bluuebunny/crossref_metadata_2025 huggingface dataset:
Demonstration of TNSA proton radiography on the National Ignition Facility Advanced Radiographic Capability (NIF-ARC) laser
Authors: Simpson R A , Mariscal D A , Kim J , Scott G G , Williams G J , Grace E , McGuffey C , Wilks S , Kemp A , Lemos N , Djordjevic B Z , Folsom E , Kalantar D , Zacharias R , Pollock B , Moody J , Beg F , Morace A , Iwata N , Sentoku Y , Manuel M J-E , Mauldin M , Quinn M , Youngblood K , Gatu-Johnson M , Lahmann B , Haefner C , Neely D , Ma T
Published: November 2021

Proton radiography using short-pulse laser drivers is an important tool in high-energy density (HED) science for dynamically diagnosing key characteristics in plasma interactions. Here we detail the first demonstration of target-normal sheath acceleration (TNSA)-based proton radiography the NIF-ARC laser system aided by the use of compound parabolic concentrators (CPCs). The multi-kJ energies available at the NIF-ARC laser allows for a high-brightness proton source for radiography and thus enabling a wide range of applications in HED science. In this demonstration, proton radiography of a physics package was performed and this work details the spectral properties of the TNSA proton probe as well as description of the resulting radiography quality.
Sheath collapse at critical shallow angle due to kinetic effects
Authors: Ewart Robert J , I Parra Felix , Geraldini Alessandro
Published: November 2021

The Debye sheath is known to vanish completely in magnetised plasmas for a sufficiently small electron gyroradius and small angle between the magnetic field and the wall. This angle depends on the current onto the wall. When the Debye sheath vanishes, there is still a potential drop between the wall and the plasma across the magnetic presheath. The magnetic field angle corresponding to the predicted sheath collapse is shown to be much smaller than previous estimates, scaling with the electron-ion mass ratio and not with the square root of the mass ratio. This is shown to be a consequence of the kinetic electron and finite ion orbit width effects, which are not captured by fluid models. The wall potential with respect to the bulk plasma at which the Debye sheath vanishes is calculated. Above this wall potential, it is possible that the Debye sheath will invert.
A fast convergence fourth-order Vlasov model for Hall thruster ionization oscillation analyses
Authors: WANG Zhexu , KAWASHIMA Rei , KOMURASAKI Kimiya
Published: November 2021

A 1D1V hybrid Vlasov-fluid model was developed for this study to elucidate discharge current oscillations of Hall thrusters (HTs). The Vlasov equation for ions velocity distribution function with ionization source term is solved using a constrained interpolation profile conservative semi-Lagrangian method. The fourth-order weighted essentially non-oscillatory (4th WENO) limiter is applied to the first derivative value to minimize numerical oscillation in the discharge oscillation analyses. The fourth-order accuracy is verified through a 1D scalar test case. Nonoscillatory and high-resolution features of the Vlasov model are confirmed by simulating the test cases of the Vlasov–Poisson system and by comparing the results with a particle-in-cell (PIC) method. A 1D1V HT simulation is performed through the hybrid Vlasov model. The ionization oscillation is analyzed. The oscillation amplitude and plasma density are compared with those obtained from a hybrid PIC method. The comparison indicates that the hybrid Vlasov-fluid model yields noiseless results and that the steady-state waveform is calculable in a short time period.
Spatiotemporal control of femtosecond laser filament-triggered discharge and its application in diagnosing gas flow fields
Authors: ZHU Zhifeng , LI Bo , GAO Qiang , ZHU Jiajian , LI Zhongshan
Published: November 2021

Precise control of the discharge in space and time is of great significance for better applications of discharge plasma. Here, we used a femtosecond laser filament to trigger and guide a high-voltage DC pulse discharge to achieve spatiotemporal control of the discharge plasma. In space, the discharge plasma is distributed strictly along the channel generated by the femtosecond laser filament. The breakdown voltage threshold is reduced, and the discharge length is extended. In time, the electrical parameters such as the electrode voltage and the electrode gap affect discharge delay time and jitter. By optimizing the parameters, we can achieve sub-nanosecond jitter of the discharge. Based on the spatiotemporal control of the discharge, we applied filament-triggered discharge for one-dimensional composition measurements of the gas flow field. Besides, the technique shows great potential in studying the spatiotemporal evolution of discharge plasma.
Discharge and post-explosion behaviors of electrical explosion of conductors from a single wire to planar wire array
Authors: LI Chen , HAN Ruoyu , LIU Yi , ZHAO Jinlin , WANG Yanan , HE Feng , OUYANG Jiting
Published: November 2021

This work deals with an experimental study of a Cu planar wire array (PWA) in air and water under the stored energy 300–1200 J. A single Cu wire is adopted as a controlled trial. Four configurations of PWA and a wire with the same mass (cross-section area) but the different specific surface areas (15–223 cm2 g−1) are exploded. The transient process is analyzed using high-speed photography in combination with the results of optical emission and discharge. Discharge characteristics revealed that PWA always has a higher electric power peak, early but higher voltage peak, as well as faster vaporization and ionization process than the single-wire case. Two to three times stronger optical emission could be obtained when replacing the single-wire with PWA, indicating a higher energy-density state is reached. Phenomenologically, in both air and water, single-wire load tends to develop a transverse stratified structure, while PWA is dominated by the uneven energy deposition among wires. Finally, the synchronism and uniformity of the PWA explosion are discussed.
Pulsed high-current discharge in water: adiabatic model of expanding plasma channel and acoustic wave
Authors: KOZYREV A , ZHERLITSYN A , SEMENIUK N
Published: November 2021

