bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Integration Change Gender Attitudes? The Effect of Randomly Assigning Women to Traditionally Male Teams
Authors: Dahl Gordon B , Kotsadam Andreas , Rooth Dan-Olof
Published: December 2020

We examine whether integrating men and women in a traditionally male-dominated environment can change men's attitudes about mixed-gender productivity, gender roles, and gender identity. Our context is the military in Norway, where we randomly assigned female recruits to some squads but not others during boot camp. We find that living and working with women for eight weeks causes men to have more egalitarian attitudes. There is a 14 percentage point higher fraction of men who think mixed-gender teams perform as well or better than same-gender teams, an 8 percentage point increase in men who think household work should be shared equally, and a 14 percentage point increase in men who do not completely disavow feminine traits. Moreover, men in mixed-gender teams are more likely to choose military occupations immediately after boot camp that have a higher fraction of women in them. But these effects do not persist once treatment stops. Treated men’s attitudes converge to those of the controls in a six-month follow-up survey, and there is no long-term effect on choosing fields of study, occupations, or workplaces with a higher fraction of women after military service ends. Contrary to the predictions of many policy makers, we do not find that integrating women into squads hurt male recruits’ performance or satisfaction with service, either during boot camp or their subsequent military assignment. These findings provide evidence that even in a highly gender-skewed environment, gender stereotypes are malleable and can be altered by integrating members of the opposite sex. But they also suggest that without continuing intensive exposure, effects are unlikely to persist.
How Much Information Is Incorporated into Financial Asset Prices? Experimental Evidence
Authors: Page Lionel , Siemroth Christoph
Published: December 2020

We investigate the informational content of prices in financial asset markets. To do so, we use a large number of market experiments in which the amount of information held by traders is precisely observed. We derive a new method to estimate how much of this information is incorporated into market prices. We find that public information is almost completely reflected in prices but that surprisingly little private information—less than 50%—is incorporated into prices. Our estimates therefore suggest that, while semistrong informational efficiency is consistent with the data, financial market prices may be very far from strong-form efficiency.
Bank Lending in the Knowledge Economy
Authors: Dell’Ariccia Giovanni , Kadyrzhanova Dalida , Minoiu Camelia , Ratnovski Lev
Published: December 2020

We study the composition of bank loan portfolios during the transition of the real sector to a knowledge economy where firms increasingly use intangible capital. Exploiting heterogeneity in bank exposure to the compositional shift from tangible to intangible capital, we show that exposed banks curtail commercial lending and reallocate lending to other assets, such as mortgages. We estimate that the substantial growth in intangible capital since the mid-1980s explains around 30% of the secular decline in the share of commercial lending in banks’ loan portfolios. We provide suggestive evidence that this reallocation increased the riskiness of banks’ mortgage lending.
Propofol-Associated Hypertriglyceridemia in Coronavirus Disease 2019 Versus Noncoronavirus Disease 2019 Acute Respiratory Distress Syndrome
Authors: Kenes Michael T. , McSparron Jakob I. , Marshall Vincent D. , Renius Karl , Hyzy Robert C.
Published: December 2020

Objectives:

To characterize the incidence and characteristics of propofol-associated hypertriglyceridemia in coronavirus disease 2019 versus noncoronavirus disease 2019 acute respiratory distress syndrome.

Design:

Single-center prospective, observational cohort study.

Setting:

Medical ICU and regional infectious containment unit.

Patients:

Patients with acute respiratory distress syndrome admitted from April 7, 2020, to May 15, 2020, requiring continuous propofol administration.

Interventions:

None.

Measurements and Main Results:

Of 50 patients enrolled, 54% had coronavirus disease 2019 acute respiratory distress syndrome. Median Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores were 35.5 (interquartile range, 30.2–41) and 8 (interquartile range, 6–9). Pao
2/Fio
2 ratio was 130.5 (interquartile range, 94.5–193.8). Patients with coronavirus disease 2019-associated acute respiratory distress syndrome experienced a higher rate of hypertriglyceridemia (triglyceride ≥ 500 mg/dL) than noncoronavirus disease 2019-associated acute respiratory distress syndrome (9 [33.3%] vs 1 [4.3%]; p = 0.014). Those with coronavirus disease 2019, compared with those without, received more propofol prior to becoming hypertriglyceridemic (median, 5,436.0 mg [interquartile range, 3,405.5–6,845.5 mg] vs 4,229.0 mg [interquartile range, 2,083.4–4,972.1 mg]; p = 0.027). After adjustment for propofol dose with logistic regression (odds ratio, 5.97; 95% CI, 1.16–59.57; p = 0.031) and propensity score matching (odds ratio, 8.64; 95% CI, 1.27–149.12; p = 0.025), there remained a significant difference in the development of hypertriglyceridemia between coronavirus disease 2019-associated acute respiratory distress syndrome and noncoronavirus disease 2019-associated acute respiratory distress syndrome. There was no difference between groups in time to hypertriglyceridemia (p = 0.063). Serum lipase was not different between those who did or did not develop hypertriglyceridemia (p = 0.545). No patients experienced signs or symptoms of pancreatitis.

