bluuebunny/crossref_metadata_2025 huggingface dataset:
A Devastating Case of Hepatitis C-Induced Mixed Cryoglobulinemia
Authors: Khalid Sameeha , Alhankawi Dhuha , Kaur Kamalmeet , Ali Ali , Kazaryan Anna , Roytman Marina
Published: October 2021

Hepatitis C-induced mixed cryoglobulinemia leading to rapidly progressive gangrene, necessitating amputations, is a rare presentation. We describe a case of a 55-year-old man with untreated chronic hepatitis C virus (HCV) presenting with arthralgia and palpable purpura, which rapidly progressed to life-threatening gangrene of all extremities requiring amputations in the setting of mixed cryoglobulinemia. Treatment for HCV was initiated which led to the arrest of gangrene progression and the patient's survival. Patients with HCV-induced cryoglobulinemia should be closely monitored and started on early therapy with direct-acting antiviral therapy to prevent progression of vasculitis to gangrene. Universal screening for HCV can aid in early diagnosis and treatment to prevent devastating consequences.
A influência da iluminação pública na segurança urbana noturna
Authors: Bertuzzi Felipe Buller
Published: October 2021

A iluminação está sendo cada vez mais compreendida como um fator fundamental para assegurar a sensação de segurança aos indivíduos. Em diversos estudos científicos predominam relatos contínuos acerca da influência da iluminação como destaque de percursos e fortalecedor da sensação de segurança. Para tanto, o presente artigo visou discutir a aplicabilidade da iluminação pública no ambiente noturno e os seus impactos com relação à segurança. Buscou-se compreender a inserção da iluminação pública nas cidades e, a partir de estudos de caso e de revisões de literatura, relacioná-la a princípios norteadores de Prevenção de Crimes por meio de Projetos (CPTED): vigilância natural, territorialidade, controle natural de acessos, manutenção, uso e atividade. Dentre as discussões, verificou-se fortemente a relação do espaço urbano com o princípio de vigilância natural, exacerbado positivamente em áreas centrais e precário em bairros mais distantes, devido a falta de locais iluminados.
Association of Preoperative Diuretic Use With Early Acute Kidney Injury in Infants With Biventricular Hearts Following Cardiac Surgery
Authors: Rathgeber Steven L. , Chakrabarti Adrija , Kapravelou Eva , Hemphill Nicole , Voss Christine , Mammen Cherry , Skippen Peter , Harris Kevin C.
Published: October 2021

Background

Diuretics are used to manage congestive heart failure in infants with congenital heart disease. Adult data indicate that preoperative diuretic use increases the risk of cardiac surgery associated acute kidney injury (CS‐AKI). We have sought to understand if preoperative diuretics in infants increases the risk of CS‐AKI.

Methods and Results

This is a single‐center retrospective study of infants (1–12 months) who had CS requiring cardiopulmonary bypass between 2013 and 2018. The diagnosis and severity of CS‐AKI was defined according to the Kidney Disease Improving Global Outcomes guidelines. Three hundred patients were included (mean 6 months, SD 2.4, range 1.2–12.9 months). A total of 149 (49.7%) patients were diagnosed with CS‐AKI (stage 1: 80 [54%], stage 2: 57 [38%], stage 3: 12 [8%]). Logistic regression analysis showed preoperative diuretics were not associated with CS‐AKI (odds ratio [OR], 0.79; 95% CI, 0.43–1.44;
P
=0.45). A diagnosis of tetralogy of Fallot was an independent risk factor for CS‐AKI (OR, 3.49; 95% CI, 1.33–9.1,
P
=0.01). A diagnosis of tetralogy of Fallot (OR, 3.6; 95% CI, 1.28–10.22;
P
=0.02) and longer cardiopulmonary bypass (OR, 1.01; 95% CI, 1.0–1.02;
P
=0.04) time are risk factors for moderate to severe CS‐AKI.

Conclusions

Preoperative diuretic use does not contribute to the risk of CS‐AKI in infants early after surgery. A diagnosis of tetralogy of Fallot was the only risk factor for CS‐AKI identified using multivariate analysis in our cohort. Furthermore, a diagnosis of tetralogy of Fallot and longer cardiopulmonary bypass time are risk factors for moderate to severe CS‐AKI.
Cardiovascular Diseases That Have Emerged From the Darkness
Authors: Maron Barry J. , Maron Martin S. , Maurer Mathew S. , Rowin Ethan J. , Maron Bradley A. , Galiè Nazzareno
Published: October 2021

