bluuebunny/crossref_metadata_2025 huggingface dataset:
Diversity and Inclusion Through Collaboration: Co-Producing a Simulation Curriculum to Address Discrimination Against Trainees
Authors: Torres Christian , Morales David , Whitley Amber , Porter Barbara , Greene Richard , Zabar Sondra
Published: September 2024

Discrimination toward trainees is a pervasive problem, with surveys showing it is often perpetrated by patients. For several years, residents and faculty in an internal medicine residency have participated in a workshop offering a framework for responding to discriminatory behavior by patients. As part of a larger effort to reinforce this teaching and promote an inclusive environment, the authors pursued a multipronged simulation curriculum that could be incorporated into graduate medical education programs across their institution. First, the authors conducted trainee and faculty focus groups to better understand their experiences. Qualitative data were collected, including recommendations for responding to discrimination, characteristics of the most common experiences, and trainees’ own ideas for worthwhile simulation scenarios. Trainees and faculty were then brought together in a collaborative process to co-develop simulation cases that were later implemented in curricula across multiple learner levels, specialties, and contexts. Participants in these simulations reported improved comfort in responding to discrimination in the moment and/or in the wake of such incidents. Through trainee-faculty collaboration, the project yielded authentic and impactful simulation experiences for learners, while also giving trainees an opportunity to turn previous trauma into constructive learning opportunities that promote an inclusive environment.
Progressive Loss of Sensitivity to Electrical Stimulation After Cochlear Implantation in X-Linked Incomplete Partition Type III Deafness
Authors: Eklöf Martin , Smeds Henrik , Karltorp Eva , Wales Jeremy
Published: September 2024

Objectives:

Patients with X-linked incomplete partition type III (IP3) deafness treated with cochlear implants exhibit higher “Most Comfortable Loudness” (MCL) levels of stimulation and more electrode deactivation than patients with normal morphology. We endeavored to analyze the progression of the MCL levels and electrode deactivation over time and assess those factors that could have led to deactivation. Furthermore, we aimed to assess whether speech perception was affected by a progressive loss of neural contact.

Design:

All 13 patients with the IP3 malformation in our clinical database were analyzed retrospectively with regard to impedance, stimulation levels, deactivated electrodes, and speech perception. A control group of patients with normal anatomy was included.

Results:

MCL levels increased over time by 2.5 charge units (qu) per year, which was not seen in the control group. Electrode deactivation was more common in IP3 malformation, and it was estimated that 25% of electrodes would be deactivated by 15 years of age. Impedance was stable but higher in the study population. Speech perception was lower in IP3 malformation generally and was correlated to the number of deactivated electrodes.

Conclusions:

Patients diagnosed with IP3 malformation deafness may suffer a greater risk of cochlear implant discontinuation compared with those with normal anatomy. A progressive loss of sensitivity to electrical stimulation may indicate a form of neural degradation in the abnormal cochlea. With time, patients in this group, even with cochlear implant technology, may experience gradual deterioration of speech perception. This has clinical implications for the counseling of parents.
Pharmacologic Therapy for Spinal Cord Injury
Authors: Sherrod Brandon A. , Porche Ken , Condie Chad K. , Dailey Andrew T.
Published: September 2024

Neuroprotective strategies aimed at preventing secondary neurologic injury following acute spinal cord injury remain an important area of clinical, translational, and basic science research. Despite recent advancement in the understanding of basic mechanisms of primary and secondary neurologic injury, few pharmacologic agents have shown consistent promise in improving neurologic outcomes following SCI in large randomized clinical trials. The authors review the existing literature and clinical guidelines for pharmacologic therapy investigated for managing acute SCI, including corticosteroids, GM-1 ganglioside (Sygen), Riluzole, opioid antagonists, Cethrin, minocycline, and vasopressors for mean arterial pressure augmentation. Therapies for managing secondary effects of SCI, such as bradycardia, are discussed. Current clinical trials for pharmacotherapy and cellular transplantation following acute SCI are also reviewed. Despite the paucity of current evidence for clinically beneficial post-SCI pharmacotherapy, future research efforts will hopefully elucidate promising therapeutic agents to improve neurologic function.
Care Bundle Approach for Oral Health Maintenance and Reduction of Ventilator-Associated Pneumonia
Authors: Sabrah Nagwa Yehya Ahmed , Pellegrino Jeffrey L. , Mansour Hend El-Sayed , Mostafa Marwa Fathallah , Kandeel Nahed Attia
Published: September 2024

Caring for patients in the intensive care unit (ICU) creates competing priorities of interventions for nurses and other health care providers. Oral care might be prioritized lower; however, its neglect may lead to sequelae such as extended time in the ICU, nosocomial diseases most notably ventilator-associated pneumonia (VAP), or oral problems. Safe patient care depends on effective and efficient oral care. The aim of this study was to lower the incidence of VAP and maintain oral health through implementing an “oral care bundle” for mechanically ventilated (MV) patients. Using a quasi-experimental design, we divided 82 adult MV patients in the ICUs of a university-based hospital in Egypt into a control group (n = 41) that received the standard of care and a bundle group (n = 41) that received an “oral care bundle.” The results of the study reported a significantly lower incidence of VAP in the intervention group (P = .015). It can be concluded that there is a significant relationship between receiving an oral care bundle and improved oral health and a reduction in the VAP rate among MV patients. This highlights the need to incorporate the oral care bundle in the daily nursing care for MV patients.
A survey and analysis of peri-operative quality indicators promoted by National Societies of Anaesthesiologists in Europe
Authors: Wacker Johannes , Haller Guy , Hendrickx Jan F.A. , Ponschab Martin
Published: September 2024

BACKGROUND

To capture preventable peri-operative patient harm and guide improvement initiatives, many quality indicators (QIs) have been developed. Several National Anaesthesiologists Societies (NAS) in Europe have implemented quality indicators. To date, the definitions, validity and dissemination of such quality indicators, and their comparability with validated published indicators are unknown.

