bluuebunny/crossref_metadata_2025 huggingface dataset:
Downregulation of Stem-Loop Binding Protein by Nicotine via α7-Nicotinic Acetylcholine Receptor and Its Role in Nicotine-Induced Cell Transformation
Authors: Sun Qi , Chen Danqi , Raja Amna , Grunig Gabriele , Zelikoff Judith , Jin Chunyuan
Published: August 2022

The use of electronic-cigarettes (e-cigs) has increased substantially in recent years, particularly among the younger generations. Liquid nicotine is the main component of e-cigs. Previous studies have shown that mice exposed to e-cig aerosols developed lung adenocarcinoma and bladder hyperplasia. These findings implicated a potential role for e-cig aerosols and nicotine in cancer development, although the underlying mechanisms are not fully understood. Here we report that exposure to liquid nicotine or nicotine aerosol generated from e-cig induces downregulation of Stem-loop binding protein (SLBP) and polyadenylation of canonical histone mRNAs in human bronchial epithelial cells and in mice lungs. Canonical histone mRNAs typically do not end in a poly(A) tail and the acquisition of such a tail via depletion of SLBP has been shown to causes chromosome instability. We show that nicotine-induced SLBP depletion is reversed by an inhibitor of α7-nicotinic acetylcholine receptors (α7-nAChR) or siRNA specific for α7-nAChR, indicating a nAChR-dependent reduction of SLBP by nicotine. Moreover, PI3K/AKT pathway is activated by nicotine exposure and CK2 and probably CDK1, 2 kinases well known for their function for SLBP phosphorylation and degradation, are shown to be involved, α7-nAChR-dependently, in nicotine-induced SLBP depletion. Importantly, nicotine-induced anchorage-independent cell growth is attenuated by inhibition of α7-nAChR and is rescued by overexpression of SLBP. We propose that the SLBP depletion and polyadenylation of canonical histone mRNAs via activation of α7-nAChR and a series of downstream signal transduction pathways are critical for nicotine-induced cell transformation and potential carcinogenesis.
Clinical and epidemiological aspects of severe acute respiratory infection: before and during the first year of the COVID-19 pandemic in Brazil
Authors: de Carvalho Felipe Cotrim , da Silva Erica Tatiane , de Almeida Walquiria Aparecida Ferreira , Maroneze Matheus Almeida , Schwartz Jaqueline de Araujo , Jardim João Pedro Vieira , Peixoto Henry Maia
Published: August 2022

Background

Widespread respiratory infections with high morbidity rates caused by respiratory viruses represent a significant global public health problem. Our objective was to describe cases and deaths from severe acute respiratory infection (SARI) in Brazil over the past 8 y as well as changes in the distribution and risk of illness and death from SARI before and in the first year of the coronavirus disease 2019 (COVID-19) pandemic (FYP).

Methods

We performed a descriptive epidemiological study of hospitalized SARI cases and deaths between 2013 and 2020 in Brazil, separated into pre-pandemic (2013 to 2019) and FYP (2020). We estimate the increase in SARI cases and deaths in the FYP as well as the mortality and infection risks attributable to the FYP (MRAP and IRAP, respectively).

Results

In 2020, an excess of 425 054 cases and 109 682 deaths was observed, with a significant increase in the risk of falling ill and dying from SARI, with an IRAP of 200.06 and an MRAP of 51.68 cases per 100 000 inhabitants. The increase in SARI cases and deaths was particularly prominent among patients with COVID-19, the elderly, males, those self-identifying as mixed race and patients with heart disease and diabetes. We conclude that an important increase in morbidity and mortality due to SARI was observed in the FYP. More vulnerable groups and those living in the Southeast, North and Center-West regions of the country suffered the most.
Faculty Development and Infrastructure to Support Educational Scholarship: A Scoping Review on Author Development
Authors: Cameron Michael W. , Crowther Lee N. , Huang Grace C.
Published: August 2022

Purpose

Medical educators are expected to produce educational scholarship, which can lead to career advancement and promotion. Institutions have developed author development programs, which vary in duration, instructional approach, and effectiveness. However, no summation of the evidence exists for academic medicine leaders to use as guidance for building similar programs. This scoping review characterizes faculty development programs that support educational scholarship and author development in academic medicine.

Method

The authors searched PubMed, Scopus, Google Scholar, and ProQuest (Healthcare Administration Database and Social Science Premium Collection) for articles published from inception to June 14, 2021. Articles that described formal instruction on scholarly writing for publishing were included. Data were analyzed by program participation, structure, content delivery, and outcomes.

Results

Of 923 articles identified, 20 met inclusion criteria. The included studies covered 18 unique programs of which 1 was sponsored jointly by a university and professional society, 5 by professional societies, 5 by university or medical school organizations, and 7 by medical departments. Nine programs relied at least in part on volunteers. Instructional approaches included didactics (7 programs) and mentoring (5 programs) but mostly featured group-based work (11 programs). Expectations for participants ranged from participation to manuscript submission. The main funding sources were grants (8 programs) and internal funds (7 programs) from the sponsoring institution. Only 4 programs reported participation fees. The impact of these programs included scholarly work products, other measures of career advancement, and participant perceptions.

