bluuebunny/crossref_metadata_2025 huggingface dataset:
A cryogenic circuit cools from afar
Authors: Miller Johanna L.
Published: November 2021

A cloud of ultracold ions can lower the temperature of a trapped proton 9 cm away.
How visual metaphors can contradict verbal occurrences
Authors: Augé Anaïs
Published: November 2021

We investigate the different interpretations related to the metaphorical
imprint
of climate change in English and French media discourses. This cross-linguistic perspective is motivated by the particularities of both languages which have been assumed to promote different understandings of climate change-related concepts. We focus on the metaphor
carbon footprint
whose meaning can be compared to another climate change metaphor in English:
fingerprint
. These two source domains share a highly specific and concrete meaning interpreted from lexical constructions enabled by the English language. In French, however, such a specification cannot be interpreted from the meaning of the metaphor
empreinte carbone
(
carbon imprint
) which defines a similar concept. We rely on visual representations of these metaphorical expressions in English and French to discuss the characteristics associated with each source domain: we show that visual metaphors can contradict expectations emerging from the interpretations of verbal metaphors.
Fundamental sensitivity bounds for quantum enhanced optical resonance sensors based on transmission and phase estimation
Authors: Dowran Mohammadjavad , Woodworth Timothy S. , Kumar Ashok , Marino Alberto
Published: November 2021

Quantum states of light can enable sensing configurations with sensitivities beyond the shot-noise limit (SNL). In order to better take advantage of available quantum resources and obtain the maximum possible sensitivity, it is necessary to determine fundamental sensitivity limits for different possible configurations for a given sensing system. Here, due to their wide applicability, we focus on optical resonance sensors, which detect a change in a parameter of interest through a resonance shift. We compare their fundamental sensitivity limits set by the quantum Cramér-Rao bound (QCRB) based on the estimation of changes in transmission or phase of a probing bright two-mode squeezed state (bTMSS) of light. We show that the fundamental sensitivity results from an interplay between the QCRB and the transfer function of the system. As a result, for a resonance sensor with a Lorentzian lineshape a phase-based scheme outperforms a transmission-based one for most of the parameter space; however, this is not the case for lineshapes with steeper slopes, such as higher order Butterworth lineshapes. Furthermore, such an interplay results in conditions under which the phase-based scheme provides a higher sensitivity but a smaller degree of quantum enhancement than the transmission-based scheme. We also study the effect of losses external to the sensor on the degree of quantum enhancement and show that for certain conditions, probing with a classical state can provide a higher sensitivity than probing with a bTMSS. Finally, we discuss detection schemes, namely optimized intensity-difference and optimized homodyne detection, that can achieve the fundamental sensitivity limits even in the presence of external losses.
Effect of silane treatments on mechanical performance of kenaf fibre reinforced polymer composites: a review
Authors: Nurazzi N M , Shazleen S S , Aisyah H A , Asyraf M R M , Sabaruddin F A , Mohidem N A , Norrrahim M N F , Kamarudin S H , Ilyas R A , Ishak M R , Abdullah N , Nor N M
Published: November 2021

Natural cellulosic fibres, such as kenaf, can be used in polymeric composites in place of synthetic fibres. The rapid depletion of synthetic resources such as petroleum and growing awareness of global environmental problems associated with synthetic products contribute to the acceptance of natural fibres as reinforcing material in polymer composite structures. In Africa and Asia, kenaf is considered a major crop used for various cordage products such as rope, twine, and burlap and in construction, it is used for thermal insulation of walls, floors, and roofs and soundproofing solutions. In the furniture and automotive industry, it is used to manufacture medium-density fibreboard and other composite materials for structural applications. Kenaf is primarily composed of cellulose (approximately 40%–80%), which accounts for its superior mechanical performance. Kenaf fibres are chemically treated before mixing with the polymer matrix to improve their fibre interaction and composite performance. The alkaline treatment with sodium hydroxide (NaOH) solution is the most frequently used chemical treatment, followed by a silane treatment. Numerous chemical concentrations of NaOH and silane solutions are investigated and several combined treatments such as alkaline-silane. The present review discusses the effect of silane treatments on the surface of kenaf fibre on the fabrication of polymer composites and their mechanical properties.
Standardized Anatomic and Regenerative Facial Fat Grafting: Objective Photometric Evaluation 1 to 19 Months After Injectable Tissue Replacement and Regeneration
Authors: Cohen Steven R , Wesson Jordan , Willens Sierra , Nadeau Taylor , Hillman Chloe , Dobke Marek , Tiryaki Tunc
Published: November 2021

Background

A standardized technique for facial fat grafting, injectable tissue replacement and regeneration (ITR2), incorporating new regenerative approaches, was developed to address anatomic volume losses in superficial and deep fat compartments as well as skin aging.

Objectives

The aim of this study was to track the short- and long-term effects of facial fat grafting by ITR2 in the midfacial zone over 19 months.

Methods

Twenty-nine females were analyzed for midfacial volume changes after autologous fat transfer with ITR2 with varying fat parcel sizes. Volumes were evaluated with an imaging system to calculate differences between a predefined, 3-dimensional midfacial zone measured preoperatively and after fat grafting.

