bluuebunny/crossref_metadata_2025 huggingface dataset:
Wave function collapses and 1/n energy spectrum induced by a Coulomb potential in a one-dimensional flat band system
Authors: Zhang Yi-Cai
Published: November 2021

We investigate the bound state problem in a one-dimensional flat band system with a Coulomb potential. It is found that, in the presence of a Coulomb potential of type I (with three equal diagonal elements), similarly to that in the two-dimensional case, the flat band could not survive. At the same time, the flat band states are transformed into localized states with a logarithmic singularity near the center position. In addition, the wave function near the origin would collapse for an arbitrarily weak Coulomb potential. Due to the wave function collapses, the eigen-energies for a shifted Coulomb potential depend sensitively on the cut-off parameter. For a Coulomb potential of type II, there exist infinite bound states that are generated from the flat band. Furthermore, when the bound state energy is very near the flat band, the energy is inversely proportional to the natural number, e.g., En
∝ 1/n, n = 1,2,3,… It is expected that the 1/n energy spectrum could be observed experimentally in the near future.
Helium bubble formation and evolution in NiMo-Y2O3 alloy under He ion irradiation
Authors: Liu Awen , Huang Hefei , Liu Jizhao , Zhu Zhenbo , Li Yan
Published: November 2021

We report helium ion irradiation experiments for a new type of dispersion-strengthened NiMo-Y2O3 alloy with three different irradiation doses and varying irradiation dose rates at 750 °C to evaluate its helium-induced damage behavior. Transmission electron microscopy was used to reveal the evolution of helium bubbles after irradiation. The experimental results show that with increasing ion dose, the number density of helium bubbles increases continuously. However, the mean size of helium bubbles first increases and then decreases, mainly due to the varied ion dose rates. The volume fractions of helium bubbles in the three investigated samples after irradiation are 0.15%, 0.32%, and 0.27%, which are lower than that of the Hastelloy N alloy (0.58%) after similar irradiation conditions. This indicates that the NiMo-Y2O3 alloy exhibits better helium-induced-swelling resistance than the Hastelloy N alloy, highlighting its potential applicability to MSRs, from the perspective of irradiation performance.
Prenormative verification and validation of a protocol for measuring magnetite–maghemite ratios in magnetic nanoparticles
Authors: Bogart Lara K , Fock Jeppe , da Costa Geraldo M , Witte Kerstin , Greneche Jean-Marc , Zukrowski Jan , Sikora Marcin , Latta Drew E , Scherer Michelle M , Hansen Mikkel Fougt , Frandsen Cathrine , Pankhurst Quentin A
Published: November 2021

An important step in establishing any new metrological method is a prenormative interlaboratory study, designed to verify and validate the method against its stated aims. Here, the 57Fe Mössbauer spectrometric ‘centre of gravity’ (COG) method was tested as a means of quantifying the magnetite/maghemite (Fe3O4/γ-Fe2O3) composition ratio in biphasic magnetic nanoparticles. The study involved seven laboratories across Europe and North and South America, and six samples—a verification set of three microcrystalline mixtures of known composition, and a validation set of three nanoparticle samples of unknown composition. The spectra were analysed by each participant using in-house fitting packages, and ex post facto by a single operator using an independent package. Repeatability analysis was performed using Mandel’s h statistic and modified Youden plots. It is shown that almost all (83/84) of the Mandel h statistic values fall within the 0.5% significance level, with the one exception being borderline. Youden-based pairwise analysis indicates the dominance of random uncertainties; and in almost all cases the data analysis phase is only a minor contributor to the overall measurement uncertainty. It is concluded that the COG method is a robust and promising candidate for its intended purpose.
Recent developments in engineering design for the quasi-axisymmetric stellarator CFQS
Authors: Shimizu A. , Kinoshita S. , Isobe M. , Okamura S. , Ogawa K. , Nakata M. , Yoshimura Y. , Suzuki C. , Osakabe M. , Murase T. , Nakagawa S. , Tanoue H. , Xu Y. , Liu H.F. , Liu H. , Huang J. , Wang X. , Cheng J. , Xiong G. , Tang C. , Yin D. , Wan Y.
Published: November 2021

A quasi-axisymmetric stellarator, the CFQS, has been designed as a joint project of the National Institute for Fusion Science and Southwest Jiaotong University to prove intrinsic advantages of quasi-axisymmetry. Principal parameters of the CFQS are as follows: the major radius is 1 m, the magnetic field strength is 1 T, the aspect ratio is 4, and the toroidal periodic number is 2. The magnetic field configuration is designed based on that of the CHS-qa. Enhanced confinement properties within the context of neoclassical theory are achieved by its quasi-axisymmetric configuration. In the entire radial range, the magnetic well is retained to keep favourable stability features in the magnetohydrodynamic equilibrium. A magnetic field coil system was designed for the CFQS, which consists of 16 modular coils, 12 toroidal field coils, and 4 poloidal field coils. The supporting structure is designed to withstand strong electromagnetic force under 1 T operation, maintaining enough space for heating and diagnostic systems. The mock-up modular coil with the most complicated shape was constructed by Hefei Keye Electro Physical Equipment Manufacturing Co., Ltd. to check manufacturability and the achieved accuracy. A heat-run test was performed to check the temperature rise of conductors, and the capability of 1 T operation was confirmed. After various tests for the mock-up coil, construction of actual modular coils and the vacuum vessel has begun.
Therapeutic application of 3B-PEG injectable hydrogel/Nell-1 composite system to temporomandibular joint osteoarthritis
Authors: Wang Chenyu , Wang Yingnan , Wang Cunyi , Liu Chao , Li Wen , Hu Shiyu , Wu Na , Jiang Shijie , Shi Jiejun
Published: November 2021