Conclusions

Author development programs require resource investment and a culture that values educational scholarship. Workshops, 1-on-1 mentoring, and peer writing groups are cornerstones of the experiential learning approach needed to build scholarship skills and can pay dividends in supporting the academic mission in medicine. These findings may benefit leaders in academic medicine who want to develop evidence-based programs in author development.
Comparison of the efficacy of physiotherapy, subacromial corticosteroid, and subacromial hyaluronic acid injection in the treatment of subacromial impingement syndrome: A retrospective study
Authors: Sadeghifar Amirreza , Saied Alireza , Abbaspour Vahid , Zandrahimi Farshad
Published: August 2022

Background:

The optimal nonoperative management for subacromial impingement syndrome (SIS) is unclear. This study evaluated the efficacy of subacromial corticosteroid versus a hyaluronic acid injection and their effectiveness against physiotherapy in patients with SIS.

Methods:

SIS patients treated with either physiotherapy or subacromial injection of triamcinolone (40 mg), or subacromial hyaluronic acid injection were included in this retrospective study. The outcome measures were evaluated 3 and 6 mo after the intervention and included pain evaluated by a visual analog scale (VAS) and limb function assessed by the Disabilities of the Arm, Shoulder, and Hand (DASH) and American Shoulder and Elbow Surgeons (ASES) questionnaires.

Results:

Eighty-eight patients with SIS were included. Treatment was done with corticosteroid injection in 31 patients, hyaluronic acid injection in 30 patients, and physiotherapy in 27 patients. The mean improvement of VAS, DASH, and ASES scores of the corticosteroid group was significantly higher when compared with the physiotherapy group at 3 mo (P=0.035, P<0.001, and P<0.001, respectively) and 6 mo (P=0.036, P<0.001, and P<0.001, respectively), also in comparison with the hyaluronic acid group at 3 mo (P=0.038, P<0.001, and P=0.002, respectively) and 6 mo (P=0.044, P<0.001, P<0.001, respectively). The mean improvement of DASH and ASES scores, but not VAS, was significantly higher in the hyaluronic acid group compared to the physiotherapy group at 3 mo (P=0.022, P=0.034, and P=0.55, respectively) and 6 mo (P=0.46, P=0.039, and P=0.51, respectively).

Conclusion:

Subacromial corticosteroid injection is more effective than physiotherapy and hyaluronic acid injection in treating SIS symptoms.

Level of Evidence:

Level III.
Variation in core clerkship grading reported on the Medical Student Performance Evaluation (MSPE) for orthopaedic surgery applicants: a retrospective review
Authors: Vaghani Parth , Samade Richard , Gordon Adam M. , Scharschmidt Thomas J. , Goyal Kanu S.
Published: August 2022

Purpose:

To understand the variation in number and verbiage in grading schemes during third-year core clerkships for orthopaedic surgery residency applicants.

Methods:

Applications to a single institution’s orthopaedic surgery residency program during the 2017-2018 match cycle were reviewed. Data extracted from the Medical Student Performance Evaluation (MSPE) included medical school name, number of core clerkships, grade options/tiers, and % grade distribution in clerkships. Applicant data collected included Step 1 Score, Step 2 Clinical Knowledge (CK) Score, Alpha Omega Alpha (AOA) membership status, clerkship grades, and medical school rank.

Results:

A total of 858 applications from 211 medical schools were reviewed. Further analysis was performed on 142 schools, representing 721 students, that reported grading distributions. The number of grade tiers varied from two to 11, with three (26.1%), 4 (43.7%), and five (20.4%) tiered grading systems being the most common. One-hundred unique verbiages were identified to describe grading amongst all schools. Schools ranked in the top 25 distributed honors more often than schools ranked outside the top 25 (P<0.001). The median for the average percentage of honors distributed by a school was 32.3%, with a total range of 2.4 to 72.6%. A significant relationship between applicant match success and medical school grading practices could not be determined (P=0.054).

Conclusions:

Significant differences in assigned grades by medical schools for third-year core clerkships were found. Therefore, students’ core clerkship grades should be reviewed in the context of the grade distributions at their medical schools.

Level of Evidence:

Level IV.
Cancer Survivors' Perspectives of Virtual Yoga for Chronic Chemotherapy-Induced Peripheral Neuropathy Pain During the COVID-19 Pandemic
Authors: Knoerl Robert , Bockhoff Julianna , Fox Erica , Giobbie-Hurder Anita , Berry Donna L. , Berfield Juliana , Meyerhardt Jeffrey , Wright Alexi , Ligibel Jennifer
Published: August 2022

With the rise in telehealth due to the COVID-19 pandemic, further research is needed to determine how to optimize virtual delivery of existing integrative oncology interventions for cancer treatment–related symptoms. The purpose of this qualitative analysis was to explore cancer survivors' perspectives of the acceptability and satisfaction of an 8-week, virtual yoga intervention for cancer survivors with chronic chemotherapy-induced peripheral neuropathy pain. Fourteen participants with chronic chemotherapy-induced peripheral neuropathy pain who completed the virtual yoga intervention were interviewed using a semistructured interview guide. Themes were derived from the data using inductive content analysis methods. Main findings from the interviews included the following: (1) participants were willing to try new nonpharmacological treatments for chemotherapy-induced peripheral neuropathy due to the high symptom burden and prior lack of success with medications; (2) participants highly rated the flexibility offered by the virtual format, but desired the social support potentially offered by practicing in-person yoga; and (3) the impact of virtual yoga on chemotherapy-induced peripheral neuropathy severity was unclear. There were several barriers to participants' use of virtual yoga for chronic chemotherapy-induced peripheral neuropathy pain (eg, technology, lack of space/equipment). The results may be used to improve the design and delivery of future trials testing virtual yoga for chronic chemotherapy-induced peripheral neuropathy pain.
Epidermotropic Cutaneous Metastasis of Colonic Adenocarcinoma Presenting as a Sister Mary Joseph Nodule
Authors: Jimenez Antonio , Winsett Frank , Kelly Brent , Goodwin Brandon
Published: August 2022

