bluuebunny/crossref_metadata_2025 huggingface dataset:
Labour market inequality
Authors: Giupponi Giulia , Machin Stephen
Published: July 2024

Wage and earnings inequality has been on the rise in the United Kingdom (UK) since the late 1970s/early 1980s, and with faster increases than comparator countries, it is now one of the countries with the highest levels of wage and earnings inequality in the developed world. Labour market inequality arises in various forms: inequalities in employment opportunities, wages, and hours worked, but also in other dimensions of employment, such as job security. This article considers key factors that have shaped labour market inequality in the UK over the last four decades, with a focus on technological changes and skill demand, labour market institutions, and contract regulation.
Place-based policies and geographical inequalities
Authors: Moretti Enrico
Published: July 2024

Place-based programmes have become an important form of government intervention with the potential to profoundly affect the location of economic activity, along with the wages, employment, and industry mix of communities and regions. The enormous social costs of concentrated poverty and unemployment suggest that forms of policy intervention that can reduce concentrated poverty and unemployment have enormous upsides. At the same time, place-based policies involve important trade-offs. The main source of the trade-offs stems from the fact that place-based policies seek to shift investments, jobs, and incomes from the most productive areas of a country towards the least productive areas. This can result in economically meaningful efficiency losses. Setting socially optimal place-based policies crucially depends on understanding the sources of geographical disparities and the trade-offs involved.
Communities, places and inequality: a reflection
Authors: Amin Ash
Published: July 2024

This commentary examines the meanings and potentials of community in addressing inequality. It reviews the characteristics of place as well as those of social ties that make for creative economic and welfare outcomes. The commentary leans towards innovations in the social economy, community assets, and decentred political capacities, noting the limitations of measures focusing on strengthening local social ties alone. It sees such steps as supplements to governmental initiatives to strengthen local asset markets and welfare provisions, and not as substitutes.
Labour market inequality in France and in the UK
Authors: Cahuc Pierre
Published: July 2024

This commentary shows that a high minimum wage, a rigid grid of minimum wages negotiated at central or sectoral level and legislation ensuring job stability for employees on permanent contracts have enabled France to contain wage inequalities. On the other hand, there is a low employment rate and a high unemployment rate that create significant inequalities in access to employment and a high poverty rate before taxes and transfers.
Labour market inequality: a comparative political economy perspective
Authors: Howell David R , Kalleberg Arne L
Published: July 2024

Large and rising earnings and employment inequalities in countries such as the USA and the UK pose fundamental questions for social scientists and challenges for policymakers. Mainstream economists have explained these outcomes mainly in terms of competitive market forces, particularly the mismatch between technology-driven demands for skills and those supplied by workers. In contrast, political economy perspectives focus on employer–employee bargaining power, driven by the monopsony power of firms and declining institutional and policy protections for workers. We critically assess the evidence on the education wage premium and employment polarization used to support the competitive market explanation for US wage inequality. We then show that the incidence of decent pay for young less-educated workers varies sharply across similarly rich countries and that new indices of institutional bargaining power closely correspond to differences in pay distributions but are uncorrelated with conventional measures of employment performance. We conclude that well-designed institutional and policy changes can substantially promote shared growth and the well-being of working families.
Individuals as active co-creators of their environments: implications for prevention of inequalities
Authors: Viding Essi , McCrory Eamon
Published: July 2024

Here we outline three important issues that warrant consideration in the context of prevention and intervention of inequalities: (1) gene–environment correlation, (2) latent vulnerability following early adversity and (3) dynamic developmental effects. (1) Gene–environment correlation research clearly shows that individuals are active co-creators of their environments—in line with their genetic predispositions. Acknowledging dispositional differences is a key to refining preventative and targeted interventions to be more tailored to specific needs of children and families, which in turn will serve to reduce inequalities. (2) Latent vulnerability following early adversity means that a child is likely to develop altered patterns of processing across a range of domains relative to peers. These alterations are posited to reflect adaptation to harmful and unpredictable environments and relate to changes in learning processes (both social and educational). If we want to reduce inequalities following adversity, we need to consider how adaptations to adversity have impacted processes that are critical for social and educational domains. (3) Research on developmentally dynamic genetic and environmental effects underscores one key message. Early intervention is important, but it is not enough. There is a need for a cross-disciplinary, integrated approach for preventing inequalities, which emphasizes the importance of social development. Within this approach individual dispositions and proximal environments are not viewed as separate things. Instead, researchers will endeavour to better understand individuals as active co-creators of their environments and consider what this means for developing more sensitive and nuanced approaches for interventions.
Socio-economic inequality in the distribution of health care in the UK
Authors: Propper Carol
Published: July 2024

This commentary begins with a discussion of how health care is modelled in a human capital approach and what that implies for inequality in the distribution of health care. This is followed by an outline of some of the key issues in the measurement of inequalities in health care. It ends with a brief review of what the empirical literature shows on inequality in health-care utilization in the UK by socio-economic status.1
Attitudes to inequality: preferences and beliefs
Authors: Almås Ingvild , Cappelen Alexander W , Sørensen Erik Ø , Tungodden Bertil
Published: July 2024

