bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring regression models to enable monitoring capability of local energy communities for self‐management in low‐voltage distribution networks
Authors: Mai Tam T. , Nguyen Phuong H. , Haque Niyam A. N. M. M. , Pemen Guus A. J. M.
Published: October 2021

This study proposes a data‐driven approach to enable the self‐management capability of local energy communities (LECs) via transformer congestion monitoring in low‐voltage distribution networks. A set of regression models is adopted in this approach, while the data from residential smart meters (SMs) is leveraged. Four machine learning algorithms, namely ridge regression, support vector regression, random forest regression (RFR) and eXtreme gradient boosting regression (XGBR), are compared to select the best‐performing regression model using a cross‐validation method. A comprehensive framework is provided to facilitate comparison of the algorithm, consisting of data pre‐processing, model fitting and validation, and model deployment. A thorough analysis is also SMs' measurements. The obtained results highlight that the regression‐based method can effectively estimate the transformer loading, that is with the Pearson correlation coefficient and root mean square error calculated for the real values and the estimated values of around 0.98 and 0.87, respectively, by using only a limited set of SM measurements (5 out of 21 SMs used) provided by the LECs while preserving customers' privacy rights. Among the examined algorithms, the XGBR algorithm appears the best method as it achieves adequate accuracy at significantly less simulation time (i.e. one‐third of the simulation time of the RFR). By applying the proposed approach, the monitoring and self‐management capability of the LECs can be realised.
Chirurgie des Mundhöhlenkarzinoms – Resektion und Rekonstruktion
Authors: Roser Martin
Published: October 2021

Tumoren der Mundhöhle sind histologisch meistens Plattenepithelkarzinome. Wenn die Tumorgröße, der zu erwartende Gewebedefekt, der Allgemeinzustand und die Begleiterkrankungen es zulassen, müssen sie operativ entfernt werden. Dies bedeutet für den Patienten immer, dass wesentliche Strukturen, die für die Sprech-, Schluck- und Kaufunktion essenziell sind, verloren gehen. Bei der OP muss es daher nicht nur gelingen, die befallenen Strukturen komplett zu entfernen – auch der Gewebedefekt muss sofort mit autologen Transplantaten rekonstruiert werden, um die Funktionen zu erhalten.
Test Protocol Optimization of the Heart Rate-based Lactate Minimum
Test
Authors: Perret Claudio , Kurzen Jan
Published: October 2021

The determination of the maximal lactate steady state (MLSS) requires at least
two constant load tests. Therefore, different testing procedures to indirectly
determine MLSS based on one single test have been developed. One such method is
the application of the lactate minimum tests (LMT), where workload and heart
rate-based protocols exist. The latter showed significant correlations between
parameters at lactate minimum (LM) and MLSS for running and cycling. However, LM
clearly underestimated MLSS. Therefore, the aim of this study was to optimize
the already existing test protocol in terms of an improved agreement between LM
and MLSS. Fourteen healthy endurance-trained male athletes (age:
39.7±8.2 y; height: 180.9±6.2 cm; body mass:
78.6±7.1 kg) performed four different heart rate-based LMT
protocols, the original and three new protocols. Additionally, they performed
several constant heart rate endurance tests for assessing MLSS exercise
intensity. Heart rate, blood lactate concentration, oxygen uptake and power at
LM of two of our new test protocols with an increased start intensity were
closer to and no longer different from MLSS data. We conclude that these two new
test protocols can be used in practice to estimate heart rate-based MLSS by
means of one single exercise test.
Ein Jahr Covid-19: Testung, Verwendung von Schutzausrüstung und Auswirkungen auf die Gastrointestinale Endoskopie in Deutschland
Authors: Kahn Maria , Zellmer Stephan , Ebigbo Alanna , Muzalyova Anna , Classen Johanna , Grünherz Vivien , Böser Janis , Breitling Lutz P. , Beyer Albert , Rosendahl Jonas , Lammert Frank , Traidl-Hoffmann Claudia , Messmann Helmut , Römmele Christoph
Published: October 2021

Hintergrund In der Bewältigung der COVID-19-Pandemie stehen Praxen und Kliniken vor großen Herausforderungen. Zu den Auswirkungen der Pandemie auf gastroenterologische Einrichtungen, insbesondere über einen zeitlichen Verlauf, gibt es bislang kaum Daten. Besonders für den ambulanten Versorgungssektor fehlt eine Datenbasis. Das Universitätsklinikum Augsburg wurde im Rahmen des Verbundprojektes B-FAST des Nationalen Forschungsnetzwerks der Universitätsmedizin beauftragt hierzu Daten zu generieren.

Methode Es wurden bundesweit mittels Onlinefragebogen gastroenterologische Einrichtungen befragt. Die Rekrutierung erfolgte über die Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und den Berufsverband niedergelassener Gastroenterologen (bng). Das vorliegende Manuskript gibt einen Überblick über Daten zur Verwendung von Schutzausrüstung, präinterventioneller Testung von Patienten, Mitarbeiterscreenings sowie wirtschaftlichen Auswirkungen über den Pandemieverlauf.