This study aims to construct a composite system of the tri-block polyethylene glycol injectable hydrogel (3B-PEG IH) and neural epithelial growth factor-like protein 1 (Nell-1), and to analyze its therapeutic effect on temporomandibular joint osteoarthritis (TMJOA). Sol-gel transition temperature was measured via inverting test. The viscoelastic modulus curves was measured by rheometer. Degradation and controlled release profiles of 3B-PEG IH were drawn in vitro. In vivo gel retention and biocompatibility were completed subcutaneously on the back of rats. After primary chondrocytes were extracted and identified, the cell viability in 3B-PEG IH was measured. Evaluation of gene expression in hydrogel was performed by real-time polymerase chain reaction. TMJOA rabbits were established by intra-articular injection of type II collagenase. Six weeks after composite systems being injected, gross morphological score, micro-CT, histological staining and grading were evaluated. The rusults showed that different types of 3B-PEG IH all reached a stable gel state at 37 °C and could support the three-dimensional growth of chondrocytes, but poly(lactide-co-caprolactone)-block-poly(ethyleneglycol)-block-poly(lactide-co-caprolactone) (PLCL-PEG-PLCL) hydrogel had a wider gelation temperature range and better hydrolytic stability for about 4 weeks. Its controlled release curve is closest to the zero-order release kinetics. In vitro, PLCL-PEG-PLCL/Nell-1 could promote the chondrogenic expression and reduce the inflammatory expression. In vivo, TMJOA rabbits were mainly characterized by the disorder of cartilage structure and the destruction of subchondral bone. However, PLCL-PEG-PLCL/Nell-1 could reverse the destruction of the subchondral trabecula, restore the fibrous and proliferative layers of the surface, and reduce the irregular hyperplasia of fibrocartilage layer. In conclusion, by comparing the properties of different 3B-PEG IH, 20 wt% PLCL-PEG-PLCL hydrogel was selected as the most appropriate material. PLCL-PEG-PLCL/Nell-1 composite could reverse osteochondral damage caused by TMJOA, Nfatc1-Runx3 signaling pathway may play a role in it. This study may provide a novel, minimally-invasive therapeutic strategy for the clinical treatment of TMJOA.
Inclusion: an individual pursuit requiring organization-level investment to sustain it
Authors: Quintero-Carmona Omar A.
Published: November 2021

If this was not happening in the midst of the COVID-19 pandemic, I imagine that I would be speaking these words instead of writing them on my laptop. Even so, I am so jazzed for this opportunity! No word or phrase describes what I am feeling in this moment in receiving the 2021 American Society for Cell Biology Prize for Excellence in Inclusivity. It is certainly an honor to be recognized in this way. I am grateful to the Howard Hughes Medical Institute for awarding me additional resources to keep on keeping on. My approach to finding the connection between people and their science certainly could use the monetary support. Resources open doors. At the same time that I am grateful for the attention, I am not exactly sure what to do with the spotlight. Importantly, there are a host of other folks out there also doing amazing things who have never been recognized. Let’s work to ensure that their contributions are supported, appreciated, and recognized. Instead of focusing the spotlight on me, I would rather redirect it to recognize my foundational influences. I also hope to encourage the need for institutional approaches beyond celebrating individual accomplishment.
Explainable machine learning predictions to support personalized cardiology strategies
Authors: Loh De Rong , Yeo Si Yong , Tan Ru San , Gao Fei , Koh Angela S
Published: November 2021

Aims

A widely practiced intervention to modify cardiac health, the effect of physical activity on older adults is likely heterogeneous. While machine learning (ML) models that combine various systemic signals may aid in predictive modelling, the inability to rationalize predictions at a patient personalized level is a major shortcoming in the current field of ML.

Methods and results

We applied a novel methodology, SHapley Additive exPlanations (SHAP), on a dataset of older adults n = 86 (mean age 72 ± 4 years) whose physical activity levels were studied alongside changes in their left ventricular (LV) structure. SHAP was tested to provide intelligible visualization on the magnitude of the impact of the features in their physical activity levels on their LV structure. As proof of concept, using repeated K-cross-validation on the train set (n = 68), we found the Random Forest Regressor with the most optimal hyperparameters, which achieved the lowest mean squared error. With the trained model, we evaluated its performance by reporting its mean absolute error and plotting the correlation on the test set (n = 18). Based on collective force plot, individually numbered patients are indicated on the horizontal axis, and each bandwidth implies the magnitude (i.e. effect) of physical parameters (higher in red; lower in blue) towards prediction of their LV structure.

Conclusions

As a tool that identified specific features in physical activity that predicted cardiac structure on a per patient level, our findings support a role for explainable ML to be incorporated into personalized cardiology strategies.
Appendicular Lean Mass, Grip Strength, and the Development of Hospital-Associated Activities of Daily Living Disability Among Older Adults in the Health ABC Study
Authors: Andrews James S , Gold Laura S , Reed May J , Garcia Jose M , McClelland Robyn L , Fitzpatrick Annette L , Hough Catherine L , Cawthon Peggy M , Covinsky Ken E
Published: November 2021

Background

Half of all physical disability, including activity of daily living (ADL) disability, among older adults occurs in the setting of hospitalization. This study examines whether appendicular lean mass (ALM) and grip strength, which are commonly included in various definitions of sarcopenia, are associated with the development of hospital-associated ADL disability in older adults in the Health ABC Study.