To understand attitudes to inequality, we need to study people’s fairness preferences and beliefs about the sources of inequality. This article reviews the existing experimental literature on fairness, including our new study ‘Fairness Across the World’ that collected novel data on attitudes to inequality in 60 countries. We establish that people in general are more willing to accept inequalities that reflect differences in performance than inequalities that reflect differences in luck—and that people care more about fairness than efficiency. We also document that people differ in their fairness preferences both within and between countries. Richer countries are more meritocratic, and, correspondingly, richer people are more meritocratic within countries. People also differ in their beliefs about the sources of inequality both between and within countries, and the evidence is consistent with people having a self-serving bias in beliefs.
Culturally Responsive Pedagogy in Physical Therapy Education
Authors: Varnado Kimberly , Richardson Shannon , Somyoo Nipaporn , Mejia-Downs Anne
Published: July 2024

The push for holistic admissions practices in physical therapy education has evoked concerns that learners who are culturally and linguistically diverse might be less qualified than the predominant demographic traditionally admitted into programs. The implications are that culturally and linguistically diverse learners struggle academically and experience challenges passing the National Physical Therapy Examination. However, as the academic preparedness of learners is discussed, rarely does the conversation include the capabilities of faculty to teach these learners. As cohorts continue to include learners from a greater variety of backgrounds and identities, the largely homogenous professorate, with more than 80% identifying as White, might need training in culturally responsive pedagogy to best serve learners from all backgrounds and identities. Educators often use a “one-size-fits-all” approach in which learners are expected to use the same resources and pace for assignments, readings, and assessments, regardless of their learning strengths or academic preparation. That approach fails to empower educators to design curricula and instruction to position all learners to excel in the classroom. This Perspective explores strategies to support all learners through three dimensions of culturally responsive pedagogy: institutional, personal, and instructional. To truly transform society, we must first transform physical therapy education. Culturally responsive pedagogy advances and supports all student achievement by recognizing, fostering, and using their strengths in the learning environment.
Assessment and mitigation of radiation hazard for individuals engaged in reconnaissance survey in uranium exploration in Jharkhand, India
Authors: Trivedi Ankur , Patra S Nilanchal , Shrivastava Hanumant Bihari , Kumar Uday , Chakrabarti Kalyan , Sinha Deepak Kumar
Published: July 2024

The present study attempts to obtain an a priori estimate of the absorbed dose received by an individual engaged in the reconnaissance survey in Uranium exploration using a predictive mathematical regression analysis. Other radiation safety parameters such as excess lifetime cancer risk are also calculated. Study reflects that the proper handling of naturally occurring radioactive materials accounts for an absorbed dose significantly less than the prescribed limit.
Mapping of uranium concentrations in groundwater samples of Davanagere district, Karnataka, India, and assessment of effective dose to the population
Authors: Hidayath Mohamed , Lavanya Bevinathalapura S K , Namitha Shivachara N , Chandrashekara Mallupura S , Pandit Sundar Achuta
Published: July 2024

The geomorphology, geohydrology, lithology and ecological features of the area influence the uranium content in groundwater. The groundwater samples were collected from 75 locations of Davanagere district, Karnataka, India. Uranium analysis in the water samples was done using LED fluorimeter, based on fluorescence of dissolved uranyl salts. The uranium concentration in water samples varied from 18.41 to 173.21 μg L−1 with a geometric mean of 39.69 μg L−1. Higher uranium concentration in groundwater was observed in Harapanahalli and Jagalur taluk of Davanagere district, which falls in the Eastern Dharwar Craton, which is generally known to contain more radioactive minerals than the Western Dharwar Craton. The effective ingestion dose and lifetime cancer risk to the population were calculated using the obtained uranium concentration in drinking water.
Estimation of radon concentration in groundwater in the mining zone of Haryana, India, for lungs and stomach annual effective dose
Authors: Dhiman Rekha , Dalal Ranjeet , Kumar Suneel , Panghal Amanjeet , Kumar Ajay , Budhwar Savita , Chaudhary Sawan , Kaur Paramjeet
Published: July 2024

The groundwater is being used for drinking and irrigation purposes in vast swathes of the Aravalli Mountain range. Since the radioisotope presence in groundwater is affected by the local mining processes, the radiation monitoring in groundwater of mining regions is of paramount importance. In the present work, we have estimated the 222Rn presence in the mining region of Aravalli in the southern part of Haryana. We measured the Radon concentration in 51 water samples from the intended area using the RAD7 alpha detector. The measured radon concentration in some of the water samples collected from the vicinity of the mining zone is higher than that of the United Nations Scientific Committee on the Effects of Atomic Radiation recommended value. Furthermore, we have estimated the annual effective doses for the lungs and stomach contributed by ingestion and inhalation. Though the calculated dose values in collected samples are not in the critical range, further monitoring of background radiation in the Aravalli region is required.
Gamma-ray interaction studies of concrete with waste glass fillers
Authors: Chikkegowda Ashwitha , Adarsh Raj Lingaraj , Belur Mohan Sankarshan , Krishnaveni Sannathammegowda
Published: July 2024

