bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of higher harmonics on gravitational wave dark sirens
Authors: Liu Jian-Dong , Han Wen-Biao , Yun Qianyun , Yang Shu-Cheng
Published: July 2024

The gravitational wave (GW) signal from the merger of two black holes can serve as a standard sirens for cosmological inference. However, a degeneracy exists between the luminosity distance and the inclination angle between the binary system’s orbital angular momentum and the observer’s line of sight, limiting the precise measurement of the luminosity distance. In this study, we investigate how higher harmonics affect luminosity distance estimation for third-generation (3G) GW detectors in binary black hole mergers. Our findings demonstrate that considering higher harmonics significantly enhances distance inference results compared with using only the (2, 2) mode. This improved accuracy in distance estimates also strengthens constraints on host galaxies, enabling more precise measurements of the Hubble constant. These results highlight the significant influence of higher harmonics on the range estimation accuracy of 3G ground-based GW detectors.
A question of personalities: evolution of viscous and wind-driven protoplanetary discs in the presence of dead zones
Authors: Tong Simin , Alexander Richard , Rosotti Giovanni
Published: July 2024

Whether the angular momentum of protoplanetary discs is redistributed by viscosity or extracted by magnetized winds is a long-standing question. Demographic indicators, such as gas disc sizes and stellar accretion rates, have been proposed as ways of distinguishing between these two mechanisms. In this paper, we implement one-dimensional gas simulations to study the evolution of ‘hybrid’ protoplanetary discs simultaneously driven by viscosity and magnetized winds, with dead zones present. We explore how the variations of disc properties, including initial disc sizes, dead zone sizes, and angular momentum transport efficiency, affect stellar accretion rates, disc surface density profiles, disc sizes, disc lifetimes, and cumulative mass-loss by different processes. Our models show that the expansion of the gas disc size can be sustained when the majority of angular momentum is removed by the magnetized wind for individual protoplanetary discs. However, when we can only observe discs via demographic screenshots, the variation of disc sizes with time is possibly diminished by the disc ‘personalities’, by which we mean the variations of initial disc properties among different discs. Our ‘hybrid’ models re-assess association of the two demographic indicators with mechanisms responsible for angular momentum transport and suggest that additional diagnostics are required to assist the differentiation.
Therapeutic Role of HPV Vaccination on Benign HPV-induced Epithelial Proliferations in Immunocompetent and Immunocompromised Patients: Case Study and Review of the Literature
Authors: Matucci-Cerinic Caterina , Herzum Astrid , Ciccarese Giulia , Rosina Silvia , Caorsi Roberta , Gattorno Marco , Occella Corrado , Viglizzo Gianmaria , Volpi Stefano
Published: July 2024

Human papillomavirus (HPV) vaccination represents a milestone in primary prevention of sexually transmitted infections. However, little is known about its possible effects on already established HPV infections. We report the case of a 9-year-old immunosuppressed girl with refractory warts, successfully treated with the nonavalent-HPV vaccine and review the literature about the therapeutic effects of HPV vaccination on benign HPV-induced epithelial proliferations in immunocompetent and immunosuppressed patients. In the literature, promising results were shown on cutaneous warts after HPV vaccination, especially in children and young adults, also in immunosuppressed patients, whereas controverse results were found on anogenital warts. These findings suggest a critical need for randomized clinical trials to assess the efficacy of HPV vaccination in the treatment of benign HPV-induced epithelial proliferations.
Populism as a centrist strategy for disqualification: The use of ‘populism(s)/populist(s)’ in Belgian, French and Spanish Parliaments
Authors: Bailly Jessy , Rondiat Coline , Augé Anaïs , Reuchamps Min
Published: July 2024

This article examines the uses of the words populism(s) and populist(s)—hereafter populis*—by Members of Parliaments from Belgium, France, and Spain in 2019. It presents noteworthy findings unexplored in the literature on the uses of populis*. First, when employed by MPs, populis* refers mainly to actions, discourses and elusive threats rather than directly blaming political enemies (except in Spain). Second, in the three focal countries, populis* is mainly used pejoratively by right and centre-right MPs as a strategy implemented to disqualify political projects and discourses deemed nationalist, demagogical, and extremist. The originality of our study lies in demonstrating similar trends in Belgium, France, and Spain, while also unveiling differences stemming from national contexts.
Progressive Strain Localization and Fluid Focusing in Mantle Shear Zones during Rifting: Petrostructural Constraints from the Zabargad Peridotites, Red Sea
Authors: Chardelin Mérope , Tommasi AndrÉa , PadrÓn-Navarta JosÉ Alberto
Published: July 2024