It is important for both the patient and physician communities to have timely access to information recognizing rapid progress in the diagnosis and treatment of familiar but relatively uncommon cardiovascular diseases. Patients with 3 cardiovascular diseases (ie, hypertrophic cardiomyopathy, pulmonary arterial hypertension, and transthyretin (TTR) cardiac amyloidosis (ATTR)]), once considered rare without effective management options and associated with malignant prognosis, have now benefited substantially from the development of a variety of innovative therapeutic strategies. In addition, in each case, enhanced diagnostic testing has expanded the patient population and allowed for more widespread administration of contemporary treatments. In hypertrophic cardiomyopathy, introduction of implantable defibrillators to prevent sudden death as well as high‐benefit:low‐risk septal reduction therapies to reverse heart failure have substantially reduced morbidity and disease‐related mortality (to 0.5% per year). For pulmonary arterial hypertension, a disease once characterized by a particularly grim prognosis, prospective randomized drug trials with aggressive single (or combined) pharmacotherapy have measurably improved survival and quality of life for many patients. In cardiac amyloidosis, development of disease‐specific drugs can for the first time reduce morbidity and mortality, prominently with breakthrough ATTR‐protein–stabilizing tafamidis. In conclusion, in less common and visible cardiovascular diseases, it is crucial to recognize substantial progress and achievement, given that penetration of such information into clinical practice and the patient community can be inconsistent. Diseases such as hypertrophic cardiomyopathy, pulmonary arterial hypertension, and ATTR cardiac amyloidosis, once linked to a uniformly adverse prognosis, are now associated with the opportunity for patients to experience satisfactory quality of life and extended longevity.
Sirtuin 1 Mediates Protection Against Delayed Cerebral Ischemia in Subarachnoid Hemorrhage in Response to Hypoxic Postconditioning
Authors: Diwan Deepti , Vellimana Ananth K. , Aum Diane J. , Clarke Julian , Nelson James W. , Lawrence Molly , Han Byung Hee , Gidday Jeffrey M. , Zipfel Gregory J.
Published: October 2021

Background

Many therapies designed to prevent delayed cerebral ischemia (DCI) and improve neurological outcome in aneurysmal subarachnoid hemorrhage (SAH) have failed, likely because of targeting only one element of what has proven to be a multifactorial disease. We previously demonstrated that initiating hypoxic conditioning before SAH (hypoxic preconditioning) provides powerful protection against DCI. Here, we expanded upon these findings to determine whether hypoxic conditioning delivered at clinically relevant time points after SAH (hypoxic postconditioning) provides similarly robust DCI protection.

Methods and Results

In this study, we found that hypoxic postconditioning (8% O
2
for 2 hours) initiated 3 hours after SAH provides strong protection against cerebral vasospasm, microvessel thrombi, and neurological deficits. By pharmacologic and genetic inhibition of SIRT1 (sirtuin 1) using EX527 and global
Sirt1
−/−
mice, respectively, we demonstrated that this multifaceted DCI protection is SIRT1 mediated. Moreover, genetic overexpression of SIRT1 using
Sirt1‐Tg
mice, mimicked the DCI protection afforded by hypoxic postconditioning. Finally, we found that post‐SAH administration of resveratrol attenuated cerebral vasospasm, microvessel thrombi, and neurological deficits, and did so in a SIRT1‐dependent fashion.

Conclusions

The present study indicates that hypoxic postconditioning provides powerful DCI protection when initiated at clinically relevant time points, and that pharmacologic augmentation of SIRT1 activity after SAH can mimic this beneficial effect. We conclude that conditioning‐based therapies administered after SAH hold translational promise for patients with SAH and warrant further investigation.
The Emerging Role of Irisin in Cardiovascular Diseases
Authors: Fu Jinjuan , Li Fangtang , Tang Yuanjuan , Cai Lin , Zeng Chunyu , Yang Yongjian , Yang Jian
Published: October 2021

Irisin, a novel hormone like polypeptide, is cleaved and secreted by an unknown protease from a membrane‐spanning protein, FNDC5 (fibronectin type III domain‐containing protein 5). The current knowledge on the biological functions of irisin includes browning white adipose tissue, regulating insulin use, and anti‐inflammatory and antioxidative properties. Dysfunction of irisin has shown to be involved in cardiovascular diseases such as hypertension, coronary artery disease, myocardial infarction, and myocardial ischemia–reperfusion injury. Moreover, irisin gene variants are also associated with cardiovascular diseases. In this review, we discuss the current knowledge on irisin‐mediated regulatory mechanisms and their roles in the pathogenesis of cardiovascular diseases.
Induction of Heme Oxygenase‐1 Is Linked to the Severity of Disease in Human Abdominal Aortic Aneurysm
Authors: Hofmann Anja , Müglich Margarete , Wolk Steffen , Khorzom Yazan , Sabarstinski Pamela , Kopaliani Irakli , Egorov Dmitry , Horn Franziska , Brunssen Coy , Giebe Sindy , Hamann Bianca , Deussen Andreas , Morawietz Henning , Poitz David M. , Reeps Christian
Published: October 2021

Background

Rupture of abdominal aortic aneurysm (rAAA) is associated with high case fatality rates, and risk of rupture increases with the AAA diameter. Heme oxygenase‐1 (gene
HMOX1
, protein HO‐1) is a stress‐induced protein and induction has protective effects in the vessel wall.

HMOX1
−/−

mice are more susceptible to angiotensin II‐induced AAA formation, but the regulation in human nonruptured and ruptured AAA is only poorly understood. Our hypothesis proposed that HO‐1 is reduced in AAA and lowering is inversely associated with the AAA diameter.

Methods and Results

AAA walls from patients undergoing elective open repair (eAAA) or surgery because of rupture (rAAA) were analyzed for aortic
HMOX1
/HO‐1 expression by quantitative real‐time polymerase chain reaction and Western blot. Aortas from patients with aortic occlusive disease served as controls.
HMOX1
/HO‐1 expression was 1.1‐ to 7.6‐fold upregulated in eAAA and rAAA. HO‐1 expression was 3‐fold higher in eAAA specimen with a diameter >84.4 mm, whereas HO‐1 was not different in rAAA. Other variables that are known for associations with AAA and HO‐1 induction were tested. In eAAA, HO‐1 expression was negatively correlated with aortic collagen content and oxidative stress parameters H
2
O
2
release, oxidized proteins, and thiobarbituric acid reactive substances. Serum HO‐1 concentrations were analyzed in patients with eAAA, and maximum values were found in an aortic diameter of 55 to 70 mm with no further increase >70 mm, compared with <55 mm.

