bluuebunny/crossref_metadata_2025 huggingface dataset:
Targeting persistent normal left ventricular geometry in the general population: a 25-year follow-up study
Authors: Cuspidi Cesare , Facchetti Rita , Seravalle Gino , Tadic Marijana , Mancia Giuseppe , Grassi Guido
Published: December 2020

Aim:

Findings regarding the extent of persistence over time of normal left ventricular (LV) geometry, a reference healthy echocardiographic phenotype, in the community are scanty. We sought to assess this issue in members of the general population enrolled in the Pressioni Arteriose Monitorate e Loro Associazioni study.

Methods:

The study included 433 participants who attended the second and third survey of the Pressioni Arteriose Monitorate e Loro Associazioni study performed after 10 and 25 years from the initial evaluation. Data collection included medical history, anthropometric parameters, office, home, ambulatory blood pressure, routine blood examinations and echocardiography.

Results:

During 25-year follow-up 167 participants showed persistently normal LV mass (LVM) and LV geometry pattern, whereas 266 participants exhibited LV hypertrophy or LV concentric remodelling at any point during study. Compared with participants developing, maintaining or regressing from LV hypertrophy and LV concentric remodelling those with a persistently normal LVM index and geometry were younger (−8 years) and more frequently female (63 vs. 45%), exhibited baseline (and follow-up) lower office and out-of-office blood pressure, BMI, serum creatinine, fasting blood glucose total serum cholesterol and rate of antihypertensive treatment. In multivariate regression analysis age [odds ratio (OR): 0.93, confidence interval (CI): 0.91–0.96, P < 0.0001] BMI (OR: 0.90, CI: 0.83–0.97, P = 0.008), office SBP (OR: 0.97, CI: 0.95–0.99, P = 0.005) and fasting blood glucose (OR: 0.96, CI: 0.93–0.99, P = 0.007) were independently associated with persistent normal LVM index and geometry.

Conclusion:

The current long-term longitudinal study suggests that persistence of normal LV geometry is associated with normal/optimal SBP, BMI and blood glucose. Thus, a closer control of these risk factors in midlife may increase the likelihood of maintaining normal ventricular geometry and, in turn, reduce the burden of subclinical cardiac organ damage and related complications in advanced age.
Software Tools for the Evaluation of Clinical Signs and Symptoms in the Medical Management of Acute Radiation Syndrome—A Five-year Experience
Authors: Port Matthias , Haupt Julian , Ostheim Patrick , Majewski Matthäus , Combs Stephanie E. , Atkinson Mike , Abend Michael
Published: December 2020

A suite of software tools has been developed for dose estimation (BAT, WinFRAT) and prediction of acute health effects (WinFRAT, H-Module) using clinical symptoms and/or changes in blood cell counts. We constructed a database of 191 ARS cases using the METREPOL (n = 167) and the SEARCH-database (n = 24). The cases ranged from unexposed (RC0), to mild (RC1), moderate (RC2), severe (RC3), and lethal ARS (RC4). From 2015–2019, radiobiology students and participants of two NATO meetings predicted clinical outcomes (RC, H-ARS, and hospitalization) based on clinical symptoms. We evaluated the prediction outcomes using the same input datasets with a total of 32 teams and 94 participants. We found that: (1) unexposed (RC0) and mildly exposed individuals (RC1) could not be discriminated; (2) the severity of RC2 and RC3 were systematically overestimated, but almost all lethal cases (RC4) were correctly predicted; (3) introducing a prior education component for non-physicians significantly increased the correct predictions of RC, ARS, and hospitalization by around 10% (p<0.005) with a threefold reduction in variance and a halving of the evaluation time per case; (4) correct outcome prediction was independent of the software tools used; and (5) comparing the dose estimates generated by the teams with H-ARS severity reflected known limitations of dose alone as a surrogate for H-ARS severity. We found inexperienced personnel can use software tools to make accurate diagnostic and treatment recommendations with up to 98% accuracy. Educational training improved the quality of decision making and enabled participants lacking a medical background to perform comparably to experts.
Analysis of Long-Term Quality Control Data for a 137Cs Dosimetry Calibration Source
Authors: Noey Jordan D. , Golduber Robert M. , Kearfott Kimberlee J.
Published: December 2020

Strict quality assurance programs are required for many radiological applications, but these seldom exist for verifying dosimetry calibration sources. After initial characterization of a dosimetry calibration facility, quality control procedures are recommended to ensure the early detection of any changes or malfunctions. These also result in refined knowledge about average dose rate and experimental variations in dose delivery. This paper describes the implementation of a phase I quality control protocol for a 137Cs dosimetry calibration source and includes an analysis of the resulting data collected over a 24-mo period. During this time, substantial data was collected to establish trial control limits. Air kerma rate measurements were obtained using an ion chamber and were adjusted for decay, corrected for ambient temperature, pressure and humidity, and then analyzed using quality control charts. Three variations of rational subgrouping methods were used in order to find assignable causes of error, and Nelson’s Rules were followed to detect any non-random statistical variations. Measurements were subgrouped according to same-day measurements in order to detect positional errors as well as atmospheric correction errors. Additionally, measurements were subgrouped according to analogous experimental setups in order to detect failure in equipment or incorrect settings. Both were analyzed using the X-bar and R chart method. Similarly, individuals and moving ranges charts were used to carefully examine each position in order to observe any situational errors that may occur which include timing, positional, or interference errors. Each method was successful in identifying unique out-of-control data points that occurred during the phase I application of forming control limits. Over the 24-mo period, enough data points were deemed in-control to establish reliable trial limits. Future experiments will include the phase II application of gaining more reliable measurements in order to fine-tune the limits, as well as performing a designed experiment, where variables are purposefully changed in order to test the variation of the data.
PERIPHERAL EXUDATIVE HEMORRHAGIC CHORIORETINOPATHY-A NEW ADDITION TO THE SPECTRUM OF PACHYCHOROID DISEASE?
Authors: Shroff Daraius , Sharma Minal , Chhablani Jay , Gupta Priyanka , Gupta Charu , Shroff Cyrus
Published: December 2020