OBJECTIVES

The aim of this study was to identify all quality indicators promoted by NAS in Europe, to assess their characteristics and to compare them with published validated quality indicators.

DESIGN

A cross-sectional study with mixed methods analysis. Using a survey questionnaire, representatives of 37 NAS were asked if their society provided quality indicators to their members and, if so, to provide the list, definitions and details of quality indicators. Characteristics of reported quality indicators were analysed.

SETTING

The 37 NAS affiliated with the European Society of Anaesthesiology and Intensive Care (ESAIC) at the time. Data collection, translations: March 2018 to February 2020.

PARTICIPANTS

Representatives of all 37 NAS completed the survey.

MAIN OUTCOME MEASURES

QIs reported by NAS.

RESULTS

Only 12 (32%) of the 37 NAS had made a set of quality indicators available to their members. Data collection was mandatory in six (16.2%) of the 37 countries. We identified 163 individual quality indicators, which were most commonly descriptive (60.1%), anaesthesia-specific (50.3%) and related to intra-operative care (21.5%). They often measured structures (41.7%) and aspects of safety (35.6%), appropriateness (20.9%) and prevention (16.6%). Patient-centred care (3.7%) was not well covered. Only 11.7% of QIs corresponded to published validated or well established quality indicator sets.

CONCLUSIONS

Few NAS in Europe promoted peri-operative quality indicators. Most of them differed from published sets of validated indicators and were often related to the structural dimension of quality. There is a need to establish a European-wide comprehensive core set of usable and validated quality indicators to monitor the quality of peri-operative care.

TRIAL REGISTRATION

No registration.
Biomechanical Evaluation of an Atraumatic Polymer-assisted Peripheral Nerve Repair System Compared with Conventional Neurorrhaphy Techniques
Authors: Wlodarczyk Alexie I. , Collin Estelle C. , Pereira Maria J.N. , Bindra Randy , Power Dominic M.
Published: September 2024

Background:

Microsuturing, the gold standard for peripheral nerve repair, can create tension and damage at the repair site, potentially impacting regeneration and causing neuroma formation. A sutureless and atraumatic polymer-assisted system was developed to address this challenge and support peripheral nerve repair. The system is based on a biocompatible and biodegradable biosynthetic polymer and consists of a coaptation chamber and a light-activated polymer for securing to the nerve. In this study, we compare the system’s biomechanical performance and mechanism of action to microsutures and fibrin repairs.

Methods:

The system’s fixation force was compared with microsutures and fibrin glue, and evaluated across various nerve diameters through tensile testing. Tension and tissue morphology at the repair site were assessed using finite element modeling and scanning electron microscopy.

Results:

The fixation force of the polymer-assisted repair was equivalent to microsutures and superior to fibrin glue. This force increased linearly with nerve diameter, highlighting the correlation between polymer surface contact area and performance. Finite element modeling analysis showed stress concentration at the repair site for microsuture repairs, whereas the polymer-assisted repair dissipated stress along the nerve, away from the repair site. Morphological analysis revealed nerve alignment with no tissue trauma for the polymer-assisted repair, unlike microsutures.

Conclusions:

The mechanical performance of the polymer-assisted coaptation system is suitable for peripheral nerve repair. The achieved fixation forces are equivalent to those of microsutures and superior to fibrin glue, minimizing stress concentration at the repair site and avoiding trauma to the severed nerve ends.
Beyond Early- and Late-onset Neonatal Sepsis Definitions: What are the Current Causes of Neonatal Sepsis Globally? A Systematic Review and Meta-analysis of the Evidence
Authors: Harrison Michelle L. , Dickson Benjamin F.R. , Sharland Mike , Williams Phoebe C.M.
Published: September 2024

Sepsis remains a leading cause of neonatal mortality, particularly in low- and lower-middle-income countries (LLMIC). In the context of rising antimicrobial resistance, the etiology of neonatal sepsis is evolving, potentially making currently-recommended empirical treatment guidelines less effective. We performed a systematic review and meta-analysis to evaluate the contemporary bacterial pathogens responsible for early-onset sepsis (EOS) and late-onset neonatal sepsis (LOS) to ascertain if historical classifications—that guide empirical therapy recommendations based on assumptions around causative pathogens—may be outdated. We analyzed 48 articles incorporating 757,427 blood and cerebrospinal fluid samples collected from 311,359 neonates across 25 countries, to evaluate 4347 significant bacteria in a random-effects meta-analysis. This revealed Gram-negative bacteria were now the predominant cause of both EOS (53%, 2301/4347) and LOS (71%, 2765/3894) globally. In LLMICs, the predominant cause of EOS was Klebsiella spp. (31.7%, 95% CI: 24.1–39.7%) followed by Staphylococcus aureus (17.5%, 95% CI: 8.5 to 28.4%), in marked contrast to the Streptococcus agalactiae burden seen in high-income healthcare settings. Our results reveal clear evidence that the current definitions of EOS and LOS sepsis are outdated, particularly in LLMICs. These outdated definitions may be guiding inappropriate empirical antibiotic prescribing that inadequately covers the causative pathogens responsible for neonatal sepsis globally. Harmonizing sepsis definitions across neonates, children and adults will enable a more acurate comparison of the epidemiology of sepsis in each age group and will enhance knowledge regarding the true morbidity and mortality burden of neonatal sepsis.
Cutaneous Manifestations of Sexually Transmitted Infections
Authors: Stuhlman Meredith , Farmer Cameron , Welch Elizabeth J. , Russell Nancy G.
Published: September 2024