This article documents the evolution of pressure and temperature conditions and the successive influence of hydrous melts and aqueous fluids on the operation of extensional shear zones, which exhumed mantle slivers from deep lithospheric or asthenospheric depths, in a rift-to-drift setting. These results are based on a re-analysis of 40 samples from three peridotite massifs of Zabargad island in the northern Red Sea. By integrating high-resolution mapping of the microstructure by electron backscattered diffraction with recent developments in barometry for plagioclase-bearing peridotites and thermodynamic modelling of peridotitic compositions, this study (1) constrains the temporal and spatial evolution of petrological and tectonic processes in the shallow mantle during rifting and (2) documents the presence of melts or aqueous fluids throughout the activity of the shear zones, unravelling substantial feedback between petrological and tectonic processes. Thermobarometry and thermodynamic modelling, constrained by the microstructural observations, document progressive strain localization associated with shearing under decreasing pressure and temperature, from near solidus conditions at >1 GPa (in the north and central peridotite massifs) or ~ 0.7 GPa (in the southern massif) to <600°C and < 0.3 GPa in all three massifs. The data substantiate local aqueous fluid saturation in the shear zones. This together with higher contents of hydrous minerals in ultramylonites indicate fluid focusing in the shear zones, with seawater ingress extending to >10 km depth. The presence of melts or fluids enabled concurrent dislocation and dissolution–precipitation creep, resulting in weakening of the shear zones. However, fluid supply was spatially heterogeneous and likely intermittent, with equilibrium achieved only locally in the ultramylonites. The present study documents therefore how the feedback between progressive strain localization and fluid focusing in extensional shear zones contributes to thinning and exhumation of the mantle during continental rifting and the rift-to-drift transition.
Nuclear factors NF-YC3 and NF-YBs positively regulate arbuscular mycorrhizal symbiosis in tomato
Authors: Chien Heng , Kuo Ting-Yu , Yao Ching-Hung , Su Yi-Ru , Chang Yu-Ting , Guo Zheng-Lin , Chang Kai-Chieh , Hsieh Yu-Heng , Yang Shu-Yi
Published: July 2024

The involvement of nuclear factor Y (NF-Y) in transcriptional reprogramming during arbuscular mycorrhizal symbiosis has been demonstrated in several plant species. However, a comprehensive picture is lacking. We showed that the spatial expression of NF-YC3 was observed in cortical cells containing arbuscules via the cis-regulatory element GCC boxes. Moreover, the NF-YC3 promoter was transactivated by the combination of CYCLOPS and autoactive calcium and calmodulin-dependent kinase (CCaMK) via GCC boxes. Knockdown of NF-YC3 significantly reduced the abundance of all intraradical fungal structures and affected arbuscule size. BCP1, SbtM1, and WRI5a, whose expression associated with NF-YC3 levels, might be downstream of NF-YC3. NF-YC3 interacted with NF-YB3a, NF-YB5c, or NF-YB3b, in yeast (Saccharomyces cerevisiae) and in planta, and interacted with NF-YA3a in yeast. Spatial expression of 3 NF-YBs was observed in all cell layers of roots under both mock and mycorrhizal conditions. Simultaneous knockdown of 3 NF-YBs, but not individually, reduced the fungal colonization level, suggesting that there might be functional redundancy of NF-YBs to regulate AM symbiosis. Collectively, our data suggest that NF-YC3 and NF-YBs positively regulate AM symbiosis in tomato, and arbuscule-related NF-YC3 may be an important downstream gene of the common symbiosis signaling pathway.
Dereliction of Duty: Congressional Inaction and the Coming Crisis in Social Security
Authors: Campbell Andrea Louise
Published: July 2024

In 2033, American social policy will reach a crossroads when the trust fund for its largest and most successful program runs out. Without Congressional action, Social Security benefits, which constitute most of the retirement income of most senior citizens, will fall by 21 percent. This shortfall has been predicted for three decades, and yet Congress has done nothing. In Fixing Social Security, R. Douglas Arnold applies the model of Congressional behavior from his seminal 1990 book, The Logic of Congressional Action, to analyze why Social Security solvency crises periodically emerge, why Congress has ignored the coming emergency, what lawmakers may do “at the precipice,” and the degree to which the rise of the conservative movement, political polarization, and other features of contemporary American politics will affect the outcome. This incisive, wonderfully well-written book will be of broad interest to the public and to scholars of social policy, Congress, and American politics.
Effect of methadone maintenance therapy on sexual disorders in males: a systematic review and meta-analysis
Authors: Dorooshi Gholamali , Otroshi Arman , Nemati Kourosh , Ramezannezhad Pantea , Eizadi-Mood Nastaran
Published: July 2024

Introduction

Methadone maintenance treatment (MMT) is a popular method of treating opioid use disorder. However, the majority of drug-using males experience sexual dysfunction.

Objectives

This systematic review and meta-analysis examined the possible impact of MMT on sexual dysfunction in drug-using males.

Methods

Cochrane, Web of Science, ProQuest, PubMed, and Google Scholar are the international databases that we used in this study. There were neither temporal nor regional limitations on the search. Stata version 14 (StataCorp) was used for data analysis.

Results

When compared with the control group, the MMT group, as measured by the International Index of Erectile Function (IIEF), exhibited significantly greater levels of intercourse satisfaction disorders (standardized mean difference [SMD], –0.52; 95% CI, –0.71 to –0.32), decreased sexual desire/drive (SMD, –0.44; 95% CI, –0.87 to –0.01), lower overall satisfaction (SMD, –0.27; 95% CI, –0.43 to –0.11), and reduced total IIEF score (SMD, –0.69; 95% CI, –0.92 to –0.47). According to the Arizona Sexual Experiences Scale, the MMT group was substantially more satisfied with orgasm than the control group (SMD, 0.58; 95% CI, 0.31-0.86). As determined by the Sexual History Form, MMT was linked to a statistically significant increase in orgasmic dysfunction in comparison with the control group (SMD, 0.65; 95% CI, 0.10-1.20). The Arizona Sexual Experiences Scale revealed a significant decrease in men reporting sexual disorder following MMT as compared with their pretreatment levels.