Conclusions:

Patients with coronavirus disease 2019 acute respiratory distress syndrome experienced a higher rate of propofol-associated hypertriglyceridemia than noncoronavirus disease 2019 acute respiratory distress syndrome patients, even after accounting for differences in propofol administration.
Thromboembolism, Hypercoagulopathy, and Antiphospholipid Antibodies in Critically Ill Coronavirus Disease 2019 Patients: A Before and After Study of Enhanced Anticoagulation
Authors: van der Linden Jan , Almskog Lou , Liliequist Andreas , Grip Jonathan , Fux Thomas , Rysz Susanne , Ågren Anna , Oldner Anders , Ståhlberg Marcus
Published: December 2020

Objectives:

To determine the prevalence of thrombotic events, functional coagulation tests, inflammatory biomarkers, and antiphospholipid antibodies before and after enhanced anticoagulation in critically ill coronavirus disease 2019 patients.

Design:

Retrospective.

Setting:

Tertiary intensive care unit.

Patients:

Two cross-sectional cohorts of ICU-treated coronavirus disease 2019 patients were included before (cohort 1, n = 12) and after (cohort 2, n = 14) enhanced prophylactic anticoagulation strategy.

Interventions:

Before and after study of enhanced anticoagulation.

Measurements and Main Results:

Thromboelastometry point-of-care coagulation tests were performed by thromboelastography (Tem International GmbH, Munich, Germany), standard blood tests were extracted from patient charts, and presence of antiphospholipid antibodies in plasma was measured. All patients were males on mechanical ventilation. In cohort 1 (low-molecular-weight heparin dose: 129 ± 53 U/kg/24 hr), 50% had pulmonary embolism, and thromboelastography analysis revealed hypercoagulation in a majority of patients and greater than 80% had detectable antiphospholipid antibodies. In the second cohort (enhanced low-molecular-weight heparin dose: 200 ± 82 U/kg/24 hr; p = 0.04 vs cohort 1), we found a nonsignificantly lower prevalence of pulmonary embolism (21%; p = 0.22), lower fibrinogen (6.3 ± 2.5 vs 8.7 ± 2.0; p = 0.02), reduced fibrinogen-dependent thromboelastography (p < 0.001), and lower inflammatory markers.

Conclusions:

In these two cross-sectional cohorts of ICU-treated coronavirus disease 2019 patients, thromboembolic complications, hypercoagulation, and antiphospholipid antibodies were common. A more aggressive anticoagulation regime was associated with a reduction in inflammatory biomarkers including plasma fibrinogen and a reduction in fibrinogen-dependent hypercoagulation, as indicated by thromboelastography analyses.
Continuing Medical Education in the Time of Social Distancing: The Case for Expanding Podcast Usage for Continuing Education
Authors: Tarchichi Tony R. , Szymusiak John
Published: December 2020

The COVID-19 pandemic is forcing society to re-evaluate how it educates learners of all levels, from medical students to faculty. Travel restrictions and limits on large public gatherings have necessitated the cancelling of numerous regional and national conferences as well as local grand rounds at many academic centers. Podcasting provides a potential solution for providing CME in a safe, socially distant way as an alternative to these more traditional CME sources for health care professionals. Using a popular CME podcast for pediatric hospitalists as an example, this article describes the many advantages that podcasting poses over more traditional CME methods, outlines some of the methodological and technological considerations that go into creating a high-quality podcast, and describes how podcasting can be leveraged during a global pandemic. Finally, we identify areas for further research regarding podcasting, including effective ways to virtually replace the more social and community building aspects of traditional conferences and grand rounds.
Part 1: Disease of the Heart and Liver
Authors: Scalzo Nicholas , Canastar Mehtap , Lebovics Edward
Published: December 2020

The heart and the liver display multifaceted, complex interactions that can be divided into cardiac effects of liver disease, hepatic effects of heart disease, and disease processes affecting both organs. In part 1 of this 2 part series, we discuss how acute and chronic heart failure can have devastating effects on the liver, such as acute cardiogenic liver injury and congestive hepatopathy. On the other hand, primary liver disease, such as cirrhosis, can lead to a plethora of cardiac insults representative in cirrhotic cardiomyopathy as systolic dysfunction, diastolic dysfunction, and electrophysiological disturbances. Nonalcoholic fatty liver disease has long been associated with cardiovascular events that increase mortality. The management of both disease processes changes when the other organ system becomes involved. This consideration is important with regard to a variety of interventions, most notably transplantation of either organ, as risk of complications dramatically rises in the setting of both heart and liver disease (discussed in part 2). As our understanding of the intricate communication between the heart and liver continues to expand so does our management.
Part 2: Disease of the Heart and Liver: A Relationship That Cuts Both Ways
Authors: Scalzo Nicholas , Canastar Mehtap , Lebovics Edward
Published: December 2020

Diseases known to affect both the heart and liver include a variety of infectious, autoimmune, and metabolic disorders, as well as toxins: most commonly alcohol. As damage to both the heart and liver progresses, transplantation is a reasonable therapeutic option. Heart failure patients with underlying congestive hepatopathy receiving cardiac transplant have demonstrated improved liver enzyme levels posttransplant. Patients with severe end-stage liver disease requiring a liver transplant must undergo careful preoperative evaluation as surgical stress exposes the myocardium to high levels of catecholamines. Clinicians must consider both cardiac and hepatic complications when evaluating heart failure, cirrhosis, and nonalcoholic fatty liver disease. In Part 2 of this review, we discuss new noninvasive techniques for assessing liver fibrosis in the preoperative stage. Both serum and radiologic studies, such as transient elastography, have begun to take the place of liver biopsy due to their decreased morbidity. Last, we explore the current research examining the benefit of combined heart-liver transplant, although more longitudinal outcome studies are needed.
Uremic- and Dialysis-Associated Pericarditis
Authors: Chugh Savneek , Singh Jagmeet , Kichloo Asim , Gupta Sanjeev , Katchi Tasleem , Solanki Shantanu
Published: December 2020

