bluuebunny/crossref_metadata_2025 huggingface dataset:
Ship’s Stores
Authors: Blower Brooke L.
Published: August 2023

Hitler’s war soars Manuel’s business to record heights, but it also throws the fate of his homeland of Spain into doubt. Yet as Axis victories multiply, rightwing Spaniards dare to dream not only that Franco’s regime will endure and a new order will triumph in Europe but also that the spirit of hispanidad will flourish in the Americas. As Axis operatives find ways to exploit Spanish “non-belligerency,” neutral ships brokered by Manuel prove useful vehicles for spies and smugglers on both sides of the Atlantic. Controversy swirls around the firm of Garcia & Diaz, soon attracting the attention of Allied intelligence agencies.
Easy Dish
Authors: Blower Brooke L.
Published: August 2023

Frank itches for a role to play in the emerging Pacific War as Japanese troops unleash their multi-pronged attack on Southeast Asia. The Mutual Broadcasting System needs correspondents and agrees to give Frank a trial on the air. Over shortwave radio, now a primary medium for spreading international news, Frank tries to make real to American listeners the transpacific connections and dependencies their nation risks losing—to bolster arguments for sending support to defend the region. Unaware of the Europe First policy settled on by high-ranking officials in Washington and London, Batavia’s Western residents subsist on rumors that such reinforcements are indeed coming. Frank’s early reporting absorbs this unwarranted hopefulness and passes it on to his audiences.
Gendered Hierarchies of Dependency, Feminism, and the Commodification of the Self
Authors: Kokot-Blamey Patrizia
Published: August 2023

Chapter 7 contains the discussion and conclusion, with the focus returning to making sense of dependency at work and women’s advancement under capitalism. It problematizes the matter of women’s time and presence at home and at work and the commodification of the self from a cross-national perspective. The chapter asks what is lost when we think of ourselves as human capital and participate in a creeping objectification of what constitutes one’s performance of work; letting go of the often messy but more dependable relationships that have traditionally governed organizational hierarchies – also with consistently gendered effects. And what, in turn, is the cost of working like a normative father might and what then does ‘Having it all’ mean in a context like his? The chapter concludes by examining how we might go about tackling the challenges ahead from a feminist perspective, resisting an upside-down future under capitalism.
A Conspicuous Public Health Care State
Authors: Grogan Colleen M.
Published: August 2023

This chapter describes the rise of the public health state from the mid-1800s to 1910. Scientific advancements with proven ability to curb deathly diseases largely explain state investments in public health during this early period. While American federalism explains why public health infrastructure developed in a completely decentralized fashion, patronage politics was a strong oppositional force and explains why the public health care state also developed in close collaboration with the voluntary sector. This foundational history is important for three reasons. First, the state-voluntary collaboration not only shaped public health but also the U.S. health care system. Second, the state’s close collaboration with the voluntary sector marked the beginning of labeling state investments as “private provision.” And third, this formative history provides insight as to why the mixture of public and private is so ubiquitous in the U.S. health care system as to be unseen.
The New Public Health Deal
Authors: Grogan Colleen M.
Published: August 2023

This chapter details debates surrounding the New Deal legislation to show that most leaders in and outside government were more interested in building up health care services and providing direct access to care than they were in developing health insurance. Twenty-five years of state investment in public health and the health care system before the 1935 Social Security legislation created a rational logic that a federated health service—what was called a “National Health Program”—was a better alternative to insurance. Three main factors explain why significant investments in a comprehensive federated health service remained hidden. First, intergovernmental administration and financing—a federated health service system—hides the true extent of government’s role; second, the reliance on private provision hides the role of government in helping that private system exist; third, this fragmented complexity creates opportunity to rhetorically conceal the role of government.
Solidifying the Grow-and-Hide Approach
Authors: Grogan Colleen M.
Published: August 2023

This chapter documents how even when the largest government health care reform to date —Medicare and Medicaid—was passed in 1965, the great extent to which all levels of government were already funding the U.S. health care system remained largely hidden to the American people. Hiding the true extent and role of government during the period of 1950–1965 is detailed in four main areas: (1) official reports of health expenditures, (2) descriptions of public health activities and jurisdiction, (3) paying for the poor and medically needy, and (4) hospital construction. By 1965, because government expenditures had already increased significantly under an extremely fragmented and unequal system, and political actors intentionally hid the government’s role, it was difficult to see the whole of government expenditures, even if one were specifically looking. In short, the Grow-and-Hide Regime was well established by 1965.
Introduction
Authors: Faxneld Per , Nilsson Johan
Published: August 2023

This introductory chapter provides an overview of the history of Satanism. As an open identity, Satanism only became possible in a time when Christianity’s hold on legal systems and social norms weakened. In that sense, Satanism is a direct product of secularization. As a religious practice or coherent system of thought, Satanism did not exist any earlier than around the year 1900, when pioneers like Stanislaw Przybyszewski and Ben Kadosh appeared. However, strands of Satanic thought can be found in a series of instances prior to this, and some of these early ideas remain influential today. The chapter also looks at the establishment of groups like the Church of Satan, the Process Church of the Final Judgement, the Temple of Set, and the Order of the Nine Angles. While never a numerically significant religion, Satanism’s controversial and confrontational character makes it an excellent case study for discussing broader methodological and theoretical issues.
Islam and Democracy in the 21st Century
Authors: Ahmad Parray Tauseef
Published: August 2023

