_metadata_2025 huggingface dataset:
Detecting Risk of Neglect in NSHAP Round 3 Using New Follow-Up Questions to Activities of Daily Living Measures
Authors: Howe Melissa J K , Choi Kyung Won , Piedra Lissette M , Zhong Selena , Pierce Grey , Cook Soren C , Ramirez Randy
Published: October 2021

Objectives

Elder neglect is a type of elder abuse wherein an older adult’s basic needs remain unmet through negligence. The risk of neglect and its harmful consequences coincides with the need for care that arises with difficulties completing activities of daily living (ADLs) and instrumental activities of daily living (IADLs). In this paper, we describe how new questions included in Round 3 (2015–2016) of the National Social Life, Health, and Aging Project (NSHAP-R3) can help detect the risk of elder neglect.

Methods

Based on the 2,340 respondents who indicated problems with at least one ADL or IADL, we categorized respondents as at a higher risk of neglect if they were either: (a) not getting wanted help (WANTHELP) or (b) getting help from an undependable caregiver (UNRELIABLE). We tested the external validity of these indicators by examining their association with NSHAP-R3 measures of physical and mental health, personal hygiene, home tidiness, social support, and elder mistreatment, using t tests and chi-square tests.

Results

Those labeled higher neglect risk based on the WANTHELP variable showed significantly worse self-rated physical health, personal hygiene, room tidiness, mental health, partner support, family support, and elder mistreatment. The same correlates were significantly associated with higher neglect risk based on the UNRELIABLE variable, except for self-rated physical health, personal hygiene, and room tidiness.

Discussion

Findings suggest that these new measures can be useful for identifying NSHAP respondents who are at risk of types of neglect that can be associated with having I/ADL limitations.
Biallelic gephyrin variants lead to impaired GABAergic inhibition in a patient with developmental and epileptic encephalopathy
Authors: Macha Arthur , Liebsch Filip , Fricke Steffen , Hetsch Florian , Neuser Franziska , Johannes Lena , Kress Vanessa , Djémié Tania , Santamaria-Araujo Jose A , Vilain Catheline , Aeby Alec , Van Bogaert Patrick , Dejanovic Borislav , Weckhuysen Sarah , Meier Jochen C , Schwarz Guenter
Published: October 2021

Synaptic inhibition is essential for shaping the dynamics of neuronal networks, and aberrant inhibition is linked to epilepsy. Gephyrin (Geph) is the principal scaffolding protein at inhibitory synapses and is essential for postsynaptic clustering of glycine (GlyRs) and GABA type A receptors. Consequently, gephyrin is crucial for maintaining the relationship between excitation and inhibition in normal brain function and mutations in the gephyrin gene (GPHN) are associated with neurodevelopmental disorders and epilepsy. We identified bi-allelic variants in the GPHN gene, namely the missense mutation c.1264G > A and splice acceptor variant c.1315-2A > G, in a patient with developmental and epileptic encephalopathy. We demonstrate that the splice acceptor variant leads to nonsense-mediated mRNA decay. Furthermore, the missense variant (D422N) alters gephyrin structure, as examined by analytical size exclusion chromatography and circular dichroism-spectroscopy, thus leading to reduced receptor clustering and sensitivity towards calpain-mediated cleavage. In addition, both alterations contribute to an observed reduction of inhibitory signal transmission in neurons, which likely contributes to the pathological encephalopathy.
Study of the thermal performance of water-soaked porous wall under a tropical climate
Authors: Sudprasert Sudaporn , Jaroensen Pornchai
Published: October 2021

The effects of water-soaked porous wall on the reduction of air temperature and cooled air distribution in adjacent rooms are not yet understood. This paper examines the thermal performance of water-soaked porous wall based on field experiments and analysis of humidified cooled air in adjacent spaces by using a computational fluid dynamic model. The results indicated that two rows of porous pipes are capable of reducing ambient air temperature by 2.2°C with a cooling capacity of 372.5–1792.7 W/m2. The simulation results at a wind velocity of 0.70 m/s showed that cooled air is distributed in the room up to 3.2 m away from the porous wall and mostly accumulated on the room’s floor.
Eight years of antibiotic consumption at a primary care outpatient facility in Trinidad and Tobago 2011–18: a synopsis of consumption trends
Authors: Khan Raveed , Gangar Misty , Gangar Melanie , Motilal Shastri
Published: October 2021

Objectives

To explore antibiotic consumption and surveillance patterns in Trinidad and Tobago.

Methods

A retrospective observational study was conducted. Stock requisition and logbooks from a District Health Facility in Trinidad were examined for the period 2011–18. Daily Defined Doses (DDDs) for each antibiotic were computed and extrapolated to represent the antibiotic consumption per 1000 residents within the population.

Results

The mean consumption across the years was 2.917 DDD per 1000 residents per day. The most consumed antibiotics were cefuroxime, amoxicillin/clavulanic acid, and azithromycin, with mean DDDs of 0.879, 0.695 and 0.373 respectively. The least consumed antibiotics were cefaclor and clarithromycin, with DDDs of 0.0006 and 0.0005, respectively.