Results

Patient data were analyzed collectively and by age (<55 and >55 years). Collective analysis revealed a trend of initial volume loss during Months 1 to 7 followed by an increase during Months 8 to 19, averaging 56.6% postoperative gain, and ending at an average of 52.3% gain in volume by 14 to 19 months. A similar trend was observed for patients <55 years of age, with a 54.1% average postoperative gain and a greater final average of 75.2%. Conversely, patients >55 years of age revealed a linear decay from 60.6% to 29.5%. Multiple regression analysis revealed no statistically significant influence of weight change throughout the study.

Conclusions

A dynamic change in facial volume was observed, with an initial decrease in facial volume followed by a rebound effect, by 19 months after treatment, of improved facial volume regardless of the amount of fat injected. Volume improvement was greater in patients <55 years old, whereas in patients >55 years old, volume gradually decreased. This study represents the first time that progressive improvement in facial volume has been shown 19 months after treatment.

Level of Evidence: 4
Bridging the gap between cyberwar and cyberpeace
Authors: Burton Joe , Christou George
Published: November 2021

The conceptual debate around the term cyber warfare has dominated the cybersecurity discipline over the last two decades. Much less attention has been given during this period to an equally important question: what constitutes cyber peace? This article draws on the literatures in peace and conflict studies and on desecuritization in critical security studies, to suggest how we might begin to rearticulate the cybersecurity narrative and shift the debate away from securitization and cyberwar to a more academically grounded focus on desecuritization and cyber peace. It is argued that such a move away from a vicious circle where states frame cybersecurity predominantly within a national security narrative and where they seek to perpetually prepare for cyberwar, to a virtual cycle of positive cyber peace, is not only a desirable, but a necessary outcome going forward. We assert that this is particularly important if we are to avoid (continuing) to construct the very vulnerabilities and insecurities that lead to the prioritization of offence and destruction in cyberspace, rather than transformative, human-centred development in information and communications technology innovation.
Djiboutian sovereignty: worlding global security networks
Authors: Cobbett Elizabeth , Mason Ra
Published: November 2021

The research problem this article addresses is whether the unique confluence of overseas security forces in a single territorial space through the leasing of land for foreign military bases compromises the state's sovereignty. We study Djibouti's practice of renting land to military powers from an analytical position that is diametrically opposed to the literature on the ‘scramble’ for Africa and often erroneous assumptions of an erosion of sovereignty. Using the concept of ‘worlding’, we argue in this article that instead of reading ‘military base diplomacy’ as eroding and undermining Djibouti's sovereignty, this case demonstrates the ways in which ‘the art of being global’ underpins new forms of territoriality and unexpected forms of locality in Africa. Consequently, we maintain that African experiences of sovereignty offer the challenges, along with the rewards, of greater analytical depth to International Relations scholarship while expanding our understanding of different empirical cases beyond the western-centric accounts of sovereignty in line with an abstract ideal that does not tell us much about the world, postcolonial experiences and global politics. Through a case-study approach, we focus specifically on the stark distinctions between Japan and China, which both have their respective first postwar overseas military bases in the country, and the Djiboutian state itself, in terms of how each are interpreting and practicing sovereignty to fit their own national narrative, international status and domestic legal frameworks. The findings challenge simplistic analyses of African states as victims of exploitative Great Powers, gradually and repeatedly being stripped of their sovereignty.
April 12, 2005—Letting Go and Mastering Fear
Authors: McQuellon Richard P.
Published: November 2021

The central themes of this dialogue are mastery of fear and letting go of worldly anchoring activities such as reading the New York Times. Reading the poetry of Mary Oliver and listening to classical music help to settle emotions and the restless mind. The tumor is growing so large that it is causing breathing problems, frightening Nell. She is worried that she might suffocate and feels panic when short of breath. She is working closely with her hospice team on the task of symptom management, especially pain and shortness of breath. Nell has found comfort in the simple acts of watching a television program with spouse Al and her treasured cat Amber curled up beside her. Her activities distract her from the ripple of fear that moves through her when she becomes short of breath and contemplates the unknown of dying.
Inference and Inductive Risk
Authors: Johnson L. Syd M
Published: November 2021

Several types of inferences are common in the diagnosis and prognosis of brain injuries. These inferences, although necessary, introduce epistemic uncertainty. This chapter details the various inferences and considers the concept of inductive risk, introduced by Richard Rudner in the 1950s, and the problem of inductive risk: given uncertainty, what is the appropriate epistemic standard of evidence for accepting a scientific (or medical) hypothesis? Two principles of inductive risk are proposed to tackle the problem of inductive risk present in disorders of consciousness (and other medical contexts): the First Principle calls on us to index epistemic risk-taking to the level of ethical risk, thus constraining acceptable epistemic risk-taking. The Second Principle tells us to index ethical risk-taking to the level of epistemic risk, thus constraining ethical risk-taking to a level commensurate with epistemic uncertainty.
The Ethics of Uncertainty
Authors: Johnson L. Syd M
Published: November 2021