Mucocutaneous manifestations of human papillomavirus (HPV) are common and vary in presentation, depending on HPV type and anatomical site. It is important for nurses to understand common presentations of HPV on the skin and identify these in practice. This article reviews the epidemiology and pathophysiology of common mucocutaneous manifestations of HPV as well as current treatment recommendations, risk factors, and prevention strategies.
Remifentanil Target-controlled Infusion Versus Standard of Care for Conscious Sedation During Ultrasound-guided Transbronchial Needle Aspiration and Biopsy
Authors: Scarlata Simone , Scaduto Valentina , Paglione Lucio , Pascarella Giuseppe , Strumia Alessandro , Bruno Federica , Antonelli Incalzi Raffaele , Carassiti Massimiliano , Agrò Felice Eugenio , Costa Fabio
Published: September 2024

Background:

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure that has become an important tool in the diagnosis and staging of mediastinal lymph node lesions in lung cancer. Adequate sedation is an important part of the procedure as it provides patient comfort and potentially increases diagnostic yield. The sedation modality varies among centers and includes moderate sedation/conscious sedation, deep sedation, and general anesthesia. The object of this study will be the evaluation of patient’s comfort and level of satisfaction with the involved health care providers (bronchoscopist and anesthesiologist) of remifentanil administration in target-controlled infusion (TCI) for conscious sedation in patients undergoing EBUS‑TBNA, with a prospective randomized study design versus the of standard sedation protocol with midazolam and/or fentanest and/or propofol.

Methods:

This study was carried out at the “Campus Biomedico di Roma” University Hospital between September 2021 and November 2021, with a total number of 30 patients enrolled who met the eligibility criteria, randomly divided into 2 groups: group 1 “REMIFENTANIL TCI” (experimental group) where the patients performed the EBUS-TBNA procedure under conscious sedation with infusion of remifentanil TCI with a target between 3 ng/mL and 6 ng/mL and group 2 “STANDARD” (control group) with patients undergoing conscious sedation with the association of midazolam and/or fentanest and/or propofol in refracted boluses based on clinical needs. Complications, safety, and level of satisfaction of the operator, the anesthesiologist, and the patient were evaluated.

Results:

The results show that sedation with remifentanil in TCI can improve the comfort level of patients, reducing the risks associated with the procedure (lower frequency of oversedations and hypotension), allowing for greater intraprocedural safety. Furthermore, the level of satisfaction of the anesthesiologist and that of the operator appears to be significantly higher in the Remifentanil group.

Conclusion:

The execution of a mild to moderate sedation with Remifentanil in TCI in patients undergoing EBUS is safe, tolerated, and allows to obtain greater intraprocedural comfort. Further studies and larger and more representative samples are obviously needed to confirm and strengthen the validity of a remifentanil TCI-based sedation in endoscopic diagnostics.
Videodistraction to reduce agitation in elderly patients in the emergency department: an open label parallel group randomized controlled trial
Authors: Güvec Enver , Koedel Uwe , Horster Sophia , Pedersen Vera , Völk Stefanie , Waldow Michaela , Weber Florian , Klein Matthias
Published: September 2024

Background and importance

Agitation of elderly patients in the emergency department (ED) often complicates workup and therapy.

Objective

In this study, we investigated if agitation in the ED can be reduced by showing calming video sequences in elderly agitated patients.

Designs

Prospective randomized intervention study.

Settings and participants

ED patients aged ≥65 years were screened for the risk of agitation/delirium using the 4-A’s test (4-AT) test. In case of ≥4 4-AT points, patients were scored using the Richmond Agitation-Sedation Scale (RASS) and the Nursing Delirium Screening Scale (Nu-DESC). They were included in the study if RASS was ≥+2 and Nu-DESC ≥ 4 after informed consent of the legal representative. Patients were then randomized to the intervention or control group. A total of n = 57 patients were included in the study.

Intervention

Patients in the intervention group were exposed to projections of calming video sequences for 60 min. Patients in the control group received standard care.

Outcome measures and analysis

Changes in RASS and Nu-DESC were assessed 30 and 60 min after the intervention was started.

Main results

A total of 57 patients were included in the study, with 30 patients in the intervention group and 27 patients in the control group. Before the intervention, the median (interquartile range) RASS scores were comparable between the intervention group [3 (2–3)] and the control group [3 (2–3)]. After 30 min of exposure to calming video sequences, patients in the intervention group showed significantly lower RASS and Nu-DESC scores compared to the control group [RASS: 1 (0–1) vs. 2 (1.5–3), P < 0.001; Nu-DESC: 3 (2–4) vs. 5 (4–6), P < 0.001]. This difference persisted at 60 min [RASS: 0 (0–1) vs. 2 (1–2.5), P < 0.001; Nu-DESC: 2 (2–3) vs. 5 (4–6), P < 0.001]. Additionally, fewer patients in the intervention group required additional sedating or antipsychotic medication (1/30) compared to the control group (9/27), with this difference being statistically significant (P = 0.004).