Purpose:

To demonstrate choroidal vascular changes and report a novel choroidal thickness contour in eyes with peripheral exudative hemorrhagic chorioretinopathy (PEHCR).

Methods:

Retrospective, observational, comparative case series. Fourteen eyes of nine patients with PEHCR and 14 eyes of 14 age-matched and sex-matched controls underwent swept-source optical coherence tomography. Choroidal thickness was measured from posterior edge of the retinal pigment epithelium–Bruch membrane to choroidoscleral interface at 11 points 1,000 µm apart. Large choroidal vessel thickness was also measured.

Results:

In PEHCR group, the choroid was thinnest at 3 mm nasal to fovea (mean 95.3 ± 33.5 µm) and thickest at 7 mm temporal to fovea (mean 272.7 ± 80.2 µm), with gradual increase in choroidal thickness from nasal to temporal periphery. The choroid was thickest subfoveally (259.7 ± 63.8 µm) in the control group. The choroid was significantly thicker in temporal periphery in PEHCR eyes as compared to controls (P = 0.0002). The mean large choroidal vessel thickness was 202.4 ± 50.8 µm in the PEHCR group and 160.6 ± 40.5 µm in the control group (P = 0.0235).

Conclusion:

Peripheral exudative hemorrhagic chorioretinopathy eyes showed progressively increasing choroidal thickness toward the temporal periphery, compared with age-matched and sex-matched controls. This gave rise to a club-shaped choroidal contour compared with the bowl-shaped contour seen in control eyes. Thicker choroid and pachyvessels favor inclusion of PEHCR in the pachychoroid disease spectrum.
Milestones in Oculofacial Plastic and Reconstructive Surgery: The Discovery of the Levator Palpebrae Superioris and Its Subsequent History
Authors: Reifler David M.
Published: December 2020

Purpose:

This review aims to substantiate attributions of priority for the discovery and first description of the levator palpebrae superioris (LPS) muscle to Matteo Realdo Colombo [Columbus] (1516–1559), and to describe the history of this muscle from ancient to modern times.

Methods:

Relevant chapters on eyelid and eye muscles in Colombo’s De re anatomica (1559) were translated, and the work was further analyzed from a historical perspective. Literature on the anatomy of human eyelid and orbital striated muscles was reviewed from the publication of the Fabrica (1543) by Andreas Vesalius (1514–1564) through modern times. The discovery of the LPS was viewed in relation to other milestones along the road that led to the establishment of the subspecialty of oculofacial and orbital plastic surgery.

Results:

The first description of the LPS appeared in De re anatomica (1559) by Colombo who correctly identified the LPS as a retractor of the (upper) eyelid and the orbicularis oculi as its protractor. The current lack of recognition of the priority of Colombo’s description of the LPS stemmed from his lifelong rivalries with other anatomists, improved descriptions of the orbital muscles by Gabriele Falloppio (1523–1562) that soon followed, and historical controversies over other anatomical discoveries.

Conclusions:

Colombo discovered the LPS and described the antagonistic functions of retractors and protractors of the eyelid, just a portion of his broader contributions to anatomy. Colombo’s discoveries of such ophthalmologic and oculofacial plastic surgical importance should be added to the ongoing reappraisals of Colombo by medical historians.
What is in a Name? It is Time to Retire the Term “Asian Blepharoplasty”
Authors: Lorden Diana S. , Kim Angela , Tejawinata Felicia , Samimi David B. , Lo Christopher C. , Dresner Steven C. , Burnstine Michael A.
Published: December 2020

Purpose:

This perspective explores the term “Asian blepharoplasty” and its socioemotional meaning to some patients.

Methods:

N/A.

Results:

Words have power. The term “Asian blepharoplasty” makes some patients uncomfortable. To our knowledge, it is the only medical descriptor that uses race.

Conclusions:

The use of the term “Asian Blepharoplasty” may unwittingly make patients uncomfortable and pathologize Asian features. Therefore, we suggest replacing the term “Asian Blepharoplasty” with “Double Eyelid Surgery.” For the subset of procedures which do not include the creation of an eyelid crease, “Blepharoplasty” is appropriate.
Vertical Lid Split to Aid Excision and Reconstruction of Conjunctival Tumors Involving the Fornices
Authors: Hickley Nicholas M. , McCormick Austin G. , Hsuan James D.
Published: December 2020

Purpose:

To describe how a vertical lid split helps excision and reconstruction of conjunctival tumors.

Methods:

All patients with a limited view of conjunctival tumors involving the fornices underwent a vertical lid split procedure to improve access during resection and reconstruction.