Conclusions

Trinidad and Tobago is not mentioned in the WHO surveillance report on antibiotic consumption. Our most recent (2018) estimate of total antibiotic consumption was 3.224 DDD per 1000 habitants per day. This figure is an underestimate, as data was derived solely from the public sector. Notwithstanding, this data is novel and can provide a baseline for future comparison and development of national surveillance programmes.
Characterization of bacterial DNA identified in abscessed and non-abscessed bovine hepatic tissue at the time of harvest
Authors: Stotz Miranda K , Henry Darren D , Crossland Whitney L
Published: October 2021

Bacteriological characterization of bovine liver abscesses has been accomplished by cultural methods but DNA methods are still needed, as many bacteria are not conducive to laboratory culture. In addition to this gap in research, there have been no studies which identify the bacterial presence within healthy, non-abscessed liver tissue. The objective of this study was to compare the bacteriome of both abscessed and non-abscessed bovine livers in an observational case–control study design. Fifty-six livers, obtained from Holstein steers, were scored according to a modified Elanco liver abscess score description where A− was partitioned into active abscesses or scarred where only scars were present. Parenchyma tissue was collected from non-abscessed livers (n = 22) and scarred livers (n = 7), and purulent material was collected from abscessed livers (n = 24), and DNA was extracted for 16s rRNA gene sequence-based bacterial analysis. Across liver samples, 21 total phyla were identified with a mean of 14. Predominant phyla, accounting for >98% of reads, were Fusobacteria (51.7%), Bacteroidetes (26.9%), Proteobacteria (8.03%), Firmicutes (5.39%), Cyanobacteria (3.85%), and Actinobacteria (2.21%). Proteobacteria, Cyanobacteria, and Firmicutes were greater in non-abscessed and scarred livers, whereas Fusobacteria and Bacteroidetes prevailed in abscessed livers. Non-abscessed livers shared 3,059 operational taxonomic units (OTU) with abscessed livers (total OTU of all livers = 4,167), but non-abscessed livers had greater richness and evenness, whereas abscessed livers had greater dominance (P ≤ 0.0014). Liver score affected the relative abundance of OTU (R = 0.463; P = 0.001) but abscessed livers shared ≥ 40% similarity and were not different from each other (P ≥ 0.370). Of the predominant OTU (top 10 as a % of reads), three OTU (Fusobacteria necrophorum, Bacteroides spp., and Trueperella pyogenes) were shared across both abscessed and non-abscessed livers. Fusobacterium necrophorum was the dominant OTU regardless of liver score, and the single most abundant OTU, even among non-abscessed livers. We describe bacterial DNA detected in non-abscessed bovine liver tissue for the first time, which indicates possible presence of viable bacteria with pathogenic potential in apparently healthy liver tissue.
No champagne for ‘Champanillo’: the protection of PDOs and PGIs against evocation for services
Authors: Vrins Olivier
Published: October 2021

Court of Justice of the European Union, C-783/19, Comité Interprofessionnel du Vin de Champagne v GB, EU:C:2021:713, 9 September 2021

In its judgment of 9 September 2021 in case C-783/19, the Court of Justice of the European Union essentially clarified whether the use for services of a sign that constitutes an evocation of a protected designation of origin (‘PDO’) and protected geographical indication (‘PGI’) and exploits this PDO’s/PGI’s reputation is prohibited under EU law, and what the factors are that need to be considered for assessing the existence of an evocation in such a situation.
Identifying resonances of the Galactic bar in Gaia DR2: II. Clues from angle space
Authors: Trick Wilma H
Published: October 2021

The Milky Way disc exhibits intricate orbit substructure of still debated dynamical origin. The angle variables (θϕ, θR) – which are conjugates to the actions (L$z$, JR), and describe a star’s location along its orbit – are a powerful diagnostic to identify l:m resonances via the orbit shape relation ΔθR/Δθϕ = −m/l. In the past, angle signatures have been hidden by survey selection effects (SEs). Using test particle simulations of a barred galaxy, we demonstrate that Gaia should allow us to identify the Galactic bar’s outer Lindblad resonance (OLR;l = +1, m = 2) in angle space. We investigate strategies to overcome SEs. In the angle data of the Gaia Data Release 2 (DR2) Radial Velocity Spectrometer (RVS) sample, we independently identify four candidates for the OLR and therefore for the pattern speed Ωbar. The strongest candidate, Ωbar ∼ 1.4Ω0, positions the OLR above the ‘Sirius’ moving group, agrees with measurements from the Galactic Centre, and might be supported by higher order resonances around the ‘Hercules/Horn’. But it misses the classic orbit orientation flip, as discussed in the companion study on actions. The candidate Ωbar ∼ 1.2Ω0 was also suggested by the action-based study, has the OLR at the ‘Hat’, is consistent with slow bar models, but still affected by SEs. Weaker candidates are Ωbar = 1.6Ω0 and 1.74Ω0. In addition, we show that the stellar angles do not support the ‘Hercules/Horn’ being created by the OLR of a fast bar. We conclude that – to resolve if ‘Sirius’ or ‘Hat’ is related to the bar’s OLR – more complex dynamical explanations and more extended data with well-behaved SEs are required.
Cosmological structure formation in scalar field dark matter with repulsive self-interaction: the incredible shrinking Jeans mass
Authors: Shapiro Paul R , Dawoodbhoy Taha , Rindler-Daller Tanja
Published: October 2021

