bluuebunny/crossref_metadata_2025 huggingface dataset:
United States Medicolegal Progress and Innovation in Telemedicine in the Age of COVID-19: A Primer for Neurosurgeons
Authors: Cruz Michael J , Nieblas-Bedolla Edwin , Young Christopher C , Feroze Abdullah H , Williams John R , Ellenbogen Richard G , Levitt Michael R
Published: June 2021

Telemedicine has received increased attention in recent years as a potential solution to expand clinical capability and patient access to care in many fields, including neurosurgery. Although patient and physician attitudes are rapidly shifting toward greater telemedicine use in light of the COVID-19 pandemic, there remains uncertainty about telemedicine's regulatory future. Despite growing evidence of telemedicine's utility, there remain a number of significant medicolegal barriers to its mass adoption and wider implementation. Herein, we examine recent progress in state and federal regulations in the United States governing telemedicine's implementation in quality of care, finance and billing, privacy and confidentiality, risk and liability, and geography and interstate licensure, with special attention to how these concern teleneurosurgical practice. We also review contemporary topics germane to the future of teleneurosurgery, including the continued expansion of reciprocity in interstate licensure, expanded coverage for homecare services for chronic conditions, expansion of Center for Medicare and Medicaid Services reimbursements, and protections of store-and-forward technologies. Additionally, we discuss recent successes in teleneurosurgery, stroke care, and rehabilitation as models for teleneurosurgical best practices. As telemedicine technology continues to mature and its expanse grows, neurosurgeons’ familiarity with its benefits, limitations, and controversies will best allow for its successful adoption in our field to maximize patient care and outcomes.
Long-Term Outcome of Spinal Cord Stimulation in Complex Regional Pain Syndrome
Authors: Hoikkanen Tomas , Nissen Mette , Ikäheimo Tiina-Mari , Jyrkkänen Henna-Kaisa , Huttunen Jukka , von und zu Fraunberg Mikael
Published: June 2021

BACKGROUND

Spinal cord stimulation (SCS) is an effective treatment in chronic neuropathic pain, but its efficacy in complex regional pain syndrome (CRPS) needs to be proven.

OBJECTIVE

To study the outcome of SCS in CRPS as measured by trial success, explantation rate, complications, and changes in opioid and neuropathic pain medication use over a 4-yr follow-up.

METHODS

We retrospectively reviewed all medical records of 35 consecutive CRPS patients who underwent SCS trials at 2 hospitals during January 1998 to December 2016. The purchase data of opioids and neuropathic pain medication during January 1995 to March 2016 were retrieved from national registries.

RESULTS

Based on a 1-wk trial, permanent SCS was implanted in 27 (77%) patients. During the median follow-up of 8 yr, 8 (30%) SCS devices were explanted, of which 7 were because of inefficient pain relief. Complications leading to revision occurred in 17 (63%) patients: 8 electrode migrations or stimulation to the wrong area, 1 deep infection, 9 hardware malfunctions, 2 pulse generator discomforts, and 2 SCS replacements. None of the 6 patients using strong opioids discontinued their use during the 2-yr follow-up. The mean opioid dose increased nonsignificantly both in patients with SCS in permanent use (53 ± 150 morphine milligram equivalents morphine milligram equivalent (MME)/day to 120 ± 240 MME/day) and in patients who had SCS explanted (27 ± 72 MME/day to 57 ± 66 MME/day).

CONCLUSION

Despite the fact that CRPS patients were not able to discontinue or reduce their strong opioid or neuropathic pain medication use, 70% continued to use their SCS device during a median 8-yr follow-up.
Geomagnetic declination derived from the positional records of Martian retrograde motion in 1491
Authors: Ahn Sang-Hyeon
Published: June 2021

Mars exhibited retrograde motions from January 4 to March 26 in 1491 CE. The Annals of the Joseon Dynasty has more than 40 records of observations with 38 lodge angles and 4 polar angles corresponding to the equatorial coordinates measured with an observing device called a small abridged armilla, as well as 34 angular separations of Mars with respect to neighboring stars estimated by eye. Accurate positions for Mars are calculated for comparison with the records, and we find a number of interesting aspects to those observations. A length unit of chi, used for reporting angular separations, is equivalent to 1 du or a Chinese angular unit. We find that the axis of the observing device might have been misaligned with the north celestial pole (NCP), and that some court astronomers might have rounded down their measurements while other astronomers might have rounded them up. In order to correct the misalignment, we apply a χ2 minimization scheme to the lodge and polar angles simultaneously, and find that the device was misaligned with the NCP by −0.°8 ± 0.°3 in elevation and −1.°3 ± 0.°3 in azimuth if the measurements had been rounded down, while it was misaligned with the NCP by −0.°4 ± 0.°3 in elevation and −2.°2 ± 0.°3 in azimuth if the measurements had been rounded up. The axis of the device was off from the NCP and aligned with a point below and to the west of the NCP. Since a magnetic compass was used for the alignment, the misalignment angle of the polar axis in azimuth is equal to the geomagnetic declination at Seoul in 1491 CE. The misalignment angles in azimuth we have obtained are in agreement with recent geomagnetic models within the 1–2 σ uncertainties of the models. Moreover, the single measurement error characterizing the observing device is estimated to be 0.°3.
Angular clustering and host halo properties of [O ii] emitters atz> 1 in the Subaru HSC survey
Authors: Okumura Teppei , Hayashi Masao , Chiu I-Non , Lin Yen-Ting , Osato Ken , Hsieh Bau-Ching , Lin Sheng-Chieh
Published: June 2021