This paper presents the results of a theoretical and experimental study of the use of a pulsed discharge in water to obtain a strong acoustic wave in a liquid medium. A discharge with a current amplitude of 10 kA, a duration of 400 ns, and an amplitude pulsed power of 280 MW in water at atmospheric pressure created an expanding acoustic wave with an amplitude of more than 100 MPa. To describe the formation of the discharge channel, an isothermal plasma model has been developed, which made it possible to calculate both the expansion dynamics of a high-current channel and the strong acoustic wave generated by it. Our calculations show that the number density of plasma in the channel reaches 1020 cm–3, while the degree of water vapor ionization is about 10%, and the channel wall extends with a velocity of 500 m s−1. The calculations for the acoustic wave are in good agreement with measurements.
Implementation and Evaluation of Virtual Laboratory Tours for Laboratory Diagnosis of Hematologic Disease
Authors: Scordino Teresa A , Darden Alix G
Published: November 2021

Objectives

There is often limited time allocated to teaching laboratory medicine to medical students. Without adequate time and context, it can be difficult for students to learn appropriate uses and limitations of laboratory tests. Introducing students to the laboratories and test methods may help them learn these concepts, but physical laboratory tours are difficult to organize for large groups, especially during the coronavirus disease 2019 pandemic.

Methods

We created virtual laboratory tours consisting of short video clips and voiceover PowerPoint slides to teach students about the laboratory tests used to diagnose hematologic malignancies. We assessed the impact on student performance on laboratory medicine–themed quiz questions and surveyed the students to determine their attitudes about the activity.

Results

In total, 129 first-year medical students participated in the study. The average score on the preactivity quiz was 59.8%, and the average score on the postactivity quiz was 92.2%. Students were more confident in their ability to answer quiz questions after completing the activity. Postactivity survey data indicated that the students enjoyed the activity and felt it was an effective way to learn the material.

Conclusions

Virtual laboratory tours show promise as a method of incorporating more laboratory medicine content into medical school curricula.
The Signaling Role of Charitable Contributions by Businesses: A Tax Policy Perspective
Authors: Blumkin Tomer , Margalioth Yoram , Sadka Efraim , Sharoni Adi
Published: November 2021

Empirical evidence suggests that charitable contributions to public goods by businesses may be driven not only by the familiar warm glow of giving motive but also as a means for businesses to signal high product quality. Building on this finding, we present an analytical framework that demonstrates that the optimal degree of subsidization should decrease with the extent to which the signal is informative and may even turn into a tax when the signal is sufficiently strong.
“The Critic’s Duty Is to Refuse”
Authors: Arac Jonathan
Published: November 2021

In Matthew Arnold’s “The Function of Criticism at the Present Time” (1864), the duty to refuse warrants the critic’s independence. Rather than a timid inertia, refusal, resistance, make the critic’s rejection of partisanship a sharply styled decision. In defining the new social role of the critic, Arnold sets loose that disquieting figure, the independent leftist, who stands apart from those you’d think of as being on the same side. In the history of criticism in the US, this role for the critic provided important opportunities for otherwise marginalized or minoritized figures such as Lionel Trilling, James Baldwin, Susan Sontag, and Edward Said. It still has a future, if we dare.

In defining the new social role of the critic, Arnold sets loose that . . . disquieting figure, the independent leftist, who stands apart from those you’d think of as being on the same side.
Cerebellar signals drive motor adjustments and visual perceptual changes during forward and backward adaptation of reactive saccades
Authors: Cheviet Alexis , Masselink Jana , Koun Eric , Salemme Roméo , Lappe Markus , Froment-Tilikete Caroline , Pélisson Denis
Published: November 2021

Saccadic adaptation ($SA$) is a cerebellar-dependent learning of motor commands ($MC$), which aims at preserving saccade accuracy. Since $SA$ alters visual localization during fixation and even more so across saccades, it could also involve changes of target and/or saccade visuospatial representations, the latter ($CDv$) resulting from a motor-to-visual transformation (forward dynamics model) of the corollary discharge of the $MC$. In the present study, we investigated if, in addition to its established role in adaptive adjustment of $MC$, the cerebellum could contribute to the adaptation-associated perceptual changes. Transfer of backward and forward adaptation to spatial perceptual performance (during ocular fixation and trans-saccadically) was assessed in eight cerebellar patients and eight healthy volunteers. In healthy participants, both types of $SA$ altered $MC$ as well as internal representations of the saccade target and of the saccadic eye displacement. In patients, adaptation-related adjustments of $MC$ and adaptation transfer to localization were strongly reduced relative to healthy participants, unraveling abnormal adaptation-related changes of target and $CDv$. Importantly, the estimated changes of $CDv$ were totally abolished following forward session but mainly preserved in backward session, suggesting that an internal model ensuring trans-saccadic localization could be located in the adaptation-related cerebellar networks or in downstream networks, respectively.
Segregating Complete Tf2 Elements Are Largely Neutral in Fission Yeast
Authors: Wang Yan , Wang Qin , Wu Zhiwei , Han Guan-Zhu
Published: November 2021

