bluuebunny/crossref_metadata_2025 huggingface dataset:
Disability, Enhancement, and Flourishing
Authors: Eberl Jason T
Published: November 2022

Recent debate among bioethicists concerns the potential to enhance human beings’ physical or cognitive capacities by means of genetic, pharmacological, cybernetic, or surgical interventions. Between “transhumanists,” who argue for unreserved enhancement of human capabilities, and “bioconservatives,” who warn against any non-therapeutic manipulation of humanity’s natural condition, lie those who support limited forms of enhancement for the sake of individual and collective human flourishing. Many scholars representing these views also share a concern over the status and interests of human beings with various types of cognitive and physical disabilities, some of which may be ameliorable by enhancement interventions. The question addressed in this paper is whether valuing the enhancement of human capabilities may be reconciled with valuing the existence and phenomenological experiences of human beings with various disabilities. Can we value enhanced capabilities without disvaluing those whose capabilities fall below a defined threshold of “normal function”? Furthermore, if certain forms of disability, particularly cognitive disabilities, negatively impact one’s flourishing, could the enhancement of one’s cognitive capacities through biotechnological means enhance one’s flourishing.
Defining Disability: Creating a Monster?
Authors: Espinoza Marissa D , Tenorio Addison S
Published: November 2022

Disability is often defined as deviation from putative norms of physical, cognitive, or affective function. This definition is normatively laden, causing people with disabilities to be thought of as “different” and treated with pity. We address the predominant theme of this issue on “Disability Identity”: defining and imposing the category of “disability” and attempting to overcome it through medical intervention. The issue culminates in a call for courageous humility as the proper response to encounters with disability, providing medical professionals with the disposition to resist medicine’s inherent drive to fix what is perceived to be broken—that which strays from the norm. We hope that this issue might act as a clarion call to medical professionals to reevaluate how they see and interact with “disability” as a category, and ultimately with people with disabilities, especially with respect to what may be owed to persons with disabilities from society.
Autotopographies of Forced Displacement: City Walking Tours as a Path for Political Visibility
Authors: Huss Michal
Published: November 2022

Though forced displacement is prominent within academic research, as well as within public, political, and media debates, all too often the image of forcibly displaced persons is that of voiceless victims and the structural causes behind their trauma are overlooked. The article works to disrupt this problematic visualization through an original study of walking tours offered by refugees and internally displaced persons in Berlin and Jaffa. It utilizes walking as the method and theme of research, mapping the potential of walking as a collaborative pedagogy and a subaltern design tactic to claim political participation and belonging in the city. Through this, the article offers a new analytical perspective concerning the agency of discalced persons to navigate the politics of their (im)mobility and (in)visibility. The main argument is that these guided tours or ‘autotopographies’ of forced displacement hold the political capacity to alter the public visibility of displaced people, but also to illuminate aspects that are overlooked or erased within the city’s official display of memory. The article therefore advances debates about the politics of urban space and heritage sites and contributes to research which seeks to theorize the multiple geo-temporal colonial entanglement of forced displacement regimes.
Ureteric trauma caused by urethral catheter insertion: case report and literature review
Authors: Sayedin Hani , Jamieson Paul
Published: November 2022

Urethral catheterization is one of the most common procedures in medical practice. Catheterization is not only restricted for urological purposes, but also used for many other indications. For instance, urethral catheterization could be used for intensive care unit patients, trauma and multiple fracture injuries, and advanced neurological condition e.g. multiple sclerosis. Therefore, it may be performed by both well trained and not fully trained medical professionals resulting in complications. We present an 82-year-old female presented to A&E with hematuria, abdominal pain and low catheter output drainage after recent catheter exchange by the district nurse. Interestingly, non-contrast computed tomography (CT) scan showed the catheter inserted into the left ureter and the catheter balloon was inflated at the level of the mid-ureter. Later contrast CT study showed extravasation confirming ureteric wall partial disruption injury. The patient was managed conservatively without apparent complications in the follow-up.
The MOSDEF survey: probing resolved stellar populations at z ∼ 2 Using a new bayesian-defined morphology metric called patchiness
Authors: Fetherolf Tara , Reddy Naveen A , Shapley Alice E , Kriek Mariska , Siana Brian , Coil Alison L , Mobasher Bahram , Freeman William R , Price Sedona H , Sanders Ryan L , Shivaei Irene , Azadi Mojegan , de Groot Laura , Leung Gene C K , Zick Tom O
Published: November 2022