The ethics of uncertainty is an approach to ethical decision-making under conditions of uncertainty. Two legal cases involving patients in the minimally conscious state—Robert Wendland, and a U.K. patient known as M—illustrate the difficulty and complexity of making decisions when so much is unknown about the experiences and minds of these patients. The ethics of uncertainty refocuses ethical enquiry concerning patients with disorders of consciousness, placing less emphasis on their contested personhood and more on inductive risk, on respect for autonomy, and on justice, especially epistemic justice, and the duties of privileged epistemic agents like physicians and medical staff. It encourages an expansive All Things Considered approach to ethical decision-making where the goal is not to arrive at clean, consistent, abstract, ideal decisions for an ideal world, but to enable decision makers facing complexity and uncertainty to fulfill their duties as moral and epistemic agents.
Individual strategies for successful ageing
Authors: Tesch-Römer Clemens , Wahl Hans-Werner , Rattan Suresh I. S. , Ayalon Liat
Published: November 2021

Individual strategies are necessary for successful ageing. Three of the models discussed in the previous chapter—the pragmatic, hedonic, and eudaimonic models—put particular emphasis on individuals’ striving to reach their desired endpoints: to be fit, autonomous and engaged; to be happy; or to be wise, respectively. Nevertheless, the primary responsibility for successful ageing lies mainly in the hands of the individual, although external factors may be in place to support the individual’s effort to age successfully. At present, ageing research has focused to a large extent on individual strategies and resources for successful to the individual level. The main results from ageing research are discussed in this chapter.
Social inequality, the welfare state, and successful ageing
Authors: Tesch-Römer Clemens , Wahl Hans-Werner , Rattan Suresh I. S. , Ayalon Liat
Published: November 2021

Social inequality is one of the major challenges for successful ageing, and the welfare state may alleviate some of the unjust and unfair allocations of resources within a population. Socio-economic differences between individuals permeate life courses from conception to death. The concept of ‘inequality’ points to vertical differences between individuals in connection with unevenly distributed access to goods and resources of value, such as education, prestige, income, and wealth. The disposal of valued resources draws the line between those who have and those who have not. Important facets of social inequality are education, income, wealth, gender, and race. Considering diversity and inequality in a population, welfare states reveal themselves as central actors in shaping requirements for successful ageing.
Peripheral nerve stimulation trial and implantation
Authors: Ferguson Kris , Abd-Elsayed Alaa
Published: November 2021

This chapter will detail the surgical recommendations and step-by-step approaches for both trial stimulation and permanent implantation of peripheral nerve stimulation to treat sacroiliac joint pain. It also provides a brief history of this procedure, which has evolved from being a procedure that required careful, open dissection of the target nerve to a sleek treatment requiring only image guidance and a minimally invasive percutaneous approach. A trial stimulation period typically ranges from 7 to 14 days; steps for the trial simulation procedure include preparation, target point identification, and lead insertion. Additional topics for the permanent implantation procedure include tunneling and pocket dissection.
Preoperative considerations
Authors: Fiala Kenneth , Martens Joshua , Abd-Elsayed Alaa
Published: November 2021

Sacroiliac joint fusion surgery is an option for patients whose sacroiliac joint pain has been refractory to conservative pain management. A good candidate for fusion surgery is one who has completed all appropriate nonsurgical management efforts, including physical therapy, intraarticular sacroiliac steroid injections, oral analgesics, and radiofrequency ablation of sacral nerve roots, without experiencing any improvement in pain. This chapter covers candidate selection, the two main surgical approaches used for this fusion surgery (open and minimally invasive), anticoagulation guidelines, and the risk of infection and complications. Before surgery it is very important to make sure the patient understands the risks of the surgery as well as the potential for success.
Posterior fusion
Authors: Ullger Cory , Jayakumar Mogana V. , Jassal Navdeep
Published: November 2021

Sacroiliac joint pain and dysfunction has increasingly been identified as an important pain generator in patients with chronic back pain or failed back surgery syndrome. It is estimated up to 30% of patients presenting with low back pain will have contributions from a painful sacroiliac joint. Historically, fusion of the joint has been performed with an open posterior or posterolateral approach. Minimally invasive surgical (MIS) approaches were introduced in 2008, and since that time MIS posterior and lateral approaches have become common. Numerous medical device companies have marketed MIS systems, and evidence of safety and efficacy is mounting. This chapter will detail the posterior approaches using fluoroscopic and navigation system guidance. Evidence for safety and efficacy of posterior sacroiliac joint fusion approaches will also be discussed.
The pharynx
Authors: van Gijn Daniel R. , Dunne Jonathan
Published: November 2021

The pharynx is the cranial limit of the alimentary tract and lies behind the nasal, oral and laryngeal cavities – extending from the skull base to the sixth cervical vertebrae. It consists of a thick muscular tube formed from the three constrictor muscles, stylopharyngeus, palatopharyngeus and salpingopharyngeus – lined by the pharyngobasilar fascia internally and buccopharyngeal fascia externally. The nasopharynx communicates with the nasal cavity anteriorly and laterally with the middle ear via the eustachian tubes. The oropharynx extends from the soft palate superiorly to the superior border of the epiglottis below, communicating with the nasopharynx above via the pharyngeal isthmus and oral cavity in front via the oropharyngeal isthmus. It is characterised by Waldeyer’s lymphatic ring. The hypopharynx extends from the epiglottis to the lower border of the cricoid cartilage, where it continues as the oesophagus. Its anterior wall is formed by the inlet of the larynx superiorly and posterior part of the cricoid cartilage inferiorly.
The face, scalp, and temporal region
Authors: van Gijn Daniel R. , Dunne Jonathan
Published: November 2021