Conclusion

In this randomized controlled trial, the use of calming video sequences in elderly patients with agitation in the ED resulted in significant reductions in agitation and the need for additional sedative or antipsychotic medication.
Path Analysis: Interrelationships Between Nurse Manager Competencies, Practice Environment Perceptions, and Frontline Nurses' Intent to Stay
Authors: Pabico Christine , Park Shin Hye , Swartwout Ellen , Warshawsky Nora E.
Published: September 2024

OBJECTIVE

To examine the correlation between nurse manager (NM) competencies, work environment (Practice Environment Scale of the Nursing Work Index [PES-NWI]), and frontline nurses' intent to stay; the direct effect of NM competency on frontline nurses' intent to stay; and the indirect effect of NM competency on frontline nurses' intent to stay, mediated by PES-NWI.

BACKGROUND

PES-NWI and NMs' competency can impact frontline nurses' intent to stay.

METHODS

Cross-sectional study with secondary analysis of NM Competency and NDNQI® (National Database of Nursing Quality Indicators®) RN Survey data with path analysis for effects of the model's variables.

RESULTS

Positive, weak correlations between NM competencies and frontline nurses' practice environments were found; NM competencies and frontline nurses' intent to stay were not correlated. Paths were NM competency/PES-NWI (β = 0.20, P = 0.001) and PES-NWI/intent to stay (β = 0.55, P < 0.001); NM competency/intent to stay was not significant. Indirect effect of NM competency on frontline nurses' intent to stay was mediated through PES-NWI (β = 0.11, P = 0.002; 95% confidence interval, 0.05-0.17).

CONCLUSIONS

Investing in NMs' competency can help create supportive work environments and frontline nurses' intent to stay.
Accredited Public Health Department Characteristics Associated With Workforce Gaps Identified in Workforce Development Plans
Authors: Burns Ashlyn , Kampman Haleigh , Karnik Harshada , Leider Jonathon P. , Yeager Valerie A.
Published: September 2024

Objective:

When pursuing accreditation by the Public Health Accreditation Board, local health departments (LHDs) must submit a workforce development plan (WDP). The purpose of this study was to examine LHD characteristics associated with workforce gaps identified and strategies implemented by LHDs.

Design:

We conducted a qualitative content analysis of all WDPs submitted to the Public Health Accreditation Board between March 2016 and November 2021.

Setting:

We examined WDPs from all accredited LHDs (n = 183) at the time of data collection in January 2022. A majority of LHDs had more than 50 staff members (n = 106, 57.9%), had a decentralized governance structure (n = 164, 89.6%), had county-level jurisdictions (n = 99, 54.1%), and served rural populations (n = 146, 79.8%).

Main Outcome Measures:

For each overarching theme, we constructed 2 binary variables indicating whether the LHD identified a workforce gap or strategy among any subthemes within each overarching theme. Logistic regressions were used to examine relationships between LHD characteristics and identification of a workforce gap or strategy for each theme.

Results:

Few LHD characteristics were significantly associated with gaps identified or strategies implemented by LHDs. LHDs applying for reaccreditation had higher odds (adjusted odds ratio [AOR], 2.44; confidence interval [CI], 1.04-5.83) of identifying a leadership gap and of identifying a recruitment gap (AOR, 2.94; CI, 1.11-7.52) compared to LHDs applying for accreditation for the first time. LHDs serving urban populations had higher odds (AOR, 2.83; CI, 1.32-6.25) of identifying a recruitment strategy compared to LHDs that only served suburban/rural populations.

Conclusions:

Overall, many workforce gaps reported by LHDs were universally observed irrespective of LHD characteristics. While most LHDs identified strategies to address gaps, our findings also reveal workforce areas where LHDs reported gaps without an accompanying strategy, indicating areas where LHDs could use more technical assistance and support.
Site-Based and Digital Cohort Participation Among Transgender Women in the Eastern and Southern United States: Findings From the LITE Study
Authors: Reisner Sari L. , Humes Elizabeth , Stevenson Megan , Cooney Erin E. , Adams Dee , Althoff Keri N. , Radix Asa , Poteat Tonia C. , Mayer Kenneth H. , Cannon Christopher M. , Malone Jowanna , Wawrzyniak Andrew , Rodriguez Allan E. , Schneider Jason , Haw J. Sonya , Wirtz Andrea L. ,   the American Cohort to Study HIV Acquisition Among Transgender Women (LITE) Study Group
Published: September 2024

Background:

Transgender women (TW) are highly burdened by HIV. There is increasing interest in digital (ie, through Internet-based interfaces) HIV research; yet few studies have assessed potential biases of digital compared with site-based data collection. This study examined differences in characteristics between TW participating through site-based versus digital-only modes in an HIV incidence cohort.

Methods:

Between March 2018 and Aug 2020, a multisite cohort of 1312 adult TW in the eastern and southern United States was enrolled in site-based and exclusively digital modes. We evaluated differences in baseline demographics, sociostructural vulnerabilities, health care access, gender affirmation, mental health, stigma, social support, and HIV acquisition risk comparing site-based vs digital modes using χ2 tests and Poisson regression modeling with robust standard errors.