We define a new morphology metric called ‘patchiness’ (P) that is sensitive to deviations from the average of a resolved distribution, does not require the galaxy centre to be defined, and can be used on the spatially resolved distribution of any galaxy property. While the patchiness metric has a broad range of applications, we demonstrate its utility by investigating the distribution of dust in the interstellar medium (ISM) of 310 star-forming galaxies at spectroscopic redshifts 1.36 < z < 2.66 observed by the MOSFIRE Deep Evolution Field survey. The stellar continuum reddening distribution, derived from high-resolution multiwaveband CANDELS/3D-HST imaging, is quantified using the patchiness, Gini, and M20 coefficients. We find that the reddening maps of high-mass galaxies, which are dustier and more metal-rich on average, tend to exhibit patchier distributions (high P) with the reddest components concentrated within a single region (low M20). Our results support a picture where dust is uniformly distributed in low-mass galaxies (≲1010 M⊙), implying efficient mixing of dust throughout the ISM. On the other hand, the dust distribution is patchier in high-mass galaxies (≳1010 M⊙). Dust is concentrated near regions of active star formation and dust mixing time-scales are expected to be longer in high-mass galaxies, such that the outskirt regions of these physically larger galaxies remain relatively unenriched. This study presents direct evidence for patchy dust distributions on scales of a few kpc in high-redshift galaxies, which previously has only been suggested as a possible explanation for the observed differences between nebular and stellar continuum reddening, star formation rate indicators, and dust attenuation curves.
The molecular gas main sequence and Schmidt–Kennicutt relation are fundamental, the star-forming main sequence is a (useful) byproduct
Authors: Baker William M , Maiolino Roberto , Belfiore Francesco , Bluck Asa F L , Curti Mirko , Wylezalek Dominika , Bertemes Caroline , Bothwell M S , Lin Lihwai , Thorp Mallory , Pan Hsi-An
Published: November 2022

We investigate the relationship between the star formation rate (SFR), stellar mass (M*), and molecular gas mass ($M_{\mathrm{ H}_2}$) for local star-forming galaxies. We further investigate these relationships for high-z (z = 1–3) galaxies and for the hosts of a local sample of active galactic nuclei (AGN). We explore which of these dependencies are intrinsic and which are an indirect byproduct by employing partial correlation coefficients and random forest regression. We find that for local star-forming galaxies, high-z galaxies, and AGN host galaxies, the Schmidt–Kennicutt (SK) relation (between $M_{\mathrm{ H}_2}$ and SFR) and the molecular gas main sequence (MGMS; between $M_{\mathrm{ H}_2}$ and M*) are intrinsic primary relations, while the relationship between M* and SFR, i.e. the star-forming main sequence (SFMS), is an indirect byproduct of the former two. Hence the SFMS is not a fundamental scaling relation for local or high-z galaxies. We find evidence for both the evolution of the MGMS and SK relation over cosmic time, where, at a given stellar mass, the higher the redshift, the greater the molecular gas mass and the star formation efficiency. We offer a parametrization of both the MGMS and SK relation’s evolution with redshift, showing how they combine to form the observed evolution of the SFMS. In addition, we find that the local AGN host galaxies follow an AGN–MGMS relation (as well as an AGN–SK relation), where the MGMS is offset to lower $M_{\mathrm{ H}_2}$ for a given M* compared to local star-forming galaxies.
The Impact of Genetic Surfing on Neutral Genomic Diversity
Authors: Schlichta Flávia , Moinet Antoine , Peischl Stephan , Excoffier Laurent
Published: November 2022

Range expansions have been common in the history of most species. Serial founder effects and subsequent population growth at expansion fronts typically lead to a loss of genomic diversity along the expansion axis. A frequent consequence is the phenomenon of “gene surfing,” where variants located near the expanding front can reach high frequencies or even fix in newly colonized territories. Although gene surfing events have been characterized thoroughly for a specific locus, their effects on linked genomic regions and the overall patterns of genomic diversity have been little investigated. In this study, we simulated the evolution of whole genomes during several types of 1D and 2D range expansions differing by the extent of migration, founder events, and recombination rates. We focused on the characterization of local dips of diversity, or “troughs,” taken as a proxy for surfing events. We find that, for a given recombination rate, once we consider the amount of diversity lost since the beginning of the expansion, it is possible to predict the initial evolution of trough density and their average width irrespective of the expansion condition. Furthermore, when recombination rates vary across the genome, we find that troughs are over-represented in regions of low recombination. Therefore, range expansions can leave local and global genomic signatures often interpreted as evidence of past selective events. Given the generality of our results, they could be used as a null model for species having gone through recent expansions, and thus be helpful to correctly interpret many evolutionary biology studies.
Proton exchange by the vacuolar nitrate transporter CLCa is required for plant growth and nitrogen use efficiency
Authors: Hodin Julie , Lind Christof , Marmagne Anne , Espagne Christelle , Bianchi Michele Wolfe , De Angeli Alexis , Abou-Choucha Fadi , Bourge Mickaël , Chardon Fabien , Thomine Sebastien , Filleur Sophie
Published: November 2022