The Sister Mary Joseph nodule is a metastatic umbilical lesion that is seen in 1%–3% of intra-abdominal and pelvic malignancies. Cutaneous metastasis of visceral malignancies is rare and has characteristic dermal or subcutaneous involvement on histopathologic examination. Epidermotropism is described as the migration of malignant cells into the epidermis and is an unusual finding in intra-abdominal malignancies and cutaneous metastases. An 81-year-old woman with a past medical history of colorectal adenocarcinoma presented to the dermatology clinic for evaluation of an enlarging, denuded umbilical mass. A tangential biopsy was obtained and sent for histopathologic examination. Histopathologic analysis demonstrated infiltration of atypical, pleomorphic cells in the dermis with spread into the epidermis, consistent with epidermotropism. An immunohistochemical panel was performed and was consistent with cutaneous metastasis of the patient's underlying adenocarcinoma. We present a case of epidermotropic cutaneous metastasis of colorectal adenocarcinoma presenting as a Sister Mary Joseph nodule, an extremely rare occurrence that has not been well-documented in the literature.
Syphilitic Folliculitis: A Case Report With Demonstration of Spirochetes Showing Follicular Epitheliotropism
Authors: Isler Madeleine F. , Hoskins Sidney , Esparza Edward M. , Ruhoy Steven M.
Published: August 2022

We report a case of a 59-year-old man presenting with a widespread follicular-based papular rash with a several-month history of myalgias, lymphadenopathy, fatigue, and weight loss who was diagnosed with acute syphilitic folliculitis by tissue biopsy analysis with immunohistochemical demonstration of spirochetes in hair follicle epithelium. Serologic analysis also showed evidence of Treponema sp. infection. Owing to the rising number of syphilis cases in the last decade, it is important to recognize classic cutaneous findings of syphilis in addition to unusual presentations such as syphilitic folliculitis.
Trichorhinophalangeal Syndrome Type 1–Positive Cells in Breast Dermal Granulation Tissues and Scars: A Potential Diagnostic Pitfall
Authors: Cho Woo Cheal , Nagarajan Priyadharsini , Ding Qingqing , Prieto Victor G. , Torres-Cabala Carlos A.
Published: August 2022

Trichorhinophalangeal syndrome type 1 (TRPS1) immunohistochemistry has been gaining popularity in recent years in the field of surgical pathology for its utility as a highly sensitive and specific marker for breast carcinomas, including those with triple-negative phenotype. More recent data suggest TRPS1 may also prove its utility in the diagnosis of mesenchymal tumors arising in the breast parenchyma, including malignant phyllodes tumors and primary chondrosarcomas and osteosarcomas of the breast. However, little is known about TRPS1 expression in nontumor cells, such as stromal fibroblasts/myofibroblasts of dermal granulation tissues and scars. Here, we describe our unique experience with TRPS1-positive cells, morphologically consistent with reactive fibroblasts/myofibroblasts, seen in dermal granulation tissues and scars from breast skin specimens of a 51-year-old woman with a history of bilateral invasive ductal carcinomas of the breast, status after bilateral total mastectomy and chemoradiation, who presented with nonhealing wounds on the chests. To the best of our knowledge, this is the first reported case of strong TRPS1 expression in dermal granulation tissue/scar. As the usage of TRPS1 immunohistochemistry in routine clinical practice, including in the field of dermatopathology, will likely increase over time, awareness of this potential diagnostic pitfall is important to avoid overinterpretation of the findings.
Microsecretory Adenocarcinoma of the Ear Canal: Novel Cutaneous Analog of a Salivary Gland Neoplasm
Authors: Chan May P. , Flack Allen B. , Grisel Jedidiah J. , Harms Paul W. , McHugh Jonathan B.
Published: August 2022

Microsecretory adenocarcinoma (MSA) of the salivary gland is a new entity recently added to the World Health Organization Classification of Head and Neck Tumors. This tumor is characterized by a recurrent MEF2C-SS18 translocation. We present a nodular tumor confined to the dermis of the ear canal of a 44-year-old patient, which demonstrated classic histopathologic features and molecular alteration of MSA. Specifically, the tumor was composed of numerous tubules and microcysts filled with abundant basophilic mucinous secretion and associated with a fibromyxoid stroma. The tumor cells were diffusely positive for CK7 and SOX10 and variably positive for S100 and p63. Breakapart fluorescence in situ hybridization for SS18 confirmed rearrangement of this gene. Together, these findings support a primary cutaneous MSA, presumably arising from ceruminous glands of the ear canal. Based on current knowledge of its salivary gland counterpart, cutaneous MSA is expected to be locally invasive but unlikely to recur or metastasize on complete excision.
ENDOGENOUS FUNGAL ENDOPHTHALMITIS AFTER COVID-19 INFECTION: CASE REPORT AND REVIEW OF LITERATURE
Authors: Zaslavsky Kirill , Grewal Parampal S. , Cruz-Pimentel Miguel , Qian Jenny , Derzko-Dzulynsky Larissa , Yan Peng
Published: August 2022

Purpose:

The purpose of this study was to describe a case of endogenous endophthalmitis (EE) after severe COVID-19 disease, review patient outcomes with EE after COVID-19 infection, and review evidence regarding risk factors for developing EE.