Ergebnisse 429 Einrichtungen beantworteten den Fragebogen. Praxen testeten ihre Patienten präinterventionell signifikant seltener als Kliniken (7,8 % vs. 82,6 %). In Kliniken wurden stationäre Patienten (93,1 %) signifikant häufiger getestet als ambulante Patienten (72,2 %). Die Verwendung von persönlicher Schutzausrüstung (PSA) nahm im Verlauf der Pandemie signifikant zu. Es konnte gezeigt werden, dass über 70 % der Einrichtungen ihre Mitarbeiter nicht-anlassbezogen auf SARS-CoV-2 screenten. Kliniken sagten im Quartal 4/2020 signifikant häufiger elektive Prozeduren ab als Praxen. Die durchgeführten Prozeduren und die Umsatzentwicklung nahmen 2020 im Vergleich zum Vorjahr ab. Jedoch waren weniger Einrichtungen von einem Umsatzverlust betroffen als in vorangegangenen Studien erwartet wurde.

Schlussfolgerung Unserer Daten veranschaulichen die unterschiedliche Umsetzung präinterventioneller SARS-CoV-2 Testung in der ambulanten und stationären Patientenversorgung. Die Verwendung adäquater PSA und Mitarbeiterscreeningmaßnahmen konnten im Verlauf der Pandemie gesteigert werden.
Reproductive Life Planning in Adolescents
Authors: Boyle Jacqueline A. , Yimer Nigus Bililign , Hall Jennifer , Walker Ruth , Jack Brian , Black Kirsten
Published: October 2021

Unplanned pregnancy in adolescents contributes to the burden of disease, mortality, and health and educational disparities experienced by young people during this vulnerable period between childhood and adulthood. Reproductive life planning (RLP) is an approach that has been endorsed and adopted internationally, which prompts individuals and couples to set personal goals regarding if and when to have children based on their own personal priorities. This review discusses RLP tools, their acceptability, effectiveness, and issues in implementation across different contexts, with a specific focus on how RLP has been applied for adolescents. While a range of RLP tools are available and considered acceptable in adult populations, there is minimal evidence of their potential benefits for adolescent populations. Online platforms and information technology are likely to promote reach and implementation of RLP interventions in adolescents. Consideration of the socioecological contexts where adolescent pregnancies are more common should be integral to much needed future work that explores RLP interventions in adolescents.
MicrosimUC: Validation of a Low-Cost, Portable, Do-It-Yourself Microsurgery Training Kit
Authors: Navia Alfonso , Tejos Rodrigo , Canahuate Sebastian , Machuca Eduardo , Searle Susana , Cuadra Alvaro , Dagnino Bruno
Published: October 2021

Background Microsurgery depends largely on simulated training to acquire skills. Courses offered worldwide are usually short and intensive and depend on a physical laboratory. Our objective was to develop and validate a portable, low-cost microsurgery training kit.

Methods We modified a miniature microscope. Twenty general surgery residents were selected and divided into two groups: (1) home-based training with the portable microscope (MicrosimUC, n = 10) and (2) the traditional validated microsurgery course at our laboratory (MicroLab, n = 10). Before the intervention, they were assessed making an end-to-end anastomosis in a chicken wing artery. Then, each member of the MicrosimUC group took a portable kit for remote skill training and completed an eight-session curriculum. The laboratory group was trained at the laboratory. After completion of training, they were all reassessed. Pre- and posttraining procedures were recorded and rated by two blind experts using time, basic, and specific scales. Wilcoxon's and Mann–Whitney tests were used to compare scores. The model was tested by experts (n = 10) and a survey was applied to evaluate face and content validity.

Results MicrosimUC residents significantly improved their median performance scores after completion of training (p < 0.05), with no significant differences compared with the MicroLab group. The model was rated very useful for acquiring skills with 100% of experts considering it for training. Each kit had a cost of U.S. $92, excluding shipping expenses.

Conclusion We developed a low-cost, portable microsurgical training kit and curriculum with significant acquisition of skills in a group of residents, comparable to a formal microsurgery course.
Adolescent Fertility Preservation: Where Do We Stand Now
Authors: Alur-Gupta Snigdha , Vu Michelle , Vitek Wendy
Published: October 2021

Adolescence is a period of flux for many body systems. While fertility potential typically increases after menarche, there are diseases where the opposite occurs and fertility preservation options need to be considered early. In cases of cancer, options vary by pubertal status and can include ovarian tissue cryopreservation, oocyte cryopreservation, sperm cryopreservation, and testicular tissue cryopreservation. Much remains to be learned about fertility and preservation options in those with differences in sexual development (DSDs); however, depending on the form of DSD, fertility preservation may not be necessary. Similarly, traditional fertility counseling in children with galactosemia may need to be changed, as data suggest that fertility rates attributed to other causes of premature ovarian insufficiency may not be as applicable to this disease. Adolescents with Turner's syndrome are at high risk for premature ovarian failure; therefore, it is important to consider options as early as possible since ovarian reserves are depleted quickly. On the other hand, transgender and gender diverse adolescents may even be able to undergo fertility preservation after starting hormone therapy. In all cases, there are additional ethical components including technical/surgical risks in childhood, offering experimental therapies without creating false hope and evaluating children's consent and assent capabilities that must be considered.
Superficial Circumflex Iliac Artery Perforator Flap Elevation Using Preoperative High-Resolution Ultrasonography for Vessel Mapping and Flap Design
Authors: Yoshimatsu Hidehiko , Karakawa Ryo , Fuse Yuma , Hayashi Akitatsu , Yano Tomoyuki
Published: October 2021

Background The superficial circumflex iliac artery (SCIA) perforator (SCIP) flap has gained acceptance among reconstructive microsurgeons, the minimal donor site morbidity being its greatest advantage. The purpose of this article is to introduce the use of preoperative ultrasonography to facilitate elevation and to avoid postoperative complications of the SCIP flap.

