bluuebunny/crossref_metadata_2025 huggingface dataset:
Sequential generation of self-starting diverse operations in all-fiber laser based on thulium-doped fiber saturable absorber
Authors: Zhang Pei , Dimyati Kaharudin , Nizamani Bilal , Najm Mustafa M. , Harun S. W.
Published: November 2021

Self-starting Q-switching, Q-switched mode-locking and mode-locking operation modes are achieved sequentially in an all-fiber erbium-doped fiber laser with thulium-doped fiber saturable absorber for the first time. The central wavelengths of Q-switching, Q-switched mode-locking and mode-locking operation modes are 1569.7 nm, 1570.9 nm, and 1572 nm, respectively. The mode-locking operation of the proposed fiber laser generates stable dark soliton with a repetition rate of 0.99 MHz and signal-to-noise ratio of 65 dB. The results validate the capability of generating soliton pulse by doped fiber saturable absorber. Furthermore, the proposed fiber laser is beneficial to the applications of optical communication and signal processing system.
Improved performance of MoS2 FET by in situ NH3 doping in ALD Al2O3 dielectric
Authors: Sun Xiaoting , Zhang Yadong , Jia Kunpeng , Tian Guoliang , Yu Jiahan , Xiang Jinjuan , Yang Ruixia , Wu Zhenhua , Yin Huaxiang
Published: November 2021

Since defects such as traps and oxygen vacancies exist in dielectrics, it is difficult to fabricate a high-performance MoS2 field-effect transistor (FET) using atomic layer deposition (ALD) Al2O3 as the gate dielectric layer. In this paper, NH3
in situ doping, a process treatment approach during ALD growth of Al2O3, is used to decrease these defects for better device characteristics. MoS2 FET has been well fabricated with this technique and the effect of different NH3
in situ doping sequences in the growth cycle has been investigated in detail. Compared with counterparts, those devices with NH3
in situ doping demonstrate obvious performance enhancements: I
on/I
off is improved by one order of magnitude, from 1.33 × 105 to 3.56 × 106, the threshold voltage shifts from –0.74 V to –0.12 V and a small subthreshold swing of 105 mV/dec is achieved. The improved MoS2 FET performance is attributed to nitrogen doping by the introduction of NH3 during the Al2O3 ALD growth process, which leads to a reduction in the surface roughness of the dielectric layer and the repair of oxygen vacancies in the Al2O3 layer. Furthermore, the MoS2 FET processed by in situ NH3 doping after the Al and O precursor filling cycles demonstrates the best performance; this may be because the final NH3 doping after film growth restores more oxygen vacancies to screen more charge scattering in the MoS2 channel. The reported method provides a promising way to reduce charge scattering in carrier transport for high-performance MoS2 devices.
Effect of the gas puff location on the divertor plasma properties in COMPASS tokamak
Authors: Dimitrova M , Tomes M , Popov Tsv , Dejarnac R , Stockel J , Adamek J , Vasileva E , Hron M , Panek R
Published: November 2021

Langmuir probes are used to study the plasma parameters in the divertor during deuterium gas puff injection on the high- (HFS) or low-field sides (LFS). The probe data were processed to evaluate the plasma potential and the electron temperatures and densities. A difference was found in the plasma parameters depending on the gas puff location.

In the case of a gas puff on the LFS, the plasma parameters changed vastly, mainly in the inner divertor – the plasma potential, the ion saturation-current density and the electron temperature dropped. After the gas puff, the electron temperature changed from 10-15 eV down to within the 5-9 eV range. As a result, the parallel heat-flux density decreased. At the same time, in the outer divertor the plasma parameters remained the same. We thus concluded that using a gas puff on the LFS will facilitate reaching a detachment regime by increasing the density of puffed neutrals.

When the deuterium gas puff was on the HFS, the plasma parameters in the divertor region remained almost the same before and during the puff. The electron temperature decreased with just few eV as a result of the increased amount of gas in the vacuum chamber.
Association of alpha-1-adrenergic antagonist use with the risk of gout development in benign prostatic hyperplasia patients: a population-based cohort study
Authors: Hsu Wei-Hung , Lai Jung-Nien , Lin Cheng-Li , Loh Ching-Hui , Huang Huei-Kai , Huang Liang-Kai
Published: November 2021

Background

Men are more likely to develop benign prostatic hyperplasia (BPH) and gout as they age. However, the role of alpha-1-adrenergic antagonists, the medication for BPH, in the development of gout is uncertain.

Objective

To investigate the effect of alpha-1-adrenergic antagonist use on the risk of developing gout in BPH patients.

Methods

Data of patients with newly diagnosed BPH were retrieved from Taiwan’s 2000–2013 National Health Insurance Research Database (total number: 15,390 patients; 7,695 patients in each cohort). Propensity score matching was conducted according to age, comorbidities, medication history for cohorts that received or did not receive alpha-1-adrenergic antagonists. Hazard ratios (HRs) were assessed for gout development using Cox proportional hazards regression models.

Results

Use of alpha-1-adrenergic antagonists was not associated with gout development in BPH patients (HR = 0.92; 95% confidence interval [CI], 0.78–1.10; P = 0.35). However, after stratification according to the average number of days of alpha-1-adrenergic antagonist use per year, patients with an average of >300 days had a significantly higher risk of gout development than patients who did not receive alpha-1-adrenergic antagonists (adjusted HR = 1.57; 95% CI, 1.25–1.97; P < 0.001). Patients with more days of medication use per year had a higher risk of gout development than those with fewer days of medication use (P < 0.001).