We study the angular correlation function of star-forming galaxies and properties of their host dark matter halos at z > 1 using the Hyper-Suprime Cam (HSC) Subaru Stragetic Program (SSP) survey. We use [O ii] emitters identified using two narrow-band (NB) filters, NB816 and NB921, in the Deep/UltraDeep layers, which respectively cover large angular areas of 16.3 deg2 and 16.9 deg2. Our sample contains 8302 and 9578 [O ii] emitters at z = 1.19 (NB816) and z = 1.47 (NB921), respectively. We detect a strong clustering signal over a wide angular range, $0{_{.}^{\circ}} 001$ < θ < 1 °, with bias $b=1.61^{+0.13}_{-0.11}$ (z = 1.19) and $b=2.09^{+0.17}_{-0.15}$ (z = 1.47). We also find a clear deviation of the correlation from a simple power-law form. To interpret the measured clustering signal, we adopt a halo occupation distribution (HOD) model that is constructed to explain the spatial distribution of galaxies selected by star formation rate. The observed correlation function and number density are simultaneously explained by the best-fitting HOD model. From the constrained HOD model, the average mass of halos hosting the [O ii] emitters is derived to be $\log {M_{\rm eff}/(h^{-1}\, {M}_{\odot })}=12.70^{+0.09}_{-0.07}$ and $12.61^{+0.09}_{-0.05}$ at z = 1.19 and 1.47, respectively, which will become halos with the present-day mass M ∼ 1.5 × 1013 h−1 M⊙. The satellite fraction of the [O ii] emitter sample is found to be fsat ∼ 0.15. All these values are consistent with previous studies of similar samples, but we obtain tighter constraints even in a larger parameter space due to the larger sample size from the HSC. The results obtained for host halos of [O ii] emitters in this paper enable the construction of mock galaxy catalogs and the systematic forecast study of cosmological constraints from upcoming emission line galaxy surveys such as the Subaru Prime Focus Spectrograph survey.
Protein kinase sensors: an overview of new designs for visualizing kinase dynamics in single plant cells
Authors: Zhang Li , Takahashi Yohei , Schroeder Julian I.
Published: June 2021

Protein kinase dynamics play key roles in regulation of cell differentiation, growth, development and in diverse cell signaling networks. Protein kinase sensors enable visualization of protein kinase activity in living cells and tissues in time and space. These sensors have therefore become important and powerful molecular tools for investigation of diverse kinase activities and can resolve long-standing and challenging biological questions. In the present Update, we review new advanced approaches for genetically encoded protein kinase biosensor designs developed in animal systems together with the basis of each biosensor’s working principle and components. In addition, we review recent first examples of real time plant protein kinase activity biosensor development and application. We discuss how these sensors have helped to resolve how stomatal signal transduction in response to elevated CO2 merges with abscisic acid signaling downstream of a resolved basal SnRK2 kinase activity in guard cells. Furthermore, recent advances, combined with the new strategies described in this Update, can help deepen the understanding of how signaling networks regulate unique functions and responses in distinct plant cell types and tissues and how different stimuli and signaling pathways can interact.
Cisplatin and paclitaxel co-delivery nanosystem for ovarian cancer chemotherapy
Authors: Wang Qiaoying , Wu Changqiang , Li Xiaoting , Yang Dixiao , Shi Liangjun
Published: June 2021

We have designed and developed an effective drug delivery system using biocompatible polymer of poly (ethylene glycol)-polyaspartic acid (mPEG-PAsp) for co-loading the chemotherapy drugs paclitaxel (PTX) and cisplatin (CP) in one nano-vehicle. This study aimed to improve the anti-cancer efficacy of combinations of chemotherapy drugs and reduce their side effects. mPEG-PAsp-(PTX/Pt) nano-micelles disperse well in aqueous solution and have a narrow size distribution (37.8 ± 3.2 nm) in dynamic light scattering (DLS). Drug release profiles found that CP released at pH 5.5 was significantly faster than that at pH 7.4. MPEG-PAsp-(PTX/Pt) nano-micelles displayed a significantly higher tumor inhibitory effect than mPEG-PAsp-PTX nano-micelles when the polymer concentrations reached 50 μg/mL. Our data indicated that polymer micelles of mPEG-PAsp loaded with the combined drug exert synergistic anti-tumor efficacy on SKOV3 ovarian cells via different action mechanisms. Results from our studies suggested that mPEG-PAsp-(PTX/Pt) nano-micelles are promising alternatives for carrying and improving the delivery of therapeutic drugs with different water solubilities.
OPTIMAL SELECTION OF BASE MATERIALS FOR ACCURATE DUAL-ENERGY COMPUTED TOMOGRAPHY: COMPARISON BETWEEN THE ALVAREZ–MACOVSKI METHOD AND DIRA
Authors: Magnusson Maria , Alm Carlsson Gudrun , Sandborg Michael , Carlsson Tedgren Åsa , Malusek Alexandr
Published: June 2021