Results:

The overall median age was 28 (interquartile range = 23–35) years and more than half identified as people of color (15% Black, 13% Multiracial, 12% Another Race, 18% Latina/e/x). A higher proportion of site-based (vs. digital mode) participants resided in the northeast, were younger, identified as people of color, experienced sociostructural vulnerabilities, had a regular health care provider, received medical gender affirmation, endorsed mental health symptoms and stigma, reported HIV acquisition risk but also greater experience with biomedical HIV prevention (preexposure and postexposure prophylaxis), and had larger social networks (all P < 0.05).

Conclusions:

Site-based and digital approaches enrolled TW with different demographics, life experiences, and HIV acquisition risks. A hybrid cohort model may achieve a more diverse and potentially representative sample of TW than either site-based or online cohorts alone for HIV research.
68Ga-DOTATATE PET/CT Versus 18F-FDG PET/CT in TENIS Syndrome: A Head-to-Head Comparison With Elevated and Suppressed TSH Levels in Papillary Thyroid Carcinoma—A Pilot Study
Authors: Almeida Ludmila Santiago , Santos Allan , Assumpção Lígia , Costa Tiago Oliveira , Araujo Maidane , Lima Mariana , Zantut-Wittmann Denise Engelbrecht , Etchebehere Elba
Published: September 2024

Background

TENIS syndrome is characterized by reduced expression of sodium-iodine symporter, rising serum thyroglobulin (Tg) levels, and negative whole-body 131I scans. In such patients, somatostatin receptor imaging with 68Ga-DOTATATE PET/CT (somatostatin receptor [SSR] PET/CT) and 18F-FDG PET/CT (FDG PET/CT) can identify metastases and were compared under 2 conditions: elevated (eTSH) and suppressed (sTSH) TSH serum levels. Potential candidates for peptide receptor radionuclide therapy (PRRNT) were identified in 15 patients prospectively enrolled. All patients underwent 4 examinations. Images were blindly evaluated for differences in SUVmax values and lesion detectability. Reference standard consisted of neck ultrasound, CT, MRI, PET/CT, biopsy, and follow-up. Three patients were received PRRNT.

Results

sTSH SSR PET/CT detected a greater number of cervical (P = 0.0253 and P = 0.0176) and distant LNs (P = 0.0253 and P = 0.0391) when compared with sTSH FDG PET/CT, respectively, in a per-patient and on a per-lesion based analysis. Likewise, eTSH SSR PET/CT detected a greater number of patients with local recurrences (P = 0.0455) and distant LN metastases (P = 0.0143). Per-lesion analysis revealed greater number of cervical and distant LNs (P = 0.0337 and P = 0.0039, respectively) when compared with eTSH FDG PET/CT. There was no difference in detection of distant metastases by both tracers for lung and bone metastases (κ = 1). Both skeletal and pulmonary lesions were also detected by conventional CT part of FDG or DOTATATE PET/CT scans. TSH stimulation had no additional value in a per-patient analysis for both FDG and DOTATATE PET scans (κ varying from 0.6087 to 1). However, TSH stimulation led to more lesion identifications in DOTATATE PET/CT; most of those metastases were not confirmed by the reference standard leading to a decrease in specificity (84% vs 74%). One of 3 patients submitted to 3 cycles of PRRNT presented with a visual partial response, a 20% reduction in quantitative analyses, and stable disease regarding Tg and TgAb levels.

Conclusions

Patients with TENIS syndrome can be imaged with SSR PET/CT as well as FDG PET/CT with high overall accuracy regardless of TSH levels (86% to 92% and 92% to 85%, respectively, with eTSH and sTSH). SSR PET/CT detected a greater number of locoregional and distant LN metastases than FDG PET/CT with both sTSH and eTSH. One of 3 patients submitted to PRRNT presented a partial response to treatment. Our findings may impact in patient restaging, management, and theranostics strategies with radiolabeled somatostatin analogs.
Demystifying Velopharyngeal Dysfunction for Plastic Surgery Trainees—Part 1: Anatomy and Physiology
Authors: MacIsaac Molly F. , Wright Joshua M. , Vieux Jamilla , Halsey Jordan N. , Rottgers S. Alex
Published: September 2024

The velopharyngeal (VP) port separates the nasopharynx from the oropharynx and is bordered by the velum, lateral pharyngeal walls, and posterior pharyngeal wall. Velopharyngeal dysfunction (VPD) is the inability to achieve proper closure of the VP port, affecting speech and swallowing. This 3-part series provides a comprehensive discussion on (1) the anatomy and physiology of the velopharyngeal mechanism; (2) fundamental speech terminology and principles of perceptual speech assessment for VPD; and (3) techniques for objective evaluation of the VP port and surgical decision-making process. In part 1, the authors focus on the anatomy and physiology of the velopharyngeal port, the anatomy of cleft palate, and the causes of VPD. There are 3 types of VPD: velopharyngeal insufficiency, involving structural deficits; velopharyngeal incompetence, resulting from neuromuscular issues; and velopharyngeal mislearning, due to maladaptive speech habits. VPD is commonly associated with cleft palate due to anatomic disruptions that impair velopharyngeal function. However, there are numerous causes of noncleft VPD, including congenital or acquired structural defects, neuromuscular conditions, and developmental/behavioral factors. Diagnosis and management of VPD require a multidisciplinary approach involving, at a minimum, surgeons and speech-language pathologists. Plastic surgery trainees often receive education on the surgical treatment of VPD, but without a foundational knowledge of the disease spectrum and speech pathology, the complex terminology can impede a thorough understanding of its diagnosis and management. This series serves as an accessible resource, providing the foundational knowledge required for surgical trainees new to this topic.
Challenging Dogmas in Plastic Surgery
Authors: Hwang Kun , Park Chan Yong
Published: September 2024