Scalar field dark matter (SFDM) comprised of ultralight (≳ 10−22 eV) bosons is an alternative to standard, collisionless cold dark matter (CDM) that is CDM-like on large scales but inhibits small-scale structure formation. As a Bose–Einstein condensate, its free-field (‘fuzzy’) limit (FDM) suppresses structure below the de Broglie wavelength, λdeB, creating virialized haloes with central cores of radius ∼ λdeB, surrounded by CDM-like envelopes, and a halo mass function (HMF) with a sharp cut-off on small scales. With a strong enough repulsive self-interaction (SI), structure is inhibited, instead, below the Thomas–Fermi (TF) radius, RTF (the size of an SI-pressure-supported (n = 1)-polytrope), when RTF > λdeB. Previously, we developed tools to describe SFDM dynamics on scales above λdeB and showed that SFDM-TF haloes formed by Jeans-unstable collapse from non-cosmological initial conditions have RTF-sized cores, surrounded by CDM-like envelopes. Revisiting SFDM-TF in the cosmological context, we simulate halo formation by cosmological infall and collapse, and derive its transfer function from linear perturbation theory to produce cosmological initial conditions and predict statistical measures of structure formation, such as the HMF. Since FDM and SFDM-TF transfer functions both have small-scale cut-offs, we can align them to let observational constraints on FDM proxy for SFDM-TF, finding FDM with particle masses 1 ≲ m/(10−22 eV/c2) ≲ 30 corresponds to SFDM-TF with 10 ≳ RTF/(1 pc) ≳ 1, favouring subgalactic (sub-kpc) core size. The SFDM-TF HMF cuts off gradually, however, leaving more small-mass haloes: Its Jeans mass shrinks so fast that scales filtered early can still recover and grow!
The structural and functional workings of KEOPS
Authors: Beenstock Jonah , Sicheri Frank
Published: October 2021

KEOPS (Kinase, Endopeptidase and Other Proteins of Small size) is a five-subunit protein complex that is highly conserved in eukaryotes and archaea and is essential for the fitness of cells and for animal development. In humans, mutations in KEOPS genes underlie Galloway–Mowat syndrome, which manifests in severe microcephaly and renal dysfunction that lead to childhood death. The Kae1 subunit of KEOPS catalyzes the universal and essential tRNA modification N6-threonylcarbamoyl adenosine (t6A), while the auxiliary subunits Cgi121, the kinase/ATPase Bud32, Pcc1 and Gon7 play a supporting role. Kae1 orthologs are also present in bacteria and mitochondria but function in distinct complexes with proteins that are not related in structure or function to the auxiliary subunits of KEOPS. Over the past 15 years since its discovery, extensive study in the KEOPS field has provided many answers towards understanding the roles that KEOPS plays in cells and in human disease and how KEOPS carries out these functions. In this review, we provide an overview into recent advances in the study of KEOPS and illuminate exciting future directions.
Negative DNA supercoiling makes protein-mediated looping deterministic and ergodic within the bacterial doubling time
Authors: Yan Yan , Xu Wenxuan , Kumar Sandip , Zhang Alexander , Leng Fenfei , Dunlap David , Finzi Laura
Published: October 2021

Protein-mediated DNA looping is fundamental to gene regulation and such loops occur stochastically in purified systems. Additional proteins increase the probability of looping, but these probabilities maintain a broad distribution. For example, the probability of lac repressor-mediated looping in individual molecules ranged 0–100%, and individual molecules exhibited representative behavior only in observations lasting an hour or more. Titrating with HU protein progressively compacted the DNA without narrowing the 0–100% distribution. Increased negative supercoiling produced an ensemble of molecules in which all individual molecules more closely resembled the average. Furthermore, in only 12 min of observation, well within the doubling time of the bacterium, most molecules exhibited the looping probability of the ensemble. DNA supercoiling, an inherent feature of all genomes, appears to impose time-constrained, emergent behavior on otherwise random molecular activity.
The UCSC Genome Browser database: 2022 update
Authors: Lee Brian T , Barber Galt P , Benet-Pagès Anna , Casper Jonathan , Clawson Hiram , Diekhans Mark , Fischer Clay , Gonzalez Jairo Navarro , Hinrichs Angie S , Lee Christopher M , Muthuraman Pranav , Nassar Luis R , Nguy Beagan , Pereira Tiana , Perez Gerardo , Raney Brian J , Rosenbloom Kate R , Schmelter Daniel , Speir Matthew L , Wick Brittney D , Zweig Ann S , Haussler David , Kuhn Robert M , Haeussler Maximilian , Kent W James
Published: October 2021

The UCSC Genome Browser, https://genome.ucsc.edu, is a graphical viewer for exploring genome annotations. The website provides integrated tools for visualizing, comparing, analyzing, and sharing both publicly available and user-generated genomic datasets. Data highlights this year include a collection of easily accessible public hub assemblies on new organisms, now featuring BLAT alignment and PCR capabilities, and new and updated clinical tracks (gnomAD, DECIPHER, CADD, REVEL). We introduced a new Track Sets feature and enhanced variant displays to aid in the interpretation of clinical data. We also added a tool to rapidly place new SARS-CoV-2 genomes in a global phylogenetic tree enabling researchers to view the context of emerging mutations in our SARS-CoV-2 Genome Browser. Other new software focuses on usability features, including more informative mouseover displays and new fonts.
UbiBrowser 2.0: a comprehensive resource for proteome-wide known and predicted ubiquitin ligase/deubiquitinase–substrate interactions in eukaryotic species
Authors: Wang Xun , Li Yang , He Mengqi , Kong Xiangren , Jiang Peng , Liu Xi , Diao Lihong , Zhang Xinlei , Li Honglei , Ling Xinping , Xia Simin , Liu Zhongyang , Liu Yuan , Cui Chun-Ping , Wang Yan , Tang Liujun , Zhang Lingqiang , He Fuchu , Li Dong
Published: October 2021