Methods:

This is a review of health records, imaging, intravitreal injection, and pars plana vitrectomy for bilateral fungal EE after severe COVID-19 disease, and is a literature review on outcomes in EE after COVID-19 disease.

Results:

Sixty-three year-old man with diabetes and hypertension was admitted to hospital for severe COVID-19 disease for 3 months. His stay required intensive care unit admission, intubation, high-dose corticosteroids, tocilizumab, and was complicated by bacteremia, empyema, and fungal esophagitis. He developed floaters and bilateral vision loss (visual acuity 20/40 in the right eye, counting fingers in the left eye) with vitritis 2.5 months into his stay that did not respond to intravitreal voriconazole. Pars plana vitrectomy was performed for both eyes, resulting in visual acuity of 20/40 in the right eye, 20/30 in the left eye. Vitreous cultures were positive for Candida albicans. Endogenous endophthalmitis after COVID-19 disease has been reported in 22 patients to date, and outcomes are poor, with 40%+ of eyes legally blind (20/200 or worse). Although influenced by availability of imaging modalities and degree of training of the evaluating physician, misdiagnosis can affect ¼ of cases, delaying treatment. Age, male sex, and diabetes increase the risk of severe COVID-19, which requires prolonged hospitalization, invasive catheterization, and immunosuppression, which in turn increases the risk of nosocomial infection.

Conclusion:

Low threshold for suspecting EE in patients presenting with floaters and decreased vision after severe COVID-19 disease is necessary to ensure prompt recognition and treatment.
Prevaccine Human Papillomavirus Status in Invasive and Intraepithelial Lesions of the Vulva in New Zealand Women
Authors: Bigby Susan M. , Eva Lois J. , Tous Sara , de Sanjosé Silvia , Bosch Xavier , Alemany Laia , Chang Kevin C.T. , Jones Ronald W.
Published: August 2022

Objective

The human papillomavirus (HPV) vaccine, introduced in New Zealand (NZ) in 2008, is predicted to substantially lower the incidence of HPV-associated precancers and cancers. The aim of this study is to estimate the proportion of vulvar intraepithelial neoplasia (VIN) lesions and invasive vulvar squamous cell carcinomas (SCCV) attributable to HPV in NZ women treated by the Auckland Regional Gynecological Oncology Service, covering an estimated 50% of the NZ population.

Materials and Methods

Polymerase chain reaction and reverse hybridization were used to analyze retrospective histologically proven SCCV from 1990 to 2007 and VIN lesions from 2000 to 2007 for HPV content and genotype in a collaborative study with the Catalan Institute of Oncology. Immunohistochemistry for p16INK4a was performed on SCCV, which were attributed to HPV if both tested positive.

Results

Polymerase chain reaction testing for HPV content and genotype was performed on 66 VIN lesions (all high-grade squamous intraepithelial lesions) and 189 SCCV. In addition, p16 immunohistochemistry was performed on 168 of the 189 SCCV (88.9%) tested for HPV-DNA. Overall, 61 SCCV cases (36.3%) were attributed to HPV (HPV+/p16+), and 89 SCCV cases (53%) were considered to have developed independently of HPV (HPV−/p16−). Known high-risk HPV genotypes were present in 96.8% of HPV-DNA–positive vulvar high-grade squamous intraepithelial lesions and 98.4% of HPV-attributable SCCV. Human papillomavirus 16 represented the most common genotype in both.

Conclusions

Overall, the HPV vaccine is likely to substantially alter the profile of SCCV in our region. The results provide a baseline assessment of the HPV status of vulvar neoplasia before the introduction of the HPV vaccine.
Development and Validation of a Novel 1-year Mortality Risk Score That Includes the Use of Antithrombotic in Patients With Overt Gastrointestinal Bleeding
Authors: Nammour Tarek , El Jamal Lara , Hosni Mohammad N. , Tamim Hani , Kerbage Anthony , Hashash Jana G. , Shaib Yasser H. , Daniel Fady , Francis Fadi , Mourad Fadi H. , Soweid Assaad , Sharara Ala I. , Makki Maha , Rockey Don C. , Barada Kassem
Published: August 2022

Goals and Background:

We aimed to develop a novel 1-year mortality risk-scoring system that includes use of antithrombotic (AT) drugs and to validate it against other scoring systems in patients with acute gastrointestinal bleeding (GIB).

Study:

We developed a risk-scoring system from prospectively collected data on patients admitted with GIB between January 2013 and August 2020, who had at least 1- year of follow-up. Independent predictors of 1-year mortality were determined after adjusting for the following confounders: the age-adjusted Charlson Comorbidity Index (CCI) (divided into 4 groups: CCI-0=0, CCI-1=1 to 3, CCI-2=4 to 6, CCI-3 ≥7), need for blood transfusion, GIB severity, need for endoscopic therapy, and type of AT. The risk score was based on independent predictors.

Results:

Five hundred seventy-six patients were included and 123 (21%) died at 1-year follow-up. Our risk -score was based on the following: CCI-2 (2 points), CCI-3 (4 points), need for blood transfusion (1 point), and no use of aspirin (1 point), as aspirin use was protective (maximum score=6). Patients with higher risk scores had higher mortality. The model had a better predictive accuracy [AUC=0.82, 95% confidence interval (0.78-0.86), P<0.0001] than the Rockall score for upper GIB (Area Under the Curve (AUC)=0.68, P<<0.0001), the Oakland score for lower GIB (AUC=0.69, p=0.004), or the Shock Index for all (AUC=0.54, P<0.0001).

