bluuebunny/crossref_metadata_2025 huggingface dataset:
Law within medical practice
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter sets out the basic legal framework governing medical practice. Essentially it is the law of tort that governs NHS work, while contracts play a more significant role in private medicine. The chapter explains the NHS Indemnity that plays an important role in protecting NHS staff from personal liability under civil law.
Issues in death and dying
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter explores the difficult questions surrounding end of life. It sets out the current legal position on murder, euthanasia and assisted dying. It also explores the ethical debates around the issue. The chapter highlights the thin lines between acts and omissions; and between intention and foresight which are the basis of the current law. It also discusses the principles of autonomy and dignity as principles which some believe should govern the ethical analysis of this area. The chapter also considers the legal and ethical issues concerning organ donation.
Medical education
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter outlines the education required for medical professionals. It emphasises the importance of obtaining consent from patients if they are used for educational purposes. It highlights the importance of teaching about confidentiality. It also refers to the controversial issue of the use of cadavers in student education.
Ethico-legal issues by medical specialism N–V
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter covers Ethico-legal issues by medical specialism and includes topics on the following subjects (N-V): Neurology: The clash of rights between a child and parents, Neonatal Surgery: Jehovah’s Witnesses, Neonatology: Consent, Neurosurgery: Information Governance, Neurosurgery: Innovation, Neurosurgery: Preservation of Evidence, Obstetrics: Needle Phobia, Ophthalmology: Statutory Disclosures, Paediatric Cardiology: Unlicensed Equipment, Plastics; Disclosure, Renal: Capacitous adult refusing treatment, Respiratory: Unwise Decisions, Speech: Capacity, Rheumatology: Doctrine of Double Effect, Trauma & Orthopaedics: Necessity, Urology: DOLS, Vascular Surgery: Disclosure
Female Genital Mutilation Act 2003
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter covers the Female Genital Mutilation Act 2003 and the subject of the offence of female genital mutilation.
Human Fertilisation and Embryology Act 1990
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter covers the Human Fertilisation and Embryology Act 1990 and includes topics on Activities involving embryos, Prohibition on germline cells, Prohibitions on Storage and Use of Gametes, The Definition of Mother, and Definition of a Father.
Suicide Act 1961
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter covers the Suicide Act 1961 and the topic of Suicide.
Interchangeability in Military Interprofessional Health Care Teams: Lessons Into Collective Self-healing and the Benefits Thereof
Authors: Cristancho Sayra , Field Emily , Bader-Larsen Karlen S , Varpio Lara
Published: November 2021

Introduction

Interchangeability—i.e., the capacity to change places with another—is necessary for military interprofessional health care teams (MIHTs) to provide around-the-clock patient care. However, while interchangeability is clearly a necessity for modern health care delivery, it raises uncomfortable questions for civilian health care teams where it is usually labeled as unsafe. This perception surfaces because interchangeability runs counter to some of health care’s cultural beliefs including those around patient ownership and professional scopes of practice. It is, therefore, not surprising that little is known about whether and how some level of interchangeability can be harnessed to improve the productivity of health care teams overall. In this article, we explore the notion of interchangeability in the particular context of MIHTs given that these health care teams are familiar with it. This exploration will offer insights into how interchangeability could maximize civilian health care teams’ capacity to adapt.

Materials and Methods

We conducted a secondary analysis of interview data as an analytic expansion: “the kind of study in which the researcher makes further use of a primary data set in order to ask new or emerging questions that derive from having conducted the original analysis but were not envisioned within the original scope of the primary study aims”. Within our secondary analysis approach, we used thematic analysis as our analytical tool to describe (1) what interchangeability looks like in MIHT teams, (2) how it is fostered in MIHTs, and (3) how it is enacted in MIHTs.

Results

Interchangeability was realized in MIHTs when individual team members adapted to take on roles and/or tasks that were not clearly niched in their specific areas of expertise but instead drew on the broad foundation of their clinical skill set. Cross-training and distributed leadership were ways in which MIHT members described how interchangeability was fostered. Furthermore, five features of working within MIHT teams were identified as key conditions to enact interchangeability: knowing your team members; being able to work with what/who you have; actively seeking others’ expertise; situating your role within the broader picture of the mission; and maintaining a learning/teaching mindset.

Conclusions

Interchangeability can be understood through the theoretical lens of Swarm Intelligence and more specifically, the principle of collective self-healing—which is the ability of collectives to continue to successfully perform despite disruption, challenges, or the loss of a team member. Our findings highlight how MIHTs have adopted interchangeability in a wide array of contexts to realize collective self-healing. Despite the discomfort it provokes, we suggest that interchangeability could be a powerful asset to civilian health care teams.
The Ties That Bind: Camaraderie in Military Interprofessional Healthcare Teams
Authors: Hamwey Meghan , Bader-Larsen Karlen S , Cruthirds Danette F , Varpio Lara
Published: November 2021

Introduction

Multiple aspects of interpersonal dynamics can help or hinder the success of teams, particularly those in a Military Interprofessional Healthcare Team (MIHT). One specific mechanism for MIHTs’ success is camaraderie and how these military teams are able to achieve, maintain, and enable the development of this important characteristic. Despite our understanding of military service members as being bonded like a family, we have a limited understanding of how this bond is translated into their MIHT experiences.