As an important post-translational modification, ubiquitination mediates ∼80% of protein degradation in eukaryotes. The degree of protein ubiquitination is tightly determined by the delicate balance between specific ubiquitin ligase (E3)-mediated ubiquitination and deubiquitinase-mediated deubiquitination. In 2017, we developed UbiBrowser 1.0, which is an integrated database for predicted human proteome-wide E3–substrate interactions. Here, to meet the urgent requirement of proteome-wide E3/deubiquitinase–substrate interactions (ESIs/DSIs) in multiple organisms, we updated UbiBrowser to version 2.0 (http://ubibrowser.ncpsb.org.cn). Using an improved protocol, we collected 4068/967 known ESIs/DSIs by manual curation, and we predicted about 2.2 million highly confident ESIs/DSIs in 39 organisms, with >210-fold increase in total data volume. In addition, we made several new features in the updated version: (i) it allows exploring proteins’ upstream E3 ligases and deubiquitinases simultaneously; (ii) it has significantly increased species coverage; (iii) it presents a uniform confidence scoring system to rank predicted ESIs/DSIs. To facilitate the usage of UbiBrowser 2.0, we also redesigned the web interface for exploring these known and predicted ESIs/DSIs, and added functions of ‘Browse’, ‘Download’ and ‘Application Programming Interface’. We believe that UbiBrowser 2.0, as a discovery tool, will contribute to the study of protein ubiquitination and the development of drug targets for complex diseases.
ID3 promotes homologous recombination via non-transcriptional and transcriptional mechanisms and its loss confers sensitivity to PARP inhibition
Authors: Bakr Ali , Hey Joschka , Sigismondo Gianluca , Liu Chun-Shan , Sadik Ahmed , Goyal Ashish , Cross Alice , Iyer Ramya Lakshmana , Müller Patrick , Trauernicht Max , Breuer Kersten , Lutsik Pavlo , Opitz Christiane A , Krijgsveld Jeroen , Weichenhan Dieter , Plass Christoph , Popanda Odilia , Schmezer Peter
Published: October 2021

The inhibitor of DNA-binding 3 (ID3) is a transcriptional regulator that limits interaction of basic helix-loop-helix transcription factors with their target DNA sequences. We previously reported that ID3 loss is associated with mutational signatures linked to DNA repair defects. Here we demonstrate that ID3 exhibits a dual role to promote DNA double-strand break (DSB) repair, particularly homologous recombination (HR). ID3 interacts with the MRN complex and RECQL helicase to activate DSB repair and it facilitates RAD51 loading and downstream steps of HR. In addition, ID3 promotes the expression of HR genes in response to ionizing radiation by regulating both chromatin accessibility and activity of the transcription factor E2F1. Consistently, analyses of TCGA cancer patient data demonstrate that low ID3 expression is associated with impaired HR. The loss of ID3 leads to sensitivity of tumor cells to PARP inhibition, offering new therapeutic opportunities in ID3-deficient tumors.
Novel biomarkers of inflammation, kidney function and chronic kidney disease in the general population
Authors: Nano Jana , Schöttker Ben , Lin Jie-sheng , Huth Cornelia , Ghanbari Mohsen , Garcia Pamela Matias , Maalmi Haifa , Karrasch Stefan , Koenig Wolfgang , Rothenbacher Dietrich , Roden Michael , Meisinger Christa , Peters Annette , Brenner Hermann , Herder Christian , Thorand Barbara
Published: October 2021

Background

Inflammatory processes have been implicated in the development of chronic kidney disease (CKD). We investigated the association of a large panel of inflammatory biomarkers reflecting aspects of immunity with kidney function and CKD incidence.

Methods

We used data from two independent population-based studies, KORA F4 (discovery, n = 1110, mean age 70.3 years, 48.7% male) and ESTHER (replication, n = 1672, mean age 61.9 years, 43.6% male). Serum levels of biomarkers were measured using proximity extension assay technology. The association of biomarkers with estimated glomerular filtration rate (eGFR) at baseline and with incident CKD was investigated using linear and logistic regression models adjusted for cardiorenal risk factors. Independent results from prospective analyses of both studies were pooled. The significance level was corrected for multiple testing by false-discovery rate (PFDR < 0.05).

Results

In the KORA F4 discovery study, 52 of 71 inflammatory biomarkers were inversely associated with eGFR based on serum creatinine. Top biomarkers included CD40, TNFRSF9 and IL10RB. Forty-two of these 52 biomarkers were replicated in the ESTHER study. Nine of the 42 biomarkers were associated with incident CKD independent of cardiorenal risk factors in the meta-analysis of the KORA (n = 142, mean follow-up 6.5 years) and ESTHER (n = 103, mean follow-up 8 years) studies. Pathway analysis revealed the involvement of inflammatory and immunomodulatory processes reflecting cross-communication of innate and adaptive immune cells.

Conclusions

Novel and known biomarkers of inflammation were reproducibly associated with kidney function. Future studies should investigate their clinical utility and underlying molecular mechanisms in independent cohorts.
Trend and Predictors of Short-term Mortality of Adult Bacteremia at Emergency Departments: A 14-Year Cohort Study of 14 625 Patients
Authors: Chiang Hsiu-Yin , Chen Tsung-Chia , Lin Che-Chen , Ho Lu-Ching , Kuo Chin-Chi , Chi Chih-Yu
Published: October 2021

Background

Bacteremia is a life-threatening condition with a high mortality rate in critical care and emergency settings. The current study investigated the trend of mortality and developed predictive models of mortality for adults with bacteremia at emergency departments (EDs).