Conclusions

Aortic HO‐1 expression was increased in eAAA and rAAA. HO‐1 increased with the severity of disease but was additionally connected to less oxidative stress and vasoprotective mechanisms.
Recent Laryngology Fellowship Graduates: Where Are They Now?
Authors: Damazo Benjamin , Bailey Traci , Fisher Daniel R. , Dehom Salem , Cress Victoria , Murry Thomas , Johns Michael M. , Krishna Priya , Crawley Brianna K.
Published: October 2021

Objectives:

Over the past 30 years laryngology fellowships have grown in number and diversity. This study investigated the career trajectories of recent laryngology fellowship graduates with the purpose of informing residents considering fellowship.

Study design:

Cross-sectional survey

Setting:

Academic medical center

Methods:

The directors of all 27 US laryngology fellowships that graduated/recruited fellows from 2010 to 2019 were contacted, and a list of former fellows was compiled. A short survey was administered in person or via email or phone. Additional data was gathered through internet searches.

Results:

One hundred eighty-three fellows were identified having completed American laryngology fellowships between 2010 and 2019 (100M:83F). Fifteen percent now practice internationally and 68% are in academic practice. A higher proportion of women than men enter laryngology fellowship after otolaryngology residency. One hundred twenty-nine fellows responded to our survey. Two-thirds of former fellows report current participation in laryngology research. Seventy-two percent of former fellows are still in their first job after fellowship and 53% believe they have their ideal practice. Women were more likely to enter academics than men after laryngology fellowship. Responders were overwhelmingly satisfied with their fellowship experience, with 95% saying they would choose to pursue fellowship training again.

Conclusions:

Most former laryngology fellows enter academia, contribute to laryngology research, practice away from their training institution, and believe they have found their ideal practice. The results of this study may be useful to residents considering fellowship training, centers considering establishing laryngology fellowships, and practices recruiting fellowship graduates.
‘Hidden Motives’? African Women, Forced Marriage and Knowledge Production at the United Nations, 1950–62
Authors: Keyse Rhian Elinor
Published: October 2021

The period following the Second World War saw much international debate around African marriage, especially practices believed by Western observers to be coercive, and the emergence of international instruments ostensibly designed to counter these practices. Drawing on feminist readings of governmentalities, this article explores United Nations debates around the 1956 Supplementary Convention on the Abolition of Slavery, the Slave Trade, and Institutions and Practices Similar to Slavery, and the 1962 Convention on Consent to Marriage, Minimum Age for Marriage and Registration of Marriages. Despite the United Nations’s preferred impression of benign universality, neither the international debates around forced and early marriage, nor the instruments they generated, were the product of neutral ‘expertise’. Rather, they represented attempts to reframe and govern marriage and the family through knowledge production. The interventions produced did not – and were not intended to – produce tangible benefits in the lives of African women and girls. Instead, they served political ends in the adversarial atmosphere of the decolonization and Cold War-era United Nations, and also represented continuities with earlier colonial ideas. In the creation of these discursive framings, African women’s voices were largely ignored, excluding them from debates that concerned them and minimizing their contributions to international ‘knowledge’.
The Platformization of Brands
Authors: Wichmann Julian R.K. , Wiegand Nico , Reinartz Werner J.
Published: October 2021

Digital platforms that aggregate products and services, such as Google Shopping or Amazon, have emerged as powerful intermediaries to brand offerings, challenging traditional product brands that have largely lost direct access to consumers. As a countermeasure, several long-established brands have built their own flagship platforms to resume control and foster consumer loyalty. For example, sports brands such as Nike, Adidas, or Asics launched tracking and training platforms that allow for ongoing versatile interactions among participants beyond product purchase. The authors analyze these emerging platform offerings, whose potential brands struggle to exploit, and provide guidance for brands that aim to platformize their business. This guidance comprises the conceptualization of digital platforms as places of consumer crowdsourcing (i.e., consumers drawing value from platform participants such as the brand, other consumers, or third-party businesses) and crowdsending (i.e., consumers providing value to platform participants) of products, services, and content along with a well-defined framework that brands can apply to assemble different types of flagship platforms. Evaluating the consequences of crowdsourcing and crowdsending for consumer–platform relationships, the authors derive a typology of archetypical relationship states and develop a set of propositions to help offline-born product brands thrive through platformization.
Navigating stigma through everyday city-making: Gendered trajectories, politics and outcomes in the periphery of Lima
Authors: Allen Adriana
Published: October 2021