Materials and Methods

This study conducted interviews among 30 individuals who had participated in, led individual, and/or led many MIHTs, using a grounded theory methodology. Participants represented 11 different health professions, including officers and enlisted military members, and three branches of the U.S. military (e.g., army, navy, and air force). Data were collected and analyzed in iterative cycles until saturation was achieved.

Results

We identified six themes that shaped the overarching concept of camaraderie in MIHTs. These themes were (1) confidence in competent peers, (2) shared goals, (3) mutual respect, (4) desire to help one another improve, (5) personal is professional, and (6) bonds of military service. This paper describes each of these themes, provides illustrative examples from the data, and describes how these components contribute to MIHTs’ team dynamics. We present a model for how to understand these themes.

Conclusions

Through the identification and exploration of these aspects of camaraderie, we are able to better understand how MIHTs are able to be successful. MIHTs that demonstrated confidence in their brother/sister in arms possessed shared goals and missions, while maintaining mutual respect, a desire to help one another do better, and creating a personal and professional overlap tended to form stronger bonds of military service. Critically, these six aspects support a more nuanced understanding of the spirit of camaraderie and how it underpins MIHT success.
Ethical Bearing Is About Our Conduct: Ethics as an Essential Component of Military Interprofessional Healthcare Teams
Authors: Meyer Holly S , Bader-Larsen Karlen S , Artino Anthony , Varpio Lara
Published: November 2021

Introduction

The need to maintain medical ethical standards during conflict and peace has been the source of considerable academic discourse. Although still an unsolved challenge, scholars have made significant contributions to the literature, constructing categorizations that can help military providers contend with ethical conflicts. However, insights into the ethical comportment of military interprofessional healthcare teams (MIHTs) have yet to be reported.

Materials and Methods

This interview-based study collected insights from 30 military healthcare providers who participated in and/or led MIHTs. Altogether, participants represented 11 health professions, both officers and enlisted military members, and the U.S. Army, Navy, and Air Force. Following Grounded Theory methodology, data were collected and analyzed in iterative cycles until theme saturation was reached.

Results

The research team identified two themes of ethical bearing that enable MIHT success in and across care contexts. One theme of successful ethical bearing is “raising concerns,” referring to speaking up when something needs to be addressed. The other is “making compromises,” where individuals have to make sacrifices (e.g., lack of equipment, non-sterile environment, etc.) to give patient care.

Conclusions

These data suggest that effective MIHTs have a collective moral compass. This moral compass is the team’s ability to judge what is ethically right and wrong, as well as the team’s willingness and ability to act accordingly—to consistently “do the right thing.” There is a collective moral compass, and while the team may not all agree on what exactly is true north—they are all bending that way.
Optimizing Military Medicine: A Team Approach
Authors: Chung Kevin K
Published: November 2021

In order to best optimize health care, we need the right combination of individuals working on interprofessional health care teams, each joining with the right mindset, in the right places, and at the right times. In this special issue of Military Medicine, Dr. Lara Varpio and her team share their findings investigating the unique dynamics of Military Interprofessional Healthcare Teams. Such research is fundamental to advance excellence of military health care by finding, exploring, and addressing existing gaps in what we currently employ and capitalizing on what we know works well. In doing so, we can improve the effectiveness of our care teams and, as a result, optimize care of our wounded on the battlefield.
Factors determining the mortality in cirrhosis patients with invasive candidiasis: A systematic review and meta-analysis
Authors: Verma Nipun , Roy Akash , Singh Shreya , Pradhan Pranita , Garg Pratibha , Singh Meenu
Published: November 2021

The impact of invasive candidiasis (IC) on the outcomes in the non-conventional high-risk cirrhosis population is poorly characterized. Therefore, we reviewed the outcomes and their influencing factors in cirrhosis patients with IC. PubMed, Embase, Ovid, CINHAL, and Web of Science were searched for full-text observational studies describing mortality due to IC in cirrhosis. We did a systematic review and random-effects meta-analysis to pool the point-estimate and comparative-odds of mortality. The estimate's heterogeneity was explored on sub-groups, outliers-test, and meta-regression. We evaluated the asymmetry in estimates on funnel plot and Eggers regression. Quality of studies was assessed on the New-Castle Ottawa scale. Of 3143 articles, 13 studies (611 patients) were included (good/fair quality: 6/7). IC patients were sick with a high model for end-stage liver disease (MELD: 27.0) and long hospital stay (33.2 days). The pooled-mortality was 54.7% (95% CI: 41.3--67.5), I2: 80%, P < 0.01. Intensive care unit (ICU) admission (P < 0.001), site of infection; viz. peritonitis and candidemia (P = 0.014) and high MELD of cases (P = 0.029) were predictors of high mortality. The odds of mortality due to IC was 4.4 times higher than controls and was 8.5 and 3.3 times higher than non-infected, and bacterially-infected controls. Studies in ICU-admitted (OR: 5.0) or acute-on-chronic liver failure (ACLF, OR: 6.3) patients had numerically higher odds of mortality than all-hospitalized cirrhosis patients (OR: 4.0). In conclusion, substantially high mortality is reported in cirrhosis patients with IC. ICU admission, ACLF, high MELD, peritonitis, and candidemia are key factors determining high mortality in cirrhosis patients with IC.