Methods

We conducted a retrospective cohort study of adults with bacteremia at the ED of China Medical University Hospital. Patient data were obtained from the Clinical Research Data Repository, and mortality information was obtained from the National Death Registry. We developed a new model to predict 7-day mortality in the derivation population and compared the model performance of the new model with Pitt Bacteremia Score (PBS) and Bloodstream Infection Mortality Risk Score (BSIMRS) in the validation population.

Results

We identified 14625 adult patients with first-time bacteremia at the ED, of whom 8.4% died within 7 days. From 2003 to 2016, both the cumulative incidence and 7-day mortality rate of bacteremia decreased significantly. The ED bacteremia mortality (ED-BM) model included PBS parameters, age, infection source, baseline steroid use, and biochemical profiles (estimated glomerular filtration rate, platelet, blood urea nitrogen, potassium, and hemoglobin) for predicting 7-day mortality. The discrimination performance of the ED-BM model (area under curve [AUC], 0.903) was significantly better than that of PBS (AUC, 0.848) or BSIMRS (AUC, 0.885).

Conclusions

Although the cumulative incidence and mortality of ED bacteremia decreased, its mortality burden remains critical. The proposed ED-BM model had significantly better model performance than other scoring systems in predicting short-term mortality for adult patients with bacteremia at EDs.
The Relationship Between Strength of the Affected Leg and Walking Speed After Stroke Varies According to the Level of Walking Disability: A Systematic Review
Authors: Dorsch Simone , Ada Louise , Sorial Tiffany , Fanayan Emma
Published: October 2021

Objective

The objectives of this review were to determine the relationship between muscle strength of the affected leg and walking speed after stroke and whether this relationship varied according to muscle group or level of walking disability.

Methods

This systematic review with meta-analysis focused on observational studies of adult survivors of stroke. Muscle strength had to be measured as maximum voluntary force production during an isometric contraction of the affected leg. Walking had to be measured as walking speed. Studies had to report correlations between muscle strength and walking speed.

Results

Thirty studies involving 1001 participants were included. Pooled mean correlations between muscle strength of the affected leg and walking speed was 0.51 (95% CI = 0.45 to 0.57). Pooled correlations between the strength of individual muscle groups and walking speed ranged from 0.42 (for the hip abductors) to 0.57 (for the ankle dorsiflexors). The correlation between level of walking disability and the mean correlation between muscle strength and walking speed was −0.70 (95% CI = −0.42 to −0.86).

Conclusion

After stroke, there is a strong relationship between strength of the affected leg and walking speed, with little variability across individual muscle groups. However, the level of walking disability of people with stroke does make a difference such that the more disabled people are, the stronger the relationship is between strength of the affected leg and walking speed.

Impact

This study suggests that the strength of all muscles of the affected leg is important for walking after stroke. It appears that increasing strength in the affected leg could be most important in people who are more disabled.

Lay Summary

After stroke, the speed at which a person can walk is highly associated with the muscle strength of their affected leg. In people whose walking speed is severely affected, this association is stronger, and the physical therapist might focus on strengthening that leg so the individual can walk faster.
PAs' attitudes about adolescent suicide screening: The Theory of Planned Behavior
Authors: Gillette Chris , Bodner Gayle , Grant Jill , Aldrich Rosalie , Mospan Cortney , Ip Edward Hak-Sing , Daniel Stephanie , Crandall Sonia
Published: October 2021

Objective:

Suicide is an increasing public health problem for adolescents and young adults. The purpose of this study was to identify the frequency of physician assistants' (PAs') self-reported adolescent suicide risk assessments and to elicit salient beliefs regarding behavioral attitudes, norm referents, control factors, and intention to conduct suicide risk assessment with adolescents.

Methods:

A convenience sample of PAs completed an anonymous cross-sectional questionnaire. Relationships were assessed using bivariate analyses and qualitative theme analysis.

Results:

Forty-three PAs completed the questionnaire. Many PAs supported suicide risk assessment screening as a strategy to identify adolescents who are suicidal at an earlier stage of their illness; lack of time during the visit and problematic parental involvement were identified as barriers.

Conclusions:

PAs recognized that screening adolescents for suicide ideation may help prevent suicides. Their practice behaviors, however, did not correspond to this belief.
Caring for the psychosocial needs of the acutely traumatized patient
Authors: Powell C. Chloe
Published: October 2021

Support for a patient in the aftermath of a potentially traumatic event is enhanced when clinicians understand the normal reactions that may occur during the traumatization process. This article discusses recommendations from international and national guidelines as well as best practices from the medical and psychiatric literature to help guide clinicians providing care for acutely traumatized patients.
Relative Efficacy and Safety of Tanezumab for Osteoarthritis
Authors: Zhang Bocheng , Tian Xiaoyuan , Qu Zhenan , Liu Jiaming , Yang Liang
Published: October 2021

Objectives:

The aim of this meta-analysis was to evaluate the efficacy and safety of tanezumab for the treatment of patients with knee or hip osteoarthritis (OA).

Methods:

PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were searched from inception to July 2020. Randomized-controlled trials comparing tanezumab with placebo or nonsteroidal anti-inflammatory drugs in patients with OA. Two investigators identified studies and independently extracted data, and conventional meta-analyses were conducted with Review Manager 5.3. The outcomes were pain relief, functional improvement, and risk of adverse events (AEs).