Conclusion

Patients who received more doses of alpha-1-adrenergic antagonists per year had a higher risk of developing gout. A causal proof of the role of alpha-1-adrenergic antagonists use in gout development should be analysed in future studies designed as double blind randomized controlled trials.
Rapid Changes in Composition and Contents of Cuticular Hydrocarbons inSitobion avenae(Hemiptera: Aphididae) Clones Adapting to Desiccation Stress
Authors: Yang Yujing , Li Xiaosai , Liu Deguang , Pei Xiaojin , Khoso Abdul Ghaffar
Published: November 2021

Cuticular hydrocarbons (CHCs) are diverse in insects, and include variable classes of cuticular lipids, contributing to waterproofing for insects under desiccation environments. However, this waterproofing function of CHCs is still not well characterized in aphids. In this study, we compared CHC profiles for desiccation-resistant and nonresistant genotypes of the grain aphid, Sitobion avenae (Fabricius), in responses to desiccation. Our result showed that a total of 27 CHCs were detected in S. avenae, and linear alkanes (e.g., n-C29) were found to be the predominant components. Long-chain monomethyl alkanes were found to associate closely with water loss rates in S. avenae in most cases. Resistant genotypes of both wing morphs had higher contents of short-chain n-alkanes under control than nonresistant genotypes, showing the importance of short-chain n-alkanes in constitutive desiccation resistance. Among these, n-C25 might provide a CHC signature to distinguish between desiccation-resistant and nonresistant individuals. Compared with linear alkanes, methyl-branched CHCs appeared to display higher plasticity in rapid responses to desiccation, especially for 2-MeC26, implying that methyl-branched CHCs could be more sensitive to desiccation, and play more important roles in induced desiccation-resistance. Thus, both constitutive and induced CHCs (linear or methyl-branched) can contribute to adaptive responses of S. avenae populations under desiccation environments. Our results provide substantial evidence for adaptive changes of desiccation resistance and associated CHCs in S. avenae, and have significant implications for aphid evolution and management in the context of global climate change.
Internal jugular phlebectasia in pediatric patients: a report of two Saudi cases
Authors: Alrabea Sultan , Eshky Anoof , Albilasi Thamer , Alenezi Mazyad , Bawazir Samir
Published: November 2021

Phlebectasia is a rare condition that refers to the dilatation of any vein in the neck. It is more common in the internal jugular vein and in boys. Diagnosis of the condition is based on ultrasound with Doppler and contrast-enhanced computed tomography. Management of this condition is conservative unless there are complications that may require surgery. Here, we present two pediatric cases of internal jugular phlebectasia. The first patient was an 8-year-old boy, and the second was a 5-year-old boy. They both presented to our clinic with recurrent tonsillitis for tonsillectomy, and both were incidental findings.
Statistics of galaxy mergers: bridging the gap between theory and observation
Authors: Huško Filip , Lacey Cedric G , Baugh Carlton M
Published: November 2021

We present a study of galaxy mergers up to z = 10 using the Planck Millennium cosmological dark matter simulation and the GALFORM semi-analytical model of galaxy formation. Utilizing the full 800 Mpc3 volume of the simulation, we studied the statistics of galaxy mergers in terms of merger rates and close pair fractions. We predict that merger rates begin to drop rapidly for high-mass galaxies (M* > 1011.3–1010.5 M⊙ for z = 0–4), as a result of the exponential decline in the galaxy stellar mass function. The predicted merger rates for massive galaxies (M* > 1010 M⊙) increase and then turn over with increasing redshift, by z = 3.5, in disagreement with hydrodynamical simulations and semi-empirical models. In agreement with most other models and observations, we find that close pair fractions flatten or turn over at some redshift (dependent on the mass selection). We conduct an extensive comparison of close pair fractions, and highlight inconsistencies among models, but also between different observations. We provide a fitting formula for the major merger time-scale for close galaxy pairs, in which the slope of the stellar mass dependence is redshift dependent. This is in disagreement with previous theoretical results that implied a constant slope. Instead, we find a weak redshift dependence only for massive galaxies (M* > 1010 M⊙): in this case the merger time-scale varies approximately as $M_*^{-0.55}$. We find that close pair fractions and merger time-scales depend on the maximum projected separation as $r_\mathrm{max}^{1.32}$, in agreement with observations of small-scale clustering of galaxies.
Memory, Knowledge, and Epistemic Luck
Authors: Lai Changsheng
Published: November 2021