Over the last two decades, a growing body of scholars from the fields of psychology, sociology, law and public health have devoted their attention to examining how and why stigma operates as a form of discrimination, paying particular attention to ethno-racially stigmatised groups. However, less attention has focused on how ordinary women and men engaged in peripheral urbanisation processes are stigmatised through multiple material, social and political mechanisms and with a myriad of outcomes. Building on this literature, and drawing on the trajectories of a man and a woman living in the periphery of metropolitan Lima, I explore how stigmatisation shapes the daily lives of poor and impoverished citizens as they try to find a place in the city, and how and why their everyday practices contribute, or not, to the transformation of stigma traps. I argue that the everyday city-making practices of the ‘unsheltered’ are inextricably linked to the politics of bare citizenship. As those stigmatised become individualised, isolated and undermined, they also are deprived of being part of a collective experience, and are deeply challenged to reclaim their agency as entitled citizens. The wider the range of stigmatisation mechanisms at work, the more difficult it is for those subjected to stigma to counteract them, as they become disadvantaged in a broad range of domains: from social relations, to tenure security, access to services and infrastructure, livelihood opportunities, and psychological and physical wellbeing. I further contend that a deep examination of the material world – the dwelling, the neighbourhood and the city – and of the practices and imaginaries that produce this material world, opens a window into the micro-politics of how stigma is negotiated, apportioned and resisted in the everyday lives of those who are politically and materially unsheltered.
Traumatic Brain Injury and Psychopathic Features Among Juvenile Offenders: Does it Matter Which Traits?
Authors: Olson Lindamarie , Vaughn Michael G.
Published: October 2021

Psychopathic traits and a history of traumatic brain injury (TBI) are common among imprisoned individuals. Although previous research has examined correlates of TBI among juvenile offenders, little research has explored the relationship between psychopathic traits and TBI among this population. Study objectives included: (1) examine the association between the history of a TBI and psychopathic traits among juvenile offenders and (2) determine if the history of a TBI predicts the manifestation of different psychopathic factors among juvenile offenders. Cross-sectional data from the Multidimensional Youth Residential Inventory consisted of 226 juvenile offenders. Bivariate and multivariate analyses were conducted. Results of linear regression analyses showed that history of a TBI significantly predicted callous unemotional and impulsive irresponsible traits. Clinical implications suggest early intervention is needed to treat the potential long-term effects of TBIs and the development of psychopathic traits. Recommendations for further research are discussed.
Higher Rate of Return to Preinjury Activity Levels After Anterior Cruciate Ligament Reconstruction With a Bone–Patellar Tendon–Bone Versus Hamstring Tendon Autograft in High-Activity Patients: Results From the New Zealand ACL Registry
Authors: Rahardja Richard , Love Hamish , Clatworthy Mark G. , Monk Andrew Paul , Young Simon W.
Published: October 2021

Background:

In primary anterior cruciate ligament (ACL) reconstruction, a bone–patellar tendon–bone (BTB) autograft is associated with lower ipsilateral failure rates. BTB autografts are associated with a higher rate of contralateral ACL injuries, which some clinicians view as a marker of success of the BTB autograft. However, there is a lack of evidence on whether BTB autografts improve the rate of return to activity and sport.

Purpose:

To compare the rate of return to preinjury activity levels in high-activity patients after ACL reconstruction with BTB autograft or hamstring tendon autograft.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

In a high-activity cohort of patients recorded between 2014 and 2018 in the New Zealand ACL Registry, prospectively collected data on preinjury and postoperative Marx activity scores were analyzed. The proportion of patients who returned to their preinjury activity levels at 1- and 2-year follow-up was compared between graft types.

Results:

Overall, 11.3% (208/1844) of patients returned to their preinjury activity levels at 1-year follow-up, and 15.5% (184/1190) returned at 2-year follow-up. At 1-year follow-up, 17.2% of patients with a BTB autograft returned to their preinjury activity levels compared with 9.3% of patients with a hamstring tendon autograft (adjusted odds ratio, 1.59 [95% CI, 1.16-2.17]; P = .004). At 2-year follow-up, 23.3% of patients with a BTB autograft had returned to their preinjury activity levels compared with 13.3% of patients with a hamstring tendon autograft (adjusted odds ratio, 1.63 [95% CI, 1.14-2.34]; P = .008). Male sex and younger age were associated with a higher rate of return to activity at both follow-up time points.

Conclusion:

The use of BTB autografts increased the odds of returning to preinjury activity levels at early follow-up. A higher rate of return to activity is a possible explanation for the higher rate of contralateral ACL injuries with the use of BTB autografts.
Time-temperature superposition of flexural creep response of carbon fiber PEKK composites manufactured using different prepreg stacking sequence
Authors: Irfan MS , Alia RA , Khan T , Cantwell WJ , Umer R
Published: October 2021