In the present work, the efficacy of waste glass as fillers in concrete for gamma-ray shielding has been studied. Glass fillers of 0, 15, 30, 45, and 60% concentrations have been incorporated into the concrete mixture. The attenuation measurements were performed using gamma spectrometer with NaI(Tl) detector at 511, 662, 1173, and 1332 keV gamma energies. Gamma-ray shielding parameters, such as the mass attenuation coefficient (μ/ρ), are determined for all filler concentrations. The mass attenuation coefficient of the prepared samples was found to be varied from 0.081 to 0.088, 0.071 to 0.088, 0.05 to 0.058, and 0.05 to 0.055 (cm2 per g) for 511, 662, 1173, and 1332 keV gamma energies, respectively. It was observed that experimentally determined (μ/ρ) values were in very good agreement with theoretical values calculated from EDAX data. Furthermore, it was observed that (μ/ρ) showed an increasing trend with an increase in filler concentration, which is attributed to the increase in the shielding property of the material. Therefore, the glass-concrete composite can be accustomed to reduce the intensity of gamma radiation.
Study on polymer composites with glass for gamma ray shielding
Authors: Chikkegowda Ashwitha , Adarsh Raj Lingaraj , Belur Mohan Sankarshan , Krishnaveni Sannathammegowda
Published: July 2024

The shielding of gamma radiation is of the utmost importance in industries, such as nuclear power plants, medical imaging, and space exploration. For the purpose of shielding objects in such an environment, it is essential to design materials with flexibility as well as high shielding capability. In order to enhance the radiation attenuation effectiveness of polymers, such as polyvinyl alcohol (PVA), glass has been blended with varying percentages. The fabricated composite has been subjected to gamma-ray interaction studies. The radiation shielding parameter, such as mass attenuation coefficient (μ/ρ), has been determined for various energies, such as 137Cs (661.6 keV) and 60Co (1173 and 1332 keV). It is observed that the PVA composite with glass exhibits improved gamma radiation shielding properties compared to PVA. Therefore, the present work paves the way for the utility of PVA polymer with glass, offering a cost-effective and sustainable approach to gamma radiation shielding in radiation environments.
NLRP3 and AIM2 inflammasomes expression is modified by LPS and titanium ions increasing the release of active IL-1β in alveolar bone-derived MSCs
Authors: Carrillo-Gálvez Ana Belén , Zurita Federico , Guerra-Valverde José Antonio , Aguilar-González Araceli , Abril-García Darío , Padial-Molina Miguel , Olaechea Allinson , Martín-Morales Natividad , Martín Francisco , O’Valle Francisco , Galindo-Moreno Pablo
Published: July 2024

Periodontitis and peri-implantitis are inflammatory diseases of infectious etiology that lead to the destruction of the supporting tissues located around teeth or implants. Although both pathologies share several characteristics, it is also known that they show important differences which could be due to the release of particles and metal ions from the implant surface. The activation of the inflammasome pathway is one of the main triggers of the inflammatory process. The inflammatory process in patients who suffer periodontitis or peri-implantitis has been mainly studied on cells of the immune system; however, it is also important to consider other cell types with high relevance in the regulation of the inflammatory response. In that context, mesenchymal stromal cells (MSCs) play an essential role in the regulation of inflammation due to their ability to modulate the immune response. This study shows that the induction of NLRP3 and absent in melanoma 2 (AIM2) inflammasome pathways mediated by bacterial components increases the secretion of active IL-1β and the pyroptotic process on human alveolar bone-derived mesenchymal stromal cells (hABSCs). Interestingly, when bacterial components are combined with titanium ions, NLRP3 expression is further increased while AIM2 expression is reduced. Furthermore, decrease of NLRP3 or AIM2 expression in hABSCs partially reverses the negative effect observed on the progression of the inflammatory process as well as on cell survival. In summary, our data suggest that the progression of the inflammatory process in peri-implantitis could be more acute due to the combined action of organic and inorganic components.
Causal relationship between immune cells and the risk of myeloperoxidase antineutrophil cytoplasmic antibody‐associated vasculitis: A Mendelian randomization study
Authors: Cai Xiaojing , Li Junhua , Wu Manyi , Liu Qingquan
Published: July 2024

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare inflammatory disease categorized as antineutrophil cytoplasmic antibody (ANCA)‐associated vasculitis. The majority of patients are ANCA‐positive, predominantly against myeloperoxidase (MPO). Previous studies have predominantly concentrated on the association between EGPA and neutrophils, but recent research has emphasized the role of lymphocytes in the development of EGPA. The objective of our research was to examine the causal association between immune cells and MPO + ANCA EGPA. A two‐sample bidirectional Mendelian randomization (MR) analysis was performed, which included 159 MPO + ANCA EGPA cases and 6688 controls and utilized Genome‐Wind Associaton Studies (GWAS) summary statistics of immune traits from approximately 3757 individuals, encompassing around 22 million single nucleotide polymorphisms (SNPs). Our findings revealed that 23 immunophenotypes were associated with MPO + ANCA EGPA. Furthermore, the reverse MR analysis showed that MPO + ANCA EGPA had significant causal effects on three immunophenotypes within the Treg panel. By integrating existing research, our study unveiled the contributions of Tregs, B cells, and monocytes to the development of EGPA. Subgroup analysis specifically examined the roles of lymphocyte subtypes, cytokines, and their surface molecules in the pathogenic mechanisms of the disease. This comprehensive approach provides a novel perspective on the biological mechanisms and early intervention strategies for MPO + ANCA EGPA by focusing on immune cells.
A translational model of chronic diabetic nephropathy in the Nile grass rat
Authors: Naseri Marzieh , Ranaei Pirmardan Ehsan , Melhorn Mark I. , Zhang Yuanlin , Barakat Aliaa , Hafezi‐Moghadam Ali
Published: July 2024

