bluuebunny/crossref_metadata_2025 huggingface dataset:
Memorization
Authors: Ginsborg Jane
Published: January 2022

Abstract: The chapter begins by explaining how memory is currently understood, with illustrations relevant to musicians. Next, it focuses on the spontaneous and deliberate processes underlying expert musicians’ memorization and recall for music and shows how musicians develop mental representations on which they draw when performing from memory. It goes on to provide a brief history of the pedagogy of music memorization, summarizes performers’ and teachers’ advice dating from more than 100 years ago, and discusses more recent empirical research on memorization by musicians and psychologists. It then addresses the practical implications of the theories of memory that were introduced at the beginning of the chapter, musicians’ own accounts of their memorizing strategies, and relevant research evidence. In conclusion, it makes recommendations for memorizing and recalling music from memory, reminds readers that performing from memory is a convention not a rule, and offers some reassurance in relation to memory lapses.
Emotion and Performance Practices
Authors: Rocke Stephanie , Davidson Jane W. , Kiernan Frederic
Published: January 2022

This chapter discusses various aspects of emotion relevant to performers. While the primary focus is upon the music-emotion relationship, performers are also encouraged to think about emotion from societal, communal, and individual perspectives as a way of generating meaningful relationships and encounters with those who shape their musical world. The second half of the chapter is particularly relevant to Western art music performers engaging with music of the past. Providing a theoretical context for understanding emotions as historically contingent, it raises issues about how emotion—both felt and portrayed—might be generated as a form of historically informed performance practice. Adopting a history of emotions perspective, many of the ways in which emotions were conceived and practiced across the history of Western art music are laid out. The chapter concludes with practical implications, including a rubric for incorporating historical understandings of emotion into performances as an innovative approach to developing a historically informed performance practice.
Musical Creativity in Performance
Authors: van der Schyff Dylan , Schiavio Andrea
Published: January 2022

Creativity research has generated an impressive body of literature that spans a range of disciplines. Despite this diversity, however, creativity studies have traditionally tended to focus on the evaluation of products generated by creative people, which are categorized in various ways according to their reception and impact on society. This orientation has been advanced in various ways by including factors such as process, personality, and cultural pressures. While these approaches have produced many important insights, it may be argued that the types of creativity involved in music performance involve additional aspects. Musical performance necessarily entails developing forms of bodily skill that play out in real-time interactive contexts that involve other people, musical instruments and technologies, acoustic spaces, and various socio-cultural factors. Accordingly, some scholars have recently posited relational, environmentally distributed, and cooperative models that better capture the complex nature of musical creativity in action. In this chapter, we review some key approaches to creative cognition, with a special focus on understanding creativity as it unfolds in the real-time dynamics of musical performance. In doing so, we introduce a number of concepts associated with recent work in cognitive science that may help to capture the adaptive interplay of body and environment in the co-enactment of musical events.
Readiness for Learning to Perform Music
Authors: Blackwell Jennifer , McPherson Gary E.
Published: January 2022

This chapter begins by discussing prominent learning theories that contextualize development and then drills down to individual components that are relevant to learning to perform music. Developmental factors, such as distinguishing giftedness from talent, predispositions to learn, sensitive and critical periods, and perceptual abilities are discussed. A section on physical maturation provides information on how to match students with instruments, including factors influencing these choices such as motor development, teeth alignment, sex differences, and gender biases. We strongly advise against using so-called standardized measures of musical aptitude to predict future success and detail some of the ways these types of measures are flawed. In the final section dealing with practical applications, we return to the broader definition of readiness as a “healthy state of mind” to provide a set of principles that can be used to guide the types of environments, approaches, and beliefs that we believe best cater for the individual needs of each child. One of the main points we stress is that there are no definitive rules for when a child is ready to learn an instrument or voice. Determining readiness is highly contextual and will vary from child to child.
The History of the Humanities and Human Flourishing
Authors: McMahon Darrin M.
Published: January 2022

The effort to encourage a eudaimonic turn in the humanities marks less a turn, than a return, to the emphasis on human flourishing that was once a central feature of the liberal arts and the humanities as they developed in the West. Though eclipsed for much of the twentieth century, this long-standing emphasis is currently being rediscovered and revived for the conditions of the twenty-first century. Just as psychologists and other social scientists have taken a positive turn in recent decades, humanists and practitioners of the liberal arts are now poised to reconnect their discipline to their foundational interest in human well-being.
Character and Virtues in the Arts and Humanities
Authors: Ruch Willibald , Gander Fabian
Published: January 2022

This chapter discusses the role of character in the arts and humanities. The authors introduce the most influential model of character, the Values in Action (VIA) classification of character strengths and virtues, review the relevance of the arts and humanities in the creation of this classification, and discuss earlier research and practice of character strengths in these disciplines. They review earlier studies and present new data on differences in character strengths between people working in an occupation related to the arts and the humanities (vs. other occupations), with a special focus on professional and amateur musicians. Finally, they examine whether the arts and humanities might also be associated with character strengths via role models. They conclude that in particular the character strength of appreciation of beauty and excellence might play a crucial role in the arts and humanities and discuss avenues for further research in this area.
The Flourishing Congregations Project: Character Strengths Pathways to Enhance Well-Being beyond the Individual
Authors: Hershberg Rachel M. , Niemiec Ryan M. , Kula Irwin
Published: January 2022