This book attempts to analyse and examine, on theoretical grounds, the relationship between Islam and its socio-political concepts and institutions and the principles of (modern) democracy, in the views of (selected) prominent Muslim scholars of the last-two-and-half-centuries—of the Arab world and South Asia. A crucial question that has highly intensified since 1980s, gained momentum in the post-9/11 era, and again came to limelight with the inception of ‘Arab Spring’ is: Is Islam compatible with democracy? It seeks to address this very crucial question by highlighting key concepts and figures that have been essential in framing the contemporary debates surrounding Islam and democracy. It (i) attempts to tread through diverse theoretical Islamic texts like the Qur’an, Sunnah, and other more contemporary works by eminent scholars on Islam–democracy (in) compatibility; (ii) endeavours to create a discursive terrain for theorizing the notions of convergence vis-à-vis the notions of divergence inherent in the debates surrounding Islam and democracy; (iii) provides an assessment of some operational key concepts/institutions of democracy in Islam, including Shura (Mutual Consultation), Bay‘ah (Oath of Allegiance), and Mithaq al-Medina (the Constitution of Medina), etc.; (iv) provides an assessment of the views and visions of some selected modern Muslim scholars (on Islam–democracy compatibility, globally (proponents) (v) deliberates, very succinctly, on the objections of the ‘Opponents’ of Islam–democracy relation. It is a helpful source for the students and scholars of Islamic political thought, comparative politics, and Islamic studies and is equally fascinating for the readers interested in knowing the contemporary political dynamics of the Muslim world.
Democracy, Democratization, and the Muslim World
Authors: Ahmad Parray Tauseef
Published: August 2023

This chapter provides a brief conceptual description of ‘democracy’ as a political system (as it is understood and described by the political theorists) so that to delineate on the persisting and prevailing features of democracy. This is followed by contextualizing the necessary framework for finding out the similarities and differences between the two systems under consideration—namely Islam (Islamic political system) and democracy—and thus is followed by a discussion on ‘defining’ democracy in the Islamic context for which it is important to answer Whose Islam? and What Islam? That is, to deliberate on the varied interpretations of contemporary Islam and to highlight the ‘Reformist/Modernist interpretation of Islam’, which helps in understanding and contextualizing the ‘Process of Democratization and the Islamic Heritage’.
Populus euphratica plant cadmium tolerance PePCR3 improves cadmium tolerance
Authors: Qiao Kun , Shan Qinghua , Zhang Haizhen , Lv Fuling , Zhou Aimin
Published: August 2023

Contamination of soils with toxic heavy metals is a major environmental problem. Growing crop plants that can promote the efflux of heavy metals is an effective strategy in contaminated soils. The plant cadmium resistance (PCR) protein is involved in the translocation of heavy metals, specifically zinc and cadmium (Cd). In this study, yeast expressing Populus euphratica PCR3 (PePCR3) showed enhanced Cd tolerance and decreased Cd accumulation under Cd treatment. Real-time quantitative PCR analyses revealed up-regulation of PePCR3 in poplar seedlings under Cd stress. Localization analysis revealed that PePCR3 localizes at the plasma membrane. The plant growth and biomass were greater in PePCR3-overexpressing (OE) transgenic hybrid poplar lines than in wild type (WT). Physiological parameters analyses indicated that, compared with WT, PePCR3-OE transgenic lines were more tolerant to Cd. In addition, more Cd was excreted in the roots of the PePCR3-OE transgenic lines than in those of WT, but the remaining Cd in transgenic lines was more translocated into the stems and leaves. Eight genes encoding transporters showed increased transcript levels in PePCR3-OE transgenic lines under Cd treatment, implying that PePCR3 interacts with other transporters to translocate Cd. Thus, PePCR3 may be an important genetic resource for generating new lines that can enhance Cd translocation to phytoremediation in contaminated soils.
Association between SARS-CoV-2 and metagenomic content of samples from the Huanan Seafood Market
Authors: Bloom Jesse D
Published: August 2023

The role of the Huanan Seafood Market in the early severe acute respiratory syndrome virus 2 (SARS-CoV-2) outbreak remains unclear. Recently, the Chinese Centers for Disease Control (CDC) released data from deep sequencing of environmental samples collected from the market after it was closed on 1 January 2020. Prior to this release, Crits-Christoph et al. analyzed data from a subset of the samples. Both that study and the Chinese CDC study concurred that the samples contained genetic material from a variety of species, including some like raccoon dogs that are susceptible to SARS-CoV-2. However, neither study systematically analyzed the relationship between the amount of genetic material from SARS-CoV-2 and different animal species. Here I implement a fully reproducible computational pipeline that jointly analyzes the number of reads mapping to SARS-CoV-2 and the mitochondrial genomes of chordate species across the full set of samples. I validate the presence of genetic material from numerous species and calculate mammalian mitochondrial compositions similar to those reported by Crits-Christoph et al. However, the SARS-CoV-2 content of the environmental samples is generally very low: only 21 of 176 samples contain more than ten SARS-CoV-2 reads, despite most samples being sequenced to depths exceeding 108 total reads. None of the samples with double-digit numbers of SARS-CoV-2 reads have a substantial fraction of their mitochondrial material from any non-human susceptible species. Only one of the fourteen samples with at least a fifth of the chordate mitochondrial material from raccoon dogs contains any SARS-CoV-2 reads, and that sample only has 1 of ~200,000,000 reads mapping to SARS-CoV-2. Instead, SARS-CoV-2 reads are most correlated with reads mapping to various fish, such as catfish and largemouth bass. These results suggest that while metagenomic analysis of the environmental samples is useful for identifying animals or animal products sold at the market, co-mingling of animal and viral genetic material is unlikely to reliably indicate whether any animals were infected by SARS-CoV-2.
Labor Market and Macroeconomic Dynamics in Latin America amid COVID: The Role of Digital-Adoption Policies
Authors: Finkelstein Shapiro Alan , Nuguer Victoria , Novoa Gomez Santiago
Published: August 2023