Methods

Individuals hospitalized during the first 5 years of follow-up (n = 1 724) were analyzed. ALM to body mass index (BMI) ratio (ALMBMI), by dual-energy x-ray absorptiometry (DXA), and grip strength, by hand-held dynamometery, were assessed annually. Development of new ADL disability was assessed at the time of the next annual assessment after hospitalization. Separate regression analyses modeled the association of prehospitalization ALMBMI or grip strength with death before the next scheduled annual assessment. Next, among those who survived to the next annual assessment, separate regression analyses modeled the association of ALMBMI or grip strength with development of ADL disability.

Results

Each standard deviation decrement in prehospitalization grip strength was associated with an adjusted 1.80 odds of new ADL disability at follow-up (95% CI: 1.18, 2.74). Low, compared with not low, grip strength (per FNIH definition) was associated with an adjusted 2.36 odds of ADL disability at follow-up (95% CI: 1.12, 4.97). ALM measures were not associated with the development of hospital-associated ADL disability. ALM and grip strength measures were not associated with death.

Conclusions

Prehospitalization lower grip strength may be an important risk factor for ADL disability among older adult survivors of hospitalization.
Strategic administration of an appeasing substance to improve performance and physiological responses of Bos indicus feedlot cattle
Authors: Fonseca Vitor G L , Cappellozza Bruno I , de Sousa Osvaldo A , Sagawa Manuella , Rett Bruna , Chizzotti Mário L , Cooke Reinaldo F
Published: November 2021

This study was designed to evaluate the timing of administration of the bovine appeasing substance (BAS) on performance and physiological responses of Bos indicus feedlot cattle. Nellore bulls (n = 100) were ranked by initial body weight (BW; 341 ± 18.5 kg) and assigned to receive BAS (n = 50) or placebo (CON; n = 50) on d -2 of the experiment. Treatments (5 mL) were applied topically to the nuchal skin area of each bull. Bulls were loaded into commercial livestock trailers immediately after treatment administration, transported for 880 km, and unloaded on d -1 at a commercial feedyard. On d 0, bulls within each treatment were again assigned to receive, in a 2 x 2 factorial arrangement, BAS or CON as previously described (25 bulls/treatment combination). Upon treatment administration on d 0, bulls were housed in 12 feedlot pens (3 pens/treatment) for a 108-d feeding period, which was divided into an adaptation (d 0 – 19), growing (d 20 – 60), and finishing (d 61 – 108) phases. Dry matter intake (DMI) was measured daily from d 0 to 108, whereas blood samples and hair from the tail switch were collected on d -2, 0, 19, 60, and 108. Administration of BAS prior to loading (d -2) improved ADG, FE, and DMI during adaptation and across the 108-d feeding period (P ≤ 0.08), resulting in greater (P = 0.03) hot carcass weight and dressing percentage upon slaughter on d 109. A treatment × day interaction was detected for serum glucose concentrations (P = 0.05), which was greater (P = 0.03) on d 60 of the feeding period in bulls receiving CON prior to loading. Administration of BAS at feedlot entry (d 0) improved DMI, ADG, and FE during adaptation (P ≤ 0.05), but it did not impact (P ≥ 0.18) performance and carcass traits during the 108-d feeding period. Bulls administered BAS prior to loading and at feedlot entry had less (P ≤ 0.05) mean serum cortisol concentrations across the 108-d feeding period (loading × feedlot entry interaction; P = 0.10), and greater (P ≤ 0.05) serum insulin concentration on d 60 (loading × feedlot entry × day interaction; P = 0.05). In summary, BAS administration prior to loading increased overall feedlot performance of Nellore bulls. These outcomes were noted in bulls that received or not a second BAS administration at feedlot entry, suggesting that the benefits of BAS are exploited when this substance is administered before transport to the feedlot.
Comparative Association Mapping Reveals Conservation of Major Gene Resistance to White Pine Blister Rust in Southwestern White Pine (Pinus strobiformis) and Limber Pine (P. flexilis)
Authors: Liu Jun-Jun , Schoettle Anna W. , Sniezko Richard A. , Waring Kristen M. , Williams Holly , Zamany Arezoo , Johnson Jeremy S. , Kegley Angelia
Published: November 2021

