bluuebunny/crossref_metadata_2025 huggingface dataset:
Interventional Procedures for Left Ventricular Assist Device-Associated Complications
Authors: Lanmueller Pia , Eulert-Grehn Jaime-Juergen , Unbehaun Axel , Klein Christoph , Hommel Matthias , Kofler Markus , Kempfert Joerg , Hoermandinger Christoph , Kaufmann Friedrich , Stawowy Philipp , Dreysse Stephan , Mulzer Johanna , Mueller Marcus , Falk Volkmar , Schoenrath Felix , Potapov Evgenij , Just Isabell A.
Published: February 2022

As patients on long-term left ventricular assist device (LVAD) face a substantial risk for open cardiac reoperation, interventional treatment approaches are becoming increasingly important in this population. We evaluated data of 871 patients who were on LVAD support between January 1, 2016 and December 1, 2020. Interventional treatments for LVAD-associated complications were performed in 76 patients. Seventeen patients underwent transcatheter aortic valve replacements (TAVR) and 61 patients underwent outflow graft interventions (OGI). TAVR improved symptoms in patients with severe symptomatic aortic regurgitation. Postinterventional complications included aggravation of preexisting right heart failure (RHF), third-degree atrioventricular block, and intrapump thrombosis (in 3 [16.7%], 2 [11.1%], and 1 [5.6%] patients, respectively). In outflow graft obstructions, OGI led to recovery of LVAD flow (p < 0.001), unloading of the left ventricle (p = 0.004), decrease of aortic valve opening time (p = 0.010), and improvement of right heart function (p < 0.001). Complications included bleeding, RHF, and others (in 9 [10.8%], 5 [6.0%], and 5 [6.0%] patients, respectively). Eight (9.6%) patients died within the hospital stay after OGI, including mortality secondary to prolonged cardiogenic shock. In conclusion, interventional procedures are a feasible and safe treatment modality for LVAD-associated complications.
Comparison of Hemostatic Changes in Pump-driven Extracorporeal Carbon Dioxide Removal and Venovenous Extracorporeal Membrane Oxygenation
Authors: Nagler Bernhard , Gleiss Andreas , Füreder Lisa , Buchtele Nina , Hermann Alexander , Bojic Andja , Schellongowski Peter , Staudinger Thomas , Robak Oliver
Published: February 2022

Extracorporeal carbon dioxide removal (ECCO2R) has gained widespread use as a supposedly less invasive alternative for hypercapnic respiratory failure besides venovenous extracorporeal membrane oxygenation (VV ECMO). Despite technological advances, coagulation-related adverse events remain a major challenge in both therapies. The overlapping operating areas of VV ECMO and pump-driven ECCO2R could allow for a device selection targeted at the lowest risk of such complications. This retrospective analysis of 47 consecutive patients compared hemostatic changes between pump-driven ECCO2R (n = 23) and VV ECMO (n = 24) by application of linear mixed effect models. A significant decrease in platelet count, increase in D-dimer levels, and decrease of fibrinogen levels were observed. However, except for fibrinogen, the type of extracorporeal support did not have a significant effect on the time course of these parameters. Our findings suggest that in terms of hemocompatibility, pump-driven ECCO2R is not significantly different from VV ECMO.
Development of a Model for the Pediatric Survival After Veno-Arterial Extracorporeal Membrane Oxygenation Score: The Pedi-SAVE Score
Authors: Geisser Diana L. , Thiagarajan Ravi R. , Scholtens Denise , Kuang Alan , Petito Lucia C. , Costello John M. , Monge Michael C. , Di Nardo Matteo , Marino Bradley S.
Published: February 2022

Pediatric cardiac extracorporeal membrane oxygenation (ECMO) patients have high mortality rates. The purpose of our study was to develop and validate the Pediatric Survival After Veno-arterial ECMO (Pedi-SAVE) score for predicting survival at hospital discharge after pediatric cardiac veno-arterial (VA) ECMO. We used data for pediatric cardiac VA-ECMO patients from the Extracorporeal Life Support Organization registry (1/1/2001–12/31/2015). Development and validation cohorts were created using 2:1 random sampling. Predictors of survival to develop pre- and postcannulation models were selected using multivariable logistic regression and random forest models. ß-coefficients were standardized to create the Pedi-SAVE score. Of 10,091 pediatric cardiac VA-ECMO patients, 4,996 (50%) survived to hospital discharge. Pre- and postcannulation Pedi-SAVE scores predicted that the lowest risk patients have a 65% and 74% chance of survival at hospital discharge, respectively, compared to 33% and 22% in the highest risk patients. In the validation cohort, pre- and postcannulation Pedi-SAVE scores had c-statistics of 0.64 and 0.71, respectively. Precannulation factors associated with survival included: nonsingle ventricle congenital heart disease, older age, white race, lower STAT mortality category, higher pH, not requiring acid-buffer administration, <2 cardiac procedures, and indication for VA-ECMO other than failure to wean from cardiopulmonary bypass. Postcannulation, additional factors associated with survival included: lower ECMO pump flows at 24 hours and lack of complications. The Pedi-SAVE score is a novel validated tool to predict survival at hospital discharge for pediatric cardiac VA-ECMO patients, and is an important advancement in risk adjustment and benchmarking for this population.
Impella Management for the Cardiac Intensivist
Authors: Papolos Alexander I. , Barnett Christopher F. , Tuli Aakash , Vavilin Ilan , Kenigsberg Benjamin B.
Published: February 2022