This paper analyzes how a policy that lowers firm digital-adoption costs shapes the labor-market and economic recovery from COVID-19 in Latin America (LA) using a framework with firm entry and unemployment, where salaried firms can adopt digital technologies and the employment and firm structure embodies key features of LA economies. Using Mexico as a case study, the model replicates the response of the labor market and output at the onset of the COVID recession and in its aftermath, including the dynamics of labor-force participation and informal employment. A policy-induced permanent reduction in the cost of adopting digital technologies at the trough of the recession bolsters the recovery of GDP, total employment, and labor income, and leads to a larger expansion in the share of formal employment compared to a no-policy scenario. In the long run, the economy exhibits a reduction in total employment but higher levels of GDP and labor income, greater average firm productivity, a larger formal employment share, and a marginally lower unemployment rate. Finally, as a side effect, the policy exacerbates the differential between formal and informal labor income, both as the economy recovers from the COVID recession and in the long run.
Should Nursing Schools Boycott Traditional College Ranking Systems?
Authors: Beard Kenya , Dobkin Finn , Webster Katherine
Published: August 2023

New measures would focus on advancing health equity.
Original Research: ‘Do I See Myself?’ Exploring the Potential for Online Images to Attract a Diverse Nursing Workforce
Authors: Johnson Marissa , Nairon Emerson , Daniel Blake , Olson DaiWai M.
Published: August 2023

Background:

The current nursing shortage is expected to worsen in the coming years. While this shortage has in part been attributed to challenging working conditions, which were exacerbated during the COVID-19 pandemic, there are other factors. Although recruiting a more diverse health care workforce might help to reduce this shortage, little is known about how to do so effectively. This study explored how online images of health care workers vary by gender and skin tone and considered how those representations might impact recruitment.

Methods:

This was a prospective pragmatic study. Using a popular image search engine, we obtained and evaluated images (photographs, drawings, and cartoons) of people representing different genders and a range of skin tones. The search terms used were student, nurse, and physician. The search took place during a single day and stopped once 50 images for each term had been retrieved. Images were included if they depicted at least one human. Each image was evaluated independently by two raters regarding gender (male or female) and skin tone (using a version of the 10-point Monk Skin Tone Scale).

Results:

The final sample comprised 150 images that depicted 259 faces. Compared with the general population, nurses were overrepresented as being female (84.1%) and having lighter skin tones (85.2%). Physicians were overrepresented as being male (58.7%) and having lighter skin tones (63.5%). Compared with physicians or students, nurses were more likely to be represented as female and as having lighter skin tones.

Conclusions:

The findings show a significant lack of diversity in gender and skin tone regarding how nurses are depicted in online images found via a popular image search engine. This lack of diversity may discourage people in some population groups from entering the health care field and could further contribute to the nursing shortage.
Exploring the Human Experience in Health Care
Authors: Doucette Jeffrey N.
Published: August 2023

This is the first article in a new series from Press Ganey—a health care performance improvement organization—that will discuss the many facets of the human experience in health care. Using the latest national data, the series will explore the intersections of safety, reliability, experience, and service, and their impact on engagement, work culture, and nurse-sensitive outcomes. Each installment will be designed as a “deep dive” into the most recent thinking and evidence-based approaches to improvement of the patient experience with a particular focus on practical and implementable tactics in each of the above subject areas.
Promoting Diabetes Self-Management in a Psychiatric Hospital
Authors: Rancy Marie , Harris Kenneth , Bhavsar Jeet
Published: August 2023

Type 2 diabetes and psychiatric illnesses have a bidirectional association, influencing each other in direct but independent ways. People with psychiatric illnesses are more likely than the general population to develop type 2 diabetes, in part because antipsychotic medications affect the metabolic system, disrupting glucose metabolism, and also because they lack diabetes self-management education and self-care skills. This study assessed the effectiveness of diabetes self-management education and support (DSMES) in patients with mental illness and diabetes using the Diabetes Self-Management Questionnaire. Analysis of paired responses to the pre- and post-DSMES survey questions showed a statistically significant increase in diabetes self-management knowledge after participation in the education sessions. These results emphasized the importance of DSMES in strengthening patients' knowledge and skills, with additional support from their psychiatrist and medical team.
The Cluster Randomized Trial Study Design
Authors: Capili Bernadette , Anastasi Joyce K.
Published: August 2023