In this work, the long-term creep response of high-performance carbon fiber PEKK (CF/PEKK) composites was evaluated by performing extrapolated short-term flexural creep tests at various temperatures. The time-temperature superposition principle (TTSP) with vertical as well as horizontal shifting was used to generate master curves at reference temperatures of 120°C. Satin weave-based CF/PEKK prepregs were used to manufacture eight-layer composites via compression molding, with three different stacking sequences: (a) zero-direction [0]8 (b) cross-ply [0, 90]4 and (c) quasi-isotropic [90, −45, 45, 0]2 s. The flexural properties under three-point bending arrangement in a universal testing machine were also evaluated. A dynamic mechanical thermal analyzer (DMTA) in three-point bending mode was used to evaluate the temperature-dependent viscoelastic properties of the three types of composites. The creep and creep-recovery behavior was evaluated at 40°C, 80°C, 120°C, 160°C and 200°C. To construct a master curve, extrapolated short-term isothermal creep tests were performed from 120°C to 180°C at the intervals of 10°C. The predicted master curve represents the creep behavior of composites over more than 10 years. It was shown that the quasi-isotropic CF/PEKK composites exhibited 27% and 12% higher creep resistance at 120°C as compared to zero-direction and cross-ply laminates, respectively. Higher flexural modulus (23%) and flexural strengths (33%) were also exhibited by the quasi-isotropic CF/PEKK composites. The final thickness of quasi-isotropic laminates was 8% lower than the 0o laminates. After analyzing the cross-sections of the composites, it was proposed that the superior mechanical properties of the quasi-isotropic laminates could be due to enhanced nesting between neighboring prepreg layers during the compression molding process, which resulted in closer packing of the fibers. It has been shown that the prepreg stacking sequence could affect the creep behavior and flexural properties of the compression-molded CF/PEKK composites.
Impact of Automated Best Practice Advisories on Provider Response to CYP2C19 Genotyping Results for Patients on Clopidogrel
Authors: Petry Natasha J. , Curtis Breanna , Feldhege Erica , Khan Shahjahan , Leedahl David D. , Breidenbach Jesse L. , Hines Lindsay
Published: October 2021

Objective

The study objective was to examine provider acceptance and genotyping responses to a best practice advisory (BPA) concerning clopidogrel and CYP2C19 intermediate and poor metabolizers within the context of a new pharmacogenomics program at a Midwestern health system . Other secondary objectives analyzed included appropriate BPA firing, the distribution of alleles in study population, indications for clopidogrel use, and impact of indication on therapy change. Methods: In this study, the progress of this program was assessed by quantifying how providers respond to BPAs generated in the electronic medical record (EMR), in the context of a single representative gene–drug–outcome relationship. Patient data was pulled via reports yielding patients with genotyped information in the EMR and cross-referenced with a report evaluating BPA firing occurrences. Results: By capturing antiplatelet therapy changes in response to CYP2C19 genotyping results, 37 patients were found that had 73 BPAs fire. Nine of those patients had alternative antiplatelet therapy ordered. Of these, 6 alternative antiplatelet therapies were ordered from the BPA. Conclusion: Providers utilized BPAs, but responded differently based on individual knowledge of genotypes and indications. Information obtained from this study can be used for provider education and as reference for future design and wording of BPAs.
Novel empirical likelihood inference for the mean difference with right-censored data
Authors: Alemdjrodo Kangni , Zhao Yichuan
Published: October 2021

This paper focuses on comparing two means and finding a confidence interval for the difference of two means with right-censored data using the empirical likelihood method combined with the independent and identically distributed random functions representation. In the literature, some early researchers proposed empirical link-based confidence intervals for the mean difference based on right-censored data using the synthetic data approach. However, their empirical log-likelihood ratio statistic has a scaled chi-squared distribution. To avoid the estimation of the scale parameter in constructing confidence intervals, we propose an empirical likelihood method based on the independent and identically distributed representation of Kaplan–Meier weights involved in the empirical likelihood ratio. We obtain the standard chi-squared distribution. We also apply the adjusted empirical likelihood to improve coverage accuracy for small samples. In addition, we investigate a new empirical likelihood method, the mean empirical likelihood, within the framework of our study. The performances of all the empirical likelihood methods are compared via extensive simulations. The proposed empirical likelihood-based confidence interval has better coverage accuracy than those from existing methods. Finally, our findings are illustrated with a real data set.
Lightbulbs and ducks: The power of tech platforms to make waste disappear
Authors: Guihot Michael
Published: October 2021

Large technology platform companies have created data centres, filled with banks of data storage and processing equipment to collect, store and process the data created in the last two decades. These consume vast amounts of electricity and emit proportional amounts of heat as waste. This article considers the power of the big technology platforms to direct attention away from these by-products. The interaction of law and power raises novel questions about how to hold power to account. If the law is to effectively respond, it must confront the myriad ways that power is exercised
Risk Factors Associated With Pressure Ulcers in Patients With Traumatic Brain Injury Admitted to the Intensive Care Unit
Authors: Yoon Jeong Eun , Cho Ok-Hee
Published: October 2021

Pressure injuries (PIs) are one of the most important and frequent complications in patients admitted to the intensive care unit (ICU) or those with traumatic brain injury (TBI). The purpose of this study was to determine the incidence and risk factors of PIs in patients with TBI admitted to the ICU. In this retrospective study, the medical records of 237 patients with TBI admitted to the trauma ICU of a university hospital were examined. Demographic, trauma-related, and treatment-related characteristics of all the patients were evaluated from their records. The incidence of PIs was 13.9%, while the main risk factors were a higher injury severity score, use of mechanical ventilation, vasopressor infusion, lower Braden Scale score, fever, and period of enteral feeding. This study advances the nursing practice in the ICU by predicting the development of PIs and their characteristics in patients with TBI.
Relationship between admission vitals and brain herniation in 32 cats: a retrospective study
Authors: Her Jiwoong , Merbl Yael , Gerken Katherine , Kim Minjeong , Hofmeister Erik , Bacek Lenore M , Kuo Kendon W , Yanke Amy B
Published: October 2021

Objectives

The aim of the study was to evaluate whether any admission vitals correlated with the presence of brain herniation diagnosed via MRI in cats presenting with neurologic signs.