Conclusion:

A simple and novel score that includes use of AT upon admission accurately predicts 1-year mortality in patients with GIB. This scoring system may help guide follow-up decisions and inform the prognosis of patients with GIB.
Global Burden of Nonalcoholic Fatty Liver Disease, 1990 to 2019
Authors: Jiang Wei , Mao Xianhua , Liu Zhenqiu , Zhang Tiejun , Jin Li , Chen Xingdong
Published: August 2022

Background:

Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver diseases worldwide. We provided a comprehensive description regarding the disease burden of NAFLD in 204 countries and territories.

Materials and Methods:

We reported the deaths and disability-adjusted life years (DALYs) related to NAFLD in the Global Burden of Disease database by sex, age, specific causes, and regions. Estimated annual percentage change was applied to describe the changing trends.

Results:

Globally, the NAFLD-related deaths and DALYs in 2019 were 0.17 million [95% uncertainty interval (UI): 0.13 to 0.21] and 4.42 million (95% UI: 3.35 to 5.67), increased by 80.2% and 62.9% compared with 1990, respectively. The overall age-standardized rate of mortality and DALYs (ASMR and ASDR) showed a downward trend from 1990 to 2019, the estimated annual percentage change were −0.67 (95% confidence interval: −0.76, −0.57) and −0.82 (95% confidence interval: −0.93, −0.7), respectively. NAFLD-related deaths due to cirrhosis and liver cancer increased by 76.7% and 95.1% between 1990 and 2019. The ASMR and ASDR were the highest in the middle and low sociodemographical index regions in 2019, respectively. Of the 21 Global Burden of Disease regions, Eastern Europe, Central Asia, High-income North America, and Australasia experienced an increase in both ASMR and ASDR.

Conclusions:

NAFLD imposes heavy disease burden on humankind worldwide, especially in countries with low-to-middle sociodemographical index level. More potent measures are urgently needed in regions with rising age-standardized rate to forestall the increase of NAFLD disease burden.
Psychosocial Exoskeletons
Authors: Yager Joel
Published: August 2022

In medical therapeutics, exoskeleton refers to external protections, supports, and appliances. By analogy, psychosocial exoskeletons can be envisioned as assistive psychological and social structures that brace and extend individuals' coping abilities. This article considers the utility of defining “psychosocial exoskeletons” as a framework to encompass psychological and social devices that enhance coping, and “therapeutic psychosocial exoskeletons” as devices assisting psychiatric treatment. Clinical observations were augmented via selective narrative review using PubMed and PsychInfo.

A range of psychological and social devices were identified that constitute psychosocial exoskeletons. In extremes, psychosocial exoskeletons may prescribe comprehensive lifestyles including dress, rites, taboos, and acceptable relationships. These devices may enhance normal or psychopathological development.

Therapeutic psychosocial exoskeletons consist of intentionally prescribed psychotherapeutic and sociotherapeutic interventions assembled to address patient-centered problems. Elements may include counseling and psychotherapies, peer-based recovery programs, institutional programs, and social interventions involving financial assistance, supported employment, pets, and other practical resources.
Enhancing DNP Project Success
Authors: Bradley Callie , Boykin Allison , Kilmer Michele
Published: August 2022

Background:

The Doctor of Nursing Practice (DNP) project is the culmination of DNP education, serving as evidence of knowledge preparation and skill achievement in translating evidence into practice.

Problem:

Review of sample DNP projects from 2015 to 2019 revealed that multiple projects had fatal flaws in the Methods and Evaluation sections, rendering the resulting DNP project with diminished value.

Approach:

We established a collaborative relationship with an educational statistics program and associated consulting center to develop and integrate statistical resources directly into the planning and evaluating stages of the DNP project process. The pilot program included workshops and individual consulting sessions provided to the student aimed at reducing fatal flaws and improving research design and evaluation analyses.

Outcomes:

Initial and follow-up surveys were adapted from the Course Experience Questionnaire to assess student satisfaction and perceived knowledge gains. Project rigor and value were assessed using the DNP-Project Critical Appraisal Tool (PCAT).

Conclusions:

The pilot program showed a decrease in the number of fatal flaws and an increase in PCAT scores on the targeted Design and Evaluation sections.
Get2PrEP: An Electronic Medical Record Laboratory Comment Increased Safe Sex Counseling But Not Preexposure Prophylaxis Services at a Large Urban Academic Medical Center in Northern Manhattan
Authors: Spicehandler Rebecca , Zucker Jason , Yumori Caitlin , Adan Matthew , Carnevale Caroline , Theodore Deborah , Castor Delivette , Meyers Kathrine , Whittier Susan , Yin Michael T. , Cohall Alwyn , Olender Susan , Gordon Peter , Sobieszczyk Magdalena E.
Published: August 2022

Background

HIV preexposure prophylaxis (PrEP) remains underutilized despite its efficacy and potential population impact. Achieving PrEP's full potential depends on providers who are knowledgeable and comfortable prescribing it to individuals at risk of acquiring HIV. Previous educational interventions targeting provider-related uptake barriers have had limited success. We designed and tested an electronic medical record (EMR) interpretative comment to improve the delivery of PrEP.