Nitrate is a major nutrient and osmoticum for plants. To deal with fluctuating nitrate availability in soils, plants store this nutrient in their vacuoles. Chloride channel a (CLCa), a 2NO3−/1H+ exchanger localized to the vacuole in Arabidopsis (Arabidopsis thaliana), ensures this storage process. CLCa belongs to the CLC family, which includes anion/proton exchangers and anion channels. A mutation in a glutamate residue conserved across CLC exchangers is likely responsible for the conversion of exchangers to channels. Here, we show that CLCa with a mutation in glutamate 203 (E203) behaves as an anion channel in its native membrane. We introduced the CLCaE203A point mutation to investigate its physiological importance into the Arabidopsis clca knockout mutant. These CLCaE203A mutants displayed a growth deficit linked to the disruption of water homeostasis. Additionally, CLCaE203A expression failed to complement the defect in nitrate accumulation of clca and favored higher N-assimilation at the vegetative stage. Further analyses at the post-flowering stages indicated that CLCaE203A expression results in an increase in N uptake allocation to seeds, leading to a higher nitrogen use efficiency compared to the wild-type. Altogether, these results point to the critical function of the CLCa exchanger on the vacuole for plant metabolism and development.
Modular symmetry of soft supersymmetry breaking terms
Authors: Kikuchi Shota , Kobayashi Tatsuo , Nasu Kaito , Otsuka Hajime , Takada Shohei , Uchida Hikaru
Published: November 2022

We study the modular symmetry of soft supersymmetry breaking terms. Soft scalar masses and A-term coefficients are invariant under the modular symmetry when we regard the F-term as a spurion with the modular weight −2. Their flavor structure is determined by the same symmetry as Yukawa couplings, i.e., fermion masses. The modular symmetric behavior of the μ-term and B-term depends on how the μ-term is generated.
Reconstructing quantum states via unambiguous state discrimination
Authors: Karimi Naser , Olyaei Hadi Z , Yahyavi Marziyeh , Jafarizadeh Mohammad Ali
Published: November 2022

In this paper, we introduce an analytical framework for the reconstruction of quantum states. The reconstruction of an unknown quantum state requires the information of a complete set of observables, obtained through experimental measurements of Hermitian operators usually defined as positive-operator-valued measures (POVMs). The scheme involves a single-qubit unambiguous state discrimination POVM, which can be generalized to perform n-qubit measurements. We also use maximum likelihood estimation as a method in the reconstruction of the density matrix from experimental data and show that the expected value of the cleaner is independent of the parameter of the density operator.
The impact of Covid-19 on animal-assisted interventions: perceptions of UK animal-assisted intervention providers
Authors: Shoesmith Emily , Gibsone Selina , Ratschen Elena
Published: November 2022

Background

Animal-assisted interventions (AAIs) are increasingly common in UK health settings. The Covid-19 pandemic has impacted on their delivery, with many organizations offering AAIs virtually during lockdown periods. This small-scale survey aims to explore the impact of Covid-19 on the delivery of AAIs, and associated challenges and opportunities.

Methods

A cross-sectional, retrospective questionnaire survey was conducted with UK AAI providers. The anonymized survey was distributed via academic and third sector networks and social media. Descriptive statistics and free-text responses are presented.

Results

Thirty-six AAI providers completed the survey. Of these, 83.3% continued to deliver AAIs during the pandemic. Twenty-eight delivered AAIs remotely and highlighted associated challenges, such as clients being unable to touch the animal, and clients having restricted access to the required technology. Over half reported their animal missed face-to-face interaction. However, they also reported advantages to remote delivery, such as for those who are allergic or fearful of animals. The most commonly reported challenges of in situ delivery included difficulty maintaining distance from the client and the use of face masks, which were perceived to hinder communication.

Conclusion

The transition to remote delivery has highlighted challenges and opportunities. Further research could explore these in greater depth and compare the impact of different delivery modes.
Relative contributions of endogenous and exogenous formaldehyde to formation of deoxyguanosine monoadducts and DNA-protein crosslink adducts of DNA in rat nasal mucosa
Authors: Conolly Rory B , Campbell Jerry L , Clewell Harvey J , Schroeter Jeffry , Kimbell Julia S , Gentry P Robinan
Published: November 2022

Understanding the dose-response for formaldehyde-induced nasal cancer in rats is complicated by (1) the uneven distribution of inhaled formaldehyde across the interior surface of the nasal cavity and, (2) the presence of endogenous formaldehyde (endoF) in the nasal mucosa. In this work, we used computational fluid dynamics (CFD) modeling to predict flux of inhaled (exogenous) formaldehyde (exogF) from air into tissue at the specific locations where DNA adducts were measured. Experimental work has identified DNA-protein crosslink (DPX) adducts due to exogF and deoxyguanosine (DG) adducts due to both exogF and endoF. These adducts can be considered biomarkers of exposure for effects of endoF and exogF on DNA that may be part of the mechanism of tumor formation. We describe a computational model linking CFD-predicted flux of formaldehyde from air into tissue, and the intracellular production of endoF, with the formation of DPX and DG adducts. We assumed that, like exogF, endoF can produce DPX. The model accurately reproduces exogDPX, exogDG, and endoDG data after inhalation from 0.7 to 15 ppm. The dose-dependent concentrations of exogDPX and exogDG are predicted to exceed the concentrations of their endogenous counterparts at about 2 and 6 ppm exogF, respectively. At all concentrations examined, the concentrations of endoDPX and exogDPX were predicted to be at least 10-fold higher than that of their DG counterparts. The modeled dose-dependent concentrations of these adducts are suitable to be used together with data on the dose-dependence of cell proliferation to conduct quantitative modeling of formaldehyde-induced rat nasal carcinogenicity.
Pressure Injury Management in Critically Ill Patients with COVID-19 in a Makeshift Hospital in Indonesia: A Report of Two Cases
Authors: Eveline Kezia , Indirayani Hemma W. , Pramanasari Rachmaniar , Alkaff Firas F.
Published: November 2022