Diabetic nephropathy (DN) is a major healthcare challenge for individuals with diabetes and associated with increased cardiovascular morbidity and mortality. The existing rodent models do not fully represent the complex course of the human disease. Hence, developing a translational model of diabetes that reproduces both the early and the advanced characteristics of DN and faithfully recapitulates the overall human pathology is an unmet need. Here, we introduce the Nile grass rat (NGR) as a novel model of DN and characterize key pathologies underlying DN. NGRs spontaneously developed insulin resistance, reactive hyperinsulinemia, and hyperglycemia. Diabetic NGRs evolved DN and the key histopathological aspects of the human advanced DN, including glomerular hypertrophy, infiltration of mononuclear cells, tubular dilatation, and atrophy. Enlargement of the glomerular tufts and the Bowman's capsule areas accompanied the expansion of the Bowman's space. Glomerular sclerosis, renal arteriolar hyalinosis, Kimmelsteil–Wilson nodular lesions, and protein cast formations in the kidneys of diabetic NGR occurred with DN. Diabetic kidneys displayed interstitial and glomerular fibrosis, key characteristics of late human pathology as well as thickening of the glomerular basement membrane and podocyte effacement. Signs of injury included glomerular lipid accumulation, significantly more apoptotic cells, and expression of KIM‐1. Diabetic NGRs became hypertensive, a known risk factor for kidney dysfunction, and showed decreased glomerular filtration rate. Diabetic NGRs recapitulate the breadth of human DN pathology and reproduce the consequences of chronic kidney disease, including injury and loss of function of the kidney. Hence, NGR represents a robust model for studying DN‐related complications and provides a new foundation for more detailed mechanistic studies of the genesis of nephropathy, and the development of new therapeutic approaches.
Determination of the Optimal Volume of 0.5% Ropivacaine in Single-injection Retroclavicular Brachial Plexus Block for Arthroscopic Shoulder Surgery: A Phase I/II Trial
Authors: Zhang Hongye , Wu Jinyu , Miao Yongsheng , Yuan Ying , Qu Zongyang , Zhang Yaonan , Hua Zhen
Published: July 2024

Background:

A brachial plexus block plays an important role in providing perioperative analgesia for shoulder surgery; however, the inherent risk of phrenic nerve block and resulting hemidiaphragmatic paralysis may limit its use in patients with compromised pulmonary function. This study aimed to evaluate the safety, efficacy, maximum tolerated volume, and optimal biologic volume of 0.5% ropivacaine used in a single-injection retroclavicular brachial plexus block for arthroscopic shoulder surgery.

Methods:

In this seamless single-arm exploratory phase I/II trial, a novel Bayesian optimal interval design was used to guide volume escalation for determination of the maximum tolerated volume, followed by sequential volume expansion using Bayesian optimal phase 2 design to establish the optimal biologic volume. Fifty-four patients who underwent arthroscopic shoulder surgery received a single-injection retroclavicular brachial plexus block with 0.5% ropivacaine ranging from 15 to 40 ml. The primary outcomes were complete or partial hemidiaphragmatic paralysis in phase I, measured using ultrasound 30 min after block completion, and the block success in phase II, defined as achieving a total sensorimotor score 12 points or greater and the total sensory score 3 points or greater, measured through manual sensorimotor testing.

Results:

The maximum tolerated volume for the single-injection retroclavicular brachial plexus block was determined to be 35 ml of 0.5% ropivacaine, with a hemidiaphragmatic paralysis rate of 0.09 (95% credible interval, 0 to 0.29). The optimal biologic volume was found to be 25 ml, with a block success rate of 1.0 (95% credible interval, 0.95 to 1.0) and a negligible hemidiaphragmatic paralysis rate of 0.01 (95% credible interval, 0 to 0.06).

Conclusions:

A single-injection retroclavicular brachial plexus block using 25 ml of 0.5% ropivacaine produced consistent block success with a minimal hemidiaphragmatic paralysis rate, suggesting the need for further studies to confirm this result in arthroscopic shoulder surgery.
Quantifying Distal Deltoid Disruption With Linear versus Curvilinear Plating of Proximal Humerus Fractures: A Cadaveric Study
Authors: Galal Youssef , Vohra Arjun , Saunders Patrick , Paul Ben , Hui Clayton , Yao Stephen , Lederman Evan , McKee Michael , Shah Anup
Published: July 2024

BACKGROUND:

Plate fixation of proximal humeral fractures is usually associated with some degree of distal deltoid dissection. The purpose of this study was to quantify deltoid release with standard linear versus curvilinear plates used in the repair of proximal humeral fractures.