The Impella mechanical circulatory support (MCS) system is a catheter-based continuous flow cardiac assist device that is widely used in the treatment of cardiogenic shock in medical and surgical cardiac intensive care units. As with all forms of MCS, device-related complications remain a major concern, the incidence of which can be mitigated by adhering to a few fundamental concepts in device management. The purpose of this review is to comprehensively describe our strategy for managing, repositioning, and weaning the Impella catheter.
Liver Injury and Acute Liver Failure After Bariatric Surgery
Authors: Moolenaar Laura R. , de Waard Nadine E. , Heger Michal , de Haan Lianne R. , Slootmaekers Caline P.J. , Nijboer Willemijn N. , Tushuizen Maarten E. , van Golen Rowan F.
Published: February 2022

The obesity epidemic has caused a surge in the use of bariatric surgery. Although surgery-induced weight loss is an effective treatment of nonalcoholic fatty liver disease, it may precipitate severe hepatic complications under certain circumstances. Acute liver injury (ALI) and acute liver failure (ALF) following bariatric surgery have been reported in several case series. Although rare, ALI and ALF tend to emerge several months after bariatric surgery. If so, it can result in prolonged hospitalization, may necessitate liver transplantation, and in some cases prove fatal. However, little is known about the risk factors for developing ALI or ALF after bariatric surgery and the mechanisms of liver damage in this context are poorly defined. This review provides an account of the available data on ALI and ALF caused by bariatric surgery, with emphasis on potential injury mechanisms and the outcomes of liver transplantation for ALF after bariatric surgery.
Racial Disparities in Liver Transplantation for Hepatocellular Carcinoma
Authors: Bodek Daniel D. , Everwine Matthew M. , Lunsford Keri E. , Okoronkwo Nneoma , Patel Pavan A. , Pyrsopoulos Nikolaos
Published: February 2022

Background:

Hepatocellular carcinoma (HCC) remains a deadly disease, with patients’ best hope for a cure being liver transplantation; however, access to health care resources, such as donor organs, between ethnic groups has historically been unbalanced. Ensuring equitable access to donor livers is crucial to minimize disparities in HCC outcomes. As a result, we sought to better elucidate the differences in transplantation rates among various ethnic groups.

Materials and Methods:

The National Inpatient Sample (NIS) was utilized to evaluate for disparities in liver transplantation in patients whose primary or secondary diagnosis was recorded as HCC or hepatoma. The study included admissions between 2007 and 2014 to centers with at least 1 documented liver transplant.

Results:

A total of 7244 transplants were performed over 70,406 weighted admissions. Black race was associated with lower transplantation rates, with an adjusted odds ratio of 0.46 (95% confidence interval: 0.42-0.51, P<0.01) when accounting for a number of possible confounders including socioeconomic and geographic factors.

Conclusions:

Our study observed decreased rates of liver transplant in blacks compared with whites for HCC. Furthermore, improved economic status and private insurance had a significantly higher odds ratio for transplantation. Hospital-level studies are needed to clarify confounding factors not apparent in large administrative datasets and help better investigate factors that lead to less optimal transplant rates among blacks. Interventions may include more optimal screening policies and procedures, improved interdisciplinary management, and earlier referrals.
ALSN 2021 Conference: Nursing Science for Leadership in the New Decade
Authors: Prestia Angela S. , Bailey K. David , Caramanica Laura , Fischer Shelly , Losty Lyn Stankiewicz , Snow Francine K. , Udod Sonia , Warshawsky Nora
Published: February 2022

The Association for Leadership Science in Nursing’s 2021 conference provided an opportunity to further enhance professional understanding of the difficulties facing nurse leaders as the COVID-19 pandemic continues to create unimaginable challenges. Presentations provided evidence in support of courageous caring leadership interventions.
Seeking to Understand
Authors: Ferren Melora D. , Von Ah Diane , Stolldorf Deonni P. , Newhouse Robin P.
Published: February 2022

OBJECTIVE

The aim of this study was to describe cultural characteristics, values, and beliefs that influence sustainability of an evidence-based practice (EBP) intervention in the acute care clinical setting.

BACKGROUND

There is an urgent need to identify best practices to sustain EBP to gain efficiencies in nursing care delivery and improve patient outcomes.

METHODS

A focused ethnographic qualitative study was conducted in a community hospital with nurses that used Screening, Brief Intervention, and Referral to Treatment (SBIRT).

RESULTS

Customizing the intervention to the unit culture evolved and was crucial for sustainability. Overlap in responsibilities, time, clinician confidence, and impact to workflow were noted as negative influences. The intervention was primarily viewed as a task to be checked off a list instead of a tool that informs the patient's plan of care.

CONCLUSIONS

Assessing clinician experiences, beliefs, and values of an EBP should be incorporated into a strategic sustainability plan. Clinician understanding of how an EBP can advance the patient plan of care could promote ownership of professional practice and sustainment.
Clinical Leader Series
Authors: Sawyer Amanda T. , Harris Stephanie , Green Jeanette F. , Du Yuan , Richard Tere , Robinson Patricia Stearnes , Celano Patricia , Kelly Kim , Bailey Amanda K.
Published: February 2022

OBJECTIVE

A virtual mental well-being initiative was developed for nurse leaders to provide education about mental health and to teach self-care skills.