Does ‘remembering that p’ entail ‘knowing that p’? The widely-accepted epistemic theory of memory (hereafter, ETM) answers affirmatively. This paper purports to reveal the tension between ETM and the prevailing anti-luck epistemology. Central to my argument is the fact that we often ‘vaguely remember’ a fact, of which one plausible interpretation is that our true memory-based beliefs formed in this way could easily have been false. Drawing on prominent theories of misremembering in philosophy of psychology (e.g. fuzzy-trace theory and simulationism), I will construct cases where the subject vaguely remembers that p while fails to meet the safety condition, which imply either that ETM is false or that safety is unnecessary for knowledge. The conclusion reached in this paper will be a conditional: if veritic epistemic luck is incompatible with knowledge, then ‘remembering that p’ does not entail ‘knowing that p’.
Response of four evergreen savanna shrubs to an incidence of extreme drought: high embolism resistance, branch shedding and maintenance of nonstructural carbohydrates
Authors: Shen Jing-Xian , Zhang Yong-Jiang , Maenpuen Phisamai , Zhang Shu-Bin , Zhang Lan , Yang Lin , Tao Lian-Bin , Yan Peng-Yun , Zhang Zhi-Ming , Li Shu-Qiong , Yuan Xia , Kongjarat Wanwalee , Kaewkamol Sasiwimol , Tinprabat Pimnara , Chen Ya-Jun
Published: November 2021

Extreme drought events are becoming frequent globally, resulting in widespread plant mortality and forest dieback. Although savanna vegetation cover ~20% of the earth’s land area, their responses to extreme drought have been less studied than that of forests. Herein, we quantified branch dieback, individual mortality and the associated physiological responses of four evergreen shrubs (Tarenna depauperate Hutch., Maytenus esquirolii (H. Lév.) C.Y. Cheng, Murraya exotica L., Jasminum nudiflorum Lindl.) in a savanna ecosystem in Southwest China to an incidence of extreme drought during 2019 and 2020. We found that 80–100% of the individuals of these species exhibited branch dieback, whereas individual mortality was only found in T. depauperate (4.5%). All species showed high resistance to stem embolism (P50, water potential at 50% loss of hydraulic conductivity ranged from −5.62 to −8.6 MPa), whereas the stem minimum water potentials reached −7.6 to ca −10.0 MPa during the drought. The low water potential caused high native embolism levels (percentage loss of hydraulic conductivity (PLC) 23–65%) in terminal branches, and the remaining stems maintained 15–35% PLC at the end of the drought. Large within-individual variations in stem vulnerability to embolism were detected, and shedding of vulnerable branches could be a mechanism for shrubs to reduce water and carbon consumption. Overall, the content of total nonstructural carbohydrates (NSC) and their components in the stem were generally comparable to or higher than those in the rainy season in three of the four species. Because the leaves were turgor-less for most time during the drought, high NSC levels during the drought could be due to recycling of NSC from dead branches or translocation from roots. Our results suggest high tolerance of savanna shrub species to extreme drought, which could be facilitated by high embolism resistance in some stems and shedding of vulnerable branches to maintain individual water and carbon balance.
Spatiotemporal Dynamics of Stemphylium Leaf Blight and Potential Inoculum Sources in New York Onion Fields
Authors: Hay Frank , Heck Daniel W. , Klein Audrey , Sharma Sandeep , Hoepting Christy , Pethybridge Sarah J.
Published: November 2021

Stemphylium leaf blight (SLB) caused by Stemphylium vesicarium is the dominant foliar disease affecting large-scale onion production in New York. The disease is managed by fungicides, but control failures are prevalent and are attributed to fungicide resistance. Little is known of the relative role of inoculum sources in initiation and spread of SLB epidemics. Plate testing of 28 commercially available organic onion seedlots from 2016 and 2017 did not detect S. vesicarium. This finding suggests that although S. vesicarium has been reported as seed-transmitted, this is unlikely to be a significant inoculum source in commercially available organic seed lots and even less so in fungicide-treated seed used to establish conventional fields. The spatial and spatiotemporal dynamics of SLB epidemics in six onion fields were evaluated along linear transects in 2017 and 2018. Average SLB incidence increased from 0 to 100% throughout the cropping seasons with an average final lesion length of 28.3 cm. Disease progress was typical of a polycyclic epidemic and the logistic model provided the best fit to 83.3% of the datasets. Spatial patterns were better described by the beta-binomial than binomial distribution in half of the datasets (50%) and random patterns were more frequently observed by the index of dispersion (59%). Geostatistical analyses also found a low frequency of datasets with aggregation (60%). Spatiotemporal analysis of epidemics detected that the aggregation was influenced by disease incidence. However, diseased units were not frequently associated with the previous time period according to the spatiotemporal association function of spatial analyses by distance indices. Variable spatial patterns suggested mixed inoculum sources dependent upon location, and likely an external inoculum source at the sampling scale used in this study. A small-plot replicated trial was also conducted in each of 2 years to quantify the effect of S. vesicarium-infested onion residue on SLB epidemics in a field isolated from other onion fields. SLB incidence was significantly reduced in plots without residue compared with those in which residue remained on the soil surface. Burial of infested residue also significantly reduced epidemic progress in 1 year. The effect of infested onion residue on SLB epidemics in the subsequent onion crop suggests rotation or residue management may have a substantial effect on epidemics. However, the presence of an inoculum source external to fields in onion production regions, as indicated by a lack of spatial aggregation, may reduce the efficacy of in-field management techniques.
Prevalence and Correlates of Positive Follow-up Screens in Primary Care for Unhealthy Alcohol and Other Drug Use After a Negative Screen
Authors: Alford Daniel P. , Kim Theresa W. , Samet Jeffrey H. , Cruz Alissa B. , Brolin Mary F. , Shanahan Christopher W. , Saitz Richard
Published: November 2021

Objective

To determine the proportion and characteristics of adults in primary care (PC) who screen positive for unhealthy substance use (SU) (alcohol and/or other drug) 1 year or more after screening negative.