Lay Summary

We report a high mortality rate of 55% in patients with liver cirrhosis and invasive candidiasis. Higher odds (4.4 times) of death, especially in patients with ACLF (6.3 times) or ICU admission (5.0 times) were seen. Candida peritonitis and candidemia are associated with high mortality in cirrhosis.

Highlights
Orbital phase-driven biases in galactic mass constraints from stellar streams
Authors: Reino Stella , Sanderson Robyn E , Panithanpaisal Nondh , Rossi Elena M , Kuijken Konrad
Published: November 2021

One of the most promising tracers of the Galactic potential in the halo region is stellar streams. However, individual stream fits can be limited by systematic biases. To study these individual stream systematics, we fit streams in Milky Way-like galaxies from Feedback In Realistic Environments cosmological galaxy formation simulations with an analytical gravitational potential by maximizing the clustering of stream stars in action space. We show that for coherent streams the quality of the constraints depends on the orbital phase of the observed stream stars, despite the fact that the phase information is discarded in action-clustering methods. Streams on intermediate phases give the most accurate results, whereas pericentre streams can be highly biased. This behaviour is tied to the amount of correlation present between positions and momenta in each stream’s data: weak correlation in pericentre streams prohibits efficient differentiation between potentials, while strong correlation in intermediate streams promotes it. Although simultaneous fitting of multiple streams is generally prescribed as the remedy to combat individual stream biases, we find that combining multiple pericentric streams is not enough to yield a bias-free result. We finally show that adopting the two-component Stäckel model does not fundamentally induce a biased mass estimate. With our full data set of two multiwrap streams, we recovered the true rotation curve of the simulated galaxy within $12{{\ \rm per\ cent}}$ over the entire range of radii covered by our set of stars (10–176 kpc) and within $6.5{{\ \rm per\ cent}}$ between the 5 and 95 percentile distance range (23–109 kpc).
Milankovitch cycles for a circumstellar Earth-analog within α Centauri-like binaries
Authors: Quarles B , Li G , Lissauer J J
Published: November 2021

An Earth-analog orbiting within the habitable zone of α Centauri B was shown to undergo large variations in its obliquity, or axial tilt, which affects the planetary climate by altering the radiative flux for a given latitude. We examine the potential implications of these obliquity variations for climate through Milankovitch cycles using an energy balance model with ice growth and retreat. Similar to previous studies, the largest amplitude obliquity variations from spin-orbit resonances induce snowball states within the habitable zone, while moderate variations can allow for persistent ice caps or an ice belt. Particular outcomes for the global ice distribution can depend on the planetary orbit, obliquity, spin precession, binary orbit, and which star the Earth-analog orbits. An Earth-analog with an inclined orbit relative to the binary orbital plane can periodically transition through several global ice distribution states and risk runaway glaciation when ice appears at both poles and the equator. When determining the potential habitability for planets in general stellar binaries, more care must be taken due to the orbital and spin dynamics. For Earth-analogs within the habitable zone of α Centauri B can experience a much greater range of climate states, which is in contrast to Earth-analogs in the habitable zone of α Centauri A.
A super-resolution analysis of the DSHARP survey: Substructure is common in the inner 30 au
Authors: Jennings Jeff , Booth Richard A , Tazzari Marco , Clarke Cathie J , Rosotti Giovanni P
Published: November 2021

The DSHARP survey evidenced the ubiquity of substructure in the mm dust distribution of large, bright protoplanetary discs. Intriguingly, these datasets have yet higher resolution information that is not recovered in a CLEAN image. We first show that the intrinsic performance of the CLEAN algorithm is resolution-limited. Then analyzing all 20 DSHARP sources using the 1D, super-resolution code Frankenstein (frank), we accurately fit the 1D visibilities to a mean factor of 4.3 longer baseline than the Fourier transform of the CLEAN images and a factor of 3.0 longer baseline than the transform of the CLEAN component models. This yields a higher resolution brightness profile for each source, identifying new substructure interior to 30 au in multiple discs; resolving known gaps to be deeper, wider, and more structured; and known rings to be narrower and brighter. Across the survey, high contrast gaps are an average $14{{\ \rm per\ cent}}$ wider and $44{{\ \rm per\ cent}}$ deeper in the frank profiles relative to CLEAN, and high contrast rings are an average $26{{\ \rm per\ cent}}$ narrower. Categorizing the frank brightness profiles into trends, we find that the relative scarcity of features interior to 30 au in the survey’s CLEAN images is an artefact of resolving power, rather than an intrinsic rarity of inner disc (or compact disc) substructure. Finally the rings in the frank profiles are narrower than the previously inferred deconvolved widths, indicating smaller α/St ratios in the local gas disc.
Revisiting a detached stellar structure in the outer north-eastern region of the Small Magellanic Cloud
Authors: Piatti Andrés E
Published: November 2021