Researchers in philosophy and psychology have called for an integration of the science of positive psychology with the humanities, to catalyze new avenues of flourishing throughout society. Religion, as a field within the humanities, may be well poised to be integrated with positive psychology, namely character strengths, to promote flourishing. On the other hand, religious institutions have entrenched and sacrosanct perspectives and traditions, which may preclude them from using the science to become houses of human flourishing. To explore this potential integration, the Flourishing Congregations Project was developed. The project included ten distinguished rabbis who were immersed in the science of character strengths and well-being, and were tasked with developing insights and practices to modify their High Holidays services to meaningfully impact their congregants. The chapter presents qualitative findings of this project, including examples of receptivity and barriers to change among rabbis and congregants, and broader implications across congregations and communities.
Inequality and the Development of Moral Emotions
Authors: Hitlin Steven , Harkness Sarah K.
Published: January 2022

This chapter outlines the authors’ thesis that the level of economic inequality in a society is reflected in its members’ moral emotional experiences. Those living in societies with more equality regularly experience more positive, binding emotions. Conversely, those living in unequal societies are significantly more likely to experience negative, sanctioning moral emotions. Growing up and living under these various social structures affects emotional development in these directions. This chapter explores the links between societal structure and individual emotion, contending that individual moral emotions represent the distal structures of society. The authors outline a broad theory linking individual emotional development to cultural patterns and structural economic inequality, supporting a thesis that sanctioning is generated by and reinforces a pronounced social hierarchy. Their focus is not only on people’s location within social structure, but on the nature of that structure itself.
Differentiation and Language Acquisition in Children’s Understanding of Emotion
Authors: Widen Sherri C. , Nelson Nicole L.
Published: January 2022

This chapter provides evidence of two processes that contribute to the acquisition of emotion categories (represented by their labels). The first is a process in which children gradually differentiate an early, valence-based (i.e., feels good vs. feels bad) emotion understanding into more discrete categories, while also learning to link the various components of emotion (e.g., causes, consequences, behaviors, facial expressions, labels) until their taxonomy closely resembles the taxonomy of the adults with whom they interact. For example, children gradually learn that some bad feelings are caused by a loss, result in tears, and are called sad, whereas others are caused by danger, result in the desire to flee, and are called scared. The second process supports the first. It is a process of elimination which enables children to quickly map novel emotion components to novel emotion categories and to begin to acquire a new emotion category.
Developmental Changes in Emotion Understanding During Middle Childhood
Authors: Kramer Hannah J. , Lagattuta Kristin Hansen
Published: January 2022

In contrast to extensive research on the emergence of emotion understanding during early childhood, less work has focused on improvement and expansion in how children reason about emotions during middle childhood. In this chapter, the authors examine gains between 5 and 12 years of age in children’s awareness that emotions can arise from the interplay of multiple contextual and cognitive sources that cross time and situation. They also consider potential mechanisms of conceptual change. What becomes abundantly clear is that emotion understanding is not “achieved” by 3 to 5 years of age: There continues to be substantial development through middle childhood into adulthood, with even adults exhibiting shortfalls in emotion cognition. The authors hope to inspire further empirical inquiries into the protracted developmental timetable for understanding the complexity of human emotion.
Historicizing Emotional Development
Authors: Vallgårda Karen , Olsen Stephanie
Published: January 2022

This chapter argues that emotions are biocultural and historically contingent phenomena. Our emotional experience is inextricably linked to the words we use to describe our emotions, to the values we attach to them, and to the embodied cultural codes of comportment and expression. The chapter challenges the idea that we can meaningfully speak of “emotional development” in historical contexts in which “emotions” were not yet invented, and introduces the concept of “formation” as a historically sensitive alternative. This concept helps us grasp the historicity of growth and change in collectives, as well as in individuals’ affective lives. Emotional formation is the process through which codes of emotions are learned and imparted, often unwittingly, through discourse and practice. In order to demonstrate the methodological utility of the concept, the chapter then exemplifies processes of emotional formation in children and youth in two different historical and geographical contexts.
Children’s Emotion Understanding and Cooperative Problem-Solving in Educational Settings
Authors: Viana Karine M. P. , Lucena Juliana , Zambrana Imac Maria , Harris Paul L. , Pons Francisco
Published: January 2022

Recent research has shown that emotion understanding (EU)—the capacity to understand the nature, causes, and consequences of emotions—plays a crucial role in the development of emotional, social, and cognitive competences. However, there are still many unanswered questions about the extent to which EU facilitates children’s cooperative problem-solving in educational settings. For instance, it is not yet clear how understanding emotions positively impacts children’s interaction both when they play freely with peers and when they are engaged in problem-solving tasks. In addition, there is no conclusive answer about whether the impact of EU on cooperative problem-solving varies depending on children’s age. This chapter aims to address this shortfall. Building on empirical findings, the usefulness of EU for children engaged in different types of cooperation (dyadic, triadic, free play), and at different ages (from toddlerhood to middle childhood) is discussed.
I Feel, You Feel, We Feel
Authors: Petkova Aleksandra V. , Brownell Celia A.
Published: January 2022