Results:

There were 11 cases where vertical lid splits were performed to assist excision and reconstruction of conjunctival tumors on patients between 2015 and 2019. There were 4 male and 7 female patients, 50–85 years of age, mean age 67.2 years. Four patients had invasive malignant melanoma, 2 melanoma in situ, 3 invasive squamous cell carcinoma, and 2 squamous cell carcinoma in situ. The authors have had no local reoccurrences in 9 patients (follow-up 8–54 months, mean 18 months). One patient’s deep margins were involved and proceeded to exenteration, and 1 patient died from liver metastases.

Conclusions:

A vertical lid split incision of either or both eyelids, well away from the visible tumor edge splays the lid open allowing the whole conjunctival surface to be stretched out and viewed as a single flat sheet. This aids excision and reconstruction of the tumor, potentially reducing the risk of seeding and simplifying the reconstruction.
Primary Adnexal Signet-Ring Cell/Histiocytoid Carcinoma
Authors: Stewart Stephen , Houghton Joe , Kamalarajah Sri , Curragh David
Published: December 2020

An 84-year-old man presented with a 2-year history of a progressive left-sided ptosis. Examination demonstrated a mechanical ptosis and concentric constriction of the palpebral aperture. CT imaging revealed demonstrated diffuse soft tissue infiltration of the upper and lower eyelids with extension into the anterior orbit. This case was diagnostically challenging because of a history of multiple other primary tumors. However, clinicoradiologic and histopathologic findings were consistent with a diagnosis of primary adnexal signet-ring cell/histiocytoid carcinoma. The patient underwent surgical excision but local recurrence was noted 2 months postoperatively.
Laser Speckle Contrast Imaging of a Rotational Full-Thickness Lower Eyelid Flap Shows Satisfactory Blood Perfusion
Authors: Berggren Johanna V. , Sheikh Rafi , Hult Jenny , Engelsberg Karl , Malmsjö Malin
Published: December 2020

Full-thickness eyelid flaps from the lower eyelid are frequently used to repair larger upper eyelid defects. Perfusion monitoring has recently been implemented in several reconstructive surgical procedures, however, perfusion monitoring of a rotational eyelid flap has not yet been described. The authors' employed laser speckle contrast imaging to monitor blood perfusion in a rotational flap from the lower eyelid, used to cover a large tumor defect in the upper eyelid. Perfusion in the flap decreased by only 50% during surgery and was almost completely restored 5 weeks later at flap division (91%). The excellent surgical outcome in the present case is deemed to be the result of satisfactory blood perfusion of the flap.
Clinical features of red blood cell–coated intraocular lens after breakthrough vitreous hemorrhage secondary to neovascular age-related macular degeneration
Authors: Kim Hyeong Min , Murakami Yusuke , Woo Se Joon
Published: December 2020

Purpose:

To investigate the incidence and clinical features of red blood cell (RBC)–coated intraocular lens (IOL) in breakthrough vitreous hemorrhage (VH) with subretinal hemorrhage (SRH) secondary to neovascular age-related macular degeneration (nAMD).

Setting:

Seoul National University Bundang Hospital, Seongnam, Korea.

Design:

Retrospective cohort analysis.

Methods:

A total of 30 patients diagnosed as breakthrough VH with SRH in nAMD who underwent pars plana vitrectomy were included in this study. Demographics and clinical characteristics of the subjects, visual acuities, and SRH sizes measured as disc diameters were analyzed. The correlation analysis between SRH size and absorption duration of RBC-coated IOL were performed.

Results:

Out of 30 eyes in 30 patients, RBC-coated IOLs were observed in 11 patients (37%). Appearance of RBC-coated IOLs was noted 1 month postoperatively, and the mean duration of SRH absorption was 8.6 ± 2.6 months. SRH sizes were significantly different between eyes with RBC-coated IOL and clear IOL (62.8 ± 20.7 vs 27.4 ± 14.2, P < .001). There was definite correlation between SRH size and absorption duration of RBC-coated IOL (correlation coefficient 0.899, P < .001, R
2 = 0.831). There were no statistically significant differences according to age, sex, laterality, underlying medical conditions, preoperative lens status, history of antivascular endothelial growth factor treatment, and visual acuities. The degenerated RBC on the surface of IOL was confirmed by electron and light microscopy.

Conclusions:

RBC-coated IOL could develop after vitrectomy surgery for breakthrough VH with massive SRH secondary to nAMD, and it can be confused with IOL opacification. Because it spontaneously disappears gradually, observation without IOL removal is warranted.
The Influence of Preparedness, Mutuality, and Self-efficacy on Home Care Workers' Contribution to Self-care in Heart Failure
Authors: Sterling Madeline R. , Barbaranelli Claudio , Riegel Barbara , Stawnychy Michael , Ringel Joanna Bryan , Cho Jacklyn , Vellone Ercole
Published: December 2020

Background

Home care workers (HCWs) are increasingly caring for patients with heart failure (HF). Previous studies have shown that they contribute to HF patients' care, but how their preparedness and their relationship with patients (mutuality) influence caregiving is unknown, as well as the role of HCWs' self-efficacy.

Objective

Guided by the Situation-Specific Theory of Caregiver Contribution to HF Self-Care, we investigated the influence of HCWs' preparedness and mutuality on HCWs' contribution to HF self-care and the mediating effect of HCWs' self-efficacy in the process.