Results:

A total of 8 articles, comprising 9 randomized-controlled trials, were included. Overall, tanezumab was superior to placebo for relieving pain and improving function, as well as in the patient’s global assessment. Tanezumab also had significant advantages over nonsteroidal anti-inflammatory drugs for relieving pain and improving function, as well as in the patient’s global assessment. Significantly more patients discontinued treatment because of AEs after treatment with tanezumab. However, the differences in serious AEs and total joint replacement were not significant. Moreover, tanezumab-treated patients experienced significantly more rapid progression of osteoarthritis.

Discussion:

Tanezumab can alleviate pain and improve function for patients with OA of the hip or knee. Although tanezumab does not cause serious AEs, rapid progression of OA occurred in a small number of participants, so more clinical trials are needed to explore its safety.
Clinical Outcomes of Surgical Correction and Fusion for Postlaminectomy Kyphosis Following Spinal Tumor Resection in Adolescent Patients
Authors: Pan Wei , Li Jie , Qiu Yong , Zhu Zezhang , Zhu Weiguo , Liu Zhen
Published: October 2021

Background:

Progressive spinal deformity following laminectomy and resection surgery of spinal tumor has been well-documented. However, the postlaminectomy deformity in adolescent patients often bring challenge to clinical treatment, which may be subjected to rapid progression of kyphosis during the growth spurt. The aim of this study is to investigate the clinical outcome of long fusion correction surgery for thoracic or thoracolumbar kyphotic deformity secondary to laminectomy and tumor resection in adolescent patients.

Methods:

Records of 12 cases underwent correction surgery of postlaminectomy thoracic (n=6) or thoracolumbar (n=6) kyphotic deformity were reviewed. The Cobb angle of sagittal and coronal curve before surgery, immediately after surgery, and at the final follow-up were measured to evaluate the correction of deformity and loss of correction. Neurological function was evaluated using the Frankel grading system. Back pain was assessed by using the visual analog score (VAS). Disability status was evaluated by the Oswestry Disability Index (ODI). Patients’ satisfaction to surgery was assessed by the patient satisfactory index.

Results:

The mean kyphosis angle reduced from 76±20 degrees before surgery to 34±18 degrees immediately after surgery and remained at 39±17 degrees at the final follow-up with the average correction rate of 58.6% and 51.0%, respectively. For 7 patients with concomitant scoliosis, the Cobb angle of major curve reduced from 52±21 degrees before surgery to 16±9 degrees immediately after surgery and 20±9 degrees at the final follow-up. The average corrective rate was 69.5% and 62.4%, respectively. The mean ODI score improved from 19.9±7.5 to 10.8±8.0, whereas the mean VAS score improved from 5.3±2.0 to 1.5±1.4. The sagittal and coronal balance of the spine, Frankel grading, ODI, and VAS were improved, and the patient satisfactory index was 100%. One patient had inferior paraplegia recovered to Frankel grade E after treatment.

Conclusions:

Satisfactory clinical outcomes can be achieved after long fusion surgery for thoracic or thoracolumbar kyphotic deformity secondary to laminectomy for spinal tumor. Due to the high risk of secondary kyphotic deformity in adolescent patients, internal fixation should be performed simultaneously with the resection of spinal tumor, especially for the cases in the thoracic or thoracolumbar region.

Level of Evidence:

Level III.
Quality of Surgery and Patient Selection Are Keys to Success in Hip Stabilization Surgery in Cerebral Palsy
Authors: Wong Janus S.H. , Kuong Evelyn E. , So Noah L.W. , Ali Abbas , To Michael K.T. , Chow Wang
Published: October 2021

Background:

Cerebral palsy patients are at risk of hip instability, to which various soft tissue and bony surgeries are performed should conservative management fail. We aim to identify factors associated with treatment failure to guide surgical management.

Methods:

Cerebral palsy patients treated at 2 university-affiliated tertiary pediatric orthopaedic referral centers with hip stabilization surgery performed for subluxation in 1998 to 2015 with minimum of 5 years follow-up were reviewed. Failure was defined as reoperation to the same hip because of recurrent subluxation. Age, sex, Gross Motor Function Classification System level, tone abnormality, operation type, Reimer’s migration index (RMI), and acetabular index (AI) were assessed. Cut-off values were identified through Youden index on receiver operating characteristic curve.

Results:

Eighty-nine hips from 55 patients with mean follow-up of 12.4 years were analyzed. Revision surgery was performed in 14 hips. Postoperative hip subluxation (P<0.001) and acetabular dysplasia (P=0.001) were predictive of failure, with postoperative RMI conferring an adjusted hazard ratio of 1.13 (95% confidence interval: 1.08-1.19, P<0.001) on multivariable survival analysis. Achieving a postoperative RMI of <27.5% predicts success with 92.9% sensitivity and 72% specificity with area under curve of 0.916 (P<0.001), while postoperative AI of <23.1 degrees predicts success with 92.3% sensitivity and 62.2% specificity with area under curve of 0.796 (P=0.001). In subgroup analysis of soft-tissue-only procedures, RMI >44% preoperative and >32% postoperative were associated with reoperation. In femur-only osteotomies, preoperative RMI >48% and postoperative RMI >28% were associated with failure. In pelvic and combined osteotomies, postoperative RMI >32% and AI >30 degrees were associated with failure. Other factors analyzed were not associated with reoperation.

