bluuebunny/crossref_metadata_2025 huggingface dataset:
Policy and political (in)coherence, security and Nordic–Baltic energy transitions
Authors: Kivimaa Paula
Published: October 2022

Global challenges, such as climate change, require increasingly horizontal governance approaches, as solving such challenges is dependent on coordinating public policies between different administrative sectors. Such coordination is difficult because administrative sectors have long traditions, their own worldviews and specific objectives they seek to advance. This paper is focused on the complications of achieving coherence between energy and security policies, in a time when the energy sector decarbonization is accelerating, and major geopolitical shifts are taking place partly in connection to the energy transition. Drawing on the policy coherence literature, this paper analyses 46 expert interviews from three Nordic–Baltic European countries: Estonia, Finland and Norway. It pays attention to policy coherence between energy and security, the presence or absence of strategies, agencies and other coordinating elements for horizontal coherence, political coherence and coordination between administrations linked to the two policy domains. Based on the analysis, the countries show significant differences and interesting features for horizontal policy coherence connected to the European energy transition. Moreover, the analysis shows that, prior to 2022, energy was desecuritized in Finland and Norway, where political incoherence also led to incoherence between policy domains and in policy mixes addressing zero-carbon energy transitions and national security. In Estonia, the policy objective of national security has shaped energy policy, but coordination between the policy domains has mostly been dependent on informal interactions leading to some conflicts and tensions.
Direct ink writing 3D printing of polydimethylsiloxane-based soft and composite materials: a mini review
Authors: Li Yun , Li Bo
Published: October 2022

Polydimethylsiloxane (PDMS) has been widely used in flexible electronics, biomedical tissue/organ devices and soft robots. With the rapid advances in 3D printing technologies, there has been considerable interest in using PDMS to create 3D, high-resolution and multifunctional structures/devices. Among different 3D printing technologies, direct ink writing (DIW), where PDMS-based ink or gel is extruded from a moving nozzle, has demonstrated advantages of low cost, simplicity and ability to combine different materials in a single processing step. Here, we provide a critical perspective on the advances and potential of DIW technology for PDMS-based materials. We will summarize the key factors and innovation in the DIW processes. Furthermore, we will also show state-of-the-art structures and applications of DIW-printed PDMS-based materials. Finally, we hope to point out specific challenges, areas for further development and provide guidelines to those interested in PDMS-based DIW.
Paleoeconomy more than demography determined prehistoric human impact in Arctic Norway
Authors: Brown Tony , Rijal Dilli P , Heintzman Peter D , Clarke Charlotte L , Blankholm Hans Peter , Høeg Helge I , Lammers Youri , Bråthen Kari Anne , Edwards Mary , Alsos Inger G
Published: October 2022

Population size has increasingly been taken as the driver of past human environmental impact worldwide, and particularly in the Arctic. However, sedimentary ancient DNA (sedaDNA), pollen and archaeological data show that over the last 12,000 years, paleoeconomy and culture determined human impacts on the terrestrial ecology of Arctic Norway. The large Mortensnes site complex (Ceavccageađgi, 70°N) has yielded the most comprehensive multiproxy record in the Arctic to date. The site saw occupation from the Pioneer period (c. 10,000 cal. years BP) with more intensive use from c. 4,200 to 2,000 cal. years BP and after 1,600 cal. years BP. Here, we combine on-site environmental archaeology with a near-site lake record of plant and animal sedaDNA. The rich animal sedaDNA data (42 taxa) and on-site faunal analyses reveal switches in human dietary composition from early-Holocene fish + marine mammals, to mixed marine + reindeer, then finally to marine + reindeer + domesticates (sheep, cattle, pigs), with highest reindeer concentrations in the last millennium. Archaeological evidence suggests these changes are not directly driven by climate or variation in population densities at the site or in the region, but rather are the result of changing socio-economic activities and culture, probably reflecting settlers’ origins. This large settlement only had discernable effects on its hinterland in the last 3,600 years (grazing) and more markedly in the last 1,000 years through reindeer keeping/herding and, possibly domestic stock. Near-site sedaDNA can be linked to and validate the faunal record from archaeological excavations, demonstrating that environmental impacts can be assessed at a landscape scale.
A guide to megastudies
Authors: Duckworth Angela L , Milkman Katherine L
Published: October 2022

How can behavioral insights best be leveraged to solve pressing policy challenges? Because research studies are typically designed to test the validity of a particular idea, surprisingly little is known about the relative efficacy of different approaches to changing behavior in any given policy context. We discuss megastudies as a research approach that can surmount this and other obstacles to developing optimal behaviorally informed policy interventions. We define a megastudy as “a massive field experiment in which many different treatments are tested synchronously in one large sample using a common, objectively measured outcome.” We summarize this apples-to-apples approach to research and lay out recommendations, limitations, and promising future directions for scholars who might want to conduct or evaluate megastudies.
67 Double impact: hypophosphatemic rickets and vitamin D intoxication
Authors: Boutrid N , Rahmoune H , Boutrid H , Bioud B , Amrane M
Published: October 2022

Background

Vitamin D prevents deficiency rickets, but its prescription must be weighed carefully!