Methods Preoperative mapping of the SCIA and the superficial circumflex iliac vein (SCIV) using a high-resolution ultrasound system were performed in patients undergoing reconstruction using a free SCIP flap. The skin paddle was designed placing the SCIA and the SCIV in the middle of the flap.

Results Preoperatively marked SCIA and SCIV were found intraoperatively in all cases. The skin paddle design for sufficient arterial inflow and venous drainage resulted in no postoperative flap complications.

Conclusion The use of a preoperative high-resolution ultrasound system significantly facilitates elevation of the SCIP flap, notably via the following 2 points: 1) pedicle can always be found under the markings made with preoperative ultrasonography, 2) satisfactory perfusion of the flap can be guaranteed via a safe flap design that includes preoperatively marked vessels within the skin paddle.
Beware, an underdog may bite: literature review and brand management framework in the context of underdog brands
Authors: Schmidt Holger J. , Steenkamp Pieter
Published: October 2021

An underdog brand is a brand with humble resources that competes with passion and determination against competitors that dominate a market. Numerous anecdotal examples and a few research articles of underdog brands exist, yet the understanding of what an underdog brand is and how brands can use the underdog effect is still limited. Considering the relevance of underdog brand management for practice, the purpose of our article is to distill the components of the concepts “underdog brand” and “the underdog effect” and to propose a conceptual framework to guide underdog brand management. To achieve this goal, we undertook a systematic review of the extant literature that resulted in (1) a clear and demarking definition of the term underdog brand, (2) an analysis of the usefulness of the underdog effect and (3) a reference frame we termed “the underdog brand management framework”. By doing so, we helped to overcome the research gap in the field of underdog brand management. To validate our findings, we tested the framework against a case study of a successful underdog brand. Our analysis resulted in a robust model that could inspire and guide practitioners who are in charge of underdog brands.
Metastatic Neoplasms Involving the Stomach
Authors: Vyas Monika , Hissong Erika , Gonzalez Raul S , Shia Jinru , Jessurun Jose
Published: October 2021

Objectives

Metastatic neoplasms involving the stomach are rare and diagnostically challenging if clinical history of malignancy is absent or unavailable. This study was designed to identify the tumors that most frequently metastasize to the stomach and the morphologic features that can provide clues to investigate the possibility of metastasis and predict the primary sites.

Methods

All patients with metastatic neoplasms involving the stomach were included in the study. The H&E- and immunohistochemical-stained slides were reviewed, and all clinical, endoscopic, and radiologic information was recorded.

Results

One hundred fifty patients, including 84 (56%) women and 66 (44%) men (mean age, 64 years), were identified. Gastric metastases were the initial presentation in 15% cases. Epithelial tumors (73.3%) comprised the largest group, followed by melanoma (20.6%), sarcomas (4%), germ cell tumors (1.3%), and hematolymphoid neoplasms (0.7%). Lobular breast carcinoma was the most common neoplasm overall in women, while in men, it was melanoma. Solid/diffuse growth pattern (75%) was more common compared with glandular morphology. The solid/diffuse category included lobular breast carcinoma (21.3%), melanoma (20.6%), and renal cell carcinoma (10.6%), while the glandular category was dominated by gynecologic serous carcinomas (7.3%) with papillary/micropapillary architecture.

Conclusions

Metastatic neoplasms should be considered in the differential diagnosis of gastric neoplasms, particularly those with a diffuse/solid growth pattern. Glandular neoplasms are difficult to differentiate from gastric primaries except for Müllerian neoplasms, which frequently show a papillary/micropapillary architecture.
Secondary Cases of Delta Variant Coronavirus Disease 2019 Among Vaccinated Healthcare Workers With Breakthrough Infections is Rare
Authors: Waldman Sarah E , Buehring Tara , Escobar Daniel J , Gohil Shruti K , Gonzales Ralph , Huang Susan S , Olenslager Keith , Prabaker Kavitha K , Sandoval Tessa , Yim Jennifer , Yokoe Deborah S , Cohen Stuart H
Published: October 2021

In a retrospective, cohort study at 4 medical centers with high coronavirus disease 2019 vaccination rates, we evaluated breakthrough severe acute respiratory syndrome coronavirus 2 Delta variant infections in vaccinated healthcare workers. Few work-related secondary cases were identified. Breakthrough cases were largely due to unmasked social activities outside of work.
Making Digital Surveillance Unacceptable? Security, Democracy, and the Political Sociology of Disputes
Authors: Aradau Claudia , Mc Cluskey Emma
Published: October 2021