The choice of the material base to which the material decomposition is performed in dual-energy computed tomography may affect the quality of reconstructed images. The aim of this work is to investigate how the commonly used bases (water, bone), (water, iodine) and (photoelectric effect, Compton scattering) affect the reconstructed linear attenuation coefficient in the case of the Alvarez–Macovski method. The performance of this method is also compared with the performance of the Dual-energy Iterative Reconstruction Algorithm (DIRA). In both cases, the study is performed using simulations. The results show that the Alvarez–Macovski method produced artefacts when iodine was present in the phantom together with human tissues since this method can only work with one doublet. It was shown that these artefacts could be avoided with DIRA using the (water, bone) doublet for tissues and the (water, iodine) doublet for the iodine solution.
Wealth as One of the “Big Four” SES Dimensions in Intergenerational Transmissions
Authors: Hällsten Martin , Thaning Max
Published: June 2021

Recent scholarship on mobility has increasingly incorporated wealth. We ask if wealth brings anything new to mobility research or is just a standard socioeconomic status (SES) dimension in disguise. We exploit Swedish administrative registers, which contain rich SES measures over individuals’ lives for both parents’ and children’s generations. Using sibling correlations to estimate a baseline of shared family background influence, we then perform a total decomposition for each SES dimension and their overlaps. We find that wealth is a distinct dimension of SES that is very different from education, occupation, and income. Parental wealth cannot be substituted for other SES dimensions in understanding child’s wealth attainment. Moreover, parental wealth substantially moderates intergenerational reproduction in other dimensions: The wealthiest have higher reproduction rates in all child outcomes, but in particular for children’s income and wealth. Excluding wealth leads to underestimating intergenerational inequality, aggravated by its qualitatively unique status as an SES resource. We conclude that—alongside the SES resources education, occupation, and income—wealth emerges as an integral and unique dimension of what we choose to call the “big four” of social stratification.
2,3,7,8-Tetrachlorodibenzo-p-Dioxin (TCDD)-Inducible Poly-ADP-Ribose Polymerase (TIPARP/PARP7) Catalytic Mutant Mice (TiparpH532A) Exhibit Increased Sensitivity to TCDD-Induced Hepatotoxicity and Lethality
Authors: Hutin David , Long Alexandra S , Sugamori Kim , Shao Peng , Singh Sachin Kumar , Rasmussen Marit , Olafsen Ninni Elise , Pettersen Solveig , Grimaldi Giulia , Grant Denis M , Matthews Jason
Published: June 2021

2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)-inducible poly-adenosine diphosphate (ADP)-ribose polymerase (TIPARP/PARP7), an aryl hydrocarbon receptor (AHR) target gene and mono-ADP-ribosyltransferase, acts as part of a negative feedback loop to repress AHR signaling. This process is prevented by a single H532A mutation in TIPARP that destroys its catalytic activity. We hypothesized that the loss of TIPARP catalytic activity would increase sensitivity to TCDD-induced toxicity in vivo. To test this, we created a catalytically deficient mouse line (TiparpH532A) by introducing a single H532A mutation in TIPARP. Treatment of mouse embryonic fibroblasts or hepatocytes isolated from TiparpH532A mice confirmed the increased TCDD-induced expression of the AHR target genes Cyp1a1, Cyp1b1, and Tiparp. TiparpH532A mice given a single injection of 10 µg/kg TCDD, a nonlethal dose in Tiparp+/+ mice, did not survive beyond day 10. All Tiparp+/+ mice survived the 30-day treatment. TCDD-treated TiparpH532A mice displayed increased expression of AHR target genes, increased steatohepatitis and hepatotoxicity. Hepatic RNA-sequencing revealed 7-fold more differentially expressed genes in TiparpH532A mice than in Tiparp+/+ mice (4542 vs 647 genes) 6 days after TCDD treatment. Differentially expressed genes included genes involved in xenobiotic metabolism, lipid homeostasis and inflammation. Taken together, these data further support TIPARP as a critical negative regulator of AHR activity and show that loss of its catalytic activity is sufficient to increase sensitivity to TCDD-induced steatohepatitis and lethality. Since TIPARP inhibition has recently emerged as a potential anticancer therapy, the impact on AHR signaling, TCDD and polycyclic aromatic hydrocarbon toxicity will need to be carefully considered under conditions of therapeutic TIPARP inhibition.
The effect of anticoagulants in blood collection tubes on Plasmodium falciparum transmission in direct membrane feeding assays
Authors: Graumans Wouter , Lanke Kjerstin , van Gemert Geert-Jan , Alkema Manon , van de Vegte-Bolmer Marga , Bousema Teun , Collins Katharine A
Published: June 2021

Background

Direct membrane feeding assays assess the transmission potential of malaria-infected individuals using whole blood collected in anticoagulant vacutainers.

Methods

The potential inhibitory effect of four commonly used anticoagulants on gametocyte infectivity to mosquitoes was assessed in standard membrane feeding assays with cultured Plasmodium falciparum.

Results

Infection burden in mosquitoes was significantly reduced when blood was collected in sodium citrate and EDTA. Transmission was highest when blood was collected in lithium heparin and sodium heparin, although a concentration-dependent inhibition of mosquito infection was also observed.