Transposable elements (TEs) comprise a large proportion of the eukaryote genomes. Yet it remains poorly understood how TEs influence the fitness of the hosts carrying them. Here, we empirically test the impact of TEs on the host fitness in the fission yeast Schizosaccharomyces pombe. We find that two families of TEs (Tf1 and Tf2 elements), both of which belong to long terminal repeat retrotransposons, are highly polymorphic among individual S. pombe strains. Only 13 complete Tf2 elements are identified in S. pombe laboratory strain 972. These 13 Tf2 elements integrated into host genomes in very recent time and are segregating within the S. pombe population. Through knocking out each of the 13 Tf2 elements in S. pombe strain 972, we find Tf2 knockout does not affect the host fitness, and Tf2 elements do not alter the expression of nearby genes. Challenged by diverse forms of stress, the Tf2 knockout strains do not exhibit different growth rates from wild-type strain. Together, we conclude that segregating complete Tf2 elements insertions are largely neutral to host fitness in the fission yeast. Our study provides genome-wide empirical support for the selfish nature of TEs in fission yeast.
Conceal, Enhance, Expose, Perfect: A Mid-Century Mormon Swimsuit Designer’s Feminine Bodily Discipline
Authors: Feller Gavin
Published: November 2021

This article analyzes feminine bodily discipline through the intersection of fashion and faith in mid-century America. Through an analysis of the life and career of Rose Marie Reid—a world-renowned swimsuit designer—this article complicates the cultural history of bodily discipline by recovering the nuances of Reid’s roles as the head of a global swimsuit business and a conservative Mormon mother. I argue that Reid’s major intervention was an insistence that a desirable female subjectivity requires discipline, diligence, and material assistance—an articulation of Reid’s deep-seated beliefs about the eternal significance of gender, the body, and marriage. Reid’s swimwear suggests that what is exposed must first be enhanced while the mechanisms of enhancement remain concealed. Taking traditional Mormon views on gender to a conservative extreme, Reid’s regime of feminine bodily discipline ultimately aimed to perfect a woman’s body in order to attract a husband to which she could eternally submit.
Comparison of different biomass methodologies to adjust sales data on veterinary antimicrobials in the USA
Authors: Bulut Ece , Ivanek Renata
Published: November 2021

Objectives

The United States (US) FDA, European Surveillance of Veterinary Antimicrobial Consumption (ESVAC), Public Health Agency of Canada (PHAC) and World Organisation for Animal Health (OIE) established methodologies that characterize antimicrobial sales for use in food animals by adjusting the sales by animal biomass. Our aim was to review and compare these methodologies on US-specific data.

Methods

Annual antimicrobial sales for cattle, swine, chickens and turkeys in the USA between 2016 and 2018 were adjusted by the FDA, ESVAC, PHAC and OIE methodologies. To better understand the advantages and disadvantages of the four methodologies, their biomass denominators were compared regarding the level of detail accounted for in the estimated US livestock biomass, their ability to observe temporal trends in animal biomass within a country and practicality in biomass estimation for comparing antimicrobial sales across countries.

Results

The four methodologies resulted in substantially different estimates of biomass-adjusted antimicrobial sales for use in US food animals. The 2018 estimates were the highest with the ESVAC methodology (314.7 mg of active antimicrobial ingredient/kg of animal biomass), followed by PHAC (191.5 mg/kg), FDA (127.6 mg/kg) and OIE (111.5 mg/kg). The animal weight parameters used in each methodology had the most impact on the biomass-adjusted sales estimates.

Conclusions

In regard to the estimation of the animal biomass, no methodology was found to be perfect; however, the FDA methodology had the best resolution in characterizing the US livestock biomass while the OIE methodology was best for biomass estimation for global monitoring of antimicrobial sales for use in food animals.
The iTHRIV Commons: a cross-institution information and health research data sharing architecture and web application
Authors: Loomba Johanna Jean , Wasson Glenn S , Chamakuri Ravi Kiran Reddy , Dash Pabitra Kumar , Patterson Stephen G , Potter Mary M A , Krisch Jason Edward , Tenzer Martha M , Johnston Karen C , Brown Don E
Published: November 2021

Objective

The integrated Translational Health Research Institute of Virginia (iTHRIV) aims to develop an information architecture to support data workflows throughout the research lifecycle for cross-state teams of translational researchers.

Materials and Methods

The iTHRIV Commons is a cross-state harmonized infrastructure supporting resource discovery, targeted consultations, and research data workflows. As the front end to the iTHRIV Commons, the iTHRIV Research Concierge Portal supports federated login, personalized views, and secure interactions with objects in the ITHRIV Commons federation. The canonical use-case for the iTHRIV Commons involves an authenticated user connected to their respective high-security institutional network, accessing the iTHRIV Research Concierge Portal web application on their browser, and interfacing with multi-component iTHRIV Commons Landing Services installed behind the firewall at each participating institution.