Methods

Screening consisted of single-item questions for unhealthy use of alcohol and other drugs (illicit drugs and prescription medications). Health educators conducted in-person screening of patients presenting for a PC appointment. SU severity (low, moderate, high) was assessed with the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Multivariate logistic regression models estimated predictors of a positive follow-up screen.

Results

Among 9215 patients who previously screened negative, 237 (2.6%) screened positive for unhealthy SU (42% alcohol only, 43% other drug only, 15% alcohol and other drug). The mean interval between screens was 19 months. Most alcohol use was low risk (ASSIST score ≤10) (81%), whereas most drug use was moderate risk (ASSIST score 4–26) (77%). Patients between ages of 18 to 25 had a higher proportion of positive follow-up screens (7.4% [33/ 443]) as well as those with a self-identified history of SU problems (9.4% [40/421]). Patients with a higher odds of a positive follow-up screen were male (adjusted odds ratio [AOR] 2.64; 95% CI: 2.02–3.45), used tobacco (AOR 2.38; 95% CI: 1.75–3.23), had a longer interval between screenings (AOR 3.26; 95% CI: 1.84–5.75).

Conclusions

Screening for unhealthy SU 1 year or more after screening negative identified additional patients at-risk. These findings highlight the need to empirically determine the incremental benefits of screening all PC patients annually.
A Predictive Model of Bilateral Sensorineural Hearing Loss in Meniere Disease Using Clinical Data
Authors: Moleon M. D. Carmen , Torres-Garcia Lidia , Batuecas-Caletrio Angel , Castillo-Ledesma Natalia , Gonzalez-Aguado Rocio , Magnoni Laura , Rossi Marcos , Di Berardino Federica , Perez-Guillen Vanesa , Trinidad-Ruiz Gabriel , Lopez-Escamez Jose A.
Published: November 2021

Objectives:

Meniere disease (MD) is defined by a clinical syndrome of recurrent attacks of spontaneous vertigo associated with tinnitus, aural fullness, and sensorineural hearing loss (SNHL). Most patients have unilateral SNHL, but some of them will develop contralateral SNHL during the course of the disease. Several studies have reported a frequency of 2 to 73% SNHL in the second ear, according to the duration of disease and the period of follow-up. We hypothesize that unilateral and bilateral MD are different conditions, the first would initially involve the apical turn of the cochlea, while bilateral MD would affect the entire length of the cochlea. The aim of the study is to search for clinical predictors of bilateral SNHL in MD to build a predictive model of bilateral involvement.

Design:

A retrospective, longitudinal study including two cohorts with a total of 400 patients with definite MD was carried out. The inception cohort consisted of 150 patients with MD and the validation cohort included 250 cases. All of the cases were diagnosed of unilateral MD according to their hearing loss thresholds. The following variables were assessed as predictors of bilateral SNHL for the two cohorts: sex, age of onset, familiar history of MD, migraine and high-frequency hearing loss (HFHL, defined if hearing threshold >20 dB in two or more consecutive frequencies from 2 to 8 KHz). A descriptive analysis was carried out according to the presence of HFHL in the first audiogram for the main variables. By using multiple logistic regression, we built-up several predictive models for the inception cohort and validated it with the replication cohort and merged dataset.

Results:

Twenty-three (19.3%) and 78 (41%) of patients with HFHL developed contralateral SNHL during the follow-up, in the inception and validation cohorts, respectively. In the inception cohort, the best predictive model included HFHL in the first audiogram (OR = 6.985, p = 0.063) and the absence of migraine (OR = 0.215, p = 0.144) as clinical predictors for bilateral SNHL [area under the curve (AUC) = 0.641, p = 0.002]. The model was validated in the second cohort (AUC = 0.621, p < 0.001). Finally, we merged both datasets to improve the precision of the model including HFHL in the first audiogram (OR = 3.168, p = 0.001), migraine (OR = 0.482, p = 0.036) and age of onset >35 years old (OR = 2.422, p = 0.006) as clinical predictors (AUC = 0.639, p < 0.001).

Conclusions:

A predictive model including the age of onset, HFHL in the first audiogram and migraine can help to assess the risk of bilateral SNHL in MD. This model may have significant implications for clinical management of patients with MD.
Long-Term Trajectory of Recovery Following Pilon Fracture Fixation
Authors: Middleton Scott D. , Guy Pierre , Roffey Darren M. , Broekhuyse Henry M. , O'Brien Peter J. , Lefaivre Kelly A.
Published: November 2021

Objectives:

To describe the trajectory of recovery following fixation of pilon fractures from baseline to 5-year follow-up.

Design:

Prospective cohort study.

Setting:

Level-1 trauma center.

Patients/Participants:

Patients with pilon fractures (OTA/AO 43.C) treated with open reduction and internal fixation.

Intervention:

None.

Main Outcomes Measures:

Patient-reported outcome measures were measured at baseline, 6 months, 1 year, and 5 years using the Short-Form 36 Health Survey (SF-36) Physical Component Score and Mental Component Score, Short Musculoskeletal Functional Assessment, and the Foot and Ankle Outcome Score.