Conclusions

Although anticoagulants can reduce transmission efficiency, lithium heparin and sodium heparin are the best anticoagulants for evaluating malaria transmission.
Tacit choice of law in international commercial contracts: an analysis of Asian jurisdictions and the Asian Principles of Private International Law
Authors: Bouwers Garth J
Published: June 2021

This article analyses the determination of a tacit choice of law in international commercial contracts in China (including Hong Kong), Japan, Singapore, and South Korea (the Republic of Korea). The article also examines the proposed Asian Principles of Private International Law (APPIL). The APPIL is intended as a model for Asian jurisdictions to interpret or supplement their private international law rules. Legislators in these jurisdictions may also use it to enact their own statutes on private international law. In the globalized era, the need for certainty regarding the rules and principles of choice of law is of the utmost importance in international commercial contracts. The APPIL may prove particularly useful in bringing more clarity to the issues related to the determination of a tacit choice of law in the region.
Conformational Changes in Three-Dimensional Chromatin Structure in Paulownia fortunei After Phytoplasma Infection
Authors: Li Bingbing , Lin Dan , Zhai Xiaoqiao , Fan Guoqiang , Zhao Zhenli , Cao Xibing , Yang Haibo , Che Tiandong , Yuan Zan , Liu Tao
Published: June 2021

Higher-order chromatin structures play important roles in regulating multiple biological processes such as growth and development as well as biotic and abiotic stress response. However, little is known about three-dimensional chromatin structures in Paulownia or about whole-genome chromatin conformational changes that occur in response to Paulownia witches’ broom (PaWB) disease. We used high-throughput chromosome conformation capture (Hi-C) to obtain genome-wide profiles of chromatin conformation in both healthy and phytoplasma-infected Paulownia fortunei genome. The heat map results indicated that the strongest interactions between chromosomes were in the telomeres. We confirmed that the main structural characteristics of A/B compartments, topologically associated domains, and chromatin loops were prominent in the Paulownia genome and were clearly altered in phytoplasma-infected plants. By combining chromatin immunoprecipitation sequencing, Hi-C signals, and RNA sequencing data, we inferred that the chromatin structure changed and the modification levels of three histones (H3K4me3/K9ac/K36me3) increased in phytoplasma-infected P. fortunei, which was associated with changes of transcriptional activity. We concluded that for epigenetic modifications, transcriptional activity might function in combination to shape chromatin packing in healthy and phytoplasm-infected Paulownia. Finally, 11 genes (e.g., RPN6, Sec61 subunit-α) that were commonly located at specific topologically associated domain boundaries, A/B compartment switching and specific loops, and had been associated with histone marks were identified and considered as closely related to PaWB stress. Our results provide new insights into the nexus between gene regulation and chromatin conformational alterations in nonmodel plants upon phytopathogen infection and plant disease resistance.
A Review of COVID-19 Chilblains-like Lesions and Their Differential Diagnoses
Authors: Sachdeva Muskaan , Mufti Asfandyar , Maliyar Khalad , Lara-Corrales Irene , Salcido Richard , Sibbald Cathryn
Published: June 2021

This review article focuses on the pathogenesis, clinical features, and diagnostic testing of the common pathologies that can manifest as chilblains-like lesions. These differentials include “COVID toes,” Raynaud phenomenon, acrocyanosis, critical limb ischemia, thromboangiitis obliterans, chilblains associated with lupus erythematosus, and idiopathic chilblains. The authors present a helpful mnemonic, ARCTIC, to assist clinicians in recognition and diagnosis.

GENERAL PURPOSE

To familiarize wound care practitioners with the differential diagnoses of chilblains-like lesions that could be associated with the complications of COVID-19.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will:

1. Identify the population most often affected by COVID toes.

2. Select the assessments that help differentiate the various conditions that cause chilblains-like lesions.

3. Choose appropriate treatment options for the various conditions that cause chilblains-like lesions.
Reconstructing Severe Lower Extremity Skin Necrosis in a Pediatric Patient
Authors: Sarrami Shayan M. , Ferry Andrew M. , Buchanan Edward P. , Gerow Frank T. , Koshy John C.
Published: June 2021

Purpura fulminans can result in significant full-thickness wounds, posing a challenge in the pediatric population, given the paucity of donor sites for reconstruction. The authors present the case of an 11-month-old patient for whom a split-thickness skin allograft (TheraSkin) was successfully implemented as a temporizing measure for a large leg wound.
Creation of Care Through Communication by Nurses, Welfare Workers, and Persons (Children) With Profound Intellectual Multiple Disabilities at a Day Care Center
Authors: Sato Tomomi
Published: June 2021

This study aimed to demonstrate how persons with profound intellectual multiple disabilities (PIMD) and nurses, together with welfare workers, communicate with one another and create care at a day care center for persons with PIMD in Japan. The ethnographic method was used. The research participants were persons with PIMD and their mothers, nurses, and welfare workers. The results indicated that care aims at autonomy based on intentions in response to signs. These findings suggest that this practice emancipated persons with PIMD and their mothers from the Japanese “culture of shame” and enable their autonomy.
A Current Update on Pelvifemoral Conditions That Should be in the Differential Diagnosis for Patients With Lower Extremity Radiculopathy
Authors: Awender Jakob F. , Lawton Cort D. , Jenkins Tyler J. , Butler Bennet A. , Selley Ryan S. , Tjong Vehniah K. , Terry Michael A. , Hsu Wellington K.
Published: June 2021

Patients presenting to an outpatient spine clinic frequently report symptoms of low back pain with associated buttock, groin, and lower extremity pain. While many of these individuals suffer from lumbar spine radiculopathy, a number of different orthopedic pathologies can mimic these symptoms. Management depends substantially on a detailed history and physical examination, in addition to working from a broad list of differential diagnoses when evaluating these patients. It is imperative that spine practitioners have a comprehensive understanding of the differential diagnoses that may mimic those originating from the lumbar spine, especially when a patient’s symptoms are atypical from classic radicular pain. Misdiagnosis can lead to unnecessary testing and treatment, while delaying an accurate clinical assessment and treatment plan. This review highlights common orthopedic diagnoses that may present similar to lumbar spine pathologies and the evidence-based evaluation of these conditions.
The State of Machine Learning in Spine Surgery
Authors: DelSole Edward M. , Keck Wyatt L. , Patel Aalpen A.
Published: June 2021

Study Design:

This was a systematic review of existing literature.