Conclusion

As compared with control, MMT increased disorders of intercourse satisfaction, sexual desire/drive, and overall satisfaction according to the IIEF. MMT was also associated with a statistically significant decrease in various aspects of male sexual function as compared with pretreatment levels—including erectile function, intercourse satisfaction, orgasmic function, sexual desire/drive, and overall satisfaction. These findings highlight the importance of including sexual dysfunction screening in the routine care of male patients undergoing MMT.
A Case-Based Review of Spine Ligamentous Anatomy and Pathology
Authors: Edwards Collin R. , Liou Connie J. , Ahmed Saheeb , Wong Tony T. , Ahmad Zohaib Y.
Published: July 2024

Back pain is a common symptom, with a variety of acute and chronic causes. Spinal ligaments play an important role in spinal stability and mechanics and may be subject to a variety of pathologic conditions presenting as acute or chronic back pain. These structures include the craniocervical ligaments (tectorial membrane, transverse ligament, and alar ligaments) and cervical, thoracic, and lumbar ligaments (anterior longitudinal, posterior longitudinal, interspinous, and supraspinous ligaments and ligamentum flavum). Each of these structures is susceptible to acute injury or chronic pathology, such as inflammatory spondyloarthropathies. MRI plays an important role in the workup of both acute spinal injury and chronic changes. Ligamentous pathology may be overlooked without specific attention to and familiarity with normal appearance of these structures. In this article, the radiologist will gain familiarity with normal and abnormal MRI appearance of spinal ligaments.
How Many Is Too Many? Using Cognitive Load Theory to Determine the Maximum Safe Number of Inpatient Consultations for Trainees
Authors: Brondfield Sam , Blum Alexander M. , Mason James M. , O’Sullivan Patricia S.
Published: July 2024

Purpose

Cognitive load, specifically extraneous load (EL) reflective of distractions, may provide evidence of a lack of focus, potentially making additional work unsafe. The assessment of trainees performing inpatient consultations provides a helpful model for examining this question. The goal of this study was to provide useful information to clinical and educational leaders to optimize inpatient consultation services and rotations and mitigate potential patient safety risk.

Method

In 2019, using the Consult Cognitive Load instrument, the authors obtained EL data from inpatient consultations performed by internal medicine fellows and psychiatry residents across 5 University of California hospitals. In 2023, the authors constructed a Wright map to compare the participants’ EL data with the number of prior initial consultations performed during the shift.

Results

Of 326 trainees contacted, 139 (43%) completed the EL survey items. The Wright map shows that trainees were estimated to agree that interruptions were already distracting at the first consultation of the shift. After 4 consultations, trainees were estimated to strongly agree that interruptions were distracting, and to agree that emotions, extraneous information, and technology were distracting.

Conclusions

The authors propose a quantitative, empirically driven, mean safety limit of 4 new inpatient consultations per shift for trainees to avoid cognitive overload, thereby potentially supporting patient safety. Clinical and educational leaders can adjust this limit to fit the unique needs of their practice setting. A similar approach using cognitive load and item response theory could be used to conduct patient safety research in other domains.
Association Between Surgeon Sex and Days Alive at Home Following Surgery: A Population-Based Cohort Study
Authors: Heybati Kiyan , Satkunasivam Raj , Aminoltejari Khatereh , Thomas Hannah S. , Salles Arghavan , Coburn Natalie , Wright Frances C. , Gotlib Conn Lesley , Luckenbaugh Amy N. , Ranganathan Sanjana , Riveros Carlos , McCartney Colin , Armstrong Kathleen , Bass Barbara , Detsky Allan S. , Jerath Angela , Wallis Christopher J. D.
Published: July 2024

Objective:

The objective of this study was to measure potential associations between surgeon sex and number of days alive and at home (DAH).

Background:

Patients treated by female surgeons appear to have lower rates of mortality, complications, readmissions, and healthcare costs when compared with male surgeons. DAH is a validated measure, shown to better capture the patient experience of postoperative recovery.

Methods:

We conducted a retrospective study of adults (≥18 years of age) undergoing common surgeries between January 01, 2007 and December 31, 2019 in Ontario, Canada. The outcome measures were the number of DAH within 30-, 90-, and 365-days. The data was summarized using descriptive statistics and adjusted using multivariable generalized estimating equations.

Results:

During the study period, 1,165,711 individuals were included, of which 61.9% (N = 721,575) were female. Those managed by a female surgeon experienced a higher mean number of DAH when compared with male surgeons at 365 days (351.7 vs. 342.1 days; P < 0.001) and at each earlier time point. This remained consistent following adjustment for covariates, with patients of female surgeons experiencing a higher number of DAH at all time points, including at 365 days (343.2 [339.5–347.1] vs. 339.4 [335.9–343.0] days). Multivariable regression modeling revealed that patients of male surgeons had a significantly lower number of DAH versus female surgeons.

Conclusions:

Patients of female surgeons experienced a higher number of DAH when compared with those treated by male surgeons at all time points. More time spent at home after surgery may in turn lower costs of care, resource utilization, and potentially improve quality of life. Further studies are needed to examine these findings across other care contexts.
E-learning Interventions for Quality Improvement Continuing Medical Education—A Scoping Review
Authors: Roth Michael J. , Maggio Lauren A. , Costello Joseph A. , Samuel Anita
Published: July 2024

Introduction:

Improving health care quality and patient safety are top priorities for the medical field. Robust continuing medical education (CME) programs represent major interventions to effectively teach quality improvement (QI) principles to practicing physicians. In particular, eLearning, a term describing online and distance learning interventions using digital tools, provides a means for CME interventions to reach broader audiences. Although there has been a focus on CME addressing QI, no knowledge synthesis has focused specifically on eLearning interventions. The purpose of this review was to examine the current landscape of eLearning interventions in QI-focused CME.

