bluuebunny/crossref_metadata_2025 huggingface dataset:
Challenging Cases
Authors: Langtry David , Lyer Kirsten Roberts
Published: January 2022

How does the Sub-Committee on Accreditation (SCA) approach its review of its institutions that are operating in conflict zones, authoritarian states, or in the midst of gross violations of human rights? This chapter examines specific cases in order to understand how the SCA has dealt with ‘challenging cases’. These are situations where the National Human Rights Institution is operating in a highly challenging national climate such as during a time of coup (Thailand, Honduras) or armed conflict (Afghanistan), where rule of law is under significant threat (Hungary and Poland), or where they or their members come under direct threat of harm (Togo).
Losing A-status
Authors: Langtry David , Lyer Kirsten Roberts
Published: January 2022

In the period of work of the Sub-Committee on Accreditation (SCA) covered by this book, there have been a number of National Human Rights Institutions (NHRIs) who have lost their Paris Principles compliant A-status accreditation following a special review or during the re-accreditation process due to either their actions or their inaction. This chapter examines some of these instances in a case-study format looking at Azerbaijan, Mauritania, Nicaragua, and Paraguay, as well as situations where NHRIs have been downgraded but not because of a failure to engage with the human rights situation but because of serious structural deficiencies, such as a structural change to the institution or financial issues.
Opioids overview
Authors: Hawley Pippa
Published: January 2022

This chapter describes and discusses the World Health Organization Cancer’s pain ladder, including modifications to reflect current practice, specifically the limited role for Step 2, and the need to consider a Step 4 of interventional pain management procedures and techniques. The chapter lists the characteristics of the commonly available opioid analgesics: morphine, hydromorphone, oxycodone and fentalyl, both generally and with specific reference to circumstances in which one opioid might be preferred over another, particularly renal failure. Buprenorphine and sublingual sufentanil are included. Methadone is coverd in a separate chapter and is not discussed in detail here. Common opioids side-effects are described, along with their prevention and mitigation recommendations. Opioid initiation and switching strategies are described, and the concept of opioid equianalgesic dosing ratios is explained. Tolerance and hyperalgesia are discussed with reference to opioid switching.
Somatic pain
Authors: Sellick Megan , Tarumi Yoko , Watanabe Sharon M.
Published: January 2022

Somatic pain is a subtype of nociceptive pain, arising from bone or soft tissue. With the skeleton being one of the most frequent sites of metastases, cancer-induced bone pain (CIBP) is one of the most commonly encountered somatic pain syndromes. Most patients with bone metastases will develop ‘skeletal-related events’ (SREs) (e.g. pain, fractures, spinal cord compression). CIBP usually manifests as continuous pain, with episodes of worsening pain, known as breakthrough pain (BTP). BTP can have ominous consequences for quality and length of life. The pathophysiology of CIBP involves mechanical instability, nerve damage and deformation, inflammation, and central nervous system sensitization. Diagnosis and treatment of CIBP require a multimodal approach, including pharmacotherapy, rehabilitation, surgery, interventional radiology, and radiation therapy. Risk factors for future complications must also be considered. Future research is required into efficacy, safety, and pharmaco-economic implications of novel therapies, and management of bone health effects from long-term opioid use.
Constipation
Authors: Hiebert Tim , Riel Stefan
Published: January 2022

This chapter examines the risk factors for constipation in the terminally ill patient, as well as explores the underlying pathophysiology of constipation in the setting of advanced illness. Normal bowel function requires coordination of gut motility with molecular transport across the bowel wall and reflexes of defecation. Disruption in any of these areas can affect normal bowel function. Unfortunately, in the setting of advanced illness, these factors are often disrupted. Patients nearing end of life often require medications to manage common symptoms related to terminal illness which often affect normal bowel function, adding another layer to consider when dealing with the patient’s constipation. Careful assessment, including history and physical examination, will be reviewed as they are needed to identify the best course of management. In certain situations, investigations and imaging may be required in order to better identify the cause. Many terminally ill patients are on opioids near end of life which are a class of medications notorious for causing constipation. This chapter will review the current evidence and management options for opioid-induced constipation, including a newer class of medications—the peripherally acting mu opioid receptor antagonists (PAMORAs).
Anorexia–cachexia
Authors: Baracos Vickie , MacDonald Neil
Published: January 2022

Anorexia–cachexia afflicts a high proportion of patients with cancer and other chronic diseases in their advanced stages. Anorexia–cachexia is a problem which may be most clearly appreciated by caregivers, whose effort to adopt a nourishing role is frustrated. An onerous burden of care inexorably falls upon them, affecting their own health, mobility, and savings. For many patients, anorexia–cachexia commonly results in hospitalization for prolonged periods, thus further creating costs for their families and the State where public health programmes exist. The primary events driving cachexia include anorexia and altered metabolism. Tumour—derived factors instigate, and immune- and central nervous systems amplify and propagate anorexia-cachexia. Systematic screening for anorexia-achexia is needed to support early initiation of treatment. Active management of symptoms, amelioration of food intake (nutritional support), suppression of inflammation-related metabolic change (anti-inflammatory drugs or nutrients) and physical activity are needed. Novel therapeutic targets for anorexia-cachexia are currently under investigation.
Grief and bereavement
Authors: Farag Alexandra
Published: January 2022