Prosocial behavior emerges in the second year of life. This chapter reviews recent empirical evidence showing that both negative and positive emotion relate to emerging prosocial behavior and that their associations with prosocial behavior differ, suggesting that negative and positive emotion serve different functions. Moderators (recipient emotion, type of prosocial behavior, age) of associations between the young child’s emotional and prosocial responses are discussed. Data appear stronger for effects of negative emotion on prosocial behavior; however, children’s empathic concern in response to another’s emotion is inconsistently influenced by the recipient’s emotion and type of prosocial behavior (e.g., helping vs. comforting). Recent studies suggest that young children exhibit positive emotion following prosocial behavior; however, these findings are limited by recipient characteristics (e.g., puppets), task demands (e.g., adult requests), lack of age comparisons, and lack of controls for temperamental emotionality. Challenges of conceptualization and measurement of emotion are highlighted and directions for future research are suggested.
The Development of Cognitive Reappraisal for Regulating Emotions
Authors: De France Kalee , Hollenstein Tom
Published: January 2022

Cognitive reappraisal—or altering the emotional impact of a situation by changing the way an individual thinks about it—is strongly associated with many indicators of well-being, such as increased physiological health, optimism, life satisfaction, and more active attempts to repair negative mood, as well as decreased experience and expression of negative affect. Moreover, the ability to change emotion-related cognitions, achieved via reappraisal, is one of the main determinants of improvement across most psychopathologies. Despite the depth of knowledge reflecting the benefits of reappraisal, there remains a lack of both theory and evidence to explain how this complex emotion-regulation strategy develops. The objective of this chapter is to outline the developmental trajectory of reappraisal by identifying the social and cognitive components necessary for the successful development and use of reappraisal, as well as the maturation of these components from infancy through adolescence.
Menopause
Authors: Ellington Kelly , Link Tamara , Saccomano Scott J.
Published: January 2022

Menopause signifies permanent cessation of ovarian function and the end of a woman's reproductive potential. Menopausal transition plays a major role in many symptoms common in middle age and may contribute to chronic conditions and disorders of aging. An evidence-based plan of care improves outcomes, enhancing quality of life.
Evolving the Systems-Based Practice Competency in Graduate Medical Education to Meet Patient Needs in the 21st-Century Health Care System
Authors: Gonzalo Jed D. , Wolpaw Daniel R. , Cooney Robert , Mazotti Lindsay , Reilly James B. , Wolpaw Terry
Published: January 2022

Medical education is increasingly recognizing the importance of the systems-based practice (SBP) competency in the emerging 21st-century U.S. health care landscape. In the wake of data documenting insufficiencies in care delivery, notably in patient safety and health care disparities, the Accreditation Council for Graduate Medical Education created the SBP competency to address gaps in health outcomes and facilitate the education of trainees to better meet the needs of patients. Despite the introduction of SBP over 20 years ago, efforts to realize its potential have been incomplete and fragmented. Several challenges exist, including difficulty in operationalizing and evaluating SBP in current clinical learning environments. This inconsistent evolution of SBP has compromised the professional development of physicians who are increasingly expected to advance systems of care and actively contribute to improving patient outcomes, patient and care team experience, and costs of care. The authors prioritize 5 areas of focus necessary to further evolve SBP: comprehensive systems-based learning content, a professional development continuum, teaching and assessment methods, clinical learning environments in which SBP is learned and practiced, and professional identity as systems citizens. Accelerating the evolution of SBP in these 5 focus areas will require health system leaders and educators to embrace complexity with a systems thinking mindset, use coproduction between sponsoring health systems and education programs, create new roles to drive alignment of system and educational goals, and use design thinking to propel improvement efforts. The evolution of SBP is essential to cultivate the next generation of collaboratively effective, systems-minded professionals and improve patient outcomes.
Epidural Analgesia and Recurrence after Colorectal Cancer Surgery: A Danish Retrospective Registry-based Cohort Study
Authors: Hasselager Rune P. , Hallas Jesper , Gögenur Ismail
Published: January 2022

Background

Surgery is the main curative treatment for colorectal cancer. Yet the immunologic and humoral response to surgery may facilitate progression of micro-metastases. It has been suggested that epidural analgesia preserves immune competency and prevents metastasis formation. Hence, the authors tested the hypothesis that epidural analgesia would result in less cancer recurrence after colorectal cancer surgery.

Methods

The Danish Colorectal Cancer Group Database and the Danish Anesthesia Database were used to identify patients operated for colorectal cancer between 2004 and 2018 with no residual tumor tissue left after surgery. The exposure group was defined by preoperative insertion of an epidural catheter for analgesia. The primary outcome was colorectal cancer recurrence, and the secondary outcome was mortality. Recurrences were identified using a validated algorithm based on data from Danish health registries. Follow-up was until death or September 7, 2018. The authors used propensity score matching to adjust for potential preoperative confounders.