METHODS:

Seven nonpaired, fresh-frozen, clavicle-to-fingertip cadaveric shoulders met the inclusion criteria for this study. Four different proximal humerus implants were tested. One of these plates was curvilinear (89 mm), and the other 3 plates were linear (85, 98, 109 mm in length). Plates were compared based on the amount of deltoid insertion released for proper plate positioning. An analysis of variance with post hoc Tukey tests was conducted to compare mean deltoid disruption across the 3 shortest plate types from each manufacturer. A linear regression analysis was conducted to analyze the effect of plate length on mean deltoid release.

RESULTS:

The mean deltoid insertion length was 39.6 ± 8.6 mm (n = 7). The curvilinear plate (89 mm) required the least amount of average deltoid release at 4.1 ± 4.5 mm, or 12.1% of the deltoid insertion. Independent analysis of variance, including the 3 shortest plates from each manufacturer, found a significant effect of which plate was used on the amount of deltoid disruption that resulted (F(2, 18) = 18.0, P < 0.001, ω = 0.6). A linear regression including all 4 plates demonstrated a statistically significant direct relationship between the plate length and the mean deltoid released (y = 0.6x − 43.8, r2 = 4).

CONCLUSION:

This study demonstrates that proximal humerus plate length has a direct relationship with the amount of deltoid released during plating. Although deltoid disruption is length dependent, plate shape (curvilinear vs. linear) could also be contributory. When comparing a curvilinear and a linear plate of similar lengths, the curvilinear plate resulted in less mean deltoid release.
Neuroinflammation and mental health outcomes in adolescents living with HIV
Authors: Mudra Rakshasa-Loots Arish , Vera Jaime H. , Laughton Barbara
Published: July 2024

Purpose of review

Adolescents living with HIV show chronic inflammation, which in turn has been linked to mental health outcomes in the general population. The increased risk for mental health issues in adolescents with HIV may thus be driven by HIV-related inflammation. In this review, we discuss the associations between peripheral and central nervous system inflammation and mental health outcomes in adolescents with HIV.

Recent findings

Preclinical models indicate that expression of HIV viral proteins early in life may lead to neuroinflammation and behavioural deficits in adolescence. Clinical evidence is available primarily in the general population and in adults with HIV, and suggests that inflammatory biomarkers such as IL-6 and TNF-α may be associated with depressive symptoms. Only one study has explored these relationships in adolescents with HIV, and did not find that inflammatory biomarkers in the blood or brain were linked to depressive symptoms. Current research in this field focuses overwhelmingly on peripheral inflammatory biomarkers (compared to neuroimaging biomarkers) and on depression (compared to other mental health conditions).

There is strong evidence to suggest that neuroinflammation and peripheral inflammation may play a role in the development of mental health issues in adolescents, but research in adolescents with HIV is sparse. Characterizing the relationship between inflammation and mental health in adolescents with HIV may help improve the prediction, prevention, early intervention, and treatment of mental health issues in this population.
Association between precipitation and mortality due to diarrheal diseases by climate zone: A multi-country modeling study
Authors: Chua Paul L. C. , Tobias Aurelio , Madaniyazi Lina , Ng Chris Fook Sheng , Phung Vera Ling Hui , Fu Sze Hang , Rodriguez Peter S. , Brown Patrick , Coelho Micheline de Sousa Zanotti Stagliorio , Saldiva Paulo Hilario Nascimento , Scovronick Noah , Deshpande Aniruddha , Salazar Miguel Antonio S. , Dorotan Miguel Manuel C. , Tantrakarnapa Kraichat , Kliengchuay Wissanupong , Abrutzky Rosana , Carrasco-Escobar Gabriel , Roye Dominic , Hales Simon , Hashizume Masahiro
Published: July 2024

Background:

Precipitation could affect the transmission of diarrheal diseases. The diverse precipitation patterns across different climates might influence the degree of diarrheal risk from precipitation. This study determined the associations between precipitation and diarrheal mortality in tropical, temperate, and arid climate regions.

Methods:

Daily counts of diarrheal mortality and 28-day cumulative precipitation from 1997 to 2019 were analyzed across 29 locations in eight middle-income countries (Argentina, Brazil, Costa Rica, India, Peru, the Philippines, South Africa, and Thailand). A two-stage approach was employed: the first stage is conditional Poisson regression models for each location, and the second stage is meta-analysis for pooling location-specific coefficients by climate zone.

Results:

In tropical climates, higher precipitation increases the risk of diarrheal mortality. Under extremely wet conditions (95th percentile of 28-day cumulative precipitation), diarrheal mortality increased by 17.8% (95% confidence interval [CI] = 10.4%, 25.7%) compared with minimum-risk precipitation. For temperate and arid climates, diarrheal mortality increases in both dry and wet conditions. In extremely dry conditions (fifth percentile of 28-day cumulative precipitation), diarrheal mortality risk increases by 3.8% (95% CI = 1.2%, 6.5%) for temperate and 5.5% (95% CI = 1.0%, 10.2%) for arid climates. Similarly, under extremely wet conditions, diarrheal mortality risk increases by 2.5% (95% CI = −0.1%, 5.1%) for temperate and 4.1% (95% CI = 1.1%, 7.3%) for arid climates.