This chapter reviews the current available literature on grief and bereavement. It looks at the important role a healthcare provider plays in the experience of grief. It also explores the ways in which the role of the healthcare provider impacts how someone copes during bereavement. It explores normal grief, anticipatory grief, complicated grief, and related conditions such as major depressive disorder, post-traumatic stress disorder, and adjustment disorders. It helps the clinician diagnose the aforementioned conditions and manage them appropriately. Finally, the chapter explores the impact the loss of patients has on clinicians and provides clinicians with strategies to manage their personal grief and grief in their professional lives.
Response to suffering
Authors: Dudgeon Deborah , Herx Leonie M. , MacDonald Susan
Published: January 2022

Suffering among those facing a life-limiting illness is a common phenomenon as terminal illness is an assault on the whole person. Suffering is experienced by the whole person and can be caused by, or manifest itself in, the physical, psychological, social, and/or spiritual/existential domains of an individual’s life. Suffering is unique to each individual and it is important to observe for emotional cues and assess the individual’s cultural background as it will also influence how suffering is expressed. Interventions to help reduce suffering can be categorized as: psycho-educational; meaning-centred; stress reduction; hope-centred; supportive–expressive; and spiritual and other. Non-physical forms of suffering may be intrinsic to the dying process and requires health professionals to be fully present in their encounters with patients; develop a trusting relationship and willingness to listen; and demonstrate that the patient’s concerns have been heard.
Public health palliative care
Authors: Marshall Denise , Barwich Doris
Published: January 2022

The increasing professionalization and specialization of palliative care over the last 40 years has had enormous impact and benefit for millions, especially with respect to symptom management. However, it may have also inadvertently created an expectation that all palliative care needs can and should be met through improving access to health services. Given the inherently social nature of dying, there is an urgent need to embrace palliative care as a public health issue and adopt models and approaches that allow communities, service delivery organizations, and policymakers to work together to improve well-being and quality of care, not just at end of life, but throughout the serious illness journey.
Chinese Linguistics
Authors: Arcodia Giorgio Francesco , Basciano Bianca
Published: January 2022

Chinese linguistics, broadly understood as the scientific study of Sinitic languages and other languages of China, may be regarded both as an established and as an emerging subfield of linguistics and Chinese studies. The Chinese tradition of reflection on language and writing began even before the Imperial Age in China, and foreign scholars, often missionaries from the West, started writing grammars and treaties on Sinitic languages at least since the sixteenth century. On the other hand, the field has experienced momentous development in the past thirty years, and perhaps even more strongly since the beginning of the third millennium: the past decade has witnessed a steady growth of conferences, journals, courses, and publications specifically dedicated to Chinese, as well as a tremendous rise in the number of language students and teachers all over the world. However, an up-to-date introductory book on Chinese linguistics for a Western audience is not easy to find. The present volume aims at filling this gap, providing an accessible general introduction to key topics in Chinese linguistics both for China scholars and for linguists, including those with little or no previous knowledge of Chinese.
Distance and History
Authors: Eve Martin Paul
Published: January 2022

This chapter considers distance and history in terms of digital literary studies. For many years now, more contemporary fiction has been published every year than a single person can read in a lifetime. The implications of such overproduction for literary history are enormous. Field mastery by a single individual is impossible and the systematizing dreams of the early Russian formalists seem far out of reach. Statistical reading methods have been billed as a potential way to overcome these human limitations. If we cannot read enough ourselves, perhaps, it is posited, we could delegate this work to the machines. After an introduction to digital-textual media studies, this chapter examines the recent advances in computational modelling with key examples from Andrew Piper and Ted Underwood.
The Originality and Influence of Tony Harrison’s The Trackers of Oxyrhynchus
Authors: Parkyn Lottie
Published: January 2022

This chapter explores the highly original contribution that Tony Harrison made to the world of ancient Greek drama performance through his ground-breaking production, The Trackers of Oxyrhynchus. This created a change in attitude towards the play fragment, which was often overlooked by playwrights and directors in favour of its complete tragic counterparts, such as Euripides’ Medea and Sophocles’ Oedipus. Harrison gave the ancient ‘lost’ play an opportunity to publicly grace the stage again, in a world in which the context and relevancy of the satyr play had been forgotten. The chapter discusses how Harrison engaged with the surviving approximately 400 lines of script that were discovered in an Egyptian rubbish heap, and rather than attempting to ‘complete’ the play, with his own interpretation of what may have concluded the original, bookended the script with new scenes. He used the relatively unknown light-hearted genre of the satyr play to open discussion about serious contemporary topics such as class, education, and social disillusionment in 1980s Britain, through the lens of the ancient. Harrison’s utterly original approach has influenced playwrights and directors not only to engage with the fragmented plays of Ancient Greece but also to utilize this new approach to have open discourse on contemporary issues.
Human Rights in a Use Case World
Authors: Kingsbury Benedict
Published: January 2022