BACKGROUND

Because of substantial demand placed on nurse leaders during the COVID-19 pandemic, organizations must address stress and burnout by providing a continuum of care to include education, support, and intervention.

METHODS

All levels of nurse leaders at a multicampus healthcare system were invited to attend. Data were collected on coping, empowerment, burnout, and quality of life. Participant responses to discussion prompts were compiled and reviewed.

RESULTS

Although the independent parallel comparison did not show significant improvements, scores on the coping, empowerment, burnout, and quality-of-life measures were maintained. Discussion prompts yielded valuable insights into nurse leader experiences and session effectiveness.

CONCLUSIONS

This type of education, as well as psychological support, will continue to be needed after the pandemic due to burnout, moral injury, and primary or secondary trauma. Findings are applicable to future crisis situations.
Treatment of Unicoronal Craniosynostosis by Rotational Flap Technique Preserves Blood Supply to the Frontal Bone Flap
Authors: Wong Alvin , Lance Samuel H. , Gosman Amanda A.
Published: February 2022

Background

Surgical correction of unicoronal craniosynostosis (UCS) remains a challenging problem. Long-term results are often unsatisfactory secondary to recurrence of the original deformity, requiring secondary operations such as fat grafting or complete revision of the calvarial remodeling. Distraction osteogenesis (DO) has recently emerged as a new modality for treatment of UCS, with promising results and decreased rates of reoperation compared with open cranial vault remodeling. A theoretical benefit of DO is preservation of blood supply to the frontal bone following osteotomy, as the frontal bone can be retained in situ compared with the complete removal and reshaping of the frontal bone during traditional fronto-orbital advancement. Preservation of blood supply to the frontal bone may allow for more robust bony healing and preservation of long-term growth potential; however, the vascularity of the frontal bone flap in DO has not previously been demonstrated. Here, we demonstrate unequivocally that blood supply to the frontal bone is preserved after creation of a rotational bone flap in DO management of UCS.

Methods

Frontal bone flap creation via osteotomy for DO treatment of UCS was performed via previously reported technique. Indocyanine green was injected intravenously, and bone perfusion was assessed with a fluorescence imaging system.

Results

Four patients underwent three cranial remodeling and three distractor removal procedures. After frontal bone flap creation via osteotomy for DO, perfusion to the osteotomized portion of the frontal bone flap is preserved. Blood flow is seen crossing the midline of the frontal bone. After removal of the distractor, perfusion in the osteoid consolidate is also observed.

Conclusions

Preservation of blood supply has not been previously demonstrated empirically in the setting of DO treatment of UCS. We show for the first time that during frontal bone flap creation, blood flow to the osteotomized portion of the frontal bone flap is maintained. Robust blood flow to the osteoid consolidate is also demonstrated. These data support the use of DO in treatment of UCS, as preserved blood supply to the bone is more likely to support improved healing and long-term results.
The Incidence of Breast Cancer After Gender-Affirming Mastectomy in Transmen
Authors: Parmeshwar Nisha , Song Siyou , Alcon Andre , Kim Esther A.
Published: February 2022

Background

The incidence of breast cancer in transmale patients and their continued risk after gender-affirming mastectomy (GAM) has not been well established. Plastic surgeons who offer GAM are often one of the few medical professionals sought out by this population, placing them in a unique position to not only deliver surgical care but also improve access to preventative cancer care.

Methods

We reviewed the senior author's experience with GAMs over the past 5 years for any incidence of breast cancer noted after or at time of surgery. We subsequently performed a thorough review of the literature for cases of breast cancer in transmen, to provide a comprehensive overview of screening, therapy, and postoperative surveillance practices.

Results

We identified 2 cases of breast cancer (ages 49 and 54 years) found on routine examination of pathology specimens after GAM at our institution. Both patients had been taking hormone therapy for the past 1 year. Pathology specimen revealed low-grade estrogen receptor–/progesterone receptor–positive ductal carcinoma in situ in 1 patient, and estrogen receptor–/progesterone receptor–positive invasive ductal carcinoma in the other. Both patients were referred to oncology for appropriate treatment, and both elected to continue their exogenous hormone therapy for personal reasons.

Review of the literature demonstrated 36 other cases of documented breast cancer in transmen. Sixty-seven percent (24) were found after GAM, and of those, 50% were incidentally found on pathology specimen. At least 50% were found to be either estrogen-, progesterone-, or androgen receptor–positive cancers. At least 17% of cases documented continued use of masculinizing hormone therapy after cancer diagnosis.

Conclusions

Most documented cases of breast cancer in transmen were diagnosed after gender-affirming surgery, which would suggest residual breast tissue does pose some risk for breast cancer. In addition, those diagnosed with cancer may elect to continue exogenous testosterone therapy despite potential added risks with hormone-receptor positivity. These cases highlight the need for agreement in current screening practices, surgical recommendations, and continuation of masculinizing hormone therapy.