Conclusions:

Patient selection and quality of surgery in terms of residual postoperative hip subluxation and acetabular dysplasia are associated with need for remedial surgery. Soft-tissue-only procedures should aim to correct RMI to <32%. Bony surgery should be considered when preoperative RMI >44%, and pelvic osteotomies if RMI >48%. Pelvic osteotomies should target postoperative RMI <32% and AI <30 degrees.

Level of Evidence:

Level II—prognostic study.
Toward Useful Interventions for Burnout in Academic Medical Faculty: The Case for Unit-Specific Approaches
Authors: McKinley Tara
Published: October 2021

Introduction:

Despite a plethora of research on the topic of physician burnout, drivers and interventions are poorly understood. This study aimed to create a holistic picture of burnout drivers in academic medical faculty within a single department of a large, research university to better inform organization-sponsored interventions.

Methods:

The author used interpretive phenomenological analysis and the Job Demands-Resources model in this qualitative study. Full-time academic medical faculty completed two semistructured interviews approximately 6 months apart. Transcripts were coded using deductive and inductive coding.

Results:

Twenty-two faculty members participated in both interviews. Factors affecting burnout depended on individual and unit-level context, but interpersonal factors such as relationships with colleagues and interaction with learners created meaning for faculty or drove intention to leave the university. All participants reported personal coping mechanisms, and none participated in organization-sponsored, individual-level interventions.

Discussion:

In striving for meaningful burnout interventions, organizations should promote interpersonal factors (relationships with colleagues and meaningful interaction with learners) and provide protected time for faculty for their own personal coping. Research has suggested moving toward a universal burnout driver and intervention plan, but these data point toward the need for unit-specific study and interventions.
The Burnout Dyad: A Collaborative Approach for Including Patients in a Model of Provider Burnout
Authors: Martinez-Hollingsworth Adrienne , Hicks Melissa , Dobrota Sylvie , Chu Larry F.
Published: October 2021

Both patients and providers in the United States (US) suffer from burnout, which can impact the clinical relationship and quality of care. Among providers, burnout is a state of exhaustion including heightened depersonalization; among patients, burnout can negatively affect clinical outcomes. More than half of clinical providers in the United States suffer from burnout; less is known about the magnitude and prevalence among patients. Understanding patient burnout will improve our recognition of treatment barriers, understanding of patient-provider communication, and perceived quality of care. The purpose of the 2019 Stanford University MedicineX Burnout Workgroup was to use a collaborative approach to expand on the National Academy of Medicine (NAM) Wellness and Resilience Model, which does not currently include the patient as an influential member of the care team potentially experiencing burnout. This collaboration among patients, physicians, students, caregivers, technologists, and researchers used a convenience sample of conference attendees, broken into three focus groups to (1) provide an expanded definition of burnout that includes patients' perspectives, (2) analyze the NAM burnout model for inclusion of the patient experience, and (3) define a care experience that includes both patients and providers. The design of this workgroup was informed by Everyone Included, a model that recognizes and rejects hierarchical traditions in clinical practice. This approach allowed for the creation of a safe space for the exchange of knowledge between the various stakeholders. The resulting inclusive conceptual model, The Burnout Dyad, describes a cocreated care experience informed by both patient and provider characteristics.
Promoting Transfer of Learning to Practice in Online Continuing Professional Development
Authors: Luhanga Ulemu , Chen Weichao , Minor Suzanne , Drowos Joanna , Berry Andrea , Rudd Mariah , Gupta Shanu , Bailey Jean M.
Published: October 2021

Leveraging online learning tools and encouraging transfer of learning to practice remains a critical challenge to successful continuing professional development (CPD) offerings. Four sets of factors are essential to the transfer of learning from CPD into practice: learner characteristics, instructional design, content, and environment. Through incorporating elements of educational theories/frameworks into the planning of online CPD activities, educators can maximize opportunities for learning transfer. In this article, we highlight four educational theories/frameworks that provide useful insight to tackle these interrelated factors in online CPD: Self-Determination Theory considers the intrinsic and extrinsic motivation of participants, which can be encouraged through flexibility, customization, and choices available in online formats. Practical Inquiry Model encourages intentionally planning and embedding opportunities for reflection and dialogue in online activities to enhance knowledge application. Virtual Communities of Practice can be used to transcend spatial and temporal boundaries, promoting interactions and relationships where participants learn from peers. Finally, Professional Learning Networks can be fostered through developing interpersonal connections and sharing resources for informal and flexible learning. Online CPD is likely to increase in the future, and educators should consider elements of these educational theories/frameworks in the design and delivery of CPD to support participants' application of newly acquired knowledge.
Regional anesthesia and cancer recurrence in patients with late-stage cancer: a systematic review and meta-analysis
Authors: Zhang Yue-Lun , Pei Li-Jian , Sun Chen , Zhao Meng-Yun , Che Lu , Huang Yu-Guang
Published: October 2021

Background:

Whether regional anesthesia may help to prevent disease recurrence in cancer patients is still controversial. The stage of cancer at the time of diagnosis is a key factor that defines prognosis and is one of the most important sources of heterogeneity for the treatment effect. We sought to update existing systematic reviews and clarify the effect of regional anesthesia on cancer recurrence in late-stage cancer patients.

Methods:

Medline, Embase, and Cochrane Library were searched from inception to September 2020 to identify randomized controlled trials (RCTs) and cohort studies that assessed the effect of regional anesthesia on cancer recurrence and overall survival (OS) compared with general anesthesia. Late-stage cancer patients were primarily assessed according to the American Joint Committee on Cancer Cancer Staging Manual (eighth edition), and the combined hazard ratio (HR) from random-effects models was used to evaluate the effect of regional anesthesia.