Methods

Medical records at two veterinary university referral centers were reviewed to identify cats that underwent brain MRI between 2010 and 2019. A control group of cats with intracranial lesions without concurrent brain herniation was analyzed for comparison. Data relating to signalment, vitals on admission, abnormalities observed on initial neurologic examination, underlying etiology, advanced imaging findings and outcome were reviewed. A Modified Glasgow Coma Scale (MGCS) score was determined retrospectively based on initial neurologic examination. Logistic regressions were performed to investigate the relationship between each risk factor and the odds of brain herniation as diagnosed on MRI.

Results

Thirty-two cats with brain herniation and 44 cats with abnormal brain MRI without evidence of herniation (as a control group) based on MRI findings were included. Cats with intracranial neoplasia vs other diagnoses were found to be at increased risk of herniation (odds ratio [OR] 4.8, 95% confidence interval [CI] 1.8–13.8; P = 0.001). The odds of herniation increased with age (OR 1.1, 95% CI 1.01–1.2; P = 0.031). Cats with herniation had a significantly lower level of consciousness in their MGCS score ( P <0.0001) than cats without herniation. There was no significant difference in either motor activity or brainstem reflexes between the groups ( P >0.05).

Conclusions and relevance

Admission heart rate and blood pressure were not associated with brain herniation. Cats with herniation were presented with a significantly lower level of consciousness in their MGCS score; however, this clinical feature cannot be directly attributable to and predictive of herniation. Older cats with intracranial neoplasia are more likely to have brain herniation.
Combined Platelet Rich Plasma and Amniotic membrane in the treatment of Perforated Corneal Ulcers
Authors: Abdelghany Ahmed A. , Bahrawy Mohamed El , Alio Jorge L.
Published: October 2021

Purpose

To report the outcomes of using synthetic amniotic membrane with platelet rich plasma for the primary management of corneal perforations.

Setting

Ophthalmology department. Faculty of Medicine, Minia University, Minia, Egypt

Methods

A case series of 10 patients diagnosed with corneal perforation underwent emergency surgical procedure for repair of the perforation through the implantation of synthetic amniotic membrane with platelet-rich plasma clot under it and the application of platelet-rich plasma eye drops, with a follow up period of up to 4 weeks.

Results

All cases demonstrated formation of adequate intraocular pressure digitally, within the first 7 days, and all cases showed complete sealing of the corneal perforation within the 4 weeks follow up period, mild symptoms were reported only in the 1st postoperative week like foreign body sensation and lacrimation. 3 of the treated patients underwent penetrating keratoplasty after 6 months with satisfactory visual outcomes.

Conclusion

The combination of amniotic membrane implant and platelet rich plasma in both the clot and eye drop forms is an effective and easy accessible method for the primary management of corneal perforations
Compelling Evidence Suggesting the Codon Usage of SARS-CoV-2 Adapts to Human After the Split From RaTG13
Authors: Zhang Yanping , Jin Xiaojie , Wang Haiyan , Miao Yaoyao , Yang Xiaoping , Jiang Wenqing , Yin Bin
Published: October 2021

SARS-CoV-2 needs to efficiently make use of the resources from hosts in order to survive and propagate. Among the multiple layers of regulatory network, mRNA translation is the rate-limiting step in gene expression. Synonymous codon usage usually conforms with tRNA concentration to allow fast decoding during translation. It is acknowledged that SARS-CoV-2 has adapted to the codon usage of human lungs so that the virus could rapidly proliferate in the lung environment. While this notion seems to nicely explain the adaptation of SARS-CoV-2 to lungs, it is unable to tell why other viruses do not have this advantage. In this study, we retrieve the GTEx RNA-seq data for 30 tissues (belonging to over 17 000 individuals). We calculate the RSCU (relative synonymous codon usage) weighted by gene expression in each human sample, and investigate the correlation of RSCU between the human tissues and SARS-CoV-2 or RaTG13 (the closest coronavirus to SARS-CoV-2). Lung has the highest correlation of RSCU to SARS-CoV-2 among all tissues, suggesting that the lung environment is generally suitable for SARS-CoV-2. Interestingly, for most tissues, SARS-CoV-2 has higher correlations with the human samples compared with the RaTG13-human correlation. This difference is most significant for lungs. In conclusion, the codon usage of SARS-CoV-2 has adapted to human lungs to allow fast decoding and translation. This adaptation probably took place after SARS-CoV-2 split from RaTG13 because RaTG13 is less perfectly correlated with human. This finding depicts the trajectory of adaptive evolution from ancestral sequence to SARS-CoV-2, and also well explains why SARS-CoV-2 rather than other viruses could perfectly adapt to human lung environment.
A low-resource digital infrastructure to streamline viewing and interpretation of radiographic images: A case study of Uganda’s hospital-wide environment
Authors: Ruhuma Edward , Edward Makumbi Fredrick , Nabukenya Josephine
Published: October 2021