The face conveys our conscious and subconscious emotions and projects vulnerability in disfigurement. Functionally, the face encompasses the muscles that surround our eyes, nose and mouth, contributing to the sphincters and dilators that allow the fine motor control of our eyelids, nostrils and lips, respectively. The face forms the anterior part of the head medial to the ears and between the hairline superiorly and the chin inferiorly. It comprises everything that lies between what is visible anteriorly and laterally. The face consists of four recognisable tissue planes – skin, a subcutaneous layer of fibroadipose tissue (held responsible for some of the changes of the ageing face), the superficial muscular aponeurotic system and the parotidomasseteric fascia. The scalp forms the soft tissue envelope of the cranial vault. The triad it forms with the forehead anteriorly and the temporal regions laterally should be considered as a continuum rather than three separate entities.
Malaria
Authors: Marsh Kevin
Published: November 2021

Epidemiology, Clinical features, Severe malaria, Differential diagnosis, Diagnosis, General management, Antimalarial chemotherapy, Treatment of severe malaria, Prevention, Monitoring antimalarial drug resistance
Cardiovascular medicine
Authors: Ntusi Ntobeko , Mayosi Bongani
Published: November 2021

Cardiology in resource-poor countries?, Cardiac arrest and advanced life support protocols?, Chest pain?, Shock?, Hypertension?, Angina?, Myocardial infarction?, Cardiac arrhythmias?, Syncope, Heart failure?, Rheumatic fever and rheumatic heart disease?, Infective endocarditis?, Pericardial disease?, Myocarditis, Cardiomyopathies?
Sexually transmitted infections
Authors: Williams Henrietta
Published: November 2021

Why are sexually-transmitted infections important??, Syndromic management of sexually-transmitted infections?, Syphilis?, Gonorrhoea?, Chlamydial infections?, Chancroid?, Granuloma inguinale donovanosis?, Trichomoniasis?, Bacterial vaginosis?, Genital herpes?, Candida vaginitis?, Human papillomavirus and genital warts?
Mental health
Authors: Hanlon Charlotte , Limenhe Asnake
Published: November 2021

Suicide and deliberate self-harm?, Acute behavioural disturbance?, Common mental disorders?, Severe mental disorders psychoses?, Disorders due to substance abuse?, Withdrawal states?, Adjustment disorders and bereavement?, Post-traumatic stress disorder?, Intellectual learning disability?, Disorders in children and adolescents?
I Can Get Fat Where? The Other Types of Fat
Authors: Denton Nathan
Published: November 2021

This chapter considers the more obscure non-white types of adipose tissue present in the human body. The first and better-known type discussed is brown fat, which contributes to the regulation of body temperature as it burns (excess) calories to generate heat. The second section explores the biology of bone marrow fat, whose enigmatic behaviour in the context of starvation and obesity does little to help define its role. After considering the relationship between bone marrow adipose tissue, bone strength, and overall metabolic health, this chapter concludes by briefly reviewing other, lesser-known types of (white) fat (e.g., epicardial fat) and their potential contribution to human biology.
Introduction to ethics
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter introduces the concept of medical ethics. It describes how the ancient Hippocratic Oath and its more modern formulations have provided a basis for ethical practice. It emphasises the importance of critical thinking, requiring reasons for acting in a particular way
Other issues of liability
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter explains when a person can be liable for failing to act. It also explores the concept of vicarious liability whereby a public body or company can be liable for the acts of employees. It also considers the circumstances in which a company can itself be liable for a crime. The chapter addresses the possibility of no fault liability which is used in some jurisdictions.
Situational Awareness: Forecasting Successful Military Medical Teams
Authors: Cruthirds Danette F , Bader-Larsen Karlen S , Hamwey Meghan , Varpio Lara
Published: November 2021

Introduction

Military healthcare providers working in military interprofessional healthcare teams (MIHTs) require situational awareness (SA) to ensure safe and efficacious patient care. This study aimed to explore SA in MIHTs to understand how SA can be reinforced and maintained in MIHTs. The research team set out to answer two questions: “What aspects of individual and team SA are particularly important for MIHTs?” and “How can we enable military healthcare providers to be effective MIHTs members with robust SA?”.

Methods

This study used Grounded Theory methodology collecting perspectives from 30 study participants from various backgrounds, including 11 different healthcare professions from the U.S. Army, Air Force, and Navy. Each study participant had experiences participating in, leading one, or leading many MIHTs. Data were collected in three cycles and analyzed within each cycle until saturation was reached.

Results

Five themes were robustly represented in the data set regarding SA: (1) contextually informed adaptability, (2) readiness, (3) trust, (4) communication, and (5) mission focus.

Conclusions

The urgency often faced by MIHTs brings SA and the principles that underpin SA into sharper focus. The SA themes identified in this research may provide insight into training effectiveness, team strengths and weaknesses, and team performance.
Frequency, etiologies, risk factors, and sequelae of falls among patients with brain metastases: A population- and institutional-level analysis
Authors: Lamba Nayan , Cao Fang , Cagney Daniel N , Catalano Paul J , Haas-Kogan Daphne A , Wen Patrick Y , Aizer Ayal A
Published: November 2021

Background

Falls in patients with cancer harbor potential for serious sequelae. Patients with brain metastases (BrM) may be especially susceptible to falls but supporting investigations are lacking. We assessed the frequency, etiologies, risk factors, and sequelae of falls in patients with BrM using 2 data sources.

