bluuebunny/crossref_metadata_2025 huggingface dataset:
The Antimicrobial and Healing Effect of Scrophularia striata Boiss Hydroalcoholic Extract on First- and Second-Grade Pressure Wounds in Patients with Brain and Spinal Cord Injury: A Randomized Clinical Trial
Authors: Bagheri Zahra , Larki-Harchegani Amir , Pourmoslemi Shabnam , Nili-Ahmadabadi Amir , Bakhtiari Ebrahim , Safarpour Hamid , Fathi Jouzdani Ali , Shamsizadeh Morteza
Published: November 2022

Introduction and Objectives. Pressure wound is one of the most common problems in patients with brain and spinal cord lesions leading to complications such as severe pain, infection, and frequent hospitalisation. The present study aimed to determine the restorative and antimicrobial effects of Scrophularia striata hydroalcoholic extract (SHE) on first- and second-grade pressure ulcers in patients with brain and spinal cord lesions. Materials and Methods. This double-blind clinical trial study was performed on grade 1 and 2 pressure wounds in 120 patients with cerebral-spinal cord lesions. The patients were randomly divided into four groups (n = 30). Topical treatments in all groups were performed twice a day. These groups included experiment 1 (SHE + phenytoin), experiment 2 (SHE + SHE), control (phenytoin + phenytoin), and placebo (eucerin + phenytoin). After evaluating the effect of SHE on wound healing, its antibacterial activity was determined by the standard agar well diffusion method. Results. Patients in each group in this study did not significantly differ in demographic and clinical variables. Complete wound healing by the 10th day of the intervention occurred in 63%, 100%, and 27% of patients in experimental 1, experimental 2, and control groups, respectively. In contrast, the placebo group had no complete wound healing until the 10th day. Topical application of SHE, twice a day in the experimental 2 groups, had a higher potency to heal wounds and reduce the duration of complete wound healing in patients compared with other groups. Conclusion. SHE, as a novel treatment option, has good potential to accelerate the healing of first- and second-degree pressure wounds in patients with brain-spinal cord injuries.
Resveratrol Inhibits Insulin-Induced Vascular Smooth Muscle Cell Proliferation and Migration by Activating SIRT1
Authors: Wang Yijie , Lei Lifu , Su Qian , Qin Si , Zhong Jian , Ni Yinxing , Yang Jian
Published: November 2022

Abnormal proliferation and migration of vascular smooth muscle cells (VSMCs) are essential for the development of hypertension. Insulin has been identified to promote VSMC proliferation and migration; resveratrol has been shown to have protective effects against cardiovascular diseases. This study aimed to investigate the effect of resveratrol on insulin-induced VSMC proliferation and migration and its potential mechanism. VSMC proliferation was measured by Cell Counting Kit-8 (CCK-8), cell counting method, and 5-ethynyl-2′-deoxyuridine (EdU) incorporation assay. Cell migration was detected by wound healing assay and transwell method. Expression of silent information regulator of transcription 1 (SIRT1) and phosphorylation levels of signaling molecules, such as phosphatidylinositol 3-kinase (PI3K) and protein kinase B (Akt), in VSMCs were detected by Western blotting. Resveratrol (25-150 μM) was found to inhibit insulin-induced VSMC proliferation. Pretreatment with 100 μM resveratrol reduced insulin (100 nM)-mediated VSMC migration. LY294002, an inhibitor of PI3K, inhibited the stimulatory effect of insulin (100 nM) on the proliferation of VSMCs. Treatment with resveratrol also decreased insulin-induced stimulatory effect on PI3K and Akt phosphorylation levels. Moreover, resveratrol treatment increased SIRT1 protein expression in VSMCs. A SIRT1 inhibitor, EX527, reversed the inhibitory effect of resveratrol on insulin-induced VSMC proliferation and migration and activation of PI3K and Akt phosphorylation levels. In conclusion, our study revealed that treatment with resveratrol inhibited insulin-mediated VSMC proliferation and migration, possibly by activating SIRT1 and downregulating the PI3K/AKT pathway.
Evaluation of Intrarow Spacing on Growth and Yield Performance of Four Onion (Allium cepa L.) Varieties in Beyeda District, North Gondar, Ethiopia
Authors: Wassie Wubetie Adnew , Assegahegn Gashaw Fenta , Tsegaye Berhanu Abraha , Mekonnen Amare Bitew
Published: November 2022