All native North American white pines are highly susceptible to white pine blister rust (WPBR) caused by Cronartium ribicola. Understanding genomic diversity and molecular mechanisms underlying genetic resistance to WPBR remains one of the great challenges in improvement of white pines. To compare major gene resistance (MGR) present in two species, southwestern white pine (Pinus strobiformis) Cr3 and limber pine (P. flexilis) Cr4, we performed association analyses of Cr3-controlled resistant traits using single nucleotide polymorphism (SNP) assays designed with Cr4-linked polymorphic genes. We found that ∼70% of P. flexilis SNPs were transferable to P. strobiformis. Furthermore, several Cr4-linked SNPs were significantly associated with the Cr3-controlled traits in P. strobiformis families. The most significantly associated SNP (M326511_1126R) almost colocalized with Cr4 on the Pinus consensus linkage group 8, suggesting that Cr3 and Cr4 might be the same R locus, or have localizations very close to each other in the syntenic region of the P. strobiformis and P. flexilis genomes. M326511_1126R was identified as a nonsynonymous SNP, causing amino acid change (Val376Ile) in a putative pectin acetylesterase, with coding sequences identical between the two species. Moreover, top Cr3-associated SNPs were further developed as TaqMan genotyping assays, suggesting their usefulness as marker-assisted selection (MAS) tools to distinguish genotypes between quantitative resistance and MGR. This work demonstrates the successful transferability of SNP markers between two closely related white pine species in the hybrid zone, and the possibility for deployment of MAS tools to facilitate long-term WPBR management in P. strobiformis breeding and conservation.
Racial Disparities in Outcomes of Women Undergoing Myomectomy
Authors: Dallas Kai , Dubinskaya Alexandra , Andebrhan Sarah B. , Anger Jennifer , Rogo-Gupta Lisa J. , Elliott Christopher S. , Ackerman A. Lenore
Published: November 2021

OBJECTIVE:

To assess the association of racial and socioeconomic factors with outcomes of abdominal myomectomies.

METHODS:

All women undergoing abdominal myomectomy in California from 2005 to 2012 were identified from the OSHPD (Office of Statewide Health Planning and Development) using appropriate International Classification of Diseases and Current Procedural Terminology codes. Demographics, comorbidities, surgical approaches, and complications occurring within 30 days of the procedure were identified. Multivariate associations were assessed with mixed effects logistic regression models.

RESULTS:

The cohort of 35,151 women was racially and ethnically diverse (White, 38.8%; Black, 19.9%; Hispanic, 20.3%; and Asian, 15.3%). Among all procedures, 33,906 were performed through an open abdominal approach, and 1,245 were performed using a minimally invasive approach. Proportionally, Black patients were more likely than White patients to have open procedures, and open approaches were associated with higher complication rates. Overall, 2,622 (7.5%) women suffered at least one complication. Although severe complications did not vary by race or ethnicity, Black (9.0%), Hispanic (7.9%), and Asian (7.5%) patients were more likely to suffer complications of any severity compared with White patients (6.7%, P<.001). As compared with patients with private insurance (6.4%), those with indigent payer status (Medicaid [12.1%] and self-pay [11.1%]) had higher complication rates (P<.001). Controlling for all factors, Black and Asian patients were more likely to suffer complications compared with White patients.

CONCLUSION:

The overall complication rate after abdominal myomectomy was 7.5%. Comorbidities, an open approach, and indigent payer status were associated with increased complication risk. Controlling for all factors, Black and Asian patients still had increased risks of complications.
Performance of a Vaginal Panel Assay Compared With the Clinical Diagnosis of Vaginitis
Authors: Broache Molly , Cammarata Catherine L. , Stonebraker Elizabeth , Eckert Karen , Van Der Pol Barbara , Taylor Stephanie N.
Published: November 2021

OBJECTIVE:

To compare the performance of vaginitis diagnosis based on clinical assessment to molecular detection of organisms associated with bacterial vaginosis, vulvovaginal candidiasis, and Trichomonas vaginalis using a vaginal panel assay.

METHODS:

This cross-sectional diagnostic accuracy study included 489 enrolled participants from five collection sites where those with vaginitis symptoms had a vaginal assay swab collected during their visit and a clinical diagnosis made. The swab was later sent to a separate testing site to perform the vaginal panel assay. Outcome measures include positive, negative, and overall percent agreement (and accompanying 95% CIs) of clinical assessment with the vaginal panel assay. P<.05 was used to distinguish significant differences in paired proportions between the vaginal panel assay and clinical diagnosis, using the McNemar test. Inter-rater agreement between the two diagnostic approaches was determined using Cohen's kappa coefficient.

RESULTS:

Clinical diagnosis had a positive percent agreement with the vaginal panel assay of 57.9% (95% CI 51.5–64.2%), 53.5% (95% CI 44.5–62.4%), and 28.0% (95% CI 12.1–49.4%) for bacterial vaginosis, vulvovaginal candidiasis, and T vaginalis, respectively. Negative percent agreement for clinical diagnosis was 80.2% (95% CI 74.3–85.2%), 77.0% (95% CI 72.1–81.4%), and 99.8% (95% CI 98.7–99.9%), respectively. Sixty-five percent (67/103), 44% (26/59), and 56% (10/18) of patients identified as having bacterial vaginosis, vulvovaginal candidiasis, and T vaginalis by assay, respectively, were not treated for vaginitis based on a negative clinical diagnosis. Compared with the assay, clinical diagnosis had false-positive rates of 19.8%, 23.0%, and 0.2% for bacterial vaginosis, vulvovaginal candidiasis, and T vaginalis, respectively. Significant differences in paired proportions were observed between the vaginal panel assay and clinical diagnosis for detection of bacterial vaginosis and T vaginalis.

CONCLUSION:

The vaginal panel assay could improve the diagnostic accuracy for vaginitis and facilitate appropriate and timely treatment.

FUNDING SOURCE:

Becton, Dickinson and Company.
Accessibility of Pharmacist-Prescribed Contraceptives in Utah
Authors: Magnusson Brianna M. , Christensen Sarah R. , Tanner Ashley B. , Eyring J. B. , Pilling Emily B. , Sloan-Aagard Chantel D.
Published: November 2021

OBJECTIVE:

To assess pharmacy participation in and accessibility of pharmacist-prescribed contraception after legislation effective in the state of Utah in 2019.