Objective

We report a rare case of iatrogenic toxic hypervitaminosis D in a child with vitamin D resistant rickets…!

Methods

We admitted a two-year-old girl, presenting signs of rickets resistant to the usual then therapeutic doses of vitamin D3. Vitamin D2 in oral suspension is then ordered in addition, for a few weeks until the onset of hearing loss motivating her hospitalization in pediatrics.

Results

Biological and radiological explorations revealed renal failure with threatening arterial hypertension, as well as diffuse and severe arteriosclerosis on Doppler signal.

Eviction (stopping vitamin D in all its forms), symptomatic and conservative management by (converting-enzyme inhibitors) and hydration allowed a progressive blood pressure normalisation, arteriosclerosis disappearance (undetected by Doppler signal and by angio-scan) along with a gradual normalising of the kidney function; all this over a period of 2 years

The girl actually had hypophosphatemic rickets, and oral phosphorus (syrup) was also prescribed

Conclusion

Vitamin D is potentially toxic with sometimes severe renal risks (lithiasis, nephrocalcinosis), and hypercalcemia might be severe, especially if renal function is impaired.

Blindly treating any rickets with vitamin D can be adventurous and might expose the child to serious morbidity.
An EHR-automated and theory-based population health management intervention for smoking cessation in diverse low-income patients of safety-net health centers: a pilot randomized controlled trial
Authors: Hitsman Brian , Matthews Phoenix A , Papandonatos George D , Cameron Kenzie A , Rittner Sarah S , Mohanty Nivedita , Long Timothy , Ackermann Ronald T , Ramirez Edgardo , Carr Jeremy , Cordova Emmanuel , Bridges Cherylee , Flowers-Carson Crystal , Giachello Aida Luz , Hamilton Andrew , Ciecierski Christina C , Simon Melissa A
Published: October 2022

This study tested the preliminary effectiveness of an electronic health record (EHR)-automated population health management (PHM) intervention for smoking cessation among adult patients of a federally qualified health center in Chicago. Participants (N = 190; 64.7% women, 82.1% African American/Black, 8.4% Hispanic/Latino) were self-identified as smokers, as documented in the EHR, who completed the baseline survey of a longitudinal “needs assessment of health behaviors to strengthen health programs and services.” Four weeks later, participants were randomly assigned to the PHM intervention (N = 97) or enhanced usual care (EUC; N = 93). PHM participants were mailed a single-page self-determination theory (SDT)-informed letter that encouraged smoking cessation or reduction as an initial step. The letter also addressed low health literacy and low income. PHM participants also received automated text messages on days 1, 5, 8, 11, and 20 after the mailed letter. Two weeks after mailing, participants were called by the Illinois Tobacco Quitline. EUC participants were e-referred following a usual practice. Participants reached by the quitline were offered behavioral counseling and nicotine replacement therapy. Outcome assessments were conducted at weeks 6, 14, and 28 after the mailed letter. Primary outcomes were treatment engagement, utilization, and self-reported smoking cessation. In the PHM arm, 25.8% of participants engaged in treatment, 21.6% used treatment, and 16.3% were abstinent at 28 weeks. This contrasts with no quitline engagement among EUC participants, and a 6.4% abstinence rate. A PHM approach that can reach all patients who smoke and address unique barriers for low-income individuals may be a critical supplement to clinic-based care.
Developing an equitable intervention approach for communities of color: mental health and co-occurring physical health concerns in the context of the COVID-19 pandemic
Authors: Gutierrez Chavez Manuel , Kaur Kiran , Baucom Katherine J W , Sanchez-Birkhead Ana , Sunada Grant R , Mukundente Valentine , Tavake-Pasi Fahina , Napia Edwin Eru , Villalta Jeannette , Asnaani Anu
Published: October 2022

The COVID-19 pandemic has exacerbated disparities in mental health treatment for people of color in the USA. Meeting the needs of those most burdened by this disparity will require swift and tactical action in partnership with these communities. The purpose of this paper is to describe how a community-based participatory research approach was employed to assess the priorities and needs of four communities of color (African immigrant, Hispanic/Latino, Black/African American, and Pacific Islander) in a major U.S. city. A brief quantitative survey devised jointly by community leaders and the research team was deployed to community members (N = 59) in the fall of 2020. The most endorsed mental health issues across the communities were excessive worry (51%) and stress regarding COVID-19, racism, and immigration policies (49%). The most endorsed physical health concerns included sleep difficulties (44%), headaches, and backaches (each 39%). Physical symptoms predicted the endorsement of a mental health issue above and beyond COVID-19–related hardships, multiplying the odds of reporting an issue by 1.73 per physical health concern endorsed. Based on these findings, the community-research team conceptualized and proposed an evidence-based, effectiveness-implementation hybrid type-2 intervention approach for chronic worry and daily stress. This paper highlights detail on how the community-research team arrived at the proposed multilevel intervention that addresses community-stated barriers to mental health treatment (e.g., preferring trusted health workers to deliver emotional health treatments) and considers the burden of the additional stressful context of COVID-19.
The impact of enhancing self-management support for diabetes in Community Health Centers through patient engagement and relationship building: a primary care pragmatic cluster-randomized trial
Authors: Hessler Danielle , Fisher Lawrence , Dickinson Miriam , Dickinson Perry , Parra José , Potter Michael B
Published: October 2022