Onion (Allium cepa L.) is a vegetable crop that belongs to the genus Allium under the family Alliaceae produced widely throughout the world. Field experiments were undertaken to evaluate the different varieties and plant spacings on the growth and bulb yield performance of onion (Allium cepa L.) in Beyeda district, North Gondar, Ethiopia. Four different levels of spacing (6, 8, 10, and 12 cm) and four different types of varieties (Shallot, Nasik red, Robat, and Nafis) were arranged under randomized complete block design (RCBD) of factorial arrangement with three replications. The experiment was arranged in 4 × 4 factorial combinations, and the total area was divided into three blocks each of which comprised 16 treatment combinations and a total of 48 plots. The highest plant height (54.18 cm), leaf length (45.48 cm), and leaf diameter (1.47 cm) were recorded from the variety of Nasik red while the lowest plant height, leaf length, and leaf diameter were measured from shallot. The highest leaf number was observed from shallot (37.53) while the lowest leaf number was recorded from the Nafis variety. The longest bulb length (4.44 cm) and the widest bulb diameter (4.67 cm) were obtained from the Nafis variety while the shortest bulb length and narrowest bulb diameter were measured from shallot. Inversely, the highest bulb weight (54.50 g/plant), total biomass (94.75 g/plant), and unmarketable bulb yield (1.75 t/ha) were recorded from shallot while the lowest bulb weight, total biomass, and unmarketable bulb yield were recorded from the Robat variety. Intrarow spacing showed a significant effect on onion growth and bulb yield parameters, as the earliest (135 days) and the most delayed (146 days) maturity were recorded at 6 cm and at 12 cm spaces, respectively. The highest unmarketable bulb yield has been seen at 8 cm and the lowest at 12 cm space of the Nasik red variety. Similarly, the highest leaf number, leaf diameter, bulb diameter, bulb weight, total biomass, marketable, and total bulb yield were recorded at 12 cm space under the Nafis variety. Furthermore, under the shallot variety, the widest bulb diameter was recorded at 10 cm while the narrowest one was recorded at 6 cm space. Generally, based on the result of marketable bulb yield performance, Nafis variety at 12 cm and 8 cm spaces, Robat at 6 cm space, and Nafis red at 10 cm space, respectively, have effective performance for onion production. The interaction effects of intrarow spacing with different varieties did not have a significant effect on all of the growth parameters and yield components.
Research on Small Target Detection Technology Based on the MPH-SSD Algorithm
Authors: Lin Qingyao , Li Su , Wang Rugang , Wang Yuanyuan , Zhou Feng , Chen Zhaofeng , Guo Naihong
Published: November 2022

To address the problems of less semantic information and low measurement accuracy when the SSD (single shot multibox detector) algorithm detects small targets, an MPH-SSD (multiscale pyramid hybrid SSD) algorithm that integrates the attention mechanism and multiscale double pyramid feature enhancement is proposed in this paper. In this algorithm, firstly, the SSD algorithm is used to extract the feature map of small targets, and the shallow feature enhancement module is added to expand the receptive field of the shallow feature layer so as to enrich the semantic information in the feature layer for small targets and improve the expression ability of shallow features. The processed shallow feature layer and deep feature layer are fused at multiple scales, and the semantic information and location information are fused together to obtain a feature map with rich information. Secondly, the cascaded double pyramid structure is used to transfer from the deep layer to the shallow layer so that the context information between different feature layers can be effectively transferred and the feature information can be further strengthened. The hybrid attention mechanism can retain more context information in the network, adaptively adjust the feature map after addition and fusion, and reduce the background interference. The experimental analysis of MPH-SSD algorithm on Pascal VOC and MS COCO datasets shows that the map of this algorithm is 87.7% and 51.1%, respectively. The results show that the MPH-SSD algorithm can make better use of the feature information in the shallow feature layer in the process of small target detection and has better detection performance for small targets.
High-Throughput Functional Evaluation of MAP2K1 Variants in Cancer
Authors: Mizuno Sho , Ikegami Masachika , Koyama Takafumi , Sunami Kuniko , Ogata Dai , Kage Hidenori , Yanagaki Mitsuru , Ikeuchi Hiroshi , Ueno Toshihide , Tanikawa Michihiro , Oda Katsutoshi , Osuga Yutaka , Mano Hiroyuki , Kohsaka Shinji
Published: November 2022

Activating mutations in mitogen-activated protein kinase kinase 1 (MAP2K1) are involved in a variety of cancers and may be classified according to their RAF dependence. Sensitivity to combined BRAF and MEK treatments is associated with co-mutations of MAP2K1 and BRAF; however, the significance of less frequent MAP2K1 mutations is largely unknown. The transforming potential and drug sensitivity of 100 MAP2K1 variants were evaluated using individual assays and the mixed-all-nominated-in-one method. In addition, A375, a melanoma cell line harboring the BRAF V600E mutation, was used to evaluate the function of the MAP2K1 variants in combination with active RAF signaling. Among a total of 67 variants of unknown significance, 16 were evaluated as oncogenic or likely oncogenic. The drug sensitivity of the individual variants did not vary with respect to BRAF inhibitors, MEK inhibitors (MEKi), or their combination. Sensitivity to BRAF inhibitors was associated with the RAF dependency of the MAP2K1 variants, whereas resistance was higher in RAF-regulated or independent variants compared with RAF-dependent variants. Thus, the synergistic effect of BRAF and MEKis may be observed in RAF-regulated and RAF-dependent variants. MAP2K1 variants exhibit differential sensitivity to BRAF and MEKis, suggesting the importance of individual functional analysis for the selection of optimal treatments for each patient. This comprehensive evaluation reveals precise functional information and provides optimal combination treatment for individual MAP2K1 variants.
Loss of Dok-3 in Non-tumor Cells Induces Malignant Transformation of Benign Epithelial Tumor Cells of the Intestine
Authors: Arimura Sumimasa , Inoue-Yamauchi Akane , Katayama Kotoe , Kanno Tatsuo , Jozawa Hiroki , Imoto Seiya , Yamanashi Yuji
Published: November 2022