Patients who are critically ill with COVID-19 need ventilation support in the ICU. However, ICU patients are at higher risk of developing a pressure injury (PI). Unfortunately, PI prevention is not optimally implemented in Indonesia, especially in the makeshift hospitals created during the COVID-19 pandemic. Here, the authors report two cases of critically ill patients with COVID-19 who developed large sacral PIs during hospitalization in a makeshift hospital in Indonesia. The first patient developed a stage 3, 7 × 7-cm sacral PI on the 14th day of hospitalization. The second patient developed a stage 4, 12 × 8-cm sacral PI on the 16th day of hospitalization. Both patients had elevated d-dimer levels and used a noninvasive ventilator for 1 week. The wounds were treated with surgical debridement, silver hydrogel dressing, and hydrocolloid dressing and complemented with static air mattress overlay. The authors recommend that in situations where there is a shortage of healthcare workers, the government should provide pressure-redistribution devices and silicone foam dressings for all critically ill patients to prevent PI development and lighten the workload of healthcare workers.
Effects of Topical Oils on Neonatal Skin: A Systematic Review
Authors: Aksucu Gözde , Azak Merve , Çağlar Seda
Published: November 2022

OBJECTIVE

To identify studies that aimed to determine the effects of topical oils on neonatal skin.

DATA SOURCES

Authors searched PubMed, Cochrane Central Register of Controlled Trials, and Science Direct databases.

STUDY SELECTION

The databases were searched for studies published through February 2022 (when the search was conducted) using the keywords “skin”, “neonatal”, “infant”, and “oil”. Fourteen randomized controlled trials that met the eligibility criteria were included in the review.

DATA EXTRACTION

Researchers used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) reporting guidelines to guide this systematic review. Two authors reviewed and evaluated the articles independently.

DATA SYNTHESIS

The 14 studies included in this review were conducted with a total of 5,683 neonates, most of whom were preterm. The included studies used blended sunflower (n = 8), coconut (n = 5), almond (n = 2), olive (n = 1), mustard (n = 1), and vegetable (n = 1) oils. These studies investigated the effects of topical oils on the skin’s barrier functions and skin integrity. Most studies used noninvasive measurement devices to evaluate the skin’s barrier functions; they used a variety of scoring systems to evaluate skin integrity. Eleven of the studies concluded that the oils used in the skincare of neonates effectively improve the skin condition and barrier functions of the skin. However, three studies found equivocal, negative, or mixed findings.

CONCLUSION

Although current evidence indicates a potential benefit, more studies with a high level of evidence on the subject are required.
Fungating Malignancies: Management of a Distinct Wound Entity
Authors: Kondra Katelyn , Pekcan Asli , Stanton Eloise , Cook Austin D. , Jimenez Christian , Aronowitz Alexandra , Winterhalter Bridget A. , Hammoudeh Jeffrey A. , Aronowitz Joel A.
Published: November 2022

GENERAL PURPOSE

To provide information on the surgical management of fungating malignancies as a distinct wound entity.

TARGET AUDIENCE

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

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will:

1. Identify characteristics of patients in a study examining the treatment of fungating malignancies.

2. Select common symptoms experienced by patients with fungating malignancies.

3. Explain issues related to the surgical treatment of fungating malignancies.

4. Identify a reason why patients with fungating breast masses may avoid medical care.

OBJECTIVE

To address the literature gap on malignant fungating wound treatment by reporting two institutions’ experiences with this disease process and proposing practices to improve care.

METHODS

A multi-institutional retrospective review was conducted of 44 patients with 45 malignant fungating wounds over an 11-year period. Patient characteristics, treatment history, and outcomes were analyzed.

RESULTS

Of the 44 patients who met the inclusion criteria, 31 (70.5%) were women and 13 (29.5%) were men. The average age at presentation was 63.0 (SD, 16.1) years. The most common malignancy was breast cancer, accounting for more than half of cases (54.5%). The average surface area of the tumors at presentation was 110.3 (SD, 215.0; range, 2.2–1,140) cm2, whereas the average surface area at time of discharge/death was 104.6 (SD, 310.7; range, 0–1,800) cm2. Neither surface area at presentation (P = .504) nor surface area at time of final follow-up (P = .472) were significantly associated with death during the study time frame.