Digital engineers diagram ‘use cases’ to design software, based on practical needs of the quotidian product user rather than big normative claims. Human rights lawyers work in the reverse direction, starting from principles of universal application then applying these to hard cases. These two modes of thinking and practice have existed separately. Digital automation of government services using algorithms and AI is bringing them abruptly together and into mutual learning. The chapter examines controversies and court decisions over digital welfare state programmes in Australia (Robodebt), the Netherlands (Syri), and the United Kingdom (Universal Credit), highlighted by Philip Alston as UN Special Rapporteur. The normative practice of human rights must grapple with data concentration and computerized decisions wherever power is exercised. The chapter proposes ‘thinking infrastructurally’ as a path to bring human rights thinking into the fast-escaping public–private practices of algorithmic government and machine learning.
Emotional Engagement and Social Understanding in Early Development
Authors: Reddy Vasudevi , Vanello Daniel
Published: January 2022

This chapter argues that the emotions are a constitutive part of the development of social understanding and therefore that it is deeply problematic to conceptualize emotion as psychologically separate from the emergence of our understanding of persons as subjects. In other words, the authors argue that emotion should not be seen as an “independent variable” in the development of social understanding. Emotions conceived more broadly as vitality affects are inevitable qualities of all actions and are categorically different from what are typically called “mental states.” Further, others’ emotions are rarely experienced in a spectatorial manner; they are more typically experienced in participation and involvement. The tendency to conceive of emotions as independent variables in the development of social understanding is an unfortunate instantiation of the traditional division in psychology between cognition, conation, and affection. The thrust of this chapter is a challenge to this traditional division in the development of social understanding.
2′,3′-cAMP treatment mimics the stress molecular response inArabidopsis thaliana
Authors: Chodasiewicz Monika , Kerber Olga , Gorka Michal , Moreno Juan C , Maruri-Lopez Israel , Minen Romina I , Sampathkumar Arun , Nelson Andrew D L , Skirycz Aleksandra
Published: January 2022

The role of the RNA degradation product 2′,3′-cyclic adenosine monophosphate (2′,3′-cAMP) is poorly understood. Recent studies have identified 2′,3′-cAMP in plant material and determined its role in stress signaling. The level of 2′,3′-cAMP increases upon wounding, in the dark, and under heat, and 2′,3′-cAMP binding to an RNA-binding protein, Rbp47b, promotes stress granule (SG) assembly. To gain further mechanistic insights into the function of 2′,3′-cAMP, we used a multi-omics approach by combining transcriptomics, metabolomics, and proteomics to dissect the response of Arabidopsis (Arabidopsis thaliana) to 2′,3′-cAMP treatment. We demonstrated that 2′,3′-cAMP is metabolized into adenosine, suggesting that the well-known cyclic nucleotide–adenosine pathway of human cells might also exist in plants. Transcriptomics analysis revealed only minor overlap between 2′,3′-cAMP- and adenosine-treated plants, suggesting that these molecules act through independent mechanisms. Treatment with 2′,3′-cAMP changed the levels of hundreds of transcripts, proteins, and metabolites, many previously associated with plant stress responses, including protein and RNA degradation products, glucosinolates, chaperones, and SG components. Finally, we demonstrated that 2′,3′-cAMP treatment influences the movement of processing bodies, confirming the role of 2′,3′-cAMP in the formation and motility of membraneless organelles.
Inhomogeneous generalization of Einstein’s static universe with Sasakian space
Authors: Ishihara Hideki , Matsuno Satsuki
Published: January 2022

We construct exact static inhomogeneous solutions to Einstein’s equations  with counter flow of particle fluid and a positive cosmological constant by using the Sasaki metrics on three-dimensional spaces. The solutions, which admit an arbitrary function that denotes the inhomogeneous number density of particles, are a generalization of Einstein’s static universe. For some examples of explicit solutions, we discuss non-linear density contrast and deviation of the metric functions.
Construction of interacting flat-band models by molecular-orbital representation: Correlation functions, energy gap, and entanglement
Authors: Mizoguchi Tomonari , Kuno Yoshihito , Hatsugai Yasuhiro
Published: January 2022

We calculate correlation functions of exactly solvable one-dimensional flat-band models by utilizing the “molecular-orbital” representation. The models considered in this paper have a gapped ground state with the flat band being fully occupied, even in the presence of the interaction. In this class of models, the space spanned by the molecular-orbitals is the co-space of that spanned by the flat bands. Thanks to this property, the correlation functions are calculated by using the information of the molecular-orbitals rather than the explicit forms of the flat-band wave functions, which simplifies the calculations. As a demonstration, several one-dimensional models and their correlation functions are presented. We also calculate the entanglement entropy by using the correlation function.
Who meets national early childhood sleep guidelines in Aotearoa New Zealand? A cross-sectional and longitudinal analysis
Authors: Muller D , Santos-Fernández E , McCarthy J , Carr H , Signal T L
Published: January 2022

Study Objectives

To investigate the proportion of children in Aotearoa New Zealand (NZ) who do or do not meet sleep duration and sleep quality guidelines at 24 and 45 months of age and associated sociodemographic factors.