Uremic pericarditis occurs as a result of inflammation of the pericardium due to toxins and immune complexes in patients with renal disease. The initial clinical manifestations of pericarditis and acute coronary syndrome may be similar, and initial EKG findings may overlap. The management of this disease needs the combined efforts of internists, cardiologists, and nephrologists. Its incidence has been reduced since the introduction of renal replacement therapy. Dialysis continues to be the mainstay of treatment.
Knowledge of Glaucoma Among Patients Attending Virtual and Face-to-Face Glaucoma Clinics
Authors: Tatham Andrew J. , Ali Ameer M. , Hillier Niamh
Published: December 2020

Precis:

No significant difference in knowledge of glaucoma was found among patients attending virtual and face-to-face glaucoma clinics. Gaps in knowledge were identified in both groups highlighting the importance of incorporating patient education into glaucoma services.

Purpose:

To examine knowledge of glaucoma among patients attending virtual compared with face-to-face glaucoma clinics.

Materials and Methods:

A survey was conducted of 105 patients with glaucoma, including 50 attending virtual and 55 attending face-to-face clinics. Participants were asked to complete a glaucoma knowledge assessment using the National Eye Health Education Program Eye-Q test. All participants had a comprehensive eye examination and completed standard automated perimetry. Knowledge of glaucoma was compared between groups and the effect of potential confounders, including age, sex, education level, and standard automated perimetry mean deviation, was explored using regression analyses. The relationship between test scores and self-perception of knowledge of glaucoma was also examined.

Results:

There was no significant difference between knowledge scores between patients attending virtual and face-to-face clinics with mean scores of 5.6±1.0 and 6.0±1.6 (P=0.762) respectively. More patients attending the virtual clinic could correctly identify the type of glaucoma they had (74% vs. 52.7%, P=0.005). Regression analyses found education level and patients’ correct knowledge of their type of glaucoma were significantly associated with Eye-Q scores. Patients with university qualifications scored significantly higher than those with no or basic school qualifications (P=0.003) and higher-level school qualifications (P=0.038). Most patients desired to know more about their condition.

Conclusions:

Patients attending virtual glaucoma clinics demonstrated similar knowledge of glaucoma compared with those attending face-to-face clinics but gaps in knowledge were identified in both groups. Patient education should be incorporated into the design of all glaucoma services.
Long-term Efficacy of Mitomycin C Augmented Trabeculectomy in a Mixed Pediatric Glaucoma Cohort
Authors: Gurney Sam P. , Ahmad Mohammad , Makanjuola Taiwo , Ramm Laura , Parulekar Manoj V.
Published: December 2020

Precis:

This paper reports a retrospective consecutive case series investigating the efficacy of Mitomycin C-augmented trabeculectomy in the treatment of primary and secondary pediatric glaucoma in a mixed etiology, multiethnic cohort of patients.

Purpose:

To evaluate the long-term efficacy and safety of Mitomycin C-augmented trabeculectomy in a mixed, tertiary-referral, pediatric glaucoma cohort.

Methods:

Retrospective consecutive review of all children (37 eyes) undergoing Mitomycin C-augmented trabeculectomy by a single surgeon between 2008 and 2016. Seventeen eyes (45.9%) had primary congenital glaucoma, and 20 eyes (54.1%) had secondary glaucoma. The median age at surgery was 11 months (range, 2 to 146). The mean follow-up was 69.2±4.7 months (range, 3.5 to 107.9).

Results:

Overall, trabeculectomy was successful in 80.6% of eyes at 12 months, 60.5% at 3 years, and 57.5% at 5 years. 45.9% cases (17 eyes) required further laser or surgery for uncontrolled intraocular pressure (IOP) and were therefore deemed as failures. The time to failure ranged from 0.4 to 65.1 months (mean, 22.2±5.1 mo). The proportion of children achieving visual acuity of 1.0 LogMAR equivalent or better increased from 43.2% preoperatively to 63.6% at 1 year and 68% at 5 years. The mean IOP reduced from 24.85±0.88 mm Hg preoperatively to 15.14±0.94 mm Hg at 3 months (39% reduction) and 17.42±1.08 mm Hg at 5 years (30% reduction). IOP-lowering medication requirement reduced from 4.14±0.20 agents preoperatively to 0.84±0.22 at 3 months (80% reduction) and 1.78±0.36 at 5 years (57% reduction). There were no sight-threatening complications such as hyphaema, bleb leak, chronic hypotony, endophthalmitis, retinal detachment, or loss of light perception.