METHODS:

A secret-shopper telephone survey was used to assess participation in pharmacist-prescribed contraception. Geospatial analysis was used to map the distribution of participating pharmacies by population characteristics.

RESULTS:

Of all operating Class A retail pharmacies in Utah, 127 (27%) were providing pharmacist-prescribed contraception 1 year after implementation of the Utah standing order. Oral contraceptive pills were widely accessible (100%); however, other allowed methods were not (vaginal ring 14%; contraceptive patch 2%). Consultation fees and medication costs varied widely. Participating pharmacies were mainly concentrated in population centers. Assuming access to a personal vehicle, urban areas with a high percentage of Hispanic people (Utah's largest minority race or ethnicity group) have access to a participating pharmacy within a 20-minute driving distance. However, access in rural areas with a high percentage Hispanic or other minority were limited. We identified 235 (40%) census tracts with a high proportion of Utah's residents living below the poverty line or of minority race or ethnicity who also had low access to pharmacist-prescribed contraception.

CONCLUSIONS:

Although the pharmacy-based model is intended to increase access to contraception, practical availability 1 year after the authorization of pharmacist-prescribed contraception in Utah suggests that this service does not adequately serve rural areas, particularly rural areas with a high proportion of minorities and those living below the federal poverty line.
Hereditary Cancer Risk Using a Genetic Chatbot Before Routine Care Visits
Authors: Nazareth Shivani , Hayward Laura , Simmons Emilie , Snir Moran , Hatchell Kathryn E. , Rojahn Susan , Slotnick Robert Nathan , Nussbaum Robert L.
Published: November 2021

OBJECTIVE:

To examine user uptake and experience with a clinical chatbot that automates hereditary cancer risk triage by collecting personal and family cancer history in routine women's health care settings.

METHODS:

We conducted a multicenter, retrospective observational study of patients who used a web-based chatbot before routine care appointments to assess their risk for hereditary breast and ovarian cancer, Lynch syndrome, and adenomatous polyposis syndromes. Outcome measures included uptake and completion of the risk-assessment and educational section of the chatbot interaction and identification of hereditary cancer risk as evaluated against National Comprehensive Cancer Network criteria.

RESULTS:

Of the 95,166 patients invited, 61,070 (64.2%) engaged with the clinical chatbot. The vast majority completed the cancer risk assessment (89.4%), and most completed the genetic testing education section (71.4%), indicating high acceptability among those who opted to engage. The mean duration of use was 15.4 minutes (SD 2 hours, 56.2 minutes) when gaps of inactivity longer than 5 minutes were excluded. A personal history of cancer was reported by 19.1% (10,849/56,656) and a family history of cancer was reported by 66.7% (36,469/54,652) of patients who provided the relevant information. One in four patients (14,850/54,547) screened with the chatbot before routine care appointments met National Comprehensive Cancer Network criteria for genetic testing. Among those who were tested, 5.6% (73/1,313) had a disease-causing pathogenic variant.

CONCLUSION:

A chatbot digital health tool can help identify patients at high risk for hereditary cancer syndromes before routine care appointments. This scalable intervention can effectively provide cancer risk assessment, engage patients with educational information, and facilitate a path toward preventive genetic testing.

FUNDING SOURCE:

Implementation of the chatbot in clinics was funded by industry support from commercial genetic testing laboratories Ambry, Invitae, and Progenity.
Creating Breast and Gynecologic Cancer Guidelines for Transgender Patients With BRCA Mutations
Authors: Bedrick Bronwyn S. , Fruhauf Timothee F. , Martin Stephen J. , Ferriss James S.
Published: November 2021

More than 1.5 million individuals in the United States identify as transgender. Transgender individuals have lower rates of health care utilization and higher rates of health care discrimination than cisgender patients. With a growing interest in providing comprehensive and compassionate care to the transgender community, there has been a concurrent increase in research on transgender health. However, lack of long-term data limits understanding the effects of hormone therapy on cancer risk factors in this population. This is particularly relevant for patients with hormonally mediated cancers and those at elevated risk from hereditary breast and ovarian cancer syndromes. Few cancer-screening and management guidelines currently exist for this population. Specific practices guided by the nuances of gender identity and gender-affirming care are essential to improve clinical management and to avoid further alienating a population that is already marginalized from the health care system. This commentary summarizes screening, management, and surveillance strategies devised for cisgender patients to offer corresponding recommendations tailored for transgender BRCA mutation carriers. In doing so, it highlights critical unanswered questions pertaining to the care of these patients. To address these questions, we must prioritize this population and adopt more inclusive frameworks in medicine and research.
Factors Underlying Patient and Surgeon Willingness to Participate in a Placebo Surgery Controlled trial
Authors: Bunzli Samantha , Nelson Elizabeth , Wall Laura , Schilling Chris , Lohmander L. Stefan , Balogh Zsolt J. , Tran Phong , Paolucci Francesco , Clarke Philip , Choong Peter F. M. , Dowsey Michelle M.
Published: November 2021

Objective:

To investigate the factors underlying willingness to participate in a hypothetical trial among patients and surgeons, to inform the design of future placebo surgery controlled trials.

Background:

Placebo surgery controlled trials are the gold standard for testing the efficacy of surgical procedures. However, these trials commonly fail to meet the target sample size and terminate underpowered.