Picture Archiving and Communication Systems (PACS) are said to improve patient quality of care through timely access to radiological images by clinicians. However, they are costly to be considered for hospital wide environment in low income countries. Ordinary core i3 computer systems (PCs) can provide an affordable and faster alternative solution for PACS workstations. This comparative study assessed the diagnostic accuracy, image quality of ordinary PC systems versus PACS workstations and patient turnaround time (PTAT). Forty images were randomly obtained and viewed by four raters from both PACS and PC. The findings showed modest agreement among raters (kappa 0.644 for PACS and 0.5164 PC) with acceptable diagnostic accuracy for PC (AUC = 0.7990), 97.5% reproduction of images on PC and significant reduction in PTAT after a switch to PC (4.8 min), p < 0.001, suggesting that PC display can improve quality of health care services through timely access to radiographic images.
Clinical Outcome of Drug-Eluted Stenting (Zilver PTX) in Patients With Femoropopliteal Occlusive Disease a Single Center Experience
Authors: AbuRahma Ali F. , Beasley Matthew , AbuRahma Zachary T. , Davis Meghan , Adams Elliot , Dean L. Scott , Shapiro Jake , Scott Grant , Davis Elaine
Published: October 2021

Background:

Few industry sponsored trials reported satisfactory outcomes in the use of drug-eluting stents (DES) for treatment of femoropopliteal arterial disease. This study analyzed the early/late clinical outcome from a real world single center.

Patient Populations/Methods:

A total of 115 limbs treated with Zilver PTX were analyzed for: major adverse limb event (MALE: above ankle limb amputation/major intervention at 1 year), major adverse events (MAEs; death, amputation, and target lesion thrombosis/reintervention), primary patency (based on duplex ultrasound ± ankle brachial indexes), limb salvage, and amputation free survival rates (AFS) at 1 and 2 years.

Results:

Indications included claudication in 32% and critical limb threatening ischemia (CLTI) in 68%. Lesions treated included: superficial femoral artery (SFA) 66%, both SFA and popliteal artery (PA) 19% and PA 15%. Mean lesion length was 21 cm and 68% had total occlusion. 45% were Trans-Atlantic Inter-Society Consensus (TASC) TASC II D lesions and 55% A–C lesions. Mean follow-up was 18.4 months (1–76 months). Perioperative major morbidity rate was 8.7% with 0% mortality. MALE rate at 1 year was 17% (13.5% for claudication vs 19.2% for CLTI, p=0.4499). MAE rate was 30% for claudication versus 52% for CLTI (p=0.0392). Overall primary patency rates at 1 and 2 years were 75% and 54% (86% and 71% for claudication vs 70% and 46% for CLTI, respectively, p=0.0213). Primary patency rates at 1 and 2 years were 94% and 88% for TASC A-C lesions versus 50% and 16% for TASC D lesions (p<0.0001). Overall freedom from MALE rate at 1 and 2 years were 85% and 79% (86% and 86% for claudication vs 84% and 74% for CLTI, p=0.2391). These rates were 96% and 93% for TASC A-C lesions versus 70% and 50% for D lesions, respectively (p<0.0001). Limb salvage rates at 1 and 2 years were 93% and 86% (100% and 100% for claudication vs 89% and 78% for CLTI, p=0.012). Overall AFS rates at 1 and 2 years were 79% and 71% (93% and 82% for TASC A–C vs 59% and 59% for D lesions, p=0.001).

Conclusion:

Clinical outcomes after DES (Zilver PTX) in femoropopliteal arterial lesions were satisfactory for TASC A–C lesions but inferior/unsatisfactory for TASC D lesions.
A Structural Equation Model of Depression Risk in Young Women With a History of Child Sexual Abuse
Authors: Cantón-Cortés David , Cortés María Rosario , Cantón José
Published: October 2021

This study aimed to propose and empirically test a model of the role of beliefs and emotions, self-destructive coping, and anxious attachment in the etiology of depression among a sample of 217 female survivors of child sexual abuse. The structural equation model showed a direct path from feelings of betrayal, self-destructive coping, and major anxious attachment to depression. The model also showed an indirect path (via self-destructive coping and anxious attachment) from feelings of powerlessness—particularly self-blame/stigma—to depression. The present results confirmed the existence of an explanatory model of depression risk in young adult women.
Marginalized Males, Disparate COVID-19 Outcomes, and Health Equity: A Profile of Highest Risk
Authors: Barnhart Tyler , Rovito Michael J. , Maresca Michael , Rovito Kathy
Published: October 2021

This paper is a direct response to Smith et al.’s (2020) call for more insight into health equity concerns pertaining to COVID-19 outcomes. The goal of this discussion is to offer the field with an evidence-informed ‘avatar’ representing the most-impacted group as it pertains to COVID-19 mortality and morbidity. Policy and practice implications are offered as a call to action for public health professionals to support these most impacted and highest risk communities.
Can a Meta-ethnography Be Updated by Different Reviewers? Reflections From a Recent Update
Authors: Germeni Evi , Garside Ruth , Frost Julia , Rogers Morwenna , Britten Nicky
Published: October 2021

Over the last decade, there has been a proliferation of published meta-ethnographies. Yet, strategies and techniques for updating have not received the same attention, rendering answers to important methodological questions still elusive. One such question has to do with who can perform an update. Although it is not uncommon for quantitative systematic reviews and statistical meta-analyses to be updated by different reviewers, qualitative synthesists might find themselves caught between a rock and a hard place. On the one hand, as meta-ethnography constitutes an interpretation three times removed from the lived experience of the participants in the original studies, it could be argued that an update by different reviewers might add an extra layer of interpretation. By comparison, updating by the same reviewers could give rise to concerns about the robustness of updated findings, as an implicit drive for making new data fit the original work might be difficult to control for. We recently reported the findings of our attempt to update an earlier meta-ethnography of primary care antibiotic prescribing, conducted by a different team of reviewers. In this article, we wish to contribute to the emerging debate on the necessity of promoting a culture of updating in qualitative evidence synthesis, by discussing some of the practical and methodological issues we considered at each stage of the process and offering lessons learnt from our experience.
Postpartum depression and suicide in Iran
Authors: Bagheri Parnia , Rostami Mehran
Published: October 2021