Results

In the study population of 11,618 individuals, 3,496 (30.1%) had an epidural catheter inserted before surgery. The epidural analgesia group had higher proportions of total IV anesthesia, laparotomies, and rectal tumors, and epidural analgesia was most frequently used between 2009 and 2012. The propensity score–matched study cohort consisted of 2,980 individuals in each group with balanced baseline covariates. Median follow-up was 58 months (interquartile range, 29 to 86). Recurrence occurred in 567 (19.0%) individuals in the epidural analgesia group and 610 (20.5%) in the group without epidural analgesia. The authors found no association between epidural analgesia and recurrence (hazard ratio, 0.91; 95% CI, 0.82 to 1.02) or mortality (hazard ratio, 1.01; 95% CI, 0.92 to 1.10).

Conclusions

In colorectal cancer surgery, epidural analgesia was not statistically significantly associated with less cancer recurrence.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
A Minimally Invasive and Highly Effective Extracorporeal CO2 Removal Device Combined With a Continuous Renal Replacement Therapy
Authors: Zanella Alberto , Pesenti Antonio , Busana Mattia , De Falco Stefano , Di Girolamo Luca , Scotti Eleonora , Protti Ilaria , Colombo Sebastiano Maria , Scaravilli Vittorio , Biancolilli Osvaldo , Carlin Andrea , Gori Francesca , Battistin Michele , Dondossola Daniele , Pirrone Federica , Salerno Domenico , Gatti Stefano , Grasselli Giacomo
Published: January 2022

OBJECTIVES:

Extracorporeal carbon dioxide removal is used to treat patients suffering from acute respiratory failure. However, the procedure is hampered by the high blood flow required to achieve a significant CO2 clearance. We aimed to develop an ultralow blood flow device to effectively remove CO2 combined with continuous renal replacement therapy (CRRT).

DESIGN:

Preclinical, proof-of-concept study.

SETTING:

An extracorporeal circuit where 200 mL/min of blood flowed through a hemofilter connected to a closed-loop dialysate circuit. An ion-exchange resin acidified the dialysate upstream, a membrane lung to increase Pco
2 and promote CO2 removal.

PATIENTS:

Six, 38.7 ± 2.0-kg female pigs.

INTERVENTIONS:

Different levels of acidification were tested (from 0 to 5 mEq/min). Two l/hr of postdilution CRRT were performed continuously. The respiratory rate was modified at each step to maintain arterial Pco
2 at 50 mm Hg.

MEASUREMENTS AND MAIN RESULTS:

Increasing acidification enhanced CO2 removal efficiency of the membrane lung from 30 ± 5 (0 mEq/min) up to 145 ± 8 mL/min (5 mEq/min), with a 483% increase, representing the 73% ± 7% of the total body CO2 production. Minute ventilation decreased accordingly from 6.5 ± 0.7 to 1.7 ± 0.5 L/min. No major side effects occurred, except for transient tachycardia episodes. As expected from the alveolar gas equation, the natural lung Pao
2 dropped at increasing acidification steps, given the high dissociation between the oxygenation and CO2 removal capability of the device, thus Pao
2 decreased.

CONCLUSIONS:

This new extracorporeal ion-exchange resin-based multiple-organ support device proved extremely high efficiency in CO2 removal and continuous renal support in a preclinical setting. Further studies are required before clinical implementation.
Analysis of community deaths during the catastrophic 2021 heat dome
Authors: Henderson Sarah B. , McLean Kathleen E. , Lee Michael J. , Kosatsky Tom
Published: January 2022

Background:

British Columbia, Canada, was impacted by a record-setting heat dome in early summer 2021. Most households in greater Vancouver do not have air conditioning, and there was a 440% increase in community deaths during the event. Readily available data were analyzed to inform modifications to the public health response during subsequent events in summer 2021 and to guide further research.

Methods:

The 434 community deaths from 27 June through 02 July 2021 (heat dome deaths) were compared with all 1,367 community deaths that occurred in the same region from 19 June through 09 July of 2013–2020 (typical weather deaths). Conditional logistic regression was used to examine the effects of age, sex, neighborhood deprivation, and the surrounding environment. Data available from homes with and without air conditioning were also used to illustrate the indoor temperatures differences.

Results:

A combined index of material and social deprivation was most predictive of heat dome risk, with an adjusted odds ratio of 2.88 [1.85, 4.49] for the most deprived category. Heat dome deaths also had lower greenness within 100 m than typical weather deaths. Indoor temperatures in one illustrative home without air conditioning ranged between 30°C and 40°C.

Conclusions:

Risk of death during the heat dome was associated with deprivation, lower neighborhood greenness, older age, and sex. High indoor temperatures likely played an important role. Public health response should focus on highly deprived neighborhoods with low air conditioning prevalence during extreme heat events. Promotion of urban greenspace must continue as the climate changes.
Alopecia Areata Treated with Advanced Platelet-rich Fibrin Using Micronization
Authors: Vazquez Oscar Adrian , Safeek Rachel H. , Komberg Jacob , Becker Hilton
Published: January 2022