Objective:

The objective of this study was to evaluate the current state-of-the-art trends and utilization of machine learning in the field of spine surgery.

Summary of Background Data:

The past decade has seen a rise in the clinical use of machine learning in many fields including diagnostic radiology and oncology. While studies have been performed that specifically pertain to spinal surgery, there have been relatively few aggregate reviews of the existing scientific literature as applied to clinical spine surgery.

Methods:

This study utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to review the scientific literature from 2009 to 2019 with syntax specific for machine learning and spine surgery applications. Specific data was extracted from the available literature including algorithm application, algorithms tested, database type and size, algorithm training method, and outcome of interest.

Results:

A total of 44 studies met inclusion criteria, of which the majority were level III evidence. Studies were grouped into 4 general types: diagnostic tools, clinical outcome prediction, surgical assessment tools, and decision support tools. Across studies, a wide swath of algorithms were used, which were trained across multiple disparate databases. There were no studies identified that assessed the ethical implementation or patient perceptions of machine learning in clinical care.

Conclusions:

The results reveal the broad range of clinical applications and methods used to create machine learning algorithms for use in the field of spine surgery. Notable disparities exist in algorithm choice, database characteristics, and training methods. Ongoing research is needed to make machine learning operational on a large scale.
Frailty Severity Impacts Development of Hospital-acquired Conditions in Patients Undergoing Corrective Surgery for Adult Spinal Deformity
Authors: Pierce Katherine E. , Kapadia Bhaveen H. , Bortz Cole , Alas Haddy , Brown Avery E. , Diebo Bassel G. , Raman Tina , Jain Deeptee , Lebovic Jordan , Passias Peter G.
Published: June 2021

Study Design:

This was a retrospective cohort study of a national dataset.

Purpose:

The purpose of this study was to consider the influence of frailty on the development of hospital-acquired conditions (HACs) in adult spinal deformity (ASD).

Summary of Background Data:

HACs frequently include reasonably preventable complications. Eleven events are identified as HACs by the Affordable Care Act. In the surgical ASD population, factors leading to HACs are important to identify to optimize health care.

Methods:

Patients 18 years and older undergoing corrective surgery for ASD identified in the American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP). The relationship between HACs and frailty as defined by the NSQIP modified 5-factor frailty index (mFI-5) were assessed using χ2 and independent sample t tests. The mFI-5 is assessed on a scale 0–1 [not frail (NF): <0.3, mildly frail (MF): 0.3–0.5, and severely frail (SF): > 0.5]. Binary logistic regression measured the relationship between frailty throughout HACs.

Results:

A total of 9143 ASD patients (59.1 y, 56% female, 29.3 kg/m2) were identified. Overall, 37.6% of procedures involved decompression and 100% fusion. Overall, 6.5% developed at least 1 HAC, the most common was urinary tract infection (2.62%), followed by venous thromboembolism (2.10%) and surgical site infection (1.88%). According to categorical mFI-5 frailty, 82.1% of patients were NF, 16% MF, and 1.9% SF. Invasiveness increased with mFI-5 severity groups but was not significant (NF: 3.98, MF: 4.14, SF: 4.45, P>0.05). Regression analysis of established factors including sex [odds ratio (OR): 1.22; 1.02–146; P=0.030], diabetes mellitus (OR: 0.70; 0.52–0.95; P=0.020), total operative time (OR: 1.01; 1.00–1.01; P<0.001), body mass index (OR: 1.02; 1.01–1.03; P=0.008), and frailty (OR: 8.44; 4.13–17.26; P<0.001), as significant predictors of HACs. Overall, increased categorical frailty severity individually predicted increased total length of stay (OR: 1.023; 1.015–1.030; P<0.001) and number of complications (OR: 1.201; 1.047–1.379; P=0.009).

Conclusions:

For patients undergoing correction surgery for ASD, the incidence of HACs increased with worsening frailty score. Such findings suggest the importance of medical optimization before surgery for ASD.
A single-center pilot study comparing dexmedetomidine continuous infusion versus propofol TCI for drug-induced sleep endoscopy (DISE)
Authors: Alicino Ilaria , Corso Ruggero , Barbara Michele , Dibenedetto Valentina I. , Barbara Francesco , De Benedetto Michele , Fossati Nicoletta , Cattano Davide
Published: June 2021

Background:

Drug-induced sleep endoscopy (DISE) has become a routine diagnostic tool to assess the upper airway in obstructive sleep apnea patients, enabling effective diagnosis and appropriate treatment of the obstruction site. A number of protocols with different drugs and availability of target-controlled infusion (TCI) systems have been reported and published, making comparisons between studies difficult. In recent years, dexmedetomidine has claimed a role as a potential alternative to propofol for DISE sedation. In a real-life study we compared the effects of dexmedetomidine continuous infusion or propofol-TCI in patients undergoing DISE on time to reach adequate observation conditions, cardio-respiratory parameters, and recovery.