CONCLUSION

In the era of advancing technologies and medical innovation, the benefits of palliative surgery, which helps mitigate an open wound, should not be overlooked. Improving end-of-life care is beneficial to the patient and families alike. As surgeons, we strive for a tangible cure, but providing palliative resection to enable death with dignity might be the most humane service of all.
Testosterone Therapy for Dropped Head Syndrome: A Case Report
Authors: Felong Timothy J. , Balos Lucia L. , Silvestri Nicholas J.
Published: November 2022

Dropped head syndrome (DHS) is an impairment of neck extension resulting in a chin-on-chest deformity. DHS is rarely seen but a major hindrance to daily function in affected patients. DHS has been associated with movement disorders, neuromuscular disorders, and electrolyte and endocrine abnormalities. DHS has also been seen in survivors of Hodgkin lymphoma (HL) years after irradiation. HL survivors are also at risk for endocrine hypogonadism after chemotherapy. We present the case of a 58-year-old male HL survivor with dropped head and limited strength in his atrophic neck extensor muscles. Laboratory testing and imaging, nerve conduction studies, electromyography, and muscle biopsy of the neck extensors revealed myopathic and neurogenic changes. Conservative management was unsuccessful. With a desire to avoid surgical fixation, he asked his primary care physician to check his testosterone levels, which returned as low normal. Within 4 months of starting testosterone therapy, he no longer experienced dropped head.
Myalgic Becker Muscular Dystrophy Due to an Exon 15 Point Mutation: Case Series and Literature Review
Authors: Tavallaee Zachary , Hamby Tyler , Marks Warren
Published: November 2022

Dystrophinopathies result from mutations to the DMD gene. We report 5 boys in 3 families with heterogenous phenotypes due to a point mutation in the DMD gene: a hemizygous tyrosine-to-cysteine change in exon 15 (c.1724T>C) resulting in an amino acid substitution of leucine to proline at codon 575. This mutation has been reported before, with at least 3 prior patients presenting with similar clinical findings of myalgia, myoglobinuria, and occasional muscle cramping. The mutation on DMD c.1724T>C (p.Leu575Pro) is listed in the Clinvar database as a variant of unknown significance. Our report provides contributing evidence that this alteration should be classified as pathogenic.
What Is in the Literature
Authors: Bromberg Mark B.
Published: November 2022

What is in the Literature focuses on chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), a neuropathy with challenges in diagnosis and treatment. A recent revision of diagnostic criteria (EFN/PNS criteria) has helped define clinical features of typical and atypical variants and what is not considered CIDP. Initiating pathologic factors is not known for typical CIDP or variants. New treatment approaches are based on immunologic mechanisms. Rare patients with a CIDP-like clinical pattern are found to have antibodies to proteins at and around the node of Ranvier and are not considered to be CIDP but a nodal-paranodopathy. Although occurring mainly in adults, CIDP also occurs in children. CIDP may have clinical and electrodiagnostic features that overlap with hereditary neuropathies, and the latter might show some response to treatment. Articles published in the past year that address these issues are discussed in this review.
Splanchnic Nerve Block: An Emerging Treatment for Heart Failure
Authors: Tung Brian , Frishman William H.
Published: November 2022

Heart failure (HF) is a disease syndrome whose management is increasingly challenging given the aging population and efficacious management of acute cardiac events. The current treatment options within our armamentarium incompletely address the unmet needs of HF. Splanchnic nerve block (SNB) is a novel technique that targets the greater splanchnic nerve, a potential therapeutic target in HF. However, the technique confers potential adverse side effects and complications that warrant further investigations. In this review paper, we aim to discuss the inextricable role of splanchnic nerve in HF by highlighting their physiological interplay, clinical studies that have exhibited favorable hemodynamic parameters in the context of acute and chronic HF, and common side effects and possible complications from SNB.
Efficacy and Safety of Clopidogrel Versus Ticagrelor for Stabilized Patients With Acute Coronary Syndromes After Percutaneous Coronary Intervention: Results From a Real-World Registry in China
Authors: Peng Wenxing , Zhang Yunnan , Li Xiaoxi , Lin Yang
Published: November 2022

Background:

The first 3 months after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) is a high-risk period for adverse events, including ischemic and bleeding events, which decrease greatly with time. It is worth investigating whether the use of potent P2Y12 inhibitors is necessary after the early stage. The purpose of this study was to investigate the differences in clinical outcomes between clopidogrel and ticagrelor in stable patients without ischemic or major bleeding events during the first 3 months after PCI.

Methods:

Data for this study were obtained from the PHARM-ACS registry (NCT04184583). Patients who were free from ischemic and major bleeding events in the first 3 months after PCI were enrolled. Inverse probability of treatment weighting (IPTW) and Cox proportional hazards model were applied to compare the differences in clinical outcomes between the 2 groups. Major adverse cardiovascular and cerebrovascular events (MACCE) were considered the primary end point, and major bleeding was considered the secondary end point.

Results:

A total of 6662 patients were included in this study. Of these, 3465 were treated with clopidogrel plus aspirin (clopidogrel group) and 3197 with ticagrelor plus aspirin (ticagrelor group). There were no significant differences in MACCE after IPTW adjustment for baseline variables (IPTW-adjusted HR, 1.06; 95% CI, 0.90–1.25) or major bleeding events (IPTW-adjusted HR, 0.97; 95% CI, 0.67–1.41) between the 2 groups. However, the incidence of minor bleeding in the clopidogrel group was significantly lower than that in the ticagrelor group (IPTW-adjusted HR, 0.65; 95% CI, 0.59–0.71).