Methods

We identified 42 648 and 111 patients with BrM utilizing Surveillance, Epidemiology, and End Results (SEER)-Medicare data (2008-2016) and Brigham and Women’s Hospital/Dana-Farber Cancer Institute (BWH/DFCI) institutional data (2015), respectively, and characterized falls in these populations.

Results

Among SEER-Medicare patients, 10 267 (24.1%) experienced a fall that prompted medical evaluation, with cumulative incidences at 3, 6, and 12 months of 18.0%, 24.3%, and 34.1%, respectively. On multivariable Fine/Gray’s regression, older age (≥81 or 76-80 vs 66-70 years, hazard ratio [HR] 1.18 [95% CI, 1.11-1.25], P < .001 and HR 1.10 [95% CI, 1.04-1.17], P < .001, respectively), Charlson comorbidity score of >2 vs 0-2 (HR 1.08 [95% CI, 1.03-1.13], P = .002) and urban residence (HR 1.08 [95% CI, 1.01-1.16], P = .03) were associated with falls. Married status (HR 0.94 [95% CI, 0.90-0.98], P = .004) and Asian vs white race (HR 0.90 [95% CI, 0.81-0.99], P = .03) were associated with reduced fall risk. Identified falls were more common among BWH/DFCI patients (N = 56, 50.4% of cohort), resulting in emergency department visits, hospitalizations, fractures, and intracranial hemorrhage in 33%, 23%, 11%, and 4% of patients, respectively.

Conclusions

Falls are common among patients with BrM, especially older/sicker patients, and can have deleterious consequences. Risk-reduction measures, such as home safety checks, physical therapy, and medication optimization, should be considered in this population.
Effect of PINK1 and Parkin gene silencing on sodium arsenite-induced mitophagy in normal rat liver cells (BRL-3A)
Authors: Hu Ting , Wu Changyan , Jian Wen , Wu Liping , Zuo Peipei , Zeng Qibing , Luo Peng
Published: November 2021

NaAsO2-induced liver damage leads to autophagy, which plays an important role in cell quality control. Mitophagy plays an important role in hepatocyte damage, and PINK1 and Parkin constitute an important pathway in mitophagy. PINK1 selectively degrades abnormal mitochondria, and Parkin can recognize damaged mitochondria. However, the mechanism underlying the involvement of PINK1/Parkin in NaAsO2-induced mitophagy is unclear. Transfection plasmids containing dsRNA were used to interfere with the expression of Parkin in the following groups: the empty plasmid group was established by add the empty plasmid only, the PINK1-knockdown (KD) group was established by adding 5 μg of PINK1 dsRNA and then by adding 10 mM NaAsO2, and the Parkin-KD group was established by adding 5 μg of Parkin dsRNA and then by adding 10 mM NaAsO2. The expression of PINK1 and Parkin in autophagy was detected by western blotting and immunofluorescence staining. The ultrastructures of autophagosomes and mitochondria were observed by transmission electron microscopy. The successful KD of PINK1 and Parkin aggravated the NaAsO2-induced damage to mitophagy. The degeneration of mitochondrial vacuoles and the appearance of autophagosomes were detected in the NaAsO2, NaAsO2 + PINK1-KD and NaAsO2 + Parkin-KD groups. NaAsO2 can induce mitophagy in rat hepatocytes, and the silencing of PINK1 and Parkin can aggravate mitochondrial damage during this process. This study explored the mechanism of NaAsO2-induced mitophagy in BRL-3A cells after PINK1 and Parkin gene silencing.
A Proposal for Addiction and Infectious Diseases Specialist Collaboration to Improve Care for Patients With Opioid Use Disorder and Injection Drug Use-Associated Infective Endocarditis
Authors: Cortes-Penfield Nicolas , Cawcutt Kelly , Alexander Bryan T. , Karre VaKara M. Meyer , Balasanova Alëna A.
Published: October 2021

Patients with injection drug use-associated infective endocarditis and opioid use disorder often receive treatment for the infection that fails to address its underlying cause. People who inject drugs (PWID) and develop serious infections also face disparities in antibiotic management, particularly with regards to use of outpatient parenteral antimicrobial therapy (OPAT). We highlight literature on OPAT in PWID challenging the notion that PWID cannot be managed with OPAT. Given that OPAT use amongst PWID and non-PWID yields similar outcomes, we argue that a bias against OPAT use in PWID is unwarranted and may reflect stigma rather than data. We further note the proven value of comprehensive OUD treatment on endocarditis treatment outcomes, which also addresses the potential safety concerns of OPAT in PWID, and propose a treatment model in which Addiction and Infectious Disease specialists collaborate to integrate opioid use disorder treatment into injection drug use-associated infective endocarditis care.
Rinse But Don’t Repeat: Single Application V.A.C. VERAFLO Salvages Infected Breast Prostheses
Authors: Antognoli Lauren E. , Singh Devinder P. , Choudhry Salman , Turcotte Justin , Holton Luther H.
Published: October 2021

Introduction:

Existing salvage protocols for infected breast prostheses using negative pressure wound therapy with instillation and dwell (NPWTi-d) require multiple returns to the operating room and prolonged length of stay. We present our expedited salvage protocol and discuss outcomes and associated costs savings.