Editor's note: This is the 17th article in a series on clinical research by nurses. The series is designed to be used as a resource for nurses to understand the concepts and principles essential to research. Each column will present the concepts that underpin evidence-based practice—from research design to data interpretation. To see all the articles in the series, go to https://links.lww.com/AJN/A204.
No Benefits of Palliative Care on Patient-Reported Outcomes Among Those Pursuing Curative-Intent Surgery for GI Cancer
Authors: Rosenberg Karen
Published: August 2023

According to this study:
Probiotics for Very-Low-Birth-Weight Neonates Are Less Effective in Practice Than Clinical Trials Suggest
Authors: Rosenberg Karen
Published: August 2023

According to this study:

The use of probiotics in U.S. neonatal units is increasing slowly and is associated with a lower risk of necrotizing enterocolitis in very-low-birth-weight neonates but not with a lower risk of mortality or sepsis.
HFNC, CPAP, and BiPAP Are Better Than Conventional Oxygen Therapy for Noninvasive Respiratory Support in Young Children
Authors: Rosenberg Karen
Published: August 2023

According to this study:
The Nurse in the Waiting Room: In Grief and Abandoned
Authors: Kokoszka Lori
Published: August 2023

Finding no guidance or support at a vulnerable moment
Opioid-sparing Anesthesia Decreases In-hospital and 1-year Postoperative Opioid Consumption Compared With Traditional Anesthesia
Authors: Ahmad Amer H. , Carreon Leah Y. , Glassman Steven D. , Harpe-Bates Jennifer , Sampedro Benjamin C. , Brown Morgan E. , Daniels Christy L. , Schmidt Grant O. , Hines Bren , Gum Jeffrey L.
Published: August 2023

Study Design.

Propensity-matched cohort.

Objective.

The aim of this study was to determine if opioid-sparing anesthesia (OSA) reduces in-hospital and 1-year postoperative opioid consumption.

Summary of Background Data.

The recent opioid crisis highlights the need to reduce opioid exposure. We developed an OSA protocol for lumbar spinal fusion surgery to mitigate opioid exposure.

Materials and Methods.

Patients undergoing lumbar fusion for degenerative conditions over one to four levels were identified. Patients taking opioids preoperatively were excluded. OSA patients were propensity-matched to non-OSA patients based on age, sex, smoking status, body mass index, American Society of Anesthesiologists grade, and revision versus primary procedure. Standard demographic and surgical data, daily in-hospital opioid consumption, and opioid prescriptions 1 year after surgery were compared.

Results.

Of 296 OSA patients meeting inclusion criteria, 172 were propensity-matched to non-OSA patients. Demographics were similar between cohorts (OSA: 77 males, mean age=57.69 yr; non-OSA: 67 males, mean age=58.94 yr). OSA patients had lower blood loss (326 mL vs. 399 mL, P=0.014), surgical time (201 vs. 233 min, P<0.001) emergence to extubation time (9.1 vs. 14.2 min, P<0.001), and recovery room time (119 vs. 140 min, P=0.0.012) compared with non-OSA patients. Fewer OSA patients required nonhome discharge (18 vs. 41, P=0.001) compared with the non-OSA cohort, but no difference in length of stay (90.3 vs. 98.5 h, P=0.204). Daily opioid consumption was lower in the OSA versus the non-OSA cohort from postoperative day 2 (223 vs. 185 morphine milligram equivalents, P=0.017) and maintained each day with lower total consumption (293 vs. 225 morphine milligram equivalents, P=0.003) throughout postoperative day 4. The number of patients with active opioid prescriptions at 1, 3, 6, and 12 months postoperative was statistically fewer in the OSA compared with the non-OSA patients.

Conclusions.

OSA for lumbar spinal fusion surgery decreases in-hospital and 1-year postoperative opioid consumption. The minimal use of opioids may also lead to shorter emergence to extubation times, shorter recovery room stays, and fewer discharges to nonhome facilities.
The association between timing in pregnancy of drought and excess rainfall, infant sex, and birthweight: Evidence from Nepal
Authors: Diamond-Smith Nadia G. , Epstein Adrienne , Zlatnik Marya G. , Treleaven Emily
Published: August 2023

Background:

Past research on the impact of climatic events, such as drought, on birth outcomes has primarily been focused in Africa, with less research in South Asia, including Nepal. Existing evidence has generally found that drought impacts birthweight and infant sex, with differences by trimester. Additionally, less research has looked at the impact of excess rain on birth outcomes or focused on the impact of rainfall extremes in the preconception period. Using data from a large demographic surveillance system in Nepal, combined with a novel measure of drought/excess rainfall, we explore the impact of these on birthweight by time in pregnancy.

Methods:

Using survey data from the 2016 to 2019 Chitwan Valley Study in rural Nepal combined with data from Climate Hazards InfraRed Precipitation with Station, we explored the association between excess rainfall and drought and birthweight, looking at exposure in the preconception period, and by trimester of pregnancy. We also explore the impact of excess rainfall and drought on infant sex and delivery with a skilled birth attendant. We used multilevel regressions and explored for effect modification by maternal age.