The fundamental difference between benign and malignant tumors lies in their invasive ability. It is believed that malignant conversion of benign tumor cells is induced by a tumor cell–intrinsic accumulation of driver gene mutations. Here, we found that disruption of the Dok-3 tumor suppressor gene led to malignant progression in the intestinal benign tumor model ApcMin/+ mice. However, Dok-3 gene expression was undetectable in epithelial tumor cells and the transplantation of bone marrow cells lacking the Dok-3 gene–induced malignant conversion of epithelial tumor cells in ApcMin/+ mice, indicating a previously unrecognized tumor cell–extrinsic mechanism. Moreover, the Dok-3 loss–induced tumor invasion in ApcMin/+ mice required CD4+ and CD8+ T lymphocytes, but not B lymphocytes. Finally, whole-genome sequencing showed an indistinguishable pattern and level of somatic mutations in tumors irrespective of the Dok-3 gene mutation in ApcMin/+ mice. Together, these data indicate that Dok-3 deficiency is a tumor-extrinsic driving force of malignant progression in ApcMin/+ mice, providing a novel insight into microenvironments in tumor invasion.

Significance:

This study uncovers tumor cell–extrinsic cues that can induce malignant conversion of benign tumors without intensifying mutagenesis in tumors, a novel concept potentially providing a new therapeutic target in malignancy.
A Case of Pigment Dispersion Syndrome after Placement of Sulcus Intraocular Lens with 7-mm Optic Diameter after Posterior Capsule Rupture
Authors: Nagata Mayumi , Matsushima Hiroyuki , Senoo Tadashi
Published: November 2022

A 48-year-old woman diagnosed with primary angle closure suspect (PACS) in the right eye underwent cataract surgery, and a 7-mm optic diameter intraocular lens (IOL) was placed in the ciliary sulcus after intraoperative posterior capsule rupture. The patient developed uveitis and blurred vision the next day. The IOL was fixed between the iris and the anterior capsule. Irregularly shaped pupils due to posterior synechia and pigmentation on the IOL surface were observed. In the Scheimpflug image, the IOL on the anterior capsule was observed and the anterior chamber depth was 2.92 mm. A diagnosis of pigment dispersion syndrome and elevated intraocular pressure due to sulcus IOL placement was made. The patient underwent intrascleral IOL fixation surgery using an already inserted IOL to reposition the IOL under the anterior capsule. After 1 week, the blurred vision, anterior chamber inflammation, and IOL surface pigmentation were resolved. The right eye IOP was 15 mm Hg and the pupil became a regular circle. Scheimpflug images showed the IOL located behind the anterior capsule and an anterior chamber depth of 3.88 mm. Because the patient had a slightly shorter axial length of 22.89 mm and PACS, pigment dispersion may have occurred due to friction between the iris and the shape of the optic edge with a large optic diameter. In cases of posterior capsule rupture with short axial length and PACS, the use of a 7-mm optic diameter IOL in the sulcus should be avoided, or intrascleral IOL fixation should be selected as the surgical technique.
Impacts of the COVID-19 Pandemic Exposure on Child Dental Caries: Difference-in-Differences Analysis
Authors: Matsuyama Yusuke , Isumi Aya , Doi Satomi , Fujiwara Takeo
Published: November 2022

The impact of the coronavirus disease 2019 (COVID-19) pandemic on dental caries is unknown. We investigated the effect of the pandemic on child dental caries in Japan by comparing the increase in dental caries from fourth to sixth grade between two cohorts, COVID-19 exposed cohort and COVID-19 unexposed cohort, using difference-in-differences analysis. Longitudinal data that followed elementary school children in Adachi City, Tokyo, were analyzed. The analysis consisted of two cohorts: those who were in fourth grade in 2016 and sixth grade in 2018 (COVID-19 unexposed cohort, N = 399) and those who were in fourth grade in 2018 and sixth grade in 2020 (COVID-19 exposed cohort, N = 3,082). Children’s dental caries were examined by school dentists. A difference-in-differences analysis, adjusting for time-variant variables, i.e., household socioeconomic status, children’s oral health behavior, and caregivers’ psychological distress, was performed. In fourth grade, the number of Decayed, Missing, and Filled permanent Teeth (DMFT) was not different between the COVID-19 unexposed and exposed cohorts (mean = 0.241 and 0.242, respectively). In sixth grade, DMFT increased by 0.067 in the COVID-19 unexposed cohort and 0.180 in the COVID-19 exposed cohort. The interaction term of grade and cohorts for caries by difference-in-differences analysis showed that dental caries among the COVID-19 exposed cohort showed a significant increase in the number of dental caries by 0.116 (95% confidence interval 0.015, 0.216) compared to the COVID-19 unexposed cohort. Child dental caries slightly increased after the pandemic. Studies with longer follow-ups are needed to evaluate the impact of the pandemic on child dental caries.
Outcome of Pregnancy in Women With D‐Transposition of the Great Arteries: A Systematic Review
Authors: Pizula Jena , Devera Justin , Ng Tien M. H. , Yeung Samantha L. , Thangathurai Jenica , Herrick Nichole , Chatfield Amy J. , Mehra Anil , Elkayam Uri
Published: November 2022

Background

Information on maternal and fetal outcomes of pregnancy in women with D‐transposition of the great arteries is limited. We conducted a systematic literature review on pregnancies in women with transposition of the great arteries after atrial and arterial switch operations to better define maternal and fetal risk.