Conclusion:

In patients with ACS who were free from ischemic or major bleeding events during the first 3 months after PCI, the subsequent clopidogrel treatment might reduce minor bleeding events without increasing the risk of MACCE compared with ticagrelor. However, the results still need to be confirmed by large randomized controlled studies in the future.
Combination of Long-Acting Injectable Antipsychotics in the Treatment of Psychiatric Disorders—A Systematic Review of the Literature and Case Series
Authors: Youykheang Marina , Al Hallaq Zaki , Menelas Kenny , Biskin Robert S. , Dagenais-Beaulé Vincent
Published: November 2022

Background

The treatment of refractory schizophrenia is complex, and compliance with oral treatment, including clozapine, can be challenging at times. The purpose of this case series and literature review article is to evaluate the efficacy of the combined use of 2 different long-acting injectable antipsychotics (LAIAs) on the number of psychiatric hospitalizations and emergency department visits. There are currently few data to support this treatment option, despite the frequent use of combinations of oral antipsychotics.

Methods

We extracted the data from 8 different patients who received combination LAIAs from 1 hospital setting. We evaluated the frequency of hospitalization and emergency department visits before and after treatment with a mirror-image study design. A systematic review of existing literature was included to find all previously reported cases of combination LAIAs.

Results

The frequency of hospitalizations was greatly reduced after the initiation of combination LAIA treatment in the majority of the cases at study site, as well as in the literature review. The number of ED visits was not as clearly affected. In the literature review, combinations of 2 LAIAs with different mechanisms of action were often documented. Symptom scores were also reduced in most reviewed cases.

Conclusions

Combinations of LAIAs seem to be promising as a treatment option for refractory psychotic disorders. This combination could be a treatment option for patients with limited alternatives, such as clozapine resistant or not eligible. The higher risk of adverse effects and long-term risks are not well documented.
Network Analysis Examining Intrahospital Traffic of Patients With Traumatic Hip Fracture
Authors: Secor Elizabeth A. , Hamilton David , D'Huyvetter Cecile , Salottolo Kristin , Bar-Or David
Published: November 2022

Introduction:

Increased intrahospital traffic (IHT) is associated with adverse events and infections in hospitalized patients. Network science has been used to study patient flow in hospitals but not specifically for patients with traumatic injuries.

Methods:

This retrospective analysis included 103 patients with traumatic hip fractures admitted to a level I trauma center between April 2021 and September 2021. Associations with IHTs (moves within the hospital) were analyzed using R (4.1.2) as a weighted directed graph.

Results:

The median (interquartile range) number of moves was 8 (7–9). The network consisted of 16 distinct units and showed mild disassortativity (−0.35), similar to other IHT networks. The floor and intensive care unit (ICU) were central units in the flow of patients, with the highest degree and betweenness. Patients spent a median of 20–28 hours in the ICU, intermediate care unit, or floor. The number of moves per patient was mildly correlated with hospital length of stay (ρ = 0.26, p = .008). Intrahospital traffic volume was higher on weekdays and during daytime hours. Intrahospital traffic volume was highest in patients aged <65 years (p = .04), but there was no difference in IHT volume by dependent status, complications, or readmissions.

Conclusions:

Network science is a useful tool for trauma patients to plan IHT, flow, and staffing.
Accreditation in the Health Professions: Implications for Physician Assistant Education
Authors: Kayingo Gerald , Gordes Karen L. , Kulo Violet , Cawley James F.
Published: November 2022

The accreditation process of health professions educational (HPE) programs is an essential ingredient in preparing a qualified healthcare workforce. Accreditation ensures that minimum standards are met by educational programs and contributes to pedagogical integrity, consistency, and academic policies and practices, leading to the desired quality of graduate outcomes. In this study, we analyzed key characteristics, policies, and practices for accreditation in 5 health professions to highlight emerging trends and discern implications for the physician assistant (PA) profession. There is growing evidence of movement toward outcome-based accreditation versus process-oriented accreditation and collaborative engagements between programs and the accreditors. Agencies are providing online discussion platforms and direct mentorship and, at the height of the coronavirus pandemic, offered virtual site visits. At an institution level, we observed a trend towards structured faculty development on accreditation, implementation of technology infrastructure for data collection, visualization and analysis, and the use of consultants for outsourcing certain elements of the accreditation process. There is a wide spectrum of approaches, from prescriptive to liberal, by the various accrediting agencies in enforcing compliance. A balance is desirable for the institutional–accreditor relationship to work effectively.
Multi-Institutional Physician Assistant Student Perception of Simulated Emergency Room Cases
Authors: Bell Ashley , Salcido Erin , Reichhart Nicole , Moverley Joy
Published: November 2022

Introduction

During clinical experiences, physician assistant (PA) students are required to participate in the management of multiple patients simultaneously. One method of preparing students for clinical experiences is through the use of simulation. Simulation allows development of decision-making and teamwork skills.
1,2
A previous study of nursing students in a multiple-patient simulation demonstrated improved student readiness to care for multiple patients.
2
The present study evaluated the effect of using simulation on PA student comfort with managing multiple patients in an emergency room setting.