Results:

Drought in the first trimester is associated with lower birthweight (β = −82.9 g; 95% confidence interval [CI] = 164.7, −1.2) and drought in the preconception period with a high likelihood of having a male (odds ratio [OR] = 1.41; 95% CI = 1.01, 2.01). Excess rainfall in the first trimester is associated with high birthweight (β = 111.6 g; 95% CI = 20.5, 202.7) and higher odds of having a male (OR = 1.48; 95% CI = 1.02, 2.16), and in the third trimester with higher odds of low birth weight (OR = 2.50; 95% CI = 1.40, 4.45).

Conclusions:

Increasing rainfall extremes will likely impact birth outcomes and could have implications for sex ratios at birth.
From a Chicken Model to a Patient: Microsurgical Repair of a Brachial Artery in Mozambique
Authors: Santos Pedro , Gonzalez Mauro , Davis Greta L. , Pusic Andrea L. , Rohde Christine H.
Published: August 2023

In sub-Saharan Africa, options for reconstruction of traumatic injuries are limited due to lack of access to microsurgery-trained surgeons. Recently, the Plastic Surgery Foundation-sponsored Surgeons in Humanitarian Alliance for Reconstruction, Research and Education group hosted a virtual microsurgery skills course for junior plastic surgeons in this region. In this report, we describe a case of complete brachial artery transection requiring microsurgical techniques and use of vein graft for repair at our provincial hospital in Mozambique. By highlighting this case, we aimed to describe a direct clinical application of the Surgeons in Humanitarian Alliance for Reconstruction, Research and Education virtual microsurgery skills course and to demonstrate the profound impact such courses can have on patient outcomes in low-and middle-income countries with limited or no access to microsurgery-trained surgeons. Further, through newly gained familiarity with standard microsurgery instruments used in reconstructive procedures, we were able to improvise and develop modified instruments to overcome lack of resources at our institution.
More Data Drives Strategy at a Rural Hospital
Authors: Fattig Martin
Published: August 2023

All leaders of healthcare organizations, individually and collectively, must make critically important decisions every day. But how are those decisions made? What factors must leaders take into account? And how has the way they make those decisions changed over the years?

In today's fast-moving world, healthcare leaders face increasing pressures to make far-reaching decisions not only accurately, but also more quickly than ever. Especially for a small critical access hospital, there is little room for error or delay. At Nemaha County Hospital, we have found that clinical and business decisions drawn from more reliable data are much better than those based on anecdotal information.
Targeted High-throughput Sequencing for Hematological Malignancies: A GBMHM Survey of Practice and Cost Evaluation in France
Authors: Darlington Meryl , Sujobert Pierre , Kosmider Olivier , Luque Paz Damien , Kaltenbach Sophie , Figeac Martin , Hayette Sandrine , Mezaour Nadia , Coquerelle Séverine , Alary Anne-Sophie , Bidet Audrey , Le Bris Yannick , Delabesse Eric , Davi Frédéric , Preudhomme Claude , Durand-Zaleski Isabelle , Macintyre Elizabeth ,   on behalf of the Groupe des Biologistes Moléculaires des Hémopathies Malignes (GBMHM)*
Published: August 2023

The objective of this study was to assess the clinical impact and financial costs of next-generation sequencing (NGS) in 5 categories of pediatric and adult hematological cancers. NGS prescriptions were prospectively collected from 26 laboratories, with varied technical and reporting practice (all or only significant targets). Impact was defined by the identification of (1) an actionable mutation, (2) a mutation with prognostic and/or theranostic value, and/or (3) a mutation allowing nosological refinement, reported by local investigators. A microcosting study was undertaken in 4 laboratories, identifying the types and volumes of resources required for each procedural step. Individual index prescriptions for 3961 patients were available for impact analysis on the management of myeloid disorders (two thirds) and, mainly mature B, lymphoid disorders (one third). NGS results were considered to impact the management for 73.4% of prescriptions: useful for evaluation of prognostic risk in 34.9% and necessary for treatment adaptation (actionable) in 19.6%, but having no immediate individual therapeutic impact in 18.9%. The average overall cost per sample was 191 € for the restricted mature lymphoid amplicon panel. Capture panel costs varied from 369 € to 513 €. Unit costs varied from 0.5 € to 5.7 € per kb sequenced, from 3.6 € to 11.3 € per target gene/hot-spot sequenced and from 4.3 € to 73.8 € per target gene/hot-spot reported. Comparable costs for the Amplicon panels were 5–8 € per kb and 10.5–14.7 € per target gene/hot-spot sequenced and reported, demonstrating comparable costs with greater informativity/flexibility for capture strategies. Sustainable funding of precision medicine requires a transparent discussion of its impact on care pathways and its financial aspects.
Efficacy of the Buried Temporary Suture Tarsorrhaphy: A Novel Technique
Authors: Ryu Christine , Chundury Rao V.
Published: August 2023

Purpose:

To describe a buried variation of the temporary suture tarsorrhaphy and determine its efficacy period.