In medicine, dogmas are subject to evolution and refinement as new research and technologies emerge. The aim of this study was to search for dogmas which were challenged and potentially revised in the plastic surgery field. A search on PubMed for “dogma and plastic surgery” yielded 80 papers. The queries “surgical dogma and craniofacial surgery” and “surgical dogma and flap” returned 9 and 21 papers, respectively. “Surgical dogma and hand” and “surgical dogma and wound healing” produced 41 and 25 papers, respectively. Removing 35 duplicate papers, 141 abstracts were reviewed. Of these, 78 were excluded, leaving 63 papers for analysis. The dogmas being challenged within the field of plastic surgery were classified into various categories. The distribution of these challenged dogmas was as follows: wound healing: 14.29%, epinephrine use: 9.52%, flap surgery: 7.94%, breast reconstruction: 6.35%, rhinoplasty: 7.94%, hand surgery: 4.76%, pressure sores: 4.76%, chemical peel: 4.76%, and hand injuries: 3.17%. The widespread focus on improving wound healing techniques indicates a need for more effective treatments and faster recovery times. Significant attention has been directed toward the use of epinephrine, particularly in fingers, which may reflect ongoing debates about its safety. Innovations and improvements in flap surgery could lead to better reconstructive outcomes. Challenging existing dogma is a vital process and a driving force in the advancement of clinical science. These challenges and potential revisions reflect the dynamic nature of plastic surgery, where ongoing research, patient outcomes, and evolving societal norms drive continuous improvement and adaptation in practices and principles.
Classification and Treatment of Complications Related to Titanium and Biodegradable Miniplates Using the Lip-Split Transmandibular Approach for Oral and Oropharyngeal Oncological Surgery
Authors: Chen Wei-liang , Tao Yu-peng , Huang Zi-xian , Chen De-tao
Published: September 2024

Background:

There is a lack of classified definitions and corresponding treatment principles for complications related to titanium miniplate (TMP) and biodegradable miniplate (BMP).

Aims:

This study proposes a classification system for complications related to TMP and BMP osteosynthesis and evaluates the effectiveness of the classification system in the treatment of the complications.

Methods:

One hundred forty-two patients with advanced-stage oral cavity and oropharynx squamous cell carcinoma (SCC) underwent oncological surgery via lip-split transmandibular (LTM) approach including midline, paramedian, stair-step, and triangle. 54.9% of patients were treated with TMP, and 45.1% were treated with BMP for osteosynthesis. The classification of complications is divided into grades 0, 1, 2, and 3. Grade 0 is defined as having no complications. The evaluation criteria for treating complications were significant improvement, partial improvement, and no improvement.

Results:

All patients underwent en bloc resection of the tumor with histologically negative margins via the LTM approach. The overall success rate of the flap is 98.6%. 25.3%, 48.6%, 14.8%, and 11.3% of patients were treated with midline, paramedian, stair-step, and triangular osteotomy approaches, respectively. A significant increase in the number of paramedian osteotomies was observed compared with other types of osteotomy (P < 0.05). Grades 0, 1, 2, and 3 developed in 54.2%, 12.0%, 14.8%, and 19.0% of patients, respectively. No significant differences in the grade of complications were observed between the TMP group and the BMP group. Sixty-five patients with complications, grades 1, 2, and 3 occurred in 26.2%, 32.3%, and 41.5% of patients. The midline, paramedian, stair-step, and triangle osteotomy approaches were used in 26.1%, 47.7%, and 10.8%, respectively. The incidence of complications in the paramedian osteotomy was significantly higher than that in the other osteotomy (P < 0.05). 83.1% of patients showed significant improvement, 10.8% showed partial improvement, and 6.1% showed no improvement. No significant differences in the treatment outcomes were observed between the TMP group and the BMP group.

Conclusions:

The incidence of complications in paramedian osteotomy is also significantly higher than 3 types of osteotomy, and 83.1% of patients showed significant improvement in complications. The complication classification system related to TMP and BMP osteosynthesis are easy to implement and feasible in clinical practice.
A Prospective European Trial Comparing Laparotomy, Laparoscopy, Robotic-Assisted, and Transanal Total Mesorectal Excision Procedures in High-Risk Patients with Rectal Cancer
Authors: Rouanet Philippe , Guerrieri Mario , Lemercier Pablo , Balik Emre , Cotte Eddy , Spinelli Antonino , Gómez-Ruiz Marcos , Wolthuis Albert , Bertani Emilio , Dubois Anne ,   on behalf the RESET study group
Published: September 2024

Objective:

To compare total mesorectal excision (TME) techniques combined with sphincter-sparing procedure in high-risk patients (HRPs).

Background:

TME is the standard treatment for rectal cancer, but can be challenging in HRPs. The available surgical approaches must be compared, especially in HRPs.