Type 2 diabetes (T2DM) self-management support (SMS) programs can yield improved clinical outcomes but may be limited in application or impact without considering individuals’ unique social and personal challenges that may impede successful diabetes outcomes. The current study compares an evidence-based SMS program with an enhanced version that adds a patient engagement protocol, to elicit and address unique patient-level challenges to support improved SMS and diabetes outcomes. Staff from 12 Community Health Center (CHC) clinical sites were trained on and delivered: Connection to Health (CTH; 6 sites), including a health survey and collaborative action planning, or Enhanced Engagement CTH (EE-CTH; 6 sites), including additional relationship building training/support. Impact of CTH and EE-CTH on behavioral self-management, psychological outcomes, and modifiable social risks was examined using general linear mixed effects. Clinics enrolled 734 individuals with T2DM (CTH = 408; EE-CTH = 326). At 6- to 12-month postenrollment, individuals in both programs reported significant improvements in self-management behaviors (sugary beverages, missed medications), psychological outcomes (stress, health-related distress), and social risks (food security, utilities; all p < .05). Compared with CTH, individuals in EE-CTH reported greater decreases in high fat foods, salt, stress and health-related distress; and depression symptoms improved within EE-CTH (all p < .05). CTH and EE-CTH demonstrated positive behavioral, psychological, and social risk impacts for T2DM in CHCs delivered within existing clinical work flows and a range of clinical roles. Given the greater improvements in psychological outcomes and behavioral self-management in EE-CTH, increased attention to relationship building strategies within SMS programs is warranted.
Interventions to promote health equity: implications for implementation science in behavioral medicine
Authors: Alcaraz Kassandra I , Yanez Betina R
Published: October 2022

Disparities in health persist despite the development of innovative and effective behavioral interventions. Both behavioral medicine and implementation science are vital to improving health care and health outcomes, and both can play a critical role in advancing health equity. However, to eliminate health disparities, more research in these areas is needed to ensure disparity-reducing behavioral interventions are continually developed and implemented. This special issue on interventions to promote health equity presents a diverse set of articles focused on implementing behavioral interventions to reduce health disparities. The current article summarizes the special issue and identifies key themes and future considerations. Articles in this special issue report on behavioral medicine intervention studies (including those examining aspects of implementation) as well as implementation science studies with implications for behavioral medicine. Articles discuss community-, provider-, and system-level interventions; implementation processes; and barriers and facilitators to implementation. Also included are commentaries calling for greater prioritization of behavioral medicine and implementation research. As evidenced in this special issue, behavioral medicine is primed to lead the implementation of behavioral interventions in historically marginalized and minoritized populations to advance health equity and improve overall population health.
Detection of Cytb Point Mutation (G143A) that Confers High-Level Resistance to Pyraclostrobin in Glomerella cingulata Using LAMP Method
Authors: Ren Wei-chao , Wang Si-jia , Wang Zhong-qiang , Zhu Mei-qi , Zhang Yi-han , Lian Sen , Li Bao-hua , Dong Xiang-li , Liu Na
Published: October 2022

Glomerella leaf spot (GLS) caused by Glomerella cingulata is a newly emerging disease that results in severe defoliation and fruit spots in apples. In China, the compound of pyraclostrobin and tebuconazole was registered to control GLS in 2018 and has achieved excellent control efficiency. In this study, we showed that the high-level resistant isolates of G. cingulata to pyraclostrobin, caused by the point mutation at codon 143 (GGT→GCT, G143A) in the cytochrome b gene, has appeared in apple orchards in Shandong Province in 2020, and the resistance frequency was 4.8%. Based on the genotype of the resistant isolates, we developed a loop-mediated isothermal amplification (LAMP) assay for detection of the pyraclostrobin resistance. The LAMP assay was demonstrated to have good specificity, sensitivity, and repeatability, and it exhibited high accuracy in detecting pyraclostrobin resistance in the field. This study reported the resistance status of GLS to pyraclostrobin in Shandong Province and developed a molecular tool for the detection of pyraclostrobin resistance, which is of practical significance for the scientific control of GLS.
Communicating Diagnostic Uncertainty at Emergency Department Discharge: A Simulation-Based Mastery Learning Randomized Trial
Authors: Rising Kristin L. , Cameron Kenzie A. , Salzman David H. , Papanagnou Dimitrios , Doty Amanda M.B. , Piserchia Katherine , Leiby Benjamin E. , Shimada Ayako , McGaghie William C. , Powell Rhea E. , Klein Matthew R. , Zhang Xiao Chi , Vozenilek John , McCarthy Danielle M.
Published: October 2022

Purpose

There are no standardized approaches for communicating with patients discharged from the emergency department with diagnostic uncertainty. This trial tested efficacy of the Uncertainty Communication Education Module, a simulation-based mastery learning curriculum designed to establish competency in communicating diagnostic uncertainty.