Methods:

From October 2019 to July 2020, eligible patients were identified from the orthopedic waiting list at a single tertiary hospital and surgeons were identified from orthopedic clinics at three tertiary hospitals in Australia. Qualitative interviews explored factors underlying willingness to participate in a hypothetical trial, including understanding of trial concepts; attitudes; and trial design preferences. Data collection and analysis were conducted in parallel. Recruitment ceased when no new concepts emerged. Interview data were analyzed using reflexive thematic analysis.

Results:

The majority of surgeons and only a few patients indicated a willingness to participate in a placebo surgery controlled trial. Factors underlying willingness were captured in four themes: (1) Understanding and attitudes toward placebo; (2) Attitudes towards randomization/perception of equipoise; (3) Perception of risk; and (4) Ethical concerns.

Conclusions:

To optimize recruitment in the future, trialists may consider embedding strategies into the recruitment process that validate patients’ symptoms, encourage an altruistic mindset, address surgeon biases, and involve surgeons in explaining trial concepts to patients. Trialists may also consider designing three arm trials that meet surgeons’ preferences for a “low” and “high” fidelity placebo.
Patient Perceptions and Determinants of Choice for Breast Reconstruction after Mastectomy among Saudi Patients
Authors: Aljaaly Hattan A. , Mortada Hatan , Trabulsi Nora H.
Published: November 2021

Background:

Undergoing mastectomy is often associated with a negative impact on the mental well-being of patients. Patients who undergo postmastectomy breast reconstruction (BR) have a better self-image and higher self-esteem. Many patients with breast cancer (BC) are unaware of the availability of BR options. This study aimed to assess BC patient perceptions and identify the determinants of patient choices to undergo BR after mastectomy.

Methods:

This study was conducted between May 10, 2019 and February 29, 2020 via an interview-based questionnaire, among BC patients at King Abdul Aziz University Hospital, Jeddah, Saudi Arabia. Ethical approval was obtained from the research ethics committee before the data collection.

Results:

Altogether, 400 patients (an overall 82% response rate) were included, of whom 155 (38.75%) were group 1 (willing to undergo BR). The mean age for group 1 was 46.04 ± 8.79, which was younger than for group 2 (unwilling to undergo BR) (P < 0.001). Furthermore, 117 (75.5%) of group 1 had no history of any chronic illness compared with 145 (59.2%) of group 2 (P < 0.001). Group 1 had more knowledge about BR (69.7%, P < 0.001), and the main reason to undergo BR was to regain femininity (26.8%). The remaining patients (31.3%) were unwilling to undergo BR in order to avoid additional surgery.

Conclusions:

The lack of knowledge and misconception about BR is one factor preventing BC patients from undergoing BR. Spreading awareness and providing accurate information regarding the procedure will allow women with BC to overcome postmastectomy fear.
Multistage Ala Nasi Repair with an Expanded and Prelaminated Forehead Flap: A Case Report
Authors: Dabrosin Nina , Bjørn Stolle Lars , Hasanbegovic Emir
Published: November 2021

An 18-year-old man presented with a fast-growing tumor of the right ala nasi. We excised the tumor and histology report revealed a keratoacanthoma with clear margins. After surgery, the patient was left with a composite defect of 3 × 2 cm. For reconstruction, we used an expanded prelaminated forehead flap with a durable cartilage graft from the ribcage and a turnover flap for inner lining. Our technique had a pleasing end result and excellent patient satisfaction.
Clinical and Immunological Characteristics of Patients with Biopolymers and Autoimmune Inflammatory Syndrome Induced by Adjuvants
Authors: Pachón S Jaime Eduardo , Salazar Marcela C. , Pores Adriana M. , Rizo Victor Z.
Published: November 2021

Background:

Biopolymers consist of non-biocompatible allogeneic materials. They have been associated with autoimmune inflammatory syndrome induced by adjuvants, as described by Yehuda Shoenfeld and Nancy Agmon-Levin. Therefore, this study aimed to evaluate the clinical and immunological characteristics of patients with autoimmune inflammatory syndrome induced by adjuvants treated at a plastic surgery clinic in Colombia.

Methods:

This cross-sectional, descriptive observational study included 190 patients with biopolymers in the buttocks with no evidence of autoimmune disease who were diagnosed with autoimmune inflammatory syndrome induced by adjuvants and underwent treatment at a private plastic surgery clinic from 2017 to 2020. The clinical and paraclinical parameters were measured preoperatively, when the diagnosis of autoimmune inflammatory syndrome induced by adjuvants and the need for material removal were established, and postoperatively after 3 months.

Results:

The most frequent symptoms were myalgia (92%), arthralgia (77.9%), asthenia (77.9%), adynamia (77.9%), and neurological symptoms (55.8%). Preoperatively, patients were positive for antinuclear antibody, lactate dehydrogenase, complement proteins C3 and C4, and lupus anticoagulant. However, after removal of the biopolymer, there was a decrease in positivity or conversion to a negative status of paraclinical tests. Moreover, there was an association between LDH positivity and disease severity (odds ratio: 4.1, 95% confidence interval: 1.94–8.92).