Results:

One hundred two patients were enrolled: mean age was 42.6 years; 69% were males; 88% had an injury severity score of 9; 74 patients (73%) completed 1-year follow-up; 40 patients (39%) completed 5-year follow-up. Trajectory of recovery of physical function showed a significant decline between baseline and 6 months, with significant improvement between 6 months and 1 year and then ongoing but slower improvement between 1 year and 5 years. Sixty-four patients returned to baseline SF-36 Physical Component Score at 5 years. Pain was a persistent issue and remained significantly worse at 5 years when compared with baseline. Psychological well-being (SF-36 Mental Component Score) did not significantly change from baseline at 5 years.

Conclusion:

Functional recovery following open reduction and internal fixation for pilon fractures was characterized by an initial decrease in function from baseline, followed by an increase between 6 months and 1 year, and then slower but continued increases from 1 year to 5 years. Function did not return to baseline levels, pain was a persistent issue, and mental well-being showed no change from baseline at 5 years. This information may be useful when counselling patients.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Dynamic Pressure Stimulation Upregulates Collagen II and Aggrecan in Nucleus Pulposus Cells Through Calcium Signaling
Authors: Tseng Mu-Cyun , Lim Jormay , Chu Ya-Cherng , Chen Chih-Wei , Feng Chi-Kuang , Wang Jaw-Lin
Published: November 2021

Study Design.

An in vitro study to investigate the effect of pressure stimulation on nucleus pulposus (NP) cells.

Objective.

The aim of this study was to investigate the question whether physical stimulation can be leveraged to enhance extracellular matrix (ECM) synthesis as a preventive measure for intervertebral disc (IVD) degeneration.

Summary of Background Data.

ECM plays an important role in regulating hydration and pressure balance of the IVD.

Methods.

Cellular stimulation devices with different pressurizing protocols were used to create a pressurized environment to cells cultures. The setup was used to mimic the pressurized conditions within IVD to investigate the effect of pressure stimulation on NP cells.

Results.

Pressure stimulation at 300 kPa can enhance the synthesis of ECM proteins Collagen II and aggrecan in NP cells and the effect of dynamic pressure stimulation outperformed the static one. The difference between static and dynamic pressure stimulation was due primarily to calcium signaling activated by pressure fluctuation. The superior effect of dynamic pressure holds for a wide range of stimulation durations, relating to the range of spontaneous calcium oscillations in NP cells.

Conclusion.

The results link mechanotransduction to the downstream ECM protein synthesis and suggest slow exercises that correspond with spontaneous calcium oscillations in NP cells can be effective to stimulate ECM synthesis in IVD.
“Time is a Great Teacher, but Unfortunately It Kills All Its Pupils”: Insights from Psychiatric Service User Engagement
Authors: Soklaridis Sophie , Cooper Rachel Beth , de Bie Alise
Published: November 2021

In this Foundations article, the authors reflect on the meaning of time through their past work creating novel roles for psychiatric service users to be involved in the education of health professions trainees and faculty. Inspired by music composer Hector Berlioz, the authors explore and critique the ableist, chrononormative temporalities of academia, and medical education. The authors introduce the conception of crip time from critical disability studies and use it to reflect on their experiences of the different temporalities that people bring to service user engagement and other collaborative projects. “Crip time” can help challenge notions of pace and productivity to create a more inclusive space for teachers and learners in health professions education.
An Interprofessional Group Intervention to Promote Faculty Well-Being: A Randomized Clinical Trial
Authors: Hata Susan R. , Berkowitz Lori R. , James Kaitlyn , Simpkin Arabella L.
Published: November 2021

Introduction:

To evaluate the effect on engagement, relational connection, and burnout of an intervention involving clinical faculty meeting in interprofessional self-facilitated groups and to determine whether a written discussion guide is necessary to achieve benefit.

Methods:

This is a randomized controlled trial, conducted at a large US academic medical center from May to August 2018. Subjects included 25 clinical physicians, nurse practitioners, and certified nurse midwives. The intervention involved three monthly self-facilitated groups for faculty. Groups were randomized to have no discussion guide, or to receive a one-page guide. Outcomes of burnout, engagement, and empowerment in work, and stress from uncertainty were assessed using validated metrics.

Results:

Rates of emotional exhaustion and depersonalization decreased significantly over the course of the 3-month study (56%–36%; P < .001; and 20%–15%; P = .006) and overall burnout decreased from 56% to 41% of faculty (P = .002). The percentage of faculty who felt engaged in their work increased from 80% to 96% (P = .03). No statistically significant differences in empowerment at work or in reaction to uncertainty were seen. The groups without a discussion guide had equivalent outcomes and benefits. Cost per participant was under $100.