Method

Resident physicians at 2 sites participated in a 2-arm waitlist randomized controlled trial from September 2019 to June 2020. After baseline (T1) assessment of all participants via a standardized patient encounter using the Uncertainty Communication Checklist (UCC), immediate access physicians received training in the Uncertainty Communication Education Module, which included immediate feedback, online educational modules, a smartphone-based application, and telehealth deliberate practice with standardized patients. All physicians were retested 16–19 weeks later (T2) via in-person standardized patient encounters; delayed access physicians then received the intervention. A final test of all physicians occurred 11–15 weeks after T2 (T3). The primary outcome measured the percentage of physicians in the immediate versus delayed access groups meeting or exceeding the UCC minimum passing standard at T2.

Results

Overall, 109 physicians were randomized, with mean age 29 years (range 25–46). The majority were male (n = 69, 63%), non-Hispanic/Latino (n = 99, 91%), and White (n = 78, 72%). At T2, when only immediate access participants had received the curriculum, immediate access physicians demonstrated increased mastery (n = 29, 52.7%) compared with delayed access physicians (n = 2, 3.7%, P < .001; estimated adjusted odds ratio of mastery for the immediate access participants, 31.1 [95% CI, 6.8–143.1]). There were no significant differences when adjusting for training site or stage of training.

Conclusions

The Uncertainty Communication Education Module significantly increased mastery in communicating diagnostic uncertainty at the first postintervention test among emergency physicians in standardized patient encounters. Further work should assess the impact of clinical implementation of these communication skills.
The Effects of Coaching Pediatric Residents on Faculty Coaches’ Relationships, Learning, and Professional Identity Formation
Authors: Selling Sarah Kate , Rooholamini Sahar N. , Grow H. Mollie , McPhillips Heather , Hoang Kim , Blankenburg Rebecca , Rassbach Caroline
Published: October 2022

Purpose

Coaching programs have been implemented in medical education to improve skill development and feedback for trainees. As more faculty take on coaching roles, it is critical to understand how being a coach affects faculty as well as trainees. This study examined the effects of coaching residents on faculty members’ relationships, learning, and professional identity formation (PIF), as they move through intersecting communities across landscapes of practice.

Method

From July 2020 to January 2021, the authors conducted a mixed-methods study of current and former coaches at 2 institutions with longitudinal pediatric resident coaching programs. They used a concurrent triangulation design in which qualitative and quantitative data were collected simultaneously and integrated during data analysis. A survey explored the impact of coaching on faculty members’ learning, relationships, and PIF, and semistructured interviews further examined coaches’ experiences. The interview transcripts were analyzed inductively guided by the sensitizing principles of PIF and landscapes of practice.

Results

Of 43 eligible coaches, 32 (74%) completed the survey, and 18 completed interviews. Four themes emerged from the interviews. (1) Coaches’ relationships supported belonging in multiple communities. (2) Coaching enabled multidimensional learning. (3) Relationships served as mechanisms of learning for coaches. (4) Coaches’ relationships and learning catalyzed PIF. Furthermore, there was a significant difference in the effects of coaching on career growth by faculty rank (P = .02). Coaches’ strengthened PIF increased a sense of purpose, meaning, and professional fulfillment, and inspired new career directions. Survey data further supported these findings.

Conclusions

Being a coach deepened faculty members’ professional identities through their varied relationships, multidimensional learning, and sense of belonging in intersecting communities. This study introduces a framework to understand the factors mediating coaches’ PIF and highlights how investing in coaching leads to important benefits for coaches.
Blocking circ_0010235 suppresses acquired paclitaxel resistance of non-small cell lung cancer by sponging miR-512-5p to modulate FAM83F expression
Authors: Li Youtang , Ma Zhiyi , Luo Machang , Liang Rongzhang
Published: October 2022

The occurrence of paclitaxel (PTX) resistance in nonsmall cell lung cancer (NSCLC) is a major challenge for NSCLC treatment. Circular RNAs (circRNAs) have been reported to associate with cancer resistance, but the role of circ_0010235 in PTX resistance of NSCLC is unclear. The expression of circ_0010235 and microRNA-512-5p (miR-512-5p) were determined by quantitative real-time PCR. Cell counting kit-8 assay, transwell assay and flow cytometry were performed to measure the PTX resistance, proliferation, migration, invasion and apoptosis of cells. All proteins were assessed via western blot analysis. The combination between miR-512-5p and circ_0010235 or FAM83F was predicted by the online database and confirmed by a dual-luciferase reporter assay. Angiogenesis assay was used to detect the ability of cells to form blood vessels. Animal experiments were employed to confirm the effect of circ_0010235 on NSCLC tumor growth in vivo. Circ_0010235 and FAM83F were upregulated in PTX-resistant NSCLC tissues and cells. Circ_0010235 knockdown suppressed the resistance to PTX, proliferation, angiogenesis and migration/invasion in A549/PTX and H1299/PTX cells but promoted apoptosis rate. MiR-512-5p could be sponged by circ_0010235, and its overexpression had an inhibition effect on the PTX resistance of NSCLC cells. FAM83F was a target of miR-512-5p and circ_0010235 could modulate FAM83F expression by sponging miR-512-5p. In vivo experiments revealed that silenced circ_0010235 could improve the sensitivity of the tumor to PTX. Therefore, these findings advocated targeting the circ_0010235/miR-512-5p/FAM83F axis as a potential therapeutic option for patients with NSCLC who are resistant to PTX.
Treatment of metastatic alveolar soft part sarcoma with axitinib and pembrolizumab in an 80-year-old patient with a history of autoimmune disorders
Authors: Dorman Klara , Burkhard-Meier Anton , Di Gioia Dorit , Kunz Wolfgang G. , Knösel Thomas , Holch Julian W. , Lindner Lars H.
Published: October 2022