Methods:

This retrospective case review includes 11 patients needing corneal protection. Six patients had lagophthalmos from facial nerve palsy, 4 had cicatricial ectropion, and 1 had neurotrophic keratopathy. A total of 14 buried temporary suture tarsorrhaphies (BTSTs) were placed. The duration of the BTST was the main outcome. The corneal status before and throughout the BTST was monitored. The eyelids were examined for any undesired changes from the BTST.

Results:

The mean duration of the BTST was 97.5 days, with a maximum of 273 days. Aside from one spontaneous dehiscence 5 days after placement, all BTSTs held until intentional removal. Five BTSTs were removed for a more definitive surgical procedure, 6 were removed after resolution of the initial indication, and 2 are still in place as the patient awaits surgery. All cases of keratopathy improved after BTST placement. There were no complications and no undesired eyelid changes.

Conclusions:

The BTST is a simple, fast, safe, and effective procedure that can be performed in the clinic or inpatient to immediately improve ocular surface coverage. As a minimally invasive procedure that can easily last several months, the BTST is an excellent option for patients who require more intense intervention than medical management alone. It can also securely bridge patients to a permanent solution such as lateral canthal resuspension.
Visual Outcomes Following Surgical Debulking in Exophytic Optic Nerve Sheath Meningiomas
Authors: Goodyear Kendall , Roelofs Kelsey A. , Chen Angela C. , Goldberg Robert A.
Published: August 2023

Purpose:

To report a case of a globular primary optic nerve sheath meningioma managed surgically with improvement in vision and review the literature for outcomes of purely intraorbital exophytic-globular primary optic nerve sheath meningiomas managed surgically.

Methods:

A literature review was conducted using Google Scholar and PubMed with the search terms “primary optic nerve sheath meningioma,” “surgery,” “exophytic,” and “globular.” Articles were included if they were available in English. Individual cases from the reviewed articles were included if the tumor was purely intraorbital with a globular or exophytic morphology, was managed with total or subtotal surgical excision, and visual outcomes were reported. Cases were excluded if the tumor extended intracanalicularly or intracranially, tumor morphology was unknown, or surgical management consisted of biopsy, optic nerve sheath decompression, or optic canal decompression rather than tumor debulking.

Results:

A total of 28 patients with intraorbital globular-exophytic primary optic nerve sheath meningiomas managed surgically have been reported in the literature. Vision improved in 29% (n = 8/28) and remained stable in 43% (n = 12/28) of patients. Furthermore, patients with good (Snellen notation ≥ 0.5) vision (n = 10) typically retained good vision postoperatively and at follow-up, with 1 patient experiencing a decline to poor (Snellen ≤0.1) vision at the last follow-up (92 months postoperatively). Similarly, patients with fair (Snellen notation >0.1 and <0.5) vision (n = 5) often improved to good vision (n = 3) or stayed at fair vision (n = 1), with 1 declining to poor vision at postoperative hospital discharge.

Conclusions:

Surgical management of exophytic or globular optic nerve meningiomas does not universally lead to vision loss and may be appropriate in select patients.
First Intraoperative Trochlea Reconstruction
Authors: van der Meeren Stijn W. , van Hulst-Ginjaar Saskia P. A. , Schalij-Delfos Nicoline E.
Published: August 2023

Traumatic detachment of the superior oblique muscle from the trochlea is very rare. The authors present a case of cyclovertical diplopia in downgaze due to traumatic trochlear damage where they performed surgery more than 40 years later. For the first time ever, they describe the reconstruction of the trochlea using a silicone tube, thereby regaining superior oblique muscle function.
Comprehensive approach for capsular bag fixation in subluxated crystalline lens: preserving the anterior/posterior anatomical segment barrier
Authors: Porat Rein Adi , Abulafia Adi , Assayag Elishai , Goldberg Mordechai , Zadok David
Published: August 2023

Purpose:

To report the intraoperative performance and postoperative outcomes of crystalline lens removal and in-the-bag intraocular lens (IOL) implantation with scleral-bag fixation by means of capsular tension segments (CTSs) and a capsular tension ring (CTR) in patients with a subluxated lens.

Setting:

Department of Ophthalmology, Shaare-Zedek Medical Center, Jerusalem, Israel.

Design:

Retrospective, consecutive case series.

Methods:

This study included patients with subluxated crystalline lens who underwent lensectomy or cataract extraction using an anterior chamber maintainer (ACM), a CTR, transscleral capsular-bag fixation by polytetrafluoroethylene suture with 2 CTSs, and in-the-bag IOL implantation. Outcome measures included intra- and postoperative complications, corrected distance visual acuity (CDVA), target and postoperative refraction, and IOL tilt.

Results:

17 eyes (9 patients) were included, with a mean follow-up of 22.06 ± 14.88 months. There was a significant improvement in mean logMAR CDVA (P < .001), with 15 eyes (88.24%) achieving a Snellen CDVA of 20/30 or better and all eyes achieving 20/40 or better. The mean refractive spherical-equivalent prediction error was 0.07 ± 1.10 diopters (D), with 10 (58.82%) and 15 (88.24%) of eyes within ±0.50 D and 1.00 D, respectively, from the intended refraction. The mean horizontal and vertical tilts were 1.9 ± 2.6 degrees and 2.6 ± 2.1 degrees, respectively. No complications were observed except for 1 case of an intraoperative posterior-capsular tear.