Methods and Results

A systematic review was performed on studies between 2000 and 2021 that identified 676 pregnancies in 444 women with transposition of the great arteries. A total of 556 pregnancies in women with atrial switch operation were tolerated by most cases with low mortality (0.6%). Most common maternal complications, however, were arrhythmias (9%) and heart failure (8%) associated with serious morbidity in some patients. Worsening functional capacity, right ventricular function, and tricuspid regurgitation occurred in ≈20% of the cases. Rate of fetal and neonatal mortality was 1.4% and 0.8%, respectively, and rate of prematurity was 32%. A total of 120 pregnancies in women with arterial switch operation were associated with no maternal mortality, numerically lower rates of arrhythmias and heart failure (6% and 5%, respectively), significantly lower rate of prematurity (11%;
P
<0.001), and only 1 fetal loss.

Conclusions

Pregnancy is tolerated by most women with transposition of the great arteries and atrial switch operation with low mortality but important morbidity. Most common maternal complications were arrhythmias, heart failure, worsening of right ventricular function, and tricuspid regurgitation. There was also a high incidence of prematurity and increased rate of fetal loss and neonatal mortality. Outcome of pregnancy in women after arterial switch operations is more favorable, with reduced incidence of maternal complications and fetal outcomes similar to women without underlying cardiac disease.
Risk Factors for Delayed Cerebral Ischemia in Good‐Grade Patients With Aneurysmal Subarachnoid Hemorrhage
Authors: Rautalin Ilari , Juvela Seppo , Martini Michael L. , Macdonald Robert Loch , Korja Miikka
Published: November 2022

Background

A subset of good‐grade patients with aneurysmal subarachnoid hemorrhage (aSAH) develop delayed cerebral ischemia (DCI) that may cause permanent disabilities after aSAH. However, little is known about the risk factors of DCI among this specific patient group.

Methods and Results

We obtained a multinational cohort of good‐grade (Glasgow Coma Scale 13–15 on admission) patients with aSAH by pooling patient data from 4 clinical trials and 2 prospective cohort studies. We collected baseline data on lifestyle‐related factors and the clinical characteristics of aSAHs. By calculating fully adjusted risk estimates for DCI and DCI‐related poor outcome, we identified the most high‐risk patient groups. The pooled study cohort included 1918 good‐grade patients with aSAH (median age, 51 years; 64% women), of whom 21% and 7% experienced DCI and DCI‐related poor outcome, respectively. Among men, patients with obesity and (body mass index ≥30 kg/m
2
) thick aSAH experienced most commonly DCI (33%) and DCI‐related poor outcome (20%), whereas none of the normotensive or young (aged <50 years) men with low body mass index (body mass index <22.5 kg/m
2
) had DCI‐related poor outcome. In women, the highest prevalence of DCI (28%) and DCI‐related poor outcome (13%) was found in patients with preadmission hypertension and thick aSAH. Conversely, the lowest rates (11% and 2%, respectively) were observed in normotensive women with a thin aSAH.

Conclusions

Increasing age, thick aSAH, obesity, and preadmission hypertension are risk factors for DCI in good‐grade patients with aSAH. These findings may help clinicians to consider which good‐grade patients with aSAH should be monitored carefully in the intensive care unit.
Prehospital Stroke Care Part 1: Emergency Medical Services and the Stroke Systems of Care
Authors: Zachrison Kori S. , Nielsen Victoria M. , de la Ossa Natalia Perez , Madsen Tracy E. , Cash Rebecca E. , Crowe Remle P. , Odom Erika C. , Jauch Edward C. , Adeoye Opeolu M. , Richards Christopher T.
Published: November 2022

Acute stroke care begins before hospital arrival, and several prehospital factors are critical in influencing overall patient care and poststroke outcomes. This topical review provides an overview of the state of the science on prehospital components of stroke systems of care and how emergency medical services systems may interact in the system to support acute stroke care. Topics include layperson recognition of stroke, prehospital transport strategies, networked stroke care, systems for data integration and real-time feedback, and inequities that exist within and among systems.
Architecture for Real-Time Granular Synthesis With Per-Grain Processing: EmissionControl2
Authors: Roads Curtis , Kilgore Jack , DuPlessis Rodney
Published: November 2022

EmissionControl2 (EC2) is a precision tool that provides a versatile and expressive platform for granular synthesis education, research, performance, and studio composition. It is available as a free download on all major operating systems.

In this article, we describe the theoretical underpinnings of the software and expose the design choices made in creating this instrument. We present a brief historical overview and cover the main features of EC2, with an emphasis on per-grain processing, which renders each grain as a unique particle of sound. We discuss the graphical user interface design choices, the theory of operation, and intended use cases that guided these choices. We describe the architecture of the real-time per-grain granular engine, which emits grains in synchronous or asynchronous streams. We conclude with an evaluation of the software.
Meta-Learning the Difference: Preparing Large Language Models for Efficient Adaptation
Authors: Hou Zejiang , Salazar Julian , Polovets George
Published: November 2022