Plastic surgeons have the unique opportunity to educate these patients on appropriate breast cancer–related surveillance both before and after chest surgery.
Medial Plantar Fasciocutaneous Flap Reconstruction for Load-Bearing Foot Defects in Patients With Acral Melanoma
Authors: Woo Soo Jin , Kang Jiwon , Hu Ju Long , Kwon Sung Tack , Chang Hak , Kim Byung Jun
Published: February 2022

Background

Acral lentiginous melanoma (ALM) is a rare subtype of malignant melanoma that usually involves the weight-bearing plantar area. Plantar defect reconstruction has traditionally been performed with skin grafts or free flaps. This study examined the efficacy and safety of a medial plantar artery perforator flap (MPAPF) for plantar defect reconstruction after wide excision of an ALM.

Method

Twenty-five patients who underwent reconstruction with a MPAPF between 2011 and 2021 were enrolled in this study. The defects were classified into 6 plantar zones. Demographic and clinical data were retrospectively analyzed.

Results

Reconstruction with medial plantar fasciocutaneous island flaps was performed in all cases, except for 4 patients who had lesions in forefoot, which required free medial plantar flaps. Defects in lateral and posterior heel were more likely to present with venous congestion and require longer healing times and revision surgery (P < 0.05). The average follow-up period was 49 months. Four and 5 patients developed local recurrence and distant metastasis, respectively. Four cases of hyperkeratosis and paresthesia were documented, but there were no cases of ulceration or wound dehiscence. None of the cases required secondary debulking procedures.

Conclusions

The MPAPF is safe and effective for plantar defect reconstruction among patients with ALM. Meticulous dissection and adequate tunneling are needed, particularly for defects in the lateral and posterior heel, to minimize flap congestion and revision operations.
Urethra Reconstruction and Revision Urethroplasty in Pedicled Anterolateral Thigh Flap Penile Reconstruction
Authors: Wu Qi , Yang Zhe , Ma Ning , Wang Weixin , Li Yangqun
Published: February 2022

Objective

Neophallic urethroplasty remains a significant challenge in penile reconstruction. Currently, there is no ideal recognized method. Through this article, we aimed to share our experiences of urethral reconstruction in the pedicled anterolateral thigh flap penile reconstruction using modified techniques and alternative flaps.

Methods

In this single-center study from 2010 to 2020, 49 patients underwent penile reconstruction with a pedicled anterolateral thigh flap; 17 patients had a micropenis, 3 had iatrogenic defects, and 29 had penile defects after trauma. Different urethroplasty methods, complications, and revision methods were separately described. The tube-in-tube technique was used in 6 cases; the superficial iliac circumflex artery perforator (SCIAP) flap and pudendal-thigh flap were used in 26 and 11 cases, respectively, and the pedicled scrotal flap was used in 6 cases. Revision urethroplasty due to postoperative necrosis (n = 3), stricture (n = 8), and fistula (n = 2) were performed in 13 cases.

Results

The urethral complications (flap necrosis, urinary fistula, and stricture) were as follows: tube-in-tube, 66.7%; SCIAP flap, 46.2%; pudendal-thigh flap, 38.5%; and scrotal septum flap, 50%. After revision procedures, all patients could urinate while standing.

Conclusions

The characteristics and requirements of patients should be considered before designing a surgical plan. The tube-in-tube technique is the first choice for reconstructing the penis and urethra in a single stage for thinner patients. For other patients, a different flap can be used as a substitute for urethral reconstruction. The SCIAP, pudendal-thigh, and pedicled scrotal flaps can be used to reconstruct the urethra. The tubed SCIAP flap and pudendal-thigh flap are reliable, simple, and suitable for revision urethroplasty.
Risk Factors Associated With Postmastectomy Breast Cancer Lymphedema
Authors: Kuruvilla Annet S. , Krajewski Aleksandra , Li Xiaoning , Yang Jie , Mulay Sagar R. , Agha Sohaib M. , Kohli Harmehar K. , Bellis Raymond M. , Tannous Henry J. , Shroyer A. Laurie W.
Published: February 2022

Background

Lymphedema is an edematous condition that afflicts the postmastectomy breast cancer population, with diminished quality of life with substantial financial costs. The factors predictive of postmastectomy lymphedema development in breast cancer patients are unknown. The objective was to evaluate the trends over time in lymphedema development and the risk factors predictive of lymphedema-related events within 2 years of mastectomy.

Methods

Using the New York Statewide Planning and Research Cooperative System multicenter deidentified database from 2010 to 2016, a total of 65,543 breast cancer postmastectomy female patients (mean age, 59 ± 20 years) were identified across 177 facilities. The breast cancer patients were followed for any 2-year postmastectomy lymphedema-related events. A multivariable model identified predictors of 2-year lymphedema using eligible variables involving demographics, comorbidities, and complications. Elixhauser score was defined as a comorbidity index based on International Classification of Diseases codes used in hospital settings.

Results

Overall, 5.2% (n = 3409) of the breast cancer postmastectomy patients experienced a lymphedema-related event within 2 years of initial surgery. Over time, 2-year postmastectomy lymphedema rates have more than doubled from 4.62% in 2010 to 9.75% in 2016 (P < 0.001). Two-year postmastectomy lymphedema rates varied significantly by mastectomy procedure type: 5.69% of the mastectomy-only procedures, 5.96% of the mastectomies with lymph node biopsies, and 7.83% of the mastectomies with lymph node dissections (P < 0.0001). Full mastectomies had a greater 2-year lymphedema rate of 7.31% when compared with partial mastectomies with 2.79% (P < 0.0001). The top predictive risk factors for a lymphedema-related event included higher Elixhauser score, prolonged hospitalization for mastectomy, more recent mastectomy procedure, obesity, younger age, non-Asian race, Medicaid insurance, and hypertension (all P's < 0.01).