Methods:

Pilot prospective, randomized not blinded, single center study. A total of 28 patients scheduled to have DISE were randomly assigned to either group P (N=14; propofol-TCI, initial propofol effect-site target concentration 2.0 µg/mL, increased by 0.3 µg/mL every 2 min) or group D (N=14; dexmedetomidine bolus 1 µg/kg over 10 min, followed by infusion at 0.7 µg/kg/h). Hemodynamic and respiratory variables (including SpO2 nadir), time to reach the observation window and overall DISE duration were recorded.

Results:

A total of 28 patients were enrolled and completed the study: the cohort included 26 males (92.85%) and 2 females (7.14%). The mean age was 45.4±11.1 years [interquartile (IQ), 25.0–65.0], body mass index 30.5±3.4 kg/m2 (IQ, 21.0–36.0), and apnea-hypopnea index 36.9±21.1 events/hour (IQ, 7.8–95.0). There were no statistically significant differences between the 2 groups in baseline apnea-hypopnea index, oxygen desaturation index, Epworth Sleepiness Scale score, preprocedural SpO2 nadir, age, sex, or body mass index. Compared with group P, group D showed significant differences in SpO2 (higher nadir during DISE, 87.09±5.4% vs. 75.0±11.0; P<0.001) and heart rate (80.4±8.9 vs. 62.8±6.6; P<0.001). While group D had longer duration of endoscopic examination times and emergence time from sedation, the grading of site of obstructions were similar in the 2 groups.

Conclusions:

Dexmedetomidine seems a limited, if viable, clinical alternative for DISE when propofol is contraindicated or not available: while causing higher SpO2 nadirs compared with propofol, it has a slow onset and longer recovery time, increasing total procedural time. Studies with greater patient numbers are needed to confirm these observations.
Effectiveness of Rhythmic Auditory Stimulation on Gait in Parkinson Disease
Authors: Burrai Francesco , Apuzzo Luigi , Zanotti Renzo
Published: June 2021

Parkinson disease is a neurodegenerative disease present in approximately 2% of the population older than 65 years. Rhythmic auditory stimulation in the early 1990s aimed to improve individual mobility in terms of gait speed, stride length, and cadence. Our systematic review and meta-analysis aimed to summarize and evaluate the evidence of the effects of rhythmic auditory stimulation on gait speed, stride length, and cadence in patients with Parkinson disease. A systematic review and meta-analysis of randomized controlled trials was conducted to determine the efficacy of rhythmic auditory stimulation in patients with Parkinson disease. Five studies were included in the review (209 patients). Rhythmic auditory stimulation resulted, on average, a gait speed improvement of 0.53 standard deviation (SD) units (95% CI, 0.23 to 0.83; P = .0005), a stride length improvement of 0.51 SD units (95% CI, 0.18 to 0.84; P = .003) greater than that in the control group. All trials contained a risk of bias due to a lack of blinding. The quality of evidence was low. No adverse events were identified. Rhythmic auditory stimulation may have a beneficial effect on gait speed and stride length in patients with Parkinson disease. Future studies should consider a power analysis to recruit an adequate number of subjects and minimize the risk of sample bias. Further research should provide the additional results required for an acceptable estimate of the effects of rhythmic auditory stimulation on gait in patients with Parkinson disease.
Perioperative factors associated with persistent postsurgical pain after hysterectomy, cesarean section, prostatectomy, and donor nephrectomy: a systematic review and meta-analysis
Authors: Sharma Lokesh R. , Schaldemose Ellen Lund , Alaverdyan Harutyun , Nikolajsen Lone , Chen Dili , Bhanvadia Shivam , Komen Helga , Yaeger Lauren , Haroutounian Simon
Published: June 2021

Persistent postsurgical pain (PPSP) is a common and often disabling postoperative morbidity, but many questions remain about factors associated with PPSP. This systematic review and meta-analysis aimed to identify preoperative, intraoperative, and postoperative factors associated with PPSP after gynecological surgeries, namely, hysterectomy and cesarean section, and urological surgeries, namely, prostatectomy and donor nephrectomy. Overall, 18 gynecological surgery studies, 4 prostatectomy studies, and 2 donor nephrectomy studies met the review criteria, providing data that could be meta-analyzed. The average (±SD) PPSP occurrence after gynecological surgery was 20 ± 11%; factors associated with increased risk of PPSP included smoking, preoperative abdominal or pelvic pain, preoperative pain elsewhere in the body, longer duration of surgery, more intense acute postoperative pain, and surgical wound infection. The use of neuraxial anesthesia was associated with decreased PPSP risk. The average PPSP occurrence was 20 ± 9% after prostatectomy and 15 ± 2% after donor nephrectomy. For urological procedures, the existing data did not allow for identification of significant factors associated with PPSP, except for laparoscopic and hand-assisted laparoscopic approaches that were associated with lower incidence of PPSP for donor nephrectomy, and the use of neuraxial anesthesia which was associated with lower incidence of PPSP after prostatectomy. Persistent postsurgical pain after gynecological and urological surgeries is common. This systematic review identified important factors associated with cesarean section and hysterectomy that can help identify women who are at high risk of PPSP. More high-quality studies with consistent methodology are needed to understand the factors associated with PPSP risk, particularly for surgeries such as prostatectomy and nephrectomy.
Studying Executive Directors and Supervisors Views of Organizational and Policy-Level Challenges Faced by Community Health Workers
Authors: Rahman Rahbel , Ross Abigail M. , Chesna Sharon , Rama Tatikola Maya , Hopwood Simone
Published: June 2021