Methods

Four PA programs participated in this quasi-experimental pretest-posttest design. Four simulation days were held, each with 4 standardized cases. Half of the students acted as standardized patients, while the remainder of the students managed patients in small groups. Surveys were administered before and after the emergency medicine course. Descriptive statistics and statistical analysis for significance were performed using Excel and SPSS.

Results

Posttest results indicated significant improvement in student confidence in emergency scenarios, ability to perform a focused medical history, ability to choose and interpret laboratory values, time management, prioritizing patients in a simulated environment, and selecting appropriate treatment. Students reported satisfaction with the experience, feedback, and debriefing. Participation in these simulations increased student interest in pursuing a position in emergency medicine upon graduation.

Discussion

In clinical rotations, PA students are expected to manage multiple patients with a variety of conditions. In this study, students were initially uncomfortable managing multiple patients. Student comfort increased after a simulation experience. Increased opportunities for students to select appropriate diagnostics and treatment may increase their overall comfort in management of patients during rotations.
Methodology Applied by a Physician Assistant Program to Evaluate the New ARC-PA 5th Edition Diversity and Inclusion Standard
Authors: Rolfs Jenna , Nicholas Joyce , Archambault Mark E. , Schmidt Eric
Published: November 2022

Diversity and inclusion in higher education are a top priority for institutions. In 2020, the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), in its 5th edition of the Accreditation Standards for Physician Assistant Education, implemented a standard specifically designed to require programs to demonstrate their commitment to diversity and inclusion. Through a protocol-driven methodology, consistent with the ARC-PA’s 4 key elements of analysis, one PA program demonstrates and explains how it examines ongoing compliance with diversity and inclusion within their program.
Factors Influencing Physician Assistant Student Attrition Rates
Authors: Kilstrom Jonathan , Neary Stephanie , Roman Chris , Garrubba Carl , LeLacheur Susan , Van Rhee James
Published: November 2022

Introduction

The aim of this study was to assess factors that influence student well-being and attrition and to compare faculty perceptions to the realities of student experience.

Methods

Three anonymous online surveys were distributed, one for each group of currently enrolled students, faculty/staff, and attritted students.

Results

Faculty estimated that an average of 12.8% of PA students in their program have considered dropping out in the past 6 months, while 22.9% of students self-reported considering dropping out in the past 6 months. The most frequently cited factors for considering dropping out were mental health and lack of connection to the program. Mental health was the highest cited reason for having taken or having considered taking a leave of absence.

Discussion

Faculty perceptions in this study were incongruent with the actual situations of their students. Mental health issues and a lack of connection to programs were the largest influencers of attrition.
Physician Assistant Program Perseveres Through COVID-19 Pandemic
Authors: Saunders Abby , McWeeney Michelle , Fernandez Christine
Published: November 2022

The COVID-19 pandemic has disrupted almost every aspect of life globally, with higher education one of many direct targets. Institutions and educators have been faced with urgent crises of how to conduct business as usual while maintaining expectations of high standards and uncompromised goals. As physician assistant (PA) educators at Seton Hall University, we rallied and brainstormed approaches to daily instruction to keep students on track and faculty both effective and sane. We tapped technological resources offered by our university, learned countless new skills, and adapted classroom activities to online virtual platforms. Creativity and flexibility became the norm as we modified the way we did everything while remaining laser focused on the ultimate objectives. Our intention was to provide insight, motivation, and, at a minimum, an example of how to do things differently when faced with roadblocks. We were inspired by an editorial by Mary Jo Bondy, DHEd, MHS, PA-C, former CEO of the Physician Assistant Education Association, in which she called for collective innovation, collaboration, publication, and circulation of stories. With that charge, we assembled a detailed account of how a didactic team within our faculty maneuvered the challenges created by COVID-19, in hopes of adding to the arsenal of small triumphs in this uncharted territory.
How Does Workplace Violence–Reporting Culture Affect Workplace Violence, Nurse Burnout, and Patient Safety?
Authors: Kim Sinhye , Lynn Mary R. , Baernholdt Marianne , Kitzmiller Rebecca , Jones Cheryl B.
Published: November 2022

Background:

Workplace violence (WPV) against nurses has a negative impact on the nurses and the care they provide. Formal reporting of WPV is necessary to understand the nature of violent incidents, develop proactive coping strategies, and provide support for nurses affected by WPV.

Purpose:

This study explored the relationships among nurses' WPV experiences, burnout, patient safety, and the moderating effect of WPV-reporting culture on these relationships.

Methods:

This descriptive cross-sectional study used secondary data collected from 1781 nurses at a large academic medical center.

Results:

Workplace violence increased nurse burnout, which in turn negatively affected patient safety. A strong WPV-reporting culture increased the negative effect of WPV on burnout but mitigated the negative effect of burnout on patient safety.

Conclusions:

The findings indicate that nurses may perceive WPV-reporting behavior as a stressor. Violence-reporting systems and procedures need to be improved to reduce the burden of reporting.
Delegation of Work Within a Patient-Centered Medical Home
Authors: Wakefield Bonnie J. , Lampman Michelle A. , Paez Monica B. , Farag Amany , Ferguson Heidi , Stewart Greg L.
Published: November 2022

OBJECTIVE

The aim of this study was to analyze the perceptions of core team members implementing patient-centered medical home (PCMH) within the Veterans Health Administration regarding delegation of work.