Methods

An EMR comment provided information on PrEP eligibility and referral resources to providers delivering positive chlamydia and gonorrhea results. Positive test results for bacterial sexually transmitted infections before intervention (January 1, 2019–August 23, 2019) and after intervention (August 24, 2019–December 31, 2019) were identified. A retrospective chart review was conducted to ascertain provider documentation of PrEP discussions or provision, HIV prevention discussions, and HIV screening. Pretest-posttest analysis was performed to compare the provision of PrEP and HIV prevention services.

Results

We reviewed 856 preintervention encounters spanning 8 months and 461 postencounters spanning 4 months. Patient demographics were comparable. We observed an increase in provider documentation of safe sex and condom counseling (odds ratios [ORs], 1.2 [95% confidence interval {CI}, 1.07–1.18] and 1.11 [95% CI, 1.05–1.17], respectively), and the absence of any HIV prevention discussion decreased (OR, 0.85; 95% CI, 0.80–0.90), but not HIV screening or PrEP documentation.

Conclusions

We demonstrated that an EMR laboratory comment had a modest effect on increasing risk reduction counseling, although not HIV screening or PrEP prescriptions. Future strategies to encourage provider delivery of sexual health services may benefit from more targeted strategies that combine behavioral and information technology approaches.
Advancing Sexual Harassment Prevention and Elimination in the Sciences: “Every sexual health organization must do something similar.”
Authors: Jennings Jacky M. , Grieb Suzanne M. , Rietmeijer Cornelis , Gaydos Charlotte A. , Hawkins Rima , Thurston Rebecca C. , Blanchard James , Cameron Caroline E. , Lewis David A.
Published: August 2022

Introduction

Sexual harassment is pervasive in science. A 2018 report found that the prevalence of sexual harassment in academia in the U.S. is 58%. An activity held at an international scientific congress was designed to advance sexual harassment prevention and elimination and empower binary and non-binary persons at risk for harassment, discrimination, and violence. The objective is to describe the activity and outcomes to provide a promising model for other scientific communities.

Methods

A description of the plenary and key components as well as the data collection and analysis of selected outcomes are provided.

Results

Among 1,338 congress participants from 61 countries, 526 (39%) attended the #MeToo plenary and the majority engaged in some way during the plenary session. Engagement included standing for the pledge (~85%), participating in the question and answer session (n = 5), seeking counseling (n = 3), and/or providing written post-it comments (n = 96). Respondents to a post-congress survey (N = 388, 24% of all attendees) ranked the plenary as number one among 14 congressional plenaries. In post-analysis, the written post-it comments were sorted into 14 themes within 6 domains including: (1) emotional responses, (2) barriers to speaking out, (3) public health priorities, (4) reframing narratives about the issue, (5) allyship, and (6) moving the issue forward.

Conclusions

Scientific organizations, agencies, and institutions have an important role to play in setting norms and changing enabling policies towards a zero-tolerance culture of sexual harassment. The activity presented offers a promising model for scientific communities with similar goals. The outcomes suggest that the plenary successfully engaged participants and had a measurable impact on the participants.
Current Estimate of Hearing Aid Utilization in the United States
Authors: Nassiri Ashley M. , Ricketts Todd A. , Carlson Matthew L.
Published: August 2022

Objective:

To present key data from a private marketing report that characterizes US hearing aid (HA) utilization, HA candidate and user population sizes, and HA pricing.

Patients:

HA candidates and users in the United States.

Interventions:

Hearing amplification.

Main Outcome Measures:

HA utilization, HA candidate and user population sizes, HA market size and value, and HA pricing.

Results:

In 2015, an estimated 8.5 million HA users accounted for a total of 15.4 million individual HA devices in the United States. Approximately 81% of HA users owned bilateral devices. In 2015, approximately 87% of devices were purchased as replacements by current HA users, while the remaining 13% of devices were purchased by new HA users. HA utilization rates among the candidate population approximated 21% in 2015, which was stable over the 3-year study period. In 2015, there was a net increase of 696,060 individuals who met HA candidacy criteria but did not undergo treatment with HAs, adding to the backlog of 31.0 million untreated HA candidates who existed before that year. The HA market was valued at $6.0 billion in 2015, with an average retail selling price of $1798 per device ($3596 per pair). In the same year, the average manufacturer selling price was $495 per device ($990 per pair), or nearly 1 quarter of the retail price.

Conclusions:

HAs are substantially under-utilized in the United States with an annually growing backlog of untreated HA candidates.
Augmented Reality Microscopy in the Management of Cerebellopontine Lesions and Microvascular Decompression: A Pilot Study
Authors: Kashat Lawrence , Parikh Purven , Rahman Khalil , Ryan Tessa , Lafreniere Denis , Bulsara Ketan R. , Roberts Daniel S.
Published: August 2022

Objective:

To evaluate whether augmented reality microscopy surgical fluorescence technology, already Food and Drug Administration approved for vascular neurosurgery, can aid in lateral skull base surgery during cerebellopontine (CPA) tumor resection and microvascular decompression.

Study Design:

Pilot prospective uncontrolled observational cohort study.

Setting:

An academic tertiary care hospital.

Patients:

Those who underwent retrosigmoid craniotomy for CPA tumor resection or microvascular decompression for hemifacial spasm, trigeminal neuralgia or pulsatile tinnitus. 11 patients were recruited: 4 underwent CPA tumor resection and 7 underwent microvascular decompression.