Large pretrained language models (PLMs) are often domain- or task-adapted via finetuning or prompting. Finetuning requires modifying all of the parameters and having enough data to avoid overfitting while prompting requires no training and few examples but limits performance. Instead, we prepare PLMs for data- and parameter-efficient adaptation by learning to learn the difference between general and adapted PLMs. This difference is expressed in terms of model weights and sublayer structure through our proposed dynamic low-rank reparameterization and learned architecture controller. Experiments on few-shot dialogue completion, low-resource abstractive summarization, and multi-domain language modeling show improvements in adaptation time and performance over direct finetuning or preparation via domain-adaptive pretraining. Ablations show our task-adaptive reparameterization (TARP) and model search (TAMS) components individually improve on other parameter-efficient transfer like adapters and structure-learning methods like learned sparsification.
The Modern Subject Sensing its Agency: Khalīl al-Khūrī’s Aesthetics of “Truth Mingled with Passion”
Authors: Guth Stephan
Published: November 2022

In the introduction to what is often labelled “the first Arabic novel”, Khalīl al-Khūrī’s Way, idhan lastu bi-Ifranjī (1859), the author not only criticises contemporary Westernisation, but also outlines a new aesthetics that integrates authenticity, logical plausibility, and passion (hawas). This article explains how al-Khūrī’s advocacy of the “indigenous way of life”, literary authenticity, and an emotionalisation of writing belong together. They spring from the same source, just as does the temporalisation inherent in the nahḍa’s predilection for plot narratives: the modern subject beginning to sense its agency and seeking to assert itself.
Legal Humility and Perceptions of Power in International Criminal Justice
Authors: Palmer Nicola , Hamilton Tomas
Published: November 2022

This article examines how judges and lawyers working in international criminal courts see their authority in relation to power exerted by states, international organisations and private actors. We draw together ethnographic research inside the International Criminal Tribunal for Rwanda (ictr) and the International Criminal Court (icc) that examined perceptions of the interactions among local, national and international legal regimes and the potential for accomplice liability for arms traders under international criminal law. Overall, we show that the legal actors in these courts routinely understood their power as severely limited by concurrent sites of private and public authority. Building on ideas of legal humility, we argue that this should be understood as ‘selective humility’. This humility demonstrated a reticence among these legal actors about what internationalised courts can achieve while offering an argumentative defence against critiques of this legal practice.
Religious Actors, Care, and Mood in the Time of COVID-19
Authors: Jammes Jérémy , Hoon Chang-Yau
Published: November 2022

The introduction to this special issue considers the interdisciplinary study of religious sentiments, religious care and social actions during the COVID-19 outbreak in South-, East- and Southeast Asia. Our approach in terms of nodes and polarisation allows one to visualise a bundle of religious and secular actors and interests, as well as original strategies and actions, in time of pandemic, which sometimes challenge local regimes of truth and authority. In many cases, faith-based NGO s have been complementing the State, activating their powerful channels of mission in urban and rural areas, under the guise of combating COVID-19 crisis. The studies presented here examine several Asian religious actors during this period of COVID-19 crisis; and the ways in which their creative digitalised measures of worship, protection and healing, and their participation in urgent public health and care provisions, have given them the opportunity to renegotiate their relationships with States and societies.
Two Unpublished Prayers by Erasmus
Authors: Trapman Johannes
Published: November 2022

Two unpublished prayers by Erasmus handed down by Beatus Rhenanus.
Neoephemeridae (Insecta, Ephemeroptera) of the Philippines and Insights on Southeast Asian biodiversity
Authors: Garces Jhoana M. , Sartori Michel
Published: November 2022

A new mayfly species, Potamanthellus panayensis sp. n. (Neoephemeridae) is described from Panay Island, Philippines, based on nymphs. Supplementary nymphal description of P. caenoides (Ulmer, 1939) and a provisional description of another Potamanthellus species from Mindanao Island, Philippines are provided. The potential underestimated diversity of Potamanthellus in Southeast Asia is discussed in line with the species delimitation in this study based on COI sequences.
Streamflow Composition and the Contradicting Impacts of Anthropogenic Activities and Climatic Change on Streamflow in the Amu Darya Basin, Central Asia
Authors: Hou Mei , Cuo Lan , Murodov Amirkhamza , Ding Jin , Luo Yi , Liu Tie , Chen Xi
Published: November 2022

Transboundary rivers are often the cause of water-related international disputes. One example is the Amu Darya River, with a catchment area of 470 000 km2, which passes through five countries and provides water resources for 89 million people. Intensified human activities and climate change in this region have altered hydrological processes and led to water-related conflicts and ecosystem degradation. Understanding streamflow composition and quantifying the change impacts on streamflow in the Amu Darya basin (ADB) are imperative to water resources management. Here, a degree-day glacier-melt scheme coupled offline with the Variable Infiltration Capacity hydrological model (VIC-glacier), forced by daily precipitation, maximum and minimum air temperature, and wind speed, is used to examine streamflow composition and changes during 1953–2019. Results show large differences in streamflow composition among the tributaries. There is a decrease in the snowmelt component (−260.8 m3 s−1) and rainfall component (−30.1 m3 s−1) at Kerki but an increase in the glacier melt component (160.0 m3 s−1) during drought years. In contrast, there is an increase in the snowmelt component (378.6 m3 s−1) and rainfall component (12.0 m3 s−1) but a decrease in the glacier melt component (−201.8 m3 s−1) during wet years. Using the VIC-glacier and climate elasticity approach, impacts of human activities and climate change on streamflow at Kerki and Kiziljar during 1956–2015 are quantified. Both methods agree and show a dominant role played by human activities in streamflow reduction, with contributions ranging 103.2%–122.1%; however, the contribution of climate change ranges from −22.1% to −3.2%.
Nonresident Fathers and the Economic Precarity of Their Children
Authors: Nepomnyaschy Lenna , Thomas Margaret , Haralampoudis Alex , Jin Huiying
Published: November 2022