Results:

A total of three RCTs and 34 cohort studies (including 64,691 patients) were identified through the literature search for inclusion in the analysis. The risk of bias was low in the RCTs and was moderate in the observational studies. The pooled HR for recurrence-free survival (RFS) or OS did not favor regional anesthesia when data from RCTs in patients with late-stage cancer were combined (RFS, HR = 1.12, 95% confidence interval [CI]: 0.58–2.18, P = 0.729, I
2 = 76%; OS, HR = 0.86, 95% CI: 0.63–1.18, P = 0.345, I
2 = 48%). Findings from observational studies showed that regional anesthesia may help to prevent disease recurrence (HR = 0.87, 95% CI: 0.78–0.96, P = 0.008, I
2 = 71%) and improve OS (HR = 0.88, 95% CI: 0.79–0.98, P = 0.022, I
2 = 79%).

Conclusions:

RCTs reveal that OS and RFS were similar between regional and general anesthesia in late-stage cancers. The selection of anesthetic methods should still be based on clinical evaluation, and changes to current practice need more support from large, well-powered, and well-designed studies.
Bleomycin Electrosclerotherapy Treatment in the Management of Vascular Malformations
Authors: Kostusiak Milosz , Murugan Srinivasen , Muir Tobian
Published: October 2021

BACKGROUND

Intralesional injection of a sclerosing agent is a standard treatment for vascular malformations, but many repeat treatments are often required to achieve a response. The temporary application of an electrical field to the treated area increases cellular membrane permeability and therefore augments drug delivery.

OBJECTIVE

To report a case series of patients with vascular malformations who received bleomycin electrosclerotherapy (EST).

MATERIALS AND METHODS

A prospective observational case series of patients with vascular malformations treated with bleomycin EST. Only patients who did not respond or had limited response to standard sclerotherapy were included. The response to the treatment was assessed using a global assessment score and patient-reported outcome measures.

RESULTS

Thirty patients were treated with EST. Most of the patients had venous malformations (57%). Complete response or significant improvement was observed in 17 (57%) and 7 (23%) patients, respectively. Most of the patients were satisfied or very much satisfied with the outcome of the treatment. Most commonly reported complications were swelling, pain, and bleeding.

CONCLUSION

Electrosclerotherapy is a promising method of augmenting the efficacy of intralesional bleomycin injections when treating vascular malformations. It can potentially lead to a reduction in the administered dose and number of treatment sessions needed.
Hutchinson Sign: Biopsy May Assist in Diagnosis of Subungual Melanoma in Situ
Authors: Oh Se Jin , Lee Jongeun , Park Sewon , Park Ji-Hye , Lee Dongyoun
Published: October 2021

BACKGROUND

Early and accurate diagnosis of subungual melanoma (SUM) through histopathologic examination is critical, but lack of clinical suspicion leads to delays in diagnosis. Hutchinson sign (HS) can be one of the important clinical indicators for diagnosing SUM.

OBJECTIVE

To evaluate the diagnostic value of small biopsies of HS for detecting SUM in situ.

METHODS

We retrospectively evaluated 12 patients who were diagnosed as SUM in situ and underwent punch biopsy at HS areas. Clinical features, dermoscopic findings, and histopathologic findings in HS regions were analyzed.

RESULTS

In most cases, HS was seen in hyponychium (11/12, 91.7%) with 1 case found in proximal nail fold, and 1 case in both the hyponychium and proximal nail fold. Dermoscopic features of HS showed irregular diffuse pigmentation (12/12, 100%) and parallel ridge pattern (7/12, 58.3%). Histopathologically, all cases showed irregularly scattered atypical melanocytes with hyperchromatic nuclei. Two cases showed subtle changes in melanocytes with little nuclear atypia, but additional section specimen showed more definitive findings of SUM in situ.

CONCLUSION

We present a supplementary biopsy technique for diagnosing SUM. Biopsy of HS may help in the diagnosis of SUM.
Merkel Cell Carcinoma: A Bibliometric Analysis of the Top 100 Cited Publications
Authors: Russomanno Kristen , Raiker Rahul , Pakhchanian Haig , Deng Min
Published: October 2021

BACKGROUND

Bibliometric studies provide a quantitative statistical analysis of the published literature within a field of interest and allow for easy identification of the major contributing authors, funding sources, and publication trends within the field. To date, no bibliometric studies have been performed pertaining to Merkel cell carcinoma (MCC).

OBJECTIVE

To identify the 100 most frequently cited articles in MCC through a bibliometric analysis of the literature.

METHODS

Web of science was queried to determine the 100 most frequently cited MCC publications published between the years 1970 and 2019. Articles were listed by title, authors and their affiliated institutions, journal title and type, year of publication, country of origin, funding sources, and citation frequency.

RESULTS

Among the 100 most frequently cited MCC publications, articles were cited between 67 and 589 times with a mean of 136.3 times. Articles were cited between 2.0 and 98.2 times per year since publication with a mean of 11.3 times per year. 67% of the articles were published in oncology journals; 33% and 10% of the articles in dermatology and surgery journals, respectively. The most represented journal was Cancer (12%). Paul Nghiem was the most frequently identified author (18%). 36% of the top 100 articles were published out of the University of Washington. The most frequent funding agency was the National Institutes of Health (77%).

CONCLUSION

Through this bibliometric analysis, researchers can easily identify key publications pertaining to MCC, which may in turn enhance their approach to understanding and practicing evidence-based medicine regarding MCC.