Conclusions:

This study provides valuable evidence that Mitomycin C-augmented trabeculectomy is safe and effective as a treatment of primary or secondary pediatric glaucoma, with particularly encouraging results in cases of secondary glaucoma. Trabeculectomy offers the potential for delaying or avoiding glaucoma drainage device surgery in a significant proportion of children.
Tube Obstruction of a Nonvalved Glaucoma Drainage Device by a Dislocated Soemmering’s Ring
Authors: Khurana Mona , Sudhir Rachapalle Reddi , Rishi Ekta , Sakaria Palak , Vijaya Lingam
Published: December 2020

The authors report a case of tube obstruction of a nonvalved glaucoma drainage device (Aurolab aqueous drainage implant; AADI) with a dislocated Soemmering’s ring (SR) leading to a postoperative intraocular pressure (IOP) spike after an initial IOP reduction. A 24-year-old man with bilateral aphakia, bilateral secondary glaucoma developed corneal decompensation in the left eye. The IOP in the left eye was 22 mm Hg with 3 topical IOP-lowering medications (timolol 0.5%, brimonidine 0.2%, and latanoprost 0.005%). To control the IOP before performing a penetrating keratoplasty, AADI was implanted. A good bleb and an IOP of 10 mm Hg were noted at 6.5 weeks postoperatively. The following day the patient developed an acute rise in IOP (42 mm Hg) because of tube obstruction of the AADI by a SR. The IOP spike was initially controlled with oral acetazolamide and topical IOP-lowering medications (fixed combination of timolol 0.5% and brimonidine 0.2%). Six days later, pars plana vitrectomy, SR removal, penetrating keratoplasty, and tube trimming were performed. Following this, the patient had good IOP control and a clear corneal graft at 1-year follow-up. In aphakic eyes undergoing nonvalved glaucoma drainage device implantation, a complete pars plana vitrectomy combined with any lens remnant removal may be considered. It helps to avoid tube obstruction because of these lens remnants, which can migrate anteriorly along with the aqueous currents.
The Effect of Add-on Buprenorphine to Matrix Program in Reduction of Craving and Relapse Among People With Methamphetamine Use Disorder
Authors: Kheirabadi Gholam Reza , Bahrami Mabobeh , Shariat Ali , Tarrahi Mohammadjavad
Published: December 2020

Background

Methamphetamine addiction is a global issue. Buprenorphine might have beneficial roles in reducing craving to methamphetamine use via altering neurotransmission signaling and dopaminergic system-related reward mechanisms.

Procedures

This clinical trial was performed in 2019 to 2020 in Khorshid Hospital, Isfahan, Iran. The study was conducted on patients with methamphetamine use disorder. The intervention group received sublingual buprenorphine for 8 weeks, and the other group also received placebo tablets. Patients were followed up and visited every month for the next 4 months. Both groups were treated simultaneously by matrix program for 2 months and observed for the next 4 months. Patients filled out the Cocaine Craving Questionnaire-Brief (CCQ-Brief) every week during intervention time (first 2 months) and every month during follow up visits (4 months). The Depression Anxiety Stress Scale (DASS-21) was also filled out before and after interventions for all of the patients. Data were analyzed using SPSS software using χ2, independent t test and repeated-measure analysis of variance tests.

Results

Our data indicated significantly lower CCQ-Brief scores in the intervention group compared with the placebo group (P < 0.05). It was also indicated that changes in CCQ-Brief scores were also significant among both groups (P < 0.001). We also showed that the anxiety, depression, and stress scores reduced significantly after interventions (P < 0.001). These scores were also significantly lower in the intervention group compared with placebo group (P < 0.05).

Conclusions

Buprenorphine may be effective and may have positive potential roles in reducing methamphetamine craving. This drug is also helpful in reducing the anxiety, depression, and stress of patients with methamphetamine use disorders.
Prolactin and Estrogen Levels in Postmenopausal Women Receiving Aripiprazole Augmentation Treatment for Depression
Authors: Rahman Tahir , Patrick Cory , Ma Cynthia , Nicol Ginger E. , Reynolds Charles F. , Mulsant Benoit H. , Hartz Sarah M. , Yingling Michael , Lenze Eric J.
Published: December 2020

Background

Antipsychotic drugs are well established to alter serum prolactin levels, often resulting in adverse effects including amenorrhea, galactorrhea, osteoporosis, and loss of libido. There is growing preclinical evidence that prolactin-elevating drugs can instigate the progression of precancerous lesions to breast cancer and that genes activated by prolactin are associated with the development and proliferation of breast cancer. Current guides advise a cautious approach (weighing risks and benefits) to the administration of prolactin-elevating antipsychotic drugs in women with a previously detected breast cancer. Aripiprazole is known to be a prolactin-sparing antipsychotic; however, data regarding its effects on prolactin and estrogens in postmenopausal women are lacking.

Methods

We examined serum hormone levels in n = 66 women who participated in a randomized, double-blind, placebo-controlled, multicenter trial of aripiprazole (high and low doses) added to an antidepressant in adults older than 60 years. Aripiprazole or placebo tablets were administered for 12 weeks as an augmentation strategy in venlafaxine-treated women. The primary outcomes were the difference in prolactin and estrogen levels.

Results

There was no significant effect of aripiprazole treatment on prolactin or estrogen levels, including in models that divided groups into low and high doses: prolactin (P = 0.075), estrone (P = 0.67), and estradiol (P = 0.96).

Conclusions

Aripiprazole addition to an antidepressant did not alter serum estrogens or prolactin. These findings may be relevant in the treatment of some postmenopausal women with depression.
Jackhammer Esophagus
Authors: Achem Sami R. , Vazquez-Elizondo Genaro , Fass Ronnie
Published: December 2020