Discussion:

A three-month, low-cost, self-facilitated series of dinner meetings for interprofessional clinical faculty decreased burnout and improved engagement, sense of connection to colleagues, and sense of departmental commitment to well-being. Structured discussion guides were not necessary to achieve benefit. This study broadens the possibilities for cost-effective opportunities to transform institutional culture and effectively enhance faculty well-being.
Barriers to Adoption of Electronic Health Record Systems from the Perspective of Nurses
Authors: Arikan Fatma , Kara Hava , Erdogan Emeti , Ulker Ferda
Published: November 2021

This study report aimed to investigate the barriers to implementation of electronic health record systems from the perspective of nurses. The research data comprised responses from nurses working in a university hospital. Our data collection instruments were the Participant Information Form and EHR Nurse Opinion Questionnaire, which were developed by the researchers. Data analysis was presented as summary statistics, including mean values of variables, standard deviation, frequency, and percentages. A total of 160 nurses participated in the study. The mean age of participants was 30.94 ± 0.59 years, and 77.5% were university graduates. Barriers to adoption of the electronic health record system included high number of patients (82.8%), limited time (79%), lack of knowledge and skills for effective use of the system (22.9%), lack of user-friendly interface and inability to create a common language within the team (17.8%), and attachment to the traditional method (17.2%). Although most nurses thought that the electronic health record system offered some advantages, they reported that factors such as large numbers of patients, limited time, and lack of user-friendly interface hindered its adoption. Innovative strategies should be explored to develop user-friendly designs for electronic health records and to produce solutions for nursing shortages to increase the time allocated for patient care.
Emergency care for chest pain in China: the unmet challenges
Authors: Wang Jiali , Xu Feng , Pang Jiaojiao , Zheng Wen , Chen Yuguo
Published: November 2021

Jiali Wang and colleagues discuss challenges owing to the assessment and management of patients presenting to emergency department with acute chest pain in China and effective strategies to lessen the pressure on health care systems and improve quality of care.
Validation of Self-reported Opioid Agonist Treatment Among People Who Inject Drugs Using Prescription Dispensation Records
Authors: Bouck Zachary , Tricco Andrea C. , Rosella Laura C. , Ling Vicki , Gomes Tara , Tadrous Mina , Fox Matthew P. , Scheim Ayden I. , Werb Dan
Published: November 2021

Background:

Studies of people who inject drugs (PWID) commonly use questionnaires to determine whether participants are currently, or have recently been, on opioid agonist treatment for opioid use disorder. However, these previously unvalidated self-reported treatment measures may be susceptible to inaccurate reporting.

Methods:

We linked baseline questionnaire data from 521 PWID in the Ontario integrated Supervised Injection Services cohort in Toronto (November 2018–March 2020) with record-level health administrative data. We assessed the validity (sensitivity, specificity, positive and negative predictive value [PPV and NPV]) of self-reported recent (in the past 6 months) and current (as of interview) opioid agonist treatment with methadone or buprenorphine–naloxone relative to prescription dispensation records from a provincial narcotics monitoring system, considered the reference standard.

Results:

For self-reported recent opioid agonist treatment, sensitivity was 78% (95% CI = 72, 83), specificity was 90% (95% CI = 86, 94), PPV was 90% (95% CI = 85, 93), and NPV was 79% (95% CI = 74, 84). For self-reported current opioid agonist treatment, sensitivity was 84% (95% CI = 78, 90), specificity was 87% (95% CI = 83, 91), PPV was 74% (95% CI = 67, 81), and NPV was 93% (95% CI = 89, 95).

Conclusions:

Self-reported opioid agonist treatment measures were fairly accurate among PWID, with some exceptions. Inaccurate recall due to a lengthy lookback window may explain underreporting of recent treatment, whereas social desirability bias may have led to overreporting of current treatment. These validation data could be used in future studies of PWID to adjust for misclassification in similar self-reported treatment measures.
How One Health System is Demonstrating the Right Way to Build a Smart Growth Strategy
Authors: Jacobson Catherine A. , Hawig Scott
Published: November 2021

Across the United States, health system growth has been tied to significant investments in physical growth such as the build-out of large, traditional hospitals. Concurrent with this infrastructure investment, value frequently has been sought by cost cutting and large-scale closures of lower-margin facilities.

At Froedtert Health, a philosophy of providing the right care at the right time in the right place is driving new growth. As the demand for unique tertiary services at its academic medical center has surged, Froedtert Health is leveraging and enhancing a new community hospital strategy while investing in new capability platforms to complement the health network’s care model across Wisconsin.
The Road to Value Demands a Smarter Approach to Risk
Authors: Fifer Joseph J.
Published: November 2021

As healthcare nears year three of the COVID-19 pandemic, hospitals and health systems should consider accepting significant responsibility for the total cost of care from all sources, per covered life, over time. One place to start: Reduce avoidable spending on chronic conditions, which, combined with mental health conditions, account for most healthcare expenditures. This shift will necessitate investments that strengthen the ability to identify at-risk populations and react in ways that help avoid complications and reduce unnecessary costs.

Even before the pandemic, it was clear that there were missed opportunities to reduce costs of care. Failures in care coordination contributed to billions of dollars in waste each year. Now, as payers explore innovative risk-based arrangements for addressing the impacts of social determinants of health and delayed care on health outcomes, healthcare providers should seek opportunities to partner with payers in developing shared-risk approaches to patient engagement and chronic condition management. Steps toward designing a model for risk innovation include rewarding physicians and clinicians for managing the total cost of care, involving physicians in discussions around acceptable levels of risk in value-based contracts, ensuring that the organization’s cost accounting approach meets its strategic needs, investing in actuaries to study data that can identify rising-risk patients, and exploring innovative partnerships for funding the infrastructure for value.
Factors Associated With Cardiac Rehabilitation Participation in Older Adults After Myocardial Infarction
Authors: Goldstein David W. , Hajduk Alexandra M. , Song Xuemei , Tsang Sui , Geda Mary , Dodson John A. , Forman Daniel E. , Krumholz Harlan , Chaudhry Sarwat I.
Published: November 2021

Purpose:

Cardiac rehabilitation (CR) is a key aspect of secondary prevention following acute myocardial infarction (AMI). While there is growing evidence of unique benefits of CR in older adults, it remains underutilized. We aimed to examine specific demographic, clinical, and functional factors associated with utilization of CR among older adults hospitalized with AMI.