Despite extensive criticisms of mass surveillance and mobilization by civil liberties and digital rights activists, surveillance has paradoxically been extended and legalized in the name of security. How do some democratic claims against surveillance appear to be normal and common-sense, whereas others are deemed unacceptable, even outlandish? Instead of starting from particular “logics” of either security or democracy, this paper proposes to develop a political sociology of disputes to trace how the relation between security and democracy is shaped by critique in practice. Disputes entail critique and demands for justification. They allow us to account for the constraints which govern whether an argument is deemed acceptable or improper; common-sensical or peculiar. We mobilize disputes in conjunction with Arjun Appadurai's reflections on “small numbers” in democracies in order to understand how justifications of surveillance for security enact a “rise in generality,” whereas critiques of digital surveillance that mobilize democratic claims enact a “descent into singularity.” To this purpose, we analyze public mobilizations against mass surveillance and challenges brought before the European Court of Human Rights (ECtHR). We draw on interviews with a range of actors involved in the disputes, the parties’ submissions, oral hearings, judgments, and public reports.
Virtual Visits for Outpatient Burn Care During the COVID-19 Pandemic
Authors: Head William T , Garcia Denise , Mukherjee Rupak , Kahn Steven , Lesher Aaron
Published: October 2021

Burn-injured patients must frequently travel long distances to regional burn centers, creating a burden on families and impairing clinical outcomes. Recent federal policies in response to the coronavirus pandemic have relaxed major barriers to conducting synchronous videoconference visits in the home. However, the efficacy and benefits of virtual visits relative to in-person visits remained unclear for burn patients. Accordingly, a clinical quality assurance database maintained during the coronavirus pandemic (3/3/2020 to 9/8/2020) for virtual and/or in-person visits at a comprehensive adult and pediatric burn center was queried for demographics, burn severity, visit quality, and distance data. A total of 143 patients were included in this study with 317 total outpatient encounters (61 virtual and 256 in-person). The savings associated with the average virtual visit were 130 ± 125 miles (mean ± standard deviation), 164 ± 134 travel minutes, $104 ± 99 driving costs, and $81 ± 66 foregone wage earnings. Virtual visit technical issues were experienced by 23% of patients and were significantly lower in pediatric (5%) than in adult patients (44%; P = .006). This study is the first to assess the efficacy of synchronous videoconference visits in the home setting for outpatient burn care. The findings demonstrate major financial and temporal benefits for burn patients and their families. Technical issues remain an important barrier, particularly for the adult population. A clear understanding of these and other barriers may inform future studies as healthcare systems and payors move toward improving access to burn care through remote healthcare delivery services.
COVID-19 outbreaks in hospital workers during the first COVID-19 wave
Authors: Piapan L , De Michieli P , Ronchese F , Rui F , Peresson M , Segat L , D’Agaro P , Negro C , Bovenzi M , Larese Filon F
Published: October 2021

Background

Health care workers (HCWs) are on the frontline, playing a crucial role in the prevention of infection and treatment of patients.

Aims

This study was aimed to evaluate the prevalence of hospital-acquired coronavirus disease 2019 (COVID-19) infection at work and related factors at the University Hospital of Trieste workers exposed to COVID-19 patients.

Methods

From March 1 to May 31, of 4216 employees, 963 were in contact with COVID-19 patients or colleagues and were followed up. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in nasopharyngeal swabs was determined every 3 days, by RT-PCR.

Results

During the follow-up period, 193 workers were positive for COVID-19 (5%), and 165 of these (86%) were symptomatic. We identified five major cluster outbreaks of COVID-19 infection in Trieste Hospitals, four of which occurred before the implementation of universal masking for HCWs and patients (1–14 March 2020). COVID-19 infection was significantly higher in high-risk ward workers (Infectious Diseases, and Geriatric and Emergency Medicine, odds ratio [OR] 13.4; 95% confidence interval [CI] 5.8–31), in subjects with symptoms (OR 5.4; 95% CI 2.9–10) and in those with contacts with COVID-19 patients and colleagues (OR 2.23; 95% CI 1.01–4.9).

Conclusions

Hospital workers were commonly infected due to contact with COVID-19 patients and colleagues, mainly in the first 15 days of the pandemic, before the implementation of universal mask wearing of HCWs and patients. Repetitive testing and follow-up permitted the identification of COVID-19 cases before symptom onset, obtaining better infection prevention and control.
Nonoperative Management of Minimally Displaced Lateral Compression Type 1 Pelvic Ring Injuries With and Without Occult Instability
Authors: Parry Joshua A. , Hadeed Michael M. , Tucker Nicholas J. , Strage Katya E. , Scott Bryan L. , Stacey Stephen C. , Heare Austin , Mauffrey Cyril
Published: October 2021

Objectives:

To determine the association of pelvic fracture displacement on lateral stress radiographs (LSRs) with the hospital course of patients with minimally displaced lateral compression type 1 (LC1) pelvic injuries.

Design:

Retrospective review.

Setting:

Level 1 trauma center.

Patients/Participants:

Twenty-eight adult patients with minimally displaced (<1 cm) LC1 injuries.

Intervention:

Nonoperative management.

Main Outcome Measurements:

Delayed operative fixation, days to clear physical therapy, mobilization, hospital length of stay, and total hospital opioid morphine equivalent dose.

Results:

LSR displacement was correlated with delayed operative fixation [r = 0.23, 95% confidence interval (CI) 0.05–1.11; P = 0.01], days to clear PT (r = 0.13, CI 0.01–0.28; P = 0.02), length of stay (r = 0.13, CI 0.006–0.26; P = 0.02), and opioid morphine equivalent dose (r = 19.4, CI 1.5–38.1; P = 0.03). A receiver operating characteristic curve for delayed operative fixation over LSR displacement had an area under the curve of 0.87. The LSR displacement threshold that maximized sensitivity and specificity for detecting patients who required delayed fixation was 10 mm (100% sensitivity and 78% specificity). Ten of the 15 patients with ≥10 mm of displacement on LSRs underwent delayed operative fixation for pain with mobilization at a median of 6 days (interquartile range 3.7–7.5). Patients with ≥10 mm of displacement on LSRs took longer to clear PT, took longer to walk 15 feet, had longer hospital stays, and used more opioids.