Methods:

Prospective, observational, multicenter trial to compare laparotomy (OTME), laparoscopy (LTME), robotic-assisted surgery (RTME), and transanal surgery (TaTME) in HRPs. The composite primary outcome included circumferential radial margin (CRM) ≥1mm, TME grade II-III, and absence of Clavien-Dindo grade III-IV complications. Three propensity score analyses were performed (LTME vs. RTME, RTME vs. TaTME, LTME vs. TaTME).

Results:

1078 HRPs (75% of men, median body mass index of 27 kg/m2, 50% of tumors in the lower third of the rectum) underwent surgery. The RTME and TaTME groups included patients with more advanced and lower tumors and coloanal anastomosis (P<0.001). Operative time was longer for RTME surgery (P<0.001). Conversion rate was similar for minimally invasive procedures (4.5%). The global R0 resection rate was 96% without difference among techniques. The primary outcome rates were 82.4%, 64.3%, 74.7%, and 80.3% for LTME, OTME, RTME, and TaTME, respectively. None achieved the expected success rate (85%), and propensity score analyses found no differences. Operative results were similar between high- and low-volume inclusion centers only for RTME.

Conclusions:

The RESET trial yielded high-quality results despite focusing on HRPs. Minimally invasive procedures showed similar sphincter-sparing procedure outcomes, but LTME included patients with more favorable tumors. Oncologic and functional outcomes will be evaluated at 2 years (ClinicalTrials.gov, ID: NCT03574493).
Analysis of Surgeon and Program Characteristics Associated with Success on American Board of Surgery Examination Outcomes
Authors: Barry Carol L , Jones Andrew T , Rubright Jonathan D , Ibáñez Beatriz , Abouljoud Marwan S , Berman Russell S , Berry Cherisse , Dent Daniel L , Buyske Jo
Published: September 2024

BACKGROUND:

Existing research exploring predictors of success on American Board of Surgery (ABS) examinations focused on either resident or residency program characteristics, but limited studies focus on both. This study examines relationships between both resident and program characteristics and ABS qualifying (QE) and certifying examination (CE) outcomes.

STUDY DESIGN:

Multilevel logistic regression was used to analyze the relationship between resident and program characteristics and ABS QE and CE first attempt pass and eventual certification. Resident characteristics were gender, international medical graduate (IMG) status, and previous performance, measured by the first attempt US Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge and Step 3 scaled scores. Program characteristics were size, %female, %IMG, and program type. The sample included surgeons with QE and CE data from 2007 to 2019 and matched USMLE scores.

RESULTS:

Controlling for other variables, previous medical performance positively related to all ABS examination outcomes. The relationships between USMLE scores and success on ABS examinations varied but were generally strong. Other resident characteristics that predicted ABS examination outcomes were gender and IMG (QE first attempt pass). The only program characteristic that significantly predicted ABS outcomes was %IMG (QE and CE first attempt pass). Despite statistical significance, gender, IMG, and %IMG translated to small differences in predicted probabilities of ABS examination success.

CONCLUSIONS:

This study highlights resident and program characteristics that predict success on ABS examinations. USMLE scores consistently and strongly related to ABS examination success, providing evidence that USMLE scores relate to future high-stakes consequences like board certification. After controlling for previous performance, gender, IMG, and program %IMG significantly related to ABS examination success, but effects were small.
On transitions in water wave propagation through consolidated to broken sea ice covers
Authors: Pitt Jordan P. A. , Bennetts Luke G.
Published: September 2024

A theoretical model is used to study water waves propagating into and through a region containing thin floating ice, for ice covers transitioning from consolidated (large floe sizes) to fully broken (small floe sizes). The degree of breaking is simulated by a mean floe length. The model predicts deterministic limits for consolidated and fully broken ice covers where the wave fields do not depend on the particular realization of the ice cover for a given mean floe length. The consolidated ice limit is consistent with classic flexural-gravity wave theory, and the fully broken limit is well-modelled by Bloch waves in a periodic ice cover. In the transition between the limits, the wave field depends on the ice cover realization, as multiple wave scattering is a dominant process. The effects of the ice cover on the wave field are quantified using a wavelength, an attenuation rate and a transferred amplitude (measuring the amplitude drop at the ice edge). The model predicts that as the ice cover breaks up (mean floe size gets smaller), the wavelength and amplitude drop decrease (transferred amplitude increases) and the attenuation rate increases. The results provide an interpretation of field observations.
Characterisation of Staphylococcus argenteus in Christchurch, New Zealand, and comparison to global strains.
Authors: Anderson Trevor , Wang Hui , Harrington Michael , Howard Julia C , Otte Erik
Published: September 2024

Staphylococcus argenteus (SARG) is a newly discovered species within the S. aureus (SAUR) complex and has been documented from various locations worldwide. In this article we describe the genomic features of five strains of SARG found in Christchurch, New Zealand. Isolates were first detected in 2019 using MALDI-TOF identification and identification confirmed using whole genome sequencing. Genomic features such as antimicrobial resistance markers and virulence factors were compared to other SARG sequences in NCBI GenBank. All five isolates belonged to ST2250 but clustered in different clades using core genome analysis. Three isolates contained staphylococcal cassette chromosome mec (SCCmec) type IV 2Bc with mecA gene which conferred resistance to beta-lactam antibiotics. The five strains shared many of the virulence genes found in SAUR but no TSST-1 or PVL pathogenic genes were detected. This publication adds further data on occurrences and genomic features of SARG.
Thiamin priming to control early blight in potato: investigation of its effectiveness and molecular mechanisms
Authors: Berrian Trenton W. , Fabian Matthew L. , Rogan Conner J. , Anderson Jeffrey C. , Clarke Christopher R. , Goyer Aymeric J.
Published: September 2024