Results

The iTHRIV Commons provides a technical framework, including both hardware and software resources located in the cloud and across partner institutions, that establishes standard representation of research objects, and applies local data governance rules to enable access to resources from a variety of stakeholders, both contributing and consuming.

Discussion

The launch of the Commons API service at partner sites and the addition of a public view of nonrestricted objects will remove barriers to data access for cross-state research teams while supporting compliance and the secure use of data.

Conclusions

The secure architecture, distributed APIs, and harmonized metadata of the iTHRIV Commons provide a methodology for compliant information and data sharing that can advance research productivity at Hub sites across the CTSA network.
Drugstore Beetle Damage Pattern of Glue Paste-Lined Oil Paintings
Authors: Lee Wen-Yuan , Liu Kai-Yuan , Wu Wan-Yu , Tsai Cheng-Lung , Wu Wei-An , Li Hou-Feng
Published: November 2021

A glue paste lining is a traditional conservation treatment used to reinforce the aged canvas of oil paintings. Several insect infestation cases concerning glue paste-lined oil paintings have been reported around the world, particularly in European countries. In 2008, Chimei Museum, a private museum located in Tainan, Taiwan, was affected by a severe beetle infestation of oil paintings. To confirm the infesting insects and to quantify the damage pattern for further development of control and monitoring methods, three severely damaged paintings were examined along with the restoration procedure. A total of four insect species were collected. The drugstore beetle, Stegobium paniceum (L.) (Coleopter: Ptinidae), was the primary pest found in all three paintings investigated and was identified based on morphological and genetic data. Thrips and booklice were considered secondary pests, and a Pteromalid wasp was speculated to have a parasitic relationship with the drugstore beetle. Drugstore beetle larvae mainly bored into the glue paste layer and original canvas and required only 5.94 ± 1.38 mm3 of feed to grow from egg to pupa. Their bores were not evenly distributed, and most of them were found in the shaded area covered by the stretcher and outer frame. The body length of drugstore beetles varied, ranging from 1.67 to 2.75 mm, which may explain the various sizes of exit holes on gummed tape surrounding the frame. Detailed and quantified information on drugstore beetle’s pattern of damage provided in this study will be beneficial for further developing conservation practices and inspection methods.
Criminalization, Securitization and other Forms of Illegalizing Indigenous Contestations in Chile: Responses from Constitutional Law and Inter-American Jurisprudence on Mapuche People’s Rights
Authors: Eichler Jessika , Barnier-Khawam Pablo
Published: November 2021

This article critically examines the contemporary ‘securitization paradigm’ adopted throughout the Chilean jurisdiction. Emphasis is placed on its explicit misuse and its arbitrary effects on the Mapuche people in light of Chile’s anti-terrorism legislation. The law thereby assumes a twofold function. ‘Judicialization strategies’ are employed by different organs of the State, resulting in the criminalization and ultimately the silencing of indigenous protest and forms of representation in the public space. These potentially transform relations between the State and its subjects, demanding a repositioning of indigenous agendas and representation under the constitutional umbrella. Conversely, judicialization also assumes a mediating role through the virtuous effects of international law and Inter-American human rights jurisprudence. The newly commencing constitutional era may further spur such developments, potentially exerting essential decolonizing effects on State institutions and society at large.
Use of a Fluorophore to Tag Arthropods for Mark-Release-Recapture Type Research
Authors: Hagler James R , Hull Allya M , Casey Miles T , Machtley Scott A
Published: November 2021

We examined the feasibility of externally marking insects with the liquid fluorescent forensic theft deterrent, SmartWater (SmartWater CSI, LLC.). We sprayed captive Lygus hesperus (Knight) (Hemiptera: Miridae), Bemisia tabaci (Gennadius) (Hemiptera: Aleyrodidae), and Hippodamia convergens Guérin-Méneville (Coleoptera: Coccinellidae) with SmartWater fluorophore, and then qualitatively examined them for fluorescence by visual inspection under ultraviolet (UV) light and quantitatively measured them with a multiwavelength microplate fluorometer. The results indicate that this product has enormous potential as a taggant for L. hesperus and B. tabaci. However, the marking efficiency for H. convergens was only adequate. The advantages and limitations of using SmartWater as a biological marker for arthropod mark-release-recapture research are discussed.
Bed site selection by female North American black bears (Ursus americanus)
Authors: Mansfield Susan A , Rogers Lynn L , Robison Sean , Powell Roger A
Published: November 2021