Methods:

Our project used data from the SILVER-AMI study, a nationwide prospective cohort study of patients age ≥75 yr hospitalized with AMI and followed them up for 6 mo after discharge. Extensive baseline data were collected on demographics, clinical and psychosocial factors, and functional and sensory impairments. The utilization of CR was collected by a survey at 6 mo. Backward selection was employed in a multivariable-adjusted logistic regression model to identify independent predictors of CR use.

Results:

Of the 2003 participants included in this analysis, 779 (39%) reported participating in CR within 6 mo of discharge. Older age, longer length of hospitalization, having ≤12 yr of education, visual impairment, cognitive impairment, and living alone were associated with decreased likelihood of CR participation; receipt of diagnostic and interventional procedures (ie, cardiac catheterization, percutaneous coronary intervention, and coronary artery bypass graft) was associated with increased likelihood of CR participation.

Conclusions:

Demographic and clinical factors, as well as select functional and sensory impairments common in aging, were associated with CR participation at 6 mo post-discharge in older AMI patients. These results highlight opportunities to increase CR usage among older adults and identify those at risk for not participating.
Differential biomechanics in resistance arteries of male compared with female Dahl hypertensive rats
Authors: Mensah Eric A. , Daneshtalab Noriko , Tabrizchi Reza
Published: November 2021

Background:

Increase in vascular stiffness is associated with a higher risk of cardiovascular morbidity and mortality and is likely sex-specific.

Method:

Our objectives were to compare structural and functional alterations in small resistance arteries as related to vascular stiffness from Dahl salt-sensitive male and female rats (n = 8, mean ± s.e.m.).

Results:

Arterial blood pressure and pulse wave velocity were significantly (P < 0.05) elevated in males (161 ± 3 mmHg; 6.4 ± 0.2 m/s) and females (147 ± 2 mmHg; 5.5 ± 0.1 m/s) on a high (H) salt compared with regular (R) diets but were significantly higher in males (H) than in all others. Significant increases in collagen and smooth muscle cell areas were evident in ultrastructure of mesenteric arteries of hypertensive males compared to normotensive or corresponding females. There were no significant differences in composite Young's modulus (CYM) between groups. Vasoconstriction resulted in significantly higher CYM in male (H: 8.6 ± 1 KPa) than R (4.5 ± 0.8 KPa), and the corresponding females (H: 5.6 ± 0.6 KPa and R: 5 ± 0.9 KPa). In contrast, vasodilation significantly reduced CYM in the male groups (H: 2.5 ± 0.4 KPa and R: 2.7 ± 0.5 KPa) compared with the corresponding values in females (H: 4.2 ± 0.6 KPa and R: 5 ± 0.5 KPa). Moreover, the slope of pressure-volume curves revealed significantly greater distended vascular compliance in male H than R, and the corresponding females.

Conclusion:

Our findings are supportive of a link between high salt intake and elevated blood pressure as being sex specific, likely involving sex-dependent changes in ultrastructure of the vessels, which ultimately may alter the biomechanics, and thus, the haemodynamic functions of both macro-circulation and micro-circulations.
Natural products against HIV latency
Authors: Otsuki Kouharu , Zhang Mi , Li Wei
Published: November 2021

Antiretroviral therapy has achieved great success in suppressing human immunodeficiency virus (HIV) replication and transforming HIV infection from a fatal disease to a manageable chronic disease. However, the latent HIV reservoir persists in the body of HIV-infected individuals and is prone to reactivation. Therefore, the development of new treatment methods aimed at a complete cure for HIV is needed. The leading strategy for HIV eradication is based on eliminating and preventing the reactivation of latent reservoirs through an approach known as “shock and kill.” This strategy involves the use of latency-reversing agents (LRAs) to activate the HIV provirus in latent viral reservoir cells. Many LRAs can be obtained from natural resources, including plants and marine organisms. In this review, we provide an overview of natural products used to eliminate HIV latency.
Noninferiority Study Comparing Latanoprost 0.005% Without Versus With Benzalkonium Chloride in Open-Angle Glaucoma or Ocular Hypertension
Authors: Wirta David , Malhotra Ranjan , Peace James , Shen Lee Bridgitte , Mitchell Brittany , Sall Kenneth , McMenemy Matthew
Published: November 2021

Objectives:

To evaluate the noninferiority of intraocular pressure (IOP)-lowering latanoprost without benzalkonium chloride (BAK) versus latanoprost with BAK (for treatment of open-angle glaucoma or ocular hypertension).

Methods:

Overall, 578 patients were randomized 1:1 to latanoprost without BAK or latanoprost with BAK once daily in the affected eye(s) for 12 weeks. The primary efficacy endpoint was IOP, measured on days 0, 7, 28, 56, and 84 (8 am, 10 am, and 4 pm). Noninferiority was established if the following criteria were met: 95% confidence interval (CI) of the mean difference between treatments included 0 mm Hg for all time points (N1), 95% CI upper limit less than 1.5 mm Hg (N2), and less than 1 mm Hg for≥7 of 12 time points (N3). Primary efficacy analysis was performed on the intent-to-treat population. Safety measurements included ocular and systemic adverse event (AE).