Background

Previous reports in several plant species have shown that thiamin applied on foliage primes plant immunity and is effective in controlling fungal, bacterial, and viral diseases. However, the effectiveness of thiamin against potato (Solanum tuberosum) pathogens has seldom been investigated. Additionally, the transcriptomics and metabolomics of immune priming by thiamin have not previously been investigated. Here, we tested the effect of thiamin application againstAlternaria solani,a necrotrophic fungus that causes early blight disease on potato foliage, and identified associated changes in gene expression and metabolite content.

Results

Foliar applications of thiamin reduced lesion size by approximately 33% when applied at an optimal concentration of 10 mM. However, the effect of thiamin on preventing lesion growth was temporally limited, as we observed a reduction of lesion size when leaves were inoculated 4 h, but not 24 h, following thiamin treatment. Additionally, we found that the effect of thiamin on lesion size was restricted to the site of application and was not systemic. Gene expression analysis via RNA-seq showed that thiamin induced the expression of genes involved in the synthesis of salicylic acid (SA) and phenylpropanoids to higher levels than the pathogen alone, as well as fatty acid metabolism genes that may be related to jasmonic acid biosynthesis. Thiamin also delayed the downregulation of photosynthesis-associated genes in plants inoculated withA. solani, which is a typical plant response to pathogens, but could also induce a similar repression of primary metabolic pathways in non-infected leaves. Metabolite analyses revealed that thiamin treatment in the absence of pathogen decreased the amounts of several organic compounds involved in the citric acid cycle as well as sugars, sugar alcohols, and amino acids.

Conclusions

Our study indicates that thiamin priming of plant defenses may occur through perturbation of primary metabolic pathways and a re-allocation of energy resources towards defense activities.
Stochasticity in Dietary Restriction-Mediated Lifespan Outcomes inDrosophila
Authors: Mosley Olivia L. , Villa Joel A. , Kamalakkannan Advaitha , James Eliyashaib , Hoffman Jessica M. , Lyu Yang
Published: September 2024

Dietary restriction (DR) is widely considered to be one of the most potent approaches to extend healthy lifespan across various species, yet it has become increasingly apparent that DR-mediated longevity is influenced by biological and non-biological factors. We propose that current priorities in the field should include understanding the relative contributions of these factors to elucidate the mechanisms underlying the beneficial effects of DR. Our work conducted in two laboratories, represents an attempt to unify DR protocols inDrosophilaand to investigate the stochastic effects of DR. Across 64 pairs of survival data (DR/ad libitum, or AL), we find that DR does not universally extend lifespan. Specifically, we observed that DR conferred a significant lifespan extension in only 26.7% (17/64) of pairs. Our pooled data show that the overall lifespan difference between DR and AL groups is statistically significant, but the median lifespan increase under DR (7.1%) is small. The effects of DR were overshadowed by stochastic factors and genotype. Future research efforts directed toward gaining a comprehensive understanding of DR-dependent mechanisms should focus on unraveling the interactions between genetic and environmental factors. This is essential for developing personalized healthspan-extending interventions and optimizing dietary recommendations for individual genetic profiles.
Assessing the Impact of Haulage drivers in Uganda’s COVID-19 Delta Wave
Authors: Muwonge Adrian , Bessell Paul R , Bronsvoort Mark Barend de Clare , Mugerwa Ibrahim , Mwaka Erisa , Ssebaggala Emmanuel , Wee Bryan Aidan , Kiayias Aggelos , Mpyangu Christine Mbabazi , Joloba Moses Lutakome
Published: September 2024

Background

Haulage truck drivers can quickly connect distant communities, with risks of potential disease introduction. However, interventions to limit such risk must balance public health protection, economic continuity, and individual rights. Here distinguishing between their role in disease introduction and its onward spread is crucial for achieving this balance.

Methods

To investigate the role of haulage during the Delta wave of COVID-19 in Uganda. We fit a susceptible-infectious-recovered (SIR) model to the 625,422 records in the national surveillance dataset to assess the notion of a “core-risk group” by examining the incidence and impact of haulage-targeted interventions in border districts associated with heavy haulage traffic compared to the districts in the central region of Uganda.

Results

Although haulage drivers accounted for only 0.036% of the cases, the border districts associated with them registered 12.02% more cases than inland districts, suggesting a role in disease introduction. This risk was particularly higher in Tororo, compared to Amuru and Kyotera, which border Kenya, South Sudan, and Tanzania, respectively. Some interventions even increased the risk in Tororo by as much as 6%. However, in general, the haulage targeted interventions reduced the case load in border districts but registered limited impact on inland districts. This suggests a limited role in secondary within country spread. We note that combining such interventions with vaccination achieved greater reduction in case load.

Conclusions

Our findings suggest that truck drivers were a core risk group, though this risk was transient and in some cases exacerbated by some interventions. Pandemic preparedness strategies should characterize risks posed by core groups to ensure interventions balance public safety with individual rights in key sectors like supply chains.