Alveolar soft part sarcoma (ASPS) is a rare malignancy with low sensitivity to chemotherapy. While localized ASPS has a very good prognosis after resection, the 5-year overall survival rate drops substantially in metastatic disease. We report the case of an 80-year-old male patient with ASPS of the left elbow and metastasis to the lung, lymph nodes and peritoneum. After weighing the benefits and risks, systemic treatment with the anti-PD-1 checkpoint inhibitor pembrolizumab combined with the vascular endothelial growth factor receptor tyrosinkinase inhibitor axitinib was initiated in this patient with a history of psoriasis and Crohn’s disease. After only two cycles of therapy, a significant size reduction of the nodal cervical metastasis became apparent. A partial response of all metastases was then confirmed in the first computed tomography restaging. So far, side effects have remained manageable, especially with regard to the development or worsening of autoimmune adverse events. The patient continued to have a high quality of life, while also remaining in ongoing partial response for 15 months at the time of submission. While sarcomas generally have low sensitivity to immunotherapies, ASPS is an exception, and checkpoint inhibition is an integral part of its systemic therapy.
Circular RNA circ-AGFG1 contributes to esophageal squamous cell carcinoma progression and glutamine catabolism by targeting microRNA-497-5p/solute carrier family 1 member 5 axis
Authors: Chen Siyang , Liu Zhizhen , Feng Qiang , Zhou Jinshan , Huang Junchao , Yu Jianghao
Published: October 2022

Circular RNAs (circRNAs) have been shown to play important regulatory roles in human malignancies. However, the role of circRNA ArfGAP with FG repeats 1 (circ-AGFG1) in esophageal squamous cell carcinoma (ESCC) progression and its associated mechanism are still largely undefined. Cell proliferation was analyzed by 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and 5-ethynyl-2’-deoxyuridine assay. Cell apoptosis was assessed by flow cytometry analysis. Transwell assay and wound healing assay were used to analyze cell invasion and migration abilities. The uptake of glutamine and the production of α-ketoglutarate and glutamate were analyzed using Glutamine Determination Kit, α-ketoglutarate Assay Kit and Glutamate Determination Kit. A xenograft tumor model was used to analyze the biological role of circ-AGFG1 in vivo. The interaction between microRNA-497-5p (miR-497-5p) and circ-AGFG1 or solute carrier family 1 member 5 (SLC1A5) was verified by dual-luciferase reporter assay. Circ-AGFG1 expression was upregulated in ESCC tissues and cell lines. Circ-AGFG1 silencing suppressed the proliferation, migration, invasion and glutaminolysis and triggered the apoptosis of ESCC cells. Circ-AGFG1 knockdown significantly slowed down tumor growth in vivo. Circ-AGFG1 acted as a sponge for miR-497-5p, and miR-497-5p interacted with the 3′ untranslated region (3′UTR) of SLC1A5. miR-497-5p silencing largely abolished circ-AGFG1 silencing-induced effects in ESCC cells. miR-497-5p overexpression-mediated influences in ESCC cells were largely reversed by the addition of SLC1A5 expressing plasmid. Circ-AGFG1 could upregulate SLC1A5 expression by sponging miR-497-5p. In summary, circ-AGFG1 acted as an oncogene to elevate the malignant potential and promote the glutamine catabolism of ESCC cells by targeting the miR-497-5p/SLC1A5 axis.
Patient and Caregiver-Derived Health Service Improvements for Better Critical Care Recovery
Authors: Haines Kimberley J. , Leggett Nina , Hibbert Elizabeth , Hall Tarli , Boehm Leanne M. , Bakhru Rita N. , Bastin Anthony J. , Butcher Brad W. , Eaton Tammy L. , Harris Wendy , Hope Aluko A. , Jackson James , Johnson Annie , Kloos Janet A. , Korzick Karen A. , Mactavish Pamela , Meyer Joel , Montgomery-Yates Ashley , Quasim Tara , Slack Andrew , Wade Dorothy , Still Mary , Netzer Giora , Hopkins Ramona O. , Mikkelsen Mark E. , Iwashyna Theodore J. , McPeake Joanne , Sevin Carla M. ,   on behalf of the Society of Critical Care Medicine’s Thrive Initiative
Published: October 2022

OBJECTIVES:

To engage critical care end-users (survivors and caregivers) to describe their emotions and experiences across their recovery trajectory, and elicit their ideas and solutions for health service improvements to improve the ICU recovery experience.