Methods

Participants were children (n = 6490) from the Growing Up in New Zealand longitudinal study of child development with sleep data available at 24 and/or 45 months of age (48.2% girls, 51.8% boys; 22.4% Māori [the Indigenous people of NZ], 12.9% Pacific, 13.4% Asian, 45.2% European/Other). Relationships between sociodemographic factors and maternally reported child sleep duration (across 24 hours) and night wakings were investigated cross-sectionally and longitudinally. Estimates of children in NZ meeting sleep guidelines were calculated using a range of analytical techniques including Bayesian linear regression, negative binomial multiple regression, and growth curve models.

Results

In NZ, 29.8% and 19.5% of children were estimated to have a high probability of not meeting sleep duration guidelines and 15.4% and 8.3% were estimated to have a high probability of not meeting night waking guidelines at 24 and 45 months respectively, after controlling for multiple sociodemographic variables. Factors associated cross-sectionally with children’s sleep included ethnicity, socioeconomic deprivation, material standard of living, rurality, and heavy traffic, and longitudinal sleep trajectories differed by gender, ethnicity, and socioeconomic deprivation.

Conclusions

A considerable proportion of young children in NZ have a high probability of not meeting sleep guidelines but this declines across the ages of 24 and 45 months. Sleep health inequities exist as early as 24 months of age in NZ.
Current concepts in metastatic carcinoma: a review of the literature
Authors: Heck Robert K. , Tobey Devon R.
Published: January 2022

Metastatic spread to the skeletal system is a leading cause of morbidity and mortality in patients with cancer. With improved diagnostic imaging, laboratory studies, and new treatments, life expectancy has improved in oncology patients. With this increase in survival, the overall healthcare burden of metastatic bone disease also has increased. Treatment of metastatic disease of bone should be multidisciplinary and provide local and systemic tumor control. The overall performance status of a patient, the presence or absence of multiple lesions, the anatomic site affected, and viscera involved will all influence surgical options. If a pathologic fracture or impending fracture is present, the treatment should be durable and expected to last for the life of the patient. This review summarizes current concepts in the diagnosis and management of metastatic bone cancer, including the clinical approach to new bone lesions in patients without a known primary carcinoma, as the origin of such tumors has a significant implication on skeletal events and overall prognoses.
Arsenic-contaminated drinking water and cholangiocarcinoma
Authors: Reyes Darrian , Ganesan Nivetha , Boffetta Paolo , Labgaa Ismail
Published: January 2022

Introduction

Cholangiocarcinoma (CCA) is an aggressive tumor occurring in bile ducts and associated with dismal outcomes. It can be classified according to anatomical location as intrahepatic cholangiocarcinoma (ICC) or extrahepatic cholangiocarcinoma (ECC). Although some risk factors have been identified, our understanding of these tumors remains limited. Arsenic (As) is a prevalent toxicant with established associations with bladder, skin and lung cancers while pilot data on its potential carcinogenic role on digestive tumors are emerging. This ecological study aimed to investigate the association between exposure to As-contaminated drinking water and CCA.

Methods

Analyses were conducted for the US, Taiwan and India due to the quality of publicly available datasets including small area-level information. Statistics included coefficient correlations analyses as well as univariate and multivariate linear regressions.

Results

In the US, no correlation was observed between As and CCA. In Taiwan, correlations were identified for ICC in men (Spearman = 0.55, P = 0.01) and women (Spearman = 0.67, P < 0.01), as well as for ECC in men (Spearman = 0.62, P < 0.01). In India, counties with As level of at least 50 µg/L showed higher incidences of ECC in men (R
2 = 0.26, P = 0.01) and women (R
2 = 0.31, P < 0.01).

Conclusion

These findings highlighted a potential carcinogenic impact of As in drinking water on bile duct cancers, paving the way for future studies aiming to replicate this association with individual data as well as its clinical and ecological implications.
Predictors of underutilization of lung cancer screening: a machine learning approach
Authors: Guo Yuqi , Yin Shuhua , Chen Shi , Ge Yaorong
Published: January 2022

Lung cancer is the second common cancer and a leading cause of cancer-related death in the US. Unfavorably, the prevalence of using low-dose computed tomography (LDCT) for lung cancer prevention in the US has remained below 4% over time. The purpose of this study is to develop machine learning models to analyze interactive pathways of factors associated with lung cancer screening use with the LDCT. The study was based on the data retrieved from the 2018 Behavioral Risk Factor Surveillance System. After dealing with missing values, 86 variables and 710 samples were included in the decision tree model and the random forest model. The data were randomly split into training (569/710, 80%) and testing (141/710, 20%) sets. Gini impurity is used to select and determine the optimal split of the nodes in the model. Machine learning performance was evaluated by model accuracy, sensitivity, specificity, F1 score, etc. The average performance metrics of the decision tree model were obtained: average accuracy is 67.78%, F1 score is 65.76%, sensitivity is 62.52%, and specificity is 73.57% based on 100 runs. In the decision model, nine interactive pathways were identified among the following factors: average drinks per month, BMI, diabetes, first smoke age, years of smoking, year(s) quit smoking, sex, last sigmoidoscopy or colonoscopy, last dental visit, general health, insurance, education, and last Pap test. Lung cancer screening utilization is the result of the interplay of multifactors. Lung cancer screening programs in clinical settings should not only focus on patients’ smoking behaviors but also consider other socioeconomic factors.
Evaluating the Efficacy of Two Regional Pain Management Modalities in Autologous Breast Reconstruction
Authors: Rendon Juan L. , Borrell-Vega Jaume , Reyes Joshua-Paolo C. , Wang Diana M. , Roeth Cory , Abdel-Rasoul Mahmoud , Skoracki Roman J. , Harter Ronald L. , Moffatt-Bruce Susan D. , Humeidan Michelle L.
Published: January 2022