Conclusions

Although more recent postmastectomy lymphedema rates may not be as high as historical estimates, the 2-year postmastectomy lymphedema rates have more than doubled from 2010 to 2016 requiring further elucidation as well as continued focus on treatment. Furthermore, risk factors were identified that predispose postmastectomy breast cancer patients to developing lymphedema. Given these findings, perioperative screening seems warranted to proactively identify, educate, and monitor postmastectomy patients at greatest risk of future lymphedema development.
Simultaneous Double Eyelid Blepharoplasty and Blepharoptosis Correction With Levator Aponeurosis Plication Technique
Authors: Hao Dong-Yue , Cang Zheng-Qiang , Cui Jiang-Bo , Fan Xiao , Ding Jian-Ke , Wei Si-Ming , Song Bao-Qiang , Cao Jiao , Liu Chao-Hua , Peng Pai
Published: February 2022

Background

Fifty percent of Asians are born without a supratarsal fold (also called single eyelid), and double eyelid blepharoplasty is one of the most commonly performed and most popular facial cosmetic surgeries in the Asian population. However, patients with single eyelid frequently present with concomitant mild blepharoptosis (degree of ptosis, ≤2 mm), which often fails to cause the attention of surgeons and misses correction.

Methods

A retrospective study of all patients who underwent double eyelid blepharoplasty and blepharoptosis correction simultaneously with the modified levator aponeurosis plication technique was performed from June of 2017 to June of 2020.

Results

A total of 108 patients (155 eyelids) underwent double eyelid blepharoplasty and blepharoptosis correction simultaneously with the modified levator aponeurosis plication technique and were enrolled in the study. The average follow-up period was 11.8 ± 4.5 months. There was a statistically significant difference between the preoperative margin reflex distance 1 (MRD1) and postoperative MRD1 (2.93 ± 0.37 vs 4.21 ± 0.39 mm, P = 0.000), and the mean MRD1 improvement was 1.28 ± 0.50 mm. Sufficient correction was obtained in 148 eyelids (95.5%), whereas undercorrection was observed in 5 eyelids (3.2%) and overcorrection was observed in 2 eyelids (1.3%). One hundred two patients (94.4%) were completely satisfied with the final result.

All patients had smooth and elegant upper eyelid margin curve, and no patients complained of distortion of the eyelid margin contour and foreign body sensation.

There were no cases of hematoma, infection, suture exposure, corneal abrasion, and keratitis in any patient.

Conclusions

This modified levator aponeurosis plication introduced in this study is a simple and effective method for creating double-eyelid crease and correcting mild blepharoptosis simultaneously, and provides a satisfactory outcome. As such, we recommend this method in treating patients with both single eyelid and mild blepharoptosis.
The Utility of the 5-Factor Modified Frailty Index to Predict Postoperative Risk in Microsurgical Reconstruction
Authors: Martinez Carlos , Atwez Abdelaziz , Durkin Martin , Averch Timothy , Mujadzic Mirsad , Friedman Harold I. , Gilstrap Jarom
Published: February 2022

Background

Microsurgical reconstruction is an integral part of plastic surgery. The 5-factor modified frailty index (5-mFI) is an effective tool to predict postoperative complications across multiple subspecialties. We aimed to determine if frailty scores using the 5-mFI can predict postoperative complications specifically in microvascular reconstruction.

Study Design

Frailty scores were retrospectively assessed in microsurgical reconstruction patients (2012–2016) using the American College of Surgeons National Quality Improvement Program base. The 5 variables that comprise the 5-mFI are history of chronic obstructive pulmonary disease, history of congestive heart failure, functional status, hypertension requiring medication and diabetes. The data were analyzed using the Goodman test, χ2 test, and a logistic regression model. The congruence was also compared between the 5-mFI and the American Society of Anesthesiology (ASA) classification in predicting complications.

Results

Of 5894 patients, the highest 5-mFI value was “3.” Analyses show an increase in postoperative complications requiring ICU care. Further models indicate an association between readmission with hypertension and chronic obstructive pulmonary disease (P < 0.05). There was an increased risk of a failure to wean from ventilator with a history of chronic obstructive pulmonary disease and diabetes and an increased risk of readmission with a history of hypertension and chronic obstructive pulmonary disease. The 5-mFI and ASA were incongruent in predicting postoperative complications.

Conclusions

The 5-mFI predicts postoperative complications in the microsurgical reconstruction population. Although the 5-mFI and ASA predict different complications, their use provides insight into the potential adjustable risks before surgery.
Mitochondrial mRNA localization is governed by translation kinetics and spatial transport
Authors: Arceo Ximena G , Koslover Elena F , Zid Brian M , Brown Aidan I
Published: February 2022