This study examines the relationship between nonresident fathers and their children’s economic precarity. We use a racially, ethnically, and socioeconomically diverse sample of children in large U.S. cities and consider a comprehensive set of measures of the involvement of nonresident fathers in their lives. We evaluate both voluntary and involuntary (court-ordered child support) involvement of fathers, and we look at material hardship and income-to-poverty ratio as measures of children’s economic precarity. We find that only high levels of formal child support have a protective effect on children’s economic well-being, while fathers’ voluntary involvement (experienced by 70 percent of children) has a more consistent protective effect. Overall, policies to reduce children’s economic precarity need to focus on improving nonresident fathers’ ability to be involved with and contribute to their children, as well as on direct assistance to custodial mother families.
Economic Precarity among Single Parents in the United States during the COVID-19 Pandemic
Authors: Parolin Zachary , Lee Emma K.
Published: November 2022

Single-parent families have historically faced greater economic precarity relative to other family types in the United States. We investigate how and whether those disparities widened after the onset of the COVID-19 pandemic. Using data on exposure to school and childcare center closures, unemployment, poverty, food hardship, and frequent worrying among single-parent families versus two-parent families throughout 2020 and 2021, we find that the challenges that single parents faced prior to the pandemic generally magnified after the arrival of COVID-19. In April 2020, one in four single parents was unemployed, and unemployment rates recovered more slowly for single parents throughout 2021, perhaps in part due to their unequal exposure to school and childcare closures. The expansion of income transfers largely buffered against potential increases in poverty and hardship, but levels of worrying among single parents continued to worsen throughout 2021.
Single Parents Competing in a Dual-Earner Society: Social Policy to Level the Playing Field
Authors: Nieuwenhuis Rense
Published: November 2022

I examine the relative poverty risk among single-parent households in countries that have a large share of households with dual earners. Data from the Luxembourg Income Study (LIS) Database are used to analyze eighteen OECD countries in the period 1984 to 2010. I find that single parents face higher relative income poverty risks in countries with a large share of dual-earner households and that this higher risk of poverty is related to higher standards of living in those countries: higher standards of living have raised poverty thresholds, and single-parent incomes are less likely to reach those higher poverty thresholds. I also find that this overall pattern varied across institutional contexts: a rise of dual-earner households puts single parents at a disadvantage only in countries that have relatively low public expenditures on childcare and relatively low income transfer policies.
Effective Policies for Single-Parent Families and Prospects for Policy Reforms in the United States: Concluding Reflections
Authors: Gornick Janet C. , Maldonado Laurie C. , Sheely Amanda
Published: November 2022

This conclusion engages two questions catalyzed by the articles in this volume. First, which policies are effective in reducing economic hardship among single-parent families overall and minimizing disparities across subgroups? Second, what are the prospects for related reforms in the United States? We draw four lessons from the articles in this volume and from prior research about effective policy design: (1) work-family reconciliation policies are crucial; (2) strengthening and stabilizing employment is necessary, but not sufficient; (3) it is important to support the accumulation of wealth in addition to shoring up income; and (4) policies can be designed to include and protect those single parents and their children who are especially at risk. Turning to the feasibility of policy change in the United States, we conclude that some factors—especially policy elements that encourage self-reliance, shifting public opinion, the COVID-19 crisis, and federalism itself—may enhance opportunities for policy development in support of single parents.
Adult Sacrococcygeal Teratomas
Authors: Audet Isabelle M. , Goldhahn Richard T. , Dent Thomas L.
Published: November 2022

We report a rare case of a benign adult sacrococcygeal teratoma discovered during pregnancy. The cystic mass was confirmed on CT scan and magnetic resonance imaging. In the fifth postpartum month, three cysts (1, 2.5, and 6 cm) were excised. Pathologically, the specimens contained differentiated tissue from all three germ layers, including endocrine tissue within the ectopic exocrine pancreas.
Axillary Lymph Node Dissection in Breast Cancer: An Evolving Question?
Authors: Lagares-Garcia Jorge A. , Garguilo Gerard , Kurek Stanley , Leblond Gennie , Diaz Francisco
Published: November 2022

Axillary lymph node dissection (ALND) is performed for staging purposes. Sentinel lymph node biopsy may decrease the cost and morbidity of ALND. Are there patients that the procedure is not indicated avoiding cost and morbidity? We retrospectively studied the incidence of lymph node metastasis in 423 patients with T1 breast cancer. Thirty-one T1a, 146 T1b, and 246 T1c tumors were seen. The mean age was 61 years. Ten per cent were premenopausal, and 84 per cent were postmenopausal. Tumor size averaged 1.29 cm. Eighty-one per cent of the tumors were node negative and 19 per cent were node positive. One T1a patient (3 per cent) had an axillary metastasis, 19 T1b patients (13%), and 61 T1c patients (25%) were node positive, respectively. Seventy-three per cent were ER positive. Thirty-three patients (8%) died from cancer. Eighty-seven per cent received surgery with axillary lymph node dissection (ALND), and three per cent had surgery without ALND. Younger age, increased tumor size, premenopausal status, and ER negativity affected node positivity rates ( P < 0.05). Death from breast cancer was more common among node-positive patients ( P < 0.05). No difference was found regarding the performance of ALND and survival ( P > 0.05). We feel that ALND can be safely omitted in T1a to reduce the morbidity and the expense of breast cancer treatment. In T1b and T1c tumors, the use of ALND is necessary, but morbidity and cost can be reduced by the use of sentinel lymph node biopsy.
Retroperitoneal Compartment Syndrome after Renal Transplantation
Authors: Koss Wega G. , Johnson Lynt B. , Kuo Paul C.
Published: November 2022