The outer north-eastern region of the Small Magellanic Cloud (SMC) is populated by a shell-like overdensity whose nature was recently investigated. We analysed 20 catalogued star clusters projected on to it from Survey of the MAgellanic Stellar History data sets. After carrying out a cleaning of field stars in the star cluster colour–magnitude diagrams (CMDs), and deriving their astrophysical properties from a comparison between the observed and synthetic CMDs, we found that four objects are not genuine star clusters, while the remaining ones are young star clusters (11, age ∼30–200 Myr) and intermediate-age (5, age ∼1.7–2.8 Gyr) star clusters, respectively. The resulting distances show that intermediate-age and some young star clusters belong to the SMC main body, while the remaining young star clusters are nearly 13.0 kpc away from those in the SMC, revealing that the shell-like overdensity is more extended along the line of sight than previously thought. We also found a clear age trend and a blurred metallicity correlation along the line of sight of young clusters, in the sense that the farther a star cluster is from the SMC, the younger, the more metal-rich, and the less massive it is. These young clusters are also affected by a slightly larger interstellar reddening than the older ones in the shell-like overdensity. These outcomes suggest that the shell-like overdensity can possibly be another tidally perturbed/formed SMC stellar structure from gas stripped off its body, caused by the interaction with the Large Magellanic Cloud or the Milky Way.
Predicted trends in Milky Way bulge proper motion rotation curves: future prospects for HST and LSST
Authors: Gough-Kelly Steven , Debattista Victor P , Clarkson William I , Gonzalez Oscar A , Anderson Stuart R , Gennaro Mario , Calamida Annalisa , Sahu Kailash C
Published: November 2021

We use an N-body+smoothed particle hydrodynamics simulation of an isolated barred galaxy to study the age dependence of bulge longitudinal proper motion (μl) rotation curves. We show that close to the minor axis (|l| ∼ 0○) the relatively young stars rotate more rapidly than the old stars, as found by Hubble Space Telescope in the Milky Way’s (MW's) bulge. This behaviour would be expected also if the MW were unbarred. At larger |l| a different behaviour emerges. Because younger stars trace a strong bar, their galactocentric radial motions dominate their μl at |l| ∼ 6○, leading to a reversal in the sign of $\langle {\rm{\mu _l}}\rangle $. This results in a rotation curve with forbidden velocities (negative $\langle {\rm{\mu _l}}\rangle $ at positive longitudes, and positive $\langle {\rm{\mu _l}}\rangle $ at negative longitudes). The old stars, instead, trace a much weaker bar and thus their kinematics are more axisymmetric, resulting in no forbidden velocities. We develop metrics of the difference in the $\langle {\rm{\mu _l}}\rangle $ rotation curves of young and old stars, and forbidden velocities. We use these to predict the locations where rotation curve reversals can be observed by HST and the Vera Rubin Telescope. Such measurements would represent support for the amplitude of the bar being a continuous function of age, as predicted by kinematic fractionation, in which the bar strength variations are produced purely by differences in the random motions of stellar populations at bar formation.
AMDB: a database of animal gut microbial communities with manually curated metadata
Authors: Yang Junwon , Park Jonghyun , Jung Yeonjae , Chun Jongsik
Published: November 2021

Variations in gut microbiota can be explained by animal host characteristics, including host phylogeny and diet. However, there are currently no databases that allow for easy exploration of the relationship between gut microbiota and diverse animal hosts. The Animal Microbiome Database (AMDB) is the first database to provide taxonomic profiles of the gut microbiota in various animal species. AMDB contains 2530 amplicon data from 34 projects with manually curated metadata. The total data represent 467 animal species and contain 10 478 bacterial taxa. This novel database provides information regarding gut microbiota structures and the distribution of gut bacteria in animals, with an easy-to-use interface. Interactive visualizations are also available, enabling effective investigation of the relationship between the gut microbiota and animal hosts. AMDB will contribute to a better understanding of the gut microbiota of animals. AMDB is publicly available without login requirements at http://leb.snu.ac.kr/amdb.
Residues at the interface between zinc binding and winged helix domains of human RECQ1 play a significant role in DNA strand annealing activity
Authors: Mukhopadhyay Swagata , Das Tulika , Bose Madhuparna , Jain Chetan Kumar , Chakraborty Mayukh , Mukherjee Sunandan , Shikha Kumari , Das Amit K , Ganguly Agneyo
Published: November 2021

RECQ1 is the shortest among the five human RecQ helicases comprising of two RecA like domains, a zinc-binding domain and a RecQ C-terminal domain containing the winged-helix (WH). Mutations or deletions on the tip of a β-hairpin located in the WH domain are known to abolish the unwinding activity. Interestingly, the same mutations on the β-hairpin of annealing incompetent RECQ1 mutant (RECQ1T1) have been reported to restore its annealing activity. In an attempt to unravel the strand annealing mechanism, we have crystallized a fragment of RECQ1 encompassing D2–Zn–WH domains harbouring mutations on the β-hairpin. From our crystal structure data and interface analysis, we have demonstrated that an α-helix located in zinc-binding domain potentially interacts with residues of WH domain, which plays a significant role in strand annealing activity. We have shown that deletion of the α-helix or mutation of specific residues on it restores strand annealing activity of annealing deficient constructs of RECQ1. Our results also demonstrate that mutations on the α-helix induce conformational changes and affects DNA stimulated ATP hydrolysis and unwinding activity of RECQ1. Our study, for the first time, provides insight into the conformational requirements of the WH domain for efficient strand annealing by human RECQ1.
Can the epigenome contribute to risk stratification for cancer onset?
Authors: Lelièvre Sophie A
Published: November 2021