Conclusions:

LC1 fracture displacement on LSRs is associated with delayed operative fixation, difficulty mobilizing secondary to pain, longer hospital stays, and opioid use.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Hindfoot Double Arthrodesis in Adults Using Cannulated Screws: How We Do It?
Authors: Galhoum Ahmed E. , Alrashidi Yousef , Herrera-Pérez Mario , Wiewiorski Martin , Miller Margaux B. , Barg Alexej , Trivedi Vineet , Valderrabano Victor
Published: October 2021

Hindfoot arthrodesis is a common orthopedic surgical procedure indicated for reconstructive surgery in patients with advanced osteoarthritis, rheumatoid arthritis, posterior tibial tendon insufficiency (stages III and IV), severe cases of tarsal coalition, advanced stages of cavovarus foot (eg, Charcot-Marie-tooth disease), or type 2 Brodsky Charcot hindfoot arthropathy. Triple arthrodesis utilizing solid (noncannulated) screws is a technically demanding procedure because accurate placement of these screws is complex. Cannulated screws have become popular because of their easier insertion than solid screws and because of a lower chance of loss of reduction during insertion. The traditional triple hindfoot arthrodesis is performed using 2 separate incisions and also by the single medial approach with cannulated screws. Both procedures are described and illustrated in detail in this paper. We recommend inserting screws starting with the joint that has the greatest preoperative deformity and address soft tissue contractures if needed earlier during surgery. Appropriate placement of screws is very important for stable reconstruction and good postoperative outcomes.

Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
Therapeutic Drug Monitoring of Anti-infective Drugs: Implementation Strategies for 3 Different Scenarios
Authors: Kim Hannah Yejin , Byashalira Kenneth C. , Heysell Scott K. , Märtson Anne-Grete , Mpagama Stellah G. , Rao Prakruti , Sturkenboom Marieke G.G. , Alffenaar Jan-Willem C.
Published: October 2021

Background:

Therapeutic drug monitoring (TDM) supports personalized treatment. For successful implementation, TDM must have a turnaround time suited to the clinical needs of patients and their health care settings. Here, the authors share their views of how a TDM strategy can be tailored to specific settings and patient groups.

Methods:

The authors selected distinct scenarios for TDM: high-risk, complex, and/or critically ill patient population; outpatients; and settings with limited laboratory resources. In addition to the TDM scenario approach, they explored potential issues with the legal framework governing dose escalation.

Results:

The most important issues identified in the different scenarios are that critically ill patients require rapid turnaround time, outpatients require an easy sampling procedure for the sample matrix and sample collection times, settings with limited laboratory resources necessitate setting-specific analytic techniques, and all scenarios warrant a legal framework to capture the use of escalated dosages, ideally with the use of trackable dosing software.

Conclusions:

To benefit patients, TDM strategies need to be tailored to the intended population. Strategies can be adapted for rapid turnaround time for critically ill patients, convenient sampling for outpatients, and feasibility for those in settings with limited laboratory resources.
Corneal Epithelial Remodeling as a Cause of Chalazion-Induced Hypermetropia
Authors: Kalas Timothy , Gunn David
Published: October 2021

Purpose:

The importance of the corneal epithelium and its role in influencing the refractive state of the eye is well established, as is the association between periocular mass lesions, such as chalazia, and changes in corneal refractive status. This case report provides new evidence linking these 2 phenomena.

Methods and Results:

A 74-year-old man presented with gradual onset of blurred vision in his right eye. Examination revealed a large central right upper lid chalazion, with associated hypermetropic shift. Corneal topography showed central corneal flattening, and anterior segment optical coherence tomography epithelial thickness mapping showed central focal epithelial thinning. The chalazion was treated with incision and drainage and subsequent LipiFlow thermal pulsation treatment. At 3- and 4-month review, corneal epithelial thickness and topographic changes were seen to normalize, with a corresponding return toward emmetropic refractive status.

Conclusions:

Chalazia can cause reversible corneal epithelial remodeling and should be considered as a differential diagnosis in cases of unexplained vision loss and changes in refractive status.
Spirituality and Vicarious Trauma Among Trauma Clinicians: A Qualitative Study
Authors: Muehlhausen Beth L.
Published: October 2021

Background:

There has been a lack of research so far on spirituality and trauma. There has been some indication that religion and spirituality are resources in protection against burnout.

Objective:

The aim of this study was to understand the phenomenon of spirituality in the context of vicarious trauma among trauma clinicians.

Methods:

This was a qualitative study based on hermeneutic phenomenological methodology. Individual interviews were conducted with 36 physicians, nurse practitioners, and physician assistants on the relationship between their spirituality and trauma work.

Results:

Participants were recruited from a large Midwest metropolitan Level I trauma center and attendees at the 2018 Eastern Association for the Surgery of Trauma annual conference. Four patterns emerged from the interviews that transcended religious or spiritual affiliation and medical specialty. These included (1) the world of trauma; (2) religious or spiritual beliefs guiding their work; (3) the need for support systems; and (4) the importance of coping mechanisms.