We report the case of a 21-year-old man with end-stage renal disease secondary to systemic lupus erythematosus who underwent living related renal transplantation and developed an extraperitoneal compartment syndrome postoperatively.
Sepsis Syndrome
Authors: Fry Donald E.
Published: November 2022

A clinical syndrome including fever, leukocytosis, elevated cardiac output, and reduced systemic vascular resistance has been associated with severe infection (i.e., sepsis). However, during the last 15 years, many patients have demonstrated all of the findings that have traditionally been associated with “sepsis” but have not had demonstrated sources of infection. This led to the term “sepsis syndrome” to refer to that population of patients who appeared to have a physiologic and metabolic response associated with, but who did not have, severe infection. More commonly called the systemic inflammatory response syndrome (SIRS), the sepsis syndrome is now associated with the nonspecific systemic activation of the human inflammatory cascade by any of a number of clinical events. The management of the SIRS patient has been ineffective because of incomplete definition of the mechanisms responsible for the syndrome. It is argued that all of the biological mechanisms that are operative in a simple wound and are beneficial are negative for the host when activated systemically. Thus, SIRS is seen in three separate scenarios at present: (1) invasive infection; (2) dissemination of microbes secondary to failure of host defense mechanisms; and (3) severe activation of inflammation by injury, shock, severe soft tissue inflammation, and other noninfectious but proinflammatory events. Newer treatment strategies will need to focus not on the inciting event itself but on better control of the complex responses of the host.
Postoperative Pneumonia
Authors: Croce Martin A.
Published: November 2022

Despite the advances made in surgical critical care, the diagnosis of one of the most common infections seen in critically ill patients remains a challenge. Ventilator-associated pneumonia is associated with a 20 to 25 per cent mortality rate. There are numerous risk factors for ventilator-associated pneumonia, including underlying disease, prolonged mechanical ventilation, direct lung injury, and shock. The standard clinical criteria for pneumonia are inaccurate. Quantitative cultures of bronchoalveolar lavage effluent are accurate for the diagnosis, and it is safe to base antibiotic therapy on the results of the quantitative cultures.
Splenic Abscess 10 Years after Splenic Trauma: A Case Report
Authors: Toevs Christine C. , Beilman Gregory J.
Published: November 2022

Splenic abscess is an uncommon complication of splenic trauma. Splenic abscess presents within several months of the trauma. We report a case of a splenic abscess 10 years after trauma and review the current understanding of splenic abscesses.
Tornado Disaster in Rural Georgia: Triage Response, Injury Patterns, Lessons Learned
Authors: Millie Michael , Senkowski Christopher , Stuart Lynn , Davis Frank , Ochsner Gage , Boyd Carl
Published: November 2022

Our objective was to characterize the medical response and injury patterns from a recent tornado disaster in rural southeastern Georgia. We conducted a retrospective review of 11 patients treated at a Level I trauma center after sustaining injuries due to an April 9, 1998 F3 tornado. Data were obtained from trauma registry and medical records. Of 11 victims, 8 (73%) were male. Ages ranged from 5 to 54 years. Two patients were triaged directly by military heliopter, six arrived as secondary triage from local rural hospitals (2 by air, 4 by ground), and three arrived by delayed secondary transfer. Six patients were thrown by the tornado, and five were struck by flying debris. All victims were either in exposed areas or mobile homes. Injuries by anatomic region included the chest (45%), abdomen (27%), extremity (91%), and head (45%). Nine (82%) of the patients required surgical intervention. These included three laparotomies, one thoracotomy, six orthopedic procedures, and one neurosurgical procedure. The average Injury Severity Score (ISS) was 23. Among patients who were thrown mean ISS was 31; among those struck by debris, mean ISS was 12. Hemodynamically significant pelvic fractures occurred in three patients (27%). The major complication, sepsis due to Serratia marcescens was seen in three patients, all of whom had been thrown and had clinically significant wound contamination. Both patients who died had Serratia sepsis and multiorgan system failure. The injuries and inclement weather characteristic of tornado disasters stress regional trauma triage responses, cause significant injury, and disrupt communities. Injury patterns involve multiple systems and require coordinated efforts among caretakers. Infectious complications are common and frequently involve Gram-negative bacilli and are associated with soil-contaminated wounds. Trauma severity increases if the victim is thrown rather than struck by flying debris.
Heartburn is More Likely to Recur after Toupet Fundoplication than Nissen Fundoplication
Authors: Farrell Timothy M. , Archer Stephen B. , Galloway Kathy D. , Branum Gene D. , Smith C. Daniel , Hunter John G.
Published: November 2022