The increasing burden of cancer requires identifying and protecting individuals at highest risk. The epigenome provides an indispensable complement to genetic alterations for a risk stratification approach for the following reasons: gene transcription necessary for cancer onset is directed by epigenetic modifications and many risk factors studied so far have been associated with alterations related to the epigenome. The risk level depends on the plasticity of the epigenome during phases of life particularly sensitive to environmental and dietary impacts. Modifications in the activity of DNA regulatory regions and altered chromatin compaction may accumulate, hence leading to the increase of cancer risk. Moreover, tissue architecture directs the unique organization of the epigenome for each tissue and cell type, which allows the epigenome to control cancer risk in specific organs. Investigations of epigenetic signatures of risk should help identify a continuum of alterations leading to a threshold beyond which the epigenome cannot maintain homeostasis. We propose that this threshold may be similar in the population for a given tissue, but the pace to reach this threshold will depend on the combination of germline inheritance and the risk and protective factors encountered, particularly during windows of epigenetic susceptibility, by individuals.
Metasediment-derived Melts in Subduction-zone Magmas and their Influence on Crustal Evolution
Authors: Spencer Christopher J , Yakymchuk Chris , Kirkland Christopher L , Keller C Brenhin , Moyen Jean-François , Johnson Tim E , Liebmann Janne
Published: November 2021

Subduction is a major process cycling material through Earth’s geochemical reservoirs. Although trends in chemical composition of arc magmas imply assimilation of metasediment, the degree of such assimilation and the loci of that metasediment contamination (whether via subducted sediment or country rock assimilation) are poorly understood. To address these issues, we explore compositional data of oceanic and continental arc systems from circum-Pacific subduction zones. We find that high-silica continental arc rocks of the circum-Pacific are associated with higher aluminium saturation indices interpreted to reflect higher degrees of metasediment assimilation, with Sr/Y suggestive of shallow emplacement levels within the crust. In contrast, high-silica oceanic rocks of the circum-Pacific display lower aluminosity and equilibrated at deeper levels within the crust. Continental arc basalts are often assumed to be the source of high-silica continental arc rocks. However, phase equilibrium modelling of partial melting and crystal fractionation of continental arc basalts yield results that question this assumption. Furthermore, continental arc rock compositions show that the assimilated metasediments have protoliths that are most probably felsic greywacke and pelite rather than mafic greywacke. These findings are consistent with the hypothesis that high-silica rocks in continental arcs are directly influenced by anatexis of metasediment at shallow crustal levels (<20 km). Based upon a new method of discriminating the contribution of metasediment-derived melt, approximately one-third of felsic rocks in continental arcs have a demonstrable and unambiguous metasedimentary component. The degree of metasedimentary reworking in continental arc magmas plays an important role in the evolution of the continental crust and highlights the importance of using sediment-sensitive geochemical proxies and a magma’s petrological history when deconvolving the histories of magmatic arcs. This study also underlines the caveats associated with the calculation of depleted mantle model ages, where traditional techniques may lead to discrepancies of the order of 0·5 billion years.
Assessment of the availability of snakebite antivenom in health facilities in Ndola District, Zambia: a cross-sectional study
Authors: Matafwali Scott K , Vlahakis Pipina A , Daka Victor , Witika Bwalya A , Nyirenda Herbert T , Chisompola Namaunga K , Mwila Chiluba
Published: November 2021

Background

Despite snakebite antivenom being included on the WHO list of essential medicines, many parts of the world, especially Africa, lack effective and safe antivenoms.

Methods

A descriptive, field-based, cross-sectional study was undertaken from August to November 2020 in 40 out of 71 health facilities in Ndola district. Interviews and physical inspection were conducted at each facility.

Results

The study revealed that only three (8%) of all the private health facilities had antivenom available at the time of the assessment. Factors significantly associated with antivenom supply included lack of central country supply (90%), lack of demand of the antivenom (55%) and no budget allocation for the antivenom (95%).

Conclusions

Despite the high number of notified snakebites within Ndola district, there remains poor availability of snakebite antivenom within the district.
Frailty Index for Prediction of Surgical Outcome in Ovarian Cancer: Results of a Prospective Study
Authors: Inci Melisa Guelhan , Anders Louise , Woopen Hannah , Richter Rolf , Guzel Duygu , Armbrust Robert , Sehouli Jalid
Published: November 2021

(Abstracted from Gynecol Oncol 2021;161:396–401)

Surgical complete tumor resection is the strongest prognostic factor for patients with ovarian cancer; however, frailty is common among this population, which raises concerns for surgical outcomes and recovery. Alternative therapies such as neoadjuvant therapy are available, and identification of the frail patient can assist with identification of the appropriate treatment.
Fetal Heart Rate Nadir During Bradycardia and Umbilical Artery Acidemia at Birth
Authors: Lepercq Jacques , Nghiem My-Anh , Goffinet François
Published: November 2021

(Abstracted from Acta Obstet Gynecol Scand 2021;100:964–970)

Although rare, fetal bradycardia caused by cord prolapse, placental abruption, or uterine rupture is associated with sudden and prolonged deceleration of the fetal heart rate. When this occurs, there is an association between the bradycardia-to-delivery interval and umbilical artery pH at birth.
When Does Fetal Head Rotation Occur in Spontaneous Labor at Term: Results of an Ultrasound-Based Longitudinal Study in Nulliparous Women
Authors: Hjartardóttir Hulda , Lund Sigrún H. , Benediktsdóttir Sigurlaug , Geirsson Reynir T. , Eggebø Torbjørn M.
Published: November 2021