Interventions:

Augmented reality microscopy with fluorescence imaging was utilized to visualize vascular flow intraoperatively. A postoperative surgeon questionnaire was administered to assess the intraoperative efficacy of this technology.

Main Outcome Measures:

Efficacy of technology in aiding with CPA tumor resection and microvascular decompression.

Results:

For all 7 microvascular decompression cases, surgeons agreed that the technology aided in identifying areas where disease was affecting tissues with no cases of vascular occlusion identified. In 3 of the 4 CPA tumor resection cases, surgeons agreed that the technology identified areas of vascular flow within the CPA and the tumor. Vascular patency of the sigmoid-transverse sinus was also confirmed. No significant adverse effects were noted except 1 instance of severe-to-profound sensorineural hearing loss.

Conclusions:

Our study shows that the augmented reality fluorescence technology works during lateral skull base surgery as it can confirm intraoperative vascular integrity. Our data also suggest that this technology may improve visualization of ambiguous vasculature and blood flow to diseased tissue.
New-onset myasthenia gravis confirmed by electrodiagnostic studies after a third dose of SARS-CoV-2 mRNA-1273 vaccine: a case report
Authors: Slavin Eileen , Fitzig Jeremy , Neubert Colleen , Garcia-Lopez Francisco , Cuevas-Trisan Ramon
Published: August 2022

COVID-19 vaccine-related pathology is a rare occurrence with few reported cases. We report on a case of a 60-year-old man experiencing symptoms of dysphagia, dysarthria, diplopia, and weakness with onset six days after receiving a third full dose of SARS-CoV-2 vaccine (mRNA-1273 vaccine) in August 2021, which he received outside of the CDC recommended guidelines, at four months after his second dose of the Moderna vaccination course in March 2021. FDA Emergency Use Authorization for mRNA-1273 booster was established in October 2021.

Over the next month, the patient’s symptoms progressed including his inability to swallow, requiring hospitalization due to dehydration and malnutrition. Evaluation including laboratory prompted referral for electrodiagnostic studies consisting of repetitive nerve stimulation studies and needle electromyography, confirming a case of new onset bulbar myasthenia gravis.
“Institutional Trends in Opioid Prescribing and Utilization after Primary Cleft Lip and Palate Repair”
Authors: Sacks Gina N. , Makar Katelyn G. , Harbaugh Calista M. , Cooper Karen A. , Vercler Christian J. , Kasten Steven J. , Buchman Steven R. , Waljee Jennifer F.
Published: August 2022

Background:

Outpatient prescriptions for post-operative pain play a significant role in the opioid epidemic. Prescribing guidelines are an effective target for intervention but require procedure-specific data to be successful. The aim of this study was to examine opioid prescribing patterns and pain control after primary cleft lip/palate repair at a large academic center.

Methods:

Children undergoing cleft lip/palate repair from 4/2018-7/2019 were included in a prospective cohort study. Data on discharge prescriptions, refills, and emergency room visits was obtained from the medical record. Caregivers were surveyed 7-21 days after surgery regarding pain control, opioid use, education exposure, storage, and disposal. Chi-square tests and one-way analysis of variance were used to examine predictors of pain control, opioid consumption, safe storage, and disposal.

Results:

After screening, 59 children were included in the study. Patients were 55.8 percent male with a median age of 12 (IQR 5-15) months. Ninety percent of patients received an opioid prescription at discharge with a mean quantity of 10 (IQR 5-15) doses. Ninety-seven percent of caregivers utilized adjunct medication, and opioids were given for a median of 3 [2-6.5] days. Seventy-six percent of caregivers gave less opioid than prescribed. There was no association between pain control and opioid quantity (p=0.68). Twenty-four percent of caregivers used locked storage. Thirty-four percent of respondents with leftover medication reported disposal.

Conclusion:

Opioids are often over-prescribed after cleft lip/palate repair. Providers should consider limiting prescriptions to a 3-day supply to help reduce the quantity of opioids available in the community.
Interfacility Transfer Guidelines for Isolated Facial Trauma: A Multi-disciplinary Expert Consensus.
Authors: Pontell ME , Steinberg JP , Mackay DR , Rodriguez ED , Strong EB , Olsson AB , Kriet JD , Kelly KJ , Ochs MW , Taub PJ , Desai SC , MacLeod S , Susarla S , Tollefson TT , Schubert W , Drolet BC , Golinko MS
Published: August 2022

Objective.

This study aims to develop guidelines for the transfer of patients with isolated craniomaxillofacial (CMF) trauma.

Methods.

A national, multidisciplinary, expert panel was assembled from leadership in national organizations and contributors to published literature on facial reconstruction. The final panel consisted of five plastic surgeons, four otolaryngologist—head and neck surgeons, and four oral and maxillofacial surgeons. The expert panelist’s opinions on transfer guidelines were collected using the modified Delphi process. Consensus was pre-defined as ≥ 90% agreement per statement.

Results.

After 4 Delphi consensus building rounds, 13 transfer guidelines were established, including statements on fractures of the frontal sinus, orbit, midface and mandible, as well as soft tissue injuries. Twelve guidelines reached consensus.

Conclusions.