Methods

We conducted a cross-sectional survey of HCWs who cared for patients with HF. The survey included the Caregiver Preparedness Scale, Mutuality Scale, Caregiver Contribution to Self-Care of HF Index, and Caregiver Self-Efficacy in Contributing to Self-Care Scale. We performed structural equation modeling and a mediation analysis.

Results

A total of 317 HCWs employed by 22 unique home care agencies across New York, NY, completed the survey. They had a median age of 50 years, 94% were women, and 44% were non-Hispanic Black. Results demonstrated that mutuality had a direct influence on HCW contribution to self-care and preparedness influenced their contribution to self-care, but only through the mediation of self-efficacy.

Conclusion

Home care workers' preparedness, mutuality, and self-efficacy have important roles in influencing their contribution to HF self-care. As a workforce increasingly involved in the care of patients with HF, knowing the mechanisms underpinning HCWs' contribution to self-care may illuminate future interventions aimed at improving their contributions and HF patient outcomes.
An Assessment of Healthcare Access and Utilization in the World Trade Center Health Program
Authors: Karasick Andrew S. , Udasin Iris G. , Gusmano Michael K. , Dasaro Christopher R. , Graber Judith M.
Published: December 2020

Objective:

Access to healthcare, a national priority, may be better understood through medical surveillance programs like the World Trade Center Health Program (WTCHP).

Methods:

Measures of healthcare access and utilization for 1159 9/11 rescue and recovery workers (“responders”) at the Rutgers Clinical Center of Excellence (CCE) were assessed using negative binomial modeling of the Benefits Eligibility Assessment Screening Tool and compared with 174 9/11 responders in the 2017 New York City Community Health Survey (NYCCHS) using z-testing.

Results:

Approximately 10.8% of Rutgers CCE respondents lacked at least one aspect of healthcare access. Problems accessing healthcare and basic needs were positively associated with CCE utilization and differed between Rutgers CCE and NYCCHS respondents.

Conclusions:

Some 9/11 responders bridge healthcare access gaps via participation in the WTCHP. Surveillance survey tools may help to identify healthcare disparities.
International service learning enhances nurse practitioner students' practice and cultural humility
Authors: Velez Roseann , Koo Laura W.
Published: December 2020

Academic and health care institutions are charged with improving quality-of-care outcomes by creating culturally educated health care professionals to practice in a global health care environment. International short-term service learning experiences provide nurse practitioner students an opportunity to meet clinical competency skills aligned with course curricula. Faculty can directly observe students' clinical practice, and students broaden diagnostic reasoning skills while earning credit for clinical hours. As project and research ideas are formulated, students develop system-level thinking to implement evidence-based practices and disseminate their knowledge and experience of caring for the underserved. Students who participate in service-learning opportunities foster their awareness of cultural humility, easing transition into practice. Some academic institutions established short-term service-learning opportunities for students, and evidence supports faculty and students' sense of well-being after participation. We describe an example of a short-term, international service-learning opportunity in Haiti where students work with an interprofessional team and experience the effect of social determinants of health on delivering quality care.
Evaluation of Recirculation During Venovenous Extracorporeal Membrane Oxygenation Using Computational Fluid Dynamics Incorporating Fluid-Structure Interaction
Authors: Conrad Steven A. , Wang Dongfang
Published: December 2020

Recirculation in venovenous extracorporeal membrane oxygenation (VV ECMO) leads to reduction in gas transfer efficiency. Studies of the factors contributing have been performed using in vivo studies and computational models. The fixed geometry of previous computational models limits the accuracy of results. We have developed a finite element computational fluid dynamics model incorporating fluid-structure interaction (FSI) that incorporates atrial deformation during atrial filling and emptying, with fluid flow solved using large eddy simulation. With this model, we have evaluated an extensive number of factors that could influence recirculation during two-site VV ECMO, and characterized their impact on recirculation, including cannula construction, insertion depth and orientation, VV ECMO configuration, circuit blood flow, and changes in volume, venous return, heart rate, and blood viscosity. Simulations revealed that extracorporeal blood flow relative to cardiac output, ratio of superior vena caval (SVC) to inferior vena caval (IVC) blood flow, position of the SVC cannula relative to the cavo-atrial junction, and orientation of the return cannula relative to the tricuspid valve had major influences (>20%) on recirculation fraction. Factors with a moderate influence on recirculation fraction (5%–20%) include heart rate, return cannula diameter, and direction of extracorporeal flow. Minimal influence on recirculation (<5%) was associated with atrial volume, position of the IVC cannula relative to the cavo-atrial junction, the number of side holes in the return cannula, and blood viscosity.
MELD Score Predicts Outcomes in Patients Undergoing Venovenous Extracorporeal Membrane Oxygenation
Authors: Watanabe Satoshi , Kurihara Chitaru , Manerikar Adwaiy , Thakkar Sanket , Saine Mark , Bharat Ankit
Published: December 2020