Jackhammer esophagus (JE) is a recently recognized esophageal motility disorder that is characterized by hypercontractile peristalsis. More than 500 cases have been reported in the literature. Among patients referred for esophageal motility disorders, the prevalence of JE ranges from 0.42% to 9%, with most series describing a prevalence of 2% to 4%. Most cases are women (60.5%). The mean reported age of patients with JE is 65.2 years, and patients commonly have dysphagia (62.8%). Reflux symptoms occur in ∼40% of patients, and chest pain affects more than one-third of patients (36.4%). JE is a heterogenous disorder that is associated with several conditions, including obesity, opioid use, lung transplantation, eosinophilic infiltration of the esophagus, neoplasia, and systemic diseases. The cause and pathogenesis remain unknown, but several observations suggest that it is the result of multiple conditions that likely precipitate increased excitation and abnormal inhibition of neuromuscular function. The natural course of JE also is unknown, but progression to achalasia has been observed in a few patients. Treatment is challenging, in part because of the insufficient understanding of the disorder’s underlying mechanisms. Various therapeutic modalities have been used, ranging from observation only to pharmacologic and endoscopic interventions (eg, botulinum toxin injection) to peroral endoscopic myotomy. Treatment efficacy remains largely anecdotal and insufficiently studied.
Clinical Genomics for the Diagnosis of Monogenic Forms of Inflammatory Bowel Disease
Authors: Uhlig Holm H. , Charbit‐Henrion Fabienne , Kotlarz Daniel , Shouval Dror S. , Schwerd Tobias , Strisciuglio Caterina , de Ridder Lissy , van Limbergen Johan , Macchi Marina , Snapper Scott B. , Ruemmele Frank M. , Wilson David C. , Travis Simon P.L. , Griffiths Anne M. , Turner Dan , Klein Christoph , Muise Aleixo M. , Russell Richard K. ,   Paediatric IBD Porto group of ESPGHAN
Published: December 2020

Background:

It is important to identify patients with monogenic IBD as management may differ from classical IBD. In this position statement we formulate recommendations for the use of genomics in evaluating potential monogenic causes of IBD across age groups.

Methods:

The consensus included paediatric IBD specialists from the Paediatric IBD Porto group of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and specialists from several monogenic IBD research consortia. We defined key topics and performed a systematic literature review to cover indications, technologies (targeted panel, exome and genome sequencing), gene panel setup, cost‐effectiveness of genetic screening, and requirements for the clinical care setting. We developed recommendations that were voted upon by all authors and Porto group members (32 voting specialists).

Results:

We recommend next‐generation DNA‐sequencing technologies to diagnose monogenic causes of IBD in routine clinical practice embedded in a setting of multidisciplinary patient care. Routine genetic screening is not recommended for all IBD patients. Genetic testing should be considered depending on age of IBD‐onset (infantile IBD, very early‐onset IBD, paediatric or young adult IBD), and further criteria, such as family history, relevant comorbidities, and extraintestinal manifestations. Genetic testing is also recommended in advance of hematopoietic stem cell transplantation. We developed a diagnostic algorithm that includes a gene panel of 75 monogenic IBD genes. Considerations are provided also for low resource countries.

Conclusions:

Genomic technologies should be considered an integral part of patient care to investigate patients at risk for monogenic forms of IBD.
The Use and Effect of the Health Storylines mHealth App on Female Childhood Cancer Survivors’ Self-efficacy, Health-Related Quality of Life and Perceived Illness
Authors: Cantrell Mary Ann , Ruble Kathy , Mensinger Janell , Birkhoff Susan , Morris Amanda , Griffith Patricia , Adams Jared
Published: December 2020

Background

mHealth apps have been not been well tested among childhood cancer survivors (CCSs) to track physical and psychosocial functioning for improved self-management of post-treatment needs.

Objectives

This pilot study had 3 aims: (1) assess the usage of the Health Storylines mHealth app; (2) examine its effect in improving self-efficacy in managing survivorship healthcare needs, health-related quality of life, and perceived illness; and (3) determine if app usage moderated the effects on the above patient-reported outcome measures among female CCSs.

Methods

Study participants accessed the Health Storylines mHealth app on their own personal device. This single-group, pilot study included 3 measurement points: baseline and 3 and 6 months after initiation of using the app.

Results

Use of the mHealth app ranged from 0 times to 902 times. Every study participant who used the app (n = 26) also used the mental health app component of the Health Storylines app. Generalized estimating equations were fit to examine the effect of the mHealth app use on self-efficacy, perceived illness, and health-related quality of life, between baseline, 3-month follow-up, and 6-month follow-up. No statistically significant changes were evident, on average, from baseline to 3- or 6-month follow-up on any outcome. Subsequent testing of effect moderation showed differential trends for high versus low users.

Conclusions

Studies are needed among this clinical population to determine who will benefit and who will perceive the app as a useful aspect of their survivorship care.

Implications for Practice

Sharing mental health functioning tracked on mhealth apps with healthcare providers may inform needed interventions for young adult female CCSs.
Rejuvenation of Aged Human Skin by Injection of Cross-linked Hyaluronic Acid
Authors: Cui Yilei , Wang Frank , Voorhees John J. , Fisher Gary J.
Published: December 2020

Background:

Dermal injection of chemically cross-linked hyaluronic acid (CL-HA) is a common procedure to smooth wrinkles and add fullness to the face. Due to its physical properties, CL-HA both fills space and exerts mechanical forces within the dermis. Dermal fibroblasts produce the collagen-rich extracellular matrix (ECM), which comprises the bulk of skin. Attachment to the ECM allows fibroblasts to achieve a stretched, morphology, which confers a functional phenotype that maintains collagen production. In aged/photoaged skin, collagen fibril fragmentation impairs fibroblast attachment, resulting in a collapsed morphology and reduced collagen production. This article describes investigations of the impact of CL-HA injection on fibroblast morphology and function in the aged/photoaged human skin.