Methods:

We conducted a scoping review using the framework developed by Arksey and O'Malley as revised by Levac. We searched five databases and identified 2467 prospective publications, which two authors independently screened for inclusion. From each included article, two authors independently extracted data on the instructional modalities and QI tools used and met regularly to achieve consensus.

Results:

Twenty-one studies were included. Most studies used blended instruction (n = 12) rather than solely eLearning interventions. Salient findings included the importance of coaching from QI experts and institutional support for planning and implementing eLearning interventions. Lack of protected time and resources for participants were identified as barriers to participation in CME activities, with small practices being disproportionately affected.

Discussion:

Partnerships between CME developers and sponsoring organizations are vital in creating sustainable eLearning interventions for QI-focused CME. Remote coaching can be an effective strategy to provide ongoing support to geographically separated learners.
German Translation and Linguistic Validation of the LIMB‑Q: A Patient-reported Outcome Measure for Lower Extremity Trauma
Authors: Zhu Katherine J. , Njoroge Moreen W. , Zimmermann Stefan M. , Tafrishi Bita , Watson Jennifer , Breitkopf Trisia , Klassen Anne F. , Mundy Lily R. , Besmens Inga S. , Lindenblatt Nicole
Published: July 2024

Background:

Lower extremity trauma can have a significant impact on a patient’s quality of life. The LIMB-Q is a recently developed and validated patient-reported outcome measure that assesses patient-specific outcomes and experience of health care. The aim of this study was to translate and linguistically validate the LIMB-Q from English to German.

Methods:

The translation was performed by combining World Health Organization and Professional Society for Health Economics and Outcomes Research guidelines. The process consisted of forward translations, a backward translation, expert panel meetings, cognitive debriefing interviews with patients, and several rounds of discussion and reconciliation with the creators of LIMB-Q. The goal was to obtain a culturally and conceptually accurate translation of LIMB-Q into German for use in Switzerland.

Results:

From the two forward translations, there was one primary discrepancy between the two translators that was discussed to determine the most conceptually accurate translation. From the backward translations, there were 63 items that required discussion and re-translation. Nine patients participated in the cognitive debriefing interviews, which led to three items being modified. The translation process led to a linguistically validated and conceptually equivalent German version of the LIMB-Q.

Conclusions:

The German (Switzerland) version of LIMB-Q is now available. This will offer a valuable tool for lower extremity trauma research and clinical care in German-speaking populations.
Post-LASIK Exophiala jeanselmei Keratitis
Authors: Ahmed Adil , Fard Ali Mahdavi , Hsu Hugo Y.
Published: July 2024

Objective:

To describe a patient diagnosed with Exophiala jeanselmei keratitis.

Methods:

We report a case of a patient who developed infectious keratitis following laser in situ keratomileusis and chronic topical steroid use for approximately six months in both eyes. An atypical infiltrate containing dark pigmentation was noted in the left eye on the initial presentation. During treatment, the infiltrates of the right eye began to exhibit a similar pigmentation.

Results:

Early treatment with topical antifungals was initiated in the left eye and later in the right eye once culture results returned. Both eyes recovered with good vision after approximately one month.

Conclusions:

Patients treated with postoperative topical corticosteroids should be cautioned of potential adverse effects of chronic use and have close follow-up. If infectious keratitis develops, particularly after two weeks, then atypical organisms, such as fungi, should be considered. In addition, our case highlights the significance of recognizing and associating dark-pigmentation with fungal etiologies.
3D X-ray computed tomography in the analyses of intraocular lenses explanted because of postoperative opacification
Authors: Werner Liliana , Wallace-Carrete Christopher , Kelkar Neil , Eid Kevin , Polson Randy
Published: July 2024

Purpose:

To use X-ray computed tomography (CT) –which describes the acquisition and reconstruction of 2-dimensional X-ray transmission images to create a 3D representation of a specimen –in the analyses of intraocular lenses (IOLs) explanted because of optical opacification occurring postoperatively.

Setting:

John A. Moran Eye Center, and Utah Nanofab, University of Utah, Salt Lake City, Utah.

Design:

Laboratory study.

Methods:

A hydrophilic acrylic and a silicone lens (the latter from an eye with asteroid hyalosis) explanted because of postoperative calcification, as well as a poly(methyl methacrylate) (PMMA) lens explanted because of snowflake degeneration underwent analysis under gross and light microscopy. Then, they were attached to an appropriate support and scanned under a Zeiss Xradia Versa X-ray microscope. After data acquisition, data segmentation was performed with a commercially available program to separate image data into components.

Results:

Morphology, size/volume, and specific location of calcified deposits on the surface or within the substance of explanted IOLs could be demonstrated by X-ray CT within the entire volume of each lens with high contrast and resolution. The PMMA lens showed multiple spaces/fissures in relation to Nd:YAG pitting of the optic, and what appeared to be sheets of delaminated PMMA material at different levels within the optic substance.

Conclusions:

The key benefit of X-ray CT is that it can be performed without physically sectioning the specimen. This preliminary study demonstrates that this technology can be potentially useful in the imaging and analyses of explanted, opacified lenses.
Cost analysis of dropless cataract surgery prophylaxis with intracameral antibiotics and subconjunctival steroids
Authors: Massa Scott , Smits David J. , Nguyen Alexander T. , Patil Sachi A. , Chen Evan M. , Shorstein Neal H. , Friedman Scott , Parikh Ravi
Published: July 2024

Purpose:

To determine whether dropless, injection-based cataract surgery prophylaxis with intracameral antibiotic and subconjunctival steroid may reduce healthcare system costs and patient out-of-pocket costs compared with topical medication regimens.