Sleep is important for memory consolidation and maintaining metabolic homeostasis, but sleep can expose animals to inclement weather and predators. Consequently, selection of sleeping sites is important. We tested three sets of hypotheses related to selection of bed sites by female American black bears (Ursus americanus) at two study sites. During 2009–2013, we outfitted 14 female black bears west of Ely, Minnesota, with Global Positioning System collars that reported bear locations every 10 min. We visited 101 bed sites, each identified from clusters of estimated locations where a bear was on site for ≥4 h on two or more occasions, and recorded bed characteristics, forest composition, canopy closure, and ground cover. We matched each bed site with a control site where we collected the same data. During 1987–1991, we outfitted three female black bears south of Ely with very high-frequency transmitter collars and walked with the bears to collect detailed behavioral data. We used the written data records to identify 62 bed sites where bears slept ≥2 h and where bed characteristics were documented. We matched each bed site with a control site approximately 6 h different when the bear was active. Of the bed sites, 132 were used during night and 31 during day. The two study areas differed in the amount of lowland habitats. At both sites, female bears chose bed sites disproportionately in lowland sites with high canopy cover and next to a tree, especially a white pine. Female bears with cubs selected upland bed sites more often than did females without cubs and also more often selected sites adjacent to a tree with coarse bark, which cubs could climb easily. Distances to roads and houses did not affect selection of bed sites by females either with or without cubs.
Mesenteric desmoid tumor after robot-assisted laparoscopic cystectomy with bladder replacement: a case report
Authors: Fukuhara Sotaro , Yoshimitsu Masanori , Yano Takuya , Chogahara Ichiya , Yamasaki Rie , Ebara Shin , Okajima Masazumi
Published: November 2021

Desmoid tumors are a very rare disease associated with familial adenomatous polyposis, surgical trauma and hormonal factors. Surgical trauma is a critical trigger for sporadic desmoid tumors. Tumor development has been reported, and laparoscopic surgery has become more widely performed than the conventional open surgery. However, a few cases of desmoid tumors have developed after robot-assisted surgery. When desmoid tumors develop after cancer surgery, they are often difficult to distinguish from cancer recurrence. This differentiation is important for patients with bladder cancer because it helps determine the treatment plan. However, very few cases of mesenteric desmoid tumors after cystectomy for bladder cancer have been reported. Herein, we present a case of desmoid tumor that developed following robot-assisted laparoscopic cystectomy for bladder cancer. The tumor was resected via minilaparotomy with laparoscopic assistance for diagnostic treatment.
Quality of Care Indicators for Hospital Physical Therapy Units: A Systematic Review
Authors: Angel-Garcia Daniel , Martinez-Nicolas Ismael , Salmeri Bianca , Monot Alizée
Published: November 2021

Objective

The purpose of this review was to identify quality indicators described in the literature that may be used as quality measures in hospital physical therapy units.

Methods

The following sources were searched for quality indicators or articles: Web of Science, MEDLINE, IBECS, Latin American and Caribbean Health Sciences Literature, Cumulative Index of Nursing and Allied Health, Academic Search Complete, SportDiscus, SciELO, PsychINFO, Consejo Superior de Investigaciones Cientificas, and Scopus databases; the Agency for Healthcare Research and Quality, National Health System Indicator Portal, Joint Commission on Accreditation of Healthcare Organizations, and Organisation for Economic Co-operation and Development websites; and the National Quality Forum’s measures inventory tool. Search terms included “quality indicator,” “quality measure,” “physiotherapy,” and “physical therapy.” Inclusion criteria were articles written in English, Spanish, French, or Portuguese aimed at measuring the quality of care in hospital physical therapy units. Evidence-based indicators with an explicit formula were extracted by 2 independent reviewers and then classified using the structure-process-outcome model, quality domain, and categories defined by a consensus method.

Results

Of the 176 articles identified, only 19 met the criteria. From these articles and from the indicator repository searches, 178 clinical care indicators were included in the qualitative synthesis and presented in this paper. Process and outcome measures were prevalent, and 5 out of the 6 quality domains were represented. No efficiency measures were identified. Moreover, structure indicators, equity and accessibility indicators, and indicators in the cardiovascular and circulatory, mental health, pediatrics, and intensive care categories were underrepresented.

Conclusions

A broad selection of quality indicators was identified from international resources, which can be used to measure the quality of physical therapy care in hospital units.

Impact

This review identified 178 quality of care indicators that can be used in clinical practice monitoring and quality improvement of hospital physical therapy units. The results highlight a lack of accessibility, equity, and efficiency measures for physical therapy units.
Documenting development of interdisciplinary collaboration among researchers by visualizing connections
Authors: Higgins Linden E , Smith Julia M
Published: November 2021

In 2015, a multidisciplinary group of academic researchers and extension personnel was awarded a US Department of Agriculture Coordinated Agricultural Project grant. The team’s goal was to understand human decision-making in the context of potential livestock disease outbreaks, investigating the impediments to increased adoption of biosecurity practices by producers from multiple perspectives. Counting publications and presentations was not deemed adequate evidence of growth of interdisciplinary collaboration. Instead, we took a developmental evaluation approach, collecting data to illuminate patterns of interconnectedness across disciplinary boundaries. These data, mapped annually on a baseline framework, reveal the team moving from disciplinary groups with disparate epistemologies and interests to a cohesive interdisciplinary team involved in many unexpected and emergent projects.
Understanding resistant hypertension
Authors: Bachinsky Alexandra , Jones Erin Leah , Thompson Tiffany , DePalma Sondra , Nicholas Joyce , Schmidt Eric
Published: November 2021