For many nuclear-encoded mitochondrial genes, mRNA localizes to the mitochondrial surface co-translationally, aided by the association of a mitochondrial targeting sequence (MTS) on the nascent peptide with the mitochondrial import complex. For a subset of these co-translationally localized mRNAs, their localization is dependent on the metabolic state of the cell, while others are constitutively localized. To explore the differences between these two mRNA types we developed a stochastic, quantitative model for MTS-mediated mRNA localization to mitochondria in yeast cells. This model includes translation, applying gene-specific kinetics derived from experimental data; and diffusion in the cytosol. Even though both mRNA types are co-translationally localized we found that the steady state number, or density, of ribosomes along an mRNA was insufficient to differentiate the two mRNA types. Instead, conditionally-localized mRNAs have faster translation kinetics which modulate localization in combination with changes to diffusive search kinetics across metabolic states. Our model also suggests that the MTS requires a maturation time to become competent to bind mitochondria. Our work indicates that yeast cells can regulate mRNA localization to mitochondria by controlling mitochondrial volume fraction (influencing diffusive search times) and gene translation kinetics (adjusting mRNA binding competence) without the need for mRNA-specifc binding proteins. These results shed light on both global and gene-specific mechanisms that enable cells to alter mRNA localization in response to changing metabolic conditions.
Shared Decision Making for Patients Hospitalized with Acute Myocardial Infarction. A Randomized Trial
Authors: Branda Megan E. , Kunneman Marleen , Meza-Contreras Alejandra I. , Shah Nilay D. , Hess Erik P. , LeBlanc Annie , Linderbaum Jane A. , Nelson Danika M. , Mc Donah Margaret R. , Sanvick Carrie , Van Houten Holly K. , Coylewright Megan , Dick Sara R. , Ting Henry H. , Montori Victor M.
Published: February 2022

Objective

Adherence to guideline-recommended medications after acute myocardial infarction (AMI) is suboptimal. Patient fidelity to treatment regimens may be related to their knowledge of the risk of death following AMI, the pros and cons of medications, and to their involvement in treatment decisions. Shared decision making may improve both patients’ knowledge and involvement in treatment decisions.

Methods

In a pilot trial, patients hospitalized with AMI were randomized to the use of the AMI Choice conversation tool or to usual care. AMI Choice includes a pictogram of the patient’s estimated risk of mortality at 6 months with and without guideline-recommended medications, i.e., aspirin, statins, beta-blockers, and angiotensin-converting enzyme inhibitors. Primary outcomes were patient knowledge and conflict with the decision made assessed via post-encounter surveys. Secondary outcomes were patient involvement in the decision-making process (observer-based OPTION12 scale) and 6-month medication adherence.

Results

Patient knowledge of the expected survival benefit from taking medications was significantly higher (62% vs. 16%, p<0.0001) in the AMI Choice group (n=53) compared to the usual care group (n=53). Both groups reported similarly low levels of conflict with the decision to start the medications (13 (SD 24.2) vs. 16 (SD 22) out of 100; p=.16). The extent to which clinicians in the AMI Choice group involved their patients in the decision-making process was high (OPTION12 score 53 out of 100, SD 12). Medication adherence at 6-months was relatively high in both groups and not different between groups.

Conclusions

The AMI Choice conversation tool improved patients’ knowledge of their estimated risk of short-term mortality after an AMI and the pros and cons of treatments to reduce this risk. The effect on patient fidelity to recommended medications of using this SDM tool and of SDM in general should be tested in larger trials enrolling patients at high risk for nonadherence.

Trial registration number

NCT00888537
Watching the release of a photopharmacological drug from tubulin using time-resolved serial crystallography
Authors: Wranik Maximilian , Weinert Tobias , Slavov Chavdar , Masini Tiziana , Furrer Antonia , Gaillard Natacha , Gioia Dario , Ferrarotti Marco , James Daniel , Glover Hannah , Carrillo Melissa , Kekilli Demet , Stipp Robin , Skopintsev Petr , Brünle Steffen , Mühlethaler Tobias , Beale John , Gashi Dardan , Nass Karol , Ozerov Dmitry , Johnson Philip J.M. , Cirelli Claudio , Bacellar Camila , Braun Markus , Wang Meitian , Dworkowski Florian , Milne Chris , Cavalli Andrea , Wachtveitl Josef , Steinmetz Michel O. , Standfuss Jörg
Published: February 2022

The binding and release of ligands from their protein targets is central to fundamental biological processes as well as to drug discovery. Photopharmacology introduces chemical triggers that allow the changing of ligand affinities and thus biological activity by light. Insight into the molecular mechanisms of photopharmacology is largely missing because the relevant transitions during the light-triggered reaction cannot be resolved by conventional structural biology. Using time-resolved serial crystallography at a synchrotron and X-ray free-electron laser, we captured the release of the anti-cancer compound azo-combretastatin A4 and the resulting conformational changes in tubulin. Nine structural snapshots from 1 ns to 100 ms complemented by simulations show howcis-to-transisomerization of the azobenzene bond leads to a switch in ligand affinity, opening of an exit channel, and collapse of the binding pocket upon ligand release. The resulting global backbone rearrangements are related to the action mechanism of microtubule-destabilizing drugs.
A unique mineralizing pool of Gli1+ stem cells builds the tendon enthesis and demonstrates therapeutic potential
Authors: Fang Fei , Xiao Yang , Zelzer Elazar , Leong Kam W. , Thomopoulos Stavros
Published: February 2022

The enthesis, a fibrocartilaginous transition between tendon and bone, is necessary for the transfer of force from muscle to bone to produce joint motion. The enthesis is prone to injury due to mechanical demands, and it cannot regenerate. A better understanding of how the enthesis develops will lead to more effective therapies to prevent pathology and promote regeneration. Here, we used single-cell RNA sequencing to define the development transcriptome of the entheses over postnatal stages. Six resident cell types, including enthesis progenitors and mineralizing chondrocytes, were identified along with their transcription factor regulons and temporal regulation. Following our prior discovery of the necessity of Gli1-lineage cells for enthesis development and healing, we then examined their transcriptomes at single cell resolution and demonstrated their clonogenicity and multipotency. Transplantation of these Gli1- lineage cells to enthesis injuries improved healing, demonstrating their therapeutic potential for enthesis regeneration.