Conclusion:

Religion or spirituality plays a role in underlying meaning making and, in the moment, coping for trauma professionals.
The level of quality care nurse practitioners provide compared with their physician colleagues in the primary care setting: A systematic review
Authors: Barnett Michael , Balkissoon Christopher , Sandhu Jodie
Published: October 2021

Background:

There is an increasing demand for high-quality primary care providers without adequate supply to meet the need. Nurse practitioners (NPs) are uniquely positioned to fill this demand but influence on regulatory practice authority from concerned groups regarding patient safety and quality of care has delayed this as an effective solution.

Objectives:

The objective was to address concerns abovt NP-led care by examining evidence regarding patient safety, clinical outcomes, cost, and patient satisfaction that reflect on the ability of NPs to provide high-quality care within the primary care setting and to compare their ability with standard models of care led by physicians.

Data sources:

A systematic review was completed using PubMed, CINHAL Complete, and Scopus. Using PRISMA guidelines to critique literature and the John's Hopkins Research Evidence Appraisal tool, articles were analyzed comparing the quality of care between NP and physician providers in the primary care setting.

Conclusions:

A total of 11 articles met the criteria and reveal that NPs provide equal or better quality of care for all outcomes outcomes when compared with their physician colleagues.

Implications for practice:

Quality patient care provided by NPs in the primary care setting is equal to, and in several cases superior to, that of physicians. Concerns for patient safety and quality care outcomes seem unsupported by data, and state legislatures should continue to grant full practice authority. as an effective source of providing high-quality primary health care.
Evaluation of acupuncture treatments of postpartum female pelvic floor dysfunction by four-dimensional transperineal pelvic floor ultrasound
Authors: Yao Liping , Li Fengzhi , Wang Dandan , Sheng Shaoqin
Published: October 2021

Introduction:

In the present investigation, a systematic evaluation of the clinical treatment performance of diagnosed with pelvic floor dysfunction is explored. By comparing the 4Dtransperineal pelvic floor ultrasound images with the acupuncture treatment performance of the patients, an evaluation system with various parameters is established to provide critical information to guide the clinical treatment fpostpartum female pelvic floor dysfunction (FPFD).

Methods:

Eighty patients diagnosed with FPFD are divided into 2 groups. After the designated treatment to the patients, they are carefully examined using transperineal pelvic floor ultrasound. The shape and activity of bladder neck, cervix and rectum anal canal under resting, anal sphincter and Valsalva movements are observed and recorded. The morphology and continuous shape of levator ani muscle in different states after 4D image reconstruction are obtained.

Results:

After the acupuncture treatment, the bladder neck descent is decreased by 3.8 cm and the anal levator muscle area is decreased by 3.4 cm2 comparing with the control group. The anal levator muscle hole diameter is decreased by 0.3 cm, while the anterior and posterior diameter is reduced by 0.5 cm. Reduced possibility of cystocele and uterine prolapse is demonstrated by X2 test. These changes upon acupuncture therapy are in line with the improved conditions of the patients, indicating these parameters can help evaluate the therapy performance.

Conclusion:

4D pelvic floor ultrasound imaging provides objective and quantified information for the clinical diagnosis and treatment of FPFD and the assessment of therapy efficacy, making it a promising novel method in practical applications.
How motor elements at 3 months influence motor performance at the age of 6 months
Authors: Gajewska Ewa , Moczko Jerzy , Kroll Paweł , Naczk Mariusz , Naczk Alicja , Sobieska Magdalena
Published: October 2021

One of the most important achievements of infancy is mobility, through which the child gradually becomes independent and can discover new places and objects. One form of mobility that occurs in a child's development is rolling over from supine-to-prone.

The assumption of the work was to check whether all particular motor elements from the 3rd month had a comparable effect on development in the 6th month of life.

The study population included 119 children, 69 born at term, and 50 born preterm. Children were born at week 38 ± 3 (born at term 40  ± 1/preterm 34 ± 3), with a mean body weight of 3100 ± 814 g (born at term 3462 ± 505/ preterm 2282 ± 788). Pre-term children were assessed at the corrected age. The physiotherapeutic qualitative assessment at the age of 3 months was performed in the prone and supine positions, and the qualitative assessment included 15 elements in the prone position and 15 in the supine position. A detailed mathematical analysis was then performed. Values of Cramer's V coefficient with confidence range, Goodman–Kruskal's coefficient, and the values of the probability coefficient p were given.

The position of the scapulae and pelvis (3rd month) had the strongest impact on achieving proper support on the upper extremities in the 6th month of life, while the supine position was most significantly affected by the position of the head, spine, and pelvis.
Clinical characteristics, diagnosis, and predictors of neurosyphilis patients with human immunodeficiency virus co-infection
Authors: Yu Jianhua , Shi JinChuan , Wan Hu , Li Jianwei , Shao Ying , Ye Jiangzhu , Dai Lili , Wang Xiwen , Liu An
Published: October 2021

This study aimed to compare between the clinical and laboratory characteristics of neurosyphilis and those of syphilis in human immunodeficiency virus (HIV) positive and explore the risk factors associated with the occurrence of neurosyphilis in the HIV infected.