Conclusions:

Associations between precipitation and diarrheal mortality exhibit variations across different climate zones. It is crucial to consider climate-specific variations when generating global projections of future precipitation-related diarrheal mortality.
Chyle Leak Management in the Setting of Tissue Expander Breast Reconstruction with Acellular Dermal Matrix: Case Series and Literature Review
Authors: O’Neill Elizabeth S. , Graham Shelby , Seu Michelle Y. , Adepoju Jubril , Toms John A. , Alvarado Rosalinda , Perez Claudia , Shenaq Deana
Published: July 2024

Background:

Chylous leakage is a rare surgical complication most frequently encountered following operations involving the neck and thorax. Even more rare are axillary chyle leaks secondary to breast cancer involving the axillary lymph nodes. Anatomic variability in the termination of the thoracic duct may play a role in the susceptibility some individuals may have to this type of leakage. There is no consensus on the definitive management of these complications, especially in the context of breast reconstruction.

Methods:

Here, we report our experience in the management of chylous leakage in three patients who underwent left axillary lymph node dissection and immediate breast reconstruction with the use of tissue expanders and acellular dermal matrix. Descriptions of each case are followed by a review of the relevant literature. We also present an original treatment algorithm.

Results:

Two of three patients with suspected chylous leakage secondary to intraoperative injury to the axillary region underwent definitive diagnosis by clinical examination and drain fluid triglyceride analysis, followed by conservative management with a low-fat diet. The third patient was diagnosed clinically with no fluid analysis. All leakages resolved through conservative means, with no need to return to the operating room for surgical exploration and repair.

Conclusions:

Based on our experience, we believe that patients with suspected chylous leakage secondary to axillary lymph node dissection in the context of breast reconstruction can be safely and effectively managed by conservative management in the acute postoperative period. If these measures are insufficient, surgical management may be necessary.
Randomized Feasibility Study Evaluating Multiple FDA-approved Microbubbles for CEUS Lymphography
Authors: Jang Samuel , Rames Jess D. , Hesley Gina K. , Brinkman Nathan J. , Tran Nho V. , Fahradyan Vahe , Lee Christine U.
Published: July 2024

Prior studies on contrast-enhanced ultrasound (CEUS) lymphography for preoperative mapping before lymphaticovenous anastomosis surgery in patients with extremity lymphedema have been limited to using only Lumason and Sonazoid as microbubble contrast agents. The purpose of this study was to determine the feasibility of using two other Food & Drug Administration–approved microbubble agents, Optison and Definity, for imaging lymphatic vessels in the upper extremities. Nine female adults with unilateral upper extremity lymphedema anticipating lymphaticovenous anastomosis surgery underwent CEUS lymphography of the unaffected upper extremity randomized to either Lumason, Definity, or Optison. Lymphatic vessels were visualized in all but one case when undilated Definity was used. In the eight upper extremities where lymphatic vessels were visualized, an average of eight intradermal injections of microbubbles were performed in the extremity. Lymphatic vessels could be identified in 57% (36 of 63) of the injections. The effective dilution for each of the microbubble agents is provided. This was the first successful demonstration of lymphatic vessel visualization using either Definity or Optison. Broadening the range of available microbubble agents for CEUS lymphography could improve accessibility to the procedure and provide potentially safer alternatives.
Circulating Activated Platelets in Children With Long COVID: A Case-Controlled Preliminary Observation
Authors: Buonsenso Danilo , Sorrentino Silvia , Ferretti Antonietta , Morello Rosa , Valentini Piero , Di Gennaro Leonardo , De Candia Erica
Published: July 2024

We investigated if children with Long COVID (n=14) have activated platelets compared with healthy controls (n=14). Platelet activation and secretion markers were investigated by flow cytometry using MoAbs directed against P-selectin, CD63, and PAC-1 in quiescent platelets and in platelets stimulated with 10-µM adenosine diphosphate and 25-µM protease activated receptor 1-activating peptide. Circulating platelets of patients with Long COVID had significantly increased expression of the activation marker cytometry using MoAbs directed against P-selectin (P = 0.019).
Risk factors for acute kidney injury or mortality and long-term follow-up in coronavirus disease 2019 infected patients in the era before vaccination
Authors: Chen Shu-Ming , Hsiao Yu-Cheng , Cheng Chung-Yi , Lin Che-Yu , Lai Wei-Shian , Zeng Guo-Qiang , Kao Chih-Chin , Wu Mei-Yi , Wu Mai-Szu , Lin Yen-Chung , Hsu Raymond K.
Published: July 2024

Background:

Acute kidney injury (AKI) is a severe complication of coronavirus disease 2019 (COVID-19) and is associated with a higher risk of mortality. Understanding the risk factors contributing to COVID-19-related AKI and mortality before vaccination is important for the initiation of preventative measures and early treatment strategies.