Platelet-rich plasma (PRP) has been shown to release a multitude of growth factors, but its preparation requires the use of anticoagulants. In contrast, advanced platelet-rich fibrin (aPRF) is produced by centrifuging whole blood and allowing it to clot. The clot contains the platelets, growth factors, and neutrophils, and it is composed of a fibrin matrix that continuously releases more growth factors over a longer time period. Advanced PRF is commonly used in dental and bone grafting procedures, but it is rarely used for cosmetic injectables because its high density makes it difficult to inject through smaller gauge needles. A technique is described whereby aPRF is reduced to an injectable form with micronization and used to treat alopecia areata (AA) in a 28-year-old patient who developed it after symptomatic COVID-19 infection a month before presentation. The patient was vaccinated in between infection, and symptoms were limited to headache and sore throat. He had complete resolution of his AA at 6-month follow-up with only two treatments as opposed to monthly intralesional steroids. We report our results using aPRF for AA with promising results as a possible future treatment for patients with this autoimmune disease.
Evidence Mapping of the Treatments for Breast Cancer–related Lymphedema
Authors: Al-Sakkaf Ali M. , Masia Jaume , Auladell-Rispau Ariadna , Shamardal Aliaa I. , Vasconcello-Castillo Luis , Sola Ivan , Bonfill Xavier
Published: January 2022

Background:

Women treated for breast cancer are facing a lifetime risk of developing lymphedema, which occurs in up to 40% of this population. There is a lack of evidence and limited knowledge regarding the treatment of breast cancer–related lymphedema (BCRL). The aim of this study was to identify, describe, and organize the currently available evidence in the treatment of BCRL.

Methods:

We conducted an evidence mapping review study according to the methodology proposed by Global Evidence Mapping. We performed a systematic search in Medline, Embase, Central (Cochrane), and Epistemonikos, from 2000–2020. We included studies about all treatment types for BCRL, including surgical and nonsurgical treatment. Results were summarized in narrative and tabular forms.

Results:

A total of 240 studies were included in this mapping review, distributed as follows: 147 experimental studies [102 randomized clinical trials (RCTs) and 45 quasi-experimental clinical trials], 48 observational studies (34 prospective and 14 retrospective studies), and 45 systematic reviews (17 of them with metanalysis). Most of the RCTs were on nonsurgical interventions. Only two RCTs addressed surgical intervention.

Conclusions:

In the last 20 years, there were an average of 12 publications per year on the treatment of BCRL. Recently this lack of attention has been partially corrected, as the majority were published in the past 5 years. However, most of them were on nonsurgical interventions. Well-designed RCTs on surgery are needed to measure the effectiveness of the applied interventions.
Usefulness of intravascular ultrasound assessment after development of the slow flow phenomenon during percutaneous coronary intervention
Authors: Nakao Yasuhisa , Inaba Shinji , Kinoshita Masaki , Sumimoto Takumi , Saito Makoto , Aono Jun , Inoue Katsuji , Ikeda Shuntaro , Yamaguchi Osamu
Published: January 2022

The slow flow phenomenon is a critical complication during percutaneous coronary intervention (PCI) that leads to poor outcomes. We aimed to evaluate the mechanisms underlying the slow flow phenomenon using intravascular ultrasound (IVUS). We retrospectively analyzed IVUS data from 62 lesions in 58 consecutive patients who experienced the slow flow phenomenon during PCI. IVUS was performed immediately after the development of the slow flow phenomenon to assess its cause. No IVUS-based evidence of mechanical obstruction was categorized as distal embolization. Distal embolization was observed in 46 lesions (74%). The slow flow phenomenon occurred in all these lesions after stent implantation. In addition to distal embolization, three different mechanisms underlying the induction of the slow flow phenomenon due to mechanical obstructions (16 lesions, 26%) were detected on IVUS, namely, medial dissection/hematoma (6 lesions), intimal flap (6 lesions), and thrombus obstruction (4 lesions). Most mechanical obstructions (13 lesions, 81%) could not be identified by angiography alone. In 15/16 lesions (94%) with mechanical obstruction, deteriorated flow improved immediately after balloon dilatation or bail-out stent implantation, although intracoronary vasodilator administration could not reestablish coronary flow. The frequency of mechanical obstruction as the cause of the slow flow phenomenon was relatively high. Given the difficulty in angiographical differentiation, IVUS-guided management of slow flow may be a useful strategy.
Medical management of gastrointestinal neuroendocrine tumors
Authors: Perez Kimberly , Chan Jennifer
Published: January 2022

Purpose of review

To summarize the recent developments in the medical treatment of gastrointestinal neuroendocrine neoplasms.

Recent findings

The medical management of gastrointestinal neuroendocrine tumors (GI-NETs) continues to evolve with advances in the management of symptoms related to hormone hypersecretion and therapeutic control of disease progression. Systemic therapy options include somatostatin analogs (SSAs), radiolabeled SSAs, molecularly targeted agents, and cytotoxic therapy. Recent progress has focused on new targeted therapies, the sequencing of therapy and the role of immunotherapy.