Within the United States, there is an absence of a national community health worker (CHW) program. There is substantial regional and state-based variability in the population served by CHWs, their disease focus, and availability of training, supervision, and other supports. This article seeks to respond to the call in the literature to work collaboratively with CHW professional associations to identify, reflect, and respond to CHW workforce development and sustainability issues. We partnered with 8 member organizations of the Association of Perinatal Networks of New York and conducted 2 focus groups with 7 executive directors and 6 supervisors. Data were analyzed using thematic analysis. Policy barriers included funding, accessibility of evidence-based practices, and credentialing. Organizational barriers included recruitment and high turnover and interorganizational referral processes and management. This study offers recommendations for supports needed to sustain CHWs, with an emphasis on greater investment in recruitment and training, higher compensation, and interorganizational collaboration.
Pressure Injuries Related to the Use of Compression Stockings in Pediatric Surgical Patients
Authors: Garcia Mayra G. , Cochrum Bailey , Dutton Hayden , Nguyen Xuan
Published: June 2021

Mechanical compression devices such as compression stockings assist in the treatment and prevention of venous thromboembolism for nonambulatory postoperative patients. Risk factors in pediatric surgical patients increase their likelihood of developing a venous thromboembolism. This article describes an adolescent patient who developed pressure injuries from prolonged compression stocking use. Although other pressure injury prevention techniques were completed by nursing, the lack of knowledge regarding the risk of pressure injuries from compression stockings resulted in a poor outcome. As a result of this event, practice changes were implemented on the pediatric surgical unit to prevent reoccurrence. The practice changes included removal of compression stockings once per shift to assess extremities, daily replacement of new stockings, and utilization of sequential compression devices as the preferred mechanical compression method. Further research is needed for compression stocking use in the pediatric and adolescent population to provide best practice implications for nursing.
Psychological Resilience, Metacognitions, and Fear of Recurrence Among Cancer Survivors and Family Caregivers
Authors: Ağaç Mehtap , Üzar-Özçetin Yeter Sinem
Published: June 2021

Background

Cancer is a life crisis that can have devastating consequences not only on the affected individual but also on his/her caregivers.

Objective

The aim of this study was to investigate the influence of psychological resilience and metacognitions of cancer survivors and their family caregivers (FCs) on fear of recurrence (FoR).

Methods

This study used a cross-sectional design while adhering to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Data were collected from 112 cancer survivors and 112 FCs recruited from 5 oncology hospitals.

Results

The cancer survivors and caregivers reported low levels of psychological resilience, which we found to be correlated with great fear of recurrence in cancer survivors and FCs. It was also in relation with metacognitions in cancer survivors and FCs.

The findings showed that psychological resilience negatively predicted the fear of recurrence, whereas the metacognitions positively predicted the fear of recurrence in cancer survivors and FCs. The total effects of psychological resilience on the FoR in cancer survivors and FCs were 0.920 (confidence interval [CI], −2.059 to 0.072) and 0.061 (CI, −0.475 to 0.474), respectively. The total effects of metacognition on the FoR in cancer survivors and FCs were 1.164 (CI, 0.217-2.371) and 0.486 (CI, 0.016-1.058), respectively.

Conclusions

The findings underline the direct and indirect mediating role of psychological resilience and metacognition of cancer survivors and FCs on FoR.

Implication for Practice

The findings are particularly important to oncology nurses, who as 24-hour care providers are important sources of psychosocial care. Their awareness of factors influencing FoR is critical for achieving positive outcomes.
The Relationship of Aging and Smoking With Rotator Cuff Disease
Authors: Grusky Alan Z. , Giri Ayush , O’Hanlon Deirdre , Jain Nitin B.
Published: June 2021

Objective

Despite rotator cuff disease being one of the most common causes of shoulder pain, its pathogenesis and biology are poorly understood. In this study, we synthesized evidence from studies reporting associations for aging and smoking status in relation to rotator cuff disease.

Design

A systematic review was performed using multiple databases (PubMed, Embase, Cochrane, CINAHL, and Science Direct). Articles that met our eligibility criteria and presented data on the association between aging and/or smoking status and rotator cuff disease were included. We performed meta-analyses and reported cumulative effects using odds ratios and corresponding 95% confidence intervals.

Results

Of the 212 articles eligible for full-text review, seven studies reported on the relationship between aging and rotator cuff disease, and 10 studies reported on the relationship between smoking and rotator cuff disease. Aging was consistently associated with increased odds of having rotator cuff disease when assessed continuously (per 10-yr increase: odds ratio = 1.20, 95% confidence interval = 1.18–1.21) or categorically (ages <40 yrs vs: [a] 40–44 yrs [odds ratio = 2.71, 95% confidence interval = 1.78–4.13], [b] 45–49 yrs [odds ratio = 4.33, 95% confidence interval = 2.88–6.55], and [c] ≥50 yrs [odds ratio = 6.97, 95% confidence interval = 4.85–10.01]). Assessing studies that reported smoking status as current smokers versus nonsmokers, current smokers were more likely to have rotator cuff disease (odds ratio = 1.94, 95% confidence interval = 1.52–2.48). However, a statistically significant association was not found when never smokers were compared with former smokers (odds ratio = 1.08, 95% confidence interval = 0.97–1.20) and to current smokers (odds ratio = 0.97, 95% confidence interval = 0.87–1.07).