(Abstracted from Am J Obstet Gynecol 2021;224:514.e1–514.e9)

The position of the fetal head is an important factor to consider during labor. Occiput posterior (OP) and transverse positions are associated with poor delivery outcomes for the mother and infant.
Outcome of Fetuses With Congenital Cytomegalovirus Infection and Normal Ultrasound at Diagnosis: Systematic Review and Meta-analysis
Authors: Buca D. , Di Mascio D. , Rizzo G. , Giancotti A. , D'Amico A. , Leombroni M. , Makatsarya A. , Familiari A. , Liberati M. , Nappi L. , Flacco M. E. , Manzoli L. , Salomon L. J. , Scambia G. , D'Antonio F.
Published: November 2021

(Abstracted from Ultrasound Obstet Gynecol 2021;57:551–559)

Cytomegalovirus (CMV) is the most common congenital viral infection that occurs during pregnancy. Prenatal imaging can detect some congenital anomalies associated with CMV, and the presence of a structural anomaly on ultrasound in pregnancies with CMV is associated with a high risk of symptomatic infection and abnormal neurodevelopmental outcomes.
Hospital Quality Improvement Interventions, Statewide Policy Initiatives, and Rates of Cesarean Delivery for Nulliparous, Term, Singleton, Vertex Births in California
Authors: Rosenstein Melissa G. , Chang Shen-Chih , Sakowski Christa , Markow Cathie , Teleki Stephanie , Lang Lance , Logan Julia , Cape Valerie , Main Elliott K.
Published: November 2021

(Abstracted from JAMA 2021;325(16):1631–1639)

The purpose of this observational study was to report on the impact of a statewide strategy to decrease the rates of cesarean delivery for nulliparous, term, singleton, vertex (NTSV) births in California. The researchers looked at 7,574,889 NTSV births in the United States between 2014 and 2019 and compared the cesarean delivery rate to 914,283 births in California over the same time period.
Determination of the Length of Pancreatic Ductotomy by Pancreaticoscopy During Frey’s Procedure for Chronic Pancreatitis
Authors: Julianov Alexander E. , Saroglu Azize S.
Published: November 2021

Objective:

To study the impact of pancreaticoscopy during Frey’s procedure for treating chronic pancreatitis (CP).

Background:

Excision of the central part of the head of the pancreas along with longitudinal pancreaticotomy (Frey’s procedure) is widely performed for the treatment of CP. However, there is no reliable method to determine the necessary length of longitudinal pancreaticotomy during surgery for CP.

Methods:

Thirty-five consecutive patients with CP were scheduled for Frey’s procedure with intraoperative pancreaticoscopy. The length of the longitudinal pancreaticotomy was tailored by pancreaticoscopy in the following manner: (1) it did not extend beyond the neck in case of a uniformly dilated main duct with patent branch duct confluences and a clear lumen; (2) in case of an obstructed main duct or branch duct confluence of any cause, the main duct was opened to include the most distal obstruction.

Results:

All patients underwent Frey’s procedure and intraoperative pancreaticoscopy. Based on the pancreaticoscopy findings, pancreaticotomy over the body of the gland was not necessary in 34% of the patients. A short (4–6 cm) ductotomy extension over the pancreatic body was required in 14% of the patients. Full-length pancreaticotomy was required in 52% of the patients. The median operative time was 145 minutes, and the median blood loss was 70 mL. Four patients (11.4%) experienced postoperative complications. There were no 90-day postoperative mortality or hospital readmission rates. At the median follow-up of 19 months, 31 patients (88.5%) had no pain attacks requiring medication.

Conclusions:

Intraoperative pancreaticoscopy helps to determine the length of longitudinal pancreaticotomy and reduce pancreatic trauma during Frey’s procedure for treating CP.
MANAGEMENT OF AUTOLOGUS RETINAL TRANSPLANT COMPLICATIONS: A CASE SERIES
Authors: Shields Ryan A. , Mahmoud Tamer H.
Published: November 2021

Purpose:

To present representative cases of the most common complications associated with an autologous retinal transplant (ART) for macular hole repair.

Methods:

A retrospective, consecutive case series on patients who underwent an ART by a single provider (Tamer H. Mahmoud).

Results:

Four cases were included in this review. Each suffered an ART-specific complication, including graft displacement and dislocation, sub-ART perfluoron, and a delayed proliferative vitreoretinopathy–associated retinal detachment.

Conclusion:

Because more surgeons use ART to treat atypical macular holes, an adequate understanding of surgery-specific complications and techniques to treat those complications is increasingly necessary.
Advancements in intraocular lens power calculation formulas
Authors: Chung Jinkwon , Bu Jennifer J. , Afshari Natalie A.
Published: November 2021

Purpose of review

We review recent studies comparing intraocular lens (IOL) formulas with an emphasis on selection of the highest performing formulas based on patient axial length, age, and history of previous corneal refractive surgery.