Conclusions:

A comprehensive surgical approach for scleral-bag fixation that combines the use of an ACM, CTR, polytetrafluoroethylene sutures, 2 CTSs with in-the-bag IOL implantation, offers an effective strategy for achieving favorable visual outcomes and a low incidence of complications in patients with subluxated crystalline lenses.
Overcoming the hurdles of steatotic grafts in liver transplantation: Insights into survival and prognostic factors
Authors: Akabane Miho , Imaoka Yuki , Esquivel Carlos O. , Melcher Marc L. , Kwong Allison , Sasaki Kazunari
Published: August 2023

With increasing metabolic dysfunction–associated steatotic liver disease, the use of steatotic grafts in liver transplantation (LT) and their impact on postoperative graft survival (GS) needs further exploration. Analyzing adult LT recipient data (2002–2022) from the United Network for Organ Sharing database, outcomes of LT using steatotic (≥30% macrosteatosis) and nonsteatotic donor livers, donors after circulatory death, and standard-risk older donors (age 45–50) were compared. GS predictors were evaluated using Kaplan-Meier and Cox regression analyses. Of the 35,345 LT donors, 8.9% (3,155) were fatty livers. The initial 30-day postoperative period revealed significant challenges with fatty livers, demonstrating inferior GS. However, the GS discrepancy between fatty and nonfatty livers subsided over time (p= 0.10 at 5 y). Long-term GS outcomes showed comparable or even superior results in fatty livers relative to nonsteatotic livers, conditional on surviving the initial 90 postoperative days (p= 0.90 at 1 y) or 1 year (p= 0.03 at 5 y). In the multivariable Cox regression analysis, the high body surface area (BSA) ratio (≥1.1) (HR 1.42,p= 0.02), calculated as donor BSA divided by recipient BSA, long cold ischemic time (≥6.5 h) (HR 1.72,p< 0.01), and recipient medical condition (intensive care unit hospitalization) (HR 2.53,p< 0.01) emerged as significant adverse prognostic factors. Young (<40 y) fatty donors showed a high BSA ratio, diabetes, and intensive care unit hospitalization as significant indicators of a worse prognosis (p< 0.01). Our study emphasizes the initial postoperative 30-day survival challenge in LT using fatty livers. However, with careful donor-recipient matching, for example, avoiding the use of steatotic donors with long cold ischemic time and high BSA ratios for recipients in the intensive care unit, it is possible to enhance immediate GS, and in a longer time, outcomes comparable to those using nonfatty livers, donors after circulatory death livers, or standard-risk older donors can be anticipated. These novel insights into decision-making criteria for steatotic liver use provide invaluable guidance for clinicians.
Revising and exploring the variations in methodologies for establishing the diagnostic reference levels for paediatric PET/CT imaging
Authors: Alhorani Qays , Alkhybari Essam , Rawashdeh Mohammad , Sabarudin Akmal , Latiff Rukiah A. , Al-Ibraheem Akram , Vinjamuri Sobhan , Mohamad Mazlyfarina
Published: August 2023

PET-computed tomography (PET/CT) is a hybrid imaging technique that combines anatomical and functional information; to investigate primary cancers, stage tumours, and track treatment response in paediatric oncology patients. However, there is debate in the literature about whether PET/CT could increase the risk of cancer in children, as the machine is utilizing two types of radiation, and paediatric patients have faster cell division and longer life expectancy. Therefore, it is essential to minimize radiation exposure by justifying and optimizing PET/CT examinations and ensure an acceptable image quality. Establishing diagnostic reference levels (DRLs) is a crucial quantitative indicator and effective tool to optimize paediatric imaging procedures. This review aimed to distinguish and acknowledge variations among published DRLs for paediatric patients in PET/CT procedures. A search of relevant articles was conducted using databases, that is, Embase, Scopus, Web of Science, and Medline, using the keywords: PET-computed tomography, computed tomography, PET, radiopharmaceutical, DRL, and their synonyms. Only English and full-text articles were included, with no limitations on the publication year. After the screening, four articles were selected, and the review reveals different DRL approaches for paediatric patients undergoing PET/CT, with primary variations observed in patient selection criteria, reporting of radiation dose values, and PET/CT equipment. The study suggests that future DRL methods for paediatric patients should prioritize data collection in accordance with international guidelines to better understand PET/CT dose discrepancies while also striving to optimize radiation doses without compromising the quality of PET/CT images.
Parental Adverse Childhood Experiences and Post-PICU Stress in Children and Parents*
Authors: Pryce Patrice , Gangopadhyay Maalobeeka , Edwards Jeffrey D.
Published: August 2023

OBJECTIVES:

Hospitalization in a PICU is a stressful experience for children and their parents, with many experiencing posttraumatic stress disorder (PTSD) after discharge. Risk factors may include preillness traumatic events, such as adverse childhood experiences (ACEs). We sought to assess the feasibility of screening ACEs in parents of children admitted to a PICU, their prevalence, and their association with post-PICU PTSD symptoms in them and their children.

DESIGN:

Single-center prospective observational study.

SETTING:

Urban academic children’s hospital from January to December 2021.