Venovenous extracorporeal membrane oxygenation (VV ECMO) is increasingly being used in the management of severe acute respiratory distress syndrome (ARDS). The Respiratory ECMO Survival Prediction (RESP) score is most commonly used to predict survival of patients undergoing ECMO. However, the RESP score does not incorporate renal and hepatic dysfunction which are frequently a part of the constellation of multiorgan dysfunction associated with ARDS. The Model for End-Stage Liver Disease (MELD) incorporates both liver and kidney dysfunction and is used in the risk stratification of liver transplant recipients as well as those undergoing cardiac surgery. The aim of this study was to assess the prognostic value of the MELD score in patients undergoing VV ECMO. Patients undergoing VV ECMO from 2016 to 2019 were extracted from our prospectively maintained institutional ECMO database and stratified based on MELD score. Baseline clinical, laboratory, and follow-up data, as well as post-ECMO outcomes, were compared. Of 71 patients, 50 patients (70.4%) had a MELD score <12 and 21 (29.6%) had a MELD score ≥12. The higher MELD score was associated with increased post-ECMO mortality but reduced risk of dialysis and tracheostomy. In multivariate analysis, higher MELD score (HR 1.35, 95% CI = 1.07–2.75), lower body surface area (HR 0.16, 0.04–0.65), RESP score (HR 0.75, 95% CI = 0.64–0.87), and platelet count (HR 0.99, 95% CI = 0.98–0.99), were significant predictors of postoperative mortality. We conclude that MELD score can be used complementarily to the RESP score to predict outcomes in patients with ARDS undergoing VV ECMO.
Three-dimensional Video Assistance Improves Early Results in Minimally Invasive Mitral Valve Surgery
Authors: Ram Eilon , Moshkovitz Yaron , Shinfeld Ami , Kogan Alexander , Peled Yael , Sternik Leonid , Raanani Ehud
Published: December 2020

Abstract: Compared with the mid-sternotomy approach, minimally invasive mitral valve surgery is usually associated with longer surgical times. The increasing use of new technology has facilitated this procedure and shortened its duration, which may further improve surgical results. Since 2004, 152 patients have undergone minimally invasive mitral valve repair. Video-assisted 2D technology was used for the first 112 patients, while video-assisted 3D technology was used for the remaining 40 patients. All patients were divided into three groups: group 1 – the first 50 patients (learning curve using 2D technology); group 2 – 62 patients (past the learning curve using 2D technology); and group 3 – 40 patients (3D technology). Mean patient age was 50 ± 12 years. There was no in-hospital mortality and no conversions to mid-sternotomy. Cardiopulmonary bypass and cross-clamp times were significantly shorter in group 3 compared with groups 2 and 1, respectively (108 ± 19 vs. 124 ± 22 vs. 139 ± 27, p < 0.001; and 76 ± 14 vs. 86 ± 18 vs. 97 ± 18, p < 0.001). Intraoperative echocardiography revealed higher freedom from more than mild residual mitral regurgitation after the first pump-run in group 3 compared to group 2 (97.5% vs. 90.3%, p = 0.04). Patients in the 3D group had less postoperative bleeding (p = 0.026) and a higher glomerular filtration rate before discharge (p < 0.001) compared with the 2D groups. No significant differences were observed in ventilation time (p = 0.066) and intensive care unit duration (p = 0.071). We concluded that in minimally invasive mitral valve repair, 3D video-assisted technology may provide shorter surgical times compared to 2D video-assisted technology.
Disposable Component Selection in Extracorporeal Life Support: A Cost Analysis
Authors: Stokes John W. , Gannon Whitney D. , Tipograf Yuliya , Ukita Rei , Warhoover Matthew , Rice Todd W. , Shah Ashish S. , Bacchetta Matthew
Published: December 2020

Extracorporeal life support (ECLS) is a resource-intensive technology. Disposable components are modifiable through device selection. Cost analysis tools are needed to inform cost-conscious device selection. We generated a disposable cost analysis to forecast estimated costs of device disposables that included an assumption table, net present value (NPV) analysis, and sensitivity analysis to examine device disposable costs over 5 years with different case volumes and device mixes. To demonstrate the function of the analysis, we included four device options using the following assumptions: 100 cases in year 1, 2.5% case growth rate, 10% discount rate, and $5,000 incremental cost (Device 4 only). Using estimated device costs of $3,000, $12,000, $13,000, and $20,000 and device mix percentages of 65%, 8%, 25%, and 2% for Device 1, 2, 3, and 4, respectively, the 5 year unadjusted and NPV of disposable device costs were $3,691,000 and $2,765,000, respectively. The sensitivity analysis incorporated six separate models with different device mix percentages. The highest and lowest estimated costs were found in Model F (75% Device 3 and 25% Device 4; NPV = $6,64,400) and Model B (100% Device 1; NPV = 1,246,000) respectively. Extracorporeal life support programs may apply this disposable cost analysis tool to reduce programmatic costs.
Parenteral nutrition in critical illness: total, supplemental or never?
Authors: Ridley Emma J.
Published: December 2020

Purpose of review

The current review summarizes recent evolutions in knowledge and discusses the concept of whom and when parenteral nutrition should be considered in critically ill patients as a total form of nutrition, in a supplemental form, or never.

Recent findings

Recent developments in our understanding of the application of parenteral nutrition in critical care include the phases of illness, avoidance of overfeeding and the population in whom parenteral nutrition may be appropriate for. Importantly, one of the greatest lessons of recent times may be who not to provide parenteral nutrition to; however, a blanket approach of increased risk with parenteral nutrition is too simple for the modern context.