Highlights

The transcriptome and differentiation trajectory of enthesis stem cells during postnatal development are defined at single cell resolution.

Transcription factor regulons drive enthesis stem cell differentiation.

Gli1-lineage enthesis stem cells demonstrate in vivo and in vitro clonogenicity and multipotency.

Transplantation of Gli1-lineage enthesis stem cells to enthesis injuries improves healing.
A simple technique to classify diffraction data from dynamic proteins according to individual polymorphs
Authors: Nguyen Thu , Phan Kim L. , Kozakov Dima , Gabelli Sandra B. , Kreitler Dale F. , Andrews Lawrence C. , Jakoncic Jean , Sweet Robert M. , Soares Alexei S. , Bernstein Herbert J.
Published: February 2022

One often observes small but measurable differences in the diffraction data measured from different crystals of a single protein. These differences might reflect structural differences in the protein and may reveal the natural dynamism of the molecule in solution. Partitioning these mixed-state data into single-state clusters is a critical step that could extract information about the dynamic behavior of proteins from hundreds or thousands of single-crystal data sets. Mixed-state data can be obtained deliberately (through intentional perturbation) or inadvertently (while attempting to measure highly redundant single-crystal data). To the extent that different states adopt different molecular structures, one expects to observe differences in the crystals; each of the polystates will create a polymorph of the crystals. After mixed-state diffraction data have been measured, deliberately or inadvertently, the challenge is to sort the data into clusters that may represent relevant biological polystates. Here, this problem is addressed using a simple multi-factor clustering approach that classifies each data set using independent observables, thereby assigning each data set to the correct location in conformational space. This procedure is illustrated using two independent observables, unit-cell parameters and intensities, to cluster mixed-state data from chymotrypsinogen (ChTg) crystals. It is observed that the data populate an arc of the reaction trajectory as ChTg is converted into chymotrypsin.
Reflections on the impact of informal sector tourism on indigenous Namibian Craft processes
Authors: Beamer Becky , Gleason Kimberly C.
Published: February 2022

Purpose

The purpose of this study is to use a spreadable form of creative expression, bookwork, to illustrate the encroachment upon the indigenous craft process of Namibian master crafters. In addition, the authors hope to inspire a dialogue regarding the value of interdisciplinary research between the arts and business and promote creative expression as scholarly output that can provide additional depth to research topics in business.

Design/methodology/approach

This study introduces bookwork as a research technique used to convey insights regarding the consequences to master crafters and indigenous craft practices arising from the economic activities of informal sector tourists as “outsiders” – those external to the indigenous Namibian Craft community.

Findings

In this paper, the authors convey the manner in which outsiders (such as tourists) permanently influence the traditional craft culture of indigenous communities in a largely unexplored cultural ecological niche in Namibia by purchasing low cost, easily mass produced, yet inauthentic brightly colored objects. It is likely that craft processes designed for revenue generation will encroach on the role of the master crafters in Namibian society and permanently redirect creative activities away from the indigenous practices.

Research limitations/implications

The researchers acknowledge the biases they have, as outsiders, in their perception of Namibian master crafters and craft practices.

Social implications

The human capital of the master crafters of Namibia is being eroded and traditional craft practices are being distorted due to incentives created by tourist preferences for cheap, inauthentic replicas of the master crafters’ work.

Originality/value

While some business disciplines, such as marketing, have incorporated the arts into their research, the use of creative expression in many business disciplines has been limited. The authors are the first to use bookwork to explore academic business research questions as per their knowledge. In addition, this study provides a new perspective, that of the outsider, in assessing how tourism impacts traditional Namibian Craft processes.
Dispatch information affects diagnosis in paramedics: an experimental study of applied dual-process theory
Authors: Keene Toby , Pammer Kristen , Lord Bill , Shipp Carol
Published: February 2022

Purpose

Previous research has shown that paramedics form intuitive impressions based on limited “pre-arrival” dispatch information and this subsequently affects their diagnosis. However, this observation has never been experimentally studied.

Design/methodology/approach

This was an experimental study of 83 Australian undergraduate paramedics and 65 Australian paramedics with median 14 years' experience (Range: 1–32 years). Participants responded to written vignettes in two parts that aimed to induce an intuitive impression by placing participants under time pressure and with a secondary task, followed by a diagnosis made without distraction or time pressure. The vignettes varied the likelihood of Acute Coronary Syndrome (ACS) and measured self-reports of typicality and confidence. Answer fluency, which is the ease with which the answer comes to mind, was also measured.

Findings

More participants exposed to the likely pre-arrival vignette recorded a final diagnosis of ACS, than those exposed to unlikely pre-arrival information (0.85 [95%CI: 0.78, 0.90] vs 0.74 [95%CI: 0.66, 0.81]; p = 0.03). This effect was greater in paramedics with more than 14 years' experience (0.94 [95%CI: 0.78, 0.99] vs 0.67 [95%CI: 0.48, 0.81]; p = 0.01). Answer fluency and confidence were associated with the impression, while the impression and confidence were associated with final diagnosis.