Background:

At our institution, multimodal opiate-sparing pain management is the cornerstone of our enhanced recovery program for autologous breast reconstruction. The purpose of this study was to compare postoperative outcomes and pain control metrics following implementation of an enhanced recovery program with two different regional analgesia approaches.

Methods:

This retrospective cohort study identified 145 women who underwent autologous breast reconstruction from 2015 to 2017. Three groups were included: historical control patients (n = 46) and enhanced recovery patients that received multimodal pain management including a postoperative transversalis abdominis plane block with either a continuous local anesthetic catheter (n = 60) or a single-shot of liposomal bupivacaine (n = 39). The primary outcome was pain scores in the first three postoperative days. Secondary outcomes were opioid consumption in oral morphine equivalents and length of stay.

Results:

Postoperative pain scores were similar across all three groups until postoperative day 3. Length of stay was significantly shorter in both of the enhanced recovery cohorts (3.0 [3.0, 4.0]) compared with control patients (4.0 [4.0, 5.0], P < 0.001). Likewise, average total oral morphine equivalents consumption was significantly reduced in enhanced recovery patients (continuous catheter 215.9 (95% CI, 165.4–266.3); liposomal bupivacaine 211.0 (95% CI, 154.8–267.2); control 518.4 (95% CI 454.2–582.7), P < 0.001). Neither length of stay (P = 0.953), nor oral morphine equivalents consumption (P = 0.883) differed by type of regional analgesia.

Conclusion:

Compared with control patients, both approaches to regional transversalis abdominis plane block analgesia as part of an opiate-sparing enhanced recovery pain management strategy were successful, but neither superior to the other.
Normal Neonatal Sleep Defined: Refining Patient Selection and Interpreting Sleep Outcomes for Mandibular Distraction
Authors: Kanack Melissa D. , Nakra Neal , Ahmad Irfan , Vyas Raj M.
Published: January 2022

Background:

Although polysomnography is paramount when evaluating neonatal airway obstruction, “normal” published references do not exist. We present normative polysomnography data for newborns age 0–1 month. We compare this reference to pre and postoperative sleep data from infants undergoing mandibular distraction osteogenesis (MDO) at this same age.

Methods:

Following IRB approval, normative subjects were recruited from our neonatal intensive care unit to undergo nap polysomnography. One blinded sleep physician read all studies. From 2016 to 2019, we prospectively collected sleep data for newborns undergoing MDO.

Results:

In total, 22 neonates without airway obstruction provided normative sleep data. Median total apnea-hypopnea index (AHI), obstructive apnea-hypopnea index (OAHI), and central apnea index (CAI) were 7.3, 4.9, and 0.7 events/hour. Median O2 nadir was 91%. Polysomnography for 13 neonates before MDO and during consolidation showed median preoperative AHI was 38.3, OAHI was 37.0, CAI was 1.9, and median O2 nadir was 83%. Following MDO, median AHI was 6.1, OAHI was 4.0, CAI was 1.3, and median O2 nadir was 92.5%. Paired t-tests confirmed significant improvements in all indices; when comparing the postoperative group with the normative group, there was no difference in oxygenation nor any respiratory index.

Conclusions:

“Normal” neonates have more obstructive events and lower oxygenation nadirs than previously appreciated. We provide normative nap polysomnography values for this age group and encourage centers with multidisciplinary MDO teams to utilize this data to calibrate patient selection algorithms, inform treatment discussions, and better understand surgical outcomes. Limitations include a small sample size and single institution study.
Toward a Universal Measure of Facial Difference Using Two Novel Machine Learning Models
Authors: Takiddin Abdulrahman , Shaqfeh Mohammad , Boyaci Osman , Serpedin Erchin , Stotland Mitchell A.
Published: January 2022

Background:

A sensitive, objective, and universally accepted method of measuring facial deformity does not currently exist. Two distinct machine learning methods are described here that produce numerical scores reflecting the level of deformity of a wide variety of facial conditions.

Methods:

The first proposed technique utilizes an object detector based on a cascade function of Haar features. The model was trained using a dataset of 200,000 normal faces, as well as a collection of images devoid of faces. With the model trained to detect normal faces, the face detector confidence score was shown to function as a reliable gauge of facial abnormality. The second technique developed is based on a deep learning architecture of a convolutional autoencoder trained with the same rich dataset of normal faces. Because the convolutional autoencoder regenerates images disposed toward their training dataset (ie, normal faces), we utilized its reconstruction error as an indicator of facial abnormality. Scores generated by both methods were compared with human ratings obtained using a survey of 80 subjects evaluating 60 images depicting a range of facial deformities [rating from 1 (abnormal) to 7 (normal)].