Setting:

U.S. national medical expenditures database.

Design:

Retrospective cost analysis.

Methods:

Costs were analyzed for topical ophthalmics from the 2020 Medical Expenditure Panel Survey (MEPS) and for dropless medications from pharmaceutical invoices/catalogs. Main outcomes included system costs, from insurance and patient payments, and out-of-pocket costs for cataract surgery topical and dropless, injection-based prophylactic medication regimens, per eye and nationally. System costs for individual topical medications and same-class dropless, injection-based medications were compared using 2-sided, 1-sample t tests.

Results:

There were 583 prophylactic topical ophthalmic purchases in MEPS. Mean system costs per eye were $76.20 ± SD 39.07 for the lowest cost topical steroid (prednisolone) compared with $4.01 for the lowest cost subconjunctival steroid (triamcinolone acetonide) (P < .001). Per eye, the lowest cost dropless, injection-based regimen, at $15.91, results in an $87.99 (84.7%) reduction in overall healthcare costs and a $43.64 (100%) reduction in patient out-of-pocket costs relative to the lowest cost topical regimen ($103.90 ± 43.14 mean system cost and $43.64 ± 37.32 mean out-of-pocket cost per eye). Use of intracameral moxifloxacin and subconjunctival triamcinolone acetonide can reduce annual national healthcare system and out-of-pocket costs up to $450 000 000 and $225 000 000, respectively.

Conclusions:

An evidence-based cataract surgery prophylactic medication regimen of intracameral moxifloxacin and subconjunctival triamcinolone acetonide can reduce healthcare system and patient out-of-pocket costs in comparison with various topical regimens.
Enhancing Annual Wellness Visits
Authors: Li Hanlin , De Francesco Michael , Mathews Tincy , Singh Goldie , Baratt Yuliya , Evans Kathleen , Jan Helen
Published: July 2024

Annual wellness visits (AWVs) guide appropriate patient care through lifestyle modifications, medication intervention, or social assistance. We launched a quality improvement program to target Medicare beneficiaries as part of an Accountable Care Organization (ACO). Key stakeholders collectively implemented a process consisting of two cohorts: AWVs completed with the support of the pharmacy team or directly by providers. A standardized workflow for the pharmacy cohort involved the clinical pharmacists and pharmacy extenders, allowing a layered learning experience. The AWV completion rate was optimized with the interventions of the pharmacy team.
Integrating the Principles of Academic Freedom and Patient-Centered Care to Promote Tolerant Listening Skills in Health Care Providers
Authors: Noller Diana T. , Cain Shannon
Published: July 2024

Collaboration is a vital skill that needs to be developed in health professions students. Developing tolerance for differing viewpoints and valuing an understanding of others' lived experiences are instrumental skills in learning to provide patient-centered care. Fostering the expression of diverse viewpoints and working through uncomfortable and distressful situations are a part of the experience in acquiring these skills. It is the educator's duty to facilitate these encounters in a way that upholds the tenants of academic freedom and civility to create optimal educational outcomes. Doing so creates opportunities for transformative learning and the facilitation of higher cognitive development when compared with the avoidance of exposing students to divergent viewpoints. It is through freedom of discussion that one must teach students that ultimately the pursuit of truth, even when it may be unwelcome, disagreeable, or deeply offensive, greatly outweighs the discomfort the process of discovering it may bring.
Efficacy and safety of intraperitoneal ropivacaine in pain management following laparoscopic digestive surgery: A systematic review and meta-analysis of RCTs
Authors: Daghmouri Mohamed Aziz , Chaouch Mohamed Ali , Deniau Benjamin , Benayoun Laurent , Krimi Bassem , Gouader Amine , Oweira Hani
Published: July 2024

Background:

Managing postoperative pain effectively with an opioid-free regimen following laparoscopic surgery (LS) remains a significant challenge. Intraperitoneal instillation of ropivacaine has been explored for its potential to reduce acute postoperative pain, but its efficacy and safety are still under debate. This study aimed to evaluate the efficacy and safety of intraperitoneal instillation of ropivacaine for acute pain management following laparoscopic digestive surgery.

Methods:

We used PRISMA 2020 and a measurement tool to assess systematic reviews 2 guidelines to conduct this review. The random-effects model was adopted using Review Manager Version 5.4 for pooled estimates.

Results:

We retained 24 eligible RCTs involving 1705 patients (862 patients in the intraperitoneal instillation group and 843 patients in the control group). The intraperitoneal instillation group reduced total opioid consumption during the first 24 hours postoperatively (MD = −21.93 95% CI [−27.64, −16.23], P < .01), decreased pain scores at different time (4 hours, 8 hours, 12 hours and 24 hours), shorter the hospital stay (MD = −0.20 95% CI [−0.36, −0.05], P < .01), reduced the postoperative shoulder pain (MD = 0.18 95% CI [0.07, 0.44], P < .01), and decreased postoperative nausea and vomiting (MD = 0.47 95% CI [0.29, 0.77], P < .01).