Results:

The 95% CI included 0 mm Hg for 7/12 time points (N1), 95% CI upper limit was less than 1.5 mm Hg for 12/12 time points (N2), and less than 1.0 mm Hg for 4/7 time points (N3). AEs were mild and similarly distributed between groups.

Conclusions:

Latanoprost without BAK did not meet two of three criteria for noninferiority and showed a similar safety profile relative to latanoprost with BAK.
Neurotrophic Keratitis in a Pediatric Patient With Goldenhar Syndrome and Trigeminal Aplasia Successfully Treated by Corneal Neurotization
Authors: Rollon-Mayordomo Angel , Mataix-Albert Beatriz , Espejo-Arjona Francisco , Herce-Lopez Javier , Lledo-Villar Leticia , Caparros-Escudero Carlos , Infante-Cossio Pedro
Published: November 2021

Herein, the authors report an unusual case of a 6-year-old boy with right-sided Goldenhar syndrome and trigeminal nerve aplasia who developed neurotrophic keratopathy (NK). Despite the use of therapeutic contact lenses and multiple temporary tarsorrhaphy, NK worsened showing a central corneal scar, neovascularization, and significant stromal thinning, with risk of corneal perforation. Cochet-Bonnet esthesiometry revealed complete corneal anesthesia. To minimize additional corneal complications, the patient underwent indirect corneal neurotization by a sural nerve autograft anastomosed to the contralateral supratrochlear nerve. At 24-month follow up, no epithelial defects, complications, or recurrence were observed. Significant improvements in corneal sensitivity with esthesiometry score of 20 mm and reflex blinking were achieved. This case highlights corneal anesthesia should be suspected among Goldenhar syndrome ophthalmologic abnormalities and monitored before corneal changes become irreversible. Since corneal neurotization can successfully improve corneal sensation, it could be considered as an early therapeutic option to avoid refractory NK.
Evidence-Based Blepharoplasty: An Analysis of Highly Cited Research Papers
Authors: Charles Walton N. , Lim Hong Kai , Charles Roselin C. , Basta Mhafrin , Khajuria Ankur
Published: November 2021

Purpose:

The purpose of the study was to appraise the methodological quality of the highest impact blepharoplasty research and to describe prevalent research themes.

Methods:

The 100 most highly cited research papers relevant to blepharoplasty were obtained from Web of Science, with no journal or date limitations applied. Data extraction included the study design, main research topic and specialty, outcome measures, and citation count. Each paper’s level of evidence was independently evaluated by 2 authors according to the Oxford Centre for Evidence-Based Medicine system.

Results:

Overall, the 100 most cited blepharoplasty research papers were cited by 4,194 papers. The mean number of citations for each paper was 73 (range: 42–239). Most of the papers presented level 4 (n = 51) or level 5 (n = 35) evidence, which is consistent with the predominance of case series (n = 47) and expert opinions (n = 18) amongst study designs. No papers achieved level 1 (highest) evidence. Six papers presented level 2 evidence and 8 papers presented level 3. Significant research foci included innovative surgical techniques (n = 65) and anatomical considerations (n = 10), with reconstructive and cosmetic implications. Senior authors were mainly affiliated with centers of plastic (n = 53) or ophthalmic/oculoplastic (n = 34) surgery. Only 3 papers used validated subjective or objective cosmetic outcome measures.

Conclusions:

Despite a significant impact on current practice, the level of evidence of the highly cited blepharoplasty research was predominantly low. Robust research methodology, through well-designed studies and standardized outcome measures, is necessary to facilitate evidence synthesis and guide clinical practice.
Functional brain mapping in patients with chronic back pain shows age-related differences
Authors: Baran Timothy M. , Lin Feng V. , Geha Paul
Published: November 2021

Low back pain is the most common pain condition and cause for disability in older adults. Older adults suffering from low back pain are more disabled than their healthy peers, are more predisposed to frailty, and tend to be undertreated. The cause of increased prevalence and severity of this chronic pain condition in older adults is unknown. Here, we draw on accumulating data demonstrating a critical role for brain limbic and sensory circuitries in the emergence and experience of chronic low back pain (CLBP) and the availability of resting-state brain activity data collected at different sites to study how brain activity patterns predictive of CLBP differ between age groups. We apply a data-driven multivariate searchlight analysis to amplitude of low-frequency fluctuation brain maps to classify patients with CLBP with >70% accuracy. We observe that the brain activity pattern including the paracingulate gyrus, insula/secondary somatosensory area, inferior frontal, temporal, and fusiform gyrus predicted CLBP. When separated by age groups, brain patterns predictive of older patients with CLBP showed extensive involvement of limbic brain areas including the ventromedial prefrontal cortex, the nucleus accumbens, and hippocampus, whereas only anterior insula paracingulate and fusiform gyrus predicted CLBP in the younger patients. In addition, we validated the relationships between back pain intensity ratings and CLBP brain activity patterns in an independent data set not included in our initial patterns' identification. Our results are the first to directly address how aging affects the neural signature of CLBP and point to an increased role of limbic brain areas in older patients with CLBP.