DESIGN:

End-user engagement as part of a qualitative design using the Framework Analysis method.

SETTING:

The Society of Critical Care Medicine’s THRIVE international collaborative sites (follow-up clinics and peer support groups).

SUBJECTS:

Patients and caregivers following critical illness and identified through the collaboratives.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Eighty-six interviews were conducted. The following themes were identified: 1) Emotions and experiences of patients—“Loss of former self; Experiences of disability and adaptation”; 2) Emotions and experiences of caregivers—“Emotional impacts, adopting new roles, and caregiver burden; Influence of gender roles; Adaptation, adjustment, recalibration”; and 3) Patient and caregiver-generated solutions to improve recovery across the arc of care—“Family-targeted education; Expectation management; Rehabilitation for patients and caregivers; Peer support groups; Reconnecting with ICU post-discharge; Access to community-based supports post-discharge; Psychological support; Education of issues of ICU survivorship for health professionals; Support across recovery trajectory.” Themes were mapped to a previously published recovery framework (Timing It Right) that captures patient and caregiver experiences and their support needs across the phases of care from the event/diagnosis to adaptation post-discharge home.

CONCLUSIONS:

Patients and caregivers reported a range of emotions and experiences across the recovery trajectory from ICU to home. Through end-user engagement strategies many potential solutions were identified that could be implemented by health services and tested to support the delivery of higher-quality care for ICU survivors and their caregivers that extend from tertiary to primary care settings.
Plastic Surgery Training across Seven Continents: Results from the First Global Trainee Survey
Authors: Lindqvist Ebba K. , Noordzij Niels , Chopra Shiv , Navia Alfonso , Cappuyns Laura , Khalaf Amr , Fernandez Diaz Oscar F. , Berner Juan Enrique , Monshizadeh Linda , Murphy Robert X.
Published: October 2022

Background:

Little is known about the demographics and ambitions of plastic surgery trainees and if these differ between regions. This study sought opinion from current and recently graduated plastic surgery trainees to map demographics, training structure, and ambitions of plastic surgery trainees worldwide.

Methods:

A cross-sectional study was designed and administered by the international trainee organization International Confederation of Societies of Plastic Surgery Trainees. A questionnaire of 45 questions was distributed digitally through several international channels using the REDCap platform.

Results:

A total of 290 junior plastic surgeons, of whom 124 (42.8%) were women, from all seven International Confederation of Societies of Plastic Surgery regions, participated in this study. Of the trainees, 21% have emigrated, and 75% expressed a desire to undertake a part of their training abroad. The most common length of training in plastic surgery is 5 years. There is a difference in working hours between regions, where more than 80-hour work weeks are most common in Asia (24.1%), and work weeks of less than 40 hours are most common in Middle East (30.8%). A majority of trainees (85%) reported a research interest, and we found a negative correlation between the extent of research ambition and reported clinical workload.

Conclusions:

We present here the first international investigation of trainee experiences of plastic surgery training. We show that training structure and organization vary between institutions, and that plastic surgery trainees report a strong interest in international training as well as in research.
Outcomes of Lymphovenous Anastomosis for Lower Extremity Lymphedema: A Systematic Review
Authors: Verhey Erik M. , Kandi Lyndsay A. , Lee Yeonsoo S. , Morris Bryn E. , Casey William J. , Rebecca Alanna M. , Marks Lisa A. , Howard Michael A. , Teven Chad M.
Published: October 2022

Background:

Lymphovenous anastomosis (LVA) is a microsurgical treatment for lymphedema of the lower extremity (LEL). This study systematically reviews the most recent data on outcomes of various LVA techniques for LEL in diverse patients.

Methods:

A comprehensive literature search was conducted in the Ovid MEDLINE, Ovid EMBASE, and Scopus databases to extract articles published through June 2021. Studies reporting data on objective postoperative improvement in lymphedema and/or subjective improvement in quality of life for patients with LEL were included. Extracted data comprised demographics, number of patients and lower limbs, duration of symptoms before LVA, surgical technique, duration of follow-up, and objective and subjective outcomes.

Results:

A total of 303 articles were identified and evaluated, of which 74 were ultimately deemed eligible for inclusion in this study, representing 6260 patients and 2554 lower limbs. The average patient age ranged from 22.6 to 76.14 years. The duration of lymphedema before LVA ranged from 12 months to 11.4 years. Objective rates of improvement in lymphedema ranged from 23.3% to 100%, with the greatest degree of improvement seen in patients with early-stage LEL.

Conclusions:

LVA is a safe and effective technique for the treatment of LEL of all stages. Several emerging techniques and variations may lead to improved patient outcomes.
Practice Patterns in Operative Flexor Tendon Laceration Repair: A 15-Year Analysis of Continuous Certification Data from the American Board of Plastic Surgery
Authors: Weissman Joshua P. , Sasson Daniel C. , Chappell Ava G. , Moran Steven L. , Gosain Arun K.
Published: October 2022

Background:

The American Board of Plastic Surgery has been collecting practice data on operative repair of flexor tendon lacerations since 2006, as part of its Continuous Certification program.