Conclusion:

Intraperitoneal instillation of ropivacaine appears to be an effective component of multimodal pain management strategies following laparoscopic digestive surgery, significantly reducing opioid consumption and improving postoperative recovery markers. Despite these promising results, additional high-quality trials are needed to confirm the efficacy and safety of this approach.

Registration:

The registration number at PROSPERO was CRD42021279238.
Causal association between triglycerides and cholesterol-lowering medication with non-rheumatic valve disease: A 2-sample Mendelian randomization study
Authors: Li Kaiyuan , Wang Xiaowen , Liu Peng , Ye Jun , Zhu Li
Published: July 2024

Previous studies have found a possible causal relationship between triglycerides and lipid-lowering drugs and valvular disease. The aim of this study was to explore the potential causal relationship between triglycerides and lipid-lowering drugs and valvular disease using Mendelian randomization (MR) analysis. Data sets associated with triglycerides (441,016 participants and 12,321,875 single nucleotide polymorphisms [SNPs]) and cholesterol-lowering drugs (209,638 participants and 9851,867 SNPs) were retrieved from the Genome-Wide Association Study (GWAS) database. A total of 297 and 49 SNPs significantly associated with triglycerides and cholesterol-lowering drugs, respectively (P < 5 × 10−8), were identified. Similarly, data sets for non-rheumatic valve diseases (NVDs) (361,194 participants and 10,080,950 SNPs) were obtained from the GWAS database. Inverse variance weighting was used as the primary method for calculating the odds ratio (OR) and 95% confidence intervals (CI). The MR-Egger, weighted median, and weighted mode analyses were also used to test the robustness of the main results. The MR-Egger intercept test and the MR-PRESSO test were used to evaluate horizontal pleiotropy. Inverse variance weighted (IVW) results showed that both triglyceride and cholesterol-lowering medication were positively associated with NVDs (OR = 1.001, 95% CI 1.000–1.0012, P = 0.006; OR = 1.007, 95% CI 1.003–1.010; P = 0.002). This study suggests that both triglyceride and cholesterol-lowering medications are positively associated with NVDs, suggesting that lowering triglyceride levels or the use of cholesterol-lowering medications may reduce the incidence of NVDs. However, larger samples are required for further validation.
Compensatory strategies of dysphagia after anterior cervical spinal surgery: A case report
Authors: Chung Sung Joon , Lee Jun Ho , Soh Yunsoo
Published: July 2024

Rationale:

Dysphagia after anterior cervical discectomy and fusion (ACDF) is a common postoperative complication. However, information regarding rehabilitation strategies for postoperative dysphagia is limited. Herein, we report a compensatory strategy for treating dysphagia after ACDF.

Patient concerns:

A 65-year-old Asian male presented with left arm pain and weakness for more than 1 month. Magnetic resonance imaging of the cervical spine revealed degenerative disc lesions and spinal stenosis at the C3 to C7 levels. The patient underwent ACDF at the C3 to C5 levels and artificial disc replacement at the C5 to C7 levels by right side approach. After surgery, the patient complained of difficulty swallowing. A video fluoroscopic swallowing study (VFSS) detected swallowing dysfunction in the pharyngeal phase, revealing an asymmetric pharyngeal residue in the anterior–posterior view.

Diagnosis:

The patient was diagnosed with dysphagia after ACDF.

Interventions:

Based on the VFSS findings, the patient underwent swallowing rehabilitation therapy and compensatory techniques, such as head rotation to the weak right side and head tilting to the robust left side.

Outcomes:

After 2 months of rehabilitation with compensatory techniques, food moved smoothly towards the robust side, and the subjective symptoms of dysphagia improved.

Lessons:

Consequently, swallowing function post-ACDF surgery must be assessed; if unilateral dysphagia is detected, compensatory techniques may prove beneficial. This case study showed that, based on the objective findings of the VFSS, an effective swallowing compensation strategy can be established and applied to patients with postoperative dysphagia.
Comparative evaluation of knee osteoarthritis: radiography vs. ultrasonography in Nepalese population: a cross-sectional study
Authors: Suwal Sundar , K.C. Bibek , Katwal Shailendra , Chataut Dinesh , Lohani Benu
Published: July 2024

Background and objectives:

Osteoarthritis (OA) is a degenerative and long-term debilitating disease with rising prevalence, predominantly involving larger joints including the knee joint. While radiography has traditionally been the primary modality for joint evaluation, there is a growing trend towards using ultrasonography (USG) for musculoskeletal disorders, including joint assessment. This study aimed to find the role of USG in the evaluation of OA of knee joints with comparison to the radiographs.

Methods:

This was a cross-sectional study done on patients with signs and symptoms of OA of the knee who visited the radiology department for knee radiographs. Kellgren and Lawrence system was used for grading OA in radiographs. USG of knee joints was done with high-frequency probes and searched for joint space width, articular cartilage thickness, marginal osteophytes, meniscal extrusion, and other articular/ extra-articular abnormalities. The USG findings were correlated with findings in anteroposterior and lateral radiographs.

Results:

The mean number of osteophytes was higher in USG compared to the radiographs (P<0.001). Mean joint spaces were comparable in both modalities. Meniscal extrusion was seen with USG, which significantly correlated with joint space width and cartilage thickness (P<0.005). USG also detected synovial changes, effusion, and Baker’s cyst.