Results:

The machine scores were highly correlated to the average human score, with overall Pearson’s correlation coefficient exceeding 0.96 (P < 0.00001). Both methods were computationally efficient, reporting results within 3 seconds.

Conclusions:

These models show promise for adaptation into a clinically accessible handheld tool. It is anticipated that ongoing development of this technology will facilitate multicenter collaboration and comparison of outcomes between conditions, techniques, operators, and institutions.
Arteriovenous Vascular Loop Using a Bifurcated Greater Saphenous Vein
Authors: Cavadas Pedro C. , Baklinska Magdalena , Almoguera-Martinez Alejandro
Published: January 2022

High-energy lower limb trauma may result in complex defects with extensive vascular damage. Free flap reconstruction in these cases may require vein grafts to reach healthy proximal recipient vessels. Vascular loops are an increasingly popular technique in managing recipient vessels in reconstructive microsurgery, especially in the lower limb. The use of an entire omega segment of the greater saphenous vein had not been described before but offered two advantages: the caliber match for arterial repair was better using one of the limbs of the omega compared with the parent greater saphenous vein, and it allowed two venous anastomoses instead of one. A case report of a fully bifurcated segment of the greater saphenous vein as a vascular loop for microvascular reconstruction in the lower limb is presented. To the best of the authors’ knowledge, no similar case has been reported previously.
Aesthetic Preferences of the Anterior Thigh as a Beauty Factor in Women
Authors: Manzaneda Cipriani Raúl Martín , Adrianzen Gerardo A. , Zulueta Jaroslav , Sarango Braulio
Published: January 2022

Background:

In body contouring surgery, some regions, such as the abdomen, thorax, upper limbs, and glutes, are prioritized over others, including the lower limbs, particularly the anterior thighs. This study aimed to identify anterior thigh preferences by age, sex, ethnicity, and region and assess their importance as a factor of female beauty by conducting an online survey.

Methods:

Photographs of a 24-year-old female model were modified in two front-view and side-view panels. Through a survey on the Amazon Mechanical Turk platform, participants were asked to order the images from the most beautiful to the least beautiful, and the results were broken down by age, sex, ethnicity, and region.

Results:

A total of 1000 respondents were surveyed, all of whom answered the survey without error; therefore, no one was excluded. Of the 1000 respondents, 504 were men (50.4%) and 496 were women (49.6%). The predominant age group was 26−35 years, with 443 people (44.3%), the region with the highest number of participants was North America, with 484 respondents (48.4%), and the predominant ethnicity was White, with 555 respondents (55.5%). The survey showed that the most beautiful images were image A on the side-view panel (25.9%) and image I on the front-view panel (28.5%)(P < 0.001).

Conclusions:

In the side view, the aesthetic preferences of the anterior thigh do not appear to be associated with the anterior projection. However, in the front view, the increase in width generates a beauty trend, but only up to an intermediate level, quantified in the ratio (0.44).
Vertical Transmission and Neonatal Outcomes Following Maternal SARS-CoV-2 Infection During Pregnancy
Authors: Kyle Margaret H. , Hussain Maha , Saltz Victoria , Mollicone Isabelle , Bence Mary , Dumitriu Dani
Published: January 2022

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected over 200 million people worldwide and has likely exposed millions of neonates to SARS-CoV-2 in utero. A large body of literature has examined the possibility of vertical transmission from pregnant women infected with SARS-CoV-2 to their neonates. In this chapter, we review mechanisms of—and evidence for—vertical transmission of SARS-CoV-2, including transplacental, through other biospecimens and breastfeeding, and discuss neonatal outcomes following in utero exposure. Based on the available literature, we conclude vertical transmission of SARS-CoV-2 is rare, and exposed neonates generally show favorable health outcomes.
Obstetric Outpatient Management During the COVID-19 Pandemic: Prevention, Treatment of Mild Disease, and Vaccination
Authors: JOSEPH NAIMA T. , MILLER EMILY S.
Published: January 2022

The majority of patients with coronavirus disease 2019 will have mild or asymptomatic disease, however, obstetric patients are uniquely at risk for disease progression and adverse outcomes. Preventive strategies including masking, physical distancing, vaccination, and chemoprophylaxis have been well studied, are critical to disease mitigation, and can be used in the pregnant population. High-quality data are needed to assess safety and effectiveness of therapeutics and vaccination in pregnancy, as well as long-term data on maternal and newborn outcomes.
Technological Advancements in Uterus Transplantation
Authors: McKenna Greg J. , Johannesson Liza , Testa Giuliano
Published: January 2022

Uterus transplantation is barely a decade old and in a young, evolving field it is hard to identify “technological advances” since it is, in of itself, a technological advance. Nonetheless, one can still identify advances in diagnostic imaging that have improved donor screening to avoid graft losses, highlight the adoption of robotic surgery to make the living donor uterus procurement more minimally invasive, and look to a future of biotechnology like perfusion pumps and bioengineering such as synthetic uterus to increase donor supply. Additional technologies are on the horizon and promise to shape the field further.
Genetic Screening and Teratogenic Exposures: Considerations in Caring for the Uterus Transplant Patient
Authors: Wang Eileen Y. , Perni Uma C. , Gregg Anthony R.
Published: January 2022