In Iran, postpartum depression is one of the common emotional symptoms which affects approximately 25% of the women who experienced childbirth. Iranian Forensic Medicine Organization (IFMO) and its branches across the country are the comprehensive sources of collecting data related to suicide deaths. In the data collecting form of suicide, there is not any item about the pregnancy of women at the time of suicide, having childbirth during the previous six weeks, and the time interval between delivery and suicide. It is suggested that, in addition to modifying the suicide registration forms by the IFMO, attention should be given to developing a mechanism that gives forensic physicians access to medical records information in the integrated health system as well as hospital information system.
Articulatory suppression delays processing of abstract words: The role of inner speech
Authors: Fini Chiara , Zannino Gian Daniele , Orsoni Matteo , Carlesimo Giovanni A , Benassi Mariagrazia , Borghi Anna M
Published: October 2021

Compared to concrete concepts, like “book,” abstract concepts expressed by words like “justice” are more detached from sensorial experiences, even though they are also grounded in sensorial modalities. Abstract concepts lack a single object as referent and are characterised by higher variability both within and across participants. According to the Word as Social Tool (WAT) proposal, owing to their complexity, abstract concepts need to be processed with the help of inner language. Inner language can namely help participants to re-explain to themselves the meaning of the word, to keep information active in working memory, and to prepare themselves to ask information from more competent people. While previous studies have demonstrated that the mouth is involved during abstract concepts’ processing, both the functional role and the mechanisms underlying this involvement still need to be clarified. We report an experiment in which participants were required to evaluate whether 78 words were abstract or concrete by pressing two different pedals. During the judgement task, they were submitted, in different blocks, to a baseline, an articulatory suppression, and a manipulation condition. In the last two conditions, they had to repeat a syllable continually and to manipulate a softball with their dominant hand. Results showed that articulatory suppression slowed down the processing of abstract more than that of concrete words. Overall results confirm the WAT proposal’s hypothesis that abstract concepts processing involves the mouth motor system and specifically inner speech. We discuss the implications for current theories of conceptual representation.
Clinical, radiological and patient-rated outcome comparison between total and partial ulnar head implants
Authors: Estermann Lea , Reissner Lisa , Rosskopf Andrea B. , Schweizer Andreas , Nagy Ladislav
Published: October 2021

This study aimed to analyse the clinical and radiological outcomes after ulnar head replacement and to compare partial and total ulnar head implants. Twenty-two patients with 23 implants were available with a mean follow-up time of 7 years (range 1.3 to 17) after distal radioulnar joint arthroplasty. At the final follow-up, patients had a low level of pain at rest and during effort, a median Disabilities of the Arm, Shoulder, and Hand (DASH) score of 12 and Patient-Rated Wrist Evaluation score of 12 with partial ulnar head implants, and scores of 20 and 22 in total ulnar head implants, respectively. While the range of motion in patients with partial ulnar head implants was slightly reduced in comparison with the preoperative condition and to the patients with total ulnar head implants, there was a tendency to a higher grip strength and rotational torque. Both types of prosthesis showed sigmoid notch resorptions and resorptions around the neck. We conclude that the results after partial ulnar head replacement do not significantly differ from the total ulnar head implants in many aspects.

Level of evidence: III
Severe COVID-19 among patients with asthma and COPD: a report from the Swedish National Airway Register
Authors: Karlsson Sundbaum Johanna , Vanfleteren Lowie E.G.W. , Konradsen Jon R. , Nyberg Fredrik , Ekberg-Jansson Ann , Stridsman Caroline
Published: October 2021

Background:

Patients with obstructive lung diseases may be at risk of hospitalization and/or death due to COVID-19.

Aim:

To estimate the frequency of severe COVID-19, and COVID-19-related mortality in a well-defined large population of patients with asthma and chronic inflammatory lung disease (COPD). Further to assess the frequency of asthma and COPD as registered comorbidities at discharge from hospital, and in death certificates.

Methods:

At the start of the pandemic, the Swedish National Airway Register (SNAR) included 271,404 patients with a physician diagnosis of asthma and/or COPD. In September 2020, after the first COVID-19 wave in Sweden, the database was linked with the National Patient Register (NPR), the Swedish Intensive Care Register and the Swedish Cause of Death Register, which all provide data about COVID-19 based on International Classification of Diseases (ICD-10) codes. Severe COVID-19 was defined as hospitalization and/or intensive care or death due to COVID-19.

Results:

Among patients in SNAR, 0.5% with asthma, and 1.2% with COPD were identified with severe COVID-19. Among patients  < 18 years with asthma, only 0.02% were severely infected. Of hospitalized adults, 14% with asthma and 29% with COPD died. Further, of patients in SNAR, 56% with asthma and 81% with COPD were also registered in the NPR, while on death certificates the agreement was lower (asthma 24% and COPD 71%).

Conclusion:

The frequency of severe COVID-19 in asthma and COPD was relative low. Mortality for those hospitalized was double as high in COPD compared to asthma. Comorbid asthma and COPD were not always identified among patients with severe COVID-19.