Conclusion:

Although radiography is the standard first-line radiological investigation for the diagnosis of OA of the knee joint, USG can be an adjunct as it well correlates with the radiograph findings and can provide more useful information.
Nurse Certification and Test Anxiety
Authors: Stanzo Karen , DeMoss Marinetta , Hollingsworth Bria , Schrah Sherrill Sarah , Cruz Maria Sarah Faye D. , Reynolds Allison , Jackson Tina , Nwawuihe James
Published: July 2024

OBJECTIVE

To determine the relationship between scores on the Westside Test Anxiety Scale (WTAS) and nurse certification rates.

BACKGROUND

Nurse certification is associated with improved outcomes. Understanding intrinsic factors associated with low certification rates including test anxiety could help nurse leaders improve certification rates.

METHODS

This descriptive, correlational study used a convenience sample of 577 RNs with at least 2 years of nursing experience. Participants completed a survey of their demographics and the 10-question WTAS.

RESULTS

Certified nurses were significantly older and had more years of experience. Noncertified nurses had significantly higher scores on the WTAS.

CONCLUSIONS

Facilities working to increase their nurse certification rates may consider adding test anxiety reduction interventions to other levels of support.
Evaluation of a Comprehensive Algorithm for PICU Patients With New Fever or Instability: Association of Clinical Decision Support With Testing Practices
Authors: Linz Matthew S. , Booth Lauren D. , Milstone Aaron M. , Stockwell David C. , Sick-Samuels Anna C.
Published: July 2024

OBJECTIVES:

Previously, we implemented a comprehensive decision support tool, a “New Fever Algorithm,” to support the evaluation of PICU patients with new fever or instability. This tool was associated with a decline in culture rates without safety concerns. We assessed the impact of the algorithm on testing practices by identifying the proportion of cultures pre- vs. post-implementation that were discordant with algorithm guidance and may have been avoidable.

DESIGN:

Retrospective evaluation 12 months pre- vs. post-quality improvement intervention.

SETTING:

Single-center academic PICU and pediatric cardiac ICU.

SUBJECTS:

All admitted patients.

INTERVENTIONS:

Implementing the “New Fever Algorithm” in July 2020.

MEASUREMENTS AND MAIN RESULTS:

Patient medical records were reviewed to categorize indications for all blood, respiratory, and urine cultures. Among cultures obtained for new fever or new clinical instability, we assessed specific testing patterns that were discordant from the algorithm’s guidance such as blood cultures obtained without documented concern for sepsis without initiation of antibiotics, respiratory cultures without respiratory symptoms, urine cultures without a urinalysis or pyuria, and pan-cultures (concurrent blood, respiratory, and urine cultures). Among 2827 cultures, 1950 (69%) were obtained for new fever or instability. The proportion of peripheral blood cultures obtained without clinical concern for sepsis declined from 18.6% to 10.4% (p < 0.0007). Respiratory cultures without respiratory symptoms declined from 41.5% to 27.4% (p = 0.01). Urine cultures without a urinalysis did not decline (from 27.6% to 25.1%). Urine cultures without pyuria declined from 83.0% to 73.7% (p = 0.04). Pan-cultures declined from 22.4% to 10.6% (p < 0.0001). Overall, algorithm-discordant testing declined from 39% to 30% (p < 0.0001).

CONCLUSIONS:

The majority of cultures obtained were for new fever or instability and introduction of the “New Fever Algorithm” was associated with reductions in algorithm-discordant testing practices and pan-cultures. There remain opportunities for improvement and additional strategies are warranted to optimize testing practices for in this complex patient population.
Ethnicity and Observed Oxygen Saturations, Fraction of Inspired Oxygen, and Clinical Outcomes: A Post-Hoc Analysis of the Oxy-PICU Trial of Conservative Oxygenation*
Authors: Jones Gareth A.L. , Wiegand Martin , Ray Samiran , Gould Doug W. , Agbeko Rachel , Giallongo Elisa , Charles Walton N. , Orzol Marzena , O’Neill Lauran , Lampro Lamprini , Lillie Jon , Pappachan John , Ramnarayan Padmanabhan , Harrison David A. , Mouncey Paul R. , Peters Mark J. ,   for the Oxy-PICU Investigators of the Pediatric Critical Care Society Study Group
Published: July 2024

OBJECTIVES:

A conservative oxygenation strategy, targeting peripheral oxygen saturations (Spo
2) between 88% and 92% in mechanically ventilated children in PICU, was associated with a shorter duration of organ support and greater survival compared with Spo
2 greater than 94% in our recent Oxy-PICU trial. Spo
2 monitors may overestimate arterial oxygen saturation (Sao
2) in patients with higher levels of skin pigmentation compared with those with less skin pigmentation. We investigated if ethnicity was associated with changes in distributions of Spo
2 and Fio
2 and outcome.

DESIGN:

Post-hoc analysis of a pragmatic, open-label, multicenter randomized controlled trial.

SETTING:

Fifteen PICUs across the United Kingdom and Scotland.

PATIENTS:

Children aged 38 weeks corrected gestational age to 15 years accepted to a participating PICU as an unplanned admission and receiving invasive mechanical ventilation with supplemental oxygen for abnormal gas exchange.

METHODS:

Hierarchical regression models for Spo
2 and Fio
2, and ordinal models for the primary trial outcome of a composite of the duration of organ support at 30 days and death, were used to examine the effects of ethnicity, accounting for baseline Spo
2, Fio
2, and mean airway pressure and trial allocation.