Conclusions:

The removal of biopolymers using an open surgical technique in symptomatic or asymptomatic patients is crucial for functional and reconstructive purposes and to improve the quality of life. Therefore, this condition should be known as “human adjuvant disease caused by biopolymers.” Further, this condition mimics autoimmune diseases, with clinical and paraclinical manifestations that improve biopolymer removal.
Differences in Time Burden across Local Therapy Strategies for Early-stage Breast Cancer
Authors: Swanick Cameron W. , Jiang Jing , Maldonado J. Alberto , Lei Xiudong , Shih Ya-Chen Tina , Caudle Abigail S. , Baumann Donald P. , Giordano Sharon H. , Shaitelman Simona F. , Shirvani Shervin M. , Smith Benjamin D.
Published: November 2021

Background:

“Time burden” (time required during treatment) is relevant when choosing a local therapy option for early-stage breast cancer but has not been rigorously studied. We compared the time burden for three common local therapies for breast cancer: (1) lumpectomy plus whole-breast irradiation (Lump+WBI), (2) mastectomy without radiation or reconstruction (Mast alone), and (3) mastectomy without radiation but with reconstruction (Mast+Recon).

Methods:

Using the MarketScan database, we identified 35,406 breast cancer patients treated from 2000 to 2011 with these local therapies. We quantified the total time burden as the sum of inpatient days (inpatient-days), outpatient days excluding radiation fractions (outpatient-days), and radiation fractions (radiation-days) in the first two years postdiagnosis. Multivariable regression evaluated the effect of local therapy on inpatient-days and outpatient-days adjusted for patient and treatment covariates.

Results:

Adjusted mean number of inpatient-days was 1.0 for Lump+WBI, 2.0 for Mast alone, and 3.1 for Mast+Recon (P < 0.001). Adjusted mean number of outpatient-days was 42.9 for Lump+WBI, 42.2 for Mast alone, and 45.8 for Mast+Recon (P < 0.001). The mean number of radiation-days for Lump+WBI was 32.4. Compared with Mast+Recon (48.9 days), total adjusted time burden was 4.7 days shorter for Mast alone (44.2 days) and 27.4 days longer for Lump+WBI (76.3 days). However, use of a 15 fraction WBI regimen would reduce the time burden differential between Lump+WBI and Mast+Recon to just 10.0 days.

Conclusions:

Although Mast+Recon confers the highest inpatient and outpatient time burden, Lump+WBI carries the highest total time burden. Increased use of hypofractionation will reduce the total time burden for Lump+WBI.
Pain control and reduction of opioid use associated with intracameral phenylephrine1.0%–ketorolac 0.3% administered during cataract surgery
Authors: Donnenfeld Eric D. , Mychajlyszyn Daniel , Mychajlyszyn Andrey , Stein Rebecca
Published: November 2021

Purpose:

To compare pain and the need for the opioid fentanyl use associated with the administration of phenylephrine 1.0%–ketorolac 0.3% (P/K) with those of epinephrine administration during cataract surgery.

Setting:

Ambulatory surgery center.

Design:

Single-center, prospective, randomized, double-masked, self-controlled trial.

Methods:

Patients undergoing bilateral, topical anesthetic cataract surgery were randomized to receive either intracameral P/K or epinephrine in their balanced salt solution for the first eye and the other for the second eye, 2 weeks later. Fentanyl was used to manage intraoperative pain. The primary end point was the need for fentanyl administration intraoperatively. Secondary outcomes included pain measurements; surgery duration; effective phacoemulsification time; pupil size; and complications.

Results:

112 eyes of 56 patients were enrolled. Significantly fewer eyes in the P/K group (7 [12.5%]) than in the epinephrine group (19 [33.9%]; P = .013) required intraoperative fentanyl administration. Mean pain scores were lower in the P/K group than those in the control group at all timepoints. For patients with no pain to mild pain (pain scores ≤ 3), 85.7% (n = 48) of the P/K group and 58.9% (n = 33) of the epinephrine group met this benchmark (P = .003) intraoperatively. The combined outcome, the number of patients not receiving intravenous fentanyl and experiencing no pain to mild pain, was significantly higher in the study (82.1%, n = 46) than in the control group (58.9%, n = 33; P = .013).

Conclusions:

P/K administration significantly reduced pain and the need for fentanyl use. Using P/K is a practical way for cataract surgeons to provide better patient care and reduce the need for intraoperative opioids.
Eight-year follow-up of excimer laser trabeculostomy alone and combined with phacoemulsification in patients with open-angle glaucoma
Authors: Berlin Michael S. , Shakibkhou Jonathan , Tilakaratna Nirosha , Giers Ulrich , Groth Sylvia Linner
Published: November 2021

Purpose:

To describe the 8-year results of excimer laser trabeculostomy (ELT) alone and ELT in conjunction with phacoemulsification (phaco).

Setting:

University hospital.

Design:

Retrospective review.

Methods:

308 nm excimer laser energy delivered through an intraocular fiber-optic probe created channels through the inner wall of Schlemm canal. 2 groups were studied: ELT alone and ELT + phaco. Inclusion criteria were adult patients with open-angle glaucoma or ocular hypertension on 1 or more intraocular pressure (IOP)-lowering medications and, in the ELT + phaco group, presence of visually significant cataract. Primary outcome measures were change of IOP from baseline and number of IOP-lowering medications.