When providing total or supplemental parenteral nutrition, avoidance of overfeeding with total calories and/or glucose alone is critical, as is consideration to the phase of illness the patient is in, the population in whom it is to be applied, premorbid nutrition status and the setting (including adequacy of line management and expertise in parenteral nutrition provision). The appropriateness of parenteral nutrition should be considered in those where death is imminent or who are well nourished, likely to commence oral and/or enteral nutrition imminently and have a short-stay in intensive care, or are in a high-risk setting.
Significantly Better Efficacy for Acute Ankle Gouty Arthritis Through Arthroscopic Debridement Compared With Simple Drug Therapy
Authors: Tang Bo , Zeng Xuezhu , Fan Cheng
Published: December 2020

Objective

The aim of this study was to compare the clinical feasibility, efficacy, and cost economics of simple drug therapy with a combination therapy of arthroscopic debridement and drug treatment of ankle acute gout arthritis.

Methods

Patients with acute ankle gout arthritis hospitalized in our department from January 2017 to August 2019 were included. Among them, 32 patients who received arthroscopic debridement in a special floating position and drug therapy were included into the observation group, and 24 patients who received drug treatment alone were included into the control group. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, the effective rate, the recurrent rate, stay of hospital, complications, and cost economics were compared between these 2 groups at postoperative 48 hours, discharge time, and 1 year.

Results

The basic data and AOFAS ankle-hindfoot score before treatment showed no significant difference (p > 0.05) between these 2 groups. Compared with the control group, the observation group showed significantly higher AOFAS score at postoperative 48 hours (80.73 ± 9.15 vs 71.09 ± 8.54, p = 0.000), discharge time (87.73 ± 9.92 vs 77.71 ± 10.26, p = 0.000), and postoperative 1 year (85.92 ± 10.39 vs 76.36 ± 8.72, p = 0.000); lower recurrence rate (15.63% vs 25%, p = 0.382); significantly shorter length of hospitalization (4.92 ± 0.88 days vs 8.90 ± 0.73 days, p = 0.000); and significantly higher cost (¥8981.2 ± ¥740.2 vs ¥3558.3 ± ¥270.1, p = 0.000) during the discharge time.

Conclusions

Ankle gout arthritis could be systematically and safely managed with ankle arthroscopic technique in special floating position. In addition, compared with conservative drug therapy alone, ankle arthroscopic debridement combined with conservative drug therapy improved clinical efficacy, lowered recurrence rate, and shortened length of hospitalization.
Hemophagocytic Lymphohistiocytosis Hospitalizations in Adults and Its Association With Rheumatologic Diseases
Authors: Patel Axi R. , Desai Parth V. , Banskota Shristi Upadhyay , Edigin Ehizogie , Manadan Augustine M.
Published: December 2020

Objective

Hemophagocytic lymphohistiocytosis (HLH) is a rare potentially fatal multisystem inflammatory condition that is often triggered by an underlying medical condition. Epidemiologic data of HLH in adults with rheumatologic diseases are limited. The aim of our study was to characterize HLH hospitalizations in the US adult population with a special focus on patients with concomitant rheumatologic diseases.

Methods

We conducted a medical records review of hospitalizations in the United States during 2016 and 2017 with a diagnosis of HLH. Hospitalizations were selected from the National Inpatient Sample. International Classification of Diseases, Tenth Revision codes were used to identify rheumatologic diseases. A multivariate logistic regression analysis was used to calculate adjusted odds ratios (ORadj) for the association of HLH and rheumatologic diseases.

Results

Seven hundred fifty hospitalizations had a principal billing diagnosis of HLH. The median age of our study population was 47.5 years, and males made up 55% of the population. Overall mortality was 17%, and the median length of stay was 12 days. Twenty-five percent of the HLH cases had a concomitant rheumatologic diagnosis. Multivariate logistic regression analysis showed systemic lupus erythematosus (SLE) with nephritis (ORadj, 5.7), SLE without nephritis (ORadj, 9.2), adult-onset Still disease (ORadj, 338.9), and ankylosing spondylitis (ORadj, 10.7) were significantly associated with HLH.

Conclusions

This analysis represents the largest sample to date to assess HLH hospitalizations. Our study showed that SLE, adult-onset Still disease, and ankylosing spondylitis were strongly associated with HLH.
Abnormal FDG Biodistribution in a Patient With Gitelman Syndrome
Authors: Yamamoto Yuka , Mitamura Katsuya , Norikane Takashi , Fujimoto Kengo , Takami Yasukage , Nishiyama Yoshihiro
Published: December 2020

Gitelman syndrome is an autosomal recessive renal tubulopathy. A 38-year-old woman was diagnosed with Gitelman syndrome. Eight years later, 18F-FDG PET/CT was performed to evaluate recurrence of endometrial cancer. FDG PET images showed an extremely abnormal FDG biodistribution. They showed decreased brain uptake, increased cardiac muscle uptake, and diffuse increased muscle and adipose tissue uptake. This pattern is similar to high insulin state; however, her glucose level was normal, and insulin level was very low.
Developing an Advanced Alternative Payment Model for Stress Urinary Incontinence
Authors: Lowder Jerry L. , Barker Matthew A. , Ferzandi Tanaz , Gardiner Haley , Hall Evelyn F. , Nihira Mikio , Holzberg Adam , Hurtado Eric , Patton Simon , Rathbun Jill , Shepherd Jonathan P. , Biller Daniel
Published: December 2020