Recent findings

The Barrett Universal II formula based on a theoretical model has consistently demonstrated high accuracy. The Olsen four-factor formula using ray tracing optics and the Hill-RBF calculator using artificial intelligence have also demonstrated good prediction results after being updated. Notably, the Kane formula, incorporating artificial intelligence, has overall shown the best performance for all axial lengths. Although newly developed and updated IOL formulas have improved refractive prediction in patients with short or long axial length eyes or prior history of corneal refractive surgery, these challenging cases still require special consideration. The Barrett True-K formula has shown accurate results regardless of preoperative data in eyes with previous myopic refractive surgery.

Advancements in optical biometry and IOL calculation formulas continue to improve refractive outcomes. The clinician can optimize refractive outcomes in the majority of patients with the use of formulas that have shown consistent results and accuracy in several large studies.
The Curb Cut
Authors: Mate Kedar S.
Published: November 2021

Coronavirus disease 2019 laid bare the gaps in our health systems. Isolation and discoordination of both individuals and systems, inequities at local and global scales, and false choices between our prosperity and our health, all exacerbated the crisis. To build a better “normal” and not just a new one, health care should employ the approach of targeted universalism, which demonstrates that we can often get to universally held societal objectives by using targeted strategies that help provide an advantage to those that have been systematically disadvantaged. The goal is universal, but achieving it requires multiple strategies that target the needs of various groups to help them share in the universal goal. This approach is perhaps most easily understood, and most urgently needed, in the context of improving health equity. Using targeted strategies to permanently remake our health systems will honor the lives of those we lost far too early.
COVID-19 vaccination in adults living with HIV
Authors: Blackwell Christopher W. , Castillo Humberto López
Published: November 2021

The Centers for Disease Control and Prevention has recommended use of vaccines manufactured by Pfizer-BioNTech, Moderna, and Johnson & Johnson/Janssen to prevent COVID-19 infection in the United States. Although these vaccines are safe and have been administered to millions of persons nationwide, special populations warrant closer focus. Adults living with HIV may have specific clinical considerations that should be acknowledged when making COVID-19 vaccination prescribing decisions. This article discusses these practice considerations and provides clinical and additional guidance for nurse practitioners and other clinicians responsible for prescribing COVID-19 vaccines in adults living with HIV.
Acamprosate may be safer than baclofen for the treatment of alcohol use disorder in patients with cirrhosis: a first description of use in real-world clinical practice
Authors: Tyson Luke David , Cheng Alexandra , Kelleher Charles , Strathie Kirstin , Lovendoski James , Habtemariam Zebib , Lewis Heather
Published: November 2021

Objectives

Patients with alcohol use disorder (AUD) and liver cirrhosis benefit from stopping alcohol intake. Baclofen has been trialled for AUD in cirrhosis and appears to be effective. However, in patients without cirrhosis acamprosate is safer and more efficacious. Acamprosate is rarely used in cirrhosis due to safety concerns: the only published report was for 24 h in a controlled setting. Our centre uses both medications off-label in cirrhotic patients. We performed an audit to pragmatically compare the safety of acamprosate to baclofen in these patients.

Methods

The electronic records of patients prescribed acamprosate or baclofen between 01/04/17 and 31/03/20 were retrospectively reviewed. Adverse events and abstinence at last follow-up were compared by Student’s t-test, Mann–Whitney U or chi-square test. Confounding variables were evaluated by logistic regression.

Results

In total 48 cirrhotic patients taking acamprosate (median 84 days, range 2–524); 44 baclofen (247 days, 8–910) met inclusion criteria. At baseline, 41% had Childs-Pugh B or C cirrhosis. More patients taking baclofen had an unplanned hospital admission or attendance (23 vs 13; P = 0.013) and the mean number per patient was higher (1.6 vs 0.6; P = 0.032). Sub-group analysis revealed increased admissions in actively drinking patients prescribed baclofen to achieve abstinence (mean 2.4 vs 0.6; P = 0.020); acamprosate use was associated with a reduced chance of admission or attendance (OR, 0.284; 0.095–0.854; P = 0.025) independent of treatment length. No difference in efficacy was observed.

Conclusions

In patients with cirrhosis, acamprosate was associated with fewer unplanned admissions than baclofen, hence may be safer despite historical concerns.
Vulvoperineal Hidradenitis Suppurativa: Diagnosis, Treatment, and Management of Deformities
Authors: Ogunleye Adeyemi A. , Ndem Idorenyin E. , Bui Helen , Sayed Christopher J.
Published: November 2021

Importance

Hidradenitis suppurativa (HS) is a chronic, inflammatory disorder affecting skin of intertriginous areas that is often encountered and treated by nondermatologic specialists.

Objective

The purpose of this literature review is to provide a comprehensive, clinical source of information on HS as it relates to incidence of disease, pathophysiology, diagnosis, and overall management of this condition.

Evidence Acquisition

Sources were obtained through a comprehensive literature search using PubMed and PMC. Various terms were used to query the database, including “hidradenitis suppurativa,” “pathogenesis,” “prevalence,” “management,” “surgery,” “perineal,” and “vulva.”

Results

Underreported prevalence and unknown pathogenesis have subsequently led to variable approaches in clinical management, often employing a combination of medical and surgical management.

Conclusion

Early diagnosis and treatment of HS may lead to better disease control and minimize patients' associated morbidity related to disease.