BACKGROUND

Significant overlap exists in the performance of work tasks among PCMH team members (primary care providers, RNs, clinical associates, clerks), and scant literature exists on appropriate delegation within PCMH teams.

METHODS

This study conducted used a quantitative and qualitative analysis of 4254 respondents to a 2018 survey.

RESULTS

Primary care providers rely heavily on team members, and nurses report being relied upon at high levels. Lack of role clarity and a perceived need for a team leader were concerns voiced by participants.

CONCLUSIONS

Findings indicated a need for clear guidance on roles and responsibilities within the team. Patient-centered medical home team members need information about the scope of practice of each professional group to allow providers to function at the top of their scope of practice and ensure effective delegation.
A peridynamic approach to simulating fatigue crack propagation in composite materials
Authors: Ni Tao , Zaccariotto Mirco , Galvanetto Ugo
Published: November 2022

In this article, a numerical tool is proposed in the framework of bond-based peridynamics to simulate fatigue crack propagation in composite materials and structures. The cycle-dependent damage-cumulative model derived from Peerlings' law and applied to a bilinear constitutive law is used to evaluate the fatigue degradation of the bond stiffness. Several benchmark cases are studied to validate the proposed approach. Finally, static and fatigue crack propagations in composite systems with single or multi-inclusions are simulated to illustrate the capabilities and characteristics of the developed approach.

This article is part of the theme issue ‘Ageing and durability of composite materials’.
Characterizing and predicting the relationship between translaminar fracture toughness and pull-out length distributions under distinct temperatures
Authors: Yu B. , Katafiasz T. J. , Nguyen S. , Allegri G. , Finlayson J. , Greenhalgh E. S. , Pinho S. T. , Pimenta S.
Published: November 2022

The translaminar fracture toughness reflects the damage tolerance of a fibre-reinforced composite under longitudinal tension, which often governs the final failure of structures. One of the main energy-dissipation mechanisms that contributes to the translaminar toughness of composites is the fibre pull-out process. The present study aims to quantify and model the statistical distribution of fibre pull-out lengths formed on the translaminar fracture surface of composites, for the first time in the literature; this is done under different temperatures, so that the relationship between pull-out length distributions, micromechanical properties and the translaminar fracture toughness can be established. The fracture surfaces of cross-ply compact tension specimens tested under three different temperatures have been scanned through X-ray computed tomography to quantify the extent of fibre pull-out on the fracture surfaces; the distribution of pull-out lengths showed alarger average and larger variability with an increase in temperature, which also lead to an increase in translaminar fracture toughness. A similar trend has been captured by the proposed analytical model, which predicts the pull-out length distribution based on the analysis of quasi-fractal idealizations of the fracture surface, yielding an overall accuracy of more than 85%.

This article is part of the theme issue 'Ageing and durability of composite materials'.
Characterization and modelling of the hygro-viscoelastic behaviour of polymer-based composites used in marine environment
Authors: Dezulier Quentin , Clement Alexandre , Davies Peter , Jacquemin Frédéric , Arhant Mael , Flageul Benjamin
Published: November 2022

This paper presents results from a study of the long-term behaviour of carbon/epoxy composites. The interactions between ageing in water and constant mechanical loads are described, first experimentally then using a simple modelling approach. An identification procedure for the model is carried out and test/model comparisons are discussed. The results show that a four-parameter Burgers model can provide a good fit of the experimental data. The analysis of the results indicates the impact of water diffusion on the viscoelastic behaviour with larger strains for both creep and recovery phases. Those changes tend to appear at the early stage of the moisture diffusion process and stabilize quite quickly.

This article is part of the theme issue 'Ageing and durability of composite materials'.
The potential causal association of systemic lupus erythematosus with congestive heart failure in the East Asian population: A two-sample Mendelian randomization study
Authors: Song Euijun
Published: November 2022

Objective: Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that increases the risk of cardiovascular disease, but the causal relationship has remained unknown in the East Asian population. We aim to determine the causal relationship between SLE and congestive heart failure (CHF) in the East Asian population. Methods: We conducted a two-sample Mendelian randomization (MR) study to examine the potential causal association of SLE with CHF, using the East Asian genome-wide association study datasets for SLE (4,222 cases, 8,431 controls) and CHF (9,413 cases, 203,040 controls). Results: The MR analysis showed that genetic susceptibility to SLE was associated with the increased risk of CHF (odds ratio [OR] 1.032, 95% confidence interval [CI] 1.004-1.061, P=0.023). After excluding the human leukocyte antigen (HLA) regions, SLE was also associated with a higher risk of CHF (OR 1.034, 95% CI 1.007-1.062, P=0.015). The multiple MR sensitivity analyses confirmed that this potential causal association was unlikely to be biased by horizontal pleiotropy. Conclusions: The findings of this MR study suggest that SLE potentially increases the risk of CHF in the East Asian population. Genetic predisposition to SLE may play a significant role in developing CHF in the East Asian population.