Historically, our health care system has been based on a fee-for-service model, which has resulted in high-cost and fragmented care. The Center for Medicare & Medicaid Services is moving toward a paradigm in which health care providers are incentivized to provide cost-effective, coordinated, value-based care in an effort to control costs and ensure high-quality care for all patients. In 2015, the Medicare Access and Children’s Health Insurance Program Reauthorization Act repealed the Sustainable Growth Rate and the fee-for-service model, replacing them with a 2-track system: Merit-based Incentive Payment System and the advanced Alternative Payment Model (aAPM) system. In 2016, the American Urogynecologic Society Payment Reform Committee was created and tasked with developing aAPMs for pelvic floor disorders. The purpose of this article is to describe the stress urinary incontinence aAPM framework, the data selected and associated data plan, and some of the challenges considered and encountered during the aAPM development.
Uterine Transplantation: Review of Livebirths and Reproductive Implications
Authors: Jones Benjamin P. , Kasaven Lorraine , Vali Saaliha , Saso Srdjan , Jalmbrant Maria , Bracewell-Milnes Timothy , Thum Meen-Yau , Quiroga Isabel , Friend Peter , Diaz-Garcia Cesar , Ghaem-Maghami Sadaf , Yazbek Joseph , Lees Christoph , Testa Giuliano , Johannesson Liza , Jones Bryony , Smith J. Richard
Published: December 2020

Uterine transplantation (UTx) is a fertility restoring treatment for women with absolute uterine factor infertility. At a time when there is no question of the procedure’s feasibility, and as the number of livebirths begins to increase exponentially, various important reproductive, fetal, and maternal medicine implications have emerged. Detailed outcomes from 17 livebirths following UTx are now available, which are reviewed herein, along with contextualized extrapolation from pregnancy outcomes in other solid organ transplants. Differences in recipient demographics and reproductive aspirations between UTx and other transplant recipients make extrapolating management strategies and outcomes in other solid organ transplants inappropriate. Whereas preterm delivery remains prominent, small for gestational age or hypertensive disorders do not appear to be as prevalent following UTx when compared to other solid organ transplants. Given the primary objective of undertaking UTx is to achieve a livebirth, publication of reproductive outcomes is essential at this early stage, to reflect on and optimize the management of future cases.
The value of MALDI-TOF failure to provide an identification of Staphylococcal species direct from blood cultures and rule out Staphylococcus aureus bacteraemia: a post-hoc analysis of the RAPIDO trial
Authors: Hamilton Fergus , Evans Rebecca , MacGowan Alasdair
Published: December 2020

Introduction. Rapid differentiation between

Staphylococcus aureus

(SA) and coagulase-negative staphylococci (CoNS) is critical in clinical infection. Direct matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) identification from blood culture is highly accurate, but is associated with a significant failure rate, delaying identification. However, MALDI-TOF failure may itself be indicative of CoNS infection.

Aim. We sought to examine whether failure of MALDI-TOF direct ID was indicative of CoNS infection and could be used as a diagnostic tool to promote antimicrobial stewardship.

Methodology. Results of Gram stains, MALDI-TOF identification and formal identification were extracted from the large, multi-centre RAPIDO trial. All blood cultures with presumed staphylococci were included. MALDI-TOF performance (correct identification, incorrect identification, failed identification) was calculated for each sample and across sites. Risk of SA disease was calculated for each group (correct, incorrect, failed) and across sites. Logistic regression was used to identify if clinical features are associated with MALDI-TOF performance.

Results. In the RAPIDO trial, 4312 patients were allocated to the MALDI-TOF arm. After exclusions, 880 patients were eligible and had a blood culture with a Gram stain consistent with presumed staphylococci. In total, 204 of these (23.2 %) were ultimately identified as SA. MALDI-ID was successful 83.9 % of the time, and was 100 % accurate when successful. Failure was more common in CoNS isolates (124/641, 19.3 %) than in SA (13/191, 6.4 %). When MALDI-TOF failed, the risk of SA disease was 9.2 % across the whole cohort, although failure rates and risk of SA disease varied significantly between centres. MALDI-TOF failure was independent of clinical characteristics.

Conclusion. Presumed staphylococci that fail direct MALDI-TOF identification from blood culture are significantly more likely to be CoNS isolates than SA. In low-risk or low-prevalence settings, SA therapy can be withheld if MALDI-TOF is unsuccessful.
Empirically examining the impact of corporate social responsibility on financial performance: evidence from Indian steel industry
Authors: Kaur Nripinder , Singh Vikramjit
Published: December 2020

Purpose

This paper aims to examine the impact of corporate social responsibility (CSR) on financial performance (FP) of Indian steel industry in terms of value-added (VAM), profitability (PM), market (MM) and growth measures (GM).

Design/methodology/approach

It is an empirical study using secondary data of 40 companies for 14 years collected from CSR/annual reports/official websites of the companies and Prowess database. The panel regression analysis, MANOVA and univariate ANOVA have been conducted to examine the impact of CSR on FP.

Findings

The result indicates a positive impact of CSR on FP in terms of VAM, PM and GM, thereby indicating that more investments in CSR will generate wealth for shareholders, enhance profitability and sales. Moreover, this study shows no noticeable relationship between CSR and MM.

Social implications

This study contributes to the literature on the CSR–FP relationship and also has implications for managers, investors and other stakeholders. Companies with higher CSR rating create a brand image, attract proficient employees, get greater profit, loyal customers and have less possibility of bribery and corruption. This study may result in being influential to companies confined not only to this sector but also reaching to the others, thus inspiring them to contribute their share of profit for the welfare of society.