Relevance

Knowledge of vulvoperineal hidradenitis is necessary for gynecologists and primary care physicians to ensure early diagnosis, management, and referral for optimal patient outcomes.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, the learner should be better able to describe the presentation and staging of hidradenitis suppurativa; explain possible medical and surgical treatments; and identify options for correction of vulvar deformities.
Elective Fetal Reduction in Dichorionic Diamniotic Twin Pregnancies on Parental Request: A Single-Centre Experience
Authors: Kaul Anita , Prasad Smriti , Anand Keerthana , Arora Saloni , Sharma Akshatha
Published: November 2021

(Abstracted from Fetal Diagn Ther 2021;48:272–278)

The incidence of multiple gestations is increasing because of increases in both maternal age and infertility treatments. Multifetal pregnancy reduction (MFPR) is a safe procedure that has not been associated with a substantial risk of miscarriage and has been associated with better pregnancy outcomes in terms of prematurity and neonatal birth weight.
Problems With Using Polygenic Scores to Select Embryos
Authors: Turley Patrick , Meyer Michelle N. , Wang Nancy , Cesarini David , Hammonds Evelynn , Martin Alicia R. , Neale Benjamin M. , Rehm Heidi L. , Wilkins-Haug Louise , Benjamin Daniel J. , Hyman Steven , Laibson David , Visscher Peter M.
Published: November 2021

(Abstracted from N Engl J Med 2021;385:78–86)

Embryo selection based on polygenic scores (ESPS) is the principle wherein one can select individualized embryos to transfer as part of in vitro fertilization based on predictions of health and other outcomes derived from genome-wide association studies (GWASs). The majority of human traits including physical characteristics and risk for disease are influenced by cumulative differences in genetic variants.
Unanticipated Uterine and Cervical Malignancy in Women Undergoing Hysterectomy for Uterovaginal Prolapse
Authors: Andiman Sarah E. , Bui Anthony H. , Hardart Anne , Xu Xiao
Published: November 2021

(Abstracted from Female Pelvic Med Reconstr Surg 2021;27:e549–e554)

Safety warnings by the US Food and Drug Administration (FDA) in 2014 about uterine power morcellation have heightened awareness of the risk of unsuspected uterine cancer at the time of hysterectomy. At the same time, uterine-sparing procedures have grown in use and acceptability.
The Levonorgestrel Intrauterine System for Prevention of Endometrial Cancer in Women With Obesity: A Cost-effectiveness Study
Authors: Bernard L. , Kwon J. S. , Simpson A. N. , Ferguson S. E. , Sinasac S. , Pina A. , Reade C. J.
Published: November 2021

(Abstracted from Gynecol Oncol 2021;161:367–373)

The incidence and age-standardized mortality rate of endometrial cancer continue to rise in North America, with a concurrent rise in obesity rate postulated to be the driving factor. Interventions such as weight loss in the postmenopausal period and bariatric surgery have shown significant reduction of risk for endometrial cancer, but these methods remain inaccessible, unsustainable, or unacceptable for some women.
An Epidemic of Pediatric HIV From Reuse of Infusion Equipment in Pakistan
Authors: Syed Muhammad Asif , Khan Adnan , Chaudhry Ambreen , Baig Mirza Amir , Memon Naveed Masood , Kumar Santosh , Bhurt Saeed Ahmed , Qadri Munaza , Vighio Anum , Baig Zeeshan Iqbal , Rabold Elizabeth M. , Ali Hammad , Blanton Curtis , Asghar Rana Jawad , Ikram Aamer , Rahim Musa , Solangi Masood , Mahipala Palitha , Fontaine Robert E.
Published: November 2021

Background:

From April to June 2019, a total of 909 new HIV infections were identified in Larkana, Pakistan; 86% was children younger than 15 years. To identify the possible transmission links in this outbreak, a case–control study was conducted in June 2019.

Methods:

For cases, we selected a systematic random sample of 100 HIV-positive children from the screening list. We chose 2 age-matched and sex-matched controls from the neighborhood of each HIV-positive case. All selected children were tested using the World Health Organization–approved rapid diagnosis test algorithm. We interviewed the parents of each selected child about previous exposures to parenteral treatment and compared exposures of case and control children using conditional logistic regression.

Results:

The ages of the selected children ranged from 1 month to 10 years. More than 90% of both HIV+ and HIV− children had received outpatient health care from MBBS-qualified private physicians. Eighty-three percent of HIV+ children versus 46% of HIV− children had received health care from one private physician [adjusted odds ratio (aOR) = 29, 95% confidence interval (95% CI): 10 to 79]. Intravenous infusions during the last outpatient visit were reported by 29% of case versus 7% of controls (aOR 57, 95% CI: 2.9 to >1000), whereas no case children and 17% of control children had received only intramuscular injections (aOR 0, 95% CI: 0 to 41). Among cases, 94% had been given infusions through a drip set compared with 85% of control children (aOR = 7.7, 95% CI: 2.3 to 26). Infusions had been administered with reused IV drip sets in 70% of cases compared with 8% of controls (aOR = 197, 95% CI: 16 to 2400).

Discussion:

Private physicians reusing intravenous drip sets to treat outpatients seen in private practice were responsible for this HIV epidemic. Mapping and regulation of private practitioners were suggested.