Methods:

This study included patients aged ≥18 years diagnosed with COVID-19 through polymerase chain reaction from May 2020 to July 2021, admitted in three local hospitals in Taiwan, with an extended follow-up until June 30, 2022. A median follow-up period of 250 days was used to assess AKI development and mortality. AKI was defined according to the Kidney Disease Improving Global Outcomes criteria. Multivarible Cox regression analysis of AKI and mortality-related risk factors were performed.

Results:

Of the 720 hospitalized patients with COVID-19, 90 (22%) developed AKI. Moreover, 80%, 10.1%, and 8.9% of the patients had stage 1, 2, and 3 AKI, respectively. Patients with stage 1 to 3 AKI had significantly lower survival rates than those without AKI (p = 0.001). The mean duration of post-admission AKI occurrence was 9.50 ± 11.32 days. Older age, hypoalbuminemia, and higher D-dimer and ferritin levels were associated with COVID-19 mortality. In COVID-19 AKI, in addition to older age and high D-dimer and ferritin levels, chronic kidney disease emerged as an independent risk factor.

Conclusion:

COVID-19-related AKI develops early, exhibits a temporal association with respiratory failure, and is linked to an unfavorable prognosis. The mortality rate increased according to the AKI stage (p = 0.001). Age, albumin, D-dimer, and ferritin levels, and the underlying chronic kidney disease status upon admission are crucial factors for predicting AKI development, which increases the mortality risk. Monitoring the renal function not only within 10 days of COVID-19 onset, but also within 1 month after the disease onset.
Eosinophilic pustular folliculitis after phlebectomy: a case report
Authors: Nailling Brian B. , Smetanick Matthew T. , Kajoian Armineh B.
Published: July 2024

Eosinophilic pustular folliculitis (EPF), also known as Ofuji disease, is a rare inflammatory condition in which eosinophils infiltrate the skin, primarily around hair follicles. Several variants of the condition exist, but all exhibit sterile erythematous folliculocentric papules with or without pustules and pruritus. Common areas affected are the seborrheic areas of the body. Although the exact pathophysiology is not fully understood, the condition is seen more commonly in people of Japanese heritage, infants, and immunosuppressed patients. Immunosuppressed manifestations are divided into human immunodeficiency virus (HIV)-associated and non-HIV–associated categories. The goals of management are identification and treatment of an underlying disorder if present, relief of pruritis, and prevention of secondary infection. Here, we present the case of an adult female patient who developed EPF after a phlebectomy.
Impact of a Participatory Wellness Continuing Medical Education Program on Physician Burnout and Well-Being
Authors: Hensrud Donald D. , Thompson Warren G. , Rieck Thomas M. , West Colin P. , Jenkins Sarah M. , Ferguson Jennifer A. , Clark Matthew M.
Published: July 2024

Objective

Examine the impact of a participatory wellness continuing medical education (CME) program on physician burnout, wellness, and well-being.

Methods

Physicians attending a 3-day wellness CME program. Self-reported questionnaires at baseline with paired analyses at 26-week follow-up.

Results

Compared to baseline, at 26 weeks there were decreases in burnout (P < 0.001, ES −0.68), red meat consumption (P = 0.02, ES −0.29), and current stress levels (P < 0.001, ES −0.50). There were increases in fruit/vegetable consumption (P < 0.001, ES 0.55), energy levels at work (P < 0.001, ES 0.60) and at home (P < 0.001, ES 0.66), quality of life (P < 0.001, ES 0.53), and confidence (P < 0.001, ES 0.89) and frequency (P = 0.01, ES 0.32) of counseling patients on wellness.

Conclusion

Attendance at this participatory wellness CME program was associated with improved physician burnout, health behaviors in diet, stress, energy, quality of life, and wellness counseling.
Recovering Work Productivity in a Population With Chronic Musculoskeletal Pain
Authors: Janela Dora , Areias Anabela C. , Moulder Robert G. , Molinos Maria , Bento Virgílio , Yanamadala Vijay , Correia Fernando Dias , Costa Fabíola
Published: July 2024

Objective

To investigate potential savings obtained from restoring productivity in employees with chronic MSK pain through a digital care program (DCP).

Methods

Secondary analysis of a prospective longitudinal study assessing cumulative savings overall or across several industry sectors by analyzing changes in Work Productivity and Activities Impairment (WPAI questionnaire).

Results

Employees from 50 U.S. states started the program (n = 5032). Significant improvements in productivity impairment were observed across all industries, yielding median cumulative savings from $151 (95% confidence interval [CI], 128–174) to $294 (95% CI, 286–303) per participant at treatment end. Twelve-month projections estimated median savings of $2916 (95% CI, 2861–2972). Additionally, significant improvements in non–work-related daily activities were observed.

Conclusions

This study underlines the burden of MSK-related productivity loss on employers' financial balance, illustrating the importance of a DCP to assist patients to recover quality of life and succeed professionally.
The Pelvic Health Curricular Exposure Scale (PHCES): A Survey of Physical Therapy Students’ Comfort Discussing Sexual Health
Authors: Levay Elizabeth , Hall-Bibb Dawn
Published: July 2024

Background:

As holistic, autonomous health care providers, physical therapists must be confident in discussing all aspects of health with patients, including sexual health. Lack of attention to patients’ sexual issues may result in aspects of health going unaddressed, leading to poor patient care.