Toupet (270°) fundoplication is commonly recommended for patients with gastroesophageal reflux (GER) and esophageal dysmotility. However, Toupet fundoplication may be less effective at protecting against reflux than Nissen (360°) fundoplication. We therefore compared the effectiveness and durability of both types of fundoplication as a function of preoperative esophageal motility. From January 1992 through January 1998, 669 patients with GER underwent laparoscopic fundoplication (78 Toupet, 591 Nissen). Patients scored heartburn, regurgitation, and dysphagia preoperatively, and at 6 weeks and 1 year postoperatively, using a 0 (“none”) to 3 (“severe”) scale. We compared symptom scores (Wilcoxon rank sum test) and redo fundoplication rates (Fisher exact test) in Toupet and Nissen patients. We also performed subgroup analyses on 81 patients with impaired esophageal motility (mean peristaltic amplitude, <30 mm Hg or peristalsis <70% of wet swallows) and 588 patients with normal esophageal motility. Toupet and Nissen patients reported similar preoperative heartburn, regurgitation, and dysphagia. At 6 weeks after operation, heartburn and regurgitation were similarly improved in both groups, but dysphagia was more prevalent among Nissen patients. After 1 year, heartburn and regurgitation were re-emerging in Toupet patients, and dysphagia was again similar between groups. Patients with impaired motility who have Nissen fundoplication are no more likely to suffer persistent dysphagia than their counterparts who have Toupet fundoplication. In addition, patients with normal motility are more likely to develop symptom recurrence after Toupet fundoplication than Nissen fundoplication, with no distinction in dysphagia rates. We conclude that since Toupet patients suffer more heartburn recurrence than Nissen patients, with similar dysphagia, selective use of Toupet fundoplication requires further study.
Experience with the Insertion of Vena Caval Filters in Acutely Burned Patients
Authors: Still Joseph , Friedman Bruce , Furman Steven , Cohen Howard , Gates Christopher , Dawson John , Law Edward
Published: November 2022

The use of inferior vena caval filters in patients at high risk of pulmonary emboli is a standard practice in many types of patients. The usefulness of such filters in acutely burned patients has yet to be established. Twenty inferior vena caval filters were inserted in burn patients. Five were inserted because of preexisting thromboembolic disease. Fifteen were placed prophylactically because of high-risk states, including prolonged immobilization, old age, bleeding problems, and obesity. There were no complications due to filter insertion. No postinsertion emboli were recognized. There were no cases of postinsertion thrombophlebitis. In this small/series, the procedure appears to be effective and safe.
Sentinel Lymphadenectomy for Staging Patients with Intermediate-Level Melanoma
Authors: Smart Kenneth R. , Cahoon Bob W. , Dale Paul S.
Published: November 2022

Sentinel lymph node dissection (SLND) as originally described by D.L. Morton et al. (Surg Oncol Clin North Am 1992;1:247–59), is currently being used at most tertiary institutions for staging patients with intermediate-level melanomas. Identification and subsequent surgical resection of occult metastasis before the development of clinical disease may improve survival in these patients. This study is a retrospective review of patients with intermediate melanomas treated by the senior author (P.S.D.). Isosulfan blue dye and a radioactive technetium-labeled dye were used to identify the sentinel node. Sentinel nodes were evaluated by routine hematoxylin and eosin staining, immunohistochemical staining for S-100 and HMB-45, and later in the study with multipanel reverse transcriptase-polymerase chain reaction analysis. All patients were followed closely. Fifty-seven patients with primary melanoma were evaluated between December 1995 and June 1998. Thirty-two patients underwent SLND; two patients underwent SLND on two separate drainage basins, for a total of 34 procedures. The median age was 49 years (range, 19–77). There were 11 females and 21 males. The locations of the primary melanoma were: head and neck, seven; extremity, 8; and trunk, 18; 1 patient had a dual primary melanoma at presentation. Clark's levels of invasion among the patients were level III, 5; and level IV, 27; median Breslow thickness was 1.4 mm (range, 0.45–3.8 mm). A sentinel node was not identified in four procedures (11.1%). Twenty-two nodes (73%) were negative by all methods, and eight (27%) were positive by at least one method. All positive patients underwent complete lymphadenectomy, and routine hematoxylin and eosin stains identified no additional positive nodes. Median follow-up was 21 months (6–36 months). Two patients developed recurrent disease. The other 30 patients remain disease free at last follow-up. SLND is a low-morbidity technique that accurately stages patients with intermediate-level melanoma. Early intervention with complete therapeutic lymphadenectomy and possible interferon therapy may improve the survival of patients with stage III melanoma. A complete discussion of the technique for SLND and an update of this data is presented.
Traumatic Shock Alias Posttrauma Critical Illness
Authors: Hardaway Robert M.
Published: November 2022

Trauma is the most common cause of death under the age of 45. Many trauma patients die of multiple organ failure, especially acute respiratory distress syndrome. The basic cause of traumatic shock has only partially been elucidated. Data resources include research papers on the subject of trauma and shock from 1875 to the present. These papers numbered more than 40,000. Almost all of the papers proposed that traumatic shock was due to hypovolemia. The concept of a shock toxin as promulgated during World War I is correct. This toxin is a thrombogenic aminophospholipid that occurs only on the inner layer of all cell membranes and is liberated by cell destruction. It causes disseminated intravascular coagulation, which may obstruct the microcirculation of any and all organs producing multiple organ failure by microclots. These microclots may be lysed by plasminogen activator and circulation to the organs restored.