In-patients diagnosed with HIV and syphilis co-infection who underwent a lumbar puncture and completed cerebrospinal fluid (CSF) examination were divided into neurosyphilis group and syphilis group. The demographic characteristics, symptoms and signs, and laboratory tests of the 2 groups were comparatively analyzed. Logistic regression analysis was used to explore the risk factors associated with the occurrence of neurosyphilis.

Among 81 patients, 33 patients were assigned to the neurosyphilis group, and 48 to the syphilis group. There were no significant differences in the age, gender, marital status, acquired immunodeficiency syndrome course, opportunistic infections, serum HIV viral load, and history of syphilis treatment. The difference in HIV transmission route between the 2 groups was statistically significant (P = .010), and the patients from the neurosyphilis group were mainly infected via heterosexual contact. The proportion of serum toludine red unheated serum test (TRUST) titer ≥1:16 in the neurosyphilis group were 78.8%, which was significantly higher compared to the syphilis group (48.9%). The level of CSF white blood cell count, CSF protein, and CSF HIV viral load in the neurosyphilis group were significantly higher than those of the syphilis group. The proportion of patients with neurological symptoms and signs in the neurosyphilis group was significantly higher compared to the syphilis group (P < .001). Multivariate logistic regression analysis showed that heterosexual contact transmission route, not received antiretroviral therapy, lower CD4 cell count and higher serum TRUST titer, untreated with syphilis, and neurological symptoms and signs were risk factors associated with the occurrence of neurosyphilis.

The serum TRUST titer, CSF white blood cell count, CSF protein level, CSF HIV viral load, and the percentage of neurological symptoms and signs in the neurosyphilis group were higher. Heterosexual transmission route, not received antiretroviral therapy, and untreated with syphilis prompted the possibility of neurosyphilis occurrence.
Effect of Tai Chi on cardiac function in patients with myocardial infarction
Authors: Zhao ShuJun , Zu YuGang , Lu Man , Jia XinWei , Chen Xi
Published: October 2021

Background:

Myocardial infarction is 1 of the most serious cardiovascular diseases. Early interventional therapy preserves the cardiac function of patients with myocardial infarction to the greatest extent, but it is far from meeting people's need only limited to cardiac revascularization. It is also necessary to help patients improve their quality of life, exercise tolerance, and reduce the incidence of acute cardiac recurrence as much as possible. All these depend on cardiac rehabilitation (CR) are based on exercise. Early and correct CR helps to improve the patient's heart function and improve living standards. Traditional Chinese exercise Tai Chi as an alternative form of CR has gradually become popular, but it lacks large samples and high-quality clinical studies to verify it. This study aims to explore the effect of Tai Chi on the cardiac function of patients with myocardial infarction, and to provide a strong basis for patients to choose which CR exercise.

Methods:

This is a prospective randomized controlled trial. 272 patients with myocardial infarction will be randomly divided into an experimental group and a control group according to 1:1, with 136 cases in each group. The control group: conventional treatment; the experimental group: increase Tai Chi exercise on the basis of the control group. Both groups will receive standard treatment for 24 weeks and will be followed up for 3 months. Observation indicators include: total effective rate, 6 minutes walking test, brain natriuretic peptide, left ventricular ejection fraction, the adverse reaction rate, etc. The data will be analyzed by using SPSS 25.0 software.

Discussion:

This study will evaluate the effect of Tai Chi on the cardiac function of patients with myocardial infarction. The results of this test will provide clinical evidence for patients to choose which CR exercise.

Trial registration:

OSF Registration number: DOI 10.17605/OSF.IO/QKWDP.
Effects of maternal sugar intake during pregnancy on allergies in offspring
Authors: Wu Yijun , Chai Xiaoli
Published: October 2021

Background:

To our knowledge, there is no comprehensive evidence quantifying the plausibility of the association between maternal free sugar intake during pregnancy and the development of offspring's allergic diseases. Thus, this systematic review examines the weight of evidence for causality from cohort studies on the association between maternal free sugar intake during pregnancy and the development of allergies in offspring.

Methods:

The present meta-analysis is prepared and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. We search PUBMED, Scopus, EMBASE, and Cochrane Library databases through October, 2021. All clinical trials to assess the efficacy of maternal sugar intake during pregnancy on allergies in offspring are considered eligible for analysis. The Comprehensive Meta-Analysis Software 2 program is used for statistical analyses of the pooled data. A P value < .05 is considered statistically significant. The outcome measure is development of allergic disease among offspring assessed by any method (parental history, doctor diagnosed, or questionnaire based).

Results:

It is hypothesized that high free sugar consumption during pregnancy may be associated with the development of allergies in offspring.
Comparison of therapeutic efficacy and toxicity of docetaxel, cisplatin, and fluorouracil (TPF)-based induction chemotherapy plus concurrent chemoradiotherapy and chemoradiotherapy alone in locally advanced nasopharyngeal carcinoma
Authors: Chen Ruijuan , Lu Yongkai , Zhang Yuemei , He Ruixin , Tang Fengwen , Yuan Wei , Li Yi , Zhang Xiaowei
Published: October 2021

Purpose:

In recent years, docetaxel, cisplatin, and fluorouracil (TPF)-based induction chemotherapy plus concurrent chemoradiotherapy (CCRT) has been commonly applied for locally advanced nasopharyngeal carcinoma (LA-NPC). However, whether TPF+CCRT regimen is the best choice for LA-NPC remains unclear. This meta-analysis aims to elucidate and compare the efficacy and toxicity of TPF+CCRT versus CCRT alone for LA-NPC.