MEASUREMENTS AND MAIN RESULTS:

Ethnicity data were available for 1577 of 1986 eligible children, 1408 (89.3%) of which were White, Asian, or Black. Spo
2 and Fio
2 distributions did not vary according to Black or Asian ethnicity compared with White children. The trial primary outcome measure also did not vary significantly with ethnicity. The point estimate for the treatment effect of conservative oxygenation in Black children was 0.64 (95% CI, 0.33–1.25) compared with 0.84 (0.68–1.04) in the overall trial population.

CONCLUSIONS:

These data do not suggest that the association between improved outcomes and conservative oxygenation strategy in mechanically ventilated children in PICU is modified by ethnicity.
Pediatric Hematology and Oncology Patients on Extracorporeal Membrane Oxygenation: Outcomes in a Multicenter, Retrospective Cohort, 2009–2021
Authors: Mowrer Michael Colin , Lima Lisa , Nair Rohit , Li Xilong , Sandhu Hitesh , Bridges Brian , Barbaro Ryan P. , Bhar Saleh , Nkwantabisa Raymond , Ghafoor Saad , Reschke Agnes , Olson Taylor , Malone Matthew P. , Shah Neel , Zinter Matt S. , Gehlbach Jon , Hollinger Laura , Scott Briana L. , Lerner Reut Kassif , Brogan Thomas V. , Raman Lakshmi , Potera Renee M.
Published: July 2024

OBJECTIVE:

To describe characteristics associated with survival for pediatric patients with an oncologic diagnosis or hematopoietic cell transplant (HCT) supported with extracorporeal membrane oxygenation (ECMO).

DESIGN:

Multicenter, retrospective study.

SETTING:

Sixteen PICUs in the United States and Israel.

PATIENTS:

We included patients aged younger than 19 years with an oncologic diagnosis or HCT who required ECMO support between 2009 and 2021.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

A total of 149 patients were included in the study cohort. There were 118 patients with an oncologic diagnosis and 31 that received HCT. The indications for ECMO were respiratory failure (46%), combined respiratory and cardiac failure (28%), and cardiac failure (25%). Venovenous (V-V) ECMO was used in 45% of patients, with 53% of patients being placed on venoarterial (V-A) ECMO. For oncologic and HCT groups, survival to ECMO decannulation was 52% (62/118) and 64% (20/31), and survival to hospital discharge was 36% (43/118) and 42% (13/31), respectively. After adjusting for other factors, requiring cardiopulmonary resuscitation was associated with greater odds ratio of mortality (3.0 [95% CI, 1.2–7.7]).

CONCLUSIONS:

Survival to ECMO decannulation of pediatric oncologic and HCT patients in this study was 52–64%, depending upon diagnosis. However, survival to hospital discharge remains poor. Future research should prioritize understanding factors contributing to this survival gap within these patient populations.
A Blast and Burn Hand Injury Caused by an Exploding Vaping Device in a Pediatric Patient: A Case Report
Authors: Kadhum Murtaza , El-Hilly Abdulrahman , O’Neill Jennifer
Published: July 2024

In this report, we present an injury to the hand caused by an exploding vaping device. This report summarizes the burn, blast and chemical injury, and discusses best practice for treatment. This case provides a warning to healthcare professionals and the public about the potential for and the seriousness of this injury. We hope to emphasize the rising incidence of vaping among children, the injuries that may occur, and the methods for treatment.
Identifying Patients At Risk for Melanoma in an Aesthetic Practice
Authors: Mogle Miranda , Vortman Rebecca , Miller Amy
Published: July 2024

In the United States, melanoma skin cancer deaths are expected to rise by 4.4% in 2023, reaching 7990. Early detection through visual screening can save lives, but the US Preventive Services Task Force cites insufficient evidence to recommend universal skin screening for all adults. For this reason, the risk for melanoma may be overlooked outside of dermatology settings, leading to delayed diagnoses and poor survival rates. Our project aimed to address this issue by increasing the identification of at-risk individuals visiting a medical aesthetic practice in the Midwest. The literature regarding melanoma risk stratification outside of dermatology settings is deficient. A search yielding 336 articles produced 8 articles for review. Five suggested melanoma risk screenings in general practice are feasible and/or can lead to early detection. Using the Plan-Do-Study-Act model, we executed our project from February through April 2023. Patients visiting the medical aesthetic practice completed a Self-Assessment Melanoma Risk Score questionnaire. We assessed the completed questionnaires and offered visual cancer screenings or dermatology referrals to patients identified as at-risk. A total of 211 patients participated, and 26% (n = 55) were identified as at-risk. This intervention improved the quality of care by identifying patients at risk for melanoma. Future steps include adapting the Self-Assessment of Melanoma Risk Score questionnaire to a new electronic medical record system, incorporating the questionnaire as part of the initial intake and annual patient documentation, and improving patient education and follow-up.
ABCD Classification of Skin Types
Authors: Pashkovska Oksana
Published: July 2024

The classification of an individual’s skin type is important because it helps dermatologists and aesthetic clinicians select the most effective methods for treating the skin. To select suitable cosmetic products and procedures that help ensure healthy and beautiful skin, clinicians must consider the patient’s skin type. An individualized classification of skin types allows the clinician to develop personalized skin care recommendations that consider an individual’s genetic and physiological characteristics. In the fields of dermatology and aesthetics, the classification of skin types is the basis for scientific research. Skin type classification systems are additionally important for both dermatologists and aesthetic practitioners because they influence the selection of cosmetic products, procedures, and treatments. The purpose of this paper was to provide a detailed review and evaluation of the relevance, suitability, and benefits of the new ABCD Classification of Skin Types, to compare it with other systems for classifying skin types, and to identify parameters for its improvement.