Counseling the uterus transplant patient requires an enhanced knowledge of unique genetic challenges that include an understanding of the spectrum of Mayer-Rokitansky-Küster-Hauser syndrome. Patients should understand their options for genetic screening and testing including preimplantation genetic testing for aneuploidy, genetic screening, and diagnostic testing. This patient population is potentially at risk for fetal anomalies due to the increased susceptibility to infections, such as cytomegalovirus. There are management strategies to minimize this risk. The risk of teratogenicity from mycophenolate is eliminated by a washout period before embryo transfer.
Uterine Transplantation in 2021: Recent Developments and the Future
Authors: Jones Benjamin P. , Kasaven Lorraine S. , Chan Maxine , Vali Saaliha , Saso Srdjan , Bracewell-Milnes Timothy , Thum Meen-Yau , Nicopoullos James , Diaz-Garcia Cesar , Quiroga Isabel , Yazbek Joseph , Smith James Richard
Published: January 2022

Uterine transplantation has evolved rapidly over the last decade. As the number of cases performed increases exponentially worldwide, emerging evidence continues to improve collective knowledge and understanding of the procedure, with the aim of improving both surgical and reproductive outcomes. Although currently restricted to women with absolute uterine factor infertility, increasing awareness as a method of fertility restoration has resulted in a demand for the procedure to be undertaken in transgender women. This manuscript summarizes the recent advances in uterine transplantation, and elaborates further upon the key novel avenues research within the field will focus on over the coming years.
Antepartum Care of the Uterus Transplant Patient: The Experience of 3 Successful US Centers
Authors: Perni Uma C. , Wang Eileen Y. , Gregg Anthony R.
Published: January 2022

We offer consensus recommendations for the antepartum management of the uterus transplant pregnancy based on our experience at 3 US centers. Patient access to accurate information is important to manage expectations and make informed decisions. Unique aspects of medical management include monitoring tacrolimus levels and performing cervical biopsies for rejection. Low-dose aspirin for preeclampsia is routinely used. Vigilant screening for gestational diabetes and preeclampsia allows for the prompt diagnosis and treatment of these common complications. We aim to deliver patients at 37 to 38 weeks by cesarean section. Shared decision making dominates whether to consider future pregnancies and timing of hysterectomy.
Characteristics, treatment, and control of hypertension in public primary healthcare centers in Nigeria: baseline results from the Hypertension Treatment in Nigeria Program
Authors: Ojji Dike B. , Baldridge Abigail S. , Orji Ikechukwu A. , Shedul Gabriel L. , Ojo Tunde M. , Ye Jiancheng , Chopra Aashima , Ale Boni M. , Shedul Grace , Ugwuneji Eugenia N. , Egenti Nonye B. , Aluka-Omitiran Kasarachi , Okoli Rosemary C.B. , Eze Helen , Nwankwo Ada , Banigbe Bolanle , Tripathi Priya , Kandula Namratha R. , Hirschhorn Lisa R. , Huffman Mark D.
Published: January 2022

Background:

There are limited data on large-scale, multilevel implementation research studies to improve hypertension diagnosis, treatment, and control rates at the primary healthcare (PHC) level in Africa. We describe the characteristics, treatment, and control rates of patients with hypertension in public PHC centers in the Hypertension Treatment in Nigeria Program.

Methods:

Data were collected from adults at least 18 years at 60 public PHC centers between January 2020 and November 2020. Hypertension treatment rates were calculated at registration and upon completion of the initial visit. Hypertension control rates were calculated based on SBP and DBPs less than 140/90 mmHg. Regression models were created to evaluate factors associated with hypertension treatment and control status.

Results:

Four thousand, nine hundred and twenty-seven individuals [66.7% women, mean (SD) age = 48.2 (12.9) years] were included. Mean (SD) SBP was higher in men compared with women [152.9 (20.0) mmHg versus 150.8 (21) mmHg, P = 0.001]. Most (58.3%) patients were on treatment at the time of registration, and by the end of the baseline visit, 89.2% of patients were on treatment. The baseline hypertension control rate was 13.1%, and control was more common among patients who were older [adjusted OR (95% CI) 1.01 [1.01 –1.02)], women [adjusted OR (95% CI) 1.30 (1.05– 1.62)], who used fixed dose combination therapy [adjusted OR (95% CI) 1.83 (1.49 –2.26)], and had higher education levels.