Methods:

Data on operative repair of flexor tendon lacerations from 2006 to 2014 were reviewed and compared with those from 2015 to 2020. National practice trends observed in these data were evaluated and reviewed alongside published literature and evidence-based medicine.

Results:

In total, 780 patients with flexor tendon laceration injuries were included. Mean patient age was 38 years; mean time between tendon injury and first evaluation was 4 days, and the mean time from injury to operative repair was 12 days. Four-strand sutures remain the most common technique of tendon repair (57%). In the recent cohort, there were significant decreases in tourniquet use (94% versus 89%), general anesthesia (88% versus 74%), and monofilament sutures (44% versus 35%), with a significant increase reported in preserving the A1 pulley (20% versus 29%). Postoperative movement was described as “almost full range of motion” or “good” in 70% of cases, and 74% of patients were satisfied with their results. Postoperative adverse events were reported in 26% of cases, with the most common complications being tendon adhesions (14%) and rupture (3%).

Conclusions:

Review of The American Board of Plastic Surgery tracer data for operative repair of flexor tendon lacerations establishes a framework by which surgeons can evaluate how their current practice aligns with that of their peers, and whether their practice patterns remain current relative to recommendations from evidence-based medicine.
Finger Abscess Caused by a Black Fungus, Exophiala xenobiotica
Authors: Nomura Takeshi , Yamawaki Yoshio
Published: October 2022

Exophiala xenobiotica is a relatively new species of black fungi that can cause infection that primarily affects the skin and soft tissues in humans. Black fungal infection is challenging to diagnose and often needs surgery. However, few studies have reported black fungal and E. xenobiotica infections in the field of plastic surgery. Herein, we report the case of a 79-year-old man who presented with a finger abscess, later identified via rDNA sequencing as E. xenobiotica infection. He did not have a history of immunosuppression. We resected the lesion and performed skin grafting. No recurrence was observed, even without antifungal medications. We compared this case with six previously reported cases and examined their similarities and differences. Surgical removal emerged as the most effective treatment option. Additional reports of successfully treated E. xenobiotica infections are needed to establish the best treatment strategy. Plastic surgeons should improve their awareness of black fungal infections.
Orbital Exenteration and Brachytherapy for the Treatment of Pediatric, Fusion-positive, Recurrent Rhabdomyosarcoma
Authors: Lopez Joseph , Qin Nancy , Woods Robbie , Golden Marjorie , Spatz Harrison , Shah Jatin , Wexler Leonard H. , Randazzo Joseph , Wolden Suzanne L. , Abramson David H.
Published: October 2022

A 20-month-old boy presented with biopsy-proven recurrent alveolar rhabdomyosarcoma without metastasis. He was previously treated with multiagent chemotherapy and external beam irradiation showing a complete response. Upon relapse, he was treated with chemotherapy, orbital exenteration, and brachytherapy. Customized, intraoperative brachytherapy has potential to limit the sequelae associated with radiation adjuvant therapy.
Hypertension and atrial fibrillation
Authors: Middeldorp Melissa E. , Ariyaratnam Jonathan P. , Kamsani Suraya H. , Albert Christine M. , Sanders Prashanthan
Published: October 2022

Hypertension is the most prevalent cardiovascular risk factor underlying atrial fibrillation and is present in up to 40% of patients with atrial fibrillation. Furthermore, attributable risk studies have shown that a history of hypertension contributes to up to 24% of incident atrial fibrillation. New data suggest that even early forms of hypertension (prehypertension and aortic stiffness) are associated with an increased risk of atrial fibrillation development. Hypertension and prehypertension are therefore critical mediators for the development of atrial fibrillation. Mechanisms for the association between hypertension and atrial fibrillation include diffuse electro-structural changes to the left atrium, driven by the haemodynamic and neurohormonal influences of hypertension and other, frequently coexisting, cardiovascular risk factors. Management of hypertension in atrial fibrillation should focus not only on blood pressure reduction but also on a comprehensive risk factor modification strategy. Such strategies have been shown to be associated with significant improvements in atrial fibrillation symptom burden as well as improved arrhythmia-free survival and reversal of the progression of atrial fibrillation. These strategies should focus on dietary modifications as well as prescribed exercise programmes involving a multidisciplinary team and patient-centred atrial fibrillation care. Risk factor management, supplemented by antihypertensive medications as needed, provides the optimum strategy for improving outcomes and even reversing the natural progression of atrial fibrillation in patients with hypertension.
Cultural Adaptation and Validation of the Health and Work Performance Questionnaire in German
Authors: Golz Christoph , Gerlach Maisa , Kilcher Gablu , Peter Karin Anne
Published: October 2022

Background

Research interest in presenteeism as a productivity loss has grown given its estimated costs for organizations. To enable researchers in German-speaking countries to compare their findings internationally, a validated German Health and Work Performance Questionnaire (HPQ) version is needed.