Resistant hypertension affects about 17% of the US population. However, it is difficult to diagnose because of multiple factors that influence adequate treatment of BP, including patient lifestyle and comorbidities, improper therapeutic regimens, and secondary mechanisms. Possible causes of resistant hypertension include nonmodulator hypertension, which affects patients who have an inappropriate response to elevated sodium through the renin-angiotensin-aldosterone system. Early identification and frequent follow-up can help patients achieve BP goals more rapidly and may reduce morbidity and mortality associated with complications of hypertension, including cerebrovascular accident, cardiovascular disease, and kidney disease.
Adhesive capsulitis
Authors: Ricci Monica
Published: November 2021

Adhesive capsulitis, a common primary care and orthopedic diagnosis often referred to as frozen shoulder, is a painful inflammatory process that leads to a mechanical block in active and passive range of shoulder motion. Risk factors include diabetes and thyroid dysfunction. Diagnosis is made based on physical examination, but can be augmented by diagnostic imaging. Nonsurgical management is the mainstay of treatment because the disease is self-limiting. However, some patients may need surgical intervention.
Effect of a PA-led arthritis center on hip and knee osteoarthritis care
Authors: Kelly McKayla , Aja Jacob , Turcotte Justin , MacDonald James
Published: November 2021

Objective:

To evaluate the effect of an arthritis center on patient care and operational throughput.

Methods:

A single-institution, retrospective review was conducted of patients with hip or knee osteoarthritis from January 2016 to October 2019. Our physician assistant (PA) led arthritis center opened in November 2017, and manages nonoperative treatment of osteoarthritis by formulating individualized treatment plans. Descriptive and inferential statistics comparing operational measures, treatment patterns, and patient satisfaction pre- and postcenter opening were performed.

Results:

Overall patient volume, new patient volume, and the proportion of new patients seen increased after the arthritis center opened. Encounters per patient and clinicians seen per patient decreased, while the rate of injections and surgery increased. Patient satisfaction improved after opening of the arthritis center.

Conclusions:

The establishment of a dedicated PA-led arthritis center is associated with improved access to care, operational efficiency, and patient satisfaction in patients with hip and knee osteoarthritis.
PA- and NP-led Ommaya clinics to manage leptomeningeal carcinomatosis
Authors: Leese Erika N. , Weeder Jamie L. , Manikowski Jesse J. , DeLaRue Angela M. , Conger Andrew R. , Mahadevan Anand , Vogel Victor G. , Mongelluzzo Gino J. , Gatson Na Tosha N.
Published: November 2021

Objectives:

Physician assistants (PAs) and NPs are essential to quality care delivery. The need to demonstrate value and optimize PA and NP roles in neurology subspecialty clinics is unmet. We outline the development of a PA- and NP-led neuro-oncology procedural clinic and provide metrics to support the institutional and clinician value added.

Methods:

We designed a PA- and NP-led Geisinger Ommaya Clinic (GOC) to manage leptomeningeal carcinomatosis (LMC) with defined clinician roles and the GOC treatment protocol. A retrospective review of 135 patients (2012-2019) compared survival outcomes for patients treated on the protocol compared with those treated off the protocol.

Results:

Centralized care in the GOCs minimized shared physician encounters and improved PA and NP autonomy and utility. LMC therapy as part of the GOC protocol improved care continuity and survival outcomes.

Conclusions:

PA- and NP-led procedural clinics optimize use of these clinicians and open physician availability for nonprocedural duties. This research highlights the institutional patient and financial benefit while demonstrating the operational and leadership growth potential for PAs and NPs.
Critically appraising the 2018 United Network for Organ Sharing donor allocation policy: adding life boats or rearranging the deck chairs?
Authors: Truby Lauren K. , Farr Maryjane , Topkara Veli K.
Published: November 2021

Purpose of review

Due to the growing mismatch between donor supply and demand as well as unacceptably high transplant waitlist mortality, the heart organ allocation system was revised in October 2018. This review gives an overview of the changes in the new heart organ allocation system and its impact on heart transplant practice and outcomes in the United States.

Recent findings

The 2018 heart allocation system offers a 6-tiered policy and therefore prioritizes the sickest patients on the transplant waitlist. Patients supported with temporary mechanical circulatory support devices are prioritized as Status 1 or Status 2, resulting in increased utilization of this strategy. Patients supported with durable left ventricular assist devices have been prioritized as Status 3 or 4, which has resulted in decreased utilization of this strategy. Broader geographic sharing in the new heart allocation system has resulted in prolonged donor ischemic times. Overall, the new heart allocation system has resulted in significantly lower candidate waitlist mortality, shorter waitlist times, and higher incidence of transplantation.

The new United Network for Organ Sharing allocation policy confers significant advantages over the prior algorithm, allowing for decreased waitlist times and improved waitlist mortality without major impact on posttransplant survival.
Is single posterior approach sufficient for effective hemivertebra resection and correction of nonflexible curves? A prospective study
Authors: Ashour Mahmoud Ahmed , Zaher Naser Hussin , Elsayed Mohamed Nabil , EL Zahlawy Hany , Hussien Mohamed Ali , Elkhateeb Tameem Mohamed
Published: November 2021

Background:

The purpose of this study was to evaluate the results of posterior-only resection of hemivertebrae in correction of congenital spinal deformities.

Methods:

Thirty consecutive patients with scoliosis, kyphosis, or kyphoscoliosis that was caused by congenital hemivertebra were included. Preoperative calculations of the curve degree and stiffness were obtained, and postoperative magnitude of corrections were calculated. The mean percentage of correction was measured. Intraoperative and postoperative complications were stated. The mean follow-up period was 48 mo.