Practical implications

The authors have experimentally shown that pre-arrival information can affect subsequent diagnosis. The most experienced paramedics were more likely to be affected.

Originality/value

This is the first experimental study of diagnostic decision-making in paramedics and paramedic students.
A conceptual analysis of the ethicality of Web-based messaging on the COVID-19 pandemic
Authors: Joseph Rhoda C. , Ali Mohammad
Published: February 2022

Purpose

The purpose of this study is to examine the primary sources and methods of Web-based messaging during the early stages of the coronavirus pandemic. The authors use ethical lens to develop a conceptual framework to inform and reduce conflicts of Web-based messaging associated with COVID-19.

Design/methodology/approach

This paper provides a comprehensive review of three different ethical schools and identifies the cohesive theme of common good across them. Common good leading to a greater good serves as the overarching ethical construct for Web-based messages that focus on society and not the singular individual, business or political ideology.

Findings

The findings suggest that the ethical construct of common good focuses on prioritizing the society over the individual and draws upon utilitarian principles focused on consequences, Kantian principles focused on intentions and Aristotelian principles focused on the definition of good. Web-based messaging on COVID-19 originates from diverse public and private sources and ethically can be governed by adherence to achieving the greatest good for society. Pervasive conflicts with COVID-19 messaging can be mitigated by pursuing a more ethical agenda with messages.

Originality/value

This manuscript provides a conceptual framework, based on ethical principles, to serve as a blueprint for Web-based messaging during a pandemic. This work offers an ethical perspective for communication during a pandemic and it is original in conceptualizing the components of Web-based messaging and decomposing them into the different levels where conflicts can occur. This article can serve as a template for Web-based communication pertaining to future pandemics and other events that benefit from prioritizing the impact on society over the impact on the individual.
An assessment of the impact of professional development and training on job performance of library staff in Federal University Oye Ekiti libraries, Nigeria
Authors: Osiesi Mensah Prince , Odobe Victor Tobiloba , Sanni Kamorudeen Taiwo , Adams Adijat Bolanle , Oke Chigozie Celestina , Omokhabi Udukhomose Suleiman , Okorie Nnaemeka Chijioke
Published: February 2022

Purpose

The purpose of this paper is to assess the impact of professional training and development for librarians/library staff in the southwest, Nigeria; especially the Federal University of OyeEkiti, Nigeria. Thus, this study intends to assess the impact of staff professional development and training on the job performance of library staff in the Federal University Oye Ekiti, Nigeria.

Design/methodology/approach

The descriptive survey research design was used in carrying out this study. The population of study cuts across all library staff/attendants in the Federal University Oye Ekiti departmental, faculty and the university libraries. The purposive sampling technique was used in selecting the sample for the study (77 library staff). Research instruments, developed by the researchers, Staff Development Programme Questionnaire (r = 0.79), Staff performance Questionnaire (r = 0.81), Challenges of Staff Professional Development and Training Questionnaire (r = 0.82), were used for data collection. The data were analysed using descriptive statistics (frequency counts and percentages, mean and standard deviation) and inference statistics (correlation and one-way ANOVA) at a 5% level of significance.

Findings

Results revealed that the level of the job performance of library staff in Federal University Oye-Ekiti (FUOYE) is high; there is a positive and statistically significant relationship between the professional development of library staff and their performance in the job; professional development and training of library staff significantly impact their job performance; orientation, in-house training, seminars, on-the-job training and instructor-led training.

Research limitations/implications

The study was limited to the university libraries in the Federal University Oye Ekiti, Nigeria. The variables used in this study were restricted to training and development of library staff and job performance of librarians in FUOYE, and professional development programmes available for FUOYE librarians.

Practical implications

Other forms of professional development programmes such as Distance Educational Programmes, Conferences/Workshops, Study visits, Formal professional library education and TETFUND Programmes should be made available for university library staff. Universities should always organise staff professional development programmes; since it enhances the job performance of library staff.

Originality/value

This article is original and has not been published elsewhere.
Can personality traits influence Brazilian university students' financial literacy?
Authors: Goulart Marco Antonio de Oliveira Vieira , da Costa Jr Newton Carneiro Affonso , Paraboni Ana Luiza , Luna Mônica Maria Mendes
Published: February 2022

Purpose

The objective of the present study is to assess the financial literacy levels of students at a Brazilian university and investigate how these levels are affected by profile characteristics and personality traits.

Design/methodology/approach

Data were collected using SurveyMonkey, and a link to the questionnaire was sent by e-mail. The questionnaire contains three blocks of questions: demographics, financial literacy and personality traits. Ordered logistic regression was applied to a sample of 1,312 students.

Findings

Younger participants, those with higher incomes and men were more likely to have a high level of financial literacy. The same was true of those who were less extrovert, i.e. assertive, sociable, optimistic and communicative students. These results contribute to the field by indicating which population segments should be prioritized in efforts to promote financial literacy.

Originality/value

To the best of our knowledge, no study has compared Financial Literacy and Personality Traits in Brazil, a developing country that is only beginning to develop national financial literacy strategies.