Conclusions

In this systematic review and meta-analysis, increasing age was a strong risk factor for rotator cuff disease. The finding that current smokers are more likely to have rotator cuff disease as compared with nonsmokers implies that cessation of smoking can potentially lead to mitigation of this risk factor.
Field assessments of heart rate dynamics during spawning migration of wild and hatchery-reared Chinook salmon
Authors: Twardek W. M. , Ekström A. , Eliason E. J. , Lennox R. J. , Tuononen E. , Abrams A. E. I. , Jeanson A. L. , Cooke S. J.
Published: June 2021

During spawning, adult Pacific salmonids (
Oncorhynchus
spp
.
) complete challenging upriver migrations during which energy and oxygen delivery must be partitioned into activities such as locomotion, maturation and spawning behaviours under the constraints of an individual's cardiac capacity. To advance our understanding of cardiac function in free-swimming fishes, we implanted migrating adult Chinook salmon (
Oncorhynchus tshawytscha
) collected near the mouth of the Sydenham River, Ontario, with heart rate (
f
H
) biologgers that recorded
f
H
every 3 min until these semelparous fish expired on spawning grounds several days later. Fundamental aspects of cardiac function were quantified, including resting, routine and maximum
f
H
, as well as scope for
f
H
(maximum−resting
f
H
). Predictors of
f
H
were explored using generalized least-squares regression, including water temperature, discharge, fish size and fish origin (wild versus hatchery). Heart rate was positively correlated with water temperature, which aligned closely with daily and seasonal shifts. Wild fish had slower resting heart rates than hatchery fish, which led to significantly higher scope for
f
H
. Our findings suggest that wild salmon may have better cardiac capacity during migration than hatchery fish, potentially promoting migration success in wild fish.

This article is part of the theme issue ‘Measuring physiology in free-living animals (Part I)’.
Bio-sensing technologies in aquaculture: how remote monitoring can bring us closer to our farm animals
Authors: Brijs J. , Føre M. , Gräns A. , Clark T. D. , Axelsson M. , Johansen J. L.
Published: June 2021

Farmed aquatic animals represent an increasingly important source of food for a growing human population. However, the aquaculture industry faces several challenges with regard to producing a profitable, ethical and environmentally sustainable product, which are exacerbated by the ongoing intensification of operations and increasingly extreme and unpredictable climate conditions. Fortunately, bio-sensors capable of measuring a range of environmental, behavioural and physiological variables (e.g. temperature, dissolved gases, depth, acceleration, ventilation, heart rate, blood flow, glucose and
l
-lactic acid) represent exciting and innovative tools for assessing the health and welfare of farmed animals in aquaculture. Here, we illustrate how these state-of-the-art technologies can provide unique insights into variables pertaining to the inner workings of the animal to elucidate animal–environment interactions throughout the production cycle, as well as to provide insights on how farmed animals perceive and respond to environmental and anthropogenic perturbations. Using examples based on current challenges (i.e. sub-optimal feeding strategies, sub-optimal animal welfare and environmental changes), we discuss how bio-sensors can contribute towards optimizing the growth, health and welfare of farmed animals under dynamically changing on-farm conditions. While bio-sensors currently represent tools that are primarily used for research, the continuing development and refinement of these technologies may eventually allow farmers to use real-time environmental and physiological data from their stock as ‘early warning systems' and/or for refining day-to-day operations to ethically and sustainably optimize production.

This article is part of the theme issue ‘Measuring physiology in free-living animals (Part I)’.
A non-invasive system to measure heart rate in hard-shelled sea turtles: potential for field applications
Authors: Sakamoto Kentaro Q. , Miyayama Masaru , Kinoshita Chihiro , Fukuoka Takuya , Ishihara Takashi , Sato Katsufumi
Published: June 2021

To measure the heart rate of unrestrained sea turtles, it has been believed that a probe must be inserted inside the body owing to the presence of the shell. However, inserting the probe is invasive and difficult to apply to animals in the field. Here, we have developed a non-invasive heart rate measurement method for some species of sea turtles. In our approach, an electrocardiogram (ECG) was performed using an animal-borne ECG recorder and two electrodes—which were electrically insulated from seawater—pasted on the carapace. Based on the measured ECG, the heartbeat signals were identified with an algorithm using a band-pass filter. We implemented this algorithm in a user-friendly program package, ECGtoHR. In experiments conducted in a water tank and in a lagoon, we successfully measured the heart rate of loggerhead, olive ridley and black turtles, but not green and hawksbill turtles. The average heart rate of turtles when resting underwater was 6.2 ± 1.9 beats min–1and that when moving at the surface was 14.0 ± 2.4 beats min–1. Our approach is particularly suitable for endangered species such as sea turtles, and has the potential to be extended to a variety of other free-ranging species.

This article is part of the theme issue ‘Measuring physiology in free-living animals (Part I)’.