Methods

First, the HPQ was translated from English into German, culturally adapted, and tested using cognitive debriefing in interviews. Second, the structural validity of the item measuring presenteeism as productivity loss was tested.

Results

Overall, 14 problems with items were identified in the cognitive debriefing. Of these, 57% were comprehension problems. Two of three alternative hypotheses for discriminative validity were accepted. No discrimination was possible for individuals with or without chronic disease.

Conclusions

The German HPQ has satisfactory cross-cultural validity and can be used to measure overall performance, as well as presenteeism in a specified sample with health problems.
Cardiac resynchronization therapy in treatment of a non-ischemic cardiomyopathy patient with massive left ventricular thrombus
Authors: Pestrea Catalin , Cicala Ecaterina , Catanescu Geanina , Gherghina Alexandra , Pintilie Irina , Gurzau Diana , Pop Dana
Published: October 2022

Rationale:

Left ventricular thrombosis is a severe and potentially fatal complication of cardiomyopathies with reduced ejection fraction. The mainstay of treatment is anticoagulation, with variable response to thrombus resolution. In patients with reduced ejection fraction and left bundle branch block, cardiac electrical resynchronization is established as a very effective therapy, leading to improvement in left ventricular function.

Patient concerns:

We present the case of a 64-year-old male with non-ischemic cardiomyopathy with severely reduced ejection fraction and left bundle branch block, who was implanted with a dual-chamber pacemaker in 2018 for sick sinus node disease and who was admitted for progressive shortness of breath.

Diagnosis:

Echocardiography showed a dilated left ventricle with a severely reduced ejection fraction (15%) and a massive left intraventricular thrombus.

Interventions:

The patient was started on anticoagulant and heart failure therapy without any response in thrombus size, so as a last resort measure, cardiac resynchronization therapy was added.

Outcomes:

The 6-month echocardiography follow-up showed a significant improvement in left ventricular function and complete thrombus resolution.

Lesson:

Cardiac resynchronization therapy promotes reverse remodeling and improves the contraction sequence in the left ventricle, thus eliminating the triggers for thrombosis and aiding in thrombus resolution.
Professional Case Management in Outpatient Settings for Patients With Myeloproliferative Neoplasms
Authors: Brennan-Cook Jill , Cadavero Allen
Published: October 2022

Purpose and Objectives:

The purpose of this discussion is to review the management and symptomatic burden of patients with myeloproliferative neoplasms (MPNs). Patients with MPNs are at increased risk for thromboembolic events; thus, cardiovascular complications are not uncommon. Professional case managers can coordinate outpatient services with the health care team and assist patients to mitigate cardiovascular complications.

Primary Practice Setting:

This discussion is relevant to professional case managers who manage patients with chronic conditions in outpatient settings.

Findings/Conclusions:

Professional case managers can intervene for patients with MPNs to improve (a) coordination of scheduled therapeutic phlebotomy procedures, and (b) education about subcutaneous injections and frequent monitoring of laboratory reports. In the outpatient setting, professional case managers can improve health care utilization for patients with MPNs and promote high-quality self-care and symptom management to prevent adverse complications.

Implications for Case Management Practice:

As a member of the outpatient health care team, the professional case manager can serve as a key clinician with comprehensive knowledge of the patient's experience of living with an MPN, their usual state of health and symptoms, and the factors affecting their quality of life. This article explores the role of the professional case manager in the outpatient setting and suggests specific interventions to improve delivery of care and contribute to better self-care management. Professional case managers can assess and validate symptom burden, coordinate and manage routine laboratory testing, support careful medication adjustment, and contribute to improved health outcomes.
The Science of Gratitude
Authors: Powell Suzanne K.
Published: October 2022

“Gratitude” is more than a buzzword and may be more important than we realize. The science of gratitude is worth delving into, as science is beginning to show the following: the symptoms of the grateful person versus the stressed person with headaches, sleeplessness, compassion fatigue, and digestive issues can be likened to the sympathetic nervous system (the fight or flight response) versus the parasympathetic nervous system (the part of the nervous system that allows our body to “rest and digest”)—the grateful person.
Alternative chemotherapy for acute myeloid leukemia with Down syndrome
Authors: Joey Gregory , Nelwan Yuke , Joseph Mantik Max Franz , Gunawan Stefanus , De Haas Valerie , Kaspers Gertjan L.
Published: October 2022

Myeloid leukemia with Down syndrome (ML-DS) is a unique entity of acute myeloid leukemia (AML) with superior treatment response and overall survival compared with children with AML. However, despite the advances in treatment approaches, ML-DS survival rates for children in low- and middle-income countries remain poor. In this article, we describe 3 cases of ML-DS, which were treated with a novel protocol using vincristine, cytarabine, and daunorubicin plus triple intrathecal drugs. All the 3 patients successfully finished the treatment, with 2 patients in complete remission until now. One patient died because of uncontrolled bleeding for 2 days after finishing the chemotherapy regimen. Our findings indicate that using our treatment protocol, ML-DS is treatable in limited-resource settings such as that in Manado, Indonesia.