Results:

The mean age of the patients was 11 yr. Scoliosis was found in 20 patients, pure kyphosis was found in six patients, and kyphoscoliosis was found in four patients. The deformity was in the thoracic region in nine patients, thoracolumbar region in 16, and lumbar region in five. Each patient had a single hemivertebra and primary posterior hemivertebra resection. The mean preoperative coronal Cobb angle in both the scoliosis and kyphoscoliosis patients was 49 degrees. The angle improved to a mean of 10.8 degrees at final follow-up with mean correction of 38.2 degrees. The mean preoperative local kyphosis angle in the kyphosis and kyphoscoliosis patients was 73.1 degrees. This improved to a mean of 21.1 degrees postoperatively with mean correction of 52 degrees. The mean preoperative regional angulation in those patients was 67.1 degrees, which improved to a mean of 24.6 degrees postoperatively with a mean correction of 42.6 degrees. Improvements in all these values were statistically highly significant (P < 0.001). Complications were recorded in six patients and included dural tear, pleural tear, and postoperative wound infection, which were managed.

Conclusions:

The posterior-only approach in hemivertebra resection can achieve good deformity correction and solid fusion with low risk of neurological complications.

Level of Evidence:

Level IV.
Current concepts in diagnosis, classification, and treatment of acute complex elbow dislocation: a review
Authors: Joly Jeannette M. , Wright Melissa A. , Murthi Anand M.
Published: November 2021

Complex elbow dislocations involve periarticular fractures in addition to capsuloligamentous disruption. These dislocations can result from a simple fall on an outstretched hand or from high-energy trauma, and the pattern of injury is affected by the direction of the force causing the injury. Fracture patterns in complex elbow dislocations vary based on whether the injury is posterolateral, anterior, posteromedial, or medial. The primary goals of care in treating complex elbow dislocations include restoring anatomical alignment of the ulnohumeral and radiocapitellar joints, providing stability, and facilitating early motion after definitive treatment. Depending on fracture pattern and joint stability, definitive treatment can be nonoperative with closed reduction and bracing or operative with capsuloligamentous repair, open reduction and internal fixation of fractures, arthroplasty, or application of an external fixator. Common complications include neurovascular injury, chronic instability, posttraumatic arthritis, compartment syndrome, stiffness, and heterotopic ossification. Understanding how best to treat each type of complex elbow dislocation is essential to optimizing long-term elbow mobility and function while avoiding potential complications.
Surgical correction of Scheuermann’s kyphosis by posterior-only approach: a prospective study
Authors: Zayan Ibrahim Mohammed , Elkhateeb Tameem Mohamed , EL Zahlawy Hany
Published: November 2021

Background:

The authors aimed to evaluate the clinical and radiographic results of the posterior-only approach in the treatment of Scheuermann’s kyphosis using pedicle screws with Ponte osteotomies.

Methods:

Twenty-one consecutive patients with Scheuermann’s kyphosis within the operative range were included in this prospective study. Patients were operated by a posterior-only approach using pedicle screws. Multiple Ponte osteotomies were performed at and around the apex. Mean operative time, blood loss, and any complications related to the procedure were reported. Patients were assessed radiographically by measuring thoracic kyphosis angle, lumbar lordosis angle, sagittal balance, and the Voutsinas index of kyphosis. Patients were assessed clinically using the Scoliosis Research Society questionnaire (SRS-22).

Results:

There were 18 male patients and 3 female patients with a mean age of 21 yr. The mean blood loss was 847.6 cc. The mean operative time was 196.9 min. The mean follow-up period was 36 mo. The mean preoperative thoracic kyphosis was 78.1±5.8 degrees, which improved to 41.9±3.7 degrees postoperatively. At the final follow-up, the mean thoracic kyphosis was 42.3±3.8 degrees. The mean lumbar lordosis was 71.1±3.4 degrees preoperatively, 51.6±1.7 degrees postoperatively, and 53.4±3.7 degrees at the final follow-up. The mean Voutsinas index of kyphosis was 19.6±7.6 preoperatively, which became 13.4±4.8 early postoperatively and 13.5±3.6 at the final follow-up. The SRS 22 questionnaire improved significantly from a mean of 2.7±1.3 preoperatively to 4.3±2.2 at the final follow-up.

Conclusions:

The posterior-only approach is a successful technique in treatment of Scheuermann’s kyphosis.

Level of Evidence:

Level IV.
Reverse total shoulder arthroplasty for fractures and posttraumatic sequelae is associated with inferior forward elevation strength: a retrospective cohort study
Authors: Ochsner Mims G. , Brolin Tyler J. , Smith Richard , Azar Frederick M. , Throckmorton Thomas W.
Published: November 2021

Background:

Studies have reported excellent results with improvement in active range of motion and pain relief after reverse total shoulder arthroplasty (RTSA), but few have specifically compared the strength and range-of-motion outcomes in RTSA done for different pathologies. The purpose of this study was to determine if strength is decreased after reverse total shoulder arthroplasty (RTSA) done for degenerative conditions compared with patients with posttraumatic or acute trauma indications.