This review will focus on treatment of GI-NETs and highlight new developments published over the last year.
Rehabilitation of COVID-19 patients with respiratory failure and critical illness disease in Slovenia: an observational study
Authors: Novak Primož , Cunder Katarina , Petrovič Olga , Oblak Tina , Dular Katja , Zupanc Aleksander , Prosič Zdenka , Majdič Neža
Published: January 2022

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection often causes pneumonia and respiratory failure that may lead to postintensive care syndrome, including critical illness neuropathy (CIN) and critical illness myopathy (CIM). The data on the rehabilitation outcomes of post-novel coronavirus disease (COVID) patients with CIN and CIM following respiratory failure and mechanical ventilation are still limited. To address this, we enrolled in our prospective observational study a sample of 50 consecutive COVID-19 patients admitted to our facility between 2 November 2020 and 3 May 2021 with electrophysiologically confirmed or clinically suspected diagnosis of CIN/CIM. The functional abilities were assessed at admission and discharge with the Functional Independence Measure (FIM), The Canadian Occupational Performance Measure, 10-metre walk test, 6-min walk test and the de Morton Mobility Index. The gain in motor FIM and the length of stay were used as an index of rehabilitation efficiency. Nutritional status was also assessed using anthropometric measurements and bioelectrical Impedance analysis. Psychologic evaluation was performed at admission only. At admission, functional limitations and severe malnutrition were present in all patients with psychologic problems in about one third. At discharge (42 ± 16 days later), clinically important and statistically significant improvements were found in all outcome measures, which was also noted by the patients. The gain in motor FIM was larger with the longer length of stay up to 2 months and plateaued thereafter. We conclude that post-COVID-19 patients who develop CIN/CIM following respiratory failure can improve functional and nutritional status during inpatient rehabilitation.
The Effect of Preoperative Education Prior to Hip or Knee Arthroplasty on Immediate Postoperative Outcomes
Authors: Jones Eric D. , Davidson Lynda J. , Cline Thomas W.
Published: January 2022

There is ample research demonstrating improved patient outcomes when using an enhanced recovery program. However, the literature reporting the impact of preoperative education alone prior to hip and knee arthroplasty is conflicting. With the number of these surgical procedures expected to increase in the next few years, the identification of strategies that positively impact outcomes is important. The aim of this study was to evaluate immediate postoperative physical therapy (PT) performance following a total hip or knee arthroplasty in patients who attended a preoperative education class compared with those who did not. This study was a retrospective chart review of 707 hip and knee arthroplasty patients, comparing outcomes based on preoperative educational session attendance. Demographics, comorbidities, length of stay (LOS), discharge disposition, and PT performance were collected from the chart review. Patients who attended the preoperative education class had significantly greater ambulation distances (p < .001), greater degrees of knee flexion (p < .001), and greater degrees of hip flexion (p = .012) on postoperative Day 1. Both hip (p < .001) and knee (p < .001) patients who attended the class had a significantly shorter LOS. The cost benefit analysis indicated a savings of $921.57 in direct costs per knee arthroplasty in those who attended a class. Patients who received preoperative education had greater mobility in the immediate postoperative period and reduced LOS for both hip and knee arthroplasties. Based on this study's results, preoperative education is effective in improving outcomes and reducing the cost of hip and knee arthroplasties.
Tobacco smoking is associated with more pain and worse functional outcomes after torsional ankle fracture
Authors: Audet Megan A. , Benedick Alex , Vallier Heather A.
Published: January 2022

Objective:

The purpose of this study was to assess the impact of current and remote tobacco smoking on clinical and functional outcomes after torsional ankle fracture.

Methods:

Nine hundred thirty-five patients treated surgically for torsional ankle fracture over 9 years were reviewed. Tobacco smoking status at the time of injury was defined as current (48.3%), former (11.7%), and nonsmoker (40.0%). Complications, unplanned secondary procedures, pain medication use, and functional outcome scores, as measured by Foot Function Index and Short Musculoskeletal Function Assessment (SMFA) surveys.

Results:

Mean age was 44.8 years, with 50.3% male. More than 6 months following injury current smokers were more likely than former smokers and nonsmokers to report ankle pain (67.8% vs 45.8% vs 47.5%) and to use prescription pain medicines (23.0% vs 10.4% vs 6.3%), all P < .05. Multiple logistic regression found current tobacco use to be an independent predictor for prescription pain medication use, and worse scores for the Foot Function Index, SMFA Dysfunction, and SMFA Bothersome scores, all P < .05. Complications occurred in 15.5% of all patients, and 10.7% underwent unplanned secondary operations. Tobacco smoking was not associated with more complications or secondary procedures.

Conclusion:

Current smokers are more likely to use prescription pain medications several months after injury and have worse patient-reported functional outcome scores after surgical treatment of torsional ankle fractures than former smokers and nonsmokers.
Brief Report: Self-Reported Knowledge of HIV Status Among Cisgender Male Sex Partners of Transgender Women in Lima, Peru
Authors: Long Jessica E. , Sanchez Hugo , Dasgupta Sayan , Huerta Leyla , Garcia Dania Calderón , Lama Javier R. , Duerr Ann
Published: January 2022

Background:

Knowledge of HIV status is a critical first step in the HIV care cascade. Cisgender male sex partners of transgender women (MSTW) are at a disproportionately high risk of HIV, but little is known about their access to HIV testing or knowledge of HIV status.

Methods:

We used cross-sectional data from a respondent-driven sampling study to analyze self-reported HIV status and predictors of knowledge of HIV status among MSTW in Lima, Peru. Mixed-effects models were used to generate crude and adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for the association between knowledge of HIV status and predictors of interest, including sociodemographics and recent sexual behavior.