Methods:

Two investigators independently and systematically searched relevant studies available on PubMed, Embase, Cochrane Library, and Web of Science published before January 7, 2021. Data were extracted from eligible studies for assessing their qualities, and calculating pooled hazard ratios (HR), odds ratio (OR) and 95% confidence intervals (CI) using Review Manager software 5.3 (RevMan 5.3).

Results:

Five studies involving 759 LA-NPC patients were analyzed in the meta-analysis. Compared to CCRT alone, TPF-based IC plus CCRT significantly improved overall survival (OS) (HR = 0.53, 95% CI: 0.35–0.81, P = .003), progression-free survival (PFS) (HR = 0.63, 95% CI: 0.46–0.86, P = .004), distant metastasis-free survival (DMFS) (HR = 0.58, 95% CI: 0.39–0.86, P = .008), and locoregional failure-free survival (LRFFS) (HR 0.62, 95% CI: 0.43–0.90, P = .01). In addition, TPF-based IC plus CCRT mainly increased risks of grade 3/4 acute hematological toxicity and non-hematological toxicities like leukopenia (OR = 1.84, 95% CI: 0.42–8.03, P = .42), neutropenia (OR = 1.78, 95% CI: 0.23–13.82, P = .58), thrombocytopenia (OR = 1.76, 95% CI: 0.53–5.81, P = .35), febrile neutropenia (OR = 2.76, 95% CI: 0.07–101.89, P = .58), vomiting (OR = 18.94, 95% CI: 0.99–362.02, P = .05) and dry mouth (OR = 2.23, 95% CI: 0.22–22.57, P = .50), which were uncomplicated and manageable.

Conclusions:

TPF + CCRT is superb than CCRT alone for the management of LA-NPC. However, TPF+CCRT increases the incidences of grade 3/4 acute hematological toxicity and some non-hematological toxicities.
The packaging and clean method contribute to insulation failure of electrosurgical instruments
Authors: Zhang Ying , Zhang Yanyan , Wang Yafei , Yang Lili , Hu Ruying
Published: October 2021

With the rapid development of medical technology, the use of electrosurgical instruments is dramatically increased in various types of surgery. However, the damage of the insulation layer of the reusable electrosurgical instrument often causes surgical accidents. The procedures of packaging and cleaning contribute to many damages to insulating layer of reusable electrosurgical instruments.

Various types of reusable electrosurgical instruments were detected for insulation failures, conduction failures, short-circuit by using a high-voltage detector, DIATEG (Morgate company). In addition, reusable electrosurgical instruments were detected for insulation failures after packaging and cleaning by different procedures.

13.1% (129/740) electrosurgical instruments had an insulation test failure; 6.2% (9/146) monopolar wires were with conduction failure; and 7.7% (16/207) bipolar wires were with short-circuit. Different packaging and cleaning procedures contribute to various degrees of damages to insulating property of reusable electrosurgical instruments.

Insulation failure was a wide problem of reusable electrosurgical instruments, while fixed packaging method and mild cleaning procedures result in fewer damages to insulating property of reusable electrosurgical instruments.
Epidemiological characteristics of COVID-19 clusters in Hainan, China
Authors: Xiao Sha , Liu Yunru , Liu Fang , Zhang Hanxi , Zhang Fan , Wang Lu
Published: October 2021

To analyze the epidemiological characteristics of coronavirus disease 2019 (COVID-19) clusters in Hainan, and to provide a basis for the prevention and control of disease clusters.

Descriptive epidemiology was used to retrospectively analyze the characteristics of disease clusters in 168 cases of COVID-19.

Of the 168 COVID-19 cases, 99 (58.93%) comprised 29 clusters, 22 (75.86%) of which were imported and included 63 cases (63.64%), while 7 clusters (24.14%) were local and included 36 cases (36.36%). Of the cluster cases, 49 were men (49.49%) and 50 were women (50.50%), the median age was 52 years, and the maximum number of cases from 41 to 60 was at 37 years (37.37%). There were 67 first generation cases (67.68%), 28 (28.28%) second generation, and 4 (4.04%) third generation. Of the clusters, 68.97% occurred from January 31 to February 7, with the highest peak on February 6. The local disease clusters occurred with a time lag. The 2 cities with the most reported incidents were Sanya (10 cases, 34.48%) and Haikou (5 cases, 17.24%). Family clusters were most frequent, with 18 clusters (62.07%) involving 62 cases (62.63%), followed by social clusters, with 3 clusters (10.34%). The most complex clusters involved 3 cluster types (family, travel, and community). There was a statistically significant difference in the infectivity of the imported clusters versus the local clusters, with imported clusters being lower (Z = –2.851, P = .004). The infectivity of all cases or family members was highest in Haikou and lowest in Sanya. The infectivity of all cases with an incubation period of ≤7 days was 1.53 ± 1.01, in which the infectivity of family members was 1.29 ± 1.10. The infectivity of all cases with an incubation period of ≤14 days was 1.89 ± 1.23, in which the infectivity of family members was 1.43 ± 1.37.

COVID-19 clusters in Hainan mainly occurred in families, and local clusters had high infectivity. Therefore, key populations and regions should be monitored, and targeted preventive measures should be carried out to provide a reference for the prevention and control of disease clusters.