Methods:

Fifty-three subjects, age 70 years or older, received a single injection of saline (vehicle control) and CL-HA (0.5 ml each) in separate adjacent skin sites on photodamaged forearm or sun-protected buttock skin. Full-thickness punch biopsies were obtained from injected skin sites at various times and analyzed for molecular and cellular changes.

Results:

Injected CL-HA forms discreet pockets that localize to areas of the dermis that contain fragmented, loosely organized collagen fibrils. These CL-HA pockets fill space and apply mechanical forces on adjacent ECM that induce stretching of fibroblasts. This stretching is associated with increased collagen gene expression and deposition of mature collagen fibril bundles, which resemble those observed in young skin.

Conclusions:

CL-HA injected into aged/photoaged human dermis acts by both filling space and inducing production of collagen by dermal fibroblasts. Deposition of mature collagen, which remains in the skin for decades, likely confers long-term benefits. Reduced collagen production in aged/photoaged skin is an adaptive response of fibroblasts to ECM fragmentation, rather than inherent cellular aging mechanisms.
Prediction of Facial Aging Using the Facial Fat Compartments
Authors: Rohrich Rod J. , Avashia Yash J. , Savetsky Ira L.
Published: December 2020

Facial aging is a multifactorial process governed by both intrinsic and extrinsic factors that impart a change to each component of the facial anatomy. Our understanding of the science of aging has evolved over the years. A recent and valuable addition to our understanding is the knowledge of both the superficial and deep facial fat compartments. The deep compartments provide structural support to the midface and the superficial fat compartments. Understanding the anatomy and the spectrum of their changes helps to tailor management options for facial rejuvenation. The authors present a review on facial aging as it relates to these fat compartments and provide a management algorithm based on the longitudinal changes seen during aging.
Surgical Treatment of Upper Extremity Gunshot Injures
Authors: Meade Anna , Hembd Austin , Cho Min-Jeong , Zhang Andrew Y.
Published: December 2020

Introduction

Firearm morbidity and mortality have been increasing in recent years, and with this, the demand for medical personnel firearm injury treatment knowledge. Extremities contribute to a majority of firearm injuries, with these injuries being particularly complex because of neurovascular proximity within a confined space. Knowledge of firearm mechanism of injury and treatment management options is important for any trauma hand surgeon. Many factors play vital roles in the treatment of complex upper extremity (UE) gunshot wounds (GSWs). The aim of our review and case illustrations is to provide hand surgeons with an up-to-date guide for initial emergent management, soft tissue, bony, and nerve repair and reconstruction.

Patient and Methods

A literature review was conducted in the current management of UE GSW injuries, and 2 specific patient case examples were included. High-energy versus low-energy GSWs were documented and compared, as well as containment injures. Management including soft tissue, bony, and nerve injuries was explored along with patient outcome. Based on these findings, guidelines for GSW management were purposed.

Conclusion

Gunshot wounds of the UE encompass a group of highly heterogeneous injuries. High-energy wounds are more extensive, and concomitant injuries to bone, vessel, nerve, muscle, and soft tissue are common. Early treatment with adequate debridement, skeletal fixation, and soft tissue coverage is indicated for complex injuries, and antibiotic treatment in the pre-, peri-, and postoperative period is indicated for operative injuries. Soft tissue coverage options include the entire reconstructive ladder, with pattern of injury and considerations of wound characteristics dictating reconstructive choice. There are arguments to using either external or internal bony fixation techniques for bone fracture management, with choice tailored to the patient. For management of nerve injuries, we advocate earlier nerve repair and a shorter duration of observation before secondary reconstruction in selective cases. If transected nerve endings cannot be brought together, nerve autografts of shorter length are recommended to bridge nerve ending gaps. A significant number of patients with GSW fail to make necessary follow-up appointments, which adds to challenges in treatment.
Potential In Vitro Tissue-Engineered Anterior Cruciate Ligament by Copolymerization of Polyvinyl Alcohol and Collagen
Authors: Pan Zhengjun , Yin Hao , Wang Shuangli , Xiong Gaoxin , Yin Zongsheng
Published: December 2020

Background and Purpose:

Suitable tissue-engineered scaffolds to replace human anterior cruciate ligament (ACL) are well developed clinically as the development of tissue engineering. As water-soluble polymer compound, polyvinyl alcohol (PVA) has been wildly used as the materials to replace ACL. The aim of this study was to explore the feasibility of constructing tissue-engineered ACL by the copolymerization of PVA and collagen (PVA/COL).

Methods:

PVA and COL were copolymerized at a mass ratio of 3:1. The pore size and porosity of the scaffold were observed by electron microscope. The maximum tensile strength of the scaffold was determined by electronic tension machine. The cytotoxicity of the scaffold was evaluated by MTT assay. The morphology of ACL cells cultured on the surface of the scaffold was observed by inverted microscope. The degradation of the scaffold was recorded in the rabbit model.

Results:

The average pore size of the polymer scaffold was 100 to 150 μm and the porosity was about 90%. The maximum tensile strength of the scaffold material was 8.10 ± 0.28 MPa. PVA/COL could promote the proliferation ability of 3T3 cells. ACL cells were successfully cultured on the surface of PVA/COL scaffold, with natural growth rate, differentiation, and proliferation. Twenty-four weeks after the plantation of scaffold, obvious degradations were observed in vivo.