Methods:

Records review identified 165 patients with 2 yr of clinical follow-up after RTSA for degenerative conditions (130), posttraumatic sequelae (19), or acute proximal humeral fractures (PHF) (16). Strength in forward elevation and internal and external rotation strength were measured at final follow-up. Secondary outcomes included active range of motion, visual analog scale (VAS) pain scores, American Shoulder and Elbow Surgeon (ASES) score, Single Assessment Numerical Evaluation (SANE) score, and complication rate.

Results:

Forward elevation strength was 4.8 in the degenerative group, 4.25 in posttraumatic patients, and 4.33 in the acute PHF group (P=0.036). Internal rotation strength was 4.95, 4.63, and 4.73 in the degenerative, posttraumatic, and acute PHF groups, respectively (P=0.053). External rotation strength was 4.8, 4.50, and 4.67 in the degenerative, posttraumatic, and acute traumatic groups, respectively. There were no significant differences in range of motion, ASES scores, VAS scores, or complication rates.

Conclusions:

RTSA for acute PHF and posttraumatic conditions results in significantly less forward elevation strength than RTSA done for degenerative conditions.

Level of Evidence:

Level III.
Combination of Full-Field and Fractional Erbium: YAG Laser for Nonhealing Wounds
Authors: Caliskan Ercan , Botsali Aysenur
Published: November 2021

BACKGROUND

To evaluate the outcomes of a heterogeneous group of patients with chronic ulcer receiving a combination regimen of full-field and fractional erbium-doped yttrium aluminum garnet (erbium: YAG) laser applications.

METHODS

Enrolled in this study were patients with chronic ulcer who had received at least 2 erbium: YAG laser sessions. Fractional applications followed the initial full-field application for debridement. The therapeutic outcomes were evaluated by serial photographs. The primary outcome measure was the proportion of patients achieving complete re-epithelialization at the first year.

RESULTS

Forty-three treatment regions from 23 patients between 40 and 90 years (F: M = 11:12; age: 60.3 ± 15.5 years, mean ± SD) were eligible. The ulcers' median duration was 24 months (min–max: 2–240 months). The median number of laser sessions was 5 (min–max: 2–12). Of arterial (n = 13), immunologic (n = 9), venous (n = 8), diabetic (n = 8), and mechanical ulcers (n = 5), the primary outcome measure was achieved in 69%, 77.7%, 75%, 88.8%, and 100% of the groups, respectively.

CONCLUSION

Full-field erbium: YAG laser applications preserve the vascular architecture and enable delicate debridement. Ongoing maintenance fractional laser sessions promote wound healing. Similar to the previous reports of erbium: YAG laser in venous and diabetic ulcers, arterial ulcers, and ulcers of immunologic origin demonstrated an objective treatment response along with different adjuvant approaches.
The analgesic efficacy of intravenous dexamethasone for post-caesarean pain
Authors: Singh Narinder Pal , Makkar Jeetinder Kaur , Yadav Neha , Goudra Basavana Gouda , Singh Preet Mohinder
Published: November 2021

BACKGROUND

Analgesic efficacy of intravenous dexamethasone has not been well defined after caesarean delivery. We performed a systematic review and meta-analysis to evaluate the impact of peri-operative dexamethasone administration on postoperative pain after caesarean delivery.

OBJECTIVES

We investigated the impact of perioperative intravenous dexamethasone on postoperative pain after caesarean delivery. The two primary outcomes of interest were early (4 to 6 h) resting pain scores and time to first rescue analgesia.

DESIGN

A systematic review and meta-analysis of randomised controlled trials (RCTs).

DATA SOURCES

PubMed, EMBASE, Scopus and the Cochrane central registers of controlled trials were searched to identify RCTs from inception to April 2021.

ELIGIBILITY CRITERIA

Prospective RCTs comparing the role of intravenous dexamethasone with non-active control were eligible for inclusion. Exclusion criteria included trials comparing various doses of dexamethasone without any control treatment arm, dexamethasone with other active drugs and trials comparing different routes of dexamethasone, for example, wound infiltration.

RESULTS

Thirteen RCTs constituting of 988 parturients undergoing caesarean delivery were included. Patients receiving dexamethasone had lower pain scores at rest at 4 to 6 h after surgery, mean difference –1.29 [95% confidence interval (CI), −1.85 to −0.73], P < 0.0001, with low quality of evidence (I
2 = 94%). Moderate quality of evidence (I
2 = 17%) suggested that the time to first rescue analgesia in the dexamethasone group was significantly longer, mean difference 2.64 h (95% CI, 1.85 to 3.42), P 
< 0.0001. Trial sequential analysis for pain scores suggested the benefit of dexamethasone; however, the requisite information size (RIS) could not be reached, whereas RIS was adequate for time to rescue analgesia. Significant reduction in pain scores at all times and opioid consumption at 24 h with dexamethasone were observed with sparse reporting on adverse effects.

CONCLUSION

Peri-operative intravenous dexamethasone was associated with a significant decrease in postoperative pain scores at rest and a longer time to first rescue analgesia, along with a small but statistically significantly reduced opioid consumption after caesarean delivery compared with nonactive control.