Results:

From February to July 2018, 196 eligible MSTW enrolled, of which 90 (46%) reported not knowing their HIV status. Recent casual or 1-time partners were reported by 84% of MSTW and 54% reported purchasing sex. In adjusted analyses, MSTW participants were less likely to know their HIV status if they reported buying sex (aPR 0.43, 95% CI: 0.32 to 0.59) or reported ≥16 recent sex partners compared with ≤5 partners [aPR 0.32, (0.20 to 0.50)]. Those who reported male sex partners were 80% more likely to know their status [aPR 1.80, (1.33 to 2.44)].

Conclusions:

Reported knowledge of HIV status was low among MSTW in Lima, and unknown HIV status was associated with behaviors linked to HIV acquisition. MSTW who reported male partners were more likely to know their status, potentially indicating that HIV testing is more accessible to men who have sex with men.
Focal FDG Uptake in the Cerebral Parenchyma Beneath the Subdural Hematoma
Authors: Liu Mingyuan , Wu Haibo , Shan Lili , Dong Aisheng , Han Yan
Published: January 2022

Changes in cerebral glucose metabolism after subdural hematoma have been rarely reported. We present a case with acute subdural hematoma detected unexpectedly on FDG PET/CT. Focal intense FDG uptake in the cerebral parenchyma beneath the subdural hematoma was seen on PET. The density of the cerebral parenchyma was normal on CT. The patient received conservative management. He recovered without any complication. This case indicates that familiarity with the changes in cerebral glucose metabolism on PET after subdural hematoma may be helpful for optimal patient care.
Beta blockade in TBI: Dose-dependent reductions in BBB leukocyte mobilization and permeability in vivo
Authors: Lopez Alfonso J. , ElSaadani Mohamed , Jacovides Christina L. , Georges Anastasia , Culkin Matthew C. , Ahmed Syed , Kumar Monisha A. , Kaplan Lewis J. , Smith Douglas H. , Pascual Jose L.
Published: January 2022

BACKGROUND

Traumatic brain injury (TBI) is accompanied by a hyperadrenergic catecholamine state that can cause penumbral neuroinflammation. Prospective human studies demonstrate improved TBI survival with beta blockade (bb), although mechanisms remain unclear. We hypothesized that deranged post-TBI penumbral blood brain barrier (BBB) leukocyte mobilization and permeability are improved by bb.

METHODS

CD1 male mice (n = 64) were randomly assigned to severe TBI—controlled cortical impact: 6 m/s velocity, 1 mm depth, 3 mm diameter—or sham craniotomy, and IP injection of either saline or propranolol (1, 2, or 4 mg/kg) every 12 hours for 2 days. At 48 hours, in vivo pial intravital microscopy visualized live endothelial-leukocyte (LEU) interactions and BBB microvascular leakage. Twice daily clinical recovery was assessed by regaining of lost body weight and the Garcia Neurological Test (motor, sensory, reflex, balance assessments). Brain edema was determined by hemispheric wet-to-dry ratios.

RESULTS

Propranolol after TBI reduced both in vivo LEU rolling and BBB permeability in a dose-dependent fashion compared with no treatment (p < 0.001). Propranolol reduced cerebral edema (p < 0.001) and hastened recovery of lost body weight at 48 hours (p < 0.01). Compared with no treatment (14.9 ± 0.2), 24-hour Garcia Neurologic Test scores were improved with 2 (15.8 ± 0.2, p = 0.02) and 4 (16.1 ± 0.1, p = 0.001) but not with 1 mg/kg propranolol.

CONCLUSION

Propranolol administration reduces post-TBI LEU mobilization and microvascular permeability in the murine penumbral neurovasculature and leads to reduced cerebral edema. This is associated with hastened recovery of post-TBI weight loss and neurologic function with bb treatment. Dose-dependent effects frame a mechanistic relationship between bb and improved human outcomes after TBI.
Impact of time to surgery on mortality in hypotensive patients with noncompressible torso hemorrhage: An AAST multicenter, prospective study
Authors: Duchesne Juan , Slaughter Kevin , Puente Ivan , Berne John D. , Yorkgitis Brian , Mull Jennifer , Sperry Jason , Tessmer Matthew , Costantini Todd , Berndtson Allison E. , Kai Taylor , Rokvic Giannina , Norwood Scott , Meadows Katelyn , Chang Grace , Lemon Brittney M. , Jacome Tomas , Van Sant Lauren , Paul Jasmeet , Maher Zoe , Goldberg Amy J. , Madayag Robert M. , Pinson Greg , Lieser Mark J. , Haan James , Marshall Gary , Carrick Matthew , Tatum Danielle
Published: January 2022

BACKGROUND

Death from noncompressible torso hemorrhage (NCTH) may be preventable with improved prehospital care and shorter in-hospital times to hemorrhage control. We hypothesized that shorter times to surgical intervention for hemorrhage control would decrease mortality in hypotensive patients with NCTH.

METHODS

This was an AAST-sponsored multicenter, prospective analysis of hypotensive patients aged 15+ years who presented with NCTH from May 2018 to December 2020. Hypotension was defined as an initial systolic blood pressure (SBP) ≤ 90 mm Hg. Primary outcomes of interest were time to surgical intervention and in-hospital mortality.