The decision to transfer a patient with CMF trauma to another facility is complex and multifactorial. While a percentage of overtriage is acceptable to promote safe disposition of trauma patients, unnecessarily high rates of secondary overtriage divert emergency medical services, increase costs, delay care, overload tertiary trauma centers, and result in tertiary hospital staff providing primary emergency coverage for referring hospitals. These CMF transfer guidelines were designed to serve as a tool to improve, and safely streamline, the care of facial trauma patients. Such efforts may decrease the additional healthcare expenditures associated with secondary overtriage while decompressing emergency medical systems and tertiary emergency departments.
Melanin-Targeted PET Imaging Sheds Light on Pigment Epithelioma in Corpus Ciliare
Authors: Zhang Xiao , Li Mengting , Hu Fan , Lan Xiaoli
Published: August 2022

A 57-year-old woman had gradually decreased visual acuity in the left eye, accompanied by distension and pain. MRI demonstrated a small neoplasm in corpus ciliare, which promoted PET imaging for further assessment. 18F-FDG PET imaging found no obvious uptake in the lesion. However, melanin-targeted PET imaging demonstrated the lesion with avid 18F-PFPN (18F-N-(2-diethylaminoethyl)-4-(2-[2-ethoxy]-ethoxy)pyridine) accumulation (SUVmax, 7.1), which suggested it with melanin expression. Pigmented epithelial adenoma was further confirmed by pathology. Our case illustrated that pigmented epithelial adenoma is characterized by avid 18F-PFPN accumulations and can be detected even in a hidden location with a size of ≤5 mm.
A Single-center Prospective Observational Study Investigating the Accuracy of Preoperative Diagnostic Procedures in the Assessment of Lymph Node Metastases in Nonfunctioning Pancreatic Neuroendocrine Tumors
Authors: Partelli Stefano , Muffatti Francesca , Andreasi Valentina , Giannone Fabio , Rossi Gemma , Palumbo Diego , Mapelli Paola , Schiavo Lena Marco , Arcidiacono Paolo Giorgio , De Cobelli Francesco , Picchio Maria , Doglioni Claudio , Falconi Massimo
Published: August 2022

Objective:

To determine the accuracy of preoperative imaging, including contrast-enhanced computed tomography (CE-CT), endoscopic ultrasound (EUS), and 68Gallium-DOTATOC positron emission tomography (68Ga-DOTATOC PET), in identifying nodal metastases (N+) in sporadic nonfunctioning pancreatic neuroendocrine tumors (NF-PanNETs).

Background:

An accurate preoperative identification of N+ in NF-PanNETs is critical for surgical planning. The accuracy of different imaging techniques in detecting lymph node (LN) metastases in NF-PanNETs has been poorly investigated.

Methods:

All consecutive patients undergoing surgery for sporadic NF-PanNETs (2018–2021) were enrolled in a prospective study (DETECTYON; NCT03918759). The accuracy of preoperative imaging techniques in detecting N+ was assessed through sensitivity, specificity positive and negative predictive values.

Results:

Overall, 100 patients with NF-PanNETs underwent CE-CT, EUS, and 68Ga-DOTATOC PET before pancreatic resection. LN metastases were found in 42 cases (42%). Sensitivity, specificity, positive predictive value, and negative predictive value of different imaging techniques were 26%, 95%, 79%, 64% for CE-CT, 19%, 98%, 89%, 63% for EUS, and 12%, 95%, 63%, 60% for 68Ga-DOTATOC PET, respectively. Radiologic tumor size >4 cm and the presence of radiologic N+ at ≥1 imaging were independent predictors of N+ at pathology. The identification of N+ at ≥1 imaging technique was associated with a higher number of positive LNs compared with negative imaging (4 vs 2) (P=0.012).

Conclusions:

CE-CT, EUS, and 68Ga-DOTATOC PET are poorly sensitive in predicting nodal status in NF-PanNETs despite a high specificity.
Ex Vivo Liver Resection and Autotransplantation
Authors: Weiner Joshua , Hemming Alan , Levi David , Beduschi Thiago , Matsumoto Rei , Mathur Abhishek , Liou Peter , Griesemer Adam , Samstein Benjamin , Cherqui Daniel , Emond Jean , Kato Tomoaki
Published: August 2022

Objective:

We herein advocate for more extensive utilization of ex vivo resection techniques for otherwise unresectable liver tumors by presenting the largest collective American experience.

Background:

Advanced in situ resection and vascular reconstruction techniques have made R0 resection possible for otherwise unresectable liver tumors. Ex vivo liver resection may further expand the limits of resectability but remains underutilized due to concerns about technical complexity and vascular thrombosis. However, we believe that the skillset required for ex vivo liver resection is more widespread and the complications less severe than widely assumed, making ex vivo resection a more attractive option in selected case.

Methods:

We retrospectively analyzed 35 cases performed by surgical teams experienced with ex vivo liver resections (at least 4 cases) between 1997 and 2021.

Results:

We categorized malignancies as highly aggressive (n=18), moderately aggressive (n=14), and low grade (n=3). All patients underwent total hepatectomy, vascular reconstruction and resection in hypothermia on the backtable, and partial liver autotransplantation. Overall survival was 67%/39%/28%, at 1/3/5 years, respectively, with a median survival of 710 days (range: 22–4824). Patient survival for highly aggressive, moderately aggressive, and low-grade tumors was 61%/33%/23%, 67%/40%/22%, and 100%/100%/100% at 1/3/5 years, respectively, with median survival 577 days (range: 22–3873), 444 days (range: 22–4824), and 1825 days (range: 868–3549).

Conclusions:

Ex vivo resection utilizes techniques commonly practiced in partial liver transplantation, and we demonstrate relatively favorable outcomes in our large collective experience. Therefore, we propose that more liberal use of this technique may benefit selected patients in centers experienced with partial liver transplantation.