Conclusion:

This baseline report of the largest facility-based hypertension study in Africa demonstrates high hypertension treatment rates but low control rates.
Historical Context of Custodial Health Nursing in New South Wales, Australia
Authors: Burton Josephine , Chiarella Mary , Waters Donna
Published: January 2022

Australia's prison healthcare originated during the establishment of the colony of New South Wales by Britain in 1788. Initially managed by the Colonial Medical Service, the history and healthcare of the penal settlement has been well documented in government records, academic works, museum displays, and fictional dramatizations. This article explores the origins and historical development of the nursing care of prisoners in Australia, starting with the original Australian prisoners, the convicts of colonial New South Wales. Largely overlooked in historical and academic studies, custodial health nurses are rarely mentioned or acknowledged for their contribution to the health of the colony. However, their expertise as healthcare professionals has continued to grow and is explored within the context of today's health landscape.
Mental Illness as a Vulnerability for Sexual Assault: A Retrospective Study of 7,455 Sexual Assault Forensic Medical Examinations
Authors: Miles Leslie , Valentine Julie L. , Mabey Linda , Downing Nancy R.
Published: January 2022

Background

Persons with severe mental illness (MI) are at a high risk of becoming victims of sexual assault (SA). Vulnerability for SA with any type of MI is unknown. This study aimed to identify the prevalence of preexisting MI and other significant factors in patients reporting preexisting MI at the time of their SA medical forensic examinations (SAMFEs).

Method

A retrospective SAMFE chart review of patients (N = 7,455) from 2010 to 2020 was conducted. Sexual assault nurse examiners completed SAMFEs. Inclusion criteria included (a) aged 14 years and older, (b) completed SAMFE with SA kit evidence collection, and (c) reported to law enforcement (restricted cases not included). Descriptive statistics and chi-square analyses were completed.

Findings

It was found that 46.7% of study participants reported preexisting MI and/or current use of psychotropic medications, more than double the MI prevalence rates in the general population. MI in patients seen for SAMFE was associated with prior history of SA, medical health problems, and physical or mental impairment. In addition, patients with MI reported more violent SAs with increased anogenital and nonanogenital injuries.

Discussion

The high prevalence rate of any MI in patients seen for SAMFE indicates MI in varying severity is a significant vulnerability for SA. The association of preexisting MI with a history of SA, health problems, and physical or mental impairment expands understanding of associated MI factors. These findings support the development of interventions by healthcare providers and stakeholders to address SA vulnerabilities in individuals with MI.
Does Type of Social Support Influence Medication Adherence Among South African Adolescents Living With HIV? A Quantitative Analysis of Pilot Data
Authors: Malo Vincenzo F. , Ritchwood Tiarney D. , Relf Michael V. , Bekker Linda-Gail
Published: January 2022

Adolescents living with HIV often experience worse medication adherence than older and younger individuals living with HIV. One factor that may mitigate poor adherence is social support. However, few studies have examined the influence of specific social support constructs on HIV outcomes like medication adherence. In response to this gap, we performed bivariate analyses using data from 104 adolescents living with HIV in Cape Town, South Africa to understand the relationship between three types of social support (emotional, informational, and instrumental support) and four HIV-related outcomes: adherence self-efficacy, last recorded CD4+ count, last recorded viral load, and adherence to clinic appointments in the past year. We found small positive associations between two social support types (emotional and informational support) and adherence self-efficacy, with no other statistically significant associations. In light of our small sample size, future studies should seek to understand the differential effects of specific types of social support on HIV-related outcomes to better inform interventions for adolescents living with HIV.
Polygenic risk scores for the diagnosis and management of dyslipidemia
Authors: Brunham Liam R. , Trinder Mark
Published: January 2022

Purpose of review

To review current progress in the use of polygenic risk scores for lipid traits and their use in the diagnosis and treatment of lipid disorders.

Recent findings

Inherited lipid disorders, including those causing extremes of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, or triglycerides were initially identified as monogenic traits, in which a single rare variant with large effect size is responsible for the phenotype. More recently, a polygenic basis for many lipid traits has also been identified. Patients with polygenic dyslipidemia can be identified through the use of polygenic risk scores (PRSs), which collapse information from a handful to several million genetic variants into a single metric.

PRSs for lipid traits may aid in the identification of the genetic basis for the lipid phenotype in individual patients, may provide additional information regarding the risk of cardiovascular disease, and could help in guiding therapeutic decision making.
The gut-liver axis in cholangiopathies: focus on bile acid based pharmacological treatment
Authors: Cariello Marica , Gadaleta Raffaella M. , Moschetta Antonio
Published: January 2022

Purpose of review

This review analyses the main features of primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) and provides an overview of the currently available (bile acid) bile acid related treatments.

Recent findings

In PBC, biliary injury is the consequence of a dysregulated intrahepatic and systemic immune response. Given the close association between PSC and inflammatory bowel disease (IBD), the microbiota represents an important factor in the development of PSC. Bile acid based pharmacological treatments could represent promising therapeutic strategies in the management of cholangiopathies.

Cholangiopathies include a spectrum of diseases resulting in cholestasis, an impairment of bile flow in the biliary tree, leading to biliary obstruction and damage as well as liver inflammation and fibrosis. PSC and PBC are highly heterogeneous cholangiopathies and progressive disorders with defined pathophysiological mechanisms. Curative treatments have not been established, and although their prevalence is low, they are a frequent indication for liver transplantation in the advanced stages of cholangiopathies. These diseases still present with unmet therapeutic strategies, also taking into account that on average 30–40% of patients undergoing liver transplantation will have recurrence of the original illness.