RESULTS

There were 242 hypotensive patients, of which 48 died (19.8%). Nonsurvivors had higher mean age (47.3 vs. 38.8; p = 0.02), higher mean New Injury Severity Score (38 vs. 29; p < 0.001), lower admit systolic blood pressure (68 vs. 79 mm Hg; p < 0.01), higher incidence of vascular injury (41.7% vs. 21.1%; p = 0.02), and shorter median (interquartile range, 25–75) time from injury to operating room start (74 minutes [48–98 minutes] vs. 88 minutes [61–128 minutes]; p = 0.03) than did survivors. Multivariable Cox regression showed shorter time from emergency department arrival to operating room start was not associated with improved survival (p = 0.04).

CONCLUSION

Patients who died arrived to a trauma center in a similar time frame as did survivors but presented in greater physiological distress and had significantly shorter times to surgical hemorrhage intervention than did survivors. This suggests that even expediting a critically ill patient through the current trauma system is not sufficient time to save lives from NCTH. Civilian prehospital advance resuscitative care starting from the patient first contact needs special consideration.

LEVEL OF EVIDENCE

Prognostic/Epidemiologic, Level III
Habitat choice promotes and constrains phenotypic plasticity
Authors: Turko Andy J. , Rossi Giulia S.
Published: January 2022

Habitat choice can either speed up or slow rates of phenotypic evolution, depending on which trait is measured. We suggest that habitat choice plays an analogous, and generally overlooked, role in shaping patterns of phenotypic plasticity. Using our work with an amphibious fish, we discuss two case studies that demonstrate how habitat choice can both promote and constrain expression of plasticity. First, habitat choice during the dry season accentuates adaptive metabolic plasticity and minimizes maladaptive changes to muscle, ultimately increasing survival time out of water. Second, a trade-off between water- and air-breathing drives matching habitat choice, resulting in positive feedback that reinforces respiratory specialization and environmental preference. Overall, these case studies demonstrate that we must consider the interactions between plasticity and habitat choice to fully understand how animals survive in the face of environmental change. Without considering both processes simultaneously, the performance of animals in challenging conditions can be either under- or over-estimated. Finally, because habitat choice shapes the frequency and predictability of environmental changes that animals experience, feedback between habitat choice and expressions of phenotypic plasticity may be an important factor that influences how plasticity evolves.
A multi-modality approach for enhancing 4D flow magnetic resonance imaging via sparse representation
Authors: Zhang Jiacheng , Brindise Melissa C. , Rothenberger Sean M. , Markl Michael , Rayz Vitaliy L. , Vlachos Pavlos P.
Published: January 2022

This work evaluates and applies a multi-modality approach to enhance blood flow measurements and haemodynamic analysis with phase-contrast magnetic resonance imaging (4D flow MRI) in cerebral aneurysms (CAs). Using a library of high-resolution velocity fields from patient-specific computational fluid dynamic simulations andin vitroparticle tracking velocimetry measurements, the flow field of 4D flow MRI data is reconstructed as the sparse representation of the library. The method was evaluated with synthetic 4D flow MRI data in two CAs. The reconstruction enhanced the spatial resolution and velocity accuracy of the synthetic MRI data, leading to reliable pressure and wall shear stress (WSS) evaluation. The method was applied onin vivo4D flow MRI data acquired in the same CAs. The reconstruction increased the velocity and WSS by 6–13% and 39–61%, respectively, suggesting that the accuracy of these quantities was improved since the raw MRI data underestimated the velocity and WSS by 10–20% and 40–50%, respectively. The computed pressure fields from the reconstructed data were consistent with the observed flow structures. The results suggest that using the sparse representation flow reconstruction within vivo4D flow MRI enhances blood flow measurement and haemodynamic analysis.
Selective localization of Mfn2 near PINK1 enables its preferential ubiquitination by Parkin on mitochondria
Authors: Vranas Marta , Lu Yang , Rasool Shafqat , Croteau Nathalie , Krett Jonathan D. , Sauvé Véronique , Gehring Kalle , Fon Edward A. , Durcan Thomas M. , Trempe Jean-François
Published: January 2022

Mutations in Parkin and PINK1 cause early-onset familial Parkinson's disease. Parkin is a RING-In-Between-RING E3 ligase that transfers ubiquitin from an E2 enzyme to a substrate in two steps: (i) thioester intermediate formation on Parkin and (ii) acyl transfer to a substrate lysine. The process is triggered by PINK1, which phosphorylates ubiquitin on damaged mitochondria, which in turn recruits and activates Parkin. This leads to the ubiquitination of outer mitochondrial membrane proteins and clearance of the organelle. While the targets of Parkin on mitochondria are known, the factors determining substrate selectivity remain unclear. To investigate this, we examined how Parkin catalyses ubiquitin transfer to substrates. We found that His433 in the RING2 domain contributes to the catalysis of acyl transfer. In cells, the mutation of His433 impairs mitophagy. In vitro ubiquitination assays with isolated mitochondria show that Mfn2 is a kinetically preferred substrate. Using proximity-ligation assays, we show that Mfn2 specifically co-localizes with PINK1 and phospho-ubiquitin (pUb) in U2OS cells upon mitochondrial depolarization. We propose a model whereby ubiquitination of Mfn2 is efficient by virtue of its localization near PINK1, which leads to the recruitment and activation of Parkin via pUb at these sites.