Originality/value

To the best of the authors' knowledge, it is the first comprehensive study to examine the impact of CSR on FP of Indian steel industry by considering four dimensions for measuring FP. It provides evidence about the relationship between CSR and FP.
The (Ir)resistible Job Offer
Authors: Kulkarni Vaibhavi
Published: December 2020

The case revolves around a job offer received by Vinita Upadhyay, a journalist working with a regional daily. Taking up the offer would mean a shift from journalism and require her to join the public relations industry. The case provides three different perspectives regarding this offer. It begins with Upadhyay's perspective, followed by the views of Geet Sethi, who has offered her the job, and finally, that of Minesh Modi, who is her maternal uncle. The case is indicative of the challenges involved in persuading someone who is not open to arguments because of normative beliefs and internal biases.
Simhadri Super Thermal Power Project (A)
Authors: Pandey Ajay , Morris Sebastian
Published: December 2020

The Indian electricity sector was opened to the private sector under the IPP policy. The NTPC, India's largest and perhaps most efficient generator had to respond to the changing scenario. It set out to set up the Simhadri project in Andhra Pradesh, going beyond to original mandate. The IPP policy, its perversities, the background of the power sector, the problems there in and the response of NTPC are discussed. Case (B) discusses the issues related to Project Planning and Implementation.
Stock prices' long memory in China and the United States
Authors: Tan Zhengxun , Fu Yao , Cheng Hong , Liu Juan
Published: December 2020

Purpose

This study aims to examine the long memory as well as the effect of structural breaks in the US and the Chinese stock markets. More importantly, it further explores possible causes of the differences in long memory between these two stock markets.

Design/methodology/approach

The authors employ various methods to estimate the memory parameters, including the modified R/S, averaged periodogram, Lagrange multiplier, local Whittle and exact local Whittle estimations.

Findings

China's two stock markets exhibit long memory, whereas the two US markets do not. Furthermore, long memory is robust in Chinese markets even when we test break-adjusted data. The Chinese stock market does not meet the efficient market hypothesis (EMHs), including the efficiency of information disclosure, regulations and supervision, investors' behavior, and trading mechanisms. Therefore, its stock prices' sluggish response to information leads to momentum effects and long memory.

Originality/value

The authors elaborately illustrate how long memory develops by analyzing not only stock market indices but also typical individual stocks in both the emerging China and the developed US, which diversifies the EMH with wider international stylized facts and findings when compared with previous literature. A couple of tests conducted to analyze structural break effects and spurious long memory demonstrate the reliability of the results. The authors’ findings have significant implications for investors and policymakers worldwide.
Online review analytics for hotel quality at macro and micro levels
Authors: Hsiao Yu-Hsiang , Hsiao Yu-Ting
Published: December 2020

Purpose

This study was to develop a methodology of online review analytics for hotel quality management at macro and micro levels. The macro level was for understanding the service properties critical to quality and future development. The micro level was for personalized quality diagnosis for individual hotels.

Design/methodology/approach

Textual reviews of superior hotels were studied using latent semantic analysis and Kano model to understand what service properties customers concern and expect. Taguchi's quality engineering was applied to establish a quality reference base using superior hotels for evaluating other hotels in the same semantic space. A decision tree algorithm was then used to identify the properties critical to quality discrimination, and the decision rules were used to diagnose individual hotels.

Findings

The service properties concerned by customers for superior hotels were identified. The market positioning and value of each property to customers were clarified. For individual hotels, the deficiencies of service properties were diagnosed. With reference to market positioning, deficient properties of priority in improvement and the strategies for enhancing competitiveness were suggested.

Originality/value

The proposed methodology demonstrated the potential value that review analysis can achieve a new and deeper understanding of customer voices and transform it into more specific business operation requirements. The research and application gap that most previous studies only stayed at the macro-level analytics was filled. Moreover, this study effectively applied the diagnostic techniques derived from quality engineering to online review analytics.
Rendering the hidden visible: subjected to “work on the self” in a local labour market measure
Authors: Sunnerfjell Jon
Published: December 2020

Purpose

The purpose of this article is to complement the literature understanding present labour market measures as infused by a so-called neoliberal rationality, fostering self-managerial selves by means of self-inspection. It does so by providing a much-needed illustration of how such “work on the self” is achieved in practice.

Design/methodology/approach

The analysis draws on ethnographic fieldwork tracing the “active society” at the local level, depicting practices aimed at activating welfare clients in a local labour market measure organised in a rural Swedish municipality. Here, the author was offered to undergo a method aimed at enhancing participants' employability. As a result, data consists of ethnographic as well as auto-ethnographic accounts from this experience.

Findings

This analysis shows how destabilisation of subjectivity was central to the remoulding of individuals into employable and self-reliant selves. Moreover, by dispersing responsibility to the individual, it is shown how the organisation was able to refrain from accountability, hence reducing the levels of uncertainty and ambiguity that is part and parcel of people-processing welfare organisations.

Practical implications

The article concludes with the warning that, in the wake of “local worlds of activation”, municipalities may sometimes draw on questionable assumptions of the human mind and behaviour, as well as the vulnerability of individuals' self-understanding, as a way of managing the “active society” at the local level.

Originality/value

The literature on activation lacks ethnographic accounts depicting concrete practices of turning the socially excluded into active and employable selves. Here, this article offers an illustrating example of such practices in action.