Objectives:

The purpose of this study was to investigate the relationship between exposure to pelvic health content in physical therapy school curricula and Doctor of Physical Therapy (DPT) students’ comfort levels discussing sexual health issues with future patients.

Study Design:

Survey research report.

Methods:

A cluster sample of DPT students in the United States (n = 167) completed a novel tool, titled the Pelvic Health Curricular Exposure Scale (PHCES), as well as an adapted version of the Students’ Attitudes Towards Addressing Sexual Health (SA-SH) questionnaire.

Results:

Exposure to and comfort with pelvic floor dysfunction (p< .001; p< .001), obstetrical issues (p= .051; p< .001), colorectal health (p= .007; p< .001), and incontinence (p= .009; p< .001), as well as participating in a pelvic health elective (r
pb = 0.05) or clinical experience (r
pb < 0.003), positively correlated with comfort discussing sexual health with future patients.

Conclusion:

DPT programs should make a dedicated effort to implement pelvic health into the curriculum with an emphasis on topics such as pelvic floor dysfunction, obstetrical issues, colorectal health, and incontinence, as well as to provide students with pelvic health electives and clinical experiences.

The Supplemental Digital Content video abstract for this article is available at: http://links.lww.com/JWHPT/A131
Characterizing Chronic Pelvic Pain: The Relationship Between Extrapelvic Muscle Stiffness, Pain Level, Health History, and Pelvic Floor Symptoms in Women With Chronic Pelvic Pain
Authors: Proulx Laurel , Brizzolara Kelli , Thompson Mary , Wang-Price Sharon , Rodriguez Patricia , Koppenhaver Shane
Published: July 2024

Purpose:

The purpose of this cross-sectional study was to assess the association of extrapelvic muscular stiffness measures with pelvic floor symptoms and clinical impairments in women with chronic pelvic pain (CPP). In addition to bivariate correlations, exploratory factor analysis (EFA) was used to identify multivariate clinical presentation patterns of CPP.

Methods:

Muscle stiffness measurements of 11 extrapelvic muscles were taken in 149 women with CPP. Associations between muscle stiffness and clinical measures such as pelvic floor function, pain, psychosocial status, and urogynecology history were calculated. In addition, variables were assessed using EFA to identify patterns of CPP.

Results:

There were small but significant correlations between muscle stiffness measurements and clinical measures. Three categorizations of CPP symptoms and impairments emerged from the 25 continuous variables chosen for EFA. These could be classified as follows: (1) pelvic floor dysfunction and psychosocial involvement; (2) muscle stiffness of the hips and thighs; and (3) muscle stiffness of the low back and abdomen, collectively making up 49.1% of the variance.

Discussion:

Stiffness of commonly treated extrapelvic muscles was not strongly correlated to pain level or health history of women with CPP. The first EFA component is consistent with patients routinely seen by pelvic health physical therapists, and the latter components are consistent with those who may benefit initially from orthopedic physical therapy. Further research looking at the relationship of muscle stiffness, pelvic floor function, and movement impairments is needed. EFA may be a starting point to better understand who may be appropriate for orthopedic physical therapy treatment versus specialized pelvic health physical therapy care.
Use of HBsAg-positive donors in liver transplantation: An ILTS-EASL-AASLD multisociety survey
Authors: Vinaixa Carmen , DiMaira Tommaso , Russo Francesco Paolo , Goldberg David , Mazzola Alessandra , Walabh Priya , Price Jennifer , Sagal Sanjiv , Kirchner Varvara , Shaker Tamer , Krag Aleksander , Pruett Timothy , Coilly Audrey , Terrault Norah , Berenguer Marina
Published: July 2024

The gap between organ supply and demand in liver transplantation remains large in most parts of the world. One strategy to increase the donor pool is to use grafts infected with HCV, HBV, and/or HIV viruses. We aimed to explore the current use of HBsAg-positive liver grafts worldwide. A prospective cross-sectional web-based survey was designed, with a total of 28 queries, assessing national and local regulations, center experience, and center-specific experience related to the topic, and sent to all members of International Liver Transplantation Society, European Association for the Study of the Liver, and American Association for the Study of the Liver, and promoted on social media. A total of 135 liver transplant centers answered the survey: 38% from WHO European Regions, 39% from American regions, and 9.7% from South-East Asian regions. Most of the participating centers (67.3%) had been performing liver transplantation for over 15 years, with a mean of 66.5 liver transplants per year, and 54% also performed living-donor liver transplants. HBV-related disease was the indication for liver transplantation in an average of 15% of all liver transplantation cases. Regarding national and/or regional regulations, 40% of the centers reported that the use of HBsAg-positive donors was permitted, and an additional 20% could use them under special circumstances. Thirty-two centers (31%) had previously used HBsAg-positive donors. Among these centers, 62.5% conducted living-donor liver transplants and showed an increased inclination toward the use of HBsAg-positive grafts in centers with elevated waitlist mortality. HBsAg-positive donors are underutilized worldwide. The use of HBsAg-positive liver grafts could help to increase the donor pool, particularly in highly endemic areas.