Methods:

Using a retrospective review, we identified 25 consecutive patients (27 breasts) with peri-prosthetic breast infection. Nine patients (10 breasts) underwent removal of infected breast prostheses followed by autologous or staged implant-based reconstruction. Sixteen patients (17 breasts) underwent our single application salvage protocol. A cost analysis was performed comparing the two groups, and an economic model was used to project the cost savings associated with using single application NPWTi-d protocol.

Results:

Fifteen of the 16 patients (94%) who underwent single application NPWTi-d had successful implant salvage. Average duration of NPWTi-d was 2 days, 7 hours, and average length of stay was 4.43 days. Compared to control, patients who received the single application protocol required significantly fewer hospitalizations and office visits. A total savings of $58,275 could have been achieved by using the single application NPWTi-d protocol in the patients who did not undergo NPWTi-d.

Conclusions:

Single application of NPWTi-d is a simple, safe, and cost-effective technique for salvage of breast prostheses, with 94% success rate, even in immunocompromised patients and severe infection. Compared to previous protocols, ours requires fewer trips to the operating room, shorter length of stay, and more permanent implants placed during salvage. Our protocol is also associated with fewer office visits and fewer returns to the operating room.
Routine left atrial appendage occlusion in patients undergoing cardiac surgery: a narrative review
Authors: Fatima Rubab , Dhingra Nitish K. , Ribeiro Roberto , Bisleri Gianluigi , Yanagawa Bobby
Published: November 2021

Purpose of review

New evidence suggests a greater prevalence of protracted postoperative atrial fibrillation (POAF) than previously recognized. The left atrial appendage (LAA) is the most common source of embolism in patients with nonvalvular atrial fibrillation. In this review, we ask whether there is evidence to support routine LAA occlusion (LAAO) in patients without preexisting atrial fibrillation undergoing cardiac surgery.

Recent findings

Overall, available studies are small, inconsistent and have varying proportions of patients with and without preexisting atrial fibrillation. There is considerable discrepancy with respect to the efficacy of LAAO in reducing the risk of POAF-related stroke. Only one study reported a lower rate of stroke in the LAAO group compared with no LAAO. Two studies included a subgroup analysis of patients that developed POAF and report a significantly higher rate of stroke in patients that developed POAF and did not undergo LAAO. There are three clinical trials ongoing that are investigating prophylactic LAAO in patients undergoing cardiac surgery: ATLAS, LAA-CLOSURE and LAACS-2.

There is currently insufficient evidence to recommend routine addition of LAAO to lower the risk of postoperative stroke. Ongoing clinical trials will provide important insight into the role of routine LAAO in all patients undergoing cardiac surgery.
Time-Trends of U.S. Occupational Noise Standard Violations by OSHA Region and Industry Type
Authors: Park Sungwon , Park Chang Gi , Hong Oi Saeng
Published: November 2021

Objective:

We examined time-trends in Occupational Noise Standard violations by OSHA region and industry type over 48 years.

Methods:

Along with descriptive analysis of original data, negative binomial regression and Poisson regression were applied to the analysis of 1972 to 2019 and 1972 to 2012 data, respectively.

Results:

A small annual decrease in violation units over the periods was revealed. The three analyses produced differing timetrends. The manufacturing industry had more violations, and Region 4 had the most violations. Regarding numbers of units, the 10 regions and 2 industries were jointly significant. Some interaction between regions and industry types appeared in both regressions.

Conclusions:

OSHA should specify how many regions report noise violations each year to ensure accurate identification of noise-related health risks to American workers. Further time-trend studies are needed for specific regions and industry types.
Current practices in the management of central airway obstruction
Authors: Ratwani Ankush P. , Davis Andrea , Maldonado Fabien
Published: November 2021

Purpose of review

Airway obstruction continues to cause substantial pulmonary morbidity and mortality. We present a review of classic, current, and evolving management techniques, highlighting recently published studies on the topic. Recommendations have historically been primarily based on anecdotal experience, case reports, and retrospective studies, but more solid evidence has emerged in the last decade.

Recent findings

Novel endobronchial stents are being developed to mitigate the issues of stent migration, mucus plugging, fracture, and granulation tissue formation. Endobronchial drug delivery has become an active area of translational and clinical research, especially with regards to antineoplastic agents used for malignant airway stenosis. Even classic or updated techniques such as spray cryotherapy, injections of mitomycin-c, and balloon dilation have recently been examined in methodologically sound studies. Finally, recently published data have confirmed that patient breathlessness and quality of life improve significantly with therapeutic airway interventions. A multimodal and multidisciplinary approach to patient care is key to achieving the best outcomes.

The treatment of central airway stenosis is often multimodal and should focus on patient-centric factors, taking into account risks and benefits of the procedure, operator, and center expertise, and always occur in the context of a multidisciplinary approach. Evidence-based clinical research is increasingly driving patient management.
Management of pneumothorax: an update
Authors: Aragaki-Nakahodo Alejandro
Published: November 2021

Purpose of review

Pneumothorax is a global health problem. To date, there is still significant variation in the management of pneumothorax. For the past few years, there have been significant developments in the outpatient management of both primary and secondary spontaneous pneumothorax (SSP). We will review the latest evidence for the management of nontraumatic pneumothorax (spontaneous and iatrogenic) to include pneumothorax associated with COVID-19 infection.