Conclusion:

The model of in-vitro tissue-engineered ACL was successfully established by PVA/COL scaffolds.
Application of Virtual Endoscopy in Microvascular Decompression of Trigeminal Neuralgia
Authors: Wei Wenbin , Liu Zhiyang , Zhang Weijie , Wang Yiwen , Chen Minjie
Published: December 2020

Purpose:

The main purpose of this study is to evaluate the accuracy of virtual endoscopy (VE) in microvascular decompression (MVD) for the treatment of trigeminal neuralgia (TN).

Methods:

A total of 30 TN patients aged 42 to 70 years were recruited from January 2015 to January 2019, and all patients were confirmed to have severe neurovascular compression (NVC) (≥degree 2) by magnetic resonance tomographic angiography (MRTA). Preoperative MRTA and enhanced CT were performed, and the data were imported into Stlview software for VE simulation of MVD. The reliability of VE, real endoscopy, and MRTA in evaluating the degree and position of MVD in TN patients was compared.

Results:

Virtual endoscopy is more reliable than MRTA in evaluating the degree of NVC, but both of them are reliable in determining the position of NVC in TN patients.

Conclusions:

Virtual endoscopy can be used in MVD for the treatment of TN, including preoperative diagnosis and risk evaluation, intraoperative guidance, and postoperative evaluation.
Mind the Gap: Current Treatment Alternatives for GERD Patients Failing Medical Treatment and Not Ready for a Fundoplication
Authors: Huynh Phuong , Konda Vani , Sanguansataya Suchakree , Ward Marc A. , Leeds Steven G.
Published: December 2020

Background:

Gastroesophageal reflux disease is associated with Barrett esophagus, esophageal adenocarcinoma, and significantly impacts quality of life. Medical management is the first line therapy with surgical fundoplication as an alternative therapy. However, a small portion of patients who fail medical therapy are referred for surgical consultation. This creates a “gap” in therapy for those patients dissatisfied with medical therapy but are not getting referred for surgical consultation. Three procedures have been designed to address these patients. These include radiofrequency ablation (RFA) of the lower esophageal sphincter, transoral incisionless fundoplication (TIF), and magnetic sphincter augmentation.

Materials and Methods:

A Pubmed literature review was conducted of all publications for RFA, TIF, and MSA. Four most common endpoints for the 3 procedures were compared at different intervals of follow-up. These include percent of patients off proton pump inhibitors (PPIs), GERD-HRQL score, DeMeester score, and percent of time with pH <4. A second query was performed for patients treated with PPI and fundoplications to match the same 4 endpoints as a control.

Results:

Variable freedom from PPI was reported at 1 year for RFA with a weighted mean of 62%, TIF with a weighted mean of 61%, MSA with a weighted mean of 85%, and fundoplications with a weighted mean of 84%. All procedures including PPIs improved quality-of-life scores but were not equal. Fundoplication had the best improvement followed by MSA, TIF, RFA, and PPI, respectively. DeMeester scores are variable after all procedures and PPIs. All MSA studies showed normalization of pH, whereas only 4 of 17 RFA studies and 3 of 11 TIF studies reported normalization of pH.

Conclusions:

Our literature review compares 3 rival procedures to treat “gap” patients for gastroesophageal reflux disease with 4 common endpoints. Magnetic sphincter augmentation appears to have the most reproducible and linear outcomes but is the most invasive of the 3 procedures. MSA outcomes most closely mirrors that of fundoplication.
Intraoperative Thermal Imaging for Evaluating Blood Perfusion During Laparoscopic Colorectal Surgery
Authors: Tokunaga Takuya , Shimada Mitsuo , Higashijima Jun , Yoshikawa Kozo , Nishi Masaaki , Kashihara Hideya , Takasu Chie , Ishikawa Daichi , Yoshimoto Toshiaki
Published: December 2020

Background:

Anastomotic leakage is a feared complication of anterior resection for rectal cancer. Among the various factors reported to be involved in the occurrence of anastomotic leakage, blood perfusion of the remnant intestine is one of the most important. Recently, the usefulness of evaluating blood perfusion using indocyanine green (ICG) has been reported. We therefore aimed to show that measuring intestinal temperature using thermography is useful for evaluating blood perfusion. The authors also investigated the relation between intestinal temperatures and the ICG fluorescence time (FT).

Materials and Methods:

Altogether, 45 patients who underwent laparoscopic anterior resection for rectal cancer between July 2017 and September 2018 were enrolled in this study. ICG FT and intestinal temperature were measured after the mesenteric dissection.

Result:

The temperature boundary could be easily identified using thermographic images. The temperature of the residual intestinal tract was significantly higher than that of the resected intestinal tract at the planned separation line (29.9 vs. 27.3°C). In addition, there was an inverse correlation between the ICG FT and the temperature of the residual intestine.

Conclusion:

Intestinal temperature measurement through thermography is a useful new tool for evaluating intestinal blood perfusion.
Little trace of floristic homogenization in peri‐urban Andean secondary forests despite high anthropogenic transformation
Authors: Hurtado‐M Ana Belén , Echeverry‐Galvis María Ángela , Salgado‐Negret Beatriz , Muñoz Juan Camilo , Posada Juan Manuel , Norden Natalia
Published: December 2020

Pervasive human impact in heavily transformed landscapes may lead disturbance‐adapted species to thrive, resulting in floristic homogenization across forest stands. However, environmental heterogeneity and dispersal limitation may be antagonistic forces to homogenization, maintaining inherent floristic differentiation across sites.