Results:

164 eyes in 2 groups, ELT alone (n = 90) and ELT + phaco (n = 74), were followed up for 8 years. Baseline IOP was 22.17 ± 7.0 mm Hg and 21.9 ± 6.44 mm Hg in the ELT alone and the ELT + phaco groups, respectively. IOP in the ELT alone group decreased to 16.84 ± 5.2 mm Hg at 1 year (n = 69) and remained at 15.9 ± 3.5 (n = 19) at 8 years. IOP in the ELT + phaco group was 14.04 ± 4.1 mm Hg at 1 year (n = 63) and 13.7 ± 2.8 mm Hg at 8 years (n = 13). The number of IOP-lowering medications at baseline in the ELT alone group was 1.85 ± 0.8 and decreased to 1.19 ± 1.10 at 1 year and 1.4 ± 1.4 at 8 years. In the ELT + phaco group, it was 1.58 ± 0.8 at baseline and decreased to 0.97 ± 0.95 at 1 year and 1.85 ± 0.7 at 8 years.

Conclusions:

ELT demonstrated long-term IOP lowering and decrease in the number of IOP-lowering medications. Benefits of this laser-based implant-free microinvasive glaucoma surgery procedure included a high safety profile and long-term efficacy.
Effect of a Flipped Classroom Compared With a Traditional Lecture on Physician Assistant Students' Exam Performance
Authors: Wright Matthew , Jia Yuane , Vidal Erich , O'Connell Claire Babcock , Palfreyman Lori , Parrott J. Scott
Published: November 2021

Purpose

The purpose of this study was to retrospectively compare the exam performance of physician assistant (PA) students given asthma instruction in a flipped classroom with PA students in a traditional lecture setting while controlling for students' previous academic performance and clinical asthma experience.

Methods

Three cohorts of PA students (n = 146) from the years 2017 (traditional-lecture setting) and 2018 and 2019 (flipped-classroom setting) were included in the study. Academic performance across cohorts was compared using answers to 11 exam questions reflective of the asthma content.

Results

Findings demonstrated significantly greater performance in the flipped classroom compared with traditional lecture. The 2018 and 2019 cohorts scored 9.4% and 13.2% higher, respectively, compared with the 2017 cohort. Exam performance of students with a low likelihood of clinical exposure to asthmatic patients before PA school was similar to those with a high likelihood.

Conclusion

This study found improved exam performance with a flipped classroom. The flipped classroom represents a potential opportunity to maximize similar performances by both less experienced students and more experienced students.
Projecting the Supply and Demand of Prosthetists and Orthotists in Singapore
Authors: Asano Miho , Ng Yu Li , Anuar Khalid , Yeo Yi Tian Felicity , Koh Gerald Choon Huat , Tan Kelvin Bryan
Published: November 2021

Introduction

Singapore's aging population and prevalence of chronic diseases and conditions continue to grow along with the need for prosthetic and orthotic services. We need to understand the supply of prosthetic and orthotic services and prosthetists and orthotists (P&Os) to optimize care. Therefore, the objective of this study was to estimate the recent and the future supply and demand for P&Os in Singapore.

Methods

This was a retrospective medical record review. We identified the seven conditions requiring prosthetic and orthotic services and applied condition-specific admission rates on the projected population of Singapore through 2060 to obtain the number of inpatient admissions requiring the services. We then converted these numbers to prosthetist/orthotist hours by multiplying by prosthetist/orthotist workload for each condition. Finally, we applied two supply scenarios to examine potential P&O shortfall.

Results

The shortfall was estimated to be 9.4 and 5.4 in 2016 under the respective scenarios. These gaps increase to 18.4 and 5.8, respectively, in 2030, and 28.1 and 6.2, respectively, in 2060.

Conclusions

The existing shortfall of P&Os in Singapore will continue to grow from 2016 to 2060. Appropriate strategies should be considered and implemented in a timely manner to manage the potential shortfall.

Clinical Relevance

Projecting the demand for future prosthetist/orthotist manpower through a specific condition-driven and time-based utility approach provides an alternative model to only a linear population growth. This may provide a more accurate predictability and selection of precise strategies to manage future manpower demands.
Transcranial Direct Current Stimulation and Yoga for Functional Movement Disorders
Authors: Park Jung E. , Hong Ji-Yi , Lee Su-Young
Published: November 2021

Background:

Functional movement disorder (FMD), a conversion disorder characterized by involuntary movements, is difficult to treat.

Methods:

We aimed to assess the effects of anodal transcranial direct current stimulation (tDCS) and yoga in FMD patients (n=5). TDCS of the right temporoparietal junction, a brain region relevant in the sense of self-agency, was conducted. Subjects underwent both sham and anodal tDCS with a washout period of 3 weeks. Yoga was used as a mode of exercise, as well as in conjunction with stimulation to sustain potential changes in neural plasticity.

Results:

A total of 5 subjects completed the study [mean age: 52 (SE: 4) y, disease duration: 5 (SE: 1.6) y], undergoing both sham and anodal tDCS. Anodal tDCS does not appear to be superior to sham tDCS in alleviating symptoms and disability, but combining tDCS and yoga appears to lead to mild improvement noted on clinical observation, based on the change in the efficacy index of Clinical Global Impression found in 4 subjects.

Conclusion:

Our study results suggest that anodal tDCS is not superior to sham tDCS in alleviating subjective symptoms and disability in FMD. However, interpretation of these results is limited due to the small number of stimulation sessions and number of subjects. Future studies using more frequent stimulation sessions are needed to further determine whether anodal tDCS may have a therapeutic effect in this patient group compared with sham tDCS.