Recent findings

Outpatient management of both primary and SSP may be safe and feasible.

Outpatient management of both primary and SSP should be included in treatment options discussion with patients.
Endobronchial treatment of severe asthma and severe emphysema with hyperinflation
Authors: Garner Justin L. , Shah Pallav L.
Published: November 2021

Purpose of review

The field of interventional pulmonology has ushered in a wave of innovations for individuals with obstructive airways disease in whom established medical therapies have failed. Leading the charge are bronchial thermoplasty for severe refractory asthma and uni-directional valves for severe emphysema with hyperinflation: both have received regulatory approvals in the United Kingdom and United States. With the commissioning of these novel treatments comes new challenges relating to implementation, positioning within therapeutic algorithms, honing of patient selection, and establishing long-term safety and benefits beyond 5 years.

Recent findings

This review summarises the evidence for their safety and efficacy, predictors of therapeutic response, mechanism(s) of action and emerging data supporting the durability of outcomes out to at least ten years.

It is anticipated the experience of treating increasing numbers of patients, the adoption of international registries, and ongoing research evaluations will serve to optimise these therapies for future generations of patients.
Lung cancer staging, the established role of bronchoscopy
Authors: Marshall Tanya , Kalanjeri Satish , Almeida Francisco Aecio
Published: November 2021

Purpose of review

Lung cancer is the leading cause of cancer-related deaths worldwide. In the absence of distant metastases, accurate mediastinal nodal staging determines treatment approaches to achieve most favourable outcomes for patients. Mediastinal staging differentiates N0/N1 disease from N2/N3 in surgical candidates. Likewise, presence of nodal involvement in nonsurgical candidates who are being considered for stereotactic body radiation therapy is also critical. This review article seeks to discuss the current options available for mediastinal staging in nonsmall cell lung cancer (NSCLC), particularly the role of bronchoscopy.

Recent findings

Although several techniques are available to stage the mediastinum, bronchoscopy with EBUS-TBNA with or without EUS-FNA appears to be superior in most clinical situations based on its ability to concomitantly diagnose and stage at once, safety, accessibility to the widest array of lymph node stations, cost and low risk of complications. However, training and experience are required to achieve consistent diagnostic accuracy with EBUS-TBNA.

EBUS-TBNA with or without EUS-FNA is considered the modality of choice in the diagnosis and staging of NSCLC in both surgical and nonsurgical candidates.
Immunotherapy-based combinations in the first-line treatment of metastatic renal cell carcinoma with sarcomatoid features: a systematic review and network meta-analysis
Authors: Quhal Fahad , Mori Keiichiro , Fajkovic Harun , Remzi Mesut , Shariat Shahrokh F. , Schmidinger Manuela
Published: November 2021

Purpose of review

To perform indirect comparisons of efficacy and safety of first-line immune checkpoint inhibitor (ICI)-based combination therapies for renal cell carcinoma with sarcomatoid features (sRCC).

Recent findings

Five trials were included in our network meta-analyses comprising 568 patients. The combinations nivolumab plus ipilimumab and nivolumab plus cabozantinib achieved significant improvement of progression-free survival (PFS), overall survival (OS), and objective response rates (ORR). Nivolumab plus ipilimumab was associated with the highest likelihood of achieving a complete response. All the included combinations significantly improved PFS and ORR. The combinations of pembrolizumab plus axitinib did not show a statistically significant association with OS. Nivolumab plus cabozantinib had the highest likelihood of improving PFS and OS.

Our network meta-analysis demonstrates that sRCC are responsive to immune-based combinations. The dual ICI with nivolumab plus ipilimumab improved all efficacy outcomes and achieved the highest complete response rates (CRR). Although the association of nivolumab plus cabozantinib with CRR was not statistically significant, this combination demonstrated the highest likelihood of PFS and OS improvements.
Management of Cervical Ectopic Pregnancies: A Scoping Review
Authors: Fowler Mary Louise , Wang Dongyu , Chia Victoria , Handal-Orefice Roxane , Latortue-Albino Paula , Mulekar Sujata , White Katharine , Perkins Rebecca
Published: November 2021

(Abstracted from Obstet Gynecol 2021;138(1):33–41)

Cervical ectopic pregnancies represent fewer than 0.1% of all ectopic pregnancies but carry increased risk of significant hemorrhage and long-term reproductive consequences if not managed properly. In part due to the rarity of their occurrence, a standard-of-care protocol for management of cervical ectopic pregnancy (EP) other than hysterectomy does not exist.
Galactorrhea After Nipple-Sparing Mastectomy
Authors: Schusterman M. Asher , Bruce Madeleine K. , Nicholas Kelly , Diego Emilia , La Cruz Carolyn De
Published: November 2021