PATIENTS:

One hundred forty-five children (2–18 yr old, admitted ≥ 2 d) and their parents.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Data on parental demographics, ACEs, coping skills, and PICU environmental stressors, as well as patient clinical data, were collected. One month after PICU discharge, parents completed inventories assessing PTSD symptoms in them and their children. Bivariate and logistic regression analyses were used to explore associations of ACEs with post-PICU PTSD. Of 145 enrolled parents, 95% completed the ACE questionnaire, 58% of whom reported greater than or equal to 1 ACE, and 14% had substantial (≥ 4) ACEs. Parent and patient follow-up was 79% and 70%, respectively. Sixteen percent of parents had provisional PTSD. Regression analysis showed parents with greater than or equal to 4 ACEs had 10 times greater odds of parental PTSD, compared to parents with less than 4 ACEs, (adjusted odds ratio [aOR] = 10.2; 95% CI, 1.03–100.9; p = 0.047). Fifty-six percent of patients screened at risk for PTSD. There was no association between substantial parental ACEs and patients’ risk for PTSD (aOR = 3.5 [95% CI, 0.56–21.31]; p = 0.18).

CONCLUSIONS:

ACEs were common among parents of critically ill children. Having substantial parental ACEs was associated with provisional parental PTSD after their child’s PICU admission, but not with PTSD in the children. Family-centered care that seeks to mitigate post-PICU stress should be mindful of the potential relevance of parental ACEs.
Applying Topical Anesthetic on Pediatric Lacerations in the Emergency Department
Authors: Faris Nagham , Mesto Mohamad , Mrad Sandra , El Kebbi Ola , Asi Noor , Sawaya Rasha D.
Published: August 2023

Objectives

Caring for pediatric lacerations in the emergency department (ED) is typically painful because of irrigation and suturing. To improve this painful experience, we aimed to increase the use of a topical anesthetic, Eutectic Mixture of Local Anesthetics (EMLA) on eligible pediatric lacerations with an attainable, sustainable, and measurable goal of 60%. The baseline rate of applying topical anesthetic to eligible lacerations was 23% in our ED. We aimed to increase the use of topical anesthetics on eligible pediatric lacerations to a measurable goal of 60% within 3 months of implementing our intervention.

Methods

We conducted a prospective, single-center, interrupted time series, ED quality improvement project from November 2019 to July 2020. A multidisciplinary team of physicians and nurses performed a cause-and-effect analysis identifying 2 key drivers: early placement of EMLA and physician buy-in on which we built our Plan, Do, Study, and Act (PDSA) cycles. We collected data on number of eligible patients receiving EMLA, as well as patient and physician feedback via phone calls within 2 days after encounter. Balancing measures included ED length of stay (LOS), patient and physician satisfaction with EMLA, and adverse effects of EMLA.

Results

We needed 3 PDSA cycles to reach our goal of 60% in 3 months, which was also maintained for 5 months. The PDSA cycles used educational interventions, direct provider feedback about noncompliance, and patient satisfaction results obtained via phone calls. Balancing measures were minimally impacted: 75% good patient satisfaction, no adverse events but an increase in LOS of patients who received EMLA compared with those who did not (1.79 ± 0.66 vs 1.41 ± 0.83 hours, P < 0.001). The main reasons for dissatisfaction for physicians were the increased LOS and the preference for procedural sedation or intranasal medications.

Conclusions

With a few simple interventions, our aim of applying EMLA to 60% of eligible pediatric lacerations was attained and maintained.
Patient Safety Culture Analysis in Dental Hospital Using Dental Office Survey on Patient Safety Culture Questionnaire: A Cross-cultural Adaptation and Validation Study
Authors: Arbianti Kusuma , Amalia Rosa , Hendrartini Julita , Kuntjoro Tjahjono
Published: August 2023

Background

The culture of safety and patient safety management in dental practice lags compared with medical practice. Hospitals strive to pursue quality and safety of healthcare services, with evidence of patient safety incidents in medical practice demonstrating the importance of promoting a safety culture. Measuring patient safety culture is a necessary first step to improving safety culture in clinical settings. As a hospital, dental hospital should improve the quality and culture of patient safety. Thus, our objective was to conduct a cross-cultural adaptation of a US measure of dental office patient safety culture for use in Indonesian dental hospitals.

Method

A cross-sectional study was conducted on 200 respondents at a dental hospital in Java, Indonesia. The first stage includes cultural adaptation and translation, followed by developing a questionnaire that was tested through expert agreement and analysis of validity and reliability using Spearman, Cronbach correlation coefficients, and correlation coefficients between classes. The Dental Office Survey on Patient Safety Culture consists of 58 items and 10 dimensions (overall perceptions of patient safety and quality, organizational learning, teamwork, staff training, work pressure and pace, management support for patient safety, office processes and standardization, communication about errors, communication openness, and patient care tracking/follow-up).

Results

A total of 200 respondents with a response rate of 61.5% and 77 invalid responses due to incomplete filling, so 123 respondents were analyzed. The validity test results on 38 question items from 10 dimensions, with a sign of 0.05%, 35 items are declared valid.

Conclusions

The Indonesian version of the Dental Office Survey on Patient Safety Culture shows good validity and good reliability and has the potential to be used to evaluate patient safety culture in dental hospitals in Indonesia.