We evaluated the extent to which peri‐urban Andean forests are undergoing floristic homogenization in both late‐ and early‐successional stands. We considered seedling assemblages as well, as they provide key insights into forests’ future. We then quantified the relative importance of dispersal limitation and environmental filtering in determining the observed patterns of floristic similarity across the landscape.

We used tree, seedling, soil and climatic data from six sites located in the high plain where Bogotá lies (Colombia). Within each site, we established six 20 × 20 m plots, three in early‐successional stands and three in late‐successional stands, for a total of 36 plots.

To evaluate the extent of floristic homogenization, we defined tree floristic similarity among late‐successional stands as a baseline, reflecting our best‐guess of the original species composition that would have once occurred previous to intense anthropogenic intervention. Tree floristic turnover across the landscape was alike in late‐ and in early‐secondary stands, a finding that does not support the homogenization scenario. Seedling species composition, in contrast, was more homogeneous among early‐ than among late‐secondary stands, an outcome suggestive of homogenization.

The relative importance of spatial and environmental drivers shifted between life stages. Distance between plots was the best predictor of tree species dissimilarity (29% of variance explained), whereas seedling compositional variation was more sensitive to changes in environmental conditions (41% of the variance explained). Relative humidity and several variables related to soil fertility showed a significant effect on floristic dissimilarity across the landscape, although significant factors were often different between life stages.

Synthesis. Despite high anthropogenic transformation, we found little trace of floristic homogenization in these peri‐urban landscapes. Inherent floristic differentiation, promoted both by dispersal limitation and environmental heterogeneity, suggests that all patches are important to the conservation in these Andean forests, critical centres of endemism.
Consumer preferences for black coffee are spread over a wide range of brew strengths and extraction yields
Authors: Cotter Andrew R. , Batali Mackenzie E. , Ristenpart William D. , Guinard Jean‐Xavier
Published: December 2020

Brewing is the final and key step in the production of the coffee beverage. Extraction related metrics such as the total dissolved solids (TDS), percentage extraction yield (PE) of solutes, and brew temperature (BT) are widely believed to govern the flavor and corresponding consumer acceptance of the resulting brew, as summarized in the industry standard “Coffee Brewing Control Chart.” In this study, we investigated how the three factors of TDS, PE, and BT affected consumer acceptance of a medium roast, single‐origin coffee and whether consumer preference segmentation would be observed based on these variables. A cohort of 118 mostly college‐age, self‐reported consumers of black coffee tasted coffees that varied in BT, TDS, and PE. For each coffee, consumers rated overall acceptance on the 9‐point hedonic scale; the adequacy of serving temperature, flavor intensity, acidity, and mouthfeel using 5‐point just‐about‐right (JAR) scales; and described the flavor using a check‐all‐that‐apply list of 17 attributes. Cluster analysis revealed two consumer segments whose preferences varied most strongly with TDS. Response surface methodology relating liking to TDS and PE produced dome‐ and saddle‐shaped surfaces for the two segments, respectively. External preference mapping and penalty analysis indicated that overall flavor intensity as well as acidity heavily influenced the preferences of the two clusters. The Coffee Brewing Control Chart's “ideal” coffee should therefore be reconsidered to reflect consumer preference segmentation.

Practical Application

This research informs the way coffee brewers manipulate brew strength and extraction of drip brew coffee for optimal consumer acceptance; and justifies a reform of the standard “Coffee Brewing Control Chart” in its representation of an “ideal” coffee as we uncovered two consumer preference segments with different positive and negative sensory drivers of liking.
Explaining differential effects of medication for opioid use disorder using a novel approach incorporating mediating variables
Authors: Rudolph Kara E. , Díaz Iván , Hejazi Nima S. , van der Laan Mark J. , Luo Sean X. , Shulman Matisyahu , Campbell Aimee , Rotrosen John , Nunes Edward V.
Published: December 2020

Background and Aims

A recent study found that homeless individuals with opioid use disorder (OUD) had a lower risk of relapse on extended‐release naltrexone (XR‐NTX) versus buprenorphine–naloxone (BUP‐NX), whereas non‐homeless individuals had a lower risk of relapse on BUP‐NX. This secondary study examined differences in mediation pathways to medication effect between homeless and non‐homeless participants.

Design

Secondary analysis of an open‐label randomized controlled, 24‐week comparative effectiveness trial, 2014–17.

Setting

Eight community addiction treatment programs in the United States.

Participants

English‐speaking adults with DSM‐5 OUD, recruited during inpatient admission (n = 570).

Intervention(s)

Randomization to monthly injection of XR‐NTX or daily sublingual BUP‐NX.

Measurements(s)

Mediation analysis estimated the direct effect of XR‐NTX versus BUP‐NX on relapse and indirect effect through mediators of medication adherence, use of illicit opioids, depressive symptoms and pain, separately by homeless status.

Findings

For the homeless subgroup, the protective indirect path contributed a 3.4 percentage point reduced risk of relapse [95% confidence interval (CI) = −12.0, 5.3] comparing XR‐NTX to BUP‐NX (explaining 21% of the total effect). For the non‐homeless subgroup, the indirect path contributed a 9.4 percentage point increased risk of relapse (95% CI = 3.1, 15.7) comparing XR‐NTX to BUP‐NX (explaining 57% of the total effect).

Conclusions

A novel approach to mediation analysis shows that much of the difference in medication effectiveness (extended‐release naltrexone versus buprenorphine–naloxone) on opioid relapse among non‐homeless adults with opioid use disorder appears to be explained by mediators of adherence, illicit opioid use, depressive symptoms and pain.