Nipple discharge is a rare but possible occurrence after nipple-sparing mastectomy (NSM). This study presents the first case of galactorrhea in a female patient after NSM. Although milky discharge due to physiologic lactation related to pregnancy is more common, galactorrhea is still possible and should be worked up appropriately to ensure that all breast tissue has been removed and that there are no other more worrisome causes.
Fast or Slow? A Comparison Between Two Transcranial Electrical Stimulation Techniques for Eliciting Motor-Evoked Potentials During Supratentorial Surgery
Authors: Lettieri Christian , Pauletto Giada , Valiante Gabriele , Ius Tamara , Verriello Lorenzo , Valente Mariarosaria , Skrap Miran , Gigli Gian L. , Budai Riccardo
Published: November 2021

Purpose:

During intraoperative neurophysiological monitoring of motor pathways, two types of transcranial electrical stimulation are available, i.e., constant-current and constant-voltage stimulation. Few previous studies, performed only during spinal surgery, analyzed and compared them during intraoperative neurophysiological monitoring. The aim of our study was to compare these two stimulation techniques for eliciting motor-evoked potentials during intraoperative neurophysiological monitoring in a group of patients affected by supratentorial lesions.

Methods:

Supratentorial lesions from 16 patients were retrospectively collected and analyzed. Motor-evoked potentials were performed only from transcranial electrical stimulation because the inability to place the subdural strip electrodes correctly did not permit to perform direct cortical stimulation. At the beginning of surgery, in each patient, motor-evoked potentials were monitored by using both “fast-charge” constant-voltage and “slow-charge” constant-current stimulation. Several neurophysiological parameters were collected and compared between the two stimulation techniques by means of statistical analysis.

Results:

“Fast-charge” constant-voltage stimulation allowed statistically higher efficiency rates for eliciting motor-evoked potentials compared with “slow-charge” constant-current stimulation, both for upper and lower limbs. We also found that threshold and maximal charge as well as charge density were significantly lower during constant-voltage stimulation, thus lowering the potential tissue damage.

Conclusions:

“Fast-charge” constant-voltage transcranial electrical stimulation is feasible and safe during intraoperative neurophysiological monitoring for supratentorial surgery and may be preferable to “slow-charge” constant-current stimulation.
In vitro characterization of six hepatitis B virus genotypes from clinical isolates using transfecting linear HBV genomes
Authors: Zafrullah Mohammad , Vazquez Carlos , Mixson-Hayden Tonya , Purdy Michael A.
Published: November 2021

Hepatitis B virus (HBV) infection is a global public health problem with about 257 million chronically infected people and over 887000 deaths annually. In this study, 32 whole HBV genomes of various genotypes were amplified from clinical isolates to create transfection clones. The clones were sequenced, and their biological properties characterized by transfecting linear HBV clones into HepG2 cells. We analysed the SPI and SPII promotor regions, X-gene, BCP/PC sequences, core, preS/S and HBV polymerase sequences. HBV clones analysed in this study revealed differential replication kinetics of viral nucleic acids and expression of proteins. Sequence analysis of HBV clones revealed mutations in preS1, preS2 and S genes; deletion and insertion and point mutations in BCP/PC region; including novel and previously reported mutations. Among the patient samples tested, HBV genotype B clones were more likely to have higher frequencies of mutations, while sub-genotype A1 and A2 clones tended to have fewer mutations. No polymerase drug resistant mutations were seen. HBeAg mutations were primarily in the BCP/PC region in genotype B, but core truncations were found in genotype E. S gene mutations affecting HBsAg expression and detection were seen in all genotypes except A2. Using an HBV clone with repetitive terminal sequences and a SapI restriction site allowed us to analyse HBV analyte production in cell culture and characterize the genetics of viral phenotypes using complete HBV genomes isolated from serum/plasma samples of infected patients.
Genotyping of structural variation using PacBio high-fidelity sequencing
Authors: Zhang Zhiliang , Zhang Jijin , Kang Lipeng , Qiu Xuebing , Niu Beirui , Bi Aoyue , Zhao Xuebo , Xu Daxing , Wang Jing , Yin Changbin , Fu Xiangdong , Lu Fei
Published: November 2021

Background

Structural variations (SVs) pervade the genome and contribute substantially to the phenotypic diversity of species. However, most SVs were ineffectively assayed because of the complexity of plant genomes and the limitations of sequencing technologies. Recent advancement of third-generation sequencing technologies, particularly the PacBio high-fidelity (HiFi) sequencing, which generates both long and highly accurate reads, offers an unprecedented opportunity to characterize SVs and reveal their functionality. Since HiFi sequencing is new, it is crucial to evaluate HiFi reads in SV detection before applying the technology at scale.

Results

We sequenced wheat genomes using HiFi, then conducted a comprehensive evaluation of SV detection using mainstream long-read aligners and SV callers. The results showed the accuracy of SV discovery depends more on aligners rather than callers. For aligners, pbmm2 and NGMLR provided the most accurate results while detecting deletion and insertion, respectively. Likewise, cuteSV and SVIM achieved the best performance across all SV callers. We demonstrated that the combination of the aligners and callers mentioned above is optimal for SV detection. Furthermore, we evaluated the impact of sequencing depth on the accuracy of SV detection. The results showed that low-coverage HiFi sequencing is capable of generating high-quality SV genotyping.

Conclusions

This study provides a robust benchmark of SV discovery with HiFi reads, showing the remarkable potential of long-read sequencing to investigate structural variations in plant genomes. The high accuracy SV discovery from low-coverage HiFi sequencing indicates that skim HiFi sequencing is an ideal approach to study structural variations at the population level.